Different Kinds of Deadly Cancer

Gastrointestinal Carcinoid Tumor

2008-08-29T20:38:00.000-07:00

General Information About Gastrointestinal Carcinoid Tumors

A gastrointestinal carcinoid tumor is cancer that forms in the lining of the gastrointestinal tract.

The gastrointestinal tract includes the stomach, small intestine, and large intestine. These organs are part of the digestive system, which processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) in foods that are eaten and helps pass waste material out of the body. Gastrointestinal carcinoid tumors develop from a certain type of hormone-making cell in the lining of the gastrointestinal tract. These cells produce hormones that help regulate digestive juices and the muscles used in moving food through the stomach and intestines. A gastrointestinal carcinoid tumor may also produce hormones. Carcinoid tumors that start in the rectum (the last several inches of the large intestine) usually do not produce hormones.

Gastrointestinal carcinoid tumors grow slowly. Most of them occur in the appendix (an organ attached to the large intestine), small intestine, and rectum. It is common for more than one tumor to develop in the small intestine. Having a carcinoid tumor increases a person's chance of getting other cancers in the digestive system, either at the same time or later.

Health history can affect the risk of developing gastrointestinal carcinoid tumors.

Risk factors include the following:

Having a family history of multiple endocrine neoplasia type 1 (MEN1) syndrome.
Having certain conditions that affect the stomach's ability to produce stomach acid, such as atrophic gastritis, pernicious anemia, or Zollinger-Ellison syndrome.
Smoking tobacco.

A gastrointestinal carcinoid tumor often has no signs in its early stages. Carcinoid syndrome may occur if the tumor spreads to the liver or other parts of the body.

The hormones produced by gastrointestinal carcinoid tumors are usually destroyed by blood and liver enzymes. If the tumor has spread to the liver, however, high amounts of these hormones may remain in the body and cause the following group of symptoms, called carcinoid syndrome:

Redness or a feeling of warmth in the face and neck.
Diarrhea.
Shortness of breath, fast heartbeat, tiredness, or swelling of the feet and ankles.
Wheezing.
Pain or a feeling of fullness in the abdomen.

These symptoms and others may be caused by gastrointestinal carcinoid tumors or by other conditions. A doctor should be consulted if any of these symptoms occur.

Tests that examine the blood and urine are used to detect (find) and diagnose gastrointestinal carcinoid tumors.

The following tests and procedures may be used:

Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:

The number of red blood cells, white blood cells, and platelets.
The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
The portion of the sample made up of red blood cells.

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as hormones, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it. The blood sample is checked to see if it contains a hormone produced by carcinoid tumors. This test is used to help diagnose carcinoid syndrome.
Twenty-four-hour urine test: A test in which a urine sample is checked to measure the amounts of certain substances, such as hormones. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it. The urine sample is checked to see if it contains a hormone produced by carcinoid tumors. This test is used to help diagnose carcinoid syndrome.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

Whether the cancer can be completely removed by surgery.
Whether the cancer has spread from the stomach and intestines to other parts of the body, such as the liver or lymph nodes.
The size of the tumor.
Where the tumor is in the gastrointestinal tract.
Whether the cancer is newly diagnosed or has recurred.

Treatment options also depend on whether the cancer is causing symptoms. Most gastrointestinal carcinoid tumors are slow-growing and can be treated and often cured. Even when not cured, many patients may live for a long time.

Stages of Gastrointestinal Carcinoid Tumors

After a gastrointestinal carcinoid tumor has been diagnosed, tests are done to find out if cancer cells have spread within the stomach and intestines or to other parts of the body.

Staging is the process used to find out how far the cancer has spread. The information gathered from the staging process determines the stage of the disease. There are no standard stages for gastrointestinal carcinoid tumors. In order to plan treatment, it is important to know the extent of the disease and whether the tumor can be removed by surgery. The following tests and procedures may be used:

Gastrointestinal endoscopy: A procedure to look inside the gastrointestinal tract for abnormal areas or cancer. An endoscope (a thin, lighted tube) is inserted through the mouth and esophagus into the stomach and first part of the small intestine. Also, a colonoscope (a thin, lighted tube) is inserted through the rectum into the colon (large intestine); this is called a colonoscopy.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
Somatostatin receptor scintigraphy (SRS): A type of radionuclide scan used to find carcinoid tumors. In SRS, radioactive octreotide, a drug similar to somatostatin, is injected into a vein and travels through the bloodstream. The radioactive octreotide attaches to carcinoid tumor cells that have somatostatin receptors. A radiation-measuring device detects the radioactive material, showing where the carcinoid tumor cells are in the body. This procedure is also called an octreotide scan.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. Tissue samples may be taken during endoscopy and colonoscopy.
Angiogram: A procedure to look at blood vessels and the flow of blood. A contrast dye is injected into the blood vessel. As the contrast dye moves through the blood vessel, x-rays are taken to see if there are any blockages.
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.
X-ray of the abdomen: An x-ray of the organs and tissues inside the abdomen. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Gastrointestinal carcinoid tumors are grouped for treatment based on where they are in the body.

Localized

Cancer is found in the appendix, colon, rectum, small intestine, and/or stomach only.

Regional

Cancer has spread from the appendix, colon, rectum, stomach, and/or small intestine to nearby tissues or lymph nodes.

Metastatic

Cancer has spread to other parts of the body.

Recurrent Gastrointestinal Carcinoid Tumors
A recurrent gastrointestinal carcinoid tumor is a tumor that has recurred (come back) after it has been treated. The tumor may come back in the stomach or intestines or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with gastrointestinal carcinoid tumors.

Different types of treatment are available for patients with gastrointestinal carcinoid tumors. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Seven types of standard treatment are used:

Surgery

Treatment of gastrointestinal carcinoid tumors usually includes surgery. One of the following surgical procedures may be used:

Appendectomy: Removal of the appendix.
Fulguration: Use of an electric current to burn away the tumor using a special tool.
Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy. The doctor may use ultrasound to guide the instrument.
Resection: Surgery to remove part or all of the organ that contains cancer. Resection of the tumor and a small amount of normal tissue around it is called a local excision.
Bowel resection and anastomosis: Removal of the bowel tumor and a small section of healthy bowel on each side. The healthy parts of the bowel are then sewn together (anastomosis). Lymph nodes are removed and checked by a pathologist to see if they contain cancer.
Radiofrequency ablation: The use of a special probe with tiny electrodes that release high-energy radio waves (similar to microwaves) that kill cancer cells. The probe may be inserted through the skin or through an incision (cut) in the abdomen.
Hepatic resection: Surgery to remove part or all of the liver.
Hepatic artery ligation or embolization: A procedure to ligate (tie off) or embolize (block) the hepatic artery, the main blood vessel that brings blood into the liver. Blocking the flow of blood to the liver helps kill cancer cells growing there.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Chemoembolization of the hepatic artery is a type of regional chemotherapy that may be used to treat a gastrointestinal carcinoid tumor that has spread to the liver. The anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug is mixed with a substance that embolizes (blocks) the artery, cutting off blood flow to the tumor. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on the substance used to block the artery. The tumor is prevented from getting the oxygen and nutrients it needs to grow. The liver continues to receive blood from the hepatic portal vein, which carries blood from the stomach and intestine.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Percutaneous ethanol injection

Percutaneous ethanol injection is a cancer treatment in which a small needle is used to inject ethanol (alcohol) directly into a tumor to kill cancer cells. This procedure is also called intratumoral ethanol injection.

Biologic therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

Other drug therapy

MIBG (metaiodobenzylguanidine) is sometimes used, with or without radioactive iodine (I131), to lessen the symptoms of gastrointestinal carcinoid tumors.

Other types of treatment are being tested in clinical trials.

Treatments being studied in clinical trials for gastrointestinal carcinoid tumors include new combinations of chemotherapy. Information about these and other ongoing clinical trials is available from the NCI Web site.

Treatment Options for Gastrointestinal Carcinoid Tumors

Localized Gastrointestinal Carcinoid Tumors
Carcinoid tumors in the appendix

Treatment of localized gastrointestinal carcinoid tumors in the appendix may include the following:

Appendectomy.
Appendectomy and local excision.
Appendectomy, bowel resection with anastomosis, and removal of lymph nodes.

Rectal carcinoid tumors

Treatment of localized gastrointestinal carcinoid tumors in the rectum may include the following:

Fulguration.
Local excision.
Resection.

Surgery that saves the sphincter muscles (the muscles that open and close the anus) may be possible.

Small bowel carcinoid tumors

Treatment of localized gastrointestinal carcinoid tumors in the small intestine may include the following:

Local excision.
Resection with removal of nearby lymph nodes.

Gastric, colon, and pancreatic carcinoid tumors

Treatment of localized gastrointestinal carcinoid tumors in the stomach, colon, or pancreas is usually resection.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with localized gastrointestinal carcinoid tumor.

Regional Gastrointestinal Carcinoid Tumors
Treatment is usually surgery to remove all the cancer that can be seen at the site of the original tumor, as well as nearby tissues and lymph nodes.

If the tumor cannot be completely removed by surgery, treatment is usually palliative therapy to relieve symptoms and improve the patient's quality of life. This may include the following:

Resection, cryosurgery, or radiofrequency ablation to remove as much of the tumor as possible.
Chemoembolization to shrink tumors in the liver.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with regional gastrointestinal carcinoid tumor.

Metastatic Gastrointestinal Carcinoid Tumors
Distant metastases

If the metastatic gastrointestinal carcinoid tumor is not causing symptoms, there may be a period of watchful waiting before treatment is given. Treatment of distant metastases of gastrointestinal carcinoid tumors is usually palliative therapy that may include the following:

Surgery to bypass or remove part of a tumor blocking the small intestine.
Chemotherapy, which may include chemoembolization.
Radiation therapy, sometimes with radioisotopes such as radioactive iodine (I131).
MIBG (metaiodobenzylguanidine) therapy.
Biologic therapy and/or hormone therapy.
Clinical trials of new treatments.

