Detecting and Treating Cancer

The earlier a cancer is detected, the better a person's chances are of a full recovery. For many cancers, early treatment can prevent the cancer from growing, invading other organs, and spreading to other parts of the body. Unfortunately, cancer is not always easy to identify, since symptoms vary greatly and may be similar to symptoms of many other illnesses. Sometimes there are no symptoms at all. Before the mid-1950s cancer was called “the silent killer.” By the time they saw a doctor, most cancer patients already had advanced cancer that had spread to other parts of the body. Today, scientists are constantly finding new and better ways to detect, diagnose, and treat cancer. It is most important, however, for individuals to be aware of how they can help detect cancer at an early stage.

Cancer's Warning Signs

The American Cancer Society (ACS) recognizes seven warning signs that may indicate cancer:

C hange in bowel or bladder habits
A sore that does not go away
U nusual bleeding or discharge
T hickening or lump in neck, breast, or other area
I ndigestion or difficulty swallowing
O bvious change in wart or mole
N agging cough or hoarseness

The first letters of the seven signs spell “caution.” People who note one or more of these signs may not have cancer, but they should report their symptoms to their doctor. Another suspicious symptom is unusual tiredness, especially when it is combined with one of the seven signs listed by the ACS.

The ABCDE Rule

Melanoma, the most serious kind of skin cancer, is a widespread type of cancer in the United States. Physicians say it is important that everyone keep a careful watch for any changes in moles on their bodies, as these could be signs of melanoma. Doctors recommend checking moles using the ABCDE rule:

A for asymmetry
   A mole that does not look the same on both sides.

B for border
   A mole with edges that are ragged or fuzzy.

C for color
   A mole that varies in shade from dark brown to red or blue or that has lost color.

D for difference
   A mole that has changed in size, shape, or color or become itchy.

E for elevation
   A mole that is raised above the skin and has an uneven surface.

If any of these symptoms exist, it is recommended that the individual schedule a checkup with a dermatologist.

Clark played football in high school and was a frequent basketball and tennis player all through his four years of college. He appeared to have boundless energy. He was president of his fraternity. He drove a school bus for several hours a day to earn extra spending money. He could study into the early hours for an exam and ace it the next day. When he entered medical school, he developed a hacking cough that wouldn't go away. He also began losing weight. Because his parents lived in a town some distance away, he was able to keep them from knowing what was going on. At this exciting point in his life he did not want any interruptions!

When his energy began to lag and the nagging cough continued, his girlfriend urged him to see a doctor. But Clark was too busy trying to keep up with classwork and the lab experiments he was doing in connection with mice and cancer drugs. Finally, though, when he developed night sweats and could barely drag himself through the day, he went to the school's doctor. Tests revealed he had Hodgkin's disease, a malignant disease of the lymphatic system. Clark's cancer was extensive, and he underwent a series of chemotherapy treatments. The treatments left him nauseated and fatigued, and they caused his hair to fall out. He had to drop all of his classes except two. In those two he did well, making As.

After months of treatment, Clark's cancer went into remission. His hair grew back, and he got back some of his old energy and drive. Unfortunately, within a few months the cancer returned, and Clark had to undergo another round of chemotherapy. He is again slowly recovering and hopes to be able to resume his medical studies. He and his family and friends often wonder, though, what would have happened if he had paid attention to the early warning signs.

Self-Examination for Men and Women

Early cancer usually does not cause pain. Even when warning symptoms—like those experienced by Clark—develop, many people do not check with their doctors. They know the same symptoms can occur with illnesses other than cancer. It is not easy to face the possibility of cancer, so they ignore the warnings. This can be a big mistake.

In addition to paying attention to warning symptoms, everyone needs to practice self-exams regularly. Women should do monthly breast self-examinations, following the instructions of their doctor or other health-care provider. They should be alert for lumps, knots, thickening, or dimpling in their breasts and for any changes in the appearance of the nipples. These changes should be reported to their doctor. Although most breast lumps are not cancer, only a professional examiner can make a diagnosis.

