Cancer

Our body is made up of cells. All cancers begin in cells, which are the fundamental unit of life. To understand cancer, it’s useful to know what happens when normal cells become cancer cells. Our body is made up of several types of cells. These cells grow and divide in a well-controlled set manner to produce more cells as they are needed to keep the body healthy. As cells become older or damaged, they die and are replaced with new cells. However, due to certain reasons this normal condition is interrupted, which leads to an abnormal behavior by the cells, typically in one part/organ of the body, where the cells continue to multiply and live beyond their lifespan. These are referred to as the ‘cancerous cells.’ The term ‘Cancer’ is used to describe a medical condition, where there is…. Abnormal and uncontrolled multiplication of the body cells Genesis is typically in one organ/part of the body These mutant cells can migrate and invade other parts of the body through blood & lymph Manifestation of the disease is the form of a tumor – a group of mutant cells that form a tissue These can affect all living cells in the body, at all ages and in both genders The cause is multi-factorial and the disease process differs at different sites.

‘Cancer’ is not a single disease but it refers to a group of diseases which share similar characteristics. Doctors classify cancer on the basis of the tissue from where it originates. For example, the term ‘carcinoma’ is used for the cancer that originates from the skin or in tissues that line or cover internal organs; and the term ‘leukemia’ is used for the caner that starts in the blood-forming tissue such as the bone marrow and causes large numbers of abnormal bold cells to be produced, which enter the blood. Factors such as tobacco consumption, environmental exposures to carcinogens, certain infections as well as genetic predisposition play an important role in carcinogenesis.

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How does Cancer start?
Cancer starts when the genetic material (DNA) of a cell can become damaged or changed, producing changed known as mutations, which affect normal cell growth and division. It is not always clear as to what causes mutations. Some mutations are inherited, some may be due to diet, and others might be caused by exposure to environment factors, which are referred to as ‘carcinogens’ such as; some chemicals, tobacco, cigarette smoke etc. When this occurs, cells do not obey the normal life cycle, so the old/damaged cell do not die, but new ones are still formed leading to large number of cells than required by the body. These excess cells form a mass of tissue, which is called a ‘tumor.’ However every tumor may not be cancerous. The medical terms to differentiate between a tumor and a cancerous tumor are – ‘benign’ and ‘malignant.’ Tumor that is not cancerous is referred to as ‘Benign’ tumor, this Can often be surgically removed In most cases rarely there is a recurrence of the condition after surgery Remains ‘contained’ within its organ of genesis and does not invade/spread to other organs/part of the body

‘Malignant’ tumors are ‘cancerous’ Cells in these tumors can invade nearby tissues and spread to other parts of the body The spread of cancer from one part of the body to another is called ‘Metastasis’

Most cancers are named after the organ or type of cell in which they originate. For example, cancer that begins in the stomach is called stomach cancer. The extent of growth of cells in the originating tissue, its invasion to nearby lymph nodes and spread to distant organs determines the seriousness, the impact and the line of treatment of the disease; this assessment is referred to as ‘Staging’ of the cancer. Usually cancer of the blood & bone marrow such leukemia do not form tumor.

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Common Cancer
In our country the most common cancers, amongst…. Men are: Lung cancer, cancer of the esophagus, stomach cancer, cancer of the head and neck, colorectal cancer and prostate cancer Women are: Cervical cancer (usually seen more in rural and semi urban areas), breast cancer, ovarian cancer, lung cancer, esophagus and stomach cancer, colorectal cancer.

The information below on varied cancer types enlists; Warning signs and symptoms Known risk factors Recommends some preventive steps

Lung Cancer
Statistics show that Lung cancer patients account for the highest number of deaths amongst male cancer patients. Lung cancer is the leading cause of cancer deaths in developed countries and is also rising at an alarming rate in developing countries Studies have estimated that deaths due to lung cancer are more than those due to colorectal, breast and prostate cancers put together

Characteristics of the disease
Classified into two types; ‘Non Small Cell’ Lung Cancer and ‘Small Cell’ Lung Cancer depending on the type of cell that originates in the lung ‘Non-Small Cell’ Lung Cancer is the most common form of lung cancer

Causes
Smoking remains the leading cause of lung cancer (Studies conducted in India have shown that smokers get the disease earlier and are at greater risk. In patients with lung cancer, a history of active tobacco smoking is present in 87% of males and in 85% of females. History of passive tobacco exposure is found in only three percent)

