What is neoplastic disease

Neoplastic disease also called cancer and benign tumor (abnormal growth that is not cancer), is medical term for diseases in which abnormal cells divide without control and can invade nearby tissues. Normally, your body forms new cells as you need them, replacing old cells that die. Sometimes this process goes wrong. New cells grow even when you don’t need them, and old cells don’t die when they should. These extra cells can form a mass called a tumor. Tumors can be benign or malignant. Benign tumors aren’t cancer while malignant ones are. Cells from malignant tumors can invade nearby tissues. They can also break away and spread to other parts of the body. Benign tumors grow only in one place. They cannot spread or invade other parts of your body. Even so, they can be dangerous if they press on vital organs, such as your brain. Neoplastic disease can start any place in your body. Neoplastic disease starts when cells grow out of control and crowd out normal cells. This makes it hard for the body to work the way it should. Neoplastic disease or cancer and benign tumor (abnormal growth that is not cancer) can be treated very well for many people. In fact, more people than ever before lead full lives after cancer treatment.

Neoplastic disease or cancer and benign tumor (abnormal growth that is not cancer) is not just one disease. There are many types of neoplastic disease. Neoplastic disease or cancer and benign tumor (abnormal growth that is not cancer) can start in the lungs, the breast, the colon, or even in the blood. Cancer and benign tumor (growth that is not cancer) are alike in some ways, but they are different in the ways they grow and spread.

Neoplastic disease develops because the DNA in a cell changes.

Over one and a half million new neoplastic disease cases are diagnosed each year. Anyone can get neoplastic disease at any age, but the risk goes up with age. Nearly 9 out of 10 neoplastic diseases are diagnosed in people ages 50 and older. Neoplastic disease can be found in people of all racial and ethnic groups, but the rate of cancer and benign tumor (growth that is not cancer) occurrence (called the incidence rate) varies from group to group.

Most neoplastic diseases do not appear to be caused or affected by infectious agents. Neoplastic disease develops because of mutations (changes) that take place in a person’s DNA, the genetic blueprint in each cell. These changes may be inherited or develop during life. Some changes happen for no known reason, while others are due to environmental exposures, such as sun (UV) damage or cigarette smoke. Some viruses are known to directly cause mutations in DNA that can develop into cancer and benign tumor (growth that is not cancer). Other germs promote cancer indirectly by causing chronic (long-term) inflammation, or by weakening a person’s immune system.

These are words that you may hear your cancer care team use:

• Benign: a tumor that’s not cancer
• Biopsy: taking out a piece of tissue to see if cancer cells are in it
• Cancer: a word used to describe more than 100 neoplastic diseases in which cells grow out of control; or a tumor with cancer in it
• Chemotherapy: the use of drugs to treat neoplastic disease. The word most often refers to drugs used to treat cancer. Sometimes it’s just called “chemo.”
• Malignant: having cancer in it
• Metastasis/Metastasized: the spread of cancer cells to distant parts of the body through the lymph system or bloodstream
• Oncologist: a doctor who treats people who have cancer
• Radiation therapy: the use of high-energy rays, like x-rays, to treat cancer
• Remission: when signs or symptoms of cancer are all or partly gone
• Stage: a word that tells whether a cancer has spread, and if so, how far

How are neoplastic disease alike?

The cells in your body all have certain jobs to do. Normal cells divide in an orderly way. They die when they are worn out or damaged, and new cells take their place. Neoplastic disease is when the cells start to grow out of control. The cancer cells keep on growing and making new cells. They crowd out normal cells. This causes problems in the part of the body where the cancer started.

Cancer cells can also spread to other parts of the body. For instance, cancer cells in the lung can travel to the bones and grow there. When cancer cells spread, it’s called metastasis. When lung cancer spreads to the bones, it’s still called lung cancer. To doctors, the cancer cells in the bones look just like the ones from the lung. It’s not called bone cancer unless it started in the bones.

How are neoplastic disease different?

Some cancers grow and spread fast. Others grow more slowly. They also respond to treatment in different ways. Some types of cancer are best treated with surgery; others respond better to drugs called chemotherapy. Often 2 or more treatments are used to get the best results.

When someone has neoplastic disease (cancer), their doctor will want to find out what kind of cancer it is. People with cancer need treatment that works for their type of cancer.

What are tumors?

Most cancers form a lump called a tumor or a growth. But not all lumps are cancer. Doctors take out a piece of the lump and look at it to find out if it’s cancer. Lumps that are not cancer are called benign. Lumps that are cancer are called malignant.

There are some cancers, like leukemia (cancer of the blood), that don’t form tumors. They grow in the blood cells or other cells of the body.

What stage is the cancer?

The doctor also needs to know if and how far the cancer has spread from where it started. This is called the cancer stage. You may have heard other people say that their cancer was stage 1 or stage 2. Knowing the stage of the cancer helps the doctor decide what type of treatment is best.

For each type of cancer there are tests that can be done to figure out the stage of the cancer. As a rule, a lower stage (such as a stage 1 or 2) means that the cancer has not spread very much. A higher number (such as a stage 3 or 4) means it has spread more. Stage 4 is the highest stage.

Ask your doctor to explain the stage of your cancer and what it means for you.

Is neoplastic disease contagious?

Neoplastic disease is NOT contagious.

A healthy person cannot “catch” cancer from someone who has it. There is no evidence that close contact or things like sex, kissing, touching, sharing meals, or breathing the same air can spread cancer from one person to another.

Cancer cells from one person are generally unable to live in the body of another healthy person. A healthy person’s immune system recognizes foreign cells and destroys them, including cancer cells from another person.

Scientific studies of cancer causes show that cancer does not spread like a contagious disease.

If cancer were contagious, we would have cancer epidemics just as we have flu epidemics – cancer would spread like measles, polio, or the common cold. We would expect a high rate of cancer among the families and friends of cancer patients and among health professionals because of their exposure to the disease. This is not the case.

The fact that cancer might happen more often in certain families does not mean that the family members have spread cancer to each other. There are other reasons this can happen:

• Family members share the same genes.
• Families may have similar unhealthy lifestyles (diet and smoking, for example).
• Family members may all be exposed to the same cancer-causing agent.

Some people point to “clusters” of cancer patients who have had contact, directly or indirectly, with one another as proof that cancer is contagious. But scientists have found that these clusters almost never reflect a greater incidence of cancer than would be found in a random survey of the general public. In the rare case that there really is more cancer in such a group, it’s hard to be sure that environmental factors and cultural factors such as diet and lifestyle are not responsible for the cancer cluster.

Cancer transfer during organ transplant

There have been some cases in which organ transplants from people with cancer have been able to cause cancer in the person who got the organ. But there’s a major factor that makes this possible – people who get organ transplants take medicines that weaken their immune systems. This must be done so their immune system won’t attack and destroy the transplanted organ. This seems to be the main reason that cancer in a transplanted organ can, in rare cases, give cancer to the person who gets the organ. Organ donors are carefully screened to reduce this risk.

