About Cancer

Like all warts, cervical warts are caused by a virus, the human papilloma virus (HPV). There are over 100 types of HPV, some types cause common skin warts, and others genital warts. There are about 30 types which can infect the cervix. If the cervix is infected with the virus this may cause visible warts but in many women infection can be only detected microscopically by a smear test.

Genital HPV is usually spread though direct sexual contact, including oral sex, but non-sexual infection, although rare, is also possible. The virus can also lie dormant in the body for many years. It would be wise not to assume anything about how you contracted the wart until you have had a full discussion with your husband about this. When transmission has occurred from an infected person, warts can take anything from a few weeks up to several months to appear. Generally the types of HPV that infect the skin of the hands and body don’t infect the genital area, so it would be very unusual to contract cervical warts in this way.
About half of the different types of HPV that can infect the cervix are associated with cervical cancer. The presence of the HPV infection in the cervix does increase the risk that mild abnormalities in the cervical tissue will progress to severe abnormalities and very occasionally to cervical cancer. However the overwhelming majority of HPV infections of the cervix never lead to cancer. Most HPV infections seem to go away by themselves, or with simple treatment from a specialist, without causing any cervical abnormalities. Cervical cancer can almost always be prevented by regular follow-up with cervical smears to detect and treat pre-cancerous changes before they go on to become invasive cervical cancer.

The most important thing to do now is to discuss the treatment and follow-up of the cervical wart with your specialist.


The short answer to your question is no, there is no link between sickle cell anaemia and cancer of any type.

Although sickle cell anaemia and cancer can both be serious illnesses, there is no link between the two conditions.  Sickle cell anaemia never turns into cancer, and people with sickle cell disease are not at any greater risk than other people of developing cancer.

Hydroxyurea is a drug sometimes used to treat sickle cell disease.  There are concerns that many years of treatment with hydroxurea can increase the risk of getting a ‘blood’ cancer but the risk is yet to be proven and appears to be small.

Sickle cell disease is due a faulty gene, which is inherited, so it runs in families.  It occurs mainly in people of African-Caribbean descent, and in some parts of central Africa is very common indeed.  It is also, much less commonly, found in people from parts of India, Saudi Arabia, Greece, Italy and North Africa.

If you inherit the sickle cell gene from just one parent then the condition is quite mild and usually causes no problems (this is called sickle cell trait), but if you inherit the gene from both your parents then this is sickle cell disease, which is much more serious.  However, over the last 25 years the treatment of the condition has improved a great deal and the outlook is very much better now than it used to be. 

For further information and support about sickle cell anaemia you may find it helpful to contact The Sickle cell society.


It may help to answer your question by starting with an explanation about lymphomas in general.

Lymphomas are cancers of the lymphoid tissue which is part of our body’s immune system.

Our immune system protects us from infection. It is a complex system made up of the bone marrow, the thymus gland (which lies behind the breast bone), the spleen and the lymph nodes (or lymph glands).

One of the most important cells in our immune system is a type of white blood cell called a lymphocyte. There are two types of lymphocytes: ‘B-cells’ and ‘T-cells’. All lymphocytes are produced in the bone marrow and start life as young, immature cells called stem cells. Some lymphocytes continue their development in the bone marrow or lymph nodes and these are called B-cells but others move to the thymus gland and they are called T-cells.

Many years ago it was thought that lymphomas could be divided into just two conditions: Hodgkin’s disease (named after Thomas Hodgkin, the London doctor who first described it over 100 years ago) and non-Hodgkin’s lymphoma (NHL). With the passage of time it has become clear that NHL is not a single illness but includes a number of cancers, which behave very differently.

The description and classification of the various types of NHL has developed over the years as more has been learnt both about the immune system and the cancers themselves. The most recent classification still recognises the difference between Hodgkin’s disease and NHL but then goes on to divide NHL into some fifteen different tumour types.

The cause for the great majority of these different types of NHL remains a mystery but in three types of the disease, all of which are very rare in the UK, a link with viruses has been established. These are Burkitt’s lymphoma, Burkitt-like lymphoma and post-transplant lymphom

In 1956 a British surgeon called Dennis Burkitt was working in equatorial AfricH described an unusual type of lymphoma which was very common in children in that region. This became known as Burkitt’s lymphomLater research showed that B-lymphocytes in these children became infected with a virus, the Epstein-Barr virus, or E-B virus. Epstein-Barr virus infections are common and usually cause no problems but in central Africa many of the children had chronic malaria infections which reduced their resistance to the virus. In some cases this allowed the virus to change the infected B-lymphocytes into cancerous cells leading to the development of the lymphom

In recent years it has been recognised that in the western world there is one type of NHL where the tumour cells have very similar appearances under the microscope to those of Burkitt’s lymphoma. This rare condition has been called Burkitt’s-like lymphoma. Further research has shown that a high proportion of patients with Burkitt-like lymphoma (but not all) are HIV positive and many have AIDS. It seems that in this condition once again an Epstein-Barr virus infection occurs and because the HIV has reduced the patient’s immunity the Epstein-Barr virus is able to survive and ‘transform’ the normal B-lymphocytes to cancerous cells.

The same situation has been seen in some patients who have had organ transplants. Often after organ transplantation drugs are given for some time, often years, to suppress the patient’s immunity in order to reduce the risk of rejection of the grafted organ. Some of these patients appear to develop E-B virus infections and once again, as their resistance is reduced, this may lead to the development of a B-cell lymphom

All three of these virally-related types of NHL behave in a very aggressive way and need immediate treatment.

In the African children with Burkitt’s lymphoma chemotherapy gives a high cure rate but the Burkitt-like lymphoma and post-transplant lymphomas tend to be more resistant to treatment. Although a variety of different drug combinations have been used cure is not possible in the majority of people. This means that a number of clinical trials are in progress to try and improve the results of treatment.

In conclusion, the likelihood of your husband’s NHL being one of those types with a known viral cause is very, very remote. Almost certainly he has one of the forms of lymphoma for which no definite cause is known.


Wart virus (also known as human papillomavirus or HPV) is known to be associated with abnormalities in the cervix known as CIN which if untreated can sometimes develop into cancer of the cervix. It is much less commonly associated with similar changes in the cells of the vagina known as VAIN (vaginal intraepithelial neoplasia) but this only very rarely leads to vaginal cancer. So once the cervix has been surgically removed (as it will have been if you have had cervical cancer), then there is no risk of getting a new cervical cancer and the chances of getting vaginal cancer are very slim indeed. There is always a very small risk of a recurrence of the original cervical cancer, but there is absolutely no evidence that having the wart virus in the vagina will increase this risk.

Although wart virus is known to be one of the factors in the development of most cervical cancers, it is also found in many other women who will never develop cervical cancer. So having the wart virus certainly does not mean a woman will develop cervical cancer. In fact only a very small number of women who ever have a wart virus will develop cancer or even pre-cancerous areas on the cervix.

There are over 80 different types of the wart virus, and some of these types are more likely to be associated with cancer development than others. For example some types are commonly found in women with cervical cancers, whereas other types just cause common skin warts. There are also other factors that may contribute to the risk of cancer; these include number of sexual partners, age, heavy smoking, number of children and other genital infections.

At this stage there is no known method for getting rid of the virus. It is likely to just go way on its own accord with the help of your natural body’s defences. It is certainly important, however, that you continue to have regular smears and examinations as follow up after your cancer.


Cancer of the vulva is a rare cancer. It usually affects women between the ages of 55 and 75, but can occur in younger or older women.

The cause of most vulval cancers remains unknown but there are a number of conditions that can affect the vulva which will sometimes lead to cancer after many years. These are: n VIN (vulval intraepithelial neoplasia) which can occur in the skin of the vulva and is linked to infection by some types of wart virus, known as human papilloma virus (HPV). There are three levels of abnormality: VIN1, VIN2 and VIN3. VIN3 is the most abnormal and, in some women, can develop into cancer of the vulva if left untreated. n vulval lichen sclerosus and vulval lichen planus. These are two non-cancerous conditions which cause inflammation of the skin of the vulva and occasionally can lead to the development of a cancer after a number of years.

Also there is evidence that cigarette smoking may increase the risk of developing both VIN and vulval cancer. This may be because smoking depresses the immune system.


The term VIN refers to particular changes which can occur in the skin that covers the vulva. VIN is not cancer and in some women it disappears without treatment. If the changes become more severe there is a chance that cancer might develop after many years, and so it is referred to as a pre-malignant condition. Although VIN used to be quite uncommon it is now being recognised and diagnosed more frequently. It can affect women of any age from the 20’s onwards.

The common type of VIN is associated with an infection in the skin of the vulva by some types of the genital wart virus known as human papilloma virus (HPV). HPV (often known as wart virus) is a very common infection. There are over 100 types of the virus and the commonest types can cause warts on the skin of the hands or verrucas on the feet. Some types can affect the genital area including the cervix, vulva and anus.

Genital HPV infection is spread by direct skin-to-skin contact during sex with someone who has the infection. HPV is so common that most sexually active women will be exposed to it at some time in their life. In most women their bodies own immune system will get rid of the HPV naturally without them ever knowing it was there. Some women notice genital warts. Some women have no visible warts, but the HPV can cause changes in the cells of the cervix or the vulv

Infection with HPV on its own is unlikely to cause VIN. Other factors that depress the bodys immune system may also need be presentsuch as smoking and much less commonlyparticular medicines (like those taken after transplant surgery)inherited immunity problems some rare bone marrow blood disorders.

The signs and symptoms of VIN vary and may include some or all of the following: n itching and soreness in the vulval area n burning, or a severe tingling sensation, that can become worse when passing urine n one or more areas of reddened or discoloured skin in the vulval area n raised areas of skin that can vary in size n a warty appearance of the skin

All these above symptoms can be caused by many conditions other than VIN. Sometimes there are no symptoms and some women are diagnosed with VIN whilst having medical tests for other health problems.

VIN is not cancer but the cells of the vulva have changed. If the cell changes are mild treatment may not be needed, but your mother will need to have the area checked regularly by her doctor. Treatment may be needed if the changes are more severe. The type of treatment that is most appropriate for your mother will depend on several things such as how abnormal the cells are and the size of the affected area.


Helicobacter pylori, or H pylori as it is also known, is a type of bacteria that is found in the lining of the stomach. A lot of different types of bacteria enter the stomach when we eat or drink. Most of this bacteria is killed by the acid contents of the stomach, but H pylori is not.

H pylori is a common bacterial infection and between 30-40% of people in Britain are infected, although the incidence is declining. H pylori can usually be successfully treated with antibiotics.

H pylori can cause inflammation of the stomach lining (gastritis) which may over time develop into stomach (gastric) cancer. As a result, H pylori has been recognized as a carcinogen (a substance that causes cancer) and people who are infected with H pylori are thought to have 3-6 times the risk of developing stomach cancer than people who are not infected. If the H pylori the treated with antibiotics this often stops the development of cancer as well.

The majority of people who are infected with H pylori will not develop stomach cancer and less than 3% of people actually do. Doctors have been looking in to why this happens but currently do not know why this is. It is thought that there may be some interaction with some of the other risk factors associated with the development of stomach cancer, such as smoking and poor diet.

In some situations H pylori is thought to protect against the development of cancer in the top of the stomach (the gastric cardia) and the lower end of the gullet (oesophagus) the tube that leads into the stomach.

There are different types of stomach cancer, named after the particular type of cell in the stomach that becomes cancerous and H pylori is more closely linked to some of these than others. The main types of stomach cancer are; adenocarcinoma, which develops in the glandular cells; sarcoma, which develops in the supporting structures of the stomach (such as the muscular wall) and lymphoma which is a cancer of the lymphatic tissue. H pylori is more closely associated with the development of stomach lymphomas, which are also known as MALT lymphomas. There is also an association between H pylori and adenocarcinoma.


In the past some studies suggested a possible increase in prostate cancer in men who had a vasectomy. Recent studies have looked at this question and found that there is no evidence that having a vasectomy increases the risk of developing prostate cancer.