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Environmental exposure to smoke during childhood is strongly associated with the risk of later development of lung cancer Exposure to chemicals such as Radon, chromium, ethers and mustard gas & air pollution are known increase the risk of lung cancer

Signs & Symptoms
The signs and symptoms of lung cancer can vary depending on the location of the tumor. However, the common symptoms include: Blood tinged cough Recurrent lung infection Choking or difficulty in swallowing Hoarseness of voice Swelling of neck and shoulders Pain in the chest wall Accumulation of fluid between the outside of lung and the inside of the chest wall causing shortness of breath and pain known as pleural effusion Unusual fatigue, weakness, fever, loss of appetite and weight loss

Sometimes a patient may not have any apparent symptoms or the impact of the symptoms may be low.

Diagnosis & Management - Diagnosis
Battery of tests, which include imaging studies, blood tests after examination to find out the cause of symptoms and confirm the disease and also to know the stage of the disease.

- Management may include
Surgery, radiation therapy and chemotherapy depending on the stage, location, age and general health of the patient. With the availability of new and better imaging techniques, chemotherapy drugs & radiation techniques, the results have improved significantly. Hence early detection helps in improving the patient’s chances of cure and survival.

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Head & Neck Cancer
Head & Neck cancer is a common form of cancer in the developing countries. More than one lakh Head & Neck cancer cases are diagnosed in our country every year.

Characteristics
Head & Neck cancer includes all the cancers occurring in ear, nose, throat and oral cavity Typically the cells lining these organs experience a cancerous growth and affect the entire organ

The most common parts affected are affect and pharynx regions.

Causes
In India most of the oral cavity cancers are seen in people who chew tobacco, tobacco related products, and smoke cigars/cigarettes. Studies have shown that in India cancer can start from a condition known as Sub Mucous Fibrosis, which is a result of chewing products containing tobacco and other ingredients such as betel nuts or ‘suparis’ for a long time. Smoking, chewing tobacco and tobacco related products as also inhalation of snuff and consumption of alcohol are the known risk factors Exposure to chemicals such asbestos, chromium, nickel, arsenic and formaldehyde Two viruses (Epstein – Barr and Human Papillo) are under investigation as possible risk factors. Epstein-Barr and Human Papilloma are also known to increase the risk of this type of cancer

Signs & Symptoms
The signs and symptoms vary with the location of the primary site and the stage of the cancer. Head & Neck cancer produces early warning signs that can lead to early diagnosis and a high probability of cure in many cases. For example, hoarseness frequently occurs in the very earliest of voice box cancers. Persistent sore throat for longer than two weeks is a symptom of possible cancer in the voice box and/or pharynx. Symptoms include Cancer of the oral cavity include pain and changes in the fit of dentures (if the patient is using one) A non-healing ulcer, difficulty in swallowing or development of a mass of tissue in the mouth may also serve as warning signs of potential carcinomas

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Although not an early sign, a neck mass may be the first presenting symptom Nasal can all indicate possibility of nasopharyngeal cancer

Diagnosis
Extensive examination of the Head& Neck region will the first step followed by imaging studies to identify the site & stage of cancer

Management
Once diagnosed the treatment plan my include surgery, radiation and chemotherapy

In case of early detection, there are greater chances of complete recovery

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Gastrointestinal Cancers
Gastrointestinal cancer includes cancer of food pipe (Esophagus), stomach, colon (large intestine) and rectum.

Cancer of Esophagus & Stomach
In India, cancer of the esophagus is the third leading type of cancer among men and fourth leading type of cancer among women. Stomach cancer is also one of the leading cancers in India. Recent studies have shown that many patients have cancer at the point where the food pipe joins the stomach. In northeastern part of our country the incidence of stomach cancer is very high.

Common risk factors
Smoking and consumption of alcohol (A recent study from South India has shown that the risk for food pipe cancer is 3.5 times higher with alcohol consumption and 2.5 times higher for tobacco users, 2.8 times higher for betel nut chewers and smokers) Consumption of smoked meat, fish and use of pickled and high salted foods Infection with bacteria known as H.Pylori, which is known to cause ulcer of the stomach, is also associated with development of stomach cancer Recent study has shown that obesity is predisposing risk factor

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Sign & Symptoms
Cancer of esophagus Difficulty in swallowing Regurgitation ( food coming back to mouth from stomach) Pain in the throat, in mid-chest or between shoulder blades are some common symptoms

