is not just one disease, but
a large group
of almost 100 diseases. Its two main characteristics are uncontrolled growth
of the cells
in the human body and the ability
of these cells
to migrate from the original site and spread
to distant sites.
If the spread
is not controlled, cancer can result
One out of every four deaths in the United States is from cancer. It is second only to heart disease as a cause of death in the states. About 1.2 million Americans are diagnosed with cancer annually; more than 500,000 die of cancer annually.
Cancer can attack anyone. Since the occurrence
of cancer increases
as individuals age, most
of the cases are seen
in adults, middle-aged
or older. Sixty percent
of all cancers are diagnosed
in people who are older than
of age. The most common cancers are skin cancer, lung cancer, colon cancer
, breast cancer (in women), and prostate cancer (in men).
In addition, cancer
of the kidneys, ovaries, uterus, pancreas, bladder, rectum, and blood and lymph node cancer (leukemias and lymphomas) are also included among the
12 major cancers that affect most Americans.
Cancer, by definition, is a disease of the genes. A gene is a small part of DNA, which is the master molecule of the cell. Genes make “proteins,” which are the ultimate workhorses of the cells. It is these proteins that allow our bodies to carry out all the many processes that permit us to breathe, think, move, etc.
Throughout people’s lives, the cells in their bodies are growing, dividing, and replacing themselves. Many genes produce proteins that are involved in controlling the processes of cell growth and division. An alteration (mutation) to the DNA molecule can disrupt the genes and produce faulty proteins. This causes the cell to become abnormal and lose its restraints on growth. The abnormal cell begins to divide uncontrollably and eventually forms a new growth known as a “tumor” or neoplasm (medical term for cancer meaning “new growth”).
In a healthy individual, the immune system can recognize the neoplastic cells and destroy them before they get a chance to divide. However, some mutant cells may escape immune detection and survive to become tumors or cancers.
Tumors are of two types, benign or malignant. A benign tumor is not considered cancer. It is slow growing, does not spread or invade surrounding tissue, and once it is removed, doesn’t usually recur. A malignant tumor, on the other hand, is cancer. It invades surrounding tissue and spreads to other parts of the body. If the cancer cells have spread to the surrounding tissues, even after the malignant tumor is removed, it generally recurs.
A majority of cancers are caused by changes in the cell’s DNA because of damage due to the environment. Environmental factors that are responsible for causing the initial mutation in the DNA are called carcinogens, and there are many types.
There are some cancers that have
a genetic basis.
In other words,
an individual could inherit faulty DNA from his parents, which could predispose him
to getting cancer. While there
is scientific evidence that both factors (environmental and genetic) play
a role, less than 10%
of all cancers are purely hereditary. Cancers that are known
a hereditary link are breast cancer, colon cancer, ovarian cancer
, and uterine cancer. Besides genes, certain physiological traits could
be inherited and could contribute
to cancers. For example, inheriting fair skin makes
a person more likely
to develop skin cancer, but only
if he or she also has prolonged exposure
to intensive sunlight.
There are several different types of cancers:
- Carcinomas are cancers that arise in the epithelium (the layer of cells covering the body’s surface and lining the internal organs and various glands). Ninety percent of human cancers fall into this category. Carcinomas can be subdivided into two types: adenocarcinomas and squamous cell carcinomas. Adenocarcinomas are cancers that develop in an organ or a gland, while squamous cell carcinomas refer to cancers that originate in the skin.
- Melanomas also originate in the skin, usually in the pigment cells (melanocytes).
- Sarcomas are cancers of the supporting tissues of the body, such as bone, muscle and blood vessels.
- Cancers of the blood and lymph glands are called leukemias and lymphomas respectively.
- Gliomas are cancers of the nerve tissue.
Causes and symptoms
The major risk factors for cancer are: tobacco, alcohol, diet, sexual and reproductive behavior, infectious agents, family history, occupation, environment and pollution.
of the American Cancer Society (ACS), approximately 40%
of cancer deaths
in 1998 were due
to tobacco and excessive alcohol use.
