Cigar Smoking and Cancer

                                     Key Points

• Cigar smoke, like cigarette smoke, contains toxic and cancer-causing chemicals that are harmful to both smokers and nonsmokers.
• There is no safe tobacco product, and there is no safe level of exposure to tobacco smoke.
• The more you smoke, the greater your risk of disease.
• Cigar smoking causes oral cavity cancers (cancers of the lip, tongue, mouth, and throat) and cancers of the larynx (voice box), esophagus, and lung.
• All cigar and cigarette smokers, whether or not they inhale, directly expose their lips, mouth, tongue, throat, and larynx to tobacco smoke and its toxic and cancer-causing chemical.

1. How are cigars different from cigarettes?

   Cigarettes usually differ from cigars in size and in the type of tobacco used (1–3). Moreover, in contrast with cigarette smoke, cigar smoke is often not inhaled.
   The main features of these tobacco products are:
   
   • Cigarettes: Cigarettes are uniform in size and contain less than 1 gram of tobacco each. U.S. cigarettes are made from different blends of tobaccos, which are never fermented, and they are wrapped with paper. Most U.S. cigarettes take less than 10 minutes to smoke.
   • Cigars: Most cigars are composed primarily of a single type of tobacco (air-cured and fermented), and they have a tobacco wrapper. They can vary in size and shape and contain between 1 gram and 20 grams of tobacco. Three cigar sizes are sold in the United States:
     
     • Large cigars can measure more than 7 inches in length, and they typically contain between 5 and 20 grams of tobacco. Some premium cigars contain the tobacco equivalent of an entire pack of cigarettes. Large cigars can take between 1 and 2 hours to smoke.
     • Cigarillos are a type of smaller cigar. They are a little bigger than little cigars and cigarettes and contain about 3 grams of tobacco.
     • Little cigars are the same size and shape as cigarettes, are often packaged like cigarettes (20 little cigars in a package), and contain about 1 gram of tobacco. Also, unlike large cigars, some little cigars have a filter, which makes it seem they are designed to be smoked like cigarettes (that is, for the smoke to be inhaled). 

2. Are there harmful chemicals in cigar smoke?

   Yes. Cigar smoke, like cigarette smoke, contains toxic and cancer-causing chemicals that are harmful to both smokers and nonsmokers. Cigar smoke is possibly more toxic than cigarette smoke (3). Cigar smoke has:
   
   • A higher level of cancer-causing substances: During the fermentation process for cigar tobacco, high concentrations of cancer-causing nitrosamines are produced. These compounds are released when a cigar is smoked. Nitrosamines are found at higher levels in cigar smoke than in cigarette smoke.
   • More tar: For every gram of tobacco smoked, there is more cancer-causing tar in cigars than in cigarettes.
   • A higher level of toxins: Cigar wrappers are less porous than cigarette wrappers. The nonporous cigar wrapper makes the burning of cigar tobacco less complete than the burning of cigarette tobacco. As a result, cigar smoke has higher concentrations of toxins than cigarette smoke.
   Furthermore, the larger size of most cigars (more tobacco) and longer smoking time result in higher exposure to many toxic substances (including carbon monoxide, hydrocarbons, ammonia, cadmium, and other substances).
   Cigar smoke can be a major source of indoor air pollution (1). There is no safe level of exposure to tobacco smoke. If you want to reduce the health risk to yourself and others, stop smoking.

3. Do cigars cause cancer and other diseases?

   Yes. Cigar smoking causes cancer of the oral cavity, larynx, esophagus, and lung. It may also cause cancer of the pancreas. Moreover, daily cigar smokers, particularly those who inhale, are at increased risk for developing heart disease and other types of lung disease. Regular cigar smokers and cigarette smokers have similar levels of risk for oral cavity and esophageal cancers. The more you smoke, the greater the risk of disease (3).

4. What if I don’t inhale the cigar smoke?

   Unlike nearly all cigarette smokers, most cigar smokers do not inhale. Although cigar smokers have lower rates of lung cancer, coronary heart disease, and lung disease than cigarette smokers, they have higher rates of these diseases than those who do not smoke cigars.
   All cigar and cigarette smokers, whether or not they inhale, directly expose their lips, mouth, tongue, throat, and larynx to smoke and its toxic and cancer-causing chemicals. In addition, when saliva containing the chemicals in tobacco smoke is swallowed, the esophagus is exposed to carcinogens. These exposures probably account for the similar oral and esophageal cancer risks seen among cigar smokers and cigarette smokers (3).

