The following material is for informational purposes only and intended to help you gain a better understanding of your medical condition.
You should always consult with your doctor on your specific medical condition and treatment options.
Human Papillomavirus (HPV)
What is HPV testing and the Pap smear?
The Pap smear and testing for HPV both look for signs of cervical cancer, but in different ways.
The cervix is the portion of the uterus where it meets the vagina (Figure 1). The cervix can develop cancer just like other parts of the body. Fortunately, the Pap test can identify changes in the cells of the cervix before they actually become cancer.
What is a Pap test?
When your doctor performs a Pap test, cells from the cervix are placed in a vial so they can be examined with a microscope. The cells can be normal, precancer, or cancer (Figure 2). In the majority of people, it takes years for normal cells to become precancer cells, and then for precancer cells to become cancer. There are several ways to treat precancer cells to prevent them from ever developing into cancer.
What is HPV?
HPV stands for human papillomavirus. HPV is a very common virus. There are over 150 different types, and about 40 of these can affect the sex organs of women and men. These types can also affect the anal canal, and mouth, and throat. Some HPV types can cause changes to the cervix that can eventually lead to cancer, while other types can cause genital warts. Researchers believe that almost all cases of cervical cancer are caused by “high-risk” types of HPV and that approximately 80% of cervical cancers are caused by HPV types 16, 18, and 45. Genital warts are usually caused by HPV 6 and HPV 11.
In most people, the body’s immune system fights off an HPV infection before it causes any problems. It is only when HPV stays on the cervix for an extended period of time that it can cause abnormal cells and eventually lead to cervical cancer.
HPV is NOT the same as HIV (human immunodeficiency virus) or herpes, though they all can be transmitted by sexual contact.
How do people get HPV?
The types of HPV that affect the cervix are transmitted by sexual contact. The HPV virus can be transmitted by vaginal, oral, or anal sex. Most people with an HPV infection do not know they have it, and they do not know they are passing it to their partner. Because HPV can linger in the cervix, it may not be found until years after the infection occurred. It has not been determined why HPV lingers in some people, but not in others.
Am I at risk of having HPV?
All women who have ever had sex are at risk of having HPV and cervical cancer. The risk increases with an increased number of sexual partners. Although using condoms can decrease the risk of getting HPV, it does not completely eliminate the chances of getting the infection.
How do I know if I have HPV?
An HPV infection does not cause any symptoms, which is one reason most people do not know they have been infected. But, the Pap test and HPV test can help determine if you have HPV.
The Pap test checks for abnormal cells on the cervix that can turn into cervical cancer. In many cases, the abnormal cells are due to an HPV infection, but other types of vaginal infections, for example, yeast and herpes, can also cause cells of the cervix to look abnormal when examined with a microscope.
Routine testing checks your cervix for the HPV virus that can cause the abnormal cells. Most HPV tests check for 13 or 14 of the high-risk HPV types that cause cervical cancer.
How are an HPV infection and an abnormal Pap smear treated?
The most important way to prevent cervical cancer is by having regular Pap smears and HPV testing. Your doctor can determine the best schedule for you based on your own personal medical history.
If your HPV test is positive, treatment depends on your Pap smear test results.
A positive HPV test means that an HPV type that can cause cervical cancer has been found. A negative test means none of the HPV types that were tested for were found on the cervix.
If your HPV test is positive and your Pap smear results are normal, your doctor will likely recommend close follow-up with repeat testing within 12 months. In most cases, HPV goes away on its own within two years of being diagnosed.
If your HPV test is positive and your Pap smear shows abnormal cells, there are a number of different treatments. In this case, the treatment depends on how abnormal the cells appear under the microscope. Your doctor may test for other types of infection, or recommend a procedure called a colposcopy. A colposcopy is done in the office, and the doctor examines the cervix with a microscope. Very small pieces of abnormal appearing areas of the cervix may be biopsied to better understand the abnormalities in the cells.
There are also a number of procedures to remove the abnormal cells that can lead to cancer. Some of the most common procedures are:
- Cone biopsy: This removes the portion of the cervix with the abnormal cells.
- Laser therapy: This uses laser light to burn away the abnormal cells.
- LEEP: This stands for loop electrosurgical excision procedure. An electrical current is used to remove a portion of the cervix with the abnormal cells.
There are also vaccines against some of the high-risk types of HPV that can prevent an HPV infection. HPV vaccination is routinely recommended for boys and girls 11 and 12 years of age; before their first sexual contact. Sexually active women may also receive the vaccine, but it will only protect against HPV types they have not already been exposed to.
Key Points
You are not alone: HPV is a very common infection. In most cases, HPV goes away on its own and does not cause abnormal cells on the cervix. It takes years for abnormal cells to become cancer cells. There are many different ways to remove abnormal cells on the cervix. The best way to prevent cervical cancer is by regular Pap smear and HPV testing.
Learn More
Here are some trusted resources you can explore to learn more.
Centers for Disease Control and Prevention (CDC):
Making Sense of Your Pap & HPV Test Results
http://www.cdc.gov/std/hpv/pap
National Cancer Institute: Pap and HPV Testing
http://www.cancer.gov/types/cervical/pap-hpv-testing-fact-sheet
American Cancer Society: HPV Testing
http://www.cancer.org/cancer/cancercauses/othercarcinogens/infectiousagents/hpv/hpv-and-hpv-testing
Chlamydia
Recently, your healthcare provider performed a laboratory test that has revealed that you tested positive for a sexually transmitted disease called chlamydia. Even though symptoms of chlamydia are usually mild or absent, serious complications can cause irreversible damage, including infertility, which can occur “silently” before a woman ever recognizes a problem. Chlamydia also can cause discharge from the penis of an infected man.
In the United States, over 3 million people are infected with chlamydia annually and under-reporting is substantial because most people with chlamydia are asymptomatic or not aware of their disease and do not seek testing. Chlamydia is a kind of bacteria that targets the cells of the mucous membranes, which are the soft, moist tissues of the body not covered by skin. Examples of such areas include the vagina, cervix, anus, penis, urethra, or eye. Chlamydia, like other sexually transmitted diseases (STDs), is passed from an infected person to a partner through certain sexual activities. Key causes of the spread of chlamydia include engaging in unsafe sex, having sex with multiple sexual partners, or having sex with someone who has had multiple partners. Women can be re-infected
if their sex partners are not treated. Chlamydia can be easily treated with antibiotics; but if left untreated, serious complications as described above may occur.
Chlamydia Background Information
Any sexually active person can be infected with chlamydia. The risk of infection increases dramatically if you have a large number of sex partners. Because the cervix (opening to the uterus) of teenage girls and young women is not fully matured they are more susceptible to infection, particularly if they are sexually active. It is estimated that one in 10 adolescent females test positive for chlamydia. Chlamydia is most prevalent in young women ages 15-24 for the reasons described above.
Although chlamydia is the most common sexually transmitted bacterial infection in the United States, many people do not know they have it because of a lack of noticeable symptoms. People who are asymptomatic or lack symptoms may pass the infection to their sex partners without knowing. Chlamydia often occurs with gonorrhea, a similar sexually transmitted disease. The infection is a serious health threat for women and usually begins on the cervix. It can then spread to the fallopian tubes or ovaries. When left untreated, up to 40% of women with a chlamydia infection will develop pelvic inflammatory disease (PID). PID can cause serious damage to a woman’s reproductive organs and can lead to infertility, chronic pelvic pain, and an increased risk of ectopic pregnancy (a pregnancy that occurs outside the uterus). If you are a pregnant woman and are infected with chlamydia, you may pass the infection on to your child at birth, and your child could encounter health complications.
Symptoms
Chlamydia is known as a “silent” disease because about three-quarters of infected women and about half of infected men have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure.
In women, the bacteria initially infect the cervix and the urethra (urine canal). Women who have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. When the infection spreads from the cervix to the fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods. Chlamydia infection of the cervix can also spread to the rectum.
Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis. Pain and swelling in the testicles are uncommon.
Men or women who have receptive anal intercourse may acquire chlamydia infection in the rectum, which can cause rectal pain, discharge, or bleeding. Chlamydia can also be found in the throats of women and men having oral sex with an infected partner.
Follow-up and Treatment Options for Chlamydia
Chlamydia can be easily treated and cured with antibiotics. It is important to remember to take all of the prescribed medicine; even if the symptoms disappear, the infection may remain in your system. It is also important that you and your partner be treated at the same time and that you both avoid sexual contact during treatment to prevent re-infection.
Women whose sex partners have not been appropriately treated are at high risk for re-infection. Having multiple infections increases a woman’s risk of serious reproductive health complications, including infertility. Retesting should be encouraged for women three to four months after treatment. This is especially true if a woman does not know if her sex partner received treatment.
To minimize your risk for chlamydia infection, you should:
- Use condoms or diaphragms during sexual intercourse;
- Remain in a monogamous relationship;
- Limit your number of sexual partners;
- Include chlamydia screening as part of your annual examination or when you have your first prenatal visit;
- Abstain from sexual intercourse.
Questions to Ask Your Healthcare Provider
- What do my test results mean?
- What follow-up actions do you recommend?
- What do you recommend in treating this disease and why?
- How can I prevent this disease from happening again?
- How often do should I get a repeat chlamydia test?
- Should I be tested for any other sexually transmitted diseases?
Sources for Additional Information
National Institute of Allergy and Infectious Diseases:
www.niaid.nih.gov
Centers for Disease Control and Prevention:
www.cdc.gov
American Social Health Association:
www.ashastd.org
Gonorrhea
Recently, your healthcare provider performed a laboratory test that has revealed that you tested positive for a sexually transmitted disease called gonorrhea. Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus. Gonorrhea is the second most common sexually transmitted bacterial infection in the United States behind chlamydia. Gonorrhea infection may be the result of engaging in unsafe sex, having sex with multiple sexual partners, having sex with someone who has multiple partners, or having a history of sexually transmitted infections. Gonorrhea can be easily treated with antibiotics; but if left untreated, serious complications may arise as outlined above.
