Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
1. What type of cancer do I have? How was the diagnosis established? Are
there any other diagnostic tests that could provide useful information?
2. What is the extent of spread (stage) of the cancer? To what extent does
the stage of the cancer influence treatment?
3. Should I get a second opinion? Can you recommend someone who could provide
a second opinion?
4. What are the treatment options? How do you decide among the different
options? Are there investigational treatments or clinical trials available for
this type of cancer?
5. How much is known about the type of cancer that I have? How common is this
cancer and the type of treatment I am to receive? Would I be better off being
treated in a more specialized center?
6. What is your experience in treating this type of cancer? What have been
the results of this treatment, in your experience?
7. How much time should I take to make a decision about treatment?
8. What is the goal of treatment (for example, to completely eradicate the
tumor, to reduce the size of the tumor, to alleviate symptoms)?
9. How often must I receive treatment? How will I feel after treatment? If
there will be side effects of treatment, are there any medications that can help
prevent or lessen the severity of these? How soon can I return to normal
activities after treatment?
Cancer is the uncontrolled growth of abnormal cells anywhere
in a body. The abnormal cells are termed cancer cells, malignant cells, or tumor
cells. Many cancers and the abnormal cells that compose the cancer tissue are
further identified by the name of the tissue that the abnormal cells originated
from (for example, breast cancer, lung cancer, colon cancer). Cancer is not
confined to humans; animals and other living organisms can get cancer. Below is
a schematic that shows normal cell division and how when a cell is damaged or
altered without repair to its system, the cell usually dies. Also shown is what
can occur when such damaged or unrepaired cells do not die and become cancer
cells and proliferate with uncontrolled growth; a mass of cancer cells develop.
Frequently, cancer cells can break away from this original mass of cells, travel
through the blood and lymph systems, and lodge in other organs where they can
again repeat the uncontrolled growth cycle. This process of cancer cells leaving
an area and growing in another body area is termed metastatic spread or
metastatic disease. For example, if breast cancer cells spread to a bone (or
anywhere else), it means that the individual has metastatic breast cancer.
There are over 200 types of cancers; most can fit into the following
categories according to the National Cancer Institute:
Carcinoma: Cancer that begins in the skin or in tissues that line or
cover internal organs
Sarcoma: Cancer that begins in bone, cartilage, fat, muscle, blood
vessels, or other connective or supportive tissue
Leukemia: Cancer that starts in blood-forming tissue such as the
bone marrow and causes large numbers of abnormal blood cells to be produced and
enter the blood
Lymphoma
and myeloma: Cancers that begin in the cells of the immune system
Central
nervous system cancers: Cancers that begin in the tissues of the brain and
spinal cord
In the U.S., according to the National Cancer Institute in 2010, the most
common cancers (excluding non-melanoma skin cancers) are listed below.
The incidence of
cancer and cancer types are influenced by many factors such as age, sex, race,
local environmental factors, diet, and genetics. Consequently, the incidence of
cancer and cancer types vary depending on these variable factors. For example,
the World Health Organization (WHO) provides the following general information
about cancer worldwide:
Cancer is a leading cause of death worldwide. It
accounted for 7.4 million deaths (around 13% of all deaths) in 2004 (statistics
published in 2009).
Lung, stomach, liver, colon, and breast cancer cause the
most cancer deaths each year.
Deaths from cancer worldwide are projected to
continue rising, with an estimated 12 million deaths in 2030.
Different areas of
the world may have cancers that are either more or less predominant then those
found in the U.S. One example is that stomach cancer is often found in Japan,
while it is rarely found in the U.S.
The objective of this article is to introduce
the reader to general aspects of cancers. It is designed to be an overview of
cancer and cannot cover every cancer type. This article will also attempt to
help guide the reader to more detailed sources about specific cancer types.
Lung cancer kills more men and women than any other form of cancer. Eight out of 10 lung cancers are due
to tobacco smoke. Lung cancers are classified as either small cell or non-small
cell cancers.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
Leukemia is a type of cancer of the blood cells in which the growth and development of the blood cells are abnormal. Strictly speaking, leukemia should refer only to cancer of the white blood cells (the leukocytes) but in practice it can apply to malignancy of any cellular element in the blood or bone marrow, as in red cell leukemia (erythroleukemia).
