What is the best treatment for me?
Some cancers respond better to surgery; others respond better to chemo or radiation. Knowing the type of cancer you have is the first step toward knowing which treatments will work best for you.
The stage of your cancer will also help the doctor decide on the best treatment for you. Stage 3 or 4 cancer is likely to respond better to treatments that treat the whole body, like chemo.
Your health and the treatment you prefer will also play a part in deciding about cancer treatment. Not all types of treatment will work for your cancer, so ask what options you have. And treatments do have side effects, so ask about what to expect with each treatment.
Don’t be afraid to ask questions. It’s your right to know what treatments are most likely to help and what their side effects may be.
Signs and Symptoms of Cancer
What are the signs and symptoms?
Signs and symptoms are both signals of injury, illness, disease – signals that something is not right in the body.
A sign is a signal that can be seen by someone else – maybe a loved one, or a doctor, nurse, or other health care professional. For example, fever, fast breathing, and abnormal lung sound heard through a stethoscope may be signs of pneumonia.
A symptom is a signal that’s felt or noticed by the person who has it, but may not be easily seen by anyone else. For example, weakness, aching, and feeling short of breath may be symptoms of pneumonia.
Having one sign or symptom may not be enough to figure out what’s causing it. For example, a rash in a child could be a sign of a number of things, such as poison ivy, measles, a skin infection, or a food allergy. But if the child has the rash along with other signs and symptoms like a high fever, chills, achiness, and a sore throat, then a doctor can get a better picture of the illness. Sometimes, a patient’s signs and symptoms still don’t give the doctor enough clues to be sure what’s causing the illness. Then medical tests, such as x-rays, blood tests, or a biopsy may be needed.
How do cancer cause signs and symptoms?
Cancer is a group of diseases that can cause almost any sign or symptom. The signs and symptoms will depend on where the cancer is, how big it is, and how much it affects the organs or tissues. If cancer has spread (metastasized), signs or symptoms may appear in different parts of the body.
As cancer grows, it can begin to push on nearby organs, blood vessels, and nerves. This pressure causes some of the signs and symptoms of cancer. If the cancer is in a critical area, such as certain parts of the brain, even the smallest tumor can cause symptoms.
But sometimes cancer starts in places where it won’t cause any signs or symptoms until it has grown quite large. Cancers of the pancreas, for example, usually don’t cause symptoms until they grow large enough to press on nearby nerves or organs (this causes back or belly pain). Others may grow around the bile duct and block the flow of bile. This causes the eyes and skin to look yellow (jaundice). By the time pancreatic cancer causes signs or symptoms like these, it’s usually in an advanced stage. This means it has grown and spread beyond the place it started – the pancreas.
Cancer may also cause symptoms like fever, extreme tiredness (fatigue), or weight loss. This may be because cancer cells use up much of the body’s energy supply, or they may release substances that change the way the body makes energy from food. Cancer can also cause the immune system to react in ways that produce these signs and symptoms.
Sometimes, cancer cells release substances into the bloodstream that cause symptoms that are not usually linked to cancer. For example, some cancers of the pancreas can release substances that cause blood clots in the veins of the legs. Some lung cancers make hormone-like substances that raise blood calcium levels. This affects nerves and muscles, making the person feel weak and dizzy.
How are the signs and symptoms helpful?
The treatment works best when cancer is found early – while it’s still small and is less likely to have spread to other parts of the body. This often means a better chance for a cure, especially if cancer can be removed with surgery.
A good example of the importance of finding cancer early is melanoma skin cancer. It can be easy to remove if it has not grown deep into the skin. The 5-year survival rate (percentage of people who live at least 5 years after diagnosis) at this early stage is around 98%. Once melanoma has spread to other parts of the body, the 5-year survival rate drops to about 16%.
Sometimes people ignore symptoms. Maybe they don’t know that the symptoms could mean something is wrong. Or they might be frightened by what the symptoms could mean and don’t want to get medical help. Maybe they just can’t afford to get medical care.
