Cancers. Naz Foundation International

Transcription

1 Cancers Naz Foundation International 1

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3 Contents Page 1 Male anogenital anatomy 3 Testicular cancer 6 Prostate cancer 15 Anal cancer 20 Rectal cancer 25 Oral cancer Naz Foundation International ii

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5 Male Anogenital Anatomy Cancers What is the name of each part and what does it do Anus The opening at the end of the digestive tract where bowel contents leave the body, MSM and transgender people often use the anus during sex. Bladder A triangular shaped, hollow organ located in the lower abdomen. It is held in place by ligaments that are attached to other organs and the pelvic bones. The bladder stores urine and empties it through the urethra. Epididymis A long tube that is located near each testicle (see next page). The epididymis is the tube in which the sperm from the testicles are moved away from the testicles. Penis The penis is made up of two parts, the shaft and the glans. The glans is the tip of the penis, while the shaft is the main part of the penis and contains the tube (urethra) that drains the bladder. All the boys are born with a foreskin, or a covering over the tip of the penis. Some boys have the foreskin removed during circumciimage source: medicalcenter.osu.edu/.../greystone/ei_0327.gif Naz Foundation International 1

6 sion. Other boys are not circumcised and may have skin that covers the tip of the penis. Prostate glands A sex gland in men. It is about 3 cm, across, and surrounds the neck of the bladder and urethra (see next page). The prostate gland secretes a fluid that forms part of the semen-a fluid that carries sperm. Rectum The lower end of the large intestine, leading to the anus. Scrotum The bag of the skin that holds and helps to protect the testicles. The testicles make sperm, and to do this, the temperature of the testicles needs to be cooler than the inside of the body. This is why the scrotum is located outside of the body. Testicles (testes) The testicles are two small organs that are found inside the scrotum. The testicles are responsible for making sperm and are also involved in producing a hormone called testosterone. Testosterone is an important hormone during male development and maturation- for developing muscles, deepening the voices, and growing body hair. Urethra The tube that allows urine to pass outside the body. The brain signals the bladder muscles to tighten, which squeezes urine out of the bladder. At the same time, the brain signals the bladder-opening muscles to relax to let urine leave the bladder thorough the urethra, When all the signals occur in the correct order, normal urination occurs. Vas deferens A tube that carries the sperm out the scrotal sac where the sperm is stored. The vas deferens connects the epididymis and the urethra together. Naz Foundation International 2

7 Testicular Cancer Cancers Testicular cancer develops from within the cells in the testes. It usually presents itself as a lump in the testicles. Regular self-examination can help to detect this cancer at an early stage. If the cancer is not treated cancer cells can break away and spread to nearby lymph nodes or other organs. Testicular cancer primarily affects younger men and is the most common form of cancer in men aged Risk Factors Age: testicular cancer is diagnosed more frequently in the young and middle-aged than in elderly men. Undescended testis at birth: the most significant risk factor, this condition may increase the risk of testicular cancer by five to ten times. Family history: having a father, brother or son who has had tes ticular cancer increases the risk of getting the disease. Inherited genetic factors may play a role in up to one in five testicular cancers. Previous testicular cancer: having had testicular cancer before increases image source: www2.kumc.edu the risk of developing cancer in the other testicle. However, cancer i both tes ticles is extremely rare. Symptoms Regular self examination will help you become more aware of the normal feel and size of your testicles so that any abnormalities can be spotted early on. Naz Foundation International 3

8 If you notice any of the following symptoms, go and see your GP as soon as you can: A lump in either testicle Any enlargement of the testicle A feeling of heaviness in the scrotum A dull ache in the abdomen Don t just wait and hope that these symptoms disappear - go and get checked out by your doctor. Most lumps are not cancerous but the earlier you find out, the earlier you can get any necessary treatment. Diagnosis and Treatment If your doctor thinks that you might be suffering from testicular cancer, he is likely to recommend one or more of the following options: Referral to a surgeon A blood test A biopsy An X-Ray An ultrasound scan These tests are firstly to determine whether you have testicular cancer and secondly, to discover to what extent, if any, the cancer might have spread. If caught early and the cancer has not spread, treatment will ordinarily be the surgical removal of the cancerous testicle. If the cancer has spread, this will usually be followed by a three to four month course of chemotherapy. How to perform a testicular self-examination The testicular self-examination (TSE) is an easy way for guys to check their own testicles to make sure there aren t any unusual lumps or bumps - which can be the first sign of testicular cancer. Although testicular cancer is rare in teenage guys, overall it is the most common cancer in males between the ages of 15 and 35. It s important to try to do a TSE every month so you can become familiar with the normal size and shape of your Naz Foundation International 4

