Author: Dr. Ricardo Kotliroff
Cancer encompasses many diseases in which cells from a particular organ reproduce in an unregulated way. When blood cells reproduce in an unregulated way, it is called a hematological malignancy, such as leukemia.
Other types of body cells reproducing in an unregulated way can form a mass, called a solid tumor. If the tumor is unable to invade nearby tissues and is unable to spread to other parts of the body, the tumor is considered benign.
If the cancer cells have the ability to break away from the tumor and travel to adjacent tissues or other regions of the body, the tumor is considered malignant and is also called a malignant neoplasm. For malignant tumors, the histological grade of the tumor cells, which is based on the degree of abnormality of the tumor cells, governs the likelihood of the tumor cells to travel to adjacent tissues and other regions of the body.
Types of Cancer
More than 100 types of cancer exist and are named for the original location (primary site) of the cancer cells in one type of tissue (such as the blood, skin, or bone), region of the body (head and neck), or organ (such as the brain, esophagus, breast, lung, stomach, pancreas, liver, gallbladder, colon, kidney, bladder, ovary, uterus, penis, prostate gland, testicles, and vagina).
Depending on the type of abnormal cell detected, cancers are classified by a pathologist. The type of cell detected is assumed to be from the original site of the tumor.
Causes of Cancer & Risk Factors
Cancer is caused by a series of changes in specific types of cells, making them reproduce without regulation, rather than the normal process of cell division occurring only to replace the natural death of an older cell.
Risk factors for cancer include genetic factors; exposure to radiation, sunlight, toxic chemicals, conventional medications, and hormones; viral infections, diet, and age. Substances that contribute to the cause of cancer are called carcinogens. Depending on the kind of cancer, the types of risks vary.
Individuals with a high likelihood of development of a specific kind of cancer, who have been advised to undergo screening for certain cancers, and who think they may have cancer should consult their physician.
Throughout the world in 2012, the incidence (i.e., new diagnoses) of cancer, not including non-melanoma kinds of skin cancer, happened to 14.1 million individuals. The same year, the estimated global prevalence of individuals (i.e., patients alive) with cancer was 32.6 million.
Common types of cancer include lung cancer, colorectal cancer, skin cancer, prostate cancer, and breast cancer. Skin cancer other than melanoma represents approximately 40% of new cases of cancer.
Most cancers are caused by environmental factors, including lifestyle choices and pollutants. An estimated 5% to 10% of cancers are caused by inherited mutations in genes. In third world countries, almost 20% of cases of cancer are caused by viral infections, such as hepatitis B (HBV), hepatitis C (HCV), and human papillomavirus (HPV).
Worldwide, cancer is responsible for 14.6% of the causes of death annually, representing 8.2 million deaths. An estimated 15% to 20% of cancer deaths are due to infections. Up to 10% of cancer deaths are estimated to be due to radiation.
Approximately 22% to 30% of cancer deaths are due to smoking cigarettes. An estimated 30% to 35% of cancer deaths are due to obesity and dietary habits. Other cancer deaths in which lifestyle choices are responsible are due to drinking alcoholic beverages and insufficient physical activity.
Lifestyle choices, such as healthy dietary habits, physical activity, avoidance of smoking, avoidance of drinking excess amounts of alcoholic beverages, avoidance of prolonged exposure to sunlight, and practicing safe sex can reduce the risk of certain types of cancer.
Signs and Symptoms of Cancer
Signs and symptoms depend on the kind of cancer, whether it has traveled to other regions of the body, and where in the body the cancer has traveled.
In many cases, the symptoms are not specific. For example, the formation of a new mass, unexplained bleeding, unexplained weight loss, unexplained buildup of fluid in the chest or abdomen, unexplained fever, unexplained coughing unexplained pain, or changed bowel movements may suggest cancer or many other diseases.
Complications of cancer depend upon the original type of cancer and where in the body the cancer is located. If untreated, the cancer cells can spread to other tissues or organs in the body. When cancer spreads to sites far from the original location in the body, the disease is called metastatic cancer.
