Cancer services

Cancer is a term used to describe a disease of the body's cells where cells divide abnormally without control.

Cancer is serious because it can spread locally to normal tissue, regionally to nearby lymph nodes and organs, and to distant parts of the body.

Cancer is not a single disease with a single cause and a single type of treatment.

There are more than 200 types of cancer that are named after the organ, or type of cell from which the tumour starts.

For example, a primary cancer that starts in the breast is called breast cancer.

Types of cancers

There are different categories of cancer.

Carcinoma

Cancer that starts from the lining cells of the body's inner surface such as lungs, bowel, reproductive organs and reproductive organs.

Sarcoma

Cancer that starts in the connective or supportive tissue. These are the cells that make up bone, cartilage, fat, muscle and blood vessels.

Leukaemia

Cancer that starts in blood forming cells such as bone marrow and spleen, which causes large numbers of white blood cells to be produced and enter the blood.

Lymphoma and myeloma

Cancers that start in the cells of the immune system.

Central nervous system cancers

Cancers that start in the tissues of the brain and spinal cord.

Normally, cells grow and multiply in an orderly way with old cells being replaced with new cells, to maintain healthy tissues and repair injuries.

However, in some cases this process goes wrong with the genetic material of cells becoming damaged and producing mutated cells.

Therefore old cells do not die and the body still produces new cells resulting in an uncontrolled growth to form a cellular mass called a tumour.

Benign and malignant cancers

There are 2 types of tumours.

Benign cancers

Benign tumours are not cancerous but can be dangerous if they press on vital organs such as the brain.

They can often be removed and in most cases they will not recur. Benign tumours do not spread to other parts of the body.

Malignant cancers

Malignant tumours are cancerous.

Cells in these tumours can invade nearby tissues and spread to other parts of the body.

Cancer cells can spread to other parts of the body from the original cancer site through the blood or lymphatic system.

This is known as either:

• invasion - the direct migration and penetration by cancer cells into neighbouring issues
• or metastasis - the ability of cancer cells to penetrate into lymphatic and blood vessels, circulate through the bloodstream and then invade normal tissues elsewhere in the body.

Advanced cancer

Advanced cancer is a term used to describe primary cancer or metastatic/secondary cancer that is unlikely to be cured.

Often this is a recurrence of cancer that has already been treated.

Advanced cancer can be treated to slow the growth and spread of the cancer for months or years, and reduce symptoms.

People with advanced stages of cancer have a life limiting illness.

Even if they are initially feeling well, death is a likely part of the future as the cancer grows and may spread to vital organs such as the lungs or brain.

Treatment will be focused on ways to enhance quality of life while managing symptoms such as pain.

Rad more about palliative care.

Your cancer journey

Your cancer journey is your individual experience of cancer.

The journey may not look the same for everybody, even if they have the same type of cancer.

Your symptoms and treatment may be quite different depending on your stage of cancer and other underlying conditions and treatment.

Different people may react differently to cancer treatments.

You may want to take an active part in making decisions about your care. It is important to learn all you can about the disease and treatment choices available.

Primary care

A visit to the doctor or clinic for a routine check up may reveal signs that need further investigation.

Sometimes people have particular symptoms that are highly indicative of cancer, but some early stage cancers have little or no obvious symptoms.

Your doctor may request further tests to make a diagnosis or may refer you to an appropriate specialist.

This could be any of the following:

• oncologist - tumour and cancer specialist
• haematologist - blood cancer specialist
• surgeon
• specialist physician.

Read more about diagnostic tests, referral to specialists, types of doctors and cancer and treatments.

The Alan Walker Cancer Care Centre is located at the Royal Darwin Hospital and has the following services for Northern Territory (NT) patients:

• radiation therapy
• outpatient chemotherapy unit
• specialist outpatients clinic
• allied health services
• other specialist cancer services.

Bowel cancer, also known as colorectal cancer, develops from the inner lining of the bowel and is preceded by growths called polyps. These can become invasive cancer if undetected.

Bowel cancer is the second most common cancer in men and women in Australia. It is more common in people over the age of 50.

People at risk

The risk of developing bowel cancer is greater for any of the following people:

• are aged 50 years or over
• have a family history of bowel cancer or polyps
• have an inflammatory bowel disease
• have previously had adenomas, a type of polyp in the bowel.

You can reduce your risk by doing all of the following:

• eating a healthy diet
• regular exercise
• drinking less alcohol 
• not smoking.

Free test you can do at home

If you are over 50 years of age you can take a simple, free test at home.

For more information, go to bowel screening or the National Bowel Cancer Screening Program website.

Symptoms

You should go to a doctor if you notice any or all of the following:

• blood in faeces
• abnormal bowel habits
• ongoing abdominal pain
• constant tiredness.

Early detection tests

Your doctor may ask you to give a blood test, including iron levels, and give you a rectal examination.

If you live in the Top End 

Your doctor may refer you to Royal Darwin Hospital or to the visiting surgeon at the Katherine District Hospital or the Gove District Hospital for diagnostic tests such as a colonoscopy and possible tissue sampling, called a biopsy. 

