Thyroid Cancer

The thyroid gland is located in the front of the neck and is attached to the lower part of the voice box (larynx) and to the upper part of the windpipe (trachea). It has two sides, or lobes, that are connected by a narrow neck. The thyroid gland produces thyroid hormones, which regulate metabolism, growth, and development and are essential for life.

Diagnosing Thyroid Cancer
Thyroid cancer may be suspected if a small abnormal growth—called a nodule—is found to protrude from the thyroid gland. Since the vast majority of thyroid nodules are benign, diagnostic tests must be conducted to determine if the nodule is malignant or cancerous.

Diagnosing thyroid cancer may involve tests that generate an image of the thyroid, such as ultrasound or PET imaging. A sample of the cells is also typically evaluated under a microscope. The sample may be removed using a needle and syringe or may be removed during surgery to treat the nodule. If initial tests indicate that the nodule is cancerous, a surgery will be scheduled to remove as much of the cancer as possible and to determine the extent of the disease—also called the stage of disease—and whether it has spread outside the thyroid gland.

Tests used to diagnose thyroid cancer include the following:

Ultrasound: Ultrasound uses high frequency sound waves and their echoes to create a two-dimensional image that is projected on a screen. Ultrasound is a simple procedure that may allow doctors to determine if a thyroid nodule is cancerous or benign based on the appearance of the image that is produced. A limitation of ultrasound is that it does not produce a sample of the cells that can be evaluated under a microscope.

Fine needle aspiration: Fine needle aspiration is a technique that uses a needle and syringe to withdraw a sample of the cells from a thyroid nodule. The cells can then be evaluated under a microscope to determine if they are cancerous or benign. Since many thyroid nodules are benign, this technique provides a minimally invasive way to determine if surgery is necessary.

Positron emission tomography (PET): Unlike techniques that provide anatomical images, such as X-ray or ultrasound, PET scans show chemical and physiological changes related to metabolism.

Before a PET scan, a patient will receive an injection of a drug that has a biological element—called an isotope—attached to it. The isotope becomes visible when a small amount of radiation is passed through the body. The most active cells take up more of the drug, allowing the doctor to see which areas are more active—a possible sign of cancer.

The radiation from a PET scan is roughly equivalent to what is administered in two chest X-rays. After the scan is complete, the radiation does not stay in the body for very long.

PET scans are covered by Medicare for the diagnosis of thyroid cancer.

Types of Thyroid Cancer
Cancer may arise from different cells of the thyroid gland. By evaluating a sample of the cancer under a microscope, doctors can determine the type of thyroid cancer. There are four main types of thyroid cancer:

Papillary: Papillary tumors are the most common form of thyroid cancer, accounting for more than 70% of all cases. Papillary cancers are typically irregular or solid masses that arise from otherwise normal thyroid tissue. More than half of papillary cancers have spread to lymph nodes in the neck. However, papillary cancers rarely spread to distant locations in the body. Papillary cancers typically occur in younger patients (30-50 years) and are commonly associated with a prior exposure to radiation. Patients with papillary cancer are highly curable with currently available treatment techniques.

Follicular: Follicular cancers account for a smaller percentage of all thyroid cancers (approximately 15%) and rarely occur after radiation exposure. Follicular cancers are more aggressive; they tend to invade blood vessels rather than lymph nodes, and distant spread is therefore more common. Potential sites of distant spread include the lung, bone, brain, liver, bladder, and skin. Patients over 40 have more aggressive disease that is more difficult to treat. Nonetheless, most follicular cancers are very curable.

Medullary: There are two subtypes of medullary thyroid cancer: sporadic and familial. Sporadic almost always occurs on both sides of the thyroid gland. Familial tumors may be malignant or benign and may be associated with a variety of symptoms.

Approximately half of medullary thyroid cancers have spread to lymph nodes. Prognosis depends on the extent of disease at diagnosis—especially spread to lymph nodes—and the ability to completely remove the cancer with surgery.

Anaplastic: Anaplastic thyroid cancer is a rare disease that may also be called undifferentiated cancer. This type of thyroid cancer is very aggressive, grows rapidly, and commonly extends beyond the thyroid gland. It typically occurs in older patients and is characterized by extensive spread in the neck area and rapid progression. Patients typically die of their disease within months of diagnosis.

Stages of Thyroid Cancer
Following a diagnosis of cancer, the most important step is to accurately determine the stage of cancer. Stage describes how far the cancer has spread. Identifying the stage of cancer is important because each stage of cancer may be treated differently.

Stage I-II: Stage I-II thyroid cancers are generally confined to the thyroid, but many include multiple sites of cancer within the thyroid. Thyroid cancer that has spread to nearby lymph nodes is still considered to be in stage I-II when the patient is younger than 45 years of age as the presence of cancer in the lymph nodes does not worsen the prognosis for these younger patients.

Early stage thyroid cancer is very treatable and many patients are cured with surgery alone.

Stage III: Stage III thyroid cancer is greater than 4 cm in diameter and is limited to the thyroid or may have minimal spread outside the thyroid. Lymph nodes near the trachea may be affected. Stage III thyroid cancer that has spread to adjacent cervical (neck) tissue or nearby blood vessels has a worse prognosis than cancer confined to the thyroid. However, lymph node metastases do not worsen the prognosis for patients younger than 45 years.

Stage III thyroid cancer is also referred to as locally advanced disease.

Stage IV: Stage IV thyroid cancer has spread beyond the thyroid to the soft tissues of the neck, lymph nodes in the neck, or distant locations in the body. The lungs and bone are the most frequent sites of distant spread. Papillary carcinoma more frequently spreads to regional lymph nodes than to distant sites. Follicular carcinoma is more likely to invade blood vessels and spread to distant locations.

Recurrent: Thyroid cancer that has recurred after treatment or progressed with treatment is called recurrent disease.

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Testicular Cancer

Testicular cancers are relatively rare but highly curable, and occur predominantly in young and middle aged males. Testicular cancers were among the first types of cancers to be cured by radiation and/or chemotherapy, and treatment has been refined over the last two decades. Currently, over 70% of all patients are curable regardless of the extent of cancer. Thus, all treatment of testicular cancer is delivered with the intent to cure. However, it is important to know the extent of cancer and the specific type of testicular cancer in order to administer the best therapy.

The testicles are located inside the scrotum (a sac of loose skin that lies directly under the penis). The testicles are similar to the ovaries in women. Sperm and male hormones are made in the testicles. Testicular cancer—also called germ cell cancer—occurs in the tissues of one or both testicles. Similar cancers called "non-gonadal germ cell cancers" can also occur outside the testicle; non-gonadal germ cell cancers are not discussed in this section.

Testicular cancer is the most common cancer in men 15 to 35 years old. Men who have an undescended testicle (a testicle that has never moved down into the scrotum) are at higher risk of developing testicular cancer than men whose testicles have moved normally down into the scrotum. This is true even if surgery has been performed early in life to place the testicle in the appropriate place in the scrotum.

A swelling in the scrotum is usually the first sign of testicular cancer. A doctor will examine the testicles to feel for any lumps. If any lumps are found, the doctor will perform an ultrasound examination, which uses sound waves to make a picture of the inside of the testes. In addition, the physician may perform a computed tomography (CT) or positron emission tomography (PET) scan to determine whether cancer is present. A PET scan is similar to a CT scan; however, PET scans can detect live cancer tissue. Prior to a PET scan, the patient receives an injection of a substance that contains a type of sugar attached to a radioactive isotope. The cancer cells “take up” the sugar and attached isotope, which emits positively charged, low energy radiation (positrons). The positrons react with electrons in the cancer cells, which creates the production of gamma rays. The gamma rays are then detected by the PET machine, which transforms the information into a picture. If no gamma rays are detected in the scanned area, it is unlikely that the mass in question contains living cancer cells.

When cancer is suspected, the entire testicle is surgically removed (orchiectomy) through an incision in the groin. The surgically removed tissue is then examined under a microscope to determine whether cancer cells are present. Removal of a small piece of tissue (biopsy) is usually not done because this is thought to cause spread of the cancer. When the cancer is small and localized to the testicle, removal of the testicle may be all of the treatment that is necessary to cure the cancer. The surgically removed testicle is examined under the microscope to determine the type of cancer. In some patients the cancer consists of only one cell type. But for many patients, the cancer under the microscope consists of a mixture of cell types.

Testicular cancer is broadly divided into two different types, seminoma and nonseminoma, based on the appearance of cells under the microscope. Nonseminomas are, in general, more difficult to cure than seminomas. Nonseminoma cell types include: embryonal carcinoma, teratoma, yolk sac carcinoma, choriocarcinoma, and various combinations that are referred to as “mixed cell types”. For nonseminoma cancer teratoma presents the lowest risk of spread and choriocarcinoma presents the highest risk of spread; the other cell types are of intermediate risk.

Treatment planning depends upon whether the testicular cancer is classified as seminoma or nonseminoma. Seminomas are more sensitive to radiation therapy and are easier to cure than nonseminomas. Patients with all stages of seminoma have a cure rate that exceeds 90%, and patients with seminoma confined to the testicle have a cure rate approaching 100%. If there is a mixture of seminoma and nonseminoma components upon examination under the microscope, the cancer is diagnosed as nonseminoma because the cancer will be more aggressive due to the nonseminoma part of the cancer.

The extent of disease, or “stage” is determined after surgical removal of the testicle. All patients will require CT or magnetic resonance imaging (MRI) scans of the abdomen, chest, and sometimes the brain or bones to look for spread of disease beyond the testicle.

Lymph nodes are small, bean-shaped structures that are an essential component of the immune system. They are found throughout the body and are interconnected with lymph channels. Testicular cancer tends to spread through lymph channels that drain into lymph nodes in the groin area, into channels near the large blood vessel (the aorta) carrying blood from the heart, and into lymph nodes between the abdomen and back called retroperitoneal lymph nodes.

