Quitting Drinking May Help Alcoholics' Bone Loss

FRIDAY, Sept. 14 (HealthDay News) -- Alcoholics who stop drinking and engage in physical activity can help reverse bone loss suffered as a result of their addiction, according to a new study.

Bone renews itself through a continual remodeling process, which excessive alcohol consumption disrupts. Austrian researchers found that avoiding alcohol for just eight weeks can help correct the imbalance between bone formation and resorption that results from alcoholism. Exercise also can help protect against reduced bone mineral density, they said.

The study appears online Sept. 14 in advance of print publication in the December issue of the journal Alcoholism: Clinical & Experimental Research.

"This study contributes to our understanding of various deteriorating effects of long-term consumption of high amounts of alcohol on the human body," Sergei Mechtcheriakov, associate professor of psychiatry at the Medical University Innsbruck, said in a journal news release.

"We can see that even bone tissue, which is often wrongly perceived as inert, can be affected by alcoholism," he said. "It would seem that a combination of direct toxic effects of alcohol and its metabolites on bone tissue turnover -- as well as lifestyle factors, such as low physical activity -- may play a significant role."

In conducting the study, 53 men in rehab for alcoholism underwent bone-density tests. The participants, who were between ages 21 and 50, had blood drawn when the study began and again after eight weeks of treatment. They also completed a questionnaire on how much physical activity they got before they began treatment.

"We found that [bone mineral density] is reduced in alcoholic men withoutliver disease," Peter Malik, the study's corresponding author and a senior scientist and physician at the university, said in the news release. "However, the initial imbalance between bone formation and resorption seems to straighten out during abstinence."

For people without the bone-thinning disease osteoporosis, this means an increased fracture risk could be reduced during abstinence, Malik explained.

"In addition, regular physical exercise seems to be 'bone protective' in alcoholic patients, likely due to the fact that a dynamic strain on bone through physical activity increases the rate of bone formation and resorption, which is good for bone density," he said.

The researchers pointed out, however, that bone metabolism is improved in the first weeks of recovery, but not fully restored.

"Recovery after long-term alcoholism takes months and probably years," Mechtcheriakov said. "We need better understanding of these processes in order to be able to conceive better rehabilitation programs."

This study supports the view that treatment programs should contain long-term moderate physical activity regimens, he said.

"But the study also suggests that deficits in the musculoskeletal system, such as [bone mineral density] reduction or muscular atrophy, should be taken into account during the rehabilitation," Mechtcheriakov added.

The study's authors advised that patients with a long history of alcoholism undergo dual-energy X-ray absorptiometry, a measurement of bone mineral density. They noted that this is particularly important if the patients smoke or have other risk factors for bone loss.

-- Mary Elizabeth Dallas

Pancreatic Cancer

Pancreatic cancer facts

• Most pancreatic cancers are adenocarcinomas.
• Few patients diagnosed with pancreatic cancer have identifiablerisk factors.
• Pancreatic cancer is highly lethal.
• Pancreatic cancer is difficult to diagnose, and the diagnosis is often made late in the disease course. Symptoms include weight loss, back pain, and jaundice.
• The only curable treatment is surgical removal of all cancer.
• Chemotherapy after surgery can lower the chances of the cancer returning.
• Chemotherapy for metastatic pancreatic cancer can extend life and improve the quality of life for people with the disease.
• Patients diagnosed with pancreatic cancer are encouraged to seek out clinical trials to improve pancreatic cancer treatment.
• Many organizations exist to help provide information and support for patients and families fighting pancreatic cancer.

What is the pancreas, and what is the function of the pancreas?

The pancreas is an organ in the abdomen that sits in front of the spine above the level of the belly button. It performs two main functions: first, it makes insulin, a hormone that regulates blood sugar levels, and second: it makes enzymes, which help break down proteins. Enzymes help digestion by chopping proteins into smaller parts so that they can be more easily absorbed by the body and used for energy. Enzymes leave the pancreas via a system of tubes called "ducts" that connect the pancreas to the intestines. The pancreas sits deep in the belly and is in close proximity to many important structures such as the small intestine (the duodenum) and the bile ducts, as well as important blood vessels and nerves.

