Introduction
What Is Multiple Myeloma?
Risk Factors
Symptoms
Diagnosis
Staging
Treatment
Side Effects of Treatment
Supportive Care
Complementary and Alternative Medicine
Nutrition
Follow-up Care
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. 04-1575) has important information about
multiple myeloma*, cancer that starts in certain white blood cells (plasma
cells). You will read about possible causes, symptoms, diagnosis, treatment,
and supportive care. You also will find ideas about how to cope with the
disease.
Each year, about 15,000 Americans learn they have multiple myeloma. Scientists
are studying this disease to find out more about how it develops. And they are
looking at better ways to treat it.
The NCI provides 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 1. (Click on the "Need Help?" at
http://www.cancer.gov. Then click on "Connect to LiveHelp.")
*Words that may be new to readers appear in italics. The "Dictionary"
section explains these terms. Some words in the "Dictionary 2"
have a "sounds-like" spelling to show how to pronounce them.
What Is Multiple Myeloma?
Multiple myeloma is
cancer
that begins in
plasma cells,
a type of
white blood cell.
To understand multiple myeloma, it is helpful to know about normal blood
cells.
Most blood cells develop from cells in the
bone marrow
called
stem cells. Bone
marrow is the soft material in the center of most bones.
Stem cells mature into different types of blood cells. Each type has a special
function:
-
White blood cells help fight
infection.
There are several types of white blood
cells.
-
Red blood cells
carry oxygen to
tissues
throughout the body.
-
Platelets
help form blood clots that control bleeding.
Plasma cells are white blood cells that make
antibodies.
Antibodies are part of
the
immune system.
They work with other parts of the immune system to help
protect the body from germs and other harmful substances. Each type of plasma
cell makes a different antibody.
Normal plasma cells help protect the body from germs and other harmful
substances.
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Myeloma, like other cancers, begins in cells. 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. In cancer, 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.
Myeloma begins when a plasma cell becomes
abnormal. The abnormal cell divides
to make copies of itself. The new cells divide again and again, making more and
more abnormal cells. The abnormal plasma cells are myeloma cells. Myeloma cells
make antibodies called
M proteins.
In time, myeloma cells collect in the bone marrow. They may crowd out normal
blood cells. Myeloma cells also collect in the solid part of the bone. The
disease is called "multiple myeloma" because it affects many bones. (If myeloma
cells collect in only one bone, the single mass is called a
plasmacytoma.)
Multiple myeloma is the most common type of
plasma cell tumor. This booklet
does not deal with other kinds of plasma cell tumors. The Cancer Information
Service (1-800-4-CANCER) can send information about those diseases.
Myeloma cell (abnormal plasma cell) making M proteins.
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Multiple myeloma is not bone cancer. Although multiple myeloma affects the
bones, it begins in blood cells, not bone cells.
Bone cancer is a different disease. It begins in bone cells, not blood cells.
Bone cancer is diagnosed and treated differently from multiple myeloma.
The NCI's fact sheet "Bone Cancer: Questions and Answers 3" provides information
about bone cancer. This fact sheet and other materials are available from the
Cancer Information Service (1-800-4-CANCER) and on NCI's Web site
(http://www.cancer.gov).
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Risk Factors
No one knows the exact causes of multiple myeloma. Doctors can seldom explain
why one person develops this disease and another does not. However, we do know
that multiple myeloma is not contagious. You cannot "catch" it from another
person.
Research has shown that people with certain
risk factors
are more likely than
others to develop multiple myeloma. A risk factor is something that may
increase the chance of developing a disease.
Studies have found the following risk factors for multiple myeloma:
-
Age: Growing older increases the chance of developing multiple myeloma.
Most people with myeloma are diagnosed after age 65. This disease is rare in
people younger than 40.
-
Race: The risk of multiple myeloma is highest among African Americans
and lowest among Asian Americans. The reason for the difference between racial
groups is not known.
-
Personal history of
monoclonal gammopathy of undetermined significance
(MGUS):
MGUS is a condition in which abnormal plasma cells make a low level of M
proteins. MGUS is a
benign
condition, but it increases the risk of certain
cancers, including multiple myeloma.
Scientists are studying other possible risk factors for multiple myeloma.
Radiation,
pesticides,
hair dye, certain
viruses,
obesity,
and diet are under
study. But it is not clear that these factors are involved in the development
of the disease. Researchers also are studying families in which more than one
person has multiple myeloma. However, such families are extremely rare.
