cancer treatment

HPV and Cervical Cancer

2008-03-14T01:09:00.000-07:00

HPV is an STI that can be transmitted through genital contact without intercourse. Most HPV infections are asymptomatic and will typically resolve themselves. Certain strains, however, can have serious clinical consequences, including genital warts and cervical cancer. HPV infection is associated with the vast majority of cases of cervical cancer.

In 2007, there were over 550,000 new cases of cervical cancer worldwide, and approximately 260,000 deaths from cervical cancer. The overwhelming majority of these women were in developing countries, where cervical cancer screening programs and infrastructures for prevention, diagnoses, and treatment are weak. In the United States, the cervical cancer incidence rate is much lower. It was estimated that 11,000 new cases of invasive cervical cancer and approximately 3,700 deaths from cervical cancer occurred in the United States in 2007. This lower rate is attributable to the success of the widespread use of the Papanicolaou (Pap) test, which detects changes in cervical tissue, and is a major tool in screening for early identification of cervical cancer.

If detected early, cervical cancer is highly treatable. In the United States, it is recommended that women receive Pap tests at least once every three years. However, many women still do not receive Pap tests at the recommended frequency. In particular, Asian/Pacific Islander women have significantly lower rates of Pap tests than women of other races. Cervical cancer incidence and mortality are approximately 1.5 times higher among African American and Latina women, compared to White women. Researchers have postulated several reasons for these disparities, including fear, cost, lack of physician referral, and cultural issues.

The HPV Vaccine

Following the FDA approval of the Gardasil vaccine, the federal Advisory Committee on Immunization Practices (ACIP), a committee of the Centers for Disease Control and Prevention (CDC), recommended the new vaccine be administered routinely to girls 11 to 12 years of age. Use at a health provider’s discretion was also recommended for girls and women between the ages of 9 to 26. these recommendations were designed to encourage vaccination before initiation of sexual activity, and were based on data from clinical trials demonstrating a greater immune response in girls ages 10 to 15 compared to young women ages 16 to 25.

Gardasil prevents infection of four strains of HPV—two strains (16, 18) that cause 70% of cervical cancer cases and two strains (6, 11) that cause 90% of genital warts cases. It does not protect against all types of cervical cancer-causing HPV. Therefore, regular Pap tests remain a critical tool for early detection of precancerous cells. Gardasil should be administered in three doses over six months. Presently, there is only enough research to show vaccine effectiveness for 5 years. Further research will determine whether booster shots are needed. Furthermore, clinical trials were conducted in 9- to 26-year-old females, so effectiveness is only known for this age group, not for older women or males.

GlaxoSmithKline has also developed a vaccine against HPV, Cervarix, targeted at strains 16 and 18, which is currently under FDA review.

Vaccine Implementation and Costs

ACIP recommendations are followed closely by health care professionals. Health care professional associations often base their own policies off of these recommendations. After ACIP makes its recommendations, each state decides whether the vaccine should be required for entry into childcare or school. There are no federal laws that mandate vaccination; thus, mandatory vaccination laws will vary from state to state. Currently, legal exemptions to vaccination on the basis of medical, religious, or philosophical grounds also vary from state to state. Some groups have already expressed opposition to mandatory vaccination for entry into school. In addition, most vaccines require parental consent. It is not yet clear how states and providers will handle consent issues, particularly with women ages 18 and under who do not need consent for STI preventive services or treatment.

Another major hurdle will be the price of the vaccine. Merck has said that the list price of the vaccine will be $360 for the three doses, making it one of the costliest vaccines on the market. Private insurance companies usually cover ACIP-recommended vaccines, so most insured individuals will likely have coverage, although it is still too soon to tell. The Vaccines for Children (VFC) program, a federal entitlement program, covers the cost for children under age 19 who are uninsured or underinsured, on Medicaid, Alaska Natives, or American Indians.

However, for women 19 and older, the policies are different. Under Medicaid—the primary form of coverage for low-income women—vaccines are considered an "optional" benefit, which means that each state decides whether or not it will be a covered service. Some states also have public health programs in place that provide free or low-cost vaccines to those whose health insurance plan does not cover vaccines. For uninsured women, Merck has announced that it will establish an assistance program to provide free vaccines, including Gardasil, to uninsured and low-income adults ages 19 and older who visit private practices that already provide Merck vaccines. Many uninsured women in this age group rely on publicly funded clinics and health centers, not physicians in private practice.

Public Acceptability

Numerous studies have evaluated acceptability and attitudes regarding the use of the HPV vaccine. Acceptability among gynecologists and physicians is generally high, depending on factors such as a patient’s gender, age, and sexual history, as well as efficacy of the vaccine. A review of research regarding STI and HPV vaccine acceptability also indicates that health care providers and professional health organizations play a large part in a parent’s decision to vaccinate his or her child. Parents are more likely to follow the recommendations and information put forth by health care providers, and health care providers are more apt to follow a professional health organization’s endorsement of a vaccine. Thus, health care providers will likely play a pivotal role in relaying information about HPV and HPV immunization in order to ensure the targeted population is vaccinated.

The approval of the new vaccine holds great promise for millions of women. Not only can it greatly reduce deaths attributable to cervical cancer, but it also has the potential to reduce the economic and emotional burdens that women experience when they are faced with an abnormal Pap smear that requires further testing and treatment. The key to the success of this new vaccine will be in how policymakers, health care providers, parents, and women and girls respond to make sure that all those who can benefit from this new technology have access to it.

radiation & hormonial therapy

2008-03-14T01:08:00.000-07:00

Radiation Therapy

Radiation therapy may cause patients to become extremely tired, especially in the later weeks of prostate cancer treatment. Resting is important, but doctors usually encourage men to try to stay as active as they can. Some men may have diarrhea or frequent and uncomfortable urination.

When men with prostate cancer receive external radiation therapy, it is common for the skin in the treated area to become red, dry, and tender. External radiation therapy can also cause hair loss in the treated area. The loss may be temporary or permanent, depending on the dose of radiation.

Both types of radiation therapy may cause impotence in some men, but internal radiation therapy is not as likely as external radiation therapy to damage the nerves that control erection. However, internal radiation therapy may cause temporary incontinence. Long-term side effects from internal radiation therapy are uncommon.

Hormonal Therapy

The side effects of hormonal therapy depend largely on the type of treatment. Orchiectomy and LH-RH agonists often cause side effects such as impotence, hot flashes, and loss of sexual desire. When first taken, an LH-RH agonist may make a patient's symptoms worse for a short time. This temporary problem is called "flare." Gradually, however, the treatment causes a man's testosterone level to fall. Without testosterone, tumor growth slows down and the patient's condition improves. (To prevent flare, the doctor may give the man an antiandrogen for a while along with the LH-RH agonist.)