Pancreas (Pancreatic Cancer)

Cancer that starts in the pancreas is called pancreatic cancer. This picture of the pancreas shows its location in the back of the abdomen, behind the stomach.

What is cancer?

Every second of every day within our body, a massive process of destruction and repair occurs. The human body is comprised of trillions of cells, and every day billions of cells wear out or are destroyed. Each time the body makes a new cell to replace one that is wearing out, the body tries to make a perfect copy of the cell that dies off, because that dying cell had a job to do and the newly made cell must be capable of performing that same function. Despite remarkably elegant systems in place to edit out errors in this process, the body makes tens of thousands of mistakes daily in normal cell division either due to random errors or from environmental pressure within the body. Most of these mistakes are corrected, or the mistake leads to the death of the newly made cell and another new cell is then made. Sometimes a mistake is made that, rather than inhibiting the cell's ability to grow and survive, allows the newly made cell to grow in an unregulated manner. When this occurs, that cell can begin to divide independent of the checks and balances that control normal cell growth. When this happens a tumor can develop.

Tumors fall into two categories; there are "benign" tumors and "malignant" or cancerous tumors. So what is the difference? The answer is that a benign tumor grows only in the tissue from which it arises. Benign tumors can sometimes grow quite large or grow rapidly and cause severe symptoms. For example, a fibroid in a woman's uterus can cause bleeding or pain, but it will never travel outside the uterus and grow as a new tumor elsewhere. Fibroids, like all benign tumors, lack the capacity to shed cells into the blood and lymph systems and cannot travel to other places in the body and grow. A cancer, on the other hand, can shed cells from the primary tumor that can float like dandelionseeds in the wind through the bloodstream or lymphatics, landing in tissues distant from the primary tumor, growing new tumors in various other sites. This process, called metastasis, is the defining characteristic of a cancerous tumor. Pancreas cancer, unfortunately, is a particularly good model for this process.

Cancers are named by the tissues from which the primary tumor arises. Hence, a lung cancer that travels to the liver is not a "liver cancer" but is described as metastatic lung cancer and a patient with a breast cancerwhich spreads to the brain is not described as having a "brain tumor" but rather as having metastatic breast cancer.

What is pancreatic cancer?

Cancers that develop within the pancreas fall into two major categories: (1) cancers of the endocrine pancreas (the part that makes insulin) are called "islet cell" or "pancreatic neuroendocrine" cancers and (2) cancers of the exocrine pancreas (the part that makes enzymes). Islet cell cancers are rare and typically grow slowly compared to exocrine pancreatic cancers. Islet cell tumors often release hormones into the bloodstream and are further characterized by the hormones they produce (insulin,glucagon, gastrin, and other hormones). Cancers of the exocrine pancreas develop from the cells that line the system of ducts that deliver enzymes to the small intestine and are called commonly referred to as pancreatic adenocarcinomas. Adenocarcinoma of the pancreas comprises 95% of all pancreatic ductal cancers and is the subject of this review.

Cells that line the ducts in the exocrine pancreas divide more rapidly than the tissues that surround them. For reasons that we do not understand, these cells can make a mistake when they divide and an abnormal cell can be made. When an abnormal ductal cell begins to divide in an unregulated way, a growth can form. These changes are called "dysplasia." Often, dysplastic cells can undergo additional genetic mistakes over time and become even more abnormal. If these dysplastic cells then begin to invade through the walls of the duct from which they arise into the surrounding tissue, a frank cancer develops.

What are pancreatic cancer causes and risk factors?

About 40,000 cases of pancreatic cancer occur yearly in the United States. Most people who develop pancreatic cancer do so without any predisposing risk factors. Perhaps the biggest risk factor is increasing age; being over the age of 60 puts an individual at greater risk. Rarely, there can be genetic syndromes that run in families that put individuals at higher risk such as BRCA-2 and, to a lesser extent, BRCA-1 gene mutations. Familial syndromes are unusual but it is important to let your doctor know if anyone else in your family has been diagnosed with cancer. Additionally, certain behaviors or conditions are thought to slightly increase an individual's risk for developing pancreatic cancer. For example, African-Americans may be at greater risk as may individuals with close family members who have been previously diagnosed with the disease. Other behaviors or conditions that may put people at risk include tobacco use, obesity, a sedentary lifestyle, a history of diabetes, chronic pancreatic inflammation (pancreatitis), and a fatty (or Western) diet. Prior stomach surgery may moderately increase one's risk as can certain chronic infections such as hepatitis B and H. pylori(an infection of the stomach lining). Certain types of pancreatic cysts may put individuals at risk of developing pancreatic cancer. Despite these associated risks, no identifiable cause is found in most people who develop pancreatic cancer.

