Volume I ABCD — Delta-9-tetrahydrocannabinol
Editor
Jeffrey A. Knight, Ph.D. Mount Holyoke College
Medical Consultan...
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Volume I ABCD — Delta-9-tetrahydrocannabinol
Editor
Jeffrey A. Knight, Ph.D. Mount Holyoke College
Medical Consultants
Laurie Jackson-Grusby, Ph.D. Children’s Hospital Boston, Harvard Medical School
Wendy White-Ryan, M.D., FAAP Golisano Children’s Hospital at Strong Memorial Hospital
SALEM PRESS, INC. Pasadena, California Hackensack, New Jersey
Editor in Chief: Dawn P. Dawson Editorial Director: Christina J. Moose Project Editors: Tracy Irons-Georges, Rowena Wildin Dehanke Editorial Assistant: Dana Garey
Production Editor: Joyce I. Buchea Acquisitions Editor: Mark Rehn Photo Editor: Cynthia Breslin Beres Design and Graphics: James Hutson Layout: William Zimmerman
Copyright © 2009, by Salem Press, Inc. All rights in this book are reserved. No part of this work may be used or reproduced in any manner whatsoever or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the copyright owner except in the case of brief quotations embodied in critical articles and reviews or in the copying of images deemed to be freely licensed or in the public domain. For information address the publisher, Salem Press, Inc., P.O. Box 50062, Pasadena, California 91115. ∞ The paper used in these volumes conforms to the American National Standard for Permanence of Paper for Printed Library Materials, Z39.48-1992 (R1997). Note to Readers The material presented in Salem Health: Cancer is intended for broad informational and educational purposes. Readers who suspect that they or someone whom they know or provide caregiving for suffers from cancer or any other physical or psychological disorder, disease, or condition described in this set should contact a physician without delay; this work should not be used as a substitute for professional medical diagnosis or staging. Readers who are undergoing or about to undergo any treatment or procedure described in this set should refer to their physicians and other health care team members for guidance concerning preparation and possible effects. This set is not to be considered definitive on the covered topics, and readers should remember that the field of health care is characterized by a diversity of medical opinions and constant expansion in knowledge and understanding. Library of Congress Cataloging-in-Publication Data Salem health : cancer / Jeffrey A. Knight, Laurie Jackson-Grusby, Wendy White-Ryan. p. cm. Includes bibliographical references and index. ISBN 978-1-58765-505-0 (set : alk. paper) — ISBN 978-1-58765-506-7 (vol. 1 : alk. paper) — ISBN 978-1-58765-507-4 (vol. 2 : alk. paper) — ISBN 978-1-58765-508-1 (vol. 3 : alk. paper) — ISBN 978-1-58765-509-8 (vol. 4 : alk. paper) 1. Cancer. I. Knight, Jeffrey A., 1948- II. Jackson-Grusby, Laurie. III. White-Ryan, Wendy. RC265.S32 2008 616.99′4—dc22 2008030861
First Printing
printed in the united states of america
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Contents Alopecia . . . . . . . . . . . . . . . . . . . . . . . . 47 ALP. See Alkaline phosphatase test Alpha-fetoprotein (AFP) levels . . . . . . . . . . . . 48 Alternative therapies. See Complementary and alternative therapies Alveolar soft-part sarcomas . . . . . . . . . . . . . . 49 Amenorrhea . . . . . . . . . . . . . . . . . . . . . . 50 American Association for Cancer Research (AACR) . . . . . . . . . . . . . . . . . . . . . . . 52 American Cancer Society (ACS) . . . . . . . . . . . 53 American Institute for Cancer Research (AICR) . . . 54 4-Aminobiphenyl . . . . . . . . . . . . . . . . . . . 56 AML. See Acute myelocytic leukemia Amputation . . . . . . . . . . . . . . . . . . . . . . 56 Amyloidosis . . . . . . . . . . . . . . . . . . . . . . 58 Anal cancer . . . . . . . . . . . . . . . . . . . . . . 59 Androgen drugs . . . . . . . . . . . . . . . . . . . . 61 Anemia . . . . . . . . . . . . . . . . . . . . . . . . 62 Anemia, aplastic. See Aplastic anemia Anemia, hemolytic. See Hemolytic anemia Angiogenesis . . . . . . . . . . . . . . . . . . . . . 64 Angiogenesis inhibitors . . . . . . . . . . . . . . . . 66 Angiography. . . . . . . . . . . . . . . . . . . . . . 68 Angiosarcomas . . . . . . . . . . . . . . . . . . . . 69 Anoscopy . . . . . . . . . . . . . . . . . . . . . . . 70 Anthraquinones . . . . . . . . . . . . . . . . . . . . 71 Anthrax . . . . . . . . . . . . . . . . . . . . . . . . 71 Antiandrogens . . . . . . . . . . . . . . . . . . . . . 72 Antidiarrheal agents . . . . . . . . . . . . . . . . . . 73 Antiestrogens . . . . . . . . . . . . . . . . . . . . . 75 Antifungal therapies . . . . . . . . . . . . . . . . . . 76 Antimetabolites in chemotherapy . . . . . . . . . . . 78 Antinausea medications . . . . . . . . . . . . . . . . 81 Antineoplastics in chemotherapy . . . . . . . . . . . 83 Antioxidants . . . . . . . . . . . . . . . . . . . . . . 86 Antiperspirants and breast cancer . . . . . . . . . . . 88 Antiviral therapies. . . . . . . . . . . . . . . . . . . 90 Anxiety . . . . . . . . . . . . . . . . . . . . . . . . 93 APBI. See Accelerated partial breast irradiation APC gene testing . . . . . . . . . . . . . . . . . . . 94 Aplastic anemia . . . . . . . . . . . . . . . . . . . . 95 Appendix cancer . . . . . . . . . . . . . . . . . . . 97 Appetite loss. . . . . . . . . . . . . . . . . . . . . . 98 APR. See Abdominoperineal resection Arsenic compounds . . . . . . . . . . . . . . . . . 100 Arterial embolization . . . . . . . . . . . . . . . . 101 Artificial sweeteners . . . . . . . . . . . . . . . . . 102 Asbestos . . . . . . . . . . . . . . . . . . . . . . . 103
Publisher’s Note . . . . . . . . . . . . . . . . . . . . ix About the Editors . . . . . . . . . . . . . . . . . . . xi Contributors . . . . . . . . . . . . . . . . . . . . . xiii Complete List of Contents . . . . . . . . . . . . . . xv AACR. See American Association for Cancer Research ABCD. . . . . . . . . . . . . . . . . . . . . . . . . . 1 ACC. See Adenoid cystic carcinoma Abdominoperineal resection (APR) . . . . . . . . . . 1 Accelerated partial breast irradiation (APBI). . . . . . 3 Achlorhydria . . . . . . . . . . . . . . . . . . . . . . 4 Acoustic neuromas . . . . . . . . . . . . . . . . . . . 4 Acquired immunodeficiency disease-related cancers. See HIV/AIDS-related cancers Acrylamides . . . . . . . . . . . . . . . . . . . . . . 6 ACS. See American Cancer Society Acupuncture and acupressure for cancer patients . . . 8 Acute lymphocytic leukemia (ALL) . . . . . . . . . 11 Acute myelocytic leukemia (AML) . . . . . . . . . . 13 Adenocarcinomas . . . . . . . . . . . . . . . . . . . 16 Adenoid cystic carcinoma (ACC) . . . . . . . . . . . 17 Adenomatoid tumors . . . . . . . . . . . . . . . . . 18 Adenomatous polyps . . . . . . . . . . . . . . . . . 18 Adenoviruses . . . . . . . . . . . . . . . . . . . . . 19 Adjuvant therapy . . . . . . . . . . . . . . . . . . . 20 Adrenal gland cancers . . . . . . . . . . . . . . . . . 21 Adrenocortical cancer . . . . . . . . . . . . . . . . . 23 Advance directives . . . . . . . . . . . . . . . . . . 24 Aflatoxins . . . . . . . . . . . . . . . . . . . . . . . 26 AFP levels. See Alpha-fetoprotein levels African Americans and cancer . . . . . . . . . . . . 28 Africans and cancer . . . . . . . . . . . . . . . . . . 31 Afterloading radiation therapy . . . . . . . . . . . . 32 Agent Orange . . . . . . . . . . . . . . . . . . . . . 34 Aging and cancer . . . . . . . . . . . . . . . . . . . 34 AICR. See American Institute for Cancer Research Aids and devices for cancer patients . . . . . . . . . 38 AIDS-related cancers. See HIV/AIDS-related cancers Air pollution . . . . . . . . . . . . . . . . . . . . . . 39 Alcohol, alcoholism, and cancer . . . . . . . . . . . 42 Aleukemia . . . . . . . . . . . . . . . . . . . . . . . 43 Alkaline phosphatase test (ALP) . . . . . . . . . . . 44 Alkylating agents in chemotherapy . . . . . . . . . . 45 ALL. See Acute lymphocytic leukemia Allicin, garlic and. See Garlic and allicin v
Salem Health: Cancer Ascites . . . . . . . . . . . . Ashkenazi Jews and cancer . Asian Americans and cancer. Astrocytomas. . . . . . . . . Ataxia telangiectasia (AT) . . Autologous blood transfusion Axillary dissection . . . . . . Azathioprine . . . . . . . . .
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105 107 109 112 114 115 116 117
Bacillus Calmette Guérin (BCG) . . . . . . . . Bacteria as causes of cancer . . . . . . . . . . . Barium enema . . . . . . . . . . . . . . . . . . Barium swallow . . . . . . . . . . . . . . . . . Barrett esophagus . . . . . . . . . . . . . . . . Basal cell carcinomas . . . . . . . . . . . . . . BCG. See Bacillus Calmette Guérin Beckwith-Wiedemann syndrome (BWS) . . . . Benign prostatic hyperplasia (BPH) . . . . . . . Benign tumors . . . . . . . . . . . . . . . . . . Benzene . . . . . . . . . . . . . . . . . . . . . Benzidine and dyes metabolized to benzidine . . Benzodiazepines . . . . . . . . . . . . . . . . . Bereavement, grief and. See Grief and bereavement Beryllium and beryllium compounds . . . . . . Beta-carotene . . . . . . . . . . . . . . . . . . Bethesda criteria . . . . . . . . . . . . . . . . . BHDS. See Birt-Hogg-Dubé syndrome Bile duct cancer . . . . . . . . . . . . . . . . . Bilobectomy . . . . . . . . . . . . . . . . . . . Bioflavonoids . . . . . . . . . . . . . . . . . . Biological therapy . . . . . . . . . . . . . . . . Biopsy. See also Computed tomography-guided biopsy; Core needle biopsy; Liver biopsy; Needle biopsies; Pleural biopsy; Stereotactic needle biopsy; Surgical biopsies . . . . . . . Birt-Hogg-Dubé syndrome (BHDS) . . . . . . . Birth control pills and cancer . . . . . . . . . . Bis(chloromethyl) ether and technical-grade chloromethyl methyl ether . . . . . . . . . . Bisphenol A (BPA) . . . . . . . . . . . . . . . Bisphosphonates . . . . . . . . . . . . . . . . . Bladder cancer . . . . . . . . . . . . . . . . . . Blood cancers . . . . . . . . . . . . . . . . . . BMT. See Bone marrow transplantation BNCT. See Boron neutron capture therapy Body image. See Self-image and body image Bone cancers . . . . . . . . . . . . . . . . . . . Bone marrow aspiration and biopsy . . . . . . . Bone marrow transplantation (BMT) . . . . . . Bone pain . . . . . . . . . . . . . . . . . . . .
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118 118 120 121 123 124
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126 128 128 130 131 132
Bone scan . . . . . . . . . . . . . . . . . . . . Boron neutron capture therapy (BNCT) . . . . . Bowen disease . . . . . . . . . . . . . . . . . . BPA. See Bisphenol A BPH. See Benign prostatic hyperplasia BPI. See Brief Pain Inventory Brachytherapy . . . . . . . . . . . . . . . . . . BRAF gene . . . . . . . . . . . . . . . . . . . . Brain and central nervous system cancers . . . . Brain scan . . . . . . . . . . . . . . . . . . . . BRCA1 and BRCA2 genes . . . . . . . . . . . . Breakthrough pain . . . . . . . . . . . . . . . . Breast, calcifications of. See Calcifications of the breast Breast, medullary carcinoma of. See Medullary carcinoma of the breast Breast cancer, cutaneous. See Cutaneous breast cancer Breast cancer, estrogen-receptor-sensitive. See Estrogen-receptor-sensitive breast cancer Breast cancer in children and adolescents . . . . Breast cancer in men . . . . . . . . . . . . . . . Breast cancer in pregnant women . . . . . . . . Breast cancers . . . . . . . . . . . . . . . . . . Breast implants. . . . . . . . . . . . . . . . . . Breast reconstruction. . . . . . . . . . . . . . . Breast self-examination (BSE). . . . . . . . . . Breast ultrasound. . . . . . . . . . . . . . . . . Breslow’s staging . . . . . . . . . . . . . . . . Brief Pain Inventory (BPI) . . . . . . . . . . . . Brompton cocktail . . . . . . . . . . . . . . . . Bronchial adenomas . . . . . . . . . . . . . . . Bronchoalveolar lung cancer . . . . . . . . . . Bronchography. . . . . . . . . . . . . . . . . . Bronchoscopy . . . . . . . . . . . . . . . . . . BSE. See Breast self-examination Burkitt lymphoma . . . . . . . . . . . . . . . . 1,3-Butadiene . . . . . . . . . . . . . . . . . . 1,4-Butanediol dimethanesulfonate . . . . . . . BWS. See Beckwith-Wiedemann syndrome
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CA 15-3 test . . . . . . . . . . . . . CA 19-9 test . . . . . . . . . . . . . CA 27-29 test . . . . . . . . . . . . CA 125 test. . . . . . . . . . . . . . Cachexia . . . . . . . . . . . . . . . Cadmium and cadmium compounds. Caffeine . . . . . . . . . . . . . . . Calcifications of the breast. . . . . . Calcium . . . . . . . . . . . . . . . Cancell . . . . . . . . . . . . . . . . vi
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205 205 206 206 207 208 209 211 212 212
Contents Cancer biology . . . . . . . . . . . . . . . . . . . Cancer care team . . . . . . . . . . . . . . . . . . Cancer clusters . . . . . . . . . . . . . . . . . . . Cancer education. . . . . . . . . . . . . . . . . . Candidiasis . . . . . . . . . . . . . . . . . . . . . Carcinoembryonic antigen antibody (CEA) test . . . . . . . . . . . . . . . . . . . . . . . . Carcinogens, known . . . . . . . . . . . . . . . . Carcinogens, reasonably anticipated. . . . . . . . Carcinoid tumors and carcinoid syndrome . . . . Carcinoma of unknown primary origin (CUP) . . . . . . . . . . . . . . . . . . . . . . Carcinomas. . . . . . . . . . . . . . . . . . . . . Carcinomas, invasive ductal. See Invasive ductal carcinomas Carcinomas, invasive lobular. See Invasive lobular carcinomas Carcinomas, leptomeningeal. See Leptomeningeal carcinomas Carcinomatosis. . . . . . . . . . . . . . . . . . . Carcinomatous meningitis . . . . . . . . . . . . . Carcinosarcomas . . . . . . . . . . . . . . . . . . Cardiomyopathy in cancer patients . . . . . . . . Cardiopulmonary resuscitation (CPR) . . . . . . . Caregivers and caregiving . . . . . . . . . . . . . Caregiving, long-distance. See Long-distance caregiving Carney complex . . . . . . . . . . . . . . . . . . Carotenoids . . . . . . . . . . . . . . . . . . . . Cartilage supplements . . . . . . . . . . . . . . . Case management . . . . . . . . . . . . . . . . . Castleman disease . . . . . . . . . . . . . . . . . CBC. See Complete blood count CBE. See Clinical breast exam CDKN2A. See Cyclin-dependent kinase inhibitor-2A CEA test. See Carcinoembryonic antigen antibody test Cell phones. . . . . . . . . . . . . . . . . . . . . Cervical cancer. . . . . . . . . . . . . . . . . . . Chemoembolization . . . . . . . . . . . . . . . . Chemoprevention . . . . . . . . . . . . . . . . . Chemotherapy . . . . . . . . . . . . . . . . . . . Chemotherapy, cognitive effects of. See Cognitive effects of cancer and chemotherapy Chewing tobacco. . . . . . . . . . . . . . . . . . Childbirth and cancer . . . . . . . . . . . . . . . Childhood cancers . . . . . . . . . . . . . . . . . Chlorambucil. . . . . . . . . . . . . . . . . . . . 1-(2-Chloroethyl)-3-(4-methylcyclohexyl)1-nitrosourea (MeCCNU) . . . . . . . . . . . .
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213 216 218 220 221
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223 224 227 230
Cholecystectomy . . . . . . . . . . . . . . . . . Chordomas . . . . . . . . . . . . . . . . . . . . Choriocarcinomas . . . . . . . . . . . . . . . . CHPP. See Continuous hyperthermic peritoneal perfusion Chromium hexavalent compounds. . . . . . . . Chromosomes and cancer . . . . . . . . . . . . Chronic lymphocytic leukemia (CLL) . . . . . . Chronic myeloid leukemia (CML). . . . . . . . Cigarettes and cigars . . . . . . . . . . . . . . . Clinical breast exam (CBE) . . . . . . . . . . . Clinical trials . . . . . . . . . . . . . . . . . . . CLL. See Chronic lymphocytic leukemia CML. See Chronic myeloid leukemia Coal tars and coal tar pitches . . . . . . . . . . Cobalt 60 radiation. . . . . . . . . . . . . . . . Coenzyme Q10. . . . . . . . . . . . . . . . . . Cognitive effects of cancer and chemotherapy . Coke oven emissions. . . . . . . . . . . . . . . Cold nodule . . . . . . . . . . . . . . . . . . . Colectomy . . . . . . . . . . . . . . . . . . . . Coloanal anastomosis . . . . . . . . . . . . . . Colon polyps . . . . . . . . . . . . . . . . . . . Colonoscopy and virtual colonoscopy . . . . . . Colony-stimulating factors (CSFs) . . . . . . . Colorectal cancer. . . . . . . . . . . . . . . . . Colorectal cancer screening . . . . . . . . . . . Colostomy . . . . . . . . . . . . . . . . . . . . Colposcopy. . . . . . . . . . . . . . . . . . . . Comedo carcinomas . . . . . . . . . . . . . . . Complementary and alternative therapies . . . . Complete blood count (CBC) . . . . . . . . . . Computed tomography (CT)-guided biopsy . . . . . . . . . . . . . . . . . . . . . Computed tomography (CT) scan . . . . . . . . Conization . . . . . . . . . . . . . . . . . . . . Continuous hyperthermic peritoneal perfusion (CHPP) . . . . . . . . . . . . . . . . . . . . Cordectomy . . . . . . . . . . . . . . . . . . . Cordotomy . . . . . . . . . . . . . . . . . . . . Core needle biopsy. . . . . . . . . . . . . . . . Corticosteroids . . . . . . . . . . . . . . . . . . Coughing . . . . . . . . . . . . . . . . . . . . . Counseling for cancer patients and survivors . . Cowden syndrome . . . . . . . . . . . . . . . . COX-2 inhibitors. See Cyclooxygenase 2 inhibitors CPR. See Cardiopulmonary resuscitation Craniopharyngiomas . . . . . . . . . . . . . . . Craniosynostosis . . . . . . . . . . . . . . . . . Craniotomy. . . . . . . . . . . . . . . . . . . .
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288 289 289 290 292 292 293 294 296 297 299 300 304 306 308 309 309 312
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Salem Health: Cancer Crohn disease . . . . . . . . . . . . . . . Cruciferous vegetables . . . . . . . . . . . Cryoablation . . . . . . . . . . . . . . . . Cryptorchidism. . . . . . . . . . . . . . . CSFs. See Colony-stimulating factors CT scan. See Computed tomography scan CTCL. See Cutaneous T-cell lymphoma Culdoscopy. . . . . . . . . . . . . . . . . CUP. See Carcinoma of unknown primary origin Curcumin. . . . . . . . . . . . . . . . . . Cushing syndrome and cancer . . . . . . . Cutaneous breast cancer . . . . . . . . . . Cutaneous T-cell lymphoma (CTCL) . . . Cyclin-dependent kinase inhibitor-2A (CDKN2A). . . . . . . . . . . . . . . .
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332 335 336 338
Cyclooxygenase 2 (COX-2) inhibitors . Cyclophosphamide. . . . . . . . . . . . Cyclosporin A . . . . . . . . . . . . . . Cystography . . . . . . . . . . . . . . . Cystoscopy . . . . . . . . . . . . . . . . Cytogenetics . . . . . . . . . . . . . . . Cytokines . . . . . . . . . . . . . . . . Cytology . . . . . . . . . . . . . . . . . Cytology, sputum. See Sputum cytology
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339 340 341 342
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344 345 346 347 347 348 350 350
D&C. See Dilation and curettage Dana-Farber Cancer Institute . . . . . . . . . . . . 354 DCIS. See Ductal carcinoma in situ DEA. See Diethanolamine DEHP. See Di(2-ethylhexyl) phthalate Delta-9-tetrahydrocannabinol . . . . . . . . . . . . 355
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Publisher’s Note not only the names of the specializations but also related subspecialists, the cancers they treat, how they are trained and certified, and the range of services and procedures they perform. Finally, a group of topics addressing social and personal issues, lifestyle choices, nutritional supplements, and complementary or alternative therapies are similarly formatted into subsections that call out key areas of interest for readers. Special features of the set include tables throughout identifying the most important chemotherapeutic and other drugs and the symptoms and conditions they address, population statistics, survival rates, and other core information. Every essay includes a section of “See also” cross-references to other essays in the set that will be of interest to those consulting the topic at hand. A fully crossreferenced “Complete List of Contents” at the beginning of every volume also assists readers in locating related topics of interest. Photographs display for readers typical instances of lesions, tumors, procedures, and anatomical cross-sections to locate areas of the body affected. In addition, 8 appendixes at the end of volume 4 provide information on the following:
Salem Health: Cancer alphabetically arranges 835 essays on all aspects of cancer for all nonspecialist interest groups—from those who have been diagnosed to caregivers, family members, students, and readers with a general interest in health. The essays in this 4-volume set address diseases, conditions, symptoms, cancer-related syndromes, chemotherapy and other drugs, cancer centers, genetics, the biology of cancer, medical specialties, tests, procedures, complementary and alternative therapies, lifestyles, healthy and preventive strategies, and the many social and personal issues surrounding cancer, from cancer’s impact on minority populations to finances, insurance, relationships, and emotional coping. Written by physicians, nurses, and professional medical writers whose credentials and degrees are clearly listed in the byline to every essay, this comprehensive reference publication will be of interest not only to public library patrons but also to premedical students and those building collections for the patient population. Essays vary in length from 400 to 2,000 words, ranging from one to five pages. The information is presented in one of six standard essay formats by type of topic covered: carcinogen, disease or condition, drug or drug class, medical specialty, procedure, or “overview” (of an aspect of cancer biology, a personal or lifestyle issue, or an area of social concern). All essays present a capsule definition of the topic, and all but the briefest essays list sources of further information from both print and online resources. The essay formats are designed for the reader for whom the information is compelling or urgent, fostering quick identification and retrieval of essential facts: Essays on diseases and conditions, for example, list “also known as” names and describe related conditions, risk factors, the disease process, incidence, symptoms, screening and diagnosis, treatment, and prognosis. Essays on carcinogens list “also known as” names for the chemical or substance, cancers related to the carcinogen, exposure routes, principal places where the substance is found, populations at risk, symptoms to watch for, and a brief history of how we came to identify the substance as a carcinogen. Essays on drugs list the Anatomical Therapeutic Chemical (ATC) classification system code if one exists; the types of cancer, side effect, or other condition for which the drug is indicated; the delivery routes (such as pill form or injection); the way the drug works; and side effects. Essays on procedures apprise patients and their caregivers of why the procedure is performed, how to prepare, aftercare, risks, and the range of results. Essays on medical specialties identify
• • • • • • • •
Drugs by Generic Name Drugs by Trade Name Associations and Agencies Cancer Centers and Hospitals Cancer Support Groups Carcinogens Glossary Bibliography
A Category List and a complete subject index round out the set. Salem Health: Cancer has been the beneficiary of many expert contributors—physicians, nurses, pharmacists, and professional medical writers—whose names and academic or professional affiliations appear in the list of contributors that follows. Finally, this publication was made possible above all by our three consulting editors: Jeffrey A. Knight, Chair of the Department of Biological Sciences at Mount Holyoke College; Laurie JacksonGrusby, Ph.D., Assistant Professor in Pathology at Harvard Medical School, Children’s Hospital Boston; and Wendy White-Ryan, M.D., FAAP, is a board-certified pediatrician and member of the American Academy of Pediatrics. ix
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About the Editors from the Sontag Foundation for her work on pediatric brain tumors.
Jeffrey A. Knight, Ph.D., is Chair of the Department of Biological Sciences at Mount Holyoke College, where he teaches courses in genetics, molecular biology, and microbiology. He has held Visiting Professor appointments at the medical schools of the Universities of Massachusetts, Florida, and Vermont. Author of several research papers on the mitochondrial genetics of baker’s yeast, he has also been a frequent contributor to Salem Press publications. He edited the first edition of the Encyclopedia of Genetics (Salem Press, 1999), winner of the American Library Association, Reference and User Services Association’s “Outstanding Reference Source,” 2000.
Wendy White-Ryan, M.D., FAAP, is a board-certified pediatrician and member of the American Academy of Pediatrics as well as Alpha Omega Alpha. She completed her B.A. at Mount Holyoke College, her M.D. at New York Medical College, and her residency training in pediatrics at Strong Memorial Hospital in Rochester, New York. She worked in toxicology research at the University of Rochester for two years between earning her bachelor’s degree and entering medical school. She practiced pediatrics full-time for nine years in the inner city of Rochester until being diagnosed with Stage IV breast cancer in 2005. She became medically stable after undergoing both conventional and integrative treatments, including changes in diet and exercise, while remaining affiliated with Golisano Children’s Hospital at Strong Memorial Hospital in Rochester. She supports mind-body work, nutritional support through nutriceuticals, and other health-promoting lifestyle changes in the prevention or treatment of cancer.
Laurie Jackson-Grusby, Ph.D., is an Assistant Professor in Pathology at Harvard Medical School, Children’s Hospital Boston, and a faculty member of the Harvard Stem Cell Institute and Kirby Center for Neuroscience. She is a visiting instructor at the Harvard Extension school, where she teaches genetics. Her laboratory investigates the role of epigenetics in development of disease. She was awarded the Distinguished Scientist Award
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Contributors
Abbie L. Abboud, M.S., C.G.C.
Kerry L. Cheesman, Ph.D.
H. Bradford Hawley, M.D.
Richard Adler, Ph.D.
Wanda E. Clark, M.T. (ASCP)
Peter B. Heller, Ph.D.
Jane Adrian, M.P.H., Ed.M., M.T. (ASCP)
Lisa M. Cockrell, B.S.
Collette Bishop Hendler, R.N., M.S.
Pam Conboy, B.S.
Michelle L. Herdman, Ph.D.
Pamela S. Cooper, Ph.D.
Jennifer M. Hickin, B.S.
Angela M. Costello, B.S.
Carl W. Hoagstrom, Ph.D.
Charlotte Crowder, M.P.H., ELS
Christine G. Holzmueller, B.L.A.
Reyniel Cruz-Aguado, Ph.D.
Mary Hurd, M.A.
D. Scott Cunningham, M.D., Ph.D.
Bernard Jacobson, Ph.D.
Arun S. Dabholkar, Ph.D.
Clair Kaplan, R.N., M.S.N., A.P.R.N. (WHNP), M.H.S., M.T. (ASCP)
Robert J. Amato, D.O. Cathy Anderson, R.N., B.A. Terry A. Anderson, B.S. Wendell Anderson, B.A. Michele Arduengo, Ph.D., ELS Bryan C. Auday, Ph.D. Tanja Bekhuis, Ph.D. Paul F. Bell, Ph.D. Alvin K. Benson, Ph.D. Anna Binda, Ph.D. Robert Bockstiegel, B.S. Scott A. Boerner, M.S. Patricia Boone, Ph.D. Andrea Bradford, M.A. Wanda Todd Bradshaw, R.N.C., M.S.N. Thomas L. Brown, Ph.D. Suzette Buhr, R.T.R., C.D.A. Amy Bull, D.S.N., A.P.N. Michael A. Buratovich, Ph.D. Bharat Burman, B.A. Jaime Stockslager Buss, M.S.P.H., ELS Alex B. Cantrell, B.A. Richard P. Capriccioso, M.D. Mary Car-Blanchard, O.T.D., B.S.O.T. Christine M. Carroll, R.N., B.S.N., M.B.A.
Helen Davidson, B.A. Martiscia Davidson, A.M. Cynthia L. De Vine, B.A. Jackie Dial, Ph.D. Jeremy W. Dugosh, Ph.D. Aldo C. Dumlao, M.D Patricia Stanfill Edens, R.N., Ph.D., FACHE Renée Euchner, R.N. Jill Ferguson, Ph.D.
Susan J. Karcher, Ph.D. Sarah Kasprowicz, M.D. Michelle Kasprzak, R.N., B.S.N., O.C.N. Keller Kaufman-Fox, B.A. Debra B. Kessler, M.D., Ph.D. A. K. Khan, M.D., M.R.C.P. M. A. Q. Khan, M.D., Ph.D. Samreen F. Khan, M.A. Ing-Wei Khor, Ph.D.
Adi Ferrara, B.S. Amber L. Fields, M.S. K. Thomas Finley, Ph.D. MaryAnn Foote, M.S., Ph.D. Jo Gambosi, M.A., B.S.N. James S. Godde, Ph.D. Janet R. Green, M.S.P.H. Katrina Green, R.N., B.S.N., O.C.N. Silke Haidekker, Ph.D. Linda Hart, M.S., M.A. Melanie Hawkins, B.S.N., R.N., O.C.N. xiii
Michael R. King, Ph.D. Samuel V. A. Kisseadoo, Ph.D. Jeffrey A. Knight, Ph.D. Marylane Wade Koch, M.S.N., R.N. Robert W. Koch, D.N.S., R.N. Lalitha Krishnan, Ph.D. Anita P. Kuan, Ph.D. Steven A. Kuhl, Ph.D. Jeffrey P. Larson, P.T., B.S., A.T.C. Lindsay Lewellyn, B.S. Lisa M. Lines, M.P.H.
Salem Health: Cancer Martha O. Loustaunau, Ph.D.
Marcia Pinneau, R.N.
Amanda McQuade, Ph.D.
Nancy A. Piotrowski, Ph.D.
Kyle J. McQuade, Ph.D.
Victoria Price, Ph.D.
Marianne M. Madsen, M.S.
Christopher Pung, B.S., C.L.Sp. (CG)
Judy Majewski, M.S.
Cynthia Racer, M.A., M.P.H.
Elizabeth A. Manning, Ph.D.
Bagirathy Ravishankar, Ph.D.
Vicki Miskovsky, B.S., R.D.
Pamela Richardson, M.S.
Paul Moglia, Ph.D.
Alice C. Richer, R.D., M.B.A., L.D.
Christina J. Moose, M.A.
Elizabeth D. Schafer, Ph.D.
Linda August Vrooman, R.N., B.S.N., O.C.N.
Karen M. Nagel, Ph.D.
Jason J. Schwartz, Ph.D., J.D.
C. J. Walsh, Ph.D.
Anita Nagypál, Ph.D.
Miriam E. Schwartz, M.D., M.A., Ph.D.
Stephanie Watson, B.S.
Amy J. Neil, M.S., M.A.P. David A. Olle, M.S. Colm A. Ó’Moráin, M.A., M.D., M.Sc., D.Sc.
Banalata Sen, Ph.D. Terry J. Shackleford, Ph.D. Lisa J. Shientag, V.M.D.
Carol Ann Suda, B.S., M.T. (ASCP), S.M. Rena C. Tabata, M.Sc. Dorothy P. Terry, R.N. Susan E. Ullmann, M.T. (ASCP), M.A. Nicole M. Van Hoey, Pharm.D. Charles L. Vigue, Ph.D.
Marcia J. Weiss, J.D. John B. Welsh, M.D., Ph.D. Bradley R. A. Wilson, Ph.D.
Ophelia Panganiban, B.S.
R. Baird Shuman, Ph.D.
Nicola E. Wittekindt, Dr.Sc. (ETH Zürich)
Jeannie V. Pasacreta, Ph.D., A.P.R.N.
Vonne Sieve, M.A.
Geetha Yadav, Ph.D.
Anna Perez, M.Sc.
Dwight G. Smith, Ph.D.
John L. Zeller, M.D., Ph.D.
Susan H. Peterman, M.P.H.
Richard S. Spira, D.V.M.
Diego Pineda, M.S.
Kelli Miller Stacy, ELS
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Complete List of Contents Volume 1 Alkylating agents in chemotherapy . . . . . . . ALL. See Acute lymphocytic leukemia Allicin, garlic and. See Garlic and allicin Alopecia . . . . . . . . . . . . . . . . . . . . . ALP. See Alkaline phosphatase test Alpha-fetoprotein (AFP) levels . . . . . . . . . Alternative therapies. See Complementary and alternative therapies Alveolar soft-part sarcomas . . . . . . . . . . . Amenorrhea . . . . . . . . . . . . . . . . . . . American Association for Cancer Research (AACR) . . . . . . . . . . . . . . . . . . . . American Cancer Society (ACS) . . . . . . . . American Institute for Cancer Research (AICR) 4-Aminobiphenyl . . . . . . . . . . . . . . . . AML. See Acute myelocytic leukemia Amputation . . . . . . . . . . . . . . . . . . . Amyloidosis . . . . . . . . . . . . . . . . . . . Anal cancer . . . . . . . . . . . . . . . . . . . Androgen drugs . . . . . . . . . . . . . . . . . Anemia . . . . . . . . . . . . . . . . . . . . . Anemia, aplastic. See Aplastic anemia Anemia, hemolytic. See Hemolytic anemia Angiogenesis . . . . . . . . . . . . . . . . . . Angiogenesis inhibitors . . . . . . . . . . . . . Angiography. . . . . . . . . . . . . . . . . . . Angiosarcomas . . . . . . . . . . . . . . . . . Anoscopy . . . . . . . . . . . . . . . . . . . . Anthraquinones . . . . . . . . . . . . . . . . . Anthrax . . . . . . . . . . . . . . . . . . . . . Antiandrogens . . . . . . . . . . . . . . . . . . Antidiarrheal agents . . . . . . . . . . . . . . . Antiestrogens . . . . . . . . . . . . . . . . . . Antifungal therapies . . . . . . . . . . . . . . . Antimetabolites in chemotherapy . . . . . . . . Antinausea medications . . . . . . . . . . . . . Antineoplastics in chemotherapy . . . . . . . . Antioxidants . . . . . . . . . . . . . . . . . . . Antiperspirants and breast cancer . . . . . . . . Antiviral therapies. . . . . . . . . . . . . . . . Anxiety . . . . . . . . . . . . . . . . . . . . . APBI. See Accelerated partial breast irradiation APC gene testing . . . . . . . . . . . . . . . . Aplastic anemia . . . . . . . . . . . . . . . . . Appendix cancer . . . . . . . . . . . . . . . . Appetite loss. . . . . . . . . . . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . . . v Publisher’s Note . . . . . . . . . . . . . . . . . . . . ix About the Editors . . . . . . . . . . . . . . . . . . . xi Contributors . . . . . . . . . . . . . . . . . . . . . xiii Complete List of Contents . . . . . . . . . . . . . . xv AACR. See American Association for Cancer Research ABCD. . . . . . . . . . . . . . . . . . . . . . . . . . 1 ACC. See Adenoid cystic carcinoma Abdominoperineal resection (APR) . . . . . . . . . . 1 Accelerated partial breast irradiation (APBI). . . . . . 3 Achlorhydria . . . . . . . . . . . . . . . . . . . . . . 4 Acoustic neuromas . . . . . . . . . . . . . . . . . . . 4 Acquired immunodeficiency disease-related cancers. See HIV/AIDS-related cancers Acrylamides . . . . . . . . . . . . . . . . . . . . . . 6 ACS. See American Cancer Society Acupuncture and acupressure for cancer patients . . . 8 Acute lymphocytic leukemia (ALL) . . . . . . . . . 11 Acute myelocytic leukemia (AML) . . . . . . . . . . 13 Adenocarcinomas . . . . . . . . . . . . . . . . . . . 16 Adenoid cystic carcinoma (ACC) . . . . . . . . . . . 17 Adenomatoid tumors . . . . . . . . . . . . . . . . . 18 Adenomatous polyps . . . . . . . . . . . . . . . . . 18 Adenoviruses . . . . . . . . . . . . . . . . . . . . . 19 Adjuvant therapy . . . . . . . . . . . . . . . . . . . 20 Adrenal gland cancers . . . . . . . . . . . . . . . . . 21 Adrenocortical cancer . . . . . . . . . . . . . . . . . 23 Advance directives . . . . . . . . . . . . . . . . . . 24 Aflatoxins . . . . . . . . . . . . . . . . . . . . . . . 26 AFP levels. See Alpha-fetoprotein levels African Americans and cancer . . . . . . . . . . . . 28 Africans and cancer . . . . . . . . . . . . . . . . . . 31 Afterloading radiation therapy . . . . . . . . . . . . 32 Agent Orange . . . . . . . . . . . . . . . . . . . . . 34 Aging and cancer . . . . . . . . . . . . . . . . . . . 34 AICR. See American Institute for Cancer Research Aids and devices for cancer patients . . . . . . . . . 38 AIDS-related cancers. See HIV/AIDS-related cancers Air pollution . . . . . . . . . . . . . . . . . . . . . . 39 Alcohol, alcoholism, and cancer . . . . . . . . . . . 42 Aleukemia . . . . . . . . . . . . . . . . . . . . . . . 43 Alkaline phosphatase test (ALP) . . . . . . . . . . . 44 xv
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Salem Health: Cancer APR. See Abdominoperineal resection Arsenic compounds . . . . . . . . . . Arterial embolization . . . . . . . . . Artificial sweeteners . . . . . . . . . . Asbestos . . . . . . . . . . . . . . . . Ascites . . . . . . . . . . . . . . . . . Ashkenazi Jews and cancer . . . . . . Asian Americans and cancer. . . . . . Astrocytomas. . . . . . . . . . . . . . Ataxia telangiectasia (AT) . . . . . . . Autologous blood transfusion . . . . . Axillary dissection . . . . . . . . . . . Azathioprine . . . . . . . . . . . . . .
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Bacillus Calmette Guérin (BCG) . . . . . . . . Bacteria as causes of cancer . . . . . . . . . . . Barium enema . . . . . . . . . . . . . . . . . . Barium swallow . . . . . . . . . . . . . . . . . Barrett esophagus . . . . . . . . . . . . . . . . Basal cell carcinomas . . . . . . . . . . . . . . BCG. See Bacillus Calmette Guérin Beckwith-Wiedemann syndrome (BWS) . . . . Benign prostatic hyperplasia (BPH) . . . . . . . Benign tumors . . . . . . . . . . . . . . . . . . Benzene . . . . . . . . . . . . . . . . . . . . . Benzidine and dyes metabolized to benzidine . . Benzodiazepines . . . . . . . . . . . . . . . . . Bereavement, grief and. See Grief and bereavement Beryllium and beryllium compounds . . . . . . Beta-carotene . . . . . . . . . . . . . . . . . . Bethesda criteria . . . . . . . . . . . . . . . . . BHDS. See Birt-Hogg-Dubé syndrome Bile duct cancer . . . . . . . . . . . . . . . . . Bilobectomy . . . . . . . . . . . . . . . . . . . Bioflavonoids . . . . . . . . . . . . . . . . . . Biological therapy . . . . . . . . . . . . . . . . Biopsy. See also Computed tomography-guided biopsy; Core needle biopsy; Liver biopsy; Needle biopsies; Pleural biopsy; Stereotactic needle biopsy; Surgical biopsies . . . . . . . Birt-Hogg-Dubé syndrome (BHDS) . . . . . . . Birth control pills and cancer . . . . . . . . . . Bis(chloromethyl) ether and technical-grade chloromethyl methyl ether . . . . . . . . . . Bisphenol A (BPA) . . . . . . . . . . . . . . . Bisphosphonates . . . . . . . . . . . . . . . . . Bladder cancer . . . . . . . . . . . . . . . . . . Blood cancers . . . . . . . . . . . . . . . . . . BMT. See Bone marrow transplantation BNCT. See Boron neutron capture therapy
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Body image. See Self-image and body image Bone cancers . . . . . . . . . . . . . . . . . . . Bone marrow aspiration and biopsy . . . . . . . Bone marrow transplantation (BMT) . . . . . . Bone pain . . . . . . . . . . . . . . . . . . . . Bone scan . . . . . . . . . . . . . . . . . . . . Boron neutron capture therapy (BNCT) . . . . . Bowen disease . . . . . . . . . . . . . . . . . . BPA. See Bisphenol A BPH. See Benign prostatic hyperplasia BPI. See Brief Pain Inventory Brachytherapy . . . . . . . . . . . . . . . . . . BRAF gene . . . . . . . . . . . . . . . . . . . . Brain and central nervous system cancers . . . . Brain scan . . . . . . . . . . . . . . . . . . . . BRCA1 and BRCA2 genes . . . . . . . . . . . . Breakthrough pain . . . . . . . . . . . . . . . . Breast, calcifications of. See Calcifications of the breast Breast, medullary carcinoma of. See Medullary carcinoma of the breast Breast cancer, cutaneous. See Cutaneous breast cancer Breast cancer, estrogen-receptor-sensitive. See Estrogen-receptor-sensitive breast cancer Breast cancer in children and adolescents . . . . Breast cancer in men . . . . . . . . . . . . . . . Breast cancer in pregnant women . . . . . . . . Breast cancers . . . . . . . . . . . . . . . . . . Breast implants. . . . . . . . . . . . . . . . . . Breast reconstruction. . . . . . . . . . . . . . . Breast self-examination (BSE). . . . . . . . . . Breast ultrasound. . . . . . . . . . . . . . . . . Breslow’s staging . . . . . . . . . . . . . . . . Brief Pain Inventory (BPI) . . . . . . . . . . . . Brompton cocktail . . . . . . . . . . . . . . . . Bronchial adenomas . . . . . . . . . . . . . . . Bronchoalveolar lung cancer . . . . . . . . . . Bronchography. . . . . . . . . . . . . . . . . . Bronchoscopy . . . . . . . . . . . . . . . . . . BSE. See Breast self-examination Burkitt lymphoma . . . . . . . . . . . . . . . . 1,3-Butadiene . . . . . . . . . . . . . . . . . . 1,4-Butanediol dimethanesulfonate . . . . . . . BWS. See Beckwith-Wiedemann syndrome
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CA 15-3 test . CA 19-9 test . CA 27-29 test CA 125 test. . Cachexia . . . xvi
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Complete List of Contents Cadmium and cadmium compounds. . . . . . . . Caffeine . . . . . . . . . . . . . . . . . . . . . . Calcifications of the breast. . . . . . . . . . . . . Calcium . . . . . . . . . . . . . . . . . . . . . . Cancell . . . . . . . . . . . . . . . . . . . . . . . Cancer biology . . . . . . . . . . . . . . . . . . . Cancer care team . . . . . . . . . . . . . . . . . . Cancer clusters . . . . . . . . . . . . . . . . . . . Cancer education. . . . . . . . . . . . . . . . . . Candidiasis . . . . . . . . . . . . . . . . . . . . . Carcinoembryonic antigen antibody (CEA) test . . . . . . . . . . . . . . . . . . . . . . . . Carcinogens, known . . . . . . . . . . . . . . . . Carcinogens, reasonably anticipated. . . . . . . . Carcinoid tumors and carcinoid syndrome . . . . Carcinoma of unknown primary origin (CUP) . . Carcinomas. . . . . . . . . . . . . . . . . . . . . Carcinomas, invasive ductal. See Invasive ductal carcinomas Carcinomas, invasive lobular. See Invasive lobular carcinomas Carcinomas, leptomeningeal. See Leptomeningeal carcinomas Carcinomatosis. . . . . . . . . . . . . . . . . . . Carcinomatous meningitis . . . . . . . . . . . . . Carcinosarcomas . . . . . . . . . . . . . . . . . . Cardiomyopathy in cancer patients . . . . . . . . Cardiopulmonary resuscitation (CPR) . . . . . . . Caregivers and caregiving . . . . . . . . . . . . . Caregiving, long-distance. See Long-distance caregiving Carney complex . . . . . . . . . . . . . . . . . . Carotenoids . . . . . . . . . . . . . . . . . . . . Cartilage supplements . . . . . . . . . . . . . . . Case management . . . . . . . . . . . . . . . . . Castleman disease . . . . . . . . . . . . . . . . . CBC. See Complete blood count CBE. See Clinical breast exam CDKN2A. See Cyclin-dependent kinase inhibitor-2A CEA test. See Carcinoembryonic antigen antibody test Cell phones. . . . . . . . . . . . . . . . . . . . . Cervical cancer. . . . . . . . . . . . . . . . . . . Chemoembolization . . . . . . . . . . . . . . . . Chemoprevention . . . . . . . . . . . . . . . . . Chemotherapy . . . . . . . . . . . . . . . . . . . Chemotherapy, cognitive effects of. See Cognitive effects of cancer and chemotherapy Chewing tobacco. . . . . . . . . . . . . . . . . . Childbirth and cancer . . . . . . . . . . . . . . .
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Childhood cancers . . . . . . . . . . . . . . . . Chlorambucil. . . . . . . . . . . . . . . . . . . 1-(2-Chloroethyl)-3-(4-methylcyclohexyl)1-nitrosourea (MeCCNU) . . . . . . . . . . . Cholecystectomy . . . . . . . . . . . . . . . . . Chordomas . . . . . . . . . . . . . . . . . . . . Choriocarcinomas . . . . . . . . . . . . . . . . CHPP. See Continuous hyperthermic peritoneal perfusion Chromium hexavalent compounds. . . . . . . . Chromosomes and cancer . . . . . . . . . . . . Chronic lymphocytic leukemia (CLL) . . . . . . Chronic myeloid leukemia (CML). . . . . . . . Cigarettes and cigars . . . . . . . . . . . . . . . Clinical breast exam (CBE) . . . . . . . . . . . Clinical trials . . . . . . . . . . . . . . . . . . . CLL. See Chronic lymphocytic leukemia CML. See Chronic myeloid leukemia Coal tars and coal tar pitches . . . . . . . . . . Cobalt 60 radiation. . . . . . . . . . . . . . . . Coenzyme Q10. . . . . . . . . . . . . . . . . . Cognitive effects of cancer and chemotherapy . Coke oven emissions. . . . . . . . . . . . . . . Cold nodule . . . . . . . . . . . . . . . . . . . Colectomy . . . . . . . . . . . . . . . . . . . . Coloanal anastomosis . . . . . . . . . . . . . . Colon polyps . . . . . . . . . . . . . . . . . . . Colonoscopy and virtual colonoscopy . . . . . . Colony-stimulating factors (CSFs) . . . . . . . Colorectal cancer. . . . . . . . . . . . . . . . . Colorectal cancer screening . . . . . . . . . . . Colostomy . . . . . . . . . . . . . . . . . . . . Colposcopy. . . . . . . . . . . . . . . . . . . . Comedo carcinomas . . . . . . . . . . . . . . . Complementary and alternative therapies . . . . Complete blood count (CBC) . . . . . . . . . . Computed tomography (CT)-guided biopsy . . . . . . . . . . . . . . . . . . . . . Computed tomography (CT) scan . . . . . . . . Conization . . . . . . . . . . . . . . . . . . . . Continuous hyperthermic peritoneal perfusion (CHPP) . . . . . . . . . . . . . . . . . . . . Cordectomy . . . . . . . . . . . . . . . . . . . Cordotomy . . . . . . . . . . . . . . . . . . . . Core needle biopsy. . . . . . . . . . . . . . . . Corticosteroids . . . . . . . . . . . . . . . . . . Coughing . . . . . . . . . . . . . . . . . . . . . Counseling for cancer patients and survivors . . Cowden syndrome . . . . . . . . . . . . . . . . COX-2 inhibitors. See Cyclooxygenase 2 inhibitors
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269 269 271 272
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274 274 276 279 281 283 285
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288 289 289 290 292 292 293 294 296 297 299 300 304 306 308 309 309 312
. . 313 . . 315 . . 317 . . . . . . . .
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318 318 319 321 321 322 324 326
Salem Health: Cancer CPR. See Cardiopulmonary resuscitation Craniopharyngiomas . . . . . . . . . . . . Craniosynostosis . . . . . . . . . . . . . . Craniotomy. . . . . . . . . . . . . . . . . Crohn disease . . . . . . . . . . . . . . . Cruciferous vegetables . . . . . . . . . . . Cryoablation . . . . . . . . . . . . . . . . Cryptorchidism. . . . . . . . . . . . . . . CSFs. See Colony-stimulating factors CT scan. See Computed tomography scan CTCL. See Cutaneous T-cell lymphoma Culdoscopy. . . . . . . . . . . . . . . . . CUP. See Carcinoma of unknown primary origin Curcumin. . . . . . . . . . . . . . . . . . Cushing syndrome and cancer . . . . . . . Cutaneous breast cancer . . . . . . . . . . Cutaneous T-cell lymphoma (CTCL) . . .
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Cyclin-dependent kinase inhibitor-2A (CDKN2A). . . . . . . . . . . . . . . Cyclooxygenase 2 (COX-2) inhibitors . Cyclophosphamide. . . . . . . . . . . . Cyclosporin A . . . . . . . . . . . . . . Cystography . . . . . . . . . . . . . . . Cystoscopy . . . . . . . . . . . . . . . . Cytogenetics . . . . . . . . . . . . . . . Cytokines . . . . . . . . . . . . . . . . Cytology . . . . . . . . . . . . . . . . . Cytology, sputum. See Sputum cytology
327 329 331 332 335 336 338
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344 344 345 346 347 347 348 350 350
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D&C. See Dilation and curettage Dana-Farber Cancer Institute . . . . . . . . . . . . 354 DCIS. See Ductal carcinoma in situ DEA. See Diethanolamine DEHP. See Di(2-ethylhexyl) phthalate Delta-9-tetrahydrocannabinol . . . . . . . . . . . . 355
339 340 341 342
Volume 2 Down syndrome and leukemia. . . . . . . . DPC4 gene testing . . . . . . . . . . . . . . DRE. See Digital rectal exam Drug resistance and multidrug resistance (MDR) . . . . . . . . . . . . . . . . . . . Dry mouth . . . . . . . . . . . . . . . . . . DSRCT. See Desmoplastic small round cell tumor Duct ectasia . . . . . . . . . . . . . . . . . Ductal carcinoma in situ (DCIS). . . . . . . Ductal lavage. . . . . . . . . . . . . . . . . Ductogram . . . . . . . . . . . . . . . . . . Duke Comprehensive Cancer Center . . . . Dukes’ classification . . . . . . . . . . . . . Duodenal carcinomas . . . . . . . . . . . . Dye, hair. See Hair dye Dysplastic nevus syndrome . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . xxxiii Complete List of Contents . . . . . . . . . . . . xxxvii Denys-Drash syndrome and cancer . . . . . . Depression . . . . . . . . . . . . . . . . . . . Dermatofibrosarcoma protuberans (DFSP) . . Dermatology oncology. . . . . . . . . . . . . DES. See Diethylstilbestrol Desmoid tumors . . . . . . . . . . . . . . . . Desmoplastic small round cell tumor (DSRCT) . . . . . . . . . . . . . . . . . . Developing nations and cancer . . . . . . . . DFSP. See Dermatofibrosarcoma protuberans Di(2-ethylhexyl) phthalate (DEHP) . . . . . . Diarrhea . . . . . . . . . . . . . . . . . . . . DIC. See Disseminated intravascular coagulation Dietary supplements . . . . . . . . . . . . . . Diethanolamine (DEA) . . . . . . . . . . . . Diethylstilbestrol (DES) . . . . . . . . . . . . Digital rectal exam (DRE) . . . . . . . . . . . Dilation and curettage (D&C) . . . . . . . . . Dioxins . . . . . . . . . . . . . . . . . . . . . Disseminated intravascular coagulation (DIC) . . . . . . . . . . . . . . . . . . . . Diverticulosis and diverticulitis . . . . . . . . DNR. See Do-not-resuscitate order Do-not-resuscitate (DNR) order . . . . . . . .
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357 357 360 362
. . . 365 . . . 365 . . . 366 . . . 368 . . . 369
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370 373 373 374 375 376
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. . . 380 xviii
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386 387 389 389 390 392 393
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Eaton-Lambert syndrome. See Lambert-Eaton myasthenic syndrome EBRT. See External beam radiation therapy Edema . . . . . . . . . . . . . . . . . . . . . Education, cancer. See Cancer education Elderly and cancer . . . . . . . . . . . . . . . Electrolarynx . . . . . . . . . . . . . . . . . . Electromagnetic radiation . . . . . . . . . . . Electroporation therapy . . . . . . . . . . . . Electrosurgery . . . . . . . . . . . . . . . . .
. . . 378 . . . 378
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396 399 399 400 401
Complete List of Contents Embolization . . . . . . . . . . . . . . . . . . . . Embryonal cell cancer . . . . . . . . . . . . . . . End-of-life care . . . . . . . . . . . . . . . . . . Endocrine cancers . . . . . . . . . . . . . . . . . Endocrinology oncology . . . . . . . . . . . . . . Endometrial cancer . . . . . . . . . . . . . . . . Endometrial hyperplasia . . . . . . . . . . . . . . Endorectal ultrasound . . . . . . . . . . . . . . . Endoscopic retrograde cholangiopancreatography (ERCP) . . . . . . . . . . . . . . . . . . . . . Endoscopy . . . . . . . . . . . . . . . . . . . . . Endoscopy, upper gastrointestinal. See Upper gastrointestinal endoscopy Endotheliomas . . . . . . . . . . . . . . . . . . . Enteritis . . . . . . . . . . . . . . . . . . . . . . Enterostomal therapy . . . . . . . . . . . . . . . Eosinophilic leukemia . . . . . . . . . . . . . . . Ependymomas . . . . . . . . . . . . . . . . . . . Epidemiology of cancer . . . . . . . . . . . . . . Epidermoid cancers of mucous membranes . . . . Epstein-Barr virus . . . . . . . . . . . . . . . . . ERCP. See Endoscopic retrograde cholangiopancreatography ERD. See Estrogen receptor downregulator Erionite. . . . . . . . . . . . . . . . . . . . . . . Erythroplakia. . . . . . . . . . . . . . . . . . . . Esophageal cancer . . . . . . . . . . . . . . . . . Esophageal speech . . . . . . . . . . . . . . . . . Esophagectomy . . . . . . . . . . . . . . . . . . Esophagitis . . . . . . . . . . . . . . . . . . . . . Essiac . . . . . . . . . . . . . . . . . . . . . . . Estrogen receptor downregulator (ERD) . . . . . Estrogen-receptor-sensitive breast cancer . . . . . Ethnicity and cancer . . . . . . . . . . . . . . . . Ethylene oxide . . . . . . . . . . . . . . . . . . . Ewing sarcoma . . . . . . . . . . . . . . . . . . . Exenteration . . . . . . . . . . . . . . . . . . . . Exercise and cancer . . . . . . . . . . . . . . . . External beam radiation therapy (EBRT) . . . . . Eye cancers . . . . . . . . . . . . . . . . . . . . Eyelid cancer. . . . . . . . . . . . . . . . . . . .
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Fallopian tube cancer . . . . . . . Family history and risk assessment Fanconi anemia . . . . . . . . . . Fatigue . . . . . . . . . . . . . . . Fecal occult blood test (FOBT) . . Fertility drugs and cancer . . . . . Fertility issues . . . . . . . . . . . Fever . . . . . . . . . . . . . . . . Fiber . . . . . . . . . . . . . . . .
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402 403 404 406 409 412 414 416
. 417 . 417
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420 421 422 424 425 426 429 431
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433 433 434 436 438 439 441 441 442 444 447 447 450 451 454 455 458
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460 461 464 466 467 469 471 472 474 xix
Fibroadenomas . . . . . . . . . . . . . . . . Fibrocystic breast changes . . . . . . . . . . Fibrosarcomas, soft-tissue . . . . . . . . . . Financial issues . . . . . . . . . . . . . . . 5HIAA test. See 5-Hydroxyindoleacetic acid test 5Q minus syndrome . . . . . . . . . . . . . Flow cytometry . . . . . . . . . . . . . . . FOBT. See Fecal occult blood test Folic acid. . . . . . . . . . . . . . . . . . . Formaldehyde . . . . . . . . . . . . . . . . Fox Chase Cancer Center . . . . . . . . . . Fred Hutchinson Cancer Research Center . . Free radicals . . . . . . . . . . . . . . . . . Fruits . . . . . . . . . . . . . . . . . . . . .
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475 476 478 481
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486 486 487 488 490 491
Gallbladder cancer . . . . . . . . . . . . . . Gallium scan . . . . . . . . . . . . . . . . . Gamma Knife . . . . . . . . . . . . . . . . Gardner syndrome . . . . . . . . . . . . . . Garlic and allicin . . . . . . . . . . . . . . . Gastric polyps . . . . . . . . . . . . . . . . Gastrinomas . . . . . . . . . . . . . . . . . Gastrointestinal cancers . . . . . . . . . . . Gastrointestinal complications of cancer treatment. . . . . . . . . . . . . . . . . . Gastrointestinal oncology . . . . . . . . . . Gastrointestinal stromal tumors (GISTs) . . GCTs. See Giant cell tumors Gene therapy . . . . . . . . . . . . . . . . . Genetic counseling . . . . . . . . . . . . . . Genetic testing . . . . . . . . . . . . . . . . Genetics of cancer . . . . . . . . . . . . . . Geography and cancer . . . . . . . . . . . . Germ-cell tumors . . . . . . . . . . . . . . Gerson therapy . . . . . . . . . . . . . . . . Gestational trophoblastic tumors (GTTs) . . Giant cell tumors (GCTs) . . . . . . . . . . Ginseng, panax. . . . . . . . . . . . . . . . GISTs. See Gastrointestinal stromal tumors Gleason grading system . . . . . . . . . . . Gliomas . . . . . . . . . . . . . . . . . . . Glomus tumors . . . . . . . . . . . . . . . . Glossectomy . . . . . . . . . . . . . . . . . Glutamine . . . . . . . . . . . . . . . . . . Gonioscopy . . . . . . . . . . . . . . . . . Grading of tumors . . . . . . . . . . . . . . Graft-versus-host disease (GVHD) . . . . . Granulosa cell tumors . . . . . . . . . . . . Green tea . . . . . . . . . . . . . . . . . . . Grief and bereavement . . . . . . . . . . . .
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493 495 497 498 499 500 501 502
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512 515 517 519 522 525 527 527 530 531
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532 533 534 535 536 536 537 538 540 540 541
Salem Health: Cancer GTTs. See Gestational trophoblastic tumors GVHD. See Graft-versus-host disease Gynecologic cancers . . . . . . . . . . . . . . . . . 543 Gynecologic oncology . . . . . . . . . . . . . . . . 547 H. pylori. See Helicobacter pylori HAI. See Hepatic arterial infusion Hair dye . . . . . . . . . . . . . . . . . . . . . . Hairy cell leukemia . . . . . . . . . . . . . . . . Hand-foot syndrome (HFS) . . . . . . . . . . . . HBV. See Hepatitis B virus HCG. See Human chorionic gonadotropin HCV. See Hepatitis C virus Head and neck cancers . . . . . . . . . . . . . . . Health maintenance organizations (HMOs) . . . . Helicobacter pylori. . . . . . . . . . . . . . . . . Hemangioblastomas . . . . . . . . . . . . . . . . Hemangiopericytomas . . . . . . . . . . . . . . . Hemangiosarcomas . . . . . . . . . . . . . . . . Hematemesis . . . . . . . . . . . . . . . . . . . . Hematologic oncology . . . . . . . . . . . . . . . Hematuria . . . . . . . . . . . . . . . . . . . . . Hemochromatosis . . . . . . . . . . . . . . . . . Hemolytic anemia . . . . . . . . . . . . . . . . . Hemoptysis. . . . . . . . . . . . . . . . . . . . . Hemorrhoids . . . . . . . . . . . . . . . . . . . . Hepatic arterial infusion (HAI) . . . . . . . . . . Hepatitis B virus (HBV) . . . . . . . . . . . . . . Hepatitis C virus (HCV) . . . . . . . . . . . . . . Hepatomegaly . . . . . . . . . . . . . . . . . . . HER2/neu protein . . . . . . . . . . . . . . . . . Herbs as antioxidants . . . . . . . . . . . . . . . Hereditary cancer syndromes . . . . . . . . . . . Hereditary diffuse gastric cancer . . . . . . . . . Hereditary leiomyomatosis and renal cell cancer (HLRCC) . . . . . . . . . . . . . . . . Hereditary mixed polyposis syndrome . . . . . . Hereditary non-VHL clear cell renal cell carcinomas . . . . . . . . . . . . . . . . . . . Hereditary pancreatitis . . . . . . . . . . . . . . . Hereditary papillary renal cell carcinomas . . . . Hereditary polyposis syndromes . . . . . . . . . . Herpes simplex virus. . . . . . . . . . . . . . . . Herpes zoster virus. . . . . . . . . . . . . . . . . HFS. See Hand-foot syndrome Hispanics and cancer. See Latinos/Hispanics and cancer Histamine 2 antagonists . . . . . . . . . . . . . . Histiocytosis X . . . . . . . . . . . . . . . . . . . HIV/AIDS-related cancers . . . . . . . . . . . . .
HLRCC. See Hereditary leiomyomatosis and renal cell cancer HMOs. See Health maintenance organizations Hodgkin disease . . . . . . . . . . . . . . . . . Home health services . . . . . . . . . . . . . . Hormonal therapies . . . . . . . . . . . . . . . Hormone receptor tests . . . . . . . . . . . . . Hormone replacement therapy (HRT) . . . . . . Horner syndrome. . . . . . . . . . . . . . . . . Hospice care . . . . . . . . . . . . . . . . . . . Hot flashes . . . . . . . . . . . . . . . . . . . . HPV. See Human papillomavirus HRAS gene testing . . . . . . . . . . . . . . . . HRT. See Hormone replacement therapy HTLV. See Human T-cell leukemia virus Human chorionic gonadotropin (HCG) . . . . . Human growth factors and tumor growth . . . . Human immunodeficiency virus-related cancers. See HIV/AIDS-related cancers Human papillomavirus (HPV) . . . . . . . . . . Human T-cell leukemia virus (HTLV) . . . . . Hydatidiform mole . . . . . . . . . . . . . . . . 5-Hydroxyindoleacetic acid (5HIAA) test . . . . Hypercalcemia . . . . . . . . . . . . . . . . . . Hypercoagulation disorders . . . . . . . . . . . Hyperthermia therapy . . . . . . . . . . . . . . Hyperthermic perfusion . . . . . . . . . . . . . Hypopharyngeal cancer . . . . . . . . . . . . . Hysterectomy . . . . . . . . . . . . . . . . . . Hysterography . . . . . . . . . . . . . . . . . . Hystero-oophorectomy. . . . . . . . . . . . . . Hysteroscopy. . . . . . . . . . . . . . . . . . .
. 550 . 550 . 552
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554 557 558 559 559 560 561 562 564 565 566 566 567 568 569 570 571 573 573 574 576
IEP. See Immunoelectrophoresis iFOBT. See Immunochemical fecal occult blood test Ileostomy. . . . . . . . . . . . . . . . . . . . . Imaging tests . . . . . . . . . . . . . . . . . . . Immune response to cancer . . . . . . . . . . . Immunochemical fecal occult blood test (iFOBT) . . . . . . . . . . . . . . . . . . . . Immunocytochemistry and immunohistochemistry . . . . . . . . . . . . Immunoelectrophoresis (IEP) . . . . . . . . . . Immunotherapy . . . . . . . . . . . . . . . . . IMRT. See Intensity-modulated radiation therapy Indoles . . . . . . . . . . . . . . . . . . . . . . Infection and sepsis . . . . . . . . . . . . . . . Infectious cancers . . . . . . . . . . . . . . . . Infertility and cancer . . . . . . . . . . . . . . .
. 577 . 579 . . . . . .
580 580 581 582 584 586
. 587 . 588 . 590 xx
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593 597 599 601 603 605 606 608
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611 612 612 613 614 615 617 618 619 620 621 622 623
. . 625 . . 626 . . 629 . . 632 . . 633 . . 634 . . 635
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638 638 641 643
Complete List of Contents Inflammatory bowel disease . . . . . . . . . . Informed consent. . . . . . . . . . . . . . . . Infusion therapies . . . . . . . . . . . . . . . Insurance . . . . . . . . . . . . . . . . . . . . Integrative oncology . . . . . . . . . . . . . . Intensity-modulated radiation therapy (IMRT) Interferon. . . . . . . . . . . . . . . . . . . . Interleukins. . . . . . . . . . . . . . . . . . . Invasive cancer. . . . . . . . . . . . . . . . . Invasive ductal carcinomas . . . . . . . . . . Invasive lobular carcinomas . . . . . . . . . . Ionizing radiation . . . . . . . . . . . . . . . Iridium seeds . . . . . . . . . . . . . . . . . . Islet cell tumors . . . . . . . . . . . . . . . . Isoflavones . . . . . . . . . . . . . . . . . . . Itching . . . . . . . . . . . . . . . . . . . . .
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645 646 647 648 651 652 653 654 655 656 657 657 658 659 661 661
Lambert-Eaton myasthenic syndrome (LEMS) Laparoscopy and laparoscopic surgery . . . . Laryngeal cancer . . . . . . . . . . . . . . . . Laryngeal nerve palsy . . . . . . . . . . . . . Laryngectomy . . . . . . . . . . . . . . . . . Laryngoscopy . . . . . . . . . . . . . . . . . Laser therapies . . . . . . . . . . . . . . . . . Latinos/Hispanics and cancer . . . . . . . . . Laxatives . . . . . . . . . . . . . . . . . . . . LCIS. See Lobular carcinoma in situ LDH test. See Lactate dehydrogenase test Leiomyomas . . . . . . . . . . . . . . . . . . Leiomyosarcomas . . . . . . . . . . . . . . . LEMS. See Lambert-Eaton myasthenic syndrome Leptomeningeal carcinomas . . . . . . . . . . Leukapharesis . . . . . . . . . . . . . . . . . Leukemia, Down syndrome and. See Down syndrome and leukemia Leukemia, eosinophilic. See Eosinophilic leukemia Leukemia, hairy cell. See Hairy cell leukemia Leukemias . . . . . . . . . . . . . . . . . . . Leukoencephalopathy . . . . . . . . . . . . . Leukopenia. . . . . . . . . . . . . . . . . . . Leukoplakia . . . . . . . . . . . . . . . . . . Leydig cell tumors . . . . . . . . . . . . . . . Li-Fraumeni syndrome (LFS) . . . . . . . . . Limb salvage . . . . . . . . . . . . . . . . . . Linear accelerator . . . . . . . . . . . . . . . Lip cancers . . . . . . . . . . . . . . . . . . . Liposarcomas . . . . . . . . . . . . . . . . . Liver biopsy . . . . . . . . . . . . . . . . . . Liver cancers . . . . . . . . . . . . . . . . . .
Jonsson Comprehensive Cancer Center (JCCC) . . . . . . . . . . . . . . . . . . . . . . 664 Journaling . . . . . . . . . . . . . . . . . . . . . . 665 Juvenile polyposis syndrome . . . . . . . . . . . . 665 Kaposi sarcoma . . . . . . . . . . . . . Karnofsky performance status (KPS) . . Keratosis . . . . . . . . . . . . . . . . . Ki67 test . . . . . . . . . . . . . . . . . Kidney cancer . . . . . . . . . . . . . . Klinefelter syndrome and cancer . . . . KPS. See Karnofsky performance status Krukenberg tumors . . . . . . . . . . .
