Cancer, Detection & TreatmentThe information provided below has been modified from that furnished by the National Institutes of Health and the National Cancer Institute of the United States of America.
How can cancer be detected early?
In many cases, the sooner cancer is diagnosed and treated, the better a person's chance for a full recovery. If you develop cancer, you can improve the chance that it will be detected early if you have regular medical checkups and do certain self-exams. Often a doctor can find early cancer during a physical exam or with routine tests, even if a person has no symptoms. Some important medical exams, tests, and self- exams are discussed on the next pages. The doctor may suggest other exams for people who are at increased risk for cancer.
Ask your doctor about your cancer risk, problems to watch for, and a schedule of regular checkups. The doctor's advice will be based on your age, medical history, and other risk factors. The doctor also can help you learn about self-exams. (More information and free booklets about self-exams are available from the Cancer Information Service).
Many local health departments have information about cancer screening or early detection programs. The Cancer Information Service also can tell you about such programs.
Exams For Both Men And Women
Skin - The doctor should examine your skin during regular checkups for signs of skin cancer. You should also check regularly for new growths, sores that do not heal, changes in the size, shape, or color of any moles, or any other changes on the skin. Warning signs like these should be reported to the doctor right away.
Colon and Rectum - Beginning at age 50, you should have a yearly fecal occult blood test. This test is a check for hidden (occult) blood in the stool. A small amount of stool is placed on a plastic slide or on special paper. It may be tested in the doctor's office or sent to a lab. This test is done because cancer of the colon and rectum can cause bleeding. However, noncancerous conditions can also cause bleeding, so having blood in the stool does not necessarily mean a person has cancer. If blood is found, the doctor orders more tests to help make a diagnosis.
To check for cancer of the rectum, the doctor inserts a gloved finger into the rectum and feels for any bumps or abnormal areas. A digital rectal exam should be done during regular checkups.
Every 3 to 5 years after age 50, an individual should have sigmoidoscopy. In this exam, the doctor uses a thin, flexible tube with a light to look inside the rectum and colon for abnormal areas.
Mouth - Your doctor and dentist should examine your mouth at regular visits. Also, by looking in a mirror, you can check inside your mouth for changes in the color of the lips, gums, tongue, or inner cheeks, and for scabs, cracks, sores, white patches, swelling, or bleeding. It is often possible to see or feel changes in the mouth that might be cancer or a condition that might lead to cancer. Any symptoms in your mouth should be checked by a doctor or dentist. Oral exams are especially important for people who use alcohol or tobacco products and for anyone over age 50.
Exams For Men
Prostate - Men over age 40 should have a yearly digital rectal exam to check the prostate gland for hard or lumpy areas. The doctor feels the prostate through the wall of the rectum.
Testicles - Testicular cancer occurs most often between ages 15 and 34. Most of these cancers are found by men themselves, often by doing a testicular self-exam. If you find a lump or notice another change, such as heaviness, swelling, unusual tenderness, or pain, you should see your doctor. Also, the doctor should examine the testicles as part of regular medical checkups.
Exams For Women
Breast - When breast cancer is found early, a woman has more treatment choices and a good chance of complete recovery. It is, therefore, important that breast cancer be detected as early as possible. The National Cancer Institute encourages women to take an active part in early detection. They should talk to their doctor about this disease, the symptoms to watch for, and an appropriate schedule of checkups. Women should ask their doctor about:
- Mammograms (x-rays of the breast);
- Breast exams by a doctor or nurse; and
- Breast self-examination (BSE)
A mammogram can often show tumors or changes in the breast before they can be felt or cause symptoms. However, we know mammograms cannot find every abnormal area in the breast. This is especially true in the breasts of young women. Another important step in early detection is for women to have their breasts examined regularly by a doctor or a nurse.
Between visits to the doctor, women should examine their breasts every month. By doing BSE, women learn what looks and feels normal for their breasts, and they are more likely to find a change. Any changes should be reported to the doctor. Most breast lumps are not cancer, but only a doctor can make a diagnosis.
Cervix - Regular pelvic exams and Pap tests are important to detect early cancer of the cervix. In a pelvic exam, the doctor feels the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum for any change in size or shape.
For the Pap test, a sample of cells is collected from the upper vagina and cervix with a small brush or a flat wooden stick. The sample is placed in a glass slide and checked under a microscope for cancer or other abnormal cells.
Women should start having a Pap test every year after they turn 18 or become sexually active. If the results are normal for 3 or more years in a row, a woman may have this test less often, based on her doctor's advice.