Darwin Private Hospital and Darwin Day Surgery also perform bowel cancer diagnostic tests.

If you live in Central Australia 

Your doctor may refer you to Alice Springs Hospital for diagnostic tests such as a colonoscopy and possible tissue sampling, called a biopsy. 

Diagnosis tests in the NT

If bowel cancer is suspected, your health professional will discuss options with you and refer you to a surgeon or a gastroenterologist.

Your surgeon will conduct further tests to determine the spread of cancer, which may include a colonoscopy, CT scan, x-ray or MRI scan.

If you live in the Top End 

You can have your colonoscopy at the Royal Darwin Hospital or through the visiting surgeon at Katherine District Hospital or the Gove District Hospital.

Tests such as CT scans only happen at Royal Darwin Hospital and in Katherine. MRI scans are only available at Royal Darwin Hospital.

If you live in Central Australia

You will be tested at Alice Springs Hospital. If you need an MRI you will need to travel to another hospital in the NT or interstate.

Treatment in the NT

Your surgeon will first discuss your treatment with other specialists, then talk to you about your treatment options.

They will include one or more of the following:

• surgery
• radiotherapy
• chemotherapy.

If you have to travel a long distance for specialist treatment you may be eligible for the Patient Assistance Travel Scheme. 

Surgery

Removal of the cancer will benefit you most, specifically if you are in the early stages.

Radiotherapy

You may have radiotherapy if you have high-risk rectal cancer. Radiotherapy is not usually needed for colon cancers.

Length of treatment is usually five to six weeks, or two weeks for pre-surgery patients.

You will need to go to the Alan Walker Cancer Care Centre in Darwin. 

Chemotherapy

Chemotherapy is likely if you have higher risk cancer.

The treatment is usually four to six months. 

You will need to go to the Alan Walker Cancer Care Centre in Darwin, Alice Springs Hospital or travel interstate.

More information

For more information on investigations, diagnosis and treatment of prostate cancer, go to the outline of the cancer pathway for prostate cancer on the Cancer Council website.

For more information read cancer journeys - bowel or go to the Bowel Cancer Australia website.

Brain cancers include: 

• primary brain tumours, which start in the brain and almost never spread to other parts of the body
• secondary tumours, or metastases, which are caused by cancers that began in another part of the body.

If you have any concerns about symptoms such as headaches, disturbed vision, nausea or loss of balance, see your general practitioner (GP) as soon as possible. 

You can also contact the oncologist at the Alan Walker Cancer Care Centre.

For more information about symptoms, diagnosis and treatment of brain cancer go to the Cancer Council website.

Breast cancer is the most common cancer affecting Australian women. It can also affect men.

Breast cancer is a cancer that develops in your breast tissue.

All women should be aware of their breasts. 

You should know what your breasts normally look and feel like so that any unusual changes can be investigated.

Reduce your risk of breast cancer

You can reduce your risk of breast cancer by doing all the following:

• drinking less alcohol
• increasing exercise
• getting regular breast checks with your local health professional.

Free screening test

If you are between 50 and 74 years of age you can have a free mammogram with BreastScreenNT.

You can have screenings at any of the following places:

• Darwin - all year
• Palmerston - weekly
• Katherine - once a year
• Gove - every second year
• Alice Springs - twice a year
• Tennant Creek - once a year
• remote communities as per the screening schedule with the BreastScreenNT bus.

For more information call 13 20 50 or go to BreastScreenNT.

Symptoms

It is important to know the normal look and feel of your breasts. Things you should look out for include:

• a new lump or lumpiness in your breasts, especially if it is only in one breast
• a change in the size and shape of your breast
• a change to the nipple such as crusting, an ulcer, redness or the nipple pulled in
• a change in the skin of your breast such as redness or dimpling or puckered skin
• a pain that does not go away.

Initial diagnostic tests in the NT

Your doctor will examine you and do other tests such as any of the following:

• mammogram
• ultrasound
• possible tissue sample, called a biopsy.

If they suspect you have cancer, they will refer you to a surgeon at the Royal Darwin Hospital or Alice Springs Hospital, depending on where you live. They can also refer you to a surgeon at Darwin Private Hospital. 

They will determine the spread of the cancer with more tests, which may include:

• mammography with ultrasounds
• tissue sample collection (biopsy).

Treatment in the NT

Your surgeon will determine the stage of cancer and will discuss surgery options with you.

If surgery is an option, they will discuss additional treatment and management of your cancer with other specialists.

Surgery

The type of surgery will depend on the stage your cancer is at. If you have late stage cancers you are unlikely to have surgery.

You may have either:

• lumpectomy - the tumour is removed from your breast
• mastectomy - removal of your breasts.

Your surgery will be carried out at either the Royal Darwin Hospital or Alice Springs Hospital, depending on where you live. You can also choose to have surgery at Darwin Private Hospital. 

Drug therapy

Drug therapy may include any of the below.

Chemotherapy

Benefits most patients. Treatment is usually three to six months.

