The American Cancer Society

Other gene mutations can also lead to inherited breast cancers. These gene mutations are much rarer and often do not increase the risk of breast cancer as much as the BRCA genes. They are not frequent causes of inherited breast cancer.

The ATM gene normally helps repair damaged DNA. Inheriting two abnormal copies of this gene causes the disease ataxia-telangiectasia. Inheriting one mutated copy of this gene has been linked to a high rate of breast cancer in some families.

The TP53 gene gives instructions for making a protein called p53 that helps stop the growth of abnormal cells. Inherited mutations of this gene cause Li-Fraumeni syndrome (named after the two researchers who first described it). People with this syndrome have an increased risk of developing breast cancer, as well as several other cancers such as leukemia, brain tumors and sarcomas. This is a rare cause of breast cancer.

The Li-Fraumeni syndrome can also be caused by inherited mutations in the CHEK2 gene. Even when it does not cause this syndrome, it can increase breast cancer risk about two-fold when it is mutated.

The PTEN gene normally helps regulate cell growth. Inherited mutations in this gene can cause Cowden syndrome, a rare disorder in which people are at increased risk for both benign and malignant breast tumors, as well as growths in the digestive tract, thyroid, uterus and ovaries. Defects in this gene can also cause a different syndrome called Bannayan-Riley-Ruvalcaba syndrome that is not thought to be linked to breast cancer.

Inherited mutations in this gene cause hereditary diffuse gastric cancer, a syndrome in which people develop a rare type of stomach cancer at an early age. Women with mutations in this gene also have an increased risk of invasive lobular breast cancer.

Defects in this gene can lead to Peutz-Jeghers syndrome. People with this disorder develop pigmented spots on their lips and in their mouths, polyps in the urinary and gastrointestinal tracts, and have an increased risk of many types of cancer, including breast cancer.

Reprinted by the permission of the American Cancer Society, Inc. from 

Articles

Other gene mutations, besides BRCA, can also lead to inherited breast cancers.

Changes in Other Genes

Renal cell carcinoma (RCC) is by far the most common type of kidney cancer. It accounts for about 9 out of 10 kidney cancers. There are several subtypes of RCC, based mainly on how the cancer cells look under a microscope:  

This is the most common form of renal cell carcinoma. About 8 out of 10 people with renal cell carcinoma have this kind of cancer. When seen under a microscope, the cells that make up clear cell RCC appear very pale or clear.

This is the second most common subtype, making up about 10 percent to 15 percent of RCC cases. These cancers form little finger-like projections called papillae in some, if not most, of the tumor. Some doctors call these cancers chromophilic because the cells take in certain dyes used so the tissue can be seen under the microscope, and look pink.

This subtype accounts for about 5 percent of RCCs. The cells of these cancers are also pale, like the clear cells, but are much larger and have certain other features that can be recognized.

This subtype is very rare. The major feature is that the cancer cells can form irregular tubes.

In rare cases, renal cell cancers are labeled as unclassified because the way they look doesn't fit into any of the other categories or because there is more than one type of cell present.

About 5 percent to 10 percent of cancers in the kidney are transitional cell carcinomas, also known as urothelial carcinomas. Under the microscope, the cells look like bladder cancer cells. Studies have shown that, like bladder cancer, these cancers are often linked to cigarette smoking and workplace exposures to certain cancer-causing chemicals. People with transitional cell carcinoma often have the same signs and symptoms as patients with renal cell cancer -- blood in the urine and, sometimes, back pain.

These cancers are usually treated by surgically removing the whole kidney and the ureter, as well as the portion of the bladder where the ureter attaches. About 9 out of 10 transitional cell carcinomas of the kidney are curable if they are found at an early stage.

About 5 percent of kidney cancers are Wilms tumors, which is almost always found in children. 

Renal sarcomas are a rare type of kidney cancer (less than 1% of all kidney tumors) that begin in the kidney's connective tissue.