Men should do monthly testicular self-exams, checking for lumps, swelling, and tenderness or pain in their testicles. Testicular cancer occurs most often in men between the ages of fifteen and forty. In Cancer Information for Teens, Wilma R. Caldwell writes: “For men, starting at age 15, monthly self-exams of the testicles are an effective way of detecting testicular cancer at an early—and very curable—stage.”⁴ In addition to lumps, swelling, or enlargement in the testicle, warning signs of testicular cancer may include an ache in the lower abdomen, back, or groin, or pain in the testicle or the scrotum.

Lance Armstrong is perhaps the best-known survivor of testicular cancer. The cycling champion has won multiple international contests, and has been called the best cyclist ever. In 1996, when the twenty-five-year-old athlete began having severe pain in his groin, he went to see a doctor. He was diagnosed with testicular cancer, which had spread to his lungs, stomach, and brain. After a long period of difficult treatments, he returned to successful competition.

Thirty-nine-year-old world and Olympic figure-skating champion Scott Hamilton's warning symptom was a persistent stomachache. In 1997 Hamilton's doctor discovered that his problem was testicular cancer. The overall cure rate for this type of cancer is over 90 percent when it is detected early, and Hamilton appears to be one of the lucky ones.

Looking for Subtle Signs

Armstrong and Hamilton were fortunate that warning symptoms made them check with their doctors. Sometimes the signs are subtle or vague—or missing entirely, until it is too late for successful treatment. Everyone should be aware of what is going on with their own bodies by giving themselves regular checkups—at least in the areas that can be seen or felt.

Oral cancers can affect all areas of the mouth, including the lips, the teeth, the tongue, the gums, the lining of the cheeks, the floor of the mouth, and the bony top of the mouth. Self-examination is done by looking in a mirror to check for changes in the color of the lips, gums, tongue, or inner cheek and to search for scabs, cracks, sores, white patches, swelling, or bleeding. Any abnormalities should be reported to a doctor.

Basal cell carcinoma of the skin is the most common human cancer. It arises from the basal cells—small, round cells found in the outer layer of the skin. Squamous cell carcinoma of the skin begins in the thin, flat cells resembling fish scales found in the tissue that forms the surface of the skin. Melanoma arises in the cells that produce pigment and usually begins in a mole. Common signs that warn of skin cancer or the potential of skin cancer are spots on the skin that grow and do not heal; bleeding sores that will not go away; and moles that keep growing, are itchy, or change shape or color.

Screening Tests for Cancer

Many people are alive today because they observed the warning signs of cancer or discovered suspicious areas through self-examination and reported these to their doctors. Others are alive because of cancer-screening procedures that are practiced routinely in many countries. Screening for cancer across a healthy population can identify individuals who have the disease but do not as yet have symptoms—in other words, looking for cancer before it shows any signs. The World Health Organization says successful screening programs depend on three principles:

• The target disease should be a common form of cancer, with high associated morbidity [sickness] and mortality [death].
• Effective treatment, capable of reducing morbidity and mortality, should be available.
• Test procedures should be acceptable, safe, and relatively inexpensive.⁵

Some proven screening tests have undoubtedly saved many lives. Mammograms are low-dose X-rays of the breasts that can reveal tumors. The Pap test is used to screen for cervical cancer. In this test, a doctor scrapes sample cells from the cervix, which is located at the top of the vagina. The cells are then checked by microscopic examination for cancer or changes that may lead to cancer. In older men, prostate cancer is common, and there are several effective screening tests for this type of cancer. There are also several methods of screening for colon cancer.

Diagnosing Cancer

When routine screening tests or signs or symptoms indicate that cancer may be present, a doctor will usually order various tests. Laboratory examination of blood and urine samples may yield important information. There are also ways doctors can actually look inside the body. Tests that make pictures of the inside of the body are known as imaging tests.

X-rays are the most common imaging test. As X-rays pass through the body, they create images that are recorded on special photographic film. Since X-rays pass through soft tissue more easily than dense tissue, solid tumors show up against the softer tissue around them.

Computerized axial tomography, also known as CAT scans, produces clearer, more detailed pictures than ordinary X-ray images. The CAT scan sends tiny streams of X-rays through the body at various angles. Although a CAT scan cannot detect very small tumors, it can detect tumors in internal organs, such as the lungs and brain, and can provide valuable information about a tumor's size and type.