Hormone therapy

Benefits patients at high risk of recurrence. Treatment is usually five years.

Targeted therapy

Only given for certain types of cancer. Treatment is usually one year. 

Drug therapy is carried out at the Alan Walker Cancer Centre in Darwin, Alice Springs Hospital or you may have to travel interstate. 

Radiotherapy

Usually used for intermediate and high risk tumours. Length of treatment is five to six weeks.

Radiotherapy is carried out at the Alan Walker Cancer Centre in Darwin or interstate.

You may be eligible for the Patient Assistance Travel Scheme.

Support services

Your doctor can refer you to other support services such as an occupational therapist or physiotherapist.

The Cancer Council NT can also provide support from a breast care nurse. They can also help you with breast prostheses.

Call the Cancer Council Helpline on 13 11 20 or go to the Cancer Council NT website.

For more information read cancer journeys - breast.

Follow up care

You are likely to need an annual mammogram.

The BreastScreenNT program is a free breast screening program for women without signs or symptoms of breast cancer.

A screening mammogram is a low dose x-ray that allows a doctor to see the inside of your breast.

It can detect breast cancer at an early stage before it can be felt or noticed.

Who is eligible

If you are between 50 and 74 years old, you are encouraged to have a free screening mammogram. It is recommended you should be screened every two years.

Research shows that a screening mammogram is the most effective way to detect breast cancer for women in this age group.

If you are aged between 40 and 49, or 75 and over, you should talk to your GP about whether you should have a free screening mammogram.

If you have a significant family history of breast cancer, you should talk to your GP.

If you are under 40

Screening mammograms are not effective for women under 40.

Hormones mean your breast tissue is denser when you are younger.

On a mammogram, dense breast tissue shows up as a white area. Breast cancers also appear white so are more difficult to see on a younger woman's mammograms.

If you have symptoms

If you have symptoms of breast cancer, you should talk to your GP about a diagnostic mammogram.

You can have a diagnostic mammogram if you notice a change in your breast such as:

• a lump
• dimpling of the skin
• thickening or swelling of part of the breast
• redness or flaky skin on the breast
• pain in the breast area.

It is usually performed in a general diagnostic imaging practice.

You will need a referral from a GP or surgeon and it will usually include other imaging such as an ultrasound and a biopsy.

If you don't have symptoms

If you have no symptoms of breast cancer and you are aged between 40 and 74, you can make an appointment for a free screening mammogram.

Not all cancers will be detected through screening.

Some cancers cannot be seen on a screening mammogram and some cancers develop during the time between screening mammograms.

A screening mammogram may also detect abnormalities in the breast tissue. These may need further tests but do not turn out to be cancer.

Preparing for your screening

Wear a separate top and bottom as you will need to remove your top and bra during your breast screen.

Do not wear talcum powder or deodorant on the day of your appointment as it may affect your breast screen.

You should arrive 10 minutes before your appointment to complete your paperwork.

During the screening

A radiographer will take two x-ray pictures of each breast.

Your breasts will be compressed for about 10 seconds when the picture is being taken. This means a clear picture can be taken with the least amount of radiation.

The digital pictures can be displayed on a high-resolution computer screen and looked at closely by two specially trained doctors called radiologists.

Your results

It can take between four to six weeks to get your results. They will be mailed to you, and your doctor if you have given us the name of your general practitioner.

With your consent, normal results of breast screening will also be published to your My Health Record.

You may be called back to an assessment clinic for more tests.

You will be contacted by a breast care nurse who will explain what happens next and answer any questions you may have.

If you have to go to an assessment clinic and live outside Darwin or Alice Springs, you may be eligible for help with travel and accommodation costs.

Risk factors

Mammograms are safe as there is minimal exposure to radiation.

For most women, the benefits of regular screening mammograms outweigh any possible risk from radiation exposure.

If you are taking hormone replacement therapy

Regular screening is recommended if you are taking hormone replacement therapy (HRT).

You should have a breast screen every two years unless otherwise advised.

If you are breastfeeding or pregnant

Pregnant women are advised to wait until after their pregnancy before having a screening mammogram.

This is because the breast tissue is denser during pregnancy which shows up as solid white on the breast screen, making small cancers impossible to see.

If you are breastfeeding, you are advised not to have a screening mammogram until six months after you have stopped breastfeeding.

If you have breast implants

Breast cancer screening is usually safe for women with implants. Breast implants can make it harder to see small breast cancers.

There is a very slight chance of damage to the implant but this is rare.

You will be asked to sign an additional consent form.

How to make an appointment

You can make an appointment by calling 13 20 50.

You don't need a doctor's referral.

If you have any concerns or notice any changes in your breasts, you should contact your GP.

There are permanent screening facilities in Darwin and Palmerston.

For all other remote areas, read about BreastScreenNT bus to find out where and when you can be screened.

The breast screening program is run by Cancer Screening Services.

Locations

Darwin

Level 1 Casuarina Health Services Centre
9 Scaturchio Street
Casuarina NT 0810

Open from Monday to Friday.

