Understanding
cancer?

Overview

Sarcomas are a group of cancers that start in the bones or the soft tissues (muscle, fat, and fibrous tissues). They are rare tumours, and make up only 1% of cancers in adults.

Symptoms

These cancers often cause a lump or swelling in the affected body party which results in people seeking medical advice. The other common problem especially if the sarcoma has started in a bone is pain or a dull ache, which is often worse at night.

Diagnosis

When a sarcoma is suspected, a series of tests are performed to identify the stage of the tumour. This involves MRI and CT scans and X-rays to identify the extent of the cancer in the area where it has started, and whether or not there has been spread to other parts of the body. To work out the exact type of cancer that is present, a sample (known as a biopsy) needs to be removed. Sometimes this is performed with a small operation, while other times a needle can be inserted into the cancer and a sample removed.

Treatment

Treatment of sarcomas requires the involvement of a team including surgeons, medical and radiation oncologists, nurses, physiotherapists along with many others. This is known as a multidisciplinary team (MDT), and members of this team will often work together alongside each other in a specialised clinic. In the background, other specialists, such as pathologists and radiologists help with the interpretation of tests such as biopsies and scans.

Treatment for people with sarcoma is individualised. This means that they type of treatment that someone receives may be different to another person with the same disease because of differences in age, other illnesses, preferences, and the precise extent and nature of their cancer. In general, however, sarcomas are treated with surgical removal. Often, chemotherapy is given before and/or after an operation to remove a sarcoma, and radiation therapy is also used on occasions. If you are a patient, it is important to discuss the treatment options that may be available to you with your treating team.

Overview

A brain tumour forms when cells grow and divide in an uncontrollable way. When this occurs, the tumour takes up space within the skull and can interfere with the brain’s normal activity.

A tumour may cause damage by increasing pressure in the brain, by shifting the brain and causing it to push against the skull, and/or by invading and damaging nerve and healthy brain tissue.

Brain tumours can be benign or malignant (brain cancer).

Symptoms

The symptoms of a brain or spinal cord tumour depend on where it is located and if it is causing pressure in the skull or spinal column. Sometimes, when a tumour grows slowly, symptoms develop gradually or you may not take much notice of them. They may be similar to other illnesses, such as a migraine or a stomach bug (e.g. headaches or nausea).

Brain and spinal cord tumours may cause weakness or paralysis in parts of the body. Some people also have trouble balancing or have seizures.

Other symptoms of brain tumours include:

• nausea and/or vomiting
• headaches
• drowsiness
• difficulty speaking or remembering words
• short-term memory problems
• disturbed vision, hearing, smell or taste
• loss of consciousness
• general irritability, depression or personality changes – this is sometimes only noticed by family or friends.

Symptoms of spinal cord tumours include:

• back and neck pain
• numbness or tingling in the arms or legs
• clumsiness or difficulty walking
• loss of bowel or bladder control (incontinence).

Most people who have common symptoms, such as a headache, do not have a tumour. However, new or worsening symptoms should be reported to your doctor.

Diagnosis

Your GP will probably arrange the first tests to assess your symptoms. You will usually be referred to a neurologist, who will arrange further tests and advise you about treatment options.

Tests to diagnose brain cancer:

• Physical examination
• CT (computerised tomography) scan
• MRI (magnetic resonance imaging) scan

Other tests that are sometimes used are:

• Magnetic resonance spectroscopy (MRS) scan
• Single photon emission computerised tomography (SPECT or SPET) scan
• Positron emission tomography (PET) scan
• Lumbar puncture (spinal tap)
• Surgical biopsy

Treatment

Surgery

Surgery in the central and peripheral nervous system is called neurosurgery. In many cases, removing all or part of the tumour may allow you to lead an active life for some time. However, you may also have other treatments.

Some tumours can be removed by neurosurgery. This type of operation is called a gross total resection. In other cases, the surgeon may only be able to remove part of the tumour. This is called a partial resection or debulking. Partial removal may be because the tumour is widespread, near major blood vessels, or cannot be removed without damaging other important parts of the brain or spinal cord. A partial resection may improve your symptoms by reducing the pressure on your brain.

Sometimes a tumour cannot be removed because it is too close to certain parts of the brain and would cause serious problems. This is called an inoperable or unresectable tumour. Your doctor will talk to you about other ways to try to ease the symptoms.

Radiotherapy for brain and spinal cord tumours

Radiotherapy (also called radiation therapy) is a type of treatment that uses high-energy x-ray beams to kill or damage cancer cells.The radiation is specifically targeted at the treatment site to reduce the risk of damage to healthy cells. The treatment is painless.

Before your radiotherapy begins, you will need to have an appointment to plan it. This is often called a simulation appointment, because you will be put in the exact position needed for your treatment.

A radiation therapist will take measurements of your body, as well as doing an x-ray or CT scan, to work out the precise area to be treated. For spinal cord tumours, some small tattoos may be marked on your skin to indicate the treatment area. For brain tumours, a face mask – also called a cast – is made to keep the head in position. It is a tight-fitting mesh, but you will only wear it for about 10 minutes at a time. However, let the radiation therapist know if wearing the mask makes you uncomfortable.

Radiotherapy treatment is usually given once daily, from Monday to Friday, for several weeks. However, the course of your treatment will depend on the size and type of the tumour.

Chemotherapy for brain and spinal cord tumours

Chemotherapy is the use of drugs to treat cancer. Generally, chemotherapy drugs travel through the bloodstream and damage or destroy rapidly dividing cells such as cancer cells, while causing the least possible damage to healthy cells. Healthy fast-growing cells, such as your bone marrow, may also be affected, causing side effects.

However, it can be difficult to treat brain tumours with chemotherapy drugs because the body has a protection system called the blood-brain barrier. This guards the brain from substances circulating in the blood, such as germs or chemicals, that could harm it. Only certain drugs can get through this barrier.

You may be given chemotherapy by taking an oral capsule or through a drip inserted into your vein (intravenously). Each treatment session is usually followed by a rest period of a few weeks.

Some patients who have a craniotomy have small, dissolvable chemotherapy wafers inserted into their brain during surgery. The wafers release drugs into the brain over a couple of weeks. As the drug is placed directly at the tumour site, it doesn’t affect other areas of the body and so reduces the chance of side effects.

Chemotherapy is often combined with radiotherapy for the treatment of glioblastomas (grade 4 tumours). This combination improves outcomes, compared with radiotherapy alone.

