Hand Skin Cancer Symptoms

Hand Skin Cancer Symptoms
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Skin cancer: Signs and symptoms
The most common warning sign of skin cancer is a change to your skin.
And the most common change is something growing on your skin. This growth can appear on the skin in many ways. The following explains the signs (what you see) and symptoms (what you feel) of the most common types of skin cancer.

Basal cell carcinoma (BCC)
This is the most common type of skin cancer. It most often appears on skin that gets lot of sun, such as the face, scalp, neck, hands, and arms. You will find BCCs on other parts of the body, too. It can appear on parts of the body that did not get lots of sun, such as the genitals.

BCC often grows slowly. It may look like a:
Reddish patch of dry skin that won’t heal
Flesh-colored (or pink, red, or brown) pearl-shaped lump
Pimple that just won’t clear
Sore that bleeds, heals, and then returns
Scar that feels waxy — may be skin-colored, white, or yellow
Group of slow-growing, shiny pink or red growths — look like sores, often scaly and bleed easily
Flat or sunken growth — feels hard, may be white or yellow

Basal cell carcinoma. This skin cancer appears in many shapes and sizes.

Squamous cell carcinoma (SCC)

This is a very common type of skin cancer. It often appears on skin that got lots of sun, such as an ear, face, bald scalp, neck, or arm. But it can appear elsewhere — even inside the mouth, on the lip, or on the genitals. 

Too much sun is often the cause, but it is not the only cause. SCC can appear on skin that was badly burned, had lots of radiation (such as x-rays), or was exposed to strong chemicals.

SCC often has a reddish color. Without treatment, it can grow deeply. If this happens, the cancer can spread to other parts of the body. This can be deadly. SCC often looks like a:

Hard (scaly or crusty) reddish bump, patch, or pearl-shaped growth

Open sore that itches and bleeds; it can heal and return

Scaly patch on the lip; skin on the lip can get thick

Squamous cell carcinoma. These patients all have forms of squamous cell carcinoma.

Melanoma

Know where you have moles on your skin! Melanoma often appears in an existing mole or looks like a new mole. By knowing where you have moles on your skin, you can find melanoma when it first appears. When treated early, melanoma is often curable. 

Here’s what to looks for:

A mole on the skin that is growing, changing shape, or changing color

A mole that looks scaly, oozes, or bleeds

New dark spot on the skin that looks like a mole, but grows quickly

Pain, itch, or bleeding in a new spot on the skin

Streak (usually brown or black) underneath a fingernail or toenail

Bruise on the foot that does not heal

Melanoma. Like other types of skin cancer, melanoma appears in many ways.

Learn more about skin cancer:

Skin cancer

Skin cancer: Who gets and causes

Skin cancer: Diagnosis, treatment, and outcome

Skin Cancer: Tips for preventing and finding

Types of skin cancer:

Actinic keratoses (AKs)

Basal cell carcinoma (BCC)

Melanoma

Squamous cell carcinoma (SCC)

Merkel cell carcinoma (MCC)

Sebaceous carcinoma

Dermatofibrosarcoma protuberans (DFSP)

Related resources:

Body Mole Map (tracking tool)

Free skin cancer screenings

SPOT Skin Cancer

Neck Cancer Symtoms

Neck Cancer Symtoms
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1.What are cancers of the head and neck?

Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example, inside the mouth, the nose, and the throat). These squamous cell cancers are often referred to as squamous cell carcinomas of the head and neck. Head and neck cancers can also begin in the salivary glands, but salivary gland cancers are relatively uncommon. Salivary glands contain many different types of cells that can become cancerous, so there are many different types of salivary gland cancer.

Cancers of the head and neck are further categorized by the area of the head or neck in which they begin. These areas are described below and labeled in the image of head and neck cancer regions.

Oral cavity: Includes the lips, the front two-thirds of the tongue, the gums, the lining inside the cheeks and lips, the floor (bottom) of the mouth under the tongue, the hard palate (bony top of the mouth), and the small area of the gum behind the wisdom teeth.

Pharynx: The pharynx (throat) is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus. It has three parts: the nasopharynx (the upper part of the pharynx, behind the nose); the oropharynx (the middle part of the pharynx, including the soft palate [the back of the mouth], the base of the tongue, and the tonsils); the hypopharynx (the lower part of the pharynx).

Larynx: The larynx, also called the voicebox, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages.

Paranasal sinuses and nasal cavity: The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.

Salivary glands: The major salivary glands are in the floor of the mouth and near the jawbone. The salivary glands produce saliva.

Head and neck cancer regions. Illustrates location of paranasal sinuses, nasal cavity, oral cavity, tongue, salivary glands, larynx, and pharynx (including the nasopharynx, oropharynx, and hypopharynx). 

Cancers of the brain, the eye, the esophagus, and the thyroid gland, as well as those of the scalp, skin, muscles, and bones of the head and neck, are not usually classified as head and neck cancers.

Sometimes, cancerous squamous cells can be found in the lymph nodes of the upper neck when there is no evidence of cancer in other parts of the head and neck (1). When this happens, the cancer is called metastatic squamous neck cancer with unknown (occult) primary. More information about this cancer type can be found in Metastatic Squamous Neck Cancer with Occult Primary (PDQ®).

2.What causes cancers of the head and neck?

Alcohol and tobacco use (including smokeless tobacco, sometimes called “chewing tobacco” or “snuff”) are the two most important risk factors for head and neck cancers, especially cancers of the oral cavity, oropharynx, hypopharynx, and larynx (2–5). At least 75 percent of head and neck cancers are caused by tobacco and alcohol use (6). People who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone (6–8). Tobacco and alcohol use are not risk factors for salivary gland cancers.

Infection with cancer-causing types of human papillomavirus (HPV), especially HPV-16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue (9–11). In the United States, the incidence of oropharyngeal cancers caused by HPV infection is increasing, while the incidence of oropharyngeal cancers related to other causes is falling (9). More information is available in the HPV and Cancer fact sheet.

Other risk factors for cancers of the head and neck include the following:

Paan (betel quid). Immigrants from Southeast Asia who use paan (betel quid) in the mouth should be aware that this habit has been strongly associated with an increased risk of oral cancer (12, 13).

Maté. Consumption of maté, a tea-like beverage habitually consumed by South Americans, has been associated with an increased risk of cancers of the mouth, throat, esophagus, and larynx (13, 14).

Preserved or salted foods. Consumption of certain preserved or salted foods during childhood is a risk factor for nasopharyngeal cancer (15, 16).

Oral health. Poor oral hygiene and missing teeth may be weak risk factors for cancers of the oral cavity (17, 18). Use of mouthwash that has a high alcohol content is a possible, but not proven, risk factor for cancers of the oral cavity (17, 18).

Occupational exposure. Occupational exposure to wood dust is a risk factor for nasopharyngeal cancer (15, 16). Certain industrial exposures, including exposures to asbestos and synthetic fibers, have been associated with cancer of the larynx, but the increase in risk remains controversial (19). People working in certain jobs in the construction, metal, textile, ceramic, logging, and food industries may have an increased risk of cancer of the larynx (20). Industrial exposure to wood or nickel dust or formaldehyde is a risk factor for cancers of the paranasal sinuses and nasal cavity (21–23).

Radiation exposure. Radiation to the head and neck, for noncancerous conditions or cancer, is a risk factor for cancer of the salivary glands (17, 24, 25).

Epstein-Barr virus infection. Infection with the Epstein-Barr virus is a risk factor for nasopharyngeal cancer (26) and cancer of the salivary glands (27, 28).

Ancestry. Asian ancestry, particularly Chinese ancestry, is a risk factor for nasopharyngeal cancer (15, 16).

3.What are the symptoms of head and neck cancers?

The symptoms of head and neck cancers may include a lump or a sore that does not heal, a sore throat that does not go away, difficulty in swallowing, and a change or hoarseness in the voice. These symptoms may also be caused by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms. Symptoms that may affect specific areas of the head and neck include the following:

Oral cavity. A white or red patch on the gums, the tongue, or the lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.