Although renal cell carcinoma is the most common type, there are other types of kidney cancer. 

Web Exclusive: Types of Kidney Cancer

Classifying non-Hodgkin lymphoma (NHL) can be confusing because there are so many types. The World Health Organization system is often used. It groups NHL by the appearance of the lymphoma cells, the chromosome features of the cells, and the presence of certain proteins on the cell surface.

B-cell lymphomas make up most (about 85 percent) of NHL cases in the United States, and diffuse large B-cell lymphoma (DLBCL) is one of the more common types. The cells are fairly large when viewed under the microscope. DLBCL can affect any age group but occurs mostly in older people. Although this lymphoma usually starts in lymph nodes, it can grow in other areas such as the intestines, bone, and even the brain or spinal cord. This is a fast growing lymphoma, but it often responds well to treatment with chemotherapy. Overall, about 75 percent of people will have no signs of disease after initial treatment, and about half of all people with this lymphoma are cured with therapy.

About 1 out of 4 lymphomas in the United States are follicular lymphomas. The term follicular is used because the cells tend to grow in a circular, or nodular, pattern in lymph nodes. The average age for people with this lymphoma is about 60. Although it is usually not considered curable by standard treatment, this is often a very slow-growing lymphoma, and the five-year survival rate is around 60 to 70 percent. Often these lymphomas are not treated when they are first diagnosed if the patient has no symptoms of the disease. Over time, about a third of follicular lymphomas changes into a fast-growing diffuse B-cell lymphoma.

Chronic Lymphocytic Leukemia /Small Lymphocytic Lymphoma

These related diseases account for about 1 out of 4 lymphomas. The same type of cell (known as a small lymphocyte) is involved in both chronic lymphocytic leukemia (CLL) and small lymphocytic leukemia (SLL). In CLL the cancer cells are mostly in the blood and bone marrow; in SLL, they are mainly in the lymph nodes. Both are slow-growing diseases, although CLL, which is much more common, tends to grow slower. They are not considered curable with standard treatments, but depending on the stage and growth rate of the disease, most patients can live longer than 10 years. Occasionally over time, these slow-growing lymphomas transform into a more aggressive type of lymphoma.

Only about 5 percent of lymphomas are of this type. Men are affected most often. The average age of patients is in the early 60s. Although this isn't a very fast growing lymphoma, it is hard to treat. Newer, more aggressive treatments may be more effective than those used in the past, which may help improve the survival rates of patients now being diagnosed.

Marginal zone lymphomas account for about 4 percent of lymphomas. The cells in these lymphomas look small under the microscope. There are three main types of marginal zone lymphomas: extranodal marginal zone B-cell lymphomas, nodal marginal zone B-cell lymphomas, and splenic marginal zone B-cell lymphomas.

Extranodal marginal zone B-cell lymphomas, also known as mucosa-associated lymphoid tissue (MALT) lymphomas start in places other than the lymph nodes and are the most common type. Most MALT lymphomas start in the stomach and are thought to be related to an infection by the bacteria 

. MALT is a slow-growing lymphoma and is often curable in its early stages. Doctors often use antibiotics as the first treatment for this type of lymphoma, especially MALT lymphoma of the stomach, as they may get rid of the infection. Nodal marginal zone B-cell lymphoma and splenic marginal zone B-cell lymphoma are rare diseases and tend to be slow-growing.

This type accounts for about 2 percent of all lymphomas and primarily affects young adults. The cells are large and resemble those of diffuse large B-cell lymphomas. This lymphoma starts in the area around the heart and behind the chest bone. It can cause trouble breathing because it often presses on the trachea leading into the lungs. It can also block the large vein that returns blood to the heart from the arms and head, which can cause the arms and face to swell. It is a fast growing lymphoma but it is treatable.

This type makes up about 1 to 2 percent of all lymphomas. Nearly all patients are male, and the average age is about 30. Although this is a fast-growing lymphoma, over half of patients can be cured by intensive chemotherapy.