Retroperitoneal Lymph Node Dissection (RPLND)
Direct surgical evaluation of the retroperitoneal lymph nodes is an important aspect of treatment planning in many adults with testicular cancer, especially those with clinically localized nonseminoma Stage I and II disease. This is because some patients will appear to have no evidence of cancer in the retroperitoneal lymph nodes on CT scan and will appear to have a Stage I cancer. They may actually have lymph nodes involved with cancer that were not detectable by the CT scan and may actually have Stage II cancer. Some patients who appear to have cancer on CT scan will not have lymph nodes involved and actually have a Stage I cancer.

RPLND for diagnosis and prevention of relapse is a relatively major operation requiring skill to sample and remove all the nodes. The major complication is damage or removal of the connections of the sympathetic nervous system, which are located next to the lymph nodes. This can lead to disruption of ejaculation of sperm, thereby leading to infertility. Surgeons have devised techniques to spare the sympathetic nervous system connections while still removing most lymph nodes; this preserves normal ejaculation in approximately 90% of patients.[1] Newer treatment strategies involving the adjuvant (post-surgery) administration of chemotherapy have decreased the number of patients requiring lymph node dissection.

Tumor or Cancer Markers
An important aspect of the evaluation of testicular cancer is the use of blood or serum tests to detect cancer markers. Cancer markers are abnormal substances in the blood associated with the presence of cancer somewhere in the body. Common cancer markers that are present in the blood of patients with testicular cancer include:

•Alpha-fetoprotein (AFP)
•Beta human chorionic gonadotropin (BHCG)
•Lactate dehydrogenase (LDH)..
These cancer markers may detect cancers that are too small to be detected with a CT scan. In males under age 15, about 90% of testicular germ cell cancers are yolk sac tumors that make AFP, which is an excellent indicator of response to therapy and disease status.

It is important to realize that the absence of cancer markers in the blood following treatment does not always mean the absence of cancer, even when cancer markers were present at diagnosis. Patients who appear to have seminoma when the cancer is examined under the microscope and have elevated serum levels of AFP are treated as if they have nonseminoma because seminoma cells do not secrete this cancer marker and other cell types must be present, even though they may not be visible under the microscope. Elevation of the BHCG is found in approximately 10% of patients with pure seminoma and is an indication of metastatic spread of disease, but does not change the cellular diagnosis.

Type of treatment and outcomes depend on the stage and spread of the cancer. In order to learn more about the most recent information available concerning the treatment of testicular cancer, click on the appropriate stage.

Stage I Seminoma: Stage I testicular cancer is limited to the testes. Pathologic Stage I cancer refers to patients who have a lymph node dissection that is free of cancer. Clinical Stage I cancer is used to classify patients who do not undergo a lymph node dissection.

Stage II Seminoma: Stage II testicular cancer involves the testes and the retroperitoneal lymph nodes. Retroperitoneal lymph node involvement is further characterized by the number and size of involved lymph nodes.

Stage III Seminoma: Stage III testicular cancer has spread beyond the retroperitoneal lymph nodes. Stage III seminoma is subdivided into "non-bulky" Stage III and "bulky" Stage III based on the amount of cancer present at diagnosis.

Recurrent and/or Refractory Seminoma: Cancer has returned or progressed after primary treatment and may be resistant to chemotherapy.

Stage I Nonseminoma: Stage I testicular cancer is limited to the testes. Pathologic Stage I cancer refers to patients who have a lymph node dissection that is free of cancer. Clinical Stage I cancer is used to classify patients who do not undergo a lymph node dissection. A retroperitoneal lymph node dissection detects cancer spread in 15–30% of patients whose diagnostic tests indicated no spread prior to surgery.

Stage II Nonseminoma: Stage II testicular cancer involves the testes and the retroperitoneal lymph nodes. Retroperitoneal lymph node involvement is further characterized by the number and size of involved lymph nodes.

Stage III Nonseminoma: Stage III testicular cancer has spread beyond the retroperitoneal lymph nodes. Stage III testicular cancer is subdivided into "non-bulky" Stage III and "bulky" Stage III based on the amount of tumor present at diagnosis.

Recurrent and/or Refractory Nonseminoma: Cancer has returned after primary treatment and may be resistant to chemotherapy.

Read More

Thyroid Cancer

The thyroid gland is located in the front of the neck and is attached to the lower part of the voice box (larynx) and to the upper part of the windpipe (trachea). It has two sides, or lobes, that are connected by a narrow neck. The thyroid gland produces thyroid hormones, which regulate metabolism, growth, and development and are essential for life.

Diagnosing Thyroid Cancer
Thyroid cancer may be suspected if a small abnormal growth—called a nodule—is found to protrude from the thyroid gland. Since the vast majority of thyroid nodules are benign, diagnostic tests must be conducted to determine if the nodule is malignant or cancerous.

Diagnosing thyroid cancer may involve tests that generate an image of the thyroid, such as ultrasound or PET imaging. A sample of the cells is also typically evaluated under a microscope. The sample may be removed using a needle and syringe or may be removed during surgery to treat the nodule. If initial tests indicate that the nodule is cancerous, a surgery will be scheduled to remove as much of the cancer as possible and to determine the extent of the disease—also called the stage of disease—and whether it has spread outside the thyroid gland.

Tests used to diagnose thyroid cancer include the following:

Ultrasound: Ultrasound uses high frequency sound waves and their echoes to create a two-dimensional image that is projected on a screen. Ultrasound is a simple procedure that may allow doctors to determine if a thyroid nodule is cancerous or benign based on the appearance of the image that is produced. A limitation of ultrasound is that it does not produce a sample of the cells that can be evaluated under a microscope.

Fine needle aspiration: Fine needle aspiration is a technique that uses a needle and syringe to withdraw a sample of the cells from a thyroid nodule. The cells can then be evaluated under a microscope to determine if they are cancerous or benign. Since many thyroid nodules are benign, this technique provides a minimally invasive way to determine if surgery is necessary.

Positron emission tomography (PET): Unlike techniques that provide anatomical images, such as X-ray or ultrasound, PET scans show chemical and physiological changes related to metabolism.

Before a PET scan, a patient will receive an injection of a drug that has a biological element—called an isotope—attached to it. The isotope becomes visible when a small amount of radiation is passed through the body. The most active cells take up more of the drug, allowing the doctor to see which areas are more active—a possible sign of cancer.

The radiation from a PET scan is roughly equivalent to what is administered in two chest X-rays. After the scan is complete, the radiation does not stay in the body for very long.

PET scans are covered by Medicare for the diagnosis of thyroid cancer.

Types of Thyroid Cancer
Cancer may arise from different cells of the thyroid gland. By evaluating a sample of the cancer under a microscope, doctors can determine the type of thyroid cancer. There are four main types of thyroid cancer:

Papillary: Papillary tumors are the most common form of thyroid cancer, accounting for more than 70% of all cases. Papillary cancers are typically irregular or solid masses that arise from otherwise normal thyroid tissue. More than half of papillary cancers have spread to lymph nodes in the neck. However, papillary cancers rarely spread to distant locations in the body. Papillary cancers typically occur in younger patients (30-50 years) and are commonly associated with a prior exposure to radiation. Patients with papillary cancer are highly curable with currently available treatment techniques.

Follicular: Follicular cancers account for a smaller percentage of all thyroid cancers (approximately 15%) and rarely occur after radiation exposure. Follicular cancers are more aggressive; they tend to invade blood vessels rather than lymph nodes, and distant spread is therefore more common. Potential sites of distant spread include the lung, bone, brain, liver, bladder, and skin. Patients over 40 have more aggressive disease that is more difficult to treat. Nonetheless, most follicular cancers are very curable.

Medullary: There are two subtypes of medullary thyroid cancer: sporadic and familial. Sporadic almost always occurs on both sides of the thyroid gland. Familial tumors may be malignant or benign and may be associated with a variety of symptoms.

Approximately half of medullary thyroid cancers have spread to lymph nodes. Prognosis depends on the extent of disease at diagnosis—especially spread to lymph nodes—and the ability to completely remove the cancer with surgery.

Anaplastic: Anaplastic thyroid cancer is a rare disease that may also be called undifferentiated cancer. This type of thyroid cancer is very aggressive, grows rapidly, and commonly extends beyond the thyroid gland. It typically occurs in older patients and is characterized by extensive spread in the neck area and rapid progression. Patients typically die of their disease within months of diagnosis.

Stages of Thyroid Cancer
Following a diagnosis of cancer, the most important step is to accurately determine the stage of cancer. Stage describes how far the cancer has spread. Identifying the stage of cancer is important because each stage of cancer may be treated differently.

Stage I-II: Stage I-II thyroid cancers are generally confined to the thyroid, but many include multiple sites of cancer within the thyroid. Thyroid cancer that has spread to nearby lymph nodes is still considered to be in stage I-II when the patient is younger than 45 years of age as the presence of cancer in the lymph nodes does not worsen the prognosis for these younger patients.

Early stage thyroid cancer is very treatable and many patients are cured with surgery alone.

Stage III: Stage III thyroid cancer is greater than 4 cm in diameter and is limited to the thyroid or may have minimal spread outside the thyroid. Lymph nodes near the trachea may be affected. Stage III thyroid cancer that has spread to adjacent cervical (neck) tissue or nearby blood vessels has a worse prognosis than cancer confined to the thyroid. However, lymph node metastases do not worsen the prognosis for patients younger than 45 years.

Stage III thyroid cancer is also referred to as locally advanced disease.

Stage IV: Stage IV thyroid cancer has spread beyond the thyroid to the soft tissues of the neck, lymph nodes in the neck, or distant locations in the body. The lungs and bone are the most frequent sites of distant spread. Papillary carcinoma more frequently spreads to regional lymph nodes than to distant sites. Follicular carcinoma is more likely to invade blood vessels and spread to distant locations.

Recurrent: Thyroid cancer that has recurred after treatment or progressed with treatment is called recurrent disease.

Read More

Testicular Cancer

Testicular cancers are relatively rare but highly curable, and occur predominantly in young and middle aged males. Testicular cancers were among the first types of cancers to be cured by radiation and/or chemotherapy, and treatment has been refined over the last two decades. Currently, over 70% of all patients are curable regardless of the extent of cancer. Thus, all treatment of testicular cancer is delivered with the intent to cure. However, it is important to know the extent of cancer and the specific type of testicular cancer in order to administer the best therapy.

