Pleural Mesothelioma

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Pleural mesothelioma develops in the mesothelial lining of the lungs, which is known as the pleura. About 75 percent of all mesothelioma cases are pleural.

Symptoms of pleural mesothelioma include difficulty swallowing, a persistent dry cough, persistent chest pain, or pain when breathing, and difficulty breathing even when resting. These mesothelioma symptoms result from pressure on the lungs and respiratory system, caused by thickening of the pleural membrane and fluid build-up between membrane layers. As the cancer advances, lumps may develop under the skin of the chest.

Diagnosis of pleural mesothelioma involves imaging tests such as chest x-rays, MRIs, and CT scans, and may also include biopsies that remove tissue and fluid to test for the presence of cancer cells. These tests also help determine the stage of the cancer and the options available for treatment. Generally, patients in stage one and two mesothelioma are good candidates for surgery, whereas patients in stages three and four have more limited treatment options, and may only be able to receive palliative treatments.

Peritoneal Mesothelioma

Peritoneal mesothelioma develops in the peritoneal lining of the abdominal cavity. This is a relatively rare form of mesothelioma; approximately 10 to 20 percent of all mesothelioma cases are peritoneal in nature.

Symptoms of peritoneal mesothelioma include pain or swelling of the abdomen, changes in bowel habits (such as constipation or diarrhea), unexplained weight loss, and nausea or vomiting. These symptoms are caused by thickening of peritoneal membranes and fluid build-up, which puts pressure on internal organs and prevents normal function of some organs. As the cancer advances, people with peritoneal mesothelioma may notice lumps developing under the skin of the abdomen.

Diagnosis of peritoneal mesothelioma involves imaging tests such as CT scans and MRIs, as well as biopsies of fluid and tissue to detect the presence of mesothelioma cells. There is currently no recognized staging process for peritoneal mesothelioma.

Peritoneal mesothelioma is problematic in terms of treatment, because the cancer can spread quickly throughout the peritoneum and often metastasizes more quickly than other types of mesothelioma. In some cases surgery is possible, but this is typically a palliative treatment option.

Pericardial Mesothelioma

 Pericardial mesothelioma accounts for approximately half of all pericardial tumors and is an extremely rare. Researchers from various mesothelioma studies report that pericardial mesothelioma accounts for approximately 1 to 6 percent of all mesotheliomas. To date, fewer than 150 cases have been presented in medical literature and approximately 200 cases have been reported worldwide. Pericardial tumors are typically diffuse (not localized) and tend to cover most of the heart.

Pericardial mesothelioma develops in the pericardium, a membrane made up of mesothelial cells that surrounds the heart and provides protection and support to this organ. The membrane is composed of two different layers: an outer layer called the parietal layer (called the heart sac or theca cordis), and an inner layer known as the visceral layer (called the epicardium). The parietal layer is part of a larger membrane that lines the entire chest cavity, while the visceral layer is the pericardial membrane that lines the heart.

Those diagnosed with pericardial mesothelioma usually have a number of questions about how to approach the treatment process. We offer a complimentary packet for pericardial mesothelioma patients containing information about their specific diagnosis, treatment options and top doctors. To receive this packet overnight,

Testicular Mesothelioma

Testicular mesothelioma is the rarest of all mesothelioma cancers, as less than one hundred cases have been recorded. This type of mesothelioma develops in the lining that surrounds the testicles, known as the tunica vaginalis.

Due to the extreme rarity of testicular mesothelioma, very little has been noted about its symptoms and the treatment options available. Often, the disease is not diagnosed until patients notice the appearance of testicular lumps. In some cases, surgery for an unrelated condition such as a hernia leads to the detection of testicular mesothelioma.

If the primary tumor has developed in the testicles, treatment involves removal of part or the entire affected testicle, followed by chemotherapy or radiation therapy. In many cases the testicular tumor is secondary, and the primary cancer is located in the peritoneum. In these cases, treatment follows established patterns for peritoneal mesothelioma in addition to removal of testicular tumors.

Mesothelioma treatment

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After diagnosis, patients and their loved ones are often anxious to do everything possible to fight mesothelioma. This may involve several different treatment options. The most common treatments mesothelioma patients utilize include surgery, chemotherapy and radiation.  Though a cure for mesothelioma does not currently exist, many patients undergo several treatments for relief from symptoms to improve the quality of life. Patients may also experience relief through experimental options and treatments available through clinical trials and alternative therapies. 

