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<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Prostate Cancer ? [/INST] Tests that examine the prostate and blood are used to detect (find) and diagnose prostate 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 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 rectum and feels the prostate through the rectal wall for lumps or abnormal areas. Prostatespecific antigen (PSA) test : A test that measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate or BPH (an enlarged, but noncancerous, prostate). Transrectal ultrasound : A procedure in which a probe that is about the size of a finger is inserted into the rectum to check the prostate. The probe is used to bounce highenergy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. Transrectal ultrasound may be used during a biopsy procedure. Transrectal magnetic resonance imaging (MRI): A procedure that uses a strong magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A probe that gives off radio waves is inserted into the rectum near the prostate. This helps the MRI machine make clearer pictures of the prostate and nearby tissue. A transrectal MRI is done to find out if the cancer has spread outside the prostate into nearby tissues. 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. The pathologist will check the tissue sample to see if there are cancer cells and find out the Gleason score. The Gleason score ranges from 210 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is to spread. A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure is usually done using transrectal ultrasound to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Prostate Cancer ? [/INST] 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 (level of PSA, Gleason score, grade of the tumor, how much of the prostate is affected by the cancer, and whether the cancer has spread to other places in the body). The patients age. Whether the cancer has just been diagnosed or has recurred (come back). Treatment options also may depend on the following: Whether the patient has other health problems. The expected side effects of treatment. Past treatment for prostate cancer. The wishes of the patient. Most men diagnosed with prostate cancer do not die of it.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Prostate Cancer ? [/INST] After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate 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 prostate cancer: Stage I Stage II Stage III Stage IV After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body. The process used to find out if cancer has spread within the prostate 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 results of the tests used to diagnose prostate cancer are often also used to stage the disease. (See the General Information section.) In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score. The following tests and procedures also may be used in the staging process: Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner. 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). 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 xray 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. Pelvic lymphadenectomy : A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells. Seminal vesicle biopsy : The removal of fluid from the seminal vesicles (glands that make semen) using a needle. A pathologist views the fluid under a microscope to look for cancer cells. ProstaScint scan : A procedure to check for cancer that has spread from the prostate to other parts of the body, such as the lymph nodes. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material attaches to prostate cancer cells and is detected by a scanner. The radioactive material shows up as a bright spot on the picture in areas where there are a lot of prostate cancer cells. The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostatespecific antigen (PSA) test and the Gleason score. The tissue samples removed during the biopsy are used to find out the Gleason score. The Gleason score ranges from 210 and describes how different the cancer cells look from normal cells and how likely it is that the tumor will spread. The lower the number, the less likely the tumor is to spread. 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 prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. Denosumab, a monoclonal antibody, may be used to prevent bone metastases. The following stages are used for prostate cancer: Stage I In stage I, cancer is found in the prostate only. The cancer: is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 10 and the Gleason score is 6 or lower; or is found in onehalf or less of one lobe of the prostate. The PSA level is lower than 10 and the Gleason score is 6 or lower; or cannot be felt during a digital rectal exam and cannot be seen in imaging tests. Cancer is found in onehalf or less of one lobe of the prostate. The PSA level and the Gleason score are not known. Stage II In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. Stage II is divided into stages IIA and IIB. In stage IIA, cancer: is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 20 and the Gleason score is 7; or is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is at least 10 but lower than 20 and the Gleason score is 6 or lower; or is found in onehalf or less of one lobe of the prostate. The PSA level is at least 10 but lower than 20 and the Gleason score is 6 or lower; or is found in onehalf or less of one lobe of the prostate. The PSA level is lower than 20 and the Gleason score is 7; or is found in more than onehalf of one lobe of the prostate. In stage IIB, cancer: is found in opposite sides of the prostate. The PSA can be any level and the Gleason score can range from 2 to 10; or cannot be felt during a digital rectal exam and cannot be seen in imaging tests. The PSA level is 20 or higher and the Gleason score can range from 2 to 10; or cannot be felt during a digital rectal exam and cannot be seen in imaging tests. The PSA can be any level and the Gleason score is 8 or higher. Stage III In stage III, cancer has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles. The PSA can be any level and the Gleason score can range from 2 to 10. Stage IV In stage IV, the PSA can be any level and the Gleason score can range from 2 to 10. Also, cancer: has spread beyond the seminal vesicles to nearby tissue or organs, such as the rectum, bladder, or pelvic wall; or may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. Cancer has spread to nearby lymph nodes; or has spread to distant parts of the body, which may include lymph nodes or bones. Prostate cancer often spreads to the bones.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Prostate Cancer ? [/INST] There are different types of treatment for patients with prostate cancer. Seven types of standard treatment are used: Watchful waiting or active surveillance Surgery Radiation therapy and radiopharmaceutical therapy Hormone therapy Chemotherapy Biologic therapy Bisphosphonate therapy There are treatments for bone pain caused by bone metastases or hormone therapy. New types of treatment are being tested in clinical trials. Cryosurgery Highintensityfocused ultrasound therapy Proton beam radiation therapy 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. Followup tests may be needed. There are different types of treatment for patients with prostate cancer. Different types of treatment are available for patients with prostate 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. Seven types of standard treatment are used: Watchful waiting or active surveillance Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test. Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life. Active surveillance is closely following a patient's condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer. Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management. Surgery Patients in good health whose tumor is in the prostate gland only may be treated with surgery to remove the tumor. The following types of surgery are used: Radical prostatectomy: A surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. There are two types of radical prostatectomy: Retropubic prostatectomy: A surgical procedure to remove the prostate through an incision (cut) in the abdominal wall. Removal of nearby lymph nodes may be done at the same time. Perineal prostatectomy: A surgical procedure to remove the prostate through an incision (cut) made in the perineum (area between the scrotum and anus). Nearby lymph nodes may also be removed through a separate incision in the abdomen. Pelvic lymphadenectomy: A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment. Transurethral resection of the prostate (TURP): A surgical procedure to remove tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra. This procedure is done to treat benign prostatic hypertrophy and it is sometimes done to relieve symptoms caused by a tumor before other cancer treatment is given. TURP may also be done in men whose tumor is in the prostate only and who cannot have a radical prostatectomy. In some cases, nervesparing surgery can be done. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery. Possible problems after prostate cancer surgery include the following: Impotence. Leakage of urine from the bladder or stool from the rectum. Shortening of the penis (1 to 2 centimeters). The exact reason for this is not known. Inguinal hernia (bulging of fat or part of the small intestine through weak muscles into the groin). Inguinal hernia may occur more often in men treated with radical prostatectomy than in men who have some other types of prostate surgery, radiation therapy, or prostate biopsy alone. It is most likely to occur within the first 2 years after radical prostatectomy. Radiation therapy and radiopharmaceutical therapy Radiation therapy is a cancer treatment that uses highenergy xrays or other types of radiation to kill cancer cells or keep them from growing. There are different types of radiation therapy: External radiation therapy uses a machine outside the body to send radiation toward the cancer. Conformal radiation is a type of external radiation therapy that uses a computer to make a 3dimensional (3D) picture of the tumor and shapes the radiation beams to fit the tumor. This allows a high dose of radiation to reach the tumor and causes less damage to nearby healthy tissue. Hypofractionated radiation therapy may be given because it has a more convenient treatment schedule. Hypofractionated radiation therapy is radiation treatment in which a larger than usual total dose of radiation is given once a day over a shorter period of time (fewer days) compared to standard radiation therapy. Hypofractionated radiation therapy may have worse side effects than standard radiation therapy, depending on the schedules used. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. In earlystage prostate cancer, the radioactive seeds are placed in the prostate using needles that are inserted through the skin between the scrotum and rectum. The placement of the radioactive seeds in the prostate is guided by images from transrectal ultrasound or computed tomography (CT). The needles are removed after the radioactive seeds are placed in the prostate. Radiopharmaceutical therapy uses a radioactive substance to treat cancer. Radiopharmaceutical therapy includes the following: Alpha emitter radiation therapy uses a radioactive substance to treat prostate cancer that has spread to the bone. A radioactive substance called radium223 is injected into a vein and travels through the bloodstream. The radium223 collects in areas of bone with cancer and kills the cancer cells. The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy, internal radiation therapy, and radiopharmaceutical therapy are used to treat prostate cancer. Men treated with radiation therapy for prostate cancer have an increased risk of having bladder and/or gastrointestinal cancer. Radiation therapy can cause impotence and urinary problems. Hormone therapy Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. In prostate cancer, male sex hormones can cause prostate cancer to grow. Drugs, surgery, or other hormones are used to reduce the amount of male hormones or block them from working. Hormone therapy for prostate cancer may include the following: Luteinizing hormonereleasing hormone agonists can stop the testicles from making testosterone. Examples are leuprolide, goserelin, and buserelin. Antiandrogens can block the action of androgens (hormones that promote male sex characteristics), such as testosterone. Examples are flutamide, bicalutamide, enzalutamide, and nilutamide. Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide. Orchiectomy is a surgical procedure to remove one or both testicles, the main source of male hormones, such as testosterone, to decrease the amount of hormone being made. Estrogens (hormones that promote female sex characteristics) can prevent the testicles from making testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects. Hot flashes, impaired sexual function, loss of desire for sex, and weakened bones may occur in men treated with hormone therapy. Other side effects include diarrhea, nausea, and itching. See Drugs Approved for Prostate Cancer for more information. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer 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 cancer 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 cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. See Drugs Approved for Prostate 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. SipuleucelT is a type of biologic therapy used to treat prostate cancer that has metastasized (spread to other parts of the body). See Drugs Approved for Prostate Cancer for more information. Bisphosphonate therapy Bisphosphonate drugs, such as clodronate or zoledronate, reduce bone disease when cancer has spread to the bone. Men who are treated with antiandrogen therapy or orchiectomy are at an increased risk of bone loss. In these men, bisphosphonate drugs lessen the risk of bone fracture (breaks). The use of bisphosphonate drugs to prevent or slow the growth of bone metastases is being studied in clinical trials. There are treatments for bone pain caused by bone metastases or hormone therapy. Prostate cancer that has spread to the bone and certain types of hormone therapy can weaken bones and lead to bone pain. Treatments for bone pain include the following: Pain medicine. External radiation therapy. Strontium89 (a radioisotope). Targeted therapy with a monoclonal antibody, such as denosumab. Bisphosphonate therapy. Corticosteroids. See the PDQ summary on Pain for more information. New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Cryosurgery Cryosurgery is a treatment that uses an instrument to freeze and destroy prostate cancer cells. Ultrasound is used to find the area that will be treated. This type of treatment is also called cryotherapy. Cryosurgery can cause impotence and leakage of urine from the bladder or stool from the rectum. Highintensityfocused ultrasound therapy Highintensityfocused ultrasound therapy is a treatment that uses ultrasound (highenergy sound waves) to destroy cancer cells. To treat prostate cancer, an endorectal probe is used to make the sound waves. Proton beam radiation therapy Proton beam radiation therapy is a type of highenergy, external radiation therapy that targets tumors with streams of protons (small, positively charged particles). This type of radiation therapy is being studied in the treatment of prostate cancer. 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. Followup 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 followup tests or checkups. Treatment Options by Stage Stage I Prostate Cancer Standard treatment of stage I prostate cancer may include the following: Watchful waiting. Active surveillance. If the cancer begins to grow, hormone therapy may be given. Radical prostatectomy, usually with pelvic lymphadenectomy. Radiation therapy may be given after surgery. External radiation therapy. Hormone therapy may be given after radiation therapy. Internal radiation therapy with radioactive seeds. A clinical trial of highintensityfocused ultrasound therapy. A clinical trial of cryosurgery. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage I prostate 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 Prostate Cancer Standard treatment of stage II prostate cancer may include the following: Watchful waiting. Active surveillance. If the cancer begins to grow, hormone therapy may be given. Radical prostatectomy, usually with pelvic lymphadenectomy. Radiation therapy may be given after surgery. External radiation therapy. Hormone therapy may be given after radiation therapy. Internal radiation therapy with radioactive seeds. A clinical trial of cryosurgery. A clinical trial of highintensityfocused ultrasound therapy. A clinical trial of proton beam radiation therapy. Clinical trials of new types of treatment, such as hormone therapy followed by radical prostatectomy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage II prostate 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 Prostate Cancer Standard treatment of stage III prostate cancer may include the following: External radiation therapy. Hormone therapy may be given after radiation therapy. Hormone therapy. Radical prostatectomy. Radiation therapy may be given after surgery. Watchful waiting. Active surveillance. If the cancer begins to grow, hormone therapy may be given. Treatment to control cancer that is in the prostate and lessen urinary symptoms may include the following: External radiation therapy. Internal radiation therapy with radioactive seeds. Hormone therapy. Transurethral resection of the prostate (TURP). A clinical trial of new types of radiation therapy. A clinical trial of cryosurgery. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage III prostate 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 Prostate Cancer Standard treatment of stage IV prostate cancer may include the following: Hormone therapy. Hormone therapy combined with chemotherapy. Bisphosphonate therapy. External radiation therapy. Hormone therapy may be given after radiation therapy. Alpha emitter radiation therapy. Watchful waiting. Active surveillance. If the cancer begins to grow, hormone therapy may be given. A clinical trial of radical prostatectomy with orchiectomy. Treatment to control cancer that is in the prostate and lessen urinary symptoms may include the following: Transurethral resection of the prostate (TURP). Radiation therapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage IV prostate 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Prostate Cancer ? [/INST] New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Cryosurgery Cryosurgery is a treatment that uses an instrument to freeze and destroy prostate cancer cells. Ultrasound is used to find the area that will be treated. This type of treatment is also called cryotherapy. Cryosurgery can cause impotence and leakage of urine from the bladder or stool from the rectum. Highintensityfocused ultrasound therapy Highintensityfocused ultrasound therapy is a treatment that uses ultrasound (highenergy sound waves) to destroy cancer cells. To treat prostate cancer, an endorectal probe is used to make the sound waves. Proton beam radiation therapy Proton beam radiation therapy is a type of highenergy, external radiation therapy that targets tumors with streams of protons (small, positively charged particles). This type of radiation therapy is being studied in the treatment of prostate cancer. 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Childhood Extracranial Germ Cell Tumors ? [/INST] Childhood extracranial germ cell tumors form from germ cells in parts of the body other than the brain. Childhood extracranial germ cell tumors may be benign or malignant. There are three types of extracranial germ cell tumors. Mature Teratomas Immature Teratomas Malignant Germ Cell Tumors Childhood extracranial germ cell tumors are grouped as gonadal or extragonadal. Gonadal Germ Cell Tumors Extragonadal Extracranial Germ Cell Tumors The cause of most childhood extracranial germ cell tumors is unknown. Having certain inherited disorders can increase the risk of an extracranial germ cell tumor. Signs of childhood extracranial germ cell tumors depend on the type of tumor and where it is in the body. Imaging studies and blood tests are used to detect (find) and diagnose childhood extracranial germ cell tumors. Certain factors affect prognosis (chance of recovery) and treatment options. Childhood extracranial germ cell tumors form from germ cells in parts of the body other than the brain. A germ cell is a type of cell that forms as a fetus (unborn baby) develops. These cells later become sperm in the testicles or eggs in the ovaries. Sometimes while the fetus is forming, germ cells travel to parts of the body where they should not be and grow into a germ cell tumor. The tumor may form before or after birth. This summary is about germ cell tumors that form in parts of the body that are extracranial (outside the brain). Extracranial germ cell tumors usually form in the following areas of the body: Testicles. Ovaries. Sacrum or coccyx (bottom part of the spine). Retroperitoneum (the back wall of the abdomen). Mediastinum (area between the lungs). Extracranial germ cell tumors are most common in adolescents 15 to 19 years of age. See the PDQ summary on Childhood Central Nervous System Germ Cell Tumors Treatment for information on intracranial (inside the brain) germ cell tumors. Childhood extracranial germ cell tumors may be benign or malignant. Extracranial germ cell tumors may be benign (noncancer) or malignant (cancer). There are three types of extracranial germ cell tumors. Extracranial germ cell tumors are grouped into mature teratomas, immature teratomas, and malignant germ cell tumors: Mature Teratomas Mature teratomas are the most common type of extracranial germ cell tumor. Mature teratomas are benign tumors and not likely to become cancer. They usually occur in the sacrum or coccyx (bottom part of the spine) in newborns or in the ovaries of girls at the start of puberty. The cells of mature teratomas look almost like normal cells under a microscope. Some mature teratomas release enzymes or hormones that cause signs and symptoms of disease. Immature Teratomas Immature teratomas also usually occur in the sacrum or coccyx (bottom part of the spine) in newborns or the ovaries of girls at the start of puberty. Immature teratomas have cells that look very different from normal cells under a microscope. Immature teratomas may be cancer. They often have several different types of tissue in them, such as hair, muscle, and bone. Some immature teratomas release enzymes or hormones that cause signs and symptoms of disease. Malignant Germ Cell Tumors Malignant germ cell tumors are cancer. There are two main types of malignant germ cell tumors: Germinomas: Tumors that make a hormone called betahuman chorionic gonadotropin (hCG). There are three types of germinomas. Dysgerminomas form in the ovary in girls. Seminomas form in the testicle in boys. Germinomas form in areas of the body that are not the ovary or testicle. Nongerminomas: There are four types of nongerminomas. Yolk sac tumors make a hormone called alphafetoprotein (AFP). They can form in the ovary, testicle, or other areas of the body. Choriocarcinomas make a hormone called betahuman chorionic gonadotropin (hCG). They can form in the ovary, testicle, or other areas of the body. Embryonal carcinomas may make a hormone called hCG and/or a hormone called AFP. They can form in the testicle or other parts of the body, but not in the ovary. Mixed germ cell tumors are made up of both malignant germ cell tumor and teratoma. They can form in the ovary, testicle, or other areas of the body. Childhood extracranial germ cell tumors are grouped as gonadal or extragonadal. Malignant extracranial germ cell tumors are gonadal or extragonadal. Gonadal Germ Cell Tumors Gonadal germ cell tumors form in the testicles in boys or ovaries in girls. Testicular Germ Cell Tumors Testicular germ cell tumors are divided into two main types, seminoma and nonseminoma. Seminomas make a hormone called betahuman chorionic gonadotropin (hCG). Nonseminomas are usually large and cause signs or symptoms. They tend to grow and spread more quickly than seminomas. Testicular germ cell tumors usually occur before the age of 4 years or in adolescents and young adults. Testicular germ cell tumors in adolescents and young adults are different from those that form in early childhood. Boys older than 14 years with testicular germ cell tumors are treated in pediatric cancer centers, but the treatment is much like the treatment used in adults. (See the PDQ summary on Testicular Cancer Treatment for more information.) Ovarian Germ Cell Tumors Ovarian germ cell tumors are more common in adolescent girls and young women. Most ovarian germ cell tumors are benign teratomas. Sometimes immature teratomas, dysgerminomas, yolk sac tumors, and mixed germ cell tumors (cancer) occur. (See the PDQ summary on Ovarian Germ Cell Tumors Treatment for more information.) Extragonadal Extracranial Germ Cell Tumors Extragonadal extracranial germ cell tumors form in areas other than the brain, testicles, or ovaries. Most extragonadal extracranial germ cell tumors form along the midline of the body. This includes the following: Sacrum (the large, triangleshaped bone in the lower spine that forms part of the pelvis). Coccyx (the small bone at the bottom of the spine, also called the tailbone). Mediastinum (the area between the lungs). Back of the abdomen. Neck. In younger children, extragonadal extracranial germ cell tumors usually occur at birth or in early childhood. Most of these tumors are teratomas in the sacrum or coccyx. In older children, adolescents, and young adults, extragonadal extracranial germ cell tumors are often in the mediastinum.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What causes Childhood Extracranial Germ Cell Tumors ? [/INST] The cause of most childhood extracranial germ cell tumors is unknown.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Childhood Extracranial Germ Cell Tumors? ? [/INST] Having certain inherited disorders can increase the risk of an extracranial germ cell tumor. 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 doesnt mean that you will not get cancer. Talk with your childs doctor if you think your child may be at risk. Possible risk factors for extracranial germ cell tumors include the following: Having certain genetic syndromes: Klinefelter syndrome may increase the risk of germ cell tumors in the mediastinum. Swyer syndrome may increase the risk of germ cell tumors in the testicles or ovaries. Turner syndrome may increase the risk of germ cell tumors in the ovaries. Having an undescended testicle may increase the risk of developing a testicular germ cell tumor.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Childhood Extracranial Germ Cell Tumors ? [/INST] Signs of childhood extracranial germ cell tumors depend on the type of tumor and where it is in the body. Different tumors may cause the following signs and symptoms. Other conditions may cause these same signs and symptoms. Check with a doctor if your child has any of the following: A lump in the abdomen or lower back. A painless lump in the testicle. Pain in the abdomen. Fever. Constipation. In females, no menstrual periods. In females, unusual vaginal bleeding.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Childhood Extracranial Germ Cell Tumors ? [/INST] Imaging studies and blood tests are used to detect (find) and diagnose childhood extracranial germ cell 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 or anything else that seems unusual. The testicles may be checked for lumps, swelling, or pain. A history of the patient's health habits and past illnesses and treatments will also be taken. Serum tumor marker test : A procedure in which a sample of blood is checked to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. Most malignant germ cell tumors release tumor markers. The following tumor markers are used to detect extracranial germ cell tumors: Alphafetoprotein (AFP). Betahuman chorionic gonadotropin (hCG). For testicular germ cell tumors, blood levels of the tumor markers help show if the tumor is a seminoma or nonseminoma. Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. Chest xray : An xray of the organs and bones inside the chest. An xray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. 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 xray 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). Ultrasound exam: A procedure in which highenergy 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. Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. In some cases, the tumor is removed during surgery and then a biopsy is done. The following tests may be done on the sample of tissue that is removed: Cytogenetic analysis : A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes. 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.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Childhood Extracranial Germ Cell Tumors ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: The type of germ cell tumor. Where the tumor first began to grow. The stage of the cancer (whether it has spread to nearby areas or to other places in the body). How well the tumor responds to treatment (lower AFP and hCG levels). Whether the tumor can be completely removed by surgery. The patient's age and general health. Whether the cancer has just been diagnosed or has recurred (come back). The prognosis for childhood extracranial germ cell tumors, especially ovarian germ cell tumors, is good.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Childhood Extracranial Germ Cell Tumors ? [/INST] After a childhood extracranial germ cell tumor has been diagnosed, tests are done to find out if cancer cells have spread from where the tumor started to nearby areas 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. Stages are used to describe the different types of extracranial germ cell tumors. Childhood nonseminoma testicular germ cell tumors Childhood ovarian germ cell tumors Childhood extragonadal extracranial germ cell tumors After a childhood extracranial germ cell tumor has been diagnosed, tests are done to find out if cancer cells have spread from where the tumor started to nearby areas or to other parts of the body. The process used to find out if cancer has spread from where the tumor started 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. In some cases, staging may follow surgery to remove the tumor. The following procedures may be used: 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, such as the lymph nodes. This procedure is also called nuclear magnetic resonance imaging. CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest or lymph nodes, taken from different angles. The pictures are made by a computer linked to an xray 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. Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner. Thoracentesis : The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells. Paracentesis : The removal of fluid from the space between the lining of the abdomen and the organs in the abdomen, using a needle. A pathologist views the fluid under a microscope to look for cancer cells. The results from tests and procedures used to detect and diagnose childhood extracranial germ cell tumors may also be used in staging. 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 an extracranial germ cell tumor spreads to the liver, the cancer cells in the liver are actually cancerous germ cells. The disease is metastatic extracranial germ cell tumor, not liver cancer. Stages are used to describe the different types of extracranial germ cell tumors. Childhood nonseminoma testicular germ cell tumors Stage I: In stage I, the cancer is found in the testicle only and is completely removed by surgery. Stage II: In stage II, the cancer is removed by surgery and some cancer cells remain in the scrotum or cancer that can be seen with a microscope only has spread to the scrotum or spermatic cord. Tumor marker levels do not return to normal after surgery or the tumor marker levels increase. Stage III: In stage III, the cancer has spread to one or more lymph nodes in the abdomen and is not completely removed by surgery. The cancer that remains after surgery can be seen without a microscope. Stage IV: In stage IV, the cancer has spread to distant parts of the body such as the liver, brain, bone, or lung. Childhood ovarian germ cell tumors There are two types of stages used for childhood ovarian germ cell tumors. The following stages are from the Children's Oncology Group: Stage I: In stage I, the cancer is in the ovary and can be completely removed by surgery and the capsule (outer covering) of the ovary has not ruptured (broken open). Stage II: In stage II, one of the following is true: The cancer is not completely removed by surgery. The remaining cancer can be seen with a microscope only. The cancer has spread to the lymph nodes and can be seen with a microscope only. The cancer has spread to the capsule (outer covering) of the ovary. Stage III: In stage III, one of the following is true: The cancer is not completely removed by surgery. The remaining cancer can be seen without a microscope. The cancer has spread to lymph nodes and the lymph nodes are 2 centimeters or larger. Cancer in the lymph nodes can be seen without a microscope. The cancer is found in fluid in the abdomen. Stage IV: In stage IV, the cancer has spread to the lung, liver, brain, or bone. The following stages are from the International Federation of Gynecology and Obstetrics (FIGO): Stage I: In stage I, cancer is found in one or both of the ovaries and has not spread. Stage I is divided into stage IA, stage IB, and stage IC. Stage IA: Cancer is found in one ovary. Stage IB: Cancer is found in both ovaries. Stage IC: Cancer is found in one or both ovaries and one of the following is true: cancer is found on the outside surface of one or both ovaries; or the capsule (outer covering) of the tumor has ruptured (broken open); or cancer cells are found in fluid that has collected in the abdomen; or cancer cells are found in washings of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen). Stage II: In stage II, cancer is found in one or both ovaries and has spread into other areas of the pelvis. Stage II is divided into stage IIA, stage IIB, and stage IIC. Stage IIA: Cancer has spread to the uterus and/or the fallopian tubes (the long slender tubes through which eggs pass from the ovaries to the uterus). Stage IIB: Cancer has spread to other tissue within the pelvis such as the bladder, rectum, or vagina. Stage IIC: Cancer has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis and one of the following is true: cancer is found on the outside surface of one or both ovaries; or the capsule (outer covering) of the tumor has ruptured (broken open); or cancer cells are found in fluid that has collected in the abdomen; or cancer cells are found in washings of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen). Stage III: In stage III, cancer is found in one or both ovaries and has spread to other parts of the abdomen. Cancer that has spread to the surface of the liver is also stage III disease. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC: Stage IIIA: The tumor is found in the pelvis only, but cancer cells that can only be seen with a microscope have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen) or to the small bowel. Stage IIIB: Cancer has spread to the peritoneum and is 2 centimeters or smaller in diameter. Stage IIIC: Cancer has spread to the peritoneum and is larger than 2 centimeters in diameter and/or has spread to lymph nodes in the abdomen. Stage IV: In stage IV, cancer is found in one or both ovaries and has metastasized (spread) beyond the abdomen to other parts of the body. Cancer that has spread to tissues in the liver is also stage IV disease. Childhood extragonadal extracranial germ cell tumors Stage I: In stage I, the cancer is in one place and can be completely removed by surgery. For tumors in the sacrum or coccyx (bottom part of the spine), the sacrum and coccyx are completely removed by surgery. Tumor marker levels return to normal after surgery. Stage II: In stage II, the cancer has spread to the capsule (outer covering) and/or lymph nodes. The cancer is not completely removed by surgery and the cancer remaining after surgery can be seen with a microscope only. Tumor marker levels do not return to normal after surgery or increase. Stage III: In stage III, one of the following is true: The cancer is not completely removed by surgery. The cancer remaining after surgery can be seen without a microscope. The cancer has spread to lymph nodes and is larger than 2 centimeters in diameter. Stage IV: In stage IV, the cancer has spread to distant parts of the body, including the liver, brain, bone, or lung.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Childhood Extracranial Germ Cell Tumors ? [/INST] There are different types of treatment for children with extracranial germ cell tumors. Children with extracranial germ cell tumors should have their treatment planned by a team of health care providers who are experts in treating cancer in children. Some cancer treatments cause side effects months or years after treatment has ended. Three types of standard treatment are used: Surgery Observation Chemotherapy New types of treatment are being tested in clinical trials. Highdose chemotherapy with stem cell transplant Radiation therapy 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. Followup tests may be needed. There are different types of treatment for children with extracranial germ cell tumors. Different types of treatments are available for children with extracranial germ cell 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 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. Because cancer in children is 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 extracranial germ cell 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 health care providers who are experts in treating children with extracranial germ cell tumors and who specialize in certain areas of medicine. These may include the following specialists: Pediatrician. Pediatric surgeon. Pediatric hematologist. Radiation oncologist. Endocrinologist. Pediatric nurse specialist. Rehabilitation specialist. Child life professional. Psychologist. Social worker. Geneticist. Some cancer treatments cause side effects months or years after treatment has ended. Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following: Physical problems. Changes in mood, feelings, thinking, learning, or memory. Second cancers (new types of cancer). For example, late effects of surgery to remove tumors in the sacrum or coccyx include constipation, loss of bowel and bladder control, and scars. Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information). Three types of standard treatment are used: Surgery Surgery to completely remove the tumor is done whenever possible. If the tumor is very large, chemotherapy may be given first, to make the tumor smaller and decrease the amount of tissue that needs to be removed during surgery. A goal of surgery is to keep reproductive function. The following types of surgery may be used: Resection: Surgery to remove tissue or part or all of an organ. Radical inguinal orchiectomy: Surgery to remove one or both testicles through an incision (cut) in the groin. Unilateral salpingooophorectomy: Surgery to remove one ovary and one fallopian tube on the same side. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy 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. Observation Observation is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. For childhood extracranial germ cell tumors, this includes physical exams, imaging tests, and tumor marker tests. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer 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 cancer 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 cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated. New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Highdose chemotherapy with stem cell transplant Highdose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays 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 of cancer and whether it has come back. External radiation therapy is being studied for the treatment of childhood extracranial germ cell tumors that have come back. 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. Followup 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 child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. For childhood extracranial germ cell tumors, alphafetoprotein (AFP) tests and betahuman chorionic gonadotropin (hCG) tests are done to see if treatment is working. Continued high levels of AFP or hCG may mean the cancer is still growing. For at least 3 years after surgery, followup will include regular physical exams, imaging tests, and tumor marker tests. Treatment Options for Childhood Extracranial Germ Cell Tumors Mature and Immature Teratomas Treatment of mature teratomas that are not in the sacrum or coccyx (bottom part of the spine) includes the following: Surgery to remove the tumor followed by observation. Treatment of immature teratomas that are not in the sacrum or coccyx includes the following: Surgery to remove the tumor followed by observation for stage I tumors. Surgery to remove the tumor for stage IIIV tumors. Treatment of immature teratomas that are in the sacrum or coccyx includes the following: Surgery (removal of the sacrum and coccyx) followed by observation. Sometimes a mature or immature teratoma also has malignant cells. The teratoma and malignant cells may need to be treated differently. Regular followup exams with imaging tests and the alphafetoprotein (AFP) tumor marker test will be done for at least 3 years. Check the list of NCIsupported cancer clinical trials that are now accepting patients with childhood teratoma. 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 child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Malignant Gonadal Germ Cell Tumors Malignant Testicular Germ Cell Tumors Treatment of malignant testicular germ cell tumors may include the following: For boys younger than 15 years: Surgery (radical inguinal orchiectomy) followed by observation for stage I tumors. Surgery (radical inguinal orchiectomy) followed by combination chemotherapy for stage IIIV tumors. A second surgery may be done to remove any tumor remaining after chemotherapy. For boys 15 years and older: Malignant testicular germ cell tumors in boys 15 years and older are treated differently than they are in young boys. Surgery may include removal of lymph nodes in the abdomen. (See the PDQ summary on Testicular Cancer Treatment for more information.) Check the list of NCIsupported cancer clinical trials that are now accepting patients with childhood malignant testicular germ cell tumor. 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 child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Malignant Ovarian Germ Cell Tumors Dysgerminomas Treatment of stage I dysgerminomas in young girls may include the following: Surgery (unilateral salpingooophorectomy) followed by observation. Combination chemotherapy may be given if the tumor comes back. Treatment of stages IIIV dysgerminomas in young girls may include the following: Surgery (unilateral salpingooophorectomy) followed by combination chemotherapy. Combination chemotherapy to shrink the tumor, followed by surgery (unilateral salpingooophorectomy). Nongerminomas Treatment of stage I nongerminomas in young girls may include the following: Surgery followed by observation. Surgery followed by combination chemotherapy. Treatment of stages IIIV nongerminomas in young girls may include the following: Surgery followed by combination chemotherapy. A second surgery may be done to remove any remaining cancer. Biopsy followed by combination chemotherapy to shrink the tumor and sometimes surgery for tumors that cannot be removed by surgery when cancer is diagnosed. The treatment for adolescents and young adults with ovarian germ cell tumor is much like the treatment for adults. (See the PDQ treatment summary on Ovarian Germ Cell Tumors for more information.) Check the list of NCIsupported cancer clinical trials that are now accepting patients with childhood malignant ovarian germ cell tumor. 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 child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Malignant Extragonadal Extracranial Germ Cell Tumors Treatment of childhood malignant extragonadal extracranial germ cell tumors may include the following: Combination chemotherapy to shrink the tumor followed by surgery to remove the sacrum and coccyx (bottom part of the spine) for tumors that are in the sacrum or coccyx. Combination chemotherapy to shrink the tumor followed by surgery to remove tumors that are in the mediastinum. Biopsy followed by combination chemotherapy to shrink the tumor and surgery to remove tumors that are in the abdomen. Surgery to remove the tumor followed by combination chemotherapy for tumors of the head and neck. Treatment of malignant extragonadal extracranial germ cell tumors in places not already described includes the following: Surgery followed by combination chemotherapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with childhood extragonadal germ cell tumor. 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 child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Recurrent Childhood Malignant Extracranial Germ Cell Tumors There is no standard treatment for recurrent childhood malignant extracranial germ cell tumors. Treatment depends on the following: The type of treatment given when the cancer was diagnosed. How the tumor responded to the initial treatment. Treatment is usually within a clinical trial and may include the following: Surgery. Surgery followed by combination chemotherapy, for most malignant extracranial germ cell tumors including immature teratomas, malignant testicular germ cell tumors, and malignant ovarian germ cell tumors. Surgery for tumors that come back in the sacrum or coccyx (bottom part of the spine), if surgery to remove the sacrum and coccyx was not done when the cancer was diagnosed. Chemotherapy may be given before surgery, to shrink the tumor. If any tumor remains after surgery, radiation therapy may also be given. Combination chemotherapy for stage I malignant testicular germ cell tumors and stage I ovarian dysgerminomas. Highdose chemotherapy and stem cell transplant. Radiation therapy followed by surgery to remove the tumor in the brain for cancer that has spread to the brain. A clinical trial of combination chemotherapy alone compared with highdose chemotherapy followed by stem cell transplant. Check the list of NCIsupported cancer clinical trials that are now accepting patients with recurrent childhood malignant germ cell tumor. 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 child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Childhood Extracranial Germ Cell Tumors ? [/INST] New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Highdose chemotherapy with stem cell transplant Highdose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays 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 of cancer and whether it has come back. External radiation therapy is being studied for the treatment of childhood extracranial germ cell tumors that have come back. 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Skin Cancer ? [/INST] Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin. There are different types of cancer that start in the skin. Skin color and being exposed to sunlight can increase the risk of nonmelanoma skin cancer and actinic keratosis. Nonmelanoma skin cancer and actinic keratosis often appear as a change in the skin. Tests or procedures that examine the skin are used to detect (find) and diagnose nonmelanoma skin cancer and actinic keratosis. Certain factors affect prognosis (chance of recovery) and treatment options. Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin. The skin is the bodys largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of three kinds of cells: Squamous cells: Thin, flat cells that form the top layer of the epidermis. Basal cells: Round cells under the squamous cells. Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment and cause the skin to darken. Skin cancer can occur anywhere on the body, but it is most common in skin that is often exposed to sunlight, such as the face, neck, hands, and arms. There are different types of cancer that start in the skin. The most common types are basal cell carcinoma and squamous cell carcinoma, which are nonmelanoma skin cancers. Nonmelanoma skin cancers rarely spread to other parts of the body. Melanoma is a much rarer type of skin cancer. It is more likely to invade nearby tissues and spread to other parts of the body. Actinic keratosis is a skin condition that sometimes becomes squamous cell carcinoma. This summary is about nonmelanoma skin cancer and actinic keratosis. See the following PDQ summaries for information on melanoma and other kinds of cancer that affect the skin: Melanoma Treatment Mycosis Fungoides and the Szary Syndrome Treatment Kaposi Sarcoma Treatment Merkel Cell Carcinoma Treatment Unusual Cancers of Childhood Treatment Genetics of Skin Cancer Nonmelanoma skin cancer and actinic keratosis often appear as a change in the skin. Not all changes in the skin are a sign of nonmelanoma skin cancer or actinic keratosis. Check with your doctor if you notice any changes in your skin. Signs of nonmelanoma skin cancer include the following: A sore that does not heal. Areas of the skin that are: Raised, smooth, shiny, and look pearly. Firm and look like a scar, and may be white, yellow, or waxy. Raised, and red or reddishbrown. Scaly, bleeding or crusty.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Skin Cancer? ? [/INST] Skin color and being exposed to sunlight can increase the risk of nonmelanoma skin cancer and actinic keratosis. 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 with your doctor if you think you may be at risk. Risk factors for basal cell carcinoma and squamous cell carcinoma include the following: Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time. Having a fair complexion, which includes the following: Fair skin that freckles and burns easily, does not tan, or tans poorly. Blue or green or other lightcolored eyes. Red or blond hair. Having actinic keratosis. Past treatment with radiation. Having a weakened immune system. Having certain changes in the genes that are linked to skin cancer. Being exposed to arsenic.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Skin Cancer ? [/INST] Tests or procedures that examine the skin are used to detect (find) and diagnose nonmelanoma skin cancer and actinic keratosis. The following procedures may be used: Skin exam: A doctor or nurse checks the skin for bumps or spots that look abnormal in color, size, shape, or texture. Skin biopsy : All or part of the abnormallooking growth is cut from the skin and viewed under a microscope by a pathologist to check for signs of cancer. There are four main types of skin biopsies: Shave biopsy : A sterile razor blade is used to shaveoff the abnormallooking growth. Punch biopsy : A special instrument called a punch or a trephine is used to remove a circle of tissue from the abnormallooking growth. Incisional biopsy : A scalpel is used to remove part of a growth. Excisional biopsy : A scalpel is used to remove the entire growth.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Skin Cancer ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) depends mostly on the stage of the cancer and the type of treatment used to remove the cancer. Treatment options depend on the following: The stage of the cancer (whether it has spread deeper into the skin or to other places in the body). The type of cancer. The size of the tumor and what part of the body it affects. The patients general health.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Skin Cancer ? [/INST] After nonmelanoma skin cancer has been diagnosed, tests are done to find out if cancer cells have spread within the skin 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. Staging of nonmelanoma skin cancer depends on whether the tumor has certain "highrisk" features and if the tumor is on the eyelid. The following stages are used for nonmelanoma skin cancer that is not on the eyelid: Stage 0 (Carcinoma in Situ) Stage I Stage I nonmelanoma skin cancer. The tumor is no more than 2 centimeters. Stage II Stage II nonmelanoma skin cancer. The tumor is more than 2 centimeters wide. Stage III Stage IV The following stages are used for nonmelanoma skin cancer on the eyelid: Stage 0 (Carcinoma in Situ) Stage I Stage II Stage III Stage IV Treatment is based on the type of nonmelanoma skin cancer or other skin condition diagnosed: Basal cell carcinoma Squamous cell carcinoma Actinic keratosis After nonmelanoma skin cancer has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body. The process used to find out if cancer has spread within the skin 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: 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 xray 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). Lymph node biopsy : For squamous cell carcinoma, the lymph nodes may be removed and checked to see if cancer has spread to them. 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 skin cancer spreads to the lung, the cancer cells in the lung are actually skin cancer cells. The disease is metastatic skin cancer, not lung cancer. Staging of nonmelanoma skin cancer depends on whether the tumor has certain "highrisk" features and if the tumor is on the eyelid. Staging for nonmelanoma skin cancer that is on the eyelid is different from staging for nonmelanoma skin cancer that affects other parts of the body. The following are highrisk features for nonmelanoma skin cancer that is not on the eyelid: The tumor is thicker than 2 millimeters. The tumor is described as Clark level IV (has spread into the lower layer of the dermis) or Clark level V (has spread into the layer of fat below the skin). The tumor has grown and spread along nerve pathways. The tumor began on an ear or on a lip that has hair on it. The tumor has cells that look very different from normal cells under a microscope. The following stages are used for nonmelanoma skin cancer that is not on the eyelid: Stage 0 (Carcinoma in Situ) In stage 0, abnormal cells are found in the squamous cell or basal cell layer of the epidermis (topmost layer of the skin). These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ. Stage I In stage I, cancer has formed. The tumor is not larger than 2 centimeters at its widest point and may have one highrisk feature. Stage II In stage II, the tumor is either: larger than 2 centimeters at its widest point; or any size and has two or more highrisk features. Stage III In stage III: The tumor has spread to the jaw, eye socket, or side of the skull. Cancer may have spread to one lymph node on the same side of the body as the tumor. The lymph node is not larger than 3 centimeters. or Cancer has spread to one lymph node on the same side of the body as the tumor. The lymph node is not larger than 3 centimeters and one of the following is true: the tumor is not larger than 2 centimeters at its widest point and may have one highrisk feature; or the tumor is larger than 2 centimeters at its widest point; or the tumor is any size and has two or more highrisk features. Stage IV In stage IV, one of the following is true: The tumor is any size and may have spread to the jaw, eye socket, or side of the skull. Cancer has spread to one lymph node on the same side of the body as the tumor and the affected node is larger than 3 centimeters but not larger than 6 centimeters, or cancer has spread to more than one lymph node on one or both sides of the body and the affected nodes are not larger than 6 centimeters; or The tumor is any size and may have spread to the jaw, eye socket, skull, spine, or ribs. Cancer has spread to one lymph node that is larger than 6 centimeters; or The tumor is any size and has spread to the base of the skull, spine, or ribs. Cancer may have spread to the lymph nodes; or Cancer has spread to other parts of the body, such as the lung. The following stages are used for nonmelanoma skin cancer on the eyelid: Stage 0 (Carcinoma in Situ) In stage 0, abnormal cells are found in the epidermis (topmost layer of the skin). These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ. Stage I Stage I is divided into stages IA, IB, and IC. Stage IA: The tumor is 5 millimeters or smaller and has not spread to the connective tissue of the eyelid or to the edge of the eyelid where the lashes are. Stage IB: The tumor is larger than 5 millimeters but not larger than 10 millimeters or has spread to the connective tissue of the eyelid, or to the edge of the eyelid where the lashes are. Stage IC: The tumor is larger than 10 millimeters but not larger than 20 millimeters or has spread through the full thickness of the eyelid. Stage II In stage II, one of the following is true: The tumor is larger than 20 millimeters. The tumor has spread to nearby parts of the eye or eye socket. The tumor has spread to spaces around the nerves in the eyelid. Stage III Stage III is divided into stages IIIA, IIIB, and IIIC. Stage IIIA: To remove all of the tumor, the whole eye and part of the optic nerve must be removed. The bone, muscles, fat, and connective tissue around the eye may also be removed. Stage IIIB: The tumor may be anywhere in or near the eye and has spread to nearby lymph nodes. Stage IIIC: The tumor has spread to structures around the eye or in the face, or to the brain, and cannot be removed in surgery. Stage IV The tumor has spread to distant parts of the body. Treatment is based on the type of nonmelanoma skin cancer or other skin condition diagnosed: Basal cell carcinoma Basal cell carcinoma is the most common type of skin cancer. It usually occurs on areas of the skin that have been in the sun, most often the nose. Often this cancer appears as a raised bump that looks smooth and pearly. Another type looks like a scar and is flat and firm and may be white, yellow, or waxy. Basal cell carcinoma may spread to tissues around the cancer, but it usually does not spread to other parts of the body. Squamous cell carcinoma Squamous cell carcinoma occurs on areas of the skin that have been in the sun, such as the ears, lower lip, and the back of the hands. Squamous cell carcinoma may also appear on areas of the skin that have been burned or exposed to chemicals or radiation. Often this cancer appears as a firm red bump. The tumor may feel scaly, bleed, or form a crust. Squamous cell tumors may spread to nearby lymph nodes. Squamous cell carcinoma that has not spread can usually be cured. Actinic keratosis Actinic keratosis is a skin condition that is not cancer, but sometimes changes into squamous cell carcinoma. It usually occurs in areas that have been exposed to the sun, such as the face, the back of the hands, and the lower lip. It looks like rough, red, pink, or brown scaly patches on the skin that may be flat or raised, or the lower lip cracks and peels and is not helped by lip balm or petroleum jelly.