Introduction | Incidence | Etiology or Causes | Risk Factor | Pathophysiology | Difference Between Benign and Malignant | Classification of Cancer | General Effects | Tumor Markers | General Symptoms | Psychological Changes | Warning sign of Cancer | Prevention of Cancer | Investigation |

Cancer: Everything you want to know!

Cancer Introduction:-

why cancer is called cancer?

Cancer is a disease of cell in which normal mechanisms of control of growth and proliferation are disturbed. Cancer is a group of cells that grows out of control, taking over the function of affected organs or it is a group of diseases characterized by uncontrolled cellular growth with local tissue invasion at systemic metastasis.

It is a disease process that begins when abnormal cells are transformed by a genetic mutation of cellular DNA.

Incidence Of Occurrence:-

Cancer affects millions of people around the world. It affects a large group but higher in very young and old age. The incidence rate is greater in men than in women.

Some of the percentages are:-

how many cancer are there?

In Male:-

Prostate cancer (32%)
Lung cancer (16%)
Oral cancer(15%)
Colorectal cancer(12%)
Urinary Tract including Urinary Bladder(9%)
Leukemia Cancer(7%)
Skin and Renal cancer(4%)
Pancreatic cancer(2%)

In Female:-

Cervical Cancer(26%)
Breast cancer(21%)
Colorectal cancer(13%)
Oral cancer(11%)
Uterine cancer(8%)
Leukemia (6%)
Skin cancer(4%)
Ovarian, Kidney’s, Thyroid Cancer(3%)

Cancer Etiology or Cancer Causes:-

The exact causes of the development of cancer are unknown.

Various theories are suggested which are the following:-

(a). Virus and Bacteria:-

Viruses and bacteria are thought to be in co-operative themselves in the genetic structure of the cells. Thus altering the future generation of that cell population leading to cancer.

For example- Herpes Simplex Virus (HSP) causes Nasopharyngeal cancer. Cytomegalovirus (CMV) and Papillomavirus can cause Cervical and vaginal cancer.

(b). Radiation:-

There is an increased incidence of cancer in persons who exposed to prolong or large amounts of radiation. Ionizing radiation involving x-ray, alpha, beta, gamma rays, and UV rays present in sunlight. It also plays a major role in promoting leukemia, melanomas, or Skin cancer. The UV rays have ionizing indications which change in DNA structure that can be lead to malignant transformation.

(c). Chemical Agents:-

It includes dyes, pesticides or fertilizers, cosmetics, tar, fuel, oil, etc. These agents can cause cancer only after closed and prolong contact. The persons affected are usually workers of industry, labors, persons working in the laboratory, and farmers. In which these chemicals are used or produced.

(d). Genetic Factor:-

Genetic factors play a large role in cancer formation. Certain types of cancer are linked to specific gene mutations.

for example- Breast cancer, Colorectal cancer, Skin cancer, Prostate cancer have a genetic tendency.

(e). Diet:-

DIet is also a major factor for the cause of malignancy. People who eat or take high fat or low fiber diet, are more prone to develop colorectal cancer and a high-fat diet is linked to breast cancer in women and prostate cancer in men.

The conception of a large number of pickles, spicy foods, smoked food, has been linked with esophageal and gastric or stomach cancer.

(f). Hormonal Factor:-

Hormonal agent that disturb the hormonal balance of the may also cause or promote cancer. For example Long term use of female hormone therapy (estrogen and progesterone), use of regular or prolong contraceptives are associated with cancer of breast, uterus, cervix, ovaries, vagina, etc. The hormonal changes during the time of puberty and reproduction are also associated with cancer. Example: DES (Diethylstilbestrol ).

(g). Immune Factor:-

A healthy immune system destroys mutant cells. Individual with altered or weak immunity and more exposed to the system fails to identify and stop the growth of malignant cells clinically cancer develops.