This type is not common. The cells are small and found mainly in the bone marrow, lymph nodes, and spleen. Most of the time the lymphoma cells make an antibody called immunoglobulin M, which is a very large protein. This antibody circulates in the blood in large amounts, and causes the liquid part of the blood to thicken. This can lead to decreased blood flow to many organs, feeling tired and weak, and a tendency to bleed easily. This lymphoma is slow growing. Although it isn't usually considered to be curable, most patients live longer than 5 years.

T-cell lymphomas represent less than 15 percent of non-Hodgkin lymphomas in the United   States. The most common type of T-cell lymphoma is peripheral T-cell lymphoma, which accounts for about 5 percent of all lymphomas. There are several types of peripheral T-cell lymphoma.

 Cutaneous T-cell lymphomas (mycosis fungoides, Sezary syndrome) start in the skin.

 Angioimmunoblastic T-cell lymphoma tends to occur in the lymph nodes and may affect the spleen or liver. This lymphoma often progresses quickly, although some patients get better with cortisone-like drugs and/or chemotherapy.

 Extranodal natural killer/T-cell lymphoma, nasal type often involves the upper airway passages, such as the nose and upper throat, but it can also invade the skin and digestive tract.

 Enteropathy type T-cell lymphoma occurs in people with sensitivity to gluten, the main protein in wheat flour.

 Subcutaneous panniculitis-like T-cell lymphoma invades the deep layers of the skin, where it causes nodules to form.

 Anaplastic large cell lymphoma usually starts in lymph nodes and can also spread to skin. There is also a form that begins in the skin. Although this type of lymphoma appears to be fast-growing, chemotherapy often works well.

 Unspecified peripheral T-cell lymphomas are types of peripheral T-cell lymphomas that don't readily fit into any of the other groups.

Web Exclusive: Types of Non-Hodgkin Lymphoma

 Many men let their fear of prostate cancer or stories from others guide their judgment when it comes to  making decisions about treatment. Rather than carefully weighing the potential  side effects and effectiveness of each option, a recent study in the journal  

 found that many men based their choices on stories they'd heard  from other prostate cancer patients and notions they already held about specific  treatments.

 Counteracting those fears is a tall order,  acknowledges lead study author Thomas Denberg, MD, PhD. But he thinks helping  men sort through their concerns point-by-point may be one way to help them make  better treatment decisions.

"We need to be very explicit with men that certain  beliefs aren't right and give very detailed explanations of why those beliefs  aren't correct," says Dr. Denberg, assistant professor of internal medicine at  the University of Colorado Health Sciences Center in Denver. "Giving them  information isn't enough to get rid of these fears. We really need to address  them directly and upfront."

Early stage prostate cancer can be treated in a  number of ways, including removing the prostate surgically, external beam  radiation or radioactive seed implants (brachytherapy), and cryotherapy  (freezing the tumor). All of these have the potential to cure the patient.  Hormone therapy and watchful waiting are not considered curative, but are also  options for certain men.

Dr. Denberg and his colleagues surveyed 20 men newly  diagnosed with early-stage prostate cancer about what factors influenced their  treatment choices. The men were all patients at a Veterans Affairs hospital and  were between the ages of 54 and 80. Each had been given written information  about treatment options and had had one consultation with a urologist.

All of the men in the study were eligible for at  least 2 forms of treatment intended to cure the disease. Yet many of the men  expressed a strong preference for one treatment over another even before they'd  had time to weigh all the pros and cons. Some men wanted surgery because they  thought it would be most likely to get rid of all the cancer quickly. Other men  rejected surgery outright because they were afraid of it or because they felt it  was too extreme. Some men preferred brachytherapy over external beam radiation  because they thought it would be more direct and have fewer side effects. 

In reality, though, each of these treatments has a  good chance of curing the patient, and each has its own risks and benefits.  Doctors need to help men see through misconceptions "so they can really validly  weigh their options," says Dr. Denberg.

