Quick Links

Who We Are

Your submission was successful! A member of our staff will be in touch soon to make your referral appointment.

At this time, The Hope Center for Cancer Care is encouraging our healthcare practitioners to utilize telemedicine when appropriate to replace in-person healthcare visits. Your cancer care provider will determine whether it is appropriate for you to be seen via telemedicine or whether an in-person visit is necessary. If you are interested in scheduling a telemedicine appointment, please contact our staff at:

Youngstown:

330-318-1100

Warren:

330-856-8600

Click here for instructions on how to use our telemedicine service.

Click to see frequently asked questions.

Helpful Guides for Your Device:

iPhone:

Android:

Computer:  

Our new Dispensary and Prescriptions management is now open on-site for added convenience, quick turn-around and personalized care.

The experienced and highly-skilled care team at The Hope Center for Cancer Care make sure each medication dosage is precise and secure. Patients can conveniently fill their prescriptions, and get expert advice and consultation from a physician specially trained to meet the unique needs of cancer patients.

  • No need to go elsewhere for your oral cancer medications
  • We can coordinate your refills with your office visits for added convenience
  • You’ll receive medication counseling and follow up from a team you already know and trust
  • We’ll confirm your benefits and go the extra mile to investigate alternative co-pay assistance options if needed
  • We accept most prescription benefits
  • We offer competitive pricing and friendly service

Frequently Asked Questions and Medically Integrated Pharmacy Advantages

Why are you offering in-office oral medication therapy?

Providing you with the most comprehensive treatment is our priority. Oral oncology drugs are different and require a level of specialization you may not find at your local pharmacy. Working closely with your doctor, we have the insight and expertise to know how your oral medications fit in with your treatment plan and how to manage side effects. In order for you to receive the most comprehensive, personalized care, it is to your benefit that your doctor can closely monitor your treatment and you can get all of your drugs as quickly and conveniently as possible. We are here to help!

What type of products do you fill?

We provide you with any self-administered or oral medications that you may need during the course of your chemotherapy and supportive therapy. You may receive the infused oncology chemotherapy per your individual treatment plan during your visit to our practice. We will also provide any additional oral medications that you can take at home, self-administered as directed by your doctor.

Do you accept my prescription benefits coverage?

We are able to process prescription claims with most major prescription benefits providers. If your plan requires you to use a selective pharmacy, we can help you determine your options for getting your prescriptions filled.

How long will it take to receive my medication?

We will fill your prescription as quickly as possible after verifying your benefits coverage and reviewing alternative co-payment assistance resources if needed.

How will I be notified my prescription is ready?

We will notify you when prescription is available. You can stop by and pick it up on your way out or we will arrange for you to get your prescriptions and counseling as soon as possible.

Will it cost me more to fill my prescription here than at a retail pharmacy?

The co-payments are determined by your individual plan and costs are comparable. Since we are able to help you determine any additional co-pay assistance or other financial options available to you it's possible you could save money.

When can I start using this service?

Talk to your doctor or clinical staff for details. Just make sure you have provided your prescription benefit card to the front desk for our files. We'll do the rest, and be there with you every step of the way.

Do I have to fill my prescription at your office?

You are welcome to fill your prescription at any pharmacy that accepts your prescription benefits coverage and meets special handling requirements for your oncology drugs. We simply offer this service as a convenience and total care option to you.

Local Resources

National Organizations

Disease-Specific Organizations

Patient Advocacy/Survivorship

Patient & Family Support Services

To ensure you never miss an important medication, it is always best to stay on top of your prescriptions and have all necessary medications prescribed during your scheduled office visits or cancer care treatment with your oncologist or another member of your cancer care team.

A good way to do ensure this happens, is by bringing your preferred pharmacys phone number and all of your current prescription medication bottles with you to each visit with your cancer specialists. If any prescriptions need to be filled, we can handle that promptly during your office visit.

