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Health Reference Series Sixth Edition
Cancer Sourcebook ■
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P.O. Box 31-1640, Detroit, MI 48231
Bibliographic Note Because this page cannot legibly accommodate all the copyright notices, the Bibliographic Note portion of the Preface constitutes an extension of the copyright notice. Edited by Karen Bellenir Health Reference Series Karen Bellenir, Managing Editor David A. Cooke, MD, FACP, Medical Consultant Elizabeth Collins, Research and Permissions Coordinator Cherry Edwards, Permissions Assistant EdIndex, Services for Publishers, Indexers *** Omnigraphics, Inc. Matthew P. Barbour, Senior Vice President Kevin M. Hayes, Operations Manager *** Peter E. Ruffner, Publisher Copyright © 2011 Omnigraphics, Inc. ISBN 978-0-7808-1145-4
Library of Congress Cataloging-in-Publication Data Cancer sourcebook : basic consumer health information about major forms and stages of cancer, featuring facts about head and neck cancers, lung cancers, gastrointestinal cancers, genitourinary cancers, lymphomas, blood cell cancers, endocrine cancers, skin cancers, bone cancers, metastatic cancers, and more; along with facts about cancer treatments, cancer risks and prevention ... / edited by Karen Bellenir. -- 6th ed. p. cm. -- (Health Reference series) Includes bibliographical references and index. Summary: "Provides basic consumer health information about risks, prevention, and treatment of major forms of cancer. Includes index, glossary of related terms, and other resources"-- Provided by publisher. ISBN 978-0-7808-1145-4 (hardcover : alk. paper) 1. Cancer--Popular works. 2. Cancer--Handbooks, manuals, etc. I. Bellenir, Karen. RC263.C294 2011 616.99'4--dc22 2011003804
Electronic or mechanical reproduction, including photography, recording, or any other information storage and retrieval system for the purpose of resale is strictly prohibited without permission in writing from the publisher. The information in this publication was compiled from the sources cited and from other sources considered reliable. While every possible effort has been made to ensure reliability, the publisher will not assume liability for damages caused by inaccuracies in the data, and makes no warranty, express or implied, on the accuracy of the information contained herein. This book is printed on acid-free paper meeting the ANSI Z39.48 Standard. The infinity symbol that appears above indicates that the paper in this book meets that standard. Printed in the United States
Table of Contents Visit www.healthreferenceseries.com to view A Contents Guide to the Health Reference Series, a listing of more than 15,000 topics and the volumes in which they are covered.
Preface........................................................................................... xiii
Part I: Cancer Risk Factors and Cancer Prevention Chapter 1—Questions and Answers about Cancer........................ 3 Chapter 2—Cancer Statistics.......................................................... 9 Section 2.1—Understanding Statistics on Incidence, Prevalence, and Mortality.......................................... 10 Section 2.2—The Role Statistics Play in Predicting a Patient’s Prognosis.......................................... 14 Section 2.3—Incidence, Mortality, and Survival Rates for Common Cancers............................................. 17
Chapter 3—Cancer Health Disparities......................................... 37 Chapter 4—Lifestyle Issues and Cancer Risk.............................. 51 Section 4.1—Tobacco Use and Cancer Risk......... 52 Section 4.2—Facts about Alcohol Use and Cancer Risk...................................... 60 Section 4.3—Questions and Answers about Obesity and Cancer Risk................. 63
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Section 4.4—The Roles of Exercise and Stress Management in Reducing Cancer Risk..................... 70 Section 4.5—Sun Exposure and Cancer Risk................................................... 76 Section 4.6—Indoor Tanning and Cancer Risk................................................... 82
Chapter 5—Hereditary Cancer Risks........................................... 85 Chapter 6—Infectious Diseases and Cancer Risk........................ 91 Section 6.1—Human Papillomaviruses and Cancer: Questions and Answers............................................ 92 Section 6.2—HIV Infection and Cancer Risk................................................... 96 Section 6.3—Kaposi Sarcoma-Associated Herpesvirus...................................... 99 Section 6.4—Hepatitis Viruses and Cancer Risk................................................. 101 Section 6.5—Human T-Lymphotropic Virus Type 1 (HTLV1) and Cancer Risk................................................. 103 Section 6.6—Epstein-Barr Virus and Cancer Risk................................................. 104 Section 6.7—Helicobacter Pylori and Cancer Risk................................................. 106
Chapter 7—Hormonal Therapies and Cancer Risk................... 115 Section 7.1—Oral Contraceptives and Cancer Risk.................................... 116 Section 7.2—Menopausal Hormone Replacement Therapy Use and Cancer..................................... 121 Section 7.3—Risk of Ovarian Cancer from Hormone Therapy Confirmed....................................... 130 Section 7.4—Diethylstilbestrol (DES) and Cancer Risk.................................... 131
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Chapter 8—Radiation and Cancer Risk................................... 137 Section 8.1—The Difference between Ionizing and Non-Ionizing Radiation..................................... 138 Section 8.2—How Radiation Affects Cancer Risk.............................................. 141 Section 8.3—Radon and Cancer....................... 145 Section 8.4—Medical X-Rays: Benefits and Risks............................................. 149 Section 8.5—Iodine-131 and Cancer Risk....... 151 Section 8.6—Magnetic Field Exposure and Cancer.......................................... 158
Chapter 9—Environmental Carcinogens.................................. 163
Part II: Common Types of Cancer Cancers Affecting the Brain and Central Nervous System Chapter 10—Brain Tumors......................................................... 173 Chapter 11—Childhood Brain and Spinal Cord Tumors........... 185 Chapter 12—Neuroblastoma....................................................... 197 Chapter 13—Primary Central Nervous System Lymphoma..... 209 Cancers Affecting the Endocrine System Chapter 14—Pituitary Tumors................................................... 217 Chapter 15—Thyroid Cancer...................................................... 229 Chapter 16—Parathyroid Cancer............................................... 245 Chapter 17—Adrenocortical Carcinoma..................................... 253 Chapter 18—Islet Cell Tumors................................................... 261 Cancers Affecting the Eyes, Mouth, and Neck Chapter 19—Retinoblastoma...................................................... 275 Chapter 20—Oral Cancer............................................................ 283 Chapter 21—Laryngeal Cancer.................................................. 293 vii
