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Radiation Therapy

Intensity Modulated Radiation Therapy (IMRT)

IMRT is an advanced form of external beam radiation therapy that is commonly used to treat breast, prostate, lung, head and neck and many other types of cancer. IMRT allows doctors to customize the radiation dose by modulating, or varying, the amount of radiation given to different parts of the area being treated. The radiation intensity is adjusted with the use of computer-controlled, moveable "leaves" which either block or allow the passage of radiation from the many beams that are aimed at the treatment area. The leaves are carefully adjusted according to the shape, size, and location of the tumor. As a result, more radiation can be delivered to the tumor cells while less is directed at the normal cells that are nearby. Unlike standard radiation techniques that allow only a constant flow of radiation from each beam, IMRT allows radiation oncologists to "paint" the radiation dose.

Erin O’Leary

Board Certification
American Board of Genetic Counseling

Graduate School
University of Pittsburgh

College
Duquesne University

Specialties: 
Genetic Counseling

Erin O’Leary earned her Bachelor of Science degree from Duquesne University in 2001 and went on to receive her Master of Science in Genetic Counseling in 2005 from the University of Pittsburgh.  She is board certified by the American Board of Genetic Counseling.

Ms. O’Leary brings extensive clinical experience to her field.  While receiving her graduate education, Ms. O’Leary acted as Clinical Research Coordinator and Graduate Student Researcher, helping to perform studies related to early head and neck cancers.  In her career, she has taken a strong interest in hereditary cancer syndromes although she also has worked in cytogenetics and prenatal genetic counseling.  During her time as Genetic Counselor at UCLA, Ms. O’Leary was involved in helping to develop a screening process for Lynch syndrome and in expanding programs in gastroenterology, endocrinology, gynecologic oncology, and pediatric oncology.  She also actively participated in tumor boards and the UCLA genomic review board.

Ms. O’Leary remains involved in several professional organizations including the National Society of Genetic Counselors and the Cancer Genetics Special Interest Group.  She is a published author and is often an invited speaker at both national and international events.  Additionally, Ms. O’Leary has experience in educating others, having mentored Master’s level students and provided continuing education to physicians. In her spare time, Ms. O’Leary enjoys hiking, practicing yoga, and cooking.

Primary Location:
Arlington Office
1635 N. George Mason Drive, Suite 170
Arlington, VA 22205

Phone Number: (703) 894-3800

Language(s): English
 

Treatment Options

Different types of treatment are available for patients with melanoma. These are the five treatment options commonly used for melanoma depending on the stage of the cancer.

Surgery

Surgery to remove the tumor is the primary treatment of all stages of melanoma. The doctor may remove the tumor as well as check to see if the cancer has spread to the lymph system.

  • Wide local excision: Surgery to remove the melanoma and some of the normal tissue around it. Some of the lymph nodes may also be removed.
  • Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer.
  • Sentinel lymph node biopsy: The removal of the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.

Skin grafting (taking skin from another part of the body to replace the skin that is removed) may be done to cover the wound caused by surgery.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body. This is called systemic chemotherapy.

When chemotherapy is placed directly into the spinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas. This is regional chemotherapy.

One type of regional chemotherapy used for melanoma patients is used to inject the anticancer drugs directly to the arm or leg the cancer is in. The flow of blood to and from the limb is temporarily stopped with a tourniquet. A warm solution with the anticancer drugs is put directly into the blood of the limb. This gives a high dose of drugs to the area where the cancer is.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Even if the doctor removes all the melanoma during surgery, there can be some left that can’t be seen. Some patients may be offered chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.

Biologic Therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

  • Interferon and interleukin-2 (IL-2) are types of biologic therapy used to treat melanoma. Interferon affects the division of cancer cells and can slow tumor growth. IL-2 boosts the growth and activity of many immune cells, especially lymphocytes (a type of white blood cell). Lymphocytes can attack and kill cancer cells.
  • Tumor necrosis factor (TNF) therapy is a type of biologic therapy used with other treatments for melanoma. TNF is a protein made by white blood cells in response to an antigen or infection. Tumor necrosis factor can be made in the laboratory and used as a treatment to kill cancer cells.

Targeted Therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. The following types of targeted therapy are being used in the treatment of melanoma:

  • Monoclonal antibody therapy: A cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies may be used with chemotherapy as adjuvant therapy. Ipilimumab is a monoclonal antibody used to treat melanoma.
  • Signal transduction inhibitors: A substance that blocks signals that are passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells. Vemurafenib is a signal transduction inhibitor used to treat advanced melanoma or tumors that cannot be removed by surgery.
  • Oncolytic virus therapy: A type of targeted therapy that is being studied in the treatment of melanoma. Oncolytic virus therapy uses a virus that infects and breaks down cancer cells but not normal cells. Radiation therapy or chemotherapy may be given after oncolytic virus therapy to kill more cancer cells.
  • Angiogenesis inhibitors: A type of targeted therapy that is being studied in the treatment of melanoma. Angiogenesis inhibitors block the growth of new blood vessels. In cancer treatment, they may be given to prevent the growth of new blood vessels that tumors need to grow.

Treatment Options

For each stage of soft tissue sarcoma, there are different treatment options available. Some of the options that may be offered by your doctor are as follows:

Stage I Sarcoma:

  • Surgery (wide local excision or Mohs microsurgery).
  • Radiation therapy before and/or after surgery.

If cancer is found in the head, neck, abdomen, or chest, treatment may include the following:

  • Surgery.
  • Radiation therapy before or after surgery.
  • Fast neutron radiation therapy.

Stages II and III adult soft tissue sarcoma treatments include:

  • Surgery (wide local excision).
  • Surgery (wide local excision) with radiation therapy, for large tumors.
  • High-dose radiation therapy for tumors that cannot be removed by surgery.
  • Radiation therapy or chemotherapy before limb-sparing surgery. Radiation therapy may also be given after surgery.
  • A clinical trial of surgery followed by chemotherapy, for large tumors.

Stage IV adult soft tissue sarcoma that involves lymph nodes may include the following treatments:

  • Surgery (wide local excision) with or without lymphadenectomy. Radiation therapy may also be given after surgery.
  • Radiation therapy before and after surgery.
  • A clinical trial of surgery followed by chemotherapy.

Treatment of stage IV adult soft tissue sarcoma that involves internal organs of the body may include the following:

  • Surgery (wide local excision).
  • Surgery to remove as much of the tumor as possible, followed by radiation therapy.
  • High-dose radiation therapy, with or without chemotherapy, for tumors that cannot be removed by surgery.
  • Chemotherapy with 1 or more anticancer drugs, before surgery or as palliative therapy to relieve symptoms and improve the quality of life.
  • A clinical trial of chemotherapy with or without stem cell transplant.
  • A clinical trial of chemotherapy following surgery to remove cancer that has spread to the lungs.

Treatment for recurring sarcoma may be somewhat different and will be guided by your cancer treatment team of physicians and nurses.

Staging

Stage I

Divided into Stages IA and IB:

  • Stage IA - the tumor is low-grade (likely to grow and spread slowly) and 5 centimeters or smaller. It may be either superficial (in subcutaneous tissue with no spread into connective tissue or muscle below) or deep (in the muscle and may be in connective or subcutaneous tissue).
  • Stage IB - the tumor is low-grade (likely to grow and spread slowly) and larger than 5 centimeters. It may be either superficial or deep in the tissue.

Stage II

Divided into Stages IIA and IIB:

  • Stage IIA - the tumor is mid-grade (somewhat likely to grow and spread quickly) or high-grade (likely to grow and spread quickly) and 5 centimeters or smaller. It may be either superficial or deep in the tissue.
  • Stage IIB - the tumor is mid-grade (somewhat likely to grow and spread quickly) and larger than 5 centimeters. It may be either superficial or deep in the tissue.

Stage III

The tumor is either:

  • High-grade (likely to grow and spread quickly), larger than 5 centimeters, and either superficial or deep in the tissue; or
  • Any grade, any size, and has spread to nearby lymph nodes.

Stage IV

The tumor is any grade, any size, and may have spread to nearby lymph nodes. Cancer has spread to distant parts of the body, such as the lungs.

Diagnosis

If a soft tissue sarcoma is suspected, a biopsy will be done. The type of biopsy will be based on the size and location of the tumor. There are three types of biopsies commonly used. Your physician will choose the best one for you:

  • Incisional biopsy: The removal of part of a lump or a sample of tissue.
  • Core biopsy: The removal of tissue using a wide needle.
  • Excisional biopsy: The removal of an entire lump or area of tissue that doesn’t look normal.

The following tests may be done on the tissue that was removed:

  • Immunohistochemistry study: is used to tell the difference between different types of cancer.
  • Light and electron microscopy: Used to look for certain changes in the cells.
  • Cytogenetic analysis: Used to look for certain changes in the chromosomes.
  • FISH (fluorescence in situ hybridization): A laboratory test used to look at genes or chromosomes in cells and tissues.
  • Flow cytometry: A laboratory test that measures the number of cells in a sample, the percentage of live cells in a sample, and certain characteristics of cells, such as size, shape, and the presence of tumor markers on the cell surface.

Sarcoma

Sarcoma develops from tissues like muscle or bone tissues. There are two primary types of sarcoma:

  • Soft tissue sarcoma which starts in the soft tissues such as fat, nerves, muscles, fibrous tissues, deep skin tissues or blood vessels.
  • Osteosarcoma, which develops from bone.

We are going to focus on soft tissue sarcoma in this section.

A sarcoma may appear as a painless lump under the skin, often on an arm or a leg. Sarcomas that begin in the abdomen may not cause symptoms until they become very large. As the sarcoma grows larger and presses on nearby organs, nerves, muscles, or blood vessels, symptoms may include pain or trouble breathing.

Visit the National Cancer Institute where you can find more information on bone and soft tissue sarcomas. And be sure to ask your cancer care team questions about your individual situation.

Treatment Options

People with early oral cancer may be treated with surgery or radiation therapy. People with advanced oral cancer may have a combination of treatments. For example, radiation therapy and chemotherapy are often given at the same time. Another treatment option is targeted therapy.

Surgery

Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be removed as well. You may have surgery alone or in combination with radiation therapy.

Surgery to remove a small tumor in your mouth may not cause any lasting problems. For a larger tumor, however, the surgeon may remove part of the palate, tongue, or jaw. This surgery may change your ability to chew, swallow, or talk. Also, your face may look different after surgery. You may have reconstructive or plastic surgery to rebuild the bones or tissues of the mouth.

Radiation Therapy

Radiation therapy can be used to treat the area where the patient is affected by oral cancer. This type of treatment focuses on treating the specific area(s) where the cancer was found.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. The drugs that treat oral cancer are usually given through a vein (intravenous). The drugs enter the bloodstream and travel throughout your body.

Chemotherapy and radiation therapy are often given at the same time. You may receive chemotherapy in outpatient therapy at a cancer center like ours.

Chemotherapy and radiation therapy can cause some of the same side effects, including painful mouth and gums, dry mouth, infection, and changes in taste. Some anticancer drugs can cause bleeding in the mouth and a deep pain that feels like a toothache.

Targeted Therapy

Some people with oral cancer receive a type of drug known as targeted therapy. It may be given along with radiation therapy or chemotherapy. Cetuximab (Erbitux) was the first targeted therapy approved for oral cancer. Cetuximab binds to oral cancer cells and interferes with cancer cell growth and the spread of cancer. You may receive cetuximab through a vein once a week for several weeks at the doctor's office.

Staging

For oral cancer, Stages I and II are combined and classified as “early cancer”. Stages III and IV are classified as “advanced cancer.” Here are the details of each class:

Early Cancer

Stage I or II oral cancer is usually a small tumor (smaller than a walnut), and no cancer cells are found in the lymph nodes.

Advanced Cancer

Stage III or IV oral cancer is usually a large tumor (as big as a lime). The cancer may have invaded nearby tissues or spread to lymph nodes or other parts of the body.

Diagnosis

Many of the following symptoms are not from oral cancer. However, if you find any of these, you should contact your physician or dentist so they can diagnose and treat the areas of concern as soon as possible. Symptoms of oral cancer include:

  • Patches inside your mouth or on your lips:
    • White patches are the most common and can become cancerous.
    • Mixed red and white patches are more likely than white patches to become malignant.
    • Red patches are brightly colored, smooth areas that often become cancerous.
  • A sore on your lip or in your mouth that doesn't heal
  • Bleeding in your mouth
  • Loose teeth
  • Difficulty or pain when swallowing
  • Difficulty wearing dentures
  • A lump in your neck
  • An earache that doesn't go away
  • Numbness of lower lip and chin

If you have symptoms that suggest oral cancer, your doctor or dentist will check your mouth and throat for red or white patches, lumps, swelling, or other problems. A physical exam includes looking carefully at the roof of your mouth, back of your throat, and insides of your cheeks and lips. The floor of your mouth and lymph nodes in your neck will also be checked.

The removal of a small piece of tissue to look for cancer cells is called a biopsy. Usually, a biopsy is done with local anesthesia. A biopsy is the only sure way to know if the abnormal area is cancer.

A few methods that are also used in the diagnosis process are as follows:

  • X-rays: An x-ray of your entire mouth can show whether cancer has spread to the jaw. Images of your chest and lungs can show whether cancer has spread to these areas.
     
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your body. You may receive an injection of dye. Tumors in your mouth, throat, neck, lungs, or elsewhere in the body can show up on the CT scan.
     
  • MRI: A powerful magnet linked to a computer is used to make detailed pictures of your body. An MRI can show whether oral cancer has spread.
     
  • Endoscopy: The doctor uses a thin, lighted tube (endoscope) to check your throat, windpipe, and lungs.
     
  • PET scan: You receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan shows whether oral cancer may have spread.

Lip & Oral

Each year in the United States, more than 21,000 men and 9,000 women are diagnosed with oral cancer. Most are over 60 years old.

The oral cavity includes the following:

  • The front two thirds of the tongue.
  • The gingiva (gums).
  • The buccal mucosa (the lining of the inside of the cheeks).
  • The floor (bottom) of the mouth under the tongue.
  • The hard palate (the roof of the mouth).
  • The retromolar trigone (the small area behind the wisdom teeth).

Risk Factors

Tobacco and alcohol use can affect the risk of developing lip and oral cavity cancer.

Risk factors for lip and oral cavity cancer include the following:

  • Using tobacco products.
  • Heavy alcohol use.
  • Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
  • Being male.
  • Being infected with human papillomavirus (HPV).

Visit the National Cancer Institute where this information and more can be found about Lip and Oral Cancer or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el cáncer del del labio y la cavidad oral.

Treatment Options

There are many options when it comes to treatment for Mesothelioma. The main three treatments are as follows:

Surgery

The following surgical treatments may be used for malignant mesothelioma:

  • Wide local excision: Surgery to remove the cancer and some of the healthy tissue around it.
     
  • Pleurectomy and decortication: Surgery to remove part of the covering of the lungs and lining of the chest and part of the outside surface of the lungs.
     
  • Extrapleural pneumonectomy: Surgery to remove one whole lung and part of the lining of the chest, the diaphragm, and the lining of the sac around the heart.
     
  • Pleurodesis: A surgical procedure that uses chemicals or drugs to make a scar in the space between the layers of the pleura. Fluid is first drained from the space using a catheter or chest tube and the chemical or drug is put into the space. The scarring stops the build-up of fluid in the pleural cavity.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Staging

The following stages are used for malignant mesothelioma:

Stage I (Localized)

Stage I is divided into Stages IA and IB:

  • In Stage IA, cancer is found in one side of the chest in the lining of the chest wall and may also be found in the lining of the chest cavity between the lungs and/or the lining that covers the diaphragm. Cancer has not spread to the lining that covers the lung.
     
  • In Stage IB, cancer is found in one side of the chest in the lining of the chest wall and the lining that covers the lung. Cancer may also be found in the lining of the chest cavity between the lungs and/or the lining that covers the diaphragm.

Stage II (Advanced)

In Stage II, cancer is found in one side of the chest in the lining of the chest wall, the lining of the chest cavity between the lungs, the lining that covers the diaphragm, and the lining that covers the lung. Also, cancer has spread into the diaphragm muscle and/or the lungs.

Stage III (Advanced)

Either of the following is true:

  • Cancer is found in one side of the chest in the lining of the chest wall. Cancer may have spread to:
    • the lining of the chest cavity between the lungs;
    • the lining that covers the diaphragm;
    • the lining that covers the lung;
    • the diaphragm muscle;
    • the lung.
       
  • Cancer has spread to lymph nodes where the lung joins the bronchus, along the trachea and esophagus, between the lung and diaphragm, or below the trachea.

or

  • Cancer is found in one side of the chest in the lining of the chest wall, the lining of the chest cavity between the lungs, the lining that covers the diaphragm, and the lining that covers the lung. Cancer has spread into one or more of the following:
    • Tissue between the ribs and the lining of the chest wall
    • Fat in the cavity between the lungs
    • Soft tissues of the chest wall
    • Sac that covers the heart
       
  • Cancer may have spread to lymph nodes where the lung joins the bronchus, along the trachea and esophagus, between the lung and diaphragm, or below the trachea.

Stage IV (Advanced)

In Stage IV, cancer cannot be removed by surgery and is found in one or both sides of the body. Cancer may have spread to lymph nodes anywhere in the chest or above the collarbone. Cancer has spread in one or more of the following ways:

  • Through the diaphragm into the peritoneum (the thin layer of tissue that lines the abdomen and covers most of the organs in the abdomen).
  • To the tissue lining the chest on the opposite side of the body as the tumor.
  • To the chest wall and may be found in the rib.
  • Into the organs in the center of the chest cavity.
  • Into the spine.
  • Into the sac around the heart or into the heart muscle.
  • To distant parts of the body such as the brain, spine, thyroid, or prostate.

Detection & Diagnosis

Sometimes malignant mesothelioma causes fluid to collect around the lung or in the abdomen. These symptoms may be caused by the fluid or malignant mesothelioma. Other conditions may also cause the same symptoms. Check with your doctor if you have any of the following problems:

  • Trouble breathing.
  • Pain under the rib cage.
  • Pain or swelling in the abdomen.
  • Lumps in the abdomen.
  • Weight loss for no known reason.

Sometimes it is hard to tell the difference between malignant mesothelioma and lung cancer. The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, exposure to asbestos, past illnesses and treatments will also be taken.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
     
  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells, white blood cells, and platelets.
    • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
    • The portion of the blood sample made up of red blood cells.
       
  • Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.
     
  • Biopsy: The removal of cells or tissues from the pleura or peritoneum so they can be viewed under a microscope by a pathologist to check for signs of cancer. Procedures used to collect the cells or tissues include the following:

    • Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
    • Cytologic exam: An exam of cells under a microscope (by a pathologist) to check for anything abnormal. For mesothelioma, fluid is taken from around the lungs or from the abdomen. A pathologist checks the cells in the fluid.

Mesothelioma

Malignant mesothelioma is a disease in which cancer cells are found in the pleura, the thin layer of tissue that lines the chest cavity and covers the lungs or the peritoneum, the thin layer of tissue that lines the abdomen and covers most of the organs in the abdomen.

Many people with malignant mesothelioma have worked or lived in places where they inhaled or swallowed asbestos. After being exposed to asbestos, it usually takes a long time for malignant mesothelioma to form. Other risk factors for malignant mesothelioma include:

  • Living with a person who works near asbestos.
  • Being exposed to a certain virus.

Visit the National Cancer Institute where this information and more can be found about Mesothelioma or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el cáncer del mesotelioma maligno en español.

Treatment Options

The treatment options for liver cancer include: surgery, ablation (this procedure uses high-frequency electric current to heat and destroy the cancer cells), embolization (this procedure involves the injection of substances to try to block or reduce the blood flow to cancer cells in the liver), targeted therapy, radiation therapy and chemotherapy.