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Skin Cancer ? [/INST] There are different types of treatment for patients with nonmelanoma skin cancer and actinic keratosis. Six types of standard treatment are used: Surgery Radiation therapy Chemotherapy Photodynamic therapy Biologic therapy Targeted therapy New types of treatment are being tested in clinical trials. Treatment for skin cancer may cause side effects. 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. Followup tests may be needed. There are different types of treatment for patients with nonmelanoma skin cancer and actinic keratosis. Different types of treatment are available for patients with nonmelanoma skin cancer and actinic keratosis. 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. Six types of standard treatment are used: Surgery One or more of the following surgical procedures may be used to treat nonmelanoma skin cancer or actinic keratosis: Mohs micrographic surgery: The tumor is cut from the skin in thin layers. During surgery, the edges of the tumor and each layer of tumor removed are viewed through a microscope to check for cancer cells. Layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible and is often used to remove skin cancer on the face. Simple excision: The tumor is cut from the skin along with some of the normal skin around it. Shave excision: The abnormal area is shaved off the surface of the skin with a small blade. Electrodesiccation and curettage: The tumor is cut from the skin with a curette (a sharp, spoonshaped tool). A needleshaped electrode is then used to treat the area with an electric current that stops the bleeding and destroys cancer cells that remain around the edge of the wound. The process may be repeated one to three times during the surgery to remove all of the cancer. Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy. 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. Dermabrasion: Removal of the top layer of skin using a rotating wheel or small particles to rub away skin cells. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays 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 of cancer being treated. External radiation therapy is used to treat skin cancer. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer 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 cancer 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 cancer cells in those areas (regional chemotherapy). Chemotherapy for nonmelanoma skin cancer and actinic keratosis is usually topical (applied to the skin in a cream or lotion). The way the chemotherapy is given depends on the condition being treated. Retinoids (drugs related to vitamin A) are sometimes used to treat squamous cell carcinoma of the skin. See Drugs Approved for Basal Cell Carcinoma for more information. Photodynamic therapy Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. For skin cancer, laser light is shined onto the skin and the drug becomes active and kills the cancer cells. Photodynamic therapy causes little damage to healthy tissue. 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. Interferon and imiquimod are biologic agents used to treat skin cancer. Interferon (by injection) may be used to treat squamous cell carcinoma of the skin. Topical imiquimod therapy (a cream applied to the skin) may be used to treat some small basal cell carcinomas. See Drugs Approved for Basal Cell Carcinoma for more information. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Targeted therapy with a signal transduction inhibitor is used to treat basal cell carcinoma. Signal transduction inhibitors block signals that are passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells. Vismodegib and sonidegib are signal transduction inhibitors used to treat basal cell carcinoma. See Drugs Approved for Basal Cell Carcinoma for more information. New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Treatment for skin cancer may cause side effects. For information about side effects caused by treatment for cancer, see our Side Effects page. 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. Followup 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 followup tests or checkups. Basal cell carcinoma and squamous cell carcinoma are likely to recur (come back), usually within 5 years, or new tumors may form. Talk to your doctor about how often you should have your skin checked for signs of cancer. Treatment Options for Nonmelanoma Skin Cancer Basal Cell Carcinoma Treatment of basal cell carcinoma may include the following: Simple excision. Mohs micrographic surgery. Radiation therapy. Electrodesiccation and curettage. Cryosurgery. Photodynamic therapy. Topical chemotherapy. Topical biologic therapy with imiquimod. Laser surgery. Treatment of recurrent basal cell carcinoma is usually Mohs micrographic surgery. Treatment of basal cell carcinoma that is metastatic or cannot be treated with local therapy may include the following: Targeted therapy with a signal transduction inhibitor. Chemotherapy. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with basal cell carcinoma of the skin. 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. Squamous Cell Carcinoma Treatment of squamous cell carcinoma may include the following: Simple excision. Mohs micrographic surgery. Radiation therapy. Electrodesiccation and curettage. Cryosurgery. Treatment of recurrent squamous cell carcinoma may include the following: Simple excision. Mohs micrographic surgery. Radiation therapy. Treatment of squamous cell carcinoma that is metastatic or cannot be treated with local therapy may include the following: Chemotherapy. Retinoid therapy and biologic therapy with interferon. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with squamous cell carcinoma of the skin. 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Skin Cancer ? [/INST] New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Treatment for skin cancer may cause side effects. For information about side effects caused by treatment for cancer, see our Side Effects page. 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Neuroblastoma ? [/INST] Neuroblastoma is a disease in which malignant (cancer) cells form in neuroblasts (immature nerve tissue) in the adrenal gland, neck, chest, or spinal cord. Neuroblastoma is sometimes caused by a gene mutation (change) passed from the parent to the child. Signs and symptoms of neuroblastoma include bone pain and a lump in the abdomen, neck, or chest. Tests that examine many different body tissues and fluids are used to detect (find) and diagnose neuroblastoma. A biopsy is done to diagnose neuroblastoma. Certain factors affect prognosis (chance of recovery) and treatment options. Neuroblastoma is a disease in which malignant (cancer) cells form in neuroblasts (immature nerve tissue) in the adrenal gland, neck, chest, or spinal cord. Neuroblastoma often begins in the nerve tissue of the adrenal glands. There are two adrenal glands, one on top of each kidney in the back of the upper abdomen. The adrenal glands make important hormones that help control heart rate, blood pressure, blood sugar, and the way the body reacts to stress. Neuroblastoma may also begin in nerve tissue in the neck, chest, abdomen or pelvis. Neuroblastoma most often begins in infancy and may be diagnosed in the first month of life. It is found when the tumor begins to grow and cause signs or symptoms. Sometimes it forms before birth and is found during a fetal ultrasound. By the time neuroblastoma is diagnosed, the cancer has usually metastasized (spread). Neuroblastoma spreads most often to the lymph nodes, bones, bone marrow, and liver. In infants, it also spreads to the skin.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Is Neuroblastoma inherited ? [/INST] Neuroblastoma is sometimes caused by a gene mutation (change) passed from the parent to the child. Gene mutations that increase the risk of neuroblastoma are sometimes inherited (passed from the parent to the child). In children with a gene mutation, neuroblastoma usually occurs at a younger age and more than one tumor may form in the adrenal glands.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Neuroblastoma ? [/INST] Signs and symptoms of neuroblastoma include bone pain and a lump in the abdomen, neck, or chest.The most common signs and symptoms of neuroblastoma are caused by the tumor pressing on nearby tissues as it grows or by cancer spreading to the bone. These and other signs and symptoms may be caused by neuroblastoma or by other conditions. Check with your childs doctor if your child has any of the following: Lump in the abdomen, neck, or chest. Bulging eyes. Dark circles around the eyes ("black eyes"). Bone pain. Swollen stomach and trouble breathing (in infants). Painless, bluish lumps under the skin (in infants). Weakness or paralysis (loss of ability to move a body part). Less common signs and symptoms of neuroblastoma include the following: Fever. Shortness of breath. Feeling tired. Easy bruising or bleeding. Petechiae (flat, pinpoint spots under the skin caused by bleeding). High blood pressure. Severe watery diarrhea. Horner syndrome (droopy eyelid, smaller pupil, and less sweating on one side of the face). Jerky muscle movements. Uncontrolled eye movements.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Neuroblastoma ? [/INST] Tests that examine many different body tissues and fluids are used to detect (find) and diagnose neuroblastoma. 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 or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Neurological exam : A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a persons mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam. Urine catecholamine studies: A procedure in which a urine sample is checked to measure the amount of certain substances, vanillylmandelic acid (VMA) and homovanillic acid (HVA), that are made when catecholamines break down and are released into the urine. A higher than normal amount of VMA or HVA can be a sign of neuroblastoma. Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. Xray : An xray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. 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 xray 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) with gadolinium : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI). mIBG (metaiodobenzylguanidine) scan : A procedure used to find neuroendocrine tumors, such as neuroblastoma. A very small amount of a substance called radioactive mIBG is injected into a vein and travels through the bloodstream. Neuroendocrine tumor cells take up the radioactive mIBG and are detected by a scanner. Scans may be taken over 13 days. An iodine solution may be given before or during the test to keep the thyroid gland from absorbing too much of the mIBG. This test is also used to find out how well the tumor is responding to treatment. mIBG is used in high doses to treat neuroblastoma. Bone marrow aspiration and biopsy : The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer. Ultrasound exam: A procedure in which highenergy 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. An ultrasound exam is not done if a CT/MRI has been done.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Neuroblastoma ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: Age of the child at the time of diagnosis. The child's risk group. Whether there are certain changes in the genes. Where in the body the tumor started. Tumor histology (the shape, function, and structure of the tumor cells). Whether there is cancer in the lymph nodes on the same side of the body as the primary cancer or whether there is cancer in the lymph nodes on the opposite side of the body. How the tumor responds to treatment. How much time passed between diagnosis and when the cancer recurred (for recurrent cancer). Prognosis and treatment options for neuroblastoma are also affected by tumor biology, which includes: The patterns of the tumor cells. How different the tumor cells are from normal cells. How fast the tumor cells are growing. Whether the tumor shows MYCN amplification. Whether the tumor has changes in the ALK gene. The tumor biology is said to be favorable or unfavorable, depending on these factors. A favorable tumor biology means there is a better chance of recovery. In some children up to 6 months old, neuroblastoma may disappear without treatment. This is called spontaneous regression. The child is closely watched for signs or symptoms of neuroblastoma. If signs or symptoms occur, treatment may be needed.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Neuroblastoma ? [/INST] After neuroblastoma has been diagnosed, tests are done to find out if cancer has spread from where it started 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 neuroblastoma: Stage 1 Stage 2 Stage 3 Stage 4 Treatment of neuroblastoma is based on risk groups. After neuroblastoma has been diagnosed, tests are done to find out if cancer has spread from where it started to other parts of the body. The process used to find out the extent or spread of cancer is called staging. The information gathered from the staging process helps determine the stage of the disease. For neuroblastoma, the stage of disease affects whether the cancer is low risk, intermediate risk, or high risk. It also affects the treatment plan. The results of some tests and procedures used to diagnose neuroblastoma may be used for staging. See the General Information section for a description of these tests and procedures. The following tests and procedures also may be used to determine the stage: Lymph node biopsy : The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells. One of the following types of biopsies may be done: Excisional biopsy : The removal of an entire lymph node. Incisional biopsy : The removal of part of a lymph node. Core biopsy : The removal of tissue from a lymph node using a wide needle. Fineneedle aspiration (FNA) biopsy : The removal of tissue or fluid from a lymph node using a thin needle. Xray of the bone: An xray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner. 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. 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 neuroblastoma spreads to the liver, the cancer cells in the liver are actually neuroblastoma cells. The disease is metastatic neuroblastoma, not liver cancer. The following stages are used for neuroblastoma: Stage 1 In stage 1, the tumor is in only one area and all of the tumor that can be seen is completely removed during surgery. Stage 2 Stage 2 is divided into stages 2A and 2B. Stage 2A: The tumor is in only one area and all of the tumor that can be seen cannot be completely removed during surgery. Stage 2B: The tumor is in only one area and all of the tumor that can be seen may be completely removed during surgery. Cancer cells are found in the lymph nodes near the tumor. Stage 3 In stage 3, one of the following is true: the tumor cannot be completely removed during surgery and has spread from one side of the body to the other side and may also have spread to nearby lymph nodes; or the tumor is in only one area, on one side of the body, but has spread to lymph nodes on the other side of the body; or the tumor is in the middle of the body and has spread to tissues or lymph nodes on both sides of the body, and the tumor cannot be removed by surgery. Stage 4 Stage 4 is divided into stages 4 and 4S. In stage 4, the tumor has spread to distant lymph nodes or other parts of the body. In stage 4S: the child is younger than 12 months; and the cancer has spread to the skin, liver, and/or bone marrow; and the tumor is in only one area and all of the tumor that can be seen may be completely removed during surgery; and/or cancer cells may be found in the lymph nodes near the tumor. Treatment of neuroblastoma is based on risk groups. For many types of cancer, stages are used to plan treatment. For neuroblastoma, treatment depends on risk groups. The stage of neuroblastoma is one factor used to determine risk group. Other factors are the age of the child, tumor histology, and tumor biology. There are three risk groups: low risk, intermediate risk, and high risk. Lowrisk and intermediaterisk neuroblastoma have a good chance of being cured. Highrisk neuroblastoma may be hard to cure.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Neuroblastoma ? [/INST] There are different types of treatment for patients with neuroblastoma. Children with neuroblastoma should have their treatment planned by a team of doctors who are experts in treating childhood cancer, especially neuroblastoma. Children who are treated for neuroblastoma may have late effects, including an increased risk of second cancers. Seven types of standard treatment are used: Observation Surgery Radiation therapy Iodine 131mIBG therapy Chemotherapy Highdose chemotherapy and radiation therapy with stem cell rescue Targeted therapy New types of treatment are being tested in clinical trials. Immunotherapy Other drug therapy 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. Followup tests may be needed. There are different types of treatment for patients with neuroblastoma. Different types of treatment are available for patients with neuroblastoma. 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. Because cancer in children is 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 neuroblastoma should have their treatment planned by a team of doctors who are experts in treating childhood cancer, especially neuroblastoma. 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 neuroblastoma and who specialize in certain areas of medicine. These may include the following specialists: Pediatric surgeon. Pediatric radiation oncologist.. Endocrinologist. Neurologist. Pediatric neuropathologist.. Neuroradiologist. Pediatrician. Pediatric nurse specialist. Social worker. Child life professional. Psychologist. Children who are treated for neuroblastoma may have late effects, including an increased risk of second cancers. Some cancer treatments cause side effects that continue or appear years after cancer treatment has ended. These are called late effects. Late effects of cancer 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 that parents of children who are treated for neuroblastoma talk with their 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. Seven types of standard treatment are used: Observation Observation is closely monitoring a patient's condition without giving any treatment until signs or symptoms appear or change. Surgery Surgery is used to treat neuroblastoma unless it has spread to other parts of the body. Depending on where the tumor is, as much of the tumor as is safely possible will be removed. If the tumor cannot be removed, a biopsy may be done instead. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays 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 of cancer being treated and the child's risk group. External radiation therapy is used to treat neuroblastoma. Iodine 131mIBG therapy Iodine 131mIBG therapy is a treatment with radioactive iodine. The radioactive iodine is given through an intravenous (IV) line and enters the bloodstream which carries radiation directly to tumor cells. Radioactive iodine collects in neuroblastoma cells and kills them with the radiation that is given off. Iodine 131mIBG therapy is sometimes used to treat highrisk neuroblastoma that comes back after initial treatment. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer 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 cancer 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 cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type of cancer being treated and the child's risk group. The use of two or more anticancer drugs is called combination chemotherapy. See Drugs Approved for Neuroblastoma for more information. Highdose chemotherapy and radiation therapy with stem cell rescue Highdose chemotherapy and radiation therapy with stem cell rescue is a way of giving high doses of chemotherapy and radiation therapy and replacing blood forming cells destroyed by cancer treatment for highrisk neuroblastoma. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient and are frozen and stored. After chemotherapy and radiation therapy are completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. Maintenance therapy is given after highdose chemotherapy and radiation therapy with stem cell rescue to kill any cancer cells that may regrow and cause the disease to come back. Maintenance therapy is given for 6 months and includes the following treatments: Isotretinoin: A vitamin like drug that slows the cancer's ability to make more cancer cells and changes how these cells look and act. This drug is taken by mouth. Dinutuximab: A type of monoclonal antibody therapy that uses an antibody made in the laboratory from a single type of immune system cell. Dinutuximab identifies and attaches to a substance, called GD2, on the surface of neuroblastoma cells. Once dinutuximab attaches to the GD2, a signal is sent to the immune system that a foreign substance has been found and needs to be killed. Then the body's immune system kills the neuroblastoma cell. Dinutuximab is given by infusion. It is a type of targeted therapy. Granulocytemacrophage colonystimulating factor (GMCSF): A cytokine that helps make more immune system cells, especially granulocytes and macrophages (white blood cells), which can attack and kill cancer cells. Interleukin2 (IL2): A type of immunotherapy that boosts the growth and activity of many immune cells, especially lymphocytes (a type of white blood cell). Lymphocytes can attack and kill cancer cells. See Drugs Approved for Neuroblastoma for more information. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack cancer cells with less harm to normal cells. There are different types of targeted therapy: Tyrosine kinase inhibitors are smallmolecule drugs that go through the cell membrane and work inside cancer cells to block signals that cancer cells need to grow and divide. Crizotinib is used to treat neuroblastoma that has come back after treatment. Antibodydrug conjugates are made up of a monoclonal antibody attached to a drug. The monoclonal antibody binds to specific proteins or receptors found on certain cells, including cancer cells. The drug enters these cells and kills them without harming other cells. Lorvotuzumab mertansine is an antibodydrug conjugate being studied to treat neuroblastoma that has come back after treatment. New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Immunotherapy Immunotherapy 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 biological therapy. Vaccine therapy uses a substance to stimulate the immune system to destroy a tumor. Vaccine therapy is being studied to treat neuroblastoma that has come back after treatment. Other drug therapy Lenalidomide is a type of angiogenesis inhibitor. It prevents the growth of new blood vessels that are needed by a tumor to grow. 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. Followup 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 child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. Treatment Options for Neuroblastoma LowRisk Neuroblastoma Treatment of lowrisk neuroblastoma may include the following: Surgery followed by observation. Chemotherapy with or without surgery, for children with symptoms, children whose tumor has continued to grow and cannot be removed by surgery, or children with unfavorable tumor biology. Observation alone for infants younger than 6 months who have small adrenal tumors. Observation alone for infants who do not have signs or symptoms of neuroblastoma. Radiation therapy to treat tumors that are causing serious problems and do not respond quickly to chemotherapy or surgery. A clinical trial of treatment based on the tumor's response to treatment and tumor biology. IntermediateRisk Neuroblastoma Treatment of intermediaterisk neuroblastoma may include the following: Chemotherapy for children with symptoms or to shrink a tumor that cannot be removed by surgery. Surgery may be done after chemotherapy. Surgery alone for infants. Observation alone for certain infants. Radiation therapy to treat tumors that are causing serious problems and do not respond quickly to chemotherapy or surgery. Radiation therapy for tumors that do not respond to other treatment. A clinical trial of treatment based on the tumor's response to treatment and tumor biology. HighRisk Neuroblastoma Treatment of highrisk neuroblastoma may include the following: A regimen of combination chemotherapy, surgery, stem cell rescue, radiation therapy, and monoclonal antibody therapy (dinutuximab) with interleukin2 (IL2), granulocytemacrophage colonystimulating factor (GMCSF), and isotretinoin. Stage 4S Neuroblastoma There is no standard treatment for stage 4S neuroblastoma but treatment options include the following: Observation with supportive care for certain children who have favorable tumor biology and do not have signs or symptoms. Chemotherapy, for children who have signs or symptoms of neuroblastoma or unfavorable tumor biology, or for very young infants. A clinical trial of treatment based on the tumor's response to treatment and tumor biology. Recurrent Neuroblastoma Patients First Treated for LowRisk Neuroblastoma Treatment for recurrent neuroblastoma that is found only in the area where the cancer first formed may include the following: Surgery followed by observation or chemotherapy. Chemotherapy that may be followed by surgery. Treatment for recurrent neuroblastoma that has spread to other parts of the body may include the following: Observation. Chemotherapy. Surgery followed by chemotherapy. Treatment as for newly diagnosed highrisk neuroblastoma for children older than 1 year. Patients First Treated for IntermediateRisk Neuroblastoma Treatment for recurrent neuroblastoma that is found only in the area where the cancer first formed may include the following: Surgery that may be followed by chemotherapy. Treatment as for newly diagnosed highrisk neuroblastoma for neuroblastoma that has spread to other parts of the body. Recurrent neuroblastoma that has spread to other parts of the body is treated the same way as newly diagnosed highrisk neuroblastoma. Patients First Treated for HighRisk Neuroblastoma Treatment for recurrent neuroblastoma may include the following: Combination chemotherapy. Iodine 131mIBG therapy to relieve symptoms and improve quality of life. It may be given alone or in combination with other therapy, or before stem cell rescue. A second course of highdose chemotherapy and stem cell rescue. Tyrosine kinase inhibitor therapy (crizotinib) for patients with changes in the ALK gene. Because there is no standard treatment for recurrent neuroblastoma in patients first treated for highrisk neuroblastoma, patients may want to consider a clinical trial. For information about clinical trials, please see the NCI website. Patients with Recurrent CNS Neuroblastoma Treatment for neuroblastoma that recurs (comes back) in the central nervous system (CNS; brain and spinal cord) may include the following: Surgery to remove the tumor in the CNS followed by radiation therapy. A clinical trial of a new therapy. Treatments Being Studied for Progressive/Recurrent Neuroblastoma Some of the treatments being studied in clinical trials for neuroblastoma that recurs (comes back) or progresses (grows, spreads, or does not respond to treatment) include the following: Combination chemotherapy and monoclonal antibody therapy (dinutuximab). Lenalidomide and monoclonal antibody therapy (dinutuximab) with or without isotretinoin. Iodine 131mIBG given alone or with other anticancer drugs. Immunotherapy (vaccine therapy). Tyrosine kinase inhibitor (crizotinib) and combination chemotherapy. Targeted therapy with an antibodydrug conjugate (lorvotuzumab mertansine).