Cancer Explained

What is cancer?

Cancer is a disease in which the cells in part of a person’s body grow uncontrollably. Although there a many different types of cancer, they all develop as a result of uncontrolled growth of abnormal malignant cells. Normally, cells grow, divide and die in an orderly way. The rates of new cell growth and old cell death are kept in balance. In a healthy person, the cells divide at a rate to repair injuries and to replace depleted or dying cells, while the old and damaged cells self-destruct in a process known as apoptosis.

This normal balance is disrupted during the development of cancer. Cancer cells continue to grow and divide uncontrollably, outliving normal cells and continuing to form new abnormal cells. This increase in cell division generates a growing mass of tissue known as a tumor or neoplasm. As new cells are being produced in greater numbers than needed by the body, the tumor will increase in size. The growth rate of a tumor depends on the rate of cell division. When cells divide rapidly, the tumor will grow quickly and vice versa.

Typically, cancer forms as a tumor. However, not all tumors are malignant. Noncancerous or benign tumors do not spread and are normally not life threatening. Some types of cancer do not involve tumor masses in one place, but are diffused throughout the body. An example is the leukemias, which involve the blood and blood-forming organs.


Frequently, cancer cells travel from the initial tumor to other areas of the body where they begin to grow and replace healthy tissue. There are two main terms used to describe the spread of cancer from its original location:

Invasion. Cancer cells invade neighboring tissues. For example, invasive cancer cells in the breast may penetrate into tissues within or near the breast. Metastasis. Cancer spreads beyond the immediate neighboring area to other body areas. It may penetrate the lymph vessels and blood vessels, enter the bloodstream and invade normal tissue in adjacent and distant areas of the body. The likelihood that cancer will metastasize depends on the type of cancer and its stage. Although each patient’s case is unique, some types of cancer have a tendency to spread to certain areas, including the lungs, bones and brain.

Cancer can develop almost anywhere in the body. Although it may spread to other parts of the body, it is always named for the area where it originated. For example, melanoma (cancer of the cells that produce skin coloring) that spreads to the liver is classified as metastatic melanoma, not liver cancer

Types and differences of cancer

Cancer can develop almost anywhere in the body, and there are many different forms of cancer. The main forms of cancer include:

Carcinomas

Develop from the cells that cover external and internal body surfaces. These are the most common type of cancer. The most common carcinomas to occur in the United States include lung cancer, breast cancer, prostate cancer and colon cancer.

Sarcomas

Develop from cells found in the supporting tissues of the body such as the bone, cartilage, fat, connective tissue and muscle.

Lymphomas

Develop in the lymph nodes and the tissues of the immune system.

Leukemias

Develop in the immature blood cells that grow in the bone marrow and accumulate in the bloodstream.

Myeloma

Develops in the plasma cells of the bone marrow, which normally make gamma globulin, an important immune system defense.

Treatment of Cancer

1

Surgery

Surgery can be used to prevent, treat, stage, and diagnose cancer. In relation to cancer treatment, surgery is done to remove tumors or as much of the cancerous tissue as possible. It is often performed in conjunction with chemotherapy or radiation therapy.

For those whose cancer is not treatable, palliative surgery may be an option to relieve pain that may be caused by the cancer. Palliative surgery is not intended to treat cure the cancer, or even to prolong life, but to lessen discomfort.

2

Chemotherapy

Chemotherapy involves the use of drugs to elimate cancer cells. Unlike surgery, chemotherapy is a type of treatment that affects the entire bosy, not just a specific part. it works by targeting rapidly multiplying cancer cells. Unfortunately, other types of cells in our bodies multiply at high rates, like hair follicle cells and the cells that line our stomachs. This is the cause for side effects like hair loss and stomach upset.

Chemotherapy is most commonly given by pill or intraveiniously (IV), but can be given in other ways. A single type of chemotherapy or drug or a combination of drugs may be prescribed for a sepcific length of time. Like surgery, chemotherapy can be prescribed alone, in conjunction with radiation therapy or biologic therapy.

