Mesothelioma Metastasis

The term "metastatic cancer" refers to any form of cancer that has spread from its original location to other parts of the body. Cancer can spread through the lymph nodes or through the blood stream. Doctors have even found that some cancers are predictable as far as the organs to which they will metastasize. In some instances, this predictability can guide doctors and help keep an eye on certain parts of the body that are susceptible to tumors.

Mesothelioma Progression

Because mesothelioma is not generally diagnosed until its later stages (usually Stage III or IV), metastatic disease is common at the time of diagnosis. Mesothelioma metastasis, however, can also occur as the disease continues to progress. Unlike many other cancers, mesothelioma progression does not generally impact the bones or brain, but normally affects the organs around the lungs on the side of the body in which the original tumor was found. This is known in the medical field as a "local spread."

It is also theorized that mesothelioma may actually travel more quickly than other types of cancer. This is because the disease is most often located in or near the lungs, which transfer oxygen throughout the body. Therefore, mesothelioma cells may be able to enter the bloodstream and circulate through the body.

Mesothelioma progression can sometimes be detected through diagnostic imaging tests, which include MRIs or CT scans. Doctors usually suspect that a cancer has spread when a patient complains of symptoms that are not generally associated with mesothelioma. At that time, tests or biopsies will be performed.

Treating Mesothelioma Metastases

Once mesothelioma has metastasized, treatment of the disease will probably change from its original course. The oncologist will need to address the cancer that has spread to other parts of the body and may recommend different therapies. In some cases, both chemotherapy for mesothelioma and radiation may be suggested. However, once the cancer has spread, doctors can usually only offer palliative treatments to ease the pain and improve the quality of life for the patient.

An oncologist with experience in treating this aggressive asbestos-related disease will be able to recommend the best course of treatment for both the original disease and the metastases. 

Mesothelioma Brain Metastases

Though not as common as localized metastases, mesothelioma brain metastases have been reported in medical literature. Malignant mesothelioma does not typically spread to the brain, bones or adrenal glands, so patients should not be highly concerned about a brain metastases. In the cases that have been reported, the mesothelioma diagnosis was typically given in a late stage of development. Once the cancer has spread to distant parts of the body, treatment options tend to be palliative in nature (which aims to relieve symptoms and provide comfort rather than cure the disease).

Mesothelioma Staging

For many decades, doctors have been addressing the seriousness of particular cancers in terms of stages. Throughout the years, various staging systems have been developed to assist cancer doctors in determining diagnosis and the best form of treatment for the individual patient.

There are three popular mesothelioma staging systems used to examine the extent of pleural mesothelioma. Since other forms of mesothelioma are even less common than the occurrence of pleural mesothelioma, there currently are no formal staging systems for other forms of this aggressive cancer (although they can be applied if desired). Each of the three different staging systems measure various factors of malignant mesothelioma, including the extent of the tumor (primary mass), the metastasis (spreading), and the involvement of the lymph nodes.

The knowledge of what particular stage a patient is in after they are diagnosed with mesothelioma greatly affects what treatment options are recommended by doctors. We offer a personalized comprehensive packet that details the various stages of mesothelioma and available treatment options and we can cater this information to meet a patient’s specific situation.

Butchart System - Mesothelioma Staging Systems 

The Butchart System is the oldest staging system for malignant mesothelioma and is the one most commonly used by doctors and specialists to diagnose and treat malignant mesothelioma. The Butchart System is based on the tumor size (mass) and divides malignant mesothelioma into four stages:

• Stage 1 - Malignant mesothelioma has affected the right or left side of the chest cavity (pleural lining) and may be seen in the diaphragm.
• Stage 2 - Malignant mesothelioma has been found in the pleura on both sides of the body and may have also moved into the heart, stomach, or esophagus on both sides. Lymph nodes may be affected.
• Stage 3 - Malignant mesothelioma has reached the abdominal cavity (peritoneum). Lymph nodes past the chest may be affected.
• Stage 4 - Malignant mesothelioma has reached other organs and has entered the blood stream.

TNM System - Mesothelioma Staging Systems 

The TNM System is a more modern staging system for malignant mesothelioma. The TNM System is based on the extent of the tumor, metastasis, and lymph node involvement. Again, the TNM System divides malignant mesothelioma into four stages:

• Stage 1 - Malignant mesothelioma is present in the left or right chest cavity (pleura) and may have metastasized to the lung, the sac around the heart (pericardium) or the diaphragm on the same side. Lymph nodes at stage 1 are not involved.
• Stage 2 - Malignant mesothelioma has reached from one side of the chest cavity to a lymph node near the lung area on the same side as the cancer. The cancer has metastasized to the diaphragm, pericardium (sac around the heart), or the lung on the same side as the primary tumor.
• Stage 3 - Malignant mesothelioma has penetrated the chest lining, heart, esophagus, muscle, ribs and vital organs within the chest cavity on the same side as the cancer. Lymph nodes may or may not be involved during this stage.
• Stage 4 - Malignant mesothelioma has metastasized to the pleural area and the lymph nodes on the opposite side of where the cancerous tumor is located. It may also have reached the chest cavities or lungs on both sides, or may have spread to the abdomen.

