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C a n c e r

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    Cancer Index        
  Cancer Basics      
    What Is Cancer?      
    Normal cells in the body      
    How cancer starts      
    How cancer spreads      
    How cancers differ      
    Tumors that are not cancer      
    How common is cancer?      
  Signs and Symptoms of Cancer      
    What are signs and symptoms?      
    How does cancer cause signs and symptoms?      
    How are signs and symptoms helpful?      
    What are some general signs and symptoms of cancer?    
    Signs and symptoms of certain cancers      
    To learn more      
  Lymph Nodes and Cancer      
    What is the lymph system?      
      The lymph system      
      Lymph nodes and what they do      
      Swollen lymph nodes      
    Cancer in the lymph nodes      
      How does cancer spread to lymph nodes?    
      How is cancer in lymph nodes found?      
      What does it mean if there’s cancer in my lymph node?    
      Cancer in nodes affects cancer stage      
    Effects of removing lymph nodes      
  Questions People Ask About Cancer    
    What is cancer?    
      Normal cells in the body    
      How cancer starts    
      How cancer spreads    
      How cancers differ    
  How common is cancer?    
  What causes cancer?    
  Other things people are exposed to    
    Genes that run in families    
    Bottom line    
  Can injuries cause cancer?    
  Can cancer be prevented?    
      Tobacco      
      Alcohol      
      Drinking and smoking      
      Diet    
      Vaccines that reduce cancer risk      
      Ultraviolet (UV) rays and sunlight      
      Diet      
      Vaccines that reduce cancer risk      
  Early detection  
  How many people alive today have ever had cancer?  
  How is cancer diagnosed?  
  How is cancer treated?  
      Surgery  
      Chemotherapy  
      Radiation therapy  
      Other types of cancer treatment  
  What are the side effects of cancer treatment?  
      Chemo side effects  
      Radiation side effects  
  Is cancer treatment worse than cancer?  
  Cancer is NOT contagious.  
      Cancer transfer after organ transplant  
  Cancer transfer during pregnancy  
  Germs are often contagious.  
  Germs can affect cancer risk.  
      Viruses  
      Bacteria  
      Parasites  
  Cancer develops because your DNA changes.  
  Scientific studies shows that cancer does not spread like contagious diseases.  
  People with cancer need to be around other people.  
  Lifetime Risk of Developing or Dying From Cancer  
      Males        
      Females        
  Cancer Prevalence: How Many People Have Cancer?  
      What is cancer prevalence?  
  The numbers  
      Estimated cancer prevalence in the United States as of January 1, 2010
  Cancer Surveillance Programs in the United States  
    Tobacco
      Cancer registries  
      Hospital registries  
      Population-based registries  
      Collecting the information  
      Confidentiality of personal information  
  Major cancer surveillance programs
      National Cancer Data Base
      The Surveillance, Epidemiology and End Results Program
      National Program of Cancer Registries
      The future for registries
      Economic Impact of Cancer
      The History of Cancer
  Cancer Information on the Internet
  User beware
  Other Sources of Cancer Information
      Research Starting Points
  Specific Cancers
      Bladder Cancer      
      Bone Metastasis      
      Brain Tumors      
      Breast Cancer      
      Carcinoid Tumors      
      Cervical Cancer      
      Childhood Cancers      
      Colorectal Cancer      
      Endometrial (Uterine) Cancer      
      Eye Cancer      
      Head and Neck Cancers (Includes Mouth and Throat Cancers)
      Hodgkin Disease      
      Kidney Cancer (Adult)      
      Leukemias, Lymphomas & Other Blood Disorders
      Liver Cancer      
      Lung Cancer      
      Lymphoma      
      Melanoma      
      Mesothelioma
      Multiple Myeloma
      Nasopharyngeal Cancer
      Non-Hodgkin Lymphoma
      Oral Cavity & Oropharyngeal Cancer
      Osteosarcoma
      Ovarian Cancer
      Pancreatic Cancer
      Pituitary Tumors
      Prostate Cancer
      Sarcoma
      Skin Cancer (Includes Melanoma and Non-melanoma Cancers)
      Thyroid Cancer
      Urinary Bladder Cancer
      Waldenstrom's Macroglobulinemia
      Rare Cancers
    Cancer Treatment
      Radiation Therapy
      Chemotherapy
      Bone Marrow/Stem Cell Transplant
      Newer or Experimental Therapies
    Clinical Trials
      Complementary & Alternative Therapies
    Patient Services and Support
      Financial/Insurance Matters
      Hospice
      Pain and Palliative Care
      Other Patient Services & Support
  Additional Cancer Resources
      Cancer Biology
      Cancer Statistics
      Hospital and Doctor Directories
      International Cancer Resources
      Medical Articles and Journals
      Newsgroups, Message Boards, Mailing Lists, etc.
      Nutrition
      Professional Resources
      Pharmaceutical and Biotech Companies
  Other Health Resources
      Government Sites
      Other Health & Disease Information
      Other
  Americans with Disabilities Act
    ADA: Information for People Facing Cancer
      What is the Americans with Disabilities Act?
      What is a disability under ADA?
    Questions and answers about employment discrimination
      Does the ADA apply to my employer?
      Whom does the ADA cover?
      Which employment practices does the ADA cover?
      What does the ADA consider to be essential job functions?
      What does the ADA consider to be reasonable accommodation?
      What are employers allowed to ask job applicants with disabilities under ADA?
      Should I tell my employer I have a disability?
      Does my employer have to provide any accommodation I request?
      Under ADA, does the employer have to hire a qualified applicant with a disability
      over other qualified applicants?
      Under ADA, can an employer offer a health insurance policy that excludes coverage        for pre-existing conditions?
      Under ADA, does an employer have to make non-work areas used by employees,
      such as cafeterias, lounges, or employer-provided transportation, accessible to
      people with disabilities?
      What should I do if I think I’m being discriminated against in a work situation
      because of my disability?
    How the ADA can help in settings other than work
    To learn more
      More information from your American Cancer Society
      National organizations and websites*
      Job and work-related disability problems
      Job Accommodation Network
      US Equal Employment Opportunity Commission (EEOC)
      Americans with Disabilities Act Technical Assistance -- US Department of Justice
      Social Security Administration (SSA)
    Other problems caused by disability
      Easter Seals Project ACTION
      Federal Communications Commission
      American Speech-Language-Hearing Association (ASHA)
      Federal Transit Administration
      United States Access Board
  References
     
 
 
         
Cancer Basics        
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What Is Cancer?
Cancer is the general name for a group of more than 100 diseases. Although there are many kinds of cancer, all cancers start because abnormal cells grow out of control. Untreated cancers can cause serious illness and death.
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Normal cells in the body
The body is made up of trillions of living cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person’s life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries.
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How cancer starts

Cancer starts when cells in a part of the body start to grow out of control. Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues, something that normal cells cannot do. Growing out of control and invading other tissues are what makes a cell a cancer cell.

Cells become cancer cells because of DNA (deoxyribonucleic acid) damage. DNA is in every cell and it directs all the cell’s actions. In a normal cell, when DNA gets damaged the cell either repairs the damage or the cell dies. In cancer cells, the damaged DNA is not repaired, and the cell doesn’t die like it should. Instead, the cell goes on making new cells that the body doesn’t need. These new cells all have the same abnormal DNA as the first cell does.

People can inherit abnormal DNA, but most DNA damage is caused by mistakes that happen while the normal cell is reproducing or by something in the environment. Sometimes the cause of the DNA damage may be something obvious like cigarette smoking or sun exposure. But it’s rare to know exactly what caused any one person’s cancer.

In most cases, the cancer cells form a tumor. Some cancers, like leukemia, rarely form tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow.

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How cancer spreads
Cancer cells often travel to other parts of the body where they begin to grow and form new tumors. This happens when the cancer cells get into the body’s bloodstream or lymph vessels. Over time, the tumors replace normal tissue. The process of cancer spreading is called metastasis.
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How cancers differ

No matter where a cancer may spread, it’s always named for the place where it started. For example, breast cancer that has spread to the liver is called metastatic breast cancer, not liver cancer. Likewise, prostate cancer that has spread to the bone is called metastatic prostate cancer, not bone cancer.

Different types of cancer can behave very differently. For instance, lung cancer and skin cancer are very different diseases. They grow at different rates and respond to different treatments. This is why people with cancer need treatment that is aimed at their kind of cancer.

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Tumors that are not cancer
Not all tumors are cancer. Tumors that aren’t cancer are called benign. Benign tumors can cause problems – they can grow very large and press on healthy organs and tissues. But they cannot grow into (invade) other tissues. Because they can’t invade, they also can’t spread to other parts of the body (metastasize). These tumors are almost never life threatening.
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How common is cancer?

Half of all men and one-third of all women in the US will develop cancer during their lifetimes.

Today, millions of people are living with cancer or have had cancer. The risk of developing many types of cancer can be reduced by changes in a person’s lifestyle, for example, by staying away from tobacco, limiting time in the sun, being physically active, and healthy eating.

There are also screening tests that can be done for some types of cancers so they can be found as early as possible – while they are small and before they have spread. In general, the earlier a cancer is found and treated, the better the chances are for living for many years.

No matter who you are, we can help. Contact us any time, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

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Signs and Symptoms of Cancer            
What are signs and symptoms?

Signs and symptoms are both signals of injury, illness, disease, or that something is not right in the body.

A sign is a signal that can be seen by someone else—maybe a loved one, or a doctor, nurse, or other health care professional. For example, fever, fast breathing, and abnormal lung sounds heard through a stethoscope may be signs of pneumonia.

A symptom is a signal that is felt or noticed by the person who has it, but may not be easily seen by anyone else. For example, weakness, aching, and feeling short of breath may be symptoms of pneumonia.

Having one sign or symptom may not be enough to figure out what’s causing it. For example, a rash in a child could be a sign of a number of things, such as poison ivy, measles, a skin infection, or a food allergy. But if the child has the rash along with other signs and symptoms like a high fever, chills, achiness, and a sore throat, then a doctor can get a better picture of the illness. Sometimes, a patient’s signs and symptoms still don’t give the doctor enough clues to be sure what is causing the illness. Then medical tests, such as x-rays, blood tests, or a biopsy may be needed.

