1.

INTRODUCTION

In most people's minds there is no scarier diagnosis than that of

cancer. Cancer is often thought of as an untreatable, unbearably
painful disease with no cure. However popular this view of cancer
may be, it is exaggerated and over-generalized. Cancer is undoubtedly
a serious and potentially life-threatening illness. For example, it is the
leading cause of death in Americans under the age of 85, and the
second leading cause of death in older Americans. There will be 1.5
million new cases of cancer occurring in the United States coming
year, and over 570,000 deaths because of it not including basal and
squamous skin cancers which are not reported but could add another
two million cases per year (ACS, 2010). However, it is a
misconception to think that all forms of cancer are untreatable and
deadly. The truth of the matter is that there are multiple types of
cancer, many of which can today be effectively treated so as to
eliminate, reduce or slow the impact of the disease on patients' lives.
While a diagnosis of cancer may still leave patients feeling helpless
and out of control, in many cases today there is cause for hope rather
than hopelessness.

Our goal in this section is to educate you on the basics of cancer and
cancer treatment. Possessing this knowledge will, we hope, help you
to better understand what cancer is, how it occurs, and how to make
informed choices about cancer care options.
 2.HISTORY

Main article: History of cancer

Engraving with two views of a Dutch woman who had a tumor removed from
her neck in 1689

Cancer has existed for all of human history.[183] The earliest written record
regarding cancer is from circa 1600 BC in the Egyptian Edwin Smith
Papyrus and describes breast cancer.[183] Hippocrates (c. 460 BC – c. 370 BC)
described several kinds of cancer, referring to them with
the Greek word καρκίνος karkinos (crab or crayfish).[183] This name comes from
the appearance of the cut surface of a solid malignant tumor, with "the veins
stretched on all sides as the animal the crab has its feet, whence it derives its
name".[184] Galen stated that "cancer of the breast is so called because of the
fancied resemblance to a crab given by the lateral prolongations of the tumor
and the adjacent distended veins".[185]:738 Celsus (c. 25 BC – 50 AD)
translated karkinos into the Latin cancer, also meaning crab and recommended
surgery as treatment.[183] Galen (2nd century AD) disagreed with the use of
surgery and recommended purgatives instead.[183] These recommendations
largely stood for 1000 years.[183]
In the 15th, 16th and 17th centuries, it became acceptable for doctors to dissect
bodies to discover the cause of death.[186] The German professor Wilhelm
Fabry believed that breast cancer was caused by a milk clot in a mammary duct.
The Dutch professor Francois de la Boe Sylvius, a follower of Descartes,
believed that all disease was the outcome of chemical processes and that
acidic lymph fluid was the cause of cancer. His contemporary Nicolaes
Tulp believed that cancer was a poison that slowly spreads and concluded that it
was contagious.[187]
The physician John Hill described tobacco snuff as the cause of nose cancer in
1761.[186] This was followed by the report in 1775 by British surgeon Percivall
Pott that chimney sweeps' carcinoma, a cancer of the scrotum, was a common
disease among chimney sweeps.[188] With the widespread use of the microscope
in the 18th century, it was discovered that the 'cancer poison' spread from the
primary tumor through the lymph nodes to other sites ("metastasis"). This view
of the disease was first formulated by the English surgeon Campbell De
Morgan between 1871 and 1874.[189]
 3.WHAT IS CANCER?
Your body is composed of many millions of tiny cells, each a self-contained
living unit. Normally, each cell coordinates with the others that compose tissues
and organs of your body. One way that this coordination occurs is reflected in
how your cells reproduce themselves. Normal cells in the body grow and divide
for a period of time and then stop growing and dividing. Thereafter, they only
reproduce themselves as necessary to replace defective or dying cells. Cancer
occurs when this cellular reproduction process goes out of control. In other
words, cancer is a disease characterized by uncontrolled, uncoordinated and
undesirable cell division. Unlike normal cells, cancer cells continue to grow and
divide for their whole lives, replicating into more and more harmful cells.

The abnormal growth and division observed in cancer cells is caused by damage
in these cells' DNA (genetic material inside cells that determines cellular
characteristics and functioning). There are a variety of ways that cellular DNA
can become damaged and defective. For example, environmental factors (such
as exposure to tobacco smoke) can initiate a chain of events that results in
cellular DNA defects that lead to cancer. Alternatively, defective DNA can be
inherited from your parents.

As cancer cells divide and replicate themselves, they often form into a clump of
cancer cells known as a tumor. Tumors cause many of the symptoms of cancer
by pressuring, crushing and destroying surrounding non-cancerous cells and
tissues.

Tumors come in two forms; benign and malignant. Benign tumors are not
cancerous, thus they do not grow and spread to the extent of cancerous tumors.
Benign tumors are usually not life threatening. Malignant tumors, on the other
hand, grow and spread to other areas of the body. The process whereby cancer
cells travel from the initial tumor site to other parts of the body is known as
metastasis.

Cancer is a group of diseases involving abnormal cell growth with the potential
to invade or spread to other parts of the body.[2][8] These contrast with benign
tumors, which do not spread.[8] Possible signs and symptoms include a lump,
abnormal bleeding, prolonged cough, unexplained weight loss and a change
in bowel movements.[1] While these symptoms may indicate cancer, they can
also have other causes.[1] Over 100 types of cancers affect humans.Cancers are a
large family of diseases that involve abnormal cell growth with the potential to
invade or spread to other parts of the body.[2][8] They form a subset
of neoplasms. 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.[24][25]
All tumor cells show the six hallmarks of cancer.
They include:

 Cell growth and division absent the proper signals

 Continuous growth and division even given contrary signals
 Avoidance of programmed cell death
 Limitless number of cell divisions
 Promoting blood vessel construction
 Invasion of tissue and formation of metastases
 4.SIGNS AND SYMPTOMS
When cancer begins, it produces no symptoms. Signs and symptoms appear as
the mass grows or ulcerates. The findings that result depend on the cancer's type
and location. Few symptoms are specific. Many frequently occur in individuals
who have other conditions. Cancer is a "great imitator". Thus, it is common for
people diagnosed with cancer to have been treated for other diseases, which
were hypothesized to be causing their symptoms.
People may become anxious or depressed post-diagnosis. The risk of suicide in
people with cancer is approximately double.
Every type of cancer is different, and has a unique set of symptoms associated
with it. Some cancer symptoms are manifest outwardly, and are relatively easy
to notice and identify (such as a lump in the breast for breast cancer, or blood in
the stool corresponding to colorectal cancer). Other symptoms are observable,
but harder to decipher. For instance, two of the major symptoms for lung cancer
are a bronchitis-like deep cough and excessive shortness of breath. Few people
would assume these symptoms were serious and fewer would associate them
with cancer. Still other forms of cancer produce no observable symptoms until
they are at a very advanced (and therefore hard to treat) stage. Specific
symptom detail for cancer subtypes is provided in our cancer subtype
documents.
Local symptoms
Local symptoms may occur due to the mass of the tumor or its ulceration. For
example, mass effects from lung cancer can block the bronchus resulting in
cough or pneumonia; oesophageal cancer can cause narrowing of
the oesophagus, making it difficult or painful to swallow; and colorectal
cancer 006Day 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 to anaemia or rectal bleeding, in the bladder
to blood in the urine and in the uterus to vaginal bleeding. Although localized
pain may occur in advanced cancer, the initial swelling is usually painless.
Some cancers can cause a build-up of fluid within the chest or abdomen.[28]
Systemic symptoms
General symptoms occur due to effects that are not related to direct or
metastatic spread. These may include: unintentional weight loss, fever,
excessive fatigue and changes to the skin.[30] Hodgkin
disease, leukemias and cancers of the liver or kidney can cause a
persistent fever.[28]
Some cancers may cause specific groups of systemic symptoms,
termed paraneoplastic syndrome. Examples include the appearance
of myasthenia gravis in thymoma and clubbing in lung cancer.[28]
Metastasis

Cancer can spread from its original site by local spread, lymphatic spread to
regional lymph nodes or by haematogenous spread via the blood to distant sites,
known as metastasis. When cancer spreads by a haematogenous route, it usually
spreads all over the body. However, cancer 'seeds' grow in certain selected site
only ('soil') as hypothesized in the soil and seed hypothesis of cancer metastasis.
The symptoms of metastatic cancers depend on the tumor location and can
include enlarged lymph nodes (which can be felt or sometimes seen under the
skin and are typically hard), enlarged liver or enlarged spleen, which can be felt
in the abdomen, pain or fracture of affected bones and neurological symptoms.
 5.CAUSES
The majority of cancers, some 90–95% of cases, are due to genetic mutations
from environmental and lifestyle factors.[3] The remaining 5–10% are due
to inherited genetics.[3]Environmental, as used by cancer researchers, means any
cause that is not inherited genetically, such as lifestyle, economic, and
behavioural factors and not merely pollution.[31]Common environmental factors
that contribute to cancer death include tobacco (25–30%), diet and obesity (30–
35%), infections (15–20%), radiation (both ionizing and non-ionizing, up to
10%), stress, lack of physical activity and pollution.[3][32]
It is not generally possible to prove what caused a particular cancer because the
various causes do not have specific fingerprints. For example, if a person who
uses tobacco heavily develops lung cancer, then it was probably caused by the
tobacco use, but since everyone has a small chance of developing lung cancer as
a result of air pollution or radiation, the cancer may have developed for one of
those reasons. Excepting the rare transmissions that occur with pregnancies and
occasional organ donors, cancer is generally not a transmissible disease.[33]

5.1 Chemicals
Further information: Alcohol and cancer and Smoking and cancer

The incidence of lung cancer is highly correlated with smoking.

Exposure to particular substances have been linked to specific types of cancer.
These substances are called carcinogens.
Tobacco smoke, for example, causes 90% of lung cancer.[34] It also causes
cancer in the larynx, head, neck, stomach, bladder,
kidney, oesophagus and pancreas.[35] Tobacco smoke contains over fifty known
carcinogens, including nitrosamines and polycyclic aromatic hydrocarbons.[36]
Tobacco is responsible for about one in five cancer deaths worldwide[36] and
about one in three in the developed world.[37] Lung cancer death rates in the
United States have mirrored smoking patterns, with increases in smoking
followed by dramatic increases in lung cancer death rates and, more recently,
decreases in smoking rates since the 1950s followed by decreases in lung cancer
death rates in men since 1990.[38][39]
In Western Europe, 10% of cancers in males and 3% of cancers in females are
attributed to alcohol exposure, especially liver and digestive tract
cancers.[40] Cancer from work-related substance exposures may cause between 2
and 20% of cases,[41] causing at least 200,000 deaths.[42] Cancers such as lung
cancer and mesothelioma can come from inhaling tobacco smoke
or asbestos fibres, or leukemia from exposure to benzene.[42]
5.2 Diet and exercise
Diet, physical inactivity and obesity are related to up to 30–35% of cancer
deaths.[3][43] In the United States, excess body weight is associated with the
development of many types of cancer and is a factor in 14–20% of cancer
deaths.[43] A UK study including data on over 5 million people showed
higher body mass index to be related to at least 10 types of cancer and
responsible for around 12,000 cases each year in that country.[44] Physical
inactivity is believed to contribute to cancer risk, not only through its effect on
body weight but also through negative effects on the immune
system and endocrine system.[43] More than half of the effect from diet is due
to over nutrition (eating too much), rather than from eating too few vegetables
or other healthful foods.
Some specific foods are linked to specific cancers. A high-salt diet is linked
to gastric cancer.[45] Aflatoxin B1, a frequent food contaminant, causes liver
cancer.[45] Betel nut chewing can cause oral cancer.[45] National differences in
dietary practices may partly explain differences in cancer incidence. For
example, gastric cancer is more common in Japan due to its high-salt
diet[46] while colon cancer is more common in the United States. Immigrant
cancer profiles mirror those of their new country, often within one
generation.[47]
5.3 Infection
Worldwide approximately 18% of cancer deaths are related to infectious
diseases.[3] This proportion ranges from a high of 25% in Africa to less than
10% in the developed world.[3]Viruses are the usual infectious agents that cause
cancer but cancer bacteria and parasites may also play a role.
Oncoviruses (viruses that can cause cancer) include human
papillomavirus (cervical cancer), Epstein–Barr virus (B-cell
lymphoproliferative disease and nasopharyngeal carcinoma), Kaposi's sarcoma
herpesvirus (Kaposi's sarcoma and primary effusion lymphomas), hepatitis
B and hepatitis C viruses (hepatocellular carcinoma) and human T-cell leukemia
virus-1(T-cell leukemias). Bacterial infection may also increase the risk of
cancer, as seen in Helicobacter pylori-induced gastric carcinoma.[48][49] Parasitic
infections associated with cancer include Schistosoma haematobium (squamous
cell carcinoma of the bladder) and the liver flukes, Opisthorchis
viverrini and Clonorchis sinensis (cholangiocarcinoma).[50]
5.4 Radiation
Main article: Radiation-induced cancer

