What is Cancer?

People get cancer when cells within their bodies divide without control or order. The body is made up of many types of cells, and it is normal for them to grow, divide and produce more cells when the body needs them. Cancer occurs when cells keep dividing, even when new cells are not needed. The mass of extra cells may produce a tumor that can be:

  • Benign (not cancer)
    Benign tumors are rarely life-threatening, and they do not spread to other parts of the body. They often can be removed and usually do not grow back.
  • Malignant (cancer)
    Malignant tumors can invade, damage and destroy nearby tissues and spread to other parts of the body.

Your body is made up of billions of cells that can only be seen under a microscope. These cells are grouped together to make up the tissues and organs of our bodies. They are a bit like building blocks. Different types of body tissues are made up of different types of body cells. For example, there are bone cells in bone and breast cells in the breast.

 

Different types of cells in the body do different jobs. They all have a center called a nucleus. Inside the nucleus are the genes. Genes are really bits of code and control the cell. They decide when it will reproduce, what it does and even when it will die.

Normally the genes make sure that cells grow and reproduce in an orderly and controlled way. If the system goes wrong for any reason, the usual result is that the cell dies. Rarely, the system goes wrong in a way that allows a cell to keep on dividing until a lump called a ‘tumour’ is formed.

 

It is the ability to spread that makes a cancer harmful. If a cancer is not treated, it can spread into the organs near to where it started growing. It can also damage other parts of the body that it spreads to.

 

The place where a cancer begins is called the ‘primary cancer’. Cancers may also spread into nearby body tissues. For example ovarian cancer can spread to the lining of the abdomen (the peritoneum). This is called locally advanced cancer.

 

Cancer cells can break away from the primary tumour and be carried in the blood or lymphatic system to other parts of the body. There they can start to grow into new tumours. Tumours from cancers that have spread are called ‘secondary cancers’ or ‘metastases’

Cancer Risk Factors

Even though it is not known why cancer occurs, there is proof that certain things can increase your chance of developing the disease. Research has shown that some of these risk factors affect the DNA of cells in the body organs, which can result in abnormal cell growth and may cause tumors to form.

About

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, unprotected exposure to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers. But risk factors don’t tell us everything.

 

Having a risk factor, or even several risk factors, does not mean that you will get the disease. And many people who get the disease may not have had any known risk factors.

 

These cancer risk factors they fall into four broad categories, which may overlap. In some cancers, different risk factors may work together to increase your cancer risk.

Lifestyle or behavioural risk factors

The factors that fall into this category are the ones you have the most control over. By following these guidelines, you can significantly reduce your risk of developing cancer.

Don’t use tobacco products:

Smoking and using smokeless tobacco are directly linked to many kinds of cancer.

  • If you don’t smoke, never start.
  • If you do smoke, quit. The chances of getting lung cancer gradually decrease once you stop smoking.
  • Avoid breathing second-hand smoke, which increases your risk for heart and lung diseases, including cancer.

Avoid harmful ultraviolet (UV) rays:

UV radiation from the sun the main cause of skin cancer.

  • Avoid being in the sun when ultraviolet rays are strongest. During the summer, that is from about 11 a.m. to 3 p.m. A general rule is to avoid the sun when your shadow is shorter than you are.
  • Use a sunscreen with a sun protection factor (SPF) of 15 or higher. You want to use one that blocks UVA and UVB rays. Wear protective clothing to help block the sun’s rays

Maintain a healthy diet:

Research points to a link between a high-fat diet and certain cancers, such as cancer of the breast, colon, uterus and prostate. The good news is studies suggest that foods containing fibre and certain nutrients help protect against some cancers.

  • Eat a lot of fruits, vegetables, grains and beans. Include lean meat and low-fat dairy products in your diet.
  • Don’t eat a lot of fat.
  • Stay at a healthy weight.
  • Most days, include in your routine 30 minutes of moderate to vigorous activity.

Alcohol:

Drinking large amounts of alcohol increases your risk of cancer of the mouth, throat, oesophagus (food pipe) and larynx (voice box). If you smoke and drink, you are at especially high risk of getting these cancers. Alcohol also can damage your liver and increase your risk of liver cancer.

