Skin Cancer (Non-Melanoma)Last Updated: July 27, 2011 This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/11 Overview
Skin cancer is the most common of all cancers, with doctors finding skin cancer in about one million Americans each year. Reducing exposure to ultraviolet (UV) radiation from sunlight can prevent most skin cancers. If skin cancer is found early, it can usually be cured by relatively simple surgery. Skin cancer is responsible for less than 1% of all cancer deaths. The skin, the body's largest organ, protects against infection and injury and helps regulate body temperature. The skin also stores water and fat and produces vitamin D. Skin is made up of two main layers: the epidermis (outer layer of skin) and the dermis (inner layer of skin). Types of skin cancer Cancer begins when normal cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). There are three main types of skin cancer: Squamous cell carcinoma. Most of the epidermis is made up of flat, scale-like cells called squamous cells. Approximately 20% of skin cancer resembles these cells and is called squamous cell carcinoma. This type of cancer is mainly caused by sun exposure, but it can appear on skin that has been burned, damaged by chemicals, or exposed to x-rays. Basal cell carcinoma. Cells in the lower epidermis are round cells known as basal cells. About 80% of skin cancer develops from this type of cell that has been exposed to the sun and is called basal cell carcinoma. Basal cell carcinoma most often forms on the head and neck. Melanoma. Where the epidermis meets the dermis, there are scattered cells called melanocytes, which produce the melanin that gives skin color. Melanoma starts in melanocytes, and it is the most aggressive of the three types of skin cancer. Learn more about melanoma. The rest of this section describes basal cell and squamous cell skin cancers. Squamous cell carcinoma and basal cell carcinoma are known as non-melanoma skin cancers, to distinguish them from melanoma, which arises from very different cells and is treated differently. Typically, non-melanoma skin cancer can be treated with relatively simple surgery. If the cancer is very small, cryosurgery (freezing) or laser surgery may be used. Learn more in the Treatment section. Basal cell carcinoma grows slowly and rarely metastasizes (spreads) to other parts of the body. Squamous cell carcinoma also rarely spreads, but it is more likely to spread than basal cell carcinoma. Find out more about basic cancer terms used in this section. Statistics
This year, more than 2 million people in the United States are expected to be diagnosed with non-melanoma skin cancer. Basal cell carcinoma is more common than squamous cell carcinoma. Basal cell carcinoma and squamous cell carcinoma are typically curable and are not traditionally included in overall cancer statistics. An estimated 2,000 deaths from non-melanoma skin cancer will occur this year. However, the number of deaths from non-melanoma skin cancer has been decreasing. Source: The American Cancer Society. Medical Illustrations
Risk Factors and Prevention
A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. The following factors may raise a person’s risk of developing skin cancer: Exposure to sunlight/UV radiation. Ultraviolet B (UVB) radiation causes sunburn and plays a role in the development of basal and squamous cell cancers. Ultraviolet A (UVA) penetrates the skin more deeply and contributes to photoaging (premature aging of the skin) or wrinkling. The role of UVA in the development of non-melanoma skin cancer is suspected, but not yet certain. People who live in areas with year-round, bright sunlight (which includes both UVA and UVB) or at high altitudes have a higher risk of developing skin cancer, as do those who spend significant time outside or on a tanning bed (which emits mostly UVA). Fair skin. Less pigment (melanin) in skin offers poorer protection against UV radiation. People with light hair and light-colored eyes who have skin that tans poorly or freckles, or those who burn easily, are more likely to develop skin cancer. Gender. Rates of skin cancer in older white men and younger women have increased in recent years. Age. Most basal cell and squamous cell cancers typically appear after age 50, but cancers may appear earlier in individuals with sun-damaged skin. In recent years, the number of skin cancers in people age 65 and older has increased dramatically. A history of sunburns or fragile skin. Skin that has been burned, sunburned, or injured from disease has a higher risk of skin cancer. Squamous cell and basal cell cancers occur more often in people with higher lifetime exposure to the sun or other sources of UV radiation. Individual history. People with weakened immune systems or those who use certain medications (such as immunosuppressive drugs, certain steroids, and drugs that make the skin sensitive to light) have a higher risk of developing skin cancer, particularly squamous cell cancer. People with some rare genetic conditions, such as xeroderma pigmentosum, nevoid basal cell carcinoma syndrome, or albinism have a much higher risk of developing skin cancer. Previous skin cancer. People who have had any form of skin cancer have a higher risk of developing another skin cancer. Thirty-five percent (35%) to 50% of people diagnosed with one basal cell cancer will develop a new skin cancer within five years. Therefore, people who have had one skin cancer need ongoing, follow-up care to watch for additional cancers. Precancerous skin conditions. Lesions called actinic keratoses (rough, red or brown scaly patches on the skin) or Bowen's disease are usually more common in areas exposed to the sun. Such areas can change into squamous cell cancers in some people. Bowen's disease in non-sun-exposed areas may be related to arsenic exposure. Use of sunscreens may decrease the risk of actinic keratoses. Human papillomavirus (HPV). Research indicates that infection with this virus is a risk factor for squamous cell carcinoma, particularly if the person’s immune system becomes suppressed. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of cancers. Learn more about HPV and cancer. Prevention Reducing exposure to sunlight and other sources of UV radiation lowers the risk of skin cancer. This is important for all age groups, but is especially important for people who have risk factors for skin cancer. Sun damage is cumulative, meaning it builds up over time. Steps to reduce sunlight exposure and help prevent skin cancer include:
Learn more about protecting your skin from the sun. It is important to note that limiting your sun exposure reduces your body’s production of vitamin D. Therefore, people with limited sun exposure should talk with their doctor about how to include good sources of vitamin D in their diet, including the use of supplements. Symptoms and Signs
People with basal cell or squamous cell carcinoma may experience the following symptoms. Sometimes, people with non-melanoma skin cancer do not show any of these symptoms or signs. Or, these symptoms may be caused by a medical condition that is not cancer. The skin features that people with basal cell or squamous cell carcinoma frequently develop are listed below. If you are concerned about a symptom or skin feature, please talk with your doctor. Changes in the skin are the main warning sign for skin cancer. Each type of skin cancer can appear differently, so it is important to talk with your doctor when you notice a change in your skin. For basal cell cancer, two or more of the following features may be present:
Squamous cell cancer can often crust, bleed, and appear as:
Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often. If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms. Early detection: Finding skin cancer early Earlier detection and recognition of skin cancer is the key to improving the chance for successful treatment. Recognizing early warning signs of skin cancer and doing regular self-examinations of your skin will help find skin cancer early when the disease is highly curable. Examinations should be performed in front of a full-length mirror in a brightly lit room. It helps to have another person check the scalp and back of the neck. In people with fair skin, non-melanoma skin cancer most often begins on skin that has frequently been exposed to the sun. However, in people with darker skin, squamous cell carcinoma occurs primarily in areas infrequently exposed to the sun, such as the lower legs. Include the following steps in a skin self-examination:
Talk with your doctor if you find any of the following:
Diagnosis
Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. A biopsy is the removal of a small amount of tissue for examination under a microscope. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
Because basal cell and squamous cell cancers rarely spread, a biopsy is often the only test needed to both diagnose and find out the stage (extent) of cancer. Your doctor will review the results of the biopsy with you. No further treatment beyond the biopsy may be necessary if the entire cancer is removed. However, if the cancer is present at the edges of the tissue (called the margin) taken during the biopsy, additional treatment will usually be necessary. Learn more about what to expect when having a biopsy. Learn more about the first steps to take after a diagnosis of cancer. Staging
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). Basal cell and squamous cell rarely spread. On rare occasions, the patient’s lymph nodes (tiny, bean-shaped organs that help fight infection) may be removed to determine if the cancer has metastasized. The doctor may perform other tests, including blood tests, chest x-rays, and imaging scans of the liver, bones, and brain, but this is uncommon. Treatment
This section outlines treatments that are the standard of care (best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Current Research sections. Treatment overview In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Descriptions of the most common treatment options for skin cancer are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Learn more about making treatment decisions. Surgery Surgery is the removal of the tumor and surrounding tissue during a medical procedure. Many skin cancers can be removed from the skin quickly and easily in a simple surgical procedure, and often no further treatment is needed. Most of these surgical procedures use a local anesthetic to numb the skin and can be done outside of a hospital by a dermatologist (a doctor who specializes in diseases and conditions of the skin), general surgeon, plastic surgeon, nurse practitioner, or physician assistant. Different types of surgical procedures are used depending on the size of the cancer and where it is located. Curettage and electrodessication. In this common procedure, the cancer is removed with a curette, which is a sharp, spoon-shaped instrument. The area can then be treated with electrodessication, which uses an electric current to control bleeding and kill any remaining cancer cells. Many people have a flat, pale scar after this procedure. Mohs surgery. This technique involves removing the visible tumor, in addition to small fragments of the edge around the area where the tumor existed. Each small fragment is examined under a microscope until all cancer is removed. This is typically used for larger tumors, those in hard to reach places, and for cancers that have come back in the