Cancer Treatment: Pre-Treatment Eating Tips
When your cancer was first diagnosed, your doctor talked to you about a treatment plan. This may have involved surgery, radiation therapy, chemotherapy, hormone therapy, and biologic immunotherapy or some combination of those treatments.
All of these methods of treating cancer kill cells. In the process of killing the cancer cells, some healthy cells are also damaged. That is what causes the side effects of cancer treatment. Side effects that can affect your ability to eat include:
- loss of appetite
- changes in weight (either losing or gaining weight)
- sore mouth or throat dry mouth
- dental and gum problems
- changes in sense of taste or smell
- nausea/vomiting
- diarrhea
- lactose intolerance
- constipation
- fatigue and/or depression
You may or may not have any of these side effects. Many factors determine whether you will have any and how severe they will be. These factors include the type of cancer you have, the part of your body being treated, the type and length of treatment, and the dose of treatment. The good news is that if you do have side effects they can often be well-controlled. Most side effects also go away after treatment ends. Your doctor or nurse can tell you more about your chances of having side effects and what they might be like.
Nutrition Recommendations Can Be Different for Cancer Patients
Recommendations about food and eating for cancer patients can be very different from the usual suggestions for healthful eating. This can be confusing for many patients because these new suggestions may seem to be the opposite of what they've always heard. Nutrition recommendations usually stress eating lots of fruits, vegetables, and whole grain breads and cereals; including a moderate amount of meat and dairy products; and cutting back on fat, sugar, alcohol, and salt. Nutrition recommendations for cancer patients may focus on helping you eat more higher calorie foods that emphasize protein. Recommendations might include eating or drinking more milk (read our Fortified Milk recipe), cream, cheese, and cooked eggs. Other suggestions might include increasing your use of sauces and gravies, or changing your cooking methods to include more butter, margarine, or oil. Sometimes, nutrition recommendations for cancer patients suggest that you eat less of certain high- fiber foods because these foods can aggravate problems such as diarrhea or a sore mouth.
Cancer Treatment - Managing Eating Problems
All the methods of treating cancer - surgery, radiation therapy, chemotherapy, hormone therapy, and biological therapy (immunotherapy) - are very powerful. Although these treatments target the fast-growing cancer cells in your body, healthy cells can also be damaged. Healthy cells that normally grow and divide rapidly, such as those in the mouth, digestive tract, and hair, are often affected by cancer treatments. The damage to healthy cells is what produces the unpleasant side effects that cause eating problems.
Side effects of cancer treatment vary from patient to patient. The part of the body being treated, the type and length of treatment, and the dose of treatment determine whether side effects will occur. The good news is that not everyone has side effects during treatment, and most side effects go away when treatment ends. Side effects can also be well-controlled with new drugs. Talk to your doctor about possible side effects from your treatment and what can be done about them.
Remember, there aren't any hard and fast nutrition rules during cancer treatment. Some patients may continue to enjoy eating and have a normal appetite throughout most of their cancer treatment. Others may have days when they don't feel like eating at all; even the thought of food may make them feel sick.
Here are some great tips to keep in mind if you or someone you know is receiving cancer treatment:
- When you can eat, try to eat meals and snacks with sufficient protein and calories; they will help you keep up your strength, prevent body tissues from breaking down, and rebuild tissues that cancer treatment may harm.
- Many people find their appetite is better in the morning. Take advantage of this and eat more then. Consider having your main meal of the day early, and have liquid meal replacements later on if you don't feel so interested in eating.
- If you don't feel well and can eat only one or two things, stick with them until you are able to eat other foods. Try a liquid meal replacement for extra calories and protein.
- On those days when you can't eat at all, don't worry about it. Do what you can to make yourself feel better. Come back to eating as soon as you can, and let your doctor know if this problem doesn't get better within a couple of days.
- Try to drink plenty of fluids, especially on those days when you don't feel like eating. Water is essential to your body's proper functioning, so getting enough fluids will ensure that your body has the water it needs. For most adults, 6-8 cups of fluid a day are a good target. Try carrying a water bottle with you during the day. That may help you get into the habit of drinking plenty of fluids.
Chemotherapy and Cancer Treatment, Coping with Side Effects
What Causes Side Effects?
Because cancer cells may grow and divide more rapidly than normal cells, many anticancer drugs are made to kill growing cells. But certain normal, healthy cells also multiply quickly, and chemotherapy can affect these cells, too. This damage to normal cells causes side effects. The fast-growing, normal cells most likely to be affected are blood cells forming in the bone marrow and cells in the digestive tract (mouth, stomach, intestines, esophagus), reproductive system (sexual organs), and hair follicles. Some anticancer drugs may affect cells of vital organs, such as the heart, kidney, bladder, lungs, and nervous system.
