What You Need To Know About™ Stomach Cancer

Page Options

	Quick Links


	Director's Corner Dictionary of Cancer Terms NCI Drug Dictionary Funding Opportunities NCI Publications Advisory Boards and Groups Science Serving People Español

Questions about cancer?


	1-800-4-CANCER

	LiveHelp® online chat

	NCI Highlights


	Virtual and Standard Colonoscopy Both Accurate New Study of Targeted Therapies for Breast Cancer The Nation's Investment in Cancer Research FY 2009 Cancer Trends Progress Report: 2007 Update Past Highlights

Treatment
Getting a Second Opinion
Treatment Methods
Surgery
Chemotherapy
Radiation Therapy

Nutrition

Follow-up Care

Complementary and Alternative Medicine

Sources of Support

The Promise of Cancer Research

National Cancer Institute Information Resources

National Cancer Institute Publications

Introduction

This National Cancer Institute (NCI) booklet (NIH Publication No. 05-1554) has important information about cancer* of the stomach. Stomach cancer is also called gastric cancer.

You will read about possible causes, symptoms, diagnosis, and treatment. You will also find ideas about how to cope with the disease.

Scientists are studying stomach cancer to find out more about its causes. And they are looking for better ways to treat it.

NCI provides free information about cancer, including the publications mentioned in this booklet. You can order these materials by telephone or on the Internet. You can also read them on the Internet and print your own copy.

Telephone (1-800-4-CANCER): Information Specialists at NCI's Cancer Information Service can answer your questions about cancer. They also can send NCI booklets, fact sheets, and other materials.
Internet (http://www.cancer.gov): You can use NCI's Web site to find a wide range of up-to-date information. For example, you can find many NCI booklets and fact sheets at http://www.cancer.gov/publications. People in the United States and its territories may use this Web site to order printed copies. This Web site also explains how people outside the United States can mail or fax their requests for NCI booklets.
You can ask questions online and get help right away from Information Specialists through LiveHelp at http://www.cancer.gov/cis.

*Words that may be new to readers appear in italics. The "Dictionary" section explains these terms. Some words in the "Dictionary" have a "sounds-like" spelling to show how to pronounce them.

The stomach is part of the digestive system. It is a hollow organ in the upper abdomen, under the ribs.

The wall of the stomach has five layers:

Inner layer or lining (mucosa): Juices made by glands in the inner layer help digest food. Most stomach cancers begin in this layer.

Submucosa: This is the support tissue for the inner layer.

Muscle layer: Muscles in this layer create a rippling motion that mixes and mashes food.

Subserosa: This is the support tissue for the outer layer.

Outer layer (serosa): The outer layer covers the stomach. It holds the stomach in place.

Food moves from the mouth through the esophagus to reach the stomach. In the stomach, the food becomes liquid. The liquid then moves into the small intestine, where it is digested even more.

This picture shows the stomach and nearby organs.

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

Benign tumors are not cancer:
- Benign tumors are rarely life-threatening.
- Most benign tumors can be removed. They usually do not grow back.
- Cells from benign tumors do not invade the tissues around them.
- Cells from benign tumors do not spread to other parts of the body.
Malignant tumors are cancer:
- Malignant tumors are generally more serious than benign tumors. They may be life- threatening.
- Malignant tumors often can be removed. But sometimes they grow back.
- Cells from malignant tumors can invade and damage nearby tissues and organs.
- Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original tumor and entering the bloodstream or the lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.

Stomach cancer can affect nearby organs and lymph nodes:

A stomach tumor can grow through the stomach's outer layer into nearby organs, such as the pancreas, esophagus, or intestine.

Stomach cancer cells can spread through the blood to the liver, lungs, and other organs.

Cancer cells also can spread through the lymphatic system to lymph nodes all over the body.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if stomach cancer spreads to the liver, the cancer cells in the liver are actually stomach cancer cells. The disease is metastatic stomach cancer, not liver cancer. For that reason, it is treated as stomach cancer, not liver cancer. Doctors call the new tumor "distant" or metastatic disease.