Up to 10% of invasive cancers are related to radiation exposure, including

both ionizing radiation and non-ionizing ultraviolet radiation.[3] Additionally,
the majority of non-invasive cancers are non-melanoma skin cancers caused by
non-ionizing ultraviolet radiation, mostly from sunlight. Sources of ionizing
radiation include medical imaging and radon gas.
Ionizing radiation is not a particularly strong mutagen.[51] Residential exposure
to radon gas, for example, has similar cancer risks as passive
smoking.[51] Radiation is a more potent source of cancer when combined with
other cancer-causing agents, such as radon plus tobacco smoke.[51] Radiation
can cause cancer in most parts of the body, in all animals and at any age.
Children and adolescents are twice as likely to develop radiation-induced
leukemia as adults; radiation exposure before birth has ten times the effect.[51]
Medical use of ionizing radiation is a small but growing source of radiation-
induced cancers. Ionizing radiation may be used to treat other cancers, but this
may, in some cases, induce a second form of cancer.[51] It is also used in some
kinds of medical imaging.[52]
Prolonged exposure to ultraviolet radiation from the sun can lead
to melanoma and other skin malignancies.[53] Clear evidence establishes
ultraviolet radiation, especially the non-ionizing medium wave UVB, as the
cause of most non-melanoma skin cancers, which are the most common forms
of cancer in the world.[53]
Non-ionizing radio frequency radiation from mobile phones, electric power
transmission and other similar sources has been described as a possible
carcinogen by the World Health Organization's International Agency for
Research on Cancer.[54] However, studies have not found a consistent link
between mobile phone radiation and cancer risk.[55]
5.5 Heredity
The vast majority of cancers are non-hereditary (sporadic). Hereditary
cancers are primarily caused by an inherited genetic defect. Less than 0.3% of
the population are carriers of a genetic mutation that has a large effect on cancer
risk and these cause less than 3–10% of cancer.[56] Some of
these syndromes include: certain inherited mutations in the
genes BRCA1 and BRCA2 with a more than 75% risk of breast cancer
and ovarian cancer,[56] and hereditary nonpolyposis colorectal cancer (HNPCC
or Lynch syndrome), which is present in about 3% of people with colorectal
cancer,[57] among others.
Statistically for cancers causing most mortality, the relative risk of
developing colorectal cancer when a first-degree relative (parent, sibling or
child) has been diagnosed with it is about 2.[58] The corresponding relative risk
is 1.5 for lung cancer,[59] and 1.9 for prostate cancer.[60] For breast cancer, the
relative risk is 1.8 with a first-degree relative having developed it at 50 years of
age or older, and 3.3 when the relative developed it when being younger than 50
years of age.[61]
Taller people have an increased risk of cancer because they have more cells than
shorter people. Since height is genetically determined to a large extent, taller
people have a heritable increase of cancer risk.[62]
5.6 Physical agents
Some substances cause cancer primarily through their physical, rather than
chemical, effects.[63] A prominent example of this is prolonged exposure
to asbestos, naturally occurring mineral fibres that are a major cause
of mesothelioma (cancer of the serous membrane) usually the serous membrane
surrounding the lungs.[63] Other substances in this category, including both
naturally occurring and synthetic asbestos-like fibres, such
as wollastonite, attapulgite, glass wool and rock wool, are believed to have
similar effects.[63] Non-fibrous particulate materials that cause cancer include
powdered metallic cobalt and nickel and crystalline
silica (quartz, cristobalite and tridymite).[63] Usually, physical carcinogens must
get inside the body (such as through inhalation) and require years of exposure to
produce cancer.[63]
Physical trauma resulting in cancer is relatively rare.[64] Claims that breaking
bones resulted in bone cancer, for example, have not been proven.[64] Similarly,
physical trauma is not accepted as a cause for cervical cancer, breast cancer or
brain cancer.[64] One accepted source is frequent, long-term application of hot
objects to the body. It is possible that repeated burns on the same part of the
body, such as those produced by kanger and kairo heaters (charcoal hand
warmers), may produce skin cancer, especially if carcinogenic chemicals are
also present.[64] Frequent consumption of scalding hot tea may produce
oesophageal cancer.[64] Generally, it is believed that cancer arises, or a pre-
existing cancer is encouraged, during the process of healing, rather than directly
by the trauma.[64] However, repeated injuries to the same tissues might promote
excessive cell proliferation, which could then increase the odds of a cancerous
mutation.
Chronic inflammation has been hypothesized to directly cause
mutation.[64][65] Inflammation can contribute to proliferation, survival,
angiogenesis and migration of cancer cells by influencing the tumor
microenvironment.[66][67] Oncogenes build up an inflammatory pro-tumorigenic
microenvironment.[68]
5.7 Hormones
Some hormones play a role in the development of cancer by promoting cell
proliferation.[69] Insulin-like growth factors and their binding proteins play a key
role in cancer cell proliferation, differentiation and apoptosis, suggesting
possible involvement in carcinogenesis.[70]
Hormones are important agents in sex-related cancers, such as cancer of the
breast, endometrium, prostate, ovary and testis and also of thyroid
cancer and bone cancer.[69] For example, the daughters of women who have
breast cancer have significantly higher levels
of oestrogen and progesterone than the daughters of women without breast
cancer. These higher hormone levels may explain their higher risk of breast
cancer, even in the absence of a breast-cancer gene.[69] Similarly, men of
African ancestry have significantly higher levels of testosterone than men of
European ancestry and have a correspondingly higher level of prostate
cancer.[69] Men of Asian ancestry, with the lowest levels of testosterone-
activating androstanediol glucuronide, have the lowest levels of prostate
cancer.[69]
Other factors are relevant: obese people have higher levels of some hormones
associated with cancer and a higher rate of those cancers.[69] Women who
take hormone replacement therapy have a higher risk of developing cancers
associated with those hormones.[69] On the other hand, people who exercise far
more than average have lower levels of these hormones and lower risk of
cancer.[69] Osteosarcoma may be promoted by growth hormones.[69] Some
treatments and prevention approaches leverage this cause by artificially
reducing hormone levels and thus discouraging hormone-sensitive cancers.[69]
5.8 Autoimmune diseases
There is an association between celiac disease and an increased risk of all
cancers. People with untreated celiac disease have a higher risk, but this risk
decreases with time after diagnosis and strict treatment, probably due to the
adoption of a gluten-free diet, which seems to have a protective role against
development of malignancy in people with celiac disease. However, the delay in
diagnosis and initiation of a gluten-free diet seems to increase the risk of
malignancies.[71] Rates of gastrointestinal cancers are increased in people
with Crohn's disease and ulcerative colitis, due to chronic inflammation.
Also, immunomodulators and biologic agents used to treat these diseases may
promote developing extra-intestinal malignancies.[72]
 6.DIAGNOSIS

6.1 Cancer diagnosis

Chest x-ray showing lung cancer in the left lung

Most cancers are initially recognized either because of the appearance of signs
or symptoms or through screening. Neither of these leads to a definitive
diagnosis, which requires the examination of a tissue sample by a pathologist.
People with suspected cancer are investigated with medical tests. These
commonly include blood tests, X-rays, (contrast) CT scans and endoscopy.
The tissue diagnosis from the biopsy indicates the type of cell that is
proliferating, its histological grade, genetic abnormalities and other features.
Together, this information is useful to evaluate the prognosis and to choose the
best treatment.
Cytogenetics and immunohistochemistry are other types of tissue tests. These
tests provide information about molecular changes (such as mutations, fusion
genes and numerical chromosome changes) and may thus also indicate the
prognosis and best treatment
Your doctor may use one or more approaches to diagnose cancer:

 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 colour 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 non-invasive 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.
 7.PREVENTION
Main article: Cancer prevention

Cancer prevention is defined as active measures to decrease cancer risk.[97] The

vast majority of cancer cases are due to environmental risk factors. Many of
these environmental factors are controllable lifestyle choices. Thus, cancer is
generally preventable.[98] Between 70% and 90% of common cancers are due to
environmental factors and therefore potentially preventable.[99]
Greater than 30% of cancer deaths could be prevented by avoiding risk factors
including: tobacco, excess weight/obesity, poor diet, physical
inactivity, alcohol, sexually transmitted infections and air pollution.[100] Not all
environmental causes are controllable, such as naturally occurring background
radiation and cancers caused through hereditary genetic disorders and thus are
not preventable via personal behaviour.
7.1 Dietary
Main article: Diet and cancer

While many dietary recommendations have been proposed to reduce cancer

risks, the evidence to support them is not definitive.[14][101] The primary dietary
factors that increase risk are obesity and alcohol consumption. Diets low in
fruits and vegetables and high in red meat have been implicated but reviews and
meta-analyses do not come to a consistent conclusion.[102][103] A 2014 meta-
analysis find no relationship between fruits and vegetables and
cancer.[104] Coffee is associated with a reduced risk of liver cancer.[105] Studies
have linked excess consumption of red or processed meat to an increased risk
of breast cancer, colon cancer and pancreatic cancer, a phenomenon that could
be due to the presence of carcinogens in meats cooked at high
temperatures.[106][107] In 2015 the IARC reported that eating processed
meat (e.g., bacon, ham, hot dogs, sausages) and, to a lesser degree, red meat was
linked to some cancers.[108][109]
Dietary recommendations for cancer prevention typically include an emphasis
on vegetables, fruit, whole grains and fish and an avoidance of processed and
red meat (beef, pork, lamb), animal fats, pickled foods and refined
carbohydrates.[14][101]
7.2 Medication
Medications can be used to prevent cancer in a few circumstances.[110] In the
general population, NSAIDs reduce the risk of colorectal cancer; however, due
to cardiovascular and gastrointestinal side effects, they cause overall harm when
used for prevention.[111] Aspirin has been found to reduce the risk of death from
cancer by about 7%.[112] inhibitors may decrease the rate of polyp formation in
people with familial adenomatous polyposis; however, it is associated with the
same adverse effects as NSAIDs.[113] Daily use
of tamoxifen or raloxifene reduces the risk of breast cancer in high-risk
women.[114] The benefit versus harm for 5-alpha-reductase inhibitor such
as finasteride is not clear.[115]
Vitamin supplementation does not appear to be effective at preventing
cancer.[116] While low blood levels of vitamin D are correlated with increased
cancer risk,[117][118][119] whether this relationship is causal and vitamin D
supplementation is protective is not determined.[120][121] One 2014 review found
that supplements had no significant effect on cancer risk.[121] Another 2014
review concluded that vitamin D3 may decrease the risk of death from cancer
(one fewer death in 150 people treated over 5 years), but concerns with the
quality of the data were noted.[122]
Beta-carotene supplementation increases lung cancer rates in those who are high
risk.[123] Folic acid supplementation is not effective in preventing colon cancer
and may increase colon polyps.[124] It is unclear if selenium supplementation has
an effect.[125][needs update]
7.3 Vaccination
Vaccines have been developed that prevent infection by
some carcinogenic viruses.[126] Human papillomavirus
vaccine (Gardasil and Cervarix) decrease the risk of developing cervical
cancer.[126] The hepatitis B vaccine prevents infection with hepatitis B virus and
thus decreases the risk of liver cancer.[126] The administration of human
papillomavirus and hepatitis B vaccinations is recommended when resources
allow.[127]
 8. TYPES OF CANCER
8.1 Breast Cancer:
8.1.1 Introduction:
Breast cancer occurs when a malignant (cancerous) tumor originates in the
breast. As breast cancer tumors mature, they may metastasize (spread) to other
parts of the body. The primary route of metastasis is the lymphatic system
which, ironically enough, is also the body's primary system for producing and
transporting white blood cells and other cancer-fighting immune system cells
throughout the body. Metastasized cancer cells that aren't destroyed by the
lymphatic system's white blood cells move through the lymphatic vessels and
settle in remote body locations, forming new tumors and perpetuating the
disease process.

Breast cancer is fairly common. Because of its well publicized nature, and
potential for lethality, breast cancer is arguably the most frightening type of
cancer diagnosis someone can receive. However, it is important to keep in mind
that, if identified and properly treated while still in its early stages, breast cancer
can be cured.

Breast cancer is not just a woman's disease. It is quite possible for men to get
breast cancer, although it occurs less frequently in men than in women. Our
discussion will focus primarily on breast cancer as it relates to women but it
should be noted that much of the information is also applicable for men.
8.1.2 Causes and Prevention:
The causes of breast cancer are not yet definitively known. However, extensive
research efforts have uncovered various risk factors that are associated with
increased incidence of breast cancer in women. Though some of these risk
factors are unavoidable and uncontrollable, some of them are very avoidable,
making it possible for people to take action so as to minimize their cancer risk.
Even a minimized risk is still a risk, however. There is no way to pre-determine
whether a person will get breast cancer until they have either been diagnosed
with it or they have lived a breast-cancer free lifetime.
Some of the risk factors for breast cancer that are difficult or impossible to
control include:

 Age. As women age their chance of getting breast cancer increase. The majority
of breast cancer cases are diagnosed in women over the age of 50. Women over
the age of 20 should get clinical (by a doctor or other health professional) breast
 exams at least every three years according to the American Cancer Society.
During the first clinical breast exam your physician should explain to you the
potential benefits and limitations of breast self exam and instruct you on
appropriate technique. The American Cancer Society now says that women
need not perform a BSE every month if they do not wish to. However, it is
important for all women to be vigilant of any changes in their breasts and to
report any changes to their physician as soon as possible. Asymptomatic
women over the age of 40 should receive clinical breast exams during their
yearly health maintenance exam (ACS, 2009). As a general rule asymptomatic
women in their 40s and older should get yearly mammograms to check for
breast cancer. The frequency with which someone should have mammograms
performed should be determined with the input of a physician.

