Understanding Cancer -- Diagnosis and Treatment

How Is Cancer Diagnosed?

The earlier cancer is diagnosed and treated, the better the chance of its being cured. Some types of cancer --
such as those of the skin, breast, mouth, testicles, prostate, and rectum -- may be detected by routine self-exam
or other screening measures before the symptoms become serious. Most cases of cancer are detected and
diagnosed after a tumor can be felt or when other symptoms develop. In a few cases, cancer is diagnosed
incidentally as a result of evaluating or treating other medical conditions.
Cancer diagnosis begins with a thorough physical exam and a complete medical history. Lab studies of blood,
urine, and stool can detect abnormalities that may indicate cancer. When a tumor is suspected, imaging tests
such as X-rays, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and fiberoptic
scope exams help doctors determine the cancer's location and size. To confirm the cancer diagnosis, a biopsy is
performed: A tissue sample is surgically removed from the suspected malignancy and studied under a
microscope to check for cancer cells.
If the diagnosis is positive (meaning cancer is present), other tests are performed to provide specific information
about the cancer; this essential follow-up phase of diagnosis is called staging. The most important thing doctors
need to know is whether cancer has spread from one area of the body to another. If your initial diagnosis is made
by a primary care doctor, or if symptoms persist even though you are told that you do not have cancer, seek a
second opinion. In any event, before the actual treatment begins, it is extremely important that you get a
confirming opinion by a doctor who specializes in cancer treatment.
What Are the Treatments for Cancer?

Depending on the type and stage of cancer, treatment attempts to eradicate or slow the cancer. These attempts
may include some combination of surgery, radiation therapy, chemotherapy, and possibly hormone therapy or
immunotherapy. When cancer is no longer detected, a patient is said to be in remission. Generally, patients who
remain cancer-free for five or more years are considered cured. Some cancers cannot be cured, but all can be
treated, and in many cases the patient will improve.
Cancer Support

Supportive care from nurses and other professionals accompanies cancer treatment. The goal is to relieve pain
and other symptoms, maintain general health, and provide emotional, psychological, and logistical support to
patients and their families. Similar supportive treatment is available to rehabilitate patients after curative
treatment. Supportive therapy such as hospice care for cancer patients nearing the end of their lives provides
relief from pain and other irreversible symptoms. Most mainstream care is geared toward providing supportive
treatment through the broad resources of a cancer treatment center. The best complementary cancer therapies,
which are generally provided outside a hospital, also provide excellent supportive care.

Exercise and Cancer

Exercise can help control fatigue, muscle tension, and anxiety in those with cancer. Patients tend to feel better if
they do exercises such as walking or swimming, which calm the mind as well as strengthen the body. Exercise
has also been shown to improve the outcome associated with cancer treatment.

Mind/Body Medicine for Cancer

Some mind/body therapies work to improve quality of life for cancer patients through behavior modification;
others encourage expression of emotions. Behavior therapies such as guided imagery, progressive muscle
relaxation, hypnotherapy, and biofeedback are used to alleviate pain, nausea, vomiting, and the anxiety that may
occur in anticipation of, or after, cancer treatment. Individual or group counseling and art or music therapy let
patients confront problems and emotions caused by cancer and receive support from fellow patients. Patients
who pursue these types of therapies tend to feel less lonely, less anxious about the future, and more optimistic
about recovery.

Nutrition, Diet, and Cancer

Scientific evidence suggests that nutrition may play a role in cancer prevention. But no diet has been shown to
slow or reverse cancer -- and no diet cures cancer. Researchers are interested in antioxidants -- vitamins A
(particularly beta carotene), C, E, and selenium -- but are also studying folic acid, vitamin B-6, magnesium, zinc,
coenzyme Q10, and phytonutrients (substances in food that seem to prevent cancer), among others. Also,
observational studies have shown that cancer is more common is some people with certain dietary habits -- such
as colorectal cancer in people who have diets rich in meat products.
 As a rule, patients should avoid any diet that claims to cure cancer, advocates abandoning standard treatment,
causes severe weight loss or weakness, requires severe food restriction, or costs a lot of money.

Acupuncture and Acupressure

Acupuncture and acupressure are perfect examples of "complementary" medicine for cancer. While neither
claims to cure the disease, evidence shows that they help reduce symptoms of the illness and side effects of the
treatment.

