What is Cancer?

- Anatomical Site or Organ of Origin: Cancers are often classNameified based on the location in the body where they begin. For example, breast cancer originates in the breast tissue, lung cancer in the lungs, and colon cancer in the colon.

- Histological Type: Cancers are further grouped based on the visual examination of cancer cells under a microscope and their tissue traits. This classNameification system helps distinguish different types of cancers and guide treatment decisions. For instance, breast cancer can be classNameified into subtypes including lobular carcinoma and ductal carcinoma

- Tumor Grade: Tumor grade refers to how abnormal the cancer cells appear under the microscope compared to normal cells. Grades may range from low-grade (cells appear relatively normal) to high-grade (cells appear highly abnormal). This classNameification helps predict how quickly the cancer is likely to grow and spread.

- Stage of Cancer: Staging describes the extent of the cancer and how far it has spread from its original site. The most commonly used staging system is the TNM system, which stands for Tumor, Node, and Metastasis. This system evaluates the size and extent of the primary tumor (T), whether cancer has spread to nearby lymph nodes (N), and whether cancer has disseminated to distant organs or tissues can be determined by the presence of metastasis, denoted by the (M) stage. Staging helps determine the prognosis and appropriate treatment approach.

- Molecular Characteristics: With advances in technology, cancers are increasingly being classNameified based on their molecular characteristics, such as specific genetic mutations or alterations. Molecular classNameification can provide valuable information for targeted therapies and personalized treatment approaches.

Cancer is one of the leading causes of death worldwide and cancer continues to pose a substantial health challenge to all of humanity. As per World Health Organization (WHO) reports, cancer is responsible for an estimated 9.6 million deaths worldwide each year.

The prevalence of cancer is increasing globally, driven by an aging populace and lifestyle modifications, which heighten the disease's challenges. Nevertheless, advancements in cancer studies, preventive measures, early detection practices, and treatment approaches have significantly improved survival rates for several types of cancer.

What causes cancer? What are the risk factors for cancer?

Cancer is a complex disease, and its causes are multifactorial. While the exact cause of cancer can vary depending on the type of cancer, some common causes and common risks factors of cancer include:

- Genetic Factors: Certain genetic mutations or alterations can increase the risk of developing cancer. Genetic mutations may arise from hereditary factors passed down by parents or acquired throughout an individual's life as a result of environmental influences or chance errors in DNA replication.

- Environmental Factors or Exposure to carcinogens:

Carcinogens are substances or agents that can promote the development of cancer by causing changes in the DNA of cells, leading to uncontrolled cell growth and tumor formation.

These substances can be found in various environmental, occupational, and lifestyle factors. Carcinogens can act through different mechanisms, such as damaging DNA directly, interfering with cellular processes, or promoting inflammation and oxidative stress. Examples of carcinogens include:

• Chemical Carcinogens: Certain chemicals found in tobacco smoke, industrial pollutants, pesticides, and certain medications or chemicals used in manufacturing processes
• Physical Carcinogens: Physical agents such as ultraviolet (UV) radiation from the sun, ionizing radiation from medical imaging procedures or nuclear fallout, and asbestos fibers can damage DNA and heighten the likelihood of developing cancer.
• Biological Carcinogens: Some infectious agents, such as certain viruses, bacteria, and parasites, can contribute to cancer development. Examples include human papillomavirus (HPV) for cervical cancer, Helicobacter pylori for stomach cancer, and hepatitis B and C viruses for liver cancer.
• Lifestyle-related Carcinogens: Factors such as smoking tobacco, excessive alcohol consumption, an unhealthy diet high in processed foods and red meat, obesity, sedentary lifestyle and physical inactivity are associated with an increased risk of cancer.

- Age: The risk of cancer generally increases with age, as cumulative exposure to risk factors and accumulated genetic mutations over time can contribute to cancer development.

- Hormonal Factors: Hormonal imbalances or changes in hormone levels can influence the development of certain cancers, such as breast and prostate cancer.