Gonorrhea Background Information
Gonorrhea is a very common infectious disease. The Centers for Disease Control (CDC) estimates that almost one million people are infected with gonorrhea each year. Approximately 75% of all cases are found in young people ages 15-29. Although gonorrhea is the second most common sexually transmitted bacterial infection in the United States, many people do not know they have it due to lack of noticeable symptoms. Approximately 50% of infected men and women do not know they have gonorrhea. People who do not have symptoms may pass the infection to their sex partners without knowing. Gonorrhea is also known as the clap, drip, or GC. Gonorrhea is a serious health threat for women, and when left untreated, can lead to pelvic inflammatory disease (PID). PID can cause serious damage to a woman’s reproductive organs and can lead to infertility, chronic pelvic pain, and an increased risk of ectopic pregnancy (a pregnancy that occurs outside the uterus). If you are a pregnant woman and are infected with gonorrhea, you are at greater risk of delivering your child prematurely. You may also pass the infection on to your child at birth and your child could encounter health complications.
Signs and Symptoms
Symptoms of gonorrhea usually appear 2 – 5 days after infection, however, in men, symptoms may take up to a month to appear. Some people do not have symptoms. They may be completely unaware that they have caught the disease, and therefore do not seek treatment. This increases the risk of complications and the chances of passing the infection on to another person.
Symptoms in men include:
- Burning and pain while urinating
- Increased urinary frequency or urgency
- Discharge from the penis (white, yellow, or green in color)
- Red or swollen opening of the penis (urethra)
- Tender or swollen testicles
- Sore throat
Symptoms in women can be very mild or non-specific and may be mistaken for another type of infection. They include:
- Vaginal discharge
- Burning and pain while urinating
- Increased urination
- Sore throat
- Painful sexual intercourse
- Severe pain in the lower abdomen (if the infection spreads to the fallopian tubes and stomach area)
- Fever (if the infection spreads to the fallopian tubes and stomach area)
Follow-up and Treatment Options for Gonorrhea
There are two goals in treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first is to cure the infection in the patient. The second is to locate and test all of the other people the person had sexual contact with and treat them to prevent further spread of the disease.
Once diagnosed, gonorrhea is easy to treat and can be cured quickly. Several antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States. Because of these drug-resistant strains, gonorrhea is becoming increasingly difficult to treat.
Penicillin used to be given to patients with gonorrhea, but it is not often used anymore because some types of gonorrhea bacteria no longer respond to the drug. This is called antibiotic resistance. Antibiotic resistance is a major public health threat in which bacteria cannot be killed with the usual antibiotic medicines. Because many people with gonorrhea also have chlamydia, another STD, antibiotics for both infections are usually given together. Persons with gonorrhea should be tested for other STDs.
To minimize your risk for gonorrhea infection, you should:
- Use latex condoms, when used consistently and correctly, they can reduce the risk of transmission of gonorrhea;
- Remain in a monogamous relationship;
- Abstain from sexual intercourse;
- Limit your number of sexual partners;
- Include gonorrhea screening as part of your annual examination or when you have your first prenatal visit.
Questions to Ask Your Healthcare Provider
- What do my results mean?
- For my condition, what follow-up options do I have?
- What do you recommend and why?
- How can I prevent this from happening again?
- When do you suggest a repeat gonorrhea test?
- Should I be tested for any other sexually transmitted diseases?
Sources for Additional Information
National Institute of Allergy and Infectious Diseases:
www.niaid.nih.gov
Centers for Disease Control and Prevention:
www.cdc.gov
American Social Health Association:
www.ashastd.org
Atypical Squamous Cells of Undetermined Significance (ASC-US)
The Pap test your clinician recently performed has shown some abnormal changes of the cervix called Atypical Squamous Cells of Undetermined Significance (ASC-US) (pronounced “ask-us”). Squamous cells are the thin flat cells that form the surface of the cervix. The squamous cells do not appear completely normal, and sometimes the changes are related to HPV infection, inflammation, or a precancerous change. ASC–US are considered mild abnormalities. Approximately 3-7% of all Pap tests result in a diagnosis of ASC-US. Although ASC-US is an abnormal result that requires additional follow-up, it is important to understand that a diagnosis of ASC-US does not necessarily mean that you have cervical cancer.
Pap Test Background Information
The Pap test (sometimes called a Pap smear) is a way to examine cells collected from the cervix (the lower, narrow end of the uterus). The main purpose of the Pap test is to find abnormal cellular changes that may arise from cervical cancer or before cancer develops. A Pap test and pelvic exam are important parts of a woman’s routine healthcare because they can detect abnormalities that may lead to invasive cancer of the cervix. These abnormalities can be treated before cancer develops. Most invasive cancers of the cervix can be prevented if women have Pap tests regularly. Also, as with many types of cancer, cancer of the cervix is more likely to be treated successfully if it is detected early. Women should talk with their healthcare provider about when and how often they should have a Pap test. Current general guidelines recommend that women have a Pap test at least once every 3 years, beginning about 3 years after they begin to have sexual intercourse, but no later than age 21. About 55 million Pap tests are performed each year in the United States. Of these, approximately 3.5 million (6 percent) are abnormal and require medical follow-up.
Follow-up and Treatment Options for ASC-US
Repeat Pap Test: Since your Pap test has shown a minor abnormality, your healthcare provider may repeat the test to determine whether further follow-up is needed. Many times, cellular changes in the cervix go away without treatment. If treatment is necessary, your doctor may choose to follow up with one of the options below.
HPV Test: Your clinician may choose to perform an additional test for Human Papillomavirus (HPV). HPV testing in women with ASC–US may help identify underlying abnormalities that need a doctor’s attention. A negative HPV test can provide reassurance that cancer or a precancerous condition is not present. The HPV test can be performed on your previous Pap test if it was collected with the liquid-based methodology. If not, a second sample may be collected to perform this test.
Colposcopy: Your healthcare provider may decide to perform an additional test called a colposcopy. In this procedure, an instrument similar to a microscope is inserted through the vagina and used to view the cervix directly. Your healthcare provider will be able to see the surface of the cervix clearly during the procedure and will look for any abnormal areas.
Biopsy: If areas of abnormal cells are seen during the colposcopy, your healthcare provider may biopsy (remove a small tissue sample) and send it to a laboratory for study under a microscope. Often, multiple areas of the cervix are biopsied during the procedure. While a Pap test is a screening test, a biopsy is a diagnostic test and will provide a definitive diagnosis.
Questions to Ask Your Healthcare Provider
- Is this diagnosis going to progress into something more severe?
- What type of follow-up do you suggest and why?
- What are the potential risks or side effects of this option?
- When do you recommend a repeat Pap test?
Sources for Additional Information
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
High-Grade Squamous Intraepithelial Lesion (HSIL)
The Pap test your healthcare provider recently performed has shown some abnormal changes of the cervix called High-Grade Squamous Intraepithelial Lesion, or HSIL. High-grade means that there are more significant changes in the size and shape of the abnormal (precancerous) cells, meaning that the cells look very different from normal cells. HSILs are more severe abnormalities and have a higher likelihood of progressing to invasive cancer. HSIL may be characterized by a long lead time before developing into cancer. Although HSIL is a precancerous result that may develop into cervical cancer and will require additional follow-up, it is important to understand that a diagnosis of HSIL does not necessarily mean that you currently have cervical cancer.
Pap Test Background Information
The Pap test (sometimes called a Pap smear) is a way to examine cells collected from the cervix (the lower, narrow end of the uterus). The main purpose of the Pap test is to find abnormal cellular changes that may arise from cervical cancer or before cancer develops.
A Pap test and pelvic exam are important parts of a woman’s routine healthcare because they can detect abnormalities that may lead to invasive cancer of the cervix. These abnormalities can be treated before cancer develops. Most invasive cancers of the cervix can be prevented if women have Pap tests regularly. Also, as with many types of cancer, cancer of the cervix is more likely to be treated successfully if it is detected early.
Women should talk with their healthcare provider about when and how often they should have a Pap test. Current general guidelines recommend that women have a Pap test at least once every 3 years, beginning about 3 years after they begin to have sexual intercourse, but no later than age 21. About 55 million Pap tests are performed each year in the United States. Of these, approximately 3.5 million (6 percent) are abnormal and require medical follow-up.
Follow-up and Treatment Options for HSIL
Colposcopy: Your healthcare provider may decide to perform an additional test called a colposcopy. In this procedure, an instrument similar to a microscope is inserted through the vagina and used to view the cervix directly. Your healthcare provider will be able to see the surface of the cervix clearly during the procedure and will look for any abnormal areas.
Biopsy: If areas of abnormal cells are seen during the colposcopy, your healthcare provider may biopsy (remove a small tissue sample) and send it to a laboratory for study under a microscope. Often, multiple areas of the cervix are biopsied during the procedure. While a Pap test is a screening test, a biopsy is a diagnostic test and will provide a definitive diagnosis.
Endocervical Curettage (ECC): In this procedure, your healthcare provider will scrape cells from the wall of your cervical canal with a small spoon-shaped tool called a curette. The cells are then sent to a laboratory and studied for abnormal changes. ECC is often performed with a biopsy. If the lab finds abnormal cells that have a high chance of becoming cancer, further treatment is needed.
Cryotherapy: In order to destroy abnormal cells, your healthcare provider may elect to use a very low-temperature probe to freeze abnormal cells. The cells that grow back during the healing process are usually normal and healthy.
Laser Therapy: In this procedure, a highly concentrated beam of light energy called a laser is focused on the affected area of the cervix, and the abnormal cells are vaporized. In time, the vaporized tissue grows back with cells that are usually normal and healthy.
LEEP (Loop Electrosurgical Excision Procedure): Your healthcare provider may use an electric loop to remove abnormal tissue from your cervix. The tissue sample is then sent to a laboratory for further examination. The cells that grow back during the healing process are usually normal and healthy.
Cone Biopsy: Your healthcare provider may remove a cone-shaped wedge of tissue from the opening of the cervix. The tissue is then sent to a laboratory for further examination. The cells that grow back during the healing process are usually normal and healthy.
Questions to Ask Your Healthcare Provider
- Is this diagnosis going to progress into something more severe?
- What type of follow-up do you suggest and why?
- What are the potential risks or side effects of this option?
- When do you recommend a repeat Pap test?