The National Institutes of Health affirms that acupuncture is an effective remedy for the vomiting and nausea
often experienced after chemotherapy, radiation, and surgery. Acupressure can also work to alleviate nausea,
and may be helpful in controlling pain. Electro-acupuncture, in which electric current is applied to the acupuncture
point, can be effective for cancer-related pain as well.

Herbs to Fight Cancer

Numerous herbal remedies profess to fight cancer and its related symptoms; unfortunately, little solid evidence
exists to prove their efficacy. A few herbs may help with specific complaints: Ginger tea and peppermint tea or
lozenges may ameliorate nausea, valerian can help with anxiety and stress, capsicum cream might relieve
muscle aches, and St. John's wort may help combat depression.

Be cautious in your use of herbs: Consult your doctor, research carefully, and confer with an expert on herbal
remedies as some of these herbs may affect your other methods of treatment.

Homeopathy and Cancer

Homeopathic preparations may ease the nausea, fatigue, and anxiety associated with cancer and its treatment.
While some believe that homeopathic medicines only act as "placebos," evidence exists that using homeopathy
increases people's sense of self-control and lessens the severity of their symptoms. Safe and free of side effects,
homeopathy only presents a danger if its use delays conventional treatment.

Social Support and Spirituality

Having the support of friends and family can help you deal with the depression, fear, and anxiety that accompany
a serious illness like cancer. In some cases, a strong support network can even affect the length of survival of
cancer patients; studies have shown that men who experience limited social contact have a shorter survival time,
while women with good social support survive longer. Strong social support may even help keep your disease in
remission, by stimulating a higher level of natural killer cells.

Prayer can relieve stress, create a sense of meaning and purpose, and provide solace. Being an actively spiritual
person may have even more benefits; in some cases, cancer patients who say they're spiritual people suffered
less anxiety and depression, and even less pain, from their disease.

Controversial Cancer Treatments

The search for new cancer treatments is a vigorous and highly controversial branch of medical research. All
treatments must be thoroughly tested and proven effective before they are authorized for general use.
Supporters of some experimental treatments claim remarkable recoveries; critics insist that objective trials, not
anecdotal claims, or testimonials, are the only true measure of their worth.

The following treatments have their share of advocates but have thus far been deemed ineffective or unproven in
independent tests and clinical trials: 

 hydrazine sulfate, studied by Dr. Joseph Gold as a cancer therapy since the 1970s
 Dr. Stanislaw Burzynski's treatment with antineoplastons, originally synthesized from human urine
 the "immuno-augmentative therapy" of the late Dr. Lawrence Burton
 Dr. Emanuel Revici's "biologically guided chemotherapy"
 Dr. Gaston Naessens' "714X" therapy
 shark cartilage supplements
 oxygen therapy
 hydrogen peroxide therapy, 
 ozone therapy
 insulin augmentation therapy

At-Home Care for Cancer

Relieving side effects of cancer treatment:
After radiation therapy for cancer, be gentle to your skin. Do not scrub it, expose it to sunlight, or wear tight
clothing. Aloe vera ointment is gentle and soothing, and you can ask your radiation oncologist or radiation
therapist about other nonirritating lotions or creams, such as vitamin E.

Eat light snacks throughout the day rather than three heavy meals. Also try eating food cold or at room
temperature to avoid nausea.

If your treatment involves lowering your white blood cell count, steer clear of sick people; tell your doctor about
any fever or unusual symptoms.

Relieving pain:
In addition to taking prescribed medication, try relaxation techniques such as yoga or meditation.

Other tips:
Join a cancer support group.

Get plenty of rest but balance that with light exercise as well.

Rather than feeling compelled to maintain a "positive attitude," express your emotions honestly. Don't worry if you
sometimes feel depressed or afraid: These are normal and legitimate reactions that will not make your cancer
worse.

Fill your days with activities you enjoy. Reading a good book, listening to music, and talking with friends are
simple pleasures but surprisingly therapeutic.

What is cancer?
The body is made up of hundreds of millions of living cells. Normal body cells grow, divide, and die in an orderly
fashion. During the early years of a person's life, normal cells divide faster to allow the person to grow. After the
person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries.

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 doesn't 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 aren't cancer are called benign. Benign tumors can cause problems –
they can grow very large and press on healthy organs and tissues. But they cannot grow into (invade) other
 tissues. Because they can't invade, they also can't spread to other parts of the body (metastasize). These tumors
are almost never life threatening.

What are basal and squamous cell skin cancers?

