Cancer Treatment #6147971

The appendix is a small hollow tube attached to the large colon (the large colon is also called large bowel or large intestine). The appendix is approximately 4 inches long and shaped like a worm. The appendix serves no known purpose, although it is thought to possibly play a role in the immune system. Very rarely, the appendix may become cancerous. Since the appendix is attached to the colon, appendix cancer is considered a type of colorectal cancer. Colorectal cancers are also part of a larger group of cancers of gastrointestinal tract, or GI cancers. Cancer of the appendix may cause appendicitis or cause the appendix to rupture. Sometimes this is the first symptom of appendix cancer. A ruptured appendix may cause a very serious condition called peritonitis, which is an infection of the lining of the abdomen and pelvis. A cancerous tumor of the appendix may also "seed" the abdomen with cancer cells. This may cause more cancerous tumors to develop in the abdomen before it is discovered. See Peritoneal Surface Malignancies and Peritoneal Carcinomatosis. Many times there are no symptoms of appendix cancer until it has progressed and is advanced. Abdominal discomfort and bloating of the abdomen can be signs of advanced appendiceal cancer There are five most common (though still VERY rare) varieties of appendix cancer: Malignant Carcinoid, Mucinous Adenocarcinoma, Adenocarcinoma, Adenocarcinoid, and Signet Ring Adenocarcinoma. To learn more about these varieties of appendix cancer, treatment and prognosis, click the links here or on the left side of this screen.

After AIDS-related lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body. The process used to find out if cancer cells have spread within the lymph system 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, but AIDS-related lymphoma is usually advanced when it is diagnosed. The following tests and procedures may be used in the staging process: CT scan (CAT scan): 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. 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. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Anal Cancer Treatment

Treatment and Diagnosis: If a patient has symptoms that suggest bladder cancer, the doctor may check general signs of health and may order lab tests. The person may have one or more of the following procedures: Physical exam -- The doctor feels the abdomen and pelvis for tumors. The physical exam may include a rectal or vaginal exam.Urine tests -- The laboratory checks the urine for blood, cancer cells, and other signs of disease.Intravenous pyelogram -- The doctor injects dye into a blood vessel. The dye collects in the urine, making the bladder show up on x-rays.Cystoscopy -- The doctor uses a thin, lighted tube (cystoscope) to look directly into the bladder. The doctor inserts the cystoscope into the bladder through the urethra to examine the lining of the bladder. The patient may need anesthesia for this procedure The doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. In many cases, a biopsy is the only sure way to tell whether cancer is present. For a small number of patients, the doctor removes the entire cancerous area during the biopsy. For these patients, bladder cancer is diagnosed and treated in a single procedure.

Treatment and Diagnosis: If you have a symptom or screening test result that suggests 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 a physical exam. Your doctor also may order a mammogram or other imaging procedure. These tests make pictures of tissues inside the breast. After the tests, your doctor may decide no other exams are needed. Your doctor may suggest that you have a follow-up exam later on. Or you may need to have a biopsy to look for cancer cells.Clinical Breast Exam Your health care provider feels each breast for lumps and looks for other problems. If you have a lump, your doctor will feel its size, shape, and texture. Your doctor will also check to see if it moves easily. Benign lumps often feel different from cancerous ones. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer.Diagnostic Mammogram Diagnostic mammograms are x-ray pictures of the breast. They take clearer, more detailed images of areas that look abnormal on a screening mammogram. Doctors use them to learn more about unusual breast changes, such as a lump, pain, thickening, nipple discharge, or change in breast size or shape. Diagnostic mammograms may focus on a specific area of the breast. They may involve special techniques and more views than screening mammograms.

Treatment and Diagnosis: If you have a symptom or screening test result that suggests 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 a physical exam. Your doctor also may order a mammogram or other imaging procedure. These tests make pictures of tissues inside the breast. After the tests, your doctor may decide no other exams are needed. Your doctor may suggest that you have a follow-up exam later on. Or you may need to have a biopsy to look for cancer cells.Clinical Breast Exam Your health care provider feels each breast for lumps and looks for other problems. If you have a lump, your doctor will feel its size, shape, and texture. Your doctor will also check to see if it moves easily. Benign lumps often feel different from cancerous ones. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer.

