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INTRODUCTION
Our goal in this section is to educate you on the basics of cancer and
cancer treatment. Possessing this knowledge will, we hope, help you
to better understand what cancer is, how it occurs, and how to make
informed choices about cancer care options.
2.HISTORY
Engraving with two views of a Dutch woman who had a tumor removed from
her neck in 1689
Cancer has existed for all of human history.[183] The earliest written record
regarding cancer is from circa 1600 BC in the Egyptian Edwin Smith
Papyrus and describes breast cancer.[183] Hippocrates (c. 460 BC – c. 370 BC)
described several kinds of cancer, referring to them with
the Greek word καρκίνος karkinos (crab or crayfish).[183] This name comes from
the appearance of the cut surface of a solid malignant tumor, with "the veins
stretched on all sides as the animal the crab has its feet, whence it derives its
name".[184] Galen stated that "cancer of the breast is so called because of the
fancied resemblance to a crab given by the lateral prolongations of the tumor
and the adjacent distended veins".[185]:738 Celsus (c. 25 BC – 50 AD)
translated karkinos into the Latin cancer, also meaning crab and recommended
surgery as treatment.[183] Galen (2nd century AD) disagreed with the use of
surgery and recommended purgatives instead.[183] These recommendations
largely stood for 1000 years.[183]
In the 15th, 16th and 17th centuries, it became acceptable for doctors to dissect
bodies to discover the cause of death.[186] The German professor Wilhelm
Fabry believed that breast cancer was caused by a milk clot in a mammary duct.
The Dutch professor Francois de la Boe Sylvius, a follower of Descartes,
believed that all disease was the outcome of chemical processes and that
acidic lymph fluid was the cause of cancer. His contemporary Nicolaes
Tulp believed that cancer was a poison that slowly spreads and concluded that it
was contagious.[187]
The physician John Hill described tobacco snuff as the cause of nose cancer in
1761.[186] This was followed by the report in 1775 by British surgeon Percivall
Pott that chimney sweeps' carcinoma, a cancer of the scrotum, was a common
disease among chimney sweeps.[188] With the widespread use of the microscope
in the 18th century, it was discovered that the 'cancer poison' spread from the
primary tumor through the lymph nodes to other sites ("metastasis"). This view
of the disease was first formulated by the English surgeon Campbell De
Morgan between 1871 and 1874.[189]
3.WHAT IS CANCER?
Your body is composed of many millions of tiny cells, each a self-contained
living unit. Normally, each cell coordinates with the others that compose tissues
and organs of your body. One way that this coordination occurs is reflected in
how your cells reproduce themselves. Normal cells in the body grow and divide
for a period of time and then stop growing and dividing. Thereafter, they only
reproduce themselves as necessary to replace defective or dying cells. Cancer
occurs when this cellular reproduction process goes out of control. In other
words, cancer is a disease characterized by uncontrolled, uncoordinated and
undesirable cell division. Unlike normal cells, cancer cells continue to grow and
divide for their whole lives, replicating into more and more harmful cells.
The abnormal growth and division observed in cancer cells is caused by damage
in these cells' DNA (genetic material inside cells that determines cellular
characteristics and functioning). There are a variety of ways that cellular DNA
can become damaged and defective. For example, environmental factors (such
as exposure to tobacco smoke) can initiate a chain of events that results in
cellular DNA defects that lead to cancer. Alternatively, defective DNA can be
inherited from your parents.
As cancer cells divide and replicate themselves, they often form into a clump of
cancer cells known as a tumor. Tumors cause many of the symptoms of cancer
by pressuring, crushing and destroying surrounding non-cancerous cells and
tissues.
Tumors come in two forms; benign and malignant. Benign tumors are not
cancerous, thus they do not grow and spread to the extent of cancerous tumors.
Benign tumors are usually not life threatening. Malignant tumors, on the other
hand, grow and spread to other areas of the body. The process whereby cancer
cells travel from the initial tumor site to other parts of the body is known as
metastasis.
Cancer is a group of diseases involving abnormal cell growth with the potential
to invade or spread to other parts of the body.[2][8] These contrast with benign
tumors, which do not spread.[8] Possible signs and symptoms include a lump,
abnormal bleeding, prolonged cough, unexplained weight loss and a change
in bowel movements.[1] While these symptoms may indicate cancer, they can
also have other causes.[1] Over 100 types of cancers affect humans.Cancers are a
large family of diseases that involve abnormal cell growth with the potential to
invade or spread to other parts of the body.[2][8] They form a subset
of neoplasms. A neoplasm or tumor is a group of cells that have undergone
unregulated growth and will often form a mass or lump, but may be distributed
diffusely.[24][25]
All tumor cells show the six hallmarks of cancer.
They include:
Cancer can spread from its original site by local spread, lymphatic spread to
regional lymph nodes or by haematogenous spread via the blood to distant sites,
known as metastasis. When cancer spreads by a haematogenous route, it usually
spreads all over the body. However, cancer 'seeds' grow in certain selected site
only ('soil') as hypothesized in the soil and seed hypothesis of cancer metastasis.
The symptoms of metastatic cancers depend on the tumor location and can
include enlarged lymph nodes (which can be felt or sometimes seen under the
skin and are typically hard), enlarged liver or enlarged spleen, which can be felt
in the abdomen, pain or fracture of affected bones and neurological symptoms.
5.CAUSES
The majority of cancers, some 90–95% of cases, are due to genetic mutations
from environmental and lifestyle factors.[3] The remaining 5–10% are due
to inherited genetics.[3]Environmental, as used by cancer researchers, means any
cause that is not inherited genetically, such as lifestyle, economic, and
behavioural factors and not merely pollution.[31]Common environmental factors
that contribute to cancer death include tobacco (25–30%), diet and obesity (30–
35%), infections (15–20%), radiation (both ionizing and non-ionizing, up to
10%), stress, lack of physical activity and pollution.[3][32]
It is not generally possible to prove what caused a particular cancer because the
various causes do not have specific fingerprints. For example, if a person who
uses tobacco heavily develops lung cancer, then it was probably caused by the
tobacco use, but since everyone has a small chance of developing lung cancer as
a result of air pollution or radiation, the cancer may have developed for one of
those reasons. Excepting the rare transmissions that occur with pregnancies and
occasional organ donors, cancer is generally not a transmissible disease.[33]
5.1 Chemicals
Further information: Alcohol and cancer and Smoking and cancer
Most cancers are initially recognized either because of the appearance of signs
or symptoms or through screening. Neither of these leads to a definitive
diagnosis, which requires the examination of a tissue sample by a pathologist.
People with suspected cancer are investigated with medical tests. These
commonly include blood tests, X-rays, (contrast) CT scans and endoscopy.
The tissue diagnosis from the biopsy indicates the type of cell that is
proliferating, its histological grade, genetic abnormalities and other features.
Together, this information is useful to evaluate the prognosis and to choose the
best treatment.