Asbestos.com offers additional information about mesothelioma treatment options, top doctors and cancer centers nationwide through a complimentary informational packet. Click here to receive your copy and learn more about symptoms, causes and support resources for mesothelioma patients. 

30. Mesothelioma types

Mesothelioma is caused by long-term, repeated exposure to asbestos fibers. The disease is generally found in four different forms: pleural, peritoneal, pericardial, and testicular. In each case, the cancer develops in mesothelial cells, which form the membranous linings that surround and protect organs. The different names for each type of mesothelioma refer to the point of origin of the cancer. 

Mesothelial membranes are made up of two different layers, called the parietal and visceral layers. Parietal layers are outer layers, and these typically cover large areas such as the chest cavity (in the case of pleural and pericardial membranes) and the abdominal cavity (as in the case of peritoneal membranes). Visceral layers are those that cover organs such as the lungs and heart. Mesothelioma develops in these membranes when asbestos fibers become trapped in the spaces between mesothelial cells. 

Mesothelioma is a particularly aggressive type of asbestos cancer, and is highly resistant to treatment, resulting in very high mortality rates and poor prognosis for people diagnosed with the disease. In general, pleural mesothelioma responds more positively to treatment, particularly if the disease is diagnosed early. However, all forms of mesothelioma are difficult to diagnose, and unfortunately, it is common for the disease to be diagnosed too late for treatment to be effective.

Mesothelioma symptomps

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When a patient learns of a mesothelioma diagnosis, confusion is often one of the first emotions experienced. What exactly is mesothelioma? Is it a disease? A virus? Mesothelioma is actually a rare type of cancer. When people refer to mesothelioma disease, they are actually referring to mesothelioma cancer. Mesothelioma develops in the mesothelium, the membrane that surrounds several body cavities. The mesothelium is comprised of mesothelial cells, which become abnormal and divide uncontrollably if mesothelioma is present.    

Four different types of mesothelioma exist. Pleural mesothelioma is the most common form of the cancer and develops in the lining of the lungs, known as the pleura. Peritoneal mesothelioma affects the lining of the abdomen, known as the peritoneum. Pericardial mesothelioma is very rare, as approximately 200 cases have been reported internationally. Pericardial mesothelioma develops in the pericardium, the membrane that surrounds the heart and protects the organ. Testicular mesothelioma is the rarest form of mesothelioma and develops in the lining surrounding the testicles, known as the tunica vaginalis. 

Approximately 2,000 to 3,000 people are diagnosed with mesothelioma annually in the United States. Many patients are not diagnosed with the cancer until it has reached later developmental stages since it may take 20 to 50 years for a patient to demonstrate symptoms of mesothelioma. The cancer is caused almost exclusively by asbestos exposure and it often takes decades for a patient to express mesothelioma symptoms from the time initial asbestos exposure occurred.

Mesothelioma disease

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When a patient learns of a mesothelioma diagnosis, confusion is often one of the first emotions experienced. What exactly is mesothelioma? Is it a disease? A virus? Mesothelioma is actually a rare type of cancer. When people refer to mesothelioma disease, they are actually referring to mesothelioma cancer. Mesothelioma develops in the mesothelium, the membrane that surrounds several body cavities. The mesothelium is comprised of mesothelial cells, which become abnormal and divide uncontrollably if mesothelioma is present.    

Four different types of mesothelioma exist. Pleural mesothelioma is the most common form of the cancer and develops in the lining of the lungs, known as the pleura. Peritoneal mesothelioma affects the lining of the abdomen, known as the peritoneum. Pericardial mesothelioma is very rare, as approximately 200 cases have been reported internationally. Pericardial mesothelioma develops in the pericardium, the membrane that surrounds the heart and protects the organ. Testicular mesothelioma is the rarest form of mesothelioma and develops in the lining surrounding the testicles, known as the tunica vaginalis.

Approximately 2,000 to 3,000 people are diagnosed with mesothelioma annually in the United States. Many patients are not diagnosed with the cancer until it has reached later developmental stages since it may take 20 to 50 years for a patient to demonstrate symptoms of mesothelioma. The cancer is caused almost exclusively by asbestos exposure and it often takes decades for a patient to express mesothelioma symptoms from the time initial asbestos exposure occurred.