Magnetic resonance imaging, or MRI, is more sophisticated than a CAT scan. It uses a powerful magnet linked to a computer to make detailed pictures of different areas in the body. These pictures can be viewed on a monitor and can also be printed out.

Even more efficient and specialized imaging tests are constantly being devised to detect the most elusive cancers.

Biopsy

After a tumor is discovered, the next step is to determine whether it is benign or malignant. The only sure way to know is through a biopsy. In a biopsy, a sample of tissue is taken from the abnormal area, or the whole tumor may be removed. The sample is examined under a microscope to determine whether it is malignant and, if so, what kind of cancer it is and whether the cells are likely to grow rapidly or slowly.

One method of obtaining material in a biopsy is by using an endoscope—a long fiber-optic cable with a small forceps on the end. The endoscope can be inserted into internal body cavities such as the bronchus, trachea, bladder, or gastrointestinal tract. The doctor can then view the area and may use the forceps to remove a tissue sample from a suspicious region.

In other areas of the body biopsies are performed by fine needle aspiration. This procedure involves pushing a small, hollow needle into the suspicious area and removing a sample of cells to analyze. Fine needle aspiration is particularly useful for reaching suspicious areas that would be difficult to reach without doing major surgery. Biopsies of the breasts, thyroid gland, pancreas, lungs, and liver are usually done this way. Leukemia patients may undergo a bone marrow biopsy in which a needle is inserted into the marrow cavity of a bone and a portion of the bone marrow is removed for examination. If the tests on the biopsied cells come back positive, the patient can begin treatment quickly, increasing the chance for a full recovery. Treatment is aimed at removing or killing cancer cells.

Treating Cancer

Oncologists today have a number of different options in treating cancer patients. Sometimes they use a combination of methods. For example, after surgery is used to remove the main tumor mass, chemotherapy and/or radiation treatment may be used to kill any stray cancer cells that have escaped from the tumor. The kind of treatment recommended will depend on the patient's age, health, and medical history as well as on the type of cancer, how much it has grown, and whether or not it has spread from its original location.

Surgery

Surgery is the oldest type of cancer treatment, and it is still the first and best option for many tumors in the earliest stages. If the tumor can be removed before it has metastasized, the patient can be completely cured. In conventional surgery, the surgeon must try to cut out all of the cancer cells, even if it means taking out some normal tissue surrounding the tumor. In addition to cutting out the tumor, the surgeon may remove one or more of the nearby lymph nodes. If the lymph nodes contain tumor cells, that means the cancer has spread beyond the site of its origin and may already have migrated to other tissues. If the nodes are positive for cancer cells, additional therapy, such as chemotherapy, is likely to be indicated.

Cryosurgery, also called cryotherapy, is a technique of freezing and killing abnormal cells. It can be used on both internal tumors and external tumors such as those on the skin. In cryosurgery, liquid nitrogen or argon gas is used to produce extreme cold. For skin tumors, liquid nitrogen is applied directly to the cancer with a swab or spraying device. For internal tumors, liquid nitrogen or argon gas is circulated through a hollow instrument called a cryoprobe, which is placed in contact with the tumor. Although cryosurgery is not appropriate for all cancers, it has some important advantages over conventional surgery. It has fewer side effects, it is less expensive, and it requires a shorter recovery time.

Laser surgery is a technique in which the surgeon uses a focused beam of high-energy light to vaporize cancer cells. In this high-tech method of zapping tumors, surrounding tissue is not destroyed. The laser produces heat that sterilizes the surgical site, so there is a lower risk of infection. Today, laser surgery is the standard treatment for a number of kinds of cancer.

Chemotherapy

Chemotherapy—treatment with powerful chemicals—has proven to be an effective method of fighting cancer. Chemotherapy can be given in different ways: through a vein (intravenously, or IV), orally, using an injection or shot, or by applying directly to the skin. When the drugs are given by mouth, they are in the form of pills, capsules, or liquid. Needles and syringes are used to give injections either into a muscle, under the skin, or directly into cancerous areas in the skin. The drugs may also be applied to the surface of the skin. But most often chemotherapy is given intravenously.

