The Cancer Handbook

The Cancer Handbook
Section A - The Molecular Basis of Cell and Tissue Organization
1. Cell and Tissue Organisation
2. Regulation of the Cell Cycle
3. Overview of Oncogenesis
4. Inherited Predispositions to Cancer
5. DNA Viruses
6. RNA Viruses
7. Genetic Instability and DNA repair
8. Telomerase
9. Apoptosis
10. Signalling by steroid receptors
11. Signalling by cytokines
12. Signalling by tyrosine kinases
13. Signalling by TGF beta
14. Wnt Signal Transduction
15. Extracellular Matrix: the networking solution
16. Invasion and Metastasis
17. Angiogenesis
18. Cell Proliferation in Carcinogenesis
Section B - The Causation and Prevention of Cancer
1. Identifying Cancer Causes through Epidemiology
2. Mechanisms of Chemical Carcinogenesis
3. The Formation of DNA Adducts
4. Physical Causes of Cancer
5. Non-Genotoxic Causes of Cancer
6. Infectious Agents and Cancer
7. Short-term Testing for Genotoxicity
8. Cancer Bioassays for Pharmaceuticals a Regulatory Perspective
9. Molecular Epidemiology of Cancer
10. Dietary Genotoxins and Cancer
11. Tobacco Use and Cancer
12. Occupational Causes of Cancer
13. Anti-Genotoxins and Cancer
14. Intervention and Chemoprevention
Section C - Diagnostic Imaging and Image-Guided Intervention
Part I- Imaging Modalities in Diagnosis and Monitoring
1. Plain Film Radiography
2. Computed Tomography
3. Ultrasound
4. Magnetic Resonance Imaging
5. Nuclear Medicine Studies
6. Mammography
Part II - Diagnostic and Therapeutic Interventional Procedures
1. Percutaneous Biopsy
2. Transcatheter Therapy
3. Direct Percutaneous Tumour Therapy
Section D - Systemic Oncology
1. Introduction to the Diagnosis of Cancer
2. Skin
3. Oral cavity & major and minor salivary glands
4. Respiratory tract
5. Upper Gastrointestinal tract
6. Lower gastrointestinal tract
7. Liver, gall bladder and extrahepatic bile ducts.
8. Pancreas
9. Endocrine organs
10. Breast
11. Female reproductive system
12. Urinary tract
13. Male reproductive system
14. Lymph nodes, spleen and bone marrow.
15. Bones and joints.
16. Soft Tissues
17. Pleura and peritoneum
18. Heart
19. Neuromuscular System
20. Eye and ocular adnexa
21. Ear
Appendum. Myeloid Leukemias and related Neoplasms
Section E - Pre-clinical Models of Human Cancer
1. Advantages and limitations of models for human cancer
2. Basic Tissue Culture
3. Transgenic technology in the study of oncogenes and Tumor Suppressor Genes
4. Gene knockouts
5. Human tumours in animal hosts
6. Mammary tumour induction in animals as a model for human breast cancer
7. Mathematical models in cancer research
8. Models for tumour growth and differentiation
9. Angiogenesis models
10. Models for tumour cell adhesion and invasion
11. Tumour metastasis models
12. Models for tumour cell-endothelial cell interactions
13. Modelling Tumor Tissue Interactives
14. Models for drug development and drug resistance
15. Models for immunotherapy and cancer vaccines
16. Gene therapy models
17. Models for epithelial carcinomas
18. Models for haematological malignancies
19. Models for melanomas and sarcomas
20. Models for CNS malignancies
21. Models for endocrine cancer
Section F - The Treatment of Human Cancer
1. Mechanisms of action of cancer chemotherapeutic agents
2. Drug Resistance & Reversal
3. Molecular mechanisms of radiotherapy
4. Antibodies and recombinant cytokines
5. Genetic and Cellular Vaccines
6. Differentiation Therapy
7. Chemoprevention
8. Antisense & ribozyme therapy
9. Hormonal Therapy
10. Antiangiogenic Therapy
11. Targeting the Extracellular Matrix
12. Growth Factor Receptor Blockade
13. Signal

bladder cancer symptom

The symptoms for bladder cancer are not specific. Many other diseases, including inflammatory conditions, involving the bladder and kidney may cause similar symptoms. However, since early detection is important in curing bladder cancer, if you have these symptoms, you should bring them to the attention of your doctor.
The most common first symptom of bladder cancer is blood in the urine called hematuria. Hematuria is either visible or microscopic.
o Gross hematuria describes urine that appears red or brown and can be seen with the naked eye
o Microscopic hematuria means the red blood cells are visible if a urine sample is examined under a microscope
Irritative urination symptoms may also be associated with bladder cancer and include:
o pain and burning on urination,
o a sense of incomplete emptying of the bladder after urination and
o having to urinate more frequently or at shorter intervals.
The symptoms above could also indicate problems (less serious) other than bladder cancer.
Bladder Cancer Symptoms
Bladder cancer is common disease in the United States. Research tells us that it occurs mainly in industrialized countries, such as the US, France, and Canada.

Bladder cancer symptoms are few, yet very noticeable. Bladder cancer symptoms include:


Blood in the urine: The presence of blood in urine, is called hematuria. Blood can either be seen by the eye, in which it is called gross hematuria. Blood can also be seen under a microscope, and it is then called microscopic hematuria.

Pain during urination: Pain during urination is called dysuria. Pain can range from mild to severe.

Frequent urination: Having to urinate often and during the night is also a symptom.

breast cancer treatment

With this report, women with breast cancer have access to information on the way breast cancer is treated at the nation’s leading cancer centers. Originally developed for cancer specialists by the National Comprehensive Cancer Network (NCCN), these treatment guidelines have now been translated for the public by the American Cancer Society.
Since 1995, doctors have looked to the NCCN for guidance on the highest quality, most effective advice on treating cancer. For more than 90 years, the public has relied on the American Cancer Society for information about cancer. The Society’s books and brochures provide comprehensive, current, and understandable information to hundreds of thousands of patients, their families and friends. This collaboration between the NCCN and ACS provides an authoritative and understandable source of cancer treatment information for the public. These patient guidelines will help you better understand your cancer treatment and your doctor’s counsel. We urge you to discuss them with your doctor. To make the best possible use of this information, you might begin by asking your doctor the following questions:
How large is my cancer? Do I have more than one tumor in the breast?
What is my cancer’s grade how abnormal the cells appear) and histology (type and arrangement of tumor cells) as seen under a microscope?
Do I have any lymph nodes with cancer (positive lymph nodes, i.e. nodal status)? If yes, how many?
What is the stage of my cancer?
Does my cancer contain hormone receptors? What does this mean for me?
Is my cancer positive for HER-2? What does this mean for me?
Is breast-conserving treatment an option for me?
In addition to surgery, what other treatment do you recommend? Radiation? Chemotherapy? Hormone therapy?
What are the side effects?
Are there any clinical trials that I should consider?
Inside Breast Tissue
The main parts of the female breast are lobules (milk-producing glands), ducts (milk passages that connect the lobules and the nipple), and stroma (fatty tissue and ligaments surrounding the ducts and lobules, blood vessels, and lymphatic vessels). Lymphatic vessels are similar to veins but carry lymph instead of blood. Most breast cancer begins in the ducts (ductal), some in the lobules (lobular), and the rest in other breast tissues.
Lymph is a clear fluid that has tissue waste products and immune system cells. Most lymphatic vessels of the breast lead to underarm (axillary) lymph nodes. Some lead to lymph nodes above the collarbone (called supraclavicular) and others to internal mammary nodes which are next to the breastbone (or sternum). Cancer cells may enter lymph vessels and spread along these vessels to reach lymph nodes. Cancer cells may also enter blood vessels and spread through the bloodstream to other parts of the body.
Lymph nodes are small, bean shaped collections of immune system cells important in fighting infections. When breast cancer cells reach the axillary lymph nodes, they can continue to grow, often causing swelling of the lymph nodes in the armpit or elsewhere.

If breast cancer cells have spread to the axillary lymph nodes, it makes it more likely that they have spread to other organs of the body as well.

Most Cancer Deaths Preventable

For overweight (n. 超重) and obesity (n. 肥胖) among adults, the picture isn't pretty anywhere: "Best" is Hawaii, where "only" 50 percent of adults are overweight or obese (adj. 极胖的；过重的).



Most cancer deaths can be avoided and some states are doing better than others, the American Cancer Society (美国癌症学会) says.







Cancer is now the leading cause of death for people under 85, but cancer experts say this is largely preventable (adj. 可预防的).



It's no secret. Here's how:



Don't smoke. If you do smoke, quit.



Keep your weight down. If you're overweight or obese, lose some weight and keep it off.



Get plenty of exercise.



Eat at least five servings (n. 一份，一客) of fruits and vegetables every day.



Stay out of the sun. Use protective (adj. 保护的) clothing and sunscreen (n. 遮光剂，保护皮肤免受阳光紫外线的照射) when you are outdoors.



Get recommended cancer screening tests.







So how are we doing? Not nearly as well as we should, according to Thursday's release of the American Cancer Society's Cancer Prevention & Early Detection Facts & Figures 2005 (“2005年癌症预防及早期诊断数据报告”).



There's still much we can do to cut our cancer risk (n. 风险). Here's how we're doing:







More than one in four men and more than one in five women still smoke cigarettes.



Nearly two-thirds of U.S. adults are overweight. That includes the 30 percent of us who are obese.







Not quite half of U.S. adults get enough exercise.



Only about one in four U.S. adults eats five or more servings of fruits and vegetables a day.

Cancer Early Detection

Always be aware of changes to your body as this might be the warning signal that something is wrong. Never assume your health. Some cancers, like cervical cancer and skin cancer are treatable when detected at an early stage. Therefore it is important that we should always "mind our own business", go for checkup and screening regularly.