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How does cancer cause signs and symptoms?
Cancer is a group of diseases that can cause almost any sign or symptom. The signs and symptoms will depend on where the cancer is, how big it is, and how much it affects the organs or tissues. If a cancer has spread (metastasized), signs or symptoms may appear in different parts of the body.

As a cancer grows, it can begin to push on nearby organs, blood vessels, and nerves. This pressure causes some of the signs and symptoms of cancer. If the cancer is in a critical area, such as certain parts of the brain, even the smallest tumor can cause symptoms.

But sometimes cancer starts in places where it will not cause any signs or symptoms until it has grown quite large. Cancers of the pancreas, for example, usually do not cause symptoms until they grow large enough to press on nearby nerves or organs (this causes back or belly pain). Others may grow around the bile duct and block the flow of bile. This causes the eyes and skin to look yellow (jaundice). By the time a pancreatic cancer causes signs or symptoms like these, it’s usually in an advanced stage. This means it has grown and spread beyond the place it started—the pancreas.

A cancer may also cause symptoms like fever, extreme tiredness (fatigue), or weight loss. This may be because cancer cells use up much of the body’s energy supply, or they may release substances that change the way the body makes energy from food. Or the cancer may cause the immune system to react in ways that produce these signs and symptoms.

Sometimes, cancer cells release substances into the bloodstream that cause symptoms which are not usually linked to cancer. For example, some cancers of the pancreas can release substances that cause blood clots in veins of the legs. Some lung cancers make hormone-like substances that raise blood calcium levels. This affects nerves and muscles, making the person feel weak and dizzy.

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How are signs and symptoms helpful?
Treatment works best when cancer is found early—while it’s still small and is less likely to have spread to other parts of the body. This often means a better chance for a cure, especially if the cancer can be removed with surgery.

A good example of the importance of finding cancer early is melanoma skin cancer. It can be easy to remove if it has not grown deep into the skin. The 5-year survival rate (percentage of people who live at least 5 years after diagnosis) at this stage is around 97%. Once melanoma has spread to other parts of the body, the 5-year survival rate drops below 20%.

Sometimes people ignore symptoms. Maybe they don’t know that the symptoms could mean something is wrong. Or they might be frightened by what the symptoms could mean and don’t want to get or can’t afford to get medical help. Some symptoms, such as tiredness or coughing, are more likely caused by something other than cancer. Symptoms can seem unimportant, especially if there’s an obvious cause or the problem only lasts a short time. In the same way, a person may reason that a symptom like a breast lump is probably a cyst that will go away by itself. But no symptom should be ignored or overlooked, especially if it has lasted a long time or is getting worse.

Most likely, any symptoms you may have will not be caused by cancer, but it’s important to have them checked out, just in case. If cancer is not the cause, a doctor can help figure out what is and treat it, if needed.

Sometimes, it’s possible to find cancer before you have symptoms. The American Cancer Society and other health groups recommend cancer-related check-ups and certain tests for people even though they have no symptoms. This helps find certain cancers early, before symptoms start. For more information on early detection tests, see our document American Cancer Society Guidelines for the Early Detection of Cancer. But keep in mind, even if you have these recommended tests, it’s still important to see a doctor if you have any symptoms.

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What are some general signs and symptoms of cancer?
You should know some of the general signs and symptoms of cancer. But remember, having any of these does not mean that you have cancer—many other things cause these signs and symptoms, too. If you have any of these symptoms and they last for a long time or get worse, please see a doctor to find out what’s going on.

Unexplained weight loss

Most people with cancer will lose weight at some point. When you lose weight for no known reason, it’s called an unexplained weight loss. An unexplained weight loss of 10 pounds or more may be the first sign of cancer. This happens most often with cancers of the pancreas, stomach, esophagus (swallowing tube), or lung.

Fever

Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all patients with cancer will have fever at some time, especially if the cancer or its treatment affects the immune system. (This can make it harder for the body to fight infection.) Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.

Fatigue

Fatigue is extreme tiredness that does not get better with rest. It may be an important symptom as cancer grows. It may happen early, though, in some cancers, like leukemia. Some colon or stomach cancers can cause blood loss that’s not obvious. This is another way cancer can cause fatigue.

Pain

Pain may be an early symptom with some cancers like bone cancers or testicular cancer. A headache that does not go away or get better with treatment may be a symptom of a brain tumor. Back pain can be a symptom of cancer of the colon, rectum, or ovary. Most often, pain due to cancer means it has already spread (metastasized) from where it started.

Skin changes

Along with cancers of the skin, some other cancers can cause skin changes that can be seen. These signs and symptoms include:

  • Darker looking skin (hyperpigmentation)
  • Yellowish skin and eyes (jaundice)
  • Reddened skin (erythema)
  • Itching (pruritis)
  • Excessive hair growth
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Signs and symptoms of certain cancers
Along with the general symptoms, you should watch for certain other common signs and symptoms that could suggest cancer. Again, there may be other causes for each of these, but it’s important to see a doctor about them as soon as possible.
 

Change in bowel habits or bladder function

Long-term constipation, diarrhea, or a change in the size of the stool may be a sign of colon cancer. Pain when passing urine, blood in the urine, or a change in bladder function (such as needing to pass urine more or less often than usual) could be related to bladder or prostate cancer. Report any changes in bladder or bowel function to a doctor.

 

Sores that do not heal

Skin cancers may bleed and look like sores that don’t heal. A long-lasting sore in the mouth could be an oral cancer. This should be dealt with right away, especially in people who smoke, chew tobacco, or often drink alcohol. Sores on the penis or vagina may either be signs of infection or an early cancer, and should be seen by a health professional.

 

White patches inside the mouth or white spots on the tongue

White patches inside the mouth and white spots on the tongue may be leukoplakia. Leukoplakia is a pre-cancerous area that’s caused by frequent irritation. It’s often caused by smoking or other tobacco use. People who smoke pipes or use oral or spit tobacco are at high risk for leukoplakia. If it’s not treated, leukoplakia can become mouth cancer. Any long-lasting mouth changes should be checked by a doctor or dentist right away.

 

Unusual bleeding or discharge

Unusual bleeding can happen in early or advanced cancer. Coughing up blood in the sputum (phlegm) may be a sign of lung cancer. Blood in the stool (which can look like very dark or black stool) could be a sign of colon or rectal cancer. Cancer of the cervix or the endometrium (lining of the uterus) can cause abnormal vaginal bleeding. Blood in the urine may be a sign of bladder or kidney cancer. A bloody discharge from the nipple may be a sign of breast cancer.

 

Thickening or lump in the breast or other parts of the body

Many cancers can be felt through the skin. These cancers occur mostly in the breast, testicle, lymph nodes (glands), and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer and should be reported to a doctor, especially if you’ve just found it or notice it has grown in size. Keep in mind that some breast cancers show up as red or thickened skin rather than the expected lump.

 

Indigestion or trouble swallowing

Indigestion or swallowing problems that don’t go away may be signs of cancer of the esophagus (the swallowing tube that goes to the stomach), stomach, or pharynx (throat). But like most symptoms on this list, they are most often caused by something other than cancer.

 

Recent change in a wart or mole or any new skin change

Any wart, mole, or freckle that changes color, size, or shape, or that loses its sharp border should be seen by a doctor right away. Any other skin changes should be reported, too. A skin change may be a melanoma which, if found early, can be treated successfully.

 

Nagging cough or hoarseness

A cough that does not go away may be a sign of lung cancer. Hoarseness can be a sign of cancer of the voice box (larynx) or thyroid gland.

 

Other symptoms

The signs and symptoms listed above are the more common ones seen with cancer, but there are many others that are not listed here. If you notice any major changes in the way your body works or the way you feel – especially if it lasts for a long time or gets worse – let a doctor know. If it has nothing to do with cancer, the doctor can find out more about what’s going on and, if needed, treat it. If it is cancer, you’ll give yourself the chance to have it treated early, when treatment works best.

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To learn more
More information from your American Cancer Society

We have selected some related information that may also be helpful to you. Many of these materials can be read on our Web site, www.cancer.org. Free copies can be ordered from our toll-free number, 1-800-227-2345.

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Lymph Nodes and Cancer  
 
What is the lymph system?
Our bodies have a network of lymph vessels and lymph nodes. This network is a part of the body’s immune system. It collects fluid, waste material, and other things (like viruses and bacteria) that are in the body tissues, outside the bloodstream.

Lymph vessels are a lot like the veins that collect and carry blood through the body. But instead of carrying blood, these vessels carry the clear watery fluid called lymph.

 

Click on image to enlarge

The lymph system

Lymph fluid flows out from capillary walls to bathe the body’s tissue cells. It carries oxygen and other nutrients to the cells, and carries away waste products like carbon dioxide (CO2) that flow out of the cells. Lymph fluid also contains white blood cells, which help fight infections.

Lymph fluid would build up and cause swelling if it were not drained in some way. That’s the role of the lymph vessels. Lymph vessels draw up the lymph fluid from around the cells to send it towards the chest. There, lymph fluid collects into a large vessel that drains into a blood vessel near the heart.

Lymph nodes and what they do  

Lymph vessels route lymph fluid through nodes throughout the body. Lymph nodes are small structures that work as filters for harmful substances. They contain immune cells that can help fight infection by attacking and destroying germs that are carried in through the lymph fluid.

There are hundreds of lymph nodes throughout the body. Each lymph node filters the fluid and substances picked up by the vessels that lead to it. Lymph fluid from the fingers, for instance, works its way toward the chest, joining fluid from the arm. This fluid may filter through lymph nodes at the elbow, or those under the arm. Fluid from the head, scalp, and face flows down through lymph nodes in the neck. Some lymph nodes are deep inside the body, such as between the lungs or around the bowel, to filter fluid in those areas. The lymph fluid slowly flows in from all around the body, making its way back to the chest. At the end of its journey, the filtered fluid, salts, and proteins are dumped back into the bloodstream.

 
Swollen lymph nodes

When there’s a problem near a lymph node, such as infection, injury, or cancer, the node or the group of lymph nodes in that area may swell or enlarge as they work to filter out the “bad” cells. This may be called lymphadenopathy (limf-ad-uh-NOP-uh-thee). Swollen lymph nodes tell you that something is not right, but other symptoms help pinpoint the problem. For instance, ear pain, fever, and enlarged lymph nodes near your ear are clues that you may have an ear infection or cold.