Brigham System - Mesothelioma Staging Systems 

 

The Brigham System is the most modern of the three malignant mesothelioma staging systems. The Brigham System looks at different variables such as the involvement of the lymph nodes and the surgical ability to remove a malignant mesothelioma tumor (respectability). For this reason, it is not often used to refer to mesothelioma stages, as the cancer is rarely operable. The Brigham System divides malignant mesothelioma into four stages:

• Stage 1 - Malignant mesothelioma tumor is still resectable (able to be removed surgically) and the lymph nodes are not affected.
• Stage 2 - Malignant mesothelioma tumor is still resectable, but the lymph nodes are now affected.
• Stage 3 - Malignant mesothelioma tumor is not resectable and the malignant mesothelioma has penetrated the heart, chest wall, abdominal cavity or diaphragm. Lymph nodes may or may not be affected.
• Stage 4 - Malignant mesothelioma tumor is not resectable and has completely metastasized (spread throughout the body).

Staging Malignant Mesothelioma

When mesothelioma is diagnosed by a physician or specialist, they must determine the extent of the cancer and how far it has spread. Most often, they will use imaging procedures to see inside the chest or abdomen to help determine the staging of the malignant mesothelioma. The imaging options physicians may use include:

• Chest x-ray
• CT scan of the chest and/or abdomen
• MRI scan of the chest and/or abdomen
• PET scan of the chest and/or abdomen

Once the doctor is able to determine the stage of the mesothelioma, they will be able to formulate a plan for treatment and provide a prognosis.

 

Malignant Mesothelioma Types

In biological terms, malignant mesothelioma is divided into three types: epithelial, sarcomatoid and biphasic. These classifications pertain to the shape and structure of the cancer cells.

Diagram of Malignant Mesothelioma Types.

Between 50 to 70 percent of malignant mesothelioma cases are epithelial, approximately 20 to 35 percent are biphasic, and 7 to 20 percent are sarcomatoid. Epithelial cells are marked by their well-defined and uniform shape and can closely resemble cells of another form of cancer known as adenocarcinoma. Sarcomatoid cells display an elongated spindle shape, which tend to be irregular rather than uniform in shape, and the cells often overlap one another. Cells of the biphasic variety contain both epithelial and sarcomatoid cells, which form in groups of like cells rather than displaying a uniform mixture.

Diagnosing what type of malignant mesothelioma a patient has can be challenging. One contributing factor is that it can be difficult to differentiate mesothelioma from adenocarcinoma, a cancer originating in glandular tissue, on small tissue specimens.

Mesothelioma ICD-9 Code

Pleural mesothelioma may also be referred to as ICD-9 code 163, a disease category and mesothelioma diagnosis code that represents malignant neoplasm of the pleura. Peritoneal mesothelioma may be called ICD-9 code 158, which accounts for malignant neoplasm of the retroperitoneum and peritoneum. Pericardial mesothelioma falls under the category ICD-9 code 164, which represents malignant neoplasm of the thymus, heart and mediastinum.

Malignant Mesothelioma Treatment

Regardless of the type of malignant mesothelioma a patient has, treatment options are available for all mesothelioma patients, though a patient’s response to different treatments will vary. The stage , or level of maturity of the cancer, as well as the patient’s general health are greatly considered when a doctor creates a treatment plan. 

Common curative treatments, or treatments designed to remove cancer cells and cure the disease, for mesothelioma patients include surgery, chemotherapy and radiation. Chemotherapy and radiation treatments aim to kill cancerous cells and stop rapid cell division and growth. Though harmful cells are targeted, the treatments can also affect healthy cells. Patients may experience side effects such as nausea throughout treatment.

Palliative treatments, designed to increase a patient’s comfort and ease pain, may also be recommended. Patients may also wish to explore experimental treatments offered in the studies testing up-and-coming drugs or procedures called clinical trials.

Malignant Mesothelioma Symptoms

Patients with malignant mesothelioma generally do not display any symptoms until 20 to 50 years after exposure to asbestos occurs. This is due to the long latency period (the amount of time it takes for a patient to demonstrate symptoms after initial exposure to a disease-causing agent) associated with mesothelioma. The symptoms of mesothelioma are very general and often resemble less serious conditions, which can make diagnosis difficult. 

Symptoms vary depending on the type of mesothelioma a patient has, but the most common symptoms expressed by pleural mesothelioma patients include shortness of breath, chest pain and persistent cough. Peritoneal mesothelioma patients may display symptoms such as abdominal swelling, changes in bowel movement and development of lumps under the skin on the abdomen. Patients with pericardial mesothelioma may experience heart palpitations, chest pain, difficulty breathing and fever or night sweats. Testicular mesothelioma patients may notice testicular lumps. 

Asbestos.com offers a complimentary informational packet personalized to a patient’s specific mesothelioma diagnosis. With information about the cancer, treatment options and top doctors, many patients and their loved ones find the packet to be a valuable resource.

Mesothelioma Types

Mesothelioma is caused by long-term, repeated exposure to asbestos fibers. The disease is generally found in four different forms: pleural, peritoneal, pericardial, and testicular. In each case, the cancer develops in mesothelial cells, which form the membranous linings that surround and protect organs. The different names for each type of mesothelioma refer to the point of origin of the cancer. 

Mesothelial membranes are made up of two different layers, called the parietal and visceral layers. Parietal layers are outer layers, and these typically cover large areas such as the chest cavity (in the case of pleural and pericardial membranes) and the abdominal cavity (as in the case of peritoneal membranes). Visceral layers are those that cover organs such as the lungs and heart. Mesothelioma develops in these membranes when asbestos fibers become trapped in the spaces between mesothelial cells. 

Mesothelioma is a particularly aggressive type of asbestos cancer, and is highly resistant to treatment, resulting in very high mortality rates and poor prognosis for people diagnosed with the disease. In general, pleural mesothelioma responds more positively to treatment, particularly if the disease is diagnosed early. However, all forms of mesothelioma are difficult to diagnose, and unfortunately, it is common for the disease to be diagnosed too late for treatment to be effective.