By law, narcotics require a written prescription. Narcotics include, but are not limited to, Percocet, MS Contin and Oxycontin. For our protection, and yours, we must strictly adhere to Federal regulations, and no exceptions can be made. This means any prescription requests for narcotics must be addressed during office visits with your physician. No narcotic pain prescriptions can be made after office hours or during the weekends. Thank you in advance for understanding the importance of this policy.

We urge you to carefully monitor your pain medication and allow ample time to acquire a written prescription. We are also available to handle non-narcotic refill requests over the phone during regular office hours. All prescription requests will be handled promptly.

If you are experiencing a life-threatening emergency, please dial 9-1-1.

For assistance on urgent matters, please call the operator and ask them to page our on call healthcare provider.

Non-emergent calls will be returned by a nurse or a physician within 24 hours.

A New Convenient Way to Connect: Online!

Access your records and other confidential information through our secure online portal.

 

https://accounts.flatiron.com/account/login

Being newly diagnosed with cancer raises several questions--and to ensure you make the best decisions about your cancer treatment, it is important to be educated and informed. The sooner you gather information regarding your cancer diagnosis, treatment and potential side effects, the sooner you’ll be able to move forward, with confidence, during your cancer journey.

Your cancer care team is the best source of information, so good communication with them is important. Don’t be afraid to speak up. They are there to answer any questions or address any concerns you may have during your treatment process.

Since it can be hard to remember everything that crosses your mind, we suggest writing it down to make it easier. To make the most out of each visit, bring your notes with you. A notebook is a useful tool to keep all of your thoughts, questions, and notes in one place. We also recommend reaching out to friends and family, asking them to accompany you during appointments and help you remember questions you have and take notes of information you receive.

Below are some general questions you may want to ask your cancer care team. We have them broken up by topic.

Cancer Diagnosis

  • Exactly what kind of cancer do I have?
  • Where is the cancer located?
  • What is the cancer’s stage? What does that mean?
  • What are my chances of survival, based on what you see?
  • How much experience do you have treating this type of cancer?
  • What are my treatment choices?
  • What treatment do you recommend?
  • What is the ultimate goal of my treatment?
  • Is genetic testing something I (or my family) could benefit from?
  • Should I get a second opinion? How do I do that?
  • Am I a good candidate for cancer clinical trials?

Treatment Plan

  • What are the chances the cancer will return after treatment?
  • If the treatment doesn’t work or the cancer comes back, what are the next steps?
  • How will treatment affect my pregnancy? Will if affect getting pregnant in the future?
  • What will treatment cost me? Will insurance cover any of it?
  • How long will treatment last? What does it involve?
  • Where will I be treated?
  • What risks will I face? What are the possible side effects?
  • Is there anything I can do to reduce risks or side effects?
  • How will treatment affect my daily routine?
  • Is treatment painful?

Before, During & After Treatment

  • What can I do to prepare for cancer treatment?
  • Should I make any lifestyle changes?
  • How will we know if treatment is working?
  • Is there anything I can do to manage possible side effects?
  • Is my activity limited? If so, what exactly?
  • Should I exercise? If so, how often?
  • Can you suggest support groups that can help?
  • How often will I need additional testing?
  • What kind of follow-up appointments will I need?
  • How will I know if the cancer has come back? What should I look for?
  • What are my options if the disease returns?

Some people have a genetic predisposition for developing certain types of diseases, such as cancer. Genetic testing looks for changes, called alterations or mutations, in genes, and determines whether or not the person is considered high risk for developing certain types of cancers.

Genetic testing can have several possible outcomes, which can be categorized as positive, negative, and inconclusive, meaning the test result did not give any useful information. Because these genetic testing results are not always straightforward, it is highly important for patients and their families to ask questions about the potential meaning of the results before and after testing.

Even though accurate test results can reveal a positive genetic mutation, it does not guarantee that a person will actually acquire the disease. Likewise, negative results do not guarantee that an individual will not develop cancer through other means. These blood tests only detect certain levels that reflect an increased risk for the cancer that they were tested for.