No one knows the exact causes of stomach cancer. Doctors often cannot explain why one person develops this disease and another does not.

Research has shown that people with certain risk factors are more likely than others to develop stomach cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for stomach cancer:

Age: Most people with this disease are 72 or older.
Sex: Men are more likely than women to develop stomach cancer.
Race: Stomach cancer is more common in Asian, Pacific Islander, Hispanic, and African Americans than in non-Hispanic white Americans.
Diet: Studies suggest that people who eat a diet high in foods that are smoked, salted, or pickled may be at increased risk for stomach cancer. On the other hand, eating fresh fruits and vegetables may protect against this disease.
Helicobacter pylori infection: H. pylori is a type of bacteria that commonly lives in the stomach. H. pylori infection increases the risk of stomach inflammation and stomach ulcers. It also increases the risk of stomach cancer, but only a small number of infected people develop stomach cancer.
Although infection increases the risk, cancer is not contagious. You cannot catch stomach cancer from another person who has it.

Smoking: People who smoke are more likely to develop stomach cancer than people who do not smoke.

Certain health problems: Conditions that cause inflammation or other problems in the stomach may increase the risk of stomach cancer:

Stomach surgery

Chronic gastritis (long-term inflammation of the stomach lining)

Pernicious anemia (a blood disease that affects the stomach)

Family history: A rare type of stomach cancer runs in some families.

Most people who have known risk factors do not develop stomach cancer. For example, many people have H. pylori in their stomach but never develop cancer. On the other hand, people who do develop the disease sometimes have no known risk factors.

If you think you may be at risk, you should talk with your doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.

Early stomach cancer often does not cause clear symptoms. As the cancer grows, the most common symptoms are:

Discomfort in the stomach area
Feeling full or bloated after a small meal
Nausea and vomiting
Weight loss

Most often, these symptoms are not due to cancer. Other health problems, such as an ulcer or infection, can cause the same symptoms. Anyone with these symptoms should tell the doctor so that problems can be found and treated as early as possible.

If you have a symptom that suggests stomach cancer, your doctor must find out whether it is really due to cancer or to some other cause. Your doctor may refer you to a gastroenterologist, a doctor whose specialty is diagnosing and treating digestive problems.

The doctor asks about your personal and family health history. You may have blood or other lab tests. You also may have:

Physical exam: The doctor checks your abdomen for fluid, swelling, or other changes. The doctor also feels for swollen lymph nodes. Your skin and eyes are checked to see if they seem yellow.
Upper GI series: The doctor orders x-rays of your esophagus and stomach. The x-rays are taken after you drink a barium solution. The solution makes your stomach show up more clearly on the x-rays.

Endoscopy: The doctor uses a thin, lighted tube (endoscope) to look into your stomach. The doctor first numbs your throat with an anesthetic spray. You also may receive medicine to help you relax. The tube is passed through your mouth and esophagus to the stomach.

Biopsy: The doctor uses an endoscope to remove tissue from the stomach. A pathologist checks the tissue under a microscope for cancer cells. A biopsy is the only sure way to know if cancer cells are present.

You may want to ask your doctor these questions about having a biopsy:

How will the biopsy be done?
Will I have to go to the hospital?
Will I have to do anything to prepare for it?
How long will it take? Will I be awake? Will it hurt?
Are there any risks? What are the chances of infection or bleeding after the procedure?
How long will it take me to recover? When can I resume my normal diet?
How soon will I know the results? Who will explain them to me?
If I do have cancer, who will talk to me about next steps? When?

To plan the best treatment, your doctor needs to know the extent (stage) of the disease. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body. Stomach cancer can spread to the lymph nodes, liver, pancreas, and other organs. The doctor may order tests to check these areas:

Blood tests: The lab does a complete blood count to check for anemia. Blood tests also show how well your liver is working.

Chest x-ray: An x-ray machine takes pictures of your lungs. The doctor can then study these pictures on film. Tumors in your lungs can show up on the x-ray.

CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive an injection of dye. The dye makes abnormal areas easier to see. Tumors in your liver, pancreas, or elsewhere in the body can show up on a CT scan.