To understand basal and squamous cell skin cancers, it helps to know about the normal structure and
function of the skin.

Normal skin
The skin is the largest organ in your body. It does several different things:

 Covers the internal organs and protects them from injury

 Serves as a barrier to germs such as bacteria

 Prevents the loss of too much water and other fluids

 Helps control body temperature

 Protects the rest of the body from ultraviolet (UV) rays

 Helps the body make vitamin D

The skin has 3 layers: the epidermis, the dermis, and the subcutis (see picture).

Epidermis
The top layer of skin is the epidermis. The epidermis is thin, averaging only 0.2 millimeters thick (about
1/100 of an inch). It protects the deeper layers of skin and the organs of the body from the environment.

Keratinocytes are the main cell type of the epidermis. These cells make an important protein called keratin.
Keratin helps the skin protect the rest of the body.
The outermost part of the epidermis is called the stratum corneum, or horny layer. It is composed of dead
keratinocytes that are continually shed as new ones form. The cells in this layer are called squamous
cells because of their flat shape.
Living squamous cells are found just below the stratum corneum. These cells have moved here from the
lowest part of the epidermis, the basal layer. The cells of the basal layer, called basal cells, continually
divide to form new keratinocytes. These replace the older keratinocytes that wear off the skin's surface.
Cells called melanocytes are also found in the epidermis. These skin cells make the brown pigment
called melanin. Melanin is what gives the skin its tan or brown color. It protects the deeper layers of the
skin from some of the harmful effects of the sun. When skin is exposed to the sun, melanocytes make more
of the pigment, causing the skin to tan or darken.
The epidermis is separated from the deeper layers of skin by the basement membrane. The basement
membrane is an important structure because when a skin cancer becomes more advanced, it generally
grows through this barrier.
Dermis
The middle layer of the skin is called the dermis. The dermis is much thicker than the epidermis. It contains
hair follicles, sweat glands, blood vessels, and nerves that are held in place by a protein called collagen.
Collagen, made by cells called fibroblasts, gives the skin its resilience and strength.
Subcutis
The deepest layer of the skin is called the subcutis. The subcutis and the lowest part of the dermis form a
network of collagen and fat cells. The subcutis helps the body conserve heat and has a shock-absorbing
effect that helps protect the body's organs from injury.

Types of skin cancer

Melanomas
Cancers that develop from melanocytes, the pigment-making cells of the skin, are called melanomas.
Melanocytes can also form benign growths called moles. Melanoma and moles are discussed in our
document called Melanoma Skin Cancer.
Skin cancers that are not melanoma are sometimes grouped together as non-melanoma
skin  cancers  because they tend to act very differently from melanomas.
Keratinocyte cancers
These are by far the most common non-melanoma skin cancers. They are called keratinocyte
carcinomas  or keratinocyte cancers  because when seen under a microscope, their cells share some
features of keratinocytes, the most abundant cell type of normal skin. The most common types of
keratinocyte cancer are basal cell carcinoma and squamous cell carcinoma.
Basal cell carcinoma
When seen under a microscope, these cancers share features with the cells in the lowest layer of the
epidermis, called the basal cell layer.

About 8 out of 10 skin cancers are basal cell carcinomas (also called basal cell cancers). They usually
develop on sun-exposed areas, especially the head and neck. Basal cell carcinoma was once found almost
exclusively in middle-aged or older people. Now it is also being seen in younger people, probably because
they are spending more time in the sun with their skin exposed.
Basal cell carcinoma tends to be slow growing. It is very rare for a basal cell cancer to spread to nearby
lymph nodes or to distant parts of the body. But if a basal cell cancer is left untreated, it can grow into
nearby areas and invade the bone or other tissues beneath the skin.

After treatment, basal cell carcinoma can recur (come back) in the same place on the skin. People who
have had basal cell cancers are also more likely to get new ones elsewhere on the skin. As many as half of
the people who are diagnosed with one basal cell cancer will develop a new skin cancer within 5 years.