Overview

Breast cancer occurs when the cells lining the breast ducts or lobules grow abnormally and out of control. A tumour can form in the ducts or lobules of the breast.

When the cells that look like breast cancer are still confined to the ducts or lobules of the breast, it is called pre-invasive breast cancer.

Most breast cancers are found when they are invasive. This means the cancer has spread outside the ducts or lobules of the breast into surrounding tissue.

Symptoms

You may notice a change in your breast or your doctor may find an unusual breast change during a clinical breast examination. Signs to look for include:

• a lump, lumpiness or thickening
• changes to the nipple – such as a change in shape, crusting, a sore or an ulcer, redness or a nipple that turns in (inverted) when it used to stick out
• changes to the skin of the breast – such as dimpling of the skin, unusual redness or other colour changes
• change in the shape or size of the breast – this might be either an increase or decrease in size
• unusual discharge from the nipple without squeezing
• swelling or discomfort in the armpit
• persistent, unusual pain – if this is not related to your normal monthly cycle, remains after a period and occurs in one breast only.

Diagnosis

Tests to diagnose breast cancer

Several tests are usually used to find out if your breast change is due to breast cancer.

Physical examination

Your doctor will feel your breasts and the lymph nodes under your arms. They will also take a full medical history and ask about your family history.

Mammogram

A mammogram is a low-dose x-ray of the breast tissue. This scan can find changes that are too small to be felt through a physical examination.

Your breast is pressed between two x-ray plates, which spread the breast tissue out so clear pictures can be taken. Both breasts are checked. Many women find this procedure uncomfortable, but it’s over in about 20 seconds.

Sometimes, the doctor will feel a lump that is not shown on a mammogram and other tests will need to be done.

Ultrasound

An ultrasound is a painless scan that uses soundwaves to create a picture of your body. A gel is spread on your breast and a small device called a transducer is moved over the area.

This sends out soundwaves that echo when they meet something dense, like an organ or tumour. A computer creates a picture from these echoes. The scan takes about 15-20 minutes.

Biopsy

Your doctor will suggest a biopsy if an abnormal or unusual area of tissue is found in your breast. During a biopsy, a small amount of tissue is removed from your breast. A pathologist examines the removed tissue and checks for cancer cells under a microscope. You may need to have more than one biopsy.

Treatment

Surgery

Surgery for breast cancer will involve one of the following:

• breast conserving surgery – removes part of the breast
• mastectomy – removes the whole breast.

In most cases, breast surgery also involves removing one or more lymph nodes from the armpit.

It can be difficult to decide which type of surgery to have. Some women do not want to have their whole breast removed. Research has shown that breast conserving surgery, with sentinel node biopsy followed by radiotherapy, is as effective as mastectomy for most women with early breast cancer.

The operations have different benefits, side effects and risks. Talk to your doctor or breast care nurse about the best option.

Removing lymph nodes

Lymph nodes (glands) are found throughout the body, including the armpit. They are small, bean-shaped collections of lymph cells that protect the body against disease and infection. The lymph nodes are part of the lymphatic system.

The lymph nodes in the armpit are often the first place breast cancer cells spread to outside the breast. To check if breast cancer has spread to the lymph nodes, they are removed. There are two ways of removing the lymph nodes.

Sentinel node biopsy

The sentinel node is the first lymph node that breast cancer cells may spread to outside the breast.
There can be more than one sentinel node. Usually it is in the armpit but it can also be found near the breast bone (sternum).

Removing only the sentinel node/s will cause fewer side effects than axillary surgery. A small amount of radioactive substance is injected around the cancer before surgery. A scan is taken to show which node the substance has travelled to. During surgery, a blue dye is injected around the cancer in your breast. The dye moves into the lymphatic vessels. The nodes that become blue or radioactive first are known as the sentinel nodes, and the surgeon will remove only those nodes so they can be tested for cancer cells.

If the sentinel nodes are clear of cancer cells, no further surgery is needed. If the sentinel nodes contain cancer cells, axillary surgery will be needed.

Axillary (lymph node) surgery

This may be done at the same time as your breast surgery or as a separate operation. The doctor will remove the least possible amount of your lymph nodes.

Lymph nodes are sent to a pathologist for examination. The pathologist will provide a report that shows how many nodes were removed and how many contain cancer cells. For instance, if 17 nodes were removed and four contained cancer cells, the report will read: 4/17.

Results help your doctor recommend further treatment.

Physical side effects

• Seroma – Fluid may collect in, or around, the scar in your breast or lymph nodes. The fluid may be drained using a fine needle and syringe. This can be done by the breast care nurse, your specialist or your GP.
• Shoulder stiffness – Exercises can help prevent or manage shoulder stiffness. A physiotherapist or occupational therapist can help.
• Numbness of the arm – Surgery may damage nerves, causing your arm, and perhaps shoulder, to feel numb. The numbness will improve but may not go away completely. Shoulder exercises will help improve movement.
• Lymphoedema – The arm may swell following lymph node surgery or sometime later.
• Fatigue – Feeling tired and having no energy may be a major problem. Treatment and the emotional impact of the diagnosis can be tiring. Your tiredness may continue for quite a while after treatment.
• Most side effects can be managed. Talk to your doctor about any side effects you experience.

Chemotherapy for breast cancer

Chemotherapy uses drugs to kill or slow the growth of cancer cells. Chemotherapy may be used:

• if the risk of the cancer returning is high, to try to prevent the breast cancer coming back or spreading to other parts of the body
• when cancer returns after surgery or radiotherapy, to gain control of the cancer and to relieve symptoms
• if the cancer doesn’t respond to hormone therapy.

There are several different types of chemotherapy drugs used to treat breast cancer. The drug combination you are given will depend on the type of breast cancer you have and what other treatments you are having. Common drugs include cyclophosphamide, docetaxel, doxorubicin, carboplatin and fluorouracil. Your medical team may also refer to the drugs by their brand (trade) names.

Chemotherapy is usually given through a vein (intravenously). You will have about 4-6 chemotherapy sessions every 2-3 weeks over several months. You usually will be treated as a day patient but occasionally an overnight stay may be recommended. The recovery time after each treatment session is called a cycle. This gives your body time to recover before the next session.

Radiotherapy for breast cancer

Radiotherapy uses high-energy x-rays to kill cancer cells or stop them growing.