Cytogenetics and immunohistochemistry are other types of tissue tests. These
tests provide information about molecular changes (such as mutations, fusion
genes and numerical chromosome changes) and may thus also indicate the
prognosis and best treatment
Your doctor may use one or more approaches to diagnose cancer:
Physical exam. Your doctor may feel areas of your body for lumps that
may indicate a tumor. During a physical exam, he or she may look for
abnormalities, such as changes in skin colour or enlargement of an organ,
that may indicate the presence of cancer.
Laboratory tests. Laboratory 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 non-invasive 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. During a biopsy, your doctor collects a sample of cells for testing
in the laboratory. There are several ways of collecting a sample. Which
biopsy procedure is right for you depends on your type of cancer and its
location. In most cases, a biopsy is the only way to definitively diagnose
cancer.
In the laboratory, doctors look at cell samples under the microscope.
Normal cells look uniform, with similar sizes and orderly organization.
Cancer cells look less orderly, with varying sizes and without apparent
organization.
7.PREVENTION
Main article: Cancer prevention
Breast cancer is fairly common. Because of its well publicized nature, and
potential for lethality, breast cancer is arguably the most frightening type of
cancer diagnosis someone can receive. However, it is important to keep in mind
that, if identified and properly treated while still in its early stages, breast cancer
can be cured.
Breast cancer is not just a woman's disease. It is quite possible for men to get
breast cancer, although it occurs less frequently in men than in women. Our
discussion will focus primarily on breast cancer as it relates to women but it
should be noted that much of the information is also applicable for men.
8.1.2 Causes and Prevention:
The causes of breast cancer are not yet definitively known. However, extensive
research efforts have uncovered various risk factors that are associated with
increased incidence of breast cancer in women. Though some of these risk
factors are unavoidable and uncontrollable, some of them are very avoidable,
making it possible for people to take action so as to minimize their cancer risk.
Even a minimized risk is still a risk, however. There is no way to pre-determine
whether a person will get breast cancer until they have either been diagnosed
with it or they have lived a breast-cancer free lifetime.
Some of the risk factors for breast cancer that are difficult or impossible to
control include:
Age. As women age their chance of getting breast cancer increase. The majority
of breast cancer cases are diagnosed in women over the age of 50. Women over
the age of 20 should get clinical (by a doctor or other health professional) breast
exams at least every three years according to the American Cancer Society.
During the first clinical breast exam your physician should explain to you the
potential benefits and limitations of breast self exam and instruct you on
appropriate technique. The American Cancer Society now says that women
need not perform a BSE every month if they do not wish to. However, it is
important for all women to be vigilant of any changes in their breasts and to
report any changes to their physician as soon as possible. Asymptomatic
women over the age of 40 should receive clinical breast exams during their
yearly health maintenance exam (ACS, 2009). As a general rule asymptomatic
women in their 40s and older should get yearly mammograms to check for
breast cancer. The frequency with which someone should have mammograms
performed should be determined with the input of a physician.
Family and genetic history. Some cases of breast cancer are known to have
been caused as a result of genetic mutation. Gene mutations can be inherited
from parents and can also occur in otherwise healthy people in response to
environmental toxins. Having a close relative on either side of your family who
has breast cancer will, in general, increase your risk of contracting breast
cancer. This is particularly true if the relative is what is called "first degree"
meaning your sister or mother. In general, the more first degree relatives that
have had breast cancer the more likely you are to develop breast cancer as well.
Previous breast cancer. A woman who previously had breast cancer and has
been cured has a greater chance for having a new breast cancer episode occur
than is a woman who never had the disease. New tumors appearing inside
someone with a previous history of cancer who has been cancer free are not
necessarily related to or caused by old eradicated tumors. Instead, new tumors
can form spontaneously in vulnerable persons.
Race. Hispanic and Asian women have lower risk for getting breast cancer than
do Caucasian and African American women. In fact, Caucasian women are at
the highest risk of getting the disease compared to women of other racial
backgrounds. African American women, however, are historically the most
likely to die from breast cancer because, in general, their tumors are diagnosed
at a later stage. Why there is a failure to identify tumors in African American
women until later in their development is not clear at this time. It may occur
because, as a group, these women have less access to healthcare, or possibly
because they are less likely as a group to seek healthcare. Research is ongoing
in this area to determine the cause of this alarming disparity.
Previous benign tumor biopsy results. Women who have had previous biopsy
that has found a benign (non-cancerous) tumor in the breast are at a greater risk
for malignant breast tumors in the future. However, the occurrence of cysts in
the breast does not increase the risk for future breast cancer.
Prior radiation treatment in the chest area. Women who receive prior
radiation treatment directed at their chest area for any reason are at a heightened
risk for future breast cancer compared to women who do not receive radiation
treatment. The earlier in life women are exposed to chest-targeted radiation
treatment, the higher their later risk for breast cancer.
Menstrual Cycles. Women who begin menopause after the age of 50 or who
had their first menstrual cycle before age 12 run a slightly higher risk for breast
cancer than women whose menstrual cycles started after age 12 and end prior to
age 50. This is due to prolonged exposure to high levels of certain reproductive
hormones.
While the above risk factors for breast cancer are difficult or impossible to
avoid, there are also numerous risk factors for breast cancer that can be avoided
by making healthy lifestyle choices. While choosing a healthy lifestyle may not
always be simple or easy, making such lifestyle changes can help you lower
your cancer risk with regard to the following risk factors:
Use of Birth Control Pills. Some studies have shown that women who use
birth control pills are at a slightly increased risk for breast cancer. However, any
relationship between breast cancer and birth control pill use remains
controversial at this time, pending further research. It's not all bad news. While
oral contraceptives (birth control pills) may slightly increase risk of breast
cancer, they appear to reduce the risk of other types of female cancers. Consult
with your doctor about the risks and benefits of birth control pills if you have
concerns about breast cancer risk.
Not Having Children. Women who have their first child after the age of 30 or
who have never had children run a slightly higher risk for contracting breast
cancer than do women who give birth before reaching age 30. This is again due
to more prolonged exposure to reproductive hormones. Be this as it may, a
decision as important as whether or not to have children should not be
influenced by the small reduction or elevation in risk for breast cancer it may
carry.
Obesity and Poor Diet. Research has established a link between being
overweight and an elevated risk of postmenopausal breast cancer. This seems to
be because the majority of reproductive hormones in postmenopausal women is
produced in the fat cells. Therefore, the more fat cells a woman have the higher
their reproductive hormone levels.
Getting one's self down to a healthy weight and staying there is likely to be a
means of reducing one's cancer risk. The best way to combat obesity is to
combine a balanced and nutritional diet with a consistent exercise program.
Reduced or eliminating portions of foods known to be high in saturated (meat,
dairy, etc.) and 'trans fats' (packaged baked goods often contain 'partially
hydrogenated' oils which are, in fact, trans fats) may further reduce risk as well.
There are numerous benefits to maintaining a healthy body weight besides
possibly lowering your cancer risk. Losing weight can also reduce your risk for
heart disease and leave you feeling healthier and more energetic.
Failing To Exercise. Some recent studies have found a small relationship
between moderate exercise and decreased risk of breast cancer. Exercising
regularly can help combat obesity as well which further lowers cancer risk.