Radiation:

Exposure to large doses of radiation can increase your cancer risk. X-rays used for diagnosis expose you to very little radiation, and the benefits nearly always outweigh the risks.

  • Talk with your doctor or dentist about the need for each X-ray.
  • Ask about the use of shields to protect other parts of your body.

Lifestyle Or Behavioral Risk Factors

The factors that fall into this category are the ones you have the most control over. By following these guidelines, you can significantly reduce your risk of developing cancer.

Don’t use tobacco products:
Smoking and using smokeless tobacco are directly linked to many kinds of cancer.

  • If you don’t smoke, never start.
  • If you do smoke, quit. The chances of getting lung cancer gradually decrease once you stop smoking.
  • Avoid breathing second-hand smoke, which increases your risk for heart and lung diseases, including cancer.

Avoid harmful ultraviolet (UV) rays:

UV radiation from the sun the main cause of skin cancer.

  • Avoid being in the sun when ultraviolet rays are strongest. During the summer, that is from about 11 a.m. to 3 p.m. A general rule is to avoid the sun when your shadow is shorter than you are.
  • Use a sunscreen with a sun protection factor (SPF) of 15 or higher. You want to use one that blocks UVA and UVB rays. Wear protective clothing to help block the sun’s rays

Maintain a healthy diet:

Research points to a link between a high-fat diet and certain cancers, such as cancer of the breast, colon, uterus and prostate. The good news is studies suggest that foods containing fiber and certain nutrients help protect against some cancers.

  • Eat a lot of fruits, vegetables, grains and beans. Include lean meat and low-fat dairy products in your diet.
  • Don’t eat a lot of fat.
  • Stay at a healthy weight.
  • Most days, include in your routine 30 minutes of moderate to vigorous activity.

Alcohol:

Drinking large amounts of alcohol increases your risk of cancer of the mouth, throat, oesophagus (food pipe) and larynx (voice box). If you smoke and drink, you are at especially high risk of getting these cancers. Alcohol also can damage your liver and increase your risk of liver cancer.

Radiation:

Exposure to large doses of radiation can increase your cancer risk. X-rays used for diagnosis expose you to very little radiation, and the benefits nearly always outweigh the risks.

  • Talk with your doctor or dentist about the need for each X-ray.
  • Ask about the use of shields to protect other parts of your body.

Hereditary Risk Factors

You are more likely to get cancer when an altered or changed gene is passed on to you from one of your parents. This link between genes and cancer is often strongest in families where:

  • Cancer develops at a much younger age than average.
  • Cancer develops in more than one generation.
  • More than one type of cancer develops in the same close relative.
  • Cancer develops in both breasts.
  • Breast cancer develops in a man.
  • Cancer develops in several close relatives.
  • Several rare cancers develop in a family.

Environmental

There are chemicals or substances used in workplaces that may put you at increased risk for developing some cancers. For instance, asbestos and radon are linked with a higher cancer risk. Try to reduce your exposure to these substances and always wear protective equipment when it is available.

Medical

Certain health conditions may increase your risk for some cancers. Among these are colon polyps (abnormal tissue growths in the lining of the bowel) , previous cancer and Hepatitis B and C infections.

Stages of Cancer.

The most frequent question about cancer asked by a patient or his relative to the doctor is “At what stage is the cancer?”

 

The answer to this question is not always simple and it depends on which cancer you are talking about and which staging system the doctor is using. Some types of cancer have more than one type of staging system.

 

Most types of cancer have 4 stages, numbered 1 – 4. Often doctors write the stage down in roman numerals. So you may see stage 4 written down as stage IV.

Here is a brief summary of what the stages mean for most types of cancer.

  • Stage 1
    usually means a cancer is relatively small and contained within the organ it started in.
  • Stage 2
  • Avoid breathing second-hand smoke, which increases your risk for heart and lung diseases, including cancer.

Avoid harmful ultraviolet (UV) rays:

UV radiation from the sun the main cause of skin cancer.