The testicles are located inside the scrotum (a sac of loose skin that lies directly under the penis). The testicles are similar to the ovaries in women. Sperm and male hormones are made in the testicles. Testicular cancer—also called germ cell cancer—occurs in the tissues of one or both testicles. Similar cancers called "non-gonadal germ cell cancers" can also occur outside the testicle; non-gonadal germ cell cancers are not discussed in this section.

Testicular cancer is the most common cancer in men 15 to 35 years old. Men who have an undescended testicle (a testicle that has never moved down into the scrotum) are at higher risk of developing testicular cancer than men whose testicles have moved normally down into the scrotum. This is true even if surgery has been performed early in life to place the testicle in the appropriate place in the scrotum.

A swelling in the scrotum is usually the first sign of testicular cancer. A doctor will examine the testicles to feel for any lumps. If any lumps are found, the doctor will perform an ultrasound examination, which uses sound waves to make a picture of the inside of the testes. In addition, the physician may perform a computed tomography (CT) or positron emission tomography (PET) scan to determine whether cancer is present. A PET scan is similar to a CT scan; however, PET scans can detect live cancer tissue. Prior to a PET scan, the patient receives an injection of a substance that contains a type of sugar attached to a radioactive isotope. The cancer cells “take up” the sugar and attached isotope, which emits positively charged, low energy radiation (positrons). The positrons react with electrons in the cancer cells, which creates the production of gamma rays. The gamma rays are then detected by the PET machine, which transforms the information into a picture. If no gamma rays are detected in the scanned area, it is unlikely that the mass in question contains living cancer cells.

When cancer is suspected, the entire testicle is surgically removed (orchiectomy) through an incision in the groin. The surgically removed tissue is then examined under a microscope to determine whether cancer cells are present. Removal of a small piece of tissue (biopsy) is usually not done because this is thought to cause spread of the cancer. When the cancer is small and localized to the testicle, removal of the testicle may be all of the treatment that is necessary to cure the cancer. The surgically removed testicle is examined under the microscope to determine the type of cancer. In some patients the cancer consists of only one cell type. But for many patients, the cancer under the microscope consists of a mixture of cell types.

Testicular cancer is broadly divided into two different types, seminoma and nonseminoma, based on the appearance of cells under the microscope. Nonseminomas are, in general, more difficult to cure than seminomas. Nonseminoma cell types include: embryonal carcinoma, teratoma, yolk sac carcinoma, choriocarcinoma, and various combinations that are referred to as “mixed cell types”. For nonseminoma cancer teratoma presents the lowest risk of spread and choriocarcinoma presents the highest risk of spread; the other cell types are of intermediate risk.

Treatment planning depends upon whether the testicular cancer is classified as seminoma or nonseminoma. Seminomas are more sensitive to radiation therapy and are easier to cure than nonseminomas. Patients with all stages of seminoma have a cure rate that exceeds 90%, and patients with seminoma confined to the testicle have a cure rate approaching 100%. If there is a mixture of seminoma and nonseminoma components upon examination under the microscope, the cancer is diagnosed as nonseminoma because the cancer will be more aggressive due to the nonseminoma part of the cancer.

The extent of disease, or “stage” is determined after surgical removal of the testicle. All patients will require CT or magnetic resonance imaging (MRI) scans of the abdomen, chest, and sometimes the brain or bones to look for spread of disease beyond the testicle.

Lymph nodes are small, bean-shaped structures that are an essential component of the immune system. They are found throughout the body and are interconnected with lymph channels. Testicular cancer tends to spread through lymph channels that drain into lymph nodes in the groin area, into channels near the large blood vessel (the aorta) carrying blood from the heart, and into lymph nodes between the abdomen and back called retroperitoneal lymph nodes.

Retroperitoneal Lymph Node Dissection (RPLND)
Direct surgical evaluation of the retroperitoneal lymph nodes is an important aspect of treatment planning in many adults with testicular cancer, especially those with clinically localized nonseminoma Stage I and II disease. This is because some patients will appear to have no evidence of cancer in the retroperitoneal lymph nodes on CT scan and will appear to have a Stage I cancer. They may actually have lymph nodes involved with cancer that were not detectable by the CT scan and may actually have Stage II cancer. Some patients who appear to have cancer on CT scan will not have lymph nodes involved and actually have a Stage I cancer.

RPLND for diagnosis and prevention of relapse is a relatively major operation requiring skill to sample and remove all the nodes. The major complication is damage or removal of the connections of the sympathetic nervous system, which are located next to the lymph nodes. This can lead to disruption of ejaculation of sperm, thereby leading to infertility. Surgeons have devised techniques to spare the sympathetic nervous system connections while still removing most lymph nodes; this preserves normal ejaculation in approximately 90% of patients.[1] Newer treatment strategies involving the adjuvant (post-surgery) administration of chemotherapy have decreased the number of patients requiring lymph node dissection.

Tumor or Cancer Markers
An important aspect of the evaluation of testicular cancer is the use of blood or serum tests to detect cancer markers. Cancer markers are abnormal substances in the blood associated with the presence of cancer somewhere in the body. Common cancer markers that are present in the blood of patients with testicular cancer include:

•Alpha-fetoprotein (AFP)
•Beta human chorionic gonadotropin (BHCG)
•Lactate dehydrogenase (LDH)..
These cancer markers may detect cancers that are too small to be detected with a CT scan. In males under age 15, about 90% of testicular germ cell cancers are yolk sac tumors that make AFP, which is an excellent indicator of response to therapy and disease status.

It is important to realize that the absence of cancer markers in the blood following treatment does not always mean the absence of cancer, even when cancer markers were present at diagnosis. Patients who appear to have seminoma when the cancer is examined under the microscope and have elevated serum levels of AFP are treated as if they have nonseminoma because seminoma cells do not secrete this cancer marker and other cell types must be present, even though they may not be visible under the microscope. Elevation of the BHCG is found in approximately 10% of patients with pure seminoma and is an indication of metastatic spread of disease, but does not change the cellular diagnosis.

Type of treatment and outcomes depend on the stage and spread of the cancer. In order to learn more about the most recent information available concerning the treatment of testicular cancer, click on the appropriate stage.

Stage I Seminoma: Stage I testicular cancer is limited to the testes. Pathologic Stage I cancer refers to patients who have a lymph node dissection that is free of cancer. Clinical Stage I cancer is used to classify patients who do not undergo a lymph node dissection.

Stage II Seminoma: Stage II testicular cancer involves the testes and the retroperitoneal lymph nodes. Retroperitoneal lymph node involvement is further characterized by the number and size of involved lymph nodes.

Stage III Seminoma: Stage III testicular cancer has spread beyond the retroperitoneal lymph nodes. Stage III seminoma is subdivided into "non-bulky" Stage III and "bulky" Stage III based on the amount of cancer present at diagnosis.

Recurrent and/or Refractory Seminoma: Cancer has returned or progressed after primary treatment and may be resistant to chemotherapy.

Stage I Nonseminoma: Stage I testicular cancer is limited to the testes. Pathologic Stage I cancer refers to patients who have a lymph node dissection that is free of cancer. Clinical Stage I cancer is used to classify patients who do not undergo a lymph node dissection. A retroperitoneal lymph node dissection detects cancer spread in 15–30% of patients whose diagnostic tests indicated no spread prior to surgery.

Stage II Nonseminoma: Stage II testicular cancer involves the testes and the retroperitoneal lymph nodes. Retroperitoneal lymph node involvement is further characterized by the number and size of involved lymph nodes.

Stage III Nonseminoma: Stage III testicular cancer has spread beyond the retroperitoneal lymph nodes. Stage III testicular cancer is subdivided into "non-bulky" Stage III and "bulky" Stage III based on the amount of tumor present at diagnosis.

Recurrent and/or Refractory Nonseminoma: Cancer has returned after primary treatment and may be resistant to chemotherapy.

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Skin Cancer

More than 1 million people are diagnosed with skin cancer every year in the United States - and many of these cases could have been prevented. Most damage that leads to skin cancer is caused by over-exposure to Ultraviolet (UV) rays from the sun or from tanning beds. This is damage that is easily preventable.

Limiting sun exposure, using sunscreen and avoiding tanning beds are all highly recommended actions that can lower the risk of skin cancer. Yet, despite efforts to inform the public of these preventative measures, the number of new skin cancer cases has been increasing over the past few decades - a strong indication that our current efforts are far from sufficient.

In addition to more public education about recommended risk-lowering actions, much more research is needed to find new ways to protect our skin.

Although most skin cancers are curable, a serious type known as melanoma was estimated to claim 8,420 American people's lives last year alone, accounting for more than 70% of all skin cancer deaths. Melanoma is more difficult to prevent because, unlike in other types of skin cancer, heredity plays a major role in melanoma development. It is also more aggressive in spreading (metastasizing) to distant body parts, and treatment is often ineffective once metastasis occurs. Studies show that only 15% of patients with metastatic melanoma could survive for 5 years or longer. Better treatment strategies are in high demand for this lethal skin cancer.

Research

NFCR funds leading cancer researchers who are dedicated to finding new and better strategies for skin cancer prevention and treatment. Below are two examples of outstanding NFCR research programs, each holding great promise in the effort to fight skin cancer and save more lives:

Searching for "A Second Layer of Sunscreen"
NFCR Fellow Helmut Sies, M.D., from Heinrich Heine Universitat, Germany

Back in the 1980s, Dr. Helmut Sies discovered the powerful anti-oxidation activity of lycopene, the famous red pigment in tomatoes and other fruits and vegetables. His recent research with volunteers showed that lycopene and other carotenoids (natural pigments) effectively ameliorated UV-induced skin damage (erythma) in humans, which consequently helped reduce the risk of skin cancer. Dr. Sies' discovery increases the possibilities of using dietary intervention for skin cancer protection, and helps the development of functional foods that may enable humans to create a second layer of powerful sunscreen from inside out.

Stopping the Lethal Spread of Melanoma
NFCR Center of Metastasis Research, University of Alabama (Birmingham) directed by Danny Welch, Ph.D

Melanoma can take a patient's life within 4-6 months once it has spread. Very little is known how cancer cells spread to distant sites in the body and many researchers have shied away from the complex biology of metastatic cancer.

