Cancer Bone cancer symptoms Possible symptoms of bone cancer include: Bone pain: Pain is the most common sign of bone cancer, and may become more noticeable as the tumor grows. Bone pain can cause a dull or deep ache in a bone or bone region (e.g., back, pelvis, legs, ribs, arms). Early on, the pain may only occur at night, or when you are active. As the cancer develops, though, the pain may become more persistent. Other conditions, like osteoporosis or arthritis, may also cause bone or joint pain. Swelling: The area where the pain is localized may begin to show signs of swelling, or a lump or mass may be present. Fractures: Cancerous cells can weaken the bone, and this may sometimes result in a fracture. The break may occur in an area of the bone that had previously been sore or painful for a period of time. Decreased mobility: In some cases, if the location of the tumor is near a joint, it may make normal movements difficult or painful. Other symptoms: Unintended weight loss and fatigue that accompanies bone pain may be a sign of bone cancer. Other symptoms, such as difficulty breathing, may develop if the cancer has spread to other organs. At stage 3, melanoma has spread to lymph nodes near the original tumor. Stage 4 melanoma has spread beyond the lymph nodes to other areas of the body. Melanoma most commonly spreads to the lungs. Other frequent sites for skin cancer metastases include the liver, brain, gastrointestinal tract, and bones Melanoma That Has Spread Melanoma becomes more deadly the more it grows. Cancer tumors within the skin grow larger as cancer advances. However, it’s what happens elsewhere in the body that makes this type of cancer so dangerous. By stage 4, melanoma has spread to the lymph nodes, internal organs, and other areas of the body. These new growths are difficult and sometimes impossible to treat without surgery, chemotherapy, radiation, or biotherapies Where Melanoma Spreads Once melanoma has progressed beyond stage 2, the skin cancer is no longer contained to its original spot. At stage 3, melanoma has spread to lymph nodes near the original tumor. Stage 4 melanoma has spread beyond the lymph nodes to other areas of the body. Melanoma most commonly spreads to the lungs. Other frequent sites for skin cancer metastases include the liver, brain, gastrointestinal tract, and bones. Skin Symptoms A doctor will diagnose stage 4 melanoma when they determine that the cancer has spread beyond the original affected area of skin. That means a diagnosis is not made based on how a skin cancer tumor or spot looks from the outside. For that reason, physical signs of stage 4 melanoma are not the same for everyone. The next few slides will give you an overview of the most common symptoms of stage 4 melanoma and what they may mean. Tumor Size The American Joint Commission on Cancer (AJCC) reports that stage 4 melanoma tumors are thicker than 4 millimeters deep. However, because stage 4 melanoma is diagnosed once the melanoma has spread to distant lymph nodes or to other organs, the size of the tumor varies from person to person. Additionally, treatment may shrink the tumor, but the cancer can still metastasize. That means that the size of the tumor isn’t always the best indicator of skin cancer staging. Stage 4 Melanoma Prognosis Getting rid of stage 4 melanoma can be difficult. Once the cancer spreads, locating and treating it becomes more and more difficult. You and your doctor can develop a plan that balances your needs. The treatment should make you comfortable, but it should also aggressively attack the cancer. This treatment plan may include radiation, biological therapies, chemotherapy, and even surgery. The good news is that even stage 4 melanoma can be treated if it’s caught and aggressively treated. The sooner the cancer is found, the sooner it can be removed—and the higher your chances are for recovery. Treatment depends on where the cancer is, how advanced it has become, and how healthy you are in general. Still, any treatment is often better than no treatment at all because cancer that remains untreated can quickly become deadly. What Is Staging? “Stage” is a term used to describe the size and extent of a melanoma cancer. Knowing the stage of a melanoma cancer is an important factor in your healthcare team’s choice of cancer treatment. Determining the stage will also serve to predict the efficacy of a particular treatment, the patient’s chance of recovery, and the risk of the cancer returning. Tests to Determine Stages There are several tests that are performed to assign a stage to a melanoma: • physical exam: The doctor checks for moles or birthmarks that appear abnormal in shape, color or texture. • lab tests: Blood, urine, and other fluids and tissues are tested. • imaging scans: Scans make detailed images of the tumor and surrounding tissues. Imaging scans include CT (computed tomography), MRI (magnetic resonance imaging), PET (positron emission tomography), and NMRI (nuclear magnetic resonance imaging). • biopsy: A sample of the abnormal tissue and some surrounding normal tissue