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Understanding Cancer
Basics of Cancer Diagnosis and Treatment

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1.What is Cancer?

The human body is composed of several healthy cells that divide and replace themselves in a controlled way. The central component is the DNA that exists in the genes of every cell. Some cells get altered due to various reasons like a mutation in the DNA and multiply out of control. These are called cancer cells. These abnormal cancer cells form a cluster of mass which is called a tumour.

It is important to note that not all tumours are cancerous. Benign or noncancerous tumours do not spread to other forms of the body and do not create new tumours. Malignant or cancerous tumours are more dangerous as they grow in size and disrupt certain functions in the body.

Cancer spreads through the process of metastasis, through the lymphatic system or blood vessels and forms tumours in other parts of the body. The cancers that are metastasized are more difficult to treat and more fatal. Tumours can cause serious health problems based on their location and size and will need immediate treatment.

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2.Types of Cancer

Some of the major types of cancers are provided below.

  • Carcinoma: This is the most common type of cancer and originates in lungs, skin, breasts, pancreas or tissues lining other organs.
  • Lymphoma and myeloma: These cancers originate in lymphocytes and affect the immune system.
  • Leukaemia: Blood cells are formed in the bone marrow. The cancer of the bone marrow and is often fatal. This is also called as blood cancer.
  • Sarcoma: These are relatively uncommon and is a cancer of the connective tissue. It can arise in muscle, bone, fat, blood vessels or cartilage.
  • Melanomas: This cancer affects the pigment-containing cells of the skin.

The most common cancers observed globally are as follows:

  • Breast cancer
  • Lung cancer
  • Skin cancer
  • Prostate cancer
  • Colorectal cancer
  • Kidney cancer
  • Bladder cancer
  • Non-Hodgkin’s lymphoma
  • Thyroid cancer
  • Endometrial cancer

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3.Risk factors of cancer

Cancer is mainly caused by genetic mutations to the DNA in the cell. In some cases, it is inherited but can also occur due to some other factors as follows:

  • Smoking
  • Radiation
  • Exposure to carcinogens or chemicals
  • Exposure to sunlight without sunscreen
  • Viruses like human papillomavirus
  • Unhealthy lifestyle and food habits

Cancer risk increases with age. Some existing health problems can also result in cancer.

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4.Prevention of cancer

Cancer that is inherited has to be managed with treatment, but cancer that is caused because of the exposure to carcinogens, sunlight or lifestyle issues can be prevented by taking certain measures.

  • Smoking is one of the leading causes of cancer. It can be prevented by stopping the use of tobacco or other tobacco products. Passive smoking is also a health hazard and should be avoided.
  • Maintaining a healthy diet is very helpful. Processed meat should be avoided, and plant-based foods, lean proteins, and healthy fat should be adopted.
  • Alcohol should be avoided.
  • Include around 30 minutes of activity in the daily schedule.
  • Weight should be managed by taking appropriate measures.
  • Exposure to sunlight without protection should be avoided.
  • Certain viruses can cause cancer, and hence it is important to get vaccinated.
  • Take precautionary measures and practice safe sex. Sharing needles for injecting medicine should be avoided.
  • Regular medical checkups can help in screening cancer earlier.

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5.Diagnosis of cancer

Cancer diagnosis

Early diagnosis of cancer can help in improved survival rates. Most of the cancers can be detected by regular tests even before the formation of a tumour. In some cases, cancer may be diagnosed while evaluating another severe health condition. The overall diagnostic process will be as follows:

  • Physical evaluation and lab tests: Diagnosis of cancer begins with physical examination and studying the complete medical history. This may follow with blood, urine and stool analysis. The laboratory tests will be able to detect abnormalities that suggest cancer.
  • Imaging tests: Doctor may recommend imaging tests like X-rays, computerised tomography (CT), magnetic resonance imaging (MRI), fiber-optic examination and ultrasound to further evaluate the location and size of the tumour in some suspected cases.
  • Biopsy test: For a more accurate diagnosis of the presence of a cancer cell, a tissue sample will be collected from the tumour and will be sent for further analysis under a microscope. Your doctors may ask for lymph node biopsy where a piece of lymph node is sent to a specialist to evaluate for cancer. Bone biopsy is another similar procedure where a sample of the outer part of the bone is sent for examination. The sample can be taken with a needle and is called a needle biopsy or through open biopsy by making an incision in the skin.

Based on these tests and biopsy reports, the doctor may confirm the diagnosis of cancer. Upon confirmation, the doctor may be further evaluating the tumour to check if it has spread to other regions of the body as it tends to be in many cases. In cases where the diagnosis is negative even in the presence of symptoms, your doctor may ask for a different set of examinations to identify the reasons.

