All women are at risk of breast cancer. Women at a higher risk for developing breast cancer are those with a strong family history of breast cancer, a personal history of breast cancer, early menarche or late menopause, or a first full-pregnancy after age 30. The risk of developing breast cancer also increases with increasing age. Long-term estrogen therapy, a high fat diet, and alcohol use have been reported as possible risk factors, but the extent of their relationship to the onset of breast cancer remains unclear. Epstein-Barr virus has also shown association with development of breast cancer. A recent study demonstrated that higher levels of adult physical exercise are associated with the modest reduction in breast cancer risk.

Mutations in the BRCA1 and BRCA2 genes account for approximately 5% of the familial breast cancer. Because of the large number of DNA mutations identified, screening a person for BRCA1 or BRCA2 requires screening of a family member with a known malignancy to identify the mutation specific for that family. Few states have safeguards to protect against employment or insurance discrimination based on genetic testing. It is extremely important that genetic counseling be provided prior to DNA testing as well as prior to disclosure of results. A recent study had shown that bilateral prophylactic oophorectomy (surgical removal of ovaries) is associated with a reduced breast cancer risk in women who carry a BRCA1 mutation. Li-Fraumeni syndrome is a rare hereditary syndrome associated with an increased incidence of breast, brain, and adrenal neoplasms, as well as sarcomas, lymphomas, and leukemias. The cause of this syndrome is believed to be associated with mutation of p53 gene, which is a tumor suppressor gene.

With modern technology, breast cancer can often be detected at a very early stage of development when the chance for cure is highest. The key to cure is early detection and prompt treatment. Physical examination, mammography, and breast self-examination comprise an early detection approach. Women over age 20 should practice the breast self-examination (BSE) monthly. BSE is best done one week after menstruation starts, or on the same day each month for the post-menopausal woman. A pamphlet illustrating the BSE technique is available from the American Cancer Society (How to Do Breast Self-Examination, No. 2674, Atlanta, ACS) and your doctor's office. Asymptomatic women should have their breasts examined by a trained health professional every three years from ages 20-40 and annually thereafter.

-A breast or axillary (armpit) lump or thickening
-Nipple scaling, retraction, thickening, or discharge
-Skin dimpling or erythema (reddening)
-Edema (swelling)
-Ulceration
-Distended veins in an irregular pattern
-Breast pain

The diagnosis of breast cancer can only be made by pathological examination of breast tissue. A lump in the breast usually warrants biopsy even when the mammogram is described as being normal. Breast tissue may be obtained by needle aspiration biopsy or surgical biopsy. Needle aspiration is used by some physicians to help differentiate between cysts and solid tumors. Cysts frequently disappear after aspiration and the removal of fluid. Cytological or pathological examinations of material removed in the aspiration can be used to identify the cancer. Ultrasound may help determine whether the lump is solid or cystic. Breast MRI is a relatively new technique and remains under investigation. Surgical biopsy is generally performed under general or local anesthesia in an ambulatory surgical center. Excisional biopsy, the most commonly performed procedure, is used when lumps are small. In these cases, the entire tumor and a margin of normal tissue are excised. If the tumor is large, incisional biopsy may be done to remove a small amount of tissue for pathological examination. Tissue obtained from surgical biopsy can be evaluated by frozen section, which permits a diagnosis within 30 minutes and may be followed by definitive surgery; but most surgeons wait for a permanent section, which take about 24-48 hours. The latter approach is allows the patient time to discuss treatment options with the physician and is the more common approach today. Breast cancer tissue should also be assayed for estrogen and progesterone receptors. These hormone receptor assays aid in predicting whether certain hormones influence the growth of the cancer. Women with positive hormone receptor assays are more like to respond to hormone therapy and also have a better overall prognosis.

The term "colon cancer" means any cancer in the colon (large intestine), from the beginning of the colon (cecum) to the end of the colon (rectum). Colon cancer, colorectal cancer and rectal cancer are all the same disease. Sometimes the treatment for rectal cancer differs because of its location. The colon and the rectum together form the lower part of the intestinal tract. Other names for the colon and rectum include the large intestine or large bowel. The large intestine is divided into the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. The rectum is the almost straight, final portion that ends in the anus. The colon and rectum make up about 7 feet of the last part of the intestine.