3

Radiation Therapy

Radiation therapy uses certain types of energy to shrink tumors or eliminate cancer cells. It works by damaging a cancer cell's DNA, making it unable to multiply. Cancer cells are highly sensitive to radiation and typically die when treated. Nearby healthy cells can be damaged as well, but are resilient and are able to fully recover.

Radiation therapy may be given alone, along with chemotherapy, and/or with surgery. The decision to combine radiation therapy with other types of treatment depends on the stage of cancer and other factors.

4

Immunotherapy

Immunotherapy is treatment that uses the body's own immune system to fight cancer. The immune system is stimulated by an outside source, such as an antibody, or synthetic immune system proteins. Immunotherapy is used in select types of cancer and is not available for everyone. Immunotherapy is given in conjunction with other cancer treatments.

Prevention of Cancer

Disease Center

  • Blood in the urine (making the urine slightly rusty to deep red)
  • Pain during urination, and
  • Frequent urination, or feeling the need to urinate without results.
  • Physical exam -- The doctor feels the abdomen and pelvis for tumors. The physical exam may include a rectal or vaginal exam.
  • Urine tests -- The laboratory checks the urine for blood, cancer cells, and other signs of disease.
  • Intravenous pyelogram -- The doctor injects dye into a blood vessel. The dye collects in the urine, making the bladder show up on x-rays.
  • Cystoscopy -- The doctor uses a thin, lighted tube (cystoscope) to look directly into the bladder. The doctor inserts the cystoscope into the bladder through the urethra to examine the lining of the bladder. The patient may need anesthesia for this procedure.

The doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. In many cases, a biopsy is the only sure way to tell whether cancer is present. For a small number of patients, the doctor removes the entire cancerous area during the biopsy. For these patients, bladder cancer is diagnosed and treated in a single procedure.

One of the following types of surgery may be done:

  • Transurethral resection (TUR) with fulguration: Surgery in which a cystoscope (a thin lighted tube) is inserted into the bladder through the urethra. A tool with a small wire loop on the end is then used to remove the cancer or to burn the tumor away with high-energy electricity. This is known as fulguration.
  • Radical cystectomy: Surgery to remove the bladder and any lymph nodes and nearby organs that contain cancer. This surgery may be done when the bladder cancer invades the muscle wall, or when superficial cancer involves a large part of the bladder. In men, the nearby organs that are removed are the prostate and the seminal vesicles. In women, the uterus, the ovaries, and part of the vagina are removed. Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, surgery to remove only the bladder may be done to reduce urinary symptoms caused by the cancer. When the bladder must be removed, the surgeon creates another way for urine to leave the body.
  • Segmental cystectomy: Surgery to remove part of the bladder. This surgery may be done for patients who have a low-grade tumor that has invaded the wall of the bladder but is limited to one area of the bladder. Because only a part of the bladder is removed, patients are able to urinate normally after recovering from this surgery.
  • Urinary diversion: Surgery to make a new way for the body to store and pass urine.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Bladder cancer may be treated with intravesical (into the bladder through a tube inserted into the urethra) chemotherapy. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
  • Common symptoms of breast cancer include:
  • A change in how the breast or nipple feels
  • A lump or thickening in or near the breast or in the underarm area
  • Nipple tenderness
  • A change in how the breast or nipple looks
  • A change in the size or shape of the breast
  • A nipple turned inward into the breast
  • The skin of the breast, areola, or nipple may be scaly, red, or swollen. It may have ridges or pitting so that it looks like the skin of an orange.
  • Nipple discharge (fluid)

Your doctor may ask about your personal and family medical history. You may have a physical exam. Your doctor also may order a mammogram or other imaging procedure such as Ultrasound or Magnetic Resonance Imaging. These tests make pictures of tissues inside the breast. After the tests, your doctor may decide no other exams are needed. Your doctor may suggest that you have a follow-up exam later on. Or you may need to have a biopsy to look for cancer cells.