Cancer risk after transplant already high

Still, recent studies have shown that cancer is more common in people who get solid-organ transplants than in people who don’t – even when the donor doesn’t have cancer. This also appears to be due to the drugs that are given to reduce the risk of transplant rejection. Research has shown that the longer and more intensely the immune system is suppressed after transplant, the higher the risk of cancer. The drugs that allow the body to accept the organ also make the immune system less able to recognize and attack pre-cancer cells and the viruses that can cause cancer.

Cancer transfer during pregnancy

Even if a woman has cancer during pregnancy, the cancer rarely affects the fetus directly. Some cancers can spread from the mother to the placenta (the organ that connects the mother to the fetus), but most cancers cannot affect the fetus itself. In a few very rare cases, melanoma (a form of skin cancer) has been found to spread to the placenta and the fetus.

Germs are contagious

Scientists know that germs (especially bacteria and viruses) can be passed from person to person through sex, kissing, touching, and sharing or preparing food. Some can even be spread by breathing the same air. But germs are much more likely to be a threat to a person with cancer than to a healthy person. This is because people with cancer often have weakened immune systems, especially when they’re getting treatment. They may not be able to fight off infections very well.

Germs can increase cancer risk.

There are some germs that can play a role in the development of certain types of cancer. This may lead some people to wrongly think that “cancer is catching.”

Viruses

Scientists know that some forms of cancer are found more often in people who are infected with certain viruses. For example:

• Certain types of human papilloma viruses (HPVs) are linked to cancers of the cervix, vagina, vulva, penis, anus, and some cancers of the mouth, throat, head, and neck. But smoking, drinking, and other factors increase the risk of these cancers, too.
• Epstein-Barr virus (EBV) is linked to nose and throat (nasopharyngeal) cancer, lymphoma of the stomach, Hodgkin lymphoma, and Burkitt lymphoma.
• Hepatitis B virus (HBV) and hepatitis C virus (HCV) are linked to long-term (chronic) liver infections, which can raise the risk of liver cancer (hepatocellular carcinoma).
• Human herpes virus Type 8 (HHV-8), also called Kaposi sarcoma herpes virus (KSHV), is linked with a type of cancer called Kaposi sarcoma. Most people with HHV-8 do not develop Kaposi sarcoma unless they are also infected with human immunodeficiency virus (HIV), the virus that causes AIDS. A few may get Kaposi sarcoma if they are taking medicines that weaken their immune systems (such as those used after an organ transplant).
• Human T-lymphotropic virus-1 (HTLV-1) is linked with certain types of lymphocytic leukemia and non-Hodgkin lymphoma (NHL).
• Invasive cervical cancer, Kaposi sarcoma, and certain lymphomas are much more common in people who are infected with the human immunodeficiency virus (HIV), the virus that weakens the immune system and causes AIDS. In many cases of HIV-related cancer, other viruses (such as HHV-8 or HPV) also play a major role in the cancer’s growth and development.

These viruses can be passed from person to person (usually through blood or sex), but the viral infection alone usually does not lead to cancer. A weakened immune system, other infections, other risk factors (such as smoking), and other health problems allow cancer to develop more readily.

Bacteria

Bacteria can also promote cancer. Helicobacter pylori is a common bacterium now known to be linked to certain kinds of cancer in the stomach. Long-term infection with these bacteria can damage the inner layer of the stomach and increase the risk of stomach cancer.

Parasites

Certain parasitic worms that can live inside the human body can also increase the risk of developing some kinds of cancer. Parasites that can cause cancer are rarely found in the United States or other developed countries, but they are linked with cancer of the bladder and the bile ducts, and possibly other cancers, too.

What causes neoplastic disease?

No one knows the exact cause of most cases of cancer. Neoplastic disease (cancer) is a complex group of diseases with many possible causes. Scientists are studying this problem and learning more about the many steps it takes for cancers to form and grow.

Some cancers are caused by things people do or expose themselves to. For example, tobacco use can cause cancer of the lungs, mouth, throat, bladder, kidneys, and many other organs. Of course, not everyone who uses tobacco will get cancer, but it greatly increases a person’s risk. It increases their chance of developing heart and blood vessel disease, too.

Spending a lot of time in the sun without protection can cause skin cancer. Melanoma is a very serious form of skin cancer linked to UV light from the sun and tanning beds.

Other things people are exposed to

Radiation can cause cancer. For instance, people exposed to nuclear fallout have a higher cancer risk than those who were not exposed. Sometimes, radiation treatment for one type of cancer can cause another cancer to grow many years later. This is why doctors and dentists use the lowest possible doses of radiation for x-rays and scans (much lower than the doses used for cancer treatment).

Certain chemicals have been linked to cancer, too. Being exposed to or working with them can increase a person’s risk of cancer.

Genes that run in families

About 5% to 10% of all cancers are linked to genes that are inherited from parents.

Here are some common causes of cancer:

• Smoking and Tobacco
• Diet and Physical Activity
• Sun and Other Types of Radiation
• Viruses and Other Infections

Can injuries cause cancer?

It’s a common myth that injuries can cause cancer. But the fact is that falls, bruises, broken bones, or other such injuries have not been linked to cancer. Sometimes a person might visit a health care provider for what’s thought to be an injury and cancer is found at that time. But the injury did not cause the cancer; the cancer was already there. It also sometimes happens that a person will remember an injury that happened long ago in the place cancer was found.

Rarely, burn scars can be the site of cancer many years after the burn has healed. Most often, skin cancer is the type that starts in a burn scar.

Can stress cause cancer?

Researchers have done many studies to see if there’s a link between personality, attitude, stress, and cancer. No scientific evidence has shown that a person’s personality or outlook affects their cancer risk.

There are many factors to look at in the relationship between stress and cancer. It’s known that stress affects the immune system, but so do many other things. Despite many studies, a link between psychological stress and cancer has not been found.

What are the risk factors for cancer?

A risk factor is anything linked to your chance of getting a disease, such as cancer. Different cancers have different risk factors. For instance, exposing skin to strong sunlight is a risk factor for skin cancer, but it’s not linked to colon cancer. Some risk factors can actually cause cancer, while others may simply be more common in people who get cancer. For example, old age by itself doesn’t cause cancer, but it is a risk factor.

Still, risk factors don’t tell us everything. Having one risk factor, or even many, does not mean that someone will get cancer. Some people with one or more risk factors never develop the disease, while others who do develop cancer have no known risk factors. Even when a person who has a risk factor is diagnosed with cancer, there’s no way to prove that the risk factor actually caused the cancer.

There are different kinds of risk factors. Some, like a person’s age or race, can’t be changed. Others are linked to cancer-causing factors in the environment. Still others are related to personal actions, such as smoking. Some factors influence risk more than others, and a person’s risk for cancer can change over time, due to factors such as aging or lifestyle.