Cancers that Affect the Lungs Chapter 22—Lung Cancer: An Overview................................... 309 Chapter 23—Small Cell Lung Cancer........................................ 319 Chapter 24—Non-Small Cell Lung Cancer................................ 325 Chapter 25—Malignant Mesothelioma....................................... 337 Cancers Affecting the Digestive Tract Chapter 26—Esophageal Cancer................................................ 345 Chapter 27—Stomach Cancer..................................................... 359 Chapter 28—Gallbladder Cancer................................................ 371 Chapter 29—Pancreatic Cancer.................................................. 379 Chapter 30—Liver Cancer........................................................... 389 Chapter 31—Extrahepatic Bile Duct Cancer............................. 401 Chapter 32—Gastrointestinal Carcinoid Tumors...................... 409 Chapter 33—Small Intestine Cancer.......................................... 417 Chapter 34—Colon Cancer.......................................................... 423 Chapter 35—Rectal Cancer......................................................... 435 Chapter 36—Anal Cancer............................................................ 445 Cancers Affecting the Urinary Tract Chapter 37—Kidney Cancers...................................................... 451 Section 37.1—Renal Cell Cancer...................... 452 Section 37.2—Wilms Tumor and Other Childhood Kidney Tumors.......................... 458
Chapter 38—Transitional Cell Cancer of the Renal Pelvis and Ureter.............................................................. 469 Chapter 39—Urethral Cancer..................................................... 475 Chapter 40—Bladder Cancer...................................................... 483 viii
Cancers Affecting the Breasts and Reproductive Organs Chapter 41—Breast Cancer........................................................ 491 Chapter 42—Gynecological Cancers........................................... 513 Section 42.1—Cervical Cancer......................... 514 Section 42.2—Endometrial Cancer.................. 519 Section 42.3—Gestational Trophoblastic Tumors....................................... 522 Section 42.4—Ovarian Epithelial Cancer........ 525 Section 42.5—Uterine Sarcoma....................... 529 Section 42.6—Vaginal and Vulvar Cancers..... 532 Section 42.7—Common Procedures for Cancers of the Female Reproductive Organs................. 539
Chapter 43—Andrological Cancers............................................. 555 Section 43.1—Penile Cancer............................. 556 Section 43.2—Prostate Cancer......................... 563 Section 43.3—Testicular Cancer...................... 576
Cancers Affecting the Blood Cells and Immune System Chapter 44—Leukemia................................................................ 585 Chapter 45—Lymphoma.............................................................. 601 Section 45.1—Hodgkin Lymphoma.................. 602 Section 45.2—Non-Hodgkin Lymphoma.......... 613
Chapter 46—Multiple Myeloma.................................................. 623 Chapter 47—Myelodysplastic and Myeloproliferative Diseases.................................................................. 633 Chapter 48—Thymoma and Thymic Carcinoma........................ 641 Cancers Affecting the Skin and Bones Chapter 49—Melanoma............................................................... 649 Chapter 50—Non-Melanoma Skin Cancer................................. 659 Chapter 51—Merkel Cell Carcinoma.......................................... 671 ix
Chapter 52—Bone Cancers......................................................... 679 Section 52.1—Questions and Answers about Bone Cancers.................. 680 Section 52.2—Osteosarcoma and Bone Fibrous Histiocytoma................ 685 Section 52.3—Ewing Sarcoma Family of Tumors................................... 694
Cancers Affecting Other or Multiple Body Systems Chapter 53—Soft Tissue Sarcomas............................................. 703 Section 53.1—Childhood Soft Tissue Sarcoma..................................... 704 Section 53.2—Adult Soft Tissue Sarcoma....... 717 Section 53.3—Synovial Sarcoma...................... 722
Chapter 54—Germ Cell Tumors................................................. 725 Section 54.1—Ovarian Germ Cell Tumors...... 726 Section 54.2—Extragonadal Germ Cell Tumors....................................... 733 Section 54.3—Childhood Extracranial Germ Cell Tumors..................... 739
Chapter 55—Carcinoma of Unknown Primary Origin.............. 749
Part III: Cancer-Related Tests and Treatments Chapter 56—Cancer Screening and Early Detection................. 755 Chapter 57—Common Medical Procedures and Tests............... 765 Section 57.1—Medical Tests and Procedures for Cancer Patients................... 766 Section 57.2—Cancer Imaging......................... 770 Section 57.3—Questions and Answers about Computed Tomography (CT)..... 777 Section 57.4—Tumor Markers......................... 780
Chapter 58—Surgical Procedures and Cancer........................... 785 Section 58.1—What You Need to Know about Surgery............................ 786
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Section 58.2—Lasers in Cancer Treatment.................................. 792 Section 58.3—Cryosurgery in Cancer Treatment.................................. 794
Chapter 59—Chemotherapy........................................................ 799 Chapter 60—Radiation Therapy................................................. 809 Chapter 61—Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation....... 823 Chapter 62—Biological Therapies.............................................. 831 Chapter 63—Molecularly Targeted Therapies........................... 839 Chapter 64—Photodynamic Therapy for Cancer....................... 849 Chapter 65—Cancer and Complementary and Alternative Medicine (CAM)..................................................... 853 Section 65.1—Thinking about CAM................ 854 Section 65.2—Dietary Supplements and Cancer Treatment..................... 862
Part IV: Recurrent and Advanced Cancer Chapter 66—Metastatic Cancer.................................................. 867 Chapter 67—Recurrent Cancer................................................... 871 Chapter 68—End-of-Life Care.................................................... 883
Part V: Cancer Research Chapter 69—How to Find a Cancer Treatment Trial................ 897 Chapter 70—Access to Investigational Drugs............................ 911 Chapter 71—Cancer Vaccines..................................................... 917 Chapter 72—Gene Therapy for Cancer...................................... 931 Chapter 73—Proton Therapy...................................................... 939 Chapter 74—The Potential of Nanotechnology in Cancer Care....................................................... 943 xi
Part VI: Additional Help and Information Chapter 75—A Glossary of Cancer-Related Terms.................... 951 Chapter 76—National Organizations Offering Cancer-Related Services...................................... 1013 Chapter 77—How to Find Resources in Your Own Community If You Have Cancer......................... 1029 Chapter 78—Beware of Online Cancer Fraud......................... 1035 Index.......................................................................................... 1041