Doctors can remove tissue from the breast in different ways:

  • Fine-needle aspiration: Your doctor uses a thin needle to remove fluid from a breast lump. If the fluid appears to contain cells, a pathologist at a lab checks them for cancer with a microscope. If the fluid is clear, it may not need to be checked by a lab.
  • Core biopsy: Your doctor uses a thick needle to remove breast tissue. A pathologist checks for cancer cells. This procedure is also called a needle biopsy.
  • Surgical biopsy: Your surgeon removes a sample of tissue. A pathologist checks the tissue for cancer cells.
  • An incisional biopsy takes a sample of a lump or abnormal area.
  • An excisional biopsy takes the entire lump or area.
Surgery

Surgery is the most common treatment for breast cancer. There are several types of surgery.

  • Breast-sparing surgery: An operation to remove the cancer but not the breast is breast-sparing surgery. It is also called breast-conserving surgery, lumpectomy, segmental mastectomy, and partial mastectomy. Sometimes an excisional biopsy serves as a lumpectomy because the surgeon removes the whole lump.

The surgeon often removes the underarm lymph nodes as well. A separate incision is made. This procedure is called an axillary lymph node dissection. It shows whether cancer cells have entered the lymphatic system.

  • Mastectomy: An operation to remove the breast (or as much of the breast tissue as possible) is a mastectomy. In most cases, the surgeon also removes lymph nodes under the arm. Some women have radiation therapy after surgery.

Sentinel lymph node biopsy is a new method of checking for cancer cells in the lymph nodes. A surgeon removes fewer lymph nodes, which causes fewer side effects. (If the doctor finds cancer cells in the axillary lymph nodes, an axillary lymph node dissection usually is done.)

Doctors use two types of radiation therapy to treat breast cancer. Some women receive both types:

  • External radiation: The radiation comes from a large machine outside the body. Most women go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks.
  • Internal radiation (implant radiation): Thin plastic tubes (implants) that hold a radioactive substance are put directly in the breast. The implants stay in place for several days. A woman stays in the hospital while she has implants. Doctors remove the implants before she goes home.

Chemotherapy uses anticancer drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. The drugs may be given as a pill or by injection into a vein (IV). Either way, the drugs enter the bloodstream and travel throughout the body.

Some breast tumors need hormones to grow. Hormone therapy keeps cancer cells from getting or using the natural hormones they need. These hormones are estrogen and progesterone. Lab tests can show if a breast tumor has hormone receptors. If you have this kind of tumor, you may have hormone therapy.

This treatment uses drugs or surgery:

  • Drugs: Your doctor may suggest a drug that can block the natural hormone. One drug is tamoxifen, which blocks estrogen. Another type of drug prevents the body from making the female hormone estradiol. Estradiol is a form of estrogen. This type of drug is an aromataseinhibitor. If you have not gone through menopause, your doctor may give you a drug that stops the ovaries from making estrogen.
  • Surgery: If you have not gone through menopause, you may have surgery to remove your ovaries. The ovaries are the main source of the body's estrogen. A woman who has gone through menopause does not need surgery. (The ovaries produce less estrogen after menopause.)

Some women with breast cancer that has spread receive a biological therapy called trastuzumab. It is a monoclonal antibody. It is made in the laboratory and binds to cancer cells.

Trastuzumab is given to women whose lab tests show that a breast tumor has too much of a specific protein known as HER2

A common symptom of colorectal cancer is a change in bowel habits. Symptoms include:

  • Having diarrhea or constipation
  • Feeling that your bowel does not empty completely
  • Finding blood (either bright red or very dark) in your stool
  • Finding your stools are narrower than usual
  • Frequently having gas pains or cramps, or feeling full or bloated
  • Losing weight with no known reason
  • Feeling very tired all the time
  • Having nausea or vomiting

If your physical exam and test results do not suggest cancer, your doctor may decide that no further tests are needed and no treatment is necessary. However, your doctor may recommend a schedule for checkups. If tests show an abnormal area (such as a polyp), a biopsy to check for cancer cells may be necessary. Often, the abnormal tissue can be removed during colonoscopy or sigmoidoscopy. A pathologist checks the tissue for cancer cells using a microscope.