</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Neuroblastoma ? [/INST] New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Immunotherapy Immunotherapy 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 biological therapy. Vaccine therapy uses a substance to stimulate the immune system to destroy a tumor. Vaccine therapy is being studied to treat neuroblastoma that has come back after treatment. Other drug therapy Lenalidomide is a type of angiogenesis inhibitor. It prevents the growth of new blood vessels that are needed by a tumor to grow. 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Parathyroid Cancer ? [/INST] Parathyroid cancer is a rare disease in which malignant (cancer) cells form in the tissues of a parathyroid gland. Having certain inherited disorders can increase the risk of developing parathyroid cancer. Signs and symptoms of parathyroid cancer include weakness, feeling tired, and a lump in the neck. Tests that examine the neck and blood are used to detect (find) and diagnose parathyroid cancer. Certain factors affect prognosis (chance of recovery) and treatment options. Parathyroid cancer is a rare disease in which malignant (cancer) cells form in the tissues of a parathyroid gland. The parathyroid glands are four peasized organs found in the neck near the thyroid gland. The parathyroid glands make parathyroid hormone (PTH or parathormone). PTH helps the body use and store calcium to keep the calcium in the blood at normal levels. A parathyroid gland may become overactive and make too much PTH, a condition called hyperparathyroidism. Hyperparathyroidism can occur when a benign tumor (noncancer), called an adenoma, forms on one of the parathyroid glands, and causes it to grow and become overactive. Sometimes hyperparathyroidism can be caused by parathyroid cancer, but this is very rare. The extra PTH causes: The calcium stored in the bones to move into the blood. The intestines to absorb more calcium from the food we eat. This condition is called hypercalcemia (too much calcium in the blood). The hypercalcemia caused by hyperparathyroidism is more serious and lifethreatening than parathyroid cancer itself and treating hypercalcemia is as important as treating the cancer.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Parathyroid Cancer? ? [/INST] Having certain inherited disorders can increase the risk of developing parathyroid cancer. Anything that increases the chance of getting a disease is called a risk factor. Risk factors for parathyroid cancer include the following rare disorders that are inherited (passed down from parent to child): Familial isolated hyperparathyroidism (FIHP). Multiple endocrine neoplasia type 1 (MEN1) syndrome. Treatment with radiation therapy may increase the risk of developing a parathyroid adenoma.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Parathyroid Cancer ? [/INST] Signs and symptoms of parathyroid cancer include weakness, feeling tired, and a lump in the neck. Most parathyroid cancer signs and symptoms are caused by the hypercalcemia that develops. Signs and symptoms of hypercalcemia include the following: Weakness. Feeling very tired. Nausea and vomiting. Loss of appetite. Weight loss for no known reason. Being much more thirsty than usual. Urinating much more than usual. Constipation. Trouble thinking clearly. Other signs and symptoms of parathyroid cancer include the following: Pain in the abdomen, side, or back that doesn't go away. Pain in the bones. A broken bone. A lump in the neck. Change in voice such as hoarseness. Trouble swallowing. Other conditions may cause the same signs and symptoms as parathyroid cancer. Check with your doctor if you have any of these problems.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Parathyroid Cancer ? [/INST] Tests that examine the neck and blood are used to detect (find) and diagnose parathyroid cancer. Once blood tests are done and hyperparathyroidism is diagnosed, imaging tests may be done to help find which of the parathyroid glands is overactive. Sometimes the parathyroid glands are hard to find and imaging tests are done to find exactly where they are. Parathyroid cancer may be hard to diagnose because the cells of a benign parathyroid adenoma and a malignant parathyroid cancer look alike. The patient's symptoms, blood levels of calcium and parathyroid hormone, and characteristics of the tumor are also used to make a diagnosis. 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 or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. To diagnose parathyroid cancer, the sample of blood is checked for its calcium level. Parathyroid hormone test: A procedure in which a blood sample is checked to measure the amount of parathyroid hormone released into the blood by the parathyroid glands. A higher than normal amount of parathyroid hormone can be a sign of disease. Sestamibi scan : A type of radionuclide scan used to find an overactive parathyroid gland. A very small amount of a radioactive substance called technetium 99 is injected into a vein and travels through the bloodstream to the parathyroid gland. The radioactive substance will collect in the overactive gland and show up brightly on a special camera that detects radioactivity. 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 xray 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. SPECT scan (single photon emission computed tomography scan): A procedure that uses a special camera linked to a computer to make a 3dimensional (3D) picture. A very small amount of a radioactive substance is injected into a vein. As the substance travels through the blood, the camera rotates around the neck and takes pictures. Blood flow and metabolism are higher than normal in areas where cancer cells are growing. These areas will show up brighter in the picture. This procedure may be done just before or after a CT scan. Ultrasound exam: A procedure in which highenergy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. Angiogram : A procedure to look at blood vessels and the flow of blood. A contrast dye is injected into the blood vessel. As the contrast dye moves through the blood vessel, xrays are taken to see if there are any blockages. Venous sampling : A procedure in which a sample of blood is taken from specific veins and checked to measure the amounts of certain substances released into the blood by nearby organs and tissues. If imaging tests do not show which parathyroid gland is overactive, blood samples may be taken from veins near each parathyroid gland to find which one is making too much PTH.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Parathyroid Cancer ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: Whether the calcium level in the blood can be controlled. The stage of the cancer. Whether the tumor and the capsule around the tumor can be completely removed by surgery. The patient's general health.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Parathyroid Cancer ? [/INST] After parathyroid cancer has been diagnosed, tests are done to find out if cancer cells have spread 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. There is no standard staging process for parathyroid cancer. After parathyroid cancer has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. The process used to find out if cancer has spread to other parts of the body is called staging. The following imaging tests may be used to determine if cancer has spread to other parts of the body such as the lungs, liver, bone, heart, pancreas, or lymph nodes: 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 xray 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). 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 parathyroid cancer spreads to the lung, the cancer cells in the lung are actually parathyroid cancer cells. The disease is metastatic parathyroid cancer, not lung cancer. There is no standard staging process for parathyroid cancer. Parathyroid cancer is described as either localized or metastatic: Localized parathyroid cancer is found in a parathyroid gland and may have spread to nearby tissues. Metastatic parathyroid cancer has spread to other parts of the body, such as the lungs, liver, bone, sac around the heart, pancreas, or lymph nodes.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Parathyroid Cancer ? [/INST] There are different types of treatment for patients with parathyroid cancer. Treatment includes control of hypercalcemia (too much calcium in the blood) in patients who have an overactive parathyroid gland. Four types of standard treatment are used: Surgery Radiation therapy Chemotherapy Supportive care 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. Followup tests may be needed. There are different types of treatment for patients with parathyroid cancer. Different types of treatment are available for patients with parathyroid 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. Treatment includes control of hypercalcemia (too much calcium in the blood) in patients who have an overactive parathyroid gland. In order to reduce the amount of parathyroid hormone that is being made and control the level of calcium in the blood, as much of the tumor as possible is removed in surgery. For patients who cannot have surgery, medication may be used. Four types of standard treatment are used: Surgery Surgery (removing the cancer in an operation) is the most common treatment for parathyroid cancer that is in the parathyroid glands or has spread to other parts of the body. Because parathyroid cancer grows very slowly, cancer that has spread to other parts of the body may be removed by surgery in order to cure the patient or control the effects of the disease for a long time. Before surgery, treatment is given to control hypercalcemia. The following surgical procedures may be used: En bloc resection: Surgery to remove the entire parathyroid gland and the capsule around it. Sometimes lymph nodes, half of the thyroid gland on the same side of the body as the cancer, and muscles, tissues, and a nerve in the neck are also removed. Tumor debulking: A surgical procedure in which as much of the tumor as possible is removed. Some tumors cannot be completely removed. Metastasectomy: Surgery to remove any cancer that has spread to distant organs such as the lung. Surgery for parathyroid cancer sometimes damages nerves of the vocal cords. There are treatments to help with speech problems caused by this nerve damage. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays 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 radiation therapy is used to treat parathyroid cancer. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer 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 cancer 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 cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Supportive care Supportive care is given to lessen the problems caused by the disease or its treatment. Supportive care for hypercalcemia caused by parathyroid cancer may include the following: Intravenous (IV) fluids. Drugs that increase how much urine the body makes. Drugs that stop the body from absorbing calcium from the food we eat. Drugs that stop the parathyroid gland from making parathyroid hormone. 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. Followup 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 followup tests or checkups. Parathyroid cancer often recurs. Patients should have regular checkups for the rest of their lives, to find and treat recurrences early. Treatment Options for Parathyroid Cancer Localized Parathyroid Cancer Treatment of localized parathyroid cancer may include the following: Surgery (en bloc resection). Surgery followed by radiation therapy. Radiation therapy. Supportive care to treat hypercalcemia (too much calcium in the blood). Check the list of NCIsupported cancer clinical trials that are now accepting patients with localized parathyroid 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. Metastatic Parathyroid Cancer Treatment of metastatic parathyroid cancer may include the following: Surgery (metastasectomy) to remove cancer from the places where it has spread. Surgery followed by radiation therapy. Radiation therapy. Chemotherapy. Supportive care to treat hypercalcemia (too much calcium in the blood). Check the list of NCIsupported cancer clinical trials that are now accepting patients with metastatic parathyroid 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. Recurrent Parathyroid Cancer Treatment of recurrent parathyroid cancer may include the following: Surgery (metastasectomy) to remove cancer from the places where it has recurred. Surgery (tumor debulking). Surgery followed by radiation therapy. Radiation therapy. Chemotherapy. Supportive care to treat hypercalcemia (too much calcium in the blood). Check the list of NCIsupported cancer clinical trials that are now accepting patients with recurrent parathyroid 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Parathyroid Cancer ? [/INST] 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Childhood Craniopharyngioma ? [/INST] Childhood craniopharyngiomas are benign brain tumors found near the pituitary gland. There are no known risk factors for childhood craniopharyngioma. Signs of childhood craniopharyngioma include vision changes and slow growth. Tests that examine the brain, vision, and hormone levels are used to detect (find) childhood craniopharyngiomas. Childhood craniopharyngiomas are diagnosed and may be removed in the same surgery. Certain factors affect prognosis (chance of recovery) and treatment options. Childhood craniopharyngiomas are benign brain tumors found near the pituitary gland. Childhood craniopharyngiomas are rare tumors usually found near the pituitary gland (a peasized organ at the bottom of the brain that controls other glands) and the hypothalamus (a small coneshaped organ connected to the pituitary gland by nerves). Craniopharyngiomas are usually part solid mass and part fluid filled cyst. They are benign (not cancer) and do not spread to other parts of the brain or to other parts of the body. However, they may grow and press on nearby parts of the brain or other areas, including the pituitary gland, the optic chiasm, optic nerves, and fluidfilled spaces in the brain. Craniopharyngiomas may affect many functions of the brain. They may affect hormone making, growth, and vision. Benign brain tumors need treatment. This summary is about the treatment of primary brain tumors (tumors that begin in the brain). Treatment for metastatic brain tumors, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not covered in this summary. See the PDQ treatment summary on Childhood Brain and Spinal Cord Tumors Treatment Overview for information about the different types of childhood brain and spinal cord tumors. Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. (See the PDQ summary on Adult Central Nervous System Tumors Treatment for more information.)</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Childhood Craniopharyngioma? ? [/INST] There are no known risk factors for childhood craniopharyngioma. Craniopharyngiomas are rare in children younger than 2 years of age and are most often diagnosed in children aged 5 to 14 years. It is not known what causes these tumors.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Childhood Craniopharyngioma ? [/INST] Signs of childhood craniopharyngioma include vision changes and slow growth. These and other signs and symptoms may be caused by craniopharyngiomas or by other conditions. Check with your childs doctor if your child has any of the following: Headaches, including morning headache or headache that goes away after vomiting. Vision changes. Nausea and vomiting. Loss of balance or trouble walking. Increase in thirst or urination. Unusual sleepiness or change in energy level. Changes in personality or behavior. Short stature or slow growth. Hearing loss. Weight gain.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Childhood Craniopharyngioma ? [/INST] Tests that examine the brain, vision, and hormone levels are used to detect (find) childhood craniopharyngiomas. 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 or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Neurological exam : A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a persons mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam. Visual field exam: An exam to check a persons field of vision (the total area in which objects can be seen). This test measures both central vision (how much a person can see when looking straight ahead) and peripheral vision (how much a person can see in all other directions while staring straight ahead). Any loss of vision may be a sign of a tumor that has damaged or pressed on the parts of the brain that affect eyesight. 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 xray 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) of the brain and spinal cord with gadolinium : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain. A substance called gadolinium is injected into a vein. The gadolinium collects around the tumor cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI). Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. Blood hormone studies: A procedure in which a blood sample is checked to measure the amounts of certain hormones released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it. For example, the blood may be checked for unusual levels of thyroidstimulating hormone (TSH) or adrenocorticotropic hormone (ACTH). TSH and ACTH are made by the pituitary gland in the brain. Childhood craniopharyngiomas are diagnosed and may be removed in the same surgery. Doctors may think a mass is a craniopharyngioma based on where it is in the brain and how it looks on a CT scan or MRI. In order to be sure, a sample of tissue is needed. One of the following types of biopsy procedures may be used to take the sample of tissue: Open biopsy: A hollow needle is inserted through a hole in the skull into the brain. Computerguided needle biopsy: A hollow needle guided by a computer is inserted through a small hole in the skull into the brain. Transsphenoidal biopsy: Instruments are inserted through the nose and sphenoid bone (a butterflyshaped bone at the base of the skull) and into the brain. A pathologist views the tissue under a microscope to look for tumor cells. If tumor cells are found, as much tumor as safely possible may be removed during the same surgery. The following laboratory test may be done on the sample of tissue that is removed: 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.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Childhood Craniopharyngioma ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: The size of the tumor. Where the tumor is in the brain. Whether there are tumor cells left after surgery. The child's age. Side effects that may occur months or years after treatment. Whether the tumor has just been diagnosed or has recurred (come back).</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Childhood Craniopharyngioma ? [/INST] The process used to find out if cancer has spread within the brain or to other parts of the body is called staging. There is no standard system for staging childhood craniopharyngioma. Craniopharyngioma is described as newly diagnosed disease or recurrent disease. The results of the tests and procedures done to diagnose craniopharyngioma are used to help make decisions about treatment.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Childhood Craniopharyngioma ? [/INST] 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 medical 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 diseases 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. Check the list of NCIsupported cancer clinical trials that are now accepting patients with childhood craniopharyngioma. 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 child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Patients can enter clinical trials before, during, or after starting their treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients who have not improved. There are also clinical trials that test new ways to stop a disease 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 clinical trials database.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Childhood Craniopharyngioma ? [/INST] There are different types of treatment for children with craniopharyngioma. Children with craniopharyngioma should have their treatment planned by a team of health care providers who are experts in treating brain tumors in children. Childhood brain tumors may cause signs or symptoms that begin before the cancer is diagnosed and continue for months or years. Some treatments for tumors cause side effects months or years after treatment has ended. Five types of treatment are used: Surgery (resection) Surgery and radiation therapy Surgery with cyst drainage Chemotherapy Biologic therapy Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their treatment. Followup tests may be needed. There are different types of treatment for children with craniopharyngioma. Different types of treatments are available for children with craniopharyngioma. 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 tumors. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Because tumors in children are rare, taking part in a clinical trial should be considered. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI website. Choosing the most appropriate treatment is a decision that ideally involves the patient, family, and health care team. Children with craniopharyngioma should have their treatment planned by a team of health care providers who are experts in treating brain tumors in children. Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with tumors. The pediatric oncologist works with other pediatric healthcare providers who are experts in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists: Pediatrician. Neurosurgeon. Radiation oncologist. Neurologist. Endocrinologist. Ophthalmologist. Rehabilitation specialist. Psychologist. Social worker. Nurse specialist. Childhood brain tumors may cause signs or symptoms that begin before the cancer is diagnosed and continue for months or years. Signs or symptoms caused by the tumor may begin before diagnosis and continue for months or years. It is important to talk with your child's doctors about signs or symptoms caused by the tumor that may continue after treatment. Some treatments for tumors cause side effects months or years after treatment has ended. Side effects from tumor treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of tumor treatment may include the following: Physical problems such as seizures. Behavior problems. Changes in mood, feelings, thinking, learning, or memory. Second cancers (new types of cancer). The following serious physical problems may occur if the pituitary gland, hypothalamus, optic nerves, or carotid artery are affected during surgery or radiation therapy: Obesity. Metabolic syndrome, including fatty liver disease not caused by drinking alcohol. Vision problems, including blindness. Blood vessel problems or stroke. Loss of the ability to make certain hormones. Some late effects may be treated or controlled. Lifelong hormone replacement therapy with several medicines may be needed. It is important to talk with your child's doctors about the effects tumor treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information). Five types of treatment are used: Surgery (resection) The way the surgery is done depends on the size of the tumor and where it is in the brain. It also depends on whether the tumor has grown into nearby tissue in a fingerlike way and expected late effects after surgery. The types of surgery that may be used to remove all of the tumor that can be seen with the eye include the following: Transsphenoidal surgery: A type of surgery in which the instruments are inserted into part of the brain by going through an incision (cut) made under the upper lip or at the bottom of the nose between the nostrils and then through the sphenoid bone (a butterflyshaped bone at the base of the skull). Craniotomy: Surgery to remove the tumor through an opening made in the skull. Sometimes all of the tumor that can be seen is removed in surgery and no further treatment is needed. At other times, it is hard to remove the tumor because it is growing into or pressing on nearby organs. If there is tumor remaining after the surgery, radiation therapy is usually given to kill any tumor cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. Surgery and radiation therapy Partial resection is used to treat some craniopharyngiomas. It is used to diagnose the tumor, remove fluid from a cyst, and relieve pressure on the optic nerves. If the tumor is near the pituitary gland or hypothalamus, it is not removed. This reduces the number of serious side effects after surgery. Partial resection is followed by radiation therapy. Radiation therapy is a tumor treatment that uses highenergy xrays 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 tumor, whether the tumor is newly diagnosed or has come back, and where the tumor formed in the brain. External and internal radiation therapy are used to treat childhood craniopharyngioma. Because radiation therapy to the brain can affect growth and development in young children, ways of giving radiation therapy that have fewer side effects are being used. These include: Stereotactic radiosurgery: For very small craniopharyngiomas at the base of the brain, stereotactic radiosurgery may be used. Stereotactic radiosurgery is a type of external radiation therapy. A rigid head frame is attached to the skull to keep the head still during the radiation treatment. A machine aims a single large dose of radiation directly at the tumor. This procedure does not involve surgery. It is also called stereotaxic radiosurgery, radiosurgery, and radiation surgery. Intracavitary radiation therapy: Intracavitary radiation therapy is a type of internal radiation therapy that may be used in tumors that are part solid mass and part fluidfilled cyst. Radioactive material is placed inside the tumor. This type of radiation therapy causes less damage to the nearby hypothalamus and optic nerves. Intensitymodulated proton therapy: A type of radiation therapy that uses streams of protons (tiny particles with a positive charge) to kill tumor cells. A computer is used to target the exact shape and location of the tumor with proton therapy. This type of 3dimensional radiation therapy may cause less damage to healthy tissue in the brain and other parts of the body. Proton radiation is different from xray radiation. Surgery with cyst drainage Surgery may be done to drain tumors that are mostly fluidfilled cysts. This lowers pressure in the brain and relieves symptoms. A catheter (thin tube) is inserted into the cyst and a small container is placed under the skin. The fluid drains into the container and is later removed. Sometimes, after the cyst is drained, a drug is put through the catheter into the cyst. This causes the inside wall of the cyst to scar and stops the cyst from making fluid or increases the amount of the time it takes for the fluid to build up again. Surgery to remove the tumor may be done after the cyst is drained. Chemotherapy Chemotherapy is a treatment that uses anticancer 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 or an organ, the drugs mainly affect tumor cells in those areas (regional chemotherapy). Intracavitary chemotherapy is a type of regional chemotherapy that places drugs directly into a cavity, such as a cyst. It is used for craniopharyngioma that has come back after treatment. 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. For craniopharyngioma that has come back after treatment, the biologic therapy drug is placed inside the tumor using a catheter (intracavitary) or in a vein (intravenous). 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 medical 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 diseases 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. Check the list of NCIsupported cancer clinical trials that are now accepting patients with childhood craniopharyngioma. 