Input: What is (are) Childhood Vascular Tumors ?

Output:
Key Points
                    - Childhood vascular tumors form from cells that make blood vessels or lymph vessels.    - Tests are used to detect (find) and diagnose childhood vascular tumors.    - Childhood vascular tumors may be classified into four groups.         - Benign tumors     - Intermediate (locally aggressive) tumors     - Intermediate (rarely metastasizing) tumors     - Malignant tumors

                    Childhood vascular tumors form from cells that make blood vessels or lymph vessels.
                    Vascular tumors can form from abnormal blood vessel or lymph vessel cells anywhere in the body. They may be benign (not cancer) or malignant (cancer). There are many types of vascular tumors. The most common type of childhood vascular tumor is hemangioma, which is a benign tumor that usually goes away on its own.   Because malignant vascular tumors are rare in children, there is not a lot of information about what treatment works best.

                    Childhood vascular tumors may be classified into four groups.

											                    Benign tumors    Benign tumors are not cancer. This summary has information about the following benign vascular tumors:            -  Infantile hemangioma.     -  Congenital hemangioma.     - Benign vascular tumors of the liver.     -  Spindle cell hemangioma.     -  Epithelioid hemangioma.     -  Pyogenic granuloma (lobular capillary hemangioma).     -  Angiofibroma.     -  Juvenile nasopharyngeal angiofibroma.              Intermediate (locally aggressive) tumors    Intermediate tumors that are locally aggressive often spread to the area around the tumor. This summary has information about the following locally aggressive vascular tumors:            -  Kaposiform hemangioendothelioma and tufted angioma.              Intermediate (rarely metastasizing) tumors    Intermediate (rarely metastasizing) tumors sometimes spread to other parts of the body. This summary has information about the following vascular tumors that rarely metastasize:            -  Retiform hemangioendothelioma.     -  Papillary intralymphatic angioendothelioma.     -  Composite hemangioendothelioma.     -  Kaposi sarcoma.              Malignant tumors    Malignant tumors are cancer. This summary has information about the following malignant vascular tumors:            -  Epithelioid hemangioendothelioma.     -  Angiosarcoma of soft tissue.

																			            Benign Tumors

																			                    Infantile Hemangioma
																			                    Infantile hemangiomas are the most common type of benign vascular tumor in children. An infantile hemangioma may also be called a "strawberry mark." Immature cells that are meant to form blood vessels form a tumor instead. These tumors are not usually seen at birth but appear when the infant is 3 to 6 weeks old. Most hemangiomas get bigger for about 5 months, then stop growing and slowly fade away completely during the next several years. It is rare for them to come back.   Hemangiomas may be on the skin, in the tissue below the skin, and/or in an organ. They are usually on the head and neck but can be anywhere on or in the body. Hemangiomas may appear as a single lesion, one or more lesions spread over a larger area of the body, or multiple lesions in more than one part of the body. Lesions that are spread over a larger area of the body or multiple lesions are more likely to cause problems.    Risk Factors    Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get the disease; not having risk factors doesnt mean that you will not get the disease. Talk with your child's doctor if you think your child may be at risk.   Infantile hemangiomas are more common in the following:          - Girls.    - Whites.    - Premature babies.    -  Twins, triplets, or other multiple births.     - Babies of mothers who are older at time of the pregnancy or who have problems with the placenta during pregnancy.        Other risk factors for infantile hemangiomas include the following:         - Having certain syndromes.               -  PHACE syndrome: A syndrome in which the hemangioma spreads across a large area of the body (usually the head or face). Other health problems involving the large blood vessels, heart, eyes, and/or brain may also occur.       -  LUMBAR/PELVIS/SACRAL syndrome: A syndrome in which the hemangioma spreads across a large area of the lower back. Other health problems that affect the urinary system, genitals, rectum, anus, brain, spinal cord, and nerve function may also occur.                 Having more than one hemangioma or an airway hemangioma increases the risk of having other health problems.         - Multiple hemangiomas: Having more than five hemangiomas on the skin is a sign that there may be hemangiomas in an organ, most commonly the liver. Heart, muscle, and thyroid gland problems can also occur.     - Airway hemangiomas: Hemangiomas in the airway usually occur along with a large, beard-shaped area of hemangioma on the face (from the ears, around the mouth, lower chin, and front of neck). It is important for airway hemangiomas to be treated before the child has trouble breathing.         Signs and Symptoms    Infantile hemangiomas may cause any of the following signs and symptoms. Check with your childs doctor if your child has any of the following:         - Skin lesions: An area of spidery veins or lightened or discolored skin may appear before the hemangioma does. Hemangiomas occur as firm, warm, bright red-blue lesions on the skin. Lesions that form ulcers are also painful. Later, as the hemangiomas go away, they begin fading in the center before flattening and losing color.    - Lesions below the skin: Lesions that grow under the skin in the fat may appear blue or purple. If the lesions are deep enough under the skin surface, they may not be seen.    - Lesions in an organ: There may be no signs that hemangiomas have formed on an organ.        Although most infantile hemangiomas are nothing to worry about, if your child develops any lumps or red or blue marks on the skin check with your child's doctor. He or she can recommend a specialist if needed.     Diagnostic Tests    A physical exam and history are usually all that are needed to diagnose infantile hemangiomas. If there is something about the tumor that looks unusual, a biopsy may be done. If the hemangioma is deeper inside the body with no change to the skin, or the lesions are spread across a large area of the body, an ultrasound or MRI may be done. See the General Information section for a description of these tests and procedures.    If the hemangiomas are part of a syndrome, more tests may be done such as an echocardiogram, magnetic resonance angiogram, and eye exam.    Treatment    Most hemangiomas fade and shrink without treatment. If the hemangioma is large or causing other health problems, treatment may include the following:          -  Propranolol or other beta-blocker therapy.    -  Steroid therapy, before beta-blocker therapy is begun or when beta-blockers cannot be used.    - Pulsed dye laser surgery, for hemangiomas that have ulcers or have not gone away.     -  Surgery (excision) for hemangiomas that have ulcers, cause vision problems, or have not gone away.    -  Topical beta-blocker therapy for hemangiomas that are in one area of the skin.    -  Combined therapy, such as propranolol and steroid therapy or propranolol and topical beta-blocker therapy.

