Cancer

Cancer Overview

The word cancer is derived from the Latin word for crab because cancers are often very irregularly shaped, and because, like a crab, they “grab on and don’t let go.” The term cancer specifically refers to a new growth which has the ability to invade surrounding tissues, metastasize (spread to other organs) and which may eventually lead to the patient’s death if untreated.

The terms tumor and cancer are sometimes used interchangeably which can be misleading. A tumor is not necessarily a cancer. The word tumor simply refers to a mass. For example, a collection of fluid would meet the definition of a tumor. A cancer is a particularly threatening type of tumor. It is helpful to keep these distinctions clear when discussing a possible cancer diagnosis.

Cancer is a group of diseases caused when abnormal cells grow and divide rapidly with the potential to invade or spread (metastasize) to other parts (tissue and organs) of the body. Cancer is genetic disease that is caused by changes to genes that control the way our cells function, especially how they grow and divide. Cancer can start almost anywhere in the human body, in all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues.

In a healthy body, trillions of cells are produced, grow and divide, as the body needs them to function normally on daily basis. Healthy cells have a specific life cycle, reproducing and dying off in a way that is determined by the type of cell. New cells take the place of old or damaged cells as they die as a natural healthy process. Cancer disrupts this process and leads to abnormal growth in cells. It’s caused by changes or mutations in DNA. Cancer begins when genetic changes interfere with this orderly process.

DNA exists in the individual genes of every cell. It has instructions that tell the cell what functions to perform and how to grow and divide.

Mutations occur frequently in DNA, but usually cells correct these mistakes. When a mistake is not corrected, a cell can become cancerous. Mutations can cause cells that should be replaced to survive instead of die, and new cells to form when they’re not needed. These extra cells can divide uncontrollably, causing growths called tumors to form. Tumors can cause a variety of health problems, depending on where they grow in the body.

All tumors are not cancerous. Benign tumors are noncancerous and do not spread to nearby tissues. Sometimes, they can grow large and cause problems when they press against neighboring organs and tissue. Malignant tumors are cancerous and can invade other parts of the body. Some cancer cells can also migrate through the bloodstream or lymphatic system to distant areas of the body. This process is called metastasis. Cancers that have metastasized are considered more advanced than those that have not. Metastatic cancers tend to be harder to treat and more fatal.

Cancer is one of the leading causes of death in the world, according to the World Health Organization (WHO) Cancer is the second leading cause of death globally, accounting for an estimated 9.6 million deaths, or one in six deaths in 2018. Lung, prostate, colorectal, stomach and liver cancer are the most common types of cancer in men, while breast, colorectal, lung, cervical and thyroid cancer are the most common among women.

Neoplasm

A neoplasm is an abnormal new growth of cells. The cells in a neoplasm usually grow more rapidly than normal cells and will continue to grow if not treated. As they grow, neoplasms can impinge upon and damage adjacent structures. The term neoplasm can refer to benign (usually curable) or malignant (cancerous) growths.

Tumor

A tumor is a commonly used, but non-specific, term for a neoplasm. The word tumor simply refers to a mass. This is a general term that can refer to benign (generally harmless) or malignant (cancerous) growths.

Benign Tumor

Benign tumors are non-malignant/non-cancerous tumor. A benign tumor is usually localized, and does not spread to other parts of the body. Most benign tumors respond well to treatment. However, if left untreated, some benign tumors can grow large and lead to serious disease because of their size. Benign tumors can also mimic malignant tumors, and so for this reason are sometimes treated.

Malignant Tumor

Malignant tumors are cancerous growths. They are often resistant to treatment, may spread to other parts of the body and they sometimes recur after they were removed. A cancer is another word for a malignant tumor (a malignant neoplasm)

Types of Cancer

There are more than100 types of cancers affect humans, cancers are named for the area *organs or tissue) in which they begin and the type of cell they are made of, even if they spread to other parts of the body. For example, a cancer that begins in the lungs and spreads to the liver is still called lung cancer. Cancers also may be described by the type of cell that formed them, such as an epithelial cell or a squamous cell. There are also several clinical terms used for certain general types of cancer:

• Carcinomas: A Carcinoma is a cancer that starts in the skin or the tissues that covers the surface of internal organs and glands. Carcinomas usually form solid tumors and are the most common type of cancer. Examples of carcinomas include prostate cancer, breast cancer, lung cancer and colorectal cancer.
• Sarcomas: A Sarcoma is a cancer which begins in the connective tissues that support and connect the body. A sarcoma can develop in body fat, nerves, tendons, joints, bones, muscles, cartilage, and blood vessels.
  