Antiandrogens can cause nausea, vomiting, diarrhea, or breast growth or tenderness. If used a long time, ketoconazole may cause liver problems, and aminoglutethimide can cause skin rashes. Men who receive total androgen blockade may experience more side effects than men who receive a single method of hormonal therapy. Any method of hormonal therapy that lowers androgen levels can contribute to weakening of the bones in older men.

Understanding the Cancer Process

2008-03-14T01:05:00.001-07:00

Understanding the Cancer Process

Cancer is a group of many related diseases. These diseases begin in cells, the body's basic unit of life. Cells have many important functions throughout the body.

Normally, cells grow and divide to form new cells in an orderly way. They perform their functions for a while, and then they die. This process helps keep the body healthy.

Sometimes, however, cells do not die. Instead, they keep dividing and creating new cells that the body does not need. They form a mass of tissue, called a growth or tumor.

Tumors can be benign or malignant:

Benign tumors are not cancer. They can usually be removed, and in most cases, they do not come back. Cells from benign tumors do not spread to other parts of the body. Most important, benign tumors of the prostate are not a threat to life.

>Benign prostatic hyperplasia (BPH) is the abnormal growth of benign prostate cells. In BPH, the prostate grows larger and presses against the urethra and bladder, interfering with the normal flow of urine. More than half of the men in the United States between the ages of 60 and 70 and as many as 90 percent between the ages of 70 and 90 have symptoms of BPH. For some men, the symptoms may be severe enough to require treatment.

Malignant tumors are cancer. Cells in these tumors are abnormal. They divide without control or order, and they do not die. They can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream and lymphatic system. This is how cancer spreads from the original (primary) cancer site to form new (secondary) tumors in other organs. The spread of cancer is called metastasis.

When prostate cancer spreads (metastasizes) outside the prostate, cancer cells are often found in nearby lymph nodes. If the cancer has reached these nodes, it means that cancer cells may have spread to other parts of the body -- other lymph nodes and other organs, such as the bones, bladder, or rectum. When cancer spreads from its original location to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if prostate cancer spreads to the bones, the cancer cells in the new tumor are prostate cancer cells. The disease is metastatic prostate cancer; it is not bone cancer.

brain cancer

2008-03-14T01:00:00.000-07:00

Brain cancer is a disease of the brain where cancer cells (malignant) grow in the brain tissue. Cancer cells grow to form a mass of cancer tissue (,tumor) that interferes with brain tissue functions such as muscle control, sensation, memory, and other normal body functions. Tumors composed of cancer cells are called malignant tumors, and those composed of noncancerous cells are called benign tumors. Cancer cells that develop from brain tissue are called primary brain tumors. Statistics suggest that brain cancer is not rare and is likely to develop in about 20,000 people per year.

What is metastatic brain cancer?

Cancer cells that develop in a body organ such as the lung (primary cancer tissue type) can go to other body organs such as the brain. Tumors formed by such cancer cells that spread (metastasize) to other organs are called metastatic tumors. Metastatic brain cancer is a mass of cells (tumor) that originated in another body organ and has spread into the brain tissue. Metastatic tumors in the brain are more common than primary brain tumors.

What causes brain cancer?

Primary brain tumors arise from many types of brain tissue (for example, glial cells, astrocytes, and other brain cell types). Metastatic brain cancer is caused by the spread of cancer cells from a body organ to the brain. However, the causes for the change from normal cells to cancer cells in both metastatic and primary brain tumors are not fully understood. Data gathered by research scientists show that people with certain risk factors (situations or things associated with people that increase the probability of developing problems) are more likely to develop brain cancer. Individuals with risk factors such as having a job in an oil refinery, as a chemist, embalmer, or rubber-industry worker show higher rates of brain cancer. Some families have several members with brain cancer, but heredity as a cause for brain tumors has not been proven. Other risk factors such as smoking, radiation exposure, and viral infection (HIV) have been suggested but not proven to cause brain cancer. There is no good evidence that brain cancer is contagious, caused by head trauma, or caused by cell phone use.

What are the symptoms of brain cancer?

The most common symptoms of brain cancer are weakness, difficulty walking, seizures, and headaches. Other common symptoms are nausea, vomiting, blurry vision, or a change in a person's alertness, mental capacity, memory, speech, or personality. These symptoms can also occur in people that do not have brain cancer, and none of these symptoms alone or in combination can predict that a person has brain cancer. A few brain cancers produce few or no symptoms.

What tests are used to diagnose brain cancer?

The initial test is an interview and physical examination of the person by a competent health-care provider. The results of this interaction will determine if other specific tests need to be done.

The most frequently used test to detect brain cancer is a CAT scan (computed automated tomography or CT). This test resembles a series of x-rays and is not painful, although sometimes a dye needs to be injected into the vein for better pictures of some internal brain structures. Another test that is gaining popularity because of its high sensitivity for detecting anatomic changes in the brain is MRI (magnetic resonance imaging). This test also resembles a series of x-rays and shows the brain structures in detail better than CT. MRI is not as widely available as CT scanning. If the tests show evidence (tumors or abnormalities in the brain tissue) of brain cancer, then other doctors such as neurosurgeons and neurologists that specialize in treating brain ailments will be consulted to help determine what should be done to treat the patient. Other tests (white blood cell counts, electrolytes, etc.) are likely to be ordered by the health-care giver to help determine the patient's state of health or to detect other health problems.

treatment.

What is the treatment for brain cancer?

A treatment plan is individualized for each brain cancer patient. The treatment plan is constructed by the doctors who specialize in brain cancer, and treatments vary widely depending on the cancer type, brain location, tumor size, patient age, and patient's general health status. A major part of the plan is also determined by the patient's wishes. Patients should discuss treatment options with their health-care providers.

Surgery, radiation therapy, and chemotherapy are the major treatment categories for most brain cancers. Individual treatment plans often include a combination of these treatments. Surgical therapy attempts to remove the tumor by cutting it away from normal brain tissue. Radiation therapy attempts to destroy tumor cells by using high energy radiation focused onto the tumor. Chemotherapy attempts to destroy tumor cells using chemicals (drugs) that are designed to destroy specific types of cancer cells. All treatments attempt to spare normal brain cells.