What are the symptoms and signs of pancreatic cancer?

Because the pancreas lies deep in the belly in front of the spine, pancreatic cancer often grows silently for months before it is discovered. Early symptoms can be absent or quite subtle. More easily identifiable symptoms develop once the tumor grows large enough to press on other nearby structures such as nerves (which causes pain), the intestines (which affects appetite and causes nausea along with weight loss), or the bile ducts (which causes jaundice or a yellowing of the skin and can cause loss of appetite and itching). Symptoms in women rarely differ from those in men. Once the tumor sheds cancer cells into the blood and lymph systems and metastasizes, more symptoms usually arise depending on the location of the metastasis. Frequent sites of metastasis for pancreatic cancer include the liver, the lymph nodes, and the lining of the abdomen (called the peritoneum). Unfortunately, most pancreatic cancers are found after the cancer has grown beyond the pancreas or has metastasized to other places.

How is the diagnosis of pancreatic cancer made?

Most people with pancreatic cancer first present to their primary-care doctor complaining of nonspecific symptoms. These complaints trigger an evaluation often including a physical examination (usually normal), blood tests, X-rays, and anultrasound. If pancreatic cancer is present, the likelihood of an ultrasound revealing an abnormality in the pancreas is about 75%. If a problem is identified, frequently acomputed tomography (CT) scan is performed as the next step in the evaluation. A pancreatic mass and the suspicion of pancreatic cancer is then raised, and a biopsy is performed to yield a diagnosis.

Different strategies can be used to perform a biopsy of the suspected cancer. Often, a needle biopsy of the liver through the belly wall (percutaneous liver biopsy) will be used if it appears that there has been spread of the cancer to the liver. If the tumor remains localized to the pancreas, biopsy of the pancreas directly usually is performed with the aid of a CT. A direct biopsy also can be made via an endoscope put down the throat and into the intestines. A camera on the tip of the endoscope allows the endoscopist to advance the endoscope within the intestine. An ultrasound device at the tip of the endoscope locates the area of the pancreas to be biopsied, and a biopsy needle is passed through a working channel in the endoscope to obtain tissue from the suspected cancer. Ultimately, a tissue diagnosis is the only way to make the diagnosis with certainty, and the team of doctors work to obtain a tissue diagnosis in the easiest way possible.

In addition to radiologic tests, suspicion of a pancreatic cancer can arise from the elevation of a "tumor marker," a blood test which can be abnormally high in people with pancreatic cancer. The tumor marker most commonly associated with pancreatic cancer is called the "CA 19-9." It is often released into the bloodstream by pancreatic cancer cells and may be elevated in patients newly found to have the disease. Unfortunately, the CA 19-9 test is not specific for pancreatic cancer. Other cancers as well as some benign conditions can cause the CA 19-9 to be elevated. Sometimes (about 10% of the time) the CA 19-9 will be at normal levels in the blood despite a confirmed diagnosis of pancreatic cancer, so the tumor marker is not perfect. It can be helpful, however, to follow during the course of illness since its rise and fall may help guide appropriate therapy.

How is pancreatic cancer staged?

Once pancreatic cancer is diagnosed, it is "staged." Pancreatic cancer is broken into four stages with stage I being the earliest stage and stage IV being the most advanced (metastatic disease). Unlike many cancers, however, patients with pancreatic cancer are typically grouped into three categories: those with local disease, those with locally advanced unresectable disease, and those with metastatic disease. Initial therapy often differs for patients in these three groups.

