Colorectal Cancer Defined

The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. Sometimes, however, the process goes wrong — cells become abnormal and form more cells in an uncontrolled way.

These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means not cancerous, or malignant, which means cancerous.

Cancer of the colon or rectum is called colorectal cancer. The colon and the rectum are part of the large intestine, which is part of the digestive system. Colorectal cancer occurs when tumors form in the lining of the large intestine, also called the large bowel.

Colorectal cancer is the second leading cause of death from cancer in both sexes in the United States. The risk of developing colorectal cancer rises after age 50. It is common in both men and women.

Sometimes, cancer cells break away from the malignant tumor and enter the bloodstream or the lymphatic system where they travel to other organs in the body. Among other things, the lymphatic system transports white blood cells that fight infection.

When cancer travels or spreads from its original location in the colon to another part of the body such as the liver, it is called metastatic colorectal cancer and not liver cancer. When colorectal cancer does spread, it tends to spread to the liver or lungs.

Today there are more ways than ever to treat colorectal cancer. As with almost all cancers, the earlier it is found, the more likely that the treatment will be successful. If colon cancer is detected in its early stages, it is up to 90 percent curable.

The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. Sometimes, however, the process goes wrong. Cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means non-cancerous, or malignant, which means cancerous.

Cancer of the colon or rectum is called colorectal cancer. The colon and the rectum are part of the large intestine, which is part of the digestive system. Colorectal cancer occurs when malignant tumors form in the lining of the large intestine, also called the large bowel.

Colorectal cancer is the second leading cause of death from cancer in both sexes in the United States. The risk of developing colorectal cancer rises after age 50. It is common in both men and women.

For men, the death rate from colorectal cancer has been declining since the 1980s, and for women the death rate has been declining since the 1950s.

Studies show that the following risk factors can increase a person’s chances of developing colorectal cancer: age, polyps, diet, personal history, family history, and ulcerative colitis.

Polyps are benign, or non-cancerous, growths on the inner wall of the colon and rectum. They are fairly common in people over age 50. Some types of polyps increase a person’s risk of developing colorectal cancer. Not all polyps become cancerous, but nearly all colon cancers start as polyps.

Yes. Ulcerative colitis is a condition in which there is a chronic break in the lining of the colon. It has been associated with an increased risk of colon cancer.

Diet may be associated with a risk of developing colorectal cancer. Colorectal cancer occurs more frequently in populations that consume a diet high in fat, protein, calories, alcohol, and both red and white meat, and low in calcium and folate, than in populations that consume a low-fat, high-fiber diet.

Parents, siblings, or children of a person who has had colorectal cancer are somewhat more likely to develop this type of cancer themselves. This is especially true if the relative had the cancer at a young age. If many family members have had colorectal cancer, the chances increase even more.

Possible signs of colorectal cancer include:

• a change in the frequency of bowel movements
• diarrhea, constipation, or feeling that the bowel does not empty completely
• either bright red or very dark blood in the stool

• stools that are narrower than usual
• general abdominal discomfort such as frequent gas pains, bloating, fullness, and/or cramps
• weight loss with no known reason
• constant tiredness
• vomiting

Here are some of the tools used to detect colorectal cancer.

• A fecal occult blood test, or FOBT, is a test used to check for hidden blood in the stool. Sometimes cancers or polyps can bleed, and FOBT can detect small amounts of bleeding.

• A sigmoidoscopy is an examination of the rectum and lower colon — or sigmoid colon — using a lighted instrument called a sigmoidoscope.

• A colonoscopy is an examination of the rectum and entire colon using a lighted instrument called a colonoscope.

• A double contrast barium enema, or DCBE, is a series of x-rays of the colon and rectum. The patient is given an enema with a solution that contains barium, a substance that outlines the colon and rectum on the x-rays.

Yes. In July 2002, the U.S. Preventive Services Task Force made its strongest ever recommendation for colorectal cancer screening: it urged all adults age 50 and over to get screened, or tested, for the disease. The task force noted that various screening tests are available, making it possible for patients and their clinicians to decide which test is best for each person.

Doctors use the following stages to describe how the cancer spreads:

• Stage 0 — The cancer is very early. It is found only in the innermost lining of the colon or rectum.
• Stage I — The cancer involves more of the inner wall of the colon or rectum.

