Natural Solution for Cancer

50 Things About 50 Cancers

This ebook from medical practitioner and family doctor Dr. Parajuli gives you all of the signs and symptoms that you need to know in order to catch cancer in the very early stages and protect yourself from it. You don't have to worry about if you have cancer anymore, and better yet you don't have to spend thousands of dollars to make sure of that either! All it takes is a bit of knowledge and you are on your way! This book also teaches about other aspects of cancer patients, such as how to live with different kinds of cancer, how to prepare yourself mentally to accept this reality if it IS a reality for you, and how to deal with doctors and insurance companies. This book is easy to read and in PDF format, so you don't have to worry at all about reading it. Make it easy on yourself! Read more...

Do I Have Cancer Overview

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My Do I Have Cancer Review

Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the writer was capable of presenting advanced techniques in an extremely easy to understand language.

This book served its purpose to the maximum level. I am glad that I purchased it. If you are interested in this field, this is a must have.

Clinical Presentation And Diagnosis Cancer

Palliative care is most commonly associated with patients who have cancer. Regardless of whether or not the cancer is curable, most patients have various degrees of physical, psychological, social, and spiritual symptoms which arise once a diagnosis is confirmed. The primary site of solid tumor and hematologic cancers associated with limited life include, but are not limited to, lung, bronchus, breast, colon, rectum, pancreas, prostate, ovaries, uterus, brain, esophagus, liver, kidneys, bladder, lymph system, bone marrow, and skin. The spread of cancer cells (metastases) to distant areas are associated with poorer prognosis. Once a cancer patient has failed curative and life-prolonging therapy, prognosis and disease trajectory is easier to determine than in patients with other life-limiting diseases. The change in focus from cure to symptom control becomes apparent and, therefore, more acceptable. Symptoms associated with cancer are dependent on both the primary tumor site and the...

Timely Diagnosis of Testicular Cancer

Screening for testicular cancer, like any true disease-screening effort, involves evaluation of an asymptomatic population for the disease in question. The goal of any cancer screening effort is to diagnose the disease at an early, more easily treatable stage with the ultimate goal of improving the disease-specific survival and minimizing treatment morbidity. Screening efforts can also be directed toward population groups most at risk for the disease to improve cost effectiveness, which is becoming increasingly important as we face the aging of the Baby Boom'' generation. Although testicular cancer is an uncommon neoplasm, it is the most common solid tumor in men between the ages of 20 and 34, and the incidence is increasing 1 . Because of the known and continuing problem of delayed diagnosis, which is discussed later, screening might be considered for this disease. Conversely, with most patients now being cured, the screening goal of increasing disease-specific survival may be...

Epidemiology of Penile Cancer

Penile cancer occurs predominantly in elderly men although the disease may also occasionally present in young men. The mean age at diagnosis of patients with penile cancer is 60 years and the age-related incidence is highest at 70 years. The incidence has remained stable over recent years with an age-standardized incidence of 0.3-1.0 per 100,000 in Western Europe and the United States, accounting for 0.4-0.6 of all malignancies in this part of the world.1,2 The incidence is significantly higher is some areas of Asia, Africa, and South America, where the disease can constitute up to 10 of malignant disease in men with incidence rates of 4.2 and 4.4 per 100,000 in Paraguay and Uganda, respectively.3,4 In terms of the annual number of penile cancers occurring globally, a total penile cancer burden of about 26,000 cases has been estimated.5 The substantial worldwide variation in penile cancer incidences is most likely due to the differences in socio-economic conditions and religious...

Note for Chronic Pain Sufferers Who Dont Have Cancer

Although this book is about the pain and symptoms associated with cancer, much of the information presented is surprisingly relevant to people who don't have cancer but who suffer from unrelenting or progressive chronic pain. These materials include Chapters 3 and 4 on assessing pain and being an active health-care consumer, all of Part II that details medication use and much of Part III, including Chapter 12 on mind-body approaches to easing pain. Just as cancer pain is still often severely undertreated, so too is chronic non-cancer pain that accompanies trauma, degenerative, infectious diseases, and other medical disorders as well as chronic pain that simply cannot be explained. Sufferers are commonly disbelieved and untreated, leaving them feeling ridiculed, humiliated, depressed, and even suicidal. Often amplified by the absence of the drama associated with cancer, the barriers to good pain management (Chapters 1 and 2) are largely the same for chronic pain. Below are some of the...

What are the signs and symptoms of an enlarged prostate either cancer related or benign

Enlargement of the prostate gland may cause changes in urinary symptoms however, the severity of urinary symptoms does not correlate with the size of the prostate. In fact, some men with mildly enlarged prostates (for example, 40 cm3) may be more

Other Sources of Pain Associated with Cancer Other Conditions

Pain may also result from other conditions that occur at the same time as the cancer (comorbid conditions) and which may or may not be directly related, such as arthritis, gastrointestinal disorders, and long-standing back pain these account for pain in about 3 percent of hospitalized cancer patients and 10 percent of those cared for at home. Some physicians also consider problems related to the side effects of cancer therapies as another category of pain, such as discomfort due to muscle spasms, muscle wasting from inactivity, constipation, mouth sores from dehydration, and other causes, such as bedsores (also called decubitus ulcers). These problems are discussed more fully in Chapters 10 and 11. As we've indicated, patients are sometimes fearful of admitting ongoing pain for fear that it means that their condition has worsened. This natural tendency toward denial underscores the importance of recognizing that not all pain associated with cancer means a tumor has grown or recurred...

Good Pain Treatment Is Good Cancer Treatment

Regardless of the source of the pain, it should be treated, not only to make the patient more comfortable but, as discussed in Chapter 1, because it is harmful to health, impairs quality of life, and interferes with the ability to fight cancer. Remember suffering is needless and will only make things worse. Pain treatment should be a high priority, not relegated to the back burner. It is as essential to treat pain as it is to treat the cancer itself, because unrelenting pain can influence the course of a cancer illness. The cancer and pain should be viewed as inseparable.

The definition of cancer

As humans we are made up of many millions of cells. Some cells are specific to certain tissues, e.g. epithelial cells are found throughout the gastrointestinal tract, bladder, lungs, vagina, breast and skin. It is this group of cells that accounts for about 70 of cancers (Venitt, 1978 Corner, 2001). the lymphatic system and bloodstream, creating secondary deposits known as 'metastases' (Walter, 1977 BMA, 1997). The 'normal' cell control mechanisms become disrupted or indeed fail (Corner, 2001). Surgical removal of the original tumour is not always a successful treatment in malignant disease, as a result of microscopic spread. Malignant tumours are often irregular in shape with ill-defined margins (Walter, 1977 Wolfe, 1986). Microscopic spread results in the tissue surrounding the visible tumour appearing unaffected by disease. However, microscopic examination of the surgical resection margins can reveal the presence of malignant cells. If left untreated, these cells will result in...

ITGCN of the Testis Contralateral Testicular Biopsy and Bilateral Testicular Cancer

ADepartment of Surgery, Division of Urology, Memorial Sloan Kettering Cancer Center, 353 E. 68th Street, New York, NY 10021, USA bDepartment of Pathology, University of Kansas School of Medicine, 2017 Wahl Hall West, Mailstop 3045, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA cDepartment of Urology, University of Kansas School of Medicine, 5017 Sudler Hall, Mailstop 3016, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA Testicular cancer is the most common solid malignancy in the 20- to 34-year-old male age range. According to the most recent Surveillance Epidemiology and End Results (SEER) data, approximately 8000 men per year will be diagnosed with testicular cancer 1 . The mean age at diagnosis was 34 years of age, while the median age of death was 39.5 years old. The age-adjusted incidence of testicular cancer in the United States for the years from 1998 to 2002 was 5.3 per 100,000 men per year 1 . European data suggest the overall lifetime risk of developing testicular...

Introduction Molecular Concept of Penile Carcinogenesis

Penile cancer is a rare disease, particularly in developed countries.1 Large case series for molecular studies are relatively limited. Only a few, albeit important, studies evaluating the molecular etiopathogenesis of penile carcinoma have been published to date. Based on these studies, a model of penile carcinogenesis describing the molecular alterations that accumulate during the pathogenesis of penile carcinoma has been proposed.2 In this molecular concept, the etiology of penile carcinoma is recognized to be heterogeneous in nature with evidence pointing to at least two independent carcinogenic routes, i.e., virus and nonvirus induced. About half of penile cancers are caused by an infection with high-risk (often also referred to as oncogenic) human papillomavirus (hrHPV), mainly type HPV-16. 3-8 The remaining penile cancers arise independent of hrHPV infection. A similar division has also been described for vulvar and head and neck carcinomas.9 Although the molecular routes of...

Are there any other blood tests to check for prostate cancer

Early Prostate Cancer Antigen (EPCA) and EPCA-2 have been demonstrated to be plasma-based markers for prostate cancer. EPCA is found throughout the prostate and represents a field effect associated with prostate cancer, whereas, EPCA-2 is found only in the prostate cancer tissue. However, EPCA-2 is able to get into the plasma, the liquid part of the blood, allowing for it to be detected by a blood test. In preliminary studies, EPCA-2 has been able to identify men with prostate cancer who had normal PSA levels. This data, however, is preliminary and further studies are needed to validate the sensitivity and specificity of these markers. Others are investigating the ability for urinary markers to detect prostate cancer, specifically alpha-methyl-acyl-CoA racemase (AMACR) and prostate cancer antigen 3 (PCA 3) urinary transcript levels obtained from urine sediments following digital rectal examination and pro-static massage.

HPVMediated Penile Carcinogenesis

HPV is associated with anogenital tumor formation and is an important factor in the development of in-situ and invasive epithelial tumors. Our understanding of HPV DNA integration into the human genome has resulted from research investigating SCC of the cervix and from the development of an HPV-specific quadrivalent vaccine. HrHPV-associated penile cancers are thought to arise from the progression of precursor lesions caused by an hrHPV infection. HrHPV infections have a strong association with anogenital tumor formation, particularly cervical cancer. HPV is a family of epitheliotropic, small double-stranded DNA viruses of approximately 8,000 bp. Sexual transmission is the most common route for viral infection, although oral and vertical transmission are also possible.10 Epidemiologic research has classified 15 genotypes of HPV as high-risk, based on their association with cervical cancer, i.e., HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82, and three types as...

