What is Cancer? Cancer is a common name for a group of diseases characterised by uncontrolled proliferation of abnormal cells. Human body is made up of several organs, which are constituted of specific characteristic cells. Cells divide for growth of an organ, for repairing tissue damage and to maintain functions of the organ. The daughter cells are the exact replica of their parent cells. Sometimes due to either some faulty mechanism or some factors that are unknown yet, the daughter cells become abnormal and unlike their parent cells. They don’t discharge the same functions but requires the same nutrition like the normal cells. These cells again divide to produce a large number of abnormal cells for which human body organs do not function normally and his nutrition is impaired rapidly. These cells cluster to form lumps, swellings, and sometimes produce ulcers in the respective organs, which we call as cancer. However, in case of blood cancer (Leukaemia), the abnormal cells start circulating in the blood stream and thus no visible lump or swellings are observed. Cancer is known by its different types like sarcoma, lymphoma, leukaemia, myeloma, carcinoma etc. Its most important characterisitc is that the cancer cells breakaway from the tissue or organ of origin and starts spreading to other parts of the body through lymphatic channels or cavities or blood vessels. They lodge in other parts of the body organ and grow. This is known as metastasis. Because of this unique characteristic, it becomes difficult to cure or to control cancer when it has spread.
Is Cancer increasing in our country? In Western countries, where accurate statistics are available, cancer is seen to increase during the last 40-50 years. Increase in human life-span, changes in life-style and increasing environmental pollution are likely to contribute to an increase in cancer incidence. In India, average 70 new cancer cases annually develop per 100, 000 population. This may appear to be a low rate, but if we consider 80 years as human life span, this estimation will be almost 16% of the population who live up to this age. Based on these, it is estimated that almost 5 lakhs of persons will develop cancer every year in the country and in any given year there will be almost 15 lakhs cancer patients. As the population increases, this number also will increase. In order to study the cancer occurrences in our country, and to monitor its trends, cancer registries have been started in several places by the Indian Council of Medical Research (ICMR).
What are the most common Cancers seen in Indians? Cancer affects different body organs due to various factors. In India, there are variations in the occurrences and patterns of cancer. However, the majority of cancers in male is found in mouth, throat, lungs, stomach etc. and in female, is largely found in uterus [cervix], breast, ovary, mouth and throat. The three most common cancers are oral, cervix and breast cancers. Through awareness these three cancers can be prevented, detected early and treated optimally for a better cure and survival. Certain cancers like Cancer Breast, Colon and Retinoblastoma in a child do have a hereditary tendency.
Does a lump always mean Cancer? No. A lump can occur in any part of the body, which may or may not contain cancer cells. Some of these lumps may grow to large sizes and produce ulcers. Because of this, they interfere with normal functions of nearby organs. However, they do not spread to other body parts or cause death and can easily be removed by surgery. Such tumours are harmless and known as benign tumours, whereas cancer is a malignant tumour that spreads and infiltrates to other organs.
Do Viruses cause Cancer? There is good evidence to suspect that viruses may cause cancer in humans: leukaemia, nasopharyngeal cancer, liver and cervix cancer are considered now as being caused by viruses.
Does heavy Alchohol consumption cause Cancer? Heavy alchohol consumption especially in the presence of smoking increases the risk of certain cancers like cancer of tongue, throat, gullet, stomach and liver.
Is Radiation a cause for Cancer? Radiation is widely used to diagnose many diseases. Radiation is also a very successful method to treat cancer. These are absolutely proper and safe uses. However, Radiation is extremely dangerous and can cause cancer when not properly handled. Over exposure to X-rays, or byproducts of atomic radiation can contribute to the development of cancer especially leukaemia.
Does Tobacco Chewing or Smoking cause Cancer? Tobacco chewers develop cancer of cheek, tongue, gums etc. They are chronic chewers, often starting the habit at a young age of 15 or 18 years. They keep the tobacco quid [pan] in the mouth for a long time and often keep the quid even while asleep. Smoking cigarettes is the cause of 75% of all lung cancers and 25% of all cancers in the Western countries. Smokers are also likely to develop cancer of the mouth, pharynx, oesophagus [Gullet] pancreas and urinary bladder. In our country, almost 50% of all cancer in men is caused by heavy tobacco chewing and smoking; rather it is worse. The bidi contains more toxic harmful chemicals than in cigarette which produces cancer. Tobacco smoking is also the major cause of heart disease, gastric ulcers, chronic bronchitis, emphysema and often the smoker dies young. Due to the husband's smoking habits, his wife [passive smoking] is also at a high risk for developing cancer of various organs. In closed environments like bus, theatre, office, train and meeting halls smoking are dangerous to non smokers also.