Some symptoms, such as tiredness or coughing, are more likely caused by something other than cancer. Symptoms can seem unimportant, especially if there’s a clear cause or the problem only lasts a short time. In the same way, a person may reason that a symptom like a breast lump is probably a cyst that will go away by itself. But no symptom should be ignored or overlooked, especially if it has lasted a long time or is getting worse.
Most likely, symptoms are not caused by cancer, but it’s important to have them checked out, just in case. If cancer is not the cause, a doctor can help figure out what the cause is and treat it, if needed.
Sometimes, it’s possible to find cancer before having symptoms. The American Cancer Society and other health groups recommend cancer-related check-ups and certain tests for people even though they have no symptoms. This helps find certain cancers early before symptoms start. For more information on early detection tests, see our document called American Cancer Society Guidelines for the Early Detection of Cancer. But keep in mind, even if you have these recommended tests, it’s still important to see a doctor if you have any symptoms.
What are some general signs and symptoms of cancer?
You should know some of the general signs and symptoms of cancer. But remember, having any of these does not mean that you have cancer – many other things cause these signs and symptoms, too. If you have any of these symptoms and they last for a long time or get worse, please see a doctor find out what’s going on.
Unexplained weight loss
Most people with cancer will lose weight at some point. When you lose weight for no known reason, it’s called an unexplained weight loss. An unexplained weight loss of 10 pounds or more may be the first sign of cancer. This happens most often with cancers of the pancreas, stomach, esophagus (swallowing tube), or lung.
Fever
Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all people with cancer will have a fever at some time, especially if cancer or its treatment affects the immune system. (This can make it harder for the body to fight infection.) Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.
Fatigue
Fatigue is extreme tiredness that doesn’t get better with rest. It may be an important symptom as cancer grows. But it may happen early in some cancers, like leukemia. Some colon or stomach cancers can cause blood loss that’s not obvious. This is another way cancer can cause fatigue.
Pain
Pain may be an early symptom with some cancers like bone cancers or testicular cancer. A headache that does not go away or get better with treatment may be a symptom of a brain tumor. Back pain can be a symptom of cancer of the colon, rectum, or ovary. Most often, pain due to cancer means it has already spread (metastasized) from where it started.
Skin changes
Along with skin cancers, some other cancers can cause skin changes that can be seen. These signs and symptoms include:
- Darker looking skin (hyperpigmentation)
- Yellowish skin and eyes (jaundice)
- Reddened skin (erythema)
- Itching (pruritus)
- Excessive hair growth
Signs and symptoms of certain cancers
Along with the general symptoms, you should watch for certain other common signs and symptoms that could suggest cancer. Again, there may be other causes for each of these, but it’s important to see a doctor about them as soon as possible – especially if there’s no other cause you can identify, the problem lasts a long time, or it gets worse over time.
Change in bowel habits or bladder function
Skin cancers may bleed and look like sores that don’t heal. A long-lasting sore in the mouth could be oral cancer. This should be dealt with right away, especially in people who smoke, chew tobacco, or often drink alcohol. Sores on the penis or vagina may either be signs of infection or early cancer and should be seen by a health professional.
White patches inside the mouth or white spots on the tongue
White patches inside the mouth and white spots on the tongue may be leukoplakia. Leukoplakia is a pre-cancerous area that’s caused by frequent irritation. It’s often caused by smoking or other tobacco use. People who smoke pipes or use oral or spit tobacco are at high risk for leukoplakia. If it’s not treated, leukoplakia can become mouth cancer. Any long-lasting mouth changes should be checked by a doctor or dentist right away.
Unusual bleeding or discharge\
Unusual bleeding can happen in early or advanced cancer. Coughing up blood may be a sign of lung cancer. Blood in the stool (which can look like very dark or black stool) could be a sign of colon or rectal cancer. Cancer of the cervix or the endometrium (lining of the uterus) can cause abnormal vaginal bleeding. Blood in the urine may be a sign of bladder or kidney cancer. A bloody discharge from the nipple may be a sign of breast cancer.
Thickening or lump in the breast or other parts of the body
Many cancers can be felt through the skin. These cancers occur mostly in the breast, testicle, lymph nodes (glands), and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer and should be reported to a doctor, especially if you’ve just found it or notice it has grown in size. Keep in mind that some breast cancers show up as red or thickened skin rather than a lump.
