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What is Cancer?

Cancer is a group of more than 100 different diseases. Cancer occurs when cells become abnormal and keep dividing and forming more cells without control or order. All organs of the body are made of cells. Normally, cells divide this orderly process which helps keeps us healthy. If cells keep dividing a mass of tissue forms. This mass of extra tissue, called a growth or tumor which can be either benign or malignant.

Most cancers are named for the type of cell or the organ in which they originate. When cancer spreads to another site, the new tumor has a similar type of abnormal cells and is identified by the same name as the primary tumor. if lung cancer spreads to the liver. The disease is called metastatic lung cancer (it is not liver cancer).




How is it caused? – Genetic mutation and carcinogens

Cancer is caused by changes, or mutations, in genes that control healthy cell division. When these genes are altered or damaged, cells divide out of control and become malignant. Basically, two types of genes are involved—oncogenes and tumour suppressor genes. Oncogenes promote normal cell division—in the same way the accelerator of your car makes it move. When an oncogene is damaged, it acts like an accelerator that gets stuck to the floor, and the cells continue dividing out of control.

Mutations in tumour suppressor genes can also lead to cancer. When they are healthy, tumour suppressor genes tell cells when to stop dividing. When a tumour suppressor gene becomes disabled, it acts like a faulty brake on a car and can no longer control runaway cell division.

These two types of genes can become damaged by substances in the environment called carcinogens, which include cigarette smoke, chemicals, radiation, and some viruses. Other factors that can cause the genetic changes that lead to cancer include hormones, the aging process, diet, an inefficient immune system, and a hereditary susceptibility.

What are the early symptoms of Cancer???

Cancer often causes symptoms that you can watch for, the word CAUTION can remind you of the most common warning signs of cancer:

1:-Change in bowel or bladder habits

2:-A sore that does not heal

3:-Unusual bleeding or discharge

4:-Thickening or lump in the breast or any part of the body

5:-Indigestion or difficulty swallowing

6:-Obvious change in a wart or mole

7:-Nagging cough or hoarseness

These symptoms can also be caused by less serious conditions. It is important to seek expert opinion if any of these symptoms are reported by a patient. Only an expert can make a diagnosis. Early cancer usually does not cause pain, so do not wait till patient develops pain, It may be too late

In many cases, a patient's signs and symptoms do not provide enough clues to determine the cause of an illness, and medical tests such as x-rays, blood tests, or a biopsy,usg, ct scans, MRI, PET scansare more sophisticated tests to assess the exact extent of cancer may be needed. Although some generalized symptoms and signs such as unexplained weight loss, fever, fatigue, or lumps may be due to several types of cancer, they are often caused by other types of diseases. Other signs and symptoms are relatively specific to a particular type of cancer.

Screening and Prevention

Screening for cancer means looking for cancer before there are symptoms. The information on lifestyles helps identify people who should be screened for certain types of cancer. Screening for some cancers is important because it can help discover cancer early and treat it successfully. Not all screening tests are helpful for all people, and some have risks.

Many cases of cancer can be prevented by not using tobacco products and choosing foods with less fat and more fibre. In addition, alcohol and exposure to certain chemicals and/or radiation may increase a person's risk of developing cancer.

Diagnosis

If a person has a sign or symptom suggestive of cancer, perform a physical exam, ask about the person’s medical history, you may refer to an oncologist to do various tests and exams. These may include imaging procedures, endoscopy (look directly inside certain organs), laboratory tests and a biopsy.

Imaging - Images of areas inside the body can be made in several ways. A special dye may show up certain organs better on film. The dye may be swallowed or put into the body through a needle or a tube.

Endoscopy - Endoscopy allows the specialist to look into the body through a thin, fibreoptic, flexible, powerful lighted tube called an endoscope. The exam is named for the organ involved (for example, colonoscopy to look inside the colon). During the exam, tissue or cells are collected for cytological or histopathological examination.

Laboratory Tests - Although no single test can be used to diagnose cancer, laboratory tests such as blood and urine tests give important information. If cancer is present, certain substances in the blood, urine, other body fluids, or tumour tissue may reflect abnormal levels.

Biopsy -The physical exam, imaging, endoscopy, and lab tests can show that something abnormal is present, but a biopsy is the only sure way to confirm cancer. A sample of tissue from the abnormal area or the whole tumour is removed. A pathologist examines the tissue under a microscope. If cancer is present, the pathologist can usually tell what kind of cancer it is and may be able to predict whether it is likely to grow slowly or quickly.