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667 669 670 670 671 674
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Lacrimal gland tumors . . . . . . . . . . . . . . . . 677 Lactate dehydrogenase (LDH) test . . . . . . . . . 678 Laetrile . . . . . . . . . . . . . . . . . . . . . . . . 679
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679 681 682 685 686 687 688 690 692
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. . . 696 . . . 698
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698 702 704 704 706 706 708 709 710 712 714 715
Volume 3 Lumps . . . . . . . . . . . . . . Lung cancer, brochoalveolar. See Bronchoalveolar lung cancer Lung cancers . . . . . . . . . . . Lutein . . . . . . . . . . . . . . Lycopene . . . . . . . . . . . . . Lymphadenectomy. . . . . . . . Lymphangiography . . . . . . . Lymphangiosarcomas . . . . . . Lymphedema. . . . . . . . . . . Lymphocytosis . . . . . . . . . . Lymphomas . . . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . . . lv Complete List of Contents . . . . . . . . . . . . . . lix Living will . . . . . . . . . . . . . . . . . Living with cancer . . . . . . . . . . . . . Lobectomy . . . . . . . . . . . . . . . . . Lobular carcinoma in situ (LCIS) . . . . . Long-distance caregiving . . . . . . . . . Loop electrosurgical excisional procedure (LEEP) . . . . . . . . . . . . . . . . . Lumbar puncture . . . . . . . . . . . . . . Lumpectomy . . . . . . . . . . . . . . . .
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719 720 723 725 726
. . . . . 727 . . . . . 728 . . . . . 730 xxi
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733 737 737 738 740 741 742 743 744
Salem Health: Cancer M. D. Anderson Cancer Center . . . . . . . . . Macrobiotic diet . . . . . . . . . . . . . . . . . Magnetic resonance imaging (MRI) . . . . . . . Malignant fibrous histiocytoma (MFH) . . . . . Malignant rhabdoid tumor of the kidney . . . . Malignant tumors . . . . . . . . . . . . . . . . MALT lymphomas. See Mucosa-associated lymphoid tissue lymphomas Mammography . . . . . . . . . . . . . . . . . . Managed care . . . . . . . . . . . . . . . . . . Mantle cell lymphoma (MCL) . . . . . . . . . . Mastectomy . . . . . . . . . . . . . . . . . . . Mastocytomas . . . . . . . . . . . . . . . . . . Matrix metalloproteinase inhibitors . . . . . . . Mayo Clinic Cancer Center . . . . . . . . . . . MCC. See Merkel cell carcinomas MCL. See Mantle cell lymphoma MDR. See Drug resistance and multidrug resistance Mediastinal tumors. . . . . . . . . . . . . . . . Mediastinoscopy . . . . . . . . . . . . . . . . . Medical marijuana . . . . . . . . . . . . . . . . Medical oncology . . . . . . . . . . . . . . . . Medicare and cancer . . . . . . . . . . . . . . . Medullary carcinoma of the breast. . . . . . . . Medulloblastomas . . . . . . . . . . . . . . . . Melanomas . . . . . . . . . . . . . . . . . . . . Melphalan . . . . . . . . . . . . . . . . . . . . Memorial Sloan-Kettering Cancer Center . . . . MEN 1. See Multiple endocrine neoplasia type 1 MEN 2. See Multiple endocrine neoplasia type 2 Meningeal carcinomatosis . . . . . . . . . . . . Meningiomas. . . . . . . . . . . . . . . . . . . Merkel cell carcinomas (MCC) . . . . . . . . . Mesenchymomas, malignant. . . . . . . . . . . Mesothelioma . . . . . . . . . . . . . . . . . . Metastasis . . . . . . . . . . . . . . . . . . . . Metastatic squamous neck cancer with occult primary . . . . . . . . . . . . . . . . . . . . MFH. See Malignant fibrous histiocytoma Microcalcifications. . . . . . . . . . . . . . . . Microwave hyperthermia therapy . . . . . . . . Mineral oils . . . . . . . . . . . . . . . . . . . Mistletoe . . . . . . . . . . . . . . . . . . . . . Mitochondrial DNA mutations. . . . . . . . . . MLH1 gene. . . . . . . . . . . . . . . . . . . . Mohs surgery. . . . . . . . . . . . . . . . . . . Molecular oncology . . . . . . . . . . . . . . . Moles. . . . . . . . . . . . . . . . . . . . . . . Monoclonal antibodies . . . . . . . . . . . . . . Motion sickness devices . . . . . . . . . . . . .
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748 750 750 752 753 754
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754 757 759 761 763 764 765
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766 768 768 770 772 774 775 776 779 780
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MRI. See Magnetic resonance imaging MSH genes . . . . . . . . . . . . . . . . . . . . Mucinous carcinomas . . . . . . . . . . . . . . Mucosa-associated lymphoid tissue (MALT) lymphomas . . . . . . . . . . . . . . . . . . Mucositis . . . . . . . . . . . . . . . . . . . . . Mucous membranes, epidermoid cancers of. See Epidermoid cancers of mucous membranes Multiple endocrine neoplasia type 1 (MEN 1). . Multiple endocrine neoplasia type 2 (MEN 2). . Multiple myeloma . . . . . . . . . . . . . . . . Mustard gas . . . . . . . . . . . . . . . . . . . Mutagenesis and cancer . . . . . . . . . . . . . Myasthenia gravis . . . . . . . . . . . . . . . . MYC oncogene . . . . . . . . . . . . . . . . . . Mycosis fungoides . . . . . . . . . . . . . . . . Myelodysplastic syndromes . . . . . . . . . . . Myelofibrosis . . . . . . . . . . . . . . . . . . Myeloma . . . . . . . . . . . . . . . . . . . . . Myeloproliferative disorders. . . . . . . . . . . Myelosuppression . . . . . . . . . . . . . . . . 2-Naphthylamine. . . . . . . . . . . . . . . . Nasal cavity and paranasal sinus cancers . . . National Cancer Institute (NCI) . . . . . . . . National Science Foundation (NSF) . . . . . . Native North Americans and cancer . . . . . . Nausea and vomiting. . . . . . . . . . . . . . NCI. See National Cancer Institute Needle biopsies . . . . . . . . . . . . . . . . Needle localization. . . . . . . . . . . . . . . Nephroblastomas. . . . . . . . . . . . . . . . Nephrostomy . . . . . . . . . . . . . . . . . . Neuroblastomas . . . . . . . . . . . . . . . . Neuroectodermal tumors. . . . . . . . . . . . Neuroendocrine tumors . . . . . . . . . . . . Neurofibromatosis type 1 (NF1) . . . . . . . . Neurologic oncology. . . . . . . . . . . . . . Neutropenia . . . . . . . . . . . . . . . . . . NF1. See Neurofibromatosis type 1 Nickel compounds and metallic nickel . . . . Night sweats . . . . . . . . . . . . . . . . . . Nijmegen breakage syndrome . . . . . . . . . Nipple discharge . . . . . . . . . . . . . . . . Non-Hodgkin lymphoma . . . . . . . . . . . Nonsteroidal anti-inflammatory drugs (NSAIDs) . . . . . . . . . . . . . . . . . . NSAIDs. See Nonsteroidal anti-inflammatory drugs NSF. See National Science Foundation Nuclear medicine scan . . . . . . . . . . . . .
781 782 783 785 786 788
. . 790 . . . . . . . . . . .
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790 791 792 793 794 795 796 796 798 800 802 xxii
. . 803 . . 803 . . 804 . . 806
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807 808 809 812 813 815 817 817 819 820 822 823 825
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826 826 829 830 832 834
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836 838 839 839 841 842 844 845 847 849
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851 852 853 854 855
. . . 858
. . . 859
Complete List of Contents Pediatric oncology and hematology . . . . . . . . . 938 Pelvic examination . . . . . . . . . . . . . . . . . . 940 Penile cancer . . . . . . . . . . . . . . . . . . . . . 941 Percutaneous transhepatic cholangiography (PTHC) . . . . . . . . . . . . . . . . . . . . . . 943 Pericardial effusion . . . . . . . . . . . . . . . . . 944 Pericardiocentesis . . . . . . . . . . . . . . . . . . 946 Peritoneovenous shunts . . . . . . . . . . . . . . . 946 Personality and cancer . . . . . . . . . . . . . . . . 947 Pesticides and the food chain . . . . . . . . . . . . 948 PET. See Positron emission tomography Peutz-Jeghers syndrome (PJS) . . . . . . . . . . . . 951 Pharmacy oncology . . . . . . . . . . . . . . . . . 952 Phenacetin . . . . . . . . . . . . . . . . . . . . . . 955 Phenolics . . . . . . . . . . . . . . . . . . . . . . . 955 Pheochromocytomas . . . . . . . . . . . . . . . . . 956 Pheresis . . . . . . . . . . . . . . . . . . . . . . . 958 Photodynamic therapy (PDT) . . . . . . . . . . . . 959 Phyllodes tumors. . . . . . . . . . . . . . . . . . . 960 Phytoestrogens . . . . . . . . . . . . . . . . . . . . 962 Pineoblastomas. . . . . . . . . . . . . . . . . . . . 963 Pituitary tumors . . . . . . . . . . . . . . . . . . . 965 PJS. See Peutz-Jeghers syndrome Placental alkaline phosphatase (PALP) . . . . . . . 968 Plant alkaloids and terpenoids in chemotherapy . . . . . . . . . . . . . . . . . . . 968 Plasticizers . . . . . . . . . . . . . . . . . . . . . . 971 Pleural biopsy . . . . . . . . . . . . . . . . . . . . 972 Pleural effusion . . . . . . . . . . . . . . . . . . . 973 Pleurodesis . . . . . . . . . . . . . . . . . . . . . . 975 Pleuropulmonary blastomas . . . . . . . . . . . . . 975 PMS genes . . . . . . . . . . . . . . . . . . . . . . 976 Pneumonectomy . . . . . . . . . . . . . . . . . . . 977 Pneumonia . . . . . . . . . . . . . . . . . . . . . . 979 Polycyclic aromatic hydrocarbons . . . . . . . . . . 981 Polycythemia vera . . . . . . . . . . . . . . . . . . 981 Polypectomy . . . . . . . . . . . . . . . . . . . . . 982 Polyps . . . . . . . . . . . . . . . . . . . . . . . . 983 Polyps, colon. See Colon polyps Polyps, gastric. See Gastric polyps Positron emission tomography (PET) . . . . . . . . 984 Poverty and cancer . . . . . . . . . . . . . . . . . . 987 PPOs. See Preferred provider organizations Prayer and cancer support . . . . . . . . . . . . . . 989 Preferred provider organizations (PPOs) . . . . . . 990 Pregnancy and cancer . . . . . . . . . . . . . . . . 992 Premalignancies . . . . . . . . . . . . . . . . . . . 994 Prevent Cancer Foundation . . . . . . . . . . . . . 997 Prevention . . . . . . . . . . . . . . . . . . . . . . 999 Primary care physician . . . . . . . . . . . . . . . 1001
Nutrition and cancer prevention . . . . . . . . . . . 861 Nutrition and cancer treatment. . . . . . . . . . . . 864 Obesity-associated cancers . . . . . Occupational exposures and cancer . Occupational therapy . . . . . . . . OCs. See Organochlorines Oligodendrogliomas . . . . . . . . . Omega-3 fatty acids . . . . . . . . . Ommaya reservoir . . . . . . . . . . Oncogenes . . . . . . . . . . . . . . Oncogenic viruses . . . . . . . . . . Oncology . . . . . . . . . . . . . . . Oncology clinical nurse specialist . . Oncology social worker . . . . . . . Oophorectomy . . . . . . . . . . . . Ophthalmic oncology . . . . . . . . Opioids . . . . . . . . . . . . . . . . Oral and maxillofacial surgery. . . . Oral and oropharyngeal cancers . . . Orbit tumors . . . . . . . . . . . . . Orchiectomy . . . . . . . . . . . . . Organ transplantation and cancer . . Organochlorines (OCs) . . . . . . . Oropharyngeal cancers. See Oral and oropharyngeal cancers Orthopedic surgery. . . . . . . . . . Otolaryngology . . . . . . . . . . . Ovarian cancers . . . . . . . . . . . Ovarian cysts. . . . . . . . . . . . . Ovarian epithelial cancer . . . . . . Overtreatment . . . . . . . . . . . .
. . . . . . . . 868 . . . . . . . . 871 . . . . . . . . 873 . . . . . . . . . . . . . . . . .
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875 877 878 878 881 882 885 887 888 889 892 893 894 897 898 899 901
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902 903 905 908 909 911
Paget disease of bone . . . . . . . . . . . . . Pain management medications. . . . . . . . . Palliative treatment . . . . . . . . . . . . . . PALP. See Placental alkaline phosphatase Palpation . . . . . . . . . . . . . . . . . . . . Pancolitis . . . . . . . . . . . . . . . . . . . . Pancreatectomy . . . . . . . . . . . . . . . . Pancreatic cancers . . . . . . . . . . . . . . . Pancreatitis . . . . . . . . . . . . . . . . . . . Pap test . . . . . . . . . . . . . . . . . . . . . Paracentesis . . . . . . . . . . . . . . . . . . Paranasal sinus cancers. See Nasal cavity and paranasal sinus cancers Paraneoplastic syndromes . . . . . . . . . . . Parathyroid cancer . . . . . . . . . . . . . . . Pathology . . . . . . . . . . . . . . . . . . . PC-SPES . . . . . . . . . . . . . . . . . . . . PDT. See Photodynamic therapy
. . . 912 . . . 914 . . . 917 . . . . . . .
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920 920 921 923 927 928 929
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931 932 934 937 xxiii
Salem Health: Cancer Primary central nervous system lymphomas . . . . . . . . . . . . . . . . Progesterone receptor assay . . . . . . . . Prostate cancer . . . . . . . . . . . . . . . Prostate-specific antigen (PSA) test . . . . Prostatectomy. . . . . . . . . . . . . . . . Prostatitis . . . . . . . . . . . . . . . . . . Proteasome inhibitors. . . . . . . . . . . . Protein electrophoresis . . . . . . . . . . . Proteomics and cancer research . . . . . . Proton beam therapy . . . . . . . . . . . . Proto-oncogenes and carcinogenesis . . . . PSA test. See Prostate-specific antigen test Psycho-oncology . . . . . . . . . . . . . . Psychosocial aspects of cancer . . . . . . . PTHC. See Percutaneous transhepatic cholangiography Radiation, ionizing. See Ionizing radiation Radiation oncology . . . . . . . . . . . . . Radiation therapies . . . . . . . . . . . . . Radiation therapy, afterloading. See Afterloading radiation therapy Radical neck dissection . . . . . . . . . . . Radiofrequency ablation . . . . . . . . . . Radionuclide scan . . . . . . . . . . . . . Radiopharmaceuticals . . . . . . . . . . . Radon . . . . . . . . . . . . . . . . . . . . RB1 gene . . . . . . . . . . . . . . . . . . Receptor analysis . . . . . . . . . . . . . .
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1003 1003 1004 1006 1008 1009 1010 1010 1012 1014 1015
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. . . . 1021 . . . . 1023
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1027 1027 1030 1030 1032 1032 1033
Reconstructive surgery . . . . . . . . . . . . . . Rectal cancer . . . . . . . . . . . . . . . . . . . Recurrence . . . . . . . . . . . . . . . . . . . . Rehabilitation . . . . . . . . . . . . . . . . . . . Relationships . . . . . . . . . . . . . . . . . . . Renal pelvis tumors. . . . . . . . . . . . . . . . Report on Carcinogens (RoC) . . . . . . . . . . Resveratrol . . . . . . . . . . . . . . . . . . . . Retinoblastomas . . . . . . . . . . . . . . . . . Rhabdomyosarcomas . . . . . . . . . . . . . . . RhoGD12 gene . . . . . . . . . . . . . . . . . . Richter syndrome . . . . . . . . . . . . . . . . . Risk assessment, family history and. See Family history and risk assessment Risks for cancer. . . . . . . . . . . . . . . . . . Robert H. Lurie Cancer Center . . . . . . . . . . RoC. See Report on Carcinogens Rothmund-Thomson syndrome . . . . . . . . . .
. . . . . . . . . . . .
Salivary gland cancer . . . . . . . . . . . . . Salpingectomy and salpingo-oophorectomy . Sarcomas, soft-tissue . . . . . . . . . . . . . Saw palmetto . . . . . . . . . . . . . . . . . Schwannoma tumors . . . . . . . . . . . . . SCLC1 gene. . . . . . . . . . . . . . . . . . Screening, colorectal cancer. See Colorectal cancer screening Screening for cancer . . . . . . . . . . . . . Second opinions . . . . . . . . . . . . . . . Self-image and body image. . . . . . . . . .
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1034 1036 1038 1038 1041 1043 1044 1045 1046 1048 1050 1050
. 1052 . 1054 . 1056 1058 1060 1062 1065 1066 1067
. . . 1067 . . . 1070 . . . 1071
Volume 4 Sjögren syndrome. . . . . . . . . . . . . . . . Skin cancers . . . . . . . . . . . . . . . . . . SLN biopsy and mapping. See Sentinel lymph node biopsy and mapping Small intestine cancer . . . . . . . . . . . . . Smoking cessation . . . . . . . . . . . . . . . Social Security Disability Insurance (SSDI) . . Soft-tissue fibrosarcomas. See Fibrosarcomas, soft-tissue Soots . . . . . . . . . . . . . . . . . . . . . . Soy foods . . . . . . . . . . . . . . . . . . . . Spermatocytomas . . . . . . . . . . . . . . . . Spinal axis tumors . . . . . . . . . . . . . . . Spinal cord compression . . . . . . . . . . . . Splenectomy . . . . . . . . . . . . . . . . . . Sputum cytology . . . . . . . . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . lxxvii Complete List of Contents . . . . . . . . . . . . . lxxix Sentinel lymph node (SLN) biopsy and mapping . . . . . . . . . . . . . . . Sepsis. See Infection and sepsis Sertoli cell tumors . . . . . . . . . . . Sexuality and cancer . . . . . . . . . . Sézary syndrome . . . . . . . . . . . . SIADH. See Syndrome of inappropriate antidiuretic hormone production Side effects . . . . . . . . . . . . . . . Sigmoidoscopy . . . . . . . . . . . . . Silica, crystalline . . . . . . . . . . . . Simian virus 40 . . . . . . . . . . . . . Singlehood and cancer . . . . . . . . .
. . . . . . 1073 . . . . . . 1073 . . . . . . 1074 . . . . . . 1076
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1078 1082 1083 1084 1084 xxiv
. . 1086 . . 1088
. . 1091 . . 1093 . . 1096
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1097 1098 1099 1100 1102 1103 1105
Complete List of Contents Squamous cell carcinomas . . . . . . . . . . . SRS. See Stereotactic radiosurgery SSDI. See Social Security Disability Insurance Staging of cancer . . . . . . . . . . . . . . . . Statistics of cancer . . . . . . . . . . . . . . . Stem cell transplantation . . . . . . . . . . . . Stent therapy . . . . . . . . . . . . . . . . . . Stereotactic needle biopsy . . . . . . . . . . . Stereotactic radiosurgery (SRS) . . . . . . . . Sterility . . . . . . . . . . . . . . . . . . . . . Stomach cancers . . . . . . . . . . . . . . . . Stomatitis . . . . . . . . . . . . . . . . . . . . Stress management . . . . . . . . . . . . . . . Sunlamps . . . . . . . . . . . . . . . . . . . . Sun’s soup . . . . . . . . . . . . . . . . . . . Sunscreens . . . . . . . . . . . . . . . . . . . Superior vena cava syndrome . . . . . . . . . Support groups . . . . . . . . . . . . . . . . . Surgical biopsies . . . . . . . . . . . . . . . . Surgical oncology. . . . . . . . . . . . . . . . Survival rates . . . . . . . . . . . . . . . . . . Survivorship issues . . . . . . . . . . . . . . . Symptoms and cancer. . . . . . . . . . . . . . Syndrome of inappropriate antidiuretic hormone production (SIADH) . . . . . . . . Synovial sarcomas . . . . . . . . . . . . . . . Taste alteration . . . . . . . . . . . . . . Teratocarcinomas . . . . . . . . . . . . . Teratomas . . . . . . . . . . . . . . . . . Testicular cancer . . . . . . . . . . . . . Testicular self-examination (TSE) . . . . Thermal imaging . . . . . . . . . . . . . Thiotepa. . . . . . . . . . . . . . . . . . Thoracentesis . . . . . . . . . . . . . . . Thoracoscopy . . . . . . . . . . . . . . . Thoracotomy . . . . . . . . . . . . . . . Throat cancer . . . . . . . . . . . . . . . Thrombocytopenia . . . . . . . . . . . . Thymomas . . . . . . . . . . . . . . . . Thymus cancer . . . . . . . . . . . . . . Thyroid cancer . . . . . . . . . . . . . . Thyroid nuclear medicine scan . . . . . . TNF. See Tumor necrosis factor TNM staging . . . . . . . . . . . . . . . Tobacco, chewing. See Chewing tobacco Tobacco-related cancers . . . . . . . . . Topoisomerase inhibitors . . . . . . . . . TP53 protein . . . . . . . . . . . . . . . Tracheostomy . . . . . . . . . . . . . . . Transfusion therapy. . . . . . . . . . . .
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Transitional care . . . . . . . . . . . Transitional cell carcinomas . . . . . Transrectal ultrasound . . . . . . . . Transvaginal ultrasound . . . . . . . Trichilemmal carcinomas. . . . . . . TSE. See Testicular self-examination Tuberous sclerosis . . . . . . . . . . Tubular carcinomas . . . . . . . . . . Tumor flare . . . . . . . . . . . . . . Tumor lysis syndrome . . . . . . . . Tumor markers . . . . . . . . . . . . Tumor necrosis factor (TNF) . . . . . Tumor-suppressor genes . . . . . . . Turcot syndrome . . . . . . . . . . . Tyrosine kinase inhibitors . . . . . .
. . 1106
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1108 1111 1114 1116 1118 1119 1120 1121 1124 1125 1127 1128 1129 1130 1132 1135 1138 1140 1143 1144
. . 1147 . . 1149 . . . . . . . . . . . . . . . .
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1151 1152 1153 1154 1156 1157 1158 1158 1160 1161 1162 1164 1166 1167 1169 1172
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1182 1183 1185 1186 1187
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1187 1188 1189 1189 1191 1193 1194 1195 1196
Ultrasound, breast. See Breast ultrasound Ultrasound, endorectal. See Endorectal ultrasound Ultrasound, transrectal. See Transrectal ultrasound Ultrasound, transvaginal. See Transvaginal ultrasound Ultrasound tests . . . . . . . . . . . . . . . Ultraviolet radiation and related exposures Umbilical cord blood transplantation. . . . Upper gastrointestinal (GI) endoscopy . . . Upper gastrointestinal (GI) series . . . . . Urethral cancer . . . . . . . . . . . . . . . Urinalysis . . . . . . . . . . . . . . . . . . Urinary system cancers . . . . . . . . . . . Urography . . . . . . . . . . . . . . . . . Urologic oncology . . . . . . . . . . . . . Urostomy . . . . . . . . . . . . . . . . . . Uterine cancer . . . . . . . . . . . . . . .
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1199 1200 1201 1202 1203 1205 1207 1209 1213 1214 1216 1217
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1220 1221 1223 1225 1226
Vaccines, preventive . . . . . . . . . . . Vaccines, therapeutic . . . . . . . . . . . Vaginal cancer . . . . . . . . . . . . . . Vascular access tubes. . . . . . . . . . . Vasectomy and cancer . . . . . . . . . . Vegetables, cruciferous. See Cruciferous vegetables Veterinary oncology . . . . . . . . . . . VHL disease. See Von Hippel-Lindau disease Vinyl chloride . . . . . . . . . . . . . . Viral oncology . . . . . . . . . . . . . . Virus-related cancers . . . . . . . . . . . Von Hippel-Lindau (VHL) disease. . . . Vulvar cancer . . . . . . . . . . . . . . .
. . . . . 1173 . . . . .
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1174 1175 1177 1179 1180 xxv
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1230 1230 1232 1235 1237
Salem Health: Cancer WAGR syndrome. See Wilms’ tumor aniridiagenitourinary anomalies-mental retardation syndrome and cancer Waldenström macroglobulinemia (WM) . . . . . . 1240 Watchful waiting . . . . . . . . . . . . . . . . . . 1242 Weight loss . . . . . . . . . . . . . . . . . . . . . 1243 Wilms’ tumor . . . . . . . . . . . . . . . . . . . . 1245 Wilms’ tumor aniridia-genitourinary anomaliesmental retardation (WAGR) syndrome and cancer . . . . . . . . . . . . . . . . . . . . . . 1248 Wine and cancer . . . . . . . . . . . . . . . . . . 1250 Wire localization . . . . . . . . . . . . . . . . . . 1250 WM. See Waldenström macroglobulinemia Wood dust . . . . . . . . . . . . . . . . . . . . . 1251
Yolk sac carcinomas . . . . . . . . . . . . . . . . 1256 Young adult cancers . . . . . . . . . . . . . . . . 1256 Zollinger-Ellison syndrome . . . . . . . . . . . . 1260 Drugs by Generic Name . . . Drugs by Trade Name . . . . Associations and Agencies . . Cancer Centers and Hospitals Cancer Support Groups . . . . Carcinogens. . . . . . . . . . Glossary . . . . . . . . . . . Bibliography . . . . . . . . .
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1265 1309 1348 1352 1357 1362 1383 1400
Category List . . . . . . . . . . . . . . . . . . . . 1409 Index . . . . . . . . . . . . . . . . . . . . . . . . 1419
X-ray tests . . . . . . . . . . . . . . . . . . . . . 1252 Xeroderma pigmentosa . . . . . . . . . . . . . . . 1254
xxvi
Volume II Denys-Drash syndrome and cancer — Liver cancers
Editor
Jeffrey A. Knight, Ph.D. Mount Holyoke College
Medical Consultants
Laurie Jackson-Grusby, Ph.D. Children’s Hospital Boston, Harvard Medical School
Wendy White-Ryan, M.D., FAAP Golisano Children’s Hospital at Strong Memorial Hospital
SALEM PRESS, INC. Pasadena, California Hackensack, New Jersey
Editor in Chief: Dawn P. Dawson Editorial Director: Christina J. Moose Project Editors: Tracy Irons-Georges, Rowena Wildin Dehanke Editorial Assistant: Dana Garey
Production Editor: Joyce I. Buchea Acquisitions Editor: Mark Rehn Photo Editor: Cynthia Breslin Beres Design and Graphics: James Hutson Layout: William Zimmerman
Copyright © 2009, by Salem Press, Inc. All rights in this book are reserved. No part of this work may be used or reproduced in any manner whatsoever or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the copyright owner except in the case of brief quotations embodied in critical articles and reviews or in the copying of images deemed to be freely licensed or in the public domain. For information address the publisher, Salem Press, Inc., P.O. Box 50062, Pasadena, California 91115. ∞ The paper used in these volumes conforms to the American National Standard for Permanence of Paper for Printed Library Materials, Z39.48-1992 (R1997). Note to Readers The material presented in Salem Health: Cancer is intended for broad informational and educational purposes. Readers who suspect that they or someone whom they know or provide caregiving for suffers from cancer or any other physical or psychological disorder, disease, or condition described in this set should contact a physician without delay; this work should not be used as a substitute for professional medical diagnosis or staging. Readers who are undergoing or about to undergo any treatment or procedure described in this set should refer to their physicians and other health care team members for guidance concerning preparation and possible effects. This set is not to be considered definitive on the covered topics, and readers should remember that the field of health care is characterized by a diversity of medical opinions and constant expansion in knowledge and understanding. Library of Congress Cataloging-in-Publication Data Salem health : cancer / Jeffrey A. Knight, Laurie Jackson-Grusby, Wendy White-Ryan. p. cm. Includes bibliographical references and index. ISBN 978-1-58765-505-0 (set : alk. paper) — ISBN 978-1-58765-506-7 (vol. 1 : alk. paper) — ISBN 978-1-58765-507-4 (vol. 2 : alk. paper) — ISBN 978-1-58765-508-1 (vol. 3 : alk. paper) — ISBN 978-1-58765-509-8 (vol. 4 : alk. paper) 1. Cancer. I. Knight, Jeffrey A., 1948- II. Jackson-Grusby, Laurie. III. White-Ryan, Wendy. RC265.S32 2008 616.99′4—dc22 2008030861
First Printing
printed in the united states of america
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Contents
Complete List of Contents . . . . . . . . . . . . xxxvii Denys-Drash syndrome and cancer . . . . . . Depression . . . . . . . . . . . . . . . . . . . Dermatofibrosarcoma protuberans (DFSP) . . Dermatology oncology. . . . . . . . . . . . . DES. See Diethylstilbestrol Desmoid tumors . . . . . . . . . . . . . . . . Desmoplastic small round cell tumor (DSRCT) . . . . . . . . . . . . . . . . . . Developing nations and cancer . . . . . . . . DFSP. See Dermatofibrosarcoma protuberans Di(2-ethylhexyl) phthalate (DEHP) . . . . . . Diarrhea . . . . . . . . . . . . . . . . . . . . DIC. See Disseminated intravascular coagulation Dietary supplements . . . . . . . . . . . . . . Diethanolamine (DEA) . . . . . . . . . . . . Diethylstilbestrol (DES) . . . . . . . . . . . . Digital rectal exam (DRE) . . . . . . . . . . . Dilation and curettage (D&C) . . . . . . . . . Dioxins . . . . . . . . . . . . . . . . . . . . . Disseminated intravascular coagulation (DIC) . . . . . . . . . . . . . . . . . . . . Diverticulosis and diverticulitis . . . . . . . . DNR. See Do-not-resuscitate order Do-not-resuscitate (DNR) order . . . . . . . . Down syndrome and leukemia. . . . . . . . . DPC4 gene testing . . . . . . . . . . . . . . . DRE. See Digital rectal exam Drug resistance and multidrug resistance (MDR) . . . . . . . . . . . . . . . . . . . . Dry mouth . . . . . . . . . . . . . . . . . . . DSRCT. See Desmoplastic small round cell tumor Duct ectasia . . . . . . . . . . . . . . . . . . Ductal carcinoma in situ (DCIS). . . . . . . . Ductal lavage. . . . . . . . . . . . . . . . . . Ductogram . . . . . . . . . . . . . . . . . . . Duke Comprehensive Cancer Center . . . . . Dukes’ classification . . . . . . . . . . . . . . Duodenal carcinomas . . . . . . . . . . . . . Dye, hair. See Hair dye Dysplastic nevus syndrome . . . . . . . . . .
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Edema . . . . . . . . . . . . . . . . . . . . . . . Education, cancer. See Cancer education Elderly and cancer . . . . . . . . . . . . . . . . . Electrolarynx . . . . . . . . . . . . . . . . . . . . Electromagnetic radiation . . . . . . . . . . . . . Electroporation therapy . . . . . . . . . . . . . . Electrosurgery . . . . . . . . . . . . . . . . . . . Embolization . . . . . . . . . . . . . . . . . . . . Embryonal cell cancer . . . . . . . . . . . . . . . End-of-life care . . . . . . . . . . . . . . . . . . Endocrine cancers . . . . . . . . . . . . . . . . . Endocrinology oncology . . . . . . . . . . . . . . Endometrial cancer . . . . . . . . . . . . . . . . Endometrial hyperplasia . . . . . . . . . . . . . . Endorectal ultrasound . . . . . . . . . . . . . . . Endoscopic retrograde cholangiopancreatography (ERCP) . . . . . . . . . . . . . . . . . . . . . Endoscopy . . . . . . . . . . . . . . . . . . . . . Endoscopy, upper gastrointestinal. See Upper gastrointestinal endoscopy Endotheliomas . . . . . . . . . . . . . . . . . . . Enteritis . . . . . . . . . . . . . . . . . . . . . . Enterostomal therapy . . . . . . . . . . . . . . . Eosinophilic leukemia . . . . . . . . . . . . . . . Ependymomas . . . . . . . . . . . . . . . . . . . Epidemiology of cancer . . . . . . . . . . . . . . Epidermoid cancers of mucous membranes . . . . Epstein-Barr virus . . . . . . . . . . . . . . . . . ERCP. See Endoscopic retrograde cholangiopancreatography ERD. See Estrogen receptor downregulator Erionite. . . . . . . . . . . . . . . . . . . . . . . Erythroplakia. . . . . . . . . . . . . . . . . . . . Esophageal cancer . . . . . . . . . . . . . . . . . Esophageal speech . . . . . . . . . . . . . . . . . Esophagectomy . . . . . . . . . . . . . . . . . . Esophagitis . . . . . . . . . . . . . . . . . . . . . Essiac . . . . . . . . . . . . . . . . . . . . . . . Estrogen receptor downregulator (ERD) . . . . . Estrogen-receptor-sensitive breast cancer . . . . . Ethnicity and cancer . . . . . . . . . . . . . . . . Ethylene oxide . . . . . . . . . . . . . . . . . . . Ewing sarcoma . . . . . . . . . . . . . . . . . . . Exenteration . . . . . . . . . . . . . . . . . . . . Exercise and cancer . . . . . . . . . . . . . . . . External beam radiation therapy (EBRT) . . . . . Eye cancers . . . . . . . . . . . . . . . . . . . . Eyelid cancer. . . . . . . . . . . . . . . . . . . .
357 357 360 362
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370 373 373 374 375 376
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386 387 389 389 390 392 393
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Eaton-Lambert syndrome. See Lambert-Eaton myasthenic syndrome EBRT. See External beam radiation therapy xxxiii
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396 399 399 400 401 402 403 404 406 409 412 414 416
. 417 . 417
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420 421 422 424 425 426 429 431
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433 433 434 436 438 439 441 441 442 444 447 447 450 451 454 455 458
Salem Health: Cancer Fallopian tube cancer . . . . . . . . . . . . Family history and risk assessment . . . . . Fanconi anemia . . . . . . . . . . . . . . . Fatigue . . . . . . . . . . . . . . . . . . . . Fecal occult blood test (FOBT) . . . . . . . Fertility drugs and cancer . . . . . . . . . . Fertility issues . . . . . . . . . . . . . . . . Fever . . . . . . . . . . . . . . . . . . . . . Fiber . . . . . . . . . . . . . . . . . . . . . Fibroadenomas . . . . . . . . . . . . . . . . Fibrocystic breast changes . . . . . . . . . . Fibrosarcomas, soft-tissue . . . . . . . . . . Financial issues . . . . . . . . . . . . . . . 5HIAA test. See 5-Hydroxyindoleacetic acid test 5Q minus syndrome . . . . . . . . . . . . . Flow cytometry . . . . . . . . . . . . . . . FOBT. See Fecal occult blood test Folic acid. . . . . . . . . . . . . . . . . . . Formaldehyde . . . . . . . . . . . . . . . . Fox Chase Cancer Center . . . . . . . . . . Fred Hutchinson Cancer Research Center . . Free radicals . . . . . . . . . . . . . . . . . Fruits . . . . . . . . . . . . . . . . . . . . .
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486 486 487 488 490 491
Gallbladder cancer . . . . . . . . . . . . . . Gallium scan . . . . . . . . . . . . . . . . . Gamma Knife . . . . . . . . . . . . . . . . Gardner syndrome . . . . . . . . . . . . . . Garlic and allicin . . . . . . . . . . . . . . . Gastric polyps . . . . . . . . . . . . . . . . Gastrinomas . . . . . . . . . . . . . . . . . Gastrointestinal cancers . . . . . . . . . . . Gastrointestinal complications of cancer treatment. . . . . . . . . . . . . . . . . . Gastrointestinal oncology . . . . . . . . . . Gastrointestinal stromal tumors (GISTs) . . GCTs. See Giant cell tumors Gene therapy . . . . . . . . . . . . . . . . . Genetic counseling . . . . . . . . . . . . . . Genetic testing . . . . . . . . . . . . . . . . Genetics of cancer . . . . . . . . . . . . . . Geography and cancer . . . . . . . . . . . . Germ-cell tumors . . . . . . . . . . . . . . Gerson therapy . . . . . . . . . . . . . . . . Gestational trophoblastic tumors (GTTs) . . Giant cell tumors (GCTs) . . . . . . . . . . Ginseng, panax. . . . . . . . . . . . . . . . GISTs. See Gastrointestinal stromal tumors Gleason grading system . . . . . . . . . . . Gliomas . . . . . . . . . . . . . . . . . . .
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493 495 497 498 499 500 501 502
Glomus tumors . . . . . . . . . . . . . . . . Glossectomy . . . . . . . . . . . . . . . . . Glutamine . . . . . . . . . . . . . . . . . . Gonioscopy . . . . . . . . . . . . . . . . . Grading of tumors . . . . . . . . . . . . . . Graft-versus-host disease (GVHD) . . . . . Granulosa cell tumors . . . . . . . . . . . . Green tea . . . . . . . . . . . . . . . . . . . Grief and bereavement . . . . . . . . . . . . GTTs. See Gestational trophoblastic tumors GVHD. See Graft-versus-host disease Gynecologic cancers . . . . . . . . . . . . . Gynecologic oncology . . . . . . . . . . . .
460 461 464 466 467 469 471 472 474 475 476 478 481
H. pylori. See Helicobacter pylori HAI. See Hepatic arterial infusion Hair dye . . . . . . . . . . . . . . . . . . Hairy cell leukemia . . . . . . . . . . . . Hand-foot syndrome (HFS) . . . . . . . . HBV. See Hepatitis B virus HCG. See Human chorionic gonadotropin HCV. See Hepatitis C virus Head and neck cancers . . . . . . . . . . . Health maintenance organizations (HMOs) Helicobacter pylori. . . . . . . . . . . . . Hemangioblastomas . . . . . . . . . . . . Hemangiopericytomas . . . . . . . . . . . Hemangiosarcomas . . . . . . . . . . . . Hematemesis . . . . . . . . . . . . . . . . Hematologic oncology . . . . . . . . . . . Hematuria . . . . . . . . . . . . . . . . . Hemochromatosis . . . . . . . . . . . . . Hemolytic anemia . . . . . . . . . . . . . Hemoptysis. . . . . . . . . . . . . . . . . Hemorrhoids . . . . . . . . . . . . . . . . Hepatic arterial infusion (HAI) . . . . . . Hepatitis B virus (HBV) . . . . . . . . . . Hepatitis C virus (HCV) . . . . . . . . . . Hepatomegaly . . . . . . . . . . . . . . . HER2/neu protein . . . . . . . . . . . . . Herbs as antioxidants . . . . . . . . . . . Hereditary cancer syndromes . . . . . . . Hereditary diffuse gastric cancer . . . . . Hereditary leiomyomatosis and renal cell cancer (HLRCC) . . . . . . . . . . . . Hereditary mixed polyposis syndrome . . Hereditary non-VHL clear cell renal cell carcinomas . . . . . . . . . . . . . . . Hereditary pancreatitis . . . . . . . . . . . Hereditary papillary renal cell carcinomas Hereditary polyposis syndromes . . . . . .
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512 515 517 519 522 525 527 527 530 531
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534 535 536 536 537 538 540 540 541
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554 557 558 559 559 560 561 562 564 565 566 566 567 568 569 570 571 573 573 574 576
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580 580 581 582
Contents Herpes simplex virus. . . . . . . . . . . . . . . . Herpes zoster virus. . . . . . . . . . . . . . . . . HFS. See Hand-foot syndrome Hispanics and cancer. See Latinos/Hispanics and cancer Histamine 2 antagonists . . . . . . . . . . . . . . Histiocytosis X . . . . . . . . . . . . . . . . . . . HIV/AIDS-related cancers . . . . . . . . . . . . . HLRCC. See Hereditary leiomyomatosis and renal cell cancer HMOs. See Health maintenance organizations Hodgkin disease . . . . . . . . . . . . . . . . . . Home health services . . . . . . . . . . . . . . . Hormonal therapies . . . . . . . . . . . . . . . . Hormone receptor tests . . . . . . . . . . . . . . Hormone replacement therapy (HRT) . . . . . . . Horner syndrome. . . . . . . . . . . . . . . . . . Hospice care . . . . . . . . . . . . . . . . . . . . Hot flashes . . . . . . . . . . . . . . . . . . . . . HPV. See Human papillomavirus HRAS gene testing . . . . . . . . . . . . . . . . . HRT. See Hormone replacement therapy HTLV. See Human T-cell leukemia virus Human chorionic gonadotropin (HCG) . . . . . . Human growth factors and tumor growth . . . . . Human immunodeficiency virus-related cancers. See HIV/AIDS-related cancers Human papillomavirus (HPV) . . . . . . . . . . . Human T-cell leukemia virus (HTLV) . . . . . . Hydatidiform mole . . . . . . . . . . . . . . . . . 5-Hydroxyindoleacetic acid (5HIAA) test . . . . . Hypercalcemia . . . . . . . . . . . . . . . . . . . Hypercoagulation disorders . . . . . . . . . . . . Hyperthermia therapy . . . . . . . . . . . . . . . Hyperthermic perfusion . . . . . . . . . . . . . . Hypopharyngeal cancer . . . . . . . . . . . . . . Hysterectomy . . . . . . . . . . . . . . . . . . . Hysterography . . . . . . . . . . . . . . . . . . . Hystero-oophorectomy. . . . . . . . . . . . . . . Hysteroscopy. . . . . . . . . . . . . . . . . . . . IEP. See Immunoelectrophoresis iFOBT. See Immunochemical fecal occult blood test Ileostomy. . . . . . . . . . . . . . . . . . . . . Imaging tests . . . . . . . . . . . . . . . . . . . Immune response to cancer . . . . . . . . . . . Immunochemical fecal occult blood test (iFOBT) . . . . . . . . . . . . . . . . . . . . Immunocytochemistry and immunohistochemistry . . . . . . . . . . . .
Immunoelectrophoresis (IEP) . . . . . . Immunotherapy . . . . . . . . . . . . . IMRT. See Intensity-modulated radiation therapy Indoles . . . . . . . . . . . . . . . . . . Infection and sepsis . . . . . . . . . . . Infectious cancers . . . . . . . . . . . . Infertility and cancer . . . . . . . . . . . Inflammatory bowel disease . . . . . . . Informed consent. . . . . . . . . . . . . Infusion therapies . . . . . . . . . . . . Insurance . . . . . . . . . . . . . . . . . Integrative oncology . . . . . . . . . . . Intensity-modulated radiation therapy (IMRT) . . . . . . . . . . . . . . . . Interferon. . . . . . . . . . . . . . . . . Interleukins. . . . . . . . . . . . . . . . Invasive cancer. . . . . . . . . . . . . . Invasive ductal carcinomas . . . . . . . Invasive lobular carcinomas . . . . . . . Ionizing radiation . . . . . . . . . . . . Iridium seeds . . . . . . . . . . . . . . . Islet cell tumors . . . . . . . . . . . . . Isoflavones . . . . . . . . . . . . . . . . Itching . . . . . . . . . . . . . . . . . .
. 584 . 586
. 587 . 588 . 590
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593 597 599 601 603 605 606 608
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. 609 . 610
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638 638 641 643 645 646 647 648 651
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652 653 654 655 656 657 657 658 659 661 661
Jonsson Comprehensive Cancer Center (JCCC) . . . . . . . . . . . . . . . . . . . . . . 664 Journaling . . . . . . . . . . . . . . . . . . . . . . 665 Juvenile polyposis syndrome . . . . . . . . . . . . 665
611 612 612 613 614 615 617 618 619 620 621 622 623
Kaposi sarcoma . . . . . . . . . . . . . Karnofsky performance status (KPS) . . Keratosis . . . . . . . . . . . . . . . . . Ki67 test . . . . . . . . . . . . . . . . . Kidney cancer . . . . . . . . . . . . . . Klinefelter syndrome and cancer . . . . KPS. See Karnofsky performance status Krukenberg tumors . . . . . . . . . . . Lacrimal gland tumors . . . . . . . . . Lactate dehydrogenase (LDH) test . . Laetrile . . . . . . . . . . . . . . . . . Lambert-Eaton myasthenic syndrome (LEMS) . . . . . . . . . . . . . . . Laparoscopy and laparoscopic surgery Laryngeal cancer . . . . . . . . . . . . Laryngeal nerve palsy . . . . . . . . . Laryngectomy . . . . . . . . . . . . . Laryngoscopy . . . . . . . . . . . . . Laser therapies . . . . . . . . . . . . .
. . 625 . . 626 . . 629 . . 632 . . 633 xxxv
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667 669 670 670 671 674
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679 681 682 685 686 687 688
Salem Health: Cancer Latinos/Hispanics and cancer . . . . . . . . . . . Laxatives . . . . . . . . . . . . . . . . . . . . . . LCIS. See Lobular carcinoma in situ LDH test. See Lactate dehydrogenase test Leiomyomas . . . . . . . . . . . . . . . . . . . . Leiomyosarcomas . . . . . . . . . . . . . . . . . LEMS. See Lambert-Eaton myasthenic syndrome Leptomeningeal carcinomas . . . . . . . . . . . . Leukapharesis . . . . . . . . . . . . . . . . . . . Leukemia, Down syndrome and. See Down syndrome and leukemia Leukemia, eosinophilic. See Eosinophilic leukemia
. 690 . 692
Leukemia, hairy cell. See Hairy cell leukemia Leukemias . . . . . . . . . . . . . . . . . . . Leukoencephalopathy . . . . . . . . . . . . . Leukopenia. . . . . . . . . . . . . . . . . . . Leukoplakia . . . . . . . . . . . . . . . . . . Leydig cell tumors . . . . . . . . . . . . . . . Li-Fraumeni syndrome (LFS) . . . . . . . . . Limb salvage . . . . . . . . . . . . . . . . . . Linear accelerator . . . . . . . . . . . . . . . Lip cancers . . . . . . . . . . . . . . . . . . . Liposarcomas . . . . . . . . . . . . . . . . . Liver biopsy . . . . . . . . . . . . . . . . . . Liver cancers . . . . . . . . . . . . . . . . . .
. 693 . 694 . 696 . 698
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698 702 704 704 706 706 708 709 710 712 714 715
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Complete List of Contents Volume 1
Contents . . . . . . . . . . . . . . . . . . . . . . . . v Publisher’s Note . . . . . . . . . . . . . . . . . . . . ix About the Editors . . . . . . . . . . . . . . . . . . . xi Contributors . . . . . . . . . . . . . . . . . . . . . xiii Complete List of Contents . . . . . . . . . . . . . . xv AACR. See American Association for Cancer Research ABCD. . . . . . . . . . . . . . . . . . . . . . . . . . 1 ACC. See Adenoid cystic carcinoma Abdominoperineal resection (APR) . . . . . . . . . . 1 Accelerated partial breast irradiation (APBI). . . . . . 3 Achlorhydria . . . . . . . . . . . . . . . . . . . . . . 4 Acoustic neuromas . . . . . . . . . . . . . . . . . . . 4 Acquired immunodeficiency disease-related cancers. See HIV/AIDS-related cancers Acrylamides . . . . . . . . . . . . . . . . . . . . . . 6 ACS. See American Cancer Society Acupuncture and acupressure for cancer patients . . . 8 Acute lymphocytic leukemia (ALL) . . . . . . . . . 11 Acute myelocytic leukemia (AML) . . . . . . . . . . 13 Adenocarcinomas . . . . . . . . . . . . . . . . . . . 16 Adenoid cystic carcinoma (ACC) . . . . . . . . . . . 17 Adenomatoid tumors . . . . . . . . . . . . . . . . . 18 Adenomatous polyps . . . . . . . . . . . . . . . . . 18 Adenoviruses . . . . . . . . . . . . . . . . . . . . . 19 Adjuvant therapy . . . . . . . . . . . . . . . . . . . 20 Adrenal gland cancers . . . . . . . . . . . . . . . . . 21 Adrenocortical cancer . . . . . . . . . . . . . . . . . 23 Advance directives . . . . . . . . . . . . . . . . . . 24 Aflatoxins . . . . . . . . . . . . . . . . . . . . . . . 26 AFP levels. See Alpha-fetoprotein levels African Americans and cancer . . . . . . . . . . . . 28 Africans and cancer . . . . . . . . . . . . . . . . . . 31 Afterloading radiation therapy . . . . . . . . . . . . 32 Agent Orange . . . . . . . . . . . . . . . . . . . . . 34 Aging and cancer . . . . . . . . . . . . . . . . . . . 34 AICR. See American Institute for Cancer Research Aids and devices for cancer patients . . . . . . . . . 38 AIDS-related cancers. See HIV/AIDS-related cancers Air pollution . . . . . . . . . . . . . . . . . . . . . . 39 Alcohol, alcoholism, and cancer . . . . . . . . . . . 42 Aleukemia . . . . . . . . . . . . . . . . . . . . . . . 43 Alkaline phosphatase test (ALP) . . . . . . . . . . . 44
Alkylating agents in chemotherapy . . . . . . . ALL. See Acute lymphocytic leukemia Allicin, garlic and. See Garlic and allicin Alopecia . . . . . . . . . . . . . . . . . . . . . ALP. See Alkaline phosphatase test Alpha-fetoprotein (AFP) levels . . . . . . . . . Alternative therapies. See Complementary and alternative therapies Alveolar soft-part sarcomas . . . . . . . . . . . Amenorrhea . . . . . . . . . . . . . . . . . . . American Association for Cancer Research (AACR) . . . . . . . . . . . . . . . . . . . . American Cancer Society (ACS) . . . . . . . . American Institute for Cancer Research (AICR) 4-Aminobiphenyl . . . . . . . . . . . . . . . . AML. See Acute myelocytic leukemia Amputation . . . . . . . . . . . . . . . . . . . Amyloidosis . . . . . . . . . . . . . . . . . . . Anal cancer . . . . . . . . . . . . . . . . . . . Androgen drugs . . . . . . . . . . . . . . . . . Anemia . . . . . . . . . . . . . . . . . . . . . Anemia, aplastic. See Aplastic anemia Anemia, hemolytic. See Hemolytic anemia Angiogenesis . . . . . . . . . . . . . . . . . . Angiogenesis inhibitors . . . . . . . . . . . . . Angiography. . . . . . . . . . . . . . . . . . . Angiosarcomas . . . . . . . . . . . . . . . . . Anoscopy . . . . . . . . . . . . . . . . . . . . Anthraquinones . . . . . . . . . . . . . . . . . Anthrax . . . . . . . . . . . . . . . . . . . . . Antiandrogens . . . . . . . . . . . . . . . . . . Antidiarrheal agents . . . . . . . . . . . . . . . Antiestrogens . . . . . . . . . . . . . . . . . . Antifungal therapies . . . . . . . . . . . . . . . Antimetabolites in chemotherapy . . . . . . . . Antinausea medications . . . . . . . . . . . . . Antineoplastics in chemotherapy . . . . . . . . Antioxidants . . . . . . . . . . . . . . . . . . . Antiperspirants and breast cancer . . . . . . . . Antiviral therapies. . . . . . . . . . . . . . . . Anxiety . . . . . . . . . . . . . . . . . . . . . APBI. See Accelerated partial breast irradiation APC gene testing . . . . . . . . . . . . . . . . Aplastic anemia . . . . . . . . . . . . . . . . . Appendix cancer . . . . . . . . . . . . . . . . Appetite loss. . . . . . . . . . . . . . . . . . .
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64 66 68 69 70 71 71 72 73 75 76 78 81 83 86 88 90 93
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Salem Health: Cancer APR. See Abdominoperineal resection Arsenic compounds . . . . . . . . . . Arterial embolization . . . . . . . . . Artificial sweeteners . . . . . . . . . . Asbestos . . . . . . . . . . . . . . . . Ascites . . . . . . . . . . . . . . . . . Ashkenazi Jews and cancer . . . . . . Asian Americans and cancer. . . . . . Astrocytomas. . . . . . . . . . . . . . Ataxia telangiectasia (AT) . . . . . . . Autologous blood transfusion . . . . . Axillary dissection . . . . . . . . . . . Azathioprine . . . . . . . . . . . . . .
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Bacillus Calmette Guérin (BCG) . . . . . . . . Bacteria as causes of cancer . . . . . . . . . . . Barium enema . . . . . . . . . . . . . . . . . . Barium swallow . . . . . . . . . . . . . . . . . Barrett esophagus . . . . . . . . . . . . . . . . Basal cell carcinomas . . . . . . . . . . . . . . BCG. See Bacillus Calmette Guérin Beckwith-Wiedemann syndrome (BWS) . . . . Benign prostatic hyperplasia (BPH) . . . . . . . Benign tumors . . . . . . . . . . . . . . . . . . Benzene . . . . . . . . . . . . . . . . . . . . . Benzidine and dyes metabolized to benzidine . . Benzodiazepines . . . . . . . . . . . . . . . . . Bereavement, grief and. See Grief and bereavement Beryllium and beryllium compounds . . . . . . Beta-carotene . . . . . . . . . . . . . . . . . . Bethesda criteria . . . . . . . . . . . . . . . . . BHDS. See Birt-Hogg-Dubé syndrome Bile duct cancer . . . . . . . . . . . . . . . . . Bilobectomy . . . . . . . . . . . . . . . . . . . Bioflavonoids . . . . . . . . . . . . . . . . . . Biological therapy . . . . . . . . . . . . . . . . Biopsy. See also Computed tomography-guided biopsy; Core needle biopsy; Liver biopsy; Needle biopsies; Pleural biopsy; Stereotactic needle biopsy; Surgical biopsies . . . . . . . Birt-Hogg-Dubé syndrome (BHDS) . . . . . . . Birth control pills and cancer . . . . . . . . . . Bis(chloromethyl) ether and technical-grade chloromethyl methyl ether . . . . . . . . . . Bisphenol A (BPA) . . . . . . . . . . . . . . . Bisphosphonates . . . . . . . . . . . . . . . . . Bladder cancer . . . . . . . . . . . . . . . . . . Blood cancers . . . . . . . . . . . . . . . . . . BMT. See Bone marrow transplantation BNCT. See Boron neutron capture therapy
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148 149 151 151 154
Body image. See Self-image and body image Bone cancers . . . . . . . . . . . . . . . . . . . Bone marrow aspiration and biopsy . . . . . . . Bone marrow transplantation (BMT) . . . . . . Bone pain . . . . . . . . . . . . . . . . . . . . Bone scan . . . . . . . . . . . . . . . . . . . . Boron neutron capture therapy (BNCT) . . . . . Bowen disease . . . . . . . . . . . . . . . . . . BPA. See Bisphenol A BPH. See Benign prostatic hyperplasia BPI. See Brief Pain Inventory Brachytherapy . . . . . . . . . . . . . . . . . . BRAF gene . . . . . . . . . . . . . . . . . . . . Brain and central nervous system cancers . . . . Brain scan . . . . . . . . . . . . . . . . . . . . BRCA1 and BRCA2 genes . . . . . . . . . . . . Breakthrough pain . . . . . . . . . . . . . . . . Breast, calcifications of. See Calcifications of the breast Breast, medullary carcinoma of. See Medullary carcinoma of the breast Breast cancer, cutaneous. See Cutaneous breast cancer Breast cancer, estrogen-receptor-sensitive. See Estrogen-receptor-sensitive breast cancer Breast cancer in children and adolescents . . . . Breast cancer in men . . . . . . . . . . . . . . . Breast cancer in pregnant women . . . . . . . . Breast cancers . . . . . . . . . . . . . . . . . . Breast implants. . . . . . . . . . . . . . . . . . Breast reconstruction. . . . . . . . . . . . . . . Breast self-examination (BSE). . . . . . . . . . Breast ultrasound. . . . . . . . . . . . . . . . . Breslow’s staging . . . . . . . . . . . . . . . . Brief Pain Inventory (BPI) . . . . . . . . . . . . Brompton cocktail . . . . . . . . . . . . . . . . Bronchial adenomas . . . . . . . . . . . . . . . Bronchoalveolar lung cancer . . . . . . . . . . Bronchography. . . . . . . . . . . . . . . . . . Bronchoscopy . . . . . . . . . . . . . . . . . . BSE. See Breast self-examination Burkitt lymphoma . . . . . . . . . . . . . . . . 1,3-Butadiene . . . . . . . . . . . . . . . . . . 1,4-Butanediol dimethanesulfonate . . . . . . . BWS. See Beckwith-Wiedemann syndrome CA 15-3 test . CA 19-9 test . CA 27-29 test CA 125 test. . Cachexia . . .
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158 161 163 165 166 167 168
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180 182 184 185 188 190 193 194 195 196 196 197 197 199 199
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205 205 206 206 207
Complete List of Contents Cadmium and cadmium compounds. . . . . . . . Caffeine . . . . . . . . . . . . . . . . . . . . . . Calcifications of the breast. . . . . . . . . . . . . Calcium . . . . . . . . . . . . . . . . . . . . . . Cancell . . . . . . . . . . . . . . . . . . . . . . . Cancer biology . . . . . . . . . . . . . . . . . . . Cancer care team . . . . . . . . . . . . . . . . . . Cancer clusters . . . . . . . . . . . . . . . . . . . Cancer education. . . . . . . . . . . . . . . . . . Candidiasis . . . . . . . . . . . . . . . . . . . . . Carcinoembryonic antigen antibody (CEA) test . . . . . . . . . . . . . . . . . . . . . . . . Carcinogens, known . . . . . . . . . . . . . . . . Carcinogens, reasonably anticipated. . . . . . . . Carcinoid tumors and carcinoid syndrome . . . . Carcinoma of unknown primary origin (CUP) . . Carcinomas. . . . . . . . . . . . . . . . . . . . . Carcinomas, invasive ductal. See Invasive ductal carcinomas Carcinomas, invasive lobular. See Invasive lobular carcinomas Carcinomas, leptomeningeal. See Leptomeningeal carcinomas Carcinomatosis. . . . . . . . . . . . . . . . . . . Carcinomatous meningitis . . . . . . . . . . . . . Carcinosarcomas . . . . . . . . . . . . . . . . . . Cardiomyopathy in cancer patients . . . . . . . . Cardiopulmonary resuscitation (CPR) . . . . . . . Caregivers and caregiving . . . . . . . . . . . . . Caregiving, long-distance. See Long-distance caregiving Carney complex . . . . . . . . . . . . . . . . . . Carotenoids . . . . . . . . . . . . . . . . . . . . Cartilage supplements . . . . . . . . . . . . . . . Case management . . . . . . . . . . . . . . . . . Castleman disease . . . . . . . . . . . . . . . . . CBC. See Complete blood count CBE. See Clinical breast exam CDKN2A. See Cyclin-dependent kinase inhibitor-2A CEA test. See Carcinoembryonic antigen antibody test Cell phones. . . . . . . . . . . . . . . . . . . . . Cervical cancer. . . . . . . . . . . . . . . . . . . Chemoembolization . . . . . . . . . . . . . . . . Chemoprevention . . . . . . . . . . . . . . . . . Chemotherapy . . . . . . . . . . . . . . . . . . . Chemotherapy, cognitive effects of. See Cognitive effects of cancer and chemotherapy Chewing tobacco. . . . . . . . . . . . . . . . . . Childbirth and cancer . . . . . . . . . . . . . . .
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Childhood cancers . . . . . . . . . . . . . . . . Chlorambucil. . . . . . . . . . . . . . . . . . . 1-(2-Chloroethyl)-3-(4-methylcyclohexyl)1-nitrosourea (MeCCNU) . . . . . . . . . . . Cholecystectomy . . . . . . . . . . . . . . . . . Chordomas . . . . . . . . . . . . . . . . . . . . Choriocarcinomas . . . . . . . . . . . . . . . . CHPP. See Continuous hyperthermic peritoneal perfusion Chromium hexavalent compounds. . . . . . . . Chromosomes and cancer . . . . . . . . . . . . Chronic lymphocytic leukemia (CLL) . . . . . . Chronic myeloid leukemia (CML). . . . . . . . Cigarettes and cigars . . . . . . . . . . . . . . . Clinical breast exam (CBE) . . . . . . . . . . . Clinical trials . . . . . . . . . . . . . . . . . . . CLL. See Chronic lymphocytic leukemia CML. See Chronic myeloid leukemia Coal tars and coal tar pitches . . . . . . . . . . Cobalt 60 radiation. . . . . . . . . . . . . . . . Coenzyme Q10. . . . . . . . . . . . . . . . . . Cognitive effects of cancer and chemotherapy . Coke oven emissions. . . . . . . . . . . . . . . Cold nodule . . . . . . . . . . . . . . . . . . . Colectomy . . . . . . . . . . . . . . . . . . . . Coloanal anastomosis . . . . . . . . . . . . . . Colon polyps . . . . . . . . . . . . . . . . . . . Colonoscopy and virtual colonoscopy . . . . . . Colony-stimulating factors (CSFs) . . . . . . . Colorectal cancer. . . . . . . . . . . . . . . . . Colorectal cancer screening . . . . . . . . . . . Colostomy . . . . . . . . . . . . . . . . . . . . Colposcopy. . . . . . . . . . . . . . . . . . . . Comedo carcinomas . . . . . . . . . . . . . . . Complementary and alternative therapies . . . . Complete blood count (CBC) . . . . . . . . . . Computed tomography (CT)-guided biopsy . . . . . . . . . . . . . . . . . . . . . Computed tomography (CT) scan . . . . . . . . Conization . . . . . . . . . . . . . . . . . . . . Continuous hyperthermic peritoneal perfusion (CHPP) . . . . . . . . . . . . . . . . . . . . Cordectomy . . . . . . . . . . . . . . . . . . . Cordotomy . . . . . . . . . . . . . . . . . . . . Core needle biopsy. . . . . . . . . . . . . . . . Corticosteroids . . . . . . . . . . . . . . . . . . Coughing . . . . . . . . . . . . . . . . . . . . . Counseling for cancer patients and survivors . . Cowden syndrome . . . . . . . . . . . . . . . . COX-2 inhibitors. See Cyclooxygenase 2 inhibitors
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288 289 289 290 292 292 293 294 296 297 299 300 304 306 308 309 309 312
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318 318 319 321 321 322 324 326
Salem Health: Cancer CPR. See Cardiopulmonary resuscitation Craniopharyngiomas . . . . . . . . . . . . Craniosynostosis . . . . . . . . . . . . . . Craniotomy. . . . . . . . . . . . . . . . . Crohn disease . . . . . . . . . . . . . . . Cruciferous vegetables . . . . . . . . . . . Cryoablation . . . . . . . . . . . . . . . . Cryptorchidism. . . . . . . . . . . . . . . CSFs. See Colony-stimulating factors CT scan. See Computed tomography scan CTCL. See Cutaneous T-cell lymphoma Culdoscopy. . . . . . . . . . . . . . . . . CUP. See Carcinoma of unknown primary origin Curcumin. . . . . . . . . . . . . . . . . . Cushing syndrome and cancer . . . . . . . Cutaneous breast cancer . . . . . . . . . . Cutaneous T-cell lymphoma (CTCL) . . .
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Cyclin-dependent kinase inhibitor-2A (CDKN2A). . . . . . . . . . . . . . . Cyclooxygenase 2 (COX-2) inhibitors . Cyclophosphamide. . . . . . . . . . . . Cyclosporin A . . . . . . . . . . . . . . Cystography . . . . . . . . . . . . . . . Cystoscopy . . . . . . . . . . . . . . . . Cytogenetics . . . . . . . . . . . . . . . Cytokines . . . . . . . . . . . . . . . . Cytology . . . . . . . . . . . . . . . . . Cytology, sputum. See Sputum cytology
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344 344 345 346 347 347 348 350 350
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D&C. See Dilation and curettage Dana-Farber Cancer Institute . . . . . . . . . . . . 354 DCIS. See Ductal carcinoma in situ DEA. See Diethanolamine DEHP. See Di(2-ethylhexyl) phthalate Delta-9-tetrahydrocannabinol . . . . . . . . . . . . 355
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Volume 2 Down syndrome and leukemia. . . . . . . . DPC4 gene testing . . . . . . . . . . . . . . DRE. See Digital rectal exam Drug resistance and multidrug resistance (MDR) . . . . . . . . . . . . . . . . . . . Dry mouth . . . . . . . . . . . . . . . . . . DSRCT. See Desmoplastic small round cell tumor Duct ectasia . . . . . . . . . . . . . . . . . Ductal carcinoma in situ (DCIS). . . . . . . Ductal lavage. . . . . . . . . . . . . . . . . Ductogram . . . . . . . . . . . . . . . . . . Duke Comprehensive Cancer Center . . . . Dukes’ classification . . . . . . . . . . . . . Duodenal carcinomas . . . . . . . . . . . . Dye, hair. See Hair dye Dysplastic nevus syndrome . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . xxxiii Complete List of Contents . . . . . . . . . . . . xxxvii Denys-Drash syndrome and cancer . . . . . . Depression . . . . . . . . . . . . . . . . . . . Dermatofibrosarcoma protuberans (DFSP) . . Dermatology oncology. . . . . . . . . . . . . DES. See Diethylstilbestrol Desmoid tumors . . . . . . . . . . . . . . . . Desmoplastic small round cell tumor (DSRCT) . . . . . . . . . . . . . . . . . . Developing nations and cancer . . . . . . . . DFSP. See Dermatofibrosarcoma protuberans Di(2-ethylhexyl) phthalate (DEHP) . . . . . . Diarrhea . . . . . . . . . . . . . . . . . . . . DIC. See Disseminated intravascular coagulation Dietary supplements . . . . . . . . . . . . . . Diethanolamine (DEA) . . . . . . . . . . . . Diethylstilbestrol (DES) . . . . . . . . . . . . Digital rectal exam (DRE) . . . . . . . . . . . Dilation and curettage (D&C) . . . . . . . . . Dioxins . . . . . . . . . . . . . . . . . . . . . Disseminated intravascular coagulation (DIC) . . . . . . . . . . . . . . . . . . . . Diverticulosis and diverticulitis . . . . . . . . DNR. See Do-not-resuscitate order Do-not-resuscitate (DNR) order . . . . . . . .
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Eaton-Lambert syndrome. See Lambert-Eaton myasthenic syndrome EBRT. See External beam radiation therapy Edema . . . . . . . . . . . . . . . . . . . . . Education, cancer. See Cancer education Elderly and cancer . . . . . . . . . . . . . . . Electrolarynx . . . . . . . . . . . . . . . . . . Electromagnetic radiation . . . . . . . . . . . Electroporation therapy . . . . . . . . . . . . Electrosurgery . . . . . . . . . . . . . . . . .
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396 399 399 400 401
Complete List of Contents Embolization . . . . . . . . . . . . . . . . . . . . Embryonal cell cancer . . . . . . . . . . . . . . . End-of-life care . . . . . . . . . . . . . . . . . . Endocrine cancers . . . . . . . . . . . . . . . . . Endocrinology oncology . . . . . . . . . . . . . . Endometrial cancer . . . . . . . . . . . . . . . . Endometrial hyperplasia . . . . . . . . . . . . . . Endorectal ultrasound . . . . . . . . . . . . . . . Endoscopic retrograde cholangiopancreatography (ERCP) . . . . . . . . . . . . . . . . . . . . . Endoscopy . . . . . . . . . . . . . . . . . . . . . Endoscopy, upper gastrointestinal. See Upper gastrointestinal endoscopy Endotheliomas . . . . . . . . . . . . . . . . . . . Enteritis . . . . . . . . . . . . . . . . . . . . . . Enterostomal therapy . . . . . . . . . . . . . . . Eosinophilic leukemia . . . . . . . . . . . . . . . Ependymomas . . . . . . . . . . . . . . . . . . . Epidemiology of cancer . . . . . . . . . . . . . . Epidermoid cancers of mucous membranes . . . . Epstein-Barr virus . . . . . . . . . . . . . . . . . ERCP. See Endoscopic retrograde cholangiopancreatography ERD. See Estrogen receptor downregulator Erionite. . . . . . . . . . . . . . . . . . . . . . . Erythroplakia. . . . . . . . . . . . . . . . . . . . Esophageal cancer . . . . . . . . . . . . . . . . . Esophageal speech . . . . . . . . . . . . . . . . . Esophagectomy . . . . . . . . . . . . . . . . . . Esophagitis . . . . . . . . . . . . . . . . . . . . . Essiac . . . . . . . . . . . . . . . . . . . . . . . Estrogen receptor downregulator (ERD) . . . . . Estrogen-receptor-sensitive breast cancer . . . . . Ethnicity and cancer . . . . . . . . . . . . . . . . Ethylene oxide . . . . . . . . . . . . . . . . . . . Ewing sarcoma . . . . . . . . . . . . . . . . . . . Exenteration . . . . . . . . . . . . . . . . . . . . Exercise and cancer . . . . . . . . . . . . . . . . External beam radiation therapy (EBRT) . . . . . Eye cancers . . . . . . . . . . . . . . . . . . . . Eyelid cancer. . . . . . . . . . . . . . . . . . . .
