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Table of Contents

Cancer Progress and Challenges

Today--25 years after the National Cancer Act of December 1971 launched an all-out research assault on the 100 malignant diseases known as cancer--more than 10 million Americans are cancer survivors. Progress includes major increases in cures for childhood cancers; Hodgkin's disease (a form of lymphoma that affects both young people and older men and women); and colon and rectal cancer.

Curing cancer of the testicle is one of the biggest success stories. This cancer usually strikes between ages 20 and 40 but can affect teens or older men. Thanks to improvements in drug therapy, testicular cancer is almost always curable when detected early. Sexual functioning remains normal after treatment.

For boys with a testicle that fails to descend normally to the scrotum or descends only after age 6, the risk of this relatively rare cancer is up to 10 times higher.

Cancer of the prostate gland has become a major challenge, however. Now the leading cause of cancer in this country, it will affect about 334,500 American men in 1997. The rate has increased 173% since the early 1970s. This dramatic rise in prostate cancer rates is due partly to improvements in early detection and partly to longer lifespans among men today. More than 80% of prostate cancers develop after age 65. However, much younger men can also develop prostate cancer, which may be more aggressive at younger ages. Improvements in surgery, radiation therapy and follow-up chemotherapy are boosting cure rates, but early detection is important for cure. African American men have the highest rates of prostate cancer in the world--66% higher than for white men. Since this cancer is relatively rare among blacks in Africa and other countries, racial heredity does not account for black Americans' increased risk. Possible risk factors being studied include dietary patterns, occupational exposure to industrial chemicals or pesticides and other environmental exposures to cancer-causing agents.

Lung cancer, though increasing among women, has started to decline in American men, largely because they started to quit smoking earlier. It is the second most common cancer among men (98,300 new cases a year) and women (79,800). However, lung cancer remains the leading cause of cancer deaths because it is rarely detected early. Get regular checkups and let your doctor know if you are at risk of lung cancer because of current or former smoking. Also tell your doctor if you have had work-related or other long-term exposure to loose asbestos, which puts you at risk of a chest cancer called mesothelioma. If caught early enough, surgery and follow-up treatment can cure or control lung or chest cancer for several years. The best means of prevention is to stop smoking.

Cancer of the colon or rectum is the third most common cancer and the third leading cause of cancer deaths among men in this country, who have higher rates of this cancer than women do. Regular screening to detect colorectal cancer early is the key to successful treatment. Because of improved surgical techniques, removal of an early colon or rectal tumor rarely results in a permanent change of bowel function.

Bladder cancer, the fourth most common cancer among American men, strikes men more than three times as often as women. Smokers have twice the risk of nonsmokers, but other risk factors include on-the-job exposure to chemicals used with dyes, rubber and leather. Blood in the urine and having to urinate more often may be signs of bladder cancer, which is curable in 93% of cases if detected early.

Gone Today, Hair Tomorrow?

The new hair-restoring medicine doctors are excited about is finasteride (Proscar)--most widely used as a nonsurgical treatment for prostate enlargement. A study shows this oral medication may be more effective in stopping hair loss and regrowing hair than minoxidil (Rogaine). It is expected to be available for hair loss in 1998.

Meanwhile, some 18,000 men across the United States are enrolled in a trial to test whether finasteride can reduce the risk of prostate cancer. Fox Chase Cancer Center in Philadelphia and its Fox Chase Network of community cancer centers in Pennsylvania and New Jersey are among the sites for this Prostate Cancer Prevention Trial. Enrollment ended in December, but the study will continue for at least five more years before results are available.

Important Screening for Young and Mature Men

Starting at age 20, men should examine their testicles for abnormal lumps on a monthly basis. For a pamphlet on how to do testicular self-examination, call the National Cancer Institute's Cancer Information Service, 1-800-4-CANCER.

Starting at age 40, men should have an annual physical examination that includes a digital rectal examination. This exam is useful in detecting signs of prostate cancer and of colon or rectal cancer. Your doctor feels the prostate through the rectum and may detect early problems, even before symptoms begin.

Starting at age 50--or ages 35 to 40 with a family history of prostate cancer--men should also have an annual blood test for prostate-specific antigen (PSA). High PSA levels often indicate prostate cancer or a noncancerous prostate problem. This test and a physical exam detect more prostate cancers earlier than either method alone.

Also at age 50--or age 40 with a family history of colon or rectal cancer--men and women should start having an annual test for blood in the stool. This blood is often known as occult, or hidden, blood because it is usually invisible to the naked eye. Studies have shown that yearly screening with this fecal occult blood test helps find colorectal cancers early enough to reduce the death rate by one-third. Periodically, you should also have an exam known as flexible sigmoidoscopy. In this exam, the doctor uses a flexible lighted tube--a sigmoidoscope--to exam the rectum and the lower colon (which forms an S shape called the sigmoid colon).

