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Benign hematology encompasses a large number of inherited and acquired blood diseases. A variety of nonmalignant (i.e., benign or noncancerous) blood disorders require specialty care. Benign blood disorders include the following:
- Anemia (too few red blood cells)
- Neutropenia (too few bacteria-fighting white cells)
- Neutrophilia (too many bacteria-fighting white blood cells)
- Thrombocytopenia (too few platelets)
- Bone marrow failure syndromes (aplastic anemia and others)
- Hypercoagulability (propensity to have blood clots)
- Bleeding disorders (hemophilia, Von Willebrand disease and others)
Many blood disorders are relatively mild, but some are challenging conditions. All require accurate diagnosis and careful management. The physicians of Shenandoah Oncology have expertise in the care and treatment of people with benign hematologic diseases. Their advanced training translates into effective treatment of bleeding disorders, clotting disorders, and other hematologic problems as well as the unique challenges these disorders present. Staff members also have expertise in the laboratory science that is critical to blood disease diagnosis and treatment planning.
You may find it difficult to maintain healthy eating habits as you receive cancer treatments, especially if you experience loss of appetite, depression, anxiety, emotional stress, or chemical changes caused by your cancer.
The food you eat can provide your body with nutrients necessary for cellular growth, repair and maintenance. You can also prevent weight loss and malnutrition by eating the right amounts of food rich in calories, protein, vitamins, and minerals.
Winchester Medical Center Nutrition Staff can provide you with personal nutrition solutions and menu ideas to prevent additional illnesses and facilitate recovery from your disease. In addition, your doctor can discuss medicines and other strategies to improve or maintain appetite. You may also find one of the following links helpful:
- American Cancer Society Nutrition for Cancer Patients
- American Cancer Society Dietitian On-Call - 1.888.227.6333
- National Cancer Institute Eating Hints for Cancer Patients
- American Institute for Cancer Research e-Recipe Newsletter
- Natural Standard
Please note that the information available through these links is not provided by Shenandoah Oncology, nor do we necessarily endorse this information. All information provided through these links is for your reference only and does not constitute medical advice. Please consult your physician before acting or relying upon such information.
The National Cancer Institute defines a Tumor Board as a treatment planning approach in which a number of doctors who are experts in different specialties review and discuss the medical condition and treatment options of a patient. In a typical Tumor Board meeting, experts in diagnostic radiology and pathology will present and demonstrate the essential findings on biopsies and imaging studies (CT, MRI, PET scans, etc) while one of the patient’s physicians will describe the history and other pertinent findings in the case. Treatment discussions are led by medical oncologists (doctors who provide cancer treatment with drugs), surgical oncologists and specialists, and radiation oncologists. The ultimate goal of the Tumor Board is to review and discuss a patient's medical condition and to identify the best possible treatment plans available.
Each week, Shenandoah Oncology actively participates in Winchester Medical Center Tumor Board meetings, during which local clinicians discuss most new or complex cancer cases seen at our center. Our Tumor Board provides multidisciplinary care perspectives for patients with an emphasis on new developments in treatment and participation in clinical trials. They also provide a forum to educate physicians, residents, nurses and other healthcare providers and to share relevant research findings.
During Tumor Boards, facts about your case may be presented, most often by your oncologist or surgeon, and are discussed in the strictest confidence and for your benefit.
We pride ourselves on being able to provide or procure all of the medications you need to fight your cancer, whether these are used for in-office infusion or for orally administered medicines at home. We also carry many of the commonly prescribed medications used to prevent and relieve side effects and other complications of your treatment. Delivering individualized comprehensive pharmacy services is important to us. Our pharmacy technicians and nurses will work closely with your oncologist to provide you the prescriptions you need.
We work with your insurance company and also help find copay assistance so that you can focus on what matters most - your treatment.
What is palliative care?
Palliative care is care that is provided to improve the quality of life for patients who have a serious illness, such as cancer. It not only provides care to patients, but also to their families. It is a holistic approach to address symptom assessment and management that may include pain, shortness of breath, nausea, vomiting, constipation, fatigue, difficulty sleeping, and loss of appetite. Palliative care works to facilitate communication among patient, families, and providers while assisting with decision-making and establishing goals of care. In addition, it aims to relieve stress and worry by addressing the emotional, spiritual, and practical needs of both patient and family.
Who can receive it?
Essentially, any patient with cancer can receive palliative care. Palliative care should begin at diagnosis and continue through treatment, after treatment, and end of life.
Can I still receive cancer treatment?
Palliative care does not replace your cancer treatment. You may continue to follow with your regular physician and healthcare team while receiving palliative care. However, if there comes a time when further treatment is not warranted, then palliative care becomes the focus of care to alleviate any symptoms and emotional distress from cancer.
What issues are addressed?
Physical. Common symptoms that you may experience are pain, loss of appetite, fatigue, nausea, vomiting, constipation, shortness of breath, and insomnia. These symptoms may be relieved with medications, physical therapy, deep breathing techniques, and nutrition therapy. Radiation therapy, chemotherapy, and surgery may also relieve pain due to tumor.
Emotional. Patients and families can experience a multitude of emotions that may develop with a cancer diagnosis and treatment. Some emotional changes that you or your family members may experience are fear, anger, depression, grief, anxiety, disbelief, and relief. The palliative care team can provide counseling, hold family meetings, and refer to support groups or mental health professionals.
Practical. Many questions and concerns regarding financial and legal issues arise from cancer patients. The palliative care team can assist with coordination of care by directing families to appropriate resources for financial counseling or identifying local resources. Advanced Care Planning is a very important aspect of your care since it allows you to identify your values and quality of life with those closest to you. It allows you to state your wishes and values and decide who in your life you wish to speak for you if you are unable to speak for yourself.
Spiritual. With a cancer diagnosis, some patients grow stronger in their faith, while others begin to question their faith. The palliative care team can assist with helping you explore your beliefs and values so that you are able to have a sense of peace with your situation.
Where can I receive palliative care?
Your oncologist will provide much, and sometimes all, of your palliative care in the normal course of your treatment and disease management. However, if specialized palliative care is indicated or desired, we can refer you to an outside palliative care provider.
Will insurance cover palliative care?
Medicare, Medicaid, and private insurers typically cover palliative care services.
What other resources are available?
Cancer is not a solo experience. If you or a loved one has cancer, there are places in our community to turn to for additional help. No one understands what you're going through better than cancer survivors and the care givers who help patients every day. Consider a support group or other organized support program to answer questions and concerns you might have. More information can be found in our Patient Support Groups.
Before beginning your radiation therapy treatments you may attend a radiation therapy orientation class. This class is designed to teach you more about your radiation treatments. The class will discuss what will happen in your initial visits within the radiation clinic including your simulation, planning and first treatment visits.
You will also be introduced to your oncology care team within the radiation clinic. Upon completion of the class there will be a tour of the department so that you can become more comfortable with the simulator and marking rooms as well as the treatment rooms.
The classes are currently offered weekly on Thursday at 12:45. Please speak with one of our radiation staff regarding scheduling of your new patient class.
Before beginning your chemotherapy treatments you may attend a chemotherapy orientation class. These classes are general teaching sessions that are designed to help patients and support persons learn about chemotherapy treatment and how to manage potential side effects associated with chemotherapy treatment. The class will also provide you with handouts, resources and contact information should you have any questions or concerns during your chemotherapy treatment course. Topics that will be covered in class include:
- Preparing for your treatment day
- Blood counts
- Signs and symptoms of infection
- Appetite changes
- Nutrition during treatment
- Nausea management
- Management of mouth and throat symptoms
- Management of constipation or diarrhea
- Hair loss
- Skin and nail changes
We offer new patients the opportunity to attend orientation classes prior to starting chemotherapy or radiation therapy. Theses classes provide an introduction to your treatment team and an overview of the treatment process. You will also receive materials that can serve as a resource for you as you proceed through your treatments. Please click on the links for the chemotherapy or the radiation therapy new patient classes for more information.
Local Supportive Care Services
Shenandoah Oncology has collaborated with Valley Health System to create an array of local support services for our oncology patients and their families. These services include:
- Wellspring: This service offers products to help manage physical and emotional side effects as well as support services to address patient needs during their treatment and recovery.
- Patient Navigator: A Patient navigator is available to meet with cancer patients to provide information to help them navigate the complex decision making required following a cancer diagnosis. The navigator also provides short term distress counseling as needed and can make patient referrals to community services.
- Specialist in Oncology Nutrition: A certified, registered dietitian is available to provide nutritional counseling for cancer patients as they are going through their treatment and recovery. The dietitian also teaches interactive nutrition classes throughout the year.
- Genetic Counseling: This collaborative service is provided in conjunction with Virginia Commonwealth University to help individuals determine their cancer risk.
- Cancer Survivorship/Rehabilitation Program: Cancer patients referred to our STAR Program work with specially trained occupational, physical and speech therapists to address the unique health and quality of life issues of people undergoing treatment or living with side effects of their cancer therapy.
- Integrative Care Program: This serves as a complementary addition to health care utilizing integrative techniques to calm the senses. This includes Reiki therapy, Music Therapy, Art Therapy, Animal Assisted Therapy and Mindfulness-Based Stress Reduction.
Patient Support Groups
Cancer affects far more than the body: patients’ psychological and emotional health must also be considered. Cancer patients can be abruptly forced to face difficult medical decisions as well as both physical and emotional side effects of their treatment.
At Shenandoah Oncology, we focus on the entire person and we also consider the needs of your family members, caregivers and loved ones. We give patients access to numerous local and nationwide support programs that can provide information, guidance, and an unparalleled understanding of living with cancer.
The purpose of a support group is to help patients in similar situations share their experiences, get tips and ideas from others, and learn more about solving their cancer related problems. Support groups are available for patients with various types of cancer and are open to both patients and family members.
Many national cancer organizations offer support groups for patients and loved ones. The American Cancer Society offers the following programs in our community:
- Peer to Peer Recovery Coaching
- Look Good...Feel Better
- Reach to Recovery
- Road to Recovery
- Dietitian on Call
- Breast prostheses and accessories
National Patient Resource Links
The following links connect you with more information regarding the illness of cancer and are provided for the convenience of our patients. Please note that the information available through these links is not provided by Shenandoah Oncology, and while this listing does not constitute an endorsement of the sites by Shenandoah Oncology, we do find them to be useful sources of information.
No website should be a substitute for professional medical advice, diagnosis or treatment. You should always seek the advice of your physician or other healthcare professional for any questions regarding your medical condition.
- American Cancer Society
- American Society of Clinical Oncology
- Clinical Trials.Gov (Service of US National Institutes of Health)
- Leukemia and Lymphoma Society
- National Cancer Instititue (NCI)
- National Comprehensive Cancer Network (NCCN)
- Susan G Komen For The Cure
- US Oncology
Shenandoah Oncology participates with most major insurance carriers. As a courtesy, claims will be filed for you. In order to ensure reimbursement, your insurance information must be kept current. Please be sure to notify us if you have any change in coverage or insurance carrier.
Shenandoah Oncology is pleased to offer you secure online access to information about your diagnosis, medications, lab results and more.
To ensure your privacy and the security of your medical records, we are asking our patients to enroll while in our office.
- Visit our office and sign a waiver form giving us permission to provide you access to your health information via the internet.
- Receive an email (usually within 72 hours of visiting the clinic) and follow the instructions to create your online account.
- Keep your password and login information. If you have lost it, visit the site and use the “forgot password” or “forgot username” links to recover them.
Already a member?
You can access your account by visiting http://www.mycareplusonline.com
Still having trouble?
If you need assistance, please contact the MyCarePlus site administrator Monday through Friday from 7:00 AM - 9:00 PM (Eastern Standard Time) at 1-855-887-6788 (toll free).
A patient navigator serves as a guide to help you anticipate, address and overcome any challenges in the cancer treatment process, as well as coordinate services to improve the quality of care you'll receive.
All services provided by patient navigators are provided as free services by Winchester Medical Center. Visit their Patient Navigator website for contact information.
With the help of a patient navigator, you are:
- Guided through the treatment process
- Assisted in filling out insurance paperwork or finding transportation to medical appointments
- Helped to identify local resources
- Given ideas about communicating effectively with health care professionals
- Encouraged and emotionally supported
Some people are at higher risk of developing of cancer because they have an inherited genetic condition. Understanding your risk of developing cancer can be an important step in making decisions around cancer prevention or about getting regular screenings that can detect cancer early, when it is most treatable.
Shenandoah Oncology, through its joint affiliation with the Winchester Medical Center/VCU Massey Cancer Center’s Genetics Counseling Clinic, provides advanced testing and counseling services for people diagnosed with cancer, as well as those with a high risk of developing cancer. Through genetic testing and counseling, we can help you learn about your inherited risk of developing such cancers as breast, gastrointestinal, uterine/ovarian and others.
Although we cannot predict whether a patient will actually develop cancer, genetic testing is available to identify those at an increased risk due to hereditary predisposition. Patients with a gene mutation may be at higher risk of developing cancer. Genetic testing will allow the patient and their physician to make changes in medical management and surveillance. In addition, negative results on genetic testing may alleviate the need for increased surveillance for some patients.
Our physicians and VCU affiliated genetic counselors are trained to navigate the testing process for patients considering genetic testing. During the testing and counseling process, we offer support to patients and their families as they are often faced with difficult decisions regarding prevention and treatment options. Deciding whether or not to have genetic testing is a personal choice that can be made at the time of the initial counseling session or at a future date.
Together with the VCU genetic counselors, we will provide information and support to patients and their families in several ways:
- Education about how genetics plays a part in cancer risk
- Assessment of the risk of a genetic disorder by researching family history and evaluating medical records
- Discussion of the medical, social and ethical impact of genetic testing
- Interpretation of genetic testing results and medical data
- Explanation of possible treatments or preventive measures
Is genetic counseling/testing the right choice?
Genetic testing may be considered and recommended if patients’ personal and/or family history is consistent with a hereditary pattern of cancer.
Will I face discrimination if I am found to have a genetic predisposition to cancer?
Insurance discrimination concerns may also be addressed. HIPAA and GINA (Genetic Information Nondiscrimination Act of 2008) protect individuals from health insurance discrimination based on genetic test results. If genetic testing is pursued, the genetic counselor will also assist with requesting insurance coverage.
For direct information on the VCU/Massey Familial Cancer Clinic, click this link.
Laboratory testing is a key component of detection, diagnosis and treatment of cancer. Our in-house laboratory provides quick results for many routine tests, helping physicians prescribe the appropriate treatments as soon as possible. Testing that does require processing at an outside laboratory will be reviewed by our physicians as soon as the results are available.
After your lab results have been reviewed by the doctor, you can view the results online on our patient portal MyCarePlus.
In addition to the treatment options described elsewhere on in this website, we also offer a variety of complimentary services that allow us to provide our patients the best possible care. In this section, you can find more information about these services, including our advanced in-house laboratory and our in-office dispensary. Through our affiliation with Massey Cancer Center at VCU, we also offer patients expert genetic counseling and testing services. Through our affiliation with Valley Health System, we also offer patient navigator services and nutritional support. Finally, we have a weekly tumor board conference where we can present challenging cases in a multidisciplinary forum where we can get input from a variety of experts, allowing us to provide the best possible care to our patients.
For so many reasons, cancer patients can feel very vulnerable, so we believe strongly in protecting and improving cancer patients' rights. Here are some ways you can learn more about the legislative and congressional activities in progress to protect and increase cancer patients' rights.
Multiple organizations, including US Oncology, work closely with the state and federal governments to protect cancer care and increase patients' access to the highest quality of care.
Organizations that Support Patient Rights
400 Campus Blvd
Winchester, VA 22601
Phone: (540) 662-1108
Fax: (540) 667-3408
For emergencies, please dial 911.
To speak to the on call provider after hours, please call the main hospital number 540-536-8000 and press "0" to reach the hospital operator.