Fear of dying from the cancer may have kept many of  the men from giving careful consideration to their treatment options. More than  half of the men wanted to be treated as quickly as possible, even though they  knew that most prostate cancers—though not all&mdash;tend to grow slowly. Men whose  cancers do not seem particularly aggressive may not need to rush their  decisions.

Likewise, many men didn't give a lot of thought to  treatment side effects because they were more afraid of dying from their cancer  than they were of dealing with problems like impotence or incontinence down the  road. But Dr. Denberg says treatment side effects should be an important  consideration, since most men with early-stage disease live a long time after  treatment.

Prostate cancer can be deadly, of course, but the  number of men who die from it is vastly smaller than the number of men who get  it. More than 234,000 new cases and about 27,000 deaths are expected in the  United States in 2006. Men with early-stage disease have a particularly good  outlook—nearly 100 percent of men with this type of prostate cancer survive at  least five years after treatment.

Another factor that had a strong influence on the  men's decisions was how other men they had known had dealt with the disease. All  but one of the men in the study had known or heard about someone with prostate  cancer. Many of the men used that person's experience as a guide for their own  decisions, even though their situations—how advanced the cancer was, what stage  it was in at diagnosis&mdash;may have been entirely different.

That doesn't come as a surprise to Mark Litwin, MD,  a urologist at the University of California, Los Angeles, Jonsson Comprehensive  Cancer Center who counsels patients every week about prostate cancer treatments.  He was not involved in the current research, but called it important information  for doctors and patients trying to sort through prostate cancer decisions.

"I think anecdotal evidence can be helpful, but it  ends up playing much too great a role in people's decision-making process," Dr.  Litwin says. "Talk to other men, but don't just talk to one. Talk to someone  who's had a good experience with surgery and someone who's had a good experience  with radiation and vice versa. Talk to people who've had suboptimal  experiences."

Getting multiple perspectives in this way can help  men make more balanced decisions, he says. The same goes for getting a second  opinion. Yet only 4 of the 20 men in the study wanted to consult another doctor.

"A lot of men were under the assumption that the  second opinion has no purpose other than to confirm the diagnosis," Dr. Denberg  says. "They didn't understand that the true purpose is to get another  clinician's perspective about treatment options."

Doctors tend to be most familiar with the type of  treatment they provide, he explains, so a surgeon (urologist) may not be as  well-versed in the benefits and risks of radiation, and a radiation oncologist  may not know as much about surgery. Getting different points of view may help  men make better treatment decisions.

"Dealing with the diagnosis and figuring out what  you're going to do is a process," he explains. "It's not something that can  happen in one clinic visit with a urologist."

Dr. Litwin also suggests men speak with their  primary care physician about their different treatment options. "It's important  for everyone who is newly diagnosed to have a conversation not only with a  surgeon, but also with a radiation oncologist," he said. "I require [my  patients] to do it."

In the end, though, men have to make a treatment  decision that feels right for them, Dr. Litwin says. "If you're not the type of  person who feels like he can live with decision A or decision B, then you should  incorporate that into your choice," Dr. Litwin says. "People are often  predisposed one way or the other, but that should be balanced as much as  possible by unbiased information."

For more information on issues of cancer  treatment, visit the American Cancer Society's website at 

's upcoming feature  on making medical decisions in the Fall 2006 issue.

Choosing which cancer treatment is right for you is tough, but it is important to weigh the risks and benefits of each option and consider getting a second opinion, and studies show that most men diagnosed with prostate cancer base treatment decisions on preconceived ideas and fears or stories heard from other patients rather than logical evaluation of each treatment option&mdash;chemotherapy, radiation, surgery&mdash;and information from doctors.

The American Cancer Society

Changes in Other Genes

Web Exclusive: Types of Kidney Cancer

Web Exclusive: Types of Non-Hodgkin Lymphoma

CURExtra - Prostate Cancer Therapy: Men Guided by What They Fear, What They Hear

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