Treatment for Breast Cancer

In recent years, there's been an explosion of life-saving treatment advances against breast cancer, bringing new hope and excitement. Instead of only one or two options, today there's an overwhelming menu of treatment choices that fight the complex mix of cells in each individual cancer. The decisions — surgery, then perhaps radiation, hormonal (anti - estrogen) therapy, and/or chemotherapy — can feel overwhelming.

1. Surgery

Surgery is usually the first line of attack against breast cancer. This section explains the different types of breast cancer surgery.
Decisions about surgery depend on many factors. You and your doctor will determine the kind of surgery that’s most appropriate for you based on the stage of the cancer, the "personality" of the cancer, and what is acceptable to you in terms of your long-term peace of mind.

LUMPECTOMY SURGERY

Lumpectomy is the removal of the breast tumor (the "lump") and some of the normal tissue that surrounds it. Lumpectomy is a form of “breast - conserving” or "breast preservation" surgery. There are several names used for breast-conserving surgery : biopsy, lumpectomy, partial mastectomy, re - excision, quadrantectomy, or wedge resection. Technically, a lumpectomy is a partial mastectomy, because part of the breast tissue is removed. But the amount of tissue removed can vary greatly. Quadrantectomy, for example, means that roughly a quarter of your breast will be removed. Make sure you have a clear understanding from your surgeon about how much of your breast may be gone after surgery and what kind of scar you will have.

Is Lumpectomy plus radiation right for you ?

While lumpectomy plus radiation is an excellent option for many women with breast cancer, it's not the best treatment for everyone.

Lumpectomy plus radiation may NOT be right for you under the following circumstances :

• You have already had radiation to the same breast for an earlier breast cancer. Radiation cannot be given twice to the same area.
• You have extensive cancer in the breast or have two or more separate areas of cancer in the same breast. If cancer is extensive or in multiple areas, a mastectomy may be required.
• You have a small breast and a large tumor and removing the tumor would be extremely disfiguring.
• Your surgeon has already made multiple attempts to remove the tumor with lumpectomy, but has not been able to completely remove the cancer and obtain clear margins.
• You have a connective tissue disease, such as lupus or vasculitis, which would make you sensitive to the side effects of radiation.
• You are pregnant. If you're pregnant, it's not save to have radiation therapy.
• You are not willing to commit to the daily schedule of radiation therapy, or distance makes it impossible.
• You believe you would have greater peace of mind with a mastectomy.

After Lumpectomy

You’ll be moved to the recovery room after lumpectomy surgery, where staff will monitor your heart rate, body temperature, and blood pressure. Staying overnight in the hospital is not usually necessary with lumpectomy, unless you're also having lymph nodes removed. As you start to feel more awake, your surgeon or nurse will give you information about recovering at home :

• Taking pain medication: You may be given pain medication in the recovery room, and your surgeon will probably give you a prescription to take with you when you leave the hospital. You might want to get it filled on your way home or have a friend or family member get it filled for you as soon as you are home. You may not need the medication, but it’s good to have it on hand in case you do.
• Caring for the bandage (dressing) over your incision: Ask your surgeon how to take care of the lumpectomy bandage. Sometimes, the surgeon will ask that you wait until your first follow-up visit so that he or she can remove the bandage.
• Caring for a surgical drain: If you have a drain in your breast area or armpit, the drain might be removed before you leave the hospital. Sometimes, however, a drain stays inserted until the first follow-up visit with the doctor, usually 1-2 weeks after surgery. If you’re going home with a drain inserted, you’ll need to empty the fluid from the detachable drain bulb a few times a day. Make sure your surgeon gives you instructions on caring for the drain before you leave the hospital.
• Stitches and staples: Most surgeons use sutures (stitches) that dissolve over time, so there's no longer any need to have them removed. But occasionally, you'll see the end of the suture poking out of the incision like a whisker. If this happens, your surgeon can easily remove it. Surgical staples — another way of closing the incision — are removed during the first office visit after surgery.
• Exercising your arm: Your surgeon may show you an exercise routine you can do after surgery to prevent arm and shoulder stiffness on the side where you had the lumpectomy. Usually, you will start the exercises the morning after surgery. Some exercises should be avoided until drains are removed. Ask your surgeon any questions you may have to make sure the exercise routine is right for you. Your surgeon should also give you written, illustrated instructions on how to do the exercises.
• Recognizing signs of infection: Your surgeon should explain how to tell if you have an infection in your incision and when to call the office.

At-Home Recovery from Lumpectomy
You’ll recuperate at home for a few days after lumpectomy surgery. Here are some guidelines to follow:

• Rest. When you get home from the hospital, you might be fatigued from the experience. Allow yourself to get enough rest so that you can return to your normal routine in a few days. There are a number of ways to manage fatigue.
• Take pain medication as needed. You might feel a mixture of numbness and pain around the surgery area in the breast (and the armpit incision, if you had lymph nodes removed). If you feel the need, take pain medication according to your doctor’s instructions. Learn more about managing pain and armpit discomfort.
• Take sponge baths until your doctor has removed your drains and/or sutures. You can take your first shower when your drains and any staples or sutures have been removed. A sponge bath can refresh you until showers or baths are approved by your doctor.
• Wear a good sports or support bra. You’ll want a supportive bra to wear both day and night for a while to minimize any movement that could cause pain. If you have larger breasts, you may find it more comfortable to sleep on the side that has not been operated on, with your healing breast supported by a pillow in front of you.
• Begin doing arm exercises. The morning after surgery, begin doing arm exercises if your surgeon has advised you to do so.

Weeks and months after lumpectomy

As nerves regrow, you may feel a weird crawly sensation, you may itch, and you may be very sensitive to touch. Your discomfort may go away by itself, or it may persist but you adapt to it. NSAIDs (pronounced EN-seds) such as acetaminophen and ibuprofen usually can address the pain related to this type of nerve injury. Opioids (pronounced OH-pee-oydz) also can be used to treat this type of pain.Lumpectomy risks

Like all surgeries, lumpectomy carries certain risks:

• Loss of sensation : There is usually some numbness and loss of sensation in part of the breast after lumpectomy, depending on the size of the lump removed. Some or most of this ability to feel can return.
• Breasts that don’t match exactly : Your breasts may not match precisely in size and shape after surgery. This is because removing breast tissue during surgery usually makes the affected breast appear smaller. You may not know this right away, because swelling in response to surgery may make your breast appear temporarily larger.

MASTECTOMY SURGERY

Mastectomy is the removal of the whole breast. There are five different types of mastectomy : "simple" or "total" mastectomy, modified radical mastectomy, radical mastectomy, partial mastectomy, and subcutaneous (nipple-sparing) mastectomy.

Is Mastectomy right for you ?

Mastectomy may be the right choice for you if the following is true for you :

• If the tumor is larger than 5 centimeters, you will probably need a mastectomy. Depending on stage and other factors, some tumors smaller than 5 centimeters may still require mastectomy, although others may be addressed by lumpectomy.
• If your breast is small and a lumpectomy would leave you with very little breast tissue, your doctor may advise you to have a mastectomy.
• If your surgeon has already made multiple attempts to remove the tumor with lumpectomy, but has not been able to completely remove the cancer and obtain clear margins, you may need a mastectomy.
• If lumpectomy plus radiation is not an option for your small tumor (for example, under 4 centimeters) because you have had prior radiation to the same breast, you have a connective tissue disease (lupus, rheumatoid arthritis), you are pregnant, or you do not want to commit to daily radiation treatment, you may need to have a mastectomy.
• If you believe mastectomy would give you greater peace of mind than lumpectomy, you might decide to have a mastectomy.

Simple or Total Mastectomy

Simple or total mastectomy concentrates on the breast tissue itself :

• The surgeon removes the entire breast.
• The surgeon does not perform axillary lymph node dissection (removal of lymph nodes in the underarm area). Sometimes, however, lymph nodes are occasionally removed because they happen to be located within the breast tissue taken during surgery.
• No muscles are removed from beneath the breast.

Who usually gets simple or total mastectomy?