HPVIndependent Penile Carcinogenesis

Studies evaluating the molecular biology of non-HPV associated penile cancer have suggested that, in general, gene alterations (i.e., p53 alterations, gene promoter methylation) are more frequent in non-HPV-associated penile carcinomas as compared to their HPV-mediated counterparts.26 Although these data should be interpreted with care as only small case series were compared, the phenomenon would be in line with studies on head and neck carcinomas.27 In head and neck carcinomas, HPV-associated cancers are characterized by the disruption of the pRb and p53 pathways by the viral oncoproteins and were found to be genetically different from those that did not contain HPV. The latter required alternative genetic damage to disrupt similar cellular pathways, including p53 gene mutations and methylation of tumor suppressor and tumor-related genes. Indeed, several studies have identified nonviral mechanism(s) leading to the disturbance of the p14ARF MDM2 p53 and or p16INK4a cyclin D Rb...

What is prostate cancer

Prostate cancer is a malignant growth of the glandular cells of the prostate. Our body is composed of billions of cells they are the smallest unit in the body. Normally, each cell functions for a while, then dies and is replaced in an organized manner. This results in the appropriate number of cells being present to carry out necessary cell functions. Sometimes there can be an uncontrolled replacement of cells, leaving the cells unable to organize as they did before. Such abnormal growth of cells is called a tumor. Tumors may be benign (noncancerous) cancer is a Abnormal tissue growth that may be cancerous or noncancerous (benign). Cancer uncontrolled growth of cells that can spread to other areas of the body and cause death. Small bean-shaped glands that are found throughout the body. Lymph fluid passes through the lymph nodes, which filter out bacteria, cancer cells, and toxic chemicals. or malignant (cancerous). Cancer is abnormal cell growth and disorder such that the cancer cells...

How common is prostate cancer

There are more than 100 different types of cancer. In the United States, a man has a 50 chance of developing some type of cancer in his lifetime. In American men, (excluding skin cancer) prostate cancer is the most common cancer. Prostate cancer accounts for about 33 (234,460) of cases of cancer (Table 2). More than 75 of the cases of prostate cancer are diagnosed in men older than 65 years. Based on cases diagnosed between 1995 and 2001, it is estimated that 91 of the new cases of prostate cancer are expected to be diagnosed at local or regional stages (see staging of prostate cancer), for which 5-year survival is nearly 100 . It is estimated that prostate cancer will be the cause of death in 9 of men, 27,350 prostate cancer related deaths. In the United States, deaths from prostate cancer have decreased significantly by 4.1 per year from 1994 to 2004. Most notably, the death rate for African American men in the United States has decreased by 6 . Table 2 Cancer Statistics for Men in...

How Serious Is Your Cancer

Several questions immediately came to mind on the day I was diagnosed with prostate cancer. How serious is it Is it likely to kill me If so, when This chapter provides information you need to begin answering such questions. Those who wish to skip the more technical discussions will find a summary at the end of the chapter. Prostate cancer is cancer. It affects the walnut-sized gland that sits beneath the bladder and contributes some of the fluid making up the semen a detailed description of the prostate can be found in Appendix A. Prostate cancer should not be confused with benign prostatic hypertrophy (BPH), the other common indeed, almost universal prostate affliction of older men. For benign prostatic hypertrophy, the operant word is benign. It is an enlargement of the prostate that can cause symptoms such as frequency (having to urinate often), urgency (difficulty in holding your urine), a weak flow, and starting and stopping of the flow. Benign prostatic hypertrophy can be...

The Patient with Cancer

The patient with cancer has five major concerns loss of control, pain, alienation, mutilation, and mortality. Loss of control makes this patient feel helpless. The knowledge of something growing uncontrolled within a patient's body creates frustration, fear, and anger. Suffering with pain is one of the most feared aspects of cancer. The feeling of alienation stems from the reactions of people around the patient. Fears of mutilation are common among patients with cancer. The fear of being perceived as lacking ''wholeness'' contributes to depression and anxiety. The young woman with breast cancer who requires a mastectomy fears that she will be rejected as no longer being a complete woman. Supportive family members are the key in reassuring this patient that they will love her just as they have before her surgery. A diagnosis of cancer makes a patient aware of mortality and leads to intense fear of unremitting pain. Family members and friends often express grief before death occurs....

Phase I Cancer Trials

Phase I studies have the primary objective of establishing a phase II dose.15 For cytotoxic agents, the phase II dose is assumed to be the maximally tolerated dose (MTD) based on dose-limiting toxicities (DLTs). For some phase I cancer studies, the selection of patients may be important. Although patients with refractory disease are often included, the important factor is normal organ function. In some instances, patients who have previously been heavily pretreated with other agents may be excluded for fear of underestimating the MTD. The design of the phase I trial depends on the nature of the therapy.1 The most common is a phase I study of a new cytotoxic agent where, as noted previously, the goal is to find an MTD. The classic design for such a study starts with a low dose that is not expected to cause any serious adverse side effects. Usually this dose is determined as one tenth of the median lethal dose, expressed as milligrams per meter squared of body surface area, in the most...

Phase Ii Cancer Trials

Once a therapeutic dose has been determined, the next step in evaluation of a treatment is to determine if there is evidence of efficacy. Although response to therapy can be described in a phase I study, this is not the primary objective. Also, phase I trials tend to be performed in patients with refractory cancers of various types, so the determination of benefit among a specific tumor type is limited by small numbers and multiple dose levels. In phase II studies, a specified tumor type is studied because the main biologic response of interest is the tumor Summary of Typical Conditions for the Different Types of Cancer Clinical Trials Most cancer phase II studies are open labeled and single arm in design. If multiple agents are concurrently available for testing or alternative regimens of the same agent are under consideration, a randomized phase II study may be conducted. In such a study patients are randomized among multiple phase II regimens with the goal not to directly test...

What are the riskfactors for prostate cancer and who is at riskIs there anything that decreases the risk of developing

Theoretically, all men are at risk for developing prostate cancer. The prevalence of prostate cancer increases with age, and the increase with age is greater for prostate cancer than for any other cancer. Theoretically, all men are at risk for developing prostate cancer. Basically, every 10 years after the age of 40 years, the incidence of prostate cancer nearly doubles, with a risk of 10 for men in their 50s increasing to 70 for those in their 80s. However, in most older men, the prostate cancer does not grow and many die of other causes and are not identified as having prostate cancer before their death. Prostate cancer is 66 more common among African Americans, and it is twice as likely to be fatal in African Americans as in Caucasians. However, blacks in Africa have one of the lowest rates of prostate cancer in the world. Males of Asian descent living in the United States have lower rates of prostate cancer than Caucasians, but higher rates than Asian males in their native...

Androgen ablation therapy of prostate cancer

Induction of programmed cell death in prostate cells by withdrawal of androgenic stimulation is the basis for the treatment of non-organ-confined prostate cancer. Although the methods of androgen withdrawal have changed over the years, the basic principle has remained the same since introduction of androgen ablation by Charles Huggins, who received the Nobel Prize for his pioneering work on prostate cancer treatment (Huggins and Hodges 1941 Huggins and Stevens, 1940). In the past, surgical castration (orchiectomy) or chemical castration by high-dose estrogen treatment were used, whereas nowadays the preferred choice of androgen ablation is treatment with gonadotropin-releasing hormone (Gn-RH) agonists that block LH production and testicular testosterone biosynthesis (Afrin and Ergul 2000 Auclerc etal. 2000 DiPaola etal. 2001). Sometimes GnRH analogs are combined with antiandrogens that block the androgen receptor (Kuil and Mulder 1994) to achieve complete androgen blockade (Crawford...

What are the warning signs of prostate cancer

Prostate cancer gives no typical warning signs that it is present in your body. It often grows very slowly, and some of the symptoms related to enlargement of the prostate are typical of noncancerous enlargement of the prostate, known as benign prostatic hyperplasia (BPH). A chemical that helps prevent changes in cells and reduce damage to the cell that can cause it to become cancerous. When the disease has spread to the bones, it may cause pain in the area. Bone pain may present in different ways. In some men, it may cause continuous pain, while in others, the pain may be intermittent. It may be confined to a particular area of the body or move around the body it may be variable during the day and respond differently to rest and activity. If there is significant weakening of the bone(s), fractures may occur. More common sites of bone metastases include the hips, back, ribs, and shoulders. Some of these sites are also common locations for arthritis, so the presence of pain in any of...

Androgen receptor as a therapy target in hormoneresistant prostate cancer

Currently there is no efficient method available to treat patients who relapse during androgen ablation therapy and develop an androgen-independently growing tumor. Based on an improved understanding of AR signaling in therapy-refractory prostate cancer, novel therapies are being developed that target AR in advanced tumor cells. Specific antisense AR oligonucleotides were identified that inhibit AR expression. Treatment of such prostate cancer cells resulted in reduced androgen receptor levels, growth inhibition and reduced PSA production in vitro and in vivo (Eder etal. 2000 2001). Another approach is the use of derivatives of the antibiotic geldanamycin that Table 2.1 Promiscuous mutant androgen receptors in prostate cancer Table 2.1 Promiscuous mutant androgen receptors in prostate cancer Of the about eighty androgen receptor gene mutations detected in prostate cancer specimens only some have been analyzed in terms of their functional consequences. Most of these mutations result in...