Sources for Additional Information
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Low-Grade Squamous Intraepithelial Lesion (LSIL)
The Pap test your healthcare provider recently performed has shown some abnormal changes of the cervix called Low-Grade Squamous Intraepithelial Lesion, or LSIL. The word squamous describes thin, flat cells that form the outer surface of the cervix. The word lesion refers to abnormal tissue. An intraepithelial lesion means that the abnormal cells are present only in the layer of cells on the surface of the cervix. Lowgrade means there are early changes in the size, shape, and number of cells. LSILs are considered mild abnormalities caused by HPV infection. Although LSIL is an abnormal result that requires additional follow-up, it is important to understand that a diagnosis of LSIL does not mean that you have cervical cancer.
Pap Test Background Information
The Pap test (sometimes called a Pap smear) is a way to examine cells collected from the cervix (the lower, narrow end of the uterus). The main purpose of the Pap test is to find abnormal cellular changes that may arise from cervical cancer or before cancer develops.
A Pap test and pelvic exam are important parts of a woman’s routine healthcare because they can detect abnormalities that may lead to invasive cancer of the cervix. These abnormalities can be treated before cancer develops. Most invasive cancers of the cervix can be prevented if women have Pap tests regularly. Also, as with many types of cancer, cancer of the cervix is more likely to be treated successfully if it is detected early.
Women should talk with their healthcare provider about when and how often they should have a Pap test. Current general guidelines recommend that women have a Pap test at least once every 3 years, beginning about 3 years after they begin to have sexual intercourse, but no later than age 21. About 55 million Pap tests are performed each year in the United States. Of these, approximately 3.5 million (6 percent) are abnormal and require medical follow-up.
Follow-up and Treatment Options for LSIL
Colposcopy: Your healthcare provider may decide to perform an additional test called a colposcopy. In this procedure, an instrument similar to a microscope is inserted through the vagina and used to view the cervix directly. Your healthcare provider will be able to see the surface of the cervix clearly during the procedure and will look for any abnormal areas.
Biopsy: If areas of abnormal cells are seen during the colposcopy, your healthcare provider may biopsy (remove a small tissue sample) and send it to a laboratory for study under a microscope. Often, multiple areas of the cervix are biopsied during the procedure. While a Pap test is a screening test, a biopsy is a diagnostic test and will provide a definitive diagnosis.
Endocervical Curettage (ECC): In this procedure, your healthcare provider will scrape cells from the wall of your cervical canal with a small spoon-shaped tool called a curette. The cells are then sent to a laboratory and studied for abnormal changes. ECC is often performed with a biopsy. If the lab finds abnormal cells that have a high chance of becoming cancer, further treatment is needed.
Cryotherapy: In order to destroy abnormal cells, your healthcare provider may elect to use a very low-temperature probe to freeze abnormal cells. The cells that grow back during the healing process are usually normal and healthy.
Laser Therapy: In this procedure, a highly concentrated beam of light energy called a laser is focused on the affected area of the cervix, and the abnormal cells are vaporized. In time, the vaporized tissue grows back with cells that are usually normal and healthy.
LEEP (Loop Electrosurgical Excision Procedure): Your healthcare provider may use an electric loop to remove abnormal tissue from your cervix. The tissue sample is then sent to a laboratory for further examination. The cells that grow back during the healing process are usually normal and healthy.
Cone Biopsy: Your healthcare provider may remove a cone-shaped wedge of tissue from the opening of the cervix. The tissue is then sent to a laboratory for further examination. The cells that grow back during the healing process are usually normal and healthy.
Questions to Ask Your Healthcare Provider
- Is this diagnosis going to progress into something more severe?
- What type of follow-up do you suggest and why?
- What are the potential risks or side effects of this option?
- When do you recommend a repeat Pap test?
Sources for Additional Information
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Atypical Glandular Cells (AGC)
The Pap test your healthcare provider recently performed has shown some abnormal changes of the cervix called Atypical Glandular Cells or AGC. AGC may arise from the endocervix (glandular portion of the cervix) or the endometrium (uterine lining tissue). Glandular cells are mucus-producing cells found in the endocervical canal (opening in the center of the cervix) or in the lining of the uterus. AGC is when the glandular cells do not appear completely normal. Although AGC is an abnormal result that requires additional follow-up, it is important to understand that a diagnosis of AGC does not mean that you necessarily have cervical or uterine cancer.
Pap Test Background Information
The Pap test (sometimes called a Pap smear) is a way to examine cells collected from the cervix (the lower, narrow end of the uterus). The main purpose of the Pap test is to find abnormal cellular changes that may arise from cervical cancer or before cancer develops.
A Pap test and pelvic exam are important parts of a woman’s routine healthcare because they can detect abnormalities that may lead to invasive cancer of the cervix. These abnormalities can be treated before cancer develops. Most invasive cancers of the cervix can be prevented if women have Pap tests regularly. Also, as with many types of cancer, cancer of the cervix is more likely to be treated successfully if it is detected early.
Women should talk with their healthcare provider about when and how often they should have a Pap test. Current general guidelines recommend that women have a Pap test at least once every 3 years, beginning about 3 years after they begin to have sexual intercourse, but no later than age 21. About 55 million Pap tests are performed each year in the United States. Of these, approximately 3.5 million (6 percent) are abnormal and require medical follow-up.
Follow-up and Treatment Options for ACG
Colposcopy: Your healthcare provider may decide to perform an additional test called a colposcopy. In this procedure, an instrument similar to a microscope is inserted through the vagina and used to view the cervix directly. Your healthcare provider will be able to see the surface of the cervix clearly during the procedure and will look for any abnormal areas.
Biopsy: If areas of abnormal cells are seen during the colposcopy, your healthcare provider may biopsy (remove a small tissue sample) and send it to a laboratory for study under a microscope. Often, multiple areas of the cervix are biopsied during the procedure. While a Pap test is a screening test, a biopsy is a diagnostic test and will provide a definitive diagnosis.
Endocervical Curettage (ECC): In this procedure, your healthcare provider will scrape cells from the wall of your cervical canal with a small spoon-shaped tool called a curette. The cells are then sent to a laboratory and studied for abnormal changes. ECC is often performed with a biopsy. If the lab finds abnormal cells that have a high chance of becoming cancer, further treatment is needed.
Endometrial Biopsy: If clinically indicated, your healthcare provider may also decide to obtain a tissue sample from the endometrium, the lining of the uterine cavity. A thin tube is inserted through the cervix into the uterus, and gentle scraping and suction are used to remove the sample.
LEEP (Loop Electrosurgical Excision Procedure): Your healthcare provider may use an electric loop to remove abnormal tissue from your cervix. The tissue sample is then sent to a laboratory for further examination. The cells that grow back during the healing process are usually normal and healthy.
Cone Biopsy: Your healthcare provider may remove a cone-shaped wedge of tissue from the opening of the cervix. The tissue is then sent to a laboratory for further examination. The cells that grow back during the healing process are usually normal and healthy.
Questions to Ask Your Healthcare Provider
- Is this diagnosis going to progress into something more severe?
- What type of follow-up do you suggest and why?
- What are the potential risks or side effects of this option?
- When do you recommend a repeat Pap test?
Sources for Additional Information
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Basal Cell Carcinoma
Basal Cell Carcinoma (BCC) is the most common form of skin cancer. Most often, BCCs are found on the parts of the body that are frequently sun-exposed – especially the face, ears, neck, scalp, shoulders, and back. One out of every three new cancers are skin cancers, with most diagnosed as basal cell carcinomas. This diagnosis affects approximately two million Americans each year.
Those with fair skin and light-colored hair are most at risk, although anyone with a history of sun exposure has the potential to develop BCCs. In limited instances, interaction with arsenic, exposure to radiation, open sores that do not heal well or chronic dermatitis can also cause basal cell carcinomas.
Look For The Signs
BCCs can show up on the skin in different ways. Warning signs may include an open sore that resists healing, a reddish patch, a growth with a raised border and a central flattening, a bump or nodule with a scar-like area. BCCs may look like a sore that bleeds easily, resists healing, oozes or crusts over, or has visible blood vessels in or around it. Although unusual, a BCC can be painful or itch; however, most often, the only sign of a BCC is the growth on the skin.
What Should We Do to Protect Ourselves?
Limiting sun exposure, especially between peak sunlight hours of 10 a.m. to 4 p.m., is a vital preventative measure to help reduce the risk of developing BCCs. This is especially important as chronic sun exposure is the leading cause of BCC development.
Regular usage of broad-spectrum sunscreen, SPF-15 or higher, on all exposed skin, even on cloudy days will increase your protection against the sun’s damaging ultraviolet rays. Wearing hats and protective clothing will also increase your protection as will reapplication of sunscreen frequently. You can also prevent BCCs by protecting your skin from harmful exposure by never using tanning beds or sun lamps.
Routinely visit your physician for yearly skin checks and inspect your entire body regularly for any skin changes.
The Treatment Options
Several effective methods are available to treat basal cell carcinoma. Your healthcare provider’s choice of therapy depends on the size, location, and subtype of basal cell carcinoma as well as your age and general health. Most basal cell carcinomas can be completely cured with the appropriate treatment. Only a physician can determine the most appropriate treatment.
Simple Excision: Most cases of basal cell carcinoma can be simply removed (cut out) along with a margin of normal skin.
Mohs Surgery: Mohs surgery, microscopically controlled surgery, is generally used when treating large tumors, tumors in certain critical locations, and those that have come back after other treatments. The cure rate is higher with Mohs surgery than any other type of treatment, however, it is complex and expensive.
Radiation: This is generally the therapy of choice for cancers that are in hard-to-reach places that are difficult to treat surgically.
Laser Surgery or Topical Chemotherapy: Either of these therapies is appropriate for individuals whose cancers are very superficial tumors.
Questions to Ask Your Healthcare Provider
- Are there any other tests that we need to perform?
- Where is my cancer located and has it spread?
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- What are the steps after treatment?
- What are the chances of recurrence after my treatment plan?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Academy of Dermatology:
www.aad.org
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Dysplastic Nevi (Atypical Moles)
Dysplastic Nevi (atypical moles) are unusual benign moles that may resemble melanoma. People who have them are at increased risk of developing single or multiple melanomas. The higher the number of these moles someone has, the higher the risk; those who have ten or more have twelve times the risk of developing melanoma compared to the general population. Dysplastic nevi are found significantly more often in melanoma patients than in the general population.