. . . . . . . .
Fallopian tube cancer . . . . . . . Family history and risk assessment Fanconi anemia . . . . . . . . . . Fatigue . . . . . . . . . . . . . . . Fecal occult blood test (FOBT) . . Fertility drugs and cancer . . . . . Fertility issues . . . . . . . . . . . Fever . . . . . . . . . . . . . . . . Fiber . . . . . . . . . . . . . . . .
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402 403 404 406 409 412 414 416
. 417 . 417
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420 421 422 424 425 426 429 431
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433 433 434 436 438 439 441 441 442 444 447 447 450 451 454 455 458
. . . . . . . . .
460 461 464 466 467 469 471 472 474 xli
Fibroadenomas . . . . . . . . . . . . . . . . Fibrocystic breast changes . . . . . . . . . . Fibrosarcomas, soft-tissue . . . . . . . . . . Financial issues . . . . . . . . . . . . . . . 5HIAA test. See 5-Hydroxyindoleacetic acid test 5Q minus syndrome . . . . . . . . . . . . . Flow cytometry . . . . . . . . . . . . . . . FOBT. See Fecal occult blood test Folic acid. . . . . . . . . . . . . . . . . . . Formaldehyde . . . . . . . . . . . . . . . . Fox Chase Cancer Center . . . . . . . . . . Fred Hutchinson Cancer Research Center . . Free radicals . . . . . . . . . . . . . . . . . Fruits . . . . . . . . . . . . . . . . . . . . .
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475 476 478 481
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486 486 487 488 490 491
Gallbladder cancer . . . . . . . . . . . . . . Gallium scan . . . . . . . . . . . . . . . . . Gamma Knife . . . . . . . . . . . . . . . . Gardner syndrome . . . . . . . . . . . . . . Garlic and allicin . . . . . . . . . . . . . . . Gastric polyps . . . . . . . . . . . . . . . . Gastrinomas . . . . . . . . . . . . . . . . . Gastrointestinal cancers . . . . . . . . . . . Gastrointestinal complications of cancer treatment. . . . . . . . . . . . . . . . . . Gastrointestinal oncology . . . . . . . . . . Gastrointestinal stromal tumors (GISTs) . . GCTs. See Giant cell tumors Gene therapy . . . . . . . . . . . . . . . . . Genetic counseling . . . . . . . . . . . . . . Genetic testing . . . . . . . . . . . . . . . . Genetics of cancer . . . . . . . . . . . . . . Geography and cancer . . . . . . . . . . . . Germ-cell tumors . . . . . . . . . . . . . . Gerson therapy . . . . . . . . . . . . . . . . Gestational trophoblastic tumors (GTTs) . . Giant cell tumors (GCTs) . . . . . . . . . . Ginseng, panax. . . . . . . . . . . . . . . . GISTs. See Gastrointestinal stromal tumors Gleason grading system . . . . . . . . . . . Gliomas . . . . . . . . . . . . . . . . . . . Glomus tumors . . . . . . . . . . . . . . . . Glossectomy . . . . . . . . . . . . . . . . . Glutamine . . . . . . . . . . . . . . . . . . Gonioscopy . . . . . . . . . . . . . . . . . Grading of tumors . . . . . . . . . . . . . . Graft-versus-host disease (GVHD) . . . . . Granulosa cell tumors . . . . . . . . . . . . Green tea . . . . . . . . . . . . . . . . . . . Grief and bereavement . . . . . . . . . . . .
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493 495 497 498 499 500 501 502
. . . . 484 . . . . 484
. . . . 506 . . . . 508 . . . . 511 . . . . . . . . . .
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512 515 517 519 522 525 527 527 530 531
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532 533 534 535 536 536 537 538 540 540 541
Salem Health: Cancer GTTs. See Gestational trophoblastic tumors GVHD. See Graft-versus-host disease Gynecologic cancers . . . . . . . . . . . . . . . . . 543 Gynecologic oncology . . . . . . . . . . . . . . . . 547 H. pylori. See Helicobacter pylori HAI. See Hepatic arterial infusion Hair dye . . . . . . . . . . . . . . . . . . . . . . Hairy cell leukemia . . . . . . . . . . . . . . . . Hand-foot syndrome (HFS) . . . . . . . . . . . . HBV. See Hepatitis B virus HCG. See Human chorionic gonadotropin HCV. See Hepatitis C virus Head and neck cancers . . . . . . . . . . . . . . . Health maintenance organizations (HMOs) . . . . Helicobacter pylori. . . . . . . . . . . . . . . . . Hemangioblastomas . . . . . . . . . . . . . . . . Hemangiopericytomas . . . . . . . . . . . . . . . Hemangiosarcomas . . . . . . . . . . . . . . . . Hematemesis . . . . . . . . . . . . . . . . . . . . Hematologic oncology . . . . . . . . . . . . . . . Hematuria . . . . . . . . . . . . . . . . . . . . . Hemochromatosis . . . . . . . . . . . . . . . . . Hemolytic anemia . . . . . . . . . . . . . . . . . Hemoptysis. . . . . . . . . . . . . . . . . . . . . Hemorrhoids . . . . . . . . . . . . . . . . . . . . Hepatic arterial infusion (HAI) . . . . . . . . . . Hepatitis B virus (HBV) . . . . . . . . . . . . . . Hepatitis C virus (HCV) . . . . . . . . . . . . . . Hepatomegaly . . . . . . . . . . . . . . . . . . . HER2/neu protein . . . . . . . . . . . . . . . . . Herbs as antioxidants . . . . . . . . . . . . . . . Hereditary cancer syndromes . . . . . . . . . . . Hereditary diffuse gastric cancer . . . . . . . . . Hereditary leiomyomatosis and renal cell cancer (HLRCC) . . . . . . . . . . . . . . . . Hereditary mixed polyposis syndrome . . . . . . Hereditary non-VHL clear cell renal cell carcinomas . . . . . . . . . . . . . . . . . . . Hereditary pancreatitis . . . . . . . . . . . . . . . Hereditary papillary renal cell carcinomas . . . . Hereditary polyposis syndromes . . . . . . . . . . Herpes simplex virus. . . . . . . . . . . . . . . . Herpes zoster virus. . . . . . . . . . . . . . . . . HFS. See Hand-foot syndrome Hispanics and cancer. See Latinos/Hispanics and cancer Histamine 2 antagonists . . . . . . . . . . . . . . Histiocytosis X . . . . . . . . . . . . . . . . . . . HIV/AIDS-related cancers . . . . . . . . . . . . .
HLRCC. See Hereditary leiomyomatosis and renal cell cancer HMOs. See Health maintenance organizations Hodgkin disease . . . . . . . . . . . . . . . . . Home health services . . . . . . . . . . . . . . Hormonal therapies . . . . . . . . . . . . . . . Hormone receptor tests . . . . . . . . . . . . . Hormone replacement therapy (HRT) . . . . . . Horner syndrome. . . . . . . . . . . . . . . . . Hospice care . . . . . . . . . . . . . . . . . . . Hot flashes . . . . . . . . . . . . . . . . . . . . HPV. See Human papillomavirus HRAS gene testing . . . . . . . . . . . . . . . . HRT. See Hormone replacement therapy HTLV. See Human T-cell leukemia virus Human chorionic gonadotropin (HCG) . . . . . Human growth factors and tumor growth . . . . Human immunodeficiency virus-related cancers. See HIV/AIDS-related cancers Human papillomavirus (HPV) . . . . . . . . . . Human T-cell leukemia virus (HTLV) . . . . . Hydatidiform mole . . . . . . . . . . . . . . . . 5-Hydroxyindoleacetic acid (5HIAA) test . . . . Hypercalcemia . . . . . . . . . . . . . . . . . . Hypercoagulation disorders . . . . . . . . . . . Hyperthermia therapy . . . . . . . . . . . . . . Hyperthermic perfusion . . . . . . . . . . . . . Hypopharyngeal cancer . . . . . . . . . . . . . Hysterectomy . . . . . . . . . . . . . . . . . . Hysterography . . . . . . . . . . . . . . . . . . Hystero-oophorectomy. . . . . . . . . . . . . . Hysteroscopy. . . . . . . . . . . . . . . . . . .
. 550 . 550 . 552
. . . . . . . . . . . . . . . . . . . . .
554 557 558 559 559 560 561 562 564 565 566 566 567 568 569 570 571 573 573 574 576
IEP. See Immunoelectrophoresis iFOBT. See Immunochemical fecal occult blood test Ileostomy. . . . . . . . . . . . . . . . . . . . . Imaging tests . . . . . . . . . . . . . . . . . . . Immune response to cancer . . . . . . . . . . . Immunochemical fecal occult blood test (iFOBT) . . . . . . . . . . . . . . . . . . . . Immunocytochemistry and immunohistochemistry . . . . . . . . . . . . Immunoelectrophoresis (IEP) . . . . . . . . . . Immunotherapy . . . . . . . . . . . . . . . . . IMRT. See Intensity-modulated radiation therapy Indoles . . . . . . . . . . . . . . . . . . . . . . Infection and sepsis . . . . . . . . . . . . . . . Infectious cancers . . . . . . . . . . . . . . . . Infertility and cancer . . . . . . . . . . . . . . .
. 577 . 579 . . . . . .
580 580 581 582 584 586
. 587 . 588 . 590 xlii
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593 597 599 601 603 605 606 608
. . 609
. . 609 . . 610
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611 612 612 613 614 615 617 618 619 620 621 622 623
. . 625 . . 626 . . 629 . . 632 . . 633 . . 634 . . 635
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638 638 641 643
Complete List of Contents Inflammatory bowel disease . . . . . . . . . . Informed consent. . . . . . . . . . . . . . . . Infusion therapies . . . . . . . . . . . . . . . Insurance . . . . . . . . . . . . . . . . . . . . Integrative oncology . . . . . . . . . . . . . . Intensity-modulated radiation therapy (IMRT) Interferon. . . . . . . . . . . . . . . . . . . . Interleukins. . . . . . . . . . . . . . . . . . . Invasive cancer. . . . . . . . . . . . . . . . . Invasive ductal carcinomas . . . . . . . . . . Invasive lobular carcinomas . . . . . . . . . . Ionizing radiation . . . . . . . . . . . . . . . Iridium seeds . . . . . . . . . . . . . . . . . . Islet cell tumors . . . . . . . . . . . . . . . . Isoflavones . . . . . . . . . . . . . . . . . . . Itching . . . . . . . . . . . . . . . . . . . . .
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645 646 647 648 651 652 653 654 655 656 657 657 658 659 661 661
Lambert-Eaton myasthenic syndrome (LEMS) Laparoscopy and laparoscopic surgery . . . . Laryngeal cancer . . . . . . . . . . . . . . . . Laryngeal nerve palsy . . . . . . . . . . . . . Laryngectomy . . . . . . . . . . . . . . . . . Laryngoscopy . . . . . . . . . . . . . . . . . Laser therapies . . . . . . . . . . . . . . . . . Latinos/Hispanics and cancer . . . . . . . . . Laxatives . . . . . . . . . . . . . . . . . . . . LCIS. See Lobular carcinoma in situ LDH test. See Lactate dehydrogenase test Leiomyomas . . . . . . . . . . . . . . . . . . Leiomyosarcomas . . . . . . . . . . . . . . . LEMS. See Lambert-Eaton myasthenic syndrome Leptomeningeal carcinomas . . . . . . . . . . Leukapharesis . . . . . . . . . . . . . . . . . Leukemia, Down syndrome and. See Down syndrome and leukemia Leukemia, eosinophilic. See Eosinophilic leukemia Leukemia, hairy cell. See Hairy cell leukemia Leukemias . . . . . . . . . . . . . . . . . . . Leukoencephalopathy . . . . . . . . . . . . . Leukopenia. . . . . . . . . . . . . . . . . . . Leukoplakia . . . . . . . . . . . . . . . . . . Leydig cell tumors . . . . . . . . . . . . . . . Li-Fraumeni syndrome (LFS) . . . . . . . . . Limb salvage . . . . . . . . . . . . . . . . . . Linear accelerator . . . . . . . . . . . . . . . Lip cancers . . . . . . . . . . . . . . . . . . . Liposarcomas . . . . . . . . . . . . . . . . . Liver biopsy . . . . . . . . . . . . . . . . . . Liver cancers . . . . . . . . . . . . . . . . . .
Jonsson Comprehensive Cancer Center (JCCC) . . . . . . . . . . . . . . . . . . . . . . 664 Journaling . . . . . . . . . . . . . . . . . . . . . . 665 Juvenile polyposis syndrome . . . . . . . . . . . . 665 Kaposi sarcoma . . . . . . . . . . . . . Karnofsky performance status (KPS) . . Keratosis . . . . . . . . . . . . . . . . . Ki67 test . . . . . . . . . . . . . . . . . Kidney cancer . . . . . . . . . . . . . . Klinefelter syndrome and cancer . . . . KPS. See Karnofsky performance status Krukenberg tumors . . . . . . . . . . .
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667 669 670 670 671 674
. . . . . . 675
Lacrimal gland tumors . . . . . . . . . . . . . . . . 677 Lactate dehydrogenase (LDH) test . . . . . . . . . 678 Laetrile . . . . . . . . . . . . . . . . . . . . . . . . 679
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679 681 682 685 686 687 688 690 692
. . . 693 . . . 694
. . . 696 . . . 698
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698 702 704 704 706 706 708 709 710 712 714 715
Volume 3 Lumps . . . . . . . . . . . . . . Lung cancer, brochoalveolar. See Bronchoalveolar lung cancer Lung cancers . . . . . . . . . . . Lutein . . . . . . . . . . . . . . Lycopene . . . . . . . . . . . . . Lymphadenectomy. . . . . . . . Lymphangiography . . . . . . . Lymphangiosarcomas . . . . . . Lymphedema. . . . . . . . . . . Lymphocytosis . . . . . . . . . . Lymphomas . . . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . . . lv Complete List of Contents . . . . . . . . . . . . . . lix Living will . . . . . . . . . . . . . . . . . Living with cancer . . . . . . . . . . . . . Lobectomy . . . . . . . . . . . . . . . . . Lobular carcinoma in situ (LCIS) . . . . . Long-distance caregiving . . . . . . . . . Loop electrosurgical excisional procedure (LEEP) . . . . . . . . . . . . . . . . . Lumbar puncture . . . . . . . . . . . . . . Lumpectomy . . . . . . . . . . . . . . . .
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719 720 723 725 726
. . . . . 727 . . . . . 728 . . . . . 730 xliii
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733 737 737 738 740 741 742 743 744
Salem Health: Cancer M. D. Anderson Cancer Center . . . . . . . . . Macrobiotic diet . . . . . . . . . . . . . . . . . Magnetic resonance imaging (MRI) . . . . . . . Malignant fibrous histiocytoma (MFH) . . . . . Malignant rhabdoid tumor of the kidney . . . . Malignant tumors . . . . . . . . . . . . . . . . MALT lymphomas. See Mucosa-associated lymphoid tissue lymphomas Mammography . . . . . . . . . . . . . . . . . . Managed care . . . . . . . . . . . . . . . . . . Mantle cell lymphoma (MCL) . . . . . . . . . . Mastectomy . . . . . . . . . . . . . . . . . . . Mastocytomas . . . . . . . . . . . . . . . . . . Matrix metalloproteinase inhibitors . . . . . . . Mayo Clinic Cancer Center . . . . . . . . . . . MCC. See Merkel cell carcinomas MCL. See Mantle cell lymphoma MDR. See Drug resistance and multidrug resistance Mediastinal tumors. . . . . . . . . . . . . . . . Mediastinoscopy . . . . . . . . . . . . . . . . . Medical marijuana . . . . . . . . . . . . . . . . Medical oncology . . . . . . . . . . . . . . . . Medicare and cancer . . . . . . . . . . . . . . . Medullary carcinoma of the breast. . . . . . . . Medulloblastomas . . . . . . . . . . . . . . . . Melanomas . . . . . . . . . . . . . . . . . . . . Melphalan . . . . . . . . . . . . . . . . . . . . Memorial Sloan-Kettering Cancer Center . . . . MEN 1. See Multiple endocrine neoplasia type 1 MEN 2. See Multiple endocrine neoplasia type 2 Meningeal carcinomatosis . . . . . . . . . . . . Meningiomas. . . . . . . . . . . . . . . . . . . Merkel cell carcinomas (MCC) . . . . . . . . . Mesenchymomas, malignant. . . . . . . . . . . Mesothelioma . . . . . . . . . . . . . . . . . . Metastasis . . . . . . . . . . . . . . . . . . . . Metastatic squamous neck cancer with occult primary . . . . . . . . . . . . . . . . . . . . MFH. See Malignant fibrous histiocytoma Microcalcifications. . . . . . . . . . . . . . . . Microwave hyperthermia therapy . . . . . . . . Mineral oils . . . . . . . . . . . . . . . . . . . Mistletoe . . . . . . . . . . . . . . . . . . . . . Mitochondrial DNA mutations. . . . . . . . . . MLH1 gene. . . . . . . . . . . . . . . . . . . . Mohs surgery. . . . . . . . . . . . . . . . . . . Molecular oncology . . . . . . . . . . . . . . . Moles. . . . . . . . . . . . . . . . . . . . . . . Monoclonal antibodies . . . . . . . . . . . . . . Motion sickness devices . . . . . . . . . . . . .
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748 750 750 752 753 754
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754 757 759 761 763 764 765
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766 768 768 770 772 774 775 776 779 780
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MRI. See Magnetic resonance imaging MSH genes . . . . . . . . . . . . . . . . . . . . Mucinous carcinomas . . . . . . . . . . . . . . Mucosa-associated lymphoid tissue (MALT) lymphomas . . . . . . . . . . . . . . . . . . Mucositis . . . . . . . . . . . . . . . . . . . . . Mucous membranes, epidermoid cancers of. See Epidermoid cancers of mucous membranes Multiple endocrine neoplasia type 1 (MEN 1). . Multiple endocrine neoplasia type 2 (MEN 2). . Multiple myeloma . . . . . . . . . . . . . . . . Mustard gas . . . . . . . . . . . . . . . . . . . Mutagenesis and cancer . . . . . . . . . . . . . Myasthenia gravis . . . . . . . . . . . . . . . . MYC oncogene . . . . . . . . . . . . . . . . . . Mycosis fungoides . . . . . . . . . . . . . . . . Myelodysplastic syndromes . . . . . . . . . . . Myelofibrosis . . . . . . . . . . . . . . . . . . Myeloma . . . . . . . . . . . . . . . . . . . . . Myeloproliferative disorders. . . . . . . . . . . Myelosuppression . . . . . . . . . . . . . . . . 2-Naphthylamine. . . . . . . . . . . . . . . . Nasal cavity and paranasal sinus cancers . . . National Cancer Institute (NCI) . . . . . . . . National Science Foundation (NSF) . . . . . . Native North Americans and cancer . . . . . . Nausea and vomiting. . . . . . . . . . . . . . NCI. See National Cancer Institute Needle biopsies . . . . . . . . . . . . . . . . Needle localization. . . . . . . . . . . . . . . Nephroblastomas. . . . . . . . . . . . . . . . Nephrostomy . . . . . . . . . . . . . . . . . . Neuroblastomas . . . . . . . . . . . . . . . . Neuroectodermal tumors. . . . . . . . . . . . Neuroendocrine tumors . . . . . . . . . . . . Neurofibromatosis type 1 (NF1) . . . . . . . . Neurologic oncology. . . . . . . . . . . . . . Neutropenia . . . . . . . . . . . . . . . . . . NF1. See Neurofibromatosis type 1 Nickel compounds and metallic nickel . . . . Night sweats . . . . . . . . . . . . . . . . . . Nijmegen breakage syndrome . . . . . . . . . Nipple discharge . . . . . . . . . . . . . . . . Non-Hodgkin lymphoma . . . . . . . . . . . Nonsteroidal anti-inflammatory drugs (NSAIDs) . . . . . . . . . . . . . . . . . . NSAIDs. See Nonsteroidal anti-inflammatory drugs NSF. See National Science Foundation Nuclear medicine scan . . . . . . . . . . . . .
781 782 783 785 786 788
. . 790 . . . . . . . . . . .
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790 791 792 793 794 795 796 796 798 800 802 xliv
. . 803 . . 803 . . 804 . . 806
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807 808 809 812 813 815 817 817 819 820 822 823 825
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826 826 829 830 832 834
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836 838 839 839 841 842 844 845 847 849
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851 852 853 854 855
. . . 858
. . . 859
Complete List of Contents Pediatric oncology and hematology . . . . . . . . . 938 Pelvic examination . . . . . . . . . . . . . . . . . . 940 Penile cancer . . . . . . . . . . . . . . . . . . . . . 941 Percutaneous transhepatic cholangiography (PTHC) . . . . . . . . . . . . . . . . . . . . . . 943 Pericardial effusion . . . . . . . . . . . . . . . . . 944 Pericardiocentesis . . . . . . . . . . . . . . . . . . 946 Peritoneovenous shunts . . . . . . . . . . . . . . . 946 Personality and cancer . . . . . . . . . . . . . . . . 947 Pesticides and the food chain . . . . . . . . . . . . 948 PET. See Positron emission tomography Peutz-Jeghers syndrome (PJS) . . . . . . . . . . . . 951 Pharmacy oncology . . . . . . . . . . . . . . . . . 952 Phenacetin . . . . . . . . . . . . . . . . . . . . . . 955 Phenolics . . . . . . . . . . . . . . . . . . . . . . . 955 Pheochromocytomas . . . . . . . . . . . . . . . . . 956 Pheresis . . . . . . . . . . . . . . . . . . . . . . . 958 Photodynamic therapy (PDT) . . . . . . . . . . . . 959 Phyllodes tumors. . . . . . . . . . . . . . . . . . . 960 Phytoestrogens . . . . . . . . . . . . . . . . . . . . 962 Pineoblastomas. . . . . . . . . . . . . . . . . . . . 963 Pituitary tumors . . . . . . . . . . . . . . . . . . . 965 PJS. See Peutz-Jeghers syndrome Placental alkaline phosphatase (PALP) . . . . . . . 968 Plant alkaloids and terpenoids in chemotherapy . . . . . . . . . . . . . . . . . . . 968 Plasticizers . . . . . . . . . . . . . . . . . . . . . . 971 Pleural biopsy . . . . . . . . . . . . . . . . . . . . 972 Pleural effusion . . . . . . . . . . . . . . . . . . . 973 Pleurodesis . . . . . . . . . . . . . . . . . . . . . . 975 Pleuropulmonary blastomas . . . . . . . . . . . . . 975 PMS genes . . . . . . . . . . . . . . . . . . . . . . 976 Pneumonectomy . . . . . . . . . . . . . . . . . . . 977 Pneumonia . . . . . . . . . . . . . . . . . . . . . . 979 Polycyclic aromatic hydrocarbons . . . . . . . . . . 981 Polycythemia vera . . . . . . . . . . . . . . . . . . 981 Polypectomy . . . . . . . . . . . . . . . . . . . . . 982 Polyps . . . . . . . . . . . . . . . . . . . . . . . . 983 Polyps, colon. See Colon polyps Polyps, gastric. See Gastric polyps Positron emission tomography (PET) . . . . . . . . 984 Poverty and cancer . . . . . . . . . . . . . . . . . . 987 PPOs. See Preferred provider organizations Prayer and cancer support . . . . . . . . . . . . . . 989 Preferred provider organizations (PPOs) . . . . . . 990 Pregnancy and cancer . . . . . . . . . . . . . . . . 992 Premalignancies . . . . . . . . . . . . . . . . . . . 994 Prevent Cancer Foundation . . . . . . . . . . . . . 997 Prevention . . . . . . . . . . . . . . . . . . . . . . 999 Primary care physician . . . . . . . . . . . . . . . 1001
Nutrition and cancer prevention . . . . . . . . . . . 861 Nutrition and cancer treatment. . . . . . . . . . . . 864 Obesity-associated cancers . . . . . Occupational exposures and cancer . Occupational therapy . . . . . . . . OCs. See Organochlorines Oligodendrogliomas . . . . . . . . . Omega-3 fatty acids . . . . . . . . . Ommaya reservoir . . . . . . . . . . Oncogenes . . . . . . . . . . . . . . Oncogenic viruses . . . . . . . . . . Oncology . . . . . . . . . . . . . . . Oncology clinical nurse specialist . . Oncology social worker . . . . . . . Oophorectomy . . . . . . . . . . . . Ophthalmic oncology . . . . . . . . Opioids . . . . . . . . . . . . . . . . Oral and maxillofacial surgery. . . . Oral and oropharyngeal cancers . . . Orbit tumors . . . . . . . . . . . . . Orchiectomy . . . . . . . . . . . . . Organ transplantation and cancer . . Organochlorines (OCs) . . . . . . . Oropharyngeal cancers. See Oral and oropharyngeal cancers Orthopedic surgery. . . . . . . . . . Otolaryngology . . . . . . . . . . . Ovarian cancers . . . . . . . . . . . Ovarian cysts. . . . . . . . . . . . . Ovarian epithelial cancer . . . . . . Overtreatment . . . . . . . . . . . .
. . . . . . . . 868 . . . . . . . . 871 . . . . . . . . 873 . . . . . . . . . . . . . . . . .
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875 877 878 878 881 882 885 887 888 889 892 893 894 897 898 899 901
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902 903 905 908 909 911
Paget disease of bone . . . . . . . . . . . . . Pain management medications. . . . . . . . . Palliative treatment . . . . . . . . . . . . . . PALP. See Placental alkaline phosphatase Palpation . . . . . . . . . . . . . . . . . . . . Pancolitis . . . . . . . . . . . . . . . . . . . . Pancreatectomy . . . . . . . . . . . . . . . . Pancreatic cancers . . . . . . . . . . . . . . . Pancreatitis . . . . . . . . . . . . . . . . . . . Pap test . . . . . . . . . . . . . . . . . . . . . Paracentesis . . . . . . . . . . . . . . . . . . Paranasal sinus cancers. See Nasal cavity and paranasal sinus cancers Paraneoplastic syndromes . . . . . . . . . . . Parathyroid cancer . . . . . . . . . . . . . . . Pathology . . . . . . . . . . . . . . . . . . . PC-SPES . . . . . . . . . . . . . . . . . . . . PDT. See Photodynamic therapy
. . . 912 . . . 914 . . . 917 . . . . . . .
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920 920 921 923 927 928 929
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931 932 934 937 xlv
Salem Health: Cancer Primary central nervous system lymphomas . . . . . . . . . . . . . . . . Progesterone receptor assay . . . . . . . . Prostate cancer . . . . . . . . . . . . . . . Prostate-specific antigen (PSA) test . . . . Prostatectomy. . . . . . . . . . . . . . . . Prostatitis . . . . . . . . . . . . . . . . . . Proteasome inhibitors. . . . . . . . . . . . Protein electrophoresis . . . . . . . . . . . Proteomics and cancer research . . . . . . Proton beam therapy . . . . . . . . . . . . Proto-oncogenes and carcinogenesis . . . . PSA test. See Prostate-specific antigen test Psycho-oncology . . . . . . . . . . . . . . Psychosocial aspects of cancer . . . . . . . PTHC. See Percutaneous transhepatic cholangiography Radiation, ionizing. See Ionizing radiation Radiation oncology . . . . . . . . . . . . . Radiation therapies . . . . . . . . . . . . . Radiation therapy, afterloading. See Afterloading radiation therapy Radical neck dissection . . . . . . . . . . . Radiofrequency ablation . . . . . . . . . . Radionuclide scan . . . . . . . . . . . . . Radiopharmaceuticals . . . . . . . . . . . Radon . . . . . . . . . . . . . . . . . . . . RB1 gene . . . . . . . . . . . . . . . . . . Receptor analysis . . . . . . . . . . . . . .
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1003 1003 1004 1006 1008 1009 1010 1010 1012 1014 1015
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1027 1027 1030 1030 1032 1032 1033
Reconstructive surgery . . . . . . . . . . . . . . Rectal cancer . . . . . . . . . . . . . . . . . . . Recurrence . . . . . . . . . . . . . . . . . . . . Rehabilitation . . . . . . . . . . . . . . . . . . . Relationships . . . . . . . . . . . . . . . . . . . Renal pelvis tumors. . . . . . . . . . . . . . . . Report on Carcinogens (RoC) . . . . . . . . . . Resveratrol . . . . . . . . . . . . . . . . . . . . Retinoblastomas . . . . . . . . . . . . . . . . . Rhabdomyosarcomas . . . . . . . . . . . . . . . RhoGD12 gene . . . . . . . . . . . . . . . . . . Richter syndrome . . . . . . . . . . . . . . . . . Risk assessment, family history and. See Family history and risk assessment Risks for cancer. . . . . . . . . . . . . . . . . . Robert H. Lurie Cancer Center . . . . . . . . . . RoC. See Report on Carcinogens Rothmund-Thomson syndrome . . . . . . . . . .
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Salivary gland cancer . . . . . . . . . . . . . Salpingectomy and salpingo-oophorectomy . Sarcomas, soft-tissue . . . . . . . . . . . . . Saw palmetto . . . . . . . . . . . . . . . . . Schwannoma tumors . . . . . . . . . . . . . SCLC1 gene. . . . . . . . . . . . . . . . . . Screening, colorectal cancer. See Colorectal cancer screening Screening for cancer . . . . . . . . . . . . . Second opinions . . . . . . . . . . . . . . . Self-image and body image. . . . . . . . . .
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1034 1036 1038 1038 1041 1043 1044 1045 1046 1048 1050 1050
. 1052 . 1054 . 1056 1058 1060 1062 1065 1066 1067
. . . 1067 . . . 1070 . . . 1071
Volume 4 Sjögren syndrome. . . . . . . . . . . . . . . . Skin cancers . . . . . . . . . . . . . . . . . . SLN biopsy and mapping. See Sentinel lymph node biopsy and mapping Small intestine cancer . . . . . . . . . . . . . Smoking cessation . . . . . . . . . . . . . . . Social Security Disability Insurance (SSDI) . . Soft-tissue fibrosarcomas. See Fibrosarcomas, soft-tissue Soots . . . . . . . . . . . . . . . . . . . . . . Soy foods . . . . . . . . . . . . . . . . . . . . Spermatocytomas . . . . . . . . . . . . . . . . Spinal axis tumors . . . . . . . . . . . . . . . Spinal cord compression . . . . . . . . . . . . Splenectomy . . . . . . . . . . . . . . . . . . Sputum cytology . . . . . . . . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . lxxvii Complete List of Contents . . . . . . . . . . . . . lxxix Sentinel lymph node (SLN) biopsy and mapping . . . . . . . . . . . . . . . Sepsis. See Infection and sepsis Sertoli cell tumors . . . . . . . . . . . Sexuality and cancer . . . . . . . . . . Sézary syndrome . . . . . . . . . . . . SIADH. See Syndrome of inappropriate antidiuretic hormone production Side effects . . . . . . . . . . . . . . . Sigmoidoscopy . . . . . . . . . . . . . Silica, crystalline . . . . . . . . . . . . Simian virus 40 . . . . . . . . . . . . . Singlehood and cancer . . . . . . . . .
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1078 1082 1083 1084 1084 xlvi
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1097 1098 1099 1100 1102 1103 1105
Complete List of Contents Squamous cell carcinomas . . . . . . . . . . . SRS. See Stereotactic radiosurgery SSDI. See Social Security Disability Insurance Staging of cancer . . . . . . . . . . . . . . . . Statistics of cancer . . . . . . . . . . . . . . . Stem cell transplantation . . . . . . . . . . . . Stent therapy . . . . . . . . . . . . . . . . . . Stereotactic needle biopsy . . . . . . . . . . . Stereotactic radiosurgery (SRS) . . . . . . . . Sterility . . . . . . . . . . . . . . . . . . . . . Stomach cancers . . . . . . . . . . . . . . . . Stomatitis . . . . . . . . . . . . . . . . . . . . Stress management . . . . . . . . . . . . . . . Sunlamps . . . . . . . . . . . . . . . . . . . . Sun’s soup . . . . . . . . . . . . . . . . . . . Sunscreens . . . . . . . . . . . . . . . . . . . Superior vena cava syndrome . . . . . . . . . Support groups . . . . . . . . . . . . . . . . . Surgical biopsies . . . . . . . . . . . . . . . . Surgical oncology. . . . . . . . . . . . . . . . Survival rates . . . . . . . . . . . . . . . . . . Survivorship issues . . . . . . . . . . . . . . . Symptoms and cancer. . . . . . . . . . . . . . Syndrome of inappropriate antidiuretic hormone production (SIADH) . . . . . . . . Synovial sarcomas . . . . . . . . . . . . . . . Taste alteration . . . . . . . . . . . . . . Teratocarcinomas . . . . . . . . . . . . . Teratomas . . . . . . . . . . . . . . . . . Testicular cancer . . . . . . . . . . . . . Testicular self-examination (TSE) . . . . Thermal imaging . . . . . . . . . . . . . Thiotepa. . . . . . . . . . . . . . . . . . Thoracentesis . . . . . . . . . . . . . . . Thoracoscopy . . . . . . . . . . . . . . . Thoracotomy . . . . . . . . . . . . . . . Throat cancer . . . . . . . . . . . . . . . Thrombocytopenia . . . . . . . . . . . . Thymomas . . . . . . . . . . . . . . . . Thymus cancer . . . . . . . . . . . . . . Thyroid cancer . . . . . . . . . . . . . . Thyroid nuclear medicine scan . . . . . . TNF. See Tumor necrosis factor TNM staging . . . . . . . . . . . . . . . Tobacco, chewing. See Chewing tobacco Tobacco-related cancers . . . . . . . . . Topoisomerase inhibitors . . . . . . . . . TP53 protein . . . . . . . . . . . . . . . Tracheostomy . . . . . . . . . . . . . . . Transfusion therapy. . . . . . . . . . . .
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Transitional care . . . . . . . . . . . Transitional cell carcinomas . . . . . Transrectal ultrasound . . . . . . . . Transvaginal ultrasound . . . . . . . Trichilemmal carcinomas. . . . . . . TSE. See Testicular self-examination Tuberous sclerosis . . . . . . . . . . Tubular carcinomas . . . . . . . . . . Tumor flare . . . . . . . . . . . . . . Tumor lysis syndrome . . . . . . . . Tumor markers . . . . . . . . . . . . Tumor necrosis factor (TNF) . . . . . Tumor-suppressor genes . . . . . . . Turcot syndrome . . . . . . . . . . . Tyrosine kinase inhibitors . . . . . .
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1108 1111 1114 1116 1118 1119 1120 1121 1124 1125 1127 1128 1129 1130 1132 1135 1138 1140 1143 1144
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1151 1152 1153 1154 1156 1157 1158 1158 1160 1161 1162 1164 1166 1167 1169 1172
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1182 1183 1185 1186 1187
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1187 1188 1189 1189 1191 1193 1194 1195 1196
Ultrasound, breast. See Breast ultrasound Ultrasound, endorectal. See Endorectal ultrasound Ultrasound, transrectal. See Transrectal ultrasound Ultrasound, transvaginal. See Transvaginal ultrasound Ultrasound tests . . . . . . . . . . . . . . . Ultraviolet radiation and related exposures Umbilical cord blood transplantation. . . . Upper gastrointestinal (GI) endoscopy . . . Upper gastrointestinal (GI) series . . . . . Urethral cancer . . . . . . . . . . . . . . . Urinalysis . . . . . . . . . . . . . . . . . . Urinary system cancers . . . . . . . . . . . Urography . . . . . . . . . . . . . . . . . Urologic oncology . . . . . . . . . . . . . Urostomy . . . . . . . . . . . . . . . . . . Uterine cancer . . . . . . . . . . . . . . .
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1199 1200 1201 1202 1203 1205 1207 1209 1213 1214 1216 1217
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1220 1221 1223 1225 1226
Vaccines, preventive . . . . . . . . . . . Vaccines, therapeutic . . . . . . . . . . . Vaginal cancer . . . . . . . . . . . . . . Vascular access tubes. . . . . . . . . . . Vasectomy and cancer . . . . . . . . . . Vegetables, cruciferous. See Cruciferous vegetables Veterinary oncology . . . . . . . . . . . VHL disease. See Von Hippel-Lindau disease Vinyl chloride . . . . . . . . . . . . . . Viral oncology . . . . . . . . . . . . . . Virus-related cancers . . . . . . . . . . . Von Hippel-Lindau (VHL) disease. . . . Vulvar cancer . . . . . . . . . . . . . . .
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1174 1175 1177 1179 1180 xlvii
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1230 1230 1232 1235 1237
Salem Health: Cancer WAGR syndrome. See Wilms’ tumor aniridiagenitourinary anomalies-mental retardation syndrome and cancer Waldenström macroglobulinemia (WM) . . . . . . 1240 Watchful waiting . . . . . . . . . . . . . . . . . . 1242 Weight loss . . . . . . . . . . . . . . . . . . . . . 1243 Wilms’ tumor . . . . . . . . . . . . . . . . . . . . 1245 Wilms’ tumor aniridia-genitourinary anomaliesmental retardation (WAGR) syndrome and cancer . . . . . . . . . . . . . . . . . . . . . . 1248 Wine and cancer . . . . . . . . . . . . . . . . . . 1250 Wire localization . . . . . . . . . . . . . . . . . . 1250 WM. See Waldenström macroglobulinemia Wood dust . . . . . . . . . . . . . . . . . . . . . 1251
Yolk sac carcinomas . . . . . . . . . . . . . . . . 1256 Young adult cancers . . . . . . . . . . . . . . . . 1256 Zollinger-Ellison syndrome . . . . . . . . . . . . 1260 Drugs by Generic Name . . . Drugs by Trade Name . . . . Associations and Agencies . . Cancer Centers and Hospitals Cancer Support Groups . . . . Carcinogens. . . . . . . . . . Glossary . . . . . . . . . . . Bibliography . . . . . . . . .
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1265 1309 1348 1352 1357 1362 1383 1400
Category List . . . . . . . . . . . . . . . . . . . . 1409 Index . . . . . . . . . . . . . . . . . . . . . . . . 1419
X-ray tests . . . . . . . . . . . . . . . . . . . . . 1252 Xeroderma pigmentosa . . . . . . . . . . . . . . . 1254
xlviii
Volume III Living will — Self-image and body image
Editor
Jeffrey A. Knight, Ph.D. Mount Holyoke College
Medical Consultants
Laurie Jackson-Grusby, Ph.D. Children’s Hospital Boston, Harvard Medical School
Wendy White-Ryan, M.D., FAAP Golisano Children’s Hospital at Strong Memorial Hospital
SALEM PRESS, INC. Pasadena, California Hackensack, New Jersey
Editor in Chief: Dawn P. Dawson Editorial Director: Christina J. Moose Project Editors: Tracy Irons-Georges, Rowena Wildin Dehanke Editorial Assistant: Dana Garey
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Copyright © 2009, by Salem Press, Inc. All rights in this book are reserved. No part of this work may be used or reproduced in any manner whatsoever or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the copyright owner except in the case of brief quotations embodied in critical articles and reviews or in the copying of images deemed to be freely licensed or in the public domain. For information address the publisher, Salem Press, Inc., P.O. Box 50062, Pasadena, California 91115. ∞ The paper used in these volumes conforms to the American National Standard for Permanence of Paper for Printed Library Materials, Z39.48-1992 (R1997). Note to Readers The material presented in Salem Health: Cancer is intended for broad informational and educational purposes. Readers who suspect that they or someone whom they know or provide caregiving for suffers from cancer or any other physical or psychological disorder, disease, or condition described in this set should contact a physician without delay; this work should not be used as a substitute for professional medical diagnosis or staging. Readers who are undergoing or about to undergo any treatment or procedure described in this set should refer to their physicians and other health care team members for guidance concerning preparation and possible effects. This set is not to be considered definitive on the covered topics, and readers should remember that the field of health care is characterized by a diversity of medical opinions and constant expansion in knowledge and understanding. Library of Congress Cataloging-in-Publication Data Salem health : cancer / Jeffrey A. Knight, Laurie Jackson-Grusby, Wendy White-Ryan. p. cm. Includes bibliographical references and index. ISBN 978-1-58765-505-0 (set : alk. paper) — ISBN 978-1-58765-506-7 (vol. 1 : alk. paper) — ISBN 978-1-58765-507-4 (vol. 2 : alk. paper) — ISBN 978-1-58765-508-1 (vol. 3 : alk. paper) — ISBN 978-1-58765-509-8 (vol. 4 : alk. paper) 1. Cancer. I. Knight, Jeffrey A., 1948- II. Jackson-Grusby, Laurie. III. White-Ryan, Wendy. RC265.S32 2008 616.99′4—dc22 2008030861
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printed in the united states of america
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Contents Medullary carcinoma of the breast. . . . . . . . Medulloblastomas . . . . . . . . . . . . . . . . Melanomas . . . . . . . . . . . . . . . . . . . . Melphalan . . . . . . . . . . . . . . . . . . . . Memorial Sloan-Kettering Cancer Center . . . . MEN 1. See Multiple endocrine neoplasia type 1 MEN 2. See Multiple endocrine neoplasia type 2 Meningeal carcinomatosis . . . . . . . . . . . . Meningiomas. . . . . . . . . . . . . . . . . . . Merkel cell carcinomas (MCC) . . . . . . . . . Mesenchymomas, malignant. . . . . . . . . . . Mesothelioma . . . . . . . . . . . . . . . . . . Metastasis . . . . . . . . . . . . . . . . . . . . Metastatic squamous neck cancer with occult primary . . . . . . . . . . . . . . . . . . . . MFH. See Malignant fibrous histiocytoma Microcalcifications. . . . . . . . . . . . . . . . Microwave hyperthermia therapy . . . . . . . . Mineral oils . . . . . . . . . . . . . . . . . . . Mistletoe . . . . . . . . . . . . . . . . . . . . . Mitochondrial DNA mutations. . . . . . . . . . MLH1 gene. . . . . . . . . . . . . . . . . . . . Mohs surgery. . . . . . . . . . . . . . . . . . . Molecular oncology . . . . . . . . . . . . . . . Moles. . . . . . . . . . . . . . . . . . . . . . . Monoclonal antibodies . . . . . . . . . . . . . . Motion sickness devices . . . . . . . . . . . . . MRI. See Magnetic resonance imaging MSH genes . . . . . . . . . . . . . . . . . . . . Mucinous carcinomas . . . . . . . . . . . . . . Mucosa-associated lymphoid tissue (MALT) lymphomas . . . . . . . . . . . . . . . . . . Mucositis . . . . . . . . . . . . . . . . . . . . . Mucous membranes, epidermoid cancers of. See Epidermoid cancers of mucous membranes Multiple endocrine neoplasia type 1 (MEN 1). . Multiple endocrine neoplasia type 2 (MEN 2). . Multiple myeloma . . . . . . . . . . . . . . . . Mustard gas . . . . . . . . . . . . . . . . . . . Mutagenesis and cancer . . . . . . . . . . . . . Myasthenia gravis . . . . . . . . . . . . . . . . MYC oncogene . . . . . . . . . . . . . . . . . . Mycosis fungoides . . . . . . . . . . . . . . . . Myelodysplastic syndromes . . . . . . . . . . . Myelofibrosis . . . . . . . . . . . . . . . . . . Myeloma . . . . . . . . . . . . . . . . . . . . . Myeloproliferative disorders. . . . . . . . . . . Myelosuppression . . . . . . . . . . . . . . . .
Complete List of Contents . . . . . . . . . . . . . . lix Living will . . . . . . . . . . . . . . . . . Living with cancer . . . . . . . . . . . . . Lobectomy . . . . . . . . . . . . . . . . . Lobular carcinoma in situ (LCIS) . . . . . Long-distance caregiving . . . . . . . . . Loop electrosurgical excisional procedure (LEEP) . . . . . . . . . . . . . . . . . Lumbar puncture . . . . . . . . . . . . . . Lumpectomy . . . . . . . . . . . . . . . . Lumps . . . . . . . . . . . . . . . . . . . Lung cancer, brochoalveolar. See Bronchoalveolar lung cancer Lung cancers . . . . . . . . . . . . . . . . Lutein . . . . . . . . . . . . . . . . . . . Lycopene . . . . . . . . . . . . . . . . . . Lymphadenectomy. . . . . . . . . . . . . Lymphangiography . . . . . . . . . . . . Lymphangiosarcomas . . . . . . . . . . . Lymphedema. . . . . . . . . . . . . . . . Lymphocytosis . . . . . . . . . . . . . . . Lymphomas . . . . . . . . . . . . . . . .
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719 720 723 725 726
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733 737 737 738 740 741 742 743 744
M. D. Anderson Cancer Center . . . . . . . Macrobiotic diet . . . . . . . . . . . . . . . Magnetic resonance imaging (MRI) . . . . . Malignant fibrous histiocytoma (MFH) . . . Malignant rhabdoid tumor of the kidney . . Malignant tumors . . . . . . . . . . . . . . MALT lymphomas. See Mucosa-associated lymphoid tissue lymphomas Mammography . . . . . . . . . . . . . . . . Managed care . . . . . . . . . . . . . . . . Mantle cell lymphoma (MCL) . . . . . . . . Mastectomy . . . . . . . . . . . . . . . . . Mastocytomas . . . . . . . . . . . . . . . . Matrix metalloproteinase inhibitors . . . . . Mayo Clinic Cancer Center . . . . . . . . . MCC. See Merkel cell carcinomas MCL. See Mantle cell lymphoma MDR. See Drug resistance and multidrug resistance Mediastinal tumors. . . . . . . . . . . . . . Mediastinoscopy . . . . . . . . . . . . . . . Medical marijuana . . . . . . . . . . . . . . Medical oncology . . . . . . . . . . . . . . Medicare and cancer . . . . . . . . . . . . .
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766 768 768 770 772 lv
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774 775 776 779 780
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781 782 783 785 786 788
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790 791 792 793 794 795 796 796 798 800 802
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807 808 809 812 813 815 817 817 819 820 822 823 825
Salem Health: Cancer 2-Naphthylamine. . . . . . . . . . . . . . . . Nasal cavity and paranasal sinus cancers . . . National Cancer Institute (NCI) . . . . . . . . National Science Foundation (NSF) . . . . . . Native North Americans and cancer . . . . . . Nausea and vomiting. . . . . . . . . . . . . . NCI. See National Cancer Institute Needle biopsies . . . . . . . . . . . . . . . . Needle localization. . . . . . . . . . . . . . . Nephroblastomas. . . . . . . . . . . . . . . . Nephrostomy . . . . . . . . . . . . . . . . . . Neuroblastomas . . . . . . . . . . . . . . . . Neuroectodermal tumors. . . . . . . . . . . . Neuroendocrine tumors . . . . . . . . . . . . Neurofibromatosis type 1 (NF1) . . . . . . . . Neurologic oncology. . . . . . . . . . . . . . Neutropenia . . . . . . . . . . . . . . . . . . NF1. See Neurofibromatosis type 1 Nickel compounds and metallic nickel . . . . Night sweats . . . . . . . . . . . . . . . . . . Nijmegen breakage syndrome . . . . . . . . . Nipple discharge . . . . . . . . . . . . . . . . Non-Hodgkin lymphoma . . . . . . . . . . . Nonsteroidal anti-inflammatory drugs (NSAIDs) . . . . . . . . . . . . . . . . . . NSAIDs. See Nonsteroidal anti-inflammatory drugs NSF. See National Science Foundation Nuclear medicine scan . . . . . . . . . . . . . Nutrition and cancer prevention . . . . . . . . Nutrition and cancer treatment. . . . . . . . . Obesity-associated cancers . . . . Occupational exposures and cancer Occupational therapy . . . . . . . OCs. See Organochlorines Oligodendrogliomas . . . . . . . . Omega-3 fatty acids . . . . . . . . Ommaya reservoir . . . . . . . . . Oncogenes . . . . . . . . . . . . . Oncogenic viruses . . . . . . . . . Oncology . . . . . . . . . . . . . . Oncology clinical nurse specialist . Oncology social worker . . . . . . Oophorectomy . . . . . . . . . . . Ophthalmic oncology . . . . . . . Opioids . . . . . . . . . . . . . . . Oral and maxillofacial surgery. . . Oral and oropharyngeal cancers . . Orbit tumors . . . . . . . . . . . . Orchiectomy . . . . . . . . . . . .
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836 838 839 839 841 842 844 845 847 849
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851 852 853 854 855
Organ transplantation and cancer . . Organochlorines (OCs) . . . . . . . Oropharyngeal cancers. See Oral and oropharyngeal cancers Orthopedic surgery. . . . . . . . . . Otolaryngology . . . . . . . . . . . Ovarian cancers . . . . . . . . . . . Ovarian cysts. . . . . . . . . . . . . Ovarian epithelial cancer . . . . . . Overtreatment . . . . . . . . . . . .
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Paget disease of bone . . . . . . . . . . . . . Pain management medications. . . . . . . . . Palliative treatment . . . . . . . . . . . . . . PALP. See Placental alkaline phosphatase Palpation . . . . . . . . . . . . . . . . . . . . Pancolitis . . . . . . . . . . . . . . . . . . . . Pancreatectomy . . . . . . . . . . . . . . . . Pancreatic cancers . . . . . . . . . . . . . . . Pancreatitis . . . . . . . . . . . . . . . . . . . Pap test . . . . . . . . . . . . . . . . . . . . . Paracentesis . . . . . . . . . . . . . . . . . . Paranasal sinus cancers. See Nasal cavity and paranasal sinus cancers Paraneoplastic syndromes . . . . . . . . . . . Parathyroid cancer . . . . . . . . . . . . . . . Pathology . . . . . . . . . . . . . . . . . . . PC-SPES . . . . . . . . . . . . . . . . . . . . PDT. See Photodynamic therapy Pediatric oncology and hematology . . . . . . Pelvic examination . . . . . . . . . . . . . . . Penile cancer . . . . . . . . . . . . . . . . . . Percutaneous transhepatic cholangiography (PTHC) . . . . . . . . . . . . . . . . . . . Pericardial effusion . . . . . . . . . . . . . . Pericardiocentesis . . . . . . . . . . . . . . . Peritoneovenous shunts . . . . . . . . . . . . Personality and cancer . . . . . . . . . . . . . Pesticides and the food chain . . . . . . . . . PET. See Positron emission tomography Peutz-Jeghers syndrome (PJS) . . . . . . . . . Pharmacy oncology . . . . . . . . . . . . . . Phenacetin . . . . . . . . . . . . . . . . . . . Phenolics . . . . . . . . . . . . . . . . . . . . Pheochromocytomas . . . . . . . . . . . . . . Pheresis . . . . . . . . . . . . . . . . . . . . Photodynamic therapy (PDT) . . . . . . . . . Phyllodes tumors. . . . . . . . . . . . . . . . Phytoestrogens . . . . . . . . . . . . . . . . . Pineoblastomas. . . . . . . . . . . . . . . . . Pituitary tumors . . . . . . . . . . . . . . . .
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875 877 878 878 881 882 885 887 888 889 892 893 894 897 898 lvi
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902 903 905 908 909 911
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951 952 955 955 956 958 959 960 962 963 965
Contents PJS. See Peutz-Jeghers syndrome Placental alkaline phosphatase (PALP) . . . . . . . 968 Plant alkaloids and terpenoids in chemotherapy . . . . . . . . . . . . . . . . . . . 968 Plasticizers . . . . . . . . . . . . . . . . . . . . . . 971 Pleural biopsy . . . . . . . . . . . . . . . . . . . . 972 Pleural effusion . . . . . . . . . . . . . . . . . . . 973 Pleurodesis . . . . . . . . . . . . . . . . . . . . . . 975 Pleuropulmonary blastomas . . . . . . . . . . . . . 975 PMS genes . . . . . . . . . . . . . . . . . . . . . . 976 Pneumonectomy . . . . . . . . . . . . . . . . . . . 977 Pneumonia . . . . . . . . . . . . . . . . . . . . . . 979 Polycyclic aromatic hydrocarbons . . . . . . . . . . 981 Polycythemia vera . . . . . . . . . . . . . . . . . . 981 Polypectomy . . . . . . . . . . . . . . . . . . . . . 982 Polyps . . . . . . . . . . . . . . . . . . . . . . . . 983 Polyps, colon. See Colon polyps Polyps, gastric. See Gastric polyps Positron emission tomography (PET) . . . . . . . . 984 Poverty and cancer . . . . . . . . . . . . . . . . . . 987 PPOs. See Preferred provider organizations Prayer and cancer support . . . . . . . . . . . . . . 989 Preferred provider organizations (PPOs) . . . . . . 990 Pregnancy and cancer . . . . . . . . . . . . . . . . 992 Premalignancies . . . . . . . . . . . . . . . . . . . 994 Prevent Cancer Foundation . . . . . . . . . . . . . 997 Prevention . . . . . . . . . . . . . . . . . . . . . . 999 Primary care physician . . . . . . . . . . . . . . . 1001 Primary central nervous system lymphomas . . . . 1003 Progesterone receptor assay . . . . . . . . . . . . 1003 Prostate cancer . . . . . . . . . . . . . . . . . . . 1004 Prostate-specific antigen (PSA) test . . . . . . . . 1006 Prostatectomy. . . . . . . . . . . . . . . . . . . . 1008 Prostatitis . . . . . . . . . . . . . . . . . . . . . . 1009 Proteasome inhibitors. . . . . . . . . . . . . . . . 1010 Protein electrophoresis . . . . . . . . . . . . . . . 1010 Proteomics and cancer research . . . . . . . . . . 1012 Proton beam therapy . . . . . . . . . . . . . . . . 1014 Proto-oncogenes and carcinogenesis . . . . . . . . 1015 PSA test. See Prostate-specific antigen test Psycho-oncology . . . . . . . . . . . . . . . . . . 1016 Psychosocial aspects of cancer . . . . . . . . . . . 1018 PTHC. See Percutaneous transhepatic cholangiography
Radiation, ionizing. See Ionizing radiation Radiation oncology . . . . . . . . . . . . . . . . Radiation therapies . . . . . . . . . . . . . . . . Radiation therapy, afterloading. See Afterloading radiation therapy Radical neck dissection . . . . . . . . . . . . . . Radiofrequency ablation . . . . . . . . . . . . . Radionuclide scan . . . . . . . . . . . . . . . . Radiopharmaceuticals . . . . . . . . . . . . . . Radon . . . . . . . . . . . . . . . . . . . . . . . RB1 gene . . . . . . . . . . . . . . . . . . . . . Receptor analysis . . . . . . . . . . . . . . . . . Reconstructive surgery . . . . . . . . . . . . . . Rectal cancer . . . . . . . . . . . . . . . . . . . Recurrence . . . . . . . . . . . . . . . . . . . . Rehabilitation . . . . . . . . . . . . . . . . . . . Relationships . . . . . . . . . . . . . . . . . . . Renal pelvis tumors. . . . . . . . . . . . . . . . Report on Carcinogens (RoC) . . . . . . . . . . Resveratrol . . . . . . . . . . . . . . . . . . . . Retinoblastomas . . . . . . . . . . . . . . . . . Rhabdomyosarcomas . . . . . . . . . . . . . . . RhoGD12 gene . . . . . . . . . . . . . . . . . . Richter syndrome . . . . . . . . . . . . . . . . . Risk assessment, family history and. See Family history and risk assessment Risks for cancer. . . . . . . . . . . . . . . . . . Robert H. Lurie Cancer Center . . . . . . . . . . RoC. See Report on Carcinogens Rothmund-Thomson syndrome . . . . . . . . . . Salivary gland cancer . . . . . . . . . . . . . Salpingectomy and salpingo-oophorectomy . Sarcomas, soft-tissue . . . . . . . . . . . . . Saw palmetto . . . . . . . . . . . . . . . . . Schwannoma tumors . . . . . . . . . . . . . SCLC1 gene. . . . . . . . . . . . . . . . . . Screening, colorectal cancer. See Colorectal cancer screening Screening for cancer . . . . . . . . . . . . . Second opinions . . . . . . . . . . . . . . . Self-image and body image. . . . . . . . . .
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Complete List of Contents Volume 1 Alkylating agents in chemotherapy . . . . . . . ALL. See Acute lymphocytic leukemia Allicin, garlic and. See Garlic and allicin Alopecia . . . . . . . . . . . . . . . . . . . . . ALP. See Alkaline phosphatase test Alpha-fetoprotein (AFP) levels . . . . . . . . . Alternative therapies. See Complementary and alternative therapies Alveolar soft-part sarcomas . . . . . . . . . . . Amenorrhea . . . . . . . . . . . . . . . . . . . American Association for Cancer Research (AACR) . . . . . . . . . . . . . . . . . . . . American Cancer Society (ACS) . . . . . . . . American Institute for Cancer Research (AICR) 4-Aminobiphenyl . . . . . . . . . . . . . . . . AML. See Acute myelocytic leukemia Amputation . . . . . . . . . . . . . . . . . . . Amyloidosis . . . . . . . . . . . . . . . . . . . Anal cancer . . . . . . . . . . . . . . . . . . . Androgen drugs . . . . . . . . . . . . . . . . . Anemia . . . . . . . . . . . . . . . . . . . . . Anemia, aplastic. See Aplastic anemia Anemia, hemolytic. See Hemolytic anemia Angiogenesis . . . . . . . . . . . . . . . . . . Angiogenesis inhibitors . . . . . . . . . . . . . Angiography. . . . . . . . . . . . . . . . . . . Angiosarcomas . . . . . . . . . . . . . . . . . Anoscopy . . . . . . . . . . . . . . . . . . . . Anthraquinones . . . . . . . . . . . . . . . . . Anthrax . . . . . . . . . . . . . . . . . . . . . Antiandrogens . . . . . . . . . . . . . . . . . . Antidiarrheal agents . . . . . . . . . . . . . . . Antiestrogens . . . . . . . . . . . . . . . . . . Antifungal therapies . . . . . . . . . . . . . . . Antimetabolites in chemotherapy . . . . . . . . Antinausea medications . . . . . . . . . . . . . Antineoplastics in chemotherapy . . . . . . . . Antioxidants . . . . . . . . . . . . . . . . . . . Antiperspirants and breast cancer . . . . . . . . Antiviral therapies. . . . . . . . . . . . . . . . Anxiety . . . . . . . . . . . . . . . . . . . . . APBI. See Accelerated partial breast irradiation APC gene testing . . . . . . . . . . . . . . . . Aplastic anemia . . . . . . . . . . . . . . . . . Appendix cancer . . . . . . . . . . . . . . . . Appetite loss. . . . . . . . . . . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . . . v Publisher’s Note . . . . . . . . . . . . . . . . . . . . ix About the Editors . . . . . . . . . . . . . . . . . . . xi Contributors . . . . . . . . . . . . . . . . . . . . . xiii Complete List of Contents . . . . . . . . . . . . . . xv AACR. See American Association for Cancer Research ABCD. . . . . . . . . . . . . . . . . . . . . . . . . . 1 ACC. See Adenoid cystic carcinoma Abdominoperineal resection (APR) . . . . . . . . . . 1 Accelerated partial breast irradiation (APBI). . . . . . 3 Achlorhydria . . . . . . . . . . . . . . . . . . . . . . 4 Acoustic neuromas . . . . . . . . . . . . . . . . . . . 4 Acquired immunodeficiency disease-related cancers. See HIV/AIDS-related cancers Acrylamides . . . . . . . . . . . . . . . . . . . . . . 6 ACS. See American Cancer Society Acupuncture and acupressure for cancer patients . . . 8 Acute lymphocytic leukemia (ALL) . . . . . . . . . 11 Acute myelocytic leukemia (AML) . . . . . . . . . . 13 Adenocarcinomas . . . . . . . . . . . . . . . . . . . 16 Adenoid cystic carcinoma (ACC) . . . . . . . . . . . 17 Adenomatoid tumors . . . . . . . . . . . . . . . . . 18 Adenomatous polyps . . . . . . . . . . . . . . . . . 18 Adenoviruses . . . . . . . . . . . . . . . . . . . . . 19 Adjuvant therapy . . . . . . . . . . . . . . . . . . . 20 Adrenal gland cancers . . . . . . . . . . . . . . . . . 21 Adrenocortical cancer . . . . . . . . . . . . . . . . . 23 Advance directives . . . . . . . . . . . . . . . . . . 24 Aflatoxins . . . . . . . . . . . . . . . . . . . . . . . 26 AFP levels. See Alpha-fetoprotein levels African Americans and cancer . . . . . . . . . . . . 28 Africans and cancer . . . . . . . . . . . . . . . . . . 31 Afterloading radiation therapy . . . . . . . . . . . . 32 Agent Orange . . . . . . . . . . . . . . . . . . . . . 34 Aging and cancer . . . . . . . . . . . . . . . . . . . 34 AICR. See American Institute for Cancer Research Aids and devices for cancer patients . . . . . . . . . 38 AIDS-related cancers. See HIV/AIDS-related cancers Air pollution . . . . . . . . . . . . . . . . . . . . . . 39 Alcohol, alcoholism, and cancer . . . . . . . . . . . 42 Aleukemia . . . . . . . . . . . . . . . . . . . . . . . 43 Alkaline phosphatase test (ALP) . . . . . . . . . . . 44 lix
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64 66 68 69 70 71 71 72 73 75 76 78 81 83 86 88 90 93
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Salem Health: Cancer APR. See Abdominoperineal resection Arsenic compounds . . . . . . . . . . Arterial embolization . . . . . . . . . Artificial sweeteners . . . . . . . . . . Asbestos . . . . . . . . . . . . . . . . Ascites . . . . . . . . . . . . . . . . . Ashkenazi Jews and cancer . . . . . . Asian Americans and cancer. . . . . . Astrocytomas. . . . . . . . . . . . . . Ataxia telangiectasia (AT) . . . . . . . Autologous blood transfusion . . . . . Axillary dissection . . . . . . . . . . . Azathioprine . . . . . . . . . . . . . .
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100 101 102 103 105 107 109 112 114 115 116 117
Bacillus Calmette Guérin (BCG) . . . . . . . . Bacteria as causes of cancer . . . . . . . . . . . Barium enema . . . . . . . . . . . . . . . . . . Barium swallow . . . . . . . . . . . . . . . . . Barrett esophagus . . . . . . . . . . . . . . . . Basal cell carcinomas . . . . . . . . . . . . . . BCG. See Bacillus Calmette Guérin Beckwith-Wiedemann syndrome (BWS) . . . . Benign prostatic hyperplasia (BPH) . . . . . . . Benign tumors . . . . . . . . . . . . . . . . . . Benzene . . . . . . . . . . . . . . . . . . . . . Benzidine and dyes metabolized to benzidine . . Benzodiazepines . . . . . . . . . . . . . . . . . Bereavement, grief and. See Grief and bereavement Beryllium and beryllium compounds . . . . . . Beta-carotene . . . . . . . . . . . . . . . . . . Bethesda criteria . . . . . . . . . . . . . . . . . BHDS. See Birt-Hogg-Dubé syndrome Bile duct cancer . . . . . . . . . . . . . . . . . Bilobectomy . . . . . . . . . . . . . . . . . . . Bioflavonoids . . . . . . . . . . . . . . . . . . Biological therapy . . . . . . . . . . . . . . . . Biopsy. See also Computed tomography-guided biopsy; Core needle biopsy; Liver biopsy; Needle biopsies; Pleural biopsy; Stereotactic needle biopsy; Surgical biopsies . . . . . . . Birt-Hogg-Dubé syndrome (BHDS) . . . . . . . Birth control pills and cancer . . . . . . . . . . Bis(chloromethyl) ether and technical-grade chloromethyl methyl ether . . . . . . . . . . Bisphenol A (BPA) . . . . . . . . . . . . . . . Bisphosphonates . . . . . . . . . . . . . . . . . Bladder cancer . . . . . . . . . . . . . . . . . . Blood cancers . . . . . . . . . . . . . . . . . . BMT. See Bone marrow transplantation BNCT. See Boron neutron capture therapy
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118 118 120 121 123 124
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126 128 128 130 131 132
Body image. See Self-image and body image Bone cancers . . . . . . . . . . . . . . . . . . . Bone marrow aspiration and biopsy . . . . . . . Bone marrow transplantation (BMT) . . . . . . Bone pain . . . . . . . . . . . . . . . . . . . . Bone scan . . . . . . . . . . . . . . . . . . . . Boron neutron capture therapy (BNCT) . . . . . Bowen disease . . . . . . . . . . . . . . . . . . BPA. See Bisphenol A BPH. See Benign prostatic hyperplasia BPI. See Brief Pain Inventory Brachytherapy . . . . . . . . . . . . . . . . . . BRAF gene . . . . . . . . . . . . . . . . . . . . Brain and central nervous system cancers . . . . Brain scan . . . . . . . . . . . . . . . . . . . . BRCA1 and BRCA2 genes . . . . . . . . . . . . Breakthrough pain . . . . . . . . . . . . . . . . Breast, calcifications of. See Calcifications of the breast Breast, medullary carcinoma of. See Medullary carcinoma of the breast Breast cancer, cutaneous. See Cutaneous breast cancer Breast cancer, estrogen-receptor-sensitive. See Estrogen-receptor-sensitive breast cancer Breast cancer in children and adolescents . . . . Breast cancer in men . . . . . . . . . . . . . . . Breast cancer in pregnant women . . . . . . . . Breast cancers . . . . . . . . . . . . . . . . . . Breast implants. . . . . . . . . . . . . . . . . . Breast reconstruction. . . . . . . . . . . . . . . Breast self-examination (BSE). . . . . . . . . . Breast ultrasound. . . . . . . . . . . . . . . . . Breslow’s staging . . . . . . . . . . . . . . . . Brief Pain Inventory (BPI) . . . . . . . . . . . . Brompton cocktail . . . . . . . . . . . . . . . . Bronchial adenomas . . . . . . . . . . . . . . . Bronchoalveolar lung cancer . . . . . . . . . . Bronchography. . . . . . . . . . . . . . . . . . Bronchoscopy . . . . . . . . . . . . . . . . . . BSE. See Breast self-examination Burkitt lymphoma . . . . . . . . . . . . . . . . 1,3-Butadiene . . . . . . . . . . . . . . . . . . 1,4-Butanediol dimethanesulfonate . . . . . . . BWS. See Beckwith-Wiedemann syndrome
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136 138 138 139
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148 149 151 151 154
CA 15-3 test . CA 19-9 test . CA 27-29 test CA 125 test. . Cachexia . . . lx
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158 161 163 165 166 167 168
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180 182 184 185 188 190 193 194 195 196 196 197 197 199 199
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205 205 206 206 207
Complete List of Contents Cadmium and cadmium compounds. . . . . . . . Caffeine . . . . . . . . . . . . . . . . . . . . . . Calcifications of the breast. . . . . . . . . . . . . Calcium . . . . . . . . . . . . . . . . . . . . . . Cancell . . . . . . . . . . . . . . . . . . . . . . . Cancer biology . . . . . . . . . . . . . . . . . . . Cancer care team . . . . . . . . . . . . . . . . . . Cancer clusters . . . . . . . . . . . . . . . . . . . Cancer education. . . . . . . . . . . . . . . . . . Candidiasis . . . . . . . . . . . . . . . . . . . . . Carcinoembryonic antigen antibody (CEA) test . . . . . . . . . . . . . . . . . . . . . . . . Carcinogens, known . . . . . . . . . . . . . . . . Carcinogens, reasonably anticipated. . . . . . . . Carcinoid tumors and carcinoid syndrome . . . . Carcinoma of unknown primary origin (CUP) . . Carcinomas. . . . . . . . . . . . . . . . . . . . . Carcinomas, invasive ductal. See Invasive ductal carcinomas Carcinomas, invasive lobular. See Invasive lobular carcinomas Carcinomas, leptomeningeal. See Leptomeningeal carcinomas Carcinomatosis. . . . . . . . . . . . . . . . . . . Carcinomatous meningitis . . . . . . . . . . . . . Carcinosarcomas . . . . . . . . . . . . . . . . . . Cardiomyopathy in cancer patients . . . . . . . . Cardiopulmonary resuscitation (CPR) . . . . . . . Caregivers and caregiving . . . . . . . . . . . . . Caregiving, long-distance. See Long-distance caregiving Carney complex . . . . . . . . . . . . . . . . . . Carotenoids . . . . . . . . . . . . . . . . . . . . Cartilage supplements . . . . . . . . . . . . . . . Case management . . . . . . . . . . . . . . . . . Castleman disease . . . . . . . . . . . . . . . . . CBC. See Complete blood count CBE. See Clinical breast exam CDKN2A. See Cyclin-dependent kinase inhibitor-2A CEA test. See Carcinoembryonic antigen antibody test Cell phones. . . . . . . . . . . . . . . . . . . . . Cervical cancer. . . . . . . . . . . . . . . . . . . Chemoembolization . . . . . . . . . . . . . . . . Chemoprevention . . . . . . . . . . . . . . . . . Chemotherapy . . . . . . . . . . . . . . . . . . . Chemotherapy, cognitive effects of. See Cognitive effects of cancer and chemotherapy Chewing tobacco. . . . . . . . . . . . . . . . . . Childbirth and cancer . . . . . . . . . . . . . . .