• Leukemias:  Leukemia is a cancer of the blood Leukemia begins when healthy blood cells change and grow uncontrollably. The main types of leukemia’s are Acute Lymphocytic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), Acute Myeloid Leukemia (AML) and Chronic Myeloid Leukemia (CML).
  
• Lymphomas: Lymphoma is a cancer that begins in the lymphatic system. The lymphatic system is a network of vessels and glands that help fight infection. There are two main types of lymphomas, Hodgkin’s Lymphoma and Non-Hodgkin’s Lymphoma.
  
• Myelomas: Myeloma is a type of cancer that develops in the cells of the bone marrow called plasma cells. Bone marrow is the spongy tissue found inside the inner part of some of our large bones. The bone marrow produces different types of blood cells. Plasma cells are part of the immune system which make antibodies, these antibodies are also called immunoglobulins. Multiple myeloma is the most common type of plasma cell cancer. The bones and bone marrow are the main sites where myeloma cells (abnormal plasma cells) are produced. The myeloma cells can form tumors, called plasmacytomas, in many bones in the body.

Signs and Symptoms of Cancer

Signs and symptoms caused by cancer will vary depending on what part of the body is affected. Cancer can be detected by certain signs and symptoms or screening tests. It is then typically further investigated by medical imaging and further confirmed by biopsy. Some general signs and symptoms associated with, but not specific to, cancer, include:

• Fatigue
• Fever
• Lump or area of thickening that can be felt under the skin
• Weight changes, including unintended loss or gain 
• Headaches
• Skin changes, such as yellowing, darkening or redness of the skin, sores that won’t heal, or changes to existing moles
• Changes in bowel or bladder habits (diarrhea or constipation)
• Anemia
• Persistent cough or trouble breathing
• Difficulty swallowing 
• Dizziness
• Hoarseness

Causes of Cancer

There are many factors which contribute in developing cancer. Tobacco use is one of the major causes and risk factor for developing cancer leading to approximately 22% of cancer deaths. Obesity, poor diet, lack of physical activity, excessive consumption of alcohol also causes cancer. Other factors include certain infections, exposure to ionizing radiation and pollutants in the environment. In certain parts of the world many cancers occur due to infections such as Helicobacter pylori, Hepatitis B, hepatitis C, Human Papillomavirus (HPV) Infection and Human Immunodeficiency Virus (HIV). These factors act, at least partly, by altering the genes of a cell. Typically, many genetic changes are required before cancer develops. Some of cancers develop due to inherited genetic defects. 

Cancer is caused by changes (mutations) to the DNA within cells. The DNA inside a cell is packaged into a large number of individual genes, each of which contains a set of instructions telling the cell what functions to perform, as well as how to grow and divide. Errors in the instructions can cause the cell to stop its normal function and may allow a cell to become cancerous.

A gene mutation can instruct a healthy cell to:

• Allow rapid growth- A gene mutation can tell a cell to grow and divide more rapidly, this creates many new cells that all have that same mutation.
• Fail to stop uncontrolled cell growth- Normal cells know when to stop growing so that you have just the right number of each type of cell. Cancer cells lose the controls (tumor suppressor genes) that tell them when to stop growing. A mutation in a tumor
  tumor suppressor gene allows cancer cells to continue growing and accumulating.
• Make mistakes when repairing DNA errors- DNA repair genes look for errors in a cell’s DNA and make corrections. A mutation in a DNA repair gene may mean that other errors aren’t corrected, leading cells to become cancerous.