Treatment and Diagnosis: If you have a symptom or screening test result that suggests 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 a physical exam. Your doctor also may order a mammogram or other imaging procedure. These tests make pictures of tissues inside the breast. After the tests, your doctor may decide no other exams are needed. Your doctor may suggest that you have a follow-up exam later on. Or you may need to have a biopsy to look for cancer cells.Clinical Breast Exam Your health care provider feels each breast for lumps and looks for other problems. If you have a lump, your doctor will feel its size, shape, and texture. Your doctor will also check to see if it moves easily. Benign lumps often feel different from cancerous ones. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer.Diagnostic Mammogram Diagnostic mammograms are x-ray pictures of the breast. They take clearer, more detailed images of areas that look abnormal on a screening mammogram. Doctors use them to learn more about unusual breast changes, such as a lump, pain, thickening, nipple discharge, or change in breast size or shape. Diagnostic mammograms may focus on a specific area of the breast. They may involve special techniques and more views than screening mammograms.

Treatment and Diagnosis: If a woman has a symptom or Pap test results that suggest precancerous cells or cancer of the cervix, her doctor will suggest other procedures to make a diagnosis.These may include: Colposcopy: The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. It is not inserted into the vagina. A colposcopy is usually done in the doctor's office or clinic.Biopsy : The doctor removes tissue to look for precancerous cells or cancer cells. Most women have their biopsy in the doctor's office with local anesthesia. A pathologist checks the tissue with a microscope.Punch biopsy: The doctor uses a sharp, hollow device to pinch off small samples of cervical tissue.LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of tissue.Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervical canal. Some doctors may use a thin, soft brush instead of a curette.Conization: The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia. Conization also may be used to remove a precancerous area.

Cervical cancer is the second most common malignancy in women worldwide, and it remains a leading cause of cancer-related death for women in developing countries. In the United States, cervical cancer is relatively uncommon. The incidence of invasive cervical cancer has declined steadily in the United States over the past few decades; however, it continues to rise in many developing countries. The change in the epidemiological trend in the United States has been attributed to mass screening with Papanicolaou tests.Frequency United States In the United States, 11, 150 new cases of cervical cancer are diagnosed each year. In addition, more than 50, 000 cases of carcinoma in situ are diagnosed.International Internationally, 500, 000 new cases are diagnosed each year.Mortality/Morbidity Of the 11, 150 patients with cervical cancer, 3, 670 will die from their disease each year in the United States. This represents 1.3% of all cancer deaths and 6.5% of deaths from gynecologic cancers.

Chordomas are rare tumors that arise from embryonic notochordal remnants along the length of the neuraxis at developmentally active sites. These sites are the ends of the neuraxis and the vertebral bodies. Chordomas comprise less than 1% of CNS tumors, though they can occur in extraaxial locations. Chordomas are thought to arise from ectopic notochord remnants.History of the Procedure In 1857, Virchow originally described chordomas when he named them ecchondrosis physaliphora, believing they were cartilaginous in origin. In 1895, Ribbert pierced a nucleus pulposus and found similar tumors. From this bit of evidence, he correctly surmised the notochordal origin of chordomas.Problem Ecchordosis physaliphora is a term that refers to small, well-circumscribed, gelatinous masses adherent to the brainstem. Although composed of notochordal remnants, ecchordosis physaliphora seldom, if ever, progresses into chordoma. Ecchordosis physaliphora is a reported finding in approximately 2% of autopsy examinations, but chordomas are quite rare. Even though chordomas usually are slow-growing tumors, they are locally aggressive with a tendency to infiltrate into adjacent tissues and organs. Local recurrence results in tissue destruction and generally is the cause of death. Metastases are recognized but are uncommon.

If a woman has symptoms that suggest uterine cancer, her doctor may check general signs of health and may order blood and urine tests. The doctor also may perform one or more of the exams or tests described on the next pages. Pelvic exam -- A woman has a pelvic exam to check the vagina, uterus, bladder, and rectum. The doctor feels these organs for any lumps or changes in their shape or size. To see the upper part of the vagina and the cervix, the doctor inserts an instrument called a speculum into the vagina.Pap test -- The doctor collects cells from the cervix and upper vagina. A medical laboratory checks for abnormal cells. Although the Pap test can detect cancer of the cervix, cells from inside the uterus usually do not show up on a Pap test. This is why the doctor collects samples of cells from inside the uterus in a procedure called a biopsy.Transvaginal ultrasound -- The doctor inserts an instrument into the vagina. The instrument aims high-frequency sound waves at the uterus. The pattern of the echoes they produce creates a picture. If the endometrium looks too thick, the doctor can do a biopsy.Biopsy -- The doctor removes a sample of tissue from the uterine lining. This usually can be done in the doctor's office. In some cases, however, a woman may need to have a dilation and curettage (D&C). A D&C is usually done as same-day surgery with anesthesia in a hospital. A pathologist examines the tissue to check for cancer cells, hyperplasia, and other conditions. For a short time after the biopsy, some women have cramps and vaginal bleeding.