Symptoms
Prevention & Early Detection

Bladder Cancer

Blood in urine


Blood clots may cause muscle spasms in bladder


Passing urine often and burning feeling


　

Do not smoke


　

Bowel cancer

Blood in the bowel motion


Change in toilet habits lasting more than two weeks


Have a family history of bowel cancer


　

Eat more vegetables and fruits


Avoid fat, salt and preserved food


Avoid excessive alcohol


　

Breast cancer

Lump in the breast


Change in size or shape of the breast


Dimpling of the skin


　

Be breast aware, seek for early medical advice


　

Liver Cancer

Often no symptoms in early stage


Vague discomfort in the upper abdomen


Loss of appetite, weight loss, nausea and lethargy


　

Avoid alcohol


Receive Hepatitis B vaccine


Avoid moudly peanuts


　

Lung Cancer

A persistent cough


Shortness of breath


Coughing up blood-stained phlegm (sputum)


　

Do not smoke


　

Nasopharyngeal Carcinoma (NPC)

Blood-stained nasal discharge


Postnasal dribbling


Nasal obstruction


Lump in the neck


Defective hearing and ringing of the ear


　

Avoid salted fish


　

Non-Hodgkin's Lymphomas

Painless swelling in the neck, armpits or groin


Excessive sweating or fever


Persistent itch all over the body


　

Yearly screening for people older than 50


　

Prostate cancer

Difficulty in passing urine, and a feel of burning


Blood in urine


Passing urine more frequently than usual


Men who have family histories of the cancer


　

Adopting a vegetarian, low- fat diet


Yearly screening for men over 40


　

Stomach Cancer

Persistent indigestion


Weight loss


Vomiting blood


Blood in stools


　

Avoid smoked and pickled food


Do not smoke


　

Cervical cancer

Abnormal vaginal bleeding or discharge


　

Have a pap-smear test at regular intervals


　

Skin cancer

Change in a wart or mole e.g. bleeding or enlargement


A sore in skin that does not heal


　

Be sun-smart, avoid too much sunlight


　


Prevention Early Detection

Despite the rising figures in new cases of cancer every year, there are many things we can do to reduce our risk. These are very simple measures and as long as you are serious about your health, you can take control.

Cancer and Children

Broadcast: February 26, 2003
By Jerilyn Watson

This is Bill White the VOA Special English Health Report.
Most children who die of cancer are in developing nations. British researchers say only ten percent of children with cancer in these countries survive. They say many more could be saved if their countries had the resources needed to find cancers and treat them.
Around the world, about one-hundred-sixty-six thousand children under age fifteen are found each year to have cancer. The researchers say eighty-four percent of these cases are found in developing countries. But many others go unnoticed.
Children from industrial countries who do get cancer also have a much better chance to survive. For example, more than seventy percent in countries like Britain and the United States are alive after five years.
An organization called Cancer Research United Kingdom announced these numbers to mark International Childhood Cancer Day on February fifteenth. The purpose of the event was to educate the public and raise money for children with cancer.
Cancer Research U-K says fifty-four percent of cancer cases among children strike in Asia. Also, more than half of all child cancer deaths happen in Asia. Africa has twenty-percent of childhood cancer cases and twenty-five percent of the deaths.
Vaskar Saha of Cancer Research U-K is a childhood cancer expert. Professor Saha called for an international campaign against childhood cancer similar to the campaign against AIDS. The goal would be to increase the supply and reduce the cost of drugs to treat cancer in developing countries.
Earlier this month, world trade negotiators1 agreed to continue to look for ways to cut drug prices for developing nations.
Chemotherapy2 drugs kill cancer cells. Drug companies say they have improved this treatment in recent years while reducing harmful side effects. But many developing countries cannot pay for chemotherapy drugs. Another way to fight cancer is to cut out the diseased cells. A third way is to use radiation to target cancer cells.
Scientists say most cancers are caused by a combination of genetic and environmental conditions. There are warning signs of childhood cancer. These can include a white spot in the eye, unusual growths, weight loss and tiredness. Unexplained bleeding, pain and high body temperature are other possible signs.

cancer

cancer
Cancer: June 22-July 22
Ruling Planet: Moon
Symbol: Crab
Color: Grays, Greens
Gem: Pearl
Flowers: White Flowers Particularly Roses
Lucky Numbers: 7 and 3
Lucky Day: Monday
Key phrase: I Feel !
Keywords: Protective, Sensitive, Tenacious
Main Trait: Loyalty
Notable Cancer: Helen Keller (June 27, 1880 American Educator)Harrison Ford (July 13, 1942; American Actor)

Personal traits: Appearing formidable and thick-skinned, Cancerian's have an unemotional demeanor, appearing uncompromising and obstinate. This is the facade they use to mask an insecure nature. In fact, the overall nature of Cancerians is deeply emotional. Their intimates, however, may see a different character, one with sympathy and sensitivity to other people, especially those they love. Cancer is a tenacious, purposeful, energetic, shrewd and intuitive type.

In their personal relationships they are a mixture of toughness and tenderness. Emotional, romantic and sentimental on one side, and tenaciously possessive and loyal on the other side.

Profession: Always interested in what people are thinking, they have an intuitive sense that makes them good journalists, writers or politicians. They do well in the public sector, and may serve in anything from welfare and nursing to catering.

New Breast Cancer Drug

By Nancy Steinbach

Broadcast: October 22, 2003

This is Phoebe Zimmermann with the VOA Special English Health Report.
Researchers say a drug developed several years ago reduces the chance that older women will get breast cancer for a second time.
The drug is called letrozole. It suppresses the production of 1)the female hormone estrogen. 2)Cancerous growths need 3)estrogen to spread.
Breast cancer is most treatable early in its development. Current practice calls for doctors to operate to remove the growth. Then women take 4)chemotherapy drugs to kill any cancer that remains. After that, women are supposed to take the drug 5)tamoxifen (ta-MOX-i-fen) for five years. This is to prevent the cancer from coming back. But tamoxifen seems to lose its effect after five years.
Researchers have found that fifteen to thirty percent of patients get breast cancer again within ten years after they stop the tamoxifen. These are the women that doctors hope the new drug can help.
Novartis 6)Pharmaceuticals makes letrozole under the name Femara. The drug is already approved in the United States to treat late forms of breast cancer.
The new study involved more than five-thousand women in the United States, Canada and Europe. All had breast cancer once and been treated with tamoxifen. For the study, half took letrozole once a day. The others took a 7)placebo, a pill they did not know contained only sugar.
In all, two-hundred-seven women got breast cancer for a second time. Of these, one-hundred-thirty-two had taken the placebo. Seventy-five had been given letrozole.
The Canadian-led study found that the drug reduced the chance of cancer returning by forty-three percent. The researchers planned to study the women for five years. But they stopped after two-and-a-half years. They said the effect was so clear, it would have been wrong to keep the drug from the other women in the study.
Because of the lack of estrogen, the women on letrozole had a higher risk of bone-thinning 8)osteoporosis. They were also more likely to experience effects similar to those of 9)menopause, like feeling hot all of a sudden.
Ending the study early left some questions unanswered -- for example, how long should women take the drug. The study involved the National Cancer Institutes in Canada and the United States. The findings appear next month in the New England Journal of Medicine.
This VOA Special English Health Report was written by Nancy Steinbach. This is Phoebe Zimmermann.

Lung cancer introduce

Lung cancer introduce

Lung cancer is the uncontrolled growth of abnormal cells in one or both of the lungs. While normal lung tissue cells reproduce and develop into healthy lung tissue, these abnormal cells reproduce rapidly and never grow into normal lung tissue. Lumps of cancer cells (tumors) then form and disrupt the lung, making it difficult to function properly. More than 87% of lung cancers are smoking related. However, not all smokers develop lung cancer. Quitting smoking reduces an individual's risk significantly, although former smokers remain at greater risk for lung cancer than people who never smoked. Exposure to other carcinogens such as asbestos and radon gas also increases an individual's risk, especially when combined with cigarette or cigar smoking. More Americans die each year from lung cancer than from breast, prostate, and colorectal cancers combined. Approximately 172,570 new cases of lung cancer will be diagnosed in 2005, accounting for 13% of all new cancer cases. An estimated 163,510 Americans will die in 2005 from lung cancer, accounting for 28% of all cancer deaths. Annually, lung cancer kills more men than prostate cancer and more women than breast cancer. While overall cancer incidence rates are declining, lung cancer incidence rates among women continue to rise. Between 1960 and 1990, deaths from lung cancer among women increased by more than 400%. An estimated 79,560 women in the U.S. will die this year from lung cancer. An estimated 93,010 men in the U.S. will die this year from lung cancer. Lung cancer is the second most common cancer among African American men and women, and kills more African Americans than any other cancer. African American men are at least 50% more likely to develop lung cancer than Caucasian men. The mortality rate of African American males with lung cancer is 100.8 per 100,000 people, compared to 70.1 for Caucasian males. The incidence of lung cancer among African American males is 117.2 per 100,000 people, compared to 77.9 of Caucasian males. African American women have the highest incidence rates of lung cancer followed by Caucasians, Asian Pacific Islanders, Hispanics, and American Indians/Native Alaskans. Similar to AIDS in the early 1980s, lung cancer patients report feeling ashamed to tell their family, friends, and others that they have been diagnosed with lung cancer because they feel that they will be blamed. For more information about lung cancer incidence and mortality for men and women, by state and nationally, download American Cancer Society’s “Cancer Facts & Figures 2005”. The document can also be found on the American Cancer Society’s Web site. (Current Revision Date - 8/2005) For more information about African Americans and lung cancer visit the Center for Disease Controls African-Americans and Tobacco statistics. For more information about Hispanics and lung cancer visit the Center for Disease Controls Hispanics and Tobacco statistics. Sources American Cancer Society (2005). Cancer Facts & Figures - 2005. Atlanta, GA. American Cancer Society (2004). Cancer Facts & Figures for African Americans 2000 - 2002. Atlanta, GA. Centers for Disease Control (2005). African Americans and Tobacco / Hispanics with Tobacco.

What Are The Stages Of Lung Cancer?

Once a diagnosis of lung cancer has been made, the doctor will attempt to determine the stage the lung cancer is at. The staging system is somewhat like a measurement system, with the numbers indicating: whether the cancerous tumors are localized or whether the tumors have spread to other parts of the body; the tumor’s size; and whether or not the tumors have spread to the lymph nodes. There are four main stages of lung cancer (Stages 1 – 4) and identification of one of the stages is what helps doctors prescribe an appropriate treatment method.

Different Cancer, Different Stages of Lung Cancer

The staging system is a bit more complicated than simply assigning a number. First of all, the stage numbering system differs slightly depending on whether the lung cancer has been diagnosed as small cell lung cancer or non-small cell lung cancer.

Non-Small Cell Lung Cancer

Non-small cell lung cancer is the more common form and it progresses more slowly than the other type. Non-small lung cancer can be broken down into 4 stages. Stage 1 means that the tumor is local; it has not spread to the lymph nodes. Adding the letter A or B to the stage 1 classification indicates the size of the tumor (“A” means it is less than 3 cm across) and whether it’s larger and growing in a sensitive area (“B”). Stage 2 means the tumor has spread into lymph nodes or the chest wall. Again, an “A” and “B” designation determines the size and the location of the tumor. Stage 3 is more complicated and can mean several things. For example, it can indicate that the tumor has spread, but it’s still only affecting one side of the lung, or that tumors have spread to other nearby body parts such as the chest wall, or that fluid is collecting in the lungs. Stage 4 is of course the worst stage and means that cancerous tumors have spread into a whole other part of the body like the pelvis or liver.