A simple or total mastectomy is appropriate for women with multiple or large areas of ductal carcinoma in situ (DCIS) and for women seeking prophylactic mastectomies — that is, breast removal in order to prevent any possibility of breast cancer occurring.

Modified Radical Mastectomy

Modified radical mastectomy involves the removal of both breast tissue and lymph nodes :

• The surgeon removes the entire breast.
• Axillary lymph node dissection is performed, during which levels I and II of underarm lymph nodes are removed (B and C in illustration).
• No muscles are removed from beneath the breast.

Who usually gets a modified radical mastectomy?
Most people with invasive breast cancer who decide to have mastectomies will receive modified radical mastectomies so that the lymph nodes can be examined. Examining the lymph nodes helps to identify whether cancer cells may have spread beyond the breast.

Radical Mastectomy

Radical mastectomy is the most extensive type of mastectomy:

• The surgeon removes the entire breast.
• Levels I, II, and III of the underarm lymph nodes are removed (B, C, and D in illustration).
• The surgeon also removes the chest wall muscles under the breast.

Who usually gets a radical mastectomy ?

Today, radical mastectomy is recommended only when the breast cancer has spread to the chest muscles under the breast. Although common in the past, radical mastectomy is now rarely performed because in most cases, modified radical mastectomy has proven to be just as effective and less disfiguring.

Partial Mastectomy
Partial mastectomy is the removal of the cancerous part of the breast tissue and some normal tissue around it. While lumpectomy is technically a form of partial mastectomy, more tissue is removed in partial mastectomy than in lumpectomy.

Subcutaneous (nipple sparing) Mastectomy

During subcutaneous ("nipple-sparing") mastectomy, all of the breast tissue is removed, but the nipple is left alone. Subcutaneous mastectomy is performed less often than simple or total mastectomy because more breast tissue is left behind afterwards that could later develop cancer. Some physicians have also reported that breast reconstruction after subcutaneous mastectomy can result in distortion and possibly numbness of the nipple. Because subcutaneous mastectomy is still an area of controversy among some physicians, your doctor may recommend simple or total mastectomy instead.

After Mastectomy surgery

You’ll be moved to the recovery room after mastectomy surgery, where staff will monitor your heart rate, body temperature, and blood pressure. If you are in pain or feel nauseous from the anesthesia, let someone know so that you can be given medication.

You’ll then be admitted to a hospital room. Hospital stays for mastectomy average 3 days or less. If you have a mastectomy and reconstruction at the same time, you may be in the hospital a little longer.

The morning after your surgery, your surgeon or nurse will show you an exercise routine you can do to prevent arm and shoulder stiffness on the side where you had the mastectomy and to help prevent the formation of significant scar tissue. Some exercises should be avoided until drains are removed. Ask your surgeon any questions you may have to make sure the exercise routine is right for you. Your surgeon should also give you written, illustrated instructions on how to do the exercises.

Before you leave the hospital, your surgeon or nurse will give you information about recovering at home:

• Taking pain medication: Your surgeon will probably give you a prescription to take with you when you leave the hospital. You might want to get it filled on your way home or have a friend or family member get it filled for you as soon as you are home so that you have it available.
• Caring for the bandage (dressing) over your incision: Ask your surgeon or nurse how to take care of the mastectomy bandage. The surgeon may ask that you not try to remove the bandage, and instead wait until your first follow-up visit so that he or she can remove the bandage.
• Caring for a surgical drain: If you have a drain in your breast area or armpit, the drain might be removed before you leave the hospital. Sometimes, however, a drain stays inserted until the first follow-up visit with the doctor, usually 1-2 weeks after surgery. If you’re going home with a drain inserted, you’ll need to empty the fluid from the detachable drain bulb a few times a day. Make sure your surgeon gives you instructions on caring for the drain before you leave the hospital.
• Stitches and staples: Most surgeons use sutures (stitches) that dissolve over time, so there's no longer any need to have them removed. But occasionally, you'll see the end of the suture poking out of the incision like a whisker. If this happens, your surgeon can easily remove it. Surgical staples — another way of closing the incision — are removed during the first office visit after surgery.
• Recognizing signs of infection: Your surgeon should explain how to tell if you have an infection in your incision and when to call the office.
• Exercising your arm: Your surgeon or nurse may show you an exercise routine you can do to prevent arm and shoulder stiffness on the side where you had surgery. Usually, you will start the exercises the morning after surgery. Some exercises should be avoided until drains are removed. Ask your surgeon any questions you may have to make sure the exercise routine is right for you. Your surgeon should also give you written, illustrated instructions on how to do the exercises.
• Recognizing signs of lymphedema: If you have had axillary dissection, you will be given information on taking care of your arm and being alert to signs of lymphedema.
• When you can start wearing a prosthesis or resume wearing a bra: The site of mastectomy surgery, and especially mastectomy with reconstruction, needs time to heal before you can wear a prosthesis or bra. Your doctor will tell you how long you may need to wait.

At-Home Recovery from Mastectomy

It can take a few weeks to recover from mastectomy surgery, and longer if you have had reconstruction. It’s important to take the time you need to heal.

In addition to your surgeon’s instructions, here are some general guidelines to follow at home:

• Rest. When you get home from the hospital, you will probably be fatigued from the experience. Allow yourself to get extra rest in the first few weeks after surgery. Read more about managing fatigue.
• Take pain medication as needed. You will probably feel a mixture of numbness and pain around the breast incision and the chest wall (and the armpit incision, if you had axillary dissection). If you feel the need, take pain medication according to your doctor’s instructions. Learn more about managing chest pain, armpit discomfort, and general pain.
• Take sponge baths until your doctor has removed your drains and/or sutures. You can take your first shower when your drains and any staples or sutures have been removed. A sponge bath can refresh you until showers or baths are approved by your doctor.
• Continue doing arm exercises each day. It’s important to continue doing arm exercises on a regular basis to prevent stiffness and to keep your arm flexible.
• Have friends and family pitch in around the house. Recovery from mastectomy can take time. Ask friends and family to help with meals, laundry, shopping, and childcare. As your body heals, don’t feel you should take on more than you can handle.

In the months after Mastectomy

Your body will continue to adjust to the effects of the surgery over a period of months. Here are some things to keep in mind:

• You may have “phantom sensations” or “phantom pain” in the months after mastectomy : As nerves regrow, you may feel a weird crawly sensation, you may itch, you may be very sensitive to touch, and you may feel pressure. Your discomfort may go away by itself, or it may persist but you adapt to it. Analgesics and NSAIDs (pronounced EN-seds) such as acetaminophen and ibuprofen usually can address the pain related to this type of nerve injury. Opioids (pronounced OH-pee-oydz) also can be used to treat this type of pain. Read more about managing phantom pain.
• Continue doing regular arm exercises : Stay with your arm exercise routine to keep your arm limber.
• You may experience fatigue from time to time in the early months after surgery : If you’re having trouble with fatigue, ask your doctor about things you can do.

Mastectomy Risks

Like all surgeries, mastectomy has some risks:

• Numbness of the skin along the incision site and mild to moderate tenderness of the adjacent area: Numbness and tenderness can happen because the nerves were cut during surgery. Find out more about numbness.
• Extra sensitivity to touch within the area of surgery: Touch sensitivity is also due to irritated nerve endings. The sensation usually improves as the nerves grow back. Read more about managing breast area sensitivity.
• Fluid collecting under the scar: Fluid collection under the scar may be the result of hematoma — an accumulation of blood in the wound — or seroma, an accumulation of clear fluid in the wound. Both usually resolve on their own or after being drained with a needle by your doctor. Learn more about hematoma and seroma.
• Delayed wound healing: During mastectomy, the blood vessels that supply your breast tissue are cut. Occasionally that can present problems when your body tries to heal the incision site. If there isn't enough blood flow to the flaps of your incision, small areas of skin may wither and scab or need to be trimmed by your surgeon. This is uncommon and is usually not a serious complication. Read more about managing delayed healing.
• Increased risk of infection in the surgical area: If infection happens, it can usually be discovered early and responds well to treatment. Talk to your doctor about the warning signs of infection.
• Scar tissue formation: With mastectomy alone and mastectomy plus reconstruction, there is a risk for scar tissue to form and build up over time. Sometimes the scar tissue can be lumpy or painful. Your surgeon can tell you about ways to manage any discomfort. Find out more about managing scar tissue formation.