Some areas where lymph nodes commonly swell are in the neck, groin, and underarms. In most cases, only one area of nodes swells at a time. When more than one area of lymph nodes is swollen it’s called generalized lymphadenopathy. Some infections (such as strep throat and chicken pox), certain medicines, immune system diseases, and cancers like lymphoma and leukemia can cause this kind of swelling. The doctor will look for more information to figure out the cause of the swelling. Lymph node swelling is often caused by something other than cancer.

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Cancer in the lymph nodes

Cancer can appear in the lymph nodes in two ways: it can either start there or it can spread there from somewhere else.

Cancer that starts in the lymph nodes is called lymphoma. You can read more about lymphoma in our documents called Hodgkin Diseaseand Non-Hodgkin Lymphoma.

More often, cancer starts somewhere else and then spreads to lymph nodes. That is the focus of this section.

How does cancer spread to lymph nodes?

Cancer can spread from where it started (the primary site) to other parts of the body.

When cancer cells break away from a tumor, they can travel to other areas of the body through either the bloodstream or the lymph system. Cancer cells can travel through the bloodstream to reach distant organs. If they travel through the lymph system, the cancer cells may end up in lymph nodes. Either way, most of the escaped cancer cells die or are killed before they can start growing somewhere else. But one or two might settle in a new area, begin to grow, and form new tumors. This spread of cancer to a new part of the body is called metastasis.

In order for cancer cells to spread to new parts of the body, they have to go through several changes. They first have to become able to break away from the original tumor and then attach to the outside wall of a lymph vessel or blood vessel. Then they must move through the vessel wall to flow with the blood or lymph to a new organ or lymph node.

When cancer grows inside lymph nodes, it usually affects the lymph nodes near the tumor itself. These nodes are the ones that have been doing most of the work to filter out or kill the cancer cells.

How is cancer in lymph nodes found?

Normal lymph nodes are tiny and can be hard to find, but when there’s infection, inflammation, or cancer, the nodes can get larger. Those near the body’s surface often get big enough to feel with your fingers, and some can even be seen. But if there are only a few cancer cells in a lymph node, it may look and feel normal. In that case, the doctor must check for cancer by removing all or part of the lymph node.

When a surgeon operates to remove a primary cancer, one or more of the nearby (regional) lymph nodes may be removed as well. Removal of one lymph node is called a biopsy. When many lymph nodes are removed, it’s called lymph node sampling or dissection. When cancer has spread to lymph nodes, there is a higher risk that the cancer might come back after surgery. This information helps the doctor decide whether more treatment, like chemo or radiation, might be needed after surgery.

Doctors may also take samples of one or more nodes using needles. Usually, this is done on lymph nodes that are enlarged. This is called a needle biopsy. The tissue that’s removed is looked at under the microscope by a pathologist (a doctor who diagnoses illness using tissue samples) to find out if there are cancer cells in it

Under the microscope, any cancer cells in the nodes look like cells from the primary tumor. For instance, when breast cancer spreads to the lymph nodes, the cells in the nodes look like breast cancer cells. The pathologist prepares a report, which details what was found. If a node has cancer in it, the report describes what it looks like and how much was seen.

Doctors may also use scans or other imaging tests to look for enlarged nodes around a cancer if the nodes are deep in the body. For more on this, see our document Imaging (Radiology) Tests. Often, enlarged lymph nodes near a cancer are assumed to contain cancer.

What does it mean if there’s cancer in my lymph node?

It depends. Sometimes there are so few cancer cells in the node that the pathologist must use special tests to find them. In the case of a very few cancer cells in a lymph node, it may not change the treatment plan at all.

If there’s a lot of cancer in a node, the large mass can be seen easily. If the cancer is growing out of the lymph node through the layer of connective tissue on the outside (called the capsule), it’s called extracapsular extension.

More cancer in the nodes may mean that the cancer is fast growing and/or more likely to spread to other places in the body. But if nearby lymph nodes are the only other place cancer is found beyond the main (primary) site, surgery to remove the main tumor and the nearby lymph nodes may be able to get rid of it all.

Cancer that has spread to nodes further away from the primary cancer will more likely need extra treatment with chemo or radiation. For instance, if nodes are affected on the other side of the body, the cancer may need more treatment.

Cancer in nodes affects cancer stage

Treatment of cancer is based on the type of cancer a person has, and the stage of the cancer. Doctors use a system to assign a stage to the cancer. The most common staging system is the TNM system. The T in TNM stands for tumor, the M stands for metastasis, and the N stands for lymph nodes. If there’s no cancer found in the lymph nodes near the cancer, the N is assigned a value of 0. If nearby or distant nodes show cancer, the N is assigned a number such as 1, 2 or sometimes 3, depending on how many nodes are affected, how much cancer is in them, how large they are, and where they are.

A cancer with lower TNM numbers is usually easier to treat and has a better outlook for survival. For instance, a cancer with T1, N0, M0, would be a cancer that was found very early, before it spread. The T1 would mean a small tumor, the N0 means that no nodes are involved, and the M0 means that no metastases were found. For more information on staging, see information about your cancer type, or read our document called Staging.

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Effects of removing lymph nodes
Nodes that have been removed during cancer surgery can leave part of the body without a way to drain off the lymph fluid in the affected area. Many of the lymph vessels now run into a dead end where the node used to be, and fluid can back up. This is called lymphedema, and it can become a life-long problem. The more lymph nodes that are removed, the more likely it is to occur.
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Questions People Ask About Cancer  

What is cancer?

Cancer is the general name for a group of more than 100 diseases in which cells in part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because abnormal cells grow out of control. Untreated cancers can cause serious illness and even death.

Normal cells in the body

The body is made up of trillions of living cells. Normal body cells grow, divide into new cells, and die in an orderly way. During the early years of a person’s life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries.

How cancer starts

Cancer starts when cells in a part of the body start to grow out of control. There are many kinds of cancer, but they all start because of out-of-control growth of abnormal cells.

Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues, something that normal cells cannot do. Growing out of control and invading other tissues are what makes a cell a cancer cell.

Cells become cancer cells because of damage to DNA. DNA is in every cell and directs all its actions. In a normal cell, when DNA gets damaged the cell either repairs the damage or the cell dies. In cancer cells, the damaged DNA isn’t repaired, and the cell doesn’t die like it should. Instead, this cell goes on making new cells that the body doesn’t need. These new cells all have the same damaged DNA as the first cell does.

People can inherit damaged DNA, but most DNA damage is caused by mistakes that happen while the normal cell is reproducing or by something in our environment. Sometimes the cause of the DNA damage is something obvious, like cigarette smoking. But often no clear cause is found.

In most cases the cancer cells form a tumor, also called a mass or a lump. Some cancers, like leukemia, rarely form tumors. Instead, these cancers involve the blood and blood-forming organs, and the cancer cells circulate through other tissues where they grow.

How cancer spreads

Cancer cells often travel to other parts of the body, where they begin to grow and form tumors that replace normal tissue. This process is called metastasis (meh-tas-tuh-sis). It happens when the cancer cells get into the bloodstream or lymph vessels of our body.

How cancers differ

No matter where a cancer may spread, it’s always named for the place where it started. For example, breast cancer that has spread to the liver is still called breast cancer, not liver cancer. Likewise, prostate cancer that has spread to the bone is metastatic prostate cancer, not bone cancer.

Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That’s why people with cancer need treatment aimed at their particular kind of cancer.

Tumors that are not cancer

Not all tumors are cancer. Tumors that aren’t cancer are called benign (be-nine). Benign tumors can cause problems—they can grow very large and press on healthy organs and tissues. But benign tumors cannot grow into (invade) other tissues. Because they can’t invade, they also can’t spread to other parts of the body (metastasize). Benign tumors are almost never life threatening.

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How common is cancer?              

Half of all men and one-third of all women in the US will develop cancer during their lifetimes.

Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person’s lifestyle, for example, by avoiding tobacco, limiting time in the sun, being physically active, staying at a healthy weight, limiting alcohol, and healthy eating.

For most types of cancer, the sooner a cancer is found and treated, the better the chances are for living for many years.

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What causes cancer?              

Things people do

Some cancers are caused by things people do or expose themselves to. For example, smoking can cause cancers of the lungs, mouth, throat, bladder, kidneys, and other organs. Of course, not everyone who smokes will get cancer, but smoking increases a person’s chance of cancer, as well as their chance of heart and blood vessel disease.

Being in the sun too much without protection can cause skin cancer. Melanoma is a very serious form of skin cancer linked to sunlight and tanning bed exposure.

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Other things people are exposed to          

Radiation can cause cancer. For example, people exposed to nuclear fallout have a higher cancer risk than those who were not exposed. Rarely, radiation treatment for one type of cancer can cause another cancer to grow many years later. This is why doctors and dentists use the lowest possible doses of radiation for x-rays and scans (much lower than the doses used for cancer treatment).

Certain chemicals have been linked to cancer, too. Being exposed to or working with them can increase a person’s risk of cancer. You can learn more about these carcinogens (substances that cause cancer) in our document called Known and Probable Human Carcinogens.

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Genes that run in families
Of every 20 cases of cancer, about 1 is linked to genes that are inherited from parents.
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Bottom line

No one knows the exact cause of most cases of cancer. We know that certain changes in our cells can cause cancer to start, but we don’t yet know exactly how it all happens. Scientists are studying this problem and learning more about the many steps it takes for cancers to form and grow. Although some of the factors in these steps may be a lot alike, the process that happens in the cells is generally different for each type of cancer.

If you are interested in taking measures to try and reduce your cancer risk, see the section below, “Can cancer be prevented?”

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Can injuries cause cancer?

It’s a common myth that injuries can cause cancer. But the fact is that falls, bruises, broken bones, or other such injuries have not been linked to cancer. Sometimes a person might visit the doctor for what is thought to be an injury and cancer is found at that time. But the injury did not cause the cancer; the cancer was already there. It also sometimes happens that a person will remember an injury that happened long ago in the place cancer was found.

Rarely, burn scars can be the site of cancer many years after the burn has healed. Most often, skin cancer is the type that starts in a burn scar.

 

Researchers have done many studies to see if there is a link between personality, stress, and cancer. No scientific evidence has shown that a person’s personality or outlook can affect their cancer risk.

There are many factors to look at in the relationship between stress and cancer. It’s known that stress affects the immune system, but so do many other things. Despite many studies, a link between psychological stress and cancer has not been proven. Looking at the studies that have been done, it seems they sometimes come to opposite conclusions.

