Some well-known cancer ribbons include the pink ribbon for breast cancer and the purple ribbon for pancreatic cancer.  The cancers they are meant to represent, and associated awareness months. A light purple or lavender ribbon is used to represent esophageal cancer and cancer survivors, as noted above, but it is also often used to represent cancers as a whole.  Sometimes, many different ribbons are combined together to represent all cancers.

Uncommon or rare cancers may be represented by a black-and-white zebra print ribbon. The choice of the zebra print comes from a common saying in medicine: When you hear hoofbeats behind you, don't expect to see a zebra. In other words, the most likely diagnosis is usually the right one.

However, that is not always the case. The zebra print ribbon is meant to draw attention to the fact that something that appears to be one thing could very well be something far less likely. "Zebra" cancers are rare. But when you add occurrences of all of them together, they are actually quite common.

It's important to note that a specific cancer may be represented by more than one ribbon color and that this can vary depending on where you live.

Some ribbon colors also represent specific nonprofit groups who advocate for a particular type of cancer. For example, a white or pearl ribbon is used to represent lung cancer, but turquoise is the color of an American Lung Association initiative.

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Nearly 30 cancer types have inspired bracelets, clothing or gear spanning at least 20 pigments and five patterns – including zebra stripe. Some wear their color proudly to represent their own cancer or support a loved one. But others fear this collage of colors creates an unnecessary division.

“I’m going to die of my breast cancer and I feel like I have a lot in common with people who have lung cancer, who have stage 4 pancreatic cancer. Our experience of life is much more similar than it is different,” said Beth Caldwell, a 38-year-old metastatic breast cancer patient, and blogger who is treated at Seattle Cancer Care Alliance, treatment arm of Fred Hutchinson Cancer Research Center.

The colors for the most common types of cancer include:

• Lung cancer: white
• Brain cancer: grey
• Breast cancer: pink
• Liver cancer: emerald green
• Lymphoma: lime green
• Prostate cancer: light blue
• Stomach cancer: periwinkle blue
• Bone cancer: yellow
• Leukemia: orange
• Colon cancer: dark blue

But the list doesn’t end there, and some cancers even share a cancer color. Orange represents kidney cancer and leukemia. Green stands for liver cancer, lymphoma, and gall bladder cancer. Variations of purple signify pancreatic cancer, testicular cancer, leiomyosarcoma, Hodgkin lymphoma, stomach cancer, and esophageal cancer.

Some activists suggest this tie-dye-like tide of wristbands, keychains and coffee mugs may further muddy the attention for individual cancers.

Consider colorectal and prostate cancers. Advocates for colorectal cancer once donned brown ribbons then switched to dark blue. Meanwhile, those building attention for prostate cancer use light blue – a shade so precise, the Prostate Cancer Foundation posts its exact mathematical formula.

“Over the years, marketing professionals tell me the blue is confusing to people because they don’t know what it means,” said Thomas N. Kirk, president and CEO of Us TOO, which provides educational materials, resources and 300 volunteer-led support groups for people with prostate cancer.

“Ovarian cancer has a teal color that looks very similar to the light blue for prostate cancer,” Kirk said. “When buildings are lit up in September – ovarian cancer is the same (awareness) month as prostate cancer – a lot times people will see a blue color and they’ll think it’s ovarian cancer or it’s prostate cancer.”

Green, purple, or red?

Then, there are certain blood cancers. In 1999, lime green became the “established” hue to “promote all lymphoma causes” and, in 2001, Hodgkin lymphoma patient Matt Terry selected violet to represent his specific disease, according to a group called the Lymphoma Club. In 2007, survivors of those diseases united the two colors in an “awareness heart ribbon” to recognize all forms of lymphoma, club members said. But in 2009, the Leukemia & Lymphoma Society began using red to represent all blood cancers.

“There has never really been any agreement across the board, and across different organizations, about which color should represent which disease,” said Andrea Greif, senior director of communications for the Leukemia & Lymphoma Society.

“... I think you’ll probably find that different organizations identify different colors for the same diseases; some might say green for lymphoma, gold for leukemia,” Greif added in an email. “We made the decision to just go with red for all blood cancers.”

And gold? It’s also been used since 1997 to symbolize all childhood cancers “because gold is a precious medal, and is therefore the perfect color to reflect the most precious thing in our lives – our children,” according to the American Childhood Cancer Organization. 

