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Source: http://www.medicinenet.com/script/main/art.asp?articlekey=13931
Cancer
Medical Author: Charles P. Davis, MD, PhD Medical Editor: Jerry Balentine, DO, FACEP
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What is cancer? What causes cancer? What are cancer symptoms and signs? What are the different types of cancer? How is cancer diagnosed? How is cancer staging determined? What is the treatment for cancer? What is the prognosis for cancer? Can cancer be prevented? Where can people find more information about cancer? Cancer At A Glance Patient Discussions: Cancer - Symptoms Patient Discussions: Cancer - Describe Your Experience
What is cancer?
Cancer is the uncontrolled growth of abnormal cells anywhere in a body. The abnormal cells are termed cancer cells, malignant cells, or tumor cells. Many cancers and the abnormal cells that compose the cancer tissue are further identified by the name of the tissue that the abnormal cells originated from (for example, breast cancer, lung cancer, colon cancer). Cancer is not confined to humans; animals and other living organisms can get cancer. Below is a schematic that shows normal cell division and how when a cell is damaged or altered without repair to its system, the cell usually dies. Also shown is what can occur when such damaged or unrepaired cells do not die and become cancer cells and proliferate with uncontrolled growth; a mass of cancer cells develop. Frequently, cancer cells can break away from this original mass of cells, travel through the blood and lymph systems, and lodge in other organs where they can again repeat the uncontrolled growth cycle. This process of cancer cells leaving an area and growing in another body area is termed metastatic spread or metastatic disease. For example, if breast cancer cells spread to a bone (or anywhere else), it means that the individual has metastatic breast cancer. There are over 200 types of cancers; most can fit into the following categories according to the National Cancer Institute:
Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs
Sarcoma: Cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue Leukemia: Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood
Lymphoma and myeloma: Cancers that begin in the cells of the immune system
Central nervous system cancers: Cancers that begin in the tissues of the brain and spinal cord
In the U.S., according to the National Cancer Institute in 2010, the most common cancers (excluding non-melanoma skin cancers) are listed below. Cancer type Bladder Breast (female-male) Colon and rectal (combined) Endometrial Kidney (renal cell) Leukemia Lung (including bronchus) Melanoma Non-Hodgkin lymphoma Pancreatic Prostate Thyroid Estimated new cases 70,530 207,090-1,970 142,570 43,470 53,581 43,050 222,520 68,130 65,540 43,140 217,730 44,670 Estimated deaths 14,680 39,840-390 51,370 7,950 11,997 21,840 157,300 8,700 20,210 36,800 32,050 1,690
The three most common cancers in men, women and children in the U.S. are as follows:
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The incidence of cancer and cancer types are influenced by many factors such as age, sex, race, local environmental factors, diet, and genetics. Consequently, the incidence of cancer and cancer types vary depending on these variable factors. For example, the World Health Organization (WHO) provides the following general information about cancer worldwide:
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Cancer is a leading cause of death worldwide. It accounted for 7.4 million deaths (around 13% of all deaths) in 2004 (statistics published in 2009).
Lung, stomach, liver, colon, and breast cancer cause the most cancer deaths each year.
Deaths from cancer worldwide are projected to continue rising, with an estimated 12 million deaths in 2030.
Different areas of the world may have cancers that are either more or less predominant then those found in the U.S. One example is that stomach cancer is often found in Japan, while it is rarely found in the U.S. The objective of this article is to introduce the reader to general aspects of cancers. It is designed to be an overview of cancer and cannot cover every cancer type. This article will also attempt to help guide the reader to more detailed sources about specific cancer types.
Schistosoma spp., and Helicobacter pylori; other bacteria are being researched as possible agents Genetics: A number of specific cancers have been linked to human genes and are as follows: breast, ovarian, colorectal, prostate, skin and melanoma; the specific genes and other details are beyond the scope of this general article so the reader is referred to http://www.cancer.gov/cancertopics/genetics for more details about genetics and cancer. It is important to point out that most everyone is exposed to cancer-causing substances (for example, sunlight, cigarette smoke, and X-rays) during their lifetime but many individuals do not develop cancer. In addition, many people have the genes that are linked to cancer but do not develop it. Why? Although researchers may not be able give a satisfactory answer for every individual, it is clear that the higher the amount or level of cancer-causing materials a person is exposed to, the higher the chance the person will develop cancer. In addition, the people with genetic links to cancer may not develop it for similar reasons (lack of enough stimulus to make the genes function). In addition, some people may have a heightened immune response that controls or eliminates cells that are or potentially may become cancer cells. There is evidence that even certain dietary lifestyles may play a significant role in conjunction with the immune system to allow or prevent cancer cell survival. For these reasons, it is difficult to assign a specific cause of cancer to many individuals. Proving that a substance does not cause or is not related to increased cancer risk is difficult. For example, antiperspirants are considered to possibly be related to breast cancer by some investigators and not by others. The official stance by the NCI is "additional research is needed to investigate this relationship and other factors that may be involved." This unsatisfying conclusion is presented because the data collected so far is contradictive. Other claims that are similar require intense and expensive research which may never be done. Reasonable advice might be to avoid large amounts of any compounds even remotely linked to cancer, although it may be difficult to do in complex, technologically advanced modern societies.