Carcinoid syndrome

Treatment of metastatic gastrointestinal carcinoid tumors that are causing carcinoid syndrome may include the following:

Resection, cryosurgery, radiofrequency ablation, or percutaneous ethanol injection for tumors in the liver.
Hepatic artery ligation or embolization, with or without regional or systemic chemotherapy.
Hormone therapy.
Biologic therapy with or without chemotherapy.
Clinical trials of new combinations of chemotherapy.

A heart valve replacement may be done for some patients with carcinoid syndrome.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with metastatic gastrointestinal carcinoid tumor.

Recurrent Gastrointestinal Carcinoid Tumors
Treatment of recurrent gastrointestinal carcinoid tumors may include the following:

Surgery to remove part or all of the tumor.
A clinical trial.

Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent gastrointestinal carcinoid tumor.

Gastrointestinal Carcinoid Tumor

2008-08-29T20:36:00.000-07:00

Gastrointestinal Carcinoid Tumor

2008-08-29T20:31:00.000-07:00

Breast Cancer And Pregnancy

2008-08-24T21:45:00.000-07:00

General Information about Breast Cancer and Pregnancy

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. The lobes and lobules are connected by thin tubes called ducts.

Anatomy of the breast, showing lymph nodes and lymph vessels. | View a Larger Version

Each breast also contains blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. The lymph vessels lead to small, bean-shaped organs called lymph nodes that help the body fight infection and disease. Lymph nodes are found throughout the body. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

Breast cancer is sometimes detected (found) in women who are pregnant or have just given birth.

In women who are pregnant or who have just given birth, breast cancer occurs most often between the ages of 32 and 38. Breast cancer occurs about once in every 3,000 pregnancies.

It may be difficult to detect (find) breast cancer early in pregnant or nursing women, whose breasts are often tender and swollen.

Women who are pregnant, nursing, or have just given birth usually have tender, swollen breasts. This can make small lumps difficult to detect and may lead to delays in diagnosing breast cancer. Because of these delays, cancers are often found at a later stage in these women.

Breast examination should be part of prenatal and postnatal care.

To detect breast cancer, pregnant and nursing women should examine their breasts themselves. Women should also receive clinical breast examinations during their routine prenatal and postnatal examinations.

Tests that examine the breasts are used to detect (find) and diagnose breast cancer.

If an abnormality is found, one or all of the following tests may be used:

Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
Mammogram: An x-ray of the breast. A mammogram can be performed with little risk to the fetus. Mammograms in pregnant women may appear negative even though cancer is present. Mammography of the right breast. | View a Larger Version
Biopsy: The removal of cells or tissues by a pathologist so they can be viewed under a microscope to check for signs of cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

The stage of the cancer (whether it is in the breast only or has spread to other places in the body).
The size of the tumor.
The type of breast cancer.
The age of the fetus.
Whether there are symptoms.
The patient’s general health.

Stages of Breast Cancer

After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.

The process used to find out if the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. (Refer to the PDQ summary on Breast Cancer Treatment for more information on the stages used for breast cancer.)

Methods used to stage breast cancer can be changed to make them safer for the fetus.

Standard methods for giving imaging scans can be adjusted so that the fetus is exposed to less radiation. Tests to measure the level of hormones in the blood may also be used in the staging process.

Treatment Option Overview

There are different types of treatment for patients with breast cancer.

Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Treatment options for pregnant women depend on the stage of the disease and the age of the fetus.

Three types of standard treatment are used:

Surgery

Most pregnant women with breast cancer have surgery to remove the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.

Types of surgery to remove the breast include:

Simple mastectomy: A surgical procedure to remove the whole breast that contains cancer. Some of the lymph nodes under the arm may also be removed for biopsy. This procedure is also called a total mastectomy. Total mastectomy. Dotted line shows entire breast is removed. Some lymph nodes under the arm may also be removed. | View a Larger Version
Modified radical mastectomy: A surgical procedure to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.Modified radical mastectomy. Dotted line shows entire breast and some lymph nodes are removed. Part of the chest wall muscle may also be removed. | View a Larger Version

Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:

Lumpectomy: A surgical procedure to remove a tumor (lump) and a small amount of normal tissue around it. Most doctors also take out some of the lymph nodes under the arm.
Partial mastectomy: A surgical procedure to remove the part of the breast that contains cancer and some normal tissue around it. Some of the lymph nodes under the arm may also be removed for biopsy. This procedure is also called a segmental mastectomy.

Breast-conserving surgery. Dotted lines show area containing the tumor that is removed and some of the lymph nodes that may be removed. | View a Larger Version
Even if the doctor removes all of the cancer that can be seen at the time of surgery, the patient may be given radiation therapy, chemotherapy, or hormone therapy after surgery to try to kill any cancer cells that may be left. Treatment given after surgery to increase the chances of a cure is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Radiation therapy should not be given to pregnant women with early stage (stage I or II) breast cancer because it can harm the fetus. For women with late stage (stage III or IV) breast cancer, it should not be given during the first 3 months of pregnancy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Chemotherapy should not be given during the first 3 months of pregnancy. Chemotherapy given after this time does not usually harm the fetus but may cause early labor and low birth weight.

New types of treatment are being tested in clinical trials. These include the following:

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

The effectiveness of hormone therapy, alone or combined with chemotherapy, in treating breast cancer in pregnant women is not yet known.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Ending the pregnancy does not seem to improve the mother’s chance of survival and is not usually a treatment option.

If the cancer must be treated with chemotherapy and radiation therapy, which may harm the fetus, ending the pregnancy is sometimes considered. This decision may depend on the stage of cancer, the age of the fetus, and the mother’s chance of survival.

Treatment Options by Stage

Early Stage Breast Cancer (Stage I and Stage II)
Treatment of early stage breast cancer (stage I and stage II) may be surgery followed by adjuvant therapy as follows:

Modified radical mastectomy.
Breast-conserving surgery: Lumpectomy, partial mastectomy or segmental mastectomy.
Breast-conserving surgery during pregnancy followed by radiation therapy after the baby is born.
Surgery during pregnancy followed by chemotherapy after the first 3 months of pregnancy.
Clinical trials of surgery followed by hormone therapy with or without chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Late Stage Breast Cancer (Stage III and Stage IV)
Treatment of late stage breast cancer (stage III and stage IV) may include the following:

Radiation therapy.
Chemotherapy.

Radiation therapy and chemotherapy should not be given during the first 3 months of pregnancy.

Other Considerations for Pregnancy and Breast Cancer

Lactation (breast milk production) and breast-feeding should be stopped if surgery or chemotherapy is planned.

If surgery is planned, breast-feeding should be stopped to reduce blood flow in the breasts and make them smaller. Breast-feeding should also be stopped if chemotherapy is planned. Many anticancer drugs, especially cyclophosphamide and methotrexate, may occur in high levels in breast milk and may harm the nursing baby. Women receiving chemotherapy should not breast-feed. Stopping lactation does not improve survival of the mother.

Breast cancer does not appear to harm the fetus.

Breast cancer cells do not seem to pass from the mother to the fetus.

Pregnancy does not seem to affect the survival of women who have had breast cancer in the past.

Some doctors recommend that a woman wait 2 years after treatment for breast cancer before trying to have a baby, so that any early return of the cancer would be detected. This may affect a woman’s decision to become pregnant. The fetus does not seem to be affected if the mother has previously had breast cancer.

Effects of certain cancer treatments on later pregnancies are not known.

The effects of treatment with high-dose chemotherapy and a bone marrow transplant, with or without radiation therapy, on later pregnancies are not known.

Male Breast Cancer

2008-08-24T21:44:00.000-07:00

General Information about Male Breast Cancer

Male breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

Breast cancer may occur in men. Men at any age may develop breast cancer, but it is usually detected (found) in men between 60 and 70 years of age. Male breast cancer makes up less than 1% of all cases of breast cancer.

The following types of breast cancer are found in men:

Infiltrating ductal carcinoma: Cancer that has spread beyond the cells lining ducts in the breast. Most men with breast cancer have this type of cancer.
Ductal carcinoma in situ: Abnormal cells that are found in the lining of a duct; also called intraductal carcinoma.
Inflammatory breast cancer: A type of cancer in which the breast looks red and swollen and feels warm.
Paget disease of the nipple: A tumor that has grown from ducts beneath the nipple onto the surface of the nipple.

Lobular carcinoma in situ (abnormal cells found in one of the lobes or sections of the breast), which sometimes occurs in women, has not been seen in men.

Radiation exposure, high levels of estrogen, and a family history of breast cancer can increase a man’s risk of developing breast cancer.

Anything that increases your risk of getting a disease is called a risk factor. Risk factors for breast cancer in men may include the following:

Being exposed to radiation.
Having a disease related to high levels of estrogen in the body, such as cirrhosis (liver disease) or Klinefelter syndrome (a genetic disorder).
Having several female relatives who have had breast cancer, especially relatives who have an alteration of the BRCA2 gene.

Male breast cancer is sometimes caused by inherited gene mutations (changes).

The genes in cells carry the hereditary information that is received from a person’s parents. Hereditary breast cancer makes up approximately 5% to 10% of all breast cancer. Some altered genes related to breast cancer are more common in certain ethnic groups. Men who have an altered gene related to breast cancer have an increased risk of developing this disease.

Tests have been developed that can detect altered genes. These genetic tests are sometimes done for members of families with a high risk of cancer. See the following PDQ summaries for more information:

Genetics of Breast and Ovarian Cancer
Prevention of Breast Cancer
Screening for Breast Cancer

Men with breast cancer usually have lumps that can be felt.

Lumps and other symptoms may be caused by male breast cancer. Other conditions may cause the same symptoms. A doctor should be seen if changes in the breasts are noticed.

Tests that examine the breasts are used to detect (find) and diagnose breast cancer in men.

The following tests and procedures may be used:

Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The following are different types of biopsies:

Needle biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle. This procedure is also called a fine-needle aspiration biopsy.
Core biopsy: The removal of part of a lump or suspicious tissue using a wide needle.
Excisional biopsy: The removal of an entire lump or suspicious tissue.