9 testicles, making it easier to tell if something feels different or abnormal in the future. Here s what to do It s best to do a TSE during or right after a hot shower or bath. The scro tum (skin that covers the testicles) is most relaxed then, which makes it easier to examine the testicles. Examine one testicle at a time. Use both hands to gently roll each testicle (with slight pressure) between your fingers. Place your thumbs over the top of your testicle, with the index and middle fingers of each hand be hind the testicle, and then roll it between your fingers. You should be able to feel the epididymis (the sperm-carrying tube), which feels soft, rope-like, and slightly tender to pressure, and is located at the top of the back part of each testicle. This is a normal lump. Remember that one testicle (usually the right one) is slightly larger than the other for most guys - this is also normal. When examining each testicle, feel for any lumps or bumps along the front or sides. Lumps may be as small as a piece of rice or a pea. If you notice any swelling, lumps, or changes in the size or color of a testicle, or if you have any pain or achy areas in your groin, let your doctor know right away. source: Lumps or swelling may not be cancer, but they should be checked by your doctor as soon as possible. Testicular cancer is almost always curable if it is caught and treated early. Naz Foundation International 5

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11 Prostate cancer Cancers The Prostate is part of a man s reproductive system. It is located in front of the rectum and under the bladder. It surrounds the urethra, the tube through which urine flows. A healthy prostate is about the size of a walnut. The prostate makes part of seminal fluid. During ejaculation, seminal fluid helps carry sperms out of the man s body as part of semen. Male harmones (androgens) make the prostate grow. The texticles are the main source of male harmones, encluding testosterone. The adrenal gland also makes testosterone, but in small amount. If the prostate grows too large, it squeezes the urethra. This may slow or stop the flow of urine from the bladder to the penis. Risk No one knows the exact causes of prostate cancer. Doctors often cannot explain why one man develops prostate cancer and another does not. However, we do know that prostate cancer is not contagious. You cannot catch it from another person. Research has shown that men with certain risk factors are more likely than others to develop prostate cancer. A risk factor is something that may increase the chance of developing a disease. Studies have found the following risk factors for prostate cancer: Age. Age is the main risk factor for prostate cancer. This disease is rare in men younger than 45. The chance of getting it goes up sharply as a man gets older. In the United States, most men with prostate cancer are older than 65. Family history. A man s risk is higher if his father or brother had prostate cancer. Race. Prostate cancer is more common in African American men than in white men, including Hispanic white men. It is less common in Asian and American Indian men. Certain prostate changes. Men with cells called high-grade prostatic in Naz Foundation International 7

12 traepithelial neoplasia (PIN) may be at increased risk for prostate cancer. These prostate cells look abnormal under a microscope. Diet. Some studies suggest that men who eat a diet high in animal fat or meat may be at increased risk for prostate cancer. Men who eat a diet rich in fruits and vegetables may have a lower risk. Many of these risk fac tors can be avoided. Others, such as family history, cannot be avoided. You can help protect yourself by staying away from known risk factors when ever possible. Screening Your doctor can check you for prostate cancer before you have any symptoms. Screening can help doctors find and treat cancer early. But studies so far have not shown that screening tests reduce the number of deaths from prostate cancer. You may want to talk with your doctor about the possible benefits and harms of being screened. The decision to be screened, like many other medical decisions, is a personal one. You should decide after learning the pros and cons of screening. Your doctor can explain more about these tests: Digital rectal exam. The doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall. The prostate is checked for hard or lumpy areas. Blood test for prostate-specific antigen (PSA). A lab checks the level of PSA in a man s blood sample. A high PSA level is commonly caused by BPH or prostatitis (inflammation of the prostate). Prostate cancer may also cause a high PSA level. The digital rectal exam and PSA test can detect a problem in the prostate. They cannot show whether the problem is cancer or a less serious condition. Your doctor will use the results of these tests to help decide whether to check further for signs of cancer. Information about other tests is in the Diagnosis section. Naz Foundation International 8

