The information in this section was originally published by the National Cancer Institute and is used with permission.
See: https://www.cancer.gov/about-cancer

Part 1:  Understanding Cancer

Cancer is not one disease.  Cancer is a collection of related diseases that can occur almost anywhere in the body. At its most basic, cancer is a disease of the genes in the cells of our body. Genes control the way our cells work. But, changes to these genes can cause cells to malfunction, causing them to grow and divide when they should not—or preventing them from dying when they should. These abnormal cells can become cancer.

Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and divide to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place.

When cancer develops, however, this orderly process breaks down. As cells become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells can divide without stopping and may form growths called tumors, which are masses of tissue. Cancers of the blood, such as leukemia, generally do not form solid tumors.

Cancerous tumors are malignant, which means they can spread into, or invade, nearby tissues. In addition, as these tumors grow, some cancer cells can break off and travel to distant places in the body through the blood or the lymph system and form new tumors far from the original tumor.

Unlike malignant tumors, benign tumors do not spread into, or invade, nearby tissues. Benign tumors can sometimes be quite large, however. When removed, they usually don’t grow back, whereas malignant tumors sometimes do. Unlike most benign tumors elsewhere in the body, benign brain tumors can be life threatening.

 

Differences between Cancer Cells and Normal Cells

Cancer cells differ from normal cells in many ways that allow them to grow out of control and become invasive. One important difference is that cancer cells are less specialized than normal cells. That is, whereas normal cells mature into very distinct cell types with specific functions, cancer cells do not. This is one reason that, unlike normal cells, cancer cells continue to divide without stopping.

In addition, cancer cells are able to ignore signals that normally tell cells to stop dividing or that begin a process known as programmed cell death, or apoptosis, which the body uses to get rid of unneeded cells.

Cancer cells may be able to influence the normal cells, molecules, and blood vessels that surround and feed a tumor—an area known as the microenvironment. For instance, cancer cells can induce nearby normal cells to form blood vessels that supply tumors with oxygen and nutrients, which they need to grow. These blood vessels also remove waste products from tumors.

Cancer cells are also often able to evade the immune system, a network of organs, tissues, and specialized cells that protects the body from infections and other conditions. Although the immune system normally removes damaged or abnormal cells from the body, some cancer cells are able to “hide” from the immune system.

Tumors can also use the immune system to stay alive and grow. For example, with the help of certain immune system cells that normally prevent a runaway immune response, cancer cells can actually keep the immune system from killing cancer cells.

 

How Cancer Arises

Cancer is a genetic disease—that is, it is caused by changes to genes that control the way our cells function, especially how they grow and divide.

Genetic changes that cause cancer can be inherited from our parents. They can also arise during a person’s lifetime as a result of errors that occur as cells divide or because of damage to DNA caused by certain environmental exposures. Cancer-causing environmental exposures include substances, such as the chemicals in tobacco smoke, and radiation, such as ultraviolet rays from the sun.

Each person’s cancer has a unique combination of genetic changes. As the cancer continues to grow, additional changes will occur. Even within the same tumor, different cells may have different genetic changes.

In general, cancer cells have more genetic changes, such as mutations in DNA, than normal cells. Some of these changes may have nothing to do with the cancer; they may be the result of the cancer, rather than its cause.

 

Part 2:  Cancer Risk Factors & Prevention

What is Prevention?

Cancer prevention is action taken to lower the chance of getting cancer. In 2020, more than 1.8 million people will be diagnosed with cancer in the United States. In addition to the physical problems and emotional distress caused by cancer, the high costs of care are also a burden to patients, their families, and to the public. By preventing cancer, the number of new cases of cancer is lowered. Hopefully, this will reduce the burden of cancer and lower the number of deaths caused by cancer.

Cancer is not a single disease but a group of related diseases. Many things in our genes, our lifestyle, and the environment around us may increase or decrease our risk of getting cancer.

Scientists are studying many different ways to help prevent cancer, including the following:

  • Ways to avoid or control things known to cause cancer.
  • Changes in diet and lifestyle.
  • Finding precancerous conditions Precancerous conditions are conditions that may become cancer.
  • Chemoprevention(medicines to treat a precancerous condition or to keep cancer from starting).
  • Risk-reducing surgery.

 

Carcinogenesis

Carcinogenesis is the process in which normal cells turn into cancer cells.

Carcinogenesis is the series of steps that take place as a normal cell becomes a cancer cell. Cells are the smallest units of the body and they make up the body’s tissues. Each cell contains genes that guide the way the body grows, develops, and repairs itself. There are many genes that control whether a cell lives or dies, divides (multiplies), or takes on special functions, such as becoming a nerve cell or a muscle cell.

Changes (mutations) in genes occur during carcinogenesis.

Changes (mutations) in genes can cause normal controls in cells to break down. When this happens, cells do not die when they should and new cells are produced when the body does not need them. The buildup of extra cells may cause a mass (tumor) to form.

Tumors can be benign or malignant (cancerous). Malignant tumor cells invade nearby tissues and spread to other parts of the body. Benign tumor cells do not invade nearby tissues or spread.

Cancer Risk Factors

  • Factors Known to Increase the Risk of Cancer:
    • Cigarette Smoking and Tobacco Use
    • Infections
    • Radiation
    • Immunosuppressive Medicines After Organ Transplant
  • Factors That May Affect the Risk of Cancer
    • Diet
    • Alcohol
    • Physical Activity
    • Obesity
    • Diabetes
    • Environmental Risk Factors

Scientists study risk factors and protective factors to find ways to prevent new cancers from starting. Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.

Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Risk factors that a person can control are called modifiable risk factors.

Many other factors in our environment, diet, and lifestyle may cause or prevent cancer. This summary reviews only the major cancer risk factors and protective factors that can be controlled or changed to reduce the risk of cancer. Risk factors that are not described in the summary include certain sexual behaviors, the use of estrogen, and being exposed to certain substances at work or to certain chemicals.

Tobacco use is strongly linked to an increased risk for many kinds of cancer. Smoking cigarettes is the leading cause of the following types of cancer:

Not smoking or quitting smoking lowers the risk of getting cancer and dying from cancer. Scientists believe that cigarette smoking causes about 30% of all cancer deaths in the United States.

Certain viruses and bacteria are able to cause cancer. Viruses and other infection-causing agents cause more cases of cancer in the developing world (about 1 in 4 cases of cancer) than in developed nations (less than 1 in 10 cases of cancer). Examples of cancer-causing viruses and bacteria include:

Two vaccines to prevent infection by cancer-causing agents have already been developed and approved by the U.S. Food and Drug Administration (FDA). One is a vaccine to prevent infection with hepatitis B virus. The other protects against infection with strains of human papillomavirus (HPV) that cause cervical cancer. Scientists continue to work on vaccines against infections that cause cancer.

Being exposed to radiation is a known cause of cancer. There are two main types of radiation linked with an increased risk for cancer:

Scientists believe that ionizing radiation causes leukemiathyroid cancer, and breast cancer in women. Ionizing radiation may also be linked to myeloma and cancers of the lungstomachcolonesophagusbladder, and ovary. Being exposed to radiation from diagnostic x-rays increases the risk of cancer in patients and x-ray technicians. Diagnostic radiation in children and adolescents has been linked with a higher risk of cancers at a young age.

The growing use of CT scans over the last 20 years has increased exposure to ionizing radiation. The risk of cancer also increases with the number of CT scans a patient has and the radiation dose used each time.

Immunosuppressive medicines are used after an organ has been transplanted from one person to another. These medicines stop an organ that has been transplanted from being rejected. These medicines decrease the body’s immune response to help keep the organ from being rejected. Immunosuppressive medicines are linked to an increased risk of cancer because they lower the body’s ability to keep cancer from forming. The risk of cancer, especially cancer caused by a virus, is higher in the first 6 months after organ transplant, but the risk lasts for many years.

 

Lifestyle Factors That May Affect the Risk of Cancer

Diet

The foods that you eat on a regular basis make up your diet. Diet is being studied as a risk factor for cancer. It is hard to study the effects of diet on cancer because a person’s diet includes foods that may protect against cancer and foods that may increase the risk of cancer.

It is also hard for people who take part in the studies to keep track of what they eat over a long period of time. This may explain why studies have different results about how diet affects the risk of cancer.

Some studies have shown that a diet high in fat, proteinscalories, and red meat increases the risk of colorectal cancer, but other studies have not shown this.

It is not known if a diet low in fat and high in fiber, fruits, and vegetables lowers the risk of colorectal cancer.

 

Alcohol

Studies have shown that drinking alcohol is linked to an increased risk of the following types of cancers:

Drinking alcohol may also increase the risk of liver cancer and female colorectal cancer.

Physical Activity

Studies show that people who are physically active have a lower risk of certain cancers than those who are not. It is not known if physical activity itself is the reason for this.

Studies show a strong link between physical activity and a lower risk of colorectal cancer. Some studies show that physical activity protects against postmenopausal breast cancer and endometrial cancer.

Obesity

Studies show that obesity is linked to a higher risk of the following types of cancer:

  • Postmenopausal breast cancer.
  • Colorectal cancer.
  • Endometrial cancer.
  • Esophageal cancer.
  • Kidney
  • Pancreatic

Some studies show that obesity is also a risk factor for cancer of the gallbladder and liver cancer.

It is not known if losing weight lowers the risk of cancers that have been linked to obesity.

 

Diabetes

Some studies show that having diabetes may slightly increase the risk of having the following types of cancer:

  • Bladder cancer.
  • Breast cancer in women.
  • Colorectal cancer.
  • Endometrial cancer.
  • Liver cancer.
  • Lung cancer.
  • Oral cancer.
  • Oropharyngeal cancer.
  • Ovarian cancer.
  • Pancreatic cancer.

Diabetes and cancer share some of the same risk factors. These risk factors include the following:

  • Being older.
  • Being obese.
  • Not eating a healthy diet.
  • Not exercising.

Because diabetes and cancer share these risk factors, it is hard to know whether the risk of cancer is increased more by diabetes or by these risk factors.

Studies are being done to see how medicine that is used to treat diabetes affects cancer risk.

Environmental Risk Factors

Being exposed to chemicals and other substances in the environment has been linked to some cancers:

  • Links between air pollution and cancer risk have been found. These include links between lung cancer and secondhand tobacco smoke, outdoor air pollution, and asbestos.
  • Drinking water that contains a large amount of arsenic has been linked to skin, bladder, and lung cancers.

Studies have been done to see if pesticides and other pollutants increase the risk of cancer. The results of those studies have been unclear because other factors can change the results of the studies.

 

Interventions Known to Lower Cancer Risk

An intervention is a treatment or action taken to prevent or treat disease, or improve health in other ways. Many studies are being done to find ways to keep cancer from starting or recurring (coming back).

Chemoprevention is being studied in patients who have a high risk of developing cancer.  Chemoprevention is the use of substances to lower the risk of cancer, or keep it from recurring. The substances may be natural or made in the laboratory. Some chemo preventive agents are tested in people who are at high risk for a certain type of cancer. The risk may be because of a precancerous conditionfamily history, or lifestyle factors.

Taking one of the following agents may lower the risk of cancer:

 

Interventions Not Yet Proven to Lower Cancer Risk

An intervention is a treatment or action taken to prevent or treat disease, or improve health in other ways.  There is not enough proof that taking multivitamin and mineral supplements or single vitamins or minerals can prevent cancer. The following vitamins and mineral supplements have been studied, but have not been shown to lower the risk of cancer:

The Selenium and Vitamin E Cancer Prevention Trial (SELECT) found that vitamin E taken alone increased the risk of prostate cancer. The risk continued even after the men stopped taking vitamin E. Taking selenium with vitamin E or taking selenium alone did not increase the risk of prostate cancer.

Vitamin D has also been studied to see if it has anticancer effects. Skin exposed to sunshine can make vitamin D. Vitamin D can also be consumed in the diet and in dietary supplements.  The Vitamin D and OmegA-3 TriaL (VITAL) is under way to study whether taking vitamin D (2000 IU/ day) and omega-3 fatty acids from marine (oily fish) sources lowers the risk of cancer.

The Physicians’ Health Study found that men who have had cancer in the past and take a multivitamin daily may have a slightly lower risk of having a second cancer.

See the following PDQ summaries for more information:

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.  Complete clinical trial information can be found online at www.ClinicalTrials.gov

Disclaimer

The information in these summaries should not be used to make decisions about treatment.  Treatment of cancer must be done in consultation with qualified medical personnel.

Part 3:  Cancer Screening

Screening means checking for cancer (or for abnormal cells that may become cancer) in people who have no symptoms.

Screening can help doctors find and treat several types of cancer early, before they cause symptoms. Early detection is important because when abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread and be harder to treat.  Several screening tests have been shown to detect cancer early and to reduce the chance of dying from that cancer.  But it is important to keep in mind that screening tests can have potential harms as well as benefits.

  • Some screening tests may cause bleeding or other health problems.
  • Screening tests can have false-positive results—that is, the test indicates that cancer may be present even though it is not. False-positive test results can cause anxiety and are usually followed by additional tests and procedures that also have potential harms.
  • Screening tests can have false-negative results—that is, the test indicates that cancer is not present even though it is. False-negative test results may provide false reassurance, leading to delays in diagnosis and possibly causing an individual to put off seeking medical care even if symptoms develop.
  • Screening can lead to over-diagnosis—that is, the screening test correctly shows that a person has cancer, but the cancer is slow growing and would not have harmed that person in his or her lifetime. Treatment of such cancers is called overtreatment.

Patients should discuss the potential harm as well as benefit of different cancer screening tests with their doctors.

Cancer Screening: A Basic Understanding

Screening tests can help find cancer at an early stage, sometimes even before symptoms appear. When abnormal tissue or cancer is found early, it may be easier to treat or cure. By the time symptoms appear, the cancer may have grown and spread. This can make the cancer harder to treat or cure.

It is important to remember that when your doctor suggests a screening test, it does not always mean he or she thinks you have cancer. Screening tests are often done when you have no cancer symptoms.

There are different kinds of screening tests including the following:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Laboratory tests: Medical procedures that test samples of tissue, bloodurine, or other substances in the body.
  • Imaging procedures: Procedures that make pictures of areas inside the body.
  • Genetic tests: A laboratory test in which cells or tissue are analyzed to look for changes in genes or chromosomes. These changes may be a sign that a person has or is at risk of having a specific disease or condition.

Screening tests have risks.  It is important to know the risks of the test and whether it has been proven to decrease the chance of dying from cancer.

Bleeding:

Some screening procedures can cause bleeding or other problems. For example, colon cancer screening with sigmoidoscopy or colonoscopy can cause tears in the lining of the colon.

False-positive test results are possible.

Screening test results may appear to be abnormal even though there is no cancer. A false-positive test result (one that shows there is cancer when there really isn’t) can cause anxiety and is usually followed by more tests and procedures, which also have risks.

False-negative test results are possible.

Screening test results may appear to be normal even though there is cancer. A person who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if there are symptoms.

Finding the cancer may not improve the person’s health or help the person live longer.

Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. There is no way to know if treating the cancer would help the person live longer than if no treatment were given. In both teenagers and adults, there is a rare risk of attempted or actual suicide in the first year after being diagnosed with cancer.

For some cancers, finding and treating the cancer early does not improve the chance of a cure or help the person live longer.

What Is “Informed Consent” and Shared Decision-Making?

It is important that you understand the benefits and harms of screening tests and make an informed choice about which screening tests are right for you.