The type of mesothelioma a patient is diagnosed with will invariably determine the treatment plan suggested by their doctor. A myriad of treatment options are available for patients diagnosed with all types of mesothelioma and a comprehensive packet detailing the options will be provided overnight to those interested who fill out this form.

Pleural Mesothelioma

 

Pleural mesothelioma develops in the mesothelial lining of the lungs, which is known as the pleura. About 75 percent of all mesothelioma cases are pleural.

Symptoms of pleural mesothelioma include difficulty swallowing, a persistent dry cough, persistent chest pain, or pain when breathing, and difficulty breathing even when resting. These mesothelioma symptoms result from pressure on the lungs and respiratory system, caused by thickening of the pleural membrane and fluid build-up between membrane layers. As the cancer advances, lumps may develop under the skin of the chest.

Diagnosis of pleural mesothelioma involves imaging tests such as chest x-rays, MRIs, and CT scans, and may also include biopsies that remove tissue and fluid to test for the presence of cancer cells. These tests also help determine the stage of the cancer and the options available for treatment. Generally, patients in stage one and two mesothelioma are good candidates for surgery, whereas patients in stages three and four have more limited treatment options, and may only be able to receive palliative treatments.

Peritoneal Mesothelioma

Peritoneal mesothelioma develops in the peritoneal lining of the abdominal cavity. This is a relatively rare form of mesothelioma; approximately 10 to 20 percent of all mesothelioma cases are peritoneal in nature.

Symptoms of peritoneal mesothelioma include pain or swelling of the abdomen, changes in bowel habits (such as constipation or diarrhea), unexplained weight loss, and nausea or vomiting. These symptoms are caused by thickening of peritoneal membranes and fluid build-up, which puts pressure on internal organs and prevents normal function of some organs. As the cancer advances, people with peritoneal mesothelioma may notice lumps developing under the skin of the abdomen.

Diagnosis of peritoneal mesothelioma involves imaging tests such as CT scans and MRIs, as well as biopsies of fluid and tissue to detect the presence of mesothelioma cells. There is currently no recognized staging process for peritoneal mesothelioma.

Peritoneal mesothelioma is problematic in terms of treatment, because the cancer can spread quickly throughout the peritoneum and often metastasizes more quickly than other types of mesothelioma. In some cases surgery is possible, but this is typically a palliative treatment option.

Pericardial Mesothelioma

 Pericardial mesothelioma accounts for approximately half of all pericardial tumors and is an extremely rare. Researchers from various mesothelioma studies report that pericardial mesothelioma accounts for approximately 1 to 6 percent of all mesotheliomas. To date, fewer than 150 cases have been presented in medical literature and approximately 200 cases have been reported worldwide. Pericardial tumors are typically diffuse (not localized) and tend to cover most of the heart.

Pericardial mesothelioma develops in the pericardium, a membrane made up of mesothelial cells that surrounds the heart and provides protection and support to this organ. The membrane is composed of two different layers: an outer layer called the parietal layer (called the heart sac or theca cordis), and an inner layer known as the visceral layer (called the epicardium). The parietal layer is part of a larger membrane that lines the entire chest cavity, while the visceral layer is the pericardial membrane that lines the heart.

Those diagnosed with pericardial mesothelioma usually have a number of questions about how to approach the treatment process. We offer a complimentary packet for pericardial mesothelioma patients containing information about their specific diagnosis, treatment options and top doctors. To receive this packet overnight,

Testicular Mesothelioma

Testicular mesothelioma is the rarest of all mesothelioma cancers, as less than one hundred cases have been recorded. This type of mesothelioma develops in the lining that surrounds the testicles, known as the tunica vaginalis.

Due to the extreme rarity of testicular mesothelioma, very little has been noted about its symptoms and the treatment options available. Often, the disease is not diagnosed until patients notice the appearance of testicular lumps. In some cases, surgery for an unrelated condition such as a hernia leads to the detection of testicular mesothelioma.

If the primary tumor has developed in the testicles, treatment involves removal of part or the entire affected testicle, followed by chemotherapy or radiation therapy. In many cases the testicular tumor is secondary, and the primary cancer is located in the peritoneum. In these cases, treatment follows established patterns for peritoneal mesothelioma in addition to removal of testicular tumors.

Mesothelioma Treatment

After diagnosis, patients and their loved ones are often anxious to do everything possible to fight mesothelioma. This may involve several different treatment options. The most common treatments mesothelioma patients utilize include surgery, chemotherapy and radiation.  Though a cure for mesothelioma does not currently exist, many patients undergo several treatments for relief from symptoms to improve the quality of life. Patients may also experience relief through experimental options and treatments available through clinical trials and alternative therapies. 

Asbestos.com offers additional information about mesothelioma treatment options, top doctors and cancer centers nationwide through a complimentary informational packet. Click here to receive your copy and learn more about symptoms, causes and support resources for mesothelioma patients. 

Mesothelioma Symptoms

Diagnosis can be difficult because symptoms often resemble more common illnesses and are non-specific. Patients are often unaware of the severity of their condition until they are diagnosed with mesothelioma. A patient with peritoneal mesothelioma may express symptoms such as a persistent dry or raspy cough, difficulty breathing and swallowing, night sweats and fever, among others. 

Pericardial mesothelioma patients may complain of swelling or pain in the abdomen, fatigue, nausea, night sweats or the appearance of lumps under the skin on the abdomen. A patient with pericardial mesothelioma may experience heart palpitations or irregular heartbeat, chest pain, difficult breathing, fever and fatigue. Testicular mesothelioma symptoms have been confined to the appearance of testicular lumps. 

