1. What is Cancer?
Cancer is not one disease, but a group of diseases each characterized by the uncontrolled growth of cells within 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 aging tissues. In some instances due to lifestyle, environment or inherited genes, the body’s normal regulatory control of cell repair and growth is unable to stop the growth of cells.
Cancer occurs when cells become abnormal and keep dividing and forming more cells without control or order. As a result, a mass of extra cells continue to develop, forming a TUMOR.
Oncology is the branch of medicine dealing with malignant i.e. cancerous tumors.3. MORE ABOUT CANCER?
Most cancers are named after the part of the body where the cancer starts, such as breast cancer or lung cancer. Cancer is further classified by its HISTOLOGY or the type of cancerous cell which is growing. To determine histology a sample of cells is typically collected through a process called FNAC (Fine Needle Aspiration Cytology), BIOPSY or by the surgical removal of all or part of the cancer. FNAC is by introduction of needle into the tumor. A histological diagnosis of cancer is made by looking at the abnormal cells under a microscope and performing special tests on the cells in the laboratory.4. WHAT ARE THE TYPES OF CANCERS AND ITS CAUSES?
The number of new cases of cancer in this country is going up each year. According to the National Cancer Control Program of the Govt. of India, cancer has become a major public health problem due to increase in life expectancy and changing lifestyles. There are about 20 lakh cases of cancer in the country at any given point of time and approximately 7 lakh new cases come up every year. People of all ages get cancer, but nearly all types are more common in middle-aged and elderly people than in young people. Oral cancer and cancers of the digestive-tract are the most common type of cancer in men. Among women cancer of the cervix is the commonest type of cancer followed by breast cancer. In children, blood related malignancies, like leukemia is the most common. Lung cancer, prostate cancers are leading causes of death from cancer for men in India.
Bone and brain cancers are the other common cancers in children and young adults. The more we can learn about what causes cancer, the more likely we are to find ways to prevent it. Scientists study patterns of cancer in the population to look for factors that affect the risk of developing this disease. In the laboratory, they explore possible causes of cancer and try to determine what actually happens when normal cells become cancerous. Our current understanding of the causes of cancer is incomplete, but it is clear that cancer is not caused by an injury, such as a bump or bruise. And although being infected with certain viruses may increase the risk of some types of cancer, cancer is not contagious; no one can “catch” cancer from another person.
It is helpful to be aware of them, but it is also important to keep in mind that not everyone with a particular risk factor for cancer actually gets the disease; in fact, most do not. People at risk can help protect themselves by avoiding risk factors where possible and by getting regular checkups so that, if cancer develops, it is likely to be found early. Below is a list of commonly implicated carcinogens:
- Air pollutants
- Water pollutants
- Food additives
- Heterocyclic amines in cooked meats
- Nitrate in drinking water
- Chemicals and other substances at the workplace
- Hormone replacement therapy
Family history and genetics of cancer :
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, due in part to environmental triggers). Other cancers, such as lung cancers in cigarette smokers, while caused primarily by external factors, are still influenced by genes which modify an individual’s risk of disease. To further our understanding of cancer etiology and risk factors, scientists are currently studying the complex ways in which genes and environment interact. Family clusters have been reported for virtually every form of cancer. In general, close relatives of a cancer patient have twice the usual risk for developing the same type of cancer, but among different cancer families the level of excess risk can vary widely. Familial cancer clusters are often due to inherited factors, but environmental influences, chance association, or a combination of these factors also must be considered. In familial cancers that are triggered by environmental carcinogens, patient education regarding the avoidance of harmful exposures can help prevent or delay the onset of cancer. Recent laboratory findings have emphasized the importance of studying cancer-prone families. The primary purpose of identifying gene carriers would be to promote earlier detection of cancer and, since prognosis is correlated closely with stage of disease at diagnosis, increased survivability. 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.
5. WHAT IS TUMOR GRADE?
Tumor grade refers to the degree of abnormality of cancer cells compared with normal cells and is a feature of the histology. Tumor grade is one of many factors that doctors consider when they develop an individual treatment plan for a cancer patient. Grade is a classification system used by pathologists to describe the degree of differentiation of tumor cells. Based on the microscopic appearance of cancer cells, pathologists commonly describe tumor grade by four degrees of severity: GRADES 1, 2, 3, AND 4. The cells of Grade 1 tumors are often well-differentiated or low-grade tumors, and are generally considered the least aggressive in behavior. Conversely, the cells of Grade 4 tumors are usually poorly differentiated or undifferentiated high-grade tumors, and are generally the most aggressive in behavior. Although grade is used by pathologists to describe most types of cancer, its importance in planning treatment and estimating the future course and outcome of disease (PROGNOSIS) is greater.