Squamous cell carcinoma

About 2 out of 10 skin cancers are squamous cell carcinomas (also called squamous cell cancers). They
commonly appear on sun-exposed areas of the body such as the face, ears, neck, lips, and backs of the
hands. They can also develop in scars or skin ulcers elsewhere. They sometimes start in actinic keratoses
(described below). Less often, they form in the skin of the genital area.
Squamous cell carcinomas tend to be more aggressive than basal cell cancers. They are more likely to
invade fatty tissues just beneath the skin, and are more likely to spread to lymph nodes and/or distant parts
of the body, although this is still uncommon.
 Keratoacanthomas are growths that are found on sun-exposed skin. They may start out growing quickly,
but their growth usually slows down. Many keratoacanthomas shrink or even go away on their own over
time without any treatment. But some continue to grow, and a few may even spread to other parts of the
body. Their growth is often hard to predict, and many skin specialists consider them a type of squamous
cell skin cancer.
Less common types of skin cancer
Along with melanoma and keratinocyte cancers, there are some other much less common types of skin
cancer. These cancers are also non-melanoma skin cancers, but they are quite different from keratinocyte
cancers and are treated differently.

Other non-melanoma skin cancers include:

 Merkel cell carcinoma

 Kaposi sarcoma
 Cutaneous (skin) lymphoma
 Skin adnexal tumors
 Various types of sarcomas
Together, these types account for less than 1% of non-melanoma skin cancers.

Merkel cell carcinoma

This uncommon type of skin cancer develops from neuroendocrine cells (hormone-making cells that
resemble nerve cells in some ways) in the skin. They are most often found on the head, neck, and arms but
can start anywhere.

These cancers are thought to be caused in part by sun exposure and in part by Merkel cell polyomavirus
(MCV). About 8 out of 10 Merkel cell carcinomas are thought to be related to MCV infection. MCV is a
common virus. Many people are infected with MCV, but it usually causes no symptoms. In a small
percentage of people with this infection, changes in the virus' DNA can lead to this form of cancer.

Unlike basal cell and squamous cell carcinomas, Merkel cell carcinomas often spread to nearby lymph
nodes and internal organs. They also tend to come back after treatment. Treatment of Merkel cell
carcinoma is described in the section called “Treating Merkel cell carcinoma.”
Kaposi sarcoma
This cancer usually starts within the dermis but can also form in internal organs. It is related to infection
with Kaposi sarcoma herpesvirus (KSHV), also known as human herpesvirus 8 (HHV8). Before the mid-
1980s, this cancer was rare and found mostly in elderly people of Mediterranean descent. Kaposi sarcoma
has become more common because it is more likely to develop in people with human immunodeficiency
virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). It is discussed in our document
called Kaposi Sarcoma.
Skin lymphomas
Lymphomas are cancers that start in lymphocytes, a type of immune system cell found throughout the body
in the bone marrow (the soft inner part of some bones), lymph nodes (bean-sized collections of immune
system cells), the bloodstream, and some internal organs. The skin also contains a large number of
lymphocytes.
Most lymphomas start in lymph nodes or internal organs, but there are certain types of lymphoma that
appear to begin mostly or entirely in the skin. Primary cutaneous lymphoma is the medical term for
lymphomas that start in the skin. The most common type of primary cutaneous lymphoma is cutaneous T-
cell lymphoma (most of these are called mycosis fungoides). Cutaneous lymphomas are discussed in our
document called Lymphoma of the Skin.
Adnexal tumors
These tumors start in the hair follicles or glands (such as sweat glands) of the skin. Benign (non-
cancerous) adnexal tumors are common, but malignant (cancerous) ones, such as sebaceous
adenocarcinoma and sweat gland adenocarcinoma, are rare.

Sarcomas
Sarcomas develop from connective tissue cells, usually in tissues deep beneath the skin. Much less often
they may develop in the skin's dermis and subcutis. Several types of sarcoma can develop in the skin,
 including dermatofibrosarcoma protuberans  (DFSP) and angiosarcoma (a blood vessel cancer). Sarcomas
are discussed in our document called Sarcoma – Adult Soft Tissue Cancer.

Pre-cancerous and pre-invasive skin conditions

These conditions may develop into skin cancer or may be very early stages in the development of skin
cancer.

Actinic keratosis (solar keratosis)

Actinic keratosis, also known as solar keratosis, is a pre-cancerous skin condition caused by overexposure
to the sun. Actinic keratoses are usually small (less than 1/4 inch across), rough spots that may be pink-red
or flesh-colored. Usually they develop on the face, ears, back of the hands, and arms of middle-aged or
older people with fair skin, although they can arise on other sun-exposed areas. People with one actinic
keratosis usually develop many more.

Actinic keratoses are slow growing. They usually do not cause any symptoms. In some cases actinic
keratoses may turn into keratinocyte cancers. They often go away on their own, but they may come back.