Studies have suggested that there is a link between smoking and bowel cancer. The evidence suggests that people who smoke for many years have are between one and a half and three times more likely to get a bowel cancer than non-smokers.

The increased chance of getting a bowel cancer does seem to be associated with long-term smoking, with people who have smoked for more than 35 to 40 years being at risk.

Over the years there have been suggestions that drinking large quantities of coffee could lead to developing certain types of cancer. Breast cancer, cancer of the bladder and cancer of the pancreas have all been mentioned in this connection.

Careful studies, however, have failed to find any definite link between coffee drinking (even when the consumption has been heavy) and any of these cancers, or any other type of cancer.

So from the point of view of cancer risk coffee drinking seems safe.


This e-mail has been doing the rounds for a year or so and has caused a great deal of concern.

There is no evidence that deodorants or antiperspirants are linked to breast cancer.

One reason that the e-mail might have come about is that breast cancers can often spread to the lymph nodes (lymph glands) situated in the armpit and, of course, antiperspirants and deodorants are often used on the skin in this areBut there is absolutely nothing to link the use of these compounds with the spread of breast cancer to the lymph glands under the arm.

Also, deodorants and antiperspirants have been around for some time now and if they were causing breast cancer then a big increase in the number of women developing the condition might have been expected and this has not happened.

The only area of research that is looking at any connection between deodorants and antiperspirants and breast cancer is that many of them contain a preservative called parabens. It has been suggested that parabens can increase oestrogen levels in the body and if this were true then it could possibly have a small effect in increasing breast cancer risk. At the moment this is all theoretical, with nothing proven, and in the very unlikely event that it is shown that parabens stimulates oestrogen then the effect on breast cancer development is still likely to be very very small.


Hormone replacement therapy (HRT) involves taking supplements to replace the female hormone oestrogen which falls during the menopause.  The menopause is the time in a woman’s life when her ovaries, which normally produce oestrogen, stop working. Menopause usually happens around the age of 50 years.

During menopause most women get symptoms, which are caused by the fall in the levels of oestrogen and can include hot flushes, night sweats, vaginal dryness, mood changes and loss of concentration.  These vary from being mild to troublesome.

Also the hormone changes, which take place during menopause, mean that in the long-term women are at greater risk of bone thinning (osteoporosis) and heart disease than previously.

When it was first introduced it was hoped that HRT would ease menopausal symptoms and also reduce the risk of osteoporosis and heart disease in later life. However, recent evidence has shown that although there may be some benefits there are also risks associated with HRT. The other questions and answers in this section explore these risks and benefits in more detail.


There are three main types of skin cancer. These are rodent ulcers (also called basal cell carcinomas), squamous carcinomas and malignant melanomOf these rodent ulcers are far the commonest, making up nearly 4 out of every 5 skin cancers. Of the remainder most are squamous carcinoma with malignant melanomas being much less common (making up about 1 in 50 skin cancers).

For some time it has been known that people who have had transplants are more likely to develop rodent ulcers or squamous carcinomas of the skin than the rest of the population. This is because they usually take medication to stop rejection of the transplant which actually reduces their natural immunity (this is often called immunosuppressive therapy). It is thought that if this medication is continued long term, as is often necessary, then it reduces the body’s natural defences and one sign of this is an increased risk of skin cancer.

Steroid drugs, like prednisolone, do have an effect on the immune system with a tendency to reduce immunity. Indeed they are sometimes used as part of immunosuppressive treatments after transplants, as well as being used in many other medical conditions.

Because of this immunosppressive effect of steroids doctors have looked to see if there is an increased risk of skin cancer in people who take these drugs long term for other conditions (like rheumatoid arthritis). Their research has shown that there is virtually no effect as far as rodent ulcers and malignant melanomas are concerned but the likelihood of getting a squamous carcinoma is increased (being about double that of the rest of the population).

Although this may sound a little alarming it still means that the chances of actually developing a squamous cancer of the skin are small (and certainly would not be a reason for stopping your steroids). The other important thing to mention is that if these cancers do develop they are usually very treatable and highly curable with simple treatment, provided they are not neglected. So if you do develop any sore or ulcer or other skin problem which fails to heal after a week or two then do see your doctor for a check up just to be on the safe side.

One final thing to point out is that the research showed there was only a risk when steroids were taken as tablets, by mouth and that when they were used as inhalers (for example in treating or preventing asthma) then there was no problem.


Unfortunately lung cancer is very common. It is the most frequently occurring cancer in the UK with over 40,000 new cases diagnosed each year. Lung cancer that is discovered early may be cured with an operation but because the disease is often only discovered at a late stage and because it is often difficult to treat most people with lung cancer can’t be cured. On average over 100 people in the UK die from lung cancer every day!

The evidence for a link between smoking and lung cancer is overwhelming and estimates are that more than 90% of all lung cancers are due to smoking.

The risk of getting lung cancer increases with the number of cigarettes smoked. So someone who smokes 20 cigarettes a day is about 20 times more likely to get lung cancer than a non-smoker, whilst someone who smokes 30 cigarettes a day is about 30 times more likely to get the disease than someone who has never smoked.

The risk is also increased by the number of years you have been smoking and this is probably even more important than the number of cigarettes you actually smoke. For example, smoking 20 cigarettes a day for 40 years is 8 times more dangerous than smoking 40 cigarettes a day for 20 years.

Other things which affect the risk of lung cancer include:

  • the age at which you start smoking, the younger you start the greater the chance of lung cancer
  • the type of cigarette you smoke, low tar cigarettes do slightly reduce the risk of lung cancer
  • whether or not you inhale, as inhaling increase the cancer risk.

Although the more you smoke the greater the chance of getting lung cancer even smoking one or two cigarettes a day still increases your chance of getting the disease compared to a non-smoker so there really is no ‘safe’ level for smoking.

The safe message just has to be stop smoking!


Snuff is usually used in one of two ways: either as a powder that is sniffed into the nose, or small packets, which can be chewed or placed against the lining of the mouth. In each case nicotine from the snuff is absorbed by the lining of the nose, or mouth, and enters the blood stream, giving a chemical lift.

Taking snuff was widespread in Britain in the 1800s but then largely died out. There are signs, however, that it is starting to become popular again.

Although snuff, like cigarettes, contains nicotine, there is no evidence that taking snuff leads to an increased risk of getting lung cancer.

Putting snuff in your mouth does, however, increase the chances of developing cancers of the lining of the mouth. But the degree of risk is uncertain and quite a controversial issue with some people claiming there is almost no risk whereas others think there is a real danger.

Taking snuff can lead to nicotine dependence and addiction and putting snuff in the mouth can cause sores, reduce the flow of saliva and damage the gums. So even if it does not actually lead to cancer, taking snuff is not without its health hazards.


Unfortunately lung cancer is very common. It is the most frequently occurring cancer in the UK with over 40,000 new cases diagnosed each year. Lung cancer that is discovered early may be cured with an operation but because the disease is often only discovered at a late stage and because it is often difficult to treat most people with lung cancer can’t be cured

The evidence for a link between smoking and lung cancer is overwhelming and estimates are that more than 90% of all lung cancers are due to smoking.

The risk of getting lung cancer increases with the number of cigarettes smoked. So someone who smokes 20 cigarettes a day is about 20 times more likely to get lung cancer than a non-smoker, whilst someone who smokes 30 cigarettes a day is about 30 times more likely to get the disease than someone who has never smoked.

Starting smoking early in life also increases the risk. For example a person aged 60 who started smoking at 15 is three times more likely to get lung cancer than someone of the same age who started smoking at 25.

Smoking also causes other cancers and non-cancerous illnesses like heart disease. Taking all this into account current estimates are that about half of all regular smokers will be killed by their habit. Putting this another way, if you take 1,000 men in their 20s who smoke regular, 250 will die of smoking-related illnesses, including lung cancer, in middle age and another 250 will die of smoking-related illnesses in old age.

Overall the life expectancy of a regular smoker is 8 years less than that of a non-smoker and lung cancer is a major cause of this reduction in survival. The overwhelming message from all this is not to smoke!


We all begin life as a single cell, when the sperm from our father fertilizes the egg (ovum) from our mother.  The single cell divides into two, and those two cell divide into two, and this process of cell division goes on and on to make the countless billions of cells that make up an adult human being.

Even after we reach adulthood, and stop growing, many of our cell carry on dividing in order to provide new cells to replace those that have become worn out and died off.

The normal process of cell reproduction, when a single cell divides into two, is called mitosis.  

During the first part of mitosis the cell nucleus divides into two. The
cytoplasm surrounding the nucleus then divides so that two new daughter
cells are produced. 

During this division the chromosomes in the nucleus multiply to make two
identical sets of chromosomes. This means that the genetic blueprint
carried through to the two new cells, which are then identical to the old cell.

A variation of this process of cell division takes place in the cells which make the female eggs (ova) and the male sperm,  Here the new cells have a single set of 23 chromosomes in their nucleus, rather than the 23 pairs of
chromosomes in normal cells. This is so that when the egg and the sperm
fuse the new cell, that will go on to make the new baby, will have one set of
chromosomes from each parent. This sort of cell division, where the new
cells have only a single set of chromosomes, is called meiosis.


Proteins are large molecules that make up a vital part of every cell in our bodies.

Proteins are made up of amino acids.  Our cells use twenty different amino acids to make the proteins we need.  Different combinations of amino acids are grouped together to make polypeptides.  These polypeptides are then built up into proteins.  So a protein is made up of a number of polypeptides, and each polypeptide is made up of a number of different amino acids.

Our bodies contain countless different proteins.

Our own cells are able to make twelve of the twenty amino acids we need.  The other eight, which are called essential amino acids, come from the protein we take in our diet, from foods like meat, fish and eggs.

The proteins that a cell makes will control how that cell develops and behaves.  So a brain cell will make a different set of proteins from a liver cell, a muscle cell will make a different set of proteins to a skin cell. 

The proteins that a cell makes are controlled by the genes.  The genes send instructions to the cell to collect the amino acids to make the particular proteins that it needs.

One special group of proteins are called enzymes.  Enzymes are proteins that control the biochemical reactions that are essential for our bodies to work properly.  So, for example, enzymes are vital for the breakdown, and digestion, of our food, and they control the complex processes that turn our food into the energy we need to carry on living.


RNA is a nucleic acid.  The initials RNA stand for ribose nucleic acid.

RNA is one of two nucleic acids that are found in human cells.  The other is DNA (deoxyribose nucleic acid). DNA is the material that makes up the genes and chromosomes in our cells.  The genes and chromosomes carry the genetic blueprint that controls our bodies and makes each of us a unique individual.  

The way this works is that the DNA carries a code for making proteins, and the different proteins that it tells our cells to make lead not only to the differences between various types of cells, but also the differences between each and every one of us.

The DNA is in the nucleus of the cell, but the proteins are made in the ribosomes, which are microscopic structures in the cytoplasm of the cell, which surrounds the nucleus.  RNA carries the blueprint for making the proteins from the DNA in the nucleus to the ribosomes. 

So the RNA acts as a messenger carrying instructions from the DNA to the ribosomes. 

Once the ribosomes get the recipe from the RNA for the protein that is to be made, they collect the necessary amino acids together and build them up into polypeptides and proteins.

The  combination of the different proteins that RNA tells the ribosomes to make is different in each and every one of us, and this unique pattern of proteins makes each of us who and what we are.


DNA is a nucleic acid.  The initials DNA stand for deoxyribose nucleic acid.

DNA is the material that makes up the genes and chromosomes in our cells.  The genes and chromosomes carry the genetic blueprint that controls our bodies and makes each of us a unique individual.  

The way this works is that the DNA carries a code for making proteins, and the different proteins that it tells our cells to make lead not only to the differences between various types of cells, but also the differences between each and every one of us.

DNA is made up of building blocks called nucleotides.   Each nucleotide is itself made up of three parts: a phosphate, a sugar (which is deoxyribose) and a chemical called a ‘base’.  There are four different types of base in DNA nucleotides: thiamine, cytosine, adenine and guanine.