 Family and genetic history. Some cases of breast cancer are known to have
been caused as a result of genetic mutation. Gene mutations can be inherited
from parents and can also occur in otherwise healthy people in response to
environmental toxins. Having a close relative on either side of your family who
has breast cancer will, in general, increase your risk of contracting breast
cancer. This is particularly true if the relative is what is called "first degree"
meaning your sister or mother. In general, the more first degree relatives that
have had breast cancer the more likely you are to develop breast cancer as well.

 BRCA gene mutation. Recent advances in genetic mapping have discovered a

gene mutation that increases the risk of certain female cancers in women with
the mutation. The two main breast and ovarian cancer susceptibility genes are
known as BRCA1 and BRCA2. I selected women who have extensive family
history of breast cancer or ovarian cancer it may be beneficial to be tested for
the mutations at an early age. This would allow affected individuals to make
informed decisions about prophylactic (preventative) surgery before they
contract either type of cancer. Fortunately, it is thought that only 5-10% of
breast cancer cases are caused by these mutations and that the mutations are
only present in about 1% of the general population (ACS, 2009). For this
reason the US Preventive Services Task Force recommends that only women
with a very strong family history of breast cancer be evaluated for the BRCA
mutations (USPSTF, 2005). The American Cancer Society states that women
with the BRCA1 mutation have a 57% chance of getting breast cancer by age 70
while those with the BRCA2 mutation have a 49% chance of getting breast
cancer by age 70 (ACS, 2009).

 Previous breast cancer. A woman who previously had breast cancer and has
been cured has a greater chance for having a new breast cancer episode occur
than is a woman who never had the disease. New tumors appearing inside
someone with a previous history of cancer who has been cancer free are not
 necessarily related to or caused by old eradicated tumors. Instead, new tumors
can form spontaneously in vulnerable persons.

 Race. Hispanic and Asian women have lower risk for getting breast cancer than
do Caucasian and African American women. In fact, Caucasian women are at
the highest risk of getting the disease compared to women of other racial
backgrounds. African American women, however, are historically the most
likely to die from breast cancer because, in general, their tumors are diagnosed
at a later stage. Why there is a failure to identify tumors in African American
women until later in their development is not clear at this time. It may occur
because, as a group, these women have less access to healthcare, or possibly
because they are less likely as a group to seek healthcare. Research is ongoing
in this area to determine the cause of this alarming disparity.

 Previous benign tumor biopsy results. Women who have had previous biopsy
that has found a benign (non-cancerous) tumor in the breast are at a greater risk
for malignant breast tumors in the future. However, the occurrence of cysts in
the breast does not increase the risk for future breast cancer.

 Prior radiation treatment in the chest area. Women who receive prior
radiation treatment directed at their chest area for any reason are at a heightened
risk for future breast cancer compared to women who do not receive radiation
treatment. The earlier in life women are exposed to chest-targeted radiation
treatment, the higher their later risk for breast cancer.

 Menstrual Cycles. Women who begin menopause after the age of 50 or who
had their first menstrual cycle before age 12 run a slightly higher risk for breast
cancer than women whose menstrual cycles started after age 12 and end prior to
age 50. This is due to prolonged exposure to high levels of certain reproductive
hormones.
While the above risk factors for breast cancer are difficult or impossible to
avoid, there are also numerous risk factors for breast cancer that can be avoided
by making healthy lifestyle choices. While choosing a healthy lifestyle may not
always be simple or easy, making such lifestyle changes can help you lower
your cancer risk with regard to the following risk factors:
 Use of Birth Control Pills. Some studies have shown that women who use
birth control pills are at a slightly increased risk for breast cancer. However, any
relationship between breast cancer and birth control pill use remains
controversial at this time, pending further research. It's not all bad news. While
oral contraceptives (birth control pills) may slightly increase risk of breast
cancer, they appear to reduce the risk of other types of female cancers. Consult
with your doctor about the risks and benefits of birth control pills if you have
concerns about breast cancer risk.
 Not Having Children. Women who have their first child after the age of 30 or
who have never had children run a slightly higher risk for contracting breast
cancer than do women who give birth before reaching age 30. This is again due
to more prolonged exposure to reproductive hormones. Be this as it may, a
decision as important as whether or not to have children should not be
influenced by the small reduction or elevation in risk for breast cancer it may
carry.

 Hormone Replacement Therapy. Hormone replacement therapy (HRT) is

sometimes prescribed to women as a means of alleviating discomfort associated
with menopause. Research indicates that women who have received HRT for
five years or more may be at a heightened risk for breast cancer. However, the
heightened risk seems to occur primarily in women using combined (estrogen
and progesterone mixture) HRT, as opposed to estrogen-only HRT. However,
estrogen-only HRT increases risk of uterine cancer. The elevated breast cancer
risk appears to be reversible in that women who discontinued HRT for five or
more years show no more increased risk for breast cancer than women who
never used it in the first place.
There are real benefits to HRT that should not be dismissed lightly just because
of the elevated breast cancer risk it may come with. Talk to your doctor about
your risks and benefits with regard to HRT. HRT may be a good idea for you if
you are at a low risk for breast cancer and could benefit from its therapeutic
effects. However, if you are already at a high risk for breast cancer you should
carefully weigh the risks and benefits before beginning HRT.

 Obesity and Poor Diet. Research has established a link between being
overweight and an elevated risk of postmenopausal breast cancer. This seems to
be because the majority of reproductive hormones in postmenopausal women is
produced in the fat cells. Therefore, the more fat cells a woman have the higher
their reproductive hormone levels.
Getting one's self down to a healthy weight and staying there is likely to be a
means of reducing one's cancer risk. The best way to combat obesity is to
combine a balanced and nutritional diet with a consistent exercise program.
Reduced or eliminating portions of foods known to be high in saturated (meat,
dairy, etc.) and 'trans fats' (packaged baked goods often contain 'partially
hydrogenated' oils which are, in fact, trans fats) may further reduce risk as well.
There are numerous benefits to maintaining a healthy body weight besides
possibly lowering your cancer risk. Losing weight can also reduce your risk for
heart disease and leave you feeling healthier and more energetic.
 Failing To Exercise. Some recent studies have found a small relationship
between moderate exercise and decreased risk of breast cancer. Exercising
regularly can help combat obesity as well which further lowers cancer risk.
Aerobic exercises, such as swimming, brisk walking, jogging, and playing
tennis are best bets as they are easy and enjoyable. However, any activity that
will get your heart rate up for an extended period of time will be beneficial. It is
a good idea to check with your doctor before beginning any kind of vigorous
exercise program.

 Breast Feeding. Multiple studies have demonstrated that breast feeding is

associated with reduced risk of breast cancer. In addition, the longer you breast
feed the better the cancer protection you appear to achieve.

 Excessive Alcohol Intake. Drinking alcohol has been shown to slightly

increase the risk of breast cancer. There is a relationship between how much
alcohol is consumed and how large breast cancer risk becomes (with women
who drink more alcohol being at higher risk for contracting breast cancer than
women drinking less alcohol). As alcohol is implicated in numerous health
problems, it is best to limit daily alcohol intake to one drink, or to abstain from
it altogether.
The more of these risk factors you can eliminate from your life the better your
chances may be of avoiding breast cancer.
8.1.3 Symptoms and Diagnosis:
Breast cancer is a disease that progresses in stages, building in intensity over
time. During the early stages of breast cancer there may be no discernable
symptoms. When symptoms are present they may be subtle and easy to confuse
with benign conditions. During the early and middle stages of breast cancer
symptoms can include the following:

 A lump, dimple or thickening in the breast

 A lump or swelling in the armpit (an enlarged lymph node)
 Change in the shape of the breast
 Change in the size of the breast, including swelling
 Change in the colour or texture of the breast and/or nipple, including redness,
scaly, dimpled, retracted, or puckered appearance
 Breast pain, especially if in one breast only
 Abnormal discharge from the nipple
It is important to remember that the appearance of these symptoms do not
indicate that a person certainly has breast cancer. It is a good idea to consult
with your doctor if you notice any of these symptoms are present.
 Breast cancer is far easier to treat when it is identified earlier rather than later.
Early identification of breast cancer can present a problem, however, as breast
cancer often occurs without producing symptoms. In the absence of obvious
symptoms, only a doctor's careful examination and testing can bring hidden
cancer to light. Regular professionally administered breast cancer screenings are
thus an essential part of proper health care for all persons who are at heightened
risk for breast cancer, and (as advancing age is a risk factor) for all women over
age 40.

Doctors use several methods to screen women for breast cancer. What follows
is some general information on two of the most commonly used tests.

 Clinical Breast Exam. During a clinical breast exam (CBE for short) a doctor
first observe your breasts for any inequalities or changes in size or shape, then
palpates (feels) your breasts and armpits looking for lumps and swellings. It can
be awkward to receive a breast exam, especially when it is given by a male
doctor. You should know that many doctors' offices have women available who
are trained to give clinical breast exams. Do not hesitate to ask for a woman to
perform the procedure if this would make you more comfortable.

 Mammogram. A mammogram is basically an x-ray image of the breast's

interior tissues and any lumps or irregularities that may exist therein. During
this procedure a doctor or specialist will have you undress and place your breast
between two plates which are then slightly compressed. Your breast is then
subject to a beam of radiation and an x-ray picture is taken. Though
uncomfortable, the pressure on your breast is necessary to improve the clarity of
the x-ray image. Fortunately, it does not last long. Also, it is good to know that
the radiation used during the procedure does not significantly increase your risk
of breast or any other form of cancer.

 Axillary Dissection and Biopsy. Recall that breast cancer starts as a tumor in
the breast, and then later spreads through the body via the lymph system. If your
doctor comes to believe that you may have cancer, he or she will want to know
whether that cancer is still localized inside your breast, or whether it has spread.
A test called an Axillary Dissection can help answer this question. An axillary
dissection involves a small surgery wherein cells from the lymph nodes in the
armpit are removed and then studied under the microscope to determine if they
are cancerous. The general name for this tissue sampling and study is "biopsy".

 Hormone receptor testing. Recent advances in testing of biopsy specimens

allow doctors to test tumor samples for certain hormone receptors. If these
hormone receptors are present in the tumor it allows doctors to use certain
 medications to help fight the cancer and can improve a person's likelihood of
survival. These will be discussed further in the treatment section.
Although only your doctor can do a definitive breast cancer screening, it is a
good idea for all women to learn to do breast cancer self-screening so as to
identify any potential symptoms as early as possible. Breast self examinations
are easy to perform. They involve a regular and systematic checking of your
breasts for lumps, irregularities and other changes that may indicate cancer. A
great number of women who survive breast cancer have been able to discover
its presence while the cancer is still in its early stages. You should practice
breast self-examination regularly so that you become familiar with your breasts
and are thus in a better position to identify changes that may be early warning
signs.
8.1.4 Treatments:
There are two general approaches to treating cancers: local treatment and
systemic (whole body) treatment. Local treatment involves treating just the
small areas of the body containing tumors while affecting the rest of the body as
little as possible. Systemic treatment approaches, on the other hand, are used to
treat cancer that has spread throughout the body. Local treatment approaches
alone may be all that is required for treatment of early stage breast cancer (e.g.,
before metastasis - the spreading of cancerous tissues through the body -- has
occurred). Combined local and systemic approaches may be necessary for
treatment of more advanced cancers. Surgical approaches tend to fall into the
local treatment category, while chemotherapy approaches fall into the systemic
category. Radiation therapy approaches can be local or systemic depending on
how they are administered.

The majority of women who are afflicted by breast cancer will require some
type of surgery. The goal of the surgical procedure is to remove the cancerous
tumor while preserving as much of the healthy breast tissue as possible. Later
stage breast cancers often require more extensive surgeries as more tissues get
involved in the disease process. Some of the surgical procedures used to treat
breast cancer are:

 Lumpectomy. Lumpectomy is a surgical procedure in which the breast tumor is

removed while sparing as much healthy surrounding tissue as possible. The
benefit of lumpectomy is that in most circumstances the mass and form of the
breast can be retained. Radiation treatment and chemotherapy are often given in
conjunction with lumpectomy. Recovery time from a lumpectomy is very short.
 Partial Mastectomy. This surgical procedure is similar in principle to a
lumpectomy but involves removing more of the tissue surrounding the
cancerous tumor. Partial mastectomy can also be followed by radiation therapy
or chemotherapy.

 Modified Radical Mastectomy. This surgical procedure involves removing the

entire breast mass and involved lymph nodes from under the arm (while
preserving as many of the lymph nodes as possible). Understandably, removal
of the entire breast and the disfigurement this creates can be traumatic and
depressing for many women. Reconstructive surgery may be desirable.