People who have a positive test result, indicating an increased risk for cancer, can then take steps to lower their risk of developing cancer or to find cancer earlier, including:

  • Being checked at a younger age or more often for signs of cancer.
  • Reducing their cancer risks by taking medications or having surgery to remove “at-risk” tissue.
  • Changing personal behaviors (i.e. like quitting smoking, getting more exercise, and eating a healthier diet) to reduce the risk of certain cancers

Prior to any genetic testing, it is important to meet with a genetic counselor. The Hope Cancer Center has in-house genetic counselors who can educate you about the testing process and address any questions or concerns you may have. Additionally, your counselor will cover information such as limitations, risks, benefits, and genetic risks based on family history, so you can make informed choices about future health care.

Inherited genetic mutations play a major role in approximately 5 to 10 percent of all cancers and more than 50 hereditary cancer syndromes have been identified. Two of the most common cancer syndromes include Hereditary Breast and Ovarian Cancer Syndrome (HBOC) and Hereditary Non-Polyposis Colorectal Cancer (HNPCC), also known as Lynch syndrome.

Keep in mind, that even if a cancer-predisposing mutation is present in a family, not everyone who inherits the mutation will necessarily develop cancer. However, genetic testing can still be useful for anyone interested in making important decisions regarding cancer prevention or early detection.

Chemotherapy works by destroying cancer cells. Because there is no guarantee that chemotherapy will target a cancer cell over a healthy one, side effects are a possibility. Common side effects include:

  • Vomiting
  • Nausea
  • Fatigue
  • Diarrhea or constipation
  • Loss of appetite
  • Mouth sores
  • Low blood counts
  • Hair loss
  • Increased risk of infection
  • Easy bruising or bleeding

While some side effects are temporary, others can be life-threatening. Talk with your cancer care team about any side effects you experience so they can help you manage them successfully throughout your treatment cycles.

To request an appointment, call the location most convenient for you.

We will help answer your questions about the cost of treatment and, on your behalf, handle insurance inquiries, verifications and claims processing. For patients whose insurance coverage is inadequate or the insurance company chooses not to cover services, our financial counselors can help identify assistance programs that may offer help in meeting financial obligations.

A second opinion is an important part of becoming educated about your specific type of cancer and your cancer treatment options. The more knowledge you have, the better chance you have of receiving the most appropriate treatment during your cancer journey. There are normally several treatment options available, many of which involve complicated procedures. Second opinions can help you understand these options and help you make an informed decision regarding your personal cancer treatment plan.

Second opinions are a normal part of cancer management, so you shouldn’t worry about offending the original oncologist. Your peace of mind is important, and a second opinion can give you the reassurance you need to make the best decision about your treatment plan.

Often times, a second opinion appointment regarding cancer treatment will be covered by your insurance provider. Some many even insist on it. Please be sure to check with your provider to get the most accurate information for your specific situation and what your insurance covers.

The cancer specialist at Hope Cancer Center are available for patient consultations, including second opinions. If you are interested in getting a second opinion from us, please speak with your current medical provider to set up the referral.

To request an appointment, call one of the two Hope Cancer Center locations most convenient for you.

As a new patient at Hope Cancer Center, it is important to us that you feel cared for, comfortable and informed during your cancer care journey. To ensure your first and future appointments go smoothly, we ask that you always:

  • Arrive at least 15-20 minutes in advance for first clinic visits
  • Bring a photo ID and your insurance card(s)
  • Have your co-pay ready
  • Notify us of any allergies
  • Bring all current medication bottles, including over-the-counter medicines, vitamins, and herbal supplements. If you are unable to bring the bottles, an updated list will suffice.
  • Update us on any changes of your address, phone number, employment, marital status and/or insurance company
  • Come ready with any questions or concerns that you may have to discuss with your cancer care team
  • Schedule your next appointment before you leave the clinic. This includes lab and radiology appointments.

In addition to the above, we recommend that you bring a friend or family member to your first appointment. Having someone with you not only provides valuable support, it also relieves some pressure of having to remember every piece of information the oncologist will provide.