What causes prostate cancer What causes prostate cancer to grow

The exact causes of prostate cancer are not known. Prostate cancer may develop because of changes in genes. Alterations in androgen (male hormone) related genes have been associated with an increased risk of cancer. Alterations in genes may be caused by environmental factors, such as diet. The more abnormal the gene, the higher is the likelihood of developing prostate cancer. In rare cases, prostate cancer may be inherited. In such cases, 88 of the individuals will have prostate cancer by the age of 85 years. Males who have a particular gene, the breast cancer mutation (BRCA1), have a threefold higher risk of developing prostate cancer than do other men. Changes in a certain chromosome, p53, in prostate cancer are associated with high-grade aggressive prostate cancer. Table 4 Common Symptom-Directed Treatment Strategies in Advanced Prostate Cancer Table 4 Common Symptom-Directed Treatment Strategies in Advanced Prostate Cancer Prostate cancer, similar to breast cancer, is hormone...

The Evolution of Cancer Drug Discovery

The ultimate goal of any cancer drug discovery process is to discover and develop effective and non-toxic therapies. Over the years this goal has been pursued using approaches driven by the available understanding of the biology of cancer cells and technologies (Suggitt and Bibby 2005). Over time, a general transition has been observed from the empirical drug screening of cytotoxic agents against poorly characterized tumor models to the target-driven drug screening of inhibitors with a defined mechanism of action. Compounds of both synthetic and natural origin were screened, starting from 1955, in a panel of cancer cell lines and of mice tumors, especially the L1210 leukemia model. The development of nude athymic mice and the successful growth of human tumor xenografts introduced the use of human cancer xenografts in nude mice for screening purposes in 1976. This observation-driven approach has generated cornerstones of cancer therapy, including taxol and antracyclines, with the...

Where does prostate cancer spread

As the prostate cancer grows, it grows through the prostate, the prostate capsule, and the fat that surrounds the prostate capsule. Because the prostate gland lies below the bladder and attaches to it, the prostate cancer can also grow up into the base of the bladder. Prostate cancer can also grow into the seminal vesicles, which are located adjacent to the prostate. It may continue to grow locally in the pelvis into muscles within the pelvis into the rectum, which lies behind the prostate or into the sidewall of the pelvis. The spread of cancer to other sites is called metastasis. When prostate cancer spreads outside of the capsule and the fatty tissue, it usually goes to two main areas in the body the lymph nodes that drain the prostate and the bones. The more commonly involved lymph nodes are those in the pelvis (Figure 5), and bones that are more From Prostate and Cancer by Sheldon H.F. Marks. Copyright 1995 by Sheldon Marks. Reprinted with permission of Perseus Books Publishers,...

What is prostate cancer screening

The goal of any screening is to evaluate populations of people in an effort to diagnose the disease early. Thus, the goal of prostate cancer screening is the early detection of prostate cancer, ideally at the curable stage. Prostate cancer screening includes both a digital rectal examination and a serum PSA. Each of these is important in the screening process, and an abnormality in either warrants further evaluation. Only about 25 of prostate cancers are revealed by rectal examination most are detected by an abnormal PSA. Some studies suggest that even with PSA-based prostate cancer screening, up to 15 of men will have undetected prostate cancer. Newer screening tools, such as EPCA and EPCA-2, are being investigated (see Question 6). Because the prostate gland lies in front of the rectum, the back wall of the prostate gland can be felt by putting a gloved, lubricated finger into the rectum and feeling the prostate by pressing on the anterior wall of the rectum (Figure 6). The rectal...

Are all prostate cancers the sameAre there different grades

Not all prostate cancers are the same. Prostate cancers may vary in the grade of the cancer and the stage of the cancer. The grade of a cancer is a term used to describe how the cancer cells look. That is, whether the cells look aggressive and not very similar to normal cells (high grade) or whether they look very similar to normal cells (low grade). The grade of the cancer is an important factor in predicting long-term results of treatment, response to treatment, and survival. With prostate cancer, the most commonly used grading system is the Gleason scale. In this grading system, cells are examined by a pathologist under the microscope and assigned a number based on how the cancer cells look and how they are arranged together (Figure 7). Because prostate cancer may be composed of cancer cells of different grades, the pathologist assigns numbers to the two predominant grades present. The numbers range from 1 (low grade) to 5 (high grade). Typically, the Gleason score is the total of...

What is prostate cancer staging

By staging your cancer, your doctor is trying to assess, based on your prostate biopsy results, your physical examination, your PSA, and other tests and X-rays (if obtained), whether your prostate cancer is confined to the prostate, and if it is not, to what extent it has spread. Studies of large numbers of men who have undergone radical prostatectomy and pelvic lymph node dissections have provided for the development of nomograms predicting the pathologic stage of CaP based on clinical stage (TNM), PSA, and Gleason score (Table 5). It was initially thought that magnetic resonance imaging (MRI) would be very helpful in determining whether capsular penetration and extracapsular disease were present however, it has only proved to be useful in centers that perform large numbers of MRIs. Similarly, the use of computed tomographic (CT) scanning in assessing whether or not the cancer has spread to the pelvic lymph nodes has been disappointing. Knowing the stage (the size and the extent of...

What options do I have for treatment of my prostate cancer

After finally realizing that, despite feeling great, I did indeed have prostate cancer, I had to figure out what the best treatment for me was. When faced with the option of leaving my prostate in place or removing it, I knew that, even though I was petrified of surgery, it would be the best thing for me in the long run. I knew that I could not live with my prostate gland and the continuous question of whether there were any viable cancer cells remaining in my prostate after interstitial seeds or radiation therapy. An alternative to immediate treatment for men with presumed low-risk prostate cancer. Involves close monitoring and withholding active treatment unless there is a significant change in the patient's symptoms or PSA. Various treatment options are available for prostate cancer, each with its own risks and benefits (Table 7). The options available may vary with the grade of tumor, the extent of tumor spread, your overall medical health and life expectancy and your personal...

Management of Clinical Stage I Nonseminomatous Germ Cell Testicular Cancer

ADepartment of Solid Tumor Oncology, Taussig Cancer Center, Cleveland Clinic Foundation, Approximately one third of patients who have nonseminomatous germ cell testicular cancer (NSGCT) have clinical stage (CS) I disease at diagnosis, defined as normal postorchiectomy serum levels of the tumor markers a-fetoprotein (AFP), human choriogonadotropin (HCG), and lactate dehydrogenase (LDH) without evidence of metastatic disease on imaging studies of the chest, abdomen, and pelvis. The optimal management of these patients continues to generate controversy. Surveillance, retroperitoneal lymph node dissection (RPLND), and chemotherapy with two cycles of bleomycin-etoposide-cisplatin (BEPx2) are established treatment options for CS I and all are associated with long-term survival rates of 97 or greater. Contributing to the controversy is the fact that occult metastases in the retroperito-neum or at distant sites are present in only 25 to 35 of patients overall. Any intervention after...

Reducing Your Risk of Colon Cancer

Can a diet rich in fiber actually lower your chance of developing colon cancer Several studies say yes, and it makes perfect sense. Think about it. Insoluble fiber helps move waste material through your intestines more quickly. Therefore, there is less time for suspicious substances to lurk around and possibly damage your colon and rectal area. In addition, fiber may bind with possibly harmful bacteria, transporting it through the intestines and out of your body. While we're down there, it's a perfect time to point out that softer, more regular bowel movements can also prevent constipation and reduce your chance of getting hemorrhoids.

Alcohol and Breast Cancer

Although many studies have shown that breast cancer rates are higher among heavier drinkers, a number of research reports suggest that only a small increase in risk begins to appear among women who normally consume just one or two drinks per day. This is not found consistently in all studies. At our institute at Boston University, we have completed a study of wine, beer, and spirits as they relate to breast cancer by using data from the Framingham Study that has been

Surgical Treatment of Recurrent or Persistent Medullary Thyroid Cancer

A, Computed tomography (CT) of liver from patient with multiple endocrine neoplasia type 2A, recurrent medullary thyroid carcinoma (MTC), and elevated calcitonin levels. There is no evidence of liver metastases on the scan. B, Laparoscopic view of liver from the same patient showing multiple small raised whitish lesions on and just beneath the surface of the liver, confirmed to be metastatic MTC by biopsy. These small, multiple metastases are often not seen with routine CT scanning or other imaging modalities, including nuclear scanning. (From Tung WS, Veseley TM, Moley JF. Laparoscopic detection of hepatic metastases in patients with residual or recurrent medullary thyroid cancer. Surgery 1995 18 1024.) FIGURE 15-5. A, Computed tomography (CT) of liver from patient with multiple endocrine neoplasia type 2A, recurrent medullary thyroid carcinoma (MTC), and elevated calcitonin levels. There is no evidence of liver metastases on the scan. B, Laparoscopic view of liver from...

Image Diagnosis of Medullary Cancer

All patients with a preoperative diagnosis of medullary cancer of the thyroid should be tested for a ret protoonco-gene germline point mutation and also be screened for pheochromocytoma and hyperparathyroidism (see other chapters regarding medullary thyroid cancer, pheochromocytoma, and hyperparathyroidism). Medullary cancer secretes calcitonin and carcinoembryonic antigen (CEA) and occasionally neuron-specific enolase, serotonin, chromogranin, gastrin-releasing peptide, substance P, pro-opiomelanocortin-derived products, and somatostatin. Among them, calcitonin and CEA are used as tumor markers for following patients for persistent disease or recurrent disease. Calcitonin is the most sensitive biochemical marker for predicting the presence of tumor. A steep slope with rapidly rising CEA levels indicates that the patients have rapidly progressive tumor. A normal CEA level or a flat slope indicates that patients may be cured or they have only slowly progressive disease.63 64 Decrease...

