BIOLOGY

INVESTIGATORY
PROJECT

By:
STUDY OF Ariza Patel
C A NC E R XII-B
Roll No. :

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 CERTIFICATE

ACKNOWLEDGEMENT

In the accomplishment of this project successfully, I would like to

thank my principal Mrs. Maninder Bhatia and biology teacher Mrs.
Akanksha Tripathi whose valuable guidance has helped me make
this project a foolproof success. Her suggestions and instructions
have served as the major contributors towards the completion of
this project. Also, I would like to thank my parents and friends
who have helped me throughout.

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S.NO CONTENTS PAGE
NO

1, WHAT IS CANCER ACTUALLY? 5

2, COMMON TYPES OF CANCER 5
3, SIGN AND SYMPTOMS 6
4, DIFFERENCE BETWEEN NORMAL CELL 7
AND CANCER CELL

5, HOW DOES CANCER CELLS ACTIVATE? 8

6, PREVENTION STEPS 9
7, DEVELOPMENT OF CANCER 10
8, MAIN CAUSES OF CANCER 11
9, TREATMENT OF CANCER 12

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10, CASE STUDY 15

11, BIBLIOGRAPHY 21

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 STUDY OF CANCER
1, What is Cancer actually?
Cancer is a disease involving abnormal cell growth with a
potential to invade to other parts of the body. In contrast benign
tumors do not spread to other parts of the body.

They form a subset of neoplasm. A neoplasm or tumor is a group

of cells that have undergone unregulated growth and will often
form a mass or lump, but may be distributed diffusely.

Cancer cells stealing energy from

normal healthy cells.

Cancer develops when the cell’s genetic

material gets damaged or mutated.

2, Common types of Cancer

Bladder Cancer

Breast Cancer

Colorectal Cancer

Kidney Cancer

Lung Cancer

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 Lymphoma- Non Hodge skin

Melanoma

Oral and Oropharyngeal Cancer

Pancreatic Cancer

Prostate Cancer

Thyroid Cancer

Uterine Cancer

Brain Cancer

3, Signs and Symptoms

It produces no symptoms at the beginning of cancer, the actual
symptoms starts when there is a mass growth or Ulcerates.
People may become anxious or depressed post-diagnosis. The risk
of suicide in people with cancer is approximately double.

Mass effects from lung cancer can block the bronchus resulting in
cough or Pneumonia; Esophageal Cancer can cause narrowing of
the Esophagus, making it difficult or painful to swallow; and
Colorectal Cancer may lead to narrowing or blockages in the
Bowel, affecting bowel habits. Masses in breasts or testicles may
produce observable lumps. Ulceration can cause bleeding that, if
it occurs in the lung, will lead to coughing up blood, in the bowels

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to anemia or rectal bleeding, in the bladder to blood in the urine
and in the uterus to vaginal bleeding.

These are some local symptoms which can show up the growth of
cancer cells.

Ulcerates: Sore on the skin or a mucous

membrane accompanied by disintegration
of tissue. Results in complete loss of
epidermis.

4, Difference between Normal Cells and Cancer Cells

NORMAL CELLS CANCER CELLS

CELL REPRODUCTION

Cell reproduction is needed to These cells may have gene

replenish the cell population
that ages or becomes
damaged or destroyed.
Normal cells reproduce
properly.
mutations or chromosome
mutations that affect the
reproductive properties the
cells. They don’t experience
biological aging and maintain
their ability to replicate and
grow.

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5, How Does Cancer cells activate?

It is well known that cancer is preceded by damaged DNA.

Because DNA is encoded with the instructions for cell behavior,
damaged DNA can alter cell processes including those that
regulate growth and division. This is supported by the fact that
tissues which have a high cell-division rate, such as bone and
lymph, are the most common sites for cancer.

Some genes, encoded on DNA, act as a switch that can be turned

on or off depending on cell needs. Free radicals have the ability to
break DNA strands which can result in some genes being
permanently switched on, such is the case with cancerous cell
growth. Although it is often taught that the DNA mutations that

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lead to cancer happen at random, research suggests there are
epigenetic triggers that may increase prevalence of DNA damage.

6, Prevention Steps:

DNA is vital for cell function and the body has mechanisms
by which it protects DNA from being damaged. One of the
most important mechanisms is the one responsible for the
production of antioxidants. A major step in the prevention
of DNA damage, and therefore cancer, would be to
optimize antioxidant activity. Research has suggested that
this can be achieved through the adoption of a diet that
incorporates antioxidant rich foods or extracts.

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Glutathione plays a major role in the antioxidant activities
of the body. Evidence shows that this molecule alone has
the ability to influence cancer risk in a directly correlative
manner. This means that by increasing your body’s supply
of glutathione, you are drastically improving its ability to
control free radicals before they damage cells. There are
several ways in which you can increase your supply of
glutathione.

7, Development of Cancer

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8, Main Causes of Cancer:
 Tobacco use is the cause of about 33% of cancer deaths.
 Another 10% is due to obesity, poor diet, lack of physical
activity, excessive drinking of alcohol.

Nearly 200% of cancer cause is due to hepatitis B, hepatitis C

and human papillomavirus.

 Approximately 5-10% of cancer is due to inherited genetic

defect from person’s parents.

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9, Treatment of Cancer:
SURGERY

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 RADIATION THERAPY

CHEMOTHERAPY

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 IMMUNOTHERAPY

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 CASE STUDY
Unusual presentation of lung cancer.

