Cancer overview

Cancer is a class of diseases, which are a widely known topic in the health care field today. Its history, cause, prognosis, diagnosis, treatment, and harmful effects on the health are still on the minds of many health care professionals around the world today. Cancer is caused by uncontrolled cell division, and the ability of those cells to invade other tissues in the body. These cells can directly grow into adjacent tissues, which is called invasion, or they can migrate to distant sites, which is called metastasis. These cells and their unregulated growth are caused by a series of acquired mutations to DNA within the cells, which then damages the genetic information that define cell functions and alters the normal control of cell division. These invading tissues are said to be malignant, which means they can cause death. Tumors, which are swelling tissues, can be either malignant and therefore cancerous, or benign and noncancerous. These malignant tissues can invade organs, causing a threat of death. Cancer has many different symptoms, depending on the site of the cancer, and how it has spread. Local symptoms of cancer are unusual lumps or swelling such as tumors, bleeding, pain, and ulceration. If these cancerous tissues become compressed, jaundice may occur. Symptoms of the cancer spreading, also known as metastasis, are enlarged lymph nodes, coughing which may include blood, an enlarged liver, fracture of affected bones and pain in them, and some neurological symptoms. Systematic symptoms of cancer are weight loss, poor appetite, excessive sweating, anemia (reduced blood cells) and hormonal changes. Each of these may be a symptom of cancer, but may not all occur at once. If cancer is suspected, cell samples will be taken and examined by a medical professional known as a pathologist. Pathologists are medical professionals that study the diagnosis of disease based on microscopic examination of cells and tissues. This process of examining cells and

tissues is called a biopsy. The tissue diagnosis will help indicate the type of cell that is growing abnormally, its severity, and the size and extent. Cytogenic tests, which are the study of chromosome material, may help in the prognosis, or future behavior of the cancer, as well as the treatment. Sometimes, cancer can be cured if entirely removed. This can be accomplished by a biopsy procedure. When the entire mass of the abnormal tissue is removed, the borders of the tissue will be examined to see if all of the malignant tissue has really been removed. This procedure is most common with cancers of the skin. Some biopsies can be performed on an outpatient basis, such as those for skin, breast, or liver cancer. Other biopsy procedures must be performed under anesthesia and require surgery, such as those for organs. Cancer screenings are tests that are performed to detect unsuspected cancers in the population. Screening for cancer can lead to an earlier diagnosis, which then in turn may lead to an extended life and treatment. If signs of cancer are detected, more invasive tests are performed to confirm the diagnosis. There have been a number of screening tests developed for the specific types of cancer. Breast cancer screening can be accomplished by self-examination. Screening by using mammograms can detect tumors even earlier than self-examination. Colorectal cancer can be detected through fecal occult blood testing, which searches for hidden blood in stool. Colonoscopy, which is the examination of the large colon with a fiber optic cable camera on a flexible tube passed through the anus, is also another way to detect colorectal cancer. Cervical cancer can be detected by using the Pap-smear, which is a cervical swab that is used to collect a sampling of cells, which are then examined. Prostate cancer can be screen by a digital rectum exam, along with a prostate specific antigen (PSA) blood testing.