Mesothelioma Disease

When a patient learns of a mesothelioma diagnosis, confusion is often one of the first emotions experienced. What exactly is mesothelioma? Is it a disease? A virus? Mesothelioma is actually a rare type of cancer. When people refer to mesothelioma disease, they are actually referring to mesothelioma cancer. Mesothelioma develops in the mesothelium, the membrane that surrounds several body cavities. The mesothelium is comprised of mesothelial cells, which become abnormal and divide uncontrollably if mesothelioma is present.    

Four different types of mesothelioma exist. Pleural mesothelioma is the most common form of the cancer and develops in the lining of the lungs, known as the pleura. Peritoneal mesothelioma affects the lining of the abdomen, known as the peritoneum. Pericardial mesothelioma is very rare, as approximately 200 cases have been reported internationally. Pericardial mesothelioma develops in the pericardium, the membrane that surrounds the heart and protects the organ. Testicular mesothelioma is the rarest form of mesothelioma and develops in the lining surrounding the testicles, known as the tunica vaginalis.

Approximately 2,000 to 3,000 people are diagnosed with mesothelioma annually in the United States. Many patients are not diagnosed with the cancer until it has reached later developmental stages since it may take 20 to 50 years for a patient to demonstrate symptoms of mesothelioma. The cancer is caused almost exclusively by asbestos exposure and it often takes decades for a patient to express mesothelioma symptoms from the time initial asbestos exposure occurred.

How Do I Know if I Have Genital Warts?

Is this topic for you?

This topic provides information about the human papillomavirus (HPV), which causes genital warts and can also cause cervical cancer. If you are looking for information about cervical cell changes or cervical cancer, see the topics Abnormal Pap Test or Cervical Cancer.

What is human papillomavirus (HPV)?

Human papillomavirus (HPV) is one of the most common sexually transmitted diseases (STDs). It is a virus that can be spread through skin-to-skin contact. There are many different types of HPV. Some types cause genital warts and are called low-risk, and some types can lead to cervical cancer and are called high-risk. There is no known cure for HPV, but there is a vaccine that can protect against some types of the virus.

What are genital warts?

For men, genital warts may appear around the anus, on the shaft of the penis, or on the scrotum. For women, genital warts may appear around the anus, on the vulva, in the vagina, or on the cervix.

Genital warts are skin growths in the groin, genital, or anal areas. They can be different sizes and shapes. Some look like flat white patches, and others are bumpy, like tiny bunches of cauliflower. Sometimes you can't see the warts at all.

What causes HPV and genital warts?

HPV is a virus. Certain types of the virus cause genital warts and some types cause abnormal cervical cell changes and cervical cancer.

HPV and genital warts can be spread through sexual contact with someone who has the virus.

What are the symptoms?

Most people infected with HPV don't have symptoms. But if they do, the symptoms may be so mild that they may not know they are infected. The symptoms may include pain, itching, and bleeding, or you may develop visible genital warts.

If you have symptoms, they will probably occur 2 to 3 months after infection. But you can have symptoms from 3 weeks to many years after infection.

Visible genital warts appear only during active infection. But it is possible to spread the virus even if you can't see the warts.

How are HPV and genital warts diagnosed?

A doctor can often tell if you have genital warts by looking closely at your genital and anal areas. He or she may ask you questions about your symptoms and your risk factors. Risk factors are things that make you more likely to get a disease.

Sometimes the doctor takes a sample of tissue from the wart for testing.

For women, if you have an abnormal Pap test, your doctor can do an HPV test that looks for high-risk types of the virus.

How are they treated?

There is no cure for HPV, but the symptoms can be treated.

Talk to your doctor about whether you should treat visible genital warts. They usually go away with no treatment, but they may also spread. Most people decide to treat them because of the symptoms or because of how the warts look. But if you don't have symptoms and are not worried about how the warts look, you can wait and see if the warts go away.

If you do decide to treat genital warts, talk to your doctor about the best treatment for you. There are prescription medicines you or your doctor can put on the warts. Or your doctor can remove them with lasers, surgery, or by freezing them off.

Even if you treat visible warts or your warts go away without treatment, the HPV infection can stay in your body's cells. It is possible to spread genital warts to your partner even if you have no signs of them.

Can HPV and genital warts be prevented?

The best way to keep from getting genital warts—or any other STD—is to not have sex. If you do have sex, practice safe sex.

• Use condoms. Condoms may help reduce the risk of spreading genital warts, but they do not protect the entire genital area against skin-to-skin contact.
• Before you have sex with someone, talk to them about STDs. Find out whether he or she is at risk for them. Remember that a person can be infected without knowing it.
• If you have symptoms of an STD, don't have sex.
• Do not have sex with anyone who has symptoms or who may have been exposed to an STD.
• Do not have more than one sex partner at a time. Having several sex partners increases your risk for disease.

What You Need to Know About the HPV Vaccine, and Why It's Controversial

Almost everyone carries the human papillomavirus (HPV), and it's usually pretty harmless. But a few strains are the main cause of cervical cancer. Gardasil, the HPV vaccine approved by the FDA in 2006, guards against two of these strains, plus two other strains that are responsible for most genital warts.

Since most adults have already been exposed to HPV, the vaccine is recommended for girls who haven't become sexually active yet. (The federal Centers for Disease Control and Prevention recommends vaccination at age 11 or 12, but Gardasil is approved for girls as young as 9.)

So far, so good. But the introduction of this new vaccine has stirred up a small fuss.

