Frequently Asked Questions (FAQ’s)

Cancer is a group of diseases that are all characterised by the uncontrolled growth of abnormal and mutated cells in the body. Normally, cells grow and divide to produce new cells in a controlled and orderly manner. This controlled cell division is the process that heals wounds and replaces ageing tissues. Cells continue to die, while new cells take their place. However, due to lifestyle, environmental, and/or heredity factors, the body’s normal regulatory control of cell repair and growth is unable to stop the abnormal growth of cells. Cancer is when these cells begin to accumulate, multiply and form tissue. This extra mass of tissue is called a tumour and is essentially dangerous because cancer cells do not die on their own.

Oncology is the branch of medicine that deals with malignant tumours, that is, cancer.

Cancer is usually categorised and named after the body part it affects, for example, breast cancer or thyroid cancer. Furthermore, cancer is alsy categorised on the basis of its histology, or the type of cancerous cell that is growing. Based on this, the major types of cancer include these:

• Oral Cancer
• Cancers of the Digestive Tract
• Cervical Cancer
• Breast Cancer
• Blood Cancers (Leukaemia, Lymphoma, Myeloma)
• Lung Cancer
• Prostate Cancer
• Bone Cancer
• Brain Cancer

The answer to this question is not straightforward because there are a number of factors that work for a long time, sometimes even an entire lifetime of a person to form a cancer. It develops gradually due to the mixing of several factors like environment, lifestyle, and heredity. However, what truly increases a person’s chances of getting cancer are certain risk factors.Most of the cases, almost 80%, are related to these risk factors, that are identified as smoking and drinking habits, improper diet, and exposure to radiation or cancer causing agents (carcinogens). Some common carcinogens known to increase the risk through exposure are these:

• Air pollutants
• Water pollutants
• Tobacco
• Diet
• Food additives
• Heterocyclic amines in cooked meats
• Nitrate in drinking water
• Alcohol
• Radiation
• Chemicals and other substances at the workplace
• Hormone replacement therapy
• Sunlight
• Pesticides

Now some people are more sensitive to these risk factors while some others are less sensitive to them. However, this distinction is made by a person’s genetics and hereditary factors. However, it is important to be aware of these risk factors even though not everyone is at a high risk of developing cancer. The information is important to protect ourselves so we can avoid such risk factors while we can and by getting regular checkups.

Most cancers are caused by a variable mix of heredity and environment. While an inherited defect can lead to cancer clusters in multiple members of certain families, the age at which cancers first appear will differ among these relatives based on the exposure to risk factors. Even cancers like lung cancers caused by smoking, which is an external factor, is still largely influenced by inheritance of modified genes, which also modify an individual’s risk of getting cancer. By studying the relationship between heredity and environment factors, and identifying the gene carriers in a family, the incidence and mortality rate of cancer can be reduced largely by early screening and timely treatment. However, identifying gene carriers in cancer-free populations is a new concept with many clinical, ethical, legal and psychosocial implications yet to be explored Knowledge about cancer genetics is rapidly expanding, with implications for all aspects of cancer management, including prevention, screening, and treatment.

Tumour grade is the reference to the degree of the abnormality of cancer cells in comparison to normal cells. It is also a feature of the histology of the cancer. It is one of the primary things that doctors consider when they develop a personalised plan for a cancer patient, as cancer affects everyone differently. It is a categorisation that describes the differentiation of tumour cells. Ranging from Grade 1 to Grade 4, it is a measure of severity of cancer in simple words. Grade 1 tumours are often well-differentiated or low-grade Tumours, and are generally considered the least aggressive in behavior. Grade 4 cancer is the opposite, with usually poorly differentiated or undifferentiated high-grade Tumours, which are generally the most aggressive in behavior.