Most people who have known risk factors (being older, being African American,
or having MGUS) do not get multiple myeloma. On the other hand, most people who
do get the disease have no known risk factors. If you think you may be at risk,
you should discuss this concern with your doctor.
Symptoms
Common
symptoms
of multiple myeloma include:
- Bone pain, usually in the back
- Broken bones, usually in the spine
- Feeling weak and very tired
- Feeling very thirsty
- Frequent infections and fevers
- Weight loss
- Nausea or constipation
- Frequent urination
Most often, these symptoms are not due to cancer. Other health problems can cause the same symptoms. Anyone with these symptoms should tell the doctor so that problems can be diagnosed and treated as early as possible.
Diagnosis
Doctors sometimes find multiple myeloma after a routine blood test. More often,
doctors suspect multiple myeloma after an
x-ray
for a broken bone. Usually
though, patients go to the doctor because they are having other symptoms.
To find out whether such problems are from multiple myeloma or some other
condition, your doctor may ask about your personal and family medical history
and do a physical exam. In addition, your doctor may order some of the
following tests and exams:
-
Blood tests: The lab checks the level of blood cells and other
substances. Myeloma causes a high level of plasma cells and
calcium.
Most
people with myeloma have
anemia.
Myeloma also causes high levels of certain
proteins. The lab checks for M protein,
beta-2-microglobulin, and other
proteins.
-
Urine tests: The lab checks for
Bence Jones protein, a type of M
protein, in urine. The lab measures the amount of Bence Jones protein in urine
collected over a 24-hour period.
If the lab finds a high level of Bence Jones protein in your urine sample,
doctors will monitor your kidneys. Bence Jones protein can clog the kidneys and
damage them.
You may want to ask the doctor these questions before having a biopsy:
-
How will the biopsy be done?
-
Where will I have my biopsy?
-
How long will it take? Will I be awake? What will I feel? Will it hurt?
-
Are there any risks? What are the chances of infection or bleeding after the
procedure?
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How long will it take me to recover?
-
How soon will I know the results? Who will explain them to me?
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If I do have cancer, who will talk to me about the next steps? When?
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Staging
If the biopsy shows that you have multiple myeloma, your doctor needs to know
the extent
(stage) of the disease to plan the best treatment.
Staging
may
involve having more tests. You may have blood tests (including
beta-2-microglobulin),
CT scans,
or an
MRI
of your bones.
Doctors may describe the disease as Stage I, Stage II, or Stage III. Higher
numbers mean that a larger number of myeloma cells are in the body. The stage
also takes into account whether the cancer is causing problems with your bones
or kidneys.
Treatment
Many people with multiple myeloma want to take an active part in making
decisions about their medical care. It is natural to want to learn all you can
about your disease and your treatment choices. However, shock and stress after
the diagnosis can make it hard to think of everything you want to ask the
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 to explain things that are not clear and to ask for more
information.
Your doctor may refer you to a specialist, or you may ask for a referral.
Specialists who treat multiple myeloma include
medical oncologists,
radiation oncologists, and
hematologists.
Before starting treatment, you might want a second opinion about the 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. Some people with multiple myeloma 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.
-
The NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about
nearby treatment centers. Information Specialists also can provide online
assistance through
LiveHelp 1 at http://www.cancer.gov.
-
A local or state medical society, a nearby hospital, or a medical school can
usually provide the names of specialists in your area.
-
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. This Directory
is in most public libraries. Or you can look up doctors at
http://www.abms.org 4. (Click on "Who's Certified.")
-
The NCI provides a helpful fact sheet called "How To Find a Doctor or Treatment
Facility If You Have Cancer." 5
-
Nonprofit organizations with an interest in multiple myeloma may be of help.
See the NCI fact sheet "National Organizations That Offer Services to People
With Cancer and Their Families." 6
The choice of treatment depends mainly on the stage and symptoms of your
disease. If you have multiple myeloma without symptoms, you may not need
treatment for the cancer. The doctor monitors your health closely so that
treatment can start when you begin to have symptoms.
If you have symptoms, your treatment will probably involve anticancer drugs
(including
steroids). Sometimes
stem cell transplantation or
radiation therapy is part of the
treatment plan. Your doctor can describe your treatment choices and the
expected results of each. You and your doctor can work together to develop a
treatment plan that meets your needs.
Because standard treatment may not control myeloma, you may want to talk to
your doctor about taking part in a
clinical trial. Clinical trials are
research studies of new treatment methods. The section on
"The Promise of Cancer Research" 7 has more information about clinical
trials.