Small-Cell Cancer

In cases of small-cell cancer, there are two stages of lung cancer – Stage 1 and Stage 2. These stages are used to designate whether the cancerous cells are limited in number or whether there exists an extensive amount that have invaded the chest and other parts of the body. When they’re limited in number, patients have a good chance of receiving effective treatment and possibly even resuming a near normal life. An extensive amount however, means treatment options are very limited.

The Staging Challenge

Although the stages of lung cancer seem well-defined, categorizing a person’s cancer into one of these stages is often challenging. Each case of cancer involves so many different factors and the combination of factors can be interpreted in many different ways by different doctors. Proper diagnosis and classification takes time and may take several rounds of testing. CT scans, MRIs, blood tests, bone scans and even testing the pleural effusion (if present) may all be needed.

What You Need To Know About Lung Cancer

Cancer is a disease in which certain body cells don't function right, divide very fast and produce too much tissue that forms a tumor. A leading cause of cancer deaths in both men and women is probably lung cancer. This is the number one cause of cancer deaths surpassing breast cancer as the leading cause of deaths in women. Cancers that begin in the lungs are divided into two major types, the non-small cell lung cancer and small cell lung cancer depending on how the cells look under a microscope.

Cigarette smoking is known to be a cause of lung cancer. The risk of developing the disease increases with the number of cigarettes smoked particularly if the person starts to smoke at a young age. The person's risk of developing lung cancer may be reduced slightly if you smoke filtered and low tar cigarettes, but it is still far greater than that of a non-smoker. Lung cancer has always been more common in men, particularly those over the age of 40, as more men used to smoke than women. Considerably, there are a growing number of women having lung cancer since women have started smoking. About 90% of all lung cancer deaths among women are from smoking. The risk of lung cancer goes down quite quickly if the person stops smoking and after about fifteen years, the person's chances of developing the disease are similar to that of a non-smoker. Passive smoking or the breathing in other people's cigarette smoke, slightly increases the risk for lung disease and lung cancer, although the risk is still much less that if you smoke yourself.

Usually, the symptoms of lung cancer do not appear until the disease is in an advanced stage. Some are diagnosed early because they are found as a result of tests for other medical conditions. Screening examinations are done to detect a disease in people without symptoms of the disease. And since lung cancer usually spreads beyond the lungs before causing any

Lung cancer cases could hit 1m

China will have the world's highest number of lung cancer patients 1 million a year by 2025 if smoking and pollution are not effectively curbed, experts have warned, citing World Health Organization (WHO) figures.

According to the national tumor prevention and cure research office affiliated to the Ministry of Health, the country had 120,000 new lung cancer patients during the past five years.

Lung cancer killed more people than any other disease one out of every four, sources said.

A recent WHO report suggests that smoking is the single, largest avoidable cause of death in the world, currently claiming 4.9 million lives a year.

"Smoking and pollution are two major causes of the high rate of lung cancer," Zhi Xiuyi, director of the lung cancer treatment center of the Beijing-based Capital Medical University, told China Daily.

Chinese smokers have surpassed the 350-million mark and account for more than a third of the world's 1.3 billion smokers; and two of three Chinese men are smokers.

It is estimated that the total output of the cigarette industry in 2006 was some 300 billion yuan ($37 billion).

The deteriorating state of the environment is also contributing to the rising rate of lung cancer in China.

Epidemiological investigations have found that the lung cancer rate in industrial and polluted regions is higher than in non-industrial regions.

"Occurrence of lung cancer is closely related with motor vehicle exhausts," Sun Yan, a cancer expert and academician of the Chinese Academy of Engineering, told the Life Times.

Zhi said that traffic policemen had a higher occurrence rate of lung cancer than people of other professions.

Pollution caused by indoor furnishings can also be a factor; and experts advise people not to choose material containing harmful chemicals for indoor furnishings.

As many as a third of lung cancer cases can be avoided through preventive efforts, Zhi said.

Experts have called for stricter controls on smoking, especially in public places, and more anti-pollution measures to cut down the spread of lung cancer.

The government has moved in that direction in the recent past, banning sales of cigarettes to minors and in vending machines as well as banning smoking in public places such as cinemas and hospitals.

About lung cancer

WHAT IS LUNG CANCER?

Lung cancer is the leading cancer killer in both men and women. An estimated 173,700 new cases of lung cancer and an estimated 160,440 deaths from lung cancer will occur in the United States during 2004.

The rate of lung cancer cases appears to be dropping among white and African-American men in the United States, while it continues to rise among both white and African-American women.

There are two major types of lung cancer: non-small cell lung cancer and small cell lung cancer. Non-small cell lung cancer is much more common. It usually spreads to different parts of the body more slowly than small cell lung cancer. Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma are three types of non-small cell lung cancer. Small cell lung cancer also called oat cell cancer, accounts for about 20% of all lung cancer.




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WHAT CAUSES LUNG CANCER?

Smoking is the number one cause of lung cancer. Lung cancer may also be the most tragic cancer because in most cases, it might have been prevented -- 87% of lung cancer cases are caused by smoking. Cigarette smoke contains more than 4,000 different chemicals, many of which are proven cancer-causing substances, or carcinogens. Smoking cigars or pipes also increases the risk of lung cancer.

The more time and quantity you smoke, the greater your risk of lung cancer. But if you stop smoking, the risk of lung cancer decreases each year as normal cells replace abnormal cells. After ten years, the risk drops to a level that is one-third to one-half of the risk for people who continue to smoke. In addition, quitting smoking greatly reduces the risk of developing other smoking-related diseases, such as heart disease, stroke, emphysema and chronic bronchitis.

Many of the chemicals in tobacco smoke also affect the nonsmoker inhaling the smoke, making "secondhand smoking" another important cause of lung cancer. It is responsible for approximately 3,000 lung cancer deaths annually.

Radon is considered to be the second leading cause of lung cancer in the U.S. today. Radon gas can come up through the soil under a home or building and enter through gaps and cracks in the foundation or insulation, as well as through pipes, drains, walls or other openings. Radon causes between 15,000 and 22,000 lung cancer deaths each year in the United States -- 12 percent of all lung cancer deaths are linked to radon.

Radon problems have been found in every state. The EPA estimates that nearly 1 out of every 15 homes in the U.S. has indoor radon levels at or above the level at which homeowners should take action -- 4 picocuries per liter of air (pCi/L) on a yearly average. Radon can be a problem in schools and workplaces, too.

Because you cannot see or smell radon, the only way to tell if you are being exposed to the gas is by measuring radon levels. Exposure to radon in combination with cigarette smoking greatly increases the risk of lung cancer. That means for smokers, exposure to radon is an even greater health risk.

Another leading cause of lung cancer is on-the-job exposure to cancer-causing substances or carcinogens. Asbestos is a well-known, work-related substance that can cause lung cancer, but there are many others, including uranium, arsenic, and certain petroleum products.

There are many different jobs that may involve exposure. Some examples are working with certain types of insulation, working in coke ovens, and repairing brakes. When exposure to job-related carcinogens is combined with smoking, the risk of getting lung cancer is sharply increased.

A recent study published in the Journal of American Medical Association suggests that particulate matter pollution can cause lung cancer.

Lung cancer takes many years to develop. But changes in the lung can begin almost as soon as a person is exposed to cancer-causing substances. Soon after exposure begins, a few abnormal cells may appear in the lining of the bronchi (the main breathing tubes). If a person continues to be exposed to the cancer-causing substance, more abnormal cells will appear. These cells may be on their way to becoming cancerous and forming a tumor.

What Are The Clinical Signs of Asbestos-Related Lung Cancer?

In general, the clinical features of asbestos-related lung cancer depends upon the state of the tumor when detected. Early detection enhances the prospect of surgical care. Symptoms can include the following:

Cough
Chest pain (usually in later stage)
Difficulty breathing
Chest x-ray detection of new mass. A tumor may not be visible on a chest x-ray until it is at least 1-0 cm in diameter.
In its late stages, typical symptoms, signs and syndromes of advanced carcinoma emerge.
Management of an asbestos-related lung cancer depends largely on the staging of the tumor. Early diagnosis and surgical resections of the tumor increase the survival rate. The presence of severe associated asbestosis, however, can affect surgical intervention. Additionally, radiation and chemotherapy may be helpful in the overall therapeutic program.

Prevention lung cancer.

Prevention lung cancer.
The research indicated that, the indoor environment pollution already became one of main causes which the lung cancer arose. The domestic and foreign quantitative investigation already confirmed that, indoor environment pollution two big origins--smoking and the radioactive substance Radon and its the subfield was induces the lung cancer the primary dangerous factor. Because 90% Radon and its the subfield is emits through the crack, therefore, the floor is lower, Radon and its the subfield thickly goes past high. With for a long time compares in Radon and its in the subfield low exposition room person, contracts the lung cancer in the high exposed room person the risk to be high 30%.
Come to here to study cancer knowledge:

Asbestos Related Lung Cancer

This web site has focused on the most lethal of the lung cancers-mesothelioma. Not every asbestos-related lung cancer, however, is a mesothelioma. Other thoracic carcinomas, such as adenocarcinoma, are also caused by exposure to asbestos.

The connection between asbestos exposure and lung cancer was noted as early as 1925, and confirmed over the next 70 years by many epidemiologic studies of asbestos-exposed workers. The four main types of commercially used asbestos, chrysotile, amosite, anthophyllite, and mixtures containing crocidolite, have all been associated with an increased risk of lung cancer. About one in seven people who suffer from asbestosis, a lung disease resulting from high exposure to asbestos, eventually develop lung cancer.

There is a relationship between cigarette smoking and asbestos exposure in causing lung cancer, such is that asbestos workers who smoke face a much higher risk than asbestos workers who do not. According to the National Cancer Institute, evidence suggests that asbestos-exposed workers who quit smoking can reduce their risk of developing lung cancer by 50% within five years of quitting.

ECONOMICS REPORT - Deep in the Heart of Texas, a Labor Union Expands

ECONOMICS REPORT - Deep in the Heart of Texas, a Labor Union Expands
By Mario Ritter

Broadcast: Friday, December 09, 2005

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I'm Steve Ember with the VOA Special English Economics Report.

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Labor unions in the United States have been losing members for years. Not all are shrinking, however. The nation's fastest-growing union has recently added thousands of members in Houston, Texas. The expansion is the result of an effort to organize the workers who clean buildings. 一起呵英语站


Striking janitors in Los Angeles in 2000
The Service Employees International Union has close to two million members. It organizes workers in a number of service areas. These include health workers, government and public service workers and workers in property services. uUlsda E

In Houston, janitors at four major companies have voted to unionize. The American Arbitration Association recognized the decision as official on November twenty-ninth. Four thousand seven hundred janitors in Houston have now joined the Service Employees International.