Colon cancer is a malignant tumor in the lining of the large intestine. It starts with a single cell that mutates and grows into a visible polyp. If a polyp is allowed to remain in the colon it can grow into a cancerous tumor that can invade other organs. Researchers don't really understand exactly how a polyp progresses to cancer, but most polyps take 3-7 years to become cancerous. Prevention of colon cancer means stopping this process by removing the polyp before it becomes cancerous. Even if the polyp is found in the early stage of becoming cancerous, surgery can cure the cancer before it can spread. Many people with colon cancer have no symptoms at all, until the cancer advances. This makes routine screening for colon cancer and knowing if you are at risk very important. Many of the symptoms of colon cancer are also symptoms of other diseases of the colon. It is very important to see your doctor if you are having any of the following symptoms, so the proper tests can be run to make a correct diagnosis.

-Bleeding: As tumors grow, they can bleed during the passage of feces through the colon. The blood may be visible if the tumor is near the anus however it is more common for blood to be hidden in the stool. Only 20% of people with rectal bleeding have colon cancer, even though it is the most common symptom. Other things, like hemorrhoids can also cause bleeding.
-Pain: There are several reasons pain may occur with colon cancer. First, if a tumor grows large enough to block the passageway (obstruction), a person can experience pain and swelling of the abdomen. Obstruction can also cause nausea and vomiting if it is severe. Second, if the tumor grows through the wall of the colon into other organs, pain may occur, along with other symptoms, depending on the organ that is affected. Pain can be vague and dull.
-Unexpected Weight Loss: Some tumors can cause loss of appetite, leading to weight loss.
-Change in Bowel Habits: Colon cancer on the left side can cause constipation, gas pain, painful bowel movements, diarrhea, and narrowing of the stool.
Many people with colon cancer have no symptoms at all, until the cancer advances. This makes routine screening for colon cancer and knowing if you are at risk very important.

The initial detection of signs that you may have prostate cancer is now most commonly the result of some regular form of check-up carried out by your primary care physician which may include a digital rectal examination (DRE) or a prostate specific antigen (PSA) test. The most common symptom which may make a man go to either his primary care physician or a urologist, and which might subsequently lead to a diagnosis of prostate cancer, is some form of problem with normal urination. The diagnosis of prostate cancer requires identification by a pathologist of prostate cancer tissue in a specimen removed from the prostate (using a technique known as a prostate biopsy). No other clinical test can provide an absolute diagnosis of prostate cancer.

There are four basic reasons why your urologist would recommend that you receive an initial prostate biopsy:
-You have an elevated standard PSA level (of 4.0 ng/ml or more).
-There is a significant change in your standard PSA level over time.
-You have a standard PSA level of between 2.5 and 10.0 ng/ml and a low free/total PSA ratio as indicated by the PSA II test.
-You have a suspicious-feeling prostate on digital rectal examination.
Expert urologists now recommend that if any one of these indicators is present, you should have a biopsy even if your ultrasound evaluation is normal.

Specialists in the diagnosis of prostate cancer now recommend that biopsies of the prostate be carried out under ultrasound guidance and that several samples of tissue be taken from the prostate using an ordered method normally called sextant biopsy.The urologist will often ask you to have an enema prior to carrying out the biopsy, but there is no need for anesthesia. You will almost certainly be given an antibiotic in order to prevent any possible infection. Finally, you will likely be asked to stop taking certain drugs for one or two weeks before the biopsy in order to minimize the risk of bleeding problems.

In carrying out the actual biopsy, using transrectal ultrasound (TRUS) to guide the precise placement of the biopsy needle, the urologist will take six or more samples of tissue from the prostate and then send them to the pathologist for examination. The precise number of samples taken will depend upon what the urologist is able to see using the ultrasound machine. Normally, he or she would expect to take six evenly spaced specimens from different areas of the prostate (called a systematic sextant biopsy), and then additional specimens from any areas which look suspicious according to the ultrasound. In this way the urologist will maximize the chance of finding prostate cancer tissue if it is there in the prostate.