Some of the major cancer risk factors that can be controlled:

• Tobacco use
• Diet
• Physical activity
• Weight
• Alcohol use
• Sun exposure
• Environmental exposures, such as radon, lead, and asbestos
• Exposure to infections such as hepatitis, HPV, and HIV

Overall, about 1 out of 5 cancers diagnosed in the US are related to excess body weight, physical inactivity, excess use of alcohol, and/or poor nutrition, and could be prevented.

Tobacco smoke

Cigarettes, cigars, and pipe tobacco are made from dried tobacco leaves. Other substances are added for flavor and to make smoking more pleasant. The smoke from these products is a complex mixture of chemicals produced by burning tobacco and its additives.

Tobacco smoke is made up of thousands of chemicals, including at least 70 known to cause cancer. These cancer-causing chemicals are referred to as carcinogens. Some of the chemicals found in tobacco smoke include:·

• Nicotine (the addictive drug that produces the effect people are looking for and one of the harshest chemicals in tobacco smoke)
• Hydrogen cyanide
• Formaldehyde
• Lead
• Arsenic
• Ammonia
• Radioactive elements, such as uranium (see below)
• Benzene
• Carbon monoxide
• Nitrosamines
• Polycyclic aromatic hydrocarbons (PAHs)

Many of these substances cause cancer. Some can cause heart disease, lung disease, or other serious health problems, too. Most of the substances come from the burning tobacco leaves themselves, not from additives included in cigarettes (or other tobacco products).

Radioactive materials in tobacco smoke

Radioactive materials are in the tobacco leaves used to make cigarettes and cigars. These materials come from the fertilizer and soil used to grow the tobacco leaves, so the amount in tobacco depends on the soil the plants were grown in and the type of fertilizers used. These radioactive materials are given off in the smoke when tobacco is burned, which smokers take into their lungs as they inhale. This may be another key factor in smokers getting lung cancer.

Is cigar smoke different?

Cigar smoke pretty much has the same toxic and carcinogenic compounds as cigarette smoke, but some of them are present at different levels.

Because of the aging process used to make cigars, cigar tobacco has high concentrations of some nitrogen compounds (nitrates and nitrites). When the fermented cigar tobacco is smoked, these compounds give off several tobacco-specific nitrosamines, some of the most potent cancer-causing substances known.

Also, because the cigar wrapper is less porous than a cigarette wrapper, the tobacco doesn’t burn as completely. This results in higher concentrations of nitrogen oxides, ammonia, carbon monoxide, and tar – all very harmful substances.

Smokeless tobacco products

Smokeless tobacco products include snuff and chewing tobacco that is put into the mouth or nose but is not burned like cigarettes or cigars. Still, smokeless products in the United States contain a variety of potentially harmful chemicals, including high levels of tobacco-specific nitrosamines.

There are also other cancer-causing agents in smokeless tobacco, such as benzo[a]pyrene and other polycyclic aromatic hydrocarbons (PAHs). These carcinogens are absorbed through the mouth and may be why several types of cancer are linked to the use of smokeless tobacco. Like other forms of tobacco, smokeless tobacco also contains radioactive substances.

Snus is a type of moist snuff that does not require spitting. It was first used in Sweden and Norway, but it is now available in the United States as well. Snus generally has lower levels of nicotine and tobacco-specific nitrosamines than traditional moist snuff brands, but can still be addictive and has been linked to some types of cancer.

Which is riskier? Smokeless tobacco or cigarette smoking?

Smokeless tobacco products are less deadly than cigarettes. On average, they kill fewer people than cigarettes. Smokeless products are often promoted as a less harmful alternative to smoking, but they are still linked with cancer and can still be deadly. And they have not been proven to help smokers quit.
E-cigarettes and similar devices

E-cigarettes and other electronic nicotine delivery systems (ENDS) are often used as substitutes for cigarettes or other tobacco products.

Marketers of e-cigarettes and other electronic nicotine delivery systems often claim the ingredients are safe. But the aerosols these products produce can contain addictive nicotine, flavorings, and a variety of other chemicals, some known to be toxic or to cause cancer. The levels of many of these substances appear to be lower than in traditional cigarettes, but the amounts of nicotine and other substances in these products can vary widely because they are not standardized. The long-term health effects of these devices are not known, but they are being studied.

Sun and other types of radiation

Ultraviolet (UV) Radiation

Ultraviolet (UV) radiation is a form of electromagnetic radiation that comes from the sun and man-made sources like tanning beds and welding torches.

Radiation is the emission (sending out) of energy from any source. There are many types of radiation, ranging from very high-energy (high-frequency) radiation – like x-rays and gamma rays – to very low-energy (low-frequency) radiation – like radio waves. UV rays are in the middle of this spectrum. They have more energy than visible light, but not as much as x-rays.

There are also different types of UV rays, based on how much energy they have. Higher-energy UV rays are a form of ionizing radiation. This means they have enough energy to remove an electron from (ionize) an atom or molecule. Ionizing radiation can damage the DNA (genes) in cells, which in turn may lead to cancer. But even the highest-energy UV rays don’t have enough energy to penetrate deeply into the body, so their main effect is on the skin.

UV radiation is divided into 3 main groups:

• UVA rays have the least energy among UV rays. These rays can cause skin cells to age and can cause some indirect damage to cells’ DNA. UVA rays are mainly linked to long-term skin damage such as wrinkles, but they are also thought to play a role in some skin cancers.
• UVB rays have slightly more energy than UVA rays. They can damage the DNA in skin cells directly, and are the main rays that cause sunburns. They are also thought to cause most skin cancers.
• UVC rays have more energy than the other types of UV rays. Fortunately, because of this, they react with ozone high in our atmosphere and don’t reach the ground, so they are not normally a risk factor for skin cancer. But UVC rays can also come from some man-made sources, such as arc welding torches, mercury lamps, and UV sanitizing bulbs used to kill bacteria and other germs (such as in water, air, food, or on surfaces).

Many studies have found that basal and squamous cell skin cancers are linked to certain behaviors that put people in the sun, as well as a number of markers of sun exposure, such as:

• Spending time in the sun for recreation (including going to the beach)
• Spending a lot of time in the sun in a swimsuit
• Living in an area that gets a lot of sunlight
• Having had serious sunburns in the past (with more sunburns linked to a higher risk)
• Having signs of sun damage to the skin, such as liver spots, actinic keratoses (rough skin patches that can be precancerous), and solar elastosis (thickened, dry, wrinkled skin caused by sun exposure) on the neck

Studies have also found links between certain behaviors and markers of sun exposure and melanoma of the skin, including:

• Activities that lead to “intermittent sun exposure,” like sunbathing, water sports, and taking vacations in sunny places
• Previous sunburns
• Signs of sun damage to the skin, such as liver spots, actinic keratoses, and solar elastosis

Because UV rays don’t penetrate deeply into the body, they wouldn’t be expected to cause cancer in internal organs, and most research has not found such links. However, some studies have shown possible links to some other cancers, including Merkel cell carcinoma (a less common type of skin cancer) and melanoma of the eye.