- Immune System Dysfunction: A weakened immune system, either due to immunosuppressive medications, certain medical conditions, or infections like HIV/AIDS, can increase susceptibility to cancer.

- Family History: Inherited genetic mutations passed down from parents can increase the risk of developing certain types of cancer. In addition, a family's cancer history may suggest similar environmental or lifestyle factors that impact the risk of developing cancer.

It's important to note that cancer often results from a combination of these factors, and not all individuals exposed to known risk factors will develop cancer. Additionally, cancer is a heterogeneous disease, with different types of cancer having different risk factors and underlying causes.

Types of cancer

Here are some of the most common types of cancers:

1. Breast cancer: This is the most common cancer in women, though men can get it too. Timely detection of breast cancer and prompt treatment significantly boost the probability of a successful outcome.

2. Lung cancer: For both males and females, this stands as the primary cause of cancer fatality. Smoking is identified as the primary risk factor contributing to the development of lung cancer.While it is linked with smoking and use of tobacco, it can also occur in non- smokers

3. Prostate cancer: This is the most common cancer in men. This is often slow-growing and may not cause symptoms in early stages. There are a range of treatment options available, and the success rate depends on the stage of the cancer when it is detected.

4. Colorectal cancer: Colorectal cancer originates in the colon or rectum as polyps before becoming cancerous. It is highly treatable if caught early, which is why regular screenings are important.

5. Skin cancer: Melanoma is regarded as the most grave form of skin cancer. This arises from mutation and uncontrolled growth of pigment-producing cells called melanocytes. Skin cancer usually arises from exposure to UV radiation from the sun. Basal cell carcinoma and squamous cell carcinoma are examples of non-melanoma skin malignancies. Skin cancers like melanoma can spread quickly to other parts of the body if not treated early. Be sure to wear sunscreen and protective clothing whenever you are going to be in the sun.

6. Bladder cancer: This cancer starts in the cells that line the bladder. Smoking and tobacco usage pose a substantial risk for the development of bladder cancer. It is common in elderly individuals

7. Non-Hodgkin lymphoma: Non-Hodgkin lymphoma is characterized by cancerous growth within the lymphatic system. There are many different types of non-Hodgkin lymphoma, and the treatment varies depending on the type.

8. Pancreatic Cancer: This cancer arises in the pancreas. This is a very aggressive cancer that is often difficult to treat. There are no good screening tests for pancreatic cancer so It is often diagnosed at advanced stages and associated with poor prognosis.

9. Kidney cancer: This cancer starts in the kidneys. There are a number of risk factors for kidney cancer, including smoking, obesity, and high blood pressure.

10. Endometrial cancer: Endometrial cancer refers to malignancy originating from the uterus lining. Irregular vaginal bleeding is commonly observed as the common indicator of this condition.

11. Leukemia: This is a group of cancers of the blood and bone marrow. There are several different types of leukemia including chronic and acute forms and the treatment for leukemia varies depending on the type.

12. Thyroid cancer: Thyroid cancer originates in the thyroid gland situated at the front or anterior region of the neck. Most thyroid cancers are treatable.

13. Liver cancer: This cancer starts in the liver. Several risk factors contribute to liver cancer, among them are chronic liver ailments such as cirrhosis, hepatitis B, or hepatitis C infections.

These are just a few examples of common types of cancer. There exists a wide spectrum of cancer types affecting various organs and tissues with each type of cancer possessing distinct attributes, risk factors, symptoms, diagnostic techniques and treatment strategies. Detecting cancer early through screening and administering timely treatment can enhance prognoses for several cancer varieties.

What are cancer symptoms?

