Test Your PAP Smear IQ

The first PAP smears were done over 60 years ago! Within the past decade we have seen the development of a vaccine reported to reduce the risk of cervical cancer, the widespread use of liquid based PAPs ("PAP in a bottle"), human papilloma virus (HPV) testing, and altered recommendations about when to do a PAP smear. So sharpen your pencils and test your PAP Smear IQ! Correct answers and scoring follow this "PAP Quiz"

1. The time to begin getting PAP smears is either age 18 or shortly after you first have sex.
   True/False



2. A PAP can diagnose sexually transmitted infections such as gonorrhea or Chlamydia.
   True/False



3. Most forms of cervical cancer can be linked to the HPV virus.
   True/False



4. If I get the new HPV vaccine I don't need to get PAP smears.
   True/False



5. By age 30, if a woman has had three, consecutive, normal PAPs she can drop down to PAP smears every two to three years.
   True/False



6. If a woman was exposed to the drug DES before birth, has HIV, or depressed immune function (e.g., on organ transplant drugs) she can now defer her PAP smears to every other year.
   True/False



7. About 50% of women with cervical cancer in the US had not had a PAP within the past five years.
   True/False



8. DNA tests for HPV are better able to discriminate the really worrisome cell changes than a PAP smear.
   True/False



9. The newer liquid based PAP smears are definitely better at identifying abnormal cells.
   True/False



10. Once you have had a hysterectomy you can stop getting PAP smears.
    True/False

ANSWERS

1. False. This was true seven to nine years ago, but newer studies have suggested that HPV infections (linked to abnormal PAP smears) tend to resolve in younger women. This may be due to better immune system function which fights off the HPV more effectively. The recommendation to wait until three years after starting intercourse is based upon the hope that many HPV infections will be spontaneously cleared. Also, abnormal cervical cells do not progress quickly to cervical cancer - especially within three years.
   
   One well done study by Ho and colleagues (1998) followed older adolescents over three years. At the end of the study some 43% became HPV positive. This confirms the ease with which HPV can be passed between sexual partners. Surprisingly, of this group of newly infected women, only 9% continued to show persisting evidence of HPV.
   
   For women who have been assaulted or sexually molested while very young, it is important that they get a PAP smear earlier. If the assault was in childhood, she should get a PAP as a teenager for there are several factors which place her at increased risk for abnormal PAP smears.



2. False. A PAP smear examines cells from the face of the cervix and the cervical canal. It does not diagnose chlamydia, gonorrhea or other sexually transmitted infections. A special test for HPV (considered a sexually transmitted infection) can be done using liquid left after doing a liquid based type of PAP smear.



3. True. Most forms of cervical cancer have been linked to HPV. Particularly strong links exist between the high risk subtypes of HPV (e.g., subtypes 16 and 18). There are more than 30 types of HPV which are sexually transmitted. These have been classified into "low risk" and "high risk" subtypes. HPV subtypes 6 and 11 are considered to be low risk. They are linked primarily to the cauliflower-appearing genital warts, and low grade cervical lesions (e.g., LGSIL, CIN 1). Subtypes 16 and 18 are considered to be high risk as they are linked with persisting HPV infections and severely abnormal PAP smears. These two high risk subtypes are the probable cause of about 70% of cervical cancers.



4. False. If one gets the newer vaccine designed to decrease the risk of cervical cancer, one is protected from HPV subtypes 16 and 18. One of the two versions of the vaccine will provide protection from subtypes 6 and 11 as well. Both vaccines have been shown in large research studies to provide 100% protection for the high risk subtypes. However, the vaccine does not cover all HPV subtypes (e.g., HPV subtypes numbered in the 30's) which have been linked to persisting abnormal PAP smears. This is why PAP smears are still recommended even in those who have had the HPV vaccine.



5. True. Between the time one gets her first PAP smear and age 30 or so, she should get PAP smears every one to three years. Then, if she has had three normal PAP smears in a row, she can drop back to PAP smears every two years or so. Once one is over the age of 30, a GYN may order an HPV test on her cervical cells. If the HPV test is positive it will likely be repeated within the next 6-12 months. A persisting HPV infection is correlated to abnormal cell changes-even if the PAP smear seems normal. By contrast, a normal PAP smear result coupled with a negative HPV test result suggests that cervical cancer is unlikely to emerge over the next several years.



6. False. Unfortunately, women exposed to DES, or those who have conditions which suppress the immune system (e.g., HIV, organ transplant drugs) still need to have yearly PAP smears. Women whose mothers took DES while pregnant have an increased risk of an unusual type of cervical/vaginal cancer. Women with blunted immune system function are less likely to be able to clear HPV infections (new or old).



7. True. Therefore it is important not to be lax about getting PAP smears within the required interval for your age. It should also be noted that some of the women who were found to have cervical cancer had NEVER had a PAP smear.



8. True. DNA based tests for HPV are better at discriminating high grade cervical lesions than PAP smears. HPV test have a high degree of sensitivity (ability to detect HPV) of 94.6%. This is compared to a conventional PAP smears had a 55% sensitivity (Mayrand, 2007). However it costs more to do HPV testing, and more importantly, has a lower specificity (more "false positives").



9. False. Initially, most all studies reported liquid based PAP smears had a better ability to detect abnormal cervical cells. Currently over three fourths of PAP smears done in the US use this method rather than conventional PAP smears where a spatula collects cells which are smeared on a glass slide. There are other advantages of the liquid PAP method such as the ability to use leftover liquid if the GYN wants to order an HPV test as well.
   
   Recently Ronco and associates (2007) studied 45,000 Italian women, and determined that both liquid based and conventional PAP smears were equal in their ability to detect CIN 2 or higher. These are the more worrisome cervical cell changes. The liquid based PAPs were able to pick up more CIN 1 (less concerning), as well as decrease the number of unsatisfactory specimens.



10. True & False. This was not meant to be a trick question. Whether one continues to need PAP smears after hysterectomy depends upon the reason for hysterectomy and the type of hysterectomy done. If the uterus and cervix were removed for a non-cancer condition (e.g., fibroids, endometriosis, abnormal bleeding) there is no need to continue getting PAP smears.
    
    By contrast, if surgery left the cervix in place (even if the hysterectomy was for benign reasons) PAP smears must be continued until the usual time of discontinuation (e.g., age 65-70). If the uterus and cervix were removed in a woman with CIN 2-3, she should have PAPs for a minimum of ten years after the surgery. For women who have had removal of cervix and uterus for a cancer, a PAP smear of the back wall of the vagina should be done until the woman is in frail health.

So tally up your score of correct answers and give yourself a grade:

100% - You probably work in a GYN office!
90% - You could work in a GYN setting.
60%-80% - Your PAP smear knowledge is way ahead of the average person.
Less than 60% - Having learned more you can now educate your friends.

Safe Sex - Topic Overview

Sexually transmitted diseases (STDs) are spread by sexual contact involving the genitals, mouth, or rectum, and can also be spread from a pregnant woman to her fetus before or during delivery. STDs, which affect both men and women, are a worldwide public health concern.