Background Information on Dysplastic Nevi
Medical reports indicate that about two to eight percent of the Caucasian population have these moles. Heredity appears to play a part in their formation. Those who have multiple dysplastic nevi plus a family history of melanoma (two or more close blood relatives with the disease) have an extremely high risk of developing melanoma. Individuals who have dysplastic nevi, but no family history of melanoma, still face a seven to twenty-seven times higher risk of developing melanoma compared to the general population. This is a great enough risk to warrant monthly self-examination, regular professional skin exams, and daily sun protection.
Early Indicators: It is important to be aware of the marks on your body, including moles, blemishes, freckles, etc. The American Cancer Society recommends checking your skin once a month to monitor any changes in these marks. Pay attention to any new growths, spots, or bumps that are getting larger (over a few months or one to two years), or to any sores that don’t heal within three months. Dysplastic Nevus will often appear as red, blue, black, or brown asymmetrical and hazy moles. They are generally larger than 1/4” (6mm) but may be smaller. Dysplastic Nevus may have several different appearances on your skin.
Risk Factors: There are several risk factors that can increase an individual’s likelihood of developing a dysplastic nevus.
- Dysplastic Nevus can be caused by chronic sun exposure.
- Individuals with fair skin and a tendency to burn are at an increased risk of developing some type of skin cancer.
- Family history of dysplastic nevi or melanoma.
- Individuals who have had skin cancer previously are at a higher risk of developing it again. These individuals should be screened more frequently
Treatment Options
Several effective methods are available to treat dysplastic nevi. Your healthcare provider’s choice of therapy depends on the size, location, and subtype of dysplastic nevus as well as your age and general health. Most dysplastic nevi can be completely cured with the appropriate treatment. Only a physician can determine the most appropriate treatment.
Excision: An excision is a procedure for the complete removal of a lesion or abnormal area of skin. The tissue specimen is then sent to the lab for further testing. Deep Shave (Saucerization)
Biopsy: This is the surgical removal of tissue to form a shallow depression in the skin. The tissue specimen is then sent to the lab for further testing.
Punch Biopsy: This is the surgical removal of a cylindrical portion of tissue to form a deep, round depression in the skin. The tissue specimen is then sent to the lab for further testing.
Protective Measures
There are measures that you can take to reduce your risk of developing skin cancer. It is critical to limit skin exposure to the sun’s harmful rays by wearing sunglasses, broad-brimmed hats, and protective clothing. In addition, the use of a broad-spectrum sunscreen rated SPF-30 or higher and with both UVA and UVB protection on all exposed skin is recommended. Avoiding tanning salons and artificial tanning devices is important as well. Conduct self-examinations and routinely visit your dermatologist for a skin examination.
Questions to Ask Your Healthcare Provider
- Are there any other tests that we need to perform?
- Where is my cancer located and has it spread?
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- What are the steps after treatment?
- What are the chances of recurrence after my treatment plan?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Academy of Dermatology:
www.aad.org
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Squamous Cell Carcinoma
Squamous cell carcinoma (SCC) is the second most common type of skin cancer. It occurs through the uncontrolled growth of abnormal cells on the skin’s outermost layer and/or on the lining of the epithelium, although they can also develop anywhere on the body. SCCs resemble wart-like growths that crust and occasionally bleed, scaly red patches with irregular borders, open sores, or elevated growths with a flattened center that can often bleed. Frequently, the skin will reveal signs of sun damage, such as wrinkling, changes in color, and loss of elasticity.
Individuals at a higher risk for development of these lesions include anyone with fair skin, light-colored eyes, or a history of large amounts of sun exposure. Asians, Hispanics, and individuals with dark complexions are less likely to develop SCC.
What Should We Do to Protect Ourselves?
Limiting sun exposure, especially between peak sunlight hours of 10 a.m. to 4 p.m., is a vital preventative measure to help reduce the risk of developing skin cancer. This is especially important as chronic sun exposure is the leading cause of lesion development.
Regular usage of broad-spectrum sunscreen, SPF-15 or higher, on all exposed skin, even on cloudy days will increase your protection against the sun’s damaging ultraviolet rays. Wearing hats and protective clothing will also increase your protection as will reapplication of sunscreen frequently. You can also prevent SCC by protecting your skin from harmful exposure by never using tanning beds or sun lamps.
Routinely visit your physician for yearly skin checks and inspect your entire body regularly for any skin changes.
The Treatment Options
Lesions that are detected early stage and removed are almost always curable and leave minimal damage. But, if left untreated, SCCs can spread in-depth and become disfiguring. Therefore, it is important to have any suspicious growth evaluated by your physician.
Physicians often diagnose and treat SCCs by closely examining the skin, but sometimes a skin biopsy is needed. After a dermatopathologist assesses your skin tissue under a microscope and determines the lesion is a Squamous Cell Carcinoma, your physician will discuss several treatment options with you. Options are based on the type, size, location, and depth of the tumor, as well as your age and general health. Treatment for SCCs is most frequently performed in an outpatient setting at the physician’s office or clinic. Therapy options can include:
Simple Excision: Most cases of squamous cell carcinoma can be simply removed (cut out) along with a margin of normal skin.
Mohs Surgery: Mohs surgery, microscopically controlled surgery, is generally used when treating large tumors, tumors in certain critical locations, and those that have come back after other treatments. The cure rate is higher with Mohs surgery than any other type of treatment, however, it is complex and expensive.
Radiation: This is generally the therapy of choice for cancers that are in hard-to-reach places that are difficult to treat surgically.
Lymph Node Removal: In situations where the squamous cell carcinomas are deeply invasive, and your physician suspects that cancer may have spread to your lymph nodes, they may decide to biopsy and/or remove them.
Questions to Ask Your Healthcare Provider
- Are there any other tests that we need to perform?
- Where is my cancer located and has it spread?
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- What are the steps after treatment?
- What are the chances of recurrence after my treatment plan?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Academy of Dermatology:
www.aad.org
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Seborrheic Keratosis
Seborrheic Keratosis (SK) is a common skin growth. They are non-cancerous lesions that can develop on any part of the body. SKs, most often, begin as rough, small, itchy bumps that can slowly thicken and become a warty surface. They can vary in color from light to black, with most a tan or brown color. SKs can resemble warts, moles, actinic keratosis and skin cancer. Their defining characteristic is the waxy, “pasted-on-the-skin” look, similar to a candle wax on the skin.
Though SKs appear to spread, they are not contagious. SKs are most often seen in those of middle to older age, with some occurring during pregnancy or following estrogen therapy. Although UV exposure is not a determining cause, there has been a correlation to an individual’s family history.
Although harmless, SKs should be observed regularly, like the rest of your skin for any changes in size, shape, or color. If you notice a growth that bleeds, itches, or becomes irritated easily, you should contact your physician for them to examine.
How to Manage Seborrheic Keratosis
Most SKs do not require additional care. Although, you should see a dermatologist if the following occurs:
- Lesion grows quickly, becomes darker, itches, or bleeds
- Many new growths appear suddenly. This could be a sign of internal cancer growth.
- The growth does not look similar to a typical SK
- The growth is dry, flat, scaly, and rough- this could be an Actinic Keratosis, which can develop into another type of skin cancer
- The growth becomes easily irritated, either from clothing rubbing against it or shaving
- The growth has changed cosmetically and you would like it removed
- Do not try to remove a seborrheic keratosis yourself. There is a risk of infection.
The Treatment Options
Physicians often diagnose and treat SKs by closely examining the skin, but sometimes a skin biopsy is needed. After a dermatopathologist assesses your skin tissue under a microscope and determines the lesion is a Seborrheic Keratosis, your physician will discuss several treatment options with you.
There are many factors to take into consideration when deciding on a treatment. Location, size of the lesion, as well as your age, and overall health are all important variables. Common treatment options include shave removal, cryosurgery, curettage, and/or electrosurgery. The removal of SKs causes minimal scarring since these lesions are mainly superficial to the skin. Your physician will guide you to decide which treatment option is best for you.
Questions to Ask Your Healthcare Provider
- Are there any other tests that we need to perform?
- Where is my cancer located and has it spread?
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- What are the steps after treatment?
- What are the chances of recurrence after my treatment plan?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Academy of Dermatology:
www.aad.org
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Malignant Melanoma
Melanoma is a serious form of skin cancer that occurs in the melanocytic cells of the epidermis. Melanocytes are the cells that produce a dark, protective pigment called melanin. With early detection and treatment, melanoma is almost always curable.
Melanoma may affect anyone and can occur anywhere on the body. Those with fair skin, light hair, and eye color or who have a family history of melanoma are at a higher level of risk. Melanoma may spread or metastasize to other organs making it difficult to treat and can become fatal. Because these tumors can develop in or near a previous mole or may appear without much warning, it is imperative to have regularly scheduled skin checks with your dermatologist.
Know Your ABCDEs of Melanoma
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Asymmetry – If you bisect the mole/lesion the two halves will not match. | |
 |
Border – The borders of the mole/lesion are uneven. | |
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Color – The mole/lesion appears in a variety of colors, e.g., brown, tan, black, red, or blue. | |
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Diameter– The mole/lesion usually measures at least ¼ inch (6 mm) in diameter but may be smaller when first detected. | |
| Evolution– Any change in size, shape, color, elevation, or the existence of bleeding, itching, or crusting of a mole/lesion is a warning sign. |
What Should We Do to Protect Ourselves?
Limiting sun exposure, especially between peak sunlight hours of 10 a.m. to 4 p.m., is a vital preventative measure to help reduce the risk of developing skin cancer. This is especially important as chronic sun exposure is the leading cause of melanoma development.
Regular usage of broad-spectrum sunscreen, SPF-30 or higher, on all exposed skin, even on cloudy days will increase your protection against the sun’s damaging ultraviolet rays. Wearing hats and protective clothing will also increase your protection as will reapplication of sunscreen frequently. You can also prevent melanoma by protecting your skin from harmful exposure by never using tanning beds or sun lamps.
Having a dark complexion can lower your risk of melanoma, but continue to check common sites such as palms of hands, soles of feet, and under the nails.
Routinely visit your physician for yearly skin checks and inspect your entire body regularly for any skin changes. Early detection is lifesaving.