Cancer advocacy groups are not required to register their colors with the U.S. Patent and Trademark Office, a USPTO spokesman said.  Where and how did some of these other colors originate? The methods vary from the formality of a boardroom to the comfort of a dining room.  

After Rose died from the disease months later, her daughter learned there were no pancreatic cancer support organizations. All she found, Marquardt said, was a “pancreas cancer” chat board on the Johns Hopkins Medicine website. Marquardt asked users there about using purple to signify the disease. They agreed.

In 1999, Marquardt founded the Pancreatic Cancer Action Network. Its website is drenched in purple. Today, purple (or orchid or violet or periwinkle) has been adopted in several places within the cancer-support landscape.

After Rose died from the disease months later, her daughter learned there were no pancreatic cancer support organizations. All she found, Marquardt said, was a “pancreas cancer” chat board on the Johns Hopkins Medicine website. Marquardt asked users there about using purple to signify the disease. They agreed.

In 1999, Marquardt founded the Pancreatic Cancer Action Network. Its website is drenched in purple. Today, purple (or orchid or violet or periwinkle) has been adopted in several places within the cancer-support landscape.

But other advocates who are seeking to ignite recognition and funding for carcinoid cancer picked a far more unusual pattern: zebra stripe.

It’s based on philosophical advice doctors get in medical school: “If you hear hoof beats think horses, not zebras.” That means: If you’re presented with symptoms of common diseases, think of common diseases, not infrequent ailments like carcinoid cancer, a type of neuroendocrine tumor.

“We want doctors to think that, in addition to one of the more common illnesses, those symptoms might be caused by something rare [like carcinoid cancer]. And that’s the zebra,” said Grace Goldstein chief operating officer of the Carcinoid Cancer Foundation. On the nonprofit’s Facebook page, a filter was recently posted allowing users to place zebra stripes over their profiles.

“It is a community. That’s also important,” Goldstein said. “But without enough awareness of the disease, there won’t be research.”

The most famous tone, pink, has more than a splash of controversy in its colorful history. In a California dining room in 1991, Charlotte Haley, then 68, started making peach ribbons to bring attention to breast cancer. On every pack of five, she tacked a postcard asking people to lobby the National Cancer Institute to boost its cancer-prevention budget. Haley distributed thousands of peach ribbons.

In 1992, the editor of Self Magazine and the vice president.

The most famous tone, pink, has more than a splash of controversy in its colorful history. In a California dining room in 1991, Charlotte Haley, then 68, started making peach ribbons to bring attention to breast cancer. On every pack of five, she tacked a postcard asking people to lobby the National Cancer Institute to boost its cancer-prevention budget. Haley distributed thousands of peach ribbons.

In 1992, the editor of Self Magazine and the vice president of Estee Lauder asked Haley to partner. She refused, saying their planned use was too commercial. The executives instead decided to use pink for their own awareness campaign, according to the Breast Cancer Consortium. 

The real surge of cancer shades began about 10 years later. In 1999, when Linda Nielsen and two partners launched ChooseHope.com, a for-profit, merchandise site for cancer patients and supporters, there were “maybe six” colors, including teal for ovarian cancer and white for lung cancer, Nielsen recalled.

“We went to each organization and said: ‘Do you have a cancer awareness color?’” said Nielsen, a breast cancer survivor whose company has since donated more than $900,000 to cancer charities.

Today, ChooseHope sells bracelets and other awareness products covering 29 cancer types or cancer groups. Their online stock includes $6 black tumblers for melanoma and $1 amber rings for appendix cancer.

“I worry about the proliferation," said Caldwell, the metastatic breast cancer patient and blogger from Seattle. “It’s not because I don’t think that the camaraderie and awareness it brings is bad. Obviously, that’s good. But as someone who lives in Breast Cancer Land and sees Pinktober, pink cans of mace or pink handguns – things obviously not good for your health – I worry that for organizations for other cancer types, their message will get co-opted the way it has with breast cancer." 

But for Pamela Acosta Marquardt, whose mother inspired purple to represent pancreatic cancer, the hue remains a way for her to honor her mom and battle the disease that took her life. She still wears the color today. 

“Purple was my mother’s favorite color. When I was a little girl, my bedroom was white and lavender. The color was always in our lives,” Marquardt said. “It’s funny, because my mom came from nothing. She grew up in the Twin Cities without much. She never really thought her life mattered, but look where we, and the color purple, are today.”