Skin cancer is a disease in which cancer (malignant) cells are found in the outer layers of your skin. Your skin protects your body against heat, light, infection, and injury. It also stores water, fat, and vitamin D. The skin has two main layers and several kinds of cells. The top layer of skin is called the epidermis. It contains three kinds of cells: flat, scaly cells on the surface called squamous cells; round cells called basal cells; and cells called melanocytes, which give your skin its color.

There are several types of cancer that start in the skin. The most common are basal cell cancer and squamous cell cancer. Skin cancer is more common in people with light colored skin who have spent a lot of time in the sunlight. Skin cancer can occur anywhere on your body, but it is most common in places that have been exposed to more sunlight, such as your face, neck, hands, and arms.

Skin cancer can look many different ways. The most common sign of skin cancer is a change on the skin, such as a growth or a sore that won't heal. Sometime there may be a small lump. This lump can be smooth, shiny and waxy looking, or it can be red or reddish brown. Skin cancer may also appear as a flat red spot that is rough or scaly. Not ail changes in your skin are cancer, but you should see your doctor if you notice changes in your skin.

Melanoma is a disease of the skin in which cancer (malignant) cells are found in the cells that color the skin (melanocytes). Melanoma usually occurs in adults, but it may occasionally be found in children and adolescents. Your skin protects your body against heat, light, infection, and injury. It is made up of two main layers: the epidermis (the top layer) and dermis (the inner layer). Melanocytes are found in the epidermis and they contain melanin, which gives the skin its color. Melanoma is sometimes called cutaneous melanoma or malignant melanoma.

Melanoma is a more serious type of cancer than the more common skin cancers, basal cell cancer or squamous cell cancer, which begin in the basal or squamous cells of the epidermis. If you have basal cell or squamous cell cancer of the skin, refer to the patient information statement for skin cancer.

Like most cancers, melanoma is best treated when it is found (diagnosed) early. Melanoma can spread (metastasize) quickly to other parts of the body through the lymph system or through the blood. (Lymph nodes are small, bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells.) You should see your doctor if you have any of the following warning signs of melanoma: change in the size, shape, or color of a mole; oozing or bleeding from a mole; or a mole that feels itchy, hard, lumpy, swollen, or tender to the touch. Melanoma can also appear on the body as a new mole. Men most often get melanoma on the trunk (the area of the body between the shoulders and hips) or on the head or neck; women most often get melanoma on the arms and legs.

If you have signs of skin cancer, your doctor will examine your skin carefully. If a mole or pigmented area doesn't look normal, your doctor will cut it out (called local excision) and look at it under the microscope to see if it contains cancer. This is usually done in a doctor's office. It is important that this biopsy is done correctly.

Cancer is a disease marked by the uncontrolled growth of abnormal cells. The abnormal cells may no longer do the work of normal cells, and they crowd out and destroy healthy tissue. Lung cancer is the most common cancer-related cause of death among men and women. It is the second most commonly occurring cancer among men and women. It has been estimated that there will be 164,100 new cases of lung cancer in the U.S. in 2000 alone. The rate of lung cancer cases appears to be declining among white and black men in the U.S., while it continues to increase among both white and African-American women. An estimated 156,900 Americans are expected to die due to lung cancer in 2000. Lung cancer may also be the most tragic cancer because, in over 80% cases, it might have been prevented. And treatment is currently limited in its effectiveness.

Cancers that begin in the lungs are divided into two major types, non-small cell lung cancer and small cell lung cancer, depending on how the cells look under a microscope. Non-small cell lung cancer generally spreads to distant organs more slowly than small cell lung cancer. Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma are three types of non-small cell lung cancer. Small cell lung cancer also called oat cell cancer is the less common lung cancer type, accounting for about 20% of all lung cancer. It is important to find out what kind of lung cancer a person has. The different types of carcinomas, involving different regions of the lung, may give rise to different symptoms and are treated differently.

Lung cancer takes many years to develop. However, changes in the lung can begin almost immediately upon exposure to carcinogens (cancer-causing substances). Soon after exposure begins, microscopic examination of the tissue lining the bronchi (the main breathing tubes) will reveal a few unusual cells. With continued exposure, more abnormal cells appear. These cells may be on their way to becoming cancerous and forming a tumor.

The symptoms of the cancer vary depending on several factors, including where in the lung the tumor is found. If the cancer is located in one of the bronchi, it can irritate the lining of the bronchus (one of the main airways that branches off of the trachea or windpipe) and cause a chronic cough. The cancerous area may bleed when a person coughs.

