Cancer Basics

This page contains a collection of what we call "cancer basics". These began life as short articles published in our regular newsletter "Progress".

Following a number of email requests for information, we decided that a collection specially designed for the website would help people looking for general information. They are designed to be simple, straightforward and written in layman's terms. It is our hope that you find the information useful and informative. The short articles are not intended to be exhaustive in nature but are designed as a starting point should you wish to know more about any given topic. More information can be found in our document library.

We would be delighted to receive your feedback on these short articles. If you have any comments on them, please email us at aicr@aicr.org.uk
Cancer Basics

* What is cancer?

* All living things - ourselves included - are made up of cells. Cells are microscopic packages of living material and we have billions of them. They come in many different types: liver cells, brain cells, blood cells and so on. In the normal adult, cells only grow and divide slowly and under very tight control to make sure that the number of cells in each tissue stays the same. Cancer begins when one cells changes and starts growing and dividing rapidly and out of control. This one cells divides to give two cells, then four, eight and so on until they form growing mass of cancer cells - called a tumour.

* What do malignant and benign mean?

* In some tumours, the cells stay in the same place and as the tumour stops growing before it gets very large - often because it simply runs out space to grow. These are called benign tumours and they are not normally dangerous. We all have benign tumours, such as moles and warts. However, in other tumours the cells are able to invade the surrounding tissue and spread into nearby organs where they can cause serious and, eventually, fatal damage. These are called malignant tumours.

* What is metastasis?

* In many malignant tumours, as the cells spread, they come across blood vessels. If they actually spread into the blood vessel, they get carried around the body and eventually get stuck in a smaller blood vessel in another part of the body. Here they begin to divide and grow again eventually forming a new tumour. These are called secondary tumours or metastases. This process of cancers spreading around the body is called metastasis.

* Do genes cause cancer?

* Every cell carries a set of coded instructions for every activity or function that it can perform. Different genes are active in different cells, which is why a brain cell carries out many different activities from muscle cell. Genes also carry the coded instructions for basic functions of the cell such as the way cells grow and divide. The growth and division of normal cells is tightly controlled by the activity of certain genes. However, when these genes are faulty or when they mechanisms controlling the activity of these genes is damaged, it can cause the growth and division of the cells to go out of control - in other words, the become cancerous. Genes themselves do not cause cancer. When they function normally, genes prevent cancer. However, it is when some genes become damaged that they can malfunction and cause cancer.

* Can you inherit cancer?

* Cancer itself cannot be inherited, but some people do inherit a higher risk of getting cancer. This is because they inherit, from their parents, a slightly damaged version of one of the genes involved in controlling cell division. On its own, this damaged gene is not enough to make cells cancerous. Normally, two or three different genes have to be damaged before a cell will become cancerous. That is why so very few of the billions of cells in our body ever become cancerous. However, if someone starts out with every cell in their body carrying damage in one of these genes, the chance of a cell getting the other types of gene damage and becoming cancerous is much higher. Some of these inherited damaged genes have been identified, such as BRCA1 and BRCA2 which increase the risk of getting breast cancer by five to seven times.

* Do tumours need a blood supply?

* A tumour usually starts with a single cancerous cell that begins growing and dividing. The resulting mass of cancer cells soon gets large enough to need a new blood supply to provide oxygen and nutrients and to remove waste products. Without a blood supply, the cells in the middle of the tumour will die off. In fact, tumours without a blood supply are unable to grow more that about one millimetre across. As soon as they start growing, tumours release small, hormone-like molecules that cause nearby blood vessels to start growing towards the tumour until they actually form a new branch supplying the tumour with blood.

Prostate Cancer FAQs

Many people are confused about the prostate. Where is it situated? What are the symptoms of prostate cancer? What treatments are available? To help better understand this important issue, we have compiled these Frequently Asked Questions.


Q. What is the prostate?

A. The prostate is a small gland located underneath the bladder in men. It is shaped like a doughnut and fits around the tube (called the urethra) which carries urine out of the bladder. The prostate produces the fluid that mixes with sperm when a man ejaculates.


Q. What is prostate cancer?

A. Prostate cancer is a very variable disease. Some tumours remain small and grow so slowly that they cause no problems and often remain undetected for decades; others are aggressive, grow quickly and become life-threatening. Many of these aggressive cases spread to the bones, where they cause severe pain.


Q. How common is prostate cancer?

A. Prostate cancer is now the most commonly diagnosed cancer in men in many western countries. Currently there are 35,000 new cases a year in the UK; 220,000 in the USA; 22,000 in Canada and 14,000 new cases a year in Australia. The number of recorded cases has increased a lot in recent years. This is partly due to the increased use of the PSA test, which has resulted in more cases being detected, and partly due to the fact that men are living longer. Like most cancers, prostate cancer is more common in the elderly.


Q. What are the symptoms of prostate cancer?

A. The main symptoms are: difficulty passing urine, inability to urinate, passing urine often (particularly at night), weak or interrupted urine flow, pain when urinating, blood in the urine and pain in the lower back, hips and upper thighs. However, all of these symptoms can also be caused by other conditions such as benign prostate enlargement. Men with any of these symptoms should consult their doctor.


Risk Factors


Q. What causes prostate cancer?

A. In most cases, we do not yet know the cause of prostate cancer. Exposure to high levels of radiation is one known cause, but this only accounts for a tiny proportion of cases. However, between 5% and 10% of cases run in families, where the patient inherits a high risk of this type of cancer.


Q. Which men are at risk?

A. Prostate cancer is very rare in men under 50. The risk increases after the age of 50 with half of all cases occurring in men over 75. Men from families with a history of prostate cancer are at higher risk than normal.