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That number is more than sixty percent of the janitors in large buildings in the city. It could increase to over seventy percent if workers at another company are able to unionize. 一起呵英语站

The Houston janitors say they want the union to help them negotiate better pay. They also hope for some form of health plan and retirement savings. u<`da E

Currently, the janitors receive about five dollars and thirty cents an hour. That is a little above the national minimum wage of five dollars and fifteen cents. The minimum wage is the lowest pay that workers can receive. u<` E

Unionized janitors in cities like Chicago, New York or Washington, D.C., earn eleven dollars or more. But most cleaning workers around the country do not belong to unions. Many workers in low-paying service jobs are recent immigrants. Some are in the country illegally. @UUlsC|3.

The Houston area is not known for organized labor activity. The union did not even have offices there. Organizers from Chicago supervised the effort.

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In July, the Service Employees International Union split with the A.F.L.-C.I.O. That came as part of a major division within the country's main labor alliance. u<` E

Andrew Stern is president of the service employees union. He says twenty-first century unions must organize by industry across borders, to deal with huge international companies.
Fifty years ago, about thirty-three percent of privately employed workers in America were in a union. By the early nineteen eighties it was twenty percent. Today about thirteen percent of American workers belong to unions.



This VOA Special English Economics Report was written by Mario Ritter. I'm Steve Ember.

HEALTH REPORT - Studies Shows Chemotherapy Improves Lung Cancer Survival

HEALTH REPORT - Studies Shows Chemotherapy Improves Lung Cancer Survival
By Cynthia Kirk

Broadcast: Wednesday, July 13, 2005 u<`da E

I'm Faith Lapidus with the VOA Special English Health Report.




An x-ray image showing lung cancer.
Lung cancer is the most common cancer and the leading cause of cancer deaths around the world. There are more than one million new cases of lung cancer each year. And more than one million people die of lung cancer around the world every year. Smoking tobacco is the main cause of all lung cancer deaths. uUlsda E

When cancer is discovered in its early stages, traditional treatment includes removing the cancerous tumor. Patients with colon, breast and ovarian cancer also usually take chemotherapy drugs to improve their chances for survival.



But earlier studies had shown that chemotherapy drugs did little to improve survival rates for lung cancer patients. And the drugs often have side effects, such as nausea, extreme tiredness and diarrhea.


Now, the results of three studies show that chemotherapy helped improve five-year survival rates in people with early-stage lung cancer. Doctor Timothy Winton of the University of Alberta in Canada led one of the studies The study began in nineteen ninety-four.

The ten-year study involved more than four hundred eighty patients with early stage lung cancer. The patients lived in Canada and the United States. Those governments paid for the study, along with the drug company GlaxoSmithKline. @UUlsC|3.

All of the patients had their lung cancer tumors removed. After their operations, some of the patients were given two chemotherapy drugs. They took the drugs once a week for sixteen weeks. The others were not given chemotherapy. WWW.17HE.COM

In patients who did not have chemotherapy, fifty-four percent survived for five years. But sixty-nine percent of the patients who had chemotherapy were still alive after five years. The study was published in June in the New England Journal of Medicine. Two other studies had similar findings.


Doctor Winton said chemotherapy drugs have improved over the years. He also said there are now better treatments for the side effects. u<` E

Doctors say the studies have already begun to change care for patients in the early stages of lung cancer. Experts are now advising doctors that chemotherapy should be given after surgery for some patients with early-stage lung cancer.



This VOA Special English Health Report was written by Cynthia Kirk. Our features are online at specialenglish.com. I'm Faith Lapidus.

How is lung cancer diagnosed?

How is lung cancer diagnosed?
Your doctor will check your symptoms and ask questions about whether you smoke or have been exposed to any cancer-causing substances. He or she will also ask about your medical history, including any history of cancer in your family. This information will help your doctor decide how likely it is that you have lung cancer and whether tests are needed to be sure.

Lung cancer is usually first found on a chest X-ray or a CT scan. More tests are done to diagnose non–small cell or small cell lung cancer and to find out whether it is confined to your lung or has spread to other parts of your body. These tests help determine what stage the cancer is in.

How will I know if I have lung cancer?

How will I know if I have lung cancer?
You may not know. Early lung cancer rarely causes symptoms. In its advanced stage, cancer may affect how your lungs work. Coughing, wheezing, or shortness of breath may be the first symptoms of lung cancer.

Lung cancer may spread (metastasize) to nearby lymph nodes, the other lung, or other tissues in the chest, such as the lining of the lungs or heart. In many people, lung cancer may also spread to other organs—such as the brain, liver, or bones—causing symptoms for which you might seek medical care.

What types of lung cancer are there?

What types of lung cancer are there?
There are two main types of lung cancer: small cell lung cancer and non–small cell lung cancer. Each looks different under a microscope and grows, spreads, and is treated differently.

Non–small cell lung cancer is more common than small cell lung cancer. More than 80% of all lung cancers are non–small cell cancer. It generally grows and spreads more slowly than small cell lung cancer. 4

About 20% of lung cancers are small cell. This type of cancer grows very rapidly and in more than 80% of people has already spread to other organs in the body by the time it is diagnosed. Small cell lung cancer is more strongly related to smoking than non–small cell cancer. 4

What types of lung cancer are there?

What types of lung cancer are there?
There are two main types of lung cancer: small cell lung cancer and non–small cell lung cancer. Each looks different under a microscope and grows, spreads, and is treated differently.

Non–small cell lung cancer is more common than small cell lung cancer. More than 80% of all lung cancers are non–small cell cancer. It generally grows and spreads more slowly than small cell lung cancer. 4

About 20% of lung cancers are small cell. This type of cancer grows very rapidly and in more than 80% of people has already spread to other organs in the body by the time it is diagnosed. Small cell lung cancer is more strongly related to smoking than non–small cell cancer. 4

What causes lung cancer?

What causes lung cancer?
Most lung cancer is caused by smoking. 2, 3 Harmful substances in tobacco smoke damage the lung cells. Secondhand smoke is also a risk factor for lung cancer. 3

Besides smoking, exposure to harmful substances such as arsenic, asbestos, radioactive dust, or radon can increase the risk for lung cancer. If you have more than one of these risk factors—for example, you are a smoker and you are also exposed to asbestos—you greatly increase your risk of developing lung cancer. Radiation exposure from work, medical, or environmental sources may also increase your risk for lung cancer.

The most effective way to prevent lung cancer is not to smoke. If you do smoke, you can reduce your risk for lung cancer by quitting now. Your risk will gradually decrease over 10 to 15 years as your lungs recover. The sooner you quit, the better.

What is lung cancer?

What is lung cancer?
Lung cancer is the rapid growth of abnormal cells in the lung. It can start anywhere in the lungs and affect any part of the respiratory system.

Smoking is the greatest risk factor for lung cancer. If you smoke, quitting smoking can, over time, gradually reduce your risk of developing lung cancer. Lung cancer is the leading cause of cancer deaths in both men and women. Fewer than half of the people who develop lung cancer live 1 more year. And only 15% of people who develop lung cancer live for 5 more years. 1

How is lung cancer diagnosed?

How is lung cancer diagnosed?
Your doctor will check your symptoms and ask questions about whether you smoke or have been exposed to any cancer-causing substances. He or she will also ask about your medical history, including any history of cancer in your family. This information will help your doctor decide how likely it is that you have lung cancer and whether tests are needed to be sure.

Lung cancer is usually first found on a chest X-ray or a CT scan. More tests are done to diagnose non–small cell or small cell lung cancer and to find out whether it is confined to your lung or has spread to other parts of your body. These tests help determine what stage the cancer is in.

How is lung cancer diagnosed?

How is lung cancer diagnosed?
Your doctor will check your symptoms and ask questions about whether you smoke or have been exposed to any cancer-causing substances. He or she will also ask about your medical history, including any history of cancer in your family. This information will help your doctor decide how likely it is that you have lung cancer and whether tests are needed to be sure.

Lung cancer is usually first found on a chest X-ray or a CT scan. More tests are done to diagnose non–small cell or small cell lung cancer and to find out whether it is confined to your lung or has spread to other parts of your body. These tests help determine what stage the cancer is in.

Lung cancer

Lung cancer
Provided by:
Last Updated: 11/10/2005
Introduction

Lung cancer is the leading cause of cancer deaths in the United States, among both men and women. It claims more lives than colon, prostate, lymph and breast cancer combined.

Yet most of these lung cancer deaths could have been prevented. That's because smoking accounts for nearly 90 percent of lung cancer cases. Although your risk of lung cancer increases with the length of time and number of cigarettes you smoke, quitting smoking, even after many years, can significantly reduce your chances of developing the disease. Protecting yourself from exposure to other leading causes of lung cancer, such as asbestos, radon and secondhand smoke, also decreases your risk.

Prevention is critical because lung cancer usually isn't discovered until it's at an advanced stage when the outlook for recovery is poor. Although the survival rates for lung cancer have improved, they remain much lower than those of many other types of cancer.


Signs and symptoms

Because lung cancer doesn't cause signs or symptoms in its earliest stages, it's often advanced by the time it's diagnosed. When symptoms do occur, the most common warning sign is a cough, which occurs when a tumor irritates the lining of the airways or blocks the passage of air. In addition to a new cough, be alert for:

"Smoker's cough" that worsens
Coughing up blood, even a small amount
Chest pain
Shortness of breath
New onset of wheezing
Repeated bouts of pneumonia or bronchitis
Hoarseness that lasts more than two weeks
Lung cancer also may cause fatigue, loss of appetite and weight loss. If it has spread to other parts of your body (metastasized), you may have headaches or bone pain.


Causes

Your lungs are two large, spongy organs shaped something like an upside-down butterfly. One lung is located on each side of your chest. They're separated by the mediastinum — the tissues and organs of your midchest, which include your heart, esophagus and windpipe (trachea) as well as lymph nodes and major blood vessels such as the aorta. Each lung is divided into upper sections called lobes. Your left lung has two lobes, and your right lung, which is larger, has three lobes.

Every time you inhale, air is carried through the windpipe to your lungs in two major airways (bronchi). Inside your lungs, the bronchi subdivide over 15 times into a million smaller airways (bronchioles), which finally end in clusters of tiny air sacs called alveoli. Within the air sacs, oxygen is absorbed into your bloodstream and carbon dioxide — a waste product of metabolism — is released.