																			                    Congenital Hemangioma
																			                    Congenital hemangioma is a benign vascular tumor that begins forming before birth and is fully formed when the baby is born. They're usually on the skin but can be in another organ.   There are three types of congenital hemangiomas:         -  Rapidly Involuting Congenital Hemangioma: These tumors go away on their own 12 to 15 months after birth. They can form ulcers, bleed, and cause temporary heart and blood clotting problems. The skin may look a little different even after the hemangiomas go away.    -  Partial Involuting Congenital Hemangioma: These tumors do not go away completely.    -  Non-Involuting Congenital Hemangioma: These tumors never go away on their own.          Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose congenital hemangioma.    Treatment    Treatment of rapidly involuting congenital hemangioma and partial involuting congenital hemangioma may include the following:         -  Observation only.        Treatment of non-involuting congenital hemangioma may include the following:         -  Surgery to remove the tumor depending on where it is and whether it is causing symptoms.

																			                    Benign Vascular Tumors of the Liver
																			                    Benign vascular tumors of the liver may be focal (a single lesion in one area of the liver), multifocal (multiple lesions in one area of the liver), or diffuse (multiple lesions in more than one area of the liver).    The liver has many functions, including filtering blood and making proteins needed for blood clotting. Sometimes, blood that normally flows through the liver is blocked or slowed by the tumor. This sends blood directly to the heart without going through the liver and is called a liver shunt. This can cause heart failure and problems with blood clotting.    Focal Tumors    Focal tumors are usually rapidly involuting congenital hemangiomas or non-involuting congenital hemangiomas.    Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose focal benign vascular tumors.    Treatment    Treatment of focal tumors of the liver depends on whether symptoms occur and may include the following:         -  Observation.    -  Drugs to manage symptoms, including heart failure and blood clotting problems.    -  Embolization of the liver to manage symptoms, including heart failure.         Multifocal and Diffuse Tumors     Multifocal and diffuse tumors of the liver are usually infantile hemangiomas. Diffuse tumors of the liver can cause serious effects, including problems with the thyroid gland and heart. The liver can enlarge, press on other organs, and cause more symptoms.    Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose multifocal or diffuse benign vascular tumors.    Treatment    Treatment of multifocal and diffuse liver tumors may include the following:         - Observation for multifocal tumors of the liver that do not cause symptoms.    -  Beta-blocker therapy (propranolol).    -  Chemotherapy.    -  Steroid therapy.    - Total hepatectomy and liver transplant, when the tumors do not respond to drug therapy. This is only done when the tumors have spread widely in the liver and more than one organ has failed.        If a vascular tumor of the liver does not respond to standard treatments, a biopsy may be done to see if the tumor has become malignant.

																			                    Spindle Cell Hemangioma
																			                    Spindle cell hemangiomas contain cells called spindle cells. Under a microscope, spindle cells look long and slender.    Risk Factors    Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get the disease; not having risk factors doesnt mean that you will not get the disease. Talk with your child's doctor if you think your child may be at risk. Spindle cell hemangiomas are likely to occur in children with the following syndromes:         -  Maffucci syndrome, which affects cartilage and skin.    -  Klippel-Trenaunay syndrome, which affects blood vessels, soft tissues, and bones.         Signs    Spindle cell hemangiomas appear on or under the skin. They are painful red-brown or bluish lesions that usually appear on the arms or legs. They can begin as one lesion and develop into more lesions over years.     Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose spindle cell hemangioma.    Treatment    There is no standard treatment for spindle cell hemangiomas. Treatment may include the following:         -  Surgery to remove the tumor.        Spindle cell hemangiomas may come back after surgery.

																			                    Epithelioid Hemangioma
																			                    Epithelioid hemangiomas usually form on or in the skin, especially the head, but can occur in other areas, such as bone.    Signs and Symptoms    Epithelioid hemangiomas are sometimes caused by injury. On the skin, they may appear as firm pink to red bumps and may be itchy. Epithelioid hemangioma of the bone may cause swelling, pain, and weakened bone in the affected area.     Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose epithelioid hemangioma.    Treatment    There is no standard treatment for epithelioid hemangiomas. Treatment may include the following:         -  Surgery (curettage or resection).    -  Sclerotherapy.    -  Radiation therapy in rare cases.        Epithelioid hemangiomas often come back after treatment.

																			                    Pyogenic Granuloma
																			                    Pyogenic granuloma is also called lobular capillary hemangioma. It is most common in older children and young adults but may occur at any age.    The lesions are sometimes caused by injury or from the use of certain medicines, including birth control pills and retinoids. They may also form for no known reason inside capillaries (the smallest blood vessels) or other places on the body. Usually there is only one lesion, but sometimes multiple lesions occur in the same area or the lesions may spread to other areas of the body.    Signs    Pyogenic granulomas are raised, bright red lesions that may be small or large and smooth or bumpy. They grow quickly over weeks to months and may bleed a lot.    Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose pyogenic granuloma.    Treatment    Some pyogenic granulomas go away without treatment. Other pyogenic granulomas need treatment that may include the following:         -  Surgery (excision or curettage) to remove the lesion.    -  Laser photocoagulation.        Pyogenic granulomas often come back after treatment.

																			                    Angiofibroma
																			                    Angiofibromas are rare. They are benign skin lesions that usually occur with a condition called tuberous sclerosis (an inherited disorder that causes skin lesions, seizures, and mental disabilities).     Signs    Angiofibromas appear as red bumps on the face.    Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose angiofibroma.    Treatment    Treatment of angiofibromas may include the following:         -  Surgery (excision) to remove the tumor.    -  Laser therapy.    -  Targeted therapy (sirolimus).

																			                    Juvenile Nasopharyngeal Angiofibroma
																			                    Juvenile nasopharyngeal angiofibromas are benign tumors but they can invade nearby tissue. They begin in the nasal cavity and may spread to the nasopharynx, the paranasal sinuses, the bone around the eyes, and sometimes to the brain.     Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose juvenile nasopharyngeal angiofibroma.    Treatment    Treatment of juvenile nasopharyngeal angiofibromas may include the following:         -  Surgery (excision) to remove the tumor.    -  Radiation therapy.    -  Chemotherapy.    -  Immunotherapy (interferon).    -  Targeted therapy (sirolimus).