The Treatment Options
Following a diagnosis of melanoma from your skin biopsy by a dermatopathologist, your dermatologist will discuss several treatment options. Treatment can vary dependent on the location, depth, spread of the tumor, and general health. Treatment options include surgical excision, Mohs micrographic surgery, chemotherapy, and radiation. Occasionally, lymph nodes will also be removed.
Questions to Ask Your Healthcare Provider
- Are there any other tests that we need to perform?
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- What are the steps after treatment?
- What are the chances of recurrence after my treatment plan?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Academy of Dermatology:
www.aad.org
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Actinic Keratosis
Actinic Keratosis (AK), also known as solar keratosis, is a precancerous skin condition caused by overexposure to the sun. Actinic Keratoses are usually small (less than 1/4 inch across), with rough spots that may be pink-red or flesh-colored. Usually, they develop on the face, ears, back of the hands, and arms of middle-aged or older people with fair skin, although they can arise in other sun-exposed areas. Individuals who are immunosuppressed, either by cancer chemotherapy treatments or organ transplants, and who have immunodeficiency disorders, are also considered high risk for developing AKs.
AKs are slow-growing and usually do not cause any symptoms. Even though most Actinic Keratoses do not become cancers, they are a warning that your skin has suffered sun damage. If not treated, AKs have the potential to become aggressive and develop into Squamous Cell Carcinoma. It is valuable to be diligent and report any suspicious skin changes to your physician.
What Should We Do to Protect Ourselves?
Limiting sun exposure, especially between peak sunlight hours of 10 a.m. to 4 p.m., is a vital preventative measure to help reduce the risk of developing AKs. This is especially important as chronic sun exposure is the leading cause of lesion development.
Regular usage of broad-spectrum sunscreen, SPF-15 or higher, on all exposed skin, even on cloudy days will increase your protection against the sun’s damaging ultraviolet rays. Wearing hats and protective clothing will also increase your protection as will reapplication of sunscreen frequently. You can also prevent AKs by protecting your skin from harmful exposure by never using tanning beds or sun lamps.
Routinely visit your physician for yearly skin checks and inspect your entire body regularly for any skin changes.
Treatment Options
Physicians often diagnose and treat AKs by closely examining the skin, but sometimes a skin biopsy is needed. After a dermatopathologist assesses your skin tissue under a microscope and determines the lesion is an Actinic Keratosis, your physician will discuss several treatment options with you.
There are many factors to take into consideration when deciding on a treatment. Location, size of the lesion, number of AKs you have developed, as well as your age and overall health are all important variables. Common treatment options include chemical peels, curettage (surgical removal), cryosurgery (freezing the suspicious area with liquid nitrogen), topical chemotherapy creams, photodynamic therapy, and laser resurfacing therapy. Your physician will guide you to decide which treatment option is best for you.
Questions to Ask Your Healthcare Provider
- Are there any other tests that we need to perform?
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- What are the steps after treatment?
- What are the chances of recurrence after my treatment plan?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Academy of Dermatology:
www.aad.org
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Adenomatous Polyps
Polyps are growths that develop in the colon or the rectum. Colorectal polyps are common and may be found in approximately nine of every 10,000 persons. Polyps are usually classified into two types: adenomatous polyps (adenomas) and hyperplastic polyps. Hyperplastic polyps are generally considered to have a very low risk of becoming cancerous (mostly noncancerous); adenomatous polyps (adenomas) are considered to have a low, but increased risk, of becoming cancerous (possibly pre-cancerous). Adenomatous colorectal polyps are small, fleshy, mushroom-shaped growths that may turn cancerous if not removed. These polyps show abnormal cellular changes. It is estimated that during a year’s time, one out of every 400 adenomatous polyps will become cancerous. Although many people will develop colon polyps in their lifetime, most polyps will not develop into cancer.
Adenomatous Polyp Background Information
Colorectal cancer is the second leading cause of cancer deaths in the United States. The risk of colorectal cancer tends to increase after the age of 50. Cancer of the colon and rectum usually begins as a polyp. Although most polyps never become cancerous, virtually all colon and rectal cancers start from these benign growths. Very rarely, colon cancers have been found that appear to have started without a preceding adjacent polyp.
Symptoms: Unless colon polyps are large and cause bleeding or pain, the only way to know if you have polyps is to have one or more tests that examine the surface of your colon. The most common test used for this examination is a colonoscopy procedure. Adenomas typically causes few symptoms; however, painless rectal bleeding and abdominal pain are the most common.
Risk factors: Most polyps are the result of a genetic mutation in the lining of the colon. The risk of developing polyps increases with age and some individuals may have more than one polyp. The likelihood of developing polyps is also higher in patients with a family history of colorectal polyps or colorectal cancer, including inherited disorders such as Gardner’s syndrome or familial adenomatous polyposis.
Follow-up and Treatment Options for Adenomatous Polyps
Polyps are usually detected during a screening test for colon cancer or other abdominal conditions. The most common screening tests which can reveal a polyp are a colonoscopy (an examination of the large bowel with a telescope-like device), a sigmoidoscopy (an examination of the lowest part of the bowel using a flexible telescope), or a barium enema (an x-ray taken after consuming a barium liquid). Only a physician can determine the most appropriate treatment.
Polypectomy: A polypectomy involves the removal of the entire polyp during a colonoscopy. The tissue sample is reviewed by a pathologist to determine whether the tissue contains cancer or other diseases. A polyp that has been completely cut out will not grow back, however, some individuals tend to form multiple polyps, so there is the chance that new polyps could develop after polypectomy.
Surgery: In some instances, although not frequently, a polyp may be too large to be removed during a colonoscopy. This generally occurs when the diameter is more than 4 cm and, particularly, if the base of the polyp is broad and not well defined. In these situations, endoscopic removal can carry an unacceptably high risk of bleeding or perforation. Such polyps are also more likely to already contain cancer and removal by surgery can be the safest option to ensure that the cancer is completely removed.
Follow-up Colonoscopy: It is important to have follow-up colonoscopies to monitor your condition and assure that new polyps have not developed.
Questions to Ask Your Healthcare Provider
- Do you recommend the removal of my polyp(s)?
- Does my polyp put me at increased risk for colorectal cancer?
- Is there anything I should be doing or not doing during treatment?
- Are there any other measures I can take to reduce my risk of future polyps?
- What are the chances of recurrence after my treatment plan?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Colorectal Cancer
Cancer of the colon or rectum is often called colorectal cancer. The colon and the rectum are part of the large intestine, which is part of the gastrointestinal tract. Colon and rectum cancers develop slowly over a period of several years. Most of these cancers begin as a polyp, which is a growth of tissue, in the center of the colon or rectum. Over the past several years, the number of new cases of colorectal cancer in the United States has been decreasing slightly and the number of deaths has decreased as well. It is important to quickly and effectively evaluate the extent of the colorectal cancer. In order to diagnose this condition, an endoscopic examination is frequently performed to visualize any abnormality in the lining of the colon. A biopsy is taken of the lining of the colon during the colonoscopy, and the tissue is sent to the pathology laboratory. The surgical pathologist at the laboratory determines whether an abnormality exists by microscopic examination of the colon tissue sample (biopsy) and whether it is benign or malignant. The treatment and the outlook for your recovery depend on the stage of the cancer. Your healthcare provider will recommend any additional testing that he/she feels is needed to evaluate the cancer prior to treatment.
Colorectal Cancer Background Information
Colorectal cancer is the second leading cause of cancer deaths in the United States. The risk of colorectal cancer tends to increase after the age of 50.
Screening: A screening test, such as a colonoscopy, can find colorectal cancers at an early stage and greatly improve the chances of successful treatment. Screening tests can also help prevent some cancers by allowing doctors to find and remove polyps that might become cancerous.
Symptoms: Individuals who are symptomatic may experience a change in bowel habits such as diarrhea or constipation, blood in the stool, abdominal cramping, or pain and tiredness.
Risk Factors: Although the cause of colorectal cancer is unknown, it can sometimes be associated with known risk factors. Many risk factors are able to be changed, though not all can be eliminated. Some of the most common risk factors are:
- Individuals over the age of 50 have an increased risk of developing colorectal cancer.
- Lack of exercise, diets high in fat and calories and low in fiber, smoking and alcohol abuse, and obesity have all been linked to colorectal cancer. Maintaining a healthy lifestyle may help reduce your risk of developing colorectal cancer.
- Conditions such as ulcerative colitis, an inflammatory disease of the colon, and polyps can increase an individual’s risk as well. Screening for colorectal cancer is recommended at an earlier age for these individuals and polyps which are found should be removed.
- Individuals who have a family history of colorectal cancer or have had colorectal cancer themselves are at a higher risk for developing it. These individuals should likely be screened earlier and more frequently
Follow-up and Treatment Options for Colorectal Cancer
The treatment or therapy depends on the stage of cancer, whether it has blocked or created a hole in the colon, the blood levels of carcinoembryonic antigen, whether cancer has recurred, and your general health. Below is a listing of potential treatment options for colorectal cancer. The main treatments for colorectal cancer are surgery, chemotherapy, and radiation therapy. Only a physician can determine the most appropriate treatment.
Surgery: The surgical removal of the cancer is the most common form of treatment for all stages of colorectal cancer. The surgeon will likely remove the cancerous tissue as well as a smaller section of healthy tissue surrounding it and sew the two ends of the colon back together. Often times the lymph nodes around the cancerous area will also be removed to determine if the cancer has spread. Sometimes chemotherapy or radiation therapy are used after surgery to kill any cancer cells that are left.
Chemotherapy: Chemotherapy is the use of drugs to kill the cancer cells or stop them from dividing. Most chemotherapy is given in the form of injections, however, some can be taken by mouth. These drugs enter the bloodstream and travel throughout the entire body. The use of chemotherapy after surgery can increase the survival rate for patients with some stages of colorectal cancer. Chemotherapy can also help relieve symptoms of advanced cancer.
Radiation therapy: Radiation therapy involves the use of high-energy rays to kill cancer cells. Radiation therapy is focused directly on the affected area and is sometimes given after surgery to kill any remaining cancer cells. If the cancer has attached to an internal organ or the lining of the abdomen, radiation therapy may be used to kill the cancer cells that are left behind after surgery. For rectal cancer, radiation is also given to prevent the cancer from coming back to the surgical site and to treat local recurrences that are causing symptoms such as pain.