 Radical Mastectomy. During this surgical procedure the entire breast is

removed as well as the lymph nodes under the arm and the pectoral (chest)
muscles under the breast. This most extreme surgical method is rarely
performed today since studies have shown that survival rates with modified
radical mastectomy are often just as high. Most mastectomy patients stay in the
hospital anywhere from four to ten days after surgery.Surgical removal of the
tumor causing a cancer is often not sufficient for a full recovery, particularly
when metastasis has occurred. It is common to see systemic chemotherapy or
radiation therapies applied in conjunction with surgery. Chemotherapy and
radiation therapies offer doctors a way to destroy any cancer cells in the
surrounding area of the main tumor that they might have missed during surgery.

 Hormonal therapy. Now that tumor biopsy specimens can be tested for
specific hormone receptors it has allowed scientists to develop drugs which can
block those receptors and slow a tumor's growth. The main type of drug used
blocks the effects of a hormone called estrogen and is usually given over a five
year period and then discontinued.
Having been diagnosed with breast cancer, many women feel an extreme sense
of urgency to begin treatment. While understandable given the gravity of the
diagnosis, a rush towards treatment can commit patients to a treatment plan they
are not comfortable with or fully educated about. Further, although treatment of
some sort is almost always necessary to prevent a negative outcome, there is
sometimes some flexibility with regard to what forms treatment might take and
how rapidly they must be applied. For these reasons it is important that patients
express any questions or concerns they may have to their doctors so as to
become as well informed and comfortable with treatment options and decisions
as possible. Patients may wish to consult with a second doctor to obtain an
independent treatment recommendation. Another specialist may provide
additional information and options, or confirm that a recommended course of
treatment is best.
 8.2 Colorectal Cancer:
8.2.1 Introduction
The term "colorectal" is a contraction of two terms, 'colon' and 'rectum'. Parts of
the digestive system, the colon is the name given to the last six or so feet of the
intestine (otherwise known as the large intestine), and the rectum is the name
for the last several inches of the large intestine just before it exits the body via
the anus.

Colorectal cancer occurs when abnormal tissues grow on the inner walls of the
colon or rectum. These abnormal tissues commonly present in the form of
polyps. Polyps grow as a projection of tissue away from the colon wall,
remaining connected to the colon wall by way of a thin stalk. Their shape is
similar to that of a mushroom. Polyps are fairly common, especially in older
people. The vast majority of polyps are not cancerous. However, some polyps
will eventually become cancerous. Unchecked, a cancerous polyp gives rise to a
tumor, which grows in size until it penetrates the bowel wall and involves
adjacent organs and lymph nodes through the process known as metastasis.

Colorectal cancer is the third most prevalent cancer in the United States and,
when undetected and untreated, the third most deadly (ACS, 2008).
Approximately 150,000 new cases of colorectal cancer are diagnosed each year,
and about 50,000 Americans die each year from colorectal cancer (ACS, 2008).
While these statistics are alarming, it is important to remember that if caught
early enough, colorectal cancer can often be cured. Early detection and removal
of polyps can even prevent pre-cancerous polyps from becoming cancerous.
8.2.2 Causes and Prevention:
The exact causes of colorectal cancer are not completely understood. However,
many risk factors for colorectal cancer have been identified. While some of the
risk factors are out of our control, a good number of them are avoidable if
healthy lifestyle choices are pursued. In any event, regular screening for
colorectal cancer after the age of 50 can help identify potential cancers early on
when they are easy to treat (Levin, 2008).

What follows is a list of some of the risk factors researchers have identified
which cannot be controlled:

 Gender. Men are at a greater risk for colorectal cancer than are women.
 Age. The older you get, the greater your risk for colorectal cancer becomes.
Individuals older than 50 years old should receive regular colorectal cancer
screenings.

 Prior Colorectal or Breast Cancer. Persons previously diagnosed with

colorectal cancer have an increased risk for getting colorectal cancer again.
Women who have previously had breast cancer are also at increased risk of
colorectal cancer.

 Genetic Background. Persons closely related to people who have had

colorectal cancer are at increased risk themselves of getting colorectal cancer.
African Americans have a greater general risk of getting colorectal cancer than
do Caucasian Americans. There are two types of familial colon cancer,
vulnerabilities for which are genetically inherited through one's parents:
Familial Adenomatous Polyposis (FAP) and Hereditary Nonpolyposis
Colorectal Cancer (HNPCC).

 Presence of Polyps. Persons who have more polyps (especially larger polyps)
are at an increased risk of colorectal cancer. Importantly, there are different
types of polyps. Some types are more likely to become cancerous than others.
Your doctor can let you know which type of polyp you have and what the
correlated risk of cancer is for that polyp type.

 Previous Bowel Disease. Bowel diseases such as Ulcerative Colitis, and

Crohn's Disease, that cause the colon to become inflamed for long periods of
time increase risk for colorectal cancer. Persons who have Ulcerative Colitis or
Crohn's should get regular screenings for colorectal cancer.
Some of the risk factors for colorectal cancer are created by poor and unhealthy
lifestyle choices. Making healthier lifestyle choices can result in a lowering of
colorectal cancer risks.

 Diet. Eating a diet high in fatty foods, especially those that come from animal
sources (e.g., meat and dairy), can greatly increase risk for colorectal cancer.
Diets that are low in fiber and low in fresh fruits and vegetables also appear to
be associated with increased risk for colorectal cancer.
As the saying goes, "An apple a day keeps the doctor away". Eating a healthy
and balanced diet reduces risk for colorectal cancer. Many Americans do not eat
enough fresh fruits and vegetables or dietary fiber, while eating too much high
fat meat. Eating five servings of fresh fruits and vegetables each day, while
cutting down on meat intake will likely go a long way towards reducing dietary
components of cancer risk. Dietary fiber can be obtained directly from fruits,
vegetables, whole grains and beans and from dietary supplements including
psyllium seed husks.
 Sedentary Lifestyle. Sedentary people who don't get enough exercise run a
much higher risk for getting colorectal cancer than people who lead an active
lifestyle. Committing to a regular program of physical exercise is a great way to
improve your overall health as well as reduce your risk for getting colorectal
cancer. Cardiovascular exercises (including aerobics, jogging, biking, brisk
walking, tennis and other court sports, etc.) which elevate your heart rate for
extended periods of time are recommended.

 Smoking. Smokers are up to 40% more likely than non-smokers to die of

colorectal cancer. Given the terrible risks associated with smoking, it is in all
smokers' interests to quit smoking as soon as possible. Smoking is addictive and
it is frequently difficult for smokers to quit. Repeated efforts at quitting may be
necessary before a permanent tobacco-free state can be achieved. The effort is
worth it in terms of improved health for the smoker and his or her family (who
benefit from the absence of secondary smoke). Doctors, health professionals
and employee assistance programs all offer programs designed to help smokers
quit smoking.

 Weight. While all heavy people are at an increased risk for colorectal cancer
compared to people who are at recommended body weight, those who carry
their weight in their belly are at especially high risk. Regular exercise, healthy
eating choices, portion control, and support groups such as Weight Watchers
can help to keep weight down.

 Alcohol. People who use alcohol excessively have a higher incidence of

colorectal cancer than those who do not.
In addition to changing your lifestyle to become more healthy (as described
above), there are a few other things that can be done to lower your chance of
getting colorectal cancer:

 Medicine. Some commonly prescribed and over-the-counter medications

appear to be helpful in reducing colorectal cancer risk. Low doses of aspirin and
other non-steroidal anti-inflammatory drugs (NSAIDs) may help, as do
estrogen-replacement therapies for older women. As with any use of
medication, it is wise to follow your physician's advice regarding
appropriateness and dosage.
 8.2.3 Symptoms and Diagnosis:
Early and middle stage colorectal cancers often present with few or no
observable symptoms, making them difficult to identify without the benefit of a
doctor's screening tests (described below). When symptoms are apparent, they
tend to take the following forms:

 Changed bathroom habits that do not resolve within a week (including diarrhea,
constipation or any obstruction of the colon)
 Bloody stool (note that stool blood is generally not visible or obvious). Blood in
stool often presents as black, tarry stool. If you notice your stools are darker or
tar-like, bring this to the attention of your doctor.
 Thinner than normal or otherwise malformed stools
 Pain in the lower abdomen
 Anemia that cannot be accounted for by other conditions (such as menstruation)
 Weight loss that cannot be accounted for by other conditions
As with many cancers, the outlook (prognosis) for patients with colorectal
cancer is better when the disease is identified earlier in its progression rather
than later. The earlier the cancer is found the greater the likelihood it can be
successfully treated and cured. Individuals who are at risk for colorectal cancer
should receive regular professional medical screenings to identify any problem
at the earliest possible opportunity.

Medical screening for colorectal cancer frequently involves one or more of the
procedures described below. As these methods involve semi-taboo procedures
such as stool sampling and rectal insertion (to check for polyps), they are
sometimes perceived as embarrassing or shameful, or as painful. On these
grounds, some people who might otherwise benefit from screening tests may
instead avoid them. It is important to keep in mind that the actual discomfort
involved in the screening process is minimal, and that the entire screening
process is private between the doctor and patient. Rationally considered, the
benefits of colorectal screening far outweigh reasons for avoiding the process.
Finding a physician with whom you feel comfortable may be the key needed to
combat any feelings of embarrassment.

Beginning at age 50 (and at a younger age for high-risk persons), people should
strongly consider scheduling themselves for regular colorectal screenings
(Levin, 2008). There are different combinations of screening protocols that are
recommended, each with its own timetable for how often it needs to occur.
Screening protocols include the following:

 Fecal occult blood test (FOBT) or fecal immunochemical test (FIT) each year.
 Flexible sigmoidoscopy every 5 years
 Yearly FOBT* or FIT plus flexible sigmoidoscopy every 5 years
 Double-contrast barium enema every 5 years
 Colonoscopy every 10 years
Regardless of which protocol you follow, any positive test results should be
followed up with a full colonoscopy so that further detail can be detected. Here
are descriptions of these screening tests:

 Fecal Occult Blood Test (FOBT). This test looks for blood within a sample of
your stool. Generally, you take your own sample, and deposit bits of it onto a
card provided as part of a take-home kit provided to you for this purpose. The
card is then submitted to a laboratory, which then conducts the analysis. A
positive finding means that something in your GI track (from your mouth to you
anus) is bleeding and merits further investigation. The test is non-specific,
however, because any number of conditions, some potentially dangerous (such
as polyps and/or tumors) and some benign (like hemorrhoids) might have
caused the bleeding. Also, many colorectal cancers do not bleed, or bleed only
intermittently. For these reasons, it is common to complement the fecal blood
test with additional tests.

 Digital Rectum Exam with Fecal Immunochemical Test (FIT). During this
test a doctor inserts gloved and lubricated fingers into your anus. The doctor
then evaluates a small sample of stool for blood. In men, this exam is also used
to check the prostate. In women, it is used to evaluate the space between the
rectum and uterus. This test is minimally invasive (as invasive tests go) and
causes little or no discomfort. This is only a screening test and is not specific for
colorectal cancer. Doctors may also use this exam to see if a patient has internal
or external hemorrhoids. This test is preferred over the FOBT. Persons over 50
should get a digital rectal exam with FIT once a year.

 Barium Enema. The barium enema test is a method of imaging the structure of
your colon. Radioactive barium dye is placed into your colon by means of an
enema, and then an x-ray picture of your colon is taken. The barium dye
highlights the colon structure and surfaces in a way that would not be possible if
the dye were not used. The enema method of inserting the dye into the colon
can cause some temporary discomfort. Doctors examine the x-ray pictures
resulting from this procedure for polyps and other signs of cancer. This test is
not as good at detecting cancer as colonoscopy and has fallen out of favor in
recent years.

 Virtual Colonoscopy. Virtual colonoscopy involves the use of sophisticated

medical imaging procedures such as computed tomography (also known as a
CT or CAT scan) and magnetic resonance imaging (known as MRI) to produce
a detailed picture of the soft tissues making up the colon and rectum. Virtual
 colonoscopy is fast, minimally invasive, and produces better images than the
older barium enema technique, but it does not resolve fine details or small
polyps nearly as well as an actual colonoscopy (described below). Further, if the
images suggest that a problem may exist, regular colonoscopy will still be
necessary in order to get tissue samples for testing. As virtual colonoscopy
technology is newer and more 'hi-tech' than older imaging techniques it can be
more expensive as well.

 Flexible Sigmoidoscopy. During this procedure a doctor inserts a small flexible

tube containing a light and a camera (an endoscope or colonoscope) into your
rectum. The doctor moves the tube through the lower sections of your colon to
look for polyps or other signs of colorectal cancer. The endoscope blows air into
your colon to inflate it so as to properly visualize the tissues. This test, which
may cause minor discomfort, commonly takes only a few minutes to perform.
Sedation is generally administered. In some cases doctors will use flexible
sigmoidoscopy in conjunction with the barium enema test to find small polyps
that the x-ray images would not otherwise resolve. If polyps or similar abnormal
tissues are found, the doctor can use the endoscope to take a sample of that
tissue for later analysis. The American Cancer Society recommends that people
50 years old or older have a sigmoidoscopy or similar procedure performed
every five years.