• Stage II — The cancer has spread outside the colon or rectum to nearby tissue, but not to the lymph nodes. Lymph nodes are small, bean-shaped structures that are part of the body’s immune system.
• Stage III — The cancer has spread to nearby lymph nodes, but not to other parts of the body.

• Stage IV — The cancer has spread to other parts of the body. Colorectal cancer tends to spread to the liver and/or lungs.
• Recurrent — Recurrent cancer means the cancer has come back after treatment. The disease may recur in the colon or rectum or in another part of the body.

The three standard treatments for colon cancer are surgery, chemotherapy, and radiation. Surgery, however, is the most common treatment for all stages of colon cancer. Surgery is an operation to remove the cancer. A doctor may remove the cancer using several types of surgery. For rectal cancer, radiation treatment also is an option.

Several types of surgery are available for someone with colorectal cancer. If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. Instead, the doctor may put a tube up the rectum into the colon and cut the cancer out. This is called a local excision.

If the cancer is found in a polyp, which is a small bulging piece of tissue, the operation is called a polypectomy.

If the cancer is larger, the surgeon will remove the cancer and a small amount of healthy tissue around it. This is called a colectomy. The surgeon may then sew the healthy parts of the colon together. Usually, the surgeon will also remove lymph nodes near the colon and examine them under a microscope to see whether they contain cancer.

If the doctor is not able to sew the two ends of the colon back together, an opening called a stoma is made on the abdomen for waste to pass out of the body before it reaches the rectum. This procedure is called a colostomy.

Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed. But if the doctor needs to remove the entire lower colon, the colostomy may be permanent.

Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may receive chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy treatment after surgery — to increase the chances of a cure — is called adjuvant therapy.

Researchers have found that patients who received adjuvant therapy usually survived longer and went for longer periods of time without a recurrence of colon cancer than patients treated with surgery alone.

Patients age 70 and older benefited from adjuvant treatment as much as their younger counterparts. In fact, adjuvant therapy is equally as effective — and no more toxic — for patients 70 and older as it is for younger patients, provided the older patients have no other serious diseases.

Adjuvant chemotherapy is standard treatment for patients whose cancer is operable and who are at high risk for a recurrence of the disease. Most cases of colon cancer occur in individuals age 65 and over. But studies have shown that older patients receive adjuvant chemotherapy less frequently than younger patients.

For surgery, the main side effects are short-term pain and tenderness around the area of the operation. For chemotherapy, the side effects depend on which drugs you take and what the dosages are. Most often the side effects include nausea, vomiting, and hair loss. For radiation therapy, fatigue, loss of appetite, nausea, and diarrhea may occur.

The main way doctors find out whether colorectal cancer has returned is to use imaging devices such as a CT scan, also known as a CAT scan; magnetic resonance imaging, also known as MRI; or ultrasound. These devices create pictures of areas inside the body and let doctors see if the cancer is coming back.

Yes. One treatment, biological therapy, stimulates the immune system’s ability to fight cancer. In this therapy, substances made by the body or in a laboratory are used to boost, direct, or restore the body’s natural defenses against disease.

Another term for biological therapy is immunotherapy. At the moment, biological therapies are not standard therapy. They are experimental treatments.

Various drugs are under study as possible treatments for colorectal cancer. In May 2002 researchers found that a drug regimen consisting of oxaliplatin, 5-fluorouracil, and leucovorin can improve outcomes for patients with colorectal cancer.

A 2005 study found that patients who took the drug Avastin^TM with their standard chemotherapy treatment had a longer survival than those who did not take Avastin. The generic name for Avastin is bevacizumab.

Scientists are also working on new vaccines and monoclonal antibodies that may improve how patients’ immune systems respond to colorectal cancers. Monoclonal antibodies are a single type of antibody that researchers make in large amounts in a laboratory.

Scientists are looking at the role that sigmoidoscopy and colonoscopy may play in reducing deaths from colorectal cancer through early detection.

Two studies reported in the July 20, 2000 issue of the New England Journal of Medicine showed that colonoscopy can find many pre-cancerous polyps that sigmoidoscopy misses. However, more studies are needed to find out if colonoscopy can actually reduce the number of deaths from colorectal cancer.