The controversy
Perhaps the main fear of the vaccine's opponents is that it might encourage adolescent promiscuity.

H. Hunter Handsfield, MD, a clinical professor of medicine at the University of Washington and a nationally recognized STD expert, believes most parents are all for it, however. "It can prevent cancer?" he says, parroting the most common parental concern. "Well, duh, give my kid the shot."

Still, questions come up all the time because the vaccine is so new. Here are a couple of the most common:

1. Should boys get the HPV vaccine?
Men rarely get cancer from HPV, but they do pass the virus to their female partners, and they do get genital warts from HPV as well. In Europe and the U.K., Gardasil is licensed for use in both boys and girls, although so far only Austria's public health program actually recommends vaccinations for both.

The reason it's not generally recommended for boys in the U.S. is because it hasn't been approved for use in boys. General thinking may be, too, that it's more cost-effective, from a public-health standpoint, to vaccinate girls only. And insurance companies won't cover vaccines that aren't recommended. Gardasil retails at around $375 for the three-dose course.

2. What about women over 26?
Older women and boys are in a similar situation, says Dr. Handsfield. "Women who get beyond their 20s are statistically at lower risk for HPV infection," he says, "so from a public-policy standpoint, it's not a priority." Also, since the research studies that led to Gardasil's approval were limited to the under-26 crowd, it's not FDA-approved for older women.

"But sure, the vaccine almost certainly would work in older women," Dr. Handsfield says. "This'll evolve."

As an older woman, you can pay out of pocket and get the vaccine, but it may not help (you may already have those strains of the virus). If you're older than 26 and considering the vaccine, it makes sense to evaluate your sexual history. "Say there's a 28-year-old woman, she's about to be out there dating again, and she's only had three or four partners; she probably is still susceptible," says Dr. Hansdfield. "She clearly needs the vaccine. "

3. If I get vaccinated, do I still need to get regular Pap smears?
Yes! Experts agree that the vaccine does not replace the need for regular Pap smears, since it protects only against the strains of the virus that cause 70% of all cervical cancers. You'll still need to protect yourself from the rest with yearly screenings.

Cervical Cancer

Is this topic for you?

This topic talks about the testing, diagnosis, and treatment of cervical cancer. For general information about abnormal Pap test results, see the topic Abnormal Pap Test.

What is cervical cancer?

Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be cured when it’s found early. It is usually found at a very early stage through a Pap test.

What causes cervical cancer?

Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms.

You can have HPV for years and not know it. It stays in your body and can lead to cervical cancer years after you were infected. This is why it is important for you to have regular Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If you treat these cell changes, you may prevent cervical cancer.

What are the symptoms?

Abnormal cervical cell changes rarely cause symptoms. But you may have symptoms if those cell changes grow into cervical cancer. Symptoms of cervical cancer may include:

• Bleeding from the vagina that is not normal, or a change in your menstrual cycle that you can't explain.
• Bleeding when something comes in contact with your cervix, such as during sex or when you put in a diaphragm.
• Pain during sex.
• Vaginal discharge that is tinged with blood.

How is cervical cancer diagnosed?

As part of your regular pelvic exam, you should have a Pap test. During a Pap test the doctor scrapes a small sample of cells from the surface of the cervix to look for cell changes. If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix.

Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such as bleeding after sex.

How is it treated?

Cervical cancer that is caught early can usually be cured. If the cancer is caught very early, you still may be able to have children after treatment.

The treatment for most stages of cervical cancer removes the cancer and makes you unable to have children. These treatments include:

• A hysterectomy and removal of pelvic lymph nodes with or without removal of both ovaries and fallopian tubes.
• Radiation therapy.
• Chemotherapy.

Depending on how much the cancer has grown, you may have one or more treatments. And you may have a combination of treatments.

It’s common to feel scared, sad, or angry after finding out that you have cervical cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area. You can also find people online who will share their experiences with you.

Can cervical cancer be prevented?

The Pap test is the best way to find cervical cell changes that can lead to cervical cancer. Regular Pap tests almost always show these cell changes before they turn into cancer. It is important to follow up with your doctor after any abnormal Pap test result to treat abnormal cell changes. This may help prevent cervical cancer.

If you are age 26 or younger, you can get the HPV shot. The vaccines Cervarix and Gardasil protect against two types of HPV that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. Three shots are given over 6 months. The series of shots is recommended for girls age 11 or 12 and can be given to females ages 9 to 26.

The virus that causes cervical cancer is spread through sexual contact. The best way to avoid getting a sexually transmitted disease is to not have sex. If you do have sex, practice safer sex, such as using condoms and limiting the number of sex partners you have.

How to Weigh Your Breast Cancer Risk Factors

Not all breast cancer risks factors have the same influence.

• "A family history will still drive [risk] much more powerfully than other reproductive risk factors—like having no children, having few children, or having children late," says Angela R. Bradbury, MD, director of the Margaret Dyson Family Risk Assessment Program at Fox Chase Cancer Center in Philadelphia.

• Having a first-degree relative such as a mother, sister, or daughter with a breast cancer history boosts your risk much more than if a cousin or more distant relative has had it—particularly if the diagnosis came before the age of 50 or your family’s background is Ashkenazi Jewish.

• Then there are the so-called breast cancer genes, BRCA-1 and BRCA-2. Mutations in these genes raise your risk even higher than the family connection alone. If you have relatives with breast cancer, you might be a candidate for BRCA testing or for other modifications to your screening for the disease. Make an appointment to talk through your options with your doctor or a genetic counselor.

What Causes Breast Cancer?