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Preface
About This Book Every year, nearly 1.5 million Americans receive a diagnosis of cancer. Cancer is not a single disease, however. It is many different diseases that all share one common characteristic: Some of the body’s cells do not die when they should. Instead they continue to grow and divide. Through this process, cancer cells can damage the body’s tissues and organs, leading to a broad array of symptoms and even death. The cellular changes that lead to the development of cancer are sometimes inherited but they may also result from environmental or lifestyle factors. Although the survival rates for many types of cancer have improved in recent years and innovative treatment protocols are being developed, cancer remains the second leading cause of death in the United States. Cancer Sourcebook, Sixth Edition provides updated information about common types of cancer affecting the head, neck, central nervous system, endocrine system, lungs, digestive and urinary tracts, blood cells, immune system, skin, bones, and other body systems. It explains how people can reduce their risk of cancer by adopting a healthy lifestyle, addressing issues related to cancer risk, and taking advantage of screening exams. Various treatment choices—including surgery, chemotherapy, radiation therapy, bone marrow transplantation, and biological therapies—are discussed, and facts are provided about cancer clinical trials and other ongoing research. The book concludes with a glossary of related terms, a directory of national cancer organizations, and suggestions for finding community-based resources. xiii
Readers seeking additional information about specific cancers, a wide variety of cancer-related topics, or disease management issues, may wish to consult the following additional volumes within Omnigraphics’ Health Reference Series: • Breast Cancer Sourcebook, 3rd Edition offers facts about breast health and breast cancer, including information about risk factors, prevention efforts, screening and diagnostic methods, treatment options, and post-treatment follow-up care. • Cancer Sourcebook for Women, 4th Edition provides additional details about gynecologic cancers and other cancers of special concern to women. It also describes benign conditions of the female reproductive system, cancer screening and prevention programs, and women’s issues in cancer treatment and survivorship. • Cancer Survivorship Sourcebook addresses such issues as the physical, educational, emotional, social, and financial needs of cancer patients beginning with diagnosis and continuing through treatment and beyond. It also includes facts about clinical trials and offers suggestions for dealing with the side effects of cancer treatments. • Disease Management Sourcebook looks at how patients and their loved ones can cope with chronic and serious illnesses. It talks about navigating the health care system, communicating with health care providers, assessing health care quality, and making informed health care decisions. • Leukemia Sourcebook details the symptoms, diagnosis, and treatments of adult and childhood forms of acute and chronic leukemia. • Pediatric Cancer Sourcebook provides facts about the types of cancer most commonly found in infants, children, and adolescents. It also includes suggestions and coping strategies for parents and other caregivers. • Prostate Cancer Sourcebook discusses the detection, diagnosis, and treatment of prostate cancer and non-malignant prostate conditions.
How to Use This Book This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part, and sections explore aspects of some topics in greater detail. xiv
Part I: Cancer Risk Factors and Cancer Prevention discusses hereditary, lifestyle, and environmental factors that can sometimes set the stage for the growth of cancer. It explains which factors can be prevented and which factors are unavoidable. Statistical information about cancer prevalence, mortality, and survival is also provided, along with facts about specific population groups that suffer disproportionately from cancer. Part II: Common Types of Cancer includes a head-to-toe list of the most frequently occurring types of cancer. Individual chapters describe the development, identification, and treatment of cancers that affect the various components of the body, including the brain and central nervous system, endocrine system, respiratory system, blood and immune system, digestive and urinary tracts, and reproductive organs, as well as the bones and skin. Part III: Cancer-Related Tests and Treatments describes the screening methods used to find cancers at their earliest stages and the procedures most commonly used in cancer diagnosis and treatment. These include medical imaging tests, surgical procedures, chemotherapy, radiation therapy, and bone marrow transplantation. The part concludes with a chapter that discusses complementary and alternative medicine (CAM) practices used in cancer care. Part IV: Recurrent and Advanced Cancer explains the factors that cause cancer to spread to distant parts of the body and to come back again after a time of remission. A chapter on end-of-life care describes some of the decisions cancer patients and their families may face and offers suggestions regarding ways to make wishes known. Part V: Cancer Research discusses cancer treatment trials and other studies of new medications. Emerging therapies for cancer treatment and prevention, including vaccines, gene therapy, and proton therapy, are also described. Part VI: Additional Help and Information includes a glossary of terms, a directory of national cancer organizations, and suggestions for finding local resources. A chapter offering cautionary guidance about cancerrelated health fraud, especially on the internet, is also provided.
Bibliographic Note This volume contains documents and excerpts from publications issued by the following U.S. government agencies: Agency for Healthcare xv
Research and Quality; National Cancer Institute; National Institute of Diabetes and Digestive and Kidney Diseases; U.S. Environmental Protection Agency; and the U.S. Food and Drug Administration. In addition, this volume contains copyrighted documents from the following organizations: American Institute for Cancer Research; American Society of Clinical Oncology; Canadian Cancer Society; Cancer Project; Cancer Research UK; National Association for Proton Therapy; Nemours Foundation; and the Vanderbilt-Ingram Cancer Center. Full citation information is provided on the first page of each chapter or section. Every effort has been made to secure all necessary rights to reprint the copyrighted material. If any omissions have been made, please contact Omnigraphics to make corrections for future editions.
Acknowledgements In addition to the organizations listed above, special thanks are due to research and permissions coordinator, Liz Collins, permissions assistant, Cherry Edwards; editorial assistant, Zachary Klimecki; and prepress service provider, WhimsyInk.