We understand that life is not always predictable and you may not be able to make your appointment. Should you have to cancel or reschedule, please provide as much notice as possible so we can accommodate other patients waiting to see the doctor.

Our sites are located in Warren and Youngstown, Ohio. To make an appointment, please contact one of the two Hope Cancer Center offices:

Laboratory testing is a key component of detection, diagnosis, and treatment of cancers and blood disorders. Cancer patients undergo many different types of tests throughout their cancer treatment. Routine laboratory tests provide quick results, helping our physicians prescribe, or adjust your cancer treatment plan as needed. Lab services are offered on-site through Quest Diagnostics. 

Although the time period required for processing and receiving test results may vary, your physician will review your results as soon as they become available, and discuss them with you at your next visit. If any of your test results require immediate attention, your oncologist or nurse will contact you without delay.

Testing that must be processed off site will be reviewed by our cancer specialists once the results are available. We will work within your insurance company’s guidelines, as your plan may require lab tests be performed at one of their contracted laboratory facilities.

At The Hope Center for Cancer Care, our sole focus is fighting cancer and blood disorders. By using the latest cancer treatments and technologies, our oncologists are able to provide patients with personalized, expert cancer care.

In addition, our advanced diagnostic and treatment services, we offer support services that are designed to provide comprehensive care for patients and their families during this difficult and overwhelming time. The dedication and experience of our oncologists and cancer care staff, keeps us on the forefront of cancer care. This means you can receive the highest quality cancer care available, in a supportive and caring environment, close to home.

Your needs are individual–and our mission is to ensure the care you receive is, too.

Our support services include:

To request an appointment, call the location most convenient for you.

Youngstown

835 Southwestern Run
Youngstown, OH 44514
Phone: 330-318-1100
Fax: 330-318-1111
 

Warren

700 Howland Wilson SE
Warren, OH 44484
Phone: 330-856-8600
Fax: 330-856-8686

For more information contact:

Denise Mavasi
Practice Manager
330-318-1134

We understand that a first visit to our cancer care center can make you feel anxious. Rest assured, we will do everything we can to make you and your family comfortable. We appreciate any feedback you’d like to provide that may help us make you feel more at ease.

Upon your arrival at Hope Cancer Center, you will find free and convenient parking. We also offer wheelchair accessibility and handicapped parking.

Your first appointment will include a comprehensive meeting and evaluation with your oncologist. You may also meet the nurses and other members of your cancer care team. Please plan for an hour-long visit at minimum. Arriving 15-20 minutes prior to your appointment will give you time to complete forms.

Your cancer specialists will make every effort to explain your cancer diagnosis and treatment plan during your first visit. In some cases, however, a follow-up visit is necessary to cover additional information. No testing or treatments (radiation or chemotherapy) will begin on your initial visit.

First visits can be complex, so we recommend that you bring a friend or family member with you. Please do not hesitate to ask questions or bring up any concerns you may have regarding your diagnosis or suggested treatment. See our Questions to Ask section for possible topics to bring up during your visit.

To ensure your first and future appointments go smoothly, we ask that you always:

  • Bring your photo ID and your insurance card(s)
  • Have your co-pay ready
  • Notify us of any allergies
  • Bring all current medication bottles, including over-the-counter medicines, vitamins, and herbal supplements. If you are unable to bring the bottles, an updated list will suffice.
  • Update us on any changes of your address, phone number, employment, marital status and/or insurance company
  • Come ready with any questions or concerns that you may have to discuss with your cancer care team
  • Schedule your next appointment before you leave the clinic. This includes lab, and radiology appointments.

Targeted therapies are drugs and other substances that block the growth and spread of cancer by interfering with specific molecules involved in the growth and progression of cancer.

While conventional cancer treatments, such as chemotherapy and radiation have the inability to distinguish between cancer cells and healthy cells, targeted therapy is much more precise. Targeting cancer cells with increased accuracy minimizes damage to normal, healthy cells, offering the advantage of an improved outcome.