LYMPH NODE REMOVAL SURGERY
If you have invasive breast cancer, your surgeon will probably remove some of the lymph nodes under your arm during your lumpectomy or mastectomy. Examining your lymph nodes helps your doctors figure out the extent of cancer involvement. Cancer in lymph nodes is associated with an increased risk of having cancer cells in other parts of your body.

Your lymph nodes act as filters for your body's lymphatic drainage system. That's why the lymph nodes are likely to "catch" or filter out cancer cells that might be floating in the fluid that drains away from the cancerous area of the breast. Doctors look at the different kinds of nodes that are involved with your breast :

• The nodes around your collarbone and neck (supraclavicular, infraclavicular, and cervical nodes) are examined manually (by hand). Your doctor will feel this area for signs of enlarged nodes.
• The nodes under your arm (axillary lymph nodes) are also examined manually and are relatively easy to get to during surgery. Surgery to remove some or all of the lymph nodes under your arm is called axillary lymph node dissection.
  

You can learn more about possible side effects of lymph node removal in our section on Arm Lymphedema.

2. Chemotherapy

Chemotherapy is a systemic therapy; this means it affects the whole body by going through the bloodstream. The purpose of chemotherapy and other systemic treatments is to get rid of any cancer cells that may have spread from where the cancer started to another part of the body.

Chemotherapy is effective against cancer cells because the drugs love to interfere with rapidly dividing cells. The side effects of chemotherapy come about because cancer cells aren't the only rapidly dividing cells in your body. The cells in your blood, mouth, intestinal tract, nose, nails, vagina, and hair are also undergoing constant, rapid division. This means that the chemotherapy is going to affect them, too.

Still, chemotherapy is much easier to tolerate today than even a few years ago. And for many women it's an important "insurance policy" against cancer recurrence. It's also important to remember that organs in which the cells do not divide rapidly, such as the liver and kidneys, are rarely affected by chemotherapy. And doctors and nurses will keep close track of side effects and can treat most of them to improve the way you feel.

You'll also read about the different chemotherapy regimens and about deciding together with your medical oncologist which regimen would be best suited to you.

It's important to remember that every woman's ideal treatment plan is different. Be aware that your "chemo" regimen may be different from someone else's, based on very individual—and sometimes subtle—breast cancer factors. These include: lymph node involvement, tumor size, hormone receptor status, grade, and oncogene expression. Be prepared for your doctor to recommend a combination of chemotherapies—together or in a series.

3. Radiation Therapy

Radiation therapy — also called radiotherapy — is a highly targeted, highly effective way to destroy cancer cells in the breast that may stick around after surgery. Radiation can reduce the risk of breast cancer recurrence by about 70%. Despite what many people fear, radiation therapy is relatively easy to tolerate and its side effects are limited to the treated area.

Your radiation treatments will be overseen by a radiation oncologist, a cancer doctor who specializes in radiation therapy.

Ten Key Points about Radiation Therapy

1. Radiation is a local, targeted therapy designed to kill cancer cells that may still exist after surgery. Radiation is given to the area where the cancer started or to another part of the body to which the cancer spread.
2. The actual delivery of radiation treatment is painless. But the radiation itself may cause some discomfort over time.
3. External radiation treatment, the most common kind of radiation therapy, does not make you radioactive.
4. Treatment is usually given 5 days a week for up to 7 weeks. Sometimes radiation may be given twice a day for 1 week.
5. Since the daily appointments usually take about 30 minutes, you'll most likely be able to follow most of your normal routine during treatment.
6. Radiation will not make you lose your hair, unless radiation is given to your head.
7. In the area where you are receiving radiation, your skin can turn pink, red, or tan, and may be sensitive and irritated. Creams and other medicines can soothe these symptoms.
8. During your treatment course, you may feel tired. This feeling can last for a few weeks–even months–after treatment ends.
9. Most radiation side effects are temporary.
10. Radiation therapy can significantly decrease the risk of cancer returning after surgery.

4. Hormonal therapy

Hormonal therapy is a very effective treatment against breast cancer that is hormone-receptor-positive. Find out if you should be tested to see if you need other therapies, as well. Sometimes called "anti-estrogen therapy," hormonal therapy blocks the ability of the hormone estrogen to turn on and stimulate the growth of breast cancer cells.

For years, tamoxifen was the hormonal medicine of choice for all women with hormone-receptor-positive breast cancer. But in 2005, the results of several major worldwide clinical trials showed that aromatase inhibitors (Arimidex [chemical name: anastrozole], Aromasin [chemical name: exemestane], and Femara [chemical name: letrozole]) worked better than tamoxifen in post-menopausal women with hormone-receptive-positive breast cancer.

Aromatase inhibitors are now considered the standard of care for post-menopausal women with hormone-receptor-positive breast cancer. Tamoxifen remains the hormonal treatment of choice for pre-menopausal women.

Hormonal therapy is an important option for anyone with hormone-receptor-positive breast cancer. That includes women of all ages, with any stage of disease, and together with or separate from other forms of treatment. Some types of hormonal therapy can also help women who've never had breast cancer but who are at increased risk for developing the disease.

You might benefit from hormonal therapy if you have:

• non-invasive disease, such as DCIS (ductal carcinoma in situ). Hormonal therapy lowers the risk of the non-invasive cancer coming back. More importantly, it also lowers the risk of developing a more serious INVASIVE cancer in either breast.
• early-stage invasive disease. Hormonal therapy can reduce the risk of the cancer coming back as well as the risk of developing a new breast cancer in either breast.
• a large cancer in the breast. Hormonal therapy can help shrink the size of the cancer before surgery to help you keep your breast and avoid mastectomy.
• a recurrence of a prior cancer. If the cancer that comes back is hormone-receptor-positive, then hormonal therapy can help. Hormonal therapy is used differently depending on whether the recurrence is:
  • local (involves just the breast)
  • regional (involves the lymph nodes next to the breast), or
  • metastatic (involves other parts of the body).
• advanced (metastatic) disease. Hormonal therapy can help get metastatic disease under control, shrink it, and limit further spread.
• a high risk of breast cancer but no prior personal history of the disease. Hormonal therapy can help reduce the risk of ever getting breast cancer for women with:
  • a strong family history of breast cancer
  • a known breast cancer gene abnormality or
  • a prior breast biopsy showing abnormal cell growth

Women who have breast cancers that are hormone - receptor - negative will want to consider other options for treatment. Without estrogen and progesterone receptors for hormonal therapies to work on, hormonal therapy offers hardly any benefit. And it's not worth dealing with side effects if there are no real benefits.

Factors to consider in choosing a hormonal therapy
Hormonal therapy can produce remarkable results with relatively few side effects in many women. But it's not perfect. There are factors you must sort out, and pros and cons you must weigh, before you start hormonal therapy. You and your doctor will go over the issues, balancing the potential benefits and side effect for your unique situation. You'll also want to discuss how these benefits and side effects may be influenced by your other health concerns.

Together with your doctor, first think about your cancer-related concerns. Learn as much as you can about the various types of hormonal therapy. Figure out which kind, or kinds, might help you. Next, look at the hormonal therapy's side effects. Then see how the hormonal therapy might influence your other medical conditions.

Step 1 : Find out wheter hormonal therapy is right for you

Here are the cancer-related concerns to help you and your doctor decide :

• The cancer's hormone - receptor status — Does the cancer have hormone receptors for estrogen or progesterone (is it hormone - receptor - positive or hormone - receptor - negative) ?
• Other treatments you've had — Have you already had chemotherapy and/or radiation? Have you had other forms of hormonal therapy before ?
• Your risk of recurrence — Do any factors put you at high risk for breast cancer recurrence or a new breast cancer, and what can you do to lower your risk ?