Other treatments that may be part of some treatment plans may include hyperthermia (heat treatments), immunotherapy (immune cells directed to kill certain cancer cell types), or steroids to reduce inflammation and brain swelling. Clinical trials (treatment plans designed by scientists to try new chemicals or methods on patients) can be another way for patients to obtain treatment specifically for their cancer cell type.

The best treatment for brain cancer is designed by the team of cancer specialists in conjunction with the wishes of the patient.

What are the side effects of brain cancer treatment?

Side effects of brain cancer treatment vary with the treatment plan and the patient. Most treatment plans try to keep all side effects to a minimum. For some patients, the side effects of brain cancer treatment can be severe. Treatment plans should include a discussion of potential side effects and the likelihood of them developing, so the patient and their caregivers (family, friends) can make appropriate treatment decisions in conjunction with their medical team. Also, if side effects develop, the patient has some knowledge of what to do about them such as when to take certain medicines or when to call their doctor to report health changes.

Surgical side effects include an increase in current symptoms, damage to normal brain tissue, brain swelling, and seizures. Other changes in brain functions such as muscle weakness, mental changes, and decreases in any brain-controlled function can occur. Combinations of these side effects may happen. The side effects are most noticeable shortly after surgery but frequently decline with time. Occasionally, the side effects do not decline.

Chemotherapy usually affects (kills) rapidly growing cancer cells but also can affect normal tissue. Chemotherapy is usually given intravenously so the drugs can reach most body organs. Common side effects of chemotherapy are nausea, vomiting, hair loss, and loss of energy. The immune system is often is depressed by chemotherapy, which results in a high susceptibility to infections. Other systems, such as the kidneys and the reproductive organs, may also be damaged by chemotherapy. Most of the side effects decline over time, but some may not.

Radiation therapy has most of the same side effects as chemotherapy. Most radiation therapy is focused onto the brain cancer tissue, so some systems do not receive direct radiation (immune system, kidneys, and others). The effects on systems not receiving the direct radiation are usually not as severe as those seen with chemotherapy. However, hair and skin are usually affected, resulting in hair loss (sometimes permanently) and reddish and darkened skin that needs protection from the sun.
What is the prognosis (outcome) of treated brain cancer?

Survival of treated brain cancer varies with the cancer type, location, and overall age and general health of the patient. In general, most treatment plans seldom result in a cure. Survival greater that five years, which is considered to be long-term survival, is less than 10% no matter what treatment plan is used.

So, why use any treatment plan? Without treatment, brain cancers are usually aggressive and result in death within a short time span. Treatment plans can prolong survival and can improve the patient's quality of life for some time. Again, the patient and caregivers should discuss their prognosis when deciding on treatment plans.

breast cancer

2008-03-14T00:50:00.000-07:00

Breast cancer is a malignant tumor that starts from cells of the breast. A malignant tumor is a group of cancer cells that may invade surrounding tissues or spread (metastasize) to distant areas of the body. The disease occurs almost entirely in women, but men can get it, too. The remainder of this document refers only to breast cancer in women. For information on breast cancer in men, see the American Cancer Society's document.

Normal Breast Structure

In order to understand breast cancer, it is helpful to have some basic knowledge about the normal structure of the breasts.

The female breast is made up mainly of lobules (milk-producing glands), ducts (tiny tubes that carry the milk from the lobules to the nipple), and stroma (fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels).

Most breast cancers begin in the cells that line the ducts (ductal cancers); some begin in the cells that line the lobules (lobular cancers), and the rest in other tissues.

The Lymph (Lymphatic) System

The lymph system is important to understand because it is one of the ways in which breast cancers can spread. This system has several parts.

Lymph nodes are small, bean-shaped collections of immune system cells that are connected by lymphatic vessels. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the breast. Lymph contains tissue fluid and waste products, as well as immune system cells (cells that are important in fighting infections). Breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes.

Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary nodes). Some lymphatic vessels connect to lymph nodes inside the chest (internal mammary nodes) and those either above or below the collarbone (supraclavicular or infraclavicular nodes).

Knowing if the cancer cells have spread to lymph nodes is important because if it has, there is a higher chance that the cells could have also gotten into the bloodstream and spread (metastasized) to other sites in the body. The more lymph nodes that are involved with the breast cancer, the more likely it is that the cancer may be found in other organs as well. This is important to know because it could affect your treatment plan. But not all women with lymph node involvement develop metastases, and it is not unusual for a woman to have negative lymph nodes and later develop metastases.

Benign Breast Lumps

Most breast lumps are not cancerous; that is, they are benign. Still, some need to be sampled and viewed under a microscope to prove they are not cancer.

Fibrocystic Changes

Most lumps turn out to be fibrocystic changes. The term "fibrocystic" refers to fibrosis and cysts. Fibrosis is the formation of fibrous (or scar-like) tissue, and cysts are fluid-filled sacs. Fibrocystic changes can cause breast swelling and pain. This often happens just before a period is about to begin. Your breasts may feel lumpy and, sometimes, you may notice a clear or slightly cloudy nipple discharge.

Other Benign Breast Lumps

Benign breast tumors such as fibroadenomas or intraductal papillomas are abnormal growths, but they are not cancer and cannot spread outside of the breast to other organs. They are not life threatening. Still, some benign breast conditions are important because women with these conditions have a higher risk of developing breast cancer.

For more information see the section, "What Are the Risk Factors for Breast Cancer?" and the American Cancer Society document, Noncancerous Breast Conditions.

Breast Cancer General Terms

It is important to understand some of the key words used to describe breast cancer.

Carcinoma

This is a term used to describe a cancer that begins in the lining layer (epithelial cells) of organs such as the breast. Nearly all breast cancers are carcinomas (either ductal carcinomas or lobular carcinomas).

Adenocarcinoma

An adenocarcinoma is a type of carcinoma that starts in glandular tissue (tissue that makes and secretes a substance). The ducts and lobules of the breast are glandular tissue (they make breast milk), so cancers starting in these areas are sometimes called adenocarcinomas.

Carcinoma In Situ

This term is used for the early stage of cancer, when it is confined to the layer of cells where it began. Specifically in breast cancer, in situ means that the cancer cells remain confined to ducts (ductal carcinoma in situ) or lobules (lobular carcinoma in situ). They have not invaded into deeper tissues in the breast or spread to other organs in the body, and are sometimes referred to as non-invasive breast cancers.

Invasive (Infiltrating) Carcinoma

An invasive cancer is one that has already invaded beyond the layer of cells where it started (as opposed to carcinoma in situ). Most breast cancers are invasive carcinomas -- either invasive ductal carcinoma or invasive lobular carcinoma.