Although most STDs can be cured, some cannot, including HIV (which causes AIDS), genital herpes, and human papillomavirus (HPV), which can cause genital warts.

STDs can be spread by people who don't know they are infected. Always use protection every time you have sex, including oral sex, until you are sure you and your partner are not infected with an STD.

If you are in a relationship, delay having sex until you are physically and emotionally prepared, have agreed to only have sex with each other, and have both been tested for STDs.

Abstinence as prevention

Completely avoiding sexual contact (abstinence), including intercourse or oral sex, is the only certain way to prevent an infection.

Discuss safe sex with your partner

Discuss STDs before you have sex with someone. Even though a sex partner doesn't have symptoms of an STD, he or she may still be infected.

Questions to ask someone before having sex include:

• How many people have you had sex with?
• Have you had sex without a condom?
• Have you ever had unprotected oral sex?
• Have you had more than one sex partner at a time?
• Do you inject illegal drugs or have you had sex with someone who injects drugs?
• Have you ever had unprotected sex with a prostitute?
• Have you had a test for HIV? What were the results?
• Have you ever had an STD, including hepatitis B or hepatitis C? Was it treated and cured?

Safe sex practices

Some STDs, such as HIV, can take up to 6 months before they can be detected in the blood. Genital herpes and the human papillomavirus (HPV) can be spread when symptoms are not present. Even if you and your partner have been tested, use condoms for all sex until you and your partner haven't had sex with another person for 6 months. Then get tested again.

• Watch for symptoms of STDs, such as unusual discharge, sores, redness, or growths in your and your partner's genital area, or pain while urinating.
• Don't have more than one sex partner at a time. The safest sex is with one partner who has sex only with you. Every time you add a new sex partner, you are being exposed to all of the diseases that all of their partners may have. Your risk for an STD increases if you have several sex partners at the same time.
• Use a condom every time you have sex. A condom is the best way to protect yourself from STDs. Latex and polyurethane condoms do not let STD viruses pass through, so they offer good protection from STDs. Condoms made from sheep intestines do not protect against STDs.
• Use a water-based lubricant such as K-Y Jelly or Astroglide to help prevent tearing of the skin if there is a lack of lubrication during sexual intercourse. Small tears in the vagina during vaginal sex or in the rectum during anal sex allow STDs to get into your blood.
• Avoid douching if you are a woman, because it can change the normal balance of organisms in the vagina and increases the risk of getting an STD.
• Be responsible. Avoid sexual contact if you have symptoms of an infection or if you are being treated for an STD or HIV. If you or your partner has herpes, avoid sexual contact when a blister is present and use condoms at all other times.

Can A Vagina Be Too Big?

Faithful readers of this blog may remember that Masters and Johnson examined the vaginal sizes of 100 women who had never been pregnant. These women showed an un-stimulated vaginal length of 2 ¾-3 ¼ inches , with a ¾ inch width at the back of the vagina. During the sexual excitement phase the vaginal lengths increased to 3 ¾- 5 ¾ inches, with the width at the back of the vagina being 2 ¼-2 ½ inches. This correlates with our most common diaphragm sizes which are between 2 ½ -3 ½ inches in length.

"But I'm not worried about vaginal length," you might be thinking. "My problem is that I think my vagina is too loose - or too wide. Is that possible? If so what can I do?" Let's examine some of the medical data available to answer these questions.

Is my vagina too loose?
The vagina is like a collapsed, expandable tube lined with skin; the tissue below the skin is loose and contains large veins. Next are smaller circular muscles surrounded by stronger bands of muscle which run the length of the vagina. In addition, the lower third of the vagina is surrounded by a ring of muscles. This is covered by more connective tissue and blood vessels. Damage to these muscles, or if they become thin and weak, can allow the bladder ("cytocele") or rectum ("rectocele") to pouch into the vagina. Thus you can understand the importance of strong vaginal muscles. The ring of muscles around the vaginal opening contract during orgasm and may contribute to the intensity of an orgasm.

So what is too loose? This can be a matter of opinion based upon the input of a sexual partner, or one's observations of vaginal tone. Researchers have devised some ways to measure vaginal tone such as a pressure sensitive intravaginal balloon device, and ultrasound measurements of vaginal area ("pelvic floor") muscle thickness. A study of 30 women aged 20-42 found that better developed vaginal muscles were linked to having orgasms, and getting physical exercise. Conversely, increased age and having been pregnant were linked to decreased strength of vaginal muscles (McKey and Dougherty 1986).

A more recent study using ultrasound measurements (Bernstein,1997) found similar connections. Muscle thickness decreases with age, especially in women older than 60. Women with urinary incontinence had thinner pelvic floor muscles than women who were not incontinent.

Will exercising the vaginal muscles make my vagina tighter?
Two ultrasound studies of women who exercised their vaginal muscles did find that their muscles were thicker and stronger after pelvic floor muscle training. Among women with urine leakage, their thinner muscles became the thickness of healthy women's pelvic floor muscles. Additionally, they had less urine leakage - whether the problem was from stress or urge types of incontinence. The use of vaginal cones and/or Kegel exercises to increase muscle strength were both found to improve tone and decrease urine loss. While some of these studies did not measure vaginal tightness per se, when muscle bulk is increased, a woman can voluntarily contract those muscles to make the vaginal opening tighter.

Do tighter vaginal muscles really improve sexual response?
Despite the fact that most every discussion of Kegel exercises includes improved sex, there are not many scientific studies to back up this claim. One recent publication (Dean, 2008) reported on sexual function and pelvic muscle factors for some 2,800 women. Women who delivered only by Caesarean section (and their partners) perceived they had better vaginal tone leading to improved sexual satisfaction. Women who were currently doing pelvic muscle exercises scored much better on sexual satisfaction questions than women who did not. Women with incontinence (probably thinner muscles) scored the worst on the sex questions.

I've tried Kegel exercises but they don't work for me.
Assuming that the Kegel exercises have been done correctly, it may be time to move to other options. One low tech choice is weighted vaginal cones. This is a set of weights, shaped more like a tampon than a cone, where one inserts the lightest version then uses the vaginal muscles to hold it up inside. This is done twice daily. When this is easy the next heaviest cone is used - and so on. This is to be done while going about normal activities so that gravity provides an additional challenge to keeping the weight up inside.

More technology is involved in the electrical stimulator. A tampon shaped probe is inserted in the vagina and small electric shocks cause the muscles to contract then relax. This is done about 20 minutes up to several times a week. One patient of mine who used this device found it sexually pleasurable.

Less commonly used may be the "magnetic chair" ("Neocontrol"). This chair uses magnetic action to stimulate the muscles. I know this sounds very "woo, woo", but there is good data showing its effectiveness. This device is not for home use; treatments are given twice weekly by specially trained health care personnel.

Will plastic surgery make my vagina smaller?
Many genital plastic surgery techniques are based upon GYN surgical procedures used for medical problems such as reconstruction after cancer treatment, gender change, repair of cystocele/rectocele, etc. Unfortunately there are few good studies showing benefit where there is no overt medical problem.