Although targeted therapy is relatively new, it is becoming a popular form of cancer treatment. However, it is not an option for every patient. Your doctor will determine if targeted therapy is right for you and whether or not it needs to be used in conjunction with other cancer treatments

Immunotherapy, a type of biological therapy, is a cancer treatment designed to boost or restore immune function to fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues of the lymph system.

One reason that cancer cells thrive is because they are able to hide from your immune system. Certain immunotherapies can mark cancer cells so it is easier for the immune system to find and destroy them. Other immunotherapies boost your immune system to work better against cancer. Through the use of natural and/or synthetic substances, immunotherapy stimulates white blood cells (T cells) in several ways, allowing them to recognize and kill cancer cells.

There are different approaches to cancer immunotherapy, some of which include:

  • Monoclonal antibodies - which are drugs that are designed to bind to specific targets in the body. They can cause an immune response that destroys cancer cells.
  • Adoptive cell transfer - which is a treatment that attempts to boost the natural ability of your T cells to fight cancer. Researchers take T cells from the tumor. They then isolate the T cells that are most active against your cancer or modify the genes in them to make them better able to find and destroy your cancer cells.
  • Checkpoint inhibitors - which us when certain proteins, called immune checkpoint proteins, are blocked to limit the strenght and duration of immune responses. Blocking the activity of immune checkpoint proteins releases the "brakes" on the immune system, increasing its ability to destroy cancer cells.
  • Cytokines - which are proteins that are made by your body’s cells. They play important roles in the body’s normal immune responses and also in the immune system’s ability to respond to cancer. The two main types of cytokines used to treat cancer are called interferons and interleukins.
  • Therapeutic vaccines - which work against cancer by boosting your immune system’s response to cancer cells. Therapeutic or treatment vaccines are different from the ones that help prevent disease.

Although the use of immunotherapy is not as widespread as other traditional cancer treatments, such as surgery, chemotherapy and radiation, it is a very active area of cancer research.

Hormones are special chemical messengers made by endocrine glands that occur naturally in the body. One of the many jobs they have on the body is the controlling of the growth and activity of certain hormone sensitive tissues and cells, such as breast and prostate tissue. Sometimes, cancer cells found in these tissues become hormone sensitive or hormone dependent, meaning they rely on hormones to grow or develop, and the cancer’s growth then may be caused by the body’s own hormones.

In cases such as these, blocking the action of hormones or altering the way they work could stop the cancer from growing. Drugs used in hormonal therapy block hormone production or change the way hormones work, and/or removal of organs that secrete hormones, such as the ovaries or testicles, are ways of fighting cancer. Similar to chemotherapy, hormone therapy is considered a systemic treatment in that it is designed to have a widespread effect on the cancer cells in the body.

Chemotherapy is any treatment involving the use of drugs to kill cancer cells. These drugs travel through the bloodstream, targeting areas of the body where the cancer may have spread. Because it can reach great distances away from the original cancer site, chemotherapy is considered a systemic cancer treatment.

Cancer chemotherapy may consist of single drugs or a combination of drugs. Each drug has a different way of working and is effective at a specific time in the life cycle of the targeted cells. Your doctor will base the most effective method against your particular type of cancer. Chemotherapy drugs may be administered in one or more of the following ways:

  • IV (intravenous or dripping medicine through a vein)
  • Shot (injections into a body cavity)
  • Pill (oral medication)

More than half of all people diagnosed with cancer receive chemotherapy. Your individual condition will typically be designed to achieve one or more of three specific goals: cure, remission, or controlling and/or relieving symptoms.

Your doctor will develop a treatment plan specifically for you, based on your type of cancer, its stage of advancement, and your overall health.

Biological Therapy

Biological therapy uses the body’s immune system to kill cancer cells. Some biological therapies for cancer use vaccines or bacteria to stimulate the body’s immune system to attack cancer cells. For patients with cancer, biological therapies may be used to treat the cancer itself or the side effects of other cancer treatments.