The symptoms of cancer can vary widely depending on the type of cancer, its location, and how advanced it is. Some common signs and symptoms that may indicate the presence of cancer include:

- Unexplained Weight Loss (especially when not associated with dietary changes or physical activity)

- Persistent fatigue that doesn't improve with rest

- A new lump, bump or swelling that appears anywhere on the body, especially in the breast, testicles, lymph nodes or soft tissues

- Changes in the size, shape, color or texture of moles or skin lesions, as well as the development of new skin abnormalities

- Persistent or worsening pain that doesn't go away (especially if it's not associated with an injury or known cause)

- changes in bowel movements such as constipation, changes in stool consistency or diarrhea may indicate colorectal cancer

- Changes in bladder habits such as blood in the urine or frequent urination may indicate bladder cancer

- Changes in Appetite or Digestive Issues like vomiting and nausea

- Discomfort after eating, persistent indigestion or trouble swallowing may be symptoms of esophageal, stomach or gastrointestinal cancers

- A persistent cough, hoarseness or difficulty swallowing that doesn't improve with time could be symptoms of lung, throat, or esophageal cancer.

- Unexplained bleeding or bruising such as blood in the stool or urine, abnormal vaginal bleeding, or bleeding from the gums, may be signs of certain cancers, such as colorectal, bladder, cervical, or leukemia.

It's essential to recognize that these symptoms may also stem from conditions that are not cancer-related. However, if one or more of these symptoms worsen over time or don’t seem to go away, consulting a doctor promptly for assessment and examinations is crucial. Early detection of cancer and timely medical treatment can improve results significantly for several cancer types.

How does cancer grow and spread?

Cancer grows and spreads through a process called tumorigenesis and metastasis. Here's a simplified step by step breakdown of how cancer spreads:

- Initiation: The process begins with a genetic mutation or alteration in a normal cell's DNA, which can occur due to exposure to carcinogens, genetic predisposition, or other factors. This mutation disrupts the cell's normal regulatory mechanisms, leading to uncontrolled cell growth.

- Promotion: The mutated cell begins to divide and proliferate rapidly, forming a small cluster of abnormal cells called a tumor. At this stage, the tumor is localized and may not yet be invasive.

- Progression and Local Invasion: Over time, additional genetic mutations and changes occur within the tumor cells, leading to further growth and acquisition of characteristics that enable the tumor to invade nearby tissues and organs. This stage is marked by the development of invasive cancer. As the tumor grows, cancer cells start invading surrounding healthy tissues. They may use enzymes to break down the extracellular matrix, the glue holding cells together, allowing them to infiltrate nearby areas.

- Angiogenesis: Tumors need a constant supply of oxygen and nutrients to sustain their rapid growth. Cancer cells can trigger the growth of new blood vessels (angiogenesis) to feed the tumor.

- Detachment and Intravasation: Some cancer cells within the tumor can detach from neighboring cells. These breakaway cells can then enter the bloodstream or lymphatic system, which are the body's transport networks.

- Circulation and Extravasation: The detached cancer cells travel through the bloodstream or lymphatic system. If these cells survive the journey, they can get lodged in distant organs or tissues.

- Metastasis: If the traveling cancer cells get stuck in a suitable spot within a new organ or tissue, they can exit the blood vessels (extravasate) or lymphatic system. Once established in the new location, they can start multiplying again, forming a secondary tumor, also called metastatic cancer. Metastatic tumors can develop in organs and tissues far from the primary tumor site, leading to widespread disease and complications. This metastatic spread is what makes cancer potentially life-threatening. It's important to note that not every cancer cell goes through all these steps. The ability to spread varies depending on the cancer type.

It's important to note that not every cancer cell goes through all these steps. The ability to spread varies depending on the cancer type.

How do healthcare providers diagnose cancer?

The diagnosis of cancer involves a multifaceted approach, which integrates an extensive examination of the patient's medical and familial cancer history, a physical examination, laboratory tests, imaging studies and sometimes biopsy. Here's an overview of the diagnostic process:

Laboratory Tests:

These tests might analyze blood, urine, or other bodily fluids to look for abnormal cell counts or the presence of specific substances indicative of cancer, often called tumor markers. However, abnormal results don't necessarily mean cancer, and further testing is usually needed. Such assessments could consist of complete blood count (CBC), blood chemistry panels, tumor markers and genetic screenings.