One study of 53 women in Santiago, Chile (Pardo, 2006) was done specifically for complaints of wide vagina and decreased sexual satisfaction. The surgeons did two procedures. The first was inside the vagina where tissue along the roof was stitched tighter. This is similar to the type of repair done for a cystocele. Secondly, tissue around the vaginal opening and between the vagina and anus was stitched tighter. This is similar to the type of repair done for episiotomies after childbirth. Six months after surgery 94% claimed they experienced a tighter vagina, and had regained or improved orgasms. Yet some 4% of the women said they regretted the surgery.

The problem with this type of study is that sexual response can be very subjective. There is no easy way to measure sexual satisfaction in a group of diverse women. Every woman knew she got the surgical treatment so six months may not be a long enough time for any placebo response to wear off.

The American College of Obstetricians and Gynecologists (ACOG, 2007) has noted the lack of both safety and effectiveness data for genital plastic surgery. The possible complications for such surgery might include: infection, changes in sensation, pain with intercourse, and scar tissue. One GYN who has been performing genital plastic surgery for a number of years (Goodman, 2009) concluded that agreed upon terminology and training standards are still lacking.

What are you going to do, Jane?
As a big advocate of resistance/weight training to build muscles, I personally think exercise is a better place to start than surgery. As always, if a woman has concerns about sexual function, vaginal/genital structures, etc she should bring these up to her GYN. A GYN sees the wide range of "normal" in vaginal appearances. Yet, if one is having sexual problems due to genital changes, your GYN needs to know that is an issue.

Vaginal Weights for Stress Incontinence

Q: I leak urine when I laugh, sneeze or jump. A friend told me that vaginal weights can help with this, but it seems sort of weird. Are they really effective?

A: About one in three women leak urine after giving birth. This is called "stress incontinence" and it's due to weakened pelvic floor muscles, allowing for the neck of the bladder to "sag down" so that urine can escape with laughing, coughing, or sneezing.

Most doctors tell women to do Kegel exercises to strengthen their pelvic floor muscles. In some cases, surgery is required. But studies have also shown that vaginal weights can strengthen the muscles enough to reduce incontinence as well.

Here's how they work: You insert a cone-shaped weight into your vagina and then work on squeezing your muscles to keep the weights in place for about 15 minutes, once or twice a day. (You can actually go about your daily business while doing this!) Once you're able to hold this weight in easily, you try a slightly heavier weight (they are sold in sets).

Advocates of the weights believe that it's easier for a woman to learn to isolate and train her pelvic floor muscles properly using the weights than it is using just Kegels, which are easy to do incorrectly.

You can get vaginal weights over-the-counter, on-line, or as a prescription, via your health care provider.

The first published study on vaginal cones for urinary stress incontinence was published in 1988! While only 30 women completed the full month of using the cones, the results were amazing. Originally scheduled for surgery for stress incontinence, 63% of the women felt cured or improved enough to cancel their surgeries.

Now, after over 40 additional studies, the results are some what more measured. While some studies show the cones to be superior to pelvic floor muscle training using Kegel exercises (Arvonen, 2001), others have not (BØ, 1999). A critical evaluation of all trials done with cones was published in 2001 as a part of the famous Cochrane Database System Review. This excellent summary found the following:

• Cones were definitely better than no treatment.
• No significance was found between cones, Kegel exercises, and electro-stimulation of the pelvic floor muscles in their effectiveness.
• There is not enough evidence to show that combining cones plus Kegels gave any better results than any single treatment.

Generally most healthcare providers will adhere to a recommendation given by the Cochrane Review. But if you are a woman considering the use of weighted vaginal cones here are some additional things to think about.

• First, one really needs to be sure that they have stress incontinence. Cones may not be as successful with other types of urine leakage.
• Second, there may be better results among women who can advance to using the heaviest cones vs the lightest.
• Third, like different forms of birth control, one type of pelvic muscle strengthening may work better for you than your friend.

With some 5% of younger women, and almost 50% of elderly women, having symptoms of stress incontinence we should be able to access as many effective treatments as possible. Your best bet is to see your own MD or GYN to confirm that the urine loss is from stress incontinence. Then investigate your options as to cost, convenience, and preference. Weighted vaginal cones may be an excellent choice for you.

My Female Organs Are Falling Down

VAGINA

VAGINA

© 2009 WebMD, LLC. All rights reserved.

Have you ever looked "down there" with a mirror (or had a lover say to you) that there seemed to be a "bulge" or "ball of tissue" at the vaginal opening? The medical name for this condition is pelvic organ prolapse (POP). POP is purported to effect up to 50% of women who have had a vaginal delivery (Maher, 2008). In other studies of women in general, rates of POP with marked symptoms are reported to be 3.6 - 6%.

The first concern is that one's uterus, or other pelvic parts, might be falling out. In one of the more severe forms of POP the uterus can drop so far down into the vaginal canal that the cervix will scrape against the woman's underpants! Fortunately this is one of the least common forms of POP. So if you were to see a "bulge" of tissue what is that likely to mean to you? The goal of this blog is to share facts about the types of POP, the risk factors, and what treatment options you might have if POP seems to be linked to other, bothersome symptoms.

How do I know what type of prolapse I have?
When you go see your GYN or clinic you might expect questions about: urinary or bowel incontinence, difficulty emptying the rectum, or sexual problems. This can suggest areas which are involved with the "bulge". An exam should be done with you standing and/or bearing down when you are on the exam table. If loss of urine is a concurrent problem then a urinalysis may be done along with a Q-tip test and/or a measure of urine left in the bladder after you have go to the bathroom.

There are several types of prolapses. When the upper part of the vaginal canal loses its muscle tone or attachments holding the vagina up (especially common among women with hysterectomies) that is called vaginal prolapse. If muscle support is poor, or interrupted, the bladder can prolapse down through the "roof" of the vagina causing a cystocele. The urethra may drop down as well (urethrocele). If the weakness is in the "floor" of the vagina the rectum can bulge upward. As was mentioned above, the uterus and cervix can slump down through the vaginal canal.

What are the risk factors for pelvic prolapse?
The most consistently cited risk factors are: increasing age, being overweight, and increased number of vaginal deliveries. Number of deliveries by C-section does not increase prolapse risk (Luckacz, 2006). Other associated factors can include irritable bowel syndrome, constipation, and overall poor health (Rortveit, 2007). African American women are less likely to have symptomatic pelvic prolapse (Rortveit, 2007). One small study even found that having a history of stretch marks doubled one's risk for prolapse (Salter, 2006).

"Stretch marks," you might be thinking "why would that be?" The bones of the female pelvis do a great job protecting lower abdominal contents, but they do not provide support. The pelvic organs are supported by the muscles in the pelvic floor and the ligaments which can attach from the organs to the bones. It has been theorized that pelvic muscle and ligament strength may be linked to strength of collagen. Collagen, along with fibrillin, is decreased in women with stretch marks (Mitts,2005).