The actual structure of the DNA is a made up of two long strands.  Each strand is a bit like a very long comb.  The back bone, or spine, of each comb is made up by the phosphates and sugars and the different bases stick out from this spine, like the teeth sticking out on a comb.   The bases of the two strands link up with one another, so that the spine of the strands, or combs, is on the outside, with the bases, or teeth, of the comb joined together inside. 

The two strands are then coiled round one another, in a pattern a bit like a spiral staircase, called a double helix.

The DNA is very tightly coiled within the nucleus of our cells.  Although it is invisible to the naked eye and can only be seen under high powered microscopes, the DNA from a single human cell, if it was uncoiled, would be about 1m (just over 3 feet) long.

The way in which the four different bases, thiamine, cytosine, adenine and guanine, are  arranged along the DNA strands makes the blueprint for producing amino acids.  These amino acids are the building blocks that make up the different proteins the cell needs. 

So the pattern of the four bases on the strands of DNA is different in each and every one of us, and this unique pattern, in the nucleic acid in the nuclei of our cells, makes each of us who and what we are.


Cells are the tiny building blocks that make up our bodies.

Each cell is covered by a membrane, which is like a thin wall separating it from surrounding cells.  Inside the membrane is the nucleus and the cytoplasm.  The nucleus contains the genetic material, and is the control centre of the cell.   The cytoplasm is made up of fluid, called cytosol, and the organelles, which carry out the instructions from the nucleus.

All of us begin life as a single cell in our mother’s womb.  That single cell goes on to divide and multiply countless times to produce the many billions of cells that make up our bodies.

As this cell division takes place different types of cell develop – bone cells, brain cells, blood cells, skin cells and so on – which form all the different organs and tissues in our bodies. 

Cells are continually wearing out, and dying off, and have to be replaced.  So even when we have finished growing we still carry on making millions and millions of new cells every day, to make good the old cells that have been lost.

This process of cell replacement is very carefully controlled, so that the number of new cells being made is always the same as the number of old cells that have died off.

A cancer develops when this process goes wrong,  and too many new cells are produced.  Over time these build up to form a tumour.  So cancer is due to disordered, or abnormal, cell growth in  a particular part of the body.


hen treatments for cancer are being tested in a clinical trial there are a number of ways of measuring how successful the treatments are.

One obvious thing to do is to see how many people are cured by the treatment.  But sometimes it may be many years before you can tell for sure whether or not someone has been cured, which means it would take a very long time for the trial to give any answers.   So another way of looking at things is to see how many people are still alive after a particular length of time.

If a new drug is being used in a trial to treat a particular type of cancer, then one measure of its effectiveness might be to see how many people are still alive a year after the treatment started.   Suppose, for example, that in this trial 100 people were given the drug, and one year later 75 are still alive.  This gives an overall survival figure of 75 out of 100, or 75%.   But of those 75 people some may have had a very good response to the treatment, with complete disappearance of all signs of their cancer, whilst others may only have had a temporary benefit, with their cancer improving but then coming back, or have had very little change in their cancer, but still be alive one year later.  These latter individuals will still be alive one year after treatment, but will still have obvious signs of their cancer being present.  

At one year after treatment the number of people still surviving will be made up of those with no sign of cancer, and those who still have evidence of the disease being present.  Those people who have no trace of cancer are called ‘disease-free’, or ‘relapse-free’ survivors.   

So, the ‘overall survival’ figure for a trial, gives the total number of people who are still alive at a particular time after treatment.  But the ‘disease-free’, or ‘relapse-free’ survival figure gives only those people who are alive and have no trace of cancer.   This means that usually the overall survival figure will always be higher than the disease-free figure – unless the treatment is exceptionally good, when the two figure might be the same, but the ‘disease-free’ number can never be higher than the ‘overall’ figure.

This also means that the higher the proportion of ‘disease-free’ survivors the better the treatment.  So if two treatments, A and B,  have been compared and both give overall survival figures of 75% at one year after treatment, but the disease-free survival figure is 60% for treatment A, and only 30% for treatment B, then treatment A is likely to be better than treatment B.


With any treatment for cancer it is obviously very important to know whether or not that treatment has worked. Rather surprisingly, accurately scientifically measuring the outcome of cancer treatment can be very difficult.

Most assessments of the results of cancer treatment are based on things which can be counted or measured: for example, how long someone survives or how large a tumour is before and after a course of treatment. Even these apparently straightforward criteria can often be difficult to determine precisely and even if they are measurable they only give ‘objective’ information about what happened and give no idea of how the person who had the cancer actually felt.

The Karnofsky scale (sometimes called the Karnofsky index) was devised by two American doctors in the 1940s (David Karnofsky and Joseph Burchenal) as an attempt to try and measure the more ‘subjective’ side of the outcome of cancer treatment.

In fact the scale relates purely to physical ability and covers 11 points, from normal health to death, each scored as a percentage. The scale is:

Normal health 100%
Minor symptoms 90%
Normal activity with some effort 80%
Unable to carry on normal activity
but able to care for oneself 70%
Requires occasional help with
personal needs 60%
Disabled 50%
Requires considerable assistance and
medical care 40%
Severely disabled, in hospital 30%
Very sick, active support needed 20%
Moribund 10%
Death 0

Not all the definitions of each stage are very precise and they say nothing about the feelings and emotions of the individual. But the scale is simple and easy to use. Also, over the years, more complex ‘psychological’ tests have shown that generally well being and quality of life match the physical scores on the Karnofsky scale (so, if you have ‘normal health’ or ‘minor symptoms’ you tend to feel pretty good, but if you are ‘severely disabled’ or ‘very sick’ you feel very low indeed). For these reasons the Karnofsky scale has stood the test of time and is still widely used to help doctors decide how well someone is doing after treatment and sometimes used to help decide what treatment should actually be given.


Myelofibrosis is a very rare condition, occurring in 1 in 100,000 people each year.

Myelofibrosis is an illness where the normal cells of the bone marrow become replaced by scar tissue, or fibrosis.   This leads to progressive failure of the bone marrow.  The bone marrow is the factory that produces many of the cells in our blood, and so bone marrow failure causes anaemia (due to a lack of red blood cells), a higher risk of infection (due to a lack of white blood cells) and an increased risk of abnormal bleeding (because the number of platelets in the blood is reduced).

As the marrow begins to fail the liver and spleen try and make up for this, and start to fill with blood-making cells.  As a result of this they become swollen and  enlarged. They can become so big that they start to cause problems with pain, and swelling of the tummy.

As well as reducing the number of blood forming cells the presence of scar tissue in the bone marrow can also cause the bone marrow to become disordered, producing increasing amounts of primitive, abnormal, blood cells.  In somewhere between 1 in 5 to 1 in 20 people with myelofibrosis this process can turn into a form of acute leukaemia.  This transformation is more likely in people aged over 70, and those who have other risk factors such as quite severe anaemia, a very low platelet count, increased numbers of primitive white cells in their blood, or certain specific changes in the genes in their bone marrow cells.  

Unfortunately, even if this leukaemic transformation does not occur, myelofibrosis is still a serious condition, with an increased risk of major bleeding, severe infection, or blood clots, which can lead to strokes or heart attacks.

So it is important that you talk to your doctor about your concerns as they will have all the information about your own condition and can advise you fully about the risks in your case.


The stage of a cancer is a measure of how far it has progressed. So, a cancer that is small and in a single site is at an early stage, whereas one that has spread to many different parts of the body is at an advanced stage.

Over the years doctors have worked out staging systems for all the different types of cancer. Some of these are quite simple whilst others are very complicated. As an example, one of the simpler systems is the one used for bowel cancer. This is divided into four stages, A to D, with A being the earliest stage. The four stages are:

  • A – the cancer is confined to the wall of the bowel
  • B – the cancer has spread through the wall of the bowel
  • C – the cancer has spread to the nearby lymph glands
  • D – the cancer has spread to other organs, such as the liver or lungs.

Some staging systems use the numbers 1 to 4 for the various stages (often subdividing each stage into a, b or c), whilst another system uses the initial T, N and M, followed by a number to describe the primary tumour (T), any involved lymph nodes (N) and the presence or absence of any spread to other organs, or metastases (M). The situation is further complicated by the fact that there are often several different staging systems for a particular cancer and different doctors may use different systems.

Doctors use the results of tests and operation findings to decide the stage of a person’s cancer. Sometimes the stage will change as more results become available. For example, someone with bowel cancer might have examinations, x-rays and scans which suggest the tumour is confined to the bowel wall (stage A) but when an operation is done, and the tissues examined under a microscope, small seedlings of tumour may be found in the lymph glands, making it a stage C cancer.

Using a staging system has two main benefits. Firstly it gives an idea of how advanced a cancer is and so helps predict what the likely outcome of treatment will be. Secondly, ‘staging’ the cancer determines what the treatment should be, since often the treatment for an early stage cancer will be different from that for a more advanced tumour.

The grade of a cancer refers to the appearances of the tumour under the microscope. Depending on the appearances cancers may be given one of three grades. A ‘low’ grade is where the cancer cells look very like normal cells, with only slightly abnormal changes (these cancers are called ‘well-differentiated’. A ‘high’ grade is where the cells look very abnormal and show little or no resemblance to normal tissue (these cancers are called ‘poorly differentiated’). An ‘intermediate’ grade is somewhere between the high and low grades (these cancers are called ‘moderately differentiated’). For some cancers, such as breast cancer, the three different grades are often given numbers, so a low grade breast cancer is called Grade I, whereas a high grade breast cancer is called Grade III.

The grade of a cancer is considered to be a guide to how aggressive the tumour is: an intermediate grade cancer is likely to be more aggressive than a low grade and a high grade cancer is likely to be more aggressive than an intermediate grade tumour.

Taken together the stage and grade of a cancer do help doctors to predict how that cancer might behave, how it might respond to treatment, and what the chance of cure might be. But the stage and grade are only guides to what might happen and cancers do not always behave in the way that might be expected from their stage and grade.


Because each of us different, and because every cancer is slightly different, it is impossible for doctors to be absolutely certain whether or not someone will be cured of their cancer as a result of treatment.

Although they cannot give guarantees about what will happen, doctors can use their experience, and their knowledge of the particular type of tumour, and the results that have been published about the outcome of treatment, to make forecasts of how likely, or unlikely, it is that someone will be cured.

One way of giving these predictions is to talk about percentages.

What doctors are doing when they use these percentages is saying ’if we had a hundred people just like you, with a cancer just like yours, how many would we expect to be able to cure?’.  

If the chances of a cure are very good, then perhaps 90 or 95 people out every 100 might expect to get better.  This would be the same as saying that there is a 90 to 95 % chance of being cured.   In the same way, if there was only a small likelihood of a cure, with only 5 or 10 people out of every100 getting better, then the chance of a cure would be between 5 to 10%.

In your mother’s case what the doctor is saying is that if they saw a 100 people in a similar situation they would expect 60 of them to be cured.  This means that she has a better than 50/50 chance of cure, and that the doctor thinks it is more likely than not, that she will be cured.  But it does also mean that they cannot be certain of the outcome.

Without wanting to be gloomy, it is important to remember this uncertainty.  It is probably human nature to be positive and optimistic in this sort of situation and to focus on the 60% chance of a cure, rather than the 40% (or 40 out 100) chance that the treatment might not be completely successful.  But even if her doctor had told your mother there was a 95% chance of cure, this would still mean that there could be a small risk that treatment might not work.

At the end of the day, the figures that any doctor gives to their patient about the chances of successful treatment, are only a guide to what might happen and cannot be an absolutely certain prediction of the future.


Radiotherapy uses a type of radiation, called ionising radiation, to destroy cancer cells. There are several types of ionising radiation including x-rays, gamma rays and beta rays.  Most radiotherapy treatment for cancer use x-rays.

Ionising radiation works by releasing chemicals in the nucleus of cells. These chemicals, called free radicals,  damage the DNA, the genetic material that is vital for the cell to multiply.  If the DNA is sufficiently damaged by the radiation then it will not be able to divide and will die off.