Interested in joining the Shenandoah Oncology team? A unique career opportunity awaits you! Click below to learn more about our current job openings.
Click here for Physician careers. You will be redirected to a secure website for USON.
Click here for Practice careers. You will be redirected to a secure website for USON.
Shenandoah Oncology’s staff works in an environment where new ideas, collaborative efforts, and quality performance are recognized and appreciated.
We offer competitive pay and a comprehensive benefit package that includes:
- Medical Insurance
- Dental Insurance
- Flexible Spending Accounts
- Paid Time Off
- Extended Illness Account
- 401K Profit Sharing Plan
- Tuition Reimbursement
- Company Paid Life Insurance
- Optional Additional Life Insurance
- Optional Dependent Life Insurance
- Company Paid Short and Long Term Disability
Shenandoah Oncology is an Equal Opportunity Employer.
Please join us in our mission to provide comprehensive and compassionate care to our patients.
In this section, you can download a form that you can to fax to us requesting that you get periodic e-mail updates regarding our research program.
In this section, you will find forms that will help our office coordinate the new patient referral process with you. We encourage you to make use of these forms to help expedite the referral process.
During your first visit, you will be asked to complete several forms. To save time, you're welcome to download, complete and bring them with you to your appointment.
If you would like more information about our clinical trials, you can discuss with your doctor or you can contact our research nurse Claudia Phillips at 540-662-1108.
If you are a referring physician and would like to periodically get updates on our clinical trials, you can sign up at www.shenandoahclinicaltrials.com, or you can print out our fax reply form and send to us.
ROZ E., 71 y.o., Arlington, VA, Metastatic Breast Cancer
When I was first diagnosed, my Arlington-based physician recommended a Shenandoah Oncology clinical drug trial which already had shown some very positive results. My only concerns were leaving my current physician AND the travel distance to Winchester. After meeting with the medical staff at Shenandoah Oncology and having the details of the trial explained, those concerns quickly evaporated. The drive to Winchester has become an easy routine that I almost look forward to (if doctor's appointments are something to look forward to). My physician and the staff at Shenandoah Oncology are just superb individuals and medical professionals. Being diagnosed with a terminal disease is daunting; however the care and understanding I have received at Shenandoah Oncology have almost made me forget the diagnosis. As for joining a clinical drug trial, it's simply the best decision I could have made. The bonus is being able to contribute to a process that could result in prolonging the lives of many others while I personally reap the benefits.
HERMAN G., MD, 75 y.o., Warren, PA, Chronic Lymphocytic Leukemia
In 2012 my chronic lymphocytic leukemia had progressed to the point that treatment was necessary. I accepted the recommendation of my hematologist that I take part in a nationwide multi-center clinical trial of one of the newer (not yet approved for general use) “targeted” therapies. Although Winchester, Virginia, is a 5 hour drive from my home, the Shenandoah Oncology group was the closest, so I signed up there. Fortunately, the treatment has been very successful. I can’t say enough about the skill, thoroughness and warmth of the care I received from Nicholas Gemma ,M.D., my oncologist, and the trial nurse coordinator Claudia Phillips, R.N. My wife and I feel very fortunate to have had my treatment and follow-ups here. Our thanks go to them and to their whole competent treatment team.
LORRAINE B., 84 y.o., Front Royal, VA, Lymphoma
I felt like if I could help in a research program that would help people in the future, then I would be glad to do it. Things went so well for me. I just don’t know how it could have been any better. I would like to compliment all the nurses and doctors because they always made me feel they had my best interests at heart.
MARY L., 74 y.o., Berryville, VA, Lymphoma
I had nothing to lose. I feel great . . . I’m glad I did the trial. The treatment’s done me good.
WAYNE W., 60 y.o., Winchester, VA, Multiple Myeloma
It’s like a big family to me here since I’ve been coming so long. I appreciate what you all are doing for me. I did the trial not only to help me but to help other people too.
Clinical trials are research studies conducted with people who volunteer to participate in the testing of new therapies. These studies can lead to the development of better therapies for cancer treatment.
Clinical trials are a critical component in expanding treatment options for people with all types of cancer. Because all new therapies must be evaluated through clinical trials, the greater the number of people who participate, the faster new anticancer therapies can be brought to patients. Clinical trials are also important because they offer hope to people with cancer by providing access to promising new therapies not yet available outside the study.
Clinical trials are designed by physicians and researchers and are conducted according to strict scientific and ethical principles. Before the study begins, a protocol is developed describing what will be done in the study, how it will be conducted and why each part of the study is necessary. This research protocol is reviewed by third party experts to make sure that study is conducted fairly and that patients are well-informed of their rights. Each study has eligibility criteria regarding who can or cannot participate in the study, which may include type of cancer, age, gender, medical history and current health status.
Patients considering participation in a clinical trial will receive important facts about the study’s purpose and what is involved, such as the tests and other procedures used, possible risks and benefits. Should a patient decide to participate, he or she will be asked to sign a written consent form that outlines the details of the study prior to beginning the trial. However, participation in the trial is completely voluntary and patients may stop at any time.
If you would like more information, you may speak to your physician about the available clinical trials or contact our research nurse Claudia Phillips at 540-662-1108.
Additional information on clinical trials can be found on the NCI website at www.cancer.gov/clinicaltrials.
At Shenandoah Oncology, research is an integral part of our comprehensive efforts to provide cancer patients in our community with access to the latest and most advanced therapies and treatment options. As a member of US Oncology Research and as a clinical research affiliate of VCU Massey Cancer Center, we are pleased to share this list of clinical trials currently enrolling at our practice.
BREAST CANCER – ADJUVANT
NSABP B-53 / S1207
Phase 3 study comparing standard adjuvant endocrine therapy to the combination of standard endocrine therapy plus everolimus in patients with high-risk hormone receptor positive and HER2 negative breast cancer. Studies show that the addition of everolimus to standard endocrine therapy can delay disease progression in metastatic disease, and the goal of this study is to establish if the combination of everolimus and standard endocrine therapy will increase the cure rate in the adjuvant setting.
Phase 3 study of adjuvant therapy comparing doxorubicin and cyclophosphamide followed by weekly paclitaxel with or without carboplatin for node-positive or high-risk node-negative triple negative invasive breast cancer.
Phase 3 randomized study of Pembrolizumab versus observation in patient with triple negative breast cancer who have ≥1cm residual disease or positive lymph nodes after neoadjuvant chemotherapy
BREAST CANCER – RECURRENT/ADVANCED
Phase 2 study assessing the tolerability of Palbociclib with Letrozole or Fulvestrant in patients aged 70 or older with hormone receptor positive and HER-2 negative metastatic breast cancer. Open label, single-arm study.
CHRONIC LYMPHOCYTIC LYMPHOMA
InformCLL: A disease registry for patients with chronic lymphocytic leukemia. The study will track current treatment patterns among CLL patients and explore the associations with baseline patient characteristics, healthcare resource utilization, and clinical outcomes.
LUNG CANCER, NON SMALL CELL
NONE AT THIS TIME
NONE AT THIS TIME
NONE AT PRESENT
NONE AT PRESENT
NONE AT PRESENT
NONE AT PRESENT
A prospective observational study to estimate the incidence of febrile neutropenia (FN) among subjects with non-myeloid malignancies at high risk for FN and receiving Neulasta onpro kit or other physicians choice for prophylaxis of FN.
Randomized phase 3 study evaluating the role of weight loss in adjuvant treatment of overweight or obese women with early HER-2 negative breast cancer.
About The US Oncology Network
Shenandoah Oncology is united in healing with The US Oncology Network, one of the nation's largest community-based cancer treatment and research networks focused on advancing cancer care in America. As an affiliate of The US Oncology Network, Shenandoah Oncology is united with approximately 1,000 physicians and 10,000 cancer professionals nationwide. Shenandoah Oncology participates in clinical trials through US Oncology Research, which has helped to develop 43 FDA approved cancer therapies. For more information, visit usoncology.com.
The US Oncology Network
The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians dedicated to advancing cancer care in America. Like-minded physicians are united through The Network around a common vision of expanding patient access to high-quality, integrated cancer care in communities throughout the nation. Leveraging healthcare information technology, shared best practices, refined evidence-based medicine guidelines, and quality measurements, physicians affiliated with The US Oncology Network are committed to advancing the quality, safety, and science of cancer care to improve patient outcomes. The US Oncology Network is supported by McKesson Specialty Health, a division of McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology and quality of care. For more information, visit usoncology.com.
Each year, the approximately 1,000 physicians in The Network touch the lives of more than 750,000 cancer patients in more than 350 sites of care and more than 80 integrated cancer centers throughout the United States.
Our pioneering, integrated approach to cancer care means that each patient’s cancer care team — medical oncologist, radiation oncologist and surgeon — collaborates to ensure delivery of high quality and advanced care to patients in the communities where they live.
US Oncology Research
Supported by McKesson Specialty Health and The US Oncology Network, US Oncology Research draws from a network of experienced investigators and dedicated clinical staff who specialize in Phase I through Phase IV oncology clinical trials. US Oncology Research serves more than 85 practices in more than 245 locations managing more than 200 active trials at any given time. Physicians in the research network have enrolled more than 52,000 patients in over 1,200 trials since inception in 1992 and have contributed to the development of 43 cancer therapies approved by the FDA.
The US Oncology Network believes that all cancer patients should have access to the care they need without the threat of severe financial hardship. Patients are offered dedicated support to help access reimbursement- assistance programs. Since the program began in 2006, more than 23,000 patients from across the country received more than $150 million in financial assistance for needed therapies. We work with federal, state and local legislators, as well as government and private payers to foster a greater understanding about oncology patient care and the vital role community oncology practices play in the lives of cancer patients and their families.
Integrated Cancer Care
The US Oncology Network’s pioneering, integrated approach to cancer care means that each patient’s cancer care team — medical oncologist, radiation oncologist and surgeon — collaborates to ensure delivery of high quality and advanced care to patients in the communities where they live.
Patients respond best to treatment when they receive integrated care close to home, relying on the support of family and friends and keeping their daily routines throughout the treatment process.
We are committed to giving patients access to high quality, advanced care close to home. Our more than 350 sites of care in The Network and more than 80 integrated cancer centers nationwide mean you can stay near your family and friends and keep your daily routine throughout your treatment process.
For more information, visit usoncology.com.
While a person experiences a variety of emotions, when a person first learns that he/she has cancer or a blood disorder/disease, the primary concern is survival. As treatment begins, however, new issues become important. Some of these include relationships with others, side effects from treatments, and nutrition and diet. Living with cancer or a blood disease/disorder is challenging, and it is best to be educated about issues surrounding survival in order to live a full and productive life.
Below are links to websites containing information for people living with cancer or a blood disorder/disease. The content provided through these links is not the information of Shenandoah Oncology nor does the practice necessarily endorse such content. In addition, all content provided through these links is for information only and does not constitute medical advice. Please consult your physician before acting or relying upon such information.
American College of Radiation Oncology (ACRO)
American Institute of Cancer Resarch
American Medical Association (AMA)
American Society of Hematology (ASH)
American Society for Therapeutic Radiology and Oncology (ASTRO)
American Society of Clinical Oncology (ASCO)
Association of Cancer Online Resources (ACOR)
Cancer News on the Net®
Cancer Research Institute (CRI)
Center Watch - Clinical Trials Listing Service
National Alliance for Caregiving (NAC)
National Comprehensive Cancer Network (NCCN)
National Institutes of Health (NIH)
National Library of Medicine (NLM)
OncoLink (University of Pennsylvania)
Oncology Nursing Society (ONS)
Society of Gynecologic Oncology
Susan G. Komen - Breast Cancer Foundation
U.S. Food and Drug Administration (FDA)
National Brain Tumor Society
Breast Cancer Network of Strength
(formerly Y-ME National Breast Cancer Organization)
Colon Cancer Alliance
National Lymphedema Network
Leukemia & Lymphoma Society
Lung Cancer Alliance
Lymphoma Research Foundation
Ovarian Cancer National Alliance
National Ovarian Cancer Coalition
Prostate Cancer Foundation
Skin Cancer Foundation
National Coalition for Cancer Survivorship
Cancer Survivors Network
National Cancer Survivor Day® Foundation, Inc.
National Patient Advocate Foundation (NPAF)
Patient Advocate Foundation
People Living With Cancer
Cancer Hope Network
Cancer Support Community
Lance Armstrong Foundation
Life Beyond Cancer Foundation
Life with Cancer
Look Good Feel Better
National Center for Complementary and Alternative Medicine
National Family Caregivers Association (NFCA)
People Living Through Cancer
The Wellness Community
Listed below are several common questions asked by patients and their family members. Click the question and the answer will appear. Or you can click "Expand All" and all of the answers will appear at once. If you have other questions, write them down for your next appointment or, if they're more urgent, please contact your physician's office and we'll be happy to assist you.
Advancing Cancer Care through Clinical Trials
Today, clinical trial research is no longer conducted exclusively at large university cancer centers or major metropolitan hospitals. Shenandoah Oncology has embraced clinical trial research as a critical component of community-based care for patients with cancer or blood disorders.
At Shenandoah Oncology we are dedicated to finding new and better ways to treat cancer through research and clinical trials. We have access to clinical trials through our affiliation with US Oncology Research and as a clinical research affiliate of Virginia Commonwealth University.
Participating in these clinical trials also allows us to provide valuable access to new investigational cancer agents to patients right here in their community. Our patients are able to access state-of-the-art investigational therapies, while their own physician directs and closely monitors their care. Patients are able to remain at home near family and loved ones.
Furthermore, our research network is also looking toward the future by developing initiatives in “personalized” or “individualized” medicine. These types of clinical trials offer the potential to recommend drug treatment based on the genetic makeup of the patient's tumor.
50,000 Patients, One Goal
As a member of the US Oncology Research Network, Shenandoah Oncology is pleased to provide local patients access to cutting-edge and innovative clinical trials in a comfortable and convenient setting. US Oncology Research, supported by McKesson Specialty Health, recently announced that it has surpassed the 50,000 milestone for number of patients enrolled in its clinical trials program. One of the largest and most reputable community-based research networks in the world, US Oncology Research specializes in Phase I–IV oncology clinical trials and has participated in over 1,200 investigator-initiated and sponsor-initiated trials since its inception, and was pivotally involved in the development and approval of over 40 innovative cancer treatments in the last decade.
In addition, Shenandoah Oncology is a proud clinical research affiliate of Virginia Commonwealth University's Massey Cancer Center, and this program allows us to offer additional innovative therapies and clinical trials to our patients to help advance the science of cancer care while offering the best possible treatments and improved patient outcomes. If you would like more information, you may speak to your physician or our research department about the open clinical trials.
Targeted therapies are drugs or other agents that block the growth and spread of cancer by interfering with specific genes or molecules involved in tumor growth and progression.
Genomic sequencing refers to the analysis of the DNA “blueprint” within a specific individual’s cancer, seeking clues as to what is driving the malignancy at its most basic and fundamental level. Because scientists often refer to these as “molecular targets," such cancer treatments are sometimes referred to as “molecularly targeted drugs/therapies.” By focusing on molecular and cellular changes that are unique to each cancer, targeted cancer therapies are often less harmful to normal cells and more effective against the cancer than other types of treatment.
Our physicians routinely test for specific mutations and other traits unique to your cancer that can reveal the best treatment options for you. However, targeted therapy is not an option every patient or every type of cancer or blood disease. However, increasing numbers of patients are benefiting from these powerful tools through clinical trial participation or as these agents become available for general use.
The goal of radiation therapy is to get a high enough dose of radiation into the body to kill the cancer cells while sparing the surrounding healthy tissue from damage. Several different radiation therapy techniques have been developed to accomplish this. Depending on the location, size and type of your tumor or tumors, you may receive one or a combination of these techniques. Your radiation oncologist and treatment team will work with you to determine which treatment and how much radiation is best for you.