Even though most actinic keratoses do not become cancers, they are a warning that your skin has suffered
sun damage. Some actinic keratoses and other skin conditions that could become cancers may have to be
removed. Your doctor should regularly check any that are not removed for changes that could indicate
cancer.

Squamous cell carcinoma in situ (Bowen disease)

Squamous cell carcinoma in situ, also called Bowen disease, is the earliest form of squamous cell skin
cancer. "In situ" means that the cells of these cancers are still entirely within the epidermis and have not
invaded the dermis.

Bowen disease appears as reddish patches. Compared with actinic keratoses, Bowen disease patches
tend to be larger (sometimes over 1/2 inch across), redder, scalier, and sometimes crusted.

Like invasive squamous cell skin cancers, the major risk factor is overexposure to the sun. Bowen disease
can also occur in the skin of the anal and genital areas. This is often related to sexually transmitted
infection with human papilloma viruses (HPVs), the viruses that can also cause genital warts.

Benign skin tumors

Most tumors of the skin are not cancerous and rarely if ever turn into cancers. These tumors include:

 Most types of moles (see our document called Melanoma Skin Cancer for information on moles)
 Seborrheic keratoses: tan, brown, or black raised spots with a waxy texture or rough surface

 Hemangiomas: benign blood vessel growths often called strawberry spots or port wine stains

 Lipomas: soft growths of benign fat cells

 Warts: rough-surfaced growths caused by a virus

What are the risk factors for basal and squamous cell
skin cancers?
A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers
have different risk factors. For example, smoking is a risk factor for cancers of the lung, mouth, throat,
kidneys, bladder, and several other organs.
 But risk factors don't tell us everything. Having a risk factor, or even several risk factors, does not mean
that you will get the disease. And many people who get the disease may not have had any known risk
factors. Even if a person with basal or squamous cell skin cancer has a risk factor, it is often very hard to
know how much that risk factor may have contributed to the cancer.

The following are known risk factors for basal cell and squamous cell carcinomas. (These factors don't
necessarily apply to other forms of non-melanoma skin cancer, such as Kaposi sarcoma and cutaneous
lymphoma.)

Ultraviolet (UV) light exposure

Ultraviolet (UV) radiation is thought to be the major risk factor for most skin cancers. Sunlight is the main
source of UV rays, which can damage the genes in your skin cells. Tanning lamps and beds are another
source of UV radiation. People with high levels of exposure to light from these sources are at greater risk
for skin cancer.

Ultraviolet radiation is divided into 3 wavelength ranges:

 UVA rays cause cells to age and can cause some damage to cells' DNA. They are mainly linked to
long-term skin damage such as wrinkles, but are also thought to play a role in some skin cancers.
 UVB rays can cause direct damage to the DNA, and are the main rays that cause sunburns. They
are also thought to cause most skin cancers.
 UVC rays don't get through our atmosphere and therefore are not present in sunlight. They are not
normally a cause of skin cancer.
While UVA and UVB rays make up only a very small portion of the sun's wavelengths, they are the main
cause of the damaging effects of the sun on the skin. UV radiation damages the DNA of skin cells. Skin
cancers begin when this damage affects the DNA of genes that control skin cell growth. Both UVA and
UVB rays damage skin and cause skin cancer. UVB rays are a more potent cause of at least some skin
cancers, but based on what is known today, there are no safe UV rays.
The amount of UV exposure depends on the strength of the rays, the length of time the skin is exposed,
and whether the skin is protected with clothing or sunscreen.

People who live in areas with year-round, bright sunlight have a higher risk. For example, the risk of skin
cancer is twice as high in Arizona compared to Minnesota. The highest rate of skin cancer in the world is in
Australia. Spending a lot of time outdoors for work or recreation without protective clothing and sunscreen
increases your risk.

Many studies also point to exposure at a young age (for example, frequent sunburns during childhood) as
an added risk factor.

Having fair skin

The risk of skin cancer is much higher for whites than for African Americans or Hispanics. This is due to the
protective effect of melanin (skin pigment) in people with darker skin. Whites with fair (light-colored) skin
that freckles or burns easily are at especially high risk. This is another reason for the high skin cancer rate
in Australia, where much of the population descends from fair-skinned immigrants from the British Isles.

Albinism is a congenital (present at birth) absence of skin pigment. People with this condition may have
pink-white skin and white hair. They have a high risk of getting skin cancer unless they are careful to
protect their skin.