Cancer screening can be of controversy when it is not sure if the test will actually save a life. This occurs when it is not clear if the benefits of the screening will outweigh the risks of the follow-up tests and treatments. An example of this would be if a PSA test detected small cancers that would never become life-threatening, but once detected would lead to unnecessary treatment such as surgery or radiation. When this occurs, it is called overdiagnosis. Prostate cancer treatment may cause an inability to control urine flow, erectile dysfunction, bleeding and infection. A cancer can be classified by the type of cell it originated from as well as the location of the cell. Carcinomas arise from epithelial cells, such as in the digestive tract or glands. Hematological malignancies arise from blood and bone marrow, such as the instances of leukemia and lymphoma. Sarcoma arises out of connective tissue, bone, muscle, or blood vessels. Melanoma is a malignant tumor of melanocytes, which are cells located in the bottom layer of the epidermis. Teratoma arises from germ cells in the testes or ovaries. There are many main types of Cancer. One of the most common types of cancer is prostate cancer. The prostate is a gland in the male reproductive system, about the size of a walnut. Its purpose is the make and store seminal fluid, which is a fluid that nourishes sperm. Prostate cancer is found mainly in men over age 55. The common age of diagnosis is 70 years old. While doctors have not found out what causes prostate cancer, or why some men get it and others do not, there are some risk factors associated with it. This disease is more common in African Americans, than in white men, and even rarer in Asian and Native Americans. Some symptoms exclusive to prostate cancer are a frequent need to urine, difficulty or an inability to start urination, painful or burning while urinating, painful ejaculation, and blood in the urine or semen.

If cancer is found in the prostate, doctors determine the stage of the disease. Staging is an attempt to find out if the cancer has spread, and where to. In Stage A of prostate cancer, the cancer cannot be determined by a rectal exam. It is usually discovered during surgery. At this point, there would be no evidence that the cancer has spread outside of the prostate. During Stage B, the tumor can be felt during a rectal exam, but there is no evidence of outside spreading. In Stage C, the cancer has spread outside the prostate to nearby tissues. Stage D, is the last stage, where it has spread to the lymph nodes and other parts of the body. As discussed earlier there are some forms of treatment for prostate cancer. Watchful waiting is a form of treatment suggested for men who have a slow growing cancer in an early stage, or for older men with serious medical problems. Men with medical problems would face risks that could possibly outweigh the benefits of future treatment. Surgery is a common treatment for early stages of prostate cancer. The doctor may remove some or the entire prostate using various surgeries. Radiation therapy uses high energy x-rays to kill cancer cells. In very early stages of prostate cancer, radiation therapy can be used instead of surgery. Cryotherapy is another method for treating prostate cancer. In cryotherapy, metal rods are inserted into the prostate and circulating liquid nitrogen is inside these rods. These rods freeze to about minus 374 degrees Fahrenheit, freezing the tissue and causing the cancerous cells to rupture and die. Hormonal therapy, otherwise known as systemic therapy because it can affect cancer cells throughout the body, is used to prevent the cancerous cells from getting the male hormones they need to grow. As there are treatments for prostate cancer, there are also side-effects to these treatments. Using the watchful waiting treatment avoids side affects of radiation and surgery, but it also reduces the chance of controlling the disease before it spreads. With surgery, it can be extremely

uncomfortable for the days after it is performed. The patient has to wear a catheter to catch the urine for anywhere from 10 days to 3 weeks. Impotence can occur, as well can fecal or urinary incontinence as well. Radiation therapys effects can cause impotence, as well as tender, red and dry skin as well in the treated area. Hormonal therapy, which causes lower testosterone levels, can cause effects such as impotence, hot flashes, and loss of sexual desire. Skin cancer is another common cancer found. There are several types of cancer that fall under the label of skin cancer. The most common types are squamous cell carcinoma, basal cell carcinoma, and malignant melanoma. Squamous cell carinoma is a form of carcinoma cancer that account for about 20 percent non-melanoma skin cancers. Squamous cell cancer usually develops in the epithelial layer of the skin and sometimes in different mucous membranes of the body. This type of cancer can be seen on the skin, lips, inside the mouth, throat and the esophagus. It is characterized by red, scaly skin that eventually becomes an open sore. Basil cell carcinoma is the most common found skin cancer. It is a tumor that is found only in the skin, from the basal layer of the epidermis. These tumor cells resemble normal basal cells, but are spindle-shaped and irregular in the middle. People at risk are those who have a high amount of exposure to sunlight, specifically UV rays, as well as chemicals such as arsenic. A biopsy is performed by a medical professional to make an accurate diagnosis. Once diagnosed, the treatment is usually surgery, with what is called electrodessication and currettage. Melanoma is the most dangerous of all of the skin cancers. As said earlier, melanoma is a malignant tumor of the melanocytes. People at risk for this, like the other skin cancers, are those who have over-exposure to sunlight and ultra-violet rays. Early stages of melanoma may look like moles or not have any color at all. There are some symptoms of melanoma, including an