Step 2 : With your doctor, choose the hormonal therapy that's right for you

If the answers to the above questions indicate that hormonal therapy will help you, the next step is for you and your doctor to choose the treatment plan that's the best one for you. You will need to consider all the factors below :

Menopausal status

• Are you pre-menopausal (still getting your period every month), peri-menopausal (having irregular periods), or post-menopausal (no longer having periods)? (In addition to a change in menses, menopause brings with it a variety of other changes in the body, including bone loss.)
• Tamoxifen is standard of care for pre-menopausal women.
• Ovarian shutdown or removal is another option for pre-menopausal women, sometimes combined with another form of hormonal therapy.
• Aromatase inhibitors are only for post-menopausal women.
• Faslodex (chemical name: fulvestrant) is another option for post-menopausal women with advanced disease.

Stage of breast cancer

• Tamoxifen is the only hormonal therapy approved to reduce risk for women at high risk (with no personal history of breast cancer) and for women with non-invasive breast cancer. It is standard of care for pre-menopausal women with any stage of disease.
• Studies of aromatase inhibitors for risk reduction for women with no personal history of breast cancer are under way.
• Aromatase inhibitors are the first choice of hormonal treatment for post-menopausal women with any stage of hormone-receptor-positive invasive breast cancer.
• Other hormonal therapies may also be used, depending on the cancer's stage and your personal situation.

Nature of the cancer

• There is early evidence that HER2-positive breast cancer in post-menopausal women may respond better to an aromatase inhibitor than tamoxifen. A study suggested choosing hormonal therapy in part based on the cancer's combined estrogen and progesterone receptor-status (ER+/PR+ or ER+/PR-).

Step 3 : Consider health concerns other than breast cancer
You may have other health concerns, unrelated to breast cancer, that might require extra management while you are taking hormonal therapy. These health concerns usually will not be the deciding factor in which hormonal therapy you should use. Rather, these health issues together with possible side effects of hormonal therapy may require extra attention and management during your course of therapy.

• A personal history of blood clots
  If you have had blood clots, your doctor will probably want you to avoid tamoxifen. But if you are pre-menopausal, your history of blood clots was not serious, and tamoxifen is an important part of your care, your doctor may recommend taking a blood thinner (such as baby aspirin) along with tamoxifen.
• Serious osteoporosis
  Some doctors will want to do bone tests before starting you on hormonal medication, because many of these medicines have been shown to affect bone health. If you have had a test to measure your bone density (a DEXA scan), your doctor will have told you whether you have osteoporosis (bone loss). If you do, you may be put on a bone-building medicine. If you don't respond to the medicine, and you've had broken bones already, then your doctor may recommend tamoxifen over an aromatase inhibitor. But if your doctor thinks that it's critical for you to be on an aromatase inhibitor, then a more effective bone-building plan may be recommended along with the aromatase inhibitor.
• Arthritis
  Arthritis is common in women with or without a diagnosis of breast cancer. Aromatase inhibitors can cause joint and muscle pain. This might be a new symptom for you, or hormonal therapy may make existing aches and pains worse.
• No hysterectomy (you still have a uterus)
  If you have NOT had a hysterectomy and still have your uterus, your doctor may suggest that you avoid tamoxifen, which is associated with a higher incidence of uterine cancer.

So the answer to the question, "who is hormonal therapy for?" includes a pretty wide range of people. All along the way, you and your doctor will re-evaluate the balance of benefits and side effects.

Learning all about the different hormonal treatments will help you to have a more informed conversation with your doctor.

Benefits of Hormonal Therapy
You might think of hormonal therapy as a critical insurance policy to back up your other treatments. Hormonal therapy gives many benefits. It can :

• reduce your risk of cancer coming back or spreading
• reduce your risk of a new cancer starting in the other breast
• shrink a medium-to-large breast cancer before surgery, making it possible for you to have lumpectomy and radiation instead of mastectomy

Also, if you have never had breast cancer but areat increased risk for getting the disease, hormonal therapy can reduce that risk.

Most of the different hormonal treatments have similar benefits. You and your doctor will choose the treatment that is right for you by looking at your medical history, your menopausal status, and your personal preferences. Your doctor's recommendation will be based on clinical guidelines as well as experience with many patients taking hormonal therapies over the years. Once you select a hormonal therapy, you have to take the medicine as prescribed in order to get the benefits.

In addition to considering the benefits, the two of you will need to look at the various side effects of the treatments. Weighing one against the other will allow you to select the best hormonal therapy for YOU.

5. Targeted Cancer Therapies

Targeted cancer therapies are treatments that target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a rapid or abnormal way. Targeted therapies are generally less likely than chemotherapy to harm normal, healthy cells. Some targeted therapies are antibodies that work like the antibodies made naturally by our immune systems. These types of targeted therapies are sometimes called immune targeted therapies.

There are currently 3 targeted therapies doctors use to treat breast cancer :

Herceptin
Herceptin (chemical name: trastuzumab) works against HER2-positive breast cancers by blocking the ability of the cancer cells to receive chemical signals that tell the cells to grow.

Tykerb

Tykerb (chemical name: lapatinib) works against HER2-positive breast cancers by blocking certain proteins that can cause uncontrolled cell growth.

Avastin
Avastin (chemical name: bevacizumab) works by blocking the growth of new blood vessels that cancer cells depend on to grow and function.

Melasma, causes and treatments

There are a number of skin conditions that can manifest visibly and affect the appearance of your skin. Many of them are exacerbated by excessive exposure to the sun. Among them, melasma is one of the most common. Despite its prevalence, there seems to be a general lack of awareness regarding melasma.

What Is Melasma ?

Melasma presents as hyperpigmented areas on the surface of the skin. These areas appear darker than a person’s normal skin tone and are usually symmetric. While the skin condition is universal, it is most prevalent among women, commonly appear on the face (chin, cheeks, forehead, etc.). While there are no known health impacts associated with melasma, the condition can have an emotional impact on those afflicted with it.

Possible Causes Of Melasma

Though the definite causes of melasma remain uncertain, studies have suggested that the condition is linked to hormones. Exposure to the sun leads to increased melanin production. The cells that produce melanin (called melanocytes) may be stimulated by estrogen and progesterone. When melanocytes produce excessive amounts of melanin, melasma can occur. Sun exposure is also thought to generate free radicals which can stimulate melanocytes, resulting in excessive melanin production.

Many doctors believe that melasma is most prevalent in those who have a predisposition. This can include skin tone, gender and ethnicity. Women are more likely than men to develop the condition. And those with a light brown skin tone are generally more susceptible than others.

Melasma Symptoms

• Dark discolored patches on skin of upper cheek, nose, lips, upperlip, and forehead.
• Melasma does not causes any other health problems beyond the cosmetic discoloration.

Melasma Treatment

• Drink more than enough water to purge all those toxins out of your body.
• Eat and drink foods containing antioxidants such as dark colored fruits and vegetables. Antioxidants fight off free radicals in the environment (like pollution and the sun).
• Take anti-oxidant supplement such as Pycnogenol 25 mg tablet with meals three times a day will enhance the results of your melasma treatment.
• Treating pigmentation and age spot should always use a potent, natural lightening cream with antioxidants for your skin.
• Cosmetic procedures can be helpful in some cases of hyperpigmentation are not recommended for melasma, they are expensive and may come back in a year.
• To prevent melasma and protect skin from the sun by using sun protection scream with SPF 8 and above.
• Hydroquinone is topical scream with a completely organic compound that occurs naturally in bombardier beetles. It works by gently lightening skin, and does not cause side effect as others.
• Melasma will clear up on their own when baby is born and hormones are adjusted after birth. There is no need treatment for this.
• Using calamine as moisturizing lotions and soothing extracts to maintain skin after successfully cure melasma.
• MSM supplements are known to treat melasma. Start out with 1 to 2 grams a day, and see how your body reacts before consume more.
• Facial peel with alpha hydroxyacids or chemical peels with glycolic acid.
• Tretinoin is an acid that increases skin cell turnover. Avoid his treatment during pregnancy.

Melasma treatment methods to avoid

Some melasma treatments are controversial. There is some debate on how to treat melasma. Like I've said, there is no magic cure, but many products and treatments will make a difference. Be wary of these three melasma treatments.

