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Cancer
Cancer
What is cancer?
The body is made up of trillions of living cells. Normal body cells grow, divide into new
cells, and die in an orderly way. During the early years of a person's life, normal cells divide
faster to allow the person to grow. After the person becomes an adult, most cells divide only
to replace worn-out or dying cells or to repair injuries.
Cancer begins when cells in a part of the body start to grow out of control. There are many
kinds of cancer, but they all start because of out-of-control growth of abnormal cells.
Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells
continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into)
other tissues, something that normal cells cannot do. Growing out of control and invading
other tissues are what makes a cell a cancer cell.
Cells become cancer cells because of damage to DNA. DNA is in every cell and directs all its
actions. In a normal cell, when DNA gets damaged the cell either repairs the damage or the
cell dies. In cancer cells, the damaged DNA is not repaired, but the cell doesnt die like it
should. Instead, this cell goes on making new cells that the body does not need. These new
cells will all have the same damaged DNA as the first cell does.
People can inherit damaged DNA, but most DNA damage is caused by mistakes that happen
while the normal cell is reproducing or by something in our environment. Sometimes the
cause of the DNA damage is something obvious, like cigarette smoking. But often no clear
cause is found.
In most cases the cancer cells form a tumor. Some cancers, like leukemia, rarely form
tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate
through other tissues where they grow.
Cancer cells often travel to other parts of the body, where they begin to grow and form new
tumors that replace normal tissue. This process is called metastasis. It happens when the
cancer cells get into the bloodstream or lymph vessels of our body.
No matter where a cancer may spread, it is always named for the place where it started. For
example, breast cancer that has spread to the liver is still called breast cancer, not liver
cancer. Likewise, prostate cancer that has spread to the bone is metastatic prostate cancer, not
bone cancer.
Different types of cancer can behave very differently. For example, lung cancer and breast
cancer are very different diseases. They grow at different rates and respond to different
treatments. That is why people with cancer need treatment that is aimed at their particular
kind of cancer.
Not all tumors are cancerous. Tumors that arent cancer are called benign. Benign tumors can
cause problems they can grow very large and press on healthy organs and tissues. But they
cannot grow into (invade) other tissues. Because they cant invade, they also cant spread to
other parts of the body (metastasize). These tumors are almost never life threatening.
The nasopharynx serves as a passageway for air from the nose to the throat (and eventually to
the lungs).
Nasopharyngeal tumors
Several types of tumors can develop in the nasopharynx. Some of these tumors are benign
(non-cancerous), but others are malignant (cancerous). It is important to discuss what type of
tumor you might have with your doctor.
Treatment of these benign tumors (if it is needed) is different from that for cancerous
nasopharyngeal tumors and is not covered further in this document. If you have one of these
tumors, you and your doctor will talk about what treatments might be appropriate for you.
Nasopharyngeal cancers
These tumors can invade surrounding tissues and spread to other parts of the body.
Nasopharyngeal carcinoma (NPC): This is by far the most common malignant tumor of the
nasopharynx. A carcinoma is a cancer that starts in epithelial cells the cells lining the
internal and external surfaces of the body. Most of the rest of this document refers to NPC.
There are 3 types of NPC, based on how the cancer cells look under the microscope:
Keratinizing squamous cell carcinoma
Non-keratinizing differentiated carcinoma
Undifferentiated carcinoma
Each of these types is seen more often in some areas of the world than in others. In southern
China, where NPC is much more common, nearly all cases are the undifferentiated type. In
the United States, where NPC is rare, about 1 out of 5 cases are the keratinizing type.
Even though these types look different when seen under a microscope, studies have shown
they start from the same cell type the epithelial cells that line the surface of the
nasopharynx. The treatment is also usually the same for all types of NPC. The stage of the
cancer how far it has grown and spread is often more important than its type in predicting
a person's outlook (prognosis).
Many NPCs also contain lots of immune system cells, especially lymphocytes. The term
lymphoepithelioma is sometimes used to describe an undifferentiated NPC with many
lymphocytes among the cancer cells. The presence of these cells does not usually affect the
choice of treatment options. But they may be a clue to developing new treatments since they
may represent the body's attempt to reject the tumor (for more information, see the section
What's new in nasopharyngeal cancer research and treatment?).