																			            Intermediate Tumors that Spread Locally

																			                    Kaposiform Hemangioendothelioma and Tufted Angioma
																			                    Kaposiform hemangioendotheliomas and tufted angiomas are blood vessel tumors that occur in infants or during early childhood. These tumors can cause Kasabach-Merritt phenomenon, a condition in which the blood is not able to clot and serious bleeding may occur. In Kasabach-Merritt phenomenon the tumor traps and destroys platelets (blood-clotting cells). Then there aren't enough platelets in the blood when needed to stop bleeding. This type of vascular tumor is not related to Kaposi sarcoma.    Signs and Symptoms    Kaposiform hemangioendotheliomas and tufted angiomas usually occur on the skin of the arms and legs, but may also form in deeper tissues, such as muscle or bone. Signs and symptoms may include the following:         - Firm, painful areas of skin that look bruised.    - Purple or brownish-red areas of skin.    - Easy bruising.    -  Bleeding more than the usual amount from mucous membranes, wounds, and other tissues.    -  Anemia (weakness, feeling tired, or looking pale).         Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose kaposiform hemangioendothelioma.   If a physical exam and MRI clearly show the tumor is a kaposiform hemangioendothelioma or a tufted angioma, a biopsy may not be needed. A biopsy is not always done because serious bleeding can occur.    Treatment    Treatment of kaposiform hemangioendotheliomas and tufted angiomas depends on the child's symptoms. Infection, delay in treatment, and surgery can cause bleeding that is life-threatening. Kaposiform hemangioendotheliomas and tufted angiomas are best treated by a vascular anomaly specialist.   Treatment and supportive care to manage bleeding may include the following:         -  Steroid therapy which may be followed by chemotherapy.    -  Non-steroidal anti-inflammatory drugs (NSAID), such as aspirin.    -  Immunotherapy (interferon).    -  Antifibrinolytic therapy to improve blood clotting.    -  Chemotherapy with one or more anticancer drugs.    -  Beta-blocker therapy (propranolol).    -  Surgery (excision) to remove the tumor, with or without embolization.    -  Targeted therapy (sirolimus).    - A clinical trial of targeted therapy (sirolimus) and steroid therapy.        Even with treatment, these tumors do not fully go away and can come back. Long-term effects include chronic pain, heart failure, bone problems, and lymphedema (the build up of lymph fluid in tissues).

																			            Intermediate Tumors that Rarely Spread

																			                    Retiform Hemangioendothelioma
																			                    Retiform hemangioendotheliomas are slow growing, flat tumors that occur in young adults and sometimes children. These tumors usually occur on or under the skin of the arms, legs, and trunk. These tumors often come back after treatment, but they usually do not spread to other parts of the body.    Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose retiform hemangioendothelioma.    Treatment    Treatment of retiform hemangioendotheliomas may include the following:         -  Surgery (excision) to remove the tumor. Follow up will include monitoring to see if the tumor comes back.    -  Radiation therapy and chemotherapy when surgery cannot be done or when the tumor has come back.

																			                    Papillary Intralymphatic Angioendothelioma
																			                    Papillary intralymphatic angioendotheliomas are also called Dabska tumors. These tumors form in or under the skin anywhere on the body. The tumors contain channels that look like lymph vessels. Lymph nodes are sometimes affected.    Signs    Papillary intralymphatic angioendotheliomas may appear as firm, raised, purplish bumps, which may be small or large. These tumors grow slowly over time.    Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose papillary intralymphatic angioendothelioma.    Treatment    Treatment of papillary intralymphatic angioendotheliomas may include the following:         -  Surgery (excision) to remove the tumor.

																			                    Composite Hemangioendothelioma
																			                    Composite hemangioendotheliomas have features of both benign and malignant vascular tumors. These tumors usually occur on or under the skin on the arms or legs. They may also occur on the head, neck, or chest. Composite hemangioendotheliomas are not likely to metastasize (spread) but they may come back in the same place. When the tumors metastasize, they usually spread to nearby lymph nodes.     Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose composite hemangioendothelioma and find out whether the tumor has spread.     Treatment     Treatment of composite hemangioendotheliomas may include the following:         -  Surgery to remove the tumor.    -  Radiation therapy and chemotherapy for tumors that have spread.

																			                    Kaposi Sarcoma
																			                    Kaposi sarcoma is a cancer that causes lesions to grow in the skin; the mucous membranes lining the mouth, nose, and throat; lymph nodes; or other organs. It is caused by the Kaposi sarcoma herpes virus (KSHV). In the United States, it usually occurs in people who have a weak immune system caused by AIDS or by drugs used in organ transplants. It is very rare in children and can be caused by HIV infection and rare immune system disorders.    Signs     Signs in children may include the following:         - Lesions in the skin, mouth, or throat. Skin lesions are red, purple, or brown and change from flat, to raised, to scaly areas called plaques, to nodules.    - Swollen lymph nodes.         Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose Kaposi sarcoma.    Treatment    Treatment of Kaposi sarcoma may include the following:         -  Chemotherapy.        See the PDQ summary on Kaposi Sarcoma Treatment for information about Kaposi sarcoma in adults.

																			            Malignant Tumors

																			                    Epithelioid Hemangioendothelioma
																			                    Epithelioid hemangioendotheliomas can occur in children, but are most common in adults between 30 and 50 years of age. They usually occur in the liver, lung, or in bone. They may be either fast growing or slow growing. In about a third of cases, the tumor spreads to other parts of the body very quickly.     Signs and Symptoms     Signs and symptoms depend on where the tumor is:          - On the skin, the tumors can be raised and rounded or flat, red-brown patches that feel warm.     - In the lung, there may be no early symptoms. Signs and symptoms that occur may include:               -  Chest pain.       - Spitting up blood.      -  Anemia (weakness, feeling tired, or looking pale).      - Trouble breathing (from scarred lung tissue).              - In bone, the tumors can cause breaks.         Diagnostic Tests    Epithelioid hemangioendotheliomas in the liver are found with CT scans and MRI scans. See the General Information section for a description of these tests and procedures used to diagnose epithelioid hemangioendothelioma and find out whether the tumor has spread. X-rays may also be done.    Treatment    Treatment of slow-growing epithelioid hemangioendotheliomas includes the following:         -  Observation.        Treatment of fast-growing epithelioid hemangioendotheliomas may include the following:         -  Surgery to remove the tumor when possible.    -  Immunotherapy (interferon) and targeted therapy (thalidomide, sorafenib, pazopanib, sirolimus) for tumors that are likely to spread.    -  Chemotherapy.    - Total hepatectomy and liver transplant when the tumor is in the liver.

																			                    Angiosarcoma of the Soft Tissue
																			                    Angiosarcomas are fast-growing tumors that form in blood vessels or lymph vessels in any part of the body, usually in soft tissue. Most angiosarcomas are in or near the skin. Those in deeper soft tissue can form in the liver, spleen, and lung.   These tumors are very rare in children. Children sometimes have more than one tumor in the skin and/or liver.    Risk Factors    Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get the disease; not having risk factors doesnt mean that you will not get the disease. Talk with your child's doctor if you think your child may be at risk. Risk factors for angiosarcomas include the following:         - Being exposed to radiation.    -  Chronic (long-term) lymphedema, a condition in which extra lymph fluid builds up in tissues and causes swelling.     - Having a benign vascular tumor. A benign tumor, such as a hemangioma, may become an angiosarcoma but this rare.         Signs    Signs of angiosarcoma depend on where the tumor is and may include the following:         - Red patches on the skin that bleed easily.    - Purple tumors.         Diagnostic Tests    See the General Information section for a description of tests and procedures used to diagnose angiosarcoma and find out whether the tumor has spread.     Treatment    Treatment of angiosarcoma may include the following:         -  Surgery to completely remove the tumor.    - A combination of surgery, chemotherapy, and radiation therapy for angiosarcomas that have spread.    -  Targeted therapy (bevacizumab) and chemotherapy for angiosarcomas that began as infantile hemangiomas.    - A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. </s>


Input: How to diagnose Childhood Vascular Tumors ?