Palmerston

Palmerston Health Precinct
Corner of Gurd and Roystonea Avenue
Palmerston NT 0830

Open on Mondays and Tuesdays.

Alice Springs

There are two screening blocks each year from April to May, and August to September.

Remote screening is done through the BreastScreenNT four-wheel drive bus - read the current schedule.

For more information, go to the BreastScreen Australia website.

The oncology and haematology clinical trials unit (CTU) at Royal Darwin Hospital and the Alan Walker Cancer Care Centre has been conducting clinical trials since 2007.

The trails are chosen by doctors based on:

• scientific merit
• ethical value
• whether they can help patients who might not have other treatment options.

In the Northern Territory (NT) there are more than 200 patients taking part in over 20 trials.

Current cancer trials

Some trials currently include:

• prostate
• breast
• colon
• rectal
• acute myeloid leukaemia
• multiple myeloma
• lymphoma
• rare and advanced cancers

More trials are planned for commencement.

Participating in clinical trials

Express your interest in joining a clinical trial by talking with your healthcare team.

For more information about clinical trials in the NT, go to the NT Health website.

Australian teletrial program

The CTU is expected to continue growing with the Australian teletrial program.

The program is funded by the Commonwealth government and aims to help people living in remote areas of the NT participate in clinical trials closer to where they live.

Read more about the teletrial program in the NT on the NT Health website.

Cervical cancer is the growth of abnormal cells in the lining of the cervix, but it can spread to tissues around the cervix such as the vagina, or to other parts of the body such as the lungs or liver.

Cervical cancer was the 15th most commonly diagnosed cancer among females in Australia in 2012.

It is expected that the incidence rate of cervical cancer is highest if you are over 85, followed by age groups 75 to 79 and 35 to 39.

Symptoms

Early changes in cervical cells rarely cause symptoms. If early cell changes develop into cervical cancer, the most common signs include:

• vaginal bleeding between periods
• menstrual bleeding that is longer or heavier than usual
• bleeding after intercourse
• pain during intercourse
• unusual vaginal discharge
• vaginal bleeding after menopause
• excessive tiredness
• leg pain or swelling
• lower back pain.

Early detection test

The National Cervical Screening Program recommends all women between 18 and 70 who have ever been sexually active have regular Pap tests.

Women should start having Pap tests every two years from 18 to 20 years of age, or one to two years after sexual activity starts - whichever is later.

For more information go to the cervical screening page.

Prevention

Vaccinating against Human Papillomavirus (HPV) provides highly effective protection against the development of HPV-related cancers and disease caused by HPV types 6, 11, 16 and 18.

The best time to be vaccinated is before a person becomes sexually active. If a person has had sexual contact then they may have been infected with some of these HPV types.

You should not have the HPV vaccine if you have had a serious allergic reaction (anaphylaxis) to a previous HPV vaccine, yeast or any other vaccine components. You should also not have the vaccine if you are pregnant.

Regular Pap tests are still important because the HPV vaccine doesn't protect against all cervical cancers.

Diagnostic test

The usual tests to diagnose cervical cancer are:

• colposcopy
• biopsy, cone biopsy or large loop excision of the transformation zone.

More tests are needed for staging the cancer including:

• blood tests
• examination under anaesthetic - cystoscopy and proctosignmoidoscopy
• chest x-ray
• CT scan
• MRI
• PET scan.

Deciding on your treatment

Your gynaecologist or surgeon will first discuss your treatment with other specialists and then discuss your treatment options with you.

If you live in the Top End

Your case will be discussed with other specialist doctors at the Royal Darwin Hospital.

If you live in Central Australia

The gynaecologists or local surgeon will assess your case and refer you to the specialists in Darwin or interstate if appropriate.

Treatment

For very early and non-bulky disease the treatment is surgery, sometimes with chemo-radiotherapy afterwards. 

If the tumour is small, a cone biopsy may be done. In some cases hysterectomy (surgical removal of the uterus) is needed.

For locally advanced disease a combination of radiotherapy and chemotherapy is used.

For metastatic disease, the treatment is chemotherapy or palliative care alone.

Many people experience feelings of shock, denial and disbelief when they are given a cancer diagnosis.

You may have feelings of anger and sadness and concern about the future. You may find it hard to understand the diagnosis.

Your diagnosis

When a doctor diagnoses cancer, they will look at all of the following:

• your symptoms
• your medical history
• test results.

Your doctor will explain the type of tests and their relevance to your situation.

Depending on your symptoms, you may need to undergo one or more of the following tests.

X-ray

A type of high-energy radiation that takes pictures of the inside of the body to diagnose cancer.

Biopsy

The removal of a small amount of tissue or fluid for examination to detect cancer cells.

Blood test

When you give blood for testing of abnormal cells.

Computerised tomography (CT) scan

A series of detailed pictures taken using x-rays from a cross section of the body at different angles. Also called a CT scan or a computerised axial tomography (CAT) scan.