Imaging of Metastases of Thyroid Cancer with Fluorine 18 Fluorodeoxyglucose

FDG-PET is primarily used to localize recurrent differentiated and poorly differentiated thyroid cancers, especially in patients who are serum thyroglobulin positive and 13II WBS negative. Serum thyroglobulin determination and diagnostic l3'I WBS provide the diagnosis of recurrent disease. Recurrent differentiated thyroid cancer may or may not take up radioiodine. 'A patient whose recurrent tumor is detected by radioiodine scanning has a significantly better prognosis than does a patient whose tumor does not take up l3'I.2 FDG-PET can be positive in the same site as a WBS-positive site or WBS-negative site, or both can be present in the same patient. Grunwald and associates3 reported that FDG-PET was particularly useful in WBS-negative patients, showing a high sensitivity of 85 . Patients with poorly differentiated thyroid cancers were more likely to be WBS negative and FDG-PET positive. Those patients also have a worse prognosis FDG-PET helps stage the disease and guide treatment...

Cancer of the Nasopharynx

Nasopharyngeal carcinoma is rare in the United States, with an annual incidence of 0.6 per 100,000 people. The incidence in Southern China is 50 times higher than in the United States.1 Native people of North Africa, the Middle East, Alaska, and Malaysia have an intermediate risk. The peak incidence for this cancer occurs in the fourth to fifth decade of life but it may occur in children and in the elderly. The male to female ratio is 2 to 3 1. The etiology of nasopharynx cancer is thought to be multifactorial with genetic, viral, dietary, and environmental influences. A genetic predisposition has not been explicitly demonstrated but data from China show common human leukocyte antigen (HLA) patterns among some patients with the disease.2 The Epstein-Barr virus (EBV) has been closely associated with cancer of the nasopharynx. Molecular studies have shown evidence of EBV infection of malignant epithelial cells within a majority of tumor specimens.3 Clinical correlation confirms that...

A diagnosis of cancer

Almost 150 years have passed since Florence Nightingale wrote these words. Cancer is a protracted illness, always raising uncertainty in the minds of those affected, and their families, as to whether the disease can be successfully treated. Historically, the management of an individual with cancer has revolved around medical models, which are investigation, diagnosis, treatment and follow-up. Although some efforts have been made in the past in addressing the holistic needs of patients and their families, it is only recently that there has been national guidance, resulting in national standards, which are contained in the Manual of Cancer Standards (DoH, 2000a, 2000b Whittaker and Sheppard, 2001 Young, 2001). As discussed earlier in this book, cancer is a group of diseases, with some forms of malignancy, such as basal cell carcinoma of the skin, carrying an excellent prognosis for the patient (Ketcham and Loescher, 2000). However, the word 'cancer' has been used. As health...

The NHS Cancer Plan

Back in 1995 a document was published by the Department of Health known as A Framework for Commissioning Cancer Services (DoH, 1995), commonly referred to as the Calman-Hine report. This document recommended the establishment of specialist cancer networks in England and Wales, and these networks would be responsible for coordinating the care provided in primary, secondary and tertiary care, to ensure that all individuals receive equity of access and a uniformly high standard of cancer care, delivered by a skilled and knowledgeable cancer workforce. Today there are 34 cancer networks in England. Following on from the publication of the Calman-Hine report (DoH, 1995), The NHS Cancer Plan (DoH, 2000a) was published in the autumn of 2000. This document stated four aims which are given in Chapter 2, page 17. The NHS Cancer Plan (DoH, 2000a) is an ambitious document setting out a strategy to integrate the prevention, screening, diagnosis, treatment and ongoing care for individuals. It also...

Cancer Services Collaborative

The Cancer Services Collaborative (CSC) is part of the NHS Modernization Agency. The objective of the CSC teams, which are linked to individual networks, is to look at the provision of specific cancer services within an organization, e.g. breast cancer, and 'map' the patient journey. The results of this mapping exercise identify where the delays are for the patient. Before the publication of The NHS Cancer Plan (DoH, 2000a), nine cancer networks were already taking part in CSC projects. The results from these early projects clearly highlighted that many of the delays in patients' treatment were a result of the way the 'systems' for delivering their care were organized. Through working with all the staff involved, the 'systems' could be redesigned to expedite patients' journeys, e.g. pre-booking patients at the time of referral for diagnostic tests, based on the information contained in their referral letter (DoH, 2000a).

Weak Opioid Medications for Cancer Pain

The following drugs are most commonly prescribed for moderate cancer pain when nonopioid drugs (NSAIDs) are no longer sufficiently effective. However, doctors often will maintain the use of a nonopioid medication to be used in combination with a weak (or strong) opioid because they relieve pain by different mechanisms thus, when used together pain-relieving effects are typically enhanced. As a result, lower doses of the opioid may be used with fewer concerns about side effects. Many of the medications listed here may require triplicate prescription forms in the states that require such forms. An allergy (very rare) or side effect to one does not predict that another will be poorly tolerated.

Molecular Carcinogenesis

The pathogenesis of radiation-induced thyroid cancer has not yet been elucidated. Gene rearrangements may play an important role in the process. Nikiforova and associates found that radiation-induced tumors had a 4 prevalence of BRAF point mutations and a 58 prevalence of RET PTC rearrangements, and sporadic papillary thyroid cancers demonstrated a 37 prevalence of BRAF point mutations and only a 20 prevalence of RET PTC rearrangements.34 Similarly, RET PTC3 rearrangement was found in aggressive tumors that occurred less than 10 years after the Chernobyl accident.35 Elisei and coauthors also found a prevalence of 38 of RET PTC rearrangements in adenomas found within radiation-exposed glands, implying that this rearrangement is not restricted to the malignant phenotype but may be a step in the development of malignant transformation of radiation-induced thyroid tumors.36

HPV Infection and Penile Cancer

Much of our understanding of how HPV infection may lead to premalignant lesions and invasive tumors is based on studies of carcinogenesis in cervical cancer. However, while almost 100 of cervical SCCs are related to sexually transmitted HPV infection, rates of HPV in penile cancer are reported between 30 to 100 .1-6 The reasons for this wide range include geographical variations and different cultural attitudes towards sex between the reporting centers, as well as technical differences in the methodology used for HPV detection. A recent systematic review of established PCR techniques has found HPV DNA in approximately 50 of all penile SCCs.7 In this respect, penile tumors are more similar to vulval carcinomas, which also share a similar pathogenesis and histology.5,8 The marked difference in the prevalence, age of peak incidence, and rate of progression of both cervical and penile tumors may underlie either differing pathogenic mechanisms or differing tissue susceptibility and...

On Important Paediatric Cancer Clinical Trials

Statistically and clinically significant improvements have been achieved in all major forms of childhood cancers through conduct of well-organised single institution and cooperative group clinical trials which have resulted in sequential and steady improvement in survival rates since the 1960s when curative treatments were first devised. SEER data document that the overall childhood cancer mortality rates have consistently declined throughout the 1975-95 time period.1 Documentation of the overall progress achieved by POG investigators has been reported, demonstrating significant improvements in overall survival (OS) and event-free survival (EFS) for 8 of 10 disease areas, in a sample of over 7000 children and adolescents treated between 1976 and 1989.4 Similar results have been achieved by CCG and by European national paediatric cooperative clinical trials organisations. There is also evidence that children and adolescents with acute lymphocytic leukaemia (ALL), non-Hodgkin's lymphoma...

Oncogenesis in Thyroid Cancers of Follicular Cell Origin

The thyroid-stimulating hormone (TSH) receptor is a transmembrane glycoprotein that is G protein coupled. TSH, acting through its receptor, is the main regulator of thyro-cyte function and growth. Its function is mediated via the adenylate cyclase and phospholipase C intracellular pathways.5 Constitutively activating mutations in the TSH receptor occur in the transmembrane segment and intracy-toplasmic loop in hot thyroid nodules ( 30 ) but are usually absent in cold thyroid nodules or thyroid cancers (Table 31-1).510 Unfortunately, the frequency of TSH receptor-activating mutations observed in hot thyroid nodules has been variable, ranging from 3 to 82 .5-12 This discrepancy is likely due to several factors such as small sample size, screening of only part of the TSH receptor gene, less sensitive screening techniques (single-strand conformation polymorphism), inaccurate characterization of thyroid nodule function, and the quality of DNA in tissue samples studied.12 In general, TSH...

Cancer of the Hypopharynx and Cervical Esophagus

The esophagus is a mucosa-lined muscular tube that serves as a conduit between the pharynx and the stomach. For the purposes of classification, staging, and reporting of cancer cases, it is divided into the following subsites cervical, upper thoracic, mid-thoracic, and lower thoracic.2 Approximately 5 percent of cases of esophageal carcinoma arise within the cervical esophagus.3 The cervical esophagus extends from the inferior border of the cricoid cartilage to the thoracic inlet.2 The wall of the esophagus is comprised of an inner mucosa of squamous epithelium, a prominent submucosa, a muscular layer and an adventitia without serosa.2,4 The submucosa contains mucous glands, blood and lymphatic vessels, and a plexus of nerves.4 The muscular layer contains an inner circular layer surrounded by an outer longitudinal layer.4 Although the lower two-thirds of the esophagus is composed of smooth muscle, the most proximal end is exclusively striated and the remainder is mixed.5

Study Design For Childhood Cancer Trials

Because childhood cancer is rare and the response to conventional treatment good, most children never experience recurrent disease and are thus POG, Pediatric Oncology Group CCG, Children's Cancer Group INSS, International Neuroblastoma Staging System NA, not applicable. Source Reproduced from Castleberry,60 (pp. 926, 930), with permission from Elsevier. are of the highest priority for cancers common among adults. These studies typically ask a randomised question about either survival or event-free survival (the time from study entry to the earliest of induction failure, relapse, second cancer, or death of any cause). Intent-to-treat40 is the analysis of choice for efficacy, with other analysis done as secondary supportive inference. For treatment questions where the randomised divergence is considerably after study entry or where a significant number of failures are expected to occur before divergence, a delayed randomisation is typically done as close to the divergence point as...