Other cancers in the nasopharynx: Other types of cancers can arise in the nasopharynx.
Lymphomas can sometimes start in the nasopharynx. They are cancers of immune system
cells called lymphocytes, which are found throughout the body, including in the nasopharynx.
These cancers are discussed in our document Non-Hodgkin Lymphoma.
Adenocarcinoma and adenoid cystic carcinoma are cancers that can develop in the minor
salivary glands in the nasopharynx, but these cancers are more commonly found in the nose
(nasal cavity) or mouth (oral cavity). More information on these cancers can be found in our
documents Oral Cavity and Oropharyngeal Cancer, Nasal Cavity and Paranasal Sinuses
Cancer, and Salivary Gland Cancer.
Smoking, alcohol, and some workplace exposures may also increase the risk of this cancer.
These risk factors are discussed in more detail below
Gender
NPC is found about twice as often in males as it is in females.
Diet
People who live in parts of Asia, northern Africa, and the Arctic region where NPC is
common, typically eat diets very high in salt-cured fish and meat. Indeed, the rate of this
cancer is dropping in southeast China as people begin eating a more Westernized diet. In
contrast, some studies have suggested that diets high in fruits and vegetables may lower the
risk of NPC.
Genetic factors
A persons genes may affect their risk for NPC. For example, just as people have different
blood types, they also have different tissue types. Studies have found that people with certain
inherited tissue types have an increased risk of developing NPC. Tissue types affect immune
responses, so this may be related to how a person's body reacts to EBV infection.
Family history
Family members of people with NPC are more likely to get this cancer. It is not known if this
is because of inherited genes, shared environmental factors (such as the same diet or living
quarters), or some combination of these.
when cells grow and divide into new cells. Viruses such as EBV also contain DNA. When a
cell is infected with the virus, the viral DNA may mix with the normal human DNA. EBV
DNA may instruct the cells of the nasopharynx to divide and grow in an abnormal way.
But EBV infection only rarely results in NPC, so other factors probably play a role in
whether or not it causes cancer. Eating a diet high in salt-cured fish and meat seems to
increase the ability of EBV to cause NPC. Studies show that foods preserved in this way may
produce chemicals that can damage DNA. The damaged DNA alters a cells ability to control
its growth and replication.
Some studies suggest that inheriting certain tissue types may contribute to a persons risk of
developing NPC. Because the tissue type plays a role in the function of the immune system,
some scientists suspect that an abnormal immune reaction to EBV infection may be involved.
The details of how certain tissue types might increase NPC risk are still being worked out.
used in families when one member has developed NPC. It isnt known if this strategy lowers
the death rate from this cancer.
Sometimes NPC can be found early if it causes symptoms that make patients seek medical
attention. The symptoms may even seem unrelated to the nasopharynx (for example, a
constant feeling of fullness in one ear). But in most people, NPCs may not cause symptoms
until they have reached an advanced stage.
Biopsy
Symptoms and the results of exams can suggest that a person might have NPC, but the actual
diagnosis is made by removing cells from an abnormal area and looking at them under a
microscope. This is known as a biopsy. Different types of biopsies may be done, depending
on where the abnormal area is.
Endoscopic biopsy
If a suspicious growth is found in the nasopharynx during an exam, the doctor may remove a
biopsy sample with small instruments and the aid of a fiber-optic scope. Often, biopsies of
the nasopharynx are done in the operating room as an outpatient procedure. The sample is
then sent to a lab, where a pathologist (a doctor who specializes in diagnosing and classifying
diseases in the lab) looks at it under a microscope. If the biopsy sample contains cancer cells,
the pathologist sends back a report describing the type of the cancer.
NPC is not always visible during an exam. If a person has symptoms suggesting NPC but
nothing abnormal is seen on exam, the doctor may biopsy normal-looking tissue, which may
be found to contain cancer cells when looked at under the microscope.
Imaging tests
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive particles to create
pictures of the inside of your body. Imaging tests may be done for a number of reasons,
including to help find a suspicious area that might be cancerous, to learn how far cancer may
have spread, and to help determine if treatment has been effective.
Chest x-ray
If you have been diagnosed with NPC, a plain x-ray of your chest may be done to see if the
cancer has spread to your lungs. This is very unlikely unless your cancer is far advanced.