You may have none of these side effects or just a few. The kinds of side effects you have and how severe they are, depend on the type and dose of chemotherapy you get and how your body reacts. Before starting chemotherapy, your doctor will discuss the side effects that you are most likely to get with the drugs you will be receiving. Before starting the treatment, you will be asked to sign a consent form. You should be given all the facts about treatment including the drugs you will be given and their side effects before you sign the consent form.
How Long Do Side Effects Last?
Normal cells usually recover when chemotherapy is over, so most side effects gradually go away after treatment ends, and the healthy cells have a chance to grow normally. The time it takes to get over side effects depends on many things, including your overall health and the kind of chemotherapy you have been taking.
Most people have no serious long-term problems from chemotherapy. However, on some occasions, chemotherapy can cause permanent changes or damage to the heart, lungs, nerves, kidneys, reproductive or other organs. And certain types of chemotherapy may have delayed effects, such as a second cancer, that show up many years later. Ask your doctor about the chances of any serious, long-term effects that can result from the treatment you are receiving (but remember to balance your concerns with the immediate threat of your cancer).
The side effects of chemotherapy can be unpleasant, but they must be measured against the treatment's ability to destroy cancer. Medicines can help prevent some side effects such as nausea. Sometimes people receiving chemotherapy become discouraged about the length of time their treatment is taking or the side effects they are having. If that happens to you, talk to your doctor or nurse. They may be able to suggest ways to make side effects easier to deal with or reduce them.
Cancer Treatment - Weight Gain
Some patients find their weight does not change during treatment. Some patients lose weight from nausea and loss of appetite. Some may even gain weight! This is particularly true for patients with cancer of the breast, prostate, and ovary who are taking certain medications or who are on hormone treatments or chemotherapy.
It is important not to go on a special diet right away if you notice weight gain. Instead, tell your doctor so you can find out what may be causing this change. Sometimes, weight gain happens because certain anticancer drugs can cause your body to hold on to excess fluid. This condition is called edema. The weight comes from the extra water. If this is the case, your doctor may ask you to talk with a registered dietician for guidelines on limiting the amount of salt you eat. This is important because salt causes your body to hold extra water. Your doctor also my want to prescribe a diuretic. This is a medication that causes your body to get rid of excess fluid.
Breast cancer patients with a primary diagnosis of cancer may be different. Over half of them may actually gain weight rather than lose during treatment. Because of this, many of the recommendations for breast cancer patients do emphasize a lower fat, reduced calorie diet similar to those provided to patients after cancer treatment has been completed.
Weight gain may also be the result of increased appetite and eating extra food and calories. If this is the case and you want to stop gaining weight, here are some tips that can help. Talk to a registered dietician for more guidance:
- Emphasize fruits, vegetables, breads, and cereals.
- Choose lean meats (lean beef or pork trimmed of fat, chicken without the skin) and low-fat dairy products (skim or 1% milk, light yogurt).
- Cut back on added butter, mayonnaise, sweets, and other extras.
- Choose low fat and low calorie cooking methods (broiling, steaming).
- Avoid eating high-calorie snacks between meals.
- If you feel up to it, increase the amount of exercise you get.
Cancer Treatment Side Effect, Dry Mouth
Chemotherapy and radiation therapy in the head or neck area can reduce the flow of saliva and cause dry mouth. When this happens, foods are harder to chew and swallow. Dry mouth also can change the way foods taste. The following suggestions below may help you deal with dry mouth:
- Have a sip of water every few minutes to help you swallow and talk more easily. Consider carrying a water bottle with you so you always have some handy.
- Try very sweet or tart foods and beverages, such as lemonade; these foods may help your mouth make more saliva. (Do not try this if you also have a tender mouth or sore throat and the sweet or tart foods make it worse.)
- Suck on hard candy or popsicles or chew gum. These can help make more saliva.
- Eat soft and pureed foods, which may be easier to swallow.
- Keep your lips moist with lip salves.
- Moisten food with sauces, gravies, and salad dressings to make it easier to swallow.
- If your dry mouth problem is severe, ask your doctor or dentist about products that coat, protect, and moisten your mouth and throat. These are sometimes called "artificial saliva."
This information has been provided with the kind permission of www.cancer.gov.