Aerobic exercises, such as swimming, brisk walking, jogging, and playing
tennis are best bets as they are easy and enjoyable. However, any activity that
will get your heart rate up for an extended period of time will be beneficial. It is
a good idea to check with your doctor before beginning any kind of vigorous
exercise program.
Doctors use several methods to screen women for breast cancer. What follows
is some general information on two of the most commonly used tests.
Clinical Breast Exam. During a clinical breast exam (CBE for short) a doctor
first observe your breasts for any inequalities or changes in size or shape, then
palpates (feels) your breasts and armpits looking for lumps and swellings. It can
be awkward to receive a breast exam, especially when it is given by a male
doctor. You should know that many doctors' offices have women available who
are trained to give clinical breast exams. Do not hesitate to ask for a woman to
perform the procedure if this would make you more comfortable.
Axillary Dissection and Biopsy. Recall that breast cancer starts as a tumor in
the breast, and then later spreads through the body via the lymph system. If your
doctor comes to believe that you may have cancer, he or she will want to know
whether that cancer is still localized inside your breast, or whether it has spread.
A test called an Axillary Dissection can help answer this question. An axillary
dissection involves a small surgery wherein cells from the lymph nodes in the
armpit are removed and then studied under the microscope to determine if they
are cancerous. The general name for this tissue sampling and study is "biopsy".
The majority of women who are afflicted by breast cancer will require some
type of surgery. The goal of the surgical procedure is to remove the cancerous
tumor while preserving as much of the healthy breast tissue as possible. Later
stage breast cancers often require more extensive surgeries as more tissues get
involved in the disease process. Some of the surgical procedures used to treat
breast cancer are:
Hormonal therapy. Now that tumor biopsy specimens can be tested for
specific hormone receptors it has allowed scientists to develop drugs which can
block those receptors and slow a tumor's growth. The main type of drug used
blocks the effects of a hormone called estrogen and is usually given over a five
year period and then discontinued.
Having been diagnosed with breast cancer, many women feel an extreme sense
of urgency to begin treatment. While understandable given the gravity of the
diagnosis, a rush towards treatment can commit patients to a treatment plan they
are not comfortable with or fully educated about. Further, although treatment of
some sort is almost always necessary to prevent a negative outcome, there is
sometimes some flexibility with regard to what forms treatment might take and
how rapidly they must be applied. For these reasons it is important that patients
express any questions or concerns they may have to their doctors so as to
become as well informed and comfortable with treatment options and decisions
as possible. Patients may wish to consult with a second doctor to obtain an
independent treatment recommendation. Another specialist may provide
additional information and options, or confirm that a recommended course of
treatment is best.
8.2 Colorectal Cancer:
8.2.1 Introduction
The term "colorectal" is a contraction of two terms, 'colon' and 'rectum'. Parts of
the digestive system, the colon is the name given to the last six or so feet of the
intestine (otherwise known as the large intestine), and the rectum is the name
for the last several inches of the large intestine just before it exits the body via
the anus.
Colorectal cancer occurs when abnormal tissues grow on the inner walls of the
colon or rectum. These abnormal tissues commonly present in the form of
polyps. Polyps grow as a projection of tissue away from the colon wall,
remaining connected to the colon wall by way of a thin stalk. Their shape is
similar to that of a mushroom. Polyps are fairly common, especially in older
people. The vast majority of polyps are not cancerous. However, some polyps
will eventually become cancerous. Unchecked, a cancerous polyp gives rise to a
tumor, which grows in size until it penetrates the bowel wall and involves
adjacent organs and lymph nodes through the process known as metastasis.
Colorectal cancer is the third most prevalent cancer in the United States and,
when undetected and untreated, the third most deadly (ACS, 2008).
Approximately 150,000 new cases of colorectal cancer are diagnosed each year,
and about 50,000 Americans die each year from colorectal cancer (ACS, 2008).
While these statistics are alarming, it is important to remember that if caught
early enough, colorectal cancer can often be cured. Early detection and removal
of polyps can even prevent pre-cancerous polyps from becoming cancerous.
8.2.2 Causes and Prevention:
The exact causes of colorectal cancer are not completely understood. However,
many risk factors for colorectal cancer have been identified. While some of the
risk factors are out of our control, a good number of them are avoidable if
healthy lifestyle choices are pursued. In any event, regular screening for
colorectal cancer after the age of 50 can help identify potential cancers early on
when they are easy to treat (Levin, 2008).
What follows is a list of some of the risk factors researchers have identified
which cannot be controlled:
Gender. Men are at a greater risk for colorectal cancer than are women.
Age. The older you get, the greater your risk for colorectal cancer becomes.
Individuals older than 50 years old should receive regular colorectal cancer
screenings.
Presence of Polyps. Persons who have more polyps (especially larger polyps)
are at an increased risk of colorectal cancer. Importantly, there are different
types of polyps. Some types are more likely to become cancerous than others.
Your doctor can let you know which type of polyp you have and what the
correlated risk of cancer is for that polyp type.
Diet. Eating a diet high in fatty foods, especially those that come from animal
sources (e.g., meat and dairy), can greatly increase risk for colorectal cancer.
Diets that are low in fiber and low in fresh fruits and vegetables also appear to
be associated with increased risk for colorectal cancer.
As the saying goes, "An apple a day keeps the doctor away". Eating a healthy
and balanced diet reduces risk for colorectal cancer. Many Americans do not eat
enough fresh fruits and vegetables or dietary fiber, while eating too much high
fat meat. Eating five servings of fresh fruits and vegetables each day, while
cutting down on meat intake will likely go a long way towards reducing dietary
components of cancer risk. Dietary fiber can be obtained directly from fruits,
vegetables, whole grains and beans and from dietary supplements including
psyllium seed husks.
Sedentary Lifestyle. Sedentary people who don't get enough exercise run a
much higher risk for getting colorectal cancer than people who lead an active
lifestyle. Committing to a regular program of physical exercise is a great way to
improve your overall health as well as reduce your risk for getting colorectal
cancer. Cardiovascular exercises (including aerobics, jogging, biking, brisk
walking, tennis and other court sports, etc.) which elevate your heart rate for
extended periods of time are recommended.
Weight. While all heavy people are at an increased risk for colorectal cancer
compared to people who are at recommended body weight, those who carry
their weight in their belly are at especially high risk. Regular exercise, healthy
eating choices, portion control, and support groups such as Weight Watchers
can help to keep weight down.
Changed bathroom habits that do not resolve within a week (including diarrhea,
constipation or any obstruction of the colon)
Bloody stool (note that stool blood is generally not visible or obvious). Blood in
stool often presents as black, tarry stool. If you notice your stools are darker or
tar-like, bring this to the attention of your doctor.
Thinner than normal or otherwise malformed stools
Pain in the lower abdomen
Anemia that cannot be accounted for by other conditions (such as menstruation)
Weight loss that cannot be accounted for by other conditions
As with many cancers, the outlook (prognosis) for patients with colorectal
cancer is better when the disease is identified earlier in its progression rather
than later. The earlier the cancer is found the greater the likelihood it can be
successfully treated and cured. Individuals who are at risk for colorectal cancer
should receive regular professional medical screenings to identify any problem
at the earliest possible opportunity.