Scientists are doing research on chemoprevention — the use of drugs to prevent cancer from developing in the first place. For example, researchers have found that anti-inflammatory drugs helped keep intestinal tumors from forming, but serious side effects have been noted so researchers are proceeding cautiously.

Studies have shown that non-steroidal anti-inflammatory drugs can keep large bowel polyps from forming. Bowel polyps can start out benign, or non-cancerous, but can become cancerous.

Researchers are working hard to understand and identify the genes involved in colorectal cancer. Hereditary nonpolyposis colorectal cancer, or HNPCC, is one condition that causes people to develop colorectal cancer at a young age. The discovery of four genes involved with this disease has provided crucial clues about the role of DNA repair in colorectal and other cancers.

Originator: NCI  Source: www.cancer.gov

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Prostate Cancer Defined

The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. Sometimes, however, the process goes wrong — cells become abnormal and form more cells in an uncontrolled way.

These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means not cancerous, or malignant, which means cancerous. Prostate cancer occurs when a malignant tumor forms in the tissue of the prostate, a gland in the male reproductive system. In its early stage, prostate cancer needs the male hormone testosterone to grow and survive.

The prostate is about the size of a large walnut. It is located below the bladder and in front of the rectum. The prostate’s main function is to make fluid for semen, a white substance that carries sperm.

Prostate cancer is one of the most common types of cancer among American men. It is a slow-growing disease that mostly affects older men. In fact, more than 65 percent of all prostate cancers are found in men over the age of 65. The disease rarely occurs in men younger than 40 years of age.

Sometimes, cancer cells break away from a malignant tumor in the prostate and enter the bloodstream or the lymphatic system and travel to other organs in the body.

When cancer spreads from its original location in the prostate to another part of the body such as the bone, it is called metastatic prostate cancer — not bone cancer. Doctors sometimes call this “distant” disease.

Today, more men are surviving prostate cancer than ever before. Treatment can be effective, especially when the cancer has not spread beyond the region of the prostate.

Causes and Risk Factors

Scientists don’t know exactly what causes prostate cancer. They cannot explain why one man gets prostate cancer and another does not. However, they have been able to identify some risk factors that are associated with the disease. A risk factor is anything that increases your chances of getting a disease.

Age is the most important risk factor for prostate cancer. The disease is extremely rare in men under age 40, but the risk increases greatly with age. More than 65 percent of cases are diagnosed in men over age 65. The average age at the time of diagnosis is 70.

Race is another major risk factor. In the United States, this disease is much more common in African American men than in any other group of men. It is least common in Asian and American Indian men.

A man’s risk for developing prostate cancer is higher if his father or brother has had the disease.

Diet also may play a role. There is some evidence that a diet high in animal fat may increase the risk of prostate cancer and a diet high in fruits and vegetables may decrease the risk. Studies to find out whether men can reduce their risk of prostate cancer by taking certain dietary supplements are ongoing.

Scientists have wondered whether an enlarged prostate, a condition also known as benign prostatic hyperplasia or BPH, might increase the risk for prostate cancer. They have also studied obesity, lack of exercise, smoking, radiation exposure, and a sexually transmitted virus to see if they might increase risk. But at this time, there is little evidence that any of these factors contribute to an increased risk.

Symptoms and Diagnosis

Most cancers in their early, most treatable stages don’t cause any symptoms. Early prostate cancer usually does not cause symptoms.

However, if prostate cancer develops and is not treated, it can cause these symptoms:

• a need to urinate frequently, especially at night
• difficulty starting urination or holding back urine

Possible symptoms of prostate cancer:

• inability to urinate
• weak or interrupted flow of urine
• painful or burning urination

Possible symptoms of prostate cancer:

• difficulty in having an erection
• painful ejaculation
• blood in urine or semen
• pain or stiffness in the lower back, hips, or upper thighs.

Any of these symptoms may be caused by cancer, but more often they are due to enlargement of the prostate, which is not cancer. If you have any of these symptoms, see your doctor or a urologist right away to find out if you need treatment. A urologist is a doctor who specializes in treating diseases of the genitourinary system.

The doctor will ask questions about your medical history and perform a digital rectal exam to try to find the cause of the prostate problems. In this exam, the doctor feels the prostate through the rectal wall. Hard or lumpy areas may mean cancer is present.