During external beam radiation therapy, a beam of radiation is directed through the skin to a tumor and the immediate surrounding area in order to destroy the main tumor and any nearby cancer cells. To minimize side effects, the treatments are typically given every day for a number of weeks. The radiation beam comes from a machine located outside of your body that does not touch your skin or the tumor. Receiving external beam radiation is similar to having an X-ray taken. It is a painless, bloodless procedure.
The most common type of machine used to deliver external beam radiation therapy is called a linear accelerator, sometimes called a “linac.” It produces a beam of high-energy X-rays or electrons. Using sophisticated treatment planning software, your radiation oncology treatment team plans the size and shape of the beam, as well as how it is directed at your body, to effectively treat your tumor while sparing the normal tissue surrounding the cancer cells.
Several special types of radiation therapy are discussed below. These are used for particular types of cancer, and your radiation oncologist will recommend one of these treatments if he or she believes it will help you.
Image Guided Radiation Therapy (IGRT): The use of various imaging technologies located on the treatment machine (known as on-board imaging), including x-rays and CT scans, to precisely localize the tumor being treated. This results in more accurate, less toxic treatment, especially for tumors located near sensitive structures.
Intensity Modulated Radiation Therapy (IMRT): An advanced treatment technology using multiple small beams which change shape during treatment. This allows the treated area to conform more accurately to the shape of the tumor, resulting in more intense radiation of the tumor while giving less radiation to surrounding normal tissues.
Stereotactic Radiotherapy: The use of numerous precisely focused radiation beams combined with advanced imaging technology to deliver highly localized radiation with millimeter accuracy. This technique is most commonly used to treat small tumors in the brain and lung. Related terms include stereotactic radiosurgery (for tumors located in the brain) and stereotactic body radiotherapy (for tumors located in other parts of the body).
Prostate Seed Implants/Brachytherapy: A procedure where multiple small radioactive seeds are placed into the prostate gland, generally in the operating room under general anesthesia using direct ultrasound guidance. This provides a highly localized dose of radiation to the prostate.
Hormones are naturally occurring substances in the body that can stimulate or modulate the growth of hormone sensitive tissues, such as the breast or prostate gland. When cancer arises in certain tissues such as breast or prostate tissue, its growth and spread may be caused by the body's own hormones. Therefore, drugs that block hormone production or change the way hormones work are often very effective and tolerable ways of treating cancer. Hormone therapy, similar to chemotherapy, is a systemic treatment in that it is designed to affect cancer cells throughout the body.
Chemotherapy is a group of medicines used to treat cancer. While surgery and radiation therapy target specific areas of cancer, chemotherapy works throughout the body and can destroy cancer cells that have spread (metastasized) from the original tumor site.
How does chemotherapy work?
Chemotherapy destroys cancer cells. Some cancer cells grow slowly; others, rapidly. As a result, different types of chemotherapy drugs are designed to target the growth patterns of specific types of cancer cells. Each drug has a different way of working and is effective at a specific time in the life cycle of the targeted cells. Your doctor will develop a treatment plan specifically for you, based on your type of cancer, its stage of advancement, and your overall health. Depending on your individual condition, your chemotherapy may be designed to achieve one or more of the three goals: cure, remission, or controlling and/or relieving symptoms.
How is chemotherapy administered?
Your doctor will choose the method that will be most effective against your particular type of cancer and cause the fewest side effects. You may receive chemotherapy drugs in one or more of the following ways:
- Shot (injections)
- IV (intravenous or dripping medicine through a tube into the vein)
- Pill (oral medication)
What is the frequency of chemotherapy treatments?
How often you take chemotherapy depends on the type of cancer and which drug or combination of drugs you receive. Different drugs work at varying times in the cancer cell growth process. Your physicians will take all of these factors into consideration as they develop your treatment schedule. Chemotherapy is usually structured in cycles with rest periods between, and generally, treatments are given daily, weekly or monthly.
What are the possible side effects of chemotherapy?
Chemotherapy works by destroying cancer cells. Unfortunately, it does not exclusively target a cancer cell over a healthy cell. Therefore, it can cause side effects. Among the most common are nausea, vomiting, hair loss, fatigue and low blood counts. Some side effects may be temporary and merely annoying. Others, however, can be life-threatening. Be sure to tell you doctor of any side effects you experience. In most cases, your doctor can help you successfully manage side effects throughout your treatment cycles.
How do I know my chemotherapy is working?
Each person responds differently to treatment. Your doctor will closely monitor and measure your progress. Because some people experience side effects associated with their treatment and others have none, the presence or absence of side effects is not a reliable means of measuring the effectiveness of chemotherapy.
Biological and Immunotherapies involve the use of treatments that either interrupt vital processes that cancer cells need to survive and spread, or promote and support the body’s immune system response to cancer. Examples include monoclonal antibodies, interferons, angiogenesis inhibitors, and tumor vaccines.
Questions to ask about chemotherapy/Biotherapy:
- Why is chemotherapy/biotherapy the best option for me?
- What specific type of drugs/medicines are you recommending?
- What is the goal of this treatment?
- Can the treatment ease my symptoms?
- What side effects might I expect, and what can I do to manage them?
- How often will I receive treatment and how long will my treatments last?
- What restrictions (dietary, working, exercising) will I have during my treatment?
- When will I be able to return to my normal activities?
- What experiences have other patients had with similar chemotherapy/biotherapy regimens?
You will have the opportunity to ask questions during your one-on-one visit with a clinician who will review your individual chemotherapy treatment plan prior to your first chemotherapy infusion.
Cancer Treatment Classes
Our nurses and staff are here to provide you and your family with support during this time as you work together with your physician and health care team.
Our Certified Oncology Nurses hold regular Chemotherapy Classes during which common reactions and their remedies are discussed, as well as useful tips on diet, cosmetic and hygienic products, and lifestyle choices that can affect your treatment and its side effects. We strongly encourage you to attend one of these sessions, preferably before you receive treatment. The scheduling desk will gladly assist you with signing up for one of these educational sessions.
In this section you will find information about the different treatments that we offer. We offer advanced care in a variety of forms, including the latest chemotherapy agents, novel targeted therapies, and state-of-the-art radiation treatment. We also have an active clinical research program that offers patients the opportunity to participate in cutting-edge clinical trials. Additionally, we offer compassionate and effective palliative care to manage our patients symptoms throughout their treatment course.
Radiation Oncologists are specialized physicians highly trained in the use of radiation techniques in the treatment of cancer. Radiation is sometimes used as the sole therapy to treat or cure certain types of cancers, and at other times it is combined with chemotherapy and/or surgery. When indicated, your radiation oncologist will assist in forming a multidisciplinary approach to your cancer by working in concert with medical and surgical oncologists, often in the form of a formal presentation of your case at our Tumor Board.
Sources of therapeutic radiation can be from external beams that send penetrating radiation beams into your body to reach the site (or target) of the cancer, or the radiation may be directly applied through an appliance placed within a body cavity or implanted in the form of radioactive seeds. Our radiation oncologists have access to the latest equipment and technologies in order to provide you with the safest and most effective means of radiotherapy treatments.
Blood disorders are a vast and complex array of benign and malignant conditions. It can be challenging to determine if a blood disorder is a benign or self-limited process, or whether it represents an underlying malignancy such as leukemia or lymphoma. Our board-certified medical oncologist/hematologists have advanced training to care for the entire spectrum of blood disorders. Examples of blood diseases we frequently manage include anemias, white blood cell disorders, platelet and clotting disorders, as well as leukemia, myeloma and lymphoma.
Our Medical Oncologists have advanced training in Internal Medicine and are all board certified in Medical Oncology. They are uniquely qualified to not only provide expert management and treatment of the full range of malignancies, but are also fully capable of managing the many complications that can occur in the course of a cancer or its treatment.
Medical oncologists use chemotherapy drugs, biologic agents, and targeted therapies in the treatment of cancer. These treatments can be the sole treatment of a malignancy, or can be combined with radiation therapy and/or surgical treatment. Such multidisciplinary treatments frequently arise from a formal presentation of your case at our Tumor Board. Sometimes your oncologist may conclude that an emerging or novel treatment is your best option, and participation in a Clinical Trial may be recommended.
Medical oncologists also provide in-patient medical care when patients require hospitalization, either as the attending physician or as a consultant in concert with your primary care physician or hospitalist.
If a patient chooses not to receive treatment, or has a condition for which all useful options have been exhausted, medical oncologists also provide out-patient and in-patient palliative and comfort care, and we cooperate with and help supervise the care from all local hospice organizations.
In this section you will find information about the different specialties that make up our practice. These specialties include medical oncology, hematology and radiation oncology. Each of these areas of expertise play an important role in offering comprehensive care to our patients. All of our physicians are highly trained in their respective specialties and are able to offer you state-of-the art treatment in their areas of expertise.
The financial aspect of dealing with cancer can be complex and overwhelming. Shenandoah Oncology has a team of dedicated Patient Financial Counselors who are an extension of our central business office and provide guidance on financial issues. They are available to address patients’ questions and concerns about the cost of treatment and can help handle insurance inquiries and verifications. For patients whose insurance coverage is inadequate, or if the insurance company chooses not to cover services, our Patient Financial Counselors can help identify assistance programs that may help in meeting financial obligations.
As a courtesy to patients, our business office bills all primary and secondary insurances as Shenandoah Oncology participates with most insurance companies. Shenandoah Oncology has a team of insurance specialists for billing and claims processing concerns. In order to ensure reimbursement, your insurance information must be kept current. Please be sure to notify us if you have any change in coverage or insurance carrier.
We strive to process requests for prescription refills as quickly as possible. The simplest and most efficient way to refill a prescription is to call your pharmacy and request a prescription refill. If you have further questions, please call our office during normal business hours 8:15am - 4:30pm. Calls received after 4:30pm will be handled the next business day. Prescriptions will be filled as quickly as possible but may take up to 48 hours.
When requesting a prescription refill, please provide the following information:
- Patient's name and date of birth
- Pharmacy name and phone number
During evenings, weekends, and holidays, the doctor on call does not have immediate access to patients’ records. It will be at the discretion of the on-call physician to refill prescription medications after normal business hours. This is for your protection; we must to be able to have access to your most up-to-date and complete medical records to ensure you receive appropriate medications for your medical conditions.
If you are experiencing a medical emergency, please dial 911.
Non-Urgent Medical Questions
Our triage nurse can assist patients with questions and issues relating to cancer, medication(s) and treatment side effects during our normal office hours.
Shenandoah Oncology- (540) 662-1108
Page On-Call Provider
For assistance after hours, over the weekend and during holidays, please call the hospital operator at the number below and ask them to page our on call healthcare provider.
Valley Health System Operator- (540) 536-8000
Listed below are several common questions asked by patients and their family members. Click the question and the answer will appear. Or you can click "Expand All" and all of the answers will appear at once. If you have other questions, write them down for your next appointment or, if they're more urgent, please contact us and we'll be happy to assist you.
For your first appointment you will need to bring the following:
- A list of all prescription medications you are taking, or all of your prescription medications in a bag to show to your physician.
- A list of all dietary supplements you are taking, or all of your dietary supplements in a bag to show your physician.
- Your completed medical history form, to discuss with your physician.
- A list of any allergies.
- Your insurance and prescription cards
Our office will attempt to obtain your medical records from your referring physician; however, we may contact you if we need your assistance. You can click here to see the types of records that we request from your referring physician.
Shenandoah Oncology utilizes an automated appointment reminder system that will call two business days before your appointment to confirm the time of your appointment. If you are unable to keep a scheduled appointment, please call the office as soon as possible to reschedule.
Thank you for choosing Shenandoah Oncology for your care and we look forward to meeting and serving you.
As a new patient at Shenandoah Oncology, we want you to feel comfortable, cared for and informed. Prior to your first visit to reduce your wait time, we ask that you print and complete our new patient forms in their entirety, then bring them to your first appointment.
We recommend if possible that you bring another person with you to your first appointment, which may last one hour or more.
Your first appointment may include the following:
- New patient evaluation with your physician
- Any additional lab tests needed for accurate diagnosis to help guide your treatment
- Meeting the nurses, medical assistants, and other members of your healthcare team
- Meeting with a patient benefit representative to discuss your insurance benefits
People with multiple myeloma have many treatment options. The options are watchful waiting, induction therapy, and stem cell transplant. Sometimes a combination of methods is used.
Radiation therapy is used sometimes to treat painful bone disease. It may be used alone or along with other therapies. See the Supportive Care section to learn about ways to relieve pain.
The choice of treatment depends mainly on how advanced the disease is and whether you have symptoms. If you have multiple myeloma without symptoms (smoldering myeloma), you may not need cancer treatment right away. The doctor monitors your health closely (watchful waiting) so that treatment can start when you begin to have symptoms.
If you have symptoms, you will likely get induction therapy. Sometimes a stem cell transplant is part of the treatment plan.
When treatment for myeloma is needed, it can often control the disease and its symptoms. People may receive therapy to help keep the cancer in remission, but myeloma can seldom be cured. Because standard treatment may not control myeloma, you may want to talk to your doctor about taking part in a clinical trial. Clinical trials are research studies of new treatment methods.
People with smoldering myeloma or Stage I myeloma may be able to put off having cancer treatment. By delaying treatment, you can avoid the side effects of treatment until you have symptoms.
If you and your doctor agree that watchful waiting is a good idea, you will have regular checkups (such as every 3 months). You will receive treatment if symptoms occur.
Although watchful waiting avoids or delays the side effects of cancer treatment, this choice has risks. In some cases, it may reduce the chance to control myeloma before it gets worse.
You may decide against watchful waiting if you don’t want to live with untreated myeloma. If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option in most cases.
Many different types of drugs are used to treat myeloma. People often receive a combination of drugs, and many different combinations are used to treat myeloma.
Each type of drug kills cancer cells in a different way:
- Chemotherapy: Chemotherapy kills fast-growing myeloma cells, but the drug can also harm normal cells that divide rapidly.
- Targeted therapy: Targeted therapies use drugs that block the growth of myeloma cells. The targeted therapy blocks the action of an abnormal protein that stimulates the growth of myeloma cells.
- Steroids: Some steroids have antitumor effects. It is thought that steroids can trigger the death of myeloma cells. A steroid may be used alone or with other drugs to treat myeloma.
You may receive the drugs by mouth or through a vein (IV). The treatment usually takes place in an outpatient part of the hospital, at your doctor’s office, or at home. Some people may need to stay in the hospital for treatment.
Stem Cell Transplant
Many people with multiple myeloma may get a stem cell transplant. A stem cell transplant allows you to be treated with high doses of drugs. The high doses destroy both myeloma cells and normal blood cells in the bone marrow. After you receive high-dose treatment, you receive healthy stem cells through a vein. (It’s like getting a blood transfusion.) New blood cells develop from the transplanted stem cells. The new blood cells replace the ones that were destroyed by treatment.
Stem cell transplants take place in the hospital. Some people with myeloma have two or more transplants.
Stem cells may come from you or from someone who donates their stem cells to you:
- From you: An autologous stem cell transplant uses your own stem cells. Before you get the high-dose chemotherapy, your stem cells are removed. The cells may be treated to kill any myeloma cells present. Your stem cells are frozen and stored. After you receive high-dose chemotherapy, the stored stem cells are thawed and returned to you.
- From a family member or other donor: An allogeneic stem cell transplant uses healthy stem cells from a donor. Your brother, sister, or parent may be the donor. Sometimes the stem cells come from a donor who isn’t related. Doctors use blood tests to be sure the donor’s cells match your cells. Allogeneic stem cell transplants are under study for the treatment of multiple myeloma.
- From your identical twin: If you have an identical twin, a syngeneic stem cell transplant uses stem cells from your healthy twin.
There are two ways to get stem cells for people with myeloma. They usually come from the blood (peripheral blood stem cell transplant). Or they can come from the bone marrow (bone marrow transplant).