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208 209 211 212 212 213 216 218 220 221
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223 224 227 230 232 233
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235 237 238 239 240 242
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245 245 246 247 248
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Childhood cancers . . . . . . . . . . . . . . . . Chlorambucil. . . . . . . . . . . . . . . . . . . 1-(2-Chloroethyl)-3-(4-methylcyclohexyl)1-nitrosourea (MeCCNU) . . . . . . . . . . . Cholecystectomy . . . . . . . . . . . . . . . . . Chordomas . . . . . . . . . . . . . . . . . . . . Choriocarcinomas . . . . . . . . . . . . . . . . CHPP. See Continuous hyperthermic peritoneal perfusion Chromium hexavalent compounds. . . . . . . . Chromosomes and cancer . . . . . . . . . . . . Chronic lymphocytic leukemia (CLL) . . . . . . Chronic myeloid leukemia (CML). . . . . . . . Cigarettes and cigars . . . . . . . . . . . . . . . Clinical breast exam (CBE) . . . . . . . . . . . Clinical trials . . . . . . . . . . . . . . . . . . . CLL. See Chronic lymphocytic leukemia CML. See Chronic myeloid leukemia Coal tars and coal tar pitches . . . . . . . . . . Cobalt 60 radiation. . . . . . . . . . . . . . . . Coenzyme Q10. . . . . . . . . . . . . . . . . . Cognitive effects of cancer and chemotherapy . Coke oven emissions. . . . . . . . . . . . . . . Cold nodule . . . . . . . . . . . . . . . . . . . Colectomy . . . . . . . . . . . . . . . . . . . . Coloanal anastomosis . . . . . . . . . . . . . . Colon polyps . . . . . . . . . . . . . . . . . . . Colonoscopy and virtual colonoscopy . . . . . . Colony-stimulating factors (CSFs) . . . . . . . Colorectal cancer. . . . . . . . . . . . . . . . . Colorectal cancer screening . . . . . . . . . . . Colostomy . . . . . . . . . . . . . . . . . . . . Colposcopy. . . . . . . . . . . . . . . . . . . . Comedo carcinomas . . . . . . . . . . . . . . . Complementary and alternative therapies . . . . Complete blood count (CBC) . . . . . . . . . . Computed tomography (CT)-guided biopsy . . . . . . . . . . . . . . . . . . . . . Computed tomography (CT) scan . . . . . . . . Conization . . . . . . . . . . . . . . . . . . . . Continuous hyperthermic peritoneal perfusion (CHPP) . . . . . . . . . . . . . . . . . . . . Cordectomy . . . . . . . . . . . . . . . . . . . Cordotomy . . . . . . . . . . . . . . . . . . . . Core needle biopsy. . . . . . . . . . . . . . . . Corticosteroids . . . . . . . . . . . . . . . . . . Coughing . . . . . . . . . . . . . . . . . . . . . Counseling for cancer patients and survivors . . Cowden syndrome . . . . . . . . . . . . . . . . COX-2 inhibitors. See Cyclooxygenase 2 inhibitors
249 251 253 254 257
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274 274 276 279 281 283 285
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288 289 289 290 292 292 293 294 296 297 299 300 304 306 308 309 309 312
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318 318 319 321 321 322 324 326
Salem Health: Cancer CPR. See Cardiopulmonary resuscitation Craniopharyngiomas . . . . . . . . . . . . Craniosynostosis . . . . . . . . . . . . . . Craniotomy. . . . . . . . . . . . . . . . . Crohn disease . . . . . . . . . . . . . . . Cruciferous vegetables . . . . . . . . . . . Cryoablation . . . . . . . . . . . . . . . . Cryptorchidism. . . . . . . . . . . . . . . CSFs. See Colony-stimulating factors CT scan. See Computed tomography scan CTCL. See Cutaneous T-cell lymphoma Culdoscopy. . . . . . . . . . . . . . . . . CUP. See Carcinoma of unknown primary origin Curcumin. . . . . . . . . . . . . . . . . . Cushing syndrome and cancer . . . . . . . Cutaneous breast cancer . . . . . . . . . . Cutaneous T-cell lymphoma (CTCL) . . .
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Cyclin-dependent kinase inhibitor-2A (CDKN2A). . . . . . . . . . . . . . . Cyclooxygenase 2 (COX-2) inhibitors . Cyclophosphamide. . . . . . . . . . . . Cyclosporin A . . . . . . . . . . . . . . Cystography . . . . . . . . . . . . . . . Cystoscopy . . . . . . . . . . . . . . . . Cytogenetics . . . . . . . . . . . . . . . Cytokines . . . . . . . . . . . . . . . . Cytology . . . . . . . . . . . . . . . . . Cytology, sputum. See Sputum cytology
327 329 331 332 335 336 338
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344 344 345 346 347 347 348 350 350
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D&C. See Dilation and curettage Dana-Farber Cancer Institute . . . . . . . . . . . . 354 DCIS. See Ductal carcinoma in situ DEA. See Diethanolamine DEHP. See Di(2-ethylhexyl) phthalate Delta-9-tetrahydrocannabinol . . . . . . . . . . . . 355
339 340 341 342
Volume 2 Down syndrome and leukemia. . . . . . . . DPC4 gene testing . . . . . . . . . . . . . . DRE. See Digital rectal exam Drug resistance and multidrug resistance (MDR) . . . . . . . . . . . . . . . . . . . Dry mouth . . . . . . . . . . . . . . . . . . DSRCT. See Desmoplastic small round cell tumor Duct ectasia . . . . . . . . . . . . . . . . . Ductal carcinoma in situ (DCIS). . . . . . . Ductal lavage. . . . . . . . . . . . . . . . . Ductogram . . . . . . . . . . . . . . . . . . Duke Comprehensive Cancer Center . . . . Dukes’ classification . . . . . . . . . . . . . Duodenal carcinomas . . . . . . . . . . . . Dye, hair. See Hair dye Dysplastic nevus syndrome . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . xxxiii Complete List of Contents . . . . . . . . . . . . xxxvii Denys-Drash syndrome and cancer . . . . . . Depression . . . . . . . . . . . . . . . . . . . Dermatofibrosarcoma protuberans (DFSP) . . Dermatology oncology. . . . . . . . . . . . . DES. See Diethylstilbestrol Desmoid tumors . . . . . . . . . . . . . . . . Desmoplastic small round cell tumor (DSRCT) . . . . . . . . . . . . . . . . . . Developing nations and cancer . . . . . . . . DFSP. See Dermatofibrosarcoma protuberans Di(2-ethylhexyl) phthalate (DEHP) . . . . . . Diarrhea . . . . . . . . . . . . . . . . . . . . DIC. See Disseminated intravascular coagulation Dietary supplements . . . . . . . . . . . . . . Diethanolamine (DEA) . . . . . . . . . . . . Diethylstilbestrol (DES) . . . . . . . . . . . . Digital rectal exam (DRE) . . . . . . . . . . . Dilation and curettage (D&C) . . . . . . . . . Dioxins . . . . . . . . . . . . . . . . . . . . . Disseminated intravascular coagulation (DIC) . . . . . . . . . . . . . . . . . . . . Diverticulosis and diverticulitis . . . . . . . . DNR. See Do-not-resuscitate order Do-not-resuscitate (DNR) order . . . . . . . .
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357 357 360 362
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370 373 373 374 375 376
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386 387 389 389 390 392 393
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Eaton-Lambert syndrome. See Lambert-Eaton myasthenic syndrome EBRT. See External beam radiation therapy Edema . . . . . . . . . . . . . . . . . . . . . Education, cancer. See Cancer education Elderly and cancer . . . . . . . . . . . . . . . Electrolarynx . . . . . . . . . . . . . . . . . . Electromagnetic radiation . . . . . . . . . . . Electroporation therapy . . . . . . . . . . . . Electrosurgery . . . . . . . . . . . . . . . . .
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396 399 399 400 401
Complete List of Contents Embolization . . . . . . . . . . . . . . . . . . . . Embryonal cell cancer . . . . . . . . . . . . . . . End-of-life care . . . . . . . . . . . . . . . . . . Endocrine cancers . . . . . . . . . . . . . . . . . Endocrinology oncology . . . . . . . . . . . . . . Endometrial cancer . . . . . . . . . . . . . . . . Endometrial hyperplasia . . . . . . . . . . . . . . Endorectal ultrasound . . . . . . . . . . . . . . . Endoscopic retrograde cholangiopancreatography (ERCP) . . . . . . . . . . . . . . . . . . . . . Endoscopy . . . . . . . . . . . . . . . . . . . . . Endoscopy, upper gastrointestinal. See Upper gastrointestinal endoscopy Endotheliomas . . . . . . . . . . . . . . . . . . . Enteritis . . . . . . . . . . . . . . . . . . . . . . Enterostomal therapy . . . . . . . . . . . . . . . Eosinophilic leukemia . . . . . . . . . . . . . . . Ependymomas . . . . . . . . . . . . . . . . . . . Epidemiology of cancer . . . . . . . . . . . . . . Epidermoid cancers of mucous membranes . . . . Epstein-Barr virus . . . . . . . . . . . . . . . . . ERCP. See Endoscopic retrograde cholangiopancreatography ERD. See Estrogen receptor downregulator Erionite. . . . . . . . . . . . . . . . . . . . . . . Erythroplakia. . . . . . . . . . . . . . . . . . . . Esophageal cancer . . . . . . . . . . . . . . . . . Esophageal speech . . . . . . . . . . . . . . . . . Esophagectomy . . . . . . . . . . . . . . . . . . Esophagitis . . . . . . . . . . . . . . . . . . . . . Essiac . . . . . . . . . . . . . . . . . . . . . . . Estrogen receptor downregulator (ERD) . . . . . Estrogen-receptor-sensitive breast cancer . . . . . Ethnicity and cancer . . . . . . . . . . . . . . . . Ethylene oxide . . . . . . . . . . . . . . . . . . . Ewing sarcoma . . . . . . . . . . . . . . . . . . . Exenteration . . . . . . . . . . . . . . . . . . . . Exercise and cancer . . . . . . . . . . . . . . . . External beam radiation therapy (EBRT) . . . . . Eye cancers . . . . . . . . . . . . . . . . . . . . Eyelid cancer. . . . . . . . . . . . . . . . . . . .
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Fallopian tube cancer . . . . . . . Family history and risk assessment Fanconi anemia . . . . . . . . . . Fatigue . . . . . . . . . . . . . . . Fecal occult blood test (FOBT) . . Fertility drugs and cancer . . . . . Fertility issues . . . . . . . . . . . Fever . . . . . . . . . . . . . . . . Fiber . . . . . . . . . . . . . . . .
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402 403 404 406 409 412 414 416
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433 433 434 436 438 439 441 441 442 444 447 447 450 451 454 455 458
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460 461 464 466 467 469 471 472 474 lxiii
Fibroadenomas . . . . . . . . . . . . . . . . Fibrocystic breast changes . . . . . . . . . . Fibrosarcomas, soft-tissue . . . . . . . . . . Financial issues . . . . . . . . . . . . . . . 5HIAA test. See 5-Hydroxyindoleacetic acid test 5Q minus syndrome . . . . . . . . . . . . . Flow cytometry . . . . . . . . . . . . . . . FOBT. See Fecal occult blood test Folic acid. . . . . . . . . . . . . . . . . . . Formaldehyde . . . . . . . . . . . . . . . . Fox Chase Cancer Center . . . . . . . . . . Fred Hutchinson Cancer Research Center . . Free radicals . . . . . . . . . . . . . . . . . Fruits . . . . . . . . . . . . . . . . . . . . .
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475 476 478 481
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486 486 487 488 490 491
Gallbladder cancer . . . . . . . . . . . . . . Gallium scan . . . . . . . . . . . . . . . . . Gamma Knife . . . . . . . . . . . . . . . . Gardner syndrome . . . . . . . . . . . . . . Garlic and allicin . . . . . . . . . . . . . . . Gastric polyps . . . . . . . . . . . . . . . . Gastrinomas . . . . . . . . . . . . . . . . . Gastrointestinal cancers . . . . . . . . . . . Gastrointestinal complications of cancer treatment. . . . . . . . . . . . . . . . . . Gastrointestinal oncology . . . . . . . . . . Gastrointestinal stromal tumors (GISTs) . . GCTs. See Giant cell tumors Gene therapy . . . . . . . . . . . . . . . . . Genetic counseling . . . . . . . . . . . . . . Genetic testing . . . . . . . . . . . . . . . . Genetics of cancer . . . . . . . . . . . . . . Geography and cancer . . . . . . . . . . . . Germ-cell tumors . . . . . . . . . . . . . . Gerson therapy . . . . . . . . . . . . . . . . Gestational trophoblastic tumors (GTTs) . . Giant cell tumors (GCTs) . . . . . . . . . . Ginseng, panax. . . . . . . . . . . . . . . . GISTs. See Gastrointestinal stromal tumors Gleason grading system . . . . . . . . . . . Gliomas . . . . . . . . . . . . . . . . . . . Glomus tumors . . . . . . . . . . . . . . . . Glossectomy . . . . . . . . . . . . . . . . . Glutamine . . . . . . . . . . . . . . . . . . Gonioscopy . . . . . . . . . . . . . . . . . Grading of tumors . . . . . . . . . . . . . . Graft-versus-host disease (GVHD) . . . . . Granulosa cell tumors . . . . . . . . . . . . Green tea . . . . . . . . . . . . . . . . . . . Grief and bereavement . . . . . . . . . . . .
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493 495 497 498 499 500 501 502
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512 515 517 519 522 525 527 527 530 531
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532 533 534 535 536 536 537 538 540 540 541
Salem Health: Cancer GTTs. See Gestational trophoblastic tumors GVHD. See Graft-versus-host disease Gynecologic cancers . . . . . . . . . . . . . . . . . 543 Gynecologic oncology . . . . . . . . . . . . . . . . 547 H. pylori. See Helicobacter pylori HAI. See Hepatic arterial infusion Hair dye . . . . . . . . . . . . . . . . . . . . . . Hairy cell leukemia . . . . . . . . . . . . . . . . Hand-foot syndrome (HFS) . . . . . . . . . . . . HBV. See Hepatitis B virus HCG. See Human chorionic gonadotropin HCV. See Hepatitis C virus Head and neck cancers . . . . . . . . . . . . . . . Health maintenance organizations (HMOs) . . . . Helicobacter pylori. . . . . . . . . . . . . . . . . Hemangioblastomas . . . . . . . . . . . . . . . . Hemangiopericytomas . . . . . . . . . . . . . . . Hemangiosarcomas . . . . . . . . . . . . . . . . Hematemesis . . . . . . . . . . . . . . . . . . . . Hematologic oncology . . . . . . . . . . . . . . . Hematuria . . . . . . . . . . . . . . . . . . . . . Hemochromatosis . . . . . . . . . . . . . . . . . Hemolytic anemia . . . . . . . . . . . . . . . . . Hemoptysis. . . . . . . . . . . . . . . . . . . . . Hemorrhoids . . . . . . . . . . . . . . . . . . . . Hepatic arterial infusion (HAI) . . . . . . . . . . Hepatitis B virus (HBV) . . . . . . . . . . . . . . Hepatitis C virus (HCV) . . . . . . . . . . . . . . Hepatomegaly . . . . . . . . . . . . . . . . . . . HER2/neu protein . . . . . . . . . . . . . . . . . Herbs as antioxidants . . . . . . . . . . . . . . . Hereditary cancer syndromes . . . . . . . . . . . Hereditary diffuse gastric cancer . . . . . . . . . Hereditary leiomyomatosis and renal cell cancer (HLRCC) . . . . . . . . . . . . . . . . Hereditary mixed polyposis syndrome . . . . . . Hereditary non-VHL clear cell renal cell carcinomas . . . . . . . . . . . . . . . . . . . Hereditary pancreatitis . . . . . . . . . . . . . . . Hereditary papillary renal cell carcinomas . . . . Hereditary polyposis syndromes . . . . . . . . . . Herpes simplex virus. . . . . . . . . . . . . . . . Herpes zoster virus. . . . . . . . . . . . . . . . . HFS. See Hand-foot syndrome Hispanics and cancer. See Latinos/Hispanics and cancer Histamine 2 antagonists . . . . . . . . . . . . . . Histiocytosis X . . . . . . . . . . . . . . . . . . . HIV/AIDS-related cancers . . . . . . . . . . . . .
HLRCC. See Hereditary leiomyomatosis and renal cell cancer HMOs. See Health maintenance organizations Hodgkin disease . . . . . . . . . . . . . . . . . Home health services . . . . . . . . . . . . . . Hormonal therapies . . . . . . . . . . . . . . . Hormone receptor tests . . . . . . . . . . . . . Hormone replacement therapy (HRT) . . . . . . Horner syndrome. . . . . . . . . . . . . . . . . Hospice care . . . . . . . . . . . . . . . . . . . Hot flashes . . . . . . . . . . . . . . . . . . . . HPV. See Human papillomavirus HRAS gene testing . . . . . . . . . . . . . . . . HRT. See Hormone replacement therapy HTLV. See Human T-cell leukemia virus Human chorionic gonadotropin (HCG) . . . . . Human growth factors and tumor growth . . . . Human immunodeficiency virus-related cancers. See HIV/AIDS-related cancers Human papillomavirus (HPV) . . . . . . . . . . Human T-cell leukemia virus (HTLV) . . . . . Hydatidiform mole . . . . . . . . . . . . . . . . 5-Hydroxyindoleacetic acid (5HIAA) test . . . . Hypercalcemia . . . . . . . . . . . . . . . . . . Hypercoagulation disorders . . . . . . . . . . . Hyperthermia therapy . . . . . . . . . . . . . . Hyperthermic perfusion . . . . . . . . . . . . . Hypopharyngeal cancer . . . . . . . . . . . . . Hysterectomy . . . . . . . . . . . . . . . . . . Hysterography . . . . . . . . . . . . . . . . . . Hystero-oophorectomy. . . . . . . . . . . . . . Hysteroscopy. . . . . . . . . . . . . . . . . . .
. 550 . 550 . 552
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554 557 558 559 559 560 561 562 564 565 566 566 567 568 569 570 571 573 573 574 576
IEP. See Immunoelectrophoresis iFOBT. See Immunochemical fecal occult blood test Ileostomy. . . . . . . . . . . . . . . . . . . . . Imaging tests . . . . . . . . . . . . . . . . . . . Immune response to cancer . . . . . . . . . . . Immunochemical fecal occult blood test (iFOBT) . . . . . . . . . . . . . . . . . . . . Immunocytochemistry and immunohistochemistry . . . . . . . . . . . . Immunoelectrophoresis (IEP) . . . . . . . . . . Immunotherapy . . . . . . . . . . . . . . . . . IMRT. See Intensity-modulated radiation therapy Indoles . . . . . . . . . . . . . . . . . . . . . . Infection and sepsis . . . . . . . . . . . . . . . Infectious cancers . . . . . . . . . . . . . . . . Infertility and cancer . . . . . . . . . . . . . . .
. 577 . 579 . . . . . .
580 580 581 582 584 586
. 587 . 588 . 590 lxiv
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593 597 599 601 603 605 606 608
. . 609
. . 609 . . 610
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611 612 612 613 614 615 617 618 619 620 621 622 623
. . 625 . . 626 . . 629 . . 632 . . 633 . . 634 . . 635
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638 638 641 643
Complete List of Contents Inflammatory bowel disease . . . . . . . . . . Informed consent. . . . . . . . . . . . . . . . Infusion therapies . . . . . . . . . . . . . . . Insurance . . . . . . . . . . . . . . . . . . . . Integrative oncology . . . . . . . . . . . . . . Intensity-modulated radiation therapy (IMRT) Interferon. . . . . . . . . . . . . . . . . . . . Interleukins. . . . . . . . . . . . . . . . . . . Invasive cancer. . . . . . . . . . . . . . . . . Invasive ductal carcinomas . . . . . . . . . . Invasive lobular carcinomas . . . . . . . . . . Ionizing radiation . . . . . . . . . . . . . . . Iridium seeds . . . . . . . . . . . . . . . . . . Islet cell tumors . . . . . . . . . . . . . . . . Isoflavones . . . . . . . . . . . . . . . . . . . Itching . . . . . . . . . . . . . . . . . . . . .
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645 646 647 648 651 652 653 654 655 656 657 657 658 659 661 661
Lambert-Eaton myasthenic syndrome (LEMS) Laparoscopy and laparoscopic surgery . . . . Laryngeal cancer . . . . . . . . . . . . . . . . Laryngeal nerve palsy . . . . . . . . . . . . . Laryngectomy . . . . . . . . . . . . . . . . . Laryngoscopy . . . . . . . . . . . . . . . . . Laser therapies . . . . . . . . . . . . . . . . . Latinos/Hispanics and cancer . . . . . . . . . Laxatives . . . . . . . . . . . . . . . . . . . . LCIS. See Lobular carcinoma in situ LDH test. See Lactate dehydrogenase test Leiomyomas . . . . . . . . . . . . . . . . . . Leiomyosarcomas . . . . . . . . . . . . . . . LEMS. See Lambert-Eaton myasthenic syndrome Leptomeningeal carcinomas . . . . . . . . . . Leukapharesis . . . . . . . . . . . . . . . . . Leukemia, Down syndrome and. See Down syndrome and leukemia Leukemia, eosinophilic. See Eosinophilic leukemia Leukemia, hairy cell. See Hairy cell leukemia Leukemias . . . . . . . . . . . . . . . . . . . Leukoencephalopathy . . . . . . . . . . . . . Leukopenia. . . . . . . . . . . . . . . . . . . Leukoplakia . . . . . . . . . . . . . . . . . . Leydig cell tumors . . . . . . . . . . . . . . . Li-Fraumeni syndrome (LFS) . . . . . . . . . Limb salvage . . . . . . . . . . . . . . . . . . Linear accelerator . . . . . . . . . . . . . . . Lip cancers . . . . . . . . . . . . . . . . . . . Liposarcomas . . . . . . . . . . . . . . . . . Liver biopsy . . . . . . . . . . . . . . . . . . Liver cancers . . . . . . . . . . . . . . . . . .
Jonsson Comprehensive Cancer Center (JCCC) . . . . . . . . . . . . . . . . . . . . . . 664 Journaling . . . . . . . . . . . . . . . . . . . . . . 665 Juvenile polyposis syndrome . . . . . . . . . . . . 665 Kaposi sarcoma . . . . . . . . . . . . . Karnofsky performance status (KPS) . . Keratosis . . . . . . . . . . . . . . . . . Ki67 test . . . . . . . . . . . . . . . . . Kidney cancer . . . . . . . . . . . . . . Klinefelter syndrome and cancer . . . . KPS. See Karnofsky performance status Krukenberg tumors . . . . . . . . . . .
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667 669 670 670 671 674
. . . . . . 675
Lacrimal gland tumors . . . . . . . . . . . . . . . . 677 Lactate dehydrogenase (LDH) test . . . . . . . . . 678 Laetrile . . . . . . . . . . . . . . . . . . . . . . . . 679
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679 681 682 685 686 687 688 690 692
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. . . 696 . . . 698
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698 702 704 704 706 706 708 709 710 712 714 715
Volume 3 Lumps . . . . . . . . . . . . . . Lung cancer, brochoalveolar. See Bronchoalveolar lung cancer Lung cancers . . . . . . . . . . . Lutein . . . . . . . . . . . . . . Lycopene . . . . . . . . . . . . . Lymphadenectomy. . . . . . . . Lymphangiography . . . . . . . Lymphangiosarcomas . . . . . . Lymphedema. . . . . . . . . . . Lymphocytosis . . . . . . . . . . Lymphomas . . . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . . . lv Complete List of Contents . . . . . . . . . . . . . . lix Living will . . . . . . . . . . . . . . . . . Living with cancer . . . . . . . . . . . . . Lobectomy . . . . . . . . . . . . . . . . . Lobular carcinoma in situ (LCIS) . . . . . Long-distance caregiving . . . . . . . . . Loop electrosurgical excisional procedure (LEEP) . . . . . . . . . . . . . . . . . Lumbar puncture . . . . . . . . . . . . . . Lumpectomy . . . . . . . . . . . . . . . .
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719 720 723 725 726
. . . . . 727 . . . . . 728 . . . . . 730 lxv
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733 737 737 738 740 741 742 743 744
Salem Health: Cancer M. D. Anderson Cancer Center . . . . . . . . . Macrobiotic diet . . . . . . . . . . . . . . . . . Magnetic resonance imaging (MRI) . . . . . . . Malignant fibrous histiocytoma (MFH) . . . . . Malignant rhabdoid tumor of the kidney . . . . Malignant tumors . . . . . . . . . . . . . . . . MALT lymphomas. See Mucosa-associated lymphoid tissue lymphomas Mammography . . . . . . . . . . . . . . . . . . Managed care . . . . . . . . . . . . . . . . . . Mantle cell lymphoma (MCL) . . . . . . . . . . Mastectomy . . . . . . . . . . . . . . . . . . . Mastocytomas . . . . . . . . . . . . . . . . . . Matrix metalloproteinase inhibitors . . . . . . . Mayo Clinic Cancer Center . . . . . . . . . . . MCC. See Merkel cell carcinomas MCL. See Mantle cell lymphoma MDR. See Drug resistance and multidrug resistance Mediastinal tumors. . . . . . . . . . . . . . . . Mediastinoscopy . . . . . . . . . . . . . . . . . Medical marijuana . . . . . . . . . . . . . . . . Medical oncology . . . . . . . . . . . . . . . . Medicare and cancer . . . . . . . . . . . . . . . Medullary carcinoma of the breast. . . . . . . . Medulloblastomas . . . . . . . . . . . . . . . . Melanomas . . . . . . . . . . . . . . . . . . . . Melphalan . . . . . . . . . . . . . . . . . . . . Memorial Sloan-Kettering Cancer Center . . . . MEN 1. See Multiple endocrine neoplasia type 1 MEN 2. See Multiple endocrine neoplasia type 2 Meningeal carcinomatosis . . . . . . . . . . . . Meningiomas. . . . . . . . . . . . . . . . . . . Merkel cell carcinomas (MCC) . . . . . . . . . Mesenchymomas, malignant. . . . . . . . . . . Mesothelioma . . . . . . . . . . . . . . . . . . Metastasis . . . . . . . . . . . . . . . . . . . . Metastatic squamous neck cancer with occult primary . . . . . . . . . . . . . . . . . . . . MFH. See Malignant fibrous histiocytoma Microcalcifications. . . . . . . . . . . . . . . . Microwave hyperthermia therapy . . . . . . . . Mineral oils . . . . . . . . . . . . . . . . . . . Mistletoe . . . . . . . . . . . . . . . . . . . . . Mitochondrial DNA mutations. . . . . . . . . . MLH1 gene. . . . . . . . . . . . . . . . . . . . Mohs surgery. . . . . . . . . . . . . . . . . . . Molecular oncology . . . . . . . . . . . . . . . Moles. . . . . . . . . . . . . . . . . . . . . . . Monoclonal antibodies . . . . . . . . . . . . . . Motion sickness devices . . . . . . . . . . . . .
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748 750 750 752 753 754
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754 757 759 761 763 764 765
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766 768 768 770 772 774 775 776 779 780
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MRI. See Magnetic resonance imaging MSH genes . . . . . . . . . . . . . . . . . . . . Mucinous carcinomas . . . . . . . . . . . . . . Mucosa-associated lymphoid tissue (MALT) lymphomas . . . . . . . . . . . . . . . . . . Mucositis . . . . . . . . . . . . . . . . . . . . . Mucous membranes, epidermoid cancers of. See Epidermoid cancers of mucous membranes Multiple endocrine neoplasia type 1 (MEN 1). . Multiple endocrine neoplasia type 2 (MEN 2). . Multiple myeloma . . . . . . . . . . . . . . . . Mustard gas . . . . . . . . . . . . . . . . . . . Mutagenesis and cancer . . . . . . . . . . . . . Myasthenia gravis . . . . . . . . . . . . . . . . MYC oncogene . . . . . . . . . . . . . . . . . . Mycosis fungoides . . . . . . . . . . . . . . . . Myelodysplastic syndromes . . . . . . . . . . . Myelofibrosis . . . . . . . . . . . . . . . . . . Myeloma . . . . . . . . . . . . . . . . . . . . . Myeloproliferative disorders. . . . . . . . . . . Myelosuppression . . . . . . . . . . . . . . . . 2-Naphthylamine. . . . . . . . . . . . . . . . Nasal cavity and paranasal sinus cancers . . . National Cancer Institute (NCI) . . . . . . . . National Science Foundation (NSF) . . . . . . Native North Americans and cancer . . . . . . Nausea and vomiting. . . . . . . . . . . . . . NCI. See National Cancer Institute Needle biopsies . . . . . . . . . . . . . . . . Needle localization. . . . . . . . . . . . . . . Nephroblastomas. . . . . . . . . . . . . . . . Nephrostomy . . . . . . . . . . . . . . . . . . Neuroblastomas . . . . . . . . . . . . . . . . Neuroectodermal tumors. . . . . . . . . . . . Neuroendocrine tumors . . . . . . . . . . . . Neurofibromatosis type 1 (NF1) . . . . . . . . Neurologic oncology. . . . . . . . . . . . . . Neutropenia . . . . . . . . . . . . . . . . . . NF1. See Neurofibromatosis type 1 Nickel compounds and metallic nickel . . . . Night sweats . . . . . . . . . . . . . . . . . . Nijmegen breakage syndrome . . . . . . . . . Nipple discharge . . . . . . . . . . . . . . . . Non-Hodgkin lymphoma . . . . . . . . . . . Nonsteroidal anti-inflammatory drugs (NSAIDs) . . . . . . . . . . . . . . . . . . NSAIDs. See Nonsteroidal anti-inflammatory drugs NSF. See National Science Foundation Nuclear medicine scan . . . . . . . . . . . . .
781 782 783 785 786 788
. . 790 . . . . . . . . . . .
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790 791 792 793 794 795 796 796 798 800 802 lxvi
. . 803 . . 803 . . 804 . . 806
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807 808 809 812 813 815 817 817 819 820 822 823 825
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826 826 829 830 832 834
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836 838 839 839 841 842 844 845 847 849
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851 852 853 854 855
. . . 858
. . . 859
Complete List of Contents Pediatric oncology and hematology . . . . . . . . . 938 Pelvic examination . . . . . . . . . . . . . . . . . . 940 Penile cancer . . . . . . . . . . . . . . . . . . . . . 941 Percutaneous transhepatic cholangiography (PTHC) . . . . . . . . . . . . . . . . . . . . . . 943 Pericardial effusion . . . . . . . . . . . . . . . . . 944 Pericardiocentesis . . . . . . . . . . . . . . . . . . 946 Peritoneovenous shunts . . . . . . . . . . . . . . . 946 Personality and cancer . . . . . . . . . . . . . . . . 947 Pesticides and the food chain . . . . . . . . . . . . 948 PET. See Positron emission tomography Peutz-Jeghers syndrome (PJS) . . . . . . . . . . . . 951 Pharmacy oncology . . . . . . . . . . . . . . . . . 952 Phenacetin . . . . . . . . . . . . . . . . . . . . . . 955 Phenolics . . . . . . . . . . . . . . . . . . . . . . . 955 Pheochromocytomas . . . . . . . . . . . . . . . . . 956 Pheresis . . . . . . . . . . . . . . . . . . . . . . . 958 Photodynamic therapy (PDT) . . . . . . . . . . . . 959 Phyllodes tumors. . . . . . . . . . . . . . . . . . . 960 Phytoestrogens . . . . . . . . . . . . . . . . . . . . 962 Pineoblastomas. . . . . . . . . . . . . . . . . . . . 963 Pituitary tumors . . . . . . . . . . . . . . . . . . . 965 PJS. See Peutz-Jeghers syndrome Placental alkaline phosphatase (PALP) . . . . . . . 968 Plant alkaloids and terpenoids in chemotherapy . . . . . . . . . . . . . . . . . . . 968 Plasticizers . . . . . . . . . . . . . . . . . . . . . . 971 Pleural biopsy . . . . . . . . . . . . . . . . . . . . 972 Pleural effusion . . . . . . . . . . . . . . . . . . . 973 Pleurodesis . . . . . . . . . . . . . . . . . . . . . . 975 Pleuropulmonary blastomas . . . . . . . . . . . . . 975 PMS genes . . . . . . . . . . . . . . . . . . . . . . 976 Pneumonectomy . . . . . . . . . . . . . . . . . . . 977 Pneumonia . . . . . . . . . . . . . . . . . . . . . . 979 Polycyclic aromatic hydrocarbons . . . . . . . . . . 981 Polycythemia vera . . . . . . . . . . . . . . . . . . 981 Polypectomy . . . . . . . . . . . . . . . . . . . . . 982 Polyps . . . . . . . . . . . . . . . . . . . . . . . . 983 Polyps, colon. See Colon polyps Polyps, gastric. See Gastric polyps Positron emission tomography (PET) . . . . . . . . 984 Poverty and cancer . . . . . . . . . . . . . . . . . . 987 PPOs. See Preferred provider organizations Prayer and cancer support . . . . . . . . . . . . . . 989 Preferred provider organizations (PPOs) . . . . . . 990 Pregnancy and cancer . . . . . . . . . . . . . . . . 992 Premalignancies . . . . . . . . . . . . . . . . . . . 994 Prevent Cancer Foundation . . . . . . . . . . . . . 997 Prevention . . . . . . . . . . . . . . . . . . . . . . 999 Primary care physician . . . . . . . . . . . . . . . 1001
Nutrition and cancer prevention . . . . . . . . . . . 861 Nutrition and cancer treatment. . . . . . . . . . . . 864 Obesity-associated cancers . . . . . Occupational exposures and cancer . Occupational therapy . . . . . . . . OCs. See Organochlorines Oligodendrogliomas . . . . . . . . . Omega-3 fatty acids . . . . . . . . . Ommaya reservoir . . . . . . . . . . Oncogenes . . . . . . . . . . . . . . Oncogenic viruses . . . . . . . . . . Oncology . . . . . . . . . . . . . . . Oncology clinical nurse specialist . . Oncology social worker . . . . . . . Oophorectomy . . . . . . . . . . . . Ophthalmic oncology . . . . . . . . Opioids . . . . . . . . . . . . . . . . Oral and maxillofacial surgery. . . . Oral and oropharyngeal cancers . . . Orbit tumors . . . . . . . . . . . . . Orchiectomy . . . . . . . . . . . . . Organ transplantation and cancer . . Organochlorines (OCs) . . . . . . . Oropharyngeal cancers. See Oral and oropharyngeal cancers Orthopedic surgery. . . . . . . . . . Otolaryngology . . . . . . . . . . . Ovarian cancers . . . . . . . . . . . Ovarian cysts. . . . . . . . . . . . . Ovarian epithelial cancer . . . . . . Overtreatment . . . . . . . . . . . .
. . . . . . . . 868 . . . . . . . . 871 . . . . . . . . 873 . . . . . . . . . . . . . . . . .
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875 877 878 878 881 882 885 887 888 889 892 893 894 897 898 899 901
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902 903 905 908 909 911
Paget disease of bone . . . . . . . . . . . . . Pain management medications. . . . . . . . . Palliative treatment . . . . . . . . . . . . . . PALP. See Placental alkaline phosphatase Palpation . . . . . . . . . . . . . . . . . . . . Pancolitis . . . . . . . . . . . . . . . . . . . . Pancreatectomy . . . . . . . . . . . . . . . . Pancreatic cancers . . . . . . . . . . . . . . . Pancreatitis . . . . . . . . . . . . . . . . . . . Pap test . . . . . . . . . . . . . . . . . . . . . Paracentesis . . . . . . . . . . . . . . . . . . Paranasal sinus cancers. See Nasal cavity and paranasal sinus cancers Paraneoplastic syndromes . . . . . . . . . . . Parathyroid cancer . . . . . . . . . . . . . . . Pathology . . . . . . . . . . . . . . . . . . . PC-SPES . . . . . . . . . . . . . . . . . . . . PDT. See Photodynamic therapy
. . . 912 . . . 914 . . . 917 . . . . . . .
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920 920 921 923 927 928 929
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931 932 934 937 lxvii
Salem Health: Cancer Primary central nervous system lymphomas . . . . . . . . . . . . . . . . Progesterone receptor assay . . . . . . . . Prostate cancer . . . . . . . . . . . . . . . Prostate-specific antigen (PSA) test . . . . Prostatectomy. . . . . . . . . . . . . . . . Prostatitis . . . . . . . . . . . . . . . . . . Proteasome inhibitors. . . . . . . . . . . . Protein electrophoresis . . . . . . . . . . . Proteomics and cancer research . . . . . . Proton beam therapy . . . . . . . . . . . . Proto-oncogenes and carcinogenesis . . . . PSA test. See Prostate-specific antigen test Psycho-oncology . . . . . . . . . . . . . . Psychosocial aspects of cancer . . . . . . . PTHC. See Percutaneous transhepatic cholangiography Radiation, ionizing. See Ionizing radiation Radiation oncology . . . . . . . . . . . . . Radiation therapies . . . . . . . . . . . . . Radiation therapy, afterloading. See Afterloading radiation therapy Radical neck dissection . . . . . . . . . . . Radiofrequency ablation . . . . . . . . . . Radionuclide scan . . . . . . . . . . . . . Radiopharmaceuticals . . . . . . . . . . . Radon . . . . . . . . . . . . . . . . . . . . RB1 gene . . . . . . . . . . . . . . . . . . Receptor analysis . . . . . . . . . . . . . .
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1003 1003 1004 1006 1008 1009 1010 1010 1012 1014 1015
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. . . . 1021 . . . . 1023
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1027 1027 1030 1030 1032 1032 1033
Reconstructive surgery . . . . . . . . . . . . . . Rectal cancer . . . . . . . . . . . . . . . . . . . Recurrence . . . . . . . . . . . . . . . . . . . . Rehabilitation . . . . . . . . . . . . . . . . . . . Relationships . . . . . . . . . . . . . . . . . . . Renal pelvis tumors. . . . . . . . . . . . . . . . Report on Carcinogens (RoC) . . . . . . . . . . Resveratrol . . . . . . . . . . . . . . . . . . . . Retinoblastomas . . . . . . . . . . . . . . . . . Rhabdomyosarcomas . . . . . . . . . . . . . . . RhoGD12 gene . . . . . . . . . . . . . . . . . . Richter syndrome . . . . . . . . . . . . . . . . . Risk assessment, family history and. See Family history and risk assessment Risks for cancer. . . . . . . . . . . . . . . . . . Robert H. Lurie Cancer Center . . . . . . . . . . RoC. See Report on Carcinogens Rothmund-Thomson syndrome . . . . . . . . . .
. . . . . . . . . . . .
Salivary gland cancer . . . . . . . . . . . . . Salpingectomy and salpingo-oophorectomy . Sarcomas, soft-tissue . . . . . . . . . . . . . Saw palmetto . . . . . . . . . . . . . . . . . Schwannoma tumors . . . . . . . . . . . . . SCLC1 gene. . . . . . . . . . . . . . . . . . Screening, colorectal cancer. See Colorectal cancer screening Screening for cancer . . . . . . . . . . . . . Second opinions . . . . . . . . . . . . . . . Self-image and body image. . . . . . . . . .
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1034 1036 1038 1038 1041 1043 1044 1045 1046 1048 1050 1050
. 1052 . 1054 . 1056 1058 1060 1062 1065 1066 1067
. . . 1067 . . . 1070 . . . 1071
Volume 4 Sjögren syndrome. . . . . . . . . . . . . . . . Skin cancers . . . . . . . . . . . . . . . . . . SLN biopsy and mapping. See Sentinel lymph node biopsy and mapping Small intestine cancer . . . . . . . . . . . . . Smoking cessation . . . . . . . . . . . . . . . Social Security Disability Insurance (SSDI) . . Soft-tissue fibrosarcomas. See Fibrosarcomas, soft-tissue Soots . . . . . . . . . . . . . . . . . . . . . . Soy foods . . . . . . . . . . . . . . . . . . . . Spermatocytomas . . . . . . . . . . . . . . . . Spinal axis tumors . . . . . . . . . . . . . . . Spinal cord compression . . . . . . . . . . . . Splenectomy . . . . . . . . . . . . . . . . . . Sputum cytology . . . . . . . . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . lxxvii Complete List of Contents . . . . . . . . . . . . . lxxix Sentinel lymph node (SLN) biopsy and mapping . . . . . . . . . . . . . . . Sepsis. See Infection and sepsis Sertoli cell tumors . . . . . . . . . . . Sexuality and cancer . . . . . . . . . . Sézary syndrome . . . . . . . . . . . . SIADH. See Syndrome of inappropriate antidiuretic hormone production Side effects . . . . . . . . . . . . . . . Sigmoidoscopy . . . . . . . . . . . . . Silica, crystalline . . . . . . . . . . . . Simian virus 40 . . . . . . . . . . . . . Singlehood and cancer . . . . . . . . .
. . . . . . 1073 . . . . . . 1073 . . . . . . 1074 . . . . . . 1076
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1078 1082 1083 1084 1084 lxviii
. . 1086 . . 1088
. . 1091 . . 1093 . . 1096
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1097 1098 1099 1100 1102 1103 1105
Complete List of Contents Squamous cell carcinomas . . . . . . . . . . . SRS. See Stereotactic radiosurgery SSDI. See Social Security Disability Insurance Staging of cancer . . . . . . . . . . . . . . . . Statistics of cancer . . . . . . . . . . . . . . . Stem cell transplantation . . . . . . . . . . . . Stent therapy . . . . . . . . . . . . . . . . . . Stereotactic needle biopsy . . . . . . . . . . . Stereotactic radiosurgery (SRS) . . . . . . . . Sterility . . . . . . . . . . . . . . . . . . . . . Stomach cancers . . . . . . . . . . . . . . . . Stomatitis . . . . . . . . . . . . . . . . . . . . Stress management . . . . . . . . . . . . . . . Sunlamps . . . . . . . . . . . . . . . . . . . . Sun’s soup . . . . . . . . . . . . . . . . . . . Sunscreens . . . . . . . . . . . . . . . . . . . Superior vena cava syndrome . . . . . . . . . Support groups . . . . . . . . . . . . . . . . . Surgical biopsies . . . . . . . . . . . . . . . . Surgical oncology. . . . . . . . . . . . . . . . Survival rates . . . . . . . . . . . . . . . . . . Survivorship issues . . . . . . . . . . . . . . . Symptoms and cancer. . . . . . . . . . . . . . Syndrome of inappropriate antidiuretic hormone production (SIADH) . . . . . . . . Synovial sarcomas . . . . . . . . . . . . . . . Taste alteration . . . . . . . . . . . . . . Teratocarcinomas . . . . . . . . . . . . . Teratomas . . . . . . . . . . . . . . . . . Testicular cancer . . . . . . . . . . . . . Testicular self-examination (TSE) . . . . Thermal imaging . . . . . . . . . . . . . Thiotepa. . . . . . . . . . . . . . . . . . Thoracentesis . . . . . . . . . . . . . . . Thoracoscopy . . . . . . . . . . . . . . . Thoracotomy . . . . . . . . . . . . . . . Throat cancer . . . . . . . . . . . . . . . Thrombocytopenia . . . . . . . . . . . . Thymomas . . . . . . . . . . . . . . . . Thymus cancer . . . . . . . . . . . . . . Thyroid cancer . . . . . . . . . . . . . . Thyroid nuclear medicine scan . . . . . . TNF. See Tumor necrosis factor TNM staging . . . . . . . . . . . . . . . Tobacco, chewing. See Chewing tobacco Tobacco-related cancers . . . . . . . . . Topoisomerase inhibitors . . . . . . . . . TP53 protein . . . . . . . . . . . . . . . Tracheostomy . . . . . . . . . . . . . . . Transfusion therapy. . . . . . . . . . . .
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Transitional care . . . . . . . . . . . Transitional cell carcinomas . . . . . Transrectal ultrasound . . . . . . . . Transvaginal ultrasound . . . . . . . Trichilemmal carcinomas. . . . . . . TSE. See Testicular self-examination Tuberous sclerosis . . . . . . . . . . Tubular carcinomas . . . . . . . . . . Tumor flare . . . . . . . . . . . . . . Tumor lysis syndrome . . . . . . . . Tumor markers . . . . . . . . . . . . Tumor necrosis factor (TNF) . . . . . Tumor-suppressor genes . . . . . . . Turcot syndrome . . . . . . . . . . . Tyrosine kinase inhibitors . . . . . .
. . 1106
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1108 1111 1114 1116 1118 1119 1120 1121 1124 1125 1127 1128 1129 1130 1132 1135 1138 1140 1143 1144
. . 1147 . . 1149 . . . . . . . . . . . . . . . .
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1151 1152 1153 1154 1156 1157 1158 1158 1160 1161 1162 1164 1166 1167 1169 1172
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1182 1183 1185 1186 1187
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1187 1188 1189 1189 1191 1193 1194 1195 1196
Ultrasound, breast. See Breast ultrasound Ultrasound, endorectal. See Endorectal ultrasound Ultrasound, transrectal. See Transrectal ultrasound Ultrasound, transvaginal. See Transvaginal ultrasound Ultrasound tests . . . . . . . . . . . . . . . Ultraviolet radiation and related exposures Umbilical cord blood transplantation. . . . Upper gastrointestinal (GI) endoscopy . . . Upper gastrointestinal (GI) series . . . . . Urethral cancer . . . . . . . . . . . . . . . Urinalysis . . . . . . . . . . . . . . . . . . Urinary system cancers . . . . . . . . . . . Urography . . . . . . . . . . . . . . . . . Urologic oncology . . . . . . . . . . . . . Urostomy . . . . . . . . . . . . . . . . . . Uterine cancer . . . . . . . . . . . . . . .
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1199 1200 1201 1202 1203 1205 1207 1209 1213 1214 1216 1217
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1220 1221 1223 1225 1226
Vaccines, preventive . . . . . . . . . . . Vaccines, therapeutic . . . . . . . . . . . Vaginal cancer . . . . . . . . . . . . . . Vascular access tubes. . . . . . . . . . . Vasectomy and cancer . . . . . . . . . . Vegetables, cruciferous. See Cruciferous vegetables Veterinary oncology . . . . . . . . . . . VHL disease. See Von Hippel-Lindau disease Vinyl chloride . . . . . . . . . . . . . . Viral oncology . . . . . . . . . . . . . . Virus-related cancers . . . . . . . . . . . Von Hippel-Lindau (VHL) disease. . . . Vulvar cancer . . . . . . . . . . . . . . .
. . . . . 1173 . . . . .
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1174 1175 1177 1179 1180 lxix
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1230 1230 1232 1235 1237
Salem Health: Cancer WAGR syndrome. See Wilms’ tumor aniridiagenitourinary anomalies-mental retardation syndrome and cancer Waldenström macroglobulinemia (WM) . . . . . . 1240 Watchful waiting . . . . . . . . . . . . . . . . . . 1242 Weight loss . . . . . . . . . . . . . . . . . . . . . 1243 Wilms’ tumor . . . . . . . . . . . . . . . . . . . . 1245 Wilms’ tumor aniridia-genitourinary anomaliesmental retardation (WAGR) syndrome and cancer . . . . . . . . . . . . . . . . . . . . . . 1248 Wine and cancer . . . . . . . . . . . . . . . . . . 1250 Wire localization . . . . . . . . . . . . . . . . . . 1250 WM. See Waldenström macroglobulinemia Wood dust . . . . . . . . . . . . . . . . . . . . . 1251
Yolk sac carcinomas . . . . . . . . . . . . . . . . 1256 Young adult cancers . . . . . . . . . . . . . . . . 1256 Zollinger-Ellison syndrome . . . . . . . . . . . . 1260 Drugs by Generic Name . . . Drugs by Trade Name . . . . Associations and Agencies . . Cancer Centers and Hospitals Cancer Support Groups . . . . Carcinogens. . . . . . . . . . Glossary . . . . . . . . . . . Bibliography . . . . . . . . .
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1265 1309 1348 1352 1357 1362 1383 1400
Category List . . . . . . . . . . . . . . . . . . . . 1409 Index . . . . . . . . . . . . . . . . . . . . . . . . 1419
X-ray tests . . . . . . . . . . . . . . . . . . . . . 1252 Xeroderma pigmentosa . . . . . . . . . . . . . . . 1254
lxx
Volume IV Sentinel lymph node (SLN) biopsy and mapping — Zollinger-Ellison syndrome Appendixes Indexes Editor
Jeffrey A. Knight, Ph.D. Mount Holyoke College Medical Consultants
Laurie Jackson-Grusby, Ph.D. Children’s Hospital Boston, Harvard Medical School
Wendy White-Ryan, M.D., FAAP Golisano Children’s Hospital at Strong Memorial Hospital
SALEM PRESS, INC. Pasadena, California Hackensack, New Jersey
Editor in Chief: Dawn P. Dawson Editorial Director: Christina J. Moose Project Editors: Tracy Irons-Georges, Rowena Wildin Dehanke Editorial Assistant: Dana Garey
Production Editor: Joyce I. Buchea Acquisitions Editor: Mark Rehn Photo Editor: Cynthia Breslin Beres Design and Graphics: James Hutson Layout: William Zimmerman
Copyright © 2009, by Salem Press, Inc. All rights in this book are reserved. No part of this work may be used or reproduced in any manner whatsoever or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the copyright owner except in the case of brief quotations embodied in critical articles and reviews or in the copying of images deemed to be freely licensed or in the public domain. For information address the publisher, Salem Press, Inc., P.O. Box 50062, Pasadena, California 91115. ∞ The paper used in these volumes conforms to the American National Standard for Permanence of Paper for Printed Library Materials, Z39.48-1992 (R1997). Note to Readers The material presented in Salem Health: Cancer is intended for broad informational and educational purposes. Readers who suspect that they or someone whom they know or provide caregiving for suffers from cancer or any other physical or psychological disorder, disease, or condition described in this set should contact a physician without delay; this work should not be used as a substitute for professional medical diagnosis or staging. Readers who are undergoing or about to undergo any treatment or procedure described in this set should refer to their physicians and other health care team members for guidance concerning preparation and possible effects. This set is not to be considered definitive on the covered topics, and readers should remember that the field of health care is characterized by a diversity of medical opinions and constant expansion in knowledge and understanding. Library of Congress Cataloging-in-Publication Data Salem health : cancer / Jeffrey A. Knight, Laurie Jackson-Grusby, Wendy White-Ryan. p. cm. Includes bibliographical references and index. ISBN 978-1-58765-505-0 (set : alk. paper) — ISBN 978-1-58765-506-7 (vol. 1 : alk. paper) — ISBN 978-1-58765-507-4 (vol. 2 : alk. paper) — ISBN 978-1-58765-508-1 (vol. 3 : alk. paper) — ISBN 978-1-58765-509-8 (vol. 4 : alk. paper) 1. Cancer. I. Knight, Jeffrey A., 1948- II. Jackson-Grusby, Laurie. III. White-Ryan, Wendy. RC265.S32 2008 616.99′4—dc22 2008030861
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Contents Superior vena cava syndrome . . . . . Support groups . . . . . . . . . . . . . Surgical biopsies . . . . . . . . . . . . Surgical oncology. . . . . . . . . . . . Survival rates . . . . . . . . . . . . . . Survivorship issues . . . . . . . . . . . Symptoms and cancer. . . . . . . . . . Syndrome of inappropriate antidiuretic hormone production (SIADH) . . . . Synovial sarcomas . . . . . . . . . . .
Complete List of Contents . . . . . . . . . . . . . lxxix Sentinel lymph node (SLN) biopsy and mapping . . . . . . . . . . . . . . . . . . . Sepsis. See Infection and sepsis Sertoli cell tumors . . . . . . . . . . . . . . . Sexuality and cancer . . . . . . . . . . . . . . Sézary syndrome . . . . . . . . . . . . . . . . SIADH. See Syndrome of inappropriate antidiuretic hormone production Side effects . . . . . . . . . . . . . . . . . . . Sigmoidoscopy . . . . . . . . . . . . . . . . . Silica, crystalline . . . . . . . . . . . . . . . . Simian virus 40 . . . . . . . . . . . . . . . . . Singlehood and cancer . . . . . . . . . . . . . Sjögren syndrome. . . . . . . . . . . . . . . . Skin cancers . . . . . . . . . . . . . . . . . . SLN biopsy and mapping. See Sentinel lymph node biopsy and mapping Small intestine cancer . . . . . . . . . . . . . Smoking cessation . . . . . . . . . . . . . . . Social Security Disability Insurance (SSDI) . . Soft-tissue fibrosarcomas. See Fibrosarcomas, soft-tissue Soots . . . . . . . . . . . . . . . . . . . . . . Soy foods . . . . . . . . . . . . . . . . . . . . Spermatocytomas . . . . . . . . . . . . . . . . Spinal axis tumors . . . . . . . . . . . . . . . Spinal cord compression . . . . . . . . . . . . Splenectomy . . . . . . . . . . . . . . . . . . Sputum cytology . . . . . . . . . . . . . . . . Squamous cell carcinomas . . . . . . . . . . . SRS. See Stereotactic radiosurgery SSDI. See Social Security Disability Insurance Staging of cancer . . . . . . . . . . . . . . . . Statistics of cancer . . . . . . . . . . . . . . . Stem cell transplantation . . . . . . . . . . . . Stent therapy . . . . . . . . . . . . . . . . . . Stereotactic needle biopsy . . . . . . . . . . . Stereotactic radiosurgery (SRS) . . . . . . . . Sterility . . . . . . . . . . . . . . . . . . . . . Stomach cancers . . . . . . . . . . . . . . . . Stomatitis . . . . . . . . . . . . . . . . . . . . Stress management . . . . . . . . . . . . . . . Sunlamps . . . . . . . . . . . . . . . . . . . . Sun’s soup . . . . . . . . . . . . . . . . . . . Sunscreens . . . . . . . . . . . . . . . . . . .
. . 1073 . . 1073 . . 1074 . . 1076
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1078 1082 1083 1084 1084 1086 1088
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1097 1098 1099 1100 1102 1103 1105 1106
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1108 1111 1114 1116 1118 1119 1120 1121 1124 1125 1127 1128 1129 lxxvii
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1130 1132 1135 1138 1140 1143 1144
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Taste alteration . . . . . . . . . . . . . . Teratocarcinomas . . . . . . . . . . . . . Teratomas . . . . . . . . . . . . . . . . . Testicular cancer . . . . . . . . . . . . . Testicular self-examination (TSE) . . . . Thermal imaging . . . . . . . . . . . . . Thiotepa. . . . . . . . . . . . . . . . . . Thoracentesis . . . . . . . . . . . . . . . Thoracoscopy . . . . . . . . . . . . . . . Thoracotomy . . . . . . . . . . . . . . . Throat cancer . . . . . . . . . . . . . . . Thrombocytopenia . . . . . . . . . . . . Thymomas . . . . . . . . . . . . . . . . Thymus cancer . . . . . . . . . . . . . . Thyroid cancer . . . . . . . . . . . . . . Thyroid nuclear medicine scan . . . . . . TNF. See Tumor necrosis factor TNM staging . . . . . . . . . . . . . . . Tobacco, chewing. See Chewing tobacco Tobacco-related cancers . . . . . . . . . Topoisomerase inhibitors . . . . . . . . . TP53 protein . . . . . . . . . . . . . . . Tracheostomy . . . . . . . . . . . . . . . Transfusion therapy. . . . . . . . . . . . Transitional care . . . . . . . . . . . . . Transitional cell carcinomas . . . . . . . Transrectal ultrasound . . . . . . . . . . Transvaginal ultrasound . . . . . . . . . Trichilemmal carcinomas. . . . . . . . . TSE. See Testicular self-examination Tuberous sclerosis . . . . . . . . . . . . Tubular carcinomas . . . . . . . . . . . . Tumor flare . . . . . . . . . . . . . . . . Tumor lysis syndrome . . . . . . . . . . Tumor markers . . . . . . . . . . . . . . Tumor necrosis factor (TNF) . . . . . . .
. . 1091 . . 1093 . . 1096
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1151 1152 1153 1154 1156 1157 1158 1158 1160 1161 1162 1164 1166 1167 1169 1172
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1174 1175 1177 1179 1180 1182 1183 1185 1186 1187
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1187 1188 1189 1189 1191 1193
Salem Health: Cancer Tumor-suppressor genes . . . . . . . . . . . . . . 1194 Turcot syndrome . . . . . . . . . . . . . . . . . . 1195 Tyrosine kinase inhibitors . . . . . . . . . . . . . 1196 Ultrasound, breast. See Breast ultrasound Ultrasound, endorectal. See Endorectal ultrasound Ultrasound, transrectal. See Transrectal ultrasound Ultrasound, transvaginal. See Transvaginal ultrasound Ultrasound tests . . . . . . . . . . . . . . . Ultraviolet radiation and related exposures Umbilical cord blood transplantation. . . . Upper gastrointestinal (GI) endoscopy . . . Upper gastrointestinal (GI) series . . . . . Urethral cancer . . . . . . . . . . . . . . . Urinalysis . . . . . . . . . . . . . . . . . . Urinary system cancers . . . . . . . . . . . Urography . . . . . . . . . . . . . . . . . Urologic oncology . . . . . . . . . . . . . Urostomy . . . . . . . . . . . . . . . . . . Uterine cancer . . . . . . . . . . . . . . . Vaccines, preventive . . . . . . . . . . . Vaccines, therapeutic . . . . . . . . . . . Vaginal cancer . . . . . . . . . . . . . . Vascular access tubes. . . . . . . . . . . Vasectomy and cancer . . . . . . . . . . Vegetables, cruciferous. See Cruciferous vegetables Veterinary oncology . . . . . . . . . . . VHL disease. See Von Hippel-Lindau disease Vinyl chloride . . . . . . . . . . . . . . Viral oncology . . . . . . . . . . . . . . Virus-related cancers . . . . . . . . . . .
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1199 1200 1201 1202 1203 1205 1207 1209 1213 1214 1216 1217
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1220 1221 1223 1225 1226
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Von Hippel-Lindau (VHL) disease. . . . . . . . . 1235 Vulvar cancer . . . . . . . . . . . . . . . . . . . . 1237 WAGR syndrome. See Wilms’ tumor aniridiagenitourinary anomalies-mental retardation syndrome and cancer Waldenström macroglobulinemia (WM) . . . . . . 1240 Watchful waiting . . . . . . . . . . . . . . . . . . 1242 Weight loss . . . . . . . . . . . . . . . . . . . . . 1243 Wilms’ tumor . . . . . . . . . . . . . . . . . . . . 1245 Wilms’ tumor aniridia-genitourinary anomaliesmental retardation (WAGR) syndrome and cancer . . . . . . . . . . . . . . . . . . . . . . 1248 Wine and cancer . . . . . . . . . . . . . . . . . . 1250 Wire localization . . . . . . . . . . . . . . . . . . 1250 WM. See Waldenström macroglobulinemia Wood dust . . . . . . . . . . . . . . . . . . . . . 1251 X-ray tests . . . . . . . . . . . . . . . . . . . . . 1252 Xeroderma pigmentosa . . . . . . . . . . . . . . . 1254 Yolk sac carcinomas . . . . . . . . . . . . . . . . 1256 Young adult cancers . . . . . . . . . . . . . . . . 1256 Zollinger-Ellison syndrome . . . . . . . . . . . . 1260 Drugs by Generic Name . . . Drugs by Trade Name . . . . Associations and Agencies . . Cancer Centers and Hospitals Cancer Support Groups . . . . Carcinogens. . . . . . . . . . Glossary . . . . . . . . . . . Bibliography . . . . . . . . .
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Category List . . . . . . . . . . . . . . . . . . . . 1409 Index . . . . . . . . . . . . . . . . . . . . . . . . 1419
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Complete List of Contents Volume 1 Alkylating agents in chemotherapy . . . . . . . ALL. See Acute lymphocytic leukemia Allicin, garlic and. See Garlic and allicin Alopecia . . . . . . . . . . . . . . . . . . . . . ALP. See Alkaline phosphatase test Alpha-fetoprotein (AFP) levels . . . . . . . . . Alternative therapies. See Complementary and alternative therapies Alveolar soft-part sarcomas . . . . . . . . . . . Amenorrhea . . . . . . . . . . . . . . . . . . . American Association for Cancer Research (AACR) . . . . . . . . . . . . . . . . . . . . American Cancer Society (ACS) . . . . . . . . American Institute for Cancer Research (AICR) 4-Aminobiphenyl . . . . . . . . . . . . . . . . AML. See Acute myelocytic leukemia Amputation . . . . . . . . . . . . . . . . . . . Amyloidosis . . . . . . . . . . . . . . . . . . . Anal cancer . . . . . . . . . . . . . . . . . . . Androgen drugs . . . . . . . . . . . . . . . . . Anemia . . . . . . . . . . . . . . . . . . . . . Anemia, aplastic. See Aplastic anemia Anemia, hemolytic. See Hemolytic anemia Angiogenesis . . . . . . . . . . . . . . . . . . Angiogenesis inhibitors . . . . . . . . . . . . . Angiography. . . . . . . . . . . . . . . . . . . Angiosarcomas . . . . . . . . . . . . . . . . . Anoscopy . . . . . . . . . . . . . . . . . . . . Anthraquinones . . . . . . . . . . . . . . . . . Anthrax . . . . . . . . . . . . . . . . . . . . . Antiandrogens . . . . . . . . . . . . . . . . . . Antidiarrheal agents . . . . . . . . . . . . . . . Antiestrogens . . . . . . . . . . . . . . . . . . Antifungal therapies . . . . . . . . . . . . . . . Antimetabolites in chemotherapy . . . . . . . . Antinausea medications . . . . . . . . . . . . . Antineoplastics in chemotherapy . . . . . . . . Antioxidants . . . . . . . . . . . . . . . . . . . Antiperspirants and breast cancer . . . . . . . . Antiviral therapies. . . . . . . . . . . . . . . . Anxiety . . . . . . . . . . . . . . . . . . . . . APBI. See Accelerated partial breast irradiation APC gene testing . . . . . . . . . . . . . . . . Aplastic anemia . . . . . . . . . . . . . . . . . Appendix cancer . . . . . . . . . . . . . . . . Appetite loss. . . . . . . . . . . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . . . v Publisher’s Note . . . . . . . . . . . . . . . . . . . . ix About the Editors . . . . . . . . . . . . . . . . . . . xi Contributors . . . . . . . . . . . . . . . . . . . . . xiii Complete List of Contents . . . . . . . . . . . . . . xv AACR. See American Association for Cancer Research ABCD. . . . . . . . . . . . . . . . . . . . . . . . . . 1 ACC. See Adenoid cystic carcinoma Abdominoperineal resection (APR) . . . . . . . . . . 1 Accelerated partial breast irradiation (APBI). . . . . . 3 Achlorhydria . . . . . . . . . . . . . . . . . . . . . . 4 Acoustic neuromas . . . . . . . . . . . . . . . . . . . 4 Acquired immunodeficiency disease-related cancers. See HIV/AIDS-related cancers Acrylamides . . . . . . . . . . . . . . . . . . . . . . 6 ACS. See American Cancer Society Acupuncture and acupressure for cancer patients . . . 8 Acute lymphocytic leukemia (ALL) . . . . . . . . . 11 Acute myelocytic leukemia (AML) . . . . . . . . . . 13 Adenocarcinomas . . . . . . . . . . . . . . . . . . . 16 Adenoid cystic carcinoma (ACC) . . . . . . . . . . . 17 Adenomatoid tumors . . . . . . . . . . . . . . . . . 18 Adenomatous polyps . . . . . . . . . . . . . . . . . 18 Adenoviruses . . . . . . . . . . . . . . . . . . . . . 19 Adjuvant therapy . . . . . . . . . . . . . . . . . . . 20 Adrenal gland cancers . . . . . . . . . . . . . . . . . 21 Adrenocortical cancer . . . . . . . . . . . . . . . . . 23 Advance directives . . . . . . . . . . . . . . . . . . 24 Aflatoxins . . . . . . . . . . . . . . . . . . . . . . . 26 AFP levels. See Alpha-fetoprotein levels African Americans and cancer . . . . . . . . . . . . 28 Africans and cancer . . . . . . . . . . . . . . . . . . 31 Afterloading radiation therapy . . . . . . . . . . . . 32 Agent Orange . . . . . . . . . . . . . . . . . . . . . 34 Aging and cancer . . . . . . . . . . . . . . . . . . . 34 AICR. See American Institute for Cancer Research Aids and devices for cancer patients . . . . . . . . . 38 AIDS-related cancers. See HIV/AIDS-related cancers Air pollution . . . . . . . . . . . . . . . . . . . . . . 39 Alcohol, alcoholism, and cancer . . . . . . . . . . . 42 Aleukemia . . . . . . . . . . . . . . . . . . . . . . . 43 Alkaline phosphatase test (ALP) . . . . . . . . . . . 44 lxxix
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64 66 68 69 70 71 71 72 73 75 76 78 81 83 86 88 90 93
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Salem Health: Cancer APR. See Abdominoperineal resection Arsenic compounds . . . . . . . . . . Arterial embolization . . . . . . . . . Artificial sweeteners . . . . . . . . . . Asbestos . . . . . . . . . . . . . . . . Ascites . . . . . . . . . . . . . . . . . Ashkenazi Jews and cancer . . . . . . Asian Americans and cancer. . . . . . Astrocytomas. . . . . . . . . . . . . . Ataxia telangiectasia (AT) . . . . . . . Autologous blood transfusion . . . . . Axillary dissection . . . . . . . . . . . Azathioprine . . . . . . . . . . . . . .