The doctor may also suggest a blood test to check your prostate specific antigen, or PSA, level. PSA levels can be high not only in men who have prostate cancer, but also in men with an enlarged prostate gland and men with infections of the prostate. PSA tests may be very useful for early cancer diagnosis. However, PSA tests alone do not always tell whether or not cancer is present.

Neither of these screening tests for prostate cancer is perfect. Screening tests check for disease in a person who shows no symptoms. Most men with mildly elevated PSA do not have prostate cancer, and many men with prostate cancer have normal levels of PSA. A recent study revealed that men with low prostate specific antigen levels, or PSA, may still have prostate cancer. Also, the digital rectal exam can miss many prostate cancers.

The doctor may order other exams, including ultrasound and x-rays, to learn more about the cause of the symptoms. But to confirm the presence of cancer, doctors must perform a biopsy. During a biopsy, the doctor uses needles to remove small tissue samples from the prostate and then looks at the samples under a microscope.

If a biopsy shows that cancer is present, the doctor will report on the grade of the tumor. Doctors describe a tumor as low, medium, or high-grade cancer, based on the way it appears under the microscope.

One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. The higher the score, the higher the grade of the tumor. High-grade tumors grow more quickly and are more likely to spread than low-grade tumors.

Treatments and Research - Planning Treatment

If tests show that you have cancer, you should talk with your doctor in order to make treatment decisions.

A team of specialists often treats people with cancer. The team will keep the primary doctor informed about the patient’s progress. The team may include a medical oncologist who is a specialist in cancer treatment, a surgeon, a radiation oncologist who is a specialist in radiation therapy, and others.

Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it.

Some prostate cancer patients take part in studies of new treatments. These studies — called clinical trials — are designed to find out whether a new treatment is safe and effective.

Often, clinical trials compare a new treatment with a standard one so that doctors can learn which is more effective. Men with prostate cancer who are interested in taking part in a clinical trial should talk with their doctor.

Treatments and Research - Staging Prostate Cancer

If cancer is found in the prostate, the doctor needs to know the stage of the disease and the grade of the tumor. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. The grade tells how closely the tumor resembles normal tissue in appearance under the microscope.

Doctors use various blood and imaging tests to learn the stage of the disease. Imaging tests, such as ultrasound and magnetic resonance imaging, or MRI, produce pictures of images inside the body.

There are four stages used to describe prostate cancer. Doctors may refer to the stages using the Roman numerals I-IV or the capital letters A-D. The higher the stage, the more advanced the cancer. Following are the main features of each stage.

Stage I or Stage A — The cancer is too small to be felt during a rectal exam and causes no symptoms. The doctor may find it by accident when performing surgery for another reason, usually an enlarged prostate. There is no evidence that the cancer has spread outside the prostate. A sub-stage, T1c, is a tumor identified by needle biopsy because of elevated PSA.

Stage II or Stage B — The tumor is still confined to the prostate but involves more tissue within the prostate. The cancer is large enough to be felt during a rectal exam, or it may be found through a biopsy that is done because of a high PSA level. There is no evidence that the cancer has spread outside the prostate.

Stage III or Stage C — The cancer has spread outside the prostate to nearby tissues. The person may be experiencing symptoms, such as problems with urination.

Stage IV or Stage D — The cancer has spread to lymph nodes or to other parts of the body. The bones are a common site of spread of prostate cancer. There may be problems with urination, fatigue, and weight loss.

Treatments and Research - Standard Treatments

There are a number of ways to treat prostate cancer, and the doctor will develop a treatment to fit each man’s needs. The choice of treatment mostly depends on the stage of the disease and the grade of the tumor. But doctors also consider a man’s age, general health, and his feelings about the treatments and their possible side effects.

Treatment for prostate cancer may involve watchful waiting, surgery, radiation therapy, or hormonal therapy. Some men receive a combination of therapies. A cure is the goal for men whose prostate cancer is diagnosed early.

You and your doctor will want to consider both the benefits and possible side effects of each option, especially the effects on sexual activity and urination, and other concerns about quality of life.

Surgery, radiation therapy, and hormonal therapy all have the potential to disrupt sexual desire or performance for a short while or permanently. Discuss your concerns with your health care provider. Several options are available to help you manage sexual problems related to prostate cancer treatment.

The doctor may suggest watchful waiting for some men who have prostate cancer that is found at an early stage and appears to be growing slowly. Also, watchful waiting may be advised for older men or men with other serious medical problems.