Pharynx. Trouble breathing or speaking; pain when swallowing; pain in the neck or the throat that does not go away; frequent headaches, pain, or ringing in the ears; or trouble hearing.

Larynx. Pain when swallowing or ear pain.

Paranasal sinuses and nasal cavity. Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; bleeding through the nose; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; or problems with dentures.

Salivary glands. Swelling under the chin or around the jawbone, numbness or paralysis of the muscles in the face, or pain in the face, the chin, or the neck that does not go away.

4.How common are head and neck cancers?

Head and neck cancers account for approximately 3 percent of all cancers in the United States (29). These cancers are nearly twice as common among men as they are among women (30). Head and neck cancers are also diagnosed more often among people over age 50 than they are among younger people.

Researchers estimated that more than 52,000 men and women in this country would be diagnosed with head and neck cancers in 2012 (30).

5.How can I reduce my risk of developing head and neck cancers?

People who are at risk of head and neck cancers―particularly those who use tobacco―should talk with their doctor about ways that they may be able to reduce their risk. They should also discuss with their doctor how often to have checkups. In addition, ongoing clinical trials are testing the effectiveness of various medications in preventing head and neck cancers in people who have a high risk of developing these diseases. A list of these trials can be found at the link below.

Clinical Trials To Prevent Head and Neck Cancers

Information specialists from NCI’s Cancer Information Service (CIS) can also help people find clinical trials for the prevention of head and neck cancers. The CIS can be reached at 1–800–4–CANCER (1–800–422–6237) or by chatting with a cancer information specialist online through LiveHelp.

Avoiding oral HPV infection may reduce the risk of HPV-associated head and neck cancers. However, it is not yet known whether the Food and Drug Administration-approved HPV vaccines Gardasil® and Cervarix® prevent HPV infection of the oral cavity, and neither vaccine has yet been approved for the prevention of oropharyngeal cancer. More information about these vaccines is in the NCI fact sheet Human Papillomavirus (HPV) Vaccines.

6.How are head and neck cancers diagnosed?

To find the cause of the signs or symptoms of a problem in the head and neck area, a doctor evaluates a person’s medical history, performs a physical examination, and orders diagnostic tests. The exams and tests may vary depending on the symptoms. Examination of a sample of tissue under a microscope is always necessary to confirm a diagnosis of cancer.

More information about the specific tests and procedures used to diagnose cancer is available in What You Need To Know About™ Cancer: Diagnosis.

If the diagnosis is cancer, the doctor will want to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Staging may involve an examination under anesthesia (in an operating room), x-rays and other imaging procedures, and laboratory tests. Knowing the stage of the disease helps the doctor plan treatment.

7.How are head and neck cancers treated?

The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person’s age and general health. Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of treatments. General information about treatment options for cancer is available in What You Need To Know About™ Cancer: Treatment.

People who are diagnosed with HPV-positive oropharyngeal cancer may be treated differently than people with oropharyngeal cancers that are HPV-negative. Recent research has shown that patients with HPV-positive oropharyngeal tumors have a better prognosis and may do just as well on less intense treatment. An ongoing clinical trial is investigating this question.

More information about treatment for specific types of head and neck cancers is in the following PDQ® cancer treatment summaries, which are available in patient and health professional versions, as well as in Spanish (the links below go to the patient versions in English):

Hypopharyngeal Cancer

Laryngeal Cancer

Lip and Oral Cavity Cancer

Metastatic Squamous Neck Cancer with Occult Primary

Nasopharyngeal Cancer

Oropharyngeal Cancer

Paranasal Sinus and Nasal Cavity Cancer

Salivary Gland Cancer

The patient and the doctor should consider treatment options carefully. They should discuss each type of treatment and how it might change the way the patient looks, talks, eats, or breathes.

8.What are the side effects of treatment?

Surgery for head and neck cancers often changes the patient’s ability to chew, swallow, or talk. The patient may look different after surgery, and the face and neck may be swollen. The swelling usually goes away within a few weeks. However, if lymph nodes are removed, the flow of lymph in the area where they were removed may be slower and lymph could collect in the tissues, causing additional swelling; this swelling may last for a long time.

After a laryngectomy (surgery to remove the larynx) or other surgery in the neck, parts of the neck and throat may feel numb because nerves have been cut. If lymph nodes in the neck were removed, the shoulder and neck may become weak and stiff.

Patients who receive radiation to the head and neck may experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. Other problems that may occur during treatment are loss of taste, which may decrease appetite and affect nutrition, and earaches (caused by the hardening of ear wax). Patients may also notice some swelling or drooping of the skin under the chin and changes in the texture of the skin. The jaw may feel stiff, and patients may not be able to open their mouth as wide as before treatment.

Patients should report any side effects to their doctor or nurse, and discuss how to deal with them. Information about rehabilitation after surgery for head and neck cancer can be found in the answer to Question 10.

Where can I find more information about clinical trials for patients with head and neck cancers?

Clinical trials are research studies conducted with people who volunteer to take part. Participation in clinical trials is an option for many patients with head and neck cancer. A list of clinical trials to treat head and neck cancers can be found at the link below.

Clinical Trials To Treat Head and Neck Cancers

People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available in the NCI booklet Taking Part in Cancer Treatment Research Studies. This booklet describes how research studies are carried out and explains their possible benefits and risks.

NCI provides information about specific clinical trials for people who have head and neck cancers. Questions about these trials can be answered by NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237), or by chatting with a cancer information specialist online through LiveHelp.

What rehabilitation or support options are available for patients with head and neck cancers?

The goal of treatment for head and neck cancers is to control the disease, but doctors are also concerned about preserving the function of the affected areas as much as they can and helping the patient return to normal activities as soon as possible after treatment. Rehabilitation is a very important part of this process. The goals of rehabilitation depend on the extent of the disease and the treatment that a patient has received.

Depending on the location of the cancer and the type of treatment, rehabilitation may include physical therapy, dietary counseling, speech therapy, and/or learning how to care for a stoma. A stoma is an opening into the windpipe through which a patient breathes after a laryngectomy, which is surgery to remove the larynx. The National Library of Medicine has more information about laryngectomy in MedlinePlus.

Sometimes, especially with cancer of the oral cavity, a patient may need reconstructive and plastic surgery to rebuild bones or tissues. However, reconstructive surgery may not always be possible because of damage to the remaining tissue from the original surgery or from radiation therapy. If reconstructive surgery is not possible, a prosthodontist may be able to make a prosthesis (an artificial dental and/or facial part) to restore satisfactory swallowing, speech, and appearance. Patients will receive special training on how to use the device.

Patients who have trouble speaking after treatment may need speech therapy. Often, a speech-language pathologist will visit the patient in the hospital to plan therapy and teach speech exercises or alternative methods of speaking. Speech therapy usually continues after the patient returns home.

Eating may be difficult after treatment for head and neck cancer. Some patients receive nutrients directly into a vein after surgery or need a feeding tube until they can eat on their own. A feeding tube is a flexible plastic tube that is passed into the stomach through the nose or an incision in the abdomen. A nurse or speech-language pathologist can help patients learn how to swallow again after surgery. The NCI booklet Eating Hints: Before, During, and After Cancer Treatment contains many useful suggestions and recipes.

9.Is follow-up care necessary? What does it involve?

Regular follow-up care is very important after treatment for head and neck cancer to make sure that the cancer has not returned, or that a second primary (new) cancer has not developed. Depending on the type of cancer, medical checkups could include exams of the stoma, if one has been created, and of the mouth, neck, and throat. Regular dental exams may also be necessary.

From time to time, the doctor may perform a complete physical exam, blood tests, x-rays, and computed tomography (CT), positron emission tomography (PET), or magnetic resonance imaging (MRI) scans. The doctor may monitor thyroid and pituitary gland function, especially if the head or neck was treated with radiation. Also, the doctor is likely to counsel patients to stop smoking. Research has shown that continued smoking by a patient with head and neck cancer may reduce the effectiveness of treatment and increase the chance of a second primary cancer (see Question 12).