Medical screening for colorectal cancer frequently involves one or more of the
procedures described below. As these methods involve semi-taboo procedures
such as stool sampling and rectal insertion (to check for polyps), they are
sometimes perceived as embarrassing or shameful, or as painful. On these
grounds, some people who might otherwise benefit from screening tests may
instead avoid them. It is important to keep in mind that the actual discomfort
involved in the screening process is minimal, and that the entire screening
process is private between the doctor and patient. Rationally considered, the
benefits of colorectal screening far outweigh reasons for avoiding the process.
Finding a physician with whom you feel comfortable may be the key needed to
combat any feelings of embarrassment.
Beginning at age 50 (and at a younger age for high-risk persons), people should
strongly consider scheduling themselves for regular colorectal screenings
(Levin, 2008). There are different combinations of screening protocols that are
recommended, each with its own timetable for how often it needs to occur.
Screening protocols include the following:
Fecal occult blood test (FOBT) or fecal immunochemical test (FIT) each year.
Flexible sigmoidoscopy every 5 years
Yearly FOBT* or FIT plus flexible sigmoidoscopy every 5 years
Double-contrast barium enema every 5 years
Colonoscopy every 10 years
Regardless of which protocol you follow, any positive test results should be
followed up with a full colonoscopy so that further detail can be detected. Here
are descriptions of these screening tests:
Fecal Occult Blood Test (FOBT). This test looks for blood within a sample of
your stool. Generally, you take your own sample, and deposit bits of it onto a
card provided as part of a take-home kit provided to you for this purpose. The
card is then submitted to a laboratory, which then conducts the analysis. A
positive finding means that something in your GI track (from your mouth to you
anus) is bleeding and merits further investigation. The test is non-specific,
however, because any number of conditions, some potentially dangerous (such
as polyps and/or tumors) and some benign (like hemorrhoids) might have
caused the bleeding. Also, many colorectal cancers do not bleed, or bleed only
intermittently. For these reasons, it is common to complement the fecal blood
test with additional tests.
Digital Rectum Exam with Fecal Immunochemical Test (FIT). During this
test a doctor inserts gloved and lubricated fingers into your anus. The doctor
then evaluates a small sample of stool for blood. In men, this exam is also used
to check the prostate. In women, it is used to evaluate the space between the
rectum and uterus. This test is minimally invasive (as invasive tests go) and
causes little or no discomfort. This is only a screening test and is not specific for
colorectal cancer. Doctors may also use this exam to see if a patient has internal
or external hemorrhoids. This test is preferred over the FOBT. Persons over 50
should get a digital rectal exam with FIT once a year.
Barium Enema. The barium enema test is a method of imaging the structure of
your colon. Radioactive barium dye is placed into your colon by means of an
enema, and then an x-ray picture of your colon is taken. The barium dye
highlights the colon structure and surfaces in a way that would not be possible if
the dye were not used. The enema method of inserting the dye into the colon
can cause some temporary discomfort. Doctors examine the x-ray pictures
resulting from this procedure for polyps and other signs of cancer. This test is
not as good at detecting cancer as colonoscopy and has fallen out of favor in
recent years.
When possible, the surgeon will reconnect the healthy colon portions back
together so that normal bowel function can be resumed. In some cases this is not
possible, however, as in the case where rectum tissues are cancerous. In such
cases, the surgeon may have to create a special opening in your abdomen (called
a colostomy) which then serves as the new point of elimination of body wastes
(stool). Colostomy is sometimes performed on a temporary basis, but it can also
become a permanent feature of your battle with cancer.
Lung cancer is now the most prevalent form of cancer affecting Americans with
an estimated 222,500 new cases every year, according to the American Cancer
Society (ACS, 2010). Beyond being the most common form of cancer, lung
cancer is also often difficult to treat. As a result, lung cancer is the most deadly
cancer with roughly 160,000 Americans dying from it every year. This is about
30% of all cancer deaths! (ACS, 2010).
Although lung cancer is difficult to treat and cure, it is for the most part
preventable. Lifestyle choices can be made which can almost eliminate your
risk for getting the disease. Your decision to stop smoking and to eat a healthy
diet featuring plenty of fresh fruits and vegetables can greatly decrease your
risk.
Small cell lung cancers comprise roughly 15% of all lung cancer cases (ACS,
2010). This type of lung cancer originates in an inner layer of the walls of the
bronchi called the bronchial submucosa, and grows aggressively (in comparison
with non small cell lung cancers), quickly spreading into surrounding tissues,
and ultimately, through the body. Though the growth of this cancer is rapid,
there are few or no clues that anything is particularly amiss. Symptoms are
generally not noticeable until the cancer has spread into other parts of the body.
Because of their rapid growth pace and tendency to metastasize, small cell
cancers are described with only two stages (limited – when spread is contained
to the localized area of the lung and immediate surrounding tissues, and
extensive – when the cancer has spread throughout the body).
Non-small cell lung cancers comprise about 85% of all lung cancers and can be
broken down into three subtypes; squamous cell carcinoma, adenocarcinoma,
and large cell lung cancer (ACS, 2010). Treatment of these types of cancer
typically includes a combination of surgery, chemotherapy and radiation
therapy.
Squamous cell carcinoma most often begins in the larger sections of the
bronchi. It progresses slowest of all of the lung cancers.
As the name suggests, large cell lung cancers form as clusters of large
undifferentiated cells. Like ademocarcinomas, they tend to occur at the
periphery of the lung, growing and spreading more aggressively than squamous
cell forms of lung cancer.
8.3.2 Causes and Prevention:
Research has revealed a number of risk factors which make it more likely that
someone might get lung cancer. As is the case with many illnesses, some of the
risk factors are avoidable, and some are out of people's control. People who are
serious about lowering their risk for lung cancer can make it a goal to avoid as
many of the following risk factors as is reasonably possible for their situation.
Smoking and Exposure to Passive Smoke. If you can do only one thing to
reduce your risk of lung cancer, that one thing should be to stop smoking
yourself (if you are a smoker) and to get yourself away from sources of
secondhand smoke (if you live or work around smokers). Tobacco smoke,
which contains cancer-causing chemicals (carcinogens), is the leading cause of
lung cancer. Roughly 90% of lung cancers in men and 80% of lung cancers in
women are linked to the smoking of tobacco (ACS). People regularly exposed
to secondhand smoke also appear to be at an increased risk for developing
cancer.
Marijuana. Some people believe that marijuana smoke is safer than cigarette
smoke. This is not the case. In reality marijuana smoke has many of the same
carcinogens as cigarette smoke and affects the lungs similarly. For this reason
individuals who smoke marijuana are at similar risk for lung cancer as people
who smoke tobacco. Smoking through a 'bong' (water-cooled pipe) offers no
substantial protection. In order to effectively reduce your risk of lung cancer, it
is necessary to stop smoking of all substances, including marijuana.
