Researchers have discovered that cancer is caused by changes in genes that control cell growth. Environmental factors such as tobacco use, exposure to ultraviolet (UV) rays, poor diet and exposure to cancer-causing substances can change normal genes into genes that allow cancer growth. Some gene changes are inherited from one or both parents, but this does not mean cancer will always develop. Researchers are still examining factors that may increase or decrease a person's chance of developing cancer.
Review the National Cancer Institute's list of risk factors and possible causes for various types of cancers.
Although there is no guaranteed way to prevent cancer, taking charge of your health and living a healthy lifestyle are the keys to lowering your cancer risk. You can reduce your risk by:
- Not using tobacco products
- Choosing foods with less fat and eating five or more servings of vegetables, fruits and whole grains
- Exercising regularly (moderate activity for 30 minutes, five days a week) and maintaining a healthy weight
- Avoiding the harmful rays of the sun, using sunscreen and wearing clothing that protects the skin
- Talking with a doctor about the possible benefits of drugs proven to reduce the risk of certain cancers
For more ways to help reduce your risk for certain cancers, visit the American Cancer Society online.
Cancer Screening Guidelines
The American Cancer Society guidelines for early detection of specific cancers, with risk based merely on age and sex, are the following:
Screening Test and Population
Sigmoidoscopy (similar to a colonoscopy) - Males and females age 50 and over: Every 3 to 5 years.
Fecal occult blood test - Males and females age 50 and over: Every year.
Digital rectal exam (DRE) - Males and females age 40 and over: Every year.
Prostate exam (DRE & PSA test) - Males age 50 and over: Every year.
Pap test - Females who are, or who have been sexually active, or have reached age 18, should have an annual Pap test and pelvic examination. After three or more consecutive normal annual examinations, the Pap test may be performed less frequently at the discretion of the physician.
Breast self-examination - Female age 20 and over: Monthly.
Breast clinical examination - Females age 20 to 40: Every three years. Females over age 40: Every year.
Mammography - Females age 40 to 49: Every 1 to 2 years. Females age 50 and over: Every year.
These are very general screening guidelines. Certain medical conditions, a specific family history of cancer, or exposure to certain toxic chemicals or conditions may increase significantly the risk of certain cancers and may warrant earlier, more frequent or more specific assessments.
More detailed information on the importance and methods of early detection of cancer can be obtained by calling the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) or visiting the American Cancer Society and the National Cancer Institute online.
Cancer Symptoms and Diagnosis
What is cancer?
Cancer is an abnormal, uncontrolled multiplication of cells. The mass of cancer cells eventually becomes large enough to produce lumps, masses, or tumors that can be detected, these abnormal growths can be benign (non-cancerous) or malignant (cancerous), in which case they may grow into adjacent tissue and/or spread (metastasize) to distant parts of the body.
Cancer can cause a variety of symptoms, including:
- Presence of a new lump in the breast or any other part of the body
- Presence of a new mole or a change in the appearance of an existing wart or mole
- A sore or wound that does not heal
- Nagging cough or hoarseness
- Changes in bowel or bladder habits
- Indigestion or difficulty swallowing
- Unexplained changes in weight
- Unusual bleeding or discharge
Many other conditions have similar symptoms. Make sure you tell your doctor if you experience any of these symptoms.
Types of Cancer
Carcinomas - cancers that occur in epithelial surfaces - the cells that form the outer surface of the body to line or cover the body's cavities, tubes and passageways.
Adenocarcinomas - cancers that form on a glandular surface, such as the lung, breast, prostate, ovary or kidney.
Sarcomas - cancers that occur in supporting structures, such as bone, muscle, cartilage, fat or fibrous tissue.
Leukemias and lymphomas - cancers that occur in blood cell elements.
How are the symptoms and types of cancer diagnosed?
When symptoms suggest cancer, your doctor may request or perform any of the following procedures to help diagnose it:
- A detailed medical history - family and personal
- A thorough physical exam
- Pelvic exam of the uterus, vagina, ovaries, bladder, and rectum (for women only)
- Pap test at the time of pelvic exam (for women only)
- Rectal exam of the prostate and rectum (for men only)
Other diagnostic procedures may be requested. These include:
- Imaging tests, such as:
- Computed tomography (CT or CAT scan). A noninvasive diagnostic imaging procedure that uses a combination of X-ray and computer technology to produce detailed images (often called slices) of the body. The CT scan may show tumors or indicate enlarged lymph nodes--a possible sign of a spreading cancer or of an infection.