Additional information can be found in the NCI fact sheet Follow-up Care After Cancer Treatment.

10.How can people who have had head and neck cancers reduce their risk of developing a second primary (new) cancer?

People who have been treated for head and neck cancers have an increased chance of developing a new cancer, usually in the head, neck, esophagus, or lungs (31–33). The chance of a second primary cancer varies depending on the site of the original cancer, but it is higher for people who use tobacco and drink alcohol (31).

Especially because patients who smoke have a higher risk of a second primary cancer, doctors encourage patients who use tobacco to quit. Information about tobacco cessation is available from NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) and in the NCI fact sheet Where To Get Help When You Decide To Quit Smoking. The federal government’s main resource to help people quit using tobacco is BeTobaccoFree.gov.The government also sponsors Smokefree Women, a website to help women quit using tobacco, and Smokefree Teen, which is designed to help teens understand the decisions they make and how those decisions fit into their lives. The toll-free number 1–800–QUIT–NOW (1–800–784–8669) also serves as a single point of access to state-based telephone quitlines.

Selected References

Mendenhall WM, Mancuso AA, Amdur RJ, et al. Squamous cell carcinoma metastatic to the neck from an unknown head and neck primary site. American Journal of Otolaryngology 2001; 22(4):281–287. [PubMed Abstract]

Gandini S, Botteri E, Iodice S, et al. Tobacco smoking and cancer: a meta-analysis. International Journal of Cancer 2008; 122(1):155–164. [PubMed Abstract]

Hashibe M, Boffetta P, Zaridze D, et al. Evidence for an important role of alcohol- and aldehyde-metabolizing genes in cancers of the upper aerodigestive tract. Cancer Epidemiology, Biomarkers and Prevention 2006; 15(4):696–703. [PubMed Abstract]

Hashibe M, Brennan P, Benhamou S, et al. Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Journal of the National Cancer Institute 2007; 99(10):777–789. [PubMed Abstract]

Boffetta P, Hecht S, Gray N, Gupta P, Straif K. Smokeless tobacco and cancer. The Lancet Oncology 2008; 9(7):667–675. [PubMed Abstract]

Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Research 1988; 48(11):3282–3287. [PubMed Abstract]

Tuyns AJ, Estève J, Raymond L, et al. Cancer of the larynx/hypopharynx, tobacco and alcohol: IARC international case-control study in Turin and Varese (Italy), Zaragoza and Navarra (Spain), Geneva (Switzerland) and Calvados (France). International Journal of Cancer 1988; 41(4):483–491. [PubMed Abstract]

Hashibe M, Brennan P, Chuang SC, et al. Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiology, Biomarkers and Prevention 2009; 18(2):541–550. [PubMed Abstract]

Chaturvedi AK, Engels EA, Pfeiffer RM, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. Journal of Clinical Oncology 2011; 29(32):4294–4301. [PubMed Abstract]

Adelstein DJ, Ridge JA, Gillison ML, et al. Head and neck squamous cell cancer and the human papillomavirus: summary of a National Cancer Institute State of the Science Meeting, November 9–10, 2008, Washington, D.C. Head and Neck 2009; 31(11):1393–1422. [PubMed Abstract]

Gillison ML, D’Souza G, Westra W, et al. Distinct risk factors profiles for human papillomavirus type 16-positive and human papillomavirus type-16 negative head and neck cancers. Journal of the National Cancer Institute 2008; 100(6):407–420. [PubMed Abstract]

Ho PS, Ko YC, Yang YH, Shieh TY, Tsai CC. The incidence of oropharyngeal cancer in Taiwan: an endemic betel quid chewing area. Journal of Oral Pathology and Medicine 2002; 31(4):213–219. [PubMed Abstract]

Goldenberg D, Lee J, Koch WM, et al. Habitual risk factors for head and neck cancer. Otolaryngology and Head and Neck Surgery 2004; 131(6):986–993. [PubMed Abstract]

Goldenberg D, Golz A, Joachims HZ. The beverage maté: a risk factor for cancer of the head and neck. Head and Neck 2003; 25(7):595–601. [PubMed Abstract]

Yu MC, Yuan JM. Nasopharyngeal Cancer. In: Schottenfeld D, Fraumeni JF Jr., editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006.

Yu MC, Yuan JM. Epidemiology of nasopharyngeal carcinoma. Seminars in Cancer Biology 2002; 12(6):421–429. [PubMed Abstract]

Mayne ST, Morse DE, Winn DM. Cancers of the Oral Cavity and Pharynx. In: Schottenfeld D, Fraumeni JF Jr., editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006.

Guha N, Boffetta P, Wünsch Filho V, et al. Oral health and risk of squamous cell carcinoma of the head and neck and esophagus: results of two multicentric case-control studies. American Journal of Epidemiology 2007; 166(10):1159–1173. [PubMed Abstract]

Olshan AF. Cancer of the Larynx. In: Schottenfeld D, Fraumeni JF Jr., editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006.

Boffetta P, Richiardi L, Berrino F, et al. Occupation and larynx and hypopharynx cancer: an international case-control study in France, Italy, Spain, and Switzerland. Cancer Causes and Control 2003; 14(3):203–212. [PubMed Abstract]

Littman AJ, Vaughan TL. Cancers of the Nasal Cavity and Paranasal Sinuses. In: Schottenfeld D, Fraumeni JF Jr., editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006.

Luce D, Leclerc A, Bégin D, et al. Sinonasal cancer and occupational exposures: a pooled analysis of 12 case-control studies. Cancer Causes and Control 2002; 13(2):147–157. [PubMed Abstract]

Luce D, Gérin M, Leclerc A, et al. Sinonasal cancer and occupational exposure to formaldehyde and other substances. International Journal of Cancer 1993; 53(2):224–231. [PubMed Abstract]

Preston-Martin S, Thomas DC, White SC, Cohen D. Prior exposure to medical and dental x-rays related to tumors of the parotid gland. Journal of the National Cancer Institute 1988; 80(12):943–949. [PubMed Abstract]

Horn-Ross PL, Ljung BM, Morrow M. Environmental factors and the risk of salivary gland cancer. Epidemiology 1997; 8(4):414–429. [PubMed Abstract]

Chien YC, Chen JY, Liu MY, et al. Serologic markers of Epstein-Barr virus infection and nasopharyngeal carcinoma in Taiwanese men. New England Journal of Medicine 2001; 345(26):1877–1882. [PubMed Abstract]

Hamilton-Dutoit SJ, Therkildsen MH, Neilsen NH, et al. Undifferentiated carcinoma of the salivary gland in Greenlandic Eskimos: demonstration of Epstein-Barr virus DNA by in situ nucleic acid hybridization. Human Pathology 1991; 22(8):811–815. [PubMed Abstract]

Chan JK, Yip TT, Tsang WY, et al. Specific association of Epstein-Barr virus with lymphoepithelial carcinoma among tumors and tumorlike lesions of the salivary gland. Archives of Pathology and Laboratory Medicine 1994; 118(10):994–997. [PubMed Abstract]

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American Cancer Society (2012). Cancer Facts and Figures 2012 Exit Disclaimer. Atlanta, GA: American Cancer Society. Retrieved December 26, 2012.