Surgery

Surgery is an option for people with an early stage of liver cancer. The surgeon may remove the whole liver (transplant) or only the part that has cancer (hepatectomy). If the whole liver is removed, it's replaced with healthy liver tissue from a donor.

Removal of part of the liver:

As much as 80 percent of the liver may be removed. The surgeon leaves behind normal liver tissue. The remaining healthy tissue takes over the work of the liver. Also, the liver can regrow the missing part. The new cells grow over several weeks.

Liver transplant:

  • A liver transplant is an option if the tumors are small, the disease has not spread outside the liver, and suitable donated liver tissue can be found. Donated liver tissue comes from a deceased person or a live donor. If the donor is living, the tissue is part of a liver, rather than a whole liver.
  • When healthy liver tissue from a donor is available, the transplant surgeon removes your entire liver (total hepatectomy) and replaces it with the donated tissue.

Ablation

Methods of ablation destroy the cancer in the liver. They may be used for people waiting for a liver transplant. Or they may be used for people who can't have surgery or a liver transplant. Surgery to remove the tumor may not be possible because of cirrhosis or other conditions that cause poor liver function, the location of the tumor within the liver, or other health problems.

Methods of ablation include the following:

  • Radiofrequency ablation: The doctor uses a special probe that contains tiny electrodes to kill the cancer cells with heat.
  • Percutaneous ethanol injection: The doctor uses ultrasound to guide a thin needle into the liver tumor. Alcohol (ethanol) is injected directly into the tumor and kills cancer cells. The procedure may be performed once or twice a week. Usually local anesthesia is used, but if you have many tumors in the liver, general anesthesia may be needed.

Embolization

For those who can't have surgery or a liver transplant, embolization or chemoembolization may be an option. The doctor inserts a tiny catheter into an artery in your leg and moves the catheter into the hepatic artery.

For embolization, the doctor injects tiny sponges or other particles into the catheter. The particles block the flow of blood through the artery. Depending on the type of particles used, the blockage may be temporary or permanent.

Without blood flow from the hepatic artery, the tumor dies. Although the hepatic artery is blocked, healthy liver tissue continues to receive blood from the hepatic portal vein.

For chemoembolization, the doctor injects an anticancer drug (chemotherapy) into the artery before injecting the tiny particles that block blood flow. Without blood flow, the drug stays in the liver longer.

Targeted Therapy

People with liver cancer who can't have surgery or a liver transplant may receive a drug called targeted therapy. Sorafenib (Nexavar) tablets were the first targeted therapy approved for liver cancer.

Targeted therapy slows the growth of liver tumors. It also reduces their blood supply. The drug is taken by mouth.

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. It may be an option for a few people who can't have surgery. Sometimes it's used with other approaches. Radiation therapy also may be used to help relieve pain from liver cancer that has spread to the bones.

Doctors use two types of radiation therapy to treat liver cancer:

  • External radiation therapy: The radiation comes from a large machine. The machine aims beams of radiation at the chest and abdomen.
  • Internal radiation therapy: The radiation comes from tiny radioactive spheres. A doctor uses a catheter to inject the tiny spheres into your hepatic artery. The spheres destroy the blood supply to the liver tumor.

Chemotherapy

Chemotherapy, the use of drugs to kill cancer cells, is sometimes used to treat liver cancer. Drugs are usually given by vein (intravenous). The drugs enter the bloodstream and travel throughout your body.

Staging

If liver cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is an attempt to find out whether the cancer has spread, and if so, to what parts of the body.

Stage I

There is one tumor and it has not spread to nearby blood vessels.

Stage II

During this stage either:

  • One tumor that has spread to nearby blood vessels; or
  • More than one tumor, none of which is larger than 5 centimeters.

Stage III

Divided into stages IIIA, IIIB, and IIIC:

  • Stage IIIA - one of the following is found: more than one tumor larger than 5 centimeters; or one tumor that has spread to a major branch of blood vessels near the liver.
  • Stage IIIB - there are one or more tumors of any size that have either: spread to nearby organs other than the gallbladder; or broken through the lining of the peritoneal cavity.
  • Stage IIIC - the cancer has spread to nearby lymph nodes.

Stage IV

Cancer has spread beyond the liver to other places in the body, such as the bones or lungs. The tumors may be of any size and may also have spread to nearby blood vessels and/or lymph nodes.

When liver cancer spreads, the cancer cells may be found in the lungs. Cancer cells also may be found in the bones and in lymph nodes near the liver.

When cancer spreads from its original place 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 liver cancer spreads to the bones, the cancer cells in the bones are actually liver cancer cells. The disease is metastatic liver cancer, not bone cancer. It's treated as liver cancer, not bone cancer. Doctors sometimes call the new tumor "distant" or metastatic disease.

To learn whether the liver cancer has spread, your doctor may order one or more of the following tests:

  • CT scan of the chest: A CT scan often can show whether liver cancer has spread to the lungs.
  • Bone scan: The doctor injects a small amount of a radioactive substance into your blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones. The pictures may show cancer that has spread to the bones.
  • PET scan: You receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan shows whether liver cancer may have spread.

Diagnosis

If you have symptoms that suggest liver cancer, your doctor will try to find out what's causing the problems. You may have one or more of the following tests:

  • Physical exam: Your doctor feels your abdomen to check the liver, spleen, and other nearby organs for any lumps or changes in their shape or size. Your doctor also checks for ascites, an abnormal buildup of fluid in the abdomen. Also, your skin and eyes may be checked for signs of jaundice.
     
  • Blood tests: Many blood tests may be used to check for liver problems. One blood test detects alpha-fetoprotein (AFP). High AFP levels could be a sign of liver cancer. Other blood tests can show how well the liver is working.
     
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your liver and other organs and blood vessels in your abdomen. You may receive an injection of contrast material so that your liver shows up clearly in the pictures. On the CT scan, your doctor may see tumors in the liver or elsewhere in the abdomen.
     
  • MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of areas inside your body. Sometimes contrast material makes abnormal areas show up more clearly on the picture.
     
  • Ultrasound test: The ultrasound device uses sound waves that can't be heard by humans. The sound waves produce a pattern of echoes as they bounce off internal organs. The echoes create a picture (sonogram) of your liver and other organs in the abdomen. Tumors may produce echoes that are different from the echoes made by healthy tissues.

Liver Cancer

Liver cancer is the fifth most common type of cancer among men, and ninth most common type of cancer among women. Around 28,000 Americans are diagnosed with liver cancer every year.

Risk factors for developing liver cancer include:

  • Having hepatitis B and/or hepatitis C.
  • Having a close relative with both hepatitis B and liver cancer.
  • Having cirrhosis.
  • Eating foods tainted with aflatoxin (poison from a fungus that can grow on foods, such as grains and nuts, that have not been stored properly).
  • Obesity.

If you experience any of the following symptoms, you should contact your physician

  • Hard lump on the right side just below the rib cage.
  • Discomfort in the upper abdomen on the right side.
  • Pain around the right shoulder blade.
  • Unexplained weight loss.
  • Jaundice (yellowing of the skin and whites of the eyes).
  • Unusual tiredness.
  • Nausea.
  • Loss of appetite.

Visit the National Cancer Institute where this information and more can be found about Liver Cancer or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el cáncer de hígado en español. 

My Care Plus - Patient Portal

 

Access your medical records online

Virginia Cancer Specialists is pleased to offer you secure, instant access to information about your diagnosis, medications, lab results and more.


We are United in Healing with the US Oncology Network, part of McKesson Specialty Health (MSH). As our partner in the delivery of exceptional community-based cancer care, MSH is helping make secure access to your health records available in a convenient and easy-to-access online format.

Enroll today

To ensure your privacy and the security of your medical records we’re asking our patients to enroll when you are in the clinic. Simply tell our staff you’re interested, and we’ll help you get started.

Already a member?

After you have completed the following steps, you can access your account by visiting https://www.mycareplusonline.com.

1.  Visit a clinic and sign a waiver form giving us permission to provide you access to your health information via the internet.
2.  Receive an email (usually within 48 hours of visiting the clinic) and follow the instructions to create your online account.
3.  Keep your password and login information. If you’ve lost it, visit the site and use the “forgot password” or “forgot username” links to recover them.

Still having trouble?

If you are experiencing technical issues or have questions regarding the content on this site, please contact the My Care Plus site administrator toll free at 1-855-887-6788.

Click here to view our Patient Portal Guide.

Click here to view our Patient Portal Brochure.

Click here to view our Patient Portal Authorization Form.

Chemotherapy Classes

Our chemotherapy classes are designed for patients beginning chemotherapy and their caregivers. Our goal is to provide the information necessary to understand how chemotherapy affects the body and to assist in understanding how to manage the side effects that can accompany chemotherapy treatment.

Donna Hafner, Patient Educator

Chemotherapy classes are taught by our Patient Educator, Donna Hafner, who is a certified Advanced Oncology Clinical Nurse Specialist.  These classes are general teaching sessions that are designed to help patients and support persons learn about chemotherapy treatment and how to manage potential side effects that can be associated with chemotherapy treatment.  Topics that will be covered in class include:
 
•  Preparing for your treatment day 
•  Blood counts 
•  Infection 
•  Anemia 
•  Bleeding 
•  Fatigue 
•  Nutrition during treatment 
•  Appetite changes 
•  Nausea and vomiting 
•  Mouth and throat changes 
•  Constipation 
•  Diarrhea 
•  Hair loss 
•  Skin and nail changes 
•  Reproductive and sexual changes
•  Nervous system changes

 

If you are interested in joining us for a class, please contact your Oncology Nurse Navigator to be scheduled for a class.

Click here to view the class brochure.

Classes are held at:

Alexandria Office 
4660 Kenmore Ave., Suite 1018
Alexandria, VA 22304 
(571) 483-1800  
Every other Friday 9:00am - 11:00am

Arlington Office 
1701 N. George Mason Dr, Suite G101
Arlington, VA 22205 
(703) 894-3800
Wednesdays 9:00am - 11:00am

Fairfax Office (Administrative Office)
3040 Williams Dr, Suite 100
Fairfax, VA 22031 
(703) 280-5390
Tuesdays 9:00am - 11:00am

Gainesville Office  
7901 Lake Manassas Dr
Gainesville, VA 20155 
(571) 222-2200
Thursdays 9:00am - 11:00am

Loudoun Office 
44035 Riverside Pkwy., Suite 300
Leesburg, VA 20176 
(703) 554-6800
Mondays 9:00am - 11:00am 

Woodbridge Office 
2280 Opitz Blvd., Suite 300
Woodbridge, VA 22191 
(703) 986-1600
Every other Thursday 1:00pm - 3:00pm  

Dates and times are subject to change.  Patients may bring one caregiver to class with them.  Please consult with your Nurse Navigator to confirm class information, and see our Practice Calendar for general dates and other events.

Treatment Options

Treatment options for people with cancer of the pancreas are surgery, chemotherapy, targeted therapy, and radiation therapy. You’ll probably receive more than one type of treatment.

The treatment that’s right for you depends mainly on the following:

  • The location of the tumor in your pancreas
  • Whether the disease has spread
  • Your age and general health

At this time, cancer of the pancreas can be cured only when it’s found at an early stage (before it has spread) and only if surgery can completely remove the tumor. For people who can’t have surgery, other treatments may be able to help them live longer and feel better.

You may have a team of specialists to help plan your treatment. Specialists who treat cancer of the pancreas include surgeons, medical oncologists, radiation oncologists, and gastroenterologists.

Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type and extent of treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.

Surgery

Surgery may be an option for people with an early stage of pancreatic cancer. The surgeon usually removes only the part of the pancreas that has cancer. But, in some cases, the whole pancreas may be removed.

The type of surgery depends on the location of the tumor in the pancreas. Surgery to remove a tumor in the head of the pancreas is called a Whipple procedure. The Whipple procedure is the most common type of surgery for pancreatic cancer. You and your surgeon may talk about the types of surgery and which may be right for you.

In addition to part or all of your pancreas, the surgeon usually removes the following nearby tissues:

  • Duodenum
  • Gallbladder
  • Common bile duct
  • Part of your stomach

Also, the surgeon may remove your spleen and nearby lymph nodes.

Surgery for pancreatic cancer is a major operation. You will need to stay in the hospital for one to two weeks afterward. Your health care team will watch for signs of bleeding, infection, or other problems. It takes time to heal after surgery, and the time needed to recover is different for each person. You may have pain or discomfort for the first few days. It’s common to feel weak or tired for a while. You may need to rest at home for one to three months after leaving the hospital.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Most people with pancreatic cancer get chemotherapy. For early pancreatic cancer, chemotherapy is usually given after surgery, but in some cases, it’s given before surgery. For advanced cancer, chemotherapy is used alone, with targeted therapy, or with radiation therapy.

Chemotherapy for pancreatic cancer is usually given by vein (intravenous). The drugs enter the bloodstream and travel throughout your body. Chemotherapy is given in cycles. Each treatment period is followed by a rest period. The length of the rest period and the number of cycles depend on the anticancer drugs used.

Some drugs used for pancreatic cancer also may cause tingling or numbness in your hands and feet.

Targeted Therapy

People with cancer of the pancreas who can’t have surgery may receive a type of drug called targeted therapy along with chemotherapy.

Targeted therapy slows the growth of pancreatic cancer. It also helps prevent cancer cells from spreading. The drug is taken by mouth.

Side effects may include diarrhea, nausea, vomiting, a rash, and shortness of breath.

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. It can be given along with other treatments, including chemotherapy.

The radiation comes from a large machine. The machine aims beams of radiation at the cancer in the abdomen. You’ll go to a hospital or clinic 5 days a week for several weeks to receive radiation therapy. Each session takes about 30 minutes.

Although radiation therapy is painless, it may cause other side effects. The side effects include nausea, vomiting, or diarrhea. You may also feel very tired.

Staging

Staging is a careful attempt to find out the following:

  • The size of the tumor in the pancreas
  • Whether the tumor has invaded nearby tissues
  • Whether the cancer has spread, and if so, to what parts of the body

When cancer of the pancreas spreads, the cancer cells may be found in nearby lymph nodes or the liver. Cancer cells may also be found in the lungs or in fluid collected from the abdomen.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original (primary) tumor. For example, if pancreatic cancer spreads to the liver, the cancer cells in the liver are actually pancreatic cancer cells. The disease is metastatic pancreatic cancer, not liver cancer. It’s treated as pancreatic cancer, not as liver cancer. Doctors sometimes call the new tumor in the liver “distant” disease.

To learn whether pancreatic cancer has spread, your doctor may order CT scans or EUS.

Also, a surgeon may look inside your abdomen with a laparoscope (a thin, tube-like device that has a light and a lens for seeing inside the body). The surgeon inserts the laparoscope through a small incision in your belly button. The surgeon will look for any signs of cancer inside your abdomen. You’ll need general anesthesia for this exam.

These are the stages of cancer of the pancreas:

  • Stage I: The tumor is found only in the pancreas.
  • Stage II: The tumor has invaded nearby tissue but not nearby blood vessels. The cancer may have spread to the lymph nodes.
  • Stage III: The tumor has invaded nearby blood vessels.
  • Stage IV: The cancer has spread to a distant organ, such as the liver or lungs.

Diagnosis

If you have symptoms that suggest cancer of the pancreas, your doctor will try to find out what’s causing the problems. You may have blood or other lab tests. Also, you may have one or more of the following tests:

  • Physical exam: Your doctor feels your abdomen to check for changes in areas near the pancreas, liver, gallbladder, and spleen. Your doctor also checks for an abnormal buildup of fluid in the abdomen. Also, your skin and eyes may be checked for signs of jaundice.
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your pancreas, nearby organs, and blood vessels in your abdomen. You may receive an injection of contrast material so your pancreas shows up clearly in the pictures. Also, you may be asked to drink water so your stomach and duodenum show up better. On the CT scan, your doctor may see a tumor in the pancreas or elsewhere in the abdomen.
  • Ultrasound: Your doctor places the ultrasound device on your abdomen and slowly moves it around. The ultrasound device uses sound waves that can’t be heard by humans. The sound waves make a pattern of echoes as they bounce off internal organs. The echoes create a picture of your pancreas and other organs in the abdomen. The picture may show a tumor or blocked ducts.
  • EUS: Your doctor passes a thin, lighted tube (endoscope) down your throat, through your stomach, and into the first part of the small intestine. An ultrasound probe at the end of the tube sends out sound waves that you can’t hear. The waves bounce off tissues in your pancreas and other organs. As your doctor slowly withdraws the probe from the intestine toward the stomach, the computer creates a picture of the pancreas from the echoes. The picture can show a tumor in the pancreas. It can also show how deeply the cancer has invaded the blood vessels.

Some doctors use the following tests also:

  • ERCP: The doctor passes an endoscope through your mouth and stomach, down into the first part of your small intestine. Your doctor slips a smaller tube through the endoscope into the bile ducts and pancreatic ducts. (See picture of ducts.) After injecting dye through the smaller tube into the ducts, the doctor takes x-ray pictures. The x-rays can show whether the ducts are narrowed or blocked by a tumor or other condition.
  • MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of areas inside your body.
  • PET scan: You’ll receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan may show a tumor in the pancreas. It can also show cancer that has spread to other parts of the body.
  • Needle biopsy: The doctor uses a thin needle to remove a small sample of tissue from the pancreas. EUS or CT may be used to guide the needle. A pathologist uses a microscope to look for cancer cells in the tissue.

If cancer of the pancreas is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment.

Pancreatic Cancer

There are two main types of pancreatic cancer.

Most often, pancreatic cancer starts in the ducts that carry pancreatic juices. This type is called exocrine pancreatic cancer. Information will focus on this type of pancreatic cancer.

Much less often, pancreatic cancer begins in the cells that make hormones. This type may be called endocrine pancreatic cancer or islet cell cancer.

Each year in the United States, more than 43,000 people are diagnosed with cancer of the pancreas. Most are over 65 years old. Visit the National Cancer Institute where this information and more can be found about Pancreatic Cancer or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el cáncer de páncreas en español.

Treatment Options

People with early oral cancer may be treated with surgery or radiation therapy. People with advanced oral cancer may have a combination of treatments. For example, radiation therapy and chemotherapy are often given at the same time. Another treatment option is targeted therapy.

The choice of treatment depends mainly on your general health, where in your mouth or throat the cancer began, the size of the tumor, and whether the cancer has spread.
 
Surgery
 
Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be removed as well. You may have surgery alone or in combination with radiation therapy.
 
Also, surgery may cause tissues in your face to swell. This swelling usually goes away within a few weeks. However, removing lymph nodes can result in swelling that lasts a long time.
 
Radiation Therapy
 
Radiation therapy uses high-energy rays to kill cancer cells. It’s an option for small tumors or for people who can’t have surgery. Or, it may be used before surgery to shrink the tumor. It also may be used after surgery to destroy cancer cells that may remain in the area.
 
Doctors use two types of radiation therapy to treat oral cancer. Some people with oral cancer have both types:
  • External radiation therapy: The radiation comes from a machine. Some treatment centers offer IMRT, which uses a computer to more closely target the oral tumor to lessen the damage to healthy tissue. You may go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks. Each treatment takes only a few minutes.
  • Internal radiation therapy (implant radiation therapy or brachytherapy): Internal radiation therapy isn’t commonly used for oral cancer. The radiation comes from radioactive material in seeds, wires, or tubes put directly in the mouth or throat tissue. You may need to stay in the hospital for several days. Usually the radioactive material is removed before you go home.
Chemotherapy
 
Chemotherapy uses drugs to kill cancer cells. The drugs that treat oral cancer are usually given through a vein (intravenous). The drugs enter the bloodstream and travel throughout your body. Chemotherapy and radiation therapy are often given at the same time.
 
