CANCER

 Cancer is the name given to a collection of related diseases. In all types of

cancer, some of the body’s cells begin to divide without stopping and spread into
surrounding tissues.
 Cancer can start almost anywhere in the human body, which is made up of
trillions of cells. Normally, human cells grow and divide to form new cells as the
body needs them. When cells grow old or become damaged, they die, and new
cells take their place.
 When cancer develops, however, this orderly process breaks down. As cells
become more and more abnormal, old or damaged cells survive when they
should die, and new cells form when they are not needed. These extra cells can
divide without stopping and may form growths called tumors.
 Many cancers form solid tumors, which are masses of tissue. Cancers of the
blood, such as leukemias, generally do not form solid tumors.
 Cancerous tumors are malignant, which means they can spread into, or invade,
nearby tissues. In addition, as these tumors grow, some cancer cells can break
off and travel to distant places in the body through the blood or the lymph system
and form new tumors far from the original tumor.
 Unlike malignant tumors, benign tumors do not spread into, or invade, nearby
tissues. Benign tumors can sometimes be quite large, however. When removed,
they usually don’t grow back, whereas malignant tumors sometimes do. Unlike
most benign tumors elsewhere in the body, benign brain tumors can be life
threatening.

Differences between Cancer Cells and Normal Cells

 Cancer cells differ from normal cells in many ways that allow them to grow out of
control and become invasive. One important difference is that cancer cells are
less specialized than normal cells. That is, whereas normal cells mature into
very distinct cell types with specific functions, cancer cells do not. This is one
reason that, unlike normal cells, cancer cells continue to divide without stopping.
 In addition, cancer cells are able to ignore signals that normally tell cells to stop
dividing or that begin a process known as programmed cell death, or apoptosis,
which the body uses to get rid of unneeded cells.
  Cancer cells may be able to influence the normal cells, molecules, and blood
vessels that surround and feed a tumor—an area known as the
microenvironment. For instance, cancer cells can induce nearby normal cells to
form blood vessels that supply tumors with oxygen and nutrients, which they
need to grow. These blood vessels also remove waste products from tumors.
 Cancer cells are also often able to evade the immune system, a network of
organs, tissues, and specialized cells that protects the body from infections and
other conditions. Although the immune system normally removes damaged or
abnormal cells from the body, some cancer cells are able to “hide” from the
immune system.
 Tumors can also use the immune system to stay alive and grow. For example,
with the help of certain immune system cells that normally prevent a
runaway immune response, cancer cells can actually keep the immune system
from killing cancer cells.

How Cancer Arises

 Cancer is a genetic disease—that is, it is caused by changes to genes that
control the way our cells function, especially how they grow and divide.
 Genetic changes that cause cancer can be inherited from our parents. They can
also arise during a person’s lifetime as a result of errors that occur as cells
divide or because of damage to DNA caused by certain environmental
exposures. Cancer-causing environmental exposures include substances, such
as the chemicals in tobacco smoke, and radiation, such as ultraviolet rays from
the sun.
 Each person’s cancer has a unique combination of genetic changes. As the
cancer continues to grow, additional changes will occur. Even within the same
tumor, different cells may have different genetic changes.
 In general, cancer cells have more genetic changes, such as mutations in
DNA, than normal cells. Some of these changes may have nothing to do with the
cancer; they may be the result of the cancer, rather than its cause.

"Drivers" of Cancer
 The genetic changes that contribute to cancer tend to affect three main types of
genes—proto-oncogenes, tumor suppressor genes, and DNA repair genes.
These changes are sometimes called “drivers” of cancer.
  Proto-oncogenes are involved in normal cell growth and division. However,
when these genes are altered in certain ways or are more active than normal,
they may become cancer-causing genes (or oncogenes), allowing cells to grow
and survive when they should not.
 Tumor suppressor genes are also involved in controlling cell growth and
division. Cells with certain alterations in tumor suppressor genes may divide in an
uncontrolled manner.
 DNA repair genes are involved in fixing damaged DNA. Cells with mutations in
these genes tend to develop additional mutations in other genes. Together, these
mutations may cause the cells to become cancerous.
 As scientists have learned more about the molecular changes that lead to
cancer, they have found that certain mutations commonly occur in many types of
cancer. Because of this, cancers are sometimes characterized by the types of
genetic alterations that are believed to be driving them, not just by where they
develop in the body and how the cancer cells look under the microscope.