Do KA, Johnson MM, Doherty DA, et al. Second primary tumors in patients with upper aerodigestive tract cancers: joint effects of smoking and alcohol (United States). Cancer Causes and Control 2003; 14(2):131–138. [PubMed Abstract]

Argiris A, Brockstein BE, Haraf DJ, et al. Competing causes of death and second primary tumors in patients with locoregionally advanced head and neck cancer treated with chemoradiotherapy. Clinical Cancer Research 2004; 10(6)1956–1962. [PubMed Abstract]

Chuang SC, Scelo G, Tonita JM, et al. Risk of second primary cancer among patients with head and neck cancers: a pooled analysis of 13 cancer registries. International Journal of Cancer 2008; 123(10):2390–2396. [PubMed Abstract]

Mouth Cancer From Smoking Cigarettes

Mouth Cancer From Smoking Cigarettes
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Smoking is the single biggest cause of cancer in the world
Experts agree that smoking is the single biggest cause of cancer in the world. 1-3 Smoking causes over a quarter of cancer deaths in developed countries and nearly one in five cancer cases. 4, 5

Around half of current smokers will be killed by their habit if they continue to smoke. And 25-40% of smokers will die in middle age 6, 7

Smoking causes even more deaths from other respiratory diseases and heart conditions than from cancer. 2 If current trends continue, scientists estimate that tobacco will kill about one billion people in the twenty-first century. 2

Smoking greatly increases the risk of lung cancer
A 2011 study found that more than four in five lung cancers are caused by smoking. 5 In 2002, lung cancer killed around 33,600 people - about one person every 15 minutes. 9

Tobacco smoke was first shown to cause lung cancer in 1950. 10 This study found that people who smoked 15-24 cigarettes a day had 26 times the lung cancer risk of non-smokers. And people who smoked less than 15 cigarettes a day still had 8 times the lung cancer risk of non-smokers.

After these first results came out, UK scientists began a large study of smoking in British doctors, which Cancer Research UK has helped to fund. 11 This  British Doctors’ Study has provided much of our current knowledge about the dangers of smoking.

The people with the highest lung cancer risks are those who:
smoke the most cigarettes per day
smoke over long periods of time, and
start smoking young
We cannot exactly calculate a person’s lung cancer risk based on how many cigarettes they smoke or the number years they have been a smoker. But studies have shown that lung cancer risk is greatest among those who smoke the most cigarettes over the longest period of time. 2

The length of time spent smoking seems to be the more important of these two factors. The British Doctors’ Study found that people who had smoked for 45 years had 100 times the lung cancer risk of people who had smoked for 15 years, regardless of whether they smoked heavily or moderately. 12. And smoking one packet a day for 40 years is about 8 times more dangerous than smoking two packets a day for 20 years. 9

Even light or irregular smoking can increase the risk of cancer. One study found that even people who smoked 1-4 cigarettes a day had much greater risks of dying from lung cancer or heart disease, 11 while another found that even people who smoke just 2 cigarettes a day are more likely to develop cancers of the mouth and oesophagus (food pipe). 14 And the EPIC study found that occasional smokers who have never smoked daily, still have higher risks of most cancers, and double the risk of bladder cancer. 15

Starting smoking at an early age increases the risk of cancer even more. One study found that young smokers are especially vulnerable to DNA damage caused by chemicals in cigarette smoke. And when they quit, they have higher levels of DNA damage than people who started smoking later in life. 16

Smoking is a major cause of several types of cancer
Smoking also increases your risk of cancers of the bladder, cervix, kidney, larynx (voice box), pharynx (upper throat), nose, mouth, oesophagus (foodpipe), pancreas, stomach, liver and some types of leukaemia. 2, 3, 17 And smokers are 7 times more likely to die of these cancer than non-smokers. 18

There is some evidence that smoking could also cause other cancers including bowel cancer and Hodgkin’s lymphoma. 19, 20

Smoking is the most important preventable cause of bladder cancer and causes more than one in three cases in the UK. 5 It increases the risk of this disease by 3-5 times. 21
Smoking doubles the risk of kidney cancer, and causes a quarter of cases in the UK. 22, 5
Smoking is the number one cause of mouth and oesophageal cancers, and together with alcohol, causes about three in four cases of these cancers in the UK. 5 By the age of 75, a non-smoker has a 1 in 125 chance of developing these cancers, but a smoker’s odds are 1 in 16. 24
Smoking is the most important preventable cause of pancreatic cancer, one of the most dangerous types of cancer in the UK. It causes over a quarter of pancreatic cancer cases. 5, 25
Smoking is an important preventable cause of stomach cancer and causes over one in five cases in the UK. 5
There is some evidence to suggest that smoking may increase the risk of breast cancer, bowel cancer and lymphomas but more research will be needed to say for sure. 27-30

Stopping smoking can reduce your risk
A large number of studies have shown that stopping smoking can greatly reduce the risk of smoking-related cancers. 2 And the earlier you stop, the better. The last results from the Doctors’ Study show that stopping smoking at 50 halved the excess risk of cancer overall, while stopping at 30 avoided almost all of it. 11

However, it’s never too late to quit. One study found that even people who quit in their sixties can experience health benefits and gain valuable years of life. 31

The effects of stopping vary depending on the cancer. For example, ten years after stopping, a person’s risk of lung cancer falls to about half that of a smoker. 32 And the increased oral and laryngeal cancer risks practically disappear within ten years of stopping. 2 But the risks of bladder cancer are still higher than normal 20 years after stopping. 21

Cutting down the number of cigarettes you smoke slightly reduces your risk of lung cancer, 33 but you’ll only experience the full health benefits if you stop altogether. One study found that even smokers who halved the number of cigarettes they smoked had similar risks of dying from heart disease and only slightly lower risks of dying from cancer. 34

Tobacco smoke contains many dangerous chemicals
Scientists have identified about 4,000 different chemicals in tobacco smoke. According to the International Agency for Research into Cancer, more than 70 of these chemicals could cause cancer 94. Many of the other thousands of chemicals are toxic and harmful to your health, including carbon monoxide, hydrogen cyanide and ammonia. 2, 35

One study compared the amounts of cancer-causing chemicals in tobacco smoke with their ability to cause cancer. It concluded that the chemicals in smoke most likely to increase our risk of cancer include 1,3-butadiene, arsenic, benzene and cadmium. 36

Cigarettes contain at least 599 different additives including chocolate, vanilla, sugar, liquorice, herbs and spices. These are not toxic but they make cigarettes taste nicer and ensure that smokers want to continue smoking. 37

Tobacco smoke contains significant amounts of dangerous chemicals
Carbon monoxide is the fourth most common chemical in tobacco smoke and can make up 3-5% of its volume. 35 Many of the other toxins are present in lower amounts, but some can still cause major damage at low concentrations. 38

Even single poisons can lead to substantial cancer risks. For example, benzene is a known cause of leukaemia. One study estimated that the benzene in cigarettes is responsible for between 10-50% of the leukaemia deaths caused by smoking. 39

Some studies have suggested that radioactive polonium-210 could account for much of the lung cancer risk caused by smoking. Polonium-210 becomes concentrated in hotspots in smokers' airways, subjecting them to very high doses of high-energy alpha-radiation. 40, 41 One study estimated that smoking 1.5 packs a day leads to as much radiation exposure as having 300 chest X-rays a year. 42

Chemicals in tobacco smoke can build up to harmful amounts
Many tobacco poisons disable the cleaning systems that our bodies use to remove toxins. Cadmium overwhelms cleaner enzymes that mop up toxins and convert them into more harmless forms 43. And many gases such as hydrogen cyanide and ammonia kill cilia, tiny hairs in our airways that help to clear away toxins 44.

So over time, tobacco poisons can build up to high levels in our blood, substantially increasing our risks of cancer and other diseases. By comparing the levels of toxins in smokers and non-smokers, some studies have found that smokers can have:

twice as much cadmium in their blood 45
four times as much polonium-210 in their lungs 46
ten times as much benzene in their breath . 47
ten times as much arsenic in their blood.
For most of us, much of our exposure to cancer-causing chemicals like benzene, formaldehyde, cadmium and nitrosamines comes from breathing in tobacco smoke. 35, 48, 49 For example, one study found that smoking households have four times as much benzene in the air as non-smoking households 50.

The chemicals in smoke are more dangerous in combination than individually
The cocktail of chemicals in tobacco smoke is even more dangerous as a mix.