Targeted Therapy
 
Some people with oral cancer receive a type of drug known as targeted therapy. It may be given along with radiation therapy or chemotherapy.
 
Cetuximab (Erbitux) was the first targeted therapy approved for oral cancer. Cetuximab binds to oral cancer cells and interferes with cancer cell growth and the spread of cancer. You may receive cetuximab through a vein once a week for several weeks at the clinic.

Staging

If oral cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. When oral cancer spreads, cancer cells may be found in the lymph nodes in the neck or in other tissues of the neck. Cancer cells can also spread to the lungs, liver, bones, and other parts of the body.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells as the primary (original) tumor. For example, if oral cancer spreads to the lungs, the cancer cells in the lungs are actually oral cancer cells. The disease is called metastatic oral cancer, not lung cancer. It’s treated as oral cancer, not lung cancer. Doctors sometimes call the new tumor “distant” or metastatic disease.
 
Your doctor may order one or more of the following tests:
 
  • X-rays: An x-ray of your entire mouth can show whether cancer has spread to the jaw. Images of your chest and lungs can show whether cancer has spread to these areas.
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your body. You may receive an injection of dye. Tumors in your mouth, throat, neck, lungs, or elsewhere in the body can show up on the CT scan.
  • MRI: A powerful magnet linked to a computer is used to make detailed pictures of your body. An MRI can show whether oral cancer has spread.
  • Endoscopy: The doctor uses a thin, lighted tube (endoscope) to check your throat, windpipe, and lungs. The doctor inserts the endoscope through your nose or mouth. Local anesthesia is used to ease your discomfort and prevent you from gagging. Some people also may be given a mild sedative. Sometimes the doctor uses general anesthesia to put a person to sleep. This exam may be done in a doctor’s office, an outpatient clinic, or a hospital.
  • PET scan: You receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan shows whether oral cancer may have spread.
Doctors describe the stage of oral cancer based on the size of the tumor, whether it has invaded nearby tissues, and whether it has spread to the lymph nodes or other tissues:
 
  • Early cancer: Stage I or II oral cancer is usually a small tumor (smaller than a walnut), and no cancer cells are found in the lymph nodes.
  • Advanced cancer: Stage III or IV oral cancer is usually a large tumor (as big as a lime). The cancer may have invaded nearby tissues or spread to lymph nodes or other parts of the body.

Diagnosis

If you have symptoms that suggest oral cancer, your doctor or dentist will check your mouth and throat for red or white patches, lumps, swelling, or other problems. A physical exam includes looking carefully at the roof of your mouth, back of your throat, and insides of your cheeks and lips. The floor of your mouth and lymph nodes in your neck will also be checked.

An ear, nose, and throat specialist can see the back of your nose, tongue, and throat by using a small, long-handled mirror or a lighted tube. Sometimes pictures need to be made with a CT scan or MRI to find a hidden tumor. (The Staging section describes imaging tests.)

The removal of a small piece of tissue to look for cancer cells is called a biopsy. Usually, a biopsy is done with local anesthesia. Sometimes, it’s done under general anesthesia. A pathologist then looks at the tissue under a microscope to check for cancer cells. A biopsy is the only sure way to know if the abnormal area is cancer.

Oral Cancer

Cancer that forms in tissues of the oral cavity (the mouth) or the oropharynx (the part of the throat at the back of the mouth).

This includes areas under the tongue

  • Lips
  • Gums and teeth
  • Tongue
  • Lining of your cheeks
  • Salivary glands (glands that make saliva)
  • Floor of your mouth (area under the tongue

This includes areas of the throat

  • Roof of your mouth (hard palate)
  • Soft palate
  • Uvula
  • Oropharynx
  • Tonsils

Visit the National Cancer Institute where this information and more can be found about Oral Cancer or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el cáncer oral en español.

Treatment Options

Common treatment options for people with kidney cancer are surgery, targeted therapy, and biological therapy. You may receive more than one type of treatment.

The treatment that’s right for you depends mainly on the following:

  • The size of the tumor
  • Whether the tumor has invaded tissues outside the kidney
  • Whether the tumor has spread to other parts of the body
  • Your age and general health

Surgery

Surgery is the most common treatment for people with kidney cancer. The type of surgery depends on the size and stage of the cancer, whether you have two kidneys, and whether cancer was found in both kidneys.

You and your surgeon can talk about the types of surgery and which may be right for you:

  • Removing all of the kidney (radical nephrectomy): The surgeon removes the entire kidney along with the adrenal gland and some tissue around the kidney. Some lymph nodes in the area may also be removed.
  • Removing part of the kidney (partial nephrectomy): The surgeon removes only the part of the kidney that contains the tumor. People with a kidney tumor that is smaller than a tennis ball may choose this type of surgery.

There are two approaches for removing the kidney. The surgeon may remove the tumor by making a large incision into your body (open surgery). Or the surgeon may remove the tumor by making small incisions (laparoscopic surgery). The surgeon sees inside your abdomen with a thin, lighted tube (a laparoscope) placed inside a small incision.

The surgeon may use other methods of destroying the cancer in the kidney. For people who have a tumor smaller than 4 centimeters and who can’t have surgery to remove part of the kidney because of other health problems, the surgeon may suggest:

  • Cryosurgery: The surgeon inserts a tool through a small incision or directly through the skin into the tumor. The tool freezes and kills the kidney tumor.
  • Radiofrequency ablation: The surgeon inserts a special probe directly through the skin or through a small incision into the tumor. The probe contains tiny electrodes that kill the kidney cancer cells with heat.

Targeted Therapy

People with kidney cancer that has spread may receive a type of drug called targeted therapy. Many kinds of targeted therapy are used for kidney cancer. This treatment may shrink a kidney tumor or slow its growth.Usually, the targeted therapy is taken by mouth. You may want to read the NCI fact sheet Targeted Cancer Therapies.

Biological Therapy

People with kidney cancer that has spread may receive biological therapy. Biological therapy for kidney cancer is a treatment that may improve the body’s natural defense (the immune system response) against cancer. The treatments used for kidney cancer can slow the growth of tumors or shrink them. The biological therapy is injected intravenously or under the skin. The treatment may be given at the hospital or a doctor’s office.

Staging

If kidney cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. The stage is based on the size of the kidney tumor and whether the cancer has invaded nearby tissues or spread to other parts of the body.

Your doctor may order one or more tests:

  • Blood tests: Your doctor can check for substances in your blood. Some people with kidney cancer have high levels of calcium or LDH. A blood test can also show how well your liver is working.
  • Chest x-ray: An x-ray of the chest can show a tumor in your lung.
  • CT scan: CT scans of your chest and abdomen can show cancer in your lymph nodes, lungs, or elsewhere.
  • MRIMRI can show cancer in your blood vessels, lymph nodes, or other tissues in the abdomen.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if kidney cancer spreads to a lung, the cancer cells in the lung are actually kidney cancer cells. The disease is metastatic kidney cancer, not lung cancer. It’s treated as kidney cancer, not as lung cancer.

These are the stages of kidney cancer:

  • Stage I: The tumor is no bigger than a tennis ball (almost 3 inches or about 7 centimeters). Cancer cells are found only in the kidney.
  • Stage II: The tumor is bigger than a tennis ball. But cancer cells are found only in the kidney.
  • Stage III: The tumor can be any size. It has spread to at least one nearby lymph node. Or it has grown through the kidney to reach nearby blood vessels.
  • Stage IV: The tumor has grown through the layer of fatty tissue and the outer layer of fibrous tissue that surrounds the kidney. Or cancer cells have spread to nearby lymph nodes or to the lungs, liver, bones, or other tissues.

Diagnosis

If you have symptoms that suggest kidney cancer, your doctor will try to find out what’s causing the problems.

You may have a physical exam. Also, you may have one or more of the following tests:

  • Urine tests: The lab checks your urine for blood and other signs of disease.
  • Blood tests: The lab checks your blood for several substances, such as creatinine. A high level of creatinine may mean the kidneys aren’t doing their job.
  • Ultrasound: An ultrasound device uses sound waves that can’t be heard by humans. The sound waves make a pattern of echoes as they bounce off organs inside your abdomen. The echoes create a picture of your kidney and nearby tissues. The picture can show a kidney tumor.
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your abdomen. You may receive an injection of contrast material so your urinary tract and lymph nodes show up clearly in the pictures. The CT scan can show cancer in the kidneys, lymph nodes, or elsewhere in the abdomen.
  • MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of your urinary tract and lymph nodes. You may receive an injection of contrast material. MRI can show cancer in your kidneys, lymph nodes, or other tissues in the abdomen.
  • IVP: You’ll receive an injection of dye into a vein in your arm. The dye travels through the body and collects in your kidneys. The dye makes them show up on x-rays. A series of x-rays then tracks the dye as it moves through your kidneys to your ureters and bladder. The x-rays can show a kidney tumor or other problems. (IVP is not used as commonly as CT or MRI for the detection of kidney cancer.)
  • Biopsy: The removal of tissue to look for cancer cells is a biopsy. In some cases, your doctor will do a biopsy to diagnose kidney cancer. Your doctor inserts a thin needle through your skin into the kidney to remove a small sample of tissue. Your doctor may use ultrasound or a CT scan to guide the needle. A pathologist uses a microscope to check for cancer cells in the tissue.
  • Surgery: After surgery to remove part or all of a kidney tumor, a pathologist can make the final diagnosis by checking the tissue under a microscope for cancer cells.

Kidney Cancer

Kidney cancer is a cancer that forms in tissues of the kidneys. Kidney cancer includes renal cell carcinoma (cancer that forms in the lining of very small tubes in the kidney that filter the blood and remove waste products) and renal pelvis carcinoma (cancer that forms in the center of the kidney where urine collects). It also includes Wilms tumor, which is a type of kidney cancer that usually develops in children under the age of 5.

Visit the National Cancer Institute where this information and more can be found about Kidney Cancer or ask your cancer care team questions about your individual situation.

Treatment Options

Treatment options for people with uterine cancer are surgery, radiation therapy, chemotherapy, and hormone therapy. You may receive more than one type of treatment.

Surgery

Surgery is the most common treatment for women with uterine cancer. You and your surgeon can talk about the types of surgery (hysterectomy) and which may be right for you.

The surgeon usually removes the uterus, cervix, and nearby tissues. The nearby tissues may include:

  • Ovaries
  • Fallopian tubes
  • Nearby lymph nodes
  • Part of the vagina

Surgery to remove lymph nodes may cause lymphedema (swelling) in one or both legs. Your health care team can tell you how to prevent or relieve lymphedema.

Radiation Therapy

Radiation therapy is an option for women with all stages of uterine cancer. It may be used before or after surgery. For women who can’t have surgery for other medical reasons, radiation therapy may be used instead to destroy cancer cells in the uterus. Women with cancer that invades tissue beyond the uterus may have radiation therapy and chemotherapy.

Radiation therapy uses high-energy rays to kill cancer cells. It affects cells in the treated area only.

Doctors use two types of radiation therapy to treat uterine cancer. Some women receive both types:

  • External radiation therapy: A large machine directs radiation at your pelvis or other areas with cancer. The treatment is usually given in a hospital or clinic. You may receive external radiation 5 days a week for several weeks. Each session takes only a few minutes.
  • Internal radiation therapy(also called brachytherapy): A narrow cylinder is placed inside your vagina, and a radioactive substance is loaded into the cylinder. This common method of brachytherapy may be repeated two or more times over several weeks. Once the radioactive substance is removed, no radioactivity is left in the body.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It may be used after surgery to treat uterine cancer that has an increased risk of returning after treatment. For example, uterine cancer that is a high grade or is Stage II, III, or IV may be more likely to return. Also, chemotherapy may be given to women whose uterine cancer can’t be completely removed by surgery. For advanced cancer, it may be used alone or with radiation therapy.

Chemotherapy for uterine cancer is usually given by vein (intravenous). It’s usually given in cycles. Each cycle has a treatment period followed by a rest period.

Hormone Therapy

Some uterine tumors need hormones to grow. These tumors have hormone receptors for the hormones estrogen, progesterone, or both. If lab tests show that the tumor in your uterus has these receptors, then hormone therapy may be an option.

Hormone therapy may be used for women with advanced uterine cancer. Also, some women with Stage I uterine cancer who want to get pregnant and have children choose hormone therapy instead of surgery.The most common drug used for hormone therapy is progesterone tablets.

Diagnosis

If you have symptoms that suggest uterine cancer, your doctor will try to find out what’s causing the problems. You may have a physical exam and blood tests. Also, you may have one or more of the following tests:

  • Pelvic exam: Your doctor can check your uterus, vagina, and nearby tissues for any lumps or changes in shape or size.
  • Ultrasound: An ultrasound device uses sound waves that can’t be heard by humans. The sound waves make a pattern of echoes as they bounce off organs inside the pelvis. The echoes create a picture of your uterus and nearby tissues. The picture can show a uterine tumor. For a better view of the uterus, the device may be inserted into the vagina (transvaginal ultrasound).
  • Biopsy: The removal of tissue to look for cancer cells is a biopsy. A thin tube is inserted through the vagina into your uterus. Your doctor uses gentle scraping and suction to remove samples of tissue. A pathologist examines the tissue under a microscope to check for cancer cells. In most cases, a biopsy is the only sure way to tell whether cancer is present.

Grade

If cancer is found, the pathologist studies tissue samples from the uterus under a microscope to learn the grade of the tumor. The grade tells how much the tumor tissue differs from normal uterine tissue. It may suggest how fast the tumor is likely to grow. Tumors with higher grades tend to grow faster than those with lower grades. Tumors with higher grades are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.

Staging

If uterine cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. The stage is based on whether the cancer has invaded nearby tissues or spread to other parts of the body.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if uterine cancer spreads to the lung, the cancer cells in the lung are actually uterine cancer cells. The disease is metastatic uterine cancer, not lung cancer. It’s treated as uterine cancer, not as lung cancer. Doctors sometimes call the new tumor “distant” disease.

To learn whether uterine cancer has spread, your doctor may order one or more tests:

  • Lab tests: A Pap test can show whether cancer cells have spread to the cervix, and blood tests can show how well the liver and kidneys are working. Also, your doctor may order a blood test for a substance known as CA-125. Cancer may cause a high level of CA-125.
  • Chest x-ray: An x-ray of the chest can show a tumor in the lung.
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your pelvis, abdomen, or chest.
  • MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of your uterus and lymph nodes.

In most cases, surgery is needed to learn the stage of uterine cancer. The surgeon removes the uterus and may take tissue samples from the pelvis and abdomen. After the uterus is removed, it is checked to see how deeply the tumor has grown. Also, the other tissue samples are checked for cancer cells.

These are the stages of uterine cancer:

  • Stage 0: The abnormal cells are found only on the surface of the inner lining of the uterus. The doctor may call this carcinoma in situ.
  • Stage I: The tumor has grown through the inner lining of the uterus to the endometrium. It may have invaded the myometrium.
  • Stage II: The tumor has invaded the cervix.
  • Stage III: The tumor has grown through the uterus to reach nearby tissues, such as the vagina or a lymph node.
  • Stage IV: The tumor has invaded the bladder or intestine. Or, cancer cells have spread to parts of the body far away from the uterus, such as the liver, lungs, or bones.

Endometrial Cancer

Endometrial cancer is a cancer that forms in the tissue lining the uterus (the small, hollow, pear-shaped organ in a woman’s pelvis in which a fetus develops). Most endometrial cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

Visit the National Cancer Institute where this information and more can be found about Endometrial Cancer including side effects of treatments, support information and more. Or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el cáncer de endometrio en español.

Nurse Practitioners & Physician Assistants

Locations

Out-Patient – Fairfax Stem Cell Transplant Program
8503 Arlington Blvd. Suite 400
Fairfax, VA 22031
(703) 208-9202 

 
Main Phone Number
(703) 208-9202

Main Fax Number
(703) 208-9284

After Hours Emergency Number  (5 p.m. to 9 a.m.)
(703) 280-5390

Out-Patient Transplant Manager & Nurse Practitioner
Katherina Sampl, RN, MSN, AOCNP
(703) 208-3179

Appointments/Scheduling Requests and Questions
Sharon Eubanks
(703) 208-9202

Prescription/Sick Calls/Illness Questions
Nursing Station
(703) 208-3109

Benefit Specialist
Kristine Jacks
(540) 351-1618

In-Patient – Inova Fairfax Hospital
3300 Gallows Rd.
Falls Church, VA 22042
(703) 970-3178  

Main Phone Number
(703) 776-4001

Main Fax Number
(703) 970-3179

Apheresis Clinic
(703) 776-2610

Emergency Room
(703) 776-3116

In-Patient Transplant Coordinator
Donna Eichna, MSN, RN, ACNS-BC, OCN
(703) 970-3178 

Transplant Team

The Fairfax Stem Cell Transplant Program is committed to your health care needs. Our goal is to make this experience as comfortable for you as possible, so please do not hesitate in contacting us at any time, regardless of where you are on your path to survivorship.

Primary Oncologist

Your primary oncologist has been caring for you and has referred you to the Transplant Program and will continue to follow your progress, even if he/she is not directly involved in your care.

Transplant Physician

The transplant physician closely monitors all aspects of your care, including any instances where you have to be hospitalized. Your transplant physician may or may not be the oncologist who has been treating your cancer up until this point. If not, your transplant physician will keep your primary oncologist informed of your progress.

Surgeon

Your transplant physician may ask a surgeon to insert a special catheter for apheresis or use during your treatment.

Transplant Nurse Coordinators & Nurses

The transplant nurse coordinators and nurses are your primary resource and work with other team members, including your caregiver, making sure your treatment is planned, scheduled, and carried out. They provide education about properly caring for yourself during this process. These inpatient and outpatient nurses have special training and experience in stem cell transplantation.

Benefit Specialist

The benefit specialist works with patients, caregivers, and insurance providers or medical plan representatives to help patients obtain reimbursement for the costs related to transplantation. The benefit specialist will help you understand the cost and reimbursement for your care before treatment begins.

Office Coordinator

The office coordinator schedules the dates and times of your appointments and tests. He/she also helps coordinate the activities of the transplant clinic. Call the office coordinator for any scheduling questions.

Laboratory Staff

The laboratory staff ensures that the proper tests are performed at the proper times and the results are communicated. Laboratory personnel are also involved with the collection, processing, storage, and thawing of your stem cells.

Apheresis Specialist

These are nurses or technicians who operate the apheresis machine which collects your stem cells. They are specially trained in this procedure and know how to take care of you while you are connected to the apheresis machine.

Social Workers

A medical social worker (MSW) is often available to you and your family to help with the feelings you may have as you go through transplant. Your MSW can also help with practical matters such as transportation, housing, disability, and financial concerns, and finding spiritual support.

Transplant & Beyond

Engraftment

Approximately 10-14 days following your transplant, signs that your stem cells are growing (engrafting) and beginning to produce new blood cells are expected. As this starts to occur, you may notice aching in your bones, especially your pelvis, lower back and thighs. As your blood counts begin to rise, your white blood cells will start to fight and prevent infections. Any fevers you may have experienced while your white blood count was low will start to resolve. Other side effects of the chemotherapy will also start to improve. 

Your transplant physician or nurse will let you know when you may stop taking the antibiotics and when other restrictions may be lifted. Remember, however, that it is a good idea to always practice good hand washing no matter what your white blood count is. As your blood counts improve, you will no longer need blood and platelet transfusions and will notice that you do not bruise or bleed as easily. Your fatigue will also start to improve, but keep in mind that your energy levels may take weeks or months to return to normal.

Recovery

Progress during this phase of treatment may seem slow. Keep in mind that the long-term recovery phase may take a year or longer. You may feel frustrated because you want to get well rapidly, but it takes time to recover. Many patients feel depressed at some point during this period. Patients tell us they cope best by taking one day at a time and setting simple, realistic goals for themselves. Community support groups such as the Leukemia Lymphoma Society and Life with Cancer may help. Other recipients of stem cell transplants are also a good source of support. Ask your transplant nurse or physician for names of recipients who are willing to speak with you. 