Tumour Markers

Tumour markers are substances that can often be detected in higher-than-normal amounts in the blood, urine, or body tissues of some patients with certain types of cancer. Tumour markers are produced either by the tumour itself or by the body in response to the presence of cancer.

Currently, the main use of tumour markers is to assess a cancer's response to treatment and to check for recurrence. Scientists continue to study these uses of tumour markers as well as their potential role in the early detection and diagnosis of cancer. Described below are some of the most commonly measured tumour markers

CA 125:is produced by a variety of cells, but particularly by ovarian cancer cells and is used primarily in the management of ovarian cancer. In women receiving chemotherapy, a falling CA 125 level generally indicates that the cancer is responding to treatment. Increasing CA 125 levels during or after treatment, on the other hand, may suggest that the cancer is not responding to therapy or residual cancer cells are present in the body. CA 125 levels is used to monitor patients for recurrence of ovarian cancer. Not all women with elevated CA 125 levels have ovarian cancer. CA 125 levels may also be elevated by cancers of the uterus, cervix, pancreas, liver, colon, breast, lung, and digestive tract. Benign conditions that can cause elevated CA 125 levels include endometriosis, pelvic inflammatory disease, peritonitis, pancreatitis, liver disease, and any condition that inflames the pleura. Menstruation and pregnancy can also cause an increase in CA 125.

Carcinoembryonic antigen (CEA):- is normally found in small amounts in the blood of most healthy people, but may be elevated in cancer or some benign conditions. CEA is used in monitoring colorectal cancer, especially when the disease has metastasized or recurred. However, a wide variety of other cancers including melanoma; lymphoma; and cancers of the breast, lung, pancreas, stomach, cervix, bladder, kidney, thyroid, liver, and ovary may lead to elevated CEA levels. Benign conditions such as inflammatory bowel disease, pancreatitis and liver disease, tobacco use can also contribute to higher levels of CEA.

Alpha-fetoprotein (AFP):- is normally produced by a developing fetus. AFP levels begin to decrease soon after birth and are usually undetectable in the blood of healthy adults (except during pregnancy). An elevated level of AFP strongly suggests the presence of either primary liver cancer or germ cell cancer (cancer that begins in the cells that give rise to eggs or sperm) of the ovary or testicle. Only rarely do patients with other types of cancer (such as stomach cancer) have elevated levels of AFP. Benign conditions that can cause elevated AFP levels include benign liver conditions, such as cirrhosis or hepatitis; ataxia telangiectasia; Wiscott-Aldrich syndrome; and pregnancy.

Human chorionic gonadotropin (HCG):- is normally produced by the placenta during pregnancy. In fact, HCG is sometimes used as a pregnancy test because it increases early within the first trimester. It is also used to screen for choriocarcinoma (a rare cancer of the uterus) in women who are at high risk for the disease, and to monitor the treatment of trophoblastic disease (a rare cancer that develops from an abnormally fertilized egg). Elevated HCG levels may also indicate the presence of cancers of the testis, ovary, liver, stomach, pancreas, and lung. Pregnancy and marijuana use can also cause elevated HCG levels.

CA 19-9:- Initially found in colorectal cancer patients, CA 19-9 has also been identified in patients with pancreatic, stomach, and bile duct cancer. Higher levels of CA 19-9 tend to be associated with more advanced cancer of pancreas. Benign conditions that may elevate CA 19-9 levels include gallstones, pancreatitis, cirrhosis of the liver, and cholecystitis.

CA 15-3:-levels are most useful in following the course of treatment in women diagnosed with breast cancer, especially advanced breast cancer. CA 15-3 levels are rarely elevated in women with early stage breast cancer. Cancers of the ovary, lung, and prostate may also raise CA 15-3 levels. Elevated levels of CA 15-3 may be associated with benign conditions, such as benign breast or ovarian disease, endometriosis, pelvic inflammatory disease, and hepatitis. Pregnancy and lactation can also cause CA 15-3 levels to rise.

CA 27-29:-. Similar to the CA 15-3 antigen, CA 27-29 is found in the blood of most breast cancer patients. CA 27-29 levels may be used in conjunction with other procedures (such as mammograms and measurements of other tumour marker levels) to check for recurrence in women previously treated for stage II and stage III breast cancer. CA 27-29 levels can also be elevated in cancers of the colon, stomach, kidney, lung, ovary, pancreas, uterus, and liver. First trimester pregnancy, endometriosis, ovarian cysts, benign breast disease, kidney disease, and liver disease are noncancerous conditions that can also elevate CA 27-29 levels.