When Cancer Spreads

ENLARGE

In metastasis, cancer cells break away from where they first formed (primary cancer),
travel through the blood or lymph system, and form new tumors (metastatic tumors) in
other parts of the body. The metastatic tumor is the same type of cancer as the primary
tumor.
  A cancer that has spread from the place where it first started to another place in
the body is called metastatic cancer. The process by which cancer cells spread
to other parts of the body is called metastasis.

 Metastatic cancer has the same name and the same type of cancer cells as the
original, or primary, cancer. For example, breast cancer that spreads to and
forms a metastatic tumor in the lung is metastatic breast cancer, not lung cancer.

 Under a microscope, metastatic cancer cells generally look the same as cells of
the original cancer. Moreover, metastatic cancer cells and cells of the original
cancer usually have some molecular features in common, such as the presence
of specific chromosome changes.

 Treatment may help prolong the lives of some people with metastatic cancer. In
general, though, the primary goal of treatments for metastatic cancer is to
control the growth of the cancer or to relieve symptoms caused by it.
Metastatic tumors can cause severe damage to how the body functions, and
most people who die of cancer die of metastatic disease.  

Tissue Changes that Are Not Cancer

 Not every change in the body’s tissues is cancer. Some tissue changes may
develop into cancer if they are not treated, however. Here are some examples of
tissue changes that are not cancer but, in some cases, are monitored:
 Hyperplasia occurs when cells within a tissue divide faster than normal and
extra cells build up, or proliferate. However, the cells and the way the tissue is
organized look normal under a microscope. Hyperplasia can be caused by
several factors or conditions, including chronic irritation.
 Dysplasia is a more serious condition than hyperplasia. In dysplasia, there is
also a buildup of extra cells. But the cells look abnormal and there are changes in
how the tissue is organized. In general, the more abnormal the cells and tissue
look, the greater the chance that cancer will form.
 Some types of dysplasia may need to be monitored or treated. An example of
dysplasia is an abnormal mole (called a dysplastic nevus) that forms on the
skin. A dysplastic nevus can turn into melanoma, although most do not.
  An even more serious condition is carcinoma in situ. Although it is sometimes
called cancer, carcinoma in situ is not cancer because the abnormal cells do not
spread beyond the original tissue. That is, they do not invade nearby tissue the
way that cancer cells do. But, because some carcinomas in situ may become
cancer, they are usually treated.

Normal cells may become cancer cells. Before cancer cells form in tissues of the body,
the cells go through abnormal changes called hyperplasia and dysplasia. In hyperplasia,
there is an increase in the number of cells in an organ or tissue that appear normal
under a microscope. In dysplasia, the cells look abnormal under a microscope but are
not cancer. Hyperplasia and dysplasia may or may not become cancer.
Credit: Terese Winslow

Types of Cancer
 There are more than 100 types of cancer. Types of cancer are usually named for
the organs or tissues where the cancers form. For example, lung cancer starts in
cells of the lung, and brain cancer starts in cells of the brain. Cancers also may
be described by the type of cell that formed them, such as an epithelial cell or a
squamous cell.
 Here are some categories of cancers that begin in specific types of cells:
Carcinoma
 Carcinomas are the most common type of cancer. They are formed by
epithelial cells, which are the cells that cover the inside and outside surfaces
of the body. There are many types of epithelial cells, which often have a
column-like shape when viewed under a microscope.
 Carcinomas that begin in different epithelial cell types have specific names:

 Adenocarcinoma is a cancer that forms in epithelial cells that produce fluids

or mucus. Tissues with this type of epithelial cell are sometimes called
glandular tissues. Most cancers of the breast, colon, and prostate are
adenocarcinomas.
 Basal cell carcinoma is a cancer that begins in the lower or basal (base)
layer of the epidermis, which is a person’s outer layer of skin.
 Squamous cell carcinoma is a cancer that forms in squamous cells, which
are epithelial cells that lie just beneath the outer surface of the skin.
Squamous cells also line many other organs, including the stomach,
intestines, lungs, bladder, and kidneys. Squamous cells look flat, like fish
scales, when viewed under a microscope. Squamous cell carcinomas are
sometimes called epidermoid carcinomas.
 Transitional cell carcinoma is a cancer that forms in a type of epithelial
tissue called transitional epithelium, or urothelium. This tissue, which is made
up of many layers of epithelial cells that can get bigger and smaller, is found in
the linings of the bladder, ureters, and part of the kidneys (renal pelvis), and a
few other organs. Some cancers of the bladder, ureters, and kidneys are
transitional cell carcinomas.