Patients with stage I and stage II cancers are thought to have local or "resectable" cancer (cancer that can be completely removed with an operation). Patients with stage III cancers have "locally advanced unresectable" disease. In this situation, the opportunity for cure has been lost but local treatments such as radiation remain options. In patients with stage IV pancreatic cancer, chemotherapy is most commonly recommended as a means of controlling the symptoms related to the cancer and extending life. Below, we will review common treatments for resectable, locally advanced unresectable, and metastatic pancreatic cancer.

What is the treatment for resectable pancreatic cancer?

If a pancreatic cancer is found at an early stage (stage I and stage II) and is contained locally within or around the pancreas, surgery may be recommended. Surgery is the only curative treatment for pancreatic cancer. The surgical procedure most commonly performed to remove a pancreatic cancer is a "Whipple" procedure(pancreatoduodenectomy). It often comprises removal of a portion of the stomach, the duodenum (the first part of the small intestine), pancreas, bile ducts, lymph nodes, and gallbladder. It is important to be evaluated at a hospital with lots of experience performing pancreatic cancer surgery because the operation is a big one and evidence shows that experienced surgeons better select people who can get through the surgery safely and also better judge who will most likely benefit from the operation. In experienced hands, mortality from the surgery itself is less than 4%.

After the Whipple surgery, patients typically spend about one week in the hospital recovering from the operation. Complications from the surgery can include blood loss (anemia), leakage from the reconnected intestines or ducts, or slow return of bowel function. Recovery to presurgical health can often take several months.

After patients recover from a Whipple procedure for pancreatic cancer, treatment to reduce the risk of the cancer returning is a standard recommendation. This treatment, referred to as "adjuvant therapy," has proven to lower the risk of recurrent cancer. Typically six months of chemotherapy is recommended, sometimes with radiation incorporated into the plan.

Unfortunately, only about 20 people out of 100 diagnosed with pancreatic cancer are found to have a tumor amenable to surgical resection. The rest have tumors that are too locally advanced to completely remove or have metastatic spread at the time of diagnosis. Even among patients who are amenable to surgery, only 20% live five years.

What is the treatment for locally advanced unresectable pancreatic cancer?

If a pancreatic cancer is found when it has grown into important local structures but not yet spread to distant sites, this is described as locally advanced unresectable pancreatic cancer (stage III). The standard of care in the United States for the treatment of locally advanced cancer is a combination of low-dose chemotherapy given simultaneously with radiationtreatments to the pancreas and surrounding tissues. Radiation treatments are designed to lower the risk of local growth of the cancer, thereby minimizing the symptoms that local progression causes (back or belly pain, nausea, loss of appetite, intestinal blockage, jaundice). Radiation treatments are typically given Monday through Friday for about five weeks. Chemotherapy given concurrently (at the same time) may improve the effectiveness of the radiation and may lower the risk for cancer spread outside the area where the radiation is delivered. When the radiation is completed and the patient has recovered, more chemotherapy is often recommended. Recently, newer forms of radiation delivery (stereotactic radiosurgery, gamma knife radiation, cyberknife radiation) have been utilized in locally advanced pancreatic cancer with varying degrees of success, but these treatments can be more toxic and are, for now, largely experimental.

What is the treatment for metastatic pancreatic cancer?

Once a pancreatic cancer has spread beyond the vicinity of the pancreas and involves other organs, it has become a problem through the system. As a result, a systemic treatment is most appropriate and chemotherapy is recommended. Chemotherapy travels through the bloodstream and goes anywhere the blood flows and, as such, treats most of the body. It can attack a cancer that has spread through the body wherever it is found. In metastatic pancreatic cancer, chemotherapy is recommended for individuals well enough to receive it. It has been proven to both extend the lives of patients with pancreatic cancer and to improve their quality of life. These benefits are documented, but unfortunately the overall benefit from chemotherapy in pancreatic cancer treatment is modest and chemotherapy prolongs life for the average patient by only a few months. Chemotherapy options for patients with pancreatic cancer vary from treatment with a single chemotherapy agent to treatment with as many as three chemotherapies given together. The aggressiveness of the treatment is determined by the cancer doctor (medical oncologist) and by the overall health and strength of the individual patient.

What are the side effects of pancreatic cancer treatment?