Endoscopy

A procedure that uses an endoscope to examine the inside of the body. An endoscope is a thin, tube-like instrument with a light and lens for viewing. It may also have a tool to remove tissue (biopsy) to be checked under a microscope for signs of disease.

Magnetic resonance imaging (MRI)

An MRI is a non-invasive imaging method that uses both magnetism and radio waves. It provides cross-section images of a particular part of the body to determine the size and shape of a tumour.

Mammogram

Radiological (x-ray) used to identify cysts, calcifications and tumours in the breast.

Positron emission tomography (PET) scan

PET scans detect hot spots in the body to show an accurate map of cancer spread. PET scans complement images from other types of scans. They are only used on certain types of cancers.

PET scans are available at Royal Darwin Hospital.

Ultrasound

The ultrasound device uses sound waves that people cannot hear. The device aims sound waves at organs inside the pelvis and the waves bounce off the organs. A computer creates a picture from the echoes.

Questions to ask your doctor

You may have questions for your doctor after your diagnosis but forget in the moment.

You should write down questions and you can record the consultation to help you remember what they said.

It may be a good idea to have a family member or friend with you for support and to ask more questions.

Some cancer organisations produce diaries to help people remember questions, answers and test results.

One example is the 'my journey kit' on the Breast Cancer Network Australia website.

Some examples of questions you can ask are:

• what are my treatment choices?
• which treatment do you recommend for me and why?
• what are the benefits of each treatment?
• what are the risks of each treatment?
• what are the side effects of each treatment?
• where can I get more information to help me make decisions about treatment?
• will I be able to work?
• how long will I be off work?
• how will it affect my life and relationships?
• has the cancer spread?
• where has it spread?
• do I need other tests?

Head and neck cancers include cancers of the tongue, gum, mouth, salivary glands, tonsils, pharynx, nasal cavity and larynx.

Alcohol and tobacco consumption are the biggest risk factors for head and neck cancers, with the exception of salivary gland cancer. Some head and neck cancers are related to human papillomavirus infection.

Choosing to quit smoking can reduce the risk of getting head and neck cancers. For more information, go to the Cancer Council website.

You can also go to the Cancer Council website for more information about the investigations, diagnosis and treatment of head and neck cancers.

Who is at risk

Major causes of head and neck cancer include all of the following:

• oral sex
• smoking
• chewing tobacco and betel nut
• heavy drinking, particularly in combination with smoking
• human papillomavirus (HPV).

Early detection and symptoms

There are no early detection screening programs for head and neck cancer.

Your should go to your doctor if you notice any of the following symptoms for more than 3 weeks:

• pain or difficulty swallowing
• persistent sore throat
• ongoing hoarseness
• lump in the neck or swelling of the jaw
• mouth ulcers or a mass in the mouth
• bleeding from the mouth or throat
• sores or lesions (red or white spots) in the mouth.

If your doctor suspects you have head and neck cancer they will refer you to a surgeon for more tests.

Diagnosis tests in the NT

Your surgeon will examine you and conduct more tests to determine the stage of cancer.

This can include giving a tissue sample (biopsy) or any of the following image scans:

• CT
• MRI
• bone thyroid scan
• PET scans.

Tests can be conducted at Royal Darwin Hospital or Alice Springs Hospital.

If you need a thyroid scan or PET scan you will need to travel interstate.

Treatment in the NT

Your surgeon will discuss your treatment with other specialists.

If you live in the Top End, your case will be discussed at the Royal Darwin Hospital's head and neck team.

If you live in Central Australia, your surgeon will refer your case to the Royal Darwin Hospital or you will be seen by the Royal Darwin Hospital team when they visit Alice Springs (once a month).

Your treatment may include one or more of the following:

• surgery
• radiotherapy
• chemotherapy.

Surgery

Surgery may be the best option if your cancer is localised.

Surgery can be performed at Royal Darwin Hospital and Alice Springs Hospital.

Radiotherapy

This may be the best option if your cancer is not suitable for surgery, or as additional therapy after surgery.

The length of treatment is usually six to eight weeks.

Radiotherapy is available at the Alan Walker Cancer Care Centre in Darwin or you may need to travel interstate.

You may be eligible for help with travel and accommodation costs through the Patient Assistance Travel Scheme.

Chemotherapy

You may have chemotherapy as well as radiotherapy.

The length of treatment is usually two to three weeks.

Chemotherapy is available at the Alan Walker Cancer Care Centre in Darwin, Alice Springs Hospital or you may need to travel interstate.

Follow up care

You will be checked at least monthly for the first year then every 3 to 6 months for 5 years.

This page has information on leukaemia, lymphoma and myeloma.

Leukaemia

Leukaemias are cancers of the white blood cells, which begin in the bone marrow. This information refers to four types of leukaemia:

• acute lymphocytic leukaemia
• chronic lymphocytic leukaemia
• acute myeloid leukaemia
• chronic myeloid leukaemia.

Leukaemias are grouped in two ways:

• the type of white blood cell affected - lymphoid or myeloid
• how quickly the disease develops and gets worse - acute leukaemia appears suddenly and grows quickly, while chronic leukaemia appears gradually and develops slowly over months or years.