A brain tumor can be either benign (non cancerous) or malignant (cancerous), primary, or secondary. Causes and risk factors include age, gender, family history, and exposure to chemicals. Symptoms range from headaches, leg and feet numbness to seizures. Treatment is dependant upon the type and location of the brain tumor.
MRSA (methicillin resistant Staphylococcus aureus) bacteria causes skin infections with the following signs and symptoms: cellulitis, abscesses, carbuncles, impetigo, styes, and boils. Normal skin tissue doesn't usually allow MRSA infection to develop. Individuals with depressed immune systems and people with cuts, abrasions, or chronic skin disease are more susceptible to MRSA infection.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Pancreatic cancer is a malignant tumor of the pancreas. Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms.
There are many types of ovarian cancer, epithelial carcinoma is the most common. Women with a family history of ovarian cancer have an increased risk of developing the disease. Some ovarian cancer symptoms include abdominal pain, nausea, diarrhea, constipation, and abnormal vaginal bleeding, however, they usually do not present until the disease has progressed. Early diagnosis is important for successful treatment.
In the U.S., more than 2,000 people are diagnosed with bone cancer every year. There are many types of bone cancer. The most common forms of bone cancer are osteosarcoma, Ewing's sarcoma, chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma, and chordoma. Pain is the most common symptom. Treatment usually involves surgery, chemotherapy, and radiation therapy.
Sjögren's syndrome is an autoimmune disease involving the abnormal production of extra antibodies that attack the glands and connective tissue. Sjögren's syndrome with gland inflammation (resulting dry eyes and mouth, etc.) that is not associated with another connective tissue disease is referred to as primary Sjögren's syndrome. Sjögren's syndrome that is also associated with a connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma, is referred to as secondary Sjögren's syndrome. Though there is no cure for Sjögren's syndrome, the symptoms may be treated by using lubricating eye ointments, drinking plenty of water, humidifying the air, and using glycerin swabs. Medications are also available to treat dry eye and dry mouth.
Colon cancer is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Skin cancer is the most common form of cancer
in humans. There are three main types of skin cancer; basal cell carcinoma and
squamous cell carcinoma (the nonmelanoma skin cancers), and melanoma.
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. Symptoms include weakness, fever, weight loss, night sweats and in worse cases, chest pain, shortness of breath, and coughing up blood. A person with an active infection (a positive TB skin test, abnormal chest x-ray and TB bacteria in their sputum) requires treatment with izoniazid, rifampin, ethambutol and pyrazinaide.
Though the cause of stomach cancer is unknown, risk factors for stomach cancer include diet, H. pylori infection, smoking age, gastritis, stomach surgery, family history, and pernicious anemia. Symptoms include stomach discomfort, feeling full after a small meal, nausea and vomiting, and weight loss. Treatment depends upon staging and may involve surgery, radiation therapy, or chemotherapy.
A pulmonary embolism occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate.
Athlete's foot (tinea pedis) is a skin infection caused by the ringworm fungus. Symptoms include itching, burning, cracking, peeling, and bleeding feet. Treatment involves keeping the feet dry and clean, wearing shoes that can breathe, and using medicated powders to keep your feet dry.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Though uterine cancer's cause is unknown, there are many factors that will put a woman at risk, including: over age 50, endometrial hyperplasia, using hormone replacement therapy, obesity, using tamoxifen, being Caucasian, having colorectal cancer. Symptoms of cancer of the uterus (endometrial cancer) include abnormal vaginal bleeding, painful urination, painful intercourse, and pelvic pain. Treatment depends on staging and may include radiation therapy or hormone therapy.
There are four major types of thyroid cancer: papillary, follicular, medullary, and anaplastic thyroid cancer. Tumors on the thyroid are referred to as thyroid nodules. Symptoms of thyroid cancer include swollen lymph nodes, pain in the throat, difficulty swallowing, hoarseness, and a lump near the Adam's apple. Treatment usually involves chemotherapy, surgery, radioactive iodine, hormone treatment or external radiation and depends upon the type of thyroid cancer, the patient's age, the tumor size, and whether the cancer has metastasized.