asymmetrical skin lesion, with an irregular border. Though often black, melanomas can be multicolored; any change in color should be noted. Other symptoms to look out for are moles increasing in diameter, as well as slow-healing lesions. Some features that may affect the prognosis, or how the cancer will progress, are the thickness of the tumor, the depth, the presence of lesions or ulcerations, and if it has spread. Melanoma can be treated with biopsy and surgery, like the other skin cancers, but only if it is within a certain size. Another treatment for melanoma is quite new, called Interleikin 2 (IL-2), which enhances the immune systems ability to kill tumor cells. Radiation therapy is also used after surgery for patients with advanced melanoma, or for people who have unresectable metastases, or cancer cells that have spread. Lung cancer is the most lethal malignant tumor worldwide. There are two main types of lung cancer: small cell, and non-small cell lung cancer. These types of lung cancer are categorized by the size and appearance of the malignant cells. The non-small cell lung cancers are epidermoid carcinoma, adenocarcinoma, and large cell carcinoma. They are grouped together because their prognosis and treatment is almost identical. Epidermoid carcinoma starts in the larger breathing tubes, but grows slower which means the size of the tumors varies. Adenocarcinoma is a form of cancer that starts near the gasexchanging surface of the lung. Large cell carcinoma is fast-growing, and grows near the surface of the lung. Small cell carcinoma is a less common form of lung cancer. It tends to start growing the in the larger breathing tubes, and grows rapidly, becoming quite large. Signs and symptoms of lung cancer are shortness of breath, coughing up blood, wheezing, chest pain, unexplained weight loss, and a hoarse voice. The populations at risk for

these signs and symptoms, as well as possible development of lung cancer are people over the age of 50, who have a history of smoking. Smoking is believed to be the main cause of lung cancer. Cigarettes contain hundreds of known carcinogens, which are substances that are known to alter DNA and cause cancer. With this known to the public, lung cancer is also one of the most preventable cancers, by the cessation of smoking. Other factors that can cause lung cancer are radiation exposure, genetic susceptibility, and viral infection. If any symptoms of lung cancer are reported, performing a chest X-ray would be the first step to diagnosing lung cancer. This would reveal any abnormal growth of tissues in the lungs. If lung cancer is suspected, a CT-guided biopsy is performed to identify the tumor type. If those results come positive, a positron emission tomography (PET) is used to determine of the patient can be operated on, and if the cancer has spread to a point where surgery would not cure it. There are several different forms of treatment for lung cancer, as with the other types of cancer. For non-small cell lung cancers, surgery is an option for removal of one lobe, two lobes, or the whole lung. After this surgery, chemotherapy, the use of drugs to help combat disease, is recommended to prevent the risk of recurrence. Small-cell lung cancer can be treated with chemotherapy, because surgery will have no influence on survival. Radiotherapy is often given with chemotherapy, to patients who are not eligible for surgery. Colorectal, or colon cancer, includes cancerous growths in the colon, rectum, and appendix. Most colon cancers are believed to arise from abnormal growths in the colon, which become malignant. Symptoms of colon cancer include changes in bowel habits. Finding blood in the stools can be an indicator, as well as bowel obstruction. As with other cancers, unexplained weight loss