  • Avoid being in the sun when ultraviolet rays are strongest. During the summer, that is from about 11 a.m. to 3 p.m. A general rule is to avoid the sun when your shadow is shorter than you are.
  • Use a sunscreen with a sun protection factor (SPF) of 15 or higher. You want to use one that blocks UVA and UVB rays. Wear protective clothing to help block the sun’s rays

Maintain a healthy diet:

Research points to a link between a high-fat diet and certain cancers, such as cancer of the breast, colon, uterus and prostate. The good news is studies suggest that foods containing fiber and certain nutrients help protect against some cancers.

  • Eat a lot of fruits, vegetables, grains and beans. Include lean meat and low-fat dairy products in your diet.
  • Don’t eat a lot of fat.
  • Stay at a healthy weight.
  • Most days, include in your routine 30 minutes of moderate to vigorous activity.

Alcohol:

Drinking large amounts of alcohol increases your risk of cancer of the mouth, throat, oesophagus (food pipe) and larynx (voice box). If you smoke and drink, you are at especially high risk of getting these cancers. Alcohol also can damage your liver and increase your risk of liver cancer.

Radiation:

Exposure to large doses of radiation can increase your cancer risk. X-rays used for diagnosis expose you to very little radiation, and the benefits nearly always outweigh the risks.

  • Talk with your doctor or dentist about the need for each X-ray.
  • Ask about the use of shields to protect other parts of your body.

Hereditary Risk Factors

You are more likely to get cancer when an altered or changed gene is passed on to you from one of your parents. This link between genes and cancer is often strongest in families where:

  • Cancer develops at a much younger age than average.
  • Cancer develops in more than one generation.
  • More than one type of cancer develops in the same close relative.
  • Cancer develops in both breasts.
  • Breast cancer develops in a man.
  • Cancer develops in several close relatives.
  • Several rare cancers develop in a family.

Environmental

There are chemicals or substances used in workplaces that may put you at increased risk for developing some cancers. For instance, asbestos and radon are linked with a higher cancer risk. Try to reduce your exposure to these substances and always wear protective equipment when it is available.

Medical

Certain health conditions may increase your risk for some cancers. Among these are colon polyps (abnormal tissue growths in the lining of the bowel) , previous cancer and Hepatitis B and C infections.

Early Signs of Cancer

While you are taking the steps to stay cancer-free, you need to keep aware of the symptoms that may be associated with cancer. These are:

  • Lumpiness or a thickened area in your breasts, any changes in the shape or colour of your breasts, unusual nipple discharge, a nipple that turns inwards (if it hasn’t always been that way) or any unusual pain.
  • A lump in the neck, armpit or anywhere else in the body.
  • Sores or ulcers that don’t heal.
  • Coughs or hoarseness that won’t go away or coughing up blood.
  • Changes in toilet habits that last more than two weeks, blood in a bowel motion.
  • New moles or skin spots, or ones that have changed shape, size or colour, or that bleed.
  • Unusual vaginal discharge or bleeding. Unexplained weight loss.

Remember, these symptoms do not always mean cancer, and only your doctor can make a diagnosis. Report these symptoms to your healthcare provider promptly.

Early Detection of Cancer.

General Advice On Early Detection:

  • Many times, the earlier cancer is diagnosed and treated, the better a person’s chances are for full recovery. Cancer in its earliest stages rarely has warning signs, so take the steps that will give you an added edge for early detection:
  • Get regular checkups by your doctor – Often your doctor can find early cancer during a physical exam or with routine tests, even if you have no symptoms. Ask your doctor about your cancer risk, problems to watch for and a schedule of regular checkups.
  • Ask to be screened for cancer – Research shows that Pap tests (for cervix cancer), mammograms (for breast cancer) and colon cancer tests save lives.
  • Do regular self-exams – Examining yourself on a regular basis can help you – Check your skin regularly for new growths; sores that don’t heal; changes in the size, shape or colour of moles; or any other changes on your skin. Report these warning signs to your doctor at once.
  • Look in a mirror to check the inside of your mouth for changes in the colour of your lips, gums, and tongue or inner cheeks. Also look for scabs, cracks, sores, white patches, swelling or bleeding. Have these symptoms checked by a doctor or dentist.
  • If you are a man, regularly do a testicular self-exam. Report a lump or other changes, such as heaviness, swelling, and unusual tenderness or pain to your doctor.
  • If you are a woman, do breast self-examination every month. This will help you learn what looks and feels normal for your breasts and will help you notice any changes. Report anything you feel is not normal to your doctor.