Questions to ask your doctor regarding chemotherapy/biotherapy:

  • Why do you think this is the best option for me?
  • What are the benefits and risks?
  • What are the chances this will be successful? How long until we know?
  • Is there any preparation needed before either treatment?
  • How often will I receive treatment and how long will treatments last?
  • Are there any lifestyle restrictions (diet, working, exercising) during treatment? How long until I can resume normal activities?
  • What are some side effects I could experience and how can they be managed?
  • What types of support are available for me?

Your cancer or blood disorder isn’t like anyone else’s–and your treatment shouldn’t be, either. At Hope Cancer Care, our expert physicians use the latest technology and therapies to provide our patients with the best treatment possible. We also help you manage cancer-related side effects, such as pain, nausea and fatigue, so you can maintain strength and stamina throughout the course of your treatment and get back to life. Cancer treatment options could include: 

Radiation therapy involves the use of high-energy rays to damage or kill cancer cells. The goal of radiation treatment, whether externally or internally delivered, is to prevent cancer cells from growing and dividing. For some cancers, radiation alone is an effective treatment; however, there are times when radiation will need to be combined with other cancer treatments, such as surgery or chemotherapy.

A radiation oncologist will oversee your cancer radiation therapy treatments. These physicians work closely with other cancer specialists, including medical oncologists and surgeons, to coordinate the best cancer treatment program for you.

At the Hope Cancer Center, our cancer specialist have access to the latest technologies and treatments used to target cancer. In addition to their expertise, our radiation oncology team works hard to deliver personalized care with support and compassion.

Hope Cancer Center radiation therapy includes:

  • External Beam Radiation Therapy
  • Three-Dimensional Conformal Radiation Therapy (3D-CRT)
  • Intensity Modulated Radiation Therapy (IMRT)
  • Image-Guided Radiation Therapy (IGRT)
  • Intraoperative Radiation Therapy (IORT)
  • Brachytherapy
  • Breast brachytherapy
  • Stereotactic Radiosurgery (SRS)

Hematology is the diagnosis, treatment, and prevention of diseases of the blood and bone marrow, as well as of the immune system, hemostatic system (which controls blood clotting), and vascular system. Common blood disorders include anemia, blood clots, bleeding disorders such as hemophilia, and blood cancers such as lymphoma, leukemia, and myeloma.

Physicians specifically trained in the diagnosis, treatment, prevention, or investigation of blood disorders are called hematologists. Some cancer specialist are trained in both hematology and medical oncology--like the ones here at Hope Cancer Center. By working together, and having dual expertise, patients will receive optimal cancer care, more cancer treatment options and more hope.

For more information about blood disorders please see the specific Disease and Drug Information section on our website.

The field of oncology has three major areas: medical, surgical, and radiation. Medical oncologists oversee a patient’s care from the moment of a patient’s cancer diagnosis throughout the course of treating their disease. They are often the main health care provider for someone who has cancer. Medical oncologists typically treat cancer with chemotherapy or other medications, such as biological (targeted) therapy, which may sometimes be used in conjunction with radiation therapy and/or surgery.  Other treatments and procedures they may use include immunotherapy, hormonal therapy and/or stem cell transplant. In some cases, medical oncologists may suggest that a patient participate in a study, known as a clinical trial, to test new methods of prevention, screening, diagnosis, or treatment of cancer.

At Hope Cancer Center, our physicians are expertly trained in Medical Oncology and Internal Medicine. Their unique qualifications allow them to deliver expert management and treatment for cancer patients.

There is no longer a “one-size-fits-all” approach to cancer treatment. Even among patients with the same type of cancer, the behavior of the cancer and it’s response to treatment can vary widely by patient. Our medical oncologists work closely with surgeons, primary care physicians, radiation oncologists, oncology-trained nurses, and you, the patient, to design a personalized cancer treatment plan that this best for you and your cancer journey.

When it comes to cancer, our name says it all. With physicians specialized in Medical Oncology, Hematology and Internal Medicine, we are able to provide comprehensive, compassionate, and high-quality cancer and blood disorder care to all patients in a supportive environment.

