Lung cancer

Cancer - lung

Last reviewed: September 26, 2010.

Lung cancer is cancer that starts in the lungs.
The lungs are located in the chest. They help you breathe. When you breathe, air goes through your nose, down your windpipe (trachea), and into the lungs, where it spreads through tubes called bronchi. Most lung cancer begins in the cells that line these tubes.
There are two main types of lung cancer:

• Non-small cell lung cancer (NSCLC) is the most common type of lung cancer.
• Small cell lung cancer makes up about 20% of all lung cancer cases.

If the lung cancer is made up of both types, it is called mixed small cell/large cell cancer.
If the cancer started somewhere else in the body and spread to the lungs, it is called metastatic cancer to the lung.

Causes, incidence, and risk factors

Lung cancer is the deadliest type of cancer for both men and women. Each year, more people die of lung cancer than breast, colon, and prostate cancers combined.
Lung cancer is more common in older adults. It is rare in people under age 45.
Cigarette smoking is the leading cause of lung cancer.
The more cigarettes you smoke per day and the earlier you started smoking, the greater your risk of lung cancer. There is no evidence that smoking low-tar cigarettes lowers the risk.
However, lung cancer has occurred in people who have never smoked.
Secondhand smoke (breathing the smoke of others) increases your risk of lung cancer. According to the American Cancer Society, an estimated 3,000 non-smoking adults will die each year from lung cancer related to breathing secondhand smoke.
The following may also increase one's risk of lung cancer:

• High levels of air pollution
• High levels of arsenic in drinking water
• Radon gas
• Asbestos
• Family history of lung cancer
• Radiation therapy to the lungs
• Exposure to cancer-causing chemicals such as uranium, beryllium, vinyl chloride, nickel chromates, coal products, mustard gas, chloromethyl ethers, gasoline, and diesel exhaust

Symptoms

Early lung cancer may not cause any symptoms. Many times, lung cancer is found when an x-ray is done for another reason.
Symptoms depend on the specific type of cancer you have, but may include:

• Cough that doesn't go away
• Coughing up blood
• Shortness of breath
• Wheezing
• Chest pain
• Loss of appetite
• Losing weight without trying
• Fatigue

Additional symptoms that may also occur with lung cancer, often in the late stages:

• Weakness
• Swallowing difficulty
• Nail problems
• Joint pain
• Hoarseness or changing voice
• Shoulder pain
• Swelling of the face or arms
• Facial paralysis
• Eyelid drooping
• Bone pain or tenderness

These symptoms can also be due to other, less serious conditions, so it is important to talk to your health care provider.
For more information, see:

• Small cell lung cancer
• Non-small cell lung cancer

Signs and tests

The health care provider will perform a physical exam and ask questions about your medical history. You will be asked if you smoke, and if so, how long you have smoked.
When listening to the chest with a stethoscope, the health care provider can sometimes hear fluid around the lungs, which could (but doesn't always) suggest cancer.
Tests that may be performed include:

• Chest x-ray
• Sputum cytology test to look for cancer cells
• Blood work
• CT scan of the chest
• MRI of the chest
• Positron emission tomography (PET) scan

To confirm lung cancer, the health care provider needs to remove a piece of tissue from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this:

• Bronchoscopy combined with biopsy
• Pleural biopsy
• CT scan directed needle biopsy
• Mediastinoscopy with biopsy
• Open lung biopsy
• Endoscopic esophageal ultrasound (EUS) with biopsy

For more information, see:

• Small cell lung cancer
• Non-small cell lung cancer

Treatment

Treatment depends on the specific type of lung cancer. Each type is treated differently. Chemotherapy, radiation, and surgery may be needed.
See the individual articles on the different types of lung cancer:

• Non-small cell lung cancer
• Small cell lung cancer

Expectations (prognosis)

How well a patient does depends on the following:

• Type of lung cancer
• Whether or not the cancer has spread
• Your age
• Your overall health
• How well you respond to treatment

The earlier the cancer is found, the better the chances of survival. Lung cancer is a deadly disease. Nearly 60% of people with lung cancer die within a year. However, some people are cured and go on to live many years.

Complications

The cancer may spread to other parts of the body (metastasis). Cancer treatment can cause significant side effects.

Calling your health care provider

Call your health care provider if you develop symptoms of lung cancer (particularly if you smoke).

Prevention

If you smoke, quit. It is never too late to stop smoking. Your risk of lung cancer drops dramatically the first year after you quit. You should also avoid breathing in the smoke from other people's cigarettes, cigars, or pipes.
Routine screening for lung cancer using chest x-ray or a lung CT scan is not recommended for people without symptoms. Many studies have been done to look at this idea. Most experts have concluded that, at this time, screening would not help improve a person's chance for a cure or for living longer.