5. Are cigars addictive?

   Yes. Even if the smoke is not inhaled, high levels of nicotine (the chemical that causes addiction) can still be absorbed into the body. A cigar smoker can get nicotine by two routes: by inhalation into the lungs and by absorption through the lining of the mouth. Either way, the smoker becomes addicted to the nicotine that gets into the body.
   A single cigar can potentially provide as much nicotine as a pack of cigarettes (1).

6. Are cigars less hazardous than cigarettes?

   Because all tobacco products are harmful and cause cancer, the use of these products is strongly discouraged. There is no safe level of tobacco use. People who use any type of tobacco product should be encouraged to quit. For help with quitting, see the National Cancer Institute (NCI) fact sheet Where To Get Help When You Decide To Quit Smoking at http://www.cancer.gov/cancertopics/factsheet/tobacco/help-quitting on the Internet.

7. Do nicotine replacement products help cigar smokers to quit?

   Nicotine replacement products, or nicotine replacement therapy (NRT), deliver measured doses of nicotine into the body, which helps to relieve the cravings and withdrawal symptoms often felt by people trying to quit smoking. Strong and consistent evidence shows that NRT can help people quit smoking cigarettes (4). Limited research has been completed to determine the usefulness of NRT for people who smoke cigars. For help with quitting cigar smoking, ask your doctor or pharmacist about NRT, as well as about individual or group counseling, telephone quitlines, or other methods.

What is leukemia? Leukemia is cancer of the blood cells. It starts in the bone marrow, the soft tissue inside most bones. Bone marrow is where blood cells are made. When you are healthy, your bone marrow makes: White blood cells, which help your body fight infection. Red blood cells, which carry oxygen to all parts of your body. Platelets, which help your blood clot. When you have leukemia, the bone marrow starts to make a lot of abnormal white blood cells, called leukemia cells. They don't do the work of normal white blood cells, they grow faster than normal cells, and they don't stop growing when they should. Over time, leukemia cells can crowd out the normal blood cells. This can lead to serious problems such as anemia, bleeding, and infections. Leukemia cells can also spread to the lymph nodes or other organs and cause swelling or pain. Are there different types of leukemia? There are several different types of leukemia. In general, leukemia is grouped by how fast it gets worse and what kind of white blood cell it affects. It may be acute or chronic. Acute leukemia gets worse very fast and may make you feel sick right away. Chronic leukemia gets worse slowly and may not cause symptoms for years. It may be lymphocytic or myelogenous. Lymphocytic (or lymphoblastic) leukemia affects white blood cells called lymphocytes. Myelogenous leukemia affects white blood cells called myelocytes. The four main types of leukemia are: Acute lymphoblastic leukemia, or ALL. Acute myelogenous leukemia, or AML. Chronic lymphocytic leukemia, or CLL. Chronic myelogenous leukemia, or CML. In adults, chronic lymphocytic leukemia (CLL) and acute myelogenous leukemia (AML) are the most common leukemias. In children, the most common leukemia is acute lymphoblastic leukemia (ALL). Childhood leukemias also include acute myelogenous leukemia (AML) and other myeloid leukemias, such as chronic myelogenous leukemia (CML) and juvenile myelomonocytic leukemia (JMML). There are less common leukemias, such as hairy cell leukemia. There are also subtypes of leukemia, such as acute promyelocytic leukemia (a subtype of AML). What causes leukemia? Experts don't know what causes leukemia. But some things are known to increase the risk of some kinds of leukemia. These things are called risk factors. You are more likely to get leukemia if you: Were exposed to large amounts of radiation. Were exposed to certain chemicals at work, such as benzene. Had some types of chemotherapy to treat another cancer. Have Down syndrome or some other genetic problems. Smoke. But most people who have these risk factors don't get leukemia. And most people who get leukemia do not have any known risk factors. What are the symptoms? Symptoms may depend on what type of leukemia you have, but common symptoms include: Fever and night sweats. Headaches. Bruising or bleeding easily. Bone or joint pain. A swollen or painful belly from an enlarged spleen. Swollen lymph nodes in the armpit, neck, or groin. Getting a lot of infections. Feeling very tired or weak. Losing weight and not feeling hungry. How is leukemia diagnosed? To find out if you have leukemia, a doctor will: Ask questions about your past health and symptoms. Do a physical exam. The doctor will look for swollen lymph nodes and check to see if your spleen or liver is enlarged. Order blood tests. Leukemia causes a high level of white blood cells and low levels of other types of blood cells. If your blood tests are not normal, the doctor may want to do a bone marrow biopsy. This test lets the doctor look at cells from inside your bone. This can give key information about what type of leukemia it is so you can get the right treatment. How is it treated? What type of treatment you need will depend on many things, including what kind of leukemia you have, how far along it is, and your age and overall health. If you have acute leukemia, you will need quick treatment to stop the rapid growth of leukemia cells. In many cases, treatment makes acute leukemia go into remission. Some doctors prefer the term "remission" to "cure," because there is a chance the cancer could come back. Chronic leukemia can rarely be cured, but treatment can help control the disease. If you have chronic lymphocytic leukemia, you may not need to be treated until you have symptoms. But chronic myelogenous leukemia will probably be treated right away. Treatments for leukemia include: Chemotherapy, which uses powerful medicines to kill cancer cells. This is the main treatment for most types of leukemia. Radiation treatments. Radiation therapy uses high-dose X-rays to destroy cancer cells and shrink swollen lymph nodes or an enlarged spleen. It may also be used before a stem cell transplant. Stem cell transplant. Stem cells can rebuild your supply of normal blood cells and boost your immune system. Before the transplant, radiation or chemotherapy may be given to destroy cells in the bone marrow and make room for the new stem cells. Or it may be given to weaken your immune system so the new stem cells can get established. Biological therapy. This is the use of special medicines that improve your body's natural defenses against cancer. For some people, clinical trials are a treatment option. Clinical trials are research projects to test new medicines and other treatments. Often people with leukemia take part in these studies. Some treatments for leukemia can cause side effects. Your doctor can tell you what problems are common and help you find ways to manage them. Finding out that you or your child has leukemia can be a terrible shock. It may help to: Learn all you can about the type of leukemia you have and its treatment. This will help you make the best choices and know what to expect. Stay as strong and well as possible. A healthy diet, plenty of rest, and regular exercise can help. Talk to other people or families who have faced this disease. Ask your doctor about support groups in your area. You can also go on the Internet and find stories of people who have leukemia.