It is common to continue to feel some fatigue in the later months of your recovery. Despite feeling fatigued, it is important to stay as active as possible. You will need to identify the most important activities for you (in other words, pace yourself). Low impact exercise such as walking may help you regain your energy level. Your primary oncologist will let you know when tests will be done to measure the effects of the chemotherapy and the results of the transplant. Some tests are done on the blood and others will be x-rays or scans. You will have regularly scheduled checkups with your primary oncologist as well as the transplant team to monitor your disease and check for any longterm side effects. 

Re-establishing your life after transplant varies from difficult and rough to relatively easy and smooth. However, the great majority of patients report that the quality of their lives is now the same or better than before transplant. Despite the intensity of the transplant experience, most patients are able to make adjustments in their life and maintain an optimistic outlook for the future. 

General Transplant Information

Thousands of cancer patients undergo stem cell transplants each year, giving them renewed hope for a longer life. 

The Fairfax Stem Cell Transplant Program offers transplant services through a unique partnership between Virginia Cancer Specialists and Inova Fairfax Hosptial.  

Patients who choose the Stem Cell Transplant Program at Fairfax are choosing a team of highly skilled and experienced oncologists, physicians, surgeons and other health professionals. Your team is fluent in the most advanced treatment options and technologies available today for those living with cancer and diseases of the blood.  Our vision is to offer world-class customer service by providing exceptional care and being recognized as leaders in stem cell transplantation and customer satisfaction. 

The Program was founded in 1989 and is one of the few programs in the country to offer comprehensive services in a community setting.  It is the only program in the Washington, D.C. area to offer a Foundation for the Accreditation of Cellular Therapy (FACT) accredited program.  FACT accreditation is the gold standard insurance companies often demand, and it is the benchmark for quality care.  

Genetic Risk Assessment

 

Genetic Risk Assessment

At Virginia Cancer Specialists, we provide advanced and comprehensive medical and support services for people diagnosed with cancer or who have a higher risk of developing cancer. If you are considering genetic testing, it is important to talk with a healthcare team that has received special training for common hereditary cancers and who can help you understand your options.

Through genetic risk assessment, we can help you learn about your inherited risk of developing cancers such as breast, gastrointestinal, uterine/ovarian and others, and help you and your family understand the results if you decide to undergo genetic testing. Furthermore, we will provide you the information you need to make decisions about prevention or treatment options.

As part of our integrated team, our oncologists, nurse practitioners and nurse specialists will provide information and support for you and your family by:

• Educating you about how genetics plays a part in cancer risk;
• Assessing your risk of a genetic disorder by researching your family’s cancer history;
• Discussing the medical, social and ethical impact of genetic testing on you and your family;
• Interpreting genetic testing results and medical data; and
• Explaining possible treatments or preventive measures.

If you are a patient with a Hereditary Risk Assessment scheduled, please fill out these forms prior to your visit.

Frequently Asked Questions

What is genetic testing? 

Today, tests are available that can detect certain gene mutations. Genetic testing can determine if you have or do not have an inherited predisposition that may put you at higher risk of developing cancer in your lifetime.

Why is genetic testing important?

By determining whether a specific gene mutation is responsible for the cancers in a family, genetic testing can reduce the risk of cancer in family members and save lives. Although genetic testing cannot predict whether you will actually develop cancer, understanding your risk of developing the disease can be an important step in making medical and lifestyle decisions that can help prevent cancer or detect cancer early, when it is most treatable.

The benefits of genetic testing include:
  • Opportunity to reduce the risk of cancer and save lives.
  • Early detection, which increases the chance of a successful outcome.
  • Knowledge regarding one's cancer risk can help make medical and lifestyle choices.
  • Information can be shared with family members, so they too can benefit and make choices about their health.
Who should have genetic testing?
  • Any individual diagnosed with cancer prior to age 50
  • Any individual who has developed more than one cancer in their lifetime
  • An individual with 2 or more family members diagnosed with the same cancer
  • Ashkenazi Jewish ancestry and a personal or family history of cancer
  • A family member with an identified gene mutation known to increase risk for cancer
  • Any individual with a rare type of cancer (e.g. pancreas, ovarian, male breast cancer)
What happens during the test?

While the actual test involves a simple blood draw and lab analysis, the pre- and post-consultation with your healthcare team is a key component of your cancer risk assessment. During the pre-test consultation, the health care provider will perform a comprehensive review of your family cancer history, provide a risk assessment and prepare you for the possible outcomes and implications of the genetic test results.

What happens after the test?    

After the test results return from the lab, we will review the results with you and address your cancer risk options, which may include closer medical observation, more frequent monitoring and therapy prevention, among others. Furthermore, as your life/needs change over time, so should your plan.  Therefore, our dedicated team will be with you every step of the way.

Will insurance cover genetic testing?

Genetic testing can range from $300 to over $3000. Most laboratories determine coverage prior to testing and because the pre- and post-consultation is with a physician, most patients do have coverage. Our Benefit Specialists can help with this process and answer any questions you might have regarding coverage. Lastly, federal and state laws protect patient privacy and prohibit health insurance providers from discrimination based on genetic information.

Your Support Team

Our care extends further than just our clinical care. This belief is why we work diligently by providing Benefit Specialists that help you navigate and best plan with your benefits.

Benefit Specialist

Your Benefit Specialist understands how stressful and overwhelming preparing for a transplant can be. Therefore, they are specially trained to investigate and verify transplant benefits and will answer any questions you may have. They will work closely with you and the transplant case manager at your insurance company to assure the entire process runs smoothly. Services provided by your Benefit Specialist

  • Contact your insurance company regarding initial eligibility, coverage and benefits for transplant.
  • Investigate coverage and benefits for donor services on behalf of the donor and patient.
  • Obtain any prior authorizations needed for pre-transplant testing and evaluation.
  • Provide all required documentation necessary for transplant approval.

Insurance/Billing

The Fairfax Stem Cell Transplant Program will work with most major insurance carriers including Medicaid and Medicare. Once the process starts and pre-insurance benefits are verified, you will be provided additional information detailing specific transplant benefits and coverages. Any insurance or billing questions should be directed to the Benefit Specialist.

Benefit Specialist

8503 Arlington Blvd. Suite 400
Fairfax, VA 22031
P (703) 754-8371
F (703) 754-8375

Hours of Operation

8:30 a.m. to 5:00 p.m.
Monday through Friday except on major holidays 

Online Resources

Below is a list of websites you may find helpful.

Life with Cancer®
An array of free services for cancer patients and their families, including information, education and support. Available to all Inova Health System patients.

Blood and Marrow Transplant Information Network
Books, free monthly newsletter, online support network.

NMDP (National Marrow Donor Program)
Donor registry, transplant center directory, patient advocacy groups.

Lymphoma Leukemia Society
Publications, support services, financial aid.

Multiple Myeloma Research Foundation 
Free newsletter, support services, disease information.

Pre-Transplant

Initial Consult

After carefully reviewing all of the characteristics and aspects of your cancer, your transplant physician will determine if you will benefit from high-dose chemotherapy with a peripheral blood stem cell transplant. High-dose chemotherapy can cause life-threatening side effects; therefore, you, your oncologist and your transplant physician must carefully consider the risks and benefits associated with a stem cell transplant. 

During this visit our transplant physician will discuss your cancer status, appropriateness for transplant, and risks and benefits of transplant and provide a general overview of the stem cell transplant process. Our transplant financial counselor will obtain information about your insurance coverage and will investigate your insurance company’s benefits as they relate to stem cell transplant. Knowing the financial arrangements and expected costs of the transplant can help you in the decision making process.

If you decide to pursue transplant as a treatment option, you and your Caregiver will then meet with the transplant nurse coordinator for a more thorough overview of each phase of the transplant process.

Out-Patient vs. In-Patient Transplant

Your transplant physician and nurse coordinator will discuss the option of out-patient versus in-patient transplantation with you. This decision is based on a number of variables, some of which include: 

  • The disease being treated
  • Your overall medical condition/pre-existing medical conditions
  • Availability of a dedicated Caregiver
  • Proximity of your home to the clinic
  • Insurance coverage

 This decision will be made with input from you and your family. You will receive excellent transplant care regardless of whether it is delivered on an out-patient or in-patient basis. The following is a description of each of these treatment choices: 

Out-Patient: As an out-patient, your entire pretransplant evaluation, administration of highdose chemotherapy and reinfusion of your stem cells will take place in the transplant clinic. The collection of your cells will take place at the hospital as an outpatient procedure. During the evaluation process, you can drive yourself to the clinic if you are able to. As you progress further in the transplant process, you will need a Caregiver to drive you to and from the clinic as well as help you with daily activities until you are well enough to start doing things on your own. You will come to the clinic in the morning, stay for most of the day and be able to return home at night. Emergency numbers will be available to you and your Caregiver after clinic hours. 

In-Patient: Certain parts of the evaluation, work-up and collection of your stem cells will take place as an out-patient. You will be admitted to Inova Fairfax Hospital to receive your high-dose chemotherapy and reinfusion of stem cells. You will remain in the hospital for 2-3 weeks following the reinfusion of your stem cells until your blood counts begin to return to normal. After discharge from the hospital, you will return to the out-patient clinic for follow-up visits. 

Your Transplant Physicians

The Fairfax Stem Cell Transplant Program is committed to your health care needs. Our goal is to make this experience as comfortable for you as possible, so please do not hesitate in contacting us at any time, regardless of where you are on your path to survivorship.

Primary Oncologist

Your primary oncologist has been caring for you and has referred you to the Transplant Program and will continue to follow your progress, even if he/she is not directly involved in your care.

Transplant Physician

The transplant physician closely monitors all aspects of your care, including any instances where you have to be hospitalized. Your transplant physician may or may not be the oncologist who has been treating your cancer up until this point. If not, your transplant physician will keep your primary oncologist informed of your progress.

Surgeon

Your transplant physician may ask a surgeon to insert a special catheter for apheresis or use during your treatment.

Transplant Nurse Coordinators & Nurses

The transplant nurse coordinators and nurses are your primary resource and work with other team members, including your caregiver, making sure your treatment is planned, scheduled, and carried out. They provide education about properly caring for yourself during this process. These inpatient and outpatient nurses have special training and experience in stem cell transplantation.

Benefit Specialist

The benefit specialist works with patients, caregivers, and insurance providers or medical plan representatives to help patients obtain reimbursement for the costs related to transplantation. The benefit specialist will help you understand the cost and reimbursement for your care before treatment begins.

Office Coordinator

The office coordinator schedules the dates and times of your appointments and tests. He/she also helps coordinate the activities of the transplant clinic. Call the office coordinator for any scheduling questions.

Laboratory Staff

The laboratory staff ensures that the proper tests are performed at the proper times and the results are communicated. Laboratory personnel are also involved with the collection, processing, storage, and thawing of your stem cells.

Apheresis Specialist

These are nurses or technicians who operate the apheresis machine which collects your stem cells. They are specially trained in this procedure and know how to take care of you while you are connected to the apheresis machine.

Social Workers

A medical social worker (MSW) is often available to you and your family to help with the feelings you may have as you go through transplant. Your MSW can also help with practical matters such as transportation, housing, disability, and financial concerns, and finding spiritual support.

What is a Stem Cell Transplant?

A stem cell is the cell from which all blood cells develop. Blood cells are essential to life. The different types of blood cells are red blood cells, white blood cells and platelets.

  • Red blood cells carry oxygen from the lungs to all the organs and pick up carbon dioxide which is carried to the lungs and expelled from the body when you exhale.
  • White blood cells are infection fighters. There are several types of white blood cells including granulocytes (also called neutrophils, polys, segs, bands, basophils and eosinophils), monocytes and lymphocytes. They work to prevent infection, and they are necessary to fight infection if it develops.
  • Platelets help the blood to clot and prevent serious bleeding when you are injured, as well as perform normal repair work in your blood vessels.

Originally, it was thought that stem cells were only found in the bone marrow. However, as scientists became more skilled at identifying different types of cells circulating in the blood, it was discovered that stem cells are also found in the blood stream or peripheral blood.

Prior to the transplant, you will receive a high-dose chemotherapy to treat your cancer. The chemotherapy will destroy cancer cells, but unfortunately the chemotherapy cannot tell the difference between cancer and healthy cells. The chemotherapy destroys many types of cells that divide and reproduce rapidly, including healthy cells that produce red blood cells, white blood cells, and platelets. Without these blood cells the risk of infections, bleeding problems, and lower amounts of oxygen in the blood (anemia) is present.

Your own stem cells or a donor's stem cells can be collected and stored before the high-dose chemotherapy is given. The stored stem cells can then be returned to you intravenously after the high-dose chemotherapy to replace the stem cells that were destroyed. This is a stem cell transplant. These stem cells may be collected from either the peripheral blood or bone marrow.

Sometimes the terms bone marrow transplant and peripheral stem cell transplant are interchanged. The main difference between the two terms is the method in which the stem cells are collected.

There are some reasons that the transplant physician will chose one collection method over the other and that will be discussed with you at the time of consult.  

Here are some commonly asked questions:

What are Stem Cells?

Stem cells are distinguished from other cell types by two characteristics. First, they are unspecialized cells capable of renewing themselves through cell division, sometimes after long periods of inactivity. Second, under certain physiologic or experimental conditions, they can become tissue- or organspecific cells with special functions. Blood stem cells are produced and reside primarily in marrow, the spongy interior of bones. These stem cells can divide to become more stem cells. People are constantly making stem cells from their bone marrow, and this continuous production helps to naturally replace the blood cells as they complete their life cycle.

How do Stem Cells Benefit Cancer Patients ?

In patients with blood cancers, the chemotherapy and radiation that destroys malignant cells also destroys healthy marrow and its blood stem cells. Whether the cancer begins in the marrow itself or in lymphoid or other organs, cancer treatment can diminish much of the body’s reserve of blood-forming stem cells. Even patients with noncancerous blood diseases can develop a shortage of blood stem cells, as occurs in lifethreatening anemias or immune disorders. In all these cases, a blood stem cell transplant can restore normal hematopoiesis, or the development of blood cells.

What is the difference between Stem Cell and Bone Marrow Transplants?

Stem cell transplantation usually refers to cases in which the stem cells are collected from the peripheral blood by a procedure called apheresis. During apheresis, small amounts of blood are removed from the person’s body and goes into the apheresis machine. The apheresis machine filters out the stem cells, and the rest of the blood components are returned back into the body. Bone marrow transplant refers to a transplant in which stem cells are collected from the bone marrow by a procedure called bone marrow harvesting. Stem cells are collected by inserting a needle into the soft center of the bone, the marrow. Most sites used for bone marrow harvesting are located in the hip bones and the sternum. The procedure takes place in the operating room. The donor will be anesthetized during the harvest and will not feel the needle. In recovery, the donor may experience some pain or discomfort in area the where the needle was inserted.

How do I know if I am an ideal candidate for Stem Cell Transplant?

Your doctor will consider your overall health and your age. Your doctor will also consider how much your disease has grown, how aggressive your cancer is, and how well it has responded to previous treatment.

What are the differences between the types of Stem Cell Transplants? 

There are three different types of stem cell transplants offered by our program: autologous transplants, allogeneic transplants and matched unrelated donor (MUD) transplants.

Autologous transplants use    u  u    use   your own stem cells. It is safer for patients to use their own stem cells in a transplant rather than someone else’s because their body will not reject its own stem cells. But it also means that these patients are more likely to have a relapse because their own marrow or blood may still contain some of the cancer cells they are trying to get rid of. Cells from another donor may work better at attacking any leftover cancer cells still in their body.

Related allogeneic transplants use related donors stem cells from a matched sibling. Many factors determine how the immune system knows the difference between ”self” and “non-self”, but the most important for transplants is the human leukocyte antigen (HLA) system. Human leukocyte antigens are proteins found on the surface of most cells. They determine a person’s tissue type. (This is different from a person’s blood type.) 

How well the donor’s and recipient’s HLA tissue types match plays a large part in determining whether the transplant will be successful.The best matches are where all of the HLA antigens are the same. Because HLA antigens are inherited, the search for a donor usually starts with the patient’s brothers and sisters, if possible. The chance that any sibling would be a perfect match (that is, that you both received the same set of HLA antigens from each of your parents) is 1 out of 4. 

Matched Unrelated Donors (MUD) use stem cells matched from an unrelated donor. If a good match is not found in a sibling, the search may then move on to a donor search pool of 10 million registered donors or to other relatives. 

Fairfax Stem Cell Program

Thousands of cancer patients undergo stem cell transplants each year, giving them renewed hope for a longer life. 

The Stem Cell Transplant Program at Fairfax offers adult transplant services through a unique partnership between Virginia Cancer Specialists and Inova Fairfax Hospital. The types of transplants the Program offers includes: 

  • Autologous Transplant – A method by which to safely deliver high-dose chemotherapy. Your own stem cells are harvested prior to chemotherapy and then re-infused after chemotherapy is completed.
  • Allogeneic Transplant – A method by which high-dose chemotherapy is delivered followed by re-infusion of stem cells from a donor other than yourself.
    • Related Donor
    • Matched Unrelated Donor (MUD)
  • Non-myelobalative/Reduced Intensity Chemotherapy (RIC) – A type of allogeneic transplant which uses a modified or reduced dose of chemotherapy.

Thank You!

 

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Clinical Trial Locations

Terms of Use

The information provided within this web site is not intended as medical advice. It should never be substituted for a consultation with a health care professional.

Please contact your physician with questions or concerns about your health condition. Nothing in this site is intended to constitute medical advice, a clinical diagnosis or treatment, nor is the information intended as a recommendation or endorsement of any specific tests, products, procedures, opinions or other information that may be mentioned in this site.

Our web site also provides links to other organizations as a service to our readers. Virginia Cancer Specialists is not responsible for, nor does it specifically endorse, the information provided within other web sites.

Privacy Policy

Virginia Cancer Specialists, P.C.                                                                  

Effective Date:  September 23, 2013                              

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

About Us

In this Notice, we use terms like “we,” “us,” “our” or "Practice" to refer to Virginia Cancer Specialists, P.C., its physicians, employees, staff and other personnel. All of the sites and locations of Virginia Cancer Specialists, P.C. follow the terms of this Notice and may share health information with each other for treatment, payment or health care operations purposes and for other purposes as described in this Notice.

Purpose of this Notice

This Notice describes how we may use and disclose your health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. This Notice also outlines our legal duties for protecting the privacy of your health information and explains your rights to have your health information protected. We will create a record of the services we provide you, and this record will include your health information. We need to maintain this information to ensure that you receive quality care and to meet certain legal requirements related to providing you care. We understand that your health information is personal, and we are committed to protecting your privacy and ensuring that your health information is not used inappropriately.

Our Responsibilities

We are required by law to maintain the privacy of your health information and to provide you notice of our legal duties and privacy practices with respect to your health information. We are also required to notify you of a breach of your unsecured health information. We will abide by the terms of this Notice.

How We May Use or Disclose Your Health Information

The following categories describe examples of the way we use and disclose health information without your written authorization:

For Treatment: We may use and disclose your health information to provide you with medical treatment or services. For example, your health information will be shared with your oncology doctor and other health care providers who participate in your care. We may disclose your health information to another oncologist for the purpose of a consultation. We may also disclose your health information to your primary care physician or another healthcare provider to be sure they have all the information necessary to diagnose and treat you.

For Payment: We may use and disclose your health information to others so they will pay us or reimburse you for your treatment. For example, a bill may be sent to you, your insurance company or a third-party payer. The bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your health plan will cover the treatment.

