Cochin Cardiac Club

Health Blog by Dr.Uday Nair


What is Cancer?

Cancer is a class of diseases characterized by out-of-control cell growth. There are over 100 different types of cancer, and each is classified by the type of cell that is initially affected.

More dangerous, or malignant, tumors form when two things occur:Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer prohibits normal blood function by abnormal cell division in the blood stream). Tumors can grow and interfere with the digestive, nervous, and circulatory systems, and they can release hormones that alter body function. Tumors that stay in one spot and demonstrate limited growth are generally considered to be benign.

  1. a cancerous cell manages to move throughout the body using the blood or lymph systems, destroying healthy tissue in a process called invasion
  2. that cell manages to divide and grow, making new blood vessels to feed itself in a process called angiogenesis.

When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is very difficult to treat.

What are the Risk factors?

A risk factor is anything that increases a person`s chance of developing cancer. Different cancers have different risk factors. Use of tobacco, certain diets, alcohol, exposure to ultraviolet (UV) radiation, and to a lesser extent, exposure to cancer causing agents (carcinogens) in the environment and the workplace are some of the potential catalysts of cancer. It is important to remember, however, that these factors increase a person`s risk but do not always "cause" the disease.

Environmental Risk Factors


High levels of radiation like those from radiation therapies and x-rays (repeated exposure) can damage normal cells and increase the risk of developing leukemia, as well as cancers of the breast, thyroid, lung, stomach and other organs.

Ultraviolet (UV) Radiation

UV radiation from the sun are directly linked to melanoma and other forms of skin cancer. These harmful rays of the sun cause premature aging and damage the skin. Artificial sources of UV radiation, such as sun lamps and tanning booths, also increase the risk of skin cancer. By wearing protective clothing and sunscreens and by avoiding prolonged exposure to the sun, one may reduce the risk of skin cancer.


Some viruses, including hepatitis B and C, human papillomaviruses(HPV), and the Epstein Barr virus, which causes infectious mononucleosis, have been associated with increased cancer risk. Immune system diseases, such as AIDS, can make one more susceptible to some cancers.


Long term exposure to chemicals such as pesticides, uranium, nickel, asbestos, radon and benzene can increase the risk of cancer. Such carcinogens may act alone or in combination with another carcinogen, such as cigarette smoke, to increase the risk of cancer and other lung diseases.


Cigarette smoking and regular exposure to tobacco smoke greatly increase lung cancer. Cigarette smokers are more likely to develop several other types of cancer like those of the mouth, larynx, esophagus, pancreas, bladder, kidney and cervix. Smoking may also increase the likelihood of developing cancers of the stomach, liver, prostate, colon and rectum. The use of other tobacco products, such as chewing tobacco, are linked to cancers of the mouth, tongue and throat. The risk of cancer decreases soon after a smoker quits, while precancerous conditions often diminish after a person stops using smokeless tobacco.


Heavy drinkers face an increased risk of cancers of the mouth, throat, esophagus, larynx and liver. Some studies suggest that even moderate drinking may slightly increase the risk of breast cancer. All cancers caused by cigarette smoking and heavy use of alcohol could be prevented completely.


High-fat, high cholesterol diets are proven risk factors for several types of cancer such as those of the colon, uterus and prostate. Obesity may be linked to breast cancer among older women as well as to cancers of the prostate, pancreas, uterus, colon and ovary. Many cancers that are related to dietary factors could be prevented. Healthy food choices and a well balanced diet including fiber, vitamins, minerals and low fat items may help to reduce cancer risk.Certain cancers are related to viral infections-for example, hepatitis B virus (HBV), human papillomavirus (HPV), human immunodeficiency virus (HIV), human T-cell leukemia/lymphoma virus-I (HTLV-I), and others-that can be prevented through behavioral changes.


Regular screening examinations by a health care professional can result in the detection of cancers of the breast, colon, rectum, cervix, prostate, testis, oral cavity, and skin at an earlier stage, when treatment is more likely to be successful. Self-examinations for cancers of the breast and skin may also result in detection of tumors at early stages. The screening-accessible cancers listed above account for about half of all new cancer cases.

The 5-year relative survival rate for these cancers is about 80%. If everyone  participated in regular cancer screenings, this rate could increase to 95%.

HereDitary Risk Factors

Twenty percent of cancers are hereditary. This means that the abnormal gene responsible for causing cancer is passed from parent to child, posing a greater risk for that type of cancer in all descendants of the family. However, just because someone has a cancer-causing gene doesn`t mean they will automatically get cancer. If hereditary cancer is suspected, family members should consider genetic counseling and testing to determine their risk. If diagnosed in the early stages, such cancers are most responsive to treatment.Signs of hereditary cancer include;


A theory exists with some scientific support, that certain smokers have a higher risk of smoking-induced lung cancer than others because of their genetic make-up.