For more information on leukaemia go to the Cancer Council website.

For more information about acute myeloid leukaemia including information on investigations, diagnosis and treatment go to the outline of the cancer pathway for acute myeloid leukaemia on the Cancer Council website.

Lymphoma

Lymphomas are the most common form of haematological or blood cancer in Australia, and the sixth most common form of cancer overall.

There are two main types of lymphoma - non-Hodgkin lymphoma and Hodgkin lymphoma - which spread and are treated differently. Around 90% of lymphomas are non-Hodgkin.

For more information on lymphoma go to the Cancer Council website.

Myeloma

Myeloma is a type of cancer that develops from plasma cells in the bone marrow. 

Myeloma is often called multiple myeloma because 90% of people have multiple bone lesions at the time it is diagnosed.

Bone marrow is found in multiple areas of the body, including the spine, skull, shoulders, ribs and pelvis.

For more information on myeloma go to the Cancer Council website.

Lung cancer is the most common cause of cancer death in the Northern Territory.

The earlier lung cancer is found, the better survival is likely to be.

The best way to prevent lung cancer is to quit smoking.

Symptoms

You should go to a doctor if you notice any of the following:

• weight loss
• weakness or fatigue, particularly if you are a smoker or ex-smoker
• persistent cough or coughing up blood
• pneumonia that won't go away
• explained bone pain or chest wall pain.

Early detection tests

There are no screening programs for lung cancer.

Your doctor will conduct tests such as an x-ray or CT scan of your chest and/or sputum test if you are coughing up blood.

If they suspect you have lung cancer they will refer you to a surgeon or physician at the Royal Darwin Hospital or Alice Springs Hospital.

Diagnostic tests

Your surgeon or physician will do more tests and examine you to find out what stage the cancer is at.

You may have travel interstate if you need a PET scan.

Deciding on your treatment

Your surgeon will first discuss your treatment with other specialists and then discuss your treatment options with you.

If you live in the Top End

Your case will be discussed with other specialist doctors at the Royal Darwin Hospital.

If you live in Central Australia

The local surgeon or local physician with a respiratory interest will assess your case and refer you to the visiting oncologist/radiotherapist if appropriate.

This can be via telehealth if necessary.

Treatment

Your treatment will depend on the stage your cancer is at.

It will include one or more of the following:

• surgery
• radiotherapy
• chemotherapy.

Surgery

You may have surgery to remove the cancer. This benefits patients who have localised disease. Surgery may also diagnose your cancer.

Your surgery will either be at Royal Darwin Hospital or Alice Springs Hospital.

Radiotherapy

You may have radiotherapy after surgery or to manage pain, bleeding or obstruction.

The length of treatment is six weeks. Consolidation radiotherapy to the lungs is three weeks.

Your radiotherapy treatment will be at the Alan Walker Cancer Care Centre in Darwin.

You may be eligible for help with accommodation and travel costs through the Patient Assistance Travel Scheme.

Chemotherapy

This may be recommended if you have advanced cancer if you have a tumour that is localised but can't be operated on.

The length of treatment is between three and six months.

Your treatment will be at the Alan Walker Cancer Care Centre in Darwin, at the Alice Springs Hospital or you may need to travel interstate.

Resources

For more information, read cancer journeys - lung cancer.

The Cancer Council website also has information to help you quit smoking, and about the investigations, diagnosis and treatment of lung cancer.

It is important to review and have follow-up care after your treatment.

This is to make sure any return, known as recurrence, of cancer is detected early. After treatment some cancer cells may remain undetected in the body. 

How often you need to visit your specialist and/or general practitioner (GP) will depend on the type of cancer and your treatment plan.

You may have to have regular follow-up checks from three to 12 months, depending on the type and aggressiveness of the cancer.

Your follow-up visits will become less frequent over time unless there are signs your cancer has returned.

Cancer outcomes

The most desirable outcome of cancer treatment is complete remission. 

However, in some cases complete remission does not happen and plans for further treatment or palliative care must be made. 

Remission

Your cancer treatment may lead to either partial or complete remission.

If you are in partial remission, some but not all of your signs and symptoms will have either lessened or disappeared.

Cancer may still be present in your body, even if you are in remission.

If you are in complete remission there are no signs and symptoms of cancer for a period of five years or longer following treatment.

Recurrence

In some cases cancer can return after a period of improvement or remission. 

This can happen at any time, from a few weeks to several years after your treatment is completed. 

The cancer may recur at the primary cancer site or in another part of the body. 

If this happens, your doctor will do tests and once again discuss all treatment options with you. 

In some cases, recurrent episodes of cancer can be effectively controlled with treatment for long periods of time.

Advanced cancer

Advanced cancer is a term commonly used to describe primary cancer or metastatic/secondary cancer that is unlikely to be cured. 

For more information go to about cancer and your cancer journey.

Ovarian cancer is the eighth most common cancer and the sixth most common cause of cancer death affecting women in Australia. 