Indigestion or trouble swallowing
Indigestion or swallowing problems that don’t go away may be signs of cancer of the esophagus (the swallowing tube that goes to the stomach), stomach, or pharynx (throat). But like most symptoms on this list, they are most often caused by something other than cancer.
The recent change in a wart or mole or any new skin change
Any wart, mole, or freckle that changes color, size, or shape or that loses its sharp border should be seen by a doctor right away. Any other skin changes should be reported, too. A skin change may be a melanoma which, if found early, can be treated successfully.
Lymph Nodes and Cancer
What is the lymph system?
Our bodies have a network of lymph vessels and lymph nodes. (Lymph is pronounced limp.) This network is a part of the body’s immune system. It collects fluid, waste material, and other things (like viruses and bacteria) that are in the body tissues, outside the bloodstream.
Lymph vessels are a lot like the veins that collect and carry blood through the body. But instead of carrying blood, these vessels carry the clear watery fluid called lymph.
Lymph fluid flows out from capillary walls to bathe the body’s tissue cells. It carries oxygen and other nutrients to the cells and carries away waste products like carbon dioxide (CO2) that flow out of the cells. Lymph fluid also contains white blood cells, which help fight infections.
Lymph fluid would build up and cause swelling if it were not drained in some way. That’s the role of the lymph vessels. Lymph vessels draw up the lymph fluid from around the cells to send it towards the chest. There, lymph fluid collects into a large vessel that drains into a blood vessel near the heart.
Lymph nodes and what they do
Lymph vessels route lymph fluid through nodes throughout the body. Lymph nodes are small structures that work as filters for harmful substances. They contain immune cells that can help fight infection by attacking and destroying germs that are carried in through the lymph fluid.
There are hundreds of lymph nodes throughout the body. Each lymph node filters the fluid and substances picked up by the vessels that lead to it. Lymph fluid from the fingers, for instance, works its way toward the chest, joining fluid from the arm. This fluid may filter through lymph nodes at the elbow or those under the arm. Fluid from the head, scalp, and face flows down through lymph nodes in the neck. Some lymph nodes are deep inside the body, such as between the lungs or around the bowel, to filter fluid in those areas. The lymph fluid slowly flows in from all around the body, making its way back to the chest. At the end of its journey, the filtered fluid, salts, and proteins are dumped back into the bloodstream.
Swollen lymph nodes
When there’s a problem, such as infection, injury, or cancer, the node or the group of lymph nodes in that area may swell or enlarge as they work to filter out the “bad” cells. This may be called lymphadenopathy (LIMF-ad-uh-NOP-uh-thee). Swollen lymph nodes tell you that something is not right, but other symptoms help pinpoint the problem. For instance, ear pain, fever, and enlarged lymph nodes near your ear are clues that you may have an ear infection or cold.
Some areas where lymph nodes commonly swell are in the neck, groin, and underarms. In most cases, only one area of nodes swells at a time. When more than one area of lymph nodes is swollen it’s called generalized lymphadenopathy. Some infections (such as strep throat and chickenpox), certain medicines, immune system diseases, and cancers like lymphoma and leukemia can cause this kind of swelling. The health care provider will look for more information to figure out the cause of the swelling. Lymph node swelling is often caused by something other than cancer.
Cancer in the lymph nodes
Cancer can appear in the lymph nodes in 2 ways: it can either start there or it can spread there from somewhere else.
Cancer that starts in the lymph nodes is called lymphoma. You can read more about lymphoma in Hodgkin Disease and Non-Hodgkin Lymphoma.
More often, cancer starts somewhere else and then spreads to lymph nodes. That is the focus of this section.
How does cancer spread to lymph nodes?
Cancer can spread from where it started (the primary site) to other parts of the body. When cancer cells break away from a tumor, they can travel to other areas of the body through either the bloodstream or the lymph system. Cancer cells can travel through the bloodstream to reach distant organs. If they travel through the lymph system, the cancer cells may end up in lymph nodes. Either way, most of the escaped cancer cells die or are killed before they can start growing somewhere else. But one or two might settle in a new area, begin to grow, and form new tumors. This spread of cancer to a new part of the body is called metastasis.