1. Bleaching creams. By using a doctor-prescribed bleaching cream on your skin you are causing the melanin-producing cells to slow down production. This can be beneficial especially if you continue to use sun block all the time, but be wary of products that are truly poisonous. Talk to your doctor about possible side-effects and existing research. Bleaching ingredients such as hydroquinone are somewhat controversial and proven to be dangerous to pregnant women.

2. Microdermabrasion. This can be an excellent treatment for a variety of skin care problems, but melasma is often worsened by heat. I'd recommend avoiding microdermabrasion and opt for a gentler exfoliation process instead.

3. Lasers and lights. These are relatively new treatments that can be incredibly expensive. If you choose to receive these treatments, be sure to work with a dermatologist or investigate the credibility of the esthetician. Also, be wary of exorbitant prices because insurance rarely covers these expenses.

Sleep makes you look younger

Every company today seems to be marketing a new product that can make you look and feel younger. You can find them all over billboards, magazines, T.V. and the internet. So why are there so many products claiming take ten years off? Simple, most people are willing to spend lots of time and money searching for the proverbial fountain of youth. If you’re one of these people, then I have a great secret to share with you. Instead of spending late nights buying creams and pills; put you wallet or pocketbook away and go to bed. If you want to look and feel younger, than look no further than a good night’s rest.

Who looks younger a healthy person, or a sick person? Chances are you answered “the healthy person”. Being sick can make you look old and haggard. Well, one big side effect of sleep deprivation is that it can severely compromise your immune system, making you get sick more often. Sleeping keeps you healthy and looking great.

Even if you don’t catch colds or other illnesses a lot; if you’re not getting enough sleep your body isn’t as healthy as it could be. Stage 4, or deep sleep, helps restore and renew the cells of our bodily organs. This helps them function properly and lets the body work as efficiently as possible. If our organs don’t work properly, it can take a toll on our physical appearance. That means you don’t look as good as you could. Plus, even if you’re not sick, you probably won’t feel as healthy as you might if you had enough sleep.

So you already now know that deep restorative sleep helps renew organ tissue and keep them in peak condition, but do you know what your body’s largest organ is? If you said skin, you’re absolutely right. And what’s the most important factor in determining how young or old you look? Your skin! Proper sleep will allow old, dead skin cells to be replaced with beautiful, fresh, new skin cells quickly and efficiently. This will leave you and your skin looking younger.

Have you ever noticed that when you’re in a bad mood, depressed, or just not feeling good about life, you don’t look as good? It’s not just your perception; how you feel affects facial expressions body posture, and other factors that determine how we look. When you’re well rested, you feel younger; and when you feel younger you look younger.
So how much sleep is enough to keep you looking and feeling younger? Well, that depends on you. Generally it’s recommended that adults get 8 hours of sleep; however, there are people who can function just fine on less. Others like myself, need at least 9 hours of sleep to feel refreshed. If you feel tired and sluggish in the morning, or require an alarm clock to get up (yes, I’m serious); you’re not getting enough sleep. If you get as much sleep as your body will allow and still feel sluggish in the morning, you may have a serious sleep disorder and should see a doctor.
So if you want to look younger and feel better, head to bed.

Prostate Cancer

What is the prostate gland ?
The prostate gland is an organ that is located at the base or outlet (neck) of the urinary bladder. (See the diagram.) The gland surrounds the first part of the urethra. The urethra is the passage through which urine drains from the bladder to exit from the penis. One function of the prostate gland is to help control urination by pressing directly against the part of the urethra that it surrounds. Another function of the prostate gland is to produce some of the substances that are found in normal semen, such as minerals and sugar. Semen is the fluid that transports the sperm. A man can manage quite well, however, without his prostate gland. (See the section on surgical treatment for prostate cancer)

In a young man, the normal prostate gland is the size of a walnut. During normal aging, however, the gland usually grows larger. This enlargement with aging is called benign prostatic hypertrophy (BPH), but this condition is not associated with prostate cancer. Both BPH and prostate cancer, however, can cause similar problems in older men. For example, an enlarged prostate gland can squeeze or impinge on the outlet of the bladder or the urethra, leading to difficulty with urination. The resulting symptoms commonly include slowing of the urinary stream and urinating more frequently, particularly at night.

What is prostate cancer ?
Prostate cancer is a malignant (cancerous) tumor (growth) that consists of cells from the prostate gland. The tumor usually grows slowly and remains confined to the gland for many years. During this time, the tumor produces little or no symptoms or outward signs (abnormalities on physical examination). As the cancer advances, however, it can spread beyond the prostate into the surrounding tissues (local spread). Moreover, the cancer also can metastasize (spread even farther) throughout other areas of the body, such as the bones, lungs, and liver. Symptoms and signs, therefore, are more often associated with advanced prostate cancer.

Why is prostate cancer important ?

Prostate cancer is the most common malignancy in American men and the second leading cause of deaths from cancer, after lung cancer. Most experts in this field, therefore, recommend that beginning at age 40, all men should undergo yearly screening for prostate cancer.

What causes prostate cancer ?

The cause of prostate cancer is unknown, but the cancer is thought not to be related to benign prostatic hypertrophy (BPH). The risk (predisposing) factors for prostate cancer include advancing age, genetics (heredity), hormonal influences, and such environmental factors as toxins, chemicals, and industrial products. The chances of developing prostate cancer increase with age. Thus, prostate cancer under age 40 is extremely rare, while it is common in men older than 80 years of age. As a matter of fact, some studies have suggested that among men over 80, between 50 and 80% of them may have prostate cancer!

Genetics (heredity), as just mentioned, plays a role in the risk of developing a prostate cancer. For example, black American men have a higher risk of getting prostate cancer than do Japanese or white American men. Environment, diet, and other unknown factors, however, can modify such genetic predispositions. For example, prostate cancer is uncommon in Japanese men living in their native Japan. However, when these men move to the United States, their incidence of prostate cancer rises significantly. Prostate cancer is also more common among family members of individuals with prostate cancer. Thus, a person whose father, grandfather, or even uncle has prostate cancer is at an increased risk for also developing prostate cancer. To date, however, no specific prostate cancer gene has been identified and verified. (Genes, which are situated on chromosomes within the nucleus of cells, are the chemical compounds that determine specific traits in individuals.)

Testosterone, the male hormone, directly stimulates the growth of both normal prostate tissue and prostate cancer cells. Not surprisingly, therefore, this hormone is thought to be involved in the development and growth of prostate cancer. The important implication of the role of this hormone is that decreasing the level of testosterone should be (and usually is) effective in inhibiting the growth of prostate cancer.

Environmental factors, such as cigarette smoking and diets that are high in saturated fat, seem to increase the risk of prostate cancer. Additional substances or toxins in the environment or from industrial sources might also promote the development of prostate cancer, but these have not yet been clearly identified.

What are the symptoms of prostate cancer ?

In the early stages, prostate cancer often causes no symptoms for many years. As a matter of fact, these cancers frequently are first detected by an abnormality on a blood test (the PSA, discussed below) or as a hard nodule (lump) in the prostate gland. Usually, the doctor first feels the nodule during a routine digital (done with the finger) rectal examination. The prostate gland is located immediately in front of the rectum. As the cancer enlarges and presses on the urethra, the flow of urine diminishes and urination becomes more difficult. Patients may also experience burning with urination or blood in the urine. As the tumor continues to grow, it can completely block the flow of urine, resulting in a painfully obstructed and enlarged urinary bladder.

In the later stages, prostate cancer can spread locally into the surrounding tissue or the nearby lymph nodes, called the pelvic nodes. The cancer then can spread even farther (metastasize) to other areas of the body. The doctor on a rectal examination can sometimes detect local spread into the surrounding tissues. That is, the physician can feel a hard, fixed (not moveable) tumor extending from and beyond the gland. Prostate cancer usually metastasizes first to the lower spine or the pelvic bones (the bones connecting the lower spine to the hips), thereby causing back or pelvic pain. The cancer can then spread to the liver and lungs. Metastases (areas to which the cancer has spread) to the liver can cause pain in the abdomen and jaundice (yellow color of the skin) in rare instances. Metastases to the lungs can cause chest pain and coughing.

What are the screening tests for prostate cancer ?