Dr. Welch and his collaborators are opening the research doors toward an understanding of the metastatic process and finding ways to stop its killing. They have discovered six "metastasis suppressor genes" including BRMS1 and KISS1 genes that stop the spread of melanoma. The impact of this research is enormously significant, as it could lead to novel anti-cancer therapies that prevent metastasis from happening or keep it dormant, putting the cancer under control and giving patients new hope for a cure and extended life.


More than one million new cases of skin cancer are diagnosed each year in the United States, making it the most commonly diagnosed type of cancer.[1]

Overview of the Skin
The skin is the largest organ in the body. It protects against germs, covers internal organs, and helps regulate the body’s temperature. The two main layers of the skin are the epidermis and the dermis. The epidermis forms the top, outer layer of the skin. The dermis is a thicker layer beneath the epidermis.

Skin cancer generally develops in the epidermis. The three main types of cells in the epidermis are squamous cells, basal cells, and melanocytes. Squamous cells form a flat layer of cells at the top of the epidermis. Basal cells are round cells found beneath the squamous cells. Melanocytes are pigment-producing cells that are generally found in the lower part of the epidermis.

Types of Skin Cancer
Skin cancer is often categorized as melanoma or non-melanoma. Melanoma is a cancer that begins in melanocytes. It is less common than non-melanoma skin cancer, but tends to be more aggressive. In 2006 an estimated 62,000 individuals in the U.S. will be diagnosed with melanoma, and close to 8,000 will die of the disease.[1]

The most common type of non-melanoma skin cancer is basal cell carcinoma. This type of cancer rarely spreads to distant sites in the body, but it can be disfiguring and may invade nearby tissues.

The second most common type of non-melanoma skin cancer is squamous cell carcinoma. Although this type of cancer is more likely to metastasize (spread to lymph nodes or other sites in the body) than basal cell carcinoma, metastasis is still rare. Both basal cell carcinoma and squamous cell carcinoma most commonly develop on sun-exposed parts of the skin, but can develop on other parts of the skin as well.

An alarming trend in both melanoma and non-melanoma skin cancers is that the frequency of these cancers in children and young adults appears to be increasing.[2] This highlights the importance of prevention at all ages.

Because of their very different characteristics and treatment, melanoma and non-melanoma skin cancer are discussed further in separate sections.

Go to the Melanoma Information Center

Go to the Non-Melanoma Information Center

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Skin Cancer

More than 1 million people are diagnosed with skin cancer every year in the United States - and many of these cases could have been prevented. Most damage that leads to skin cancer is caused by over-exposure to Ultraviolet (UV) rays from the sun or from tanning beds. This is damage that is easily preventable.

Limiting sun exposure, using sunscreen and avoiding tanning beds are all highly recommended actions that can lower the risk of skin cancer. Yet, despite efforts to inform the public of these preventative measures, the number of new skin cancer cases has been increasing over the past few decades - a strong indication that our current efforts are far from sufficient.

In addition to more public education about recommended risk-lowering actions, much more research is needed to find new ways to protect our skin.

Although most skin cancers are curable, a serious type known as melanoma was estimated to claim 8,420 American people's lives last year alone, accounting for more than 70% of all skin cancer deaths. Melanoma is more difficult to prevent because, unlike in other types of skin cancer, heredity plays a major role in melanoma development. It is also more aggressive in spreading (metastasizing) to distant body parts, and treatment is often ineffective once metastasis occurs. Studies show that only 15% of patients with metastatic melanoma could survive for 5 years or longer. Better treatment strategies are in high demand for this lethal skin cancer.

Research

NFCR funds leading cancer researchers who are dedicated to finding new and better strategies for skin cancer prevention and treatment. Below are two examples of outstanding NFCR research programs, each holding great promise in the effort to fight skin cancer and save more lives:

Searching for "A Second Layer of Sunscreen"
NFCR Fellow Helmut Sies, M.D., from Heinrich Heine Universitat, Germany

Back in the 1980s, Dr. Helmut Sies discovered the powerful anti-oxidation activity of lycopene, the famous red pigment in tomatoes and other fruits and vegetables. His recent research with volunteers showed that lycopene and other carotenoids (natural pigments) effectively ameliorated UV-induced skin damage (erythma) in humans, which consequently helped reduce the risk of skin cancer. Dr. Sies' discovery increases the possibilities of using dietary intervention for skin cancer protection, and helps the development of functional foods that may enable humans to create a second layer of powerful sunscreen from inside out.

Stopping the Lethal Spread of Melanoma
NFCR Center of Metastasis Research, University of Alabama (Birmingham) directed by Danny Welch, Ph.D

Melanoma can take a patient's life within 4-6 months once it has spread. Very little is known how cancer cells spread to distant sites in the body and many researchers have shied away from the complex biology of metastatic cancer.

Dr. Welch and his collaborators are opening the research doors toward an understanding of the metastatic process and finding ways to stop its killing. They have discovered six "metastasis suppressor genes" including BRMS1 and KISS1 genes that stop the spread of melanoma. The impact of this research is enormously significant, as it could lead to novel anti-cancer therapies that prevent metastasis from happening or keep it dormant, putting the cancer under control and giving patients new hope for a cure and extended life.


More than one million new cases of skin cancer are diagnosed each year in the United States, making it the most commonly diagnosed type of cancer.[1]

Overview of the Skin
The skin is the largest organ in the body. It protects against germs, covers internal organs, and helps regulate the body’s temperature. The two main layers of the skin are the epidermis and the dermis. The epidermis forms the top, outer layer of the skin. The dermis is a thicker layer beneath the epidermis.

Skin cancer generally develops in the epidermis. The three main types of cells in the epidermis are squamous cells, basal cells, and melanocytes. Squamous cells form a flat layer of cells at the top of the epidermis. Basal cells are round cells found beneath the squamous cells. Melanocytes are pigment-producing cells that are generally found in the lower part of the epidermis.

Types of Skin Cancer
Skin cancer is often categorized as melanoma or non-melanoma. Melanoma is a cancer that begins in melanocytes. It is less common than non-melanoma skin cancer, but tends to be more aggressive. In 2006 an estimated 62,000 individuals in the U.S. will be diagnosed with melanoma, and close to 8,000 will die of the disease.[1]

The most common type of non-melanoma skin cancer is basal cell carcinoma. This type of cancer rarely spreads to distant sites in the body, but it can be disfiguring and may invade nearby tissues.

The second most common type of non-melanoma skin cancer is squamous cell carcinoma. Although this type of cancer is more likely to metastasize (spread to lymph nodes or other sites in the body) than basal cell carcinoma, metastasis is still rare. Both basal cell carcinoma and squamous cell carcinoma most commonly develop on sun-exposed parts of the skin, but can develop on other parts of the skin as well.

An alarming trend in both melanoma and non-melanoma skin cancers is that the frequency of these cancers in children and young adults appears to be increasing.[2] This highlights the importance of prevention at all ages.

Because of their very different characteristics and treatment, melanoma and non-melanoma skin cancer are discussed further in separate sections.

Go to the Melanoma Information Center

Go to the Non-Melanoma Information Center

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Uterine Cancer

The uterus is the female reproductive organ where the unborn baby grows and develops until birth. This muscular organ is connected to the vagina by the cervix and contains entrances for the two fallopian tubes, which transfer eggs from the ovaries. The uterus is a highly hormone sensitive organ with monthly bleeding and shedding cycles (menstruation) in the absence of pregnancy. The growth of the most common uterine cancer, adenocarcinoma, is also sensitive to female hormones. Uterine cancer usually arises from the surface of the uterus or endometrium and less frequently from glands in the uterus. For most women, uterine cancer is brought to medical attention because of unanticipated or problematic bleeding from the uterus, usually occurring after menopause. Fortunately, 80% of women diagnosed after developing abnormal bleeding will have cancer limited to the uterus (stage I and II) and a high proportion are cured.

Uterine (endometrial) cancer is one of the most common gynecologic cancers in women, with 36,100 new cases each year. The incidence of uterine cancer would be even higher if it weren’t for the relatively large number of hysterectomies performed for non-cancerous reasons. It is estimated that approximately 6,500 women will die of uterine cancer in the U.S. in 2001. There has been an increase in the incidence of uterine cancer since the mid 1970s, which has been attributed to the use of hormone replacement therapy. Surgery is the primary treatment for uterine cancer and approximately 82% of women survive 5 years after diagnosis. For more information about the cause of uterine cancer and programs for early detection, go to Prevention and Screening.

Currently, a dilation and curettage (D&C) is the most reliable method for diagnosing uterine cancer. During a D&C, a sample of the cells lining the uterus is removed for examination under a microscope to determine if cancer is present. Following a diagnosis of uterine cancer, additional tests are performed on the cancer cells to determine the stage of the cancer in order to provide optimal treatment.

There are several types of uterine cancer, which vary based on their appearance under the microscope. The most common type of uterine cancer is adenocarcinoma. Other variants of uterine cancer that behave more aggressively include serous carcinoma, uterine clear cell carcinoma and mixed type. These cancers, stage for stage, have a worse outcome than adenocarcinoma. Outcomes following treatment of adenocarcinoma can also be affected by the appearance of cancer when examined under the microscope. Doctors grade adenocarcinomas, as poorly, moderately or well differentiated. These terms describe how closely the cancer resembles normal cells of the uterus. In general, the less differentiated the cells, the more aggressive the cancer. More poorly differentiated cancers have a higher rate of recurrence. The reason doctors are interested in this is that more or better treatments may be indicated for patients with more aggressive cancers.

In addition to the type and grade of the cancer, the stage or extent of spread of cancer is the most useful predictor of survival and is relevant for treatment planning. Currently, surgery to remove the uterus, ovaries and lymph nodes is relied upon to determine the stage of the cancer.

Other tests that may be utilized to help stage the cancer include magnetic resonance imaging (MRI) scans and ultrasound. The most common method for examining the uterus is with transvaginal sonography. During transvaginal sonography, an ultrasound apparatus is passed through the vagina in order to examine the uterus. Another test, sonohysterography, improves the accuracy of sonography by first infusing a salt solution into the uterus through the cervix. MRI scans can also be useful in determining whether the lymph nodes are involved with cancer and may prevent the need for lymph node dissection.