Q. Is diet linked to prostate cancer?

A. Some evidence suggests that a low-fat diet can reduce the risk of prostate cancer. Other studies have suggested that a diet high in tomatoes, Vitamin E, cruciform vegetables (such as broccoli, cabbage, cauliflower and brussel sprouts) and selenium can also reduce your risk. However, apart from selenium (see below), these findings have not been confirmed.


Q. Will a vasectomy increase the risk of prostate cancer?

A. It was thought that a vasectomy increased the risk of getting this cancer, but more recent research has suggested that there is no real difference in risk between men who have had a vasectomy and those who have not.


Q. Can prostate cancer be prevented?

A. Although there is no known way of preventing prostate cancer, studies have shown that men who took 200 microgrammes of selenium each day substantially reduced their risk of prostate cancer.


Q. Does prostate cancer run in families?

A. Some families have a higher risk of prostate cancer than others. The normal risk of getting prostate cancer some time in your life is 1 in 13. Having one or more close relatives (father or brother) who got prostate cancer under the age of 70 increases your risk by two or three times (ie your lifetime risk is between 1 in 7 and 1 in 4).
Testing / Screening


Q. Is early diagnosis important?

A. If prostate cancer is diagnosed early, it can be treated very successfully. However, when the cancer is advanced, it becomes very difficult to cure. All men over 50 should be aware of the warning signs and take themselves to their doctor.


Q. What tests can be used to detect prostate cancer?

A. A number of different tests are used to help diagnose prostate cancer:

* Digital rectal examination - by inserting a gloved finger into the back passage your doctor can actually feel the prostate gland, to find out whether it has any lumps or is larger than it should be. Even if it is enlarged, this does not mean that it is cancerous.
* PSA blood test - if the level of Prostate Specific Antigen (PSA) in your blood is too high, this suggests that there is a prostate cancer, but there are several other conditions which cause an increase in blood PSA levels.
* Ultrasound - a small probe is inserted into the back passage and used to do an ultrasound scan, showing the exact size of the prostate.

However, the definitive test is done by taking a biopsy. This involves taking a tiny sample of tissue from the prostate. A probe is inserted into the back passage and a small hollow needle jabbed into the prostate itself. Studying the tissue sample taken by the needle can determine whether there is a tumour and how aggressive it is. If a tumour is found, an x-ray can reveal whether there is any cancer which has spread to the bones near the prostate.


Q. Who should have a PSA test?

A. We recommend that men over 50 should have a PSA test every 2 years, along with information about what the result may mean. It is important to understand that a raised PSA level does not specifically indicate prostate cancer because there are several more common conditions that cause an increased PSA level. Overall, 2 out of every 3 men found to have a raised PSA will not have prostate cancer. Also, about one third of men with prostate cancer do not have elevated PSA levels. However, regular PSA testing can give an indication of whether further testing is advisable.


Q. Is there prostate cancer screening?

A. At the moment, routine screening for prostate cancer is not carried out in any country, because there is no firm evidence that it would save lives. However, two large research studies are currently being conducted to find out if routine screening of men over 50 with the PSA test results in a reduction in the death rate from this cancer.


Q. Can prostate cancer be cured?

A. In half or more of patients the cancer is detected at an early stage and treatment is successful for nine out of ten of these cases. The other half of the patients are not diagnosed until the cancer is advanced and has spread. Treatment can give these patients several extra years of life and stop the pain of the disease, but cannot normally cure them.


Treatment


Q. What treatments are available for prostate cancer?

A. Sometimes prostate cancers are so slow growing that no treatment is needed. ‘Watchful waiting’ is used in these cases, with regular monitoring of the patient to find out if the cancer changes. However, when treatment is necessary, there are four main types used:

* Surgery - in an operation called a prostatectomy, the whole prostate gland is removed.
* Radiotherapy - in radiation treatment, high energy rays kill the cancer cells. This will destroy the original tumour and also reduces the pain caused by tumour cells which have spread to the bones.
* Brachytherapy - this is a newer type of radiotherapy in which small radioactive pellets or wires are inserted directly into the tumour, killing it from the inside. This is at least as effective as the other treatments.
* Hormone therapy - since the growth and division of the prostate cancer cells depends on androgens (the male hormones), drugs can be used to either reduce the level of androgens produced by the body or block the effect of androgens on the cancer cells. These stop the growth of the tumour and sometimes shrink it. However, after a while (anything between 3 and 20 years), most prostate cancers develop the ability to grow without androgens and the hormone therapy stops working.


Q. What newer treatments are available?

A. Cryotherapy (inserting a metal probe into the prostate tumour which freezes the tissue and kills the cells) and High Intensity Focused Ultrasound of HIFU (which causes localised heating inside the tumour that kills the cells) are available in some cancer hospitals. Although both of these treatments appear to be as effective in the short term as surgery or radiotherapy, their long-term effectiveness is not yet known.


Q. What are the side-effects of prostate cancer treatment?

A. The treatments for prostate cancer carry a significant risk of side-effects, both long-term and short-term. After a prostatectomy operation there is a high risk of impotence and a small risk of urinary incontinence. Radiotherapy carries a similar risk of impotence but has a smaller risk of incontinence. Brachytherapy appears to have a lower risk of impotence. Almost all patients receiving hormone therapy experience impotence during the course of the treatment. Hot flushes, tiredness and weight gain are also common, but all side-effects cease when the treatment stops. The levels of side-effects reported for cryotherapy and HIFU varies a lot, but appears to be similar to radiotherapy or surgery.

The good news is prostate cancer need not be a death sentence. Early diagnosis is so important and there is a great deal all men can do to safeguard their health.

Breast Cancer FAQs

The survival rate for Breast Cancer has risen dramatically over the last 20 years. With increased education and research, we trust this trend will continue.


