What is Cancer

The body is made up of trillions of living cells. Normal body cells grow, divide into new cells, and die in an orderly way. During the early years of a person's life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries.

Cancer begins when cells in a part of the body start to grow out of control. There are many kinds of cancer, but they all start because of out-of-control growth of abnormal cells.

Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues, something that normal cells cannot do. Growing out of control and invading other tissues are what makes a cell a cancer cell.

Cancers develop because of a complicated interaction between our genes, the environment and chance.

How are cancers different?

Some cancers grow and spread fast. Others grow more slowly. They also respond to treatment in different ways. Some types of cancer are best treated with surgery; others respond better to drugs called chemotherapy or to Radiotherapy. Often 2 or more treatments are used to get the best results.

♦ Cancer is a global problem
♦ Cancer can affect people of all nationalities and age groups.
♦ Cancer can occur at any age.

A cancer spreads by

By direct spread---to surrounding organs.
By lymphatic spread---to lymph nodes.
By blood ---to distant organs like liver, lung, bones, brain

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Type of Cancer

Heamatological -- Main role of Rx in haematological cancers is CT. Solid tumors -- Main role of Rx in solid tumors is surgery/CT/RT.

Types of Cancer (According to sites) –

Head and Neck Cancer – includes cancer of the oral cavity, pharynx, larynx, nasopharynx, thyroid, parathyroid, eye, ear.
Breast Cancer – includes cancer of the breast.
GI Cancer – includes cancer of the small intestine, colon, rectum, mesentery.
Urological Cancer – includes cancer of the kidney, ureter, bladder, urethra, penis, testis.
Hepatobiliary Cancer – includes cancer of the gall bladder, CBD, pancreas, liver.
Sarcoma – inludes cancer of the bone, muscles.
Skin Cancer – includes cancer of the skin, subcutaneous appendages.
Thorax Cancer – includes cancer of the lungs, mediastinum, esophagus, thymus.
Gynaecological Cancer – includes cancer of the ovary, cervix, uterus, vagina.
Haematological Cancers – includes cancer arising from haemato-lymphopoetic cells like Hodgkin’s Lymphoma, Non Hodgkin’s Lymphoma, AML, ALL, CML, CLL etc.

Types of Cancer (According to histology) –

Different types of cancer may be present at same site according to histology like –

Adenocarcinoma
Squamous cell carcinoma
Melanoma
Lymphoma
Mesenchymal tumors
Neuroendocrine tumors
Metastasis
Etc.

Different treatment for different types of tumor at same site.

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Stage of Cancer

Cancer is usually divided into 4 stages depending on increasing extent of disease. Knowing the stage of the cancer helps the doctor decide what type of treatment is best.

Types of Cancer (According to sites) –

Stage I. Local Disease.
Stage II. Spread to nearby organs.
Stage III. Locally advanced Disease.
Stage IV. Metastatic Disease.
Earlier the stage in which cancer is detected, more are the chances of survival.

Common Symptoms

Signs and symptoms depend on site of origin of cancer, extent of spread of disease.
Some cancers may have obvious signs and symptoms in early stage while some cancers may not have obvious signs and symptoms till late stage.

Warning signs { danger signals} --

A lump in the breast
A change in the mole/wart
A persistent change in bowel habits
A persistent cough or hoarseness
Excessive monthly blood loss/ in between blood loss
Blood loss from any natural orifice
A swelling or ulcer that does not get better
Unexplained loss of weight

Unusual Presentations –

Jaundice
Anaemia
Weight loss
Weakness/fatigue
PUO
Cough
Pathological fractures of bones/ bone pains
Cervical LAP
Ascitis/hepatomegaly

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Treatment of Cancer

The most common treatments for cancer are surgery, chemotherapy, and radiation therapy.
Surgery can be used to remove the disease and sometimes the body part affected by cancer. Surgery is not used for all types of cancer. For example, blood cancers like leukemia are best treated with drugs.
Chemotherapy is the use of drugs to kill cancer cells or slow their growth. Because chemo drugs travel to nearly all parts of the body, they are useful for cancer that has spread. Chemo can be given before surgery to reduce the burden of tumour or after surgery to control the microscopic disease left behind.
Radiation is also used to kill or slow the growth of cancer cells. It can be used alone or with surgery or chemo.

What treatment is best for you?

Your cancer treatment will depend on what’s best for you.

♦ Some cancers respond better to surgery; others respond better to chemo or radiation.
♦ Knowing the type of cancer you have is the first step toward knowing which treatments will work best for you.
♦ The stage of your cancer will also help the doctor decide on the best treatment for you.
♦ Your health and the treatment you prefer will also play a part in deciding about cancer treatment.