13 Symptoms A man with prostate cancer may not have any symptoms. For men who have symptoms of prostate cancer, common symptoms include: Urinary problems Not being able to urinate Having a hard time starting or stopping the urine flow Needing to urinate often, especially at night Weak flow of urine Urine flow that starts and stops Pain or burning during urination Difficulty having an erection Blood in the urine or semen Frequent pain in the lower back, hips, or upper thighs Most often, these symptoms are not due to cancer. BPH, an infection, or another health problem may cause them. Any man with these symptoms should tell his doctor so that problems can be diagnosed and treated as early as possible. He may see his regular doctor or a urologist. A urologist is a doctor whose specialty is diseases of the urinary system. Treatment Treatment methods Men with prostate cancer have many treatment options. The treatment that is best for one man may not be best for another. Treatment may involve surgery, radiation therapy, or hormone therapy. You may have a combination of treatments. If your doctor recommends watchful waiting, your health will be monitored closely. You will have treatment only if symptoms occur or get worse. Cancer treatment is either local therapy or systemic therapy: Local therapy. Surgery and radiation therapy are local treatments. They remove or destroy cancer in the prostate. When prostate cancer has spread to other parts of the body, local therapy may be used to control the dis ease in those specific areas. Naz Foundation International 9

14 Systemic therapy. Hormone therapy is systemic therapy. Hormones are given to control cancer that has spread. The treatment that is right for you depends on the stage of the cancer, the grade of the tumor, your symptoms, and your general health. Your doctor will describe your treatment choices and the expected results. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each man, and they may change from one treatment session to the next. You should consider both the expected benefits and possible side effects of each treatment option. You may want to discuss with your doctor the possible effects on sexual activity. You can work with your doctor to create a treatment plan that reflects your medical needs and personal values. At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. You may want to ask your doctor these questions before your treatment begins: What is the stage of the disease? Do any lymph nodes show signs of cancer? Has the cancer spread? What is the grade of the tumor? What is the goal of treatment? What are my treatment choices? Which do you recommend for me? Why? What are the expected benefits of each kind of treatment? What are the risks and possible side effects of each treatment? How can side effects be managed? What can I do to prepare for treatment? Will I need to stay in the hospital? If so, for how long? How will treatment affect my normal activities? Will it affect my sex life? Will I have urinary problems? Will I have bowel problems? What will the treatment cost? Will my insurance cover it? Naz Foundation International 10

15 Would a clinical trial (research study) be appropriate for me? Surgery: Surgery is a common treatment for early stage prostate cancer. Your doctor may remove the whole prostate or only part of it. In some cases, your doctor can use a method known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. But if you have a large tumor or a tumor that is very close to the nerves, you may not be able to have this surgery. Each type of surgery has benefits and risks. Your doctor can further describe these types: Radical retropubic prostatectomy. The doctor removes the entire prostate and nearby lymph nodes through an incision (cut) in the abdo men. Radical perineal prostatectomy. The doctor removes the entire prosta through a cut between the scrotum and the anus. Nearby lymph nodes may be removedthrough a separate cut in the abdomen. Laparoscopic prostatectomy. The doctor removes the entire prostate and nearby lymph nodes through small incisions, rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) is used to help remove the protate. Transurethral resection of the prostate (TURP). The doctor removes part of the prostate with a long, thin device that is inserted through the urethra. The cancer is cut from the prostate. TURP may not remove all of the cancer. But it can remove tissue that blocks the flow of urine. Cryosurgery. This type of surgery for prostate cancer is under study at some medical centers. Pelvic lymphadenectomy. This is routinely done during prostatecto my. The doctor removes lymph nodes in the pelvis to see if cancer has spread to them. If there are cancer cells in the lymph nodes, the disease may have spread to other parts of the body. In this case, the doctor may suggest other types of treatment. The time it takes to heal after surgery is different for each man and depends on the type of surgery he has had. You may be uncomfortable for the first few days. However, medicine can help control the 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. Naz Foundation International 11