Diagnosing Esophageal Cancer To help find the cause of symptoms, the doctor evaluates a person's medical history and performs a physical exam. The doctor usually orders a chest x-ray and other diagnostic tests. These tests may include the following: A barium swallow (also called an esophagram) is a series of x-rays of the esophagus. The patient drinks a liquid containing barium, which coats the inside of the esophagus. The barium makes any changes in the shape of the esophagus show up on the x-rays.Esophagoscopy (also called endoscopy) is an examination of the inside of the esophagus using a thin lighted tube called an endoscope. An anesthetic (substance that causes loss of feeling or awareness) is usually used during this procedure. If an abnormal area is found, the doctor can collect cells and tissue through the endoscope for examination under a microscope. This is called a biopsy. A biopsy can show cancer, tissue changes that may lead to cancer, or other conditions Staging the Disease If the diagnosis is esophageal cancer, the doctor needs to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to what parts of the body. Knowing the stage of the disease helps the doctor plan treatment. Listed below are descriptions of the four stages of esophageal cancer. Stage I. The cancer is found only in the top layers of cells lining the esophagus.Stage II. The cancer involves deeper layers of the lining of the esophagus, or it has spread to nearby lymph nodes. The cancer has not spread to other parts of the body.Stage III. The cancer has invaded more deeply into the wall of the esophagus or has spread to tissues or lymph nodes near the esophagus. It has not spread to other parts of the body.Stage IV. The cancer has spread to other parts of the body. Esophageal cancer can spread almost anywhere in the body, including the liver, lungs, brain, and bones.

Gallbladder Cancer

Treatment and Diagnosis: If you have a symptom that suggests stomach cancer, your doctor must find out whether it is really due to cancer or to some other cause. Your doctor may refer you to a gastroenterologist, a doctor whose specialty is diagnosing and treating digestive problems. The doctor asks about your personal and family health history. You may have blood or other lab tests. You also may have: Physical exam: The doctor checks your abdomen for fluid, swelling, or other changes. The doctor also feels for swollen lymph nodes. Your skin and eyes are checked to see if they seem yellow.Upper GI series: The doctor orders x-rays of your esophagus and stomach. The x-rays are taken after you drink a barium solution. The solution makes your stomach show up more clearly on the x-rays.Endoscopy: The doctor uses a thin, lighted tube (endoscope) to look into your stomach. The doctor first numbs your throat with an anesthetic spray. You also may receive medicine to help you relax. The tube is passed through your mouth and esophagus to the stomach.Biopsy: The doctor uses an endoscope to remove tissue from the stomach. A pathologist checks the tissue under a microscope for cancer cells. A biopsy is the only sure way to know if cancer cells are present.

Carcinoid, a term first applied to hormonally active tumors by Oberndorfer in 1907, follows a more benign clinical course than most other malignancies. Carcinoid of the small intestine, a well-differentiated neuroendocrine tumor, is the most common distal small bowel malignancy, with an occurrence rate of 1 case per 300 autopsies. Carcinoid tumors of the appendix account for 0.2-0.7% of all appendicectomies, and they are the most common tumor of the appendix, accounting for 80% of appendiceal growths.2 Even though the frequency of the primary tumor is high, the incidence of metastasis is quite low (1 metastasis per 300, 000 incidences). Common sites of metastatic spread include the regional mesenteric and para-aortic lymph nodes and the liver. With distant spread, especially to the liver, carcinoid syndrome can develop. The association of flushing, diarrhea, bronchoconstriction, and cardiac disease with carcinoid tumors was first reported by Thorson and colleagues in 1954.The findings that 5-hydroxytryptamine (serotonin) was present in carcinoid tumors and that patients with carcinoid syndrome excrete increased quantities of the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA) led to the hypothesis that the humoral manifestations of carcinoid syndrome could be attributed to the overproduction of serotonin by these tumors. However, serotonin is not the only mediator of the clinical syndrome. Other substances, such as the tachykinins, play a significant role in the different clinical characteristics of affected patients.