For a more personalised and effective treatment, oncologists also need correct information about the extent of spread or the stage of cancer. This, paired with the histology of the cancer cells increases the effectiveness of a treatment plan. Staging of cancer is the process of determining the location of cancer at the time of diagnosis. The American Joint Commission on Cancer (AJC) is the most widely used cancer staging system. The stage is determined by measuring the size of the primary Tumour (T), the extent of lymph node involvement (N), and the absence or presence of METASTASIS (M). This is referred to as the TNM Staging System. Most types of cancer can be staged as Stage I, II, II, & IV. While Stage I is an early Tumour, Stage IV indicates advanced disease. This staging provides a uniformity in the reporting and treatment of cancer for cases around the world.

In a majority of cases, cancer can be identified at a much earlier stage, well before it even begins to show symptoms. Checking for cancer in a person without symptoms, is thus, called cancer screening. It contains physical examinations, lab tests, and an examination of internal organs either directly or indirectly.

Because there are so many different types and classifications, there is not a very well defined set of symptoms that are related to cancer. In fact, most cancers initially do not show any symptoms. This goes on to say cancer symptoms in the initial stages are invisible and painless. Don’t wait to feel pain because early stage cancer usually does not cause pain. There are 7 signs and symptoms which are usually associated with cancer all across the country:

• Persistant hoarse voice or nagging cough
• Difficulty or pain in swallowing
• Changes in bowel or bladder habits
• A sore that does not heal
• Unusual bleeding or discharge
• Lump or swelling in any part of the body
• Obvious change in a wart or mole

However, a presence of these symptoms may not necessarily mean cancer and may not actually lead to cancer. But the only person who can make that distinction is a doctor. Go for regular screenings and tests if these symptoms persist for a long time.

No, cancer is not a contagious condition and does not spread from one person to another. Isolation, distancing, or separation from a cancer patient is not necessary unless it is specifically advised by the physician.

• The most common type of Urinary Bladder Cancer is transitional cell carcinoma, which lines the inside of the bladder. This type of cancer is also called Urothelial Carcinoma. Other types of bladder cancer include Squamous Cell Carcinoma (cancer that begins in thin, flat cells lining the bladder) and Adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).
• People who smoke have an increased risk of Bladder Cancer. Being exposed to certain chemicals and having chronic bladder infections can also increase the risk of Bladder Cancer.
• The most common sign of Bladder Cancer is blood in the urine. Bladder Cancer is often diagnosed at an early stage when the cancer is easier to treat.

• Most cases of lung cancer are caused by smoking. Lung cancer is the leading cause of death from cancer.
• The two main types of lung cancer are Non-Small Cell Lung Cancer and Small Cell Lung Cancer. The types are based on the way the cells look under a microscope. Non-Small Cell Lung Cancer is more common than Small Cell Lung Cancer.

• The brain and spinal cord make up the central nervous system (CNS). Brain and spinal cord tumours are growths of abnormal cells in tissues of the brain or spinal cord. Tumours that start in the brain are called Primary Brain Tumours. A tumour that starts in another part of the body and spreads to the brain is called a metastatic Brain Tumour.
• Brain and spinal cord tumours may be either benign (non-cancerous) or malignant (cancerous).
• Both benign and malignant tumours cause signs and symptoms and need treatment. Benign brain and spinal cord tumours grow and press on nearby areas of the brain but rarely spread into other parts of the brain. Malignant brain and spinal cord tumours are likely to grow quickly and spread into other parts of the brain.
• There are many types of brain and spinal cord tumours. They form in different cell types and different areas of the brain and spinal cord. The signs and symptoms of brain and spinal cord tumours depend on where the tumour forms, its size, how fast it is growing, and the age of the patient.
• Brain and spinal cord tumours can occur in both adults and children. The types of tumours that form and the way they are treated are different in children and adults.
• The prognosis (chance of recovery) depends on many factors, including age, Tumour size, Tumour type, and where the Tumour is in the CNS.

• The breast is made up of glands called lobules that can make milk and thin tubes called ducts that carry the milk from the lobules to the nipple. Breast tissue also contains fat and connective tissue, lymph nodes, and blood vessels.
• The most common type of breast cancer is Ductal Carcinoma, which begins in the cells of the ducts. Breast cancer can also begin in the cells of the lobules and in other tissues in the breast. Ductal Carcinoma in situ is a condition in which abnormal cells are found in the lining of the ducts but they haven’t spread outside the duct. Breast cancer that has spread from where it began in the ducts or lobules to surrounding tissue is called invasive breast cancer. In inflammatory breast cancer, the breast looks red and swollen and feels warm because the cancer cells block the lymph vessels in the skin.