In order for the radiotherapy to release the free radicals that damage the DNA there needs to be a good supply of oxygen in the cells.   If the cells are starved of oxygen then this actually protects them against the effects of the x-rays and makes treatment less effective.

Oxygen is carried to the tissues and cells in our bodies by the haemoglobin in the red blood cells. If we are anaemic then the haemoglobin level in the blood is low, and so the amount of oxygen carried by the blood to our cells is reduced.

So in order to get the best results from a course of radiotherapy it is important to be sure that you are not very anaemic before you start treatment. 

If you are anaemic then your doctors may well suggest a blood transfusion before you start your treatment.  This will boost your haemoglobin level and will increase the oxygen in your blood, which will increase the chances of success from your radiotherapy treatment.

Many people are frightened about the prospect of chemotherapy, particularly because of all the publicity that has been given to possible side effects. However, modern chemotherapy and medications to avoid or reduce side effects have made chemotherapy better tolerated for most people.When a bladder cancer has spread to other organs in the body then treatment with chemotherapy,  is designed to try and shrink the growth, improve symptoms,  maintain a good quality of life and to prolong life, if possible. Unfortunately at this advanced stage of the cancer a cure isn’t possible, and making decisions about treatment in these circumstances is always difficult.

If you do have the chemotherapy it is possible that this will lead to control, and possibly shrinkage, of the cancer with relief of any symptoms, improvement in quality of life, and maybe even some prolongation of life. These benefits still cannot be guaranteed. Some people will have significant benefit while others will have no improvement at all and will therefore have the side-effects of the treatment without any benefit. The fitter a person is  generally the more likely they are to have benefit and less likely to have side-effects.

The alternative to having chemotherapy would be to have ‘supportive treatment’ which is aimed not at controlling the cancer itself but at easing any troublesome symptoms and maintaining quality of life. This would usually  mean ‘non-chemotherapy’ medication like steroids and pain killers, and occasionally a short course of radiotherapy. There would still be contact with a medical and nursing team to oversee your care during this time. So not having chemotherapy does not mean that you would be left to cope on your own.

The choice of treatment is a difficult one and will depend on your own feelings at this time, so  it is important to talk this through with your specialist, about the potential benefits of chemotherapy in your own situation.


When a good friend or a relative gets cancer it is often a very difficult time and people often handle the situation by cutting down the number of visits and meetings because they might be difficult or distressing. Although this is understandable it is often very upsetting for the person who has the cancer who can find themselves apparently deserted by long-time friends and members of the family at a time when they really need them. So the first way in which you can help is simply by keeping in touch and keeping up with your regular contacts just as you did before the cancer was discovered.

There are then two main ways in which you can make a difference: by giving emotional support and offering practical help. The best way to make a start with these is by talking, or perhaps even more importantly, by listening.

Everyone is different and some people with cancer will find it very helpful to talk about their illness and its treatment whilst others cope by acting as though everything was normal and life was going on as usual, so knowing just the right thing to say is difficult. If someone is happy to talk about how they feel and how they are coping then listening sympathetically can be very useful indeed and make a real difference. If they are less forthcoming and keeping things more to themselves then direct questions like ‘how are you feeling?’ or ‘how are you managing?’ will probably get short answers like ‘fine’ or ‘OK’ and lead nowhere. On the other hand using questions asking about specific aspects of well being, like ‘how are you sleeping?’, ‘do you get very tired?’, ‘what sort of things do you enjoy eating?’, can be easier to answer and can often get people talking more about how they are and what problems there might be.

This can also open opportunities for practical help, things like doing a bit of shopping, walking the dog, taking your friend to the hospital for their next appointment, taking the children to school one morning a week and a hundred and one other possible ways in which quite small things you could do would not only make the day to day chores of life a bit easier for your friend but also show her that you do care and are there to help her.

For a while at least your friendship may be under strain, especially if your friend is having great difficulty in coping and coming to terms with the diagnosis and its treatment but by keeping in touch, by ‘being there’ and letting them know they can rely on you then you will be making a real contribution to their quality of life at a time when it really matters. .


It is very common for people with cancer to have problems with sleeping at night. This may be because of general anxiety, fears about treatment or worries about the future. All of these reasons are very understandable but they can lead to insomnia with either difficulty in getting off to sleep or waking up during the night and having trouble dropping off again.

If this continues and starts to affect your quality of life then you could chat to your General Practitioner about the possibility of tablets to help you sleep. Many people, however, prefer to avoid sleeping pills and there are a number of tips to offer about ways of helping to get a good night’s rest which you might like to try as an alternative. These include:

  • establish a regular routine of going to bed at about the same time each night and waking up about the same time each morning
  • if you are able to manage some regular, gentle, exercise during the day (such as having a walk for half an hour) then this can help deepen sleep
  • a warm bath just before bedtime, with the addition of soothing oils or essences (such as lavender oil or geranium oil) is very relaxing
  • a warm, milky, drink just before bedtime will avoid hunger during the night, which can disturb sleep
  • alcohol can make you feel sleepy but it often disrupts the sleeping pattern during the night so avoid large amounts of wine or spirits just before bedtime
  • tea, coffee and cola drinks all act as stimulants and are best avoided for a few hours before going to bed as they tend to keep you awake
  • some people find that a few drops of lavender oil sprinkled on their pillow helps them relax and sleep better
  • if you sleep a lot during the day try seeing if you can cut back a bit on daytime naps
  • work out just how much sleep you need in order to feel refreshed the next day and avoid spending too long in bed as trying to sleep too much can actually lead to disturbed and shallow sleep
  • if you wake up during the night and can’t get back to sleep after a few minutes and are unable to relax (just lying quietly can still be very restful if you are relaxed but not if you are tense and worrying) then try reading a book or watching television for a while or listening to tapes, like talking books, on a personal stereo or make a hot drink

Although sleep disturbance is quite normal and understandable for people who are worried about their cancer occasionally insomnia can be a sign of underlying ‘clinical’ depression which does need medical treatment and can be very much helped by simple medication. Key symptoms of depression include:

  • a low mood for most of the time
  • not feeling your usual self
  • not being able to be taken out of your low mood by yourself or your friends
  • loss of interest or enjoyment in your favourite activities as pastimes

If you are experiencing these problems as well as your sleeping difficulty then it would definitely be worth having a word with your doctor to check on whether or not you are developing depression. .


Unless it is treated a cancer will usually continue to grow, sometimes slowly, sometimes more quickly. At some point during its growth it will often send of seedlings of tumour to other parts of the body. The lymph nodes (lymph glands) nearest to the growth are frequently the first place these seedlings spread to and then they travel more widely to other organs in the body. This process of development is often called the ‘natural history’ of the cancer.

When a cancer is first diagnosed it is important for doctors to be able to tell how far it has progressed, whether it is still in one site (the primary tumour) or whether it has spread to other places (forming secondary cancers or metastases). This will let the medical team know what stage the cancer is at in the journey through its natural history. The information on the ‘stage’ of the cancer is then very valuable in deciding what is the best treatment and what the outcome of that treatment is likely to be. There are hundreds of different types of cancer that can affect the human body and different cancers can behave very differently.

Over the years specialists have worked out ‘staging schemes’ for all the main types of cancer. These staging schemes lay down a set of rules which allow doctors to work out how far the cancer has progressed, what ‘stage’ it has reached. The TNM system is one of these staging schemes.

The initials T, N and M stand for ‘tumour’, ‘nodes’ and ‘metastases’. T describes the size and extent of the ‘primary’ tumour, the starting point of the cancer. N says whether or not the lymph nodes are affected by the cancer , and how extensive that involvement is. M says whether or not there is spread to other organs elsewhere in the body. Depending on how big the growth is and how widely it has spread different numbers and letters are added after the initials T, N and M to exactly identify the ‘stage’. So, for example, a small breast cancer which had not spread to the lymph glands or other parts of the body would be a T1, N0, M0 cancer, whereas a bigger breast cancer that had spread to the skin over the breast, the lymph nodes and the bones would be a T4b, N1, M1 tumour.

Because different sorts of cancer behave differently the TNM staging system varies slightly from one type of cancer to another, so the TNM staging of a bladder cancer will be slightly different from that of a breast cancer.

The system is complicated and what makes it even more confusing is that the TNM staging system is only one of a number of different staging systems used by cancer specialists (although the TNM system is standardised world wide and so means the same in different countries).

But although it is difficult the TNM scheme does give invaluable information which can be used to guide the choice of treatment and predict what might happen afterwards, as well as allowing doctors to compare the results of treatment for cancers of a similar ‘stage’.


With modern day treatments many cancers are completely cured but unfortunately there are still many others which are not.
Although it is not always possible to be certain, doctors are often able to tell whether or not a particular cancer might be cured. Even if cancer is incurable they will usually still offer treatment in the hope of prolonging life and, controlling, symptoms.

For many cancers these treatments can be very successful and they can keep the tumour under control for many months and sometimes for years.
So lots of people with incurable cancer are still able to lead normal lives for long periods of time.

Only when the cancer finally fails to respond to all treatments does someone enter the ‘terminal’ stage of their illness.
Although there are no precise definitions for when a person becomes ‘terminal’ the word is usually used to describe the last few weeks, or months, of life.

A lot of men and women who have incurable cancers will live for a long time before their cancer becomes terminal.  With some slow growing cancers, especially in older people, it may be possible to have a normal life expectancy and die of another illness rather than of cancer.


Cancer isn’t a single disease but is a description of a whole range of illnesses. In all there are several hundred types of cancer, each behaving in a different way, causing different symptoms and needing different treatment.

To make sense of this huge number of conditions doctors have devised ways of classifying cancers into groups which have some features in common.

The simplest, and most widely used, of these classification schemes is based on the type of cell which has produced the cancer. This gives four main headings which include the great majority of all cancers: carcinomas, sarcomas, lymphomas and leukaemias.

Carcinomas arise from the lining cells of the body (which are also called the epithelial cells). These cells from the outer layers of the skin and the membranes lining the digestive tract, the bladder, the womb and all the tubes and ducts which run through every organ of the body.

Sarcomas arise from cells which form the supporting tissues in the body (which is also called connective tissue). These cells are the ones that make up the bone, muscle and cartilage and also form the fatty and fibrous tissues in the body.

Lymphomas are cancers of the lymphoid tissue, which is part of our immune system. This tissue is found in the lymph nodes, the spleen, the bone marrow and the thymus gland (which lies behind the breast bone).

Leukaemias develop from the white blood cells which are circulating in our blood and also affect the bone marrow and spleen.

Carcinomas are by far the commonest of these four types of cancer, making up about 80%, four out of five, of all cases.

Carcinomas are themselves divided into subgroups depending on which type of epithelial cell produced the cancer and which part of the body it started in.

The four main types of epithelial cell are squamous, adeno cells, transitional and basal. Squamous cells are found in the skin, the lining of the mouth, the gullet, the airways and fine tubes in the lungs and some other parts of the body. Adeno cells form the lining of all the glands in the body, so any organ that contains glandular tissue contain them, these include the digestive organs (such as the stomach, bowel and pancreas), the breasts, the kidneys and many other sites. Transitional cells are only found in the lining of the bladder and parts of the urinary tract. Basal cells form one of the layers of the skin.

So, a cancer that starts in squamous cells, is called a squamous carcinoma. A cancer that starts in glandular epithelial cells, is called an adenocarcinoma, A cancer that starts in transitional cells is a transitional cell carcinoma and a cancer that starts in basal cells is a basal cell carcinom

These are then further described by giving the name of the organ or tissue where the cancer first began. So a cancer arising from the lining of the bladder would be a transitional cell carcinoma of the bladder, whereas a cancer arising from the glands in the breast would be an adenocarcinoma of the breast.

Some organs contain more than one type of epithelial cell and so can produce different types of cancer at the same site. For example, although the great majority of bladder cancers are transitional cell carcinomas the bladder does contain some glandular tissue so occasionally adenocarcinomas may develop instead.