Studies have found that people who use tanning beds (or booths) have a higher risk of skin cancer, including melanoma and squamous and basal cell skin cancers. The risk of melanoma is higher if the person started indoor tanning before age 30 or 35, and the risk of basal and squamous cell skin cancer is higher if indoor tanning started before age 25.

In addition to skin cancer, exposure to UV rays can cause other health problems:

• UV rays, either from the sun or from artificial sources like tanning beds, can cause sunburn.
• Exposure to UV rays can cause premature aging of the skin and signs of sun damage such as wrinkles, leathery skin, liver spots, actinic keratosis, and solar elastosis.
• UV rays can also cause eye problems. They can cause the cornea (on the front of the eye) to become inflamed or burned. They can also lead to the formation of cataracts (clouding of the lens of the eye) and pterygium (tissue growth on the surface of the eye), both of which can impair vision.
• Exposure to UV rays can also weaken the immune system, so that the body has a harder time fending off infections. This can lead to problems such as reactivation of herpes triggered by exposure to the sun or other sources of UV rays. It can also cause vaccines to be less effective.

Some people are more sensitive to the damaging effects of UV radiation. Some medications can also make you more sensitive to UV radiation, making you more likely to get sunburned. And certain medical conditions can be made worse by UV radiation.

The International Agency for Research on Cancer (IARC) is part of the World Health Organization (WHO). One of its major goals is to identify causes of cancer. Based on the available data, IARC has made the following determinations:

• Solar radiation is carcinogenic to humans.
• Use of UV-emitting tanning devices is carcinogenic to humans.
• UV radiation (including UVA, UVB, and UVC) is carcinogenic to humans.

The National Toxicology Program (NTP) is formed from parts of several different US government agencies, including the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA). The NTP has made the following determinations:

• Solar radiation is known to be a human carcinogen.
• Exposure to sunlamps or sunbeds is known to be a human carcinogen.
• Broad-spectrum UV radiation is known to be a human carcinogen.
• UVA radiation is reasonably anticipated to be a human carcinogen.
• UVB radiation is reasonably anticipated to be a human carcinogen.
• UVC radiation is reasonably anticipated to be a human carcinogen.

How are people exposed to UV radiation?

Sunlight

Sunlight is the main source of UV radiation, even though UV rays make up only a small portion of the sun’s rays. Different types of UV rays reach the ground in different amounts. About 95% of the UV rays from the sun that reach the ground are UVA rays, with the remaining 5% being UVB rays.

The strength of the UV rays reaching the ground depends on a number of factors, such as:

• Time of day: UV rays are strongest between 10 am and 4 pm.
• Season of the year: UV rays are stronger during spring and summer months. This is less of a factor near the equator.
• Distance from the equator (latitude): UV exposure goes down as you get farther from the equator.
• Altitude: More UV rays reach the ground at higher elevations.
• Clouds: The effect of clouds can vary, but what’s important to know is that UV rays can get through to the ground, even on a cloudy day.
• Reflection off surfaces: UV rays can bounce off surfaces like water, sand, snow, pavement, or even grass, leading to an increase in UV exposure.
• Contents of the air: Ozone in the upper atmosphere, for example, filters out some UV radiation.

The amount of UV exposure a person gets depends on the strength of the rays, the length of time the skin is exposed, and whether the skin is protected with clothing or sunscreen.

Man-made sources of UV rays

People can also be exposed to man-made sources of UV rays. These include:

• Sunlamps and sunbeds (tanning beds and booths): The amount and type of UV radiation someone is exposed to from a tanning bed (or booth) depends on the specific lamps used in the bed, how long a person stays in the bed, and how many times the person uses it. Most modern UV tanning beds emit mostly UVA rays, with the rest being UVB.
• Phototherapy (UV therapy): Some skin problems (such as psoriasis) are helped by treatment with UV light. For a treatment known as PUVA, a drug called a psoralen is given first. The drug collects in the skin and makes it more sensitive to UV. Then the patient is treated with UVA radiation. Another treatment option is the use of UVB alone (without a drug).
• Black-light lamps: These lamps use bulbs that give off UV rays (mostly UVA). The bulb also gives off some visible light, but it has a filter that blocks most of that out while letting the UV rays through. These bulbs have a purple glow and are used to view fluorescent material. Bug-zapping insect traps also use “black light” that gives off some UV rays, but the bulbs use a different filter that causes them to glow blue.
• Mercury-vapor lamps: Mercury-vapor lamps can be used to light large public areas such as streets or gyms. They do not expose people to UV rays if they are working properly. They are actually made up of 2 bulbs: an inner bulb that emits light and UV rays, and an outer bulb that filters out the UV. UV exposure can only occur if the outer bulb is broken. Some mercury-vapor lamps are designed to turn themselves off when the outer bulb breaks. The ones that don’t have this feature are only supposed to be installed behind a protective layer or in areas where people wouldn’t be exposed if part of the bulb breaks.
• High-pressure xenon and xenon-mercury arc lamps, plasma torches, and welding arcs: Xenon and xenon-mercury arc lamps are used as sources of light and UV rays for many things, such as UV “curing” (of inks, coatings, etc.), disinfection, to simulate sunlight (to test solar panels, for example), and even in some car headlights. Most of these, along with plasma torches and welding arcs, are mainly of concern in terms of workplace UV exposure.

Tanning beds

Some people think that getting UV rays from tanning beds is a safe way to get a tan, but this isn’t true.

Both International Agency for Research on Cancer (IARC) and National Toxicology Program (NTP) classify the use of UV-emitting tanning devices (including sunlamps and tanning beds) as carcinogenic to humans.

The US Food and Drug Administration (FDA), which refers to all UV lamps used for tanning as “sunlamps,” requires them to carry a label that states, “Attention: This sunlamp product should not be used on persons under the age of 18 years.”

The FDA also requires that user instructions and sales materials directed at consumers (including catalogs, specification sheets, descriptive brochures, and webpages) carry the following statements:

• Contraindication: This product is contraindicated for use on persons under the age of 18 years.
• Contraindication: This product must not be used if skin lesions or open wounds are present.
• Warning: This product should not be used on individuals who have had skin cancer or have a family history of skin cancer.
• Warning: Persons repeatedly exposed to UV radiation should be regularly evaluated for skin cancer.

The FDA has also proposed a new rule to ban the use of indoor tanning devices by anyone under age 18, to require tanning facilities to inform adult users about the health risks of indoor tanning, and to require a signed risk acknowledgment from all users. Some US states have already banned indoor tanning by all people younger than 18, while others have banned use by younger teens and children.

X-rays and Gamma Rays

When talking about radiation and cancer risk, it is often x-rays and gamma rays that people think about. X-rays and gamma rays are known human carcinogens (cancer-causing agents). The evidence for this comes from many different sources, including studies of atomic bomb survivors in Japan, people exposed during the Chernobyl nuclear accident, people treated with high doses of radiation for cancer and other conditions, and people exposed to high levels of radiation at work, such as uranium miners.