• The cervix is the lower, narrow end of the uterus (the organ where a fetus grows). The cervix leads from the uterus to the vagina (birth canal).
• The main types of Cervical Cancer are Squamous Cell Carcinoma and Adenocarcinoma. Squamous Cell Carcinoma begins in the thin, flat cells that line the cervix. Adenocarcinoma begins in cervical cells that make mucus and other fluids.
• Long-lasting infections with certain types of Human Papillomavirus (HPV) cause almost all cases of Cervical Cancer. Vaccines that protect against infection with these types of HPV can greatly reduce the risk of Cervical Cancer. Having a Pap test to check for abnormal cells in the cervix or a test to check for HPV can find cells that may become Cervical Cancer. These cells can be treated before cancer forms.
• Cervical Cancer can usually be cured if it is found and treated in the early stages.

• Colorectal Cancer is cancer that starts in the colon or rectum. The colon and the rectum are parts of the large intestine, which is the lower part of the body’s digestive system. During digestion, food moves through the stomach and small intestine into the colon. The colon absorbs water and nutrients from the food and stores waste matter (stool). Stool moves from the colon into the rectum before it leaves the body.
• Most Colorectal Cancers are Adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). Colorectal CANCER often begins as a growth called a polyp, which may form on the inner wall of the colon or rectum. Some polyps become cancer over time. Finding and removing polyps can prevent Colorectal Cancer.

• Esophageal Cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus. The esophagus is a muscular tube that moves food and liquids from the throat to the stomach.
• The most common types of Esophageal Cancer are Squamous Cell Carcinoma and Adenocarcinoma. Squamous Cell Carcinoma begins in flat cells lining the esophagus. Adenocarcinoma begins in cells that make and release mucus and other fluids.
• Smoking and heavy alcohol use increase the risk of esophageal Squamous Cell Carcinoma. Gastroesophageal reflux disease and Barrett esophagus may increase the risk of Esophageal Adenocarcinoma.
• Esophageal cancer is often diagnosed at an advanced stage because there are no early signs or symptoms.

• The prostate gland makes fluid that forms part of semen. The prostate lies just below the bladder in front of the rectum. It surrounds the urethra (the tube that carries urine and semen through the penis and out of the body).
• Almost all prostate cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). Prostate cancer often has no early symptoms. Advanced prostate cancer can cause men to urinate more often or have a weaker flow of urine, but these symptoms can also be caused by benign prostate conditions.
• Prostate Cancer usually grows very slowly. Most men with prostate cancer are older than 65. Talk to your doctor about your risk of prostate cancer and whether you need screening tests.

• There are two kidneys, one on each side of the spine, above the waist. The kidneys clean the blood to take out waste and make urine. Urine collects in the renal pelvis, the area at the center of the kidney, and then passes through the ureter, into the bladder, and out of the body. The kidneys also make hormones that help control blood pressure and signal the bone marrow to make red blood cells when needed.
• There are three main types of kidney cancer. Renal Cell Cancer is the most common type in adults and Wilms Tumours are the most common in children. These types form in the tissues of the kidney that make urine. Transitional Cell Cancer forms in the renal pelvis and ureter in adults.
• Smoking and taking certain pain medicines for a long time can increase the risk of adult kidney cancer. Certain inherited disorders can increase the risk of kidney cancer in children and adults. These include von Hippel-Lindau syndrome, Hereditary Leiomyomatosis and Renal Cell Cancer, Birt-Hogg-Dubé syndrome, and Hereditary Papillary Renal Cancer.
• Kidney Tumours may be benign or malignant.