Q. How common is breast cancer?

A. There are over 212,000 cases of breast cancer diagnosed in the USA each year. In Canada the figure is 20,500, Australia 13,000 and in the UK the figure is 41,000. Overall, one woman in every nine will get breast cancer at some time in her life.


Q. Who is most at risk?

A. Breast cancer is overwhelmingly a female disease, but about 1% of cases occur in men (around 300 per year in the UK). Amongst women it becomes more common as age increases. More than 80% of cases occur in women over 50. Taking the contraceptive pill slightly increases the risk. Taking hormone replacement therapy significantly increases your risk somewhat more, but the health benefits derived from hormone replacement are better overall. Obesity and heavy drinking also significantly increase the risk.
If one or more relatives have had breast cancer, this also increases your risk of developing it (see below).


Q. Does breast cancer run in families?

A. Having one close relative (mother or sister) with breast cancer doubles your risk of getting breast cancer, when compared to women with no cases in the family. Having two close relatives affected increases your risk further.
There are a very few families in which breast cancer is very common - ie four or more cases. Most of these families carry faulty versions of the 'BRCA' breast cancer genes. Women with a faulty BRCA gene have a 50% to 80% chance of getting breast cancer. Testing for faulty BRCA genes is available on the NHS.


Q. Is the use of deodorants linked to breast cancer?

A. There has been a persistent internet rumour that underarm deodorants cause breast cancer and even one or two newspaper articles that suggested this was backed up by research findings. However, there is no good evidence from cancer research to support this idea. On the contrary: in a large study comparing breast cancer patients and healthy women, there was no difference found at all in their use of underarm deodorants.


Q. Are there different types of breast cancer?

A. There are two main places in the breast where cancer can occur: the lobules (the milk-producing tissue) and the ducts (which carry the milk to the nipple).
* Ductal carcinoma in situ means an early cancer in the milk ducts. It can be detected by mammograms and is normally easy to cure.
* Invasive ductal carcinoma means a cancer that started in the milk ducts but has now spread beyond them.
* Lobular carcinoma in situ is not considered to be cancer. It is a pre-cancerous condition. Most women with lobular carcinoma in situ do not get breast cancer, but they have an increased risk of getting it, so they are given frequent checkups.
* Invasive lobular carcinoma is a cancer that starts in the lobules and has spread. These can be difficult to diagnose as they do not always form a lump or show up on mammograms.


Q. What are the symptoms of Breast Cancer?

A. Screening for breast cancer by mammography (X-raying the breast) is offered every three years in the UK to all women between 50 and 64. The highest number of cases of breast cancer occurs in women between these ages.
Mammography can detect very early breast tumours, when they are too small to be felt. In fact, most of the breast cancers detected by screening are at this very early stage, when they are relatively easy to cure. Studies have shown that women who take part in screening are more likely to have breast cancer diagnosed early and more likely to have it cured and, as a result, are less likely to die from it, than women who do not take part in mammography screening.
Another method of screening available to all women is to feel the breasts for any lumps. A guide on how to do this properly can be obtained at any doctor's surgery. Women should also check for the other main symptoms:
* Change in the size or shape of a breast
* Dimpling of the breast skin
* The nipple becoming inverted
* Swelling or a lump in the armpit


Diagnosis

The most important method used to diagnose breast cancer is by taking a biopsy (a tissue sample). A hollow needle is pushed into the breast lump to capture a tiny sample of the tissue. This is examined under a microscope. The shape and appearance of the cells in the tissue sample reveals whether the lump is benign, which is true of the vast majority, or if it is cancerous.


Q. How important is early detection?

A. We can currently cure six out of every seven patients who are diagnosed when their breast cancer is at the early stage. However, if they are diagnosed when it has become advanced, the cure rate falls to about one in seven. It is extremely important to catch breast cancer at an early stage.


Treatment

The main treatment for breast cancer is surgery. In most cases, conservative surgery is used, which preserves the shape and appearance of the breast. For very early breast cancer, only the lump and a small area of tissue around it is removed. For later stage breast cancer, much more tissue is removed but it is replaced with muscle to rebuild the breast. Since breast cancer cells usually spread first to the lymph node in the armpit, the surgeon will usually cut into it to check for any spread.
The surgery may be followed by a short course of radiotherapy or chemotherapy, depending on the type of tumour and how advanced it is. In most cases, the patient will be given a longer course of hormone therapy (eg tamoxifen) which reduces the risk of the cancer recurring.
The treatment for breast cancer has been improving for the last twenty years. In the early 1970's, only half of all women diagnosed with the disease survived for five years. Now, over three quarters survive for that long and most of them will live for very much longer.

Lung Cancer FAQs

Lung cancer is one of the most common types of cancer in the developed world. Here are some frequently asked questions about the symptoms, causes and treatment of the disease.


Q. What causes lung cancer?

A. The vast majority - over 80% - of lung cancers are caused by smoking tobacco or by indirect exposure to tobacco smoke (passive smoking). The other main causes are breathing industrial chemicals such as asbestos, arsenic and polycyclic hydrocarbons or the natural radioactive gas, radon.


Q. Who is at risk?

A. Like most cancers, the risk of lung cancer increases with age. The longer you smoke, the greater your risk. Very few cases are diagnosed in people under 40 and the most common age of diagnosis is between 70 and 74. In the US 91,000 men and 79,000 women are diagnosed with lung cancer each year. In the UK the figures are 23,000 men and 15,000 women.


Q. Does lung cancer run in families?

A. There are very few, if any, inherited conditions that increase the risk of lung cancer in non-smokers. However, not all of the people who smoke get lung cancer and there may be an inherited component which influences whether or not smoking will cause lung cancer.