Sarcoma

Sarcomas are cancers that start from connective tissues such as fat tissue or blood vessels. Sarcomas of the breast are rare.

Types of Breast Cancers

There are several types of breast cancer, although some of them are quite rare. It is not unusual for a single breast tumor to be a combination of these types and to have a mixture of invasive and in situ cancer.

Ductal Carcinoma In Situ (DCIS)

Ductal carcinoma in situ (also known as intraductal carcinoma) is the most common type of non-invasive breast cancer. DCIS means that the cancer cells are inside the ducts but have not spread through the walls of the ducts into the surrounding breast tissue.

About 1 out of 5 new breast cancer cases will be DCIS. Nearly all women diagnosed at this early stage of breast cancer can be cured. A mammogram is often the best way to find DCIS early.

When DCIS is diagnosed, the pathologist (a doctor specializing in diagnosing disease from tissue samples) will look for an area of dead or dying cancer cells, called tumor necrosis, within the tissue sample. If necrosis is present, the tumor is likely to be more aggressive. The term comedocarcinoma is often used to describe DCIS with necrosis.

Lobular Carcinoma In Situ (LCIS)

Although not a true cancer, LCIS (also called lobular neoplasia) is sometimes classified as a type of non-invasive breast cancer, and this is why it is included here. It begins in the milk-producing glands but does not grow through the wall of the lobules.

Most breast cancer specialists think that LCIS itself does not become an invasive cancer very often, but women with this condition do have a higher risk of developing an invasive breast cancer in the same breast or in the opposite breast. For this reason, women with LCIS should pay close attention to having regular mammograms.

Invasive (or Infiltrating) Ductal Carcinoma (IDC)

This is the most common type of breast cancer. It starts in a milk passage (duct) of the breast, has broken through the wall of the duct, and invaded the fatty tissue of the breast. At this point, it may have the ability to spread (metastasize) to other parts of the body through the lymphatic system and bloodstream. About 8 out of 10 invasive breast cancers are infiltrating ductal carcinomas.

Invasive (or Infiltrating) Lobular Carcinoma (ILC)

Invasive lobular carcinoma starts in the milk-producing glands (lobules). Like IDC, it can spread (metastasize) to other parts of the body. About 1 out of 10 invasive breast cancers are ILCs. Invasive lobular carcinoma may be harder to detect by a mammogram than invasive ductal carcinoma.

Less Common Types of Breast Cancer

Inflammatory breast cancer: This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breast cancers. Usually there is no single lump or tumor. Instead, inflammatory breast cancer (IBC) makes the skin of the breast look red and feel warm and gives the skin a thick, pitted appearance that looks a lot like an orange peel. Doctors now know that these changes are not caused by inflammation or infection, but by cancer cells blocking lymph vessels in the skin. The affected breast may become larger or firmer, tender, or itchy. Inflammatory breast cancer is often mistaken for infection (mastitis) in its early stages. Because there is no defined lump, it may not appear on a mammogram, which may make it even harder to catch it early. It typically has a higher chance of spreading and a worse outlook than typical invasive ductal or lobular cancer.

Mixed tumors: Mixed tumors are those that contain a variety of cell types, such as invasive ductal cancer combined with invasive lobular breast cancer. In this situation, the tumor is treated as if it were an invasive ductal cancer.

Medullary cancer: This special type of infiltrating breast cancer has a rather well-defined, distinct boundary between tumor tissue and normal tissue. It also has some other special features, including the large size of the cancer cells and the presence of immune system cells at the edges of the tumor. Medullary carcinoma accounts for about 3% to 5% of breast cancers. The outlook (prognosis) for this kind of breast cancer is generally better than for the more common types of invasive breast cancer. These are often hard to distinguish from invasive ductal carcinoma. Most cancer specialists think that true medullary cancer is very rare, and that cancers that are called medullary cancer should be treated as the usual invasive ductal breast cancer.

Metaplastic carcinoma: Metaplastic carcinoma (also known as carcinoma with metaplasia) is a very rare variant of invasive ductal cancer. These tumors include cells that are normally not found in the breast, such as cells that look like skin cells (squamous cells) or cells that make bone. These tumors are treated like invasive ductal cancer.

Mucinous carcinoma: Also known as colloid carcinoma, this rare type of invasive breast cancer is formed by mucus-producing cancer cells. The prognosis for mucinous carcinoma is usually better than for the more common types of invasive breast cancer.

Paget disease of the nipple: This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple and then to the areola, the dark circle around the nipple. It is rare, accounting for only about 1% of all cases of breast cancer. The skin of the nipple and areola often appears crusted, scaly, and red, with areas of bleeding or oozing. The woman may notice burning or itching.

Paget disease is almost always associated with either ductal carcinoma in situ (DCIS) or, more often, with infiltrating ductal carcinoma. If no lump can be felt in the breast tissue and the biopsy shows DCIS but no invasive cancer, the prognosis is excellent.

Tubular carcinoma: Tubular carcinomas are another special type of invasive ductal breast carcinoma. It was named tubular because of the way the cells look under the microscope. Tubular carcinomas account for about 2% of all breast cancers and tend to have a better prognosis than infiltrating ductal or lobular carcinomas.

Papillary carcinoma: The cells of these cancers tend to be arranged in small, finger-like projections when viewed under the microscope. These cancers are most often considered to be a subtype of ductal carcinoma in situ (DCIS), and are treated as such. In rare cases they are invasive, in which case they are treated like invasive ductal carcinoma, although the outlook is likely to be better. These cancers make up no more than 1% or 2% of all breast cancers, and they tend to be diagnosed in older women.

Adenoid cystic carcinoma (adenocystic carcinoma): These cancers are so named because they have both glandular (adenoid) and cylinder-like (cystic) features when viewed under the microscope. They make up less than 1% of breast cancers. They rarely spread to the lymph nodes or distant areas, and they tend to have a very good prognosis.

: This very rare breast tumor develops in the stroma (connective tissue) of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Other names for these tumors include phylloides tumor and cystosarcoma phyllodes. These tumors are usually benign but on rare occasions may be malignant.

Benign phyllodes tumors are treated by removing the mass along with a margin of normal breast tissue. A malignant phyllodes tumor is treated by removing it along with a wider margin of normal tissue, or by mastectomy. While surgery is often all that is needed, these cancers may not respond as well to the other treatments used for invasive ductal or lobular breast cancer.