For solid tumors, proper diagnosis by a medical oncologist (or neurological oncologist, gastroenterologist, gynecological oncologist, or urologist, depending on the presumed site of the cancer), a pathologist, and a radiologist is important.
For hematological malignancies, proper diagnosis by a hematological oncologist and a pathologist is important.
The following types of diagnostic tools may be performed:
- Evaluation of symptoms
- Assays to determine what levels of certain molecules (such as prostate-specific antigen) are present are present in the blood
- Biopsies (taking a specimen from a part of the body)
- Endoscopy (using a tube and camera to detect tumors in the upper gastrointestinal tract)
- Colonoscopy (using a tube and camera to detect tumors in the lower gastrointestinal tract)
- Radiologic examination, such as X-rays, nuclear medicine procedures, computed tomography (CT) scans, magnetic resonance imaging (MRI), or positron emission tomography (PET)
A pathologist examines a prepared biopsy specimen under the microscope to determine if abnormalities in the cells are seen, suggesting the presence of pre-cancer cells or cancer cells. Also, a pathologist examines a biopsy specimen to determine if certain molecules are present on the surface of cancer cells, which can help evaluate whether targeted therapy is possible.
A radiologist studies the radiographs to determine whether a mass is observed in different parts of the body.
The outcome of therapy (i.e., the prognosis) depends on the kind of cancer, the grade of the tumor cells, the stage of disease (i.e., how far the cancer has traveled from the original region), the general health of the patient, the age of the patient, and the type of treatment. Therefore, a dramatic difference in survival rates has been observed, even for the same type of cancer.
After diagnosis, the sooner a cancer is treated, the more likely a cure is possible. Types of conventional medical treatment depend on the type and stage of cancer and the goal of the treatment. Treatments can have curative intent, palliative intent (i.e., making the patient comfortable), or supportive intent (reducing side effects of therapy).
Conventional forms of cancer therapy include:
- Surgery by a surgical oncologist
- Hormone therapy that is prescribed by a gynecological oncologist, urological oncologist, or medical oncologist
- Chemotherapy prescribed by a medical oncologist or hematological oncologist
- Targeted therapy (sometimes termed personalized therapy or precision medicine) prescribed by a medical oncologist or hematological oncologist
- Biologic therapy prescribed by a medical oncologist or hematological oncologist
- Immunotherapy prescribed by a medical oncologist or hematological oncologist
- Stem cell transplantation from peripheral blood, bone marrow, and cord blood prescribed by a hematological oncologist
- Photodynamic therapy prescribed by a radiation oncologist
- Laser therapy prescribed by a radiation oncologist
- External beam radiation therapy prescribed by a radiation oncologist
- Radiosurgery prescribed by a radiation oncologist
- Brachiotherapy, which involves implantation of radioactive substances prescribed by a radiation oncologist or nuclear medicine physician
- Combinations of conventional types of cancer therapy, which can reduce the likelihood of recurrence or spread of the cancer
Side effects of surgery, which depend on the part of the body involved in the surgery, include infections. Common side effects of hormone therapy include effects on sexual and reproductive function. All types of radiation therapy (photodynamic therapy, laser therapy, external beam radiation therapy, radiosurgery, and brachiotherapy) can affect normal cells and organs in the radiation field adjacent to the cancer cells being irradiated.
As chemotherapy involves administration of toxic chemicals, it can affect normal cells, as well as cancer cells, Therefore, common side effects of chemotherapy include hair loss (called alopecia), inflammation of the lining of the mouth (called mucositis), and effects on memory and cognition (termed chemobrain). Although targeted therapy, which is based on the surface characteristics and/or genetics of the tumor cells, is designed to affect tumor cells more than normal cells, even targeted therapy has side effects.
Supportive therapy includes:
- Transfusion of blood products recommended by a hematological oncologist
- Biologic therapy recommended by a hematological or medical oncologist
Alternative and complementary types of cancer therapy include:
- Hyperthermia, which involves exposure of part of the body to high temperatures
- Chelation therapy, which involves using chemical agents to bind minerals and/or heavy metals in the body
- Visualization techniques performed by the patient
- Homeopathic treatment
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