No one knows very much about why breast cancer happens, except that it likely starts in our genes. "Cancer in general is a disease of aging, and breast cancer is probably caused by an error in gene replication—the older we get, the more error prone we get," says Ramona F. Swaby, MD, a medical oncologist specializing in breast cancer at Fox Chase Cancer Center in Philadelphia. Indeed, a woman’s chance of getting breast cancer doesn’t rise to the terrifying one in eight until she’s reached 85 years of age. If you’re a woman under 40, for instance, your risk is much lower: one in 233.

Approximatly 5% to 10% of the roughly 200,000 American women diagnosed with breast cancer each year have an inherited gene mutation that puts them at higher risk for developing the disease. Most of these genes remain unidentified, but scientists know that mutations to the BRCA-1 and BRCA-2 (Breast Cancer 1 and 2) genes, which normally help prevent cancer by regulating cell growth, are linked to an increased risk for breast and ovarian cancer.

If you’re wondering whether you carry the BRCA-1 or BRCA-2 mutations, you may have considered getting a genetic test to find out. That’s a tough decision, because it’s not always clear what to do with your test results. Some women who know they are at higher risk without taking the test simply commit to more frequent mammograms; others feel the need to know as much as possible and may consider prophylactic surgery if they test positive.

What African-American Women Need to Know About Breast Cancer

Even though breast cancer incidence rates are slightly lower overall among African-American women than white women (the incidence is lower still among Hispanic, Asian, and Native American women), a combination of socioeconomic factors and unexplained biological differences make the disease more deadly—and in some cases, harder to treat—in the black community. Also, African-American women under 45 have a greater incidence of breast cancer than white women in the same age range.

Many women are "triple negative"
No one yet knows precisely why, but African-American women are roughly twice as likely as white women to have triple-negative breast cancer—so called because tumor cells in this particularly aggressive form of the disease test negative for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2). This puts Herceptin and hormone therapies, such as tamoxifen and aromatase inhibitors, entirely out of reach as treatment options. It's suspected that some combination of genetics and environmental factors are at play in triple-negative disease.

 

Socioeconomic factors
The five-year survival rate for white women is approximately 90%; for African-American women it's roughly 77%. Differences in medical coverage and health-care access likely explain this. Overall, African Americans tend to have more trouble finding consistent, good-quality health care—which amounts to fewer breast cancer screenings and inferior treatment when they are diagnosed.

"Black women have been noted to present [at a doctor's office] with later stage cancer, which has a worse outcome—and they don't always get adequate care," says Ruth O’Regan, MD, associate professor of hematology and oncology and director of the translational breast cancer research program at Emory University's Winship Cancer Institute in Atlanta. Seeking medical help when a tumor is larger, higher grade, and/or with more lymph nodes involved can dramatically lower a woman's odds for survival.

Not in the research yet
Another potential problem for African-American women seeking treatment for breast cancer is that they have been underrepresented in chemotherapy breast cancer research, so it has been difficult to determine whether they might metabolize chemotherapy drugs differently from the primarily white research subjects. The issue is being actively researched now.

Breast Cancer

Breast cancer (malignant breast neoplasm) is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas.

Prognosis and survival rate varies greatly depending on cancer type and staging. Computerized models are available to predict survival. With best treatment and dependent on staging, 10-year disease-free survival varies from 98% to 10%. Treatment includes surgery, drugs (hormonal therapy and chemotherapy), and radiation.

Worldwide, breast cancer comprises 10.4% of all cancer incidence among women, making it the most common type of non-skin cancer in women and the fifth most common cause of cancer death. In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths). Breast cancer is about 100 times more common in women than in men, although males tend to have poorer outcomes due to delays in diagnosis.

Some breast cancers are sensitive to hormones such as estrogen and/or progesterone, which makes it possible to treat them by blocking the effects of these hormones in the target tissues. Estrogen and progesterone receptor positive tumors have better prognosis and require less aggressive treatment than hormone negative cancers.

Breast cancers without hormone receptors, or which have spread to the lymph nodes in the armpits, or which express certain genetic characteristics, are higher-risk, and are treated more aggressively. One standard regimen, popular in the U.S., is cyclophosphamide plus doxorubicin (Adriamycin), known as CA; these drugs damage DNA in the cancer, but also in fast-growing normal cells where they cause serious side effects. Sometimes a taxane drug, such as docetaxel, is added, and the regime is then known as CAT; taxane attacks the microtubules in cancer cells. An equivalent treatment, popular in Europe, is cyclophosphamide, 

methotrexate, and fluorouracil (CMF). Monoclonal antibodies, such as trastuzumab (Herceptin), are used for cancer cells that have HER2/neu overexpressed. Radiation is usually added to the surgical bed to control cancer cells that were missed by the surgery, which usually extends survival, although radiation exposure to the heart may cause damage and heart failure in the following years.

Melanoma Exams and Tests

Evaluation of a skin lesion

A physical exam of the skin is used to evaluate the skin for melanoma. If melanoma is suspected, a skin biopsy will be done. For this, your doctor will remove a sample of skin tissue and send it to a pathologist to be looked at under a microscope. If the biopsy shows melanoma, the pathologist will measure the thickness of the melanoma to find out how advanced the cancer is.

Other techniques may include total-body photography to monitor for changes in any mole and to watch for new moles appearing in normal skin. A series of photos of the suspicious lesions may be taken. Then the photos can be used as a baseline to compare with follow-up photos.

Evaluation of lymph nodes

Testing the lymph nodes may not be needed if the melanoma is less than 1 mm (0.04 in.) thick when measured with a microscope, because the risk of the cancer spreading may be low. But if your melanoma is large or thick, you can expect more lab tests.