same place. Freezing. Used most often on precancerous skin conditions, this procedure (called cryosurgery) uses liquid nitrogen to freeze and kill cells. The skin will later blister and shed off. This procedure will sometimes leave a pale scar. More than one freezing may be needed. Laser therapy. A narrow beam of high-intensity light can destroy precancer that is located only in the outer layer of the skin. Grafting. When a large tumor is removed, surgeons may use skin from another part of the body to both close the wound and reduce scarring. Reconstructive surgery. Since skin cancer often occurs on a person’s face, a reconstructive (plastic) surgeon or facial specialist may be part of your health care team. Before surgery begins, talk with your doctors about whether changes to your appearance are likely. Learn more about cancer surgery. Radiation therapy Radiation therapy is the use of high-energy rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. Radiation therapy may be used for skin cancer that is hard to treat with surgery, such as skin cancer that appears on the eyelid, tip of the nose, and ear; several treatments may be needed. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. The side effects from radiation therapy may include a rash, dry or red skin, or a change in the color of the skin. Most side effects go away soon after treatment is finished. Learn more about radiation therapy. Topical chemotherapy Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. For cancers located only on the top layer of the skin or to treat precancerous skin conditions, doctors may prescribe chemotherapy in a cream or lotion. These drugs are usually applied daily for several weeks. They may cause inflammation, which goes away once treatment is finished. In addition to the topical chemotherapy that has been used for many years, some doctors are using imiquimod (Aldara), a topical immune response modifier, to treat early basal cell carcinomas, actinic keratoses (a precancer to squamous cell carcinoma), and very thin squamous cell carcinoma. Imiquimod is applied several times a week. Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases. Recurrent skin cancer Once your treatment is complete, talk with your doctor about the possibility of the cancer returning. Many people with one skin cancer later develop another skin cancer. Sometimes, people feel worried or anxious about the possibility that the cancer will come back. Learn more about coping with this fear. If the skin cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. People with recurrent cancer often experience emotions such as fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence. Metastatic skin cancer In rare cases, non-melanoma skin cancer can grow deeper into the skin and can spread to other parts of the body. If cancer has spread to another location in the body, it is called metastatic cancer. Sites of a chronic inflammatory skin condition, mucous membranes (skin that lines the mouth, nose, anus, and a woman’s vagina), and the lips are most susceptible to squamous cell cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials studying new treatments. Surgery alone is not effective to treat skin cancer that has metastasized. To control this distant spread, a person’s health care team may recommend chemotherapy, radiation therapy, or immunotherapy. Immunotherapy (also called biologic therapy) is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to bolster, target, or restore immune system function. In addition to treatment to slow, stop, or eliminate the cancer (also called disease-directed treatment), an important part of metastatic cancer care is relieving a person’s symptoms and side effects. It includes supporting the patient with his or her physical, emotional, and social needs, an approach called palliative or supportive care. People often receive disease-directed therapy and treatment to ease symptoms at the same time. If disease-directed treatment is not successful, this may also be called advanced cancer. This diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Learn more about advanced cancer care planning. Find out more about common terms used during cancer treatment. About Clinical Trials
Doctors and scientists are always looking for better ways to treat patients with skin cancer. To make scientific advances, doctors create research studies involving people, called clinical trials. Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment. There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease. Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating skin cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with skin cancer. Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials. To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find clinical trials. For specific topics being studied for non-melanoma skin cancer, lean more in the Current Research section. Patients who participate in a clinical trial may stop participating at any time, for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trials ends, and/or if the patient chooses to leave the clinical trial before it ends. Side Effects