Chemicals such as nitrosamines, benzo(a)pyrene, benzene, acrolein, cadmium and polonium-210 can damage DNA. Studies have shown that benzo[a]pyrene damages a gene called p53 that normally protects our cells from cancer. 51

One study found that chromium makes PAHs stick more strongly to DNA increasing the chances of serious DNA damage 52. Others have found that chemicals like arsenic, cadmium and nickel stop our cells from repairing DNA damage. 53 This worsens the effects of chemicals like benzo(a)pyrene and makes it even more likely that damaged cells will eventually turn cancerous.

The poisons in cigarettes can affect almost every organ in the body
The many toxins in tobacco smoke can harm many different parts of your body.

Many tobacco poisons can damage your heart and its blood vessels. By comparing the amounts and strengths of different chemicals, one study found that hydrogen cyanide and arsenic alone can cause major damage to our bodies’ blood network. 36

Acrolein, acetaldehyde and formaldehyde are most likely to cause diseases in our lungs and airways. 36 Gases like hydrogen sulphide and pyridine can also irritate our airways 35, radioactive polonium-210 deposits damage surrounding cells, and nitrogen oxide constricts the airways, making breathing more difficult. 54

A protein called haemoglobin carries oxygen round our bloodstream. But carbon monoxide and nitrogen oxide stick more strongly to haemoglobin than oxygen, and reduces the levels of oxygen in our blood. This starves our organs of this vital gas. 35

Toluene can interfere with the development of brain cells. It also disrupts the insulating sheath that surround nerve cells, making them less efficient at carrying signals. 55, 56

Nicotine is a very addictive drug
The Royal College of Physicians compared nicotine to other supposedly ‘harder’ drugs such as heroin and cocaine. They looked at many things including how these drugs cause addiction, how difficult it is to stop using them, and how many deaths they caused. The panel concluded that nicotine causes addiction in much the same way as heroin or cocaine and is just as addictive, if not more so, than these ‘harder’ drugs. 57

Smokers associate smoking with feeling good because nicotine makes the brain release dopamine - a chemical linked to feelings of pleasure. 57 Smokers can also make mental links between abstract things like the taste of cigarettes or the feeling of smoking. These behaviours can become just as addictive as the nicotine itself. 58

Smokers are still exposed to dangerous chemicals if they smoke filtered or ‘low-tar’ cigarettes
Filters do not block out the many toxic gases in smoke, such as hydrogen cyanide, ammonia and carbon monoxide. They also do nothing to reduce levels of sidestream smoke from the burning end of the cigarette.

Some of the most dangerous chemicals in tobacco smoke, like hydrogen cyanide, are present as gases, and do not count as part of tar. This means that cigarettes with less tar are not necessarily any less dangerous. 36

Besides, researchers have found that people who smoked low-tar brands smoked harder and more frequently to satisfy their nicotine cravings. 59 - 61 For example, in one study, low-tar smokers inhaled 40% more smoke per cigarette and ended up with similar nicotine levels as smokers who use normal brands. 60

And some smokers block filters with fingers or saliva. One Canadian study showed that over half of discarded cigarette butts showed blocked filters. 62

According to one study, low-tar smokers ended up inhaling about 80% more smoke, and had similar levels of cancer-causing chemicals in their blood. 63 They can also inhale over twice as much tar and nicotine as smokers of normal brands. 64

Alcohol and other substances worsen the effect of smoking
Tobacco, as well as alcohol, can cause mouth, oesophageal and liver cancers. Scientists have also found that together, their effects are much worse. 65 - 67 And while alcohol does not cause stomach cancer, it can worsen the risk of this disease in smokers. 68

One study found that together, smoking and drinking increased liver cancer risk by ten times. 65 And a Spanish team found that people who smoke and drink heavily could increase their risk of oesophageal cancer by up to 50 times. 67, 69 This problem is made even worse because heavy drinkers and smokers often have poor diets. 70

Smoking also interacts with many other cancer risk factors and worsens their effects. For example the lung cancer risk due to exposure to high levels of radon gas is 25 times higher in smokers than in non-smokers. 71

Second-hand smoking also causes cancer and kills thousands of people every year
Several studies have shown that breathing in other people’s smoke causes cancer in non-smokers. 2, 72  Second-hand smoke contains several cancer causing chemicals. Many of these chemicals are present in higher concentrations than in the smoke inhaled by the smoker themselves. 2

One study analysed 55 studies from around the world found that non-smoking spouses of people who smoke at home have 27% higher risks of lung cancer. 73 And a review of 22 studies found that people exposed to second-hand smoke in the workplace have 24% higher risks of lung cancer. Those who were exposed to the highest levels of second-hand smoke at work had twice the risks of lung cancer. 74

One study estimates that passive smoking may kill over 11,000 people every year in the UK from cancer, heart disease, strokes and other diseases. 75

Second-hand smoking also causes other health problems in non-smokers including asthma and heart disease. One study showed that even 30 minutes of exposure to second-hand smoke can reduce blood flow in a non-smoker’s heart. 76

Children are especially at risk from second-hand smoking.
Children are particularly at risk because they breathe faster than adults and have underdeveloped immune systems. A study by the Royal College of Physicians showed that about 17,000 children in the UK are admitted to hospital every year because of illnesses caused by second-hand smoke. 77

A large study of over 300,000 people found that children who were frequently exposed to cigarette smoke at home had a higher risks of lung cancer as adults. 78 Another study found that children in households where both parents smoke have a 72% higher risk of respiratory diseases. And the EPIC study found that exposing children to second-hand smoke increases the risk of bladder cancer later on in life by a third. 79

Childhood exposure to second-hand smoke had also been linked to a wide range of other conditions including asthma, Sudden Infant Death Syndrome (or cot death) 80, childhood meningitis 81 and mental disabilities. 82

Smoking while pregnant can harm your baby
Smoking during pregnancy hinders the blood flow to the placenta, which reduces the amount of nutrients that reach the baby. 83 Because of this, women who smoke while pregnant have lighter babies than those who don’t smoke. 84 And low birth weight can lead to higher risks of diseases and death in infancy and early childhood.

There is also evidence that women exposed to second-hand smoke during pregnancy also have lighter babies. 85

Smoking during pregnancy has also been linked to other pregnancy complications including miscarriage, stillbirth, ectopic pregnancy and cot death. It may also have consequences for the physical and mental development of the child. 86

Smokeless tobacco can also cause cancer
Smokeless tobacco, also known as chewing tobacco or snuff, is popular in South Asian communities in the UK. Many studies have shown that smokeless tobacco can cause oral cancer, and may cause pancreatic cancer. 87, 88 One study found that people who used smokeless tobacco had almost 50 times higher oral cancer risks than those who didn’t. 89

The most dangerous chemicals in smokeless tobacco are called tobacco-specific nitrosamines (TSNAs). One review found that people who use smokeless tobacco expose themselves to up to a thousand times more TSNAs than non-smokers, and up to 50 times more than smokers. 90

Smokeless tobacco is also as addictive as cigarettes. Some studies found that the amount of nicotine absorbed from smokeless tobacco is 3-4 times greater than that deliver by a cigarette. 91 The nicotine is also absorbed more slowly and stays in the bloodstream for a longer time.

A Swedish type of smokeless tobacco called snus is often promoted as “safe” but studies have found that even this can increase the risk of oesophageal, stomach and pancreatic cancers.

Bone Marrow Cancer Symptoms

Bone Marrow Cancer Symptoms
Source(google.com.pk)

Myeloma is a cancer that affects cells in the bone marrow called plasma cells. As the cancerous plasma cells fill the bone marrow, you are not able to make enough normal blood cells. This can lead to anaemia, bleeding problems and infections. Other symptoms include bone pain, fractures due to bone damage, and kidney damage. In many cases, treatment with chemotherapy and other treatments can control the disease, ease symptoms and prolong survival for a number of years.