The commonest site in the body for transitional cell carcinomas is wall of the bladder. Occasionally they may occur in the ureter, the tube joining the kidney to the bladder, or the part of the kidney that is closest to the ureter.

When a cancer forms in one of these organs it is called a primary cancer – so a cancer which first starts in the bladder would be a primary transitional cell carcinoma of the bladder.

All transitional cell carcinomas have the ability to spread to other organs and form secondary cancers there. When these secondary cancers form they are made up of cells which closely resemble and behave like, the cells of the original, primary cancer. So if cells from an transitional cell carcinoma of the bladder spread to the lungs they look and behave like bladder cancer cells, not lung cancer cells, and are called secondary bladder cancers. (Secondary cancers are also called metastases and so these tumours could also be called metastases from a bladder cancer or metastatic bladder cancer).

The type of treatment that might be needed and the success of treatment varies with every individual cancer. So to know more about your own condition you will need to discuss this with your medical team who will be able to put you in the picture.


BCG is used in the treatment of the two main types of early, superficial bladder tumours, which are papillomas of the bladder and carcinoma in situ of the bladder. The first line of treatment for these tumours is to have them removed surgically but if they keep coming back, or if there are several growths present at the same time (as is often the case) then putting either chemotherapy drugs or a solution of BCG into the bladder may be recommended.

BCG is the vaccine which is used to protect against tuberculosis, TB. The use of BCG in bladder cancer is often called ‘immunotherapy’ as it is thought that it may stimulate the body’s own immune system to attack the tumour cells. But, in truth, no one is absolutely sure how it works. Nonetheless BCG is helpful for many people with either papillomas or carcinoma in situ and can prevent or delay tumours reappearing after surgery and also greatly reduces the risk of a more serious invasive bladder cancer developing.

The BCG solution is given directly to the lining of the bladder. A catheter is inserted through the urethra (the tube carrying urine from the bladder to the outside). The BCG solution is then instilled through the catheter into the bladder and remains there for about two hours. During that time you are asked to change position at regular intervals to circulate the BCG around the bladder.

The procedure can usually be done as an out-patient or a day-patient at hospital. BCG treatments are usually given once a week for 5 to 12 weeks.

Some doctors have given injections of BCG under the skin or suggested taking BCG solution by mouth, as well as the bladder treatment, but there is no evidence that doing this improves the results of treatment.

Common side effects include some discomfort in the bladder and when passing urine (often a stinging or burning sensation, which is called dysuria). Passing water more often for a day or two after the treatment is also common. About half the time there will be a little blood in the urine as well. 1 in every 4 people will notice a temporary fever for a day or so. Very very occasionally this fever does not settle after the first few days. If fever does continue it is important to have this checked by your medical team because BCG is a ‘live’ vaccine, this means that, rarely, it can actually cause the onset of tuberculosis. In the very unlikely event that this happens it is easily treated with appropriate anti-TB tablets.


Although there are some cancers which may run in families , such as breast, ovarian or bowel cancer (even then most of these  do not develop from a genetic cause) most bladder cancers seem to happen for reasons that we do not understand and  but are not thought to be related to a genetic cause (an inherited gene from a parent which may increase the chance of a cancer).

There are risk factors which are known to increase the chance of developing bladder cancer. These include smoking, chronic bladder infections and exposure to chemicals from working in dye factories or the chemicals industry. However, even for people working in these industries it would take many years of exposure to these chemicals to cause a bladder cancer. If you do not have any of these risk factors, then you are no more likely to develop a bladder cancer than the rest of the population.

It can be natural to wonder what may have caused a cancer, particularly when a close family member has been diagnosed. Some families may have similar cancers in a number of family members but this can be due to them sharing lifestyle factors, such as smoking, rather than a genetic cause..


Screening for cancer means testing people who appear to be well, and have no symptoms, in order to find tumours at an  earlierstage. If a cancer is detected early it is usually (but not always) more treatable, and more likely to be cured, than if it is found at a later stage. So a successful screening programme should improve the life expectancy of people with that particular cancer.

There are hundreds of different types of cancer – some are common, while others are rare. At the moment there is no way of screening to see if someone simply ‘has a cancer’ but there are screening tests for certain types of cancer such as breast and cervical cancer.

For screening to be useful for a particular type of cancer two conditions must be met:

  1. There must be tests that can be relied upon to find that cancer before it produces symptoms.
  2. There must be evidence that finding and treating that type of cancer at an early stage will improve the chances of a cure.

Although there are screening tests that are currently being tested in trials for bladder cancer, it will be a number of years before we know if they are effective in detecting cancer at an earlier stage, before symptoms occur.A problem in the past has been that too many people have test positive for bladder cancer when it is not present.

At the moment the only test that can reliably detect early cancers of the bladder is a cystoscopy and biopsy. This involves passing a cystoscope, (a thin flexible telescope), through the urethra (the tube that joins the bladder to the outside) into the bladder. Photographs of the bladder can then be taken and samples of tissue (biopsies) taken from any abnormal looking areas, for examination under the microscope. This test involves either a stay of several hours in hospital . It may be done with sedation or  under a general anaesthetic. Unfortunately it is not practical to do this examination on a regular basis on the whole population as a screening test forbladder cancer.

Cystoscopies are  used to monitor  people who have benign (non-cancerous) conditions which may turn into cancers. The commonest of these are called papillomas. Papillomas are non-cancerous (benign) tumours which grow out from the lining of the bladder into the urine-containing inner cavity of the bladder. They look like small mushrooms or warts. About 1 in 20 people who have bladder papillomas will eventually, often after many years, develop a bladder cancer. So if papillomas are discovered then people will be offered regular cystoscopies, at intervals of six to twelve months, to check that there are no signs of cancer developing.


The bladder is a balloon-like organ, with an outer layer of muscle lined with an inner layer of cells called the urothelium.

Most bladder tumours develop in the cells of the urothelium. If the tumour only involves the inner, lining of the bladder it is called a superficial bladder tumour. If the tumour has spread from the inner lining into the muscle wall of the bladder then it is called an invasive, or infiltrating, bladder cancer. Superficial bladder tumours are about four times more common than invasive bladder cancers.

About 15-20% of people who have superficial tumours will eventually, often after many years, develop an invasive bladder cancer.

There are several treatments for superficial bladder tumours, and which treatment you have will depend on a number of factors including the type of tumour and its grade (how quickly growing the cancer cells are).

The usual treatment is to have a cystoscopy. This is when a small telescope, called a cystoscope, is passed into the bladder through the urethra, ( the  tube that joins the bladder to the outside). Superficial bladder tumours can be removed during this procedure which is carried out under anaesthetic. This is called a transurethral resection of a bladder tumour.

They can reappear after the initial treatment, sometimes in other parts of the bladder lining. So regular cystoscopies will need to be done to check for this.

If there are a large number of superficial tumours in the bladder, or if they keep coming back after surgery, then other effective treatments may be given. These can involve putting chemotherapy drugs into the bladder or ‘immunotherapy’, (using a vaccine called BCG, which once again is put into the bladder).


The urachus is a tube, or canal, present during our embryonic development. It runs from the top of the bladder towards the umbilicus (the belly button). In the months before birth it gradually closes off and remains as a fibrous cord or ligament. How much of the urachus is still present in adults varies from person to person, sometimes there are traces of it all the way from the bladder to the umbilicus, but often there is just a remnant at the bladder end.

Cancers of the urachus in adults can occur but they are very rare.

They usually develop close to the bladder and are often mistaken for bladder tumours at first. But bladder cancers usually arise from the cells which line the inside of the bladder whereas urachal cancers, although they usually occur in the wall of the bladder, lie more deeply and are below the lining layer of cells. The cells look different under the microscope to those of bladder cancers.

Symptoms of urachal cancers include blood in the urine, abdominal discomfort and mucus in the urine. Because of the embryological remnants there may occasionally be bleeding or discharge from the belly button.
The main treatment for these tumours is surgery. Sometimes if the growth is very small this can be done with a partial removal of the area of the bladder where that cancer has appeared but as these tumours have a tendency to spread along the wall of the bladder a complete removal of the bladder is usually required. This operation is called a radical cystectomy and usually involves removal of some of the nearby lymph nodes as well.

Surgery is the most effective treatment for urachal cancers. Radiotherapy and chemotherapy may be used but do not do not appear to be very effective.  in treating urachal cancers.


If a bladder cancer is present it will often causesome bleeding, although this may only  be  visible under a microscope (microscopic).). The presence of blood in the urine (haematuria) can be detected by simple urine tests, which can pick up even smalltraces of blood.

Unfortunately there are many different conditions which can cause haematuria. For example, a urinary tract infection will often lead to some blood in the urine. So detecting blood in the urineis not specific enough to help diagnose a bladder cancer.

Despite this, clinical trials have been done both in the UK and USA to see if looking for haematuria in apparently healthy adults might lead to greater detection of bladder cancer. But these studies have shown that even when haematuria is discovered, less than 1 in 10 people actually had a bladder cancer, and the conclusion was that routine urine testing simply isn’t an effective way of screening the healthy population for bladder cancer.

There are currently trials looking at other types of urine tests which may be more sensitive and accurate in helping to detect bladder cancer. However, it will be a number of years before the results of these trials are known. At this time there is no reliable method of screening the general population for bladder cancer.


Major surgery for a bladder cancer usually means complete removal of the bladder (a total cystectomy). Urine produced in the kidneys drains into the bladder through two tubes called the ureters. The bladder then stores the urine until it is passed out through another tube, the urethra, which runs along the vagina or penis. If the bladder is removed then a new storage space for the urine will need to be created.

The most common way of doing this is to form a urostomy. This is done at the same time as the removal of the bladder.

Whilst you are under the anaesthetic your surgeon will remove a piece of your small bowel (ileum) and join the two ureters to one end of it. The other, open end will be brought out through the skin of your abdomen. The tube of bowel then forms what is called an ileal conduit, which acts as a channel to take the urine from the ureters to the surface of the abdomen. The small hole in the skin through which the urine now passes out of the body is called a stoma (the ileal conduit and stoma together are called a urostomy.)

The small bowel is rejoined after the section to be used for the urostomy has been removed. The removal of the short section of bowel wont cause any problems with the normal working of the bowel.

The urine will then be collected in a flat, watertight bag is placed over the stoma.. Special adhesive seals keep it in place. It will fill with urine in the same way as the bladder and will need to be emptied regularly.

Most people who have a urostomy live a normal life. Many return to their jobs and take up favourite pastimes again, including swimming. Learning to look after your urostomy, however, takes time and patience and no one will expect you to cope straightaway.One member of your care team will be a specialist nurse, called a stoma nurse, who will teach you how to look after your urostomy and help you through any problems. Once you are home you will still be able to  contact the stoma care nurse in the hospital, or sometimes they can visit you at home, if you need advice.


In recent years doctors have been looking at the possibility of giving chemotherapy before surgery for a number of different types of cancer, including bladder cancer. This way of using chemotherapy is called neoadjuvant therapy.

There are two reasons for giving neoadjuvant chemotherapy for bladder cancer. The first is to try and kill off any microscopic seedlings of tumour which might have spread outside the bladder and so increase the chance of a cure. The second is to try and shrink the cancer and make the operation easier, possibly even avoiding the need for complete removal of the bladder.

A number of trials have looked at whether neoadjuvant chemotherapy before bladder removal(called a cystectomy) improves cure rates. Recent trials have shown that giving a combination of chemotherapy drugs which includes a platinum chemotherapy may give an additional benefit in reducing the recurrence of bladder cancer and in improving cure rates.. However, neoadjuvant chemotherapy has not become standard practice before cystectomy for bladder cancer, but may still be given in individual circumstances as part of a clinical trial.

You may find it helpful to discuss this with your specialist to see whether chemotherapy may be suitable in your situation.Whether or not neoadjuvant chemotherapy reduces the need for complete removal of the bladder for some patients is still uncertain. This is currently being looked at in clinical  trials but it will be a number of years before we have the answer to this.