This x-ray can be done in any outpatient setting. If the results are normal, you probably dont
have cancer in your lungs.
MRI scans may be a little more uncomfortable than CT scans. They take longer often up to
an hour. You may be asked to lie on a table that slides inside a large tube, which is confining
and can upset people with a fear of enclosed spaces. Special, open MRI machines can
sometimes help with this if needed, but the drawback is that the images may not be as clear.
The MRI machine makes buzzing and clicking noises that you may find disturbing. Some
places will provide earplugs to help block this noise out.
Like CT scans, MRIs can be used to try to determine if the cancer has grown into structures
near the nasopharynx. MRIs are a little better than CT scans at showing the soft tissues in the
nose and throat, but theyre not quite as good for looking at the bones at the base of the skull,
a common place for nasopharyngeal cancer to grow.
Blood tests
Blood tests are not used to diagnose NPC, but they may be done for other reasons, such as to
help determine whether the cancer may have spread to other parts of the body.
Stage IVB: Any T, N3, M0: The tumor may or may not have extended into nearby soft
tissues or bones (any T). It has spread to lymph nodes that are larger than 6 cm across and/or
are located in the shoulder area above the collarbone (N3). The cancer has not spread to
distant sites (M0).
Stage IVC: Any T, any N, M1: The tumor may or may not have extended into nearby soft
tissues or bones (any T). It may or may not have spread to nearby lymph nodes (any N). It
has spread to distant sites (M1).
Stage
Relative 5-year
survival rates
72%
II
64%
III
62%
IV
38%
Many other specialists may be involved in your care as well, including nurse practitioners,
nurses, nutrition specialists, social workers, and other health professionals.
It is important to discuss all of your treatment options, including goals and possible side
effects, with your doctors to help make the decision that best fits your needs. (See the section
What should you ask your doctor about nasopharyngeal cancer? for some questions to ask.)
If time permits, it is often a good idea to get a second opinion. A second opinion can give
you more information and help you feel confident about your chosen treatment plan.
The next few sections describe the various types of treatments used for nasopharyngeal
cancers. This is followed by a description of the most common approaches used for these
cancers, based on their stage.
A modified radical neck dissection removes lymph nodes on one side of the neck
between the jaw bone and collarbone, as well as some muscle and nerve tissue. The main
nerve to the shoulder muscle is usually preserved.
A radical neck dissection removes nearly all lymph nodes on one side as well as even
more muscles, nerves, and veins.
Sores in the mouth and throat which can lead to trouble swallowing and weight loss from
not eating
Hoarseness
Loss of taste
These side effects get better once radiation has stopped. Other side effects may not get better
over time, such as:
Problems with hearing or vision because of damage to certain nerves
Damage to bones in the skull
Tooth problems
Damage to the salivary glands
Radiation to these areas can make any tooth problems that you already have worse and hard
to fix. Most doctors advise that you have your teeth checked by a dentist before you have
radiation therapy to the head or neck area. In some cases, the dentist may even advise
removing some teeth before treatment to lessen the chance you will have problems later.
A major concern with radiation therapy for NPC is that it can damage the salivary glands.
This damage can result in dry mouth that does not go away, making it hard to swallow food.
Dry mouth can also lead to severe tooth decay. To help prevent dental problems, people
treated with radiation to the head or neck area need to practice careful oral hygiene.
Dry mouth is less of a problem if radiotherapy techniques such as IMRT are used. Some of
the damage to the salivary glands may also be lessened if a drug called amifostine (Ethyol)
is given before each radiation treatment. This drug can have bothersome side effects, though.
The thyroid gland is often damaged if the neck area is treated with external beam radiation.
The damage doesnt cause problems seen right way, so your doctor will watch your thyroid
function with blood tests in the years after treatment. If your thyroid function goes down,
pills to replace thyroid hormone may be needed.
The pituitary gland, which is responsible for controlling many hormones in the body, can
also be damaged by treatment of a tumor in the nasopharynx. This can also be found with
blood tests. If the damage is serious enough, this might require taking certain hormones to
replace the ones that are missing.
The carotid arteries, which are major blood vessels in the neck that deliver blood to the brain,
can sometimes become narrowed after radiation, which could raise a persons risk of stroke
or other problems. This usually takes several years to occur.