If the tumor grows larger, it may gradually fill the bronchus so that air can't pass in or out. A blocked bronchus may also cause repeated lung infections or pneumonia. A tumor located in the outer part of the lung may not produce any symptoms until it is fairly large. Sometimes the first sign may be chest pain from the tumor growing into the lining of the lungs or the ribs and muscle of the chest wall. A person's lungs have extensive networks of blood and lymph vessels. Cancer cells may grow into these vessels and be carried by the blood or lymph to circulate through the body. The cancer cells may then be deposited in other organs of the body. A new colony of cancer cells which started in another organ is known as metastasis.

The first site of tumor metastasis is usually the lymph nodes within the lungs and the mediastinum (the space between the two lungs in the middle of the chest).

It is possible for cancer cells that begin in other organs to spread to the lungs. These cases are very different medical problems, however. Depending on the organ of origin, such cases might be termed "primary breast cancer, metastatic to the lungs," or "primary kidney cancer,metastatic to the lungs." These cancers are less often treated with surgery or radiation therapy, but with chemotherapy.

Smoking is the number one cause of lung cancer. It is thought that more than 80% of lung cancers result from smoking. Cigarette smoke contains more than 4,000 different chemicals, many of which are proven carcinogens, while hundreds of others increase the cancer-causing power of carcinogens.

Many of these chemicals also affect the nonsmoker inhaling "secondhand" or sidestream smoke,* making "passive smoking" another important cause of lung cancer. In a 1993 report, the U.S. Environmental Protection Agency (EPA) concluded that involuntary or "passive" smoking causes 3,000 lung cancer deaths in nonsmokers each year. Sidestream smoke, with its high concentration of carcinogens, goes directly into the air from burning tobacco (cigarettes, cigars, etc.) and is inhaled by both smokers and nonsmokers. If you smoke, you are much more likely to develop the disease; men who smoke are estimated to be 22 times more likely to develop lung cancer, while women who smoke are estimated to be 12 times more likely. The more you smoke and the longer you smoke, the greater your risk of lung cancer. But if you stop smoking, the risk of cancer decreases steadily each year as abnormal cells are replaced by normal cells. In ten years, the risk decreases to a level that is 30 to 50 percent of the risk for people who continue to smoke. In addition, quitting smoking dramatically reduces the risk of developing other smoking-related diseases, such as heart disease and stroke, and significantly reduces the risk of serious emphysema and chronic bronchitis.

Radon, by its own action and by its interaction with cigarette smoking, is considered to be the second leading cause of lung cancer in the U.S. today. Radon is a radioactive gas that is found in the earth's rock and soil and is formed by the natural breakdown of radium, which is a radioactive product of decaying uranium. It is estimated that 15,000 American die each year from residential radon induced lung cancer. Radon can be a problem in schools and workplaces, too. Because radon is invisible and odorless, the only way to determine if you are being exposed to the gas is by measuring radon levels. In addition, exposure to radon, in combination with cigarette smoking, significantly increases the risk of lung cancer. Therefore, for smokers, exposure to radon is an even greater health risk.

Another leading cause of lung cancer is on-the-job exposure to carcinogens. Asbestos is perhaps the best known of the industrial substances associated with lung cancer, but there are many cancer-causing substances that people may deal with at work. These include asbestos,uranium, arsenic, certain petroleum products, and others.

In addition, it is important to realize that there are many different jobs that may involve exposure. Some examples are working with certain types of insulation, working in certain environments, such as with coke ovens, and repairing brakes. As is the case with radon, when exposure to job-related carcinogens is combined with smoking, the risk of getting lung cancer is sharply increased.

Testicular cancer usually strikes men between the ages of 15 and 35 and, although it is the most common cancer for men in this age group, it accounts for only about one percent of all cancers in men. This type of cancer is much more common in Caucasian men than in men of other ethnic groups. Some 7,000 cases of germ-cell tumor, which make up 95 percent of cancer arising in the testicles, are diagnosed each year.