Screening tests are those that are done at regular intervals to detect a disease such as prostate cancer at an early stage. If the result of a screening test is normal, the disease is presumed not to be present. If a screening test is abnormal, the disease is then suspected to be present, and further tests usually are needed to confirm the suspicion (that is, to make the diagnosis definitively). Prostate cancer usually is suspected initially because of an abnormality of one or both of the two screening tests that are used to detect prostate cancer. These screening tests are a digital rectal examination and a blood test called the prostate specific antigen (PSA).

In the digital rectal examination, the doctor feels (palpates) the prostate gland with his gloved index finger in the rectum to detect abnormalities of the gland. Thus, a lump, irregularity, or hardness felt on the surface of the gland is a finding that is suspicious for prostate cancer. Accordingly, doctors usually recommend doing a digital rectal examination annually in men age 40 and over.

The PSA test is a simple, reproducible, and accurate blood test. It is used to detect a protein (the prostate specific antigen) that is released from the prostate gland into the blood. Most importantly, the level of the PSA is usually higher in people with prostate cancer than in people without the cancer. The PSA, therefore, is valuable as a screening test for prostate cancer. Accordingly, doctors usually recommend doing a PSA annually in men age 50 and over. Furthermore, for men who have high risks for prostate cancer as discussed above, most doctors recommend starting the PSA screening at an even younger age (for example, at age 40).

Results of the PSA test under 4 nanograms per milliliter of blood are generally considered normal. (See the next two sections on false-positive elevations of the PSA and on refinements in the PSA test.) Results between 4 and 10 are considered borderline. These borderline values are interpreted in the context of the patient's age, symptoms, signs, family history, and changes in the PSA levels over time. Results higher than 10 are considered abnormal, suggesting the possibility of prostate cancer. The higher the PSA value, the more likely the diagnosis of prostate cancer. Moreover, the level of PSA tends to increase when the cancer has progressed from organ-confined prostate cancer to local spread to distant (metastatic) spread. Very high values, such as 30 or 40 and over, are usually caused by prostate cancer.

How is the staging of prostate cancer done ?

The staging of a cancer refers to determining the extent of the disease. Once a prostate cancer is diagnosed on a biopsy, additional tests are done to assess whether the cancer has spread beyond the gland. For this assessment, biopsies of the surrounding organs, such as the rectum or urinary bladder, or of the nearby (pelvic) lymph nodes might be done. In addition, imaging tests are usually performed. For example, radionuclide bone scans can determine if there is a spread of the tumor to the bones. Additionally, CAT scans (coaxial tomography) and MRIs (magnetic resonance imaging) can determine if the cancer has spread to adjacent tissues or organs such as the bladder or rectum or to other parts of the body such as the liver or lungs. Newer scanning using a method called PET scan can sometimes help to detect hidden locations of cancer that has spread to various areas of the body.

In brief, doctors do the staging of prostate cancer based primarily on the results of the prostate biopsy, possibly other biopsies, and imaging tests. In staging a cancer, doctors assign various letters and numbers to the cancer, depending on which of the classifications for staging they use. The numbers and letters in the different classifications define the volume or amount of the tumor and the spread of the cancer. The stage of the prostate cancer, therefore, helps to predict the expected course of the disease and determine the choice of treatment.

Two main systems are used to stage prostate cancer. In the American urologic staging system, stage A describes a minimal cancer that can neither be palpated (felt) on physical examination nor seen by imaging techniques. Such a tumor is so small that it can be detected only by viewing it under a microscope. Stage B refers to a larger cancer that may be palpated, but that still is confined (localized) to the prostate gland. Stage C indicates local spread beyond the prostate into the surrounding tissues. Stage D1 signifies a spread to the nearby (pelvic) lymph nodes and D2 is for distant spread (metastasis), for example, to the bones, liver, or lungs.

The other main system for staging prostate cancer is called the tumor, nodes, and metastasis (TNM) classification. In this system, T1 and T2 are equivalent to stage A and B (respectively) in the American urologic system. T3 describes cancer that extends just beyond the capsule (coat) of the prostate, and T4 describes cancer that is fixed to the surrounding tissues. N1 is equivalent to Stage D1 and M1 is equivalent to D2.

What about surgical treatment for prostate cancer ?
The surgical treatment for prostate cancer is commonly referred to as a radical or total prostatectomy, which is the removal of the entire prostate gland. Since 1990, the radical prostatectomy has been the most common treatment for prostate cancer in the United States. This operation is done in about 36% of patients with organ-confined (localized) prostate cancer. The American Cancer Society estimates a 90% cure rate nationwide when the disease is confined to the prostate and the entire gland is removed. The potential complications of a radical prostatectomy include the risks of anesthesia, local bleeding, impotence (loss of sexual function) in 30%-70% of patients, and incontinence (loss of control of urination) in 3%-10% of patients.

Great strides have been made in lowering the frequency of the complications of radical prostatectomy. These advances have been accomplished largely through improved anesthesia and surgical techniques. The improved surgical techniques, in turn, stem from a better understanding of the key anatomy and physiology of sexual potency and urinary continence. Specifically, the recent introduction of nerve-sparing techniques for the prostatectomy has helped to reduce the frequency of impotence and incontinence.

If post-treatment impotence does occur, it can be treated by sildenafil (Viagra) tablets, injections of such medications as alprostadil (Caverject) into the penis, various devices to pump up or stiffen the penis, or a penile prosthesis (an artificial penis). Incontinence after treatment often improves with time, special exercises, and medications to improve the control of urination. Occasionally, however, incontinence requires implanting an artificial sphincter around the urethra. The artificial sphincter is made up of muscle or other material and is designed to control the flow of urine through the urethra.

What about radiation therapy for prostate cancer ?
The goal of radiation therapy is to damage the cancer cells and stop their growth or kill them. This works because the rapidly dividing (reproducing) cancer cells are more vulnerable to destruction by the radiation than are the neighboring normal cells. Clinical trials have been conducted using radiation therapy for patients with organ-confined (localized) prostate cancer. These trials have shown that radiation therapy resulted in a rate of survival (being alive) at 10 years after treatment that is comparable to that for radical prostatectomy. Incontinence and impotence can occur as complications of radiation therapy, as with surgery, although perhaps less often than with surgery. More data are needed, however, on the risks and benefits of radiation therapy beyond 10 years, especially because late recurrences (reappearances) of the cancer can sometimes occur after radiation.

Choosing between radiation and surgery to treat organ-confined prostate cancer involves considerations of the patient's preference, age, and co-existing medical conditions (fitness for surgery), as well as of the extent of the cancer. Approximately 30% of patients with organ-confined prostate cancer are treated with radiation. Sometimes, oncologists combine radiation therapy with surgery or hormonal therapy in efforts to improve the long-term results of treatment in the early or later stages of prostate cancer.

Radiation therapy can be given either as external beam radiation over perhaps 6 or 7 weeks or as an implant of radioactive seeds (brachytherapy) directly into the prostate. In external beam radiation, high energy x-rays are aimed at the tumor and the area immediately surrounding it. In brachytherapy, radioactive seeds are inserted through needles into the prostate gland under the guidance of transrectally taken ultrasound pictures. Brachy, from the Greek language, means short. The term brachytherapy thus refers to placing the treatment (radiation therapy) directly into or a short distance away from the cancerous target tissue. The theoretical advantage of brachytherapy over external beam radiation is that delivering the radiation energy directly into the prostate tissue should minimize damage to the surrounding tissues and organs. The actual advantages or disadvantages of brachytherapy as compared to external beam radiation, however, are still being studied.

What about hormonal treatment for prostate cancer ?
The male (androgenic) hormone is called testosterone. It stimulates the growth of cancerous prostatic cells and, therefore, is the primary fuel for the growth of prostate cancer. The idea of all of the hormonal treatments (medical and surgical), in short, is to decrease the stimulation by testosterone of the cancerous prostatic cells. Testosterone normally is produced by the testes in response to stimulation from a hormonal signal called LH-RH. The LH-RH stands for luteinizing hormone-releasing hormone and is also called gonadotropin-releasing hormone. This hormone comes from a control station in the brain and travels in the blood stream to the testes. Once there, the LH-RH stimulates the testes to produce and release testosterone.