What is myeloma / multiple myeloma?
Myeloma is a cancer of certain white blood cells called plasma cells. The cancerous plasma cells build up in the bone marrow. They also make a lot of one type of antibody. As a result, various symptoms develop. Myeloma is sometimes called multiple myeloma or myelomatosis.

Related articles q
Stem Cell Transplant
What are the bone marrow, plasma cells and antibodies?
The bone marrow is the soft sponge-like material in the centre of bones. The bone marrow is where blood cells are made by stem cells. Stem cells are the immature cells that can develop into mature blood cells. Stem cells constantly divide and produce new cells. Some new cells remain as stem cells, and others go through a series of maturing stages (precursor or blast cells) before forming into mature blood cells. The blood cells made by stem cells are red blood cells, white blood cells and platelets.

You make millions of blood cells every day. There is normally a fine balance between the number of blood cells that you make, and the number that die and are broken down. Various factors help to maintain this balance. For example, certain hormones in the bloodstream and chemicals in the bone marrow called growth factors help to regulate the number of blood cells that you make.

Plasma cells are one type of white blood cell. White blood cells are a main part of the immune system, defending the body from infection. There are various types of white blood cells including plasma cells.

Antibodies (immunoglobulins) are made by plasma cells. Antibodies are proteins that attach to, and help to destroy, germs such as bacteria and viruses. Normally, plasma cells make many different antibodies, each able to attack different bacteria and viruses.

What is cancer?
Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cells in the body, and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and do not respond to normal control mechanisms. Large numbers of cancer cells build up either because they multiply out of control, or they live much longer than normal cells would do, or both. Myeloma is one type of cancer.

What happens in myeloma?
As with other cancers, what seems to happen is that the cancer starts with one abnormal cell. In the case of myeloma, one plasma cell at first becomes cancerous. This abnormal cell then multiplies to produce many identical abnormal plasma cells (a clone of cells). The cancerous plasma cells mainly collect in the bone marrow and continue to multiply without any control.

In the vast majority of cases of myeloma, the abnormal plasma cells make large quantities of one antibody. This single type of antibody is called a paraprotein (or sometimes called a monoclonal antibody, as it is an antibody which comes from a single clone of plasma cells).

There are several different types of antibody. (Antibodies are sometimes called immunoglobulins or Ig for short.) These are called IgM, IgG, IgA, IgD and IgE. Myelomas are sub-classified by the type of antibody that they make. For example, IgG myeloma is the most common type.

What causes myeloma?
It is not known why a plasma cell becomes cancerous. Factors such as infection, or chemicals, or other environmental factors may play a part in damaging cells and causing cancers such as myeloma. However, no factor has been proven as a cause for myeloma. It is not a hereditary disease.

How common is myeloma and who does it affect?
Myeloma is uncommon. It develops in about 4,000 people in the UK each year.

Most cases occur in people over the age of 50, and it becomes more common with increasing age. The average age of diagnosis is 70. Rarely, it occurs in younger adults, and it does not occur in children. Men are affected more often than women.

What are the symptoms and problems with myeloma?
There may be no symptoms at first in the early stages of the disease. Some people are diagnosed by chance because they have a blood test done for other reasons which may detect early myeloma. As the disease progresses, symptoms develop.

The symptoms and problems which develop are mainly due to the uncontrolled production of plasma cells in the bone marrow, and the excess amount of antibody (paraprotein) that the plasma cells make.

Bone damage and related problems
The increasing numbers of plasma cells in the bone marrow act like growing tumours (plasmacytomas) inside the bones. They also make a chemical that can damage bone. In time, small parts of bone are destroyed and are called lytic lesions. The term multiple myeloma is sometimes used which means there are multiple (lots of) areas in bones throughout the body which are affected.

The damage to bone can cause:

Bone pain. This is often the first symptom and can become severe. Any bone can be affected but the most common sites where pain first develops are the lower back, pelvis, and the ribs. The pain tends to be persistent, and made worse by movement.
Fractures. Affected bones may easily fracture (break) following a mild injury or even no injury.
Compression of nerves coming out of the spinal cord. The compression usually happens because of fractures of the vertebrae (the bones surrounding the spinal cord). This can cause a variety of symptoms such as weakness in muscles of the legs, numbness of areas of the body or legs, bladder or bowel problems, and pain. If you have any of these symptoms you need to seek urgent medical attention.
Hypercalcaemia. This means a high level of calcium in the blood (due to the bone breaking down). This can make you very thirsty and can cause nausea and vomiting, dehydration, constipation and also kidney damage.

Bone marrow failure
Much of the bone marrow fills with abnormal plasma cells. Because of this, it is difficult for normal cells in the bone marrow to survive and to develop into normal mature blood cells. Therefore, problems which can develop include:

Anaemia. This occurs as the number of red blood cells goes down. This can cause tiredness, breathlessness and other symptoms. You may also look pale.
Blood clotting problems. This is due to low levels of platelets. This can cause easy bruising, bleeding from the gums, and other bleeding-related problems.
Serious infections. The abnormal plasma cells only make one type of antibody. This does not protect against infection. There is a reduced number of normal plasma cells and other types of white blood cells which usually combat infection. Therefore, serious infections are more likely to develop.
Kidney damage
The kidneys may be damaged by an increased calcium level in the bloodstream, and/or by the high level of the abnormal antibody (paraprotein).

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Hyperviscosity
This means that the blood may become too thick due to a very high level of paraprotein. Symptoms of hyperviscosity occur in less than one in ten cases of myeloma and include problems such as bruising, nose bleeds, hazy vision, headaches, sleepiness and various other symptoms. If you develop these symptoms then you need to seek medical advice without delay.

Amyloidosis
This is an uncommon complication of myeloma. This is a condition where abnormal protein (amyloid) accumulates in various parts of the body. It can cause various symptoms.

How is myeloma diagnosed?
Tests commonly done to confirm the diagnosis of myeloma include:

A blood or urine test to detect the paraprotein. Other blood tests are also usually done - for example, to see if your are anaemic, to test for the function of your kidneys and to check your calcium level.
A bone marrow sample. For this test, a needle is inserted into the pelvic bone, or occasionally the breastbone (sternum). Local anaesthetic is used to numb the area. Then a small amount of marrow is removed. The sample is placed under the microscope to look for abnormal cells. The diagnosis is confirmed when large numbers of plasma cells are seen in the bone marrow sample. (See separate leaflet called 'Biopsy - Bone Marrow' for details.)
X-rays of bones. The areas of damaged bones often show up as typical patterns on X-ray pictures. MRI, CT or ultrasound scans may be done if X-ray tests do not give enough detailed information. (There are separate leaflets that give details of these tests.) Sometimes more specialised scans (for example, a PET scan) are performed.
These tests may be repeated from time to time to monitor the progress of the disease and also to monitor the response to treatment.

Other tests which are commonly done to assess the severity of the disease and to monitor the response to treatment include:

Blood tests to check on your kidney function.
Blood tests to check the level of calcium in your blood.
Blood tests to check the level of paraprotein in your blood.
Chromosome and gene testing of the myeloma cells. This can help to identify the exact type of myeloma so that doctors can decide which treatment is best.
Blood tests to measure proteins in the blood, called beta-2 microglobulin and albumin. The levels of these proteins are affected by myeloma and give an indication as to the severity of the disease.
Other disorders related to myeloma
The following are other plasma cell abnormalities. If you are diagnosed with any of these conditions, myeloma may develop sometime later, but not always.

Isolated (solitary) plasmacytoma of bone. In this condition only one plasma cell tumour is found in a bone. There is no other evidence of myeloma anywhere else in the body.
Extramedullary plasmacytoma. In this condition, one or more plasma cell tumours occur outside the bone marrow. These most commonly occur in the tonsils or the tissues around the nose.
Monoclonal gammopathy of unknown significance (MGUS). In this condition a paraprotein is found in the blood, without other symptoms or signs of myeloma. (Monoclonal gammopathy is another way of saying a high level of a monoclonal, or single type of, antibody.) This condition does not require treatment but needs monitoring. Around 1 in 100 people with MGUS develops myeloma in the future.
What are the aims of the treatment for myeloma?
Treatments may be used to treat and to control the myeloma itself; also, to ease symptoms and complications of the myeloma. Treatments options are briefly discussed below.