Estrogen and progesterone receptor test: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If cancer is found in the breast, tissue from the tumor is checked in the laboratory to find out whether estrogen and progesterone could affect the way cancer grows. The test results show whether hormone therapy may stop the cancer from growing.
HER2 test: A test to measure the amount of HER2 in cancer tissue. HER2 is a growth factor protein that sends growth signals to cells. When cancer forms, the cells may make too much of the protein, causing more cancer cells to grow. If cancer is found in the breast, tissue from the tumor is checked in the laboratory to find out if there is too much HER2 in the cells. The test results show whether monoclonal antibody therapy may stop the cancer from growing.

Survival for men with breast cancer is similar to survival for women with breast cancer.

Survival for men with breast cancer is similar to that for women with breast cancer when their stage at diagnosis is the same. Breast cancer in men, however, is often diagnosed at a later stage. Cancer found at a later stage may be less likely to be cured.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

The stage of the cancer (whether it is in the breast only or has spread to other places in the body).
The type of breast cancer.
Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
Whether the cancer is also found in the other breast.
The patient’s age and general health.

Stages of Male Breast Cancer

After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. This process is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Breast cancer in men is staged the same as it is in women. (See the PDQ summary on Breast Cancer Treatment for more information.) The spread of cancer from the breast to lymph nodes and other parts of the body appears to be similar in men and women.

Recurrent Male Breast Cancer

Recurrent breast cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the breast, in the chest wall, or in other parts of the body.

Treatment Option Overview

There are different types of treatment for men with breast cancer.

Different types of treatment are available for men with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Four types of standard treatment are used to treat men with breast cancer:

Surgery

Surgery for men with breast cancer is usually a modified radical mastectomy (removal of the breast, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles).

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical trials. These include the following:

Monoclonal antibodies as adjuvant therapy

Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies are also used in combination with chemotherapy as adjuvant therapy (treatment given after surgery to increase the chances of a cure).

Trastuzumab (Herceptin) is a monoclonal antibody that blocks the effects of the growth factor protein HER2.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Treatment Options for Male Breast Cancer
Breast cancer in men is treated the same as breast cancer in women. (See the PDQ summary on Breast Cancer Treatment for more information.)

Initial Surgery
Treatment for men diagnosed with breast cancer is usually modified radical mastectomy.

Adjuvant Therapy
Therapy given after an operation when cancer cells can no longer be seen is called adjuvant therapy. Even if the doctor removes all the cancer that can be seen at the time of the operation, the patient may be given radiation therapy, chemotherapy, hormone therapy, and/or monoclonal antibody therapy after surgery to try to kill any cancer cells that may be left.

Node-negative: For men whose cancer is node-negative (cancer has not spread to the lymph nodes), adjuvant therapy should be considered on the same basis as for a woman with breast cancer because there is no evidence that response to therapy is different for men and women.
Node-positive: For men whose cancer is node-positive (cancer has spread to the lymph nodes), adjuvant therapy may include the following:

Chemotherapy plus tamoxifen (to block the effect of estrogen).
Other hormone therapy.
A clinical trial of trastuzumab (Herceptin).

These treatments appear to increase survival in men as they do in women. The patient’s response to hormone therapy depends on whether there are hormone receptors (proteins) in the tumor. Most breast cancers in men have these receptors. Hormone therapy is usually recommended for male breast cancer patients, but it can have many side effects, including hot flashes and impotence (the inability to have an erection adequate for sexual intercourse).

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Distant Metastases
Treatment for men with distant metastases (cancer that has spread to other parts of the body) may be hormone therapy, chemotherapy, or both. Hormone therapy may include the following:

Orchiectomy (the removal of the testicles to decrease hormone production).
Luteinizing hormone-releasing hormone agonist with or without total androgen blockade (to decrease the production of sex hormones).
Tamoxifen for cancer that is estrogen-receptor positive.
Progesterone (a female hormone).
Aromatase inhibitors (to lessen the amount of estrogen produced).

Hormone therapies may be used in sequence (one after the other). Standard chemotherapy regimens may be used if hormone therapy does not work. Men usually respond to therapy in the same way as women who have breast cancer.

Treatment Options for Locally Recurrent Male Breast Cancer
For men with locally recurrent disease (cancer that has come back in a limited area after treatment), treatment is usually either:

surgery combined with chemotherapy; or
radiation therapy combined with chemotherapy.

Breast Cancer

2008-08-24T21:40:00.000-07:00

General Information About Breast Cancer

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

Anatomy of the breast, showing lymph nodes and lymph vessels. | View a Larger Version

Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.

Age and health history can affect the risk of developing breast cancer.

Anything that increases your chance of getting a disease is called a risk factor. Risk factors for breast cancer include the following:

Older age.
Menstruating at an early age.
Older age at first birth or never having given birth.
A personal history of breast cancer or benign (noncancer) breast disease.
A mother or sister with breast cancer.
Treatment with radiation therapy to the breast/chest.
Breast tissue that is dense on a mammogram.
Taking hormones such as estrogen and progesterone.
Drinking alcoholic beverages.
Being white.

Breast cancer is sometimes caused by inherited gene mutations (changes).

The genes in cells carry the hereditary information that is received from a person’s parents. Hereditary breast cancer makes up approximately 5% to 10% of all breast cancer. Some altered genes related to breast cancer are more common in certain ethnic groups.

Women who have an altered gene related to breast cancer and who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast. These women also have an increased risk of developing ovarian cancer, and may have an increased risk of developing other cancers. Men who have an altered gene related to breast cancer also have an increased risk of developing this disease. (For more information, refer to the PDQ summary on Male Breast Cancer Treatment.)

Tests have been developed that can detect altered genes. These genetic tests are sometimes done for members of families with a high risk of cancer. (Refer to the PDQ summaries on Screening for Breast Cancer, Prevention of Breast Cancer, and Genetics of Breast and Ovarian Cancer for more information.)

Tests that examine the breasts are used to detect (find) and diagnose breast cancer.

A doctor should be seen if changes in the breast are noticed. The following tests and procedures may be used:

Mammogram: An x-ray of the breast. Mammography of the right breast. | View a Larger Version
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, the doctor may need to cut out a small piece of the lump. Four types of biopsies are as follows:

Excisional biopsy: The removal of an entire lump or suspicious tissue.
Incisional biopsy: The removal of part of a lump or suspicious tissue.
Core biopsy: The removal of part of a lump or suspicious tissue using a wide needle.
Needle biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle. This procedure is also called a fine-needle biopsy.

Estrogen and progesterone receptor test: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If cancer is found in the breast, tissue from the tumor is checked in the laboratory to find out whether estrogen and progesterone could affect the way cancer grows. The test results show whether hormone therapy may stop the cancer from growing.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

The stage of the cancer (whether it is in the breast only or has spread to lymph nodes or other places in the body).
The type of breast cancer.
Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
A woman’s age, general health, and menopausal status (whether a woman is still having menstrual periods).
Whether the cancer has just been diagnosed or has recurred (come back).

Stages of Breast Cancer

After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.

The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

The following stages are used for breast cancer:

Stage 0 (carcinoma in situ)

There are 2 types of breast carcinoma in situ:

Ductal carcinoma in situ (DCIS) is a noninvasive, precancerous condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive.
Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast. This condition seldom becomes invasive cancer; however, having lobular carcinoma in situ in one breast increases the risk of developing breast cancer in either breast.

Pea, peanut, walnut, and lime show tumor sizes. | View a Larger Version

Stage I

In stage I, the tumor is 2 centimeters or smaller and has not spread outside the breast.

Stage IIA

In stage IIA:

no tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm); or
the tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes; or
the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes.

Stage IIB

In stage IIB, the tumor is either:

larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes; or
larger than 5 centimeters but has not spread to the axillary lymph nodes.

Stage IIIA

In stage IIIA:

no tumor is found in the breast, but cancer is found in axillary lymph nodes that are attached to each other or to other structures; or
the tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are attached to each other or to other structures; or
the tumor is larger than 5 centimeters and has spread to axillary lymph nodes that may be attached to each other or to other structures.

Stage IIIB

In stage IIIB, the cancer may be any size and:

has spread to tissues near the breast (the skin or chest wall, including the ribs and muscles in the chest); and
may have spread to lymph nodes within the breast or under the arm.

Stage IIIC

In stage IIIC, the cancer:

has spread to lymph nodes beneath the collarbone and near the neck; and
may have spread to lymph nodes within the breast or under the arm and to tissues near the breast.

Stage IIIC breast cancer is divided into operable and inoperable stage IIIC.

In operable stage IIIC, the cancer:

is found in 10 or more of the lymph nodes under the arm; or
is found in the lymph nodes beneath the collarbone and near the neck on the same side of the body as the breast with cancer; or
is found in lymph nodes within the breast itself and in lymph nodes under the arm.

In inoperable stage IIIC breast cancer, the cancer has spread to the lymph nodes above the collarbone and near the neck on the same side of the body as the breast with cancer.

Stage IV

In stage IV, the cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.

Inflammatory Breast Cancer
In inflammatory breast cancer, the breast looks red and swollen and feels warm. The redness and warmth occur because the cancer cells block the lymph vessels in the skin. The skin of the breast may also show the pitted appearance called peau d’orange (like the skin of an orange). Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.

Inflammatory breast cancer of the left breast showing peau d’orange and inverted nipple. | View a Larger Version

Recurrent Breast Cancer
Recurrent breast cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the breast, in the chest wall, or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with breast cancer.

Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Four types of standard treatment are used:

Surgery

Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.

Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:

Lumpectomy: Surgery to remove a tumor (lump) and a small amount of normal tissue around it.
Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.

Breast-conserving surgery. Dotted lines show area containing the tumor that is removed and some of the lymph nodes that may be removed. | View a Larger Version
Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy. This procedure is called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision.

Other types of surgery include the following:

Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision. Total mastectomy. Dotted line shows entire breast is removed. Some lymph nodes under the arm may also be removed. | View a Larger Version
Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles. Modified radical mastectomy. Dotted line shows entire breast and some lymph nodes are removed. Part of the chest wall muscle may also be removed. | View a Larger Version
Radical mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy, or hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast’s shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time. The reconstructed breast may be made with the patient’s own (nonbreast) tissue or by using implants filled with saline or silicone gel. Before the decision to get an implant is made, patients can call the Food and Drug Administration's (FDA) Center for Devices and Radiologic Health at 1-888-INFO-FDA (1-888-463-6332) or visit the FDA's Web site for more information on breast implants.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of developing endometrial cancer. Women taking tamoxifen should have a pelvic exam every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.