An additional one-third
of the deaths were related
to diet and nutrition
of the one million skin cancers diagnosed
in 1998 were due
to ultraviolet light from the sun’s rays.
|Frequency Of Cancer-Related Death
||Number of Deaths Per Year
|Colon and rectum
of lung cancer cases occur
in smokers. Smoking has also been shown
to be a contributory factor
of upper respiratory tract, esophagus, larynx, bladder, pancreas, and probably liver, stomach, breast, and kidney
as well. Recently, scientists have also shown that second-hand smoke (or passive smoking) can increase one’s risk
of developing cancer.
is a risk factor
in certain cancers, such
as liver cancer
in combination with tobacco, significantly increases the chances that
an individual will develop mouth, pharynx, larynx, and esophageal cancers.
of all cancers are due
to dietary causes. Excessive intake
of fat leading
to obesity has been associated with cancers
of the breast, colon, rectum, pancreas, prostate, gall bladder, ovaries, and uterus.
Sexual and reproductive behavior
The human papillomavirus, which is sexually transmitted, has been shown to cause cancer of the cervix. Having too many sex partners and becoming sexually active early has been shown to increase one’s chances of contracting this disease. In addition, it has also been shown that women who don’t have children or have children late in life have an increased risk for both ovarian and breast cancer.
In the last 20 years, scientists have obtained evidence to show that approximately 15% of the world’s cancer deaths can be traced to viruses, bacteria, or parasites. The most common cancer-causing pathogens and the cancers associated with them are shown in table form.
Certain cancers like breast, colon, ovarian, and uterine cancer recur generation after generation
in some families.
A few cancers, such
as the eye cancer “retinoblastoma,”
of colon cancer, and
of breast cancer known
as “early-onset breast cancer,” have been shown
to be linked
to certain genes that can
be tracked within
It is therefore possible that inheriting particular genes makes
a person susceptible
to certain cancers.
to prove that certain occupational hazards account for
4% of all cancer deaths. For example, asbestos workers have
an increased incidence
of lung cancer. Similarly,
a higher likelihood
of getting bladder cancer
is associated with dye, rubber and gas workers; skin and lung cancer with smelters, gold miners and arsenic workers; leukemia with glue and varnish workers; liver cancer with PVC manufacturers; and lung, bone and bone marrow cancer with radiologists and uranium miners.
Radiation is believed to cause 1-2% of all cancer deaths. Ultra-violet radiation from the sun accounts for a majority of melanoma deaths. Other sources of radiation are x rays, radon gas, and ionizing radiation from nuclear material.
Several studies have shown that there is a well-established link between asbestos and cancer. Chlorination of water may account for a small rise in cancer risk. However, the main danger from pollution occurs when dangerous chemicals from the industries escape into the surrounding environment. It has been estimated that 1% of cancer deaths are due to air, land, and water pollution.
|COMMON PATHOGENS AND THE CANCERS ASSOCIATED WITH THEM
||Type of Cancer
||Cancer of the cervix
|Hepatitis B virus
|Hepatitis C virus
|Cancers of the upper
|Hodgkin’s lymphoma, Non-Hodgkin’s
lymphoma, Gastric cancers
|Kaposi’s sarcoma Lymphoma
||Stomach cancer Lymphomas
is a progressive disease, and goes through several stages. Each stage may produce
of symptoms. Some symptoms are produced early and may occur due
to a tumor that
is growing within
or a gland.
As the tumor grows,
it may press
on the nearby nerves, organs, and blood vessels. This causes pain and some pressure which may
be the earliest warning signs
Despite the fact that there are several hundred different types of cancers, producing very different symptoms, the ACS has established the following seven symptoms as possible warning signals of cancer:
- changes in the size, color, or shape of a wart or a mole
- a sore that does not heal
- persistent cough, hoarseness, or sore throat
- a lump or thickening in the breast or elsewhere
- unusual bleeding or discharge
- chronic indigestion or difficulty in swallowing
- any change in bowel or bladder habits
Many other diseases, besides cancer, could produce the same symptoms. However, it is important to have these symptoms checked, as soon as possible, especially if they linger. The earlier a cancer is diagnosed and treated, the better the chance of it being cured. Many cancers such as breast cancer may not have any early symptoms. Therefore, it is important to undergo routine screening tests such as breast self-exams and mammograms.
