Cancer is named from the place it originates. This makes a difference on what type of treatments will be effective. Being diagnosed with cancer of the unknown primary (CUP) means that cancer has been found in the body but the place of origin is unknown.

If later, the place of origin is found then the type of cancer diagnosis changes from an unknown primary to the specific organ or body area that the disease first began.

Some cases of cancer of the unknown primary are unfortunately never found. Physicians will then decide on the best course of treatment based on two factors: The way the cells look under the microscope and which organs are currently involved.

Statistics and Prognosis:

The exact number of cases of this disease is not known. It may be about 2% to 5% of all cancers in the United States. It is found more often among men than among women. The average age of people with this cancer is about 60 years.

This is a very dangerous cancer. Only half of patients will live 9 to 12 months after their cancer is found. There are several reasons why this cancer is so serious. First, most of these are fast-spreading cancers. Second, because the exact type is not known, it is harder for doctors to know what treatment is best. Also, the cancer is often widespread, making it harder to cure.

In recent years, microscopic and other diagnostic techniques have improved dramatically. For this reason, doctors can now determine the primary site in about four out of five cases.

Overview of osteosarcoma:

There are about 900 new cases of osteosarcoma diagnosed in the US each year. About 400 occur in children and adolescents younger than 20 years of age.

Osteosarcoma forms in the bones. It is most commonly diagnosed in those who are 15 to 25 years of age. It is also the most common type of bone cancer, and the sixth most common type of cancer in children.

Other types of cancer can eventually metastasize to the bone, however this disease originates in the bone and can spread elsewhere to other parts of the body.

Many cases of osteosarcoma, around 80 percent, begin in or around the knee area.

What are the risks of osteosarcoma?

The disease is most seen in boys and can arise from unpredictable errors in the DNA of growing bone cells during times of intense bone growth. Currently, there is no effective way to prevent this type of cancer but with proper treatment most kids diagnosed with osteosarcoma do recover.

Limits are being placed on profits doctors can make on some cancer drugs, causing oncologists to search for new income. Some fear these physicians may resort to prescribing additional treatments for some patients. Not just any treatments, though -- just the ones with the best reimbursements.

Until 2005, Medicare paid a markup of 20 to 100 percent for many cancer drugs. In 2005, Congress changed the reimbursement system to pay physicians just six percent more than the average price for a given treatment. This decrease has made it difficult for small practices to break even on cancer drug purchases because the purchases are not large enough to receive rebates or discounts from drug manufacturers.

According to a recent New York Times article, some oncologists have attempted to increase profits by performing chemotherapy more often, ordering more diagnostic scans, and by putting pressure on patients to make out-of-pocket drug co-payments.

Say it isn't so.

Seventy year old Ronald Baker says that "its hard to think about cancer on a growling bulldozer". He was diagnosed with prostate cancer and receives radiation daily, where he says is the only time during the day he thinks about having cancer.

Baker enjoys driving the two ton bulldozer and feels that staying busy is keeping his mind off of his cancer diagnosis and treatments. When he isn't working Ronald stays at Jack's Place, a temporary home for people needing long-term cancer treatments.

Ronald lives with his wife on a secluded ranch in Colorado where he rides horses and takes people on guided hunting trips in the winter. There wasn't a good treatment center available where he lives so he was referred to Jack's Place, a place he could live and find a job to keep busy during his radiation treatments.

Way to go Ronald!

Telling your doctor or nurse about pain is not a sign of weakness and you should not accept pain as a normal part of having cancer. You have a right as a cancer patient who is experiencing pain to ask for pain relief. When you are free of pain, you can sleep and eat better, enjoy the company of those around you, and can continue on with work and hobbies.

If your doctor suggests no other options to reduce your pain after discussing it with him, then ask to see a pain specialist or ask your doctor to consult with a pain specialist which may be an oncologist, anesthesiologist, neurologist, or neurosurgeon.

Use a pain scale when talking with your doctor. For example, your pain might be 5 on a scale of 0 to 10. Other important factors you should discuss with your doctor include ...

At the 2007 meeting of the American Society of Clinical Oncology, results were presented from a clinical trial that stated -- Continuous maintenance therapy may improve survival among patients with metastatic colorectal cancer.

