Bladder Cancer

Facts About Bladder Cancer

  • The American Cancer Society estimates that more than 67,000 new cases of bladder cancer will be diagnosed in the United States this year.
  • Bladder cancer is four times more common in men than in women and two times more common in Caucasians than African-Americans.
  • In the United States, bladder cancer is the fourth most common cancer in men and the eighth most common in women.
  • The five-year survival rate for all types of bladder cancer is 82 percent. If the cancer is confined to the bladder (noninvasive), the survival rate is 94 percent.

About Bladder Cancer

The bladder is located in the pelvis. It collects and stores urine and has a muscular wall that allows it to contract and expand.

  • About 90 percent of bladder cancers are transitional cell carcinomaSquamous cell carcinomaadenocarcinoma and small cell carcinoma account for the rest.
  • Cancer that is only in the bladder lining is called superficial bladder cancer. More than 75 percent of bladder cancer is diagnosed as a superficial disease and has an excellent survival rate.
  • Invasive bladder cancer penetrates the layers of muscles in the bladder and is more likely to spread to other parts of the body.

Treating Bladder Cancer

Treatment options are based on the type of cancer, your age and your overall health. Bladder cancer, if caught early, can often be cured. The main treatments include:

  • Surgery by a surgical oncologist or urologist to remove the cancer or possibly part or all of the bladder.
  • Radiation therapy where a radiation oncologist uses high-energy X-rays to destroy the tumor.
  • Chemotherapy where a medical oncologist uses drugs to eliminate the cancer. In some instances, drugs may be put directly into the bladder.
  • Biologic therapy (also called immunotherapy) where doctors stimulate your immune system to fight the cancer.

In the past, complete removal of the bladder was the only way to treat bladder cancer. With advances in radiation therapy and chemotherapy, doctors are sometimes able to treat the cancer while preserving the bladder. This allows many patients to preserve normal urinary function.

Radiation Therapy Options for Bladder Cancer

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat cancer.

  • Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
  • Healthy cells are also affected by radiation, but they are able to repair themselves in a way cancer cells cannot.

External beam radiation therapy is the main type of radiation used to treat bladder cancer, often in combination with chemotherapy.Internal radiation therapy, or brachytherapy, is also sometimes used.

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to deliver radiation to the bladder. These treatments take less than half an hour each, five days a week, for five to seven weeks.

  • 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the cancer. This technique helps keep radiation away from nearby healthy tissue.

Potential Side Effects

The side effects you might feel will depend on the part of your body being treated, the dose of radiation given and whether you also receive other treatments, such as chemotherapy. Before treatment begins, ask your doctor about possible side effects and how you can best manage them.

  • Bladder irritation with increased need to urinate.
  • Bowel irritation with abdominal cramping, rectal pressure and diarrhea are possible.
  • Fatigue where you feel tired much of the time.
  • You may experience a mild skin irritation, like a sunburn, and you may lose your pubic hair. Side effects are usually limited to the part of your body that receives radiation and should get better after treatment ends.
  • Some patients may also suffer from sexual problems, such as vaginal dryness or difficulty achieving an erection.
  • Most side effects should go away after the treatments end.

Talk to your doctor or nurse about any discomfort you feel. He or she may be able to provide drugs or other treatments to help.

Caring for Yourself During Treatment

  • Get plenty of rest during treatment.
  • Follow your doctor’s orders. Ask if you are unsure about anything or if you have questions about your treatments and side effects.
  • Tell your doctor about any medications or vitamins you are taking to make sure they’re safe to use during radiation therapy.
  • Eat a balanced diet. If food tastes funny or if you’re having trouble eating, tell your doctor or dietician. They may be able to help you change the way you eat.
  • Treat the skin exposed to radiation with special care. Stay out of the sun, avoid hot or cold packs, and only use lotions and ointments after checking with your doctor or nurse. When cleaning the area, use only water and a mild soap.
  • Fighting cancer is a tough struggle. Don’t be afraid to ask friends, family, support groups and your radiation oncology team for help.

Brain Tumors

About Brain Tumors

The brain is the center of thought, memory, emotion, speech, sensation and motor function. The spinal cord and special nerves in the head called cranial nerves carry and receive messages between the brain and the rest of the body.

  • There are two types of brain tumors:
    • Primary — a tumor that starts in the brain. Primary brain tumors can be benign (not cancerous) or malignant (cancerous). Primary tumors in the brain or spinal cord rarely spread to distant organs.
    • Metastatic — a tumor caused by cancer elsewhere in the body that spreads to the brain. Metastatic brain tumors are always cancerous.
  • Brain tumors cause damage because, as they grow, they can interfere with surrounding cells that serve vital roles in our everyday life.