What can be done if I have a mild form of prolapse, or do not want to have surgery?
According to the American College of Obstetrics and Gynecology (ACOG, 2007): "Pessaries can be fitted in most women with prolapse, regardless of prolapse stage or site of predominant prolapse." A pessary is a doughnut shaped device which can be made of various materials. There are also pessaries shaped like a cube, and similar to a shoe horn. If one has ever used a diaphragm for birth control, inserting and removing a pessary may seem familiar. Like a diaphragm, a pessary should be fit by a GYN as they come in different sizes.

Kegel exercises have been recommended for POP but, unlike urinary stress incontinence, there are few large studies demonstrating the effectiveness of Kegels. According to one recent study of 48 women, pelvic floor exercise/Kegels significantly improved symptoms of prolapse (Hagen, 2009). Kegels may not be as successful as they are with urinary incontinence for once the attachment ligaments are damaged, strengthening the pelvic muscles may not fix the prolapse.

What about surgery?
If one has a prolapse of the uterus, hysterectomy may be suggested. Care is taken to refasten the top of the vaginal canal to other structures so it does not droop down after the hysterectomy.

If the prolapse is coming from the top or "roof "of the vagina, pelvic fascia tissue can be used to bridge the weak area. If the prolapse is coming from the lower or "floor" of the vagina (causing a bulging of the rectum into the vaginal canal), the rectal muscles can be used to close the defect.

More recently synthetic mesh has been used to support the weakened areas. Mesh has been used extensively for repair of abdominal hernias. Overall, the use of mesh seems to decrease the reoccurrence of cystocele when an anterior ("top") of the vagina repair is done (Maher, 2008). The primary concern for mesh is that long term follow up in large numbers of POP women is lacking. Cases of the mesh eroding through vaginal tissues have been reported (Altman, 2007). By October of 2008 the FDA released a notification to GYN surgeons relating adverse events connected to mesh use as reported by manufacturers of different types of mesh. Some of these unwanted events included erosion, infection, and pain. Not surprisingly, the strength and health of the woman's own tissues will have an impact. Her own tissues will have to be incorporated into the mesh to form a strong bond.

In one study of 2,460 of women in their 50's, about 3% of women reported having surgery for POP (Fritel, 2009). Further, women who had such symptoms of POP as problems having a bowel movement or urinating, and abdominal pain reported a much lower quality of life than other women. In one very large study (Barber, 2009), 85% of women considered themselves "much better" when compared to before their surgery. Bottom line, surgery of some type can be very helpful if a woman has symptoms from her prolapse.

My mom and her sisters had prolapse; can I do anything to prevent it happening to me?
We cannot change our genetics, age, or number of vaginal births! Sadly there are not many scientific studies testing different forms of POP prevention. The strategies for prevention that are most often suggested include:

• Kegel exercises up to four times daily. The hope is that by strengthening muscles in the pelvic floor that those muscles can help delay, or reduce, the onset of prolapse. For information about how to do Kegels correctly check out this article: Kegel Exercises - Topic Overview


• Physical exercise. Regular exercise can help keep one's body weight down, and being overweight is linked to prolapse. Exercise is also reputed to keep muscles and ligaments more flexible.


• Decrease straining to have a bowel movement. Constipation, or having to bear down, increases pressure in the abdomen which "pushes down" on pelvic organs. Eating a healthy diet with whole grains, fruits, and vegetable not only helps constipation, but can improve body weight.


• Treat chronic coughs. If one is a smoker - quit. If there is another reason for a chronic cough - have it treated. A cough increases the pressure inside the abdomen which can "push down" on pelvic organs. There are studies linking smoking with poorer tissue integrity after POP repair (Araco, 2009).


• Use a correct technique for heavy lifting. Straining to lift increases pressure within the abdomen. Here is a good over view of safe lifting: Back Problems - Proper Lifting


• Hysterectomy surgery considerations. If one is having a hysterectomy there are studies which suggest that attaching the uterine ligaments to the top of the vagina may help to keep the vagina from dropping down (

General Information About Renal Cell Cancer

Renal cell cancer is a disease in which malignant (cancer) cells form in tubules of the kidney.

Renal cell cancer (also called kidney cancer or renal adenocarcinoma) is a disease in which malignant (cancer) cells are found in the lining of tubules (very small tubes) in the kidney. There are 2 kidneys, one on each side of the backbone, above the waist. The tiny tubules in the kidneys filter and clean the blood, taking out waste products and making urine. The urine passes from each kidney into the bladder through a long tube called a ureter. The bladder stores the urine until it is passed from the body.

Cancer that starts in the ureters or the renal pelvis (the part of the kidney that collects urine and drains it to the ureters) is different from renal cell cancer. Refer to the PDQ summary on Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment for more information).

Smoking and misuse of certain pain medicines can affect the risk of developing renal cell cancer.

Risk factors include the following:

• Smoking.
• Misusing certain pain medicines, including over-the-counter pain medicines, for a long time.
• Having certain genetic conditions, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma.

Possible signs of renal cell cancer include blood in the urine and a lump in the abdomen.

These and other symptoms may be caused by renal cell cancer. Other conditions may cause the same symptoms. There may be no symptoms in the early stages. Symptoms may appear as the tumor grows. A doctor should be consulted if any of the following problems occur:

• Blood in the urine.
• A lump in the abdomen.
• A pain in the side that doesn't go away.
• Loss of appetite.
• Weight loss for no known reason.
• Anemia.

Tests that examine the abdomen and kidneys are used to detect (find) and diagnose renal cell cancer.

The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
• Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
• Liver function test: A procedure in which a sample of blood is checked to measure the amounts of enzymes released into it by the liver. An abnormal amount of an enzyme can be a sign that cancer has spread to the liver. Certain conditions that are not cancer may also increase liver enzyme levels.
• Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. To do a biopsy for renal cell cancer, a thin needle is inserted into the tumor and a sample of tissue is withdrawn.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• The stage of the disease.
• The patient's age and general health.

Cancer May Pass From Pregnant Mom to Baby

Researchers Say Cancer Cells May Cross Placenta to Fetus and Cause Disease

Researchers have found new evidence that it's possible for a mother with cancer to pass the disease on to her unborn child.

A case report shows that cancer cells in an infant genetically match those from her mother; the mother was diagnosed with leukemia shortly after a normal full-term delivery.

Researchers say rare cases of mothers' cancer cells in infants have been reported over the last 100 years, which has suggested the possibility that cancer cells may be passed from mother to infant. But until now it had not been confirmed genetically.

In the case report, published in the Proceedings of the National Academy of Sciences, researchers used genetic tracking to prove that the cancer cells had been transmitted from mother to infant.

The mother was a 28-year-old woman who was diagnosed with leukemia shortly after giving birth; her 11-month-old daughter developed a similar type of cancer.

Genetic testing showed the infant's cancer cells shared a unique genetic match to her mother's. Special markers in the cancer cells of the infant confirmed they were of maternal origin.

Additional testing showed that the infant's cancer cells lacked a portion of genetic material that would have flagged them as intruder cells and targeted them for elimination by her immune system.