Of Trials In Children With Cancer

The tragic death of an 18-year-old research subject in 1999 in a gene-transfer trial at a major research university in which human subjects were not protected, adverse events had not been reported and financial conflicts of interest were involved, served to trigger several new federal initiatives to further strengthen protections of human research subjects in clinical trials,46 including the imposition of sanctions on investigators who fail to adhere to regulations. As this chapter goes to press, the federal Office for Protection from Research Risks (OPRR) has been reorganised, expanded and renamed the Office for Human Research Protections (OHRP) and transferred to the Office of the Secretary, Health and Human Services (HHS) and the National Biothetics Advisory Commission, at the request of the President, has undertaken a sweeping examination of the ethical and policy issues in the oversight of human research in the United States (see www.bioethics.gov). As a result, the ethical and...

Look Into The Future Of Childhood Cancer Research

Despite the progress of the last half century there remain a number of challenges in childhood cancer. The focus of research in certain patient subsets with very high cure rates will be on quality of life endpoints. For example, retinoblastoma is curable in nearly 100 of cases, so preservation of sight and reduction of second malignancies (not survival) are now considered to be the primary goals and endpoints, and trials avoiding enucleation and eliminating external beam therapy are now the norm. One would hope that future therapies for childhood cancer will be developed which would be more rational, less empirical and less toxic, relying more on strategies for growth control (e.g., anti-angiogenesis) and regulation of gene expression and cell proliferation, and or induction of apoptotic pathways or blocking of anti-apoptotic signals, than on cytotoxic or ablative treatments. Assuming that deregulated and or mutated cellular proto-oncogenes or loss of tumour suppressor genes are the...

NIS and Thyroid Cancer

As previously mentioned, the treatment of patients with WDTC includes three modalities thyroidectomy, radioiodine (131I) ablation, and TSH suppression. Unfortunately, about 25 of WDTCs are initially resistant and about 50 of recurrent thyroid cancers are resistant to 131I treatment. These patients have a worse prognosis, and many studies have attempted to enhance radioiodine uptake in thyroid cancer cells in such patients. 1,2'34'37'3S Thyroid cancer has not been shown to involve the mutations seen in congenital ITD. Russo and colleagues51 performed direct sequencing of NIS cDNA from five papillary and two follicular thyroid cancers and found no mutations in the NIS gene. The proposed mechanism of reduced radioactive uptake in thyroid cancer has been associated with decreased expression of the NIS gene. Bidart and associates52 showed that NIS protein immunostaining is increased in Graves' disease and reduced in Hashimoto's and thyroid cancer. Our own studies have confirmed that NIS...

Hormonedependent cancers

The relationship between physical activity and breast, ovarian or uterine cancers has been investigated in more than 20 studies. Most of the cohort studies suffer from methodologic problems involving the assessment of physical activity, lack of statistical power and a very long follow-up period. The latter increases misclassifi-cation because of true changes in behavior since the baseline measurement. A recent Norwegian study included 25624 women with 351 cases of breast cancer 93 . After adjustment for age, BMI, number of children and socioeconomic background, the physically active at work had only half the rate of the physically inactive and in the analysis of physical activity in leisure time, the active had a 0.63 lower rate. However, more good studies are needed before sound conclusions can be drawn about the relationship between physical activity and these types of cancers. In men, the association between physical activity fitness and risk of prostate and testicular cancers has...

Presentation and Evaluation of Patients with Advanced Penile Cancer

Muneer et al. (eds.), Textbook of Penile Cancer, The nature of penile cancer combined with the pattern of disease dissemination means that patients with a delayed presentation often have unsightly fungating inguinal disease together with impaired urinary and anorectal function. The majority of these patients will have some functional impairment in voiding as the primary tumor obstructs the penile urethra. These patients may present with urinary retention but commonly dribbling incontinence is the main feature. More proximal involvement of the membranous urethra and prostate will cause urinary incontinence.

Locally Advanced Penile Cancer

Traditionally patients with penile cancer have been surgically managed using one of three procedures, circumcision for preputial tumors, partial penectomy for distal tumors involving the glans penis or distal penile shaft, total penectomy combined with a perineal urethrostomy for more extensive tumors infiltrating into the proximal penile shaft. These techniques have been utilized in order to ensure clear tumor margins which traditionally have been defined as being 2 cm. However, studies have challenged this and demonstrated that smaller resection margins do not appear to compromise oncological control.1,6,7 More recently penile-preserving surgery such as glansectomy or wide local excisions with grafting have been employed in order to maintain penile length resulting in a more acceptable functional and cosmetic outcome. Partial penec-tomy and total penectomy procedures are now reserved for cases where penile-preserving surgical options are not suitable due to the extent of the disease.

Brain Metastasis From Nonsmall Cell Lung Cancer

Brain metastases from tumors arising outside the central nervous system are exceptionally common. There are an estimated 75,000 to 100,000 cases of brain metastasis each year in the United States. Approximately 30 to 60 of all brain metastases originate in a primary lung cancer. In light of the marked frequency with which this illness is encountered in general oncology practice, a thorough understanding of the principles of diagnosis and treatment is essential for all practitioners. Lung cancers are primarily classified as either small cell or non-small cell lung cancer (NSCLC), with NSCLC representing more than 80 of cases. These two classes each have a distinct biologic activity and response to various forms of therapy and should therefore be considered as distinct entities from a clinical perspective. Only NSCLC will be considered in this chapter.

Nonsmall Cell Lung Cancer Staging

Metastatic spread of NSCLC is very common, with bone, adrenal, and brain being the most common sites.14 Brain metastases occur in approximately 33 of patients. Solitary metastases are noted in approximately 30 of cases. NSCLC stages are typically designated I to IV, including subsets IIA, IIB, IIIA, and IIIB. Staging is determined using standard tumor, node, and metastasis (T, N, M) criteria. The extent of staging tests performed depends on a number of factors, including the presenting symptoms, the extent of disease, and the exact tumor type. A thorough medical history and physical examination are the most important steps in the staging and subsequent work-up of a patient with suspected lung cancer. Clinical symptoms suggestive of brain metastasis include headache, seizures, or focal neurologic deficits. If a thorough medical history and physical examination demonstrate no evidence of extrapulmonary metastases, and a chest computed tomography (CT) scan sug Patients with stage IV lung...

Aetiology of oral cancer

The aetiology of oral squamous cancer is complex. The main factors associated with this disease are tobacco and alcohol consumption. Each of these factors increases the likelihood of oral cancer and both show a strong dose-related increase in incidence. It would seem that heavy smoking and heavy drinking have a synergistic effect, leading to an exponential rise in relative risk (Fig. 17.1). Tobacco is the main aetiological agent associated with oral cancer. The risk of oral cancer is related to the number of cigarettes per day and the length of time the This formulation allows a calculation of the relative risk of each patient. The relative risk returns to that of a non-smoker 10 years after the cessation of smoking. Topical tobacco, particularly, when mixed with areca nut, slaked lime, and betel and placed as a quid in the buccal sulcus, is a potent carcinogen. On the Indian subcontinent, where the practice of chewing tobacco is common, oral cancer makes up 40 of the total incidence...

Oral cancer morbidity

The number of deaths from oral cancer has been rising over the last 30 years. The death to registration ratio is 0.4, which is higher than many other cancers and similar to cancer of the uterine cervix and breast. The site in the mouth is an important prognostic indicator, with the tongue having the poorest prognosis and highest mortality (Table 17.2). Cancer surveillance group 1998

Impact and Sequelae of Cancer

Treatments of pediatric cancer include surgery, chemotherapy, radiation, and various combinations of these elements, depending on the histology and stage of the malignancy (Ludwig 2008). All of these treatments have the immediate impact of being strange and often frightening for pediatric patients and their families. Most treatment protocols also involve discomfort or pain, removal from familiar environments, and interference with usual developmental tasks, such as school and peer relationships. In addition to the acute impact of treatment, cancer diagnosis and treatment have long-term effects that are life altering physically and emotionally for the family and child. We consider first what is known about the acute emotional and physical impacts of pediatric cancer on child and family and then discuss the long-term emotional and physical sequelae. Table 15-2. Cancer death ratesa in U.S. children ages 0-19 years by sex, 2002-2006 Table 15-2. Cancer death ratesa in U.S. children ages...

Clinical Trials In Lung Cancer

Three US randomised screening studies failed to detect an impact of screening high-risk patients with chest radiographs or sputum cytology on mortality, although earlier stage cancers were detected in the screened groups.3-5 These studies have been criticised for a number of potential methodological and statistical problems, such as over-diagnosis and analysing data by survival rather than mortality.6 Recently, several clinical studies have demonstrated that early stage lung cancers can be detected with the use of spiral CT that would not have been detected by routine chest X-ray.7 Spiral CT is a CT scan which does not evaluate the mediastinum and thus does not use contrast or require the presence of a radiologist, employs low doses of radiation and can be completed within one patient 'breath'. Because it can be done rapidly and does not require a radiologist to be present, it is being used in some centres to screen for lung cancers in high-risk populations. However, it has not been...

Cancer as a genetic disease

It is known that cancer is linked to harmful genetic alterations of cells and many genes have been linked to various forms of cancer, but the genetics of cancer is very complicated and less well understood than classic genetics. No single cancer-causing gene has ever been discovered that is mutated in all cancers, and even in specific tumour types there can be several possible genetic mechanisms and genes involved in the formation of the tumour. In some families an inherited disposition has been shown to play a role in cancer formation, but these familial cancers make up only a small proportion of cancer cases. Cancer is a collection of disorders sharing the common feature of uncontrolled cell growth, leading to the formation of a mass of cells known as a 'neoplasm' or 'tumour'. Malignant neoplasms have the ability to invade adjacent tissues and often metastasize to more distant parts of the body, a process that is the cause of 90 of cancer deaths (Sporn, 1996). There are more than...

