Cancer

Do all cases of DCIS breast cancer need aggressive treatment?

DEAR DOCTOR K: I have been diagnosed with ductal carcinoma in situ. My doctor wants me to have surgery. But recently I read about a study that said not all women with this type of breast cancer even need to be treated. Can you help clear this up?

DEAR READER: Ductal carcinoma in situ (DCIS) is a type of breast cancer. In DCIS, the cancerous cells are contained within the breast's ducts (which carry milk to the nipple) but have not invaded surrounding tissue.

What are the risks and benefits of mammograms?

DEAR READERS: In yesterday's column, I answered a question from a 47-year-old woman who had never had a mammogram and wondered if she should have one. She had heard that one group of experts -- the American Cancer Society (ACS) -- had recently changed its recommendations on this issue.

When should I start getting mammograms?

DEAR DOCTOR K: I'm a 47-year-old woman who has never had a mammogram. Some experts recommend I get one, but others do not. I understand that the American Cancer Society recently updated its recommendations about breast cancer screening. Does it say I should have a mammogram? If so, which experts should I believe?

DEAR READER: I'm surprised when people are bothered by medical experts having different opinions. Expert politicians, expert lawyers, expert architects -- experts of all kinds disagree with each other all the time. Why? Because it is rare for the "truth" of any question to be clear beyond dispute.

Can aspirin really help to prevent cancer?

DEAR DOCTOR K: I read that aspirin might help to prevent cancer. Is there anything to this idea?

DEAR READER: Open any medicine cabinet in America and you're likely to find a bottle of aspirin. Aspirin has been on the market for more than 110 years. It's an old standby for fighting fever, quieting inflammation and reducing pain. For some, it can help prevent a heart attack or stroke. And growing research points to a possible new benefit for this old friend: reducing the risk of dying from cancer.

What is the treatment for melanoma?

DEAR DOCTOR K: My doctor just discovered that I have melanoma, but didn't really explain the treatment. Can you tell me what I'm in for?

DEAR READER: Melanoma is skin cancer that begins in the melanocytes -- cells that give skin its color. Usually these cells first form a precancerous condition called a dysplastic (diss-PLAS-tik) mole. Then the cells turn cancerous and start to reproduce aggressively.

My doctor advised active surveillance for my prostate cancer. What does this mean?

DEAR DOCTOR K: After an abnormal PSA test and biopsy, I have been diagnosed with early-stage, non-aggressive prostate cancer. My doctor advised active surveillance. What does this mean?

DEAR READER: Prostate cancer is the uncontrolled growth of abnormal cells in the prostate. This walnut-sized gland sits below the bladder, in front of the rectum, near the base of the penis. Prostate cancer is common, but it is not always dangerous. People are often surprised to hear "cancer" and "not dangerous" in the same sentence.

What should I look for when I examine my skin for melanoma?

DEAR DOCTOR K: My aunt developed the skin cancer called melanoma, and I hear that this cancer can run in families. What should I look for when I examine my skin for melanoma?

DEAR READER: Skin cancers are the most common cancers in the United States, and skin checks are an important way to identify them. You asked about the deadliest type of skin cancer, melanoma. My Harvard Medical School colleague, dermatologist Dr. Kenneth Arndt, says that more than half of melanomas are identified by patients, either alone or with the help of a partner. That's important because more than 90 percent of cases can be cured with early detection and treatment. Skin carries out many functions that help maintain health. It forms a defensive barrier, protecting inner organs from foreign invaders such as bacteria and viruses.

I have basal cell skin cancer, what will happen during Mohs surgery?

DEAR DOCTOR K: I have basal cell skin cancer on my face and am scheduled to have Mohs surgery. Can you describe what will happen during the procedure?

DEAR READER: Skin cancer is the most common cancer in the United States. Basal cell cancer is a very slow-growing type of skin cancer. It is unlikely to spread to other parts of the body, and therefore is rarely life-threatening. The most common cause of basal cell cancer is damage from sun exposure. Basal cell carcinoma begins in basal cells, which are located deep in the skin. When these basal cells turn cancerous, they invade surrounding tissues, spreading downward and outward below the skin's surface.

Is cancer caused by risky behavior or bad luck?

DEAR DOCTOR K: I thought cancer was the result of risky behaviors like smoking and spending too much time in the sun. But then I read an article about cancer and bad luck. So which is it -- behaviors or luck?

DEAR READER: I know the article you are referring to, and I wasn't very happy with the way it was presented by the media. Let me start with the bottom line: Cancer is caused by (1) our genes, and by (2) our lifestyle (risky behaviors) and environment. It's not just one or the other. Sometimes genes that we inherit from our parents cause cancer. An example is the BRCA1 gene that causes some cases of breast cancer.

What happens during a bone marrow transplant?

DEAR DOCTOR K: I have leukemia. Thankfully, a family member was a bone marrow match. Can you tell me what to expect during my bone marrow transplant procedure?

DEAR READER: A bone marrow transplant can be a life-saving treatment. To understand how it works, you need to understand how blood cells are created. And what leukemia is. Your blood contains red and white blood cells. There are several types of white blood cells, which are a key part of your immune system. All your blood cells are made by blood stem cells, which live primarily in the spongy center of your big bones.