• Bone cancer is a malignant Tumour that arises from the cells that make up the bones of the body. This is also known as Primary Bone Cancer. When cancer is detected in bones, it either originated in the bones (as in primary bone cancer) or has spread to the bone after originating elsewhere (cancer that has metastasized to bone).
• Breast, prostate, and lung cancers are among the types of cancers that commonly spread to the bone in their advanced stages.
• Bone cancers are more common in children and younger adults than in older people. Cancer found in the bones of an older adult usually has spread to the bone after originating from another location in the body.
• Pain is the most common symptom of bone cancer. The pain may initially develop at certain times of the day, often at night, or with physical activity. The pain tends to progress and worsen over time.

• Leukemia is cancer of the blood cells. Most blood cells form in the bone marrow. In leukemia, immature blood cells become cancer. These cells do not work the way they should and they crowd out the healthy blood cells in the bone marrow.
• Different types of leukemia depend on the type of blood cell that becomes cancer. For example, Lymphoblastic Leukemia is a cancer of the Lymphoblasts (white blood cells, which fight infection). White blood cells are the most common type of blood cell to become cancer. But red blood cells (cells that carry oxygen from the lungs to the rest of the body) and platelets (cells that clot the blood) may also become cancer.
• Leukemia occurs most often in adults older than 55 years, but it is also the most common cancer in children younger than 15 years.
• Leukemia can be either acute or chronic. Acute leukemia is a fast-growing cancer that usually gets worse quickly. Chronic leukemia is a slower-growing cancer that gets worse slowly over time. The treatment and prognosis for leukemia depend on the type of blood cell affected and whether the leukemia is acute or chronic.

• The thyroid is a gland at the base of the throat near the windpipe. It is shaped like a butterfly, with a right lobe and a left lobe. A thin piece of tissue connects the two lobes. The thyroid makes hormones that help control heart rate, blood pressure, body temperature, and weight.
• There are four types of thyroid cancer. These are papillary, follicular, medullary, and anaplastic thyroid cancer. Papillary is the most common type of thyroid cancer.
• Anaplastic Thyroid Cancer is hard to cure with current treatment. Other types of thyroid cancer can usually be cured.
• Being exposed to radiation to the head and neck as a child increases the risk of Thyroid Cancer. Having certain genetic conditions such as Familial Medullary Thyroid Cancer, Multiple Endocrine Neoplasia Type 2A Syndrome, and Multiple Endocrine Neoplasia Type 2B Syndrome can also increase the risk of Thyroid Cancer.

• The liver has many important functions in the body. For example, it cleans toxins from the blood, makes bile that helps digest fat, makes substances that help blood clot, and makes, stores, and releases sugar for energy.
• Primary Liver Cancer is cancer that starts in the liver. The most common type of Primary Liver Cancer is Hepatocellular Carcinoma, which occurs in the tissue of the liver. When cancer starts in other parts of the body and spreads to the liver, it is called liver metastasis.
• Liver Cancer is rare in children and teenagers, but there are two types of liver cancer that can form in children. Hepatoblastoma occurs in younger children, and Hepatocellular Carcinoma occurs in older children and teenagers.
• The bile ducts are tubes that carry bile between the liver and gallbladder and the intestine. Bile duct cancer is also called Cholangiocarcinoma. When it begins in the bile ducts inside the liver, it is called Intrahepatic Cholangiocarcinoma. When it begins in the bile ducts outside the liver, it is called Extrahepatic Cholangiocarcinoma. Extrahepatic Cholangiocarcinoma is much more common than Intrahepatic Cholangiocarcinoma.

• Head and neck cancers are cancers that start in the tissues and organs of the head and neck. They include cancers of the larynx (voice box), throat, lips, mouth, nose, and salivary glands.
• Most head and neck cancers begin in squamous cells, which are cells that line moist surfaces such as those inside the head and neck (for example, the mouth, nose, and throat). Salivary glands have many different types of cells that can become cancer so there are many different types of salivary gland cancer.
• Tobacco use, heavy alcohol use, and infection with Human Papillomavirus (HPV) increase the risk of many types of head and neck cancer.
• To get the right information about treatment and prognosis, you need to know exactly what type of head and neck cancer you have and what stage it is.