The earliest symptom of testicular cancer is, most often, pain, swelling, or hardness in the testis, or some combination of these symptoms. Less often, the first symptom a patient will notice is a small, painless lump on the testicle. A man with testicular cancer might also feel heaviness in the scrotum, an ache in the lower abdomen or groin area, an accumulation of blood or fluid in the scrotum, or a change in the way a testicle feels. More rarely, there is tenderness in the man's breast area usually caused by high levels of a hormone called human chronic gonadotropin (HCG). Remember, though, that these symptoms do not necessarily indicate cancer. There could be other causes, such as an infection. Only a doctor can tell you the ultimate cause of any symptom.

Not too long ago, testicular cancer was considered a difficult and dangerous type of tumor. Advances in treatment mean that most men diagnosed with testicular cancer, especially those diagnosed when the cancer is at an early, treatable stage, can now expect to survive the disease. Today, the overall cure rate for testicular cancer, when detected early, is above 90 percent.

So far, research has not shown a connection between testicular cancer and any particular habits, activities, or lifestyles. There is evidence that the risk of testicular cancer is higher in men whose testicles did not descend normally. That is, move down from lower abdomen into the scrotum. For this reason, surgery is often performed to correct this problem before the testicle has been left undescended for very long. It has been said that the risk of testicular cancer may be higher in men infected with HIV, the virus that causes AIDS, but evidence for this is weak.

Treatment for testicular cancer almost always involves orchiectomy, the surgical removal of the affected testicle. This is done, in part, because anticancer drugs are not readily taken in by the testes. Because of the risk of spreading the cancer through contact with the loose skin of the scrotum, the surgery is usually done through an opening made in the groin where the thigh meets the torso. Since only two percent of men with testicular cancer will experience a new tumor in the other testicle, the remaining testicle is usually left intact.

Post-surgical treatment depends partly on whether the cancer has spread beyond the testicle. It can also depend on what type the tumor is. Testicular tumors are either pure seminoma or non-seminomatous. Seminomas, which occur when germ cells, the cells that divide to produce sperm cells, become cancerous at a very early stage in their development, are the most common type of testicular tumor, accounting for 50 percent of cases.

The rest are different types of non-seminomatous tumors and mixtures of tumor types. 20-25 percent are embryonal carcinomas, which can arise in more mature germ cells. Another 25-30 percent are teratoma carcinomas, which contain different kinds of tissue, often types not normally found in the testes. These other types of tissue are present because the malignant germ cells begin to "differentiate" or develop into various types of body tissue. For example cartilage, nerve, or muscle, which normally does not happen until after the mature sperm cell combines with a woman's egg cell. As they develop, these prematurely differentiated cells can sometimes become malignant. About one percent of testicular cancers are choriocarcinomas, a particularly malignant type of germ cell tumor which shares some characteristics with placenta, the blood-filtering tissue that normally forms in the uteruses of pregnant women.

Testicular cancers tend to spread through the spermatic cord, the tube that carries sperm away from the testicle, and associated blood and lymph vessels to the nearby lymph glands called the retroperitoneal lymph nodes. When the disease spreads beyond the lymph nodes, it's most likely to arise in the lungs or liver. Occasionally in patients with non-seminomatous tumors or if there is no sign of spread beyond the testicle, doctors will recommend surveillance after surgery, waiting to see if there is a relapse before starting any further treatment. This approach is followed because, when the main tumor is removed early, testicular cancer has a high cure rate even if there is a relapse, so there may be no clear advantage to treatment if there is no evidence the disease has spread. Given the slight risk of leukemia resulting from the use of some chemotherapies. When doctors do use chemotherapy for testicular cancer, they will usually administer cisplatin and etoposide, two drugs that do a very good job of controlling the disease with minimal side effects.

If the doctor recommends watching for signs of recurrence, it is extremely important that the patient keep all follow-up appointments and perform regular self-examination. Testicular cancer is still a very serious disease if not found early, and it can grow rapidly. The disease can progress from stage one, localized disease in the testicle only, to stage three disease, where cancer has spread to distant parts of the body, in just a few months.

There is no consensus regarding the optimal treatment of patients with liver tumors. This contributes to the pessimistic attitude that many have regarding the treatment of liver cancer. Aggressive treatment strategies can cure or significantly prolong the life of many patients with liver cancer.