Hormone therapy with an aromatase inhibitor is given to some postmenopausal women who have hormone-dependent breast cancer. Hormone-dependent breast cancer needs the hormone estrogen to grow. Aromatase inhibitors decrease the body's estrogen by blocking an enzyme called aromatase from turning androgen into estrogen.

For the treatment of early stage breast cancer, certain aromatase inhibitors may be used as adjuvant therapy instead of tamoxifen or after 2 or more years of tamoxifen. For the treatment of metastatic breast cancer, aromatase inhibitors are being tested in clinical trials to compare them to hormone therapy with tamoxifen.

New types of treatment are being tested in clinical trials. These include the following:

Sentinel lymph node biopsy followed by surgery

Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the surgeon removes the tumor (breast-conserving surgery or mastectomy).

Sentinel lymph node biopsy. Radioactive substance and/or blue dye is injected near the tumor (first panel), the injected material is followed visually or with a probe (middle panel), and the first lymph nodes to take up the material are removed and checked for cancer cells (last panel).

High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

Studies have shown that high-dose chemotherapy followed by stem cell transplant does not work better than standard chemotherapy in the treatment of breast cancer. Doctors have decided that, for now, high-dose chemotherapy should be tested only in clinical trials. Before taking part in such a trial, women should talk with their doctors about the serious side effects, including death, that may be caused by high-dose chemotherapy.

Monoclonal antibodies as adjuvant therapy

Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies are also used in combination with chemotherapy as adjuvant therapy.

Trastuzumab (Herceptin) is a monoclonal antibody that blocks the effects of the growth factor protein HER2, which transmits growth signals to breast cancer cells. About one-fourth of patients with breast cancer have tumors that may be treated with trastuzumab combined with chemotherapy.

Tyrosine kinase inhibitors as adjuvant therapy

Tyrosine kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow. Tyrosine kinase inhibitors may be used in combination with other anticancer drugs as adjuvant therapy.

Lapatinib is a tyrosine kinase inhibitor that blocks the effects of the HER2 protein and other proteins inside tumor cells. It may be used to treat patients with HER2-positive breast cancer that has progressed following treatment with trastuzumab.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Treatment Options by Stage

Ductal Carcinoma In Situ (DCIS)
Treatment of ductal carcinoma in situ (DCIS) may include the following:

Breast-conserving surgery and radiation therapy with or without tamoxifen.
Total mastectomy with or without tamoxifen.
Breast-conserving surgery without radiation therapy.
Clinical trials testing breast-conserving surgery and tamoxifen with or without radiation therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with ductal breast carcinoma in situ.

Lobular Carcinoma In Situ (LCIS)
Treatment of lobular carcinoma in situ (LCIS) may include the following:

Biopsy to diagnose the LCIS followed by regular examinations and regular mammograms to find any changes as early as possible. This is referred to as observation.
Tamoxifen to reduce the risk of developing breast cancer.
Bilateral prophylactic mastectomy. This treatment choice is sometimes used in women who have a high risk of getting breast cancer. Most surgeons believe that this is a more aggressive treatment than is needed.
Clinical trials testing cancer prevention drugs.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with lobular breast carcinoma in situ.

Stage I, Stage II, Stage IIIA, and Operable Stage IIIC Breast Cancer
Treatment of stage I, stage II, stage IIIA , and operable stage IIIC breast cancer may include the following:

Breast-conserving surgery to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy.
Modified radical mastectomy with or without breast reconstruction surgery.
A clinical trial evaluating sentinel lymph node biopsy followed by surgery.

Adjuvant therapy (treatment given after surgery to increase the chances of a cure) may include the following:

Radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy.
Systemic chemotherapy with or without hormone therapy.
Hormone therapy.
A clinical trial of trastuzumab (Herceptin) combined with systemic chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I breast cancer, stage II breast cancer, stage IIIA breast cancer and stage IIIC breast cancer.

Stage IIIB, Inoperable Stage IIIC, Stage IV, and Metastatic Breast Cancer

Stage IIIB and inoperable stage IIIC breast cancer
Treatment of stage IIIB and inoperable stage IIIC breast cancer may include the following:

Systemic chemotherapy.
Systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.
Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Stage IV and metastatic breast cancer
Treatment of stage IV or metastatic breast cancer may include the following:

Hormone therapy and/or systemic chemotherapy with or without trastuzumab (Herceptin).
Tyrosine kinase inhibitor therapy with lapatinib combined with capecitabine.
Radiation therapy and/or surgery for relief of pain and other symptoms.
Clinical trials testing new systemic chemotherapy and/or hormone therapy.
Clinical trials of new combinations of trastuzumab (Herceptin) with anticancer drugs.
Clinical trials of new combinations of lapatinib with anticancer drugs.
Clinical trials testing other approaches, including high-dose chemotherapy with stem cell transplant.
Bisphosphonate drugs to reduce bone disease and pain when cancer has spread to the bone.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IIIB breast cancer, stage IIIC breast cancer and stage IV breast cancer.

Treatment Options for Inflammatory Breast Cancer
Treatment of inflammatory breast cancer may include the following:

Systemic chemotherapy.
Systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.
Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with inflammatory breast cancer.

Treatment Options for Recurrent Breast Cancer
Treatment of recurrent breast cancer (cancer that has come back after treatment) in the breast or chest wall may include the following:

Surgery (radical or modified radical mastectomy), radiation therapy, or both.
Systemic chemotherapy or hormone therapy.
A clinical trial of trastuzumab (Herceptin) combined with systemic chemotherapy.

Childhood Visual Pathway And Hypothalamic Glioma

2008-08-24T21:39:00.000-07:00

What is childhood visual pathway glioma?

Childhood visual pathway glioma is a type of brain tumor in which cancer (malignant) cells begin to grow in the tissues of the brain. The brain controls memory and learning, the senses (hearing, sight, smell, taste, and touch), and emotion. It also controls other parts of the body, including muscles, organs, and blood vessels. Other than leukemia or lymphoma, brain tumors are the most common type of cancer that occurs in children.

Gliomas are a type of astrocytoma, tumors that start in brain cells called astrocytes. A visual pathway glioma occurs along the nerve that sends messages from the eye to the brain (the optic nerve). Visual pathway gliomas are visual pathway tumors. They may grow rapidly or slowly, depending on the grade of the tumor.

This PDQ summary covers tumors that start in the brain (primary brain tumors). Often cancer found in the brain has started somewhere else in the body and has spread (metastasized) to the brain. This is called brain metastasis (refer to the PDQ summary on Adult Brain Tumors Treatment for more information).

Like most cancer, childhood brain tumor is best treated when it is found (diagnosed) early. If your child has symptoms, the doctor may order a computed tomographic (CT) scan, a special x-ray that uses a computer to make a picture of your child’s brain. A magnetic resonance imaging (MRI) scan, which uses magnetic waves to make a picture of your child’s brain, may also be done.

Often, surgery is required to see whether there is a brain tumor and to tell what type of tumor it is. The doctor may cut out a piece of tissue from the brain and look at it under a microscope. This is called a biopsy.

There are many types of brain tumors in children and the chance of recovery (prognosis) depends on the type of tumor, where it is located within the brain, and your child’s age and general health.

Stage Explanation
Once childhood visual pathway glioma is found, more tests will be done to find out the type of tumor. If a biopsy specimen is taken, the cancer cells will be looked at carefully under a microscope to see how different they are from the normal cells. This will determine the histologic grade of the tumor. Your child’s doctor needs to know the type and grade of tumor in order to plan treatment.

There is no staging for childhood visual pathway glioma. The treatment depends on whether or not your child has received treatment.

Untreated childhood visual pathway glioma
Untreated childhood visual pathway glioma means that no treatment has been given except to treat symptoms.

Recurrent visual pathway glioma
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the brain or in the head or spinal area.

Treatment Option Overview
There are treatments for all children with visual pathway glioma. Three kinds of treatment are used:

Surgery (taking out the cancer in an operation).
Radiation therapy (using high-dose x-rays to kill cancer cells).
Chemotherapy (using drugs to kill cancer cells).

Childhood Supratentorial Primitive Neuroectodermal Tumors

2008-08-24T21:37:00.000-07:00

General Information About Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma

Childhood supratentorial primitive neuroectodermal tumors and pineoblastoma are tumors in which malignant (cancer) cells form in the tissues of the brain.

Childhood supratentorial primitive neuroectodermal tumors start in the cerebrum. The cerebrum, which is at the top of the head, is the largest part of the brain. The cerebrum controls thinking, learning, problem solving, speech, emotions, reading, writing, and voluntary movement. Childhood supratentorial primitive neuroectodermal tumors are also called cerebral neuroblastomas or cerebral medulloblastomas.

Pineoblastoma form in or near the pineal gland. The pineal gland is a tiny organ in the brain that produces melatonin, a substance that helps control our sleeping and waking cycle.

Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia and lymphoma.

This summary refers to the treatment of primary brain tumors (tumors that begin in the brain). Treatment of metastatic brain tumors, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary.

Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. (Refer to the PDQ treatment summary on Adult Brain Tumors for more information.)

The cause of most childhood brain tumors is unknown.

The symptoms of childhood supratentorial primitive neuroectodermal tumors and pineoblastoma vary and often depend on the child’s age, where the tumor is located, and the size of the tumor.

These symptoms may be caused by a supratentorial primitive neuroectodermal tumor, a pineoblastoma, or by other conditions. A doctor should be consulted if any of the following problems occur:

Weakness or change in sensation on one side of the body.
Morning headache or headache that goes away after vomiting.
Nausea and vomiting.
Seizures.
Unusual sleepiness or change in energy level.
Change in personality or behavior.
Unexplained weight loss or weight gain.

Tests that examine the brain and spinal cord are used to detect (find) childhood supratentorial primitive neuroectodermal tumors and pineoblastoma.

The following tests and procedures may be used:

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Childhood supratentorial primitive neuroectodermal tumors and pineoblastoma are diagnosed and removed in surgery.

