What is cancer?

Cancer begins in your cells, which are the building blocks of your body. Normally, your body forms new cells as you need them, replacing old cells that die. Sometimes this process goes wrong. New cells grow even when you don't need them, and old cells don't die when they should. These extra cells can form a mass called a tumor. Tumors can be benign or malignant. Benign tumors aren't cancer while malignant ones are. Cells from malignant tumors can invade nearby tissues. They can also break away and spread to other parts of the body.

Cancer is not just one disease but many diseases. There are more than 100 different types of cancer. Most cancers are named for where they start. For example, lung cancer starts in the lung, and breast cancer starts in the breast. The spread of cancer from one part of the body to another is called metastasis. Symptoms and treatment depend on the cancer type and how advanced it is. Most treatment plans may include surgery, radiation and/or chemotherapy. Some may involve hormone therapy, biologic therapy, or stem cell transplantation.

What is cancer?

The body is made up of many types of cells. Normally, cells grow, divide and then die. Sometimes, cells mutate (change) and begin to grow and divide more quickly than normal cells. Rather than dying, these abnormal cells clump together to form tumors. If these tumors are cancerous (also called malignant tumors), they can invade and kill your body's healthy tissues. From these tumors, cancer cells can metastasize (spread) and form new tumors in other parts of the body. By contrast, noncancerous tumors (also called benign tumors) do not spread to other parts of the body.

There are many different types of cancer, but all cancers begin with abnormal cells growing out of control. The type of cancer is determined by what type of cells begin to grow abnormally and where in the body the abnormal growth occurs. The most common cancers in adults are skin cancer, lung cancer, colon cancer, rectal cancer, breast cancer, endometrial cancer, ovarian cancer and prostate cancer.

Who is at risk for cancer?

Everyone has some risk for cancer. In the United States, cancer is likely to affect 1 in 2 men and 1 in 3WOMEN at least once in their lifetime. The amount of risk you have depends on a number of factors. These factors include tobacco use, lifestyle choices (such as diet and exercise), family history and factors in your workplace and environment.

How do I know if I am at risk for cancer?

Talk to your doctor. Your doctor can help you understand your risk for cancer, especially if other members of your family have a history of cancer. Your doctor can also help you understand how your risk for cancer is affected by the following:

• Using or having used tobacco products, such as cigarettes or chewing tobacco
• Drinking alcohol
• Having eaten a diet high in fat for much of your life
• Being exposed to chemicals that can cause cancer
• Being at risk for skin cancer

Depending on your age and your risk factors, your doctor may begin screening you for certain types of cancer. Screening means looking for certain cancers before they cause any symptoms. Some doctors recommend that people who are at high risk or have a family history of cancer be screened more often, or at a younger age, than people who have average cancer risks. The recommendations for screening vary for different cancers.

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How does smoking and other tobacco use affect my risk for cancer?

If you smoke, quitting smoking is the single most Important thing you can do for your health. Cigarette smoking is a major cause of cancers of the lung, larynx (voice box), mouth and esophagus, and it can also contribute to cancers in other parts of the body.

According to the American Cancer Society, people who quit smoking at any age live longer than those who continue to smoke. For example, smokers who quit before age 50 have half the risk of dying within 15 years compared with those who continue smoking. And the more you smoke, the more damage you do. People who smoke 2 packs or more per day are nearly 20 times more likely to develop cancer than nonsmokers.

Other forms of tobacco can also cause cancer, such as cigars, chewing tobacco and snuff. If you use tobacco products and want to stop, talk to your family doctor. He or she can help you make a plan to quit.

How does my family history affect my risk for cancer?

Unfortunately, some types of cancer seem to run in families. People of a certain race or ethnic group may also have a higher risk of some kinds of cancer.

Your doctor will ask you whether other people in your family have had cancer. If someone in your immediate family (a parent, brother, sister or child) has had cancer, you probably are at higher risk for cancer, also.

You can't change your family history, but it helps to be aware of it. If you and your doctor know that cancer tends to run in your family, you can watch more closely for the early signs of the disease. For example, if you are a woman and have a family history of breast cancer, your doctor may want you to start having mammograms more often or at a younger age.

What about factors in my workplace or environment?