How Do I Know if I Have Genital Warts?

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Is this topic for you?

This topic provides information about the human papillomavirus (HPV), which causes genital warts and can also cause cervical cancer. If you are looking for information about cervical cell changes or cervical cancer, see the topics Abnormal Pap Test or Cervical Cancer.

What is human papillomavirus (HPV)?

Human papillomavirus (HPV) is one of the most common sexually transmitted diseases (STDs). It is a virus that can be spread through skin-to-skin contact. There are many different types of HPV. Some types cause genital warts and are called low-risk, and some types can lead to cervical cancer and are called high-risk. There is no known cure for HPV, but there is a vaccine that can protect against some types of the virus.

What are genital warts?

For men, genital warts may appear around the anus, on the shaft of the penis, or on the scrotum. For women, genital warts may appear around the anus, on the vulva, in the vagina, or on the cervix.

Genital warts are skin growths in the groin, genital, or anal areas. They can be different sizes and shapes. Some look like flat white patches, and others are bumpy, like tiny bunches of cauliflower. Sometimes you can't see the warts at all.

What causes HPV and genital warts?

HPV is a virus. Certain types of the virus cause genital warts and some types cause abnormal cervical cell changes and cervical cancer.

HPV and genital warts can be spread through sexual contact with someone who has the virus.

What are the symptoms?

Most people infected with HPV don't have symptoms. But if they do, the symptoms may be so mild that they may not know they are infected. The symptoms may include pain, itching, and bleeding, or you may develop visible genital warts.

If you have symptoms, they will probably occur 2 to 3 months after infection. But you can have symptoms from 3 weeks to many years after infection.

Visible genital warts appear only during active infection. But it is possible to spread the virus even if you can't see the warts.

How are HPV and genital warts diagnosed?

A doctor can often tell if you have genital warts by looking closely at your genital and anal areas. He or she may ask you questions about your symptoms and your risk factors. Risk factors are things that make you more likely to get a disease.

Sometimes the doctor takes a sample of tissue from the wart for testing.

For women, if you have an abnormal Pap test, your doctor can do an HPV test that looks for high-risk types of the virus.

How are they treated?

There is no cure for HPV, but the symptoms can be treated.

Talk to your doctor about whether you should treat visible genital warts. They usually go away with no treatment, but they may also spread. Most people decide to treat them because of the symptoms or because of how the warts look. But if you don't have symptoms and are not worried about how the warts look, you can wait and see if the warts go away.

If you do decide to treat genital warts, talk to your doctor about the best treatment for you. There are prescription medicines you or your doctor can put on the warts. Or your doctor can remove them with lasers, surgery, or by freezing them off.

Even if you treat visible warts or your warts go away without treatment, the HPV infection can stay in your body's cells. It is possible to spread genital warts to your partner even if you have no signs of them.

Can HPV and genital warts be prevented?

The best way to keep from getting genital warts—or any other STD—is to not have sex. If you do have sex, practice safe sex.

• Use condoms. Condoms may help reduce the risk of spreading genital warts, but they do not protect the entire genital area against skin-to-skin contact.
• Before you have sex with someone, talk to them about STDs. Find out whether he or she is at risk for them. Remember that a person can be infected without knowing it.
• If you have symptoms of an STD, don't have sex.
• Do not have sex with anyone who has symptoms or who may have been exposed to an STD.
• Do not have more than one sex partner at a time. Having several sex partners increases your risk for disease.

Should boys get the HPV vaccine?

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Men rarely get cancer from HPV, but they do pass the virus to their female partners, and they do get genital warts from HPV as well. In Europe and the U.K., Gardasil is licensed for use in both boys and girls, although so far only Austria's public health program actually recommends vaccinations for both.

The reason it's not generally recommended for boys in the U.S. is because it hasn't been approved for use in boys. General thinking may be, too, that it's more cost-effective, from a public-health standpoint, to vaccinate girls only. And insurance companies won't cover vaccines that aren't recommended. Gardasil retails at around $375 for the three-dose  course

What about women over 26?

Older women and boys are in a similar situation, says Dr. Handsfield. "Women who get beyond their 20s are statistically at lower risk for HPV infection," he says, "so from a public-policy standpoint, it's not a priority." Also, since the research studies that led to Gardasil's approval were limited to the under-26 crowd, it's not FDA-approved for older women.