Cervical Cancer

What is cervical cancer? Cervical cancer occurs when abnormal cells on the cervix camera grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be successfully treated when it's found early. It is usually found at a very early stage through a Pap test. What causes cervical cancer? Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms. You can have HPV for years and not know it. It stays in your body and can lead to cervical cancer years after you were infected. This is why it is important for you to have regular Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If you treat these cell changes, you may prevent cervical cancer. What are the symptoms? Abnormal cervical cell changes rarely cause symptoms. But you may have symptoms if those cell changes grow into cervical cancer. Symptoms of cervical cancer may include: Bleeding from the vagina that is not normal, or a change in your menstrual cycle that you can't explain. Bleeding when something comes in contact with your cervix, such as during sex or when you put in a diaphragm. Pain during sex. Vaginal discharge that is tinged with blood. How is cervical cancer diagnosed? As part of your regular pelvic exam, you should have a Pap test. During a Pap test, the doctor scrapes a small sample of cells from the surface of the cervix to look for cell changes. If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix. Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such as bleeding after sex. How is it treated? The treatment for most stages of cervical cancer includes: Surgery, such as a hysterectomy and removal of pelvic lymph nodes with or without removal of both ovaries and fallopian tubes. Chemotherapy. Radiation therapy. Depending on how much the cancer has grown, you may have one or more treatments. And you may have a combination of treatments. If you have a hysterectomy, you won't be able to have children. But a hysterectomy isn't always needed, especially when cancer is found very early. It's common to feel scared, sad, or angry after finding out that you have cervical cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area. You can also find people online who will share their experiences with you. Can cervical cancer be prevented? The Pap test is the best way to find cervical cell changes that can lead to cervical cancer. Regular Pap tests almost always show these cell changes before they turn into cancer. It's important to follow up with your doctor after any abnormal Pap test result so you can treat abnormal cell changes. This may help prevent cervical cancer. If you are age 26 or younger, you can get the HPV vaccine, which protects against two types of HPV that cause cervical cancer. The virus that causes cervical cancer is spread through sexual contact. The best way to avoid getting a sexually transmitted infection is to not have sex. If you do have sex, practice safer sex, such as using condoms and limiting the number of sex partners you have.