- Radionuclide or nuclear medicine scan. An imaging scan in which a small amount of radioactive substance is injected into the vein. A machine measures levels of radioactivity in certain tissues or organs, thereby detecting any abnormal areas or tumors. Some examples are bone scans, PET scans, thyroid scans, and gallium scans.
- Ultrasound. An imaging technique that uses high-frequency sound waves to produce an image on a monitor of the abdominal organs, such as the uterus, liver, and kidneys.
- Magnetic resonance imaging (MRI). A noninvasive procedure that produces detailed views of an internal organ or structure, especially the brain and spinal cord, without the use of X-rays. The MRI may show abnormal nodules in bones or lymph nodes--a sign that cancer may be spreading.
- Endoscopy. Use of a flexible tube with a lens or tiny camera (and a light on the end), which is connected to a computer screen, allowing the doctor to see inside the hollow organs, such as the esophagus, stomach, intestines, bladder, or uterus. Biopsy samples (tiny pieces of tissue) can be taken through the tube for further evaluation.
- Laboratory tests. These are done to examine blood, urine, other fluids, or tumor tissue from a biopsy.
- Biopsy. This is done to remove a sample of the suspicious tissue for examination in a lab by a pathologist. Biopsy can be done with several different procedures depending on the location of the tumor and size. Endoscopy, needle biopsy with image guidance, and surgical biopsy are a few examples.
For most types of cancer, exams and imaging tests might suggest a person has cancer, but a biopsy is usually needed to be sure of the diagnosis.
Once the cancer is diagnosed, an evaluation will be made to determine the extent (stage) of the cancer. This is often done with some of the imaging tests described above.
Cancer Grades and Stages
After the determination is made as to the type of cancer, the cancer is graded from low to high - a measurement of how aggressive the tumor is. Once cancer is diagnosed, more tests will be done to find out if the cancer cells have spread to other parts of the body. This testing is called staging.
The following are the most common methods of treating the major types of cancer. Get more information on treatment at the Markey Cancer Center.
- Radiation therapy
- Hormone therapy
- Immunotherapy or biological therapy
- Investigational treatment/clinical trials
Advances in surgery, radiation and medical oncology often involve breakthrough technology. The Markey Cancer Center is committed to providing access to clinical trials to our patients.
It can be difficult to manage the emotional and physical side effects of cancer after diagnosis or treatment, especially if your child has cancer. Our Psych-Oncology Services staff are available to help our patients and their caregivers cope throughout their treatment. Visit the National Cancer Institute's Coping with Cancer website for answers on how to cope with fatigue, pain, anxiety and depression.
More than 100 different types of cancer exist and each type of cancer must be treated differently at different stages of disease. Markey Cancer Center's expert teams are committed to developing new and more advanced ways to fight cancer and utilizing breakthrough technology to maintain and improve patients' quality of life.
Clinical Genetic Counseling
A key component of Markey Cancer Center's mission to provide advanced patient care and leading-edge research is the Genetic Counseling Program. The program provides risk assessment for individuals with a strong family history of cancer. Individuals who are predisposed to cancer can review clinical management options for themselves and potentially at-risk family members.
Our genetic counselor provides patients with a personalized assessment of hereditary cancer risks and discusses cancer detection and risk reduction options. Patients' concerns are addressed with sensitivity and support. Genetic testing is offered when appropriate and the patient is returned to the referring physician for any necessary follow-up care.
To refer a patient for cancer genetics evaluation, pleasee-mail it to us directly. If you have questions, please contact us at 859-323-2798.
For clinical questions, contact UK•MDs at 1-800-888-5533
Please read the information about referral guidelines for cancer genetics evaluation.
Referral Guidelines for Cancer Genetics Evaluation
Hereditary breast-ovarian cancer syndrome - Patient or first-degree relative with ANY of the following:
- Breast or ovarian cancer and two or more first- or second-degree relatives (related through a single lineage) with breast or ovarian cancer.
- Breast or ovarian cancer and one or more relatives with breast cancer diagnosed at an early age (younger than 50) or ovarian cancer diagnosed at any age.
- Breast or ovarian cancer diagnosed at an early age (younger than 50).
- Male breast cancer at any age.
- Documented mutations in the BRCA1 or BRCA2 gene.
- Ashkenazi Jewish descent with breast or ovarian cancer.
- Suspicion of a genetic disorder/syndrome associated with increased risk of breast cancer.
Hereditary Non-Polyposis Colorectal Cancer Syndrome (HNPCC) - Patient or first-degree relative with ANY of the following:
- Two or more HNPCC-associated cancers (colorectum, endometrium, small bowel, ureter, renal pelvis) in the same individual.