It is important to discuss the possible side effects of radiation therapy with your doctor before
starting treatment, and to make sure everything is being done to try to limit these side effects
as much as possible.
For more general information about radiation therapy, see the Radiation Therapy section of
our website, or our document Understanding Radiation Therapy: A Guide for Patients and
Families.
Gemcitabine (Gemzar)
Bleomycin
Methotrexate
Often, combinations of 2 or more of these drugs are used.
For more general information about chemotherapy, see the Chemotherapy section on our
website or our document A Guide to Chemotherapy.
Cetuximab (Erbitux)
Cetuximab is a monoclonal antibody (a man-made version of an immune system protein) that
targets the epidermal growth factor receptor (EGFR). EGFR is a protein found on the surface
of cells. It normally receives signals telling the cells to grow and divide. Nasopharyngeal
cancer (NPC) cells sometimes have more than normal amounts of EGFR, which can help
them grow faster. By blocking EGFR, cetuximab may slow or stop this growth.
The exact role of cetuximab in treating NPC is still being studied. It is most often used along
with chemo and/or radiation in cases where the cancer has come back or continues to grow
after initial chemo.
Cetuximab is given by IV infusion, usually once a week. Common side effects include:
Skin problems, such as an acne-like rash on the face and chest during treatment, which in
some cases can lead to infections.
Headache
Tirednes,
Fever
Diarrhea
A rare but serious side effect of cetuximab is an allergic reaction during the first infusion,
which could cause breathing problems and low blood pressure. You may be given medicine
before treatment to help prevent this.
For information about managing skin problems from targeted therapy, see our document
Targeted Therapy.
Complementary methods: Most complementary treatment methods are not offered as cures
for cancer. Mainly, they are used to help you feel better. Some methods that are used along
with regular treatment are meditation to reduce stress, acupuncture to help relieve pain, or
peppermint tea to relieve nausea. Some complementary methods are known to help, while
others have not been tested. Some have been proven not to be helpful, and a few have even
been found harmful.
Alternative treatments: Alternative treatments may be offered as cancer cures. These
treatments have not been proven safe and effective in clinical trials. Some of these methods
may pose danger, or have life-threatening side effects. But the biggest danger in most cases is
that you could lose the chance to be helped by standard medical treatment. Delays or
interruptions in your medical treatments may give the cancer more time to grow and make it
less likely that treatment will help.
Stages 0 and I
The usual treatment for these early stage cancers is radiation therapy aimed at the
nasopharyngeal tumor.
Although the cancer has not yet spread to lymph nodes in these stages, the nearby lymph
nodes in the neck are usually treated with radiation therapy as well. This is considered
preventive (prophylactic) radiation. Some patients may have cancer cells in these lymph
nodes that cant be detected. Although there are too few cancer cells in the lymph nodes to
cause them to be enlarged, these cells could continue to grow and spread if not destroyed by
radiation therapy.
Stage IVC
These nasopharynx cancers have spread to distant parts of the body and can be hard to treat.
The usual treatment is chemo, often with cisplatin and one other drug. If there is no sign of
the cancer after chemotherapy, radiation therapy to the nasopharynx and the lymph nodes in
the neck or chemoradiation is given to try to kill any remaining cancer cells. Another option
in some cases is to give chemoradiation as the first treatment.
If there are still signs of cancer after the initial chemotherapy, another chemotherapy regimen
using different drugs may be tried. Chemotherapy plus the targeted drug cetuximab (Erbitux)
may be another option.
Because these cancers can be hard to treat effectively, taking part in a clinical trial of newer
treatments may be a good option.
The NCCN, made up of experts from many of the nations leading cancer centers, develops
cancer treatment guidelines for doctors to use when treating patients. These are available on
the NCCN website (www.nccn.org). (Information on nasopharyngeal cancers is found in the
NCCN Head and Neck Cancers guideline.)
Along with these sample questions, you might want to write down some of your own. For
instance, you might want more information about recovery times so you can plan your work
or activity schedule. Or you may want to ask about second opinions or about clinical trials
for which you may qualify. Keep in mind, too, that doctors are not the only ones who can
give you information. Other health care professionals, such as nurses and social workers,
may have the answers you seek.