Angiosarcoma: This is a form of cancer that starts from cells that line blood vessels. It rarely occurs in the breasts. When it does, it is usually seen as a complication of radiation to the breast. It tends to develop about 5 to 10 years after radiation treatment. However, this is an extremely rare complication of breast radiation therapy. Angiosarcoma can also occur in the arm of women who develop lymphedema as a result of lymph node surgery or radiation therapy to treat breast cancer. (For information on lymphedema, see the section, "How Is Breast Cancer Treated?") These cancers tend to grow and spread quickly. Treatment is generally the same as for other sarcomas.

treatment

The main treatments for breast cancer are

Surgery

Radiotherapy

Hormone therapy

Chemotherapy

Biological treatments (such as Herceptin)

You may have any of these treatments, or all of them, depending on your situation. It is impossible to generalise about breast cancer treatment because there are so many different sets of circumstances. Your doctor will take many different factors into account when deciding how to treat you. Some of the factors to be considered are

Whether you have had your menopause

The type of breast cancer you have

The size of your breast tumour

The stage of your breast cancer

The grade of your cancer cells

The results of tests on your cancer cells

Your general health

If you feel strongly about having or not having any particular treatment, do tell your doctor. There may be other options for you. And if you are set on a particular treatment, but your specialist hasn't suggested it, do ask them. There are almost certainly very good reasons why and your specialist should be able to explain them to you.

Stage and grade

Both of these are important for helping to decide which treatments you need. The stage of your breast cancer means how far it has grown and whether it has spread. Grade means what the cancer cells look like under the microscope. Breast cancers can be

Low grade or grade 1 (slow growing)

Intermediate grade or grade 2

High grade or grade 3 (fast growing)

Low grade cancers tend to grow more slowly than high grade. High grade cancers are more likely to come back after they have first been treated. But these are both rules of thumb, and can only provide a guideline about how any individual cancer will behave. Having said that, doctors will look grade, as well as stage, when deciding which treatments to offer you.

If you have a high grade cancer, your doctor will probably want to give you chemotherapy after surgery, even if there is no sign of cancer spread. This reduces the chance of the cancer coming back.

If you've got a cancer that has spread beyond the breast and lymph nodes in the armpit by the time it is diagnosed, your specialist may say that there is no point in putting you through an operation that will only get rid of the cancer in the breast. You may have radiotherapy and chemotherapy instead, combined with other treatments.

Tests on your cancer cells

Your breast cancer cells can be tested to see if they have 'hormone receptors' or biological therapy receptors. There are oestrogen receptors and progesterone receptors. You may hear your doctor talk about 'your oestrogen receptor status', 'ER status' or 'PR status'. Sometimes, doctors may say you are 'ER positive' or 'ER negative'.

Oestrogen and progesterone are female sex hormones. Many breast cancers are stimulated to grow by the female sex hormones. Now these tests can show whether the receptors are present on the surface of your breast cancer cells. If they are, your cancer is likely to respond to hormone therapy.

A hormone receptor is like a lock on the surface of the cell. The 'lock' is the same shape as an oestrogen molecule or a progesterone molecule. The hormone acts like the key to the lock. When it fits into its receptor, the cancer cell is stimulated to grow and divide into 2 new cells. So the breast cancer grows.

If your cancer has oestrogen receptors, then it is also likely to respond to treatment that blocks oestrogen - hormone therapy. Women with breast cancers that are 'ER positive' will usually have hormone therapy to help stop their cancer coming back. Current national guidelines for breast cancer treatment recommend that:

if you are ER positive you should have hormone therapy

if you are ER negative you should have chemotherapy

You may have hormone therapy if your cancer cells are progesterone receptor positive, even if they are oestrogen receptor negative. In some circumstances, doctors recommend both types of treatment. Younger women who are ER positive will probably have chemotherapy as well as hormone therapy. They will get benefit from both. The chemotherapy can stop the ovaries from working and so cut off the hormone supply to the cancer (see the section below about switching off the ovaries). Older women who have a small, ER negative cancer with a low risk of it coming back might not always have chemotherapy. It depends on how much benefit the doctor thinks it would give. There is more about chemotherapy and hormone therapy further down the page.

You may have heard of another test called Her2. This test is to see if your breast cancer would respond to the biological therapy called trastuzumab (Herceptin). Your breast cancer will only respond to Herceptin if the cells test strongly positive for a protein called Her2. You may also see this written as HER2neu or erbB2. This protein is on the surface of the cells of up to 1 in 4 breast cancers. It is the protein that Herceptin targets. If your breast cancer cells don't have this protein, Herceptin won't help you. There is more about Her2 testing in the breast cancer questions section.

Switching off the ovaries

Women who haven't had their menopause before being diagnosed with breast cancer are still producing oestrogen. If you have an ER positive cancer, then oestrogen can stimulate the breast cancer cells to grow. So doctors recommend treatment to stop oestrogen production. They call this ovarian ablation. There are various ways of doing it. To stop your ovaries working permanently, you may have

Chemotherapy

Surgery to remove your ovaries

Chemotherapy is used most often. If you do not want your ovaries to stop working permanently, there is another option that may be suitable. This is to take a drug called an 'LHRH analogue' or 'pituitary downregulator' for 2 to 3 years. These drugs switch off the ovaries. When you stop having the drug, your ovaries should start to work again. But the nearer you are to the age at which you would naturally have the menopause, the more likely it is that these drugs will switch off your ovaries permanently. There is more about pituitary downregulators in the section on hormone therapy for breast cancer.

All these methods are likely to cause menopausal symptoms. These are often quite intense, as you will have gone into menopause in such a short space of time. The moenpause is immediate if you had surgery or pituitary downregulators.

Researchers are looking into the role of ovarian ablation and chemotherapy for younger women. In May 2007, the journal 'The Lancet' published a review of the research into LHRH analogues. The reviewers found that switching off the ovaries with an LHRH analogue is an alternative to chemotherapy for women under 40, with hormone sensitive breast cancer. The advantage of an LHRH analogue compared to other methods of ovarian ablation is that for most women it is temporary. Their periods return 6 to 12 months after finishing treatment and they will become fertile again. For most women, any other menopausal symptoms they’ve had will also stop soon after treatment ends.

There are ongoing trials to find out more about the role of ovarian ablation in treating breast cancer. There is more information about these trials in our what's new page in this section.