Radon Exposure. Radon is a radioactive gas that is present in some rocks,
soils, and building materials. People get exposed to radon gas when it seeps into
the buildings where they live and work. Exposure to radon gas has been shown
to increase a person’s risk for getting lung cancer. Luckily, most people are not
at substantial risk of being exposed to radon, which is commonly tested for in
home inspections. Risk today is largely concentrated in occupations such as
mining. It is important for anyone who is commonly exposed to radon in their
working environment to wear a mask to protect their lungs from the gas.
Air Pollution. Some recent studies suggest that air pollution may contribute to
lung cancer risk. However, these results are considered controversial. For those
who do wish to avoid air pollution, it is not enough to simply 'move to the
country' as the presence of nearby industry may render even rural areas
polluted.
Asbestos. Asbestos is a fibrous mineral that used to be widely used as building
insulation. It became a universally banned material when it became clear that
asbestos fibers were carcinogens when breathed into the body. A history of
regular unprotected exposure to asbestos raises an individual's risk of lung
cancer moderately. Higher levels of risk occur when exposure to asbestos is
combined with smoking. Although asbestos insulation is still present in some
older buildings, it is not harmful until it is released into the air. Careful sealing
over of installed asbestos insulation can provide protection for building
inhabitants.
Diet. It has recently been suggested that diets low in fresh fruits in vegetables
can increase risk for lung cancer. This effect is probably due to the presence of
vitamins and other nutrients found in the fruits and vegetables. The risk of a
poor diet being associated with lung cancer increases when smoking is also
present.
Genetic, Sex and Racial Factors. Lung cancer risk is also influenced by other
factors including genetic, sex and race. Persons with blood relatives who had
lung cancer, for instance, are at some increased risk of developing lung cancer
themselves. Similarly, male smokers are roughly twenty times more likely to
get lung cancer than men who do not smoke, while female smokers are only 10
times more likely to get the disease than women who do not smoke. African
American men are noted to be at higher risk for developing lung cancer than are
Caucasian men, although this disparity may be able to be accounted for more or
less in terms of different cultural smoking habits within these groups.
A stubborn cough that will not quit, sometimes accompanied by a hoarse throat
Wheezing breathing
Pain in the chest, shoulders or back
Diminished appetite
Unintentional weight loss
Respiratory infections
Shortness of breath with only moderate exertion
As the cancer worsens and spreads the patient may experience:
Difficulty concentrating
Severe coughing which produces blood
Feelings of weakness and fatigue
Swellings in the face and/or neck
Difficulty while swallowing
Pain in the bones
Numbness in the limbs
Jaundice (yellow coloration of the skin and eyes)
Dizziness
Odd lumps appearing on the body
Persons who experience one or more of these symptoms unexpectedly should
strongly consider seeking immediate medical attention. While it is quite likely that
something other than cancer may be causing the symptoms to occur, as the old
saying observes, it is better to be safe than to be sorry.
Diagnosis
If your doctor suspects you may have lung cancer he or she will most likely order
one or more of the following tests.
Chest X-Ray. Often the first test a doctor will perform when looking for lung cancer
will be a chest x-ray. The x-ray picture is formed by passing radiation through your
body and capturing the result on sensitive film. The resulting image shows some
detail of the structures within your body based on how those structures deflected or
passed the x-ray radiation. The x-ray pictures give your doctor a preliminary idea of
whether you might have cancerous tissues and the general locations of the cancer if
it exists. In the event of a positive finding on the x-ray (that cancerous tissue appears
to exist), the doctor will likely order further tests to try to get a more detailed look
Your doctor may opt to do interval x-rays 6 months or 1 year later to evaluate any
changes in the size of the mass. If the mass remains stable, no further work-up may
be necessary.
CT Scan. A CT or computed tomography scan is basically similar to an x-ray.
However, where a normal x-ray procedure involves only taking a small set of images,
the CT scan procedure involves making many pictures of the body, and then using a
computer to assemble them into an extensively detailed image of your body. In some
cases the radiologist performing the CT scan procedure can increase the resolution
of the CT scan by injecting the patient with a special dye that causes certain features
of the body to stand out in the resulting image. Some patients experience a warming
sensation similar to a hot flash when this dye is injected, but the sensation does not
last long. CT scans are very helpful in determining the size, shape and location of
tumors, and can also be helpful in locating areas of metastasized cancer.
MRI. MRI stands for magnetic resonance imaging, a method of creating images of
body structures using magnetism rather than radiation. During an MRI radio waves
and high powered magnets are used to create a cross section image of the body
which often has greater resolution than CT or x-ray images. MRIs are generally used
to determine if the cancer has spread to the brain or spinal cord; areas of soft tissue
which MRIs excel at imaging. The MRI procedure requires that you be placed into an
open-ended tube containing enormous magnets, and then lie motionless inside this
tube while the machine clacks and clanks around you for up to an hour. Being inside
the machine bothers some individuals who have a fear of confined spaces. Luckily,
new MRI machines called 'Open MRIs' are now available that have a less confining
design. Ask your doctor about options for Open MRI in your area if you think you will
have a problem with the tight confines of the regular machine.
PET Scan. PET stands for positron emission tomography, an imaging technique that
can be used to make movies of biological activity in the body. Tissues in the body
burn sugar as food, and PET techniques are capable of making movies showing how
much sugar different tissues in the body burn. In PET, the patient receives special
radioactively-tagged sugars which then get taken up by the patient's various body
tissues. The tagged sugars emit weak radiation which is then picked up by special
movie cameras. Cancerous tissues are very metabolically active and so burn up
more of the radioactive sugars than their non-cancerous neighbours. PET images
thus enable doctors to see where cancers exist in the body by showing where there
are areas of greater-than-normal sugar utilization. PET movies help verify whether or
not an abnormality in a chest x-ray is actually cancer, and can also help identify
cancers that have spread to other parts of the body.
Bone Scan. This test is often performed if doctors believe that lung cancer may
have spread to the bones. In this test a radioactive substance is injected into the
bloodstream. The radioactive substance is easily absorbed by cancer cells and a
special camera is used to record areas of the bone where cancer is present. The
patient will usually have to wait two to four hours for the radioactive substance to
have sufficient time to be absorbed by the cancer. The actual scanning process lasts
about an hour.
Bronchoscopy. Bronchoscopy is used to locate tumors or collect tissue samples
from the trachea and upper bronchi. Before the test begins you will be given
medicine that will help you relax and remain comfortable. In this test a doctor places
an instrument called a capula into your mouth which holds down your tongue. Next,
an anesthetic is sprayed into your throat to numb it. A flexible metal tube is then
inserted into the numbed throat and used to take tissue and fluid samples from your
throat and bronchi. Some individuals feel the sensation of choking while the tube is
in their throat, however there is no real danger of suffocation. Your throat may feel a
bit scratchy for a few days after the procedure is performed.
Sputum Cytology. This tests calls for a sample of your spit (phlegm) to be analyzed
under the microscope to look for cancer cells.