Hormonal treatment, also referred to as androgenic deprivation (depriving the prostate of testosterone), can be accomplished surgically or medically. The surgical hormonal treatment is removal of the testes in an operation called an orchiectomy or a castration. This surgery thus removes the body's source of testosterone. The medical hormonal treatment involves taking one or two types of medication. One type is referred to as the LH-RH agonists. They work by competing with the body's own LH-RH. These drugs thereby inhibit (block) the release of LH-RH from the brain. The other type of drug is referred to as anti-androgenic, meaning that these drugs work against the male hormone. That is, they work by blocking the effect of testosterone itself on the prostate.

Today, most men electing hormonal treatment choose medication over surgery, probably because they view surgical castration as more devastating cosmetically or psychologically. Actually, however, the effectiveness and side effects of medical hormonal treatment as compared to surgical hormonal treatment are very much the same. Both types of hormonal treatment usually effectively eliminate stimulation of the cancer cells by testosterone. Some tumors of the prostate, however, do not respond to this form of treatment. They are referred to as androgen-independent prostate cancers. The principal side effects of all of these hormonal treatments (that is, the side effects of androgenic deprivation) are enlarged breasts (gynecomastia) that often are tender, flushing (like hot flashes), and impotence.

The LH-RH agonists, leuprolide (Lupron) or goserelin (Zoladex), are given as monthly injections in the doctor's office. The anti-androgenic drugs, flutamide (Eulexin) or bicalutamide (Casodex), are oral capsules that are used usually in combination with the LH-RH agonists. The LH-RH agonists are often effective alone. The anti-androgenic drugs are added, however, if the cancer progresses despite the use of the LH-RH agonists. The hormonal treatments may have value, as well, when combined with radiation therapy. Studies are currently being conducted to determine if hormonal therapy enhances the therapeutic effect of radiation.

Generally, hormonal treatment is reserved for individuals who have advanced prostate cancer with local spread or metastases. Occasionally, an individual with organ-confined (localized) prostate cancer will receive hormonal treatment because he has severe associated medical problems or simply because he refuses to undergo surgery or radiation. Hormonal treatment is used in less than 10% of men with organ-confined (localized) prostate cancer. Remember that the intent of hormonal therapy usually is palliative. This means that the goal is to control the cancer rather than cure it because a cure is not possible.

What is cryotherapy for prostate cancer ?
Cryotherapy is one of the newer treatments that is being evaluated for use in the early stage of prostate cancer. This treatment kills the cancer cells by freezing them. The freezing is accomplished by inserting a freezing liquid (for example, liquid nitrogen or argon) through needles directly into the prostate gland. The procedure is accomplished under the guidance of ultrasound images. Actually, cryotherapy is not a new technique. Rather, it is a modification of a procedure that was tried previously, but had an unacceptably high rate of complications. Thus, cryotherapy was used in the 1960s to freeze the lining of the stomach to treat ulcers, but was discontinued because it also severely damaged the lining of the stomach.

At present, cryotherapy is recommended for patients with locally advanced prostate cancer who, for whatever reason, are not candidates for the more established treatments. Cryotherapy is further being studied to determine which other patients might benefit from this treatment. For example, studies are underway to establish whether cryotherapy is beneficial as an initial treatment for organ-confined (localized) prostate cancer. The effectiveness of cryotherapy in eliminating prostate cancer, however, has not yet been proven. We do know that sometimes the freezing liquid fails to kill all of the cancer cells. Moreover, the potential side effects of this treatment include damage to the urethra and bladder. This damage can cause obstruction (blockage) of the urethra, fistulas (abnormal tunnels) that leak urine, or serious infections.

What is chemotherapy for prostate cancer ?
Chemotherapeutic agents, or chemotherapy, are anti-cancer drugs. They are used (for hormone resistant prostate cancer) as a palliative treatment (palliation to relieve symptoms) in patients with advanced cancer for whom a cure is unattainable. Recall that the goal of palliation is simply to slow the tumor's growth and relieve the patient's symptoms. Chemotherapy is not ordinarily used for organ-confined or locally advanced prostate cancers because a cure in these cases is possible with other treatments. Currently, chemotherapy is used only for advanced metastatic prostate cancers that have failed to respond to other treatments.

Several chemotherapeutic agents have been used effectively to palliate metastatic prostate cancer. One such agent is estramustine (Emcyt). Another agent, mitoxantrone (Novantrone), has been shown to be effective in combination with prednisone for palliating androgen-independent prostate cancer. As mentioned previously, metastatic tumors that have not responded specifically to hormonal therapy are referred to as androgen-independent (hormone-refractory) prostate cancers.

The more common side effects of chemotherapy include weakness, nausea, hair loss and suppression of the bone marrow. The suppression of marrow, in turn, can decrease the red blood cells (causing anemia), the white blood cells (leading to infections), and the platelets (resulting in bleeding).

New chemotherapeutic agents for prostate cancer are continually being studied for their effectiveness and safety in cancer centers throughout the United States and elsewhere. For example, cancer specialists (oncologists) have been evaluating paclitaxel (Taxol) or docetaxel (Taxotere) for metastatic prostate cancer. (These two drugs are effective in palliating metastatic breast cancer). Another one of the newer chemotherapeutic agents under investigation for androgen independent prostate cancer is Suramin.

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 acupunture. 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.

One new treatment for prostate cancer, new at least in the United States, is an herbal medicine called PC Spes. The name comes from PC, which stands for prostate cancer, and Spes, which is the Latin word for hope. In some initial trials of PC Spes in men who have failed the traditional treatments (hormonal therapy and chemotherapy) for advanced prostate cancer, this herbal medicine appeared to be promising. More rigorous studies are ongoing to evaluate more fully the risks and benefits of this treatment.

Can prostate cancer be prevented?
No specific measures are known to prevent the development of prostate cancer. At present, therefore, we can hope only to prevent progression of the cancer by making early diagnoses and then attempting to cure the disease. Early diagnoses can be made by screening men for prostate cancer. Screening is done, as mentioned previously, by routine yearly digital rectal examinations beginning at age 40 and the addition of an annual PSA test beginning at age 50. The purpose of the screening is to detect early, tiny, or even microscopic cancers that are confined to the prostate gland. Early treatment of these malignancies (cancers) can stop the growth, prevent the spread, and possibly cure the cancer.

Based on some research in animals and people, certain dietary measures have been suggested to prevent the progression of prostate cancer. For example, low fat diets, particularly avoiding red meats, have been suggested because they are thought to slow down the growth of prostate tumors in a manner not yet known. Soybean products, which work by decreasing the amount of testosterone circulating in the blood, also reportedly can inhibit the growth of prostate tumors. Finally, other studies show that tomato products (lycopenes), the mineral selenium, and vitamin E might slow the growth of prostate tumors in ways that are not yet understood.

Cervical Cancer - Causes And Treatments

Cervical cancer causes are primarily related to a specific virus. Cervical cancer or cervical cancer signs symptoms usually evolve very slowly. Over a period of several years, cells on the surface of the cervix change from normal to abnormal.

As for cervical cancer causes, at least 95% or 9 out of every 10 cases of cervical cancer are linked to the human papilloma virus (HPV), which is a sexually transmitted infection.

Symptoms of HPV very often have no cervical cancer signs symptoms. Warts can appear after weeks or even years after sexual contact with anyone with HPV. These growths very often stay flat and invisible.

The Pap Smear is defined as a test for cancerous or precancerous cells of the cervix. HPV can be detected through an annual pap smear test. While pap smear tests are necessary because they are the best screening technique currently available, they are not always accurate in detecting a cervical signs symptoms. A newer testing method is being developed that uses a small fiber optic probe that may replace pap smears. This new method is still being tested and it should give women more accurate screening, eliminate unnecessary biopsies and find cervical cancer signs symptoms at its early stages. Research is ongoing to possibly find an HPV vaccine for men and women. Ask your doctor if any newer, more accurate tests are now available in his or her practice.

What are the early symptoms of cervical cancer ?