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Bacillus Calmette Guérin (BCG) . . . . . . . . Bacteria as causes of cancer . . . . . . . . . . . Barium enema . . . . . . . . . . . . . . . . . . Barium swallow . . . . . . . . . . . . . . . . . Barrett esophagus . . . . . . . . . . . . . . . . Basal cell carcinomas . . . . . . . . . . . . . . BCG. See Bacillus Calmette Guérin Beckwith-Wiedemann syndrome (BWS) . . . . Benign prostatic hyperplasia (BPH) . . . . . . . Benign tumors . . . . . . . . . . . . . . . . . . Benzene . . . . . . . . . . . . . . . . . . . . . Benzidine and dyes metabolized to benzidine . . Benzodiazepines . . . . . . . . . . . . . . . . . Bereavement, grief and. See Grief and bereavement Beryllium and beryllium compounds . . . . . . Beta-carotene . . . . . . . . . . . . . . . . . . Bethesda criteria . . . . . . . . . . . . . . . . . BHDS. See Birt-Hogg-Dubé syndrome Bile duct cancer . . . . . . . . . . . . . . . . . Bilobectomy . . . . . . . . . . . . . . . . . . . Bioflavonoids . . . . . . . . . . . . . . . . . . Biological therapy . . . . . . . . . . . . . . . . Biopsy. See also Computed tomography-guided biopsy; Core needle biopsy; Liver biopsy; Needle biopsies; Pleural biopsy; Stereotactic needle biopsy; Surgical biopsies . . . . . . . Birt-Hogg-Dubé syndrome (BHDS) . . . . . . . Birth control pills and cancer . . . . . . . . . . Bis(chloromethyl) ether and technical-grade chloromethyl methyl ether . . . . . . . . . . Bisphenol A (BPA) . . . . . . . . . . . . . . . Bisphosphonates . . . . . . . . . . . . . . . . . Bladder cancer . . . . . . . . . . . . . . . . . . Blood cancers . . . . . . . . . . . . . . . . . . BMT. See Bone marrow transplantation BNCT. See Boron neutron capture therapy
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Body image. See Self-image and body image Bone cancers . . . . . . . . . . . . . . . . . . . Bone marrow aspiration and biopsy . . . . . . . Bone marrow transplantation (BMT) . . . . . . Bone pain . . . . . . . . . . . . . . . . . . . . Bone scan . . . . . . . . . . . . . . . . . . . . Boron neutron capture therapy (BNCT) . . . . . Bowen disease . . . . . . . . . . . . . . . . . . BPA. See Bisphenol A BPH. See Benign prostatic hyperplasia BPI. See Brief Pain Inventory Brachytherapy . . . . . . . . . . . . . . . . . . BRAF gene . . . . . . . . . . . . . . . . . . . . Brain and central nervous system cancers . . . . Brain scan . . . . . . . . . . . . . . . . . . . . BRCA1 and BRCA2 genes . . . . . . . . . . . . Breakthrough pain . . . . . . . . . . . . . . . . Breast, calcifications of. See Calcifications of the breast Breast, medullary carcinoma of. See Medullary carcinoma of the breast Breast cancer, cutaneous. See Cutaneous breast cancer Breast cancer, estrogen-receptor-sensitive. See Estrogen-receptor-sensitive breast cancer Breast cancer in children and adolescents . . . . Breast cancer in men . . . . . . . . . . . . . . . Breast cancer in pregnant women . . . . . . . . Breast cancers . . . . . . . . . . . . . . . . . . Breast implants. . . . . . . . . . . . . . . . . . Breast reconstruction. . . . . . . . . . . . . . . Breast self-examination (BSE). . . . . . . . . . Breast ultrasound. . . . . . . . . . . . . . . . . Breslow’s staging . . . . . . . . . . . . . . . . Brief Pain Inventory (BPI) . . . . . . . . . . . . Brompton cocktail . . . . . . . . . . . . . . . . Bronchial adenomas . . . . . . . . . . . . . . . Bronchoalveolar lung cancer . . . . . . . . . . Bronchography. . . . . . . . . . . . . . . . . . Bronchoscopy . . . . . . . . . . . . . . . . . . BSE. See Breast self-examination Burkitt lymphoma . . . . . . . . . . . . . . . . 1,3-Butadiene . . . . . . . . . . . . . . . . . . 1,4-Butanediol dimethanesulfonate . . . . . . . BWS. See Beckwith-Wiedemann syndrome
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CA 15-3 test . CA 19-9 test . CA 27-29 test CA 125 test. . Cachexia . . . lxxx
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Complete List of Contents Cadmium and cadmium compounds. . . . . . . . Caffeine . . . . . . . . . . . . . . . . . . . . . . Calcifications of the breast. . . . . . . . . . . . . Calcium . . . . . . . . . . . . . . . . . . . . . . Cancell . . . . . . . . . . . . . . . . . . . . . . . Cancer biology . . . . . . . . . . . . . . . . . . . Cancer care team . . . . . . . . . . . . . . . . . . Cancer clusters . . . . . . . . . . . . . . . . . . . Cancer education. . . . . . . . . . . . . . . . . . Candidiasis . . . . . . . . . . . . . . . . . . . . . Carcinoembryonic antigen antibody (CEA) test . . . . . . . . . . . . . . . . . . . . . . . . Carcinogens, known . . . . . . . . . . . . . . . . Carcinogens, reasonably anticipated. . . . . . . . Carcinoid tumors and carcinoid syndrome . . . . Carcinoma of unknown primary origin (CUP) . . Carcinomas. . . . . . . . . . . . . . . . . . . . . Carcinomas, invasive ductal. See Invasive ductal carcinomas Carcinomas, invasive lobular. See Invasive lobular carcinomas Carcinomas, leptomeningeal. See Leptomeningeal carcinomas Carcinomatosis. . . . . . . . . . . . . . . . . . . Carcinomatous meningitis . . . . . . . . . . . . . Carcinosarcomas . . . . . . . . . . . . . . . . . . Cardiomyopathy in cancer patients . . . . . . . . Cardiopulmonary resuscitation (CPR) . . . . . . . Caregivers and caregiving . . . . . . . . . . . . . Caregiving, long-distance. See Long-distance caregiving Carney complex . . . . . . . . . . . . . . . . . . Carotenoids . . . . . . . . . . . . . . . . . . . . Cartilage supplements . . . . . . . . . . . . . . . Case management . . . . . . . . . . . . . . . . . Castleman disease . . . . . . . . . . . . . . . . . CBC. See Complete blood count CBE. See Clinical breast exam CDKN2A. See Cyclin-dependent kinase inhibitor-2A CEA test. See Carcinoembryonic antigen antibody test Cell phones. . . . . . . . . . . . . . . . . . . . . Cervical cancer. . . . . . . . . . . . . . . . . . . Chemoembolization . . . . . . . . . . . . . . . . Chemoprevention . . . . . . . . . . . . . . . . . Chemotherapy . . . . . . . . . . . . . . . . . . . Chemotherapy, cognitive effects of. See Cognitive effects of cancer and chemotherapy Chewing tobacco. . . . . . . . . . . . . . . . . . Childbirth and cancer . . . . . . . . . . . . . . .
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208 209 211 212 212 213 216 218 220 221
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Childhood cancers . . . . . . . . . . . . . . . . Chlorambucil. . . . . . . . . . . . . . . . . . . 1-(2-Chloroethyl)-3-(4-methylcyclohexyl)1-nitrosourea (MeCCNU) . . . . . . . . . . . Cholecystectomy . . . . . . . . . . . . . . . . . Chordomas . . . . . . . . . . . . . . . . . . . . Choriocarcinomas . . . . . . . . . . . . . . . . CHPP. See Continuous hyperthermic peritoneal perfusion Chromium hexavalent compounds. . . . . . . . Chromosomes and cancer . . . . . . . . . . . . Chronic lymphocytic leukemia (CLL) . . . . . . Chronic myeloid leukemia (CML). . . . . . . . Cigarettes and cigars . . . . . . . . . . . . . . . Clinical breast exam (CBE) . . . . . . . . . . . Clinical trials . . . . . . . . . . . . . . . . . . . CLL. See Chronic lymphocytic leukemia CML. See Chronic myeloid leukemia Coal tars and coal tar pitches . . . . . . . . . . Cobalt 60 radiation. . . . . . . . . . . . . . . . Coenzyme Q10. . . . . . . . . . . . . . . . . . Cognitive effects of cancer and chemotherapy . Coke oven emissions. . . . . . . . . . . . . . . Cold nodule . . . . . . . . . . . . . . . . . . . Colectomy . . . . . . . . . . . . . . . . . . . . Coloanal anastomosis . . . . . . . . . . . . . . Colon polyps . . . . . . . . . . . . . . . . . . . Colonoscopy and virtual colonoscopy . . . . . . Colony-stimulating factors (CSFs) . . . . . . . Colorectal cancer. . . . . . . . . . . . . . . . . Colorectal cancer screening . . . . . . . . . . . Colostomy . . . . . . . . . . . . . . . . . . . . Colposcopy. . . . . . . . . . . . . . . . . . . . Comedo carcinomas . . . . . . . . . . . . . . . Complementary and alternative therapies . . . . Complete blood count (CBC) . . . . . . . . . . Computed tomography (CT)-guided biopsy . . . . . . . . . . . . . . . . . . . . . Computed tomography (CT) scan . . . . . . . . Conization . . . . . . . . . . . . . . . . . . . . Continuous hyperthermic peritoneal perfusion (CHPP) . . . . . . . . . . . . . . . . . . . . Cordectomy . . . . . . . . . . . . . . . . . . . Cordotomy . . . . . . . . . . . . . . . . . . . . Core needle biopsy. . . . . . . . . . . . . . . . Corticosteroids . . . . . . . . . . . . . . . . . . Coughing . . . . . . . . . . . . . . . . . . . . . Counseling for cancer patients and survivors . . Cowden syndrome . . . . . . . . . . . . . . . . COX-2 inhibitors. See Cyclooxygenase 2 inhibitors
249 251 253 254 257
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288 289 289 290 292 292 293 294 296 297 299 300 304 306 308 309 309 312
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318 318 319 321 321 322 324 326
Salem Health: Cancer CPR. See Cardiopulmonary resuscitation Craniopharyngiomas . . . . . . . . . . . . Craniosynostosis . . . . . . . . . . . . . . Craniotomy. . . . . . . . . . . . . . . . . Crohn disease . . . . . . . . . . . . . . . Cruciferous vegetables . . . . . . . . . . . Cryoablation . . . . . . . . . . . . . . . . Cryptorchidism. . . . . . . . . . . . . . . CSFs. See Colony-stimulating factors CT scan. See Computed tomography scan CTCL. See Cutaneous T-cell lymphoma Culdoscopy. . . . . . . . . . . . . . . . . CUP. See Carcinoma of unknown primary origin Curcumin. . . . . . . . . . . . . . . . . . Cushing syndrome and cancer . . . . . . . Cutaneous breast cancer . . . . . . . . . . Cutaneous T-cell lymphoma (CTCL) . . .
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Cyclin-dependent kinase inhibitor-2A (CDKN2A). . . . . . . . . . . . . . . Cyclooxygenase 2 (COX-2) inhibitors . Cyclophosphamide. . . . . . . . . . . . Cyclosporin A . . . . . . . . . . . . . . Cystography . . . . . . . . . . . . . . . Cystoscopy . . . . . . . . . . . . . . . . Cytogenetics . . . . . . . . . . . . . . . Cytokines . . . . . . . . . . . . . . . . Cytology . . . . . . . . . . . . . . . . . Cytology, sputum. See Sputum cytology
327 329 331 332 335 336 338
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344 344 345 346 347 347 348 350 350
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D&C. See Dilation and curettage Dana-Farber Cancer Institute . . . . . . . . . . . . 354 DCIS. See Ductal carcinoma in situ DEA. See Diethanolamine DEHP. See Di(2-ethylhexyl) phthalate Delta-9-tetrahydrocannabinol . . . . . . . . . . . . 355
339 340 341 342
Volume 2 Down syndrome and leukemia. . . . . . . . DPC4 gene testing . . . . . . . . . . . . . . DRE. See Digital rectal exam Drug resistance and multidrug resistance (MDR) . . . . . . . . . . . . . . . . . . . Dry mouth . . . . . . . . . . . . . . . . . . DSRCT. See Desmoplastic small round cell tumor Duct ectasia . . . . . . . . . . . . . . . . . Ductal carcinoma in situ (DCIS). . . . . . . Ductal lavage. . . . . . . . . . . . . . . . . Ductogram . . . . . . . . . . . . . . . . . . Duke Comprehensive Cancer Center . . . . Dukes’ classification . . . . . . . . . . . . . Duodenal carcinomas . . . . . . . . . . . . Dye, hair. See Hair dye Dysplastic nevus syndrome . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . xxxiii Complete List of Contents . . . . . . . . . . . . xxxvii Denys-Drash syndrome and cancer . . . . . . Depression . . . . . . . . . . . . . . . . . . . Dermatofibrosarcoma protuberans (DFSP) . . Dermatology oncology. . . . . . . . . . . . . DES. See Diethylstilbestrol Desmoid tumors . . . . . . . . . . . . . . . . Desmoplastic small round cell tumor (DSRCT) . . . . . . . . . . . . . . . . . . Developing nations and cancer . . . . . . . . DFSP. See Dermatofibrosarcoma protuberans Di(2-ethylhexyl) phthalate (DEHP) . . . . . . Diarrhea . . . . . . . . . . . . . . . . . . . . DIC. See Disseminated intravascular coagulation Dietary supplements . . . . . . . . . . . . . . Diethanolamine (DEA) . . . . . . . . . . . . Diethylstilbestrol (DES) . . . . . . . . . . . . Digital rectal exam (DRE) . . . . . . . . . . . Dilation and curettage (D&C) . . . . . . . . . Dioxins . . . . . . . . . . . . . . . . . . . . . Disseminated intravascular coagulation (DIC) . . . . . . . . . . . . . . . . . . . . Diverticulosis and diverticulitis . . . . . . . . DNR. See Do-not-resuscitate order Do-not-resuscitate (DNR) order . . . . . . . .
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386 387 389 389 390 392 393
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Eaton-Lambert syndrome. See Lambert-Eaton myasthenic syndrome EBRT. See External beam radiation therapy Edema . . . . . . . . . . . . . . . . . . . . . Education, cancer. See Cancer education Elderly and cancer . . . . . . . . . . . . . . . Electrolarynx . . . . . . . . . . . . . . . . . . Electromagnetic radiation . . . . . . . . . . . Electroporation therapy . . . . . . . . . . . . Electrosurgery . . . . . . . . . . . . . . . . .
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396 399 399 400 401
Complete List of Contents Embolization . . . . . . . . . . . . . . . . . . . . Embryonal cell cancer . . . . . . . . . . . . . . . End-of-life care . . . . . . . . . . . . . . . . . . Endocrine cancers . . . . . . . . . . . . . . . . . Endocrinology oncology . . . . . . . . . . . . . . Endometrial cancer . . . . . . . . . . . . . . . . Endometrial hyperplasia . . . . . . . . . . . . . . Endorectal ultrasound . . . . . . . . . . . . . . . Endoscopic retrograde cholangiopancreatography (ERCP) . . . . . . . . . . . . . . . . . . . . . Endoscopy . . . . . . . . . . . . . . . . . . . . . Endoscopy, upper gastrointestinal. See Upper gastrointestinal endoscopy Endotheliomas . . . . . . . . . . . . . . . . . . . Enteritis . . . . . . . . . . . . . . . . . . . . . . Enterostomal therapy . . . . . . . . . . . . . . . Eosinophilic leukemia . . . . . . . . . . . . . . . Ependymomas . . . . . . . . . . . . . . . . . . . Epidemiology of cancer . . . . . . . . . . . . . . Epidermoid cancers of mucous membranes . . . . Epstein-Barr virus . . . . . . . . . . . . . . . . . ERCP. See Endoscopic retrograde cholangiopancreatography ERD. See Estrogen receptor downregulator Erionite. . . . . . . . . . . . . . . . . . . . . . . Erythroplakia. . . . . . . . . . . . . . . . . . . . Esophageal cancer . . . . . . . . . . . . . . . . . Esophageal speech . . . . . . . . . . . . . . . . . Esophagectomy . . . . . . . . . . . . . . . . . . Esophagitis . . . . . . . . . . . . . . . . . . . . . Essiac . . . . . . . . . . . . . . . . . . . . . . . Estrogen receptor downregulator (ERD) . . . . . Estrogen-receptor-sensitive breast cancer . . . . . Ethnicity and cancer . . . . . . . . . . . . . . . . Ethylene oxide . . . . . . . . . . . . . . . . . . . Ewing sarcoma . . . . . . . . . . . . . . . . . . . Exenteration . . . . . . . . . . . . . . . . . . . . Exercise and cancer . . . . . . . . . . . . . . . . External beam radiation therapy (EBRT) . . . . . Eye cancers . . . . . . . . . . . . . . . . . . . . Eyelid cancer. . . . . . . . . . . . . . . . . . . .
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Fallopian tube cancer . . . . . . . Family history and risk assessment Fanconi anemia . . . . . . . . . . Fatigue . . . . . . . . . . . . . . . Fecal occult blood test (FOBT) . . Fertility drugs and cancer . . . . . Fertility issues . . . . . . . . . . . Fever . . . . . . . . . . . . . . . . Fiber . . . . . . . . . . . . . . . .
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402 403 404 406 409 412 414 416
. 417 . 417
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420 421 422 424 425 426 429 431
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433 433 434 436 438 439 441 441 442 444 447 447 450 451 454 455 458
. . . . . . . . .
460 461 464 466 467 469 471 472 474
Fibroadenomas . . . . . . . . . . . . . . . . Fibrocystic breast changes . . . . . . . . . . Fibrosarcomas, soft-tissue . . . . . . . . . . Financial issues . . . . . . . . . . . . . . . 5HIAA test. See 5-Hydroxyindoleacetic acid test 5Q minus syndrome . . . . . . . . . . . . . Flow cytometry . . . . . . . . . . . . . . . FOBT. See Fecal occult blood test Folic acid. . . . . . . . . . . . . . . . . . . Formaldehyde . . . . . . . . . . . . . . . . Fox Chase Cancer Center . . . . . . . . . . Fred Hutchinson Cancer Research Center . . Free radicals . . . . . . . . . . . . . . . . . Fruits . . . . . . . . . . . . . . . . . . . . .
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486 486 487 488 490 491
Gallbladder cancer . . . . . . . . . . . . . . Gallium scan . . . . . . . . . . . . . . . . . Gamma Knife . . . . . . . . . . . . . . . . Gardner syndrome . . . . . . . . . . . . . . Garlic and allicin . . . . . . . . . . . . . . . Gastric polyps . . . . . . . . . . . . . . . . Gastrinomas . . . . . . . . . . . . . . . . . Gastrointestinal cancers . . . . . . . . . . . Gastrointestinal complications of cancer treatment. . . . . . . . . . . . . . . . . . Gastrointestinal oncology . . . . . . . . . . Gastrointestinal stromal tumors (GISTs) . . GCTs. See Giant cell tumors Gene therapy . . . . . . . . . . . . . . . . . Genetic counseling . . . . . . . . . . . . . . Genetic testing . . . . . . . . . . . . . . . . Genetics of cancer . . . . . . . . . . . . . . Geography and cancer . . . . . . . . . . . . Germ-cell tumors . . . . . . . . . . . . . . Gerson therapy . . . . . . . . . . . . . . . . Gestational trophoblastic tumors (GTTs) . . Giant cell tumors (GCTs) . . . . . . . . . . Ginseng, panax. . . . . . . . . . . . . . . . GISTs. See Gastrointestinal stromal tumors Gleason grading system . . . . . . . . . . . Gliomas . . . . . . . . . . . . . . . . . . . Glomus tumors . . . . . . . . . . . . . . . . Glossectomy . . . . . . . . . . . . . . . . . Glutamine . . . . . . . . . . . . . . . . . . Gonioscopy . . . . . . . . . . . . . . . . . Grading of tumors . . . . . . . . . . . . . . Graft-versus-host disease (GVHD) . . . . . Granulosa cell tumors . . . . . . . . . . . . Green tea . . . . . . . . . . . . . . . . . . . Grief and bereavement . . . . . . . . . . . .
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493 495 497 498 499 500 501 502
lxxxiii
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475 476 478 481
. . . . 484 . . . . 484
. . . . 506 . . . . 508 . . . . 511 . . . . . . . . . .
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512 515 517 519 522 525 527 527 530 531
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532 533 534 535 536 536 537 538 540 540 541
Salem Health: Cancer GTTs. See Gestational trophoblastic tumors GVHD. See Graft-versus-host disease Gynecologic cancers . . . . . . . . . . . . . . . . . 543 Gynecologic oncology . . . . . . . . . . . . . . . . 547 H. pylori. See Helicobacter pylori HAI. See Hepatic arterial infusion Hair dye . . . . . . . . . . . . . . . . . . . . . . Hairy cell leukemia . . . . . . . . . . . . . . . . Hand-foot syndrome (HFS) . . . . . . . . . . . . HBV. See Hepatitis B virus HCG. See Human chorionic gonadotropin HCV. See Hepatitis C virus Head and neck cancers . . . . . . . . . . . . . . . Health maintenance organizations (HMOs) . . . . Helicobacter pylori. . . . . . . . . . . . . . . . . Hemangioblastomas . . . . . . . . . . . . . . . . Hemangiopericytomas . . . . . . . . . . . . . . . Hemangiosarcomas . . . . . . . . . . . . . . . . Hematemesis . . . . . . . . . . . . . . . . . . . . Hematologic oncology . . . . . . . . . . . . . . . Hematuria . . . . . . . . . . . . . . . . . . . . . Hemochromatosis . . . . . . . . . . . . . . . . . Hemolytic anemia . . . . . . . . . . . . . . . . . Hemoptysis. . . . . . . . . . . . . . . . . . . . . Hemorrhoids . . . . . . . . . . . . . . . . . . . . Hepatic arterial infusion (HAI) . . . . . . . . . . Hepatitis B virus (HBV) . . . . . . . . . . . . . . Hepatitis C virus (HCV) . . . . . . . . . . . . . . Hepatomegaly . . . . . . . . . . . . . . . . . . . HER2/neu protein . . . . . . . . . . . . . . . . . Herbs as antioxidants . . . . . . . . . . . . . . . Hereditary cancer syndromes . . . . . . . . . . . Hereditary diffuse gastric cancer . . . . . . . . . Hereditary leiomyomatosis and renal cell cancer (HLRCC) . . . . . . . . . . . . . . . . Hereditary mixed polyposis syndrome . . . . . . Hereditary non-VHL clear cell renal cell carcinomas . . . . . . . . . . . . . . . . . . . Hereditary pancreatitis . . . . . . . . . . . . . . . Hereditary papillary renal cell carcinomas . . . . Hereditary polyposis syndromes . . . . . . . . . . Herpes simplex virus. . . . . . . . . . . . . . . . Herpes zoster virus. . . . . . . . . . . . . . . . . HFS. See Hand-foot syndrome Hispanics and cancer. See Latinos/Hispanics and cancer Histamine 2 antagonists . . . . . . . . . . . . . . Histiocytosis X . . . . . . . . . . . . . . . . . . . HIV/AIDS-related cancers . . . . . . . . . . . . .
. 550 . 550 . 552
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554 557 558 559 559 560 561 562 564 565 566 566 567 568 569 570 571 573 573 574 576
. 577 . 579 . . . . . .
580 580 581 582 584 586
. 587 . 588 . 590
HLRCC. See Hereditary leiomyomatosis and renal cell cancer HMOs. See Health maintenance organizations Hodgkin disease . . . . . . . . . . . . . . . . . Home health services . . . . . . . . . . . . . . Hormonal therapies . . . . . . . . . . . . . . . Hormone receptor tests . . . . . . . . . . . . . Hormone replacement therapy (HRT) . . . . . . Horner syndrome. . . . . . . . . . . . . . . . . Hospice care . . . . . . . . . . . . . . . . . . . Hot flashes . . . . . . . . . . . . . . . . . . . . HPV. See Human papillomavirus HRAS gene testing . . . . . . . . . . . . . . . . HRT. See Hormone replacement therapy HTLV. See Human T-cell leukemia virus Human chorionic gonadotropin (HCG) . . . . . Human growth factors and tumor growth . . . . Human immunodeficiency virus-related cancers. See HIV/AIDS-related cancers Human papillomavirus (HPV) . . . . . . . . . . Human T-cell leukemia virus (HTLV) . . . . . Hydatidiform mole . . . . . . . . . . . . . . . . 5-Hydroxyindoleacetic acid (5HIAA) test . . . . Hypercalcemia . . . . . . . . . . . . . . . . . . Hypercoagulation disorders . . . . . . . . . . . Hyperthermia therapy . . . . . . . . . . . . . . Hyperthermic perfusion . . . . . . . . . . . . . Hypopharyngeal cancer . . . . . . . . . . . . . Hysterectomy . . . . . . . . . . . . . . . . . . Hysterography . . . . . . . . . . . . . . . . . . Hystero-oophorectomy. . . . . . . . . . . . . . Hysteroscopy. . . . . . . . . . . . . . . . . . . IEP. See Immunoelectrophoresis iFOBT. See Immunochemical fecal occult blood test Ileostomy. . . . . . . . . . . . . . . . . . . . . Imaging tests . . . . . . . . . . . . . . . . . . . Immune response to cancer . . . . . . . . . . . Immunochemical fecal occult blood test (iFOBT) . . . . . . . . . . . . . . . . . . . . Immunocytochemistry and immunohistochemistry . . . . . . . . . . . . Immunoelectrophoresis (IEP) . . . . . . . . . . Immunotherapy . . . . . . . . . . . . . . . . . IMRT. See Intensity-modulated radiation therapy Indoles . . . . . . . . . . . . . . . . . . . . . . Infection and sepsis . . . . . . . . . . . . . . . Infectious cancers . . . . . . . . . . . . . . . . Infertility and cancer . . . . . . . . . . . . . . .
lxxxiv
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593 597 599 601 603 605 606 608
. . 609
. . 609 . . 610
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611 612 612 613 614 615 617 618 619 620 621 622 623
. . 625 . . 626 . . 629 . . 632 . . 633 . . 634 . . 635
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638 638 641 643
Complete List of Contents Inflammatory bowel disease . . . . . . . . . . Informed consent. . . . . . . . . . . . . . . . Infusion therapies . . . . . . . . . . . . . . . Insurance . . . . . . . . . . . . . . . . . . . . Integrative oncology . . . . . . . . . . . . . . Intensity-modulated radiation therapy (IMRT) Interferon. . . . . . . . . . . . . . . . . . . . Interleukins. . . . . . . . . . . . . . . . . . . Invasive cancer. . . . . . . . . . . . . . . . . Invasive ductal carcinomas . . . . . . . . . . Invasive lobular carcinomas . . . . . . . . . . Ionizing radiation . . . . . . . . . . . . . . . Iridium seeds . . . . . . . . . . . . . . . . . . Islet cell tumors . . . . . . . . . . . . . . . . Isoflavones . . . . . . . . . . . . . . . . . . . Itching . . . . . . . . . . . . . . . . . . . . .
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645 646 647 648 651 652 653 654 655 656 657 657 658 659 661 661
Lambert-Eaton myasthenic syndrome (LEMS) Laparoscopy and laparoscopic surgery . . . . Laryngeal cancer . . . . . . . . . . . . . . . . Laryngeal nerve palsy . . . . . . . . . . . . . Laryngectomy . . . . . . . . . . . . . . . . . Laryngoscopy . . . . . . . . . . . . . . . . . Laser therapies . . . . . . . . . . . . . . . . . Latinos/Hispanics and cancer . . . . . . . . . Laxatives . . . . . . . . . . . . . . . . . . . . LCIS. See Lobular carcinoma in situ LDH test. See Lactate dehydrogenase test Leiomyomas . . . . . . . . . . . . . . . . . . Leiomyosarcomas . . . . . . . . . . . . . . . LEMS. See Lambert-Eaton myasthenic syndrome Leptomeningeal carcinomas . . . . . . . . . . Leukapharesis . . . . . . . . . . . . . . . . . Leukemia, Down syndrome and. See Down syndrome and leukemia Leukemia, eosinophilic. See Eosinophilic leukemia Leukemia, hairy cell. See Hairy cell leukemia Leukemias . . . . . . . . . . . . . . . . . . . Leukoencephalopathy . . . . . . . . . . . . . Leukopenia. . . . . . . . . . . . . . . . . . . Leukoplakia . . . . . . . . . . . . . . . . . . Leydig cell tumors . . . . . . . . . . . . . . . Li-Fraumeni syndrome (LFS) . . . . . . . . . Limb salvage . . . . . . . . . . . . . . . . . . Linear accelerator . . . . . . . . . . . . . . . Lip cancers . . . . . . . . . . . . . . . . . . . Liposarcomas . . . . . . . . . . . . . . . . . Liver biopsy . . . . . . . . . . . . . . . . . . Liver cancers . . . . . . . . . . . . . . . . . .
Jonsson Comprehensive Cancer Center (JCCC) . . . . . . . . . . . . . . . . . . . . . . 664 Journaling . . . . . . . . . . . . . . . . . . . . . . 665 Juvenile polyposis syndrome . . . . . . . . . . . . 665 Kaposi sarcoma . . . . . . . . . . . . . Karnofsky performance status (KPS) . . Keratosis . . . . . . . . . . . . . . . . . Ki67 test . . . . . . . . . . . . . . . . . Kidney cancer . . . . . . . . . . . . . . Klinefelter syndrome and cancer . . . . KPS. See Karnofsky performance status Krukenberg tumors . . . . . . . . . . .
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667 669 670 670 671 674
. . . . . . 675
Lacrimal gland tumors . . . . . . . . . . . . . . . . 677 Lactate dehydrogenase (LDH) test . . . . . . . . . 678 Laetrile . . . . . . . . . . . . . . . . . . . . . . . . 679
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679 681 682 685 686 687 688 690 692
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. . . 696 . . . 698
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698 702 704 704 706 706 708 709 710 712 714 715
Volume 3 Lumps . . . . . . . . . . . . . . Lung cancer, brochoalveolar. See Bronchoalveolar lung cancer Lung cancers . . . . . . . . . . . Lutein . . . . . . . . . . . . . . Lycopene . . . . . . . . . . . . . Lymphadenectomy. . . . . . . . Lymphangiography . . . . . . . Lymphangiosarcomas . . . . . . Lymphedema. . . . . . . . . . . Lymphocytosis . . . . . . . . . . Lymphomas . . . . . . . . . . .
Contents . . . . . . . . . . . . . . . . . . . . . . . . lv Complete List of Contents . . . . . . . . . . . . . . lix Living will . . . . . . . . . . . . . . . . . Living with cancer . . . . . . . . . . . . . Lobectomy . . . . . . . . . . . . . . . . . Lobular carcinoma in situ (LCIS) . . . . . Long-distance caregiving . . . . . . . . . Loop electrosurgical excisional procedure (LEEP) . . . . . . . . . . . . . . . . . Lumbar puncture . . . . . . . . . . . . . . Lumpectomy . . . . . . . . . . . . . . . .
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719 720 723 725 726
. . . . . 727 . . . . . 728 . . . . . 730 lxxxv
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733 737 737 738 740 741 742 743 744
Salem Health: Cancer M. D. Anderson Cancer Center . . . . . . . . . Macrobiotic diet . . . . . . . . . . . . . . . . . Magnetic resonance imaging (MRI) . . . . . . . Malignant fibrous histiocytoma (MFH) . . . . . Malignant rhabdoid tumor of the kidney . . . . Malignant tumors . . . . . . . . . . . . . . . . MALT lymphomas. See Mucosa-associated lymphoid tissue lymphomas Mammography . . . . . . . . . . . . . . . . . . Managed care . . . . . . . . . . . . . . . . . . Mantle cell lymphoma (MCL) . . . . . . . . . . Mastectomy . . . . . . . . . . . . . . . . . . . Mastocytomas . . . . . . . . . . . . . . . . . . Matrix metalloproteinase inhibitors . . . . . . . Mayo Clinic Cancer Center . . . . . . . . . . . MCC. See Merkel cell carcinomas MCL. See Mantle cell lymphoma MDR. See Drug resistance and multidrug resistance Mediastinal tumors. . . . . . . . . . . . . . . . Mediastinoscopy . . . . . . . . . . . . . . . . . Medical marijuana . . . . . . . . . . . . . . . . Medical oncology . . . . . . . . . . . . . . . . Medicare and cancer . . . . . . . . . . . . . . . Medullary carcinoma of the breast. . . . . . . . Medulloblastomas . . . . . . . . . . . . . . . . Melanomas . . . . . . . . . . . . . . . . . . . . Melphalan . . . . . . . . . . . . . . . . . . . . Memorial Sloan-Kettering Cancer Center . . . . MEN 1. See Multiple endocrine neoplasia type 1 MEN 2. See Multiple endocrine neoplasia type 2 Meningeal carcinomatosis . . . . . . . . . . . . Meningiomas. . . . . . . . . . . . . . . . . . . Merkel cell carcinomas (MCC) . . . . . . . . . Mesenchymomas, malignant. . . . . . . . . . . Mesothelioma . . . . . . . . . . . . . . . . . . Metastasis . . . . . . . . . . . . . . . . . . . . Metastatic squamous neck cancer with occult primary . . . . . . . . . . . . . . . . . . . . MFH. See Malignant fibrous histiocytoma Microcalcifications. . . . . . . . . . . . . . . . Microwave hyperthermia therapy . . . . . . . . Mineral oils . . . . . . . . . . . . . . . . . . . Mistletoe . . . . . . . . . . . . . . . . . . . . . Mitochondrial DNA mutations. . . . . . . . . . MLH1 gene. . . . . . . . . . . . . . . . . . . . Mohs surgery. . . . . . . . . . . . . . . . . . . Molecular oncology . . . . . . . . . . . . . . . Moles. . . . . . . . . . . . . . . . . . . . . . . Monoclonal antibodies . . . . . . . . . . . . . . Motion sickness devices . . . . . . . . . . . . .
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748 750 750 752 753 754
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754 757 759 761 763 764 765
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766 768 768 770 772 774 775 776 779 780
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781 782 783 785 786 788
. . 790 . . . . . . . . . . .
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790 791 792 793 794 795 796 796 798 800 802
MRI. See Magnetic resonance imaging MSH genes . . . . . . . . . . . . . . . . . . . . Mucinous carcinomas . . . . . . . . . . . . . . Mucosa-associated lymphoid tissue (MALT) lymphomas . . . . . . . . . . . . . . . . . . Mucositis . . . . . . . . . . . . . . . . . . . . . Mucous membranes, epidermoid cancers of. See Epidermoid cancers of mucous membranes Multiple endocrine neoplasia type 1 (MEN 1). . Multiple endocrine neoplasia type 2 (MEN 2). . Multiple myeloma . . . . . . . . . . . . . . . . Mustard gas . . . . . . . . . . . . . . . . . . . Mutagenesis and cancer . . . . . . . . . . . . . Myasthenia gravis . . . . . . . . . . . . . . . . MYC oncogene . . . . . . . . . . . . . . . . . . Mycosis fungoides . . . . . . . . . . . . . . . . Myelodysplastic syndromes . . . . . . . . . . . Myelofibrosis . . . . . . . . . . . . . . . . . . Myeloma . . . . . . . . . . . . . . . . . . . . . Myeloproliferative disorders. . . . . . . . . . . Myelosuppression . . . . . . . . . . . . . . . . 2-Naphthylamine. . . . . . . . . . . . . . . . Nasal cavity and paranasal sinus cancers . . . National Cancer Institute (NCI) . . . . . . . . National Science Foundation (NSF) . . . . . . Native North Americans and cancer . . . . . . Nausea and vomiting. . . . . . . . . . . . . . NCI. See National Cancer Institute Needle biopsies . . . . . . . . . . . . . . . . Needle localization. . . . . . . . . . . . . . . Nephroblastomas. . . . . . . . . . . . . . . . Nephrostomy . . . . . . . . . . . . . . . . . . Neuroblastomas . . . . . . . . . . . . . . . . Neuroectodermal tumors. . . . . . . . . . . . Neuroendocrine tumors . . . . . . . . . . . . Neurofibromatosis type 1 (NF1) . . . . . . . . Neurologic oncology. . . . . . . . . . . . . . Neutropenia . . . . . . . . . . . . . . . . . . NF1. See Neurofibromatosis type 1 Nickel compounds and metallic nickel . . . . Night sweats . . . . . . . . . . . . . . . . . . Nijmegen breakage syndrome . . . . . . . . . Nipple discharge . . . . . . . . . . . . . . . . Non-Hodgkin lymphoma . . . . . . . . . . . Nonsteroidal anti-inflammatory drugs (NSAIDs) . . . . . . . . . . . . . . . . . . NSAIDs. See Nonsteroidal anti-inflammatory drugs NSF. See National Science Foundation Nuclear medicine scan . . . . . . . . . . . . .
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. . 803 . . 803 . . 804 . . 806
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807 808 809 812 813 815 817 817 819 820 822 823 825
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826 826 829 830 832 834
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836 838 839 839 841 842 844 845 847 849
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851 852 853 854 855
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Complete List of Contents Nutrition and cancer prevention . . . . . . . . . . . 861 Nutrition and cancer treatment. . . . . . . . . . . . 864 Obesity-associated cancers . . . . . Occupational exposures and cancer . Occupational therapy . . . . . . . . OCs. See Organochlorines Oligodendrogliomas . . . . . . . . . Omega-3 fatty acids . . . . . . . . . Ommaya reservoir . . . . . . . . . . Oncogenes . . . . . . . . . . . . . . Oncogenic viruses . . . . . . . . . . Oncology . . . . . . . . . . . . . . . Oncology clinical nurse specialist . . Oncology social worker . . . . . . . Oophorectomy . . . . . . . . . . . . Ophthalmic oncology . . . . . . . . Opioids . . . . . . . . . . . . . . . . Oral and maxillofacial surgery. . . . Oral and oropharyngeal cancers . . . Orbit tumors . . . . . . . . . . . . . Orchiectomy . . . . . . . . . . . . . Organ transplantation and cancer . . Organochlorines (OCs) . . . . . . . Oropharyngeal cancers. See Oral and oropharyngeal cancers Orthopedic surgery. . . . . . . . . . Otolaryngology . . . . . . . . . . . Ovarian cancers . . . . . . . . . . . Ovarian cysts. . . . . . . . . . . . . Ovarian epithelial cancer . . . . . . Overtreatment . . . . . . . . . . . .
. . . . . . . . 868 . . . . . . . . 871 . . . . . . . . 873 . . . . . . . . . . . . . . . . .
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875 877 878 878 881 882 885 887 888 889 892 893 894 897 898 899 901
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902 903 905 908 909 911
Paget disease of bone . . . . . . . . . . . . . Pain management medications. . . . . . . . . Palliative treatment . . . . . . . . . . . . . . PALP. See Placental alkaline phosphatase Palpation . . . . . . . . . . . . . . . . . . . . Pancolitis . . . . . . . . . . . . . . . . . . . . Pancreatectomy . . . . . . . . . . . . . . . . Pancreatic cancers . . . . . . . . . . . . . . . Pancreatitis . . . . . . . . . . . . . . . . . . . Pap test . . . . . . . . . . . . . . . . . . . . . Paracentesis . . . . . . . . . . . . . . . . . . Paranasal sinus cancers. See Nasal cavity and paranasal sinus cancers Paraneoplastic syndromes . . . . . . . . . . . Parathyroid cancer . . . . . . . . . . . . . . . Pathology . . . . . . . . . . . . . . . . . . . PC-SPES . . . . . . . . . . . . . . . . . . . . PDT. See Photodynamic therapy
. . . 912 . . . 914 . . . 917 . . . . . . .
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920 920 921 923 927 928 929
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931 932 934 937
Pediatric oncology and hematology . . . . . . . . . 938 Pelvic examination . . . . . . . . . . . . . . . . . . 940 Penile cancer . . . . . . . . . . . . . . . . . . . . . 941 Percutaneous transhepatic cholangiography (PTHC) . . . . . . . . . . . . . . . . . . . . . . 943 Pericardial effusion . . . . . . . . . . . . . . . . . 944 Pericardiocentesis . . . . . . . . . . . . . . . . . . 946 Peritoneovenous shunts . . . . . . . . . . . . . . . 946 Personality and cancer . . . . . . . . . . . . . . . . 947 Pesticides and the food chain . . . . . . . . . . . . 948 PET. See Positron emission tomography Peutz-Jeghers syndrome (PJS) . . . . . . . . . . . . 951 Pharmacy oncology . . . . . . . . . . . . . . . . . 952 Phenacetin . . . . . . . . . . . . . . . . . . . . . . 955 Phenolics . . . . . . . . . . . . . . . . . . . . . . . 955 Pheochromocytomas . . . . . . . . . . . . . . . . . 956 Pheresis . . . . . . . . . . . . . . . . . . . . . . . 958 Photodynamic therapy (PDT) . . . . . . . . . . . . 959 Phyllodes tumors. . . . . . . . . . . . . . . . . . . 960 Phytoestrogens . . . . . . . . . . . . . . . . . . . . 962 Pineoblastomas. . . . . . . . . . . . . . . . . . . . 963 Pituitary tumors . . . . . . . . . . . . . . . . . . . 965 PJS. See Peutz-Jeghers syndrome Placental alkaline phosphatase (PALP) . . . . . . . 968 Plant alkaloids and terpenoids in chemotherapy . . . . . . . . . . . . . . . . . . . 968 Plasticizers . . . . . . . . . . . . . . . . . . . . . . 971 Pleural biopsy . . . . . . . . . . . . . . . . . . . . 972 Pleural effusion . . . . . . . . . . . . . . . . . . . 973 Pleurodesis . . . . . . . . . . . . . . . . . . . . . . 975 Pleuropulmonary blastomas . . . . . . . . . . . . . 975 PMS genes . . . . . . . . . . . . . . . . . . . . . . 976 Pneumonectomy . . . . . . . . . . . . . . . . . . . 977 Pneumonia . . . . . . . . . . . . . . . . . . . . . . 979 Polycyclic aromatic hydrocarbons . . . . . . . . . . 981 Polycythemia vera . . . . . . . . . . . . . . . . . . 981 Polypectomy . . . . . . . . . . . . . . . . . . . . . 982 Polyps . . . . . . . . . . . . . . . . . . . . . . . . 983 Polyps, colon. See Colon polyps Polyps, gastric. See Gastric polyps Positron emission tomography (PET) . . . . . . . . 984 Poverty and cancer . . . . . . . . . . . . . . . . . . 987 PPOs. See Preferred provider organizations Prayer and cancer support . . . . . . . . . . . . . . 989 Preferred provider organizations (PPOs) . . . . . . 990 Pregnancy and cancer . . . . . . . . . . . . . . . . 992 Premalignancies . . . . . . . . . . . . . . . . . . . 994 Prevent Cancer Foundation . . . . . . . . . . . . . 997 Prevention . . . . . . . . . . . . . . . . . . . . . . 999 Primary care physician . . . . . . . . . . . . . . . 1001
lxxxvii
Salem Health: Cancer Primary central nervous system lymphomas . . . . . . . . . . . . . . . . Progesterone receptor assay . . . . . . . . Prostate cancer . . . . . . . . . . . . . . . Prostate-specific antigen (PSA) test . . . . Prostatectomy. . . . . . . . . . . . . . . . Prostatitis . . . . . . . . . . . . . . . . . . Proteasome inhibitors. . . . . . . . . . . . Protein electrophoresis . . . . . . . . . . . Proteomics and cancer research . . . . . . Proton beam therapy . . . . . . . . . . . . Proto-oncogenes and carcinogenesis . . . . PSA test. See Prostate-specific antigen test Psycho-oncology . . . . . . . . . . . . . . Psychosocial aspects of cancer . . . . . . . PTHC. See Percutaneous transhepatic cholangiography Radiation, ionizing. See Ionizing radiation Radiation oncology . . . . . . . . . . . . . Radiation therapies . . . . . . . . . . . . . Radiation therapy, afterloading. See Afterloading radiation therapy Radical neck dissection . . . . . . . . . . . Radiofrequency ablation . . . . . . . . . . Radionuclide scan . . . . . . . . . . . . . Radiopharmaceuticals . . . . . . . . . . . Radon . . . . . . . . . . . . . . . . . . . . RB1 gene . . . . . . . . . . . . . . . . . . Receptor analysis . . . . . . . . . . . . . .
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1003 1003 1004 1006 1008 1009 1010 1010 1012 1014 1015
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1027 1027 1030 1030 1032 1032 1033
Reconstructive surgery . . . . . . . . . . . . . . Rectal cancer . . . . . . . . . . . . . . . . . . . Recurrence . . . . . . . . . . . . . . . . . . . . Rehabilitation . . . . . . . . . . . . . . . . . . . Relationships . . . . . . . . . . . . . . . . . . . Renal pelvis tumors. . . . . . . . . . . . . . . . Report on Carcinogens (RoC) . . . . . . . . . . Resveratrol . . . . . . . . . . . . . . . . . . . . Retinoblastomas . . . . . . . . . . . . . . . . . Rhabdomyosarcomas . . . . . . . . . . . . . . . RhoGD12 gene . . . . . . . . . . . . . . . . . . Richter syndrome . . . . . . . . . . . . . . . . . Risk assessment, family history and. See Family history and risk assessment Risks for cancer. . . . . . . . . . . . . . . . . . Robert H. Lurie Cancer Center . . . . . . . . . . RoC. See Report on Carcinogens Rothmund-Thomson syndrome . . . . . . . . . .
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Salivary gland cancer . . . . . . . . . . . . . Salpingectomy and salpingo-oophorectomy . Sarcomas, soft-tissue . . . . . . . . . . . . . Saw palmetto . . . . . . . . . . . . . . . . . Schwannoma tumors . . . . . . . . . . . . . SCLC1 gene. . . . . . . . . . . . . . . . . . Screening, colorectal cancer. See Colorectal cancer screening Screening for cancer . . . . . . . . . . . . . Second opinions . . . . . . . . . . . . . . . Self-image and body image. . . . . . . . . .
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1034 1036 1038 1038 1041 1043 1044 1045 1046 1048 1050 1050
. 1052 . 1054 . 1056 1058 1060 1062 1065 1066 1067
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Volume 4 Contents . . . . . . . . . . . . . . . . . . . . . . lxxvii Complete List of Contents . . . . . . . . . . . . . lxxix Sentinel lymph node (SLN) biopsy and mapping . . . . . . . . . . . . . . . Sepsis. See Infection and sepsis Sertoli cell tumors . . . . . . . . . . . Sexuality and cancer . . . . . . . . . . Sézary syndrome . . . . . . . . . . . . SIADH. See Syndrome of inappropriate antidiuretic hormone production Side effects . . . . . . . . . . . . . . . Sigmoidoscopy . . . . . . . . . . . . . Silica, crystalline . . . . . . . . . . . . Simian virus 40 . . . . . . . . . . . . . Singlehood and cancer . . . . . . . . .
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1078 1082 1083 1084 1084
Sjögren syndrome. . . . . . . . . . . . . . . . Skin cancers . . . . . . . . . . . . . . . . . . SLN biopsy and mapping. See Sentinel lymph node biopsy and mapping Small intestine cancer . . . . . . . . . . . . . Smoking cessation . . . . . . . . . . . . . . . Social Security Disability Insurance (SSDI) . . Soft-tissue fibrosarcomas. See Fibrosarcomas, soft-tissue Soots . . . . . . . . . . . . . . . . . . . . . . Soy foods . . . . . . . . . . . . . . . . . . . . Spermatocytomas . . . . . . . . . . . . . . . . Spinal axis tumors . . . . . . . . . . . . . . . Spinal cord compression . . . . . . . . . . . . Splenectomy . . . . . . . . . . . . . . . . . . Sputum cytology . . . . . . . . . . . . . . . .
lxxxviii
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1097 1098 1099 1100 1102 1103 1105
Complete List of Contents Squamous cell carcinomas . . . . . . . . . . . SRS. See Stereotactic radiosurgery SSDI. See Social Security Disability Insurance Staging of cancer . . . . . . . . . . . . . . . . Statistics of cancer . . . . . . . . . . . . . . . Stem cell transplantation . . . . . . . . . . . . Stent therapy . . . . . . . . . . . . . . . . . . Stereotactic needle biopsy . . . . . . . . . . . Stereotactic radiosurgery (SRS) . . . . . . . . Sterility . . . . . . . . . . . . . . . . . . . . . Stomach cancers . . . . . . . . . . . . . . . . Stomatitis . . . . . . . . . . . . . . . . . . . . Stress management . . . . . . . . . . . . . . . Sunlamps . . . . . . . . . . . . . . . . . . . . Sun’s soup . . . . . . . . . . . . . . . . . . . Sunscreens . . . . . . . . . . . . . . . . . . . Superior vena cava syndrome . . . . . . . . . Support groups . . . . . . . . . . . . . . . . . Surgical biopsies . . . . . . . . . . . . . . . . Surgical oncology. . . . . . . . . . . . . . . . Survival rates . . . . . . . . . . . . . . . . . . Survivorship issues . . . . . . . . . . . . . . . Symptoms and cancer. . . . . . . . . . . . . . Syndrome of inappropriate antidiuretic hormone production (SIADH) . . . . . . . . Synovial sarcomas . . . . . . . . . . . . . . . Taste alteration . . . . . . . . . . . . . . Teratocarcinomas . . . . . . . . . . . . . Teratomas . . . . . . . . . . . . . . . . . Testicular cancer . . . . . . . . . . . . . Testicular self-examination (TSE) . . . . Thermal imaging . . . . . . . . . . . . . Thiotepa. . . . . . . . . . . . . . . . . . Thoracentesis . . . . . . . . . . . . . . . Thoracoscopy . . . . . . . . . . . . . . . Thoracotomy . . . . . . . . . . . . . . . Throat cancer . . . . . . . . . . . . . . . Thrombocytopenia . . . . . . . . . . . . Thymomas . . . . . . . . . . . . . . . . Thymus cancer . . . . . . . . . . . . . . Thyroid cancer . . . . . . . . . . . . . . Thyroid nuclear medicine scan . . . . . . TNF. See Tumor necrosis factor TNM staging . . . . . . . . . . . . . . . Tobacco, chewing. See Chewing tobacco Tobacco-related cancers . . . . . . . . . Topoisomerase inhibitors . . . . . . . . . TP53 protein . . . . . . . . . . . . . . . Tracheostomy . . . . . . . . . . . . . . . Transfusion therapy. . . . . . . . . . . .
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1108 1111 1114 1116 1118 1119 1120 1121 1124 1125 1127 1128 1129 1130 1132 1135 1138 1140 1143 1144
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1151 1152 1153 1154 1156 1157 1158 1158 1160 1161 1162 1164 1166 1167 1169 1172
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1174 1175 1177 1179 1180
Transitional care . . . . . . . . . . . Transitional cell carcinomas . . . . . Transrectal ultrasound . . . . . . . . Transvaginal ultrasound . . . . . . . Trichilemmal carcinomas. . . . . . . TSE. See Testicular self-examination Tuberous sclerosis . . . . . . . . . . Tubular carcinomas . . . . . . . . . . Tumor flare . . . . . . . . . . . . . . Tumor lysis syndrome . . . . . . . . Tumor markers . . . . . . . . . . . . Tumor necrosis factor (TNF) . . . . . Tumor-suppressor genes . . . . . . . Turcot syndrome . . . . . . . . . . . Tyrosine kinase inhibitors . . . . . .
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1182 1183 1185 1186 1187
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1187 1188 1189 1189 1191 1193 1194 1195 1196
Ultrasound, breast. See Breast ultrasound Ultrasound, endorectal. See Endorectal ultrasound Ultrasound, transrectal. See Transrectal ultrasound Ultrasound, transvaginal. See Transvaginal ultrasound Ultrasound tests . . . . . . . . . . . . . . . Ultraviolet radiation and related exposures Umbilical cord blood transplantation. . . . Upper gastrointestinal (GI) endoscopy . . . Upper gastrointestinal (GI) series . . . . . Urethral cancer . . . . . . . . . . . . . . . Urinalysis . . . . . . . . . . . . . . . . . . Urinary system cancers . . . . . . . . . . . Urography . . . . . . . . . . . . . . . . . Urologic oncology . . . . . . . . . . . . . Urostomy . . . . . . . . . . . . . . . . . . Uterine cancer . . . . . . . . . . . . . . .
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1199 1200 1201 1202 1203 1205 1207 1209 1213 1214 1216 1217
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1220 1221 1223 1225 1226
Vaccines, preventive . . . . . . . . . . . Vaccines, therapeutic . . . . . . . . . . . Vaginal cancer . . . . . . . . . . . . . . Vascular access tubes. . . . . . . . . . . Vasectomy and cancer . . . . . . . . . . Vegetables, cruciferous. See Cruciferous vegetables Veterinary oncology . . . . . . . . . . . VHL disease. See Von Hippel-Lindau disease Vinyl chloride . . . . . . . . . . . . . . Viral oncology . . . . . . . . . . . . . . Virus-related cancers . . . . . . . . . . . Von Hippel-Lindau (VHL) disease. . . . Vulvar cancer . . . . . . . . . . . . . . .
lxxxix
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1230 1230 1232 1235 1237
Salem Health: Cancer WAGR syndrome. See Wilms’ tumor aniridiagenitourinary anomalies-mental retardation syndrome and cancer Waldenström macroglobulinemia (WM) . . . . . . 1240 Watchful waiting . . . . . . . . . . . . . . . . . . 1242 Weight loss . . . . . . . . . . . . . . . . . . . . . 1243 Wilms’ tumor . . . . . . . . . . . . . . . . . . . . 1245 Wilms’ tumor aniridia-genitourinary anomaliesmental retardation (WAGR) syndrome and cancer . . . . . . . . . . . . . . . . . . . . . . 1248 Wine and cancer . . . . . . . . . . . . . . . . . . 1250 Wire localization . . . . . . . . . . . . . . . . . . 1250 WM. See Waldenström macroglobulinemia Wood dust . . . . . . . . . . . . . . . . . . . . . 1251
Yolk sac carcinomas . . . . . . . . . . . . . . . . 1256 Young adult cancers . . . . . . . . . . . . . . . . 1256 Zollinger-Ellison syndrome . . . . . . . . . . . . 1260 Drugs by Generic Name . . . Drugs by Trade Name . . . . Associations and Agencies . . Cancer Centers and Hospitals Cancer Support Groups . . . . Carcinogens. . . . . . . . . . Glossary . . . . . . . . . . . Bibliography . . . . . . . . .
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1265 1309 1348 1352 1357 1362 1383 1400
Category List . . . . . . . . . . . . . . . . . . . . 1409 Index . . . . . . . . . . . . . . . . . . . . . . . . 1419
X-ray tests . . . . . . . . . . . . . . . . . . . . . 1252 Xeroderma pigmentosa . . . . . . . . . . . . . . . 1254
xc
Salem Health: Cancer
u ABCD Category: Procedures Also known as: Jewett staging system or the WhitmoreJewett staging system (for prostate cancer) Definition: There are two distinct ABCD rating systems for cancer. The first uses the symbols A, B, C, and D to define the stages of prostate cancer. The second uses these designations to describe the early warning signs of melanoma, the most serious type of skin cancer.
Abdominoperineal resection (APR)
•
A (asymmetry): The two halves of the skin lesion are dissimilar. • B (border irregularity): The lesion has ragged or poorly defined edges. • C (color): The color of the lesion is uneven with different shades of brown or black. • D (diameter): The lesion is usually greater than 6 millimeters or 0.25 inch. Anna Binda, Ph.D. See also Melanomas; Moles; Premalignancies; Prostate cancer.
Cancers monitored: Prostate cancer and melanoma (each with its own distinct ABCD rating) Why performed: After detecting prostate cancer, the physician will evaluate the stage of the tumor according to its size, its location, and the extent to which it may have spread to other parts of the body. This information is important for choosing the best treatment plan. Staging of prostate cancer is based on the findings of clinical tests, mainly a digital rectal examination, a test to measure the level of prostate-specific antigen (PSA) in the blood, and transrectal ultrasonography. For melanoma prevention, the American Cancer Society recommends monthly skin self-examinations. The ABCD guideline serves as a reference when looking for any suspicious changes in the appearance of spots or sores that do not heal. Usually, this means monitoring any variation in the size, shape, or color of a mole. Any suspicious mole should be checked by a physician, who may decide to resect an abnormal-looking lesion and send the tissue for pathological review. Results: The ABCD rating for prostate cancer is used to classify the disease into four basic stages. • Stage A: Localized disease in which the cancer is very small, confined to the prostate gland, not palpable during a rectal examination, and identified by high PSA levels and biopsy. • Stage B: Localized disease in which the cancer is larger and confined to the prostate gland, but a lump is palpable during a rectal examination. • Stage C: Regional disease in which the cancer has grown through the prostate capsule and into surrounding tissues, perhaps into the seminal vesicles. • Stage D: Metastatic disease in which the cancer has grown into the pelvic area or has spread to the lymph nodes, bones, or other parts of the body. The ABCD rule for melanoma detection lists the four usual warning signs of the disease for most types of melanoma.
u Abdominoperineal resection
(APR) Category: Procedures Also known as: Abdominoperineal excision, anorectal excision, anoproctectomy Definition: Abdominoperineal resection (APR) is the surgical removal of the anus, rectum, and surrounding membrane called the mesentery, as well as the lower part of the colon supported by that mesentery. The upper part of the colon is rerouted through a new opening (ostomy) in the lower abdomen, forming an opening called a stoma. Cancers treated: Low rectal cancer, advanced anal cancer, metastatic pelvic disease Why performed: APR is performed to remove cancerous tissue, thereby curing or controlling the cancer or relieving symptoms of advanced disease. APR is the preferred procedure for large rectal tumors and tumors near the anal sphincter, but other tumor characteristics and patientspecific factors are also considered. Patient preparation: A series of medical tests are completed to plan effective treatment and to evaluate the patient’s fitness for major surgery. A specialist counsels the patient and helps choose the location for the stoma required by an APR. Radiation therapy, chemotherapy, or both may be recommended before the procedure. Certain patient medications may need to be stopped, the patient’s bowel must be cleaned, and the patient’s stomach must be empty. Steps of the procedure: APR is scheduled in a hospital. Sensors are placed to monitor the patient’s condition. An intravenous line is started, and an antibiotic is infused. General anesthetic is administered, and a breathing tube is 1
Abdominoperineal resection (APR) placed. The patient is positioned, a urinary catheter is inserted, and the incision sites are prepared. APR is a complex operation requiring incisions first on the abdomen (abdominal resection) and then on the perineum (perineal resection), which may be performed by one or two surgeons. Abdominal resection prepares the lower colon and rectum for removal during the perineal resection and forms the stoma. Perineal resection frees the anus and removes all the diseased tissue. In some instances, the abdominal resection may be performed laparoscopically; however, this approach will remain controversial until long-term studies prove its safety and efficacy for APR. To begin, the surgeon makes an midline incision in the abdomen large enough to see the tumor and to examine lymph nodes and other organs for metastases. If the tumor is removable, then the procedure continues. Within the abdomen, rectal blood vessels are tied, and the mesentery is clamped. The lower colon is freed from attachments. The peritoneum is divided, enabling the surgeon to free the rectum. The tied blood vessels and clamped mesentery are divided and sealed. Then, the ostomy opening is made in the abdomen. The colon is divided. The lower end of the colon is covered and tucked below the peritoneum for removal during the perineal resection, and the peritoneum is closed. The upper end of the colon is passed through the ostomy opening, the colon segment is sized to an appropriate length, and the edge of the cut end is folded back and stitched to the abdomen, forming a stoma. Next, other organs are examined for cancer; if other lesions or metastases are found, then they may also be removed. Finally, the abdominal cavity is inspected and cleaned, and the abdominal incision is closed. On the perineum, the surgeon makes an elliptical incision around the anus. Blood vessels are clamped, then tied as needed. The anus is freed from attachments, including as much surrounding tissue as possible without disturbing major blood vessels, nerves, and healthy organs; however, if the cancer has spread into these structures, then part or all of these structures may be included. The anus is pulled out, as well as the rectum and lower colon freed during the abdominal resection. All tissues are taken to the laboratory for histopathologic evaluation. Finally, the pelvic cavity is inspected and cleaned, and the perineal incision is closed, with a small tube inserted to drain excess fluid. After the procedure: Anesthetic is stopped, and the breathing tube is removed. The urinary catheter and the intravenous line are kept. A clear collection pouch (ostomy appliance) is fitted over the stoma. The patient is trans2
Salem Health: Cancer ferred to the recovery room, then to a hospital room. Medications are given to control pain and infection. The patient slowly progresses to a normal diet. The ostomy is monitored; once it starts functioning, the patient learns how to care for the stoma, empty and change pouches, and manage bowel function. At home, the patient follows the physician’s instructions about medications, activities, and diet. Further treatment with radiation therapy, chemotherapy, or both may be recommended. Risks: APR is moderately safe, with low mortality. Risks relate to anesthesia, infection, and inadvertent damage to other structures. Side effects are common because of the complex anatomy and the difficulty of operating within the bony pelvis. The most frequent side effects are urinary dysfunction and infection, perineal infections or bleeding, and ostomy-related problems. Less frequent side effects are male impotence and infertility, abdominal wound infection, and intestinal obstruction. Results: The long-term outcome varies considerably with patient-specific factors (such as disease stage, overall health, and body characteristics), among medical institutions (as a result of surgical protocol and specialized experience), and with therapeutic combinations. The five-year survival rate has increased as the recurrence rate has decreased because of more complete removal of diseased tissue and more effective therapeutic combinations. Survival is improved significantly by the removal of metastases. Patricia Boone, Ph.D. u
For Further Information American Cancer Society. Detailed Guide: Colon and Rectum Cancer Surgery. Available online at http:// www.cancer.org. American Cancer Society and National Comprehensive Cancer Network. Colon and Rectal Cancer: Treatment Guidelines for Patients. Version IV. Atlanta: American Cancer Society, 2005. Available online at http://www .nccn.org. Levin, Bernard, et al., eds. American Cancer Society’s Complete Guide to Colorectal Cancer. Atlanta: American Cancer Society, 2006. See also Anal cancer; Anoscopy; Appendix cancer; Colectomy; Coloanal anastomosis; Colorectal cancer; Colostomy; Crohn disease; Enterostomal therapy; Ileostomy; Laparoscopy and laparoscopic surgery; Rectal cancer; Sexuality and cancer.
