Cancer

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Cancer is a complex group of diseases that affect various parts of the body, from the skin to internal organs to the blood. There are many different forms of cancer, each with its own pattern of progression and each with a different potential for early detection and treatment. The main thing that happens with cancer cells is that they grow and sometimes travel around the body. The goal usually is to stop the growth or remove the tumor if possible.

A relatively small number of cancers make up the majority of cancer cases in the United States. Men’s most prevalent cancers, in order, are prostate, lung, colon and rectal, bladder, lymphoma (lymph system), melanoma (skin) and kidney. Women’s cancers, in order of prevalence, are breast, lung, colon and rectal, uterine, lymphoma, and melanoma. Of all of these cancers, lung, breast, prostate, and colorectal account for more than 50 percent of all cancer deaths. Cancer symptoms vary widely, depending on the type. We recommend the American Cancer Society and Center for Disease Control (CDC) web sites, to get reliable information about cancer types and symptoms. Listed below are several types of cancer, risk factors, prevention measures (if known) and screenings.

Prostate Cancer
Risk factors

  • Affects only men
  • Age
  • Race/ethnicity
  • Nationality
  • Family history
  • Genetic factors
  • Diet
  • Obesity
  • Smoking
  • Lack of exercise

Screenings
Prostate cancer is detected through prostate-specific antigen (PSA) blood tests, digital rectal exams (DRE), and transrectal ultrasounds (TRUS). The PCA3 urine test is a new screening that can also diagnose prostate cancer. Along with other new molecular diagnostics and genetics testing, this is a promising screening. Recommended for men ages 50 and over, Medicare will pay for one PSA and one DRE test every year.

Lung Cancer
Risk Factors

  • Exposure to tobacco smoke
  • Gender
  • Race/ethnicity
  • Age
  • Genetics and family history
  • Smoking is closely associated with lung cancer

Routine x-rays are recommended, especially for those with lingering coughs.

Colon and Rectal Cancers
Risk Factors

  • Age
  • Personal history of polyps
  • Personal history of inflammatory bowel disease
  • Family history
  • Genetic predisposition
  • Regular consumption of red meat and a high fat diet
  • Physical inactivity
  • Obesity
  • Smoking
  • Heavy alcohol use
  • Type 2 diabetes

Prevention
Preventive measures include a diet high in fruits and vegetables, limiting alcohol to 1-2 drinks per day, losing weight, engaging in physical activity 30 minutes per day five times per week, using multivitamins with folic acid and Vitamin D, keeping calcium intake at less than 1500 mg per day, and taking aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).
Screenings
Potential screenings include stool DNA test, fecal immunochemical test, fecal occult blood test, double contrast barium enema, CT — colonography, sigmoidoscopy and colonoscopy. Medicare covers fecal occult blood test annually, barium enema once every 4 years, sigmoidoscopy once every 4 years, and colonoscopy once every 10 years.

Bladder Cancer
Risk Factors

  • Smoking
  • Workplace exposure to chemicals
  • Race
  • Age
  • Gender (more common in men)
  • Experience of chronic bladder infection
  • Personal history of bladder cancer
  • Bladder birth defects
  • Genetics
  • Chemotherapy and radiation
  • Arsenic in drinking water
  • Low fluid intake
  • Smoking

Prevention
To decrease risk of bladder cancer, avoid exposure to chemicals in the workplace, drink plenty of fluids, and eat fruits and vegetables.
Screenings
There are no reliable recommended screening tests for bladder cancer.

Lymphoma (lymph system cancer)
Risk Factors

  • Infectious mononucleosis
  • Age
  • Gender (more often in men than women)
  • Geography
  • Family history
  • Higher socioeconomic status
  • HIV Positive

Prevention and Screenings
No preventive measures are known at this time and there are no recommended screenings.