Researcher Takeshi Isoda of Tokyo Medical and Dental University and colleagues say this genetic trait likely enabled the mother's cancer cells to evade the infant's protective placental barrier.

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Understanding Cancer - Symptoms

What Are the Symptoms of Cancer?

In its early stages, cancer usually has no symptoms, but eventually a malignant tumor will grow large enough to be detected. As it continues to grow, it may press on nerves and produce pain, penetrate blood vessels and cause bleeding, or interfere with the function of a body organ or system.

The Seven Warning Signs of Cancer

To remember the seven early warning signs of cancer (as designated by the American Cancer Society), think of the word CAUTION:

C hange in bowel or bladder habits.

A sore that does not heal.

U nusual bleeding or discharge.

T hickening or lump in the breast, testicles, or elsewhere.

I ndigestion or difficulty swallowing.

O bvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore.

N agging cough or hoarseness.

The following symptoms may also signal the presence of some form of cancer:

• Persistent headaches
• Unexplained loss of weight or appetite
• Chronic pain in bones
• Persistent fatigue, nausea, or vomiting
• Persistent low-grade fever, either constant or intermittent
• Repeated instances of infection

Call Your Doctor About Cancer If:

You develop symptoms that may signal cancer, are not clearly linked to another cause, and persist for more than two weeks. You should schedule a medical examination. If the cause of your symptoms is cancer, early diagnosis and treatment will offer a better chance of cure.

Cancer Information

Do Children have Cancers?

Children do suffer from cancers but cancers are uncommon during childhood. In the developed countries where statistical data are more complete, cancers affect 120-160 per 1,000,000 children under the age of 15 years every year. Approximately one in every 300-500 people will develop cancers before their 20th birthday.

Why do Children Get Cancers?

The answer to this question is still not resolved for most cancers. For any child who suffers from cancer, it is almost impossible to tell why he or she gets cancer.


From a statistical point, we understand that cancers in children may be related to genetic defects, chromosomal aberrations, immune deficiencies, infections like Epstein-Barr virus, Hepatitis B virus and human immunodeficiency virus infections, radiation mishaps, immunosuppressive treatments, or even anticancer treatments.
On the other hand, there is NO or insufficient evidence to associate the following with cancers in children: mother's diet during pregnancy, vitamin K injection given to the newborn infant, vaccinations, electromagnetic field, or power lines near residence.

Are Cancers in Children Similar to Those in Adults?

No, cancers in children are quite unique (see below). Even for cancers of the same type, the biological features and the responses to treatment are very different between children and adults. In general, the outcomes of cancers in children are better than adults. Therefore, it is not appropriate to apply what is known about the cancers in adult to those found in children.

What Investigations are Needed?

Investigations are needed to (a) confirm the diagnosis and classify the cancer type, and (b) define the extent of the disease (staging). The results are important to select the most suitable treatment for the child. In addition to physical evaluation, the child will have blood and urine tests, scans or imaging studies, and part of the tumour tissue will be taken out for microscopic examination (pathological diagnosis). Some children may need a bone marrow biopsy too.

How are Cancers in Children Treated?

After the diagnosis is confirmed and the cancer has been classified and staged, the doctor will decide what the best treatment or combination of treatment that the child would require. The treatment options include surgery, chemotherapy, radiotherapy, and other biologic agents.

Can Children Endure their Treatment?

The answer is yes, but they need good supportive care. The treatment of cancers in children carries both immediate and delayed complications. Some of these complications such as bleeding or infection can be dangerous. It is important that children with cancers should be treated in specialized centres where the medical team is experienced and the facilities are well established.

What are the Outcomes of Treatment?

The outcomes of anticancer treatment in children depend on the primary disease and its extent (see below). On the whole, 70-75% of children diagnosed to date are expected to be long-term survivors (and thus cured), provided that they are treated with contemporary protocols by experienced medical teams with supportive facilities.

Types of cancer

Acute Lymphoblastic Leukaemia (ALL). This is the commonest type of cancer seen in children. Almost 30% of childhood cancers are ALL. The affected child may have fever, bruises, tiring easily, and enlargement of the glands in the neck. Most children with ALL need chemotherapy only; some may require radiation treatment to the brain. On the whole, 75-80% of children can be cured after treatment.
Acute Myeloid Leukaemia (AML). This is an uncommon form of leukaemia. The affected child has symptoms that are similar to those of acute lymphoblastic leukaemia. Most children with AML need chemotherapy only. On the whole, 45-60% of children can be cured after treatment.
Non-Hodgkin Lymphoma (NHL). This is a cancer of the lymphatic glands. The affected child may have fever, tiring easily, and enlargement of the glands in the neck or inside the chest. Some children may complain of difficulty in breathing or abdominal pain. On the whole, over 80% of children can be cured with chemotherapy alone. Only a small proportion of children will need surgery or radiation treatment.
Hodgkin Lymphoma. This is another form of cancer of the lymphatic glands and the symptoms are similar to those of non-Hodgkin Lymphoma. Treatment with chemotherapy, and radiation in some children, results in cure rates of over 80% even in advanced disease.
Brain Tumours. Brain Tumours are the commonest form of solid cancer in children, accounting for 15-20% of the cases. There are different kinds of brain tumours in children and their treatments are not the same. Children with brain tumours may complain of headache, vision problems, vomiting, weakness of one side of the body, unsteadiness in walking, or epilepsy. In general, the affected children will need surgery and often radiation treatment afterwards. Medulloblastomas, a tumour commonly seen in the cerebellum of children, is treated with surgery, radiation and chemotherapy. The chance of cure is 60-70% when the tumour has not spread.


Germ cell tumours inside the brain (intracranial) are more commonly seen in Oriental children. They are peculiar because most of them can be treated with chemotherapy and radiation without the need for complicated surgery. The cure rates range from 60-90% depending on the type of germ cell tumour.
Neuroblastoma. This is a cancer of the adrenal glands inside the abdomen. Occasionally they are found in the nervous tissues inside the neck or the chest. The affected child may have fever, aches in the bones, and distended abdomen. For early disease, the outcome is excellent and more than 90% of the children can be cured. Unfortunately, most children present with advanced disease with spread to other parts of the body. Treatment with surgery, chemotherapy and sometimes radiation is needed. High-dose chemotherapy followed by stem cell transplantation is now part of the standard treatment. Only 10-30% of children can survive long-term.
Wilms Tumour. This is a cancer of the kidneys and most of the affected children present with distention of the abdomen. The standard treatment consists of surgery, chemotherapy and radiation. The outcome is excellent with 80-90% of cure even in advanced disease.
Germ Cell Tumours. This is a cancer of the testis in boys or the ovaries in girls. Sometimes they may occur inside the abdomen, the chest, the neck or at the coccyx near the anus. Some patients may need surgery alone, while others can be treated with only chemotherapy. The cure rates ranged from 75-90% even with advanced diseases.
Rhabdomyosarcoma. This is a cancer of the muscles and it commonly presents as a mass. Any part of the body may be affected. Treatment consists of surgery, chemotherapy and radiation. The long-term cure rates ranged from 70-80% when the disease has not spread.
Osteosarcoma (or Osteogenic Sarcoma). This is a cancer of the bones and commonly present as a swelling in the thigh or leg bones. Treatment consists of surgery and chemotherapy. About 60-70% of children can survive long-term after treatment when the cancer has not spread.
Ewing Sarcoma (or Primitive Neuroectodermal Tumour). This is a cancer of the nervous system that may affect the bones or the soft tissues. The symptoms are therefore similar to those of Rhabdomyosarcoma or Osteosarcoma. Treatment consists of surgery, chemotherapy and radiation. For disease that has not spread, the long-term survival rates are 70-80%.
Hepatoblastoma. This is a cancer of the liver. The affected child usually presents with a distended abdomen. With surgery and chemotherapy, the long-term survival rates are close to 90% for disease that has not spread.
Retinoblastoma. This is a cancer of the eyeball. During the early stage, parents may notice a white reflex (cat's eye reflex) in the affected eye, especially when the child's face is photographed. In early stages, the cancer can be treated by surgery or cryosurgery. For more advanced disease, radiation treatment and chemotherapy may be needed. Long-term survival rates are well above 90% unless the disease has spread beyond the eyeball.