Treatment

Patients with cancer are often treated by a team of specialists which may include a surgical oncologist, a medical oncologist (specialist physician in cancer treatment), a radiation oncologist (specialist in radiation therapy), and others. The doctors may decide to use one treatment method or a combination of methods. The choice of treatment depends on the type and location of the cancer, the stage of the disease, the patient's age and general health, and other factors such as training and experience of the individual who examined the patient first and makes a decision on treatment e.g., T1 tongue cancer will be advised operation if he goes to a surgeon and will be advised radiation if he sees a radiation oncologist. Each treatment may have certain favourable and unfavourable points.

Surgery

Surgery remains one of the most important treatment components for solid tumours. Surgery alone can be curative in patients with localized disease, but because many patients (~70%) have evidence of micro-metastases at diagnosis, combining surgery with other treatment modalities is usually necessary to achieve higher response rates. Continuing advances in cancer surgery have improved patient outcomes and permitted more complex operative procedures. These include:

  • a) improved technical ability to perform complex, radical surgeries, as well as greater understanding about the appropriate applications of radical surgery;
  • b) improved surgical intensive care units resulting in reduced mortality;
  • c) new techniques and improved prosthetics to decrease disability and disfigurement caused by radical surgery; and
  • d) the use of antibiotic therapy to reduce morbidity secondary to infection.

Principles of Cancer Surgery - A number of principles are used by the surgical oncologist in the management of malignant disease:

  • Slow growing cancers are the most amenable to surgical treatment.
  • The initial surgery for malignancy is more successful than secondary operations for recurrence. This is the guiding principle behind many radical surgeries.
  • A margin of normal tissue must be excised to assure an adequate resection.
  • Clinical staging to determine the extent of disease should be completed before definitive surgery, if possible.
  • Removal of the tumour with adjacent lymph nodes is preferable to simple tumour excision (if no serious disfigurement results).
  • The patient must find the potential impairment resulting from the surgery acceptable.
  • Immediate reconstruction and rehabilitation are essential components of cancer surgery and postoperative care.

Types of Cancer Surgery - Surgical procedures for malignancies may be divided into the following categories: diagnostic, staging, definitive (curative), preventative, reconstructive, palliative, and supportive. Surgical procedures are also used in the management of some oncological emergencies.

Staging surgeries are performed to determine the extent of disease. The information obtained helps the oncologist select the surgical procedure and additional therapy most appropriate for that stage of the disease. Exploratory surgery is commonly used to stage disease in patients with Hodgkin’s disease or ovarian cancers. During staging operations, abdominal organs are exposed and palpated for gross evidence of disease. Multiple biopsies are taken from the peritoneal cavity.

Definitive Surgery - The goal of definitive surgery is to excise as much of the tumour as possible. During a curative surgery, the entire tumour, associated lymphatics, margin of surrounding tissue are removed as one specimen. This decreases the possibility of seeding normal tissue with cancer cells. Surgery can be curative for early-stage cervical, breast, GI tract, skin, and vulvar cancers, among others. Ultimately, the selection of the appropriate surgical procedure considers the size of the tumour, its anatomic extent, and the patient's physiological status.

Preventive Surgery plays a limited role in the prevention of malignancy. Surgical intervention may be indicated for a patient with a strong family history of cancer, an underlying condition, or congenital predisposition that increases the risk of developing cancer. For example, colectomy may be recommended for a patient with ulcerative colitis or a history of familial polyposis who has an increased risk of developing colon cancer. Occasionally, prophylactic subcutaneous mastectomies are considered for women with a very strong family history of breast cancer and previous fibrocystic disease. Before any prophylactic surgery, patients should be informed of the statistical risks of developing malignancy as well as the risks and benefits of prophylactic surgery.

Side Effects of Cancer Treatment

It is hard to limit the effects of treatment so that only cancer cells are destroyed. Treatment also damages healthy cells and tissues, resulting in unpleasant and variable side effects.

They depend mainly on the type and extent of the treatment. Each person reacts differently. Efforts are made to keep side effects to a minimum.

Surgery. The side effects of surgery depend on the location of the tumour, the type of operation, the patient's general health, and other factors. Although patients are often uncomfortable during the first few days after surgery, postoperative pain can be controlled with medications. It is also common for patients to feel tired or weak for a while. The length of time it takes to recover from an operation varies for each patient.