Ethnic Groups

Some cancers are more common among certain ethnic groups.

Family History

Many cancers are associated with having a family history of that cancer. Breast, ovarian, prostate and colon are some of these cancers.

What are the Signs and symptoms?

You should know some of the general signs and symptoms of cancer. But remember, having any of these does not mean that you have cancer -- many other things cause these signs and symptoms, too. If you have any of these symptoms and they last for a long time or get worse, please see a doctor to find out what is going on.

Unexplained weight loss

Most people with cancer will lose weight at some point. When you lose weight with no known reason, it's called an unexplained weight loss. An unexplained weight loss of 10 pounds or more may be the first sign of cancer. This happens most often with cancers of the pancreas, stomach, esophagus, or lung.


Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all patients with cancer will have fever at some time, especially if the cancer or its treatment affects the immune system. This can make it harder for the body to fight infection. Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.


Fatigue is extreme tiredness that does not get better with rest. It may be an important symptom as cancer grows. It may happen early, though, in cancers like leukemia. Some colon or stomach cancers can cause blood loss. This is another way cancer can cause fatigue.


Pain may be an early symptom with some cancers like bone cancers or testicular cancer. A headache that does not go away or get better with treatment may be a symptom of a brain tumor. Back pain can be a symptom of cancer of the colon, rectum, or ovary. Most often, pain due to cancer is a symptom of cancer that has already spread from where it started (metastasized).

Skin changes

Along with cancers of the skin, some other cancers can cause skin symptoms or signs that can be seen. These signs and symptoms include:
  • Darker looking skin (hyperpigmentation)
  • Yellowish skin and eyes (jaundice)
  • Reddened skin (erythema)
  • Itching (pruritis)
  • Excessive hair growth

Signs and symptoms of certain cancers

Along with the general symptoms, you should watch for certain other common symptoms and signs which could suggest cancer. Again, there may be other causes for each of these, but it is important to see a doctor about them as soon as possible.

Change in bowel habits or bladder function

Long-term constipation, diarrhea, or a change in the size of the stool may be a sign of colon cancer. Pain when passing urine, blood in the urine, or a change in bladder function (such as needing to pass urine more or less often than usual) could be related to bladder or prostate cancer. Report any changes in bladder or bowel function to a doctor.

Sores that do not heal

Skin cancers may bleed and look like sores that do not heal. A long-lasting sore in the mouth could be an oral cancer. This should be dealt with right away, especially in people who smoke, chew tobacco, or often drink alcohol. Sores on the penis or vagina may either be signs of infection or an early cancer, and should be checked by a doctor.

White patches inside the mouth or white spots on the tongue

White patches inside the mouth and white spots on the tongue may be leukoplakia. Leukoplakia is a pre-cancerous area that is caused by frequent irritation. It is often caused by smoking or other tobacco use. People who smoke pipes or use oral or spit tobacco are at high risk for leukoplakia. If it is not treated, leukoplakia can become oral cancer. Any long-lasting mouth changes should be checked by a doctor or dentist right away.

Unusual bleeding or discharge

Unusual bleeding can happen in early or advanced cancer. Blood in the sputum (phlegm) may be a sign of lung cancer. Blood in the stool (or a dark or black stool) could be a sign of colon or rectal cancer. Cancer of the cervix or the endometrium(lining of the uterus) can cause abnormal vaginal bleeding. Blood in the urine may be a sign of bladder or kidney cancer. A bloody discharge from the nipple may be a sign of breast cancer.

Thickening or lump in the breast or other parts of the body

Many cancers can be felt through the skin. These cancers occur mostly in the breast, testicle, lymph nodes (glands), and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer and should be reported to a doctor, especially if you've just found it or notice it has grown in size.

Indigestion or trouble swallowing

Indigestion or swallowing problems may be signs of cancer of the esophagus (the swallowing tube that goes to the stomach), stomach, or pharynx (throat). But like most symptoms on this list, they are most often caused by something other than cancer.

Recent change in a wart or mole or any new skin change

Any wart, mole, or freckle that changes color, size, or shape, or that loses its sharp border should be seen by a doctor right away. Any other skin changes should be reported, too. A skin change may be a melanoma which, if found early, can be treated successfully.

Nagging cough or hoarseness

A cough that does not go away may be a sign of lung cancer. Hoarseness can be a sign of cancer of the voice box (larynx) or thyroid gland.
Most cancers are initially recognized either because signs or symptoms appear or through screening. Neither of these lead to a definitive diagnosis, which usually requires the opinion of a pathologist, a type of physician (medical doctor) who specializes in the diagnosis of cancer and other diseases.
The signs and symptoms listed above are the ones more commonly seen with cancer, but there are many others that are less common and are not listed here. If you notice any major changes in the way your body works or the way you feel -- especially if it lasts for a long time or gets worse -- let a doctor know. If it has nothing to do with cancer, the doctor can find out more about what's going on and, if needed, treat it. If it is cancer, you'll give yourself the chance to have it treated early, when treatment works best.