At any stage of disease, you may receive
supportive care to control health
problems (such as infections) caused by multiple myeloma. (See the
"Supportive Care" 8 section.)
You may want to ask the doctor these questions before treatment begins:
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What is the stage of my disease?
-
Is the disease affecting my kidneys?
-
What are my treatment choices? Which do you recommend for me? Will I have more
than one kind of treatment? How will my treatment change over time?
-
What are the expected benefits of each kind of treatment?
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What are the risks and possible
side effects of each treatment?
What can we do to control my side effects?
-
How will treatment affect my normal activities?
-
What can I do to take care of myself during treatment?
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What is the treatment likely to cost? Does my insurance cover this treatment?
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How often will I need to have checkups?
-
Would a clinical trial (research study) be appropriate for me?
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Treatment of myeloma usually involves anticancer drugs. This treatment is
called
systemic therapy because the drugs
enter the bloodstream and can affect myeloma cells all over the body.
Many different types of drugs are used to treat myeloma. Each type kills cancer
cells in a different way.
Types of
chemotherapy in common use include
melphalan,
cyclophosphamide,
vincristine, and
doxorubicin.
Prednisone is a steroid that is
often used. In some cases, the doctor may suggest new options, such as
thalidomide and
bortezomib. People often receive a
combination of drugs.
You may receive the drugs by mouth or through a vein. The treatment usually
takes place in an outpatient part of the hospital, at your doctor's office, or
at home. Patients rarely need to stay in the hospital during treatment.
You may want to ask the doctor these questions before having anticancer drug
therapy:
-
Which drug or drugs will I have?
-
What are the expected benefits of the treatment?
-
What are the risks and possible side effects of treatment? What can we do about
them?
-
Are there any long-term effects?
-
When will treatment start? When will it end?
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How will treatment affect my normal activities?
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Some people with multiple myeloma have stem cell transplantation. A stem cell
transplant allows a person to receive high doses of chemotherapy, radiation
therapy, or both. The high doses destroy both myeloma cells and normal blood
cells in the bone marrow. Later, the patient receives healthy stem cells
through a flexible tube placed in a large vein in the neck or chest area. New
blood cells develop from the transplanted stem cells.
Stem cell transplants take place in the hospital. Some patients have two or
more transplants.
Stem cells may come from the patient or from a donor:
-
Autologous stem cell transplantation:
This type of transplant uses the patient's own stem cells. The stem cells are
removed from the patient, and the cells may be treated to kill myeloma cells
that may be present. The stem cells are frozen and stored. After the patient
receives high-dose treatment, the stored stem cells are thawed and returned to
the patient.
-
Allogeneic stem cell transplantation:
Sometimes healthy stem cells from a donor are available. The patient's brother,
sister, or parent may be the donor. Or the stem cells may come from an
unrelated donor. Doctors use blood tests to be sure the donor's cells match the
patient's cells.
-
Syngeneic stem cell transplantation:
This type of transplant uses stem cells from the patient's healthy identical
twin.
You may want to ask the doctor these questions before having a stem cell
transplant:
-
What are the possible benefits and risks of different types of transplants?
-
What kind of stem cell transplant will I have? If I need a donor, how will we
find one?
-
Will I need to be in the hospital? If so, for how long? Will I need special
care?
-
How will we know if the treatment is working?
-
What can we do about side effects?
-
How will treatment affect my normal activities?
-
What is my chance of a full recovery?
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Radiation therapy (also called radiotherapy) uses high-energy rays to kill
myeloma cells and to help control pain. People receive radiation therapy at a
hospital or clinic.
Radiation therapy is given two ways for people with myeloma:
-
Local radiation: A large machine aims radiation at the bone or the part
of the body where myeloma cells have collected. It is
local therapy because it affects
cells only in the treated area. This is the main treatment for people with a
single plasmacytoma. People receive radiation for 4 to 5 weeks. A shorter
course of radiation therapy can be used to control the growth of tumors in
bones and help relieve pain.
-
Total-body irradiation: Some
patients receive radiation to their whole body before stem cell
transplantation. The radiation treatments may be given 2 to 3 times a day for
several days.
You may want to ask the doctor these questions before having radiation therapy:
-
Why do I need this treatment?
-
What are the risks and side effects of this treatment? What can we do about
them?
-
Are there any long-term effects?
-
When will the treatments begin? When will they end?
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How will I feel during therapy?
-
How will treatment affect my normal activities?