In one large Danish study, people who reported major stressors in their lives did not appear to have a seriously increased risk for any type of cancer. Another study that looked at women with major life stressors, such as divorce or the death of someone close, found a slight increase (about 1/3 higher than average) in breast cancer compared to women without these stressors. In the area of day-to-day stress, another study showed higher breast cancer risk linked to stress. Yet another found that women reporting higher day-to-day stress actually were less likely to be diagnosed with breast cancer within the next 18 years.

It’s hard to explain these differences. Some may be related to the groups that were studied, while others may be due to the way the study was done. Chance may have played a role, too. All that can be said for now is that a definite link between stress and cancer risk has not yet been found.

 

In the past, people often stayed away from someone who had cancer. They were afraid they might “catch” the disease. But cancer is not like the flu or a cold. You cannot catch cancer from someone who has it. You will not get cancer by being around or touching someone with cancer. Don’t be afraid to visit someone with cancer. They need the support of their family and friends.

You can get more details on this in our document called Is Cancer Contagious?

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Can cancer be prevented?

There is no sure way to prevent cancer, but there are things you can do that might reduce your chances of getting it.

Tobacco

Many cancers might be prevented if people didn’t use tobacco.

Smoking damages nearly every organ in the human body and accounts for some 30% of all cancer deaths. Cigarettes, cigars, pipes, and oral (smokeless) tobacco products cause cancer and should not be used. People who use tobacco should try to quit. Studies clearly show that ex-smokers have less cancer than people who continue to smoke.

It’s best to never use tobacco at all and to stay away from secondhand smoke.

Alcohol

Drinking alcohol is also linked to a higher risk of certain types of cancer.

Some people think that certain types of alcohol are safer than others. But ethanol is the type of alcohol found in all alcoholic drinks, whether they are beers, wines, or liquors (distilled spirits). Overall, it’s the amount of alcohol that is drunk over time, not the type of drink, which seems to be the most important factor in raising cancer risk.

If you drink, limit your intake to no more than 2 drinks per day for men and 1 drink a day for women. This may help curb your cancer risk. You can find out more in our document called Alcohol Use and Cancer.

Drinking and smoking

The combined use of alcohol and tobacco raises the risk of mouth, throat, voice box, and esophagus cancer far more than the effects of either drinking or smoking alone.

Ultraviolet (UV) rays and sunlight

You can lower your chances of getting skin cancer by

  • Staying out of the sun between the hours of 10 a.m. and 4 p.m.
  • Wearing a hat, shirt, and sunglasses when you are in the sun
  • Using sunscreen with a sun protection factor (SPF) of 15 or higher
  • Not using tanning beds or sun lamps

Diet

We know that our diet (what we eat or don’t eat) is linked to some types of cancer, but the exact reasons are not yet clear. The best information we have suggests a lower cancer risk for people who:

  • Eat a lot of fresh vegetables and fruits (at least 2½ cups a day)
  • Choose whole grains rather than refined grains and sugars
  • Limit red meats (beef, pork, and lamb)
  • Limit processed meats (such as bacon, deli meats, and hot dogs)
  • Choose foods in amounts that help them get to and stay at a healthy weight
  • Limit alcohol intake to 1 alcoholic drink a day or less for women and 2 or less for men

Vaccines that reduce cancer risk

We now know that some cancers are caused by infections, mostly viruses. One virus that’s well known for causing cancer is the human papilloma virus (HPV). It has been linked to cervical cancer, anal cancer, many genital cancers, and some head and neck cancers. There are 2 vaccines to help prevent HPV infections, so they should help prevent the cancers caused by HPV. But most adults have already been infected with HPV, and the vaccines have not been proven to help people who already have HPV. Still, young people who are not yet sexually active should have a lower future cancer risk if they get one of the vaccines before they’re exposed to HPV. The American Cancer Society recommends them for girls aged 11 and 12, though they can be given to girls and boys as young as 9.

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Early detection
To find cancer early, while it’s small and before it has spread, adults should have regular tests called screening exams. These tests help doctors find common cancers before they cause symptoms. Talk to your doctor about which screening tests might be right for you. If cancer is found early, it can be easier to treat. Survival also tends to be longer for those with early cancer.
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How many people alive today have ever had cancer?

Today, almost 14 million people alive in the United States have had some type of cancer. Some of these people are cancer-free; others still have it.

Years ago, most people who had cancer did not live very long. That is not the case anymore. Every year more and more people survive cancer. This is especially true of children with cancer and those whose cancers were found early, before they spread.

The survival rates are different for people with different types of cancers. Some types of cancer grow very slowly. Some respond to treatment very well. Others grow and spread faster and are harder to treat. If you know someone who has cancer, keep in mind that what happens to them could be very different from what happens to someone else with another type of cancer.

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How is cancer diagnosed?

If your doctor suspects cancer you are likely to need more tests, such as x-rays, blood tests, or a biopsy. In most cases a biopsy is the only way to be sure whether or not cancer is present.

To do a biopsy a piece of the lump or abnormal area is taken out and sent to the lab. There a pathologist (a doctor who specializes in diagnosing diseases) looks at the cells under a microscope to see if cancer cells are present. If there are cancer cells the doctor tries to figure out what type of cancer it is and whether it is likely to grow slowly or more quickly.

Scans can measure the size of the cancer and can often show if it has spread to nearby tissues. Blood tests can tell doctors about your overall health, show how well your organs are working, and give information about blood cancers.

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How is cancer treated?
Surgery, chemotherapy, and radiation are the 3 main types of cancer treatment. A person with cancer may have any or all of these treatments.

Surgery

Surgery is often the first treatment option if the cancer is a tumor that can be removed from the body. Sometimes only part of the cancer can be removed. Radiation or chemotherapy might be used to shrink the cancer before or after surgery.

Chemotherapy

Doctors use chemotherapy or “chemo” drugs to kill cancer cells. Usually, the drugs are given intravenously (IV or into a vein) or taken by mouth. Chemo drugs then travel throughout the body in the bloodstream. They can reach cancer cells that may have metastasized (spread) from the tumor.

Radiation therapy

Radiation therapy is treatment with high energy rays (such as x-rays) to kill or shrink cancer cells. The radiation may come from outside the body, called external radiation, or from radioactive materials placed right into the tumor (internal or implant radiation). Getting external radiation is a lot like getting an x-ray. It’s painless, but it can cause side effects.

Other types of cancer treatment

Other kinds of treatment you might hear about include hormone therapy, stem cell or bone marrow transplant, and immunotherapy. Hormone therapy is sometimes used to treat certain kinds of prostate and breast cancers. Immunotherapy is treatment designed to boost the cancer patient’s own immune system to help fight the cancer. If you’d like more information on these treatments, see the “To learn more” section.

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What are the side effects of cancer treatment?
The type of treatment a person gets depends on the type and stage (extent) of the cancer, the age of the patient, and his or her medical history and general health. Each drug or treatment plan has different side effects. It’s hard to predict what side effects a patient will have, even if patients get the same treatment. Some effects can be severe and others fairly mild. It’s true that some people have a tough time with cancer treatment, but many others manage quite well throughout treatment. And most cancer treatment side effects can be treated.

Chemo side effects

Short-term (and often treatable) side effects of chemo can include nausea and vomiting, loss of appetite, hair loss, and mouth sores. Because chemo can damage the blood-making cells in the bone marrow, patients may have low blood cell counts. This can lead to:

  • Higher risk of infection (from a shortage of white blood cells)
  • Bleeding or bruising after minor cuts or injuries (from a shortage of blood platelets)
  • Anemia (from low red blood cell counts), which can cause tiredness, shortness of breath, pale skin, and other symptoms

Cancer care teams must work carefully with the patient to manage the side effects of chemo.

Everyone will respond differently to chemo. Most of the side effects of chemo go away after treatment ends. For example, hair lost during treatment grows back after treatment is over. In the meantime, most patients are able to use wigs, scarves, or hats to cover, warm, or protect their heads.

Radiation side effects

Radiation treatments are much like x-rays and are not painful. The most common side effects are skin irritation and fatigue (fuh-teeg). Fatigue is a feeling of extreme tiredness and low energy that does not get better with rest. It’s especially common when treatments go on for many weeks. Other side effects can happen, too, depending on what part of the body is being treated.

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Is cancer treatment worse than cancer?

This is a belief that can be dangerous to many people. People who think this is true might not get treatment that can save their lives.

It’s easy to understand one of the sources of this belief. Often people diagnosed with early cancer have not yet had any symptoms or pain, or the problems they’ve had have been fairly small. In the early stages of cancer, symptoms tend to be minor, if there are any at all. It’s often only after the treatment begins that people start to feel sick. It’s also true that chemo, radiation, and surgery can cause distressing symptoms. But the side effects fade after the treatment is over, and the treatment can be life-saving for many people.

If cancer is allowed to progress without treatment, symptoms get worse and new symptoms build up over time. Symptoms differ based on the type of cancer and the locations to which it spreads.

Sometimes a person in very poor health may not be able to take cancer treatment. Or because of age and other health conditions, the person might decide not to be treated for cancer, even knowing that it will result in death. A person in this situation may have learned that cancer treatment will not offer a chance for cure, and decide that it’s not worth the time it will take or the effects it will cause. This is every person’s choice, as long as the person is a competent adult who is able to handle his or her affairs.

A person who is thinking of refusing cancer treatment should talk with the doctor to clearly understand the likely outcomes of both treatment and non-treatment before making a decision.

Later in the course of cancer, when more serious symptoms start, curative treatment may not be an option. Cancer kills by invading the intestines, lungs, brain, liver, kidneys, or other vital organs, interfering with body functions that are necessary for life. Untreated cancer commonly causes death.

In contrast, cancer treatment can be fairly short term and often saves lives—especially when cancer is found and treated early. Even when it cannot cure the cancer, treatment can often prolong life. And medical care can always be used to make a person more comfortable by reducing pain and other symptoms. This is why it’s important for a person to know the goal of each course of treatment, and make informed decisions throughout the cancer experience.

There are times when every person being treated for cancer questions their commitment to the difficult journey of treatment and its side effects. Sometimes they get discouraged by the uncertainty of treatment and wonder if it’s worth it. This is normal. It may help to know that doctors are always learning better ways to work with patients to control treatment side effects. And remember each year brings advances in cancer treatments.