Salem Health: Cancer
u Accelerated partial breast
irradiation (APBI) Category: Procedures Definition: Accelerated partial breast irradiation (APBI) is an alternative to traditional radiation therapy after lumpectomy that can reduce the time of treatment from weeks to days. It is considered an experimental procedure by many doctors. Cancers treated: Breast cancer Why performed: Radiation therapy is given after a lumpectomy to kill any cancer cells that remain in the breast. Accelerated partial breast irradiation is an alternative therapy that delivers radiation in a way that reduces the time and number of treatments required. Radiation therapy usually requires visits to the outpatient center or clinic five days a week for six or seven weeks. APBI reduces the amount of time required for treatment to about five days in total. Patient preparation: Patients who are undergoing accelerated partial breast irradiation treatment are generally enrolled in a clinical trial, because the procedure is still considered experimental. A clinical trial is a carefully controlled study, supervised by doctors who are also researchers, that is designed to investigate the risks or benefits of a new or experimental procedure. Different types of APBIs are being investigated in clinical trials, using different methods and techniques. As a result, the patient preparation for APBI will differ depending on the specifics of the therapy. In general, the preparation for APBI is the same as for any other radiation therapy treatment. Steps of the procedure: Just as with traditional radiation therapy, the actual time elapsed during a treatment of accelerated partial breast irradiation is usually very short. The time that it takes to get the equipment and patient set up, however, may be significant. First, the patient and the patient’s breast are positioned appropriately for the machine. During traditional radiation therapy, the entire breast receives radiation. During APBI, however, the only part of the breast that receives radiation is the area around the lumpectomy site. Therefore, the breast must be positioned very exactly so that the right area receives the radiation. To place the breast in the correct position, the cancer care team may label the breast with marker or tattooing. The patient should check with her cancer care team to see if these marks are temporary. Once the breast and equipment are correctly positioned, a dose of radiation is given to the breast. Radiation machines deliver beams of high-energy particles to the tis-
Accelerated partial breast irradiation (APBI) sue that destroy cancer cells. Accelerated partial breast irradiation uses amounts of radiation during treatment that are higher than those used by traditional radiation therapy. This is part of the reason that the treatment time of APBI is so short. After the procedure: After the procedure, the patient may experience fatigue, as well as pain or swelling in the breast. Aftercare depends on the procedure that is used. Patients should discuss aftercare with their cancer care team before the day of the first procedure so that anything needed, such as transportation home after the procedure, can be arranged in advance. Risks: Some risks are associated with any procedure involving radiation. With an experimental therapy such as APBI, ongoing clinical trials are trying to determine any long-term side effects that may result from the procedure. Most studies, however, have found the risks associated with APBI to be relatively mild, not greater than risks associated with traditional radiation therapy, and decreasing over time. The most common side effects of APBI are believed to be fatigue, skin changes similar to sunburn in the treated area, swelling in the breast, breast heaviness, and breast discoloration. The creation of small, hard nodes in the breast is also possible. These nodes are not dangerous, but they can occasionally be mistaken for a return of the breast cancer when felt or seen on a mammogram. A very rare but extremely serious possible complication of any radiation to the breast is the development of angiosarcoma, an aggressive form of cancer. Results: Studies done comparing women who received APBI and those who received traditional radiation therapy after lumpectomy have generally found comparable rates of recurrence, even after many years. Researchers, however, are still conducting more studies and clinical trials. Most studies have been conducted only on very specific groups of women, and more research is being done to study the larger population of women with breast cancer to help determine whether APBI is a technique that could be beneficial to all women, and should be integrated into standard breast cancer treatment practices. The results that any individual woman experiences after APBI will depend on many different factors, including genetics, the type of original cancer, and the size of the original cancer. Helen Davidson, B.A. u
For Further Information Pasqualini, Jorge R., ed. Breast Cancer: Prognosis, Treatment, and Prevention. 2d ed. New York: Informa Healthcare, 2008. 3
Achlorhydria Smith, Terry L. Breast Cancer: Current and Emerging Trends in Detection and Treatment. New York: Rosen, 2006. Torosian, Michael H., ed. Breast Cancer: A Guide to Detection and Multidisciplinary Therapy. Totowa, N.J.: Humana Press, 2002. Winchester, David J., et al. Breast Cancer. 2d ed. Hamilton, Ont.: BC Decker, 2006. See also Afterloading radiation therapy; Breast cancer in children and adolescents; Breast cancer in men; Breast cancer in pregnant women; Breast cancers; Cutaneous breast cancer; Ductal carcinoma in situ (DCIS); Invasive ductal carcinomas; Invasive lobular carcinomas; Lobular carcinoma in situ (LCIS); Lumpectomy; Lumps; Mastectomy; Medullary carcinoma of the breast; Radiation therapies; Radiofrequency ablation.
u Achlorhydria Category: Diseases, symptoms, and conditions Also known as: Profound hypochlorhydria Related conditions: Helicobacter pylori infection, chronic atrophic gastritis, gastric adenocarcinoma, gastric carcinoid Definition: Achlorhydria is the absence of acid secretion by the stomach caused by either atrophy of the acid-producing parietal cells or direct inactivation of the protonpumping enzyme in parietal cells responsible for acid secretion. Risk factors: The risk of achlorhydria increases with age and with long-term, untreated infection with the bacteria Helicobacter pylori. Patients with autoimmune conditions are also at increased risk. The condition has no predilection for sex or race. Etiology and the disease process: Chronic inflammation of the stomach in response to untreated H. pylori infection lasting many years leads to the atrophy of stomach cells and a corresponding loss of acid-secreting capacity. Some patients may be more predisposed to achlorhydria in the presence of H. pylori because they respond to the infection by producing a specific inflammatory agent that is also a potent proton pump inhibitor. Autoimmune disease can also produce achlorhydria if the body makes antibodies that inactivate parietal cell proteins. Achlorhydria is associated with the development of malignant cancer of the stomach. Over 60 percent of patients with gastric cancer have achlorhydria compared with 20 percent of healthy individuals. Acid normally acts 4
Salem Health: Cancer as a disinfectant to prevent overgrowth of harmful bacteria; achlorhydria contributes to cancer development because the bacteria synthesize carcinogenic chemicals from nitrates present in food. Achlorhydria is also associated with the formation of gastric carcinoid tumors. If acid output by the stomach is disrupted, the body overproduces the hormone gastrin, which stimulates overgrowth of enterochromaffinlike (ECL) cells in the stomach. This overgrowth may progress to carcinoid formation. Incidence: Gastric carcinoids constitute 0.5 percent of gastric cancers. They are typically associated with autoimmune conditions and have a low risk of malignancy. Symptoms: Achlorhydria itself causes no symptoms; rather, symptoms are secondary to the absence of acid. Lack of acid can cause vitamin B12 or calcium deficiency. Diarrhea may occur because of the overgrowth of bacteria. Screening and diagnosis: Diagnosis is made by measuring the acidity of a stomach fluid sample after an intravenous injection of pentagastrin, which stimulates acid secretion in normal patients. Acidity will not increase in the stomach fluid of achlorhydric patients. Treatment and therapy: Treatment focuses on addressing the underlying condition causing achlorhydria. Because vitamin B12 and calcium absorption are decreased, supplementation or injections of B12 may be necessary. Prognosis, prevention, and outcomes: Restoration of normal acid production depends on prognosis and treatment for the underlying condition responsible for achlorhydria. Pamela S. Cooper, Ph.D. See also Adenocarcinomas; Bacteria as causes of cancer; Gastric polyps; Gastrointestinal cancers; Helicobacter pylori; Hereditary diffuse gastric cancer; Premalignancies; Stomach cancers.
u Acoustic neuromas Category: Diseases, symptoms, and conditions Also known as: Vestibular schwannomas Related conditions: Neurofibromatosis type 2 Definition: Acoustic neuromas are benign (or nonmalignant) tumors that originate from Schwann cells surrounding the vestibular nerve (eighth cranial nerve) in the internal auditory canal. The term “neuroma” is somewhat misleading, as the tumors are not neuromas, nor do they
Salem Health: Cancer arise from the acoustic or cochlear nerve. Acoustic neuroma typically occurs as unilateral (one-sided) sporadic tumors in 95 percent of all cases, but in rare cases tumors can be bilateral (two-sided) and are associated with an inherited syndrome called neurofibromatosis type 2 (NF2). Approximately 2 to 4 percent of patients diagnosed with acoustic neuromas have NF2 type, a prevalence of 1 in 50,000 in the general population. Risk factors: Although high-dose ionizing radiation is a known risk factor of acoustic neuroma, environmental factors including noise exposure, radio frequency electromagnetic fields, and allergens have been reported as potential sources that may contribute to the formation of acoustic neuroma. One publication has reported the findings from an international multicenter case-control study that investigated the effects of these environmental factors in ninety-seven patients with acoustic neuroma and in agematched control subjects. The study reported that increased risks were found for exposure to persistent noise and hay fever, but not for ionizing radiation or for regular mobile phone use. Etiology and the disease process: Currently, the etiology of acoustic neuroma is not known. However, as an anomaly, it is rarely inherited. Nonetheless, neurofibromatosis type 2 should be suspected in young patients and those with family history. Neurofibromatosis is an autosomal dominant disease; thus patients who inherit a defective copy of the NF2 tumor-suppressor gene have a 95 percent chance of developing bilateral tumors; however, half of the cases have no family history of NF2, which could indicate mutations in the germline that were not inherited. Incidence: Sporadic acoustic tumors, the most common form of manifestation, occur in approximately 10 per 1 million persons per year—in other words the chance of an average person developing an acoustic neuroma in his or her lifetime is about 1 in 100,000. Neurofibromatosis is rarer, with only several thousand affected persons in the entire United States, corresponding to 1 in 40,000 individuals. However, a study has highlighted that the true incidence of acoustic neuroma may be higher than what has been envisaged, as 7 unsuspected schwannomas per 10,000 brain magnetic resonance imaging studies were identified, an equivalent of 0.07 percent. Acoustic neuromas, or schwannomas, occur largely in adults, typically in the fourth and fifth decades, with a mean presentation age of fifty years. They are uncommon in children; only thirty-nine cases had been reported as of 2007. Symptoms: Acoustic neuromas are histologically benign; however, if large, they can cause hydrocephalus, brain-
Acoustic neuromas stem compression, herniation, and eventually death. Hearing loss is the most prevalent symptom, occurring in more than 95 percent of patients, and the duration of hearing loss may extend to three or four years before clinical diagnosis is made—a majority of the patients experience one-sided, slowly progressing hearing impairment associated with high-frequency sounds. Alternative complaints or accompanying symptoms include tinnitus, dizziness, vertigo, and a sensation of fullness in the ear. With the progression of the tumor, patients may experience facial numbness, headaches, loss of coordination, and difficulty in swallowing. Vertigo is prevalent with smaller tumors, while unsteadiness, headache, and facial sensory disturbance are associated with large tumors. Screening and diagnosis: Acoustic neuroma can be diagnosed by a number of screening methods. These include conventional audiometry, auditory brainstem response (ABR), and gadolinium-enhanced magnetic resonance imaging (MRI). Among these, gadolinium-enhanced MRI is the optimal diagnostic test. Typically, on MRI scans acoustic neuromas appear as dense and uniformly enhanced. Acoustic neuromas are staged according to their location and size. Small tumors are less than 1.5 centimeters (cm), moderate tumors between 1.5 and 3 cm, and large tumors greater than 3 cm in size. Based on the location, they are staged as intracanalicular (located in the internal auditory canal), cisternal (extending outside the internal auditory canal), compressive (having progressed to touch the cerebellum or brainstem), and hydrocephalus (having progressed to obstruct the drainage of cerebrospinal fluid in the fourth ventricle). Treatment and therapy: The treatment options for acoustic neuroma include observation, microsurgery, stereotactic radiosurgery, and radiotherapy. Patients with advanced age or those deemed unfit for surgical intervention with small tumors at diagnosis are observed; treatment is withheld while tumor progression is monitored in serial imaging studies. However, treatment by observation has its own risks, as there is a greater risk of losing useful hearing. If microsurgery is the choice for treatment, many factors need to be assessed when evaluating its primary and secondary outcomes. First, there are three standard surgical approaches, each with its own advantages and disadvantages: suboccipital, middle fossa, and translabyrinthine. In the suboccipital approach, the tumor is reached through the skull behind the ear. As the procedure involves the retraction of the cerebellum, the approach is intrinsically dangerous and prone to complications. Although the middle fossa method can preserve hearing in theory, this 5
Acrylamides approach is also dangerous as it too requires the retraction of part of the brain. In the translabyrinthine approach, the tumor is accessed through the inner ear, and thus hearing loss is expected and inevitable. However, this method is unsuitable for large tumors. Second, microsurgery is technically challenging; therefore the rate of success is lower with a less experienced surgeon. Third, large tumors (greater than 3 cm) are difficult to resect without concomitant morbidity, such as facial palsy. Some of the complications that may arise from microsurgery are cerebrospinal fluid leak (12 percent of all cases), meningitis (5 percent), intracranial hemorrhage (2 percent), facial weakness with complete paralysis (31 percent), and delayed or partial paresis (50 percent). Radiosurgery refers to the administration of a single fraction of radiotherapy using stereotactic techniques to localize the tumor and align the fields. Radiosurgery may be performed either with a Gamma Knife or a linear accelerator (linac) based system. Gamma Knife is an emerging treatment option for those who are at high risk during microsurgery. High-dose Gamma Knife procedures are less favored due to the possibility of radiation complications; thus low-dose radiation (for example, 13 gray, or Gy) therapies are advised because of safety and lower risk of facial weakness. Radiotherapy refers to the administration of fractionated radiotherapy and includes stereotactic radiotherapy (radiation with other than gamma rays) and conventional radiotherapy techniques. Complications of Gamma Knife radiosurgery include injury to facial and trigeminal nerves. However, with the current dosing regimen of 12.5 Gy, the risk of trigeminal or facial nerve injury has decreased significantly. Although the potential for complications is higher with microsurgical procedures than with radiotherapy or radiosurgery, an important issue that should be considered with irradiation therapies is the low risk of inducing malignancies within the radiation area. Current recommendations are to offer microsurgery and radiosurgery options for patients with definite treatment indications. While microsurgery is the treatment of choice for large tumors because of the low risk of radiation-induced malignancies, microsurgery is also considered for younger patients. Prognosis, prevention, and outcomes: The microsurgical techniques for acoustic neuroma have improved the anatomical and functional preservation of the facial and cochlear nerves. These techniques, accompanied by continuous electrophysiological monitoring, have resulted in marked changes in the primary goals of management. In the past, the primary goal of acoustic neuroma manage6
Salem Health: Cancer ment was to preserve the patient’s life, whereas the objective today is to preserve the neurological function. Long-term follow-ups show negligible recurrence rates, suggesting that the preservation of neurological function does not restrict the tumor removal. Despite these advances, loss of nerve function and even deafness may occur postoperatively in some cases. Bagirathy Ravishankar, Ph.D. u
For Further Information Battaglia, A., et al. “Comparisons of Growth Patterns of Acoustic Neuromas with and Without Radiosurgery.” Otology and Neurotology 27 (2006): 705-712. Mendenhall, W., et al. “Management of Acoustic Schwannoma.” American Journal of Otolaryngology 25 (2004): 38-47. Neff, B., et al. “The Molecular Biology of Vestibular Schwannomas: Dissecting the Pathogenic Process at the Molecular Level.” Otology and Neurotology 27 (2006): 197-208. Schlehofer, B., et al. “Environmental Risk Factors for Sporadic Acoustic Neuroma.” European Journal of Cancer 43 (2007): 1741-1747. Yohay, K. “Neurofibromatosis Types 1 and 2.” The Neurologist 12 (2006): 86-93.
u
Other Resources
Acoustic Neuroma Association http://anausa.org American Cancer Society http://www.cancer.org See also Ependymomas; Neurofibromatosis type 1 (NF1); Schwannoma tumors; Stereotactic radiosurgery (SRS).
u Acrylamides Category: Carcinogens and suspected carcinogens RoC status: Reasonably anticipated human carcinogen since 1991 Also known as: 2-propenamide, propenamide, acrylic amide, vinyl amide, ethylene carboxamide Related cancers: Although an acrylamide-cancer connection in humans has not been established with certainty, the level of suspicion is high because under laboratory conditions in rats and mice, the following cancers have been associated with acrylamide: adrenal pheochromocytomas and mesotheliomas in the testes; adenomas in the
Salem Health: Cancer
Acrylamides
pituitary and mammary glands; adenocarcinomas of the clitoris, uterus, and thyroid gland; squamous cell carcinoma of the skin; and adenomas of the lung. Definition: Acrylamide is a compound of carbon, hydrogen, nitrogen, and oxygen resulting in the chemical formula, C3H5NO. This white, odorless, and crystalline compound is soluble in water, ethanol, ether, and chloroform, accounting for not only its many industrial uses but also its potential for uncomplicated entry into the human body. Many of its industrial and agricultural uses require the conversion of acrylamide to the polymer polyacrylamide. Exposure routes: Experimentally in rats and mice, cancer-inducing exposure routes include administration in the drinking water, intraFrench fries contain high levels of acrylamide. (©Birgit Reitz-hofmann/ Dreamstime.com) peritoneal injection, and topical application. In humans, during everyday activity and work, acrylamide gains entrance through unbroken At risk: Because of its almost ubiquitous presence at skin, mucous membranes, lungs, and the gastrointestinal the dinner table and its known neurotoxic and carcinotract. The primary occupational exposure routes are skin genic potential, acrylamide poses a health risk to humans. contact and through the inhalation of dust and vapor. Microwaving, baking, and frying will produce acrylamide, and as the food continues to cook, ever larger amounts Where found: Acrylamides are used in the treatment of of acrylamide are produced. As the risk potential for wastewater, drinking water, and sewage; in the production acrylamides in foods becomes more publicized, some of paper, plastics, and dyes; and in the manufacture of persteps are under way to modify food production methods, manent press fabrics, adhesives, and food packaging. It is such as using vacuum frying at lower temperatures. Raw also fundamental to ore processing. Acrylamide finds its or boiled foods pose little risk for acrylamides. way into a number of everyday products such as building Workers engaged in oil drilling, paper and pulp manumaterials, contact lenses, textiles, soap, food, and gelatin facture, general construction, plastics manufacture, mincapsules. Acrylamides have also established a place on ing, food processing, textile and cosmetics processing, and people’s dining tables: It is found in fried and baked agricultural industries are at increased risk of acrylamide goods, coffee, olives, and prune juice. Smoking is also a exposure. major acrylamide producer. Some acrylamide contaminates drinking water because Etiology and symptoms of associated cancers: Although of its use in water treatment facilities, but curiously, the research has not firmly established the acrylamide-cancer amount of acrylamide in a large order of fast-food french connection in humans, there is no question that acrylamide fries is more than three hundred times what the U.S. Enviis a serious neurotoxin. Depending on dosage levels, exporonmental Protection Agency allows in a single glass of sure can cause damage to the male reproductive glands, water. This pervasiveness of acrylamide prompted Dale skin, and eyes. Additionally, it may result in urinary inconHattis, a risk analysis expert at Clark University, to specutinence, numbness, weakening in the legs and hands, and late that “acrylamide causes several thousand cancers per irritation of the mucous membranes. year in Americans.” The National Institute for Occupational Health and Additionally, polyacrylamide, the polymer of acrylamSafety (NIOSH) lists the common acrylamide exposure ide, finds widespread global use in pesticides and in soil symptoms in an industrial setting: irritation of the eyes and treatment formulations. This has resulted in notable resiskin, ataxia, numbness of the limbs, paresthesia, muscle dues of polyacrylamide in the most widely consumed vegeweakness, absent deep tendon reflex, hand sweating, lassitables such as potatoes and grains. There is little governtude (weakness, exhaustion), drowsiness, and reproducment oversight or measurement of polyacrylamide in foods. 7
Acupuncture and acupressure for cancer patients tive effects. The institute further cautions that acrylamide is a potential occupational carcinogen. History: Production of acrylamide in the United States exceeds one million pounds per year. It was not until 2002 that Swedish scientists found high levels of acrylamide in certain fried and baked starchy foods. In the same year, the Center for Science in the Public Interest in the United States reported finding high levels of acrylamide in popular brands of snack chips, french fries, taco shells, and breakfast cereals. Government action concerning these findings has been very slow, but in 2005 the California attorney general filed a lawsuit requiring a warning label for french fries and potato chips. Although NIOSH considers the compound dangerous to life and health, the Food and Drug Administration allows acrylamide to be used for packaging, in plastics that are in contact with food, and in treating food to maximum levels ranging up to 0.20 percent. Although research has firmly established the canceracrylamide connection in rats and mice, the findings are still mixed in human studies. Some experts claim the very pervasiveness of acrylamide in the Western diet confuses the results. Richard S. Spira, D.V.M. u For Further Information Brown, L., M. M. Rhead, K. C. C. Bancroft, and N. Allen. “Model Studies of the Degradation of Acrylamide Monomer.” Water Research 14, no. 7 (1980): 775-778. Rice, Jerry M. “The Carcinogenicity of Acrylamide.” Mutation Research/Genetic Toxicology and Environmental Mutagenesis 580, nos. 1/2 (2005): 3-20. Smith, E., S. Prues, and F. Ochme. “Environmental Degradation of Polyacrylamides: Effect of Artificial Environmental Conditions.” Ecotoxicology and Environmental Safety 35 (1996): 121-135. Tareke, E., et al. “Analysis of Acrylamide, a Carcinogen Formed in Heated Foodstuffs.” Journal of Agriculture and Food Chemistry 50, no. 17 (2002): 4998-5006. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Eleventh Report on Carcinogens. Research Triangle Park, N.C.: Author, 2005. Weiss, G. “Acrylamide in Food: Uncharted Territory.” Science 27 (2002): 297. u
Other Resources
National Institute for Occupational Safety and Health http://www.cdc.gov/niosh 8
Salem Health: Cancer National Library of Medicine Toxicology Data Network http://toxnet.nlm.nih.gov U.S. Food and Drug Administration Draft Action Plan for Acrylamide in Food http://www.cfsan.fda.gov/~dms/acrypla3.html See also Adenocarcinomas; Endocrine cancers; Testicular cancer; Vulvar cancer.
u Acupuncture and acupressure
for cancer patients Category: Procedures Also known as: Traditional Chinese medicine (TCM), complementary and alternative medicine (CAM), Oriental medicine (OM) Definition: Acupuncture is a technique in which hair-thin, sterile, disposable needles of varying lengths are inserted into the skin and muscles at specific anatomical points (called acupoints) in order to treat ailments, including pain and certain diseases. It is one branch of traditional Chinese medicine (TCM) that originated in China around four thousand years ago to prevent, diagnose, and treat diseases in both humans and animals. Acupressure is a variation of acupuncture, in which therapists or patients press on acupoints with their fingers instead of inserting needles. Only specifically trained, licensed professionals can treat patients using acupuncture needles, but patients can be taught (preferably by a licensed professional) to perform acupressure on themselves. In 1996, the Food and Drug Administration (FDA) approved the acupuncture needle as a medical device. In 1997, the National Institutes of Health (NIH) began evaluating the safety and effectiveness of acupuncture as a complementary and alternative treatment. According to TCM principles, fourteen meridians are theorized to course invisibly along the body surface, including six paired and two unpaired channels. These meridians correspond to and connect with certain internal organs and physiological systems as understood in both traditional Chinese and Western medicine. Every acupoint is named and numbered according to its location on a specific meridian (for example, P6, or pericardium 6). Upon needling, the acupuncturist attempts to unblock, move, or alter what TCM refers to as the qi or chi (pronounced “chee”) of the body. This qi is a vital force that is thought to flow along the meridians and throughout the
Salem Health: Cancer body and organ systems. TCM posits that qi is formed from a merging of yin and yang, which are opposite energy states that permeate the universe. An imbalance of yin and yang in the body is thought to lead to a disruption of qi, leading to disharmony in physical and psychic well-being and thus to certain ailments or diseases. The acupuncturist (or acupressure practitioner) tries to restore a healthier balance of yin and yang in the patient. Many Western and Eastern acupuncturists currently blend TCM theory with modern understanding of neuroanatomy and the immune and other physiological systems. Cancers diagnosed or treated: In Western cancer management, acupuncture and acupressure are primarily used to mitigate the side effects related to conventional cancer treatments such as chemotherapy, radiation treatment, and surgery, or side effects of the disease itself. These side effects include chemotherapy-related nausea and vomiting, dyspnea (shortness of breath in advanced cancer cases), pain (either from a conventional treatment or the cancer itself), fatigue, depression, vasomotor symptoms (hot flashes), and treatment- or cancerrelated immunosuppression. In most instances, the acupuncture or acupressure interventions are used in addition to state-of-the-art pharmaceutical treatments, such as antiemetic therapy (such as Odansetron) for nausea and vomiting. Why performed: Cancer patients and their clinicians often resort to acupuncture and acupressure (and other alternative medical treatment modalities) for symptoms that are not amenable or are unresponsive to traditional therapies. Sometimes they are used to augment the effectiveness of conventional medicines, as in the case of antiemetic therapies for nausea and vomiting, which can lead to weight loss and depression. Some patients (and their clinicians) are seeking a more holistic approach to healing, viewing acupuncture and acupressure as methods that restore harmony to the body, treating the whole person instead of just the disease. Often patients take solace in the “mysterious” mechanisms underlying alternative treatments. Many acupuncturists are intrigued by the TCM philosophies and theories, at the same time applying current Western knowledge of anatomy and neurophysiology to their techniques. Most acupoints correspond to specific nerve pathways or receptors and/or highly vascular areas. There is strong evidence that acupuncture modulates neurotransmitters, leading to the release of endogenous opioids (endorphins and
Acupuncture and acupressure for cancer patients enkephalins) for analgesia (pain relief). Manipulation of certain acupoints stimulates the autonomic nervous system, leading to changes in blood circulation and engaging components of the immune and endocrine systems (proteins called cytokines or the release of endogenous corticosteroids and other hormones). These procedures can also alter blood pressure, heart rhythms, and body temperature. Not all the mechanisms involved in successful acupuncture and acupressure treatment are understood, and they remain a subject of scientific investigation. Some skeptics still believe that they work primarily via the placebo effect. Patient preparation: Very little patient preparation is required for these procedures. The patient disrobes to the extent required for examination and the placement of acupuncture needles or accessibility to acupressure points. Some acupuncturists will take a patient’s medical history
A patient receives an acupuncture treatment. (PhotoDisc)
9
Acupuncture and acupressure for cancer patients and ask questions about diet and exercise. Some will also look at the patient’s tongue and feel his or her pulse in order to make a TCM diagnosis and appropriate acupoint prescription tailored to the patient’s needs. A more Westernized approach would be to apply a standard point prescription for a particular malady, omitting such TCM elements as tongue and pulse exams. Steps of the procedure: The acupuncturist will feel for the appropriate acupoints, often massaging the area prior to needle insertion. The skin is then cleaned with an alcohol wipe and the needle is inserted until the practitioner feels some resistance and/or the patient feels a tingling or cramping sensation. This is referred to as “obtaining the qi,” or De Qi. Many practitioners then manipulate the needle, using hand technique (shou fa) to move, supplement or drain the qi and/or yin and yang. The needles are then usually left in place for ten to twenty minutes. In acupressure, the patient or practitioner applies pressure to the acupoints for a few minutes, repeating this action at intermittent intervals over a specified period of time. Sometimes a band with an attached stud is applied over an acupoint and the patient is instructed to press the stud into the point at prescribed intervals in an effort to obtain a De Qi response during point stimulation. Sometimes an acupuncturist will apply a small electric current to the needles in a technique called electroacupuncture. This is another method of stimulating the acupoints. Various other methods of stimulation are employed as well. Moxibustion applies heat to the acupoints using burning mugwort herb (Artemisia vulgaris). Aquapuncture is a technique in which acupoints are injected with drugs, vitamins, flower essences, herbal extracts, or other fluids for longer-term stimulation of acupoints. After the procedure: A properly treated patient should experience relaxation, deeper respiration, and increased vitality following acupuncture, since energetic balance has supposedly been restored. For treatment of specific cancer-related symptoms, some immediate relief is expected, followed by delayed improvement, especially after multiple acupuncture or acupressure sessions. Risks: Acupuncture should be avoided in patients with thromobocytopenia or aplasia or in those treated with anticoagulants. Some common side effects are bruising, local bleeding, and mild pain in the treated areas. The risk of infection is small if sterile, disposable needles are used. There is a very small risk that the lungs or other internal organs can be punctured if a needle is placed too deep. 10
Salem Health: Cancer Results: The results of many random, controlled clinical trials have demonstrated that acupuncture is effective for reducing episodes of acute vomiting following chemotherapy for breast and other cancers. The same and other studies have shown that acupressure at certain acupoints is effective for reducing episodes of acute nausea following chemotherapy. Both acupuncture and acupressure have been more effective for prophylactic treatment of vomiting and nausea following conventional cancer treatment rather than stopping these symptoms once they have started. One study indicated that the effectiveness of acupuncture for reducing vomiting episodes following chemotherapy was increased for up to twenty-four hours when acupressure followed needling therapy. One review of acupuncture for the relief of cancerrelated pain found that ear acupuncture (stimulation of acupoints corresponding to different body areas on the ear) was effective for reducing cancer-related pain. Other clinical trials have shown that acupuncture helps reduce the number of hot flashes in men being treated with hormones or surgery for prostate cancer and women being treated with tamoxifen or related hormone therapies for breast cancer. Investigators, however, have noted a dearth of random, double-blind, controlled clinical trials for proving the effectiveness of these alternative therapies. The development of a sham acupuncture needle (the needle withdraws into the shaft upon “insertion” at true acupoints) is expected to improve the rigorousness of these trials and to provide substantive evidence for or against acupuncturerelated therapies. Lisa J. Shientag, V.M.D. u
For Further Information Ezzo, J. M., M. A. Richardson, and A. Vickers. “Acupuncture Point Stimulation for Chemotherapy-Induced Nausea or Vomiting.” The Cochrane Database of Systematic Reviews 2 (2007). Hyangsook, L., K. Schmidt, and E. Ernst. “Acupuncture for the Relief of Cancer-Related Pain: A Systematic Review.” European Journal of Pain 9, no. 4 (August, 2005): 437-444. Sagar, Stephen M. Restored Harmony: An Evidence Based Approach for Integrating Traditional Chinese Medicine into Complementary Cancer Care. Hamilton, Ont.: Dreaming DragonFly Communications, 2001. See also Bone cancers; Bone pain; Complementary and alternative therapies; Home health services; Integrative oncology; Living with cancer; Pneumonia; Side effects; Smoking cessation.
Salem Health: Cancer
Acute lymphocytic leukemia (ALL)
u Acute lymphocytic leukemia
(ALL) Category: Diseases, symptoms, and conditions Also known as: Acute childhood leukemia, acute lymphoblastic leukemia, acute lymphoid leukemia Related conditions: Acute myeloid leukemia, chronic lymphocytic leukemia, chronic myeloid leukemia Definition: Acute lymphocytic leukemia (ALL) is a cancer of the white blood cells. A lymphocyte is a type of white blood cell made in the bone marrow that helps fight infection. In this fast-growing type of cancer, for unknown reasons, the bone marrow begins to make lymphocytes that develop abnormally. “Acute” means that the disease affects lymphocytes before they are fully formed and that it progresses rapidly if not treated. Risk factors: Few risk factors exist for ALL. Receiving high doses of radiation, usually as treatment for another type of cancer, is one risk factor. Exposure to benzene may also be a factor. Risk increases in people with certain other diseases, such as Down syndrome, Fanconi anemia, Bloom syndrome, and some other genetic diseases. In about 25 percent of ALL cases, the patient has a chromosome mutation in which parts of chromosome 9 and chromosome 22 have changed places. Having a sibling, especially a twin, with ALL also increases the risk for this disease. Researchers are exploring lifestyle or environmental relationships, but it appears that many factors, including a combination of genetic and environmental factors, may be involved in developing ALL.
and slightly more common in white children than in children of other races. ALL occurs in people of all ages but has a peak incidence in children between the ages of two and five. After age five, risk decreases, then increases again in people over age fifty. It is the most common type of leukemia in children under the age of fifteen, accounting for about 80 percent of childhood leukemias. It occurs more often in developed countries and in people with higher socioeconomic status. Symptoms: Symptoms of ALL include anemia, body aches, bone pain, bruises without any injury, enlarged lymph nodes, an enlarged spleen, excessive bleeding from minor injuries, fever with no illness or lasting low-grade fever, frequent infections, headaches, joint pain, nosebleeds, paleness, shortness of breath during activity, tiredness, vomiting, and unexplained weight loss. Screening and diagnosis: There is no screening test for ALL. Blood and bone marrow tests are necessary to diagnose ALL. These tests look for abnormal lymphocyte cells. A bone marrow aspirate test (using a long needle to take marrow out of the bone) and a bone marrow biopsy (surgical removal of some bone marrow) are two possible tests. The bone marrow aspirate test looks for abnormal
Etiology and the disease process: Through a genetic process that is not completely understood, cells in bone marrow begin to form abnormally. ALL can begin in two different types of lymphocytes, either B cells or T cells. As the abnormal lymphocytes quickly grow, they crowd out the red and white blood cells and platelets that the body needs and that are also created in the bone marrow. The symptoms of ALL come from the crowding out of these normal, healthy cells. These cells may then spread into the lining of the spine and brain. Incidence: About 5,200 people in the United States were diagnosed with ALL in 2007. It is slightly more common in men than in women
A nine-year-old girl with acute lymphocytic leukemia describes her condition to a health care worker. (Simon Fraser/Photo Researchers, Inc.)
11
Acute lymphocytic leukemia (ALL)
Age at Death for Acute Lymphocytic Leukemia, 2001-2005 Age Group
Deaths (%)
Under 20 20-34 35-44 45-54 55-64 65-74 75-84 85 and older
21.4 15.9 9.7 11.2 11.7 12.7 11.5 5.8
Source: Data from National Cancer Institute, Surveillance Epidemiology and End Results, Cancer Stat Fact Sheets, 2008 Note: The median age of death from 2001 to 2005 was fortyseven, with an age-adjusted death rate of 0.5 per 100,000 men and women.
cells in the bone marrow and can also be used for other types of analysis. A bone marrow biopsy can show how much disease is already in the bone marrow. The results of these tests help determine which type of drug therapy to use and how long treatment should last. If a patient has been diagnosed with ALL, a lumbar puncture may be performed to see if the abnormal cells have moved into the fluid surrounding the spine and brain. Chest X rays, ultrasounds, or additional blood tests may also be used to determine the spread of the disease. Depending on where the cancer started and the results of testing, ALL may be categorized into early pre-B-cell ALL, common ALL, pre-B-cell ALL, mature B-cell ALL, pre-T-cell ALL, or mature T-cell ALL. The type of ALL helps determine which therapy to use and how long treatment should last. About 85 percent of ALL cases begin in B cells, and these cases are generally classified as lower risk. ALL may also be classified or staged using the FrenchAmerican-British (FAB) classification system. In this older system, ALL is classified according to the type of abnormal cells as follows: • ALL-11: small, uniform abnormal cells • ALL-12: large, varied abnormal cells • ALL-13: large, varied, bubble-like cells Treatment and therapy: Patients diagnosed with ALL should start treatment immediately. The course and length of treatment chosen depend on the results of the patient’s bone marrow tests, the patient’s age, the number of ALL cells in the blood, whether certain chromosomal changes 12
Salem Health: Cancer have already happened, whether ALL cells began in the B cells or the T cells, and whether ALL has spread to the brain covering or spinal cord. During therapy, bone marrow tests may be done again to make sure the treatment is destroying the cancer cells. The first part of treatment for ALL is called induction therapy. This therapy helps kill ALL cells and get a patient’s blood counts back to normal (remission). Some of the drugs used in induction therapy are given by mouth. Others are given in a vein, usually through the patient’s chest. Most often, this chemotherapy for ALL involves combining drugs to improve the effects of the drugs. Often, ALL spreads into the lining of the spinal cord and the brain. To kill these ALL cells, drugs are injected directly into the spinal fluid. Radiation therapy may be used on the spine and brain either with or without the injected drugs. Post-induction therapy, the second part of treatment for ALL, begins when a patient has reached remission. This type of therapy is needed because usually some ALL cells that cannot be detected by tests remain in the body. Postinduction therapy usually happens in two- or three-year cycles. The drugs used in post-induction therapy are usually different from those used in induction therapy, and the type of drugs used depends on how the patient responded to induction therapy and whether the patient has certain chromosome abnormalities. A patient may also need maintenance therapy after post-induction therapy to prevent the cells from regrowing. T-cell ALL, infant ALL, and adult ALL are all forms of high-risk ALL. These types of ALL are usually treated with higher doses of drugs during both induction and postinduction therapy. Some patients with high-risk types of ALL may respond well to bone marrow or cord blood transplant therapy. A bone marrow or cord blood transplant may be used when high doses of drugs are given to kill the ALL cells. These high doses of drugs may also kill healthy cells in the bone marrow. This transplant gives a patient healthy cells to replace the killed bone marrow cells. A transplant is a high-risk procedure and will probably not be used unless a patient does not have a good possibility of long-term remission with chemotherapy. High-risk ALL patients are more likely to have a transplant. The timing of a transplant is important; a patient has a better chance of a successful transplant when he or she is in remission at the time of transplant. Prognosis, prevention, and outcomes: There is no known way to prevent ALL. Most children with ALL can be cured of this disease with proper treatment. The overall survival rate for children after chemotherapy is nearly 80 percent.
Salem Health: Cancer Children with low-risk ALL have even higher survival rates. Most adults also improve with treatment; the number of adults who have remissions has increased, and the length of adult remissions has improved. The overall survival rate for adults after chemotherapy is about 40 percent, and adults with low-risk ALL have even higher survival rates. Marianne M. Madsen, M.S. u For Further Information Abeloff, M. D., et al. Clinical Oncology. 3d ed. Orlando, Fla.: Churchill Livingstone, 2004. Hoffman, R., et al. Hematology: Basic Principles and Practice. 4th ed. Orlando, Fla.: Churchill Livingstone, 2005. Lichtman, M. A., et al., eds. William’s Hematology. 7th ed. New York: McGraw-Hill, 2006. Pui, C-H, ed. Childhood Leukemias. 2d ed. New York: Cambridge University Press, 2006. u
Other Resources
Association of Cancer Online Resources http://www.acor.org CureSearch: National Childhood Cancer Foundation, Children’s Oncology Group http://www.curesearch.org Leukemia and Lymphoma Society http://www.leukemia-lymphoma.org National Cancer Institute http://www.cancer.gov/cancertopics/treatment/ See also Acute myelocytic leukemia (AML); Aleukemia; Blood cancers; Childhood cancers; Chronic lymphocytic leukemia (CLL); Chronic myeloid leukemia (CML); Hemolytic anemia; Leukemias; Myelodysplastic syndromes; Myelofibrosis; Myeloproliferative disorders; Topoisomerase inhibitors.
u Acute myelocytic leukemia
(AML) Category: Diseases, symptoms, and conditions Also known as: Acute myeloid leukemia, acute myelogenous leukemia, acute myeloblastic leukemia, acute myelomonocytic leukemia, granulocytic leukemia, acute nonlymphocytic leukemia, acute promyelocytic leukemia
Acute myelocytic leukemia (AML) Related conditions: Acute lymphoblastic leukemia, myelodysplastic syndrome Definition: Acute myelocytic leukemia (AML) describes a malignant proliferation in the bone marrow of an undifferentiated blood-forming cell of the myeloid line. AML begins with the genetic alteration of a single cell. That cell, called a blast cell, is the foundation from which the leukemia follows. The process of normal blood cell formation, or hematopoiesis, begins with undifferentiated cells, known as stem cells, inside the bone marrow. Stem cells differentiate into blasts, and these primitive blast cells give rise to red blood cells, platelets, and white blood cells. It is the accumulation of blast cells in the bone marrow and their failure to differentiate that has lethal consequences within just a few weeks or months if unchecked. Although the rate of cure has improved, treatment is still associated with high morbidity and mortality. Risk factors: Certain genetic disorders have an associated AML risk, including Down syndrome, Fanconi anemia, and Shwachman-Diamond syndrome. Other risk factors include some forms of chemotherapy, radiation therapy, and exposure to tobacco smoke and benzene. Etiology and the disease process: The process leading to acute myelocytic leukemia involves the interruption in the progression of an undifferentiated progenitor cell in the bone marrow that normally matures into red blood cells, white blood cells (neutrophils, eosinophils, basophils, and monocytes), and megakaryocytes. Megakaryocytes are bone marrow cells responsible for the production of the blood platelets necessary for blood clotting. Bone marrow is the soft interior of some bones, such as the skull, shoulder blades, ribs, pelvis, and backbones. It comes in two varieties: red marrow and yellow marrow. The red marrow, also called myeloid tissue, is the source of AML activity. Red blood cells, platelets, and most white blood cells arise from a parent cell in the red marrow. Many references limit discussion of AML to only the direct descendants of the myeloid line; these are the neutrophils, eosinophils, and basophils. When blast cells do not mature properly, they accumulate in the bone marrow. It is the proliferation and the accumulation of this hemopoietic cell in the bone marrow that defines AML. Although research has not completely unraveled the process of this leukemic transformation, there is strong evidence of underlying chromosomal damage. For example, a variety of mutations are associated with AML, with damage to the gene for FMS-related tyrosine kinase (FLT3) being the most prominent. Normally, the receptor encoded by FLT3 signals undifferentiated blast 13
Acute myelocytic leukemia (AML) cells in the bone marrow to proliferate when there is a need for additional circulating blood cells. The signal stops when the supply is sufficient, but in AML, the switch stays on, and unconstrained blast cell proliferation follows. Although AML begins with defective bone marrow cells, it generally moves quickly into the peripheral blood and may spread to other parts of the body, such as the liver, spleen, testes, brain, spinal cord, and lymph nodes. Incidence: Because AML is associated with accumulating genetic defects, the incidence increases with age. AML ranges from 0.7 to 3.9 cases per 100,000 in people up through the age of sixty and increases to 6.7 to 19.2 cases per 100,000 in people who are over sixty. The median age of onset is more than sixty-seven years. Each year AML will strike about 13,400 adults and 650 children in the United States. Symptoms: Clinical findings reflect the replacement of normal bone marrow elements with malignant blast cells. Probably the most consistent early complaints in AML are a history of increasing lethargy later followed by skin, soft-tissue, or respiratory infection. Some patients will have small red or purple spots on the body, called petichia, resulting from broken blood vessels. Liver, spleen, and lymph node enlargement is common, as is weight loss. Some symptoms are nonspecific but quite common in AML patients. These include swollen gums; pale skin; black-and-blue marks; achiness in the knees, hips, or shoulder; mild fever; shortness of breath during even light exertion; and the slow healing of cuts. Screening and diagnosis: The diagnostician must distinguish AML from other myeloproliferative disorders,
Age at Diagnosis for Acute Myelocytic Leukemia, 2001-2005 Age Group
Diagnosed (%)
Under 20 20-34 35-44 45-54 55-64 65-74 75-84 85 and older
6.3 6.3 6.8 10.9 14.8 21.1 24.6 9.2
Source: Data from National Cancer Institute, Surveillance Epidemiology and End Results, Cancer Stat Fact Sheets, 2008
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Salem Health: Cancer chronic myelogenous leukemia, and myelodysplastic syndrome. Although many supporting tests and symptoms point toward a diagnosis, the definitive finding of AML will require bone marrow aspirate and biopsy. Short of biopsy examination, other indicators will raise suspicion. About one-third of AML patients will have an enlarged spleen and high levels of uric acid in the blood. The peripheral white blood cell count is not a good indicator, as it may be increased, decreased, or normal. However, there usually will be reduced numbers of granulocytes (neutrophils, basophils, and eosinophils) and platelets in the blood. Blast cells in the peripheral blood appear in only 15 percent of AML patients initially, but this number rises to half of those patients with decreased number of circulating white blood cells (leukopenia). There is no standard staging system for AML. Generally, doctors describe the status of the condition as untreated, in remission, or recurrent. However, bone marrow examination more closely defines AML as belonging to one of eight cell subtypes. Doctors tailor the treatment to the subtype. The subtypes are as follows:
• • • • • • • •
M0: Myeloblastic, on special analysis M1: Myeloblastic, without maturation M2: Myeloblastic, with maturation M3: Promyeloctic M4: Myelomonocytic M5: Monocytic M6: Erythroleukemic M7: Megakaryocytic
Treatment and therapy: The goal of AML treatment is the destruction of the leukemic cells. However, this requires the suppression of bone marrow activity, which brings unfortunate side effects. With the bone marrow suppressed, fewer white cell are available to fight infection and fewer red cells and platelets are present to maintain a healthy oxygen exchange and clot formation. This almost always requires treatment with antibiotics and blood transfusions. Initial treatment or induction therapy begins with a hospital stay of about a week using chemotherapy in a combination of drug types. Generally induction therapy requires more than one round of treatment, as it is likely that some AML cells will survive. Even if the induction therapy seems successful, the doctors assume that leukemic cells still exist though unrevealed on biopsy examination. In the unusual event that leukemia has spread to the brain or spinal cord, chemotherapy is also introduced into the cerebrospinal fluid. At a later date, a follow-up round of less intensive treat-
Salem Health: Cancer
Acute myelocytic leukemia (AML)
ments called consolidation therapy brings the patient back to the hospital to maintain remission status. Remission describes a normal peripheral blood profile, a normal bone marrow free of excess blasts, and a normal clinical status. Doctors generally reserve stem cell transplantation with more vigorous chemotherapy for those patients susceptible to relapse, although it is sometimes part of the consolidation regimen. However, there is some debate among doctors as to the risks and benefits of this treatment. For relapsed patients who are unable to undergo the rigors of stem cell transplantation, additional chemotherapy is generally not well tolerated or effective. Doctors adapt specific chemotherapies Human cells with acute myelocytic leukemia in the pericardial fluid. (National Cancer Institute) to the subtype of the leukemia. Usually this will be some combination of an anthracycline class agent with cytabrine. In u For Further Information some cases a third drug, 6-thioguanine, is added. Also facEzzone, Susan, and Kim Schmit-Pokorny, eds. Blood and tored into the treatment strategy are the patient’s age, cliniMarrow Stem Cell Transplantation: Principles, Praccal status, and leukemia profile. Although quite variable, tices, and Nursing Insights. Sudbury, Mass.: Jones and hospital stays for induction and consolidation therapies Bartlett, 2007. may require weeks or even months. Typically, chemotherHoffman, Ronald, et al. Hematology: Basic Principles and apy will drive the patient’s blood cell counts down to danPractice. 4th ed. St. Louis: Elsevier Churchill Livinggerously low levels. This will require drugs to elevate stone, 2005. white blood cell counts as well as antibiotics and blood Hutton, John J. “The Leukemias and Polcythemia Vera.” transfusions to protect against complications. In Internal Medicine, edited by Jay H. Stein. 5th ed. St. Louis: Mosby, 1998. Prognosis, prevention, and outcomes: The prognosis of Lichtman, Marshall A., and Jane A. Liesvelt. “Acute patients with AML largely depends on the patient’s age. In Myelogenous Leukemia.” In Williams Hematology, part this is due to chemoresistance or the biological reedited by Marshall A. Lichtman, et al. 7th ed. New sponse of cells to survive the toxic stress of chemotherapy. York: McGraw-Hill, 2006. Because chemoresistance tends to increase with age, important therapies are less effective in older patients. Also, the difference in the mechanisms of chromosome translou Other Resources cations in the young and older patients allows for a more The Leukemia and Lymphoma Society favorable outcome in the younger patient. Acute Lyelogenous Leukemia In the absence of treatment, most people stricken with http://www.leukemia-lymphoma.org/all_mat_toc AML will die less than two months after the diagnosis. .adp?item_id=3113 With therapy, between 20 and 40 percent of people survive for at least five years. The poorest prognoses are reserved National Marrow Donor Program for those patients older than sixty and for those developing Acute Myelogenous Leukemia AML following chemotherapy and radiation therapy for http://www.marrow.org/PATIENT/Undrstnd_ other cancers. In general, four years following consolidaDisease_Treat/Lrn_about_Disease/AML/index.html tion therapy, approximately 40 percent of patients under sixty years of age will be free of any signs of leukemia, See also Acute lymphocytic leukemia (ALL); Blood cancers; Childhood cancers; Chronic lymphocytic leukemia with that number dropping to 15 percent in older patients. (CLL); Chronic myeloid leukemia (CML); Fanconi aneRichard S. Spira, D.V.M. 15
Adenocarcinomas mia; Genetics of cancer; Leukemias; Leukopenia; Myelodysplastic syndromes; Myeloproliferative disorders; Myelosuppression.
u Adenocarcinomas Category: Diseases, symptoms, and conditions Also known as: Malignant adenomas, other names vary by type Related conditions: Lung cancer, breast cancer, colon cancer, renal cell carcinomas Definition: Adenocarcinoma is a type of cancer that develops in the epithelial tissue of glandular (secretory) organs. Although it is commonly associated with lung cancer (and is the most common form of lung cancer), adenocarcinoma can also develop in such organs as the breast, colon, kidney, liver, pancreas, prostate, and stomach. It is classified according to the kind of tissue from which it
Salem Health: Cancer arose (such as lung or breast) or according to a particular product of the cells (such as mucinous adenocarcinoma). Adenocarcinoma can spread (metastasize) to other parts of the body and also destroy surrounding tissues. Risk factors: Smoking increases the risk of almost every type of cancer. Other risk factors for adenocarcinoma vary by organ site. Age, race, family history, medication use, and lifestyle factors such as diet have been implicated in certain forms of adenocarcinoma. Etiology and the disease process: Etiology of and the disease process for adenocarcinoma vary with the involved organ. Incidence: Incidence of adenocarcinoma varies by type. Adenocarcinoma is the most common form of lung, pancreatic, prostate, and stomach cancer. Symptoms: Symptoms of adenocarcinoma vary by type. Small adenocarcinomas may produce only mild symptoms that go undetected. Large adenocarcinomas produce more noticeable symptoms that vary with the site of in-
A surgical specimen showing colonic adenocarcinoma. (Centers for Disease Control and Prevention)
16
Salem Health: Cancer volvement. The first signs of adenocarcinoma may be a noticeable lump and pain or discomfort. Screening and diagnosis: Diagnosis of adenocarcinoma begins with a medical history and physical examination. Lumps are commonly biopsied, and specialized imaging techniques, such as X rays and computed tomography (CT) scans, are used to determine the extent of the disease (staging). Staging of adenocarcinoma varies by type. Treatment and therapy: Specific treatment protocols vary by adenocarcinoma type and other factors, such as overall patient health and extent of the disease. Conventional treatment options include surgery, chemotherapy, and radiation therapy. Early-stage, localized disease may be treated by surgery alone (surgical removal of the tumor and surrounding tissue) or surgery with adjuvant chemotherapy or radiation therapy. Advanced adenocarcinoma has no cure. Newly emerging treatments for adenocarcinoma include hormone therapy and stem cell transplantation. Prognosis, prevention, and outcomes: Without treatment, adenocarcinoma is fatal. Routine physical examinations and avoidance of risk factors, such as smoking, are keys to early detection and prevention. Jaime Stockslager Buss, M.S.P.H., ELS See also Adenoid cystic carcinoma (ACC); Appendix cancer; Bile duct cancer; Breast cancer in children and adolescents; Bronchoalveolar lung cancer; Carcinomas; Duodenal carcinomas; Esophageal cancer; Fallopian tube cancer; Gallbladder cancer; Gastrointestinal cancers; Granulosa cell tumors; Head and neck cancers; Helicobacter pylori; Lung cancers; Mesothelioma; Mucinous carcinomas; Nasal cavity and paranasal sinus cancers; Oncogenic viruses; Pancreatic cancers; Prostate cancer; Rectal cancer; Salivary gland cancer; Small intestine cancer; Stomach cancers; Throat cancer; Urethral cancer; Urinary system cancers; Uterine cancer; Vaginal cancer; Vulvar cancer.
u Adenoid cystic carcinoma
(ACC) Category: Diseases, symptoms, and conditions Also known as: Adenocystic carcinoma, cribriform carcinoma, cylindroma, malignant cylindroma, AdCC Related conditions: Adenoma, adenocarcinoma Definition: Adenoid cystic carcinoma (ACC) is a rare malignant cancer of the secretory glands. Neoplasms usually
Adenoid cystic carcinoma (ACC) originate in the major and minor salivary glands of the head and neck region but can also occur in places such as in the trachea, lacrimal glands, breast, skin, and vulva. Risk factors: Environmental and genetic risk factors have not been identified. Etiology and the disease process: There is little information available regarding pathogenesis except for some evidence suggesting that the TP53 tumor-suppressor gene is inactivated in the most aggressive forms or stages of ACC. Incidence: Both children and adults may develop ACC; however, most patients are diagnosed between the fourth and sixth decades of life. ACC affects more women than men at a ratio of approximately 3:2. Symptoms: Signs and symptoms depend on the origin of the neoplasm. Screening and diagnosis: Unfortunately, no screening tests exist because of a lack of serum markers. Diagnosis is made after histologic analysis obtained through biopsy or resection of a tumor. ACC is classified into three major groups according to distinctive histologic growth pattern: cribriform, tubular, and solid. Treatment and therapy: The primary treatment option for adenoid cystic carcinoma is surgery. Postoperative radiotherapy or neutron beam therapy is sometimes recommended to help limit local failure. There is no effective chemotherapy for metastatic or unresectable ACC; however, several clinical trials are testing the effectiveness of new chemotherapeutic drugs (for example, paclitaxel and gemcitabine) when used alone or in combination with other drugs. Radiofrequency ablation and cryoablation are also being explored as treatment options. Prognosis, prevention, and outcomes: ACC growth and disease progression tend to be slow but relentless. ACC is atypical of carcinomas and seldom metastasizes to regional lymph nodes. Distant metastasis is the predominant reason for treatment failure and occurs most frequently in the lung, followed by the liver. Tumors with solid growth patterns and perineural invasion of major nerves or positive margins tend to have poor prognosis. In one study that followed 160 ACC patients, disease-specific survival was 89 percent at five years and 40 percent at fifteen years. Rena C. Tabata, M.Sc. See also Bronchial adenomas; Lacrimal gland tumors; Lung cancers; Nasal cavity and paranasal sinus cancers; Salivary gland cancer; Throat cancer. 17
Adenomatoid tumors
u Adenomatoid tumors Category: Diseases, symptoms, and conditions Also known as: Adenofibromyomas, Recklinghausen’s tumors Related conditions: None Definition: An adenomatoid tumor is a small benign tumor of mesothelial origin usually occurring in the male epididymis or female Fallopian tube, ovary, or uterus. Rarely, these tumors can be seen within the testes and prostate. Extragenital adenomatoid tumors have also been identified in the heart, mesentery, pleura, lymph nodes, omentum, and adrenal glands. Because of its glandular appearance, it may be confused with an adenocarcinoma or metastatic carcinoma, especially signet ring cell carcinoma. Risk factors: There are no known risk factors for adenomatoid tumors. Etiology and the disease process: An adenomatoid tumor is a benign hamartoma that is a malformation resulting from faulty development in an organ and is made up of an abnormal mixture of tissue elements normally present at that site. Most adenomatoid tumors are composed of fibrous tissue separated by numerous slitlike pseudotubular spaces crossed by peculiar threadlike bridging strands, which are their typical morphologic feature. The most common benign tumor of the epididymis, adenomatoid tumors usually arise in the tail of the epididymis and may rarely invade adjacent testicular parenchyma. Although they may occur at any age, they are most commonly seen in patients between twenty and fifty years of age and are usually asymptomatic. Although usually under 5 centimeters (cm) in size, they can grow quite large under hormonal influence. Incidence: In one study, the reported incidence of adenomatoid tumors is 1.2 percent, although the true incidence is probably greater, as most tumors are never biopsied because of their small size and similarity to leiomyomas of the uterus. When found in the male genital tract, these tumors are usually seen in an extratesticular location, usually involving the epididymis, representing approximately 30 percent of tumors arising in the paratesticular area. Symptoms: Adenomatoid tumors usually are asymptomatic. However, when adenomatoid tumors occur in the genital tract, they can grow quite large and can be painful. Screening and diagnosis: Often mistaken for uterine fibroids on magnetic resonance imaging, the radiologic appearance can vary from solid to cystic depending on the 18
Salem Health: Cancer relative amounts of cystic spaces, smooth muscle, and fibrous tissue contained within the tumor. Ultrasound is useful in diagnosing adenomatoid tumors of epididymal origin. They usually appear as a round or oval, solitary, solid, well-circumscribed mass of variable echogenicity measuring between 5 millimeters (mm) and 5 cm. Occasionally they may appear cystic sonographically and rarely appear plaquelike and ill-defined. Treatment and therapy: Surgical removal. Prognosis, prevention, and outcomes: Excellent. Debra B. Kessler, M.D., Ph.D. See also Endometrial cancer; Fallopian tube cancer; Fibrosarcomas, soft-tissue; Gynecologic cancers; Oophorectomy; Ovarian cancers; Ovarian cysts; Testicular cancer.
u Adenomatous polyps Category: Diseases, symptoms, and conditions Also known as: Colorectal adenomas Related conditions: Colon cancer, benign polyps, familial adenomatous polyposis (FAP) Definition: Polyps are abnormal tissue growths stemming from the lining of mucous membranes. Colorectal adenomatous polyps are benign (noncancerous) polyps that project from the inner lining of the colon or rectum and protrude into the lumen of the intestines. Despite their benign characteristics, adenomatous polyps can become cancerous if not removed. Risk factors: Adenomatous polyps are one of the most common types of colon polyp. Individuals over the age of fifty years are much more likely to develop these growths, as are those people with a family history of colon polyps. Additionally, having a mutation in the APC gene can cause a condition named familial adenomatous polyposis (FAP), a disorder that causes numerous polyps to grow in the intestines and almost always develop into tumors. Etiology and the disease process: Adenomatous polyps are a collection of cells that display uncontrolled proliferation, forming a growth that stems from the inner lining of the colon. Incidence: The prevalence of adenomatous polyps ranges from 10 to 25 percent of the population, depending on the type of screening procedure used. Symptoms: Most adenomatous polyps are asymptomatic, and patients are unaware of their presence until they are
Salem Health: Cancer identified through screening. When adenomatous polyps are not removed and continue to grow larger, they can eventually induce rectal bleeding, diarrhea, or constipation. Screening and diagnosis: The most common screening method to detect adenomatous polyps is colonoscopy, a procedure by which a doctor inserts a viewing tube into the colon and removes any visually identified polyps. Other screening methods that may be used are flexible sigmoidoscopy and barium enema. Removed polyps are then biopsied to determine if they are benign or have developed into precancerous or cancerous lesions. Treatment and therapy: When identified through screening, the general treatment is immediate removal of adenomatous polyps to prevent their possible development into cancer. Most doctors recommend that patients undergo subsequent colorectal screening on a regular basis for several years following the removal of adenomatous polyps. Prognosis, prevention, and outcomes: When discovered and removed, adenomatous polyps do not significantly change a patient’s quality of life. However, if left undetected, some of these polyps can develop into colon cancer, which has a higher mortality rate than any other cancer type in the United States. Some possible ways to prevent the development of adenomatous polyps is to maintain a diet that is high in fiber and low in fat, as well as refraining from smoking and excessive drinking. Lisa M. Cockrell, B.S.
Adenoviruses human viruses in the family Adenoviridae. Adenoviruses can be genetically engineered to serve as vectors that deliver targeted gene therapy to human cells. Cancers treated: Breast, colorectal, head and neck, liver, and prostate cancers Delivery routes: Injection How these agents work: Adenoviruses are nonenveloped, or naked, viruses, meaning that they lack a lipid and protein outer covering. Counterintuitively, viruses without this outer covering are better able to withstand environmental stressors such as an acidic environment, drying, and heat—and therefore may live longer outside a host cell. Most adenoviruses cause respiratory illnesses, conjunctivitis (pinkeye), or gastroenteritis and are transmitted via respiratory droplets or through fecal-oral transmission. Adenoviruses are well suited to gene therapy because of their environmental robustness, the ease of manipulating the adenovirus genome, and their ability to infect a number of different kinds of tissue. The DNA inside the adenovirus may one day be altered to encode up to forty genes.
See also Colon polyps; Colorectal cancer; Desmoid tumors; Duodenal carcinomas; Enterostomal therapy; Gardner syndrome; Gastric polyps; Genetics of cancer; Hereditary cancer syndromes; Hereditary polyposis syndromes; Polyps; Small intestine cancer; Stomach cancers; Turcot syndrome.
u Adenoviruses Category: Chemotherapy and other drugs Also known as: Adenoviridae viruses Definition: An adenovirus is a twenty-sided symmetrical icosahedron measuring between 80 and 100 nanometers in diameter with 252 capsomers forming its outside “capsid,” or protein shell. Adenoviruses contain double-stranded, linear deoxyribonucleic acid (DNA), sometimes referred to as dsDNA. These viruses are named for the the adenoids, as they were first isolated from human tonsils in the 1950’s. There are now more than forty identified types of
An electron micrograph of an adenovirus. (Centers for Disease Control and Prevention)
19
Adjuvant therapy In cancer therapy, adenoviruses are first inactivated to make them incapable of causing infection once inside the body. When injected into cancer cells, the virus can cause cell death or tumor suppression by producing toxic proteins, flagging cells for destruction by the immune system, breaking the cell apart (cell lysis), or activating genes that will cause the cell to die (apoptosis) or stop replicating. To gain access to host cells, adenoviruses attach to a receptor on the host cell, which triggers the host cell to surround, engulf, and coat the virus with chemicals. Once the virus is inside the host, the coating dissolves and the virus releases into the host cell cytoplasm. The virus makes its way to the host cell nucleus, where it disassembles itself and releases viral DNA into the host’s nuclear pores. Soon the host cell nucleus stops replicating its DNA and instead begins replicating the DNA of the adenovirus. Eventually the host cell breaks apart (lyses) and releases the newly created adenoviruses. Since most people have been exposed to adenoviruses, the immune system can mount an immune response to the adenoviruses before they have a chance to target the cancer cells. With more research into the specific targeting of cancer cells, however, a vigorous immune response may serve as a beneficial side effect of treatment. Side effects: The side effects of adenovirus use in cancer therapy include inflammation at site of injection, inappropriate immune response, fever, and coldlike symptoms. Pamela Richardson, M.S. See also Gene therapy; Oncogenes; Oncogenic viruses; Simian virus 40.
u Adjuvant therapy Category: Procedures Definition: An adjuvant therapy is any treatment given after the primary treatment to increase the likelihood of killing all cancer cells. Cancers treated: Many types, including cancers of the breast, colon, kidney, ovary, and testicle Why performed: After the primary treatment removes or kills a detected primary tumor, additional cancerous cells or microtumors may still be present in the body. Adjuvant therapy may be administered to help prevent the recurrence of cancer after the primary tumor is removed. Generally, the larger the primary tumor size at detection, the larger is the probability that residual cancer cells may be left behind following surgery. Cancer cells can break away 20
Salem Health: Cancer from the primary tumor and metastasize even when the disease is in an early stage, and they exist in a form too small to detect by radiological or laboratory testing. Patient preparation: In the decision regarding whether to undergo adjuvant therapy, a number of prognostic factors enter into the determination, such as patient age, size of primary tumor, spread to lymph nodes, and microscopic appearance of the cancer cells. Doctors consider these factors and others in order to estimate the likelihood of recurrence. The higher the risk for recurrence, the greater is the motivation to pursue adjuvant therapy options. Local adjuvant radiation treatment typically commences about three to six weeks following the primary treatment. If a combination of chemotherapy and radiotherapy as adjuvant therapy is chosen, then usually chemotherapy is received first followed by radiation, although they may be administered simultaneously in some cases. It is not known how effective adjuvant therapy may be if started later than six weeks following primary therapy. Steps of the procedure: The term “adjuvant therapy” actually encompasses many different treatment forms, including chemotherapy, radiation, hormonal therapy, targeted therapy, or some combination thereof. Adjuvant therapy can be either systemic or local. Chemotherapy, for instance, is given by mouth or injected into the bloodstream. Adjuvant chemotherapy is administered in cycles of treatment followed by recovery and typically lasts for three to six months. Side effects from adjuvant therapy such as chemotherapy or radiation may be experienced. For example, the effects of adjuvant chemotherapy may include loss of hair, loss of appetite, vomiting, diarrhea, mouth sores, psychological distress, and some loss of cognitive brain function. Medications are available to help control vomiting and nausea induced by chemotherapy. Researchers at the University of Rochester have reported that treatment with modafinil (Provigil) can alleviate the cognitive symptoms of so-called chemo brain experienced in certain cancer treatment regimens. Longer-term side effects may include infertility. Another example of adjuvant therapy is hormone adjuvant therapy to treat breast cancer. Hormone adjuvant therapy is used on breast cancer cells that have been found to be estrogen or progesterone receptor positive. Some standard hormone therapies include the synthetic hormone tamoxifen and aromatase inhibitors. Tamoxifen as an adjuvant therapy has been found to decrease the chance of recurrence in women with early-stage hormone receptor positive breast cancer. It is also used to treat women who are at risk of one day developing breast cancer. Aromatase inhibitors are used as adjuvants to reduce the levels of es-
Salem Health: Cancer trogen in postmenopausal women; they include anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara). These drugs are not to be used by premenopausal women. Combination adjuvant therapies comprising hormone treatment together with chemotherapy are also available for some patients. After the procedure: It is advised that patients undergo regular checkups following adjuvant therapy in order to monitor any cancer recurrence. Hormone adjuvant therapy, such as used to treat some forms of breast cancer, involves longer-term procedures, with five-year regimens recommended. Risks: The risks associated with different forms of adjuvant therapy are similar to the risks of corresponding primary treatments with chemotherapy, radiotherapy, or hormone therapy. The main risk of declining to participate in adjuvant therapy is the possibility of cancer cells spreading undetected to other parts of the body. While patients with invasive cancers are often urged to consider undergoing adjuvant therapy, other options are available. Patients who turn down the option of adjuvant therapy are advised to participate in regular follow-up clinical examinations to facilitate the detection of new tumors. This alternative is often referred to as “watchful waiting.” Some of the side effects of hormone adjuvant therapy mimick the symptoms of menopause, such as hot flashes and an increased risk for the development of osteoporosis. Results: The goal of adjuvant therapy is to make primary treatment more effective and result in years of disease-free survival. Successful adjuvant therapy is marked by a lack of detectable tumor recurrence or metastasis formation in the months and years following primary therapy. Michael R. King, Ph.D. u For Further Information Henderson, I. Craig, ed. Adjuvant Therapy of Breast Cancer. Boston: Kluwer Academic, 1992. Kirkwood, John M., ed. Strategies in Adjuvant Therapy. Malden, Mass.: Blackwell, 2000. Murphy, Kevin. Adjuvant Chemotherapy Guide. Available online at http://www.cancerguide.org. Salmon, Charles G. Adjuvant Therapy of Cancer. Philadelphia: Lippincott Williams & Wilkins, 1993. u
Other Resources
Mayo Clinic Adjuvant Therapy for Breast Cancer Guide http://www.MayoClinic.com
Adrenal gland cancers National Cancer Institute http://www.cancer.gov See also Biological therapy; Chemotherapy; Hormonal therapies; Pain management medications; Radiation therapies; Watchful waiting.
u Adrenal gland cancers Category: Diseases, symptoms, and conditions Also known as: Pheochromocytoma, adrenal cortical cancer, adrenocortical cancer, neuroblastoma Related conditions: Cushing syndrome, Conn syndrome, adrenogenital syndrome Definition: The adrenal glands are hormone-producing endocrine glands located directly above the kidneys. The outer layer of each gland is called the adrenal cortex. Hormones produced in the adrenal cortex include cortisol (aids in regulating blood sugar level), aldosterone (aids in regulating fluid and electrolyte balance and blood pressure), and testosterone and estrogen (male and female sex hormones). A primary malignant tumor in the adrenal cortex—one that originates in that location—is called adrenocortical cancer. The inner area of each gland is called the adrenal medulla. Hormones produced in the medulla include epinephrine and norepinephrine, which help regulate the body’s response to physical and emotional stress. A primary malignant tumor that originates in the medulla is called a pheochromocytoma. Another form of cancer that originates in the medulla is neuroblastoma, typically found in infants and children younger than age ten. Adrenal tumors are commonly classified by their effect on hormone production in the affected area. Adrenal tumors that increase hormone production are called functioning tumors; those that do not produce hormones are called nonfunctioning tumors. Risk factors: Although specific risk factors for adrenal cancers have not been identified, they have been associated with genetically linked familial syndromes, such as Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, and Carney complex. Etiology and the disease process: The cause of adrenal cancer is unknown. Functioning tumors that secrete hormones produce changes in the body systems affected by those hormones. Nonfunctioning tumors typically grow large enough to produce pressure on other organs, causing discomfort or pain in the abdomen or flank. 21
Adrenal gland cancers
Salem Health: Cancer
Incidence: Primary adrenal gland cancers are rare, affecting only 1 or 2 persons per 1 million people. Approximately 60 to 80 percent of adrenal cancers are functional, secreting large amounts of adrenal hormones. Adrenocortical cancer is most common in men between the ages of forty and fifty; neuroblastoma most commonly affects children younger than age five; and pheochromocytoma is most common between ages thirty and forty. Symptoms: A functioning adrenocortical cancer tumor typically produces excess amounts of cortisol and aldosterone, which can cause elevated blood pressure, weight gain, thirst, urinary frequency, facial swelling (moon face), cramping of the muscles in the arms and legs, and increased hair growth on the face, arms, and back. If the tu-
mor produces sex hormones, men may develop a loss of sex drive, impotence, and enlarged breasts; women may develop a deeper voice, menstrual irregularities, and increased facial hair; and children may experience early puberty. A neuroblastoma can cause an unusual abdominal lump or fullness, weight loss, extreme tiredness, persistent diarrhea, flushing, sweating, elevated blood pressure, and behavior indicating the presence of abdominal pain. A pheochromocytoma can cause elevated blood pressure that is resistant to treatment, excessive sweating, severe headaches, tremors, rapid pulse, palpitations, and extreme anxiety. A nonfunctioning adrenal cancer may not produce symptoms until the cancer is advanced or has metastasized. Typical symptoms are caused by the tumor pressing on
Adrenal Glands
Kidney
Kidney
The adrenal glands are located on top of the kidneys. (LifeART© 2008 Wolters Kluwer Health, Inc.-Lippincott Williams &Wilkins. All rights reserved.)
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Salem Health: Cancer
Adrenocortical cancer therapy may be used after surgery or to treat metastatic pheochromocytoma.
Relative Survival Rates for Adrenal Gland Cancers, 1988-2001
Prognosis, prevention, and outcomes: There is no known prevention for adrenal cancer. The prognosis for adrenal cancer depends on the type of tumor and the stage of the disease. The five-year survival rate after surgery for adrenocortical cancer is approximately 10 to 35 percent; for localized pheochromocytomas it is about 95 percent. The prognosis for neuroblastoma varies widely depending on the child’s risk grouping. The five-year survival rate ranges from about 95 percent for a low-risk child to about 30 percent for a high-risk child. Metastatic tumors of all types have a poor prognosis. Dorothy P. Terry, R.N.
Survival Rates (%) Cancer Type Adrenal gland (all) Adrenocorticol Pheochromocytoma
1-Year
3-Year
5-Year
10-Year
59.4 66.0 84.5
45.5 48.5 73.0
38.7 41.2 64.8
29.6 31.3 44.0
Source: Data from L. A. G. Ries et al., eds., Cancer Survival Among Adults: U.S. SEER Program, 1988-2001—Patient and Tumor Characteristics, NIH Pub. No. 07-6215 (Bethesda, Md.: National Cancer Institute, 2007)
other abdominal organs, causing pain or an abnormal feeling of fullness. Tiredness, fever, and weight loss may also be present. Screening and diagnosis: There are no screening tests for adrenal cancer. Diagnosis begins with a thorough patient and family medical history and physical examination. If adrenal cancer is suspected, the patient’s blood and urine are tested for elevated levels of adrenal hormones, and computed tomography scanning and magnetic resonance imaging are performed to identify tumors. The metaiodobenzylguanidine (MIBG) scan, during which images are taken after the injection of small amounts of radioactive materials, is used to detect the presence and location of a pheochromocytoma. Staging of adrenal cancer depends on the specific type of tumor. Treatment and therapy: Treatment for adrenal cancer usually includes surgery to remove the affected gland, followed by chemotherapy to destroy any remaining cancer cells. The type and combination of chemotherapeutic drugs used varies with the type of tumor. Mitotane, most commonly used after surgery for adrenocortical cancer, blocks hormone production and destroys adrenal cancer cells. It is also used to treat inoperable, recurrent, and metastatic adrenocortical cancer. If the patient cannot tolerate mitotane therapy or it is ineffective, cisplatin is typically used, either alone or combined with cyclophosphamide and doxorubicin, fluorouracil and doxorubicin, or VP-16. Following surgery, neuroblastoma may be treated with chemotherapy using carboplatin, doxorubicin, cyclophosphamide, and etoposide. Surgery to remove a pheochromocytoma is typically preceded by the administration of medication to block the secretion of adrenalin, which can cause very high blood pressure and serious surgical complications. MIBG radio-
u
For Further Information Bertagna, Xavier, ed. Adrenal Cancer. Montrouge, France: John Libbey Eurotext, 2006. Souhami, Robert, and Jeffrey Tobias. Cancer and Its Management. Malden, Mass.: Blackwell, 2005. Stern, Theodore A., and Mikkael A. Sekeres. Facing Cancer: A Complete Guide for People with Cancer, Their Families, and Caregivers. New York: McGraw-Hill, 2004.
u
Other Resources
American Cancer Society http://www.cancer.org Endocrine Web http://www.endocrineweb.com National Cancer Institute http://www.nci.nih.gov/cancertopics See also Adrenocortical cancer; Computed tomography (CT) scan; Cushing syndrome and cancer; Endocrine cancers; Endocrinology oncology; Hepatomegaly; Radiofrequency ablation.
u Adrenocortical cancer Category: Diseases, symptoms, and conditions Also known as: Adrenal cortex carcinoma Related conditions: Cushing syndrome, Conn syndrome, virilization Definition: Adrenocortical cancer is an aggressive malignancy that occurs when a tumor develops in the tissue of 23
Advance directives the adrenal cortex, the outer layer of tissues that surround the adrenal gland and produce steroid hormones. Risk factors: Certain hereditary diseases, including LiFraumeni syndrome, Beckwith-Wiedemann syndrome, and Carney complex, are the main known risk factors. Etiology and the disease process: The cause of these tumors is unknown. An adrenocortical cancer tumor is either nonfunctioning or functioning, meaning that it overproduces certain hormones that the adrenal cortex normally produces. These hormones include cortisol, aldosterone, testosterone, and estrogen. Adrenocortical cancer commonly becomes malignant, spreading to the lung, liver, bone, and peritoneum (lining of the abdominal cavity). Incidence: Adrenocortical cancer is relatively rare, affecting only 1 to 2 people out of 1 million every year. Although it generally occurs in adults between the ages of thirty and forty years, children can develop this cancer, usually under the age of six.
Salem Health: Cancer of the cancer at diagnosis, the general health of the patient, and whether the tumor is recurrent. Lisa M. Cockrell, B.S. See also Adrenal gland cancers.
u Advance directives Category: Social and personal issues Also known as: Living wills, durable powers of attorney for health care (DPOA), do-not-resuscitate (DNR) orders Definition: Advance directives are written instructions in the form of legal documents that allow people to communicate their desires about medical care and treatment if they cannot speak for themselves due to a terminal condition. Patients with advanced cancer may use them to allow their wishes to be known and followed.
Treatment and therapy: When discovered early, adrenocortical cancer can be cured through surgical removal of the tumor. However, because most tumors are not diagnosed until they are advanced, other treatment strategies such as radiation therapy and chemotherapy must be used. Most chemotherapy regimens to treat adrenocortical cancer include the drug mitotane, which is toxic to adrenal cortex cells, in addition to other chemotherapeutic agents such as cisplatin, doxorubicin, and etoposide.