Last year I was diagnosed as having polyps in the bladder. I was told they were pre-cancerous. I had another cystoscopy and more polyps removed three months ago but my doctors say they are coming back again and I need chemotherapy. I am worried about what this means and what the treatment may involve

Bladder cancers can be divided into two groups: superficial and invasive.

Superficial cancers account for four out of five of all bladder tumours. These growths arise from the lining of the bladder and usually look like delicate fronds of tissue projecting into the cavity of the bladder. The growths may be single or multiple. The ‘roots’ of the growths are confined to the lining of the bladder and they do not penetrate, or invade, the wall of the bladder. In about one person in seven one of these growths will eventually turn into an invasive cancer, which will begin to penetrate the wall of the bladder.

Single superficial bladder cancers can be treated by simple surgical removal at the time of a cystoscopy. Regular cystoscopies should then be carried out to check the condition of the bladder lining. If tumours come back, or if there are multiple tumours then further treatment is required. This usually takes the form of chemotherapy.

Chemotherapy for bladder cancer can be either given by putting it into the bladder or intravenously (into the vein), so that the drugs can circulate around the body in the bloodstream.

The chemotherapy for superficial bladder cancer is given directly to the lining of the bladder. A catheter is inserted through the urethra (the tube carrying urine from the bladder to the outside). The chemotherapy drug is then instilled through the catheter into the bladder and remains there for about two hours. During that time you are asked to change position at regular intervals to circulate the drug around the bladder. The procedure can usually be done as an out-patient or a day-patient at hospital. There is a little discomfort with the insertion of the catheter and the chemotherapy may cause some slight inflammation of the bladder leading to symptoms of cystitis for a while afterwards (passing urine more frequently and/or stinging or burning when passing water).

The chemotherapy is usually given weekly for six to eight weeks.

A variety of different chemotherapy drugs are used for this treatment including mitomycin, thiotepa and doxorubicin. Sometimes a preparation called BCG is used. This is actually a vaccine, more commonly given through the skin to prevent tuberculosis, but it has been proven to be effective in controlling superficial bladder cancers. Because BCG is a vaccine, it may be called immunotherapy, rather than chemotherapy. BCG has rather more side effects than the chemotherapy drugs. These include symptoms similar to a bladder infection – having to pass urine frequently, burning on passing urine and blood in the urine. People also sometimes have a fever with it, all of these effects usually settle within a day or two.


Very often when a cancer is treated the treatment will take away all evidence of that cancer: symptoms will disappear, physical examination and special tests (like blood tests and scans) will all go back to normal. All the appearances will suggest that the problem has been cured.

But sometimes there will be microscopic traces of the cancer left behind. Because they are so tiny these traces will not cause any symptoms and they will be too small to show up on even the most careful of examinations and most sensitive of special tests. These tiny clusters of cancer cells may lie dormant for months or years but may eventually grow and the cancer may come back.

Since these minute cells that might have been left behind cannot be detected in any way it is impossible to give an absolute guarantee that a cancer has been cured after treatment.

Having said this, very many people are cured of their cancer by modern day treatment. The chances of getting a cure depend on the type of cancer that someone has, how advanced (how large it was and how far it had spread) at the time it was first discovered (this is sometimes known as the ‘stage’ of the cancer) and how well that cancer responds to treatment.

There are now masses of statistics which doctors can use as a guide to predicting the chances of a cure for any particular cancer at any particular stage. These show that for some of the more curable types of cancer the chances of the cancer coming back after treatment are very small indeed, particularly if it was discovered at an early stage. Whereas for other types or  cancers diagnosed when they were more advanced, the outcome is likely to be poorer.

These figures are only ‘statistics’ which means they cannot absolutely predict what will happen to an individual but they do give a good idea of the ‘chances’ of whether, or not, someone will be cured. So doctors rely on these figures for deciding what the likely outcome is for each person at the end of their treatment.

These days many many people are cured of their cancers. So if your doctors have given you the ‘all clear’, although there is no absolute way of proving they are right and guaranteeing you are cured, they obviously think your chances of success are excellent and you should look forward to the future with confidence.

The short answer to this is, yes. Many people are cured of their cancers – but unfortunately some are not.

There are three important factors which affect the chance of having a cure: the type of cancer, how ‘advanced’ that cancer is when it is discovered, and how well the cancer responds to treatment.

Cancer is not a single disease. There are hundreds of different types of cancer and each of these different types has different chances of cure. So, for example, cures are very common in conditions like breast cancer, bowel cancer, testicular cancer, skin cancer and Hodgkin’s disease, but they are much less common in cancers of the  lung, pancreas and stomach.

For any one type of cancer, a tumour that is diagnosed when it is small and has not spread at all will always have a better chance of a cure than one that is only discovered when it is more advanced, and has grown to a large size and sent seedlings, called secondary cancers, to other parts of the body. So, for example, a bowel cancer that has not spread beyond the lining of the wall of the bowel is usually completely cured by an operation whereas a bowel cancer that is only found when it has already sent seedlings to the liver is only rarely curable. On the other hand, with cancers that are very sensitive to treatment, such as Hodgkin’s disease or testicular cancer, most people can still be cured even when the cancer has developed widespread secondaries.

It is important to mention that modern cancer treatments are also improving cure rates. Many kinds of cancer that were almost always incurable fifty years ago are now routinely cured by modern day therapies.


Bladder cancer makes up about 1 in every 25 cancers and is almost three times  more commonin men than women. About 11,000 people in the UKare diagnosed with bladder cancer each year. Bladder cancer occurs most commonly between the ages of 50 and 70. Bladder cancer is rare in men and women below the age of 40.

Smoking increases the risk of getting bladder cancer.

The main symptom of cancer of the bladder is blood in the urine(haematuria). Most people with bladder cancer notice this as their first symptom. In some cases haematuria may not be visible to the naked eye, and a simple urine test can help detect this.Other less common symptoms include persistent burning or having to pass urine more frequently but these symptoms are more likely to be caused by bladder irritation or infection rather than cancer or in a man due to their prostate being enlarged.

The Department of Health has given guidelines to family doctors (GPs) suggesting they should arrange an urgent appointment with a specialist in bladder disease (called a urologist) to check for anyone who comes with either of the following problems: 

  • you have blood in your urine
  • you are over 50 and your GP detects tiny amounts of blood in your urine

There are many other causes other than cancer which can cause haematuria,  however if you do notice that your are passing blood you should see your GP who can discuss this with you and, if they think it is necessary, arrange an appointment with a specialist to be on the safe side.


Despite the advances that have been made in the treatment of cancer there are still many tumours that cannot be cured. In these situations it often possible for different treatments to stop the growth and spread of the cancer, or even to shrink  it for a period of time.

Depending on the type of cancer and treatment which has been given this period of time when the tumour is no longer growing may last from a few weeks to a number of years.During this time the tumour is said to be  under control or ‘stable’. 

Other phrases which are sometimes used to describe this situation are ‘static disease’ and ‘ISQ’ (in status quo). If the cancer has shrunk  by at least 50% before the period of ‘stabilisation’ this may be referred to as a ‘partial remission’ or ‘partial regression’ or ‘partial response’ (all three terms mean the same thing).

Small changes in tumour size, either recorded by direct measurement or by looking at images on x-rays or scans are difficult to assess precisely. Therefore there is general agreement among cancer specialists that in order for a cancer to show signs of progression, or a relapse, there must be a greater than 25% change in the measurements that have been used to assess it. So provided that any change is less then this level, and assuming there has been no other evidence to suggest the disease is becoming active again), then the condition will still recorded as being ‘stable’.

The urethra is the tube which links the bladder to the penis in men or the vulva in women. This means that surgeons can pass a tube, called a cystoscope. through the urethra into the bladder. Instruments can then be passed through the cystoscope and used to snip off the tumour and, using a probe carrying a high frequency electric current, can cauterize (burn) the area to prevent excessive bleeding. This operation is called a transurethral resection of the bladder tumour or TURBT. Sometimes the probe is used simply to burn off the tumour, rather than cutting it away, and this is known as a cystodiathermy.

Both TURBT and cystodiathermy are simple operations but they do need an anaesthetic and a stay of a day or two in hospital.

TURBT, or csytodiathermy, are used to treat superficial bladder cancers (tumours which are confined to the lining of the bladder and don’t penetrate, or invade, more deeply into the muscle of the bladder). These superficial tumours account for about 8 out of 10 of all bladder cancers.

After this treatment, follow-up cystoscopies (examinations of the bladder through the cystoscope) are needed at regular intervals (usually every three to four months at first) because the tumours can often come back. Most follow-up cystoscopies can be done in the out-patient department under a local anaesthetic. If there is any recurrence of the cancer the tumours can usually be surgically removed (by a further TURBP or cystodiathermy) while there still at an early stage.


When someone has incurable cancer it is very natural that their relatives want to know how long they might live for (even if the patient themselves does not want to know) so that they can plan and start to come to terms with a distressing situation.

Unfortunately it is usually difficult, even for the most experienced cancer specialist, to give an accurate answer. This is because every patient is a unique individual and will be affected differently by their illness. Even two people of the same age, with the same type of cancer, which has spread to the same extent, can have very different survival times. This can happen because many other things influence survival including general fitness, will power, the response to treatment and the development (or avoidance) of unexpected complications.

Despite all this, if the doctor knows the type of cancer and how far it has spread then they will be able to offer ‘average’ figures for life expectancy. But, very importantly, these are only averages. This means that some people will live a little longer, and a few will live a lot longer, than predicted, whilst others will survive a shorter time.

So, in many ways, even an expert opinion of life expectancy for any individual patient is little more than informed guess.

Sometimes, however, even if doctors explain the uncertainties, patients and their relatives will still put great faith in the time they have been given. This can then lead to problems if things go down hill more quickly (and sometimes there are even difficulties if people live much longer than expected).

Because of this uncertainty some doctors are reluctant to offer survival times to their patients (or to relatives). Most specialists, however, will be prepared to discuss the issue, realising that people do need some idea of time scales in order to plan their lives and cope with things. But their advice is still only a guide to what might happen and not a precise forecast of what will happen. .


In recent years there have been a great many studies looking at the effects of exercise and the likelihood of developing cancer.

There is now good evidence that people who are physically active do have a lower risk of developing cancer of the colon (part of the bowel) and cancer of the breast. For colon cancer, where the evidence is strongest, it has been suggested that people whose life includes some moderate exercise have half the risk of developing the cancer compared to those lead an entirely sedentary existence.

For a number of other cancers, including prostate cancer, cancer of the womb and testicular cancer, the figures are less certain with some reports showing exercise is beneficial and others showing no difference.

In over 200 reports, however, there have been none suggesting that exercise increases cancer risk. So as moderate exercise is good for us anyway, reducing the risk of conditions like heart disease and diabetes, it makes sense to keep active.


As a result of  recent clinical trials a number of chemotherapy combinations have been found to be active in bladder cancer. Until recently the best chemotherapy for advanced bladder cancer was regarded to be a treatment called M-VAC. This is a combination of four different chemotherapy drugs: methotrexate, vincristine, adriamycin (also known as doxorubicin) and cisplatin. Recent trials of new drugs such as gemcitabine and taxol in combination with cisplatinor carboplatin suggest that these combinations may be at least as effective as MVAC and  have less side effects. 

 In clinical trials about half the patients who have received one of these regimes had a benefit. This benefit consisted of shrinkage of the tumour or control of the cancer for a period of time but, unfortunately, did not bring about a cure.

These chemotherapy regimes, particularly MVAC, have  a number of side effects, some of which can be quite severe. These include damage to the kidneys, a high risk of infections, hearing impairment, a sore mouth and hair loss. Fortunately, most of these side effects can be reduced with the use of medication given at the same time as the chemotherapy.

Bladder cancer often occurs in elderly people who are more likely to have other medical problems apart from their cancer. Generally this means that they may not be able to tolerate the treatment as well as someone who is younger and fitter, and therefore may experience more side effects.