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 child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Patients can enter clinical trials before, during, or after starting their treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients who have not improved. There are also clinical trials that test new ways to stop a disease 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 clinical trials database. Followup tests may be needed. Some of the tests that were done to diagnose the disease or decide how to treat it 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. These tests are sometimes called followup tests or checkups. After treatment, followup testing with MRI will be done for several years to check if the tumor has come back. Treatment Options for Childhood Craniopharyngioma Newly Diagnosed Childhood Craniopharyngioma Treatment of newly diagnosed childhood craniopharyngioma may include the following: Surgery (resection) with or without radiation therapy. Partial resection followed by radiation therapy. Cyst drainage with or without radiation therapy or surgery. Check the list of NCIsupported cancer clinical trials that are now accepting patients with childhood craniopharyngioma. 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 child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Recurrent Childhood Craniopharyngioma Craniopharyngioma may recur (come back) no matter how it was treated the first time. Treatment options for recurrent childhood craniopharyngioma depend on the type of treatment that was given when the tumor was first diagnosed and the needs of the child. Treatment may include the following: Surgery (resection). Externalbeam radiation therapy. Stereotactic radiosurgery. Intracavitary radiation therapy. Intracavitary chemotherapy or intracavitary biologic therapy. Intravenous biologic therapy. Cyst drainage. A clinical trial of biologic therapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with childhood craniopharyngioma. 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 child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Melanoma ? [/INST] Melanoma is a disease in which malignant (cancer) cells form in melanocytes (cells that color the skin). There are different types of cancer that start in the skin. Melanoma can occur anywhere on the skin. Unusual moles, exposure to sunlight, and health history can affect the risk of melanoma. Signs of melanoma include a change in the way a mole or pigmented area looks. Tests that examine the skin are used to detect (find) and diagnose melanoma. Certain factors affect prognosis (chance of recovery) and treatment options. Melanoma is a disease in which malignant (cancer) cells form in melanocytes (cells that color the skin). The skin is the bodys largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of three kinds of cells: Squamous cells: Thin, flat cells that form the top layer of the epidermis. Basal cells: Round cells under the squamous cells. Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural color. When skin is exposed to the sun or artificial light, melanocytes make more pigment and cause the skin to darken. The number of new cases of melanoma has been increasing over the last 40 years. Melanoma is most common in adults, but it is sometimes found in children and adolescents. (See the PDQ summary on Unusual Cancers of Childhood Treatment for more information on melanoma in children and adolescents.) There are different types of cancer that start in the skin. There are two forms of skin cancer: melanoma and nonmelanoma. Melanoma is a rare form of skin cancer. It is more likely to invade nearby tissues and spread to other parts of the body than other types of skin cancer. When melanoma starts in the skin, it is called cutaneous melanoma. Melanoma may also occur in mucous membranes (thin, moist layers of tissue that cover surfaces such as the lips). This PDQ summary is about cutaneous (skin) melanoma and melanoma that affects the mucous membranes. The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. They are nonmelanoma skin cancers. Nonmelanoma skin cancers rarely spread to other parts of the body. (See the PDQ summary on Skin Cancer Treatment for more information on basal cell and squamous cell skin cancer.) Melanoma can occur anywhere on the skin. In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma forms most often on the arms and legs. When melanoma occurs in the eye, it is called intraocular or ocular melanoma. (See the PDQ summary on Intraocular (Uveal) Melanoma Treatment for more information.)</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Melanoma? ? [/INST] Unusual moles, exposure to sunlight, and health history can affect the risk of melanoma. 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 melanoma include the following: Having a fair complexion, which includes the following: Fair skin that freckles and burns easily, does not tan, or tans poorly. Blue or green or other lightcolored eyes. Red or blond hair. Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time. Being exposed to certain factors in the environment (in the air, your home or workplace, and your food and water). Some of the environmental risk factors for melanoma are radiation, solvents, vinyl chloride, and PCBs. Having a history of many blistering sunburns, especially as a child or teenager. Having several large or many small moles. Having a family history of unusual moles (atypical nevus syndrome). Having a family or personal history of melanoma. Being white. Having a weakened immune system. Having certain changes in the genes that are linked to melanoma. Being white or having a fair complexion increases the risk of melanoma, but anyone can have melanoma, including people with dark skin. See the following PDQ summaries for more information on risk factors for melanoma: Genetics of Skin Cancer Skin Cancer Prevention</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Melanoma ? [/INST] Signs of melanoma include a change in the way a mole or pigmented area looks. These and other signs and symptoms may be caused by melanoma or by other conditions. Check with your doctor if you have any of the following: A mole that: changes in size, shape, or color. has irregular edges or borders. is more than one color. is asymmetrical (if the mole is divided in half, the 2 halves are different in size or shape). itches. oozes, bleeds, or is ulcerated (a hole forms in the skin when the top layer of cells breaks down and the tissue below shows through). A change in pigmented (colored) skin. Satellite moles (new moles that grow near an existing mole). For pictures and descriptions of common moles and melanoma, see Common Moles, Dysplastic Nevi, and Risk of Melanoma.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Melanoma ? [/INST] Tests that examine the skin are used to detect (find) and diagnose melanoma. If a mole or pigmented area of the skin changes or looks abnormal, the following tests and procedures can help find and diagnose melanoma: Skin exam: A doctor or nurse checks the skin for moles, birthmarks, or other pigmented areas that look abnormal in color, size, shape, or texture. Biopsy : A procedure to remove the abnormal tissue and a small amount of normal tissue around it. A pathologist looks at the tissue under a microscope to check for cancer cells. It can be hard to tell the difference between a colored mole and an early melanoma lesion. Patients may want to have the sample of tissue checked by a second pathologist. If the abnormal mole or lesion is cancer, the sample of tissue may also be tested for certain gene changes. It is important that abnormal areas of the skin not be shaved off or cauterized (destroyed with a hot instrument, an electric current, or a caustic substance) because cancer cells that remain may grow and spread. See the PDQ summary on Skin Cancer Screening for more information.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Melanoma ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: The thickness of the tumor and where it is in the body. How quickly the cancer cells are dividing. Whether there was bleeding or ulceration of the tumor. How much cancer is in the lymph nodes. The number of places cancer has spread to in the body. The level of lactate dehydrogenase (LDH) in the blood. Whether the cancer has certain mutations (changes) in a gene called BRAF. The patients age and general health.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Melanoma ? [/INST] After melanoma has been diagnosed, tests are done to find out if cancer cells have spread within the skin 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 method used to stage melanoma is based mainly on the thickness of the tumor and whether cancer has spread to lymph nodes or other parts of the body. The following stages are used for melanoma: Stage 0 (Melanoma in Situ) Stage I Stage II Stage III Stage IV After melanoma has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body. The process used to find out whether cancer has spread within the skin 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: 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. Lymph node mapping and sentinel lymph node biopsy : Procedures in which a radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through lymph ducts to the sentinel node or nodes (the first lymph node or nodes where cancer cells are likely to spread). The surgeon removes only the nodes with the radioactive substance or dye. A pathologist views a sample of tissue under a microscope to check for cancer cells. If no cancer cells are found, it may not be necessary to remove more nodes. 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 xray 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. For melanoma, pictures may be taken of the chest, abdomen, and pelvis. 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. MRI (magnetic resonance imaging) with gadolinium : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the brain. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI). Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. For melanoma, the blood is checked for an enzyme called lactate dehydrogenase (LDH). LDH levels that are higher than normal may be a sign of melanoma. The results of these tests are viewed together with the results of the tumor biopsy to find out the stage of the melanoma. 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 melanoma spreads to the lung, the cancer cells in the lung are actually melanoma cells. The disease is metastatic melanoma, not lung cancer. The method used to stage melanoma is based mainly on the thickness of the tumor and whether cancer has spread to lymph nodes or other parts of the body. The staging of melanoma depends on the following: The thickness of the tumor. The thickness is described using the Breslow scale. Whether the tumor is ulcerated (has broken through the skin). Whether the tumor has spread to the lymph nodes and if the lymph nodes are joined together (matted). Whether the tumor has spread to other parts of the body. The following stages are used for melanoma: Stage 0 (Melanoma in Situ) In stage 0, abnormal melanocytes are found in the epidermis. These abnormal melanocytes may become cancer and spread into nearby normal tissue. Stage 0 is also called melanoma in situ. Stage I In stage I, cancer has formed. Stage I is divided into stages IA and IB. Stage IA: In stage IA, the tumor is not more than 1 millimeter thick, with no ulceration. Stage IB: In stage IB, the tumor is either: not more than 1 millimeter thick and it has ulceration; or more than 1 but not more than 2 millimeters thick, with no ulceration. Stage II Stage II is divided into stages IIA, IIB, and IIC. Stage IIA: In stage IIA, the tumor is either: more than 1 but not more than 2 millimeters thick, with ulceration; or more than 2 but not more than 4 millimeters thick, with no ulceration. Stage IIB: In stage IIB, the tumor is either: more than 2 but not more than 4 millimeters thick, with ulceration; or more than 4 millimeters thick, with no ulceration. Stage IIC: In stage IIC, the tumor is more than 4 millimeters thick, with ulceration. Stage III In stage III, the tumor may be any thickness, with or without ulceration. One or more of the following is true: Cancer has spread to one or more lymph nodes. Lymph nodes are joined together (matted). Cancer is in a lymph vessel between the primary tumor and nearby lymph nodes. The cancer is more than 2 centimeters away from the primary tumor. Very small tumors are found on or under the skin, not more than 2 centimeters away from the primary tumor. Stage IV In stage IV, the cancer has spread to other places in the body, such as the lung, liver, brain, bone, soft tissue, or gastrointestinal (GI) tract. Cancer may have spread to places in the skin far away from where it first started.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Melanoma ? [/INST] There are different types of treatment for patients with melanoma. Five types of standard treatment are used: Surgery Chemotherapy Radiation therapy Immunotherapy Targeted therapy New types of treatment are being tested in clinical trials. Treatment for melanoma may cause side effects. 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. Followup tests may be needed. There are different types of treatment for patients with melanoma. Different types of treatment are available for patients with melanoma. 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. Five types of standard treatment are used: Surgery Surgery to remove the tumor is the primary treatment of all stages of melanoma. A wide local excision is used to remove the melanoma and some of the normal tissue around it. Skin grafting (taking skin from another part of the body to replace the skin that is removed) may be done to cover the wound caused by surgery. It is important to know whether cancer has spread to the lymph nodes. Lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. 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 found, more lymph nodes will be removed and tissue samples will be checked for signs of cancer. This is called a lymphadenectomy. Even if the doctor removes all the melanoma that can be seen at the time of surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. Surgery to remove cancer that has spread to the lymph nodes, lung, gastrointestinal (GI) tract, bone, or brain may be done to improve the patients quality of life by controlling symptoms. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer 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 cancer 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 cancer cells in those areas (regional chemotherapy). One type of regional chemotherapy is hyperthermic isolated limb perfusion. With this method, anticancer drugs go directly to the arm or leg the cancer is in. The flow of blood to and from the limb is temporarily stopped with a tourniquet. A warm solution with the anticancer drug is put directly into the blood of the limb. This gives a high dose of drugs to the area where the cancer is. The way the chemotherapy is given depends on the type and stage of the cancer being treated. See Drugs Approved for Melanoma for more information. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays 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 radiation therapy is used to treat melanoma, and may also be used as palliative therapy to relieve symptoms and improve quality of life. Immunotherapy Immunotherapy 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 biologic therapy. The following types of immunotherapy are being used in the treatment of melanoma: Immune checkpoint inhibitor therapy: Some types of immune cells, such as T cells, and some cancer cells have certain proteins, called checkpoint proteins, on their surface that keep immune responses in check. When cancer cells have large amounts of these proteins, they will not be attacked and killed by T cells. Immune checkpoint inhibitors block these proteins and the ability of T cells to kill cancer cells is increased. They are used to treat some patients with advanced melanoma or tumors that cannot be removed by surgery. There are two types of immune checkpoint inhibitor therapy: CTLA4 inhibitor: CTL4A is a protein on the surface of T cells that helps keep the bodys immune responses in check. When CTLA4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell. CTLA4 inhibitors attach to CTLA4 and allow the T cells to kill cancer cells. Ipilimumab is a type of CTLA4 inhibitor. PD1 inhibitor: PD1 is a protein on the surface of T cells that helps keep the bodys immune responses in check. When PD1 attaches to another protein called PDL1 on a cancer cell, it stops the T cell from killing the cancer cell. PD1 inhibitors attach to PDL1 and allow the T cells to kill cancer cells. Pembrolizumab and nivolumab are types of PD1 inhibitors. Interferon: Interferon affects the division of cancer cells and can slow tumor growth. Interleukin2 (IL2): IL2 boosts the growth and activity of many immune cells, especially lymphocytes (a type of white blood cell). Lymphocytes can attack and kill cancer cells. Tumor necrosis factor (TNF) therapy: TNF is a protein made by white blood cells in response to an antigen or infection. TNF is made in the laboratory and used as a treatment to kill cancer cells. It is being studied in the treatment of melanoma. See Drugs Approved for Melanoma for more information. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. The following types of targeted therapy are used or being studied in the treatment of melanoma: Signal transduction inhibitor therapy: Signal transduction inhibitors block signals that are passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells. Vemurafenib, dabrafenib, trametinib, and cobimetinib are signal transduction inhibitors used to treat some patients with advanced melanoma or tumors that cannot be removed by surgery. Vemurafenib and dabrafenib block the activity of proteins made by mutant BRAF genes. Trametinib and cobimetinib affect the growth and survival of cancer cells. Oncolytic virus therapy: A type of targeted therapy that is used in the treatment of melanoma. Oncolytic virus therapy uses a virus that infects and breaks down cancer cells but not normal cells. Radiation therapy or chemotherapy may be given after oncolytic virus therapy to kill more cancer cells. Angiogenesis inhibitors: A type of targeted therapy that is being studied in the treatment of melanoma. Angiogenesis inhibitors block the growth of new blood vessels. In cancer treatment, they may be given to prevent the growth of new blood vessels that tumors need to grow. New targeted therapies and combinations of therapies are being studied in the treatment of melanoma. See Drugs Approved for Melanoma for more information. New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website Treatment for melanoma may cause side effects. For information about side effects caused by treatment for cancer, see our Side Effects page. 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. Followup 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 followup tests or checkups. Treatment Options by Stage Stage 0 (Melanoma in Situ) Treatment of stage 0 is usually surgery to remove the area of abnormal cells and a small amount of normal tissue around it. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage 0 melanoma. 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 I Melanoma Treatment of stage I melanoma may include the following: Surgery to remove the tumor and some of the normal tissue around it. Sometimes lymph node mapping and removal of lymph nodes is also done. A clinical trial of new ways to find cancer cells in the lymph nodes. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage I melanoma. 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 Melanoma Treatment of stage II melanoma may include the following: Surgery to remove the tumor and some of the normal tissue around it. Sometimes lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the lymph nodes at the same time as the surgery to remove the tumor. If cancer is found in the sentinel lymph node, more lymph nodes may be removed. Surgery followed by immunotherapy with interferon if there is a high risk that the cancer will come back. A clinical trial of new types of treatment to be used after surgery. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage II melanoma. 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 Melanoma That Can Be Removed By Surgery Treatment of stage III melanoma that can be removed by surgery may include the following: Surgery to remove the tumor and some of the normal tissue around it. Skin grafting may be done to cover the wound caused by surgery. Sometimes lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the lymph nodes at the same time as the surgery to remove the tumor. If cancer is found in the sentinel lymph node, more lymph nodes may be removed. Surgery followed by immunotherapy with ipilimumab or interferon if there is a high risk that the cancer will come back. A clinical trial of immunotherapy or targeted therapy to be used after surgery. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage III melanoma. 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 Melanoma That Cannot Be Removed By Surgery, Stage IV Melanoma, and Recurrent Melanoma Treatment of stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma may include the following: Immunotherapy with ipilimumab, pembrolizumab, nivolumab, or interleukin2 (IL2). Sometimes ipilimumab and nivolumab are given together. Targeted therapy with vemurafenib, dabrafenib, trametinib, or cobimetinib. Sometimes vemurafenib and cobimetinib or dabrafenib and trametinib are given together. Injections into the tumor, such as oncolytic virus therapy. Chemotherapy. Palliative therapy to relieve symptoms and improve the quality of life. This may include: Surgery to remove lymph nodes or tumors in the lung, gastrointestinal (GI) tract, bone, or brain. Radiation therapy to the brain, spinal cord, or bone. Treatments that are being studied in clinical trials for stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma include the following: Immunotherapy alone or in combination with other therapies such as targeted therapy. Targeted therapy, such as signal transduction inhibitors, angiogenesis inhibitors, oncolytic virus therapy, or drugs that target certain gene mutations. These may be given alone or in combination. Surgery to remove all known cancer. Regional chemotherapy (hyperthermic isolated limb perfusion). Some patients may also have immunotherapy with tumor necrosis factor. Systemic chemotherapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage IV melanoma and recurrent melanoma. 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Melanoma ? [/INST] New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website Treatment for melanoma may cause side effects. For information about side effects caused by treatment for cancer, see our Side Effects page. 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. Followup 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 followup tests or checkups.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Colorectal Cancer ? [/INST] Colorectal cancer is a disease in which malignant (cancer) cells form in the tissues of the colon or the rectum. Colorectal cancer is the second leading cause of death from cancer in the United States. Different factors increase or decrease the risk of getting colorectal cancer. Colorectal cancer is a disease in which malignant (cancer) cells form in the tissues of the colon or the rectum. The colon and rectum are parts of the body's digestive system. The digestive system removes and processes 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 mouth, throat, 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 68 inches long. The anal canal ends at the anus (the opening of the large intestine to the outside of the body). Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer. Cancer that begins in either of these organs may also be called colorectal cancer. See the following PDQ summaries for more information about colorectal cancer: Colorectal Cancer Prevention Colon Cancer Treatment Rectal Cancer Treatment Genetics of Colorectal Cancer Colorectal cancer is the second leading cause of death from cancer in the United States. The number of new colorectal cancer cases and the number of deaths from colorectal cancer are decreasing a little bit each year. But in adults younger than 50 years, there has been a small increase in the number of new cases each year since 1998. Colorectal cancer is found more often in men than in women.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Colorectal Cancer? ? [/INST] Different factors increase or decrease the risk of getting colorectal cancer. Anything that increases your chance of getting a disease is called a risk factor. Anything that decreases your chance of getting a disease is called a protective factor. For information about risk factors and protective factors for colorectal cancer, see the PDQ summary on Colorectal Cancer Prevention.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Merkel Cell Carcinoma ? [/INST] Merkel cell carcinoma is a very rare disease in which malignant (cancer) cells form in the skin. Sun exposure and having a weak immune system can affect the risk of Merkel cell carcinoma. Merkel cell carcinoma usually appears as a single painless lump on sunexposed skin. Tests and procedures that examine the skin are used to detect (find) and diagnose Merkel cell carcinoma. Certain factors affect prognosis (chance of recovery) and treatment options. Merkel cell carcinoma is a very rare disease in which malignant (cancer) cells form in the skin. Merkel cells are found in the top layer of the skin. These cells are very close to the nerve endings that receive the sensation of touch. Merkel cell carcinoma, also called neuroendocrine carcinoma of the skin or trabecular cancer, is a very rare type of skin cancer that forms when Merkel cells grow out of control. Merkel cell carcinoma starts most often in areas of skin exposed to the sun, especially the head and neck, as well as the arms, legs, and trunk. Merkel cell carcinoma tends to grow quickly and to metastasize (spread) at an early stage. It usually spreads first to nearby lymph nodes and then may spread to lymph nodes or skin in distant parts of the body, lungs, brain, bones, or other organs.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Merkel Cell Carcinoma? ? [/INST] un exposure and having a weak immune system can affect the risk of Merkel cell carcinoma. 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 Merkel cell carcinoma include the following: Being exposed to a lot of natural sunlight. Being exposed to artificial sunlight, such as from tanning beds or psoralen and ultraviolet A (PUVA) therapy for psoriasis. Having an immune system weakened by disease, such as chronic lymphocytic leukemia or HIV infection. Taking drugs that make the immune system less active, such as after an organ transplant. Having a history of other types of cancer. Being older than 50 years, male, or white.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Merkel Cell Carcinoma ? [/INST] Merkel cell carcinoma usually appears as a single painless lump on sunexposed skin. This and other changes in the skin may be caused by Merkel cell carcinoma or by other conditions. Check with your doctor if you see changes in your skin. Merkel cell carcinoma usually appears on sunexposed skin as a single lump that is: Fastgrowing. Painless. Firm and domeshaped or raised. Red or violet in color.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Merkel Cell Carcinoma ? [/INST] Tests and procedures that examine the skin are used to detect (find) and diagnose Merkel cell carcinoma. 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 or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Fullbody skin exam: A doctor or nurse checks the skin for bumps or spots that look abnormal in color, size, shape, or texture. The size, shape, and texture of the lymph nodes will also be checked. Skin biopsy : The removal of skin cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Merkel Cell Carcinoma ? [/INST] 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 size of the tumor and whether it has spread to the lymph nodes or other parts of the body). Where the cancer is in the body. Whether the cancer has just been diagnosed or has recurred (come back). The patient's age and general health. Prognosis also depends on how deeply the tumor has grown into the skin.