UNDERSTANDING CANCER

What is Cancer?

Our body is made up of many millions of cells which keep constantly multiplying (dying and renewing). Normally the body keeps a continuous check so that these cells do not go out of control. Cancer occurs when some cells decide to behave independently, go out of control and evade the inbuilt body check systems. Sometimes, these tiny cancer cells can become very notorious and immigrate through channels in the body such as blood vessels and lymphatics and reach areas far away from their original site.

Is Cancer infectious?

Though cancer can be caused by infectious viruses, it is not a communicable disease. On the contrary, cancer patients have lowered immunity and are thus vulnerable to rare infections.

What is a Tumor Marker?

A tumor marker is a substance that is often released by tumor cells and can be detected in the blood or body fluid. Tumor markers are very highly specific for certain tumors. They can be either new compounds formed by the tumor, or increased amounts of normal blood parameters.

Is Cancer preventable?

Certain cancers have well established risk factors. Some examples:

Whatever the cause, the urgency and need for regular screening to detect cancers in an early stage cannot be emphasized enough.

What are the treatment options for cancer?

The following treatment options are tailored to the stage of disease and used in isolation or combination for the treatment of cancer.

Surgery: Best option for disease localized to a single organ.
Chemotherapy: indicated when regional or distant spread is anticipated or evident.

When should you suspect breast cancer?

Some of the common indicators of breast cancer have been enumerated below. Consult your doctor if you have any of the following symptoms:

Detection of any lump, nodule or alteration in the texture of the breast should raise your suspicion. Such detection can only be made if you routinely examine your breast at least once every month. Screening is the best way to detect such lumps. Once any such abnormality is detected, you should consult a doctor immediately.

How is breast cancer diagnosed? The earlier the diagnosis, the better the chance of a cure

Screening is an important way of detecting breast cancer early. Screening helps in detection of tumors in the early stages i.e. when their size is smaller and therewith likelier to be confined to the breast, improving overall survival chances. All women of 20 years of age and above should go in for regular screening for breast cancer. The various options available for breast cancer screening and their merits & suitability have been enumerated below.

Breast USG

Ultrasonography is also performed in certain extraordinary situations: such as, when a young patient in whom mammography was being avoided or when mammography conducted is not confirmatory. Another situation is when a patient presents with discharge from the nipple but without any obvious mass.

What is the difference between cancer and a tumor?

Tumors can be benign or malignant. Benign tumors, as the name suggests, are less harmful. They grow only in the local area destroying adjacent tissues and thus are amenable to surgical cure.

On the other hand malignant tumors often invade lymphatic channels and blood vessels and travel to far off regions where they again grow to form tumor masses. Such masses can grow in many different sites, depending on the spread of tumor cells. Once a tumor spreads to far off sites in the body they cannot be cured by surgery alone and is more difficult to treat. The word cancer is usually used for malignant tumors of all types.

In which parts of the body can cancer occur?

Cancer can occur in living cells in any part of the body except in hair and nails, because these are tissues which comprise only of dead cells.

There are over 100 types of cancer. Each type is named according to the site of origin and the type of cancer cells. Likewise, cancer of the epithelium (skin/ surface of cavities and organs) is called a carcinoma, cancer of the muscles and bones is a sarcoma, cancer of the lymph nodes is a lymphoma, cancer of the white blood cells is leukaemia, and so on.

Thus, “breast Carcinoma”, often denoted as breast cancer, occurs when cancerous cells first start growing in the breast epithelium.

What is a PET Scan?

A PET scan is an imaging technique which deals with detection of tumor tissue and differentiates it from other tissues. It is helpful especially in rapidly growing tumors and is based on cell metabolism of tumors.

What is cancer screening?

Screening is the process of conducting regular checkups and tests to detect cancer in the early stage while it is still localized, ie, restricted to one area of the body and has not yet spread to distant regions.
Screening is advised in some cancers like: cervical cancer, breast cancer, colon cancer, stomach cancer and prostate cancer.

Radiotherapy?

Hormone therapy, Immunotherapy / Immunomodulation.
Other individualized treatments like Laser, Cryosurgery, Radio-ablation etc are also used upon certain tumors.

How often does it occur?