Surgery and radiotherapy

You will probably have some choice about your treatment. Most people begin their treatment with surgery. There are different types of surgery. Depending on the size and position of the tumour, you may be able to have just the cancerous lump removed (lumpectomy) plus several weeks of radiotherapy to the rest of the breast. Or you may prefer the idea of a mastectomy. To help you decide, you may want to consider

How you feel about having a breast removed

How you feel about having only part of the breast removed

How you feel about having radiotherapy

How quickly you want the treatment to be finished

How you would cope with travelling to hospital daily for radiotherapy

There are no right and wrong answers to many treatment decisions. Some women feel that they must keep their breast if at all possible. Others feel that once the breast has had cancer in it, they would rather have it removed completely.

Some women feel strongly against radiotherapy. Others welcome it if it means keeping their breast. The most important thing is to take time to find out how you feel and make the right decision for you.

Unfortunately some women do not have much of a choice about surgery. If the cancer is too big, or right in the centre of the breast, the only option may be to remove the whole breast.

Remember - You don't have to make an ‘on the spot’ decision about treatment. You can say that you need some time to think over your options. Use the time to discuss the issues with family or friends, find out more about the treatments, or just to quietly reflect on your own about how you really feel.

There is more information about these treatments in the CancerHelp UK sections about surgery for breast cancer and radiotherapy for breast cancer.

Breast reconstruction

This is an operation to make a new breast shape after having a breast removed. You should be able to choose whether you would like breast reconstruction or not if you have a mastectomy. There is more about breast reconstruction in CancerHelp UK.

Hormone therapy and chemotherapy

You may have chemotherapy or hormone therapy before or after your surgery and radiotherapy.

Doctors call cancer treatment before surgery 'neo-adjuvant treatment', or sometimes 'primary treatment'. You may have chemotherapy before surgery to try to make the cancer smaller and easier to remove. In older women with locally advanced breast cancer, doctors sometimes use an aromatase inhibitor as a first treatment. These drugs can be very effective at shrinking the cancer in the breast. It will usually be obvious within 6 weeks of starting this treatment how well it is going to work.

Chemotherapy or hormone therapy after surgery is called adjuvant treatment. Your doctor will suggest this because it helps to lower the chance of the cancer coming back. Which treatment you have depends on

Whether you have had your menopause

Tests on your cancer cells that help show whether hormone therapy or Herceptin will work for you

The grade of your cancer cells

The size of the cancer in the breast and whether it has spread to your lymph nodes

Biological therapy

This is the newest type of cancer treatment. Trastuzumab or Herceptin is a type of biological therapy that can be used to treat breast cancer. If you have early breast cancer, there is now evidence that Herceptin may help to stop your HER2 positive breast cancer from coming back. If you have advanced breast cancer, it may help to keep it under control for longer.

In 2002 NICE approved Herceptin to treat advanced breast cancer. And in August 2006, they approved it for women with early breast cancer. There is information about the NICE guidance on Herceptin in early breast cancer in this section. Herceptin is not suitable for everyone. You may not be able to have it if you have certain heart problems. The links above will take you to more information about who can have treatment with Herceptin.

Swapping notes

When you are first diagnosed with breast cancer, the treatment can sometimes seem very complicated. As you can see there are quite a few different ways of treating it. And it can seem even more confusing if other people you meet are having different treatments. The variation in treatment may be because the other people have different circumstances to you. They may

Be older or younger than you

Have a different type of breast cancer

Have a different stage of breast cancer

Have a cancer with different hormone receptor status

Don’t be afraid to ask your doctor or nurse if something is puzzling you. This is a complicated area of medicine, even for doctors. And no one will think it strange that you are asking questions about your treatment.

Second opinions

If you do not feel you are getting the treatment you want or need, you can ask for a second opinion. This means going to see another specialist with your test results and X-rays and asking them what treatment they think you should have. It does not usually mean they take over your treatment and care. Just that they discuss with your doctor the right approach to take. Most doctors are quite happy to arrange this for you. It takes time to arrange a second opinion and so your treatment may be delayed for a while.

It is worth discussing your specialists' approach with them first. Once you have heard why they want to treat you in a certain way you may feel more confident.

prostate cancer

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prostate cancer disease in which cancer develops in the prostate, a gland in the malereproductive system. It occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, erectile dysfunction and other symptoms.

Rates of prostate cancer vary widely across the world. Although the rates vary widely between countries, it is least common in South and East Asia, more common in Europe, and most common in the United States.

^[1] According to the American Cancer Society, prostate cancer is least common among Asian men and most common among black men, with figures for white men in-between.

^[2]However, these high rates may be affected by increasing rates of detection.

^[3]Prostate cancer develops most frequently in men over fifty. This cancer can occur only in men, as the prostate is exclusively of the male reproductive tract. It is the most common type of cancer in men in the United States, where it is responsible for more male deaths than any other cancer, except lung cancer. However, many men who develop prostate cancer never have symptoms, undergo no therapy, and eventually die of other causes. Many factors, including genetics and diet, have been implicated in the development of prostate cancer.

Prostate cancer is most often discovered by physical examination or by screening blood tests, such as the PSA (prostate specific antigen) test. There is some current concern about the accuracy of the PSA test and its usefulness. Suspected prostate cancer is typically confirmed by removing a piece of the prostate (biopsy) and examining it under a microscope. Further tests, such as X-rays and bone scans, may be performed to determine whether prostate cancer has spread.

Prostate cancer can be treated with surgery, radiation therapy, hormonal therapy, occasionally chemotherapy, proton therapy, or some combination of these. The age and underlying health of the man as well as the extent of spread, appearance under the microscope, and response of the cancer to initial treatment are important in determining the outcome of the disease. Since prostate cancer is a disease of older men, many will die of other causes before a slowly advancing prostate cancer can spread or cause symptoms. This makes treatment selection difficult.^[5] The decision whether or not to treat localized prostate cancer (a tumor that is contained within the prostate) with curative intent is a patient trade-off between the expected beneficial and harmful effects in terms of patient survival and quality of life.

treatment

Prostate Cancer Treatment Methods

Treatment for prostate cancer may involve watchful waiting, surgery, radiation therapy, or hormonal therapy. Some patients receive a combination of therapies. In addition, doctors are studying other methods of treatment to find out whether they are effective against this disease. (The "Promise of Cancer Research" section has information about research studies.)

Watchful waiting may be suggested for some men who have prostate cancer that is found at an early stage and appears to be slow growing. Also, watchful waiting may be advised for older men or men with other serious medical problems. For these men, the risks and possible side effects of surgery, radiation therapy, or hormonal therapy may outweigh the possible benefits. Men with early stage prostate cancer are taking part in a study to determine when or whether treatment may be necessary and effective. (See "The Promise of Prostate Cancer Research" section for information about this study.)