8.3.4 Treatment:
Like many other cancers, lung cancer is generally treated with some
combination of surgery, chemotherapy and radiation therapy. Surgical
approaches are most likely to resolve the cancer when it is caught early on in its
progression. Later stage cancers are more likely to have metastasized and
therefore require more globally acting treatments (such as chemotherapy and
radiation therapy). Common surgical techniques for addressing lung cancer
involve removing cancerous portions of the lung and are described below:
Skin is constructed of two major layers: the epidermis (or surface layer), and the
dermis (or interior layer). The thin epidermis layer is composed of constantly
renewing layers of cells called keratinocytes which rise in layers from the
interior of the epidermis only to get sloughed off at the surface, and other
supporting cell types including melanocytes (pigmented cells responsible for
skin colour or freckles), dendritic cells (involved in skin immune function), and
basal cells. The thicker, deeper dermis layer is composed of connective tissues
and embedded blood vessels, nerve and sensory fiber endings, oil and sweat
glands, body hair follicles and a variety of other structures.
Like any other organ in the body, the skin is subject to cancer. Skin cancer
occurs when malignant (cancerous) growths or tumors form on or in the skin.
Today, skin cancer is the most prevalent form of cancer, accounting for about
50% of all cancer cases reported annually, according to the American Cancer
Society (ACS, 2010).
Skin cancers are divided into two major forms: Nonmelanomas and Melanomas.
These cancer subtypes are largely differentiated based on where in the skin
layers they form.
For completeness, the factors identified as putting people at increased risk for
skin cancer are as follows:
Previous Skin Cancer. Anyone who has previously had skin cancer has a
heightened risk for getting another skin cancer as compared to a person who has
never had skin cancer.
Immune System Suppression. Your immune system helps your body fight off
cancer as well as other diseases and infections. People with weakened immune
systems have a higher risk for developing skin cancer than people who have a
strong and healthy immune system, and also commonly are at increased risk for
the rapid spread of those cancers. Immune system weakness can be the result of
a disease process (such as HIV/AIDS), or it can be induced by doctors when it
is advantageous for other reasons (e.g., to prevent the rejection of transplanted
organs, or to slow the progress of autoimmune disorders).
Moles. Moles are not present at birth and usually develop during childhood or
teenaged years. Regular moles are essentially benign (non-cancerous) tumors,
and are not in of themselves cause for concern. However, some mole subtypes
do increase melanoma risk. Dyplastic nevus moles look similar to normal moles
except that they are larger. They run in families, and commonly appear in areas
exposed to the sun and/or around the groin and upper thighs. Congenital
melanocytic nevus moles are observed at birth and similarly increase melanoma
cancer risk. Moles can start out normal and then become cancerous. It is
important to monitor moles for change in shape, change in colour, or irregular
borders, and to have any irregularities you discover checked by a physician.
Family Background. Persons with close blood relatives who have developed
melanoma skin cancer are themselves at increased risk for developing the same.
The increased risk may be due to a genetic vulnerability that is passed down in
families. Alternative explanations for the increased risk are that all family
members may share a common family "sun worship" culture.
Age. While melanoma skin cancer is the most common form of skin cancer at
any age, a person's risk for developing melanoma increases as they age.
The following list describes risk factors specific to non-melanoma skin cancers:
Smoking. People who smoke are more likely to develop squamous cell
carcinomas compared with nonsmokers.
Permanent Skin Injury. Permanent skin injuries such as burns and scars pose
a small increase in risk for non-melanoma skin cancer developing at the site of
injury.
Asymmetry. Skin cancers are often irregularly shaped rather than symmetrical.
Colour. Skin cancers often show a colour variation rather than being evenly
toned.
Diameter. Skin cancers are often larger than noncancerous skin features and
may be observed to grow over time.
Elevation. Skin cancers are commonly raised off the surface of the skin.
Any one of these changes may be an early indication of skin cancer and should
be checked as soon as possible by your primary care physician or by a
dermatologist.
Diagnosis
In diagnosing skin cancer, your doctor will examine your skin for suspicious
looking moles, blotches and growths. You can expect to be asked questions
about when particular marks first appeared, and if they have changed since you
have known about them, whether you have previously had skin cancer, and the
extent to which you have been exposed to UV radiation.
If your doctor finds marks which may potentially be cancerous, he or she will
probably schedule you for a biopsy, a procedure in which the doctor will take
samples of skin from suspect areas so that they can be investigated under a
microscope. There are a few ways in which a biopsy for skin cancer can be
performed:
Shave Biopsy. During a shave biopsy the doctor will use a surgical knife to
remove the uppermost layer of skin. The patient is given local anesthetic and
should not feel any pain. Shave biopsies are not commonly used if melanoma is
suspected because a shave biopsy does not offer access to deeper tissues.
Punch Biopsy. During a punch biopsy the doctor uses a special instrument
which resembles a cookie cutter to remove all of the layers of skin over the
trouble area. Local anesthetic is used and the patient should not feel any pain.
Punch biopsies are not the preferred method for determining if the patient has
melanoma.
There are other tests doctors may order if they believe that skin cancer may
have spread beyond the skin tissue:
Lymph Node Biopsy involves the surgical removal of a lymph node that is
believed to be cancerous. The lymph node is then sent to a lab where it is
checked for cancer. The incision involved in this procedure is small and only a
localized anesthetic is necessary.
Fine Needle Aspiration (FNA) Biopsy. During an FNA biopsy a thin needle is
inserted into tissues believed to contain a tumor so as to remove a small tissue
sample from that area. There are advantages to FNA in that no anesthetic is
necessary (the procedure feels no worse than a conventional shot) and no
scaring risk is incurred.
Chest X-Ray. Doctors may order an x-ray picture be taken of your chest area if
they believe that skin cancer may have spread to your lungs.
Simple Excision. During simple excision a skin cancer tumor and a little
adjacent healthy tissue is removed with a surgical knife. The incision is then
sewn back together. Incisions are generally small, necessitating only local
anesthetic be used. This procedure, which may leave a scar, is appropriate for
treating both melanoma and nonmelanoma forms of skin cancer.
1. Curettage with Electrodessication. During this procedure the tumor is scraped
off using an instrument called a curette. After most of the tumor is scraped away
the surrounding area is treated with an electrode (an electrically charged piece
of metal) to kill any remaining cancer cells. The process may need to be
repeated a few times, and often leaves a scar. It is most often used to treat small
basal and squamous cell cancers.
4. Mohs Surgery. During this procedure the surgeon will remove a small layer of
skin which he or she believes contains cancer cells. The sample is then checked
immediately for cancer. If they doctor find the sample to contain cancer then the
doctor will remove another layer of skin and check the new sample for cancer.
The process is repeated until the sample layer does not contain cancer. This
process is slower than some of the other options but because it can save more
healthy skin tissue than alternatives, it appeals to many patients.
5. Laser Surgery. During laser surgery the doctor aims a special laser beam at
cancer cells to kill them. This surgery can only be used on skin cancers which
are close to the surface of the skin. Laser surgery is a relatively new procedure.
6. Lymph Node Removal. During this procedure a surgeon will remove lymph
nodes near the skin cancer to see if these nodes contain any cancer. Removed
nodes are later examined under a microscope by a specialist to determine if they
contain cancer. If the lymph nodes do contain cancer then it is likely that the
cancer has spread to other parts of the body.
