NCI Publication – What You Need To Know About ™ Bladder Cancer
Source: National Cancer Institute Information Resources
Each year, nearly 55,000 people in the United States learn that they havebladder cancer. The National Cancer Institute (NCI) has written this booklet to help patients with bladder cancer and their families and friends better understand this disease. We hope others will read it as well to learn more about bladder cancer.
This booklet discusses symptoms, diagnosis, treatment, and rehabilitation. It also has information to help patients cope with bladder cancer.
Our knowledge about bladder cancer keeps increasing. For up-to-date information or to order this publication, call the NCI-supported Cancer Information Service (CIS) toll free at 1-800-4-CANCER (1-800-422-6237).
The CIS staff uses a National Cancer Institute cancer information database called PDQ and other NCI resources to answer callers’ questions. Cancer information specialists can send callers information from PDQ and other NCI materials about cancer, its treatment, and living with the disease.
The bladder is a hollow organ in the lower abdomen. It stores urine, the waste that is produced when thekidneys filter the blood. The bladder has a muscular wall that allows it to get larger and smaller as urine is stored or emptied. The wall of the bladder is lined with several layers of transitional cells.
Urine passes from the two kidneys into the bladder through two tubes called ureters. Urine leaves the bladder through another tube, the urethra.
What Is Cancer?
Canceris a group of many different diseases that have some important things in common. They all affect cells, the body’s basic unit of life. To understand different types of cancer, such as bladder cancer, it is helpful to know about normal cells and what happens when they become cancerous.
The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy. Sometimes cells keep dividing when new cells are not needed. These cells form a mass of extra tissue, called a growth or tumor. Tumors can bebenign or malignant.
Benign tumors are not cancer. They often can be removed and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life. Malignant tumors are cancer. Cells in malignant tumors are abnormal and divide without control or order. These cancer cells can invade and destroy the tissues around them. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic system. This process is the way cancer spreads from the original (primary) tumor to form new tumors in other parts of the body. The spread of cancer is called metastasis.
Most cancers are named for the part of the body or type of cells in which they begin. About 90 percent of bladder cancers are transitional cell carcinomas, cancers that begin in the cells lining the bladder. Cancer that is confined to the lining of the bladder is called superficial bladder cancer. After treatment, superficial bladder cancer can recur; if this happens, most often it recurs as another superficial cancer.
In some cases, cancer that begins in the transitional cells spreads through the lining of the bladder and invades the muscular wall of the bladder. This is known as invasive bladder cancer. Invasive cancer may grow through the bladder wall and spread to nearby organs.
Bladder cancer cells may also be found in thelymph nodes surrounding the bladder. If the cancer has reached these nodes, it may mean that cancer cells have spread to other lymph nodes and to distant organs, such as the lungs. The cancer cells in the new tumor are still bladder cancer cells. The new tumor is called metastatic bladder cancer rather than lung cancer because it has the same kind of abnormal cells that were found in the bladder.
Some common symptoms of bladder cancer include:
Blood in the urine (slightly rusty to deep red in color). Pain during urination. Frequent urination, or feeling the need to urinate without results.
When symptoms occur, they are not sure signs of bladder cancer. They may also be caused by infections, benign tumors, bladder stones, or other problems. Only a doctor can make a diagnosis. (People with symptoms like these generally see their family doctor or a urologist, a doctor who specializes in diseases of the urinary system.) It is important to see a doctor so that any illness can be diagnosed and treated as early as possible.
Diagnosis and Staging
To find the cause of symptoms, the doctor asks about the patient’s medical history and does a physical exam. The physical will include a rectal or vaginal exam that allows the doctor to check for tumors that can be felt. In addition, urine samples are sent to the laboratory for testing to check for blood and cancer cells.