How cancer forms
The lining of the airways and windpipe is made up of rectangular-shaped surface cells (columnar epithelium) and glands that produce mucus and other fluids. In healthy lungs, these cells divide in a controlled and orderly way. But when a cell becomes cancerous, it can continue to reproduce even when new cells aren't needed.

Although it may take years for lung cancer to develop, changes in lung tissue can begin almost immediately after your lungs are exposed to the cancer-causing substances (carcinogens) in cigarette smoke. With repeated exposure, normal cells are increasingly damaged, and eventually some may become cancerous. Because of the way lung cancer cells behave and because these cells have easy access to a large number of blood and lymph vessels, cancerous cells may spread to other parts of your body before you ever experience symptoms.

Leading causes of lung cancer
Cigarette smoking is the main cause of lung cancer. Tobacco smoke contains more than 3,500 chemicals, at least 40 of which are known carcinogens. Cigarettes also contain more than 30 toxic metals, including nickel and cadmium, as well as radioactive compounds.

Other causes of lung cancer include exposure to secondhand smoke, to asbestos and other industrial carcinogens, and to high concentrations of radon — an odorless gas that's released into the air from the breakdown of uranium in the soil and water. Smokers exposed to asbestos and radon are more likely to develop cancer than are nonsmokers.

Lung cancer that begins in the lungs (primary lung cancer) is uncommon in nonsmokers, but cancer of the breast, colon, prostate, testicle, kidney, thyroid, bone or other organs may spread to the lungs. In that case, the cancer is still referred to by the name of the organ in which it originated, rather than being called lung cancer. There's no connection between smoking and the spread of cancer cells to the lungs from other parts of the body.

Types of lung cancer
Lung cancer is commonly divided into two types: small cell and non-small cell. Each grows and spreads in different ways and is treated differently. Small cell lung cancer spreads early in the course of the disease and occurs almost exclusively in smokers. Surgical removal usually isn't an option for this type of cancer; instead, it's best treated with chemotherapy and radiation. Even so, the five-year survival rate for small cell lung cancer is very low.

Non-small cell lung cancer, which is more common, accounts for more than 75 percent of lung cancers. If caught early when it's confined to a small area, it often can be removed surgically. There are four major categories of non-small cell lung cancer:

Squamous cell carcinoma. This cancer forms in cells lining your airways. It's the most common type of lung cancer in men.
Adenocarcinoma. This type of cancer usually begins in the mucous-producing cells of the lung. It's the most common type of lung cancer in women and in people who have never smoked or were exposed to secondhand smoke.
Large cell carcinoma. This type of cancer originates in the peripheral part of the lungs.
Bronchoaveolar carcinoma. This uncommon type of non-small cell lung cancer tends to grow more slowly than other forms of the disease. It occurs more often in smokers than in nonsmokers and tends to arise in more than one location at the same time.


The lungs are two spongy organs located in the chest. Cancer may begin in the lungs or spread to the lungs from other organs.

Risk factors

Smoking remains the greatest risk factor for lung cancer, accounting for as many as 9 out of every 10 cases of the disease. Your risk increases with the number of cigarettes you smoke each day and the number of years you have smoked. Your risk is also greater if you start smoking early in life — even if you later quit. Smoking filtered, low-tar or low-nicotine tobacco offers no additional protection because most people who smoke these cigarettes inhale more deeply, which also increases the risk.

On the other hand, quitting — at any age — can significantly lower your risk of developing lung cancer. After 10 years of not smoking, your risk of lung cancer is reduced by one-third. Cutting the number of cigarettes you smoke may also reduce your risk, though not as dramatically as quitting completely.

Other risk factors include:

Your sex. Current or former women smokers are at greater risk of lung cancer than are men who have smoked an equal amount. Although the exact reasons for this are unknown, some experts speculate that women may have a greater susceptibility to the cancer-causing substances found in tobacco. Others believe that estrogen may play a role. Women also are known to inhale more than men do, and they are less likely to quit.
Exposure to secondhand smoke. Even if you don't smoke yourself, you're at high risk of lung cancer if you're exposed to the smoke of others. Daily exposure to secondhand smoke may increase your chances of developing lung cancer.
Exposure to radon gas. Second only to smoking as a cause of lung cancer, radon comes from the natural (radioactive) breakdown of uranium in soil, rock and water that eventually becomes part of the air you breathe. Although unsafe levels of radon can accumulate in any building, the greatest exposure risk most people face is at home. The Surgeon General and the Environmental Protection Agency recommend that all homeowners check for the presence of radon. The best tests are those that take three to six months. For more information, contact your county public health department or visit the Environmental Protection Agency Web site.
Exposure to asbestos and other chemicals. Workplace exposure to asbestos and other cancer-causing agents — such as vinyl chloride, nickel chromates and coal products — also can increase your risk of developing lung cancer, especially if you're a smoker.
Race. Black Americans are at a higher risk of lung cancer. They also develop the disease at an earlier age and are less likely to survive. Doctors don't think there's a genetic reason for this disparity. Rather, it is more likely to be related to inequities in health care and to environmental factors.
Heredity. Research increasingly points to a genetic factor in lung cancer. Although smoking is undeniably the primary cause, people with a parent, sibling or other first-degree relative with lung cancer are at increased risk of the disease, whether they smoke or not.

Screening and diagnosis

Screening for lung cancer is controversial. The American Cancer Society currently doesn't recommend screening tests for lung cancer, even in high-risk individuals. But some doctors believe that smokers, especially those 50 years or older, should have annual screenings. The debate is becoming more heated with the increasing use of imaging tests such as helical and electron beam computerized tomography (CT) scans that could potentially detect early-stage cancers more effectively than older tests do — and with far less exposure to radiation. But CT screening has a serious drawback: It detects small, benign nodules that commonly occur in the lungs, leading, in some cases, to needless worry and unnecessary and invasive tests.

A standard chest X-ray can reveal an abnormal mass or nodule in your lungs. And a CT scan may show very small lesions and whether cancer has spread to other areas. But as with all types of cancer, lung cancer can be definitively diagnosed only by looking at a tissue sample (biopsy) under a microscope. The sample may be removed using one of the following techniques:

Sputum cytology. If you have a cough and are producing sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells. Before the test, you may be asked to breathe a mildly irritating mist to help you produce more sputum.
Bronchoscopy. In this test, a flexible tube called a bronchoscope is passed into your airway. The bronchoscope allows your doctor to look inside your lungs as well as to take a tissue sample for examination in the laboratory.
Mediastinoscopy. In this test, an instrument passed through a small incision at the base of your neck allows your doctor to take a biopsy of lymph nodes in your chest. This helps determine how far the cancer has spread and whether surgery is a reasonable option for removing the tumor.
Transthoracic needle biopsy. Using an X-ray or CT scan for guidance, your doctor takes a small needle and places it into a mass in your lung, removing a small piece for study.
Thoracentesis. If you have fluid in your chest cavity, your doctor can remove a sample by inserting a thin needle into your chest between the ribs. The fluid is then examined in the laboratory for presence of cancer cells. Removing a large amount of fluid with thoracentesis also can improve your breathing.
Video thoracoscopy. In this procedure, your doctor inserts a tube (endoscope) through a small incision between your ribs and partially collapses one of your lungs. This creates a space through which a pen-sized instrument with a video device is passed between the ribs and through your chest wall. Your doctor then can perform biopsies of nodules or masses while watching the procedure on a video screen. Your lung will expand again after the procedure.
Staging
Staging is a system of classifying information about cancer, including where and to what extent the cancer has spread. In many cases, Roman numerals are used to describe stages, with 0 being the least advanced and IV the most advanced. Your doctor uses this information to determine what treatment you need and to evaluate how your cancer might progress.

Non-small cell lung cancer
Non-small cell lung cancer is staged according to the size of the tumor, the level of lymph node involvement and the extent to which the cancer has spread. Stages of non-small cell lung cancer include:

Stage 0. At this stage, cancer is limited to the lining of the air passages and hasn't invaded lung tissue. Stage 0 cancers almost always are found during bronchoscopy, which is likely to have been performed to assess an abnormality on a chest X-ray. If found and treated promptly, cancers at this stage usually can be eliminated.
Stage I. Cancer at this stage has invaded the underlying lung tissue but hasn't spread to the lymph nodes.
Stage II. This stage cancer has spread to neighboring lymph nodes or invaded the chest wall.
Stage IIIA. At this stage, cancer has spread from the lung to lymph nodes in the center of the chest.
Stage IIIB. The cancer has spread locally to areas such as the heart, blood vessels, trachea and esophagus — all within the chest — or to lymph nodes in the area of the collarbone.
Stage IV. The cancer has spread to other parts of the body, such as the liver, bones or brain.
Small cell lung cancer
Small cell lung cancer is staged differently from non-small cell types. Rather than using numbers, it's classified as either limited or extensive:

Limited. Cancer is confined to one lung and to its neighboring lymph nodes.
Extensive. Cancer has spread beyond one lung and nearby lymph nodes, and may have invaded both lungs, more remote lymph nodes or other organs.
Staging tests
Tests to determine how far cancer has spread are of primary importance in planning treatments. In addition to CT scans, these tests include:

Magnetic resonance imaging (MRI). Instead of radiation, this test uses radio waves and high-powered magnets to produce internal images of your body. It's especially good at detecting tumors that have spread to the brain or spinal cord.
Positron emission tomography (PET) scan. Unlike other scanning techniques, a PET scan doesn't produce clear structural images of organs. Instead, it shows images containing areas of more or less intense color to provide information about chemical activity within certain organs and tissues. This chemical activity can indicate whether cancer cells have spread to nearby lymph nodes, even before the lymph nodes become enlarged, a distinct improvement over older staging methods. But PET scans need to be interpreted carefully because sometimes benign conditions can resemble cancer.


A PET scan, unlike a normal X-ray, can detect cancer before organ or gland enlargement occurs. Here a normal X-ray of the chest (left) is compared with a PET scan of the chest producing normal results (top right) and a PET scan revealing cancer that's spread to the lymph nodes (bottom right).

Complications

The lungs have an abundant supply of blood vessels and lymph channels, which means that lung cancer can spread to other parts of your body through your bloodstream and lymph system. Small cell cancer, in particular, is a fast-growing tumor that quickly spreads to other organs. At the time of diagnosis, this type of cancer has already spread in a majority of people. Without treatment, the tumor will continue to grow and may prove fatal within a matter of months.

Small cell cancer often responds to chemotherapy and radiation therapy, but even when there is a positive response to treatment, relapses usually occur within two years. Unfortunately, at that point the cancer usually isn't as responsive to further therapy.

In addition, some non-small cell lung cancers — even those identified at any early stage — may have already spread undetectably (micrometastasis) to lymph nodes and other organs. As a result, cancer can reappear months and even years after treatment.