For Health Care Operations: We may use and disclose your health information in order to support our business activities. These uses and disclosures are necessary to run the Practice and make sure our patients receive quality care. For example, we may use your health information for quality assessment activities, training of medical students, necessary credentialing, and for other essential activities. We may also disclose your health information to third party "business associates" that perform various services on our behalf, such as transcription, billing and collection services. In these cases, we will enter into a written agreement with the business associate to ensure they protect the privacy of your health information.

Individuals Involved in Your Care or Payment for Your Care and Notification: If you verbally agree to the use or disclosure and in certain other situations, we will make the following uses and disclosures of your health information. We may disclose to your family, friends, and anyone else whom you identify who is involved in your medical care or who helps pay for your care, health information relevant to that person's involvement in your care or paying for your care. We may also make these disclosures after your death.

We may use or disclose your information to notify or assist in notifying a family member, personal representative or any other person responsible for your care regarding your physical location within the Practice, general condition or death. We may also use or disclose your health information to disaster-relief organizations so that your family or other persons responsible for your care can be notified about your condition, status and location.

We are also allowed to the extent permitted by applicable law to use and disclose your health information without your authorization for the following purposes:

As Required by Law: We may use and disclose your health information when required to do so by federal, state or local law.

Judicial and Administrative Proceedings: If you are involved in a legal proceeding, we may disclose your health information in response to a court or administrative order. We may also release your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Health Oversight Activities: We may use and disclose your health information to health oversight agencies for activities authorized by law. These oversight activities are necessary for the government to monitor the health care system, government benefit programs, compliance with government regulatory programs, and compliance with civil rights laws.

Law Enforcement: We may disclose your health information, within limitations, to law enforcement officials for several different purposes:

  • To comply with a court order, warrant, subpoena, summons, or other similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About the victim of a crime, if the victim agrees or we are unable to obtain the victim’s agreement;
  • About a death we suspect may have resulted from criminal conduct;
  • About criminal conduct we believe in good faith to have occurred on our premises; and
  • To report a crime not occurring on our premises, the nature of a crime, the location of a crime, and the identity, description and location of the individual who committed the crime, in an emergency situation.

Public Health Activities: We may use and disclose your health information for public health activities, including the following:

  • To prevent or control disease, injury, or disability;
  • To report births or deaths;
  • To report child abuse or neglect;
  • Activities related to the quality, safety or effectiveness of FDA-regulated products;
  • To notify a person who may have been exposed to a communicable disease or may be at risk for contracting or spreading a disease or condition as authorized by law; and
  • To notify an employer of findings concerning work-related illness or injury or general medical surveillance that the employer needs to comply with the law if you are provided notice of such disclosure.

Serious Threat to Health or Safety: If there is a serious threat to your health and safety or the health and safety of the public or another person, we may use and disclose your health information to someone able to help prevent the threat or as necessary for law enforcement authorities to identify or apprehend an individual.

Organ/Tissue Donation: If you are an organ donor, we may use and disclose your health information to organizations that handle procurement, transplantation or banking of organs, eyes, or tissues.

Coroners, Medical Examiners, and Funeral Directors: We may use and disclose health information to a coroner or medical examiner. This disclosure may be necessary to identify a deceased person or determine the cause of death. We may also disclose health information, as necessary, to funeral directors to assist them in performing their duties.

Workers’ Compensation: We may disclose your health information as authorized by and to the extent necessary to comply with laws related to workers’ compensation or similar programs that provide benefits for work-related injuries or illness.

Victims of Abuse, Neglect, or Domestic Violence: We may disclose health information to the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.

Military and Veterans Activities: If you are a member of the Armed Forces, we may disclose your health information to military command authorities. Health information about foreign military personnel may be disclosed to foreign military authorities.

National Security and Intelligence Activities: We may disclose your health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services for the President and Others: We may disclose your health information to authorized federal officials so they may provide protective services for the President and others, including foreign heads of state.

Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information to the correctional institution or law enforcement official to assist them in providing you health care, protecting your health and safety or the health and safety of others, or for the safety of the correctional institution.

Research: We may use and disclose your health information for certain research activities without your written authorization. For example, we might use some of your health information to decide if we have enough patients to conduct a cancer research study. For certain research activities, an Institutional Review Board (IRB) or Privacy Board may approve uses and disclosures of your health information without your authorization.

Other Uses and Disclosures of Your Health Information that Require Written Authorization:

Other uses and disclosures of your health information not covered by this Notice will be made only with your written authorization. Some examples include:

  • Psychotherapy Notes: We usually do not maintain psychotherapy notes about you. If we do, we will only use and disclose them with your written authorization except in limited situations.
  • Marketing: We may only use and disclose your health information for marketing purposes with your written authorization. This would include making treatment communications to you when we receive a financial benefit for doing so.
  • Sale of Your Health Information: We may sell your health information only with your written authorization.

If you authorize us to use or disclose your health information, you may revoke your authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your health information as specified by your revocation, except to the extent that we have taken action in reliance on your authorization.

Your Rights Regarding Your Health Information

You have the following rights regarding the health information we maintain about you:

Right to Request Restrictions: You have the right to request restrictions on how we use and disclose your health information for treatment, payment or health care operations. In most circumstances, we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing and submit it to Virginia Cancer Specialists, P.C., Privacy Official, 3040 Williams Dr., Suite 100, Fairfax, VA 22031. We are required to agree to a request that we restrict a disclosure made to a health plan for payment or health care operations purposes that is not otherwise required by law, if you, or someone other than the health plan on your behalf, paid for the service or item in question out-of-pocket in full.

Right to Request Confidential Communications: You have the right to request that we communicate with you in a certain manner or at a certain location regarding the services you receive from us. For example, you may ask that we only contact you at work or only by mail. To request confidential communications, you must make your request in writing and submit it to Virginia Cancer Specialists, P.C., Privacy Official, 3040 Williams Dr., Suite 100, Fairfax, VA 22031. We will not ask you the reason for your request. We will attempt to accommodate all reasonable requests.

Right to Inspect and Copy: You have the right to inspect and copy health information that may be used to make decisions about your care. To inspect and copy your health information, you must make your request in writing by filling out the appropriate form provided by us and submitting it to Virginia Cancer Specialists, P.C., Privacy Official, 3040 Williams Dr., Suite 100, Fairfax, VA 22031. You may request access to your medical information in a certain electronic form and format if readily producible or, if not readily producible, in a mutually agreeable electronic form and format. Further, you may request in writing that we transmit a copy of your health information to any person or entity you designate. Your written, signed request must clearly identify such designated person or entity and where you would like us to send the copy. If you request a copy of your health information, we may charge a cost-based fee for the labor, supplies, and postage required to meet your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed by a licensed health care professional chosen by us. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Right to Amend: If you feel that your health information is incorrect or incomplete, you may request that we amend your information. You have the right to request an amendment for as long as the information is kept by or for us. To request an amendment, you must make your request in writing by filling out the appropriate form provided by us and submitting it to Virginia Cancer Specialists, P.C., Privacy Official, 3040 Williams Dr., Suite 100, Fairfax, VA 22031.

We may deny your request for an amendment. If this occurs, you will be notified of the reason for the denial and given the opportunity to file a written statement of disagreement with us that will become part of your medical record.

Right to an Accounting of Disclosures: You have the right to request an accounting of disclosures we make of your health information. Please note that certain disclosures need not be included in the accounting we provide to you.

To request an accounting of disclosures, you must make your request in writing by filling out the appropriate form provided by us and submitting it to Virginia Cancer Specialists, P.C., Privacy Official, 3040 Williams Dr., Suite 100, Fairfax, VA 22031. Your request must state a time period which may not be longer than six years, and which may not include dates before April 14, 2003. The first accounting you request within a 12-month period will be free. For additional accountings, we may charge you for the costs of providing the accounting. We will notify you of the costs involved and give you an opportunity to withdraw or modify your request before any costs have been incurred

Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice at any time, even if you previously agreed to receive this Notice electronically. To obtain a paper copy of this Notice, please contact Virginia Cancer Specialists, P.C., Privacy Official, 3040 Williams Dr., Suite 100, Fairfax, VA 22031. You may also obtain a paper copy of this Notice at our website, http://www.virginiacancerspecialists.com.

Changes to this Notice

We reserve the right to change the terms of this Notice at any time. We reserve the right to make the new Notice provisions effective for all health information we currently maintain, as well as any health information we receive in the future. If we make material or important changes to our privacy practices, we will promptly revise our Notice. We will post a copy of the current Notice in the reception area of each Virginia Cancer Specialists, P.C. office. Each version of the Notice will have an effective date listed on the first page. Updates to this Notice are also available at our website, www. http://www.virginiacancerspecialists.com.

Complaints

If you have any questions about this Notice or would like to file a complaint about our privacy practices, please direct your inquiries to: Virginia Cancer Specialists, P.C., Privacy Official, 3040 Williams Dr., Suite 100, Fairfax, VA 22031. You may also file a complaint with the Secretary of the Department of Health and Human Services. You will not be retaliated against or penalized for filing a complaint.

Questions

If you have questions about this Notice, please contact Virginia Cancer Specialists, P.C., Privacy Official, 3040 Williams Dr., Suite 100, Fairfax, VA 22031 (703) 280-5390.

Treatment Options

People with multiple myeloma have many treatment options. The options are watchful waiting, induction therapy, and stem cell transplant. Sometimes a combination of methods is used.

Radiation therapy is used sometimes to treat painful bone disease. It may be used alone or along with other therapies. See the Supportive Care section to learn about ways to relieve pain.

The choice of treatment depends mainly on how advanced the disease is and whether you have symptoms. If you have multiple myeloma without symptoms (smoldering myeloma), you may not need cancer treatment right away. The doctor monitors your health closely (watchful waiting) so that treatment can start when you begin to have symptoms.

If you have symptoms, you will likely get induction therapy. Sometimes a stem cell transplant is part of the treatment plan.

When treatment for myeloma is needed, it can often control the disease and its symptoms. People may receive therapy to help keep the cancer in remission, but myeloma can seldom be cured. Because standard treatment may not control myeloma, you may want to talk to your doctor about taking part in a clinical trial. Clinical trials are research studies of new treatment methods.

Watchful Waiting

People with smoldering myeloma or Stage I myeloma may be able to put off having cancer treatment. By delaying treatment, you can avoid the side effects of treatment until you have symptoms.

If you and your doctor agree that watchful waiting is a good idea, you will have regular checkups (such as every 3 months). You will receive treatment if symptoms occur.

Although watchful waiting avoids or delays the side effects of cancer treatment, this choice has risks. In some cases, it may reduce the chance to control myeloma before it gets worse.

You may decide against watchful waiting if you don’t want to live with untreated myeloma. If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option in most cases.

Induction Therapy

Many different types of drugs are used to treat myeloma. People often receive a combination of drugs, and many different combinations are used to treat myeloma.

Each type of drug kills cancer cells in a different way:

  • Chemotherapy: Chemotherapy kills fast-growing myeloma cells, but the drug can also harm normal cells that divide rapidly.
  • Targeted therapy: Targeted therapies use drugs that block the growth of myeloma cells. The targeted therapy blocks the action of an abnormal protein that stimulates the growth of myeloma cells.
  • Steroids: Some steroids have antitumor effects. It is thought that steroids can trigger the death of myeloma cells. A steroid may be used alone or with other drugs to treat myeloma.

You may receive the drugs by mouth or through a vein (IV). The treatment usually takes place in an outpatient part of the hospital, at your doctor’s office, or at home. Some people may need to stay in the hospital for treatment.

Stem Cell Transplant

Many people with multiple myeloma may get a stem cell transplant. A stem cell transplant allows you to be treated with high doses of drugs. The high doses destroy both myeloma cells and normal blood cells in the bone marrow. After you receive high-dose treatment, you receive healthy stem cells through a vein. (It’s like getting a blood transfusion.) New blood cells develop from the transplanted stem cells. The new blood cells replace the ones that were destroyed by treatment.

Stem cell transplants take place in the hospital. Some people with myeloma have two or more transplants.

Stem cells may come from you or from someone who donates their stem cells to you:

  • From you: An autologous stem cell transplant uses your own stem cells. Before you get the high-dose chemotherapy, your stem cells are removed. The cells may be treated to kill any myeloma cells present. Your stem cells are frozen and stored. After you receive high-dose chemotherapy, the stored stem cells are thawed and returned to you.
  • From a family member or other donor: An allogeneic stem cell transplant uses healthy stem cells from a donor. Your brother, sister, or parent may be the donor. Sometimes the stem cells come from a donor who isn’t related. Doctors use blood tests to be sure the donor’s cells match your cells. Allogeneic stem cell transplants are under study for the treatment of multiple myeloma.
  • From your identical twin: If you have an identical twin, a syngeneic stem cell transplant uses stem cells from your healthy twin.

There are two ways to get stem cells for people with myeloma. They usually come from the blood (peripheral blood stem cell transplant). Or they can come from the bone marrow (bone marrow transplant).

After a stem cell transplant, you may stay in the hospital for several weeks or months. You’ll be at risk for infections because of the large doses of chemotherapy you received. In time, the transplanted stem cells will begin to produce healthy blood cells.

Staging

If the biopsy shows that you have multiple myeloma, your doctor needs to learn the extent (stage) of the disease to plan the best treatment. Staging may involve having more tests:

  • Blood tests: For staging, the doctor considers the results of blood tests, including albumin and beta-2-microglobulin.
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your bones.
  • MRI: A powerful magnet linked to a computer is used to make detailed pictures of your bones.

Doctors may describe multiple myeloma as

  • Smolderinga
  • Stage I
  • Stage II
  • Stage III

The stage takes into account whether the cancer is causing problems with your bones or kidneys. Smoldering multiple myeloma is early disease without any symptoms. For example, there is no bone damage. Early disease with symptoms (such as bone damage) is Stage I. Stage II or III is more advanced, and more myeloma cells are found in the body.

Diagnosis

Doctors sometimes find multiple myeloma after a routine blood test. More often, doctors suspect multiple myeloma after an x-ray for a broken bone. Usually though, patients go to the doctor because they are having other symptoms.

To find out whether such problems are from multiple myeloma or some other condition, your doctor may ask about your personal and family medical history and do a physical exam. Your doctor also may order some of the following tests:

  • Blood tests: The lab does several blood tests:
    • Multiple myeloma causes high levels of proteins in the blood. The lab checks the levels of many different proteins, including M protein and other immunoglobulins (antibodies), albumin, and beta-2-microglobulin.
    • Myeloma may also cause anemia and low levels of white blood cells and platelets. The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets.
    • The lab also checks for high levels of calcium.
    • To see how well the kidneys are working, the lab tests for creatinine.
  • Urine tests: The lab checks for Bence Jones protein, a type of M protein, in urine. The lab measures the amount of Bence Jones protein in urine collected over a 24-hour period. If the lab finds a high level of Bence Jones protein in your urine sample, doctors will monitor your kidneys. Bence Jones protein can clog the kidneys and damage them.
  • X-rays: You may have x-rays to check for broken or thinning bones.An x-ray of your whole body can be done to see how many bones could be damaged by the myeloma.
  • Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether myeloma cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hip bone or another large bone. A pathologist uses a microscope to check the tissue for myeloma cells.

There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:

  • Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
  • Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.

Multiple Myeloma

Myeloma begins when a plasma cell becomes abnormal. The abnormal cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. These abnormal plasma cells are called myeloma cells.

In time, myeloma cells collect in the bone marrow. They may damage the solid part of the bone. When myeloma cells collect in several of your bones, the disease is called “multiple myeloma.” This disease may also harm other tissues and organs, such as the kidneys.

Myeloma cells make antibodies called M proteins and other proteins. These proteins can collect in the blood, urine, and organs.

Visit the National Cancer Institute where this information and more can be found about Multiple Myeloma or ask your cancer care team questions about your individual situation.

Treatment Options

Your doctor can describe your treatment choices and the expected results. You and your doctor can work together to develop a treatment plan that meets your needs.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat Hodgkin lymphoma include hematologists, medical oncologists, and radiation oncologists . Your doctor may suggest that you choose an oncologist who specializes in the treatment of Hodgkin lymphoma. Often, such doctors are associated with major academic centers. Your health care team may also include an oncology nurse and a registered dietitian.

The choice of treatment depends mainly on the following:

  • The type of your Hodgkin lymphoma (most people have classical Hodgkin lymphoma)
  • Its stage (where the lymphoma is found)
  • Whether you have a tumor that is more than 4 inches (10 centimeters) wide
  • Your age
  • Whether you’ve had weight loss, drenching night sweats, or fevers.

People with Hodgkin lymphoma may be treated with chemotherapy, radiation therapy, or both.

If Hodgkin lymphoma comes back after treatment, doctors call this a relapse or recurrence. People with Hodgkin lymphoma that comes back after treatment may receive high doses of chemotherapy, radiation therapy, or both, followed by stem cell transplantation.

Chemotherapy

Chemotherapy for Hodgkin lymphoma uses drugs to kill lymphoma cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach lymphoma cells in almost all parts of the body.

Usually, more than one drug is given. Most drugs for Hodgkin lymphoma are given through a vein (intravenous), but some are taken by mouth.

Chemotherapy is given in cycles. You have a treatment period followed by a rest period. The length of the rest period and the number of treatment cycles depend on the stage of your disease and on the anticancer drugs used.

You may have your treatment in a clinic, at the doctor’s office, or at home. Some people may need to stay in the hospital for treatment.

Radiation Therapy

Radiation therapy (also called radiotherapy) for Hodgkin lymphoma uses high-energy rays to kill lymphoma cells. It can shrink tumors and help control pain.

A large machine aims the rays at the lymph node areas affected by lymphoma. This is local therapy because it affects cells in the treated area only. Most people go to a hospital or clinic for treatment 5 days a week for several weeks.

Stem Cell Transplantation

If Hodgkin lymphoma returns after treatment, you may receive stem cell transplantation. A transplant of your own blood-forming stem cells (autologous stem cell transplantation) allows you to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both Hodgkin lymphoma cells and healthy blood cells in the bone marrow.

Stem cell transplants take place in the hospital. Before you receive high-dose treatment, your stem cells are removed and may be treated to kill lymphoma cells that may be present. Your stem cells are frozen and stored. After you receive high-dose treatment to kill Hodgkin lymphoma cells, your stored stem cells are thawed and given back to you through a flexible tube placed in a large vein in your neck or chest area. New blood cells develop from the transplanted stem cells.

Diagnosis

If you have swollen lymph nodes or another symptom that suggests Hodgkin lymphoma, your doctor will try to find out what’s causing the problem. Your doctor may ask about your personal and family medical history.

You may have some of the following exams and tests:

  • Physical exam: Your doctor checks for swollen lymph nodes in your neck, underarms, and groin. Your doctor also checks for a swollen spleen or liver.
  • Blood tests: The lab does a complete blood count to check the number of white blood cells and other cells and substances.
  • Chest x-rays: X-ray pictures may show swollen lymph nodes or other signs of disease in your chest.
  • Biopsy: A biopsy is the only sure way to diagnose Hodgkin lymphoma. Your doctor may remove an entire lymph node (excisional biopsy) or only part of a lymph node (incisional biopsy). A thin needle (fine needle aspiration) usually cannot remove a large enough sample for the pathologist to diagnose Hodgkin lymphoma. Removing an entire lymph node is best.

The pathologist uses a microscope to check the tissue for Hodgkin lymphoma cells. A person with Hodgkin lymphoma usually has large, abnormal cells known as Reed-Sternberg cells. They are not found in people with non-Hodgkin lymphoma. See the photo of a Reed-Sternberg cell.

Staging

The doctor considers the following to determine the stage of Hodgkin lymphoma:

  • The number of lymph nodes that have Hodgkin lymphoma cells
  • Whether these lymph nodes are on one or both sides of the diaphragm (see picture)
  • Whether the disease has spread to the bone marrow, spleen, liver, or lung.