Before having any screening test, it is important that you discuss the test with your doctor or other health care provider. Every screening test has both benefits and harms. Your health care provider should talk to you about the benefits and harms of a screening test and include you in the decision about whether the screening test is right for you. This is called informed and shared decision-making.

 

  1. Your health care provider will talk to you about the possible benefits, harms, and unknowns of a screening test. This may include information about the benefits of finding a cancer early or the harms related to false test results, overdiagnosis, and overtreatment. Your health care provider may also give you information in a leaflet, booklet, video, website, or other material.
  2. After you understand the benefits and harms of a screening test, you can decide whether or not you want to have the screening test based on what is best for you. Sometimes the harms and benefits are closely matched and the decision about whether to have a screening test is hard to make.
  3. Your health care provider will write your decision down in your medical record and order the screening test, if that was your decision.

What Are the Goals of Screening Tests?

Screening tests have many goals.  A screening test that works the way it should and is helpful does the following:

Screening vs. Diagnosis

Screening tests usually do not diagnose cancer. If a screening test result is abnormal, more tests may be done to check for cancer. For example, a screening mammogram may find a lump in the breast. A lump may be cancer or something else. More tests need to be done to find out if the lump is cancer. These are called diagnostic tests. Diagnostic tests may include a biopsy, in which cells or tissues are removed so a pathologist can check them under a microscope for signs of cancer.

Who Needs to Be Screened?

Certain screening tests may be suggested only for people who have a high risk for certain cancers.  Anything that increases the chance of cancer is called a cancer risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer.

Some screening tests are used only for people who have known risk factors for certain types of cancer. People known to have a higher risk of cancer than others include those who have any of the following:

People who have a high risk of cancer may need to be screened more often or at an earlier age than other people.

How is Cancer Risk Measured?

Cancer risk is measured in different ways. The findings from surveys and studies about cancer risk are studied and the results are explained in different ways. Some of the ways risk is explained include absolute riskrelative risk, and odds ratios.

 

  • Absolute risk

 

This is the risk a person has of developing a disease, in a given population (for example, the entire U.S. population) over a certain period of time. Researchers estimate the absolute risk by studying a large number of people that are part of a certain population (for example, women in a given age group). Researchers count the number of people in the group who get a certain disease over a certain period of time. For example, a group of 100,000 women between the ages of 20 and 29 are observed for one year, and 4 of them get breast cancer during that time. This means that the one-year absolute risk of breast cancer for a woman in this age group is 4 in 100,000, or 4 chances in 100,000.

 

  • Relative risk

This is often used in research studies to find out whether a trait or a factor can be linked to the risk of a disease. Researchers compare two groups of people who are a lot alike. However, the people in one of the groups must have the trait or factor being studied (they have been “exposed”). The people in the other group do not have it (they have not been exposed). To figure out relative risk, the percentage of people in the exposed group who have the disease is divided by the percentage of people in the unexposed group who have the disease.

Relative risks can be:

  • Larger than 1: The trait or factor is linked to an increase in risk.
  • Equal to 1: The trait or factor is not linked to risk.
  • Less than 1: The trait or factor is linked to a decrease in risk.

Relative risks are also called risk ratios.

  • Odds ratio

In some types of studies, researchers don’t have enough information to figure out relative risks. They use something called an odds ratio instead. An odds ratio can be an estimate of relative risk.

One type of study that uses an odds ratio instead of relative risk is called a case-control study. In a case-control study, two groups of people are compared. However, the individuals in each group are chosen based on whether or not they have a certain disease. Researchers look at the odds that the people in each group were exposed to something (a trait or factor) that might have caused the disease. Odds describes the number of times the trait or factor was present or happened, divided by the number of times it wasn’t present or didn’t happen. To get an odds ratio, the odds for one group are divided by the odds for the other group.

Odds ratios can be:

  • Larger than 1: The trait or factor is linked to an increase in risk.
  • Equal to 1: The trait or factor is not linked to risk.
  • Less than 1: The trait or factor is linked to a decrease in risk.

Looking at traits and exposures in people with and without cancer can help find possible risk factors. Knowing who is at an increased risk for certain types of cancer can help doctors decide when and how often they should be screened.

Does Screening Help People Live Longer?

Finding some cancers at an early stage (before symptoms appear) may help decrease the chance of dying from those cancers.

For many cancers, the chance of recovery depends on the stage (the amount or spread of cancer in the body) of the cancer when it was diagnosed. Cancers that are diagnosed at earlier stages are often easier to treat or cure.

Studies of cancer screening compare the death rate of people screened for a certain cancer with the death rate from that cancer in people who were not screened. Some screening tests have been shown to be helpful both in finding cancers early and in decreasing the chance of dying from those cancers. These include mammograms for breast cancer and sigmoidoscopy and fecal occult blood testing for colorectal cancer. Other tests are used because they have been shown to find a certain type of cancer in some people before symptoms appear, but they have not been proven to decrease the risk of dying from that cancer. If a cancer is fast-growing and spreads quickly, finding it early may not help the person survive the cancer.

Screening studies are done to see whether deaths from cancer decrease when people are screened.

When collecting information on how long cancer patients live, some studies define survival as living 5 years after the diagnosis. This is often used to measure how well cancer treatments work. However, to see if screening tests are useful, studies usually look at whether deaths from the cancer decrease in people who were screened. Over time, signs that a cancer screening test is working include:

The number of deaths from cancer is lower today than it was in the past. It is not always clear if this is because screening tests found the cancers earlier or because cancer treatments have gotten better, or both. The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute collects and reports information on survival times of people with cancer in the United States. This information is studied to see if finding cancer early affects how long these people live.

Certain factors may cause survival times to look like they are getting better when they are not.

These factors include lead-time biasover-diagnosis, and healthy screenee bias.

 

  • Lead-time bias

Survival time for cancer patients is usually measured from the day the cancer is diagnosed until the day they die. Patients are often diagnosed after they have signs and symptoms of cancer. If a screening test leads to a diagnosis before a patient has any symptoms, the patient’s survival time is increased because the date of diagnosis is earlier. This increase in survival time makes it seem as though screened patients are living longer when that may not be happening. This is called lead-time bias. It could be that the only reason the survival time appears to be longer is that the date of diagnosis is earlier for the screened patients. But the screened patients may die at the same time they would have without the screening test.

  • Over-diagnosis

Sometimes, screening tests find cancers that don’t matter because they would have gone away on their own or never caused any symptoms. These cancers would never have been found if not for the screening test (for example, a computed tomography [CT] scan). Finding these cancers is called over-diagnosis. Over-diagnosis can make it seem like more people are surviving cancer longer, but in reality, these are people who would not have died from cancer anyway.

 

  • Healthy screenee bias

People who choose to have screening tests are often more health conscious than the general public and tend to make other healthy choices in their lives. People with early-stage cancer found by screening may live longer than people who don’t get screened. They may live longer because of the benefits of their healthy lifestyle rather than screening. This is sometimes called healthy screenee bias.

How do Screening Tests Become Standard Tests?

Results from research studies help doctors decide when a screening test works well enough to be used as a standard test.

Evidence about how safe, accurate, and useful cancer screening tests are comes from clinical trials (research studies with people) and other kinds of research studies. When enough evidence has been collected to show that a screening test is safe, accurate, and useful, it becomes a standard test. Examples of cancer screening tests that were once under study but are now standard tests include:

Cancer screening trials study new ways of finding cancer in people before they have symptoms. Screening trials also study screening tests that may find cancer earlier or are more accurate than existing tests, or that may be easier, safer, or cheaper to use. Screening trials are designed to find the possible benefits and possible harms of cancer screening tests. Different clinical trial designs are used to study cancer screening tests.

The strongest evidence about screening comes from research done in clinical trials. However, clinical trials cannot always be used to study questions about screening. Findings from other types of studies can give useful information about how safe, useful, and accurate cancer screening tests are.  The following types of studies are used to get information about cancer screening tests:

Randomized controlled trials

Randomized controlled trials give the highest level of evidence about how safe, accurate, and useful cancer screening tests are. In these trials, volunteers are assigned randomly (by chance) to one of two or more groups. The people in one group (the control group) may be given a standard screening test (if one exists) or no screening test. The people in the other group(s) are given the new screening test(s). Test results for the groups are then compared to see if the new screening test works better than the standard test, and to see if there are any harmful side effects.

Using chance to assign people to groups means that the groups will probably be very much alike and that the trial results won’t be affected by human choices or something else.

Nonrandomized controlled trials

In nonrandomized clinical trials, volunteers are not assigned randomly (by chance) to different groups. They choose which group they want to be in or the study leaders assign them. Evidence from this type of research is not as strong as evidence from randomized controlled trials.

Cohort studies

cohort study follows a large number of people over time. The people are divided into groups, called cohorts, based on whether or not they have had a certain treatment or been exposed to certain things. In cohort studies, the information is collected and studied after certain outcomes (such as cancer or death) have occurred. For example, a cohort study might follow a group of women who have regular Pap tests, and divide them into those who test positive for the human papillomavirus (HPV) and those who test negative for HPV. The cohort study would show how the cervical cancer rates are different for the two groups over time.

Case-control studies

Case-control studies are like cohort studies but are done in a shorter time. They do not include many years of follow-up. Instead of looking forward in time, they look backward. In case-control studies, information is collected from cases (people who already have a certain disease) and compared with information collected from controls (people who do not have the disease). For example, a group of patients with melanoma and a group without melanoma might be asked about how they check their skin for abnormal growths and how often they check it. Based on the different answers from the two groups, the study may show that checking your skin is a useful screening test to decrease the number of melanoma cases and deaths from melanoma.  Evidence from case-control studies is not as strong as evidence from clinical trials or cohort studies.

 

Ecologic studies

Ecologic studies report information collected on entire groups of people, such as people in one city or county. Information is reported about the whole group, not about any single person in the group. These studies may give some evidence about whether a screening test is useful.  The evidence from ecologic studies is not as strong as evidence from clinical trials or other types of research studies.

 

Expert opinions

Expert opinions can be based on the experiences of doctors or reports of expert committees or panels. Expert opinions do not give strong evidence about the usefulness of screening tests.

Screening tests for cancer are being studied in clinical trials.

Information about clinical trials and cancer screening can be found at www.ClinicalTrials.gov.

 

Part 4:  Diagnosis

Cancer can cause many different symptoms. Most often these symptoms are not caused by cancer, but by benign tumors or other problems. If you have symptoms that last for a couple of weeks, your doctor will do a physical exam and order tests or other procedures to find out what is causing your symptoms.

If you do find out you have cancer, your doctor will order another set of tests or procedures to figure out its stage. Stage refers to the extent of your cancer and is based on factors such as how large the tumor is and if it has spread. Once your doctor knows the stage of your cancer, he will be able to suggest treatment and discuss your prognosis with you. Understanding your cancer and knowing what to expect can help you and your loved ones feel more in control and cope with your diagnosis.

Symptoms of Cancer

Cancer can cause many symptoms, but these symptoms are most often caused by illness, injury, benign tumors, or other problems. If you have symptoms that do not get better after a few weeks, see your doctor so that problems can be diagnosed and treated as early as possible. Often, cancer does not cause pain, so do not wait to feel pain before seeing a doctor.

Some of the symptoms that cancer may cause include:

Breast changes

  • Lump or firm feeling in your breast or under your arm
  • Nipple changes or discharge
  • Skin that is itchy, red, scaly, dimpled, or puckered

 Bladder changes

  • Trouble urinating
  • Pain when urinating
  • Blood in the urine

Bleeding or bruising, for no known reason

Bowel changes 

  • Blood in the stools
  • Changes in bowel habits

 Cough or hoarseness that does not go away

Eating problems

  • Pain after eating (heartburn or indigestion that doesn’t go away)
  • Trouble swallowing
  • Belly pain
  • Nausea and vomiting
  • Appetite changes

Fatigue that is severe and lasts

Fever or night sweats for no known reason

Mouth changes

  • A white or red patch on the tongue or in your mouth
  • Bleeding, pain, or numbness in the lip or mouth

Neurological problems

  • Headaches
  • Seizures
  • Vision changes
  • Hearing changes
  • Drooping of the face

Skin changes

  • A flesh-colored lump that bleeds or turns scaly
  • A new mole or a change in an existing mole
  • A sore that does not heal
  • Jaundice (yellowing of the skin and whites of the eyes)

Swelling or lumps anywhere such as in the neck, underarm, stomach, and groin

Weight gain or weight loss for no known reason

 

Understanding How Cancer Is Diagnosed

If you have a symptom or a screening test result that suggests cancer, your doctor must find out whether it is due to cancer or some other cause. The doctor may start by asking about your personal and family medical history and do a physical exam. The doctor also may order lab tests, imaging tests (scans), or other tests or procedures. You may also need a biopsy, which is often the only way to tell for sure if you have cancer.

Lab Tests

High or low levels of certain substances in your body can be a sign of cancer. So, lab tests of your bloodurine, or other body fluids that measure these substances can help doctors make a diagnosis. However, abnormal lab results are not a sure sign of cancer.

Some lab tests involve testing blood or tissue samples for tumor markers. Tumor markers are substances that are produced by cancer cells or by other cells of the body in response to cancer. Most tumor markers are made by normal cells and cancer cells but are produced at much higher levels by cancer cells.

Imaging Tests

Imaging tests create pictures of areas inside your body that help the doctor see whether a tumor is present. These pictures can be made in several ways:

CT Scan

CT scan uses an x-ray machine linked to a computer to take a series of pictures of your organs from different angles. These pictures are used to create detailed 3-D images of the inside of your body.

Sometimes, you may receive a dye or other contrast material before you have the scan. You might swallow the dye, or it may be given by a needle into a vein. Contrast material helps make the pictures easier to read by highlighting certain areas in the body.

During the CT scan, you will lie still on a table that slides into a donut-shaped scanner. The CT machine moves around you, taking pictures. Learn more about CT scans and how they are used to diagnose cancer.

MRI

An MRI uses a powerful magnet and radio waves to take pictures of your body in slices. These slices are used to create detailed images of the inside of your body, which can show the difference between healthy and unhealthy tissue.

When you have an MRI, you lie still on a table that is pushed into a long, round chamber. The MRI machine makes loud thumping noises and rhythmic beats.

Sometimes, you might have a special dye injected into your vein before or during your MRI exam. This dye, called a contrast agent, can make tumors show up brighter in the pictures.

Nuclear Scan

nuclear scan uses radioactive material to take pictures of the inside of the body. This type of scan may also be called radionuclide scan.

Before this scan, you receive an injection of a small amount of radioactive material, which is sometimes called a tracer. It flows through your bloodstream and collects in certain bones or organs.

During the scan, you lie still on a table while a machine called a scanner detects and measures the radioactivity in your body, creating pictures of bones or organs on a computer screen or on film.

After the scan, the radioactive material in your body will lose its radioactivity over time. It may also leave your body through your urine or stool.

Bone Scan

Bone scans are a type of nuclear scan that check for abnormal areas or damage in the bones. They may be used to diagnose bone cancer or cancer that has spread to the bones (also called metastatic bone tumors).

Before this test, a very small amount of radioactive material is injected into your vein. As it travels through the blood, the material collects in abnormal areas in the bone. Areas where the material collects show up on pictures taken by a special scanner. These areas are called “hot spots.”

PET scan

PET scan is a type of nuclear scan that makes detailed 3-D pictures of areas inside your body where glucose is taken up. Because cancer cells often take up more glucose than healthy cells, the pictures can be used to find cancer in the body.