Cancer treatments do have some side effects, so ask about what to expect with each treatment.

Multimodality therapy (Team efforts)

Cancer treatment is a multimodality treatment means requires co-operation of multiple departments for better outcome. It requires co-ordination between

• Surgical oncologist.
• Medical oncologist.
• Radiation oncologist.
• Radiologist (Onco).
• Plastic surgeon.
• Pathologist.
• Physiotherapist.
• Dietician.
• Rehabilitation.
• Onco-nursing.
• Blood bank.
• + many more

Remember

• Best chance of cure is at first attempt and proper treatment.
• Right Rx at right time at right place under expert hands.
• Don’t ignore painless lumps.
• Seek early treatment.
• Best results are in early stages.
• Proper treatment is must for cure.
• Rx to be decided by doctor and not by patient.
• Relief of symptoms can be offered even in late stages.

Nowadays good screening programmes are available for Breast, Cervical and Colon Cancers. Screening programme may also be offered for Prostate, Lung and Ovarian malignancy selectively.

What is screening?

Cancer screening is meant for healthy people with no symptoms at all. Screening looks for early signs that could indicate cancer is developing. It can help spot cancers at an early stage, when treatment is more likely to be successful and the chances of survival are much better. In some cases, it can even prevent cancers from developing at all, by picking up early changes that can then be treated to stop them turning into cancer. Cervical screening is the best example of this.Screening is not the same as the tests done for diagnosing or treating cancer.

Universal screening, mass screening or population screening involves screening everyone, usually within a specific age group.

Selective screening identifies people who are known to be at higher risk of developing cancer, such as people with a family history of cancer.

What about people with a high family risk of cancer?

Some people may have a higher risk of certain cancers, perhaps because of a strong family history. Their doctors may recommend they have some extra tests that are different to screening for the general population.

What if I’m not eligible for screening?

No matter what age you are, if you notice anything out of the ordinary for you and your body, it’s important to see your doctor to get checked out.

Should I be screened?

Whether or not to go for screening is your choice. Read about the benefits and risks of the test, so it will help you to make an informed decision.

Benefits of screening

Cancer screening saves thousands of lives each year.

Screening can detect cancer at an early stage. If cancer is picked up early, it means that treatments are more likely to work and more people survive.

Some screening programmes can also prevent cancer. The cervical screening programme, as well as the new Bowel Scope test, can detect abnormal changes before they can turn into cancer. Treating these early changes can prevent cancer from developing.

Risks of screening

Screening is not perfect, and it can miss cancers. How often this happens varies for different types of screening test. That’s why it is still important to know your body and see your doctor about any unusual changes, even if you have had screening.

Screening can also mean people have to come back for more tests and then find out they don’t have cancer. If this happens, you might feel very anxious.

Sometimes, screening can pick up cancers that would not grow at all, or be very slow growing, and the person may never even know they had it. This is called overdiagnosis. It means that people can get a diagnosis of cancer, and have to go through lots of treatments, that they didn’t really need. But doctors can’t tell which cancers need treating and which don’t, so they offer treatment to everyone diagnosed with cancer. This is a particular problem with breast screening.

Sometimes, the tests themselves can have risks or side effects, like bleeding, pain, or infections.

Know your body

Screening programmes can save lives from cancer. But not all cancers can be screened for, and screening tests are not perfect.

Knowing your body and what’s normal for you can help you to notice any unusual changes that could be signs of cancer. Even if you have been screened for breast, cervical or bowel cancer, if you notice any unusual or persistent changes in your body, it’s is important that you go and see your doctor.

Why isn't screening available for all cancers?

Screening programmes can only be set up for a particular cancer type if it will save lives without too much risk. But at the moment, there isn’t enough evidence for screening for all types of cancer.

A screening programme needs to have a good enough test for it to work. This test must:

• reliably detect any cancers or abnormal changes that could lead to cancer
• not cause too many false alarms
• be acceptable, so that people will actually take the test
• not be dangerous to health
• be cost-effective.

If a test doesn’t do these things, it’s unlikely to be effective for screening the whole population.

If a cancer is rare, it wouldn’t be an effective use of time and money to screen the entire population, and it would be harder for the benefits to outweigh the harms. It would also cause unnecessary worry for those being screened. If good tests are available for rarer cancers, doctors will often offer them to people who have the highest risk of the disease.

If there isn’t a good enough test, or if there isn’t enough evidence that screening would save lives and not cause too much harm, then screening isn’t introduced.

At the moment, there isn’t enough evidence to say that screening for any type of cancer other than breast, bowel, and cervical cancer would be a good idea.