Breast

EARLY DETECTION OF BREAST CANCER

As of current statistics in India, 1 in every 22 women is at a life time risk of developing a breast cancer. When breast cancer is detected early, women have a much greater chance of being treated successfully and for most women the cancer will not come back after treatment. Screening mammograms are currently the best method available for detecting breast cancer early. Mammograms may find a breast cancer which is too small to feel.

WHAT IS A SCREENING MAMMOGRAM?

Mammograms are low dose x-rays of a woman’s breasts. Screening mammograms are performed on women without any symptoms of breast cancer. Women over 50 years of age are advised to have a mammogram every year.

WHO SHOULD HAVE A REGULAR SCREENING MAMMOGRAM?

The biggest risk factors for developing breast cancer are being a woman and getting older. Screening mammograms are often less reliable for younger women. The density of breast tissue in younger women often makes it difficult to detect cancers on mammograms. All women aged 50 and above should have a screening mammogram every year.

WHEN SHOULD I DO A BREAST SELF EXAMINATION?

From age 20 on, monthly Breast Self-Examination (BSE) is recommended seven to 10 days after a woman’s period begins. After menopause, BSE should be performed on the first day of the month. BSE only takes a few minutes, costs nothing, and helps find tumors at a smaller size.

WHAT TO LOOK OUT FOR?

Women of all ages should be familiar with the normal look and feel of their breasts. If you notice any of the following changes please see your doctor immediately:

  • A lump, lumpiness or thickening of the breast.
  • Changes in the skin of a breast, such as puckering, dimpling or a rash.
  • Persistent or unusual breast pain.
  • Persistent or unusual breast pain.
  • Discharge from a nipple, a nipple rash or a change in its shape.

Nine out of every 10 breast lumps are found by women themselves. Although eight out of every ten lumps are NOT cancerous, it is important to seek medical help immediately when a change or lump is detected.

WHAT IF I HAVE A FAMILY HISTORY OF BREAST CANCER?

A woman’s risk for developing breast cancer increases if her mother, sister, or daughter had breast cancer, especially at a young age. Screening should begin early in these cases. Breast self examination should be performed regularly and screen mammography should begin at as early as 35 years of age.

Intestine (Bowel)

EARLY DETECTION OF INTESTINE (BOWEL) CANCER

Bowel cancer, also known as colorectal cancer, occurs in the colon or rectum. Bowel cancer is the third most commonly diagnosed cancer. If bowel cancer is detected early, the chance of successful treatment and long-term survival improves significantly.

WHAT ARE THE SYMPTOMS?

Not all bowel cancers show symptoms, however you should see your doctor if you notice:

  • Bleeding from the back passage or any sign of blood after a bowel motion.
  • A change in usual bowel habit, such as straining (constipation) to go to the toilet or loose motions (diarrhoea).
  • Abdominal pain or bloating.
  • Weight loss for no obvious reason, or loss of appetite.
  • Symptoms of anaemia – including unexplained tiredness, weakness or breathlessness.
  • Experiencing any of the symptoms listed does not necessarily mean you have bowel cancer. Any unusual or persisting symptoms should be reported to your doctor immediately.

WHO IS AT RISK?

Everyone is at risk of developing bowel cancer; however the risk greatly increases with age. Some people may be at a greater risk of developing bowel cancer, including those with:

  • A previous history of polyps in the bowel.
  • A previous history of bowel cancer.
  • Chronic inflammatory bowel disease (eg. Crohn’s disease).
  • A strong family history of bowel cancer.

People who are at an increased risk of developing bowel cancer should discuss possible surveillance options with their doctor.

HOW IS BOWEL CANCER DETECTED?