For these men, the risks and possible side effects of surgery, radiation therapy, or hormonal therapy may outweigh the possible benefits. Doctors monitor these patients with regular check-ups. If symptoms appear or get worse, the doctor may recommend active treatment.

Surgery is used to remove the cancer. It is a common treatment for early stage prostate cancer. The surgeon may remove the entire prostate with a type of surgery called radical prostatectomy or, in a few cases, remove only part of it.

Sometimes the surgeon will also remove nearby lymph nodes. Side effects of the operation may include lack of sexual function or impotence, or problems holding urine or incontinence.

Improvements in surgery now make it possible for some men to keep their sexual function. In some cases, doctors can use a new technique known as nerve-sparing surgery. This may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery.

Some men with trouble holding urine may regain control within several weeks of surgery. Others continue to have problems that require them to wear a pad.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Doctors may recommend it instead of surgery or after surgery to destroy any cancer cells that may remain in the area.

In advanced stages, the doctor may recommend radiation to relieve pain or other symptoms. It may also be used in combination with hormonal therapy. Radiation can cause problems with impotence and bowel function.

The radiation may come from a machine, which is external radiation, or from tiny radioactive seeds placed inside or near the tumor, which is internal radiation. Men who receive only the radioactive seeds usually have small tumors. Some men receive both kinds of radiation therapy.

For external radiation therapy, patients go to the hospital or clinic — usually 5 days a week for several weeks. Internal radiation may require patients to stay in the hospital for a short time.

Hormonal therapy deprives cancer cells of the male hormones they need to grow and survive. This treatment is often used for prostate cancer that has spread to other parts of the body.

Sometimes doctors use hormonal therapy to try to keep the cancer from coming back after surgery or radiation treatment. Side effects can include impotence, hot flashes, loss of sexual desire, and thinning of bones. Some hormone therapies increase the risk of blood clots.

Regardless of the type of treatment you receive, you will be closely monitored to see how well the treatment is working. Monitoring may include

• a PSA blood test — usually every 3 months to 1 year.
• bone scan and/or CT scan to see if the cancer has spread.

Monitoring may include

• a complete blood count to monitor for signs and symptoms of anemia.
• looking for signs or symptoms that the disease might be progressing, such as fatigue, increased pain, or decreased bowel and bladder function.

Treatments and Research - Latest Research

Scientists continue to look at new ways to prevent, treat, and diagnose prostate cancer. Research has already led to a number of advances in these areas.

Several studies are under way to explore the causes of prostate cancer. Some researchers think that diet may affect a man’s chances of developing prostate cancer. For example, some studies show that prostate cancer is more common in populations that consume a high-fat diet, particularly animal fat, and in populations with diets that lack certain nutrients.

Some research suggests that high levels of testosterone may increase a man’s risk of prostate cancer. The difference in prostate cancer risk among racial groups could be related to high testosterone levels, but it also could result from diet or other lifestyle factors.

Researchers are studying changes in genes that may increase the risk for developing prostate cancer. Some studies are looking at the genes of men who were diagnosed with prostate cancer at a relatively young age, such as less than 55 years old, and the genes of families who have several members with the disease. Other studies are trying to identify which genes, or arrangements of genes, are most likely to lead to prostate cancer. Much more work is needed, however, before scientists can say exactly how genetic changes relate to prostate cancer.

Several studies are under way to explore ways to prevent prostate cancer. These include the use of dietary supplements such as vitamin E and selenium. In addition, recent studies suggest that a diet that regularly includes tomato-based foods may help protect men from prostate cancer.

According to results of a recent study, men who took finasteride, a drug that affects male hormone levels, reduced their chances of getting prostate cancer by nearly 25 percent compared to men who took a placebo.

Scientists are also looking at ways to stop prostate cancer from returning in men who have already been treated for the disease. These approaches use drugs such as finasteride, flutamide, nilutamide, and LH-RH agonists that manipulate hormone levels. One recent study found that the combination of nilutamide and an experimental cancer vaccine was effective in reducing recurrence of prostate cancer. The experimental vaccine was designed to strengthen the body’s natural defenses against prostate cancer.

Researchers also are looking at diets that are low in fat and high in soy, fruits, vegetables, and other food products to see if they might prevent a recurrence.