Before the scan, you receive an injection of a tracer called radioactive glucose. During the scan, you will lie still on a table that moves back and forth through a scanner.

Ultrasound

An ultrasound exam uses high-energy sound waves that people cannot hear. The sound waves echo off tissues inside your body. A computer uses these echoes to create pictures of areas inside your body. This picture is called a sonogram.

During an ultrasound exam, you will lie on a table while a tech slowly moves a device called a transducer on the skin over the part of the body that is being examined. The transducer is covered with a warm gel that makes it easier to glide over the skin.

X-rays

X-rays use low doses of radiation to create pictures inside your body. An x-ray tech will put you in position and direct the x-ray beam to the correct part of your body. While the images are taken, you will need to stay very still and may need to hold your breath for a second or two.
Biopsy

In most cases, doctors need to do a biopsy to diagnose cancer. A biopsy is a procedure in which the doctor removes a sample of tissue. A pathologist looks at the tissue under a microscope and runs other tests to see if the tissue is cancer. The pathologist describes the findings in a pathology report, which contains details about your diagnosis. Pathology reports play an important role in diagnosing cancer and helping decide treatment options. Learn more about pathology reports and the type of information they contain.

The biopsy sample may be obtained in several ways:

With a needle: The doctor uses a needle to withdraw tissue or fluid. This method is used for bone marrow aspirationsspinal taps, and some breast, prostate, and liver biopsies.

 

With endoscopy: The doctor uses a thin, lighted tube called an endoscope to examine areas inside the body. Endoscopes go into natural body openings, such as the mouth or anus. If the doctor sees abnormal tissue during the exam, he will remove the abnormal tissue along with some of the surrounding normal tissue through the endoscope.

Examples of endoscopy exams include:

Colonoscopy, which is an exam of the colon and rectum. In this type of exam, an endoscope goes through the anus, allowing the doctor to examine the rectum and colon. If the doctor sees polyps, she will remove them and send them to a lab for testing.

Bronchoscopy, which is an exam of the tracheabronchi, and lungs. In this type of exam, an endoscope goes through the mouth or nose and down the throat.

With surgery: A surgeon removes an area of abnormal cells during an operation. Surgery may be excisional or incisional.

In an excisional biopsy, the surgeon removes the entire area of abnormal cells. Often some of the normal tissue around these cells is also removed.

In an incisional biopsy, the surgeon removes just part of the abnormal area.

Some biopsies may require a sedative or anesthesia

Sedatives are medicine that help you relax and stay very still or sleep during a biopsy.

Anesthesia keeps you from feeling pain. It refers to drugs or other substances that cause you to lose feeling or awareness. There are three types of anesthesia:

Local anesthesia, which causes loss of feeling in one small area of the body

Regional anesthesia, which causes loss of feeling in a part of the body, such as an arm or leg 

General anesthesia, which causes loss of feeling and a complete loss of awareness that seems like a very deep sleep

 

After Cancer Is Diagnosed

If the biopsy and other tests show that you have cancer, you may have more tests to help your doctor plan treatment. For instance, your doctor will need to figure out the stage of your cancer. For some cancers, knowing the grade of the tumor or risk group that you fall into are important for deciding on the best treatment. Your tumor may also be tested further for other tumor or genetic markers.

 

Cancer Staging

Stage refers to the extent of your cancer, such as how large the tumor is, and if it has spread. Knowing the stage of your cancer helps your doctor:

  • Understand how serious your cancer is and your chances of survival
  • Plan the best treatment for you
  • Identify clinical trials that may be treatment options for you

A cancer is always referred to by the stage it was given at diagnosis, even if it gets worse or spreads. New information about how a cancer has changed over time gets added on to the original stage. So, the stage doesn’t change, even though the cancer might.

How Stage Is Determined

To learn the stage of your disease, your doctor may order x-rays, lab tests, and other tests or procedures. See the section on Diagnosis to learn more about these tests.

Systems that Describe Stage

There are many staging systems. Some, such as the TNM staging system, are used for many types of cancer. Others are specific to a particular type of cancer. Most staging systems include information about:

The TNM Staging System

The TNM system is the most widely used cancer staging system. Most hospitals and medical centers use the TNM system as their main method for cancer reporting. You are likely to see your cancer described by this staging system in your pathology report, unless you have a cancer for which a different staging system is used. Examples of cancers with different staging systems include brain and spinal cord tumors and blood cancers.

In the TNM system:

  • The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor.
  • The N refers to the number of nearby lymph nodes that have cancer.
  • The M refers to whether the cancer has metastasized. This means that the cancer has spread from the primary tumor to other parts of the body.

When your cancer is described by the TNM system, there will be numbers after each letter that give more details about the cancer—for example, T1N0MX or T3N1M0. The following explains what the letters and numbers mean:

Primary tumor (T)

  • TX: Main tumor cannot be measured.
  • T0: Main tumor cannot be found.
  • T1, T2, T3, T4: Refers to the size and/or extent of the main tumor. The higher the number after the T, the larger the tumor or the more it has grown into nearby tissues. T’s may be further divided to provide more detail, such as T3a and T3b.

 

Regional lymph nodes (N)

  • NX: Cancer in nearby lymph nodes cannot be measured.
  • N0: There is no cancer in nearby lymph nodes.
  • N1, N2, N3: Refers to the number and location of lymph nodes that contain cancer. The higher the number after the N, the more lymph nodes that contain cancer.

 

Distant metastasis (M)

  • MX: Metastasis cannot be measured.
  • M0: Cancer has not spread to other parts of the body.
  • M1: Cancer has spread to other parts of the body.

Other Ways to Describe Stage

The TNM system helps describe cancer in great detail. But, for many cancers, the TNM combinations are grouped into five less-detailed stages. When talking about your cancer, your doctor or nurse may describe it as one of these stages:

Stage What it means
Stage 0 Abnormal cells are present but have not spread to nearby tissue. Also called carcinoma in situ, or CIS. CIS is not cancer, but it may become cancer.
Stage I, Stage II, and Stage III Cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues.
Stage IV The cancer has spread to distant parts of the body.

Another staging system that is used for all types of cancer groups the cancer into one of five main categories. This staging system is more often used by cancer registries than by doctors. But, you may still hear your doctor or nurse describe your cancer in one of the following ways:

In situ—Abnormal cells are present but have not spread to nearby tissue.

Localized—Cancer is limited to the place where it started, with no sign that it has spread.

Regional—Cancer has spread to nearby lymph nodes, tissues, or organs.

Distant—Cancer has spread to distant parts of the body.

Unknown—There is not enough information to figure out the stage.

 

Cancer Prognosis

If you have cancer, you may have questions about how serious your cancer is and your chances of survival. The estimate of how the disease will go for you is called “prognosis.” It can be hard to understand what prognosis means and also hard to talk about, even for doctors.

Many Factors Can Affect Your Prognosis.

Some of the factors that affect prognosis include:

The type of cancer and where it is in your body

The stage of the cancer, which refers to the size of the cancer and if it has spread to other parts of your body

The cancer’s grade, which refers to how abnormal the cancer cells look under a microscope. Grade provides clues about how quickly the cancer is likely to grow and spread.

Certain traits of the cancer cells

Your age and how healthy you were before cancer

How you respond to treatment

Seeking Information About Your Prognosis Is a Personal Decision

When you have cancer, you and your loved ones face many unknowns. Understanding your cancer and knowing what to expect can help you and your loved ones make decisions. Some of the decisions you may face include:

  • Which treatment is best for you
  • If you want treatment
  • How to best take care of yourself and manage treatment side effects
  • How to deal with financial and legal matters

Many people want to know their prognosis. They find it easier to cope when they know more about their cancer. You may ask your doctor about survival statistics or search for this information on your own. Or, you may find statistics confusing and frightening, and think they are too impersonal to be of value to you. It is up to you to decide how much information you want.

If you do decide you want to know more, the doctor who knows the most about your situation is in the best position to discuss your prognosis and explain what the statistics may mean.

Understanding Statistics About Survival

Doctors estimate prognosis by using statistics that researchers have collected over many years about people with the same type of cancer. Several types of statistics may be used to estimate prognosis. The most commonly used statistics include:

Cancer-specific survival
This is the percentage of patients with a specific type and stage of cancer who have not died from their cancer during a certain period of time after diagnosis. The period of time may be 1 year, 2 years, 5 years, etc., with 5 years being the time period most often used. Cancer-specific survival is also called disease-specific survival. In most cases, cancer-specific survival is based on causes of death listed in medical records.

Relative survival
This statistic is another method used to estimate cancer-specific survival that does not use information about the cause of death. It is the percentage of cancer patients who have survived for a certain period of time after diagnosis compared to people who do not have cancer.

Overall survival
This is the percentage of people with a specific type and stage of cancer who have not died from any cause during a certain period of time after diagnosis.

Disease-free survival
This statistic is the percentage of patients who have no signs of cancer during a certain period of time after treatment. Other names for this statistic are recurrence-free or progression-free survival.

Because statistics are based on large groups of people, they cannot be used to predict exactly what will happen to you. Everyone is different. Treatments and how people respond to treatment can differ greatly. Also, it takes years to see the benefit of new treatments and ways of finding cancer. So, the statistics your doctor uses to make a prognosis may not be based on treatments being used today.

Still, your doctor may tell you that you have a good prognosis if statistics suggest that your cancer is likely to respond well to treatment. Or, he may tell you that you have a poor prognosis if the cancer is harder to control. Whatever your doctor tells you, keep in mind that a prognosis is an educated guess. Your doctor cannot be certain how it will go for you.

If You Decide Not to Have Treatment

If you decide not to have treatment, the doctor who knows your situation best is in the best position to discuss your prognosis.

Survival statistics most often come from studies that compare treatments with each other, rather than treatment with no treatment. So, it may not be easy for your doctor to give you an accurate prognosis.

Understanding the Difference Between Cure and Remission

Cure means that there are no traces of your cancer after treatment and the cancer will never come back.

Remission means that the signs and symptoms of your cancer are reduced. Remission can be partial or complete. In a complete remission, all signs and symptoms of cancer have disappeared.

If you remain in complete remission for 5 years or more, some doctors may say that you are cured. Still, some cancer cells can remain in your body for many years after treatment. These cells may cause the cancer to come back one day. For cancers that return, most do so within the first 5 years after treatment. But, there is a chance that cancer will come back later. For this reason, doctors cannot say for sure that you are cured. The most they can say is that there are no signs of cancer at this time.

Because of the chance that cancer can come back, your doctor will monitor you for many years and do tests to look for signs of cancer’s return. They will also look for signs of late side effects from the cancer treatments you received.

Part 5: Cancer Treatments

There are many types of cancer treatment. The types of treatment that you have will depend on the type of cancer you have and how advanced it is. Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy. You may also have immunotherapytargeted therapy, or hormone therapy.

Clinical trials might also be an option for you. Clinical trials are research studies that involve people. Understanding what they are and how they work can help you decide if taking part in a trial is a good option for you.

When you need treatment for cancer, you have a lot to learn and think about. It is normal to feel overwhelmed and confused. But, talking with your doctor and learning all you can about all your treatment options, including clinical trials, can help you make a decision in which you have confidence.

Surgery to Treat Cancer

Surgery, when used to treat cancer, is a procedure in which a surgeon removes cancer from your body. Surgeons are medical doctors with special training in surgery.

How Surgery Is Performed

Surgeons often use small, thin knives, called scalpels, and other sharp tools to cut your body during surgery. Surgery often requires cuts through skin, muscles, and sometimes bone. After surgery, these cuts can be painful and take some time to recover from.

  • Anesthesia keeps you from feeling pain during surgery. Anesthesia refers to drugs or other substances that cause you to lose feeling or awareness. There are three types of anesthesia:
  • Local anesthesia causes loss of feeling in one small area of the body.
  • Regional anesthesia causes loss of feeling in a part of the body, such as an arm or leg.
  • General anesthesia causes loss of feeling and a complete loss of awareness that seems like a very deep sleep.

There are other ways of performing surgery that do not involve cuts with scalpels. Some of these include:

  • Cryosurgery
    Cryosurgery is a type of treatment in which extreme cold produced by liquid nitrogen or argon gas is used to destroy abnormal tissue. Cryosurgery may be used to treat early-stage skin cancer, retinoblastoma, and precancerous growths on the skin and cervix. Cryosurgery is also called cryotherapy.
  • Lasers
    This is a type of treatment in which powerful beams of light are used to cut through tissue. Lasers can focus very accurately on tiny areas, so they can be used for precise surgeries. Lasers can also be used to shrink or destroy tumors or growths that might turn into cancer.
  • Lasers are most often used to treat tumors on the surface of the body or on the inside lining of internal organs. Examples include basal cell carcinoma, cervical changes that might turn into cancer, and cervical, vaginal, esophageal, and non-small cell lung cancer.

Hyperthermia
Hyperthermia is a type of treatment in which small areas of body tissue are exposed to high temperatures. The high heat can damage and kill cancer cells or make them more sensitive to radiation and certain chemotherapy drugs. Radiofrequency ablation is one type of hyperthermia that uses high-energy radio waves to generate heat. Hyperthermia is not widely available and is being studied in clinical trials.

Photodynamic Therapy
Photodynamic therapy is a type of treatment that uses drugs which react to a certain type of light. When the tumor is exposed to this light, these drugs become active and kill nearby cancer cells. Photodynamic therapy is used most often to treat or relieve symptoms caused by skin cancer, mycosis fungoides and non-small cell lung cancer.

Types of Surgery

There are many types of surgery. The types differ based on the purpose of the surgery, the part of the body that requires surgery, the amount of tissue to be removed, and, in some cases, what the patient prefers.

Surgery may be open or minimally invasive.

In open surgery, the surgeon makes one large cut to remove the tumor, some healthy tissue, and maybe some nearby lymph nodes.

In minimally invasive surgery, the surgeon makes a few small cuts instead of one large one. She inserts a long, thin tube with a tiny camera into one of the small cuts. This tube is called a laparoscope. The camera projects images from the inside of the body onto a monitor, which allows the surgeon to see what she is doing. She uses special surgery tools that are inserted through the other small cuts to remove the tumor and some healthy tissue.

Because minimally invasive surgery requires smaller cuts, it takes less time to recover from than open surgery.

Who Has Surgery

Many people with cancer are treated with surgery. Surgery works best for solid tumors that are contained in one area. It is a local treatment, meaning that it treats only the part of your body with the cancer. It is not used for leukemia (a type of blood cancer) or for cancers that have spread.  Sometimes surgery will be the only treatment you need. But most often, you will also have other cancer treatments.

How Surgery Works against Cancer

Depending on your type of cancer and how advanced it is, surgery can be used to:

  • Remove the entire tumor
    Surgery removes cancer that is contained in one area.
  • Debulk a tumor
    Surgery removes some, but not all, of a cancer tumor. Debulking is used when removing an entire tumor might damage an organ or the body. Removing part of a tumor can help other treatments work better.
  • Ease cancer symptoms
    Surgery is used to remove tumors that are causing pain or pressure.

Risks of Surgery

Surgeons are highly trained and will do everything they can to prevent problems during surgery. Even so, sometimes problems do occur. Common problems are:

Pain
After surgery, most people will have pain in the part of the body that was operated on. How much pain you feel will depend on the extent of the surgery, the part of your body where you had surgery, and how you feel pain.

Your doctor or nurse can help you manage pain after surgery. Talk with your doctor or nurse before surgery about ways to control pain. After surgery, tell them if your pain is not controlled.