Locally Advanced and Inflammatory Breast Cancer

Current data suggest that patients with advanced stage III disease who are at least T3 (> 5 cm in maximal diameter), T4 (extension to chest wall or skin), or N2 (fixed or matted axillary lymphadenopathy) are best treated with preoperative chemotherapy or hormonal therapy, followed by surgery and then local-regional fractionated radiation therapy. Limited data support the addition of adjuvant chemotherapy or hormonal therapy postoperatively and after radiation therapy. Excellent local control can be achieved in 80 to 90 of women, and approximately 30 of women with stage IIIb disease (direct invasion of skin or chest wall) or inflammatory breast cancer remain free of cancer after 1 year.24,68

Conversion of paracrine to autocrine mechanism of androgen action during prostatic carcinogenesis

While it is clear that prostate cancer arises from the epithelial compartment, the identification of the specific epithelial cell subtype which the carcinogenic process initiates has only recently been the focus of study. Currently, the precursor for most peripheral zone prostatic carcinomas is thought to be high-grade prostatic intraepithelial neoplasia (HGPIN) (McNeal and Bostwick 1986). It is believed that HGPIN arises from low-grade PIN, which in turn is thought to stem from normal prostate epithelium. The cell type of origin for HGPIN, however, is still incompletely understood. A widely held view of carcinogenesis is that the common carcinomas generally arise in self-renewing tissues in which dividing cells acquire somatic genetic alterations in growth regulatory genes. In normal human prostate epithelium, most cell divisions take place in the basal cell compartment where the tissue stem and presumably the transit amplifying cells reside (Bonkhoff etal. 1994 1998). The majority...

Role of androgen in prostate cancer

In order to appreciate the therapeutic relevance of these mechanistic distinctions, an understanding of the cellular heterogeneity and responsiveness of prostate cancer cellular subtypes is required. Androgen ablation therapy, whether by surgical or medical means, induces the elimination of only testosterone-dependent prostate cancer cells since these cells require a critical level of physiological androgen for their continuous proliferation and survival (Gao and Isaacs 1998 Gao etal. 2001 Kyprianou etal. 1990). Unfortunately, androgen ablation is not curative because, once clinically detected, prostate cancers are heterogeneously composed of clones of androgen-dependent cancer cells and also malignant clones which are androgen-independent (Isaacs 1999). These latter cells are androgen-independent since androgen occupancy of their nuclear AR is not required for their survival (Isaacs 1999). There are two basic subtypes of such androgen-independent prostate cancer cells. One subtype...

Cancer The Conventional View

Our bodies are amazing in the way trillions of cells are made and distributed throughout a complex network of systems. Normal cells grow, reproduce, and die in response to internal and external signals from our body. When normal cells mutate or change into cancer cells, then the problem begins. Cancer is the abnormal growth, reproduction, and spread of body cells. These cells do not obey the normal signals of the body that control other cells, and behave independently instead of working in harmony with your system. Sometimes cancer cells reproduce and form a lump or tumor. If the tumor is self-contained and doesn't spread, it's called benign and is usually surgically removed. If tumor cells grow, divide, damage the normal cells around them, and invade other tissue or travel through your bloodstream, the cells are called malignant or cancerous. Metastasis refers to a malignant tumor's cells that enter the bloodstream. The danger comes from the spread of these cancer cells to other...

Fallopian Tube Cancer

Primary tumors of the fallopian tube are extremely rare entities, accounting for less than 1 of gynecologic malignancies.37 These tumors appear to behave in a manner similar to ovarian cancer and are classified and treated in much the same way. Some fallopian tube neoplasms may be prone to early blood-borne micrometastasis, resulting in poor long-term disease-free survival and contributing to the formation of brain metasta-sis.37,47 The few cases of such brain metastases reported in the irradiation literature were treated with brain irradiation and systemic chemotherapy because of the presence of active pul-

Screening Guidelines for Early Detection of Cancer of the Breast

The National Cancer Institute recommends that women begin receiving screening mammograms every 1 to 2 years starting at 40 years of age and every year once they reach 50 years of age, continuing for as long as a woman is in good health. Screening mammography involves taking low-dose radiographs from two views of each breast, typically from above (craniocaudal view) and from an oblique or angled position (mediolateral-oblique view). Mammography can detect approximately 85 of breast cancers. If the mammogram indicates an abnormality, the woman will most likely be urged to undergo further breast imaging (i.e., with spot-view mammogra-phy, ultrasonography, or other imaging tests). If further imaging confirms or reveals an abnormality, the woman may be referred for a biopsy to determine whether she has breast cancer. Screening mammography can miss 10 to 15 of breast cancers. These tumors can be missed (1) if the tumor is very small (2) if the tumor is in an area not easily imaged (e.g., in...

Relationship With Specific Systemic Cancers

In patients with an unknown primary site and brain metastases, the lung represents the most common primary tumor site discovered antemortem, accounting for between 45 and 83 of identifiable primary sites (see Table 60-2). The lung also appears to be the most common primary site regardless of whether it becomes known early (within 2 months) or late (after 2 months) after the diagnosis of brain metastases.33,46 In contrast, when the primary site is discovered only after autopsy, there does not appear to be a predominant organ of origin.14,26,30 In the general population of patients with brain metastases, the lung is identified as a primary site in 50 to 70 of patients and is followed in frequency by breast cancer metastases in women.24,34,49 By comparison, the breast appears to be under-represented as a primary tumor site in patients in whom the site these studies, the abdominal and pelvic organs are typically the second most common primary site. This difference may be a result of the...

Genetic screening of cancer

As cancer has a strong genetic basis, genetic screening should have potential applications for determining prognostic information. In classic monogenic (one-gene) familial genetic disorders such as Huntington's disease, screening of potentially affected family members can allow people to know what their chances are of developing a disease. Screening can also allow potential parents to know what the likelihood is of any future offspring developing the condition. Unfortunately in cancer studies this is not as straightforward, as a result of the complexity of cancer genetics. Inherited cancer syndromes that act similarly to classic genetic diseases cause only about 1 of human cancer. A further 5-10 of all cancers (depending on how strictly defined) have a more general familial basis (Ponder, 2001). In these families several cases of common cancers are found, usually falling into general groups of cancers (e.g. breast and ovary, or colon, endometrium and urinary). Only these rarer...

Future applications of cancer genetics chemosensitivity and gene therapy

Aside from the applications of genetic screening in the small number of familial cancers, genetic technologies will have more and more applications in the research and treatment of cancer. By defining the genetic abnormalities and alterations in specific types of cancer, we have massively increased our understanding of how these tumours develop, helping us to understand how to target and fight them, and at the same time discovering new drug targets. The closer that specific tumour cells have been studied, the more genetic abnormalities and differences in their genetic profile have been discovered, even in cells that are supposedly from the same tumour type. Techniques such as DNA microchips are allowing us simultaneously to profile many of the genetic changes from tumour to tumour. The more we understand how certain tumours with certain molecular profiles behave, the more we will be able specifically to tailor treatments for them. Eventually we will be able to tailor specific drug...

Risk Factors for the Development of Urethral Cancer

The risk factors associated with the development of urethral cancer include advancing age, chronic inflammation of the urethra, and urethral stricture disease. Previous urethral surgery and radiotherapy are also risk factors as are immunosuppression and smoking. Infection of the distal urethra with HPV-16 has also been implicated.2,14 A study by Cupp et al. reported that all six of their patients diagnosed with distal urethral carcinomas and one at the penoscrotal junction was HPV-16 positive whereas no HPV-16 DNA was detected in the remaining nine proximal urethral carcinomas.14 This suggests that the pathogenesis in the development of distal and proximal urethral carcinomas may differ.

Staging of Urethral Cancer

The most commonly used staging system utilizes the TNM classification as indicated in the 2010 AJCC cancer staging handbook (Table 8.3).13 Table 8.5 Reported frequency of the presenting symptoms for patients with urethral cancer Table 8.5 Reported frequency of the presenting symptoms for patients with urethral cancer

The Clinical Presentation of Male Urethral Cancer

The diagnosis of early urethral cancer is difficult and the presentation is often delayed by which time the tumor is obvious. Urethral bleeding, urethral discharge, and hematuria are common presenting symptoms as are urinary frequency and obstructive voiding symptoms (Table 8.5). Recurrent urethral strictures, penile pain, and even a palpable mass in the penile urethra may also be a presenting feature. In the later stages periurethral abscesses, urethrocutaneous fistulae, and incontinence may also occur.

The Diagnosis and Investigation of Urethral Cancer

The management of urethral cancer depends on the anatomical location of the tumor and the staging of the primary lesion and the status of the inguinal lymph nodes. Examination of the penis may reveal a discrete nodular lump in the anterior urethra. More distal tumours progressively infiltrate the glans spongiosum and eventually extend out of the urethral meatus (Fig. 8.2). The physical examination should also include a bilateral inguinal examination in order to detect the presence of palpable lymphadenopathy. Cytological examination of the urine may detect the presence of malignant cells, although it is noted that voided urine cytology has a high sensitivity

NonMEN Familial Hyperparathyroidism and Parathyroid Cancer

Both parathyroid cancer and NMFH are rare parathyroid disorders. The association of these rare conditions suggests a common cause. Until 2002, 29 patients with NMFH and parathyroid cancer in 22 families were reported.16,21,23,27*33,35,43 Sixteen of these families have NMFH-JT or FIH-JT, and about one fourth of reported NMFH families have one or two affected members suffering from parathyroid cancer. Endocrinologists and surgeons should be aware of this association for proper management of these patients. Reviews of 15 cases of NMFH and cancer were reported before 1993. The mean age of the patients with NMFH and parathyroid cancer at initial diagnosis was 30 years (range, 14 to 43 years), which is considerably younger than that of other patients with parathyroid cancer (50 years) (Table 55-3).41 Seven males and eight females were affected. The clinical manifestations among these patients were similar to those of other patients with parathyroid cancer. The mean serum calcium level was...

The Role of Radiotherapy in the Management of Urethral Cancer

External beam radiotherapy (EBRT) and brachytherapy implants or a combination of both have been used in the management of urethral tumors. Historically EBRT has been used in the adjuvant setting following surgery for male urethral cancer but is often a primary treatment for urethral cancers in females. A number of studies have shown that the outcomes following radiotherapy alone are poor.3 3 However, these studies involve selected patients who may have presented with poor prognostic features or a poor performance status, hence prevented radical surgery being undertaken. However, the nonuniformity of the patients and the treatments given in these studies does not lend itself to providing recommendations. Advanced urethral cancers fared worse with the survival rate declining to 34 .1,27 In locally advanced tumors the use of radiotherapy alone again shows poor results. There is some evidence to suggest that a combination of brachytherapy with EBRT with the aim of increasing the overall...