Questions to Ask Your Healthcare Provider
- Are there any other tests that we need to perform?
- Where is my cancer located and has it spread?
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- Is there anything I should be doing or not doing during treatment?
- What are the steps after treatment?
- What are the chances of recurrence after my treatment plan?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Crohn’s Disease
Crohn’s disease is a chronic (ongoing) disorder that causes inflammation of the digestive or gastrointestinal (GI) tract. Although it can involve any area of the GI tract from the mouth to the anus, it most commonly affects the small intestine and/or colon. In Crohn’s disease, all layers of the intestine may be involved, and there can be normal healthy bowel in between patches of diseased bowel. There is no individual test that can definitively diagnose Crohn’s disease. To determine the diagnosis, your physician will evaluate the results of laboratory tests, Xrays, and findings on endoscopy and pathology tests. Other testing may need to be performed to eliminate other conditions. It may take some time to come to the proper diagnosis because the symptoms of Crohn’s disease mimic those of other gastrointestinal disorders.
Crohn’s Disease Background Information
Crohn’s and a related disease, ulcerative colitis, are the two main disease categories that belong to a larger group of illnesses called inflammatory bowel disease (IBD). It is estimated that nearly half a million Americans have Crohn’s disease. The incidence of the disease is similar in males and females. Crohn’s disease occurs primarily in individuals between the ages of 15-35. It can, however, affect individuals of all ages. Crohn’s disease is a chronic disease and is associated with a slightly increased risk of small intestinal and colorectal cancer.
Symptoms: Individuals with Crohn’s disease can experience any range of symptoms ranging from mild to severe. The symptoms will range in severity depending on whether or not the disease is in a period of remission or flare-up. The more common symptoms an individual may experience are prolonged or bloody diarrhea, unexplained weight loss, fever, and abdominal pain.
Risk Factors: Some of the most common risk factors are:
- Individuals are at a higher risk of developing Crohn’s disease if they have a family member with the disease. The risk is ten times greater if a person has a relative with the disease and thirty times greater if the relative is a brother or sister.
- Crohn’s disease affects certain ethnic groups more than others. The disease is also more prominent in Caucasians and African Americans.
- The environment is also thought to have some effect on increasing the risk of Crohn’s disease. For example, the incidence is higher in highly developed countries.
Follow-up and Treatment Options for Crohn’s Disease
Follow-up and diagnosis of Crohn’s disease frequently requires an endoscopic examination by your physician. The endoscopic examination may include a colonoscopy and an endoscopy of the stomach and small intestine. The treatment for Crohn’s disease depends on the location and severity of the disease, complications, and response to previous treatment. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding. The main treatment alternatives are drugs, nutrition supplements, or surgery. Unfortunately, treatment can help control the disease, but there is no cure. Only a physician can determine the most appropriate treatment.
Drug Therapy: Medication is usually prescribed to help reduce inflammation. In addition, oftentimes physicians will prescribe a drug to help suppress or modify the immune system and an antibiotic to treat bacterial overgrowth.
Nutrition: Attention to your diet will be instrumental in reducing symptoms and maintaining good nutritional status. Oftentimes individuals with Crohn’s disease experience loss of appetite and have increased caloric needs. These individuals would benefit from the inclusion of a nutritional supplement in their diet. Soft and bland foods are also generally tolerated better than hot and spicy foods.
Surgery: When medication is no longer effective in controlling the symptoms of Crohn’s disease, surgery may be recommended. Surgery may be useful in repairing fistulas or removing bowel obstructions. During these surgeries, the surgeon will remove the affected portion of the bowel and sew the two segments together, which is also known as bowel resection.
Questions to Ask Your Healthcare Provider
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- Is there anything I should be doing or not doing during treatment?
- What are the steps after treatment?
- How should I manage my diet to reduce my symptoms?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Gastroenterological Association:
www.gastro.org
Crohn’s and Colitis Foundation of America:
www.ccfa.org
National Institute of Health:
www.nih.gov
Gastric Cancer
Gastric cancer is cancer of the stomach. The most common type of stomach cancer occurs in the glandular tissue of the stomach and is known as gastric adenocarcinoma. Over the past several years, the number of new cases of gastric cancer in the United States has been steady and the number of deaths has decreased significantly due to early detection and improved treatment options. It is important to quickly and effectively evaluate the extent of gastric cancer. Early detection and diagnosis are achieved by endoscopic examination of the stomach and other tests by a gastroenterologist or endoscopic surgeon. Oftentimes gastric cancer can spread to the liver, pancreas, lungs, and other organs near the stomach. Staging is the process of finding out how far the cancer has spread. This is very important because the treatment and the outlook for your recovery depend on the stage of the cancer. Your clinician will recommend any additional testing that he/she feels is needed to evaluate the cancer prior to treatment.
Gastric Cancer Background Information
Gastric or stomach cancer is one of the most common cancers of the digestive tract. The incidence of this cancer is approximately 2 in 10,000. Gastric cancer affects men twice as often as women and is more common in African-Americans than Caucasians. Diagnosis of gastric cancer is often delayed due to the lack of symptoms in early-stage disease and due to self-treatment of symptoms.
Symptoms: Possible early signs of gastric cancer include indigestion, stomach discomfort, nausea, or loss of appetite. In more advanced stages of gastric cancer, symptoms such as blood in the stools, vomiting, and unexplained weight loss may occur. These and other symptoms may be caused by gastric cancer or by other conditions.
Risk factors: Gastric cancer can sometimes be associated with known risk factors for the disease. Many risk factors are able to be changed though not all can be eliminated. Some of the most common risk factors are:
- An increased risk of gastric cancer is associated with diets containing large amounts of smoked foods, salted fish and meat, and pickled vegetables. Having a high intake of fresh fruits and vegetables including foods that contain beta-carotene and vitamin C may decrease the risk of gastric cancer.
- There are several pre-existing conditions that put an individual at a higher risk of developing gastric cancer. These include individuals who are infected with a bacterium called Helicobacter pylori, those who have had previous surgery to remove a portion of their stomach due to ulcers, and those with long-standing reflux of gastric contents and the development of an abnormal cellular lining.
- Smoking increases stomach cancer risk, particularly for cancers of the proximal stomach (the upper portion of the stomach closest to the esophagus). The rate of stomach cancer is approximately doubled in smokers.
- Individuals who have a family history of stomach cancer are at an increased risk.
Follow-up and Treatment Options for Gastric Cancer
Treatment is available for all stages of gastric cancer. The choice of treatment depends on many factors including the location and the stage of the tumor, age, state of health, and personal preferences. The main treatments for gastric cancer are surgery, chemotherapy, and radiation therapy. Only a physician can determine the most appropriate treatment.
Surgery: Surgery is the only way to cure gastric cancer. If gastric cancer is in its early stages and the patient is healthy enough, an attempt should be made to completely remove the cancer. Even when the cancer is too widespread to be completely removed by surgery, most patients’ surgery may be done with the intentions of relieving or preventing symptoms, but not curing the cancer.
Chemotherapy: Chemotherapy is the use of drugs to kill the cancer cells or stop them from dividing. Most chemotherapy is given in the form of injections, however, some can be taken by mouth. This type of therapy is useful for cancer that has spread to organs outside of the stomach. These drugs enter the bloodstream and travel throughout the entire body. It can even be helpful in relieving symptoms in some patients. Chemotherapy is currently being studied as a pre-surgical treatment and as an adjunctive treatment. In some instances, chemotherapy is combined with radiation therapy to increase the effects of both.
Radiation Therapy: Radiation therapy involves the use of high-energy rays to kill cancer cells. Radiation therapy is focused directly on the affected area and is sometimes given after surgery to kill any remaining cancer cells. Some studies show that radiation may prevent the recurrence of cancer after surgery. In addition, radiation therapy can be useful in relieving some symptoms.
Questions to Ask Your Healthcare Provider
- Are there any other tests that we need to perform?
- Has the cancer spread outside of the stomach?
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- Is there anything I should be doing or not doing during treatment?
- What are the steps after treatment?
- What are the chances of recurrence after my treatment plan?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Gastritis
Gastritis is the result of one of several conditions which cause inflammation of the stomach lining. Possible causes of gastritis include drinking too much alcohol, excessive use of aspirin or ibuprofen, or the presence of a bacterium called Helicobacter pylori (H. pylori). Gastritis can even develop as the result of bowel surgery or other diseases. In most situations, effective treatment is available and serious complications are unusual. By working with the physician, a positive outcome usually occurs. To diagnose this condition, a gastroenterologist or endoscopic surgeon will use a tube-like device to examine the lining of the stomach and duodenum for changes that may indicate gastritis or peptic ulcer disease. During the procedure, a biopsy sample will be taken from the abnormal areas of the stomach lining. This biopsy sample will be examined microscopically by a surgical pathologist in the laboratory to determine if gastritis is present, and if so what type of abnormality is seen.
Background Information
H. pylori is one of the most common causes of gastritis (inflammation) and affects nearly two-thirds of the world’s population. Historically, peptic ulcers (ulcers in the lining of the stomach) were believed to have been caused by stress or by eating the wrong foods. Although these things can aggravate existing ulcers, we now know that the large majority of ulcers are actually caused by H. pylori. H. pylori is a bacterium that lives in the protective mucus layer of the stomach. The bacterium weakens the mucus layer and allows the stomach acid to reach the underneath stomach lining. This acid can irritate the stomach lining and cause an ulcer. If left untreated, this condition could cause recurrent ulcers and, in some instances, lead to gastric (stomach) cancer.
Symptoms: Individuals with gastritis from H. pylori often live with this condition without suffering from significant symptoms. However, those with inflammation or ulcers can experience any range of symptoms ranging from mild to severe. The severity of symptoms is dependent on the amount of time the inflammation has been present and on its acuity. During acute phases, an individual may experience abdominal pain, nausea, and vomiting. During more chronic phases, the abdominal pain will likely be duller and the individual will likely experience a loss of appetite.
Follow-up and Treatment Options for Gastritis
Only a physician can determine the most appropriate treatment. Gastritis can also be caused by reflux of bile into the stomach from the duodenum, and from medications, e.g., aspirin and other anti-inflammatory drugs used to treat arthritis. Medications that protect the lining of the stomach have been reported to help relieve symptoms for some patients with this form of gastritis. If H. pylori infection is the cause of gastritis it can be effectively treated with medications as well. Antibiotics are used to treat the infection, either alone, or in combination with other drugs designed to reduce the stomach acid. This therapy should help alleviate any symptoms and heal the inflammation.