Output: Tests are used to detect (find) and diagnose childhood vascular tumors. The following tests and procedures may be used:         -   Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps, lesions, or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken.     -   Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.    -   CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.    -   MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).     -   Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy is not always needed to diagnose a vascular tumor. </s>


Input: What are the treatments for Childhood Vascular Tumors ?

Output:
Key Points
                    - There are different types of treatment for childhood vascular tumors.    - Children with childhood vascular tumors should have their treatment planned by a team of health care providers who are experts in treating cancer in children.     - Some treatments cause side effects months or years after treatment has ended.    - Eleven types of standard treatment are used:         - Beta-blocker therapy     - Surgery     - Photocoagulation     - Embolization     - Chemotherapy     - Sclerotherapy     - Radiation therapy     - Targeted therapy     - Immunotherapy     - Other drug therapy     - Observation        - New types of treatment are being tested in clinical trials.    - Patients may want to think about taking part in a clinical trial.    - Patients can enter clinical trials before, during, or after starting their cancer treatment.    - Follow-up tests may be needed.

                    There are different types of treatment for childhood vascular tumors.
                    Different types of treatment are available for children with vascular tumors. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.   Because vascular tumors in children are rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

                    Children with childhood vascular tumors should have their treatment planned by a team of health care providers who are experts in treating cancer in children.
                    Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health care providers who are experts in treating children with cancer and who specialize in certain areas of medicine. These may include the following specialists:         - Pediatric vascular anomaly specialist (expert in treating children with vascular tumors).    -  Pediatric surgeon.    -  Orthopedic surgeon.    -  Radiation oncologist.    -  Pediatric nurse specialist.    -  Rehabilitation specialist.    -  Psychologist.    -  Social worker.

                    Some treatments cause side effects months or years after treatment has ended.
                    Some treatments, such as chemotherapy and radiation therapy, cause side effects that continue or appear months or years after treatment has ended. These are called late effects. Late effects of treatment may include:         - Physical problems.    - Changes in mood, feelings, thinking, learning, or memory.    -  Second cancers (new types of cancer).        Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information).

                    Eleven types of standard treatment are used:
                    Beta-blocker therapy     Beta-blockers are drugs that decrease blood pressure and heart rate. When used in patients with vascular tumors, beta-blockers may help shrink the tumors. Beta-blocker therapy may be given by vein (IV), by mouth, or placed on the skin (topical). The way the beta-blocker therapy is given depends on the type of vascular tumor and where the tumor first formed.    The beta-blocker propranolol is usually the first treatment for hemangiomas. Infants treated with IV propranolol may need to have their treatment started in a hospital. Propranolol is also used to treat benign vascular tumor of liver and kaposiform hemangioendothelioma.    Other beta-blockers used to treat vascular tumors include atenolol, nadolol, and timolol.     Infantile hemangioma may also be treated with propranolol and steroid therapy or propranolol and topical beta-blocker therapy.    See the drug information summary on Propranolol Hydrochloride for more information.       Surgery    The following types of surgery may be used to remove many types of vascular tumors:             -  Excision: Surgery to remove the entire tumor and some of the healthy tissue around it.     -  Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a skin lesion such as a tumor. Surgery with a pulsed dye laser may be used for some hemangiomas. This type of laser uses a beam of light that targets blood vessels in the skin. The light is changed into heat and the blood vessels are destroyed without damaging nearby skin.      - Total hepatectomy and liver transplant: A surgical procedure to remove the entire liver followed by a transplant of a healthy liver from a donor.     -  Curettage: A procedure in which abnormal tissue is removed using a small, spoon-shaped instrument called a curette.           The type of surgery used depends on the type of vascular tumor and where the tumor formed in the body.    For malignant tumors, even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the tumor will come back, is called adjuvant therapy.       Photocoagulation     Photocoagulation is the use of an intense beam of light, such as a laser, to seal off blood vessels or destroy tissue. It is used to treat pyogenic granuloma.       Embolization     Embolization is a procedure that uses particles, such as tiny gelatin sponges or beads, to block blood vessels in the liver. It may be used to treat some benign vascular tumors of the liver and kaposiform hemangioendothelioma.       Chemotherapy     Chemotherapy is a treatment that uses drugs to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach tumor cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect tumor cells in those areas (regional chemotherapy). Chemotherapy for hemangiomas may also be given topically (applied to the skin in a cream or lotion).     The way the chemotherapy is given depends on the type of the vascular tumor being treated.       Sclerotherapy     Sclerotherapy is a treatment used to destroy the blood vessel with the tumor. A liquid is injected into the blood vessel, causing it to scar and break down. Over time, the destroyed blood vessel is absorbed into normal tissue. The blood flows through nearby healthy veins instead. Sclerotherapy is used in the treatment of epithelioid hemangioma.       Radiation therapy     Radiation therapy is a treatment that uses high-energy x-rays or other types of radiation to kill tumor cells or keep them from growing. There are two types of radiation therapy:             -  External radiation therapy uses a machine outside the body to send radiation toward the tumor.     -  Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the tumor.           The way the radiation therapy is given depends on the type of the vascular tumor being treated. External radiation is used to treat some vascular tumors.       Targeted therapy     Targeted therapy is a type of treatment that uses drugs or other substances to attack specific tumor cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Angiogenesis inhibitors are a type of targeted therapy.            - Angiogenesis inhibitors are drugs that stop cells from dividing and prevent the growth of new blood vessels that tumors need to grow. The targeted therapy drugs thalidomide, sorafenib, pazopanib, sirolimus, and bevacizumab are angiogenesis inhibitors used to treat childhood vascular tumors.              Immunotherapy     Immunotherapy is a treatment that uses the patients immune system to fight disease. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against disease.     Interferon is a type of immunotherapy used to treat childhood vascular tumors. It interferes with the division of tumor cells and can slow tumor growth. It is used in the treatment of juvenile nasopharyngeal angiofibroma, kaposiform hemangioendothelioma, and epithelioid hemangioendothelioma.       Other drug therapy    Other drugs used to treat childhood vascular tumors or manage their effects include the following:            -  Steroid therapy: Steroids are hormones made naturally in the body. They can also be made in a laboratory and used as drugs. Steroid drugs help shrink some vascular tumors.     -  Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs are commonly used to decrease fever, swelling, pain, and redness. Examples of NSAIDs are aspirin, ibuprofen, and naproxen. In the treatment of vascular tumors, NSAIDs can increase the flow of blood through the tumors and decrease the chance that an unwanted blood clot will form.      -  Antifibrinolytic therapy: These drugs help the blood clot in patients who have Kasabach-Merritt syndrome. Fibrin is the main protein in a blood clot that helps stop bleeding and heal wounds. Some vascular tumors cause fibrin to break down and the patient's blood does not clot normally, causing uncontrolled bleeding. Antifibrinolytics help prevent the breakdown of fibrin.               Observation     Observation is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change.