Infection
Infection is another problem that can happen after surgery. To help prevent infection, follow your nurse’s instructions about caring for the area where you had surgery. If you do develop an infection, your doctor can prescribe a medicine (called an antibiotic) to treat it.

Other risks of surgery include bleeding, damage to nearby tissues, and reactions to the anesthesia. Talk to your doctor about possible risks for the type of surgery you will have.

How Much Surgery Costs

The cost of surgery depends on many factors, including:

  • The type of surgery you have
  • How many specialists are involved in your surgery
  • If you need local, regional, or general anesthesia
  • Where you have surgery—at an outpatient clinic, a doctor’s office, or the hospital
  • If you need to stay in the hospital, and for how long
  • The part of the country where you live
  • Talk with your health insurance company about what services it will pay for. Most insurance plans pay for surgery to treat cancer. To learn more, talk with the business office of the clinic or hospital where you go for treatment. If you need financial assistance, there are organizations that may be able to help.

Where You Have Surgery

Where you have surgery depends on:

  • The type of surgery
  • How extensive it is
  • Where the surgeon practices
  • The type of facility your insurance will cover
  • You can have outpatient surgery in a doctor’s office, surgery center, or hospital. Outpatient means that you do not spend the night. Or, you may have surgery in the hospital and stay the night. How many nights you stay will depend on the type of surgery you have and how quickly you recover.

What to Expect before, during, and after surgery

Before Surgery

Before surgery, a nurse may call you to tell you how to prepare. He or she may tell you about tests and exams you need to have before the surgery. Common tests that you may need, if you have not had them lately, are:

Blood tests

Chest x-ray

Electrocardiogram (ECG)

You may not be able to eat or drink for a certain period of time before the surgery. It is important to follow the instructions about eating and drinking. If you don’t, your surgery may need to be rescheduled.

You may also be asked to have supplies on hand for taking care of your wounds after surgery. Supplies might include antiseptic ointment and bandages.

 

During Surgery

Once you are under anesthesia, the surgeon removes the cancer, usually along with some healthy tissue around it. Removing this healthy tissue helps improve the chances that all the cancer has been removed.

Sometimes, the surgeon might also remove lymph nodes or other tissues near the tumor. These tissues will be checked under a microscope to see if the cancer has spread. Knowing if the nearby tissue contains cancer will help your doctors suggest the best treatment plan for you after surgery.

After Surgery

Once you are ready to go home after surgery, the nurse will tell you how to take care of yourself. He or she will explain:

  • How to control pain
  • Activities you should and should not do
  • How to take care of your wound
  • How to spot signs of infection and steps to take if you do
  • When you can return to work

You will have at least one more visit with the surgeon a week or two after you go home. For more complex surgeries, you may need to see the surgeon more often. You may have stitches removed, and the surgeon will check to make sure you are healing as you should.

Special Diet Needs before and after Surgery

Surgery increases your need for good nutrition. If you are weak or underweight, you may need to eat a high-protein, high-calorie diet before surgery.

Some types of surgery may change how your body uses food. Surgery can also affect eating if you have surgery of the mouth, stomach, intestines, or throat. If you have trouble eating after surgery, you may be given nutrients through a feeding tube or IV (through a needle directly into a vein).

Talk with a dietitian for help with eating problems caused by surgery.

 

Working after Surgery

You will need to take time off from work to have and recover from surgery. You may need only 1 day or many weeks. How long you need to recover depends on many factors, such as:

The type of anesthesia you have. If you have local or regional anesthesia, you will probably return to work more quickly than if you have general anesthesia.

The type of surgery you have, and how extensive it is

The type of work you do. If you have an active job, you may need to take off more time than if you sit at a desk. If your job allows, you may want to see if you can work at home, or start back part time, to help you ease back into a full work day.

Ask your doctor how long you will need to recover from your surgery. If you expect a longer recovery time, talk with your employer to find out if you can take medical leave. Check to make sure your health insurance will cover costs if you are on medical leave and not working for a time.

 

Radiation Therapy to Treat Cancer

Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. At low doses, radiation is used in x-rays to see inside your body, as with x-rays of your teeth or broken bones.

How Radiation Therapy Works Against Cancer

At high doses, radiation therapy kills cancer cells or slows their growth by damaging their DNA. Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and removed by the body.  Radiation therapy does not kill cancer cells right away. It takes days or weeks of treatment before DNA is damaged enough for cancer cells to die. Then, cancer cells keep dying for weeks or months after radiation therapy ends.

Types of Radiation Therapy

There are two main types of radiation therapy, external beam and internal.  The type of radiation therapy that you may have depends on many factors, including:

  • The type of cancer
  • The size of the tumor
  • The tumor’s location in the body
  • How close the tumor is to normal tissues that are sensitive to radiation
  • Your general health and medical history
  • Whether you will have other types of cancer treatment
  • Other factors, such as your age and other medical conditions

 

External Beam Radiation Therapy

External beam radiation therapy comes from a machine that aims radiation at your cancer. The machine is large and may be noisy. It does not touch you, but can move around you, sending radiation to a part of your body from many directions.

External beam radiation therapy is a local treatment, which means it treats a specific part of your body. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.

 

Internal Radiation Therapy

Internal radiation therapy is a treatment in which a source of radiation is put inside your body. The radiation source can be solid or liquid.

Internal radiation therapy with a solid source is called brachytherapy. In this type of treatment, seeds, ribbons, or capsules that contain a radiation source are placed in your body, in or near the tumor. Like external beam radiation therapy, brachytherapy is a local treatment and treats only a specific part of your body.  With brachytherapy, the radiation source in your body will give off radiation for a while.

Internal radiation therapy with a liquid source is called systemic therapy. Systemic means that the treatment travels in the blood to tissues throughout your body, seeking out and killing cancer cells. You receive systemic radiation therapy by swallowing, through a vein via an IV line, or through an injection.  With systemic radiation, your body fluids, such as urine, sweat, and saliva, will give off radiation for a while.

Radiation-based drugs are emerging as cancer treatment.  Radiopharmaceuticals deliver radiation therapy directly and specifically to cancer cells.

 

Why People with Cancer Receive Radiation Therapy

Radiation therapy is used to treat cancer and ease cancer symptoms.

When used to treat cancer, radiation therapy can cure cancer, prevent it from returning, or stop or slow its growth.

When treatments are used to ease symptoms, they are known as palliative treatments. External beam radiation may shrink tumors to treat pain and other problems caused by the tumor, such as trouble breathing or loss of bowel and bladder control. Pain from cancer that has spread to the bone can be treated with systemic radiation therapy drugs called radiopharmaceuticals.

Types of Cancer that Are Treated with Radiation Therapy

External beam radiation therapy is used to treat many types of cancer.

Brachytherapy is most often used to treat cancers of the head and neck, breast, cervix, prostate, and eye.

A systemic radiation therapy called radioactive iodine, or I-131, is most often used to treat certain types of thyroid cancer.  Another type of systemic radiation therapy, called targeted radionuclide therapy, is used to treat some patients who have advanced prostate cancer or gastroenteropancreatic neuroendocrine tumor (GEP-NET). This type of treatment may also be referred to as molecular radiotherapy.

How Radiation Is Used with Other Cancer Treatments

For some people, radiation may be the only treatment you need. But, most often, you will have radiation therapy with other cancer treatments, such as surgerychemotherapy, and immunotherapy. Radiation therapy may be given before, during, or after these other treatments to improve the chances that treatment will work. The timing of when radiation therapy is given depends on the type of cancer being treated and whether the goal of radiation therapy is to treat the cancer or ease symptoms.

When radiation is combined with surgery, it can be given:

  • Before surgery, to shrink the size of the cancer so it can be removed by surgery and be less likely to return.
  • During surgery, so that it goes straight to the cancer without passing through the skin. Radiation therapy used this way is called intraoperative radiation. With this technique, doctors can more easily protect nearby normal tissues from radiation.
  • After surgery to kill any cancer cells that remain.

Lifetime Dose Limits

There is a limit to the amount of radiation an area of your body can safely receive over the course of your lifetime. Depending on how much radiation an area has already been treated with, you may not be able to have radiation therapy to that area a second time. But, if one area of the body has already received the safe lifetime dose of radiation, another area might still be treated if the distance between the two areas is large enough.

Radiation Therapy Can Cause Side Effects

Radiation not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Damage to healthy cells can cause side effects.

How Much Radiation Therapy Costs

Radiation therapy can be expensive. It uses complex machines and involves the services of many health care providers. The exact cost of your radiation therapy depends on the cost of health care where you live, what type of radiation therapy you get, and how many treatments you need.

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for radiation therapy. To learn more, talk with the business office at the clinic or hospital where you go for treatment. If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database, Organizations that Offer Support Services and search for “financial assistance.” Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.

Special Diet Needs

Radiation can cause side effects that make it hard to eat, such as nausea, mouth sores, and throat problems called esophagitis. Since your body uses a lot of energy to heal during radiation therapy, it is important that you eat enough calories and protein to maintain your weight during treatment.

If you are having trouble eating and maintaining your weight, talk to your doctor or nurse. You might also find it helpful to speak with a dietitian. For more information about coping with eating problems see the booklet Eating Hints or read more about side effects.

Working During Radiation Therapy

Some people are able to work full-time during radiation therapy. Others can work only part-time or not at all. How much you are able to work depends on how you feel. Ask your doctor or nurse what you may expect from the treatment you will have.

You are likely to feel well enough to work when you first start your radiation treatments. As time goes on, do not be surprised if you are more tired, have less energy, or feel weak. Once you have finished treatment, it may take just a few weeks for you to feel better—or it could take months.

You may get to a point during your radiation therapy when you feel too sick to work. Talk with your employer to find out if you can go on medical leave. Check that your health insurance will pay for treatment while you are on medical leave.

Chemotherapy to Treat Cancer

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs/chemicals to kill cancer cells.

How Chemotherapy Works against Cancer

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. Chemotherapy is used to:

Treat cancer
Chemotherapy can be used to cure cancer, lessen the chance it will return, or stop or slow its growth.

Ease cancer symptoms
Chemotherapy can be used to shrink tumors that are causing pain and other problems.

Who Receives Chemotherapy

Chemotherapy is used to treat many types of cancer. For some people, chemotherapy may be the only treatment you receive. But most often, you will have chemotherapy and other cancer treatments. The types of treatment that you need depends on the type of cancer you have, if it has spread and where, and if you have other health problems.

How Chemotherapy Is Used with Other Cancer Treatments

When used with other treatments, chemotherapy can:

Make a tumor smaller before surgery or radiation therapy. This is called neoadjuvant chemotherapy.

Destroy cancer cells that may remain after treatment with surgery or radiation therapy. This is called adjuvant chemotherapy.

Help other treatments work better.

Kill cancer cells that have returned or spread to other parts of your body.

Chemotherapy Can Cause Side Effects

Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better or go away after you have finished chemotherapy.

The most common side effect is fatigue, which is feeling exhausted and worn out. You can prepare for fatigue by:

  • Asking someone to drive you to and from chemotherapy
  • Planning time to rest on the day of and day after chemotherapy
  • Asking for help with meals and childcare on the day of and at least one day after chemotherapy
  • There are many ways you can help manage chemotherapy side effects. For more information, see the section on side effects.
  • How Much Chemotherapy Costs
  • The cost of chemotherapy depends on:
  • The types and doses of chemotherapy used
  • How long and how often chemotherapy is given
  • Whether you get chemotherapy at home, in a clinic or office, or during a hospital stay
  • The part of the country where you live
  • Talk with your health insurance company about what services it will pay for. Most insurance plans pay for chemotherapy. To learn more, talk with the business office where you go for treatment.
  • What to Expect When Receiving Chemotherapy

How Chemotherapy Is Given

Chemotherapy may be given in many ways. Some common ways include:

  • Oral
    The chemotherapy comes in pills, capsules, or liquids that you swallow
  • Intravenous (IV)
    The chemotherapy goes directly into a vein
  • Injection
    The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly
  • Intrathecal
    The chemotherapy is injected into the space between the layers of tissue that cover the brain and spinal cord
  • Intraperitoneal (IP)
    The chemotherapy goes directly into the peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver
  • Intra-arterial (IA)
    The chemotherapy is injected directly into the artery that leads to the cancer
  • Topical
    The chemotherapy comes in a cream that you rub onto your skin
  • Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. IV chemotherapy may also be given through catheters or ports, sometimes with the help of a pump.
  • Catheter
    A catheter is a thin, soft tube. A doctor or nurse places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until you have finished your chemotherapy treatments. Catheters can also be used to give you other drugs and to draw blood. Be sure to watch for signs of infection around your catheter. See the section about infection for more information.
  • Port
    A port is a small, round disc that is placed under your skin during minor surgery. A surgeon puts it in place before you begin your course of treatment, and it remains there until you have finished. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for longer than one day. Be sure to watch for signs of infection around your port. See the section about infection for more information.
  • Pump
    Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port, allowing you to receive your chemotherapy outside of the hospital. Pumps can be internal or external. External pumps remain outside your body. Internal pumps are placed under your skin during surgery.

How Your Doctor Decides Which Chemotherapy Drugs to Give You

There are many different chemotherapy drugs. Which ones are included in your treatment plan depends mostly on:

  • The type of cancer you have and how advanced it is
  • Whether you have had chemotherapy before
  • Whether you have other health problems, such as diabetes or heart disease

Where You Go for Chemotherapy

You may receive chemotherapy during a hospital stay, at home, or as an outpatient at a doctor’s office, clinic, or hospital. Outpatient means you do not stay overnight. No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and help you manage them. For more information on side effects and how to manage them, see the section on side effects.

How Often You Receive Chemotherapy

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:

Your type of cancer and how advanced it is

Whether chemotherapy is used to:

  • Cure your cancer
  • Control its growth
  • Ease symptoms
  • The type of chemotherapy you are getting
  • How your body responds to the chemotherapy

You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive chemotherapy every day for 1 week followed by 3 weeks with no chemotherapy. These 4 weeks make up one cycle. The rest period gives your body a chance to recover and build new healthy cells.

Missing a Chemotherapy Treatment

It is best not to skip a chemotherapy treatment. But, sometimes your doctor may change your chemotherapy schedule if you are having certain side effects. If this happens, your doctor or nurse will explain what to do and when to start treatment again.

How Chemotherapy May Affect You

Chemotherapy affects people in different ways. How you feel depends on:

  • The type of chemotherapy you are getting
  • The dose of chemotherapy you are getting
  • Your type of cancer
  • How advanced your cancer is
  • How healthy you are before treatment
  • Since everyone is different and people respond to chemotherapy in different ways, your doctor and nurses cannot know for sure how you will feel during chemotherapy.

How Will I Know If My Chemotherapy Is Working?

You will see your doctor often. During these visits, she will ask you how you feel, do a physical exam, and order medical tests and scans. Tests might include blood tests. Scans might include MRICT, or PET scans.

You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well, or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

Special Diet Needs

Chemotherapy can damage the healthy cells that line your mouth and intestines and cause eating problems. Tell your doctor or nurse if you have trouble eating while you are receiving chemotherapy. You might also find it helpful to speak with a dietitian. For more information about coping with eating problems see the booklet Eating Hints or the section on side effects.

Working during Chemotherapy

Many people can work during chemotherapy, as long as they match their work schedule to how they feel. Whether or not you can work may depend on what kind of job you have. If your job allows, you may want to see if you can work part-time or from home on days you do not feel well.
Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.