The cervical cancer symptoms are : vaginal bleeding after sexual intercourse, pelvic pain, pain during sexual intercourse, unusual vaginal discharge, abnormal bleeding between menstrual periods, heavy bleeding during your menstrual period, and increased urinary frequency.

When the early symptoms of the cervical cancer are suspected, Pap smear test and other screening techniques are currently available to evaluate the cells status in the cervix.

Treatment of cervical cancer

Staging

If the screening test shows that you have cancer, your doctor will do a thorough pelvic exam and may remove additional tissue to learn the extent (stage) of your disease. The stage tells whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body.

These are the stages of cervical cancer :

• Stage 0: The cancer is found only in the top layer of cells in the tissue that lines the cervix. Stage 0 is also called carcinoma in situ.
• Stage I: The cancer has invaded the cervix beneath the top layer of cells. It is found only in the cervix.
• Stage II: The cancer extends beyond the cervix into nearby tissues. It extends to the upper part of the vagina. The cancer does not invade the lower third of the vagina or the pelvic wall (the lining of the part of the body between the hips).
• Stage III: The cancer extends to the lower part of the vagina. It also may have spread to the pelvic wall and nearby lymph nodes.
• Stage IV: The cancer has spread to the bladder, rectum, or other parts of the body.
• Recurrent cancer: The cancer was treated, but has returned after a period of time during which it could not be detected. The cancer may show up again in the cervix or in other parts of the body.

To learn the extent of disease and suggest a course of treatment, the doctor may order some of the following tests :

• Chest x-rays: X-rays often can show whether cancer has spread to the lungs.
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive contrast material by injection in your arm or hand, by mouth, or by enema. (Some people are allergic to contrast materials that contain iodine. Tell your doctor or nurse if you have allergies.) The contrast material makes abnormal areas easier to see. A tumor in the liver, lungs, or elsewhere in the body can show up on the CT scan.
• MRI: A powerful magnet linked to a computer is used to make detailed pictures of your pelvis and abdomen. The doctor can view these pictures on a monitor and can print them on film. An MRI can show whether cancer has spread. Sometimes contrast material makes abnormal areas show up more clearly on the picture.
• Ultrasound: An ultrasound device is held against the abdomen or inserted into the vagina. The device sends out sound waves that people cannot hear. The waves bounce off the cervix and nearby tissues, and a computer uses the echoes to create a picture. Tumors may produce echoes that are different from the echoes made by healthy tissues. The picture can show whether cancer has spread.

Treatment

Many women with cervical cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask the doctor. It often helps to make a list of questions before an appointment.

To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor—to take part in the discussion, to take notes, or just to listen.

You do not need to ask all your questions at once. You will have other chances to ask your doctor to explain things that are not clear and to ask for more information.

Your doctor may refer you to a specialist, or you may ask for a referral. Gynecologists, gynecologic oncologists, medical oncologists, and radiation oncologists are specialists who treat cervical cancer.

Getting a second opinion

Before starting treatment, you might want a second opinion about the diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. Usually it is not a problem to take several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some women with cervical cancer need treatment right away.

There are a number of ways to find a doctor for a second opinion :

• Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.
• NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby treatment centers. Information Specialists also can provide online assistance through LiveHelp at http://www.cancer.gov.
• A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists in your area.
• The American Board of Medical Specialties (ABMS) has a list of doctors who have had training and passed exams in their specialty. You can find this list in the Official ABMS Directory of Board Certified Medical Specialists. This Directory is in most public libraries. Or you can look up doctors at http://www.abms.org. (Click on "Who's Certified.")

Preparing for treatment

The choice of treatment depends mainly on the size of the tumor and whether the cancer has spread. If a woman is of childbearing age, the treatment choice may also depend on whether she wants to become pregnant someday.

Your doctor can describe your treatment choices and the expected results of each. You and your doctor can work together to develop a treatment plan that meets your medical needs and personal values.

You may want to ask the doctor these questions before treatment begins:

• What is the stage of my disease ? Has the cancer spread ? If so, where ?
• What are my treatment choices ? Which do you recommend for me ? Will I have more than one kind of treatment ?
• What are the expected benefits of each kind of treatment ?
• What are the risks and possible side effects of each treatment ? What can we do to control my side effects ?
• How will treatment affect my normal activities ?
• What can I do to take care of myself during treatment ?
• How long will treatment last ?
• Will I have to stay in the hospital ? What is the treatment likely to cost ? Does my insurance cover this treatment ?
• How often should I have checkups ?
• Would a clinical trial (research study) be appropriate for me ?

Methods of treatment

Women with cervical cancer may be treated with surgery, radiation therapy, chemotherapy, radiation therapy and chemotherapy, or a combination of all three methods.

At any stage of disease, women with cervical cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care. Information about such treatment is available on NCI's Web site and from NCI's Cancer Information Service at 1-800-4-CANCER.

You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. The section on "The Promise of Cancer Research" has more information about clinical trials.

1. Surgery

Surgery treats the cancer in the cervix and the area close to the tumor.

Most women with early cervical cancer have surgery to remove the cervix and uterus (total hysterectomy). However, for very early (Stage 0) cervical cancer, a hysterectomy may not be needed. Other ways to remove the cancerous tissue include conization, cryosurgery, laser surgery, or LEEP.

Some women need a radical hysterectomy. A radical hysterectomy is surgery to remove the uterus, cervix, and part of the vagina.

With either total or radical hysterectomy, the surgeon may remove both fallopian tubes and ovaries. (This procedure is a salpingo-oophorectomy.)

The surgeon may also remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body.

You may want to ask the doctor these questions about surgery :

• What kind of operation will I have ? Will my ovaries be removed ?
• Do I need to have lymph nodes removed ? Will other tissues be removed ? Why ?
• How will I feel after the operation ?
• If I have pain, how will it be controlled ?
• How long will I have to stay in the hospital ?
• Will I have any lasting side effects ? If I don't have a hysterectomy, will I be able to get pregnant and have children ? Is there increased risk of miscarriage ?
• When will I be able to resume normal activities ?
• How will the surgery affect my sex life ?

2. Radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

Women have radiation therapy alone, with chemotherapy, or with chemotherapy and surgery. The doctor may suggest radiation therapy instead of surgery for the small number of women who cannot have surgery for medical reasons. Most women with cancer that extends beyond the cervix have radiation therapy and chemotherapy. For cancer that has spread to distant organs, radiation therapy alone may be used.

Doctors use two types of radiation therapy to treat cervical cancer. Some women receive both types:

• External radiation: The radiation comes from a large machine outside the body. The woman usually has treatment as an outpatient in a hospital or clinic. She receives external radiation 5 days a week for several weeks.
• Internal radiation (intracavitary radiation): Thin tubes (also called implants) containing a radioactive substance are left in the vagina for a few hours or up to 3 days. The woman may stay in the hospital during that time. To protect others from the radiation, the woman may not be able to have visitors or may have visitors for only a short period of time while the tubes are in place. Once the tubes are removed, no radioactivity is left in her body. Internal radiation may be repeated two or more times over several weeks.

You may want to ask the doctor these questions before having radiation therapy :

• What is the goal of this treatment ?
• How will the radiation be given ?
• Will I need to stay in the hospital ? If so, for how long ?
• When will the treatments begin ? When will they end ?
• How will I feel during therapy? Are there side effects ?
• How will we know if the radiation therapy is working ?
• Will I be able to continue my normal activities during treatment ?
• How will radiation therapy affect my sex life ?
• Will I be able to get pregnant and have children after my treatment is over ?

3. Chemotherapy

Chemptherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because the drugs enter the bloodstream and can affect cells all over the body. For treatment of cervical cancer, chemotherapy is generally combined with radiation therapy. For cancer that has spread to distant organs, chemotherapy alone may be used.

Anticancer drugs for cervical cancer are usually given through a vein. Women usually receive treatment in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a woman needs to stay in the hospital during treatment.

You may want to ask the doctor these questions before having chemotherapy:

• Why do I need this treatment ?
• Which drug or drugs will I have ?
• How do the drugs work ?
• What are the expected benefits of the treatment ?
• What are the risks and possible side effects of treatment ? What can we do about them ?
• When will treatment start ? When will it end ?
• How will treatment affect my normal activities ?