Diagnosis begins with
a thorough physical examination and
a complete medical history. The doctor will observe, feel and palpate (apply pressure
by touch) different parts
of the body
to identify any variations from the normal size, feel, and texture
of the organ
of the physical exam, the doctor will inspect the oral cavity,
or the mouth.
a light into the mouth,
he will look for abnormalities
in color, moisture, surface texture,
of any thickening
in the lips, tongue, gums, the hard palate
on the roof
of the mouth, and the throat.
To detect thyroid cancer
, the doctor will observe the front
of the neck for swelling.
He may gently manipulate the neck and palpate the front and side surfaces
of the thyroid gland (located
at the base
of the neck)
to detect any nodules
of the physical examination, the doctor will also palpate the lymph nodes
in the neck, under the arms and
in the groin. Many illnesses and cancers cause
of the lymph nodes.
The doctor may conduct a thorough examination of the skin to look for sores that have been present for more than three weeks and that bleed, ooze, or crust; irritated patches that may itch or hurt, and any change in the size of a wart or a mole.
Examination of the female pelvis is used to detect cancers of the ovaries, uterus, cervix, and vagina. In the visual examination, the doctor looks for abnormal discharges or the presence of sores. Then, using gloved hands the physician palpates the internal pelvic organs such as the uterus and ovaries to detect any abnormal masses. Breast examination includes visual observation where the doctor looks for any discharge, unevenness, discoloration, or scaling. The doctor palpates both breasts to feel for masses or lumps.
For males, inspection of the rectum and the prostate is also included in the physical examination. The doctor inserts a gloved finger into the rectum and rotates it slowly to feel for any growths, tumors, or other abnormalities. The doctor also conducts an examination of the testes, where the doctor observes the genital area and looks for swelling or other abnormalities. The testicles are palpated to identify any lumps, thickening or differences in the size, weight and firmness.
If the doctor detects an abnormality on physical examination, or the patient has some symptom that could be indicative of cancer, the doctor may order diagnostic tests.
of sputum (sputum cytology), blood, urine, and stool can detect abnormalities that may indicate cancer. Sputum cytology
is a test where the phlegm that
up from the lungs
is microscopically examined.
It is often used
to detect lung cancer.
A blood test for cancer
to perform, usually inexpensive and risk-free. The blood sample
by a lab technician
or a doctor
a needle into
a vein and
is relatively painless. Blood tests can
be either specific
or non-specific. Often,
in certain cancers, the cancer cells release particular proteins (called tumor markers
) and blood tests can
to detect the presence
of these tumor markers. However, with
a few exceptions, tumor markers are not used for routine screening
of cancers, because several non-cancerous conditions also produce positive results. Blood tests are generally more useful
in monitoring the effectiveness
of the treatment,
or in following the course
of the disease and detecting recurrent disease.
Imaging tests such
as computed tomography scans (CT scans), magnetic resonance imaging (MRI), ultrasound and fiberoptic scope examinations help the doctors determine the location
of the tumor even
if it is deep within the body. Conventional
x rays are often used for initial evaluation, because they are relatively cheap, painless and easily accessible.
to increase the information obtained from
x ray, air
or a dye (such
or iodine) may
as a contrast medium
or highlight parts
of the body.
The most definitive diagnostic test is the biopsy, wherein a piece of tissue is surgically removed for microscope examination. Besides confirming a cancer, the biopsy also provides information about the type of cancer, the stage it has reached, the aggressiveness of the cancer and the extent of its spread. Since a biopsy provides the most accurate analysis, it is considered the gold standard of diagnostic tests.
Screening examinations conducted regularly
by healthcare professionals can result
in the detection
of the breast, colon, rectum, cervix, prostate, testis, tongue, mouth, and skin
at early stages, when treatment
is more likely
to be successful. Some
of the routine screening tests recommended
by the ACS are sigmoidoscopy (for colorectal cancer), mammography (for breast cancer), pap smear (for cervical cancer
), and the PSA test (for prostate cancer). Self-examinations for cancers
of the breast, testes, mouth, and skin can also help
in detecting the tumors before the symptoms become serious.