Sarcoma
 Sarcomas are cancers that form in bone and soft tissues, including muscle, fat, blood
vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments).
 Osteosarcoma is the most common cancer of bone. The most common types of soft
tissue sarcoma are leiomyosarcoma, Kaposi sarcoma, malignant fibrous
histiocytoma, liposarcoma, and dermatofibrosarcoma protuberans.

Leukemia
 Cancers that begin in the blood-forming tissue of the bone marrow are called
leukemias. These cancers do not form solid tumors. Instead, large numbers of
 abnormal white blood cells (leukemia cells and leukemic blast cells) build up in
the blood and bone marrow, crowding out normal blood cells. The low level of
normal blood cells can make it harder for the body to get oxygen to its tissues,
control bleeding, or fight infections.  
 There are four common types of leukemia, which are grouped based on how
quickly the disease gets worse (acute or chronic) and on the type of blood cell
the cancer starts in (lymphoblastic or myeloid).

Lymphoma
 Lymphoma is cancer that begins in lymphocytes (T cells or B cells). These are
disease-fighting white blood cells that are part of the immune system. In
lymphoma, abnormal lymphocytes build up in lymph nodes and lymph vessels,
as well as in other organs of the body.
 There are two main types of lymphoma:
o Hodgkin lymphoma – People with this disease have abnormal
lymphocytes that are called Reed-Sternberg cells. These cells usually
form from B cells.
o Non-Hodgkin lymphoma – This is a large group of cancers that start in
lymphocytes. The cancers can grow quickly or slowly and can form
from B cells or T cells.

Multiple Myeloma
 Multiple myeloma is cancer that begins in plasma cells, another type of
immune cell. The abnormal plasma cells, called myeloma cells, build up in
the bone marrow and form tumors in bones all through the body. Multiple
myeloma is also called plasma cell myeloma and Kahler disease.

Melanoma
 Melanoma is cancer that begins in cells that become melanocytes, which are
specialized cells that make melanin (the pigment that gives skin its color).
Most melanomas form on the skin, but melanomas can also form in other
pigmented tissues, such as the eye.
 Brain and Spinal Cord Tumors
 There are different types of brain and spinal cord tumors. These tumors are
named based on the type of cell in which they formed and where the tumor
first formed in the central nervous system. For example, an astrocytic
tumor begins in star-shaped brain cells called astrocytes, which help
keep nerve cells healthy. Brain tumors can be benign (not cancer) or
malignant (cancer).

Other Types of Tumors

Germ Cell Tumors
 Germ cell tumors are a type of tumor that begins in the cells that give rise to
sperm or eggs. These tumors can occur almost anywhere in the body and
can be either benign or malignant.

Neuroendocrine Tumors
 Neuroendocrine tumors form from cells that release hormones into the blood
in response to a signal from the nervous system. These tumors, which may
make higher-than-normal amounts of hormones, can cause many different
symptoms. Neuroendocrine tumors may be benign or malignant.

Carcinoid Tumors
 Carcinoid tumors are a type of neuroendocrine tumor. They are slow-
growing tumors that are usually found in the gastrointestinal system (most
often in the rectum and small intestine). Carcinoid tumors may spread to the
liver or other sites in the body, and they may secrete substances such as
serotonin or prostaglandins, causing carcinoid syndrome.
Source: cancer.org

RISK FACTORS
The list below includes the most-studied known or suspected risk factors for cancer.
Although some of these risk factors can be avoided, others—such as growing older—
cannot. Limiting your exposure to avoidable risk factors may lower your risk of
developing certain cancers.