But researchers are always looking for new tests and new ways to spot cancers early, and there are some types of cancer where the evidence about screening is growing, for example, lung and ovarian cancers.

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World Cancer Day

World Cancer Day is an international day marked on February 4 to raise awareness of cancer and to encourage its prevention, detection, and treatment. The primary goal of the World Cancer Day is to significantly reduce illness and death caused by cancer by 2020.World Cancer Day targets misinformation, raises awareness, and reduces stigma.

World Cancer Day is the one singular initiative under which the entire world can unite together in the fight against the global cancer epidemic. It takes place every year on 4 February.

World Cancer Day aims to save millions of preventable deaths each year by raising awareness and education about cancer, and pressing governments and individuals across the world to take action against the disease.

History of World Cancer Day

World Cancer Day celebration was planned in the Geneva, Switzerland in 1933 under the direction of UICC (Union for International Cancer Control) and with the support various other well-known cancer societies, research institutes, treatment centers and patient groups.

The day was planned to start its annual celebration in order to save millions lives from the cancer as well as instruct people to check its symptoms, follow its preventive measures and gets saved from the risk of this epidemic disease.

How World Cancer Day is Celebrated

To spread the special messages about the cancer awareness and its prevention, the leading health organizations as well as nongovernmental organizations takes part by organizing the camps, awareness programs, rallies, lectures, seminars and etc. Variety of control measures policies gets implemented and people are promoted to join in masses.

During the event celebration, people are targeted to let them known about the risk factors causing the cancer such as tobacco use, overweight or obese, low fruit or vegetable intake, less or no physical activity, alcohol use, sexual transmission of HPV-infection, urban areas air pollution, indoor smoke, genetically risk factors, over exposure to sunlight and etc. People are also made aware about the vaccination method against the human papilloma virus and hepatitis B virus.

Why World Cancer Day is Celebrated

World cancer day is celebrated to make aware the normal people about the risk factors and preventive measures of the cancer to get prevented or its early detection. Generally, people suffering from the cancer are hated by the normal people in the society and behaved like an untouched person. There are various other social myths related to the cancer that normal people think that they would got cancer if they would touch or live with the person having cancer. The day is celebrated as well to remove such type of the social myths related to the cancer. It is celebrated to make the normal aware about all the reality of the cancer like its symptoms, causing factors, treatment, and etc.

World Cancer Day Theme:

World cancer day is celebrated every year using a particular theme; some of the year wise themes are listed below:

2016-2018 Theme: 'We can. I can'

Taking place under the tagline ‘We can. I can.’, World Cancer Day 2016-2018 will explore how everyone - as a collective or as individuals - can do their part to reduce the global burden of cancer.

You can reduce the risk of getting a cancerous (malignant) tumor by:

• Eating a healthy diet
• Exercising regularly
• Limiting alcohol
• Maintaining a healthy weight
• Minimizing your exposure to radiation and toxic chemicals
• Not smoking or chewing tobacco
• Reducing sun exposure, especially if you burn easily

Disclaimer

The information mentioned in the site is for general awareness of lay public and not for specific treatment. As medical science continues to progress, treatments and therapies mentioned herein can change from time to time. Patients are advised to consult their oncologist for proper evaluation before starting any treatment. The author admits no responsibility for any damage or harm occurring from unsupervised self treatment.

Important Links

Associations

National Comprehensive Cancer Network 
American Society of Clinical Oncology
American Joint Committee on Cancer
Association of Surgeons of India
Association of Physician of India
Indian society of Anaesthesiologist
Indian Association of Surgical Oncology
The Association of Colon & Rectal Surgeons of India
Medical Council of India (MCI)
Rajasthan Medical Council
Delhi Medical Council

Hospitals

SMS medical college, Jaipur -- http://www.education.rajasthan.gov.in/smsmcjaipur
Rajasthan University for Health Sciences -- http://www.ruhsraj.org/
Pt. B.D. Sharma, PGIMS, Rohtak -- http://pgimsrohtak.nic.in/
Manipal Hospital, Jaipur -- https://jaipur.manipalhospitals.com
Rajasthan University -- https://www.uniraj.ac.in/

Journals

Indian Journal of Cancer -- http://www.journalonweb.com/ijc/

Medical humour –

Medical Laughter -- http://www.medicallaughter.com
Medical Humour -- http://www.medindia.net