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Side Effects of Treatment
Because cancer treatment often damages healthy cells and tissues, unwanted 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.
The NCI provides helpful booklets about cancer treatments and coping with side
effects, such as Chemotherapy and You 9,
Radiation Therapy and You 10,
and Eating Hints for Cancer Patients 11.
The side effects of anticancer drugs depend mainly on the specific drugs and
the dose. The drugs affect cancer cells and other cells that divide rapidly:
-
Blood cells: When drugs affect your healthy blood cells, you are more
likely to get infections, bruise or bleed easily, and feel very weak and tired.
-
Cells in hair roots: Anticancer drugs can cause you to lose your hair.
The hair will grow back, but it may be somewhat different in color and texture.
-
Cells that line the
digestive tract:
Anticancer drugs can cause poor
appetite, nausea and vomiting, diarrhea, or mouth and lip sores.
The drugs used for myeloma also may cause skin rash, blisters, cramps, blurred
vision, lung problems, headache, dizziness, drowsiness, numbness or tingling in
hands or feet, and blood clots.
Your doctor can suggest ways to control many of these side effects.
People who have stem cell transplantation face an increased risk of infection,
bleeding, and other side effects because of the large doses of chemotherapy or
radiation they receive. In addition,
graft-versus-host disease
(GVHD) may occur
in people who receive stem cells from a donor. In GVHD, the donated stem cells
react against the patient's tissues. Most often, GVHD affects the liver, skin,
or digestive tract. GVHD can be serious. It can occur any time after the
transplant, even years later. Steroids or other drugs may help treat or control
GVHD.
The NCI offers a fact sheet called
"Bone Marrow Transplantation and Peripheral
Blood Stem Cell Transplantation: Questions and Answers." 12 You can read it on the
Internet at http://www.cancer.gov/publications. Also, Information Specialists
at the NCI's Cancer Information Service at 1-800-4-CANCER can send you this
fact sheet and answer questions about stem cell transplantation.
The side effects of radiation therapy depend mainly on the dose of radiation
and the part of the body that is treated. For example, your skin in the treated
area may become red, dry, and tender. You also may lose your hair in the
treated area.
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 relieve them.
Supportive Care
Multiple myeloma and its treatment can lead to other health problems. You
probably will receive supportive care to prevent or control these problems and
to improve your comfort and
quality of life.
This section tells about health problems that myeloma may cause and describes
the supportive care people may need. Detailed information about supportive care
is available on NCI's Web site at http://www.cancer.gov/cancertopics/coping and
from NCI's Cancer Information Service at 1-800-4-CANCER.
People with multiple myeloma get infections very easily. You may receive
antibiotics and other drugs to help protect you. Your health care team may
advise you to stay away from crowds and from people with colds or other
contagious diseases. If an infection develops, it can be serious and should be
treated promptly. Some people need to stay in the hospital for treatment.
Myeloma and its treatment can lead to anemia, which may make you feel very
tired. Drugs or
blood transfusions
can help with this problem.
Multiple myeloma often causes bone pain. Your health care provider can suggest
ways to relieve or reduce pain. For example, drugs and local radiation therapy
can help control bone pain. A brace may relieve pain in the neck or back. Some
people get pain relief from massage or
acupuncture
when used along with other
approaches. Also, the patient may learn relaxation techniques such as listening
to slow music or breathing slowly and comfortably. Sometimes surgery is needed
if the spinal cord is compressed (squeezed).
The NCI offers booklets called
Pain Control: A Guide for People with Cancer and
Their Families 13,
Get Relief from Cancer Pain 14, and
Understanding Cancer Pain 15.
Myeloma cells keep new bone cells from forming, and bones become thin wherever
there are myeloma cells. Your doctor may give you drugs to prevent bone
thinning and help reduce the risk of fractures. Physical activity, such as
walking, also helps keep bones strong.
Multiple myeloma may cause calcium to leave the bones and enter the
bloodstream. If you have a very high level of calcium in your blood, you may
lose your appetite. You also may feel nauseated, restless, or confused. A high
calcium level can also make you very tired, weak,
dehydrated, and thirsty.
Drinking a lot of fluids and taking drugs that lower the calcium in the blood
can be helpful.
Some patients with multiple myeloma have kidney problems. If the problems are
severe, they may need
dialysis.
Dialysis removes wastes from the blood. In some
cases, people with serious kidney problems may need a kidney transplant.
Some people with myeloma develop
amyloidosis.