                    New types of treatment are being tested in clinical trials.
                    Information about clinical trials is available from the NCI website.

                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the research process. Clinical trials are done to find out if new treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way disease will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose tumors have not gotten better. There are also clinical trials that test new ways to stop tumors from recurring (coming back) or reduce the side effects of treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

                    Follow-up tests may be needed.
                    Some of the tests that were done to diagnose the vascular tumor may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.   Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the tumor has recurred (come back). These tests are sometimes called follow-up tests or check-ups. </s>


Input: what research (or clinical trials) is being done for Childhood Vascular Tumors ?

Output:
New types of treatment are being tested in clinical trials.
                    Information about clinical trials is available from the NCI website.

                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the research process. Clinical trials are done to find out if new treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way disease will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose tumors have not gotten better. There are also clinical trials that test new ways to stop tumors from recurring (coming back) or reduce the side effects of treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. </s>


Input: What is (are) Polycythemia Vera ?

Output:
Key Points
                    - Polycythemia vera is a disease in which too many red blood cells are made in the bone marrow.    - Symptoms of polycythemia vera include headaches and a feeling of fullness below the ribs on the left side.    - Special blood tests are used to diagnose polycythemia vera.

                    Polycythemia vera is a disease in which too many red blood cells are made in the bone marrow.
                    In polycythemia vera, the blood becomes thickened with too many red blood cells. The number of white blood cells and platelets may also increase. These extra blood cells may collect in the spleen and cause it to swell. The increased number of red blood cells, white blood cells, or platelets in the blood can cause bleeding problems and make clots form in blood vessels. This can increase the risk of stroke or heart attack. In patients who are older than 65 years or who have a history of blood clots, the risk of stroke or heart attack is higher. Patients also have an increased risk of acute myeloid leukemia or primary myelofibrosis. </s>


Input: What are the symptoms of Polycythemia Vera ?

Output: Symptoms of polycythemia vera include headaches and a feeling of fullness below the ribs on the left side. Polycythemia vera often does not cause early signs or symptoms. It may be found during a routine blood test. Signs and symptoms may occur as the number of blood cells increases. Other conditions may cause the same signs and symptoms. Check with your doctor if you have any of the following:         - A feeling of pressure or fullness below the ribs on the left side.    - Headaches.    - Double vision or seeing dark or blind spots that come and go.    - Itching all over the body, especially after being in warm or hot water.    - Reddened face that looks like a blush or sunburn.    - Weakness.    - Dizziness.    - Weight loss for no known reason. </s>


Input: How to diagnose Polycythemia Vera ?

Output: Special blood tests are used to diagnose polycythemia vera. In addition to a complete blood count, bone marrow aspiration and biopsy, and cytogenetic analysis, a serum erythropoietin test is used to diagnose polycythemia vera. In this test, a sample of blood is checked for the level of erythropoietin (a hormone that stimulates new red blood cells to be made). In polycythemia vera, the erythropoietin level would be lower than normal because the body does not need to make more red blood cells. </s>


Input: What are the treatments for Polycythemia Vera ?

Output: The purpose of treatment for polycythemia vera is to reduce the number of extra blood cells. Treatment of polycythemia vera may include the following:             -  Phlebotomy.     -  Chemotherapy with or without phlebotomy.     -  Biologic therapy using interferon alfa or pegylated interferon alpha.     - Low-dose aspirin.            Check the list of NCI-supported cancer clinical trials that are now accepting patients with polycythemia vera. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. </s>


Input: What is (are) Vulvar Cancer ?

Output:
Key Points
                    - Vulvar cancer is a rare disease in which malignant (cancer) cells form in the tissues of the vulva.    - Having vulvar intraepithelial neoplasia or HPV infection can affect the risk of vulvar cancer.    - Signs of vulvar cancer include bleeding or itching.    - Tests that examine the vulva are used to detect (find) and diagnose vulvar cancer.    - Certain factors affect prognosis (chance of recovery) and treatment options.

                    Vulvar cancer is a rare disease in which malignant (cancer) cells form in the tissues of the vulva.
                    Vulvar cancer forms in a woman's external genitalia. The vulva includes:         - Inner and outer lips of the vagina.    - Clitoris (sensitive tissue between the lips).     - Opening of the vagina and its glands.    - Mons pubis (the rounded area in front of the pubic bones that becomes covered with hair at puberty).    -  Perineum (the area between the vulva and the anus).         Vulvar cancer most often affects the outer vaginal lips. Less often, cancer affects the inner vaginal lips, clitoris, or vaginal glands.    Vulvar cancer usually forms slowly over a number of years. Abnormal cells can grow on the surface of the vulvar skin for a long time. This condition is called vulvar intraepithelial neoplasia (VIN). Because it is possible for VIN to become vulvar cancer, it is very important to get treatment.

                    Having vulvar intraepithelial neoplasia or HPV infection can affect the risk of vulvar cancer.
                    Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for vulvar cancer include the following:         - Having vulvar intraepithelial neoplasia (VIN).    - Having human papillomavirus (HPV) infection.    - Having a history of genital warts.        Other possible risk factors include the following:         - Having many sexual partners.    - Having first sexual intercourse at a young age.    - Having a history of abnormal Pap tests (Pap smears).

							            Recurrent Vulvar Cancer
							            Recurrent vulvar cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the vulva or in other parts of the body. </s>


Input: What are the symptoms of Vulvar Cancer ?

Output: Signs of vulvar cancer include bleeding or itching. Vulvar cancer often does not cause early signs or symptoms. Signs and symptoms may be caused by vulvar cancer or by other conditions. Check with your doctor if you have any of the following:         - A lump or growth on the vulva.    - Changes in the vulvar skin, such as color changes or growths that look like a wart or ulcer.    - Itching in the vulvar area, that does not go away.    - Bleeding not related to menstruation (periods).    - Tenderness in the vulvar area. </s>


Input: How to diagnose Vulvar Cancer ?