 

Immunotherapy to Treat Cancer

Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues of the lymph system.

Immunotherapy is a type of biological therapy. Biological therapy is a type of treatment that uses substances made from living organisms to treat cancer.

How does immunotherapy work against cancer?

As part of its normal function, the immune system detects and destroys abnormal cells and most likely prevents or curbs the growth of many cancers. For instance, immune cells are sometimes found in and around tumors. These cells, called tumor-infiltrating lymphocytes or TILs, are a sign that the immune system is responding to the tumor. People whose tumors contain TILs often do better than people whose tumors don’t contain them.

Even though the immune system can prevent or slow cancer growth, cancer cells have ways to avoid destruction by the immune system. For example, cancer cells may:

  • Have genetic changes that make them less visible to the immune system.
  • Have proteins on their surface that turn off immune cells.
  • Change the normal cells around the tumor so they interfere with how the immune system responds to the cancer cells.
  • Immunotherapy helps the immune system to better act against cancer.
  • What are the types of immunotherapy?

Several types of immunotherapy are used to treat cancer. These include:

Immune checkpoint inhibitors, which are drugs that block immune checkpoints. These checkpoints are a normal part of the immune system and keep immune responses from being too strong. By blocking them, these drugs allow immune cells to respond more strongly to cancer.

T-cell transfer therapy, which is a treatment that boosts the natural ability of your T cells to fight cancer. In this treatment, immune cells are taken from your tumor. Those that are most active against your cancer are selected or changed in the lab to better attack your cancer cells, grown in large batches, and put back into your body through a needle in a vein.  T-cell transfer therapy may also be called adoptive cell therapy, adoptive immunotherapy, or immune cell therapy.

Monoclonal antibodies, which are immune system proteins created in the lab that are designed to bind to specific targets on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system. Such monoclonal antibodies are a type of immunotherapy.  Monoclonal antibodies may also be called therapeutic antibodies.

Treatment vaccines, which work against cancer by boosting your immune system’s response to cancer cells. Treatment vaccines are different from the ones that help prevent disease.

 Immune system modulators, which enhance the body’s immune response against cancer. Some of these agents affect specific parts of the immune system, whereas others affect the immune system in a more general way.

Which cancers are treated with immunotherapy?

Immunotherapy drugs have been approved to treat many types of cancer. However, immunotherapy is not yet as widely used as surgerychemotherapy, or radiation therapy.

What are the side effects of immunotherapy?

Immunotherapy can cause side effects, many of which happen when the immune system that has been revved-up to act against the cancer also acts against healthy cells and tissues in your body.

How is immunotherapy given?

Different forms of immunotherapy may be given in different ways. These include:

Intravenous (IV)
The immunotherapy goes directly into a vein.

Oral
The immunotherapy comes in pills or capsules that you swallow.

Topical
The immunotherapy comes in a cream that you rub onto your skin. This type of immunotherapy can be used for very early skin cancer.

Intravesical
The immunotherapy goes directly into the bladder.

Where do you go for immunotherapy?

You may receive immunotherapy in a doctor’s office, clinic, or outpatient unit in a hospital. Outpatient means you do not spend the night in the hospital.

How often do you receive immunotherapy?

How often and how long you receive immunotherapy depends on:

Your type of cancer and how advanced it is

The type of immunotherapy you get

How your body reacts to treatment

You may have treatment every day, week, or month. Some types of immunotherapy given in cycles. A cycle is a period of treatment followed by a period of rest. The rest period gives your body a chance to recover, respond to the immunotherapy, and build new healthy cells.

How can you tell if immunotherapy is working?

You will see your doctor often. He or she will give you physical exams and ask you how you feel. You will have medical tests, such as blood tests and different types of scans. These tests will measure the size of your tumor and look for changes in your blood work.

What is the current research in immunotherapy?

Researchers are focusing on several major areas to improve immunotherapy, including:

Finding solutions for resistance.
Researchers are testing combinations of immune checkpoint inhibitors and other types of immunotherapy, targeted therapy, and radiation therapy to overcome resistance to immunotherapy.

Finding ways to predict responses to immunotherapy.
Only a small portion of people who receive immunotherapy will respond to the treatment. Finding ways to predict which people will respond to treatment is a major area of research. 

Learning more about how cancer cells evade or suppress immune responses against them.
A better understanding of how cancer cells get around the immune system could lead to the development of new drugs that block those processes.

How to reduce the side effects of treatment with immunotherapy.

How do you find clinical trials that are testing immunotherapy?

To find clinical research studies that involve immunotherapy visit Find NCI-Supported Clinical Trials or call the Cancer Information Service, NCI’s contact center, at 1-800-4-CANCER (1-800-422-6237).

NCI’s list of cancer clinical trials includes all NCI-supported clinical trials that are taking place across the United States and Canada, including the NIH Clinical Center in Bethesda, MD. 

Targeted Therapy to Treat Cancer

What is targeted therapy?

Targeted therapy is the foundation of precision medicine. It is a type of cancer treatment that targets proteins that control how cancer cells grow, divide, and spread. As researchers learn more about the DNA changes and proteins that drive cancer, they are better able to design promising treatments that target these proteins.

What are the types of targeted therapy?

Most targeted therapies are either small-molecule drugs or monoclonal antibodies.

Small-molecule drugs are small enough to enter cells easily, so they are used for targets that are inside cells.

Monoclonal antibodies, also known as therapeutic antibodies, are proteins produced in the lab. These proteins are designed to attach to specific targets found on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system. Other monoclonal antibodies directly stop cancer cells from growing or cause them to self-destruct. Still others carry toxins to cancer cells.

How Monoclonal Antibodies Treat Cancer

Who is treated with targeted therapy?

For some types of cancer, most patients with that cancer will have a target for a certain drug, so they can be treated with that drug. But, most of the time, your tumor will need to be tested to see if it contains targets for which we have drugs.

To have your tumor tested for targets, you may need to have a biopsy. A biopsy is a procedure in which your doctor removes a piece of the tumor for testing. There are some risks to having a biopsy. These risks vary depending on the size of the tumor and where it is located. Your doctor will explain the risks of having a biopsy for your type of tumor.

How does targeted therapy work against cancer?

Most types of targeted therapy help treat cancer by interfering with specific proteins that help tumors grow and spread throughout the body. They treat cancer in many ways. They can:

Help the immune system destroy cancer cells. One reason that cancer cells thrive is because they can hide from your immune system. Certain targeted therapies can mark cancer cells so it is easier for the immune system to find and destroy them. Other targeted therapies help boost your immune system to work better against cancer.

Stop cancer cells from growing. Healthy cells in your body usually divide to make new cells only when they receive strong signals to do so. These signals bind to proteins on the cell surface, telling the cells to divide. This process helps new cells form only as your body needs them. But, some cancer cells have changes in the proteins on their surface that tell them to divide whether or not signals are present. Some targeted therapies interfere with these proteins, preventing them from telling the cells to divide. This process helps slow cancer’s uncontrolled growth.

Stop signals that help form blood vessels. Tumors need to form new blood vessels to grow beyond a certain size. In a process called angiogenesis, these new blood vessels form in response to signals from the tumor. Some targeted therapies called angiogenesis inhibitors are designed to interfere with these signals to prevent a blood supply from forming. Without a blood supply, tumors stay small. Or, if a tumor already has a blood supply, these treatments can cause blood vessels to die, which causes the tumor to shrink.

Deliver cell-killing substances to cancer cells. Some monoclonal antibodies are combined with toxinschemotherapy drugs, and radiation. Once these monoclonal antibodies attach to targets on the surface of cancer cells, the cells take up the cell-killing substances, causing them to die. Cells that don’t have the target will not be harmed.

Cause cancer cell death. Healthy cells die in an orderly manner when they become damaged or are no longer needed. But, cancer cells have ways of avoiding this dying process. Some targeted therapies can cause cancer cells to go through this process of cell death.

Starve cancer of the hormones it needs to grow. Some breast and prostate cancers require certain hormones to grow. Hormone therapies are a type of targeted therapy that can work in two ways. Some hormone therapies prevent your body from making specific hormones. Others prevent the hormones from acting on your cells, including cancer cells.

Are there drawbacks to targeted therapy?

Targeted therapy does have some drawbacks. These include:

Cancer cells can become resistant to targeted therapy. For this reason, they may work best when used with other types of targeted therapy or with other cancer treatments, such as chemotherapy and radiation.

Drugs for some targets are hard to develop. Reasons include the target’s structure, the target’s function in the cell, or both.

What are the side effects of targeted therapy?

Targeted therapy can cause side effects. The side effects you may have depend on the type of targeted therapy you receive and how your body reacts to the therapy.

The most common side effects of targeted therapy include diarrhea and liver problems. Other side effects might include problems with blood clotting and wound healing, high blood pressure, fatigue, mouth sores, nail changes, the loss of hair color, and skin problems. Skin problems might include rash or dry skin. Very rarely, a hole might form through the wall of the esophagus, stomach, small intestine, large bowel, rectum, or gallbladder.

There are medicines for many of these side effects. These medicines may prevent the side effects from happening or treat them once they occur.

Most side effects of targeted therapy go away after treatment ends.

What are other risks of targeted therapy?

Since your tumor may be tested to find targets for treatment, there may be risks to the privacy of your personal information. The privacy of all information found from these tests is protected by law. But, there is a slight risk that genetic or other information from your health records may be obtained by people outside of the medical team.

 

How is targeted therapy given?

Small-molecule drugs are pills or capsules that you can swallow.

Monoclonal antibodies are usually given through a needle in a blood vein.

Where do I go for targeted therapy?

Where you go for treatment depends on which drugs you are getting and how they are given. You may take targeted therapy at home. Or, you may receive targeted therapy in a doctor’s office, clinic, or outpatient unit in a hospital. Outpatient means you do not spend the night in the hospital.

How often will I receive targeted therapy?

How often and how long you receive targeted therapy depends on:

Your type of cancer and how advanced it is

The type of targeted therapy

How your body reacts to treatment

You may have treatment every day, every week, or every month. Some targeted therapies are given in cycles. A cycle is a period of treatment followed by a period of rest. The rest period gives your body a chance to recover and build new healthy cells.

How will targeted therapy affect me?

Targeted therapy affects people in different ways. How you feel depends on how healthy you are before treatment, your type of cancer, how advanced it is, the kind of targeted therapy you are getting, and the dose. Doctors and nurses cannot know for certain how you will feel during treatment.

How will I know whether targeted therapy is working?

While you are receiving targeted therapy, you will see your doctor often. He or she will give you physical exams and ask you how you feel. You will have medical tests, such as blood tests, x-rays, and different types of scans. These regular visits and tests will help the doctor know whether the treatment is working.

 

Hormone Therapy to Treat Cancer

How Hormone Therapy Works against Cancer

Hormone therapy is used to:

Treat cancer. Hormone therapy can lessen the chance that cancer will return or stop or slow its growth.

Ease cancer symptoms. Hormone therapy may be used to reduce or prevent symptoms in men with prostate cancer who are not able to have surgery or radiation therapy.

Types of Hormone Therapy

Hormone therapy falls into two broad groups, those that block the body’s ability to produce hormones and those that interfere with how hormones behave in the body.

 

Who Receives Hormone Therapy

Hormone therapy is used to treat prostate and breast cancers that use hormones to grow. Hormone therapy is most often used along with other cancer treatments. The types of treatment that you need depend on the type of cancer, if it has spread and how far, if it uses hormones to grow, and if you have other health problems.

How Hormone Therapy Is Used with Other Cancer Treatments

When used with other treatments, hormone therapy can:

Make a tumor smaller before surgery or radiation therapy. This is called neo-adjuvant therapy.

Lower the risk that cancer will come back after the main treatment. This is called adjuvant therapy.

Destroy cancer cells that have returned or spread to other parts of your body.

Hormone Therapy Can Cause Side Effects

Because hormone therapy blocks your body’s ability to produce hormones or interferes with how hormones behave, it can cause unwanted side effects. The side effects you have will depend on the type of hormone therapy you receive and how your body responds to it. People respond differently to the same treatment, so not everyone gets the same side effects. Some side effects also differ if you are a man or a woman.

Some common side effects for men who receive hormone therapy for prostate cancer include:

Some common side effects for women who receive hormone therapy for breast cancer include:

  • Hot flashes
  • Vaginal dryness
  • Changes in your periods if you have not yet reached menopause
  • Loss of interest in sex
  • Nausea
  • Mood changes
  • Fatigue

How Hormone Therapy Is Given

Hormone therapy may be given in many ways. Some common ways include:

Oral. Hormone therapy comes in pills that you swallow.

Injection. The hormone therapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly.

Surgery. You may have surgery to remove organs that produce hormones. In women, the ovaries are removed. In men, the testicles are removed.

Where You Receive Hormone Therapy

Where you receive treatment depends on which hormone therapy you are getting and how it is given. You may take hormone therapy at home. Or, you may receive hormone therapy in a doctor’s office, clinic, or hospital.

How Hormone Therapy May Affect You

Hormone therapy affects people in different ways. How you feel depends on the type of cancer you have, how advanced it is, the type of hormone therapy you are getting, and the dose. Your doctors and nurses cannot know for certain how you will feel during hormone therapy.

How to Tell If Hormone Therapy Is Working

If you are taking hormone therapy for prostate cancer, you will have regular PSA tests. If hormone therapy is working, your PSA levels will stay the same or may even go down. But, if your PSA levels go up, this may be a sign that the treatment is no longer working. If this happens, your doctor will discuss treatment options with you.

If you are taking hormone therapy for breast cancer, you will have regular checkups. Checkups usually include an exam of the neck, underarm, chest, and breast areas. You will have regular mammograms, though you probably won’t need a mammogram of a reconstructed breast. Your doctor may also order other imaging procedures or lab tests.

 

Special Diet Needs

Hormone therapy for prostate cancer may cause weight gain. Talk with your doctor, nurse, or dietitian if weight gain becomes a problem for you.

Working during Hormone Therapy

Hormone therapy should not interfere with your ability to work.

 

Stem Cell Transplants in Cancer Treatment

Stem cell transplants are procedures that restore blood-forming stem cells in people who have had theirs destroyed by the very high doses of chemotherapy or radiation therapy that are used to treat certain cancers.

Blood-forming stem cells are important because they grow into different types of blood cells. The main types of blood cells are:

White blood cells, which are part of your immune system and help your body fight infection

Red blood cells, which carry oxygen throughout your body

Platelets, which help the blood clot

You need all three types of blood cells to be healthy.

 

Types of Stem Cell Transplants

In a stem cell transplant, you receive healthy blood-forming stem cells through a needle in your vein. Once they enter your bloodstream, the stem cells travel to the bone marrow, where they take the place of the cells that were destroyed by treatment. The blood-forming stem cells that are used in transplants can come from the bone marrow, bloodstream, or umbilical cord. Transplants can be:

Autologous, which means the stem cells come from you, the patient

Allogeneic, which means the stem cells come from someone else. The donor may be a blood relative but can also be someone who is not related.

Syngeneic, which means the stem cells come from your identical twin, if you have one

To reduce possible side effects and improve the chances that an allogeneic transplant will work, the donor’s blood-forming stem cells must match yours in certain ways.

 

How Stem Cell Transplants Work against Cancer

Stem cell transplants do not usually work against cancer directly. Instead, they help you recover your ability to produce stem cells after treatment with very high doses of radiation therapy, chemotherapy, or both.