Cancer Risk Factor:-

Age:- Increased incidence is seen in very young and older persons. Example: Acute leukemia in children, Prostate cancer seen in older persons.
Gender:- Women have a risk for developing certain types of cancer and men also have a risk for developing certain types of cancer. Example: In older males Testicular, Prostate cancer is common. In women breast cancer, cervical cancer is common.
Environmental / Geographical area/ location:- The environmental factor such as climate excessive hot, cold, air, water, soil, pollution, humidity, etc. The environmental factor also plays an important role in developing cancer. The people living in urban areas are more prone to cancer than the rural areas.
LifeStyle / Habits:- Lifestyle/habit include lack of physical activity or exercise, poor personal hygiene, improper sleeping or rest, smoking use of tobacco or betel nuts, use of drugs, and excessive conception of alcohol, or beverage.
Stress:- Hypothalamus regulates hormones or the immune system increased stress causes hormonal or immunological changes that affect the growth and proliferation of the cell.
Other factors:– It includes occupation, exposure to radio-isotopes.

Cancer Pathophysiology [Carcinogenesis, Oncogenesis]:-

Carcinogen:- Factor that associated with cancer conversion or production. for example: Maybe radiation, chemical, virus, bacteria, and other agents, in addition, hormones and stress play a significant role in the development of cancer.

Cancer is caused by a serious mutation.

Proliferation:– Rapid multiplication of cells may occur in malignant growth or during wound healing.

Infiltration:- The entrance and diffusion of some substances, had usually form those, either fluid or solids into the cells, tissues, or membrane.

It is the transformation of normal cells into the cancer cells also called Oncogenesis. The process through which normal cells are transformed into the malignant or cancer cells called Carcinogenesis.

Carcinogenesis also called Oncogenesis or Tumorogenesis. It is the formation of cancer were by normal cells are transformed into cancer cells. The process is characterized by changes at the cellular, genetic and epigenetic levels, and abnormal cell division.

There are four broadly identified stages or processes of carcinogenesis which are:-

Initiation
Promotion
Malignant conversion
Progression

Initiation or Cancer 1st stage:- Initiation occurs when carcinogens damage DNA. Carcinogens cause a change in the structure and function of the cells at the genetic or molecular level. This damage may be reversible or maybe lead to a genetic mutation that is not repaired. However, the mutation may not lead immediately to cancer.
Promotion or Cancer 2nd stage:– Promotion occurs with additional assault ( sudden attack or destroy)to the self resulting in further genetic damage.
Malignant Conversion or Cancer 3rd stage:- At some point, these genetic events result in management conversion.
Progression or Cancer 4th stage:- With progression cells are increasing malignant in appearance and invasive development with active cancer with metastasis to distant body parts or area.

Difference between Benign Tumour and Malignant Tumour:-

Classification of Cancer:-

Anatomical Classification
Histological Classification [ Grade ]
The extent of Disease [ Stage, Metastasis ]
T.N.M. Classification [ Tumour Nodes Metastasis ]

1. Anatomical Classification:-

2. Histological Classification [ Grading ]:-

It defines types of tissues from which the tumor is originated and the degree to which the tumor cells retain the functions and histological characteristics of tissue of tissues of their origin [growth].

Grade 1st:- cells differ slightly from normal cells and well-differentiated (mild or slight dysplasia).

Grade 2nd:- More abnormal cells with moderate differentiation (moderate dysplasia).

Grade 3rd:- Cells are very abnormal and poor differentiation (Severe Dysplasia).

Grade 4th:- Cells are immature, primitive, and undifferentiated (anaplasia).

3. The extent of Disease [ staging, metastasis]:-

Stage 1st:- Tumour in situ. Tumour is limited to the tissue of origin or localized.

Stage 2nd:– Increase in tumor size with local metastasis.

Stage 3rd:- Metastasis to regional lymph nodes.

Stage 4th:- Distant metastasis.

4. T.N.M. classification:-

T – [primary tumor]

T (x) – Tumor cannot adequately be assessed.

T (o) – No evidence of primary tumor.

T (is) – Tumor in situ or localized.

T (1-4) – progressive increase in tumor size or extent of the primary tumor.