Q. Does diet affect the risk of getting lung cancer?

A. This is still being investigated, but research to date has not found any link between diet and lung cancer.


Q. Are there different types of lung cancer?

A. There are four main types of lung cancer: small cell lung cancer, squamous cell carcinoma, large cell carcinoma and adenocarcinoma. Tobacco smoking is strongly linked to the first three but only weakly linked to adenocarcinoma. However, this type of lung cancer has been linked to the use of low-tar cigarettes.


Q. What are the symptoms of lung cancer?

A. There are a variety of symptoms of lung cancer, including difficulty breathing, coughing up blood, chest pain, loss of appetite, weight loss and general fatigue. Some lung cancers do not cause any noticeable symptoms until they are quite advanced and have spread to other parts of the body.


Q. How is lung cancer diagnosed?

A. Lung cancers are sometimes first detected on routine chest X-rays. However, the main method of diagnosis is bronchoscopy, in which a thin, flexible tube is inserted down the airways (under anaesthetic), allowing doctors to see the inside of the lungs and even take a biopsy (a sample small of the suspect tissue). A CT scan, liver ultrasound or bone scan may also be used to find out if the cancer has spread.


Q. How is lung cancer treated?

A. Drug treatment (chemotherapy) is the usual treatment for small cell lung cancers, because they usually spread too quickly for surgery to be useful. Radiotherapy is also often used. For the other types of lung cancer, surgery is first used to remove the main tumour, if it has not spread too far. If surgery is not possible, then radiotherapy is used instead. Depending on the type of tumour and how advanced it is, chemotherapy can be used in different ways: either to shrink the tumour before surgery or after surgery to kill off any remaining cancer cells.


Q. How effective is the treatment?

A. Lung cancer is one of the most dangerous cancers. The available treatments can prolong the patient's life, but complete cures are very rare. Four out of every five lung cancer patients die within one year of being diagnosed. Only one in twenty is alive five years after diagnosis. Many of these are people diagnosed with early squamous cell carcinomas, which can be treated successfully by surgical removal.


Q. What are the side effects of treatment?

A. The drug treatments cause bruising, fatigue, hair loss, diarrhoea, nausea and vomiting. However, the nausea and vomiting can now be reduced or even eliminated by special drugs. The hair loss may be partial or complete, but it is always temporary. The hair will grow back.

Colon Cancer FAQs

Colon cancer is one of the most common types of cancer in the developed world. Here we answer some frequently asked questions about Colon Cancer symptoms, causes and treatments.


Q. What is colon cancer?

A. Colon cancer is the term commonly used to describe colo-rectal (or bowel) cancer. The colon is part of the intestines. These consist of the small intestine (the section between the stomach and the appendix) and the large intestine (from the appendix to the anus). The large intestine is divided into the long colon and a short rectum, just before the anus. Two thirds of these cancers occur in the colon and one third in the rectum, with very few in the small intestine.


Q. Who is at risk of colon cancer?

A. There are about 106,000 new cases in the USA each year and 35,000 cases in the UK. More than 80% of these are in people over 60. Obesity can increase the risk of cancer of the colon by up to one third. High alcohol intake is also known to increase the risk of colon cancer. However, some common drugs, such as aspirin-like painkillers and hormone replacement therapy, are known to reduce the risk of bowel cancer.


Q. Does the diet affect the risk of colon cancer?

A. The risk of colon cancer appears to be linked to diet, although the evidence for which types of food are involved is not very clear. Low fat, high fibre diets appear to carry a lower risk. Greater consumption of vegetables and fruit has also been shown to reduce the risk. Increased consumption of red meat and processed meat has been linked to a higher risk. By comparison, eating fish does not appear to be a risk factor. Some evidence suggests that certain dietary supplements, such as calcium, selenium and, possibly, folic acid can reduce the risk.


Q. Does colon cancer run in families?

A. There are two inherited conditions which carry a substantially higher risk of colon cancer. In Familial Adenomatous Polyposis, affected family members develop thousands of small benign growths, called polyps, in the large intestine. Before the age of 40, one or more of these polyps will develop into a bowel cancer. In Hereditary Non-Polyposis Colorectal Cancer (also called Lynch Syndrome), patients develop cancer of the bowels and other organs, usually at an early stage. However, these conditions are very rare and only cause one in twenty cases of bowel cancer. Overall, the risk of bowel cancer doubles if you have a close relative (parent, bother or sister) with this cancer.


Q. Can we screen for colon cancer?

A. There are several ways in which we can screen for colon cancer. Checking for blood in the faeces is the simplest method, although there can be other reasons for this. A more accurate, but less pleasant method, is sigmoidoscopy, in which a flexible optical device is used to examine the inside of the rectum and colon. Both these methods of screening are currently being tested out in the UK to determine which is the best and whether such screening should be used for the whole population. Other screening methods are also being developed.


Q. What are the symptoms of colon cancer?

A. There are a variety of known symptoms of colon cancer including abdominal pain, diarrhoea and constipation, blood in the faeces, or even a blockage of the bowel. However, the symptoms vary from case to case and some cases do not cause any symptoms at all.


Q. How is colon cancer diagnosed?

A. Sigmoidoscopy (see above) or (the very similar) colonoscopy are used to visually examine the inside of the colon. Usually, a barium enema is used to take an x-ray of the shape of the inside of the bowel. Other techniques such as CT scanning or ultrasound can also be used to diagnose how advanced the cancer is.