is also an indicator. An enlargement of the liver due to the spreading of the cancer is another symptom of colon cancer. There also may be no symptoms at all, too. This is why periodical screening is recommended. There are several risk factors associated with colon cancer. Age is a large risk factor associated with colon cancer. Most cases occur in the 60s and 70s, although cases before age 50 can occur, usually if a family history of early colon cancer is present. Smokers are more likely to die of colon cancer than non-smokers. Physical inactivity is also a risk factor associated with developing colon cancer. Like prostate cancer, there are similar ways to diagnose colon cancer. The digital rectal exam can help detect tumors large enough to be felt. The fecal occult blood test will test for blood in the stool. Colonoscopy, which is the process of a lighted probe inserted into the rectum, can also be accomplished to detect growths in the colon. The pathology, or extent and future prediction of the diseases course, can be reported from an analysis of tissue taken during a biopsy or surgery. The treatment of colon cancer is similar to the treatment of prostate cancer, with treatment depending on the stage of the cancer. If the tumor is localized, or hasnt spread, then surgery is the most likely way to go. If it is an advanced cancer growth, part of the colon may have to be removed, and then the remaining parts are surgically put together to form a functioning colon. Chemotherapy is generally applied after surgery for colon cancer, although can be used before and during. Radiation therapy can be used to kill tumor tissue before of after surgery, or when surgery is not needed. Bladder cancer, although not as common as lung or skin cancer, can still be lethal. Bladder cancer is any type of abnormal growth in the urinary bladder.

Those at risk for bladder cancer are people with genetic predispositions, smokers, and those who have exposure to chemicals such as aniline. X-rays are the primary means to diagnose bladder cancer. Once diagnosed, there are different treatment paths. Superficial tumors, which have no entered the muscle layer, can be shaved off using an electrocautery device. Tumors that infiltrate the bladder require more extensive surgery where part or the entire bladder is removed, and the urinary stream is diverted. Radiation therapy may also be used to treat this form of cancer. Pancreatic cancer occurs when a malignant tumor grows within the small pancreas organ. Symptoms of pancreatic cancer are so non-specific that the cancer tends to be discovered while it is in a later stage of progression. Common symptoms include abdominal pain, loss of appetite or unexplained weight loss, jaundice, and digestive problems. Pancreatic cancer is usually diagnosed through imaging tests, such as CT scans, MRI imaging, or ultrasound. This helps to get a picture of the internal organ and as to whether it has spread or not. The most definitive test for pancreatic cancer is a biopsy, like the many of the other forms of cancer. Pancreatic cancer can be treated through surgery. During this surgery, called pancreaticoduodenectomy, the tumor is removed from the pancreas. When the tumor cannot be removed from the pancreas, a combination of radiation and chemotherapy may be recommended. If the cancer has spread, however, chemotherapy alone is usually used. Breast cancer is one of the most common cancers found in women today. There are many symptoms that are associated with breast cancer, mainly a lump in the breast being the most common. Finding a lump or mass in the armpit as well can be symptom. A bloody or pus-like

discharge from the nipple is also an indicator. Any changes in color, or feel to the breast, nipple, or areola are signs to look for as well. There are many risk factors associated with breast cancer. As age increases, the susceptibility of breast cancer increases as well. Females are more likely to develop breast cancer than men as well. If there is a history of breast cancer in the family, then that can pose as a risk as well. Women who start menstruating before age 12 or go through menopause after age 55 are also at a higher risk for breast cancer development. If someone has undergone hormonal replacement therapy, that also can be a risk as well. Exposure to radiation can also lead to many cancers, including breast cancer. Most breast cancers can be detected through mammograms. If a suspicious lump in found during a self examination, a mammogram is performed to evaluate the lump. A biopsy can be performed to confirm if the cells are cancerous in the breast. When a palpable mass is not well seen on a mammogram, an ultrasound screening may be performed to help differentiate between solid and cystic masses. Treatment options for breast cancer include surgery, chemotherapy, and radiation therapy. The extent of the surgery depends on whether or not the cancer has spread. If the tumor is less than about 1.6 inches, or there isnt a chance it will return, the doctor may remove the tumor alone. If the cancer has spread to the lymph nodes, the doctor will then perform a surgery, called a mastectomy, where the entire breast is removed. Surgeries for any type of cancer almost always follow-up with radiation, and sometimes chemotherapy for treatment continuity. Ovarian cancer has no specific signs or symptoms in the early stages of the disease. Some possible symptoms of ovarian cancer, however, do exist. A sense of pelvic heaviness could be a symptom, along with lower abdominal discomfort. Vaginal bleeding and abnormal menstrual