About the Health Reference Series The Health Reference Series is designed to provide basic medical information for patients, families, caregivers, and the general public. Each volume takes a particular topic and provides comprehensive coverage. This is especially important for people who may be dealing with a newly diagnosed disease or a chronic disorder in themselves or in a family member. People looking for preventive guidance, information about disease warning signs, medical statistics, and risk factors for health problems will also find answers to their questions in the Health Reference Series. The Series, however, is not intended to serve as a tool for diagnosing illness, in prescribing treatments, or as a substitute for the physician/patient relationship. All people concerned about medical symptoms or the possibility of disease are encouraged to seek professional care from an appropriate health care provider.
A Note about Spelling and Style Health Reference Series editors use Stedman’s Medical Dictionary as an authority for questions related to the spelling of medical terms xvi
and the Chicago Manual of Style for questions related to grammatical structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series include many documents from a wide variety of different producers and copyright holders, and the editor’s primary goal is to present material from each source as accurately as is possible following the terms specified by each document’s producer. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn’s disease vs. Crohn disease) or that British spelling norms be retained (leukaemia vs. leukemia).
Locating Information within the Health Reference Series The Health Reference Series contains a wealth of information about a wide variety of medical topics. Ensuring easy access to all the fact sheets, research reports, in-depth discussions, and other material contained within the individual books of the Series remains one of our highest priorities. As the Series continues to grow in size and scope, however, locating the precise information needed by a reader may become more challenging. A Contents Guide to the Health Reference Series was developed to direct readers to the specific volumes that address their concerns. It presents an extensive list of diseases, treatments, and other topics of general interest compiled from the Tables of Contents and major index headings. To access A Contents Guide to the Health Reference Series, visit www.healthreferenceseries.com.
Medical Consultant Medical consultation services are provided to the Health Reference Series editors by David A. Cooke, MD, FACP. Dr. Cooke is a graduate of Brandeis University, and he received his M.D. degree from the University of Michigan. He completed residency training at the University of Wisconsin Hospital and Clinics. He is board-certified in Internal Medicine. Dr. Cooke currently works as part of the University of Michigan Health System and practices in Ann Arbor, MI. In his free time, he enjoys writing, science fiction, and spending time with his family. xvii
Our Advisory Board We would like to thank the following board members for providing guidance to the development of this Series: • Dr. Lynda Baker, Associate Professor of Library and Information Science, Wayne State University, Detroit, MI • Nancy Bulgarelli, William Beaumont Hospital Library, Royal Oak, MI • Karen Imarisio, Bloomfield Township Public Library, Bloomfield Township, MI • Karen Morgan, Mardigian Library, å°“ University of Michigan-Dearborn, Dearborn, MI • Rosemary Orlando, St. Clair Shores Public Library, St. Clair Shores, MI
Health Reference Series Update Policy The inaugural book in the Health Reference Series was the first edition of Cancer Sourcebook published in 1989. Since then, the Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Omnigraphics felt it was necessary to implement a policy of updating volumes when warranted. Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to: Editor Health Reference Series Omnigraphics, Inc. P.O. Box 31-1640 Detroit, MI 48231 E-mail:
[email protected] xviii
Part One Cancer Risk Factors and Cancer Prevention
Chapter 1
Questions and Answers about Cancer Cancer is the second leading cause of death in the United States. However, improvements in cancer detection, diagnosis, and treatment have increased the survival rate for many types of cancer.
What is cancer? Cancer is a group of many related diseases that begin in cells, the body’s basic building blocks. To understand cancer, it is helpful to know what happens when normal cells become cancerous. The body is made up of many types of cells. Normally, cells grow and divide to produce more cells as they are needed to keep the body healthy. Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. The extra cells form a mass of tissue called a growth or tumor. Not all tumors are cancerous; tumors can be benign or malignant. Benign tumors are not cancer: They can often be removed and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life. Malignant tumors are cancer: Cells in malignant tumors are abnormal and divide without control or order. Cancer cells invade and From “Cancer: Questions and Answers,” National Cancer Institute (www .cancer.gov), June 6, 2005. Reviewed by David A. Cooke, MD, FACP, September 2010.
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Cancer Sourcebook, Sixth Edition destroy the tissue around them. Cancer cells can also break away from a malignant tumor and enter the bloodstream or lymphatic system. Blood vessels include a network of arteries, capillaries, and veins through which the blood circulates in the body. The lymphatic system carries lymph and white blood cells through lymphatic vessels (thin tubes) to all the tissues of the body. By moving through the bloodstream or lymphatic system, cancer can spread from the primary (original) cancer site to form new tumors in other organs. The spread of cancer is called metastasis.
What causes cancer? Scientists have learned that cancer is caused by changes in genes that normally control the growth and death of cells. Certain lifestyle and environmental factors can change some normal genes into genes that allow the growth of cancer. Many gene changes that lead to cancer are the result of tobacco use, diet, exposure to ultraviolet (UV) radiation from the sun, or exposure to carcinogens (cancer-causing substances) in the workplace or in the environment. Some gene alterations are inherited (from one or both parents). However, having an inherited gene alteration does not always mean that the person will develop cancer; it only means that the chance of getting cancer is increased. Scientists continue to examine the factors that may increase or decrease a person’s chance of developing cancer. Although being infected with certain viruses, such as the human papillomavirus (HPV), hepatitis B and C (HepB and HepC), and human immunodeficiency virus (HIV), increases the risk of some types of cancer, cancer itself is not contagious. A person cannot catch cancer from someone who has this disease. Scientists also know that an injury or bruise does not cause cancer.
Can cancer be prevented? Although there is no guaranteed way to prevent cancer, people can reduce their risk (chance) of developing cancer by following these guidelines: • Not using tobacco products • Choosing foods with less fat and eating more vegetables, fruits, and whole grains • Exercising regularly and maintaining a lean weight • Avoiding the harmful rays of the sun, using sunscreen, and wearing clothing that protects the skin 4
Questions and Answers about Cancer • Talking with a doctor about the possible benefits of drugs proven to reduce the risk of certain cancers Although many risk factors can be avoided, some, such as inherited conditions, are unavoidable. Still, it is helpful to be aware of them. It is also important to keep in mind that not everyone with a particular risk factor for cancer actually gets the disease; in fact, most do not. People who have an increased likelihood of developing cancer can help protect themselves by avoiding risk factors whenever possible and by getting regular checkups so that, if cancer develops, it is likely to be found and treated early. Treatment is often more effective when cancer is detected early. Screening exams, such as sigmoidoscopy or the fecal occult blood test, mammography, and the Pap test, can detect precancerous conditions (which can be treated before they turn into cancer) and early-stage cancer. The National Cancer Institute (NCI) is conducting many cancer prevention studies to explore ways to reduce the risk of developing cancer. These studies are evaluating dietary supplements, chemopreventive agents, nutrition, personal behaviors, and other factors that may prevent cancer.