Q. How is colon cancer treated?

A. Surgery is the main method of treatment. The part of the colon containing the tumour is chopped out and usually a colostomy is performed. In a colostomy, the end of the bowel is diverted to the surface of the abdomen, where the faeces are collected in a plastic bag. Sometimes this is a temporary measure and when the part of the colon that had the cancer has recovered, it can be reconnected to the rest of the bowel. However, if the tumour is in the lower rectum, then both the rectum and anus have to be removed and the colostomy will be permanent. Often patients are given radiotherapy or chemotherapy after the operation as this can kill off any remaining cancer cells.


Q. What are the side effects of treatment?

A. Surgery, of any sort, causes tiredness and some pain, but these pass. The long-term side effects of a colostomy are described above. The main side effects of chemotherapy can be thinning or loss of hair (which only happens with some drugs and is temporary), tiredness, diarrhoea, nausea, sore mouth and minor infections. These all stop when the treatment stops. Radiotherapy has some similar side effects (tiredness, diarrhoea and nausea) and some different ones: red and sore skin where the treatment was given and bladder inflammation, causing frequent and uncomfortable urination.


Q. How effective is the treatment?

A. If diagnosed early, before the tumour has spread from the bowel, these treatments are very effective, with about 90% of patients alive five years after diagnosis. However, if the cancer is advanced at the time of diagnosis (ie it has spread to the lymph nodes) only about half of the patients survive for five years.

Skin Cancer FAQs

Skin cancer symptoms can sometimes be easily overlooked. Much is written about the disease, but just how much do you know? Here we discuss the symptoms, causes and treatments of skin cancer.


Q. What types of skin cancer are there?

A. There are three main types of skin cancer: basal cell carcinomas, squamous cell carcinomas and malignant melanoma. The first two are slow-growing and easy to treat, but malignant melanoma is a dangerous, fast-growing cancer that spreads very quickly.


Q. How common is skin cancer?

A. The official UK figures are 6,000 cases of melanoma a year and 62,000 cases of other skin cancers. The incidence of melanoma is increasing, probably because of increased exposure to sunlight but also due to better diagnosis. The figure of 62,000 other skin cancers is an underestimate because these cancers are slow-growing and often remain undiagnosed in elderly people. Roughly three out of every four non-melanoma skin cancers are basal cell carcinomas and the other quarter are squamous cell carcinomas.


Q. What are the risk factors for skin cancer?

A. For all types of skin cancer, over-exposure to ultraviolet light, from sunlight or sunbeds, is the main risk. Research into malignant melanoma suggests that over-exposure in childhood puts people at risk of getting melanomas later in life. There are several other things that increase the risk of skin cancer: having very fair skin that burns easily, having lots of moles (over 50) on your body, having had skin cancer before, your close relatives having skin cancer and being treated with anti-rejection drugs (ie after an organ transplant). Exposure to radiation or long-term exposure to chemicals such as coal tar, soot, pitch, asphalt, creosote, paraffin wax or arsenic, can increase your risk of non-melanoma skin cancer.


Q. What are the symptoms of melanomas - what do they look like?

A. The majority of melanomas occur on the head, neck, arms and back - ie the skin exposed most to sunlight. Most of them are very dark or black, but they can sometimes be lighter brown or even speckled. The surface is usually raised and sometimes rough. They are not normally circular in shape, but some can be quite close to a circle. In their early stages, they often look like a mole, but with a ragged outline or different shades of colour in it. Sometimes, they appear to be a mole that is bleeding, oozing or crusty. However, the most important thing is that melanomas usually change shape or colour as they grow. Any spot that changes colour or shape should be reported to your doctor.


Q. What do basal cell carcinomas look like?

A. The vast majority of basal cell carcinomas occur on the face. They start as a small, pink, pearly or waxy spot, often circular or oval in shape. As they grow, they become a raised, flat spot with a 'rolled' edge and they may develop a crust. Next, they begin to bleed from the centre and an ulcer develops. This is called a rodent ulcer and, if left long enough, it can become quite large and eat away the skin and tissue below.


Q. What do squamous cell carcinomas look like?

A. Squamous cell carcinomas are most common on the limbs, head and neck. They are pink and irregular in shape, usually with a hard, scaly or horny surface, although they can sometimes become an ulcer. The edges are sometimes raised. They can be tender to the touch.


Q. How dangerous are skin cancers?

A. Malignant melanoma can be one of the most dangerous types of cancer. They all spread into nearby tissues, but some grow faster and spread further than others. If diagnosed late, treatment is not usually able to cure the cancer.
Squamous cell carcinomas also spread, but most of them spread so slowly that they are not very dangerous. Even the ones that spread more rapidly can be effectively treated as long as they are diagnosed reasonably early.
Basal cell carcinomas almost never spread, apart from the slow growth of the rodent ulcer itself. Even in advanced cases, treatment is almost always successful.


Q. Does skin cancer run in families?

A. There are some rare, inherited skin diseases that make people highly sensitive to sunlight and much more likely to get any type of skin cancer. People inherit their normal skin type and skin cancer is more common in paler, freckly skin. In addition, there is good evidence that, if you have a close relative (brother, sister parent or child) with skin cancer, you have about twice the normal risk of getting that type of skin cancer.


Q.What causes skin cancer?

A. Ultraviolet light - from sunlight or sunbeds - is the main cause of skin cancer. It can damage the DNA that makes up the genes in skin cells. The wrong type of damage to the wrong genes will make a cell become cancerous. There are three types of UV light, called A, B and C. UVC is filtered out by the atmosphere and does not get to our skin. UVB was originally found to cause sunburn and skin cancer, but more recently, it has been discovered that UVA can also cause skin cancer.


Q. Can sun beds cause skin cancer?

A. UVB is known to cause sunburn and skin cancer, so most sunbeds were originally designed to produce UVA only. However, more recent research has found that UVA can also cause skin cancers. As a result, many modern sunbeds produce far less UVA, although others still produce very high levels.


