Cancer of the Bone Cancer of the Liver
Brain Cancer Cancer of the Stomach
Breast Cancer Cervical Cancer
Cancer of the Colon and Rectum Prostate Cancer

Cancer of the Bone

In the human body, there are 206 bones, which serve many different purposes. They support our body, they protect our internal organs, and they serve as anchoring locations for the muscles of our body to allow movement. The bones also serve as a storage location for the bone marrow, which is the soft spongy portion in the center of many bones, which manufactures and stores many of our blood cells. When a cancer begins in the bone it is called a primary bone cancer. Every year in the United States only two thousand people are diagnosed with a primary bone cancer. These can occur in any bone in the body; however, they are much more commonly seen in the arms and legs. Children and Young adults are much more likely to develop bone cancers than older adults are. Cancers, which begin in the bone, are referred to as sarcomas. There are several types of sarcomas, which can develop, and each type begins in a different type of bone tissue. Three of the most common types of bone sarcomas are called osteosarcoma, Ewing’s sarcoma, and chondrosarcoma.

Osteosarcoma is the most prevalent type of bone cancer, which is diagnosed in young people. It is most commonly found between the ages of 10 and 25 and seems to affect males more often than females. It is generally found to involve the long bones of the body, mainly the arms or legs. It also tends to begin at the end of these bones.

A second type of primary bone cancer is called a Ewing’s sarcoma. It again is generally found in young people between the age of 10 and 25 years of age affecting teenagers most often. This tumor is much more common in the hip bones and the long bones of the thigh and upper arm region but can also be seen with relative frequency in the ribs. In comparison to an osteosarcoma, this cancer generally forms in the middle portion of the bone.

The third most common type of primary bone tumor is known as a chondrosarcoma. This type of tumor actually forms in the cartilage found in and around the bones which is generally associated as being the rubbery tissue around the joints themselves. This type of tumor is found mainly in adults. There are some other types of primary bone cancers, which are quite rare but can be seen and these are known as fibrosarcomas, malignant giant cell tumors, and chordomas. These rare cancers more commonly affect adults over the age of 30.

The most common symptoms of bone cancer depend upon the type of cancer, the location, and the size of the tumor. The symptoms related to a bone cancer tend to develop very slowly over time with pain being the most frequently described symptom. Sometimes a firm, tender lump on the bone can be felt through the skin. Also, occasionally bone cancer can weaken a bone, which leads to a fracture, which may be the initial reason for diagnosing an abnormality. Numerous tests such as plain x-rays, CT scans, and MRI scans are utilized in the diagnostic work-up of a cancer and eventually a biopsy of the lesion must be obtained to determine the proper diagnosis. Bone cancer, depending upon the type, is then treated with surgery, radiation therapy, chemotherapy, or a combination of the above. Surgery is part of the treatment for the majority of bone cancers. In the past, amputations were quite common, however, with the advent of advancements in radiation therapy and chemotherapy, we are often able to do limited surgical resections and then supplement the treatment with radiation therapy and chemotherapy to prevent an amputation.

While you can see that primary cancers of the bone are quite rare, it, again, is not uncommon to find other types of cancer, which spread to the bone. When dealing with a cancer which spreads to the bone from another site, the treatment of that cancer will depend upon where the primary cancer originated. Treatment at that time generally consists of radiation therapy, chemotherapy, hormone therapy, or a combination of the above.

by Dr. C. Joseph Bennett, Jr.

Brain Cancer

One must distinguish tumors, which occur in the brain from those which truly develop in the brain and those which spread from other sites of the body to the brain. These tumors which spread from other locations such as the lungs are actually metastatic lesions and are not considered to be primary brain tumors. Each year in this country, roughly sixteen thousand people are diagnosed with a primary brain tumor. One must also distinguish between benign and malignant tumors of the brain. Benign brain tumors are basically simple overgrowths of normal tissue of the brain. When these tumors are looked at under the microscope, they do not contain characteristic cancer cells and do not possess the ability to spread to other locations of the body. Malignant tumors on the other hand when viewed under the microscope do possess changes, which are seen and represent cancer cells. They tend to grow much more rapidly and actually invade into the healthy tissue around them. Unfortunately, however, even benign tumors of the brain can be life threatening. The bony skull basically does not allow for any expansion of the tissue within the head and if a benign tumor begins to grow, it can cause significant damage to the surrounding brain tissue simply by placing pressure upon it. Benign brain tumors can even lead to death if they are not properly treated.