How does early diagnosis help? When cancer has not spread beyond its site of origin a complete cure is often possible. When a cervix cancer is localized, almost 100% cure is possible but when it has spread to nearby bladder or rectum, not even 20% will live up to 5 years. Similarly, an early breast cancer when treated adequately would have a more than 85% chance of surviving more than 5 years whereas when it is spread to lungs less than 10% would survive 5 years. Thus early diagnosis ensures a better cure rate.
How is an early cancer detected? One should know the warning signals of cancer. These need not always be due to cancer, but when a symptom is noted, promptly undergo a through medical examination by a competent physician or cancer specialist. Secondly, self examination methods and periodic self examination of mouth and breast can detect many cancers in early or precancerous stages. In case of ulterine cervix, a simple cervical smear tests necessary for early detection.
What are the warning signals of cancer?
• A sore or ulcer that does not heal within 3 weeks even after taking antibiotics.
• Pearly white patches in the mouth.
• Inability to hold salty food in mouth.
• Unusual bleeding or discharge from any orifice.
• Thickening or lump in breast or elsewhere in the body.
• Repeated abdominal cramps, indigestion. Difficulty in swallowing which lasts more than 3 weeks.
• Changes in bowel habits [Diarrhoea & Consumption] lasting for more than 3 weeks.
• Hoarseness of voice, nagging cough; persisting even after treatment for 3 weeks.
• Difficulty in urination, blood in urine, especially if you are above 45 years of age.
• Change in wart or mole.
• Listlessness, anaemia, intermittent fever which are not controlled by conversational medication.
• Impairment in vision, white patches the eye, often shining at night.
• These signs need not always be due to Cancer. But consult a specialist doctor if you have any of the above symptoms.
How is Cancer Diagnosed? The diagnosis of cancer can be made only after a careful clinical examination and several laboratory tests to accurately know the primary site of origin of cancer, type of cancer and to learn the extent of spread of the disease. These are necessary for planning effective treatment. Identifying cancer cells with the help of a microscope in an aspirate of body issue or scrapings of fluids aspirated by a needle and syringe is called cytology. The examination of a piece of body tissue after processing is called biopsy and histopathology examination. Endoscopes passed in to the body are used to diagnose cancer of deep seated internal organs like oesophagus, stomach, intestines, thoracic and abdominal cavities. For diagnosing leukamia, blood examination is essential. Plain X-ray pictures are used to diagnose cancers of bone. Some times special X-rays like Barium X-rays, angiograms etc. are taken. Ultrasound scanning, CT scanning, NMR scanning and scanning by radio-isotopes are also used depending the site of cancer. Certain biochemical tests are undertaken to diagnose multiple myeloma. Generally, the doctor will do two or three tests for a suspected cancer.
Is it possible to prevent cancer? It is recognized that some cancers can be prevented. Most mouth cancers can be prevented by not chewing tobacco and most lung and throat cancers can be prevented by not smoking. Certain cancers are produced by chemicals used in industry. If workers are protected against contact with such occupational factors, some cancers can be prevented. A well balanced diet with less fat and more green leafy vegetables, citrus fruits, milk etc. can protect people. Above all, even though not all cancers are preventable, many deaths due to cancer can be prevented by early detection and proper treatment. Knowledge of the warning signals of cancer helps one to get an early diagnosis and a successful treatment.
Can diet cause for prevent cancer? Many scientists are now studying this factor to establish a cause - effect relationship. It is generally suggested that a high fat diet can cause cancer of Intestine, Colon, Rectum, Prostate, Uterus and Breast. In Japan the use of salted pickles, is believed to be the cause for the high stomach cancer rate. By the use of grilled meat reached oil, one consumes significant quantities of certain chemicals that can produce cancer. Certain food additives and coloring agents are also highly suspected to cause cancer. Diet with plenty of fiber is shown to be protective against Intestinal cancer. Studies in Japan and other western countries have established that there is a strong protective effect for green leafy vegetables, carrot, milk, citrus fruits etc. against many forms of cancers. The American Cancer Society is now propagating the use of fresh green leafy vegetables and fruits in their campaign against cancer.
How can we detect oral cancer early? Oral cancer is the commonest cancer in our country. The disease can arise in one of the several structures within the mouth like the inside lining of cheek [commonest] tongue, gums, roof of mouth etc. It is commonly observed that a mouth cancer starts as a pearly white patch in the mouth which cannot be scraped off. Very often this is caused by chronic tobacco chewing. All such white patches [leukoplakia] will not develop into cancer, but some will certainly. So it is most essential such patches are regularly observed and treated by competent doctors. One can learn to examine the mouth using a mirror himself/ herself to see clearly the inside of cheek, tongue, sides and undersurface, floor of mouth, the gums and areas joining the gums and cheek, the roof of mouth and lips. Any red discoloration or white patches or in fact any deviation from normal should be shown to the doctor for his advice. An ulcer caused by sharp teeth, repeated injuries to the tongue and cheek, an ill fitting denture producing constant irritation and injury are also found to progress into cancer if left untreated.