16 After surgery, the urethra needs time to heal. You will have a catheter. A catheter is a tube put through the urethra into the bladder to drain urine. You will have the catheter for 5 days to 3 weeks. Your nurse or doctor will show you how to care for it. Surgery may cause short-term problems, such as incontinence. After surgery, some men may lose control of the flow of urine (urinary incontinence). Most men regain bladder control after a few weeks. Some men may become impotent. Nerve-sparing surgery is an attempt to avoid the problem of impotence. If a man can have nerve-sparing surgery and the operation is a success, impotence may not last. In some cases, men become permanently impotent. You can talk with your doctor about medicine and other ways to help manage the sexual effects of cancer treatment. If your prostate is removed, you will no longer produce semen. You will have dry orgasms. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure. You may want to ask your doctor these questions before choosing surgery: What kinds of surgery can I consider? Is nerve-sparing surgery an option for me? Which operation do you recommend for me? Why? How will I feel after the operation? If I have pain, how can we control it? Will I have any lasting side effects? Is there someone I can talk with who has had the same surgery I ll be having? Radiation therapy Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area. For early stage prostate cancer, radiation treatment may be used 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. Naz Foundation International 12

17 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. Men go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks. Many men receive 3-dimensional confor mal radiation therapy. This type of treatment more closely targets the can cer. It s spares healthy tissue. Internal radiation (implant radiation or brachytherapy). The radiation comes from radioactive material usually contained in small seeds. The seeds are put into the tissue. They give off radiation for months. The seeds are harmless and do not need to be removed. Side effects depend mainly on the dose and type of radiation. You are likely to be very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can. If you have external radiation, you may have diarrhea or frequent and uncomfortable urination. Some men have lasting bowel or urinary problems. Your skin in the treated area may become red, dry, and tender. You may lose hair in the treated area. The hair may not grow back. Internal radiation treatment may cause incontinence. This side effect usually goes away. Lasting side effects from internal radiation are not common. Both internal and external radiation can cause impotence. Internal radiation is less likely to have this effect. You may want to ask your doctor these questions before choosing radiation therapy: How will radiation be given? When will treatment start? When will it end? How often will I have treatments? What can I do to take care of myself before, during, and after treatment? How will I feel during treatment? Will I be able to drive myself to and from treatment? How will we know the treatment is working? Naz Foundation International 13

18 How will I feel after the radiation? Are there any lasting effects? What is the chance that the cancer will come back in my prostate? How often will I need checkups? Hormone therapy Cancers Hormone therapy keeps prostate cancer cells from getting the male hormones (androgens) they need to grow. The testicles are the body s main source of the male hormone testosterone. The adrenal gland makes a small amount of testosterone. Hormone treatment 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 leupro lide and goserelin. 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. However, the adrenal gland still produces a small amount 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. Studies have not shown whether total androgen blockade is more effective than surgery or an LH-RH agonist alone. Doctors can usually control prostate cancer that has spread to other parts of the body with hormone therapy. The cancer often does not grow for several years. But in time, most prostate cancers can grow with very little or no male hormones. Hormone therapy is no longer helpful. At that time, your doctor may suggest other forms of treatment that are under study. Naz Foundation International 14

19 Hormone therapy is likely to affect your quality of life. It often causes side effects such as impotence, hot flashes, loss of sexual desire, and weaker bones. An LH- RH agonist may make your symptoms worse for a short time when you first take it. This temporary problem is called flare. The treatment gradually causes your testosterone level to fall. Without testosterone, tumor growth slows. Your condition may improve. (To prevent flare, your doctor may give you an antiandrogen for a while along with the LH-RH agonist.) Antiandrogens (such as nilutamide) can cause nausea, diarrhea, or breast growth or tenderness. Rarely, they may cause liver problems (pain in the abdomen, yellow eyes, or dark urine). Some men who use nilutamide may have difficulty breathing. Some may have trouble adjusting to sudden changes in light. If used for a long time, ketoconazole may cause liver problems, and aminoglutethimide can cause skin rashes. If you receive total androgen blockade, you may have more side effects than if you have just one type of hormone treatment. Any treatment that lowers hormone levels can weaken your bones. Your doctor can suggest medicines or dietary supplements that can reduce your risk of bone fractures. You may want to ask your doctor these questions before choosing hormone therapy: What kind of hormone therapy will I have? Would you recommend drugs or surgery? Why? When will treatment start? How often will I have treatments? When will it end? Where will I go for treatment? Will I be able to drive home afterward? If I have surgery, how long will I need to stay in the hospital? How will I feel during treatment? What can I do to take care of myself during treatment? How will we know the treatment is working? Which side effects should I tell you about? Will there be lasting side effects? Watchful waiting You may choose watchful waiting if the risks and possible side effects of treatment outweigh the possible benefits. Your doctor may offer this choice if you Naz Foundation International 15