As with many types of malignancies, the cause of brain tumors is unknown. Brain tumors can occur at any age; however, studies have shown that they are most common in either children between the ages of 3 to 12 or in adults between the age of 40 to 70. Certain studies have shown risk factors associated with a greater chance of developing a brain tumor. These include people who have had exposure to certain industrial types of jobs such as oil refining, rubber manufacturing, and drug manufacturing. Other studies have also shown that chemists and embalmers also have a higher incidence of brain tumors. A great deal of research is now going into whether or not viruses may contribute to the development of brain tumors. In most instances, however, there are no clear risk factors when talking to someone about a brain tumor.

Brain tumors can present many varied symptoms. These symptoms depend greatly on the size of the tumor and the location of the tumor within the brain. Symptoms can be related to pressure on the brain or by swelling that occurs as a reaction to the tumor, which is known as edema. The most frequent symptoms associated with brain tumors include headaches which tend to be worse in the morning and then ease up during the day, seizures, nausea or vomiting, weakness or loss of feeling in the arms or legs, a change in ones coordination which may lead to stumbling, abnormal eye movements or visual changes, drowsiness, personality and memory changes, or changes in speech. If a brain tumor is suspected, a physician will typically order either a computer tomography (CT) scan or a magnetic resonance imaging (MRI) scan. These studies will allow the physician to determine the extent of the abnormality and also rule out other causes of mental status changes.

The Many Types of Brain Tumors

Tumors that begin in the brain tissue are known as primary brain tumors. This distinguishes them from secondary tumors or those, which metastasize from other parts of the body to the brain. Primary tumors of the brain are typically classified based on the type of tissue, which they begin in. The most common types of brain tumors are gliomas, which begin in glial tissue. Glial tissue is basically the supportive tissue of the brain. There are many different types of gliomas. The most common gliomas are known as astrocytomas. Astrocytomas arise from very small cells known as astrocytes and can grow anywhere in the brain or the spinal cord. In adults, the astrocytomas typically begin in the cerebrum, which is the larger, more superior portion of the brain. In children, gliomas more often occur in the brain stem or the lower portion of the brain where it tapers to form the spinal cord. They can also be seen in the cerebrum and the cerebellum of children. A very aggressive or poorly differentiated form of an astrocytoma is known as a glioblastoma multiforme.

Another type of glioma is known as an ependymoma. Ependymomas usually develop in the lining of a portion of the brain known as the ventricles. The ventricles house the spinal fluid, which circulates to and from the brain to the spinal cord. Ependymomas can also develop in the spinal cord and these tumors can develop at any age. They are, however, most common in childhood and adolescence.

A third common type of glioma is known as an oligodendroglioma. Oligodendrogliomas arise in cells, which produce a chemical known as myelin. Myelin is a fatty type chemical, which covers and protects the nerves of the brain. These types of tumors typically arise in the upper portion of the brain known as the cerebrum and they tend to grow very slowly. Most often, they do not spread to involve the surrounding brain tissue. Oligodendrogliomas are extremely rare and they occur most often in middle-aged adults but have been noted in all age groups.

Another common tumor of the brain, which is seen most often in children, is known as a medulloblastoma. Medulloblastomas develop from very primitive nerve cells which for some reason or another remain present long after birth when they should not. Most medulloblastomas arise in the lower portion of the brain known as the cerebellum and are most often seen in children with a frequency higher in boys than in girls.

Another type of brain tumor, which begins in the lining of the brain, is known as a meningioma. These tumors grow from the meninges, which are a fibrous type of lining of the brain. Most often, meningiomas are benign and grow very slowly. It is not uncommon for these tumors to obtain a great deal of size before they cause symptoms. Meningiomas are most often seen and are more common in women than men between the ages of 30 and 50. This basically gives you an overview of the more common types of tumors seen in the brain. There are several other types, which are seen with a very low frequency.