Purposes: Advance directives are designed to allow competent patients an opportunity to express their wishes for future health decisions in the event that they are unable to participate in medical decision making because of their poor state of health. Advance directives take the pressure off family and friends by letting them know what care and services the cancer patient prefers and what treatment the patient would refuse in the event that communication is not possible. The patient can also designate a person or persons to make decisions. In families in which there is disagreement about what an ill relative would prefer, the advance directive provides clarification. If there is no advance directive and the patient becomes incapacitated with no surrogate designated, state law will dictate the order of surrogate decision makers, usually other family members. By designating a surrogate decision maker, the patient’s choice supersedes that of the state. This is particularly valuable for people without close family or in nontraditional relationships. Advance directives are important because complex choices about end-of-life care are difficult and can seem overwhelming if a someone close to the decision maker is involved. Avoiding these decisions during healthy times will place a heavy burden on family and friends later. Communicating wishes about end-of-life care will ensure that the cancer patient’s wishes are respected.
Prognosis, prevention, and outcomes: The prognosis for patients diagnosed with adrenocortical cancer is generally very poor, and dependent on several factors. These include the ability of the tumor to be surgically removed, the stage
Types: Advance directives emerged in the late 1960’s and early 1970’s as a major social and medical phenomenon resulting from the conflict between professional ethics based on the Hippocratic oath and the physician’s duty to
Symptoms: Nonfunctioning adrenocortical cancer tumors usually do not have symptoms. Functioning adrenocortical cancer tumors can generate many symptoms, owing to their overproduction of steroid hormones. Depending on the hormone, symptoms can include weight gain, high blood pressure, muscle weakness, acne, and changes in menstrual cycles. Screening and diagnosis: Laboratory testing can be used to confirm changes in steroid hormone production. Abdominal radiological examination, such as computed tomography scanning and magnetic resonance imaging, can be used to determine the exact location and extent of the tumor. Adrenocortical cancer tumors are staged on a scale of I to IV, according to the size of the tumor and the degree of invasion, both locally and to distant sites.
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Advance directives
dated, witnessed, notarized, copied, and incorporated into benefit the patient according to the physician’s own ability the patient’s medical record. A copy should be placed in and judgment and the patient’s autonomy. In Schloendorff the chart and given to the patient’s physician and attorney. v. Society of New York Hospital (1914), the Supreme Court Advance directives should be reviewed periodically and ruled that patients were entitled to complete information kept current. Some people even take their directives with about their illness and shared decision making. The Patient them when they travel. Advance directives remain in efSelf-Determination Act of 1991 mandated that all patients fect until they are revoked. admitted to acute care hospitals, long-term care facilities, health maintenance organizations, and home care proConditions: Advance directives are recognized in all fifty grams are to be informed about their rights under state law states and can be considered legally binding, provided to participate in health care decision making, including they are executed in accordance with state guidelines. their right to have written directives. Some directives are written only to apply in particular clinDespite widespread media attention, the majority of seical situations, such as when the patient has a terminal type riously ill patients do not have a written advance directive. of cancer or an incurable illness (advanced or aggressive For those without directives, family members collaborate cancers would fit these categories). Ambiguous terms with a health care provider to make decisions generally resuch as “extraordinary means” and “unnaturally prolongflective of substituted judgment or best-interest principles ing my life,” should be placed within the context of the pa(that is, what the patient would have wanted based on pretient’s values to be understood. Because these ambiguous vious statements and values). This approach, of course, is terms necessitate interpretation by caregivers, revised state problematic because often there is little evidence about the forms have attempted to overcome this problem by adpreferences of any particular patient. dressing specific interventions that are to be withheld in all Advance directives include living wills, durable powers circumstances (for example, blood transfusions, dialysis, of attorney for health care (DPOA), and do-not-resuscitate ventilators and respirators, CPR, artificial nutrition and (DNR) orders. There are two broad categories of advance hydration, withholding of food and fluids, and organ and directives: instructive and proxy. Instructive directives altissue donation). low an opportunity to express preferences regarding the It is important to understand that a decision not to reprovision of particular treatment options. Living wills ceive “aggressive medical care” is not the same as withare the most common examples of instructional directives holding all medical care. A cancer patient can still receive in which the patient’s preferences are specified, but there antibiotics, nutrition and hydration, medication, radiation are also other types such as no transfusion or no cardiopultherapy, and pain management (palliative or comfort care). monary resuscitation (CPR) directives. The proxy direcAnother approach can provide instructions in the event of tive, generally a durable power of attorney for health a specific circumstance or diagnosis (such as a prolonged care, allows the patient to designate a surrogate decision maker of the patient’s choosing. This surrogate makes health care decisions for the patient in the case of incapacity. Choosing a Surrogate Decision Maker It should be noted that advance directives Picking a proxy decision maker can be a difficult task. Generally, experts are applicable only in situations in which parecommend that the proxy has the following qualities: tients are unable to participate in their health care decision making. The assessment of ca• shares the patient’s values and beliefs about end-of-life care and death pacity for decision making is sometimes dif• is a person with whom the patient can comfortably talk about difficult ficult and may involve a psychiatric evaluaissues tion and even a legal determination. If a • is a responsible, calm, mature person patient is competent and communicative, • is willing to assume this responsibility however, the advance directive will not • ideally is a person who lives close or is able to travel to the patient’s apply. location A health care proxy or surrogate is a per• is not the patient’s health care provider (for legal reasons) son appointed to make a patient’s medical • is chosen separate from considerations of who will handle the patient’s financial issues decisions if and when the patient is unable to do so. The durable power of attorney for • is the person, whether relative or friend, that the patient trusts the most to make medical decisions health care is the legal document that names the health care proxy. It should be signed, 25
Aflatoxins state of unconsciousness, trauma, or a diagnosis of dementia). Some living wills state that patients do not want lifeprolonging treatments if their condition necessitates constant care and supervision. Alternatively, others can state that patients wish their lives to be prolonged as long as possible. Advance directives can be revised or revoked as long as the patient remains competent to participate in medical decisions. Decisions by competent patients always supersede written directives. If there is disagreement among family members about the interpretation or authority of a patient’s advance directive, the medical team or a medical ethicist should meet with the family, clarify, and attempt to resolve the issue. Limitations: Living wills cannot possibly be made allencompassing because of the great variability in end-oflife care. Pain alleviation or management is among the most controversial end-of-life issues. Laws regulating drug addiction are inconsistent among the states, and the role of lethal drugs in the management of end-of-life pain and discomfort is being debated in Congress. Cancer patients making or considering writing advance directives are encouraged to communicate their preferences with their medical providers and surrogate decision makers. Most states ensure that patients remain in charge of their medical care until at least two physicians declare them to be incapacitated. Health care providers may refuse to honor the patient’s stated wishes or decisions because of personal standards or institutional policies. If either is the case, it is up to the individual health care provider to inform the surrogate immediately and transfer the patient to another provider. Marcia J. Weiss, J.D. u
For Further Information King, Nancy. Making Sense of Advance Directives. Dordrecht, Netherlands: Kluwer, 1991. Mappes, Thomas A., and David De Grazia. Biomedical Ethics. 6th ed. New York: McGraw-Hill, 2006. Sass, Hans-Martin, Robert M. Veatch, and Ribito Kimura, eds. Advance Directives and Surrogate Decision Making in Health Care: United States, Germany, and Japan. Baltimore: Johns Hopkins University Press, 1998. Ulrich, Lawrence P. The Patient Self-Determination Act: Meeting the Challenges in Patient Care. Washington, D.C.: Georgetown University Press, 1999. Weir, Robert F. Abating Treatment with Critically Ill Patients: Ethical and Legal Limits to the Medical Prolongation of Life. New York: Oxford University Press, 1989. 26
Salem Health: Cancer u
Other Resources
American Cancer Society Advance Directives http://www.cancer.org/docroot/MIT/mit_3_1_1.asp National Cancer Institute End-of-Life Decisions http://www.cancer.gov/cancertopics/pdq/ supportivecare/transitionalcare/HealthProfessional/ page9 See also Cardiopulmonary resuscitation (CPR); Do-notresuscitate (DNR) order; End-of-life care; Living will; Long-distance caregiving; Transitional care.
u Aflatoxins Category: Carcinogens and suspected carcinogens RoC status: Known human carcinogen since 1980 Also known as: Aflatoxin B1, aflatoxin B2, aflatoxin G1, aflatoxin G2, aflatoxin M1 Related cancers: Liver cancer, primary liver cell cancer, hepatocellular carcinoma, lung cancer Definition: Aflatoxins are naturally occurring toxic metabolites produced by certain fungi that grow on some agricultural products. At least thirteen different aflatoxins are produced in nature, with the four major aflatoxins called aflatoxin B1, B2, G1, and G2. Aflatoxin B1 is typically the most predominant as well as the most toxic. Aflatoxin M1 is found primarily in milk. Exposure routes: Ingestion and inhalation Where found: Numerous agricultural commodities, including corn and other grains, peanuts, tree nuts, and cottonseed meal. Milk, eggs, and meat products can be contaminated if animals consume aflatoxin-contaminated feed. At risk: Those living in countries where agricultural products that readily support the growth of aflatoxin-producing fungi are a dietary staple. Farmers and other agricultural workers are at risk for occupational exposure through inhalation of dust generated during handling of contaminated crops and feeds. Etiology and symptoms of associated cancers: Aflatoxin-producing fungi can grow on a wide range of agricultural products. Corn and groundnuts are major sources of human exposure because of greater susceptibility to contamination and widespread consumption. Worldwide,
Salem Health: Cancer
Aflatoxins
These peanuts are contaminated with aflatoxins. (AP/Wide World Photos)
corn is probably of greatest concern because it is grown in climates that readily support the growth of fungi and is a dietary staple in many countries. Aflatoxin-producing fungi often grow on crops in the field before harvest, particularly if the crops have experienced drought stress. After harvest, contamination can occur during storage. The growth of aflatoxin-producing fungi and subsequent production of aflatoxins are influenced by weather conditions such as temperature and humidity. As a result, aflatoxin contamination varies with geographic location, agricultural and agronomic practices, and the susceptibility of crops to fungal growth. Exposure to aflatoxins occurs primarily by consuming contaminated food. Aflatoxin consumption is commonplace in developing countries where food supplies are limited and regulations of aflatoxin levels are not enforced or nonexistent. In developed countries, food supplies are generally more abundant and diverse, and aflatoxin levels are monitored to limit toxin ingestion. Although the sale of heavily contaminated food supplies is not permitted in
developed countries, chronic exposure to low levels of aflatoxins may still be a concern. The most common aflatoxin-producing fungi are Aspergillus flavus and Aspergillus parasiticus. Although many aflatoxins are produced by these fungi, aflatoxin B1 is the most prevalent and the most toxic. Aflatoxin B1 is also the most potent naturally occurring carcinogen. Aflatoxins are both toxic and carcinogenic, with exposure to high levels resulting in toxic effects referred to as aflatoxicosis and chronic exposure to low levels potentially resulting in cancer. Susceptibility to aflatoxin-related diseases is influenced by many factors, including age, exposure level, duration of exposure, health, nutritional status, and exposure to other agents, such as the hepatitis B virus (HBV). The liver is the primary target organ of aflatoxin exposure, although other organs can also be affected. Metabolic activation by liver enzymes is required for the carcinogenic effects of aflatoxin B1. In the liver, aflatoxin B1 is metabolized to a highly reactive form that readily binds deoxyribonucleic acid (DNA) and proteins and can lead to 27
African Americans and cancer liver damage and subsequent formation of tumors in the liver. Exposure to aflatoxins in the diet has been shown to be one of the major etiological factors in the development of primary hepatocellular carcinoma in some countries, such as China and many African countries. Concurrent infection with HBV and exposure to aflatoxins results in significantly greater liver damage than either infection or exposure alone, a synergy that is likely produced because HBV interferes with the liver’s ability to detoxify aflatoxins. Although aflatoxin is most well known as an agent that promotes liver cancer, inhalation of contaminated grain dust has been associated with an increased incidence of lung cancer. Liver cancer is not associated with any symptoms in the early stages. As the cancer progresses, symptoms may include pain in the upper abdomen on the right side, which may also extend to the back and shoulder. Other symptoms include a swollen or bloated abdomen, weight loss, loss of appetite, feeling of fullness, weakness, fatigue, nausea and vomiting, yellowish skin and eyes, dark urine, and fever. History: Aflatoxins have been recognized as a significant contaminant since the 1960’s, when more than 100,000 young turkeys on poultry farms in England died from what was termed turkey X disease. The mortalities were traced to consumption of mold-contaminated peanut meal. In 1961 the toxin-producing fungus, A. flavus, was identified and the toxin given the name aflatoxin. The International Agency for Research on Cancer (IARC) first recognized aflatoxins as carcinogenic in 1976. In 1987 naturally occurring mixtures of aflatoxins and AFB1 were classified as Group I carcinogens. Aflatoxins are considered unavoidable contaminants of food and feed, even when good manufacturing practices have been followed. Although absolute safety can never be achieved, many countries have attempted to limit exposure to aflatoxins by imposing regulatory limits on commodities intended for consumption. The Food and Drug Administration has established specific guidelines that regulate this toxin to very low concentrations in human food and animal feed. Catherine J. Walsh, Ph.D. u
For Further Information Bennet, J. W., and M. Klich. “Mycotoxins.” Clinical Microbiology Reviews 16, no. 3 (2003): 497-516. Eaton, D. L., and J. D. Groopman. The Toxicology of Aflatoxins. New York: Academic Press, 1994. Goldblatt, L., ed. Aflatoxin: Scientific Background, Control, and Implications. New York: Academic Press, 1969. 28
Salem Health: Cancer U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Eleventh Report on Carcinogens. Research Triangle Park, N.C.: Author, 2005. u
Other Resources
Centers for Disease Control and Prevention http://www.cdc.gov National Cancer Institute http://www.cancer.gov National Toxicology Program http://ntp.niehs.nih.gov U.S. Food and Drug Administration Center for Food Safety and Nutrition http://www.cfsan.fda.gov See also Free radicals; Hepatomegaly; Infectious cancers; Liver cancers; Risks for cancer.
u African Americans and cancer Category: Social and personal issues Definition: Cancer is the second leading cause of death among African Americans. African Americans experience higher cancer rates than any other racial or ethnic group in the United States, as well as higher mortality rates from those cancers. Description of the population: The U.S. government identifies as African Americans “individuals whose origins are from any of the black racial groups of Africa,” including people who self-report their ethnicity as “Black, African American, or Negro” or who describe themselves as African American, Afro-American, Angolan, Negro, West Indian, Afro-Caribbean, Nigerian, Haitian, Gullah, Creole, West African, Afro-Latin, Afro-Brazilian, Congolese, Americo-Liberian, Bantu, Guinean, Moor, Pygmy, or Liberian. According to the Census Bureau, African Americans represented more than 13 percent of the U.S. population as of 2006. Incidence, death, and survival statistics: The average U.S. life expectancy was 49.2 years in the nineteenth century. The National Vital Statistics Reports (vol. 47, no. 28) note that African American life expectancy is 70.2 years, as opposed to 76.5 years for the U.S. population overall. African American men have a life expectancy of only 66.1 years; for all U.S. men it is 73.6 years. These statistics are
Salem Health: Cancer reflected in the cancer morbidity rates for African Americans: In 2003, for example, cancer was the second leading cause of death of African Americans (topped only by heart disease). The death rate outstripped that of whites, with 234.5 African Americans (versus 188.3 whites) dying of cancer per every 100,000 in the U.S. population. Overall, African Americans have higher cancer rates than any other racial or ethnic group in the United States, and their death rates from those cancers are also higher. The five-year survival rate among African Americans for all cancers improved from 27 percent in 1960-1963 to 57 percent in 1996-2002. Nevertheless, at more than 63 percent, whites were still more likely to survive five years after diagnosis. African American men are more likely to succumb to cancer than are white men, although this disparity, after peaking in the early 1990’s, has begun to decline. Death rates for African American women are closer to those for white women—although still higher. The fact that African Americans are more likely to be diagnosed with cancer later in the disease process and have less access to high-quality care in part explains their increased likelihood of death. The American Cancer Society reported that between 2000 and 2003, the cancers afflicting African American men most often were, from highest to lowest incidence, prostate cancer, lung and bronchial cancers, colorectal cancer, kidney and renal pelvic cancers, urinary bladder cancer, oral cavity and pharyngeal cancers, stomach cancer, non-Hodgkin lymphoma, pancreatic cancer, myeloma, leukemia, liver and intrahepatic bile duct cancers, laryngeal cancer, esophageal cancer, brain and other nervous system cancers, small intestinal cancer, soft-tissue (including heart) cancers, Hodgkin disease, Kaposi sarcoma, thyroid cancer, testicular cancer, melanoma of the skin, and mesothelioma. For all these cancers combined, African American men were afflicted, on average, 1.2 times more often than white men, with particularly noticeable disparities in Kaposi sarcoma, myeloma, and small intestinal cancers. For the same period, cancers afflicting African American women were, from highest to lowest incidence, breast cancer, colorectal cancer, lung and bronchial cancers, uterine corpus cancer, pancreatic cancer, non-Hodgkin lymphoma, uterine-cervical cancer, ovary, kidney and renal pelvic cancers, stomach cancer, myeloma, leukemia, urinary bladder cancer, thyroid cancer, oral cavity and pharyngeal cancers, brain and other nervous system cancers, liver and intrahepatic bile duct cancers, esophageal cancer, soft-tissue (including heart) cancers, small intestinal cancer, Hodgkin disease, laryngeal cancer, and melanoma of the skin. The overall incidence for African Amer-
African Americans and cancer
Five-Year Relative Survival Rates for Selected Cancers for African Americans and Whites in the United States, 1996-2002 Survival Rates (%) Cancer Type Prostate Female breast Bladder Uterus Cervix Colon and rectum Non-Hodgkin lymphoma Leukemia Mouth Lungs and bronchi Esophagus
African American
White
98 77 64 60 63 55 54 40 40 12 11
100 90 82 85 73 65 64 49 61 15 16
Source: Data from National Cancer Institute, Surveillance Epidemiology and End Results, Cancer Stat Fact Sheets, 2008 Note: Based on cancer patients diagnosed between 1996 and 2002 and followed through 2003
ican women was, on average, slightly less than for white women, although the incidence of myeloma, stomach cancer, and small intestinal cancer among African American women was more than twice that among white women— balanced by lower incidence rates for other cancers, including breast and uterine corpus. For 1996-2002 (in descending order), survival rates among African Americans as a whole were best for prostate, female breast, urinary bladder, uterine corpus, uterine cervical, colorectal, non-Hodgkin lymphoma, leukemia, oral cavity, lung and bronchial, and esophageal cancers. For these same cancers combined, white survival rates exceeded those of African Americans by an average of 11.45 percent (ranging from 2 to 25 percent). The greatest disparities in survival rates could be seen in uterine corpus and oral cavity cancers: Whites outlived blacks by 25 percent and 21 percent, respectively. For 2007, the cancers projected to be diagnosed most often in African American men were prostate (37 percent), lung (15 percent), and colorectal (12 percent) cancers. African American women were expected to be diagnosed most often with breast (27 percent), lung (13 percent), and colorectal (12 percent) cancers. Risk statistics: The major risk factors for cancer in all populations are socioeconomic status, tobacco use, and 29
African Americans and cancer being overweight or obese. African Americans are disproportionately poor: In 2004, more than 29 percent of African Americans fell below the poverty line, as opposed to 13 percent of whites. Because one-fifth of African Americans are uninsured, access to care, particularly preventive and screening care, is limited relative to the rest of the population. Limited detection, in turn, leads to later diagnoses and thus cancers that are more difficult to treat and to survive. Tobacco use—the biggest risk factor for the deadliest cancer, lung cancer—accounts for about 30 percent of cancer deaths overall. Among African Americans, lung cancer death rates are higher than those of whites, even though most African Americans begin smoking at a later age and smoke fewer cigarettes per day. The amount of each cigarette smoked, the type of cigarettes commonly smoked (mentholated, with higher concentrations of carbon monoxide), and the condition of the individuals who smoke (nutritional status and genetic differences) are predicted to account for the higher death rates. Overweight and obesity, which constitute a growing pandemic in American society generally, are defined as a body mass index (BMI) greater than 25 (overweight) or greater than 30 (obese). After tobacco use, obesity is the second leading cause of preventable deaths in the United States. According to the 2003 National Health and Nutrition Examination Survey, nearly 33 percent of U.S. adults were obese, and as early as 2002, overweight individuals formed 65 percent of the U.S. population. Among African Americans, 76 percent were either overweight or obese as of the year 2004. Obesity is positively correlated with certain cancers, particularly breast, endometrial, and colon cancers. Perspective and prospects: From the early 1970’s to 1992, rates of both incidence of and deaths from cancer increased among African Americans. After 1992, both death and incidence rates for all cancers among both sexes of African Americans, fortunately, declined. Five-year survival rates also improved, from only 27 percent in the early 1960’s to 57 percent by 2002. Nevertheless, to bring about parity with the rest of the population, some key factors must be addressed: The current health care system must educate, train, and prepare a health care workforce that is intimately aware of African American health issues and must be sensitive to perceptions, concerns, and fears that may exist in the African American population. A concerted effort must also be made to educate African Americans regarding the role they play in improving their own health. They must understand the importance of health care screenings, weight re30
Salem Health: Cancer duction and management, exercise, and regular physical examinations. Beyond prevention, however, African Americans continue to need better access to the health care system, improved medical insurance, more routine screenings, earlier detection, and better treatments upon diagnosis. With better access, informed African Americans can become empowered to take control of their health by seizing every opportunity to improve it. Christina J. Moose, M.A. u
For Further Information American Cancer Society. Cancer Facts and Figures for African Americans. Atlanta: Author, 2007. Bailey, Eric J. Medical Anthropology and African American Health. Westport, Conn.: Bergin & Garvey, 2000. Byrd, W. Michael, and Linda A. Clayton. A Medical History of African Americans and the Problem of Race, Beginnings to 1900. Foreword by Robert J. Blendon. New York: Routledge, 2000-2002. Collins, Catherine Fisher. African American Women’s Health and Social Issues. Foreword by Vivian W. Pinn. Westport, Conn.: Praeger, 2006. Rawls, George, Frank P. Lloyd, Jr., and Herbert Stern. Managing Cancer: The African American’s Guide to Prevention, Diagnosis, and Treatment. Roscoe, Ill.: Hilton, 2001. Reed, James, Neil Shulman, and Charlene Shucker. The Black Man’s Guide to Good Health: Essential Advice for the Special Concerns of African-American Men. New York: Berkley, 1994. Williams, Christopher Kwesi O., Olufunmilayo I. Olopade, and Carla I. Falkson, eds. Breast Cancer in Women of African Descent. London: Springer, 2006. u
Other Resources
African American Health Network http://www.aahn.com MedlinePlus African-American Health http://www.nlm.nih.gov/medlineplus/ africanamericanhealth.html National Cancer Institute Center to Reduce Cancer Health Disparities http://crchd.cancer.gov/index.html NetWellness African American Health Center http://www.netwellness.org/healthtopics/aahealth
Salem Health: Cancer
Africans and cancer
See also Africans and cancer; Asian Americans and cancer; Epidemiology of cancer; Ethnicity and cancer; Geography and cancer; Latinos/Hispanics and cancer; Polyps; Sézary syndrome; Smoking cessation; Statistics of cancer; Stomach cancers; Survival rates; Testicular cancer.
million people. In contrast, the average radiation machine in Europe serves a population of only about 250,000 people. Additionally, only fifteen countries in Africa have any radiation machines at all. The United Nations estimates that only about 20 percent of Africa’s population has any kind of radiation therapy available to them, and in many cases, available can mean hundreds of miles away.
u Africans and cancer
Problems of prevention and treatment: Africa faces many significant challenges to the successful prevention, early diagnosis, and treatment of cancer. Prevention of cancer requires education of the population about what types of things may increase the risks of developing cancer, and what things and lifestyle choices are believed to reduce the risk of cancer. Smoking and use of tobacco products in any form have been linked to cancer for many years. However, public education about the perils of smoking can be difficult, time-consuming, and expensive. Most African governments are already highly burdened, and there are rarely any budget dollars left to go to public education about something as intangible as smoking or tobacco use and its correlation with an increased risk for cancer. Another barrier to prevention in Africa is that what is considered a healthy lifestyle for cancer prevention is not accessible to many Africans. Most African countries have a per capita national income that labels them as low- or very low-income countries. Fresh, clean water and many different fruits, vegetables, whole grains, and lean proteins, all considered part of a healthy lifestyle in the United States and other developed countries, are not reasonably accessible to many people living in Africa. The opportunity for early diagnosis is severely lacking in most areas of Africa. Diagnosing cancer when it is in its earliest stages leads to the most positive prognosis. Many cancers that are treatable if found early are almost never treatable when diagnosed in a very late stage. Preventive health care is not readily accessible in most parts of Africa, and many people seek medical attention only when there is an obvious problem. Unfortunately, because many cancers produce severe symptoms only when in the later stages, this means that most cancers diagnosed in Africa are diagnosed at a stage too late to be treated successfully. This problem is caused by many interacting factors, including many people living too far from health care to reasonably get preventive screenings, lack of education about the benefits of early detection, and lack of medical professionals and facilities to do the screenings. The cost of preventive medicine and screenings is also often a barrier to early diagnosis. Even when an early diagnosis is made, there are many
Category: Social and personal issues Definition: According to the World Health Organization, cancer is the leading cause of death worldwide, and more than 70 percent of those deaths occur in countries that are considered low or middle income. Cancer is one of the top health problems in Africa, where access to quality health care is often barred by distance, availability, and income. Statistics: There are many barriers to good statistical analysis of cancer trends in Africa. There are no governmental agencies charged with the collection and monitoring of cancer statistics and trends as there are in the United States. In addition, many Africans live in remote areas and do not necessarily seek treatment in hospitals or clinics, so data about cancer incidence and mortality are difficult to collect and assess accurately. However, the World Health Organization (WHO) did compile statistics about cancer incidence and mortality in Africa as a whole in 2002. In that year, about 582,000 people (283,000 men and 299,000 women) living in sub-Saharan Africa developed cancer. Also in 2002, 412,100 in the same area died due to cancer. The most common forms of cancer in Africa among women were breast cancer, cervical cancer, and Kaposi sarcoma (a form of cancer common in individuals with acquired immunodeficiency syndrome, or AIDS). In men the most common cancers were Kaposi sarcoma, prostate cancer, and liver cancer. Lung cancer and stomach cancer were also very common and were especially likely to result in death. It is estimated that in 2020 804,000 people living in sub-Saharan Africa will develop cancer, and that 624,000 will die of it that year. There are many barriers to the successful treatment of cancer in Africa. In August, 2007, the World Health Organization estimated that 80 to 90 percent of the cancer cases that are encountered by doctors and hospital personnel in Africa are diagnosed when the cancer has developed and spread too far to be successfully treated. Additional difficulties occur because of significant lack of resources. According to the United Nations, Ethiopia did not receive a radiation therapy machine until 1997, and many years later it still had only one machine to serve a population of 65
31
Afterloading radiation therapy barriers to effective cancer care in Africa. There is a significant lack of the resources and equipment necessary for the treatment of cancer. Treating cancer is a process that requires many experts and technologically advanced equipment and drugs. Unfortunately, much of the necessary equipment is prohibitively expensive for most hospitals and clinics in Africa. Additionally, there is a lack of training programs and trained health professionals to run the equipment, administer medication, and oversee treatment. The dispersed nature of the population over most of Africa is also a barrier to effective care. Even if a country does have a few hospitals or centers with the staff and equipment necessary for cancer treatment, many millions of individuals may live too far from the center to be able to make effective use of what it offers. Another problem facing the African health care community in its attempts to successfully treat cancer is the AIDS epidemic. Millions of Africans are infected with the human immunodeficiency virus (HIV) or have AIDS, and it contributes to problems for cancer treatment in a number of ways. The AIDS epidemic is stretching the resources of the health care systems in most African countries very thin. Because AIDS impairs the immune system’s ability to function properly and ward off disease, individuals with AIDS need significant medical treatment for the many complications that occur. Individuals with AIDS are also more likely to develop cancer, especially Kaposi sarcoma, one of the most common cancers in Africa. This stretches the cancer resources that do exist even more thinly.
Salem Health: Cancer too bright, even small improvements in resources and education can make a huge difference in the number of Africans affected by cancer. Cancers that are usually detected early and cured in the United States and Europe could also be cured in Africa if they were detected early enough and the right treatment options were available. Progress made in improving the AIDS epidemic may also have beneficial effects on the rates of cancer incidence and mortality in Africa. As Kaposi sarcoma, a cancer common among those with AIDS, is one of the leading cancers in Africa, reducing the number of individuals infected with HIV should cause a reduction in the number of individuals with AIDS-related cancers. Helen Davidson, B.A. u
For Further Information O’Keefe, Stephen J. D., et al. “Why Do African Americans Get More Colon Cancer than Native Africans?” Journal of Nutrition 137, no. 1 (January, 2003): 175183. Sloan, Frank A., and Hellen Gelband, eds. Cancer Control Opportunities in Low- and Middle-Income Countries. Washington, D.C.: National Academies Press, 2007. U.S. Department of Health and Human Services, National Institutes of Health, and the National Cancer Institute. NCI International Portfolio: Addressing the Global Challenge of Cancer. Bethesda, Md.: National Cancer Institute, 2006.
u
Outlook for the future: The outlook for the future of cancer in Africa is not excellent, but it is improving. Although estimates suggest that there will be increasing numbers of cancer cases in Africa over the next decades, some organizations and groups are making strong efforts to stop the problem. Many of these efforts focus on increased access to prevention, early diagnosis, and access to treatment. In May, 2005, the World Health Organization adopted a resolution on cancer prevention and control. The resolution called on member states of the organization to take steps to reduce cancer incidence and mortality by creating and putting into action programs of cancer control. The WHO breaks down the areas of concern for countries that are working to stop cancer into four broad categories: prevention, early detection, diagnosis and treatment, and palliative care. Some private and corporate organizations are also working to help prevent and treat cancer in Africa. Various programs work to raise awareness of the problem of cancer in Africa and to raise money for desperately needed equipment, training, and education. Although the outlook is not 32
Other Resources
Cancer-Africa http://www.ialphan.com/cancerafrica/ World Health Organization http://www.who.int See also African Americans and cancer; HIV/AIDS-related cancers; Kaposi sarcoma; Rectal cancer.
u Afterloading radiation
therapy Category: Procedures Also known as: High dose rate remote afterloading (HDR) Definition: Afterloading radiation therapy is a form of high dose rate brachytherapy that uses a computer-controlled machine called an afterloader to deliver radiation from iridium 192 directly to a tumor. Iridium 192 is a radioac-
Salem Health: Cancer tive source that emits high-energy gamma rays, a type of radiation that is used to kill cancer cells. The radioactive source is contained in the lead-shielded machine and welded to a stainless steel cable that is inserted into the tumor through catheters, needles, or balloons placed in the tumor or tumor bed. Afterloading radiation therapy is considered a temporary implant because the radioactive source does not remain in the patient, and the patient is not radioactive. Cancers treated: Lung cancer, breast cancer, prostate cancer, head and neck cancers, uterine cancer, cervical cancer, esophageal and bile duct cancers, soft-tissue sarcoma, rectal cancer, others under study Why performed: The use of a high-dose remote afterloader provides more targeted therapy to the tumor, or to the tumor bed after the bulk of the tumor is removed in surgery. The afterloader provides more accurate dose delivery to the target site while better protecting normal tissue. Its use also provides a shorter course of therapy of approximately one week, as compared to external beam radiation therapy, which takes place over four to six weeks. The dose distribution is more even, and there are fewer hot (overdose) spots or cold (underdose) spots. Side effects occur less often with HDR therapy. Patient preparation: Planning for the use of afterloading radiation therapy often begins before an initial surgery, depending on the type of cancer and its site. The surgeon and the radiation oncologist will confer, as the catheters used in administering the radiation may be placed at the time of the initial surgery for the cancer. Catheters or needles may also be placed in an outpatient setting under local anesthesia or other sedation. Imaging or radiology studies may be used to assist in treatment planning for the optimal radiation dose delivery to the tumor site and to verify the location of the catheters, especially if it has been a few weeks since their placement. A simulation is done to visualize the tumor or tumor site in comparison to adjacent organs and tissues using a computed tomography (CT) scan or X ray. This procedure assists the radiation oncologist in planning the amount of dose that the afterloader will deliver. The simulation data are then loaded into a treatment-planning computer, which calculates the dose needed. Steps of the procedure: The patient arrives in the radiation oncology center and may change into a gown prior to receiving treatment. For some prostate treatments, needles may be placed prior to the treatment under local anesthesia. Upon entering the treatment room, the patient is assisted to a comfortable position that also allows access to
Afterloading radiation therapy the ends of the catheters or needles. The treatment catheters or needles from the patient are attached to the transfer tubes from the afterloader. The treatment personnel leave the room but can observe the patient using closed-circuit television and an intercom for communication. The treatment data loaded into the HDR unit control the movement of the source into the patient and the time that the source remains at various stops along the catheters or needles in order to achieve the distribution of dose planned. The source is placed in the patient for approximately ten to fifteen minutes, but a single treatment may take up to one hour or more. The complexity of the treatment, the site being treated, and the strength of the radioactive source will dictate the time involved. The radiation oncologist will discuss the number of treatments needed based on the disease, but treatment times vary from a few days to slightly more than a week. After the procedure: Depending on the site being treated, the patient may need to stay in the hospital or may be allowed to go home between treatments. A bandage may be placed over the catheters. After all treatments are complete, the catheters are removed by clipping the sutures holding the catheters, and they are withdrawn. A small amount of bleeding may occur, but it is quickly controlled with direct pressure, and a bandage is applied over the site. Risks: Risks are related to catheter movement out of the site being treated. It is important for patients to tell the radiation staff if a catheter seems to have moved, or if it gets snagged on clothing or the bandage at any time. A misplaced catheter or needle may deliver radiation to normal tissues or organs, causing radiation burns. There is a risk that cancer cells may be missed by the radiation. Results: Outcomes vary by the disease being treated, but success rates for HDR treatments are comparable to other forms of treatment in most instances. Patricia Stanfill Edens, R.N., Ph.D., FACHE u
For Further Information Hoskin, P. J., and P. Bownes. “Innovative Technologies in Radiation Therapy: Brachytherapy.” Seminars in Radiation Oncology 16, no. 4 (October, 2006): 209-217. Hoskin, P. J., K. Motohashi, P. Bownes, L. Bryant, and P. Ostler. “High Dose Rate Brachytherapy in Combination with External Beam Radiotherapy in the Radical Treatment of Prostate Cancer: Initial Results of a Randomized Phase Three Trial.” Radiotherapy & Oncology 84, no. 2 (August, 2007): 114-120. 33
Agent Orange National Cancer Institute. Radiotherapy and You: Support for People with Cancer. Available online at http://www .cancer.gov/cancertopics/radiation-therapy-and-you. u
Other Resources
American Cancer Society http://www.cancer.org American Society for Therapeutic Radiology and Oncology Patient Web Site http://www.rtanswers.org See also Brachytherapy; Cobalt 60 radiation; External beam radiation therapy (EBRT); Intensity-modulated radiation therapy (IMRT); Iridium seeds; Proton beam therapy; Radiation therapies; Radiofrequency ablation; Stereotactic radiosurgery (SRS).
u Agent Orange Category: Carcinogens and suspected carcinogens Also known as: Super Orange Related cancers: Soft-tissue sarcoma, non-Hodgkin lymphoma, Hodgkin disease, chronic lymphocytic leukemia (CLL), acute myelogenous leukemia (AML) Definition: Agent Orange was a chemical mixture used in the United States to control weeds and in Vietnam during the Vietnam War to remove forest cover. So named because of the orange stripes painted on its storage drums, Agent Orange is a blend of two herbicides: 2,4-dichlorophenoxyacetic acid (2,4-D) and 2,4,5-trichlorophenoxyacetic acid (2,4,5-T). Although 2,4,5-T is not highly poisonous, the manufacturing process generates a toxic by-product called TCDD, or 2,3,7,8-tetrachlorodibenzop-dioxin. This dioxin, classified as a human carcinogen, tainted Agent Orange formulations. Exposure routes: Inhalation, ingestion, skin contact, ocular absorption Where found: Herbicide mixtures formerly used for agricultural, forestry, and military purposes At risk: Combatants and civilians exposed to Agent Orange during the Vietnam War and their children, workers occupationally exposed to the chemical, and populations exposed through domestic herbicide spraying Etiology and symptoms of associated cancers: Because epidemiologic data on Vietnam veterans is limited, the 34
Salem Health: Cancer health effects of Agent Orange have been studied indirectly in certain populations highly exposed to dioxin or dioxin-tainted herbicides. These studies provide sufficient evidence linking Agent Orange to chloracne, an acnelike skin disorder, and to certain cancers, induced when TCDD activates a protein receptor in target cells. The soft-tissue sarcomas develop from fat, muscle, or deep body tissues and usually appear as a lump. Hodgkin disease (highly curable) and non-Hodgkin lymphoma originate in lymphatic tissue and result in painless swelling of lymph nodes under the skin. Chronic lymphocytic leukemia, which develops from white blood cells, is often asymptomatic, but later is marked by enlarged lymph nodes. Paternal exposure to Agent Orange has been associated with acute myelogenous leukemia in children. This fastgrowing cancer of the bone marrow produces abnormal white blood cells and results in fatigue, shortness of breath, and increased susceptibility to infection. Only limited evidence links Agent Orange to respiratory cancer, prostate cancer, and multiple myeloma. History: Phenoxy herbicides, including the 2,4,5-T component of Agent Orange, were developed in the 1940’s and widely used in agriculture and forestry. Starting in 1960 during the Vietnam War, the United States military sprayed Agent Orange onto lands in Vietnam and Laos. It suspended this activity in 1970, after a study in laboratory animals linked 2,4,5-T to birth defects. Since the 1980’s, various groups of Vietnam veterans have filed lawsuits against the makers of Agent Orange. The United States has permanently banned all uses of 2,4,5-T and, consequently, Agent Orange. Anna Binda, Ph.D. See also Dioxins; Multiple myeloma; Mycosis fungoides; Organochlorines (OCs); Pesticides and the food chain.
u Aging and cancer Category: Social and personal issues Definition: The most significant risk factor associated with developing cancer is age, with 60 percent of all cancers occurring in people who are sixty-five and over. Mortality rates are also highest in this age group; older individuals typically have additional chronic medical conditions that enhance the risk for simultaneously occurring psychiatric morbidity. These complex and potentiating trends are creating new clinical challenges that threaten to overwhelm the current health care system. Based on projections that 1 in 5 Americans will be over the age of
Salem Health: Cancer
Aging and cancer
Cancer is more common and deadlier in the elderly. (Digital Stock)
sixty-five by 2030, there is an immediate need to better understand the influence of age on cancer detection, diagnosis, and treatment, with the goal of modifying infrastructure, practices, and the educational preparation of future health care providers. Biology of aging and cancer: Based on the population trends, research aimed at illuminating the biology of aging and mechanisms that enhance cancer susceptibility are increasing. A clearer understanding of the well-documented age-related increase in cancer incidence is needed to develop well-conceived primary cancer prevention strategies. This line of research has been designated as a priority by the National Cancer Institute. At present, there are three major hypotheses that explain the association between cancer and age: Hypothesis 1 holds that the link between aging and cancer is simply related to duration of carcinogenesis. In other words, the high prevalence of cancer in older individuals simply reflects more prolonged exposure to carcinogens. Hypothesis 2 proposes that age-related, progressive changes within the human organism may provide an in-
creasingly favorable environment for the induction of new cancers and the growth of preexisting but latent malignant cells. These mechanisms may be related to proliferative senescence, whereby aging cells lose their ability to undergo apoptosis (a form of cell death that leads to the sequential elimination of cells without releasing harmful substances into the body). When apoptosis does not work right, cells that should be eliminated become immortal, stimulating cancer-related mutations at the cellular level. Hypothesis 3 combines aspects of the first two hypotheses and proposes that the aging, cancer-prone human phenotype is characterized by an accumulation of dysfunctional senescent cells. These cells proliferate via synergistic, simultaneous physiologic processes that foster progressive accumulation of cancer-prone mutations; silencing of genes that previously functioned to prevent cancerpredisposing mutations from developing in response to carcinogens (failure of epigenetic gene silencing); and telomere dysfunction (telomeres are specialized structures at chromosome ends that regulate their replication and stability). These changes are particularly relevant to the production of malignancies because they occur within the 35
Aging and cancer context of an aging microenvironment of surrounding tissues. Cancer, aging, and psychiatric comorbidity: As increased longevity contributes to rising cancer incidence, those diagnosed often have one or more additional chronic medical conditions. Paradoxically, new treatment discoveries have extended survival for multiple medical illnesses but often within the context of troubling side effects and consequences that in turn have led to documented increases in the incidence of psychiatric morbidity. The incidence of psychiatric morbidity is further enhanced as the burden of cancer care progressively shifts from the health care system to family caregivers. Family caregivers are usually aging spouses with medical problems of their own or adult children, with their own families, jobs, responsibilities, and problems. When the role of providing complex cancer care for a loved one is added to their already stressful lives, risk for psychiatric morbidity is significantly enhanced. Although the preceding issues have been largely ignored, they continue to strain the U.S. health care system to its limit. The preceding trends are occurring within a system in which mental health services are a low priority. Stigma, limited knowledge regarding the nature and intensity of psychiatric symptoms associated with clinical need, and inconsistent, generally inadequate reimbursement mechanisms are a sampling of the multiple issues contributing to
Problems to Consider in Treating Pain in Older Cancer Patients Other chronic illnesses: Patients taking multiple medications may be at risk for drug interactions. Impairments in hearing, vision, and mental function: Patients may need to be monitored more frequently and tests may need to be simplified. Patient-controlled analgesia: Patients are more sensitive to the side effects of these drugs, which remain in their bodies longer. Opioids: Patients may be more sensitive to the effects of these drugs and experience longer periods of pain relief. Side effects from nonsteroidal anti-inflammatory drugs (NSAIDs): Stomach and kidney toxicity, constipation, headaches, and difficulties with the ability to think may arise. Administration of medicine: Some older patients may not be able to administer some drugs as directed (for example, inserting a drug into the rectum). Source: National Cancer Institute
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Salem Health: Cancer our dismal state of mental health services. Research, professional education, and clinical services are most deficient with regard to the psychiatric morbidity that occurs within the context of a chronic medical illness. Psychiatric symptoms are typically treated only when they emerge as disease states within an expensive, fragmented, specialtyoriented system. Reimbursement for psychiatric treatment is difficult to obtain, yet paying out of pocket is prohibitive and biases care toward the affluent. Limited solutions to these consequential problems potentiate untold human suffering, negative clinical outcomes, and high resource utilization that could be avoided if problems were dealt with before they got out of hand. Cancer screening in the elderly: Considerable uncertainty regarding the use of cancer screening procedures in the elderly is illustrated by the range of age cutoffs recommended by various guideline panels. To address inconsistencies, it has been suggested that a comprehensive framework rather than specific age parameters should inform individual screening decisions in older cancer patients. Screening decisions should encompass estimates of life expectancy, risk of cancer death, documented screening outcomes, and a risk-benefit screening ratio. For example, harm may result from screening practices that detect and treat cancers that never would have become clinically significant. Because many cancer screening decisions in older adults cannot be answered solely by quantitative estimates of benefits and harms, consideration of predicted outcomes within the context of an individual’s values and preferences is an important aspect of informed screening decisions. Statistics reveal considerable underutilization of cancer screening practices in the United States. Having health insurance, a regular doctor, and a point of usual care all are associated with higher cancer screening rates and better preventive health care overall. When these supports are absent, cancer screening rates drop considerably. The lack of preventive services reimbursed by Medicare, the limited number of elders with comprehensive, employerprovided health coverage, and growing numbers of elders who are homebound or lack a regular physician and point of care make elderly Americans especially prone to lacking supports that facilitate cancer screening practices. Age-related differences in cancer treatment: Cancer treatments may produce different therapeutic and adverse responses based on patient age. For example, chemotherapy resistance and toxicity have been shown to vary by age, being more common and severe in the elderly. Treatment toxicities may develop in old versus young recipients because of increased vulnerability of target organs and de-
Salem Health: Cancer layed renal excretion of treatment agents and metabolites. These problems should be managed with treatment modifications determined by kidney function and other relevant parameters of individual health status and treatment response. Aging cancer patients often do not receive adequate information to assist with or inform a definitive treatment plan. Understanding why these deficiencies exist is vital to reducing disparities in cancer mortality between young and old. Studies suggest that treatment uncertainty could be better addressed if elderly cancer patients were offered a choice from a group of definitive therapies. Treatment discussions should also address common concerns related to the costs and functional consequences of each treatment in relation to expected benefits. Current understanding of age-related differences in pharmacokinetics, drug interactions, adverse events, and treatment adherence is extremely limited. Palliative cancer care of the elderly: Despite ambitious research, treatment, and educational initiatives, the quality of palliative care provided to the elderly has historically been and remains poor. Research consistently demonstrates unnecessary suffering among elderly patients with advanced cancer. Their suffering is related to myriad issues, including uncontrolled physical symptoms, depression, and unaddressed existential concerns. Wide gaps in palliative care services targeted to elderly patients with cancer occur across a range of settings, including hospice, where the approach to palliative care has been largely insufficient. Some studies report lower levels of psychological distress in elderly versus young cancer patients, which has been erroneously interpreted to mean that elders are better equipped to manage existential concerns because they are at a stage in life when death is expected. However, data may more accurately reflect age-related differences in exposure to prevention, screening, and treatment practices; the resultant cancer course; and symptom profiles. Results therefore indicate the need for ongoing research and education targeted to unraveling complex relationships between aging and cancer. Knowledge development and dissemination must be met aggressively with clinical initiatives throughout the twenty-first century and beyond as population, demographic, and clinical trends continue to outpace the availability of resources for elderly individuals with cancer. Jeannie V. Pasacreta, Ph.D., A.P.R.N. u For Further Information Hassett, M. J., et al. “Frequency and Cost of Chemotherapy-Related Serious Adverse Effects in a Population
Aging and cancer Sample of Women with Breast Cancer.” Journal of the National Cancer Institute 98, no. 16 (2006): 11081117. Kumar, H., P. Soares, L. Balducci, and B. Djulbegovic. “Treatment Tolerance and Efficacy in Geriatric Oncology: A Systematic Review of Phase III Randomized Trials Conducted by Five National Cancer InstituteSponsored Cooperative Groups.” Journal of Clinical Oncology 25, no. 10 (2007): 1272-1276. Lichtman, S. M., et al. “International Society of Geriatric Oncology Chemotherapy Taskforce: Evaluation of Chemotherapy in Older Patients—An Analysis of the Medical Literature.” Journal of Clinical Oncology 25, no. 14 (2007): 1832-1843. Muss, H. B. “Older Age: Not a Barrier to Cancer Treatment.” New England Journal of Medicine 345 (2001): 28-29. Talarico, Lilia, Gang Chen, and Richard Pazdur. “Enrollment of Elderly Patients in Clinical Trials for Cancer Drug Registration: A Seven-Year Experience by the U.S. Food and Drug Administration.” Journal of Clinical Oncology 22, no. 22 (2004): 4626-4631. Trimble, E. L., and M. C. Christian. “Cancer Treatment and the Older Patient.” Clinical Cancer Research 12, no. 7 (2006): 1956-1957. Yancik, R., et al. “Perspectives on Comorbidity and Cancer in Older Patients: Approaches to Expand the Knowledge Base.” Journal of Clinical Oncology 19 (2006): 1147-1151. u
Other Resources
AARP Foundation http://www.aarp.org/foundation American Cancer Society http://www.cancer.org American Geriatrics Society/Foundation http://www.americangeriatrics.org Family Caregiver Alliance http://www.caregiver.org Geriatric Mental Health Foundation http://www.gmhfonline.org/gmhf Medicare.gov http://www.medicare.gov National Institute on Aging http://www.nih.gov/nia See also Advance directives; Aids and devices for cancer patients; Caregivers and caregiving; Childbirth and can37
Aids and devices for cancer patients cer; Counseling for cancer patients and survivors; Do-notresuscitate (DNR) order; Elderly and cancer; End-of-life care; Living will; Medicare and cancer; Nutrition and cancer prevention; Occupational therapy; Overtreatment; Palliative treatment; Self-image and body image; Singlehood and cancer; Support groups; Survivorship issues; Young adult cancers.
u Aids and devices for cancer
patients Category: Social and personal issues Also known as: Prostheses, breast forms, positioning aids, nutritional aids, braces, canes, walkers, wheelchairs, aromatherapy products, music therapy products Definition: Aids and devices for cancer patients are designed to help a person live a more comfortable and enjoyable life in spite of the side effects of cancer treatment. Some aids and devices help temporarily hide the effects of a cancer treatment while others can improve mobility or provide comfort permanently.
Salem Health: Cancer Another side effect of cancer treatment can be difficulty swallowing and keeping food down. To help people facing this situation get proper nutrition, there are thickening products available to add substance to liquefied foods. These products include gelatin, tapioca flour, cornstarch, commercial thickeners, pureed vegetables, instant potatoes, and baby cereal. There are also a number of liquid nutritional supplement drinks, many available at local grocery stores, that can provide needed nutrition when other types of food cannot be eaten. Some cancer patients experience sun sensitivity. Sunscreen or protective clothing can help protect sensitive skin from the sun. Sunscreens can be found at drug and grocery stores, and a number of companies create clothing—pants, shirts, hats, and gloves—that has built-in sun protection. For both men and women, making an extra effort to maintain personal grooming routines can be a way to maintain a positive attitude. Organizations such as the American Cancer Society provide classes that address special concerns cancer patients may have about their grooming and beauty routines (for example, how to deal with thinning hair). Music can be a wonderful aid in lowering stress levels and helping cancer patients sleep better. It is also shown to reduce pain by increasing endorphins and boosting immunity. It is recommended that the music be sixty beats or less per minute to provide relaxation. Much classical music falls into this category. Many hospitals offer group music therapy sessions.
Comfort aids and devices: A number of products can help cancer patients with some of the physical and emotional discomfort they may experience because of their cancer treatment. Specialty positioning pillows and foam wedges can help patients on bed rest prevent bedsores. In addition, special seat cushions for wheelchair users can help distribute their weight evenly over a large area, preventing sores and easing discomfort. These cushions tend to be filled with either water or gel. Water-filled products help decrease body temperature and gel-filled help maintain body temperature. A simple straw can make drinking beverages easier for cancer patients with sores in the mouth. If dry mouth is a problem after the salivary glands have been removed or damaged by radiation, saliva substitute products can add moisture to a cancer patient’s mouth. A cool-mist humidifier can also help prevent dry mouth by moistening the air within a room. Note that it is important to keep the humidifier clean so that germs are not spread. A wheelchair can provide mobility for a cancer patient. (PhotoDisc) 38
Salem Health: Cancer Aromatherapy may also help ease discomfort. Scents are available to help with all kinds of ailments, from pain and discomfort to lethargy. For example, lavender is a calming scent and can help ease anxiety or sleeplessness. Aromatherapy products and books explaining how to use scents can be found at many health food stores and online. Patients should check for any side effects or interactions with medical conditions before using a particular scent. An inexpensive way that many cancer patients deal with their emotions is to keep a journal. Writing down their thoughts about their situation can be very therapeutic and make it easier to keep a positive outlook. Prosthetic devices: A second category of aids and devices includes prosthetic body parts. Prostheses are available for a large number of body parts, and cancer patients should discuss with their doctors the options available to them for replacing amputated extremities. These products can help individuals regain mobility or provide cosmetic benefits. Braces, canes, walkers, and wheelchairs can improve mobility, whether used on their own or in combination with prosthetic limbs. For breast cancer patients who have undergone mastectomies, prostheses provide more than cosmetic benefits. They can provide protection and pain relief during healing, help maintain proper posture, and help prevent back and shoulder pain. Breast forms made of silicone or fiber can be inserted into a specially made mastectomy bra or worn next to the skin with a special adhesive. Cooling pads can also be inserted into bras to help relieve pain while the area heals. Specialty vests with flat panels can provide post-radiation treatment comfort. In addition, special arm sleeves can be worn to help reduce swelling by providing graduated compression. Cancer patients experiencing hair loss may want to try using a satin pillowcase to help minimize loss and to provide comfort to their sensitive scalps. Head scarves and wigs can be worn to hide hair loss. Sleep and swim caps are also available to protect remaining hair and minimize additional hair loss. Cost and insurance coverage: Some comfort and prosthetic devices are covered by public and private insurance providers. Patients should contact the insurance company before purchasing an item to find out whether the device in question is covered and if any paperwork or special authorization is needed. Some companies may require a prescription from a physician and preauthorization before they will pay for a device. Other insurance companies ask patients to pay up front for an item and then be reimbursed. If an insurance company will not cover a product and the patient cannot afford it, sometimes local cancer sup-
Air pollution port agencies such as the American Cancer Society or CancerCare can help obtain the needed item or suggest other ways to get the necessary money to pay for the item. Jennifer M. Hickin, B.S. u
For Further Information Garrison, Kevin S. It’s Just a Matter of Balance. Baltimore: Gateway Press, 2005. Gaynor, Mitchell L. The Healing Power of Sound: Recovery from Illness by Using Sound, Voice, and Music. Boulder, Colo.: Shambhala, 2002. Kelly, Mary Olson. Number One Best Tools and Tips from the Trenches of Breast Cancer. Austin, Tex.: Books Beyond Borders, 2006. Klein, Karen. Mama Said There’d Be Days like This: A Twelve-Step Guide to Surviving a Mastectomy. Farmington, Conn.: Variegate Press, 2001. Oritz, Lori M. Facing the Mirror with Cancer: A Guide to Using Makeup to Make a Difference. Chicago: Belle Press, 2004. Shurr, Donald G., and John W. Michael. Prosthetics and Orthotics. Upper Saddle River, N.J.: Prentice Hall, 2001. Wilson, A. Bennett, Jr. A Primer on Limb Prosthetics. Springfield, Ill.: Charles C Thomas, 1998. u
Other Resources
American Cancer Society http://www.cancer.org CancerCare http://cancercare.org TLC http://www.tlcdirect.org See also Breast implants; Breast reconstruction; Caregivers and caregiving; Electrolarynx; Esophageal speech; Home health services; Hospice care; Integrative oncology; Living with cancer; Reconstructive surgery; Self-image and body image; Side effects.
u Air pollution Category: Carcinogens and suspected carcinogens RoC status: Asbestos, known human carcinogen since 1980; diesel exhaust particulate, reasonably anticipated human carcinogen since 2000. Other air pollutants that are known human carcinogens include benzene, 1,3-butadiene, radon, and tobacco smoke; 39
Air pollution
Salem Health: Cancer
those that are reasonably anticipated human carcinogens include formaldehyde and polycyclic aromatic hydrocarbons. Air pollutants such as ozone, oxides of nitrogen, and sulfur oxides are not listed in the Report on Carcinogens (RoC); however, epidemiologic studies (studies on populations) provide some evidence of their association with lung cancer. Of the many components of particulate matter (PM), only diesel exhaust particulate has been the subject of studies that led to its current classification. Also known as: Criteria air pollutants, toxic air pollutants Related cancers: Lung cancer, pleural and peritoneal mesotheliomas, gastrointestinal cancers, laryngeal cancer, cancers of the lymphatic and blood-forming systems (1,3butadiene) Definition: Air pollution is the presence of contaminants, many of which are carcinogens, in the air. Outdoors, pollution is largely a consequence of the combustion of fossil fuels for transport, power generation, and other human activities. Indoors, pollution is generated by burning solid
fuels, and the air may also contain asbestos, radon gas, environmental tobacco smoke, formaldehyde, and volatile organic compounds. Exposure routes: Inhalation Where found: Indoor and outdoor air. Outdoor pollutants can be carried far from their original source by air currents. At risk: Populations exposed to smog and particulate matter in air pollution, including inner-city residents; people living near electric-power-generating plants, factories, and refining plants; occupationally exposed railroad workers and synthetic rubber industry workers; people cooking indoors with solid fuels Etiology and symptoms of associated cancers: According to the World Health Organization, the air contains a complex mixture of pollutants, including primary emissions such as diesel soot particles and oxides of nitrogen produced during combustion processes, the products of atmospheric transformation such as ozone, and the sulfate particles formed by burning sulfur-containing fuels. Although air pollution is a minor contributor to lung
Exhaust from cars on congested freeways contains carcinogens. (©iStockphoto.com/Dan Eckert)
40
Salem Health: Cancer cancer compared with tobacco smoke, it can affect entire populations, and components of the pollutant mix might interact with other carcinogens, possibly increasing their effects. In 1995 researchers Aaron Cohen and C. Arden Pope III analyzed epidemiological studies and found that they consistently suggested that ambient air pollution, chiefly as a result of the incomplete combustion of fossil fuels, is responsible for increased rates of lung cancer. A study published in 1998 of nonsmoking adults over a fifteen-year period by David Abbey and his coworkers showed a strong association between ozone levels and lung cancer. The ozone at ground level (which people inhale) is not emitted directly into the air. It is created by chemical reactions between oxides of nitrogen, emitted in motor vehicle exhaust and by industrial facilities, and volatile organic compounds from many sources, including gasoline vapors and chemical solvents. The relation between ozone levels and lung cancer has been reported in many additional scientific studies. The major outdoor air pollutants linked to lung cancer are particulate matter, sulfur oxides, ozone, oxides of nitrogen, and volatile organic compounds. Particulate matter is the term for a mixture of solid particles and liquid droplets found in the air that come from soot, smoke, and diesel exhaust. The particles of most concern are those smaller than 10 micrometers in diameter. Once inhaled, the smaller particles can travel to the deepest regions of the lungs, where chemicals (such as those adsorbed to diesel exhaust particulate) can be released. Some of these chemicals cause deoxyribonucleic acid (DNA) mutations, which can lead to cancer. Many studies have demonstrated that exposure to indoor air pollutants has adverse effects on health. More than three billion people worldwide depend on solid fuels, including biomass fuels and coal, for their cooking and energy needs. Combustion of these materials indoors produces high levels of smoke that contains many pollutants, and there is consistent evidence of lung cancer in adults exposed to coal-generated pollutants, according to the World Health Organization. Inhaling asbestos fibers released from damaged or crumbled insulating materials or other products containing this material can lead to mesothelioma and several other cancers. Other common indoor air pollutants include formaldehyde, environmental tobacco smoke, radon gas, and polycyclic aromatic hydrocarbons (a class of volatile organic compounds). History: Many of the components of air pollution are recognized as known or reasonably anticipated carginogens, such as asbestos, benzene, 1,3-butadiene, radon, tobacco
Air pollution smoke, diesel exhaust particulate, formaldehyde, and polycyclic aromatic hydrocarbons. Other components have scientific research supporting their link to human cancer. The Clean Air Act as amended in 1990 requires the U.S. Environmental Protection Agency to set national ambient air quality standards for ozone, oxides of nitrogen, particulate matter, and sulfur oxides. The agency is mandated to work with state and local governments to reduce the release of other air pollutants classified as toxic air pollutants. Bernard Jacobson, Ph.D. u
For Further Information Beeson, W. L., D. E. Abbey, and S. F. Knutsen. “LongTerm Concentrations of Ambient Air Pollutants and Incident Lung Cancer in California Adults.” Environmental Health Perspectives 106 (1998): 813-822. Cohen, A. J., and C. Arden Pope III. “Lung Cancer and Air Pollution.” Environmental Health Perspectives 103, suppl. 8 (1995): 219-224. Jacobson, M. Z. Atmospheric Pollution. New York: Cambridge University Press, 2002. Krzyzanowski, M., B. Kunnadibbert, and J. Schneider, eds. Health Effects of Transport-Related Air Pollution. Geneva, Switzerland: World Health Organization, 2005. McGranahan, G., and F. Murray. Air Pollution and Health in Developing Countries. London: Earthscan, 2003. Pluschke, P., ed. Indoor Air Pollution. New York: Springer, 2004. Pope, C. Arden, III, et al. “Lung Cancer, Cardiopulmonary Mortality, and Long-Term Exposure to Fine Particulate Air Pollution.” Journal of the American Medical Association 287 (2002): 1132-1141. Ramachandran, G. Occupational Exposure Assessment for Air Contaminants. New York: CRC Press, 2005. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Eleventh Report on Carcinogens. Research Triangle Park, N.C.: Author, 2005. u
Other Resources
U.S. Environmental Protection Agency Pollutants/Toxics: Air Pollutants http://www.epa.gov/ebtpages/pollairpollutants.html World Health Organization Air Pollution http://www.who.int/topics/air_pollution/en/ See also Arsenic compounds; Bronchoalveolar lung cancer; 1,3-Butadiene; Cigarettes and cigars; Coke oven emis41
Alcohol, alcoholism, and cancer sions; Dioxins; Lung cancers; Occupational exposures and cancer; Polycyclic aromatic hydrocarbons; Radon; Smoking cessation; Soots; Tobacco-related cancers; Wood dust.
u Alcohol, alcoholism, and
cancer Category: Carcinogens and suspected carcinogens Definition: Alcohol is a chemical that is generated during fermentation of sugar. Ethyl alcohol is the specific chemical that is generally referred to as alcohol. Alcohol is the most commonly used intoxicating agent around the world. Alcoholism (also called alcohol-dependence syndrome) is a phenomenon of continuous intake of alcohol, with a compulsive need to consume it. Alcohol has been linked to several cancers but a direct causal relationship between the two has not been established. Alcohol as carcinogen: Intake of alcohol is considered a risk factor for developing various kinds of cancers, and therefore, alcohol has been classified as a carcinogen. Ethyl alcohol, the form in which alcohol is commonly consumed, undergoes an array of metabolic changes when ingested. The main enzymes that are involved in metabolism of alcohol are alcohol dehydrogenase and aldehyde dehydrogenase. A small amount (approximately 10 percent) is metabolized by microsomal cytochrome P4502E1 (CYP2E1). Alcohol dehydrogenase converts about 80 percent of ethanol to acetaldehyde. Acetaldehyde is a mutagen and a carcinogen and is considered a risk factor in many cancers of the upper gastrointestinal tract. Acetaldehyde is implicated in a variety of processes such as inflammation of the tracheal epithelium, delaying of cell cycle progression, induction of apoptosis, chromosomal damages and aberrations, and sister chromatid exchanges. Much of the carcinogenic effect of alcohol is attributed to this single metabolite. Direct association between the concentration of acetaldehyde in saliva and development of cancer has been reported. Acetaldehyde covalently bonds with deoxyribonucleic acid (DNA) and forms structures called DNA-adducts. The most common DNA-acetaldehyde adduct is N2-ethyl-dG, which is not mutagenic. Acetaldehyde also induces the formation of the mutagenic DNA adduct called Cr-PdG (alpha-methylgamma-hydroxy-1, N2-propano-2′-deoxyguanosine). Polyamines are one of the basic molecules essential for cells and are implicated in cell growth and differentiation, nucleic acid synthesis, and protection against oxidative 42
Salem Health: Cancer damage. Polyamines facilitate acetaldehyde-induced formation of Cr-PdG adducts. Cr-PdG adducts are highly mutagenic and interfere with DNA replication and repair, inducing cancer formation. Polyamines also react with acetaldehyde and form crotonaldehyde, which is highly carcinogenic. Response to alcohol is individualistic and differs among people and races. This is because of polymorphisms in the genes for the enzymes alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). Presence of the ALDH2*1/2 allele significantly increases the risk of upper aerodigestive tract cancer. In addition to these enzymes, oral bacteria also generate acetaldehyde. High amounts of acetaldehyde are detected in saliva after alcohol consumption. Saliva is directly in contact with the upper aerodigestive tract, and this contact is considered a possible mechanism for its carcinogenic effects. Alcohol and breast cancer: Alcohol is one of the most ancient intoxicants known to humankind. Consuming one or two drinks a day is not just common but is also a social custom in many cultures. However, research suggests that even one or two drinks a day could put women at a greater risk for developing breast cancer. A study conducted at the
Alcohol has been linked to several cancers, although a direct causal relationship has not been established. (PhotoDisc)
Salem Health: Cancer
How Much Is Too Much? The risk for cancers of the mouth, esophagus, pharynx, larynx, and liver in men and women and breast cancer in women increases after about two drinks per day for men and one per day for women. One drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80proof liquor. The risk for liver cancer goes up significantly after five or more drinks per day. Source: National Cancer Institute
National Cancer Institute tested postmenopausal women for differences in hormone levels after alcohol consumption (15 or 30 grams of alcohol per day) for eight weeks. Results showed a significant elevation of estrone sulfate (an estrogen metabolite) and the hormone DHEAS (dehydroepiandrosterone sulfate). DHEAS is secreted by the adrenal glands, and increased levels of DHEAS indicate induction of a process called adrenal steroidogenesis, reflecting stimulation of the hypothalamic-pituitaryadrenal axis in the brain as a response to alcohol consumption. Alcohol and liver cancers: Excessive consumption of alcohol leads to alcohol liver disease. One type of alcohol liver disease is called alcoholic cirrhosis of the liver, a condition in which normal liver tissue is completely destroyed. Cirrhosis of the liver is considered the primary risk factor for development of hepatocellular carcinoma (liver cancer). Even though alcohol does not seem to cause liver cancer directly, there is a strong association between alcohol and liver cancer.
Aleukemia all cancer-related deaths are caused by chronic alcohol consumption. Education to make people aware of the link between alcohol consumption and cancer should aid in prevention of such cancers. Geetha Yadav, Ph.D. u
For Further Information Cho, Chi Hin, and Vishnudutt Purohit, eds. Alcohol, Tobacco, and Cancer. New York: Karger, 2006. Dorgan, J. F., et al. “Serum Hormones and the AlcoholBreast Cancer Association in Postmenopausal Women.” Journal of the National Cancer Institute 93 (2001): 710-715. Seitz, H. K., B. Maurer, and F. Stickel. “Alcohol Consumption and Cancer of the Gastrointestinal Tract.” Digestive Diseases 23 (2005): 297-303. Seitz, H. K., and F. Stickel. “Molecular Mechanisms of Alcohol-Mediated Carcinogenesis.” Nature Reviews 7 (2007): 599-612. Yirmiya, Raz, and Anna N. Taylor, eds. Alcohol, Immunity, and Cancer. Boca Raton, Fla.: CRC Press, 1993.
u
Other Resources
American Cancer Society Alcohol and Cancer http://www.cancer.org/docroot/PRO/content/ PRO_1_1x_Alcohol.pdf.asp?sitearea=PRO National Cancer Institute Alcohol Consumption http://progressreport.cancer.gov/doc_detail .asp?pid=1&did=2007&chid=71&coid=706&mid= See also Esophageal cancer; Gastrinomas; Gastrointestinal cancers; Hepatomegaly; Laryngeal cancer; Liver cancers; Pancreatic cancers; Pancreatitis.
Alcohol and other cancers: Drinking two or more drinks per day increases the risk of oral and upper gastrointestinal tract (GI) cancers in both men and women. Alcoholrelated cancers include those of the mouth, esophagus, and larynx. Drinking alcohol together with smoking increases the risk of developing cancer more than drinking alone. Alcohol is addictive, and alcoholism leads to enhanced tolerance levels, loss of control, cravings for alcohol, and an inability to stop drinking even when people wish to stop or need to stop for their health. Evidence shows that the nutritional status of the body is also negatively affected by alcohol.
Related conditions: Acute and chronic myelogenous leukemia (AML and CML), acute and chronic lymphatic leukemia (ALL and CLL)
Perspectives and progress: According to World Health Organization statistics, alcohol is responsible for about 1.8 million deaths a year, and alcohol-related cancer is the most common cause of these deaths. Some 3.6 percent of
Definition: Aleukemia describes a condition in which a patient has a normal or reduced white blood cell count. Leukemia cells are present in the bone marrow. Leukemia cells may also be present in the blood. Aleukemia may be
u Aleukemia Category: Diseases, symptoms, and conditions Also known as: Aleukemic myelosis, aleukemic leukemia
43
Alkaline phosphatase test (ALP)
Salem Health: Cancer
present in any of the four major types of leukemia: AML, CML, ALL, and CLL.
u Alkaline phosphatase test
Risk factors: The risk factors are the same as those for leukemia. The risks include age, genetic diseases, prolonged exposure to some chemicals such as benzene, chemotherapies used to treat other forms of cancer, and exposure to high doses of radiation or tobacco smoke.