Output: Tests that examine the vulva are used to detect (find) and diagnose vulvar cancer. The following tests and procedures may be used:         -   Physical exam and history : An exam of the body to check general signs of health, including checking the vulva for signs of disease, such as lumps or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken.     -   Biopsy : The removal of samples of cells or tissues from the vulva so they can be viewed under a microscope by a pathologist to check for signs of cancer. </s>


Input: What is the outlook for Vulvar Cancer ?

Output: Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following:         - The stage of the cancer.    - The patient's age and general health.    - Whether the cancer has just been diagnosed or has recurred (come back). </s>


Input: What are the stages of Vulvar Cancer ?

Output:
Key Points
                    - After vulvar cancer has been diagnosed, tests are done to find out if cancer cells have spread within the vulva or to other parts of the body.    - There are three ways that cancer spreads in the body.    - Cancer may spread from where it began to other parts of the body.    - In vulvar intraepithelial neoplasia (VIN), abnormal cells are found on the surface of the vulvar skin.    - The following stages are used for vulvar cancer:         - Stage I     - Stage II     - Stage III     - Stage IV

                    After vulvar cancer has been diagnosed, tests are done to find out if cancer cells have spread within the vulva or to other parts of the body.
                    The process used to find out if cancer has spread within the vulva or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:         -   Pelvic exam : An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.    -   Colposcopy : A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) or a brush and checked under a microscope for signs of disease.     -   Cystoscopy : A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.    -   Proctoscopy : A procedure to look inside the rectum and anus to check for abnormal areas. A proctoscope is inserted into the anus and rectum. A proctoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.    -   X-rays : An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. To stage vulvar cancer, x-rays may be taken of the organs and bones inside the chest, and the pelvic bones.    -   Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer has spread to these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters and bladder, x-rays are taken to see if there are any blockages. This procedure is also called intravenous urography.    -   CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.    -   MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).    -   PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.     -   Sentinel lymph node biopsy : The removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. Sentinel lymph node biopsy may be done during surgery to remove the tumor for early-stage vulvar cancer.

                    There are three ways that cancer spreads in the body.
                    Cancer can spread through tissue, the lymph system, and the blood:         - Tissue. The cancer spreads from where it began by growing into nearby areas.     - Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.     - Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

                    Cancer may spread from where it began to other parts of the body.
                    When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.         - Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.    - Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.        The metastatic tumor is the same type of cancer as the primary tumor. For example, if vulvar cancer spreads to the lung, the cancer cells in the lung are actually vulvar cancer cells. The disease is metastatic vulvar cancer, not lung cancer.

                    In vulvar intraepithelial neoplasia (VIN), abnormal cells are found on the surface of the vulvar skin.
                    These abnormal cells are not cancer. Vulvar intraepithelial neoplasia (VIN) may become cancer and spread into nearby tissue. VIN is sometimes called stage 0 or carcinoma in situ.

                    The following stages are used for vulvar cancer:
                    Stage I    In stage I, cancer has formed. The tumor is found only in the vulva or perineum (area between the rectum and the vagina). Stage I is divided into stages IA and IB.               - In stage IA, the tumor is 2 centimeters or smaller and has spread 1 millimeter or less into the tissue of the vulva. Cancer has not spread to the lymph nodes.     - In stage IB, the tumor is larger than 2 centimeters or has spread more than 1 millimeter into the tissue of the vulva. Cancer has not spread to the lymph nodes.              Stage II    In stage II, the tumor is any size and has spread into the lower part of the urethra, the lower part of the vagina, or the anus. Cancer has not spread to the lymph nodes.       Stage III    In stage III, the tumor is any size and may have spread into the lower part of the urethra, the lower part of the vagina, or the anus. Cancer has spread to one or more nearby lymph nodes. Stage III is divided into stages IIIA, IIIB, and IIIC.            - In stage IIIA, cancer is found in 1 or 2 lymph nodes that are smaller than 5 millimeters or in one lymph node that is 5 millimeters or larger.     - In stage IIIB, cancer is found in 2 or more lymph nodes that are 5 millimeters or larger, or in 3 or more lymph nodes that are smaller than 5 millimeters.     - In stage IIIC, cancer is found in lymph nodes and has spread to the outside surface of the lymph nodes.              Stage IV    In stage IV, the tumor has spread into the upper part of the urethra, the upper part of the vagina, or to other parts of the body. Stage IV is divided into stages IVA and IVB.             - In stage IVA:                  -  cancer has spread into the lining of the upper urethra, the upper vagina, the bladder, or the rectum, or has attached to the pelvic bone; or       - cancer has spread to nearby lymph nodes and the lymph nodes are not moveable or have formed an ulcer.                 - In stage IVB, cancer has spread to lymph nodes in the pelvis or to other parts of the body. </s>


Input: what research (or clinical trials) is being done for Vulvar Cancer ?

Output:
New types of treatment are being tested in clinical trials.
                    Information about clinical trials is available from the NCI website.

                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. </s>


Input: What are the treatments for Vulvar Cancer ?

Output:
Key Points
                    - There are different types of treatment for patients with vulvar cancer.    - Four types of standard treatment are used:         - Surgery     - Radiation therapy     - Chemotherapy     - Biologic therapy        - New types of treatment are being tested in clinical trials.     - Patients may want to think about taking part in a clinical trial.    - Patients can enter clinical trials before, during, or after starting their cancer treatment.    - Follow-up tests may be needed.