Treatment

Treatments for lung cancer depend on the type and stage of cancer, as well as on your overall health. If you have emphysema, for instance, your poor lung function may prevent you from having surgery, even if you have a tumor that would otherwise be operable.

Other factors also come into play, no matter what type of lung cancer you have. There are times, for instance, when the potential side effects of treatment outweigh the benefits. When that is the case, your doctor may suggest comfort (supportive) care only. This means treating the symptoms the cancer is causing, such as pain and difficulty breathing, but not treating the cancer itself.

Small cell lung cancer
Because most small cell lung cancers have spread beyond the lungs by the time they're discovered, an operation usually isn't a treatment option. Instead, the most effective treatment is chemotherapy, either alone or in combination with radiation therapy.

Chemotherapy. This treatment uses drugs to kill cancer cells. In cases of small cell lung cancer, chemotherapy may be used to shrink the cancer, to slow the cancer's growth, to prevent it from spreading further, or to relieve symptoms and make you more comfortable (palliative care). A combination of drugs usually is given in a series of treatments over a period of weeks or months, with breaks in between so that your body can recover. Even so, because the drugs damage healthy cells along with malignant ones, they can cause serious side effects. In fact, for many people, side effects from chemotherapy are the most disturbing aspect of cancer treatment. Fast-growing cells such as those in your digestive tract, bone marrow and hair are especially likely to be affected. But although side effects are common, their severity depends on the drugs used and your response to them. Sometimes you may have few reactions. On the other hand, you may experience symptoms such as nausea and vomiting, dizziness, severe fatigue and an increased risk of infection. Ask your treatment team about the side effects of any treatment you're considering and the best ways to minimize those effects. If you choose to receive chemotherapy, be sure you understand the long- and short-term goals of your therapy and the overall risks and benefits.
Radiation therapy. This uses X-rays to kill cancer cells. In some cases, the radiation may come from outside your body (external radiation). In others, a radioactive substance may be placed inside needles, seeds or catheters and inserted into or near the cancer (internal radiation). The way in which radiation is delivered depends on the type and stage of the cancer being treated. Radiation therapy may be given before, during or after chemotherapy. In all cases, however, the goal of treatment is to destroy cancer cells while harming as little normal tissue as possible. Side effects of treatment may include redness and swelling of the skin where the radiation enters your body, a cough, shortness of breath, fatigue and sometimes difficulty swallowing if your esophagus is within the area receiving the radiation. You may not be a candidate for chest radiation if you have severe lung disease.

Small cell lung cancer often spreads to the brain. For that reason, your doctor may sometimes recommend brain radiation therapy to prevent cancer from metastasizing to that part of the body or to eliminate micrometastases that aren't yet detectable with imaging studies. Brain radiation therapy can cause short-term memory problems, fatigue, nausea and other serious side effects. If your cancer is in remission, discuss the risks and benefits of this treatment with your doctor.

Non-small cell lung cancer
Surgery is usually the best treatment for early-stage non-small cell lung cancer. In some cases, only the portion of the lung that contains the tumor is removed. In others, one lobe or even the entire lung may be taken. Surgery to remove all or part of a lung often involves opening one side of the chest, a procedure called a thoracotomy.

Operations to treat lung cancer include:

Wedge resection. In this operation, your doctor removes only the section of your lung that contains the tumor along with a margin of normal tissue.
Lobectomy. The most common type of lung cancer surgery, lobectomy involves removing an entire lobe of one lung.
Pneumonectomy. In this operation, an entire lung is removed. Because pneumonectomy will decrease lung function considerably, as well as lead to other complications, it's performed only when absolutely necessary and then only if your breathing capacity is sufficient to allow you to breathe with a single lung.
Sampling lymph nodes
No matter which operation is performed, your surgeon will sample lymph nodes from the center of your chest (mediastinum) and from the hilum — the region where the bronchus and blood vessels to the lungs originate. A pathologist usually examines the sample immediately, and your surgeon receives the report within 10 minutes. If cancer has spread to these nodes, your surgeon may decide not to remove any lung tissue. Unless the affected lymph nodes are at the base of the lobe containing the cancer, it's nearly impossible to remove all of the cancerous nodes. In addition, extensive lymph node involvement usually means that the cancer already has spread to other parts of the body, even though this spread may not yet have been detected.

Effects of surgery and your recovery
Surgery to remove lung tissue is a major operation. Depending on the extent and type of your surgery, you're likely to spend up to a week in the hospital. Once you return home, it may take weeks or even months to regain your strength. If you have other lung conditions, such as emphysema or bronchitis, your hospital stay and recovery may be even longer.

You're also likely to experience certain complications following surgery. The muscles of your chest and arm on the side where you had the operation will be very sore, for example, making it difficult to use the arm the way you used to. In that case, your doctor may recommend physical therapy or other rehabilitation program to help restore your strength and range of motion.

In addition, because you have less lung tissue, you initially may feel short of breath. Over time, however, your remaining lung tissue should expand, improving your ability to breathe. But if you have emphysema or other lung conditions, the shortness of breath may become worse.

No matter how much lung tissue is removed, you're likely to experience pain following your operation. Your doctor will work with you to ensure that you receive medication to keep you as comfortable as possible.

Treating advanced non-small cell lung cancer
More advanced non-small cell lung cancers are generally treated with chemotherapy, radiation, or a combination of both chemotherapy and radiation, although treatment of stage III non-small cell lung tumors is often individualized. Some people, for instance, may have surgery after first being treated with chemotherapy and radiation.

Still, because the best treatment for this stage of the disease isn't known, your doctor may suggest that you participate in a clinical trial — a research study that tries to improve current treatments or find new treatments for specific diseases. This can give you access to experimental therapies that might not otherwise be available. There are no guarantees with clinical trials, however, and you should fully understand the potential risks as well as possible benefits before undertaking this step.

New treatments
Researchers are developing new treatments for all types of cancer, including lung cancers, such as:

Erlotinib. This oral medication targets the epidermal growth factor receptors on the surface of cells that are involved in cell growth and proliferation. Abnormalities in these receptors, which can lead to the constant production of new cells, have been associated with several types of cancer. Erlotinib has been approved for use in treating recurrent non-small cell lung cancers and is being studied for use in other stages of the disease.
Bevacizumab. Given as an injection in conjunction with standard chemotherapy, this treatment helps stop the growth of blood vessels that supply nutrients to tumors. Bevacizumab has improved survival in some people with colorectal and lung cancers, but because the drug can have potentially fatal side effects, it's only used in certain cases.

Prevention

The best known way to prevent lung cancer is to not smoke. If you already smoke, quitting now can reduce your risk — even if you've smoked for years.

These measures also can help prevent lung cancer:

Avoid secondhand smoke. Breathing the smoke of others can be just as damaging as smoking is.
Test for radon. Have the radon levels in your home checked, especially if you live in an area where radon is known to be a problem.
Avoid carcinogens. Take precautions to protect yourself from exposure to toxic chemicals such as vinyl chloride, nickel chromates and coal products. Your risk of lung damage from these carcinogens increases if you also smoke.
Eat a healthy diet. Some studies have documented the relationship between food and cancer. The American Cancer Society recommends eating five to six servings of fruits and vegetables every day. In the case of lung cancer, certain foods seem to be especially protective. For example, a large study in China, where smoking rates are high, found that certain chemicals in cruciferous vegetables such as broccoli, cabbage and bok choy appeared to lower the risk of lung cancer. Other protective chemicals called cumestrans are found in beans, peas, spinach and sprouts. Isoflavones, the most common anticancer chemicals, occur in a wide range of foods, including soybeans, chickpeas and yams. Other studies have found a connection between consumption of large amounts of fresh fish — though not dried or salted fish — and a reduced rate of lung cancer. The American Cancer Society says more research is needed to establish a clear link, however.

Self-care

One of the best things you can do to care for yourself if you have lung cancer is also one of the most obvious — don't smoke. It's best to also avoid being around people who are smoking. Although it may be too late to prevent developing lung cancer, this will help optimize your lung function while you're being treated and improve your tolerance to treatment that may have some effects on your lungs.

Regular exercise, such as walking, exercise bicycling or swimming, will help you to maintain your general strength and stamina. Experts recommend at least 30 minutes of exercise on most days.

In addition, eating well and managing stress are both ways to promote your overall health and cope with any form of cancer. Eating well during cancer treatment can help you maintain your stamina and better cope with the side effects of chemotherapy or radiation. Good nutrition may also help you prevent infections and remain more active.

Eating suggestions
Cancer itself and some cancer treatments can affect your appetite. At times you simply may not feel like eating, or you may have nausea and vomiting as a result of chemotherapy. In that case, a registered dietitian can be especially helpful with food planning. The following suggestions also may help:

Eat small, frequent meals rather than three large ones.
Emphasize easily digested foods such as chicken soup or broth, plain boiled rice (or rice cooked in chicken broth), toast and baked potatoes. These are usually better tolerated than rich or spicy foods.
Don't worry if you just can't eat for a day or two.
Drink plenty of liquids, especially if you're not eating.

Coping skills

A diagnosis of cancer can be extremely challenging. It's important to remember that no matter what your concerns or prognosis, you're not alone. Here are some strategies and resources that may make dealing with cancer easier:

Know what to expect. Find out everything you can about your cancer — the type, the stage, your treatment options and their side effects. The more you know, the more active you can be in your own care. In addition to talking with your doctor, look for information in your local library and on the Internet. The National Cancer Institute will answer questions from the public. You can reach them at 800-4-CANCER, (800-422-6237), or contact the American Cancer Society (ACS) at 800-227-2345.
Be proactive. Although you may feel tired and discouraged, don't let others — including your family or your doctor — make important decisions for you. Take an active role in your treatment.
Maintain a strong support system. Having a support system can help you cope with any issues, pain and anxieties that might occur. Although friends and family can be your best allies, they sometimes may have trouble dealing with your illness. If so, the concern and understanding of a formal support group or others coping with cancer can be especially helpful. Although support groups aren't for everyone, they can be a good source for practical information. You may also find you develop deep and lasting bonds with people who are going through the same things you are.
Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But don't choose goals you can't possibly reach. You may not be able to work a 40-hour week, for example, but you may be able to work at least half time. In fact, many people find that continuing to work can be helpful.
Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for the downtimes when you may need to rest more or limit what you do.
Stay active. A diagnosis of cancer doesn't mean you have to stop doing the things you enjoy or normally do. For the most part, if you feel well enough to do something, go ahead and do it. It's important to stay involved with life.

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How is lung cancer diagnosed?

How is lung cancer diagnosed?