What are some of the common signs and symptoms of cancer? Cancer can cause a variety of symptoms. Possible signs of cancer include the following: • New thickening or lump in the breast or any other part of the body • New mole or an obvious change in the appearance of an existing wart or mole • A sore that does not heal • Nagging cough or hoarseness • Changes in bowel or bladder habits • Persistent indigestion or difficulty swallowing • Unexplained changes in weight • Unusual bleeding or discharge When these or other symptoms occur, they are not always caused by cancer. They can be caused by infections, benign tumors, or other problems. It is important to see a doctor about any of these symptoms 5
Cancer Sourcebook, Sixth Edition or about other physical changes. Only a doctor can make a diagnosis. A person with these or other symptoms should not wait to feel pain because early cancer usually does not cause pain. If symptoms occur, the doctor may perform a physical examination, order blood work and other tests, and/or recommend a biopsy. In most cases, a biopsy is the only way to know for certain whether cancer is present. During a biopsy, the doctor removes a sample of tissue from the abnormal area. A pathologist studies the tissue under a microscope to identify cancer cells.
How is cancer treated? Cancer treatment can include surgery, radiation therapy, chemotherapy, hormone therapy, and biological therapy. The doctor may use one method or a combination of methods, depending on the type and location of the cancer, whether the disease has spread, the patient’s age and general health, and other factors. Because treatment for cancer can also damage healthy cells and tissues, it often causes side effects. Some patients may worry that the side effects of treatment are worse than the disease. However, patients and doctors generally discuss the treatment options, weighing the likely benefits of killing cancer cells and the risks of possible side effects. Doctors can suggest ways to reduce or eliminate problems that may occur during and after treatment. Surgery is an operation to remove cancer. The side effects of surgery depend on many factors, including the size and location of the tumor, the type of operation, and the patient’s general health. Patients have some pain after surgery, but this pain can be controlled with medicine. It is also common for patients to feel tired or weak for a while after surgery. Patients may worry that having a biopsy or other type of surgery for cancer will spread the disease. This is a very rare occurrence because surgeons take special precautions to prevent cancer from spreading during surgery. Also, exposing cancer to air during surgery does not cause the disease to spread. Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells in a targeted area. Radiation can be given externally by a machine that aims radiation at the tumor area. It can also be given internally; needles, seeds, wires, or catheters containing a radioactive substance are placed directly in or near the tumor. Radiation treatments are painless. The side effects are usually temporary, and most can be treated or controlled. Patients are likely to feel very tired, especially in the later weeks of treatment. Radiation therapy 6
Questions and Answers about Cancer may also cause a decrease in the number of white blood cells, which help protect the body against infection. With external radiation, it is also common to have temporary hair loss in the treated area and for the skin to become red, dry, tender, and itchy. There is no risk of radiation exposure from coming in contact with a patient undergoing external radiation therapy. External radiation does not cause the body to become radioactive. With internal radiation (also called implant radiation), a patient may need to stay in the hospital, away from other people, while the radiation level is highest. Implants may be permanent or temporary. The amount of radiation in a permanent implant goes down to a safe level before the person leaves the hospital. With a temporary implant, there is no radioactivity left in the body after the implant is removed. Chemotherapy is the use of drugs that kill cancer cells throughout the body. Healthy cells can also be harmed, especially those that divide quickly. The doctor may use one drug or a combination of drugs. The side effects of chemotherapy depend mainly on the drug(s) and the dose(s) the patient receives. Hair loss is a common side effect of chemotherapy; however, not all anticancer drugs cause loss of hair. Anticancer drugs may also cause temporary fatigue, poor appetite, nausea and vomiting, diarrhea, and mouth and lip sores. Drugs that prevent or reduce nausea and vomiting can help with some of these side effects. Normal cells usually recover when chemotherapy is over, so most side effects gradually go away after treatment ends. Hormone therapy is used to treat certain cancers that depend on hormones for their growth. It works by keeping cancer cells from getting or using the hormones they need to grow. This treatment may include the use of drugs that stop the production of certain hormones or that change the way hormones work. Another type of hormone therapy is surgery to remove organs that make hormones. For example, the ovaries may be removed to treat breast cancer, or the testicles may be removed to treat prostate cancer. Hormone therapy can cause a number of side effects. Patients may feel tired, or have fluid retention, weight gain, hot flashes, nausea and vomiting, changes in appetite, and, in some cases, blood clots. Hormone therapy may also cause bone loss in premenopausal women. Depending on the type of hormone therapy used, these side effects may be temporary, long lasting, or permanent. Biological therapy uses the body’s immune system, directly or indirectly, to fight disease and to lessen some of the side effects of cancer treatment. Monoclonal antibodies, interferon, interleukin-2, and colony-stimulating factors are some types of biological therapy. 7
Cancer Sourcebook, Sixth Edition The side effects caused by biological therapy vary with the specific treatment. In general, these treatments tend to cause flu-like symptoms, such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Patients also may bleed or bruise easily, get a skin rash, or have swelling. These problems can be severe, but they go away after the treatment stops.
Are clinical trials (research studies) available? Where can people get more information about clinical trials? Yes. Clinical trials are an important treatment option for many cancer patients. To develop new, more effective treatments, and better ways to use current treatments, the NCI is sponsoring clinical trials in many hospitals and cancer centers around the country. Clinical trials are a critical step in the development of new methods of treatment. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. People interested in taking part in a clinical trial should talk with their doctor.