20 are older or have other serious health problems. Your doctor may also suggest watchful waiting if you are diagnosed with early stage prostate cancer that seems to be slowly growing. Your doctor will offer you treatment if symptoms occur or get worse. Watchful waiting avoids or delays the side effects of surgery and radiation, but this choice has risks. It may reduce the chance to control cancer before it spreads. Also, it may be harder to cope with surgery and radiation therapy as you age. You may decide against watchful waiting if you do not want to live with an untreated cancer. If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor. A different approach is nearly always available. Nutrition and physical activity It is important for men with prostate cancer to take care of themselves. Taking care of yourself includes eating well and staying as active as you can. You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy. Your doctor, dietitian, or other health care provider can suggest a healthy diet. Many men find they feel better when they stay active. Walking, yoga, swimming, and other exercise can keep you strong and increase your energy. Exercise may reduce pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it. How can prostate cancer be prevented? A healthy, low-fat diet may help to prevent prostate cancer, and vitamin E, selenium and lycopene (found in tomatoes) may offer protection. Source: National Cancer Institute Naz Foundation International 16

21 Anal Cancer Cancers JOHN L. PFENNINGER, M.D., The National Procedures Institute, Midland, Michigan GEORGE G. ZAINEA, M.D., Midland, Michigan Anal cancer, an uncommon cancer, is a disease in which cancer (malignant) cells are found in the anus. The anus is the opening at the end of the rectum (the end part of the large intestine) through which body waste passes. Cancer in the outer part of the anus is more likely to occur in men; cancer of the inner part of the rectum (anal canal) is more likely to occur in women. If the anus is often red, swollen, and sore, there is a greater chance of getting anal cancer. Tumors found in the area of skin with hair on it just outside the anus are skin tumors, not anal cancer. A doctor should be seen if one or more of the following symptoms appear: bleeding from the rectum (even a small amount), pain or pressure in the area around the anus, itching or discharge from the anus, or a lump near the anus. If there are signs of cancer, a doctor will usually examine the outside part of the anus and give a patient a rectal examination. In a rectal examination, a doctor, wearing thin gloves, puts a greased finger into the rectum and gently feels for lumps. The doctor may also check any material on the glove to see if there is blood in it. The doctor may give the patient general anesthesia, medicine that puts patients to sleep, to continue the examination if pain is felt during it. The doctor may cut out a small piece of tissue and look at it under a microscope to see if there are any cancer cells. This procedure is called a biopsy. The prognosis (chance of recovery) and choice of treatment depend on the stage of the cancer (whether it is just in the anus or has spread to other places in the body) and the patient s general health. Naz Foundation International 17

22 Stage explanation Stages of anal cancer Once anal cancer is found (diagnosed), more tests will be done to find out if cancer cells have spread to other parts of the body. This testing is called staging. To plan treatment, a doctor needs to know the stage of the disease. The following stages are used for anal cancer. Stage 0 or carcinoma in tissue Stage 0 anal cancer is very early cancer. The cancer is found only in the top layer of anal tissue. Stage I The cancer has spread beyond the top layer of anal tissue, is smaller than 2 centimeters in diameter (less than 1 inch), but has not spread to the muscle tissue of the sphincter. Stage II Cancer has spread beyond the top layer of anal tissue and is larger than 2 centimeters in diameter, but has not spread to nearby organs or lymph nodes (small, bean-shaped structures found throughout the body that produce and store infectionfighting cells). Stage IIIA Cancer has spread beyond the top layer of anal tissue source: Cancer has spread to the lymph nodes around the rectum or to nearby organs such as the vagina or bladder. Stage IIIB Cancer has spread to the lymph nodes in the middle of the abdomen or in the groin, or the cancer has spread to both nearby organs and the lymph nodes around the rectum. Naz Foundation International 18