Maintenance therapy is used when a patient's cancer is stable and not exhibiting signs of progression. Researchers want to find a way to improve survival, but they also want to find a program that is not too intense and will have limited side effects.

This brings us to the study that was done on 202 patients with metastatic colorectal cancer. The patients were split in two groups, one group received continuous maintenance chemotherapy with a drug called Eloxatin (oxaliplatin). The second group was only treated again with chemotherapy once their cancer had started to progress.

Norwegian researchers report that about 68 percent of patients who wish to have children manage to do so after successful treatment of Hodgkin's lymphoma.

The researchers studied both men and women survivors. They found that the type of treatment was significantly associated with successful parenthood. The highest probability was in patients treated with radiation only or with less damaging types of chemotherapy.

Dr. Kiserud told Reuters Health, "Information on fertility issues is important in clinical oncological practice, and fertility saving tasks should be discussed with patients at risk of post-treatment infertility. Females should be informed that both the treatment and their age at treatment influence their fertility potential."

The one constant thing that gives people fighting cancer hope is the continued support of friends and family. Phone calls, emails, a surprise or planned visit at the door that has a big hug on the other side, a held hand over coffee or tea, or sitting patiently by their side as they go in for treatments. When that support falls by the wayside, it makes the determination to fight this disease or any other less worth the effort. In my humble opinion as someone fighting cancer, we sometimes fight harder to overcome disease for others more than ourselves. Because it is in their caring and the will in their eyes that gives us a much brighter hope than we find in ourselves. It is the lack of support or caring that sets off an internal depression that makes it ten times harder to find the will to fight. People seem to find it easier to hug a tree than a human. Try to imagine if you will sitting in a house alone and thinking about a disease that can run rampant through your body. It is hard to imagine and something that we do not want to think about. Yet many many people face that struggle every day of their lives.

So if you haven't reached out to someone you know, a neighbor, a friend, someone in your church or where you work, or even a family member that is struggling with cancer or any other disease, then find it in your heart to do so. It will make a difference. And if you have reached out to someone once or even twice, know that once is not enough and twice is not enough. No matter how much you think you are being a nuisance, that constant reminder of love and support is 95 percent of your friend's battle. The old saying "You never know who your true friends are until you go through a crisis and see who stands by our side" is very very true. So go stand by someone's side today, tomorrow, and for many days to come to offer support and encourage strength until their fight is successful. Even a phone call goes a long long way.

For those of you who stay in touch with me by phone and emails and that come knocking on my door in this time of need, I thank you very much for giving me the strength and will to survive.

Way to go Wake Forest University scientists -- for adding to the body of evidence connecting stress to illness and for reporting before anyone else that the stress hormone epinephrine causes changes in prostate and breast cancer cells that may make them resistant to death.

Emotional stress contributes not only to the development of cancer, says lead researcher George Kulik, D.V.M., Ph.D, but it also reduces the effectiveness of cancer treatments.

Previous research shows levels of epinephrine, produced by the adrenal glands, are sharply increased during stressful situations and can stay elevated during long-term stress and depression.

During this study, published in the on-line Journal of Biological Chemistry, Kulik and colleagues found that a protein called BAD -- the cause of cell death -- becomes inactive when cancer cells are exposed to epinephrine.

This is huge for patients and researchers.

"It may be important for patients who have increased responses to stress to learn to manage the effects," said Kulik. "And, the results point to the possibility of developing an intervention to block the effects of epinephrine."

In the news there has been a lot of questioning whether or not it is wise for someone diagnosed with cancer, and needs therapy or treatments to control their cancer, should still work or carry on with their life the way it was before cancer entered into their lives.

Its a good question -- but all cancer survivors or patients must make this decision themselves and should not be judged either way. Treatments can be physically mild or debilitating and everywhere in between.

I know women who are walking in Elizabeth Edward's shoes and have metastatic breast cancer. These women that I know might not be blazing the campaign trail but they are still keepin-on- keepin-on with life like it was before their breast cancer returned. They still get up and go to work, do the laundry, feed their children, all the normal things that you and I do everyday. Not to say that days can't be really tough, emotionally and physically. But I see women who are living with the disease -- really living and not giving up any of their dreams.