If a melanoma is thicker than 1 mm (0.04 in.), your doctor will do a physical exam that includes checking the lymph nodes to see whether they are larger than normal. This may be followed by a lymph node biopsy to see whether the melanoma has spread to the lymph system.

A sentinel lymph node biopsy is a relatively new technique that may be used instead of conventional lymph node biopsy. Like a conventional biopsy, sentinel lymph node biopsy is done to identify lymph nodes that may contain melanoma.

Evaluation for possible metastases (spread of cancer)

A complete medical history and a physical exam are needed to find out whether the cancer has spread (metastasized) to other parts of the body. Imaging tests, including positron emission tomography (PET scan), computed tomography (CT scan) or magnetic resonance imaging (MRI), may be used to identify metastases in other parts of the body, such as the lungs, brain, liver, or other organs.

Early Detection

Skin self-exam is a good way to detect early skin changes that may point to melanoma. A skin self-exam is used to identify suspicious growths that may be cancer or growths that may develop into skin cancer (precancers). Adults should examine their skin once every month. Look for any abnormal skin growth or any change in the color, shape, size, or appearance of a skin growth. Check for any area of injured skin (lesion) that does not heal. Have your spouse or someone such as a close friend help you monitor your skin, especially places that are hard to see such as your scalp and back.

There are other steps you can take to prevent skin cancer or detect it at an early stage.

• Be aware of the risk of skin cancer and the steps you can take to prevent it, including using sunscreen, wearing protective clothing, and staying out of the midday sun.
• Have your doctor examine any suspicious skin changes. Screening guidelines from the American Cancer Society and other expert groups advise adults older than 40 to have their skin checked by a doctor at least once a year and during all other health exams. This may lead to early treatment, which may prevent the spread of cancer. You may wish to begin screening earlier, especially if you have:
  • Familial atypical mole and melanoma (FAM-M) syndrome, which is an inherited tendency to develop melanoma. Examine your skin every month and be examined by a doctor every 4 to 6 months, preferably by the same doctor each time.
  • Increased occupational or recreational exposure to ultraviolet (UV) radiation.
  • Abnormal moles called atypical moles (dysplastic nevi). These moles are not cancerous. But their presence is a warning of an inherited tendency to develop melanoma.

What is Melanoma ?

Melanoma is a kind of skin cancer. It is not as common as other types of skin cancer, but it is the most serious.


Melanoma can affect your skin only, or it may spread to your organs and bones. Luckily, it can be cured if it’s found and treated early.

Melanoma is a serious form of skin cancer that starts in the pigment-producing skin cells (melanocytes). These cells become abnormal, grow uncontrollably, and aggressively invade surrounding tissues.

What causes melanoma?

You can get melanoma by spending too much time in the sun. This causes normal skin cells to become abnormal. These abnormal cells quickly grow out of control and attack the tissues around them.
Melanoma tends to run in families. Other things in your family background can increase your chances of getting the disease. For example, you may have abnormal, or atypical, moles. Atypical moles may fade into the skin and have a flat part that is level with the skin. They may be smooth or slightly scaly, or they may look rough and “pebbly.” These moles don't cause cancer by themselves. But having many of them is a sign that melanoma may run in your family.

What are the symptoms ?

The main sign of melanoma is a change in a mole or other skin growth, such as a birthmark. Any change in the shape, or of a mole may be a sign of melanoma.

The most important warning sign for melanoma is a change in size, shape, or color of a mole or other skin growth, such as a birthmark. One of the things to watch for is diameter.
Diameter is width. If the diameter across a mole or skin growth is larger than 1/4 inch (6 mm), or about the size of a pencil eraser, talk to your doctor. Also, call your doctor if any mole seems to be growing, even if it is still smaller than 1/4 inch (6 mm).

Melanoma skin cancer

Melanoma is the least common type of skin cancer. Still, it is the most deadly because it can spread if not caught early. Melanoma symptoms include a change in the shape, size, or color of a mole, but melanomas can also look like a bruise that doesn't heal or a dark streak under a finger or toenail. Excess sun is linked to melanoma risk. However, melanomas can also occur on skin not exposed to the sun (such as inside the mouth).

Mesothelioma diagnosis

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytopathology if this fluid is aspirated with a syringe. For pleural fluid, this is done by thoracentesis or tube thoracostomy (chest tube); for ascites, with paracentesis or ascitic drain; and for pericardial^{[disambiguation needed]} effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure). Unfortunately, the diagnosis of malignant mesothelioma by cytology alone is difficult, even with expert pathologists.

Generally, a biopsy is needed to confirm a diagnosis of malignant mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. Alternatively, the chest surgeon might directly open the chest (thoracotomy). If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

Immunohistochemical studies play an important role for the pathologist in differentiating malignant mesothelioma from neoplastic mimics. There are numerous tests and panels available. No single test is perfect for distinguishing mesothelioma from carcinoma or even benign versus malignant.

Mesothelioma couses

Working with asbestos is the major risk factor for mesothelioma. In the United States, asbestos is the major cause of malignant mesothelioma and has been considered "indisputably^" associated with the development of mesothelioma. Indeed, the relationship between asbestos and mesothelioma is so strong that many consider mesothelioma a “signal” or “sentinel” tumor. A history of asbestos exposure exists in most cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite. Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.