23 Stage IV Cancer has spread to distant lymph nodes within the abdomen or to organs in other parts of the body. Recurrent Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the anus or in another part of the body. Treatment option overview How anal cancer is treated There are treatments for all patients with anal cancer. Three kinds of treatment are used: Surgery (taking out the cancer in an operation) radiation therapy (using highdose x-rays or other high energy rays to kill cancer cells) Chemotherapy (using drugs to kill cancer cells) Surgery is a common way to diagnose and treat anal cancer. A doctor may take out the cancer using one of the following methods: Local resection is an operation that takes out only the cancer. Often the ring of muscle around the anus that opens and closes it (the sphincter muscle) can be saved during surgery so that you will be able to pass the body wastes as before. Abdominoperineal resection is an operation in which the doctor removes the anus and the lower part of the rectum by cutting into the abdomen and the perineum, which is the space between the anus and the scrotum (in men) or the anus and the vulva (in women). A doctor will then make an opening (stoma) on the outside of the body for waste to pass out of the body. This opening is called a colostomy. Although this operation was once commonly used for anal cancer, it is not used as much today because radiation therapy with or without chemotherapy is an equally effective treatment option but does not require a colostomy. If a patient has a colostomy, a special bag will need to be worn to collect body wastes. This bag, which sticks to the skin around the stoma with a special glue, can be thrown away after it is used. This bag does not show under clothing, and most people take care of these bags themselves. Lymph nodes Naz Foundation International 19

24 may also be taken out at the same time or in a separate operation (lymph node dissection). Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). Radiation can be used alone or in addition to other treatments. Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Some chemotherapy drugs can also make cancer cells more sensitive to radiation therapy. Radiation therapy and chemotherapy can be used together to shrink tumors and make an abdominoperineal resection unnecessary. When only limited surgery is required, the sphincter muscle can often be saved. Treatment by stage Treatments for anal cancer depend on the type of disease, stage of disease, and the patient s age and general health. Standard treatment may be considered, based on its effectiveness in patients in past studies, or participation in a clinical trial. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of anal cancer. Stage 0 Anal cancer Treatment will probably be simple surgery to remove all of the cancer. Stage I Anal cancer Treatment may be one of the following: 1. Simple surgery to remove all of the cancer. 2. Radiation therapy with or without chemotherapy. Some patients may also Naz Foundation International 20

25 receive therapy that involves placing radioactive substances in the tissue surrounding the cancer to destroy the cancer (interstitial radiation therapy). 3. If cancer cells remain following therapy, surgery removing the anus and lower part of the rectum may be performed. An opening will be made for waste to pass of out the body (colostomy) into a disposable bag attached near the colostomy (colostomy bag). 4. If cancer cells remain following therapy, additional chemotherapy plus radiation therapy may be performed. 5. Radiation therapy followed by interstitial radiation therapy. Stage II Anal cancer Treatment may be one of the following: 1. Simple surgery to remove all of the cancer. 2. Radiation therapy plus chemotherapy. Some patients may also receive therapy that involves placing radioactive substances in the tissues surrounding the cancer to destroy the cancer (interstitial radiation therapy). 3. If cancer cells remain following therapy, surgery removing the anus and lower part of the rectum may be performed. An opening will be made for waste to pass of out the body (colostomy) into a disposable bag attached near the colostomy (colostomy bag). 4. If cancer cells remain following therapy, additional chemotherapy plus radiation therapy may be performed. Stage IIIA Anal cancer Treatment may be one of the following: 1. Radiation therapy plus chemotherapy. 2. Additional radiation therapy following previous treatment. Stage IIIB Anal cancer Treatment will probably be radiation therapy plus chemotherapy followed by surgery. Depending on how much cancer remains following chemotherapy and radiation, surgery to remove the cancer or surgery to remove the anus and the lower part of the rectum (abdominoperineal resection) may be done. During surgery, the lymph nodes in the groin may be removed (lymph node dissection). Naz Foundation International 21

26 Stage IV Anal cancer Treatment may be one of the following: 1. Surgery to relieve symptoms caused by the cancer. 2. Radiation therapy to relieve symptoms caused by the cancer. 3. Chemotherapy and radiation therapy to relieve symptoms caused by the cancer. 4. A clinical trial evaluating new treatments. The choice of treatment will be based on what treatment the patient received when the cancer was first treated. If the patient was treated with surgery, radiation therapy may be given if the cancer recurs. If the patient were treated with radiation, surgery may be used if the cancer recurs. Clinical trials are studying new chemotherapy drugs with or without radiation therapy. The patient may also receive additional chemotherapy and radiation therapy. Naz Foundation International 22