Bowel cancer can be detected using a variety of methods.

Faecal Occult Blood Test (FOBT) or commonly called Stool test is a simple screening test that looks for hidden traces of blood in a bowel motion in people without symptoms. It can help detect bowel cancer in its early stages. People should have an FOBT every two years from age 50 years. If stool test finds blood other further diagnostic tests are needed.

Colonoscopy is a test that involves a long, thin, flexible tube with a video camera lens on the end, enabling a specialist to look at the inside of your bowel. If a polyp or bowel cancer is found, it can be removed during the procedure. Colonoscopy is usually performed under sedation as a day procedure. Colonoscopies are also used as a surveillance test for people at increased risk of developing bowel cancer.

Sigmoidoscopy is similar to colonoscopy, however only explores the lower part of the bowel, where cancer is more likely to develop. If a precancerous polyp is detected during the procedure a full bowel examination by colonoscopy is usually needed.

WHAT ELSE CAN I DO?

Bowel cancer is one of the most preventable cancers. Many lifestyle risk factors may contribute to bowel cancer. Your most effective protection against bowel cancer is to:

  • Be screened for bowel cancer every two years if over 50 years of age.
  • Get 30 to 60 minutes of moderate to vigorous intensity exercise per day.
  • Maintain a healthy body weight.
  • Eat a well balanced diet.
  • Avoid processed and burnt meat. Limit red meat intake to three to four times per week.
  • Avoid or limit your alcohol intake.
  • Quit smoking.

Ovary

EARLY DETECTION OF BREAST CANCER

As of current statistics in India, 1 in every 22 women is at a life time risk of developing a breast cancer. When breast cancer is detected early, women have a much greater chance of being treated successfully and for most women the cancer will not come back after treatment. Screening mammograms are currently the best method available for detecting breast cancer early. Mammograms may find a breast cancer which is too small to feel.

WHAT IS A SCREENING MAMMOGRAM?

Mammograms are low dose x-rays of a woman’s breasts. Screening mammograms are performed on women without any symptoms of breast cancer. Women over 50 years of age are advised to have a mammogram every year.

WHO SHOULD HAVE A REGULAR SCREENING MAMMOGRAM?

The biggest risk factors for developing breast cancer are being a woman and getting older. Screening mammograms are often less reliable for younger women. The density of breast tissue in younger women often makes it difficult to detect cancers on mammograms. All women aged 50 and above should have a screening mammogram every year.

WHEN SHOULD I DO A BREAST SELF EXAMINATION?

From age 20 on, monthly Breast Self-Examination (BSE) is recommended seven to 10 days after a woman’s period begins. After menopause, BSE should be performed on the first day of the month. BSE only takes a few minutes, costs nothing, and helps find tumors at a smaller size.

WHAT TO LOOK OUT FOR?

Women of all ages should be familiar with the normal look and feel of their breasts. If you notice any of the following changes please see your doctor immediately:

  • A lump, lumpiness or thickening of the breast.
  • Changes in the skin of a breast, such as puckering, dimpling or a rash.
  • Persistent or unusual breast pain.
  • A change in the shape or size of a breast.
  • Discharge from a nipple, a nipple rash or a change in its shape.

Nine out of every 10 breast lumps are found by women themselves. Although eight out of every ten lumps are NOT cancerous, it is important to seek medical help immediately when a change or lump is detected.

WHAT IF I HAVE A FAMILY HISTORY OF BREAST CANCER?

A woman’s risk for developing breast cancer increases if her mother, sister, or daughter had breast cancer, especially at a young age. Screening should begin early in these cases. Breast self examination should be performed regularly and screen mammography should begin at as early as 35 years of age.

Cervix

WHAT IS CERVICAL CANCER?

A woman’s risk for developing breast cancer increases if her mother, sister, or daughter had breast cancer, especially at a young age. Screening should begin early in these cases. Breast self examination should be performed regularly and screen mammography should begin at as early as 35 years of age.