If a brain tumor is suspected, a biopsy is done by removing part of the skull and using a needle to remove a sample of brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on:

Size and spread of the tumor before surgery.
Cancer cells remaining after surgery.

Treatment options depend on:

The age of the child when the tumor is found.
The location of the tumor.
The amount of tumor remaining after surgery.
Whether the cancer has spread to other parts of the central nervous system, such as the meninges (membranes covering the brain) and spinal cord.
Whether the cancer has spread to other parts of the body, such as the bone or lung.

Stages of Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma

After the childhood supratentorial primitive neuroectodermal tumor or pineoblastoma has been removed, tests are done to find out if there is tumor remaining.

The extent or spread of cancer is usually described as stages. For childhood supratentorial primitive neuroectodermal tumors and pineoblastoma, risk groups are used instead of stages. Risk groups are described by the amount of remaining tumor or spread of cancer cells within the central nervous system (brain and spinal cord) or to other parts of the body. It is important to know the risk group in order to plan treatment. The following tests and procedures may be used in determining the risk group:

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. A pathologist views the fluid under a microscope to look for cancer cells. This procedure is also called an LP or spinal tap.
Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

The following risk categories are used for childhood supratentorial primitive neuroectodermal tumors and pineoblastoma:

Average risk

Childhood supratentorial primitive neuroectodermal tumors and pineoblastoma are called average risk if all of the following are true:

The child is older than 3 years.
All of the tumor was removed by surgery or there was a very small amount remaining.
The cancer has not spread to other parts of the brain or body, including the spinal cord.

Poor risk

Childhood supratentorial primitive neuroectodermal tumors and pineoblastoma are called poor risk if any of the following are true:

The child is younger than 3 years.
The tumor is near the center of the brain.
Some of the tumor was not removed by surgery.
The cancer has spread to other parts of the brain or body, including the spinal cord.

In general, cancer is more likely to recur (come back) in patients in the poor risk group.

Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma
Recurrent childhood supratentorial primitive neuroectodermal tumors and pineoblastoma are tumors that have recurred (come back) after they have been treated. Childhood supratentorial primitive neuroectodermal tumors and pineoblastoma often recur. A tumor may come back many years later, usually in the brain, meninges (membranes covering the brain), or spinal cord. It can also come back in other parts of the body, such as the bone or lung.

Treatment Option Overview

There are different types of treatment for children with supratentorial primitive neuroectodermal tumors and pineoblastoma.

Different types of treatment are available for children with supratentorial primitive neuroectodermal tumors and pineoblastoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the “standard” treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Children with supratentorial primitive neuroectodermal tumors and pineoblastoma should have their treatment planned by a team of doctors with expertise in treating childhood brain tumors.

Your child’s treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other pediatric doctors who have experience and expertise in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:

Neurosurgeon.
Neurologist.
Neuropathologist.
Neuroradiologist.
Rehabilitation specialist.
Radiation oncologist.
Medical oncologist.
Endocrinologist.
Psychologist.

Three types of standard treatment are used:

Surgery

Surgery is used to diagnose and treat childhood supratentorial primitive neuroectodermal tumors and pineoblastoma as described in the General Information section of this summary.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Because radiation therapy to the brain can affect growth and brain development in young children, clinical trials are studying ways of using chemotherapy to delay or reduce the need for radiation therapy.

Other types of treatment are being tested in clinical trials.

Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Treatment Options for Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma

Untreated Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma
Untreated childhood supratentorial primitive neuroectodermal tumors and pineoblastoma are tumors for which no treatment has been given. The child may have received drugs or treatment to relieve symptoms caused by the tumor.

Standard treatment of supratentorial neuroectodermal tumors or pineoblastoma in children 3 years of age and older may include the following:

Surgery.
Surgery followed by radiation therapy to the whole brain and spinal cord.
Surgery followed by radiation therapy to the whole brain and spinal cord, and chemotherapy.

Childhood Supratentorial Primitive Neuroectodermal Tumors

2008-08-24T21:35:00.000-07:00

Childhood Medulloblastoma

2008-08-24T21:33:00.000-07:00

General Information About Childhood Medulloblastoma

Childhood medulloblastoma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain.

Childhood medulloblastoma (tumor) usually forms in the cerebellum, which is at the lower back of the brain. The cerebellum is the part of the brain that controls movement, balance, and posture. Childhood medulloblastoma may also be called primitive neuroectodermal tumor (PNET).

About 1 out of 5 childhood brain tumors are medulloblastomas. Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia and lymphoma.

This summary refers to the treatment of primary brain tumors (tumors that begin in the brain). Treatment for metastatic brain tumors, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary. See the PDQ treatment summary on Childhood Brain Tumors for information about the different types of childhood brain and spinal cord tumors.

Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. (See the PDQ treatment summary on Adult Brain Tumors for more information.)

The cause of most childhood brain tumors is unknown.

The signs of childhood medulloblastoma vary and often depend on the child’s age and where the tumor is located.

Symptoms caused by medulloblastoma may also be caused by other conditions. A doctor should be consulted if any of the following problems occur:

Loss of balance, trouble walking, worsening handwriting, or slow speech.
Morning headache or headache that goes away after vomiting.
Nausea and vomiting.
Unusual sleepiness or change in energy level.
Change in personality or behavior.
Unexplained weight loss or weight gain.

Tests that examine the brain and spinal cord are used to detect (find) childhood medulloblastoma.

The following tests and procedures may be used:

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Childhood medulloblastoma is diagnosed and removed in surgery.

If a brain tumor is suspected, a biopsy is done by removing part of the skull and using a needle to remove a sample of the tumor tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as possible during the same surgery.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on:

The age of the child when the tumor is found.
The location of the tumor.
The amount of tumor remaining after surgery.
Whether the cancer has spread to other parts of the central nervous system (brain and spinal cord), or to other parts of the body, such as the bones.

Stages of Childhood Medulloblastoma

After childhood medulloblastoma has been diagnosed, tests are done to find out if there is tumor remaining or if cancer cells have spread.

The extent or spread of cancer is usually described as stages. For childhood medulloblastoma, risk groups are used instead of stages. Risk groups are described by the amount of remaining tumor or spread of cancer cells within the central nervous system (brain and spinal cord) or to other parts of the body. It is important to know the risk group in order to plan treatment. The following tests and procedures may be used to determine the risk group:

MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.
Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

The following risk categories are used for childhood medulloblastoma:

Average risk

Childhood medulloblastoma is called an average risk if all of the following are true:

The child is older than 3 years of age.
The tumor is at the very back of the brain.
All of the tumor was removed by surgery or there was a very small amount remaining.
The cancer has not spread to other parts of the body.

Poor risk

Childhood medulloblastoma is called a poor risk if any of the following are true:

The child is younger than 3 years of age.
The tumor is not at the very back of the brain.
Some of the tumor was not removed by surgery.
The cancer has spread to other parts of the body.

In general, cancer is more likely to recur (come back) in patients in the poor risk group.

Recurrent Childhood Medulloblastoma
Recurrent childhood medulloblastoma is a tumor that has recurred (come back) after it has been treated. Childhood medulloblastoma often recurs. A tumor may come back many years later at the same place or a different place in the brain. It can also come back in other parts of the body such as the spinal cord.

Treatment Option Overview

There are different types of treatment for children with childhood medulloblastoma.

Different types of treatment are available for children with childhood medulloblastoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Children with medulloblastoma should have their treatment planned by a team of doctors with expertise in treating childhood brain tumors.

Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric doctors who are experts in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:

Neurosurgeon.
Neurologist.
Neuropathologist.
Neuroradiologist.
Rehabilitation specialist.
Radiation oncologist.
Medical oncologist.
Endocrinologist.
Psychologist.

Some cancer treatments cause side effects months or years after treatment has ended.

Some cancer treatments cause side effects that continue or appear months or years after cancer treatment has ended. These are called late effects. Late effects of cancer treatment may include:

Physical problems.
Changes in mood, feelings, thinking, learning or memory.
Second cancers (new types of cancer).

Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information).

Four types of standard treatment are used:

Surgery

Surgery is used to diagnose and treat childhood medulloblastoma as described in the General Information section of this summary.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Radiation therapy to the brain can affect growth and development in young children. For this reason, ways of giving radiation therapy that limit damage to healthy brain tissue are being studied.

Conformal radiation therapy uses a computer to create a 3-D picture of the tumor. The radiation beams are shaped to fit the tumor.
Stereotactic radiation therapy uses a head frame to aim radiation at the tumor only.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Because radiation therapy can affect growth and brain development in young children, clinical trials are studying ways of using chemotherapy to delay or reduce the need for radiation therapy.

Cerebrospinal fluid diversion

Cerebrospinal fluid diversion is a method used to drain fluid that has built up around the brain and spinal cord. A shunt (long, thin tube) is placed in a ventricle (hollow space) of the brain and threaded under the skin to another part of the body, usually the abdomen. The shunt carries excess fluid away from the brain so it may be absorbed elsewhere in the body.

New types of treatment are being tested in clinical trials. These include the following:

High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with bone marrow or stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Childhood Ependymoma

2008-08-24T21:32:00.000-07:00

General Information About Childhood Ependymoma

Childhood ependymoma is a disease in which malignant (cancer) cells form in the tissues of the brain and spinal cord.

The brain controls vital functions such as memory and learning, the senses (hearing, sight, smell, taste, and touch), and emotion. The spinal cord is made up of bundles of nerve fibers that connect the brain with nerves in most parts of the body.

About 1 in 11 childhood brain tumors are ependymomas. Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia and lymphoma.

This summary refers to the treatment of primary brain tumors (tumors that begin in the brain). Treatment of metastatic brain tumors, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary.

There are many different types of brain tumors. Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. Refer to the following PDQ summaries for more information:

Childhood Brain Tumors Treatment
Adult Brain Tumors Treatment

The cause of most childhood brain tumors is unknown.

The symptoms of childhood ependymoma vary and often depend on the child’s age and where the tumor is located.

These symptoms may be caused by childhood ependymoma or other conditions. A doctor should be consulted if any of the following problems occur:

Frequent headaches.
Seizures.
Frequent nausea and vomiting.
Loss of balance or trouble walking.