The doctor may use an instrument to look directly into the bladder, a procedure called cystoscopy. This procedure may be done with local or general anesthesia. The doctor inserts a thin, lighted tube (called a cystoscope) into the bladder through the urethra to examine the lining of the bladder. The doctor can remove samples of tissues through this tube. The sample is then examined under a microscope by a pathologist. The removal of tissue to look for cancer cells is called a biopsy. In many cases, performing a biopsy is the only sure way to tell whether cancer is present. If the entire cancer is removed during the biopsy, bladder cancer can be diagnosed and treated in a single procedure.
A patient who needs a biopsy may want to ask the doctor some of the following questions: Why do I need to have a biopsy? How long will it take? Will I be awake? Will it hurt? What side effects can I expect? How soon will I know the results? If I do have cancer, who will talk with me about treatment? When?
Once bladder cancer is diagnosed, the doctor will want to learn thegrade of the cancer and the stage, or extent, of the disease. Grade is important because it tells how closely the cancer resembles normal tissue and suggests how fast the cancer is likely to grow. Low-grade cancers more closely resemble normal tissue and are likely to grow and spread more slowly than high-grade cancers.
Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. The stage of bladder cancer may be determined at the time of diagnosis, or it may be necessary to perform additional tests. Such tests may includeimaging tests–CT scan, MRI, sonogram, IVP, bone scan, or chest x-ray.
Treatment for bladder cancer depends on the stage of the disease (particularly if, or how deeply, the cancer has invaded the bladder wall), the grade of the cancer, the patient’s general health, and other factors. People with bladder cancer are often treated by a team of specialists, which may include a urologist, oncologist, andradiation oncologist. The doctors develop a treatment plan to fit each patient’s needs. Depending on its stage and grade, bladder cancer may be treated with surgery, radiation therapy, chemotherapy, or biological therapy. Doctors may recommend one treatment method or a combination of methods. It is important for patients to discuss the treatment plan with their doctors.
Some patients take part in aclinical trial (research study) using new treatment methods. Such studies are designed to improve cancer treatment.
Getting a Second Opinion
Before starting treatment, the patient may want a second specialist to review the diagnosis and the treatment plan. It may take a week or two to arrange for a second opinion. A short delay will not reduce the chance that treatment will be successful. Some insurance companies require a second opinion; others may cover a second opinion if the patient requests it.
There are a number of ways to find a doctor who can give a second opinion: The patient’s doctor may be able to suggest specialists to consult. The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute. Patients can get the names of doctors from their local medical society, a nearby hospital, or a medical school. The Directory of Medical Specialists lists doctors’ names along with their specialty and their background. This resource is in most public libraries.
Preparing for Treatment
Many people with cancer want to learn all they can about the disease and their treatment choices so they can take an active part in decisions about their medical care. When a person is diagnosed with cancer, shock and stress are natural reactions. These feelings may make it difficult to think of everything to ask the doctor. Often, it helps to make a list of questions. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor–to take part in the discussion, to take notes, or just to listen.
People do not need to ask all of their questions or remember all of the answers at one time. Questions may arise throughout the treatment process. Patients may ask doctors, nurses, or other members of the health care team to explain things further or to provide more information.
These are some questions a patient may want to ask the doctor before treatment begins: What is the diagnosis? What is the stage of the disease? What is the grade of the disease? What are the treatment choices? Which do you recommend? Why? What are the risks and possible side effects of each treatment? What are the chances that the treatment will be successful? What new treatments are being studied in clinical trial? Would a clinical trial be appropriate? How long will treatment last? Will treatment affect my normal activities? If so, for how long? What is the treatment likely to cost?
Methods of Treatment
Surgery is a common form of treatment for bladder cancer. Early (superficial) bladder cancer may be treated at the time of diagnosis through a procedure called transurethral resection (TUR). During TUR, the doctor inserts a cystoscope into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer or to burn away cancer cells with an electric current (fulguration). TUR requires anesthesia and may be done in the hospital.
Surgery to remove part or all of the bladder is called cystectomy. The most common form of surgery for invasive bladder cancer is radical cystectomy. This surgery may be done when the bladder cancer invades the muscle wall, or when superficial cancer involves a large part of the bladder.