is removed and checked for cancer cells. Different Staging Systems i There are different staging systems for different types of cancer, but all staging symptoms indicate the following functions: • location of the cancer • type of cancer cells • size of the cancer tissue • whether tumor cells have spread to nearby lymph nodes grade of the tumor The Stages of Melanoma With the staging system, basic information about the cancer is described in five consecutive levels, starting with stage 0. At stage 0, the melanoma cells are isolated in one area on the outer layer of the skin, but there is danger that they’ll spread. Each stage describes a more dangerous level of cancer spread. At stage 4, the last stage, the cancer cells have invaded the lymph nodes, tissues, and organs far from the original tumor. • • • • • • How Melanoma Spreads Melanoma cells are pigmented (colored) skin cells called melanocytes. Instead of dying as normal cells do, these abnormal cells continue to divide and grow until they form a mass, or tumor. Some of the cells may break off and invade nearby tissues and metastasize, or grow new tumors. If these abnormal melanoma cells enter the bloodstream or the lymphatic system, they can quickly spread throughout the body. They may invade tissues and organs far away from the first tumor where they started. What Is Staging? “Stage” is a term used to describe the size and extent of a melanoma cancer. Knowing the stage of a melanoma cancer is an important factor in your healthcare team’s choice of cancer treatment. Determining the stage will also serve to predict the efficacy of a particular treatment, the patient’s chance of recovery, and the risk of the cancer returning. Tests to Determine Stages There are several tests that are performed to assign a stage to a melanoma: physical exam: The doctor checks for moles or birthmarks that appear abnormal in shape, color or texture. lab tests: Blood, urine, and other fluids and tissues are tested. imaging scans: Scans make detailed images of the tumor and surrounding tissues. Imaging scans include CT (computed tomography), MRI (magnetic resonance imaging), PET (positron emission tomography), and NMRI (nuclear magnetic resonance imaging). biopsy: A sample of the abnormal tissue and some surrounding normal tissue is removed and checked for cancer cells. • • • • • Different Staging Systems There are different staging systems for different types of cancer, but all staging symptoms indicate the following functions: location of the cancer type of cancer cell size of the cancer tissue whether tumor cells have spread to nearby lymph node grade of the tumor • The Stages of Melanoma i With the staging system, basic information about the cancer is described in five consecutive levels, starting with stage 0. At stage 0, the melanoma cells are isolated in one area on the outer layer of the skin, but there is danger that they’ll spread. Each stage describes a more dangerous level of cancer spread. At stage 4, the last stage, the cancer cells have invaded the lymph nodes, tissues, and organs far from the original tumor. Adding Letters for More Details Each melanoma stage can be broken into stages a, b, or c. The staging tool can help a patient’s healthcare team efficiently work together to treat a particular patient. The letters that follow the stage level signify something about the disease. For example: • stage 1a: The tumor is no more than one millimeter thick, with no ulceration. • stage 2b: The tumor ranges from two to four millimeters thick and has ulcerated (broken through the skin). Or, the tumor is more than four millimeters thick, but with no ulceration. stage 2c: The tumor is both ulcerated and more than four millimeters thick. Treatments Vary for Each Stage Surgery is the standard treatment for the first three stages of melanoma. A surgical procedure removes the cancerous tumor, any lymph nodes that are involved, and some healthy surrounding tissue to ensure that no cancerous cells are left behind. However, sometimes the cancer can’t be surgically removed. The tumor might be located in a dangerous spot, for instance, or the patient may be in too poor of health for surgery. These circumstances would warrant other cancer treatments. In stage 4 cancer, treatments include targeted therapy, biologic therapy with interleukin-2, chemotherapy and, if necessary, palliative therapy. Palliative therapy relieves symptoms and improves a patient’s quality of life. What Do Higher Stages Mean? With melanoma, the higher the stage, the more difficult the cancer is to treat. A higher stage could mean that the cancer cells have spread to other parts of the body. The lymph nodes, the brain, the lungs, the bones, or the liver may contain cancer cells. When melanoma cancer reaches higher stages, patients are often encouraged to join treatment clinical trials along with standard treatments in the hope that the clinical trial drugs might work. But even if the clinical drugs don’t work, patients in clinical treatment trials can help others who require cancer treatment in the future.