Older age
The risk of basal and squamous cell skin cancers goes up as people get older. This is probably because of
accumulated sun exposure over time. These cancers are now being seen in younger people as well,
probably because they are spending more time in the sun with their skin exposed.

Male gender
Men are about 2 times as likely as women to have basal cell cancers and about 3 times as likely to have
squamous cell cancers of the skin. This is thought to be due mainly to higher levels of sun exposure.

Exposure to certain chemicals

Exposure to large amounts of arsenic increases the risk of developing skin cancer. Arsenic is a heavy
metal found naturally in well water in some areas. It is also used in making some pesticides.

Workers exposed to industrial tar, coal, paraffin, and certain types of oil may also have an increased risk for
non-melanoma skin cancer.

Radiation exposure
People who have had radiation treatment have a higher risk of developing skin cancer in the area that
received the treatment. This is particularly a concern in children who have had radiation treatment for
cancer.

Previous skin cancer

Anyone who has had a keratinocyte cancer has a much higher chance of developing another one.

Long-term or severe skin inflammation or injury

Scars from severe burns, areas of skin over severe bone infections, and skin damaged by some severe
inflammatory skin diseases are more likely to develop keratinocyte skin cancers, although this risk is
generally small.

Psoriasis treatment
Psoralen and ultraviolet light treatments (PUVA) given to some patients with psoriasis (a long-lasting
inflammatory skin disease) can increase the risk of developing squamous cell skin cancer and probably
other skin cancers also.

Xeroderma pigmentosum (XP)

This very rare inherited condition reduces the skin's ability to repair damage to DNA caused by sun
exposure. People with this disorder often develop many skin cancers starting in childhood.

Basal cell nevus syndrome (Gorlin syndrome)

In this rare congenital (present at birth) condition, people develop many basal cell cancers over their
lifetimes. Most, but not all, cases are inherited. Affected people may also have abnormalities of the jaw and
other bones, eyes, and nervous tissue. In families with this syndrome, those affected often begin
developing basal cell cancers when they are young (under age 20).

Reduced immunity
The immune system helps the body fight cancers of the skin and other organs. People with weakened
immune systems (due to certain diseases or medical treatments) are more likely to develop non-melanoma
skin cancer, including squamous cell cancer and less common types such as Kaposi sarcoma and Merkel
cell carcinoma.

For example, organ transplant patients are usually given medicines that weaken their immune system to
prevent their body from rejecting the new organ. This increases their risk of developing skin cancer. The
rate of skin cancer in people who have had transplants can be as high as 70% within 20 years after the
transplant. Skin cancers in people with weakened immune systems tend to grow faster and are more likely
to be fatal.

Treatment with large doses of corticosteroid drugs can also depress the immune system. This may also
increase a person's risk of skin cancer.
Human papilloma virus (HPV) infection
Human papilloma viruses (HPVs) are a group of more than 100 viruses that can cause papillomas, or
warts. The warts that people commonly get on their hands and feet appear to be unrelated to any form of
cancer. But some of the HPV types, especially those that people get in their genital and anal area, appear
to be related to skin cancers in these areas.

Smoking
People who smoke are more likely to develop squamous cell skin cancer, especially on the lips. Smoking is
not a known risk factor for basal cell cancer.

Do we know what causes basal and squamous cell skin

cancers?
Most basal cell and squamous cell skin cancers are caused by unprotected exposure of the skin to
ultraviolet (UV) rays. This radiation comes from sunlight, as well as from man-made sources such as
tanning beds.

Repeated and unprotected sun exposure over many years increases a person's risk of skin cancer. Most
skin cancers are probably caused by exposures that happened many years earlier. The pattern of exposure
may also be important. For example, frequent sunburns in childhood may increase the risk for basal cell
cancer many years or even decades later.

DNA is the chemical in each of our cells that makes up our genes – the instructions for how our cells
function. We usually look like our parents because they are the source of our DNA. However, DNA affects
more than just how we look. Some genes contain instructions for controlling when our cells grow, divide,
and die.

UV radiation (from sunlight or tanning lamps) can damage DNA. Sometimes this damage affects certain
genes that control how and when cells grow and divide. Usually the cells can repair the damage, but in
some cases this results in abnormal DNA, which may be the first step on the path to cancer.