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Cancer is NOT contagious.

A healthy person cannot “catch” cancer from someone who has it. There is no evidence that close contact or things like sex, kissing, touching, sharing meals, or breathing the same air can spread cancer from one person to another.

Cancer cells from one person are generally unable to live in the body of another healthy person. A healthy person’s immune system recognizes foreign cells and destroys them, including cancer cells from another person.

Cancer transfer after organ transplant

There have been a few cases in which organ transplants from people with cancer have been able to cause cancer in the person who got the organ. But there’s a major factor that makes this possible – people who get organ transplants take medicines that weaken their immune systems. This must be done so their immune system won’t attack and destroy the transplanted organ. This seems to be the main reason that cancer in a transplanted organ can, in rare cases, give cancer to the person who gets the organ. Organ donors are carefully screened to help keep this from happening.

Still, recent studies have shown that cancer is more common in people who get solid-organ transplants than in people who don’t – even when the donor doesn’t have cancer. This is also probably due to the drugs that are used to reduce the risk of transplant rejection. These drugs weaken the immune response and make the immune system less able to recognize and attack pre-cancer cells and the viruses that can cause cancer.

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Cancer transfer during pregnancy
Even if a woman has cancer during pregnancy, the cancer rarely affects the fetus directly. Some cancers can spread from the mother to the placenta (the organ that connects the mother to the fetus), but most cancers cannot affect the fetus itself. In a few very rare cases, melanoma (a form of skin cancer) has been found to spread to the placenta and the fetus.
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Germs are often contagious.
We know that germs (mainly bacteria and viruses) can be passed from person to person through sex, kissing, touching, and sharing or preparing food. Some can even be spread by breathing the same air. But germs are much more likely to be a threat to a person with cancer than to a healthy person. This is because people with cancer often have weakened immune systems (especially when they are getting treatment), and they may not be able to fight off infections very well.
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Germs can affect cancer risk.
There are some germs that can play a role in the development of certain types of cancer. This may lead some people to wrongly think that “cancer is catching.”
Viruses

We know that some forms of cancer are found more often in people who are infected with certain viruses. For example:

  • Certain types of human papilloma viruses (HPVs) are linked to cancers of the cervix, vagina, vulva, penis, anus, and some cancers of the mouth, throat, head, and neck. But smoking, drinking, and other factors increase the risk of these cancers, too.
  • Epstein-Barr virus (EBV) is linked to nose and throat (nasopharyngeal) cancer, lymphoma of the stomach, Hodgkin lymphoma, and Burkitt lymphoma.
  • Hepatitis B virus (HBV) and hepatitis C virus (HCV) are linked to long-term (chronic) liver infections, which can raise the risk of liver cancer (hepatocellular carcinoma).
  • Human herpes virus Type 8 (HHV-8), also called Kaposi sarcoma herpes virus (or KSHV), is linked with a type of cancer called Kaposi sarcoma. Most people with HHV-8 do not develop Kaposi sarcoma unless they are also infected with human immunodeficiency virus (HIV), the virus that causes AIDS. A few may get Kaposi sarcoma if they are taking medicines that weaken their immune systems (such as those used after an organ transplant).
  • Human T-lymphotropic virus-1 (HTLV-1) is linked with certain types of lymphocytic leukemia and non-Hodgkin lymphoma (NHL).
  • Invasive cervical cancer, Kaposi sarcoma, and certain lymphomas are much more common in people who are infected with the human immunodeficiency virus (HIV), the virus that causes AIDS. In many cases of HIV-related cancer, other viruses (such as HHV-8 or HPV) also play a major role in the cancer’s growth and development.

These viruses can be passed from person to person (usually through blood or sex), but the viral infection alone usually does not lead to cancer. A weakened immune system, other infections, other risk factors (such as smoking), and other health problems allow cancer to develop more readily.

Bacteria

Bacteria can also promote cancer. Helicobacter pylori is a common bacterium now known to be linked to certain kinds of cancer in the stomach. Long-term infection with these bacteria can damage the inner layer of the stomach and increase the risk of stomach cancer.

Parasites

Certain parasitic worms that can live inside the human body can also increase the risk of developing some kinds of cancer. Parasites that can cause cancer are rarely found in the United States or other developed countries, but they are linked with cancer of the bladder and the bile ducts, and possibly other cancers, too.

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Cancer develops because your DNA changes.
Most cancers do not appear to be caused or affected by infectious agents. Cancer develops because of mutations (changes) that take place in a person’s DNA, the genetic blueprint in each cell. These changes may be inherited or develop during life. Some changes happen for no known reason, while others are due to environmental exposures, such as sun (UV) damage or cigarette smoke. Some viruses are known to directly cause mutations in DNA that can develop into cancer. Other germs promote cancer indirectly by causing chronic (long-term) inflammation, or by weakening a person’s immune system.
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Scientific studies shows that cancer does not spread like contagious diseases.

If cancer were contagious, we would have cancer epidemics just as we have flu epidemics – cancer would spread like measles, polio, or the common cold. We would expect a high rate of cancer among the families and friends of cancer patients and among health professionals because of their exposure to the disease. This is not the case.

The fact that cancer might happen more often in certain families does not mean that the family members have spread cancer to each other. There are other reasons this can happen:

  • Family members share the same genes.
  • Families may have similar unhealthy lifestyles (diet and smoking, for example).
  • Family members may all be exposed to the same cancer-causing agent.

Some people point to “clusters” of cancer patients who have had contact, directly or indirectly, with one another as proof that cancer is contagious. But scientists have found that these clusters almost never reflect a greater incidence of cancer than would be found in a random survey of the general public.

It’s also impossible to be sure that environmental factors and cultural factors such as diet and lifestyle are not responsible when studying the causes of clusters of cancers.

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People with cancer need to be around other people.

Even today, families, friends, and co-workers of people with cancer sometimes stay away when they learn about the disease. As a result, people with cancer often say they feel isolated and alone.

You don’t have to stay away from someone with cancer – you cannot “catch” it from them. Don’t be afraid to visit a person with cancer. They need your visits and support.

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Lifetime Risk of Developing or Dying From Cancer

The lifetime risk of developing or dying from cancer refers to the chance a person has, over the course of his or her lifetime (from birth to death), of being diagnosed with or dying from cancer. These risk estimates, like annual incidence and mortality data, provide another measure of how widespread cancer is in the United States.

The following tables list lifetime risks of developing and dying from certain cancers for men and women. The information is from the US National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) Database, and is based on incidence and mortality data for the United States from 2008 through 2010, the most current years for which data are available.

The risk is expressed both in terms of a percentage and as odds. For example, the risk that a man will develop bladder cancer during his lifetime is 3.82%. This means he has about 1 chance in 26 of developing bladder cancer (100/3.82 = 26). Put another way, 1 out of every 26 men in the United States will develop bladder cancer during his lifetime.

These numbers are average risks for the overall US population. Your risk may be higher or lower than these numbers, depending on your particular risk factors.

   
Males Risk of developing   Risk of dying from
       %     1 in   % 1 in
All invasive Sites 43.92 2   22.94 4
Bladder (includes in situ) 3.82 26   0.90 111
Brain and nervous system 0.69 145   0.50 200
Breast 0.13 769   0.03 3,333
Colon and rectum 5.01 20   2.07 48
Esophagus 0.80 125   0.79 127
Hodgkin disease 0.25 400   0.04 2,500
Kidney and renal pelvis 2.05 49   0.61 164
Larynx (voice box) 0.60 167   0.21 476
Leukemia 1.65 61   1.02 98
Liver and bile duct 1.23 81   0.87 115
Lung and bronchus 7.62 13   6.61 15
Melanoma of the skin 2.54 39   0.43 233
Multiple myeloma 0.80 125   0.46 217
Non-Hodgkin lymphoma 2.36 42   0.87 115
Oral cavity and pharynx 1.52 66   0.38 263
Pancreas 1.50 67   1.34 75
Prostate 15.33 7   2.71 37
Stomach 1.08 93   0.50 200
Testicles 0.39 256   0.02 5,000
Thyroid 0.55 182   0.05 2,000
 
 
 Females Risk of Developing Risk of Dying From
  % 1 in   % 1 in
All Invasive Sites 38.00 2   22.94 5
Bladder (Includes in Situ) 3.82 26   0.34 294
Brain and Nervous System 0.69 145   0.40 250
Breast 0.13 769   2.74 36
Colon and Rectum 5.01 20   0.23 435
Esophagus 0.80 125   1.90 53
Hodgkin Disease 0.25 400   0.21 476
Kidney and Renal Pelvis 2.05 49   0.03 3,333
Larynx (Voice Box) 0.60 167   0.34 294
Leukemia 1.65 61   0.05 2,000
Liver and Bile Duct 1.23 81   0.72 139
Lung and bronchus 7.62 13   0.45 222
Melanoma of the skin 2.54 39   0.43 20
Multiple myeloma 0.80 125   0.46 476
Non-Hodgkin lymphoma 2.36 42   0.87 270
Oral cavity and pharynx 1.52 66   0.38 263
Pancreas 1.50 67   1.34          75
Prostate 15.33 7   2.71 37
Stomach 1.08 93   0.50         200
Testicles 0.39 256   0.02 5,000
Thyroid 0.55 182   0.05 2,000
 
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Cancer Surveillance Programs in the United States

Cancer surveillance is the ongoing, timely, and systematic collection and analysis of information on new cancer cases, extent of disease, screening tests, treatment, survival, and cancer deaths. What that really means is that scientists and health officials are keeping an eye on cancer and tracking it for public health reasons.

This cancer information (data) can be used to look for trends over time, to find cancer patterns in certain regions or groups of people, and to show whether screening and other prevention measures are making a difference. For instance, the data can show differences in cancer rates and death in certain states or regions of the country.

Regions without such registries don’t know how many cancer cases there are in that location, or how many people die from cancer. Registries and surveillance information are key parts of cancer prevention and control efforts.

No single surveillance program in the United States collects data on all cancers diagnosed each year. Certain segments of the US population are covered by separate programs sponsored by government or private organizations, and these programs provide reliable data on their segments. These programs are built on a foundation of existing cancer registries or registries that are being set up throughout the country to record and report cancer cases in the areas they cover.