Surgery

Surgery is the most common treatment for colorectal cancer.

  • Colonoscopy: A small malignant polyp may be removed from your colon or upper rectum with a colonoscope. Some small tumors in the lower rectum can be removed through your anus without a colonoscope.
  • Laparoscopy: Early colon cancer may be removed with the aid of a thin, lighted tube (laparoscope). Three or four tiny cuts are made into your abdomen. The surgeon sees inside your abdomen with the laparoscope. The tumor and part of the healthy colon are removed. Nearby lymph nodes also may be removed. The surgeon checks the rest of your intestine and your liver to see if the cancer has spread.
  • Open surgery: The surgeon makes a large cut into your abdomen to remove the tumor and part of the healthy colon or rectum. Some nearby lymph nodes are also removed. The surgeon checks the rest of your intestine and your liver to see if the cancer has spread.

When a section of your colon or rectum is removed, the surgeon can usually reconnect the healthy parts. However, sometimes reconnection is not possible. In this case, the surgeon creates a new path for waste to leave your body. The surgeon makes an opening (stoma) in the wall of the abdomen, connects the upper end of the intestine to the stoma, and closes the other end. The operation to create the stoma is called a colostomy. A flat bag fits over the stoma to collect waste, and a special adhesive holds it in place.

For most people, the stoma is temporary. It is needed only until the colon or rectum heals from surgery. After healing takes place, the surgeon reconnects the parts of the intestine and closes the stoma. Some people, especially those with a tumor in the lower rectum, need a permanent stoma.

Chemotherapy for colorectal cancer can cause the skin on the palms of the hands and bottoms of the feet to become red and painful. The skin may peel off.

Your health care team can suggest ways to control many of these side effects. Most side effects usually go away after treatment ends.

Doctors use two types of radiation therapy to treat breast cancer. Some women receive both types:

  • External radiation: The radiation comes from a large machine outside the body. Most women go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks.
  • Internal radiation (implant radiation): Thin plastic tubes (implants) that hold a radioactive substance are put directly in the breast. The implants stay in place for several days. A woman stays in the hospital while she has implants. Doctors remove the implants before she goes home.

Some people with colorectal cancer that has spread receive a monoclonal antibody, a type of biological therapy. The monoclonal antibodies bind to colorectal cancer cells. They interfere with cancer cell growth and the spread of cancer. People receive monoclonal antibodies through a vein.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area.

Doctors use different types of radiation therapy to treat cancer. Sometimes people receive two types:

  • External radiation: The radiation comes from a machine. The most common type of machine used for radiation therapy is called a linear accelerator. Most patients go to the hospital or clinic for their treatment, generally 5 days a week for several weeks.
  • Internal radiation (implant radiation or brachytherapy): The radiation comes from radioactive material placed in thin tubes put directly into or near the tumor. The patient stays in the hospital, and the implants generally remain in place for several days. Usually they are removed before the patient goes home.

(IORT): In some cases, radiation is given during surgery

Common symptoms of kidney cancer include:

  • Blood in the urine (making the urine slightly rusty to deep red)
  • Pain in the side that does not go away
  • A lump or mass in the side or the abdomen
  • Weight loss
  • Fever
  • Feeling very tired or having a general feeling of poor health

Physical exam: The doctor checks general signs of health and tests for fever and high blood pressure. The doctor also feels the abdomen and side for tumors.