A recent revolution
in molecular biology and cancer genetics has contributed
a great deal
to the development
of several tests designed
to assess one’s risk
of getting cancers. These new techniques include genetic testing
, where molecular probes are used
to identify mutations
in certain genes that have been linked
to particular cancers.
At present, however, there are
to genetic testing and its utility appears ambiguous, emphasizing the need
to develop better strategies for early detection.
Treatment and prevention
of cancers continue
to be the focus
of a great deal
In 2003, research into new cancer therapies included cancertargeting gene therapy
, virus therapy, and
a drug that stimulated apoptosis,
of cancer cells, but not healthy cells. However, all
of these new therapies take years
of clinical testing and research.
The aim of cancer treatment is to remove all or as much of the tumor as possible and to prevent the recurrence or spread of the primary tumor. While devising a treatment plan for cancer, the likelihood of curing the cancer has to be weighed against the side effects of the treatment. If the cancer is very aggressive and a cure is not possible, then the treatment should be aimed at relieving the symptoms and controlling the cancer for as long as possible.
Cancer treatment can take many different forms, and
it is always tailored
to the individual patient. The decision
on which type
is the most appropriate depends
on the type and location
of cancer, the extent
it has already spread, the patient’s age, sex, general health status and personal treatment preferences. The major types
of treatment are: surgery, radiation, chemotherapy
, immunotherapy, hormone therapy, and bone-marrow transplantation.
Surgery is the removal of a visible tumor and is the most frequently used cancer treatment. It is most effective when a cancer is small and confined to one area of the body.
Surgery can be used for many purposes.
- Treatment. Treatment of cancer by surgery involves removal of the tumor to cure the disease. This is typically done when the cancer is localized to a discrete area. Along with the cancer, some part of the normal surrounding tissue is also removed to ensure that no cancer cells remain in the area. Since cancer usually spreads via the lymphatic system, adjoining lymph nodes may be examined and sometimes are removed as well.
- Preventive surgery. Preventive or prophylactic surgery involves removal of an abnormal looking area that is likely to become malignant over time. For example, 40% of people with a colon disease known as ulcerative colitis, ultimately die of colon cancer. Rather than live with the fear of developing colon cancer, these people may choose to have their colons removed and reduce the risk significantly.
- Diagnostic purposes. The most definitive tool for diagnosing cancer is a biopsy. Sometimes, a biopsy can be performed by inserting a needle through the skin. However, at other times, the only way to obtain a tissue sample for biopsy is by performing a surgical operation.
- Cytoreductive surgery is a procedure where the doctor removes as much of the cancer as possible, and then treats the remaining area with radiation therapy or chemotherapy or both.
- Palliative surgery is aimed at curing the symptoms, not the cancer. Usually, in such cases, the tumor is so large or has spread so much that removing the entire tumor is not an option. For example, a tumor in the abdomen may be so large that it may press on and block a portion of the intestine, interfering with digestion and causing pain and vomiting. “Debulking surgery” may remove a part of the blockage and relieve the symptoms. In tumors that are dependent on hormones, removal of the organs that secrete the hormones is an option. For example, in prostate cancer, the release of testosterone by the testicles stimulates the growth of cancerous cells. Hence, a man may undergo an “orchiectomy” (removal of testicles) to slow the progress of the disease. Similarly, in a type of aggressive breast cancer, removal of the ovaries (oophorectomy) will stop the synthesis of hormones from the ovaries and slow the progression of the cancer.
Radiation kills tumor cells. Radiation is used alone in cases where a tumor is unsuitable for surgery. More often, it is used in conjunction with surgery and chemotherapy. Radiation can be either external or internal. In the external form, the radiation is aimed at the tumor from outside the body. In internal radiation (also known as brachytherapy), a radioactive substance in the form of pellets or liquid is placed at the cancerous site by means of a pill, injection or insertion in a sealed container.
Chemotherapy is the use of drugs to kill cancer cells. It destroys the hard-to-detect cancer cells that have spread and are circulating in the body. Chemotherapeutic drugs can be taken either orally (by mouth) or intravenously, and may be given alone or in conjunction with surgery, radiation or both.
