Treating Cancer

Treating Cancer

The ideal cancer therapy would kill or remove all cancerous cells while leaving normal tissue untouched. Sometimes this is almost possible, as when a surgeon removes a small superficial tumor of the skin. Typically, however, the tumor is less accessible, so some combination of surgery, radiation therapy, and chemotherapy must be used (see “Common Questions Answered” for new and emerging cancer treatments).

Surgery For most cancers, surgery is the most useful treatment. In many cases, the organ containing the tumor is not essential for life and can be partially or completely removed. Surgery is less effective when the tumor involves cells of the

FREQUENCY

Beginning in their early 20s, women should be told about the benefits and limitations of breast self-examination (BSE). The importance of prompt reporting of any new breast symptoms to a health professional should be emphasized. Women who choose to do BSE should receive instruction and have their technique reviewed on the occasion of a periodic health examination. It is acceptable for women to choose not to do BSE or to do BSE irregularly.

For women in their 20s and 30s, it is recommended that clinical breast examination (CBE) be part of a periodic health examination, preferably at least every three years. Asymptomatic women age 40 and over should continue to receive a clinical breast examination as part of a periodic health examination, preferably annually.

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Begin annual mammography at age 40.

Annual, starting at age 50. Testing at home with adherence to manufacturer’s recommendation for collection techniques and number of samples is recommended. FOBT with the single stool sample collected on the clinician’s fingertip during a digital rectal examination is not recommended. Guaiac-based toilet bowl FOBT tests also are not recommended. In comparison with guaiac-based tests for the detection of occult blood, immunochemical tests are more patient friendly and are likely to be equal or better in sensitivity and specificity. There is no justification for repeating FOBT in response to an initial positive finding.

Interval uncertain, starting at age 50.

Every five years, starting at age 50. FSIG can be performed alone, or consideration can be given to combining FSIG performed every five years with a highly sensitive gFOBT or FIT performed annually.

Every five years, starting at age 50.

Every 10 years, starting at age 50.

Every five years, starting at age 50.

Men who have at least a 10-year life expectancy should have an opportunity to make an informed decision with their health care provider about screening for prostate cancer after receiving information about the uncertainties, risks, and potential benefits associated with screening. Prostate cancer screening should not occur without an informed decision-making process.

Cervical cancer screening should begin at age 21. Screening should be done every three years with conventional or liquid-based Pap tests. For women ages 30-65, screening should be done every five years with both the HPV test and the Pap test (preferred), or every three years with the Pap test alone (acceptable). Women aged 65 and over who have had three or more consecutive negative Pap tests or two or more consecutive negative HPV and Pap tests within the past 10 years, with the most recent test occurring within five years, and women who have had a total hysterectomy should stop cervical cancer screening. Women should not be screened annually by any method at any age.

Clinicians with access to high-volume, high quality lung cancer screening and treatment centers should initiate a discussion about lung cancer screening with apparently healthy patients ages 55-74 who have at least a 30 pack-year smoking history, and who currently smoke or have quit within the past 15 years. A process of informed and shared decision making with a clinician related to the potential benefits, limitations, and harms associated with screening for lung cancer with LDCT should occur before any decision is made to initiate lung cancer screening. Smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers, who should be informed of their continuing risk of lung cancer. Screening should not be viewed as an alternative to smoking cessation.

Endometrial Women, at menopause At the time of menopause, women at average risk should be informed about risks and symptoms of endometrial cancer and strongly encouraged to report any unexpected bleeding or spotting to their physicians.

Cancer-related checkup Men and women, age 20+ On the occasion of a periodic health examination, the cancer-related checkup should include examination for cancers of the thyroid, testicles, ovaries, lymph nodes, oral cavity, and skin, as well as health counseling about tobacco, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental and occupational exposures.

Beginning at age 40, annual clinical breast examination should be performed prior to mammography.

Individuals with a personal or family history of colorectal cancer or adenomas, inflammatory bowel disease, or high-risk genetic syndromes should continue to follow the most recent recommendations for individuals at increased or high risk.

The stool DNA test approved for colorectal cancer screening in 2008 is no longer commercially available. New stool DNA tests are presently undergoing evaluation and may become available at some future time.immune system, which are widely distributed throughout the body, or when the cancer has already metastasized.

Chemotherapy Chemotherapy is the use of targeted drugs that destroy rapidly growing cancer cells. Many chemotherapy drugs work by interfering with DNA synthesis and replication in rapidly dividing cells. Normal cells, which usually grow slowly, are not destroyed by these drugs. However, some normal tissues such as intestinal, hair, and blood-forming cells are always growing, and damage to these tissues produces the unpleasant side effects of chemotherapy, including nausea, vomiting, diarrhea, and hair loss.

Radiation In cancer radiation therapy, a beam of X-rays or gamma rays is directed at the tumor, killing the tumor cells. Occasionally, when an organ is small enough, radioactive seeds are surgically placed inside the cancerous organ to destroy the tumor; they are then removed later, if necessary. Radiation destroys both normal and cancerous cells, but because it can be precisely directed at the tumor, it is usually less toxic for the patient than either surgery or chemotherapy, and it can often be performed on an outpatient basis. Radiation may be used as an exclusive treatment or in combination with surgery and/or chemotherapy.

TIPS FOR TODAY AND THE FUTURE

A growing body of research suggests that we can take an active role in preventing many cancers by adopting a wellness lifestyle.

RIGHT NOW YOU CAN

If you are a woman, do a breast self-exam; if you are a man, do a testicular self-exam.

Buy multiple bottles of sunscreen and put them in places where you will most likely need them, such as your backpack, gym bag, or car.

Check the cancer screening guidelines in this chapter, and make sure you are up-to-date on your screenings.

IN THE FUTURE YOU CAN

Learn where to find information about daily UV radiation levels in your area, and learn how to interpret the information. Many local newspapers and television stations (and their websites) report current UV levels every day.

Gradually add foods with abundant phytochemicals to your diet, choosing from the list shown in Table 12.1.

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