 Age - Advancing age is the most important risk factor for cancer overall, and for
many individual cancer types. According to the most recent statistical data
 from NCI’s Surveillance, Epidemiology, and End Results program, the median
age of a cancer diagnosis is 66 years. This means that half of cancer cases
occur in people below this age and half in people above this age. One-quarter of
new cancer cases are diagnosed in people aged 65 to 74.

 Alcohol - Drinking alcohol can increase your risk of cancer of the mouth, throat,
esophagus, larynx (voice box), liver, and breast. The more you drink, the higher
your risk. The risk of cancer is much higher for those who drink alcohol and also
use tobacco. It has been suggested that certain substances in red wine, such as
resveratrol, have anticancer properties. However, there is no evidence that
drinking red wine reduces the risk of cancer.

 Cancer-Causing Substances - The substances listed below are among the most
likely carcinogens to affect human health, according to the National Toxicology
Program's 14th Report on Carcinogens. Simply because a substance has been
designated as a carcinogen, however, does not mean that the substance will
necessarily cause cancer. Many factors influence whether a person exposed to a
carcinogen will develop cancer, including the amount and duration of the
exposure and the individual’s genetic background.

o Aflatoxins

o Aristolochic Acids

o Arsenic

o Asbestos

o Benzene

o Benzidine

o Beryllium

o 1,3-Butadiene

o Cadmium
 o Coal Tar and Coal-Tar Pitch

o Coke-Oven Emissions

o Crystalline Silica (respirable size)

o Erionite

o Ethylene Oxide

o Formaldehyde

o Hexavalent Chromium Compounds

o Indoor Emissions from the Household Combustion of Coal

o Mineral Oils: Untreated and Mildly Treated

o Nickel Compounds

o Radon

o Secondhand Tobacco Smoke (Environmental Tobacco Smoke)

o Soot

o Strong Inorganic Acid Mists Containing Sulfuric Acid

o Thorium

o Trichloroethylene

o Vinyl Chloride

o Wood Dust

 Chronic Inflammation - In chronic inflammation, the inflammatory process may

begin even if there is no injury, and it does not end when it should. Why the
inflammation continues is not always known. Chronic inflammation may be
caused by infections that don’t go away, abnormal immune reactions to normal
 tissues, or conditions such as obesity. Over time, chronic inflammation can cause
DNA damage and lead to cancer. For example, people with chronic inflammatory
bowel diseases, such as ulcerative colitis and Crohn disease, have an increased
risk of colon cancer.

 Diet - Scientists have studied many additives, nutrients, and other dietary
components for possible associations with cancer risk. These include:

o Acrylamide
Acrylamide is a chemical found in tobacco smoke and some foods. It can
be produced when certain vegetables, such as potatoes, are heated to
high temperatures. Studies in animal models have found that acrylamide
exposure increases the risk for several types of cancer. However, there is
no consistent evidence that dietary acrylamide exposure is associated
with the risk of any type of cancer in humans.

o Alcohol
Although red wine has been suspected of reducing cancer risk, there is no
scientific evidence for such an association. Also, alcohol is a known cause
of cancer. Heavy or regular alcohol consumption increases the risk of
developing cancers of the oral cavity (excluding the lips), pharynx (throat),
larynx (voice box), esophagus, liver, breast, colon, and rectum. The risk of
developing cancer increases with the amount of alcohol a person drinks.

o Antioxidants
Antioxidants are chemicals that block the activity of other chemicals,
known as free radicals, that may damage cells. Laboratory and animal
research have shown that exogenous antioxidants can help prevent the
free radical damage associated with the development of cancer, but
research in humans has not demonstrated convincingly that taking
antioxidant supplements can help reduce the risk of developing or dying
from cancer. Some studies have even shown an increased risk of some
cancers.

o Artificial sweeteners
Studies have been conducted on the safety of several artificial
sweeteners, including saccharin, aspartame, acesulfame potassium,
 sucralose, neotame, and cyclamate. There is no clear evidence that the
artificial sweeteners available commercially in the United States are
associated with cancer risk in humans.