After a stem cell transplant, you may stay in the hospital for several weeks or months. You’ll be at risk for infections because of the large doses of chemotherapy you received. In time, the transplanted stem cells will begin to produce healthy blood cells.
If the biopsy shows that you have multiple myeloma, your doctor needs to learn the extent (stage) of the disease to plan the best treatment. Staging may involve having more tests:
- Blood tests: For staging, the doctor considers the results of blood tests, including albumin and beta-2-microglobulin.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your bones.
- MRI: A powerful magnet linked to a computer is used to make detailed pictures of your bones.
Doctors may describe multiple myeloma as:
- Stage I
- Stage II
- Stage III
The stage takes into account whether the cancer is causing problems with your bones or kidneys. Smoldering multiple myeloma is early disease without any symptoms. For example, there is no bone damage. Early disease with symptoms (such as bone damage) is Stage I. Stage II or III is more advanced, and more myeloma cells are found in the body.
Doctors sometimes find multiple myeloma after a routine blood test. More often, doctors suspect multiple myeloma after an x-ray for a broken bone. Usually though, patients go to the doctor because they are having other symptoms.
To find out whether such problems are from multiple myeloma or some other condition, your doctor may ask about your personal and family medical history and do a physical exam. Your doctor also may order some of the following tests:
Blood tests: The lab does several blood tests:
- Multiple myeloma causes high levels of proteins in the blood. The lab checks the levels of many different proteins, including M protein and other immunoglobulins (antibodies), albumin, and beta-2-microglobulin.
- Myeloma may also cause anemia and low levels of white blood cells and platelets. The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets.
- The lab also checks for high levels of calcium.
- To see how well the kidneys are working, the lab tests for creatinine.
- Urine tests: The lab checks for Bence Jones protein, a type of M protein, in urine. The lab measures the amount of Bence Jones protein in urine collected over a 24-hour period. If the lab finds a high level of Bence Jones protein in your urine sample, doctors will monitor your kidneys. Bence Jones protein can clog the kidneys and damage them.
- X-rays: You may have x-rays to check for broken or thinning bones.An x-ray of your whole body can be done to see how many bones could be damaged by the myeloma.
- Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether myeloma cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hip bone or another large bone. A pathologist uses a microscope to check the tissue for myeloma cells.
There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:
- Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
- Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.
Myeloma begins when a plasma cell becomes abnormal. The abnormal cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. These abnormal plasma cells are called myeloma cells.
In time, myeloma cells collect in the bone marrow. They may damage the solid part of the bone. When myeloma cells collect in several of your bones, the disease is called “multiple myeloma.” This disease may also harm other tissues and organs, such as the kidneys.
Myeloma cells make antibodies called M proteins and other proteins. These proteins can collect in the blood, urine, and organs.
Visit the National Cancer Institute where this information and more can be found about Multiple Myeloma or ask your cancer care team questions about your individual situation.
Your doctor can describe your treatment choices and the expected results. You and your doctor can work together to develop a treatment plan that meets your needs.
Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat Hodgkin lymphoma include hematologists, medical oncologists, and radiation oncologists . Your doctor may suggest that you choose an oncologist who specializes in the treatment of Hodgkin lymphoma. Often, such doctors are associated with major academic centers. Your health care team may also include an oncology nurse and a registered dietitian.
The choice of treatment depends mainly on the following:
- The type of your Hodgkin lymphoma (most people have classical Hodgkin lymphoma)
- Its stage (where the lymphoma is found)
- Whether you have a tumor that is more than 4 inches (10 centimeters) wide
- Your age
- Whether you’ve had weight loss, drenching night sweats, or fevers.
People with Hodgkin lymphoma may be treated with chemotherapy, radiation therapy, or both.
If Hodgkin lymphoma comes back after treatment, doctors call this a relapse or recurrence. People with Hodgkin lymphoma that comes back after treatment may receive high doses of chemotherapy, radiation therapy, or both, followed by stem cell transplantation.
Chemotherapy for Hodgkin lymphoma uses drugs to kill lymphoma cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach lymphoma cells in almost all parts of the body.
Usually, more than one drug is given. Most drugs for Hodgkin lymphoma are given through a vein (intravenous), but some are taken by mouth.
Chemotherapy is given in cycles. You have a treatment period followed by a rest period. The length of the rest period and the number of treatment cycles depend on the stage of your disease and on the anticancer drugs used.
You may have your treatment in a clinic, at the doctor’s office, or at home. Some people may need to stay in the hospital for treatment.
Radiation therapy (also called radiotherapy) for Hodgkin lymphoma uses high-energy rays to kill lymphoma cells. It can shrink tumors and help control pain.
A large machine aims the rays at the lymph node areas affected by lymphoma. This is local therapy because it affects cells in the treated area only. Most people go to a hospital or clinic for treatment 5 days a week for several weeks.
Stem Cell Transplantation
If Hodgkin lymphoma returns after treatment, you may receive stem cell transplantation. A transplant of your own blood-forming stem cells (autologous stem cell transplantation) allows you to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both Hodgkin lymphoma cells and healthy blood cells in the bone marrow.
Stem cell transplants take place in the hospital. Before you receive high-dose treatment, your stem cells are removed and may be treated to kill lymphoma cells that may be present. Your stem cells are frozen and stored. After you receive high-dose treatment to kill Hodgkin lymphoma cells, your stored stem cells are thawed and given back to you through a flexible tube placed in a large vein in your neck or chest area. New blood cells develop from the transplanted stem cells.
The doctor considers the following to determine the stage of Hodgkin lymphoma:
- The number of lymph nodes that have Hodgkin lymphoma cells
- Whether these lymph nodes are on one or both sides of the diaphragm (see picture)
- Whether the disease has spread to the bone marrow, spleen, liver, or lung.
The stages of Hodgkin lymphoma are as follows:
- Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the lymphoma cells are not in the lymph nodes, they are in only one part of a tissue or an organ
- Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or, the lymphoma cells are in one part of a tissue or an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.
- Stage III: The lymphoma cells are in lymph nodes above and below the diaphragm. Lymphoma also may be found in one part of a tissue or an organ (such as the liver, lung, or bone) near these lymph node groups. It may also be found in the spleen.
- Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues. Or, the lymphoma is in an organ (such as the liver, lung, or bone) and in distant lymph nodes.
- Recurrent: The disease returns after treatment.
In addition to these stage numbers, your doctor may also describe the stage as A or B:
- A: You have not had weight loss, drenching night sweats, or fevers.
- B: You have had weight loss, drenching night sweats, or fevers.
If you have swollen lymph nodes or another symptom that suggests Hodgkin lymphoma, your doctor will try to find out what’s causing the problem. Your doctor may ask about your personal and family medical history.
You may have some of the following exams and tests:
- Physical exam: Your doctor checks for swollen lymph nodes in your neck, underarms, and groin. Your doctor also checks for a swollen spleen or liver.
- Blood tests: The lab does a complete blood count to check the number of white blood cells and other cells and substances.
- Chest x-rays: X-ray pictures may show swollen lymph nodes or other signs of disease in your chest.
- Biopsy: A biopsy is the only sure way to diagnose Hodgkin lymphoma. Your doctor may remove an entire lymph node (excisional biopsy) or only part of a lymph node (incisional biopsy). A thin needle (fine needle aspiration) usually cannot remove a large enough sample for the pathologist to diagnose Hodgkin lymphoma. Removing an entire lymph node is best.
The pathologist uses a microscope to check the tissue for Hodgkin lymphoma cells. A person with Hodgkin lymphoma usually has large, abnormal cells known as Reed-Sternberg cells. They are not found in people with non-Hodgkin lymphoma. See the photo of a Reed-Sternberg cell.
Hodgkin lymphoma is a cancer that begins in cells of the immune system. The immune system fights infections and other diseases.
Hodgkin lymphoma can start almost anywhere. Usually, it's first found in a lymph node above the diaphragm, the thin muscle that separates the chest from the abdomen. But Hodgkin lymphoma also may be found in a group of lymph nodes. Sometimes it starts in other parts of the lymphatic system.
Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal. The abnormal cell is called a Reed-Sternberg cell. (See photo below.)
The Reed-Sternberg cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. The abnormal cells don't die when they should. They don't protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
Visit the National Cancer Institute where this information and more can be found about Hodgkin Lymphoma or ask your cancer care team questions about your individual situation.
Your doctor can describe your treatment choices and the expected results. You and your doctor can work together to develop a treatment plan that meets your needs.
Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat non-Hodgkin lymphoma include hematologists, medical oncologists, and radiation oncologists. Your doctor may suggest that you choose an oncologist who specializes in the treatment of lymphoma. Often, such doctors are associated with major academic centers. Your health care team may also include an oncology nurse and a registered dietitian.
The choice of treatment depends mainly on the following:
- The type of non-Hodgkin lymphoma (for example, follicular lymphoma)
- Its stage (where the lymphoma is found)
- How quickly the cancer is growing (whether it is indolent or aggressive lymphoma)
- Your age
- Whether you have other health problems
If you have indolent non-Hodgkin lymphoma without symptoms, you may not need treatment for the cancer right away. The doctor watches your health closely so that treatment can start when you begin to have symptoms. Not getting cancer treatment right away is called watchful waiting.
If you have indolent lymphoma with symptoms, you will probably receive chemotherapy and biological therapy. Radiation therapy may be used for people with Stage I or Stage II lymphoma.
If you have aggressive lymphoma, the treatment is usually chemotherapy and biological therapy. Radiation therapy also may be used.
If non-Hodgkin lymphoma comes back after treatment, doctors call this a relapse or recurrence. People with lymphoma that comes back after treatment may receive high doses of chemotherapy, radiation therapy, or both, followed by stem cell transplantation.
People who choose watchful waiting put off having cancer treatment until they have symptoms. Doctors sometimes suggest watchful waiting for people with indolent lymphoma. People with indolent lymphoma may not have problems that require cancer treatment for a long time. Sometimes the tumor may even shrink for a while without therapy. By putting off treatment, they can avoid the side effects of chemotherapy or radiation therapy.
If you and your doctor agree that watchful waiting is a good idea, the doctor will check you regularly (every 3 months). You will receive treatment if symptoms occur or get worse.
Some people do not choose watchful waiting because they don’t want to worry about having cancer that is not treated. Those who choose watchful waiting but later become worried should discuss their feelings with the doctor.
Chemotherapy for lymphoma uses drugs to kill lymphoma cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach lymphoma cells in almost all parts of the body.
You may receive chemotherapy by mouth, through a vein, or in the space around the spinal cord. Treatment is usually in an outpatient part of the hospital, at the doctor’s office, or at home. Some people need to stay in the hospital during treatment.
Chemotherapy is given in cycles. You have a treatment period followed by a rest period. The length of the rest period and the number of treatment cycles depend on the stage of your disease and on the anticancer drugs used.
If you have lymphoma in the stomach caused by H. pylori infection, your doctor may treat this lymphoma with antibiotics. After the drug cures the infection, the lymphoma also may go away.
People with certain types of non-Hodgkin lymphoma may have biological therapy. This type of treatment helps the immune system fight cancer.
Monoclonal antibodies are the type of biological therapy used for lymphoma. They are proteins made in the lab that can bind to cancer cells. They help the immune system kill lymphoma cells. People receive this treatment through a vein at the doctor’s office, clinic, or hospital.
Radiation therapy (also called radiotherapy) uses high-energy rays to kill lymphoma cells. It can shrink tumors and help control pain.
Two types of radiation therapy are used for people with lymphoma:
- External radiation: A large machine aims the rays at the part of the body where lymphoma cells have collected. This is local therapy because it affects cells in the treated area only. Most people go to a hospital or clinic for treatment 5 days a week for several weeks.
- Systemic radiation: Some people with lymphoma receive an injection of radioactive material that travels throughout the body. The radioactive material is bound to monoclonal antibodies that seek out lymphoma cells. The radiation destroys the lymphoma cells.
Stem Cell Transplantation
If lymphoma returns after treatment, you may receive stem cell transplantation. A transplant of your own blood-forming stem cells allows you to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both lymphoma cells and healthy blood cells in the bone marrow.
Stem cell transplants take place in the hospital. After you receive high-dose treatment, healthy blood-forming stem cells are given to you through a flexible tube placed in a large vein in your neck or chest area. New blood cells develop from the transplanted stem cells.
The stem cells may come from your own body or from a donor: :
- Autologous stem cell transplantation: This type of transplant uses your own stem cells. Your stem cells are removed before high-dose treatment. The cells may be treated to kill lymphoma cells that may be present. The stem cells are frozen and stored. After you receive high-dose treatment, the stored stem cells are thawed and returned to you.
- Allogeneic stem cell transplantation: Sometimes healthy stem cells from a donor are available. Your brother, sister, or parent may be the donor. Or the stem cells may come from an unrelated donor. Doctors use blood tests to be sure the donor’s cells match your cells.
- Syngeneic stem cell transplantation: This type of transplant uses stem cells from a patient’s healthy identical twin.
Your doctor needs to know the extent (stage) of non-Hodgkin lymphoma to plan the best treatment. Staging is a careful attempt to find out what parts of the body are affected by the disease.
Lymphoma usually starts in a lymph node. It can spread to nearly any other part of the body. For example, it can spread to the liver, lungs, bone, and bone marrow.
Staging may involve one or more of the following tests:
- Bone marrow biopsy: The doctor uses a thick needle to remove a small sample of bone and bone marrow from your hipbone or another large bone. Local anesthesia can help control pain. A pathologist looks for lymphoma cells in the sample.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your head, neck, chest, abdomen, or pelvis. You may receive an injection of contrast material. Also, you may be asked to drink another type of contrast material. The contrast material makes it easier for the doctor to see swollen lymph nodes and other abnormal areas on the x-ray.
- MRI: Your doctor may order MRI pictures of your spinal cord, bone marrow, or brain. MRI uses a powerful magnet linked to a computer. It makes detailed pictures of tissue on a computer screen or film.
- Ultrasound: An ultrasound device sends out sound waves that you cannot hear. A small hand-held device is held against your body. The waves bounce off 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 possible tumors.
- Spinal tap: The doctor uses a long, thin needle to remove fluid from the spinal column. Local anesthesia can help control pain. You must lie flat for a few hours afterward so that you don’t get a headache. The lab checks the fluid for lymphoma cells or other problems.
- PET scan: You receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in your body. Lymphoma cells use sugar faster than normal cells, and areas with lymphoma look brighter on the pictures.
The stage is based on where lymphoma cells are found (in the lymph nodes or in other organs or tissues). The stage also depends on how many areas are affected. The stages of non-Hodgkin lymphoma are as follows:
- Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the abnormal cells are not in the lymph nodes, they are in only one part of a tissue or organ (such as the lung, but not the liver or bone marrow).
- Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. (See the picture of the diaphragm.) Or, the lymphoma cells are in one part of an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.
- Stage III: The lymphoma is in lymph nodes above and below the diaphragm. It also may be found in one part of a tissue or an organ near these lymph node groups.
- Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues (in addition to the lymph nodes). Or, it is in the liver, blood, or bone marrow.
- Recurrent: The disease returns after treatment.
In addition to these stage numbers, your doctor may also describe the stage as A or B:
- A: You have not had weight loss, drenching night sweats, or fevers.
- B: You have had weight loss, drenching night sweats, or fevers.
This information is about non-Hodgkin lymphoma, a cancer that starts in the immune system. Non-Hodgkin lymphoma is also called NHL.
Non-Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal. The abnormal cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. The abnormal cells don't die when they should. They don't protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
Because lymphatic tissue is in many parts of the body, Hodgkin lymphoma can start almost anywhere. Usually, it's first found in a lymph node.
When lymphoma is found, the pathologist reports the type. There are many types of lymphoma. The most common types are diffuse large B-cell lymphoma and follicular lymphoma.