 Colonoscopy. Colonoscopy (not to be confused with virtual colonoscopy) is

very similar in principle to flexible sigmoidoscopy. The major difference is that
colonoscopy is far more thorough, involving visualization of the entire colon
(rather than just the lower half as in sigmoidoscopy). Colonoscopy is the best
test available for discovering signs of colorectal cancer, but also one of the more
expensive tests that can be conducted. The American Cancer Society
recommends that people 50 years old or older have a colonoscopy every ten
years. One benefit of a colonoscopy is that they can be both diagnostic and
therapeutic (used to treat any concerning polyps).
8.2.4 Treatment:
Assuming that polyps are found during a colonoscopy, they can be removed
surgically or with the colonoscope. Whether or not actual cancer is found in the
colon, the removal of existing polyps is thought to have a preventative function,
reducing the risk that any polyps will go on to turn into cancer.

Surgery is generally necessary to remove cancerous polyps or tumors. The

earlier cancers can be located, the less extensive the procedures that have to be
done in order to remove the cancerous tissues. In early stage cancer, it may be
sufficient to remove the inner layers of tissue inside the colon. When tumors
have penetrated through the colon wall it can be necessary to remove entire
diseased sections of the colon; a process called segmental resection. To the
extent that tumors have metastasized, additional involved tissues (nearby lymph
nodes, etc.) may need to be removed as well.

When possible, the surgeon will reconnect the healthy colon portions back
together so that normal bowel function can be resumed. In some cases this is not
possible, however, as in the case where rectum tissues are cancerous. In such
cases, the surgeon may have to create a special opening in your abdomen (called
a colostomy) which then serves as the new point of elimination of body wastes
(stool). Colostomy is sometimes performed on a temporary basis, but it can also
become a permanent feature of your battle with cancer.

Common side-effects of colorectal surgery include short-term pain and

tenderness as well as diarrhea and constipation. After surgery most patients will
need to remain in the hospital for five to seven days with their food intake
restricted for the first few days. Most patients fully recover within two months.

In addition to surgery that removes localized cancerous tissues, radiation and

chemotherapies may be prescribed as additional treatment to target cancers that
may have spread into the body, or for cancer that is inoperable.

Radiation therapy consists of using high energy beams (such as x-rays or

gamma radiation) to kill any cancer cells that the surgery may have missed.
Radiation is commonly administered externally by aiming highly focused
beams at the infected region. Radiation therapy can also be administered by
placing radioactive material directly into the body near where inoperable tumors
are found. Side effects of radiation therapy, which can include fatigue, bleeding,
diarrhea, and loss of appetite, commonly disappear soon after treatment has
ended.

Chemotherapy involves the use of powerful anticancer drugs injected directly

into the bloodstream or taken by mouth. These drugs are designed to destroy
cells that divide rapidly as cancer cells do. Unfortunately cancer cells are not the
only cells in the body that divide rapidly. Common side effects of chemotherapy
include fatigue, hair loss, nausea, diarrhea, and increased prevalence of
infection. However, as is the case with radiation therapy, these side effects tend
to go away soon after treatment ends.
8.3 Lung Cancer:
8.3.1 Introduction:
Lung cancer occurs when a malignant (cancerous) tumor grows inside the lungs,
in structures such as the bronchi (small tubes that connect the windpipe to the
inner surfaces of the lungs where gas transfer takes place). Like many other
types of cancer, lung cancer is capable of spreading (metastasizing) to other
parts of the body. In this case, cancer beginning in the lungs most commonly
spreads to the brain, bones, adrenal glands and liver, via any of three
mechanisms: direct extension, via the blood vessels, or via the lymph system.
Direct extension occurs when a tumor grows rapidly in size such that it begins
to touch an adjacent organ or structure, and then begins to penetrate itself into
that adjacent organ or structure. Tumor cells are also able to get into the blood
and lymph circulatory systems and travel, one by one, to distant structures.

Lung cancer is now the most prevalent form of cancer affecting Americans with
an estimated 222,500 new cases every year, according to the American Cancer
Society (ACS, 2010). Beyond being the most common form of cancer, lung
cancer is also often difficult to treat. As a result, lung cancer is the most deadly
cancer with roughly 160,000 Americans dying from it every year. This is about
30% of all cancer deaths! (ACS, 2010).

Although lung cancer is difficult to treat and cure, it is for the most part
preventable. Lifestyle choices can be made which can almost eliminate your
risk for getting the disease. Your decision to stop smoking and to eat a healthy
diet featuring plenty of fresh fruits and vegetables can greatly decrease your
risk.

Types of Lung Cancer

Lung cancers are broken down into two major types, small cell lung cancer and
non small cell lung cancer.

Small cell lung cancers comprise roughly 15% of all lung cancer cases (ACS,
2010). This type of lung cancer originates in an inner layer of the walls of the
bronchi called the bronchial submucosa, and grows aggressively (in comparison
with non small cell lung cancers), quickly spreading into surrounding tissues,
and ultimately, through the body. Though the growth of this cancer is rapid,
there are few or no clues that anything is particularly amiss. Symptoms are
generally not noticeable until the cancer has spread into other parts of the body.
Because of their rapid growth pace and tendency to metastasize, small cell
cancers are described with only two stages (limited – when spread is contained
 to the localized area of the lung and immediate surrounding tissues, and
extensive – when the cancer has spread throughout the body).
Non-small cell lung cancers comprise about 85% of all lung cancers and can be
broken down into three subtypes; squamous cell carcinoma, adenocarcinoma,
and large cell lung cancer (ACS, 2010). Treatment of these types of cancer
typically includes a combination of surgery, chemotherapy and radiation
therapy.
 Squamous cell carcinoma most often begins in the larger sections of the
bronchi. It progresses slowest of all of the lung cancers.

 Adenocarcinomas have the fastest growing incidence of any type of lung

cancer in the United States, reported with frequency in both smokers and
persons who never smoked. They typically occur at the periphery of the lungs,
and grow more aggressively than squamous cell forms of lung cancer.

 As the name suggests, large cell lung cancers form as clusters of large
undifferentiated cells. Like ademocarcinomas, they tend to occur at the
periphery of the lung, growing and spreading more aggressively than squamous
cell forms of lung cancer.
8.3.2 Causes and Prevention:
Research has revealed a number of risk factors which make it more likely that
someone might get lung cancer. As is the case with many illnesses, some of the
risk factors are avoidable, and some are out of people's control. People who are
serious about lowering their risk for lung cancer can make it a goal to avoid as
many of the following risk factors as is reasonably possible for their situation.

 Smoking and Exposure to Passive Smoke. If you can do only one thing to
reduce your risk of lung cancer, that one thing should be to stop smoking
yourself (if you are a smoker) and to get yourself away from sources of
secondhand smoke (if you live or work around smokers). Tobacco smoke,
which contains cancer-causing chemicals (carcinogens), is the leading cause of
lung cancer. Roughly 90% of lung cancers in men and 80% of lung cancers in
women are linked to the smoking of tobacco (ACS). People regularly exposed
to secondhand smoke also appear to be at an increased risk for developing
cancer.
 Marijuana. Some people believe that marijuana smoke is safer than cigarette
smoke. This is not the case. In reality marijuana smoke has many of the same
carcinogens as cigarette smoke and affects the lungs similarly. For this reason
individuals who smoke marijuana are at similar risk for lung cancer as people
who smoke tobacco. Smoking through a 'bong' (water-cooled pipe) offers no
 substantial protection. In order to effectively reduce your risk of lung cancer, it
is necessary to stop smoking of all substances, including marijuana.
 Radon Exposure. Radon is a radioactive gas that is present in some rocks,
soils, and building materials. People get exposed to radon gas when it seeps into
the buildings where they live and work. Exposure to radon gas has been shown
to increase a person’s risk for getting lung cancer. Luckily, most people are not
at substantial risk of being exposed to radon, which is commonly tested for in
home inspections. Risk today is largely concentrated in occupations such as
mining. It is important for anyone who is commonly exposed to radon in their
working environment to wear a mask to protect their lungs from the gas.

 Air Pollution. Some recent studies suggest that air pollution may contribute to
lung cancer risk. However, these results are considered controversial. For those
who do wish to avoid air pollution, it is not enough to simply 'move to the
country' as the presence of nearby industry may render even rural areas
polluted.
 Asbestos. Asbestos is a fibrous mineral that used to be widely used as building
insulation. It became a universally banned material when it became clear that
asbestos fibers were carcinogens when breathed into the body. A history of
regular unprotected exposure to asbestos raises an individual's risk of lung
cancer moderately. Higher levels of risk occur when exposure to asbestos is
combined with smoking. Although asbestos insulation is still present in some
older buildings, it is not harmful until it is released into the air. Careful sealing
over of installed asbestos insulation can provide protection for building
inhabitants.

 History of Lung Cancer or other Serious Respiratory Illnesses. People who

have previously survived lung cancer are at higher risk of developing lung
cancer again than are people who have never had the disease. Similar higher
than normal risk for lung cancer occurs for people who have previously had
serious respiratory illnesses such as tuberculosis (TB), or chronic obstructive,
pulmonary disease (COPD).

 Diet. It has recently been suggested that diets low in fresh fruits in vegetables
can increase risk for lung cancer. This effect is probably due to the presence of
vitamins and other nutrients found in the fruits and vegetables. The risk of a
poor diet being associated with lung cancer increases when smoking is also
present.

 Genetic, Sex and Racial Factors. Lung cancer risk is also influenced by other
factors including genetic, sex and race. Persons with blood relatives who had
lung cancer, for instance, are at some increased risk of developing lung cancer
themselves. Similarly, male smokers are roughly twenty times more likely to
 get lung cancer than men who do not smoke, while female smokers are only 10
times more likely to get the disease than women who do not smoke. African
American men are noted to be at higher risk for developing lung cancer than are
Caucasian men, although this disparity may be able to be accounted for more or
less in terms of different cultural smoking habits within these groups.

8.3.3 Symptoms and Diagnosis:

It is difficult to catch lung cancer while still in its early stages. There are few outward
symptoms that appear serious enough to warrant seeing a doctor. Symptoms often
do not become apparent or troubling until after metastasis has occurred and cancer
has spread to and infected other organs, including the liver, the brain and the bones.
When early symptoms are apparent, they often take the following forms:

 A stubborn cough that will not quit, sometimes accompanied by a hoarse throat
 Wheezing breathing
 Pain in the chest, shoulders or back
 Diminished appetite
 Unintentional weight loss
 Respiratory infections
 Shortness of breath with only moderate exertion
As the cancer worsens and spreads the patient may experience:

 Difficulty concentrating
 Severe coughing which produces blood
 Feelings of weakness and fatigue
 Swellings in the face and/or neck
 Difficulty while swallowing
 Pain in the bones
 Numbness in the limbs
 Jaundice (yellow coloration of the skin and eyes)
 Dizziness
 Odd lumps appearing on the body
Persons who experience one or more of these symptoms unexpectedly should
strongly consider seeking immediate medical attention. While it is quite likely that
something other than cancer may be causing the symptoms to occur, as the old
saying observes, it is better to be safe than to be sorry.

Diagnosis
If your doctor suspects you may have lung cancer he or she will most likely order
one or more of the following tests.

 Chest X-Ray. Often the first test a doctor will perform when looking for lung cancer
will be a chest x-ray. The x-ray picture is formed by passing radiation through your
body and capturing the result on sensitive film. The resulting image shows some
detail of the structures within your body based on how those structures deflected or
 passed the x-ray radiation. The x-ray pictures give your doctor a preliminary idea of
whether you might have cancerous tissues and the general locations of the cancer if
it exists. In the event of a positive finding on the x-ray (that cancerous tissue appears
to exist), the doctor will likely order further tests to try to get a more detailed look
Your doctor may opt to do interval x-rays 6 months or 1 year later to evaluate any
changes in the size of the mass. If the mass remains stable, no further work-up may
be necessary.
 CT Scan. A CT or computed tomography scan is basically similar to an x-ray.
However, where a normal x-ray procedure involves only taking a small set of images,
the CT scan procedure involves making many pictures of the body, and then using a
computer to assemble them into an extensively detailed image of your body. In some
cases the radiologist performing the CT scan procedure can increase the resolution
of the CT scan by injecting the patient with a special dye that causes certain features
of the body to stand out in the resulting image. Some patients experience a warming
sensation similar to a hot flash when this dye is injected, but the sensation does not
last long. CT scans are very helpful in determining the size, shape and location of
tumors, and can also be helpful in locating areas of metastasized cancer.