Radical cystectomy removes the entire bladder, nearby lymph nodes, and any surrounding organs that contain cancerous cells. In men, the nearby organs that are removed are theprostate and the seminal vesicles. In women, the uterus, the ovaries, and part of the vagina are removed. Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, surgery to remove only the bladder may be done to relieve urinary symptoms caused by the cancer. When the bladder must be removed, the doctor creates another way for urine to leave the body. (SeeSide Effects of Treatment and Rehabilitation).
In some cases, patients may have part of the bladder removed in an operation called segmental cystectomy. This type of surgery may be done when a patient has a low-grade cancer that has invaded the wall of the bladder but is limited to one area of the organ. Because most of the bladder remains intact, a patient urinates normally after recovering from this surgery.
These are some questions a patient may want to ask the doctor before surgery: What kind of operation will it be? Will I need more treatment after surgery? What kind? How will I feel after the operation? If I have pain, how will you help? Will I urinate in a normal way? How will surgery affect my normal activities?
In radiation therapy (also called radiotherapy), high-energy rays are used to kill cancer cells. Like surgery, radiation therapy is local therapy; it affects cancer cells only in the treated area. Sometimes, radiation is given before or after surgery or along with anticancer drugs. When bladder cancer has spread to other organs, radiation therapy may be used to relieve symptoms caused by the cancer.
Radiation may come from a machine outside the body (external radiation) or from a small container of radioactive material, called a radiation implant, placed directly into the bladder (internal radiation). Some patients have both kinds of radiation therapy.
External radiation therapy is usually given on an outpatient basis in a hospital or clinic 5 days a week for 5 to 7 weeks. Treatment may be shorter when external radiation is given along with radiation implants.
These are some questions a patient may want to ask the doctor before having radiation therapy: What is the goal of this treatment? How will the radiation be given? What type of treatment schedule will I follow? How will I feel during therapy? What can I do to take care of myself during therapy? How will we know if the radiation is working? When will I be able to resume my normal activities?
For internal radiation, radiation implants are placed in the bladder either through the urethra or during surgery. The patient stays in the hospital for several days while the implant is in place. To protect others from exposure to radiation, patients may not be able to have visitors or may have visitors for only a short time. Once an implant is removed, there is no radioactivity in the body.
Chemotherapy is the use of drugs to kill cancer cells. The doctor may use one drug or a combination of drugs. Chemotherapy may be used alone or after TUR with fulguration to treat superficial bladder cancer. In a treatment calledintravesical chemotherapy, anticancer drugs are placed in the bladder through a tube called a catheter, which is inserted through the urethra. When given in this way, the anticancer drugs, which remain in the bladder for several hours, affect mainly the cells of the bladder. The treatment is usually done once a week for several weeks. Sometimes, the treatments continue once or several times a month for up to a year.
Chemotherapy also may be used to help control the disease when cancer cells have deeply invaded the bladder or spread to lymph nodes or other organs. In this case, the anticancer drugs are usually given by injection into a vein (IV); some may be given by mouth. This form of chemotherapy is systemic therapy, meaning that the drugs flow through the bloodstream to nearly every part of the body. The drugs are usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Chemotherapy may be used alone or in combination with surgery or radiation therapy.
These are some questions patients may want to ask the doctor before starting chemotherapy: What is the goal of this treatment? What drugs will I be taking? Will the drugs cause side effects? What can I do about them? How long will I need to take this treatment? What can I do to take care of myself during treatment? How will I know if the drugs are working?
Usually a patient has chemotherapy as an outpatient (at the hospital, at the doctor’s office, or at home). However, depending on which drugs are given and the patient’s general health, a short hospital stay may be needed.
Biological therapy (also called immunotherapy) is a form of treatment that uses the body’s natural ability (immune system) to fight cancer. Biological therapy for bladder cancer is most often used when the disease is superficial. Like chemotherapy, biological therapy may be used alone to treat bladder cancer or after TUR with fulguration to help prevent the cancer from recurring. This form of treatment involves placing a solution of BCG, a substance that stimulates the immune system, into the bladder. The medicine stays in the bladder for about 2 hours before the patient is allowed to empty the bladder by urinating. This treatment is usually done once a week for 6 weeks and may need to be prolonged or repeated. Doctors are also studying the use of other forms of biological therapy for other stages of bladder cancer.
