Cancer /ˈkænsə(r)/ ( listen) (medical term: malignant neoplasm) is a class of diseases

in which a group of cells display uncontrolled growth (division beyond the normal
limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes
metastasis (spread to other locations in the body via lymph or blood). These three
malignant properties of cancers differentiate them from benign tumors, which are self-
limited, and do not invade or metastasize. Most cancers form a tumor but some, like
leukemia, do not. The branch of medicine concerned with the study, diagnosis, treatment,
and prevention of cancer is oncology.

Cancer affects people at all ages with the risk for most types increasing with age.[1]
Cancer caused about 13% of all human deaths in 2007[2] (7.6 million).[3]

Cancers are caused by abnormalities in the genetic material of the transformed cells.[4]
These abnormalities may be due to the effects of carcinogens, such as tobacco smoke,
radiation, chemicals, or infectious agents. Other cancer-promoting genetic abnormalities
may randomly occur through errors in DNA replication, or are inherited, and thus present
in all cells from birth. The heritability of cancers is usually affected by complex
interactions between carcinogens and the host's genome.

Genetic abnormalities found in cancer typically affect two general classes of genes.
Cancer-promoting oncogenes are typically activated in cancer cells, giving those cells
new properties, such as hyperactive growth and division, protection against programmed
cell death, loss of respect for normal tissue boundaries, and the ability to become
established in diverse tissue environments. Tumor suppressor genes are then inactivated
in cancer cells, resulting in the loss of normal functions in those cells, such as accurate
DNA replication, control over the cell cycle, orientation and adhesion within tissues, and
interaction with protective cells of the immune system.

Definitive diagnosis requires the histologic examination of a biopsy specimen, although

the initial indication of malignancy can be symptomatic or radiographic imaging
abnormalities. Most cancers can be treated and some cured, depending on the specific
type, location, and stage. Once diagnosed, cancer is usually treated with a combination of
surgery, chemotherapy and radiotherapy. As research develops, treatments are becoming
more specific for different varieties of cancer. There has been significant progress in the
development of targeted therapy drugs that act specifically on detectable molecular
abnormalities in certain tumors, and which minimize damage to normal cells. The
prognosis of cancer patients is most influenced by the type of cancer, as well as the stage,
or extent of the disease. In addition, histologic grading and the presence of specific
molecular markers can also be useful in establishing prognosis, as well as in determining
individual treatments.
Signs and symptoms

Roughly, cancer symptoms can be divided into three groups:

• Local symptoms: unusual lumps or swelling (tumor), hemorrhage (bleeding), pain

and/or ulceration. Compression of surrounding tissues may cause symptoms such
as jaundice (yellowing the eyes and skin).
• Symptoms of metastasis (spreading): enlarged lymph nodes, cough and
hemoptysis, hepatomegaly (enlarged liver), bone pain, fracture of affected bones
and neurological symptoms. Although advanced cancer may cause pain, it is often
not the first symptom.
• Systemic symptoms: weight loss, poor appetite, fatigue and cachexia (wasting),
excessive sweating (night sweats), anemia and specific paraneoplastic
phenomena, i.e. specific conditions that are due to an active cancer, such as
thrombosis or hormonal changes.

Every symptom in the above list can be caused by a variety of conditions (a list of which
is referred to as the differential diagnosis). Cancer may be a common or uncommon cause
of each item.

Causes
Cancer is a diverse class of diseases which differ widely in their causes and biology. Any
organism, even plants, can acquire cancer. Nearly all known cancers arise gradually, as
errors build up in the cancer cell and its progeny (see mechanisms section for common
types of errors).

Anything which replicates (our cells) will probabilistically suffer from errors (mutations).
Unless error correction and prevention is properly carried out, the errors will survive, and
might be passed along to daughter cells. Normally, the body safeguards against cancer
via numerous methods, such as: apoptosis, helper molecules (some DNA polymerases),
possibly senescence, etc. However these error-correction methods often fail in small
ways, especially in environments that make errors more likely to arise and propagate. For
example, such environments can include the presence of disruptive substances called
carcinogens, or periodic injury (physical, heat, etc.), or environments that cells did not
evolve to withstand, such as hypoxia[5] (see subsections). Cancer is thus a progressive
disease, and these progressive errors slowly accumulate until a cell begins to act contrary
to its function in the animal.

The errors which cause cancer are often self-amplifying, eventually compounding at an
exponential rate. For example:

• A mutation in the error-correcting machinery of a cell might cause that cell and its
children to accumulate errors more rapidly
• A mutation in signaling (endocrine) machinery of the cell can send error-causing
signals to nearby cells
 • A mutation might cause cells to become neoplastic, causing them to migrate and
disrupt more healthy cells
• A mutation may cause the cell to become immortal (see telomeres), causing them
to disrupt healthy cells forever

Thus cancer often explodes in something akin to a chain reaction caused by a few errors,
which compound into more severe errors. Errors which produce more errors are
effectively the root cause of cancer, and also the reason that cancer is so hard to treat:
even if there were 10,000,000,000 cancerous cells and one killed all but 10 of those cells,
those cells (and other error-prone precancerous cells) could still self-replicate or send
error-causing signals to other cells, starting the process over again. This rebellion-like
scenario is an undesirable survival of the fittest, where the driving forces of evolution
itself work against the body's design and enforcement of order. In fact, once cancer has
begun to develop, this same force continues to drive the progression of cancer towards
more invasive stages, and is called clonal evolution.[6]

Prevention
Cancer prevention is defined as active measures to decrease the incidence of cancer.
Greater than 30% of cancer is preventable via avoiding risk factors including: tobacco,
overweight or obesity, low fruit and vegetable intake, physical inactivity, alcohol,
sexually transmitted infection, air pollution.[31] This can be accomplished by avoiding
carcinogens or altering their metabolism, pursuing a lifestyle or diet that modifies cancer-
causing factors and/or medical intervention (chemoprevention, treatment of pre-
malignant lesions). The epidemiological concept of "prevention" is usually defined as
either primary prevention, for people who have not been diagnosed with a particular
disease, or secondary prevention, aimed at reducing recurrence or complications of a
previously diagnosed illness.