Breast Cancer

There are two main types of breast cancer. The most common variety is called Ductal Carcinoma secondary to the fact that it originates in the internal lining of the milk ducts of the breast. The second most common type is called Lobular Carcinoma secondary to the fact that it develops within the lobules of the breast which are involved in the production of breast milk. These tumors are also divided into invasive and non-invasive cancers. Ductal carcinoma in-situ (DCIS) and lobular carcinoma in-situ (LCIS) are cancers of the ducts and lobules respectively that remain confined to the ductules and lobules and have not invaded into the supporting tissue of the breast. This is a very important pathologic finding because it is through invasion of the surrounding breast tissue that breast cancer can spread to lymph nodes or other areas of the body. Women found to have DCIS or LCIS do not have to undergo a procedure called axillary dissection, a process of sampling the lymph nodes under the arm to determine if the tumor has spread, or metastasized. However, if the tumor has extended beyond the lobules or ductules, it is called an invasive cancer of the ductules or lobules, and axillary dissection is performed because the lymph nodes under the arm are typically the first route of spread. This sampling of the lymph nodes provides your physician with information vital in the complete course of therapy. A third form of breast cancer is called Inflammatory Breast Cancer and represents a rare type of breast cancer where the breast is warm to the touch and very red or inflamed. This is due to involvement of lymphatic vessels in the skin of the breast and represents a very aggressive form of breast cancer.

Cancer of the Colon and Rectum

Cancer of the colon and rectum will be diagnosed in roughly 150,000 Americans this year. Currently, 50% of patients who are diagnosed with these cancers will survive for five years, but with recent advances in treatment, this number is expected to rise over the next 10 years or so. One must realize, however, that cancers of the colon and rectum account for nearly 60,000 deaths per year, second only to lung cancer. As with most cancers, early detection leads to a higher rate of long-term survival and cure.

Cancers of the colon and rectum are generally seen in the elderly population. Eighty percent of colon cancers and 75% of rectal cancers are diagnosed in patients 60 years of age or older. The most common sites are the ascending colon (the first part of the large intestine), the sigmoid colon (the last part of the colon prior to entering the rectum) and the rectum itself.

Many disease processes are linked to an increased risk of colon and rectal cancers. Some of these include a positive family history of excessive colon polyps, the presence of what is termed the inflammatory bowel diseases which include both Crohn’s disease and ulcerative colitis, as well as a genetic predisposition that has been well documented. If any of these risk factors are present, patients need to undergo frequent regular screening to allow for early detection of these cancers. In patients with a strong family history of multiple polyps, a screening colonoscopy should be performed shortly after they turn 15. Many of the cancers of the colon are believed to originate from polyps, which have been present for a long time. As they grow and enlarge, the risk of developing a cancer in a polyp increases. If multiple polyps are noted, it is generally recommended that they consider surgical removal of the colon before the age of 30 secondary to the fact that one or more of these polyps will almost certainly turn into a cancer over time. The risk in patients with either ulcerative colitis or Crohn’s disease is more difficult to estimate; therefore these patients must also be followed carefully and may also benefit from removal of the colon if the risk seems to be increasing.

There are other factors, which may play a role in the development or prevention of colon cancer. The risk of colon cancer in the western world is higher than that seen in the east, the arctic, and Finland. The increase in fat consumption appears to increase the risk of developing a colon cancer. This appears to be linked to an increase in the production of bile acids in cultures with a high fat diet, and these levels of bile acids will decrease rapidly with diet modification. The use of a high fiber diet, such as that seen in Finland, also appears to play a role in the risk of colon cancer. The higher level of fiber in theory dilutes the concentration of bile acid in the colon and also speeds up the process of stool passing through the colon. All of this combines to decrease the amount of time the colon wall is exposed to the bile acids, and thus appears to lower the risk of colon cancer.

Diagnosis and Treatment

The diagnosis can be made, depending on the location, by digital exam, a sigmoidoscopy, or a colonoscopy. When the tumor is located, a biopsy is obtained. After the diagnosis is made, surgery is the mainstay of treatment. For lesions of the colon, the area of the tumor and a margin of normal tissue were resected. Depending upon the extent of the disease, chemotherapy may be recommended after surgery. Several studies have shown a benefit using chemotherapy when there is evidence of tumor spread to the draining lymph nodes. If the lesion is extensive and spreads locally to invade other structures in the abdomen, a course of radiation therapy treatments may also be offered after surgery.

With regard to rectal cancers, surgery again is the mainstay of treatment and it is usually accompanied by both chemotherapy and radiation therapy. Studies have shown a clear advantage to the addition of both chemotherapy and radiation when tumors of the rectum invade into the deeper portion of the rectal wall or when there is spread to the draining lymph nodes. Historically, radiation therapy has been given after surgery, however, it often precedes the surgery to shrink the tumor and assist the surgeon in the resection of the tumor.