So chemotherapy may be an option for some people with advanced bladder cancer but the benefits are limited and have to be balanced against the side effects from the treatment. Your father may find it helpful to talk this through with his specialist to see if chemotherapy might be an option for him.


If a bladder cancer is present it will often lead to some blood in the urine, although this may not be apparent to the naked eye. Bladder cancers may also shed cells which can appear in the urine. This means that urine can be tested for either traces of blood or the presence of cancer cells. Unfortunately, neither of these tests have been particularly helpful in diagnosing bladder cancer, as blood in the urine can be due to a number of reasons (such as a urine infection) and is not specific enough to help detect a cancer. A test looking for cancer cells in the urine is known as urine cytology. If  cancer cells are seen this usually means that a bladder cancer is present. However, the test is negative for the majority of early bladder cancers, and even  with more advanced cancers only about 3 out of 4 will be detected in this way. As a negative cytology test does not rule out the presence of a bladder cancer it is not a reliable diagnostic test.

There are several testing kits that are available over the counter in shops, however they aren’t used widely because they aren’t very sensitive or specific to bladder cancer. If you are concerned that you may have bladder cancer do speak with your doctor.

Recently doctors in the UK have developed a new urine test which may help detect bladder cancer at an earlier stage, and reduce the need for examinations such as a cystoscopy (examining the bladder with a small telescope). This urine test measures the levels of a protein called Mcm5 which has been found to be  higher in someone with bladder cancer. This test is currently being tested in a trial in the UK to find out if it is as effective as examining the bladder with a cytsopscope. This trial will take a few years to complete, so until these results are known, cystoscopy is still the most effective test to detect bladder cancer.


There are many causes for blood in the urine(called haematuria). Often this symptom is due to problems like infections but it can sometimes be a sign of acancer. So this symptom should never be ignored. Your mother should arrange to see her family doctor (GP) for a check up as soon as she can to find the cause. The GP  is likely to do a simple test on a sample of her urine which can detect  even traces of blood in the urine which may not be visible to the naked eye.

The Department of Health has given guidelines to GP’s suggesting they should arrange an urgent appointment with a specialist (called a urologist) to check for anyone who  has either of the following problems:

  • passing blood in their urine
  • someone who is over 50 and when their urine is tested there are traces of blood present, even though these are not visible.

An urgent hospital appointment usually means that the specialist will see your mother within two weeks.

When your mother sees the specialist they will take a full medical history and examine her. Depending on what the specialist findsthere may be more specialised tests carried out, to help them diagnosis the cause. These tests may include:

  • blood tests
  • a cystoscopy, ( a small flexible telescope) helps the specialist to look at the bladder and the tube from the bladder to the outside (the urethra). If anything abnormal is seen then they will take tiny samples of tissue (biopsies) to look at under the microscope. This is usually done under a general anaesthetic
  • an IVU or IVP,( a special x-ray which uses a dye injected into a vein in the arm), to show up the kidneys, the ureters (the tubes joining the kidneys to the bladder) and the bladder.
  • a CT scan, which uses x-rays to build up a three dimensional picture of the structures in the body
  • an ultrasound scan, which uses sound waves to build up pictures of the structures of the body.

If these tests show that your mother does have a cancer then  any treatment will depend on several factors including the type of bladder cancer as well as the stage(how deeply the cancer is affecting the lining of the bladder) and grade( how quickly growing the cells are). Treatment  commonly involves an operation to remove the growth, or sometimes radiotherapy or occasionally chemotherapy may be given.


The cystoscopy examination uses a  small telescope(the cystoscope) that allows doctors to look at the lining of the bladder. During the examination they can also take samples of any abnormal looking tissue for examination under the microscope (called a biopsy).

Although this test has confirmed that your husband has bladder cancer the cystoscopy will only have looked  at the surface of the bladder and will not have given information about whether the cancer may (or may not) has spread into the musclewall of the bladder, or surrounding tissue in the pelvis.

In order to decide the best treatment for bladder cancer it is important to know whether the cancer is within the bladder or if  it  has spread through the wall of the bladder to surrounding tissues.  The scan can help the doctors to see the extent of the cancer and help them decide the best treatment. The types of scans used can either be  a CT scan or an MRI scan. Both scans use special machines to take a series of pictures of the pelvis which produce a detailed image of the inside of the body.

Both scans involve having an injection of a dye into a vein to help show up the bladder and surrounding structures.and can be done as an out-patient (taking less than one hour). As with all medical tests the scans are not always 100 per cent accurate but they do give valuable additional information about the size and extent of the cancer.


In the early days of radiotherapy treatment, skin burns during treatment and sometimes permanent damage or scarring of the skin, was common.

This changed during the late 1950s and 1960s as two new types of machine were introduced to give the radiotherapy treatment. These are called Linear Accelerators and Cobalt Units. These machines produce irradiating rays of a much greater energy than the previous machines. This higher energy of the rays give the treatments greater accuracy and greater penetration of the tissues (allowing treatment of cancers deep inside the body and also reduce skin damage. This is because the high energy rays pass through the first centimetre or two of the first tissue they meet, before they actually begin to give out any radiation.
Skin problems are uncommon with modern radiotherapy treatment. Occasionally skin problems can occur because of the location of the cancer and the area of the body treated. Usually this will cause no more than some temporary pinkness or redness of the skin for a week or two after treatment. If any soreness does develop it will only last a short time and can usually be eased with creams or lotions, which you will be given at the hospital. Severe or permanent skin damage is  rare indeed.

The fact that skin damage was common forty or fifty years ago means that people can remember friends or relatives who had bad experiences with their radiotherapy treatments which  probably account for the stories you have heard. Nowadays the situation is very different and things have improved enormously.

Radiotherapy is almost always a local treatment, limited to a particular part of the body. Only the skin in that area will be irradiated and the skin elsewhere will not be affected.

The doses of radiotherapy used can vary but even with quite high doses modern radiotherapy machines usually cause a little skin irritation. Even so this does mean that the skin which has been irradiated will be more sensitive to sunlight than your normal skin.

The degree of sensitivity will vary from person to person. The increased sensitivity also reduces gradually with time but probably never disappears completely.

Having had radiotherapy does not mean you must avoid the sun completely but you should take care over exposing the treated skin. It is very important to cover the treated area for at least the first year after radiotherapy. Wear clothing made of cotton or natural fibres which have a closer weave and offer more protection against the sun. Even after this time the area treated will be more delicate, so extra care should be given. You should also use a high factor sunscreen (of at least factor 15). Remember, too much sunbathing does carry the risk of leading to skin cancer and should be avoided.

Very occasionally radiotherapy is given to the whole body. In this situation the doses are normally quite low but you should still take precautions in exposure to strong sunlight. Seek advice  from your doctors if you are having this type of treatment.

For a long time it has been known that some cancers occur more commonly in some families than others. There are at least two possible reasons for this. It could be due to some shared environmental factor (something in the diet or something else to do with a lifestyle common to a number of family members). Or it could be due to abnormalities in the genes, which are passed from one generation to another.

In recent years research has shown that a small minority of three common forms of cancer, breast cancer, cancer of the ovary and cancer of the bowel are due to abnormal genes. There are other, rarer cancers associated with these commons cancers: there seems to be a higher risk of skin, prostate and pancreatic cancer in families with many breast and ovarian cancers. Families who have a bowel cancer gene also can have cases of endometrial, ovarian, pancreatic, stomach and kidney cancer. These genes can be passed from one generation to the next and so do account for some, but not all, of those families where these cancers are commoner than usual.

The abnormal genes do not themselves cause the cancer but they do mean that someone who has the faulty gene is more likely to develop cancer than someone who does not. So what is inherited is a greater risk of developing cancer and not the certainty that a cancer will develop. The degree of risk varies with different genes, with some it is quite small whilst with others it is very high indeed. Families that are affected by a faulty gene normally have a number of the same cases of cancer in the family, and people tend to develop the cancer earlier than usual (under 60 years).

It is true to say, however, that for the great majority of cancers, including most breast, ovary and bowel cancers, that there is no obvious family tendency and no evidence that they can be inherited. If you have two or more cases of the same cancer on the same side of your close family, you might want to talk to your GP.


There is a widespread public belief that stress can lead to cancer.

Over the last twenty years there have been many scientific studies looking at whether there really is a relationship between stress and cancer. These studies have used a number of different methods. Some have looked at women with benign and malignant (cancerous) breast lumps and compared the number of major stressful events in the five years or so before their condition was diagnosed, to see if the women with cancers had suffered more stress. Others have followed the lives of people who have been bereaved, or who were prisoners of war, to see if these stresses led to a greater chance of cancer developing in the future when compared to the normal population.

When the results of all these studies are analysed there is absolutely no evidence that stress does cause cancer.

At the end of the day stressful life events – bereavement, divorce, redundancy, moving house and so on are very very common and inevitably many people who do develop cancer will have experienced one or more of these in the few years before their tumour was discovered. Doctors often don’t know the cause of any particular cancer and people are distressed to find that there is no definite explanation as to why they developed cancer. They find it very plausible to believe that their cancer was caused by stress but there is no scientific evidence to suggest that these events are any commoner for cancer patients than for the population at large.

When a new drug is being considered as a treatment for cancer it has to go through many tests to make sure it is both safe and of benefit.

If tests in the laboratory (known as preclinical testing) have been promising then the drug can be tested in people (this is clinical testing, or clinical trials). These trials follow a set pattern through various Phases, from Phase I to Phase III or IV.

A Phase I trial simply looks at the side-effects and dose of the drug in order to work out a safe way of using it.

If the Phase I trial is successful then Phase II trials can be begin. The Phase II trials are intended to see whether the drug might be effective as a treatment against cancer.

The usual pattern for Phase II trials is for the new drug to be given to groups of people with different types of advanced cancer. Because the drug is new, and its benefits are unknown, it is usually only people who have cancers which are no longer controlled by conventional treatment who are considered for Phase II studies (since it would be wrong to give someone a treatment of uncertain value, even if it is new, when there are tried and tested treatments already available which could be helpful).

For each type of cancer which it is tested against, the new drug is initially given to about 15 to 20 people. If some of those people show an improvement as a result of having the drug then more people with that particular type of cancer will be tested to try and get a more accurate idea of how active the drug is. In this way doctors can decide whether the drug is likely to be useful and also decide which cancers are most likely to be controlled by the new treatment.

Unfortunately only a minority new drugs which reach the Phase II stage prove to be of value in cancer treatment. This means that taking part in a Phase II trial does not guarantee any benefit in terms of tumour control, and increased life expectancy. In fact it could involve a lot of extra inconvenience (with hospital visits and regular check-ups) and possible side effects from the treatment. So the chances of getting a further remission by taking part in a Phase II trial are usually quite small. Many people with advanced cancer do volunteer for these studies, partly in the hope that they may get a benefit and also to help medical science and possibly benefit other people in the future.

Another word of caution is that Phase II trials often get misreported by the media (who are always anxious for a new story about cancer). Newspaper articles, TV programmes or internet pages will often suggest that these studies are a ‘breakthrough’ or are using a ‘wonder drug’ and so, understandably, people think the drug is far more promising than is the case.

No. Diabetes is a common condition and surgeons are used  to operating regularly on people who are diabetic. Usually they will put up a drip, into a vein in the arm or back of the hand, before the operation. This will then be used to give insulin and sugar solutions to keep your blood sugar at the correct level throughout the operation and will continue until you can eat and drink normally. Throughout this time your blood sugar level will be regularly checked and the drip adjusted as necessary. This means it will be perfectly safe for you to go ahead with the surgery that you need.

Adhesions are a type of scar tissue which sometimes develops after surgery.

Adhesions take the form of either strips or bands of fibrous tissue. Sometimes adhesions will cause organs to stick to one another or to surrounding tissues. Occasionally, after abdominal surgery, the bands of adhesions may interfere with the normal movement of the bowel leading to colicky spasms or even temporary obstruction (blockage) of the bowel.

Usually adhesions cause little in the way of symptoms but sometimes they can cause discomfort or even pain although this is usually only temporary. Simple pain killers, like paracetemol, or antispasmodics such as buscopan, will usually ease the discomfort which will normally disappear on its own after a short time.