Does cancer always cause pain? Having cancer does not always mean having pain. Whether a patient has pain may depend on the type of cancer, the extent of the disease, and the patient’s tolerance for pain. Most pain occurs when the cancer grows and presses against bones, organs, or nerves. Pain may also be a side effect of treatment. However, pain can generally be relieved or reduced with prescription medicines or over-the-counter drugs recommended by the doctor. Other ways to reduce pain, such as relaxation exercises, may also be useful. Pain should not be accepted as an unavoidable part of having cancer. It is important for patients to talk about pain so steps can be taken to help relieve it. The fear of addiction or “losing control” should not stop patients from taking pain medication. Patients who take medications for cancer pain, as prescribed by their doctor, rarely become addicted to them. In addition, changing the dose or type of medication can usually help if the patient has troublesome side effects.
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Chapter 2
Cancer Statistics
Chapter Contents Section 2.1—Understanding Statistics on Incidence, Prevalence, and Mortality...................... 10 Section 2.2—The Role Statistics Play in Predicting a Patient’s Prognosis.............................. 14 Section 2.3—Incidence, Mortality, and Survival Rates for Common Cancers..................................... 17
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Cancer Sourcebook, Sixth Edition
Section 2.1
Understanding Statistics on Incidence, Prevalence, and Mortality “Understanding Statistics on Incidence, Prevalence, and Mortality: Estimating Risk and Recommending Screening.” Reprinted with permission. © 2010 American Society of Clinical Oncology (www.cancer.net). All rights reserved.
Key Messages • Statistics are used to help doctors understand who is at risk for cancer. • Several types of statistics are used to determine cancer risk for large groups of people: incidence, prevalence, and mortality. • Understanding your risk of cancer can help you receive appropriate screening tests and make lifestyle choices to reduce cancer risk. Many people may want to know their individual risk of being diagnosed with cancer. Statistics are used to determine the risk of cancer for groups of people and can be helpful to estimate your risk of cancer based on individual aspects that are similar to the groups at risk. However, statistics cannot tell you if you will develop cancer. Read below to learn more about the types of statistics used to estimate cancer risk.
Estimating How Many People Will Be Diagnosed with Cancer during the Year Incidence is used to determine an estimate of the number of the people diagnosed with cancer in a given population (for example, all men in the United States) over a specific period of time (typically one year). Expected incidence of cancer cases for the current year is calculated by using the number of cancer cases that occurred each year over a range of years and fitting those numbers to a statistical model, which predicts the number of new cases that are expected for the current 10
Cancer Statistics year. The range may be used differently in different statistical reports and for different types of statistics. • Example: In the American Cancer Society’s publication, Cancer Facts & Figures 2010, cancer incidence for 2010 was calculated by using the number of cancer cases from 1995 to 2006. Incidence is frequently given as an incidence rate that states the number of people estimated to be diagnosed with cancer per 100,000 people. • Example: The 2010 incidence rate for prostate cancer in the United States is about 156, which means that almost 156 out of every 100,000 men in the United States are expected to be diagnosed with prostate cancer in 2010. Incidence is often stated as an age-adjusted incidence rate. The number of people who fall into different age groups varies (for example, there are many more 30 to 40 year olds than 80 to 90 year olds). This is referred to as age distribution. Incidence rates can be adjusted to account for these age distribution differences so that populations can be compared. • Example: Florida has a large number of older adults, while most people who live in Alaska, by comparison, are young. Because the incidence of breast cancer increases with age, the annual absolute incidence rate of invasive breast cancer is much higher in Florida than in Alaska. However, when adjusted for age, the annual age-adjusted incidence rate (cases per 100,000 women) for Alaska was higher than that of Florida from 2002– 2006: 114.1 in Florida compared with 126.4 in Alaska. Incidence statistics can be given for large populations, such as all people in the United States, or for more specific population groups, such as only women ages 20 to 24. Large population statistics are usually estimates based on information collected from a smaller sample of the whole population. When these statistics describe particular population groups, they are usually referred to as “specific.” • Example: The age-specific incidence rate for breast cancer in 20-year-olds to 24-year-olds is 1.6 (per 100,000 women). Incidence statistics may also be given for several cancers combined, for specific types of cancer, for specific stages of a type of cancer, or for specific cancer risk factors (anything that increases a person’s chance of developing a type of cancer). 11
Cancer Sourcebook, Sixth Edition
Calculating How Many People Have or Have Had Cancer Prevalence is used to describe the number of people in a specific population that have a certain type of cancer at a specific point in time. While incidence describes the estimated number of new cases of a cancer, prevalence can describe all cases, including newly diagnosed and people who are being treated or who have been treated for cancer in the past. Prevalence can be expressed in terms of an absolute number or as a percentage. • Example: The estimated prevalence of ovarian cancer in the United States in 2007 was 177,162. This means that 177,162 of the women in the United States were living with or had a history of ovarian cancer. Prevalence rates express the number of cases of cancer per 100,000 people. • Example: The estimated prevalence rate for ovarian cancer in the United States in 2007 was 59. This means, in 2007, almost 59 out of every 100,000 women were living with or had a history of ovarian cancer. Like incidence, prevalence can also be used for large populations, specific population groups, several cancers combined, specific types of cancer, specific stages of a type of cancer, or cancer risk factors. • Example: Genetic mutations in either one of two specific genes, BRCA1 and BRCA2, are associated with increased breast cancer risk. It is estimated that the prevalence of mutations of one of these two genes is less than 1%. This means that less than 1% of women have a mutated BRCA1 or BRCA2 gene. However, the prevalence of a BRCA gene mutation among women with breast cancer is approximately 5% to 10%. This means that out of all women who have breast cancer, 5% to 10% have a BRCA gene mutation. The increased prevalence of BRCA gene mutations among women with breast cancer means that a woman with a BRCA gene mutation has an increased risk of breast cancer.
Calculating How Many People Die from Cancer In cancer statistics, mortality is used to describe the number of deaths from cancer during a specific time period. The cancer mortality rate describes the number of deaths from cancer per 100,000 people 12
Cancer Statistics during a specific time period, usually one year. Mortality rates can be calculated for specific types of cancer and for specific subsets of the population (such as children under 12, smokers, or women with the BRCA1 gene mutation). As with incidence rates, mortality rates can also be given as age-adjusted mortality rates. Mortality rates can change dramatically with advances in treatment, screening, and prevention. • Example: The age-adjusted mortality rate for Hodgkin lymphoma in the United States in the early 1960s was greater than 1.55 (1.55 deaths per 100,000 people). Following the introduction of combination chemotherapy in the late 1960s, the rate dropped to less than 0.5 by the 1990s.