Cancer Information

Do Children have Cancers?

Children do suffer from cancers but cancers are uncommon during childhood. In the developed countries where statistical data are more complete, cancers affect 120-160 per 1,000,000 children under the age of 15 years every year. Approximately one in every 300-500 people will develop cancers before their 20th birthday.

Why do Children Get Cancers?

The answer to this question is still not resolved for most cancers. For any child who suffers from cancer, it is almost impossible to tell why he or she gets cancer.

From a statistical point, we understand that cancers in children may be related to genetic defects, chromosomal aberrations, immune deficiencies, infections like Epstein-Barr virus, Hepatitis B virus and human immunodeficiency virus infections, radiation mishaps, immunosuppressive treatments, or even anticancer treatments.
On the other hand, there is NO or insufficient evidence to associate the following with cancers in children: mother's diet during pregnancy, vitamin K injection given to the newborn infant, vaccinations, electromagnetic field, or power lines near residence.

Are Cancers in Children Similar to Those in Adults?

No, cancers in children are quite unique (see below). Even for cancers of the same type, the biological features and the responses to treatment are very different between children and adults. In general, the outcomes of cancers in children are better than adults. Therefore, it is not appropriate to apply what is known about the cancers in adult to those found in children.

What Investigations are Needed?

Investigations are needed to (a) confirm the diagnosis and classify the cancer type, and (b) define the extent of the disease (staging). The results are important to select the most suitable treatment for the child. In addition to physical evaluation, the child will have blood and urine tests, scans or imaging studies, and part of the tumour tissue will be taken out for microscopic examination (pathological diagnosis). Some children may need a bone marrow biopsy too.

How are Cancers in Children Treated?

After the diagnosis is confirmed and the cancer has been classified and staged, the doctor will decide what the best treatment or combination of treatment that the child would require. The treatment options include surgery, chemotherapy, radiotherapy, and other biologic agents.

Can Children Endure their Treatment?

The answer is yes, but they need good supportive care. The treatment of cancers in children carries both immediate and delayed complications. Some of these complications such as bleeding or infection can be dangerous. It is important that children with cancers should be treated in specialized centres where the medical team is experienced and the facilities are well established.

What are the Outcomes of Treatment?

The outcomes of anticancer treatment in children depend on the primary disease and its extent (see below). On the whole, 70-75% of children diagnosed to date are expected to be long-term survivors (and thus cured), provided that they are treated with contemporary protocols by experienced medical teams with supportive facilities.

Types of cancer

Acute Lymphoblastic Leukaemia (ALL). This is the commonest type of cancer seen in children. Almost 30% of childhood cancers are ALL. The affected child may have fever, bruises, tiring easily, and enlargement of the glands in the neck. Most children with ALL need chemotherapy only; some may require radiation treatment to the brain. On the whole, 75-80% of children can be cured after treatment.
Acute Myeloid Leukaemia (AML). This is an uncommon form of leukaemia. The affected child has symptoms that are similar to those of acute lymphoblastic leukaemia. Most children with AML need chemotherapy only. On the whole, 45-60% of children can be cured after treatment.
Non-Hodgkin Lymphoma (NHL). This is a cancer of the lymphatic glands. The affected child may have fever, tiring easily, and enlargement of the glands in the neck or inside the chest. Some children may complain of difficulty in breathing or abdominal pain. On the whole, over 80% of children can be cured with chemotherapy alone. Only a small proportion of children will need surgery or radiation treatment.
Hodgkin Lymphoma. This is another form of cancer of the lymphatic glands and the symptoms are similar to those of non-Hodgkin Lymphoma. Treatment with chemotherapy, and radiation in some children, results in cure rates of over 80% even in advanced disease.
Brain Tumours. Brain Tumours are the commonest form of solid cancer in children, accounting for 15-20% of the cases. There are different kinds of brain tumours in children and their treatments are not the same. Children with brain tumours may complain of headache, vision problems, vomiting, weakness of one side of the body, unsteadiness in walking, or epilepsy. In general, the affected children will need surgery and often radiation treatment afterwards. Medulloblastomas, a tumour commonly seen in the cerebellum of children, is treated with surgery, radiation and chemotherapy. The chance of cure is 60-70% when the tumour has not spread.

Germ cell tumours inside the brain (intracranial) are more commonly seen in Oriental children. They are peculiar because most of them can be treated with chemotherapy and radiation without the need for complicated surgery. The cure rates range from 60-90% depending on the type of germ cell tumour.
Neuroblastoma. This is a cancer of the adrenal glands inside the abdomen. Occasionally they are found in the nervous tissues inside the neck or the chest. The affected child may have fever, aches in the bones, and distended abdomen. For early disease, the outcome is excellent and more than 90% of the children can be cured. Unfortunately, most children present with advanced disease with spread to other parts of the body. Treatment with surgery, chemotherapy and sometimes radiation is needed. High-dose chemotherapy followed by stem cell transplantation is now part of the standard treatment. Only 10-30% of children can survive long-term.
Wilms Tumour. This is a cancer of the kidneys and most of the affected children present with distention of the abdomen. The standard treatment consists of surgery, chemotherapy and radiation. The outcome is excellent with 80-90% of cure even in advanced disease.
Germ Cell Tumours. This is a cancer of the testis in boys or the ovaries in girls. Sometimes they may occur inside the abdomen, the chest, the neck or at the coccyx near the anus. Some patients may need surgery alone, while others can be treated with only chemotherapy. The cure rates ranged from 75-90% even with advanced diseases.
Rhabdomyosarcoma. This is a cancer of the muscles and it commonly presents as a mass. Any part of the body may be affected. Treatment consists of surgery, chemotherapy and radiation. The long-term cure rates ranged from 70-80% when the disease has not spread.
Osteosarcoma (or Osteogenic Sarcoma). This is a cancer of the bones and commonly present as a swelling in the thigh or leg bones. Treatment consists of surgery and chemotherapy. About 60-70% of children can survive long-term after treatment when the cancer has not spread.
Ewing Sarcoma (or Primitive Neuroectodermal Tumour). This is a cancer of the nervous system that may affect the bones or the soft tissues. The symptoms are therefore similar to those of Rhabdomyosarcoma or Osteosarcoma. Treatment consists of surgery, chemotherapy and radiation. For disease that has not spread, the long-term survival rates are 70-80%.
Hepatoblastoma. This is a cancer of the liver. The affected child usually presents with a distended abdomen. With surgery and chemotherapy, the long-term survival rates are close to 90% for disease that has not spread.
Retinoblastoma. This is a cancer of the eyeball. During the early stage, parents may notice a white reflex (cat's eye reflex) in the affected eye, especially when the child's face is photographed. In early stages, the cancer can be treated by surgery or cryosurgery. For more advanced disease, radiation treatment and chemotherapy may be needed. Long-term survival rates are well above 90% unless the disease has spread beyond the eyeball.