Last Editorial Review: 12/20/2002
Testicular Cancer: Survival High with Early Treatment
Most Common Cancer in Young Men
Cancer of the testicles --egg-shaped sex glands in the scrotum that secrete male hormones and produce sperm--accounts for only about 1 percent of all cancers in men, according to the National Cancer Institute. About 7,000 Americans were expected to get the disease in 1995, with an estimated 325 deaths. Compared with prostate cancer, estimated to kill 40,400 of its 244,000 victims in 1995, testicular cancer is relatively rare. However, in men aged 15 to 34, it ranks as the most common cancer. For unknown reasons, the disease is about four times more common in white men than in black men.
Only 15 years ago, a diagnosis of testicular cancer was grim news. Ten times as many patients died then as now. But dramatic advances in therapeutic drugs in the last two decades, along with improved diagnostics and better tests to gauge the extent of the disease, have boosted survival rates remarkably. Now, testicular cancer often is completely curable, especially if found and treated early.
The Food and Drug Administration has approved several drugs to treat testicular cancer, including Ifex (ifosamide), Vepesid (etoposide), Velban (vinblastine sulfate), Blenoxane (bleomycin sulfate), and Platinol (cisplatin).
Many medical professionals regard Platinol as the "magic bullet" for treating certain forms of testicular cancer. FDA approved the platinum-based drug for use after surgery or radiation. Platinol almost always is used in combination with other chemotherapy drugs.
"[Platinum-based treatment] is truly the great success story for solid-tumor chemotherapy," says S. Bruce Malkowicz, M.D., co-director of urologic oncology at the University of Pennsylvania Medical Center. These drugs have helped cut testicular cancer's death rate and bolster its cure rate, he says, adding that many patients "respond very nicely" to platinum-based drug treatments, which are effective even when cancer has spread beyond the testicle.
"That is not a death sentence," Malkowicz says. About 70 percent of men with advanced testicular cancer can be cured, according to the National Cancer Institute.
Most testicular tumors are discovered by patients themselves--either by accident, as Knies did, or while performing a self-examination on each testicle. "The usual presentation is of an enlarged, painless lump," says Malkowicz. "Occasionally there can be pain." The lump typically is pea-sized, but sometimes it might be as big as a marble or even an egg.
Cancer Treatment: Getting the Support You Need
Chemotherapy, like cancer, can bring major changes to a person's life. While it can help cure your cancer, it can sometimes affect overall health, cause stress, disrupt day-to-day schedules, and strain personal relationships. It is no wonder, then, that some people feel tearful, anxious, angry, or depressed at some point during their chemotherapy.
These emotions can be perfectly normal, but they can also be disturbing. Fortunately, there are ways to deal with these emotional side effects, just as there are ways to cope with the physical side effects of chemotherapy.
How Can I Get Support?
You can draw on many sources of support. Here are some of the most important:
Doctors, nurses, and other health professionals. If you have questions or worries about your cancer treatment, talk with members of your health care team. Tell them if you are feeling anxious or depressed, or if you are experiencing other emotional or physical changes.
Counseling professionals. There are many kinds of counselors who can help you express, understand, and cope with your feelings. If you are depressed, you should consider seeking professional help. Feeling hopeless, worthless, guilty, or that life is not worth living are signs of depression. Depending on your preferences and needs, you may want to talk with a psychiatrist, psychologist, social worker, sex therapist, or member of the clergy. There are also medicines that can be used to treat depression. Many cancer centers have "psycho-oncology" programs with psychiatrists, psychologists, and social workers trained to work with cancer patients. Your doctor, nurse, or social worker may be able to suggest who to contact.
Friends and family members. Talking with friends or family members can help you feel a lot better. Often, they can comfort and reassure you in ways that no one else can. However, you may need to help them help you. At a time when you might expect that others will rush to your aid, you may have to make the first move.
Asking friends and family for help. Many people do not understand cancer, and may withdraw from you because they are afraid of your illness and not know what to do to help you. Others may worry that they will upset you by saying "the wrong thing." You can help by being open in talking with others about your illness, your treatment, your needs, and your feelings. By talking openly, you can correct mistaken ideas about cancer. You can also let people know that there is no single "right" thing to say, as long as their caring comes through loud and clear. Once people know they can talk with you honestly, they may be more willing and able to open up and lend their support. Accepting help may be hard. When you allow others to help, you make them feel less helpless. In a sense, you are helping others deal with your illness.
The National Cancer Institute's booklet, Taking Time, offers useful advice to help cancer patients, their families and friends communicate with one another.