7. Skin Grafting. During a skin graft, healthy skin sections are removed and used
to cover over wounds created by prior skin cancer removals. Skin grafting
procedures are useful in helping large surgical wounds that could not be stitched
back together to heal properly. Skin grafts can also help reduce scarring and
other appearance issues resulting from skin cancer surgery.
Surgery is not appropriate as a treatment in all cases. General health concerns,
and metastasized cancer scenarios can also compromise surgical treatment.
Radiation therapy can be used as an adjunct to surgical treatments, or by itself
when surgery is not appropriate. Radiation therapy involves the use of
directional high energy radiation to kill cancer cells. While radiation alone can
be used to cure small nonmelanoma skin cancers, it generally can only slow
down growth and symptom progression for more serious forms of skin cancer.
Side effects of radiation therapy include irritation, redness and drying of the
skin area.
Cancers are caused by a series of mutations. Each mutation alters the behaviour
of the cell somewhat.
9.1 Genetics
Main article: Oncogenomics
The central role of DNA damage and epigenetic defects in DNA repair genes in
carcinogenesis
The classical view of cancer is a set of diseases that are driven by progressive
genetic abnormalities that include mutations in tumor-suppressor genes and
oncogenes and chromosomal abnormalities. Later epigenetic alterations' role
was identified.[77]
Epigenetic alterations are functionally relevant modifications to the genome that
do not change the nucleotide sequence. Examples of such modifications are
changes in DNA methylation (hypermethylation and hypomethylation), histone
modification[78] and changes in chromosomal architecture (caused by
inappropriate expression of proteins such as HMGA2 or HMGA1).[79] Each of
these alterations regulates gene expression without altering the underlying DNA
sequence. These changes may remain through cell divisions, last for multiple
generations and can be considered to be epimutations (equivalent to mutations).
Epigenetic alterations occur frequently in cancers. As an example, one study
listed protein coding genes that were frequently altered in their methylation in
association with colon cancer. These included 147 hypermethylated and 27
hypomethylated genes. Of the hypermethylated genes, 10 were hypermethylated
in 100% of colon cancers and many others were hypermethylated in more than
50% of colon cancers.[80]
While epigenetic alterations are found in cancers, the epigenetic alterations in
DNA repair genes, causing reduced expression of DNA repair proteins, may be
of particular importance. Such alterations are thought to occur early in
progression to cancer and to be a likely cause of the genetic instability
characteristic of cancers.[81][82][83][84]
Reduced expression of DNA repair genes disrupts DNA repair. This is shown in
the figure at the 4th level from the top. (In the figure, red wording indicates the
central role of DNA damage and defects in DNA repair in progression to
cancer.) When DNA repair is deficient DNA damage remains in cells at a
higher than usual level (5th level) and cause increased frequencies of mutation
and/or epimutation (6th level). Mutation rates increase substantially in cells
defective in DNA mismatch repair[85][86] or in homologous
recombinational repair (HRR).[87]Chromosomal rearrangements and aneuploidy
also increase in HRR defective cells.[88]
Higher levels of DNA damage cause increased mutation (right side of figure)
and increased epimutation. During repair of DNA double strand breaks, or
repair of other DNA damage, incompletely cleared repair sites can cause
epigenetic gene silencing.[89][90]
Deficient expression of DNA repair proteins due to an inherited mutation can
increase cancer risks. Individuals with an inherited impairment in any of 34
DNA repair genes (see article DNA repair-deficiency disorder) have increased
cancer risk, with some defects ensuring a 100% lifetime chance of cancer (e.g.
p53 mutations).[91] Germ line DNA repair mutations are noted on the figure's
left side. However, such germline mutations (which cause highly penetrant
cancer syndromes) are the cause of only about 1 percent of cancers.[92]
In sporadic cancers, deficiencies in DNA repair are occasionally caused by a
mutation in a DNA repair gene but are much more frequently caused by
epigenetic alterations that reduce or silence expression of DNA repair genes.
This is indicated in the figure at the 3rd level. Many studies of heavy metal-
induced carcinogenesis show that such heavy metals cause a reduction in
expression of DNA repair enzymes, some through epigenetic mechanisms.
DNA repair inhibition is proposed to be a predominant mechanism in heavy
metal-induced carcinogenicity. In addition, frequent epigenetic alterations of the
DNA sequences code for small RNAs called microRNAs (or miRNAs).
miRNAs do not code for proteins, but can "target" protein-coding genes and
reduce their expression.
Cancers usually arise from an assemblage of mutations and epimutations that
confer a selective advantage leading to clonal expansion (see Field defects in
progression to cancer). Mutations, however, may not be as frequent in cancers
as epigenetic alterations. An average cancer of the breast or colon can have
about 60 to 70 protein-altering mutations, of which about three or four may be
"driver" mutations and the remaining ones may be "passenger" mutations.[93]
9.3 Metastasis
Main article: Metastasis
Metastasis is the spread of cancer to other locations in the body. The dispersed
tumors are called metastatic tumors, while the original is called the primary
tumor. Almost all cancers can metastasize.[94] Most cancer deaths are due to
cancer that has metastasized.[95]
Metastasis is common in the late stages of cancer and it can occur via the blood
or the lymphatic system or both. The typical steps in metastasis are
local invasion, intravasation into the blood or lymph, circulation through the
body, extravasation into the new tissue, proliferation and angiogenesis.
Different types of cancers tend to metastasize to particular organs, but overall
the most common places for metastases to occur are the lungs, liver, brain and
the bones.[94]
11.SCREENING
Main article: Cancer screening
Unlike diagnostic efforts prompted by symptoms and medical signs, cancer
screening involves efforts to detect cancer after it has formed, but before any
noticeable symptoms appear.[128] This may involve physical
examination, blood or urine tests or medical imaging.[128]
Cancer screening is not available for many types of cancers. Even when tests
are available, they may not be recommended for everyone. Universal
screening or mass screening involves screening everyone.[129] Selective
screening identifies people who are at higher risk, such as people with a family
history.[129] Several factors are considered to determine whether the benefits of
screening outweigh the risks and the costs of screening.[128] These factors
include:
Possible harms from the screening test: for example, X-ray images involve
exposure to potentially harmful ionizing radiation
The likelihood of the test correctly identifying cancer
The likelihood that cancer is present: Screening is not normally useful for
rare cancers.
Possible harms from follow-up procedures
Whether suitable treatment is available
Whether early detection improves treatment outcomes
Whether the cancer will ever need treatment
Whether the test is acceptable to the people: If a screening test is too
burdensome (for example, extremely painful), then people will refuse to
participate.[129]
Cost
12.CANCER TREATMENTS
Doctors prescribe cancer treatment regimens based on a variety of factors
specific to patients' individual circumstance. These factors often include the
cancer's stage (type, location, and size of the cancer being treated), as well as
patients' age, medical history, and overall health. The doctor may also ask
patients to specify their treatment preferences before determining an optimal
treatment plan. So long as their condition does not require emergency
intervention, patients should feel free to ask questions about various treatment
options so as to become comfortable with the plan they will ultimately follow.