However, in multiple myeloma and some types of leukemia, the stem cell transplant may work against cancer directly. This happens because of an effect called graft-versus-tumor that can occur after allogeneic transplants. Graft-versus-tumor occurs when white blood cells from your donor (the graft) attack any cancer cells that remain in your body (the tumor) after high-dose treatments. This effect improves the success of the treatments.

Who Receives Stem Cell Transplants

Stem cell transplants are most often used to help people with leukemia and lymphoma. They may also be used for neuroblastoma and multiple myeloma.

Stem cell transplants for other types of cancer are being studied in clinical trials, which are research studies involving people.

 

Stem Cell Transplants Can Cause Side Effects

The high doses of cancer treatment that you have before a stem cell transplant can cause problems such as bleeding and an increased risk of infection. Talk with your doctor or nurse about other side effects that you might have and how serious they might be.

If you have an allogeneic transplant, you might develop a serious problem called graft-versus-host disease. Graft-versus-host disease can occur when white blood cells from your donor (the graft) recognize cells in your body (the host) as foreign and attack them. This problem can cause damage to your skin, liver, intestines, and many other organs. It can occur a few weeks after the transplant or much later. Graft-versus-host disease can be treated with steroids or other drugs that suppress your immune system.

The closer your donor’s blood-forming stem cells match yours, the less likely you are to have graft-versus-host disease. Your doctor may also try to prevent it by giving you drugs to suppress your immune system.

How Much Stem Cell Transplants Cost

Stem cells transplants are complicated procedures that are very expensive. Most insurance plans cover some of the costs of transplants for certain types of cancer. Talk with your health plan about which services it will pay for. Talking with the business office where you go for treatment may help you understand all the costs involved.

To learn about groups that may be able to provide financial help, go to the National Cancer Institute database and search “financial assistance.” Or call toll-free 1-800-4-CANCER (1-800-422-6237) for information about groups that may be able to help.

Where You Go for a Stem Cell Transplant

When you need an allogeneic stem cell transplant, you will need to go to a hospital that has a specialized transplant center. The National Marrow Donor Program® maintains a list of transplant centers in the United States that can help you find a transplant center.

Unless you live near a transplant center, you may need to travel from home for your treatment. You might need to stay in the hospital during your transplant, you may be able to have it as an outpatient, or you may need to be in the hospital only part of the time. When you are not in the hospital, you will need to stay in a hotel or apartment nearby. Many transplant centers can assist with finding nearby housing.

How Long It Takes to Have a Stem Cell Transplant

A stem cell transplant can take a few months to complete. The process begins with treatment of high doses of chemotherapy, radiation therapy, or a combination of the two. This treatment goes on for a week or two. Once you have finished, you will have a few days to rest.

Next, you will receive the blood-forming stem cells. The stem cells will be given to you through an IV catheter. This process is like receiving a blood transfusion. It takes 1 to 5 hours to receive all the stem cells.

After receiving the stem cells, you begin the recovery phase. During this time, you wait for the blood cells you received to start making new blood cells.

Even after your blood counts return to normal, it takes much longer for your immune system to fully recover—several months for autologous transplants and 1 to 2 years for allogeneic or syngeneic transplants.

How Stem Cell Transplants May Affect You

Stem cell transplants affect people in different ways. How you feel depends on:

  • The type of transplant that you have
  • The doses of treatment you had before the transplant
  • How you respond to the high-dose treatments
  • Your type of cancer
  • How advanced your cancer is
  • How healthy you were before the transplant
  • Since people respond to stem cell transplants in different ways, your doctor or nurses cannot know for sure how the procedure will make you feel.

How to Tell If Your Stem Cell Transplant Worked

Doctors will follow the progress of the new blood cells by checking your blood counts often. As the newly transplanted stem cells produce blood cells, your blood counts will go up.

Special Diet Needs

The high-dose treatments that you have before a stem cell transplant can cause side effects that make it hard to eat, such as mouth sores and nausea. Tell your doctor or nurse if you have trouble eating while you are receiving treatment. You might also find it helpful to speak with a dietitian.

 

Working during Your Stem Cell Transplant

Whether or not you can work during a stem cell transplant may depend on the type of job you have. The process of a stem cell transplant, with the high-dose treatments, the transplant, and recovery, can take weeks or months. You will be in and out of the hospital during this time. Even when you are not in the hospital, sometimes you will need to stay near it, rather than staying in your own home. So, if your job allows, you may want to arrange to work remotely part-time.

Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during treatment. You can learn more about these laws by talking with a social worker.

 

Precision Medicine in Cancer Treatment

Precision medicine is an approach to patient care that allows doctors to select treatments that are most likely to help patients based on a genetic understanding of their disease. This may also be called personalized medicine. The idea of precision medicine is not new, but recent advances in science and technology have helped speed up the pace of this area of research.

Today, when you are diagnosed with cancer, you usually receive the same treatment as others who have same type and stage of cancer. Even so, different people may respond differently, and, until recently, doctors didn’t know why. After decades of research, scientists now understand that patients’ tumors have genetic changes that cause cancer to grow and spread. They have also learned that the changes that occur in one person’s cancer may not occur in others who have the same type of cancer. And, the same cancer-causing changes may be found in different types of cancer.

 

The Promise of Precision Medicine

The hope of precision medicine is that treatments will one day be tailored to the genetic changes in each person’s cancer. Scientists see a future when genetic tests will help decide which treatments a patient’s tumor is most likely to respond to, sparing the patient from receiving treatments that are not likely to help. Research studies are going on now to test whether treating patients with treatments that target the cancer-causing genetic changes in their tumors, no matter where the cancer develops in the body, will help them. Many of these treatments are drugs known as targeted therapies.

Currently, if you need treatment for cancer, you may receive a combination of treatments, including surgerychemotherapyradiation therapy, and immunotherapy. Which treatments you receive usually will depend on the type of cancer, its size, and whether it has spread. With precision medicine, information about genetic changes in your tumor can help decide which treatment will work best for you.

There are drugs that have been proven effective against cancers with specific genetic changes and are approved by the FDA. Approved treatments should be available wherever you have cancer treatment.

Precision Medicine as a Treatment Approach

Even though researchers are making progress every day, the precision medicine approach to cancer treatment is not yet part of routine care for most patients. Many new treatments designed to target a specific change are being tested right now in precision medicine clinical trials. Some clinical trials are accepting patients with specific types and stages of cancer. Others accept patients with a variety of cancer types and stages. To be eligible for precision medicine trials, your tumor must have a genetic change that can be targeted by a treatment being tested.

Precision Medicine Does Not Yet Apply to Everyone

If there is a targeted drug or other treatment approved for your type of cancer, you will likely be tested to see if the genetic change targeted by the treatment is present in your cancer. For instance, people with melanoma, some leukemias, and breast, lung, colon, and rectal cancers usually have their cancers tested for certain genetic changes when they are diagnosed. Since additional genetic changes that can drive cancer may occur over time, you might also have your cancer tested if it comes back or gets worse.

If there is not an approved targeted treatment for your type of cancer, you still may be tested for genetic changes. For instance, your cancer may be tested to see if you can join a precision medicine clinical trial.

How Genetic Changes in Your Cancer Are Identified

To figure out which genetic changes are in your cancer, you may need to have a biopsy. A biopsy is a procedure in which your doctor removes a sample of the cancer. This sample will be sent to a special lab, where a machine called a DNA sequencer looks for genetic changes that may be causing the cancer to grow. The process of looking for genetic changes in cancer may be called DNA sequencing, genomic testing, molecular profiling, or tumor profiling.

 

Paying for Precision Medicine

Testing for genetic changes in your cancer may or may not be covered by your insurance.

If you join a precision medicine clinical trial, the cost of testing for genetic changes may be covered by the organization sponsoring the trial. To be sure, check with the trial staff and make sure that you understand your consent form.

Treatment using precision medicine can be expensive. It takes many years, sometimes decades, of research to develop treatments that target the changes that cause cancer to develop, grow, and spread. So, by the time these treatments are available on the market, they are often very expensive.

 

Precision Medicine Research Moving Forward

Researchers have not yet discovered all the genetic changes that can cause cancer to develop, grow, and spread. But, they are making progress and discover new changes every day. Information from this research is being collected in databases where researchers from across the country can access the data and use them in their own studies. This sharing of data helps move the field of precision medicine forward.

Once genetic changes are discovered, another active area of research involves looking for drugs that can target these changes, then testing these drugs with people in clinical trials. Clinical trials are going on across the United States.  Researchers are also working to understand and solve the problem of drug resistance that can limit how well targeted therapies work. Many researchers believe that precision medicine is the key to unlocking these secrets.

Side Effects of Cancer Treatment

Cancer treatments and cancer can cause side effects. Side effects are problems that occur when treatment affects healthy tissues or organs. Speak up about any problems you have. Your health care team can treat and/or talk with you about ways to reduce these side effects, so you feel better.

Anemia and Cancer Treatment

Anemia is a condition that can make you feel very tired, short of breath, and lightheaded. Other signs of anemia may include feeling dizzy or faint, headaches, a fast heartbeat, and/or pale skin.

Cancer treatments, such as chemotherapy and radiation therapy, as well as cancers that affect the bone marrow, can cause anemia. When you are anemic, your body does not have enough red blood cells. Red blood cells are the cells that that carry oxygen from the lungs throughout your body to help it work properly. You will have blood tests to check for anemia. Treatment for anemia is also based on your symptoms and on what is causing the anemia.

Ways to Manage Anemia

Here are some steps you can take if you have fatigue caused by anemia:

  • Save your energy and ask for help. Choose the most important things to do each day. When people offer to help, let them do so. They can take you to the doctor, make meals, or do other things you are too tired to do.
  • Balance rest with activity. Take short naps during the day, but keep in mind that too much bed rest can make you feel weak. You may feel better if you take short walks or exercise a little every day.
  • Eat and drink well. Talk with your doctor, nurse, or a registered dietitian to learn what foods and drinks are best for you. You may need to eat foods that are high in protein or iron.

Talking With Your Health Care Team about Anemia

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

  • What is causing the anemia?
  • What problems should I call you about?
  • What steps can I take to feel better?
  • Would medicine, iron pills, a blood transfusion, or other treatments help me?
  • Would you give me the name of a registered dietitian who could also give me advice?

 

Appetite Loss and Cancer Treatment

Cancer treatments may lower your appetite or change the way food tastes or smells. Side effects such as mouth and throat problems, or nausea and vomiting often make eating difficult.  Cancer-related fatigue can also lower appetite.

Talk with your health care team if you are not hungry or if you find it difficult to eat. Don’t wait until you feel weak, have lost too much weight, or are dehydrated, to talk with your doctor or nurse. It’s important to eat well, especially during treatment for cancer.

Ways to Manage Appetite Loss

Take these steps to get the nutrition you need to stay strong during treatment:

Drink plenty of liquids. Drinking plenty of liquids is important, especially if you have less of an appetite. Losing fluid can lead to dehydration, a dangerous condition. You may become weak or dizzy and have dark yellow urine if you are not drinking enough liquids.

Choose healthy and high-nutrient foods. Eat a little, even if you are not hungry. It may help to have five or six small meals throughout the day instead of three large meals. Most people need to eat a variety of nutrient-dense foods that are high in protein and calories. Learn ways to add calories and protein to your diet in our Eating Hints booklet.

Be active. Being active can actually increase your appetite. Your appetite may increase when you take a short walk each day.

 

Talking With Your Health Care Team about Appetite Loss

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

  • What symptoms or problems should I call you about?
  • What steps can I take to feel better?
  • What food and drink choices are best for me?
  • Do you recommend supplemental nutrition drinks for me?
  • Are there vitamins and supplements that I should avoid? Are there any I should take?
  • Would you recommend a registered dietitian who could also help me?

Bleeding and Bruising (Thrombocytopenia) and Cancer Treatment

You may bruise or bleed a lot or very easily and have tiny purple or red spots on your skin. This condition is called thrombocytopenia. It is important to tell your doctor or nurse if you notice any of these changes.

Call your doctor or nurse if you have more serious problems, such as:

Bleeding that doesn’t stop after a few minutes; bleeding from your mouth, nose, or when you vomit; bleeding from your vagina when you are not having your period (menstruation); urine that is red or pink; stools that are black or bloody; or bleeding during your period that is heavier or lasts longer than normal.

Head or vision changes such as bad headaches or changes in how well you see, or if you feel confused or very sleepy.

 

Ways to Manage Bleeding and Bruising

Steps to take if you are at increased risk of bleeding and bruising:

Avoid certain medicines. Many over-the-counter medicines contain aspirin or ibuprofen, which can increase your risk of bleeding. When in doubt, be sure to check the label. Get a list of medicines and products from your health care team that you should avoid taking. You may also be advised to limit or avoid alcohol if your platelet count is low.

Take extra care to prevent bleeding. Brush your teeth gently, with a very soft toothbrush. Wear shoes, even when you are inside. Be extra careful when using sharp objects. Use an electric shaver, not a razor. Use lotion and a lip balm to prevent dry, chapped skin and lips. Tell your doctor or nurse if you are constipated or notice bleeding from your rectum.

Care for bleeding or bruising. If you start to bleed, press down firmly on the area with a clean cloth. Keep pressing until the bleeding stops. If you bruise, put ice on the area.

Talking With Your Health Care Team about Bleeding and Bruising

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

  • What steps can I take to prevent bleeding or bruising?
  • How long should I wait for the bleeding to stop before I call you or go the emergency room?
  • Do I need to limit or avoid things that could increase my risk of bleeding, such as alcohol or sexual activity?
  • What medicines, vitamins, or herbs should I avoid? Could I get a list from you of medicines to avoid?

 

Constipation and Cancer Treatment

Constipation is when you have infrequent bowel movements and stool that may be hard, dry, and difficult to pass. You may also have stomach cramps, bloating, and nausea when you are constipated.

Cancer treatments such as chemotherapy can cause constipation. Certain medicines (such as pain medicines), changes in diet, not drinking enough fluids, and being less active may also cause constipation.

There are steps you can take to prevent constipation. It is easier to prevent constipation than to treat its complications which may include fecal impaction or bowel obstruction.

Ways to Prevent or Treat Constipation

Take these steps to prevent or treat constipation:

Eat high-fiber foods. Adding bran to foods such as cereals or smoothies is an easy way to get more fiber in your diet. Ask your health care team how many grams of fiber you should have each day. If you have had an intestinal obstruction or intestinal surgery, you should not eat a high-fiber diet.

Drink plenty of liquids. Most people need to drink at least 8 cups of liquid each day. You may need more based on your treatment, medications you are taking, or other health factors. Drinking warm or hot liquids may also help.

Try to be active every day. Ask your health care team about exercises that you can do. Most people can do light exercise, even in a bed or chair. Other people choose to walk or ride an exercise bike for 15 to 30 minutes each day.

Learn about medicine. Use only medicines and treatments for constipation that are prescribed by your doctor, since some may lead to bleeding, infection, or other harmful side effects in people being treated for cancer. Keep a record of your bowel movements to share with your doctor or nurse.

Talking With Your Health Care Team about Constipation

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

  • What problems should I call you about?
  • What information should I keep track of and share with you? (For example, you may be asked to keep track of your bowel movements, meals that you have, and exercise that you do each day.)
  • How much liquid should I drink each day?
  • What steps can I take to feel better?
  • Would you give me the name of a registered dietitian who can tell me about foods that might help?
  • Should I take medicine for constipation? If so, what medicine should I take? What medicine should I avoid?