The stages of Hodgkin lymphoma are as follows:

  • Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the lymphoma cells are not in the lymph nodes, they are in only one part of a tissue or an organ
  • Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or, the lymphoma cells are in one part of a tissue or an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.
  • Stage III: The lymphoma cells are in lymph nodes above and below the diaphragm. Lymphoma also may be found in one part of a tissue or an organ (such as the liver, lung, or bone) near these lymph node groups. It may also be found in the spleen.
  • Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues. Or, the lymphoma is in an organ (such as the liver, lung, or bone) and in distant lymph nodes.
  • Recurrent: The disease returns after treatment.

In addition to these stage numbers, your doctor may also describe the stage as A or B:

  • A: You have not had weight loss, drenching night sweats, or fevers.
  • B: You have had weight loss, drenching night sweats, or fevers.

Hodgkin Lymphoma

Hodgkin lymphoma is a cancer that begins in cells  of the immune system. The immune system fights infections  and other diseases.

Hodgkin lymphoma can start almost anywhere. Usually, it's first found in a lymph node above the diaphragm, the thin muscle that separates the chest from the abdomen. But Hodgkin lymphoma also may be found in a group of lymph nodes. Sometimes it starts in other parts of the lymphatic system.
Hodgkin Lymphoma Cells

Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal. The abnormal cell is called a Reed-Sternberg cell. (See photo below.)

The Reed-Sternberg cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. The abnormal cells don't die when they should. They don't protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Visit the National Cancer Institute where this information and more can be found about  Hodgkin Lymphoma or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el linfoma de Hodgkin.

Treatment Options

Your doctor can describe your treatment choices and the expected results. You and your doctor can work together to develop a treatment plan that meets your needs.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat non-Hodgkin lymphoma include hematologists, medical oncologists, and radiation oncologists. Your doctor may suggest that you choose an oncologist who specializes in the treatment of lymphoma. Often, such doctors are associated with major academic centers. Your health care team may also include an oncology nurse and a registered dietitian.

The choice of treatment depends mainly on the following:

  • The type of non-Hodgkin lymphoma (for example, follicular lymphoma)
  • Its stage (where the lymphoma is found)
  • How quickly the cancer is growing (whether it is indolent or aggressive lymphoma)
  • Your age
  • Whether you have other health problems

If you have indolent non-Hodgkin lymphoma without symptoms, you may not need treatment for the cancer right away. The doctor watches your health closely so that treatment can start when you begin to have symptoms. Not getting cancer treatment right away is called watchful waiting.

If you have indolent lymphoma with symptoms, you will probably receive chemotherapy and biological therapy. Radiation therapy may be used for people with Stage I or Stage II lymphoma.

If you have aggressive lymphoma, the treatment is usually chemotherapy and biological therapy. Radiation therapy also may be used.

If non-Hodgkin lymphoma comes back after treatment, doctors call this a relapse or recurrence. People with lymphoma that comes back after treatment may receive high doses of chemotherapy, radiation therapy, or both, followed by stem cell transplantation.

Watchful Waiting

People who choose watchful waiting put off having cancer treatment until they have symptoms. Doctors sometimes suggest watchful waiting for people with indolent lymphoma. People with indolent lymphoma may not have problems that require cancer treatment for a long time. Sometimes the tumor may even shrink for a while without therapy. By putting off treatment, they can avoid the side effects of chemotherapy or radiation therapy.

If you and your doctor agree that watchful waiting is a good idea, the doctor will check you regularly (every 3 months). You will receive treatment if symptoms occur or get worse.

Some people do not choose watchful waiting because they don’t want to worry about having cancer that is not treated. Those who choose watchful waiting but later become worried should discuss their feelings with the doctor.

Chemotherapy

Chemotherapy for lymphoma uses drugs to kill lymphoma cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach lymphoma cells in almost all parts of the body.

You may receive chemotherapy by mouth, through a vein, or in the space around the spinal cord. Treatment is usually in an outpatient part of the hospital, at the doctor’s office, or at home. Some people need to stay in the hospital during treatment.

Chemotherapy is given in cycles. You have a treatment period followed by a rest period. The length of the rest period and the number of treatment cycles depend on the stage of your disease and on the anticancer drugs used.

If you have lymphoma in the stomach caused by H. pylori infection, your doctor may treat this lymphoma with antibiotics. After the drug cures the infection, the lymphoma also may go away.

Biological Therapies

People with certain types of non-Hodgkin lymphoma may have biological therapy. This type of treatment helps the immune system fight cancer.

Monoclonal antibodies are the type of biological therapy used for lymphoma. They are proteins made in the lab that can bind to cancer cells. They help the immune system kill lymphoma cells. People receive this treatment through a vein at the doctor’s office, clinic, or hospital.

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill lymphoma cells. It can shrink tumors and help control pain.
Two types of radiation therapy are used for people with lymphoma:

  • External radiation: A large machine aims the rays at the part of the body where lymphoma cells have collected. This is local therapy because it affects cells in the treated area only. Most people go to a hospital or clinic for treatment 5 days a week for several weeks.
  • Systemic radiation: Some people with lymphoma receive an injection of radioactive material that travels throughout the body. The radioactive material is bound to monoclonal antibodies that seek out lymphoma cells. The radiation destroys the lymphoma cells.

Stem Cell Transplantation

If lymphoma returns after treatment, you may receive stem cell transplantation. A transplant of your own blood-forming stem cells allows you to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both lymphoma cells and healthy blood cells in the bone marrow.

Stem cell transplants take place in the hospital. After you receive high-dose treatment, healthy blood-forming stem cells are given to you through a flexible tube placed in a large vein in your neck or chest area. New blood cells develop from the transplanted stem cells.
The stem cells may come from your own body or from a donor: :

  • Autologous stem cell transplantation: This type of transplant uses your own stem cells. Your stem cells are removed before high-dose treatment. The cells may be treated to kill lymphoma cells that may be present. The stem cells are frozen and stored. After you receive high-dose treatment, the stored stem cells are thawed and returned to you.
  • Allogeneic stem cell transplantation: Sometimes healthy stem cells from a donor are available. Your brother, sister, or parent may be the donor. Or the stem cells may come from an unrelated donor. Doctors use blood tests to be sure the donor’s cells match your cells.
  • Syngeneic stem cell transplantation: This type of transplant uses stem cells from a patient’s healthy identical twin.

Staging

Your doctor needs to know the extent (stage) of non-Hodgkin lymphoma to plan the best treatment. Staging is a careful attempt to find out what parts of the body are affected by the disease.

Lymphoma usually starts in a lymph node. It can spread to nearly any other part of the body. For example, it can spread to the liver, lungs, bone, and bone marrow.

Staging may involve one or more of the following tests:

  • Bone marrow biopsy: The doctor uses a thick needle to remove a small sample of bone and bone marrow from your hipbone or another large bone. Local anesthesia can help control pain. A pathologist looks for lymphoma cells in the sample.
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your head, neck, chest, abdomen, or pelvis. You may receive an injection of contrast material. Also, you may be asked to drink another type of contrast material. The contrast material makes it easier for the doctor to see swollen lymph nodes and other abnormal areas on the x-ray.
  • MRI: Your doctor may order MRI pictures of your spinal cord, bone marrow, or brain. MRI uses a powerful magnet linked to a computer. It makes detailed pictures of tissue on a computer screen or film.
  • Ultrasound: An ultrasound device sends out sound waves that you cannot hear. A small hand-held device is held against your body. The waves bounce off nearby tissues, and a computer uses the echoes to create a picture. Tumors may produce echoes that are different from the echoes made by healthy tissues. The picture can show possible tumors.
  • Spinal tap: The doctor uses a long, thin needle to remove fluid from the spinal column. Local anesthesia can help control pain. You must lie flat for a few hours afterward so that you don’t get a headache. The lab checks the fluid for lymphoma cells or other problems.
  • PET scan: You receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in your body. Lymphoma cells use sugar faster than normal cells, and areas with lymphoma look brighter on the pictures.

The stage is based on where lymphoma cells are found (in the lymph nodes or in other organs or tissues). The stage also depends on how many areas are affected. The stages of non-Hodgkin lymphoma are as follows:

  • Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the abnormal cells are not in the lymph nodes, they are in only one part of a tissue or organ (such as the lung, but not the liver or bone marrow).
  • Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. (See the picture of the diaphragm.) Or, the lymphoma cells are in one part of an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.
  • Stage III: The lymphoma is in lymph nodes above and below the diaphragm. It also may be found in one part of a tissue or an organ near these lymph node groups.
  • Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues (in addition to the lymph nodes). Or, it is in the liver, blood, or bone marrow.
  • Recurrent: The disease returns after treatment.

In addition to these stage numbers, your doctor may also describe the stage as A or B:

  • A: You have not had weight loss, drenching night sweats, or fevers.
  • B: You have had weight loss, drenching night sweats, or fevers.

Non-Hodgkin Lymphoma

This information is about non-Hodgkin lymphoma, a cancer that starts in the immune system. Non-Hodgkin lymphoma is also called NHL.

Non-Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal. The abnormal cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. The abnormal cells don't die when they should. They don't protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Because lymphatic tissue is in many parts of the body, Hodgkin lymphoma can start almost anywhere. Usually, it's first found in a lymph node.

When lymphoma is found, the pathologist reports the type. There are many types of lymphoma. The most common types are diffuse large B-cell lymphoma and follicular lymphoma.

Lymphomas may be grouped by how quickly they are likely to grow:

  • Indolent (also called low-grade) lymphomas grow slowly. They tend to cause few symptoms.
  • Aggressive (also called intermediate-grade and high-grade) lymphomas grow and spread more quickly. They tend to cause severe symptoms. Over time, many indolent lymphomas become aggressive lymphomas.

It’s a good idea to get a second opinion about the type of lymphoma that you have. The treatment plan varies by the type of lymphoma. A pathologist at a major referral center can review your biopsy. See the Second Opinion section for more information.


Visit the National Cancer Institute where this information and more can be found about Non Hodgkin Lymphoma or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el linfoma no Hodgkin.

Treatment Options

People with leukemia have many treatment options. The options are watchful waiting, chemotherapy, targeted therapy, biological therapy, radiation therapy, and stem cell transplant. If your spleen is enlarged, your doctor may suggest surgery to remove it. Sometimes a combination of these treatments is used.

The choice of treatment depends mainly on the following:

  • The type of leukemia (acute or chronic)
  • Your age
  • Whether leukemia cells were found in your cerebrospinal fluid

It also may depend on certain features of the leukemia cells. Your doctor also considers your symptoms and general health.

People with acute leukemia need to be treated right away. The goal of treatment is to destroy signs of leukemia in the body and make symptoms go away. This is called a remission. After people go into remission, more therapy may be given to prevent a relapse. This type of therapy is called consolidation therapy or maintenance therapy. Many people with acute leukemia can be cured.

If you have chronic leukemia without symptoms, you may not need cancer treatment right away. Your doctor will watch your health closely so that treatment can start when you begin to have symptoms. Not getting cancer treatment right away is called watchful waiting.

When treatment for chronic leukemia is needed, it can often control the disease and its symptoms. People may receive maintenance therapy to help keep the cancer in remission, but chronic leukemia can seldom be cured with chemotherapy. However, stem cell transplants offer some people with chronic leukemia the chance for cure.

Your doctor can describe your treatment choices, the expected results, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

You may want to talk with your doctor about taking part in a clinical trial, a research study of new treatment methods. See the Taking Part in Cancer Research section.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat leukemia include hematologists, medical oncologists, and radiation oncologists. Pediatric oncologists and hematologists treat childhood leukemia. Your health care team may also include an oncology nurse and a registered dietitian.

Whenever possible, people should be treated at a medical center that has doctors experienced in treating leukemia. If this isn’t possible, your doctor may discuss the treatment plan with a specialist at such a center.

Before treatment starts, ask your health care team to explain possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.

Watchful Waiting

People with chronic lymphocytic leukemia who do not have symptoms may be able to put off having cancer treatment. By delaying treatment, they can avoid the side effects of treatment until they have symptoms.

If you and your doctor agree that watchful waiting is a good idea, you’ll have regular checkups (such as every 3 months). You can start treatment if symptoms occur.

Although watchful waiting avoids or delays the side effects of cancer treatment, this choice has risks. It may reduce the chance to control leukemia before it gets worse.

You may decide against watchful waiting if you don’t want to live with an untreated leukemia. Some people choose to treat the cancer right away.

If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor. A different approach is nearly always available.

Chemotherapy

Many people with leukemia are treated with chemotherapy. Chemotherapy uses drugs to destroy leukemia cells.

Depending on the type of leukemia, you may receive a single drug or a combination of two or more drugs.

You may receive chemotherapy in several different ways:

  • By mouth: Some drugs are pills that you can swallow.
  • Into a vein (IV): The drug is given through a needle or tube inserted into a vein.
  • Through a catheter (a thin, flexible tube): The tube is placed in a large vein, often in the upper chest. A tube that stays in place is useful for patients who need many IV treatments. The health care professional injects drugs into the catheter, rather than directly into a vein. This method avoids the need for many injections, which can cause discomfort and injure the veins and skin.
  • Into the cerebrospinal fluid: If the pathologist finds leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord, the doctor may order intrathecal chemotherapy. The doctor injects drugs directly into the cerebrospinal fluid. Intrathecal chemotherapy is given in two ways:
    • Into the spinal fluid: The doctor injects the drugs into the spinal fluid.
    • Under the scalp: Children and some adult patients receive chemotherapy through a special catheter called an Ommaya reservoir. The doctor places the catheter under the scalp. The doctor injects the drugs into the catheter. This method avoids the pain of injections into the spinal fluid.

Intrathecal chemotherapy is used because many drugs given by IV or taken by mouth can’t pass through the tightly packed blood vessel walls found in the brain and spinal cord. This network of blood vessels is known as the blood-brain barrier.

Chemotherapy is usually given in cycles. Each cycle has a treatment period followed by a rest period.

You may have your treatment in a clinic, at the doctor’s office, or at home. Some people may need to stay in the hospital for treatment.

Targeted Therapy

People with chronic myeloid leukemia and some with acute lymphoblastic leukemia may receive drugs called targeted therapy. Imatinib (Gleevec) tablets were the first targeted therapy approved for chronic myeloid leukemia. Other targeted therapy drugs are now used too.

Targeted therapies use drugs that block the growth of leukemia cells. For example, a targeted therapy may block the action of an abnormal protein that stimulates the growth of leukemia cells.

Biological Therapy

Some people with leukemia receive drugs called biological therapy. Biological therapy for leukemia is treatment that improves the body’s natural defenses against the disease.

One type of biological therapy is a substance called a monoclonal antibody. It’s given by IV infusion. This substance binds to the leukemia cells. One kind of monoclonal antibody carries a toxin that kills the leukemia cells. Another kind helps the immune system destroy leukemia cells.

For some people with chronic myeloid leukemia, the biological therapy is a drug called interferon. It is injected under the skin or into a muscle. It can slow the growth of leukemia cells.

You may have your treatment in a clinic, at the doctor’s office, or in the hospital. Other drugs may be given at the same time to prevent side effects.

Diagnosis

Doctors sometimes find leukemia after a routine blood test. If you have symptoms that suggest leukemia, your doctor will try to find out what’s causing the problems. Your doctor may ask about your personal and family medical history.

You may have one or more of the following tests:

  • Physical exam: Your doctor checks for swollen lymph nodes, spleen, or liver.
  • Blood tests: The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets. Leukemia causes a very high level of white blood cells. It may also cause low levels of platelets and hemoglobin, which is found inside red blood cells.
  • Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether leukemia cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hipbone or another large bone. A pathologist uses a microscope to check the tissue for leukemia cells.

There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:

  • Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
  • Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.

Other Tests

The tests that your doctor orders for you depend on your symptoms and type of leukemia. You may have other tests:

  • Cytogenetics: The lab looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. If abnormal chromosomes are found, the test can show what type of leukemia you have. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome.
  • Spinal tap: Your doctor may remove some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the lower spine. The procedure takes about 30 minutes and is performed with local anesthesia. You must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for leukemia cells or other signs of problems.
  • Chest x-ray: An x-ray can show swollen lymph nodes or other signs of disease in your chest.

Leukemia

Leukemia is cancer that starts in the tissues that forms blood.

The types of leukemia can be grouped based on how quickly the disease develops and gets worse. Leukemia is either chronic (which usually gets worse slowly) or acute (which usually gets worse quickly):

  • Chronic leukemia: Early in the disease, the leukemia cells can still do some of the work of normal white blood cells. People may not have any symptoms at first. Doctors often find chronic leukemia during a routine checkup – before there are any symptoms. Slowly, chronic leukemia gets worse. As the number of leukemia cells in the blood increases, people get symptoms, such as swollen lymph nodes or infections. When symptoms do appear, they are usually mild at first and get worse gradually.
  • Acute leukemia: The leukemia cells can’t do any of the work of normal white blood cells. The number of leukemia cells increases rapidly. Acute leukemia usually worsens quickly. 

Lo que usted necesita saber sobre la leucemia.

Types

The types of leukemia also can be grouped based on the type of white blood cell that is affected. Leukemia can start in lymphoid cells or myeloid cells.  Leukemia that affects lymphoid cells is called lymphoid, lymphocytic, or lymphoblastic leukemia.  Leukemia that affects myeloid cells is called myeloid, myelogenous, or myeloblastic leukemia.

There are four common types of leukemia:
  • Chronic lymphocytic leukemia (CLL): CLL affects lymphoid cells and usually grows slowly. It accounts for more than 15,000 new cases of leukemia each year. Most often, people diagnosed with the disease are over age 55. It almost never affects children.
  • Chronic myeloid leukemia (CML): CML affects myeloid cells and usually grows slowly at first. It accounts for nearly 5,000 new cases of leukemia each year. It mainly affects adults.
  • Acute lymphocytic (lymphoblastic) leukemia (ALL): ALL affects lymphoid cells and grows quickly. It accounts for more than 5,000 new cases of leukemia each year. ALL is the most common type of leukemia in young children. It also affects adults.
  • Acute myeloid leukemia (AML): AML affects myeloid cells and grows quickly. It accounts for more than 13,000 new cases of leukemia each year. It occurs in both adults and children.
  • Hairy Cell Leukemia: A rare type of leukemia in which abnormal B-lymphocytes (a type of white blood cell) are present in the bone marrow, spleen, and peripheral blood. When viewed under a microscope, these cells appear to be covered with tiny hair-like projections.

Staging

To plan the best treatment, your doctor needs to learn the extent (stage) of the disease. Staging is a careful attempt to find out the size of the nodule, whether the cancer has spread, and if so, to what parts of the body.

Thyroid cancer spreads most often to the lymph nodes, lungs, and bones. When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original cancer. For example, if thyroid cancer spreads to the lungs, the cancer cells in the lungs are actually thyroid cancer cells. The disease is metastatic thyroid cancer, not lung cancer. For that reason, it’s treated as thyroid cancer, not lung cancer. Doctors call the new tumor “distant” or metastatic disease.

Staging may involve one or more of these tests:

  • Ultrasound: An ultrasound exam of your neck may show whether cancer has spread to lymph nodes or other tissues near your thyroid.
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of areas inside your body. A CT scan may show whether cancer has spread to lymph nodes, other areas in your neck, or your chest.
  • MRI: MRI uses a powerful magnet linked to a computer. It makes detailed pictures of tissue. Your doctor can view these pictures on a screen or print them on film. MRI may show whether cancer has spread to lymph nodes or other areas.
  • Chest x-ray: X-rays of your chest may show whether cancer has spread to the lungs.
  • Whole body scan: You may have a whole body scan to see if cancer has spread from the thyroid to other parts of the body. You get a small amount of a radioactive substance. The substance travels through the bloodstream. Thyroid cancer cells in other organs or the bones take up the substance. Thyroid cancer that has spread may show up on a whole body scan.