Q. Does sun cream protect against skin cancer?

A. UVB is known to cause sunburn and skin cancer, so sun creams were originally designed to block out only the UVB. We now know that UVA can also cause skin cancer and, these days, some sun creams block out a lot of UVA as well as UVB. However, the main concern is that, because sun creams prevent burning, they make people think they can spend much longer in the sun, which will definitely increase their risk of getting skin cancer.


Q. How is skin cancer treated?

A. For almost all non-melanoma skin cancers and for early melanomas, surgery to remove the cancer and a small amount of surrounding tissue is all that is necessary. If a melanoma has spread, chemotherapy can be used, but it is not usually effective. After a melanoma has spread, surgery and radiotherapy can be used on the secondary tumours. This will prolong life but it is not a cure.


Q. How effective are skin cancer treatments?

A. Surgical treatment of non-melanoma skin cancer is usually completely effective. For melanomas, if the tumour can be removed surgically before it has spread, the treatment is usually very effective. By removing more tissue around the tumour (the margin), the surgeon is more likely to remove the beginning of any spread and increase the chance of a cure. Once a melanoma has spread around the body, treatment is usually aimed at prolonging life as the chance of a cure is very small.


Q. Is early diagnosis important?

A. Early diagnosis is absolutely crucial for malignant melanoma (see above) as treatments for advanced melanoma are rarely effective. However, for other types of skin cancer, early diagnosis is sensible, but not a matter of life or death.

Cervical Cancer FAQs

Cervical cancer is a major concern for many women. Screening programmes have done much to put minds at ease over recent years, but just how much do you know about Cervical Cancer symptoms, causes and treatments? These questions and answers are designed to get to the facts.


Q. What is cervical cancer?

A. The cervix is a ring of muscle at the top of the vagina. It is the entrance to the womb. During childbirth the cervix expands until it is wide enough to let the baby out. The surface of the cervix facing into the vagina is covered with a type of skin which can become cancerous.


Q. What are the symptoms of cervical cancer?

A. It is unusual for women to experience the symptoms of cervical cancer these days as the vast majority of cases are diagnosed during cervical screening. When symptoms are observed, they are abnormal vaginal bleeding (between periods) and – more rarely – discomfort during intercourse.


Q. Are there different types of cervical cancer?

A. This is one of the few types of cancer where there are clear early stages which can be diagnosed and treated. The first stage is called CIN 1 and simply means that the cells on the cervix are slightly abnormal. This may have several causes and often clears up after a while. CIN 2 is not cancer, but the cells on the surface of the cervix show a number of cancer-like changes which can be seen under the microscope. The third stage, CIN 3, is close to cancer and is also known as 'carcinoma in situ'. If left untreated, CIN 3 has a 50% chance of developing into cancer.


Q. Who is at risk of cervical cancer?

A. Each year, over 40,000 women are found to have CIN 2 or CIN 3. Almost all of them are successfully treated. However, over 3,000 new cases of cervical cancer are diagnosed each year in the UK and 11,000 in the USA. Younger women are more likely to have CIN 3 than older women. The risk is low during the teens but is highest during the ages of 20 to 29, slowly decreasing thereafter.


Q. What is cervical screening?

A. To check for CIN, a doctor or nurse will take a smear from the surface of the cervix. A small wooden or plastic spatula is inserted into the vagina and painlessly scraped over the cervix. A number of cell from the cervix stick to the spatula. These are examined under the microscope for any abnormalities. Women found to have CIN2 or CIN 3 can be treated to prevent them getting cervical cancer.


Q. How important is cervical screening?

A. All women over the age of 20 should have a cervical screen at least every five years.
Cervical screening started in 1964 and the effects have been quite clear. The death rate from this cancer has fallen by two thirds since then. It has been estimated that, over a 10-year period, cervical screening has saved the lives of 8,000 women in the UK.


Q. How effective is the treatment?

A. The treatment for CIN 2 or CIN 3 is very effective indeed. Even when someone is diagnosed as having cervical cancer, the treatments are still very good. Overall, three out of every five patients will be cured. For women under 50, nearly four out of every five are cured.

Ovarian Cancer FAQs

Ovarian cancer is a concern for many women. This page attempts to address the main issues concerned with cancer of the ovaries and discusses the symptoms, causes and treatments.



Q. Where are the ovaries?

A. The ovaries are above the womb and connected to it by two short tubes (the Fallopian tubes). This means that they are below and to either side of the navel.


Q. How common is ovarian cancer?

A. In the year 2000 (the most recent for which figures are available) there were 6,734 cases of ovarian cancer diagnosed in the UK. In the USA the estimated 2004 incidence is 25,500 cases. Overall about one woman in 50 will get ovarian cancer at some time during her life.


Q. How dangerous are ovarian cancers?

A. In 2002, 4,687 women in the UK died of ovarian cancer, making it a more common cause of death than cervical and uterine cancer combined. In the USA it is estimated that 16,000 women will die from ovarian cancer in 2004.


Q. What are the risk factors for ovarian cancer?

A. Like most cancers it is more common with increasing age. The other risk factor is if you carry certain genes (see below). Having children reduces the risk: women with three or four children have only half the risk of a childless woman. Infertile women (ie women who cannot conceive despite trying for several years) appear to have an even higher risk than other childless women. Taking the contraceptive pill reduces the risk of ovarian cancer by somewhere between a third and a half, depending on how long it is taken for.
Although the effect of hormone replacement therapy (HRT) on ovarian cancer risk has been studied, the results are unclear. Some studies have found an increased risk, but analysis of all the published research shows conflicting results.
There have been some reports claiming that using talc in the genital area increases the risk of ovarian cancer. However, most of the research conducted on this has not produced reliable findings and there is no good evidence to support these claims.