Typically, cancers of the colon can be resected in a fashion, which allows the surgeon to reattach the remaining intestinal tract and avoid a colostomy. However, when tumors involve the lowermost aspect of the rectum, it becomes difficult, if not impossible, for the surgeon to reattach the intestinal system and obtain good function. In this instance, the entire rectum is removed and the intestine is drained externally through the wall of the abdomen using a colostomy.

Today, roughly 60% of patients who are diagnosed with colon and rectal cancers will be alive and well without evidence of cancer 5 years later. This number continues to improve with earlier detection and advances in treatment.

Cancer of the Liver

Primary tumors of the liver are relatively uncommon in the United States. They are more common in other areas such as Asia and Africa. Unfortunately, even though tumors of the liver are quite rare, they are extremely severe forms of cancer with an extremely low cure rate. It is much more common to see tumors in the liver which have metastasized or spread from other parts of the body to the liver.

Most tumors, which primarily begin in the liver, are called hepatocellular carcinoma. These account for approximately 75% of all true primary liver cancers. One can also develop cancers within the liver, which begin within the biliary ductal system of the liver. There are also some other very rare forms of cancer such as sarcomas, which may originate in the liver. There are many various risk factors, which have been identified to be associated with the development of liver cancers and will explain the reason why it is more prevalent in certain parts of the world than in others. These known risk factors consist of a prior history of hepatitis B infection, cirrhosis of the liver secondary to chronic heavy alcohol abuse, exposure to foods which are contaminated with a chemical called aflatoxin, and the utilization of certain drugs and medications. These medications consist of the utilization of steroids which may be seen in athletes and body builders when they are attempting to build muscle mass, drugs which are designed to suppress the immune system to prevent organ transplants in patients who have had organ transplants, and certain pesticides and chemicals which can be potential agents which cause liver cancer.

A very common finding in people who develop liver cancer is the presence of liver cirrhosis. It is felt that the risk of developing liver cancer when a patient has cirrhosis secondary to poor nutrition is approximately 10%. In patients with a prior history of hepatitis B and cirrhosis of the liver secondary to this infection, the incidence of liver cancer increases to approximately 20%. One can see that this would be a very common cancer in areas of the world where hepatitis B is an extremely common infection. It has been found that approximately 70% of patients who develop hepatocellular cancer throughout the world are found to have had hepatitis B infection. Another cause of liver cancer is exposure to parasitic infections which is certainly not very common in this country but can be seen in underdeveloped nations throughout the world. This chronic parasitic infection leads to scarring and damage of the liver, which over time increases the risk of developing liver cancer. Therefore, as one can see, simply by avoiding situations where parasitic infection is common, utilizing alcohol in small amounts or avoiding it altogether, and avoiding activities which may lead to a hepatitis B infection, the risk of hepatocellular or liver cancer can be very greatly reduced.

Cancer of the Stomach

Cancer of the stomach is a disease in which cancer cells are found within the tissues lining the stomach. Cancer of the stomach can be quite different from patient to patient. Sometimes cancer can be in the stomach for a long period of time and grow to be very large before it causes any symptoms whatsoever. In the early stages of cancer of the stomach, patients may experience indigestion, discomfort, a bloated feeling after eating, nausea, loss of appetite, or heartburn. These symptoms certainly can also be found when the lining of the stomach is irritated or when stomach ulcers may be present as well. In more advance stages of stomach cancer, patients may notice blood in the stool, vomiting, weight loss, and pain in the abdomen.

Several different risk factors have been associated with an increased risk of stomach cancer. One of the most recent findings is the presence of bacteria in the stomach called Helicobacter pylon. This infection is also associated with the development of ulcers and if treated assist in the healing of the ulcer and prevention of developing further ulcers. It also appears that this infection may be associated with stomach cancer as well. Men are also more likely to develop stomach cancer than women are and there is a clear association of stomach cancer with cigarette and alcohol utilization. Studies have also shown that there is an increased risk of stomach cancer in populations who eat a lot of dry salted foods in their diet. Certain hereditary conditions have also been associated with an increased risk of stomach cancer.