In order to learn more about the most recent information available concerning the treatment of uterine cancer, click on the appropriate stage.

Stage I: Cancer does not spread outside the body of the uterus.

Stage II: Cancer involves the body of the uterus and the cervix.

Stage III: Cancer extends outside the uterus, but is confined to the pelvis.

Stage IV: Cancer involves the bladder or bowel or distant sites.

Recurrent: Cancer has returned after initial treatment.

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Uterine Cancer

The uterus is the female reproductive organ where the unborn baby grows and develops until birth. This muscular organ is connected to the vagina by the cervix and contains entrances for the two fallopian tubes, which transfer eggs from the ovaries. The uterus is a highly hormone sensitive organ with monthly bleeding and shedding cycles (menstruation) in the absence of pregnancy. The growth of the most common uterine cancer, adenocarcinoma, is also sensitive to female hormones. Uterine cancer usually arises from the surface of the uterus or endometrium and less frequently from glands in the uterus. For most women, uterine cancer is brought to medical attention because of unanticipated or problematic bleeding from the uterus, usually occurring after menopause. Fortunately, 80% of women diagnosed after developing abnormal bleeding will have cancer limited to the uterus (stage I and II) and a high proportion are cured.

Uterine (endometrial) cancer is one of the most common gynecologic cancers in women, with 36,100 new cases each year. The incidence of uterine cancer would be even higher if it weren’t for the relatively large number of hysterectomies performed for non-cancerous reasons. It is estimated that approximately 6,500 women will die of uterine cancer in the U.S. in 2001. There has been an increase in the incidence of uterine cancer since the mid 1970s, which has been attributed to the use of hormone replacement therapy. Surgery is the primary treatment for uterine cancer and approximately 82% of women survive 5 years after diagnosis. For more information about the cause of uterine cancer and programs for early detection, go to Prevention and Screening.

Currently, a dilation and curettage (D&C) is the most reliable method for diagnosing uterine cancer. During a D&C, a sample of the cells lining the uterus is removed for examination under a microscope to determine if cancer is present. Following a diagnosis of uterine cancer, additional tests are performed on the cancer cells to determine the stage of the cancer in order to provide optimal treatment.

There are several types of uterine cancer, which vary based on their appearance under the microscope. The most common type of uterine cancer is adenocarcinoma. Other variants of uterine cancer that behave more aggressively include serous carcinoma, uterine clear cell carcinoma and mixed type. These cancers, stage for stage, have a worse outcome than adenocarcinoma. Outcomes following treatment of adenocarcinoma can also be affected by the appearance of cancer when examined under the microscope. Doctors grade adenocarcinomas, as poorly, moderately or well differentiated. These terms describe how closely the cancer resembles normal cells of the uterus. In general, the less differentiated the cells, the more aggressive the cancer. More poorly differentiated cancers have a higher rate of recurrence. The reason doctors are interested in this is that more or better treatments may be indicated for patients with more aggressive cancers.

In addition to the type and grade of the cancer, the stage or extent of spread of cancer is the most useful predictor of survival and is relevant for treatment planning. Currently, surgery to remove the uterus, ovaries and lymph nodes is relied upon to determine the stage of the cancer.

Other tests that may be utilized to help stage the cancer include magnetic resonance imaging (MRI) scans and ultrasound. The most common method for examining the uterus is with transvaginal sonography. During transvaginal sonography, an ultrasound apparatus is passed through the vagina in order to examine the uterus. Another test, sonohysterography, improves the accuracy of sonography by first infusing a salt solution into the uterus through the cervix. MRI scans can also be useful in determining whether the lymph nodes are involved with cancer and may prevent the need for lymph node dissection.

In order to learn more about the most recent information available concerning the treatment of uterine cancer, click on the appropriate stage.

Stage I: Cancer does not spread outside the body of the uterus.

Stage II: Cancer involves the body of the uterus and the cervix.

Stage III: Cancer extends outside the uterus, but is confined to the pelvis.

Stage IV: Cancer involves the bladder or bowel or distant sites.

Recurrent: Cancer has returned after initial treatment.

Read More

Uterine Cancer

The uterus is the female reproductive organ where the unborn baby grows and develops until birth. This muscular organ is connected to the vagina by the cervix and contains entrances for the two fallopian tubes, which transfer eggs from the ovaries. The uterus is a highly hormone sensitive organ with monthly bleeding and shedding cycles (menstruation) in the absence of pregnancy. The growth of the most common uterine cancer, adenocarcinoma, is also sensitive to female hormones. Uterine cancer usually arises from the surface of the uterus or endometrium and less frequently from glands in the uterus. For most women, uterine cancer is brought to medical attention because of unanticipated or problematic bleeding from the uterus, usually occurring after menopause. Fortunately, 80% of women diagnosed after developing abnormal bleeding will have cancer limited to the uterus (stage I and II) and a high proportion are cured.

Uterine (endometrial) cancer is one of the most common gynecologic cancers in women, with 36,100 new cases each year. The incidence of uterine cancer would be even higher if it weren’t for the relatively large number of hysterectomies performed for non-cancerous reasons. It is estimated that approximately 6,500 women will die of uterine cancer in the U.S. in 2001. There has been an increase in the incidence of uterine cancer since the mid 1970s, which has been attributed to the use of hormone replacement therapy. Surgery is the primary treatment for uterine cancer and approximately 82% of women survive 5 years after diagnosis. For more information about the cause of uterine cancer and programs for early detection, go to Prevention and Screening.

Currently, a dilation and curettage (D&C) is the most reliable method for diagnosing uterine cancer. During a D&C, a sample of the cells lining the uterus is removed for examination under a microscope to determine if cancer is present. Following a diagnosis of uterine cancer, additional tests are performed on the cancer cells to determine the stage of the cancer in order to provide optimal treatment.

There are several types of uterine cancer, which vary based on their appearance under the microscope. The most common type of uterine cancer is adenocarcinoma. Other variants of uterine cancer that behave more aggressively include serous carcinoma, uterine clear cell carcinoma and mixed type. These cancers, stage for stage, have a worse outcome than adenocarcinoma. Outcomes following treatment of adenocarcinoma can also be affected by the appearance of cancer when examined under the microscope. Doctors grade adenocarcinomas, as poorly, moderately or well differentiated. These terms describe how closely the cancer resembles normal cells of the uterus. In general, the less differentiated the cells, the more aggressive the cancer. More poorly differentiated cancers have a higher rate of recurrence. The reason doctors are interested in this is that more or better treatments may be indicated for patients with more aggressive cancers.

In addition to the type and grade of the cancer, the stage or extent of spread of cancer is the most useful predictor of survival and is relevant for treatment planning. Currently, surgery to remove the uterus, ovaries and lymph nodes is relied upon to determine the stage of the cancer.

Other tests that may be utilized to help stage the cancer include magnetic resonance imaging (MRI) scans and ultrasound. The most common method for examining the uterus is with transvaginal sonography. During transvaginal sonography, an ultrasound apparatus is passed through the vagina in order to examine the uterus. Another test, sonohysterography, improves the accuracy of sonography by first infusing a salt solution into the uterus through the cervix. MRI scans can also be useful in determining whether the lymph nodes are involved with cancer and may prevent the need for lymph node dissection.

In order to learn more about the most recent information available concerning the treatment of uterine cancer, click on the appropriate stage.

Stage I: Cancer does not spread outside the body of the uterus.

Stage II: Cancer involves the body of the uterus and the cervix.

Stage III: Cancer extends outside the uterus, but is confined to the pelvis.

Stage IV: Cancer involves the bladder or bowel or distant sites.

Recurrent: Cancer has returned after initial treatment.

Read More

Renal Cancer

The kidneys are organs that are responsible for eliminating waste material from the blood by making urine. The kidneys also produce hormones, which regulate blood pressure and control red blood cell production. Located just above the kidneys are the adrenal glands, which produce several essential hormones. Adrenal hormones help to regulate metabolism, blood pressure, inflammation, and response to stress. The adrenal glands also produce small amounts of sex hormones (androgens and estrogens).The body can function perfectly well with one kidney and one adrenal gland if they are normal. This allows for the removal of one entire kidney and adrenal gland when necessary to remove a cancer localized to the kidney area. If patients have poor kidney function before developing cancer of the kidney, it may not be possible to remove one kidney and still have normal function.

Normal Anatomy: Most people have two kidneys. The kidneys produce urine, which drains through narrow tubes (called ureters) into the urinary bladder (Figure 1). The kidneys are located toward the back of the flank, with one kidney on either side (Figure 2). The kidney is contained within a fibrous sheath called Gerota’s fascia (Figure 3). Within this fascia is a layer of fat that surrounds the kidney. The capsule is a thin layer that covers the outer surface of the kidney (analogous to the red external layer of an apple). The primary vein that drains the kidney (renal vein) merges with the vein that takes blood to the heart (vena cava). The term “renal” means pertaining to the kidney. An adrenal gland is located above each kidney within Gerota's fascia.







Several types of tumors both benign and malignant may occur in the kidney. A kidney tumor is an abnormal area within the kidney. The terms mass, lesion, and tumor are often used interchangeably. Tumors may be benign (not cancerous) or malignant (cancerous). The most common type of kidney tumor is a fluid-filled area called a cyst. Simple cysts are benign and have a typical appearance on imaging studies. Simple cysts do not progress to cancer and usually require no follow-up treatment. Complex cysts do not have the typical benign appearance and may contain cancer. When complex cysts are present, the need for treatment is determined on an individual basis. Another type of kidney tumor is a solid kidney tumor (i.e. not fluid-filled). Solid kidney tumors may be benign, but are usually malignant. In fact, more than 90% of solid kidney tumors are cancerous.

In the United States, kidney cancer accounts for about 3% of all cancers, with approximately 12,000 kidney cancer deaths each year. Kidney cancer occurs slightly more often in males and is usually diagnosed between the ages of 50 and 70, but can occur at any age. In adults, the most common type of kidney cancer is renal cell cancer, also called renal adenocarcinoma or hypernephroma.