"But sure, the vaccine almost certainly would work in older women," Dr. Handsfield says. "This'll evolve."

As an older woman, you can pay out of pocket and get the vaccine, but it may not help (you may already have those strains of the virus). If you're older than 26 and considering the vaccine, it makes sense to evaluate your sexual history. "Say there's a 28-year-old woman, she's about to be out there dating again, and she's only had three or four partners; she probably is still susceptible," says Dr. Hansdfield. "She clearly needs the vaccine. "

  

If I get vaccinated, do I still need to get regular Pap smears?

Yes! Experts agree that the vaccine does not replace the need for regular Pap smears, since it protects only against the strains of the virus that cause 70% of all cervical cancers. You'll still need to protect yourself from the rest with yearly screenings.

Can cervical cancer be prevented?

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The Pap test is the best way to find cervical cell changes that can lead to cervical cancer. Regular Pap tests almost always show these cell changes before they turn into cancer. It is important to follow up with your doctor after any abnormal Pap test result to treat abnormal cell changes. This may help prevent cervical cancer.

If you are age 26 or younger, you can get the HPV shot. The vaccines Cervarix and Gardasil protect against two types of HPV that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. Three shots are given over 6 months. The series of shots is recommended for girls age 11 or 12 and can be given to females ages 9 to 26.

The virus that causes cervical cancer is spread through sexual contact. The best way to avoid getting a sexually transmitted disease is to not have sex. If you do have sex, practice safer sex, such as using condoms and limiting the number of sex partners you have.

Almost everyone carries the human papillomavirus (HPV), and it's usually pretty harmless. But a few strains are the main cause of cervical cancer. Gardasil, the HPV vaccine approved by the FDA in 2006, guards against two of these strains, plus two other strains that are responsible for most genital warts.

Since most adults have already been exposed to HPV, the vaccine is recommended for girls who haven't become sexually active yet. (The federal Centers for Disease Control and Prevention recommends vaccination at age 11 or 12, but Gardasil is approved for girls as young as 9.)

So far, so good. But the introduction of this new vaccine has stirred up a small fuss.

The controversy

Perhaps the main fear of the vaccine's opponents is that it might encourage adolescent promiscuity.

H. Hunter Handsfield, MD, a clinical professor of medicine at the University of Washington and a nationally recognized STD expert, believes most parents are all for it, however. "It can prevent cancer?" he says, parroting the most common parental concern. "Well, duh, give my kid the shot.

Servical cancer

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Is this topic for you?

This topic talks about the testing, diagnosis, and treatment of cervical cancer. For general information about abnormal Pap test results, see the topic Abnormal Pap Test.

What is cervical cancer?

Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be cured when it’s found early. It is usually found at a very early stage through a Pap test.

What causes cervical cancer?

Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms.

You can have HPV for years and not know it. It stays in your body and can lead to cervical cancer years after you were infected. This is why it is important for you to have regular Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If you treat these cell changes, you may prevent cervical cancer.

What are the symptoms?

Abnormal cervical cell changes rarely cause symptoms. But you may have symptoms if those cell changes grow into cervical cancer. Symptoms of cervical cancer may include:

• Bleeding from the vagina that is not normal, or a change in your menstrual cycle that you can't explain.
• Bleeding when something comes in contact with your cervix, such as during sex or when you put in a diaphragm.
• Pain during sex.
• Vaginal discharge that is tinged with blood.

How is cervical cancer diagnosed?

As part of your regular pelvic exam, you should have a Pap test. During a Pap test the doctor scrapes a small sample of cells from the surface of the cervix to look for cell changes. If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix.

Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such as bleeding after sex.

How is it treated?

Cervical cancer that is caught early can usually be cured. If the cancer is caught very early, you still may be able to have children after treatment.

The treatment for most stages of cervical cancer removes the cancer and makes you unable to have children. These treatments include:

• A hysterectomy and removal of pelvic lymph nodes with or without removal of both ovaries and fallopian tubes.
• Radiation therapy.
• Chemotherapy.

Depending on how much the cancer has grown, you may have one or more treatments. And you may have a combination of treatments.

It’s common to feel scared, sad, or angry after finding out that you have cervical cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area. You can also find people online who will share their experiences with you.