27 Rectal cancer Cancers Rectal cancer: Cancer that forms in the tissues of the rectum (the last several inches of the large intestine before the anus). Causes Rectal cancer usually develops over several years, first growing as a precancerous growth called a polyp. Some polyps have the ability to turn into cancer and begin to grow and penetrate the wall of the rectum. The actual cause of rectal cancer is unclear. However, the following are risk factors for developing rectal cancer: Increasing age Smoking Family history of colon or rectal cancer High-fat diet and/or a diet mostly from animal sources Personal or family history of polyps or colorectal cancer Family history is a factor in determining the risk of rectal cancer. If a family history of colorectal cancer is present in a first-degree relative (a parent or a sibling), then endoscopy of the colon and rectum should begin 10 years before the age of the relative s diagnosis or at age 50 years, whichever comes first. An often forgotten risk factor, but perhaps the most important, is the lack of screening for rectal cancer. Routine cancer screening of the colon and rectum is the best way to prevent rectal cancer. Rectal cancer symptoms Rectal cancer can cause many symptoms that require a person to seek medical care. However, rectal cancer may also be present without any symptoms, underscoring the importance of routine health screening. Symptoms to be aware of include the following: Naz Foundation International 23

28 Bleeding Seeing blood mixed with stool is a sign to seek immediate medical care. Although many people bleed due to hemorrhoids, a doctor should still be notified in the event of rectal bleeding. Prolonged rectal bleeding (perhaps in small quantities that is not seen in the stool) may lead to anemia, causing fatigue, shortness of breath, light-headedness, or a fast heartbeat. Obstruction A rectal mass may grow so large that it prevents the normal passage of stool. This blockage may lead to the feeling of severe constipation or pain when having a bowel movement. In addition, abdominal pain or cramping may occurdue to the blockage. The stool size may appear narrow so that it can be passed around the rectal mass. Therefore, pencil-thin stool may be another sign of an obstruction from rectal cancer. A person with rectal cancer may have a sensation that the stool cannot be completely evacuated after a bowel movement. Weight loss: Cancer may cause weight loss. Unexplained weight loss (in the absence of dieting or a new exercise program) requires a medical evaluation. Exams and Tests Appropriate colorectal screening leading to the detection and removal of precancerous growths is the only way to prevent this disease. Screening tests for rectal cancer include the following: Fecal occult blood test (FOBT): Early rectal cancer may damage blood vessels of the rectal lining and cause small amounts of blood to leak into the feces. The stool appearance may not change. The fecal occult blood test requires placing a small amount of stool on a special paper that is provided by a doctor. The doctor then applies a chemical to that paper to see if blood is present in the stool sample. Endoscopy: During endoscopy, a doctor inserts a flexible tube with a camera at the end (called an endoscope) through the anus and into the rectum and colon. During this procedure, the doctor can see and remove abnormalities on the inner lining of the colon and rectum. If rectal cancer is suspected, the tumor can be physically detected through either digital rectal examination (DRE) or endoscopy. Naz Foundation International 24

29 A digital rectal examination is performed by a doctor using a lubricated gloved finger inserted through the anus to feel the cancer on the rectal wall. Not all rectal cancers can be felt this way, and detection is dependent on how far the tumor is from the anus. If an abnormality is detected by a digital rectal examination, then an endoscopy is performed for further evaluation of the cancer. Flexible sigmoidoscopy is the insertion of a flexible tube with a camera on the end (called an endoscope) through the anus and into the rectum. An endoscope allows a doctor to see the entire rectum, including the lining of the rectal wall. Rigid sigmoidoscopy is the insertion of a rigid optical scope inserted through the anus and into the rectum. Rigid sigmoidoscopy is usually performed by either a gastroenterologist or a surgeon. The advantage of rigid sigmoidoscopy is that a more exact measurement of the tumor s distance from the anus can be obtained, which may be relevant if surgery is required. A colonoscopy may be performed. For a colonoscopy, a flexible endoscope is inserted through the anus and into the rectum and colon. A colonoscopy allows a doctor to see abnormalities in the entire colon, including the rectum. Because the depth of the cancer s growth into the rectal wall is important in determining treatment, an endoscopic ultrasound (EUS) may be performed during endoscopy. An endoscopic ultrasound uses an ultrasound probe at the tip of an endoscope that allows a doctor to see how deeply the cancer has penetrated. In addition, a doctor can measure the size of the lymph nodes around the rectum during an endoscopic ultrasound. Based on the size of the lymph nodes, a good prediction can be made as to whether the cancer has spread to the lymph nodes. Once an abnormality is seen with endoscopy, a biopsy specimen is obtained using the endoscope and sent to a pathologist. The pathologist can confirm that the abnormality is a cancer and needs treatment. A person may experience small amounts of bleeding after a biopsy is performed. If this bleeding is heavy or lasts longer than a few days, a doctor should be notified immediately. A chest x-ray and a CT scan of the abdomen and pelvis are most likely performed to see whether the cancer has spread further than the rectum or surrounding lymph nodes. Routine blood studies are performed to assess how a person might tolerate the upcoming treatment. Naz Foundation International 25