Diagnosis

If you have symptoms that suggest thyroid cancer, your doctor will help you find out whether they are from cancer or some other cause. Your doctor will ask you about your personal and family medical history. You may have one or more of the following tests:

  • Physical exam: Your doctor feels your thyroid for lumps (nodules). Your doctor also checks your neck and nearby lymph nodes for growths or swelling.
  • Blood tests: Your doctor may check for abnormal levels of thyroid-stimulating hormone (TSH) in the blood. Too much or too little TSHmeans the thyroid is not working well. If your doctor thinks you may have medullary thyroid cancer, you may be checked for a high level of calcitonin and have other blood tests.
  • Ultrasound: An ultrasound device uses sound waves that people cannot hear. The device aims sound waves at the thyroid, and a computer creates a picture of the waves that bounce off the thyroid. The picture can show thyroid nodules that are too small to be felt. The doctor uses the picture to learn the size and shape of each nodule and whether the nodules are solid or filled with fluid. Nodules that are filled with fluid are usually not cancer. Nodules that are solid may be cancer.
  • Thyroid scan: Your doctor may order a scan of your thyroid. You swallow a small amount of a radioactive substance, and it travels through the bloodstream. Thyroid cells that absorb the radioactive substance can be seen on a scan. Nodules that take up more of the substance than the thyroid tissue around them are called “hot” nodules. Hot nodules are usually not cancer. Nodules that take up less substance than the thyroid tissue around them are called “cold” nodules. Cold nodules may be cancer.
  • Biopsy: A biopsy is the only sure way to diagnose thyroid cancer. A pathologist checks a sample of tissue for cancer cells with a microscope.

Your doctor may take tissue for a biopsy in one of two ways:

  • Fine-needle aspiration: Most people have this type of biopsy. Your doctor removes a sample of tissue from a thyroid nodule with a thin needle. An ultrasound device can help your doctor see where to place the needle.
  • Surgical biopsy: If a diagnosis cannot be made from fine-needle aspiration, a surgeon removes the whole nodule during an operation. If the doctor suspects follicular thyroid cancer, surgical biopsy may be needed for diagnosis.

Treatment Options

People with thyroid cancer have many treatment options. Treatment usually begins within a few weeks after the diagnosis, but you will have time to talk with your doctor about treatment choices and get a second opinion.

The choice of treatment depends on:

  • the type of thyroid cancer (papillary, follicular, medullary, or anaplastic)
  • the size of the nodule
  • your age
  • whether the cancer has spread

You and your doctor can work together to develop a treatment plan that meets your needs.

Your doctor can describe your treatment choices and the expected results. Thyroid cancer may be treated with surgery, thyroid hormone treatment, radioactive iodine therapy, external radiation therapy, or chemotherapy. Most patients receive a combination of treatments. For example, the standard treatment for papillary cancer is surgery, thyroid hormone treatment, and radioactive iodine therapy. Although external radiation therapy and chemotherapy are not often used, when they are, the treatments may be combined.

Surgery and external radiation therapy are local therapies. They remove or destroy cancer in the thyroid. When thyroid cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.

Thyroid hormone treatment, radioactive iodine therapy, and chemotherapy are systemic therapies. Systemic therapies enter the bloodstream and destroy or control cancer throughout the body.

Surgery
Most people with thyroid cancer have surgery. The surgeon removes all or part of the thyroid. The type of surgery depends on the type and stage of thyroid cancer, the size of the nodule, and your age.

  • Total thyroidectomy: This surgery can be used for all types of thyroid cancer. The surgeon removes all of the thyroid through an incision in the neck. If the surgeon is not able to remove all of the thyroid tissue, it can be destroyed by radioactive iodine therapy later.

Nearby lymph nodes also may be removed. If cancer has invaded tissue within the neck, the surgeon may remove nearby tissue. If cancer has spread outside the neck, surgery, radioactive iodine therapy, or external radiation therapy may be used to treat those areas.

  • Lobectomy: Some people with follicular or papillary thyroid cancer may have only part of the thyroid removed. The surgeon removes one lobe and the isthmus. Some people who have a lobectomy later have a second surgery to remove the rest of the thyroid. Less often, the remaining thyroid tissue is destroyed by radioactive iodine therapy.

The time it takes to heal after surgery is different for each person. You may be uncomfortable for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

Surgery for thyroid cancer removes the cells that make thyroid hormone. After surgery, nearly all people need to take pills to replace the natural thyroid hormone. You will need thyroid hormone pills for the rest of your life.

If the surgeon removes the parathyroid glands, you may need to take calcium and vitamin D pills for the rest of your life.

Thyroid Hormone Treatment

After surgery to remove part or all of the thyroid, nearly everyone needs to take pills to replace the natural thyroid hormone. However, thyroid hormone pills are also used as part of the treatment for papillary or follicular thyroid cancer. Thyroid hormone slows the growth of thyroid cancer cells left in the body after surgery.

Thyroid hormone pills seldom cause side effects. Your doctor gives you blood tests to make sure you’re getting the right dose of thyroid hormone. Too much thyroid hormone may cause you to lose weight and feel hot and sweaty. It may also cause a fast heart rate, chest pain, cramps, and diarrhea. Too little thyroid hormone may cause you to gain weight, feel cold and tired, and have dry skin and hair. If you have side effects, your doctor can adjust your dose of thyroid hormone.

Radioactive Iodine Therapy

Radioactive iodine (I-131) therapy is a treatment for papillary or follicular thyroid cancer. It kills thyroid cancer cells and normal thyroid cells that remain in the body after surgery.

People with medullary thyroid cancer or anaplastic thyroid cancer usually do not receive I-131 therapy. These types of thyroid cancer rarely respond to I-131 therapy.

Even people who are allergic to iodine can take I-131 therapy safely. The therapy is given as a liquid or capsule that you swallow. I-131 goes into the bloodstream and travels to thyroid cancer cells throughout the body. When thyroid cancer cells take in enough I-131, they die.

Many people get I-131 therapy in a clinic or in the outpatient area of a hospital and can go home afterward. Some people have to stay in the hospital for one day or longer. Ask your health care team to explain how to protect family members and coworkers from being exposed to the radiation.

Most radiation from I-131 is gone in about one week. Within three weeks, only traces of I-131 remain in the body.

During treatment, you can help protect your bladder and other healthy tissues by drinking a lot of fluids. Drinking fluids helps I-131 pass out of the body faster.

Some people have mild nausea the first day of I-131 therapy. A few people have swelling and pain in the neck where thyroid cells remain. If thyroid cancer cells have spread outside the neck, those areas may be painful too.

You may have a dry mouth or lose your sense of taste or smell for a short time after I-131 therapy. Chewing sugar-free gum or sucking on sugar-free hard candy may help.

A rare side effect in men who receive a high dose of I-131 is loss of fertility. In women, I-131 may not cause loss of fertility, but some doctors advise women to avoid getting pregnant for one year after a high dose of I-131.

Researchers have reported that a very small number of patients may develop a second cancer years after treatment with a high dose of I-131. See the “Follow-up Care” section for information about checkups after treatment.

A high dose of I-131 also kills normal thyroid cells, which make thyroid hormone. After radioactive iodine therapy, you need to take thyroid hormone pills to replace the natural hormone.

Radiation Therapy
External Radiation Therapy

External radiation therapy (also called radiotherapy) is a treatment for any type of thyroid cancer that can’t be treated with surgery or I-131 therapy. It’s also used for cancer that returns after treatment or to treat bone pain from cancer that has spread.

External radiation therapy uses high-energy rays to kill cancer cells. A large machine directs radiation at the neck or other tissues where cancer has spread.

Most patients go to the hospital or clinic for their treatment, usually 5 days a week for several weeks. Each treatment takes only a few minutes.

Chemotherapy

Chemotherapy is a treatment for anaplastic thyroid cancer. It’s sometimes used to relieve symptoms of medullary thyroid cancer or other thyroid cancers.

Chemotherapy uses drugs to kill cancer cells. The drugs are usually given by injection into a vein. They enter the bloodstream and can affect cancer cells all over the body.

You may have treatment in a clinic, at the doctor’s office, or at home. Some people may need to stay in the hospital during treatment.

Thyroid Cancer

There are several types of thyroid cancer:


* Papillary thyroid cancer: In the United States, this type makes up about 80 percent of all thyroid cancers. It begins in follicular cells and grows slowly. If diagnosed early, most people with papillary thyroid cancer can be cured.

* Follicular thyroid cancer: This type makes up about 15 percent of all thyroid cancers. It begins in follicular cells and grows slowly. If diagnosed early, most people with follicular thyroid cancer can be treated successfully.

* Medullary thyroid cancer: This type makes up about 3 percent of all thyroid cancers. It begins in the C cells of the thyroid. Cancer that starts in the C cells can make abnormally high levels of calcitonin. Medullary thyroid cancer tends to grow slowly. It can be easier to control if it's found and treated before it spreads to other parts of the body.

* Anaplastic thyroid cancer: This type makes up about 2 percent of all thyroid cancers. It begins in the follicular cells of the thyroid. The cancer cells tend to grow and spread very quickly. Anaplastic thyroid cancer is very hard to control.

Visit the National Cancer Institute where this information and more can be found about Thyroid Cancer or ask your cancer care team questions about your individual situation.

Treatment Options

The treatment that’s right for you depends mainly on your age, the grade of the tumor (the Gleason score), the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, your symptoms, and your general health. Your doctor can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

Active Surveillance

You may choose active surveillance if the risks and possible side effects of treatment outweigh the possible benefits. Your doctor may suggest active surveillance if you’re diagnosed with early stage prostate cancer that seems to be slowly growing. Your doctor may also offer this option if you are older or have other serious health problems.

Choosing active surveillance doesn’t mean you’re giving up. It means you’re putting off the side effects of surgery or radiation therapy. Having surgery or radiation therapy is no guarantee that a man will live longer than a man who chooses to put off treatment.

If you and your doctor agree that active surveillance is a good idea, your doctor will check you regularly (such as every 3 to 6 months, at first). After about one year, your doctor may order another biopsy to check the Gleason score. You may begin treatment if your Gleason score rises, your PSA level starts to rise, or you develop symptoms. You’ll receive surgery, radiation therapy, or another approach.

Active surveillance avoids or delays the side effects of surgery and radiation therapy, but this choice has risks. For some men, it may reduce the chance to control cancer before it spreads. Also, it may be harder to cope with surgery or radiation therapy when you’re older.

If you choose active surveillance but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option for most men.

Surgery
Surgery is an option for men with early (Stage I or II) prostate cancer. It’s sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it.

Before the surgeon removes the prostate, the lymph nodes in the pelvis may be removed. If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment.

There are several types of surgery for prostate cancer. Each type has benefits and risks. You and your doctor can talk about the types of surgery and which may be right for you:

  • Open surgery: The surgeon makes a large incision (cut) into your body to remove the tumor. There are two approaches:
    • Through the abdomen: The surgeon removes the entire prostate through a cut in the abdomen. This is called a radical retropubic prostatectomy.
    • Between the scrotum and anus: The surgeon removes the entire prostate through a cut between the scrotum and the anus. This is called a radical perineal prostatectomy.
  • Laparoscopic prostatectomy: The surgeon removes the entire prostate through small cuts, rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) helps the surgeon remove the prostate.
  • Robotic laparoscopic surgery: The surgeon removes the entire prostate through small cuts. A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot’s arms.
  • Cryosurgery: For some men, cryosurgery is an option. The surgeon inserts a tool through a small cut between the scrotum and anus. The tool freezes and kills prostate tissue. Cryosurgery is under study. See the section on Taking Part in Cancer Research.
  • TURP: A man with advanced prostate cancer may choose TURP(transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate.TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.

Surgery can damage the nerves around the prostate. Damaging these nerves can make a man impotent (unable to have an erection). In some cases, your surgeon can protect the nerves that control erection. But if you have a large tumor or a tumor that’s very close to the nerves, surgery may cause impotence. Impotence can be permanent. You can talk with your doctor about medicine and other ways to help manage the sexual side effects of cancer treatment.

If your prostate is removed, you will no longer produce semen. You’ll have dry orgasms. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure before surgery.

Radiation Therapy

Radiation therapy is an option for men with any stage of prostate cancer. Men with early stage prostate cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. In later stages of prostate cancer, radiation treatment may be used to help relieve pain.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:

  • External radiation: The radiation comes from a large machine outside the body. You will go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks. Many men receive 3-dimensional conformal radiation therapy or intensity-modulated radiation therapy. These types of treatment use computers to more closely target the cancer to lessen the damage to healthy tissue near the prostate.
  • Internal radiation (implant radiation or brachytherapy): The radiation comes from radioactive material usually contained in very small implants called seeds. Dozens of seeds are placed inside needles, and the needles are inserted into the prostate. The needles are removed, leaving the seeds behind. The seeds give off radiation for months. They don’t need to be removed once the radiation is gone.

Both internal and external radiation can cause impotence. You can talk with your doctor about ways to help cope with this side effect.

Hormone Therapy
A man with prostate cancer may have hormone therapy before, during, or after radiation therapy. Hormone therapy is also used alone for prostate cancer that has returned after treatment.

Male hormones (androgens) can cause prostate cancer to grow. Hormone therapy keeps prostate cancer cells from getting the male hormones they need to grow. The testicles are the body’s main source of the male hormone testosterone. The adrenal gland makes other male hormones and a small amount of testosterone.

Hormone therapy uses drugs or surgery:

  • Drugs: Your doctor may suggest a drug that can block natural hormones:
    • Luteinizing hormone-releasing hormone (LH-RH) agonists: These drugs can prevent the testicles from making testosterone. Examples are leuprolide, goserelin, and triptorelin. The testosterone level falls slowly. Without testosterone, the tumor shrinks, or its growth slows. These drugs are also called gonadotropin-releasing hormone (GnRH) agonists.
    • Antiandrogens: These drugs can block the action of male hormones. Examples are flutamide, bicalutamide, and nilutamide.
    • Other drugs: Some drugs can prevent the adrenal gland from making testosterone. Examples are ketoconazole and aminoglutethimide.
  • Surgery: Surgery to remove the testicles is called orchiectomy.

After orchiectomy or treatment with an LH-RH agonist, your body no longer gets testosterone from the testicles, the major source of male hormones. Because the adrenal gland makes small amounts of male hormones, you may receive an antiandrogen to block the action of the male hormones that remain. This combination of treatments is known as total androgen blockade (also called combined androgen blockade). However, studies have shown that total androgen blockade is no more effective than surgery or an LH-RH agonist alone.

Doctors usually treat prostate cancer that has spread to other parts of the body with hormone therapy. For some men, the cancer will be controlled for two or three years, but others will have a much shorter response to hormone therapy. In time, most prostate cancers can grow with very little or no male hormones, and hormone therapy alone is no longer helpful. At that time, your doctor may suggest chemotherapy or other forms of treatment that are under study. In many cases, the doctor may suggest continuing with hormone therapy because it may still be effective against some of the cancer cells.

Chemotherapy
Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy.

Testing & Diagnosis

Your doctor can check for prostate cancer before you have any symptoms. During an office visit, your doctor will ask about your personal and family medical history. You’ll have a physical exam. You may also have one or both of the following tests:

  • Digital rectal exam: Your doctor inserts a lubricated, gloved finger into the rectum and feels your prostate through the rectal wall. Your prostate is checked for hard or lumpy areas.
  • Blood test for prostate-specific antigen (PSA): A lab checks the level ofPSA in your blood sample. The prostate makes PSA. A high PSA level is commonly caused by BPH or prostatitis (inflammation of the prostate). Prostate cancer may also cause a high PSA level. See theNCI fact sheet The Prostate-Specific Antigen (PSA) Test: Questions and Answers.

The digital rectal exam and PSA test are being studied in clinical trials to learn whether finding prostate cancer early can lower the number of deaths from this disease.

The digital rectal exam and PSA test can detect a problem in the prostate. However, they can’t show whether the problem is cancer or a less serious condition. If you have abnormal test results, your doctor may suggest other tests to make a diagnosis. For example, your visit may include other lab tests, such as a urine test to check for blood or infection. Your doctor may order other procedures:

  • Transrectal ultrasound: The doctor inserts a probe into the rectum to check your prostate for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.
  • Transrectal biopsy: A biopsy is the removal of tissue to look for cancer cells. It’s the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.

If Cancer Is Found

If cancer cells are found, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow.

Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with your age and other factors to suggest treatment options.

One system of grading is with the Gleason score. Gleason scores range from 2 to 10. To come up with the Gleason score, the pathologist uses a microscope to look at the patterns of cells in the prostate tissue. The most common pattern is given a grade of 1 (most like normal cells) to 5 (most abnormal). If there is a second most common pattern, the pathologist gives it a grade of 1 to 5, and adds the two most common grades together to make the Gleason score. If only one pattern is seen, the pathologist counts it twice. For example, 5 + 5 = 10. A high Gleason score (such as 10) means a high-grade prostate tumor. High-grade tumors are more likely than low-grade tumors to grow quickly and spread.

Another system of grading prostate cancer uses grades 1 through 4 (G1 to G4). G4 is more likely than G1, G2, or G3 to grow quickly and spread. Read more in the Staging Section.

Staging

When prostate cancer spreads, it’s often found in nearby lymph nodes. If cancer has reached these nodes, it also may have spread to other lymph nodes, the bones, or other organs.

When cancer spreads from its original place 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 bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, it’s treated as prostate cancer, not bone cancer. Doctors call the new tumor “distant” or metastatic disease.

These are the stages of prostate cancer:

  • Stage I: The cancer can’t be felt during a digital rectal exam, and it can’t be seen on a sonogram. It’s found by chance when surgery is done for another reason, usually for BPH. The cancer is only in the prostate. The grade is G1, or the Gleason score is no higher than 4.
  • Stage II: The tumor is more advanced or a higher grade than Stage I, but the tumor doesn’t extend beyond the prostate. It may be felt during a digital rectal exam, or it may be seen on a sonogram.
  • Stage III: The tumor extends beyond the prostate. The tumor may have invaded the seminal vesicles, but cancer cells haven’t spread to the lymph nodes.
  • Stage IV: The tumor may have invaded the bladder, rectum, or nearby structures (beyond the seminal vesicles). It may have spread to the lymph nodes, bones, or to other parts of the body.

Prostate Cancer

Each year, more than 186,000 American men learn they have this disease. Prostate cancer is the second most common type of cancer among men in this country. Only skin cancer is more common.

Learning about medical care for prostate cancer can help you take an active part in making choices about your care. This booklet tells about:

  • Diagnosis and staging
  • Treatment options
  • Tests you may have after treatment

Visit the National Cancer Institute where this information and more can be found about Prostate Cancer or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el cáncer de próstata en español.

Diagnosis

If you have a symptom that suggests ovarian cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history.

You may have one or more of the following tests. Your doctor can explain more about each test:

  • Physical exam: Your doctor checks general signs of health. Your doctor may press on your abdomen to check for tumors or an abnormal buildup of fluid (ascites). A sample of fluid can be taken to look for ovarian cancer cells.
  • Pelvic exam: Your doctor feels the ovaries and nearby organs for lumps or other changes in their shape or size. A Pap test is part of a normal pelvic exam, but it is not used to collect ovarian cells. The Pap test detects cervical cancer. The Pap test is not used to diagnose ovarian cancer.
  • Blood tests: Your doctor may order blood tests. The lab may check the level of several substances, including CA-125. CA-125 is a substance found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer or other conditions. The CA-125 test is not used alone to diagnose ovarian cancer. This test is approved by the Food and Drug Administration for monitoring a woman’s response to ovarian cancer treatment and for detecting its return after treatment.
  • Ultrasound: The ultrasound device uses sound waves that people cannot hear. The device aims sound waves at organs inside the pelvis. The waves bounce off the organs. A computer creates a picture from the echoes. The picture may show an ovarian tumor. For a better view of the ovaries, the device may be inserted into the vagina (transvaginal ultrasound).
  • Biopsy: A biopsy is the removal of tissue or fluid to look for cancer cells. Based on the results of the blood tests and ultrasound, your doctor may suggest surgery (a laparotomy) to remove tissue and fluid from the pelvis and abdomen. Surgery is usually needed to diagnose ovarian cancer. To learn more about surgery, see the “Treatment” section.