Endoscopic ultrasound: The doctor passes a thin, lighted tube (endoscope) down your throat. A probe at the end of the tube sends out sound waves that you cannot hear. The waves bounce off tissues in your stomach and other organs.

Laparoscopy: A surgeon makes small incisions (cuts) in your abdomen. The surgeon inserts a thin, lighted tube (laparoscope) into the abdomen. The surgeon may remove lymph nodes or take tissue samples for biopsy.

Sometimes staging is not complete until after surgery to remove the tumor and nearby lymph nodes.

These are the stages of stomach cancer:

Stage 0: The cancer is found only in the inner layer of the stomach. It is carcinoma in situ.

Stage I is one of the following:

The tumor has invaded only the submucosa. (The picture in section 2 shows the layers of the stomach.) Cancer cells may be found in up to 6 lymph nodes.
Or, the tumor has invaded the muscle layer or subserosa. Cancer cells have not spread to lymph nodes or other organs.

Stage II is one of the following:

The tumor has invaded only the submucosa. Cancer cells have spread to 7 to 15 lymph nodes.
Or, the tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 1 to 6 lymph nodes.
Or, the tumor has penetrated the outer layer of the stomach. Cancer cells have not spread to lymph nodes or other organs.

Stage III is one of the following:

The tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 7 to 15 lymph nodes.
Or, the tumor has penetrated the outer layer. Cancer cells have spread to 1 to 15 lymph nodes.
Or, the tumor has invaded nearby organs, such as the liver or spleen. Cancer cells have not spread to lymph nodes or to distant organs.

Stage IV is one of the following:

Cancer cells have spread to more than 15 lymph nodes.
Or, the tumor has invaded nearby organs and at least 1 lymph node.
Or, cancer cells have spread to distant organs.

Recurrent cancer: The cancer has come back (recurred) after a period of time when it could not be detected. It may recur in the stomach or in another part of the body.

Many people with stomach cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about the disease and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask your doctor. It often helps to make a list of questions before an appointment.

To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor - to take part in the discussion, to take notes, or just to listen.

You do not need to ask all your questions at once. You will have other chances to ask your doctor or nurse to explain things that are not clear and to ask for more details.

Your doctor may refer you to a specialist who has experience treating stomach cancer, or you may ask for a referral. Specialists who treat stomach cancer include gastroenterologists, surgeons, medical oncologists, and radiation oncologists.

Getting a Second Opinion

Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. Usually it is not a problem to take several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Sometimes people with stomach cancer need treatment right away.

There are a number of ways to find a doctor for a second opinion:

Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.
NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby treatment centers. Information Specialists also can assist you online through LiveHelp at http://www.cancer.gov/cis.
A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.
The American Board of Medical Specialties (ABMS) has a list of doctors who have had training and passed exams in their specialty. You can find this list in the Official ABMS Directory of Board Certified Medical Specialists. The Directory is in most public libraries. Also, ABMS offers this information at http://www.abms.org. (Click on "Who's Certified.")
NCI provides a helpful fact sheet called "How To Find a Doctor or Treatment Facility If You Have Cancer."

Treatment Methods

The choice of treatment depends mainly on the size and place of the tumor, the stage of disease, and your general health. Treatment for stomach cancer may involve surgery, chemotherapy, or radiation therapy. Many people have more than one type of treatment.

Your doctor can describe your treatment choices and the expected results. You and your doctor can work together to develop a treatment plan that meets your needs.

Cancer treatment is either local therapy or systemic therapy:

Local therapy: Surgery and radiation therapy are local therapies. They remove or destroy cancer in or near the stomach. When stomach cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
Systemic therapy: Chemotherapy is systemic therapy. The drug enters the bloodstream and destroys or controls cancer throughout the body.

Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each person, and they may change from one treatment session to the next.

Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them. NCI provides helpful booklets about cancer treatments and coping with side effects. These include Chemotherapy and You, Radiation Therapy and You, and Eating Hints for Cancer Patients.