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Stomach Cancer
Initial symptoms are vague, thus delaying detection to advanced stage of the disease. The most common symptom may be an unexplained loss of weight. Other symptoms may include: Feeling of fullness of stomach after meals Actual bloating up of the stomach after meals A constant felling nausea Heartburn or a felling of burning in the throat and stomach Diarrhea or constipation Weakness and fatigue Passage of black, tarry stools

Diagnosis
After physical examination the Doctor may suggest A test to visualize the gastrointestinal tract known as gastroendoscopy or A test where a solution called barium is to be swallowed followed by X-rays. A small piece of the suspected tissue may be removed; this provedure is known as biopsy Other tests may follow

Management - For cancer of the food pipe and stomach, treatment plan may include surgery and
chemotherapy and radiation therapy depending on the stage

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Cancer of the Colon & Rectum
Colon cancer is seen mostly in developed countries. However, in the recent past the incidence has increased in India. Doctors have concluded that increasing consumption of western style food with less fiber may be one key contributing factor. In India colon and rectal cancers are seen in relatively young patients compared to the western population.

Characteristics
Colon cancer is the cancer of large intestine (colon), the lower part of our digestive system Rectal cancer is cancer of the last 6 inches of the colon Most cases of colon cancer begin as small, non cancerous (benign) clumps of cells called ‘adenomatous polyps.’ Over time some of these polyps become colon cancers

Causes & Risk Factors
Presence of polyps 9as small, non-cancerous (benign) clumps of cells) in the colon A diet rich in fat and starch without fiber Sedentary life style Smoking and alcohol consumption A family history of colon polyps A history of inflammatory bowel disease (two diseases Ulcerative Colitis & Crohn’s disease).

Signs & Symptoms
As with other cancers, the early symptoms are quite vague. However, the following signs and symptoms are quite common: A change in your bowel habits, including diarrhea or a change in the consistency of stool for more than a couple of weeks Rectal bleeding or blood in stool Persistent abdominal discomfort, such as cramps, gas or pain, Abdominal pain with a bowel movement A feeling that bowel doesn’t empty completely Unexplained weight loss and fatigue

Diagnosis
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A blood test called ‘fecal occult’ blood test, which identifies hidden blood in the stool Followed by visualization of colon through a procedure known as colonoscopy

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Other tests including biopsy, where a piece of suspected tissue is taken for examination, may follow

Management
The management plan is chalked out once the disease is identified and staged Treatment plan may include surgery, chemotherapy and radiation depending on the stage of disease

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Breast Cancer
Breast cancer is the second leading cancer amongst women in India. However, amongst the urban women it has the highest incidence. The average incidence rate caries from 22-28 per 100,000 women per year in urban settings to 6 per 100,000 women per year in rural areas.

Causes
Risk factors that can lead to breast cancer are Early age at menarche, late age at menopause, or first childbirth at a late age Fewer children and shorter duration of breast-feeding Family history of breast cancer increases the risk as follows: (If a woman has a mother who has suffered from breast cancer her risk increases about 3 fold while having a sister with cancer, the risk increases by about 2-3 fold. About 5% of breast cancers are hereditary) Obesity is also now recognized as a predisposing factor

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Signs & Symptoms
Generally lumps in the breasts do indicate some change, which warrants medical opinion. Most breast lumps aren’t cancerous. The most common sign of breast cancer: Lump or thickening in the breast. Often, the lump is painless A spontaneous clear or bloody discharge from your nipple, often associated with a breast lump Retraction or indentation of nipple A change in the size or contours of breast Any flattening or indentation of the skin over breast Redness or pitting of the skin over breast Mass below the arms

Diagnosis
The first test after physical evaluation may include X-ray of the breast known as ‘Mammography’ This could be followed by biopsy and other imaging tests

Management
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The treatment plan would include surgery, radiation therapy and chemotherapy depending on the stage of the disease Early detection can lead to curing of the disease.

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Ovarian Cancer
Women have two ovaries, one on each side of the uterus. The ovaries – each about the size of an almond – produce eggs (ova) as well as the female sex hormones estrogen and progesterone.

Characteristics
Ovarian cancer is the third most common cancer amongst women It usually occurs in women above 50 years of age This form of cancer is often called the ‘silent killer’ because the symptoms manifest at a late stage of the disease Since the ovaries are located deep inside the abdomen, they are not easily accessible for examination

Causes
The exact cause of this disease is still under investigation. However studies shows that women who… Have no children Have had breast or colon cancer Use fertility drugs regularly Are on or have undergone hormone replacement therapy …are at higher risk.