When chemotherapy is used before surgery or radiation, it is known as primary chemotherapy or “neoadjuvant chemotherapy.” An advantage of neoadjuvant chemotherapy is that since the cancer cells have not been exposed to anti-cancer drugs, they are especially vulnerable. It can therefore be used effectively to reduce the size of the tumor for surgery or target it for radiation. However, the toxic effects of neoadjuvant chemotherapy are severe. In addition, it may make the body less tolerant to the side effects of other treatments that follow such as radiation therapy. The more common use of chemotherapy is adjuvant therapy, which is given to enhance the effectiveness of other treatments. For example, after surgery, adjuvant chemotherapy is given to destroy any cancerous cells that still remain in the body. In 2003, a new technique was developed to streamline identification of drug compounds that are toxic to cancerous cells but not to healthy cells. The technique identified nine dugs, one of which had never before been identified for use in cancer treatment. Researchers began looking into developing the new drug for possible use.
Immunotherapy uses the body’s own immune system to destroy cancer cells. This form of treatment is being intensively studied in clinical trials and is not yet widely available to most cancer patients. The various immunological agents being tested include substances produced by the body (such as the interferons, interleukins, and growth factors), monoclonal antibodies, and vaccines. Unlike traditional vaccines, cancer vaccines do not prevent cancer. Instead, they are designed to treat people who already have the disease. Cancer vaccines work by boosting the body’s immune system and training the immune cells to specifically destroy cancer cells.
Hormone therapy is standard treatment for some types of cancers that are hormone-dependent and grow faster in the presence of particular hormones. These include cancer of the prostate, breast, and uterus. Hormone therapy involves blocking the production or action of these hormones. As a result the growth of the tumor slows down and survival may be extended for several months or years.
Bone marrow transplantation
The bone marrow is the tissue within the bone cavities that contains blood-forming cells. Healthy bone marrow tissue constantly replenishes the blood supply and is essential to life. Sometimes, the amount of drugs or radiation needed to destroy cancer cells also destroys bone marrow. Replacing the bone marrow with healthy cells counteracts this adverse effect. A bone marrow transplant is the removal of marrow from one person and the transplant of the blood-forming cells either to the same person or to someone else. Bone-marrow transplantation, while not a therapy in itself, is often used to “rescue” patients, by allowing those with cancer to undergo aggressive therapy.
Many different specialists generally work together as a team to treat cancer patients. An oncologist is a physician who specializes in cancer care. The oncologist provides chemotherapy, hormone therapy, and any other non-surgical treatment that does not involve radiation. The oncologist often serves as the primary physician and coordinates the patient’s treatment plan.
The radiation oncologist specializes in using radiation to treat cancer, while the surgical oncologist performs the operations needed to diagnose or treat cancer. Gynecologist-oncologists and pediatric-oncologists, as their titles suggest, are physicians involved with treating women’s and children’s cancers respectively. Many other specialists also may be involved in the care of a cancer patient. For example, radiologists specialize in the use of x rays, ultrasounds, CT scans, MRI imaging and other techniques that are used to diagnose cancer. Hematologists specialize in disorders of the blood and are consulted in case of blood cancers and bone marrow cancers. The samples that are removed for biopsy are sent to a laboratory, where a pathologist examines them to determine the type of cancer and extent of the disease. Only some of the specialists who are involved with cancer care have been mentioned above. There are many other specialties, and virtually any type of medical or surgical specialist may become involved with care of the cancer patient should it become necessary.
There are a multitude of alternative treatments available to help the person with cancer. They can be used in conjunction with, or separate from, surgery, chemotherapy, and radiation therapy. Alternative treatment of cancer is a complicated arena and a trained health practitioner should be consulted.
Although the effectiveness
of complementary therapies such
in alleviating cancer pain has not been clinically proven, many cancer patients find
it safe and beneficial. Bodywork therapies such
as massage and reflexology ease muscle tension and may alleviate side effects such
as nausea and vomiting
. Homeopathy and herbal remedies used
in Chinese traditional herbal medicine also have been shown
to alleviate some
of the side effects
of radiation and chemotherapy and are being recommended
by many doctors.
Certain foods including many vegetables, fruits, and grains are believed
to offer protection against various cancers. However, isolation
of the individual constituent
of vegetables and fruits that are anti-cancer agents has proven difficult.