 

Delirium and Cancer Treatment

Delirium is a confused mental state that includes changes in awareness, thinking, judgment, sleeping patterns, as well as behavior. Although delirium can happen at the end of life, many episodes of delirium are caused by medicine or dehydration and are reversible.

The symptoms of delirium usually occur suddenly (within hours or days) over a short period of time and may come and go. Although delirium may be mistaken for depression or dementia, these conditions are different and have different treatments.

Types of Delirium

The three main types of delirium include:

  • Hypoactive delirium: The patient seems sleepy, tired, or depressed
  • Hyperactive delirium: The patient is restless, anxious, or suddenly agitated and uncooperative
  • Mixed delirium: The patient changes back and forth between hypoactive delirium and hyperactive delirium

Causes of Delirium

Your health care team will work to find out what is causing delirium, so that it can be treated. Causes of delirium may include:

  • advanced cancer
  • older age
  • brain tumors
  • dehydration
  • infection
  • taking certain medicines, such as high doses of opioids
  • withdrawal from or stopping certain medicines
  • Early monitoring of someone with these risk factors for delirium may prevent it or allow it to be treated more quickly.

Changes caused by delirium can be upsetting for family members and dangerous to the person with cancer, especially if judgment is affected. People with delirium may be more likely to fall, unable to control their bladder and/or bowels, and more likely to become dehydrated. Their confused state may make it difficult to talk with others about their needs and make decisions about care. Family members may need to be more involved in decision-making.

Ways to Treat Delirium in People with Cancer

Steps that can be taken to treat symptoms related to delirium include:

Treat the causes of delirium: If medicines are causing delirium, then reducing the dose or stopping them may treat delirium. If conditions such as dehydration, poor nutrition, and infections are causing the delirium, then treating these may help.

Control surroundings: If the symptoms of delirium are mild, it may help to keep the room quiet and well lit, with a clock or calendar and familiar possessions. Having family members around and keeping the same caregivers, as much as possible, may also help.

Consider medicines: Medicines are sometimes given to treat the symptoms of delirium. However, these medicines have serious side effects and patients receiving them require careful observation by a doctor.

Sometimes sedation may help: After discussion with family members, sedation is sometimes used for delirium at the end of life, if it does not get better with other treatments. The doctor will discuss the decisions involved in using sedation to treat delirium with the family.

Talking with Your Family Member’s Health Care Team

Prepare for the visit by making a list of questions to ask. Consider adding these questions to your list:

  • Is my family member at risk for delirium?
  • What is causing the delirium?
  • What problems should we call you about?
  • What treatments are advised for my family member?

 

Diarrhea and Cancer Treatment

Diarrhea means having bowel movements that are soft, loose, or watery more often than normal. If diarrhea is severe or lasts a long time, the body does not absorb enough water and nutrients. This can cause you to become dehydrated or malnourished. Cancer treatments, or the cancer itself, may cause diarrhea or make it worse. Some medicines, infections, and stress can also cause diarrhea. Tell your health care team if you have diarrhea.

Diarrhea that leads to dehydration (the loss of too much fluid from the body) and low levels of salt and potassium (important minerals needed by the body) can be life threatening. Call your health care team if you feel dizzy or light headed, have dark yellow urine or are not urinating, or have a fever of 100.5 °F (38 °C) or higher.

 

Ways to Manage Diarrhea

You may be advised to take steps to prevent complications from diarrhea:

Drink plenty of fluid each day. Most people need to drink 8 to 12 cups of fluid each day. Ask your doctor or nurse how much fluid you should drink each day. For severe diarrhea, only clear liquids or IV (intravenous) fluids may be advised for a short period.

Eat small meals that are easy on your stomach. Eat six to eight small meals throughout the day, instead of three large meals. Foods high in potassium and sodium (minerals you lose when you have diarrhea) are good food choices, for most people. Limit or avoid foods and drinks that can make your diarrhea worse.

Check before taking medicine. Check with your doctor or nurse before taking medicine for diarrhea. Your doctor will prescribe the correct medicine for you.

Keep your anal area clean and dry. Try using warm water and wipes to stay clean. It may help to take warm, shallow baths. These are called sitz baths.

Talking With Your Health Care Team about Diarrhea

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

  • What is causing the diarrhea?
  • What symptoms should I call you about?
  • How much liquid should I drink each day?
  • Can I speak to a registered dietitian to learn more about foods and drinks that are best for me?
  • What medicine or other steps can I take to prevent diarrhea and to decrease rectal pain?

 

Edema (Swelling) and Cancer Treatment

Edema, a condition in which fluid builds up in your body’s tissues, may be caused by some types of chemotherapy, certain cancers, and conditions not related to cancer.

Signs of edema may include:

  • swelling in your feet, ankles, and legs
  • swelling in your hands and arms
  • swelling in your face or abdomen
  • skin that is puffy, shiny, or looks slightly dented after being pressed
  • shortness of breath, a cough, or irregular heartbeat

Tell your health care team if you notice swelling. Your doctor or nurse will determine what is causing your symptoms, advise you on steps to take, and may prescribe medicine.

Some problems related to edema are serious. Call your doctor or nurse if you feel short of breath, have a heartbeat that seems different or is not regular, have sudden swelling or swelling that is getting worse or is moving up your arms or legs, you gain weight quickly, or you don’t urinate at all or urinate only a little.

 

Ways to Prevent or Lessen Edema

Steps you can take to prevent or lessen edema-related swelling include:

Get comfortable. Wear loose clothing and shoes that are not too tight. When you sit or lie down, raise your feet with a stool or pillows. Avoid crossing your legs when you sit. Talk with your health care team about wearing special stockings, sleeves, or gloves that help with circulation if your swelling is severe.

Exercise. Moving the part of your body with edema can help. Your doctor may give you specific exercises, including walking, to improve circulation. However, you may be advised not to stand or walk too much at one time.

Limit salt (sodium) in your diet. Avoid foods such as chips, bacon, ham, and canned soup. Check food labels for the sodium content. Don’t add salt or soy sauce to your food.

Take your medicine. If your doctor prescribes a medicine called a diuretic, take it exactly as instructed. The medicine will help move the extra fluid and salt out of your body.

Talking With Your Health Care Team about Edema

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

  • Are my medications or treatment likely to increase my risk of developing edema?
  • Are there steps I can take to prevent edema?
  • What symptoms or problems should I call you about?
  • What steps can I take to feel better if I notice swelling?
  • Are there foods, drinks, or activities I should avoid?

 

Fatigue and Cancer Treatment

Fatigue is a common side effect of many cancer treatments, including chemotherapyimmunotherapyradiation therapybone marrow transplant, and surgery. Conditions such as anemia, as well as pain, medications, and emotions, can also cause or worsen fatigue.

People often describe cancer-related fatigue as feeling extremely tired, weak, heavy, run down, and having no energy. Resting does not always help with cancer-related fatigue. Cancer-related fatigue is one of the most difficult side effects for many people to cope with.

Tell your health care team if you feel extremely tired and are not able to do your normal activities or are very tired even after resting or sleeping. There are many causes of fatigue. Keeping track of your levels of energy throughout the day will help your doctor to assess your fatigue. Write down how fatigue affects your daily activities and what makes the fatigue better or worse.

Ways to Manage Fatigue

You may be advised to take these and other steps to feel better:

Form a plan that balances rest and activity. Choose activities that are relaxing for you. Many people choose to listen to music, read, meditate, practice guided imagery, or spend time with people they enjoy. Relaxing can help you save your energy and lower stress. Light exercise may also be advised by your doctor to give you more energy and help you feel better.

Plan time to rest. If you are tired, take short naps of less than 1 hour during the day. However, too much sleep during the day can make it difficult to sleep at night. Choose the activities that are most important to you and do them when you have the most energy. Ask for help with important tasks such as making meals or driving.

Eat and drink well. Meet with a registered dietitian to learn about foods and drinks that can increase your level of energy. Foods high in protein and calories will help you keep up your strength. Some people find it easier to eat many small meals throughout the day instead of three big meals. Stay well hydrated. Limit your intake of caffeine and alcohol.

Meet with a specialist. It may help to meet with a counselorpsychologist, or psychiatrist. These experts help people to cope with difficult thoughts and feelings. Lowering stress may give you more energy. Since pain that is not controlled can also be major source of fatigue, it may help to meet with a pain or palliative care specialist.

Talking With Your Health Care Team about Fatigue

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

  • What is most likely causing my fatigue?
  • What should I keep track of and share so we can develop a plan to help me feel better?
  • What types of exercise (and how much) do you recommend for me?
  • How much rest should I have during the day? How much sleep should I get at night?
  • What food and drinks are best for me?
  • Are there treatments or medicines that could help me feel better?

 

Fertility issues in Males

Many cancer treatments can affect a boy’s or a man’s fertility. Most likely, your doctor will talk with you about whether or not cancer treatment may lower fertility or cause infertility. However, not all doctors bring up this topic. Sometimes you, a family member, or parents of a child being treated for cancer may need to initiate this conversation.

Whether or not your fertility is affected depends on factors such as:

  • your baseline fertility
  • your age at the time of treatment
  • the type of cancer and treatment(s)
  • the amount (dose) of treatment
  • the length (duration) of treatment
  • the amount of time that has passed since treatment
  • other personal health factors
  • It’s important to learn how the recommended cancer treatment may affect fertility before starting treatment if at all possible. Consider asking questions such as:
  • Could treatment increase the risk of, or cause, infertility?
  • Are there other recommended cancer treatments that might not cause fertility problems?
  • Which fertility preservation options would you advise for me?
  • What fertility preservation options are available at this hospital? At a fertility clinic?
  • Would you recommend a fertility specialist (such as a reproductive endocrinologist) that I could talk with to learn more?
  • Is condom use advised, based on the treatment I’m receiving?
  • Is birth control also recommended?
  • What are the chances that my fertility will return after treatment?

Cancer Treatments May Affect Your Fertility

Cancer treatments are important for your future health, but they may harm reproductive organs and glands that control fertility. Changes to your fertility may be temporary or permanent. Talk with your healthcare team to learn what to expect based on your treatment(s):

Chemotherapy (especially alkylating drugs) can damage sperm in men and sperm-forming cells (germ cells) in young boys.

Hormone therapy (also called endocrine therapy) can decrease the production of sperm.

Radiation therapy to the reproductive organs as well as radiation near the abdomenpelvis, or spine may lower sperm counts and testosterone levels, causing infertility. Radiation may also destroy sperm cells and the stem cells that make sperm. Radiation therapy to the brain can damage the pituitary gland and decrease the production of testosterone and sperm. For some types of cancers, the testicles can be protected from radiation through a procedure called testicular shielding.

Surgery for cancers of the reproductive organs and for pelvic cancers (such as bladder, colon, prostate, and rectal cancer) can damage these organs and/or nearby nerves or lymph nodes in the pelvis, leading to infertility.

Stem cell transplants such as bone marrow transplants and peripheral blood stem cell transplants, involve receiving high doses of chemotherapy and/or radiation. These treatments can damage sperm and sperm-forming cells.

Other treatments: Talk with your doctor to learn whether or not other types of treatment, such as immunotherapy and targeted cancer therapy, may affect your fertility.

Emotional Considerations and Support for Fertility Issues

For some men, infertility can be one of the most difficult and upsetting long-term effects of cancer treatment. Although it might feel overwhelming to think about your fertility right now, most people benefit from having talked with their doctor (or their child’s doctor, when a child is being treated for cancer) about how treatment may affect their fertility and learning about options to preserve their fertility.

Although most people want to have children at some point in their life, families can come together in many ways. For extra support during this time, reach out to your health care team with questions or concerns, as well as to professionally led support groups.

 

Fertility Preservation Options for Boys and Men

Men and boys with cancer have options to preserve their fertility. These procedures may be available at the hospital where you are receiving cancer treatment or at a fertility preservation clinic.

Talk with your doctor about the best option(s) for you based on your age, the type of cancer you have, and the specific treatment(s) you will be receiving. The success rate, financial cost, and availability of these procedures varies.

Sperm banking (also called semen cryopreservation) is the most common and easy option for young men of reproductive age who would like to have children one day. Samples of semen are collected and checked under a microscope in the laboratory. The sperm are then frozen and stored (banked) for the future. Sperm can be frozen for an indefinite amount of time.

Testicular shielding (also called gonadal shielding) is a procedure in which a protective cover is placed on the outside of the body to shield the testicles from scatter radiation to the pelvis when other parts of the body are being treated with radiation.

Testicular sperm extraction (TESE) is a procedure for males who are not able to produce a semen sample. Sperm is collected through a medical procedure and frozen for future use.

Testicular tissue freezing (also called testicular tissue cryopreservation) is still considered an experimental procedure at most hospitals. For boys who have not gone through puberty and are at high risk of infertility, this procedure may be an option.

If you choose to take steps to preserve your fertility, your doctor and a fertility specialist will work together to develop a treatment plan that includes fertility preservation procedures whenever possible.

 

Fertility Issues in Females with Cancer

Many cancer treatments can affect a girl’s or woman’s fertility. Most likely, your doctor will talk with you about whether or not cancer treatment may increase the risk of, or cause, infertility. However, not all doctors bring up this topic. Sometimes you, a family member, or parents of a child being treated for cancer may need to initiate this conversation.

Whether or not fertility is affected depends on factors such as:

  • your baseline fertility
  • your age at the time of treatment
  • the type of cancer and treatment(s)
  • the amount (dose) of treatment
  • the length (duration) of treatment
  • the amount of time that has passed since cancer treatment
  • other personal health factors
  • It’s important to learn how the recommended cancer treatment may affect fertility before starting treatment, whenever possible. Consider asking questions such as:
  • Could treatment increase the risk of, or cause, infertility? Could treatment make it difficult to become pregnant or carry a pregnancy in the future?
  • Are there other recommended cancer treatments that might not cause fertility problems?
  • Which fertility option(s) would you advise for me?
  • What fertility preservation options are available at this hospital? At a fertility clinic?
  • Would you recommend a fertility specialist (such as a reproductive endocrinologist) who I could talk with to learn more?
  • Is condom use advised, based on the treatment I’m receiving?
  • Is birth control recommended?
  • After treatment, what are the chances that my fertility will return? How long might it take for my fertility to return?

Cancer Treatments May Affect Your Fertility

Cancer treatments are important for your future health, but they may harm reproductive organs and glands that control fertility. Changes to your fertility may be temporary or permanent. Talk with your health care team to learn what to expect, based on your treatment(s):

Chemotherapy (especially alkylating agents) can affect the ovaries, causing them to stop releasing eggs and estrogen. This is called primary ovarian insufficiency (POI). Sometimes POI is temporary and your menstrual periods and fertility return after treatment. Other times, damage to your ovaries is permanent and fertility doesn’t return. You may have hot flashes, night sweats, irritability, vaginal dryness, and irregular or no menstrual periods. Chemotherapy can also lower the number of healthy eggs in the ovaries. Women who are closer to the age of natural menopause may have a greater risk of infertility. The National Institute for Child Health and Human Development (NICHD) has more information about primary ovarian insufficiency.

Radiation therapy to or near the abdomenpelvis, or spine can harm nearby reproductive organs. Some organs, such as the ovaries, can often be protected by ovarian shielding or by oophoropexy—a procedure that surgically moves the ovaries away from the radiation area. Radiation therapy to the brain can also harm the pituitary gland. This gland is important because it sends signals to the ovaries to make hormones such as estrogen that are needed for ovulation. The amount of radiation given and the part of your body being treated both play a role in whether or not fertility is affected.