Most often, non-melanoma skin cancer can be treated with relatively simple surgery, with the main side effect being possible scarring of the skin. Talk with your doctor about what scarring or other side effects you can expect before surgery begins. If the person treated for skin cancer is experiencing pain from surgery, he or she should speak with a pain management specialist to find ways to manage pain. If the skin cancer has spread at the time of diagnosis, which is rare, cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatment you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and your overall health. Common side effects for each treatment option are described in detail within the Treatment section. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health care team. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Care of a patient’s symptoms and side effects is an important part of a person’s overall treatment plan; this is called palliative or supportive care. It helps people with cancer at any stage of illness be as comfortable as possible. Learn more about the the most common side effects of cancer and different treatments, along with ways to prevent or control them. Be sure to talk with your doctor about the level of caregiving you may need during treatment and recovery, as family members and friends may play an important role in the care of a person with skin cancer. Learn more about caregiving. In addition to physical side effects, there may be psychosocial (emotional and social) effects are well. For many patients, a diagnosis of skin cancer is stressful and can bring difficult emotions. Patients and their families are encouraged to share their feelings with a member of their health care team, who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your medical care. A side effect that occurs more than five years after treatment is called a late effect. Treatment of late effects is an important part of survivorship care. Learn more about late effects or long-term effects by reading the After Treatment section or talking with your doctor. After Treatment
After treatment for skin cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. An important part of follow-up care is routine screening for new additional skin cancers, including whole body skin examinations by a health care professional. This is because many people treated for one skin cancer later develop other skin cancers. Also, people treated for skin cancer are encouraged to talk with their doctors about following a healthy diet that includes foods containing antioxidants such as vitamins E and C and selenium. Sun protection is essential to help prevent other skin cancers. Many people who are treated for skin cancer lead an active, outdoor lifestyle, but it is very important to take steps to protect yourself from further skin damage. Participating in outdoor activities before 10:00 AM or after 4:00 PM and wearing long sleeves, pants, sunscreen, sunglasses with UV protection, and a hat will protect against further skin damage. Learn more about protecting your skin from the sun. For most skin cancers, the surgery removes only a small part of the skin, so there is little need for rehabilitation. However, in some cases, there may be some need for rehabilitation services if surgery was more extensive. People who have surgery, particularly multiple surgeries, on their face may have a substantially altered appearance. Rarely, the eyelid may be altered. The eyelid may not close well, and the person may need to use drops to moisten the eye. In those rare cases when extensive facial surgery is necessary, the person will need support and possibly the help of a caregiver during treatment and recovery. Some of these surgeries are multi-stage and may require prolonged absence from work or other activities. Rarely, when radiation therapy is used, there is the possibility of a second cancer, which may not appear for more than 10 years after treatment. Chemotherapy is used extremely rarely in advanced disease. It is unlikely that the chemotherapy for advanced disease would have common late effects. It is important to note that chemotherapy is not curative for advanced squamous cell carcinoma and is unlikely to cause leukemia. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed. People recovering from skin cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes. Find out more about common terms used after cancer treatment is complete. Current Research
Doctors are working to learn more about skin cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you. Photodynamic therapy. Photodynamic therapy is the use of a cream or other medication that may be combined with light or laser therapy to remove identified skin lesions. Topical medications for actinic keratoses. Ongoing clinical trials of topical medications (creams or lotions) for use on actinic keratoses are being studied to prevent second cancers. Imiquimod for superficial squamous cell cancer and basal cell cancer. As explained in Treatment, imiquimod is a type of immune response modifier in which the body uses its own immune system as a method of treatment. Research is ongoing to learn more about imiquimod’s uses. EGFR inhibitors for advanced or metastatic squamous cell carcinoma. Many squamous cell carcinomas express epidermal growth factor receptor (EGFR), a tumor protein that helps cancer cells grow. Several clinical trials are investigating whether drugs that inhibit EGFR are effective against advanced or metastatic disease. “Hedgehog pathway” inhibitor for advanced basal cell carcinoma. Researchers are studying the use of a “hedgehog pathway” inhibitor (GDC-0449) in treating people with these cancers who have the PTCH1 genetic mutation, which contributes to the uncontrolled growth of basal cell carcinoma. Learn more about this type of approach, called targeted therapy. Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current skin cancer treatments, in order to improve patients’ comfort and quality of life. Learn more about common statistical terms used in cancer research. To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now. Questions to Ask the Doctor
Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. Before a diagnosis of skin cancer
After a diagnosis of non-melanoma skin cancer
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