At any stage of disease, supportive care is available to relieve the side effects of treatment, to control pain and other symptoms, and to ease emotional concerns. Information about such care is available on NCI's Web site at http://www.cancer.gov/cancertopics/coping, and from Information Specialists at 1-800-4-CANCER or LiveHelp (http://www.cancer.gov/cis).

You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. The section on "The Promise of Cancer Research" has more information about clinical trials.

You may want to ask your doctor these questions about treatment:

What is the stage of the disease?
What are my treatment choices? Which do you suggest for me? Why?
Would a clinical trial (research study) be a good choice for me?
Will I have more than one kind of treatment?
What are the expected benefits of each kind of treatment?
What are the risks and possible side effects of each treatment? What can we do to control my side effects? How else can I take care of myself during treatment?
How will treatment affect my normal activities? Am I likely to have eating or other problems?
Whom should I call if I have problems during treatment?
What is the treatment likely to cost? Does my insurance cover this treatment?
How often should I have checkups?

Surgery

Surgery is the most common treatment for stomach cancer. The type of surgery depends on the extent of the cancer. There are two main types of stomach cancer surgery:

Partial (subtotal) gastrectomy: The surgeon removes the part of the stomach with cancer. The surgeon also may remove part of the esophagus or part of the small intestine. Nearby lymph nodes and other tissues may be removed.

Total gastrectomy: The doctor removes the entire stomach, nearby lymph nodes, parts of the esophagus and small intestine, and other tissues near the tumor. The spleen also may be removed. The surgeon then connects the esophagus directly to the small intestine. The surgeon makes a new "stomach" out of tissue from the intestine.

It is natural to be concerned about eating after surgery for stomach cancer. During surgery, the surgeon may place a feeding tube into your small intestine. This tube helps you get enough nutrition while you heal. Information about eating after surgery is in the "Nutrition" section.

The time it takes to heal after surgery is different for each person. You may be uncomfortable for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

Many people who have stomach surgery feel tired or weak for a while. The surgery also can cause constipation or diarrhea. These symptoms usually can be controlled with diet changes and medicine. Your health care team will watch for signs of bleeding, infection, or other problems that may require treatment.

You may want to ask your doctor these questions about surgery:

What kind of surgery do you recommend for me?
Will you remove lymph nodes? Will you remove other tissue? Why?
How will I feel after surgery?
Will I need a special diet?
If I have pain, how will you control it?
How long will I be in the hospital?
Am I likely to have eating problems? Will I need a feeding tube? If so, for how long? How do I take care of it? Who can help me if I have a problem?
Will I have any lasting side effects?

Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells. The drugs enter the bloodstream and can affect cancer cells all over the body.

Most people who receive chemotherapy have it after surgery. Radiation therapy may be given along with chemotherapy.

Anticancer drugs for stomach cancer are usually injected into a blood vessel. But some drugs may be given by mouth. You may have your treatment in a clinic at the hospital, at the doctor's office, or at home. Some people may need to stay in the hospital during treatment.

The side effects of chemotherapy depend mainly on the specific drugs and the dose. The drugs affect cancer cells and other cells that divide rapidly:

Blood cells: These cells fight infection, help blood to clot, and carry oxygen to all parts of your body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired.
Cells in hair roots: Chemotherapy drugs can cause hair loss. Your hair will grow back, but it may be somewhat different in color and texture.
Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores.

The drugs used for stomach cancer also may cause a skin rash or itching. Your health care team can suggest ways to control many of these side effects.

You may want to ask your doctor these questions about chemotherapy:

Why do I need this treatment?
Which drug or drugs will I have?
How do the drugs work?
When will treatment start? When will it end?

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

The radiation comes from a large machine outside the body. Most people go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks.

Side effects depend mainly on the dose of radiation and the part of your body that is treated. Radiation therapy to the abdomen may cause pain in the stomach or the intestine. You may have nausea and diarrhea. Also, your skin in the treated area may become red, dry, and tender.

You 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.

Although the side effects of radiation therapy can be distressing, your doctor can usually treat or control them. Also, side effects usually go away after treatment ends.

You may want to ask your doctor these questions about radiation therapy:

Why do I need this treatment?
When will the treatments begin? When will they end?
How will I feel during treatment?
How will we know if the radiation treatment is working?
Are there any lasting effects?