Hepatocellular carcinoma

Hepatocellular carcinoma is cancer of the liver.

Causes, incidence, and risk factors

Hepatocellular carcinoma accounts for most liver cancers. This type of cancer occurs more often in men than women. It is usually seen in people ages 50 - 60.

The disease is more common in parts of Africa and Asia than in North or South America and Europe.

Hepatocellular carcinoma is not the same as metastatic liver cancer, which starts in another organ (such as the breast or colon) and spreads to the liver.

In most cases, the cause of liver cancer is usually scarring of the liver (cirrhosis). Cirrhosis may be caused by:

•Alcohol abuse (the most common cause in the United States)

•Certain autoimmune diseases of the liver

•Diseases that cause long-term inflammation of the liver

•Hepatitis B or C virus infection

•Too much iron in the body (hemochromatosis)

Patients with hepatitis B or C are at risk for liver cancer, even if they do not have cirrhosis.

Symptoms

•Abdominal pain or tenderness, especially in the upper-right part

•Easy bruising or bleeding

•Enlarged abdomen

•Yellow skin or eyes (jaundice)

Signs and tests

Physical examination may show an enlarged, tender liver.

Tests include:

•Abdominal CT scan

•Abdominal ultrasound

•Liver biopsy

•Liver enzymes (liver function tests)

•Liver scan

•Serum alpha fetoprotein

Some high-risk patients may get periodic blood tests and ultrasounds to see whether tumors are developing.

Treatment

Aggressive surgery or a liver transplant can successfully treat small or slow-growing tumors if they are diagnosed early. However, few patients are diagnosed early.

Chemotherapy and radiation treatments are not usually effective. However, they may be used to shrink large tumors so that surgery has a greater chance of success.

Sorafenib tosylate (Nexavar), an oral medicine that blocks tumor growth, is now approved for patients with advanced hepatocellular carcinoma.

Support Groups

You can ease the stress of illness by joining a support group with members who share common experiences and problems. See:

•Cancer - support group

•Liver disease - support group

Expectations (prognosis)

The usual outcome is poor, because only 10 - 20% of hepatocellular carcinomas can be removed completely using surgery.

If the cancer cannot be completely removed, the disease is usually fatal within 3 - 6 months. However, survival can vary, and occasionally people will survive much longer than 6 months.

Complications

•Gastrointestinal bleeding

•Liver failure

•Spread (metastasis) of the carcinoma

Calling your health care provider

Call your health care provider if you develop persistent abdominal pain, especially if you have a history of any liver disease.

Prevention

Preventing and treating viral hepatitis may help reduce your risk. Childhood vaccination against hepatitis B may reduce the risk of liver cancer in the future.

Avoid drinking excessive amounts of alcohol. Certain patients may benefit from screening for hemochromatosis.

If you have chronic hepatitis or known cirrhosis, periodic screening with liver ultrasound or measurement of blood alpha fetoprotein levels may help detect this cancer early.

Bladder cancer Signs and tests

Signs and tests

The health care provider will perform a physical examination, including a rectal and pelvic exam.

Diagnostic tests that may be done include:

·   Abdominal CT scan

·   Bladder biopsy (usually performed during cystoscopy)

·   Cystoscopy (examining the inside of the bladder with a camera)

·   Intravenous pyelogram - IVP

·   Urinalysis

·   Urine cytology

Treatment

The choice of treatment depends on the stage of the tumor, the severity of the symptoms, and the presence of other medical conditions.

Stage 0 and I treatments:

·   Surgery to remove the tumor without removing the rest of the bladder

·   Chemotherapy or immunotherapy directly into the bladder

Stage II and III treatments:

·   Surgery to remove the entire bladder (radical cystectomy)

·   Surgery to remove only part of the bladder, followed by radiation and chemotherapy

·   Chemotherapy to shrink the tumor before surgery

·   A combination of chemotherapy and radiation (in patients who choose not to have surgery or who cannot have surgery)

Most patients with stage IV tumors cannot be cured and surgery is not appropriate. In these patients, chemotherapy is often considered.

CHEMOTHERAPY

Chemotherapy may be given to patients with stage II and III disease either before or after surgery to help prevent the tumor from returning.

Chemotherapy may be given as a single drug or in different combinations of drugs. These drugs include:

·   Carboplatin

·   Cisplatin

·   Cyclophosphamide

·   Docetaxel

·   Doxorubicin

·   Gemcitabine

·   Ifosfamide

·   Methotrexate

·   Paclitaxel

·   Vinblastine

The combination of gemcitabine and cisplatin is as effective as an older treatment called MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) with fewer side effects. Many centers have replaced MVAC with this new combination. Paclitaxel and carboplatin is another effective combination that is frequently used.