These are some questions patients may want to ask the doctor before starting biological therapy: What is the goal of this treatment? What drugs will be used? What type of treatment schedule will I follow? Will the treatment cause side effects? If so, what can I do about them? Will I have to be in the hospital to receive treatment? How long will I be on treatment? Will I be able to continue my normal activities?
Another treatment option for people with bladder cancer is to take part in clinical trials (treatment studies). Doctors conduct clinical trials to learn the effectiveness and side effects of new treatments. In some clinical trials, all patients receive the new treatment. In other trials, doctors compare different therapies by giving the new treatment to one group of patients and the standard therapy to another group.
People who take part in these studies have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science.
Doctors are studying new ways of treating bladder cancer with radiation therapy, chemotherapy, biological therapies, and ways of combining various types of treatment. In addition, some trials are designed to study ways to reduce the side effects of treatment and to improve the quality of life.
Patients who are interested in taking part in a trial should talk with their doctor. They may want to read the National Cancer Institute bookletTaking Part in ClinicalTrials: What Cancer Patients Need To Know which explains the possible benefits and risks of clinical trials.
One way to learn about clinical trials is through PDQ, a cancer information database developed by the National Cancer Institute. PDQ contains information about cancer treatment and about clinical trials in progress all over the country. The Cancer Information Service can provide PDQ information to doctors, patients, and the public.
Side Effects of Treatment
It is hard to limit the effects of cancer therapy so that only cancer cells, not healthy cells, are removed or destroyed. Because treatment can damage healthy cells and tissues, it often causes side effects.
These side effects depend mainly on the type and extent of the cancer treatment. Also, the effects may not be the same for each person, and they may even change from one treatment to the next. Doctors and nurses can explain the possible side effects of treatment, and they can help relieve symptoms that may occur during and after treatment.
TUR causes few problems. Patients may have some blood in their urine and difficulty or pain when urinating for a few days afterward.
After any bladder surgery, particularly radical cystectomy, patients are often uncomfortable during the first few days. However, this pain can be controlled with medicine. Patients should feel free to discuss pain relief with the doctor or nurse. It is also common for patients to feel tired or weak for a while. The length of time it takes to recover from an operation varies for each patient.
After segmental cystectomy, patients may not be able to hold as much urine in their bladder. In most cases, this problem is temporary, but some patients may have long-lasting changes in bladder capacity.
When the bladder is removed, the patient needs a new way to store and pass urine. Various methods are used. In one common method, the surgeon uses a piece of the person’ssmallintestine to form a new tube through which urine can pass. The ureters are attached to one end, and the other end is brought out through an opening in the wall of the abdomen. This new opening is called a stoma. A flat bag fits over the stoma to collect urine, and special adhesive holds it in place. The patient will be taught how to care for the stoma. The surgical procedure to create a stoma is called aurostomy or an ostomy.
A newer method uses part of the small intestine to make a new storage pouch (called a continent reservoir) inside the body. Urine collects there instead of emptying into a bag. The pouch is connected either to a stoma or to the urethra. The patient learns to use a catheter to drain the urine through the stoma or the urethra.
Women who have had a radical cystectomy are not able to have children because their uterus has been removed. In addition, the vagina may be narrower or shallower, which may make sexual intercourse difficult.
In the past, nearly all men wereimpotent after radical cystectomy, but improvements in surgery have made it possible to prevent this side effect in some cases. However, men who have had their prostate and seminal vesicles removed no longer produce semen, so they do not ejaculate when they have an orgasm and are not able to father children.
With radiation therapy, the side effects depend mainly on the treatment dose and the part of the body that is treated. Patients are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.
With external radiation, there may be permanent darkening or "bronzing" of the skin in the treated area. In addition, it is common to lose hair in the treated area and for the skin to become red, dry, tender, and itchy. These problems are temporary, and the doctor may be able to suggest ways to relieve them.
Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or urinary discomfort. Radiation therapy also may cause a decrease in the number of white blood cells, cells that help protect the body against infection. Usually, the doctor can suggest certain diet changes or medicine to ease these problems. For both men and women, radiation treatment for bladder cancer can affect sexuality. Women may experience vaginal dryness, and men may have difficulty with erections.
Although the side effects of radiation therapy can be distressing, the doctor can usually treat or control them. It also helps to know that, in most cases, side effects are not permanent. The National Cancer Institute bookletRadiation Therapy and You has helpful information about radiation therapy and managing its side effects.
The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives as well as how the drugs are given. In addition, as with other types of treatment, side effects vary from person to person.
Anticancer drugs that are placed in the bladder may irritate the bladder for a few days after treatment, causing some discomfort or bleeding. Some drugs, if they come into contact with the skin or genitals, may cause a rash.
Systemic chemotherapy affects rapidly dividing cells throughout the body. These cells include blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells in hair roots and cells that line the digestive tract also divide rapidly. As a result, patients may lose their hair and may have other side effects such as poor appetite, nausea and vomiting, or mouth sores. Usually, these side effects go away gradually during the recovery periods between treatments or after treatment is over. Certain drugs used in the treatment of bladder cancer also may cause kidney damage. Patients are given large amounts of fluid while taking these drugs. Anticancer drugs can also cause tingling in the fingers, ringing in the ears, or hearing loss. These problems may not clear up after treatment stops. The National Cancer Institute booklet Chemotherapy and You has helpful information about chemotherapy and coping with side effects.
Treatment with BCG can irritate the bladder for a few days after treatment. This may cause pain, especially while urinating, and the feeling of an urgent need to urinate. Patients also may have some blood in their urine, have a low fever, or feel tired or nauseated.
Other types of biological therapy may cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Patients also may bleed or bruise easily, get a rash, or have swelling. These problems can be severe, but they go away after the treatment stops.
Nutrition for Cancer Patients
Eating well during cancer treatment means getting enough calories and protein to help prevent weight loss and regain strength. Eating well often helps people feel better and have more energy.
Some people with cancer find it hard to eat well. They may lose their appetite. In addition to loss of appetite, common side effects of treatment, such as nausea, vomiting, or mouth sores, can make eating difficult. Often, foods taste different. Also, people being treated for cancer may not feel like eating when they are uncomfortable or tired.
Doctors, nurses, and dietitians can offer advice for healthy eating during cancer treatment. Patients and their families also may want to read the National Cancer Institute booklet EatingHints for Cancer Patients, which contains many useful suggestions.
Rehabilitation after cancer is an important part of the overall treatment process. The goal of rehabilitation is to improve a person’s quality of life after cancer treatment. The medical team, which may include doctors, nurses, a physical therapist, or a social worker, develops a rehabilitation plan to meet the patient’s physical and emotional needs, helping the patient to return to normal activities as soon as possible. People who have had cancer and their families may discuss any concerns about rehabilitation with the medical team.
Bladder cancer patients who have a urostomy need special instructions for care.Enterostomal therapists teach them to care for themselves and their stomas after surgery. They often visit patients before surgery to discuss what to expect and talk about lifestyle issues including emotional, physical, and sexual concerns. Enterostomal therapists can also provide information about resources and support groups for people who have a urostomy.
Recovery and Outlook
People with bladder cancer and their families are naturally concerned about recovery from cancer and their outlook for the future. Sometimes people use statistics to try to figure out their chances of being cured. It is important to remember, however, that statistics are averages based on large numbers of patients. They cannot be used to predict what will happen to a particular patient because no two patients are alike; treatments and responses vary greatly. The patient’s doctor is in the best position to discuss the issue of prognosis, or chance of recovery.