There may be substances in your surroundings that can cause cancer or put you at a higher risk of developing cancer. These can include dust and vapors in the air you breathe and chemicals that touch your skin. Exposure to the sun without protection can cause skin cancer and breathing tobacco smoke (by smoking yourself or by breathing secondhand smoke) puts you at risk of lung cancer and other types of cancers.

Ask your employer if there are any materials in your workplace that can cause cancer. These may include asbestos, solvents and chemicals used for manufacturing or cleaning, smoke or fumes from burning materials and many others. Your employer should have a material safety data sheet (MSDS) for each substance that could potentially damage your health. All employers are required by law to complete these forms and you have a right to see them. Your employer should also provide safety equipment, such as a mask and protective clothing, to help decrease your exposure to any harmful materials.

Take a look at the environments you spend time in outside your workplace, as well. Too much exposure to the sun can cause skin cancer, the most common form of cancer. Try to stay out of the sun as much as you can. If you must spend time in the sun, wear protective clothing and sunscreen with an SPF (sun protection factor) of at least 15.

Breathing in smoke from a cigarette, cigar or pipe (even if you're not the person who's smoking) causes damage to your body that can lead to cancer. If you smoke, you need to quit. If someone in your family smokes,OFFER to help him or her quit, or ask him or her to not smoke when you are around. Cigarette smoke that clings to surfaces like carpet or clothing can also pose a risk, especially for infants and toddlers.

Diagnosis & Tests

What screening tests should women have?

Increasing age is the most important risk factor for breast cancer for most Women. To help find breast cancer early, your doctor may perform a clinical breast exam (where he or she checks your breasts for lumps). Discuss the benefits and harms of a clinical breast exam with your doctor.

A mammogram is a SPECIAL type of low-radiation X-ray of the breast. If you are between the ages of 50 and 75, you should have a mammogram every 2 years. If you are at high risk for breast cancer, such as a history of breast cancer in your family, your doctor may want you to have mammograms more often or at a younger age than 50. The value of mammography for average-risk women in their 40s is controversial and you should discuss the pros and cons of this with your doctor to make a decision you are comfortable with.

During a Pap smear, your doctor takes a sample of cells from your cervix to be tested for cervical cancer. Unless your doctor suggests that you need one more often, you should have a Pap smear:

• Every 3 years beginning at 21 years of age and continuing until 65 years of age
• Within 3 years of when you start having sex if you are younger than 21 years of age
• If you are between 30 and 65 years of age and you want to have Pap smears less often, talk to your doctor about combining a Pap smear with human papillomavirus (HPV)testing every 5 years

Certain things put you at higher or lower risk for cervical cancer. Your doctor will consider these when recommending how often you should have a Pap smear.

If you're older than 65 years of age, talk with your doctor about how often you need a Pap smear. If you've been having Pap smears regularly and they've been normal, you may not need to keep having them.

If you've had a hysterectomy with removal of your cervix, talk with your doctor about how often you need a Pap smear.

If you've never had a high-grade precancerous lesion or cervical cancer, ask your doctor how often you need a Pap smear.

What screening tests should men have?

To make a decision about screening for prostate cancer, first talk to your doctor about the pros and cons of screening. Factors such as family history, age and race play a part in the risk of prostate cancer.

The National Cancer Institute, the American Cancer Society, the U.S. Preventive Services Task Force and the American Academy of Family Physicians recommend that men talk to their doctors about screening and make a decision based on the risk and potential benefits of screening, as well as their own personal values and preferences.

If you decide to have screening, your doctor will Order a blood test called the PSA test. PSA is short for prostate-specific antigen. Men who have prostate cancer may have a higher level of PSA in their blood. However, the PSA level can also be high because of less serious causes, such as infection.

The AAFP recommends against prostate-specific antigen (PSA)-based screening for prostate cancer.

Treatment

Why is it important to find cancer early?

Some common cancers are easier to treat and cure if they are found early. If the tumor is found when it is still small and has not yet spread, curing the cancer can be easy. However, the longer the tumor goes unnoticed, the greater the chance that the cancer has spread. This usually makes treatment more difficult.

What are the different kinds of cancer treatment?

The three most common types of cancer treatment are surgery, radiotherapy and chemotherapy. Treatment is aimed at removing the cancer cells or destroying them with medicines or by other means.