Estimating a Person’s Risk of Cancer to Recommend Screening By looking at the incidence and prevalence statistics for different types of cancer in various groups of people, researchers can estimate which groups of people may have an increased risk of developing certain types of cancer. Statistics tell us that older women are at higher risk for breast cancer than younger women, black men are at higher risk for prostate cancer than white men, and people who drink alcohol often are at higher risk for liver cancer than people who don’t drink alcohol. Risk information from incidence and prevalence statistics is combined with mortality statistics to provide some of the basis for cancer screening recommendations. • Example: Prevalence and incidence statistics show that coloÂ� rectal cancer is among the most common cancers in the United States. Age-specific prevalence and incidence rates also show that colorectal cancer is most common in people over age 50. The mortality rates for colorectal cancer show that treatment is much more successful when cancer is found early than if the cancer has spread. Therefore, combining these pieces of information, doctors recommend that routine screening for colorectal cancer begin at age 50 to increase the likelihood of prevention or early detection. Other risk factors, such as family history, presence of other illnesses, and various lifestyle factors, are also taken into account when making screening recommendations specific to an individual. 13
Cancer Sourcebook, Sixth Edition
Points to Remember • Statistics are estimates that describe trends in large numbers of people. Statistics cannot be used to predict what will actually happen to a single person. • Incidence, prevalence, and mortality statistics for different cancer stages, age groups, or time periods can vary dramatically. People are encouraged to ask their doctor for the most appropriate statistics based on their individual medical condition. • As with any medical information, talk with your doctor for clarification if cancer-related statistics seem unclear.
Section 2.2
The Role Statistics Play in Predicting a Patient’s Prognosis “Understanding Prognosis and Cancer Statistics: Questions and Answers,” National Cancer Institute (www.cancer.gov), March 7, 2008.
What is a prognosis? People facing cancer are naturally concerned about what the future holds. A prognosis gives an idea of the likely course and outcome of a disease—that is, the chance that a patient will recover or have a recurrence (return of the cancer).
What factors affect a patient’s prognosis? Many factors affect a person’s prognosis. Some of the most important are the type and location of the cancer, the stage of the disease (the extent to which the cancer has metastasized, or spread), and its grade (how abnormal the cancer cells look and how quickly the cancer is likely to grow and spread). In addition, for hematologic cancers (cancers of the blood or bone marrow) such as leukemias and lymphomas, the presence of chromosomal abnormalities and abnormalities in the 14
Cancer Statistics patient’s complete blood count (CBC) can affect a person’s prognosis. Other factors that may also affect the prognosis include the person’s age, general health, and response to treatment.
How do statistics contribute to predicting a patient’s prognosis? When doctors discuss a person’s prognosis, they carefully consider all factors that could affect that person’s disease and treatment and then try to predict what might happen. The doctor bases the prognosis on information researchers have collected over many years about hundreds or even thousands of people with cancer. When possible, the doctor uses statistics based on groups of people whose situations are most similar to that of an individual patient. Several types of statistics might be used to discuss prognosis. Some commonly used statistics are described below: • Survival rate indicates the percentage of people with a certain type and stage of cancer who survive for a specific period of time after their diagnosis. For example, 55 out of 100 people with a certain type of cancer will live for at least five years, and the other 45 people will not. Survival statistics may further categorize the people who die by cause of death because some will die from unrelated causes. For example, of the 45 people mentioned above, 35 may die from their cancer and 10 may die from other causes. • The five-year survival rate indicates the percentage of people who are alive five years after their cancer diagnosis, whether they have few or no signs or symptoms of cancer, are free of disease, or are having treatment. Five-year survival rates are used as a standard way of discussing prognosis as well as a way to compare the value of one treatment with another. It does not mean that a patient can expect to live for only five years after treatment or that there are no cures for cancer. • Disease-free or recurrence-free survival rates represent how long one survives free of the disease, rather than until death. Because survival rates are based on large groups of people, they cannot be used to predict what will happen to a particular patient. No two patients are exactly alike, and treatment and responses to treatment vary greatly. The doctor may speak of a favorable prognosis if the cancer is likely to respond well to treatment. The prognosis may be unfavorable if the 15
Cancer Sourcebook, Sixth Edition cancer is likely to be difficult to control. It is important to keep in mind, however, that a prognosis is only a prediction. Again, doctors cannot be absolutely certain about the outcome for a particular patient.
Is it helpful to know the prognosis? Cancer patients and their loved ones face many unknowns. Understanding cancer and what to expect can help patients and their loved ones plan treatment, think about lifestyle changes, and make decisions about their quality of life and finances. Many people with cancer want to know their prognosis. They find it easier to cope when they know the statistics. They may ask their doctor or search for statistics such as survival rates on their own. Other people find statistical information confusing and frightening, and they think it is too impersonal to be of use to them. The doctor who is most familiar with a patient’s situation is in the best position to discuss the prognosis and to explain what the statistics may mean for that person. At the same time, it is important to understand that even the doctor cannot tell exactly what to expect. In fact, a person’s prognosis may change if the cancer progresses or if treatment is successful. Seeking information about the prognosis is a personal decision. It is up to each patient to decide how much information he or she wants and how to deal with it.
What is the prognosis if a patient decides not to have treatment? Because everyone’s situation is different, this question can be difficult to answer. Prognostic statistics often come from studies comparing new treatments with best available treatments, not with “no treatment.” Therefore, it is not always easy for doctors to accurately estimate prognosis for patients who decide not to have treatment. However, as mentioned above, the doctor who is most familiar with a patient’s situation is in the best position to discuss prognosis, taking into account individual characteristics of the patient that can affect the overall situation. There are many reasons patients decide not to have treatment. One reason may be concern about side effects related to treatment. Patients should discuss this concern with their doctor and cancer nurse. Many medications are available to prevent or control the side effects caused by cancer therapies. Another reason patients might decide not to have treatment is that their type of cancer does not have a 16
Cancer Statistics good prognosis even when treated. In these cases, patients may want to explore clinical trials (research studies). A clinical trial may offer access to new drugs that may be more promising than the standard treatments available.