In other words, we provide HOPE.

Working diligently together, our team of certified physicians create a custom treatment plan for each patient–and also equip them with the support they need before, during, and after the cancer treatment process. Every patient is different–and we understand that, which is why we take the time to get to know you, as well as your loved ones.

At The Hope Center for Cancer Care, we offer a complete range of advanced diagnostic and treatment services including chemotherapy, hormonal therapy, immunotherapy and biological (targeted) therapies. Additionally, we offer financial counseling, routine laboratory tests, online resources to help you navigate through your journey, and genetic testing for those curious about their cancer risk. We’ll even connect you with oncology social workers and cancer support groups so that you never feel alone. You can be certain we are here for you and your family every step of the way.

To give you quality care close to home, we offer two convenient locations in the Warren and Youngstown metropolitan area.

As a new patient you will meet with our Patient Account Representatives and complete a patient information form and verify your insurance information. Please bring your insurance identification card(s) with you. A photocopy will be placed in your billing file. If you are covered by more than one insurance company, please let us know which company is the primary carrier. This will help to avoid any delays in receiving benefits. If there is any change in your health coverage, please contact the office to update your records.

We participate with most major insurance companies and will submit claims to your carrier on your behalf. Medicaid patients are welcome. We also accept Medicare assignment — however, you will be responsible for the deductible and your 20% co-payment for Medicare’s allowed charges for physician care, chemotherapy drugs, and laboratory tests. If you belong to an HMO or PPO plan, please verify that our physicians are in the plan before your treatment begins. Also, please inform our office if pre-certification is necessary with your plan.

Some insurance companies require you to use a specific laboratory or to obtain referrals or pre-authorization for office visits, hospital admissions, and treatment. It is your responsibility to obtain the initial referral and bring this with you on the first day of your first visit. If you need assistance with your insurance requirements, our staff will make every effort to help you.

Co-payments are payable at the time of your visit. We accept Visa, MasterCard, Discover, and American Express. We will be happy to assist you in developing a payment plan.

Please call our Patient Accounts Representative if you have questions or need assistance in coordinating and filing claims with your insurance company. Please be assured that your confidentiality will be respected at all times.

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.

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:

  • Smoldering
  • 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.

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.

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.

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.

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.

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.

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 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.

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.

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.

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.

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.

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.

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.

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.

Your blood is living tissue made up of liquid and solids. The liquid part, called plasma, is made of water, salts and protein. Over half of your blood is plasma. The solid part of your blood contains red blood cells, white blood cells and platelets.

Red blood cells deliver oxygen from your lungs to your tissues and organs. White blood cells fight infection and are part of your body's defense system. Platelets help blood to clot. Bone marrow, the spongy material inside your bones, makes new blood cells. Blood cells constantly die and your body makes new ones. Red blood cells live about 120 days, platelets six days and white cells less than one day.

There are several cancers of the blood including Hodgkin's and non-Hodgkin's lymphoma, leukemia and myeloma.

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.

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.

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.

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 TSH means 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.

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.

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.

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.

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.

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.

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.

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. 

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 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.

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.

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.

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 of PSA 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 the NCI 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.

Each year, more than 241,000 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.

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 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

  • 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.
  • Mediastinoscopy: A surgical procedure to look at the organs, tissues, and lymph nodes between the lungs for abnormal areas. An incision (cut) is made at the top of the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope 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.
  • Anterior mediastinotomy: A surgical procedure to look at the organs and tissues between the lungs and between the breastbone and heart for abnormal areas. An incision (cut) is made next to the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope 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. This is also called the Chamberlain procedure.

Occult (hidden) Stage

In the occult (hidden) stage, cancer cells are found in sputum (mucus coughed up from the lungs), but no tumor can be found in the lung by imaging or bronchoscopy, or the primary tumor is too small to be checked.