cycles are also some signs to pay attention to. Ovarian cancer can be very deadly, since the symptoms are so vague and non-specific. By the time cancer has been diagnosed, the tumor has often spread beyond the ovaries to other organs. When ovarian cancer is suspected, the physician may order blood tests. A blood protein called CA125 is elevated when there is ovarian cancer. To determine whether the tumor is benign or cancerous, to make an accurate diagnosis, surgery is necessary. A biopsy will be performed, where the physician will make an incision in the abdomen to insert a tube, where then tissue is collected for examination. Surgery is the primary way to treat ovarian cancer. In most cases, the ovaries, uterus, and fallopian tubes may be removed. Rarely, if the cancer is in an early stage, and the female has not had children yet, only one ovary may be removed, and the fallopian tubes and uterus left intact. Chemotherapy is usually used after the surgery to destroy any remaining cancer. Stomach cancer can develop in any section of the stomach, and from there, spread to other tissues and organs. Often there are not any symptoms in the early stages, and in many cases, the cancer has spread before it is found. The symptoms are non-specific and can be attributed to other health problems. Indigestion and heartburn can be a symptom of stomach cancer. Vomiting, constipation, and diarrhea can also be indicators of stomach cancer. Having bloody stools is also a sign. To find the cause of these symptoms, a medical doctor may order a fecal occult blood test, or perform a gastroscopic exam where a thin tube is placed through the mouth and esophagus to view the stomach. If any abnormal tissue is noted, a sample will be taken and biopsied to check for the presence of cancerous cells.

As of now, gastrectomy, or the removal of the stomach, is the only curative treatment. Depending on the location and stage of the cancer, either the proximal portion or distal portion of the stomach may be removed. If the cancer has spread too much, the entire stomach may be removed. If part of the stomach is removed, generally patients can still go on to live normal lived. If the whole stomach is removed, then patients have to adapt to a different eating schedule, where they eat small quantifies of food more frequently. Chemotherapy can be either a primary mode of treatment or a post-surgery form of treatment to kill remaining cancer cells. Radiation therapy can also be given post-surgery to kill remaining cancer cells. Testicular cancer is an abnormal growth of cancerous cells in the testicles. It usually shows no early symptoms, but it is suspected when a mass if felt in the testes. An enlargement in the testicle or change in the way it feels is a symptom, along with a lump or swelling. A feeling of heaviness in the scrotum is also common. To diagnose testicular cancer, a series of tests are performed. A CT Scan of the abdomen, pelvis, as well as chest X-rays are performed to determine whether or not cancer has spread to other areas of the body. Sometimes blood tests will be done, to check levels of alpha-fetoprotein and bet-subunit human chorionic gonadotropin, which are a protein and a hormone where abnormal levels, would indicate the type, extent, and severity of the cancer. Surgery, radiation therapy and chemotherapy are the three basic types of treatment when it comes to testicular cancer. Surgery usually involves the removal of the affected testicle. Chemotherapy and radiation therapy can follow to kill the remaining cancerous cells, and prevent recurrence. Thyroid cancer occurs when thyroid cells grow uncontrollably and form tumors. The most frequent symptom of thyroid cancer is a lump that can be felt in the neck. Other symptoms