Skin changes (coloration, sores that do not heal, white spots in mouth or on tongue, wart changes)
Anyone with these signs and symptoms should consult their doctor. Many cancers will present with some of the above general symptoms but often have one or more symptoms that are more specific for the cancer type. For example, lung cancer may present with common symptoms of pain, but usually the pain is located in the chest. The patient may have unusual bleeding, but the bleeding usually occurs when the patient coughs. Lung cancer patients often become short of breath, and then become very fatigued. Because there are so many cancer types (see next section) with so many nonspecific and sometimes more specific symptoms, the best way to learn about signs and symptoms of specific cancer types is to spend a few moments researching symptoms of a specific body area in question. Conversely, a specific body area can be searched to discover what signs and symptoms a person should look for in that area that is suspected of having cancer. The following examples are two ways to proceed to get information on symptoms:
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Use a search engine (Google, Bing) to find links to cancer by listing the symptom followed by the term "cancer." For example, listing "blood in urine and cancer" will bring a person to web sites that list possible organs and body systems where cancer may produce the listed symptoms.
Use a search engine as above and list the suspected body area and cancer (for example, bladder and cancer), and the person will see sites that list the signs and
symptoms of cancer in that area (blood in urine being one of several symptoms listed). In addition, if the cancer type is known (diagnosed), then even more specific searches can be done listing the diagnosed cancer type and whatever may be questioned about the cancer (symptoms, tumor grades, treatments, prognosis, and many other items). Your own research should not replace consulting a health-care provider if you ae concerned about cancer.
Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs -- "skin, lung, colon, pancreatic, ovarian cancers," epithelial, squamous and basal cell carcinomas, melanomas, papillomas, and adenomas
Sarcoma: Cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue -- "bone, soft tissue cancers," osteosarcoma, synovialsarcoma, liposarcoma, angiosarcoma, rhabdosarcoma, and fibrosarcoma
Leukemia: Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood -"leukemia," lymphoblastic leukemias (ALL and CLL), myelogenous leukemias (AML and CML), T-cell leukemia, and hairy-cell leukemia
Lymphoma and myeloma: Cancers that begin in the cells of the immune system -"lymphoma," T-cell lymphomas, B-cell lymphomas, Hodgkin lymphomas, nonHodgkin lymphoma, and lymphoproliferative lymphomas
Central nervous system cancers: Cancers that begin in the tissues of the brain and spinal cord -- "brain and spinal cord tumors," gliomas, meningiomas, pituitary adenomas, vestibular schwannomas, primary CNS lymphomas, and primitive neuroectodermal tumors
Not included in the above types listed are metastatic cancers; this is because metastatic cancer cells usually arise from a cell type listed above and the major difference from the above types is that these cells are now present in a tissue from which the cancer cells did not originally
develop. Consequently, if the terms "metastatic cancer" is used, for accuracy, the tissue from which the cancer cells arose should be included. For example, a patient may say they have or are diagnosed with "metastatic cancer" but the more accurate statement is "metastatic (breast, lung, colon, or other type) cancer."
Site of the primary tumor Tumor size and number of tumors Lymph node involvement (spread of cancer into lymph nodes)
Cell type and tumor grade* (how closely the cancer cells resemble normal tissue cells)
However, there are two main methods that form the basis for the more specific or individual cancer type staging. The TMN staging is used for most solid tumors while the Roman numeral or stage grouping method is used by some clinicians and researchers on almost all cancer types. The following is how the NCI describes the TNM staging system: 1. The TNM system is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of distant metastasis (M). A number is added to each letter to indicate the size or extent of the primary tumor and the extent of cancer spread (higher number means bigger tumor or more spread). Primary tumor (T) TX - Primary tumor cannot be evaluated T0 - No evidence of primary tumor Tis - Carcinoma in situ (CIS; abnormal cells are present but have not spread to neighboring tissue; although not cancer, CIS may become cancer and is sometimes called pre-invasive cancer) T1, T2, T3, T4 - Size and/or extent of the primary tumor 2. Regional lymph nodes (N) NX - Regional lymph nodes cannot be evaluated N0 - No regional lymph node involvement N1, N2, N3 - Involvement of regional lymph nodes (number of lymph nodes and/or extent of spread) 3. Distant metastasis (M) MX - Distant metastasis cannot be evaluated M0 - No distant metastasis M1 - Distant metastasis is present
Consequently, a person's cancer could be listed as T1N2M0, meaning it is a small tumor (T1), but has spread to some regional lymph nodes (N2), and has no detected metastasis (M0). The Roman numeral or stage grouping method is described by the NCI as follows: Stage Stage 0 Definition Carcinoma in situ.