In laboratory studies, vitamins such
as A, C and
E, as well
as compounds such
as isothiocyanates and dithiolthiones found
in broccoli, cauliflower, and cabbage, and beta-carotene found
in carrots have been shown
to protect against cancer. Studies have shown that eating
a diet rich
in fruits and vegetables reduces the risk
of colon cancer. Exercise and
a low fat diet help control weight and reduce the risk
of endometrial, breast, and colon cancer.
Certain drugs, which are currently being used for treatment, could also be suitable for prevention. For example, the drug tamoxifen (Nolvadex), which has been very effective against breast cancer, is currently being tested by the National Cancer Institute for its ability to prevent cancer. Similarly, retinoids derived from vitamin A are being tested for their ability to slow the progression or prevent head and neck cancers. Certain studies have suggested that cancer incidence is lower in areas where soil and foods are rich in the mineral selenium. More trials are needed to explain these intriguing connections.
“Lifetime risk” is the term that cancer researchers use to refer to the probability that an individual over the course of a lifetime will develop cancer or die from it. In the United States, men have a one in two lifetime risk of developing cancer, and for women the risk is one in three. Overall, African Americans are more likely to develop cancer than whites. African Americans are also 30% more likely to die of cancer than whites.
Most cancers are curable if detected and treated at their early stages. A cancer patient’s prognosis is affected by many factors, particularly the type of cancer the patient has, the stage of the cancer, the extent to which it has metastasized and the aggressiveness of the cancer. In addition, the patient’s age, general health status and the effectiveness of the treatment being pursued also are important factors.
To help predict the future course and outcome of the disease and the likelihood of recovery from the disease, doctors often use statistics. The five-year survival rates are the most common measures used. The number refers to the proportion of people with cancer who are expected to be alive, five years after initial diagnosis, compared with a similar population that is free of cancer. It is important to note that while statistics can give some information about the average survival experience of cancer patients in a given population, it cannot be used to indicate individual prognosis, because no two patients are exactly alike.
According to nutritionists and epidemiologists from leading universities in the United States, a person can reduce the chances of getting cancer by following some simple guidelines:
- eating plenty of vegetables and fruits
- exercising vigorously for at least 20 minutes every day
- avoiding excessive weight gain
- avoiding tobacco (even second hand smoke)
- decreasing or avoiding consumption of animal fats and red meats
- avoiding excessive amounts of alcohol
- avoiding the midday sun (between 11 A.M. and 3 P.M.) when the sun’s rays are the strongest
- avoiding risky sexual practices
- avoiding known carcinogens in the environment or work place
In addition, following the advice of physicians in refraining from certain activities or drugs that are proven as risk factors for certain cancers can help lower one’s risk. For instance, while physicians have long known a small increased risk for breast cancer was linked to use of HRT, a landmark study released in 2003 proved the risk was greater than thought. The Women’s Health Initiative found that even relatively short-term use of estrogen plus progestin is associated with increased risk of breast cancer, diagnosis at a more advanced stage of the disease, and a higher number of abnormal mammograms. The longer a woman used HRT, the more her risk increased.
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“HRT Linked to Higher Breast Cancer Risk, Later Diagnosis, Abnormal Mammograms.” Women’s Health Weekly July 17, 2003: 2.
“New Way to Stop Cancer Cell Growth Described.” Gene Therapy Weekly December 12, 2002: 9.
“Researchers Find New Way to Trigger Self-Destruction of Certain Cancer Cells.” Biotech Week July 16, 2003: 285.
“Technique Streamlines Search for Anticancer Drugs.” Cancer Weekly April 15, 2003: 62.
“Virus Therapy Attacks Cancer Cells.” Cancer Weekly July 29, 2003: 50.
American Cancer Society. 1599 Clifton Road, N.E. Atlanta, GA 30329 (800) 227-2345. http://www.cancer.org.
Cancer Research Institute (National Headquarters). 681, Fifth Avenue, New York, NY 10022 (800) 992-2623. http://www.cancerresearch.org.
National Cancer Institute. 9000 Rockville Pike, Building 31, room 10A16, Bethesda, Maryland, 20892 (800) 422-6237. http://wwwicic.nci.nih.gov.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.