Surgery

Surgery is a way to physically remove the cancer. Surgery can be very successful in treating some kinds of cancer, but it isn't an option in all cases. If the cancer is in the form of a malignant tumor (a tumor that spreads) but the tumor is still in one place (localized), it may be possible to safely remove the tumor and any surrounding affected tissue. Surgery may not be possible if the cancer has spread to other areas of the body or if the tumor cannot be removed without damaging vital organs, such as the liver or brain.

Different types of surgery are used to remove cancer. Some of these include:

• Laser surgery. Beams of light and sometimes heat from a laser are used to target and destroy cancer cells.
• Laparoscopic surgery. Very small incisions are made in the body, and the doctor uses a tiny camera to see inside your body. The camera sends signals to a video screen so that your doctor can see the tumor and your organs. The doctor uses a surgical tool to remove the tumor.
• Mohs’ surgery. Layers of cancer cells are removed one at a time. Each layer is examined before the doctor removes the next layer. In this way, only the diseased layers are removed and healthy tissue remains intact.
• Cryosurgery. Cancer cells are frozen and destroyed using a very cold material, such as liquid nitrogen.

Radiotherapy

Radiotherapy uses radiation—in the form of a special kind of X-ray, gamma rays or Electrons—to damage cancer cells so that they can't multiply. There is usually no pain during this kind of therapy. Depending on the area that is treated, side effects from radiation damage to normal tissues may occur. Your doctor can tell you what to expect. Radiotherapy is sometimes the only treatment needed, or it may be used with other therapies. A combination of surgery and radiotherapy may be used for tumors that grow in one place.

Chemotherapy

Chemotherapy uses medicines to attack the cancer cells. The word "chemotherapy" sometimes causes a lot of fear because the side effects can be severe. However, not all people experience severe side effects. The side effects of chemotherapy can often be treated with other medicines.

Chemotherapy is usually used when the cancer has spread to other areas in the body. Chemotherapy can also be used in combination with surgery and radiation. Sometimes the tumor is surgically removed and then chemotherapy is used to make sure any remaining cancer cells are killed.

Other Treatments

Another kind of treatment is biological therapy (also called immunotherapy). This treatment is used to trigger the body's immune system to produce more white blood cells, called lymphocytes (say: limf-o-sites). Two kinds of lymphocytes can attack and kill cancer cells: T-cells and B-cells. Immunotherapy aims to boost the ability of the T-cell and B-cell lymphocytes to kill cancer. This kind of therapy can also be used in combination with surgery, radiation therapy or chemotherapy.

Hormone therapy is sometimes used to treat breast or prostate cancer, often in addition to chemotherapy or radiotherapy. Hormone therapy involves taking drugs that contain other hormones to block the effects of estrogen and TESTOSTERONE, also hormones. These drugs are necessary because the hormone estrogen can make breast cancer tumors grow faster. Similarly, the hormone testosterone can make cancerous tumors in the prostate grow faster. In other cases, surgery to remove the ovaries or the testicles may be used. Removing these organs reduces the amount of estrogen or testosterone in the body.

Other SPECIALIZED treatments may be available. Your doctor may talk to you about these treatments if they are an option for you.

Prevention

Unfortunately, some risk factors for cancer (such as family history) are out of your control. But there are things you can do each day to improve your health and lower your risk of cancer. The best ways to lower your cancer risk are to stop smoking and to maintain a healthy weight, be active and eat a healthy diet. Limiting how much alcohol you drink is also IMPORTANT, as is limiting your exposure to sunlight or tanning beds. If you are a cancer survivor, these same lifestyle habits can help you stay healthy.

Seeing your doctor regularly can also help. Depending on your age and medical history, your doctor will probably run tests (called screenings) to try to detect the early signs of certain cancers. For most types of cancer, the sooner the cancer is found and treatment begins, the better your chances of recovering.

Reaching and staying at a healthy weight lowers your risk of many different cancers. Maintaining a healthy weight will also help lower your risk of other conditions, such as heart disease and diabetes. Ask your doctor what a healthy weight would be for you. If you are above a healthy weight, even losing just 5 percent to 10 percent of your current weight can help your health.