Researchers don't yet know all of the DNA changes that result in skin cancer, but they have found that
many skin cancers have changes in tumor suppressor genes. These genes normally function to help keep
cells from growing out of control.
The gene most often found to be altered in squamous cell cancers is called p53. This gene normally
causes damaged cells to die. When this gene is altered, these abnormal cells may live longer and perhaps
go on to become cancerous.
A gene commonly found to be mutated in basal cell cancers is the "patched" (PTCH) gene. This tumor
suppressor gene normally helps keep cell growth in check, so changes in this gene can allow cells to grow
out of control. People who have basal cell nevus syndrome, which is often inherited from a parent and
results in many basal cell cancers, have an altered PTCH gene in all the cells of their body.

These are not the only gene changes that may play a role in the development of skin cancer. There are
likely to be many others as well.

People with xeroderma pigmentosum (XP) have a high risk for skin cancer. XP is a rare, inherited condition
resulting from a defect in an enzyme that repairs damage to DNA. Because people with XP are less able to
repair DNA damage caused by sunlight, they develop huge numbers of cancers on sun-exposed areas of
their skin.

The link between squamous cell skin cancer and human papilloma virus (HPV) infection also involves DNA
and genes. These viruses contain genes that instruct infected cells to make certain proteins that affect the
growth-regulating proteins of normal skin cells. This can cause skin cells to grow too much and to not die
when they're supposed to.
 Scientists are studying other links between DNA changes and skin cancer. In the future, better
understanding of how damaged DNA leads to skin cancer might be used to design treatments to overcome
or repair that damage.

Can basal and squamous cell skin cancers be

prevented?
Not all basal and squamous cell skin cancers can be prevented, but there are things you can do that may
reduce your risk of getting skin cancer.

Limit ultraviolet (UV) exposure

The most important way to lower your risk of basal and squamous cell skin cancers is to limit your
exposure to UV radiation. Practice sun safety when you are outdoors. "Slip! Slop! Slap!… and Wrap" is a
catch phrase that can help you remember the 4 key steps you can take to protect yourself from UV rays:

 Slip on a shirt.

 Slop on sunscreen.

 Slap on a hat.

 Wrap on sunglasses to protect the eyes and sensitive skin around them.

Protect your skin with clothing

Clothes provide different levels of UV protection, depending on many factors. Long-sleeved shirts, long
pants, or long skirts are the most protective. Dark colors generally provide more protection than light colors.
A tightly woven fabric protects better than loosely woven clothing. Dry fabric is generally more protective
than wet fabric.

Be aware that covering up doesn't block out all UV rays. If you can see light through a fabric, UV rays can
get through too.

Some companies in the United States now make clothing that is lightweight, comfortable, and protects
against UV exposure even when wet. These sun-protective clothes may have a label listing the ultraviolet
protection factor (UPF) value – the level of protection the garment provides from the sun's UV rays (on a
scale from 15 to 50+). The higher the UPF, the higher the protection from UV rays.

Newer products, which are used in the washing machine like laundry detergents, can increase the UPF
value of clothes you already own. They add a layer of UV protection to your clothes without changing the
color or texture.

Wear a hat
A hat with at least a 2- to 3-inch brim all around is ideal because it protects areas often exposed to intense
sun, such as the ears, eyes, forehead, nose, and scalp. A shade cap (which looks like a baseball cap with
about 7 inches of fabric draping down the sides and back) also is good, and will provide more protection for
the neck. These are often sold in sports and outdoor supply stores.

A baseball cap can protect the front and top of the head but not the neck or the ears, where skin cancers
commonly develop. Straw hats are not as protective as ones made of tightly woven fabric.

Use sunscreen
Use sunscreens and lip balms on areas of skin exposed to the sun, especially when the sunlight is strong
(for example, between the hours of 10 am and 4 pm). Many groups, including the American Academy of
Dermatology, recommend using products with a sun protection factor (SPF) of 30 or more. Use sunscreen
even on hazy days or days with light or broken cloud cover because the UV light still comes through.

Always follow directions when applying sunscreen. Ideally, a 1-ounce application (a palmful of sunscreen)
is recommended to cover the arms, legs, neck, and face of the average adult. Protection is greatest when
sunscreen is used thickly on all sun-exposed skin. To ensure continued protection, sunscreens should be
reapplied. It is often recommended to do so every 2 hours. Many sunscreens wash off when you sweat or
swim and then wipe off with a towel, so they must be reapplied for maximum effectiveness. And don't forget
your lips; lip balm with sunscreen is also available.