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Merkel Cell Carcinoma ? [/INST] After Merkel cell carcinoma has been diagnosed, tests are done to find out if cancer cells have spread 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 Merkel cell carcinoma: Stage 0 (carcinoma in situ) Stage IA Stage IB Stage IIA Stage IIB Stage IIC Stage IIIA Stage IIIB Stage IV After Merkel cell carcinoma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. The process used to find out if cancer has spread 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: 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 xray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. A CT scan of the chest and abdomen may be used to check for primary small cell lung cancer, or to find Merkel cell carcinoma that has spread. A CT scan of the head and neck may also be used to find Merkel cell carcinoma that has spread to the lymph nodes. 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. Lymph node biopsy : There are two main types of lymph node biopsy used to stage Merkel cell carcinoma. 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. Lymph node dissection : A surgical procedure in which the lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer. For a regional lymph node dissection, some of the lymph nodes in the tumor area are removed. For a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed. This procedure is also called lymphadenectomy. 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. 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 Merkel cell carcinoma spreads to the liver, the cancer cells in the liver are actually cancerous Merkel cells. The disease is metastatic Merkel cell carcinoma, not liver cancer. The following stages are used for Merkel cell carcinoma: Stage 0 (carcinoma in situ) In stage 0, the tumor is a group of abnormal cells that remain in the place where they first formed and have not spread. These abnormal cells may become cancer and spread to lymph nodes or distant parts of the body. Stage IA In stage IA, the tumor is 2 centimeters or smaller at its widest point and no cancer is found when the lymph nodes are checked under a microscope. Stage IB In stage IB, the tumor is 2 centimeters or smaller at its widest point and no swollen lymph nodes are found by a physical exam or imaging tests. Stage IIA In stage IIA, the tumor is larger than 2 centimeters and no cancer is found when the lymph nodes are checked under a microscope. Stage IIB In stage IIB, the tumor is larger than 2 centimeters and no swollen lymph nodes are found by a physical exam or imaging tests. Stage IIC In stage IIC, the tumor may be any size and has spread to nearby bone, muscle, connective tissue, or cartilage. It has not spread to lymph nodes or distant parts of the body. Stage IIIA In stage IIIA, the tumor may be any size and may have spread to nearby bone, muscle, connective tissue, or cartilage. Cancer is found in the lymph nodes when they are checked under a microscope. Stage IIIB In stage IIIB, the tumor may be any size and may have spread to nearby bone, muscle, connective tissue, or cartilage. Cancer has spread to the lymph nodes near the tumor and is found by a physical exam or imaging test. The lymph nodes are removed and cancer is found in the lymph nodes when they are checked under a microscope. There may also be a second tumor, which is either: Between the primary tumor and nearby lymph nodes; or Farther away from the center of the body than the primary tumor is. Stage IV In stage IV, the tumor may be any size and has spread to distant parts of the body, such as the liver, lung, bone, or brain.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Merkel Cell Carcinoma ? [/INST] There are different types of treatment for patients with Merkel cell carcinoma. Three types of standard treatment are used: Surgery Radiation therapy Chemotherapy New types of treatment are being tested in clinical trials. Treatment for Merkel cell carcinoma may cause side effects. 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. Followup tests may be needed. There are different types of treatment for patients with Merkel cell carcinoma. Different types of treatments are available for patients with Merkel cell carcinoma. 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. Three types of standard treatment are used: Surgery One or more of the following surgical procedures may be used to treat Merkel cell carcinoma: Wide local excision: The cancer is cut from the skin along with some of the tissue around it. A sentinel lymph node biopsy may be done during the wide local excision procedure. If there is cancer in the lymph nodes, a lymph node dissection also may be done. Lymph node dissection: A surgical procedure in which the lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer. For a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; for a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed. This procedure is also called lymphadenectomy. 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 cancer will come back, is called adjuvant therapy. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays 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 radiation therapy is used to treat Merkel cell carcinoma, and 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, or a body cavity such as the abdomen, 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. New types of treatment are being tested in clinical trials. Treatment for Merkel cell carcinoma may cause side effects. For information about side effects caused by treatment for cancer, see our Side Effects page. 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. Followup 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 followup tests or checkups. Treatment Options by Stage Stage I and Stage II Merkel Cell Carcinoma Treatment of stage I and stage II Merkel cell carcinoma may include the following: Surgery to remove the tumor, such as wide local excision with or without lymph node dissection. Radiation therapy after surgery. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage I neuroendocrine carcinoma of the skin and stage II neuroendocrine carcinoma of the skin. 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 Merkel Cell Carcinoma Treatment of stage III Merkel cell carcinoma may include the following: Wide local excision with or without lymph node dissection. Radiation therapy. A clinical trial of chemotherapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage III neuroendocrine carcinoma of the skin. 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 Merkel Cell Carcinoma Treatment of stage IV Merkel cell carcinoma may include the following as palliative treatment to relieve symptoms and improve quality of life: Chemotherapy. Surgery. Radiation therapy. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage IV neuroendocrine carcinoma of the skin. 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Merkel Cell Carcinoma ? [/INST] New types of treatment are being tested in clinical trials. 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Childhood Ependymoma ? [/INST] Childhood ependymoma is a disease in which malignant (cancer) cells form in the tissues of the brain and spinal cord. There are different types of ependymomas. The part of the brain that is affected depends on where the ependymoma forms. The cause of most childhood brain tumors is unknown. The signs and symptoms of childhood ependymoma are not the same in every child. Tests that examine the brain and spinal cord are used to detect (find) childhood ependymoma. Childhood ependymoma is diagnosed and removed in surgery. Certain factors affect prognosis (chance of recovery) and treatment options. Childhood ependymoma is a disease in which malignant (cancer) cells form in the tissues of the brain and spinal cord. The brain controls vital functions such as memory and learning, emotion, and the senses (hearing, sight, smell, taste, and touch). The spinal cord is made up of bundles of nerve fibers that connect the brain with nerves in most parts of the body. Ependymomas form from ependymal cells that line the ventricles and passageways in the brain and the spinal cord. Ependymal cells make cerebrospinal fluid (CSF). This summary is about the treatment of primary brain tumors (tumors that begin in the brain). Treatment of metastatic brain tumors, which are tumors that begin in other parts of the body and spread to the brain, is not discussed in this summary. There are many different types of brain tumors. Brain tumors can occur in both children and adults. However, treatment for children is different than treatment for adults. See the following PDQ summaries for more information: Childhood Brain and Spinal Cord Tumors Treatment Overview Adult Central Nervous System Tumors Treatment There are different types of ependymomas. The World Health Organization (WHO) groups ependymal tumors into five main subtypes: Subependymoma (WHO Grade I). Myxopapillary ependymoma (WHO Grade I). Ependymoma (WHO Grade II). RELA fusionpositive ependymoma (WHO Grade II or Grade III with change in the RELA gene). Anaplastic ependymoma (WHO Grade III). The grade of a tumor describes how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Lowgrade (Grade I) cancer cells look more like normal cells than highgrade cancer cells (Grade II and III). They also tend to grow and spread more slowly than Grade II and III cancer cells. The part of the brain that is affected depends on where the ependymoma forms. Ependymomas can form anywhere in the fluid filled ventricles and passageways in the brain and spinal cord. Most ependymomas form in the fourth ventricle and affect the cerebellum and the brain stem. Once an ependymoma forms, areas of the brain that may be affected include: Cerebrum: The largest part of the brain, at the top of the head. The cerebrum controls thinking, learning, problemsolving, speech, emotions, reading, writing, and voluntary movement. Cerebellum: The lower, back part of the brain (near the middle of the back of the head). The cerebellum controls movement, balance, and posture. Brain stem: The part that connects the brain to the spinal cord, in the lowest part of the brain (just above the back of the neck). The brain stem controls breathing, heart rate, and the nerves and muscles used in seeing, hearing, walking, talking, and eating. Spinal cord: The column of nerve tissue that runs from the brain stem down the center of the back. It is covered by three thin layers of tissue called membranes. The spinal cord and membranes are surrounded by the vertebrae (back bones). Spinal cord nerves carry messages between the brain and the rest of the body, such as a message from the brain to cause muscles to move or a message from the skin to the brain to feel touch.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What causes Childhood Ependymoma ? [/INST] The cause of most childhood brain tumors is unknown.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Childhood Ependymoma ? [/INST] The signs and symptoms of childhood ependymoma are not the same in every child. Signs and symptoms depend on the following: The child's age. Where the tumor has formed. Signs and symptoms may be caused by childhood ependymoma or by other conditions. Check with your child's doctor if your child has any of the following: Frequent headaches. Seizures. Nausea and vomiting. Pain or stiffness in the neck. Loss of balance or trouble walking. Weakness in the legs. Blurry vision. Back pain. A change in bowel function. Trouble urinating. Confusion or irritability.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Childhood Ependymoma ? [/INST] Tests that examine the brain and spinal cord are used to detect (find) childhood ependymoma. 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 or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Neurological exam : A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a persons mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam. MRI (magnetic resonance imaging) with gadolinium : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into a vein and travels through the bloodstream. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI). Lumbar puncture : A procedure used to collect cerebrospinal fluid (CSF) from the spinal column. This is done by placing a needle between two bones in the spine and into the CSF around the spinal cord and removing a sample of fluid. The sample of CSF is checked under a microscope for signs of tumor cells. The sample may also be checked for the amounts of protein and glucose. A higher than normal amount of protein or lower than normal amount of glucose may be a sign of a tumor. This procedure is also called an LP or spinal tap. Childhood ependymoma is diagnosed and removed in surgery. If the diagnostic tests show there may be a brain tumor, a biopsy is done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery. The following test may be done on the tissue that was removed: 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 brain stem glioma and other brain tumors. An MRI is often done after the tumor is removed to find out whether any tumor remains.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Childhood Ependymoma ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on: Where the tumor has formed in the central nervous system (CNS). Whether there are certain changes in the genes or chromosomes. Whether any cancer cells remain after surgery to remove the tumor. The type of ependymoma. The age of the child when the tumor is diagnosed. Whether the cancer has spread to other parts of the brain or spinal cord. Whether the tumor has just been diagnosed or has recurred (come back). Prognosis also depends on the type and dose of radiation therapy that is given.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Childhood Ependymoma ? [/INST] 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Childhood Ependymoma ? [/INST] The area where the tumor is found and the childs age are used in place of a staging system to plan cancer treatment. The information from tests and procedures done to detect (find) childhood ependymoma is used to plan cancer treatment. The area where the tumor is found and the childs age are used in place of a staging system to plan cancer treatment. Staging is the process used to find out how much cancer there is and if cancer has spread. There is no standard staging system for childhood ependymoma. Treatment is based on where the cancer is in the body and the age of the child. The information from tests and procedures done to detect (find) childhood ependymoma is used to plan cancer treatment. Some of the tests used to detect childhood ependymoma are repeated after the tumor is removed by surgery. (See the General Information section.) This is to find out how much tumor remains after surgery.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Childhood Ependymoma ? [/INST] There are different types of treatment for children with ependymoma. Children with ependymoma should have their treatment planned by a team of health care providers who are experts in treating childhood brain tumors. Childhood brain and spinal cord tumors may cause signs or symptoms that begin before the cancer is diagnosed and continue for months or years. Some cancer treatments cause side effects months or years after treatment has ended. Four types of standard treatment are used: Surgery Radiation therapy Chemotherapy 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. Followup tests may be needed. There are different types of treatment for children with ependymoma. Different types of treatment are available for children with ependymoma. 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. Because cancer in children is 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 ependymoma should have their treatment planned by a team of health care providers who are experts in treating childhood brain tumors. 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 brain tumors and who specialize in certain areas of medicine. These may include the following specialists: Pediatric neurosurgeon. Neurologist. Neuropathologist. Neuroradiologist. Pediatrician. Rehabilitation specialist. Radiation oncologist. Medical oncologist. Endocrinologist. Psychologist. Childhood brain and spinal cord tumors may cause signs or symptoms that begin before the cancer is diagnosed and continue for months or years. Childhood brain and spinal cord tumors may cause signs or symptoms that continue for months or years. Signs or symptoms caused by the tumor may begin before diagnosis. Signs or symptoms caused by treatment may begin during or right after treatment. Some cancer treatments cause side effects months or years after treatment has ended. These are called late effects. Late effects of cancer treatment may include the following: 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 effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information). Four types of standard treatment are used: Surgery If the results of diagnostic tests show there may be a brain tumor, a biopsy is done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to check for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery. An MRI is often done after the tumor is removed to find out whether any tumor remains. If tumor remains, a second surgery to remove as much of the remaining tumor as possible may be done. 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 to lower the risk that the cancer will come back after surgery is called adjuvant therapy. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays 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. Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy tissue. These types of radiation therapy include the following: Conformal radiation therapy: Conformal radiation therapy is a type of external radiation therapy that uses a computer to make a 3dimensional (3D) picture of the tumor and shapes the radiation beams to fit the tumor. Intensitymodulated radiation therapy (IMRT): IMRT is a type of 3dimensional (3D) radiation therapy that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles. Protonbeam radiation therapy: Protonbeam therapy is a type of highenergy, external radiation therapy. A radiation therapy machine aims streams of protons (tiny, invisible, positivelycharged particles) at the cancer cells to kill them. Stereotactic radiosurgery: Stereotactic radiosurgery is a type of external radiation therapy. A rigid head frame is attached to the skull to keep the head still during the radiation treatment. A machine aims a single large dose of radiation directly at the tumor. This procedure does not involve surgery. It is also called stereotaxic radiosurgery, radiosurgery, and radiation surgery. 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 of cancer being treated. External radiation therapy is used to treat childhood ependymoma. Children younger than 3 years who receive radiation therapy to the brain have a higher risk of problems with growth and development than older children. 3D conformal radiation therapy and protonbeam therapy are being studied in children younger than 3 years to see if the effects of radiation on growth and development are lessened. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer 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 cancer 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 cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type of cancer being treated. Observation Observation is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Observation may be used to treat a child with a subependymoma who has no symptoms and whose tumor is found while treating another condition. 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. Followup 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 child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. Followup tests for childhood ependymoma include an MRI (magnetic resonance imaging) of the brain and spinal cord every 3 months for the first 1 or 2 years after treatment. After 2 years, MRIs may be done every 6 months for the next 3 years. Treatment Options for Childhood Ependymoma Newly Diagnosed Childhood Ependymoma A child with a newly diagnosed ependymoma has not had treatment for the tumor. The child may have had treatment to relieve signs or symptoms caused by the tumor. Subependymoma Treatment of newly diagnosed subependymoma (WHO Grade I) is: Surgery. Observation (rarely). Myxopapillary ependymoma Treatment of newly diagnosed myxopapillary ependymoma (WHO Grade I) is: Surgery with or without radiation therapy. Childhood ependymoma, anaplastic ependymoma, or RELA fusionpositive ependymoma Treatment of newly diagnosed childhood ependymoma (WHO Grade II), anaplastic ependymoma (WHO Grade III), or RELA fusionpositive ependymoma (WHO Grade II or Grade III) is: Surgery. After surgery, the plan for further treatment depends on the following: Whether any cancer cells remain after surgery. Whether the cancer has spread to other parts of the brain or spinal cord. The age of the child. When the tumor is completely removed and cancer cells have not spread, treatment may include the following: Radiation therapy. A clinical trial of radiation therapy followed by chemotherapy. A clinical trial of observation for patients whose tumor is completely removed or who have no sign of cancer after chemotherapy. When part of the tumor remains after surgery, but cancer cells have not spread, treatment may include the following: A second surgery to remove as much of the remaining tumor as possible. Radiation therapy. Chemotherapy followed by radiation therapy. A clinical trial of chemotherapy given before and after radiation therapy. When cancer cells have spread within the brain and spinal cord, treatment may include the following: Radiation therapy to the brain and spinal cord. Treatment for children younger than 3 years of age may include the following: Chemotherapy. Radiation therapy. A clinical trial of 3dimensional (3D) conformal radiation therapy or protonbeam radiation therapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with newly diagnosed childhood ependymoma. 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 child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Recurrent Childhood Ependymoma Treatment of recurrent childhood ependymoma may include the following: Surgery. Radiation therapy, which may include stereotactic radiosurgery, intensitymodulated radiation therapy, or protonbeam radiation therapy. Chemotherapy. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with recurrent childhood ependymoma. 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 child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Intraocular (Uveal) Melanoma ? [/INST] Intraocular melanoma is a disease in which malignant (cancer) cells form in the tissues of the eye. Being older and having fair skin may increase the risk of intraocular melanoma. Signs of intraocular melanoma include blurred vision or a dark spot on the iris. Tests that examine the eye are used to help detect (find) and diagnose intraocular melanoma. A biopsy of the tumor is rarely needed to diagnose intraocular melanoma. Certain factors affect prognosis (chance of recovery) and treatment options. Intraocular melanoma is a disease in which malignant (cancer) cells form in the tissues of the eye. Intraocular melanoma begins in the middle of three layers of the wall of the eye. The outer layer includes the white sclera (the "white of the eye") and the clear cornea at the front of the eye. The inner layer has a lining of nerve tissue, called the retina, which senses light and sends images along the optic nerve to the brain. The middle layer, where intraocular melanoma forms, is called the uvea or uveal tract, and has three main parts: Iris The iris is the colored area at the front of the eye (the "eye color"). It can be seen through the clear cornea. The pupil is in the center of the iris and it changes size to let more or less light into the eye. Intraocular melanoma of the iris is usually a small tumor that grows slowly and rarely spreads to other parts of the body. Ciliary body The ciliary body is a ring of tissue with muscle fibers that change the size of the pupil and the shape of the lens. It is found behind the iris. Changes in the shape of the lens help the eye focus. The ciliary body also makes the clear fluid that fills the space between the cornea and the iris. Intraocular melanoma of the ciliary body is often larger and more likely to spread to other parts of the body than intraocular melanoma of the iris. Choroid The choroid is a layer of blood vessels that bring oxygen and nutrients to the eye. Most intraocular melanomas begin in the choroid. Intraocular melanoma of the choroid is often larger and more likely to spread to other parts of the body than intraocular melanoma of the iris. Intraocular melanoma is a rare cancer that forms from cells that make melanin in the iris, ciliary body, and choroid. It is the most common eye cancer in adults.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Intraocular (Uveal) Melanoma? ? [/INST] Being older and having fair skin may increase the risk of intraocular melanoma. 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 doesnt mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for intraocular melanoma include the following: Having a fair complexion, which includes the following: Fair skin that freckles and burns easily, does not tan, or tans poorly. Blue or green or other lightcolored eyes. Older age. Being white.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Intraocular (Uveal) Melanoma ? [/INST] Signs of intraocular melanoma include blurred vision or a dark spot on the iris. Intraocular melanoma may not cause early signs or symptoms. It is sometimes found during a regular eye exam when the doctor dilates the pupil and looks into the eye. Signs and symptoms may be caused by intraocular melanoma or by other conditions. Check with your doctor if you have any of the following: Blurred vision or other change in vision. Floaters (spots that drift in your field of vision) or flashes of light. A dark spot on the iris. A change in the size or shape of the pupil. A change in the position of the eyeball in the eye socket.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Intraocular (Uveal) Melanoma ? [/INST] Tests that examine the eye are used to help detect (find) and diagnose intraocular melanoma. 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 or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Eye exam with dilated pupil: An exam of the eye in which the pupil is dilated (enlarged) with medicated eye drops to allow the doctor to look through the lens and pupil to the retina. The inside of the eye, including the retina and the optic nerve, is checked. Pictures may be taken over time to keep track of changes in the size of the tumor. There are several types of eye exams: Ophthalmoscopy : An exam of the inside of the back of the eye to check the retina and optic nerve using a small magnifying lens and a light. Slitlamp biomicroscopy : An exam of the inside of the eye to check the retina, optic nerve, and other parts of the eye using a strong beam of light and a microscope. Gonioscopy : An exam of the front part of the eye between the cornea and iris. A special instrument is used to see if the area where fluid drains out of the eye is blocked. Ultrasound exam of the eye: A procedure in which highenergy sound waves (ultrasound) are bounced off the internal tissues of the eye to make echoes. Eye drops are used to numb the eye and a small probe that sends and receives sound waves is placed gently on the surface of the eye. The echoes make a picture of the inside of the eye and the distance from the cornea to the retina is measured. The picture, called a sonogram, shows on the screen of the ultrasound monitor. Highresolution ultrasound biomicroscopy : A procedure in which highenergy sound waves (ultrasound) are bounced off the internal tissues of the eye to make echoes. Eye drops are used to numb the eye and a small probe that sends and receives sound waves is placed gently on the surface of the eye. The echoes make a more detailed picture of the inside of the eye than a regular ultrasound. The tumor is checked for its size, shape, and thickness, and for signs that the tumor has spread to nearby tissue. Transillumination of the globe and iris: An exam of the iris, cornea, lens, and ciliary body with a light placed on either the upper or lower lid. Fluorescein angiography : A procedure to look at blood vessels and the flow of blood inside the eye. An orange fluorescent dye (fluorescein) is injected into a blood vessel in the arm and goes into the bloodstream. As the dye travels through blood vessels of the eye, a special camera takes pictures of the retina and choroid to find any areas that are blocked or leaking. Indocyanine green angiography: A procedure to look at blood vessels in the choroid layer of the eye. A green dye (indocyanine green) is injected into a blood vessel in the arm and goes into the bloodstream. As the dye travels through blood vessels of the eye, a special camera takes pictures of the retina and choroid to find any areas that are blocked or leaking. Ocular coherence tomography : An imaging test that uses light waves to take crosssection pictures of the retina, and sometimes the choroid, to see if there is swelling or fluid beneath the retina. A biopsy of the tumor is rarely needed to diagnose intraocular melanoma. A biopsy is the removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. Rarely, a biopsy of the tumor is needed to diagnose intraocular melanoma. Tissue that is removed during a biopsy or surgery to remove the tumor may be tested to get more information about prognosis and which treatment options are best. The following tests may be done on the sample of tissue: Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes. Gene expression profiling : A laboratory test in which cells in a sample of tissue are checked for certain types of RNA. A biopsy may result in retinal detachment (the retina separates from other tissues in the eye). This can be repaired by surgery.