                    There are different types of treatment for patients with vulvar cancer.
                    Different types of treatments are available for patients with vulvar cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

                    Four types of standard treatment are used:
                    Surgery     Surgery is the most common treatment for vulvar cancer. The goal of surgery is to remove all the cancer without any loss of the woman's sexual function. One of the following types of surgery may be done:            -  Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.     -  Wide local excision: A surgical procedure to remove the cancer and some of the normal tissue around the cancer.     -  Radical local excision: A surgical procedure to remove the cancer and a large amount of normal tissue around it. Nearby lymph nodes in the groin may also be removed.      - Ultrasound surgical aspiration (USA): A surgical procedure to break the tumor up into small pieces using very fine vibrations. The small pieces of tumor are washed away and removed by suction. This procedure causes less damage to nearby tissue.     - Vulvectomy: A surgical procedure to remove part or all of the vulva:                  -  Skinning vulvectomy: The top layer of vulvar skin where the cancer is found is removed. Skin grafts from other parts of the body may be needed to cover the area where the skin was removed.       -  Modified radical vulvectomy: Surgery to remove part of the vulva. Nearby lymph nodes may also be removed.       -  Radical vulvectomy: Surgery to remove the entire vulva. Nearby lymph nodes are also removed.                -  Pelvic exenteration: A surgical procedure to remove the lower colon, rectum, and bladder. The cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.           Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may have chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.       Radiation therapy     Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:            -  External radiation therapy uses a machine outside the body to send radiation toward the cancer.     -  Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.           The way the radiation therapy is given depends on the type and stage of the cancer being treated. External and internal radiation therapy are used to treat vulvar cancer, and external radiation therapy may also be used as palliative therapy to relieve symptoms and improve quality of life.       Chemotherapy    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, a body cavity such as the abdomen, or onto the skin, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.     Topical chemotherapy for vulvar cancer may be applied to the skin in a cream or lotion.     See Drugs Approved to Treat Vulvar Cancer for more information.       Biologic therapy     Biologic therapy is a treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.      Imiquimod is a biologic therapy that may be used to treat vulvar lesions and is applied to the skin in a cream.

                    New types of treatment are being tested in clinical trials.
                    Information about clinical trials is available from the NCI website.

                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

                    Follow-up tests may be needed.
                    Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.   Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.   It is important to have regular follow-up exams to check for recurrent vulvar cancer.

            							Treatment Options by Stage
                    Vulvar Intraepithelial Neoplasia (VIN): Treatment of vulvar intraepithelial neoplasia (VIN) may include the following:         - Removal of single lesions or wide local excision.    -  Laser surgery.    - Ultrasound surgical aspiration.    -  Skinning vulvectomy with or without a skin graft.    -  Biologic therapy with topical imiquimod.
                    - Stage I Vulvar Cancer: Treatment of stage I vulvar cancer may include the following:         -  Wide local excision for lesions that are less than 1 millimeter deep..    -  Radical local excision and removal of nearby lymph nodes.    - Radical local excision and sentinel lymph node biopsy. If cancer is found in the sentinel lymph node, nearby lymph nodes are also removed.    -  Radiation therapy for patients who cannot have surgery.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage I vulvar cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
                    - Stage II Vulvar Cancer: Treatment of stage II vulvar cancer may include the following:         -  Radical local excision and removal of nearby lymph nodes.    -  Modified radical vulvectomy or radical vulvectomy for large tumors. Nearby lymph nodes may be removed. Radiation therapy may be given after surgery.    - Radical local excision and sentinel lymph node biopsy. If cancer is found in the sentinel lymph node, nearby lymph nodes are also removed.    - Radiation therapy for patients who cannot have surgery.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage II vulvar cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
                    - Stage III Vulvar Cancer: Treatment of stage III vulvar cancer may include the following:         -  Modified radical vulvectomy or radical vulvectomy. Nearby lymph nodes may be removed. Radiation therapy may be given after surgery.    - Radiation therapy or chemotherapy and radiation therapy followed by surgery.    - Radiation therapy with or without chemotherapy for patients who cannot have surgery.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage III vulvar cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
                    - Stage IV Vulvar Cancer: Treatment of stage IVA vulvar cancer may include the following:         -  Radical vulvectomy and pelvic exenteration.    - Radical vulvectomy followed by radiation therapy.    - Radiation therapy or chemotherapy and radiation therapy followed by surgery.    - Radiation therapy with or without chemotherapy for patients who cannot have surgery.        There is no standard treatment for stage IVB vulvar cancer. Treatment may include a clinical trial of a new treatment.   Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage IVB vulvar cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.

								            Treatment Options for Recurrent Vulvar Cancer
								            Treatment of recurrent vulvar cancer may include the following:  - Wide local excision with or without radiation therapy to treat cancer that has come back in the same area.
								  -  Radical vulvectomy and pelvic exenteration to treat cancer that has come back in the same area.
								  -  Chemotherapy and radiation therapy with or without surgery.
								  -  Radiation therapy followed by surgery or chemotherapy.
								  -  Radiation therapy as palliative treatment to relieve symptoms and improve quality of life.
								  -  A clinical trial of a new treatment.
								Check the list of NCI-supported cancer clinical trials that are now accepting patients with recurrent vulvar cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. </s>


Input: What is (are) Rectal Cancer ?

Output:
Key Points
                    - Rectal cancer is a disease in which malignant (cancer) cells form in the tissues of the rectum.     - Health history affects the risk of developing rectal cancer.    - Signs of rectal cancer include a change in bowel habits or blood in the stool.    - Tests that examine the rectum and colon are used to detect (find) and diagnose rectal cancer.    - Certain factors affect prognosis (chance of recovery) and treatment options.

                    Rectal cancer is a disease in which malignant (cancer) cells form in the tissues of the rectum.
                    The rectum is part of the bodys digestive system. The digestive system takes in nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The colon (large bowel) is the first part of the large intestine and is about 5 feet long. Together, the rectum and anal canal make up the last part of the large intestine and are 6-8 inches long. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).     See the following PDQ summaries for more information about rectal cancer:         -  Unusual Cancers of Childhood Treatment (see Colorectal Cancer section)    -  Colorectal Cancer Prevention     -   Colorectal Cancer Screening    -  Gastrointestinal Stromal Tumors Treatment     -  Genetics of Colorectal Cancer </s>


Input: Who is at risk for Rectal Cancer? ?

Output: Health history affects the risk of developing rectal cancer. Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesnt mean that you will not get cancer. Talk to your doctor if you think you may be at risk for colorectal cancer.    Risk factors for colorectal cancer include the following:            - Having a family history of colon or rectal cancer in a first-degree relative (parent, sibling, or child).     - Having a personal history of cancer of the colon, rectum, or ovary.     - Having a personal history of high-risk adenomas (colorectal polyps that are 1 centimeter or larger in size or that have cells that look abnormal under a microscope).     - Having inherited changes in certain genes that increase the risk of familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary nonpolyposis colorectal cancer).     - Having a personal history of chronic ulcerative colitis or Crohn disease for 8 years or more.     - Having three or more alcoholic drinks per day.     - Smoking cigarettes.     - Being black.     - Being obese.           Older age is a main risk factor for most cancers. The chance of getting cancer increases as you get older. </s>


Input: What are the symptoms of Rectal Cancer ?