I can't really speak for women with metastatic disease, I can only talk about what I see, because I am not walking in their shoes and don't completely understand what it is like living with recurrent breast cancer.

Recurrent breast cancer can mean being on some kind of cancer treatment for the rest of your life, it can mean long times of remission or no evidence of disease.

Can it mean Elizabeth Edwards being first lady with metastatic breast disease? I think so.

Theranostics Health LLC is a company that was formed by George Mason University cancer researchers Dr. Lance Liotta and Emanuel Petricoin.

The company plans to tailor cancer treatments to individual patients based on proteomics, the study of proteins. Proteins play a central role in our bodies. Understanding the structure and function of each protein and its complexities of protein interactions can be critical for developing the most effective diagnostic techniques and disease treatments in the future.

Information about protein activity in tumors can allow doctors to choose the best drugs to kill the cancer cells. President and CEO of the company Joseph Reilly said "The physicians will then be provided a new class of information about that patients' individual cancer. This will enable the physician to tailor the therapy based on the individual patients' tumor."

One size fits all for cancer treatment is hopefully on its way out. We need to prescribe the right therapy to the right patient. This will increase treatment success rates and also spare patients unnecessary toxicity from chemotherapy drugs that would be unsuitable for their tumor.

Today I offer you not so much a Thought for the Day but a Question for the Day. Before I ask my pressing question, though, I want you to consider this story.

Diagnosed with a rare malignant melanoma on her retina in 2001, Ann Guthrie, a South Carolina wife and mother of two grown sons, endured radiation and chemotherapy. The treatments shrunk Guthrie's tumor, but another mass appeared two years later, forcing the removal of her right eye.

At about the same time Guthrie lost her eye, cancer was discovered in her lungs. It was inoperable. Then cancer landed in her brain. And now, without any approved treatment avenues, Guthrie is out of options.

Like many people with terminal illnesses, this woman is willing to try just about anything -- a clinical trial, experimental drugs, risky treatments -- to extend her life. If she's going to die anyway, why not? She just might live longer. And if she doesn't, she could at least help advance science by offering herself up as a sort of guinea pig.

While the Food and Drug Administration (FDA) has proposed changes that would make it easier for patients to access options like these, it's just not that simple right now.

There are ethical issues -- like weighing the needs of people who think anything is better than death against the need of society to prove drugs and treatments work safely. The only way to ensure a sort of balance is through clinical trials -- and letting anyone participate in clinical trials, for example, would make the results harder to interpret.

And there are medical and legal risks. What if terminally ill patients end up in worse shape after a treatment with an experimental drug, for example? What if the FDA or a physician is considered responsible for adverse drug reactions?

Denying terminal patients their last bits of hope is difficult. "It's a hard discussion to have with a patient and his family," says one doctor. "There's a lot of tears. We all would love to be able to get them access to some form of therapy."

And now for my question:

What do you think about terminally ill cancer patients and their access to anything that might extend -- or save -- their lives?

My good friend Deb, a young breast cancer survivor, emailed me this morning. She told me that she just filled her last prescription for Tamoxifen today. In the email she said it was a 'weird feeling'. I myself, will be going off Tamoxifen this October and will have fulfilled my five years on the drug as well.

I asked Deb to tell me more about how she felt and what it means in her life now that she will be discontinuing Tamoxifen for her breast cancer treatment.

"I have truly mixed feelings! It is bittersweet. It can be a scary, anxiety-provoking thought just thinking about ending it. It was my protection and security after chemotherapy for so long. I know that Tamoxifen still has effects in my body for years after stopping. I have three months left and I will stop Tamoxifen in June. Part of me is glad to stop it, to not have to remember to take a pill daily and my breast cancer treatment is now complete."

"Yet there is the other part of having to trust my body again. It failed me once. It means I'll have to modify some things in my life, substitute for taking a pill to fight off cancer. It means taking exercise more seriously, exercise can cut your risk for recurrence up to fifty percent. It means I'll stick to my diet a little better. I may also decide to take a Cox 2 inhibitor, like celebrex, as an anti-inflammatory. When Vioxx was pulled from the market, these similar Cox 2 inhibitors were pulled from clinical trials, now those trials are back open and are showing benefit. I have injuries in my knees, so will be taking it for that as well."