Questions to Ask Your Healthcare Provider
- What is the cause of my gastritis?
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- Is there anything I should be doing or not doing during treatment?
- What are the steps after treatment?
- After I am done with my treatment, what are the chances of gastritis recurring?
- How should I manage my diet to reduce my symptoms?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Gastroenterological Association:
www.gastro.org
Centers for Disease Control and Prevention:
www.cdc.gov
National Institute of Health:
www.nih.gov
Hyperplastic Polyps
Polyps are growths that develop in the colon or the rectum. Colorectal polyps are common and may be found in approximately nine of every 10,000 persons. Polyps are usually classified into two types: adenomatous polyps (adenomas) and hyperplastic polyps. The more common hyperplastic polyps are benign and, in most circumstances, are not considered to be premalignant. A definitive distinction between the two types requires polyp removal and microscopic examination by a pathologist. The adenomatous polyps (adenomas) have an increased risk of becoming pre-malignant compared to the hyperplastic polyp. Some hyperplastic-looking polyps called serrated adenomas have a risk profile similar to adenomatous polyps (adenomas). Although many people will develop colon polyps in their lifetime, most polyps will not develop into cancer.
Hyperplastic Polyp Background Information
Colorectal cancer is the second leading cause of cancer deaths in the United States. The risk of colorectal cancer tends to increase after the age of 50. Cancer of the colon and rectum usually begins as a polyp. Although most polyps never become cancerous, virtually all colon and rectal cancers start from these benign growths.
Symptoms: Unless colon polyps are large and cause bleeding or pain, the only way to know if you have polyps is to have one or more tests that explore the surface of your colon. Most hyperplastic polyps are much smaller than adenomatous polyps.
Risk factors: Most polyps are the result of a genetic mutation in the lining of the colon. The risk of developing polyps increases with age and some individuals may have more than one polyp. The likelihood of developing polyps is also higher in patients with a family history of colorectal polyps or colorectal cancer, including inherited disorders such as Gardner’s syndrome or familial adenomatous polyposis.
Follow-up and Treatment Options for Hyperplastic Polyps
Polyps are usually detected during a screening test for colon cancer or other abdominal conditions. The most common screening tests which can reveal a polyp are a colonoscopy (an examination of the large bowel with a telescope-like device), a sigmoidoscopy (an examination of the lowest part of the bowel using a flexible telescope), or a barium enema (an x-ray taken after consuming a barium liquid). A colonoscopy is now considered the best screening tool. Only a physician can determine the most appropriate treatment.
Polypectomy: A polypectomy involves the removal of the entire polyp during a colonoscopy. The tissue sample is reviewed by a pathologist to determine whether the tissue contains cancer or other diseases. A polyp that has been completely cut out will not grow back, however, some individuals tend to form multiple polyps, so there is the chance that new polyps could develop after polypectomy.
Surgery: In some instances, although not frequently, a polyp may be too large to be removed during a colonoscopy. This generally occurs usually when the size of the polyp is greater and, particularly, if the base of the polyp is broad and not well defined. In these situations, endoscopic removal can carry an unacceptably high risk of bleeding or perforation. Such polyps are also more likely to already contain cancer and removal by surgery can be the safest option to ensure that the cancer is completely removed. Follow-up
Colonoscopy: It is important to have follow-up colonoscopies to monitor your condition and assure that new polyps have not developed.
Follow-up Questions to Ask Your Healthcare Provider
- Do you recommend the removal of my polyp(s)?
- Does my polyp put me at increased risk for colorectal cancer?
- Is there anything I should be doing or not doing during treatment?
- Are there any other measures I can take to reduce my risk of future polyps?
- What are the chances of recurrence after my treatment plan?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Ulcerative Colitis
Ulcerative colitis is a chronic (ongoing) disease of the colon or large intestine that causes inflammation and ulceration of the colon inner lining. Pus, mucus, and blood are excreted by ulcers, or tiny open sores, that form on the lining of the gastrointestinal tract. Ulcerative colitis usually begins with inflammation in the rectum and lower colon, but it may also involve the entire colon. To determine the diagnosis, your physician will evaluate the results of laboratory tests, X-rays, and findings on endoscopy and pathology tests. The endoscopic examination examines the colon mucosal surface for disease changes. Any abnormal areas of the lining are diagnosed by the endoscopist, and pictures are taken. In addition, a small piece of the mucosa is sent to the pathology laboratory for a microscopic diagnosis. Other testing may need to be performed to eliminate other conditions. It may take some time to come to the proper diagnosis because the symptoms of ulcerative colitis mimic those of other gastrointestinal disorders including infectious causes of diarrhea.
Ulcerative Colitis Background Information
Ulcerative colitis and a related condition, Crohn’s disease, are the two main disease categories that belong to a larger group of illnesses called inflammatory bowel disease (IBD). It is estimated that nearly half of a million Americans have ulcerative colitis. The incidence of the disease is similar in males and females. Crohn’s disease occurs primarily in individuals under the age of 30. It can, however, affect individuals of all ages. Ulcerative colitis is a chronic disease and is associated with a slightly increased risk of small intestinal and colorectal cancer. As a result, patients with this disease need to be screened more closely by endoscopic and other methods, as determined by their physician.
Symptoms: Individuals with ulcerative colitis can experience any range of symptoms ranging from mild to severe. The symptoms will range in severity depending on whether or not the disease is in a period of remission or flare-up. Some of the symptoms an individual may experience are unexplained weight loss, diarrhea, fever, and abdominal pain.
Risk Factors: Some of the most common risk factors are:
- Individuals are at a higher risk of developing ulcerative colitis if they have a family member with the disease. There does not appear to be a clear-cut pattern to this inheritance and it is unknown which gene(s) is involved in the disease.
- Ulcerative colitis affects certain ethnic groups more than others.
- The environment is also thought to have some effect on increasing the risk of ulcerative colitis. Foreign substances may be the direct cause of the inflammation, or they may stimulate the body’s defenses to produce an inflammation that continues without control.
Follow-up and Treatment Options for Ulcerative Colitis
The treatment for ulcerative colitis depends on the severity of the disease, complications, and response to previous treatment. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding. Most individuals with ulcerative colitis are treated with medication and some severe cases require surgery. Only a physician can determine the most appropriate treatment.
Drug Therapy: The goal of drug therapy is to induce and lengthen remission periods and reduce the severity of symptoms. Anti-inflammatory drugs are almost often used to reduce inflammation. In some situations, other medications may be appropriate to treat diarrhea, pain, or infection.
Surgery: Surgical removal of the colon or rectum may be necessary for patients who fail to respond to medical therapy or for those who have complications associated with the disease, such as cancer.
Questions to Ask Your Healthcare Provider
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- Is there anything I should be doing or not doing during treatment?
- What are the steps after treatment?
- How should I manage my diet to reduce my symptoms?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Gastroenterological Association:
www.gastro.org
Crohn’s and Colitis Foundation of America:
www.ccfa.org
National Institute of Health:
www.nih.gov
Benign Prostatic Hyperplasia (BPH)
Benign prostatic hyperplasia is a noncancerous enlargement of the prostate gland. By middle age, your prostate gland enlarges normally as new cells grow and old cells do not die. It is not known what causes these growths, but they may be related to hormonal changes that occur with aging. When the prostate is enlarged, it pushes against the urethra and the bladder affecting the flow of urine.
Background Information on BPH
It is possible to have prostate enlargement and prostate cancer at the same time, but it is important to remember that prostate enlargement is not prostate cancer. In addition, having benign prostatic hyperplasia (BPH) does not seem to increase your chances of developing prostate cancer. Over 12 million Americans suffer from the effects of BPH. By age 60, more than half of all American men have microscopic signs of BPH, and by age 70, more than 40% will have enlargement that can be felt on physical examination. The size of the prostate does not always determine how severe the obstruction or how severe the symptoms will be. Some men with greatly enlarged glands have little obstruction and few symptoms, while others whose glands are less enlarged may have more blockage and greater problems.
Symptoms: Men with BPH may experience difficulty initiating a urine stream or maintaining urination, an increased need to urinate frequently, powerful urges to urinate, and the feeling that the bladder is never completely empty. If the prostate enlarges too much, urinary tract infections may develop and lead to possible kidney damage.
Follow-up and Treatment Options for BPH
The treatment or therapy depends on the severity of symptoms and degree of enlargement. Below is a listing of potential treatment options for BPH. The main treatments for BPH are either to “watch and wait,” medication, or surgery. Only a physician can determine the most appropriate treatment.
Watchful Waiting: If your symptoms are considered mild, then this is usually the best option. Medication or therapy is not recommended. You should continue to have an annual exam so that your physician can monitor the growth. Your physician may also recommend certain lifestyle changes such as increasing physical activity.
Drug Therapy: If your symptoms are considered moderate, this is usually the best option. Two types of drugs are used: one to relax the prostatic-urethral muscle thereby improving urinary flow, and the other to help shrink the prostate.
Surgery: If your symptoms are severe, surgery is usually the best option. There are several types of surgery that are available to relieve the symptoms of BPH. Although prostate surgery has a high success rate, it also has a higher rate of complications than drug therapy. There are three common types of surgery.
- Transurethral Resection of the Prostate (TURP): This procedure accounts for more than 90% of all BPH surgeries. TURP relieves symptoms quickly, typically doubling the urinary flow within weeks. This procedure involves removing the urethra’s lining and bits of excess prostate tissue to expand the urethra.
- Transurethral Needle Ablation (TUNA): Uses radiofrequency energy to kill excess prostate tissue.
- Prostatectomy: A portion of the prostate gland is surgically removed to relieve pressure on the urethra.
Questions to Ask Your Healthcare Provider
- Are there any other tests that we need to perform?
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- What are the steps after treatment?