Follow-up care
After you have completed treatment, your doctors will still want to watch you closely. It is
very important to go to all of your follow-up appointments. During these visits, your doctors
will ask questions about any problems you may have and may do exams and lab tests or
imaging tests (such as MRI or CT scans) to look for signs of cancer or treatment side effects.
Your health care team will discuss which tests should be done and how often based on the
stage of your cancer and the type of treatment you received.
Most doctors recommend follow-up exams at least every few months for the first 2 years
after treatment, then less often after this. If you had radiation therapy to the neck, your doctor
will check your thyroid function with blood tests once or twice a year.
You may be advised to see your dentist after treatment to check on the health of your teeth.
Your doctor will also want to keep a close eye on your hearing, speech, and swallowing,
which can be affected by treatment. If you are having problems with any of these, your
doctor may refer you to a therapist for help with rehabilitation.
Imaging tests such as CT or PET/CT scans may be done after treatment to get an idea of what
the nasopharynx and neck area now look like. Further imaging tests may be done if you later
develop any signs or symptoms that might be caused by a return of the cancer.
Almost any cancer treatment can have side effects. Some may last for a few weeks to
months, but others can last the rest of your life. This is the time for you to talk to your cancer
care team about any changes or problems you notice and any questions or concerns you have.
It is very important to report any new symptoms to the doctor right away, because they may
prompt your doctor to do tests that could help find recurrent cancer as early as possible, when
the chance of successful treatment is greatest.
If cancer does recur, further treatment will depend on the location of the cancer, what
treatments youve had before, and your health. For more information on how recurrent
cancer is treated, see the section "Treatment options, by stage of nasopharyngeal cancer." For
more general information on dealing with a recurrence, you may also want to see our
document When Your Cancer Comes Back: Cancer Recurrence.
It is important to have health insurance. Tests and doctor visits cost a lot, and even though no
one wants to think of their cancer coming back, this could happen.
Eating better
Eating right can be hard for anyone, but it can get even tougher during and after cancer
treatment. This is especially true for cancers of the head and neck, such as nasopharyngeal
cancer. The cancer or its treatment may affect how you swallow or cause dry mouth, changes
in taste, or other problems. Nausea can be a problem from some treatments. You may not feel
like eating and lose weight when you don't want to.
If treatment caused weight changes or eating or taste problems, do the best you can and keep
in mind that these problems usually get better over time. You may find it helps to eat small
portions every 2 to 3 hours until you feel better. You may also want to ask your cancer team
about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with
these treatment side effects.
One of the best things you can do after cancer treatment is put healthy eating habits into
place. You may be surprised at the long-term benefits of some simple changes, like
increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight,
eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of
types of cancer, as well as having many other health benefits.
For more information, see our document Nutrition and Physical Activity During and After
Cancer Treatment: Answers to Common Questions.
Almost everyone who is going through or has been through cancer can benefit from getting
some type of support. You need people you can turn to for strength and comfort. Support can
come in many forms: family, friends, cancer support groups, church or spiritual groups,
online support communities, or one-on-one counselors. Whats best for you depends on your
situation and personality. Some people feel safe in peer-support groups or education groups.
Others would rather talk in an informal setting, such as church. Others may feel more at ease
talking one-on-one with a trusted friend or counselor. Whatever your source of strength or
comfort, make sure you have a place to go with your concerns.
The cancer journey can feel very lonely. It is not necessary or good for you to try to deal with
everything on your own. And your friends and family may feel shut out if you do not include
them. Let them in, and let in anyone else who you feel may help. If you arent sure who can
help, call your American Cancer Society at 1-800-227-2345 and we can put you in touch
with a group or resource that may work for you. You can also read our document Distress in
People with Cancer or see the Emotional Side Effects section of our website for more
information.
Palliative care helps relieve symptoms, but is not expected to cure the disease. It can be given
along with cancer treatment, or can even be cancer treatment. The difference is its purpose
the main purpose of palliative care is to improve the quality of your life, or help you feel as
good as you can for as long as you can. Sometimes this means using drugs to help with
symptoms like pain or nausea. Sometimes, though, the treatments used to control your
symptoms are the same as those used to treat cancer. For instance, radiation might be used to
help relieve bone pain caused by cancer that has spread to the bones. Or chemo might be
used to help shrink a tumor and keep it from blocking the bowels. But this is not the same as
treatment to try to cure the cancer. You can learn more about the changes that occur when
curative treatment stops working, and about planning ahead for yourself and your family, in
our documents Nearing the End of Life and Advance Directives.