Support groups. Support groups are made up of people who are going or have gone through the same kinds of experiences as you. Many people with cancer find they can share thoughts and feelings with group members that they do not feel comfortable sharing with anyone else. Support groups also can serve as an important source of practical information about living with cancer. Some studies suggest that not only can support groups help with how you are feeling emotionally, but may also help you recover physically from your cancer.
Support can also be found in one-to-one programs that put you in touch with another person very similar to you in age, sex, type of cancer, and so forth. In some programs, this person comes to visit you. In others, a "hotline" puts you in touch with someone you can talk with on the telephone. Later, you may want to help others who are going through the same experience you did.
Sources for information about support programs, counseling advice, financial assistance, transportation to and from treatment, and information about cancer include neighborhood organizations, local health care providers, and your hospital, clinic, or medical center where you are being treated. At public libraries and patient libraries at hospitals, a librarian can help you find books and articles through a literature search. The National Cancer Institute's Cancer Information Service (1-800-4-CANCER) is also an excellent source of information and publications.
How Can I Make My Daily Life More Enjoyable?
- Share your feelings with friends and family.
- Watch funny movies. Help someone else.
- Listen to music.
- Try new hobbies and learn new skills.
- Exercise, if you can.
- Do things that interest you.
Cancer Treatment: Complementary and Alternative Medicine
Many people with cancer are exploring complementary therapies. These methods focus on the mind, body, and spirit. They do not take the place of medical therapies, but add to them. They can reduce stress, lessen side effects from cancer and cancer treatments, and enhance well-being. And they can help you feel more in control; it is something you can do for yourself.
A few of the therapies available are described here. Many more therapies exist such as art therapy, humor, journaling, reiki, music therapy, pet therapy and others. You may want to check with your doctor before using these techniques, especially if you have lung problems. A social worker, psychologist, or nurse may be able to help you with these therapies. You may also want to read books, listen to audiotapes, and watch videotapes about these techniques.
Biofeedback
With training in biofeedback, you can control body functions such as heart rate, blood pressure, and muscle tension. A machine will sense when your body shows signs of tension and lets you know in some way such as making a sound or flashing a light. The machine also gives you feedback when you relax your body. Eventually, you can control your relaxation responses without having to depend on feedback from the machine. Your doctor, nurse, or social worker can refer you to someone trained in teaching biofeedback.
Distraction
Distraction is the use of an activity to take your mind off your worries or discomforts. Talking with friends or relatives, watching TV, listening to the radio, reading, going to the movies, or working with your hands by doing needlework or puzzles, building models, or painting are all ways to distract yourself. Many cancer centers now have music or creative art therapists who can be very helpful to you while you are getting treatment for your cancer. Ask your nurse or social work department about possible resources in your area.
Hypnosis
Hypnosis puts you in a deeply-relaxed state that can help reduce discomfort and anxiety. You can be hypnotized by a qualified person, or you can learn how to hypnotize yourself. If you are interested in learning more, ask your doctor, nurse, or social worker to refer you to someone trained in the technique.
Imagery
Imagery is a way of daydreaming that uses all your senses. It is usually done with your eyes closed. To begin, breathe slowly and feel yourself relax. Imagine a ball of healing energy-- perhaps a white light--forming somewhere in your body. When you can "see" the ball of energy, imagine that as you breathe in you can blow the ball to any part of the body where you feel pain, tension, or discomfort such as nausea. When you breathe out, picture the air moving the ball away from your body, taking with it any painful or uncomfortable feelings. (Be sure to breathe naturally; do not blow.) Continue to picture the ball moving toward you and away from you each time you breathe in and out. You may see the ball getting bigger and bigger as it takes away more and more tension and discomfort. To end the imagery, count slowly to three, breathe in deeply, open your eyes, and say to yourself, "I feel alert and relaxed."
Massage Therapy
The idea that touch can heal is an old one. The first written records of massage date back 3,000 years ago to China. Massage therapy involves touch and different methods of stroking and kneading the muscles of the body. A licensed massage therapist should do the therapy. Talk to your doctor before beginning this therapy.
Meditation and Prayer
Meditation is a relaxation technique that allows you to focus your energy and your thoughts on something very specific. This is especially helpful when your mind and body are stressed from cancer treatment. For example, you may want to repeat a word (over and over), or look at an object, such as a picture. Another form of meditation is allowing your thoughts, feelings, and images to flow through your mind. For patients who believe in a higher spiritual power, prayer can provide strength, comfort and inspiration throughout the cancer experience. Whether you pray alone, with family and friends, or as a member of a religious community, prayer may help. A member of the clergy or your spiritual advisor can help you incorporate prayer into your daily life.
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