o Calcium
Calcium is an essential dietary mineral that can be obtained from food and
supplements. Research results overall support a relationship between
higher intakes of calcium and reduced risks of colorectal cancer, but the
results of studies have not always been consistent. Whether a relationship
exists between higher calcium intakes and reduced risks of other cancers,
such as breast and ovarian cancer, is unclear. Some research suggests
that a high calcium intake may increase the risk of prostate cancer

o Certain chemicals, called HCAs and PAHs, are formed when muscle

meat, including beef, pork, fish, and poultry, is cooked using high-
temperature methods. Exposure to high levels of HCAs and PAHs can
cause cancer in animals; however, whether such exposure causes cancer
in humans is unclear.

o Cruciferous vegetables
Cruciferous vegetables contain chemicals known as glucosinolates, which
break down into several compounds that are being studied for possible
anticancer effects. Some of these compounds have shown anticancer
effects in cells and animals, but the results of studies with humans have
been less clear.

o Fluoride
Fluoride in water helps to prevent and can even reverse tooth decay.
Many studies, in both humans and animals, have shown no association
between fluoridated water and cancer risk.

o Tea
Tea contains polyphenol compounds, particularly catechins, which are
antioxidants. Results of epidemiologic studies examining the association
between tea consumption and cancer risk have been inconclusive. Few
clinical trials of tea consumption and cancer prevention have been
conducted and their results have also been inconclusive.
 o Vitamin D
Vitamin D helps the body use calcium and phosphorus to make strong
bones and teeth. It is obtained primarily through exposure of the skin to
sunlight, but it can also be obtained from some foods and dietary
supplements. Epidemiologic studies in humans have suggested that
higher intakes of vitamin D or higher levels of vitamin D in the blood may
be associated with a reduced risk of colorectal cancer, but the results of
randomized studies have been inconclusive.

 Hormones - Estrogens, a group of female sex hormones, are known human

carcinogens. Although these hormones have essential physiological roles in both
females and males, they have also been associated with an increased risk of
certain cancers. For instance, taking combined menopausal hormone therapy
(estrogen plus progestin, which is a synthetic version of the female hormone
progesterone) can increase a woman’s risk of breast cancer. Menopausal
hormone therapy with estrogen alone increases the risk of endometrial cancer
and is used only in women who have had a hysterectomy.

 Immunosuppression - Many people who receive organ transplants take

medications to suppress the immune system so the body won’t reject the organ.
These "immunosuppressive" drugs make the immune system less able to detect
and destroy cancer cells or fight off infections that cause cancer. Infection with
HIV also weakens the immune system and increases the risk of certain cancers. 

 Infectious Agents - Certain infectious agents, including viruses, bacteria, and

parasites, can cause cancer or increase the risk that cancer will form. Some
viruses can disrupt signaling that normally keeps cell growth and proliferation in
check. Also, some infections weaken the immune system, making the body less
able to fight off other cancer-causing infections. And some viruses, bacteria, and
parasites also cause chronic inflammation, which may lead to cancer.

 Obesity

 Radiation

 Sunlight
  Tobacco

Source: cancer.gov

CLINICAL MANIFESTATIONS (GENERAL)

1. Unexplained Weight Loss

When you lose weight for no reason, call your doctor. A loss of 10 pounds or
more could be nothing to worry about. However, in rare cases, it may be the first
sign of cancer.

2. Fatigue
This isn’t fatigue similar to how you feel after a long day of work or play. The
extreme fatigue that doesn’t get better with rest can be an early sign of cancer.

Cancer uses your body’s nutrients to grow and advance, so those nutrients are
no longer replenishing your body. This “nutrient theft” can make you feel
extremely tired.

There are lots of underlying causes of fatigue, many of them not cancer-related.
If your symptoms are severe enough to affect your quality of life, call your doctor.

3. Fever
Fever can be a common symptom of routine colds and the flu. Often, it’s nothing
to worry about.

Certain characteristics of fever can foretell a possible cancer connection. You

should pay particular attention if:

o A fever happens mostly at night.

o You have no other signs of infection.
o You experience night sweats.
4. Pain
Pain is another symptom that can be caused by a multitude of things, many of
them routine, but it can also hint at an underlying disease.
 Cancer can cause pain in different ways, including:

o A mass or tumor pushing on other areas of your body

o The chemicals a cancer releases
o Metastasis, or spreading from where a cancer started

If you’re experiencing pain that doesn’t go away — and you’re not sure where it
came from — your doctor can help with the best next steps.