 

Cancer registries Data on cancer in the United States is collected through several systems of registries. The data collected depends on the purpose of the registry. Two types are:

  • Hospital registries, which may be part of a facility’s cancer program
  • Population-based registries, which are usually tied to state health departments

Hospital registries provide complex data used to evaluate patient care within the hospital. This data may be focused on things like care of the cancer patient and educating health care providers. Some hospitals pool their data and use the collected information to learn more about the course of cancer. They can be used in studies that compare patterns of care among providers, population subsets, or geographic regions.

Population-based registries, such as those under state health departments, collect information on all cases diagnosed within a certain geographic area. Population-based registries in cities and states collect and consolidate information from multiple reporting facilities within defined geographic regions that can include:

  • Hospitals
  • Doctors’ offices
  • Nursing homes
  • Pathology laboratories
  • Ambulatory care facilities
  • Radiation and chemotherapy treatment centers
  • Other cancer care facilities

These registries provide data that can show things like incidence (new cancer cases) and mortality (death) rates across regions of the country. They can look at cancer rates in certain types of jobs, or see whether cancer survival is improving. They can also watch cancer trends over time to find out if cancer rates are going up or down. They can be used to keep an eye on which age and racial groups are most affected by different types of cancer.

Information from cancer registries helps guide cancer prevention and control programs that are focused on changing certain behaviors (like smoking) and reducing other environmental risks. Cancer registries can help identify a need for cancer screening in a certain region or area.

Collecting the information

Registries are usually staffed with cancer registrars who have met stringent standards of training, testing, and continuing education. The highest level is Certified Tumor Registrar (CTR). These registrars locate timely, accurate, and complete cancer information to report to the registry.

Cancer registration begins with casefinding, or identifying people with cancer who have sought care at hospitals and other medical care settings. Most often, it’s the patient's doctor who starts the data record, noting the cancer site and type, patient demographics (certain aspects like gender, race, and age), and extent of disease (or stage) in the medical record. Some cancer registry programs require that the registrar summarize and record certain other information from the patient record, such as type of treatment, and follow up each year to track cancer recurrence and survival.

Confidentiality of personal information
Before any statistics or other cancer information is published, the law requires that identifying details be removed so that nothing can be traced back to any individual. This is sometimes called de-identified data.
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Major cancer surveillance programs
The following are brief descriptions of the major cancer surveillance programs in the United States.

National Cancer Data Base

Established in 1989, the National Cancer Data Base (NCDB) is a joint program of hospital registries of the Commission on Cancer (COC) and the American Cancer Society. Its purpose is to ensure quality cancer care by providing data to:

  • Evaluate patient management within hospitals and other treatment centers
  • Make comparisons of cancer care and outcomes between institutions
  • Set standards to help improve quality of cancer care

Groups of specialists design and monitor patient care evaluation (PCE) studies to provide timely information on patterns of care related to geographic, socioeconomic, and clinical factors. To share the results of PCE studies, the findings are presented at professional meetings and reports are published in peer-reviewed journals. More than 1,400 cancer treatment centers in the United States and Puerto Rico contribute data to the NCDB. The NCDB contains about 26 million records from hospital cancer registries.

 

The Surveillance, Epidemiology and End Results Program

The National Cancer Institute's (NCI) Surveillance, Epidemiology and End Results (SEER) program is a large population-based registry. It collects information from certain geographic areas which represent 28% of the US population, including:

  • Cancer incidence (new cases)
  • Survival
  • Prevalence (number of people living with cancer during a given time period)

SEER compiles reports on all of these, plus cancer mortality (deaths) for the entire United States.

The NCI contracts with non-profit organizations to collect data on new cancer diagnoses in these geographic locations. Cases are followed up each year to determine survival. The data, along with data on cancer-related deaths from the National Center for Health Statistics (NCHS), are analyzed and are published annually in the SEER Cancer Statistics Review.

 

National Program of Cancer Registries

The National Program of Cancer Registries (NPCR) of the Center for Disease Control and Prevention (CDC) supports population-based registries in state health departments. This program was established by the Cancer Registries Amendments Act in 1992 to respond to the need to collect data on larger percentages of state populations. This legislation authorizes the Centers for Disease Control and Prevention (CDC) to provide funds to states and territories to:

  • Improve existing cancer registries
  • Plan and set up registries where they do not exist
  • Develop model legislation and regulations for states to enhance success of registry operations
  • Set standards for completeness, timeliness, and quality
  • Provide training for registry staff
  • Help set up a computerized reporting and data processing system

State cancer registries today are computerized, and have many public health uses. They are designed to:

  • Monitor cancer trends over time.
  • Look for cancer patterns in different groups of people.
  • Guide planning and evaluation of cancer control programs. For instance, look at whether prevention, screening, and treatment efforts are making a difference.
  • Help set priorities for allocating health resources.
  • Advance clinical, epidemiologic, and health services research.
  • Provide information for a national data base of cancer incidence.

Before the NPCR was established, 10 states had no registry, and most states with registries lacked the resources and legislative support they needed to gather complete data. Today, the NPCR supports central cancer registries in 45 states, the District of Columbia, Puerto Rico, and the US Pacific Island Jurisdictions. The data represent 96% of the US population.

Together, the NPCR and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program collect data for the entire US population.

The future for registries
Future directions for cancer registries include support of more electronic information sharing. It’s hoped this will allow better studies on things like access to care for people with cancer and survivorship. The CDC is already planning ways to let research be done on de-identified cancer information, which should result in doctors getting more complete information on cancer and its care.
Economic Impact of Cancer

The financial costs of cancer are high for both the person with cancer and for society as a whole.

The National Institutes of Health (NIH) estimated the 2009 overall annual costs of cancer were as follows:

    Total cost: $216.6 billion

    Direct medical costs (total of all health expenditures): $86.6 billion

    Indirect mortality costs (cost of lost productivity due to premature death): $130 billion

PLEASE NOTE: These estimates are not comparable to those published in Cancer Facts & Figures before 2012 because in 2011, the NIH began using a different data source: the Medical Expenditure Panel Survey (MEPS) of the Agency for Healthcare Research and Quality. The MEPS estimates are based on more current, nationally representative data and are used extensively in scientific publications. As a result, direct and indirect costs will no longer be projected to the current year, and estimates of indirect morbidity costs have been discontinued. For more information, please visit www.nhlbi.nih.gov/about/factpdf.htm.

One of the major costs of cancer is cancer treatment. But lack of health insurance and other barriers to health care prevent many Americans from even getting good, basic health care.

    • According to the US Census Bureau, about 48.6 million people were uninsured in 2011.
    • About 10% of children in the United States had no health insurance coverage in 2011.

And according to Cancer Facts & Figures 2014, “Uninsured patients and those from ethnic minorities are substantially more likely to be diagnosed with cancer at a later stage, when treatment can be more extensive and more costly.” In fact, this leads not only to higher medical costs, but also poorer outcomes and higher cancer death rates.

This year, about 585,720 US residents are expected to die of cancer – that’s more than 1,600 people a day. Cancer is the second most common cause of death in the United States, exceeded only by heart disease. Cancer accounts for nearly 1 out of every 4 deaths in the United States.

Cancer costs us billions of dollars. It also costs us the people we love. Reducing barriers to cancer care is critical in the fight to eliminate suffering and death due to cancer.

Contact your American Cancer Society any time, day or night, for cancer information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

The History of Cancer
Download Printable Version (PDF)
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Cancer Information on the Internet

For many people, the Internet has become the first place to go when looking for information. You can get instant access to almost any topic you can think of – including a lot of cancer information. People facing cancer often use this information to make decisions about their illness and treatment. Some of this information is more reliable than the rest, but it can be hard to tell at first glance.

On many websites you can find basic facts about certain types of cancer, locate the most current clinical trials, and find support in dealing with cancer. You can also get vast amounts of information on research studies, doctors and hospitals, cancer treatment guidelines, drugs, and complementary and alternative treatment methods. But, unfortunately, a lot of what passes for cancer information on the Internet is made up of opinion, salesmanship, testimonials, and other information that isn’t grounded in careful science. It may take some extra time and effort, but you need to find accurate information. The wrong information can hurt you when it comes to cancer.

Here are some ideas on what to look for and what to avoid as you look for the information you need to make the best possible decisions.

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User beware

Cancer information on the Internet comes from many different sources – expert health organizations, government agencies, universities, merchants, interest groups, the general public, and scam artists. Many of these sources are people or groups that really want to help others learn more. But because anyone can post any kind of information online, some people may be passing along information that’s limited, inaccurate, or just plain wrong. Some will even try to deceive you.

Scam artists and other dishonest people use the Internet for 2 main reasons: low cost and relative anonymity (no one knows who they are). Selling a product (bogus or not) over the Internet costs much less money than opening and running an actual store. What’s more, you can get your message or product out to people all over the world. All it takes is a computer, some basic web design knowledge, and a host to set up a website. For social media and other such accounts, a person may only need Internet access and a smartphone to start sending out information. (We will not cover that separately here. But the same questions and concerns apply).

The impersonal nature of the web makes it easier to mislead people. For example, if you saw a sign in front of a small, run-down store that claimed it was the largest supplier of medical devices in the United States, you’d probably be suspicious right away. But if you saw a professional-looking site on the Internet making the same claim, you might have a harder time deciding if it was real. Both of these might be run by the same person. There may be no way for you to know if a professional-looking site is run by a lawful organization or by a few people who are just out to make money.

This is not to say that you shouldn’t trust anything on the Internet – just that you have to choose your sources carefully. Even on trusted, highly regarded websites, it’s important to note that the health information is just general information that might not apply to you at all. Always remember that the information found on the Internet should not take the place of medical advice. If you have a health-related problem, please talk to a doctor. There’s no other way to get the same experience and care as sitting down with a doctor who can look at your health history, your unique medical situation, examine you, and talk with you about how you’ve been feeling.

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Other Sources of Cancer Information
Research Starting Points

These sources should be used for informational purposes only*. If you have a health-related problem, please consult a doctor.