Non-Hodgkin's lymphoma is cancer of the lymphatic system, a vital part of the body's immune system. Symptoms include swollen lymph nodes, fever, night sweats, coughing, weakness, chest pain, unexplained weight loss, and abdominal pain. Treatment depends on which type of non-Hodgkin's lymphoma you have, the stage of the cancer, your age, how fast the cancer is growing, and whether you have other health problems.
Thrush is an infection of the mouth caused by the candida fungus. Symptoms of Thrush include pain or difficulty swallowing, a feeling that food gets stuck in the throat, and fever.
Cervical cancer is cancer of the entrance to the womb (uterus). Regular pelvic exams and Pap testing can detect precancerous changes in the cervix. Precancerous changes in the cervix may be treated with cryosurgery, cauterization, or laser surgery. The most common symptom of cancer of the cervix is abnormal bleeding.
Breast cancer is the most common cancer in women and the second most common cause of cancer death in women in the U.S. Symptoms include a lump in the breast or underarm area, nipple pain, change in breast size or shape, an inverted nipple, nipple discharge, and breast skin changes. Treatment may involve chemotherapy, radiation therapy, biological therapy, hormone therapy, or surgery.
There are several types of kidney cancer, including renal cell cancer (renal adenocarcinoma or hypernephroma), transitional cell carcinoma, and Wilms tumor. Symptoms of kidney cancer include blood in the urine, an abdominal lump or mass, chronic pain in the side, and tiredness. Treatment of kidney cancer--which may include surgery, arterial embolization, radiation therapy, biological therapy or chemotherapy--depends upon the stage of the disease and the patient's overall health.
Treatment for bladder cancer depends on the stage of the disease, the grade of the tumor, and the type of bladder cancer. Options for treatment include surgery, radiation therapy, chemotherapy, and biological therapy.
The term oral cancer includes cancer of the mouth (oral cavity) and the back of the mouth (oropharynx). Red and white patches inside the mouth, bleeding, loose teeth, pain upon swallowing, a lump in the neck, earache, and a sore on your lip or in your mouth that won't heal are all symptoms of oral cancer. Treatment for oral cancer depends upon the staging of the disease and usually involves surgery, radiation therapy, or chemotherapy.
Esophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett's esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms. Treatment depends upon the size, location and staging of the cancer and the health of the patient.
Melanoma is a type of skin cancer which begins in skin cells called melanocytes and affects more than 53,600 people in the United States each year. These melanocytes can grow together to form benign moles which, after a change in size, shape, or color can be a sign of melanoma. Caused by sun exposure, early detection becomes extremely important to avoid a spread to other areas of the body. Diagnosis is confirmed through a biopsy of the abnormal skin and treatment depends on the extent and characteristics of the patient.
Jock itch is an itchy red rash that appears in the groin area. The rash may be caused by a bacterial or fungal infection. People with diabetes and those who are obese are more susceptible to developing jock itch. Antifungal shampoos, creams, and pills may be needed to treat fungal jock itch. Bacterial jock itch may be treated with antibacterial soaps and topical and oral antibiotics.
Familial adenomatous polyposis (FAP) is an inherited disorder
characterized by cancer of the
large intestine (colon) and
rectum. People with the classic type of familial adenomatous polyposis may
begin to develop multiple noncancerous (benign)
growths (polyps) in the colon as early as their
teenage years. Unless the
colon is removed, these polyps will become malignant (cancerous). The average
age at which an individual develops colon cancer in classic familial adenomatous
polyposis is 39 years. Some people have a variant of the disorder, called
attenuated familial adenomatous polyposis, in which
polyp growth is delayed. The
average age of colorectal cancer onset for attenuated familial adenomatous
polyposis is 55 years.
In people with classic familial adenomatous polyposis, the number of polyps
increases with age, and hundreds to thousands of polyps can develop in the
colon. Also of pa...
1. What type of cancer do I have? How was the diagnosis established? Are
there any other diagnostic tests that could provide useful information?
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