These mutations are the most common ones found in cancer, but many other gene mutations can contribute to causing cancer.

Gene mutations can occur for several reasons, for instance:

• Gene mutations you’re born with- You may be born with a genetic mutation that you inherited from your parents, this type of mutation accounts for a small percentage of cancers.
• Gene mutations that occur after birth- Most gene mutations occur after you’re born and aren’t inherited. A number of factors can cause gene mutations, such as smoking, radiation, viruses, cancer-causing chemicals (carcinogens), obesity, hormones, chronic inflammation and a lack of exercise.

Gene mutations occur frequently during normal cell growth. However, cells contain a mechanism that recognizes when a mistake occurs and repairs the mistake. Occasionally, a mistake is missed. This could cause a cell to become cancerous. The gene mutations you’re born with and those that you acquire throughout your life work together to cause cancer. For instance, if you’ve inherited a genetic mutation that predisposes you to cancer, that doesn’t mean you’re certain to get cancer. Instead, you may need one or more other gene mutations to cause cancer. Your inherited gene mutation could make you more likely than other people to develop cancer when exposed to a certain cancer-causing substance. It’s not clear just how many mutations must accumulate for cancer to form. It’s likely that this varies among cancer types. The genetic changes or drivers that contribute to cancer tend to affect three main types of genes, proto-oncogenes, tumor suppressor genes, and DNA repair genes.

Cancer Risk Factors

Majority of cancers occur in people who don’t have any known risk factors. Genetic changes that cause cancer can be inherited from our parents. They can also arise during a person’s lifetime as a result of errors that occur as cells divide or because of damage to DNA caused by certain environmental exposures. Factors known to increase the risk of cancer include:

Age

Cancer can take decades to develop. That’s why most people diagnosed with cancer are 65 or older. While it’s more common in older adults, cancer isn’t exclusively an adult disease, cancer can be diagnosed at any age.

Habits

Certain lifestyle choices are known to increase your risk of cancer. Smoking, drinking more than one alcoholic drink a day (for women of all ages and men older than age 65) or two drinks a day (for men age 65 and younger), excessive exposure to the sun or frequent blistering sunburns, being obese, and having unsafe sex can contribute to cancer.

Family History

Only a small portion of cancers are due to an inherited condition. If cancer is common in your family, it’s possible that mutations are being passed from one generation to the next. You might be a candidate for genetic testing to see whether you have inherited mutations that might increase your risk of certain cancers. Keep in mind that having an inherited genetic mutation doesn’t necessarily mean you’ll get cancer.

Health Conditions

Some chronic health conditions and diseases, such as ulcerative colitis, can increase the risk of developing certain cancers. Also certain viral infections can lead to cancer, such as hepatitis B, C and HPV.

Environmental Factors

The environment around you may contain harmful chemicals that can increase your risk of cancer. Even if you don’t smoke, you might inhale secondhand smoke if you go where people are smoking or if you live with someone who smokes. Chemicals in your home or workplace, such as asbestos and benzene, also are associated with an increased risk of cancer. Cancer-causing environmental exposures include substances, such as the chemicals in tobacco smoke, and radiation, such as ultraviolet rays from the sun. 

Complications of Cancer

Cancer and its treatment can cause several complications, including:

• Pain: Pain can be caused by cancer or by cancer treatment, though not all cancer is painful. Medications and other approaches can effectively treat cancer-related Pain.
• Fatigue: Fatigue in cancer patients has many causes, but it can often be managed. Fatigue
  associated with chemotherapy or radiation therapy treatments is common, but it’s usually temporary.
• Difficulty Breathing: Cancer or cancer treatment may cause a feeling of being short of breath. Treatments may bring relief.
• Nausea: Certain cancers and cancer treatments can cause Nausea. Some of the cancer treatments and chemotherapy are known to likely cause nausea. Medications and other treatments are available and may help prevent or decrease nausea.
• Diarrhea or constipation: Cancer and cancer treatment can affect your bowels and cause Diarrhea or constipation.
• Weight loss: Cancer and cancer treatment may cause weight loss. Cancer steals food from normal cells and deprives them of nutrients. This is often not affected by how many calories or what kind of food is eaten; it’s difficult to treat. In most cases, using artificial nutrition through tubes into the stomach or vein does not help change the weight loss.
• Chemical changes in your body: Cancer can upset the normal chemical balance in your body and increase your risk of serious complications. Signs and symptoms of chemical imbalances might include excessive thirst, frequent urination, constipation and confusion.
• Brain and nervous system problems: Cancer can press on nearby nerves and cause Pain
  and loss of function of one part of your body. Cancer that involves the brain can cause Headache
  and stroke-like signs and symptoms, such as weakness on one side of your body.
• Unusual immune system reactions to cancer: In some cases the body’s immune system may react to the presence of cancer by attacking healthy cells, which is called paraneoplastic syndrome. These rare reactions can lead to a variety of signs and symptoms, such as difficulty walking and seizures.
• Cancer that spreads: As cancer advances, it may spread (metastasize) to other parts and organs of the body. Cancer metastasis depends on the type of cancer.
• Cancer that returns: Cancer survivors have a risk of cancer recurrence, some cancers are more likely to recur than others. It is necessary to devise a follow-up care plan after cancer treatment, which may include periodic scans and exams in the months and years after the treatment, to look for cancer recurrence.

Cancer Diagnosis

Often, a diagnosis begins when a person visits a doctor about an unusual symptom, the doctor will discuss his or her medical history and symptoms. Doctor will do various tests to find out the cause of these symptoms, sometimes a doctor finds cancer after a screening test in an otherwise healthy person. Examples of screening tests include colonoscopy, mammography, and a Pap test.

There are several approaches available to diagnose cancer:

• Physical Exam: Physical exams are conducted by the doctor to feel areas of your body for lumps that may indicate a tumor. During a physical exam, the doctor may look for abnormalities, such as changes in skin color or enlargement of an organ, that may indicate the presence of cancer.
• Laboratory Tests: Lab tests, such as urine and blood tests, may help your doctor identify abnormalities that can be caused by cancer. For instance, in people with leukemia, a common blood test called complete blood count may reveal an unusual number or type of white blood cells.
• Imaging Tests: Imaging tests allow your doctor to examine your bones and internal organs in a noninvasive way. Imaging tests used in diagnosing cancer may include a computerized tomography (CT) scan, bone scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, ultrasound and X-ray, among others.
• Biopsy: Biopsy procedure is performed to collect a small amount of tissue sample or tumor cancer cells for testing and further study in the laboratory. There are several ways of collecting a sample, biopsy procedure will depend on the type of cancer and its location. In most cases, a biopsy is the only way to definitively diagnose cancer.

Treatment of Cancer

Cancer treatment has different objectives, depending on the type of cancer and how advanced it is. These objectives include:

• Finding a cure: This is not possible for all cancers and situations.
• Providing primary treatment: Killing the cancer cells in the body.
• Providing adjuvant treatment: Killing cancer cells that remain after primary treatment to reduce the risk of the cancer coming back.
• Providing palliative treatment: Relieving health symptoms associated with cancer, such as trouble breathing and pain.

The most common types of Cancer treatment are:

Surgery

Surgically removes as much of the cancer as possible.

Chemotherapy

Uses medications that are toxic to cells to kill rapidly-dividing cancer cells.

Radiation Therapy

Uses powerful, focused beams of radiation inside (brachytherapy) or outside (external beam radiation) the body to kill cancer cells.

Stem Cell (Bone Marrow) Transplant

Repairs diseased bone marrow with healthy stem cells. Stem cells are undifferentiated cells that can have a variety of functions. These transplants allow doctors to use higher doses of chemotherapy to treat the cancer.

Immunotherapy (Biological Therapy)

Immunotherapy uses antibodies to help your body’s immune system recognize cancer so it can fight it off.

Hormone Therapy: Hormone therapy removes or blocks hormones that fuel certain cancers to stop cancer cells from growing.

Targeted Drug Therapy

Targeted therapies are drugs which interfere with certain molecules that help cancer cells grow and survive.

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