Lymphomas may be grouped by how quickly they are likely to grow:
- Indolent (also called low-grade) lymphomas grow slowly. They tend to cause few symptoms.
- Aggressive (also called intermediate-grade and high-grade) lymphomas grow and spread more quickly. They tend to cause severe symptoms. Over time, many indolent lymphomas become aggressive lymphomas.
It’s a good idea to get a second opinion about the type of lymphoma that you have. The treatment plan varies by the type of lymphoma. A pathologist at a major referral center can review your biopsy. See the Second Opinion section for more information.
Visit the National Cancer Institute where this information and more can be found about Non Hodgkin Lymphoma or ask your cancer care team questions about your individual situation.
People with leukemia have many treatment options. The options are watchful waiting, chemotherapy, targeted therapy, biological therapy, radiation therapy, and stem cell transplant. If your spleen is enlarged, your doctor may suggest surgery to remove it. Sometimes a combination of these treatments is used.
The choice of treatment depends mainly on the following:
- The type of leukemia (acute or chronic)
- Your age
- Whether leukemia cells were found in your cerebrospinal fluid
It also may depend on certain features of the leukemia cells. Your doctor also considers your symptoms and general health.
People with acute leukemia need to be treated right away. The goal of treatment is to destroy signs of leukemia in the body and make symptoms go away. This is called a remission. After people go into remission, more therapy may be given to prevent a relapse. This type of therapy is called consolidation therapy or maintenance therapy. Many people with acute leukemia can be cured.
If you have chronic leukemia without symptoms, you may not need cancer treatment right away. Your doctor will watch your health closely so that treatment can start when you begin to have symptoms. Not getting cancer treatment right away is called watchful waiting.
When treatment for chronic leukemia is needed, it can often control the disease and its symptoms. People may receive maintenance therapy to help keep the cancer in remission, but chronic leukemia can seldom be cured with chemotherapy. However, stem cell transplants offer some people with chronic leukemia the chance for cure.
Your doctor can describe your treatment choices, the expected results, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.
You may want to talk with your doctor about taking part in a clinical trial, a research study of new treatment methods. See the Taking Part in Cancer Research section.
Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat leukemia include hematologists, medical oncologists, and radiation oncologists. Pediatric oncologists and hematologists treat childhood leukemia. Your health care team may also include an oncology nurse and a registered dietitian.
Whenever possible, people should be treated at a medical center that has doctors experienced in treating leukemia. If this isn’t possible, your doctor may discuss the treatment plan with a specialist at such a center.
Before treatment starts, ask your health care team to explain possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.
People with chronic lymphocytic leukemia who do not have symptoms may be able to put off having cancer treatment. By delaying treatment, they can avoid the side effects of treatment until they have symptoms.
If you and your doctor agree that watchful waiting is a good idea, you’ll have regular checkups (such as every 3 months). You can start treatment if symptoms occur.
Although watchful waiting avoids or delays the side effects of cancer treatment, this choice has risks. It may reduce the chance to control leukemia before it gets worse.
You may decide against watchful waiting if you don’t want to live with an untreated leukemia. Some people choose to treat the cancer right away.
If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor. A different approach is nearly always available.
Many people with leukemia are treated with chemotherapy. Chemotherapy uses drugs to destroy leukemia cells.
Depending on the type of leukemia, you may receive a single drug or a combination of two or more drugs.
You may receive chemotherapy in several different ways:
- By mouth: Some drugs are pills that you can swallow.
- Into a vein (IV): The drug is given through a needle or tube inserted into a vein.
- Through a catheter (a thin, flexible tube): The tube is placed in a large vein, often in the upper chest. A tube that stays in place is useful for patients who need many IV treatments. The health care professional injects drugs into the catheter, rather than directly into a vein. This method avoids the need for many injections, which can cause discomfort and injure the veins and skin.
- Into the cerebrospinal fluid: If the pathologist finds leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord, the doctor may order intrathecal chemotherapy. The doctor injects drugs directly into the cerebrospinal fluid. Intrathecal chemotherapy is given in two ways:
- Into the spinal fluid: The doctor injects the drugs into the spinal fluid.
- Under the scalp: Children and some adult patients receive chemotherapy through a special catheter called an Ommaya reservoir. The doctor places the catheter under the scalp. The doctor injects the drugs into the catheter. This method avoids the pain of injections into the spinal fluid.
Intrathecal chemotherapy is used because many drugs given by IV or taken by mouth can’t pass through the tightly packed blood vessel walls found in the brain and spinal cord. This network of blood vessels is known as the blood-brain barrier.
Chemotherapy is usually given in cycles. Each cycle has a treatment period followed by a rest period.
You may have your treatment in a clinic, at the doctor’s office, or at home. Some people may need to stay in the hospital for treatment.
People with chronic myeloid leukemia and some with acute lymphoblastic leukemia may receive drugs called targeted therapy. Imatinib (Gleevec) tablets were the first targeted therapy approved for chronic myeloid leukemia. Other targeted therapy drugs are now used too.
Targeted therapies use drugs that block the growth of leukemia cells. For example, a targeted therapy may block the action of an abnormal protein that stimulates the growth of leukemia cells.
Some people with leukemia receive drugs called biological therapy. Biological therapy for leukemia is treatment that improves the body’s natural defenses against the disease.
One type of biological therapy is a substance called a monoclonal antibody. It’s given by IV infusion. This substance binds to the leukemia cells. One kind of monoclonal antibody carries a toxin that kills the leukemia cells. Another kind helps the immune system destroy leukemia cells.
For some people with chronic myeloid leukemia, the biological therapy is a drug called interferon. It is injected under the skin or into a muscle. It can slow the growth of leukemia cells.
You may have your treatment in a clinic, at the doctor’s office, or in the hospital. Other drugs may be given at the same time to prevent side effects.
Doctors sometimes find leukemia after a routine blood test. If you have symptoms that suggest leukemia, your doctor will try to find out what’s causing the problems. Your doctor may ask about your personal and family medical history.
You may have one or more of the following tests:
- Physical exam: Your doctor checks for swollen lymph nodes, spleen, or liver.
- Blood tests: The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets. Leukemia causes a very high level of white blood cells. It may also cause low levels of platelets and hemoglobin, which is found inside red blood cells.
- Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether leukemia cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hipbone or another large bone. A pathologist uses a microscope to check the tissue for leukemia cells.
There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:
- Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
- Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.
The tests that your doctor orders for you depend on your symptoms and type of leukemia. You may have other tests:
- Cytogenetics: The lab looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. If abnormal chromosomes are found, the test can show what type of leukemia you have. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome.
- Spinal tap: Your doctor may remove some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the lower spine. The procedure takes about 30 minutes and is performed with local anesthesia. You must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for leukemia cells or other signs of problems.
- Chest x-ray: An x-ray can show swollen lymph nodes or other signs of disease in your chest.
The types of leukemia also can be grouped based on the type of white blood cell that is affected. Leukemia can start in lymphoid cells or myeloid cells. Leukemia that affects lymphoid cells is called lymphoid, lymphocytic, or lymphoblastic leukemia. Leukemia that affects myeloid cells is called myeloid, myelogenous, or myeloblastic leukemia.
There are four common types of leukemia:
- Chronic lymphocytic leukemia (CLL): CLL affects lymphoid cells and usually grows slowly. It accounts for more than 15,000 new cases of leukemia each year. Most often, people diagnosed with the disease are over age 55. It almost never affects children.
- Chronic myeloid leukemia (CML): CML affects myeloid cells and usually grows slowly at first. It accounts for nearly 5,000 new cases of leukemia each year. It mainly affects adults.
- Acute lymphocytic (lymphoblastic) leukemia (ALL): ALL affects lymphoid cells and grows quickly. It accounts for more than 5,000 new cases of leukemia each year. ALL is the most common type of leukemia in young children. It also affects adults.
- Acute myeloid leukemia (AML): AML affects myeloid cells and grows quickly. It accounts for more than 13,000 new cases of leukemia each year. It occurs in both adults and children.
- Hairy Cell Leukemia: A rare type of leukemia in which abnormal B-lymphocytes (a type of white blood cell) are present in the bone marrow, spleen, and peripheral blood. When viewed under a microscope, these cells appear to be covered with tiny hair-like projections.
Leukemia is cancer that starts in the tissues that forms blood.
The types of leukemia can be grouped based on how quickly the disease develops and gets worse. Leukemia is either chronic (which usually gets worse slowly) or acute (which usually gets worse quickly):
- Chronic leukemia: Early in the disease, the leukemia cells can still do some of the work of normal white blood cells. People may not have any symptoms at first. Doctors often find chronic leukemia during a routine checkup – before there are any symptoms. Slowly, chronic leukemia gets worse. As the number of leukemia cells in the blood increases, people get symptoms, such as swollen lymph nodes or infections. When symptoms do appear, they are usually mild at first and get worse gradually.
- Acute leukemia: The leukemia cells can’t do any of the work of normal white blood cells. The number of leukemia cells increases rapidly. Acute leukemia usually worsens quickly.
Your blood is living tissue made up of liquid and solids. The liquid part, called plasma, is made of water, salts and protein. Over half of your blood is plasma. The solid part of your blood contains red blood cells, white blood cells and platelets.
Red blood cells deliver oxygen from your lungs to your tissues and organs. White blood cells fight infection and are part of your body's defense system. Platelets help blood to clot. Bone marrow, the spongy material inside your bones, makes new blood cells. Blood cells constantly die and your body makes new ones. Red blood cells live about 120 days, platelets six days and white cells less than one day.
There are several cancers of the blood including Hodgkin's and non-Hodgkin's lymphoma, leukemia and myeloma.
People with thyroid cancer have many treatment options. Treatment usually begins within a few weeks after the diagnosis, but you will have time to talk with your doctor about treatment choices and get a second opinion.
The choice of treatment depends on:
- the type of thyroid cancer (papillary, follicular, medullary, or anaplastic)
- the size of the nodule
- your age
- whether the cancer has spread
You and your doctor can work together to develop a treatment plan that meets your needs.
Your doctor can describe your treatment choices and the expected results. Thyroid cancer may be treated with surgery, thyroid hormone treatment, radioactive iodine therapy, external radiation therapy, or chemotherapy. Most patients receive a combination of treatments. For example, the standard treatment for papillary cancer is surgery, thyroid hormone treatment, and radioactive iodine therapy. Although external radiation therapy and chemotherapy are not often used, when they are, the treatments may be combined.
Surgery and external radiation therapy are local therapies. They remove or destroy cancer in the thyroid. When thyroid cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
Thyroid hormone treatment, radioactive iodine therapy, and chemotherapy are systemic therapies. Systemic therapies enter the bloodstream and destroy or control cancer throughout the body.
Most people with thyroid cancer have surgery. The surgeon removes all or part of the thyroid. The type of surgery depends on the type and stage of thyroid cancer, the size of the nodule, and your age.
- Total thyroidectomy: This surgery can be used for all types of thyroid cancer. The surgeon removes all of the thyroid through an incision in the neck. If the surgeon is not able to remove all of the thyroid tissue, it can be destroyed by radioactive iodine therapy later.
Nearby lymph nodes also may be removed. If cancer has invaded tissue within the neck, the surgeon may remove nearby tissue. If cancer has spread outside the neck, surgery, radioactive iodine therapy, or external radiation therapy may be used to treat those areas.
- Lobectomy: Some people with follicular or papillary thyroid cancer may have only part of the thyroid removed. The surgeon removes one lobe and the isthmus. Some people who have a lobectomy later have a second surgery to remove the rest of the thyroid. Less often, the remaining thyroid tissue is destroyed by radioactive iodine therapy.
The time it takes to heal after surgery is different for each person. You may be uncomfortable for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.
Surgery for thyroid cancer removes the cells that make thyroid hormone. After surgery, nearly all people need to take pills to replace the natural thyroid hormone. You will need thyroid hormone pills for the rest of your life.
If the surgeon removes the parathyroid glands, you may need to take calcium and vitamin D pills for the rest of your life.
Thyroid Hormone Treatment
After surgery to remove part or all of the thyroid, nearly everyone needs to take pills to replace the natural thyroid hormone. However, thyroid hormone pills are also used as part of the treatment for papillary or follicular thyroid cancer. Thyroid hormone slows the growth of thyroid cancer cells left in the body after surgery.
Thyroid hormone pills seldom cause side effects. Your doctor gives you blood tests to make sure you’re getting the right dose of thyroid hormone. Too much thyroid hormone may cause you to lose weight and feel hot and sweaty. It may also cause a fast heart rate, chest pain, cramps, and diarrhea. Too little thyroid hormone may cause you to gain weight, feel cold and tired, and have dry skin and hair. If you have side effects, your doctor can adjust your dose of thyroid hormone.
Radioactive Iodine Therapy
Radioactive iodine (I-131) therapy is a treatment for papillary or follicular thyroid cancer. It kills thyroid cancer cells and normal thyroid cells that remain in the body after surgery.
People with medullary thyroid cancer or anaplastic thyroid cancer usually do not receive I-131 therapy. These types of thyroid cancer rarely respond to I-131 therapy.
Even people who are allergic to iodine can take I-131 therapy safely. The therapy is given as a liquid or capsule that you swallow. I-131 goes into the bloodstream and travels to thyroid cancer cells throughout the body. When thyroid cancer cells take in enough I-131, they die.
Many people get I-131 therapy in a clinic or in the outpatient area of a hospital and can go home afterward. Some people have to stay in the hospital for one day or longer. Ask your health care team to explain how to protect family members and coworkers from being exposed to the radiation.
Most radiation from I-131 is gone in about one week. Within three weeks, only traces of I-131 remain in the body.
During treatment, you can help protect your bladder and other healthy tissues by drinking a lot of fluids. Drinking fluids helps I-131 pass out of the body faster.
Some people have mild nausea the first day of I-131 therapy. A few people have swelling and pain in the neck where thyroid cells remain. If thyroid cancer cells have spread outside the neck, those areas may be painful too.
You may have a dry mouth or lose your sense of taste or smell for a short time after I-131 therapy. Chewing sugar-free gum or sucking on sugar-free hard candy may help.
A rare side effect in men who receive a high dose of I-131 is loss of fertility. In women, I-131 may not cause loss of fertility, but some doctors advise women to avoid getting pregnant for one year after a high dose of I-131.
Researchers have reported that a very small number of patients may develop a second cancer years after treatment with a high dose of I-131. See the “Follow-up Care” section for information about checkups after treatment.
A high dose of I-131 also kills normal thyroid cells, which make thyroid hormone. After radioactive iodine therapy, you need to take thyroid hormone pills to replace the natural hormone.
External Radiation Therapy
External radiation therapy (also called radiotherapy) is a treatment for any type of thyroid cancer that can’t be treated with surgery or I-131 therapy. It’s also used for cancer that returns after treatment or to treat bone pain from cancer that has spread.
External radiation therapy uses high-energy rays to kill cancer cells. A large machine directs radiation at the neck or other tissues where cancer has spread.
Most patients go to the hospital or clinic for their treatment, usually 5 days a week for several weeks. Each treatment takes only a few minutes.
Chemotherapy is a treatment for anaplastic thyroid cancer. It’s sometimes used to relieve symptoms of medullary thyroid cancer or other thyroid cancers.
Chemotherapy uses drugs to kill cancer cells. The drugs are usually given by injection into a vein. They enter the bloodstream and can affect cancer cells all over the body.
You may have treatment in a clinic, at the doctor’s office, or at home. Some people may need to stay in the hospital during treatment.
To plan the best treatment, your doctor needs to learn the extent (stage) of the disease. Staging is a careful attempt to find out the size of the nodule, whether the cancer has spread, and if so, to what parts of the body.
Thyroid cancer spreads most often to the lymph nodes, lungs, and bones. When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original cancer. For example, if thyroid cancer spreads to the lungs, the cancer cells in the lungs are actually thyroid cancer cells. The disease is metastatic thyroid cancer, not lung cancer. For that reason, it’s treated as thyroid cancer, not lung cancer. Doctors call the new tumor “distant” or metastatic disease.