Cancer Treatmentrelated Pain

Up to a third of women develop pain as a result of treatment of breast cancer.173 The pain is often described as a general burning and aching sensation referred to the axilla, the medial upper arm, the chest, or all of these areas. There may be paroxysmal episodes of shooting and lancinating pain. In addition, some women report phantom breast pain, mainly in the nipple. The pain may be exacerbated with arm movement, leading to a frozen shoulder as the patient attempts to

The immune system and cancer

The interrelationship of immune response, old age and high incidence of cancer In recent years several factors have been associated with the development of human cancers, including smoking, dietary factors, infectious agents (viruses and bacteria), chemicals, radiation and hereditary factors (see Chapter 2). The treatment of normal cells with these factors results in the mutation of a wide range of genes such as tumour suppressor genes or genes coding for growth factor, growth factor receptors, and motility and invasion factors. Such As the incidence of cancer increases rapidly in old age, ageing is another important factor associated with human cancers. Around 65 of all cancers are diagnosed in people over the age of 65. Although the increasing accumulation of mutations in genes with time can be one factor that contributes to the high incidence of cancers in old age, recent evidence suggests that malfunction of the immune system may also contribute to the high incidence of cancers in...

What Happens if the Cancer Spreads or Comes Back

Living with prostate cancer, said one man, is ''like being trapped inside a cage with a baby lion.'' In the beginning, the lion is small and nonthreatening, but you know that the lion will grow and may eventually devour you. This man's cancer did spread and in the end did ''devour'' him.1 Prior to the PSA era, by the time of diagnosis the prostate cancer would have already spread beyond the prostate in the majority of cases. By the 1990s, this number had been reduced to one third, and by now it is presumably significantly lower than that. Prostate cancers that have spread at the time of diagnosis present many of the same treatment problems as cancers that recur after the initial treatment. In some cases, the recurrence is expected because of a Gleason score of 8 to 10, a PSA over 20, or other indicators of a large and serious cancer. In other cases, the recurrence of the cancer is unexpected, as when a man has a low Gleason score, a low PSA, and a small tumor. Some of these men are...

The Future of Epithelial Cancer Therapy

He goal of cancer research is to improve our ability to prevent and cure epithelial cancers like breast cancer. Though our achievements in cancer prevention are less than impressive, Mario's and Joan's stories show that we have made great progress in curing patients. But even in childhood leukemia and stage 3A breast cancer, two types of cancer that are very responsive to modern treatment, we only cure 80 percent of those who are afflicted. That is a huge increase in the cure rate over the nearly fifty years of my experience, but it isn't good enough. We need much more understanding of epithelial cancer biology if we are to develop the treatments that will capture the last 20 percent. Fortunately, we are gaining that vital knowledge. Cancer is an acquired genetic disease, and we are learning a vast amount about the human genome. As a result, we know much more about the genetic changes that cause cancer. From that knowledge we will gain new and much smarter therapeutic options and have...

Treatment Options For Recurrent Cancer

There are two goals in treating prostate cancer that has spread (1) improve the quantity of the man's life, and (2) improve the quality of the man's life. The dilemmas in treatment arise when attempts to improve quantity make the quality worse, not better. Honest assessments of treatment options are crucial to resolving these dilemmas. The mainstay for treating recurrent prostate cancer is hormone therapy, as described in Chapter 5. Prostate cancers use testosterone to grow, so blocking testosterone slows the growth. Prostate cancers contain cells that are sensitive to testosterone and other cells that are not sensitive. Over time the testosterone-insensitive cells become predominant and hormone therapy becomes ineffective. The cancer is then called androgen independent. The average duration of effectiveness for hormone therapy for a prostate cancer that has already metastasized is approximately two years,10 but during that time men often have comfortable remissions. One of the two...

Cancerous Hens and Constipated Mice

For the moment, Ken did not need any treatment because he had no detectable disease. The cells that had been scattered around his abdomen when the tumor ruptured had not yet formed new cancers. But Ken knew that time would change the situation. Sooner or later, his abdomen would become full of GIST tumors, and they would kill him if they were not stopped in their tracks. The story about how GIST was identified, how Gleevec might ameliorate it, and the start of the present cancer treatment revolution has its roots in the nineteenth century when a strange cancer epidemic was repeatedly sweeping through U.S. poultry farms where hens were packed tightly together. Typically the affected birds would develop swollen bellies and gasp for breath. When the hens were cut open, their abdomens were full of masses of cells cancers. Or, less commonly, the birds would grow large tumors on their wings. In most outbreaks the tumors seemed to be masses of white blood cells, but some of the time the...

Insights Gained in the Role of EGFR in Cancer

Abnormalities in egfr copy number are frequent in cancer. In a report that investigated egfr and EGFR expression (by fluorescent in situ hybridization FISH and immunohistochemistry IHC , respectively) in 183 NSCLC patients, trisomy, polysomy and gene amplification were observed in 40 percent, 13 percent and 9 percent of the cases, respectively (50). EGFR over-expression was observed in 62 percent of the cases and correlated with increased gene copy number. Increased EGFR gene copy number detected by FISH is associated with improved survival after gefitinib therapy in patients with NSCLC (51). In this report, amplification or high polysomy of the egfr (documented in 33 of 102 patients) and high protein expression (observed in 58 of 98 patients) were significantly associated with better response (36 versus 3 , mean difference 34 , 95 CI 16.6 to 50.3 P < 0.001), disease control rate (67 versus 26 , mean difference 40.6 , 95 CI 21.5 to 59.7 P < 0.001), time to progression (9.0 versus...

Psychological Responses to Cancer

As we've said, about half of cancer patients adjust normally to being ill with cancer, leaving about half whose psychological problems may become debilitating. Of those, about two-thirds suffer from reactive anxiety and depression that is, new anxiety and depression that are a direct response to the illness. However, when in pain, patients are about twice as likely to develop anxiety and depression than those whose pain is well controlled.1 Undergoing chemotherapy may be a particularly emotional time often more so than during radiation treatments or surgery, because of concerns about unpleasant side effects that may or may not occur. Often the first chemotherapy treatments and those with very high chances of success are first associated with upbeat and hopeful feelings. If the cancer advances, the frequency of psychiatric problems among cancer patients increases, as might be expected. It is, of course, always difficult to know whether some of these symptoms (poor appetite and sleep,...

The Typical Distress of Cancer Patients

From the moment a lump is spotted, a mysterious and insistent pain nags, or sudden weight loss is noticed, almost everyone experiences some anxiety. First, an unspoken fear nags that it could be cancer. If a doctor confirms it, new fears arise concerns about treatment, pain, disfigurement, and even death. The anxiety can mushroom into panic or chronic anxiety that can threaten the patient's ability to cope and comply with treatment recommendations. Some people react to cancer by detaching themselves from decisions about their medical treatment, discussions about their illness, and, in the advanced stages of cancer, thoughts of death and dying. This detachment is another form of denial and serves as a buffer for the patient and to protect family members. Like the other negative emotions discussed here, this is normal up to a point. This form of denial may be just another step in coming to terms with a very unpleasant situation, but if it persists, professional counseling can help....

The Cancer Counselling Center of Ohio

The Cancer Counselling Center of Ohio has worked mainly with persons who have a life-threatening or chronic illness. Loss (of job, of money, of physical mobility, etc.) and possible death are constants in the treatment process. Zimpfer's (1992) holistic model includes perspectives that focus on the body, mind, spirit, and emotions. A spirit of harmony among these dimensions is sought, whether one strives to maintain a life amid losses, or whether one anticipates death. The model is based on the concept of wellness Our experience with persons who have cancer is that they are often isolated. Their associates at work, their neighbors, relatives, even fellow churchgoers, will 'write them off' as already dead and interact with them no longer. A spouse may abandon the ill one on the premise that he she didn't get married to take care of an invalid. Sometimes spouses or friends exert pressure to 'get well', or accuse the ill one of not trying hard enough. This only compounds the desolation,...

Cancer as a Post Traumatic Stress Disorder

When people believe the diagnosis of cancer is a life-threatening event, they may be thrown into a series of psychological changes that are similar to those triggered by combat, rape, physical, sexual abuse, or other traumatic events that are outside the range of everyday experience. These psychological changes are collectively called post-traumatic stress disorder (PTSD), and in the cancer patient may include attempts to avoid all thoughts or feelings associated with the illness forgetfulness about what the doctor has said a sudden loss of interest in things that used to be meaningful, such as young children or a job one loved feeling and acting estranged from others inability to have or express loving feelings and a sense of a suddenly foreshortened future.

Biological Cancer Treatments

The Gerson regimen is an example of an old alternative cancer treatment that remains popular today. Developed by Max Gerson in the 1930s, it involves eating raw fruit and vegetable juices, eliminating salt from the diet, taking many supplements such as potassium, vitamin B12, thyroid hormone and pancreatic enzymes, and using coffee enemas to detoxify the liver and stimulate metabolism. Scientific research does not support any of these ideas. Moreover, despite proponents' claims of recovery rates as high as 70 to 90 , case reviews by the U.S. National Cancer Institute (NCI) and the New York County Medical Society found no evidence of usefulness for this regimen. An NCI-sponsored study of Gonzalez therapy, which is similar to the Gerson diet and popular today, showed that patients with inoperable pancreatic cancer who underwent standard gemcitabine chemotherapy survived three times longer and had better quality of life than those who chose Gerson-type therapy with pancreatic enzymes,...