  • Urine tests: Urine is checked for blood and other signs of disease.
  • Blood tests: The lab checks the blood to see how well the kidneys are working. The lab may check the level of several substances, such as creatinine. A high level of creatinine may mean the kidneys are not doing their job.
  • Intravenous pyelogram (IVP): The doctor injects dye into a vein in the arm. The dye travels through the body and collects in the kidneys. The dye makes them show up on x-rays. A series of x-rays then tracks the dye as it moves through the kidneys to the ureters and bladder. The x-rays can show a kidney tumor or other problems.
  • CT scan (CAT scan): An x-ray machine linked to a computer takes a series of detailed pictures of the kidneys. The patient may receive an injection of dye so the kidneys show up clearly in the pictures. A CT scan can show a kidney tumor.
  • Ultrasoundtest: The ultrasound device uses sound waves that people cannot hear. The waves bounce off the kidneys, and a computer uses the echoes to create a picture called a sonogram. A solid tumor or cyst shows up on a sonogram.
  • Biopsy: In some cases, the doctor may do a biopsy. A biopsy is the removal of tissue to look for cancer cells. The doctor inserts a thin needle through the skin into the kidney to remove a small amount of tissue. The doctor may use ultrasound or x-rays to guide the needle. A pathologist uses a microscope to look for cancer cells in the tissue.
  • Surgery: In most cases, based on the results of the CT scan, ultrasound, and x-rays, the doctor has enough information to recommend surgery to remove part or all of the kidney. A pathologist makes the final diagnosis by examining the tissue under a microscope.

Surgery is the most common treatment for kidney cancer. It is a type of local therapy. It treats cancer in the kidney and the area close to the tumor.

An operation to remove the kidney is called a nephrectomy. There are several types of nephrectomies. The type depends mainly on the stage of the tumor. The doctor can explain each operation and discuss which is most suitable for the patient:

Radical nephrectomy: Kidney cancer is usually treated with radical nephrectomy. The surgeon removes the entire kidney along with the adrenal gland and some tissue around the kidney. Some lymph nodes in the area also may be removed.

  • Simple nephrectomy: The surgeon removes only the kidney.
  • Partial nephrectomy: The surgeon removes only the part of the kidney that contains the tumor. This type of surgery may be used when the person has only one kidney, or when the cancer affects both kidneys. Also, a person with a small kidney tumor (less than 4 centimeters or three-quarters of an inch) may have this type of surgery.

Arterial embolization is a type of local therapy that shrinks the tumor. Sometimes it is done before an operation to make surgery easier. When surgery is not possible, embolization may be used to help relieve the symptoms of kidney cancer.

The doctor inserts a narrow tube (catheter) into a blood vessel in the leg. The tube is passed up to the main blood vessel (renalartery) that supplies blood to the kidney. The doctor injects a substance into the blood vessel to block the flow of blood into the kidney. The blockage prevents the tumor from getting oxygen and other substances it needs to grow.

Radiation therapy (also called radiotherapy) is another type of local therapy. It uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area. A large machine directs radiation at the body. The patient has treatment at the hospital or clinic, 5 days a week for several weeks.

A small number of patients have radiation therapy before surgery to shrink the tumor. Some have it after surgery to kill cancer cells that may remain in the area. People who cannot have surgery may have radiation therapy to relieve pain and other problems caused by the cancer.

Biological therapy is a type of systemic therapy. It uses substances that travel through the bloodstream, reaching and affecting cells all over the body. Biological therapy uses the body's natural ability (immune system) to fight cancer.

For patients with metastatic kidney cancer, the doctor may suggest interferon alpha or interleukin-2 (also called IL-2 ). The body normally produces these substances in small amounts in response to infections and other diseases. For cancer treatment, they are made in the laboratory in large amounts.

Some people with colorectal cancer that has spread receive a monoclonal antibody, a type of biological therapy. The monoclonal antibodies bind to colorectal cancer cells. They interfere with cancer cell growth and the spread of cancer. People receive monoclonal antibodies through a vein.

Chemotherapy is also a type of systemic therapy. Anticancer drugs enter the bloodstream and travel throughout the body. Although useful for many other cancers, anticancer drugs have shown limited use against kidney cancer.