Staging may involve one or more of these tests:
- Ultrasound: An ultrasound exam of your neck may show whether cancer has spread to lymph nodes or other tissues near your thyroid.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of areas inside your body. A CT scan may show whether cancer has spread to lymph nodes, other areas in your neck, or your chest.
- MRI: MRI uses a powerful magnet linked to a computer. It makes detailed pictures of tissue. Your doctor can view these pictures on a screen or print them on film. MRI may show whether cancer has spread to lymph nodes or other areas.
- Chest x-ray: X-rays of your chest may show whether cancer has spread to the lungs.
- Whole body scan: You may have a whole body scan to see if cancer has spread from the thyroid to other parts of the body. You get a small amount of a radioactive substance. The substance travels through the bloodstream. Thyroid cancer cells in other organs or the bones take up the substance. Thyroid cancer that has spread may show up on a whole body scan.
If you have symptoms that suggest thyroid cancer, your doctor will help you find out whether they are from cancer or some other cause. Your doctor will ask you about your personal and family medical history. You may have one or more of the following tests:
- Physical exam: Your doctor feels your thyroid for lumps (nodules). Your doctor also checks your neck and nearby lymph nodes for growths or swelling.
- Blood tests: Your doctor may check for abnormal levels of thyroid-stimulating hormone (TSH) in the blood. Too much or too little TSH means the thyroid is not working well. If your doctor thinks you may have medullary thyroid cancer, you may be checked for a high level of calcitonin and have other blood tests.
- Ultrasound: An ultrasound device uses sound waves that people cannot hear. The device aims sound waves at the thyroid, and a computer creates a picture of the waves that bounce off the thyroid. The picture can show thyroid nodules that are too small to be felt. The doctor uses the picture to learn the size and shape of each nodule and whether the nodules are solid or filled with fluid. Nodules that are filled with fluid are usually not cancer. Nodules that are solid may be cancer.
- Thyroid scan: Your doctor may order a scan of your thyroid. You swallow a small amount of a radioactive substance, and it travels through the bloodstream. Thyroid cells that absorb the radioactive substance can be seen on a scan. Nodules that take up more of the substance than the thyroid tissue around them are called “hot” nodules. Hot nodules are usually not cancer. Nodules that take up less substance than the thyroid tissue around them are called “cold” nodules. Cold nodules may be cancer.
- Biopsy: A biopsy is the only sure way to diagnose thyroid cancer. A pathologist checks a sample of tissue for cancer cells with a microscope.
Your doctor may take tissue for a biopsy in one of two ways:
- Fine-needle aspiration: Most people have this type of biopsy. Your doctor removes a sample of tissue from a thyroid nodule with a thin needle. An ultrasound device can help your doctor see where to place the needle.
- Surgical biopsy: If a diagnosis cannot be made from fine-needle aspiration, a surgeon removes the whole nodule during an operation. If the doctor suspects follicular thyroid cancer, surgical biopsy may be needed for diagnosis.
There are several types of thyroid cancer:
- Papillary thyroid cancer: In the United States, this type makes up about 80 percent of all thyroid cancers. It begins in follicular cells and grows slowly. If diagnosed early, most people with papillary thyroid cancer can be cured.
- Follicular thyroid cancer: This type makes up about 15 percent of all thyroid cancers. It begins in follicular cells and grows slowly. If diagnosed early, most people with follicular thyroid cancer can be treated successfully.
- Medullary thyroid cancer: This type makes up about 3 percent of all thyroid cancers. It begins in the C cells of the thyroid. Cancer that starts in the C cells can make abnormally high levels of calcitonin. Medullary thyroid cancer tends to grow slowly. It can be easier to control if it's found and treated before it spreads to other parts of the body.
- Anaplastic thyroid cancer: This type makes up about 2 percent of all thyroid cancers. It begins in the follicular cells of the thyroid. The cancer cells tend to grow and spread very quickly. Anaplastic thyroid cancer is very hard to control.
Visit the National Cancer Institute where this information and more can be found about Thyroid Cancer or ask your cancer care team questions about your individual situation.
There are different types of treatment for patients with small cell lung cancer.
Different types of treatment are available for patients with small cell lung cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Five types of standard treatment are used:
Surgery may be used if the cancer is found in one lung and in nearby lymph nodes only. Because this type of lung cancer is usually found in both lungs, surgery alone is not often used. Occasionally, surgery may be used to help determine the patient’s exact type of lung cancer. During surgery, the doctor will also remove lymph nodes to see if they contain cancer.
Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. Prophylactic cranial irradiation (radiation therapy to the brain to reduce the risk that cancer will spread to the brain) may also be given. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.
Endoscopic stent placement
An endoscope is a thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may be used to place a stent in a body structure to keep the structure open. Endoscopic stent placement can be used to open an airway blocked by abnormal tissue.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
After small cell lung cancer has been diagnosed, tests are done to find out if cancer cells have spread within the chest or to other parts of the body.
The process used to find out if cancer has spread within the chest or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Some of the tests used to diagnose small cell lung cancer are also used to stage the disease. (See the General Information section.) Other tests and procedures that may be used in the staging process include the following:
- Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
- Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
- MRI (magnetic resonance imaging) of the brain: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. EUS may be used to guide fine-needle aspiration (FNA) biopsy of the lung, lymph nodes, or other areas.
- Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.
- Radionuclide bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
The following stages are used for small cell lung cancer:
- Limited-Stage Small Cell Lung Cancer:
- In limited-stage, cancer is found in one lung, the tissues between the lungs, and nearby lymph nodes only.
- Extensive-Stage Small Cell Lung Cancer:
- In extensive-stage, cancer has spread outside of the lung in which it began or to other parts of the body.
Tests and procedures that examine the lungs are used to detect (find), diagnose, and stage small cell lung cancer.
The following tests and procedures may be used:
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- CT scan (CAT scan) of the brain, chest, and abdomen: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- Sputum cytology: A microscope is used to check for cancer cells in the sputum (mucus coughed up from the lungs).
- Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
- Fine-needle aspiration (FNA) biopsy of the lung: The removal of tissue or fluid from the lung using a thin needle. A CT scan, ultrasound, or other imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. A chest x-ray is done after the procedure to make sure no air is leaking from the lung into the chest.
- Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure is used to remove part of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.
- Thoracentesis: The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.
There are two types of small cell lung cancer.
These two types include many different types of cells. The cancer cells of each type grow and spread in different ways. The types of small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look when viewed under a microscope:
- Small cell carcinoma (oat cell cancer).
- Combined small cell carcinoma.
Smoking tobacco is the major risk factor for developing small cell lung cancer.
Visit the National Cancer Institute where this information and more can be found about Small Cell Lung Cancer or ask your cancer care team questions about your individual situation.
For each stage of soft tissue sarcoma, there are different treatment options available. Some of the options that may be offered by your doctor are as follows:
Stage I Sarcoma:
- Surgery (wide local excision or Mohs microsurgery).
- Radiation therapy before and/or after surgery.
If cancer is found in the head, neck, abdomen, or chest, treatment may include the following:
- Radiation therapy before or after surgery.
- Fast neutron radiation therapy.
Stages II and III adult soft tissue sarcoma treatments include:
- Surgery (wide local excision).
- Surgery (wide local excision) with radiation therapy, for large tumors.
- High-dose radiation therapy for tumors that cannot be removed by surgery.
- Radiation therapy or chemotherapy before limb-sparing surgery. Radiation therapy may also be given after surgery.
- A clinical trial of surgery followed by chemotherapy, for large tumors.
Stage IV adult soft tissue sarcoma that involves lymph nodes may include the following treatments:
- Surgery (wide local excision) with or without lymphadenectomy. Radiation therapy may also be given after surgery.
- Radiation therapy before and after surgery.
- A clinical trial of surgery followed by chemotherapy.
Treatment of stage IV adult soft tissue sarcoma that involves internal organs of the body may include the following:
- Surgery (wide local excision).
- Surgery to remove as much of the tumor as possible, followed by radiation therapy.
- High-dose radiation therapy, with or without chemotherapy, for tumors that cannot be removed by surgery.
- Chemotherapy with 1 or more anticancer drugs, before surgery or as palliative therapy to relieve symptoms and improve the quality of life.
- A clinical trial of chemotherapy with or without stem cell transplant.
- A clinical trial of chemotherapy following surgery to remove cancer that has spread to the lungs.
Treatment for recurring sarcoma may be somewhat different and will be guided by your cancer treatment team of physicians and nurses.
Divided into Stages IA and IB:
- Stage IA - the tumor is low-grade (likely to grow and spread slowly) and 5 centimeters or smaller. It may be either superficial (in subcutaneous tissue with no spread into connective tissue or muscle below) or deep (in the muscle and may be in connective or subcutaneous tissue).
- Stage IB - the tumor is low-grade (likely to grow and spread slowly) and larger than 5 centimeters. It may be either superficial or deep in the tissue.
Divided into Stages IIA and IIB:
- Stage IIA - the tumor is mid-grade (somewhat likely to grow and spread quickly) or high-grade (likely to grow and spread quickly) and 5 centimeters or smaller. It may be either superficial or deep in the tissue.
- Stage IIB - the tumor is mid-grade (somewhat likely to grow and spread quickly) and larger than 5 centimeters. It may be either superficial or deep in the tissue.
The tumor is either:
- High-grade (likely to grow and spread quickly), larger than 5 centimeters, and either superficial or deep in the tissue; or
- Any grade, any size, and has spread to nearby lymph nodes.
The tumor is any grade, any size, and may have spread to nearby lymph nodes. Cancer has spread to distant parts of the body, such as the lungs.
If a soft tissue sarcoma is suspected, a biopsy will be done. The type of biopsy will be based on the size and location of the tumor. There are three types of biopsies commonly used. Your physician will choose the best one for you:
- Incisional biopsy: The removal of part of a lump or a sample of tissue.
- Core biopsy: The removal of tissue using a wide needle.
- Excisional biopsy: The removal of an entire lump or area of tissue that doesn’t look normal.
The following tests may be done on the tissue that was removed:
- Immunohistochemistry study: is used to tell the difference between different types of cancer.
- Light and electron microscopy: Used to look for certain changes in the cells.
- Cytogenetic analysis: Used to look for certain changes in the chromosomes.
- FISH (fluorescence in situ hybridization): A laboratory test used to look at genes or chromosomes in cells and tissues.
- Flow cytometry: A laboratory test that measures the number of cells in a sample, the percentage of live cells in a sample, and certain characteristics of cells, such as size, shape, and the presence of tumor markers on the cell surface.
Sarcoma develops from tissues like muscle or bone tissues. There are two primary types of sarcoma:
- Soft tissue sarcoma which starts in the soft tissues such as fat, nerves, muscles, fibrous tissues, deep skin tissues or blood vessels.
- Osteosarcoma, which develops from bone.
We are going to focus on soft tissue sarcoma in this section.
A sarcoma may appear as a painless lump under the skin, often on an arm or a leg. Sarcomas that begin in the abdomen may not cause symptoms until they become very large. As the sarcoma grows larger and presses on nearby organs, nerves, muscles, or blood vessels, symptoms may include pain or trouble breathing.
Visit the National Cancer Institute where you can find more information on bone and soft tissue sarcomas. And be sure to ask your cancer care team questions about your individual situation.
The treatment that’s right for you depends mainly on your age, the grade of the tumor (the Gleason score), the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, your symptoms, and your general health. Your doctor can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.
You may choose active surveillance if the risks and possible side effects of treatment outweigh the possible benefits. Your doctor may suggest active surveillance if you’re diagnosed with early stage prostate cancer that seems to be slowly growing. Your doctor may also offer this option if you are older or have other serious health problems.
Choosing active surveillance doesn’t mean you’re giving up. It means you’re putting off the side effects of surgery or radiation therapy. Having surgery or radiation therapy is no guarantee that a man will live longer than a man who chooses to put off treatment.
If you and your doctor agree that active surveillance is a good idea, your doctor will check you regularly (such as every 3 to 6 months, at first). After about one year, your doctor may order another biopsy to check the Gleason score. You may begin treatment if your Gleason score rises, your PSA level starts to rise, or you develop symptoms. You’ll receive surgery, radiation therapy, or another approach.
Active surveillance avoids or delays the side effects of surgery and radiation therapy, but this choice has risks. For some men, it may reduce the chance to control cancer before it spreads. Also, it may be harder to cope with surgery or radiation therapy when you’re older.
If you choose active surveillance but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option for most men.
Surgery is an option for men with early (Stage I or II) prostate cancer. It’s sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it.
Before the surgeon removes the prostate, the lymph nodes in the pelvis may be removed. If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment.
There are several types of surgery for prostate cancer. Each type has benefits and risks. You and your doctor can talk about the types of surgery and which may be right for you:
- Open surgery: The surgeon makes a large incision (cut) into your body to remove the tumor. There are two approaches:
- Through the abdomen: The surgeon removes the entire prostate through a cut in the abdomen. This is called a radical retropubic prostatectomy.
- Between the scrotum and anus: The surgeon removes the entire prostate through a cut between the scrotum and the anus. This is called a radical perineal prostatectomy.
- Laparoscopic prostatectomy: The surgeon removes the entire prostate through small cuts, rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) helps the surgeon remove the prostate.
- Robotic laparoscopic surgery: The surgeon removes the entire prostate through small cuts. A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot’s arms.
- Cryosurgery: For some men, cryosurgery is an option. The surgeon inserts a tool through a small cut between the scrotum and anus. The tool freezes and kills prostate tissue. Cryosurgery is under study. See the section on Taking Part in Cancer Research.
- TURP: A man with advanced prostate cancer may choose TURP (transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate. TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.
Surgery can damage the nerves around the prostate. Damaging these nerves can make a man impotent (unable to have an erection). In some cases, your surgeon can protect the nerves that control erection. But if you have a large tumor or a tumor that’s very close to the nerves, surgery may cause impotence. Impotence can be permanent. You can talk with your doctor about medicine and other ways to help manage the sexual side effects of cancer treatment.
If your prostate is removed, you will no longer produce semen. You’ll have dry orgasms. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure before surgery.
Radiation therapy is an option for men with any stage of prostate cancer. Men with early stage prostate cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. In later stages of prostate cancer, radiation treatment may be used to help relieve pain.
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.
Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:
- External radiation: The radiation comes from a large machine outside the body. You will go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks. Many men receive 3-dimensional conformal radiation therapy or intensity-modulated radiation therapy. These types of treatment use computers to more closely target the cancer to lessen the damage to healthy tissue near the prostate.
- Internal radiation (implant radiation or brachytherapy): The radiation comes from radioactive material usually contained in very small implants called seeds. Dozens of seeds are placed inside needles, and the needles are inserted into the prostate. The needles are removed, leaving the seeds behind. The seeds give off radiation for months. They don’t need to be removed once the radiation is gone.
Both internal and external radiation can cause impotence. You can talk with your doctor about ways to help cope with this side effect.
A man with prostate cancer may have hormone therapy before, during, or after radiation therapy. Hormone therapy is also used alone for prostate cancer that has returned after treatment.
Male hormones (androgens) can cause prostate cancer to grow. Hormone therapy keeps prostate cancer cells from getting the male hormones they need to grow. The testicles are the body’s main source of the male hormone testosterone. The adrenal gland makes other male hormones and a small amount of testosterone.
Hormone therapy uses drugs or surgery:
- Drugs: Your doctor may suggest a drug that can block natural hormones:
- Luteinizing hormone-releasing hormone (LH-RH) agonists: These drugs can prevent the testicles from making testosterone. Examples are leuprolide, goserelin, and triptorelin. The testosterone level falls slowly. Without testosterone, the tumor shrinks, or its growth slows. These drugs are also called gonadotropin-releasing hormone (GnRH) agonists.