What are the symptoms of cancer cervix? Certain changes in the cells take place years before they turn into cancer. Such changes can be identified examining the cells which are collected from the cervix uterus. The cells which are exfoliated [shred] from the cervix are collected by a spatula. These are then examined under a microscope. The process is named as Pap smear test. By this procedure a correct diagnosis is arrived at in more than 95% cases. The procedure is simple painless, takes less than 5 minutes and needs no medication or preparation of the patient. Dysplastic changes, which may turn to cancer, years later, can be identified and the process of cancer information can be stopped. All married women should undergo this test and if two annual consecutive tests are negative, one needs to undergo this test only once in three years. By using this procedure in the population several western countries have rapidly reduced the cervical cancer incidence in their population. This is a Cytology test. How is lung cancer detected? The symptoms of lung cancer only appear in a late stage. These are persistent cough, blood in sputum, chest pain etc. The most prominent method for detecting lung cancer is by routine chest x-rays. Sputum examination may also reveal a lung cancer. It is to be noted that a lung cancer detected is never an early cancer. Even with the best methods of treatment, whether it is surgery, radiation or chemotherapy the survival rate is very poor. The most effective way to control lung cancer is by preventing its occurrence by not smoking. What are the Symptoms of cervix cancer? White discharge, unusual or excessive bleeding during menses or between menstrual cycles especially after sexual intercourse or during postmenopausal years are symptoms of cancer cervix. These need not always mean that cancer is present; however, an expert medical examination is necessary when such symptoms are present.
How is Uterine Cancer detected? There are very effective and simple ways of detecting cancer of the uterus. Curetting [scrapings from the inner lining of the uterus] and the neck of the uterus [cervix] can be examined under a microscope to detect cancer. Tissue is sometimes removed from the suspected cancer area for biopsy. Colposcope is an instrument used to examine the uterus and to identify the correct areas for taking a biopsy.
What are the factors that increase the risk of Uterus Cancer? Cancer of the uterine cervix [neck of the uterus] is the commonest cancer in Indian women. Early marriage and pregnancy, frequent deliveries, more than one marital partner, poor genital hygiene and HPV virus are observed to increase the risk of cervix cancer. Infertility, amenorrhea and certain hormones are observed to be a associated with the occurrences of cancer of the body of the uterus.
How can we control Cervix Cancer? Cervix cancer is one of the cancers that can be controlled. This disease can be prevented, can be detected early, and a 100% cure can be achieved if treated in early stages. Certain high risk factors are known for cervix cancer. These are early marriage, poor genital hygiene, and more than one marital partner. Pap smear technique can detect early changes in the cells which may ultimately become cancer if untreated. The technique is simple and can be undertaken in doctor's offices. Smear examination should be made routine examinations as part of regular health check up for married women. Popularization of Pap smear technique among the public is thus necessary for cervix cancer control. Early cancer, when detected, should be treated promptly.Appropriate treatment would ensure a hundred percent cure. Periodical physical examination [Gynaecological] is also essential.
What are the methods by which cancer is treated now? The treatment methods for cancer depend on several factors, of which the most important are the site of cancer, type of cancer, spread of the disease when diagnosed, general health of the patient etc. Some cancers are best removed by operation and are cured by this method. For some other types the best treatment is radiation: given externally, [Teletherapy] which is administered with Cobalt or Linear accelerator units or by inserting radioactive needles [Iridium, Caesium, Cobalt etc.] into the body [Brachytherapy] or by combining both external and brachytherapy methods. Certain cancers are treated by drugs [chemotherapy] only. Very often some cancers need all the three methods of treatment. The treating doctor chooses the best method considering several of the above factors. In some cases surgery will remove a portion of the tumour, then treatment is continued by radiation. Radiation is given also to shrink the tumour so that a removal of the tumour by surgery can be done later.
What are the side effects of Radiation and Chemotherapy? First it has to be understood that all the side effects are temporary and will vanish in course of time. Depending on the site of radiation treatment, the symptoms will vary. Diarrhoea, dryness of mouth, mouth soreness, difficulty in swallowing, loss of appetite and taste and abdominal cramps are some of the side effects due to radiation. Chemotherapeutic drugs also can cause severe discomfort. Losses of hair, nausea, vomiting, diarrhoea, anaemia are some of the several complaints. As in the case of sickness caused by radiotherapy, the sickness caused by chemotherapy also vanishes 2 to 3 weeks after completion of treatment.