"In a sense I'll be flying on my own again. I remember them saying five years thinking how long that would be, it actually slipped right by. I will get tested to see if I'm in menopause, but seriously doubt that I am. It would be nice to go on an AI, but I really don't want to be in menopause quite yet. So, my prescription is diet and exercise and perhaps a Cox 2 inhibitor as preventative. I will still continue to see my oncologist every six months. I will continue to celebrate life and live it to its fullest and appreciate those things and people that truly make a difference in my life"

Deb Kirkland -- Young Breast Cancer Survivor

One in 18 men and women will be diagnosed with colorectal cancer during their lifetimes -- that translates into more than 150,000 people diagnosed and more than 52,000 colorectal cancer deaths each year, securing the disease as the second leading cause of cancer death in the United States.

Fortunately, mortality rates for this disease have been declining due to earlier screenings, awareness of symptoms, removal of polyps, and improved treatments through advances in research discoveries -- like today's genetic breakthroughs.

In a recent study, researchers identified a cell pathway critical in the development of colon cancer and also lung and stomach cancers.

STAT3 (signal transducer and activator of transcription 3) is the newest discovery and is a target regulated by PRPRT (receptor protein tyrosine phosphatase T), already identified to be mutated in these cancers.

"The role of protein tyrosine phosphatase in cancer is still an under-explored area," says Zhenghe John Wang, Ph.D., Assistant Professor, Department of Genetics at Case Western Reserve University School of Medicine and Case Comprehensive Cancer Center.

"Our study shows that receptor protein tyrosine phosphatase T regulates an important signaling pathway that is critical in cancer development. This identification will allow new approaches to pharmacological designs and facilitate alternative approaches for cancer treatment."

This study, published in the Proceedings of the National Academy of Sciences (PNAS Online Edition Feb. 20-23, 2007), provides new hope for the development of drugs that will target this potentially deadly disease.

Luanne Austin says chemotherapy is not all it's cracked up to be. She doesn't mean it's cracked up to be something really great but is far from such a thing. She means it's cracked up to be something pretty horrible but is really not all that bad.

Austin says the day her doctor announced she would receive chemotherapy was almost as bad as the day she learned she had breast cancer. That's because she had heard nothing but bad things about the treatment. She expected to be laying in bed with her life in the balance -- nauseated, vomiting, sick -- as the "cure" killed her.

All expectations aside, Austin decided to tackle chemotherapy with a positive attitude. This may seem a daunting task -- turning a dreaded chemotherapy protocol into a not-so-bad experience -- but Austin mastered the task. And here are seven of her positive thoughts about a treatment that is not all it's cracked up to be.

• Austin talked to people who had traveled journeys similar to hers. What she learned is that many women continued working through treatment. Some suffered very few side effects. One woman even told Austin her experience was super. Austin was inspired by the positive women she tracked down. And now she inspires others.
  

• Austin did some reading. She learned that chemotherapy drugs target quickly-dividing cells, like cancer cells, red and white blood cells, blood platelets, and digestive tract cells. Learning about the process helped her realize chemotherapy was intended to make her well, not make her suffer.

• Austin learned how to support her body through treatment. She came to understand that the best chance of surviving breast cancer comes from conventional medicine -- surgery, chemotherapy, radiation -- but that alternative treatments can complement the traditional approach. She recommends the book Breast Cancer: Beyond Convention and considers her pursuit of a healthy diet, exercise, supplements, and a good night's sleep some of her most helpful chemotherapy add-ons.

• When Austin felt weak, tired, and just plain zoned out, she retreated to her bed with a good book and a cup of tea. Instead of considering it a setback, she called this downtime a good excuse to spend hours reading.

• Austin found relief from her nurses. They were terrific, she recalls, and professional and friendly and respectful too. Getting to know her medical crew -- and receiving hugs from them at the end of her treatment -- confirmed chemotherapy has some good points.

• For Austin, God -- who carried her through her whole journey -- was instrumental in her positive outlook. She felt lifted up and carried, she says.

• And then there's love -- pure and simple love from her husband and family members -- that allows her to conclude that chemotherapy is not so bad. "I'd have to say chemotherapy hasn't been all that bad," she says. "Not bad at all."