Prostate Cancer - Other Treatment

Radiation therapy

Radiation therapy may be used alone or combined with hormone treatment or surgery to treat prostate cancer. Like surgery, it is most effective in treating cancer that has not spread outside the prostate. When combined with surgery, radiation is used to destroy any cancer cells that might be left behind and to relieve pain when the cancer has spread.

There are two main types of radiation treatment for prostate cancer:

• External beam radiation, in which a machine aims high-energy X-rays or protons at the cancer from outside the body. External radiation also includes conformal radiotherapy, intensity-modulated radiation therapy, and proton therapy.
  • Conformal radiotherapy (3D-CRT) uses a three-dimensional planning system to target a strong dose of radiation to the prostate cancer. This helps to protect healthy tissue from radiation.
  • Intensity-modulated radiation therapy (IMRT) uses a carefully adjusted amount of radiation. This provides even more protection for healthy tissue than conformal radiotherapy.
  • Proton therapy uses a different type of energy (protons) rather than X-rays. This allows a higher amount of specifically directed radiation, which offers the most protection possible to nearby healthy tissue, especially the rectum.¹³ Sometimes proton therapy is combined with X-ray therapy.
• Brachytherapy, in which tiny seeds containing radioactive material are injected directly into or near the cancer and left there. In time, the material loses its radioactivity and the seeds can remain where they are.

Side effects

Radiation treatment may cause erection problems and bladder problems. It sometimes causes diarrhea. The ability to have an erection sometimes returns or at least improves over time. So does the ability to control urination.

Side effects are common. Some men develop long-term problems that may have a big impact on the quality of their lives. Long-term problems that can be caused by radiation treatment include:

• An irritated rectum that can cause an urgent need to pass stool. This is called proctitis.
• An inflamed bladder and urination problems. This is called cystitis.
• An inflamed intestine and diarrhea. This is called enteritis.
• Being unable to have an erection. This is called impotence.
• Being unable to control urination. This is called incontinence.
• Painful urination. This is called dysuria.

Immunotherapy

Researchers also are testing many new ways to treat prostate cancer using the body's immune system to destroy the cancer cells. This type of treatment is called immunotherapy . Much has been learned in the past 20 years about the body's ability to attack prostate cancer cells with help from the outside, and research is still being done in this area. This type of treatment either stimulates your immune system or adds to it, for example, by giving you immune cells from another person.

Complementary therapy

Complementary therapies, such as acupuncture, herbs, biofeedback, meditation, yoga, and vitamins, are sometimes used along with medical treatment. Some people feel that they benefit from some of these therapies.

Before you try a complementary therapy, talk to your doctor about its possible value and side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.

Clinical trials

Clinical trials are being run to find ways to prevent, detect, diagnose, and treat prostate cancer. For example, researchers are studying whether vitamin E and selenium, which is a mineral found in certain foods, can prevent prostate cancer.

Prostate Cancer - Prevention

You can take steps that may lower your chances of getting prostate cancer.¹¹

Eat more low-fat, high-fiber foods, or foods with omega-3 fatty acids, such as:

• Soy products, like tofu and soy beans.
• Tomatoes and foods that contain tomato sauce.
• Vegetables like broccoli, cauliflower, and cabbage.
• Fish, like salmon, albacore tuna, and sardines.
• Walnuts and flaxseed, and their oils.

Researchers are looking into other things that may help prevent prostate cancer. These include:

• Medicines, such as finasteride or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Drinking red wine or green tea.
• Supplements, such as vitamins D and E, and selenium.

Prostate Cancer,Advanced or Metastatic - Topic Overview

Is this topic for you?

This topic is about prostate cancer that has spread or come back after treatment. For information on early cancer of the prostate gland, see the topic Prostate Cancer.

What is prostate cancer?

Prostate cancer is a group of cells that grows faster than normal in a man's prostate gland. It can spread into other areas and kill normal tissue.
The prostate gland sits just below a man's bladder. It makes part of the fluid for semen. In young men, the prostate is about the size of a walnut. It usually grows larger as you grow older.
The cancer may be one of these types:

• Locally advanced prostate cancer. This is cancer that has grown through the outer rim of the prostate and into nearby tissue.
• Metastatic prostate cancer. This is cancer that has spread, or metastasized, to the lymph nodes or other parts of the body.
• Recurrent prostate cancer. This is cancer that has come back after it was treated. The cancer can come back in the prostate, near the prostate, or in another part of the body. If it comes back in another part of the body-often the bones-it is still called prostate cancer, because it started in the prostate.

What causes prostate cancer?
Experts don't know what causes prostate cancer. But they believe that getting older and having a family history of prostate cancer raise your chance of getting it.
What are the symptoms?
Sometimes there are no symptoms of either locally advanced or metastatic prostate cancer.
When they do appear, symptoms of locally advanced prostate cancer include:

• Waking up many times during the night to urinate.
• Having trouble starting your urine stream, having a weaker-than-normal stream, or not being able to urinate at all.
• Having pain or a burning feeling when you urinate.
• Having blood in your urine.
• Having a deep pain or stiffness in your lower back, upper thighs, or hips.

Symptoms of metastatic prostate cancer may include:

• Bone pain.
• Weight loss.
• Swelling in your legs and feet.

How is prostate cancer diagnosed?
Your doctor will do a digital rectal exam, in which he or she puts a gloved, lubricated finger in your rectum to feel your prostate. You may also have a blood test called a prostate-specific antigen (PSA) test. These tests will help find out if you have prostate cancer or if your prostate cancer has come back.
Your doctor also may do a biopsy. In this test, your doctor takes a sample of tissue from your prostate gland or from the area where the cancer may have spread and sends the sample to a lab for testing. A biopsy is the only way to know for sure that you have prostate cancer.

If you have had prostate cancer before, your doctor may also order a bone scan, CT scan, or MRI to see if it has come back or spread.