For early disease (stages 0 and I), chemotherapy is usually given directly into the bladder. Several different types of chemotherapy medications may be delivered directly into the bladder. They include:

·   Doxorubicin (Adriamycin)

·   Mitomycin-C (Mutamycin)

·   Thiotepa (Thioplex)

A Foley catheter can be used to deliver the medication into the bladder. Common side effects include bladder wall irritation and pain when urinating. For more advanced stages (II-IV), chemotherapy is usually given by vein (intravenously).

IMMUNOTHERAPY

Bladder cancers are often treated by immunotherapy. In this treatment, a medication causes your own immune system to attack and kill the tumor cells. Immunotherapy for bladder cancer is usually performed using the Bacille Calmette-Guerin vaccine (commonly known as BCG). It is given through a Foley catheter directly into the bladder. If BCG does not work, patients may receive interferon.

Possible side effects include:

·   Frequent urination

·   Irritable bladder

·   Painful urination

·   Urgent need to urinate

These symptoms usually improve within a few days after treatment. Rare side effects include:

·   Blood in the urine

·   Chills

·   Itching

·   Joint pain

·   Malaise

·   Nausea

Rarely, a tuberculosis-like infection can develop. This requires treatment with an anti-tuberculosis medication.

TRANSURETHRAL RESECTION OF THE BLADDER (TURB)

People with stage 0 or I bladder cancer can be treated with transurethral resection of the bladder (TURB). This surgical procedure is performed under general or spinal anesthesia. A cutting instrument is inserted through the urethra to remove the bladder tumor.

BLADDER REMOVAL

Many people with stage II or III bladder cancer may need to have their bladder removed (radical cystectomy). Partial bladder removal may be performed in some patients. Removal of part of the bladder is usually followed by radiation therapy and chemotherapy to help decrease the chances of the cancer returning. Patients who have the entire bladder removed will receive chemotherapy after surgery to decrease the risk of the cancer coming back.

Radical cystectomy in men usually involves removing the bladder, prostate, and seminal vesicles. In women, the urethra, uterus, and the front wall of the vagina are removed along with the bladder. Often, the pelvic lymph nodes are also removed during the surgery to be examined in the laboratory.

A urinary diversion surgery (a surgical procedure to create an alternate method for urine storage) is usually done with radical cystectomy. Two common types of urinary diversion are an ileal conduit and a continent urinary reservoir.

ILEAL CONDUIT

An ileal conduit is a small urine reservoir that is surgically created from a small segment of bowel. The ureters that drain urine from the kidneys are attached to one end of the bowel segment. The other end is brought out through an opening in the skin (a stoma). The stoma allows the patient to drain the collected urine out of the reservoir.

People who have had an ileal conduit need to wear a urine collection appliance outside their body at all times. Possible complications with ileal conduit surgery include:

·   Bowel obstruction

·   Blood clots

·   Long-term damage to the upper urinary tract

·   Pneumonia

·   Skin breakdown around the stoma

·   Urinary tract infection

CONTINENT URINARY RESERVOIR

A continent urinary reservoir is an alternate method of storing urine. A segment of colon is removed. It is used to create an internal pouch to store urine.

Patients are able to insert a catheter periodically to drain the urine. A small stoma is placed in the skin to allow for this.

Possible complications include:

·   Blood clots

·   Bowel obstruction

·   Pneumonia

·   Skin breakdown around the stoma

·   Ureteral obstruction

·   Ureteral reflux

·   Urinary tract infection

ORTHOTOPIC NEOBLADDER

This surgery is becoming more common in patients undergoing cystectomy. A segment of bowel is folded over to make a pouch (a neobladder, which means "new bladder"). Then it is attached to the place in the urethra where the urine normally empties from the bladder.

This procedure allows patients to maintain some normal urinary control. However, there are complications (including urine leakage at night). Urination is usually not the same as it was before surgery.

Some patients may not be good candidates for this procedure. Discuss the pros and cons with your urologist.

Expectations (prognosis)

Patients are closely monitored to see whether the disease gets worse, regardless of which kind of treatment they received. Monitoring may include:

·   Bone scan and/or CT scan to check for cancer spread

·   Checking for other signs of disease progression, such as fatigue, weight loss, increased pain, decreased bowel and bladder function, and weakness

·   Complete blood count (CBC) to monitor for anemia

·   Cystoscopic evaluations every 3 to 6 months after treatment

·   Urine cytology evaluations (for people whose bladder has not been removed)

How well a patient does depends on the initial stage and response to treatment of the bladder cancer. The outlook for stage 0 or I cancers is fairly good. Although the risk of the cancer returning is high, most bladder cancers that return can be surgically removed and cured.