Ovarian Cancer Treatment

Treatment and Diagnosis: If you have symptoms that suggest oral cancer, the doctor or dentist checks your mouth and throat for red or white patches, lumps, swelling, or other problems. This exam includes looking carefully at the roof of the mouth, back of the throat, and insides of the cheeks and lips. The doctor or dentist also gently pulls out your tongue so it can be checked on the sides and underneath. The floor of your mouth and lymph nodes in your neck also are checked. If an exam shows an abnormal area, a small sample of tissue may be removed. Removing tissue to look for cancer cells is called a biopsy. Usually, a biopsy is done with local anesthesia. Sometimes, it is 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 cancerous.

Malignancies of the tongue represent one of the greatest management challenges for the head and neck oncologist because of the adverse effects of treatment on oral and pharyngeal function, the eventual quality of life, and the poor prognosis of advanced disease. The unique behavior of these tumors also requires aggressive management to minimize the risk of locoregional spread. Clinical appearance of a lateral tongue squamous cell carcinoma in an 80-year-old man with a previous history of smoking and regular alcoholic beverage consumption.Frequency The tongue is the most common intraoral site of cancer in most countries. The worldwide incidence of oral cancer varies widely. Because of this variability, cancer of the tongue is a serious public health problem with significant mortality and morbidity. Cancers of the oral cavity represent 2% of all cancers diagnosed annually in the United States. The disease affects males more frequently than females, with a male-to-female ratio of 2:1. In Europe and Australia, the incidence of oral cavity cancer is very low, accounting for less than 5% of all cancers. In France (male incidence rates up to 8 per 100, 000 per annum), it is the third most common cancer in males and the second most common cause of death from cancer. In India, the incidence rate approaches 50% (male incidence rates up to 6.5 per 100, 000 per annum). This incidence variability may relate to different societal habits, such as chewing betel nuts and habitual reverse smoking observed in Asia and the higher incidence of smoking and alcohol intake in certain European countries.

Ovarian cancer is the most common cause of cancer death from gynecologic tumors in the United States. Early disease causes minimal, nonspecific, or no symptoms. Therefore, most patients are diagnosed in an advanced stage. Overall, prognosis for these patients remains poor. Standard treatment involves aggressive debulking surgery followed by chemotherapy. Many histological types of ovarian tumors are described. However, more than 90% of malignant tumors are epithelial tumors. Therefore, the remainder of this article focuses on these tumors. For specific information on malignant lesions of the ovaries, see Malignant Lesions of the Ovaries.Pathophysiology Ovarian carcinoma can spread by local extension, lymphatic invasion, intraperitoneal implantation, hematogenous dissemination, and transdiaphragmatic passage. Intraperitoneal dissemination is the most common and recognized characteristic of ovarian cancer. Malignant cells can implant anywhere in the peritoneal cavity but are more likely to implant in sites of stasis along the peritoneal fluid circulation. As discussed later, these mechanisms of dissemination represent the rationale to conduct surgical staging, debulking surgery, and intraperitoneal administration of chemotherapy. On the other hand, early hematogenous spread is clinically unusual, although it is not infrequent in patients with advanced disease.

Ovarian cancer is the most common cause of cancer death from gynecologic tumors in the United States. Early disease causes minimal, nonspecific, or no symptoms. Therefore, most patients are diagnosed in an advanced stage. Overall, prognosis for these patients remains poor. Standard treatment involves aggressive debulking surgery followed by chemotherapy. Many histological types of ovarian tumors are described. However, more than 90% of malignant tumors are epithelial tumors. Therefore, the remainder of this article focuses on these tumors. For specific information on malignant lesions of the ovaries, see Malignant Lesions of the Ovaries.Pathophysiology Ovarian carcinoma can spread by local extension, lymphatic invasion, intraperitoneal implantation, hematogenous dissemination, and transdiaphragmatic passage. Intraperitoneal dissemination is the most common and recognized characteristic of ovarian cancer. Malignant cells can implant anywhere in the peritoneal cavity but are more likely to implant in sites of stasis along the peritoneal fluid circulation. As discussed later, these mechanisms of dissemination represent the rationale to conduct surgical staging, debulking surgery, and intraperitoneal administration of chemotherapy. On the other hand, early hematogenous spread is clinically unusual, although it is not infrequent in patients with advanced disease.