Facts About Brain Tumors

  • The Central Brain Tumor Registry of the United States estimates that more than 359,000 persons are living with the diagnosis of primary brain and central nervous system tumors in the United States.
  • An estimated 43,800 new cases of primary benign and malignant brain and central nervous system tumors are expected to be diagnosed in the United States this year.

Treating Brain Tumors

If doctors determine that you have a tumor, the treatment options and prognosis are based on the following factors:

  • Tumor type.
  • Location and size of tumor.
  • Tumor grade (how abnormal the cells are).
  • Your age, medical history and general health.

Understanding Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat many different kinds of tumors.

  • Doctors called radiation oncologists use radiation therapy to try to kill tumors, to control tumor growth or to relieve symptoms.
  • Radiation therapy works within tumor cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
  • Healthy cells near the tumor may be affected by radiation, but they are able to repair themselves in a way tumor cells cannot.

Radiation Therapy Options for Brain Tumors

People with brain tumors should discuss treatment options with a number of cancer specialists, including a radiation oncologist. A radiation oncologist is a doctor who will help you understand the types of radiation therapy available to treat your tumor. Radiation therapy treatment options for brain tumors include:

  • External beam radiation therapy.
  • Brachytherapy or internal radiation therapy.

Depending on your tumor, you may also undergo surgery and/or chemotherapy, either before or after radiation.

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments over several weeks to accurately deliver radiation to the brain. Radiation is often given after surgery, and sometimes it is used instead of surgery.

  • 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the brain. Tailoring each of the radiation beams to the patient's tumor allows coverage of the diseased cells while keeping radiation away from nearby organs, such as the eyes.
  • Intensity modulated radiation therapy (IMRT) is the most recent advance in the delivery of radiation. IMRT differs from 3D-CRT by modifying the intensity of the radiation within each of the radiation beams.
  • Stereotactic radiotherapy, sometimes called radiosurgery, is a type of external beam radiation therapy that pinpoints high doses directly on the tumor, in some cases in only one treatment. At some centers, stereotactic radiotherapy is called by the name of the company that makes the equipment.

X-rays, electrons and protons are all types of energy used in external beam radiation therapy.

Internal Radiation Therapy

Internal radiation therapy, or brachytherapy, works by placing radioactive sources in, or just next to, a tumor.

  • During brachytherapy, a tube or balloon called a catheter will be inserted into the brain. The radiation will then be carried to the tumor using this catheter.
  • The radioactive source will then be left in place from several hours to several days to kill the tumor cells.
  • In some cases, the radiation is permanently placed directly into the tumor or the area where the tumor was before surgery.

Newer Techniques

Doctors are constantly exploring newer and better ways to treat primary brain tumors.

  • Drugs that make tumor cells more sensitive to radiation are called radiosensitizers. Combining radiation with radiosensitizers may allow doctors to kill more tumor cells.

Possible Side Effects

  • Side effects from radiation can include fatigue, hair loss where you received radiation, scalp irritation and muffled hearing. These will usually resolve a month or so after treatment. However, you hair might not grow back exactly as it was before treatment.
  • Radiation may also cause some short-term memory loss and difficulty thinking.
  • Side effects are different for each person. Medications may be prescribed to make you as comfortable as possible.
  • If at any time during your treatment you feel discomfort, tell your doctor or nurse. They can prescribe medicine to help you feel better.

Be sure to talk to your radiation oncologist before you start treatment, to make sure you understand what side effects are common for your treatment and how best to handle them.

Caring for Yourself During Treatment

  • Get plenty of rest during treatment, and don't be afraid to ask for help.
  • Follow your doctor's orders. Ask if you are unsure about anything. There are no stupid questions.
  • Tell your doctor about any medications or vitamins you are taking, to make sure they are safe to use during radiation therapy.
  • Eat a balanced diet. If food tastes funny or if you're having trouble eating, tell your doctor, nurse or dietician. They may be able to help you change the way you eat.
  • Treat the skin exposed to radiation with special care. Stay out of the sun, avoid hot or cold packs, only use lotions and ointments after checking with your doctor or nurse, and clean the area with warm water and mild shampoo or baby shampoo.
  • Battling cancer is tough. Seek our help from support groups and friends.

Breast Cancer

Facts About Breast Cancer

Breast cancer is the most common type of cancer in American women, according to the American Cancer Society.