X-rays and gamma rays can come from natural sources, such as radon gas, radioactive elements in the earth, and cosmic rays that hit the earth from outer space. But this type of radiation can also be man-made. X-rays and gamma rays are created in power plants for nuclear energy, and are also used in smaller amounts for medical imaging tests, cancer treatment, food irradiation, and airport security scanners.

X-rays and gamma rays are both types of high energy (high frequency) electromagnetic radiation. They are packets of energy that have no charge or mass (weight). These packets of energy are known as photons. Because X-rays and gamma rays have the same properties and health effects, they are grouped together in this document.

Both x-rays and gamma rays are forms of high-frequency ionizing radiation, which means they have enough energy to remove an electron from (ionize) an atom or molecule. Ionized molecules are unstable and quickly undergo chemical changes.

If ionizing radiation passes through a cell in the body, it can lead to mutations (changes) in the cell’s DNA, the part of the cell that contains its genes (blueprints). Sometimes this causes the cell to die, but sometimes it can lead to cancer later on. The amount of damage caused in the cell is related to the dose of radiation it receives. The damage takes place in only a fraction of a second, but other changes such as the beginning of cancer may take years to develop.

Gamma rays and x-rays aren’t the only kinds of ionizing radiation. Some types of ultraviolet (UV) radiation are also ionizing. Ionizing radiation can also exist in particle form, such as protons, neutrons, and alpha and beta particles.

People may be exposed to this type of radiation from 3 main sources:

1. Natural background radiation comes from cosmic rays from our solar system and radioactive elements normally present in the soil. This is the major contributor to worldwide radiation exposure.
2. Medical radiation is used for x-rays, CT scans, and other tests, as well as for radiation therapy. Radiation therapy is used to treat some types of cancer and involves dosages many thousand times higher than those used in diagnostic x-rays.
3. Non-medical, man-made radiation is used in small amounts in food irradiation, airport security scanners, and some consumer products. Exposure to man-made radiation can happen in certain workplaces, or in communities as a result of above ground nuclear weapons testing and nuclear accidents.

Atomic bomb survivors

Much of what we know about cancer risks from radiation is based on studies of the survivors of the atomic bombs in Nagasaki and Hiroshima. These people had higher risks of some, but not all cancers. Studies have found an increased risk of the following cancers (from higher to lower risk):

• Most types of leukemia (although not chronic lymphocytic leukemia)
• Multiple myeloma
• Thyroid cancer
• Bladder cancer
• Breast cancer
• Lung cancer
• Ovarian cancer
• Colon cancer (but not rectal cancer)
• Esophageal cancer
• Stomach cancer
• Liver cancer
• Lymphoma
• Skin cancer (besides melanoma)

For most of these cancers, the risk was highest for those exposed as children, and was lower as the age at exposure increased. Those exposed while still in the womb (in utero) had lower risks than those exposed during childhood.

Higher radiation exposure was linked to higher risk of cancer, but even low amounts of radiation were linked to an increased risk of getting and dying from cancer. There was no clear cut-off for safe radiation exposure.

These cancers took years to develop, but some cancers appeared sooner than others. Deaths from leukemia went up about 2 to 3 years after exposure, with the number of cases peaking after about 10 years and going down after that. Solid tumors took longer to develop. For example, excess deaths from lung cancer began to be seen about 20 years after exposure.

Chernobyl accident

Children and adolescents living near the Chernobyl plant at the time of the accident had an increased risk of thyroid cancer linked to exposure to radioactive iodine. The risk was higher in areas that were iodine deficient. This increased risk was not seen in adults living in the area.

Workers employed in cleanup operations from 1986-1990 had an increased risk of leukemia (all types). These individuals had higher and more prolonged radiation exposures that the population residing around the plant.

Nuclear weapons testing

Studies suggest that some people who were children during the period of above ground nuclear testing in the US may develop thyroid cancer as a result of exposure to radioactive iodine in milk.

Radiation therapy

Although radiation therapy is now mostly used to treat cancer, it was used to treat a number of benign (non-cancerous) diseases before the risks were clearer. Studies of these patients have helped us learn about how radiation affects cancer risk.

• Peptic ulcer disease: A large study of people who were treated with high doses of radiation (an average of 15 Gy or 15,000 mSv) for the treatment of peptic ulcers found a higher risk of cancer of the stomach and pancreas.
• Ringworm of the scalp: Studies of people who were treated with radiation to treat a fungal infection of the scalp (called scalp ringworm or tinea capitis) have found an increased risk of basal cell skin cancers. The risk was lower in people who were older when treated. This increased risk was seen only in white patients, and the cancers occurred more often in sun-exposed skin of the head and neck (as opposed to the scalp), which implies that ultraviolet (UV) radiation plays a role in these cancers as well.
• Ankylosing spondylitis: Studies have looked at the cancer risks of patients with the autoimmune disease ankylosing spondylitis who were injected with a form of radium. In one study, patients who received a high dose (average bone dose of 31,000 mGy) had an increased risk of bone sarcoma. The risks of some other cancers, such as breast, liver, kidney, bladder, and other sarcomas, may also have been increased. About one-quarter of the patients in this study were younger than 20 years of age when they were treated with radiation. In another study, patients treated with a lower dose of radium (average bone dose of 6,000 mGy) had a higher risk of leukemia, but not of any other cancers. Most of the patients in this study were adults at the time of treatment.
• Other studies: Treatment of the head and neck area with radiation for benign conditions has also been linked to cancers of the salivary gland and brain and spinal cord in adults in some studies. Children treated with radiation to this area also have an increased risk of thyroid cancer.

Radiation therapy to treat cancer

Studies have linked radiation therapy to treat cancer with an increased risk of leukemia, thyroid cancer, early-onset breast cancer, and some other cancers. The risk of cancer depends on a number of factors, include the dose of radiation, the part of the body being treated, the age of the person getting it (younger people are generally at greater risk), and the use of other treatments such as chemotherapy.

For example, people who get pelvic radiation therapy would not be expected to have higher rates of cancers in the head and neck because these areas weren’t exposed to the radiation from the treatment. Other factors might also play a role in how likely a person exposed to radiation is to develop cancer. For example, some genetic conditions can mean that a person’s cells are more vulnerable to radiation damage, which might in turn raise their risk more than in someone without these gene changes.

If cancer does develop after radiation therapy, it does not happen right away. For leukemias, most cases develop within 5 to 9 years after exposure. In contrast, other cancers often take much longer to develop. Most of these cancers are not seen for at least 10 years after radiation therapy, and some are diagnosed even more than 15 years later.