Sadly, most lung cancer is diagnosed too late for curative treatment to be possible. In over half of people with lung cancer the disease has already spread (metastasised) at the time of diagnosis.

Early diagnosis is difficult because many of the common symptoms of lung cancer are similar to those of smokers' lung (chronic obstructive pulmonary disease or COPD).

In addition to this, most lung cancer patients will also have COPD because both conditions are mainly caused by smoking. However, only 1 or 2 per cent of COPD patients will go on to develop lung cancer.

The first investigation is a chest X-ray. If a lung tumour is present, it needs to be at least a centimetre in diameter to be detectable by an ordinary X-ray. However, by the time a tumour has reached this size the original cell which became cancerous has divided (or doubled) 36 times. As death usually results after 40 such cell divisions, it is clear that lung cancer is a disease that is usually detected late in its natural course.

Some simple blood tests and further examinations may also be carried out.

Bronchoscopy is direct inspection of the inside of the breathing tubes with a thin fibre-optic instrument using local anaesthetic and is the best test for tumours in the main bronchi (air passages) in the centre of the chest.

Depending on the site of the cancer, a biopsy will be obtained either by a bronchoscopy or a needle biopsy. Needle biopsy is better for cancers near the periphery of the lungs (ie closer to the ribs than the centre of the chest), beyond the reach of the bronchoscope.

Usually, a sample of sputum - the material coughed up from the respiratory tract - will also be examined for cancer cells and this can avoid the need for biopsy.

A CT scan provides more information about how much the tumour may have spread.

There are three main types of lung cancer, based on their appearance when examined under the microscope by a pathologist:


small cell carcinoma


squamous cell carcinoma


adenocarcinoma.


It is important to know which type of cancer a patient has because small cell cancers respond best to chemotherapy (anti-cancer medicines) whereas the other types (often referred to collectively as non-small cell cancer) are better treated with surgery or radiotherapy (X-ray treatment). The pathologist therefore needs a small tissue sample (biopsy) to examine. This will confirm that the diagnosis of suspected cancer is definitely correct and show which type of cell is involved.

What are the symptoms of lung cancer?

What are the symptoms of lung cancer?

The symptoms of lung cancer include:


a chronic cough.


worsening breathlessness.


weight loss.


excessive fatigue.


persistent pain in the chest or elsewhere, (possibly from the cancer spreading to a bone).


symptoms can be due to the original tumour in the lung or to the effects of secondary tumours elsewhere in the body.


one of the most significant symptoms of lung cancer is coughing up blood or haemoptysis. This can sometimes occur as an early warning sign of a cancer which may still be curable. Any person who coughs up blood should see their GP for advice urgently as lung cancer must be considered, particularly if the person is a smoker over the age of 40.

What causes lung cancer?

What causes lung cancer?

Tobacco smoke is the primary cause of lung cancer. Although nonsmokers can get lung cancer, the risk is about 10 times greater for smokers and is also increased by the number of cigarettes smoked per day.

If you are a heavy smoker consuming more than 20 cigarettes a day, the risk of developing lung cancer is about 30 to 40 times higher than if you don't smoke.

The main reason for the substantial increase in the disease over the last 50 years has been the increase in the number of people who smoke cigarettes. This has resulted from the industrial production and marketing of tobacco.

The risk of lung cancer in an ex-smoker falls to the same level as a nonsmoker after about 15 years.

What is lung cancer?

What is lung cancer?


Lung cancer is one of the largest killers in the Western world. The risk of developing lung cancer is increased 10-40 times if you smoke.


The cells of all living organisms normally divide and grow in a controlled manner. Cancer results when this control process is lost. A lump or tumour, known as the primary tumour can grow locally or spread to produce secondary tumours somewhere else in the body. This spreading process is called metastasis.

About 40,000 people in the UK die every year from lung cancer. It is the most common form of cancer in the UK and the most common cause of death from cancer in both men and women although it affects more men than women.

Esophageal CancerWhat Is It?

What Is It?

Esophageal cancer is the abnormal growth of cells in the esophagus, the tube that carries food and drink from your throat to your stomach. The normal lining of the esophagus is called squamous epithelium, a cellular lining that is found in the mouth, throat and the lung. The junction of the esophagus, as it enters the beginning of the stomach is lined by a different type of cellular structure that contains many glands or structures that secrete various chemicals. If a cancer of the esophagus arises from that portion that lines the tube before it enters the stomach, the cancer is called squamous cell carcinoma. If it arises from the glandular portions of the esophagus, it is called adenocarcinoma (cancers of glandular structures).

There are two types of esophageal cancer:

Squamous cell carcinoma starts in the cells that line the esophagus. This type of esophageal cancer can occur anywhere in the esophagus. In the past, this type of esophageal cancer was the most common. Over the past few decades, adenocarcinomas have accounted for many new cases of esophageal cancer.


Adenocarcinoma starts in the lower portion of the esophagus near the opening to the stomach. It starts when cells in the lining transform into glandular type cells, a condition called Barrett's esophagus.
Esophageal cancer is common in Asia, Africa and Latin America, but less common in the United States. However, the number of cases of adenocarcinoma of the esophagus is increasing faster than almost all other cancers in the United States. Many experts have associated this increase with a regurgitation of the stomach contents into the lower portion of the esophagus, so called gastroesophageal reflux disease or GERD. No one is certain what causes esophageal cancer, but risk factors include the following:

Age � Most people who develop esophageal cancer are over 50.


Sex � Both types of esophageal cancer occur about three times more often in men than women.


Race � Squamous cell esophageal cancer is three times more common among African-Americans than whites. However, Caucasians have a higher incidence of adenocarcinomas of the lower esophagus than African-Americans.


Tobacco use � Tobacco consumed in any form increases the risk of esophageal cancer. The longer you smoke and the more you smoke each day, the greater the risk. This is primarily true for squamous cell esophageal cancer. Patients that develop esophageal cancer may also be at risk of developing cancer of the head and neck area, also related to tobacco use.


Alcohol consumption � Chronic or excessive consumption of alcohol, especially when combined with tobacco use, increases the risk. Again, this is primarily true for squamous cell esophageal cancer. Consumption of hard liquor, rather than beer and wine, may have a stronger association, although it is the quantity of consumption that is most important. Some research suggests that the metabolism of alcohol may be different among individuals who develop esophageal cancer compared to those who drink and do not develop this cancer.


Barrett's esophagus � Irritation caused by chronic acid reflux is believed to cause the cells at the bottom of the esophagus to transform into glandular cells similar to cells in the stomach lining. These glandular cells are more likely to become cancerous. This is the strongest known risk factor for cancer of the lower esophagus, adenocarcinoma.


Chemical irritation � Damage to the esophagus from swallowing lye, most often during childhood, or from prior radiation increases the risk of esophageal cancer. Chemical irritation also can occur in a condition called achalasia, where part of the esophagus is dilated (expanded) and collects partially digested foods. This condition is also associated with a loss of the muscular ability of the esophagus to propel food into the stomach, leading to food accumulation and widening of the esophagus.


Diet � A diet low in fruits and vegetables and certain minerals and vitamins has been associated with a higher risk of esophageal cancer. Nitrates in foods and fungal toxins from pickled vegetables also have been associated with esophageal cancer.


Medical conditions � Two conditions are associated with a higher risk of esophageal cancers: Plummer-Vinson, also called Paterson-Kelly syndrome, and tylosis. Plummer-Vinson is the presence of small weblike projections in the tubular portion of the esophagus, so called esophageal webs with iron deficiency anemia. Tylosis is a condition associated with excessive keratin formation (hyperkeratosis) on the palms and soles of the feet. Both conditions may be associated with an increased risk of esophageal cancer.
Symptoms

Early esophageal cancer may not cause any symptoms. As the cancer progresses, it usually causes one or more of the following symptoms:

Difficult or painful swallowing or difficulty swallowing only solid foods (called dysphagia or odynophagia). Often, patients will complain that the food feels "stuck" in the middle of the chest, just behind the breast bone.
Pain in the chest or between the shoulder blades
Frequent heartburn or acid reflux
Severe weight loss
Hoarseness or chronic cough
Vomiting
Coughing up blood
Other conditions can cause these symptoms. If you experience any of these, you should see your doctor. If you have chest pain or vomit blood, seek medical attention immediately.

Expected Duration

If it is not detected, esophageal cancer will continue to grow and can spread to almost any part of the body. The chance of survival increases greatly if the disease is detected early.

How long treatment lasts and what kind of treatments given will depend on such factors as your age and general health, how advanced the cancer is, and how well your body responds to and is able to tolerate treatment. Treatments can take several months to complete. If surgery is done, the recovery period typically lasts at least three to four weeks and can be longer.

Prevention

While some risk factors for esophageal cancer can't be avoided, you can take steps to decrease your risk:

Don't use tobacco in any form. If you smoke or use smokeless tobacco, get the help you need to stop.
Never consume anything that may damage your digestive tract.
If you drink alcohol, drink in moderation. Most experts recommend that women have no more than one drink a day and that men have no more than two drinks a day.
If you suffer from heartburn, discuss with your doctor how to avoid heartburn and ways to treat it, if necessary.
If you suffer from chronic reflux or heartburn symptoms, an esophagoscopy may be done to look for Barrett's esophagus. If you have Barrett's esophagus, some doctors recommend periodic exams or biopsies to look for abnormalities before they develop into cancer.

Treatment

Treatment for esophageal cancer depends on the size and location of your tumor, your symptoms and your general health. Many different treatments and combinations of treatments may be used. Your team of specialists may include a surgeon, a gastroenterologist (a specialist in diagnosing and treating disorders of the digestive system), a medical oncologist (a specialist in treating cancer) and a radiation oncologist (a specialist in using radiation to treat cancer). Other testing may also be required before treatments begin to determine how well your heart and kidneys are functioning.

Here are the key treatments for esophageal cancer:

Surgery � Removing the tumor and affected tissue offers the best chance to cure esophageal cancer. Usually, the surgeon removes all or a portion of the esophagus and the neighboring lymph nodes to prevent the cancer from spreading. Sometimes, the upper part of the stomach also is removed. The surgeon then uses the remaining portion of the stomach or a part of the intestine to reconnect the digestive tract, so that you can swallow. This is very intensive surgery and requires that the patient be able to tolerate this approach. Recently, modifications using techniques that are minimally invasive may be considered in the appropriate patient. Another important consideration is to select an institution or surgeon who has done a large number of procedures for esophageal cancer. The short-term side effect rate may be lessened when treatment is given in hospitals that do many procedures, as opposed to performing few.


Chemotherapy � There are many new chemotherapeutic agents and other types of chemical treatments that have been introduced over the past five years that show some promise in increasing the success rates.