5. Skin Changes
Our skin is the largest organ of our body and can be a window into our overall
health. Jaundice (yellowing of eyes or fingertips) is one symptom that could
suggest a possible infection. Whether the cause is cancer or a more routine
infection, you should get it checked out.

Changes in moles can also be cause for concern. Call your doctor if a mole:

o Is asymmetrical, or has jagged edges

o Has funny or irregular borders
o Changes color or gets darker
o Is large or growing

C-hanges in bladder or bowel habits

A-sore that doesn’t heal

U-nusual bleeding or discharges

T-hickening or lumps

I-ndigestion od diffuclty swallowing

O-bvious changes in warts, moles, or the skin

N-agging cough or hoarseness of voice

U-nexplained anemia

S-udden loss of weight

Source: hopkinsmedicine.org
Diagnostic Finding

 Physical exam. Your doctor may feel areas of your body for lumps that may
indicate a tumor. During a physical exam, he or she may look for abnormalities,
such as changes in skin color or enlargement of an organ, that may indicate the
presence of cancer.
 Laboratory tests. Laboratory tests, such as urine and blood tests, may help your
doctor identify abnormalities that can be caused by cancer. For instance, in
people with leukemia, a common blood test called complete blood count may
reveal an unusual number or type of white blood cells.
 Imaging tests. Imaging tests allow your doctor to examine your bones and
internal organs in a noninvasive way. Imaging tests used in diagnosing cancer
may include a computerized tomography (CT) scan, bone scan, magnetic
resonance imaging (MRI), positron emission tomography (PET) scan, ultrasound
and X-ray, among others.
 Biopsy. During a biopsy, your doctor collects a sample of cells for testing in the
laboratory. There are several ways of collecting a sample. Which biopsy
procedure is right for you depends on your type of cancer and its location. In
most cases, a biopsy is the only way to definitively diagnose cancer.
 In the laboratory, doctors look at cell samples under the microscope. Normal
cells look uniform, with similar sizes and orderly organization. Cancer cells look
less orderly, with varying sizes and without apparent organization.

Source: mayoclinic.org

MEDICAL MANAGEMENT

Surgery

When used to treat cancer, surgery is a procedure in which a surgeon removes cancer
from your body.

Radiation Therapy

Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses
of radiation to kill cancer cells and shrink tumors. At low doses, radiation is used in x-
rays to see inside your body, as with x-rays of your teeth or broken bones.

Chemotherapy

Chemotherapy is a type of cancer treatment that uses drugs to kill cancer cells.

Immunotherapy to Treat Cancer

Immunotherapy is a type of cancer treatment that helps your immune system fight
cancer. The immune system helps your body fight infections and other diseases. It is
made up of white blood cells and organs and tissues of the lymph system.

Immunotherapy is a type of biological therapy. Biological therapy is a type of treatment

that uses substances made from living organisms to treat cancer.

Targeted Therapy

Targeted therapy is the foundation of precision medicine. It is a type of cancer treatment

that targets proteins that control how cancer cells grow, divide, and spread. As
researchers learn more about the DNA changes and proteins that drive cancer, they are
better able to design promising treatments that target these proteins.

Hormone Therapy

Hormone therapy is a cancer treatment that slows or stops the growth of cancer that
uses hormones to grow. Hormone therapy is also called hormonal therapy, hormone
treatment, or endocrine therapy.

Stem Cell Transplant

Stem cell transplants are procedures that restore blood-forming stem cells in people
who have had theirs destroyed by the very high doses of chemotherapy or radiation
therapy that are used to treat certain cancers.

Blood-forming stem cells are important because they grow into different types of
blood cells. The main types of blood cells are:

 White blood cells, which are part of your immune system and help your body fight
infection
 Red blood cells, which carry oxygen throughout your body
 Platelets, which help the blood clot

Precision Medicine

Precision medicine is an approach to patient care that allows doctors to select

treatments that are most likely to help patients based on a genetic understanding of
their disease. This may also be called personalized medicine. The idea of precision
medicine is not new, but recent advances in science and technology have helped speed
up the pace of this area of research.