When considering radiation exposure from radiation therapy treatment for cancer, the benefits generally outweigh the risks. Overall, radiation therapy alone does not appear to be a very strong cause of second cancers. This is probably due to the fact that doctors try to focus the radiation on the cancer cells as much as possible, which means few normal cells are exposed to radiation. However, some combinations of radiation therapy and chemotherapy are more risky than others. Doctors do their best to ensure the treatment that is given destroys the cancer while limiting the risk that a secondary cancer will develop later on.

Imaging tests

Some studies have estimated the risk of radiation exposure from imaging tests based on the risks from similar amounts of radiation exposure in the studies of the atomic bomb survivors. Based on these studies, the US Food and Drug Administration (FDA) estimates that exposure to 10 mSv from an imaging test would be expected to increase the risk of death from cancer by about 1 chance in 2000.

It can be difficult to study cancer risks from imaging studies that use radiation. In order to see small risks (such as 1 in 2000), a study would have to look at 10s or 100s of thousands of people. Information about other exposures that could be cancer risk factors would be needed, to see if it was likely that the cancer came from the radiation exposure. Since cancers from radiation take years to develop, the study would need to follow the patients for many years.

Often, scientists use questionnaire studies to look for possible causes of cancer. These studies compare exposures among people who have a certain cancer to those who don’t. They may instead compare people who had a certain exposure (like to radiation) to those who didn’t. However, this is difficult to do for diagnostic radiation exposure since many people cannot accurately recall information about things that happened many years before (such as in childhood) and information about all the imaging tests that were done is often not available. There is also a concern that people with cancer tend to over report exposures that they worry may have caused their cancers.

Studies that have found increased risk of cancer after imaging tests that use x-rays often involve people who had multiple tests or high dose procedures, including:

• Fluoroscopy: Studies of women who had been imaged many times with fluoroscopy as a teenager or young woman during treatment for tuberculosis have found an increased risk of breast cancer years later.
• Spine x-rays: Teenagers and young women who had many x-rays of the spine to monitor scoliosis have been found to have an increased risk of breast cancer later on.
• Dental x-rays: A study compared a group of people with meningioma (a brain tumor that is most often benign) with a group without the tumors. It found that the people who had the tumors were more likely to have had a type of dental x-ray called a bite-wing, and to have had bite-wing or Panorex x-rays every year.
• CT scans: A study in England of exposure to radiation from CT scans found that children who received a dose of at least 30 mGy (the same as 30 mSv) to the bone marrow had 3 times the risk of leukemia compared to those who received a dose of 5 mGy or less. For brain tumors, a dose of 50 mGy or more to the brain was linked to more than 3 times the risk. A study in Australia of exposure to radiation from CT scans in childhood and adolescence found that after an average of about 9 ½ years, those who had a CT scan had a 24% higher risk of cancer overall. The risk of cancer was higher the more CT scans the person had, and it was also higher the younger the person was at the time of the CT scan. Still, the overall risk of cancer was still low. A study from Taiwan found that children and teens who had a CT scan of the head did not have a higher risk of brain cancer or leukemia, but were more likely to be diagnosed with a benign brain tumor.

Doses of radiation

Radiation exposure can be expressed in certain units.

The absorbed dose is the amount of energy deposited per unit of mass. Most often this is measured in grays (Gy). A milligray (mGy), which is 1/1000th of a Gy, may also be used.

The equivalent dose is the absorbed dose multiplied by a converting factor based on the medical effects of the type of radiation. It is often expressed in sieverts (Sv) or millisieverts (mSv), which is 1/1000th of a Sv.

For x-rays and gamma rays (and beta particles), the equivalent dose in Sv is the same as the absorbed dose in Gy.

Less common radiation dose units include rads, rems, and roentgens.

Infections that can lead to cancer

Since the start of the 20th century, it’s been known that certain infections play a role in cancer in animals. More recently, infections with certain viruses, bacteria, and parasites have been recognized as risk factors for several types of cancer in humans.

Worldwide, infections are linked to about 15% to 20% of cancers. This percentage is even higher in developing countries, but it is lower in the United States and other developed countries. This is partly because certain infections are more common in developing countries, and partly because some other risk factors for cancer, such as obesity, are more common in developed countries.

Infections can raise a person’s risk of cancer in different ways. For example:

• Some viruses directly affect the genes inside cells that control their growth. These viruses can insert their own genes into the cell, causing the cell to grow out of control.
  • Human papilloma viruses (HPVs)
  • Epstein-Barr virus (EBV)
  • Hepatitis B virus (HBV) and hepatitis C virus (HCV)
  • Human immunodeficiency virus (HIV)
  • Human herpes virus 8 (HHV-8)
  • Human T-lymphotrophic virus-1 (HTLV-1)
  • Merkel cell polyomavirus (MCV)
  • Simian virus 40 (SV40)
• Some infections can cause long-term inflammation in a part of the body. This can lead to changes in the affected cells and in nearby immune cells, which can eventually lead to cancer.
  • Helicobacter pylori
  • Chlamydia trachomatis
  • Opisthorchis viverrini and Clonorchis sinensis are liver flukes (a type of flatworm) that have been linked to increased risk of developing cancer of the bile ducts.
  • Schistosoma haematobium: Infection with this parasite (an illness called schistosomiasis) has been linked to bladder cancer.
• Some types of infections can suppress a person’s immune system, which normally helps protect the body from some cancers.

Any of these changes might lead to a higher risk of cancer.

Even though the infections described here can raise a person’s risk of certain types of cancer, most people with these infections never develop cancer. The risk of developing cancer is also influenced by other factors. For example, infection with Helicobacter pylori (H pylori) bacteria might increase your risk of stomach cancer, but what you eat, whether or not you smoke, and other factors also affect your risk.

Many of the infections that influence cancer risk can be passed from person to person, but cancer itself cannot. A healthy person can’t “catch” cancer from someone who has it.

Diet and Physical Activity

Research has shown that poor diet and not being active are 2 key factors that can increase a person’s cancer risk. The good news is that you can do something about this.

Besides quitting smoking, some of the most important things you can do to help reduce your cancer risk are:

• Get to and stay at a healthy weight throughout life.
• Be physically active on a regular basis.
• Make healthy food choices with a focus on plant-based foods.

The evidence for this is strong. The World Cancer Research Fund estimates that about 20% of all cancers diagnosed in the US are related to body fatness, physical inactivity, excess alcohol consumption, and/or poor nutrition, and thus could be prevented.

Control your weight

Getting to and staying at a healthy weight is important to reduce the risk of cancer and other chronic diseases, such as heart disease and diabetes. Being overweight or obese increases the risk of several cancers, including those of the breast (in women past menopause), colon and rectum, endometrium (the lining of the uterus), esophagus, pancreas, and kidney, among others.

Being overweight can increase cancer risk in many ways. One of the main ways is that excess weight causes the body to produce and circulate more estrogen and insulin, hormones that can stimulate cancer growth.

To reduce cancer risk, most people need to keep their Body Mass Index (BMI) below 25. Ask your doctor what your BMI number means and what action (if any) you should take.