Surgery is a common treatment for early stage prostate cancer. The doctor may remove all of the prostate (a type of surgery called radical prostatectomy) or only part of it. In some cases, the doctor can use a new technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery.

The doctor can describe the types of surgery and can discuss and compare their benefits and risks.

In radical retropubic prostatectomy, the doctor removes the entire prostate and nearby lymph nodes through an incision in the abdomen.

In radical perineal prostatectomy, the doctor removes the entire prostate through an incision between the scrotum and the anus. Nearby lymph nodes are sometimes removed through a separate incision in the abdomen.

In transurethral resection of the prostate (TURP), the doctor removes part of the prostate with an instrument that is inserted through the urethra. The cancer is cut from the prostate by electricity passing through a small wire loop on the end of the instrument. This method is used mainly to remove tissue that blocks urine flow.

If the pathologist finds cancer cells in the lymph nodes, it is likely that the disease has spread to other parts of the body. Sometimes, the doctor removes the lymph nodes before doing a prostatectomy. If the prostate cancer has not spread to the lymph nodes, the doctor then removes the prostate. But if cancer has spread to the nodes, the doctor usually does not remove the prostate, but may suggest other treatment.

These are some questions a patient may want to ask the doctor before having surgery:

What kind of operation will I have?

How will I feel after the operation?

If I have pain, how will you help?

How long will I be in the hospital?

When can I get back to my normal activities?

Will I have any lasting side effects?

What is my chance of a full recovery?

Radiation therapy (also called radiotherapy) uses high-energy x-rays to kill cancer cells. Like surgery, radiation therapy is local therapy; it can affect cancer cells only in the treated area. In early stage prostate cancer, radiation can be used instead of surgery, or it may be used after surgery to destroy any cancer cells that may remain in the area. In advanced stages, it may be given to relieve pain or other problems.

Radiation may be directed at the body by a machine (external radiation), or it may come from tiny radioactive seeds placed inside or near the tumor (internal or implant radiation, or brachytherapy). Men who receive radioactive seeds alone usually have small tumors. Some men with prostate cancer receive both kinds of radiation therapy.

For external radiation therapy, patients go to the hospital or clinic, usually 5 days a week for several weeks. Patients may stay in the hospital for a short time for implant radiation.

Hormonal therapy keeps cancer cells from getting the male hormones they need to grow. It is called systemic therapy because it can affect cancer cells throughout the body. Systemic therapy is used to treat cancer that has spread. Sometimes this type of therapy is used to try to prevent the cancer from coming back after surgery or radiation treatment.

There are several forms of hormonal therapy:

Orchiectomy is surgery to remove the testicles, which are the main source of male hormones.

Drugs known as luteinizing hormone-releasing hormone (LH-RH) agonists can prevent the testicles from producing testosterone. Examples are leuprolide, goserelin, and buserelin.

Drugs known as antiandrogens can block the action of androgens. Two examples are flutamide and bicalutamide.

Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide.

After orchiectomy or treatment with an LH-RH agonist, the body no longer gets testosterone from the testicles. However, the adrenal glands still produce small amounts of male hormones. Sometimes, the patient is also given an antiandrogen, which blocks the effect of any remaining male hormones. This combination of treatments is known as total androgen blockade. Doctors do not know for sure whether total androgen blockade is more effective than orchiectomy or LH-RH agonist alone.

Prostate cancer that has spread to other parts of the body usually can be controlled with hormonal therapy for a period of time, often several years. Eventually, however, most prostate cancers are able to grow with very little or no male hormones. When this happens, hormonal therapy is no longer effective, and the doctor may suggest other forms of treatment that are under study.

Mesothelomia Diagnosis

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Mesothelomia Diagnosis A proper diagnosis is essential to a treatment plan.

The National Cancer Institute states that: "Malignant Mesothelomia, a rare form of cancer, is a disease in which cancer (malignant) cells are found in the sac lining the chest (the pleura) or abdomen (the peritoneum). Most people with malignant mesothelioma have worked on jobs where they breathed asbestos."

A doctor should be seen if a person has shortness of breath, pain in the chest, or pain or swelling in the abdomen. If there are symptoms, the doctor may order an x-ray of the chest or abdomen. The doctor may look inside the chest cavity with a special instrument called a thoracoscope. A cut will be made through the chest wall and the thoracoscope will be put into the chest between two ribs. This test, called thoracoscopy, is usually done in the hospital. Before the test, the patient will be given a local anesthetic (a drug that causes a loss of feeling for a short period of time). Some pressure may be felt, but usually there is no pain.

The doctor may also look inside the abdomen (peritoneoscopy) with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is also usually done in the hospital. Before the test is done, a local anesthetic will be given.

If tissue that is not normal is found, the doctor will need to cut out a small piece and have it looked at under a microscope to see if there are any cancer cells. This is called a biopsy. Biopsies are usually done during the thoracoscopy or peritoneoscopy.

The treatment program depends on the size of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope, how the cancer responds to treatment, and the patient's age and desires.

The dense white encircling tumor mass is arising from the visceral pleura and is a mesothelioma. These are big bulky tumors that can fill the chest cavity.The risk factor for mesothelioma is asbestos exposure. However, mesothelioma is rare even in persons with asbestos exposure. Asbestosis more commonly predisposes to bronchogenic carcinomas, increasing the risk by a factor of five. Smoking increases the risk for lung cancer by a factor of ten. Thus, smokers with a history of asbestos exposure have a risk 50 fold greater likelihood of for developing lung cancer.

This is the causative agent for asbestosis. This long, thin object is an asbestos fiber. Many houses and offices still contain building materials with asbestos, particularly insulation, so care must be taken when doing remodelling or reconstruction.

The asbestos fiber becomes coated with iron and calcium, which is why it is often referred to as a "ferruginous body" as seen here with an iron stain. Ingestion of these fibers by macrophages sets off a fibrogenic response via release of growth factors that promote collagen deposition by fibroblasts.

Another gross lesion typical for pneumoconioses, and asbestosis in particular, is a fibrous pleural plaque. Seen here on the pleural side of the diaphragmatic leaves are several tan-white pleural plaques.

Mesothelioma

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Mesothelioma is a deadly cancer that has recently become a concern amongst many people as the dangers of asbestos and its wide-spread use before the late 1970's become more well-known.

Mesothelioma is a Form of Cancer Caused by Exposure to Asbestos

The first thing to realize about Mesothelioma is that it is a malignant cancer caused usually by exposure to asbestos or asbestos-containing materials. The symptoms of Mesothelioma often do not show up until years after the asbestos exposure.