N – [ Regional Lymph nodes ]

N (o) – Regional lymph nodes cannot be assessed.

N (x) – No evidence of lymph nodes involvement.

N (1-4) – Increase in the degree of lymph nodes involvement.

M – [ Metastasis ]

M (x) – The presence of metastasis cannot be assessed.

M (o) – No evidence of metastasis or distant metastasis.

M (1-4) – Distant metastasis.

Cancer General Effects:-

Tumor in the bowel:-

Bowel obstruction
Constipation
diarrhea
G.I. Disturbance
Bleeding

Tumor in Prostate:-

Urinary problems
Urinary Bladder distension
Incontinence
Urinary retention
Sexual disfunction
Decreased libido

Tumor in the Liver:-

Fat, lipid, carbohydrate, protein metabolism will be disturbed.

Tumor in the Lungs:-

Respiratory distress, dyspnea.

Tumor in Mouth:-

Difficulty in mastication, Dysphagia.

Hematological Effects:-

Hematocrit decreases
WBC count (increase or decrease)
Hemoglobin Decreases.

Tumor Markers:-

Cancer Antigen 125:- Increases in ovarian and pancreatic cancer.
Prostatic Specific Antigen (PSA):- Increased in prostate cancer.
Prostate Acid Phosphate:- Increased in metastatic prostate cancer.
Carcinoembryonic antigen (CEA):- Increase in colorectal, breast, lungs, pancreatic, stomach, etc.

Cancer General symptoms:-

Anorexia
Weight loss
Anemia
Extreme fatigue
Pain
Headache
Nausea, Vomiting.

Cancer Psychological changes/Responses:-

Malaise
Grief
Hopelessness
Guilt
ANger
Anxiety
Fear of Death
Body image disturbance
Lack of confidence
Disfunction in sexual desire
Isolation or withdrawal.

can cancer be prevented?

Prevention of Cancer:-

What are cancer 7 warning signs?

cancer 7 warning signs:-

C – Change in bowel and bladder habits.

A – A sore that doesn’t heal.

U – Unusual bleeding or discharge.

T – Thickening of lumps ( breast or lymph nodes ).

I – Indigestion and dysphagia.

O – Obvious changes in moles.

N – Nagging cough/harshness.

The prevention of cancer is classified into three stages. These three interrelated activities involved in cancer prevention and control. These are:-

Primary Prevention
Early Detection
Screening

Primary Prevention Involves measures to avoid or reduce exposure to carcinogenesis.

Early detection involves finding the pre-cancer lesions (warning sign) or cancer detect in the earliest and most treatable stage.

Seven process helps to identify high-risk population or individuals.

Primary Prevention:-

Primary prevention activity is in at intervention before pathology change has begun. They can help to reduce cancer risk through alteration of lifestyle, behavior, habits to eliminate and reduce exposure to carcinogens.

Many cancers are associated with smoking, dietary habits, and alcohol consumption. Some of cancer caused by combined tobacco or alcohol consumption should be avoided.

Adopting a more healthy diet, limiting exposure to sun and other sources like radiation or UV rays, modifying sexual practices, and increasing exposure to environmental and occupational carcinogens would lead to further reduction of cancer incidence.

Early Detection:-

Secondary prevention also referred to as early detection. Provides the opportunity to detect pre-cancers lesions or early-stage cancer before manifestation becomes readily apparent to the client to treat them promptly.

Screening efforts anticipate early detection, method of early detection are inception, palpation, and the uses of tests or procedures.

Inspection is useful in identifying lesions of the skin, lips, mouth, extragenital area, lumps, and nodules in the breast, salivary glands, mouth, subcutaneous tissues in the prostate, testis as well as enlarged lymph nodes can be detected through palpation.

Mammography, smear, blood test, and endoscopy examination and radiologic imaging studies are some of the test investigations or procedures that can be used.

As a result of the early detection pre-malignant lesion may be attested, removed, reversed, or cancer treatment can be started either often by the cancer is in a stage more enable to treatment.