This treatment is recommended after breast conserving surgery to help destroy any cancer cells left in the breast and reduce the risk of the cancer coming back. It is also occasionally given after a mastectomy.

Treatment is carefully planned to do as little harm as possible to your normal body tissues. Before you start treatment, you will have a planning session at the radiotherapy centre. During this visit, x-rays are taken to pinpoint the area to be treated and marks will be put on your skin so that the radiation oncologist treats the same area each time. These marks are small dots and may be temporary or permanent (tattoos).

Once treatment starts, you will probably have radiotherapy once a day from Monday to Friday for 5-6 weeks. Usually you can have outpatient treatment and go to the radiotherapy centre each day.

Each radiotherapy session will be in a treatment room. Although you will only get radiation for 1-5 minutes, you might be in the treatment room for 10-30 minutes. Most of the time is spent positioning you and the treatment machine.

You will lie on a table under the radiotherapy machine. The radiation therapist will leave the room then turn on the machine, but you can talk to staff through an intercom. Radiotherapy is not painful but you need to lie still while the treatment is given.

Side effects

Radiotherapy may cause the following side effects:

• Tiredness – You may feel tired or fatigued 1-2 weeks after radiotherapy starts and during treatment. This usually eases a few weeks after treatment finishes.
• Red and dry skin – The skin near the treatment site may become red and dry after a few weeks of treatment. The skin usually returns to normal 4-6 weeks after your treatment ends. Radiotherapy nurses will show you how to care for your skin.
• Inflammation and blistering – Less commonly, your skin may become very irritated. This will be closely monitored by the treatment team.

Radiotherapy to the breast does not cause hair loss. It also does not make you radioactive – it is safe to interact with your friends and family.

Side effects

The side effects caused by chemotherapy depend on the drugs used. Most side effects are temporary and steps can often be taken to prevent or reduce them.

Side effects may include feeling sick (nauseous), vomiting, tiredness, mouth ulcers or weight changes. Most people who have chemotherapy lose their head and body hair.

Some women’s periods become irregular or stop during chemotherapy but return to normal after treatment. For others, chemotherapy may cause periods to stop permanently (menopause).

Hormone therapy for breast cancer

Hormone therapy, also called endocrine therapy, is for people who have ER+ hormone receptors on their breast cancer cells. The aim of hormone therapy is to slow or stop the growth of hormone receptor positive cancer cells.

Ask your doctor if hormone therapy is suitable for you. This will depend on your age, the type of breast cancer you have and whether you have reached menopause.

Overview

Bowel cancer is cancer in any part of the large bowel (colon or rectum). It is sometimes also known as colorectal cancer.

Bowel cancer grows from the inner lining of the bowel (mucosa). It may develop from growths on the bowel wall called polyps. Polyps are usually harmless (benign), but they may become cancerous (malignant) over time. Malignant polyps may be small or large, flat or mushroom-shaped.

If untreated, bowel cancer can grow locally into the deeper layers of the bowel wall. It can spread from there to the lymph nodes (glands). These small, bean-shaped masses are part of the body’s lymphatic system. If the cancer advances further, it can spread to other organs, such as the liver or lungs (metastasis).

In most cases, it develops fairly slowly and stays in the bowel for months or years before spreading.

Symptoms

In its early stages, bowel cancer often has no symptoms. However, some people may experience the following:

• a change in bowel habits, such as diarrhoea, constipation, or smaller, more frequent bowel movements
• a change in appearance of bowel movements (e.g. narrower stools or mucus in stools)
• a feeling of fullness or bloating in the bowel or rectum
• a feeling that the bowel hasn’t emptied completely after a bowel movement
• blood in the stools or on the toilet paper
• unexplained weight loss
• weakness or fatigue
• rectal or anal pain
• a lump in the rectum or anus
• abdominal pain or swelling
• a low red blood cell count (anaemia), which can cause tiredness and weakness.

Not everyone who has these symptoms has bowel cancer. Other medical conditions, such as haemorrhoids or tears in anal tissue, and some foods or medications, can also cause these changes.

If you have any of the above symptoms for more than two weeks, see your doctor for a check-up.

Diagnosis

Your GP will examine you and refer you to a specialist for further tests. The tests you have depend on your specific situation and may include:

• general tests to check your overall health and body function
• tests to find cancer
• tests to see if the cancer has spread (metastasised).

Some tests may be repeated during or after treatment to check how well the treatment is working.

Treatment

Radiotherapy for bowel cancer

Radiotherapy uses high-energy x-rays or electron beams (radiation) to kill or damage cancer cells. The radiation is targeted to cancer sites in your body, and treatment is carefully planned to do as little harm as possible to your normal body tissue around the cancer.

Radiotherapy is often part of the treatment for rectal cancer. It can also be given:

• before or after surgery, to reduce the chance of the cancer coming back
• instead of surgery
• at the same time as chemotherapy (chemoradiation)
• as a palliative treatment.

During treatment, you will lie under a machine that delivers x-ray beams to the treatment area. Each treatment only takes a few minutes once it has started, but setting up the machine and seeing the radiation oncologist may take more time.

If radiotherapy is given along with chemotherapy for rectal cancer, you will probably have it once a day, Monday to Friday, for about 5–7 weeks. You may have a shorter course of radiotherapy if it is given by itself. The number of treatments you have depends on your radiation oncologist’s recommendation.

Side effects

Radiotherapy can cause temporary and permanent side effects. Side effects of radiotherapy may include:

• bleeding
• diarrhoea
• nausea
• tiredness or fatigue
• mild headaches
• urinary or faecal incontinence
• redness and soreness in the treatment area
• reduced fertility.

People react to treatment differently, so some people may have few side effects while others have many. Tell your treatment team about the side effects you have so they can give you advice about how to manage them.

Chemotherapy for bowel cancer

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells. If the cancer is contained inside the bowel, surgery is usually the only treatment needed and chemotherapy is not used.

Chemotherapy may be used for the following reasons:

• Neo-adjuvant therapy – Some people who have surgery have chemotherapy (and/or radiotherapy) beforehand to shrink the tumour and make it easier to remove during surgery.
• Adjuvant chemotherapy – Chemotherapy is often recommended for people after surgery if the cancer hasn’t been completely removed or if it has spread into the lymph nodes. Chemotherapy may be given if there is a chance the cancer could come back, or as treatment if the cancer does come back.
• Palliative treatment – If the cancer has spread to other organs, such as the liver or bones, chemotherapy may be used to reduce your symptoms and make you more comfortable.