- Colorectal cancer with a first-degree relative with an HNPCC-associated cancer or colorectal adenoma; one of the cancers diagnosed at younger than 50 years; adenoma diagnosed at younger than 40 years.
- Colorectal or endometrial cancer diagnosed at younger than 45 years.
- Right-sided colon cancer with an undifferentiated pattern diagnosed younger than 50 years.
- Signet ring cell type colorectal cancer diagnosed at younger than 50 years.
- Adenomas diagnosed at younger than 40 years.
- Documented mutation in an HNPCC-associated gene (MLH1, MSH2, MSH6, PMS2, and EPCAM).
Familial Adenomatous Polyposis (FAP)
- Patient with more than 20 adenomatous colorectal polyps.
- Patient or family member with a clinical diagnosis of FAP.
- Patient or family member with a documented mutation in the APC or MYH gene.
Suspicion of a genetic condition associated with increased risk of malignancy:
- Personal history of cancer, and one or more relatives with the same type of cancer, one of the cancers diagnosed at younger than 50 years.
- Personal history of two or more primary cancers, particularly if one of the diagnoses occurred at younger than 50 years, with or without family history of cancer.
- Family history of cancer suggestive of a known syndrome (e.g. breast/thyroid:Cowden, breast/sarcoma:Li-Fraumeni).
Genetic Counseling FAQs
How can genetic counseling help you?
If you have a family history of cancer, genetic counseling can help you:
What happens during a clinical genetic counseling appointment?
The goal of genetic counseling is to provide understandable information about your risk of hereditary cancer in a supportive and educational setting. You will meet with a genetic counselor who is specially trained in cancer genetics, which means that you will get a thorough and accurate assessment of your risk of hereditary cancer. The genetic counseling appointment usually takes about 60 minutes. The length of your appointment will depend on the complexity of your medical and family history.
What is genetic testing?
Genetic testing is a laboratory test, usually done on a blood sample, which can help us determine your risk for cancer. Genetic testing may help you and your physician make important decisions about your medical care. Deciding whether or not to have genetic testing is a personal choice that can be made at the time of the counseling session or at a future date.
You will receive a cancer risk assessment from your genetic counseling session whether or not you undergo genetic testing; you are not required to have genetic testing if you come for a genetic counseling appointment. However, you must receive genetic counseling before we will perform a genetic test. Genetic counseling allows us to obtain the necessary information to give you accurate information about the risk of hereditary cancer, to determine if a genetic test would be useful, to determine which genetic test is appropriate, and to help you and your family make informed decisions about your medical care.
Who can participate?
Genetic counseling is available to anyone who is concerned about a personal or family history of cancer. A specially trained genetic counselor provides a personalized assessment of your risk of hereditary cancer; discusses cancer detection, management, and risk reduction options; and offers genetic testing when appropriate.
Who can benefit from genetic counseling?
If you answer "yes" to any of the following questions, you may benefit from genetic counseling:
Have you or a close relative been diagnosed with cancer at age 50 or younger? Has more than one member of your family been diagnosed with the same type of cancer? Have you or a family member been diagnosed with more than one type of cancer? Are you related to someone who is known to have a genetic condition or mutation that increases the risk of cancer?
We understand that many personal factors must be considered when making decisions regarding cancer detection, prevention and genetic testing. These include your medical issues, your state of mind, your beliefs and your family's experience with cancer. The genetic counselor can address your concerns with sensitivity and support, and tailor each counseling session to fit your personal needs.
Is genetic counseling for cancer and genetic testing covered by insurance?
Most insurance companies cover genetic counseling and testing. To determine whether genetic counseling is covered by your specific insurance, you may contact your insurance company directly. The procedure code that we bill is 96040. Genetic testing is billed separately from genetic counseling and is typically covered, provided that you meet criteria.
The option of genetic testing and any insurance issues regarding testing will be discussed with you during your appointment. If you do not have insurance or if you are covered by Medicare or Medicaid, you can contact our office at 859-323-2798 with your questions regarding coverage.
Can genetic testing affect my insurance?
Federal law (Genetic Information Nondiscrimination Act) makes it illegal for health insurers to use genetic information to deny insurance coverage, change the terms of coverage or increase individual premiums. If you have concerns about the effect of genetic testing on your insurance, they will be addressed during the genetic counseling appointment.
What about my privacy?
We will not release information about your hereditary cancer risk assessment to anyone other than you and your referring physician without your prior written consent.
Is clinical genetic counseling right for me?
If you think genetic counseling might be helpful to you, discuss it with your doctor.
For more information, or to schedule an appointment, call the UK Markey Cancer Center's Clinical Genetic Counseling Program at 859-323-2798.