There are three types of ovarian cancer:

• the common epithelial type (90% of cases) that arises from cells on the outside of the ovary
• the germ cell type that arises from the cells that produce eggs
• the rare stromal type arising from supporting tissues within the ovary.

Symptoms

There may be no symptoms or symptoms can be non-specific and include:

• abdominal bloating
• difficulty eating or feeling full quickly
• frequent or urgent urination
• back, abdominal or pelvic pain
• constipation
• menstrual irregularities
• fatigue
• indigestion
• pain during sexual intercourse.

Diagnosis

There is currently no screening for ovarian cancer in Australia. If you are experiencing possible symptoms of ovarian cancer, your doctor may suggest several tests or scans to look for cysts, tumours or other changes. 

These tests may include:

• physical examination where the doctor will check your abdomen for any lumps and do an internal vaginal examination
• blood tests
• imaging scans
• ultrasound
• CT scan
• PET scan
• colonoscopy.

These can show if there are any abnormalities, but a biopsy (taking a tissue sample) is the only way to confirm a cancer diagnosis.

Ovarian cancer resources

The Cancer Council website has information on ovarian cancer, as well as the cancer pathway for ovarian cancer, which includes investigations, diagnosis and treatment.

Once your diagnosis has been confirmed, your doctor will refer you to any of the following specialists:

• specialist surgeon
• oncologist - a doctor who specialises in treating cancer
• haematologist - a doctor who specialises in treating diseases of the blood.

There are five public hospitals throughout the Northern Territory (NT) and one private hospital located in Darwin. 

Oncology (cancer) services are provided at three of these hospitals - Royal Darwin, Alice Springs and Darwin Private Hospitals. 

The Alan Walker Cancer Care Centre  is located within the Royal Darwin Hospital premises. 

It provides NT patients with professional, high quality radiation therapy treatment as well as an out-patient chemotherapy unit, specialist out-patients clinics and allied health cancer specialist staff. 

Treatment for some cancers will involve referral to interstate cancer treatment centres as not all can be treated in the NT.

Your treatment plan

Your specialist will talk to you about your options for treatment and will decide what your treatment plan will be. They will take your preferences for treatment into account.

Treatment planning involves all aspects of cancer care including all of the following:

• surgery
• chemotherapy
• radiation
• physiotherapy
• occupational therapy
• dietetics
• speech pathology
• audiology
• social work
• psychology.

Go to treatment options for more information about different types of treatment. 

When you need to travel interstate

There are certain types of cancer and treatments that are not available in the NT.

These include all of the following:

• central nervous system cancer
• some types of blood cancer
• rare types of cancer
• cancer in children
• cancer that require specialist treatment.

You may be eligible for financial help with accommodation and transport if you need to travel for treatment. Go to the Patient Assistance Travel Scheme for more information.

Not all treatments for cancer are available in the Northern Territory (NT). 

Your cancer treatment will depend on the type and stage of cancer.

This page explains the most common forms of treatments and their possible side effects, although these can be different for each patient.

You should discuss your treatment options and side effects with your doctor. 

Side effects of treatment

You may notice side effects within a few hours after treatment or a few weeks later.

It is common to experience nausea within a few hours after receiving chemotherapy, but you may lose your hair one or two weeks later.

Surgery

This involves the partial or total removal of a tumour or body part affected by cancer. Each cancer type has its own name that refers to the removal of the tumour. 

Many cases can be treated in the NT. You may have to travel interstate for complex cases.

Side effects of surgery

Side effects depend on which part of the body is affected, where the tumour is and how complicated it is to remove.

You may have pain where you have been operated on. 

You may also have infections and reactions to anesthetic.

Lymphoedema, which is swelling in one or more areas of the body, is a common side effect if your lymph nodes have been removed. 

Go to the Australian Lymphology Association website for more information.

Chemotherapy

Chemotherapy is the use of drugs to kill and slow the growth of cancer cells. 

The drugs circulate through the blood stream and attack the dividing cancerous cells to prevent them from multiplying.

There are many different types of chemotherapy drugs that can be used alone or in combination, depending on the type and stage of cancer.

There are many ways of administrating chemotherapy and the appropriate drug, dose and route will be decided by the your consultant/specialist.

This treatment is available in Darwin at the Alan Walker Cancer Care Centre.

Side effects of chemotherapy

You may have nausea and vomiting before treatment which can worsen after treatment and last for days.

Other side effects include hair loss and mouth ulcers.

It can also temporarily affect your vision, hearing and balance.

Radiotherapy

Radiation with high-frequency x-ray beams directed at the tumour to destroy dividing cancer cells so they cannot multiply. 

Radiotherapy is used to treat both primary cancer and cancer that has spread to other parts of the body.

Radiotherapy focuses on cancer cells, however surrounding tissue that is also exposed to radiation may be affected. For example, skin may appear sunburnt.

You can have this treatment at the Alan Walker Cancer Care Centre in Darwin.

Side effects of radiotherapy

Short term side effects are localised and depend on which parts of the body are receiving treatment.