Section 2.3
Incidence, Mortality, and Survival Rates for Common Cancers Statistics in this section were excerpted from “SEER Stat Fact Sheets” and are based on Surveillance Epidemiology and End Results (SEER) incidence and National Center for Health Statistics (NCHS) mortality statistics. Most can be found within this document: Horner MJ, Ries LAG, Krapcho M, Neyman N, Aminou R, Howlader N, Altekruse SF, Feuer EJ, Huang L, Mariotto A, Miller BA, Lewis DR, Eisner MP, Stinchcomb DG, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2006, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2006/, based on November 2008 SEER data submission, posted to the SEER web site, 2009.
Cancer, Totals for All Sites It is estimated that 1,479,350 men and women (766,130 men and 713,220 women) will be diagnosed with cancer and 562,340 men and women will die of cancer of all sites in 2009. Surveillance Epidemiology and End Results (SEER) Incidence: From 2002–2006, the median age at diagnosis for cancer of all sites was 66 years of age. Approximately 1.1% were diagnosed under age 20; 2.7% between 20 and 34; 5.8% between 35 and 44; 13.9% between 45 and 54; 21.8% between 55 and 64; 24.9% between 65 and 74; 22.2% between 75 and 84; and 7.6% 85 or more years of age. U.S. Mortality: From 2002–2006, the median age at death for cancer of all sites was 73 years of age. Approximately 0.4% died under age 20; 0.8% between 20 and 34; 2.7% between 35 and 44; 9.0% between 45 and 54; 17.5% between 55 and 64; 25.2% between 65 and 74; 29.9% between 75 and 84; and 14.6% 85 or more years of age. 17
Cancer Sourcebook, Sixth Edition Table 2.1. Incidence Rates by Race Race/Ethnicity
Male
Female
All Races
541.8 per 100,000 men
408.5 per 100,000 women
White
544.3 per 100,000 men
420.5 per 100,000 women
Black
633.7 per 100,000 men
398.9 per 100,000 women
Asian/Pacific Islander
349.1 per 100,000 men
287.5 per 100,000 women
American Indian/ Alaska Native
331.0 per 100,000 men
302.2 per 100,000 women
Hispanic
409.7 per 100,000 men
312.5 per 100,000 women
For additional details regarding these statistics, visit http://seer.cancer.gov/statfacts/ html/all.html.
Table 2.2. Death Rates by Race Race/Ethnicity
Male
Female
All Races
229.9 per 100,000 men
157.8 per 100,000 women
White
226.7 per 100,000 men
157.3 per 100,000 women
Black
304.2 per 100,000 men
183.7 per 100,000 women
Asian/Pacific Islander
135.4 per 100,000 men
95.1 per 100,000 women
American Indian/ Alaska Native
183.3 per 100,000 men
140.1 per 100,000 women
Hispanic
154.7 per 100,000 men
103.9 per 100,000 women
For additional details regarding these statistics, visit http://seer.cancer.gov/statfacts/ html/all.html.
Survival: Survival examines how long after diagnosis people live. Cancer survival is measured in a number of different ways depending on the intended purpose. The survival rates presented here are based on the relative survival rate, which measures the survival of the cancer patients in comparison to the general population to estimate the effect of cancer. The overall five-year relative survival rate for 1999–2005 from 17 SEER geographic areas was 66.1%. Five-year relative survival rates by race and sex were: 67.0% for white men; 66.9% for white women; 60.6% for black men; 55.2% for black women. 18
Cancer Statistics Lifetime Risk: Based on rates from 2004–2006, 40.58% of men and women born today will be diagnosed with cancer at some time during their lifetime. These statistics are called the lifetime risk (the probability of developing cancer in the course of one’s lifespan). Sometimes it is more useful to look at the probability of developing cancer between two age groups. For example, 20.45% of men will develop cancer between their 50th and 70th birthdays compared to 15.33% for women. Prevalence: On January 1, 2006, in the United States there were approximately 11,384,892 men and women alive who had a history of cancer—5,168,889 men and 6,216,003 women. This includes any person alive on January 1, 2006 who had been diagnosed with cancer at any point prior to January 1, 2006 and includes persons with active disease and those who are cured of their disease. Prevalence can also be expressed as a percentage, and it can also be calculated for a specific amount of time prior to January 1, 2006 such as diagnosed within five years of January 1, 2006.
Anal Cancer It is estimated that 5,290 men and women (2,100 men and 3,190 women) will be diagnosed with, and 710 men and women will die of, cancer of the anus, anal canal, and anorectum in 2009. SEER incidence: From 2002–2006, the median age at diagnosis for cancer of the anus, anal canal, and anorectum was 61 years of age. Approximately 0.0% were diagnosed under age 20; 1.2% between 20 and 34; 10.5% between 35 and 44; 23.6% between 45 and 54; 23.0% between 55 and 64; 19.0% between 65 and 74; 16.2% between 75 and 84; and 6.4% 85 or more years of age. U.S. mortality: From 2002–2006, the median age at death for cancer of the anus, anal canal, and anorectum was 65 years of age. Approximately 0.0% died under age 20; 1.0% between 20 and 34; 7.5% between 35 and 44; 18.5% between 45 and 54; 22.1% between 55 and 64; 19.3% between 65 and 74; 20.7% between 75 and 84; and 10.9% 85 or more years of age. Survival: The overall five-year relative survival rate for 1999–2005 from 17 SEER geographic areas was 66.3%. Five-year relative survival rates by race and sex were: 61.8% for white men; 70.3% for white women; 53.7% for black men; 65.7% for black women. 19
Cancer Sourcebook, Sixth Edition
Figure 2.1. Trends in Seer incidence Rates (Source: SEER 13 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry and Rural Georgia) and US Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention. For sex-specific cancer sites, the population was limited to the population of the appropriate sex. Underlying rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103). *The Annual Percent Change is significantly different from zero (p