Common Investigations

Associations

Various tests available for cancer detection and staging are --
Pathological investigations –
Biopsy – is must before starting treatment.
• FNAC
• Imprint cytology
• Biopsy – Incisional, Excisional, Punch biopsy, Core biopsy
• IHC
• PAP smear
Radiological investigations –
• Chest Xray
• CECT Scan
• MRI
• Mammography
• PET-CT Scan
• Bone scan
• OPG
• Thyroid scan
Endoscopies –
• Upper GI endoscopy
• Colonoscopy
• Bronchoscopy
• DL scopy – Direct laryngoscopy
• FOL – Fibre optic laryngoscopy
• EBUS
• EUS
Tumour Markers –
• CA 125- Ca ovary
• CEA – Ca colon, GI malignancies
• CA 19-9 – Hepatobiliary malignancies
• PSA – Ca Prostate
• AFP
• B-HCG
• Others
A patient may require one or multiple of above mentioned investigations for diagnosis and staging and decision making for treatment.

Common Terminology

Associations

Benign : Benign (not cancer) tumor cells grow only locally and cannot spread by invasion or metastasis.
Biopsy : taking out a piece of tissue to see if cancer cells are in it.
Malignant : cells invade neighboring tissues, enter blood vessels, and metastasize to different sites.
Chemotherapy : the use of anti-cancer drugs to treat disease.
Metastasis/Metastasized : the spread of cancer cells from site of origin to distant parts of the body through the lymph system or bloodstream.
Oncologist : a doctor who treats people who have cancer.
Radiation therapy : the use of high-energy rays, like x-rays, to treat cancer disease.
Remission : when signs or symptoms of cancer are all or partly gone.
Stage : tells whether a cancer has spread, and if so, how far.

MYTH AND FACTS ABOUT CANCER

There is a lot of information about cancer available, but some of it is misleading or inaccurate. Below you will find the truth behind some of the most common cancer myths and misconceptions.

MYTH: CANCER IS CONTAGIOUS.

No cancer is contagious.
However, some cancers are caused by viruses that can be spread from person to person. The human papillomavirus (HPV) is a sexually transmitted disease that increases the risk of developing cervical, anal, and some types of head and neck cancers. Other viruses, such as hepatitis B and hepatitis C, which are transmitted by infected intravenous needles and sexual activity, increase the risk of developing liver cancer.

MYTH: IF YOU HAVE A FAMILY HISTORY OF CANCER, YOU WILL GET IT TOO; THERE’S NOTHING YOU CAN DO ABOUT IT.

Although having a family history of cancer increases your risk of developing the disease, it is not a definite prediction of your future health.
In fact, an estimated 4 out of 10 cancers can be prevented by making simple lifestyle changes, such as eating a nutritious diet, maintaining a healthy weight, exercising, limiting alcoholic beverages, and avoiding tobacco products. Additionally, doctors may recommend that some people who have inherited a genetic mutation (change) that puts them at high risk for cancer have surgery or take medication to reduce the chance that cancer will develop.

MYTH: CANCER THRIVES ON SUGAR.

Many people with cancer wonder if they should stop eating sugar because they have heard sugar feeds cancer growth. However, there is no conclusive evidence that proves eating sugar will make cancer grow and spread more quickly. All cells in the body, both healthy cells and cancer cells, depend on sugar (glucose) to grow and function. However, eating sugar won’t speed up the growth of cancer, just as cutting out sugar completely won’t slow down its growth.

MYTH: CANCER TREATMENT IS USUALLY WORSE THAN THE DISEASE.

Although cancer treatments, such as chemotherapy and radiation therapy, can cause unpleasant and sometimes serious side effects, recent advances have resulted in many drugs and radiation treatments that are much better tolerated than in the past. As a result, symptoms like severe nausea and vomiting, hair loss, and tissue damage are much less common these days. Managing side effects still remains an important part of cancer care, though.

MYTH: IT IS EASIER TO REMAIN UNAWARE YOU HAVE CANCER.

You should not ignore the symptoms or signs of cancer, such as a breast lump or an abnormal-looking mole. Although the thought of having cancer is frightening, talking with your doctor and getting a diagnosis will give you the power to make informed choices and seek the best possible care. Because treatment is usually more effective during the early stages of cancer, an early diagnosis often improves a person’s chances of survival.

MYTH: POSITIVE THINKING WILL CURE CANCER.

Although a positive attitude may improve a person’s quality of life during cancer treatment, there is no scientific evidence that it can cure cancer. Placing such importance on attitude may lead to unnecessary guilt and disappointment if, for reasons beyond your control, your health does not improve.

MYTH: DRUG COMPANIES, THE GOVERNMENT, AND THE MEDICAL ESTABLISHMENT ARE HIDING A CURE FOR CANCER.