of thyroid cancer are hoarseness or changing in voice, and a difficulty swallowing. A cough, with or without blood is also a symptom of thyroid cancer. Exposure to radiation as a child is a risk factor associated with thyroid cancer, as well as a diet low in iodine, a substance managed in the thyroid. A physician may use several tests to confirm an accurate diagnosis of thyroid cancer. Imaging tests such as a CT scan or ultrasound can be used to produce an image of the thyroid. A test known as the calcitonin test may be ordered when thyroid cancer is suspected. Calcitonin is a hormone found only in the thyroid gland, and, when cells of the thyroid become cancerous, too much calcitonin is produced. Also, like many of the other cancers, a biopsy can help make the accurate diagnosis by examining the cells. If the cancer has not spread to any distant parts of the body, surgery is the usual treatment. The surgeon may remove some or the entire thyroid, and any affected lymph nodes. Radiation therapy is also a way for treatment, with radioactive X-rays being beamed externally to kill cancer cells, or the patient may swallow a drink containing radioactive iodine, which thyroid cells will absorb, killing any cancer cells. Chemotherapy is also a way for killing or slowing the growth of cancer cells, usually when surgery is not an option. Throat cancer is cancer that is characterized by abnormal growth of tissues in the larynx, pharynx, or mouth. There are three major causes of throat cancer: tobacco use, alcohol use, and occupational exposures. Carcinogens such as tobacco can cause abnormal growths, as discussed with lung cancer. Heavy consumption of alcoholic beverages has also been found to cause a majority of cancers in the larynx and pharynx. Using both tobacco and alcohol has been found to not just double the risk of cancer, but multiply it. Occupation risk factors include long and intense exposure to wood dust, paint fumes, and chemicals in metalworking, plastics, and textile

industries. These chemicals contain carcinogens believed to contribute to cancerous growth in the lungs and throat. There are many symptoms for the types of throat cancer. A persisting lump in the neck can be a sign of cancer in the throat area. Cancers in the larynx can cause a change in voice, including hoarseness. Having trouble swallowing, such as food getting stuck at a certain point in the throat, is also an indicator of possible cancer. Persistent earache can also be linked to throat cancer, in combination with other symptoms. For a physician to make an accurate diagnosis of throat cancer, exams have to be accomplished, just as with the many other cancers. CT scans may be performed to get an accurate picture of the affected area, so the physician can see if the cancer has spread.. Again, a biopsy would be needed as well to examine the cells to see if they are cancerous. Again, for treatment of throat cancer, surgery is the usual form of treatment if it has not spread to distant areas of the body. Post surgery, chemotherapy and radiation therapy would follow to kill the remaining cancer cells and prevent the chance of recurrence. If the cancer has spread beyond areas of the throat, then radiation and chemotherapy may be used as the forms of treatment to kill and slow the growth of new cancerous cells. There are many clinical trials performed these days, such as gene therapy, that are not available on the common healthcare market. There are several manners in which professionals are studying gene therapy to help combat cancer. One way to help treat cancer is the process of replacing unhealthy genes, which may be prone to cancer, with healthy ones. These genes are inserted into the body by using carriers, or vectors. The most common vectors are viruses, because viruses have the unique ability to recognize certain cells and insert DNA into the cells. Researchers are also studying ways to improve the cells in the immune system, so the bodys

natural immune system can help attack cancer cells. Another approach is to inject cancer cells with genes that can be used to destroy the cells. These suicide genes are then activated by a drug given to the patient, leading to the destruction of the cancer cells. There are some risks though associated with gene therapy. One danger is that the new gene might be inserted into the wrong location in the DNA, which can cause cancer or other harmful mutations. Viral vectors may also infect healthy cells as well as cancerous cells. When viruses are used to deliver DNA to cells inside of the patients body, there is a chance the DNA could be introduced into the reproductive cells, producing changes that may be passed on. Because of these serious risks, gene therapy is only available in clinical trials. With the many different types of cancer still affecting many people today, as well as the treatments for it changing with time, cancer remains a hot topic in the health care field. We can only hope that as the health community gathers a better understanding of the aspects and types of cancer, the treatments for it will improve to the point that it will not be a topic of discussion associated with the many deaths it causes each year.

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