Treatment is usually given to those people with myeloma who have some organ or tissue damage due to the myeloma. For example, if you are anaemic or have some impairment in the function of your kidneys.

Treatment is not usually started in those people who have no symptoms from their myeloma. However, these people are normally monitored closely by a specialist as there is a chance that treatment may be needed in the future.

However, different treatments suit different people. You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the treatment options for myeloma.

Treatments to control the myeloma
In many cases, treatment can control the myeloma and put the disease into remission. Remission is not necessarily a cure. Full remission means that tests cannot detect the abnormal plasma cells in the blood or bone marrow, and the bone marrow is producing normal blood cells again. Some remissions are partial which means there is some improvement, often a great improvement, but some myeloma cells remain. In many cases where there is remission or partial remission, at some point in the future the disease returns (relapses). Further treatment may be considered if the disease relapses. However, in time, the relapses become more difficult to treat.

Treatments that may be used include one or more of the following:

Chemotherapy
Chemotherapy is a treatment which uses anticancer drugs to kill cancer (myeloma) cells, or to stop them from multiplying. Various drugs are used and myeloma may be treated with chemotherapy drugs given as tablets or injections. The exact combination of drugs used, and the length of the course of chemotherapy, depends on various factors. For example, the severity of the myeloma, the exact type of myeloma, if you have kidney damage, your age and general health. (See separate leaflet called 'Chemotherapy' for more details.)

If a course of chemotherapy achieves a remission, you may then be advised to take drugs as a regular maintenance treatment. These may include interferon, steroids, thalidomide, lenalidomide or bortezomib. This is, in effect, low-level chemotherapy which aims to keep you in remission for as long as possible.

Recent developments in drugs to combat myeloma have improved the outlook. For example, thalidomide, lenalidomide and bortezomib are relatively new and seem to be improvements on previous drugs. Various research trials of these drugs, and combinations of drugs, are underway.

Your doctor will be able to discuss with you the most suitable type of chemotherapy for you in more detail.

Stem cell transplant
A stem cell transplant may be an option. It is an intensive treatment that is not suitable in all cases. However, this treatment generally gives the best chance of a complete remission.

Stem cells are the immature cells that develop into mature blood cells in the bone marrow. Briefly, a stem cell transplant involves high-dose treatment with chemotherapy (and sometimes radiotherapy) to kill all the abnormal plasma cells. However, this also kills the stem cells that make normal blood cells. So, after the high-dose treatment, some stem cells are given to you via a drip into a vein (like having a blood transfusion). The stem cells are usually obtained from the blood of the patient with the myeloma before the high-dose treatment is started. The stem cells from the transfusion make their way to the bone marrow where they then multiply and make normal blood cells, including plasma cells. (See separate leaflet called 'Stem Cell Transplant' for more details.)

Treatments to ease symptoms
Depending on the effects of the myeloma, one or more of the following may be advised:

Painkillers - to ease any pain.
A bisphosphonate drug. Bisphosphonates are a type of medicine that is used to strengthen your bones. It is now recommended that all people with myeloma that is causing any symptoms should take a bisphosphonate.
Erythropoietin. This is a hormone that helps to increase the number of red cells made in the bone marrow. It may be used to help improve anaemia.
Blood transfusions to correct anaemia.
Plasma exchange or exchange blood transfusions if you have a very high level of paraprotein in your blood, which is causing hyperviscosity symptoms.
Antibiotics if you develop infections. If you develop any symptoms to suggest an infection you should go and see a doctor as soon as possible. Some people will need to have intravenous antibiotics in hospital if they develop an infection.
Surgery is sometimes needed to help heal fractured bones or to ease pressure on a trapped nerve due to fractures of the spinal bones.
Kidney dialysis if you develop kidney damage and kidney failure.
People with myeloma will also usually be advised to drink plenty of fluids (at least three litres a day). This helps to lower a high calcium level.

What is the prognosis (outlook)?
In general, with treatment, about half of people with myeloma are alive and well 3-4 years after diagnosis. However, this is the general overview. In some cases the disease responds very well to treatment and survival is much longer. In particular, a successful stem cell transplant gives a good chance of a complete remission. In some cases the disease does not respond to treatment very well, or life-threatening complications develop such as kidney failure.

The treatment of cancer and myeloma is a developing area of medicine. New treatments continue to be developed and the information on outlook, above, is very general. As mentioned above, there are some newer drugs that have been introduced in the last few years that show promise to improve the outlook. The specialist who knows your case can give more accurate information about the outlook for your particular situation.

Eye Cancer Symptoms In Babies

Eye Cancer Symptoms In Babies
Source(google.com.pk)

Retinoblastoma (eye) in Children 

The Pediatric Solid Tumor Program at The Children's Hospital of Philadelphia consists of a multidisciplinary team of highly experienced and compassionate professionals who will provide expert management of your child's retinoblastoma. In addition, many of our pediatric oncologists are at the forefront of researching and developing new therapies to treat this type of cancer.

What is retinoblastoma?
Retinoblastoma is a rare cancer originating in the part of the eye called the retina. The retina is a thin layer of nerve tissue that coats the back of the eye and enables the eye to see. Most cases involve only one eye (unilateral), but both eyes may be involved (bilateral). If retinoblastoma spreads, it can spread to the lymph nodes, bones or the bone marrow. Rarely, it can involve the central nervous system (CNS).

Retinoblastoma is a malignant tumor composed of retinoblasts (immature baby cells) in the retina. These cells form the nerve tissues (rods and cones) at the back of the eye. Their job is to form images. The images are then transmitted by the optic nerve to the area of the brain responsible for sight.

Retinoblasts develop from a single cell during the early development of an infant in the womb. During gestation and early life, these cells are able to divide and multiply. This is the process that helps make enough cells to populate the retina. As children age, their cells undergo a process called differentiation and become mature rods and cones. The cells are no longer able to divide and multiply, which is why retinoblastoma occurs very rarely after the age of 5 years. Children may be born with retinoblastoma, but the disease is rarely diagnosed at birth.

We do not know what causes retinoblasts to turn into cancer cells but we do know that in order for retinoblastoma to develop there must be a change or mutation in both copies (one from each parent) of a gene called RB1. What precisely triggers this change or mutation is not known.
Most children who begin treatment before the retinoblastoma has spread beyond the eye are cured. A major goal of treatment in children with retinoblastoma is preserving vision.

Great strides have been made in treating retinoblastoma in recent years; many children retain their vision and more than 95 percent of children with retinoblastoma can be cured.

Who is diagnosed with retinoblastoma?
About 300 children are diagnosed with retinoblastoma in the United States each year. The disease occurs most often in children under 4 years old, and accounts for 2.8 percent of all cancers in children ages 0 to 14 years old. The average age of children with retinoblastoma is 18 months — and boys and girls are affected equally.

About 60 percent of children with retinoblastoma develop a single tumor in one eye only (unilateral). There is no increased risk of additional tumors later in life.

When retinoblastoma affects both eyes (bilateral), it is considered a genetic condition. Rarely, the genetic form occurs only in one eye. The genetic form of the disease occurs in the youngest children (rarely beyond 1 year old) and increases the child's risk of developing another cancer later in life. The risk of additional tumors is higher in children who receive radiation therapy to the orbit (eye socket) to preserve vision or to other parts of the body where the tumor has spread.