General Cancer Information
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Specific Cancers
Bladder Cancer Bone Metastasis Brain Tumors Breast Cancer Carcinoid Tumors Cervical Cancer Childhood Cancers Colorectal Cancer Endometrial (Uterine) Cancer Eye Cancer Head and Neck Cancers (Includes Mouth and Throat Cancers) Hodgkin Disease

See Leukemias, Lymphomas & Other Blood Disorders

Kidney Cancer (Adult) Leukemias, Lymphomas & Other Blood Disorders Liver Cancer Lung Cancer Lymphoma

See Leukemias, Lymphomas & Other Blood Disorders

Melanoma

See Skin Cancers

Mesothelioma Multiple Myeloma Nasopharyngeal Cancer

See Head and Neck Cancers

Non-Hodgkin Lymphoma

See Leukemias, Lymphomas & Other Blood Disorders

Oral Cavity & Oropharyngeal Cancer

See Head and Neck Cancers

Osteosarcoma

See Childhood Cancers

Ovarian Cancer Pancreatic Cancer Pituitary Tumors Prostate Cancer Sarcoma

Skin Cancer (Includes Melanoma and Non-melanoma Cancers)

Thyroid Cancer

Urinary Bladder Cancer See Bladder Cancer

Waldenstrom's Macroglobulinemia

  • International Waldenstrom's Macroglobulinemia Foundation (www.iwmf.com)
Rare Cancers

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Other Sources of Cancer information
Cancer Prevention and Early Detection
Tobacco
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Cancer Treatment
Radiation Therapy Chemotherapy Bone Marrow/Stem Cell Transplant Newer or Experimental Therapies
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Clinical Trials
Complementary & Alternative Therapies
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Patient Services and Support
Financial/Insurance Matters Hospice Pain and Palliative Care Other Patient Services & Support
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Additional Cancer Resources
Cancer Biology Cancer Statistics Hospital and Doctor Directories International Cancer Resources Medical Articles and Journals Newsgroups, Message Boards, Mailing Lists, etc. Nutrition Professional Resources Pharmaceutical and Biotech Companies
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Other Health Resources
Government Sites Other Health & Disease Information Other

*Inclusion on this list does not imply endorsement by the American Cancer Society.

Americans with Disabilities Act
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Americans With Disabilities Act: Information for People Facing Cancer
What is the Americans with Disabilities Act?

The Americans with Disabilities Act of 1990 (ADA) protects the civil rights of people with disabilities. It can help people with disabilities gain equal opportunity in:

  • Employment
  • Public accommodations (places that are generally open to and used by the public)
  • Transportation
  • State and local government services
  • Telecommunications
What is a disability under ADA?

The Americans with Disabilities Act may apply to you if:

  • You have a physical or mental problem that substantially limits one or more of your “major life activities”
  • You have a record of having had such a problem in the past.
  • Other people think you have such a problem, even if you do not actually have it.

Some of the “major life activities” covered by ADA include but are not limited to caring for yourself, doing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working.

On January 1, 2009, the ADA Amendments Act of 2008 went into effect. It made some major changes to the way the definition of disability had been interpreted under ADA in the past. The 2008 Amendments Act covers major body functions, including but not limited to functions of the immune system, normal cell growth, digestive, bowel, bladder, brain and nervous system, respiratory, circulatory, endocrine, and reproductive systems. These changes can help people with cancer, because in the past they often had a hard time meeting the definition of disability.

The next section deals only with employment discrimination, a potential problem for people who have or have had cancer. The part of the ADA that applies to jobs is called Title I. After the discussion of jobs, there is information about the ADA in settings and situations other than the workplace. The sections of the ADA that apply to these different settings and situations are Titles II through IV.

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Questions and answers about employment discrimination
Does the ADA apply to my employer?

The law applies to employers with 15 or more employees. Job discrimination against people with disabilities by these employers is not legal if practiced by:

  • Private employers
  • State and local governments
  • Employment agencies
  • Labor organizations
  • Labor management committees

Employees of the US government are not covered under the ADA. But they have the same protections under a different law, which is enforced by the Office of Federal Operations of the EEOC. To file a complaint, a federal employee must first contact an equal employment opportunity counselor at the agency in which they believe the discrimination took place. You can read more about these protections at www.eeoc.gov/federal/fed_employees/index.cfm.

 
Whom does the ADA cover?

In order to be protected by the ADA at work, the ADA must apply to your employer. And, you must be qualified for and able to perform the “essential functions” of the job. (See the section called “What are the essential functions of a job under ADA?”)

Although the ADA defines the term disability, it does not include a list of conditions that are always considered disabilities. Instead, each case must be looked at on its own merits.

According to the United States Equal Employment Opportunities Commission (EEOC), cancer is not always considered a disability. The ADA can help protect you when cancer prevents or makes it very hard for you to do everyday tasks such as household chores, bathing, and brushing your teeth. But this kind of disability must be permanent or long-term.

The ADA protects you if you had cancer in the past, but are doing well now. An employer may not discriminate against you because you used to be sick.

The ADA also prevents an employer from discriminating against you if he or she thinks you are sick, even if you aren’t.

 
Which employment practices does the ADA cover?

If you have a disability and are qualified for a job, the ADA does not allow the employers noted above to discriminate in employment practices, such as:

  • Recruiting and advertising for job openings
  • Job application and hiring
  • Training
  • Job assignments
  • Tenure
  • Promotions
  • Pay
  • Benefits
  • Leave
  • Firing
  • Lay off
  • All other employment-related activities, terms, conditions, and privileges

An employer cannot take action against you because you ask for your rights under the ADA. The Act also protects you if you are discriminated against because of your family, business, social, or other type of relationship or association with a person who has a disability. For instance, this means an employer cannot discriminate against you because your spouse or child has cancer.

Still, the ADA does not completely protect your job just because you have a disability and are qualified for the job. The employer can still fire or lay off (terminate) an employee with a disability for legitimate business reasons. For instance, a disabled worker would not be protected during downsizing.

 
What does the ADA consider to be essential job functions?

If you have a disability, you must be qualified to perform the essential functions of a job in order to be protected from job discrimination by the ADA. Essential functions are the fundamental duties required by the job itself. An employer cannot refuse to hire you because your disability prevents you from performing duties that are not essential to the job.

But you must satisfy the employer’s job requirements such as education, employment experience, skills, or licenses. Employers are not required to lower their job standards to accommodate someone with a disability. Nor do they have to provide personal-use items such as glasses or hearing aids.

You also must be able to perform the essential functions of the job either on your own or with reasonable accommodation (see definition of accommodation in the next section).

 
What does the ADA consider to be reasonable accommodation?

Reasonable accommodation is how an employer makes adjustments to a job that allow an employee with a disability to perform the essential functions of that job. But reasonable accommodation can start even before hiring; for example, it may be a change in procedure that allows a qualified disabled person to apply for a job.

For those already working, reasonable accommodation can be a change that allows disabled people to enjoy benefits and privileges of employment the same as those enjoyed by employees without disabilities. Examples of reasonable accommodations may include:

  • Providing equipment or devices, or adapting them so the person with a disability can use them
  • Restructuring a job
  • Changing work schedules
  • Reassigning the employee to a vacant position
  • Adjusting or modifying tests, training materials, or policies
  • Providing e-readers and/or interpreters
  • Making the workplace easy to get into and use by people with disabilities

An employer must accommodate a qualified applicant or employee with a disability unless the employer can show that making the accommodation would not be reasonable. That means that the accommodation would be very difficult or expensive (an “undue hardship”). These factors include the type and cost of the accommodation in relation to the size, resources, nature, and structure of the employer’s operation. In general, a larger employer would be expected to make accommodations requiring greater effort or expense than would be required of a smaller employer.

The facts of your case will help determine whether an accommodation will make it possible for you to do the job and, if so, what kind of accommodation is needed. Employers do not have to know about every kind of disability to know whether or how to make a reasonable accommodation. They are required to accommodate only those disabilities they know about and that do not cause too much hardship for the employer. The requirement is usually triggered by a request from a person with a disability, who often can suggest a workable accommodation.

Accommodations must be made on a case-by-case basis because the type and extent of a disability and the requirements of the job will vary in each case. If you don’t ask for an accommodation, the employer is not required to provide one. If you ask for an accommodation, but cannot suggest one that will work for you, you and the employer should work together to identify one. There are also many public and private resources that can provide help without cost. See the “To learn more” section for some places to start.

 

What are employers allowed to ask job applicants with disabilities under ADA?

When you apply for a job, employers can’t ask you if you are disabled. They also cannot ask about the type or how severe a disability you have. Employers may not ask you if you have or have ever had cancer. They can’t ask about the medicines you take, or past illness. But they can ask you about your ability to perform certain job tasks. An employer can ask you to describe or show them how, with or without reasonable accommodation, you will perform the duties of the job.

If all new employees in similar jobs are required to have a medical exam, you may be offered a job conditionally, pending the results of a medical exam. The medical exams must be related to the job and in line with the employer’s business needs. But an employer cannot reject you because of information the medical exam reveals about your disability unless the reasons for rejection are related to the job and necessary to conduct the employer’s business. The results of all medical exams must be kept confidential. Medical files must be kept separate from work or personnel files.

 
Should I tell my employer I have a disability?

If you think you will need accommodation in order to apply for a job or to perform essential job functions, you should tell the employer that you have a disability. Employers are only required to provide reasonable accommodation if they know about the disability. Generally, the employee is the person who must tell the employer that an accommodation is needed. But you are not required to offer information about having cancer or another disability when you apply for a job.

 
Does my employer have to provide any accommodation I request?

No. There is some flexibility built into the reasonable accommodation requirement under the ADA. For example:

  • Employers can choose among effective accommodation options and do not always have to provide the accommodation that the employee requests.
  • Employers do not have to provide accommodations that pose an undue hardship for them.
  • Employers do not have to provide personal-use items that are needed for daily activities both on and off the job.
  • Employers do not have to make an accommodation for a person who isn’t otherwise qualified for the job.
  • Employers do not have to remove essential functions, create new jobs, or lower production standards to accommodate a disabled employee.
 
Under ADA, does the employer have to hire a qualified applicant with a disability over other qualified applicants?

No. The ADA does not require an employer to hire a person with a disability over other applicants because the person has a disability. The ADA only prohibits discrimination on the basis of disability. It makes it unlawful to refuse to hire a qualified applicant with a disability just because he or she is disabled. It’s also unlawful to refuse to hire the qualified person because a reasonable accommodation is required to make it possible for this person to perform essential job functions.

 
Do I have to pay for it if I need reasonable accommodation under ADA?