DNA and You: Do You Have a Family Risk of Cancer?

Many men do not realize they might have a higher than average risk of certain cancers due to family patterns of the disease. Just as some families have high rates of female breast or ovarian cancer, some families have high rates of prostate cancer, colon cancer and the serious skin cancer known as melanoma. People in these families may have inherited a genetic susceptibility--a variation in their DNA that affects a particular gene.

All cancer does start with one or more genetic changes, but not all cancer is hereditary. Often several genes are involved and most cancer-related gene alterations take place during a person's lifetime. That's why the risk of most cancers increases with age. However, a strong family pattern of a particular cancer indicates that an inherited defect in a gene may be passed from one generation to the next. For example, research indicates that about 90% of hereditary breast cancers--only 5% to 10% of all breast cancers--may result from two flawed "breast-cancer genes," BRCA1 and BRCA2. These genes also increase the risk of ovarian cancer in women and prostate cancer in men, while BRCA2 greatly increases the risk of rare male breast cancer.

The first gene known to be linked directly with hereditary prostate cancer, called HPC-1, is currently being isolated in a collaborative effort led by researchers at Johns Hopkins University. As with breast cancer, only 5 to 10% of prostate cancers are estimated to result from a specific inherited abnormality in a gene. Other hereditary factors may increase susceptibility to prostate cancer in 25% to 30% of families with a history of the disease.

This hereditary susceptibility has important implications for men. When prostate cancer runs in families, it tends to occur at progressively younger ages and is more aggressive than the slow-growing prostate cancers that typically affect elderly patients.

A test for the newly discovered prostate-cancer gene may be available by 1998. Individuals will then have the option of genetic counseling and testing. Research to isolate the various genes involved in producing colon cancer, melanoma and other cancers is taking place at Fox Chase Cancer Center and elsewhere. This work includes a search for molecular markers--proteins produced by the cancer-related genes that can serve as early warning signs.

Eventually, in addition to improving early cancer detection, scientists expect genetic research to improve the precision of cancer treatment, either by developing ways to restore normal function to the defective genes or new drugs to target only the genes in cancer cells.

9+ Reasons to Quit Tobacco

Lung cancer is the second leading cause of cancer in the United States, but it remains the top cause of cancer deaths among both men and women--second only to heart disease. Smoking vastly increases the risk of both these killers, while smokeless tobacco use is a major risk factor for cancers of the head and neck.

Despite the recent decline in lung cancer among American men, their annual deaths from lung cancer (94,400) are more than double U.S. deaths from prostate cancer (41,800).

Breaking the tobacco habit will reduce your risk of:
  • heart disease
  • cancers of the lung, mouth, throat, esophagus, pancreas, kidney and bladder
  • stroke
  • chronic bronchitis
  • emphysema and other pulmonary diseases
  • gastric ulcers
  • bone loss and brittleness (osteoporosis)
  • visual impairment (macular degeneration causing fuzzy vision)
  • excessive facial wrinkles

Reversing Precancerous Conditions

People who are or have been long-term smokers may be eligible for Fox Chase Cancer Center's lung cancer prevention trial. The study will determine if a drug called oltipraz can raise the body's protective enzymes enough to reverse precancerous abnormalities in the lungs. A free examination to see if an individual has precancerous tissue in the lungs will determine whether a person can enroll. For more information, call 1-800-ENROLL ME (1-800-367-6556).

An oral cancer prevention trial by Fox Chase Cancer Center is designed to see if precancerous white or red patches in the mouth can be eliminated. These patches, called oral leukoplakia, are common in people who smoke or use smokeless tobacco products. People in this study will take the drug DFMO, which laboratory studies have shown can halt the abnormal multiplication of cells. Participants will also receive a year of medical follow-up examinations free of charge.

The oral prevention trial is available not only at Fox Chase in Northeast Philadelphia but also at two West Philadelphia locations. Call 1-800-ENROLL ME (1-800-367-6556).

Questions & Answers About Prostate Cancer Myths and Mysteries

Q. Even though some men get prostate cancer in their 50s, isn't it almost always an elderly man's disease?
A. Not necessarily. While more than 80% of prostate cancers are diagnosed after age 65, men can develop this disease in their 40s and 50s and even as young as their early 30s. This is most likely if there is a family history of prostate cancer. Men in the following generations may develop prostate cancer at younger ages and have a more aggressive type than the slow-growing prostate cancers that typically affect elderly men.