How to Weigh Your Breast Cancer Risk Factors

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Not all breast cancer risks factors have the same influence.

• "A family history will still drive [risk] much more powerfully than other reproductive risk factors—like having no children, having few children, or having children late," says Angela R. Bradbury, MD, director of the Margaret Dyson Family Risk Assessment Program at Fox Chase Cancer Center in Philadelphia.

• Having a first-degree relative such as a mother, sister, or daughter with a breast cancer history boosts your risk much more than if a cousin or more distant relative has had it—particularly if the diagnosis came before the age of 50 or your family’s background is Ashkenazi Jewish.

• Then there are the so-called breast cancer genes, BRCA-1 and BRCA-2. Mutations in these genes raise your risk even higher than the family connection alone. If you have relatives with breast cancer, you might be a candidate for BRCA testing or for other modifications to your screening for the disease. Make an appointment to talk through your options with your doctor or a genetic counselor.

What Causes Breast Cancer?

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No one knows very much about why breast cancer happens, except that it likely starts in our genes. "Cancer in general is a disease of aging, and breast cancer is probably caused by an error in gene replication—the older we get, the more error prone we get," says Ramona F. Swaby, MD, a medical oncologist specializing in breast cancer at Fox Chase Cancer Center in Philadelphia. Indeed, a woman’s chance of getting breast cancer doesn’t rise to the terrifying one in eight until she’s reached 85 years of age. If you’re a woman under 40, for instance, your risk is much lower: one in 233.

Approximatly 5% to 10% of the roughly 200,000 American women diagnosed with breast cancer each year have an inherited gene mutation that puts them at higher risk for developing the disease. Most of these genes remain unidentified, but scientists know that mutations to the BRCA-1 and BRCA-2 (Breast Cancer 1 and 2) genes, which normally help prevent cancer by regulating cell growth, are linked to an increased risk for breast and ovarian cancer.

If you’re wondering whether you carry the BRCA-1 or BRCA-2 mutations, you may have considered getting a genetic test to find out. That’s a tough decision, because it’s not always clear what to do with your test results. Some women who know they are at higher risk without taking the test simply commit to more frequent mammograms; others feel the need to know as much as possible and may consider prophylactic surgery if they test positive.

What African American woman need to know about breast cancer

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Even though breast cancer incidence rates are slightly lower overall among African-American women than white women (the incidence is lower still among Hispanic, Asian, and Native American women), a combination of socioeconomic factors and unexplained biological differences make the disease more deadly—and in some cases, harder to treat—in the black community. Also, African-American women under 45 have a greater incidence of breast cancer than white women in the same age range.

Many women are "triple negative"

No one yet knows precisely why, but African-American women are roughly twice as likely as white women to have triple-negative breast cancer—so called because tumor cells in this particularly aggressive form of the disease test negative for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2). This puts Herceptin and hormone therapies, such as tamoxifen and aromatase inhibitors, entirely out of reach as treatment options. It's suspected that some combination of genetics and environmental factors are at play in triple-negative disease.

Socioeconomic factors

The five-year survival rate for white women is approximately 90%; for African-American women it's roughly 77%. Differences in medical coverage and health-care access likely explain this. Overall, African Americans tend to have more trouble finding consistent, good-quality health care—which amounts to fewer breast cancer screenings and inferior treatment when they are diagnosed.

"Black women have been noted to present [at a doctor's office] with later stage cancer, which has a worse outcome—and they don't always get adequate care," says Ruth O’Regan, MD, associate professor of hematology and oncology and director of the translational breast cancer research program at Emory University's Winship Cancer Institute in Atlanta. Seeking medical help when a tumor is larger, higher grade, and/or with more lymph nodes involved can dramatically lower a woman's odds for survival.

Another potential problem for African-American women seeking treatment for breast cancer is that they have been underrepresented in chemotherapy breast cancer research, so it has been difficult to determine whether they might metabolize chemotherapy drugs differently from the primarily white research subjects. The issue is being actively researched now.

Breast cancer

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Breast cancer (malignant breast neoplasm) is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas.

Prognosis and survival rate varies greatly depending on cancer type and staging. Computerized models are available to predict survival. With best treatment and dependent on staging, 10-year disease-free survival varies from 98% to 10%. Treatment includes surgery, drugs (hormonal therapy and chemotherapy), and radiation.