Symptoms: Many kidney tumors go undetected due to the lack of symptoms and are incidentally detected during the medical evaluation of an unrelated problem. Kidney tumors can cause symptoms by compressing, stretching or invading structures near or within the kidney. Symptoms caused by these processes include pain (in the flank, abdomen or back) and blood in the urine (small amounts may not be visible). If cancer spreads beyond the kidney, symptoms depend upon which organ is involved. Shortness of breath or coughing up blood may occur when cancer is in the lungs; bone pain or fracture may occur when cancer in the bone; and neurologic symptoms may occur when cancer is in the brain. In some cases, the cancer causes associated clinical or laboratory abnormalities called paraneoplastic syndromes. These syndromes are observed in approximately 30% of patients with kidney cancer and can occur in any stage. Clinical symptoms include weight loss, loss of appetite, fever, sweats and high blood pressure. Laboratory findings include elevated erythrocyte sedimentation rate, low red blood cell count (anemia), high calcium level in the blood, abnormal liver function tests, elevated alkaline phosphatase in the blood, and high white blood cell count. In many cases, the paraneoplastic syndrome resolves after the cancer is removed.

Detecting Kidney Cancer: When a kidney tumor is suspected, a kidney imaging study is obtained. The initial imaging study is usually an ultrasound or CT scan. In some cases, a combination of imaging studies may be required to completely evaluate the tumor. If cancer is suspected, the patient should be evaluated to see if the cancer has spread beyond the kidney.

Staging: Determining the extent of the spread or the stage of the cancer requires a number of tests. Staging tests include X-rays, computerized tomography (CT) scans, ultrasonography or magnetic resonance imaging (MRI). Other tests include an intravenous pyelogram (IVP) and arteriography. Intravenous pyelogram involves the injection of dye into a vein to help visualize the kidneys, ureters and bladder. If the patient has bone pain, recent bone fractures, or certain abnormalities on the blood tests, a bone scan is also recommended. Additional tests may be obtained as needed. Kidney cancer has the propensity to grow into the renal vein and vena cava. The portion of the cancer that extends into these veins is called “tumor thrombus.” Imaging studies help determine if tumor thrombus is present. There are no blood or urine tests that directly detect the presence of kidney tumors. Arteriography involves the injection of dye into the blood vessels supplying the kidney. Staging is ultimately confirmed by surgical removal of the cancer and exploration of the area adjacent to the kidney. The surgeon will often remove regional lymph nodes for examination under the microscope. Examination of both kidneys is essential to assure that one is working normally. Sometimes, more progressed stages of the disease can be determined by such tests without the need for surgery.

In 40% of patients, renal cell cancer will be limited to the kidney and is treated exclusively by surgery, which is curative 90% of the time. In the 60% of patients with renal cell cancer that has spread outside the kidney, the disease is generally not curable with surgery and other specialists, such as medical oncologists and possibly even radiation therapists, are involved with treatment.

Following completion of all diagnostic tests and surgery, a final "pathologic" stage and grade will be given. All new treatment information concerning renal cell cancer is categorized and discussed by the stage. Tumor grade is a subjective measure of how aggressive the tumor looks under the microscope; therefore, it is determined from a surgical specimen. Grade cannot be determined from radiographic imaging (CT scans, MRI, etc..), blood tests or urine tests. Grade usually ranges from 1 to 4 with higher numbers indicating a more aggressive tumor. Thus, higher grade implies a worse prognosis.

The following are simplified definitions of the various stages of kidney cancer. Click on each for a stage by stage overview of the most recent information available concerning the comprehensive treatment of renal cancer.

Stage I: The primary cancer is 7 centimeters (about 3 inches) or less and is limited to the kidney, with no spread to lymph nodes or distant sites.

Stage II: The primary cancer is greater than 7 centimeters (about 3 inches) and is limited to the kidney, with no spread to lymph nodes or distant sites.

Stage III: The primary cancer is less or greater than 7 centimeters (about 3 inches), but has spread to only a single regional lymph node. The primary tumor may have spread to the renal veins or vena cava (large vein returning blood to the heart located in the middle of the abdomen near the back), but has only spread directly and not out of the local area of the kidney.

Stage IV: The cancer has spread to distant sites, invades directly beyond the local area or has more than one lymph node involved.

Recurrent Renal Cell Cancer: Renal cell cancer has returned after primary treatment with surgery, chemotherapy, radiation or biological modifiers.

Clinical stage is based on radiographic imaging before surgery, whereas pathologic stage is based on the analysis of surgically removed tissue. Staging the cancer helps predict prognosis and survival.

Physicians further denote the stage of a cancer according to a system developed by the American Joint Committee on Cancer (AJCC). This staging system includes the following criteria:

1.) the size or extent of the primary kidney tumor growth into the kidney or T stage

Primary Tumor Stage (T stage) Graphic Representation Description
T1 Tumor is confined to the kidney (i.e. no penetration through the capsule) and is7 centimeters or less in greatest dimension
T2 Tumor is confined to the kidney (i.e. no penetration through the capsule) and is greater than 7 centimeters in greatest dimension
T3a Tumor penetrates through the kidney capsule into the surrounding fat or the adrenal gland, but not through Gerota’s fascia.
T3b or T3c

Tumor extends into the renal vein or into the vena cava.

-T3b indicates that the tumor thrombus does not extend above the level of the chest diaphragm.

-T3c indicates that the tumor thrombus extends above the level of the chest diaphragm.

T4 Tumor penetrates through Gerota’s fascia.

2.) the status of lymph nodes near the kidney or N stage (in renal cell cancer the lymph nodes near the kidney are referred to as regional lymph nodes); and

Regional Lymph Nodes (N stage) Description
N0 No cancer in the lymph nodes
N1 Cancer in a single lymph node
N2 Cancer in more than one lymph node

3.) the presence or absence of cancer spread to distant sites (metastases) or M stage

Distant Metastasis (M Stage) Description
M0 No metastasis
M1 Distant metastasis present

In general, cancers with higher T stage, lymph node metastasis (N stage) or distant metastasis (M stage) are associated with a worse prognosis and typically shorter survival periods.

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Rectal Cancer

The colon and rectum are parts of the body's digestive system and together form a long, muscular tube called the large intestine. The colon is the first 6 feet of the large intestine and the rectum is the last 8-10 inches. The last part of the rectum contains the rectal sphincter or anus. The rectal sphincter is the muscle that controls defecation. Preservation of the rectal sphincter during surgery for rectal cancer is necessary in order to maintain control of bowel function. Treatment approaches differ between cancers of the colon or rectum, and are therefore discussed separately. A separate section has been created for Colon Cancer.

Adenocarcinoma is the most common type of cancer that originates in the cells that line the rectum or large intestine. It accounts for over 90-95% of cancers originating in the rectum. Other types of cancer including carcinoid and leiomyosarcoma also originate in the rectum, but are not referred to as rectal cancer. This treatment overview deals only with adenocarcinoma of the rectum, which will be referred to as rectal cancer.

The treatment of rectal cancer may involve several physicians, including a gastroenterologist, a surgeon, a medical oncologist, a radiation oncologist, and/or other specialists. Care must be carefully coordinated between the various treating physicians involved in management of your cancer.

Staging
In order to understand the best treatment options available for treatment of rectal cancer, it is important to first determine where the cancer has spread in the body. The initial spread of rectal cancer occurs circumferentially around the rectum and laterally into the adjacent fat and muscles. Rectal cancer can then invade nearby organs and spread through the lymph and blood systems. Rectal cancer cells may spread via the blood throughout the body to the liver, lungs and other organs.

Determining the stage of the cancer or the extent of the spread requires a number of tests and is ultimately confirmed by surgical removal of the cancer and exploration of the abdominal cavity.

Computerized Tomography (CT) Scan: A CT scan is a technique for imaging body tissues and organs, during which X-ray transmissions are converted to detailed images, using a computer to synthesize X-ray data. A CT scan is conducted with a large machine positioned outside the body that can rotate to capture detailed images of the organs and tissues inside the body. This method is more sensitive and precise than the chest x-ray.

Magnetic Resonance Imaging (MRI): MRI uses a magnetic field rather than X-rays, and can often distinguish more accurately between healthy and diseased tissue. MRI gives better pictures of tumors located near bone than CT, does not use radiation as CT does, and provides pictures from various angles that enable doctors to construct a three-dimensional image of the tumor.

Colonoscopy: A colonoscopy may be used to identify whether a second cancer is present in the colon or rectum prior to surgery. During a colonoscopy, a long flexible tube that is attached to a camera is inserted through the rectum, allowing physicians to examine the internal lining of the colon for polyps or other abnormalities. The physician may perform a biopsy during a colonoscopy in order to collect samples of suspicious tissues or cells for closer examination.

Endorectal Ultrasound (EUS): Endorectal ultrasound (EUS) involves the use of a special probe that is inserted into the rectum to help determine the thickness of the cancer. By determining the thickness of the cancer, EUS can help determine the stage.

Doppler Ultrasound: One technique that may help predict an increased risk of cancer recurrence is Doppler ultrasound. Doppler ultrasound has been used to measure blood flow in the artery to the liver (hepatic artery) and total liver flow in patients with rectal cancer. This measurement may be helpful because abnormalities occurring in hepatic artery blood flow can be used to detect early cancer metastasis to the liver.

Surgery
Upon completion of the clinical "staging evaluation", surgery is performed to remove the cancer, along with part of the normal adjacent tissues of the rectum. Surgery also helps to further determine the level of spread within the rectal wall and abdomen. The type of surgery performed depends on the size and the location of the cancer. Surgery is commonly performed through an abdominal incision. In some cases, the rectal cancer is located close to the anus and the anus is removed with the cancer. Large rectal cancers close to the anus that cannot be removed without damaging anal function are sometimes treated with chemotherapy to help shrink the cancer before surgery. This is referred to as neoadjuvant chemotherapy. If there is enough shrinkage of the cancer, surgery may be performed that preserves anal function. However, in some cases, the cancer is too close to the anus and the anus is removed with the cancer. In other instances, the cancer may be localized, but too large to remove surgically. In these cases, administration of chemotherapy and/or radiation before surgery may shrink the cancer and allow complete surgical removal. For more information, go to Surgical Management of Rectal Cancer.