 MRI. MRI stands for magnetic resonance imaging, a method of creating images of
body structures using magnetism rather than radiation. During an MRI radio waves
and high powered magnets are used to create a cross section image of the body
which often has greater resolution than CT or x-ray images. MRIs are generally used
to determine if the cancer has spread to the brain or spinal cord; areas of soft tissue
which MRIs excel at imaging. The MRI procedure requires that you be placed into an
open-ended tube containing enormous magnets, and then lie motionless inside this
tube while the machine clacks and clanks around you for up to an hour. Being inside
the machine bothers some individuals who have a fear of confined spaces. Luckily,
new MRI machines called 'Open MRIs' are now available that have a less confining
design. Ask your doctor about options for Open MRI in your area if you think you will
have a problem with the tight confines of the regular machine.

 PET Scan. PET stands for positron emission tomography, an imaging technique that
can be used to make movies of biological activity in the body. Tissues in the body
burn sugar as food, and PET techniques are capable of making movies showing how
much sugar different tissues in the body burn. In PET, the patient receives special
radioactively-tagged sugars which then get taken up by the patient's various body
tissues. The tagged sugars emit weak radiation which is then picked up by special
movie cameras. Cancerous tissues are very metabolically active and so burn up
more of the radioactive sugars than their non-cancerous neighbours. PET images
thus enable doctors to see where cancers exist in the body by showing where there
are areas of greater-than-normal sugar utilization. PET movies help verify whether or
not an abnormality in a chest x-ray is actually cancer, and can also help identify
cancers that have spread to other parts of the body.

 Bone Scan. This test is often performed if doctors believe that lung cancer may
have spread to the bones. In this test a radioactive substance is injected into the
bloodstream. The radioactive substance is easily absorbed by cancer cells and a
special camera is used to record areas of the bone where cancer is present. The
patient will usually have to wait two to four hours for the radioactive substance to
 have sufficient time to be absorbed by the cancer. The actual scanning process lasts
about an hour.
 Bronchoscopy. Bronchoscopy is used to locate tumors or collect tissue samples
from the trachea and upper bronchi. Before the test begins you will be given
medicine that will help you relax and remain comfortable. In this test a doctor places
an instrument called a capula into your mouth which holds down your tongue. Next,
an anesthetic is sprayed into your throat to numb it. A flexible metal tube is then
inserted into the numbed throat and used to take tissue and fluid samples from your
throat and bronchi. Some individuals feel the sensation of choking while the tube is
in their throat, however there is no real danger of suffocation. Your throat may feel a
bit scratchy for a few days after the procedure is performed.

 Sputum Cytology. This tests calls for a sample of your spit (phlegm) to be analyzed
under the microscope to look for cancer cells.

8.3.4 Treatment:
Like many other cancers, lung cancer is generally treated with some
combination of surgery, chemotherapy and radiation therapy. Surgical
approaches are most likely to resolve the cancer when it is caught early on in its
progression. Later stage cancers are more likely to have metastasized and
therefore require more globally acting treatments (such as chemotherapy and
radiation therapy). Common surgical techniques for addressing lung cancer
involve removing cancerous portions of the lung and are described below:

 Lobectomy. Lobectomy involves the removal of a section of the lung (lobe)

containing cancer cells. The patient is completely asleep with general anesthesia
and feels no pain during the surgery. When the patient is fully asleep, surgeons
make an incision in the chest and separate the ribs so as to expose and remove
the cancerous section of the lung. The normal hospital stay after surgery is
roughly a week. Deep breathing exercises, which help to prevent infection and
pneumonia, are taught during recuperation. Normally, patients fully recover
within a few months.

 Wedge Resection. A wedge resection is a similar surgery to lobectomy,

differing primarily in the amount of tissue removed. In wedge resection, only a
portion of lung section is removed, while in lobectomy an entire lung section is
removed.

 Pneumonectomy. This procedure is fundamentally the same as the lobectomy

and wedge resection surgeries except that an entire lung is removed in a
pneumonectomy.
 8.4 Skin Cancer:
8.4.1 Introduction
When we think about the prominent organs that make up our bodies, we think
of the heart, the lungs, the brain and perhaps the liver. Seldom would we think
about our humble skin. However, our skin is actually the largest of our organs
and plays as vital a role in maintaining our lives as those other more popular
organs. The main function of the skin is to act as the first line of defense for the
body. Skin protects and buffers the body from being damaged by heat,
chemicals, ultraviolet radiation, bacteria and other biological contaminants and
physical impacts. Via our ability to sweat and shiver, our skin also helps us to
maintain our body temperature and fluid balance. It even serves as the medium
for our sense of touch.

Skin is constructed of two major layers: the epidermis (or surface layer), and the
dermis (or interior layer). The thin epidermis layer is composed of constantly
renewing layers of cells called keratinocytes which rise in layers from the
interior of the epidermis only to get sloughed off at the surface, and other
supporting cell types including melanocytes (pigmented cells responsible for
skin colour or freckles), dendritic cells (involved in skin immune function), and
basal cells. The thicker, deeper dermis layer is composed of connective tissues
and embedded blood vessels, nerve and sensory fiber endings, oil and sweat
glands, body hair follicles and a variety of other structures.

Like any other organ in the body, the skin is subject to cancer. Skin cancer
occurs when malignant (cancerous) growths or tumors form on or in the skin.
Today, skin cancer is the most prevalent form of cancer, accounting for about
50% of all cancer cases reported annually, according to the American Cancer
Society (ACS, 2010).

Skin cancers are divided into two major forms: Nonmelanomas and Melanomas.
These cancer subtypes are largely differentiated based on where in the skin
layers they form.

 Melanoma. Melanoma is a form of skin cancer that affects the melanocytes in

the epidermis. Melanocytes are special skin pigment cells that give our skin
colour, and which allow our skin to “tan” when exposed to ultraviolet light from
the sun. The darkening of the skin we call tanning provides the deeper body
tissues extra protection from ultraviolet radiation.
Melanoma skin cancer will effect roughly 70,000 Americans in 2010 and
roughly 12,000 Americans will die from melanoma in 2010 (ACS, 2010). The
 danger posed by melanoma is largely due to the risk of metastasis; Melanoma is
much more likely to spread to other parts of the body, and to do so faster, than
are non-melanoma skin cancers. As is the general case, metastasized cancers are
harder to successfully treat than are localized cancers. Melanoma skin cancer is
quite treatable provided it is caught early on before significant metastasis has
taken place.

 Non-melanoma. As the non-creative name suggests, non-melanoma skin cancer

is a sort of "blanket" term used to group together the types of skin cancer that
aren't melanoma. There are two primary forms of non-melanoma skin cancer,
and a handful of other rare non-melanoma types which will not be covered here.
o Basal cell Carcinomas begin in the basal cell layer of the epidermis (the most
interior part of the outer skin layer). Basal cell skin cancers are common, and
typically appear on the head, neck, arms, and other body parts frequently
exposed to the sun. Basal cell carcinomas tend to progress very slowly and
usually do not spread to other parts of the body.
o Squamous Cell Carcinomas originate in the outer layers of the epidermis. Like
basal cell carcinoma they most commonly appear on areas of the body most
exposed to the sun, although they can appear on the genitals as well. Squamous
cell carcinomas rapidly progress to involve deeper dermal layers of the skin
tissue but (like basal cell carcinoma) are unlikely to spread to other parts of the
body.

8.4.2 Causes and Prevention:

Though there are multiple risk factors that can contribute to the incidence of
skin cancer, doctors now believe that in many cases skin cancers are principally
caused by overexposure to ultraviolet (UV) radiation. The most common source
of UV radiation is the sun, but UV radiation also comes from tanning beds and
sun lamps. UV radiation appears to cause cancer by directly affecting DNA (the
genetic material in cells that tells the cells how to grow and reproduce properly).
When UV radiation causes a defect in a cell's DNA, that cell can later become
cancerous.

For completeness, the factors identified as putting people at increased risk for
skin cancer are as follows:

 Ultraviolet (UV) Radiation. Skin damage caused by too much unprotected

exposure to the sun, tanning booths or sun lamps has been identified as the
leading cause of all forms of skin cancer. Whatever the source, the overall
amount of UV exposure (and therefore risk) people face is determined by the
length of time they remain exposed, the intensity of the radiation they are
exposed to, and the amount of protection (e.g., sunscreen, a hat, appropriate
 clothing) that has been applied to the skin. Do not be fooled into thinking that
you are safe from the sun's rays on a cloudy day. UV radiation penetrates clouds
easily. Always wear appropriate protection when you go out.
 Skin Tone. Skin pigment provides protection from damaging UV radiation. The
darker the pigment in your skin the better that pigment can protect your lower
skin tissue layers from UV radiation. As a result, the lighter your skin tone, the
greater your risk for getting skin cancers. As an illustration, Caucasian persons
are ten times more likely to get melanoma skin cancer than are persons of
African descent ACS, 2010). Skin pigment conditions such as albinism (absence
of skin pigment from birth) can also increase a person's risk for the disease.
 Gender. Men are more likely to get skin cancers than are women. The reasons
for why this is so are not fully understood.

 Previous Skin Cancer. Anyone who has previously had skin cancer has a
heightened risk for getting another skin cancer as compared to a person who has
never had skin cancer.

 Immune System Suppression. Your immune system helps your body fight off
cancer as well as other diseases and infections. People with weakened immune
systems have a higher risk for developing skin cancer than people who have a
strong and healthy immune system, and also commonly are at increased risk for
the rapid spread of those cancers. Immune system weakness can be the result of
a disease process (such as HIV/AIDS), or it can be induced by doctors when it
is advantageous for other reasons (e.g., to prevent the rejection of transplanted
organs, or to slow the progress of autoimmune disorders).

 Xeroderma Pigmentosum. Xeroderma pigmentosum is an inherited disease

that affects the body's ability to repair damaged skin cell DNA. Individuals with
xeroderma pigmentosum have a higher risk for getting skin cancer than people
who do not have the disease. People with xeroderma pigmentosum need to be
especially careful about exposure to UV radiation.
The following list describes risk factors specific to melanoma skin cancers:

 Moles. Moles are not present at birth and usually develop during childhood or
teenaged years. Regular moles are essentially benign (non-cancerous) tumors,
and are not in of themselves cause for concern. However, some mole subtypes
do increase melanoma risk. Dyplastic nevus moles look similar to normal moles
except that they are larger. They run in families, and commonly appear in areas
exposed to the sun and/or around the groin and upper thighs. Congenital
melanocytic nevus moles are observed at birth and similarly increase melanoma
cancer risk. Moles can start out normal and then become cancerous. It is
 important to monitor moles for change in shape, change in colour, or irregular
borders, and to have any irregularities you discover checked by a physician.

 Family Background. Persons with close blood relatives who have developed
melanoma skin cancer are themselves at increased risk for developing the same.
The increased risk may be due to a genetic vulnerability that is passed down in
families. Alternative explanations for the increased risk are that all family
members may share a common family "sun worship" culture.

 Age. While melanoma skin cancer is the most common form of skin cancer at
any age, a person's risk for developing melanoma increases as they age.
The following list describes risk factors specific to non-melanoma skin cancers:

 Exposure to non-UV Radiation. While UV radiation increases skin cancer risk

across the board, people exposed to other forms of radiation (such as therapeutic
radiation), are at heightened risk for developing nonmelanoma skin cancers.
Patients who have had radiation therapy should get into the habit of periodically
monitoring the skin around their treatment sites to check for skin cancers.
 Basal Cell Nevus Syndrome. Basal cell nevus syndrome is a rare, genetically
inherited disease that increases risk of non-melanoma skin cancer and does so at
early ages, including in individuals younger than twenty years of age.

 Chemical Exposure. People who are routinely exposed to industrial chemicals

like arsenic, coal, tar, and certain oils have a greater risk for getting
nonmelanoma skin cancer than individuals who are not regularly exposed to
these chemicals.

 Smoking. People who smoke are more likely to develop squamous cell
carcinomas compared with nonsmokers.

 Permanent Skin Injury. Permanent skin injuries such as burns and scars pose
a small increase in risk for non-melanoma skin cancer developing at the site of
injury.

8.4.3 Symptoms and Diagnosis:

Skin cancer is very curable when it is found early. While only your doctor can
determine whether or not you have skin cancer, you can take an active role in
checking for symptoms and warning signs.

A monthly skin check self-examination is a good practice to cultivate. You

should become familiar with the pattern of moles and other markings on your
 skin so that you will recognize if and when any changes occur. Self-
examinations should be performed in a well lit area in front of a large mirror.
Check yourself all over for blemishes or marks on the skin that are unfamiliar to
you or which have changed in size, shape, texture or colour. The "ABCDE"
rules can also help you discriminate between potentially cancerous and
noncancerous skin:

 Asymmetry. Skin cancers are often irregularly shaped rather than symmetrical.

 Border. Skin cancers often have irregular (jagged) borders.

 Colour. Skin cancers often show a colour variation rather than being evenly
toned.

 Diameter. Skin cancers are often larger than noncancerous skin features and
may be observed to grow over time.

 Elevation. Skin cancers are commonly raised off the surface of the skin.
Any one of these changes may be an early indication of skin cancer and should
be checked as soon as possible by your primary care physician or by a
dermatologist.