Worldwide, breast cancer comprises 10.4% of all cancer incidence among women, making it the most common type of non-skin cancer in women and the fifth most common cause of cancer death. In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths). Breast cancer is about 100 times more common in women than in men, although males tend to have poorer outcomes due to delays in diagnosis.

Some breast cancers are sensitive to hormones such as estrogen and/or progesterone, which makes it possible to treat them by blocking the effects of these hormones in the target tissues. Estrogen and progesterone receptor positive tumors have better prognosis and require less aggressive treatment than hormone negative cancers.

Breast cancers without hormone receptors, or which have spread to the lymph nodes in the armpits, or which express certain genetic characteristics, are higher-risk, and are treated more aggressively. One standard regimen, popular in the U.S., is cyclophosphamide plus doxorubicin (Adriamycin), known as CA; these drugs damage DNA in the cancer, but also in fast-growing normal cells where they cause serious side effects. Sometimes a taxane drug, such as docetaxel, is added, and the regime is then known as CAT; taxane attacks the microtubules in cancer cells. An equivalent treatment, popular in Europe, is cyclophosphamide, 

methotrexate, and fluorouracil (CMF). Monoclonal antibodies, such as trastuzumab (Herceptin), are used for cancer cells that have HER2/neu overexpressed. Radiation is usually added to the surgical bed to control cancer cells that were missed by the surgery, which usually extends survival, although radiation exposure to the heart may cause damage and heart failure in the following years.

What are the symptoms ?

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The main sign of melanoma is a change in a mole or other skin growth, such as a birthmark. Any change in the shape, or of a mole may be a sign of melanoma.

The most important warning sign for melanoma is a change in size, shape, or color of a mole or other skin growth, such as a birthmark. One of the things to watch for is diameter.

Diameter is width. If the diameter across a mole or skin growth is larger than 1/4 inch (6 mm), or about the size of a pencil eraser, talk to your doctor. Also, call your doctor if any mole seems to be growing, even if it is still smaller than 1/4 inch (6 mm).

Melanoma Exams and Tests

Evaluation of a skin lesion

A physical exam of the skin is used to evaluate the skin for melanoma. If melanoma is suspected, a skin biopsy will be done. For this, your doctor will remove a sample of skin tissue and send it to a pathologist to be looked at under a microscope. If the biopsy shows melanoma, the pathologist will measure the thickness of the melanoma to find out how advanced the cancer is.

Other techniques may include total-body photography to monitor for changes in any mole and to watch for new moles appearing in normal skin. A series of photos of the suspicious lesions may be taken. Then the photos can be used as a baseline to compare with follow-up photos.

Evaluation of lymph nodes

Testing the lymph nodes may not be needed if the melanoma is less than 1 mm (0.04 in.) thick when measured with a microscope, because the risk of the cancer spreading may be low. But if your melanoma is large or thick, you can expect more lab tests.

If a melanoma is thicker than 1 mm (0.04 in.), your doctor will do a physical exam that includes checking the lymph nodes to see whether they are larger than normal. This may be followed by a lymph node biopsy to see whether the melanoma has spread to the lymph system.

A sentinel lymph node biopsy is a relatively new technique that may be used instead of conventional lymph node biopsy. Like a conventional biopsy, sentinel lymph node biopsy is done to identify lymph nodes that may contain melanoma.

Evaluation for possible metastases (spread of cancer)

A complete medical history and a physical exam are needed to find out whether the cancer has spread (metastasized) to other parts of the body. Imaging tests, including positron emission tomography (PET scan), computed tomography (CT scan) or magnetic resonance imaging (MRI), may be used to identify metastases in other parts of the body, such as the lungs, brain, liver, or other organs.

Early Detection

Skin self-exam is a good way to detect early skin changes that may point to melanoma. A skin self-exam is used to identify suspicious growths that may be cancer or growths that may develop into skin cancer (precancers). Adults should examine their skin once every month. Look for any abnormal skin growth or any change in the color, shape, size, or appearance of a skin growth. Check for any area of injured skin (lesion) that does not heal. Have your spouse or someone such as a close friend help you monitor your skin, especially places that are hard to see such as your scalp and back.

There are other steps you can take to prevent skin cancer or detect it at an early stage.