In order for cancer cells to spread to new parts of the body, they have to go through several changes. They first have to become able to break away from the original tumor and then attach to the outside wall of a lymph vessel or blood vessel. Then they must move through the vessel wall to flow with the blood or lymph to a new organ or lymph node.
When cancer grows inside lymph nodes, it usually affects the lymph nodes near the tumor itself. These are the nodes that have been doing most of the work to filter out or kill the cancer cells.
How is cancer in lymph nodes found?
Normal lymph nodes are tiny and can be hard to find, but when there’s infection, inflammation, or cancer, the nodes can get larger. Those near the body’s surface often get big enough to feel with your fingers, and some can even be seen. But if there are only a few cancer cells in a lymph node, it may look and feel normal. In that case, the doctor must check for cancer by removing all or part of the lymph node.
When a surgeon operates to remove primary cancer, one or more of the nearby (regional) lymph nodes may be removed as well. Removal of one lymph node is called a biopsy. When many lymph nodes are removed, it’s called lymph node sampling or lymph node dissection. When cancer has spread to lymph nodes, there’s a higher risk that cancer might come back after surgery. This information helps the doctor decide whether more treatment, like chemo or radiation, might be needed after surgery.
Doctors may also take samples of one or more nodes using needles. Usually, this is done on lymph nodes that are enlarged. This is called a needle biopsy. The tissue that’s removed is looked at under the microscope by a pathologist (a doctor who diagnoses illness using tissue samples) to find out if there are cancer cells in it.
Under the microscope, any cancer cells in the nodes look like the cancer cells from the primary tumor. For instance, when breast cancer spreads to the lymph nodes, the cells in the nodes look like breast cancer cells. The pathologist prepares a report, which details what was found. If a node has cancer in it, the report describes what it looks like and how much was seen.
Doctors may also use scans or other imaging tests to look for enlarged nodes that deep in the body. For more on this, see Imaging (Radiology) Tests. Often, enlarged lymph nodes near a cancer are assumed to contain cancer.
What does it mean if there’s cancer in my lymph node?
It depends. Sometimes there are so few cancer cells in the node that the pathologist must use special tests to find them. In the case of very few cancer cells in a lymph node, it may not change the treatment plan at all.
If there’s a lot of cancer in a node, the large mass can be seen easily. If the cancer is growing out of the lymph node through the layer of connective tissue on the outside (called the capsule), it’s called extracapsular extension.
More cancer in the nodes may mean that the cancer is fast-growing and/or more likely to spread to other places in the body. But if nearby lymph nodes are the only other place cancer is found beyond the main (primary) site, surgery to remove the main tumor and the nearby lymph nodes may be able to get rid of it all.
Cancer that has spread to nodes further away from primary cancer will more likely need extra treatment with chemo or radiation.
Cancer in nodes affects cancer stage
Treatment of cancer is based on the type of cancer a person has, and the stage of cancer. Doctors use a system to assign a stage to cancer. The most common staging system is the TNM system. The T in TNM stands for tumor, the M stands for metastasis, and the N stands for lymph nodes. If there’s no cancer found in the lymph nodes near cancer, the N is assigned a value of 0. If nearby or distant nodes show cancer, the N is assigned a number such as 1, 2, or sometimes 3, depending on how many nodes are affected, how much cancer is in them, how large they are, and where they are.
Cancer with lower TNM numbers is usually easier to treat and has a better outlook for survival. For instance, cancer with T1, N0, M0, would be cancer that was found very early, before it spread. The T1 would mean a small tumor, the N0 means that no nodes are involved, and the M0 means that no metastases were found. For more information on staging, see information about your cancer type, or read Staging.
Effects of removing lymph nodes
Nodes that have been removed during cancer surgery can leave part of the body without a way to drain off the lymph fluid in the affected area. Many of the lymph vessels now run into a dead end where the node used to be, and fluid can back up. This is called lymphedema, and it can become a life-long problem. The more lymph nodes that are removed, the more likely it is to occur.
Removing lymph nodes during cancer surgery is highly unlikely to weaken a person’s immune system since the immune system is large and complex and is located throughout the body.
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