How does cancer start? What are the most effective treatments? An expert in the field answers your most common questions about this condition...
One-third of all women and half of all men in the United States will develop cancer during their lifetimes, according to the American Cancer Society.
But thanks to better screening tools leading to earlier diagnoses and more effective treatments, people are more likely to survive cancer than ever before, says Robert J. Morgan Jr., M.D., co-director of the Gynecological Oncology/Peritoneal Malignancy Program at the City of Hope in Duarte, Calif.
He shares his expertise about what causes cancer, treatments for cancers, risk factors and more.
What exactly is cancer?
Cancer is the abnormal growth and spread of bodily tissues.
Cancer has two properties that normal tissue does not have: It invades normal tissue instead of stopping when it bumps into adjoining tissues, and it spreads and grows in organs where it doesn’t belong, interfering with organ functioning.
What are the cancer “stages”?
The stage describes the extent of the cancer when it is diagnosed — from Stage I, which is early cancer, to Stage IV, advanced disease. The stage of cancer is usually based on a combination of three factors:
T – tumor size
N – nodal involvement [lymph node involvement]
M – the presence or absence of metastases – cancer growing outside the area from which it arose
Based on these factors, the doctor can predict the likelihood that a cancer will recur and estimate how treatment might reduce that risk.
Tobacco and sun exposure have received a lot of press as causes of cancer. What are other risk factors and causes?
Some known causes are radiation, poisons, some infectious causes such as Human papilloma virus, Helicobacter infection, and hereditary causes such as breast/ovarian cancer syndrome (BRCA mutations) and hereditary nonpolyposis colon cancer (Lynch syndrome).
But doctors and scientists don’t know why most cases of cancer happen.
We call these sporadic cancers, and they make up about 85% of all cancers.
Are cancer symptoms always identifiable?
Typical symptoms include abnormal masses, pain, unexplained weight loss or severe fatigue.
But cancer symptoms can be subtle, particularly in the early stages.
That is why it is important for women to get their Pap smears and mammograms, for men to get their prostates checked and for both genders to have their recommended colonoscopies.
What types of treatments are prescribed for cancer?
Generally, therapy must be tailored to the individual patient and cancer type.
Most solid tumor cancers require surgery with or without radiation and/or chemotherapy.
Blood cancers such as leukemia require chemotherapy and possibly bone marrow transplantation.
More recently, we have learned more about what is abnormal in cancer cells and have designed “targeted agents” to specifically address their functioning.
How is chemotherapy used to treat cancer?
Chemotherapy treatment may be given to control side effects of the cancer or as a preventative to keep cancer that has been removed by surgery from coming back.
This is called adjuvant treatment – treatment done in addition to the primary surgery.
Blood cancers, such as leukemia, lymphoma, and multiple myeloma, are best treated with radiation and/or chemotherapy depending on the type and stage.
If adjuvant, chemotherapy will be given for a set number of cycles — usually 4-6 cycles over about 4-6 months.
When treating metastatic cancer (cancer that has spread to other parts of the body), chemotherapy is usually given for 2-3 months with pre-treatment and post-treatment X-ray assessment.
What are some general side effects associated with chemotherapy?
Chemotherapy is often associated with decreases in blood counts, making infections or bleeding more frequent.
Skin rashes, dysfunction of internal organs, nausea and vomiting are also side effects, but we have good anti-nausea medications now.
All of these side effects must be watched by the doctor.
How is radiation used to treat cancer?
It depends on the type of cancer and the reason for the radiation.
If radiation is given to treat pain, for example, a short course of daily radiation for 10-15 days is often recommended.
If radiation is given for possible cure, as in cervical cancer, daily radiation for 5-6 weeks is often necessary.
What are the general side effects of radiation?
Side effects depend upon where the radiation is being given and may include skin rash, possible nausea or vomiting, and sometimes urinary burning and diarrhea. Fatigue is almost universal.
When is surgery recommended to treat cancer?
Usually, surgery is indicated for the excision, or removal, of cancers in a specific site, if there is no evidence the cancer has spread and is growing elsewhere.
Solid tumors that are found in local/regional stages virtually always require some form of surgery to control them. Then, they often require some radiation and/or chemotherapy to decrease the chance that the cancer will recur.
Also, surgery may be performed for patients with specific symptoms due to the cancer, such as bowel blockage, for which other treatments wouldn’t be effective.
Will diet/exercise and other lifestyle changes affect how well the patient is before, after and during treatment?
I usually tell my patients it’s best if they maintain a stable or slightly increased weight, done by following a balanced diet.
Obesity is known to increase the risk of some cancers such as uterine cancer.
Physical activity is good for patients.
What new research is being done in treating cancer?
New targeted agents are being designed to interfere with abnormal functioning of cancer cells.
An example of a targeted agent is bevacizumab, which blocks the formation of blood vessels that feed the tumor.
Targeted agents might also block the abnormal growth of cancer cells.
Improvements in surgery have also been developed.
For example, robotic surgery allows the surgeon to do more surgery with less severe incisions.
Radiation can be more precisely aimed at the tumor, in a procedure called stereotactic radiosurgery.
Upon receiving a cancer diagnosis, do you suggest the person get a second opinion?
Generally, yes.
Most often, the second opinion may confirm the first doctor’s opinion.
But, this is also helpful because it helps the patient to feel better about accepting the treatment recommendation.
If the second opinion is obtained at a specialty hospital, a clinical trial may be available that may not be available in the community.
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