Generally, no. The ADA requires the employer to provide the accommodation unless doing so would cause an undue hardship on the employer’s business. If the cost of providing the needed accommodation would be too much, you must be given the choice of:

  • Providing the accommodation yourself, or
  • Paying for the portion of the accommodation that causes the undue hardship

An employer cannot make up the cost of providing a reasonable accommodation by lowering your salary or paying you less than other employees in similar jobs. Typically, employers don’t pay a lot to accommodate employees with disabilities. When asked, employers noted that most accommodations cost nothing; those that did cost averaged $500 or less.

 
Under ADA, can an employer offer a health insurance policy that excludes coverage for pre-existing conditions?

Yes. The ADA does not affect pre-existing condition clauses in health insurance policies. But other laws now limit the employer’s use of pre-existing condition exclusions for employees in group health plans. See our document, Health Insurance and Financial Assistance for the Person With Cancer, and our booklet, The Health Care Law: How It Can Help People With Cancer and Their Families for more information.

 

If the health insurance offered by my employer does not cover all medical expenses related to my disability, does the company have to get extra coverage for me under ADA?

No. The ADA only requires an employer to provide employees with disabilities equal access to whatever health insurance coverage is offered to other employees. The same is true for employees with cancer or for employees who have family members with cancer or a history of cancer.

 
Under ADA, does an employer have to make non-work areas used by employees, such as cafeterias, lounges, or employer-provided transportation, accessible to people with disabilities?

Yes, unless making these changes would pose an undue hardship on the employer. Employers must accommodate the disabled person for all services, programs, and non-work facilities they provide, if the changes are reasonable. If making an existing facility accessible would be an undue hardship, the employer can provide a comparable facility that will let a person with a disability enjoy the same benefits and privileges of employment as those enjoyed by other employees, unless doing so also would be an undue hardship.

 
What agency enforces ADA job protections?

The Equal Employment Opportunities Commission (EEOC), along with state and local civil rights enforcement agencies, enforces the part of the ADA that covers employment protection.

 
What should I do if I think I’m being discriminated against in a work situation because of my disability?

You have a limited time to act, although the time limit varies by employer and the state in which you work. If you think you have been discriminated against at work because of a disability, you can file a complaint with an Equal Employment Opportunity Commission (EEOC) field office located in certain cities throughout the United States. If you work for a state or local government, the process is the same as for a private employer. A discrimination charge generally must be filed with the EEOC within 180 days of the action that you think is discriminatory. You can contact EEOC at 1-800-669-4000.

If you work for the US government, you have only 45 days to contact your agency EEOC officer, and the process is somewhat different from that for private employers. See the section “Questions and answers about employment discrimination.”

If your state or local laws cover discrimination on the basis of disability, the charge must be filed with the proper state or local fair employment practice agency within 300 days of the discriminatory action. EEOC field offices can refer you to the agencies that enforce those laws (see the “To learn more” section). But to protect your rights, it’s best to contact the EEOC right away if you suspect discrimination, at 1-800-669-4000.

If the EEOC decides that you have been discriminated against, you are entitled to a remedy that will place you in the position you would have been in if the discrimination had never occurred. You may be entitled to hiring, promotion, reinstatement, back pay, or reasonable accommodation, including reassignment. You also may be entitled to have your legal fees paid. Keep in mind that these decisions may take a long time depending on the nature of the claim and how it’s resolved.

If the EEOC does not find proof that discrimination has occurred, or when attempts to resolve the problem have failed and the EEOC decides not to sue on your behalf, you can request a “right to sue” letter from the EEOC 180 days after filing your complaint. After you get this notice of right to sue, you have 90 days to file the suit. If you sue, you may want to hire a private attorney to represent you.

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How the ADA can help in settings other than work
This section deals only with discrimination in settings other than work.
 
What are “public accommodations” as defined by ADA?

Places of public accommodation are those generally open to everyone, such as restaurants, hotels, theaters, doctors’ offices, drug stores, retail stores, museums, libraries, parks, private schools, and day care centers.

The ADA requires the property administrators of these kinds of public places to remove barriers when it is “readily achievable” to do so. This means that it must be fairly easy to do without much trouble or expense. Examples of removing barriers would include making a simple ramp over a few steps or other modest adjustments to parts of a public place’s physical structure that may impose barriers for people with disabilities.

Private clubs and religious organizations are not required to meet the ADA’s requirements for public accommodations.

The United States Department of Justice enforces the ADA requirements in 3 areas:

  • Title I: Employment practices by units of state and local government (remember that the EEOC enforces most work-related practices.)
  • Title II: Programs, services, and activities of state and local government, including public transportation
  • Title III: Public accommodations and commercial facilities (private businesses and non-profit service providers). This can include privately owned or privately run transportation, movie theaters, restaurants, stores, doctors’ offices, fitness centers, zoos, convention centers, private schools, day care centers, homeless shelters, funeral homes, and more.

Title IV of the ADA covers people with hearing and speech problems, and is enforced by the Federal Communications Commission (the FCC). See the “To learn more” section for more on those rules, or visit www.fcc.gov/cgb/dro/title4.html.

 
Where can I find information about discrimination in areas other than employment?

The US Department of Justice has a toll-free ADA Information Line (1-800-514-0301). This service permits businesses, state and local government officials, or others to call and ask questions about general or specific ADA requirements, including questions about the ADA Standards for Accessible Design.

ADA specialists are available Monday through Friday from 9:30 a.m. until 5:30 p.m. (Eastern Time) except on Thursdays, when the hours are 12:30 p.m. until 5:30 p.m. A Spanish language service is also available.

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To learn more
More information from your American Cancer Society

Here is more information you might find helpful. You also can order free copies of our documents from our toll-free number, 1-800-227-2345, or read them on our website, www.cancer.org.

Family and Medical Leave Act (FMLA) (also in Spanish)

Financial Guidance for Cancer Survivors and Their Families: In Treatment (also in Spanish)

Financial Guidance for Cancer Survivors and Their Families: Off Treatment

Coping with Cancer in Everyday Life (also in Spanish)

What is HIPAA? (also in Spanish)

The Health Care Law: How It Can Help People With Cancer and Their Families (also in Spanish)

National organizations and websites*

Along with the American Cancer Society, other sources of information and support are listed here. Some have more specific information about ADA requirements affecting employment.

Job and work-related disability problems

Job Accommodation Network
Toll-free number: 1-800-526-7234
TTY: 1-877-781-9403
Website: www.askjan.org

    This is a free consulting service of the US Department of Labor that gives information on the ADA, your rights, how to talk to an employer, and how to ask for accommodations. A list of available publications can be found online at http://askjan.org/pubsandres/list.htm

US Equal Employment Opportunity Commission (EEOC)
Toll-free number: 1-800-669-4000
TTY: 1-800-669-6820
Website: www.eeoc.gov

    How to find EEOC offices in your area; how to file charges of workplace discrimination; information on federal equal employment opportunity regulations, practices, and policies; publications such as Questions and Answers About Cancer in the Workplace and the Americans with Disabilities Act (ADA), which has special information for people with cancer. It’s on the EEOC website at www.eeoc.gov/facts/cancer.html

Americans with Disabilities Act Technical Assistance -- US Department of Justice
Toll-free number: 1-800-514-0301
TTY: 1-800-514-0383
Website: www.ada.gov

    Specialists answer questions about the ADA and the programs, services, and activities of state and local governments. The website has a list of free booklets and publications you can order or read online, many of which are available in other languages.

Social Security Administration (SSA)
Toll-free number: 1-800-772-1213
TTY: 1-800-325-0778
Website: www.socialsecurity.gov

    Has general information, qualification criteria, and information about how to apply for program benefits (such as Social Security Disability Income and Supplemental Security Income) if you cannot work. Makes referrals to local SSA and Medicare/Medicaid offices

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Other problems caused by disability
Easter Seals Project ACTION
Toll-free number: 1-800-659-6428
TTY: 202-347-7385

Website: www.projectaction.org

    For more specific information about accessibility and transportation services for people with disabilities

Federal Communications Commission
Toll-free number: 1-888-225-5322
TTY: 1-888-835-5322
Website: www.fcc.gov/cgb/dro/trs.html

    For TRS (Telecommunications Relay Services, which allow people with hearing or speech disabilities to place and receive phone calls) questions and fact sheets; also offers technical assistance on ADA telephone service requirements

American Speech-Language-Hearing Association (ASHA)
Toll-free number: 1-800-638-8255
TTY: 301-296-5650
Website: www.asha.org

    Provides information and support so that all people with speech, language, and hearing disorders have access to quality services to help them communicate

Federal Transit Administration
Toll-free number: 1-888-446-4511 (FTA ADA Assistance Line, voice/relay)
TTY: 1-800-877-8339
Website: www.fta.dot.gov/civilrights/civil_rights_2360.html

    For problems with public transportation only; to get information or file a complaint

United States Access Board
Toll-free number: 1-800-872-2253
TTY: 1-800-993-2822
Website: www.access-board.gov

    Has specific information on accessibility requirements for people with disabilities. The Board develops and maintains design criteria for the built environment, transit vehicles, telecommunications equipment, and for electronic and information technology

*Inclusion on this list does not imply endorsement by the American Cancer Society.

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

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References

Equal Employment Opportunity Commission, Disability Discrimination. Accessed at www.eeoc.gov/laws/types/disability.cfm on October 26, 2012.

Job Accommodation Network. Accessed at www.askjan.org on October 26, 2012.

Job Accommodation Network Fact Sheet Series (2011 update). Workplace Accommodations: Low Cost, High Impact.Accessed at http://askjan.org/media/LowCostHighImpact.doc on October 26, 2012.

Job Accommodation Network. Accommodation and Compliance Series: The ADA Amendments Act of 2008. Accessed at http://askjan.org/bulletins/adaaa1.htm on October 26, 2012.

US Department of Justice. ADA home page. Americans with Disabilities Act Information and Technical Assistance. Accessed at www.ada.gov on October 26, 2012.

US Department of Justice. A Guide to Disability Rights Laws, July 2009. Accessed at www.ada.gov/cguide.htm on October 26, 2012.

US Department of Labor, Office of Disability Employment Policy. Employment rights: Who has them and who enforces them. Accessed at www.dol.gov/odep/pubs/fact/rights.htm on October 26, 2012.

US Equal Employment Opportunity Commission. Filing A Charge of Discrimination. Accessed at www.eeoc.gov/employees/charge.cfm on October 26, 2012.

 
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