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Intraocular (Uveal) Melanoma ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: How the melanoma cells look under a microscope. The size and thickness of the tumor. The part of the eye the tumor is in (the iris, ciliary body, or choroid). Whether the tumor has spread within the eye or to other places in the body. Whether there are certain changes in the genes linked to intraocular melanoma. The patient's age and general health. Whether the tumor has recurred (come back) after treatment.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Intraocular (Uveal) Melanoma ? [/INST] After intraocular melanoma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. The following sizes are used to describe intraocular melanoma: Small Medium Large There are three ways that cancer spreads in the body. Cancer may spread from where it began to other parts of the body. There are two staging systems for intraocular melanoma. The following stages are used for intraocular melanoma of the iris: Stage I Stage II Stage III Stage IV The following stages are used for intraocular melanoma of the ciliary body and choroid: Stage I Stage II Stage III Stage IV After intraocular melanoma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. The process used to find out if cancer has spread 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: Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. Liver function tests : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign the cancer has spread to the liver. Ultrasound exam: A procedure in which highenergy sound waves (ultrasound) are bounced off internal tissues or organs, such as the liver, and make echoes. The echoes form a picture of body tissues called a sonogram. Chest xray : An xray of the organs and bones inside the chest. An xray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. 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). CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, or pelvis, taken from different angles. The pictures are made by a computer linked to an xray 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. PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A very 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. Sometimes a PET scan and a CT scan are done at the same time. If there is any cancer, this increases the chance that it will be found. The following sizes are used to describe intraocular melanoma: Small The tumor is 5 to 16 millimeters in diameter and from 1 to 3 millimeters thick. Medium The tumor is 16 millimeters or smaller in diameter and from 3.1 to 8 millimeters thick. Large The tumor is: more than 8 millimeters thick and any diameter; or at least 2 millimeters thick and more than 16 millimeters in diameter. Though most intraocular melanoma tumors are raised, some are flat. These diffuse tumors grow widely across the uvea. 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 intraocular melanoma spreads to the liver, the cancer cells in the liver are actually intraocular melanoma cells. The disease is metastatic intraocular melanoma, not liver cancer. There are two staging systems for intraocular melanoma. Intraocular melanoma has two staging systems. The staging system used depends on where in the eye the cancer first formed: Iris. Ciliary body and choroid. If intraocular melanoma spreads to the optic nerve or nearby tissue of the eye socket, it is called extraocular extension. The following stages are used for intraocular melanoma of the iris: Stage I In stage I, the tumor is in the iris only and is not more than one fourth the size of the iris. Stage II Stage II is divided into stages IIA and IIB. In stage IIA, the tumor: is in the iris only and is more than one fourth the size of the iris; or is in the iris only and has caused glaucoma; or has spread next to and/or into the ciliary body, choroid, or both. The tumor has caused glaucoma. In stage IIB, the tumor has spread next to and/or into the ciliary body, choroid, or both, and has also spread into the sclera. The tumor has caused glaucoma. Stage III Stage III is divided into stages IIIA and IIIB. In stage IIIA, the tumor has spread through the sclera to the outside of the eyeball. The part of the tumor outside the eyeball is not more than 5 millimeters thick. In stage IIIB, the tumor has spread through the sclera to the outside of the eyeball. The part of the tumor outside the eyeball is more than 5 millimeters thick. Stage IV In stage IV, the tumor may be any size and has spread: to nearby lymph nodes; or to other parts of the body, such as the liver, lung, or bone, or to areas under the skin. The following stages are used for intraocular melanoma of the ciliary body and choroid: Intraocular melanoma of the ciliary body and choroid is grouped into four size categories. The category depends on how wide and thick the tumor is. Category 1 tumors are the smallest and category 4 tumors are the biggest. Category 1: The tumor is not more than 12 millimeters wide and not more than 3 millimeters thick; or the tumor is not more than 9 millimeters wide and 3.1 to 6 millimeters thick. Category 2: The tumor is 12.1 to 18 millimeters wide and not more than 3 millimeters thick; or the tumor is 9.1 to 15 millimeters wide and 3.1 to 6 millimeters thick; or the tumor is not more than 12 millimeters wide and 6.1 to 9 millimeters thick. Category 3: The tumor is 15.1 to 18 millimeters wide and 3.1 to 6 millimeters thick; or the tumor is 12.1 to 18 millimeters wide and 6.1 to 9 millimeters thick; or the tumor is 3.1 to 18 millimeters wide and 9.1 to 12 millimeters thick; or the tumor is 9.1 to 15 millimeters wide and 12.1 to 15 millimeters thick. Category 4: The tumor is more than 18 millimeters wide and may be any thickness; or the tumor is 15.1 to 18 millimeters wide and more than 12 millimeters thick; or the tumor is 12.1 to 15 millimeters wide and more than 15 millimeters thick. Stage I In stage I, the tumor is size category 1 and is in the choroid only. Stage II Stage II is divided into stages IIA and IIB. In stage IIA, the tumor: is size category 1 and has spread to the ciliary body; or is size category 1 and has spread through the sclera to the outside of the eyeball. The part of the tumor outside the eyeball is not more than 5 millimeters thick. The tumor may have spread to the ciliary body; or is size category 2 and is in the choroid only. In stage IIB, the tumor: is size category 2 and has spread to the ciliary body; or is size category 3 and is in the choroid only. Stage III Stage III is divided into stages IIIA, IIIB, and IIIC. In stage IIIA, the tumor: is size category 2 and has spread through the sclera to the outside of the eyeball. The part of the tumor outside the eyeball is not more than 5 millimeters thick. The tumor may have spread to the ciliary body; or is size category 3 and has spread to the ciliary body; or is size category 3 and has spread through the sclera to the outside of the eyeball. The part of the tumor outside the eyeball is not more than 5 millimeters thick. The tumor has not spread to the ciliary body; or is size category 4 and is in the choroid only. In stage IIIB, the tumor: is size category 3 and has spread through the sclera to the outside of the eyeball. The part of the tumor outside the eyeball is not more than 5 millimeters thick. The tumor has spread to the ciliary body; or is size category 4 and has spread to the ciliary body; or is size category 4 and has spread through the sclera to the outside of the eyeball. The part of the tumor outside the eyeball is not more than 5 millimeters thick. The tumor has not spread to the ciliary body. In stage IIIC, the tumor: is size category 4 and has spread through the sclera to the outside of the eyeball. The part of the tumor outside the eyeball is not more than 5 millimeters thick. The tumor has spread to the ciliary body; or may be any size and has spread through the sclera to the outside of the eyeball. The part of the tumor outside the eyeball is more than 5 millimeters thick. The tumor has not spread to the ciliary body. Stage IV In stage IV, the tumor may be any size and has spread: to nearby lymph nodes; or to other parts of the body, such as the liver, lung, or bone, or to areas under the skin.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Intraocular (Uveal) Melanoma ? [/INST] There are different types of treatments for patients with intraocular melanoma. Five types of standard treatment are used: Surgery Watchful Waiting Radiation therapy Photocoagulation Thermotherapy New types of treatment are being tested in clinical trials. Treatment for intraocular (uveal) melanoma may cause side effects. 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. Followup tests may be needed. There are different types of treatments for patients with intraocular melanoma. Different types of treatments are available for patients with intraocular melanoma. 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. Five types of standard treatment are used: Surgery Surgery is the most common treatment for intraocular melanoma. The following types of surgery may be used: Resection: Surgery to remove the tumor and a small amount of healthy tissue around it. Enucleation: Surgery to remove the eye and part of the optic nerve. This is done if vision cannot be saved and the tumor is large, has spread to the optic nerve, or causes high pressure inside the eye. After surgery, the patient is usually fitted for an artificial eye to match the size and color of the other eye. Exenteration: Surgery to remove the eye and eyelid, and muscles, nerves, and fat in the eye socket. After surgery, the patient may be fitted for an artificial eye to match the size and color of the other eye or a facial prosthesis. Watchful Waiting Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Pictures are taken over time to keep track of changes in the size of the tumor and how fast it is growing. Watchful waiting is used for patients who do not have signs or symptoms and the tumor is not growing. It is also used when the tumor is in the only eye with useful vision. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays 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. Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy tissue. These types of external radiation therapy include the following: Chargedparticle external beam radiation therapy is a type of externalbeam radiation therapy. A special radiation therapy machine aims tiny, invisible particles, called protons or helium ions, at the cancer cells to kill them with little damage to nearby normal tissues. Chargedparticle radiation therapy uses a different type of radiation than the xray type of radiation therapy. Gamma Knife therapy is a type of stereotactic radiosurgery used for some melanomas. This treatment can be given in one treatment. It aims tightly focused gamma rays directly at the tumor so there is little damage to healthy tissue. Gamma Knife therapy does not use a knife to remove the tumor and is not an operation. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. Certain ways of giving radiation therapy can help keep radiation from damaging healthy tissue. This type of internal radiation therapy may include the following: Localized plaque radiation therapy is a type of internal radiation therapy that may be used for tumors of the eye. Radioactive seeds are attached to one side of a disk, called a plaque, and placed directly on the outside wall of the eye near the tumor. The side of the plaque with the seeds on it faces the eyeball, aiming radiation at the tumor. The plaque helps protect other nearby tissue from the radiation. 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 intraocular melanoma. Photocoagulation Photocoagulation is a procedure that uses laser light to destroy blood vessels that bring nutrients to the tumor, causing the tumor cells to die. Photocoagulation may be used to treat small tumors. This is also called light coagulation. Thermotherapy Thermotherapy is the use of heat from a laser to destroy cancer cells and shrink the tumor. New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Treatment for intraocular (uveal) melanoma may cause side effects. For information about side effects caused by treatment for cancer, see our Side Effects page. 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. Followup 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 followup tests or checkups. Treatment Options for Intraocular (Uveal) Melanoma Iris Melanoma Treatment of iris melanoma may include the following: Watchful waiting. Surgery (resection or enucleation). Plaque radiation therapy, for tumors that cannot be removed by surgery. Check the list of NCIsupported cancer clinical trials that are now accepting patients with iris melanoma. 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. Ciliary Body Melanoma Treatment of tumors in the ciliary body and choroid may include the following: Plaque radiation therapy. Chargedparticle externalbeam radiation therapy. Surgery (resection or enucleation). Check the list of NCIsupported cancer clinical trials that are now accepting patients with ciliary body and choroid melanoma, small size. 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. Choroid Melanoma Treatment of small choroid melanoma may include the following: Watchful waiting. Plaque radiation therapy. Chargedparticle externalbeam radiation therapy. Gamma Knife therapy. Thermotherapy. Surgery (resection or enucleation). Treatment of medium choroid melanoma may include the following: Plaque radiation therapy with or without photocoagulation or thermotherapy. Chargedparticle externalbeam radiation therapy. Surgery (resection or enucleation). Treatment of large choroid melanoma may include the following: Enucleation when the tumor is too large for treatments that save the eye. Check the list of NCIsupported cancer clinical trials that are now accepting patients with ciliary body and choroid melanoma, small size. 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. Extraocular Extension Melanoma and Metastatic Intraocular (Uveal) Melanoma Treatment of extraocular extension melanoma that has spread to the bone around the eye may include the following: Surgery (exenteration). A clinical trial. An effective treatment for metastatic intraocular melanoma has not been found. A clinical trial may be a treatment option. Talk with your doctor about your treatment options. Check the list of NCIsupported cancer clinical trials that are now accepting patients with extraocular extension melanoma and metastatic intraocular melanoma. 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. Recurrent Intraocular (Uveal) Melanoma An effective treatment for recurrent intraocular melanoma has not been found. A clinical trial may be a treatment option. Talk with your doctor about your treatment options. Check the list of NCIsupported cancer clinical trials that are now accepting patients with recurrent intraocular melanoma. 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Intraocular (Uveal) Melanoma ? [/INST] 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Neuroblastoma ? [/INST] Neuroblastoma is a disease in which malignant (cancer) cells form in nerve tissue. Most cases of neuroblastoma are diagnosed before 1 year of age. The risk factors for neuroblastoma are not known. Neuroblastoma is a disease in which malignant (cancer) cells form in nerve tissue. Neuroblastoma often begins in the nerve tissue of the adrenal glands. There are two adrenal glands, one on top of each kidney, in the back of the upper abdomen. The adrenal glands make important hormones that help control heart rate, blood pressure, blood sugar, and the way the body reacts to stress. Neuroblastoma may also begin in the abdomen, chest, spinal cord, or in nerve tissue near the spine in the neck. Neuroblastoma most often begins during early childhood, usually in children younger than 5 years of age. See the PDQ summary on Neuroblastoma Treatment for more information about neuroblastoma. Most cases of neuroblastoma are diagnosed before 1 year of age. Neuroblastoma is the most common type of cancer in infants. The number of new cases of neuroblastoma is greatest among children under 1 year of age. As children get older, the number of new cases decreases. Neuroblastoma is slightly more common in males than females. Neuroblastoma sometimes forms before birth but is usually found later, when the tumor begins to grow and cause symptoms. In rare cases, neuroblastoma may be found before birth, by fetal ultrasound.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Neuroblastoma? ? [/INST] The risk factors for neuroblastoma are not known.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Neuroblastoma? ? [/INST] Screening tests have risks. The risks of neuroblastoma screening include the following: Neuroblastoma may be overdiagnosed. Falsenegative test results can occur. Falsepositive test results can occur. Screening tests have risks. Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer. The risks of neuroblastoma screening include the following: Neuroblastoma may be overdiagnosed. When a screening test result leads to the diagnosis and treatment of a disease that may never have caused symptoms or become lifethreatening, it is called overdiagnosis. For example, when a urine test result shows a higher than normal amount of homovanillic acid (HMA) or vanillyl mandelic acid (VMA), tests and treatments for neuroblastoma are likely to be done, but may not be needed. At this time, it is not possible to know which neuroblastomas found by a screening test will cause symptoms and which neuroblastomas will not. Diagnostic tests (such as biopsies) and cancer treatments (such as surgery, radiation therapy, and chemotherapy) can have serious risks, including physical and emotional problems. Falsenegative test results can occur. Screening test results may appear to be normal even though neuroblastoma is present. A person who receives a falsenegative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if there are symptoms. Falsepositive test results can occur. Screening test results may appear to be abnormal even though no cancer is present. A falsepositive test result (one that shows there is cancer when there really isn't) can cause anxiety and is usually followed by more tests and procedures, which also have risks.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Myelodysplastic Syndromes ? [/INST] Myelodysplastic syndromes are a group of cancers in which immature blood cells in the bone marrow do not mature or become healthy blood cells. The different types of myelodysplastic syndromes are diagnosed based on certain changes in the blood cells and bone marrow. Age and past treatment with chemotherapy or radiation therapy affect the risk of a myelodysplastic syndrome. Signs and symptoms of a myelodysplastic syndrome include shortness of breath and feeling tired. Tests that examine the blood and bone marrow are used to detect (find) and diagnose myelodysplastic syndromes. Certain factors affect prognosis and treatment options. Myelodysplastic syndromes are a group of cancers in which immature blood cells in the bone marrow do not mature or become healthy blood cells. In a healthy person, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time. A blood stem cell may become a lymphoid stem cell or a myeloid stem cell. A lymphoid stem cell becomes a white blood cell. A myeloid stem cell becomes one of three types of mature blood cells: Red blood cells that carry oxygen and other substances to all tissues of the body. Platelets that form blood clots to stop bleeding. White blood cells that fight infection and disease. In a patient with a myelodysplastic syndrome, the blood stem cells (immature cells) do not become mature red blood cells, white blood cells, or platelets in the bone marrow. These immature blood cells, called blasts, do not work the way they should and either die in the bone marrow or soon after they go into the blood. This leaves less room for healthy white blood cells, red blood cells, and platelets to form in the bone marrow. When there are fewer healthy blood cells, infection, anemia, or easy bleeding may occur. The different types of myelodysplastic syndromes are diagnosed based on certain changes in the blood cells and bone marrow. Refractory anemia: There are too few red blood cells in the blood and the patient has anemia. The number of white blood cells and platelets is normal. Refractory anemia with ring sideroblasts: There are too few red blood cells in the blood and the patient has anemia. The red blood cells have too much iron inside the cell. The number of white blood cells and platelets is normal. Refractory anemia with excess blasts: There are too few red blood cells in the blood and the patient has anemia. Five percent to 19% of the cells in the bone marrow are blasts. There also may be changes to the white blood cells and platelets. Refractory anemia with excess blasts may progress to acute myeloid leukemia (AML). See the PDQ Adult Acute Myeloid Leukemia Treatment summary for more information. Refractory cytopenia with multilineage dysplasia: There are too few of at least two types of blood cells (red blood cells, platelets, or white blood cells). Less than 5% of the cells in the bone marrow are blasts and less than 1% of the cells in the blood are blasts. If red blood cells are affected, they may have extra iron. Refractory cytopenia may progress to acute myeloid leukemia (AML). Refractory cytopenia with unilineage dysplasia: There are too few of one type of blood cell (red blood cells, platelets, or white blood cells). There are changes in 10% or more of two other types of blood cells. Less than 5% of the cells in the bone marrow are blasts and less than 1% of the cells in the blood are blasts. Unclassifiable myelodysplastic syndrome: The numbers of blasts in the bone marrow and blood are normal, and the disease is not one of the other myelodysplastic syndromes. Myelodysplastic syndrome associated with an isolated del(5q) chromosome abnormality: There are too few red blood cells in the blood and the patient has anemia. Less than 5% of the cells in the bone marrow and blood are blasts. There is a specific change in the chromosome. Chronic myelomonocytic leukemia (CMML): See the PDQ summary on Myelodysplastic/ Myeloproliferative Neoplasms Treatment for more information.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Myelodysplastic Syndromes ? [/INST] There are different types of treatment for patients with myelodysplastic syndromes. Treatment for myelodysplastic syndromes includes supportive care, drug therapy, and stem cell transplantation. Three types of standard treatment are used: Supportive care Drug therapy Chemotherapy with stem cell transplant 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 treatment. Followup tests may be needed. There are different types of treatment for patients with myelodysplastic syndromes. Different types of treatment are available for patients with myelodysplastic syndromes. 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. Treatment for myelodysplastic syndromes includes supportive care, drug therapy, and stem cell transplantation. Patients with a myelodysplastic syndrome who have symptoms caused by low blood counts are given supportive care to relieve symptoms and improve quality of life. Drug therapy may be used to slow progression of the disease. Certain patients can be cured with aggressive treatment with chemotherapy followed by stem cell transplant using stem cells from a donor. Three types of standard treatment are used: Supportive care Supportive care is given to lessen the problems caused by the disease or its treatment. Supportive care may include the following: Transfusion therapy Transfusion therapy (blood transfusion) is a method of giving red blood cells, white blood cells, or platelets to replace blood cells destroyed by disease or treatment. A red blood cell transfusion is given when the red blood cell count is low and signs or symptoms of anemia, such as shortness of breath or feeling very tired, occur. A platelet transfusion is usually given when the patient is bleeding, is having a procedure that may cause bleeding, or when the platelet count is very low. Patients who receive many blood cell transfusions may have tissue and organ damage caused by the buildup of extra iron. These patients may be treated with iron chelation therapy to remove the extra iron from the blood. Erythropoiesisstimulating agents Erythropoiesisstimulating agents (ESAs) may be given to increase the number of mature red blood cells made by the body and to lessen the effects of anemia. Sometimes granulocyte colonystimulating factor (GCSF) is given with ESAs to help the treatment work better. Antibiotic therapy Antibiotics may be given to fight infection. Drug therapy Lenalidomide Patients with myelodysplastic syndrome associated with an isolated del(5q) chromosome abnormality who need frequent red blood cell transfusions may be treated with lenalidomide. Lenalidomide is used to lessen the need for red blood cell transfusions. Immunosuppressive therapy Antithymocyte globulin (ATG) works to suppress or weaken the immune system. It is used to lessen the need for red blood cell transfusions. Azacitidine and decitabine Azacitidine and decitabine are used to treat myelodysplastic syndromes by killing cells that are dividing rapidly. They also help genes that are involved in cell growth to work the way they should. Treatment with azacitidine and decitabine may slow the progression of myelodysplastic syndromes to acute myeloid leukemia. Chemotherapy used in acute myeloid leukemia (AML) Patients with a myelodysplastic syndrome and a high number of blasts in their bone marrow have a high risk of acute leukemia. They may be treated with the same chemotherapy regimen used in patients with acute myeloid leukemia. Chemotherapy with stem cell transplant Stem cell transplant is a method of giving chemotherapy and replacing bloodforming cells destroyed by the treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of a donor and are frozen for storage. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. This treatment may not work as well in patients whose myelodysplastic syndrome was caused by past treatment for cancer. 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 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. Followup 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 followup tests or checkups.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Colon Cancer ? [/INST] Colon cancer is a disease in which malignant (cancer) cells form in the tissues of the colon. Health history affects the risk of developing colon cancer. Signs of colon cancer include blood in the stool or a change in bowel habits. Tests that examine the colon and rectum are used to detect (find) and diagnose colon cancer. Certain factors affect prognosis (chance of recovery) and treatment options. Colon cancer is a disease in which malignant (cancer) cells form in the tissues of the colon. The colon is part of the bodys digestive system. The digestive system removes and processes 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 about 68 inches long. The anal canal ends at the anus (the opening of the large intestine to the outside of the body). Gastrointestinal stromal tumors can occur in the colon. See the PDQ summary on Gastrointestinal Stromal Tumors Treatment for more information. See the PDQ summary about Unusual Cancers of Childhood Treatment for information about colorectal cancer in children.