*From: 1Assistant Professor,2Professor and Head, Department of

General Surgery, Father Muller Medical College, Mangalore,
Karnataka, India.

ABSTRACT
The most common presentation of lung cancer is a cough.
Gastrointestinal metastasis of lung cancer is a rare presentation,
but it is well documented in the literature with the small intestine
being the most common site metastasis. We report the case of a
67-year-old man, an undiagnosed case of lung cancer that
presented to our emergency department with acute abdominal
pain due to jejunal perforation.

Key words: Lung cancer, Metastasis, Perforation, Small intestine.

Approximately 50% of the patients diagnosed with non-small cell

lung cancer have metastatic disease at the time of diagnosis. Lung
cancers usually metastasize to the mediastinal lymph nodes. Liver,
brain, adrenal glands, and bones. Metastasis to the
gastrointestinal (GI) tract is extremely rare. We report the case of
a 63-year-old man that presented with acute abdominal due0
metastatic perforation of the small intestine from squamous cell
carcinoma of the lung.

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CASE REPORT
A 63-year-old male patient presented to our emergency
department with complaints of acute abdominal pain for 2 days.
The pain was more in the upper abdomen, non-radiating, dull-
aching in nature with no aggravating, or relieving factors. The
patient did not have any previous history of dyspepsia or history
suggestive of acid peptic disease. The patient has been a chronic
smoker for over 32 years.

On examination, the patient had a pulse rate of 110 beats per

minute with a blood pressure of 110/70 mmHg and was afebrile.
His saturation at room air was 90%. On examination of his
abdomen, there was diffuse abdominal tenderness, and
abdominal rigidity was present.

A chest X-ray and an erect X-ray of the abdomen were taken.

Abdominal X-ray revealed air under the diaphragm, as shown in
Fig. 1, while the chest X-ray showed a small area of consolidation
in the left lung, as shown in Fig. 2.

The patient was taken up for an explorative laparotomy in view of

peritonitis and X-ray showing gas under the diaphragm.
Intraoperative findings showed a 2 cm × 1 cm perforation in the
mid-jejunum as shown in Fig. 3 with hyperemia and edema noted
in the surrounding small intestine. Ascitic fluid was also present,
which was sent for cytology. It did not yield any malignant cells. A

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Figure 1: Abdominal X-ray showing Figure 2: Chest X-ray showing
gas under the diaphragm small area of consolidation in the
left lung

limited resection and anastomosis of the perforated segment of

the bowel were performed followed by a thorough peritoneal
lavage. Histopathological analysis of the resected specimen
showed metastatic carcinoma – probably squamous cell
carcinoma, as shown in Fig. 4.

In view of the chest X-ray showing area of consolidation, the

primary site was thought to be lung and a contrast-enhanced
computerized tomography (CECT) chest was taken. It revealed a
large heterogeneously enhancing lesion in the superior segment
in the left lobe of the left lung with enlarged mediastinal lymph
nodes. A CT-guided biopsy confirmed the diagnosis of squamous
cell carcinoma of the lung. An oncology opinion was sought and
the patient was started on a cisplatin-based chemotherapy
regimen. The patient was planned to receive six cycles of

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chemotherapy but had received only two cycles and was then lost
to follow-up.

DISCUSSION
The metastasis of lung cancer to the GI tract has been reported in
the literature but is not commonly seen. Furthermore, metastatic
lung cancer resulting in GI perforation is extremely rare. McNeil et
al. conducted a study to determine the incidence of clinically
apparent metastases and also occult metastases of lung cancer to
the small intestine. They found that bowel metastasis was present
with peritonitis, of which nine had undiagnosed lung cancer
similar to our case.

Among the various histological types, adenocarcinoma is most

commonly associated with bowel perforation (23.5%). While small
cell carcinoma is the least (19.6%). The exact mechanism by which
tumor metastasizes to the bowel remains controversial. The
hematogenous route appears to be the most likely means of
spread. Some authors have even suggested a lymphatic route
through the thoracic duct.

The various clinical features that can be seen following GI

metastasis depends on the location of metastasis and invasion of
the bowel wall. Dysphagia anemia, abdominal pain, melena,
nausea, vomiting, and weight loss are the most commonly
complained symptoms. Complication such as intestinal
obstruction is more common compared to perforation. When
diagnosed case of lung cancer present with an acute abdomen,
CECT can play an important role in diagnosing obstruction or site
of perforation.

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Figure 3: Intraoperative finding; Jejunal perforation

Figure 4: Histopathology showing metastatic squamous cell carcinoma to

the small intestine

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CONCLUSION
Acute abdomen as a presentation of lung cancer metastasis is rare
and accounts for a poor prognosis. When patients with a known
case of pulmonary neoplasm present with acute abdominal pain,
it is necessary to consider complications of intestinal metastasis.
Among the various parts of the GI tract, the small intestine is the
most common site of metastasis. An undiagnosed case of lung
cancer presenting with acute abdominal pain will require a strong
degree of suspicion to determine the primary site.

THANK YOU!

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BIBLIOGRAPHY
 www.google.com
 www.thoughtco.com
 www.cancer.net
 www.healthtap.com
 www.cancerresearchuk.org
 www.academia.edu
 www.quora.com
 www.researchgate.net

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