30 In addition, a blood test called CEA (carcinoembryonic antigen) is obtained. The CEA is often produced by colorectal cancers and can be a useful gauge of how the treatment is working. After the treatment, the doctor may regularly check the CEA level as one indicator of whether the cancer has returned. However, checking the CEA level is not an absolute test for colorectal cancers, and other conditions may cause a rise in the CEA level. Likewise, a normal CEA level is not a guarantee that the cancer is no longer present. Medical Treatment The treatment and prognosis of rectal cancer depend on the stage of the cancer, which is determined by the following 3 considerations: How deeply the tumor has invaded the wall of the rectum Whether the lymph nodes appear to have cancer in them Whether the cancer has spread to any other locations in the body (Organs that rectal cancer commonly spreads to include the liver and the lungs.) The stages of rectal cancer are as follows: Stage I: The tumor involves only the first or second layer of the rectal wall and no lymph nodes are involved. Stage II: The tumor penetrates into the mesorectum, but no lymph nodes are involved. Stage III: Regardless of how deeply the tumor penetrates, the lymph nodes are involved with the cancer. Stage IV: Convincing evidence of the cancer exists in other parts of the body, outside of the rectal area. Localized rectal cancer includes stag e I- III. Metastatic rectal cancer is Stage IV: The goals of treating localized rectal cancer are to ensure the removal of all the cancer and to prevent a recurrence of the cancer, either near the rectum or elsewhere in the body. If stage I rectal cancer is diagnosed, then surgery is likely to be the only necessary step in treatment. The risk of the cancer coming back after surgery is low, and, therefore, chemotherapy is not usually offered. Sometimes, after the removal of a tumor, the doctor discovers that the tumor penetrated into the mesorectum (stage II) or that the lymph nodes contained cancer cells (stage III). In these cases, chemotherapy and radiation therapy are offered Naz Foundation International 26

31 after recovery from the surgery to reduce the chance of the cancer returning. Chemotherapy and radiation therapy given after surgery is called adjuvant therapy. If the initial exams and tests show a person to have stage II or III rectal cancer, then chemotherapy and radiation therapy should be considered before surgery. Chemotherapy and radiation given before surgery is called neoadjuvant therapy. This therapy lasts approximately 6 weeks. Neoadjuvant therapy is performed to shrink the tumor so it can be more completely removed by surgery. In addition, a person is likely to tolerate the side effects of combined chemotherapy and radiation therapy better if this therapy is administered before surgery rather than afterward. After recovery from the surgery, a person who has undergone neoadjuvant therapy should meet with the oncologist to discuss the need for more chemotherapy. If the rectal cancer is metastatic, then surgery and radiation therapy would only be performed if persistent bleeding or bowel obstruction from the rectal mass exist. Otherwise, chemotherapy alone is the standard treatment of metastatic rectal cancer. At this time, metastatic rectal cancer is not curable. However, average survival times for people with metastatic rectal cancer have lengthened over the past several years because of the introduction of new medications. Naz Foundation International 27

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33 Oral Cancer Cancers Oral cancer can form in any part of the mouth or throat. Most oral cancers begin in the tongue and in the floor of the mouth. Anyone can get oral cancer, but the risk is higher if you are male, over age 40, Symptoms of oral cancer include White or red patches in your mouth A mouth sore that won t heal Bleeding in your mouth Loose teeth Problems or pain with swallowing A lump in your neck An earache Source: Oral cancer treatments may include surgery, radiation therapy or chemotherapy. Some patients have a combination of treatments. Naz Foundation International 29