Diagnosis
In diagnosing skin cancer, your doctor will examine your skin for suspicious
looking moles, blotches and growths. You can expect to be asked questions
about when particular marks first appeared, and if they have changed since you
have known about them, whether you have previously had skin cancer, and the
extent to which you have been exposed to UV radiation.

If your doctor finds marks which may potentially be cancerous, he or she will
probably schedule you for a biopsy, a procedure in which the doctor will take
samples of skin from suspect areas so that they can be investigated under a
microscope. There are a few ways in which a biopsy for skin cancer can be
performed:

 Shave Biopsy. During a shave biopsy the doctor will use a surgical knife to
remove the uppermost layer of skin. The patient is given local anesthetic and
should not feel any pain. Shave biopsies are not commonly used if melanoma is
suspected because a shave biopsy does not offer access to deeper tissues.

 Punch Biopsy. During a punch biopsy the doctor uses a special instrument
which resembles a cookie cutter to remove all of the layers of skin over the
trouble area. Local anesthetic is used and the patient should not feel any pain.
 Punch biopsies are not the preferred method for determining if the patient has
melanoma.

 Incisional and Excisional Biopsies. During an incisional biopsy the doctor

uses a surgical knife to remove a portion of the skin tumor. During an excisional
biopsy the doctor will use a surgical knife to remove the entire skin tumor.
Local anesthetic is given and the patient should feel no pain. These methods are
generally regarded as the best way for determining if a particular tumor is
melanoma.
All of these methods of taking a skin tumor biopsy are very quick and require
no hospital stay, but can result in scaring.

There are other tests doctors may order if they believe that skin cancer may
have spread beyond the skin tissue:

 Lymph Node Biopsy involves the surgical removal of a lymph node that is
believed to be cancerous. The lymph node is then sent to a lab where it is
checked for cancer. The incision involved in this procedure is small and only a
localized anesthetic is necessary.

 Fine Needle Aspiration (FNA) Biopsy. During an FNA biopsy a thin needle is
inserted into tissues believed to contain a tumor so as to remove a small tissue
sample from that area. There are advantages to FNA in that no anesthetic is
necessary (the procedure feels no worse than a conventional shot) and no
scaring risk is incurred.

 Chest X-Ray. Doctors may order an x-ray picture be taken of your chest area if
they believe that skin cancer may have spread to your lungs.

 Computed Tomography (CT) Scan. Doctors may order a CT scan of body

areas suspected to have been compromised by metastasizing skin cancers. A CT
scan is basically a computer-assembled highly detailed series of x-ray images
that can reveal if anything out of the ordinary (like a tumor) is growing in
scanned tissues.
8.4.4 Treatment:
Surgery is a primary method for treating skin cancers. There are different
surgical approaches surgeons may choose based on the type of skin cancer you
have:

 Simple Excision. During simple excision a skin cancer tumor and a little
adjacent healthy tissue is removed with a surgical knife. The incision is then
 sewn back together. Incisions are generally small, necessitating only local
anesthetic be used. This procedure, which may leave a scar, is appropriate for
treating both melanoma and nonmelanoma forms of skin cancer.
1. Curettage with Electrodessication. During this procedure the tumor is scraped
off using an instrument called a curette. After most of the tumor is scraped away
the surrounding area is treated with an electrode (an electrically charged piece
of metal) to kill any remaining cancer cells. The process may need to be
repeated a few times, and often leaves a scar. It is most often used to treat small
basal and squamous cell cancers.

2. Amputation. In some cases if a melanoma skin tumor is on a finger or a toe, the

doctor may call for surgical removal of that appendage. Amputations are no
longer performed on whole arms or legs.

3. Cryosurgery. During cryosurgery cancerous cells are destroyed by freezing

them with liquid nitrogen. This procedure may cause the skin in the treated area
to blister and leave a scar. It often takes a few weeks for the wound to heal.
Cryosurgery is used to treat small squamous and basal cell carcinomas.

4. Mohs Surgery. During this procedure the surgeon will remove a small layer of
skin which he or she believes contains cancer cells. The sample is then checked
immediately for cancer. If they doctor find the sample to contain cancer then the
doctor will remove another layer of skin and check the new sample for cancer.
The process is repeated until the sample layer does not contain cancer. This
process is slower than some of the other options but because it can save more
healthy skin tissue than alternatives, it appeals to many patients.

5. Laser Surgery. During laser surgery the doctor aims a special laser beam at
cancer cells to kill them. This surgery can only be used on skin cancers which
are close to the surface of the skin. Laser surgery is a relatively new procedure.

6. Lymph Node Removal. During this procedure a surgeon will remove lymph
nodes near the skin cancer to see if these nodes contain any cancer. Removed
nodes are later examined under a microscope by a specialist to determine if they
contain cancer. If the lymph nodes do contain cancer then it is likely that the
cancer has spread to other parts of the body.

7. Skin Grafting. During a skin graft, healthy skin sections are removed and used
to cover over wounds created by prior skin cancer removals. Skin grafting
procedures are useful in helping large surgical wounds that could not be stitched
back together to heal properly. Skin grafts can also help reduce scarring and
other appearance issues resulting from skin cancer surgery.
Surgery is not appropriate as a treatment in all cases. General health concerns,
and metastasized cancer scenarios can also compromise surgical treatment.
Radiation therapy can be used as an adjunct to surgical treatments, or by itself
when surgery is not appropriate. Radiation therapy involves the use of
directional high energy radiation to kill cancer cells. While radiation alone can
be used to cure small nonmelanoma skin cancers, it generally can only slow
down growth and symptom progression for more serious forms of skin cancer.
Side effects of radiation therapy include irritation, redness and drying of the
skin area.

Immunotherapy is a treatment that is commonly used with patients who have

advanced melanoma. In immunotherapy patients are administered drugs that
boost their immune response which in turn boosts their body's natural defenses
against cancer. Though results of immunotherapy are typically modest, and do
not often result in destruction of existing melanoma tumors, the effects do
include slowing and shrinking of existing tumors which can result in symptom
relief. Side effects of immunotherapy include fever, chills, fatigue, fluid
retention, and achiness.
 9.PATHOPHYSIOLOGY
Main article: Carcinogenesis

Cancers are caused by a series of mutations. Each mutation alters the behaviour
of the cell somewhat.

9.1 Genetics
Main article: Oncogenomics

Cancer is fundamentally a disease of tissue growth regulation. In order for a

normal cell to transform into a cancer cell, the genes that regulate cell growth
and differentiation must be altered.[73]
The affected genes are divided into two broad categories. Oncogenes are genes
that promote cell growth and reproduction. Tumor suppressor genes are genes
that inhibit cell division and survival. Malignant transformation can occur
through the formation of novel oncogenes, the inappropriate over-expression of
normal oncogenes, or by the under-expression or disabling of tumor suppressor
genes. Typically, changes in multiple genes are required to transform a normal
cell into a cancer cell.[74]
Genetic changes can occur at different levels and by different mechanisms. The
gain or loss of an entire chromosome can occur through errors in mitosis. More
common are mutations, which are changes in the nucleotide sequence of
genomic DNA.
Large-scale mutations involve the deletion or gain of a portion of a
chromosome. Genomic amplification occurs when a cell gains copies (often 20
or more) of a small chromosomal locus, usually containing one or more
oncogenes and adjacent genetic material. Translocation occurs when two
separate chromosomal regions become abnormally fused, often at a
characteristic location. A well-known example of this is the Philadelphia
chromosome, or translocation of chromosomes 9 and 22, which occurs
in chronic myelogenous leukemia and results in production of the BCR-ABL
fusion protein, an oncogenic tyrosine kinase.
Small-scale mutations include point mutations, deletions, and insertions, which
may occur in the promoter region of a gene and affect its expression, or may
occur in the gene's coding sequence and alter the function or stability of
its protein product. Disruption of a single gene may also result from integration
of genomic material from a DNA virus or retrovirus, leading to the expression
of viral oncogenes in the affected cell and its descendants.
Replication of the data contained within the DNA of living cells
will probabilistically result in some errors (mutations). Complex error
correction and prevention is built into the process and safeguards the cell
against cancer. If a significant error occurs, the damaged cell can self-destruct
through programmed cell death, termed apoptosis. If the error control processes
fail, then the mutations will survive and be passed along to daughter cells.
Some environments make errors more likely to arise and propagate. Such
environments can include the presence of disruptive substances
called carcinogens, repeated physical injury, heat, ionising radiation
or hypoxia.[75]
The errors that cause cancer are self-amplifying and compounding, for example:

 A mutation in the error-correcting machinery of a cell might cause that cell

and its children to accumulate errors more rapidly.
 A further mutation in an oncogene might cause the cell to reproduce more
rapidly and more frequently than its normal counterparts.
 A further mutation may cause loss of a tumor suppressor gene, disrupting the
apoptosis signaling pathway and immortalizing the cell.
 A further mutation in the signaling machinery of the cell might send error-
causing signals to nearby cells.
The transformation of a normal cell into cancer is akin to a chain
reaction caused by initial errors, which compound into more severe errors, each
progressively allowing the cell to escape more controls that limit normal tissue
growth. This rebellion-like scenario is an undesirable survival of the fittest,
where the driving forces of evolution work against the body's design and
enforcement of order. Once cancer has begun to develop, this ongoing process,
termed clonal evolution, drives progression towards more
invasive stages.[76] Clonal evolution leads to intra-tumour heterogeneity (cancer
cells with heterogeneous mutations) that complicates designing effective
treatment strategies.
Characteristic abilities developed by cancers are divided into categories,
specifically evasion of apoptosis, self-sufficiency in growth signals,
insensitivity to anti-growth signals, sustained angiogenesis, limitless replicative
potential, metastasis, reprogramming of energy metabolism and evasion of
immune destruction.[26][27]
9.2 EPIGENETICS

The central role of DNA damage and epigenetic defects in DNA repair genes in
carcinogenesis
The classical view of cancer is a set of diseases that are driven by progressive
genetic abnormalities that include mutations in tumor-suppressor genes and
oncogenes and chromosomal abnormalities. Later epigenetic alterations' role
was identified.[77]
Epigenetic alterations are functionally relevant modifications to the genome that
do not change the nucleotide sequence. Examples of such modifications are
changes in DNA methylation (hypermethylation and hypomethylation), histone
modification[78] and changes in chromosomal architecture (caused by
inappropriate expression of proteins such as HMGA2 or HMGA1).[79] Each of
these alterations regulates gene expression without altering the underlying DNA
sequence. These changes may remain through cell divisions, last for multiple
generations and can be considered to be epimutations (equivalent to mutations).
Epigenetic alterations occur frequently in cancers. As an example, one study
listed protein coding genes that were frequently altered in their methylation in
association with colon cancer. These included 147 hypermethylated and 27
hypomethylated genes. Of the hypermethylated genes, 10 were hypermethylated
in 100% of colon cancers and many others were hypermethylated in more than
50% of colon cancers.[80]
While epigenetic alterations are found in cancers, the epigenetic alterations in
DNA repair genes, causing reduced expression of DNA repair proteins, may be
of particular importance. Such alterations are thought to occur early in
progression to cancer and to be a likely cause of the genetic instability
characteristic of cancers.[81][82][83][84]
Reduced expression of DNA repair genes disrupts DNA repair. This is shown in
the figure at the 4th level from the top. (In the figure, red wording indicates the
central role of DNA damage and defects in DNA repair in progression to
cancer.) When DNA repair is deficient DNA damage remains in cells at a
higher than usual level (5th level) and cause increased frequencies of mutation
and/or epimutation (6th level). Mutation rates increase substantially in cells
defective in DNA mismatch repair[85][86] or in homologous
recombinational repair (HRR).[87]Chromosomal rearrangements and aneuploidy
also increase in HRR defective cells.[88]
Higher levels of DNA damage cause increased mutation (right side of figure)
and increased epimutation. During repair of DNA double strand breaks, or
repair of other DNA damage, incompletely cleared repair sites can cause
epigenetic gene silencing.[89][90]
Deficient expression of DNA repair proteins due to an inherited mutation can
increase cancer risks. Individuals with an inherited impairment in any of 34
DNA repair genes (see article DNA repair-deficiency disorder) have increased
cancer risk, with some defects ensuring a 100% lifetime chance of cancer (e.g.
p53 mutations).[91] Germ line DNA repair mutations are noted on the figure's
left side. However, such germline mutations (which cause highly penetrant
cancer syndromes) are the cause of only about 1 percent of cancers.[92]
In sporadic cancers, deficiencies in DNA repair are occasionally caused by a
mutation in a DNA repair gene but are much more frequently caused by
epigenetic alterations that reduce or silence expression of DNA repair genes.
This is indicated in the figure at the 3rd level. Many studies of heavy metal-
induced carcinogenesis show that such heavy metals cause a reduction in
expression of DNA repair enzymes, some through epigenetic mechanisms.
DNA repair inhibition is proposed to be a predominant mechanism in heavy
metal-induced carcinogenicity. In addition, frequent epigenetic alterations of the
DNA sequences code for small RNAs called microRNAs (or miRNAs).
miRNAs do not code for proteins, but can "target" protein-coding genes and
reduce their expression.
Cancers usually arise from an assemblage of mutations and epimutations that
confer a selective advantage leading to clonal expansion (see Field defects in
progression to cancer). Mutations, however, may not be as frequent in cancers
as epigenetic alterations. An average cancer of the breast or colon can have
about 60 to 70 protein-altering mutations, of which about three or four may be
"driver" mutations and the remaining ones may be "passenger" mutations.[93]