Surgery for cancers of the reproductive system and for cancers in the pelvis region can harm nearby reproductive tissues and cause scarring, which can affect your fertility. The size and location of the tumor are important factors in whether or not fertility is affected.

Hormone therapy (also called endocrine therapy) used to treat cancer can disrupt the menstrual cycle, which may affect your fertility. Side effects depend on the specific hormones used and may include hot flashes, night sweats, and vaginal dryness.

Bone marrow transplantsperipheral blood stem cell transplants, and other stem cell transplants involve receiving high doses of chemotherapy and/or radiation. These treatments can damage the ovaries and may cause infertility.

Other treatments: Talk with your doctor to learn whether or not other types of treatment such as immunotherapy and targeted cancer therapy may affect your fertility.

Emotional Considerations and Support for Fertility Issues

For some women, infertility can be one of the most difficult and upsetting long-term effects of cancer treatment. While it might feel overwhelming to think about your fertility right now, most people benefit from having talked with their doctor (or their child’s doctor, when a child is being treated for cancer) about how treatment may affect their fertility and about options to preserve fertility.

Although most people want to have children at some point in their life, families can come together in many ways. For extra support during this time, reach out to your health care team with questions or concerns, as well as to professionally led support groups.

Women and girls with cancer have options to preserve their fertility. These procedures may be available at the hospital where you are receiving cancer treatment or at a fertility preservation clinic.

Talk with your doctor about the best option(s) for you based on your age, the type of cancer you have, and the specific treatment(s) you will be receiving. The success rate, financial cost, and availability of these procedures varies.

Egg freezing (also called egg or oocyte cryopreservation) is a procedure in which eggs are removed from the ovary and frozen. Later the eggs can be thawed, fertilized with sperm in the lab to form embryos, and placed in a woman’s uterusEgg freezing is a newer procedure than embryo freezing.

Embryo freezing (also called embryo banking or embryo cryopreservation) is a procedure in which eggs are removed from the ovary. They are then fertilized with sperm in the lab to form embryos and frozen for future use.

Ovarian shielding (also called gonadal shielding) is a procedure in which a protective cover is placed on the outside of the body, over the ovaries and other parts of the reproductive system, to shield them from scatter radiation.

Ovarian tissue freezing (also called ovarian tissue cryopreservation) is still considered an experimental procedure, for young girls who haven’t gone through puberty and don’t have mature eggs. It involves surgically removing part or all of an ovary and then freezing the ovarian tissue, which contains eggs. Later, the tissue is thawed and placed back in a woman. Although pregnancies have occurred as a result of this procedure, it’s only an option for some types of cancer.

Ovarian transposition (also called oophoropexy) is an operation to move the ovaries away from the part of the body receiving radiation. This procedure may be done during surgery to remove the cancer or through laparoscopic surgery.

Radical trachelectomy (also called radical cervicectomy) is surgery used to treat women with early-stage cervical cancer who would like to have children. This operation removes the cervix, nearby lymph nodes, and the upper part of the vagina. The uterus is then attached to the remaining part of the vagina, with a special band that serves as the cervix.

Treatment with gonadotropin-releasing hormone agonist (also called GnRHa), a substance that causes the ovaries to stop making estrogen and progesterone. Research is ongoing to assess the effectiveness of giving GnRHa to protect the ovaries.

If you choose to take steps to preserve your fertility, your doctor and a fertility specialist will work together to develop a treatment plan that includes fertility preservation, whenever possible.

Flu-Like Symptoms Caused by Cancer Treatments

Flu-like symptoms (also called flu-like syndrome) are a group of related side effects that may be caused by cancer treatments, such as chemotherapy and immunotherapy. If flu-like symptoms are severe, you may be advised to seek immediate medical attention. Some people who receive higher doses of treatment, or more than one treatment at a time, may have more severe flu-like symptoms.

 

Talk with your doctor so you know what flu-like symptoms to expect, based on your cancer treatment.

 

Some types of chemotherapy can cause flu-like symptoms within a few hours after treatment. These symptoms generally last for 2 to 3 days.

Some types of immunotherapy increase your body’s natural immune response, which can cause mild to severe flu-like symptoms. These symptoms often peak shortly after treatment and become less severe over time. Immunotherapy treatments such as CAR T-cell therapy and some monoclonal antibodies may cause cytokine release syndrome (CRS), a condition that can lead to severe flu-like symptoms as well as a rash, rapid heartbeat, low blood pressure, and trouble breathing. Doctors may refer to severe cases of CRS as a cytokine storm.

Ask Your Health Care Team about Flu-Like Symptoms

What signs and symptoms might I have, based on the type of cancer treatment I am receiving?

Which flu-like symptoms should I call you about? Which can be managed at home?

Make note of flu-like symptoms you should call your health care team about:

  • Appetite loss
  • Body aches (muscle or joint aches)
  • Chills
  • Diarrhea
  • Fatigue; lack of energy
  • Fever of 100.5°F (38°C) or higher
  • Headache
  • Nausea and/or vomiting

 

Ways to Manage Flu-Like Symptoms during Cancer Treatment

Keep in mind that when these symptoms occur in people receiving immunotherapy they may be diagnosed, managed, and treated differently than when they are caused by other cancer treatments.

When your doctor recommends self-care, here are steps you can take to feel better:

Appetite loss: Drink water and other fluids advised by your health care team to stay hydrated. Drinking fluids is especially important if you are not eating much. It may be easier to eat small meals, and to eat more often. Choose foods that are high in calories and protein to give your body strength. Learn more about how to manage appetite loss.

 Chills: Chills are your body’s way of increasing your temperature. Ask your health care team what steps you should take if you have chills. Your health care team may advise you not to pile on blankets, since this can cause your temperature to rise even higher. When chills are severe, doctors may prescribe medicine.

 Diarrhea: Drink plenty of water to replace fluids you lose when you have diarrhea. Water and other fluids will help prevent dehydration, which may cause you to feel weak, dizzy, and disoriented. Your doctor may prescribe an over-the-counter diarrhea medicine. If you are receiving immunotherapy, diagnostic tests may be advised to rule out gastritis, a more serious medical condition.

 Fatigue: Balance periods of rest with periods of activity. Choose the time of the day when you have the most energy to do an activity or to exercise. Regular exercise can help you to keep up your strength and stamina during treatment.

Fever: Your body loses fluids when you have a fever, so it’s important to drink water to prevent dehydration. You may want to rest and put an ice pack on your forehead. Sometimes taking medicine to lower a fever can mask a more serious problem. For this reason, you may be advised to call your doctor before taking medicine to lower a fever.

Headache and/or body aches: Use ice packs or place a cold washcloth on your forehead to get relief. If advised by your doctor, take over-the-counter pain relievers such as acetaminophenibuprofen, or aspirin.

Nausea and vomiting: Try to take small sips of water, fruit juices, ginger ale, tea, and/or sports drinks, if recommended, throughout the day. Learn more about how to manage nausea and vomiting.

If these symptoms last or become severe, your doctor may advise diagnostic tests to identify what is causing these problems and determine how best to treat them.

Talking with Your Health Care Team about Flu-Like Symptoms

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

  • What flu-like symptoms are common for the type of treatment I’m receiving?
  • What problems should I call you about? Are there any symptoms that need urgent medical care?
  • When might these symptoms start? How long might they last?
  • Should I keep track of any symptoms?
  • How much fluid should I drink every day? What types of fluids are best for me to drink?
  • Are there medicines I should take to feel better? Are there medicines I should avoid or call you before taking?
  • How often should I check my temperature?

 

Hair Loss (Alopecia) and Cancer Treatment

Some types of chemotherapy cause the hair on your head and other parts of your body to fall out. Radiation therapy can also cause hair loss on the part of the body that is being treated. Hair loss is called alopecia. Talk with your health care team to learn if the cancer treatment you will be receiving causes hair loss. Your doctor or nurse will share strategies that have help others, including those listed below.

Ways to Manage Hair Loss

Talk with your health care team about ways to manage before and after hair loss:

Treat your hair gently. You may want to use a hairbrush with soft bristles or a wide-tooth comb. Do not use hair dryers, irons, or products such as gels or clips that may hurt your scalp. Wash your hair with a mild shampoo. Wash it less often and be very gentle. Pat it dry with a soft towel.

You have choices. Some people choose to cut their hair short to make it easier to deal with when it starts to fall out. Others choose to shave their head. If you choose to shave your head, use an electric shaver so you won’t cut yourself. If you plan to buy a wig, get one while you still have hair so you can match it to the color of your hair. If you find wigs to be itchy and hot, try wearing a comfortable scarf or turban.

Protect and care for your scalp. Use sunscreen or wear a hat when you are outside. Choose a comfortable scarf or hat that you enjoy and that keeps your head warm. If your scalp itches or feels tender, using lotions and conditioners can help it feel better.

Talk about your feelings. Many people feel angry, depressed, or embarrassed about hair loss. It can help to share these feelings with someone who understands. Some people find it helpful to talk with other people who have lost their hair during cancer treatment. Talking openly and honestly with your children and close family members can also help you all. Tell them that you expect to lose your hair during treatment.

 

Ways to Care for Your Hair When It Grows Back

Be gentle. When your hair starts to grow back, you will want to be gentle with it. Avoid too much brushing, curling, and blow-drying. You may not want to wash your hair as frequently.

After chemotherapy. Hair often grows back in 2 to 3 months after treatment has ended. Your hair will be very fine when it starts to grow back. Sometimes your new hair can be curlier or straighter—or even a different color. In time, it may go back to how it was before treatment.

After radiation therapy. Hair often grows back in 3 to 6 months after treatment has ended. If you received a very high dose of radiation your hair may grow back thinner or not at all on the part of your body that received radiation.

Talking With Your Health Care Team about Hair Loss

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

  • Is treatment likely to cause my hair to fall out?
  • How should I protect and care for my head? Are there products that you recommend? Ones I should avoid?
  • Where can I get a wig or hairpiece?
  • What support groups could I meet with that might help?
  • When will my hair grow back?

 

Infection and Neutropenia during Cancer Treatment

An infection is the invasion and growth of germs in the body, such as bacteriavirusesyeast, or other fungi. An infection can begin anywhere in the body, may spread throughout the body, and can cause one or more of these signs:

  • fever of 100.5 °F (38 °C) or higher or chills
  • cough or sore throat
  • diarrhea
  • ear pain, headache or sinus pain, or a stiff or sore neck
  • skin rash
  • sores or white coating in your mouth or on your tongue
  • swelling or redness, especially where a catheter enters your body
  • urine that is bloody or cloudy, or pain when you urinate

Call your health care team if you have signs of an infection. Infections during cancer treatment can be life threatening and require urgent medical attention. Be sure to talk with your doctor or nurse before taking medicine—even aspirin, acetaminophen (such as Tylenol®), or ibuprofen (such as Advil®) for a fever. These medicines can lower a fever but may also mask or hide signs of a more serious problem.

Some types of cancer and treatments such as chemotherapy may increase your risk of infection. This is because they lower the number of white blood cells, the cells that help your body to fight infection. During chemotherapy, there will be times in your treatment cycle when the number of white blood cells (called neutrophils) is particularly low and you are at increased risk of infection. Stress, poor nutrition, and not enough sleep can also weaken the immune system, making infection more likely.

You will have blood tests to check for neutropenia (a condition in which there is a low number of neutrophils). Medicine may sometimes be given to help prevent infection or to increase the number of white blood cells.

Ways to Prevent Infection

Your health care team will talk with you about these and other ways to prevent infection:

Wash your hands often and well. Use soap and warm water to wash your hands well, especially before eating. Have people around you wash their hands well too.

Stay extra clean. If you have a catheter, keep the area around it clean and dry. Clean your teeth well and check your mouth for sores or other signs of an infection each day. If you get a scrape or cut, clean it well. Let your doctor or nurse know if your bottom is sore or bleeds, as this could increase your risk of infection.

Avoid germs. Stay away from people who are sick or have a cold. Avoid crowds and people who have just had a live vaccine, such as one for chicken pox, polio, or measles. Follow food safety guidelines; make sure the meat, fish, and eggs you eat are well cooked. Keep hot foods hot and cold foods cold. You may be advised to eat only fruits and vegetables that can be peeled, or to wash all raw fruits and vegetables very well.

Talking With Your Health Care Team about Infection

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

  • Am I at increased risk of infection during treatment? When am I at increased risk?
  • What steps should I take to prevent infection?
  • What signs of infection should I look for?
  • Which signs signal that I need urgent medical care at the emergency room? Which should I call you about?

 

Lymphedema and Cancer Treatment

Lymphedema is a condition in which the lymph fluid does not drain properly. It may build up in the tissues and causes swelling. This can happen when part of the lymph system is damaged or blocked, such as during surgery to remove lymph nodes, or radiation therapy. Cancers that block lymph vessels can also cause lymphedema.

Lymphedema usually affects an arm or leg, but it can also affect other parts of the body, such as the head and neck. You may notice symptoms of lymphedema at the part of your body where you had surgery or received radiation therapy. Swelling usually develops slowly, over time. It may develop during treatment or it may start years after treatment.

 

At first, lymphedema in an arm or leg may cause symptoms such as:

  • swelling and a heavy or achy feeling in your arms or legs that may spread to your fingers and toes
  • a dent when you press on the swollen area
  • swelling that is soft to the touch and is usually not painful at first
  • Lymphedema that is not controlled may cause:
  • more swelling, weakness, and difficulty moving your arm or leg
  • itchy, red, warm skin, and sometimes a rash
  • wounds that don’t heal, and an increased risk of skin infections that may cause pain, redness, and swelling
  • thickening or hardening of the skin
  • tight feeling in the skin; pressing on the swollen area does not leave a dent
  • hair loss
  • Lymphedema in the head or neck may cause:
  • swelling and a tight uncomfortable feeling on your face, neck, or under your chin
  • difficulty moving your head or neck

Tell your health care team as soon as you notice symptoms. Early treatment may prevent or reduce the severity of problems caused by lymphedema.

Ways to Manage Lymphedema

Steps you may be advised to take to prevent lymphedema or to keep it from getting worse:

Protect your skin. Use lotion to avoid dry skin. Use sunscreen. Wear plastic gloves with cotton lining when working in order to prevent scratches, cuts, or burns. Keep your feet clean and dry. Keep your nails clean and short to prevent ingrown nails and infection. Avoid tight shoes and tight jewelry.

Exercise. Work to keep body fluids moving, especially in places where lymphedema has developed. Start with gentle exercises that help you to move and contract your muscles. Ask your doctor or nurse what exercises are best for you.

Manual lymph drainage. See a trained specialist (a certified lymphedema therapist) to receive a type of therapeutic massage called manual lymph drainage. Therapeutic massage works best to lower lymphedema when given early, before symptoms progress.

Ways to Treat Lymphedema

Your doctor or nurse may advise you to take these and other steps to treat lymphedema:

Wear compression garments or bandages. Wear special garments, such as sleeves, stockings, bras, compression shorts, gloves, bandages, and face or neck compression wear. Some garments are meant to be worn during the day, while others are to be worn at night.

Other practices. Your health care team may advise you to use compression devices (special pumps that apply pressure periodically) or have laser therapy or other treatments.

Talking With Your Health Care Team about Lymphedema

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

  • What can I do to prevent these problems?
  • What symptoms should I call you about?
  • What steps can I take to feel better?
  • Would you recommend that I see a certified lymphedema therapist?
  • If lymphedema advances, what special garments should I wear during the day? During the night?