Early lung cancer often does not cause symptoms. But as the cancer grows, common symptoms may include:

  • a cough that gets worse or does not go away
  • breathing trouble, such as shortness of breath
  • constant chest pain
  • coughing up blood
  • a hoarse voice
  • frequent lung infections, such as pneumonia
  • feeling very tired all the time
  • weight loss with no known cause
  • Physical exam: Your doctor checks for general signs of health, listens to your breathing, and checks for fluid in the lungs. Your doctor may feel for swollen lymph nodes and a swollen liver.
  • Chest x-ray: X-ray pictures of your chest may show tumors or abnormal fluid.
  • CT scan: Doctors often use CT scans to take pictures of tissue inside the chest. An x-ray machine linked to a computer takes several pictures. For a spiral CT scan, the CT scanner rotates around you as you lie on a table. The table passes through the center of the scanner. The pictures may show a tumor, abnormal fluid, or swollen lymph nodes

The only sure way to know if lung cancer is present is for a pathologist to check samples of cells or tissue.

Your doctor may order one or more of the following tests to collect samples:

  • Sputum cytology: Thick fluid (sputum) is coughed up from the lungs. The lab checks samples of sputum for cancer cells.
  • Thoracentesis: The doctor uses a long needle to remove fluid (pleural fluid) from the chest. The lab checks the fluid for cancer cells.
  • Bronchoscopy: The doctor inserts a thin, lighted tube (a bronchoscope) through the nose or mouth into the lung. This allows an exam of the lungs and the air passages that lead to them. The doctor may take a sample of cells with a needle, brush, or other tool. The doctor also may wash the area with water to collect cells in the water.
  • Fine-needle aspiration: The doctor uses a thin needle to remove tissue or fluid from the lung or lymph node. Sometimes the doctor uses a CT scan or other imaging method to guide the needle to a lung tumor or lymph node.
  • Thoracoscopy: The surgeon makes several small incisions in your chest and back. The surgeon looks at the lungs and nearby tissues with a thin, lighted tube. If an abnormal area is seen, a biopsy to check for cancer cells may be needed.
  • Thoracotomy: The surgeon opens the chest with a long incision. Lymph nodes and other tissue may be removed.
  • Mediastinoscopy: The surgeon makes an incision at the top of the breastbone. A thin, lighted tube is used to see inside the chest. The surgeon may take tissue and lymph node samples.

Surgery for lung cancer removes the tissue that contains the tumor. The surgeon also removes nearby lymph nodes.

The surgeon removes part or all of the lung:

  • A small part of the lung (wedge resection or segmentectomy): The surgeon removes the tumor and a small part of the lung.
  • A lobe of the lung (lobectomy or sleeve lobectomy): The surgeon removes a lobe of the lung. This is the most common surgery for lung cancer.
  • All of the lung (pneumonectomy): The surgeon removes the entire lung.

After lung surgery, air and fluid collect in the chest. A chest tube allows the fluid to drain. Also, a nurse or respiratory therapist will teach you coughing and breathing exercises. You'll need to do the exercises several times a day.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area. You may receive external radiation. This is the most common type of radiation therapy for lung cancer. The radiation comes from a large machine outside your body. Most people go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks.

The side effects depend mainly on the type of radiation therapy, the dose of radiation, and the part of your body that is treated. External radiation therapy to the chest may harm the esophagus, causing problems with swallowing. You may also feel very tired. In addition, your skin in the treated area may become red, dry, and tender. After internal radiation therapy, a person may cough up small amounts of blood.

Chemotherapy is given in cycles. You have a rest period after each treatment period. The length of the rest period and the number of cycles depend on the anticancer drugs used.

Targeted therapy uses drugs to block the growth and spread of cancer cells. The drugs enter the bloodstream and can affect cancer cells all over the body. Some people with non-small cell lung cancer that has spread receive targeted therapy.