Mesothelioma is a Malignant Cancer that Affects the Heart, Lungs and Stomach

Mesothelioma is a malignant cancer that affects the linings of the heart, lungs and stomach. The symptoms experienced will therefore differ depending on the organ affected. Peritoneal Mesothelioma (Mesothelioma of the stomach) leads to loss of appetite, pain in the abdomen and problems with bowel functioning. Pleural Mesothelioma on the other hand affects the lungs and chest pain, difficulty breathing, and coughing up blood. All Mesothelioma is malignant and will often lead to death.

treatment

New approaches to treat malignant mesothelioma are currently being tested. They often combine traditional treatments or include something entirely new. They include:

Angiogenesis and Anti-angiogenesis Drugs Although progress has been made in the early detection of cancer, and in improved treatment options once cancer is diagnosed, there are still many cancers, including mesothelioma, which can not be cured and rfobiotecin difficult to treat effectively. In recent years, researchers have learned a great deal about how cancer cells differ from normal cells and, in an effort to find drugs without the potentially severe side effects of chemotherapy, have now discovered drugs which target the tumor itself while sparing the body’s normal cells. One such group are the anti-angiogenesis drugs. Learn more about anti-angiogenesis agents in the treatment of mesothelioma.

Immunotherapy, sometimes called biological therapy, uses the body's own immune system to protect itself against disease. Researchers have found that the immune system may be able to recognize the difference between healthy cells and cancer cells, and eliminate those that become cancerous. Immunotherapy is designed to repair, stimulate, or enhance the immune system's natural anticancer function.Substances used in immunotherapy, called biological response modifiers (BRMs) alter the interaction between the body's immune defenses and cancer, thereby improving the body's ability to fight disease. Some BRMs, such as cytokines and antibodies, occur naturally in the body, however, it is now possible to make BRMs in the laboratory that can imitate or influence natural immune response agents. These BRMs may:
- Enhance the immune system to fight cancer cell growth.
- Eliminate, regulate, or suppress body responses that permit cancer growth.
- Make cancer cells more susceptible to destruction by the immune system.
- Alter cancer cell's growth patterns to behave like normal cells.
- Block or reverse the process that changes a normal cell into a cancer cell.
- Prevent a cancer cell from spreading to other sites.
Many BRMs are currently being used in cancer treatment, including interferons, interleukins, tumor necrosis factor, colony-stimulating factors, monoclonal antibodies, and cancer vaccines. More on immunotherapy for mesothelioma.

Photodynamic therapy (PDT) is a type of cancer treatment based on the premise that single-celled organisms, if first treated with certain photosensitive drugs, will die when exposed to light at a particular frequency. PDT destroys cancerous cells by using this fixed frequency light to activate photosensitizing drugs which have accumulated in body tissues.In PDT, a photosensitizing drug is administered intravenously. Within a specific time frame (usually a matter of days), the drug selectively concentrates in diseased cells, while rapidly being eliminated from normal cells. The treated cancer cells are then exposed to a laser light chosen for its ability to activate the photosensitizing agent. This laser light is delivered to the cancer site, (in the case of mesothelioma, the pleura), through a fiberoptic device that allows the laser light to be manipulated by the physician. As the agent in the treated cells absorbs the light, an active form of oxygen destroys the surrounding cancer cells. The light exposure must be carefully timed, so that it occurs when most of the photosensitizing drug has left the healthy cells, but is still present in cancerous ones.The major side effect of PDT is skin sensitivity. Patients undergoing this type of therapy are usually advised to avoid direct and even indirect sunlight for at least six weeks. Other side effects may include nausea, vomiting, a metallic taste in the mouth, and eye sensitivity to light. These symptoms may sometimes come as a result of the injection of the photosensitizing agent.

Gene therapy is an approach to treating potentially fatal or disabling diseases by modifying the expression of an individual's genes toward a therapeutic goal. The premise of gene therapy is based on correcting disease at the DNA level and compensating for the abnormal genes. Replacement gene therapy replaces a mutated or missing gene, most often a tumor suppressor gene, with a normal copy of that gene which serves to keep cell growth and division under control. The p53 gene, the most common gene mutated in cancer has become a prime target for gene replacement, and has met with some success in inhibiting cell growth, inhibiting angiogenesis (the development of a tumor's blood supply), and inducing apoptosis (cell death). Knockout gene therapy targets the products of oncogenes (a gene that can induce tumor formation) in an effort to render them inactive and reduce cell growth.With constantly expanding knowledge of the genes associated with cancer, their functions, and the delivery systems used in administering these genes, gene therapy has a promising future.

Complementary and alternative medicine covers a wide range of healing philosophies that conventional medicine does not commonly accept or make available to its patients. Some of these practices include the use of acupuncture, herbs, homeopathy, therapeutic massage, and Far Eastern medicine to treat health conditions.These therapies may be used alone as an alternative to conventional medicine, or in addition to conventional medicine, in which case they are referred to as complementary. Many are considered holistic, meaning their focus is to treat the whole patient - physically, mentally, emotionally, and spiritually. These treatments are not widely taught as a part of the medical curriculum, are not generally used in hospitals, and, for the most part, are not covered under insurance policies.Many cancer patients try various complementary and/or alternative medicine techniques during the course of their treatment, and although they may not work for everyone, some patients benefit by managing their symptoms or side effects. One important caveat, is to discuss any complementary or alternative treatments you may be considering with your doctor to be sure nothing interferes with your conventional care. For instance, dietary supplements such as herbs or vitamins may be "natural", but not necessarily "safe". They may lessen the effectiveness of certain anticancer drugs, or when taken with other drugs or in large doses, may actually cause harm. Since supplements of this nature are not governed by the FDA (Food and Drug Administration), and a prescription is not necessary to purchase, it is up to the consumer to make informed and conscientious decisions regarding their use.Your personal physician may be able to advise you about the use of complementary and alternative treatments and therapies, and how they relate to mesothelioma. The combinaton of complementary and conventional therapies is sometimes referred to as

integrative medicine.

Unconventional methods of cancer treatment make claims that can not be scientifically substantiated. They commonly claim to be effective against cancers that are considered incurable, and tout treatments with relatively few, if any, side effects.The use of these unconventional methods may result in the loss of valuable time and the opportunity to receive potentially effective therapy. It is always important to rfobiotecin in the care of a qualified physician who uses accepted methods of treatment or who is participating in scientifically designed investigational therapies.

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