In the unlikely event of adhesions leading to bowel obstruction (causing severe colicky abdominal pain, sickness and constipation) a short stay in hospital may be necessary. During this time the bowel will be rested, by giving you a drip so you do not need to eat or drink, and usually the blockage will disappear after a day or so. Occasionally it will be necessary to put a fine tube via your nose into your stomach to drain of the gastric juices (a nasogastric tube) so as to rest the bowel more completely.

Very occasionally surgeons may need to do another operation to divide and separate adhesions but they will usually try to avoid this since doing another operation raises the risk of forming yet more adhesions

Category: BILE DUCT

No. Diabetes is a common condition and surgeons are used  to operating regularly on people who are diabetic. Usually they will put up a drip, into a vein in the arm or back of the hand, before the operation. This will then be used to give insulin and sugar solutions to keep your blood sugar at the correct level throughout the operation and will continue until you can eat and drink normally. Throughout this time your blood sugar level will be regularly checked and the drip adjusted as necessary. This means it will be perfectly safe for you to go ahead with the surgery that you need.


Understandably, ‘nothing more to be done’ is a phrase that can cause alarm, despondency and despair. So it is important to be clear just what this means. It isn’t the end of care and support for your relative. What it does mean is that their specialists do not think there is any treatment left that has a reasonable chance of actually controlling the cancer. There is no further ‘active’ treatment, that is treatment which is given to contain or reduce the cancer, that they can usefully offer.

This decision will change the emphasis of your relative’s medical care from ‘active treatment’ to ‘supportive care’. Their GP, Macmillan nurses and the team from the local hospice team will become more involved and you may find that the hospital will play a smaller part than before.

The emphasis of care is attention to easing, and preventing, upsetting symptoms of the cancer and giving practical support, both physically and emotionally, to your relative and the family. Quality of life will become most important and, perhaps surprisingly, people with advanced cancer often find that at this late stage of their illness their quality and enjoyment of life can actually improve.

Part of this improvement can be because they no longer have the inconvenience of regular hospital visits and tests and the physical effort and burden this may involve when faced with an advanced cancer. Less disruption to a person’s daily life, and not having to cope with the often unpleasant side effects of treatment can be a benefit, particularly if the treatment is not helping to control the cancer.

It is natural to feel despair when the specialists say there is nothing more that can be done. So your question is one that is frequently asked. Very often, however, it is asked by relatives and not by the person who actually has the cancer. Sometimes this is because that person has come to terms with their condition and is quite willing, and possibly even relieved, to go along with the change in their care. At the same time their relatives, with the best of intentions, still feel they shouldn’t ‘give up’ and that ‘something must be done’. If your relative is still looking for active treatment there are two things they can do.

The first is for your relative to talk to their specialist (a phone call to his or her secretary should easily arrange this). They can ask about any experimental treatments and clinical trials that may be suitable. It may be that they will say there really is nothing to be offered or they may tell them about new or experimental treatments which are being tested at another hospital and might offer to refer your mother there for advice.

There are always new drugs and treatments being tested for cancer, unfortunately many of these do not prove to be successful or the benefits are likely to be small. Despite this reality, many new experimental treatments do get enthusiastic reports in the media, which all too often raise false hopes for patients and their families. Sadly this happens frequently.

However having active treatment helps some people feel positive and hopeful even though they know the chances of benefit are small. People sometimes find it easier to cope if they feel they are doing something active to try and treat the cancer, and many people are also happy to be contributing to the advancement of knowledge about cancer and its treatment. The downside is the disruption, and possible distress, from treatment and its side effects that your relative might have to go through. Also, even when there is a response to these treatments it is, at best, usually a matter of prolonging life by a few weeks or months.

If your relative doesn’t want to see the specialist, or if they feel the interview was not satisfactory, then the second thing you or they can do is ask the consultant or GP to arrange a second opinion from a consultant at another hospital. Doctors are usually happy to do this, as they appreciate a persons need to find any available treatment that may help. Even if you do this, however, it is likely that the new specialist will not be able to offer anything more. But at least you will then know that they have explored every possible avenue for their future care.

When someone has incurable cancer it is very natural that their relatives want to know how long they might live for (even if the patient themselves does not want to know) so that they can plan and start to come to terms with such a distressing situation.

Unfortunately it is usually difficult, even for the most experienced cancer specialist, to give an accurate answer. This is because every patient is a unique individual and will be affected differently by their illness. Even two people of the same age, with the same type of cancer, which has spread to the same extent, can have very different survival times. This can happen because many other things influence survival including general fitness, will power, the response to treatment and the development (or avoidance) of unexpected complications.

Despite all this, if the doctor knows the type of cancer and how far it has spread then they will be able to offer ‘average’ figures for life expectancy. But, very importantly, these are only averages. This means that some people will live a little longer, and a few will live a lot longer, than predicted, whilst others may survive a shorter time.

So, in many ways, even an expert opinion of life expectancy for any individual patient is little more than informed guess.

Sometimes, however, even if doctors explain the uncertainties, patients and their relatives will still put great faith in the time they have been given. (This can then lead to problems if someone deteriorates sooner than expected).

Because of this uncertainty some doctors are reluctant to offer survival times to their patients (or to relatives). Most specialists, however, will be prepared to discuss the issue, realising that people do need some idea of time scales in order to plan their lives and cope with things. But their advice is still only a guide to what might happen and not a precise forecast of what will happen.

Anal cancers are rare with only about 300 new cases in the UK each year.

Despite the small numbers several different types of cancer can occur in the anal region.

The majority of these (more than 4 out 5) arise in the lining cells of the wall of the anus or the skin around the opening of the anus (the anal margin). These cancers are called squamous carcinomas.

In the past pathologists have described several types of cancer which when seen under the microscope look slightly different from normal squamous carcinomas. These include transitional, cloacogenic and basaloid carcinomas. Despite their differences in appearance these growths all seem to behave exactly like squamous carcinomas and so are treated in exactly the same way.

Other cancers that may occur in the anal region include adenocarcinomas, malignant melanomas and basal cell carcinomas. These cancers do behave differently to the squamous carcinomas and require different approaches to treatment.


The anus is the name for the muscular area at the end of the large bowel. It includes the muscle, which opens and closes to control bowel movements, and is where the bowel opens to the outside. The internal part of the anus is called the anal canal.

The anal canal is quite short, being a cylinder of tissue about 2-3 centimetres long (about one inch). This means that any operation to remove a cancer of the anal canal will have to take away the whole of the anal canal to be sure of clearing the growth. This surgery includes the removal of the muscle controlling bowel movements and so leads to permanent incontinence. Because of this a colostomy is always necessary afterwards (this involves bringing the end of the bowel out on to the front of the abdomen and having a bag to collect the faeces). The skin where the anus was is then sown together.

This is obviously quite a big operation and also has the disadvantage that your mother would be left with a colostomy for the rest of her life.

During the 1980s doctors wondered whether giving radiotherapy, together with chemotherapy, might offer an alternative to surgery for squamous caricnomas of the anal canal. Clinical trials have now shown that the chance of cure with this non-surgical treatment is every bit as good as with an operation. Although it does involve quite a lot of treatment over a period of several months it does, of course, avoid the need for a colostomy.

Another point worth bearing in mind is that if your mother was one of the unfortunate minority of people for whom the radiotherapy and chemotherapy failed to completely clear the cancer, so that it came back at a later time, then an operation could always still be done, giving another chance of a cure.


Cancer of the anus is quite rare with only about 300 new cases in the United Kingdom each year. Like most cancers the cause for the great majority of anal cancers is unknown.

A minority of anal tumours are, however, associated with infection by a virus called the human papilloma virus (HPV). This virus can cause warts in the genital area and very occasionally, often after many years, a cancer may develop in one of these warts. Anal cancer is commoner in the receptive partners of anal intercourse and HPV infection may be a factor in this.

Anal cancer is also commoner in people who have AIDS. No one is sure whether this is due to the presence of the HIV virus (the human immunodeficiency virus, which causes AIDS) or whether the reduced immunity of AIDS patients makes them ore at risk to the possible cancerous effects HPV.

The anus is the name for the muscular area at the end of the large bowel. It includes the muscle, which opens and closes to control bowel movements, and is where the bowel opens to the outside.

The internal part of the anus is called the anal canal. It is a cylinder of tissue about 2-3 centimetres long (about one inch). The patch of skin immediately around the opening of the anus is known as the anal margin. Sometimes doctors talk about the point where the anal canal and anal margin meet one another as being the anal verge.

Anal cancers are quite rare, with only about 300 new cases each year in the United Kingdom. The great majority of these tumours will develop in the anal canal but about 1 in 5 will be in the anal margin.

It is important for your mother’s doctors to be certain whether her cancer is in the anal canal or anal margin as the treatment of the two types of tumour can sometimes be different. Most anal canal tumours will normally need a course of radiotherapy and chemotherapy, which usually results in most people being cured, but an anal margin tumour, if it is small, can often be treated with a minor operation.


For about fifty years 5FU (5-fluorouracil) has been accepted as the most effective chemotherapy drug for the treatment of bowel (colon) cancer.
5FU works by blocking an enzyme in the cells. The blockingof this enzyme means that cells are not able to correctly make the nucleic acid DNA, which they need in order to reproduce. This can then lead to a slow down in the growth of the cancer.

During the 1980s it was discovered that giving folinic acid (also called leucovorin), which is a form of the vitamin folic acid, increased the duration and extent of 5FU’s blocking of this enzyme. Clinical trials have since confirmed that giving 5FU with folinic acid in the treatment of bowel cancer is more effective than giving 5FU on its own.


Backache is a very common problem and has many causes other than cancer, so chances are that your back problems have nothing to do with your previous tumour.

It is possible, that your backache could be due to the cancer. This could happen for one of two reasons. Either because invisible, microscopic remnants of the tumour which could not be detected, and had not been completely removed at the time of the original surgery have started to regrow (a local recurrence of the tumour), or because of minute seedlings of tumour which had spread to the bone before your surgery, forming secondary cancers in the bone, which have now begun to grow. Secondaries to the bone are, however,very uncommon in colon cancer.

It is important to make sure that the backache is not related t the colon cancer, both for your own peace of mind and to get the right treatment to make things better. So do see your doctor as soon as possible and get his or her advice on the problem.


The bowel is made up of the intestines which join the stomach to the anus. The intestines are in two parts, the small intestine (or, small bowel) and the large intestine (or, large bowel). The large intestine also has two parts, the colon and the rectum.

The small intestine is a narrow tube made up of layers of muscle, lined with a moist mucous membrane. It is five or six metres in length and lies coiled in the abdomen. As partly digested food from the stomach passes along the small bowel essential nutrients are taken from it and pass into the body. Cancers can develop in the small bowel but they are extremely uncommon.

The first part of the large bowel is the colon. This joins the large bowel low down in the abdomen on the right. This first part of the colon is often called the caecum. The colon then runs up the right side of the abdomen to the level of the diaphragm (the muscle that separates the chest from the abdomen). This part of the large bowel is called the ascending colon. It then runs across the top of the abdomen as the transverse colon. Next it turns and lies down the left side of the abdomen and is called the descending colon. The last part of the colon is a short curved passage at the lower part of the abdomen linking the colon to the rectum and this is called the sigmoid colon. The rectum is the last 20cm or so of the large bowel which joins the colon to the anus, where the bowel opens to the outside.

Like the small intestine, the walls of the large bowel are made up of layers of muscle, lined with a moist mucous membrane. As the undigested, liquid, remains of food pass along the large bowel water is taken from them to make them increasingly more solid, finally forming the faeces, or stool, which is stored in the rectum.

Both the colon and rectum are common sites for cancer. In the United Kingdom each year there are almost 20,000 new cases of colon cancer (which is slightly commoner in women than men) and almost 12,000 new cases of rectal cancer (which is slightly more common in men than women). By contrast there are less than 500 new cases of cancer of the small intestine discovered each year.


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