Stage I, Stage Higher numbers indicate more extensive disease: Larger tumor size and/or II, and Stage spread of the cancer beyond the organ in which it first developed to nearby III lymph nodes and/or organs adjacent to the location of the primary tumor Stage IV The cancer has spread to another organ(s).
As mentioned above, variations of these staging methods exist. For example, some cancer registries use surveillance, epidemiology, and end results program (SEER) termed summary staging. SEER groups cancer cases into five main categories:
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In situ: Abnormal cells are present only in the layer of cells in which they developed.
Localized: Cancer is limited to the organ in which it began, without evidence of spread.
Regional: Cancer has spread beyond the primary site to nearby lymph nodes or organs and tissues.
Distant: Cancer has spread from the primary site to distant organs or distant lymph nodes.
Staging of cancer is important; it helps the physician to decide on the most effective therapeutic protocols, provides a basis for estimating the prognosis (outcome) for the patient, and provides a system to communicate the patient's condition to other health professionals that become involved with the patients' care.
at the same time if the cancer is entirely surgically removed when the surgeon removes the tissue for biopsy. Although patients may obtain a unique treatment protocol for their cancer, most treatments have one or more of the following components: surgery, chemotherapy, radiation therapy, or combination treatments (a combination of two or all three treatments). Individuals obtain variations of these treatments for cancer. Patients with cancers that cannot be cured (completely removed) by surgery usually will get combination therapy, the composition determined by the cancer type and stage. Palliative therapy (medical care or treatment used to reduce disease symptoms but unable to cure the patient) utilizes the same treatments described above. It is done with the intent to extend and improve the quality of life of the terminally ill cancer patient. There are many other palliative treatments to reduce symptoms such as pain medications and antinausea medications.
Anemia (both)
Insomnia (both)
Nausea (both)
Lymphedema (both)
Pain (both)
studies are breast exams, testicular exams, colon-rectal exams (colonoscopy), mammography, PSA levels, prostate exams, and others. People who have any suspicion that they may have cancer should discuss their concerns with their doctor as soon as possible. The earlier cancer is disproved or diagnosed and treated, the person will be better served.
Cancer At A Glance y y y
Cancer is the uncontrolled growth of abnormal cells anywhere in a body. There are over 200 types of cancer. Anything that may cause a normal body cell to develop abnormally potentially can cause cancer; general categories of cancer-related or causative agents are as follows: chemical or toxic compound exposures, ionizing radiation, some pathogens, and human genetics. Cancer symptoms and signs depend on the specific type and grade of cancer; general signs and symptoms are not very specific but are as follows: fever, fatigue, weight loss, pain, skin changes, change in bowel or bladder function, unusual bleeding, persistent cough or voice change, lumps, or tissue masses Although there are many tests to presumptively find or presumptively diagnose cancer, the definite diagnosis is made by examination of a biopsy sample of suspected cancer tissue. Cancer staging is often determined by biopsy results and helps determine the aggressiveness of the cancer type and the extent of cancer spread; staging also helps caregivers determine treatment protocols. In general, most staging methods show that the higher the number assigned (usually between 0-4), the more aggressive the cancer type or more widespread is the cancer in the body. Treatment protocols vary according to the type and stage of the cancer. Most treatment protocols are designed to fit the individual patient's disease. However, most treatments include at least one of the following and may include all: surgery, chemotherapy, and radiation therapy. The prognosis of cancer can range from excellent to poor. The prognosis depends on the cancer type and its staging with those cancers known to be aggressive and those staged with higher numbers (3-4) often have a prognosis that ranges more toward poor. Some cancers can be prevented by taking simple precautions, other cancers may have the risk of contracting them reduced by several methods, and a few may be difficult to avoid for some individuals.
REFERENCES: Switzerland. World Health Organization. "Cancer." Feb. 2011. <http://www.who.int/mediacentre/factsheets/fs297/en/index.html>. United States. Agency for Toxic Substances & Disease Registry. "Cancer Fact Sheet." Aug. 30, 2002. <http://www.atsdr.cdc.gov/com/cancer-fs.html>. United States. Centers for Disease Control. "Human Papillomavirus (HPV)." Sept. 22, 2010. <http://www.cdc.gov/hpv/>. United States. National Cancer Institute. "Cancer Genetics." <http://www.cancer.gov/cancertopics/genetics>. United States. National Cancer Institute. "Cancer Vaccines." Aug. 4, 2010. <http://www.cancer.gov/cancertopics/factsheet/Therapy/cancer-vaccines>. United States. National Cancer Institute. "Common Cancer Types." Nov. 4, 2010. <http://www.cancer.gov/cancertopics/types/commoncancers>.
Last Editorial Review: 2/14/2011
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