Category: Procedures Also known as: ALKP, alk phos, alkaline phosphatase total
Etiology and the disease process: Aleukemias start when there is damage to the deoxyribonucleic acid (DNA) of blood cells. Normal cell development is interrupted, causing a decrease of mature cells and an increase in immature cells. Incidence: Aleukemia is present at the start of about 25 to 30 percent of acute leukemias. It is more prevalent in hairy cell leukemia, which is a slow-growing subtype of CLL. Symptoms: There may be no symptoms present. Patients may experience fatigue, weight loss, easy bruising, fever, and infections. Screening and diagnosis: No specific screening test exists for aleukemia. A low white blood cell count found when a complete blood count (CBC) is done as part of a routine exam or in response to symptoms may lead to further testing and diagnosis. Diagnosis is made by the examination of blood smears and bone marrow for the presence of leukemia cells. Staging is not done for any of the leukemias except CLL. The staging of CLL is based on imaging studies, blood tests, and bone marrow examination. The stages, ranging from Stage 0 to IV, are based on the involvement of lymph nodes, spleen, and liver, and decreasing numbers of red blood cells. The other forms of leukemia are classified by cell type. Treatment and therapy: Treatment depends on the type of cell involved and the classification or staging level. In leukemias that progress slowly, treatment may not start until the disease is more advanced. Prognosis, prevention, and outcomes: Prognosis depends on the type of cell involved and the rate of progression. No method of prevention exists. Treatment may slow the progress of the disease or cause complete remission. Some types of leukemia may not respond to treatment. Wanda E. Clark, M.T. (ASCP) See also Acute lymphocytic leukemia (ALL); Acute myelocytic leukemia (AML); Anemia; Antiandrogens; Blood cancers; Chronic lymphocytic leukemia (CLL); Chronic myeloid leukemia (CML); Eosinophilic leukemia; Fanconi anemia; Leukemias. 44
(ALP)
Definition: Alkaline phosphatase (ALP) is an enzyme that helps in the process of digestion and bone development. All tissues contain ALP. Higher concentrations are found in the liver, bone, kidney, and intestines. Various processes within the tissues release ALP into the blood. By measuring ALP blood levels, doctors can determine the presence of liver and bone disease, including cancer. ALP levels are determined by testing serum or plasma on an automated chemistry analyzer. Cancers diagnosed: Cancers of the bone, renal cells, liver, gallbladder, and bile ducts Why performed: The test is done as a part of a chemistry or liver panel to detect liver or bone disease. Once a diagnosis has been made and treatment started, the test may be done to determine if treatment is effective or if disease has progressed or returned. Patient preparation: The patient may be asked not to eat or drink or take certain medications for six to twelve hours prior to the test. Steps of the procedure: A small sample of blood is collected from a vein and placed in a tube. In children, blood may be obtained from a capillary in the heel or finger. After the procedure: A small gauze or cotton ball is applied at the site of needle insertion. The patient is asked to apply pressure. The person collecting the blood observes the site for bleeding and may apply a bandage. The bandage may usually be removed in thirty to sixty minutes. Risks: Risks from the procedure include bleeding, bruising, hematoma (bleeding under the skin), fainting, lightheadedness, or the need for multiple needle sticks to obtain a sample. Results: Normal ALP levels vary by the patient’s sex and age and by the analyzer used. Each laboratory establishes a set of normal ranges based on this information. The physician receives a report of the test results with the normal values established by the testing laboratory. Elevated levels indicate the possibility of liver or bone disease, including the presence of a tumor. The test does not distinguish from which tissue the increased amount of alkaline phosphatase comes. The physician may order
Salem Health: Cancer
Alkylating agents in chemotherapy reactive compounds containing alkyl groups. They are employed as antineoplastics, drugs that kill neoplasms (cancerous tumor cells) by interfering with their deoxyribonucleic acid (DNA) and cell division.
other blood tests, including an alkaline phosphatase isoenzyme test that determines if the increased ALP comes from bone, liver, or intestine. Other procedures such as X rays may also be ordered. Following cancer treatment, ALP levels are expected to decrease. If levels remain high or increase, then some cancer may remain or has returned. Wanda E. Clark, M.T. (ASCP)
Cancers treated: Various, especially slow-growing cancers such as solid tumors and leukemias Subclasses of this group: Alkyl sulfonates, ethyleneimines and methylmelamines, nitrogen mustards, nitrosoureas, platinum compounds, triazenes
See also Immunocytochemistry and immunohistochemistry; Paget disease of bone; Placental alkaline phosphatase (PALP).
Delivery routes: These drugs are administered both intravenously and orally in capsule and tablet form, on an inpatient, outpatient, and at-home basis, depending on the specific drug, type of cancer, and its location and aggressiveness. When possible, these drugs are best delivered to the tumor site to limit damage to normal cells.
u Alkylating agents in
chemotherapy Category: Chemotherapy and other drugs ATC code: 101A
How these drugs work: One of the oldest classes of chemotherapeutic drugs, alkylating agents were discovered during World War II when physician Cornelius P. Rhoads drew a connection between the lowered white
Definition: Alkylating neoplastic agents form a class of chemotherapeutic drugs, all of which consist of highly
Common Alkylating Agents Subclass
Delivery Mode
Cancers Treated
Altretamine Hexalen (hexamethylmelamine)
Ethylenimines
Oral
Ovarian cancer
Busulfan
Alkyl sulfonates
Oral, IV
Chronic myelogenous leukemia, other blood cancers
Platinum compounds
IV
Ovarian carcinoma
Drug
Brands
Carboplatin (CBDCA)
Paraplatin
Carmustine (BCNU)
BiCNU, Nitrosoureas Gliadel Wafer
IV
Brain tumors, multiple myeloma, Hodgkin disease, non-Hodgkin lymphoma, malignant melanoma, breast cancer, gastrointestinal cancers, Ewing sarcoma, and Burkitt lymphoma; applied topically for mycosis fungoides
Chlorambucil
Leukeran
Nitrogen mustards
Oral
Chronic lymphocytic leukemia, some non-Hodgkin lymphomas, advanced Hodgkin disease
Cisplatin (CDDP)
Platinol-AQ
Platinum compounds
IV
Metastatic testicular tumors, metastatic ovarian tumors, advanced bladder carcinoma
Cyclophosphamide (CTX)
Cytoxan
Nitrogen mustards
Oral, IV
Lymphomas, multiple myelomas, leukemias, mycosis fungoides, neuroblastoma, ovarian carcinoma, retinoblastoma, breast cancer
Dacarbazine (DTIC)
DTIC-Dome
Triazenes
IV
Melanoma, Hodgkin disease
Ifosfamide (isophosphamide)
Ifex
Nitrogen mustards
IV
Germ cell testicular cancer, sarcomas
(continued on page 46)
45
Alkylating agents in chemotherapy
Salem Health: Cancer Side effects: Although alkylating agents are more toxic to cancer cells than to normal cells, these drugs are nonspecific. That is, they target normal as well as cancerous tissue, so they exhibit the “Janus effect”: They kill both bad and good cells. Therefore they have toxic side effects, depending on the specific drug, its dosage, the duration of administration, and the individual patient’s physical condition and attitude. Common side effects include depressed blood cell counts, tiredness and fatigue, diarrhea, alopecia (hair loss), nausea and vomiting, infertility (both amenorrhea in women and impaired spermatogenesis in men), damage to intestinal mucosa, exfoliation of the bladder epithelium resulting in fluid retention, and in extreme cases cardiotoxicity, which would mitigate the chemotherapy regimen. In addition, some alkylating agents increase the risk of future malignancies, such as acute myeloid leukemia, which may emerge years after treatment. Christina J. Moose, M.A.
blood cell counts in six hundred sailors (who had been exposed to mustard gas during the sinking of the Liberty in 1943) and the possibility that the nitrous mustards could be adopted for use in leukemia patients. It was later observed that alkylating agents substitute alkyl groups for the hydrogen groups in the DNA of tumor cells. The alkyl groups cross-link guanine nucleobases in the double-helix strands of DNA, which makes it impossible for the two DNA strands to uncoil and separate in preparation for replication. As a result, these drugs prevent tumor cells from dividing during mitosis, stopping the cells’ growth. They may also stimulate the natural process of cell death (apoptosis). Because DNA is more actively replicated and transcribed in rapidly dividing cancer cells than in normal cells, these drugs are more toxic to tumor tissue than to normal tissue. Alkylating agents are also known to add methyl or alkyl groups onto any of the four nitrogenous bases found in DNA(adenine, guanine, cytosine, thymine), frequently altering the base-pairing relationships and leading to new mutations.
Common Alkylating Agents (continued)
46
Drug
Brands
Subclass
Delivery Mode
Lomustine (CCNU)
CeeNU
Nitrosoureas
Oral
Brain tumors, Hodgkin disease, bronchogenic carcinoma, non-Hodgkin lymphomas, malignant melanoma, breast cancer, renal cell carcinoma, carcinoma of the GI tract
Mechlorethamine (nitrogen mustard)
Mustargen
Nitrogen mustards
IV
Hodgkin disease, lymphosarcoma, chronic myelocytic or chronic lymphocytic leukemia; polycythemia vera; mycosis fungoides, bronchogenic carcinoma, non-Hodgkin lymphomas, malignant melanoma, breast cancer, renal cell carcinoma, carcinoma of the GI tract; applied topically for mycosis fungoides
Melphalan (L-PAM)
Alkeran
Nitrogen mustards
Oral, IV
Multiple myeloma, ovarian carcinoma
Oxaliplatin (oxalatoplatin, oxalatoplatinum)
Eloxatin, Transplatine
Platinum compounds
IV
Advanced ovarian cancer; may be effective for head and neck cancers, skin cancer, lung cancers, and non-Hodgkin lymphomas
Procarbazine
Matulane, Natulane
Hydrazine derivatives
Oral
Hodgkin disease and other lymphomas, brain tumors, skin cancer, lung cancer, multiple myeloma, mycosis fungoides
Cancers Treated
Streptozocin
Zanosar
Nitrosoureas
IV
Pancreatic islet cell cancer
Temozolomide
Temodar
Triazenes
Oral
Brain tumors (astrocytomas)
Thiotepa
Thioplex
Ethylenimines
IV, spinal injection, bladder infusion
Bladder cancer, ovarian cancer, breast cancer, lymphomas, bronchogenic carcinoma, and metastatic pleural, pericardial, and peritoneal cancers
Salem Health: Cancer
Alopecia
u For Further Information Chabner, Bruce A., and Dan L. Longo, eds. Cancer Chemotherapy and Biotherapy: Principles and Practice. Philadelphia: Lippincott Williams & Wilkins, 2006. Fischer, David S., et al. The Cancer Chemotherapy Handbook. 6th ed. St. Louis: Mosby, 2003. Panasci, Lawrence C., and Moulay A. Alaoui-Jamali, eds. DNA Repair in Cancer Therapy. Totowa, N.J.: Humana Press, 2004. Podolsky, M. Lawrence. Cures out of Chaos. Newark, N.J.: Harwood Academic, 1997. Skeel, Roland T. Handbook of Cancer Chemotherapy. 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2003. u
Other Resources
National Cancer Institute Drug Information Summaries http://www.cancer.gov/cancertopics/druginfo/ alphalist See also Antineoplastics in chemotherapy; Bis(chloromethyl) ether and technical-grade chloromethyl methyl ether; 1,4-Butanediol dimethanesulfonate; Carcinogens, known; Carcinogens, reasonably anticipated; Chemotherapy; Chlorambucil; 1-(2-Chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea (MeCCNU); Cyclophosphamide; Infertility and cancer; Mustard gas; Sterility; Thiotepa.
u Alopecia Category: Diseases, symptoms, and conditions Also known as: Alopecia disseminata, alopecia universalis, alopecia totalis, baldness, hair loss, acomia, pelade Related conditions: Anagen effluvium, telogen effluvium Definition: Alopecia is abnormal loss of hair, a common side effect of treatments for cancers, including chemotherapy and radiation therapy. There are many types of alopecia, with many causes, including certain skin cancers and other types of cancer that spread to the skin, although marked hair loss from skin cancer is extremely rare. Risk factors: Chemotherapy for any cancer greatly increases the risk of alopecia, and radiation therapy increases the risk of hair loss from the irradiated area. Etiology and the disease process: Each human hair grows from a hair follicle, an elongated pouch formed during fe-
Chemotherapy has caused this woman to lose her hair. (© Lisa F. Young/Dreamstime.com)
tal development by growth of the upper part of the skin, the epidermis, down into the lower part, the dermis. The lower part of the follicle, the hair bulb, contains the germinal matrix, the cells that form the hair. Each hair goes through a three-phase growth cycle: anagen, or active growth; catagen, or regression; and telogen, or resting. When the telogen phase for each hair is complete, a new anagen phase begins. Human hairs complete their recurring growth cycle, as old hairs are pushed out by new hairs, in random order. At any given time, about 85 percent of hairs are in the anagen, or active growth phase. Chemotherapeutic agents target rapidly reproducing cells, like cancer cells. Unfortunately, these agents do not know the difference between a cancer cell and the rapidly reproducing cells of the germinal matrix in a hair bulb. They stop cell division, or mitosis, in matrix cells, just as they do in cancer cells. The anagen phase comes to a stop, and in many cases, all the hair that is in the anagen phase is shed. Hair lost through chemotherapy almost always regrows, because the hair follicle is left intact. Radiation therapy also stops the reproduction of rapidly dividing cells, but in higher doses, 47
Alpha-fetoprotein (AFP) levels radiation can damage the hair follicles it touches, preventing regrowth of hair. Incidence: At least some degree of hair loss is likely with many forms of chemotherapy. Certain drugs or combinations of drugs are virtually certain to cause some degree of hair loss. A few drugs cause nearly complete hair loss. Symptoms: Symptoms of alopecia related to cancer range from temporary thinning or breakage of a small patch of hair to loss of hair all over the body (alopecia disseminata, alopecia universalis, alopecia totalis), and hair loss can be temporary or permanent, depending on the cause. Screening and diagnosis: Diagnosis of chemotherapyrelated alopecia follows visible hair loss within days or weeks of administration of chemotherapeutic drugs. Treatment and therapy: Therapies for alopecia caused by chemotherapy include administration of vitamins, minerals, or omega-3 and omega-6 fatty acids—substances that promote healthy hair. The benefit of these therapies on cancer-related hair loss is still being researched, and consumption of some vitamins and minerals may reduce the effectiveness of chemotherapy, so any treatment for hair loss during therapy should be approved by the treating physician. Treatment for cancer-caused alopecia includes treatment for the underlying cancer, which may include surgery or chemotherapy. Again, noticeable hair loss from cancer itself is extremely rare. Prognosis, prevention, and outcomes: The prognosis for alopecia caused by chemotherapy depends on the chemicals used, the dosage, and the frequency of treatment. More intensive treatment is likely to cause more extensive hair loss. Whatever the amount or type of hair loss from chemotherapy, the prognosis is eventual regrowth of hair. Patchy regrowth may begin before chemotherapy is completed, an average of three to five months after initial hair loss from the first treatment. Because chemotherapy disrupts the matrix from which the hair is formed, including the melanocytes, or cells that give hair its color, regrown hair may differ in color or texture from the original hair. There has been some limited success in preventing scalp hair loss from chemotherapy through use of scalp cooling or a hairline tourniquet during administration of the chemotherapy. These, however, have been successful with only certain chemical agents. Their use has been questioned by some oncologists because, while they protect scalp follicles from damage, they also protect any cancer cells present in the scalp. Research trials are being conducted on other treatments that may reduce hair loss from chemotherapy. The prognosis for alopecia caused by radi48
Salem Health: Cancer ation therapy depends on the dosage of radiation. High doses usually cause permanent hair loss to the irradiated area; low doses more often cause temporary, local hair loss. Cathy Anderson, R.N., B.A. u
For Further Information Bleiker, T. O., N. Nicolaou, J. Traulsen, and P. E. Hutchinson. “‘Atrophic Telogen Effluvium’ from Cytotoxic Drugs and a Randomized Controlled Trial to Investigate the Possible Protective Effect of Pretreatment with a Topical Vitamin D3 Analogue in Humans.” British Journal of Dermatology 153, no. 1 (2005): 103-112. Jothilakshmi, P. K., A. J. Watson, and E. Jude. “Acute Alopecia Due to Metformin Treatment for Polycystic Ovarian Syndrome.” Journal of Obstetrics and Gynaecology 26, no. 6 (2006): 584-585. Wang, J., Z. Lu, and J. L. Au. “Protection Against Chemotherapy-Induced Alopecia.” Pharmaceutical Research 23, no. 11 (2006): 2505-2514. Wyatt, A. J., G. D. Leonard, and D. L. Sachs. “Cutaneous Reactions to Chemotherapy and Their Management.” American Journal of Clinical Dermatology 7, no. 1 (2006): 45-63.
u
Other Resources
Chemotherapy.com http://www.chemotherapy.com Healthline http://www.healthline.com WebMD http://www.webmd.com See also Alkylating agents in chemotherapy; Chemotherapy; Cyclophosphamide; Paraneoplastic syndromes; Radiation therapies; Self-image and body image; Side effects.
u Alpha-fetoprotein (AFP) levels Category: Procedures Also known as: Total AFP, AFP-13 percent, alphafetoglobulin, αFP, AFP tumor marker Definition: Alpha fetoprotein (AFP) is a protein produced by fetal tissue and by tumors. There are several forms of AFP. The test for AFP generally measures total AFP. The test is performed on serum or plasma on an automated chemistry analyzer.
Salem Health: Cancer Cancers diagnosed: Cancers of the liver, testes, and ovaries Why performed: The AFP test is done to detect and monitor cancers of the liver, testes, and ovaries. Physicians may order the test for patients with chronic liver disease because of the high risk of developing liver cancer. Because AFP is also produced by a fetus, AFP levels are generally higher in pregnant women. A test for AFP done on pregnant women is not done to detect a tumor but is used with other data to detect possible abnormalities in the developing fetus. Patient preparation: No special preparation is necessary. Steps of the procedure: A small sample of blood is collected from a vein and placed in a tube. In children, blood may be obtained from a capillary in the heel or finger. After the procedure: A small gauze or cotton ball is applied at the site of needle insertion. The patient is asked to apply pressure. The person collecting the blood observes the site for bleeding and may apply a bandage. The bandage may usually be removed in thirty to sixty minutes. Risks: Risks include bleeding, bruising, hematoma (bleeding under the skin), fainting, light-headedness, or the need for multiple needle sticks to obtain a sample. Results: Normal AFP levels vary by the patient’s sex and age and by the analyzer used. Each laboratory establishes normal ranges based on this information. The physician receives a report of the test results with the normal values established by the testing laboratory. AFP decreases at birth, and adult levels are normally low. Elevated levels are present in liver cancer and in some cancers of the testes and ovaries. Generally, higher levels of AFP indicate a larger tumor. The test is not considered specific for diagnosis, but it is an indicator that a tumor may be present. Physicians may order imaging studies and additional laboratory tests to determine the presence of a tumor. Some physicians order a test called AFP-13 percent, as 13 is one of the forms of AFP that make up the total. An increased percentage of AFP-13 to total AFP indicates an increased risk of developing liver cancer or a poorer prognosis. AFP levels usually return to normal within a month of treatment. Wanda E. Clark, M.T. (ASCP) See also Ataxia telangiectasia (AT); Beckwith-Wiedemann syndrome (BWS); Germ-cell tumors; Pathology; Placental alkaline phosphatase (PALP); Proteomics and cancer research; Testicular cancer; Yolk sac carcinomas.
Alveolar soft-part sarcomas
u Alveolar soft-part sarcomas Category: Diseases, symptoms, and conditions Also known as: Nonrhabdomyosarcoma soft-tissue sarcomas, ASPS Related conditions: Soft-tissue sarcomas Definition: Alveolar soft-part sarcoma is a slow-growing, malignant tumor that develops in deep soft tissues and muscles, most often in the thighs and buttocks. It is also found in the arm, chest, bladder, abdomen, and—in children—the head and neck. It gets its name from the way the tumor cells are clustered, resembling alveoli, or the air sacs of the lungs. Risk factors: No risk factors are known, and alveolar softpart sarcoma is nonhereditary. Etiology and the disease process: The disease’s etiology is murky. Early development of alveolar soft-part sarcoma appears to be linked to a genetic mutation involving the separation of a gene from chromosome 17 and its attachment to the X chromosome. A wealth of blood vessels allows tumor cells to enter the bloodstream and spread to other areas, usually the lungs and brain. Childhood alveolar soft-part sarcoma appears to have a different, and generally less aggressive, biology. Incidence: Alveolar soft-part sarcoma is rare, with 40 to 80 new cases annually in the United States. About half of alveolar soft-part sarcoma patients are between the ages of fifteen and twenty-nine, and women generally outnumber men, especially among younger patients. Symptoms: Common symptoms include a soft, painless lump, soreness, reduced range of motion, and numbness. Because alveolar soft-part sarcoma grows slowly in deep, elastic tissues, patients often do not notice symptoms until the cancer is advanced or has spread. Screening and staging: Diagnostic procedures include laboratory tests and imaging studies such as computed tomography (CT) scans, magnetic resonance imaging (MRI), and bone scans. A biopsy is required, however, to confirm alveolar soft-part sarcoma. Tumors are staged based on size, grade, and degree of spread: • Stage I: Low grade, with little potential for spreading • Stages II and III: High grade, with increased potential for spreading • Stage IV: Metastasis to distant organs Other criteria are typically used for staging pediatric alveolar soft-part sarcoma. 49
Amenorrhea Treatment and therapy: Surgical removal of the tumor and surrounding tissue is the primary treatment. Radiation therapy may be used before to shrink the tumor and after to kill any remaining cells, although it is used in children only if surgery alone is ineffective. Chemotherapy is not generally beneficial. Other therapies are under study. Prognosis, prevention, and outcomes: The five-year survival rate for patients with localized tumors is around 80 percent. If the disease has metastasized, the rate drops to 20 percent. However, long-term survival is possible even with spread because alveolar soft-part sarcoma grows slowly. The prognosis for children is considerably better, as their tumors are generally smaller and localized. Alveolar soft-part sarcoma can recur more than ten years after initial diagnosis, so long-term follow-up is recommended. Judy Majewski, M.S. See also Dermatofibrosarcoma protuberans; Ewing sarcoma; Fibrosarcomas, soft-tissue; Hemangiosarcomas; Liposarcomas; Mesenchymomas, malignant; Rhabdomyosarcomas; Sarcomas, soft-tissue; Synovial sarcomas.
u Amenorrhea Category: Diseases, symptoms, and conditions Also known as: Primary amenorrhea, secondary amenorrhea, absent periods, absent menses, absent menarche Related conditions: Pregnancy, menopause, pituitary or gynecologic tumors Definition: Amenorrhea is the absence of menstruation, whether temporary or permanent. Amenorrhea is normal prior to puberty, during pregnancy and lactation, and after menopause. Amenorrhea may also occur as the symptom of a variety of abnormal conditions, including pituitary or gynecologic tumors, and is an expected result of many chemotherapeutic cancer drugs. Primary amenorrhea is the absence of menarche, the initial menstrual period, in women age sixteen and older. Menarche occurs normally in women between the eleventh and seventeenth year. The average age of menarche in the United States is 12.8 years. Secondary amenorrhea is absence of menses for three months in a woman with previously normal menstruation and for nine months in a woman with oligomenorrhea, which is infrequent periods and fewer than the normal eleven to thirteen a year. 50
Salem Health: Cancer Risk factors: Both primary and secondary amenorrhea can be influenced by a host of other factors, some of which include immunodeficiency, anorexia nervosa, congenital abnormalities of the reproductive tract, obesity, diabetes, dietary restriction, starvation, metabolic disorders, drugs, and excessive physical exercise. Amenorrhea can also signal a pituitary or a gynecologic tumor, and it is a common and even expected result of chemotherapy or radiation treatment for cancer. Etiology and the disease process: Amenorrhea is often due to the absence or change in hormones produced in the hypothalamus, the pituitary gland, or the ovaries (the triad that directs reproduction), and it can result from an abnormality in the outflow tract. In primary amenorrhea, in the presence of secondary sex characteristics and a uterus, the most common cause is outflow tract obstruction with a transverse vaginal septum or imperforate hymen, both easily correctable. However, primary amenorrhea can also have a genetic cause. The most common cause of secondary amenorrhea is pregnancy during a woman’s reproductive years. Secondary amenorrhea may also be related to lifestyle choices. Athletes and ballet dancers who train vigorously often experience missed periods. Stress, obesity, and starvation can also result in secondary amenorrhea. In these cases, women stop menstruating because the ovaries do not produce enough estrogen in a cyclic manner to cause the uterine lining to thicken and shed normally. If pregnancy is not the cause, the physician may test the patient’s levels of hormones produced by the thyroid and the pituitary glands. When amenorrhea is accompanied by elevated levels of prolactin, galactorrhea, headaches, or visual disturbances, a pituitary tumor may be the cause. Adenomas are the most common cause of anterior pituitary dysfunction. Gynecological tumors such as ovarian cancer must also be ruled out in the presence of amenorrhea. Cancer treatments such chemotherapy and radiation are often associated with amenorrhea. The greater the dose of the chemotherapeutic agent, the greater the chance of amenorrhea. Studies linking particular cancer treatments to the incidence of amenorrhea remain incomplete, but two drugs particularly linked to amenorrhea are doxorubicin and cyclophosphamide. Incidence: In the United States, the incidence of primary amenorrhea is 2.5 percent. The incidence of secondary amenorrhea is between 1 and 4 percent. Rarely, the cause of amenorrhea is a tumor of the pituitary. The true incidence of pituitary adenomas is difficult
Salem Health: Cancer to know with certainty because they are often asymptomatic; autopsy estimates range from 2.7 to 27 percent. Symptoms: The first sign of primary amenorrhea is the absence of menses. If the cause of absence of flow is an anomaly of the outflow tract of the blood, the patient may experience cramping and severe abdominal pain. In the case of secondary amenorrhea, other that the absence of menstruation, symptoms may include: • galactorrhea, in which case the breasts produce milk in a woman who is not pregnant or breastfeeding • headache or reduced peripheral vision as a potential sign of an intracranial tumor • hirsutism, or increased hair growth in a male pattern caused by excess androgen • vaginal dryness, hot flashes, night sweats, or disordered sleep, suggesting ovarian insufficiency or premature ovarian failure (premature menopause) • excessive weight gain or loss • anxiety Screening and diagnosis: With primary amenorrhea and the absence of secondary sex characteristics, the physician may order an ultrasound to determine if a uterus is present and measure the levels of two hormones produced by the anterior pituitary: the follicle stimulating hormone (FSH), which stimulates growth of the follicle in the ovary, and luteinizing hormone (LH), which triggers ovulation. Very low levels suggest that the gonads, or sex glands, have failed to develop or begin functioning. Karyotyping to study the chromosome arrangement may reveal a genetic reason for the absence of menarche. An example is Turner syndrome, which is a congenital endocrine disorder caused by failure of the ovaries to respond to pituitary hormone stimulation. In addition to primary amenorrhea and failure of sexual maturation, the physical examination may note short stature. About onethird of the patients show webbing of the neck, marled cubitus valgus (a deformity of the arm in which the forearm deviates laterally), and developmental disabilities. Often genetic studies reveal the presence of only 45 chromosomes, the second X chromosome being absent. Treatment and therapy: A thorough medical history often reveals the cause of amenorrhea, which can then be corrected by surgery, medication, or lifestyle changes. Secondary amenorrhea may be caused by some medications such as phenothiazines, some narcotics, and any condition related to pituitary insufficiency or thyroid dysfunction. For cases due to lifestyle choices, reducing the amount or intensity of exercise and maintaining a healthy
Amenorrhea weight should correct hormone levels and result in a return to regular periods. If is determined to be a symptom of a pituitary or gyencologic tumor, the patient will undergo tests for malignancy and follow-up treatment and therapy indicated for the particular cancer diagnosed. Prognosis, prevention, and outcomes: Most cases of amenorrhea are treatable, although some resulting from genetic conditions cannot be corrected. In women with low thyroid-stimulating hormone (TSH), or hypothyroidism, which is more often associated with hypermenorrhea or oligomenorrhea, the menstrual cycle is often returned to normal following hormone replacement therapy. If a pituitary tumor is causing the amenorrhea, these tumors are rare and often asymptomatic, seldom resulting in death. They are typically slow growing and benign. However, the numerous hormones produced in the pituitary orchestrate many bodily functions, so patients with these tumors may face a lifetime of hormone replacement and long-term follow-up care. Jane Adrian, M.P.H., Ed.M., M.T. (ASCP) u
For Further Information Bell, Ruth, et al. Changing Bodies, Changing Lives: A Book for Teens on Sex and Relationships. 3d ed. New York: Times Books, 1998. Hobart, Julie A., and Douglas R. Smucker. “The Female Athlete Triad.” American Family Physician 61, no. 11 (June 1, 2000). Master-Hunter, Tarannum, and Diana L. Heiman. “Amenorrhea: Evaluation and Treatment. ” American Family Physician 73, no. 8 (April 15, 2006). Slap, Gail B. “Amenorrhea.” In The Gale Encyclopedia of Childhood and Adolescence, edited by Jerome Kagan. Detroit: Gale, 1998.
u
Other Resources
American College of Obstetricians and Gynecologists http://www.acog.org American Society for Reproductive Medicine http://www.asrm.org See also Alkylating agents in chemotherapy; Chemotherapy; Endometrial cancer; Infertility and cancer; Neuroendocrine tumors; Ovarian cysts; Sterility. 51
American Association for Cancer Research (AACR)
u American Association for
Cancer Research (AACR) Category: Organizations Definition: Founded in 1907, the American Association for Cancer Research (AACR) is a nongovernmental organization of physicians, scientists, and advocates seeking to overcome the burden of cancer through research and dissemination of information. With more than 24,000 members in more than sixty countries, it is one of the largest organizations of its kind. Funding research: The AACR does not conduct cancer research itself but instead acts as a base of financial support for researchers. There are two basic types of support provided by the organization: direct research funding and scholarly or travel grants. As of 2007, the annual budget of the AACR was approximately $3.65 million. Approximately 69 percent of that went to funding research, while 15 percent went to education programs, and the remaining 16 percent was required for operational expenses. The AACR has provided more than $16 million dollars in research funding since 1993. The AACR provides three major grants that directly fund cancer research. The Jeannik M. Littlefield-AACR Grants in Metastatic Colon Cancer Research provide awards ranging from $500,000 to $1 million; four of these grants were given in 2007. The BCRF-AACR Grants for Translational Breast Cancer Research provide awards up to $250,000; three of these grants were given in 2007. The Avon Foundation-AACR International Scholar Awards in Breast Cancer Research provide up to $100,000; twelve of these grants were awarded in 2007. The AACR also has four other grants that range from $30,000 to $50,000. All of these awards pay for expenses such as laboratory equipment, materials, salaries, and limited travel. The other type of grant that the AACR provides helps students and scientists attend the many workshops and conferences offered by the AACR and other cancer research organizations. These types of grants may cover travel expenses, housing, and registration fees. Without such grants, many researchers, especially those who are younger or are just beginning to build a reputation in the field, would not be able to attend these collaborative events. Publications: Because dissemination of information is of vital importance, both to researchers seeking to make scientific progress and to the doctors and patients seeking treatment options, the AACR publishes five journals and one magazine. Each of these journals is peer-reviewed, 52
Salem Health: Cancer and together they contain approximately 23,000 pages each year. The AACR’s earliest journal, Cancer Research, was first published in January of 1949. It is the most highly quoted cancer journal worldwide. It accepts work from all areas of cancer research and is published bimonthly. Clinical Cancer Research focuses specifically on innovative clinical research, especially that which bridges the gap between laboratory research and clinical application. It began in January of 1995 and is also published on a bimonthly basis. Cancer Epidemiology, Biomarkers and Prevention was first published in November of 1991 and is published monthly. The journal focuses on the causes of cancer and cancer prevention. The AACR’s newest journals, Molecular Cancer Therapeutics and Molecular Cancer Research, were first published in 2001 and 2002, respectively. These journals focus on cancer research developments in molecular biology and are published on a monthly basis. CR magazine, which stands for “collaborations, results,” is intended not only for research scientists and physicians but also for people who have cancer, survivors of cancer, and anyone who is affected by the disease. The AACR hopes to help create community and camaraderie among people affected by cancer, providing the emotional support that many patients and family members need. The editorial board for the magazine is made up of cancer research scientists, cancer advocates, and cancer survivors. It began publication in the spring of 2006 and is published quarterly. CR magazine also provides podcasts of cancer news stories on its Web site. Events: To facilitate communication among scientists, the AACR holds numerous workshops, meetings, and conferences. The Annual Meeting of the AACR is the largest annual meeting in the field and is regarded by many cancer researchers as the most important. In 2007, it hosted more than 16,000 cancer scientists at the Los Angeles Convention Center. For five days, these scientists attended forty-six symposia, twenty forums, sixty-nine sessions, and more than forty minisymposia. Almost six thousand abstracts were presented at the seven poster sessions. The AACR publishes the proceedings of its annual meeting and also makes them available on its Web site, along with audio recordings and Webcasts from the event. In addition to the annual meeting, the AACR holds several large conferences and around a dozen smaller conferences. The larger conferences usually have between 500 and 3,000 attendees and focus on such topics as racial and ethnic disparities in cancer, molecular diagnostics, and cancer prevention. Smaller conferences usually attract be-
Salem Health: Cancer tween 150 and 400 people, and the topics tend to cover a great variety of special subjects, such as oncogenomics or proteomics in cancer research. The AACR also aids younger cancer researchers by organizing educational workshops throughout the year. These workshops are designed to provide opportunities for young investigators to develop essential research skills. Robert Bockstiegel, B.S. u For Further Information Jeffries, Lee P., ed. Leading Topics in Cancer Research. New York: Nova Science, 2007. Martakis, Ignatius K., ed. Cancer Research at the Leading Edge. New York: Nova Science, 2007. Pereira, Larissa S., ed. Cancer Research Perspectives. New York: Nova Science, 2008. u
Other Resources
American Association for Cancer Research http://www.aacr.org American Society of Clinical Oncology http://www.asco.org Association of American Cancer Institutes http://www.aaci-cancer.org See also American Cancer Society (ACS); American Institute for Cancer Research (AICR); Dana-Farber Cancer Institute; Duke Comprehensive Cancer Center; Fox Chase Cancer Center; Fred Hutchinson Cancer Research Center; Jonsson Comprehensive Cancer Center (JCCC); M. D. Anderson Cancer Center; Mayo Clinic Cancer Center; Memorial Sloan-Kettering Cancer Center; National Cancer Institute (NCI); National Science Foundation (NSF); Prevent Cancer Foundation; Robert H. Lurie Cancer Center.
u American Cancer Society
(ACS) Category: Organizations Also known as: American Society for the Control of Cancer Definition: The American Cancer Society (ACS) is an organization that provides cancer information, aids cancer patients, and collects and contributes funds for cancer research. History: Several New York City physicians established the American Society for the Control of Cancer (ASCC),
American Cancer Society (ACS) the ACS’s predecessor, in 1913. At that time, approximately 75,000 people in the United States died of cancer each year. ASCC leaders strove to educate people, including medical professionals, regarding cancerous conditions and treatments. The ASCC published articles in both mainstream and professional periodicals. During the mid-1930’s, ASCC Women’s Field Army volunteers distributed cancer information directly to people and collected funds for the organization’s work. By 1938, approximately 150,000 people were affiliated with the ASCC. After World War II, the renamed American Cancer Society (ACS) embraced research to control cancer. The ACS introduced its list of seven cancer warnings in 1947. Services and procedures performed: The ACS emphasizes cancer prevention, mitigating physical and emotional pain, and survival. The society strives to decrease cancer occurrence and death rates. ACS funds from donors advance cancer research, create educational material, staff the National Cancer Information Center, provide such support services as housing near cancer centers for patients and people accompanying them, and publicize issues relevant to cancer control. The ACS Web site posts cancer information, and the organization distributes printed and visual media to individuals and health centers. The ACS’s Cancer Survivor Network enables people affected by cancer to communicate. The ACS seeks donors, ranging from individuals to corporations. Fund-raisers include the ACS’s Relay for Life. A board of directors oversees national ACS activities, including distribution of fellowships and grants. Divisions and local units also conduct ACS work. By 2006, about three million volunteers, representing both medical professionals and people from other walks of life, participated in providing ACS services. Research: The ACS invests the most private funds for oncology investigations in the United States. ACS leaders support innovative research seeking to identify causes of cancer and to improve prevention and treatment methods. By the early twenty-first century, the ACS had invested $3 billion for researchers to pursue investigations. As of 2007, the ACS awarded peer-evaluated projects $130 million yearly. ACS-supported achievements created better screening techniques such as the prostate-specific antigen (PSA) test. The ACS funded research evaluating the use of Pap smears to detect cervical cancer and mammograms to detect breast cancer. Treatment methods also benefited from ACS financial support. Funded by the ACS, Sidney Farber studied the use of aminopterin to accomplish remission of 53
American Institute for Cancer Research (AICR) cancer, enabling chemotherapy to become a viable method to treat many cancers. ACS-supported researchers focusing on pediatric oncology developed more effective methods to combat leukemia in children. Investigators used ACS research money to study genes associated with cancer. An ACS-financed study linked cigarettes and cancer. ACS research funds contributed to creation of anticancer pharmaceuticals. Education: The ACS creates and distributes educational information to enhance people’s awareness of cancer issues. The society stresses preventing cancers by embracing healthy behaviors. The ACS urges people to seek cancer screening to detect cancers and seek treatment expeditiously to aid survival. The society’s information is incorporated in health lessons taught in many U.S. schools. ACS advertisements in various media promote colorectal and breast cancer screening and stopping smoking. The ACS publishes three journals for medical professionals, educational guides devoted to specific cancers, and books for patients’ children and caregivers. The society’s cookbook has appeared in several editions as new information regarding nutritional aspects of cancer prevention is determined. The ACS distributes Cure: Cancer Updates, Research & Education. The society supports workshops and conferences where medical professionals learn about current oncology information and methods. Advocacy: In 2007, the ACS devoted $15 million to advertisements for print and television commercials stressing how lack of insurance affects cancer detection and treatment. The ACS allied with other health groups and the American Association of Retired Persons (AARP) to promote better health care access. The nonpartisan Cancer Action Network (CAN) complements the ACS, conducting lobbying, which the ACS cannot pursue. CAN’s political work includes securing nonsmoking areas, preparing voter guides, and sponsoring a hotline to contact politicians. Elizabeth D. Schafer, Ph.D. u For Further Information American Cancer Society. The American Cancer Society’s Healthy Eating Cookbook: A Celebration of Food, Friends, and Healthy Living. 3d ed. Atlanta: American Cancer Society, 2005. Herdman, Roger, and Leonard Lichtenfeld, eds. Fulfilling the Potential of Cancer Prevention and Early Detection: An American Cancer Society and Institute of Medicine Symposium. Washington, D.C.: National Academies Press, 2004.
54
Salem Health: Cancer Ross, Walter S. Crusade: The Official History of the American Cancer Society. New York: Arbor House, 1987. Stein, Kevin, et al. “The American Cancer Society’s Studies of Cancer Survivors.” American Journal of Nursing 106, no. 3 (March, 2006): 83-85. u
Other Resources
American Cancer Society http://www.cancer.org American Cancer Society Cancer Action Network http://www.acscan.org Cure: Cancer Updates, Research, and Education http://www.curetoday.com See also American Association for Cancer Research (AACR); American Institute for Cancer Research (AICR); Dana-Farber Cancer Institute; Duke Comprehensive Cancer Center; Fox Chase Cancer Center; Fred Hutchinson Cancer Research Center; Jonsson Comprehensive Cancer Center (JCCC); M. D. Anderson Cancer Center; Mayo Clinic Cancer Center; Memorial Sloan-Kettering Cancer Center; National Cancer Institute (NCI); National Science Foundation (NSF); Prevent Cancer Foundation; Robert H. Lurie Cancer Center.
u American Institute for Cancer
Research (AICR) Category: Organizations Definition: The American Institute for Cancer Research (AICR) is a private charity that sponsors research into the relationship between diet and cancer and works to disseminate findings about that relationship. History: Before the 1980’s, most cancer research was focused on diagnosis and treatment of the disease. Many scientists believed that cancer operated like a virus that affected cell metabolism, and they focused on early intervention and chemotherapy as their main strategies. The AICR was established in 1982 around the principle that cancer is preventable and that the disease is not random but is affected by lifestyle choices. At the time of its founding, this principle was not widely accepted. Later that same year however, the National Academy of Sciences published a report entitled Diet, Nutrition, and Cancer, and this document became the initial basis for the AICR’s cancer education program. In 1997, the AICR collaborated with the World Cancer
Salem Health: Cancer
American Institute for Cancer Research (AICR)
Research Fund (WCRF), based in the United Kingdom, to publish a 670-page report called Food, Nutrition, and the Prevention of Cancer: A Global Perspective. The report was the work of sixteen scientists from eight countries, who spent three years reviewing studies on diet and cancer. It was developed with participation from experts at the National Cancer Institute and the World Health Organization and was peer-reviewed. The report indicated that between 30 and 40 percent of all cancers could be directly linked to lifestyle choices such as food, drink, exercise, and overall health. The AICR produced more than 30,000 copies of the report and freely distributed it to cancer researchers and politicians. In 1999 the AICR published Stopping Cancer Before It Starts, a book that brought the message of the report to the public. The AICR began to expand more rapidly after the publication of these works. Private donations, the primary source of funding for the organization, increased both in number and size. As of 2007, more than 12 million Americans had made a donation to the organization, which had a total annual revenue exceeding $38 million and had contributed more than $82 million to research projects.
AICR Recommendations for Cancer Prevention
Educating the public: Spreading the message that people can lower their risk of cancer is a major part of the AICR’s program. In 2006, approximately $20 million, over 50 percent of the organization’s annual budget, went to educational activities. One of the ways the AICR fulfills its mission is through a free quarterly newsletter, which the AICR sends to more than 1.5 million homes. The newsletter provides meal-planning suggestions, recipes, and basic nutritional health information. The organization also produces more than seventy brochures, covering a wide array of topics within the subject of nutrition and cancer. Its latest series, The New American Plate, encourages people to fill two-thirds of their plate with fruits, vegetables, and grains, and keep protein to one-third or less. The AICR has also produced public service announcements, which have been carried by hundreds of television stations across the United States. Newspapers and magazines have also been a resource for the AICR. The organization also maintains a Web site and a national nutrition hotline to provide more in-depth information about ways that people can reduce their risk of cancer. The institute also hosts educational seminars and an annual conference. These educational seminars are offered free of charge and presented by registered dieticians. As of 2007, more than 41,000 people had attended a seminar, and they had been offered in more than 133 cities. The AICR annual research conference is becoming a major event in the field of cancer research, as the 2005 con-
• • • •
Eat mostly plant-based foods, limit consumption of red meat (beef, pork, and lamb), and avoid processed meats. Engage in physical activity every day for at least thirty minutes. Maintain a healthy weight throughout life, preferably as lean as possible without being underweight. Do not smoke or chew tobacco.
ference hosted more than four hundred participants and speakers from twenty-five universities and research facilities. Research grants: The AICR works to contribute funding to scientists in the field of cancer research who focus on the connection between cancer and diet. Approximately 14 percent of the annual budget goes to funding proposed research. To decide which proposals to fund, the institute follows a set of grant review process standards, established by the National Cancer Institute. Proposals are reviewed by a panel of experts on the basis of scientific merit. Final decisions about funding are made by the AICR Board of Directors. The AICR Investigator Initiated Grants Program awards up to $75,000 per year for up to two years to be used for research into either diet and cancer or physical activity and cancer. The AICR Post Doctoral Awards Program is intended for less established researchers and provides up to $38,000 per year for up to two years. The AICR also provides matching funds grants. The institute also supports the Marilyn Gentry Fellowship Program at the University of North Carolina at Chapel Hill School for Public Health, department of nutrition. The fellowship is named after AICR president Marilyn Gentry and is intended to support researchers as they transition from postdoctoral work into assistant professorships. Robert Bockstiegel, B.S. u
For Further Information American Institute for Cancer Research. Diet and Health Recommendations for Cancer Prevention: Healthy Living and Lower Cancer Risk. Washington, D.C.: Author, 2006. _______. The New American Plate Cookbook: Recipes for a Healthy Weight and a Healthy Life. Berkeley: University of California Press, 2005. 55
4-Aminobiphenyl Weldon, Glen, ed. Dietary Options for Cancer Survivors: A Guide to Research on Foods, Food Substances, Herbals, and Dietary Regimens That May Influence Cancer. Washington, D.C.: American Institute for Cancer Research, 2002. u
Other Resources
American Institute for Cancer Research http://www.aicr.org American Society of Clinical Oncology Http://www.asco.org Association of American Cancer Institutes http://www.aaci-cancer.org See also American Association for Cancer Research (AACR); American Cancer Society (ACS); Dana-Farber Cancer Institute; Duke Comprehensive Cancer Center; Fox Chase Cancer Center; Fred Hutchinson Cancer Research Center; Jonsson Comprehensive Cancer Center (JCCC); M. D. Anderson Cancer Center; Mayo Clinic Cancer Center; Memorial Sloan-Kettering Cancer Center; National Cancer Institute (NCI); National Science Foundation (NSF); Prevent Cancer Foundation; Robert H. Lurie Cancer Center.
u 4-Aminobiphenyl Category: Carcinogens and suspected carcinogens RoC status: Known human carcinogen since 1980 Also known as: 4-Biphenylamine, p-aminobiphenyl, para-aminobiphenyl, p-aminodiphenyl Related cancers: Bladder cancer, liver cancer Definition: 4-Aminobiphenyl, an aromatic amine, occurs as a colorless to yellowish brown crystalline solid that turns purple in air and has an floral odor. Exposure routes: When heated, 4-aminobiphenyl emits toxic fumes. For the general public, exposure to 4-aminobiphenyl comes from inhalation of tobacco smoke. Occupational exposure occurs from inhalation by laboratory personnel who are doing research with 4-aminobiphenyl. When most of the 4-aminobiphenyl was disposed of by injection into underground wells in the late 1980’s, small amounts of it were released into the air, subjecting some individuals to possible contamination. Where found: 4-Aminobiphenyl is a by-product of tobacco smoke and is found as a contaminant in diphenylamine. Its use is confined to laboratory research, although 56
Salem Health: Cancer it may still be found in some dyes, particularly in cosmetics and drugs that contain yellow dye number 1 and in rubber compounds that were manufactured before the mid1950’s. At risk: Scientists and laboratory technicians who work where 4-aminobiphenyl is used in research as a chemical antioxidant have a high risk for 4-aminobiphenyl contamination. Because 4-aminobiphenyl is generated in tobacco smoke, people who smoke are at high risk for contamination. The general public is at risk for contamination from secondhand tobacco smoke. Etiology and symptoms of associated cancers: Inhalation of 4-aminobiphenyl can produce headaches, lethargy, urinary burning, and blood in the urine (hematuria). When metabolized, it can be activated by liver enzymes to form adducts with blood serum proteins, particularly hemoglobin and albumin. Hemoglobin adducts are associated with an increased risk for liver cancer. In some cases, 4-aminobiphenyl can undergo additional metabolism to form reactive compounds that are transported to the bladder, where they bind to deoxyribonucleic acid (DNA) molecules. In laboratory tests on cultured human cells, 4-aminobiphenyl caused genetic damage that included cell transformation and inhibition of DNA repair. 4-aminobiphenyl can cross the human placenta and has been detected in fetal blood. History: 4-Aminobiphenyl was commercially produced in the United States from the early 1930’s until the mid1950’s. It was used in the detection of sulfates, in the production of azo dyes and yellow-dye stuffs, and as an antioxidant in the production of rubber. There are still a few companies in the United States that manufacture 4-aminobiphenyl for use in laboratory research. Alvin K. Benson, Ph.D. See also Bladder cancer; Cigarettes and cigars; Diethanolamine (DEA); Liver cancers; Tobacco-related cancers.
u Amputation Category: Procedures Definition: Surgical removal of all or part of a limb as a result of peripheral vascular disease, trauma, tumor, infection, or congenital anomaly. Cancers treated: Soft-issue neoplasias (malignant fibrous histiocytoma, fibrosarcoma, rhabdomyosarcoma, synovial sarcoma); bone malignancies (osteosarcoma, chondrosarcoma, adamantinoma, Ewing sarcoma)
Salem Health: Cancer
Amputation
Why performed: Amputations are performed to remove extremities that are severely diseased, injured, or no longer functional. Amputation has five goals: removal of all diseased tissue; relief of pain; proper wound healing; prevention of metastatic spread of tumor cells; and construction of a stump that will permit useful function. Amputation as a musculoskeletal procedure is often accomplished as an alternative to limb salvage and should be considered a reconstructive maneuver. Because of the psychological implications and the alteration of body self-image with amputation, a multidisciplinary team approach should be taken to return the patient to a maximum level of independent function. The process should be considered the first step in the rehabilitation of the patient rather than a failure of treatment. Epidemiologic data on the incidence of amputation in the United States from 1993 to 2003 show that the number of lower-extremity amputations increased 14 percent, from 99,522 to 123,379 cases. Average hospital charge for this procedure increased 40 percent, from $24,332 to $34,046. Nearly two-thirds of amputations are performed in individuals with diabetes, even though these individuals represent only 6 percent of the entire population. Patient preparation: Amputation and subsequent healing depend on several factors, including vascular inflow, nutrition, and an adequate immune system. Prior to surgery, patients should be evaluated regarding these parameters. Patients with malnutrition or immune deficiency have a high rate of wound breakdown or infection. A serum albumin level below 3.5 grams per deciliter (g/dl) indicates a malnourished patient. An absolute lymphocyte count below 1,500 cubic millimeters is a sign of immune deficiency. If possible, amputation should be delayed in patients until these values can be improved by nutritional support. In severely affected patients, nasogastric or percutaneous gastric feeding tubes are necessary. Oxygenated blood is a prerequisite for wound healing. A hemoglobin level of more than 10 g/dl is required. Doppler ultrasonography has been used to measure vascular inflow and to predict the success of wound healing. An absolute Doppler pressure of 70 millimeters of mercury (mm Hg) and an ischemic index of 0.5 or greater are necessary at the surgical site. The transcutaneous partial pressure of oxygen (Tcp02) is now regarded as the gold standard in the measurement of vascular inflow. Values greater than 40 mm Hg correlate with acceptable healing rates. Steps of the procedure: With regard to tumor stage and desired functional outcome, there are a variety of surgical procedures pertaining to upper-limb, lower-extremity, or
Treatment of some cancers involves amputation, which requires the patient to learn new living skills. (Digital Stock)
axial skeletal amputation. Patients with musculoskeletal neoplasms face new choices in treatment with the development of limb salvage techniques and adjuvant chemotherapy and radiation therapy. If an amputation is chosen, then the incision must be planned carefully to achieve the appropriate surgical margin. These surgical margins are characterized by the relationship of the surgical incision to the lesion, to the inflammatory zone surrounding the lesion, and to the anatomic compartment in which the lesion is located. The four types of surgical margins include the following: • intralesional: the surgical incision enters the lesion • marginal: the surgical incision enters the inflammatory zone but not the lesion • wide margin: the incision enters the same anatomic compartment of the lesion but is outside the inflammatory zone • radical: the incision remains outside the anatomic compartment 57
Amyloidosis After the procedure: A variety of wound care methods are used after amputation, including rigid dressings, soft dressings, controlled environment chambers, air splints, and skin traction. The use of an immediate postoperative prosthesis (IPOP) has been shown to be effective in decreasing the time to limb maturation and definitive prosthetic fitting. Rehabilitation and prosthetic fitting remain the primary postoperative goals. Risks: The amputee is at risk for deep vein thrombosis (15 percent) and pulmonary embolism (2 percent). Prolonged postoperative immobilization, stagnation of blood due to ligation of large veins, delayed prosthetic fitting, and inactivity increase the overall risk of thromboembolism (clot). Approximately 80 to 90 percent of amputees experience some episodes of phantom limb pain, which are often severe but infrequent. Other major complications include failure of wound healing, infection, postoperative edema, joint contractures, and dermatological problems such as skin irritation as a result of improper prosthetic fit, breakdown over stump margins, and episodes of contact dermatitis. Results: There is an ongoing controversy when comparing limb salvage to amputation with regard to energy expenditure to ambulate, quality-of-life measures, and the performance of activities of daily living. Studies suggest that functional outcomes are comparable with either limb salvage or amputation. Overall survival remains comparable with either treatment. With some tumors, amputation may achieve better local disease control. Both treatment groups report qualityof-life problems involving employment, health insurance, social isolation, and poor self-esteem. John L. Zeller, M.D., Ph.D. u
For Further Information Bone, M., P. Critchley, and D. Buggy. “Gabapentin in Postamputation Phantom Limb Pain: A Randomized, Double-Blind Placebo-Controlled, Cross-Over Study.” Regional Anesthesia and Pain Medicine 27, no. 5 (2002): 481. Doherty, Gerard M., and Lawrence W. Way, eds. Current Surgical Diagnosis and Treatment. 12th ed. New York: Lange Medical Books/McGraw-Hill, 2006. Menendez, L. R., ed. Orthopaedic Knowledge Update: Musculoskeletal Tumors. Rosemont, Ill.: American Academy of Orthopedic Surgeons, 2002. Peabody, T. D., et al. “Evaluation and Staging of Musculoskeletal Neoplasms.” The Journal of Bone and Joint Surgery: American Volume 80, no. 8 (1998): 1204. Skinner, Harry B., ed. Current Diagnosis and Treatment 58
Salem Health: Cancer in Orthopedics. 4th ed. New York: Lange Medical Books/McGraw-Hill, 2006. u
Other Resources
American Academy of Orthopedic Surgeons http://www.aaos.org American College of Surgeons http://www.acs.org See also Bone cancers; Fibrosarcomas, soft-tissue; Hyperthermic perfusion; Juvenile polyposis syndrome; Limb salvage; Liposarcomas; Lymphangiosarcomas; Mastectomy; Neuroectodermal tumors; Occupational therapy; Orthopedic surgery; Sarcomas, soft-tissue; Surgical oncology; Synovial sarcomas; Veterinary oncology.
u Amyloidosis Category: Diseases, symptoms, and conditions Also known as: AL amyloidosis, immunoglobulin lightchain amyloidosis, primary amyloidosis Related conditions: Multiple myeloma Definition: Amyloidoses are a class of illnesses in which fibrillar protein deposits form throughout the body. Immunoglobulin-related (AL) amyloidosis, a disorder sometimes caused by cancerous antibody-secreting plasma cells, results when misfolded antibody chains form deposits that impair function of the heart, kidneys, and other organs. Risk factors: There are no known risk factors. Etiology and the disease process: In a minority of patients with multiple myeloma, antibody fragments that are produced by malignant plasma cells form insoluble fibrillar protein deposits. Deposits can form in many organs but are most often found in the kidney, heart, liver, and peripheral and autonomous nervous systems. These deposits ultimately lead to death, most commonly via heart disease and renal failure. Incidence: The overall incidence of AL amyloidosis is approximately 1 in 100,000 people per year. Men are more likely than women to develop AL amyloidosis. Approximately 15 percent of patients with multiple myeloma develop AL amyloidosis, but cases of myeloma-associated amyloidosis make up a small fraction of AL amyloidosis cases. Symptoms: Symptoms depend on the organs involved and vary among patients. Common symptoms include periph-
Salem Health: Cancer eral edema, proteinuria, hepatomegaly, hypotension, shortness of breath, irregular heartbeat, purpura, macroglossia, carpal tunnel syndrome, and peripheral neuropathy. Screening and diagnosis: Many amyloidoses are diagnosed by Congo Red staining of tissues biopsied from subcutaneous fat pads, rectal mucosa, bone marrow, or other sources. Once diagnosis of amyloidosis is established, a free light chain blood test is performed to confirm immunoglobulin chains as the cause of amyloid deposits. Treatment and therapy: Current treatments for amyloidosis parallel those used for multiple myeloma. Melphalan plus predisone reduces the number of malignant plasma cells and levels of circulating immunoglobulin light chains. This is often followed by autologous stem cell transplantation, aimed at rebuilding healthy bone marrow. In some patients, treatment results in a temporary resorption of amyloid fibrils and improvement in organ function. The malignant plasma cells are not completely eradicated, however, and remission is the usual course. IDOX (4′deoxy-4′-iododoxorubicin), a drug that binds to amyloid fibrils and promotes their disassembly, has shown promise in early trials. Prognosis, prevention, and outcomes: Prognosis for patients with AL amyloidosis depends on which organs are affected. Patients with cardiac involvement have the worst prognosis, while patients with involvement limited to other organs have longer median survival times. There is no known way to prevent amyloidosis. Kyle J. McQuade, Ph.D. See also Bone marrow transplantation (BMT); Crohn disease; Orbit tumors; Paraneoplastic syndromes; Stem cell transplantation.
Anal cancer
Stage at Diagnosis and Five-Year Relative Survival Rates for Cancer of the Anus, 1996-2004 Stage Localizeda Regionalb Distantc Unstaged
Individuals Diagnosed (%) Survival Rate (%) 49 32 10 10
81.7 61.1 2.8 57.6
Source: Data from National Cancer Institute, Surveillance Epidemiology and End Results, Cancer Stat Fact Sheets, 2008 a Cancer still confined to primary site b Cancer has spread to regional lymph nodes or directly beyond the primary site c Cancer has metastasized
Risk factors: There are several risk factors for anal cancer, including cigarette smoking and anal receptive sexual intercourse. Infection with the human papillomavirus (HPV16), the sexually transmitted disease that causes genital warts, can cause anal squamous intraepithelial lesions (ASIL), which may develop into anal cancer. People with a suppressed immune system from cancer, cancer treatments, organ transplantation, HIV, or AIDS have an increased risk of anal cancer. The number of people with both HIV and anal cancer is rising. Etiology and the disease process: Researchers do not know the exact cause of the genetic changes that make healthy cells turn into anal cancer cells, although multiple risk factors have been identified. The anal cancer cells multiply and form masses or tumors.
Related conditions: Anorectum cancer, anal squamous intraepithelial lesions (ASIL), human papillomavirus (HPV), human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS)
Incidence: Anal cancer is a rare form of cancer; however, the number of new cases began to increase in the early 1980’s. The incidence of anal cancer is 1 in 100,000 people. New cases in 2007 in the United States were estimated to reach 4,650. Anal cancer occurs more frequently in women than in men. Women are more likely to develop cancer in the anal canal. Men are more likely to develop cancer tumors on the outside of the anus. Anal cancer occurs most frequently in adults in their early sixties, at a median age of sixty-one years.
Definition: Anal cancer is a rare cancer that forms in the anus, which is at the end of the rectum. The anus is about 1.5 inches long and contains sphincter muscles that control bowel movements. Stool passes through the anus as it leaves the body.
Symptoms: Anal cancer may not cause symptoms. Bleeding from the anus is a common early sign. This type of cancer may cause pain, itching, abnormal anal discharge, and changes in the diameter of stools. A mass or growth may develop in the anus. Nearby lymph nodes may
u Anal cancer Category: Diseases, symptoms, and conditions Also known as: Cancer of the anus, anal canal cancer
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Anal cancer
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be swollen. The anus may feel unusually full. Screening and diagnosis: Screening tests for anal cancer are recommended for people with a high risk of anal cancer. Women should receive anal cancer screening as part of a yearly exam. Annual anal cancer screening is recommended for men after the age of fifty. Anal cancer is diagnosed with a series of tests and procedures. A digital rectal exam (DRE) is used to check for lumps, masses, or growths in the anus. Endoscopy, using an anoscope or rigid protosigmoidoscopy, allows inspection of the interior anal canal. An anoscope is a thin tube with a viewing instrument and light that is inserted into the anus. A protosigmoidoscope is longer and allows sections of the colon to be viewed as well. Ultrasound, computed tomography (CT) scans, positron emission (PET) scans, and magnetic resonance imaging (MRI) scans are used to provide images of the anal structures and to help determine if the cancer has spread. Fine needle aspiration and sentinel lymph node biopsy are used to obtain cells for examination to confirm if cancer is present. Staging is used to identify cancer growth and metastasis, plan treatment, and predict recovery. Fortunately, anal cancer rarely metastasizes. • Stage I: Anal cancer is 2 centimeters (cm) or less. • Stage II: Anal cancer is larger than 2 cm, is confined to the anus, and has not spread beyond the anus. • Stage IIIA: Anal cancer is any size with spread to nearby lymph nodes or close areas, such as the bladder, urethra, or vagina. • Stage IIIB: Anal cancer is any size with spread to nearby lymph nodes and close areas, or it has spread to lymph nodes in the pelvis. • Stage IV: Anal cancer has spread to distant locations in the body. Treatment and therapy: Chemoradiation is the treatment of choice for anal cancer. External radiation, brachytherapy, or both may be used. Chemotherapy 5-FU and Mutamycin (mitomycin) may be used in combination with radiation or surgery. Surgery is used for patients with residual anal cancer and includes local resection or abdominoperineal resection (APR). Prognosis, prevention, and outcomes: Anal cancer screening, HPV testing, HIV testing, quitting smoking, 60
Cancer of the anus. (BSIP/Photo Researchers, Inc.)
knowing the STD status of sexual partners before intercourse, and not participating in anal sex may help prevent anal cancer. Condoms may reduce the risk of HPV and HIV, but they are not a guarantee. HPV vaccination is available for girls and women. Many cases of anal cancer that are detected and treated early can be cured. However, anal cancer may recur even with treatment. It was estimated that 690 men and women with anal cancer would die in the United States in 2007, a rate of 0.2 per 100,000 people. Mary Car-Blanchard, O.T.D., B.S.O.T. u
For Further Information Cranston, R. D., et al. “The Prevalence, and Predictive Value, of Abnormal Anal Cytology to Diagnose Anal Dysplasia in a Population of HIV-Positive Men Who Have Sex with Men.” International Journal of STD and AIDS 18, no. 2 (February, 2007): 77-80. Das, P., C. H. Crane, and J. A. Ajani. “Current Treatment for Localized Anal Carcinoma.” Current Opinions in Oncology 19, no. 4 (July, 2007): 396-400. Meyer, J., B. Czito, F. F. Yin, and C. Willett. “Advanced Radiation Therapy Technologies in the Treatment of Rectal and Anal Cancer: Intensity-Modulated Photon Therapy and Proton Therapy.” Clinical Colorectal Cancer 6, no. 5 (January, 2007): 348-356. Uronis, H. E., and J. C. Bendell. “Anal Cancer: An Overview.” Oncologist 12, no. 5 (May, 2007): 524-534.
Salem Health: Cancer u
Androgen drugs
Other Resources
American Cancer Society How Is Anal Cancer Diagnosed? Http://www.cancer.org/docroot/CRI/content/CRI_ 2_4_3X_How_Is_Anal_Cancer_Diagnosed_47.asp National Cancer Institute Anal Cancer Treatment http://www.cancer.gov/cancertopics/pdq/treatment/ anal/patient See also Abdominoperineal resection (APR); Anoscopy; Colostomy; Computed tomography (CT) scan; Digital rectal exam (DRE); Endoscopy; Gastrointestinal cancers; Gastrointestinal oncology; Infectious cancers; Risks for cancer; Sexuality and cancer; Sigmoidoscopy.
u Androgen drugs Category: Chemotherapy and other drugs ATC code: G03B Definition: Androgens are steroid hormones produced by the adrenal glands and testes or ovaries, responsible for male sex characteristics in the body. Testosterone, an endogenous androgen, is converted to estrogen by the enzyme aromatase. Androgenic agents can be used in the treatment of breast cancer. Cancers treated: Metastatic hormone-responsive breast cancer in postmenopausal women, or in premenopausal women who have undergone ovary ablation Subclasses of this group: Anabolic steroids, alkylated androgens, testosterone esters Delivery routes: Administered orally as tablets or capsules, or by intramuscular injection How these drugs work: Testosterone esters are lipophilic compounds that, when dissolved in oil, are administered via intramuscular injection. Alkylated androgens can be
given orally as their metabolic deactivation is hindered by the alkyl group at the 17α position. The mechanism of action for androgenic agents in breast cancer has not been fully established, though they are believed to block the growth of estrogen-dependent tumors by inhibiting aromatase activity. Older drugs such as calusterone underwent clinical trials in the 1960’s and 1970’s, with response rates of approximately 20 percent. Androgen drugs are not considered first-line therapy for breast cancer, as they are more toxic than other hormonal agents in use and response rates remain low. Androgens, when used, are frequently given in combination with aromatase inhibitors to inhibit the production of estrogen in vivo. Side effects: Androgens are male sex hormones and can cause masculinizing effects in women, including deepening voice, hirsutism, acne, and clitoral enlargement. Alkylated androgens are less potent than testosterone and hence possess a lower risk of these side effects, but liver toxicity, cholestatic hepatitis, and jaundice can occur at relatively low doses. Androgen therapy should be discontinued following abnormal liver function tests until the cause has been determined. Androgen therapy in patients with preexisting cardiac, renal, or hepatic disease increases the risk of edema and progression to congestive heart failure. In such cases, dosing should be discontinued and administration of a diuretic considered. Breast cancer patients undergoing androgen therapy are at increased risk of bone breakdown and reabsorption, leading to hypercalcemia. If this occurs, then drug therapy should be discontinued and the patient evaluated, as hypercalcemia may also indicate the progression of bone metastases. Karen M. Nagel, Ph.D. See also Amenorrhea; Antiandrogens; Appetite loss; Bisphenol A (BPA); Breast cancer in men; Chemoprevention; Endocrine cancers; Fanconi anemia; Granulosa cell tumors; Hormonal therapies; Myelofibrosis; Receptor analysis; Tumor flare.
Androgen Drugs for Breast Cancer Treatment Drug
Brands
Subclass
Delivery Mode
Testolactone Testosterone enanthate Fluoxymesterone Methyltestosterone
Teslac Delatestryl Androxy, Halotestin, Ora-Testrylm Android-F, Hysterone Tested, Virilon, Android-10, Methitest
Anabolic steroid Testosterone ester Alkylated androgen Alkylated androgen
Oral Intramuscular Oral Oral
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Anemia
Salem Health: Cancer
u Anemia Category: Diseases, symptoms, and conditions Also known as: Low red blood cell count, erythropenia, iron-poor blood Related conditions: Cytopenia Definition: Anemia is a low number of red blood cells, decreased volume of red blood cells, or a reduced concentration of hemoglobin. Risk factors: For anemia of cancer, risk is associated with the type of cancer, stage of disease, and treatment regimen. Etiology and the disease process: Anemia may be caused by deficiencies of vitamin B12, folic acid, or iron; antibody formation; kidney failure; lead poisoning; bone-marrow dysfunction; chemotherapy; or radiation therapy. It can also result from infiltration of bone marrow by leukemia or lymphomas or from internal bleeding or excessive blood loss from repeated blood sampling. Anemias caused by deficiencies in folic acid, vitamin
B12, and iron are generally known as nutritional anemias. In these forms of anemia, the endogenous hormone erythropoietin, responsible for red blood cell production, appears to be present in adequate amounts. Patients with cancer, however, can be anemic because of deficiencies in these nutrients. The anemia of cancer, a subset of anemia of chronic disease, is marked by reduction in the amount of the hormone erythropoietin found in the circulation, suppression of bone marrow function, disturbances in iron metabolism, and activation of the inflammatory and immune systems in response to the insult of cancer that activates hormones, which in turn decrease the production of endogenous erythropoietin. Another form of anemia is aplastic anemia, which may be caused by chemotherapy, radiation therapy, or drugs. In the normal state of health, endogenous erythropoietin is released by peritubular cells in the kidney cortex when specialized cells sense hypoxia (low oxygen content of the blood). In the bone marrow, erythropoietin stimulates the proliferation and differentiation of primitive cells (that is, progenitor cells) that will mature and differentiate
Numerous types of anemia exist.
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Anemia
into red blood cells. As the cells mature and differentiate, they synthesize hemoglobin, the iron-containing pigment that is responsible for carrying oxygen to all cells in the body and carrying carbon dioxide away from cells.
sions. In cases of severe anemia, however, transfusions are routinely used because it takes several days for the erythropoiesis-stimulating proteins to increase red blood cell count and hemoglobin concentration.
Incidence: It is estimated th