Blood Tumor Markers:

- AFP: Elevated levels of AFP in adults may indicate the presence of specific cancers, notably liver cancer (hepatocellular carcinoma) and germ cell tumors.

- CEA: Primarily utilized as a tumor marker, the CEA test aids in the detection and monitoring of certain cancers, particularly colorectal cancer, but may also be heightened in pancreatic, gastric, lung, breast, and liver cancers.

- CA 125: For women with ovarian cancer, the CA 125 test serves to monitor treatment effectiveness and detect cancer recurrence. Serial CA 125 measurements over time offer valuable insights into disease progression and response to treatment.

- Human Chorionic Gonadotropin or hCG: In individuals not pregnant, heightened hCG levels may suggest the presence of specific cancers like testicular cancer, ovarian germ cell tumors, or gestational trophoblastic tumors. Measurement of hCG levels is utilized in diagnostic testing, treatment monitoring, and follow-up care for these cancers.

- CA15.3: Elevated CA 15-3 levels may indicate breast cancer recurrence, often before clinical symptoms or imaging results manifest. Regular monitoring of CA 15-3 levels in individuals with a breast cancer history aids in early detection of disease recurrence, potentially enabling more effective treatment.

- Calcitonin: Increased levels of calcitonin in the bloodstream can signal the presence of medullary thyroid cancer (MTC), a rare form of thyroid cancer originating from the C cells. Monitoring calcitonin levels is pivotal in diagnosing individuals suspected of MTC or in tracking those already diagnosed. Additionally, in cases where genetic mutations linked to MTC are hereditary, screening family members may include assessing calcitonin levels to detect MTC signs early and enable prompt intervention.

- Thyroglobulin: Thyroglobulin serves as a tumor marker in thyroid cancer management. Following thyroidectomy or radioactive iodine therapy, ideally, blood thyroglobulin levels should be undetectable or minimal. Elevated thyroglobulin levels post-treatment may suggest residual or recurrent thyroid cancer.

- PSA: PSA testing is a common screening tool for prostate cancer, particularly in men aged 50 and older or those with higher risk factors like family history. Elevated PSA levels may indicate prostate cancer presence, though they can also occur in non-cancerous prostate conditions. PSA testing aids in early detection and risk assessment rather than providing a definitive prostate cancer diagnosis.

- CA19.9: CA 19-9, a protein, may be heightened in individuals with pancreatic cancer, serving as a tumor marker for diagnosis, staging, and monitoring. While elevated CA 19-9 levels suggest pancreatic cancer, they aren't exclusive to it and can also occur in other gastrointestinal cancers and non-cancerous conditions affecting the pancreas, liver, bile ducts, and gallbladder.

These tests can be employed in conjunction with additional diagnostic assessments, imaging procedures (e.g., ultrasound, CT scans), and physical exams to aid in the diagnosis and surveillance of these cancers.

Imaging tests: X-rays, CT scans, MRIs, PET scans, ultrasounds and PET CT scans can generate detailed pictures of your internal organs and tissues. This helps identify masses or abnormalities that could be cancerous. While CT scans can help pinpoint a cancer tumor’s location and its effect on bones and organs, PET scans aid the early diagnosis of cancers. A special nuclear imaging test known as iodine meta-iodobenzylguanidine (MIGB) aids in the detection of cancer, including carcinoid tumors and neuroblastoma.

Detection of Cancer Susceptibility Genes: Screening tests for hereditary cancer usually concentrate on examining particular genes linked to a heightened susceptibility to certain cancer types. These may encompass well-known genes like BRCA1 and BRCA2, linked with breast, ovarian, and various other cancers, alongside others such as TP53 (associated with Li- Fraumeni syndrome) and PTEN (associated with Cowden syndrome).