The side effects of chemotherapy vary with each individual. The drugs used in chemotherapy are often very toxic. Common side effects are nausea, fatigue, weight loss, and hair loss. Donna, a young college professor, underwent chemotherapy after having a cancerous breast removed. The cancer had metastasized, and the potent drugs used in the chemo treatment were designed to find and destroy cells that had spread. Donna kept on with her teaching schedule. She explained her condition to her students so they understood why she was often so tired she remained seated during classes. They also understood that the brightly colored bandannas she wore covered her hair loss. Their sympathetic understanding enabled her to keep teaching—a job she loved and one that kept her from brooding over her condition. Other cancer patients, like Clark, manage to keep up with their careers by cutting down on their workload.

Radiation

Radiation therapy is another common way to treat cancer. According to the National Cancer Institute, more than half of all patients with cancer undergo some form of radiation therapy during treatment. Radiation may be used alone or in combination with other types of treatment. Different kinds of cancer are treated with different types of radiation. Sometimes the goal of radiation is to completely destroy a tumor. In other cases, the goal is to shrink a tumor and relieve symptoms such as pain.

In external radiation therapy, a special machine outside the body delivers X-rays to tumors inside the body. To help protect normal cells from the effects of radiation, the treatments are usually given in small doses five days a week for a period of several weeks. The treatments are painless.

Internal radiation, in which small capsules or other vessels containing the radiation are implanted into or near a tumor, is less commonly used. This procedure may require a hospital stay of a few days. Other ways of delivering internal radiation are to have the patient swallow a radioactive material or to inject a radioactive substance into the bloodstream or body cavity.

Some radiation patients suffer no side effects from the treatment. For those who do, the most common side effects are fatigue and skin irritation. Depending on the type of cancer and its location in the body, radiation treatment may cause patients to suffer from diarrhea, hair loss, and dental problems. Fortunately for most people, the side effects disappear in a few months after the treatments are over.

Feeling Better by Looking Better

In addition to the trauma of having the disease, cancer patients have to cope with various side effects brought on by treatments. For example, hair loss is a major concern for chemotherapy patients. There are a number of nonprofit organizations, though, that help cancer patients feel better about their appearance. Locks of Love and Wigs for Kids were created to provide complimentary hairpieces for children and young adults undergoing chemotherapy. People can donate their long hair to these organizations, which then make the hair into custom-made wigs for eligible patients.

Look Good … Feel Better is a program developed by the Personal Care Products Council Foundation in cooperation with the American Cancer Society. At the local level, beauticians from various salons donate their time and talent to hold workshops at which they instruct cancer patients in skin care, makeup, and the use of wigs, turbans, and scarves to help them look better. Large cosmetic companies donate generous gifts of makeup and perfumes, which the beauticians distribute to participants. There is also a Look Good … Feel Better for Teens, which offers an Internet network as well as local meetings.

Other Cancer Treatments

Researchers are constantly searching for better ways to treat cancer. Some of their discoveries have proven to be lifesavers. For example, leukemia was once considered incurable. Today bone marrow transplants give hope to thousands of leukemia victims.

Immunotherapy works to use the body's own defense system to fight cancer. It uses substances designed to strengthen the patient's immune system and make it more effective in recognizing and attacking cancer cells. Vaccines are also used to stimulate the immune system. Interferons, chemical messengers used to fight viruses, inhibit tumor cells from reproducing. Hormonal treatments are also under study. Hormones are substances secreted by certain glands that pass into the blood and stimulate the action of specific organs. It has been shown that certain hormones made by the testes and ovaries can influence the growth of tumors in the breast and prostate. Today, instead of surgically removing the testes or ovaries, drugs are used to block the effects of these hormones.

Although there are other new and potentially helpful treatments being studied by researchers, in general, doctors and cancer treatment facilities do not accept alternative treatments. These treatments include special diets, medicines made from various plants, and vitamin supplements. The National Cancer Institute is constantly reviewing and testing alternative treatments to weigh their possible benefits against the possibility of their doing harm. Most doctors agree that trying to cure cancer with alternative therapies alone may keep patients from receiving standard treatments that have been proven effective.