If you have chemotherapy after surgery, you will probably have 6–8 weeks to recover. You will start chemotherapy when your wounds are healed and you are strong enough.

Chemotherapy drugs are usually injected into a vein (given intravenously) or supplied in tablet form. Some people have a small medical appliance called a port-a-cath or catheter placed beneath their skin through which they receive chemotherapy. You will probably have sessions of chemotherapy over several weeks or months. Your medical team will work out your treatment schedule.Your doctor may advise you to use contraception during chemotherapy, due to the effects of the drugs.

Side effects

Some chemotherapy drugs can cause side effects. The side effects depend on the drugs used and the dosage levels. The most common side effects include:

• tiredness
• feeling sick (nausea)
• diarrhoea
• mouth sores and ulcers
• loss of appetite
• sore hands or feet
• a drop in levels of blood cells
• skin peeling and increased sensitivity to sunlight, particularly for people who are given a type of chemotherapy
• called fluorouracil (or 5FU).

People react to treatment differently – some people may have few side effects while others have many. Most side effects are temporary, and there are ways to prevent or reduce them. Your doctor may prescribe medication to manage the side effects, arrange a break in your treatment, or change your treatment.

Surgery for rectal and anal cancers

There are different types of surgery for bowel cancer. The aim of surgery is to remove all the cancer and nearby lymph nodes.

Overview

Cervical cancer is a malignant tumour in the tissues of the cervix. It most commonly begins in an area called the transformation zone, which is where two types of cells meet.

At diagnosis, the cancer is often within the cervix, but it may have spread to tissues around the cervix (e.g. the vagina) or to other parts of the body.

Symptoms

The early stages of cervical cancer usually have no symptoms. The only way to know if there are abnormal cells in the cervix, which may develop into cervical cancer, is to have a Pap smear.

If symptoms are present, they usually include:

• vaginal bleeding between periods, after menopause or after intercourse
• pain during intercourse
• unusual vaginal discharge
• excessive tiredness
• leg pain or swelling
• lower back pain.

Diagnosis

Your cancer may have been diagnosed following investigations for an abnormal pap smear or following investigations into abnormal bleeding or other symptoms. Further tests are required to determine the stage of the cancer.

• CT scan
• MRI
• PET scan
• Examination under anaesthetic

Treatment

Surgery

Surgery is common for small tumours found only within the cervix. The extent of the cancer in the cervix will determine the type of surgery needed:

• Cone biopsy
• Hysterectomy
• Trachelectomy

Unless your cervical cancer is a very early stage you will require a pelvic lymphadenectomy which is the removal of lymph nodes in the pelvis This may cause leg swelling (lymphoedema) particularly if surgery occurs in combination with radiotherapy. For this reason investigations such as PET and MRI scan are carried out to assess whether the lymph nodes have cancer in them. If the lymph nodes appear to be affected chemoradiation will be given even for early cancers and surgery will not be required.
Radiotherapy for cervical cancer

Your doctor will advise you on the best treatment for the cancer. This will depend on the results of your tests, the location of the cancer and whether it has spread, your age and general health.

The most common treatments for cervical cancer are surgery or a combination of chemotherapy and radiotherapy.

Radiotherapy uses x-rays to kill cancer cells or injure them so they cannot multiply. The radiation is targeted at cancer sites and treatment is carefully planned to do as little harm as possible to the healthy body tissues.

Radiotherapy is usually given if you are not well enough for a major operation or if the cancer has spread into the tissues or lymph nodes surrounding the cervix. It may also be used after surgery or in combination with chemotherapy.

Side effects

The side effects of chemotherapy vary according to the drugs used. You may experience nausea or vomiting, feel tired, or lose some hair from your body or head. Some women’s periods stop for a while and they may experience premature menopause.

While you’re having treatment, the chemotherapy may also reduce the number of blood cells in your body. Depending on the type of blood cells affected, you may feel very tired and be more prone to infections such as colds and flu.

Most side effects are temporary and there are ways to prevent or reduce them. Tell your medical team if you experience side effects.

Overview

Ovarian cancer is a malignant tumour in one or both ovaries. Some cases of ovarian cancer may form in the fallopian tube and spread to the ovary.

Types of ovarian cancer

There are many types of ovarian cancer. The three most common types are:

Epithelial ovarian cancers

The majority of women with ovarian cancer have cancer that starts in the surface of the ovary (epithelium). Types of epithelial ovarian cancer include serous, clear cell, endometrioid and mucinous cancers.

Germ cell ovarian cancers

About 4% of women have these rare types of cancer, which start in the egg-producing cells. Germ cell cancers usually affect women aged around 35.

Sex-cord stromal cancers

Rare tumours may develop in the cells that produce female hormones. These cancers can occur at any age, and may produce extra hormones, such as oestrogen. They generally respond very well to treatment.

Some women (usually younger women) are diagnosed with a borderline tumour. This is not considered to be cancer because, although it can spread, it does not invade other organs. For this reason borderline tumours are called low malignant potential tumours and usually have a good prognosis.

Symptoms

Ovarian cancer may not cause any symptoms in its early stages, or it may cause only vague ones that are hard to recognise. If symptoms occur, they may include:

• a swollen, bloated abdomen
• pressure, discomfort or pain in the abdomen or pelvis
• heartburn and nausea
• changes in toilet habits (e.g. constipation, diarrhoea, frequent urination due to pressure, increased flatulence)
• tiredness and loss of appetite
• unexplained weight loss or weight gain
• changes in your menstrual pattern or postmenopausal bleeding
• or pain during sex.

If these symptoms are new for you or continue over a four-week period, make an appointment with your general practitioner (GP). Having these symptoms does not necessarily mean you have cancer, but it is best to have a check-up

Diagnosis

Most ovarian cancer tumours are present for some time before they are discovered. Sometimes ovarian cancer is found unexpectedly during an operation such as a hysterectomy.

The Pap test does not detect ovarian cancer, but it may show if cancer cells have spread to the cervix.

• Physical Examination
• Blood tests
• Imaging scans

Treatment

Surgery

Treatment for ovarian cancer depends on what type of cancer you have, the stage, your general health and fitness, your doctors’ recommendations and your wishes.

• Epithelial ovarian cancer is commonly treated with surgery, chemotherapy and/or radiotherapy.
• Borderline tumours are usually treated with surgery.
• Non-epithelial ovarian cancer is usually treated with surgery and/or chemotherapy.

Your gynaecological oncologist will talk to you about the most appropriate type of surgery. An exploratory laparotomy is usually recommended if ovarian cancer is suspected. In this operation, the doctor makes a long, vertical cut from your bellybutton to your pubic bone hairline while you are under a general anaesthetic.

The surgeon will take tissue (biopsy) and fluid samples from the abdomen. While still in theatre, the tissue samples are sent to a specialist called a pathologist who examines them for signs of cancer. This is called a frozen section analysis. If the pathologist confirms that cancer is present, the surgeon will continue the operation.

If there is obvious spread of cancer, the surgeon will remove as much of the cancer as is possible. This is called surgical debulking. Surgical debulking allows chemotherapy treatment to be more effective.

Radiotherapy

Radiotherapy uses x-rays to kill or damage cancer cells and reduce their activity. It is used less often than chemotherapy. The main use for radiotherapy is to ease symptoms or problems which are not responding to chemotherapy or when chemotherapy can no longer be given.

If the cancer has spread, you will usually receive radiotherapy to the pelvis, or other parts of your body.

During radiotherapy you will be in a room and lie on an examination couch or table. A radiotherapy machine will be moved around you depending on the body part being treated. The radiation therapist will position you and the machine and then leave the room during treatment.

You will not feel anything during treatment, which will only take a few minutes each time. You may be in the room for a total of about 10–20 minutes for each appointment.

The number of radiotherapy sessions you have will depend on the type and size of the cancer. You may have treatment for a week or daily outpatient treatment for several weeks. Your doctor will explain the treatment schedule and the possible side effects.
Side effects

The side effects of radiotherapy depend on the strength of the dose and the part of your body that is treated. You may experience the following:

• fatigue and tiredness
• diarrhoea
• increased urination and stinging when emptying your bladder
• slight burn to the skin around the treatment site.

Chemotherapy

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim is to destroy cancer cells while causing the least possible damage to normal, healthy cells.

Although surgery may have removed most of the ovarian cancer, there may still be some cancer cells in the body. For this reason, chemotherapy is usually given soon after an operation.

Women with early stage epithelial ovarian cancer or borderline tumours may not need chemotherapy.

Women with epithelial ovarian cancer that has spread outside the ovaries usually receive a combination of two chemotherapy drugs. However, a single chemotherapy drug may be prescribed for frail or elderly women, or if there are other particular medical concerns.

Chemotherapy is usually given through an intravenous drip. Some people have a small medical appliance called a port-a-cath or catheter placed beneath their skin through which they receive chemotherapy.

Current standard treatment after surgery (adjuvant chemotherapy) is six treatments, given every 3–4 weeks over 5–6 months. Each chemotherapy treatment is called a cycle. However, some centres give chemotherapy in weekly doses and treatment varies for different women. Ask your doctor about the treatment plan recommended for you.

Overview

Cancer of the uterus (also called uterine cancer) is a cancer of the female reproductive system. It begins from abnormal cells in the lining of the uterus (endometrium) or the muscle tissue of the uterus (myometrium).
Symptoms

• abnormal vaginal discharge or bleeding, particularly after menopause (can appear watery or bloody, and may be smelly)
• discomfort or pain in the abdomen
• difficult or painful urination
• pain during sex.

Diagnosis

• Physical examination
• Transvaginal ultrasound
• CT, MRI and PET scans

Treatment

Your doctor will advise you on the best treatment for the cancer. This will depend on the results of your tests, where the cancer is, if it has spread, your age and your general health.

The main treatment for cancer of the uterus is surgery because it is often diagnosed at an early stage before it has spread. This means that for many women, surgery will be the only treatment they need.

If the cancer has spread beyond the uterus, radiotherapy, hormone treatment or chemotherapy may also be used.

Radiotherapy for cancer of the uterus

Radiotherapy uses x-rays to kill cancer cells or injure them so they cannot multiply. The radiation can be targeted at cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your healthy body tissues.

Radiotherapy may be recommended if you are not well enough for a major operation. It is also commonly used as an additional treatment to reduce the chance of the disease coming back. This is called adjuvant therapy.

Chemotherapy for cancer of the uterus

Chemotherapy is the use of cytotoxic drugs, which kill or slow the growth of cancer cells. The aim is to destroy cancer cells while causing the least possible damage to healthy cells. Chemotherapy may be used:

• for certain types of uterine cancer, such as serous carcinoma
• when cancer comes back after surgery or radiotherapy, to gain control of the cancer and to relieve symptoms
• if the cancer does not respond to hormone treatment
• if the cancer has spread beyond the uterus at the time of diagnosis.

Chemotherapy is usually given by injecting the drugs into a vein (intravenously). You may need to stay in the hospital overnight or you may be treated as an outpatient. You will have a number of treatments, sometimes up to six, every 3–4 weeks over several months. Your doctor will talk to you about how long your treatment will last.

Overview

Acute leukaemia appears suddenly and develops quickly. It occurs when immature white blood cells (blast cells) grow out of control and continue to divide but never mature into normal cells.

The abnormal blast cells are known as leukaemia cells. Because they are immature and abnormal, leukaemia cells do not carry out the usual function of white blood cells. They also crowd out the normal white blood cells, which leads to an increased risk of infections.

When the bone marrow fills with leukaemia cells, there is little room for healthy red cells and platelets to be produced. This causes a variety of health problems.

What types are there?

There are two types of acute leukaemia, depending on what type of white blood cell is involved:

• acute lymphoblastic leukaemia (ALL)
• acute myeloid leukaemia (AML).

ALL is a leukaemia involving lymphoid blast cells, which are known as lymphoblasts. ALL is also sometimes called acute lymphatic leukaemia.

AML is a leukaemia involving myeloid blast cells, also called myeloblasts.

Other types of leukaemia

There are several different types of leukaemia. All leukaemias start in the bone marrow and affect white blood cell production. They are grouped depending on how quickly the disease develops and which type of white blood cell is affected (lymphoid or myeloid).

• Acute leukaemia – affects immature blood cells, occurs suddenly and develops quickly.
• Chronic leukaemia – usually affects older cells, appears gradually and develops slowly over months to years.

Symptoms

The main symptoms are caused by the continually increasing number of leukaemia cells in the bone marrow, which reduces the number of normal blood cells.

The main signs include:

• Anaemia: The lack of red blood cells can cause paleness, weakness and breathlessness.
• Repeated or persistent infections: The lack of normal white blood cells can cause sore mouth and throat, fevers, frequent passing of urine with irritation, boils and infected cuts.
• Increased bruising and bleeding: The lack of platelets can cause easy bruising, frequent nosebleeds or bleeding gums, and heavy periods in women.

Diagnosis

An initial blood test will show if leukaemia cells are present or if the levels of blood cells are different to those of a healthy person. Other tests will confirm a diagnosis and will determine what type of leukaemia you have.

• Bone Marrow biopsy
• Chest x-ray and other imaging
• Lumbar puncture

Treatment

Treatment usually begins as soon as you have been diagnosed and will depend on what type of acute leukaemia you have.

• You will probably have chemotherapy and radiotherapy.
• You may have steroid therapy.
• You may have a peripheral blood stem cell or bone marrow transplantation.
• In cases of advanced cancer, you may have palliative care

Radiotherapy for acute leukaemia

Uses x-rays to destroy cancer cells or injure them so they cannot multiply. It is used for people with acute lymphoblastic leukaemia and, less commonly, acute myeloid leukaemia. It is usually directed at the brain and spine. It is sometimes given to the whole body in preparation for a transplant. Your radiation oncologist and haematologist will discuss the type of radiotherapy and the number of treatments you need.

Chemotherapy for acute leukaemia

Chemotherapy uses anti-cancer drugs to kill cancer cells while doing the least possible damage to healthy cells.

It is usually given by injection into a vein (intravenously). Sometimes it is given in tablet form or as an injection into the spine during a lumbar puncture.

Chemotherapy for acute leukaemia is given in two or three stages: induction, consolidation and maintenance. Only people with acute lymphoblastic leukaemia and a rare type of acute myeloid leukaemia are given maintenance treatment.

Overview

Head and neck cancer occurs when malignant tumours grow in any of the tissue in the head or neck. Not all tumours in the head and neck are malignant, but benign and malignant tumours are treated in a similar way.

• Mouth or oral cancer – includes cancer that starts anywhere in the mouth, such as the lips, inside cheeks, the front two-thirds of the tongue and the gums.
• Salivary gland cancer – can occur in any of the paired major glands in front of the ears or beneath the jaw or tongue.
• Pharyngeal cancer – cancers in the pharynx (throat): nasopharyngeal, oropharyngeal and hypopharyngeal cancers.
• Laryngeal cancer – starts in the larynx (voice box).
• Nasal cancer or paranasal sinus cancer – includes cancers starting in the nose, nasal cavity or the sinuses.

Symptoms

Oral Cancer

• a white patch on your gums, tongue or lining of your mouth
• a red patch on your gums, tongue or lining of your mouth
• a change in your speech or difficulty pronouncing words
• difficulty swallowing food, or food that gets ‘stuck’
• a lump in the neck
• loose teeth or dentures that no longer fit well

Pharyngeal cancer symptoms

• throat pain
• a persistent sore throat or cough
• coughing up bloody phlegm
• difficulty swallowing
• a change in the sound of your voice, or hoarseness
• a feeling that your air supply is blocked
• dull pain around your breastbone
• a lump in the neck
• an earache

Laryngeal cancer symptoms

• swelling in the neck or throat
• a change in the sound of your voice, or hoarseness
• a lump in the neck
• difficulty swallowing
• a persistent sore throat

Nasal and para nasal symptoms

• a persistent blocked nose, particularly in one nostril
• a decreased sense of smell
• nosebleeds
• mucus drainage in the back of your nose or throat
• frequent headaches or a feeling of sinus pressure
• a bulging or watery eye
• complete or partial loss of your eyesight
• double vision
• a lump on your face, or in your nose or mouth
• loose or painful teeth
• pressure or pain in your ears

Diagnosis

If you have symptoms that could be due to a head or neck cancer, your general practitioner (GP) can do initial tests but will then refer you to a specialist for further tests. Depending on your symptoms, you may have one or more of the following tests, which include physical and visual examinations, tissue sampling (biopsy) and imaging tests. You will probably also have blood tests.

Surgery for head and neck cancers

The aim of surgery is to remove cancerous tissue and preserve the functions of the head and neck, such as breathing, swallowing and speech, as much as possible. There are different ways surgeons can operate.

The surgeons may only need to cut out a small area, which will include an area of healthy tissue around the tumour called a margin. If the operation is small, the healing is usually fast, with few long-term side effects.

For more advanced cancer, an operation will be more extensive and will cause longer-lasting or permanent side effects.

Your doctors will discuss whether surgery is an option for you, and the best type of operation for you.

Radiotherapy for head and neck cancers

Radiotherapy is the use of high-energy x-rays or electrons to kill or damage cancer cells so they can no longer grow and multiply. It can be used alone or with other treatment. Radiotherapy can be given in different ways, either externally or internally.

Before radiotherapy begins, the staff will see you to plan the treatment. You will have scans and you may need to be fitted for a mask to wear so that the same location is treated at each session. You will wear the mask for up to an hour in the planning session, but only for 5-40 minutes during treatment, depending on the location of the cancer. You can see and breathe through the mask.

Chemotherapy for head and neck cancers

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs and newer “˜targeted’ agents. The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells. It can be given for different reasons:

• It is often used with radiotherapy – this is called chemoradiation, where the drug increases the effects of the radiotherapy.
• It may be given to try to shrink a tumour before surgery or radiotherapy. This is called neoadjuvant chemotherapy.
• Chemotherapy can be given after surgery, along with radiotherapy, to reduce the chances of the cancer coming back.
• It can also be given as a palliative treatment for symptom management. This aims to reduce pain or discomfort by stopping the cancer from growing and pressing on nerves and other tissue. See the next page for more information.

You will probably receive chemotherapy by injection into a vein (intravenously) at treatment sessions over several weeks.

Overview

Thyroid cancer occurs when the cells of the thyroid gland grow and divide in a disorderly way.

The four main types are:

• Papillary thyroid cancer
• Follicular thyroid cancer
• Medullary thyroid cancer
• Anaplastic thyroid cancer

Symptoms

Thyroid cancer usually develops slowly, without many obvious signs or symptoms. However, some people experience one or more of the following:

• a painless lump in the neck or throat, which may gradually get bigger
• difficulty swallowing or breathing
• a hoarse voice
• swollen lymph glands in the neck, which may slowly grow in size over months or years
• gastrointestinal changes, such as diarrhoea and constipation.

Having a painless lump in the neck is the most common sign. However, thyroid lumps, known as nodules, are relatively common and most are benign. In about 90% of cases, a thyroid nodule is a symptom of a goitre (a benign enlarged thyroid gland) or another condition affecting the head or neck.

Diagnosis

• Blood test
• Ultrasound
• Biopsy
• Radioisotope scan
• CT scan
• MRI scan
• PET scan

Treatment

The type of treatment you have depends on:

• the type of cancer you have
• the stage of the cancer
• recommendations of your medical team
• what you want.

Surgery for thyroid cancer

Treatment for thyroid cancer usually includes surgery, thyroid hormone replacement therapy and radioactive iodine treatment. Some people also need external radiotherapy or chemotherapy. Most people receive a combination of treatments.

Surgery is the most common treatment for thyroid cancer.

External radiotherapy for thyroid cancer

External radiotherapy is the use of high-energy x-rays or electron beams to kill or damage cancer cells.

Radiotherapy may be given after surgery, or as an additional treatment to radioactive iodine treatment if the cancer has spread to lymph nodes in the neck. It is commonly used to treat medullary or anaplastic thyroid cancer because radioactive iodine treatment is usually less effective for these types of cancers.

You will not be radioactive after external radiotherapy treatment, so it is safe to be with other people.

Before the treatment starts, you will have a planning (simulation) session. Your doctor will take CT scans to determine the precise area to be treated, and may make small marks or tattoos on your skin. This ensures the same part of your body is targeted during each treatment session.

You may be fitted for a mask to wear during treatment. This will help make sure that you don’t move and the radiation beams always treat the correct areas of your neck.

Radiotherapy is usually given five days a week over several weeks. Treatment sessions usually take about 10 minutes. During this time, you will be able to see and breathe through the mask. Let your doctor know if you are afraid of confined spaces (claustrophobic).

Chemotherapy for thyroid cancer

Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. It is sometimes used to treat advanced thyroid cancer that is not responding to radioactive iodine treatment.

The drugs are usually given by injection into a vein (intravenously). You will probably have several treatment sessions over a few weeks – your medical team will determine the schedule.

Overview

Lung cancer is a malignant tumour in the tissue of one or both lungs. There are several types of lung cancer, which are classified according to the type of cell affected: non-small cell lung cancer; small cell lung cancer; and mesothelioma.

Symptoms

The main symptoms of lung cancer are:

• a new dry cough or change in a chronic cough
• chest pain or breathlessness
• repeated bouts of pneumonia or bronchitis
• coughing or spitting up blood.

Lung cancer is often discovered when it is advanced. A person may have experienced symptoms such as fatigue, weight loss, hoarseness or wheezing, difficulty swallowing, or abdominal and joint pain.

Having any one of these symptoms does not necessarily mean that you have cancer. Some of these symptoms may be caused by other conditions or by the side effects of smoking. Talk to your doctor to have your symptoms checked.

Lung cancer is sometimes detected during routine tests for other problems and if so is more likely to be in an early stage
of development.

Diagnosis

If lung cancer is suspected, a number of tests will be done to help make a diagnosis.

• Imaging tests
• Tissue sampling tests

Treatment

Surgery for lung cancer

Surgical removal of a tumour offers the best chance of a cure for patients who have early-stage cancer. The surgeon, who is part of the multidisciplinary team, will determine if the cancer is confined to your lung, assess your general wellbeing and fitness for an operation, and assess your breathing capacity.

Patients must cease smoking for a minimum of four weeks before any surgery will be performed.

Radiotherapy for lung cancer

Radiotherapy treats cancer by using x-ray beams to kill cancer cells. Radiotherapy is offered when lung cancer cannot be managed by surgery and has not spread outside the chest. Radiotherapy can also be used to treat cancer that has spread to the lymph nodes. This may stop the cancer from spreading further or from returning later. It is often given together with chemotherapy if the intention is to cure the cancer.

It can also be used:

• to treat an early stage small peripheral (on the outer portions of the lung rather than deep inside) lung cancer,
• where the patient is not fit for an operation or cannot abstain from smoking
• after surgery to treat sites where lymph nodes were taken as an attempt to reduce the chances of the cancer coming back
• to treat cancer that has spread to other organs such as the brain or bones
• as palliative treatment, to reduce symptoms, improve your quality of life or extend your life.

Chemotherapy for lung cancer

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells.

Chemotherapy is commonly given to patients whose cancer is large or has spread outside the lungs. It may be given:

• before surgery, to try to shrink the cancer and make the operation easier
• before radiotherapy or during radiotherapy (chemoradiation), to increase the chance of the radiotherapy working
• after surgery, to reduce the chances of the cancer coming back
• as palliative treatment, to reduce symptoms, improve your quality of life or extend your life.

Generally, chemotherapy is administered intravenously through a drip or a plastic catheter (tube) inserted into a vein in your arm, hand or chest. Some types of chemotherapy are given orally (that is in tablet form).

Chemotherapy is given in cycles that typically last three weeks each. Intravenous chemotherapy may be given for a few days. The rest of the time is a break from treatment. The number of treatments you have will depend on the type of lung cancer you have and how well your body is handling the side effects.

Overview

Pancreatic cancer occurs when malignant cells develop in a part of the pancreas. This may affect the normal functioning of the pancreas, including the way the exocrine or endocrine glands work.

About 70% of pancreatic cancers are located in the head of the pancreas. This can block the common bile duct, which will decrease the flow of bile and cause a build-up of bile pigment in the blood. This is known as jaundice.

Symptoms

Early stages of pancreatic cancer rarely cause symptoms. Symptoms also may be unnoticed until the cancer is large enough to affect nearby organs.

Symptoms of pancreatic cancer may include:

• indigestion
• appetite loss
• feeling sick (nausea)
• vomiting
• weight loss
• pain in the upper abdomen, side or back, which may cause you to wake up at night
• changed bowel motions – either diarrhoea, severe constipation, or stools that are pale and hard to flush away
• jaundice, which causes yellowish skin and eyes, dark urine, pale stools and itchiness
• onset of diabetes within the last two years, or worsening of existing diabetes – in up to 50% of people with pancreatic cancer, the cancer stops the pancreas from making insulin properly
• for PNETs, too much sugar in the blood (hyperglycaemia)
• for PNETs, blurred vision.

Symptoms of pancreatic cancer are also common to other conditions. See your doctor if you experience any of these symptoms.

Diagnosis

To confirm the diagnosis of pancreatic cancer, your doctor will take a full medical history and you will have several tests. Some tests will help the doctor determine if cancer has spread to other parts of your body. This is called staging.

• Blood tests
• Ultrasound
• CT (computerised tomography) scan
• MRI and MRCP scans
• Endoscopy
• Endoscopic ultrasound
• Scintigraphy

Treatment

Although research has improved outcomes for many people, pancreatic cancer can be difficult to treat. Surgery in combination with chemotherapy, and possibly radiotherapy, is the most effective treatment.

The type of treatment you have will depend on:

• the stage of the tumour (the site, size and if it has spread)
• your general health
• your preferences.

Types of Surgery

• Surgery to remove the tumour
• Surgical removal of the tumour (resection) is the most suitable treatment for people who have early-stage disease and who are in reasonably good health, and can cope physically with a major operation.
• Surgery to relieve symptoms

Surgery may also be used to relieve symptoms, such as intestinal (bowel) obstruction or jaundice. Jaundice is a condition in which the skin and the eyes turn a yellow colour as bile builds up in the blood.

Radiotherapy

Radiotherapy treats cancer by using x-rays to kill cancer cells or injure them so they cannot multiply. These x-rays can be targeted at cancer sites in your body.

Radiotherapy may be used:

• to shrink the tumour before removing it with surgery
• to destroy any cancer cells that may remain after surgery
• to relieve symptoms such as pain by shrinking the tumour, which may be pushing on a nerve or another organ
• together with chemotherapy to treat tumours that cannot be operated on.

Treatment is usually given Monday to Friday, for up to five weeks. It is painless and each session takes a few minutes. Treatment is planned to do as little harm as possible to your normal body tissues.

Overview

Prostate cancer develops when abnormal cells in the prostate gland grow more quickly than in a normal prostate, forming a malignant tumour.

Most prostate cancers grow slower than other types of cancer.

Early (or localised) prostate cancer means cancer cells have grown, but they have not spread beyond the prostate. Some prostate cancers may spread to other parts of the body, such as the bones and lymph nodes. This is called advanced prostate cancer.

Symptoms

Early prostate cancer rarely causes symptoms. This is because the cancer usually grows in the outer part of the gland and is not large enough to put pressure on the urethra. If the cancer grows and spreads beyond the prostate (advanced or metastatic cancer), it may cause:

• pain or burning when urinating
• increased frequency or difficulty urinating
• blood in the urine or semen
• pain in the lower back, hips or upper thighs
• weight loss.

These symptoms are common to other conditions, including benign prostate enlargement, and may not be a sign of advanced prostate cancer. If you are concerned and/or are experiencing any of these symptoms, speak to your doctor.

Treatment

External radiotherapy for prostate cancer

External beam radiotherapy uses high-energy x-rays to kill cancer cells or injure them so they cannot multiply. Radiotherapy is usually considered if you have early cancer and are otherwise in good general health. It may be used instead of surgery or in combination with surgery.

Before your treatment session, a radiotherapy technician will set up the machine. You may see the radiation oncologist and have blood tests. Preparation usually takes about 1 hour. During the treatment session, you will lie on an examination table under the machine that aims at your prostate. Treatment is painless and each session usually takes about 15 minutes.

Treatment is planned to ensure as little harm as possible to the normal tissue and organs surrounding the prostate. Modern machines are more accurate and can limit radiation exposure to surrounding healthy tissue. Usually, you will have radiotherapy treatment every week day for up to eight weeks. Some newer machines have shortened treatments to five sessions.

You can have radiotherapy as an outpatient and go to the treatment centre or hospital each day for your treatment session. Many men continue to work during the course of radiotherapy.

Side effects of radiotherapy

You may have some of the following side effects. Other side effects such as tiredness, bowel and bladder problems are becoming less common due to machines that are better at targeting the tumour.

• Erectile dysfunction (impotence) – Problems with erections are common after external radiotherapy in about 50% of men because of damage to the blood vessels needed for erections. Problems may not occur immediately, but may develop over time and be ongoing.
• Tiredness – When your body has to cope with the effects of radiation on normal cells, it becomes fatigued. Your weariness may build up slowly during treatment, it should go away when treatment is over but can last for up to about six months.
• Urinary problems – You may experience burning when urinating, or an increased urgency to urinate. These side effects usually go away after treatment, but your doctor can prescribe medication to reduce any discomfort you experience. Injury to the lining of the bladder can sometimes cause bleeding. This is called radiation cystitis. Radiation is unlikely to cause incontinence but it can cause a build-up of scar tissue that makes it difficult to urinate. It is important to report any problems to your doctor.
• Bowel problems – Some men may bleed when passing a bowel motion. This is caused by damage to the fine blood vessels in the lower bowel. It is important to let your doctor know if you experience rectal bleeding. A few men may have diarrhoea or difficulty holding on to their bowel motions. These problems are usually temporary, but see your doctor if they continue to check there isn’t another medical problem.

Radical prostatectomy

Your doctor may suggest surgery if you have early prostate cancer, are fit enough for surgery and expect to live longer than 10 years. The procedure is called a radical prostatectomy, which is the removal of the prostate gland, part of the urethra and the seminal vesicles, glands located close by that store semen. For more aggressive cancer, the adjacent lymph glands may also be removed (pelvic lymph node dissection).

Radical prostatectomy may be performed using different surgery techniques (open, laparoscopic or robotic-assisted). Whichever approach is used, a radical prostatectomy is major surgery. Men usually return to normal activities within 2–6 weeks.

Androgen deprivation therapy

Prostate cancer needs the male hormone testosterone to grow. Slowing the production of testosterone may slow the growth of the cancer or shrink it. This is called androgen deprivation therapy (ADT) or hormone therapy.

ADT is normally used when the prostate cancer cells have spread beyond the prostate. It will not cure the cancer but can keep it under control for many months or years. It can also help with symptoms such as pain caused by the cancer spreading, and make the symptoms of cancer temporarily reduce or disappear (temporary remission).

The timing of ADT may vary. It may be given before radiotherapy or together with radiotherapy and may be continued after radiotherapy to increase the effectiveness of treatment.