Radiation Therapy. With radiation therapy, the side effects depend on the treatment dose and the part of the body that is treated. The most common side effects are tiredness, skin reactions (such as a rash or redness) in the treated areas, nausea, vomiting and loss of appetite. Radiation therapy also may cause a decrease in the number of white blood cells, cells that help protect the body against infection. Although the side effects of radiation therapy can be unpleasant, they can be usually treated or controlled. In most cases, they are not permanent.

Chemotherapy. The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives. Generally, anticancer drugs affect cells that divide rapidly. These include white blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells that line the digestive tract also divide rapidly. As a result of chemotherapy, patients may have side effects, such as loss of appetite, nausea and vomiting, hair loss, or sore mouth. Drugs are given to prevent nausea and vomiting. Usually, these side effects gradually reduce during the recovery period or after completion of treatment.

Hair loss, another side effect of chemotherapy, is a major concern for many patients. Some drugs only cause the hair to thin out, while others may result in the loss of all body hair. Patients may feel better if they decide how to handle hair loss before starting treatment.

Hormone Therapy can also cause a number of side effects. Patients may have nausea and vomiting, swelling or weight gain, and, in some cases, hot flashes. In women, hormone therapy also may cause interrupted menstrual periods, vaginal dryness, and, sometimes, loss of fertility. Hormone therapy in men may cause impotence, loss of sexual desire, or loss of fertility. These changes may be temporary, long lasting, or permanent.

Biological Therapy. The side effects of biological therapy depend on the type of treatment. Often, these treatments cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Some patients get a rash, and some bleed or bruise easily. In addition, interleukin therapy can cause swelling. Depending on how severe these problems are, patients may need to stay in the hospital during treatment. These side effects are usually short-term; they gradually go away after completion of treatment.

Nutritional Effects of Cancer

Anorexia is a frequent problem. Changes in the hypothalamic function or in taste, the development of food aversions, early satiety and the psychological stress of the cancer diagnosis have been suggested as causes of anorexia. Ultimately, they affect the patient's ability to consume enough nutrients to maintain a normal weight.

Cancer cachexia,a complex metabolic problem, is seen in the majority of patients with advanced cancer. Cachexia is characterized clinically by anorexia, early satiety, weight loss, electrolyte and water abnormalities, and a progressive weakening of vital functions. The tumour itself is responsible for initiating cachexia; only by controlling the disease can the symptom be reversed.

The weight loss is a the result of a negative balance between caloric intake and expenditure. Decreased intake cannot entirely explain the progressive weight loss. The body's normal response to decreased food intake is the lowering of the basal metabolic rate (BMR). Although rarely seen, some patients with cancer exhibit a significant increase in BMR and total energy expenditure, possibly as a result of tumour growth and metabolic alterations. Not all patients with cancer manifest increased energy needs.

Support for Cancer Patients

Living with a serious disease is difficult. Cancer patients and those who care about them face many problems and challenges. Coping with these problems is often easier when people have helpful information and support services.

Cancer patients may worry about holding their job, caring for their family, or keeping up daily activities. Worries about tests, treatments, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or daily activities. Meeting with a social worker or counselor also can be helpful to patients who want to talk about their feelings or discuss their concerns about the future or about personal relationships.

Friends and relatives, especially those who have had personal experience with cancer, can be very supportive. It helps patients to meet others who are facing problems like theirs. Cancer patients often get together in support groups, where they share what they have learned about cancer and its treatment and about coping with the disease. Each patient is

different. Treatments and ways of dealing with cancer that work for one person may not be right for another-- even if both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the doctor.

Often, a social worker at the hospital or clinic can suggest groups that help with rehabilitation, emotional support, financial aid, transportation, or home care.

CANCER PATIENTS AID ASSOCIATION
[Financial Aid for Cancer Pts.]
Phone: 307 7812 - 8154; 261 7255 - 8964

MASTECTOMEE ASSOCIATION
(Mrs. Vimal Kamath)
[Counselling for Breast Cancer Pts.]
Phone: 605 6899; 605 7959, Mobile: 98201 40371

INDIAN CANCER SOCIETY
Tel.: 412 2351

V CARE
(Mrs. Uma Joshi)
[Emotional Support for Cancer Pts.]
Phone 636 3655, Mobile: 98210 58659

OSTOMY ASSOCIATION OF INDIA
Tel.: 412 8087

CIPLA PALLIATIVE CARE & TRAINING CENTRE, WARJE, PUNE
(Lt. Col. R. Mukherjee)
[Hospice Care for Terminally Ill Cancer Pts.]
Phone: (020) 5466835; 5465744

SHANTI AVEDNA ASHRAM
[Hospice Care for Terminally Ill Pts.]
Phone: 6421889; 6427464

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