A man with prostate cancer may not have any symptoms. For men who have symptoms of prostate cancer, common symptoms include:

  • Urinary problems
  • Not being able to urinate
  • Having a hard time starting or stopping the urine flow
  • Needing to urinate often, especially at night
  • Weak flow of urine
  • Urine flow that starts and stops
  • Pain or burning during urination
  • Difficulty having an erection
  • Blood in the urine or semen
  • Frequent pain in the lower back, hips, or upper thighs

Your doctor will ask about your personal and family medical history. You will have a physical exam. You may have lab tests. Your visit may include a digital rectal exam, a urine test to check for blood or infection, and a blood test to measure PSA level.

You also may have other exams:

  • Transrectal ultrasound: The doctor inserts a probe into the man's rectum to check for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.
  • Cystoscopy: The doctor uses a thin, lighted tube to look into the urethra and bladder.
  • Transrectal biopsy: A biopsy is the removal of tissue to look for cancer cells. It is the only sure way to diagnose prostate cancer. The doctor inserts a needle through the rectum into the prostate. The doctor takes small tissue samples from many areas of the prostate. Ultrasound may be used to guide the needle. A pathologist checks for cancer cells in the tissue.

Surgery is a common treatment for early stage prostate cancer. Your doctor may remove the whole prostate or only part of it. In some cases, your doctor can use a method known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. But if you have a large tumor or a tumor that is very close to the nerves, you may not be able to have this surgery.

Each type of surgery has benefits and risks. Your doctor can further describe these types:

  • Radical retropubic prostatectomy: The doctor removes the entire prostate and nearby lymph nodes through an incision (cut) in the abdomen.
  • Radical perineal prostatectomy: The doctor removes the entire prostate through a cut between the scrotum and the anus. Nearby lymph nodes may be removed through a separate cut in the abdomen.
  • Laparoscopic prostatectomy: The doctor removes the entire prostate and nearby lymph nodes through small incisions, rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) is used to help remove the prostate.
  • Transurethral resection of the prostate (TURP): The doctor removes part of the prostate with a long, thin device that is inserted through the urethra. The cancer is cut from the prostate. TURP may not remove all of the cancer. But it can remove tissue that blocks the flow of urine.
  • Pelvic lymphadenectomy: This is routinely done during prostatectomy. The doctor removes lymph nodes in the pelvis to see if cancer has spread to them. If there are cancer cells in the lymph nodes, the disease may have spread to other parts of the body. In this case, the doctor may suggest other types of treatment.

After surgery, the urethra needs time to heal. You will have a catheter. A catheter is a tube put through the urethra into the bladder to drain urine. You will have the catheter for 5 days to 3 weeks. Your nurse or doctor will show you how to care for it.

Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:

  • External radiation: The radiation comes from a large machine outside the body. Men go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks. Many men receive 3-dimensional conformal radiation therapy. This type of treatment more closely targets the cancer. It spares healthy tissue.
  • Internal radiation (implant radiation therapy or brachytherapy): The radiation comes from radioactive material usually contained in small seeds. The seeds are put into the tissue. They give off radiation for months. The seeds are harmless and do not need to be removed

Hormone therapy keeps prostate cancer cells from getting the male hormones (androgens) they need to grow. The testicles are the body's main source of the male hormone testosterone. The adrenal gland makes a small amount of testosterone.

Hormone treatment uses drugs or surgery:

  • Drugs: Your doctor may suggest a drug that can block natural hormones.
  • Luteinizing hormone-releasing hormone (LH-RH) agonists: These drugs can prevent the testicles from making testosterone. Examples are leuprolide and goserelin.
  • Antiandrogens: These drugs can block the action of male hormones. Examples are flutamide, bicalutamide, and nilutamide.
  • Other drugs: Some drugs can prevent the adrenal gland from making testosterone. Examples are ketoconazole and aminoglutethimide.
  • Surgery: Surgery to remove the testicles is called orchiectomy