- Antiandrogens: These drugs can block the action of male hormones. Examples are flutamide, bicalutamide, and nilutamide.
- Other drugs: Some drugs can prevent the adrenal gland from making testosterone. Examples are ketoconazole and aminoglutethimide.
- Surgery: Surgery to remove the testicles is called orchiectomy.
After orchiectomy or treatment with an LH-RH agonist, your body no longer gets testosterone from the testicles, the major source of male hormones. Because the adrenal gland makes small amounts of male hormones, you may receive an antiandrogen to block the action of the male hormones that remain. This combination of treatments is known as total androgen blockade (also called combined androgen blockade). However, studies have shown that total androgen blockade is no more effective than surgery or an LH-RH agonist alone.
Doctors usually treat prostate cancer that has spread to other parts of the body with hormone therapy. For some men, the cancer will be controlled for two or three years, but others will have a much shorter response to hormone therapy. In time, most prostate cancers can grow with very little or no male hormones, and hormone therapy alone is no longer helpful. At that time, your doctor may suggest chemotherapy or other forms of treatment that are under study. In many cases, the doctor may suggest continuing with hormone therapy because it may still be effective against some of the cancer cells.
Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy.
When prostate cancer spreads, it’s often found in nearby lymph nodes. If cancer has reached these nodes, it also may have spread to other lymph nodes, the bones, or other organs.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if prostate cancer spreads to bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, it’s treated as prostate cancer, not bone cancer. Doctors call the new tumor “distant” or metastatic disease.
These are the stages of prostate cancer:
- Stage I: The cancer can’t be felt during a digital rectal exam, and it can’t be seen on a sonogram. It’s found by chance when surgery is done for another reason, usually for BPH. The cancer is only in the prostate. The grade is G1, or the Gleason score is no higher than 4.
- Stage II: The tumor is more advanced or a higher grade than Stage I, but the tumor doesn’t extend beyond the prostate. It may be felt during a digital rectal exam, or it may be seen on a sonogram.
- Stage III: The tumor extends beyond the prostate. The tumor may have invaded the seminal vesicles, but cancer cells haven’t spread to the lymph nodes.
- Stage IV: The tumor may have invaded the bladder, rectum, or nearby structures (beyond the seminal vesicles). It may have spread to the lymph nodes, bones, or to other parts of the body.
Your doctor can check for prostate cancer before you have any symptoms. During an office visit, your doctor will ask about your personal and family medical history. You’ll have a physical exam. You may also have one or both of the following tests:
- Digital rectal exam: Your doctor inserts a lubricated, gloved finger into the rectum and feels your prostate through the rectal wall. Your prostate is checked for hard or lumpy areas.
- Blood test for prostate-specific antigen (PSA): A lab checks the level of PSA in your blood sample. The prostate makes PSA. A high PSA level is commonly caused by BPH or prostatitis (inflammation of the prostate). Prostate cancer may also cause a high PSA level. See the NCI fact sheet The Prostate-Specific Antigen (PSA) Test: Questions and Answers.
The digital rectal exam and PSA test are being studied in clinical trials to learn whether finding prostate cancer early can lower the number of deaths from this disease.
The digital rectal exam and PSA test can detect a problem in the prostate. However, they can’t show whether the problem is cancer or a less serious condition. If you have abnormal test results, your doctor may suggest other tests to make a diagnosis. For example, your visit may include other lab tests, such as a urine test to check for blood or infection. Your doctor may order other procedures:
- Transrectal ultrasound: The doctor inserts a probe into the rectum to check your prostate for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.
- Transrectal biopsy: A biopsy is the removal of tissue to look for cancer cells. It’s the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.
If Cancer Is Found
If cancer cells are found, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow.
Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with your age and other factors to suggest treatment options.
One system of grading is with the Gleason score. Gleason scores range from 2 to 10. To come up with the Gleason score, the pathologist uses a microscope to look at the patterns of cells in the prostate tissue. The most common pattern is given a grade of 1 (most like normal cells) to 5 (most abnormal). If there is a second most common pattern, the pathologist gives it a grade of 1 to 5, and adds the two most common grades together to make the Gleason score. If only one pattern is seen, the pathologist counts it twice. For example, 5 + 5 = 10. A high Gleason score (such as 10) means a high-grade prostate tumor. High-grade tumors are more likely than low-grade tumors to grow quickly and spread.
Another system of grading prostate cancer uses grades 1 through 4 (G1 to G4). G4 is more likely than G1, G2, or G3 to grow quickly and spread. Read more in the Staging Section.
Each year, more than 241,000 American men learn they have this disease. Prostate cancer is the second most common type of cancer among men in this country. Only skin cancer is more common.
Learning about medical care for prostate cancer can help you take an active part in making choices about your care. This booklet tells about:
- Diagnosis and staging
- Treatment options
- Tests you may have after treatment
Visit the National Cancer Institute where this information and more can be found about Prostate Cancer or ask your cancer care team questions about your individual situation.
Treatment options for people with cancer of the pancreas are surgery, chemotherapy, targeted therapy, and radiation therapy. You’ll probably receive more than one type of treatment.
The treatment that’s right for you depends mainly on the following:
- The location of the tumor in your pancreas
- Whether the disease has spread
- Your age and general health
At this time, cancer of the pancreas can be cured only when it’s found at an early stage (before it has spread) and only if surgery can completely remove the tumor. For people who can’t have surgery, other treatments may be able to help them live longer and feel better.
You may have a team of specialists to help plan your treatment. Specialists who treat cancer of the pancreas include surgeons, medical oncologists, radiation oncologists, and gastroenterologists.
Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type and extent of treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.
Surgery may be an option for people with an early stage of pancreatic cancer. The surgeon usually removes only the part of the pancreas that has cancer. But, in some cases, the whole pancreas may be removed.
The type of surgery depends on the location of the tumor in the pancreas. Surgery to remove a tumor in the head of the pancreas is called a Whipple procedure. The Whipple procedure is the most common type of surgery for pancreatic cancer. You and your surgeon may talk about the types of surgery and which may be right for you.
In addition to part or all of your pancreas, the surgeon usually removes the following nearby tissues:
- Common bile duct
- Part of your stomach
Also, the surgeon may remove your spleen and nearby lymph nodes.
Surgery for pancreatic cancer is a major operation. You will need to stay in the hospital for one to two weeks afterward. Your health care team will watch for signs of bleeding, infection, or other problems. It takes time to heal after surgery, and the time needed to recover is different for each person. You may have pain or discomfort for the first few days. It’s common to feel weak or tired for a while. You may need to rest at home for one to three months after leaving the hospital.
Chemotherapy uses drugs to kill cancer cells. Most people with pancreatic cancer get chemotherapy. For early pancreatic cancer, chemotherapy is usually given after surgery, but in some cases, it’s given before surgery. For advanced cancer, chemotherapy is used alone, with targeted therapy, or with radiation therapy.
Chemotherapy for pancreatic cancer is usually given by vein (intravenous). The drugs enter the bloodstream and travel throughout your body. Chemotherapy is given in cycles. Each treatment period is followed by a rest period. The length of the rest period and the number of cycles depend on the anticancer drugs used.
Some drugs used for pancreatic cancer also may cause tingling or numbness in your hands and feet.
People with cancer of the pancreas who can’t have surgery may receive a type of drug called targeted therapy along with chemotherapy.
Targeted therapy slows the growth of pancreatic cancer. It also helps prevent cancer cells from spreading. The drug is taken by mouth.
Side effects may include diarrhea, nausea, vomiting, a rash, and shortness of breath.
Radiation therapy uses high-energy rays to kill cancer cells. It can be given along with other treatments, including chemotherapy.
The radiation comes from a large machine. The machine aims beams of radiation at the cancer in the abdomen. You’ll go to a hospital or clinic 5 days a week for several weeks to receive radiation therapy. Each session takes about 30 minutes.
Although radiation therapy is painless, it may cause other side effects. The side effects include nausea, vomiting, or diarrhea. You may also feel very tired.
Staging is a careful attempt to find out the following:
- The size of the tumor in the pancreas
- Whether the tumor has invaded nearby tissues
- Whether the cancer has spread, and if so, to what parts of the body
When cancer of the pancreas spreads, the cancer cells may be found in nearby lymph nodes or the liver. Cancer cells may also be found in the lungs or in fluid collected from the abdomen.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original (primary) tumor. For example, if pancreatic cancer spreads to the liver, the cancer cells in the liver are actually pancreatic cancer cells. The disease is metastatic pancreatic cancer, not liver cancer. It’s treated as pancreatic cancer, not as liver cancer. Doctors sometimes call the new tumor in the liver “distant” disease.
To learn whether pancreatic cancer has spread, your doctor may order CT scans or EUS.
Also, a surgeon may look inside your abdomen with a laparoscope (a thin, tube-like device that has a light and a lens for seeing inside the body). The surgeon inserts the laparoscope through a small incision in your belly button. The surgeon will look for any signs of cancer inside your abdomen. You’ll need general anesthesia for this exam.
These are the stages of cancer of the pancreas:
- Stage I: The tumor is found only in the pancreas.
- Stage II: The tumor has invaded nearby tissue but not nearby blood vessels. The cancer may have spread to the lymph nodes.
- Stage III: The tumor has invaded nearby blood vessels.
- Stage IV: The cancer has spread to a distant organ, such as the liver or lungs.
If you have symptoms that suggest cancer of the pancreas, your doctor will try to find out what’s causing the problems. You may have blood or other lab tests. Also, you may have one or more of the following tests:
- Physical exam: Your doctor feels your abdomen to check for changes in areas near the pancreas, liver, gallbladder, and spleen. Your doctor also checks for an abnormal buildup of fluid in the abdomen. Also, your skin and eyes may be checked for signs of jaundice.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your pancreas, nearby organs, and blood vessels in your abdomen. You may receive an injection of contrast material so your pancreas shows up clearly in the pictures. Also, you may be asked to drink water so your stomach and duodenum show up better. On the CT scan, your doctor may see a tumor in the pancreas or elsewhere in the abdomen.
- Ultrasound: Your doctor places the ultrasound device on your abdomen and slowly moves it around. The ultrasound device uses sound waves that can’t be heard by humans. The sound waves make a pattern of echoes as they bounce off internal organs. The echoes create a picture of your pancreas and other organs in the abdomen. The picture may show a tumor or blocked ducts.
- EUS: Your doctor passes a thin, lighted tube (endoscope) down your throat, through your stomach, and into the first part of the small intestine. An ultrasound probe at the end of the tube sends out sound waves that you can’t hear. The waves bounce off tissues in your pancreas and other organs. As your doctor slowly withdraws the probe from the intestine toward the stomach, the computer creates a picture of the pancreas from the echoes. The picture can show a tumor in the pancreas. It can also show how deeply the cancer has invaded the blood vessels.
Some doctors use the following tests also:
- ERCP: The doctor passes an endoscope through your mouth and stomach, down into the first part of your small intestine. Your doctor slips a smaller tube through the endoscope into the bile ducts and pancreatic ducts. (See picture of ducts.) After injecting dye through the smaller tube into the ducts, the doctor takes x-ray pictures. The x-rays can show whether the ducts are narrowed or blocked by a tumor or other condition.
- MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of areas inside your body.
- PET scan: You’ll receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan may show a tumor in the pancreas. It can also show cancer that has spread to other parts of the body.
- Needle biopsy: The doctor uses a thin needle to remove a small sample of tissue from the pancreas. EUS or CT may be used to guide the needle. A pathologist uses a microscope to look for cancer cells in the tissue.
If cancer of the pancreas is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment.
There are two main types of pancreatic cancer.
Most often, pancreatic cancer starts in the ducts that carry pancreatic juices. This type is called exocrine pancreatic cancer. Information will focus on this type of pancreatic cancer.
Much less often, pancreatic cancer begins in the cells that make hormones. This type may be called endocrine pancreatic cancer or islet cell cancer.
Each year in the United States, more than 43,000 people are diagnosed with cancer of the pancreas. Most are over 65 years old. Visit the National Cancer Institute where this information and more can be found about Pancreatic Cancer or ask your cancer care team questions about your individual situation.
Your doctor can describe your treatment choices and the expected results. Most women have surgery and chemotherapy. Rarely, radiation therapy is used.
Cancer treatment can affect cancer cells in the pelvis, in the abdomen, or throughout the body:
- Local therapy: Surgery and radiation therapy are local therapies. They remove or destroy ovarian cancer in the pelvis. When ovarian cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
- Intraperitoneal chemotherapy: Chemotherapy can be given directly into the abdomen and pelvis through a thin tube. The drugs destroy or control cancer in the abdomen and pelvis.
- Systemic chemotherapy: When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and destroy or control cancer throughout the body.
You may want to know how treatment may change your normal activities. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.
The surgeon makes a long cut in the wall of the abdomen. This type of surgery is called a laparotomy. If ovarian cancer is found, the surgeon removes:
- both ovaries and fallopian tubes (salpingo-oophorectomy)
- the uterus (hysterectomy)
- the omentum (the thin, fatty pad of tissue that covers the intestines)
- nearby lymph nodes
- samples of tissue from the pelvis and abdomen
If the cancer has spread, the surgeon removes as much cancer as possible. This is called “debulking” surgery.
If you have early Stage I ovarian cancer, the extent of surgery may depend on whether you want to get pregnant and have children. Some women with very early ovarian cancer may decide with their doctor to have only one ovary, one fallopian tube, and the omentum removed.
Chemotherapy uses anticancer drugs to kill cancer cells. Most women have chemotherapy for ovarian cancer after surgery. Some women have chemotherapy before surgery.
Usually, more than one drug is given. Drugs for ovarian cancer can be given in different ways:
- By vein (IV): The drugs can be given through a thin tube inserted into a vein.
- By vein and directly into the abdomen: Some women get IV chemotherapy along with intraperitoneal (IP) chemotherapy. For IP chemotherapy, the drugs are given through a thin tube inserted into the abdomen.
- By mouth: Some drugs for ovarian cancer can be given by mouth.
Chemotherapy is given in cycles. Each treatment period is followed by a rest period. The length of the rest period and the number of cycles depend on the anticancer drugs used.
You may have your treatment in a clinic, at the doctor’s office, or at home. Some women may need to stay in the hospital during treatment.
Radiation therapy is rarely used in the initial treatment of ovarian cancer, but it may be used to relieve pain and other problems caused by the disease. The treatment is given at a hospital or clinic. Each treatment takes only a few minutes.
To plan the best treatment, your doctor needs to know the grade of the tumor and the extent (stage) of the disease. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body.
Usually, surgery is needed before staging can be complete. The surgeon takes many samples of tissue from the pelvis and abdomen to look for cancer.
Your doctor may order tests to find out whether the cancer has spread:
- CT scan: Doctors often use CT scans to make pictures of organs and tissues in the pelvis or abdomen. An x-ray machine linked to a computer takes several pictures. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly. Abdominal fluid or a tumor may show up on the CT scan.
- Chest x-ray: X-rays of the chest can show tumors or fluid.
- Barium enema x-ray: Your doctor may order a series of x-rays of the lower intestine. You are given an enema with a barium solution. The barium outlines the intestine on the x-rays. Areas blocked by cancer may show up on the x-rays.
- Colonoscopy: Your doctor inserts a long, lighted tube into the rectum and colon. This exam can help tell if cancer has spread to the colon or rectum.
These are the stages of ovarian cancer:
- Stage I: Cancer cells are found in one or both ovaries. Cancer cells may be found on the surface of the ovaries or in fluid collected from the abdomen.
- Stage II: Cancer cells have spread from one or both ovaries to other tissues in the pelvis. Cancer cells are found on the fallopian tubes, the uterus, or other tissues in the pelvis. Cancer cells may be found in fluid collected from the abdomen.
- Stage III: Cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes. Cancer cells may be found on the outside of the liver.