It is important to eat well during and after cancer treatment. You need the right amount of calories, protein, vitamins, and minerals. Eating well may help you feel better and have more energy.

Eating well can be hard. Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. You also may have side effects of treatment such as poor appetite, nausea, vomiting, or diarrhea.

A registered dietitian can suggest ways to deal with these problems. Some people with stomach cancer are helped by receiving nutrition by a feeding tube or by injection into a blood vessel. Some are helped by nutritional beverage products.

You may want to read the NCI booklet Eating Hints for Cancer Patients. It contains many useful ideas and recipes.

Nutrition After Stomach Surgery

Weight loss after surgery for stomach cancer is common. You may need to change the types of food you eat. A registered dietitian can help you plan a diet that will give you the nutrition you need.

Another common problem after stomach surgery is dumping syndrome. This problem occurs when food or liquid enters the small intestine too fast. It can cause cramps, nausea, bloating, diarrhea, and dizziness. Eating smaller meals can help prevent dumping syndrome. Also, you may wish to cut down on very sweet foods and drinks, such as cookies, candy, soda, and juices. A registered dietitian can suggest foods to try. Also, your health care team may suggest medicine to control the symptoms.

You may need to take daily supplements of vitamins and minerals, such as calcium. You also may need injections of vitamin B12.

You may want to ask a registered dietitian these questions about nutrition:

What foods are best soon after surgery?
How can I avoid dumping syndrome?
Are there foods or drinks I should avoid?

Follow-up care after treatment for stomach cancer is important. Even when there are no longer any signs of cancer, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Your doctor will monitor your recovery and check for recurrence of the cancer. Checkups help ensure that any changes in your health are noted and treated if needed. Checkups may include a physical exam, lab tests, x-rays, CT scans, endoscopy, or other tests. Between scheduled visits, you should contact the doctor if you have any health problems.

Facing Forward Series: Life After Cancer Treatment is an NCI booklet for people who have finished their treatment. It answers questions about follow-up care and other concerns. It has tips for making the best use of medical visits. It also suggests ways to talk with the doctor about making a plan of action for recovery and future health.

Some people with cancer use complementary and alternative medicine (CAM):

An approach is generally called complementary medicine when it is used along with standard treatment.
An approach is called alternative medicine when it is used instead of standard treatment.

Acupuncture, massage therapy, herbal products, vitamins or special diets, visualization, meditation, and spiritual healing are types of CAM.

Many people say that CAM helps them feel better. However, some types of CAM may change the way standard treatment works. These changes could be harmful. And some types of CAM could be harmful even if used alone. Before trying any type of CAM, you should discuss its possible benefits and risks with your doctor.

Some types of CAM are expensive. Health insurance may not cover the cost.

NCI offers a booklet called Thinking About Complementary and Alternative Medicine.

You also may request materials from the Federal Government's National Center for Complementary and Alternative Medicine. You can reach their clearinghouse toll-free at 1-888-644-6226 (voice) and 1-866-464-3615 (TTY). In addition, you can visit the Center's Web site at http://www.nccam.nih.gov, or send an e-mail to info@nccam.nih.gov.

You may want to ask your doctor these questions about CAM:

What benefits can I expect from this approach?
What are its risks?
Do the expected benefits outweigh the risks?
What side effects should I watch for?
Will CAM change the way my cancer treatment works? Could this be harmful?
Is this approach under study in a clinical trial? If so, who sponsors the trial?
Will my health insurance pay for this approach?

Living with a serious disease such as stomach cancer is not easy. You may worry about caring for your family, keeping your job, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy also can be helpful if you want to talk about your feelings or concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.

Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.

Information Specialists at 1-800-4-CANCER and at LiveHelp (http://www.cancer.gov/cis) can help you locate programs, services, and publications. For a list of organizations offering support, you may want to get the NCI fact sheet "National Organizations That Offer Services to People With Cancer and Their Families." For tips on coping, you may want to read the NCI booklet Taking Time: Support for People With Cancer and the People Who Care About Them.

Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). For stomach cancer, they are studying surgery, chemotherapy, radiation therapy, and combinations of these types of treatment.

Clinical trials are designed to answer important questions and to find out whether new approaches are safe and effective. Research already has led to advances, and researchers continue to search for more effective methods for dealing with stomach cancer.

People who join clinical trials may be among the first to benefit if a new approach is effective. And even if people in a trial do not benefit directly, they still make an important contribution by helping doctors learn more about stomach cancer and how to control it in other patients. Although clinical trials may have some risks, doctors do all they can to protect their patients.

If you are interested in being part of a clinical trial, talk with your doctor. You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies. It explains how clinical trials are carried out and explains their possible benefits and risks.

NCI's Web site includes a section on clinical trials at http://www.cancer.gov/clinicaltrials. It has general information about clinical trials as well as a search form to help you find studies of stomach cancer in progress. Information Specialists at 1-800-4-CANCER or at LiveHelp at http://www.cancer.gov/cis can answer questions and provide information about clinical trials.

You may want more information for yourself, your family, and your doctor. The following National Cancer Institute (NCI) services are available to help you.

Telephone

The NCI's Cancer Information Service (CIS) provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information Specialists explain the latest scientific information in plain language and respond in English, Spanish, or on TTY equipment. Calls to the CIS are free.

1-800-4-CANCER

Internet

The NCI's Web site (http://www.cancer.gov) provides information from many NCI sources. It offers current information on cancer prevention, screening, diagnosis, treatment, genetics, supportive care, and ongoing clinical trials. It has information about NCI's research programs and funding opportunities, cancer statistics, and the Institute itself. Information Specialists provide live, online assistance through LiveHelp at http://www.cancer.gov/cis.

National Cancer Institute (NCI) publications can be ordered by writing to the address below:

Many NCI publications can be viewed, downloaded, and ordered from http://www.cancer.gov/publications on the Internet. In addition, people in the United States and its territories may order these and other NCI publications by calling the NCI's Cancer Information Service at 1-800-4-CANCER.

Cancer Treatment and Support
Chemotherapy and You: A Guide to Self-Help During Cancer Treatment (also available in Spanish: La quimioterapia y usted: una guía de autoayuda durante el tratamiento del cáncer)
Helping Yourself During Chemotherapy: 4 Steps for Patients
Radiation Therapy and You: A Guide to Self-Help During Cancer Treatment (also available in Spanish: La radioterapia y usted: una guía de autoayuda durante el tratamiento del cáncer)
Eating Hints for Cancer Patients: Before, During & After Treatment (also available in Spanish: Consejos de alimentación para pacientes con cáncer: antes, durante y después del tratamiento)
Understanding Cancer Pain (also available in Spanish: El dolor relacionado con el cáncer)
Pain Control: A Guide for People with Cancer and Their Families (also available in Spanish: Control del dolor: guía para las personas con cáncer y sus familias)
Get Relief from Cancer Pain
Thinking About Complementary and Alternative Medicine: A Guide for People with Cancer
"La medicina complementaria y alternativa en el tratamiento del cáncer: preguntas y respuestas"
"How To Find a Doctor or Treatment Facility If You Have Cancer" (also available in Spanish: "Cómo encontrar a un doctor o un establecimiento de tratamiento si usted tiene cáncer")
"National Organizations That Offer Services to People With Cancer and Their Families" (also available in Spanish: "Organizaciones nacionales que brindan servicios a las personas con cáncer y a sus familias")

Living With Cancer
Advanced Cancer: Living Each Day
Facing Forward Series: Life After Cancer Treatment (also available in Spanish: Siga adelante: la vida después del tratamiento del cáncer)
Facing Forward Series: Ways You Can Make a Difference in Cancer
Taking Time: Support for People with Cancer and the People Who Care About Them
When Cancer Recurs: Meeting the Challenge

Clinical Trials
Taking Part in Cancer Treatment Research Studies
Taking Part in Clinical Trials: Cancer Prevention Studies: What Participants Need To Know (also available in Spanish: La participación en los estudios clínicos: estudios para la prevención del cáncer)