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6.Is cancer curable?

It is difficult to identify if all the cancer cells are destroyed from the body after treatment. Hence, your doctor may not be able to confirm the outcome. A different word called 'remission' is used to explain the current status of the disease. Your doctor will be working towards a complete remission in which the regular tests cannot identify any cancer cells in the body. In some cases, the cancer cells reappear years after remission.

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7.Treatment options for cancer

Cancer treatment

Once the diagnosis is made, the type of cancer and stage of the disease is analysed. Patients will be recommended treatment to slow the growth of the tumour or eradicate it. Doctors will suggest various treatment methods that include chemotherapy, hormone therapy, radiation therapy and immunotherapy.

Chemotherapy:

In this procedure, the cancer cells are killed using different kinds of medication. The chemo medication is injected into the vein through an injection or is provided by a shot to the muscle, under the skin or as an ointment or cream. Oral chemotherapy is also available where the medication is taken in liquid, tablet or capsule form. It can be taken at home as well.

The drugs act by targeting cells that divide and multiply quickly, which is a characteristic of cancer cells. The treatment is not focused like radiation therapy or surgery and affects the whole body. Since this therapy is not target-specific, it can also affect healthy cells which multiply quickly like the cells of the skin, hair, and intestine. This can result in side-effects. Some of the most common side-effects with chemotherapy are as follows:

  • Nausea
  • Vomiting
  • Fatigue
  • Diarrhoea
  • Hair loss
  • Mouth sores
  • Pain

In particular cases, chemotherapy can cause long-term side-effects like infertility and nerve damage. Consult with the doctor regarding all the risks with chemotherapy before initiating the procedure.

Chemotherapy can be used to destroy all the cancer cells in the body. However, in some cases, the cancer cells may reappear affecting the outcome of the treatment. Patients will be checked for complete remission regularly where all the tests indicate the complete removal of cancer cells. The doctor may sometimes recommend this treatment to control the spread of the cancer to other parts of the body. In some cases, it is used just to reduce the size of the tumour. Chemotherapy may be also combined with other forms of treatment like surgery, radiation therapy or biological therapy to treat cancer.

Radiation therapy:

In this procedure, high-energy waves or particles are used to kill tumour cells without destroying too many healthy cells. Doctors may recommend this treatment alone, or might combine it with surgery/chemotherapy.

This treatment is not painful but can cause side-effects because of the impact on healthy cells. It is difficult to predict the probability of side-effects as it differs between individuals. It depends on the type of radiation, the period of exposure, the region of exposure and also on the patient’s health status. Nausea and fatigue are the early side-effects that get better after some time. Side-effects such as heart and lung problems are called late side-effects which show-up later in life but are often permanent. Patients may also experience other side-effects such as hair loss and skin problems based on the type of radiation.

Surgery:

In some cases where the cancer does not respond to chemotherapy or radiotherapy, surgery is performed to remove as much cancer tissue as possible. The surgeon removes tumours, tissue and the areas affected by cancer like the lymph nodes. Sometimes surgery is combined with other treatment options like chemotherapy and radiotherapy to improve treatment outcomes based on the tolerance level of the patient. In some cases, surgery is performed to identify the extent of cancer, size of the tumour or the extent of the spread.

Surgery is often the ideal approach as it helps in the complete removal of the tumour and gets rid of the disease if it has not spread to other organs. Some additional surgical procedures that are used to manage cancer are as follows:

  • Laser surgery: In this procedure, a beam of light is used to make the incision
  • Cryosurgery: The surgeon will use very cold temperatures to freeze and kill cancer cells
  • Electrosurgery: The surgeon will use electric current to conduct this operation

Patients will be provided with pain medication before and after surgery. They will also be provided certain other medications like antibiotics to prevent infections after the surgery.

Stem cell transplant:

Stem cells have a wide variety of functions and have opened up several novel treatment methods to treat cancer. They can repair diseased bone marrow, and the transplantation helps doctors increase the dose of chemotherapy for better treatment outcomes.

Immunotherapy:

Cancer cells have certain features of a healthy cell but act abnormally. Immunotherapy is a treatment where antibodies are used to identify abnormal cancer cells in the body so that the immune system can neutralise them.

Hormone therapy:

Tumours formed by cancer cells depend on hormones and nutrition to grow in size and spread to different parts of the body. In this treatment, certain hormones are blocked to prevent tumour growth and proliferation.

Targeted drug therapy:

In this treatment, certain medicines are used to interfere with certain compounds or processes that promote the growth of cancer cells or tumors.

Photodynamic therapy:

In this procedure, a specific drug is injected into the bloodstream. Then a specific light is used to monitor and kill abnormal cancer cells.