Some people use sunscreen because they want to stay out in the sun for long periods of time without
getting sunburned. Sunscreen should not be used to spend more time in the sun than you otherwise would,
as you will still end up with damage to your skin.

Sunscreen can reduce your chance of actinic keratoses and squamous cell cancer. But there is no
guarantee, and if you stay in the sun a long time, you are at risk of developing skin cancer even if you have
applied sunscreen.

If you want a tan, one option is using a sunless tanning lotion. These can provide the look, without the
danger. Sunless tanning lotions contain a substance called dihydroxyacetone (DHA). DHA works by
interacting with proteins on the surface of the skin to produce color. You do not have to go out in the sun for
these to work. The color tends to wear off after a few days. Most sunless tanning lotions provide very little
protection from UV rays, so if you use one, you should still use sunscreen and wear protective clothing
when going outside.

Wear sunglasses
Wrap-around sunglasses with at least 99% UV absorption provide the best protection for the eyes and the
skin area around the eyes. Look for sunglasses labeled as blocking UVA and UVB light. Labels that say
"UV absorption up to 400 nm" or "Meets ANSI UV Requirements" mean the glasses block at least 99% of
UV rays. If there is no label, don't assume the sunglasses provide any protection.

Seek shade
Another way to limit exposure to UV light is to avoid being outdoors in direct sunlight too long. This is
particularly important in the middle of the day between the hours of 10 am and 4 pm, when UV light is
strongest. If you are unsure about the sun's intensity, use the shadow test: if your shadow is shorter than
you are, the sun's rays are the strongest, and it is important to protect yourself..
When you are outdoors, protect your skin. Keep in mind that sunlight (and UV rays) can come through light
clouds, can reflect off water, sand, concrete, and snow, and can reach below the water's surface.

The UV Index: The amount of UV light reaching the ground in any given place depends on a number of
factors, including the time of day, time of year, elevation, and cloud cover. To help people better
understand the intensity of UV light in their area on a given day, the National Weather Service and the US
Environmental Protection Agency have developed the UV Index. It gives people an idea of how strong the
UV light is in their area, on a scale from 1 to 11+. A higher number means a higher chance of sunburn, skin
damage, and ultimately skin cancers of all kinds. Your local UV Index should be available daily in your local
newspaper, on TV weather reports, and online (www.epa.gov/sunwise/uvindex.html).
Avoid tanning beds and sunlamps
Many people believe the UV rays of tanning beds are harmless. This is not true. Tanning lamps give out
UVA and usually UVB rays as well, both of which can cause long-term skin damage and can contribute to
skin cancer. Most skin doctors and health organizations recommend not using tanning beds and sun
lamps.

Protect children from the sun

Children need special attention, since they tend to spend more time outdoors and can burn more easily.
Parents and other caregivers should protect children from excess sun exposure by using the steps above.
Older children need to be cautioned about sun exposure as they become more independent. It is important,
particularly in parts of the world where it is sunnier, to cover your children as fully as is reasonable. You
should develop the habit of using sunscreen on exposed skin for yourself and your children whenever you
go outdoors and may be exposed to large amounts of sunlight.

Babies younger than 6 months should be kept out of direct sunlight and protected from the sun using hats
and protective clothing. Sunscreen may be used on small areas of exposed skin only if adequate clothing
and shade are not available.

A word about sun exposure and vitamin D

Doctors are learning that vitamin D has many health benefits. It may even help to lower the risk for some
cancers. Vitamin D is made naturally by your skin when you are in the sun. How much vitamin D you make
depends on many things, including how old you are, how dark your skin is, and how intensely the sun
shines where you live.

At this time, doctors aren't sure what the optimal level of vitamin D is. A lot of research is being done in this
area. Whenever possible, it is better to get vitamin D from your diet or vitamin supplements rather than
from sun exposure, because dietary sources and vitamin supplements do not increase risk for skin cancer,
and are typically more reliable ways to get the amount you need.

For more information on how to protect yourself and your family from UV exposure, see our document
called Skin Cancer: Prevention and Early Detection.

Avoid harmful chemicals

Exposure to certain chemicals, such as arsenic, can increase a person's risk of skin cancer. People can be
exposed to arsenic from well water in some areas, pesticides and herbicides, some medicines (such as
arsenic trioxide) and herbal remedies (arsenic has been found in some traditional herbal remedies imported
from China), and in certain occupations (such as mining and smelting).