At this time, doctors are not sure whether screening for prostate cancer actually saves lives, even if the disease is found at an earlier stage. The National Cancer Institute is sponsoring the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial to find out whether certain detection tests can reduce the number of deaths from these cancers.

This trial is looking at the usefulness of prostate cancer screening by performing a digital rectal exam and checking the PSA level in the blood in men ages 55 to 74. The results of this trial may change the way men are screened for prostate cancer.

Some researchers are working to develop new blood tests to detect the antibodies that the immune system produces to fight prostate cancer. When used along with PSA testing, the antibody tests may provide more accurate results about whether or not a man has prostate cancer.

Through research, doctors are trying to find new, more effective ways to treat prostate cancer. Cryosurgery — destroying cancer by freezing it — is under study as an alternative to surgery and radiation therapy. To avoid damaging healthy tissue, the doctor places an instrument known as a cryoprobe in direct contact with the tumor to freeze it.

Doctors are studying new ways of using radiation therapy and hormonal therapy, too. Studies have shown that hormonal therapy given after radiation therapy can help certain men whose cancer has spread to nearby tissues.

Scientists are also testing the effectiveness of chemotherapy and biological therapy for men whose cancer does not respond, or stops responding, to hormonal therapy. They are also exploring new ways to schedule and combine various treatments. For example, they are studying hormonal therapy to find out if using it to shrink the tumor before a man has surgery or radiation might be a useful approach.

For men with early stage prostate cancer, researchers are also comparing treatment with watchful waiting. The results of this work will help doctors know whether to treat early stage prostate cancer immediately or only later on, if symptoms occur or worsen.

The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy. Sometimes, however, the process goes wrong — cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means not cancerous, or malignant, which means cancerous.

The prostate is a male sex gland, about the size of a large walnut. It is located below the bladder and in front of the rectum. The prostate’s main function is to make fluid for semen, a white substance that carries sperm.

Prostate cancer occurs when a malignant tumor forms in the tissue of the prostate. In its early stage, prostate cancer needs the male hormone testosterone to grow and survive.

Prostate cancer is one of the most common types of cancer among American men. It is a slow-growing disease that mostly affects older men. In fact, more than 65 percent of all prostate cancers are found in men over the age of 65. The disease rarely occurs in men younger than 40 years of age.

Sometimes, cancer cells break away from the malignant tumor in the prostate and enter the bloodstream or the lymphatic system and travel to other organs in the body.

When cancer spreads from its original location in the prostate to another part of the body such as the bone, it is called metastatic prostate cancer, not bone cancer. Doctors sometimes call this “distant” disease.

Yes. Today, more men are surviving prostate cancer than ever before. In fact, the number of deaths from prostate cancer has been declining since the early 1990s. If found early, the disease can very likely be cured.

Scientists don’t know exactly what causes prostate cancer. They cannot explain why one man gets prostate cancer and another does not. However, they have been able to identify some risk factors that are associated with the disease. A risk factor is anything that increases your chances of getting a disease.

Age is the most important risk factor for prostate cancer. The disease is extremely rare in men under age 40, but the risk increases greatly with age. More than 65 percent of cases are diagnosed in men over age 65. The average age at the time of diagnosis is 70.

Yes. Race is another major risk factor. In the United States, this disease is much more common in African American men than in any other group of men. It is least common in Asian and American Indian men. A man’s risk for developing prostate cancer is higher if his father or brother has had the disease.

Diet also may play a role. There is some evidence that a diet high in animal fat may increase the risk of prostate cancer and a diet high in fruits and vegetables may decrease the risk. Studies to find out whether men can reduce their risk of prostate cancer by taking certain dietary supplements are ongoing.

Scientists have wondered whether an enlarged prostate, a condition also known as benign prostatic hyperplasia or BPH, might increase the risk for prostate cancer.

They have also studied obesity, lack of exercise, smoking, radiation exposure, and a sexually transmitted virus to see if they might increase risk. But at this time, there is little evidence that any of these factors contribute to an increased risk.