Q. Does the diet affect the risk of ovarian cancer?

A. There is some evidence that being overweight can increase your risk of ovarian cancer. Some research has suggested that beta-carotene in the diet can reduce the risk of this cancer, although this finding has not yet been confirmed.


Q. Does ovarian cancer run in families?

A. There are several genes, which are known to carry increased risks of various cancers, which can run in families. The BRCA1 and BRCA2 genes were originally discovered because they cause an increased risk of breast cancer, but we now know that they also substantially increase the risk of ovarian cancer. The HNPCC gene was discovered because it increases the risk of colon cancer, but women with this gene also have a greater chance of getting ovarian cancer. Overall, if you have one close relative (mother, sister or daughter) who has had ovarian cancer, your risk goes up about 4-fold. If you have two cases amongst close relatives, your risk goes up 10-fold or more.


Q. Can we screen for ovarian cancer?

A. There is no reliable method of screening for ovarian cancer. However, both the CA125 blood test and vaginal ultrasound are currently being tested as possible methods for screening women for ovarian cancer.


Q. What are the symptoms of ovarian cancer?

A. There are few clear symptoms of ovarian cancer. Typically it can cause pain in the abdomen, a feeling of being bloated, fatigue, weight loss, or problems with urination. However, these can all be caused by a number of other diseases. This makes it difficult to diagnose ovarian cancer by symptoms alone.


Q. How is ovarian cancer diagnosed?

A. If ovarian cancer is suspected, two main tests are used to make the diagnosis. First, an ultrasound scan of the abdomen is performed. Sometimes the scan is taken from inside the vagina. The second test is to measure the level of the CA125 marker in the blood. Neither of these tests gives a definite diagnosis of ovarian cancer, but if both tests are positive, the patient is usually referred to a surgeon who will operate to see if the ovaries show any signs of cancer.


Q. How is ovarian cancer treated?

A. The treatment used will depend on how advanced the cancer is and how old the patient is. For younger patients with early cancer, limited surgery is used to preserve their fertility. For older patients with more advanced cancers, the ovaries and the womb are usually removed. If the cancer has spread, further tissue may need to be removed to get out as much of the cancer as possible. Chemotherapy is normally used after the surgery to kill any remaining cancer cells. Sometimes it is also used before the surgery to shrink the tumour and make it easier to remove completely.


Q. How effective are the treatments?

A. Overall, only about two out of every five women with ovarian cancer can be cured. Like all other cancers, the stage at which ovarian cancer is diagnosed determines how easily it is to cure. If diagnosed and treated while the cancer is still confined to the ovaries, nearly 75% of women can be cured. However, once it has spread into the pelvic cavity, the cure rate drops to one third. If it has spread further, only one quarter to on sixth of patients can be cured. For these figures 'cured' is defined as surviving for five years after the first diagnosis.

Testicular Cancer Faqs

Testicular cancer is a concern for many men. This page attempts to address the main issues concerned with testicular cancer and discusses the symptoms, causes and treatments.


Q. How common is testicular cancer?

A. In 2000 (the last year for which figures are available) there were 2,000 new cases of testicular cancer diagnosed in the UK. In the USA, it is estimated that there will be 9,000 new cases diagnosed in 2004. This means it is between 1% and 2% of all cancers in men. The number of cases has been slowly increasing for some time.


Q. What causes testicular cancer?

A. We do not yet understand what causes this type of cancer.


Q. What are the risk factors for testicular cancer?

A. Unlike most cancers, testicular cancer does not get more common as you get older. Most cases occur in men aged between 25 and 45, with very few cases in men over 75. This type of cancer is most common in white Caucasian males. Men of other races have a much lower incidence, even when living in the same county. The only exception to this is the New Zealand Maoris, who have a high rate of testicular cancer. Within Europe, this cancer is up to five times as common in some northern countries (eg Denmark, Sweden and UK) than in many southern countries (Italy, Spain and Greece).
Babies born with undescended testicles are known to have a 5 to 10 times higher risk of testicular cancer. There are a few medical conditions, which if present during childhood, also increase the risk. These include an inguinal hernia, mumps infection of the testicles and testicular torsion. Having a vasectomy does not increase the risk of testicular cancer.


Q. Are there different types of testicular cancer?

A. The vast majority of testicular tumours are called germ-cell tumours. There are two main types of germ cell tumour: seminomas and teratomas. Younger patients are more likely to have seminomas and older patients to have teratomas.


Q. How dangerous are testicular cancers?

A. There are relatively few deaths from testicular cancer, because it is one of the easiest to cure. In the year 2002, only 74 men died of this cancer in the UK and, in the USA only 360 are expected to die in 2004. This means it is a very rare cause of death.


Q. Does the diet affect the risk of testicular cancer?

A. There is no evidence that diet affects the risk of getting testicular cancer.


Q. Does testicular cancer run in families?

A. Research has found that an increased risk of testicular cancer can run in families. If you have a brother with testicular cancer, you are between 6 and 10 times more likely to get it than normal. If your father had it, you are 3 or 4 times more likely than normal to also suffer from it.


Q. What are the symptoms of testicular cancer?

A. The most common symptom of testicular cancer is a painless swelling or lump in one of the testicles. Other, less common, symptoms include enlargement of a testicle, a pain in one testicle and an ache in the lower stomach.


Q. Is there screening for testicular cancer?

A. Men can screen themselves by feeling for lumps in their testicles. Men between 25 and 45 should do this every few months. If a lump is found on one testicle, check the other one to see if the same lump is present. If there are similar lumps on both, then it is almost certainly a normal part of the testicles. If the lump is only on one testicle, you should consult your doctor.