- Stage IV: Cancer cells have spread to tissues outside the abdomen and pelvis. Cancer cells may be found inside the liver, in the lungs, or in other organs.
If you have a symptom that suggests ovarian cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history.
You may have one or more of the following tests. Your doctor can explain more about each test:
- Physical exam: Your doctor checks general signs of health. Your doctor may press on your abdomen to check for tumors or an abnormal buildup of fluid (ascites). A sample of fluid can be taken to look for ovarian cancer cells.
- Pelvic exam: Your doctor feels the ovaries and nearby organs for lumps or other changes in their shape or size. A Pap test is part of a normal pelvic exam, but it is not used to collect ovarian cells. The Pap test detects cervical cancer. The Pap test is not used to diagnose ovarian cancer.
- Blood tests: Your doctor may order blood tests. The lab may check the level of several substances, including CA-125. CA-125 is a substance found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer or other conditions. The CA-125 test is not used alone to diagnose ovarian cancer. This test is approved by the Food and Drug Administration for monitoring a woman’s response to ovarian cancer treatment and for detecting its return after treatment.
- Ultrasound: The ultrasound device uses sound waves that people cannot hear. The device aims sound waves at organs inside the pelvis. The waves bounce off the organs. A computer creates a picture from the echoes. The picture may show an ovarian tumor. For a better view of the ovaries, the device may be inserted into the vagina (transvaginal ultrasound).
- Biopsy: A biopsy is the removal of tissue or fluid to look for cancer cells. Based on the results of the blood tests and ultrasound, your doctor may suggest surgery (a laparotomy) to remove tissue and fluid from the pelvis and abdomen. Surgery is usually needed to diagnose ovarian cancer. To learn more about surgery, see the “Treatment” section.
Although most women have a laparotomy for diagnosis, some women have a procedure known as laparoscopy. The doctor inserts a thin, lighted tube (a laparoscope) through a small incision in the abdomen. Laparoscopy may be used to remove a small, benign cyst or an early ovarian cancer. It may also be used to learn whether cancer has spread.
A pathologist uses a microscope to look for cancer cells in the tissue or fluid. If ovarian cancer cells are found, the pathologist describes the grade of the cells. Grades 1, 2, and 3 describe how abnormal the cancer cells look. Grade 1 cancer cells are not as likely as to grow and spread as Grade 3 cells.
Ovarian epithelial cancer is the most common type of ovarian cancer. It begins in the tissue that covers the ovaries. This information is not about ovarian germ cell tumors or other types of ovarian cancer. To find out more about all types of of ovarian cancer, please visit the National Cancer Institute Web site or ask your cancer care team about your individual situation.
People with early oral cancer may be treated with surgery or radiation therapy. People with advanced oral cancer may have a combination of treatments. For example, radiation therapy and chemotherapy are often given at the same time. Another treatment option is targeted therapy.
The choice of treatment depends mainly on your general health, where in your mouth or throat the cancer began, the size of the tumor, and whether the cancer has spread.
Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be removed as well. You may have surgery alone or in combination with radiation therapy.
Also, surgery may cause tissues in your face to swell. This swelling usually goes away within a few weeks. However, removing lymph nodes can result in swelling that lasts a long time.
Radiation therapy uses high-energy rays to kill cancer cells. It’s an option for small tumors or for people who can’t have surgery. Or, it may be used before surgery to shrink the tumor. It also may be used after surgery to destroy cancer cells that may remain in the area.
Doctors use two types of radiation therapy to treat oral cancer. Some people with oral cancer have both types:
- External radiation therapy: The radiation comes from a machine. Some treatment centers offer IMRT, which uses a computer to more closely target the oral tumor to lessen the damage to healthy tissue. You may go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks. Each treatment takes only a few minutes.
- Internal radiation therapy (implant radiation therapy or brachytherapy): Internal radiation therapy isn’t commonly used for oral cancer. The radiation comes from radioactive material in seeds, wires, or tubes put directly in the mouth or throat tissue. You may need to stay in the hospital for several days. Usually the radioactive material is removed before you go home.
Chemotherapy uses drugs to kill cancer cells. The drugs that treat oral cancer are usually given through a vein (intravenous). The drugs enter the bloodstream and travel throughout your body. Chemotherapy and radiation therapy are often given at the same time.
Some people with oral cancer receive a type of drug known as targeted therapy. It may be given along with radiation therapy or chemotherapy.
Cetuximab (Erbitux) was the first targeted therapy approved for oral cancer. Cetuximab binds to oral cancer cells and interferes with cancer cell growth and the spread of cancer. You may receive cetuximab through a vein once a week for several weeks at the clinic.
If oral cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. When oral cancer spreads, cancer cells may be found in the lymph nodes in the neck or in other tissues of the neck. Cancer cells can also spread to the lungs, liver, bones, and other parts of the body.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells as the primary (original) tumor. For example, if oral cancer spreads to the lungs, the cancer cells in the lungs are actually oral cancer cells. The disease is called metastatic oral cancer, not lung cancer. It’s treated as oral cancer, not lung cancer. Doctors sometimes call the new tumor “distant” or metastatic disease.
Your doctor may order one or more of the following tests:
- X-rays: An x-ray of your entire mouth can show whether cancer has spread to the jaw. Images of your chest and lungs can show whether cancer has spread to these areas.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your body. You may receive an injection of dye. Tumors in your mouth, throat, neck, 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 body. An MRI can show whether oral cancer has spread.
- Endoscopy: The doctor uses a thin, lighted tube (endoscope) to check your throat, windpipe, and lungs. The doctor inserts the endoscope through your nose or mouth. Local anesthesia is used to ease your discomfort and prevent you from gagging. Some people also may be given a mild sedative. Sometimes the doctor uses general anesthesia to put a person to sleep. This exam may be done in a doctor’s office, an outpatient clinic, or a hospital.
- PET scan: You receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan shows whether oral cancer may have spread.
Doctors describe the stage of oral cancer based on the size of the tumor, whether it has invaded nearby tissues, and whether it has spread to the lymph nodes or other tissues:
- Early cancer: Stage I or II oral cancer is usually a small tumor (smaller than a walnut), and no cancer cells are found in the lymph nodes.
- Advanced cancer: Stage III or IV oral cancer is usually a large tumor (as big as a lime). The cancer may have invaded nearby tissues or spread to lymph nodes or other parts of the body.
If you have symptoms that suggest oral cancer, your doctor or dentist will check your mouth and throat for red or white patches, lumps, swelling, or other problems. A physical exam includes looking carefully at the roof of your mouth, back of your throat, and insides of your cheeks and lips. The floor of your mouth and lymph nodes in your neck will also be checked.
An ear, nose, and throat specialist can see the back of your nose, tongue, and throat by using a small, long-handled mirror or a lighted tube. Sometimes pictures need to be made with a CT scan or MRI to find a hidden tumor. (The Staging section describes imaging tests.)
The removal of a small piece of tissue to look for cancer cells is called a biopsy. Usually, a biopsy is done with local anesthesia. Sometimes, it’s done under general anesthesia. A pathologist then looks at the tissue under a microscope to check for cancer cells. A biopsy is the only sure way to know if the abnormal area is cancer.
Cancer that forms in tissues of the oral cavity (the mouth) or the oropharynx (the part of the throat at the back of the mouth).
This includes areas under the tongue:
- Gums and teeth
- Lining of your cheeks
- Salivary glands (glands that make saliva)
- Floor of your mouth (area under the tongue
This includes areas of the throat:
- Roof of your mouth (hard palate)
- Soft palate
Visit the National Cancer Institute where this information and more can be found about Oral Cancer or ask your cancer care team questions about your individual situation.
Your doctor can describe your treatment choices and what to expect. You and your doctor can work together to develop a treatment plan that meets your needs.
Sometimes all of the cancer is removed during the biopsy. In such cases, no more treatment is needed. If you do need more treatment, your doctor will describe your options.
Treatment for skin cancer depends on the type and stage of the disease, the size and place of the growth, and your general health and medical history. In most cases, the aim of treatment is to remove or destroy the cancer completely.
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.
Surgery to treat skin cancer may be done in one of several ways. The method your doctor uses depends on the size and place of the growth and other factors.
Your doctor can further describe these types of surgery:
- Excisional skin surgery is a common treatment to remove skin cancer. After numbing the area, the surgeon removes the growth with a scalpel. The surgeon also removes a border of skin around the growth. This skin is the margin. The margin is examined under a microscope to be certain that all the cancer cells have been removed. The size of the margin depends on the size of the growth.
- Mohs surgery (also called Mohs micrographic surgery) is often used for skin cancer. The area of the growth is numbed. A specially trained surgeon shaves away thin layers of the growth. Each layer is immediately examined under a microscope. The surgeon continues to shave away tissue until no cancer cells can be seen under the microscope. In this way, the surgeon can remove all the cancer and only a small bit of healthy tissue.
- Electrodesiccation and curettage is often used to remove small basal cell skin cancers. The doctor numbs the area to be treated. The cancer is removed with a sharp tool shaped like a spoon. This tool is a curette. An electric current is sent into the treated area to control bleeding and kill any cancer cells that may be left. Electrodesiccation and curettage is usually a fast and simple procedure.
- Cryosurgery is often used for people who are not able to have other types of surgery. It uses extreme cold to treat early stage or very thin skin cancer. Liquid nitrogen creates the cold. The doctor applies liquid nitrogen directly to the skin growth. This treatment may cause swelling. It also may damage nerves, which can cause a loss of feeling in the damaged area. The NCI fact sheet “Cryosurgery in Cancer Treatment: Questions and Answers” has more information.
- Laser surgery uses a narrow beam of light to remove or destroy cancer cells. It is most often used for growths that are on the outer layer of skin only. The NCI fact sheet “Lasers in Cancer Treatment: Questions and Answers” has more information.
- Grafts are sometimes needed to close an opening in the skin left by surgery. The surgeon first numbs and then removes a patch of healthy skin from another part of the body, such as the upper thigh. The patch is then used to cover the area where skin cancer was removed. If you have a skin graft, you may have to take special care of the area until it heals.
Chemotherapy uses anticancer drugs to kill skin cancer cells. When a drug is put directly on the skin, the treatment is topical chemotherapy. It is most often used when the skin cancer is too large for surgery. It is also used when the doctor keeps finding new cancers.
Most often, the drug comes in a cream or lotion. It is usually applied to the skin one or two times a day for several weeks. A drug called fluorouracil (5-FU) is used to treat basal cell and squamous cell cancers that are in the top layer of the skin only. A drug called imiquimod also is used to treat basal cell cancer only in the top layer of skin.
Photodynamic therapy (PDT) uses a chemical along with a special light source, such as a laser light, to kill cancer cells. The chemical is a photosensitizing agent. A cream is applied to the skin or the chemical is injected. It stays in cancer cells longer than in normal cells. Several hours or days later, the special light is focused on the growth. The chemical becomes active and destroys nearby cancer cells.
PDT is used to treat cancer on or very near the surface of the skin.
The side effects of PDT are usually not serious. PDT may cause burning or stinging pain. It also may cause burns, swelling, or redness. It may scar healthy tissue near the growth. If you have PDT, you will need to avoid direct sunlight and bright indoor light for at least 6 weeks after treatment.
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. The rays come from a large machine outside the body. They affect cells only in the treated area. This treatment is given at a hospital or clinic in one dose or many doses over several weeks.
Radiation is not a common treatment for skin cancer. But it may be used for skin cancer in areas where surgery could be difficult or leave a bad scar. You may have this treatment if you have a growth on your eyelid, ear, or nose. It also may be used if the cancer comes back after surgery to remove it.
If the biopsy shows that you have cancer, your doctor needs to know the extent (stage) of the disease. In very few cases, the doctor may check your lymph nodes to stage the cancer.
The stage is based on:
- The size of the growth
- How deeply it has grown beneath the top layer of skin
- Whether it has spread to nearby lymph nodes or to other parts of the body
These are the stages of skin cancer:
- Stage 0: The cancer involves only the top layer of skin. It is carcinoma in situ.
- Stage I: The growth is 2 centimeters wide (three-quarters of an inch) or smaller.
- Stage II: The growth is larger than 2 centimeters wide (three-quarters of an inch).
- Stage III: The cancer has spread below the skin to cartilage, muscle, bone, or to nearby lymph nodes. It has not spread to other places in the body.
- Stage IV: The cancer has spread to other places in the body.
If you have a change on the skin, the doctor must find out whether it is due to cancer or to some other cause. Your doctor removes all or part of the area that does not look normal. The sample goes to a lab. A pathologist checks the sample under a microscope. This is a biopsy. A biopsy is the only sure way to diagnose skin cancer.
You may have the biopsy in a doctor’s office or as an outpatient in a clinic or hospital. Where it is done depends on the size and place of the abnormal area on your skin. You probably will have local anesthesia.
There are four common types of skin biopsies:
- Punch biopsy: The doctor uses a sharp, hollow tool to remove a circle of tissue from the abnormal area.
- Incisional biopsy: The doctor uses a scalpel to remove part of the growth.
- Excisional biopsy: The doctor uses a scalpel to remove the entire growth and some tissue around it.
- Shave biopsy: The doctor uses a thin, sharp blade to shave off the abnormal growth.
Skin cancer (non-melanoma) is the most common type of cancer in the United States. They are named for the type of cells that become cancerous.
The two most common types of skin cancer are basal cell cancer and squamous cell cancer. These cancers usually form on the head, face, neck, hands, and arms. These areas are exposed to the sun. But skin cancer can occur anywhere.
- Basal cell skin cancer grows slowly. It usually occurs on areas of the skin that have been in the sun. It is most common on the face. Basal cell cancer rarely spreads to other parts of the body.
- Squamous cell skin cancer also occurs on parts of the skin that have been in the sun. But it also may be in places that are not in the sun. Squamous cell cancer sometimes spreads to lymph nodes and organs inside the body.
If skin cancer spreads from its original place to another part of the body, the new growth has the same kind of abnormal cells and the same name as the primary growth. It is still called skin cancer.
Visit the National Cancer Institute where this information and more can be found about Skin Cancer or ask your cancer care team questions about your individual situation.
Occult Non-Small Cell Lung Cancer
Treatment of occult non-small cell lung cancer depends on where the cancer has spread. It can usually be cured by surgery.
Treatment of stage 0 may include the following:
- Surgery (wedge resection or segmental resection).
- Photodynamic therapy using an endoscope.
- Electrocautery, cryosurgery, or laser surgery using an endoscope.
Treatment of stage I non-small cell lung cancer may include the following:
- Surgery (wedge resection, segmental resection, sleeve resection, or lobectomy).
- External radiation therapy (for patients who cannot have surgery or choose not to have surgery).
- A clinical trial of surgery followed by chemoprevention.
Treatment of stage II non-small cell lung cancer may include the following:
- Surgery (wedge resection, segmental resection, sleeve resection, lobectomy, or pneumonectomy).
- External radiation therapy (for patients who cannot have surgery or choose not to have surgery).
- Surgery followed by chemotherapy.
Treatment of stage IIIA non-small cell lung cancer that can be removed with surgery may include surgery followed by chemotherapy.
Treatment of stage IIIA non-small cell lung cancer that cannot be removed with surgery may include the following:
- Chemotherapy combined with radiation therapy.
- External radiation therapy alone (for patients who cannot be treated with combined therapy).
Some stage IIIA non-small cell lung tumors that have grown into the chest wall may be completely removed. Treatment of chest wall tumors may include the following:
- Surgery and radiation therapy.
- Radiation therapy alone.
- Chemotherapy combined with radiation therapy and/or surgery.
Treatment of stage IIIB non-small cell lung cancer may include the following:
- Chemotherapy combined with external radiation therapy.
- External radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life.
Treatment of stage IV non-small cell lung cancer may include the following:
- External radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life.
- Combination chemotherapy.
- Combination chemotherapy and targeted therapy.
- Laser therapy and/or internal radiation therapy using an endoscope.
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