• a need to urinate frequently, especially at night
• difficulty starting urination or holding back urine
• inability to urinate
• weak or interrupted flow of urine

If prostate cancer develops and is not treated, it can cause these symptoms:

• painful or burning urination
• difficulty in having an erection
• painful ejaculation
• blood in urine or semen
• pain or stiffness in the lower back, hips, or upper thighs

Yes. Any of the symptoms caused by prostate cancer may also be due to enlargement of the prostate, which is not cancer. If you have any of the symptoms mentioned in question #9, see your doctor or a urologist right away to find out if you need treatment. A urologist is a doctor who specializes in treating diseases of the genitourinary system.

Doctors use the following tests to detect prostate abnormalities, but these tests cannot show whether abnormalities are cancer or another, less serious condition. The results from these tests will help the doctor decide whether to check the patient further for signs of cancer.

• Digital Rectal Exam — the doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall to check for hard or lumpy areas. A recent study revealed that men with low prostate specific antigen levels, or PSA, may still have prostate cancer.

• Blood test for prostate specific antigen or PSA — a lab measures the levels of PSA in a blood sample. The level of PSA may rise in men who have prostate cancer, an enlarged prostate, or infection in the prostate.

The doctor may order other exams, including ultrasound and x-rays, to learn more about the cause of the symptoms. But to confirm the presence of cancer, doctors must perform a biopsy. During a biopsy, the doctor uses needles to remove small tissue samples from the prostate and then looks at the samples under a microscope.

If a biopsy shows that cancer is present, the doctor will report on the grade of the tumor. Doctors describe a tumor as low, medium, or high-grade cancer, based on the way it appears under the microscope.

If cancer is found in the prostate, the doctor needs to stage the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. The doctor also needs to find out the grade of the cancer. The grade tells how closely the tumor resembles normal tissue.

There are four stages used to describe prostate cancer. Doctors may refer to the stages using Roman numerals I-IV or capital letters A-D. The higher the stage, the more advanced the cancer. Following are the main features of each stage.

Stage I or Stage A — The cancer is too small to be felt during a rectal exam and causes no symptoms. The doctor may find it by accident when performing surgery for another reason, usually an enlarged prostate. There is no evidence that the cancer has spread outside the prostate. A sub-stage, T1c, is a tumor identified by needle biopsy because of elevated PSA.

Stage II or Stage B — The tumor is still confined to the prostate but involves more tissue within the prostate. The cancer is large enough to be felt during a rectal exam, or it may be found through a biopsy that is done because of a high PSA level. There is no evidence that the cancer has spread outside the prostate.

Stage III or Stage C — The cancer has spread outside the prostate to nearby tissues. The person may be experiencing symptoms, such as problems with urination.

Stage IV or Stage D — The cancer has spread to lymph nodes or to other parts of the body. There may be problems with urination, fatigue, and weight loss.

There are a number of ways to treat prostate cancer, and the doctor will develop a treatment to fit each man’s needs. The choice of treatment mostly depends on the stage of the disease and the grade of the tumor. But doctors also consider a man’s age, general health, and his feelings about the treatments and their possible side effects.

Treatment for prostate cancer may involve watchful waiting, surgery, radiation therapy, or hormonal therapy. Some men receive a combination of therapies. A cure is probable for men whose prostate cancer is diagnosed early.

Surgery, radiation therapy, and hormonal therapy all have the potential to disrupt sexual desire or performance for a short while or permanently. Discuss your concerns with your health care provider. Several options are available to help you manage sexual problems related to prostate cancer treatment.

With watchful waiting, a man’s condition is closely monitored, but treatment does not begin until symptoms appear or change. The doctor may suggest watchful waiting for some men who have prostate cancer that is found at an early stage and appears to be growing slowly.

Also, watchful waiting may be advised for older men or men with other serious medical problems. For these men, the risks and possible side effects of surgery, radiation therapy, or hormonal therapy may outweigh the possible benefits. Doctors monitor these patients with regular check-ups. If symptoms appear or get worse, the doctor may recommend active treatment.

Surgery is a common treatment for early stage prostate cancer. It is used to remove the cancer. The surgeon may remove the entire prostate — a type of surgery called radical prostatectomy — or, in a few cases, remove only part of it.

Sometimes the surgeon will also remove nearby lymph nodes. Side effects may include lack of sexual function, which is called impotence, or problems holding urine, which is called incontinence.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Doctors may recommend it instead of surgery or after surgery to destroy any cancer cells that may remain in the area. In advanced stages, the doctor may recommend it to relieve pain or other symptoms. Radiation can cause problems with impotence and bowel function.