Hereditary retinoblastoma
Some children (40 percent of patients with retinoblastoma) are born with a change in one copy of the RB1 gene in every cell in the body, including the cells in the retina. If the second copy of the gene undergoes a change, a retinoblastoma tumor can develop. That's because every cell already has the first copy of RB1 mutated — making it relatively easy for more than one cell to undergo a change in the second copy or the gene. These children may have more than one tumor, and they usually have both eyes affected.
Most children (80 percent) with the genetic form do not have a parent with retinoblastoma. The change in the gene occurred in either the egg or the sperm of one parent before conception. Even if your child has the genetic form, if neither parent has the tumor there is less than a 1% chance that retinoblastoma will occur in another child in your family.

Children with the genetic form may also develop tumors in other parts of their body, such as the pineal gland in the brain. The pineal gland develops from cells that sense light and are similar to retinoblasts. As is the case with retinoblastoma, when these cells become mature and can no longer divide and multiply (sometime around age 5), they are much less likely to become cancer cells.

Nonhereditary retinoblastoma
Most children with retinoblastoma (60 percent) do not have the genetic form. They are not born with the RB1 gene mutated in every cell of the body. They develop a tumor in only one eye because both RB1 genes in a single retinoblast have undergone the mutation. We don't know how or why this occurs.
If neither parent has had retinoblastoma and the child is over 2 years of age at diagnosis, the probability of having the genetic form is very small. If eye tumor tissue is available for study, there is a blood test that can be done to determine whether a child with a unilateral tumor is one of the 10 percent of children with a tumor in only one eye who has the genetic form.

Your child's oncologist will discuss with you which form of retinoblastoma your child has and what this means for follow-up for the child and for other members of your family.

What are the signs and symptoms of retinoblastoma?
Sometimes children with retinoblastoma do not show any of the following signs or symptoms. Often, doctors find retinoblastoma on a routine well-baby examination. Most often, however, parents notice symptoms such as:

White (leukocoria) or red pupil instead of the normal black
Misaligned eyes (strabismus) looking toward the ear or nose
Reddened, painful eye
Enlarged pupil
Different-colored irises
Poor vision

How do we diagnose retinoblastoma in your child?
The diagnosis of retinoblastoma is made by examining the eyes. If a newborn has a family history of retinoblastoma, the baby should be examined shortly after birth by an ophthalmologist (medical eye doctor) who specializes in cancers of the eye.

If a white pupil or strabismus (crossed-eyes) is noticed by a parent or pediatrician, the child should be referred to an ophthalmologist familiar with the treatment of retinoblastoma. The doctor will do a thorough examination to check the retina for a tumor. Depending on the age of the child, either a local or general anesthetic is used during the eye examination. The ophthalmologist will make a drawing or take a photograph of the tumors in the eyes to provide a record for future examinations and treatments, and may use additional tests to confirm or detect tumors. These tests may include:

Imaging tests
Ultrasound. This test looks for tumors in the child's body using sound waves.
Computerized tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the child's body with an X-ray machine. A computer then puts these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a special dye (a contrast medium) is injected into a vein to provide better detail. A CT scan helps the doctor find cancer outside of the eye.
Magnetic resonance imaging (MRI). MRI uses electromagnetic waves to create computer-generated pictures of the brain and spinal column. MRIs may create more detailed pictures than CT scans and provide the specialist with a picture of the inside of the eye and the brain.

Additional tests
Children who are diagnosed with retinoblastoma will require a complete physical examination and, if there are any additional symptoms or abnormal findings, may also undergo additional tests to determine if the cancer has spread elsewhere in the body. Some of these tests also will be performed when the child starts therapy.

Blood tests. These tests evaluate the blood and check for problems with the liver and kidneys. The doctor may also look at the blood for changes in chromosome 13. Chromosomes are the part of the cell that contains genes. In a few cases of retinoblastoma, these genes are either missing or nonfunctional.

Lumbar puncture (spinal tap). In this test, a small amount of cerebrospinal fluid is removed with a needle from the child's back and examined under a microscope to detect cancer cells.

Bone marrow aspiration. This procedure is performed to determine if any retinoblastoma cells have spread to the marrow. For this test, a small amount of bone marrow is removed from the hip with a needle and examined under a microscope.

MRI or CT scan of the brain. This may be recommended to determine if there is an abnormality of the pineal gland for children with the genetic form of retinoblastoma. This includes children with bilateral (in both eyes) disease and those with unilateral with a positive family history. Very young children with a tumor in one eye who do not have a positive family history may also be at risk, and these studies may be recommended for them. Scans may also be recommended years after treatment for children who have received external beam radiation, either as a baseline in the event that problems arise, or to follow-up on a symptom or sign.
Hearing test. Children with retinoblastoma taking certain chemotherapy drugs may have their hearing tested (audiology test) to make sure the drugs are not causing hearing loss.

Staging
After a retinoblastoma has been detected, the doctor will determine the extent of disease in the eye and if the disease has spread (metastasized) outside the eye. This is called staging, and it helps doctors plan treatment.
Staging categories include:

Intraocular. This means that cancer occurs in one or both eyes, but has not spread into surrounding tissues or other parts of the body.
Recurrent. The cancer has recurred (come back) in the eye or continued to grow after it has been treated.
Extraocular. The cancer has spread to tissues around the eye or to other parts of the body.

How do we treat pediatric retinoblastoma?
The goal of treatment is to prevent tumor cells from growing and spreading, and to preserve vision.
Standard treatment for retinoblastoma has changed over the years. A decade ago, treatment options included enucleation (removal of the involved eye) or radiation. When only one eye is involved, enucleation is usually the treatment of choice. Children adjust very well to the loss of one eye, and their vision does not suffer a great deal. However, if a child is very young, there is a risk that a tumor will develop in the other eye, so the goal in these children is to remove as much of the tumor as possible while preserving vision.
Small tumors can often be treated successfully using local measures, including:

Cryotherapy. Extreme cold may be used to destroy cancer cells. The procedure is done in the operating room. The child is discharged the same day after recovering from anesthesia.

Photocoagulation (laser therapy). Laser light may be used to destroy blood vessels that supply nutrients to the tumor. The procedure is done in the operating room. The child is discharged the same day after recovering from anesthesia.

Thermotherapy. Heat may be used to destroy cancer cells. Radioactive plaques, sewn into the back of the eye and removed after the required dose of radiation is delivered, are also successful.

Plaque radiotherapy. A radioactive device is implanted in the affected eye with a specific dose of radiation directly applied to the tumor. The procedure is performed in the operating room. The child will have to stay in the hospital for a few days while the implanted radiation plaque delivers the planned dose to the tumor.

Radiation therapy
The goal in treating children with tumors in both eyes is to save the child's life and preserve vision with a minimum of side effects. Radiation therapy has been the treatment of choice for children with bilateral disease. However, radiation may produce damage to the retina many years after it has been given. That damage can result in loss of vision.

Radiation when given to very young children also results in decreased growth of the bone surrounding the orbit. It can also increase the risk of second non-retinoblastoma cancers from 10 to 50 years after treatment.
Chemotherapy
Chemotherapy is medication used to destroy cancer cells. When tumors are too large to apply local measures, we may recommend chemotherapy to shrink the tumors so that local therapy can be used successfully.

Because chemotherapy can also affect normal cells along with cancer cells, certain side effects can occur. Any plan of chemotherapy will include a discussion of the potential side effects, the ways in which they can be prevented, and what tests we may need to do to look for them.

All of the chemotherapy medications given for retinoblastoma are given via an intravenous (IV) catheter placed in the arm or foot. Some children may require a semi-permanent type of IV catheter, called a central venous catheter, that is placed under the skin in the chest.

Each child is affected differently by chemotherapy. Before each cycle of chemotherapy, a pediatric oncologist will examine your child.

As with any cancer, the prognosis and long-term survival can vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Great strides have been made in treating retinoblastoma in recent years. More than 95 percent of children with retinoblastoma can be cured. Many children with tumors in both eyes can retain vision.

Late effects/cancer survivorship
Some children treated for retinoblastoma develop complications years later. Our Cancer Survivorship Program provides information about the potential long-term effects of the specific treatment your child received, including ways of monitoring and treating these effects.