Alternative medicine:

Apart from the traditional treatment methods, there are several other alternative medicines to decrease symptoms of cancer and manage the side-effects of the treatment. They include yoga, meditation, acupuncture, hypnosis and relaxation techniques.

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8.Remission and recurrence

It is difficult to identify whether all the cancer cells are eliminated from the body. The doctor will be using the word 'remission' to clarify the current state of cancer. There are two types of remission, as explained below:

  • Partial remission: This signifies that cancer has reduced in severity which can be identified as the reduced tumour size or lesser cancer growth in the body. Your doctor may stop the treatment until the cancer grows back again. This will help you cope with side-effects and improve your health status to fight the cancer.
  • Complete remission: This is good news as all the tests point to the complete elimination of cancer from the body. This does not mean that the disease is cured as there is always a chance for cancer cells to recur later. Complete remission is also called as NED or 'no evidence of disease'.

In some cases, the cancer cells can reappear in the body, years after remission. It is not unusual and is called recurrence. Although it is difficult to predict the chances of recurrence, you must be aware that this can happen any time after treatment.

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9.Palliative Care and Support

Patients and their families will also be offered palliative care by a multidisciplinary team during and after the treatment of cancer. The team includes pharmacists, physical therapists, dietitians, social workers and counsellors. Palliative care helps with pain-relief and improve quality of life along with providing emotional and psychological support.

Palliative care focuses on easing side-effects like nausea, fatigue, pain, and shortness of breath that are common with cancer treatment. Patients will be provided with medication, nutritional support and relaxation techniques along with emotional and spiritual counselling. Care also includes support with legal, insurance and employment issues. Care helps both the patient and the family who act as caregivers. The palliative care team will be provided in direct consultation with the doctor to help handle treatment-related pain and other symptoms. Palliative care can begin once the diagnosis is made to help the patients get through the treatment. Care can be provided at the clinic or at home, based on the patient's requirements.

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10.Cancer FAQs: All your concerns addressed.

Q.   Is there a process to know if the treatment is working?

  1. Once you are diagnosed with cancer, your doctor will choose treatments that will help in the complete remission of the disease. The treatment will also depend on your ability to tolerate these various methods. Since the cancer cells are deep inside your body, it is important to conduct tests regularly to check if there is any change in the tumour size or if there is a remission in the condition overall. The results will help the doctor to modify the treatment accordingly. Your doctor will explain to you about 'partial remission' and 'complete remission' which helps you to understand how the treatment is affecting the disease. He might also refer to the disease as 'stable' which means cancer has stayed the same or 'progression' which means cancer has grown or spread. Your doctor will make treatment changes accordingly.

Q.   Can modern medicine cure cancer?

  1. Since it is difficult to identify if all the cancer cells are removed from the body, your doctor may not be able to confirm that the disease is cured. However, the disease can go into complete remission, which means the tests cannot identify any cancer cells in your body. In some cases, your doctor may inform you that you are in partial remission where there is no further growth of the tumour. You will be advised to stay off treatment until you see the symptoms of cancer growth again.

Q.   How often should I get tested for cancer?

  1. Early diagnosis can be beneficial to improve treatment outcomes. Cancer will be in different stages, and starting treatment early can prevent the progression of the disease. Regular medical checkups can help in preventing or effectively treating the condition.

Q.   What are the signs and symptoms of cancer that I should be aware of?

  1. You should consult a doctor if you have any of the following symptoms.
  • Continuous nagging cough
  • Difficulty in swallowing
  • Unusual bleeding
  • Any unexpected changes in wart/mole on the skin
  • Recent changes in bowel or bladder habits
  • A sore that does not heal

Q.   Will it impact the treatment if I cannot tolerate the side-effects?

  1. Your doctor will choose various treatments based on the severity of the condition and your ability to tolerate the treatment. The treatment will be modified based on your ability to handle the side-effects. The majority of the side-effects will subside after a period of time. You will be provided palliative care to manage treatment-related side-effects and pain, along with emotional and psychological support.

Q.   Are there any recommendations to help me cope with cancer?

  1. Learn more about cancer. Speak to your doctor and know about the steps you should take to manage the disease. Make use of all available resources or speak to your friends and family. Speak to other patients who have been through the condition.
  • Seek support from social workers, counsellors and support groups. Your friends and family can be of great support as well.
  • Speak to your doctor about palliative care.
  • Always keep a positive attitude as it will help fight the disease.
  • A healthy and balanced meal will help you to maintain nutrition and increase your strength.
  • Exercise regularly at least 30 minutes a day.
  • Sleep well and try to be relaxed.
  • Avoid alcohol.
  • You may discuss alternative medicine like yoga, relaxation techniques with your doctor to help you manage stress.

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11.Stories of Hope

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