The radiation may come from a machine, which is external radiation, or from tiny radioactive seeds placed inside or near the tumor, which is internal radiation. Men who receive only the radioactive seeds usually have small tumors. Some men receive both kinds of radiation therapy.

For external radiation therapy, patients go to the hospital or clinic — usually 5 days a week for several weeks. Internal radiation may require patients to stay in the hospital for a short time.

Hormonal therapy deprives cancer cells of the male hormones they need to grow and survive. This treatment is often used for prostate cancer that has spread to other parts of the body. Sometimes doctors use hormonal therapy to try to keep the cancer from coming back after surgery or radiation treatment. Side effects can include impotence, hot flashes, loss of sexual desire, and thinning of bones.

Regardless of the type of treatment you receive, you will be closely monitored to see how well the treatment is working.

Monitoring may include

• a PSA blood test, usually every 3 months to 1 year.
• bone scan and/or CT scan to see if the cancer has spread.

• a complete blood count to monitor for signs and symptoms of anemia.
• looking for signs or symptoms that the disease might be progressing, such as fatigue, increased pain, or decreased bowel and bladder function.

Through research, doctors are trying to find new, more effective ways to treat prostate cancer. Cryosurgery — destroying cancer by freezing it — is under study as an alternative to surgery and radiation therapy. To avoid damaging healthy tissue, the doctor places an instrument known as a cryoprobe in direct contact with the tumor to freeze it.

Doctors are studying new ways of using radiation therapy and hormonal therapy, too. Studies have shown that hormonal therapy given after radiation therapy can help certain men whose cancer has spread to nearby tissues.

Scientists are also testing the effectiveness of chemotherapy and biological therapy for men whose cancer does not respond or stops responding to hormonal therapy.

They are also exploring new ways to schedule and combine various treatments. For example, they are studying hormonal therapy to find out if using it to shrink the tumor before a man has surgery or radiation might be a useful approach. They are also testing combinations of hormone therapy and vaccines to prevent recurrence of prostate cancer.

Researchers are studying changes in genes that may increase the risk for developing prostate cancer. Some studies are looking at the genes of men who were diagnosed with prostate cancer at a relatively young age, less than 55 years old, and the genes of families who have several members with the disease. Other studies are trying to identify which genes, or arrangements of genes, are most likely to lead to prostate cancer.

Much more work is needed, however, before scientists can say exactly how genetic changes relate to prostate cancer. At the moment, no genetic risk has been firmly established.

Some prostate cancer patients take part in studies of new treatments. These studies — called clinical trials — are designed to find out whether a new treatment is safe and effective. Often, clinical trials compare a new treatment with a standard one so that doctors can learn which is more effective. People with prostate cancer who are interested in taking part in a clinical trial should talk with their doctor.

Diet may play a role. There is some evidence that a diet high in animal fat may increase the risk of prostate cancer and a diet high in fruits and vegetables may decrease the risk.

Researchers are also looking at diets that are low in fat and high in soy, fruits, vegetables, and other food products to see if they might prevent a recurrence of prostate cancer. In addition, recent studies suggest that a diet that regularly includes tomato-based foods may help protect men from prostate cancer.

Studies to find out whether men can reduce their risk of prostate cancer by taking certain dietary supplements are ongoing.

These studies include the use of dietary supplements such as vitamin E and selenium. At the moment, no dietary factor has been proven to change your risk of developing prostate cancer or to alter the course of the disease after diagnosis.

Living with a serious disease such as cancer is not easy. Some people find they need help coping with the emotional as well as the practical aspects of their disease. Patients often get together in support groups where they can share what they have learned about coping with their disease and the effects of treatment. Patients may want to talk with a member of their health care team about finding a support group.

People living with cancer may worry about caring for their families, keeping their jobs, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, dietitians, and other members of the health care team can answer questions about treatment, working, or other activities.

Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for help with rehabilitation, emotional support, financial aid, transportation, or home care.

It is natural for a man and his partner to be concerned about the effects of prostate cancer and its treatment on their sexual relationship. They may want to talk with the doctor about possible side effects and whether these are likely to be temporary or permanent. Whatever the outlook, it is usually helpful for patients and their partners to talk about their concerns and help one another find ways to be intimate during and after treatment.

Originator: NCI Source: www.cancer.gov

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