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Colon Cancer? ? [/INST] Health history affects the risk of developing colon 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 firstdegree relative (parent, sibling, or child). Having a personal history of cancer of the colon, rectum, or ovary. Having a personal history of highrisk 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Colon Cancer ? [/INST] Signs of colon cancer include blood in the stool or a change in bowel habits. These and other signs and symptoms may be caused by colon cancer or by other conditions. Check with your doctor if you have any of the following: A change in bowel habits. Blood (either bright red or very dark) in the stool. Diarrhea, constipation, or feeling that the bowel does not empty all the way. Stools that are narrower than usual. Frequent gas pains, bloating, fullness, or cramps. Weight loss for no known reason. Feeling very tired. Vomiting.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Colon Cancer ? [/INST] Tests that examine the colon and rectum are used to detect (find) and diagnose colon 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 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 : An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the rectum to feel for lumps or anything else that seems unusual. Fecal occult blood test (FOBT): A test to check stool (solid waste) for blood that can only be seen with a microscope. A small sample of stool is placed on a special card or in a special container and returned to the doctor or laboratory for testing. Blood in the stool may be a sign of polyps, cancer, or other conditions. There are two types of FOBTs: Guaiac FOBT : The sample of stool on the special card is tested with a chemical. If there is blood in the stool, the special card changes color. Immunochemical FOBT : A liquid is added to the stool sample. This mixture is injected into a machine that contains antibodies that can detect blood in the stool. If there is blood in the stool, a line appears in a window in the machine. This test is also called fecal immunochemical test or FIT. Barium enema : A series of xrays of the lower gastrointestinal tract. A liquid that contains barium (a silverwhite metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and xrays are taken. This procedure is also called a lower GI series. Sigmoidoscopy : A procedure to look inside the rectum and sigmoid (lower) colon for polyps (small areas of bulging tissue), other abnormal areas, or cancer. A sigmoidoscope is inserted through the rectum into the sigmoid colon. A sigmoidoscope is a thin, tubelike 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. Colonoscopy : A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope is inserted through the rectum into the colon. A colonoscope is a thin, tubelike 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. Virtual colonoscopy : A procedure that uses a series of xrays called computed tomography to make a series of pictures of the colon. A computer puts the pictures together to create detailed images that may show polyps and anything else that seems unusual on the inside surface of the colon. This test is also called colonography or CT colonography. Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Colon Cancer ? [/INST] 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 the cancer is in the inner lining of the colon only or has spread through the colon wall, or has spread to lymph nodes or other places in the body). Whether the cancer has blocked or made a hole in the colon. Whether there are any cancer cells left after surgery. Whether the cancer has recurred. The patients general health. The prognosis also depends on the blood levels of carcinoembryonic antigen (CEA) before treatment begins. CEA is a substance in the blood that may be increased when cancer is present.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Colon Cancer ? [/INST] After colon cancer has been diagnosed, tests are done to find out if cancer cells have spread within the colon 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 colon cancer: Stage 0 (Carcinoma in Situ) Stage I Stage II Stage III Stage IV After colon cancer has been diagnosed, tests are done to find out if cancer cells have spread within the colon or to other parts of the body. The process used to find out if cancer has spread within the colon 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: CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen or chest, taken from different angles. The pictures are made by a computer linked to an xray 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 colon. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. 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. Chest xray : An xray of the organs and bones inside the chest. An xray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. Surgery : A procedure to remove the tumor and see how far it has spread through the colon. Lymph node biopsy : The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells. Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following: The number of red blood cells, white blood cells, and platelets. The amount of hemoglobin (the protein that carries oxygen) in the red blood cells. The portion of the blood sample made up of red blood cells. 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 colon cancer or other conditions. 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 colon cancer spreads to the lung, the cancer cells in the lung are actually colon cancer cells. The disease is metastatic colon cancer, not lung cancer. The following stages are used for colon cancer: Stage 0 (Carcinoma in Situ) In stage 0, abnormal cells are found in the mucosa (innermost layer) of the colon 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 colon wall and has spread to the submucosa (layer of tissue under the mucosa). Cancer may have spread to the muscle layer of the colon wall. Stage II Stage II colon cancer is divided into stage IIA, stage IIB, and stage IIC. Stage IIA: Cancer has spread through the muscle layer of the colon wall to the serosa (outermost layer) of the colon wall. Stage IIB: Cancer has spread through the serosa (outermost layer) of the colon wall but has not spread to nearby organs. Stage IIC: Cancer has spread through the serosa (outermost layer) of the colon wall to nearby organs. Stage III Stage III colon cancer is divided into stage IIIA, stage IIIB, and stage IIIC. In stage IIIA: Cancer has spread through the mucosa (innermost layer) of the colon wall to the submucosa (layer of tissue under the mucosa) and may have spread to the muscle layer of the colon 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 colon 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 colon wall to the serosa (outermost layer) of the colon 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 colon wall or to the serosa (outermost layer) of the colon 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 colon wall to the submucosa (layer of tissue under the mucosa) and may have spread to the muscle layer of the colon wall. Cancer has spread to 7 or more nearby lymph nodes. In stage IIIC: Cancer has spread through the serosa (outermost layer) of the colon 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 colon wall to the serosa (outermost layer) of the colon 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 colon 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 colon cancer is divided into stage IVA and stage IVB. Stage IVA: Cancer may have spread through the colon wall and may have spread to nearby organs or lymph nodes. Cancer has spread to one organ that is not near the colon, such as the liver, lung, or ovary, or to a distant lymph node. Stage IVB: Cancer may have spread through the colon wall and may have spread to nearby organs or lymph nodes. Cancer has spread to more than one organ that is not near the colon or into the lining of the abdominal wall.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Colon Cancer ? [/INST] There are different types of treatment for patients with colon cancer. Six types of standard treatment are used: Surgery Radiofrequency ablation Cryosurgery Chemotherapy Radiation therapy Targeted 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. Followup tests may be needed. There are different types of treatment for patients with colon cancer. Different types of treatment are available for patients with colon 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. Six types of standard treatment are used: Surgery Surgery (removing the cancer in an operation) is the most common treatment for all stages of colon cancer. A doctor may remove the cancer using one of the following types of surgery: Local excision: If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. Instead, the doctor may put a tube with a cutting tool through the rectum into the colon and cut the cancer out. This is called a local excision. If the cancer is found in a polyp (a small bulging area of tissue), the operation is called a polypectomy. Resection of the colon with anastomosis: If the cancer is larger, the doctor will perform a partial colectomy (removing the cancer and a small amount of healthy tissue around it). The doctor may then perform an anastomosis (sewing the healthy parts of the colon together). The doctor will also usually remove lymph nodes near the colon and examine them under a microscope to see whether they contain cancer. Resection of the colon with colostomy: If the doctor is not able to sew the 2 ends of the colon back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a colostomy. A bag is placed around the stoma to collect the waste. Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed. If the doctor needs to remove the entire lower colon, however, the colostomy may be permanent. Even if the doctor removes all the cancer that can be seen at the time of the operation, 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 cancer will come back, is called adjuvant therapy. Radiofrequency ablation Radiofrequency ablation is the use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital with general anesthesia. Cryosurgery Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer 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 cancer 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 cancer cells in those areas (regional chemotherapy). Chemoembolization of the hepatic artery may be used to treat cancer that has spread to the liver. This involves blocking the hepatic artery (the main artery that supplies blood to the liver) and injecting anticancer drugs between the blockage and the liver. The livers arteries then deliver the drugs throughout the liver. Only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on what is used to block the artery. The liver continues to receive some blood from the hepatic portal vein, which carries blood from the stomach and intestine. The way the chemotherapy is given depends on the type and stage of the cancer being treated. See Drugs Approved for Colon and Rectal Cancer for more information. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays 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 radiation therapy is used as palliative therapy to relieve symptoms and improve quality of life. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Types of targeted therapies used in the treatment of colon cancer include the following: Monoclonal antibodies: Monoclonal antibodies are made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Bevacizumab and ramucirumab are types of monoclonal antibodies that bind to a protein called vascular endothelial growth factor (VEGF). This may prevent the growth of new blood vessels that tumors need to grow. Cetuximab and panitumumab are types of monoclonal antibodies that bind to a protein called epidermal growth factor receptor (EGFR) on the surface of some types of cancer cells. This may stop cancer cells from growing and dividing. Angiogenesis inhibitors: Angiogenesis inhibitors stop the growth of new blood vessels that tumors need to grow. Zivaflibercept is a vascular endothelial growth factor trap that blocks an enzyme needed for the growth of new blood vessels in tumors. Regorafenib is used to treat colorectal cancer that has spread to other parts of the body and has not gotten better with other treatment. It blocks the action of certain proteins, including vascular endothelial growth factor. This may help keep cancer cells from growing and may kill them. It may also prevent the growth of new blood vessels that tumors need to grow. See Drugs Approved for Colon and Rectal Cancer for more information. 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. Followup 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 followup tests or checkups. Treatment Options for Colon Cancer Stage 0 (Carcinoma in Situ) Treatment of stage 0 (carcinoma in situ) may include the following types of surgery: Local excision or simple polypectomy. Resection and anastomosis. This is done when the tumor is too large to remove by local excision. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage 0 colon 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 I Colon Cancer Treatment of stage I colon cancer usually includes the following: Resection and anastomosis. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage I colon 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 Colon Cancer Treatment of stage II colon cancer may include the following: Resection and anastomosis. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage II colon 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 Colon Cancer Treatment of stage III colon cancer may include the following: Resection and anastomosis which may be followed by chemotherapy. Clinical trials of new chemotherapy regimens after surgery. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage III colon 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 and Recurrent Colon Cancer Treatment of stage IV and recurrent colon cancer may include the following: Local excision for tumors that have recurred. Resection with or without anastomosis. Surgery to remove parts of other organs, such as the liver, lungs, and ovaries, where the cancer may have recurred or spread. Treatment of cancer that has spread to the liver may also include the following: Chemotherapy given before surgery to shrink the tumor, after surgery, or both before and after. Radiofrequency ablation or cryosurgery, for patients who cannot have surgery. Chemoembolization of the hepatic artery. Radiation therapy or chemotherapy may be offered to some patients as palliative therapy to relieve symptoms and improve quality of life. Chemotherapy and/or targeted therapy with a monoclonal antibody or an angiogenesis inhibitor. Clinical trials of chemotherapy and/or targeted therapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage IV colon cancer and recurrent colon 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Colon Cancer ? [/INST] 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>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Oral Cavity and Oropharyngeal Cancer ? [/INST] Oral cavity and oropharyngeal cancer are diseases in which malignant (cancer) cells form in the mouth and throat. The number of new cases of oral cavity and oropharyngeal cancer and the number of deaths from oral cavity and oropharyngeal cancer varies by race and gender. Different factors increase or decrease the risk of oral cavity and oropharyngeal cancer. Oral cavity and oropharyngeal cancer are diseases in which malignant (cancer) cells form in the mouth and throat. Oral cavity cancer forms in any of these tissues of the oral cavity: The front two thirds of the tongue. The gingiva (gums). The buccal mucosa (the lining of the inside of the cheeks). The floor (bottom) of the mouth under the tongue. The hard palate (the front of the roof of the mouth). The retromolar trigone (the small area behind the wisdom teeth). Oropharyngeal cancer forms in any of these tissues of the oropharynx: The middle part of the pharynx (throat) behind the mouth. The back one third of the tongue. The soft palate (the back of the roof of the mouth). The side and back walls of the throat. The tonsils. Most oral cavity and oropharyngeal cancers start in squamous cells, the thin, flat cells that line the lips, oral cavity, and oropharynx. Cancer that forms in squamous cells is called squamous cell carcinoma. See the following PDQ summaries for more information about the screening, diagnosis, and treatment of oral cavity and oropharyngeal cancer: Oral Cavity and Oropharyngeal Cancer Prevention Lip and Oral Cavity Cancer Treatment Oropharyngeal Cancer Treatment The number of new cases of oral cavity and oropharyngeal cancer and the number of deaths from oral cavity and oropharyngeal cancer varies by race and gender. Over the past ten years, the number of new cases and deaths from oral cavity and oropharyngeal cancer slightly increased in white men and women. The number slightly decreased among black men and women. Oral cavity and oropharyngeal cancer is more common in men than in women. Although oral cavity and oropharyngeal cancer may occur in adults of any age, it occurs most often in those aged 55 to 64 years. France, Brazil, and parts of Asia have much higher rates of oral cavity and oropharyngeal cancer than most other countries. The number of new cases of oropharyngeal cancer caused by certain types of human papillomavirus (HPV) infection has increased. One kind of HPV, called HPV 16, is often passed from one person to another during sexual activity.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Oral Cavity and Oropharyngeal Cancer? ? [/INST] The number of new cases of oral cavity and oropharyngeal cancer and the number of deaths from oral cavity and oropharyngeal cancer varies by race and gender. Over the past ten years, the number of new cases and deaths from oral cavity and oropharyngeal cancer slightly increased in white men and women. The number slightly decreased among black men and women. Oral cavity and oropharyngeal cancer is more common in men than in women. Although oral cavity and oropharyngeal cancer may occur in adults of any age, it occurs most often in those aged 55 to 64 years. France, Brazil, and parts of Asia have much higher rates of oral cavity and oropharyngeal cancer than most other countries. The number of new cases of oropharyngeal cancer caused by certain types of human papillomavirus (HPV) infection has increased. One kind of HPV, called HPV 16, is often passed from one person to another during sexual activity.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Oral Cavity and Oropharyngeal Cancer? ? [/INST] Different factors increase or decrease the risk of oral cavity and oropharyngeal cancer. Anything that increases your chance of getting a disease is called a risk factor. Anything that decreases your chance of getting a disease is called a protective factor. For information about risk factors and protective factors for oral cavity and oropharyngeal cancer, see the PDQ summary on Oral Cavity and Oropharyngeal Cancer Prevention.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Pituitary Tumors ? [/INST] A pituitary tumor is a growth of abnormal cells in the tissues of the pituitary gland. The pituitary gland hormones control many other glands in the body. Having certain genetic conditions increases the risk of developing a pituitary tumor. Signs of a pituitary tumor include problems with vision and certain physical changes. Imaging studies and tests that examine the blood and urine are used to detect (find) and diagnose a pituitary tumor. Certain factors affect prognosis (chance of recovery) and treatment options. A pituitary tumor is a growth of abnormal cells in the tissues of the pituitary gland. Pituitary tumors form in the pituitary gland, a peasized organ in the center of the brain, just above the back of the nose. The pituitary gland is sometimes called the "master endocrine gland" because it makes hormones that affect the way many parts of the body work. It also controls hormones made by many other glands in the body. Pituitary tumors are divided into three groups: Benign pituitary adenomas: Tumors that are not cancer. These tumors grow very slowly and do not spread from the pituitary gland to other parts of the body. Invasive pituitary adenomas: Benign tumors that may spread to bones of the skull or the sinus cavity below the pituitary gland. Pituitary carcinomas: Tumors that are malignant (cancer). These pituitary tumors spread into other areas of the central nervous system (brain and spinal cord) or outside of the central nervous system. Very few pituitary tumors are malignant. Pituitary tumors may be either nonfunctioning or functioning. Nonfunctioning pituitary tumors do not make extra amounts of hormones. Functioning pituitary tumors make more than the normal amount of one or more hormones. Most pituitary tumors are functioning tumors. The extra hormones made by pituitary tumors may cause certain signs or symptoms of disease. The pituitary gland hormones control many other glands in the body. Hormones made by the pituitary gland include: Prolactin: A hormone that causes a womans breasts to make milk during and after pregnancy. Adrenocorticotropic hormone (ACTH): A hormone that causes the adrenal glands to make a hormone called cortisol. Cortisol helps control the use of sugar, protein, and fats in the body and helps the body deal with stress. Growth hormone: A hormone that helps control body growth and the use of sugar and fat in the body. Growth hormone is also called somatotropin. Thyroidstimulating hormone: A hormone that causes the thyroid gland to make other hormones that control growth, body temperature, and heart rate. Thyroidstimulating hormone is also called thyrotropin. Luteinizing hormone (LH) and folliclestimulating hormone (FSH): Hormones that control the menstrual cycle in women and the making of sperm in men.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Pituitary Tumors? ? [/INST] Having certain genetic conditions increases the risk of developing a pituitary tumor.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 doesnt mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for pituitary tumors include having the following hereditary diseases: Multiple endocrine neoplasia type 1 (MEN1) syndrome. Carney complex. Isolated familial acromegaly.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Pituitary Tumors ? [/INST] Signs of a pituitary tumor include problems with vision and certain physical changes. Signs and symptoms can be caused by the growth of the tumor and/or by hormones the tumor makes or by other conditions. Some tumors may not cause signs or symptoms. Check with your doctor if you have any of these problems. Signs and symptoms of a nonfunctioning pituitary tumor Sometimes, a pituitary tumor may press on or damage parts of the pituitary gland, causing it to stop making one or more hormones. Too little of a certain hormone will affect the work of the gland or organ that the hormone controls. The following signs and symptoms may occur: Headache. Some loss of vision. Loss of body hair. In women, less frequent or no menstrual periods or no milk from the breasts. In men, loss of facial hair, growth of breast tissue, and impotence. In women and men, lower sex drive. In children, slowed growth and sexual development. Most of the tumors that make LH and FSH do not make enough extra hormone to cause signs and symptoms. These tumors are considered to be nonfunctioning tumors. Signs and symptoms of a functioning pituitary tumor When a functioning pituitary tumor makes extra hormones, the signs and symptoms will depend on the type of hormone being made. Too much prolactin may cause: Headache. Some loss of vision. Less frequent or no menstrual periods or menstrual periods with a very light flow. Trouble becoming pregnant or an inability to become pregnant. Impotence in men. Lower sex drive. Flow of breast milk in a woman who is not pregnant or breastfeeding. Too much ACTH may cause: Headache. Some loss of vision. Weight gain in the face, neck, and trunk of the body, and thin arms and legs. A lump of fat on the back of the neck. Thin skin that may have purple or pink stretch marks on the chest or abdomen. Easy bruising. Growth of fine hair on the face, upper back, or arms. Bones that break easily. Anxiety, irritability, and depression. Too much growth hormone may cause: Headache. Some loss of vision. In adults, acromegaly (growth of the bones in the face, hands, and feet). In children, the whole body may grow much taller and larger than normal. Tingling or numbness in the hands and fingers. Snoring or pauses in breathing during sleep. Joint pain. Sweating more than usual. Dysmorphophobia (extreme dislike of or concern about one or more parts of the body). Too much thyroidstimulating hormone may cause: Irregular heartbeat. Shakiness. Weight loss. Trouble sleeping. Frequent bowel movements. Sweating. Other general signs and symptoms of pituitary tumors: Nausea and vomiting. Confusion. Dizziness. Seizures. Runny or "drippy" nose (cerebrospinal fluid that surrounds the brain and spinal cord leaks into the nose).</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Pituitary Tumors ? [/INST] Imaging studies and tests that examine the blood and urine are used to detect (find) and diagnose a pituitary tumor. 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 or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Eye exam: An exam to check vision and the general health of the eyes. Visual field exam: An exam to check a persons field of vision (the total area in which objects can be seen). This test measures both central vision (how much a person can see when looking straight ahead) and peripheral vision (how much a person can see in all other directions while staring straight ahead). The eyes are tested one at a time. The eye not being tested is covered. Neurological exam : A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a persons mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam. MRI (magnetic resonance imaging) with gadolinium : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI). Blood chemistry study : A procedure in which a blood sample is checked to measure the amounts of certain substances, such as glucose (sugar), released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. Blood tests: Tests to measure the levels of testosterone or estrogen in the blood. A higher or lower than normal amount of these hormones may be a sign of pituitary tumor. Twentyfourhour urine test: A test in which urine is collected for 24 hours to measure the amounts of certain substances. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it. A higher than normal amount of the hormone cortisol may be a sign of a pituitary tumor and Cushing syndrome. Highdose dexamethasone suppression test: A test in which one or more high doses of dexamethasone are given. The level of cortisol is checked from a sample of blood or from urine that is collected for three days. This test is done to check if the adrenal gland is making too much cortisol or if the pituitary gland is telling the adrenal glands to make too much cortisol. Lowdose dexamethasone suppression test: A test in which one or more small doses of dexamethasone are given. The level of cortisol is checked from a sample of blood or from urine that is collected for three days. This test is done to check if the adrenal gland is making too much cortisol. Venous sampling for pituitary tumors: A procedure in which a sample of blood is taken from veins coming from the pituitary gland. The sample is checked to measure the amount of ACTH released into the blood by the gland. Venous sampling may be done if blood tests show there is a tumor making ACTH, but the pituitary gland looks normal in the imaging tests. Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The following tests may be done on the sample of tissue that is removed: 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. Immunocytochemistry : A test that uses antibodies to check for certain antigens in a sample of cells. The antibody is usually linked to a radioactive substance or a dye that causes the cells to light up under a microscope. This type of test may be used to tell the difference between different types of cancer. Light and electron microscopy : A laboratory test in which cells in a sample of tissue are viewed under regular and highpowered microscopes to look for certain changes in the cells.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Pituitary Tumors ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) depends on the type of tumor and whether the tumor has spread into other areas of the central nervous system (brain and spinal cord) or outside of the central nervous system to other parts of the body. Treatment options depend on the following: The type and size of the tumor. Whether the tumor is making hormones. Whether the tumor is causing problems with vision or other signs or symptoms. Whether the tumor has spread into the brain around the pituitary gland or to other parts of the body. Whether the tumor has just been diagnosed or has recurred (come back).</s>