6. WHAT IS STAGING OF CANCER?
In order to plan the most effective treatment, in addition to the histological type, appropriate treatment planning depends on determining the extent of spread or stage of cancer. Staging is the process of describing the location of the disease 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 tumor (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 tumor, Stage IV indicates advanced disease. This staging is based on certain internationally accepted criteria, allowing uniformity in the description / reporting of the cancer. Most TREATMENT PROTOCOLS are based on this staging system. It is important for physicians to know as much as possible about a cancer’s grade and stage because both the extent to which the disease has progressed (stage), and its microscopic features (grade) are important factors in planning treatment and estimating a patient’s prognosis When the histology, grade and the stage of the cancer is known, treatment options can be discussed and the treatment started.
7. WHAT IS CANCER SCREENING?
At times, it is felt that cancer can be found before the disease causes symptoms. Checking for cancer in a person who does not have any symptoms of the disease is called cancer screening. Screening may involve a physical exam, lab tests, and/or procedures to look at internal organs, either directly or indirectly. During a physical exam, the doctor looks for anything unusual and feels for any lumps or growths. Examples of lab tests include blood tests, urine tests, Pap test or stool test. Internal organs can be seen directly through an endoscopy or indirectly with x-ray images or CT & MRI pictures. Doctors consider many factors before recommending a screening test. They weigh factors related to the individual, the test, and the cancer that the test is intended to detect. Doctors also take into account the person’s age, medical history and general health, family history, and lifestyle. In addition, they assess the accuracy and the risks of the screening test and any follow up tests that may be necessary. The concept of cancer screening is however limited to a few types of cancer and it has its share of controversy. “YOUR DOCTOR CAN EXPLAIN THE PROS AND CONS OF CANCER SREEENING IN YOUR CASE.”
8. WHAT ARE THE SYMPTOMS OF CANCER?
There are no well-defined symptoms of cancer. In fact most types of cancer are initially without any symptoms. Hence one should consult a doctor for regular checkups and not wait for problems to occur. The most unfortunate part about cancer is that unlike other diseases where there is a visible or experienced symptom, early symptoms of cancer are both painless and invisible. It is only very late that a person begins to feel pain or observes some symptoms in his body. 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
These symptoms are not always a sign of cancer and they might not always lead to cancer. They can also be caused by less serious conditions. But only a doctor can make this diagnosis. It is important to see a doctor if there are any of these symptoms. Your doctor can evaluate your symptoms and help you with the necessary tests that may need to be done.
9. IS CANCER CONTAGIOUS?
No. Cancer does not spread from one person to another as in an infection. Hence isolation or separation is not indicated unless specifically advised by the treating physician.
Support for Cancer Patients:
Living with a disease like cancer is difficult. Cancer patients and those who care about them face many problems and challenges. Coping with these problems is often easier when people have helpful information and support services. Cancer patients are often lonely. Relatives and friends may avoid them. Worry about holding their job, caring for their family, or keeping up daily activities produces tremendous stress. The cost of treatment, the duration of treatment, the fact that treatment may require change of place, etc. are sources of great worry. Patients tend to become irritable or severely depressed. Doctors, nurses, and other members of the health care team can answer questions on all these issues. Patients need to be told that cancer does not mean death. Hopeful discussion on the treatment options often helps the patient to focus on the positive aspect of his or her disease. Friends and relatives, especially those who have had personal experience with cancer, can be very supportive. Also, it helps many patients to meet with others who are facing problems like theirs. It is important to keep in mind, however, that each patient is different. Treatments and ways of dealing with cancer that work for one person may not be right for another– even if both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the doctor. Often, a social worker at the hospital or clinic can suggest groups that help with rehabilitation, emotional support, financial aid, transportation, or home care. Researchers are finding better ways to detect and treat cancer, and the chance of recovery keeps improving. Still, it is natural for patients to be concerned about their future. The doctor who takes care of the patient is in the best position to discuss the chance of recovery (prognosis). Patients should feel free to ask the doctor about their prognosis, but they should keep in mind that not even the doctor knows exactly what will happen. Doctors often talk about surviving cancer, or they may use the term remission rather than cure. Even though many cancer patients are cured, doctors use these terms because the disease may recur.