Tests that examine the brain and spinal cord are used to detect (find) childhood ependymoma.

The following tests and procedures may be used:

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Childhood ependymoma is diagnosed and removed in surgery.

If a brain tumor is suspected, a biopsy is done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery.

Certain factors affect prognosis (chance of recovery).

The prognosis (chance of recovery) depends on:

Amount of tumor removed during surgery.
Tumor histology (how the tumor cells look under a microscope).
The age of the child when the tumor was found.

Stages of Childhood Ependymoma

After the childhood ependymoma has been removed, tests are done to find out if there is tumor remaining. The extent or spread of cancer is usually described as stages. For childhood ependymoma, tumors are described by grade and by where they are located in the central nervous system (brain and spinal cord). The grade of the tumor refers to how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. It is important to know the grade of the tumor and if there were any cancer cells remaining after surgery in order to plan treatment. The following tests and procedures may be used:

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.

Recurrent Childhood Ependymoma
Recurrent childhood ependymoma is a tumor that has recurred (come back) after it has been treated. Childhood ependymoma commonly recurs, usually at the original cancer site. The tumor may come back as long as 15 years or more after initial treatment.

Treatment Option Overview

There are different types of treatment for children with ependymoma.

Different types of treatment are available for children with ependymoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Children with ependymoma should have their treatment planned by a team of doctors with expertise in treating childhood brain tumors.

Your child’s treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other pediatric doctors who have experience and expertise in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:

Neurosurgeon.
Neurologist.
Neuropathologist.
Neuroradiologist.
Rehabilitation specialist.
Radiation oncologist.
Medical oncologist.
Endocrinologist.
Psychologist.

Some cancer treatments cause side effects that continue or appear years after cancer treatment has ended. These are called late effects. Late effects of cancer treatment may include physical problems; changes in mood, feelings, thinking, learning or memory; and having second cancers (new types of cancer). Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. Refer to the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.

Three types of standard treatment are used:

Surgery

Surgery is used to diagnose and treat childhood ependymoma as described in the General Information section of this summary.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Certain ways of giving radiation therapy can help keep radiation away from healthy tissue:

Conformal radiation therapy uses a computer to create a 3-D picture of the tumor. The radiation beams are shaped to fit the tumor.
Stereotactic radiation therapy uses a head frame attached to the skull to aim radiation beams directly at the tumor.

Radiation therapy to the brain can affect growth and development in young children and is not standard treatment for children younger than 3 years. For this reason, conformal radiation therapy that limits damage to healthy brain tissue is being studied in infants and children with ependymoma.

Damage to the brain in young children treated for ependymoma is not always due to the effects of radiation therapy. For example, when hydrocephalus (abnormal buildup of fluid in the brain) is found at diagnosis, it is linked with lower intelligence test scores following surgery and before radiation therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Childhood Cerebral Astrocytoma/malignant Glioma

2008-08-24T21:30:00.000-07:00

General Information About Childhood Cerebral Astrocytoma

Cerebral astrocytoma is a type of malignant glioma.

Childhood cerebral astrocytoma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain.

Astrocytomas are tumors that start in brain cells called astrocytes. Cerebral astrocytomas form in the area of the brain called the cerebrum. The cerebrum, which is at the top of the head, is the largest part of the brain. The cerebrum controls thinking, learning, problem-solving, speech, emotions, reading, writing, and voluntary movement.

Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia and lymphoma.

This summary refers to the treatment of primary brain tumors (tumors that begin in the brain). Treatment for metastatic brain tumors, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary. Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. (Refer to the PDQ treatment summary on Adult Brain Tumors for more information.)

The cause of most childhood brain tumors is unknown.

The symptoms of childhood cerebral astrocytoma vary and often depend on the child’s age, where the tumor is located, and the size of the tumor.

These symptoms may be caused by an astrocytoma or other conditions. A doctor should be consulted if any of the following problems occur:

Weakness or change in feeling on one side of the body.
Seizures.
Morning headache or headache that goes away after vomiting.
Nausea and vomiting.
Unusual sleepiness or change in energy level.
Change in personality or behavior.

Tests that examine the brain are used to detect (find) childhood cerebral astrocytoma.

The following tests and procedures may be used:

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Childhood cerebral astrocytoma is diagnosed and may be removed in surgery.

If a brain tumor is suspected, a brain biopsy is done by removing part of the skull and using a needle to remove a sample of the tumor tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on:

Cancer cells remaining after surgery.
The type of astrocytoma.
The location of the tumor.

Treatment options depend on:

Whether cancer cells remain after surgery.
The location of the tumor.
The child’s age.
Whether the cancer has just been diagnosed or has recurred (come back).

Stages of Childhood Cerebral Astrocytoma

After childhood cerebral astrocytoma has been removed, tests are done to find out if there is tumor remaining. The extent or spread of cancer is usually described as stages. For childhood cerebral astrocytoma, the grade of the tumor is used instead of stages. The grade of the tumor refers to how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. It is important to know the grade of the tumor and if there were any cancer cells remaining after surgery in order to plan treatment.

The following grades are used for childhood cerebral astrocytoma:

Low grade cerebral astrocytoma: Tumors that are very slow-growing and rarely spread.
High grade or malignant cerebral astrocytoma: Tumors that are fast-growing and may spread throughout the brain.

The following procedure may be used to determine if any cancer cells remained in the brain after surgery:

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Cerebral astrocytomas may form at more than one place in the brain and do not usually spread to other parts of the body.

Recurrent Childhood Cerebral Astrocytoma
Recurrent childhood cerebral astrocytoma is a tumor that has recurred (come back) after it has been treated. The tumor may recur many years after the first tumor. High grade cerebral astrocytoma, however, usually recurs within 3 years after it is first diagnosed. A recurrent tumor may come back in the brain or in other parts of the central nervous system.

Treatment Option Overview

There are different types of treatment for children with cerebral astrocytoma.

Different types of treatment are available for children with cerebral astrocytoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the “standard” treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Children with cerebral astrocytoma should have their treatment planned by a team of doctors with expertise in treating childhood brain tumors.

Your child’s treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other pediatric doctors who have experience and expertise in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:

Neurosurgeon.
Neurologist.
Neuropathologist.
Neuroradiologist.
Rehabilitation specialist.
Radiation oncologist.
Medical oncologist.
Endocrinologist.
Psychologist.

Some cancer treatments cause side effects that continue or appear years after cancer treatment has ended. These are called late effects. Late effects of cancer treatment may include physical problems; changes in mood, feelings, thinking, learning or memory; and having second cancers (new types of cancer). Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. Refer to the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.

Three types of standard treatment are used:

Surgery

Surgery is used to diagnose and treat childhood cerebral astrocytoma as discussed in the General Information section of this summary. For patients with slow-growing tumors who are having seizures, MRI-guided surgery may be used to control both seizures and tumor growth.

Radiation therapy

Radiation therapy is a cancer treatment that uses high energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. Radiation therapy may be used in addition to chemotherapy.

Because radiation therapy can affect growth and brain development in young children, it is often used only when the cancer has started to spread. Newer ways of giving radiation are being studied that may have fewer side effects than standard methods. Conformal radiation therapy uses a computer to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while sparing as much normal tissue as possible.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Childhood Cerebellar Astrocytoma

2008-08-24T21:29:00.000-07:00

General Information About Childhood Cerebellar Astrocytoma

Childhood cerebellar astrocytoma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain.

Astrocytomas are tumors that develop from brain cells called astrocytes. Cerebellar astrocytomas start in the cerebellum, which is located at the lower back of the brain. The cerebellum is the part of the brain that controls movement, balance, and posture.

About 15-25% of all childhood brain tumors are cerebellar astrocytomas. Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia and lymphoma.

This summary refers to the treatment of primary brain tumors (tumors that begin in the brain). Treatment for metastatic brain tumors, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary.

Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. (Refer to the PDQ treatment summary on Adult Brain Tumors for more information.)

The cause of most childhood brain tumors is unknown.

The symptoms of childhood cerebellar astrocytoma vary and often depend on the child’s age and where the tumor is located.

These symptoms may be caused by an astrocytoma or other conditions. A doctor should be consulted if any of the following problems occur:

Loss of balance, difficulty walking, worsening handwriting, or slow speech.
Morning headache or headache that goes away after vomiting.
Nausea and vomiting.
Unusual sleepiness or change in energy level.
Change in personality or behavior.
Unexplained weight loss or weight gain.

Tests that examine the brain and spinal cord are used to detect (find) childhood cerebellar astrocytoma.

The following tests and procedures may be used:

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Childhood cerebellar astrocytoma is diagnosed and removed in surgery.

If a brain tumor is suspected, a biopsy is done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on:

The type of astrocytoma.
Whether cancer cells remain after surgery.

Treatment options depend on:

Whether cancer cells remain after surgery or have spread to other parts of the brain.
The location of the tumor.
The child’s age.

Stages of Childhood Cerebellar Astrocytoma

After the childhood cerebellar astrocytoma has been removed, tests are done to find out if there is tumor remaining. The extent or spread of cancer is usually described as stages. For childhood cerebellar astrocytoma, the grade of the tumor is used instead of stages. The grade of the tumor refers to how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. It is important to know the grade of the tumor and if there were any cancer cells remaining after surgery in order to plan treatment.

There are two grades for childhood cerebellar astrocytoma:

Grade I pilocytic tumors are very slow-growing and rarely spread. These tumors form inside cysts.
Grade II diffuse or fibrillary tumors spread slowly within the brain.

The following procedure may be used to determine if any cancer cells remain in the brain after surgery:

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Cerebellar astrocytomas do not usually spread from the cerebellum to other parts of the brain or body.

Recurrent Childhood Cerebellar Astrocytoma
Recurrent childhood cerebellar astrocytoma is a tumor that has recurred (come back) after it has been treated. Childhood cerebellar astrocytoma may recur many years after initial treatment. The tumor may recur at the same place in the brain or in other parts of the central nervous system (brain and spinal cord), especially if the original tumor was a diffuse or fibrillary tumor.

Treatment Option Overview

There are different types of treatment for children with cerebellar astrocytoma.