In general, it is not a good idea to rush into a treatment plan merely as a way to
reduce the understandable anxiety of having a cancer diagnosis.
Each form of cancer is different and calls for a different set of treatment
approaches. This being true, there are two common approaches used to treat
almost all types of cancer. These two treatments are chemotherapy and radiation
therapy. Chemotherapy and radiation therapy are covered here in some detail to
avoid having to restate the information at length in later sections covering
specific cancer subtypes.
12.1 Chemotherapy:
Chemotherapy is one of the most commonly used methods to treat cancer
patients. It is commonly prescribed for patients whose cancer is not localized
but instead has possibly metastasized, or spread, to various locations in the
body. Chemotherapy can be used to reduce the symptoms and pain associated
with cancer as well as to slow the growth of cancerous tumors. In some
circumstances chemotherapy may even kill spreading cancerous cells.
Chemotherapy utilizes a powerful combination of drugs that are either taken by
mouth or injected directly into the bloodstream. Drug doses are commonly
given in a repeating pattern over a set amount of time. Treatment frequency and
duration depend on the type of cancer each patient has, and the manner in which
the patient tolerates and responds to the drugs. Chemotherapy drugs target cells
in the body that divide and grow quickly and are usually able to destroy these
cells. Unfortunately, cancer cells are not the only cells in the body which divide
and replicate quickly. In addition to cancerous cells, chemotherapy drugs also
kill some regular healthy cells, causing side effects such as the fatigue, nausea,
and hair loss. To some extent, side effects can be controlled or alleviated with
other medications or by altering the schedule of chemotherapy treatments. It is
important to alert your doctor immediately if you experience side effects so that
the doctor can adjust treatment to make you more comfortable. Chemotherapy
can be a long and arduous process, but it does not last forever and negative side
effects generally disappear upon completion of the treatment.
12.2 Radiation Therapy.:
Radiation therapy is a method of treating cancer that utilizes radiation energy.
Radiation is most commonly used to treat localized cancers as opposed to
cancer that has spread throughout the body. The goal of radiation therapy is to
kill cancer cells or at least limit their ability to grow and divide by damaging
their genetic material. Like chemotherapy, radiation therapy is not perfectly
precise in its targeting of cancer cells, and some normal, healthy cells can also
become damaged. Patients should not become too concerned about damage to
healthy cells, however. Doctors generally do a good job shielding and
protecting healthy cells surrounding cancer areas from radiation damage. Also,
healthy cells that do sustain damage during radiation treatment are usually able
to repair their genetic material when treatment ends.
There are two main ways in which radiation therapy can be administered:
externally and internally. When delivered externally, special machines are used
to project a focused beam of radiation into targeted areas of tissue within the
body. Internal radiation therapy involves surgical placement of radioactive
materials near cancerous tumors or afflicted body areas. When placed internally,
the source of radiation is often sealed in a small compartment such as a catheter
or capsule prior to implantation.
12.3 Surgery
Surgery is the primary method of treatment for most isolated, solid cancers and
may play a role in palliation and prolongation of survival. It is typically an
important part of definitive diagnosis and staging of tumors, as biopsies are
usually required. In localized cancer, surgery typically attempts to remove the
entire mass along with, in certain cases, the lymph nodes in the area. For some
types of cancer this is sufficient to eliminate the cancer.[146]
12.4 Palliative care
Palliative care is treatment that attempts to help the patient feel better and may
be combined with an attempt to treat the cancer. Palliative care includes action
to reduce physical, emotional, spiritual and psycho-social distress. Unlike
treatment that is aimed at directly killing cancer cells, the primary goal of
palliative care is to improve quality of life.
People at all stages of cancer treatment typically receive some kind of palliative
care. In some cases, medical specialty professional organizations recommend
that patients and physicians respond to cancer only with palliative care.[156] This
applies to patients who:[157]
Acupuncture
Hypnosis
Massage
Meditation
Relaxation techniques
Yoga
Targeted therapy, in which drugs work against specific parts of cancer cells
to keep them from growing or spreading.
Immunotherapy, also called biologic therapy, which gets the body’s immune
system to fight cancer.
Hormone therapy, also called hormone treatment or hormonal therapy,
which treats cancers that use hormones to grow (such as breast
cancer and prostate cancer).
Stem cell transplants. Doctors use chemo or radiation to destroy as many
cancer cells as possible, then try to replace them with healthy stem cells
from bone marrow or blood.
Photodynamic therapy. Doctors inject a special drug into the bloodstream,
then use a specific type of light to make it kill cancer cells.
With any cancer treatment, it might take a while before you know how it affects
your disease. Stay in touch with your doctor and keep her in the loop about
anything that doesn’t feel right. You are the most important part of your cancer
care team.
13.RESEARCH
Main article: Cancer research
Agents (e.g. viruses) and events (e.g. mutations) that cause or facilitate
genetic changes in cells destined to become cancer.
The precise nature of the genetic damage and the genes that are affected by
it.
The consequences of those genetic changes on the biology of the cell, both
in generating the defining properties of a cancer cell and in facilitating
additional genetic events that lead to further progression of the cancer.
The improved understanding of molecular biology and cellular biology due to
cancer research has led to new treatments for cancer since US President Richard
Nixon declared the "War on Cancer" in 1971. Since then, the country has spent
over $200 billion on cancer research, including resources from public and
private sectors.[213] The cancer death rate (adjusting for size and age of the
population) declined by five percent between 1950 and 2005.[214]
Competition for financial resources appears to have suppressed the creativity,
cooperation, risk-taking and original thinking required to make fundamental
discoveries, unduly favouring low-risk research into small incremental
advancements over riskier, more innovative research. Other consequences of
competition appear to be many studies with dramatic claims whose results
cannot be replicated and perverse incentives that encourage grantee institutions
to grow without making sufficient investments in their own faculty and
facilities.[215][216][217][218]
Virotherapy, which uses convert viruses, is being studied.
14.CONCLUSION
A plan for the diagnosis and treatment of cancer is a key component of any
overall cancer control plan. Its main goal is to cure cancer patients or prolong
their life considerably, ensuring a good quality of life. In order for a diagnosis
and treatment programme to be effective, it must never be developed in
isolation. It needs to be linked to an early detection programme so that cases are
detected at an early stage, when treatment is more effective and there is a
greater chance of cure. It also needs to be integrated with a palliative care
programme, so that patients with advanced cancers, who can no longer benefit
from treatment, will get adequate relief from their physical, psychosocial and
spiritual suffering. Furthermore, programmes should include an awareness-
raising component, to educate patients, family and community members about
the cancer risk factors and the need for taking preventive measures to avoid
developing cancer.
Where resources are limited, diagnosis and treatment services should initially
target all patients presenting with curable cancers, such as breast, cervical and
oral cancers that can be detected early. They could also include childhood acute
lymphatic leukaemia, which has a high potential for cure although it cannot be
detected early. Above all, services need to be provided in an equitable and
sustainable manner. As and when more resources become available, the
programme can be extended to include other curable cancers as well as cancers
for which treatment can prolong survival considerably.