Cancer Prevention And Environmental Risk

In a speech that she gave at a community forum in 1996 entitled The Politics of Breast Cancer, Nancy Evans, then president of BCA, quoted this passage, which she attributed to a speech delivered by Sandra Steingraber in Santa Fe, New Mexico, in 1994. I quote it here partly to illustrate the way discourses traveled within the culture of environmental cancer activism. 2. I began doing participant observation of the TLC in October 1994, shortly after its formation. Most of the information on the history of the TLC comes from my notes on those meetings and from my participation in early events, including the 1994 demonstration at Race for the Cure. The information about the first two meetings of the TLC is based on interviews with cancer activist Judy Brady and on the public recounting of this history at various events. I conducted participant observation research with the TLC from 1994 to 1999. 3. Quotation taken from AstraZeneca International, Community and Company Projects US Breast...

Nonsmall Cell Lung Cancer

The first step in treatment of NSCLC involves confirmation of the clinical stage and determination of resectability of the tumor. This decision should always be made by a thoracic surgeon who routinely performs lung cancer surgery. Treatment options depend on the advancement of disease (i.e., local, locally advanced, or metastatic), PS, and eligibility for resection.

Penile Cancer Imaging

As regards neoplasms of the penis, it has been demonstrated that lymphotropic nano-particle-enhanced magnetic resonance imaging (LNMRI) with ferumoxtran-10 can accurately predict the pathological status of regional lymph nodes.33,34 Ferumoxtran-10 is made up of superparamagnetic iron oxide nanoparticles, which are phagocytosed by macrophages in normal lymph nodes and these show homogeneous uptake of ferumoxtran-10 and appear dark on T2-weighted MR images. However, lymph nodes containing metastases lack these macrophages and subsequently do not accumulate the nanoparticles and appear bright on T2 imaging. Using this technique it is possible to detect subcentimeter metastases in morphologically normal lymph nodes and also to accurately differentiate malignancy from enlarged reactive lymph nodes. In seven patients with penile cancer, MRI with lymphotrophic nanoparticles was 100 sensitive and 97 specific for lymph node metastasis.33

Paraneoplastic Retinal Degeneration or Cancer Associated Retinopathy

Sera from patients with paraneoplastic retinal degeneration or cancer-associated retinopathy contain antibodies binding antigens that are both a photoreceptor cell-specific protein and a protein expressed by small cell lung cancer. y Pathologically, widespread degeneration of the outer retinal layers with relative preservation of the other retinal layers occurs. This syndrome is usually associated with small cell lung cancer but is also observed with other tumors, including melanoma and cervical cancer. The distinctive clinical triad consists of photosensitivity, ring scotomatous visual field loss, and attenuated caliber of retinal arterioles. U

Colorectal Cancer Prevention

Strategies to prevent colorectal cancer can be done with pharmacologic or surgical interventions and involve either preventing the initial development of colorectal cancer (primary prevention) or preventing cancer in patients that demonstrate early signs of colorectal cancer (secondary prevention). The most widely studied agents for the chemoprevention of colorectal cancer are agents that inhibit COX-2 (aspirin, NSAIDs, and selective COX-2 inhibitors) and calcium supplementation.19 COX-2 appears to play a role in polyp formation and COX-2 inhibition suppresses polyp growth. In 1999, the FDA approved the use of celecoxib to reduce the number of colorectal polyps in patients with FAP, as an adjunct to usual care. This may delay the need for surgical intervention in these patients but the results cannot be extrapolated to the general population. The dose of celecoxib for this indication is 400 mg orally twice daily and the risk of cardiovascular damage from COX-2 inhibition needs to be...

Differentiated Thyroid Cancers

The two primary types of differentiated thyroid cancers are papillary and follicular. Several variants exist and include a follicular variant of papillary carcinoma, a tall cell variant of papillary carcinoma and a Hurthle cell carcinoma which is a variant of follicular carcinoma. The latter two subtypes are more ominous lesions. Primary surgery is the initial treatment approach. The surgical therapeutic decisions are based on prognostic variables. At Memorial Sloan-Kettering Cancer Center, those patients who are felt to be at high risk are assessed based on GAMES, for example (1) Grade high, (2) Age > 45 years, (3) Metastasis positive, (4) Extracapsular extension positive, (5) Size > 4 cm.89 The patients at low risk do well irrespective of the extent of surgery. The surgical goal is to remove all gross disease that is clinically detectable. The different operations represent the variations in the volume of the thyroid gland that is resected and include partial thyroidectomy and...

Hereditary Breast and Ovarian Cancer

A family history of premenopausal breast cancer in a first-degree relative doubles personal breast cancer risk. These women may benefit from earlier screening and should be counseled about the benefits of early detection. An autosomal dominant pattern of inheritance is seen in a much smaller number of families, perhaps 5 of women with breast cancer, known as hereditary breast and ovarian cancer (HBOC) syndrome. Current USPSTF guidelines suggest that physicians should recognize individuals from such families Women with BRCA mutations may have up to an 80 lifetime risk of breast cancer and a 40 risk of ovarian cancer depending on the mutation. The risk of other cancers is also greater, although less so. It is important to recognize that males with a BRCA mutation develop breast cancer at much higher rates than the general population. In fact, a diagnosis of male breast cancer should lead to a careful review of family history. Personal risk depends on the specific gene variant involved...

Hereditary Colorectal Cancer

About 10 of the general population has a first-degree relative with colorectal cancer (CRC) this history increases personal lifetime risk for CRC to 9 to 16 . Many guidelines recommend early screening for these individuals by age 40, or 10 years earlier than the age at diagnosis of a family member. Early detection and removal of adenomatous polyps have made determining family history more difficult. Patients should be asked about removal of polyps in relatives, and those who have adenomatous polyps should be encouraged to tell their families. A family history that contains many relatives with CRC, adenomatous polyps, or endometrial cancer, especially in more than one generation or with early-onset (age < 50) suggests an autosomal dominant pattern of inheritance. Two relatively common, autosomal dominant, hereditary colorectal cancer syndromes account for about 3 to 5 of all CRC cases. Lynch syndrome, or hereditary nonpolyposis colon cancer syndrome (HNPCC), occurs in about 1 in 200...

The Prostate Cancer Research Program

The Prostate Cancer Research Program is run by the U.S. Army under the Department of Defense. Its origins are a classic Washington tale. In 1992, women's advocacy groups for breast cancer research were putting pressure on the federal government to increase funding. Representative Patricia Schroeder, at that time, chaired the House Armed Services Committee, overseeing spending by the Department of Defense. Since expenditures for the National Cancer Institute were restricted by federal regulations, Schroeder arranged to give 25 million to the Army to coordinate additional breast cancer research. Over the next three years, Congress added 390 million more and asked the Institute of Medicine to evaluate the program. The evaluating committee published its report in 1997, calling the Department of Defense breast cancer research ''a unique and valuable entity,'' especially for its ''potential to focus on innovation, in ways that go beyond what traditional institutions like the National...

Patients Experiences Prior to and at the Time of Diagnosis of Penile Cancer

Psychology undoubtedly plays a role in the delay in diagnosis that is commonly seen in this disease as evidenced by the frequency with which patients present with advanced cancer, and the significant delay that commonly occurs between the development of symptoms and the presentation to a physician. For instance, in one series of 700 men, over 50 had at least T2 disease at the time of diagnosis and treatment1 while in a second series of men with a localized tumor of the penis, treated by laser therapy, over a third of patients experienced a delay of more than 6 months between the appearance of symptoms and the definitive diagnosis being made.2 While some of the delays undoubtedly reflect medical misdiagnosis, it has been suggested that between 15 and 50 of men delay seeking treatment for penile cancer for psychological reasons.3 These reasons include fear, embarrassment, and symptom denial despite the abnormality being clearly visible and palpable. While there is a suggestion that this...

List of Links Related to Cancer Pain Resources

National Cancer Institute Information Resources Pain Control Program from Cancer Supportive Care http www.cancersupportivecare.com pain.html Pain Management in Children with Cancer Handbook Patt Center for Cancer Pain and Wellness Based in Houston, Texas, this Web site provides medical care for patients suffering from cancer pain or chronic pain, http www.cancerpain.org Persistent Pain After Breast Surgery Includes articles about cancer pain, discussion boards, and Ask the Expert, http Publishes Cancer Pain Relief, second edition (1996), available in English, Spanish, and French, and Cancer Pain Relief and Palliative Care in Children. WHO Publications Center USA 49 Sheridan Ave Albany, NY 12210 518-436-9686 Fax 518-436-74 33

Michael Milkens Prostate Cancer Foundation

Ironically, both Giuliani and Milken were subsequently diagnosed with prostate cancer and became friends and national advocates for prostate cancer sufferers. Milken was diagnosed with prostate cancer in 1993, shortly after his release from prison. Just 46 years old, he had a Gleason score of 9, a PSA of 24, and the cancer had already spread to his lymph nodes. He was treated with beam radiation and hormones and began a very strict diet thirteen years later he remains in remission. Milken approached prostate cancer in the same manner he had approached Wall Street securities. ''I decided that I had to change the course of history,'' he recalls, and proposed ''a Manhattan Project'' for prostate cancer to discover the causes and better treatments.5 He pledged 25 million of his own funds and in 1993 began CaPCURE (cancer of the prostate cure), a foundation that in 2003 was renamed the Prostate Cancer Foundation (PCF). Milken has accomplished a remarkable...

Research ethics relating to cancer

Research is surely a good thing it is not immediately obvious that there are any ethical considerations beyond some sort of imperative to undertake it. After all, there would be no reliably effective treatment and care were it not for research and the evidence base of health-care interventions would simply not exist. Effective cancer care and treatment, perhaps more than any other discipline, rely on previous and current research and we hope that future endeavours will provide hitherto elusive, curative treatment for some of the most serious cancers. Although strongly supporting research, this chapter aims to elucidate necessary limits on the enterprise. These limits may be identified by considering issues such as the motives of the researcher, the value of the research and, most importantly, the welfare of participants. In simple terms, these limits highlight the differences between research (which might actually provide extremely useful knowledge) and ethical research. research...

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

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