Side effects of treatment for pancreatic cancer vary depending on the type of treatment. For example, radiation treatment (which is a local treatment) side effects tend to accumulate throughout the course ofradiation therapy and include fatigue, nausea, and diarrhea. Chemotherapy side effects depend on the type of chemotherapy given (less aggressive chemotherapy treatments typically cause fewer side effects whereas more aggressive combination regimens are more toxic) and can include fatigue, loss of appetite, change in taste,hair loss (although not usually), and lowering of the immune system with risk for infections (immunosuppression). While these lists of side effects may seem worrisome, recognize that radiation doctors (radiation oncologists) and medical oncologists have much better supportive medications than they did in years past to control any nausea, pain, diarrhea, or immunosuppression related to treatment. The risks associated with pancreatic cancer treatment must be weighed against the inevitable and devastating risks associated with uncontrolled pancreatic cancer and, if the treatments control progression of the cancer, most patients feel better on treatment that they otherwise would.

What is the prognosis of pancreatic cancer?

Pancreatic cancer is a difficult disease. Even for surgically resectable (and therefore curable) tumors, the risk of cancer recurrence and subsequent death remains high. Only about 20% of patients undergoing a Whipple procedure for curable pancreatic cancer live five years, with the rest surviving on average less than two years. For patients with incurable (locally advanced unresectable or metastatic) pancreatic cancer, survival is even shorter; typically it is measured in months. With metastatic disease (stage IV), the average survival is just over six months. Doctors around the world continue to study this terrible disease and strive to improve treatments, but progress has been difficult to come by.

What research is being done on pancreatic cancer?

Doctors and researchers all over the world are hard at work developing better treatments for pancreatic cancer. Cooperative research led by centers of excellence in this country and many others continue daily to test new surgical techniques, radiation strategies, chemotherapy agents, and alternative therapies in an effort to improve care. Given the slow progress experienced over the last quarter century, many doctors feel that every eligible patient with pancreatic cancer should be offered enrollment in a research trial. For a complete list of clinical trials in pancreatic cancer treatment, please check online at http://www.cancer.gov.

Is complimentary or alternative medicine effective in pancreatic cancer treatment?

Complimentary or alternative medicine is of unclear benefit in pancreatic cancer treatment. No specific complimentary or alternative therapy has been proven beneficial, but many adjunctive treatments have been tried. Compounds such as circumin, the principle ingredient in turmeric, have shown efficacy in nonhuman research and are being tested in clinical trials in pancreatic cancer. Given the modest benefit derived from chemotherapy and radiation in this disease, alternative approaches in the treatment of pancreatic cancer in conjunction with (rather than instead of) standard treatment is warranted.

Can pancreatic cancer be prevented?

At this time there is no known surveillance strategy to reduce the risk of pancreatic cancer for the general population. With only 40,000 new diagnoses a year occurring in a country with over 300 million people, screening blood tests or X-rays have never been proven to be cost effective or beneficial. Additionally, doctors do not routinely screen individuals with family members diagnosed with the disease aside from the rare instance where a known genetic risk factor is present.

Where can people get support when coping with pancreatic cancer?

There are many fine organizations helping provide support for individuals and families battling pancreatic cancer. Many hospitals provide support networks utilizing the expertise of trained social workers with experience in caring for people with cancer. Additionally, the Pancreatic Cancer Action Network (PANCAN) and the American Cancer Society both provide information and support for people living with pancreatic cancer. Visit their web sites athttp://www.pancan.org andhttp://www.cancer.org.

Where can people find additional information about pancreatic cancer?

Again, both PANCAN and the American Cancer Society are excellent resources for additional information regarding pancreatic cancer. The American Society of Clinical Oncology web site http://www.cancer.netalso boasts a wealth of information for patients, family members, and professionals interesting in learning more about this disease.

REFERENCES:

American Cancer Society. "Cancer Facts & Figures 2008." <http://www.cancer.org/acs/groups/
content/@nho/documents/document/
2008cafffinalsecuredpdf.pdf>.

Nugent, F., and K. Stuart. "Adjuvant and Neoadjuvant Therapy for Curable Pancreatic Cancer." Surg Clin North Amer 90.2 (2010): 323-339.