Although most women have a laparotomy for diagnosis, some women have a procedure known as laparoscopy. The doctor inserts a thin, lighted tube (a laparoscope) through a small incision in the abdomen. Laparoscopy may be used to remove a small, benign cyst or an early ovarian cancer. It may also be used to learn whether cancer has spread.

A pathologist uses a microscope to look for cancer cells in the tissue or fluid. If ovarian cancer cells are found, the pathologist describes the grade of the cells. Grades 1, 2, and 3 describe how abnormal the cancer cells look. Grade 1 cancer cells are not as likely as to grow and spread as Grade 3 cells.

Treatment Options

Your doctor can describe your treatment choices and the expected results. Most women have surgery and chemotherapy. Rarely, radiation therapy is used.

Cancer treatment can affect cancer cells in the pelvis, in the abdomen, or throughout the body:

  • Local therapy: Surgery and radiation therapy are local therapies. They remove or destroy ovarian cancer in the pelvis. When ovarian cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
  • Intraperitoneal chemotherapy: Chemotherapy can be given directly into the abdomen and pelvis through a thin tube. The drugs destroy or control cancer in the abdomen and pelvis.
  • Systemic chemotherapy: When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and destroy or control cancer throughout the body.

You may want to know how treatment may change your normal activities. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

Surgery
The surgeon makes a long cut in the wall of the abdomen. This type of surgery is called a laparotomy. If ovarian cancer is found, the surgeon removes:

  • both ovaries and fallopian tubes (salpingo-oophorectomy)
  • the uterus (hysterectomy)
  • the omentum (the thin, fatty pad of tissue that covers the intestines)
  • nearby lymph nodes
  • samples of tissue from the pelvis and abdomen

If the cancer has spread, the surgeon removes as much cancer as possible. This is called “debulking” surgery.

If you have early Stage I ovarian cancer, the extent of surgery may depend on whether you want to get pregnant and have children. Some women with very early ovarian cancer may decide with their doctor to have only one ovary, one fallopian tube, and the omentum removed.

Chemotherapy
Chemotherapy uses anticancer drugs to kill cancer cells. Most women have chemotherapy for ovarian cancer after surgery. Some women have chemotherapy before surgery.

Usually, more than one drug is given. Drugs for ovarian cancer can be given in different ways:

  • By vein (IV): The drugs can be given through a thin tube inserted into a vein.
  • By vein and directly into the abdomen: Some women get IV chemotherapy along with intraperitoneal (IP) chemotherapy. For IP chemotherapy, the drugs are given through a thin tube inserted into the abdomen.
  • By mouth: Some drugs for ovarian cancer can be given by mouth.

Chemotherapy is given in cycles. Each treatment period is followed by a rest period. The length of the rest period and the number of cycles depend on the anticancer drugs used.

You may have your treatment in a clinic, at the doctor’s office, or at home. Some women may need to stay in the hospital during treatment.

Radiation Therapy

Radiation therapy is rarely used in the initial treatment of ovarian cancer, but it may be used to relieve pain and other problems caused by the disease. The treatment is given at a hospital or clinic. Each treatment takes only a few minutes.

Staging

To plan the best treatment, your doctor needs to know the grade of the tumor and the extent (stage) of the disease. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body.

Usually, surgery is needed before staging can be complete. The surgeon takes many samples of tissue from the pelvis and abdomen to look for cancer.

Your doctor may order tests to find out whether the cancer has spread:

  • CT scan: Doctors often use CT scans to make pictures of organs and tissues in the pelvis or abdomen. An x-ray machine linked to a computer takes several pictures. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly. Abdominal fluid or a tumor may show up on the CT scan.
  • Chest x-ray: X-rays of the chest can show tumors or fluid.
  • Barium enema x-ray: Your doctor may order a series of x-rays of the lower intestine. You are given an enema with a barium solution. The barium outlines the intestine on the x-rays. Areas blocked by cancer may show up on the x-rays.
  • Colonoscopy: Your doctor inserts a long, lighted tube into the rectum and colon. This exam can help tell if cancer has spread to the colon or rectum.

These are the stages of ovarian cancer:

  • Stage I: Cancer cells are found in one or both ovaries. Cancer cells may be found on the surface of the ovaries or in fluid collected from the abdomen.
  • Stage II: Cancer cells have spread from one or both ovaries to other tissues in the pelvis. Cancer cells are found on the fallopian tubes, the uterus, or other tissues in the pelvis. Cancer cells may be found in fluid collected from the abdomen.
  • Stage III: Cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes. Cancer cells may be found on the outside of the liver.
  • Stage IV: Cancer cells have spread to tissues outside the abdomen and pelvis. Cancer cells may be found inside the liver, in the lungs, or in other organs.

Ovarian Cancer

Ovarian epithelial cancer is the most common type of ovarian cancer. It begins in the tissue that covers the ovaries. This information is not about ovarian germ cell tumors or other types of ovarian cancer. To find out more about all types of of ovarian cancer, please visit the National Cancer Institute Web site or ask your cancer care team about your individual situation.

Staging

If the diagnosis is melanoma, the doctor needs to learn the extent, or stage, of the disease before planning treatment. Staging is a careful attempt to learn how thick the tumor is, how deeply the melanoma has invaded the skin, and whether melanoma cells have spread to nearby lymph nodes or other parts of the body. The doctor may remove nearby lymph nodes to check for cancer cells. (Such surgery may be considered part of the treatment because removing cancerous lymph nodes may help control the disease.) The doctor also does a careful physical exam and, if the tumor is thick, may order chest x-rays, blood tests, and scans of the liver, bones, and brain.

The following stages are used for melanoma:

  • Stage 0: In stage 0, the melanoma cells are found only in the outer layer of skin cells and have not invaded deeper tissues.
  • Stage I: Melanoma in stage I is thin:
    • The tumor is no more than 1 millimeter (1/25 inch) thick. The outer layer (epidermis) of skin may appear scraped. (This is called an ulceration).
    • Or, the tumor is between 1 and 2 millimeters (1/12 inch) thick. There is no ulceration. The melanoma cells have not spread to nearby lymph nodes.
  • Stage II: The tumor is at least 1 millimeter thick:
    • The tumor is between 1 and 2 millimeters thick. There is ulceration.
    • Or, the thickness of the tumor is more than 2 millimeters. There may be ulceration. The melanoma cells have not spread to nearby lymph nodes.
  • Stage III: The melanoma cells have spread to nearby tissues:
    • The melanoma cells have spread to one or more nearby lymph nodes.
    • Or, the melanoma cells have spread to tissues just outside the original tumor but not to any lymph nodes.
  • Stage IV: The melanoma cells have spread to other organs, to lymph nodes, or to skin areas far away from the original tumor.
  • Recurrent: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may have come back in the original site or in another part of the body.

Diagnosis

If the doctor suspects that a spot on the skin is melanoma, the patient will need to have a biopsy. A biopsy is the only way to make a definite diagnosis. In this procedure, the doctor tries to remove all of the suspicious-looking growth. This is an excisional biopsy. If the growth is too large to be removed entirely, the doctor removes a sample of the tissue. The doctor will never “shave off” or cauterize a growth that might be melanoma.

A biopsy can usually be done in the doctor’s office using local anesthesia. A pathologist then examines the tissue under a microscope to check for cancer cells. Sometimes it is helpful for more than one pathologist to check the tissue for cancer cells.

Melanoma

Melanoma is the most serious type of cancer of the skin. Each year in the United States, more than 53,600 people learn they have melanoma.


In some parts of the world, especially among Western countries, melanoma is becoming more common every year. In the United States, for example, the percentage of people who develop melanoma has more than doubled in the past 30 years.

Visit the National Cancer Institute where this information and more can be found about Melanoma or ask your cancer care team questions about your individual situation.

Treatment Options

Your doctor can describe your treatment choices and what to expect. You and your doctor can work together to develop a treatment plan that meets your needs.

Sometimes all of the cancer is removed during the biopsy. In such cases, no more treatment is needed. If you do need more treatment, your doctor will describe your options.

Treatment for skin cancer depends on the type and stage of the disease, the size and place of the growth, and your general health and medical history. In most cases, the aim of treatment is to remove or destroy the cancer completely.

It often helps to make a list of questions before an appointment. To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor — to take part in the discussion, to take notes, or just to listen.

Surgery

Surgery to treat skin cancer may be done in one of several ways. The method your doctor uses depends on the size and place of the growth and other factors.

Your doctor can further describe these types of surgery:

  • Excisional skin surgery is a common treatment to remove skin cancer. After numbing the area, the surgeon removes the growth with a scalpel. The surgeon also removes a border of skin around the growth. This skin is the margin. The margin is examined under a microscope to be certain that all the cancer cells have been removed. The size of the margin depends on the size of the growth.
  • Mohs surgery (also called Mohs micrographic surgery) is often used for skin cancer. The area of the growth is numbed. A specially trained surgeon shaves away thin layers of the growth. Each layer is immediately examined under a microscope. The surgeon continues to shave away tissue until no cancer cells can be seen under the microscope. In this way, the surgeon can remove all the cancer and only a small bit of healthy tissue.
  • Electrodesiccation and curettage is often used to remove small basal cell skin cancers. The doctor numbs the area to be treated. The cancer is removed with a sharp tool shaped like a spoon. This tool is a curette. An electric current is sent into the treated area to control bleeding and kill any cancer cells that may be left. Electrodesiccation and curettage is usually a fast and simple procedure.
  • Cryosurgery is often used for people who are not able to have other types of surgery. It uses extreme cold to treat early stage or very thin skin cancer. Liquid nitrogen creates the cold. The doctor applies liquid nitrogen directly to the skin growth. This treatment may cause swelling. It also may damage nerves, which can cause a loss of feeling in the damaged area. The NCI fact sheet “Cryosurgery in Cancer Treatment: Questions and Answers” has more information.
  • Laser surgery uses a narrow beam of light to remove or destroy cancer cells. It is most often used for growths that are on the outer layer of skin only. The NCI fact sheet “Lasers in Cancer Treatment: Questions and Answers” has more information.
  • Grafts are sometimes needed to close an opening in the skin left by surgery. The surgeon first numbs and then removes a patch of healthy skin from another part of the body, such as the upper thigh. The patch is then used to cover the area where skin cancer was removed. If you have a skin graft, you may have to take special care of the area until it heals.

Topical Chemotherapy

Chemotherapy uses anticancer drugs to kill skin cancer cells. When a drug is put directly on the skin, the treatment is topical chemotherapy. It is most often used when the skin cancer is too large for surgery. It is also used when the doctor keeps finding new cancers.

Most often, the drug comes in a cream or lotion. It is usually applied to the skin one or two times a day for several weeks. A drug called fluorouracil (5-FU) is used to treat basal cell and squamous cell cancers that are in the top layer of the skin only. A drug called imiquimod also is used to treat basal cell cancer only in the top layer of skin.

Photodynamic Therapy

Photodynamic therapy (PDT) uses a chemical along with a special light source, such as a laser light, to kill cancer cells. The chemical is a photosensitizing agent. A cream is applied to the skin or the chemical is injected. It stays in cancer cells longer than in normal cells. Several hours or days later, the special light is focused on the growth. The chemical becomes active and destroys nearby cancer cells.

PDT is used to treat cancer on or very near the surface of the skin.

The side effects of PDT are usually not serious. PDT may cause burning or stinging pain. It also may cause burns, swelling, or redness. It may scar healthy tissue near the growth. If you have PDT, you will need to avoid direct sunlight and bright indoor light for at least 6 weeks after treatment.

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. The rays come from a large machine outside the body. They affect cells only in the treated area. This treatment is given at a hospital or clinic in one dose or many doses over several weeks.

Radiation is not a common treatment for skin cancer. But it may be used for skin cancer in areas where surgery could be difficult or leave a bad scar. You may have this treatment if you have a growth on your eyelid, ear, or nose. It also may be used if the cancer comes back after surgery to remove it.

Staging

If the biopsy shows that you have cancer, your doctor needs to know the extent (stage) of the disease. In very few cases, the doctor may check your lymph nodes to stage the cancer.

The stage is based on:

  • The size of the growth
  • How deeply it has grown beneath the top layer of skin
  • Whether it has spread to nearby lymph nodes or to other parts of the body

These are the stages of skin cancer:

  • Stage 0: The cancer involves only the top layer of skin. It is carcinoma in situ.
  • Stage I: The growth is 2 centimeters wide (three-quarters of an inch) or smaller.
  • Stage II: The growth is larger than 2 centimeters wide (three-quarters of an inch).
  • Stage III: The cancer has spread below the skin to cartilage, muscle, bone, or to nearby lymph nodes. It has not spread to other places in the body.
  • Stage IV: The cancer has spread to other places in the body.

Diagnosis

If you have a change on the skin, the doctor must find out whether it is due to cancer or to some other cause. Your doctor removes all or part of the area that does not look normal. The sample goes to a lab. A pathologist checks the sample under a microscope. This is a biopsy. A biopsy is the only sure way to diagnose skin cancer.

You may have the biopsy in a doctor’s office or as an outpatient in a clinic or hospital. Where it is done depends on the size and place of the abnormal area on your skin. You probably will have local anesthesia.

There are four common types of skin biopsies:

  1. Punch biopsy: The doctor uses a sharp, hollow tool to remove a circle of tissue from the abnormal area.
  2. Incisional biopsy: The doctor uses a scalpel to remove part of the growth.
  3. Excisional biopsy: The doctor uses a scalpel to remove the entire growth and some tissue around it.
  4. Shave biopsy: The doctor uses a thin, sharp blade to shave off the abnormal growth.

Treatment Options

There are different types of treatment for patients with small cell lung cancer.

Different types of treatment are available for patients with small cell lung cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Five types of standard treatment are used:

Surgery

Surgery may be used if the cancer is found in one lung and in nearby lymph nodes only. Because this type of lung cancer is usually found in both lungs, surgery alone is not often used. Occasionally, surgery may be used to help determine the patient’s exact type of lung cancer. During surgery, the doctor will also remove lymph nodes to see if they contain cancer.

Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. Prophylactic cranial irradiation (radiation therapy to the brain to reduce the risk that cancer will spread to the brain) may also be given. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Laser therapy

Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.

Endoscopic stent placement

An endoscope is a thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may be used to place a stent in a body structure to keep the structure open. Endoscopic stent placement can be used to open an airway blocked by abnormal tissue.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Nonmelanoma Skin Cancer

Skin cancer (non-melanoma) is the most common type of cancer in the United States. They are named for the type of cells that become cancerous.

The two most common types of skin cancer are basal cell cancer and  squamous cell cancer. These cancers usually form on the head, face, neck, hands, and arms. These areas are exposed to the sun. But skin cancer can occur anywhere.

  • Basal cell skin cancer grows slowly. It usually occurs on areas of the skin that have been in the sun. It is most common on the face. Basal cell cancer rarely spreads to other parts of the body.
  • Squamous cell skin cancer also occurs on parts of the skin that have been in the sun. But it also may be in places that are not in the sun. Squamous cell cancer sometimes spreads to lymph nodes and organs inside the body.

If skin cancer spreads from its original place to another part of the body, the new growth has the same kind of abnormal cells and the same name as the primary growth. It is still called skin cancer.

Visit the National Cancer Institute where this information and more can be found about Skin Cancer or ask your cancer care team questions about your individual situation.

Staging

After small cell lung cancer has been diagnosed, tests are done to find out if cancer cells have spread within the chest or to other parts of the body.

The process used to find out if cancer has spread within the chest or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Some of the tests used to diagnose small cell lung cancer are also used to stage the disease. (See the General Information section.) Other tests and procedures that may be used in the staging process include the following:

  • Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
  • Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
  • MRI (magnetic resonance imaging) of the brain: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. EUS may be used to guide fine-needle aspiration (FNA) biopsy of the lung, lymph nodes, or other areas.
  • Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.
  • Radionuclide bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

The following stages are used for small cell lung cancer:

Limited-Stage Small Cell Lung Cancer
In limited-stage, cancer is found in one lung, the tissues between the lungs, and nearby lymph nodes only.

Extensive-Stage Small Cell Lung Cancer
In extensive-stage, cancer has spread outside of the lung in which it began or to other parts of the body.

Diagnosis

Tests and procedures that examine the lungs are used to detect (find), diagnose, and stage small cell lung cancer.

The following tests and procedures may be used:

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

CT scan (CAT scan) of the brain, chest, and abdomen: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Sputum cytology: A microscope is used to check for cancer cells in the sputum (mucus coughed up from the lungs).

Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Fine-needle aspiration (FNA) biopsy of the lung: The removal of tissue or fluid from the lung using a thin needle. A CT scan, ultrasound, or other imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. A chest x-ray is done after the procedure to make sure no air is leaking from the lung into the chest.

Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure is used to remove part of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.

Thoracentesis: The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.

Small Cell Lung Cancer

There are two types of small cell lung cancer.

These two types include many different types of cells. The cancer cells of each type grow and spread in different ways. The types of small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look when viewed under a microscope:

  • Small cell carcinoma (oat cell cancer).
  • Combined small cell carcinoma.

Smoking tobacco is the major risk factor for developing small cell lung cancer.

Visit the National Cancer Institute where this information and more can be found about Small Cell Lung Cancer or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el cáncer de pulmón de células pequeñas.

Treatment Options

Occult Non-Small Cell Lung Cancer

Treatment of occult non-small cell lung cancer depends on where the cancer has spread. It can usually be cured by surgery.

Stage 0
Treatment of stage 0 may include the following:

  • Surgery (wedge resection or segmental resection).
  • Photodynamic therapy using an endoscope.
  • Electrocautery, cryosurgery, or laser surgery using an endoscope.

Stage I
Treatment of stage I non-small cell lung cancer may include the following:

  • Surgery (wedge resection, segmental resection, sleeve resection, or lobectomy).
  • External radiation therapy (for patients who cannot have surgery or choose not to have surgery).
  • A clinical trial of surgery followed by chemoprevention.

Stage II
Treatment of stage II non-small cell lung cancer may include the following:

  • Surgery (wedge resection, segmental resection, sleeve resection, lobectomy, or pneumonectomy).
  • External radiation therapy (for patients who cannot have surgery or choose not to have surgery).
  • Surgery followed by chemotherapy.

Stage III
Treatment of stage IIIA non-small cell lung cancer that can be removed with surgery may include surgery followed by chemotherapy.

Treatment of stage IIIA non-small cell lung cancer that cannot be removed with surgery may include the following:

  • Chemotherapy combined with radiation therapy.
  • External radiation therapy alone (for patients who cannot be treated with combined therapy).

Some stage IIIA non-small cell lung tumors that have grown into the chest wall may be completely removed. Treatment of chest wall tumors may include the following:

  • Surgery.
  • Surgery and radiation therapy.
  • Radiation therapy alone.
  • Chemotherapy combined with radiation therapy and/or surgery.

Treatment of stage IIIB non-small cell lung cancer may include the following:

  • Chemotherapy combined with external radiation therapy.
  • External radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life.

Stage IV
Treatment of stage IV non-small cell lung cancer may include the following:

  • External radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life.
  • Combination chemotherapy.
  • Combination chemotherapy and targeted therapy.
  • Laser therapy and/or internal radiation therapy using an endoscope.