Different types of treatment are available for children with cerebellar astrocytoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the “standard” treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Children with cerebellar astrocytoma should have their treatment planned by a team of doctors with expertise in treating childhood brain tumors.

Your child’s treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other pediatric doctors who have experience and expertise in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:

Neurosurgeon.
Neurologist.
Neuropathologist.
Neuroradiologist.
Rehabilitation specialist.
Radiation oncologist.
Medical oncologist.
Endocrinologist.
Psychologist.

Three types of standard treatment are used:

Surgery

Surgery is used to diagnose and treat childhood cerebellar astrocytoma as discussed in the General Information section of this summary.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Childhood Brain Stem Glioma

2008-08-24T21:27:00.000-07:00

General Information About Childhood Brain Stem Glioma

Childhood brain stem glioma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain stem.

The brain stem is the part of the brain connected to the spinal cord. It is located in the lowest part of the brain, just above the back of the neck. The brain stem is the part of the brain that controls breathing, heart rate, and nerves and muscles used in seeing, hearing, walking, talking, and eating. Most childhood brain stem gliomas are pontine gliomas, which form in a part of the brain stem called the pons.

Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia or lymphoma.

This summary refers to the treatment of primary brain tumors (tumors that begin in the brain). Treatment for metastatic brain tumors, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary. Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. (Refer to the PDQ treatment summary on Adult Brain Tumors for more information.)

The cause of most childhood brain tumors is unknown.

The symptoms of childhood brain stem glioma vary and often depend on the child’s age and where the tumor is located.

These and other symptoms may be caused by a brain stem glioma. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

Loss of balance and trouble walking.
Vision and hearing problems.
Morning headache or headache that goes away after vomiting.
Nausea and vomiting.
Unusual sleepiness or change in energy level.

Tests that examine the brain are used to detect (find) childhood brain stem glioma.

The following tests and procedures may be used:

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Childhood brain stem glioma is diagnosed and removed in surgery.

If the tumor has not spread widely within the brain stem, a biopsy may be done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on:

The type of brain stem glioma.
Where the tumor is located and if it has spread within the brain stem.
Whether or not the child has an underlying condition called neurofibromatosis type 1.
Whether the glioma has just been diagnosed or has recurred (come back).

Treatment options depend on the type and location of the glioma.

Stages of Childhood Brain Stem Glioma

After the childhood brain stem glioma has been removed, tests are done to find out if there is tumor remaining. The extent or spread of cancer is usually described as stages. For childhood brain stem glioma, the tumors are described by type:

Diffuse intrinsic pontine glioma is a tumor that has spread widely throughout the brain stem.
Focal or low-grade glioma is a tumor that is localized to one area of the brain stem.

Recurrent Childhood Brain Stem Glioma
Recurrent childhood brain stem glioma is a tumor that has recurred (come back) after it has been treated. If childhood brain stem glioma recurs, it may do so many years after initial treatment. The tumor may come back in the brain or in other parts of the central nervous system.

Treatment Option Overview

There are different types of treatment for children with brain stem glioma.

Different types of treatment are available for children with brain stem glioma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Children with brain stem glioma should have their treatment planned by a team of doctors with expertise in treating childhood brain tumors.

Your child’s treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other pediatric doctors who have experience and expertise in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:

Neurosurgeon.
Neuropathologist.
Radiation oncologist.
Neuro-oncologist.
Neurologist.
Rehabilitation specialist.
Neuroradiologist.
Endocrinologist.
Psychologist.

Five types of standard treatment are used:

Surgery

Surgery is used to diagnose and treat childhood brain stem glioma as discussed in the General Information section of this summary.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Radiation therapy to the brain can affect growth and development in young children. Certain ways of giving radiation therapy can help keep radiation from damaging healthy tissue:

Conformal radiation therapy uses a computer to create a 3-D picture of the tumor. The radiation beams are then shaped to fit the tumor.
Hyperfractionated radiation therapy is a way of giving radiation therapy in smaller-than-usual doses two or three times a day instead of once a day.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. Radiation therapy may be used alone or in addition to chemotherapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Because radiation therapy to the brain can affect growth and brain development in young children, clinical trials are studying ways of using chemotherapy to delay or reduce the need for radiation therapy.

Cerebrospinal fluid diversion

Cerebrospinal fluid diversion is a method used to drain fluid that has built up around the brain and spinal cord. A shunt (long, thin tube) is placed in a ventricle (hollow space) of the brain and threaded under the skin to another part of the body, usually the abdomen. The shunt carries excess fluid away from the brain so it may be absorbed elsewhere in the body.

Watchful waiting

Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change.

New types of treatment are being tested in clinical trials.

Radiation therapy with radiosensitizers

Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Adult Brain Tumor

2008-08-24T21:26:00.000-07:00

What are adult brain tumors?
Adult brain tumors are diseases in which cancer (malignant) cells begin to grow in the tissues of the brain. The brain controls memory and learning, senses (hearing, sight, smell, taste, and touch), and emotion. It also controls other parts of the body, including muscles, organs, and blood vessels. Tumors that start in the brain are called primary brain tumors.

What are metastatic brain tumors?
Often, tumors found in the brain have started somewhere else in the body and spread (metastasized) to the brain. These are called metastatic brain tumors.

What are the symptoms of an adult brain tumor?
A doctor should be seen if the following symptoms appear:

Frequent headaches.
Vomiting.
Loss of appetite.
Changes in mood and personality.
Changes in ability to think and learn.
Seizures.

What tests are used to find and diagnose adult brain tumors?
Tests that examine the brain and spinal cord are used to detect (find) adult brain tumor. The following tests and procedures may be used:

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Adult brain tumor is diagnosed and removed in surgery. If a brain tumor is suspected, a biopsy is done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery. An MRI may then be done to determine if any cancer cells remain after surgery. Tests are also done to find out the grade of the tumor.

What is the grade of a tumor?
The grade of a tumor refers to how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. The pathologist determines the grade of the tumor using tissue removed for biopsy. The following grading system may be used for adult brain tumors:

Grade I

The tumor grows slowly, has cells that look similar to normal cells, and rarely spreads into nearby tissues. It may be possible to remove the entire tumor by surgery.

Grade II

The tumor grows slowly, but may spread into nearby tissue and may become a higher-grade tumor.

Grade III

The tumor grows quickly, is likely to spread into nearby tissue, and the tumor cells look very different from normal cells.

Grade IV

The tumor grows very aggressively, has cells that look very different from normal cells, and is difficult to treat successfully.

The chance of recovery (prognosis) and choice of treatment depend on the type, grade, and location of the tumor and whether cancer cells remain after surgery and/or have spread to other parts of the brain.

Types of Adult Brain Tumor

The extent or spread of cancer is usually described as stages. There is no standard staging system for brain tumors. Primary brain tumors may spread within the central nervous system (brain and spinal cord), but they rarely spread to other parts of the body. For treatment, brain tumors are classified by the type of cell in which the tumor began, the location of the tumor in the central nervous system, and the grade of the tumor.

Types of adult brain tumors include the following:

Brain Stem Gliomas

These are tumors that form in the brain stem, the part of the brain connected to the spinal cord. They are often high-grade. Brain stem gliomas that are high-grade or spread widely throughout the brain stem are difficult to treat successfully. To prevent damage to healthy brain tissue, brain stem glioma is usually diagnosed without a biopsy.

(Refer to the PDQ summary on Childhood Brain Stem Glioma Treatment for more information.)

Pineal Astrocytic Tumor

Pineal tumors form in or near the pineal gland. The pineal gland is a tiny organ in the brain that produces the hormone melatonin, a substance that helps control our sleeping and waking cycle. There are several kinds of pineal tumors. Pineal astrocytic tumors are astrocytomas that occur in the pineal region and may be any grade.

Pilocytic Astrocytoma (grade I)

Astrocytomas are tumors that start in brain cells called astrocytes. Pilocytic astrocytomas grow slowly and rarely spread into the tissues around them. These tumors occur most often in children and young adults. They usually can be treated successfully.

Diffuse Astrocytoma (grade II)

Diffuse astrocytomas grow slowly, but they often spread into nearby tissues. Some of them progress to a higher grade. They occur most often in young adults.

Anaplastic Astrocytoma (grade III)

Anaplastic astrocytomas are also called malignant astrocytomas. They grow rapidly and spread into nearby tissues. The tumor cells look different from normal cells. The average age of patients developing anaplastic astrocytomas is 41 years.

Glioblastoma (grade IV)

Glioblastomas are malignant astrocytomas that grow and spread aggressively. The cells look very different from normal cells. Glioblastoma is also called glioblastoma multiforme or grade IV astrocytoma. They occur most often in adults between the ages of 45 and 70 years.

Refer to the following PDQ summaries for more information on astrocytomas:

Childhood Cerebral Astrocytoma/Malignant Glioma Treatment
Childhood Cerebellar Astrocytoma Treatment
Childhood Visual Pathway and Hypothalamic Glioma Treatment

Oligodendroglial Tumors

Oligodendroglial tumors begin in the brain cells called oligodendrocytes, which support and nourish nerve cells. Grades of oligodendroglial tumors include the following:

Oligodendroglioma (grade II): Oligodendrogliomas are slow-growing tumors with cells that look very much like normal cells. These tumors occur most often in patients between the ages of 40 and 60 years.
Anaplastic oligodendroglioma (grade III): Anaplastic oligodendrogliomas grow quickly and the cells look very different from normal cells.

Mixed Gliomas

Mixed gliomas are brain tumors that contain more than one type of cell. The prognosis is affected by the cell type with the highest grade present in the tumor.

Oligoastrocytoma (grade II): Oligoastrocytomas are slow-growing tumors composed of cells that look like astrocytes and oligodendrocytes.
Anaplastic oligoastrocytoma (grade III): These are higher-grade oligoastrocytomas. The average age of patients developing anaplastic oligoastrocytomas is 45 years.

Ependymal Tumors

Ependymal tumors usually begin in cells that line the spaces in the brain and around the spinal cord. These spaces contain cerebrospinal fluid, a liquid that cushions and protects the brain and spinal cord. Grades of ependymal tumors include the following:

Grade I and grade II ependymomas: These ependymomas grow slowly and have cells that look very much like normal cells. They can often be removed completely by surgery.
Anaplastic ependymoma (grade III): Anaplastic ependymomas grow very quickly.