Finding out that you have cancer can be scary. It may help to talk with your doctor or with other people who have had cancer. Your local American Cancer Society chapter can help you find a support group.

How is it treated?

Choosing treatment for prostate cancer can be confusing. Your choices depend on your overall health, how fast the cancer is growing, and how far it has spread.

Locally advanced prostate cancer may be treated with surgery, radiation therapy, or hormone therapy.

Treatment of metastatic cancer focuses on slowing the spread of the cancer and relieving symptoms, such as bone pain. It also can help you feel better and live longer. Treatment may include hormone therapy, radiation therapy, or chemotherapy.

Prostate Cancer Vaccine Meets Goal

Provenge, an experimental treatment vaccine for advanced prostate cancer, met researchers' goal in a key trial needed for FDA approval.

That news comes from Dendreon, the company that makes Provenge.

"We believe this is truly a breakthrough for the prostate cancer community and a testament to the promise of the field of cancer immunotherapies," Dendreon's president and chief executive officer Mitchell Gold, MD, said in a conference call today.

Provenge is a biologic drug given by infusion to spur the immune system to fight advanced prostate cancer that doesn't respond to anti-androgen treatment.

In 2007, an FDA advisory panel recommended that the FDA approve Provenge. But instead, the FDA requested more information about whether Provenge prolongs survival.

That request led to a new study of 512 men with advanced prostate cancer. Those men had metastatic, androgen-independent prostate cancer, meaning their cancer had spread and wasn't responding to anti-androgen treatment.

In that study, overall survival was significantly better for men taking Provenge than those taking a placebo.

The study's results were "unambiguous" and "very consistent" with previous Provenge trials, Gold says.

Dendreon plans to submit the study's results to the FDA in the fourth quarter of 2009; after that, the FDA will have six months to review the material, Gold says.

"This data supports Provenge being used as front-line treatment in men with metastatic, androgen-independent prostate cancer," says Gold, who notes that no new side effects from Provenge stood out in the study. In previous trials, the most common side effects in men taking Provenge were chills, fever, headache, fatigue, shortness of breath, vomiting, and tremor, mainly at a low level and for one to two days following infusion.

Gold says that those men would first have surgery or some form of local therapy, then anti-androgen therapy if their cancer recurred, and if their PSA levels rose after that, "Provenge would come into play as a potential treatment option for them."

In men with prostate cancer, PSA (prostate-specific androgen) levels are used to gauge the success of prostate cancer treatment.

Dendreon isn't releasing any further details of the study until April 28, when the findings will be presented at the American Urological Association's annual meeting in Chicago.

The technology used to make Provenge may also prove useful against other forms of cancer, Gold says.

American Cancer Society Responds

The American Cancer Society released a statement about today's Provenge news. The statement comes from Otis W. Brawley, MD, chief medical officer at the American Cancer Society.

Dendreon's announcement about the new Provenge study "is reason for optimism about a vaccine that has generated controversy for several years," Brawley says. "We have to respect the scientific process, an important part of which is a full disclosure and careful review and discussion of the data, which the company says will not be released until an upcoming medical meeting."

"One of the most important questions we'll be looking at will be the magnitude of the survival advantage; how much longer the men taking the vaccine lived compared to those on standard therapy," Brawley continues. "As with any new therapy, it will take a detailed analysis to fully understand the impact of this potential new treatment for patients with advanced prostate cancer. We look forward to the presentation of the study at the upcoming meeting."

Urine Test for Lung Cancer?

Researchers Developing Urine Test to Determine Smokers at Highest Risk for Lung Cancer

Researchers are a step closer to developing a simple urine test to identify smokers at high risk of developing lung cancer.

Although the test is still years away, the hope is to spot high-risk people earlier, when there’s still time to prevent or treat the cancer, says Jian-Min Yuan, MD, associate professor of cancer epidemiology at the University of Minnesota.

Early identification will give doctors a chance to step up smoking cessation and screening efforts, he tells WebMD.

“It might motivate smokers who are having trouble quitting” to finally kick the habit, Yuan says.

If that fails, “We can at least have them come in for lung cancer screening every six months,” he says. That way, doctors can catch cancer earlier, when there’s a higher chance it can be treated successfully with surgery, radiation, and/or chemotherapy.

The findings were presented at the annual meeting of the American Association for Cancer Research.

Smoking Causes Lung Cancer

Lung cancer is the leading cancer killer, claiming the lives of more than 160,000 Americans last year, according to the American Cancer Society. 

Smoking tobacco is the major risk factor for lung cancer. In the United States, about 90% of lung cancer deaths in men and nearly 80% of lung cancer deaths in women are from smoking, according to the CDC. People who smoke are 10 to 20 times more likely to get lung cancer or die from lung cancer than people who do not smoke.

But not every smoker develops lung cancer, and there is no way to predict exactly who will develop the disease, says Peter G. Shields, MD, deputy director of the Lombardi Comprehensive Cancer Center in Washington, D.C.

“We all know that the more you smoke, the higher your risk. But only about one in 10 heavy smokers gets lung cancer,” he tells WebMD.

“It’s really remarkable that we have tests for cholesterol and so on, but we don’t have a blood or urine test for smoking,” Shields says.

Developing a Urine Test

In an effort to develop such a test, Yuan and colleagues culled data from two large studies that began about 20 years ago. One, called the Shanghai Cohort Study, involved more than 18,000 men in Shanghai, China. The other, the Singapore Chinese Health Study, included 63,257 men and women of Chinese descent.

At the time of enrollment, urine and blood samples were collected from all the participants and frozen for future use. They were also asked to answer a battery of questions, including whether they smoked, how much they smoked, and for how long they smoked.

For the new analysis, the researchers focused on 245 smokers in the studies who developed lung cancer and 245 smokers who didn’t get cancer.

Then they thawed their urine samples and measured levels of NNAL, a byproduct of one of the most potent tobacco lung carcinogens identified to date.

“When you smoke, you suck in about 60 carcinogens. One of the most potent, called NNK, breaks down and becomes NNAL in the body,” Yuan says.

NNAL has been shown to induce lung cancer in laboratory animals, but the effect in humans had not yet been studied, he says.

Then the smokers were divided into three groups based on their levels of NNAL in the urine.

Compared with those with the lowest levels, people with a mid-range level of NNAL had a 43% increased risk of lung cancer. Those with the highest levels had more than twice the risk of lung cancer.

Then the researchers measured a byproduct of nicotine, called cotinine, in the urine.

Smokers with the highest levels of both cotinine and NNAL had an 8.5-fold increase in the risk of lung cancer compared with smokers who had the lowest levels.

The findings held true even after taking into account the number of cigarettes smoked per day, the number of years of smoking, and other factors.

The next step is to measure another tobacco-carcinogen byproduct called PAH in the participants’ urine and look at whether high levels of all three chemicals even further raises risk, Yuan says.

“The idea is to build up a risk model that incorporates many of these biomarkers as well as smoking history, so we can best identify which smokers will eventually develop lung cancer,” he says.