• Be aware of the risk of skin cancer and the steps you can take to prevent it, including using sunscreen, wearing protective clothing, and staying out of the midday sun.
• Have your doctor examine any suspicious skin changes. Screening guidelines from the American Cancer Society and other expert groups advise adults older than 40 to have their skin checked by a doctor at least once a year and during all other health exams. This may lead to early treatment, which may prevent the spread of cancer. You may wish to begin screening earlier, especially if you have:
• Familial atypical mole and melanoma (FAM-M) syndrome, which is an inherited tendency to develop melanoma. Examine your skin every month and be examined by a doctor every 4 to 6 months, preferably by the same doctor each time.
• Increased occupational or recreational exposure to ultraviolet (UV) radiation.
• Abnormal moles called atypical moles (dysplastic nevi). These moles are not cancerous. But their presence is a warning of an inherited tendency to develop melanoma.

What is Melanoma ?

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Melanoma is a kind of skin cancer. It is not as common as other types of skin cancer, but it is the most serious.
Melanoma can affect your skin only, or it may spread to your organs and bones. Luckily, it can be cured if it’s found and treated early. Melanoma is a serious form of skin cancer that starts in the pigment-producing skin cells (melanocytes). These cells become abnormal, grow uncontrollably, and aggressively invade surrounding tissues.

What  causes melanoma?

You can get melanoma by spending too much time in the sun. This causes normal skin cells to become abnormal. These abnormal cells quickly grow out of control and attack the tissues around them.

Melanoma tends to run in families. Other things in your family background can increase your chances of getting the disease. For example, you may have abnormal, or atypical, moles. Atypical moles may fade into the skin and have a flat part that is level with the skin. They may be smooth or slightly scaly, or they may look rough and “pebbly.” These moles don't cause cancer by themselves. But having many of them is a sign that melanoma may run in your family.

melanoma skin cancer

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Melanoma is the least common type of skin cancer. Still, it is the most deadly because it can spread if not caught early. Melanoma symptoms include a change in the shape, size, or color of a mole, but melanomas can also look like a bruise that doesn't heal or a dark streak under a finger or toenail. Excess sun is linked to melanoma risk. However, melanomas can also occur on skin not exposed to the sun (such as inside the mouth).

What about herbal or other alternative medicine treatments for prostate cancer?

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Alternative medicine, also called integrative or complementary medicine, includes such non-traditional treatments as herbs, dietary supplements, and acupuncture. A major problem with most herbal treatments is that their composition is not standardized. Moreover, the way herbal treatments work and their long-term side effects usually are not known. Currently, there is no evidence to prove that these medications have any therapeutic benefit in prostate cancers that have What is active surveillance for prostate cancer?

Active surveillance is observing a patient while no immediate treatment is given. Such a patient usually has a less aggressive, small-sized, organ-confined tumor and no symptoms. This management strategy is based on the premise that most early prostate cancers are slow-growing tumors and will remain confined to the prostate gland for a significant length of time. This implies that in selected patients it may be possible to defer definitive treatment for many years or avoid it altogether thereby preventing the side effects associated with treatments like surgery or radiation. Understand, however, that although active surveillance involves no actual treatment, the patient still needs close follow-up and monitoring. The follow-up involves frequent visits to the doctor, perhaps every three to six months. The visits include questions about new or worsening symptoms and digital rectal examinations for any change in the prostate gland. In addition, blood tests are done to watch for a rising PSA, and imaging studies can be conducted to detect the spread of the cancer. Most experts also recommend performing a confirmatory set of prostate biopsies to ensure that there is low-volume disease. Additional prostate biopsy is required every year to detect any increase in the volume and Gleason grade of the cancer. As mentioned before, Gleason grade is a measure of aggressiveness of the tumor and increase in this value may point toward a need to treat the cancer with other means. If the history, examinations, or any of the tests signal the possibility of an advancing cancer, the active surveillance usually is discontinued and active treatment is recommended, often with radiotherapy or surgery.

Active surveillance is different from watchful waiting. Watchful waiting means following up patients without any tests or biopsies and treating them only when symptoms arise. This is reserved for men who have a life expectancy of less than 10 years. Therefore, watchful waiting seems to make sense for organ-confined (localized) prostate cancers in men who are elderly. Additionally, watchful waiting often is the most appropriate choice in men who are ill with other serious medical diseases, such as heart or lung disease, poorly controlled high blood pressure, diabetes, AIDS, or other cancers.