Following surgical removal of rectal cancer, a final "pathologic" stage will be given. This is based on extent of spread of cancer after looking at the removed tissue under a microscope. The stage may be a letter or a number, as several different staging systems are used to describe rectal cancer. All new treatment information concerning rectal cancer is categorized and discussed by the stage. In order to learn more about the most recent information available concerning the treatment of rectal cancer, click on the appropriate stage.

Stage I (A-B1): Cancer is confined to the lining of the rectum.

Stage II (B2-3): Cancer may penetrate the wall of the rectum into the surrounding fat or muscles or other adjacent organs, but does not invade any local lymph nodes.

Stage III (C1-3): Cancer invades one or more of the local lymph nodes, but has not spread to other distant organs.

Stage IV (D): Cancer has spread to distant locations in the body, which may include the liver, lungs, bones or other sites.

Recurrent/Relapsed: The rectal cancer has progressed or returned (recurred/relapsed) following an initial treatment.

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Renal Cancer

The kidneys are organs that are responsible for eliminating waste material from the blood by making urine. The kidneys also produce hormones, which regulate blood pressure and control red blood cell production. Located just above the kidneys are the adrenal glands, which produce several essential hormones. Adrenal hormones help to regulate metabolism, blood pressure, inflammation, and response to stress. The adrenal glands also produce small amounts of sex hormones (androgens and estrogens).The body can function perfectly well with one kidney and one adrenal gland if they are normal. This allows for the removal of one entire kidney and adrenal gland when necessary to remove a cancer localized to the kidney area. If patients have poor kidney function before developing cancer of the kidney, it may not be possible to remove one kidney and still have normal function.

Normal Anatomy: Most people have two kidneys. The kidneys produce urine, which drains through narrow tubes (called ureters) into the urinary bladder (Figure 1). The kidneys are located toward the back of the flank, with one kidney on either side (Figure 2). The kidney is contained within a fibrous sheath called Gerota’s fascia (Figure 3). Within this fascia is a layer of fat that surrounds the kidney. The capsule is a thin layer that covers the outer surface of the kidney (analogous to the red external layer of an apple). The primary vein that drains the kidney (renal vein) merges with the vein that takes blood to the heart (vena cava). The term “renal” means pertaining to the kidney. An adrenal gland is located above each kidney within Gerota's fascia.







Several types of tumors both benign and malignant may occur in the kidney. A kidney tumor is an abnormal area within the kidney. The terms mass, lesion, and tumor are often used interchangeably. Tumors may be benign (not cancerous) or malignant (cancerous). The most common type of kidney tumor is a fluid-filled area called a cyst. Simple cysts are benign and have a typical appearance on imaging studies. Simple cysts do not progress to cancer and usually require no follow-up treatment. Complex cysts do not have the typical benign appearance and may contain cancer. When complex cysts are present, the need for treatment is determined on an individual basis. Another type of kidney tumor is a solid kidney tumor (i.e. not fluid-filled). Solid kidney tumors may be benign, but are usually malignant. In fact, more than 90% of solid kidney tumors are cancerous.

In the United States, kidney cancer accounts for about 3% of all cancers, with approximately 12,000 kidney cancer deaths each year. Kidney cancer occurs slightly more often in males and is usually diagnosed between the ages of 50 and 70, but can occur at any age. In adults, the most common type of kidney cancer is renal cell cancer, also called renal adenocarcinoma or hypernephroma.

Symptoms: Many kidney tumors go undetected due to the lack of symptoms and are incidentally detected during the medical evaluation of an unrelated problem. Kidney tumors can cause symptoms by compressing, stretching or invading structures near or within the kidney. Symptoms caused by these processes include pain (in the flank, abdomen or back) and blood in the urine (small amounts may not be visible). If cancer spreads beyond the kidney, symptoms depend upon which organ is involved. Shortness of breath or coughing up blood may occur when cancer is in the lungs; bone pain or fracture may occur when cancer in the bone; and neurologic symptoms may occur when cancer is in the brain. In some cases, the cancer causes associated clinical or laboratory abnormalities called paraneoplastic syndromes. These syndromes are observed in approximately 30% of patients with kidney cancer and can occur in any stage. Clinical symptoms include weight loss, loss of appetite, fever, sweats and high blood pressure. Laboratory findings include elevated erythrocyte sedimentation rate, low red blood cell count (anemia), high calcium level in the blood, abnormal liver function tests, elevated alkaline phosphatase in the blood, and high white blood cell count. In many cases, the paraneoplastic syndrome resolves after the cancer is removed.

Detecting Kidney Cancer: When a kidney tumor is suspected, a kidney imaging study is obtained. The initial imaging study is usually an ultrasound or CT scan. In some cases, a combination of imaging studies may be required to completely evaluate the tumor. If cancer is suspected, the patient should be evaluated to see if the cancer has spread beyond the kidney.

Staging: Determining the extent of the spread or the stage of the cancer requires a number of tests. Staging tests include X-rays, computerized tomography (CT) scans, ultrasonography or magnetic resonance imaging (MRI). Other tests include an intravenous pyelogram (IVP) and arteriography. Intravenous pyelogram involves the injection of dye into a vein to help visualize the kidneys, ureters and bladder. If the patient has bone pain, recent bone fractures, or certain abnormalities on the blood tests, a bone scan is also recommended. Additional tests may be obtained as needed. Kidney cancer has the propensity to grow into the renal vein and vena cava. The portion of the cancer that extends into these veins is called “tumor thrombus.” Imaging studies help determine if tumor thrombus is present. There are no blood or urine tests that directly detect the presence of kidney tumors. Arteriography involves the injection of dye into the blood vessels supplying the kidney. Staging is ultimately confirmed by surgical removal of the cancer and exploration of the area adjacent to the kidney. The surgeon will often remove regional lymph nodes for examination under the microscope. Examination of both kidneys is essential to assure that one is working normally. Sometimes, more progressed stages of the disease can be determined by such tests without the need for surgery.

In 40% of patients, renal cell cancer will be limited to the kidney and is treated exclusively by surgery, which is curative 90% of the time. In the 60% of patients with renal cell cancer that has spread outside the kidney, the disease is generally not curable with surgery and other specialists, such as medical oncologists and possibly even radiation therapists, are involved with treatment.

Following completion of all diagnostic tests and surgery, a final "pathologic" stage and grade will be given. All new treatment information concerning renal cell cancer is categorized and discussed by the stage. Tumor grade is a subjective measure of how aggressive the tumor looks under the microscope; therefore, it is determined from a surgical specimen. Grade cannot be determined from radiographic imaging (CT scans, MRI, etc..), blood tests or urine tests. Grade usually ranges from 1 to 4 with higher numbers indicating a more aggressive tumor. Thus, higher grade implies a worse prognosis.

The following are simplified definitions of the various stages of kidney cancer. Click on each for a stage by stage overview of the most recent information available concerning the comprehensive treatment of renal cancer.

Stage I: The primary cancer is 7 centimeters (about 3 inches) or less and is limited to the kidney, with no spread to lymph nodes or distant sites.

Stage II: The primary cancer is greater than 7 centimeters (about 3 inches) and is limited to the kidney, with no spread to lymph nodes or distant sites.

Stage III: The primary cancer is less or greater than 7 centimeters (about 3 inches), but has spread to only a single regional lymph node. The primary tumor may have spread to the renal veins or vena cava (large vein returning blood to the heart located in the middle of the abdomen near the back), but has only spread directly and not out of the local area of the kidney.

Stage IV: The cancer has spread to distant sites, invades directly beyond the local area or has more than one lymph node involved.

Recurrent Renal Cell Cancer: Renal cell cancer has returned after primary treatment with surgery, chemotherapy, radiation or biological modifiers.

Clinical stage is based on radiographic imaging before surgery, whereas pathologic stage is based on the analysis of surgically removed tissue. Staging the cancer helps predict prognosis and survival.

Physicians further denote the stage of a cancer according to a system developed by the American Joint Committee on Cancer (AJCC). This staging system includes the following criteria:

1.) the size or extent of the primary kidney tumor growth into the kidney or T stage

Primary Tumor Stage (T stage) Graphic Representation Description
T1 Tumor is confined to the kidney (i.e. no penetration through the capsule) and is7 centimeters or less in greatest dimension
T2 Tumor is confined to the kidney (i.e. no penetration through the capsule) and is greater than 7 centimeters in greatest dimension
T3a Tumor penetrates through the kidney capsule into the surrounding fat or the adrenal gland, but not through Gerota’s fascia.
T3b or T3c

Tumor extends into the renal vein or into the vena cava.

-T3b indicates that the tumor thrombus does not extend above the level of the chest diaphragm.

-T3c indicates that the tumor thrombus extends above the level of the chest diaphragm.

T4 Tumor penetrates through Gerota’s fascia.

2.) the status of lymph nodes near the kidney or N stage (in renal cell cancer the lymph nodes near the kidney are referred to as regional lymph nodes); and

Regional Lymph Nodes (N stage) Description
N0 No cancer in the lymph nodes
N1 Cancer in a single lymph node
N2 Cancer in more than one lymph node

3.) the presence or absence of cancer spread to distant sites (metastases) or M stage

Distant Metastasis (M Stage) Description
M0 No metastasis
M1 Distant metastasis present

In general, cancers with higher T stage, lymph node metastasis (N stage) or distant metastasis (M stage) are associated with a worse prognosis and typically shorter survival periods.

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Rectal Cancer

The colon and rectum are parts of the body's digestive system and together form a long, muscular tube called the large intestine. The colon is the first 6 feet of the large intestine and the rectum is the last 8-10 inches. The last part of the rectum contains the rectal sphincter or anus. The rectal sphincter is the muscle that controls defecation. Preservation of the rectal sphincter during surgery for rectal cancer is necessary in order to maintain control of bowel function. Treatment approaches differ between cancers of the colon or rectum, and are therefore discussed separately. A separate section has been created for Colon Cancer.