How is Cancer diagnosed?


People with suspected cancer are investigated with medical tests. These commonly include blood tests, X-rays, CT scans and endoscopy.


A cancer may be suspected for a variety of reasons, but the definitive diagnosis of most malignancies must be confirmed by histological examination of the cancerous cells by a pathologist. Tissue can be obtained from a biopsy or surgery. Many biopsies (such as those of the skin, breast or liver) can be done in a doctor's office. Biopsies of other organs are performed under anesthesia and require surgery in an operating room.
The tissue diagnosis given by the pathologist indicates the type of cell that is proliferating, its histological grade, genetic abnormalities, and other features of the tumor. Together, this information is useful to evaluate the prognosis of the patient and to choose the best treatment. Cytogenetics and immunohistochemistry are other types of testing that the pathologist may perform on the tissue specimen. These tests may provide information about the molecular changes (such as mutations, fusion genes, and numerical chromosome changes) that has happened in the cancer cells, and may thus also indicate the future behavior of the cancer (prognosis) and best treatment.

How is cancer treated?

Cancer treatment depends on the type of cancer, the stage of the cancer (how much it has spread), age, health status, and additional personal characteristics. There is no single treatment for cancer, and patients often receive a combination of therapies and palliative care. Treatments usually fall into one of the following categories: surgery, radiation, chemotherapy, immunotherapy, hormone therapy, or gene therapy.


Surgery is the oldest known treatment for cancer. If a cancer has not metastasized, it is possible to completely cure a patient by surgically removing the cancer from the body. This is often seen in the removal of the prostate or a breast or testicle. After the disease has spread, however, it is nearly impossible to remove all of the cancer cells. Surgery may also be instrumental in helping to control symptoms such as bowel obstruction or spinal cord compression.


Radiation treatment, also known as radiotherapy, destroys cancer by focusing high-energy rays on the cancer cells. This causes damage to the molecules that make up the cancer cells and leads them to commit suicide. Radiotherapy utilizes high-energy gamma-rays that are emitted from metals such as radium or high-energy x-rays that are created in a special machine. Early radiation treatments caused severe side-effects because the energy beams would damage normal, healthy tissue, but technologies have improved so that beams can be more accurately targeted. Radiotherapy is used as a standalone treatment to shrink a tumor or destroy cancer cells (including those associated with leukemia and lymphoma), and it is also used in combination with other cancer treatments.


Chemotherapy utilizes chemicals that interfere with the cell division process - damaging proteins or DNA - so that cancer cells will commit suicide. These treatments target any rapidly dividing cells (not necessarily just cancer cells), but normal cells usually can recover from any chemical-induced damage while cancer cells cannot. Chemotherapy is generally used to treat cancer that has spread or metastasized because the medicines travel throughout the entire body. It is a necessary treatment for some forms of leukemia and lymphoma. Chemotherapy treatment occurs in cycles so the body has time to heal between doses. However, there are still common side effects such as hair loss, nausea, fatigue, and vomiting. Combination therapies often include multiple types of chemotherapy or chemotherapy combined with other treatment options.


Immunotherapy aims to get the body's immune system to fight the tumor. Local immunotherapy injects a treatment into an affected area, for example, to cause inflammation that causes a tumor to shrink. Systemic immunotherapy treats the whole body by administering an agent such as the protein interferon alpha that can shrink tumors. Immunotherapy can also be considered non-specific if it improves cancer-fighting abilities by stimulating the entire immune system, and it can be considered targeted if the treatment specifically tells the immune system to destroy cancer cells. These therapies are relatively young, but researchers have had success with treatments that introduce antibodies to the body that inhibit the growth of breast cancer cells. Bone marrow transplantation (hematopoetic stem cell transplantation) can also be considered immunotherapy because the donor's immune cells will often attack the tumor or cancer cells that are present in the host.

Hormone therapy

Several cancers have been linked to some types of hormones, most notably breast and prostate cancer. Hormone therapy is designed to alter hormone production in the body so that cancer cells stop growing or are killed completely. Breast cancer hormone therapies often focus on reducing estrogen levels (a common drug for this is tamoxifen) and prostate cancer hormone therapies often focus on reducing testosterone levels. In addition, some leukemia and lymphoma cases can be treated with the hormone cortisone.

Gene therapy

The goal of gene therapy is to replace damaged genes with ones that work to address a root cause of cancer: damage to DNA. For example, researchers are trying to replace the damaged gene that signals cells to stop dividing (the p53 gene) with a copy of a working gene. Other gene-based therapies focus on further damaging cancer cell DNA to the point where the cell commits suicide. Gene therapy is a very young field and has not yet resulted in any successful treatments.

No comments: