21st Century Adult Cancer Sourcebook: Melanoma (Skin Cancer) - Clinical Data for Patients, Families, and Physicians
Edition 1.0 - October 2011
National Cancer Institute
Smashwords Edition
Copyright 2011 Progressive Management
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American Cancer Society (ACS) * http://www.cancer.org/
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PART ONE
Chapter 1A: Melanoma (Skin Cancer) Patient Information
Chapter 2A: Melanoma (Skin Cancer) Health Professional Information
Chapter 3A: Melanoma (Skin Cancer) NCI Drugs
Chapter 4A: Melanoma (Skin Cancer) Background Information
Chapter 5A: Melanoma (Skin Cancer) Clinical Trials
PART TWO
Chapter 1B: Levels of Evidence for Adult and Pediatric Cancer Treatment Studies (NCI)
Chapter 2B: Glossary of Clinical Trial Terms
Chapter 3B: Clinical Trials Background Information
Chapter 4B: Cancer Clinical Trials -The Basic Workbook
Chapter 5B: Cancer Clinical Trials - The In-Depth Program
Chapter 6B: Clinical Trials at NIH
Chapter 7B: How To Find A Cancer Treatment Trial: A Ten Step Guide
Chapter 8B: Taking Part in Cancer Treatment Research Studies
Chapter 9B: Cancer Clinical Trials
Chapter 10B: Access to Investigational Drugs
Chapter 12B: Taking Time: Support for People with Cancer
Chapter 13B: Facing Forward - Life After Cancer Treatment
Chapter 14B: Chemotherapy and You
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PART ONE
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Chapter 1A: Melanoma (Skin Cancer) Patient Information
Patient Version
Last Modified: 12/01/2010
General Information About Melanoma
Key Points for This Section
* Melanoma is a disease in which malignant (cancer) cells form in the skin cells called melanocytes (cells that color the skin).
* Melanoma can occur anywhere on the body.
* Unusual moles, exposure to sunlight, and health history can affect the risk of developing melanoma.
* Possible signs of melanoma include a change in the appearance of a mole or pigmented area.
* Tests that examine the skin are used to detect (find) and diagnose melanoma.
* Certain factors affect prognosis (chance of recovery) and treatment options.
Melanoma is a disease in which malignant (cancer) cells form in the skin cells called melanocytes (cells that color the skin).
Melanocytes are found throughout the lower part of the epidermis. They make melanin, the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment, causing the skin to tan, or darken.
Melanocytes are in the layer of basal cells at the deepest part of the epidermis.
The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. The skin has 2 main layers: the epidermis (upper or outer layer) and the dermis (lower or inner layer).
When melanoma starts in the skin, the disease is called cutaneous melanoma. This is about cutaneous (skin) melanoma. Melanoma may also occur in the eye and is called intraocular or ocular melanoma.
There are 3 types of skin cancer:
* Melanoma.
* Basal cell skin cancer.
* Squamous cell skin cancer.
Melanoma is more aggressive than basal cell skin cancer or squamous cell skin cancer.
Melanoma can occur anywhere on the body.
In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma often develops on the arms and legs. Melanoma usually occurs in adults, but it is sometimes found in children and adolescents.
Unusual moles, exposure to sunlight, and health history can affect the risk of developing melanoma.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for melanoma include the following:
* Having a fair complexion, which includes the following:
* Fair skin that freckles and burns easily, does not tan, or tans poorly.
* Blue or green or other light-colored eyes.
* Red or blond hair.
* Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
* Having a history of many blistering sunburns as a child.
* Having several large or many small moles.
* Having a family history of unusual moles (atypical nevus syndrome).
* Having a family or personal history of melanoma.
* Being white and male.
Possible signs of melanoma include a change in the appearance of a mole or pigmented area.
These and other symptoms may be caused by melanoma. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
A mole that:
* changes in size, shape, or color.
* has irregular edges or borders.
* is more than 1 color.
* is asymmetrical (if the mole is divided in half, the 2 halves are different in size or shape).
* itches.
* oozes, bleeds, or is ulcerated (a hole forms in the skin when the top layer of cells breaks down and the tissue below shows through).
* Change in pigmented (colored) skin.
* Satellite moles (new moles that grow near an existing mole).
Tests that examine the skin are used to detect (find) and diagnose melanoma.
If a mole or pigmented area of the skin changes or looks abnormal, the following tests and procedures can help detect and diagnose melanoma:
* Skin examination: A doctor or nurse checks the skin for moles, birthmarks, or other pigmented areas that look abnormal in color, size, shape, or texture.
* Biopsy: A local excision is done to remove as much of the suspicious mole or lesion as possible. A pathologist then looks at the tissue under a microscope to check for cancer cells. Because melanoma can be hard to diagnose, patients should consider having their biopsy sample checked by a second pathologist.
Suspicious areas of the skin should be biopsied and not be shaved off or cauterized (destroyed with a hot instrument, an electrical current, or a caustic substance).
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
* The thickness of the tumor and where it is in the body.
* How quickly the cancer cells are dividing.
* Whether there was bleeding or ulceration at the primary site.
* Whether cancer has spread to the lymph nodes or to other places in the body.
* The number of places cancer has spread to in the body and the level of lactate dehyrogenase (LDH) in the blood.
* The patient’s general health.
Although many people are successfully treated, melanoma can recur (come back).
Glossary Terms
abnormal (ab-NOR-mul)
* Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
aggressive (uh-GREH-siv)
* In medicine, describes a tumor or disease that forms, grows, or spreads quickly. It may also describe treatment that is more severe or intense than usual.
asymmetry (ay-SIH-meh-tree)
* Lack or absence of balanced proportions between parts of a thing.
basal cell carcinoma (BAY-sul sel KAR-sih-NOH-muh)
* Cancer that begins in the lower part of the epidermis (the outer layer of the skin). It may appear as a small white or flesh-colored bump that grows slowly and may bleed. Basal cell carcinomas are usually found on areas of the body exposed to the sun. Basal cell carcinomas rarely metastasize (spread) to other parts of the body. They are the most common form of skin cancer. Also called basal cell cancer.
biopsy (BY-op-see)
* The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
blood (blud)
* A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
cauterize (KAW-teh-RIZE)
* To destroy tissue using a hot or cold instrument, an electrical current, or a chemical that burns or dissolves the tissue. This process may be used to kill certain types of small tumors or to seal off blood vessels to stop bleeding.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
cutaneous (kyoo-TAY-nee-us)
* Having to do with the skin.
dermis (DER-mis)
* The inner layer of the two main layers of the skin. The dermis has connective tissue, blood vessels, oil and sweat glands, nerves, hair follicles, and other structures. It is made up of a thin upper layer called the papillary dermis, and a thick lower layer called the reticular dermis.
diagnosis (DY-ug-NOH-sis)
* The process of identifying a disease, such as cancer, from its signs and symptoms.
epidermis (EH-pih-DER-mis)
* The outer layer of the two main layers of the skin.
excisional biopsy (ek-SIH-zhuh-nul BY-op-see)
* A surgical procedure in which an entire lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope.
family history (FA-mih-lee HIH-stuh-ree)
* A record of the relationships among family members along with their medical histories. This includes current and past illnesses. A family history may show a pattern of certain diseases in a family. Also called family medical history.
infection (in-FEK-shun)
* Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
intraocular melanoma (IN-truh-AH-kyoo-ler MEH-luh-NOH-muh)
* A rare cancer of melanocytes (cells that produce the pigment melanin) found in the eye. Also called ocular melanoma.
lactate dehydrogenase (LAK-tayt dee-hy-DRAH-jeh-nays)
* One of a group of enzymes found in the blood and other body tissues and involved in energy production in cells. An increased amount of lactate dehydrogenase in the blood may be a sign of tissue damage and some types of cancer or other diseases. Also called lactic acid dehydrogenase and LDH.
lesion (LEE-zhun)
* An area of abnormal tissue. A lesion may be benign (not cancer) or malignant (cancer).
lymph node (limf node)
* A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
melanin (MEH-luh-nin)
* A pigment that gives color to skin and eyes and helps protect it from damage by ultraviolet light.
melanocyte (meh-LAN-oh-site)
* A cell in the skin and eyes that produces and contains the pigment called melanin.
melanoma (MEH-luh-NOH-muh)
* A form of cancer that begins in melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines.
microscope (MY-kroh-SKOPE)
* An instrument that is used to look at cells and other small objects that cannot be seen with the eye alone.
mole (mole)
* A benign (not cancer) growth on the skin that is formed by a cluster of melanocytes (cells that make a substance called melanin, which gives color to skin and eyes). A mole is usually dark and may be raised from the skin. Also called nevus.
nevus (NEE-vus)
* A benign (not cancer) growth on the skin that is formed by a cluster of melanocytes (cells that make a substance called melanin, which gives color to skin and eyes). A nevus is usually dark and may be raised from the skin. Also called mole.
nurse (nurs)
* A health professional trained to care for people who are ill or disabled.
ocular melanoma (AH-kyoo-ler MEH-luh-NOH-muh)
* A rare cancer of melanocytes (cells that produce the pigment melanin) found in the eye. Also called intraocular melanoma.
organ (OR-gun)
* A part of the body that performs a specific function. For example, the heart is an organ.
pathologist (puh-THAH-loh-jist)
* A doctor who identifies diseases by studying cells and tissues under a microscope.
PDQ
* PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.
personal history (PER-suh-nul HIH-stuh-ree)
* A collection of information about a person’s health. It may include information about allergies, illnesses and surgeries, and dates and results of physical exams, tests, screenings, and immunizations. It may also include information about medicines taken and about diet and exercise. Also called personal health record and personal medical history.
pigment (PIG-ment)
* A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair.
primary tumor (PRY-mayr-ee TOO-mer)
* The original tumor.
prognosis (prog-NO-sis)
* The likely outcome or course of a disease; the chance of recovery or recurrence.
recover (ree-KUH-ver)
* To become well and healthy again.
recur
* To come back or to return.
risk factor (... FAK-ter)
* Something that increases the chance of developing a disease. Some examples of risk factors for cancer are age, a family history of certain cancers, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic changes.
squamous cell carcinoma (SKWAY-mus sel KAR-sih-NOH-muh)
* Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma.
symptom (SIMP-tum)
* An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
syndrome (SIN-drome)
* A set of symptoms or conditions that occur together and suggest the presence of a certain disease or an increased chance of developing the disease.
tissue (TIH-shoo)
* A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer)
* An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
ulceration (UL-seh-RAY-shun)
* The formation of a break on the skin or on the surface of an organ. An ulcer forms when the surface cells die and are cast off. Ulcers may be associated with cancer and other diseases.
Table of Links
1 http://www.cancer.gov/cancertopics/pdq/treatment/intraocularmelanoma/Patient
2 http://www.cancer.gov/cancertopics/pdq/treatment/skin/Patient
Stages of Melanoma
Key Points for This Section
* After melanoma has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.
* There are three ways that cancer spreads in the body.
* The method used to stage melanoma is based mainly on the thickness of the tumor and whether cancer has spread to lymph nodes or other parts of the body.
* The following stages are used for melanoma:
* Stage 0 (Melanoma in Situ)
* Stage I
* Stage II
* Stage III
* Stage IV
After melanoma has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.
The process used to find out whether cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Talk with your doctor about what the stage of your cancer is.
The following tests and procedures may be used in the staging process:
* Wide local excision: A surgical procedure to remove some of the normal tissue surrounding the area where melanoma was found, to check for cancer cells.
* Lymph node mapping and sentinel lymph node biopsy: Procedures in which a radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through lymph ducts to the sentinel node or nodes (the first lymph node or nodes where cancer cells are likely to have spread). The surgeon removes only the nodes with the radioactive substance or dye. A pathologist then checks the sentinel lymph nodes for cancer cells. If no cancer cells are detected, it may not be necessary to remove additional nodes.
* Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
* CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For melanoma, pictures may be taken of the chest, abdomen, and pelvis.
* MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
* PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
* Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
* Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. For melanoma, the blood is checked for an enzyme called lactate dehydrogenase (LDH).
The results of these tests are viewed together with the results of the tumor biopsy to determine the melanoma stage.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
* Through tissue. Cancer invades the surrounding normal tissue.
* Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
* Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The method used to stage melanoma is based mainly on the thickness of the tumor and whether cancer has spread to lymph nodes or other parts of the body.
The staging system is based on the following:
* The thickness of the tumor. The thickness is described using the Breslow scale.
* Whether the tumor is ulcerated (has broken the skin).
* Whether the tumor has spread to the lymph nodes and if the lymph nodes are joined together (matted).
* Whether the tumor has spread to other parts of the body.
The following stages are used for melanoma:
Stage 0 (Melanoma in Situ)
Stage 0 melanoma in situ. Abnormal melanocytes are in the epidermis (outer layer of the skin).
In stage 0, abnormal melanocytes are found in the epidermis. These abnormal melanocytes may become cancer and spread into nearby normal tissue. Stage 0 is also called melanoma in situ.
Millimeters (mm). A sharp pencil point is about 1 mm, a new crayon point is about 2 mm, and a new pencil eraser is about 5 mm.
Stage I
Stage I melanoma. In stage IA, the tumor is not more than 1 millimeter thick, with no ulceration (break in the skin). In stage IB, the tumor is either not more than 1 millimeter thick, with ulceration, OR more than 1 but not more than 2 millimeters thick, with no ulceration. Skin thickness is different on different parts of the body.
In stage I, cancer has formed. Stage I is divided into stages IA and IB.
* Stage IA: In stage IA, the tumor is not more than 1 millimeter thick, with no ulceration.
* Stage IB: In stage IB, the tumor is either:
* not more than 1 millimeter thick and it has ulceration; or
* more than 1 but not more than 2 millimeters thick, with no ulceration.
Stage II
Stage II melanoma. In stage IIA, the tumor is either more than 1 but not more than 2 millimeters thick, with ulceration (break in the skin), OR it is more than 2 but not more than 4 millimeters thick, with no ulceration. In stage IIB, the tumor is either more than 2 but not more than 4 millimeters thick, with ulceration, OR it is more than 4 millimeters thick, with no ulceration. In stage IIC, the tumor is more than 4 millimeters thick, with ulceration. Skin thickness is different on different parts of the body.
Stage II is divided into stages IIA, IIB, and IIC.
* Stage IIA: In stage IIA, the tumor is either:
* more than 1 but not more than 2 millimeters thick, with ulceration; or
* more than 2 but not more than 4 millimeters thick, with no ulceration.
* Stage IIB: In stage IIB, the tumor is either:
* more than 2 but not more than 4 millimeters thick, with ulceration; or
* more than 4 millimeters thick, with no ulceration.
* Stage IIC: In stage IIC, the tumor is more than 4 millimeters thick, with ulceration.
Stage III
Stage III melanoma. The tumor may be any thickness, with or without ulceration (a break in the skin), and (a) cancer has spread to one or more lymph nodes; (b) lymph nodes with cancer may be joined together (matted); (c) cancer may be in a lymph vessel between the primary tumor and nearby lymph nodes; and/or (d) very small tumors may be found on or under the skin, not more than 2 centimeters away from the primary tumor.
In stage III, the tumor may be any thickness, with or without ulceration. One or more of the following is true:
* Cancer has spread to one or more lymph nodes.
* Lymph nodes may be joined together (matted).
* Cancer may be in a lymph vessel between the primary tumor and nearby lymph nodes.
* Very small tumors may be found on or under the skin, not more than 2 centimeters away from where the cancer first started.
Stage IV
Stage IV melanoma. The tumor has spread to other parts of the body.
In stage IV, the cancer has spread to other places in the body, such as the lung, liver, brain, bone, soft tissue, or gastrointestinal (GI) tract. Cancer may also spread to places in the skin far away from where the cancer first started.
Glossary Terms
abdomen (AB-doh-men)
* The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
abnormal (ab-NOR-mul)
* Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
biopsy (BY-op-see)
* The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
blood (blud)
* A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
blood chemistry study (blud KEH-mih-stree STUH-dee)
* A procedure in which a sample of blood is examined to measure the amounts of certain substances made in the body. An abnormal amount of a substance can be a sign of disease in the organ or tissue that produces it.
bone cancer (bone KAN-ser)
* Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).
breast cancer (brest KAN-ser)
* Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
Breslow thickness (BRES-loh THIK-nes)
* A measure of how deeply a melanoma tumor has grown into the skin. The tumor thickness (depth) is usually measured from the top of the tumor to the deepest tumor cells. If the tumor is ulcerated (the skin is broken), it is measured from the base of the ulcer to the deepest tumor cells. Breslow thickness is used to help determine the stage of cancer. Thicker tumors are linked with lower survival rates. Also called Breslow depth.
capillary (KA-pih-layr-ee)
* The smallest type of blood vessel. A capillary connects an arteriole (small artery) to a venule (small vein) to form a network of blood vessels in almost all parts of the body. The wall of a capillary is thin and leaky, and capillaries are involved in the exchange of fluids and gases between tissues and the blood.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
centimeter (SEN-tih-MEE-ter)
* A measure of length in the metric system. There are 100 centimeters in a meter and 2½ centimeters in an inch.
chest x-ray (chest EX-ray)
* An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.
contrast material (KON-trast muh-TEER-ee-ul)
* A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
CT scan (… skan)
* A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
diagnosis (DY-ug-NOH-sis)
* The process of identifying a disease, such as cancer, from its signs and symptoms.
duct (dukt)
* In medicine, a tube or vessel of the body through which fluids pass.
enzyme (EN-zime)
* A protein that speeds up chemical reactions in the body.
epidermis (EH-pih-DER-mis)
* The outer layer of the two main layers of the skin.
gastrointestinal tract (GAS-troh-in-TES-tih-nul trakt)
* The stomach and intestines. The gastrointestinal tract is part of the digestive system, which also includes the salivary glands, mouth, esophagus, liver, pancreas, gallbladder, and rectum.
glucose (GLOO-kose)
* A type of sugar; the chief source of energy for living organisms.
injection (in-JEK-shun)
* Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
invasive cancer (in-VAY-siv KAN-ser)
* Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.
laboratory test (LA-bruh-tor-ee...)
* A medical procedure that involves testing a sample of blood, urine, or other substance from the body. Tests can help determine a diagnosis, plan treatment, check to see if treatment is working, or monitor the disease over time.
lactate dehydrogenase (LAK-tayt dee-hy-DRAH-jeh-nays)
* One of a group of enzymes found in the blood and other body tissues and involved in energy production in cells. An increased amount of lactate dehydrogenase in the blood may be a sign of tissue damage and some types of cancer or other diseases. Also called lactic acid dehydrogenase and LDH.
liver (LIH-ver)
* A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.
lung
* One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.
lymph (limf)
* The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.
lymph node (limf node)
* A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
lymph node mapping
* The use of dyes and radioactive substances to identify lymph nodes that may contain tumor cells. Also called lymphatic mapping.
lymph vessel (limf ...)
* A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.
lymphatic system (lim-FA-tik SIS-tem)
* The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.
malignant (muh-LIG-nunt)
* Cancerous. Malignant cells can invade and destroy nearby tissue and spread to other parts of the body.
melanocyte (meh-LAN-oh-site)
* A cell in the skin and eyes that produces and contains the pigment called melanin.
melanoma (MEH-luh-NOH-muh)
* A form of cancer that begins in melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines.
melanoma in situ (MEH-luh-NOH-muh in SY-too)
* Abnormal melanocytes (cells that make melanin, the pigment that gives skin its color) are found in the epidermis (outer layer of the skin). These abnormal melanocytes may become cancer and spread into nearby normal tissue. Also called stage 0 melanoma.
metastasis (meh-TAS-tuh-sis)
* The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).
millimeter (MIH-luh-MEE-ter)
* A measure of length in the metric system. A millimeter is one thousandth of a meter. There are 25 millimeters in an inch.
monitor (MAH-nih-ter)
* In medicine, to regularly watch and check a person or condition to see if there is any change. Also refers to a device that records and/or displays patient data, such as for an electrocardiogram (EKG).
MRI
* A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.
organ (OR-gun)
* A part of the body that performs a specific function. For example, the heart is an organ.
pathologist (puh-THAH-loh-jist)
* A doctor who identifies diseases by studying cells and tissues under a microscope.
pelvis (PEL-vus)
* The lower part of the abdomen, located between the hip bones.
PET scan (… skan)
* A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body. Also called positron emission tomography scan.
primary tumor (PRY-mayr-ee TOO-mer)
* The original tumor.
radioactive (RAY-dee-oh-AK-tiv)
* Giving off radiation.
scanner (SKA-ner)
* In medicine, an instrument that takes pictures of the inside of the body.
sentinel lymph node (SEN-tih-nel limf node)
* The first lymph node to which cancer is likely to spread from the primary tumor. When cancer spreads, the cancer cells may appear first in the sentinel node before spreading to other lymph nodes.
sentinel lymph node biopsy (SEN-tih-nel limf node BY-op-see)
* Removal and examination of the sentinel node(s) (the first lymph node(s) to which cancer cells are likely to spread from a primary tumor). To identify the sentinel lymph node(s), the surgeon injects a radioactive substance, blue dye, or both near the tumor. The surgeon then uses a probe to find the sentinel lymph node(s) containing the radioactive substance or looks for the lymph node(s) stained with dye. The surgeon then removes the sentinel node(s) to check for the presence of cancer cells.
soft tissue (... TIH-shoo)
* Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body.
stage
* The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
stage 0 melanoma (... MEH-luh-NOH-muh)
* Abnormal melanocytes (cells that make melanin, the pigment that gives skin its color) are found in the epidermis (outer layer of the skin). These abnormal melanocytes may become cancer and spread into nearby normal tissue. Also called melanoma in situ.
stage I melanoma (... MEH-luh-NOH-muh)
* Stage I is divided into stages IA and IB. In stage IA, the tumor is not more than 1 millimeter thick, with no ulceration (a break in the skin). In stage IB, (1) the tumor is not more than 1 millimeter thick and it has ulceration; or (2) the tumor is more than 1 but not more than 2 millimeters thick, with no ulceration.
stage II melanoma (... MEH-luh-NOH-muh)
* Stage II is divided into stages IIA, IIB, and IIC. In stage IIA, (1) the tumor is more than 1 but not more than 2 millimeters thick, with ulceration (a break in the skin); or (2) more than 2 but not more than 4 millimeters thick, with no ulceration. In stage IIB, (1) the tumor is either more than 2 but not more than 4 millimeters thick, with ulceration; or (2) more than 4 millimeters thick, with no ulceration. In stage IIC, the tumor is more than 4 millimeters thick, with ulceration.
stage III melanoma (... MEH-luh-NOH-muh)
* The tumor may be any thickness, with or without ulceration (a break in the skin), and one or more of the following is true: (1) cancer has spread to one or more lymph nodes; (2) lymph nodes may be joined together (matted); (3) cancer may be in a lymph vessel between the primary tumor and nearby lymph nodes; and/or (4) very small tumors may be found on or under the skin, not more than 2 centimeters away from where the cancer first started.
stage IV melanoma (... MEH-luh-NOH-muh)
* Cancer has spread to other places in the body, such as the lung, liver, brain, bone, soft tissue, gastrointestinal (GI) tract, or to places in the skin far away from where the cancer first started.
staging (STAY-jing)
* Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.
surgeon (SER-jun)
* A doctor who removes or repairs a part of the body by operating on the patient.
surgery (SER-juh-ree)
* A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.
tissue (TIH-shoo)
* A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer)
* An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
ulceration (UL-seh-RAY-shun)
* The formation of a break on the skin or on the surface of an organ. An ulcer forms when the surface cells die and are cast off. Ulcers may be associated with cancer and other diseases.
urine (YOOR-in)
* Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.
vein (vayn)
* A blood vessel that carries blood to the heart from tissues and organs in the body.
wide local excision (…LOH-kul ek-SIH-zhun)
* Surgery to cut out the cancer and some healthy tissue around it.
x-ray (EX-ray)
* A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.