Q. How is testicular cancer diagnosed?

A. First, your family doctor will check your testicles and, if there is any cause for concern, he will refer you to a specialist. An ultrasound scan of the testicles is used to check for any growths. If any are found, an operation is performed to take a tissue sample from the lump. This is examined by a pathologist, to determine if the lump is cancerous or not. Blood test will also be done to check the levels of HCG (human chorionic gonadotrophin) and AFP (alpha fetoprotein), which indicate how advanced the cancer is.


Q. How is testicular cancer treated?

A. The exact treatment used will depend on the type of testicular cancer and how advanced it is. An operation to remove the affected testicle is normal in all cases. The loss of one testicle does not affect a man's ability to have an erection or father children and an artificial testicle can be put in the scrotum to restore a normal appearance. If the cancer has gone beyond the testicle, radiotherapy or chemotherapy are also used. Radiotherapy is more effective for seminomas. Chemotherapy is used for both types of testicular cancer, even if it has not spread. In advanced cases, chemotherapy is given at a very high dose, which kills not only the cancer cells but also the bone marrow cells as well. However, the patient is given a stem cell or bone marrow infusion to restore the bone marrow cells.


Q. What are the side-effects of treatment?

A. Radiotherapy can cause nausea, tiredness and diarrhoea. However, these are not severe and can be helped or prevented by drugs. Chemotherapy can cause loss of appetite, tiredness, ringing in the ears, shortness of breath, nausea, vomiting, mouth ulcers, infections, kidney problems and hair loss. The higher the dosage, the more severe the side effects. Patients on high-dose chemotherapy are monitored carefully by their doctors.


Q. How effective are the treatments?

A. The current treatments are very effective. If the tumour is diagnosed early, a complete cure is achieved in nearly 95% of cases. The later tumours are more difficult to treat, but even in advanced testicular cancer over 50% of pateints are cured. For these figures, a complete cure is defined as surviving ten years after the first diagnosis.


Q. Is early diagnosis important?

As with all cancers, the earlier the diagnosis, the easier the cancer is to cure.

Kidney Cancer FAQs

Kidney cancer is a concern for many people. This page attempts to address the main issues concerned with kidney cancer and discusses the symptoms, causes and treatments.


Q. Where are the kidneys?

A. We have two kidneys, which are located either side of the spine, in the small of the back.


Q. Are there different types of kidney cancer?

A. The vast majority of kidney cancers are renal cell cancers. Most of the others are cancers of the renal pelvis. There are several types of renal cell cancers. Most are classed as 'clear cell' or 'conventional'. A smaller number fall into other types, which are called papillary, chromaphobe, collecting duct and unclassified renal cell cancers.


Q. How common is kidney cancer?

A. There are about 190,000 newcases of kidney cancer each year around the world, which means it accounts for about one in fifty cancers. In the UK and USA it about the tenth most common type of cancer.


Q. What are the risk factors for kidney cancer?

A. Like most cancers, kidney cancer becomes more common as you get older. Two-thirds of all kidney cancers occur in people over the age of 60. Kidney cancer is also more common in men: 60% of cases and in men and only 40% in women. Obesity is a major risk factor, involved in one quarter of all cases of kidney cancer. Another major risk is smoking, which increases the risk of getting kidney cancer between two and three times. Smaller increases in risk have also been found for people with kidney diseases and people working in the iron and steel industries.


Q. Does the diet affect the risk of kidney cancer?

A. There is no clear evidence to suggest that diet affects the risk of getting kidney cancer.


Q. Does kidney cancer run in families?

A. Kidney cancer does not normally run in families, so having one or more relatives with this type of cancer would not increase your risk. However, there are some rare inherited conditions which carry a very high risk of getting kidney and other cancers.


Q. How dangerous is kidney cancer?

A. Slightly over half of all people diagnosed with kidney cancer will die from the disease. The older the patient, the greater the risk, with only one third of patients over 70 surviving for more than five years after they are diagnosed. Over the last thirty years there has been a slow increase in the number of people dying from kidney cancer.


Q. What are the symptoms of kidney cancer?

A. The most common symptom, found in about half of all cases, is blood in the urine. However, only a minority of people with this symptom actually have cancer. In most cases it is caused by a kidney infection or kidney stones. Another quite common symptom is pain in the lower back or a swelling in the kidney area. Fatigue, weight loss, anaemia and sweating, which are the symptoms for many types of cancer, have also been reported.


Q. How is kidney cancer diagnosed?

A. The main methods of diagnosis are by X-ray, CAT scan or ultrasound scan. These tests can show if there is a mass in the kidney. Usually, they would be followed by a biopsy: taking a small tissue sample from the mass, by inserting a thin needle. The tissue can be examined to determine if the mass is cancerous or not.


Q. How is kidney cancer treated?

A. The main treatment is surgery to remove the affected kidney. We have two kidneys and people can live perfectly well with the one remaining kidney. In a few cases, where the tumour is very small, it is possible to remove only part of the affected organ. If the cancer has spread outside the kidney, the surgeon may remove other tissue. In some cases, when the tumour is too large to remove, the surgeon may block off the blood flow to the tumour, which will cause it to shrink. In some cases, radiation treatment will be used in addition to, or even instead of, surgery. In some cases, treatment with hormones, interferon or interleukin can be used.


Q. How effective are the treatments?

A. If the cancer is diagnosed at an early stage, before it has spread outside the kidney, between 80 and 90% of patients can be cured. Once the tumour spreads outside the kidney, it is more difficult to treat. Depending on their age and other factors, between 50% and 80% of patients diagnosed at this stage can be cured. Advanced kidney caner is very difficult to cure completely and only about one in six or seven patients can be cured. For these figures, we are defining 'cured' as surviving five years after the first diagnosis.