Adenocarcinoma is the most common type of cancer that originates in the cells that line the rectum or large intestine. It accounts for over 90-95% of cancers originating in the rectum. Other types of cancer including carcinoid and leiomyosarcoma also originate in the rectum, but are not referred to as rectal cancer. This treatment overview deals only with adenocarcinoma of the rectum, which will be referred to as rectal cancer.

The treatment of rectal cancer may involve several physicians, including a gastroenterologist, a surgeon, a medical oncologist, a radiation oncologist, and/or other specialists. Care must be carefully coordinated between the various treating physicians involved in management of your cancer.

Staging
In order to understand the best treatment options available for treatment of rectal cancer, it is important to first determine where the cancer has spread in the body. The initial spread of rectal cancer occurs circumferentially around the rectum and laterally into the adjacent fat and muscles. Rectal cancer can then invade nearby organs and spread through the lymph and blood systems. Rectal cancer cells may spread via the blood throughout the body to the liver, lungs and other organs.

Determining the stage of the cancer or the extent of the spread requires a number of tests and is ultimately confirmed by surgical removal of the cancer and exploration of the abdominal cavity.

Computerized Tomography (CT) Scan: A CT scan is a technique for imaging body tissues and organs, during which X-ray transmissions are converted to detailed images, using a computer to synthesize X-ray data. A CT scan is conducted with a large machine positioned outside the body that can rotate to capture detailed images of the organs and tissues inside the body. This method is more sensitive and precise than the chest x-ray.

Magnetic Resonance Imaging (MRI): MRI uses a magnetic field rather than X-rays, and can often distinguish more accurately between healthy and diseased tissue. MRI gives better pictures of tumors located near bone than CT, does not use radiation as CT does, and provides pictures from various angles that enable doctors to construct a three-dimensional image of the tumor.

Colonoscopy: A colonoscopy may be used to identify whether a second cancer is present in the colon or rectum prior to surgery. During a colonoscopy, a long flexible tube that is attached to a camera is inserted through the rectum, allowing physicians to examine the internal lining of the colon for polyps or other abnormalities. The physician may perform a biopsy during a colonoscopy in order to collect samples of suspicious tissues or cells for closer examination.

Endorectal Ultrasound (EUS): Endorectal ultrasound (EUS) involves the use of a special probe that is inserted into the rectum to help determine the thickness of the cancer. By determining the thickness of the cancer, EUS can help determine the stage.

Doppler Ultrasound: One technique that may help predict an increased risk of cancer recurrence is Doppler ultrasound. Doppler ultrasound has been used to measure blood flow in the artery to the liver (hepatic artery) and total liver flow in patients with rectal cancer. This measurement may be helpful because abnormalities occurring in hepatic artery blood flow can be used to detect early cancer metastasis to the liver.

Surgery
Upon completion of the clinical "staging evaluation", surgery is performed to remove the cancer, along with part of the normal adjacent tissues of the rectum. Surgery also helps to further determine the level of spread within the rectal wall and abdomen. The type of surgery performed depends on the size and the location of the cancer. Surgery is commonly performed through an abdominal incision. In some cases, the rectal cancer is located close to the anus and the anus is removed with the cancer. Large rectal cancers close to the anus that cannot be removed without damaging anal function are sometimes treated with chemotherapy to help shrink the cancer before surgery. This is referred to as neoadjuvant chemotherapy. If there is enough shrinkage of the cancer, surgery may be performed that preserves anal function. However, in some cases, the cancer is too close to the anus and the anus is removed with the cancer. In other instances, the cancer may be localized, but too large to remove surgically. In these cases, administration of chemotherapy and/or radiation before surgery may shrink the cancer and allow complete surgical removal. For more information, go to Surgical Management of Rectal Cancer.

Following surgical removal of rectal cancer, a final "pathologic" stage will be given. This is based on extent of spread of cancer after looking at the removed tissue under a microscope. The stage may be a letter or a number, as several different staging systems are used to describe rectal cancer. All new treatment information concerning rectal cancer is categorized and discussed by the stage. In order to learn more about the most recent information available concerning the treatment of rectal cancer, click on the appropriate stage.

Stage I (A-B1): Cancer is confined to the lining of the rectum.

Stage II (B2-3): Cancer may penetrate the wall of the rectum into the surrounding fat or muscles or other adjacent organs, but does not invade any local lymph nodes.

Stage III (C1-3): Cancer invades one or more of the local lymph nodes, but has not spread to other distant organs.

Stage IV (D): Cancer has spread to distant locations in the body, which may include the liver, lungs, bones or other sites.

Recurrent/Relapsed: The rectal cancer has progressed or returned (recurred/relapsed) following an initial treatment.

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Prostate Cancer

Prostate cancer is the most common male malignancy in the United States: it is estimated that 192,280 new cases of prostate cancer will be diagnosed in 2009 alone. Over the past 25 years, dramatic improvements have been made in patient survival of this disease; in fact, the 5-year survival rate has increased from 69% to nearly 99%. However, once the cancer has spread, or "metastasized," the disease is fatal. Currently, no eff ective treatment is currently available. That is why prostate cancer remains the second leading cause of cancer death in American males, and an estimated 27,360 patients will lose their battle to the disease this year, dying predominantly from metastatic prostate cancer.

Patients with late stage prostate cancer may benefit from hormone therapy (androgen ablation), which removes the main source of fuel to tumor growth by suppressing male hormones (androgens). Unfortunately, patients ultimately become non-responsive to this treatment after a few years, resulting in uncontrolled disease status and patient death. New and more effective treatments must be developed quickly to address this critical issue.

Research

NFCR is currently supporting scientists whose research is focused on unraveling the root causes of prostate cancer metastasis and developing new and effective treatment for patients with metastatic prostate cancer. Here are some highlights:

NFCR Project Director Paul B. Fisher, M.Ph., Ph.D.
Virginia Commonwealth University School of Medicine, Richmond, VA

NFCR Project Director Paul B. Fisher, M.Ph., Ph.D., has developed an innovative gene therapy to treat prostate cancer - especially metastatic prostate cancer, which aff ects 60% of patients. This new therapeutic is a genetically reprogrammed virus, called "Cancer Terminator Virus" (CTV). CTV is designed to specifi cally infect tumor cells and destroy them by replicating itself within the cells. Th e secret of restricted tumor targeting lies in a special control system employed in CTV. Dr. Fisher's therapeutic virus employs a special gene element he discovered earlier which can only turn on virus replication in tumor cells, but not in normal cells. Once turned on, the virus copies itself inside a tumor cell and eventually causes cell death. On the other hand, the normal cells are prevented from being harmed because CTV can not replicate in them. This smart control system ensures that this small biological killing machine only fi res on tumor cells.

To further improve its killing eff ects, Dr. Fisher's team made the virus capable of producing another tumor-killing molecule, interferon gamma (IFNγ), when replicating in the tumor cells. IFNγ, a natural product of our immune system, can directly kill tumor cells as well as indirectly by eliciting immune responses. Intriguingly, both the viruses and IFNγ generated by them go and seek out tumor cells, whether localized or metastatic, and destroy them, without harming normal healthy cells in the body. This unique feature could make it especially useful for patients whose prostate cancer has already metastasized.

Currently, with NFCR support, Dr. Fisher is further testing CTV in prostate cancer cell lines and tumor models to confi rm its eff ects and observe potential side eff ects. In fact, this novel gene therapy has been tested in pancreatic cancer cells and tumor models and the results are very encouraging. If tests in the laboratory run well, CTV may soon be used in clinical studies and provide a more effective treatment to late stage prostate cancer patients. This new "lethal weapon" could be especially encouraging to patients whose prostate cancer has stopped responding to other treatments.

NFCR Project Director David Lyden, M.D., Ph.D.
Cornell University, New York, NY

NFCR Project Director, David Lyden, M.D., Ph.D., at Cornell University, has reasoned that the failure of current therapies to treat prostate cancer is due to the lack of deep down understanding of how cancer progresses and spreads in the body. Dr. Lyden has been looking into this issue from an important perspective - cancer microenvironments.

More and more scientific evidence suggests that cancer does not spread randomly in the body. Instead, it is a "seed and soil" matching process -- once the cancer cells (the "seed") get into the bloodstream, they must interact with a proper receptive environment (the "soil") at distant tissue or organs to prepare for the start of metastasis. Intriguingly, Dr. Lyden and his research team have found that prostate cancer cells produce growth factors which stimulate certain adult bone marrow immature (stem) cells to grow and enter the blood stream. These cells then travel to the tumor to support the growth of new blood vessels, which are a critical nutrient provider for rapid tumor growth.

Interestingly, Dr. Lyden discovered that these bone marrow stem cells also travel to distant organs and "prepare" them for the arrival of the metastatic tumor cells. Upon arrival at the distant organs, these bone marrow cells appear to interact with the surrounding tissues (cancer microenvironments) and change them to a more fertile nest for the tumor cells to attach and grow.

These intriguing findings suggest that these bone marrow stem cells may be an important factor for prostate cancer growth and metastasis. Dr. Lyden hypothesizes that the metastasis of prostate cancer is mediated by a well-defined sequence of events dependent upon the proliferation and mobilization of bone marrow stem cells.

With NFCR's support, Dr. Lyden will further explore how these bone marrow stem cells promote prostate cancer to grow and spread. This critical research may lead to breakthroughs in prediction and treatment of prostate cancer metastasis in patients. By measuring the stem cells identified in Dr. Lyden's lab, it is possible to predict which patients will be more prone to developing metastasis of their prostate cancer. Moreover, Dr. Lyden's team has identified key molecules on the surface of these stem cells and has developed drugs that specifically target those proteins and kill the stem cells, hence removing essential factors that support tumor metastasis. Without the necessary support and nourishment from these bone marrow cells, the tumor cells and especially those at metastatic locations will die. These drugs will be used in clinical trials for patients whose prostate cancer does not respond to any other therapies. If the clinical trials prove to be successful, these new drugs developed in Dr. Lyden's lab will be further tested and may soon be available to more prostate cancer patients. Dr. Lyden's work may change the entire scope of treating prostate cancer and lead to increased survival in late stage prostate cancer patients.

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