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the innermost lining of the lung. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. Stage I is divided into stages IA and IB:

  • Stage IA: The tumor is in the lung only and is 3 centimeters or smaller.
  • Stage IB: One or more of the following is true:
    • The tumor is larger than 3 centimeters.
    • Cancer has spread to the main bronchus of the lung, and is at least 2 centimeters from the carina (where the trachea joins the bronchi).
    • Cancer has spread to the innermost layer of the membrane that covers the lungs.
    • The tumor partly blocks the bronchus or bronchioles and part of the lung has collapsed or developed pneumonitis (inflammation of the lung).

Stage II

Stage II is divided into stages IIA and IIB:

  • Stage IIA: The tumor is 3 centimeters or smaller and cancer has spread to nearby lymph nodes on the same side of the chest as the tumor.
  • Stage IIB:
    • Cancer has spread to nearby lymph nodes on the same side of the chest as the tumor and one or more of the following is true:
      • The tumor is larger than 3 centimeters.
      • Cancer has spread to the main bronchus of the lung and is 2 centimeters or more from the carina (where the trachea joins the bronchi).
      • Cancer has spread to the innermost layer of the membrane that covers the lungs.
      • The tumor partly blocks the bronchus or bronchioles and part of the lung has collapsed or developed pneumonitis (inflammation of the lung).

or

  • Cancer has not spread to lymph nodes and one or more of the following is true:
    • The tumor may be any size and cancer has spread to the chest wall, or the diaphragm, or the pleura between the lungs, or membranes surrounding the heart.
    • Cancer has spread to the main bronchus of the lung and is no more than 2 centimeters from the carina (where the trachea meets the bronchi), but has not spread to the trachea.
    • Cancer blocks the bronchus or bronchioles and the whole lung has collapsed or developed pneumonitis (inflammation of the lung).

Stage III

In stage IIIA, cancer has spread to lymph nodes on the same side of the chest as the tumor. Also:

  • The tumor may be any size.
  • Cancer may have spread to the main bronchus, the chest wall, the diaphragm, the pleura around the lungs, or the membrane around the heart, but has not spread to the trachea.
  • Part or all of the lung may have collapsed or developed pneumonitis (inflammation of the lung).

In stage IIIB, the tumor may be any size and has spread:

  • To lymph nodes above the collarbone or in the opposite side of the chest from the tumor; and/or
  • To any of the following:
    • Heart.
    • Major blood vessels that lead to or from the heart.
    • Chest wall.
    • Diaphragm.
    • Trachea.
    • Esophagus.
    • Sternum (chest bone) or backbone.
    • More than one place in the same lobe of the lung.
    • The fluid of the pleural cavity surrounding the lung.

Stage IV

In stage IV, cancer may have spread to lymph nodes and has spread to another lobe of the lungs or to other parts of the body, such as the brain, liver, adrenal glands, kidneys, or bone.

The process used to find out if cancer has spread within the lungs 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 non-small cell lung cancer are also used to stage the disease.  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.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the brain. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • 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.
  • 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.

Each year in the United States, more than 226,000 people are diagnosed with non-small cell lung cancer. There are several different types of this cancer.

Each type of non-small cell lung cancer has different kinds of cancer cells. The cancer cells of each type grow and spread in different ways. The types of non-small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look under a microscope:

  • Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. This is also called epidermoid carcinoma.
  • Large cell carcinoma: Cancer that may begin in several types of large cells.
  • Adenocarcinoma: Cancer that begins in the cells that line the alveoli and make substances such as mucus.

Other less common types of non-small cell lung cancer are: pleomorphic, carcinoid tumor, salivary gland carcinoma, and unclassified carcinoma.

Smoking can increase the risk of developing non-small cell lung cancer.

Visit the National Cancer Institute where this information and more can be found about Non-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 no pequeñas.

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.

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.

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.

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.

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.

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.

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 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.

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. 

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.

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 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.

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.

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.

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.

Our Locations

Warren

700 Howland Wilson SE
Warren, OH 44484
 Ph: 330-856-8600
Fax: 330-856-8686

Youngstown

835 Southwestern Run
Youngstown, OH 44514
 Ph: 330-318-1100
Fax: 330-318-1111