Melanoma (skin cancer)
Risk Factors

  • Ultraviolet light exposure
  • Moles
  • Fair skin
  • Freckling
  • Light hair
  • Family history
  • Personal history
  • Immune suppression in individuals with organ transplants
  • Age
  • Gender (more often in men than women)
  • Xeroderma pigmentosum
  • Genetics

Prevention
Preventive measures include reducing exposure to sun (use sunscreens, hats, shirts and sunglasses), avoiding tanning beds and sunlamps, removing abnormal moles. In addition, cancer specialists recommend self-examinations for changes in moles, blemishes, and overall skin. Watch for sores that don’t heal, scaling, oozing or bleeding, itchiness, tenderness, pain, redness or swelling, and spreading of the pigment of the mole. The ABCD rule is another guide to the usual signs of melanoma:

  1. Asymmetry: One half of a mole or birthmark does not match the other
  2. Border: The edges are irregular, ragged, notched, or blurred
  3. Color: The color is not the same all over and may include shades of brown or black, or sometimes with patches of pink, red, white, or blue
  4. Diameter: The spot is larger than 6 millimeters across (about 1/4 inch — the size of a pencil eraser), although melanomas can sometimes be smaller than this

Kidney Cancer
Risk Factors

  • Smoking
  • Obesity
  • Workplace exposures
  • Genetics and family history
  • High blood pressure
  • Advanced disease
  • Gender (more common in men)
  • Race (higher rates in African Americans)

Prevention and Screening
Since the cause is not known, preventive measures are unknown. However, increased exercise is advised, as well as a diet with fruits and vegetables. There are no recommended screenings at this time.

Breast Cancer
Risk Factors

  • Gender (most common in women)
  • Age (2/3 of breast cancers are in women age 55 and over)
  • Genetics
  • Family history
  • Personal history
  • Race and ethnicity (white women are more susceptible)
  • Dense breast tissue
  • Menstrual periods starting before age of 12 or lasting through age 55
  • Chest radiation
  • Getting pregnant with the first child after age 30
  • Oral contraceptive use
  • Hormone therapy after menopause
  • Not breast feeding
  • High use of alcohol
  • Being overweight and obese
  • Physical inactivity

Prevention and Screenings
Since the cause is unknown, it cannot be prevented. Screenings include annual mammograms for women over age 40 and a monthly breast self-exam. Medicare pays for one mammogram every 12 months.

Uterine Cancer
Risk Factors

  • Gender (only occurs in women
  • Race (more common in African Americans)
  • pelvic radiation (in most cases, the benefits of pelvic radiation outweigh the risks of uterine cancer)

Screenings
The Pap test is effective in finding cervical cancer, and sometimes identifies uterine sarcoma. Medicare pays for one Pap test every two years in low risk individuals and annually in high-risk individuals.

Treatment & Management of Cancer

Treatment can include surgery, radiation, chemotherapy depending on the type of cancer, individual preferences, and response to available treatments. Some patients can participate in clinical trials. If you are a cancer patient, join Cancer Survivors Network at csn.cancer.org, an online community to share stories and get support, and/or join groups in your community that meet to provide support.

Questions For Your Doctor

  • What is the extent or stage of the cancer I have?
  • What is my prognosis?
  • What are my treatment options? What treatment(s) do you suggest?
  • Why do you favor this treatment over others?
  • Would a clinical trial be appropriate for me?
  • What will happen if I choose not to have treatment?
  • What are the associated financial costs, and will my insurance cover the recommended treatment?

Tips

  • For snacks, switch from chips or crackers to almonds, and treat yourself to celery and rice crackers with hummus or goat cheese
  • Don’t have X-rays any more frequently than is absolutely necessary. Is that annual routine chest film medically necessary? Some dentists want frequent X-rays. Make sure you really need x-rays before agreeing, and be sure to ask for a thyroid neck collar during the procedure
  • Map out an extended family history cancer tree and bring it to your next doctor’s appointment. Knowing your family history can help your doctor decide whether you need screenings earlier and more often, and/or if you should be tested for genetic mutations linked to certain cancers

Test the home for radon. According to the Environmental Protection Agency, if the radon level is 4 pCi/L, making the necessary home repairs can reduce the risk of cancer.

Resources