First and foremost, if anyone has symptoms associated with a change in the stomach as mentioned above, your physician should be consulted immediately. In many instances, a gastroenterologist will perform an examination. This examination may consist of x-ray studies such as an upper GI series, at which time a patient drinks barium, which will allow the radiologist to examine the shape and contour of the stomach to look for any abnormality. Your doctor or a gastroenterologist may also look inside your stomach with a small, thin, lighted tube during a procedure called an upper endoscopy. This scope allows them to visualize the lining of the stomach and the upper portion of the small intestine. If an abnormal area is noted, your physician will then take a biopsy of this, which will be evaluated by a pathologist.

Cervical Cancer

This year, roughly 15,000 cases of cervical cancer will be diagnosed in the United States. With the widespread utilization of the yearly Papanicolaou (Pap) smears, the risk of developing cervical cancer has dramatically declined over the past 25 years.

The cervix is the lower portion of the uterus, which opens into the vagina. All women who are 18 or older or sexually active should have regular yearly Pap smears. These Pap smears allow for the detection and treatment of any pre-malignant changes before they turn to a true cancer. Many methods and techniques exist to treat dysplasia, the pre-malignant changes that can be detected by a Pap smear.

Several risk factors have been associated with cancer of the cervix. They include sexual intercourse at an early age, a history of multiple sexual partners, a large number of pregnancies, a history of venereal warts, and smoking. Exposure to the human papilloma virus (HPV) with infection has been strongly tied to the development and risk of cervical cancer. On the other hand, cervical cancer is rare in sexually inactive women and in those who have not given birth.

The typical symptoms of cervical cancer include abnormal vaginal bleeding, pelvic pain, and an increase in urinary frequency or blood in the urine. If an examination reveals an abnormality of the cervix, a biopsy is obtained and computed tomography (CT) scans are also obtained to assist in determining the extent of the disease. It is often also helpful to visualize the bladder and rectum with cystoscopy and sigmoidoscopy respectively to rule out extension of the tumor to these organs.

The treatment of cervical cancer depends upon the extent of the disease at the time of diagnosis and the general health of the patient. Generally speaking, for early small lesions confined to the cervix with no evidence of local or distant spread, surgery utilizing a radical hysterectomy and removal of lymph nodes in the pelvis or radiation therapy can be utilized with equal and good results. Many factors, including age and health will help to determine which is best. For larger more advanced lesions, radiation therapy is the treatment of choice. The utilization of chemotherapy has been looked at in several clinical trials and does appear to induce a response with tumor shrinkage in about 50 to 60% of patients and continues to be evaluated in combination with both surgery and radiation therapy.

As with most cancers, the long-term prognosis after treatment is dependent upon how early the tumor is detected and treated. For early lesions, the five-year survival rate is about 90%. This drops to about 60% for larger lesions, and down to about 15% percent for very advanced cancers, which have spread beyond the pelvis. The Pap smear represents one of the most successful advances in both the prevention and early detection of cervical cancer in use today. It is therefore vital that women continue to have regular Pap smears according to their physician’s recommendation.

Prostate Cancer

Prostate cancer is a malignancy of one of the major male sex glands. Along with the testicles and the seminal vesicles, the prostate secretes the fluid that makes up semen. The prostate is about the size of a walnut and lies just behind the urinary bladder. A tumor in the prostate interferes with proper control of the bladder and normal sexual functioning. Often the first symptom of prostate cancer is difficulty in urinating. However, because a very common, non-cancerous condition of the prostate, benign prostatic hyperplasia (BPH), also causes the same problem, difficulty in urination is not necessarily due to cancer.

Cancerous cells within the prostate itself are generally not deadly on their own. However, as the tumor grows, some of the cells break off and spread to other parts of the body through the lymph or the blood, a process known as metastasis. The most common sites for prostate cancer to metastasize are the seminal vesicles, the lymph nodes, the lungs, and various bones around the hips and the pelvic region. The effects of these new tumors are what can cause death.

Second only to skin cancer, the American Cancer Society estimates that in 2000 at least 180,400 new cases of prostate cancer were diagnosed. Of this number, the disease will cause at least 31,900 deaths. Although prostate cancer is often very slow growing, it can be aggressive, especially in younger men. Given its slow growing nature, many men with the disease die of other causes rather than from the cancer itself.

Prostate cancer affects African-American men twice as often as white men and the mortality rate among African-Americans is also two times higher. African-Americans have the highest rate of prostate cancer of any world population group.