9.3 Metastasis
Main article: Metastasis

Metastasis is the spread of cancer to other locations in the body. The dispersed
tumors are called metastatic tumors, while the original is called the primary
tumor. Almost all cancers can metastasize.[94] Most cancer deaths are due to
cancer that has metastasized.[95]
Metastasis is common in the late stages of cancer and it can occur via the blood
or the lymphatic system or both. The typical steps in metastasis are
local invasion, intravasation into the blood or lymph, circulation through the
body, extravasation into the new tissue, proliferation and angiogenesis.
Different types of cancers tend to metastasize to particular organs, but overall
the most common places for metastases to occur are the lungs, liver, brain and
the bones.[94]
 11.SCREENING
Main article: Cancer screening
Unlike diagnostic efforts prompted by symptoms and medical signs, cancer
screening involves efforts to detect cancer after it has formed, but before any
noticeable symptoms appear.[128] This may involve physical
examination, blood or urine tests or medical imaging.[128]
Cancer screening is not available for many types of cancers. Even when tests
are available, they may not be recommended for everyone. Universal
screening or mass screening involves screening everyone.[129] Selective
screening identifies people who are at higher risk, such as people with a family
history.[129] Several factors are considered to determine whether the benefits of
screening outweigh the risks and the costs of screening.[128] These factors
include:

 Possible harms from the screening test: for example, X-ray images involve
exposure to potentially harmful ionizing radiation
 The likelihood of the test correctly identifying cancer
 The likelihood that cancer is present: Screening is not normally useful for
rare cancers.
 Possible harms from follow-up procedures
 Whether suitable treatment is available
 Whether early detection improves treatment outcomes
 Whether the cancer will ever need treatment
 Whether the test is acceptable to the people: If a screening test is too
burdensome (for example, extremely painful), then people will refuse to
participate.[129]
 Cost
 12.CANCER TREATMENTS
Doctors prescribe cancer treatment regimens based on a variety of factors
specific to patients' individual circumstance. These factors often include the
cancer's stage (type, location, and size of the cancer being treated), as well as
patients' age, medical history, and overall health. The doctor may also ask
patients to specify their treatment preferences before determining an optimal
treatment plan. So long as their condition does not require emergency
intervention, patients should feel free to ask questions about various treatment
options so as to become comfortable with the plan they will ultimately follow.
In general, it is not a good idea to rush into a treatment plan merely as a way to
reduce the understandable anxiety of having a cancer diagnosis.

Each form of cancer is different and calls for a different set of treatment
approaches. This being true, there are two common approaches used to treat
almost all types of cancer. These two treatments are chemotherapy and radiation
therapy. Chemotherapy and radiation therapy are covered here in some detail to
avoid having to restate the information at length in later sections covering
specific cancer subtypes.

12.1 Chemotherapy:
Chemotherapy is one of the most commonly used methods to treat cancer
patients. It is commonly prescribed for patients whose cancer is not localized
but instead has possibly metastasized, or spread, to various locations in the
body. Chemotherapy can be used to reduce the symptoms and pain associated
with cancer as well as to slow the growth of cancerous tumors. In some
circumstances chemotherapy may even kill spreading cancerous cells.
Chemotherapy utilizes a powerful combination of drugs that are either taken by
mouth or injected directly into the bloodstream. Drug doses are commonly
given in a repeating pattern over a set amount of time. Treatment frequency and
duration depend on the type of cancer each patient has, and the manner in which
the patient tolerates and responds to the drugs. Chemotherapy drugs target cells
in the body that divide and grow quickly and are usually able to destroy these
cells. Unfortunately, cancer cells are not the only cells in the body which divide
and replicate quickly. In addition to cancerous cells, chemotherapy drugs also
kill some regular healthy cells, causing side effects such as the fatigue, nausea,
and hair loss. To some extent, side effects can be controlled or alleviated with
other medications or by altering the schedule of chemotherapy treatments. It is
important to alert your doctor immediately if you experience side effects so that
the doctor can adjust treatment to make you more comfortable. Chemotherapy
can be a long and arduous process, but it does not last forever and negative side
effects generally disappear upon completion of the treatment.
12.2 Radiation Therapy.:
Radiation therapy is a method of treating cancer that utilizes radiation energy.
Radiation is most commonly used to treat localized cancers as opposed to
cancer that has spread throughout the body. The goal of radiation therapy is to
kill cancer cells or at least limit their ability to grow and divide by damaging
their genetic material. Like chemotherapy, radiation therapy is not perfectly
precise in its targeting of cancer cells, and some normal, healthy cells can also
become damaged. Patients should not become too concerned about damage to
healthy cells, however. Doctors generally do a good job shielding and
protecting healthy cells surrounding cancer areas from radiation damage. Also,
healthy cells that do sustain damage during radiation treatment are usually able
to repair their genetic material when treatment ends.
There are two main ways in which radiation therapy can be administered:
externally and internally. When delivered externally, special machines are used
to project a focused beam of radiation into targeted areas of tissue within the
body. Internal radiation therapy involves surgical placement of radioactive
materials near cancerous tumors or afflicted body areas. When placed internally,
the source of radiation is often sealed in a small compartment such as a catheter
or capsule prior to implantation.

12.3 Surgery
Surgery is the primary method of treatment for most isolated, solid cancers and
may play a role in palliation and prolongation of survival. It is typically an
important part of definitive diagnosis and staging of tumors, as biopsies are
usually required. In localized cancer, surgery typically attempts to remove the
entire mass along with, in certain cases, the lymph nodes in the area. For some
types of cancer this is sufficient to eliminate the cancer.[146]
12.4 Palliative care
Palliative care is treatment that attempts to help the patient feel better and may
be combined with an attempt to treat the cancer. Palliative care includes action
to reduce physical, emotional, spiritual and psycho-social distress. Unlike
treatment that is aimed at directly killing cancer cells, the primary goal of
palliative care is to improve quality of life.
People at all stages of cancer treatment typically receive some kind of palliative
care. In some cases, medical specialty professional organizations recommend
that patients and physicians respond to cancer only with palliative care.[156] This
applies to patients who:[157]

1. display low performance status, implying limited ability to care for

themselves[156]
2. received no benefit from prior evidence-based treatments[156]
 3. are not eligible to participate in any appropriate clinical trial[156]
4. no strong evidence implies that treatment would be effective[156]
Palliative care may be confused with hospice and therefore only indicated when
people approach end of life. Like hospice care, palliative care attempts to help
the patient cope with their immediate needs and to increase comfort. Unlike
hospice care, palliative care does not require people to stop treatment aimed at
the cancer.
Multiple national medical guidelines recommend early palliative care for
patients whose cancer has produced distressing symptoms or who need help
coping with their illness. In patients first diagnosed with metastatic disease,
palliative care may be immediately indicated. Palliative care is indicated for
patients with a prognosis of less than 12 months of life even given aggressive
treatment.[158][159][160]
12.5 Immunotherapy
Main article: Cancer immunotherapy

A variety of therapies using immunotherapy, stimulating or helping the immune

system to fight cancer, have come into use since 1997. Approaches
include antibodies, checkpoint therapy and adoptive cell transfer.[161]
12.6 Laser therapy
Main article: Lasers in cancer treatment

Laser therapy uses high-intensity light to treat cancer by shrinking or destroying

tumors or precancerous growths. Lasers are most commonly used to treat
superficial cancers that are on the surface of the body or the lining of internal
organs. It is used to treat basal cell skin cancer and the very early stages of
others like cervical, penile, vaginal, vulvar, and non-small cell lung cancer. It is
often combined with other treatments, such as surgery, chemotherapy, or
radiation therapy. Laser-induced interstitial thermotherapy (LITT), or interstitial
laser photocoagulation, uses lasers to treat some cancers using hyperthermia,
which uses heat to shrink tumors by damaging or killing cancer cells. Laser are
more precise than surgery and cause less damage, pain, bleeding, swelling, and
scarring. A disadvantage is surgeons must have specialized training. It may be
more expensive than other treatments.[162]
12.7 Alternative medicine
Complementary and alternative cancer treatments are a diverse group of
therapies, practices and products that are not part of conventional
medicine.[163] "Complementary medicine" refers to methods and substances used
along with conventional medicine, while "alternative medicine" refers to
compounds used instead of conventional medicine.[164] Most complementary
and alternative medicines for cancer have not been studied or tested using
conventional techniques such as clinical trials. Some alternative treatments have
been investigated and shown to be ineffective but still continue to be marketed
and promoted. Cancer researcher Andrew J. Vickers stated, "The label
'unproven' is inappropriate for such therapies; it is time to assert that many
alternative cancer therapies have been 'disproven'."[165]
Some alternative medicine options found to be helpful for people with cancer
include:

 Acupuncture
 Hypnosis
 Massage
 Meditation
 Relaxation techniques
 Yoga

12.8 Other Cancer Treatments

Your doctor may recommend other options as part of your treatment plan,
including:

 Targeted therapy, in which drugs work against specific parts of cancer cells
to keep them from growing or spreading.
 Immunotherapy, also called biologic therapy, which gets the body’s immune
system to fight cancer.
 Hormone therapy, also called hormone treatment or hormonal therapy,
which treats cancers that use hormones to grow (such as breast
cancer and prostate cancer).
 Stem cell transplants. Doctors use chemo or radiation to destroy as many
cancer cells as possible, then try to replace them with healthy stem cells
from bone marrow or blood.
 Photodynamic therapy. Doctors inject a special drug into the bloodstream,
then use a specific type of light to make it kill cancer cells.

With any cancer treatment, it might take a while before you know how it affects
your disease. Stay in touch with your doctor and keep her in the loop about
anything that doesn’t feel right. You are the most important part of your cancer
care team.
 13.RESEARCH
Main article: Cancer research

University of Florida Cancer Hospital

Because cancer is a class of diseases,[206][207] it is unlikely that there will ever be

a single "cure for cancer" any more than there will be a single treatment for
all infectious diseases.[208] Angiogenesis inhibitors were once incorrectly
thought to have potential as a "silver bullet" treatment applicable to many types
of cancer.[209] Angiogenesis inhibitors and other cancer therapeutics are used in
combination to reduce cancer morbidity and mortality.[210]
Experimental cancer treatments are studied in clinical trials to compare the
proposed treatment to the best existing treatment. Treatments that succeeded in
one cancer type can be tested against other types.[211] Diagnostic tests are under
development to better target the right therapies to the right patients, based on
their individual biology.[212]
Cancer research focuses on the following issues:

 Agents (e.g. viruses) and events (e.g. mutations) that cause or facilitate
genetic changes in cells destined to become cancer.
 The precise nature of the genetic damage and the genes that are affected by
it.
 The consequences of those genetic changes on the biology of the cell, both
in generating the defining properties of a cancer cell and in facilitating
additional genetic events that lead to further progression of the cancer.
The improved understanding of molecular biology and cellular biology due to
cancer research has led to new treatments for cancer since US President Richard
Nixon declared the "War on Cancer" in 1971. Since then, the country has spent
over $200 billion on cancer research, including resources from public and
private sectors.[213] The cancer death rate (adjusting for size and age of the
population) declined by five percent between 1950 and 2005.[214]
Competition for financial resources appears to have suppressed the creativity,
cooperation, risk-taking and original thinking required to make fundamental
discoveries, unduly favouring low-risk research into small incremental
advancements over riskier, more innovative research. Other consequences of
competition appear to be many studies with dramatic claims whose results
cannot be replicated and perverse incentives that encourage grantee institutions
to grow without making sufficient investments in their own faculty and
facilities.[215][216][217][218]
Virotherapy, which uses convert viruses, is being studied.
 14.CONCLUSION
A plan for the diagnosis and treatment of cancer is a key component of any
overall cancer control plan. Its main goal is to cure cancer patients or prolong
their life considerably, ensuring a good quality of life. In order for a diagnosis
and treatment programme to be effective, it must never be developed in
isolation. It needs to be linked to an early detection programme so that cases are
detected at an early stage, when treatment is more effective and there is a
greater chance of cure. It also needs to be integrated with a palliative care
programme, so that patients with advanced cancers, who can no longer benefit
from treatment, will get adequate relief from their physical, psychosocial and
spiritual suffering. Furthermore, programmes should include an awareness-
raising component, to educate patients, family and community members about
the cancer risk factors and the need for taking preventive measures to avoid
developing cancer.
Where resources are limited, diagnosis and treatment services should initially
target all patients presenting with curable cancers, such as breast, cervical and
oral cancers that can be detected early. They could also include childhood acute
lymphatic leukaemia, which has a high potential for cure although it cannot be
detected early. Above all, services need to be provided in an equitable and
sustainable manner. As and when more resources become available, the
programme can be extended to include other curable cancers as well as cancers
for which treatment can prolong survival considerably.