(Refer to the PDQ summary on Childhood Ependymoma Treatment for more information.)

Medulloblastoma (grade IV)

Medulloblastomas are brain tumors that begin in the lower back of the brain. They are formed from abnormal brain cells at a very early stage in development. Medulloblastomas are usually found in children or young adults between the ages of 21 and 40 years. This type of cancer may spread from the brain to the spine through the cerebrospinal fluid.

(Refer to the PDQ summary on Childhood Medulloblastoma Treatment for more information.)

Pineal Parenchymal Tumors

Pineal parenchymal tumors form from parenchymal cells or pinocytes, the cells that make up most of the pineal gland. These differ from pineal astrocytic tumors, which are astrocytomas that form in tissue that supports the pineal gland. Grades of pineal parenchymal tumors include the following:

Pineocytomas (grade II): Pineocytomas are slow-growing pineal tumors that occur most often in adults aged 25 to 35.
Pineoblastomas (grade IV): Pineoblastomas are rare and highly malignant. They usually occur in children.

(Refer to the PDQ summary on Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma Treatment for more information.)

Meningeal Tumors

Meningeal tumors form in the meninges, thin layers of tissue that cover the brain and spinal cord. Types of meningeal tumors include the following:

Grade I meningioma: Meningiomas are the most common meningeal tumor. Grade I meningiomas are slow-growing and benign. They are found most often in women.
Grade II and III meningiomas and hemangiopericytomas: These are rare malignant meningeal tumors. They grow quickly and are likely to spread within the brain and spinal cord. Grade III meningiomas are more common in men. Hemangiopericytomas often recur after treatment and most of them spread to other parts of the body.

Germ Cell Tumor

Germ cell tumors arise from germ cells, cells that are meant to form sperm in the testicles or eggs in the ovaries. These cells may travel to other parts of the body and form tumors. Types of germ cell tumors include germinomas, embryonal cell carcinomas, choriocarcinomas, and teratomas. They can occur anywhere in the body and can be either benign or malignant. In the brain, they usually form in the center, near the pineal gland, and can spread to other parts of the brain and spinal cord. Most germ cell tumors occur in children.

(Refer to the PDQ summary on Childhood Brain Tumors for more information.)

Craniopharyngioma (grade II)

Craniopharyngiomas occur in the sellar region of the brain, near the pituitary gland. The pituitary gland is a small organ about the size of a pea, located at the base of the brain. This gland controls many of the body's functions, especially growth. In adults, these tumors occur most often after the age of 50 years. Craniopharyngiomas can press on vital brain tissue and cause symptoms to appear. The tumors can also block fluid in the brain and cause swelling. The prognosis is good for craniopharyngiomas that are completely removed in surgery.

Pituitary tumors also occur in this region. Refer to the PDQ summary on Pituitary Tumor Treatment for more information.

Other Adult Brain Tumors

For information about other types of adult brain tumors, refer to the PDQ health professional summary on Adult Brain Tumors.

Recurrent Adult Brain Tumor

Recurrent adult brain tumor is a tumor that has recurred (come back) after it has been treated. Adult brain tumors often recur, sometimes many years after the first tumor. The tumor may come back in the brain or in other parts of the body.

Metastatic Brain Tumors

The types of cancer that commonly spread to the brain are cancers of the lung, breast, unknown primary site, melanoma, and colon. About half of metastatic spinal cord tumors are caused by lung cancer.

Prognosis depends on the following:

Whether the patient is younger than 60 years.
Whether there are fewer than 3 tumors in the brain and/or spinal cord.
The location of the tumors in the brain and/or spinal cord.
How well the tumor responds to treatment.
Whether the primary tumor continues to grow or spread.

The prognosis is better for brain metastases from breast cancer than from other types of primary cancer. The prognosis is worse for brain metastases from colon cancer.

Treatment Option Overview

How are adult brain tumors treated?
Different types of treatment are available for patients with adult brain tumor. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used.
Surgery

Surgery is used, when possible, to treat adult brain tumor, as described in the Description section of this summary.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). A dissolving wafer may be used to deliver an anticancer drug directly into the brain tumor site after the tumor has been removed by surgery. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Bladder Cancer

2008-08-24T21:24:00.000-07:00

General Information About Bladder Cancer

Bladder cancer is a disease in which malignant (cancer) cells form in the tissues of the bladder.

The bladder is a hollow organ in the lower part of the abdomen. It is shaped like a small balloon and has a muscular wall that allows it to get larger or smaller. The bladder stores urine until it is passed out of the body. Urine is the liquid waste that is made by the kidneys when they clean the blood. The urine passes from the two kidneys into the bladder through two tubes called ureters. When the bladder is emptied during urination, the urine goes from the bladder to the outside of the body through another tube called the urethra.

There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant (cancerous):

Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells.
Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation.
Adenocarcinoma: Cancer that begins in glandular (secretory) cells that may form in the bladder after long-term irritation and inflammation.

Cancer that is confined to the lining of the bladder is called superficial bladder cancer. Cancer that begins in the transitional cells may spread through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes; this is called invasive bladder cancer.

See the following PDQ summaries for more information:

Screening for Bladder and Other Urothelial Cancers
Unusual Cancers of Childhood

Smoking, gender, and diet can affect the risk of developing bladder cancer.

Anything that increases your chance of getting a disease is called a risk factor. Risk factors for bladder cancer include the following:

Smoking.
Being exposed to certain substances at work, such as rubber, certain dyes and textiles, paint, and hairdressing supplies.
A diet high in fried meats and fat.
Being older, male, or white.
Having an infection caused by a certain parasite.

Adrenocortical Carcinoma

2008-08-24T21:21:00.000-07:00

General Information About Adrenocortical Carcinoma

Adrenocortical carcinoma is a rare disease in which malignant (cancer) cells form in the outer layer of the adrenal gland.

There are two adrenal glands. The adrenal glands are small and shaped like a triangle. One adrenal gland sits on top of each kidney. Each adrenal gland has two parts. The outer layer of the adrenal gland is the adrenal cortex. The center of the adrenal gland is the adrenal medulla.

The adrenal cortex makes important hormones that:

* Balance the water and salt in the body.

* Help keep blood pressure normal.

* Help manage the body's use of protein, fat, and carbohydrates.

* Cause the body to have masculine or feminine characteristics.

The adrenal medulla makes hormones that help the body react to stress.

Adrenocortical carcinoma is also called cancer of the adrenal cortex. A tumor of the adrenal cortex may be functioning (makes more hormones than normal) or nonfunctioning (does not make hormones). The hormones made by functioning tumors may cause certain signs or symptoms of disease.

Cancer that forms in the adrenal medulla is called pheochromocytoma. See the PDQ summary on Pheochromocytoma Treatment for more information.

Anal Cancer

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Anal cancer begins in the end of the large intestine (colon), called the anus. The anus is about an inch and a half long and connects the lower part of the large intestine to the outside of the body. The anus opens to allow the passage of stool (feces) during a bowel movement. It is lined with cells that are like the cells lining the bladder, vagina, urethra, and other places in the body.

These cells are known as squamous cells. Many kinds of tumors can grow in the anus. Some can start off harmless but later change into cancer. These tumors are referred to as potentially pre-cancerous. The term "dysplasia" (dis-play-zhuh) is also used to describe this condition. Other tumors of the anus are not cancerous, and are called "benign" (be-nine). Examples of benign tumors are warts and skin tags (small pieces of skin that hang loose from the body).

Metastatic Cancer

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Metastatic cancer is cancer that has spread from the part of the body where it started (its primary site) to other parts of the body. Keep in mind that when cancer spreads in this way it is still named after the part of the body where it started.

Sometimes the “new” tumors have already begun to grow when the cancer is first found. In some cases the metastasis may be found before the primary tumor is found. If cancer is widely spread throughout the body when it is found, it may not possible to tell where it started. This is called cancer of unknown primary. It is covered in a separate American Cancer Society document.

Advanced Cancer

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Advanced cancer is cancer that has grown beyond the organ where it first started. Often it has spread to many places in the body. But advanced cancer is not exactly the same as metastatic cancer. A cancer might be called advanced if it involves a vital organ and can’t be removed.
Often the term advanced cancer means that it can’t be cured. Still, even if there is no cure, treatment can sometimes shrink the cancer, help relieve symptoms, and allow the person to live longer. Some people can live many years with advanced cancer.

In many cases, advanced cancer happens after the person has had cancer for some time and treatment is no longer working. But for some people the cancer may already be advanced when they first find out they have the disease. In any case, symptoms such as pain and depression can almost always be treated.

DEADLY CANCER

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What Is Cancer?

Cancer develops when cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells.
Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide more rapidly until the person becomes an adult. After that, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries.
Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to form new abnormal cells.

Cancer cells often travel to other parts of the body where they begin to grow and replace normal tissue. This process, called metastasis, occurs as the cancer cells get into the bloodstream or lymph vessels of our body. When cells from a cancer like breast cancer spread to another organ like the liver, the cancer is still called breast cancer, not liver cancer.

Cancer cells develop because of damage to DNA. This substance is in every cell and directs all its activities. Most of the time when DNA becomes damaged the body is able to repair it. In cancer cells, the damaged DNA is not repaired. People can inherit damaged DNA, which accounts for inherited cancers. Many times though, a person’s DNA becomes damaged by exposure to something in the environment, like smoking.

Cancer usually forms as a tumor. Some cancers, like leukemia, do not form tumors. Instead, these cancer cells involve the blood and blood-forming organs, and circulate through other tissues where they grow.

Not all tumors are cancerous. Benign (noncancerous) tumors do not spread to other parts of the body (metastasize) and, with very rare exceptions, are not life-threatening.
Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their particular kind cancer.

Cancer is the second leading cause of death in the United States. Half of all men and one-third of all women in the US will develop cancer during their lifetimes. Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person's lifestyle, for example, by quitting smoking and eating a better diet. The sooner a cancer is found and treatment begins, the better are the chances for living for many years.