Eczema

Eczema: A particular type of inflammatory reaction of the skin in which there are typically vesicles (tiny blister-like raised areas) in the first stage followed by erythema (reddening), edema (swelling), papules (bumps), and crusting of the skin followed, finally, by lichenification (thickening) and scaling of the skin.Eczema characteristically causes itching and burning of the skin.

Eczema, which is also called atopic dermatitis, is a very common skin problem. It may start in infancy, later in childhood, or in adulthood. Once it gets underway, it tends not to go quickly away.

There are numerous types of eczema, including:

• Atopic dermatitis -- a chronic skin disease characterized by itchy, inflamed skin
• Contact eczema -- a localized reaction that includes redness, itching, and burning where the skin has come into contact with an allergen (an allergy-causing substance) or with an irritant such as an acid, a cleaning agent, or other chemical
• Allergic contact eczema -- a red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions
• Seborrheic eczema -- a form of skin inflammation of unknown cause that presents as yellowish, oily, scaly patches of skin on the scalp, face, and occasionally other parts of the body
• Nummular eczema -- coin-shaped patches of irritated skin - most commonly on the arms, back, buttocks, and lower legs - that may be crusted, scaling, and extremely itchy
• Neurodermatitis -- scaly patches of skin on the head, lower legs, wrists, or forearms caused by a localized itch (such as an insect bite) that becomes intensely irritated when scratched
• Stasis dermatitis -- a skin irritation on the lower legs, generally related tocirculatory problems
• Dyshidrotic eczema -- irritation of the skin on the palms of hands and soles of the feet characterized by clear, deep blisters that itch and burn.

Image Source: Stephane Bidouze/BigStockPhoto.com 

Penis Cancer

Penile cancer is a disease in which malignant (cancer) cells form in the tissues of the penis.

The penis is a rod-shaped male reproductive organ that passes sperm and urine from the body. It contains two types of erectile tissue (spongy tissue with blood vessels that fill with blood to make an erection):

·         Corpora cavernosa: The two columns of erectile tissue that form most of the penis.

·         Corpus spongiosum: The single column of erectile tissue that forms a small portion of the penis. The corpus spongiosum surrounds the urethra (the tube through which urine and sperm pass from the body).

The erectile tissue is wrapped in connective tissue and covered with skin. The glans (head of the penis) is covered with loose skin called the foreskin.

Human papillomavirus infection may increase the risk of developing penile cancer.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for penile cancer include the following:

Circumcision may help prevent infection with the human papillomavirus (HPV). A circumcision is an operation in which the doctor removes part or all of the foreskin from the penis. Many boys are circumcised shortly after birth. Men who were not circumcised at birth may have a higher risk of developing penile cancer.

Other risk factors for penile cancer include the following:

·         Being age 60 or older.

·         Having phimosis (a condition in which the foreskin of the penis cannot be pulled back over the glans).

·         Having poor personal hygiene.

·         Having many sexual partners.

·         Using tobacco products.

Possible signs of penile cancer include sores, discharge, and bleeding.

These and other symptoms may be caused by penile cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

·         Redness, irritation, or a sore on the penis.

·         A lump on the penis.

Tests that examine the penis are used to detect (find) and diagnose penile cancer.

The following tests and procedures may be used:

·         Physical exam and history: An exam of the body to check general signs of health, including checking the penis for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.

·         Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.

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

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

·         The stage of the cancer.

·         The location and size of the tumor.

·         Whether the cancer has just been diagnosed or has recurred (come back).

Stages of penile cancer

After penile cancer has been diagnosed, tests are done to find out if cancer cells have spread within the penis or to other parts of the body.

The process used to find out if cancer has spread within the penis or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

·         CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

·         MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

·         Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

·         Through tissue. Cancer invades the surrounding normal tissue.

·         Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.

·         Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for penile cancer:

Stage 0 (carcinoma in situ)

In stage 0, abnormal cells are found on the surface of the skin of the penis. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and spread to connective tissue just under the skin of the penis.

Stage II

In stage II, cancer has spread to:

·         connective tissue just under the skin of the penis and to one lymph node in the groin; or

·         erectile tissue (spongy tissue that fills with blood to make an erection) and may have spread to one lymph node in the groin.