Output: Signs of rectal cancer include a change in bowel habits or blood in the stool. These and other signs and symptoms may be caused by rectal cancer or by other conditions. Check with your doctor if you have any of the following:         -  Blood (either bright red or very dark) in the stool.    - A change in bowel habits.               -  Diarrhea.       -  Constipation.      - Feeling that the bowel does not empty completely.      - Stools that are narrower or have a different shape than usual.             - General abdominal discomfort (frequent gas pains, bloating, fullness, or cramps).    - Change in appetite.    - Weight loss for no known reason.    - Feeling very tired. </s>


Input: How to diagnose Rectal Cancer ?

Output: Tests that examine the rectum and colon are used to detect (find) and diagnose rectal cancer. Tests used to diagnose rectal cancer include the following:         -   Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken.    -   Digital rectal exam (DRE): An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual. In women, the vagina may also be examined.    -   Colonoscopy : A procedure to look inside the rectum and colon for polyps (small pieces of bulging tissue), abnormal areas, or cancer. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.    -   Biopsy : The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. Tumor tissue that is removed during the biopsy may be checked to see if the patient is likely to have the gene mutation that causes HNPCC. This may help to plan treatment. The following tests may be used:               -  Reverse transcriptionpolymerase chain reaction (RTPCR) test: A laboratory test in which cells in a sample of tissue are studied using chemicals to look for certain changes in the structure or function of genes.      -  Immunohistochemistry : A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer.             -   Carcinoembryonic antigen (CEA) assay : A test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of rectal cancer or other conditions. </s>


Input: What is the outlook for Rectal Cancer ?

Output: Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following:         - The stage of the cancer (whether it affects the inner lining of the rectum only, involves the whole rectum, or has spread to lymph nodes, nearby organs, or other places in the body).    - Whether the tumor has spread into or through the bowel wall.    - Where the cancer is found in the rectum.    - Whether the bowel is blocked or has a hole in it.    - Whether all of the tumor can be removed by surgery.    -  The patients general health.     - Whether the cancer has just been diagnosed or has recurred (come back). </s>


Input: What are the stages of Rectal Cancer ?

Output:
Key Points
                    -  After rectal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the rectum or to other parts of the body.    - There are three ways that cancer spreads in the body.    - Cancer may spread from where it began to other parts of the body.     - The following stages are used for rectal cancer:         - Stage 0 (Carcinoma in Situ)      - Stage I      - Stage II     - Stage III     - Stage IV

                    After rectal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the rectum or to other parts of the body.
                    The process used to find out whether cancer has spread within the rectum or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.   The following tests and procedures may be used in the staging process:         -   Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.    -   Colonoscopy : A procedure to look inside the rectum and colon for polyps (small pieces of bulging tissue). abnormal areas, or cancer. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.    -   CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen, pelvis, or chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.    -   MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).    -   PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.     -   Endorectal ultrasound : A procedure used to examine the rectum and nearby organs. An ultrasound transducer (probe) is inserted into the rectum and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The doctor can identify tumors by looking at the sonogram. This procedure is also called transrectal ultrasound.

                    There are three ways that cancer spreads in the body.
                    Cancer can spread through tissue, the lymph system, and the blood:         - Tissue. The cancer spreads from where it began by growing into nearby areas.     - Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.     - Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

                    Cancer may spread from where it began to other parts of the body.
                    When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.         - Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.    - Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.        The metastatic tumor is the same type of cancer as the primary tumor. For example, if rectal cancer spreads to the lung, the cancer cells in the lung are actually rectal cancer cells. The disease is metastatic rectal cancer, not lung cancer.

                    The following stages are used for rectal cancer:
                    Stage 0 (Carcinoma in Situ)      In stage 0, abnormal cells are found in the mucosa (innermost layer) of the rectum wall. These abnormal cells may become cancer and spread. Stage 0 is also called carcinoma in situ.       Stage I      In stage I, cancer has formed in the mucosa (innermost layer) of the rectum wall and has spread to the submucosa (layer of tissue under the mucosa). Cancer may have spread to the muscle layer of the rectum wall.        Stage II      Stage II rectal cancer is divided into stage IIA, stage IIB, and stage IIC.            - Stage IIA: Cancer has spread through the muscle layer of the rectum wall to the serosa (outermost layer) of the rectum wall.      - Stage IIB: Cancer has spread through the serosa (outermost layer) of the rectum wall but has not spread to nearby organs.      - Stage IIC: Cancer has spread through the serosa (outermost layer) of the rectum wall to nearby organs.               Stage III     Stage III rectal cancer is divided into stage IIIA, stage IIIB, and stage IIIC.     In stage IIIA:            -  Cancer has spread through the mucosa (innermost layer) of the rectum wall to the submucosa (layer of tissue under the mucosa) and may have spread to the muscle layer of the rectum wall. Cancer has spread to at least one but not more than 3 nearby lymph nodes or cancer cells have formed in tissues near the lymph nodes; or     - Cancer has spread through the mucosa (innermost layer) of the rectum wall to the submucosa (layer of tissue under the mucosa). Cancer has spread to at least 4 but not more than 6 nearby lymph nodes.             In stage IIIB:            - Cancer has spread through the muscle layer of the rectum wall to the serosa (outermost layer) of the rectum wall or has spread through the serosa but not to nearby organs. Cancer has spread to at least one but not more than 3 nearby lymph nodes or cancer cells have formed in tissues near the lymph nodes; or      - Cancer has spread to the muscle layer of the rectum wall or to the serosa (outermost layer) of the rectum wall. Cancer has spread to at least 4 but not more than 6 nearby lymph nodes; or      - Cancer has spread through the mucosa (innermost layer) of the rectum wall to the submucosa (layer of tissue under the mucosa) and may have spread to the muscle layer of the rectum wall. Cancer has spread to 7 or more nearby lymph nodes.            In stage IIIC:            - Cancer has spread through the serosa (outermost layer) of the rectum wall but has not spread to nearby organs. Cancer has spread to at least 4 but not more than 6 nearby lymph nodes; or     - Cancer has spread through the muscle layer of the rectum wall to the serosa (outermost layer) of the rectum wall or has spread through the serosa but has not spread to nearby organs. Cancer has spread to 7 or more nearby lymph nodes; or      - Cancer has spread through the serosa (outermost layer) of the rectum wall and has spread to nearby organs. Cancer has spread to one or more nearby lymph nodes or cancer cells have formed in tissues near the lymph nodes.              Stage IV     Stage IV rectal cancer is divided into stage IVA and stage IVB.             - Stage IVA: Cancer may have spread through the rectum wall and may have spread to nearby organs or lymph nodes. Cancer has spread to one organ that is not near the rectum, such as the liver, lung, or ovary, or to a distant lymph node.      - Stage IVB: Cancer may have spread through the rectum wall and may have spread to nearby organs or lymph nodes. Cancer has spread to more than one organ that is not near the rectum or into the lining of the abdominal wall. </s>