IMPORTANCE OF CERVICAL CANCER SCREENING

The goal of screening for cervical cancer is to find cervix cell changes and early cervical cancers before they cause symptoms. Screening tests offer the best chance to detect cervical cancer at an early stage when successful treatment is likely.

 

Cancer of the cervix may be prevented or detected early by regular Pap tests. If it is detected early, cervical cancer is one of the most successfully treatable cancers.

WHAT ARE THE RISK FACTORS FOR CERVICAL CANCER?

The most important risk factor for cervical cancer is infection by the human papilloma virus (HPV). The Pap test looks for changes in cervical cells caused by HPV infection.

You can prevent most pre-cancers of the cervix by avoiding exposure to HPV. In women, HPV infections occur mainly at younger ages and are less common in women older than 30. The reason for this is not clear. Certain types of sexual behaviour increase a woman’s risk of getting HPV infection, such as:

  • Having sex at an early age
  • Having many sexual partners
  • Having a partner who has had many sex partners
  • Having sex with uncircumcised males
  • Discharge from a nipple, a nipple rash or a change in its shape.

I HAVE HEARD ABOUT SOME VACCINES. HOW USEFUL ARE THEY?

Vaccines have been developed that can protect women from HPV infections. So far, a vaccine that protects against HPV types 6, 11, 16 and 18 (Gardasil®) and one that protects against types 16 and 18 (Cervarix®) have been studied. Both vaccines require a series of 3 injections over a 6-month period. Side effects are usually mild. The most common one is short-term redness, swelling, and soreness at the injection site.

 

In clinical trials, both vaccines prevented pre-cancers and cancers of the cervix caused by HPV types 16 and 18. Both vaccines only work to prevent HPV infection — they will not treat an infection that is already there. That is why, to be most effective, the HPV vaccine should be given before a person starts having sex.

 

The American Cancer Society guidelines also recommend that the vaccine be routinely given to girls ages 11 to 12 and as early as age 9 at the discretion of doctors. The Society also agrees that “catch-up” vaccinations should be given to females up to age 18. The independent panel making the Society recommendations found that there was not yet enough proof that catch-up vaccinations for all women aged 19 to 26 years would be beneficial. As a result, the American Cancer Society recommends that women aged 19 to 26 talk with their health care provider about their risk of previous HPV exposure and potential benefit from vaccination before deciding to get the vaccine. These vaccines have been tested in older women, and do seem to be effective in producing an immune reaction to the HPV types in the vaccine and also reduce cervical cancers and pre-cancers in those vaccinated.

 

It is important to realize that the vaccine doesn’t protect against all cancer-causing types of HPV, so routine Pap tests are still necessary. One other benefit of the vaccine is that it protects against the 2 viruses that cause 90% of genital warts.

WHO SHOULD GET SCREENED?

The American Cancer Society recommends the following guidelines for early detection:
All women should begin cervical cancer testing (screening) about 3 years after they start having sex (vaginal intercourse). A woman who waits until she is over 18 to have sex should start screening no later than age 21. A regular Pap test should be done every year. If a liquid-based Pap test is used instead, women should be tested every 2 years.

Beginning at age 30, many women who have had 3 normal Pap test results in a row may be tested less often – every 2 to 3 years. Either the conventional (regular) Pap test or the liquid-based Pap test can be used.

Women who have certain risk factors should continue getting tested yearly. This includes women exposed to diethylstilbestrol (DES) before birth, those with a history of treatment for a pre-cancer, and those with a weakened immune system (from HIV infection, organ transplant, chemotherapy, or chronic steroid use).

Women who have had a total hysterectomy (removal of the uterus and cervix) may choose to stop having cervical cancer testing, unless the hysterectomy was done as a treatment for cervical cancer or pre-cancer. Women who have had a hysterectomy without removal of the cervix (called a supra-cervical hysterectomy) need to continue cervical cancer screening. They should continue to follow the guidelines above.

Women 70 years of age or older who have had 3 or more normal Pap test results in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer testing. Women with a history of cervical cancer, DES exposure before birth, HIV infection, or a weakened immune system should continue to have testing as long as they are in good health.

Some women believe that they can stop having Pap tests once they have stopped having children. This is not correct