  • This year nearly 213,000 women and 1,700 men will learn they have breast cancer.
  • Another 62,000 women will learn they have noninvasive (also called in situ) breast cancer.
  • Nearly 41,000 women and 500 men will die from breast cancer this year.
  • Breast cancer can often be cured. About 80 percent of all patients with breast cancer are free of the disease 10 years after their diagnosis.

Risk Factors for Breast Cancer

Many women who develop breast cancer do not have known risk factors. Patient qualities that may increase the risk of developing the disease include:

  • Age is the biggest risk factor. More than 75 percent of women diagnosed with breast cancer are over age 50.
  • Family history of breast cancer in your mother or sister.
  • Early onset of periods.
  • Having children later in life, or not at all.
  • Hormone replacement therapy with estrogen and progesterone.

Being physically active, keeping a healthy weight, breast feeding and limiting alcohol intake may lower your risk for developing breast cancer.

Diagnosing Breast Cancer

Many breast tumors are found by a breast X-ray study called a mammogram. At age 40, women should begin having regular mammograms. If you have a family history of the disease or other risk factors, ask your healthcare provider about earlier screening.

  • If you notice a lump in the breast or underarm, have it checked by a doctor. Breast swelling, skin discoloration, dimpling of the skin or nipple discharge should also be checked.
  • In addition to a mammogram, your doctor may also recommend ultrasound or MRI scans.
  • In some cases, a biopsy to see if you have breast cancer will be done if your mammogram is abnormal or you have a lump. Sometimes a small needle will be used to remove tissue from the lump and look at it under a microscope. Somtimes it is better to have a surgeon remove the entire lump to be sure about the diagnosis.

Treating Breast Cancer

The main treatment for breast cancer is surgery. This is often followed by radiation therapy. Some patients will also need chemotherapy and/or hormone blocking therapy.

  • Breast conserving surgery is surgical removal of only the cancerous tissue. This operation is called a lumpectomy and is usually followed by radiation.
  • Mastectomy is surgical removal of the breast.
  • Both surgeries may be done in combination with tests that check the lymph nodes near the breast for cancer.
  • Radiation therapy involves a radiation oncologist delivering radiation to the breast to destroy cancer cells. Radiation therapy works within cancer cells to make them unable to multiply. When these cells die, the body naturally eliminates them. Healthy tissue is able to repair itself in a way cancer cells cannot.
  • Chemotherapy is medication prescribed by a medical oncologist to destroy cancer cells that may have traveled elsewhere in the body.
  • Hormonal therapy is medication prescribed by a medical oncologist to block the effects of hormones that may be helping your tumor grow.

External Beam Radiation Therapy

Painless radiation treatments are delivered in a series of sessions Monday through Friday, for five to eight weeks. Each treatment lasts less than 30 minutes.

  • The usual course of radiation treats only the breast, although you may need to have nearby lymph node areas treated also.
  • 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and spare surrounding normal tissue.

Side effects can include fatigue, skin irritation similar to a moderate sunburn, and mild to moderate breast swelling. These changes are temporary and can be treated by skin creams and/or medications. Tell your radiation oncologist or nurse about any discomfort you may feel.

Accelerated Partial Breast Irradiation

External beam radiation therapy over several weeks is the standard of care. In national clinical trials, doctors are studying if accelerated partial breast irradiation (or APBI) — where radiation is delivered to only part of the breast over four to five days — works as well. These techniques are only available in a few clinics and then only to a select group of patients.

  • Breast brachytherapy involves placing flexible plastic tubes called catheters or a balloon into the breast. Twice a day for five days, the catheters or the balloon are connected to a brachytherapy machine, also called a high dose rate afterloader. Your radiation oncologist then directs a special computer to guide a small, radioactive seed into the breast tissue near where the tumor was removed. The radiation is left in place for several minutes. After the end of the five days, the catheters or balloon are removed.
  • 3-D conformal partial breast irradiation is where only part of the breast receives external beam radiation.
  • Intra-operative radiation therapy (IORT) involves doctors delivering radiation to the breast during surgery.

The long-term results of these techniques are still being studied. Talk with your radiation oncologist for more information.

After Mastectomy Radiation

After a mastectomy, your doctor may suggest radiation therapy for the chest wall and nearby lymph node areas.

  • Whether or not radiation therapy should be used after removal of the breast depends on several factors. These factors include the number of lymph nodes involved, tumor size, and whether or not cancer cells were found near the edge of the tissue that was removed.

Many patients who have a mastectomy can safely skip radiation therapy. Ask your doctor for more information.