The cure rates for people with stage III tumors are less than 50%. Patients with stage IV bladder cancer are rarely cured.

Complications

Bladder cancers may spread into the nearby organs. They may also travel through the pelvic lymph nodes and spread to the liver, lungs, and bones. Additional complications of bladder cancer include:

·   Anemia

·   Swelling of the ureters (hydronephrosis)

·   Urethral stricture

·   Urinary incontinence

Calling your health care provider

Call your health care provider if you have blood in your urine or other symptoms of bladder cancer, including:

·   Frequent urination

·   Painful urination

·   Urgent need to urinate

Also, call your health care provider for an appointment if:

·   You are exposed to possible cancer-causing chemicals at work

·   You smoke

Prevention

Quitting cigarette smoking and eliminating environmental hazards will reduce your risk of developing bladder cancer.

bladder cancer Symptoms

Definition of bladder cancer: Cancer that forms in tissues of the bladder (the organ that stores urine). Most bladder cancers are transitional cell carcinomas (cancer that begins in cells that normally make up the inner lining of the bladder). Other types include squamous cell carcinoma (cancer that begins in thin, flat cells) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). The cells that form squamous cell carcinoma and adenocarcinoma develop in the inner lining of the bladder as a result of chronic irritation and inflammation.

Estimated new cases and deaths from bladder cancer in the United States in 2010:

	New cases: 70,530
	Deaths: 14,680            Bladder cancer is a cancerous tumor in the bladder. The bladder is the organ in the center of the lower abdomen that holds urine. Causes, incidence, and risk factors In the United States, bladder cancers usually start from the cells lining the bladder (transitional cells). These tumors are classified based on the way they grow: ·   Papillary tumors have a wart-like appearance and are attached to a stalk. ·   Nonpapillary (sessile) tumors are much less common. However, they are more invasive and have a worse outcome. As with most other cancers, the exact cause of bladder cancer is uncertain. However, several factors may contribute to its development: ·   Cigarette smoking. Smoking increases the risk of developing bladder cancer nearly fivefold. As many as 50% of all bladder cancers in men and 30% in women may be caused by cigarette smoke. People who quit smoking have a gradual decline in risk. ·   Chemical exposure at work. About one in four cases of bladder cancer is caused by exposure to cancer-causing chemicals (carcinogens) on the job. Dye workers, rubber workers, aluminum workers, leather workers, truck drivers, and pesticide applicators are at the highest risk. Arylamines are the chemicals most responsible. However, arylamines have been reduced or eliminated in many workplaces. ·   Radiation and chemotherapy. Women who received radiation therapy for the treatment of cervical cancer have an increased risk of developing transitional cell bladder cancer. Some people who have received the chemotherapy drug cyclophosphamide (Cytoxan) are also at increased risk. ·   Bladder infection. A long-term (chronic) bladder infection or irritation may lead to the development of squamous cell bladder cancer. Bladder infections do not increase the risk of transitional cell cancers. ·   Parasite infection. Infection with the schistosomiasis parasite has been linked to the development of bladder cancer. The association between artificial sweeteners and bladder cancer has been studied and is weak or nonexistent. Bladder cancers are classified, or staged, based on their aggressiveness and how much they differ from the surrounding bladder tissue. There are several different ways to stage tumors. Recently, the TNM (Tumor, Nodes, Metastasis) staging system has become common. This staging system categorizes tumors using the following scale: ·   Stage 0 -- Noninvasive tumors that are only in the bladder lining ·   Stage I -- Tumor goes through the bladder lining, but does not reach the muscle layer of the bladder ·   Stage II -- Tumor goes into the muscle layer of the bladder ·   Stage III -- Tumor goes past the muscle layer into tissue surrounding the bladder ·   Stage IV -- Tumor has spread to neighboring lymph nodes or to distant sites (metastatic disease) Bladder cancer spreads by extending into the nearby organs, including the: ·   Prostate ·   Rectum ·   Ureters ·   Uterus ·   Vagina It can also spread to lymph nodes in the pelvis, or to other parts of the body, such as: ·   Bones ·   Liver ·   Lungs Symptoms Most of the symptoms of bladder cancer can also occur with non-cancerous conditions. It's important to get evaluated if you have any of these symptoms: ·   Blood in the urine ·   Painful urination ·   Urinary frequency ·   Urinary urgency Other symptoms that can occur with this disease: ·   Abdominal pain ·   Anemia ·   Bone pain or tenderness ·   Lethargy or fatigue ·   Urinary incontinence ·   Weight loss