When doctors talk about surviving cancer, they may use the term remission rather than cure. Although many cancer patients are cured, doctors use this term because cancer can return. (The return of cancer is called a recurrence.) Superficial bladder cancer tends to recur as an another superficial cancer in the bladder. The disease can also recur in the bladder muscle or elsewhere in the body. Therefore, people who have had bladder cancer may wish to discuss the possibility of recurrence with the doctor.
It is important for people who have had cancer to have regular followup examinations after their treatment is over. For people with bladder cancer who have not had their bladder removed, the doctor will check the bladder with a cystoscope and remove any superficial tumors that may have recurred. Patients also may have urine tests to check for cancer cells. Followup care may also include blood tests, a CT scan, a chest x-ray, or other tests.
Followup care is an important part of the overall treatment process, and people with cancer should not hesitate to discuss it with the doctor. Regular followup care ensures that changes in health are noted so that recurrent cancer or other problems can be treated as soon as possible. Between checkups, people who have had bladder cancer should report any health problems as soon as they appear.
Support for People With Cancer
Living with a serious disease is not easy. People with cancer and those who care about them face many problems and challenges. Coping with these problems is often easier when people have helpful information and support services. Several useful booklets, including Taking Time, are available from the Cancer Information Service.
Friends and relatives can be very supportive. Also, it helps many patients to discuss their concerns with others who have cancer. Cancer patients often get together in support groups, where they can share what they have learned about coping with cancer and the effects of treatment. It is important to keep in mind, however, that each person is different. Treatments and ways of dealing with cancer that work for one person may not be right for another–even if they both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the doctor.
People living with cancer may worry about what the future holds. They may worry about caring for their family, holding their job, or continuing daily activities. Concerns about tests, treatments, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful to people who want to talk about their feelings or discuss their concerns.
Often, a social worker can suggest groups that can help with rehabilitation, emotional support, financial aid, transportation, or home care.
The Cancer Information Service can supply information about bladder cancer and about programs and services for patients and their families.
Possible Causes and Prevention
Researchers at hospitals and medical centers all across the country are studying bladder cancer. They are trying to learn what causes the disease and how to prevent it.
At this time, the causes of bladder cancer are not fully understood. It is clear, however, that this disease is not contagious; no one can "catch" cancer from another person.
Some researchers study patterns of cancer in the population. They look for factors that are more common in people who get bladder cancer than in people who don’t get this disease. Studying such patterns helps researchers identify risk factors for bladder cancer. However, most people with these risk factors do not get cancer, and many people who do get bladder cancer have none of the known risk factors.
Researchers have found that white people in the United States get bladder cancer twice as often as African-Americans, and men are affected about three times as often as women. People with family members who have bladder cancer may be more likely to get the disease as well. Most bladder cancers occur after the age of 55, but the disease can also develop in younger people.
Known and possible risk factors for bladder cancer include: Smoking. This is a major risk factor. Cigarette smokers develop bladder cancer two to three times more often than do nonsmokers. Quitting smoking reduces the risk of bladder cancer, lung cancer, and several other types of cancer, as well as a number of other diseases. Occupational risk. Workers in some occupations are at higher risk of getting bladder cancer because of exposure to carcinogens in the workplace. Increased risk is seen in people in the rubber, chemical, and leather industries, as well as in hairdressers, machinists, metal workers, printers, painters, textile workers, and truck drivers.
People who think they may be at risk for developing bladder cancer should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.
The Promise of Cancer Research
Research advances in detection, treatment, rehabilitation, and pain control have improved the outlook and quality of life for people with bladder cancer. By using a combination of therapies, doctors can treat some bladder cancers without removing the patient’s bladder. However, when cystectomy is necessary, new surgical techniques allow doctors to create new ways of storing and passing urine, which improve patients’ recovery and long-term comfort. Researchers are also conducting studies to learn more about what causes the development of bladder cancer. Although there is still much more work to be done, there are many reasons to be optimistic about the future.
National Cancer Institute Information Resources
You may want more information for yourself, your family, and your health care provider. The following National Cancer Institute (NCI) services are available to help you.
Cancer Information Service (CIS)
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