Radiation therapy � This treatment uses high-energy rays to kill cancer cells. The radiation may come from a machine outside the body (external radiation) or from radioactive elements placed in or near the tumor (internal radiation). Radiation therapy may be done instead of surgery, either alone or in combination with chemotherapy, especially if the size or location of the tumor makes surgery difficult. Radiation therapy may be combined with chemotherapy to shrink the tumor before doing surgery. If the tumor can't be removed by surgery or destroyed by radiation therapy, radiation may help to ease pain and make swallowing easier.
In general, the determination(s) of whether to use surgery, chemotherapy, or radiation therapy, alone or in combination, will ultimately depend upon the stage (assessment of the extent of the cancer) of the cancer as determined by the tests listed above.

In making a decision about what treatment to recommend, your cancer team will weigh the benefits of surgery against the risks of this serious operation, which has many potential complications. For many people, radiation therapy alone or in combination with chemotherapy may offer the same chance of survival as surgery. In addition, there are other options to improve symptoms, including:

A stent (small wire mesh) placed into the esophagus. This is done to bypass the blockage resulting from the cancer, thus allowing the patient to eat properly.
A laser to reduce the size of a tumor, which can prevent blockage and improve swallowing.
A simpler surgery, in which feeding tubes are inserted into the stomach or intestine for nutrition and to avoid swallowing problems.
When To Call a Professional

See your doctor if you experience any characteristic symptoms of esophageal cancer, such as difficulty swallowing, weight loss or vomiting. If you have chest pain or vomit blood, seek medical attention immediately. If you have the sensation that food is sticking in the swallowing tube, you should contact your physician as well. Individuals who have been diagnosed with GERD, too, should seek consultation with a gastroenterologist, to determine whether any pre-cancerous conditions are present in the lower esophageal � upper stomach area.

Prognosis

Once cancer has been diagnosed, your doctor will conduct tests to determine what stage your cancer has reached. The stages are labeled 0 to IV. The higher the stage number, the further the cancer has spread. For example, in stage 0, the cancer is confined to the superficial lining of the esophagus. In stage I, the cancer has not invaded the outer muscle layer of the esophagus.

Surgery to remove the tumor offers the best chance for cure. However, cure is relatively rare, since many patients have already experienced spread to the surrounding lymph node tissue or other organs, even when the cancer is first diagnosed. If the disease is caught early, the five-year survival rate is much higher � 75% for patients diagnosed in stage 0 and 40% to 50% for those diagnosed in stage I. Most esophageal cancer is diagnosed at the more advanced stages when the five-year survival is only about 15% to 20% or less. With or without surgery, chemotherapy and radiation therapy can help to improve the quality of life and prolong survival, even in advanced stages.

Colorectal CancerWhat Is It?

What Is It?

Colorectal cancer is a type of uncontrolled growth of abnormal cells that can develop in the colon, rectum or both. Together, the colon and rectum make up the large intestine (also called the large bowel). The large intestine carries the remnants of digested food from the small intestine and eliminates them as waste through the anus.

Colorectal tumors begin as small growths (polyps) on the inside of the large intestine. Polyps that aren't removed eventually can become cancerous, break through the wall of the colon or rectum, and spread to other areas.

Colorectal cancer is a common type of cancer in the United States. It is the second most common cause of death from cancer in the country. The American Cancer Society estimates that about 145,000 new cases of colorectal cancer are diagnosed each year, and about 56,000 people in the United States die of this disease each year.

Risk Factors
The older you get, the more likely you are to develop colorectal cancer. Other factors that increase the risk of developing colorectal cancer include:

Family history — Heredity may play a role in up to 10% of all cases of colorectal cancer. Genetic defects have been linked to a number of cancer syndromes that run in families. These make family members more likely to develop polyps and colorectal cancer.


A personal history of the disease — If you have been diagnosed with colorectal cancer once, you are more likely to develop the disease again.


A personal history of adenomatous polyps — If you once had polyps, this increases your risk of colorectal cancer.


Inflammatory bowel disease (chronic ulcerative colitis, Crohn's disease) — The longer and more severely the colon is inflamed, the greater the risk of cancer.


Poor diet — Diets low in fiber and high in fat, especially saturated fat, may increase the risk of colorectal cancer.


A sedentary lifestyle — Among people who exercise regularly, the risk of colon cancer is reduced by half. Even regular brisk walking may reduce a person's risk of developing colon cancer.


Race and ethnicity — Different racial and ethnic groups in the United States have very different rates of colorectal cancer. Alaska natives are most likely to develop the disease while Hispanics and Filipinos are the least likely. Whites and African-Americans fall somewhere in between.
Symptoms

Precancerous polyps and early colorectal cancer generally don't cause symptoms. More advanced cancer can cause any of the following symptoms.

A change in bowel habits (more often, less often, a feeling that the bowel does not empty completely)
Diarrhea or constipation
Blood in the stool (bright red, black or very dark)
Narrowed stools (about the thickness of a pencil)
Bloating, fullness or stomach cramps
Frequent gas pains
A feeling that the bowel does not empty completely
Weight loss without dieting
Continuing fatigue
Diagnosis

Doctors usually diagnose colorectal cancer using a sigmoidoscopy or colonoscopy. In these tests, a doctor inserts a flexible viewing tube into your rectum and colon to look for polyps or cancerous masses. You may have a test called a barium enema, in which a fluid containing a substance called barium is pumped into your rectum and then X-rays are taken. The barium helps abnormalities show up on the X-rays. These tests provide information about the size and location of the cancer.

Sometimes, if the cancer has spread outside the colon or rectum, you may need a biopsy of that area. In a biopsy, a doctor or surgeon removes a small piece of tissue that is examined in a laboratory.

Other possible tests include:

An abdominal computed tomography (CT) scan


An endorectal ultrasound scan with cancer of the rectum.


A complete physical examination and a chest X-ray after the cancer is diagnosed to see if it has spread.


Blood tests to measure levels of a substance called carcinoembryonic antigen, which sometimes is higher than normal in people with colorectal cancer. Blood tests also can check how well your liver is functioning because colon cancer often spreads to the liver.
Expected Duration

Without treatment, colon cancer will continue to grow.

Prevention

The best defense against the spread of colorectal cancer is regular screening. Screening tests are designed to find precancerous growths (benign polyps) so they can be removed before they become cancerous (malignant). The American Cancer Society recommends that all adults begin screening for colorectal cancer at age 50. People at higher risk should begin screening earlier. Recommended screening methods include:

Digital rectal examination — Beginning at age 40, then yearly after 50; do not use as the only screening method


Fecal occult blood test — Yearly beginning at age 50


Sigmoidoscopy — Every five years beginning at age 50, unless you have a colonoscopy


Colonoscopy — As a routine screening test every 10 years, beginning at age 50, unless you have a screening sigmoidoscopy every five years


Double-contrast barium enema — Not the preferred method of routine screening, but it can be used instead of colonoscopy or in addition to sigmoidoscopy every five years
Virtual colonoscopy — More accurate X-ray pictures of the colon using CT scanning technology. This is a possible alternative to other methods of screening.
To reduce your risk of developing colon cancer, consider the following. Daily exercise and a diet low in fats, especially saturated fats may lower your risk of colorectal cancer. Also, some studies suggest that taking aspirin or folate every day may reduce a person's risk of colon cancer. Talk to your doctor to see if they are appropriate for you.

Treatment

Surgery is the primary method of treating colorectal cancer. After surgery, you may have chemotherapy or radiation. The extent of surgery and whether you need treatment after surgery depends on the stage of the disease and whether it is in the colon or rectum.

There are three slightly different systems for categorizing colon cancer: Dukes, Astler-Coller and AJC/TNM. Here are the stages in the AJC/TNM system, aloing with recommendations for treatment in addition to surgery:

Stage 0 — Cancer is confined to the inner layer of the colon or the rectal lining. No treatment is recommended after surgery to remove polyps or cancer.


Stage I — Cancer has grown through the inner rectal wall or the inner lining of the colon and the underlying layers, but has not broken through the colon wall. Usually, no treatment is recommended after surgery.


Stage II — Cancer has grown completely through the colon or rectal wall but it hasn't spread to nearby lymph nodes. Chemotherapy may be used after surgery in some cases of colon cancer. For rectal cancer, chemotherapy and radiation can be used before or after surgery.


Stage III — Cancer has spread to nearby lymph nodes but not to other parts of the body. For colon cancer, chemotherapy typically is recommended after surgery. For rectal cancer, chemotherapy and radiation usually are given before or after surgery.


Stage IV — Cancer has spread to distant organs, most commonly to the liver or lungs. Treatment after surgery consists of chemotherapy, radiation therapy or both to relieve the symptoms of advanced cancer and, in rectal cancer, to prevent the blockage of the rectum. Occasionally, surgery is needed to remove cancer from the sites where it has spread.
For colon cancer, surgery removes the cancerous area of the colon and some surrounding normal tissue and the nearby lymph nodes. The two ends of the colon are reconnected so that the colon can function normally. Occasionally, very early cancers can be removed through colonoscopy. People who have had colon cancer surgery usually do not need a colostomy, in which a hole is made in the abdomen, and the colon is rerouted through the hole to rid the body of stool. This procedure may be done temporarily if emergency surgery is needed to remove a cancerous area. Recuperation time varies depending on several factors, including the person's age, general health and the extent of the surgery.

For rectal cancer, treatment often combines surgery with chemotherapy and radiation, depending on the stage of the disease. Chemotherapy and radiation can be given before or after surgery.

Surgical procedures used for rectal cancer depend on the location and stage of the cancer. They include:

Polypectomy — This procedure removes polyps containing stage 0 tumors.


Local excision — This procedure removes superficial cancers and some nearby tissue from the rectum's inner layer, often working through the anal canal.


Low anterior resection — This procedure is used for most rectal cancers, except when the tumor is very close to the anal sphincter. The colon and rectum are reconnected, and no colostomy is needed.


Abdominoperineal resection — This surgery treats cancer in the lowest part of the rectum. Once the cancerous area is removed, a colostomy is needed to allow wastes to drain through an opening in the abdominal wall.


Pelvic exenteration — This surgery removes the rectum, bladder, prostate, uterus and other nearby organs if cancer has spread to them. A colostomy and drainage for urine are needed. This type of aggressive surgery is rarely needed.
When To Call A Professional

Visit a doctor for regular screenings according to the guidelines. Also, see your doctor if you have any of the signs or symptoms of colorectal cancer.

Prognosis

The outlook for colorectal cancer depends on the stage of the disease. The percent of people who survive 5 years or more range from near 100% for stage 0 to about 5% for stage IV.