Breast Cancer in India:

Breast cancer is the second commonest cancer among Indian women, and the commonest among women in metropolitan cities like Delhi and Mumbai. According to the Delhi Registry,  its incidence is 30/100,000. Presently, 75,000 new cases occur in Indian women every year. It is commoner in urban than rural India. Unfortunately, only few patients present with early disease. Locally-advanced breast cancer constitutes > 50% of patients presenting for treatment in the country.

Breast Self Examination (BSE)

BSE involves the serial and systemic examination of the breast by individuals every month after each menstrual cycle and can help in the early detection of small breast cancers All women above 20 years of age should examine their breasts every month. Learn the right technique of breast self examination on this link to Wikipedia: : https://en.wikipedia.org/wiki/Breast_self-examination

FNAC/ Needle Biopsy Core Biopsy

All suspicious lesions should be confirmed by a Needle Cytology or Needle Biopsy. This test is mandatory to confirm the existence of cancer and is required before any further treatment can be administered.

Why does it occur?

The development of normal cells into cancer cells is part of a multi-step process known as carcinogenesis.

Carcinogenesis occurs due to changes in certain important genes involved in the task of promoting/preventing multiplication or, ensuring cell decay. These faulty genes may be inherited from one’s parents or, normal genes may get mutated through exposure to cancer-causing substances in our food and environment. Merely having the faulty gene does not mean that the disease will manifest itself: it often requires an additional environmental modification for that to happen. On the other hand and if one has these flawed genes, one can contract the disease even if it did not manifest itself in an earlier generation. Certain viruses like HIV, Ebstein-Barr, hepatitis and others, too, can also cause alterations in genes and therewith cancer.

How is cancer diagnosed?

Most cancers are diagnosed by FNAC or Biopsy. In these methods some of the tumor cells are aspirated from the mass or a small bit of tumor tissue is removed and examined under a microscope with special stains.
FNAC/ Biopsy gives the following information:

Do remember that biopsy or FNAC tests are essential for the diagnosis of tumors.

However and in cases where FNAC and / or biopsy are either not possible or risky, tumors can be diagnosed by newer imaging techniques and tumor markers.  But it may be noted that tumor markers are not a substitute for biopsy or FNAC.

What is a CT scan / MRI?

CT Scan and MRI are tests used to detect the extent of tumor growth, their relation to adjacent vital structures and distant dissemination.

What is meant by stage of cancer?

The questions that arise after cancer has been diagnosed are:  How much has it spread ? How can it be treated? Is it curable?

Staging is the process of determining the extent of disease spread, evaluating the available treatment options and predicting the likelihood of cure with local or extensive therapies. Usually, cancers are staged in a scale of 1-4, whereby 1 signifies early disease – which is, by and large, curable – and 4 signifies advanced disease, in which the tumor cells have spread extensively to sites far away from that of the cancer’s origin.

What is Breast Cancer?

Cancer arising from the breast epithelium is known as breast carcinoma.

What are the risk factors for breast cancer?

Age: Age is the most important risk factor for breast cancer. The greater the age, the higher the risk .

Personal History:  An earlier incidence of breast cancer in a given patient increases his / her risk of getting it again.

Family History: Some patterns of family history are associated with a relatively higher risk of breast cancer:

As given below: (These apply to either your mother’s OR father’s side of the family):
1. Prolonged Exposure to estrogens:

2. Certain Cellular changes in the breast epithelium:

3. Smoking, Diet and Stress:

Smoking is associated with a small increase in breast cancer risk.
Diet plays an important role in your level of risk for breast cancer.
Avoiding high-fat foods is a healthy choice for many reasons: Being overweight IS a known factor for an increased risk of breast cancer. Stress has not been clearly associated with increased breast cancer risk. But one can confidently emphasize that stress is injurious to overall health and must be cut down.

Mammography

Mammography aids in detecting very small cancers.

In breast cancer, the term ‘screening’ usually refers to screening by mammographic examination. Mammographic screening is a routine procedure during health-checks in some western countries.

Clinical Breast Examination

CBE has a higher sensitivity in the age group of  40-49 yrs as compared to that of 50-59 yrs. CBE is also the most feasible method of mass screening in younger age groups with denser breasts, in situations where mammography is difficult or, in developing countries like India where these cancers occur in younger age groups and mammography can be a costly procedure.