Be more active

Watching how much you eat will help you control your weight. The other key is to be more physically active. Being active helps reduce your cancer risk by helping with weight control. It can also help improve your hormone levels and the way your immune system works.

More good news – physical activity helps you reduce your risk of heart disease and diabetes, too! So grab your athletic shoes and head out the door!

The latest recommendations for adults call for at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week, or an equivalent combination, preferably spread throughout the week. This is over and above usual daily activities like using the stairs instead of the elevator at your office or doing housework. For kids, the recommendation is at least 60 minutes of moderate or vigorous intensity activity each day, with vigorous intensity activity occurring at least 3 days each week.

Moderate activities are those that make you breathe as hard as you would during a brisk walk. This includes things like walking, biking, even housework and gardening. Vigorous activities make you use large muscle groups and make your heart beat faster, make you breathe faster and deeper, and also make you sweat.

It’s also important to limit sedentary behavior such as sitting, lying down, watching television, or other forms of screen-based entertainment.

Being more physically active than usual, no matter what your level of activity, can have many health benefits.

Eat healthy foods

Eating well is an important part of improving your health and reducing your cancer risk. Take a good hard look at what you typically eat each day and try these tips to build a healthy diet plan for yourself and your family:

Choose foods and drinks in amounts that help you get to and maintain a healthy weight.

• Read food labels to become more aware of portion sizes and calories. Be aware that “low-fat” or “non-fat” does not necessarily mean “low-calorie.”
• Eat smaller portions when eating high-calorie foods.
• Choose vegetables, whole fruit, legumes such as peas and beans, and other low-calorie foods instead of calorie-dense foods such as French fries, potato and other chips, ice cream, donuts, and other sweets.
• Limit your intake of sugar-sweetened beverages such as soft drinks, sports drinks, and fruit-flavored drinks.
• When you eat away from home, be especially mindful to choose food low in calories, fat, and added sugar, and avoid eating large portion sizes.

Limit how much processed meat and red meat you eat.

• Minimize your intake of processed meats such as bacon, sausage, lunch meats, and hot dogs.
• Choose fish, poultry, or beans instead of red meat (beef, pork, and lamb).
• If you eat red meat, choose lean cuts and eat smaller portions.
• Prepare meat, poultry, and fish by baking, broiling, or poaching rather than by frying or charbroiling.

Eat at least 2½ cups of vegetables and fruits each day.

• Include vegetables and fruits at every meal and snack.
• Eat a variety of vegetables and fruits each day.
• Emphasize whole fruits and vegetables; choose 100% juice if you drink vegetable or fruit juices.
• Limit your use of creamy sauces, dressings, and dips with fruits and vegetables.

Choose whole grains instead of refined grain products.

• Choose whole-grain breads, pasta, and cereals (such as barley and oats) instead of breads, cereals, and pasta made from refined grains, and brown rice instead of white rice.
• Limit your intake of refined carbohydrate foods, including pastries, candy, sugar-sweetened breakfast cereals, and other high-sugar foods.

If you drink alcohol, limit how much

People who drink alcohol should limit their intake to no more than 2 drinks per day for men and 1 drink per day for women. The recommended limit is lower for women because of their smaller body size and slower breakdown of alcohol.

A drink of alcohol is defined as 12 ounces of beer, 5 ounces of wine, or 1½ ounces of 80-proof distilled spirits (hard liquor). In terms of cancer risk, it is the amount of alcohol, not the type of alcoholic drink that is important.

These daily limits do not mean it’s safe to drink larger amounts on fewer days of the week, since this can lead to health, social, and other problems.

Neoplastic disease symptoms

A sign is a signal that can be seen by someone else – maybe a loved one, or a doctor, nurse, or other health care professional. For example, fever, fast breathing, and abnormal lung sounds heard through a stethoscope may be signs of pneumonia.

A symptom is a signal that’s felt or noticed by the person who has it, but may not be easily seen by anyone else. For example, weakness, aching, and feeling short of breath may be symptoms of pneumonia.

Neoplastic disease (cancer) is a group of diseases that can cause almost any sign or symptom. The signs and symptoms will depend on where the cancer is, how big it is, and how much it affects the organs or tissues. If a cancer has spread (metastasized), signs or symptoms may appear in different parts of the body.

As a cancer grows, it can begin to push on nearby organs, blood vessels, and nerves. This pressure causes some of the signs and symptoms of cancer. If the cancer is in a critical area, such as certain parts of the brain, even the smallest tumor can cause symptoms.

But sometimes cancer starts in places where it won’t cause any signs or symptoms until it has grown quite large. Cancers of the pancreas, for example, usually don’t cause symptoms until they grow large enough to press on nearby nerves or organs (this causes back or belly pain). Others may grow around the bile duct and block the flow of bile. This causes the eyes and skin to look yellow (jaundice). By the time a pancreatic cancer causes signs or symptoms like these, it’s usually in an advanced stage. This means it has grown and spread beyond the place it started – the pancreas.

A cancer may also cause symptoms like fever, extreme tiredness (fatigue), or weight loss. This may be because cancer cells use up much of the body’s energy supply, or they may release substances that change the way the body makes energy from food. Cancer can also cause the immune system to react in ways that produce these signs and symptoms.

Sometimes, cancer cells release substances into the bloodstream that cause symptoms that are not usually linked to cancer. For example, some cancers of the pancreas can release substances that cause blood clots in veins of the legs. Some lung cancers make hormone-like substances that raise blood calcium levels. This affects nerves and muscles, making the person feel weak and dizzy.

Having one sign or symptom may not be enough to figure out what’s causing it. For example, a rash in a child could be a sign of a number of things, such as poison ivy, measles, a skin infection, or a food allergy. But if the child has the rash along with other signs and symptoms like a high fever, chills, achiness, and a sore throat, then a doctor can get a better picture of the illness. Sometimes, a patient’s signs and symptoms still don’t give the doctor enough clues to be sure what’s causing the illness. Then medical tests, such as x-rays, blood tests, or a biopsy may be needed.

What are some general signs and symptoms of neoplastic disease?

You should know some of the general signs and symptoms of neoplastic disease (cancer). But remember, having any of these does not mean that you have cancer – many other things cause these signs and symptoms, too. If you have any of these symptoms and they last for a long time or get worse, please see a doctor to find out what’s going on.

Treatment works best when cancer is found early – while it’s still small and is less likely to have spread to other parts of the body. This often means a better chance for a cure, especially if the cancer can be removed with surgery.

A good example of the importance of finding cancer early is melanoma skin cancer. It can be easy to remove if it has not grown deep into the skin. The 5-year survival rate (percentage of people who live at least 5 years after diagnosis) at this early stage is around 98%. Once melanoma has spread to other parts of the body, the 5-year survival rate drops to about 16%.

Sometimes people ignore symptoms. Maybe they don’t know that the symptoms could mean something is wrong. Or they might be frightened by what the symptoms could mean and don’t want to get medical help. Maybe they just can’t afford to get medical care.