Abnormal protein collects in
tissues of the body. The build-up of protein can cause many problems, some of
them severe. For example, protein can build up in the heart, causing chest pain
and swollen feet. Drugs are used to treat amyloidosis.
Complementary and Alternative Medicine
Some people with cancer use
complementary and alternative medicine
(CAM) to
ease stress or to reduce side effects and symptoms:
Acupuncture, massage therapy, herbal products, vitamins or special diets,
visualization, meditation, and spiritual healing are types of CAM. Many people
say that such approaches help them feel better.
However, some types of CAM may interfere with standard treatment. Combining CAM
with standard treatment may even be harmful. 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.
The NCI offers a fact sheet called
"Complementary and Alternative Medicine in
Cancer Treatment: Questions and Answers." 16
Nutrition
It is important for people with multiple myeloma to eat well and to drink plenty of fluids. Eating well means getting enough calories to maintain a good weight and enough protein to keep up your strength. Good nutrition often helps people with cancer feel better and have more energy.
But eating well can be difficult. You may not feel like eating if you are uncomfortable or tired. Also, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can be a problem. Some people find that foods do not taste as good during cancer therapy.
The doctor, a
dietitian,
or another health care provider can suggest ways to maintain a healthy diet. The NCI booklet
Eating Hints for Cancer Patients 11 has many useful ideas and recipes.
Follow-up Care
Follow-up care after treatment for multiple myeloma is important. Your doctor
will monitor your health and check for
recurrence
or changes in the cancer.
Checkups help ensure that any changes in your health are noted and treated as
needed. Checkups may include a physical exam, lab tests, bone marrow
aspiration, and x-rays. Between scheduled visits, you should contact the doctor
right away if you have any health problems.
To help answer questions about follow-up care and other concerns, the NCI has a
booklet for people who have completed their treatment.
Facing Forward Series:
Life After Cancer Treatment 17 provides tips for making the best use of medical
visits. It describes how to talk with the doctor about creating a plan of
action for recovery and future health.
Sources of Support
Living with a serious disease such as multiple myeloma 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
the health care team can answer questions about treatment, work, or other
activities. Meeting with a social worker, counselor, or member of the clergy
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.
Cancer Information Specialists at 1-800-4-CANCER and at
LiveHelp 1 (http://www.cancer.gov) can help you locate
programs, services, and publications. Also, you may want to see the NCI fact
sheets called "Cancer Support Groups: Questions and Answers" 18 and
"National Organizations That Offer Services to People With Cancer and Their Families." 6
The Promise of Cancer Research
Doctors all over the country are conducting clinical trials (research studies
in which people volunteer to take part). Many are studying new ways to treat
multiple myeloma.
Clinical trials are designed to answer important questions and to find out
whether the new treatments are safe and effective. Research already has led to
advances, such as stem cell transplantation, and researchers continue to look
for better ways to treat multiple myeloma.
Researchers are testing anticancer drugs (such as thalidomide and bortezomib)
and drug combinations. They are also testing ways to improve stem cell
transplantation for people with multiple myeloma.
People who join clinical trials may be among the first to benefit if a new
approach is effective. And even if participants do not benefit directly, they
still make an important contribution to medicine by helping doctors learn more
about the disease and how to control it. Although clinical trials may pose some
risks, researchers do all they can to protect their patients.
If you are interested in being part of a clinical trial, you should talk with
your doctor. You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies 19. 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 detailed information about specific ongoing studies
of multiple myeloma. Information Specialists at 1-800-4-CANCER or at
LiveHelp 1 at
http://www.cancer.gov can answer questions
and provide information about clinical trials.
National Cancer Institute Information Resources
You may want more information for yourself, your family, and your doctor. The following National Cancer Institute (NCI) services are available to help you.
Cancer Information Service (CIS)
The CIS provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information Specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment. Calls to the CIS are free.
Telephone: 1-800-4-CANCER (1-800-422-6237)
TTY: 1-800-332-8615
The NCI's Web site (http://www.cancer.gov) provides information from numerous 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 1.
National Cancer Institute Publications
National Cancer Institute (NCI) publications can be ordered by writing to the
address below: Publications Ordering Service
National Cancer Institute
Suite 3035
6116 Executive Boulevard, MSC 8322
Bethesda, MD 20892-8322
Many NCI publications can be viewed, downloaded, and ordered from
http://www.cancer.gov/publications 20 on the Internet. In addition, people
in the United States and its territories may order these and other NCI
publications by calling the Cancer Information Service at 1-800-4-CANCER.
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