Active surveillance and watchful waiting in prostate cancer, however, remains controversial. Some medical authors have stated outright that it is not a good choice. They point out that few doctors would just watch other cancers to see whether they would spread without treatment. Furthermore, the treatment for an individual could become less effective in the future if and when the cancer does progress. Moreover, there is no standardized protocol for selecting appropriate patients for active surveillance with different institutions having their own different guidelines. Studies are under way to compare these protocols with more established methods of treatment, and more information is likely to emerge in the future.

What are the differences between hormonal treatment and chemotherapy?

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Hormonal therapy is the mainstay of treatment for symptomatic, advanced-staged prostate cancer. A vast majority of prostate cancers, particularly initially, are dependent on testosterone (the male hormone produced by the testes) for their growth and spread. The objective of hormonal treatment is to withdraw this source of sustenance for prostate cancer cells in an attempt to slow down or control this disease. The following are treatments available for hormonal therapy:

Orchiectomy is the surgical removal of the testicles. Luteinizing hormone-releasing hormone (LHRH) agonists, such as leuprolide (Lupron, Viadur, Eligard), goserelin (Zoladex), or buserelin (Suprefact), stop the production of testosterone from the testes and induce a state of "medical castration" (castration without surgery). Many men prefer this over surgical castration.

Antiandrogens, such as flutamide (Eulexin) or bicalutamide (Casodex), block the action of testosterone on the prostate cancer cells and other parts of the body. Each of the above two classes of medicines produce symptomatic relief in about 80% of patients. Improvement is often dramatic.

Side effects of these medications vary. Orchiectomy and LHRH agonists may cause impotence, hot flashes, and loss of sexual desire. Antiandrogens may cause nausea, vomiting, diarrhea, and breast enlargement or tenderness. Any of these therapies can weaken bones and lead to osteoporosis and bone fracture.

Other agents that are helpful include the following: progestins such as megestrol acetate given daily orally and other drugs that inhibit androgen production such as aminoglutethimide (Cytadren) or ketoconazole (Nizoral, Extina, Xolegel, Kuric). These agents are effective but are sometimes difficult to tolerate. Corticosteroids are often given simultaneously.

As opposed to hormonal therapy, chemotherapy provides relief in only 20%-25% of symptomatic patients with prostate cancer. Various regimens are being used. Estramustine, cisplatin, 5-FU, vinorelbine, and mitoxantrone are the most popular agents. However, recently docetaxel (Taxotere) has become the drug of choice used by oncologists in treating castrate-resistant prostate cancer (prostate cancer which has become unresponsive to hormonal therapy).

When to use hormonal therapy and chemotherapy depends on the nature of the prostate cancer itself. If the prostate cancer is hormone-sensitive, then hormonal therapy is the therapy of choice. When the cancer becomes hormone-resistant (for example, manipulation of the hormone levels has no effect on the prostate cancer), then the only potential therapy available to the patient is chemotherapy. Chemotherapy, then, is used generally when advanced prostate cancer is hormone-resistant. Unfortunately, chemotherapy after hormone therapy is nowhere near as effective as hormonal therapy because the cancer itself has often evolved to become more aggressive so that the prognosis is significantly worse. When prostate cancer transforms from being hormone-sensitive to hormone-resistant, the prognosis has taken a significant turn for the worse and the chemotherapy option at that particular time is usually the only treatment option available.

Other factors considered in choosing treatment include the age, general health, and preference of the individual and the Gleason score and stage of the cancer. The results of the PSA test sometimes also can help to decide on the treatment. For example, a borderline elevation of the PSA (4-10), if shown to be due to a prostate cancer, suggests that the cancer is confined to the gland. If other tests also point to an organ-confined tumor, surgery or possibly radiation can be considered to attempt a cure. In contrast, a very high PSA (for example, over 30 or 40) raises the possibility of metastases. If the metastases are then confirmed by other tests, the treatment options would be limited to hormonal therapy or chemotherapy.

PSA tests also should be done periodically after treatment to help assess the results of treatment. For example, an increasing PSA suggests growth or spread of the cancer, despite the treatment. In contrast, a decreasing PSA indicates improvement. As a matter of fact, a post-treatment undetectable PSA (PSA less than 0.05 or 0.1 ng/ml) may indicate complete control or cure of the cancer.