Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Overview

Cancer is a term that describes a broad range of diseases. What all forms of cancer share in common is that somewhere in the body, over the course of a lifetime, a single cell has acquired a collection of injuries to its genetic make-up (DNA), called mutations, which cause the cell to grow and divide uncontrollably. 

We do not know all the ways that a cell can acquire these mutations. But we do know that people may be born with them or can acquire one or more mutations from something they are exposed to in the environment. Sometimes mutations are caused by infections; mutations can also happen "by accident." For whatever reason, we currently believe that for a cell to become a cancer cell it likely requires several mutations that, when acquired in just the wrong combination, may result in cancer.

When a mutation causes uncontrolled cell multiplication, a growing mass of cells called a tumor develops. A malignant tumor may damage the normal tissue where it is growing and can even enter the bloodstream and spread elsewhere. If it does spread, the cancer is said to have metastasized.

The type of cancer is classified based on the original tissue from which the cancer cell arose. For example, a cancer that begins in the colon is called colon cancer, even if it spreads to another location such as the liver. In that case, we may refer to it as a colon cancer metastatic to the liver, rather than as "liver cancer," which would imply that the original cell originated from liver tissue.

There are also hematologic cancers, which affect the blood and lymphatic systems. Examples of these types of cancers include leukemia and lymphoma.

As we learn more about cancer, we discover that the same cancer can differ from person to person. While all cancers arising from the same tissue may be assigned the same name, it is clear that they behave very differently in different people.

Symptoms

Patients frequently ask: "What should I look out for?" or "What symptoms should worry me?"

In general, symptoms caused by cancer depend on the cancer's size and location. A cancer that starts or spreads to the bones may or may not cause pain at the site to which it has spread. Because a tumor may grow slowly over several months, symptoms may gradually increase over time. For this reason, symptoms that occur over time may be less noticeable than a more acute, more immediate set of symptoms that have "come and gone."

Regardless of the type of cancer, it is important to remember that symptoms can differ enormously from patient to patient. Some patients have no symptoms whatsoever, even if they have a large tumor, while other patients may experience symptoms that mimic common, less serious diseases. 

Screening

The term "screening" refers to testing to look for any signs of early cancer. The hope is that a cancer will be found early, when it can be more easily treated. If cancer is discovered at a later stage, when it might be more advanced, it can be more difficult to treat. Screening is much more successful, therefore, in organs where removing a small, harmless abnormality poses minimal risk to the patient. This is particularly true of cancers of the cervix, colon, and breast, for which early detection has improved outcomes.

In some instances, increased screening can also result in "false positives," where growths that initially seem like cancer do not turn out to be.

Diagnosis

While cancer may be suspected based upon an exam, lab findings, or X-rays, the gold standard for making a diagnosis is the biopsy.

A biopsy is a procedure in which a piece of tissue is removed from the body and examined by a physician specialist called a pathologist.

Often the tissue is sent to a specialized laboratory where it is subjected to analysis (for example, immune histochemistry) or to a variety of molecular tests that look for unique changes in the DNA of the tumor cells. These newer genetic tests often take time to perform and can lead to frustration for the patient who is anxious to receive the results. It is useful to remember that these newer, often time-consuming technologies help us arrive at an accurate diagnosis.

Staging

The term stage refers to one of several systems that categorize how far a particular cancer has spread. Cancers that are small and remain localized are generally assigned to a lower stage, while cancers that have spread to lymph nodes or some distant site are generally given a higher stage. Patients with low-stage cancers generally do better than those with more advanced-stage cancers.

The pathologist (the doctor who stages the cancer) also usually assigns a "grade" to the cancer. Cancer cells arise from normal tissue made up of normal cells that have undergone a process called "differentiation." When a cell differentiates, it develops the features and appearance unique to the tissue of which it is a part. The more differentiated a cancer cell is – that is, the more it resembles a normal cell – the lower its grade. A high-grade cancer often bears little resemblance to the tissue from which it arose.

Increasingly, with modern scientific tools, we are discovering other features that help us categorize a cancer. The newer categorizations usually rely on molecular or genetic changes in cancer cells that can be measured with an array of new, modern technologies.

At Kaiser Permanente, we have several laboratories that specialize in molecular, genetic, or immunohistochemical analyses of cancers. Because of our expertise, we are able to analyze cancer specimens with an extremely high level of sophistication. Increasingly, these newer techniques are being used to supplement more traditional diagnostic tools to provide physicians and patients with insight into possible outcomes (prognosis).

Even with all of these tools, predicting the long-term outcome for an individual patient is an informed guess. In many situations, we have experience based on large numbers of patients and can often tell a patient what happens "on average" to patients like themselves. However, an average implies that half (50 percent) of patients do better than average and the other half (the other 50 percent) do worse. While we always hope that all of our patients will do better than average, it is probably prudent for patients to think about several possible outcomes.

Treatments

Cancer treatments often involve:

  • Surgery
  • Radiation therapy
  • Chemotherapy, also known as drug therapy

Treatment plans can usually include a combination of these treatment methods. For some patients, a supervised observation, also known as "watchful waiting," might be the best approach.

Surgery

With some exceptions, surgery is usually considered part of a treatment plan. Surgery can be particularly effective for a cancer that is localized, meaning it has not spread or metastasized to distant sites.

Surgery is a good treatment option for certain types of cancer if:

  • They are localized.
  • They are in an operable location.
  • Surgery is compatible with the patient's overall health status.

It is generally up to the surgeon to determine whether to use specialized, high-tech tools such as a laparoscope, thoracoscope, lasers, or even robots.

Radiation Therapy

Radiation therapy refers to cancer treatment through the use of high-energy radiation beamed at the tumor. This can be quite useful in many situations, but the side effects of radiation depend on the volume of tissue being targeted and the organs that may be included in the "target area." For these reasons, radiation is usually used only when a small area of the body needs to be treated or when the cancer is located in an area of the body relatively resistant to the effects of radiation.

A physician who specializes in administering radiation therapy is called a radiation oncologist.

Chemotherapy (Drug Therapy)

Chemotherapy is often used to describe a specific category of drug treatments for cancer. The chemotherapy drugs kill the cancer cells to help prevent them from growing and spreading. Typically, chemotherapy is administered intravenously (through an IV needle) or taken orally (by mouth). The type of chemotherapy given to a patient depends upon the type and stage of the cancer. You can better understand what to expect during chemotherapy using our Emmi tool.

There are also other types of drug treatment for cancer, including hormone therapy and even biologic therapy. Hormonal agents are frequently used to treat many breast cancers and prostate cancer. Biologic agents (also known as "targeted therapies") refer to a group of high-tech treatments that have arisen from our increased understanding of the molecular causes of cancer.

Clinical Trials

We may also discuss with you the possibility of enrolling in a clinical trial. Clinical trials are research studies designed to improve treatment for cancer patients. Some trials investigate new cancer drugs and treatments while others compare standard treatments with new treatments.

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder. This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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