Some symptoms, such as tiredness or coughing, are more likely caused by something other than cancer. Symptoms can seem unimportant, especially if there’s a clear cause or the problem only lasts a short time. In the same way, a person may reason that a symptom like a breast lump is probably a cyst that will go away by itself. But no symptom should be ignored or overlooked, especially if it has lasted a long time or is getting worse.

Most likely, symptoms are not caused by cancer, but it’s important to have them checked out, just in case. If cancer is not the cause, a doctor can help figure out what the cause is and treat it, if needed.

Sometimes, it’s possible to find cancer before having symptoms. The American Cancer Society and other health groups recommend cancer-related check-ups and certain tests for people even though they have no symptoms. This helps find certain cancers early, before symptoms start.

Unexplained weight loss

Most people with cancer will lose weight at some point. When you lose weight for no known reason, it’s called an unexplained weight loss. An unexplained weight loss of 10 pounds or more may be the first sign of cancer. This happens most often with cancers of the pancreas, stomach, esophagus (swallowing tube), or lung.

Fever

Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all people with cancer will have fever at some time, especially if the cancer or its treatment affects the immune system. This can make it harder for the body to fight infection. Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.

Fatigue

Fatigue is extreme tiredness that doesn’t get better with rest. It may be an important symptom as cancer grows. But it may happen early in some cancers, like leukemia. Some colon or stomach cancers can cause blood loss that’s not obvious. This is another way cancer can cause fatigue.

Pain

Pain may be an early symptom with some cancers like bone cancers or testicular cancer. A headache that does not go away or get better with treatment may be a symptom of a brain tumor. Back pain can be a symptom of cancer of the colon, rectum, or ovary. Most often, pain due to cancer means it has already spread (metastasized) from where it started.

Skin changes

Along with skin cancers, some other cancers can cause skin changes that can be seen. These signs and symptoms include:

• Darker looking skin (hyperpigmentation)
• Yellowish skin and eyes (jaundice)
• Reddened skin (erythema)
• Itching (pruritis)
• Excessive hair growth

Signs and symptoms of certain neoplastic diseases

Along with the general symptoms, you should watch for certain other common signs and symptoms that could suggest cancer. Again, there may be other causes for each of these, but it’s important to see a doctor about them as soon as possible – especially if there’s no other cause you can identify, the problem lasts a long time, or it gets worse over time.

Change in bowel habits or bladder function

Long-term constipation, diarrhea, or a change in the size of the stool may be a sign of colon cancer. Pain when passing urine, blood in the urine, or a change in bladder function (such as needing to pass urine more or less often than usual) could be related to bladder or prostate cancer. Report any changes in bladder or bowel function to a doctor.

Sores that do not heal

Skin cancers may bleed and look like sores that don’t heal. A long-lasting sore in the mouth could be an oral cancer. This should be dealt with right away, especially in people who smoke, chew tobacco, or often drink alcohol. Sores on the penis or vagina may either be signs of infection or an early cancer, and should be seen by a health professional.

White patches inside the mouth or white spots on the tongue

White patches inside the mouth and white spots on the tongue may be leukoplakia. Leukoplakia is a pre-cancerous area that’s caused by frequent irritation. It’s often caused by smoking or other tobacco use. People who smoke pipes or use oral or spit tobacco are at high risk for leukoplakia. If it’s not treated, leukoplakia can become mouth cancer. Any long-lasting mouth changes should be checked by a doctor or dentist right away.

Unusual bleeding or discharge

Unusual bleeding can happen in early or advanced cancer. Coughing up blood may be a sign of lung cancer. Blood in the stool (which can look like very dark or black stool) could be a sign of colon or rectal cancer. Cancer of the cervix or the endometrium (lining of the uterus) can cause abnormal vaginal bleeding. Blood in the urine may be a sign of bladder or kidney cancer. A bloody discharge from the nipple may be a sign of breast cancer.

Thickening or lump in the breast or other parts of the body

Many cancers can be felt through the skin. These cancers occur mostly in the breast, testicle, lymph nodes (glands), and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer and should be reported to a doctor, especially if you’ve just found it or notice it has grown in size. Keep in mind that some breast cancers show up as red or thickened skin rather than a lump.

Indigestion or trouble swallowing

Indigestion or swallowing problems that don’t go away may be signs of cancer of the esophagus (the swallowing tube that goes to the stomach), stomach, or pharynx (throat). But like most symptoms on this list, they are most often caused by something other than cancer.

Recent change in a wart or mole or any new skin change

Any wart, mole, or freckle that changes color, size, or shape, or that loses its sharp border should be seen by a doctor right away. Any other skin changes should be reported, too. A skin change may be a melanoma which, if found early, can be treated successfully.

Nagging cough or hoarseness

A cough that does not go away may be a sign of lung cancer. Hoarseness can be a sign of cancer of the larynx ( voice box) or thyroid gland.

Other symptoms

The signs and symptoms listed above are the more common ones seen with cancer, but there are many others that are not listed here. If you notice any major changes in the way your body works or the way you feel – especially if it lasts for a long time or gets worse – let a doctor know. If it has nothing to do with cancer, the doctor can find out more about what’s going on and, if needed, treat it. If it is cancer, you’ll give yourself the chance to have it treated early, when treatment works best.

How is neoplastic disease treated?

The most common treatments for neoplastic disease (cancer) are surgery, chemotherapy, and radiation (radiotherapy).

Surgery can be used to take out the cancer. The doctor might also take out some or all of the body part the cancer affects. For breast cancer, part (or all) of the breast might be removed. For prostate cancer, the prostate gland might be taken out. Surgery is not used for all types of cancer. For example, blood cancers like leukemia are best treated with drugs.

Chemo short for chemotherapy, is the use of drugs to kill cancer cells or slow their growth. Some chemo can be given by IV (into a vein through a needle), and others are a pill you swallow. Because chemo drugs travel to nearly all parts of the body, they are useful for cancer that has spread.

Radiation (also called radiotherapy, is also used to kill or slow the growth of cancer cells. It can be used alone or with surgery or chemo. Radiation treatment is like getting an x-ray. Sometimes it’s given by putting a “seed” inside the cancer to give off the radiation.

What treatment is best for me?

Your cancer treatment will depend on what’s best for you. Some cancers respond better to surgery; others respond better to chemo or radiation. Knowing the type of cancer you have is the first step toward knowing which treatments will work best for you.

The stage of your cancer will also help the doctor decide on the best treatment for you. A stage 3 or 4 cancer is likely to respond better to treatments that treat the whole body, like chemo.

Your health and the treatment you prefer will also play a part in deciding about cancer treatment. Not all types of treatment will work for your cancer, so ask what options you have. And treatments do have side effects, so ask about what to expect with each treatment.

Don’t be afraid to ask questions. It’s your right to know what treatments are most likely to help and what their side effects may be.