The liver is a common site of metastases from a variety of organs such as lung, breast, colon and rectum. When liver metastases occur at the time of initial diagnosis of the primary tumor, they are described as synchronous. If detected after the initial diagnosis, they are described as metachronous. The liver is frequently involved since it receives blood from the abdominal organs via the portal vein. Malignant cells detach from the primary cancer, enter the bloodstream or lymphatic channels, travel to the liver, and grow independently. We do not understand the mechanism of how a tumor cell can leave the primary site and grow in specific organs. Potentially, the environment of the liver is suitable to the growth of certain tumor cells. Once a tumor begins to grow in the liver, it receives its blood supply from the hepatic artery.

Early stages of cancer can be asymptomatic and may go undetected for months or even years. When symptoms do develop, they are most pronounced as pain. Pain associated with cancer is a result of several possibilities: invasion or destruction of normal tissue with cancer cells; stretching of internal tissue by tumor growth; pressure of tumor on an organ; blockage of a vital passageway by the tumor; and infection caused by cancer. Other symptoms may include loss of appetite, loss of weight, fever of unknown origin, limb weakness, sensory loss, or an absence of tendon reflexes in the limb.

Liver cancer, both primary and metastatic, often exhibits symptoms of general malaise as well as pain and tenderness. The discomfort is usually of a moderate degree and most often in the upper or upper right part of the abdomen. In more advanced cases, symptoms of jaundice, a yellowing of the skin and eyes, may also appear.When your primary care physician finds a reason to suspect cancer in the liver, you will be advised to undergo a series of diagnostic tests. Some of these tests are noninvasive and require a brief visit to a clinic or lab. Others are more involved and may require an overnight stay in a hospital.

-Surgery
-Cryosurgery
-Chemotherapy
-Chemoembolization
-Alcohol Injection
-Radiation Therapy
-Radiofrequency Ablation
-Interstitial Laser Photocoagulation
-Isolated Liver Perfusion
-Liver Transplantation

Ovarian cancer is very treatable when it is detected early, but the vast majority of cases are not diagnosed until it is too late. In cases where ovarian cancer is detected before it has spread beyond the ovaries, 95% of women will survive longer than five years. Only 25% of ovarian cancer cases in the U.S. are diagnosed in the beginning stages. When diagnosed in advanced stages, the chance of five-year survival is only 28%. Ovarian cancer may be difficult to diagnose because symptoms are easily confused with other diseases, and because there is no reliable, simple to administer screening tool.

Raising public awareness of ovarian cancer by educating doctors and women about the disease could save lives. Many people do not know that ovarian cancer often presents with symptoms that include abdominal pressure or bloating, constant and progressive changes in bowel or bladder patterns, persistent digestive problems, excessive fatigue, abnormal bleeding and pain during intercourse. Early recognition of symptoms is the best way to save women’s lives. Without increased education about ovarian cancer, many women and their doctors will continue to ignore or misinterpret the symptoms of the disease. Recognition of women who are at heightened risk for developing ovarian cancer is also key. Risk factors include: increasing age, personal or family history of ovarian, breast, or colon cancer, and not bearing a child.

More ovarian cancer research is needed- to develop early detection tools, better therapies, cures, and to prevent the disease. Much more needs to be learned about what causes ovarian cancer and how to prevent it. There are still large gaps in knowledge on key scientific aspects of the disease. 90% of women diagnosed do not have a family history that puts them at higher risk. There is still no reliable and easy to administer screening test like the Pap smear for cervical cancer and the mammogram for breast cancer. Ovarian cancer research is drastically under-funded. The National Cancer Institute is spending only $62 million dollars in 2000 on ovarian cancer research. Although one-third as many women die of ovarian cancer as die of breast cancer, NCI is spending only one-seventh as much money for ovarian cancer as for breast cancer research this year.

-Pressure or bloating in your abdomen
-Constant and progressive changes in bowel or bladder patterns
-Persistent digestive problems
-Ongoing excessive fatigue
-Abnormal bleeding
-Pain during intercourse

Ovarian cancer symptoms are often subtle and easily confused with symptoms for other disorders. Frequently, women don't recognize the symptoms, and too often doctors lack sufficient awareness to effectively diagnose the disease. The tragic result is that too many women never have a chance against ovarian cancer.

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