Asbestos was known in antiquity, but it was not mined and widely used commercially until the late 19th century. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the official position of the U.S. Occupational Safety and Health Administration (OSHA) and the U.S. EPA is that protections and "permissible exposure limits" required by U.S. regulations, while adequate to prevent most asbestos-related non-malignant disease, they are not adequate to prevent or protect against asbestos-related cancers such as mesothelioma. Likewise, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE assumes that no such "safe" threshold exists. Others have noted as well that there is no evidence of a threshold level below which there is no risk of mesothelioma.There appears to be a linear, dose-response relationship, with increasing dose producing increasing disease.Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer. Again, there is no known safe level of exposure to asbestos as it relates to increased risk of mesothelioma.

The duration of exposure to asbestos causing mesothelioma can be short. For example, cases of mesothelioma have been documented with only 1–3 months of exposure. People who work with asbestos wear personal protective equipment to lower their risk of exposure.

Latency, the time from first exposure to manifestation of disease, is prolonged in the case of mesothelioma. It is virtually never less than fifteen years and peaks at 30–40 years^. In a review of occupationally related mesothelioma cases, the median latency was 32 years. Based upon the data from Peto et al, the risk of mesothelioma appears to increase to the third or fourth power from first exposure.

Mesothelioma signs and symptoms

Symptoms or signs of mesothelioma may not appear until 20 to 50 years (or more) after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space (pleural effusion) are often symptoms of pleural mesothelioma.

Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of Peritoneal Mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions.

Mesothelioma that affects the pleura can cause these signs and symptoms:

• Chest wall pain
• Pleural effusion, or fluid surrounding the lung
• Shortness of breath
• Fatigue or anemia
• Wheezing, hoarseness, or cough
• Blood in the sputum (fluid) coughed up (hemoptysis)

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:

• Abdominal pain
• Ascites, or an abnormal buildup of fluid in the abdomen
• A mass in the abdomen
• Problems with bowel function
• Weight loss

In severe cases of the disease, the following signs and symptoms may be present:

• Blood clots in the veins, which may cause thrombophlebitis
• Disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
• Jaundice, or yellowing of the eyes and skin
• Low blood sugar level
• Pleural effusion
• Pulmonary emboli, or blood clots in the arteries of the lungs
• Severe ascites

A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.

What is mesothelioma ?

Mesothelioma, more precisely malignant mesothelioma, is a rare form of cancer that develops from the protective lining that covers many of the body's internal organs, the mesothelium. It is usually caused by exposure to asbestos.

Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart, the pericardium (a sac that surrounds the heart) or tunica vaginalis.

Most people who develop mesothelioma have worked on jobs where they inhaled asbestos and glass particles, or they have been exposed to asbestos dust and fiber in other ways. It has also been suggested that washing the clothes of a family member who worked with asbestos or glass can put a person at risk for developing mesothelioma.Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases the risk of other asbestos-induced cancers. Those who have been exposed to asbestos often utilize attorneys to collect damages for asbestos-related disease, including mesothelioma. Compensation via asbestos funds or lawsuits is an important issue in mesothelioma (see asbestos and the law).

The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.

What about herbal or other alternative medicine treatments for prostate cancer?

Alternative medicine, also called integrative or complementary medicine, includes such non-traditional treatments as herbs, dietary supplements, and acupuncture. A major problem with most herbal treatments is that their composition is not standardized. Moreover, the way herbal treatments work and their long-term side effects usually are not known. Currently, there is no evidence to prove that these medications have any therapeutic benefit in prostate cancers that haveWhat is active surveillance for prostate cancer?

Active surveillance is observing a patient while no immediate treatment is given. Such a patient usually has a less aggressive, small-sized, organ-confined tumor and no symptoms. This management strategy is based on the premise that most early prostate cancers are slow-growing tumors and will remain confined to the prostate gland for a significant length of time. This implies that in selected patients it may be possible to defer definitive treatment for many years or avoid it altogether thereby preventing the side effects associated with treatments like surgery or radiation. Understand, however, that although active surveillance involves no actual treatment, the patient still needs close follow-up and monitoring. The follow-up involves frequent visits to the doctor, perhaps every three to six months. The visits include questions about new or worsening symptoms and digital rectal examinations for any change in the prostate gland. In addition, blood tests are done to watch for a rising PSA, and imaging studies can be conducted to detect the spread of the cancer. Most experts also recommend performing a confirmatory set of prostate biopsies to ensure that there is low-volume disease. Additional prostate biopsy is required every year to detect any increase in the volume and Gleason grade of the cancer. As mentioned before, Gleason grade is a measure of aggressiveness of the tumor and increase in this value may point toward a need to treat the cancer with other means. If the history, examinations, or any of the tests signal the possibility of an advancing cancer, the active surveillance usually is discontinued and active treatment is recommended, often with radiotherapy or surgery.

Active surveillance is different from watchful waiting. Watchful waiting means following up patients without any tests or biopsies and treating them only when symptoms arise. This is reserved for men who have a life expectancy of less than 10 years. Therefore, watchful waiting seems to make sense for organ-confined (localized) prostate cancers in men who are elderly. Additionally, watchful waiting often is the most appropriate choice in men who are ill with other serious medical diseases, such as heart or lung disease, poorly controlled high blood pressure, diabetes, AIDS, or other cancers.

Active surveillance and watchful waiting in prostate cancer, however, remains controversial. Some medical authors have stated outright that it is not a good choice. They point out that few doctors would just watch other cancers to see whether they would spread without treatment. Furthermore, the treatment for an individual could become less effective in the future if and when the cancer does progress. Moreover, there is no standardized protocol for selecting appropriate patients for active surveillance with different institutions having their own different guidelines. Studies are under way to compare these protocols with more established methods of treatment, and more information is likely to emerge in the future.