No one is withholding a miracle treatment. The fact is, there will not be a single cure for cancer. Hundreds of types of cancer exist, and they respond differently to various types of treatment. There is still much to learn, which is why clinical trials continue to be essential for making progress in preventing, diagnosing, and treating cancer.

MYTH: IF I’M NOT OFFERED ALL OF THE TESTS, PROCEDURES, AND TREATMENTS AVAILABLE, I AM NOT GETTING THE BEST CANCER CARE.

Not every test, treatment, or procedure is right for every person. You and your doctor should discuss which ones will increase your chance of recovery and help you maintain the best quality of life and which ones could increase your risk of side effects and lead to unnecessary costs. If you decide after this discussion that you need more information before making treatment decisions, it may be helpful to seek a second opinion.

MYTH: NO TREATMENT OF LUMP BECAUSE ITS PAINLESS.

When lump becomes painfull, it is already advanced disease.
Seek treatment early to get better results.

MYTH: CANCER IS INCURABLE.

Cancer is curable if treated early and proper treatment at proper place is done.
Early the stage – more the chances of cure.
Higher the stage – less the chance of cure.

MYTH: CANCER WILL INCREASE ONCE TOUCHED (BY SURGERY OR BIOPSY).

Cancer is growing at its own speed whether touched or not.
It increases after surgery only when improper surgery (inadequate) is done.

MYTH - IF YOU ARE DIAGNOSED WITH CANCER, YOU WILL PROBABLY DIE.

Cancer is not a death sentence.
Advances in cancer detection and treatment have increased survival rates for most common types of cancer.
In fact, more than 60% of people with cancer survive five years or more after their initial diagnosis.

MYTH - SOME PEOPLE ARE TOO OLD FOR CANCER TREATMENT.

There is no age limit for cancer treatment. People with cancer should receive the treatment that is best suited to their condition, regardless of age.
Many older patients respond as well to cancer treatments as younger patients.
However, some older adults may have other illnesses that limit the use of specific treatments, so older adults with cancer are encouraged to talk with their doctor about the best approach for managing their disease.

MYTH - PEOPLE BEING TREATED FOR CANCER CAN’T STAY AT HOME, WORK, OR PARTICIPATE IN THEIR USUAL ACTIVITIES.

Most people living with cancer are treated in their home community on an outpatient basis (with periodic appointments at a hospital or clinic rather than an overnight stay at a hospital) and often continue with some or all of their day-to-day activities.
Many people can work part-time or full-time, care for their children, and attend social activities, despite undergoing cancer treatment.

MYTH - THERE ARE NO SIGNS OR SYMPTOMS OF CANCER.

Truth: For many cancers, there are warning signs and symptoms and the benefits of early detection are indisputable.
Early detection is multifaceted. Strategies that raise awareness about cancer and the importance of seeking care when symptoms are present, along with interventions for early diagnosis have the greatest chance of improving cancer outcomes.

MYTH : CANCEROUS LUMPS.

Misconception: Any lumps or large masses detected during cancer screenings are cancerous.
Not every abnormality is an automatic cancer diagnosis.
Some tumors are benign, meaning they are non-cancerous, however, determining which are benign, pre-cancerous, and cancerous is why screenings are important.

Myth :

Common people think that cancer is a disease for wealthy and old age people however it is a global and epidemic disease which can affect all age group.

ABOUT NATIONAL CANCER SURVIOVRS DAY

National Cancer Survivors Day is an annual, treasured Celebration of Life that is held in hundreds of communities nationwide, and around the world, on the first Sunday in June.

It is a CELEBRATION for those who have survived, an INSPIRATION for those recently diagnosed, a gathering of SUPPORT for families, and an OUTREACH to the community.

On National Cancer Survivors Day, people gather across the globe to honor cancer survivors and to show the world that life after a cancer diagnosis can be fruitful, rewarding, and even inspiring.

It is a day for everyone, whether you're a cancer survivor, a family member, friend, or medical professional. This day provides an opportunity for all people living with a history of cancer to connect with each other, celebrate milestones, and recognize those who have supported them along the way.

It is also a day to draw attention to the ongoing challenges of cancer survivorship in order to promote more resources, research, and survivor-friendly legislation to improve cancer survivors’ quality of life.

The nonprofit National Cancer Survivors Day Foundation provides free guidance, education, and networking to hundreds of hospitals, support groups, and other cancer-related organizations that host NCSD events in their communities.

Through National Cancer Survivors Day, the Foundation works to improve the quality of life of cancer survivors by raising awareness of the ongoing challenges of cancer survivorship.

Who is a cancer survivor? The National Cancer Survivors Day Foundation defines a survivor as anyone living with a history of cancer – from the moment of diagnosis through the remainder of life.