At some point, you may benefit from hospice care. This is special care that treats the person
rather than the disease; it focuses on quality rather than length of life. Most of the time, it is
given at home. Your cancer may be causing problems that need to be managed, and hospice
focuses on your comfort. You should know that while getting hospice care often means the
end of treatments such as chemo and radiation, it doesnt mean you cant have treatment for
the problems caused by your cancer or other health conditions. In hospice the focus of your
care is on living life as fully as possible and feeling as well as you can at this difficult time.
You can learn more about hospice in our document called Hospice Care.
Staying hopeful is important, too. Your hope for a cure may not be as bright, but there is still
hope for good times with family and friends times that are filled with happiness and
meaning. Pausing at this time in your cancer treatment gives you a chance to refocus on the
most important things in your life. Now is the time to do some things youve always wanted
to do and to stop doing the things you no longer want to do. Though the cancer may be
beyond your control, there are still choices you can make.
better predict the response to treatment. These tests are now being studied in areas of the
world where this cancer is common.
Treatment
New surgical techniques
Advances in the field of skull base surgery such as the use of endoscopes in the nose now
allow doctors to remove some tumors from hard to reach areas like the nasopharynx. This
type of surgery requires a specialized team that has expertise in this field. It may offer hope
for some patients with recurrent NPC and patients with the keratinizing type of NPC, which
often doesnt respond to radiation therapy.
Chemotherapy
Researchers continue to develop new chemotherapy drugs, new drug combinations, and new
ways to give drugs that might be more effective against advanced NPC. Several drugs that
are already used to treat other cancers, such as capecitabine, oxaliplatin, and gemcitabine,
have been studied for use against NPC as well.
Clinical trials are also testing ways to best combine chemotherapy with radiation therapy. For
example, studies are comparing the effectiveness of chemotherapy given before, during, or
after radiation therapy.
Targeted therapy
Drugs that target specific parts of cancer cells may prove to be useful against NPC and have
fewer side effects than standard chemotherapy drugs.
The drug cetuximab (Erbitux), which targets the epidermal growth factor receptor (EGFR).
protein found on the surface of cells, is already being used in some cases of NPC that recur
or keep growing after treatment with chemotherapy. Other drugs that target EGFR are also
being studied for use against NPC, including nimotuzumab and icotinib.
Other newer drugs target a tumors ability to develop new blood vessels, which they need in
order to grow larger. These drugs are called angiogenesis inhibitors. Several of these drugs
are now being tested for use against NPC, including bevacizumab (Avastin), sorafenib
(Nexavar), and pazopanib (Votrient).
Immunotherapy
NPC seems to be caused at least in part by infection with the Epstein-Barr virus (EBV).
Although patients immune systems can be shown to have reacted against EBV, this doesnt
seem to be enough to kill the cancer. Researchers are trying to use different ways to boost the
immune system or help it better target EBV-infected cells.
One way to do this is to remove T lymphocytes (immune system cells) from the blood of
patients with NPC and alter them in the lab to increase their numbers and their power to kill
EBV. The cells are then injected back into the patients. Early results with small numbers of
patients have been promising, and larger studies of this technique are now under way.
Gene therapy
Scientists have recently discovered how certain gene mutations (changes) in nasopharyngeal
cells may cause them to become cancerous. A clinical trial using a virus to replace the
damaged tumor suppressor gene p53 in the cancer cells had some promising results. This
approach is still being studied.
Caring for the Patient With Cancer at Home: A Guide for Patients and Families (also
available in Spanish)
Guide to Controlling Cancer Pain (also available in Spanish)
Sexuality for the Woman with Cancer (also available in Spanish)
Sexuality for the Man with Cancer (also available in Spanish)
Living with Uncertainty: The Fear of Cancer Recurrence
When Your Cancer Comes Back: Cancer Recurrence
Your American Cancer Society also has books that you might find helpful. Call us at 1-800227-2345 or visit our bookstore online to find out about costs or to place an order.
No matter who you are, we can help. Contact us anytime, day or night, for information and
support. Call us at 1-800-227-2345 or visit www.cancer.org.
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Last Medical Review: 1/15/2015
Last Revised: 3/3/2015
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