Q. When men have to urinate more often, it seems the problem is either an enlarged prostate gland or prostate cancer? What's the difference?
A. As a man becomes older, the prostate gland may give him problems in urinating because it is located just beneath the bladder. Difficult or frequent urination most often results from a noncancerous enlarged prostate that presses on the urethra (the tube that carries urine out of the body). Some urinary problems could be caused by a cancerous growth, or tumor, in the prostate. In these cases, symptoms tend to develop less gradually and become more severe than with prostate enlargement. Unless treated early, the tumor will eventually spread beyond the prostate and affect other organs.

  • By age 40, about 10% of all men have some enlargement of the prostate.
  • By age 60, most men have an enlarged prostate.
  • After age 50, up to 75% of all men show signs of prostate problems--such as prostate enlargement; prostate cancer; or painful inflammation, called prostatitis, which usually results from an infection and can be cured with antibiotic drugs.
Don't be embarrassed or afraid to tell your doctor about any urinary problems you're having. Chances are they don't mean prostate cancer, but it's better to be sure.

Q. Does having an enlarged prostate gland lead to prostate cancer?
A. No. Even untreated, prostate enlargement doesn't lead to cancer. You may want treatment, however, to relieve discomfort. There is a choice of surgical treatment and medication for an enlarged prostate.

Q. Is a lump or sore in the groin or scrotum, near the testicles, one of the first signs of prostate cancer?
A. No. But you should have such a lump checked, since it may indicate testicular cancer; lymphoma, a cancer of the immune system; or, more likely, a hernia or a noncancerous cyst. Early prostate cancer often produces no noticeable symptoms, but as a prostate tumor grows bigger, symptoms may include: � difficulty or pain in urinating; � frequent urination; � blood in the urine; � lower back pain.

Q. Does sexual intercourse help cause or help prevent prostate cancer?
A. Neither. There is no evidence that the frequency or lack of sexual relations has anything to do with cancer of the prostate.

Q. After prostate-cancer treatment, can a man urinate normally? Can he ever have sex again?
A. Men who have either surgery or radiation therapy for early prostate cancer have high survival rates with no evidence of cancer. Depending on the surgeon's skill and the type of procedure, surgery carries a higher risk of long-term side effects. From 10% to 15% of surgical patients experience some incontinence--the inability to hold your urine, compared to 6% to 7% of radiation therapy patients. (However, radiation therapy often produces severe diarrhea.)

New, nerve-sparing surgery reduces the risk of impotence--the inability to have and maintain an erection. With this surgical technique or with carefully planned radiation therapy, from 50% to 75% of men will have full sexual function. For those who don't, several treatments for impotence exist.

Q. Once a man has prostate cancer, even if he is probably cured, can he give cancer to a woman if he has sex with her?
A. No one can catch cancer from another person. Cancer is never transmitted by coughing, sneezing, sexual contact or any other physical contact.

Q. Can a fruit a day keep prostate cancer away?
A. Not apples, but tomatoes (which are really a fruit) may help a lot. In a study of what 48,000 male health professionals ate, those regularly eating 10 or more servings of tomato-based products a week had less than half the prostate-cancer risk of men who ate fewer than four servings.

This protective effect was strong with tomato sauce, plain tomatoes and even pizza--but not with tomato juice. The Harvard Medical School researchers who did the study attributed the protection to a vitamin A-related compound, lycopene, that is a powerful antioxidant. The body appears to absorb this less well from tomato juice. Changing your diet once cancer is detected won't help, however. Dietary changes need to start as early as possible in life for the maximum reduction in risk.

Body Building for Your Bones

More Half of all Americans--men as well as women--don't get enough calcium in their diets.
Lack of calcium not only leads to brittle bones -- osteoporosis -- but is increasingly linked with high blood pressure, leading in turn to heart disease, stroke and kidney disease. Stress, overweight and heavy drinking increase the need for calcium. Studies suggest that adults need at least 1,000 milligrams a day: the equivalent of calcium found in a cup of skim milk, 3 ounces of sardines, an ounce of cheese, one-half cup of broccoli and one-half cup of green beans. Leafy dark green vegetables are rich not only in calcium but also in fiber and other nutrients that may help prevent colon cancer.

Since men start with more bone mass than women, they don't lose bone as early as women, whose bone density starts declining in their 50s. However, men are just as vulnerable to bone loss in later decades. All adults need at least 1,500 milligrams of calcium daily after age 65. Along with adding calcium, weight-bearing exercise--from jogging or weight-lifting to moderate walking, golfing or even cleaning out the garage--can help maintain strong bones as well as a trim physique.

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