Stage III

In stage III, cancer has spread to:

·         connective tissue or erectile tissue of the penis and to more than one lymph node on one or both sides of the groin; or

·         the urethra or prostate, and may have spread to one or more lymph nodes on one or both sides of the groin.

Stage IV

In stage IV, cancer has spread:

·         to tissues near the penis and may have spread to lymph nodes in the groin or pelvis; or

·         anywhere in or near the penis and to one or more lymph nodes deep in the pelvis or groin; or

·         to distant parts of the body.

Recurrent penile cancer

Recurrent penile cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the penis or in other parts of the body.

Treatment option overview

There are different types of treatment for patients with penile cancer.

Different types of treatments are available for patients with penile cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Three types of standard treatment are used:

Surgery

Surgery is the most common treatment for all stages of penile cancer. A doctor may remove the cancer using one of the following operations:

·         Mohs microsurgery: A procedure in which the tumor is cut from the skin in thin layers. During the surgery, the edges of the tumor and each layer of tumor removed are viewed through a microscope to check for cancer cells. Layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible and is often used to remove cancer on the skin. It is also called Mohs surgery.

·         Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.

·         Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy.

·         Circumcision: Surgery to remove part or all of the foreskin of the penis.

·         Wide local excision: Surgery to remove only the cancer and some normal tissue around it.

·         Amputation of the penis: Surgery to remove part or all of the penis. If part of the penis is removed, it is a partial penectomy. If all of the penis is removed, it is a total penectomy.

Lymph nodes in the groin may be taken out during surgery.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapyafter surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly onto the skin (topical chemotherapy) or into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Topical chemotherapy may be used to treat stage 0 penile cancer.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied.

Biologic therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Topical biologic therapy may be used to treat stage 0 penile cancer.

Radiosensitizers

Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers helps kill more tumor cells.

Sentinel lymph node biopsy followed by surgery

Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the surgeon removes the cancer.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment options by stage

Stage 0 (carcinoma in situ)

Treatment of stage 0 may be one of the following:

·         Mohs microsurgery.

·         Topical chemotherapy.

·         Topical biologic therapy.

·         Laser surgery.

·         Cryosurgery.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage 0 penile cancer.

Stage I penile cancer

If the cancer is only in the foreskin, wide local excision and circumcision may be the only treatment needed.

Treatment of stage I penile cancer may include the following:

·         Surgery (partial or total penectomy with or without removal of lymph nodes in the groin).

·         External or internal radiation therapy.

·         Mohs microsurgery.

·         A clinical trial of laser therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I penile cancer.

Stage II penile cancer

Treatment of stage II penile cancer may include the following:

·         Surgery (partial or total penectomy, with or without removal of lymph nodes in the groin).

·         External or internal radiation therapy followed by surgery.

·         A clinical trial of sentinel lymph node biopsy followed by surgery.

·         A clinical trial of laser surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II penile cancer.

Stage III penile cancer

Treatment of stage III penile cancer may include the following:

·         Surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy.

·         Radiation therapy.

·         A clinical trial of sentinel lymph node biopsy followed by surgery.

·         A clinical trial of radiosensitizers.

·         A clinical trial of chemotherapy before or after surgery.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III penile cancer.

Stage IV penile cancer

Treatment of stage IV penile cancer is usually palliative (to relieve symptoms and improve the quality of life). Treatment may include the following:

·         Surgery (wide local excision and removal of lymph nodes in the groin).

·         Radiation therapy.

·         A clinical trial of chemotherapy before or after surgery.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV penile cancer.

Treatment options for recurrent penile cancer

Treatment of recurrent penile cancer may include the following:

·         Surgery (penectomy).

·         Radiation therapy.

·         A clinical trial of biologic therapy.

·         A clinical trial of chemotherapy.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent penile cancer.

Get More Information From NCI

Call 1-800-4-CANCER

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.

Chat online

The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write to us

For more information from the NCI, please write to this address:

NCI Public Inquiries Office Suite 3036A 6116 Executive Boulevard, MSC8322Bethesda, MD 20892-8322

Search the NCI Web site

The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

SOURCE:

National Cancer Institute, U.S. National Institutes of Health, http://www.cancer.gov/