Signs & Symptoms
The symptoms of ovarian cancer are often not recognized early in the disease. They may also be so vague in the earlier stages, that they can easily be ignored. Some of the common symptoms are: Stomach ache and abdominal discomfort accompanied by a feeling of belatedness or fullness of the stomach Abnormal vaginal bleeding Sudden weight gain or weight loss without any apparent reason Loss of appetite, nausea, vomiting, constipation and frequent urination in some cases

Diagnosis
Pelvic examination conducted by a gynecologist may detect ovarian cancer

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This has to be followed by various imaging techniques and blood tests including biops if necessary

Management
As with other cancer treatment plans, this will also include surgery, radiation therapy or chemotherapy depending on the stage and type of cancer

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Cervical Cancer
Cervical cancer is one of the most common cancers that affect a woman’s reproductive system. Cervical cancer is the leading cancer of women in developing countries, including India Its incidence is higher among women in rural areas Usually it affects relatively younger women.

Causes
A virus known as Human Papilloma is strongly associated with cervical cancer. This virus is sexually transmitted. Early sexual activity Multiple sex partners Infection with Sexually transmitted diseases …are known risk factors for development of cervical cancer.

Signs & Symptoms
Early cervical cancer generally produces no signs or symptoms. As the cancer progresses, theses symptoms and signs may indicate cancer of the cervix: Vaginal bleeding after intercourse, between periods or after menopause Watery, bloody vaginal discharge that may be heavy and has a foul odor Pelvic pain or pain during intercourse

Diagnosis
Regular Pap smear test can help detect any changes very early Visualization of cervical area Biopsy may recommended followed by other tests depending on the stage and type of tumor

Management
Surgery and radiation play key role in the management of cervical caner

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Prostate Cancer
Prostate cancer is cancer of the small walnut-shaped gland near the urinary bladder in men that produces seminal fluid. (Seminal fluid nourishes and transports sperm. The prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body) Older men, usually at the sixth decade of their life are at a higher risk of this disease.

Causes
The exact cause is under investigation. However, increasing age and high testosterone are known risk factors

Signs & Symptoms
At early stages of this cancer, most men will not experience any symptoms. Some men, however, will experience the following symptoms that might indicate the presence of prostate cancer: Need to urinate frequently, especially at night Difficulty in starting urination or holding back urine Weak or interrupted flow of urine Painful or burning urination Difficulty in having an erection Painful ejaculation Blood in urine or semen Frequent pain or stiffness in the lower back, hips, or upper thigh

Diagnosis
Since these symptoms can also indicate the presence of other diseases or disorders, men who experience any of these symptoms should undergo a thorough work-up to determine the underlying cause of the symptoms A blood test for a protein known as Prostate Specific Antigen (PSA) An ultrasound examination through rectum is suggested usually after examination of prostate through rectum by the doctor (Digital rectal examination-DRE)

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Management
Depending on the stage of the disease, hormonal therapy, surgery and/or radiation therapy are initiated Some patients may require chemotherapy at a larger stage

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Cancer prevention
Adopting a healthy style which includes the following will help reduce the risk of cancer. Say Yes to… 1. A low calorie diet taken as small meals periodically that should include… At least 5 servings of fruits and vegetables per day Poultry products (chicken, duck, geese) and sea food (fish, shell fish etc.) Fiber rich food (whole grain cereals, brown rice), fresh fruits and vegetables (tomatoes, citrus fruits, carrots, green leafy vegetables) - Drinking at least 6-8 glasses of filtered water daily - Healthy oils (vegetable oil or olive oil) - Quality protein (wheat flour, groundnut, milk, rice, soybean, almond, chicken and eggs) - Foods rich in vitamins such as citrus fruits, green leafy vegetables. - Calcium rich food (milk, cheese, curds and dark-green leafy vegetables) - Food rich in Vitamin D (cow’s milk, egg yolks, chicken livers, butter, soya and ragi) 2. Attaining and maintaining of a healthy body weight by being physically active and taking light exercise daily Say No to… 1. 2. 3. 4. A high fat content diet that include… Red meat (mutton and lamb) and processed meat (beef and roasted pork) Sugar rich desserts, high-fat dairy products and fried foods Potential food allergens such as preservatives and food additives Too much coffee and other stimulants Spicy, very hot, very cold or highly acidic foods Smoking Alcohol Sedentary and unhealthy lifestyle

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