Diet
Main article: Diet and cancer

The consensus on diet and cancer is that obesity increases the risk of developing cancer.
Particular dietary practices often explain differences in cancer incidence in different
countries (e.g. gastric cancer is more common in Japan, while colon cancer is more
common in the United States. In this example the preceding consideration of
Haplogroups are excluded). Studies have shown that immigrants develop the risk of their
new country, often within one generation, suggesting a substantial link between diet and
cancer.[36] Whether reducing obesity in a population also reduces cancer incidence is
unknown.

Despite frequent reports of particular substances (including foods) having a beneficial or

detrimental effect on cancer risk, few of these have an established link to cancer. These
reports are often based on studies in cultured cell media or animals. Public health
recommendations cannot be made on the basis of these studies until they have been
validated in an observational (or occasionally a prospective interventional) trial in
humans.

Proposed dietary interventions for primary cancer risk reduction generally gain support
from epidemiological association studies. Examples of such studies include reports that
reduced meat consumption is associated with decreased risk of colon cancer,[37] and
reports that consumption of coffee is associated with a reduced risk of liver cancer.[38]
Studies have linked consumption of grilled meat to an increased risk of stomach cancer,
[39]
colon cancer,[40] breast cancer,[41] and pancreatic cancer,[42] a phenomenon which could
be due to the presence of carcinogens such as benzopyrene in foods cooked at high
temperatures.

A 2005 secondary prevention study showed that consumption of a plant-based diet and
lifestyle changes resulted in a reduction in cancer markers in a group of men with
prostate cancer who were using no conventional treatments at the time.[43] These results
were amplified by a 2006 study in which over 2,400 women were studied, half randomly
assigned to a normal diet, the other half assigned to a diet containing less than 20%
calories from fat. The women on the low fat diet were found to have a markedly lower
risk of breast cancer recurrence, in the interim report of December, 2006.[44]

Recent studies have also demonstrated potential links between some forms of cancer and
high consumption of refined sugars and other simple carbohydrates.[45][46][47][48][49]
Although the degree of correlation and the degree of causality is still debated,[50][51][52]
some organizations have in fact begun to recommend reducing intake of refined sugars
and starches as part of their cancer prevention regimens.[53][54][55]

In November 2007, the American Institute for Cancer Research (AICR), in conjunction
with the World Cancer Research Fund (WCRF), published Food, Nutrition, Physical
Activity and the Prevention of Cancer: a Global Perspective, "the most current and
comprehensive analysis of the literature on diet, physical activity and cancer".[56] The
WCRF/AICR Expert Report lists 10 recommendations that people can follow to help
reduce their risk of developing cancer, including the following dietary guidelines: (1)
reducing intake of foods and drinks that promote weight gain, namely energy-dense foods
and sugary drinks, (2) eating mostly foods of plant origin, (3) limiting intake of red meat
and avoiding processed meat, (4) limiting consumption of alcoholic beverages, and (5)
reducing intake of salt and avoiding mouldy cereals (grains) or pulses (legumes).[57][58]

Some mushrooms offer an anti-cancer effect, which is thought to be linked to their ability
to up-regulate the immune system. Some mushrooms known for this effect include,
Reishi,[59][60] Agaricus blazei, [1], Maitake,[2] and Trametes versicolor[3]. Research
suggests the compounds in medicinal mushrooms most responsible for up-regulating the
immune system and providing an anti-cancer effect, are a diverse collection of
polysaccharide compounds, particularly beta-glucans. Beta-glucans are known as
"biological response modifiers", and their ability to activate the immune system is well
documented. Specifically, beta-glucans stimulate the innate branch of the immune
system. Research has shown beta-glucans have the ability to stimulate macrophage, NK
cells, T cells, and immune system cytokines. The mechanisms in which beta-glucans
stimulate the immune system is only partially understood. One mechanism in which beta-
glucans are able to activate the immune system, is by interacting with the Macrophage-1
antigen (CD18) receptor on immune cells.[61]

Prophylactic vaccines have been developed to prevent infection by oncogenic infectious

agents such as viruses, and therapeutic vaccines are in development to stimulate an
immune response against cancer-specific epitopes.[73]

As reported above, a preventive human papillomavirus vaccine exists that targets certain
sexually transmitted strains of human papillomavirus that are associated with the
development of cervical cancer and genital warts. The only two HPV vaccines on the
market as of October 2007 are Gardasil and Cervarix.[73] There is also a hepatitis B
vaccine, which prevents infection with the hepatitis B virus, an infectious agent that can
cause liver cancer.[73] A canine melanoma vaccine has also been developed.[74][75]

Authentic and accurate information and public education is basic to any disease control
initiative. It is more so for a disease like cancer where more than 70% of disease burden
is related to life-style factors such as food & beverage practices, personal habits,
infections, tobacco consumption and social customs. In addition, urbanization,
industrialization and increasing life-span are also known to influence the cancer pattern
globally. This necessitates proper appreciation of risk factors and other causes of cancer
by the people. At CFI we consider information and public education to be of vital
importance in our cancer prevention initiatives. CFI has continuously worked on
developing new communication strategy, methods and modules for urban and rural
populations