- What are the chances of recurrence after my treatment plan?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
High-Grade Prostatic Intraepithelial Neoplasia (PIN)
Some physicians believe that prostate cancer begins with a condition called prostatic intraepithelial neoplasia (PIN). In this condition, there are changes in the size and shape of the cells in the prostate gland. These changes can be categorized as either low-grade or high-grade, based on the level of abnormality in the cells. If the high-grade PIN is diagnosed on a prostate biopsy, there is a 30% to 50% chance that cancer is also present within your prostate. Because of the close relationship between high-grade PIN and prostate cancer, your physician may recommend additional follow-up testing to further examine your prostate for the presence of prostate cancer.
Background Information on Prostate Cancer
The prostate is an organ found only in men, and it is about the same size and shape as a walnut. The prostate gland is located just below the bladder, in front of the rectum, and surrounds the urethra, the tube that carries the urine out of the body. In most men, prostate cancer grows very slowly, however in some situations, especially with younger men, it has been seen to grow more quickly. Prostate cancer is the most common type of cancer found in American men, other than skin cancer, with about 185,000 new cases diagnosed in the United States each year.
Symptoms: After the age of 50, most men are given a DRE (digital rectal exam) and a PSA (prostate-specific antigen) blood test at their annual exam. Prostate cancer is often detected by these tests since symptoms are rare. An individual with late-stage prostate cancer may experience pain during urination, blood in the urine, and impotence. However, these symptoms are also common with other diseases and conditions so your physician should perform a biopsy to confirm the diagnosis.
Risk Factors: Although the cause of prostate cancer is unknown, it can sometimes be associated with known risk factors. Many risk factors are able to be changed, though not all can be eliminated. Some of the most common risk factors are:
- As men age, they have an increased risk of developing prostate cancer.
- A lack of exercise and diets high in red meat and dairy products and low in fruits and vegetables have been linked to prostate cancer.
- Individuals who have a family history of prostate cancer are at a higher risk of developing it. These individuals should likely be screened earlier and more frequently.
Follow-up and Treatment Options for High-Grade PIN
Prostate-Specific Antigen (PSA) Test: PSA is a substance made mostly by the prostate that may be found in an increased amount in the blood of men who have a high-grade PIN or prostate cancer. Your healthcare provider may draw another blood specimen from you for an additional PSA test.
Repeat Prostate Biopsy: Your healthcare provider may recommend an additional ultrasound-guided biopsy of your prostate. This may help determine whether or not you have prostate cancer. After the biopsy, the tissue is sent to a pathology laboratory where a physician specialist (surgical pathologist) evaluates the tissue using a microscope to determine if there is high-grade PIN and/or prostate cancer. Depending on clinical findings, your healthcare provider may find it necessary to perform a very thorough repeat biopsy sampling of the prostate requiring individual examination of six to eighteen biopsy samples by a pathologist. This second examination may help determine whether or not you have prostate cancer when high-grade PIN is only seen at the first biopsy.
Questions to Ask Your Healthcare Provider
- Are there any other tests that we need to perform?
- What follow-up option do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- Am I at an increased risk for prostate cancer?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Prostate Cancer
Prostate cancer is a malignant tumor that begins in the prostate. It is important to quickly and effectively evaluate the extent of prostate cancer. Through a pathologist review of a microscopic prostate tissue sample (biopsy), the surgical pathologist determines whether an abnormality exists and, if so, whether it is benign or malignant. The treatment and the outlook for your recovery depend on the grade and stage of cancer. The system used most often for grading prostate cancer is called the Gleason system. Samples from two areas of prostate cancer are each graded from 1 to 5, and the numbers are added to give a combined number called your Gleason score. The lower the number, the closer to normal your prostate cells look. The higher the number, the more abnormal your prostate cells look and the more likely the cancer is to grow more quickly. Your healthcare provider will recommend any additional testing that he/she feels is needed to evaluate the cancer prior to treatment.
Prostate Cancer Background Information
The prostate is an organ found only in men that is about the same size and shape as a walnut.
The prostate gland is located just below the bladder, in front of the rectum, and surrounds the urethra, the tube that carries the urine out of the body. In most men, prostate cancers grow very slowly, however in some situations, especially with younger men, it has been seen to grow more quickly. Prostate cancer is the most common type of cancer found in American men, other than skin cancer, with about 185,000 new cases diagnosed in the United States each year. The incidence of prostate cancer increases with age. Fortunately, most prostate cancers found in older men (>70 yrs) are of low risk to the patient.
Symptoms: After the age of 50, most men are given a DRE (digital rectal exam) and a PSA (prostate-specific antigen) blood test at their annual exam. Prostate cancer is often detected by these tests since symptoms are rare. An individual with late-stage prostate cancer may experience pain during urination, blood in the urine, and impotence. However, these symptoms are also common with other diseases and conditions so your physician should perform a biopsy to confirm the diagnosis.
Risk Factors: Although the cause of prostate cancer is unknown, it can sometimes be associated with known risk factors. Many risk factors are able to be changed, though not all can be eliminated. Some of the most common risk factors are:
- As men age, they have an increased risk of developing prostate cancer.
- A lack of exercise and diets high in red meat and dairy products and low in fruits and vegetables have been linked to prostate cancer.
- Individuals who have a family history of prostate cancer are at a higher risk of developing it. These individuals should likely be screened earlier and more frequently.
Follow-up and Treatment Options for Prostate Cancer
The treatment or therapy depends on the stage or grade of cancer, your age, overall health, and your feelings about the treatment options. Below is a listing of potential treatment options for prostate cancer. The main treatments for prostate cancer are surgery, radiation therapy, and hormone therapy. Only a physician can determine the most appropriate treatment.
Watchful Waiting: One alternative to treatment is watchful waiting. Although this is not an active treatment, it may be a good choice for some men. Your doctor may suggest a “watch and wait” approach if you are older and if the cancer is small and has not spread outside the gland. Because prostate cancer often grows slowly, many older men who have the disease may never need any treatment.
Surgery: The purpose of prostate surgery is to remove the cancer from your body. The main types of prostate surgery are radical prostatectomy (removal of the prostate gland) and cryosurgery (freezing of the prostate).
Radiation Therapy: Radiation therapy involves the use of high-energy rays to kill cancer cells. Radiation therapy is focused directly on the affected area and is sometimes given after surgery to kill any remaining cancer cells. Radiation is used most often for cancer that has not spread outside the prostate gland or has spread only to nearby tissue. If the disease is more advanced, radiation may be used to shrink the tumor and provide pain relief.
Hormone Therapy: Hormone therapy is designed to lower the level of male hormones, testosterone specifically, which is known to cause cancer to grow. By lowering the amount of testosterone, the cancer is likely to shrink or grow more slowly. This is a good alternative for patients whose surgery or radiation is not appropriate or for those whose cancer has spread outside of the prostate gland. Hormone therapy does not cure cancer but can delay the progression of the cancer and provide relief of the symptoms.
Questions to Ask Your Healthcare Provider
- Are there any other tests that we need to perform?
- Where is my cancer located and has it spread?
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- Is there anything I should be doing or not doing during treatment?
- What are the steps after treatment?
- What are the chances of recurrence after my treatment plan?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
Prostatitis
Prostatitis is inflammation of the prostate gland. There are two types of prostatitis that are caused by bacterial infection: acute bacterial prostatitis and chronic bacterial prostatitis. The two other types of prostatitis are nonbacterial prostatitis and prostatodynia, but the cause of these types is unknown. Prostatitis is a very common disorder that affects approximately 50% of men in their lifetime. It can affect a man at any age.
Types of Prostatitis
Acute Bacterial Prostatitis: One in ten men with prostatitis have this type of prostatitis. It develops suddenly like any other major bacterial infection. It may be caused by E. coli, Klebsiella, Pseudomonas, or other types of bacteria. Symptoms are often severe and, therefore, are usually quickly diagnosed.
Chronic bacterial prostatitis: One in ten men with prostatitis have this type of prostatitis as well. This type of prostatitis tends to reoccur after the initial infection has been treated and symptoms disappear. Symptoms are less severe than those experienced with acute bacterial prostatitis.
Nonbacterial Prostatitis: Six in ten men with prostatitis have this type of prostatitis. The inflammation may be related to organisms other than bacteria or to factors that are unknown or difficult to determine.
Prostatodynia: This type of prostatitis is also known as chronic pelvic pain syndrome. Individuals with prostatodynia experience the same symptoms as they would with prostatitis, but do not have the inflammation that is present with prostatitis.
Symptoms: The symptoms you may experience will vary depending on the type of prostatitis that you have. Some symptoms common to all types of prostatitis include fever, lower back pain, and frequent urinary tract infections. Prostatitis is sometimes difficult to distinguish from other infections in the urinary tract.
Risk Factors: There are some factors that can increase the risk of developing prostatitis. Some of these risk factors include:
- Obstruction of the bladder outlet from a stone, tumor, or benign prostatic hyperplasia (BPH) can increase the risk of prostatitis.
- Suppressed immune system.
- Utilization of a catheter.
- Presence of sexually transmitted diseases.
Follow-up and Treatment Options for Prostatitis
The follow-up and treatment plan for an individual with prostatitis varies depending on whether or not it is caused by an infection. Only a physician can determine the most appropriate treatment.
Acute Bacterial Prostatitis: Your physician will likely prescribe antibiotics to eliminate the infection which is causing the inflammation.
Chronic Bacterial Prostatitis: This condition is often more difficult to cure than acute bacterial prostatitis. There is generally an underlying factor that needs to be removed before antibiotics can effectively treat the infection.
Nonbacterial Prostatitis: Antibiotics will not help nonbacterial prostatitis. Changing your diet or taking warm baths may help. Your doctor may prescribe an alpha-blocker to relax the muscle tissue in the prostate. Depending on the cause of irritation, different treatments may be used.
Prostatodynia: Muscle relaxants, alpha-blockers, biofeedback, and relaxation exercises may alleviate some of the symptoms experienced by individuals with prostatodynia.
Questions to Ask Your Healthcare Provider
- What type of prostatitis do I have?
- Are there any other tests that we need to perform?
- What treatment do you suggest?
- What are the benefits of this type of treatment?
- What are the risks and side effects of this treatment option?
- What are the steps after treatment?
- What are the chances of recurrence after my treatment plan?
Sources for Additional Information
Here are some trusted resources you can explore to learn more.
American Cancer Society:
www.cancer.org
National Cancer Institute:
www.cancer.gov
CancerCare:
www.cancercare.org