Screening:-

Screening identifies a high risk of a group of people more likely to have cancer or pre-cancer lesions. It is estimated that some of the cancer can be cured in all available screening tests and self-examination methods worthy practiced routinely.

Criteria for Screening:-

The population to be screen as a high incidence of disease.
The disease is detectable in its pre-symptomatic stages.
Prognosis is poor if diagnosis delayed and manifestation is appearing and effective treatment is available for a disease that is diagnosed early.
The potential benefits of screening outweigh its potential risk and cost.

Approaches to Prevent Cancer:-

Education:- It beliefs that influence the effectiveness of education consist of client perception of susceptibility to developing cancer, about the harmful and beneficial consequences of lifestyle, behavior, and perception about the benefits of prevention and early detection.

Regulation:- Method of regulation utilized on the contrary includes prohibiting the selling of tobacco and alcohol to minors, limiting or restricting smoking in a public place, imposing excise taxes, regulating the use of manifested carcinogens, and prohibiting carcinogenesis in packed food.

Host modification:- Its aims to alter the body’s internal environment to decrease the risk of cancer or to reverse the carcinogenic.

Other Prevention:-

Educate the community or family about cancer and to avoid carcinogenesis.
Increase fiber-rich diet intake to decrease the risk of gastric and colorectal cancer.
Decrease intake of fats to decrease the risk of prostate and breast cancer.
Stop cigarette smoking (active and passive).
Avoid tobacco and betel nut.
Avoid overexposure to sunlight and radiation.
Advice to participate in regular exercise programs and self-examination.
Take adequate rest and sleep (6-8 hours/day) eliminate and reduce physical and mental stress.
Tell the people or community about the warning sign of cancer.

Investigation:-

The investigation is generally divided into two categories:-

Cytological Study
Radiological Study

1. Cytological Studies:-

Cytology is the study of anatomy, physiology, pathology, and chemistry of the cells. One of the most common cytological studies are:-

Staining technique developed by George M. Papanicolaou [ PAP test ], which is used to detect malignant cells. This test is used to study of vaginal and cervical cells, sometimes it may be used for other tissues obtained easily by smearing or scraping such as oral, bronchial, genital tract and tissues not available for scraping must be obtained by biopsy, which the removal of tissues for diagnostic studies.

Many times a fixative or refrigeration is used to prevent tissues decomposition by section method [ Frozen or Freezing technique ].

Biopsy:-

It is the surgical removal of tissues or cells. It helps in accurate identification of nature or type of cancer cells [ Benign or Malignant ]. The biopsy procedure is divided either open or closed.

1. Open Biopsy:-

A surgical incision is needed for open biopsy. There are two types of open biopsy.

Incisional Open Biopsy:- In this type of biopsy, a selected part or portion of lesion or tumor is removed. This type of biopsy is commonly completed during endoscopic examination.
Excisional Open Biopsy:- In this type of biopsy, the entire lesion or tumor and a margin of surrounding normal tissues are removed. This is the procedure of choice in most cases [ to prevent infiltration ]. There are procedures usually performed in an i=operative room or minor OT with the use of local anesthesia or IV sedation. After the procedure, the incision is closed with the sutures, and dressing is placed over the site.

2. Closed Biopsy:-

In a closed biopsy, no open surgical incision is used. The closed biopsy includes:-

Needle Aspiration Biopsy:- A needle aspiration biopsy is inserted into the tissues or tumor, the aspirated cells or tissues are then examined under the microscope. This technique is common for the biopsy of the breast or prostate masses or tumors.
Core Needle Aspiration Biopsy:- A special needle cuts specimen from tissues or tumors which not in view. This technique is common for biopsy of kidneys, liver, prostate, etc.
Stereotactic Biopsy or Imaging Biopsy:- A 3D view of abnormal tissues is created on the basis of imaging research, then the needle is inserted into the mass or tumor. The client must be motionless for about 20-30 minutes while the procedure. This technique is used for biopsy of certain lungs tumor or lesions.

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