They can include any of the following:

• lethargy
• headaches
• drowsiness
• nausea
• hair loss
• reddening of the skin near the treatment area.

Long terms effects may include any of the following:

• reduced hair growth
• skin and tissue thickening
• infertility
• reduced thyroid function
• the possibility of secondary cancer.

Hormone therapy

Hormones are chemicals released by some cells (for example the thyroid) that affect cells in other parts of the body. 

Only a small amount of hormone is required to alter cell metabolism. It is also a chemical messenger that transports a signal from one cell to another.

Hormone therapy works by controlling, removing or reducing the production of a stimulating hormone, or preventing the hormone from stimulating cancer cells.

Hormone therapy can be used in conjunction with surgery, radiotherapy and chemotherapy. 

It can be given to you by a tablet, injection or a drip. 

Side effects of hormone therapy

Side effects depend on your age.

For men, side effects can include any of the following:

• weight gain
• impotence
• infertility
• hot flushes
• depression
• fatigue
• low sex drive
• osteoporosis
• breast tenderness
• erection problems
• reduced bone substance and muscle mass.

For females, side effects may include any of the following:

• increased risk of blood clots
• weight gain
• irregular vaginal bleeding or discharge
• low sex drive
• hot flushes
• osteoporosis
• tenderness or pain in joints or bones
• generalised swelling.

Steroid therapy

Steroids are produced naturally in the body but can also be artificially made.

For cancer treatment, corticosteroid drugs are used to improve appetite and reduce pain, nausea or swelling to the brain.

These drugs may be given to you by tablets, injection or a drip.

Steroid therapy is usually given for a short period of time.

Side effects of steroid therapy

Temporary side effects include any of the following:

• increased appetite
• mood swings
• feelings of restlessness
• sleeping problems
• increased thirst
• weight gain
• muscle weakness.

Long term side effects may lead to any of the following:

• increased facial hair
• increased blood glucose levels
• puffiness in cheeks, hands, neck and feet
• increased risk of infection. 

Stem cell and bone marrow transplants

Stem cells are immature, early-stage blood cells from which other blood and body cells develop. 

They are found in bone marrow, blood stream or umbilical cord blood. Stem cells assist with immunity and prevent excessive bleeding.

Stem cell transplant is a treatment method where immature healthy blood cells are introduced into your body to resupply those that have been destroyed by cancer treatment. 

A stem cell transplant can assist your body by making healthy white blood cells, red blood cells and platelets. This reduces the risk of infections, anaemia and bleeding.

Depending on the source of the stem cells, the procedure is called a bone marrow transplant, a peripheral blood stem cell or a cord blood transplant. 

Stem cell transplants can use cells from your own body, known as an autologous stem cell transplant, or use stem cells from related or unrelated donors, known as an allogenic stem cell transplant.

Side effects of stem cell and bone marrow transplants

Because of the high doses of drugs, your immune system is weakened and susceptible to infections for a month or more.

Complications for allogenic transplants can happen. The donor tissue may be rejected and cause reactions that lead to jaundice, rashes and diarrhoea. This is known as acute graft versus host disease.

These symptoms usually settle with treatment or may persist for many months and become chronic acute graft versus host disease.

The chronic disease can cause any of the following:

• thick or dry skin
• skin discolouration
• dryness of the mouth and eyes
• difficulty in absorbing food.

Complementary and alternative therapies

This includes yoga, acupuncture or art therapy and focuses on your physical and emotional well being.

They may be used with conventional therapies.

Some alternative therapies such as vitamin infusions or diets may be recommended in place of traditional cancer therapies.

You should discuss the options with your doctor. There is little research-based evidence about how effective alternative therapies are.

Side effects of complementary and alternative therapies

This depends on the therapy you are receiving.

In some cases, complementary therapies can decrease the side effects of conventional treatment, such as nausea.

After your cancer diagnosis, your treatment will be handled by a team of doctors, nurses and specialists with different skills and expertise.

Your treatment plan will depend on your type of cancer and the services that are available in the Northern Territory (NT). 

The team may include any of the following professionals:

• haematologist
• radiation oncologist
• specialist surgeon
• pathologist
• cancer care nurse
• breast cancer nurse
• cancer care coordinator
• chemotherapy nurse
• general practitioner
• nutritionists
• occupational therapist
• physiotherapist
• psychologist
• speech pathologist
• social worker.

General practitioners (GPs) and your cancer diagnosis

Your GP plays an important role in both preventing cancer and detecting cancer early. This includes ordering preliminary tests, referring you to specialists and taking part in screening programs.

The Northern Territory has cancer care coordinators who are experienced clinician whose role it is to:

• coordinate care
• help patients and families navigate cancer health services
• provide a point of contact information and support through the patient journey.

Coordinators are based at the:

• Royal Darwin Hospital
• Katherine Hospital
• Alice Springs Hospital.

There are McGrath breast care nurses in the Top End and in Central Australia, find a nurse on the McGrath foundation website.

Community-based coordinators are also available at:

• Danila Dilba
• Cancer Council NT
• Leukaemia Foundation.