Recurrent Melanoma
Recurrent melanoma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the original site or in other parts of the body, such as the lungs or liver.
Treatment Option Overview
Key Points for This Section
* There are different types of treatment for patients with melanoma.
* Four types of standard treatment are used:
* Surgery
* Chemotherapy
* Radiation therapy
* Biologic therapy
* New types of treatment are being tested in clinical trials.
* Chemoimmunotherapy
* Targeted therapy
* Vaccine therapy
* Patients may want to think about taking part in a clinical trial.
* Patients can enter clinical trials before, during, or after starting their cancer treatment.
* Follow-up tests may be needed.
There are different types of treatment for patients with melanoma.
Different types of treatment are available for patients with melanoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Four types of standard treatment are used:
Surgery
Surgery to remove the tumor is the primary treatment of all stages of melanoma. The doctor may remove the tumor using the following operations:
* Local excision: Taking out the melanoma and some of the normal tissue around it.
* Wide local excision with or without removal of lymph nodes.
* Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer.
* Sentinel lymph node biopsy: The removal of the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed for biopsy. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.
* Sentinel lymph node biopsy of the skin. A radioactive substance and/or blue dye is injected near the tumor (first panel). The injected material is detected visually and/or with a probe that detects radioactivity (middle panel). The sentinel nodes (the first lymph nodes to take up the material) are removed and checked for cancer cells (last panel).
Skin grafting (taking skin from another part of the body to replace the skin that is removed) may be done to cover the wound caused by surgery.
Even if the doctor removes all the melanoma that can be seen at the time of the operation, some patients may be offered chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
In treating melanoma, anticancer drugs may be given as a hyperthermic isolated limb perfusion. This technique sends anticancer drugs directly to the arm or leg in which the cancer is located. The flow of blood to and from the limb is temporarily stopped with a tourniquet, and a warm solution containing anticancer drugs is put directly into the blood of the limb. This allows the patient to receive a high dose of drugs in the area where the cancer occurred.
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Biologic therapy
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site 1
Chemoimmunotherapy
Chemoimmunotherapy is the use of anticancer drugs combined with biologic therapy to boost the immune system to kill cancer cells.
Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy is a type of targeted therapy being studied in the treatment of melanoma.
Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies may be used in combination with chemotherapy as adjuvant therapy.
Vaccine therapy
Vaccine therapy is a type of biologic therapy. Cancer vaccines work by helping the immune system recognize and attack specific types of cancer cells. Vaccine therapy can also be a type of targeted therapy.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Glossary Terms
abdomen (AB-doh-men)
* The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
adjuvant therapy (A-joo-vunt THAYR-uh-pee)
* Additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy.
antibody (AN-tee-BAH-dee)
* A protein made by plasma cells (a type of white blood cell) in response to an antigen (a substance that causes the body to make a specific immune response). Each antibody can bind to only one specific antigen. The purpose of this binding is to help destroy the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen.
biological therapy (BY-oh-LAH-jih-kul THAYR-uh-pee)
* Treatment to boost or restore the ability of the immune system to fight cancer, infections, and other diseases. Also used to lessen certain side effects that may be caused by some cancer treatments. Agents used in biological therapy include monoclonal antibodies, growth factors, and vaccines. These agents may also have a direct antitumor effect. Also called biological response modifier therapy, biotherapy, BRM therapy, and immunotherapy.
biopsy (BY-op-see)
* The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
blood (blud)
* A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
cancer vaccine (KAN-ser vak-SEEN)
* A type of vaccine that is usually made from a patient’s own tumor cells or from substances taken from tumor cells. A cancer vaccine may help the immune system kill cancer cells. Also called cancer treatment vaccine.