Biopsy: This is the most definitive way to diagnose cancer. A small tissue sample is extracted from a suspicious area, examined by a pathologist under a microscope to determine if the cells are cancerous. There are different biopsy procedures depending on the location of the suspected cancer.

- Needle Biopsy: It is also known as fine needle aspiration or fine needle biopsy, involves using a thin hollow needle and syringe to extract cells, fluid, or tissue from suspicious lumps. It's commonly used to diagnose breast cancer, thyroid cancer, or cancer in lymph nodes.

- Skin biopsy: This entails removing a small sample of skin to diagnose skin cancer

- Bone marrow biopsy: This involves removing a small sample of bone marrow to test for signs of disease, including cancers like leukemia

- Endoscopic or laparoscopic biopsy: This biopsy utilizes an endoscope or laparoscope to visualize the inside of the body. A small incision is made in the skin, and an instrument is inserted to obtain a sample.

- Excisional or incisional biopsy: This procedure involves surgically removing either the entire tumor (excisional) or a portion of it (incisional) for testing or treatment.

- Perioperative biopsy: It is also called a frozen section biopsy and is conducted during another procedure. Tissue is removed and tested immediately, allowing for prompt treatment if necessary.

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Frequently Asked Questions

1. What are the side effects of cancer treatment?

Ans -Side effects resulting from cancer treatment can differ based on the modality of treatment administered and numerous individual factors, but common side effects include nausea, vomiting, fatigue, hair loss, decreased blood cell counts leading to increased risk of infections and bleeding, loss of appetite, and skin changes.

2. How does chemotherapy work in cancer treatment?

Ans - Chemotherapy works by targeting rapidly dividing cells, which includes cancerous or malignant cells. It disrupts the cell cycle and prevents cancer cells from growing and dividing. Nonetheless, it may also disrupt the functioning of healthy cells in the body, resulting in side effects.

3. How can cancer be prevented?

Ans - Cancer prevention strategies include maintaining a healthy lifestyle with regular exercise, a balanced diet rich in fruits and vegetables, avoiding tobacco and excessive alcohol consumption, protecting yourself from sun exposure, getting vaccinated against cancer-causing infections like HPV and hepatitis B, and staying informed about potential cancer risks in your environment.

4. How often should I get screened for cancer?

Ans - Cancer screening guidelines may vary significantly depending on factors such as age, sex, and risk factors. The ideal approach is to have a discussion with your doctor to arrive at a personalized cancer screening schedule, considering your unique risk factors, health conditions and medical history.

5. What is the prognosis for different types of cancer?

Ans - Prognosis for different types of cancer varies widely depending on factors such as the stage of the cancer at diagnosis, its location, and its response to treatment. Some types of cancers such as skin cancer (non-melanoma), thyroid cancer, testicular cancer, and prostate cancer when detected early and treated promptly, with 5-year survival rates often exceeding 90%. On the other hand, cancers like pancreatic cancer, lung cancer, liver cancer, and esophageal cancer, often diagnosed at advanced stages can have very poor prognosis and outcomes.

6. How does genetics play a role in cancer risk?

Ans - Genetics can play a significant role in cancer risk, with certain genetic mutations increasing the likelihood of developing specific types of cancer. For example:

- Mutations in the BRCA1 and BRCA2 genes significantly increase the risk of breast and ovarian cancers. Additionally, BRCA mutations are also associated with increased risks of other cancers, including prostate, pancreatic, and male breast cancer.

- Mutations in the APC gene are associated with an increased risk of developing colorectal cancer. These mutations are often found in individuals with familial adenomatous polyposis (FAP), a hereditary condition characterized by the development of numerous polyps in the colon and rectum, which significantly increases the risk of colorectal cancer if not treated.

Understanding one’s family history of cancer, genetic testing and counseling can help identify individuals at higher risk and guide personalized prevention and screening strategies.

7. Who should consider a hereditary cancer screening test?

Ans - People with a family history of cancer may benefit from hereditary cancer screening or genetic testing to see if they have inherited gene mutations that increase their risk of certain cancers.