catheter (KA-theh-ter)
* A flexible tube used to deliver fluids into or withdraw fluids from the body.
cavity (KA-vih-tee)
* A hollow area or hole. It may describe a body cavity (such as the space within the abdomen) or a hole in a tooth caused by decay.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
cerebrospinal fluid (seh-REE-broh-SPY-nul FLOO-id)
* The fluid that flows in and around the hollow spaces of the brain and spinal cord, and between two of the meninges (the thin layers of tissue that cover and protect the brain and spinal cord). Cerebrospinal fluid is made by tissue called the choroid plexus in the ventricles (hollow spaces) in the brain. Also called CSF.
chemoimmunotherapy (KEE-moh-IH-myoo-noh-THAYR-uh-pee)
* Chemotherapy combined with immunotherapy. Chemotherapy uses different drugs to kill or slow the growth of cancer cells; immunotherapy uses treatments to stimulate or restore the ability of the immune system to fight cancer.
chemotherapy (KEE-moh-THAYR-uh-pee)
* Treatment with drugs that kill cancer cells.
clinical trial (KLIH-nih-kul TRY-ul)
* A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.
contrast material (KON-trast muh-TEER-ee-ul)
* A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
diagnosis (DY-ug-NOH-sis)
* The process of identifying a disease, such as cancer, from its signs and symptoms.
dose (dose)
* The amount of medicine taken, or radiation given, at one time.
drug (drug)
* Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
duct (dukt)
* In medicine, a tube or vessel of the body through which fluids pass.
excisional biopsy (ek-SIH-zhuh-nul BY-op-see)
* A surgical procedure in which an entire lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope.
external radiation therapy (...RAY-dee-AY-shun THAYR-uh-pee)
* A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.
follow-up (FAH-loh-up)
* Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.
hyperthermic perfusion (HY-per-THER-mik per-FYOO-zhun)
* A procedure in which a warmed solution containing anticancer drugs is used to bathe, or is passed through the blood vessels of, the tissue or organ containing the tumor.
immune system (ih-MYOON SIS-tem)
* The complex group of organs and cells that defends the body against infections and other diseases.
infusion (in-FYOO-zhun)
* A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion.
injection (in-JEK-shun)
* Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
internal radiation therapy (in-TER-nul RAY-dee-AY-shun THAYR-uh-pee)
* A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, implant radiation therapy, and radiation brachytherapy.
isolated limb perfusion (I-soh-LAY-ted LIM per-FYOO-zhun)
* A procedure that may be used to deliver anticancer drugs directly to an arm or leg. The flow of blood to and from the limb is temporarily stopped with a tourniquet (a tight band around the limb), and anticancer drugs are put directly into the blood of the limb. This allows the person to receive a high dose of drugs in the area where the cancer occurred. Also called limb perfusion.
lymph (limf)
* The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.
lymph node (limf node)
* A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
lymphadenectomy (LIM-fa-deh-NEK-toh-mee)
* A surgical procedure in which the lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer. For a regional lymphadenectomy, some of the lymph nodes in the tumor area are removed; for a radical lymphadenectomy, most or all of the lymph nodes in the tumor area are removed. Also called lymph node dissection.
melanoma (MEH-luh-NOH-muh)
* A form of cancer that begins in melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines.
microscope (MY-kroh-SKOPE)
* An instrument that is used to look at cells and other small objects that cannot be seen with the eye alone.
monoclonal antibody (MAH-noh-KLOH-nul AN-tee-BAH-dee)
* A type of protein made in the laboratory that can bind to substances in the body, including tumor cells. There are many kinds of monoclonal antibodies. Each monoclonal antibody is made to find one substance. Monoclonal antibodies are being used to treat some types of cancer and are being studied in the treatment of other types. They can be used alone or to carry drugs, toxins, or radioactive materials directly to a tumor.
NCI
* NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. It conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://www.cancer.gov. Also called National Cancer Institute.