Cancer: Understanding Basics, Simplifying Jargon - Dr. Baiju Senadhipan Cancer: Understanding Basics, Simplifying Jargon - Dr. Baiju Senadhipan

Cancer: Understanding Basics, Simplifying Jargon

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Battling Cancer requires good medical care, support from the family, financial security and most importantly enormous courage.

But the process of healing and recovery can effectively begin only when one is armed with accurate and reliable information. Moreover, in India, the subject of Cancer is often considered taboo in some social circles. Access to information and an understanding that Cancer is very often treatable, would enable to open the minds of those who are unwilling to discuss it.

Questions like what exactly Cancer is or what chemotherapy means are often not addressed by doctors for lack of time or other reasons. Moreover, terms like Stage IB, radiotherapy, endoscopy etc. that are commonly used by medical practitioners in the realm of cancer treatment are complicated and not easily comprehensible for ordinary people.

In this column, Dr Senadhipan, one of the leading cancer surgeons of Kerala who has successfully operated several Gastro intestinal cancer patients through keyhole surgery, has chosen to answer such basic questions about Cancer and simplify the jargon associated with Cancer. Apart from questions related to cancer treatment and cure, the information is also important for those seeking answers about cancer prevention and early detection.

The information appears in the form of Frequently Asked Questions (FAQs) and answers to those questions in simple words with the endeavour of aiding you in making an informed choice. Hope you find this helpful.

What exactly is Cancer?
The basic unit of the human body is a cell. As children grow to become adults, these cells are constantly multiplying. Even as adults, when there is an injury to any part of the body, cells multiply to heal the injured part. However, when this process of cell multiplication takes place at an uncontrolled rate, it becomes an abnormality.
1-how-cancer-develops
Cancer is a type of disease which involves an uncontrolled growth of cells anywhere in the body. When cells begin to multiply abnormally, they invade other tissues. This disease is called Cancer.

The Cancer is named after the organ or cell type where the process of abnormal multiplication of cells originated. So, for instance, breast cancer is cancer that has originated in the breast. Liver cancer is cancer that has originated in the liver although it may have later spread to other parts of the body.

What is a tumour? Is it a cancerous growth in the body?
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When cells that grow at an abnormal pace continue to divide out of control, they may form a lump or mass in the body. This lump of cells is called a tumour.

A tumour may or may not be cancerous. A non-cancerous tumour is known as a benign tumour. A cancerous one is known as malignant tumour.

It is important to know that being diagnosed with a tumour does not necessarily mean that the person has cancer.

What are the different forms of cancer? What amongst these are the most common forms?
There are over 100 different forms of cancer. The most common type of cancer worldwide is skin cancer.

However, when analysed on a gender-wise basis, it has been found that the most common type of cancer amongst women across the world is breast cancer. While the most common type worldwide amongst men is lung cancer.

What are the causes of cancer?
Research on the causes of cancer has been going on for several years. Although there are no definite answers to this question, there are a few factors that have been found to increase the risk of cancer. These are as follows –

1. Pre-disposition – A greater tendency to develop cancer due to hereditary or other factors;
2. Exposure – exposure to triggers that may cause cancer such as tobacco usage.

Is Cancer preventable?

In a large number of cases, Yes.

In many cases, cancer has been found to be hereditary. Those who have had cases of cancer in the family, can prevent cancer by getting themselves screened early and at regular intervals. This may help in preventing cancer completely or in beginning treatment at an early stage of the disease.
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A large number of cancer cases are related to lifestyle. Obesity, lack of exercise, an imbalanced diet comprising mainly of processed food, smoking, drinking, consumption of smoked / processed meat etc. increase the risk of cancer.

Tobacco has been found to be responsible for a large number of cancer deaths. Some estimates say up to 22% cancer deaths are caused by tobacco use. These are definitely preventable cases of cancer.

An uncle has been told that his cancer has metastasised. What does this mean? What is the meaning of metastatic cancer?
When cancer cells begin to multiply rapidly and move to other locations in the body, it is known as metastatic cancer.

Malignant tumours that consist of cancerous cells may break away from the place it has originated from and travel to other parts of the body. This process of transmission can take place through the blood stream or through the lymph node system that connects different parts of the human body. This stage of cancer is known as metastasis.

I have often heard the term Carcinoma. What does this mean?
Cancer can be grouped into a few broad categories which are as follows –

1. Carcinoma – Cancer that originates in the skin or tissues that line the internal organs.
2. Sarcoma – Cancer that begins in the bone, muscle, blood vessels etc.
3. Leukemia – Cancer that begins in the blood forming tissue such as the bone marrow.
4. Lymphoma – cancer that begins in the immune system.

These terms are used by doctors to classify a particular case of cancer in the appropriate category.

What are the symptoms of cancer?
The symptoms of cancer depend on the type of cancer and the location it has originated in the body. It also depends on the stage of cancer. Weight loss is one of the most common symptoms of cancer. Fever, fatigue, lumps etc. are also different symptoms that may be observable.

Often, cancer does not present itself with any symptoms until a late stage.

How is cancer diagnosed?
The diagnoses of cancer would depend on the type of cancer that one is suspected to have.

Lab tests for urine and blood are used to determine whether certain values in them are high or low. That would serve as an indicator of cancer. However, results of lab tests are only an indicator and cannot be used as the sole factor to diagnose cancer.

4a-pet-scan
Imaging tests like an X-ray, CT scan, MRI test, Ultrasound tests are also employed for the purpose of diagnoses.

A PET scan is often used to diagnose cancer. This is a type of scan, where a tracer is injected into the patient’s body to observe where it collects which helps to determine how the tissues of the body are working.

In most cases, the patient is recommended to undergo a Biopsy. This is a procedure where a sample of the tissue or cells in the region where cancer is suspected, are removed for the purpose of examination. While imaging scans like CT scans and others may be indicative of cancer, it is only by performing a biopsy, that the doctor will be able to tell with certainty whether the cells are cancerous or otherwise.

A biopsy may be conducted with a needle or a tube called an endoscope. This process in painless and uncomplicated. It does not involve any risk at all. On the other hand, it helps determine the existence, nature and extent of the cancer cells in the body.

Another process that is used in the diagnoses of cancer of the digestive tract is known as an Endoscopy. This is a procedure whereby an endoscope which is a viewing instrument attached onto a tube is inserted into the digestive tract allowing the doctor to examine the internal organs. This is a non-surgical procedure. Where this process is done for determining colorectal cancer it is also called a Colonoscopy.

In the event cancer is detected during the Endoscopy, the next step is Cancer Staging. This is done to determine where in the body the cancer is located, where the tumour has originated, how much it has spread, whether lymph nodes are involved, how severe the cancer is etc. This is done with the help of various procedures like physical examination, pathology tests etc.

Imaging tests like CT scan, MRI scan, PET Scan etc. are crucial in the process of cancer staging.

My friend has been told that his father’s cancer is at Stage II. What does this mean? What are the various stages of Cancer?
The stage of cancer indicates the extent of the disease in a patient. The process of staging described above determines the severity of the patient’s case by providing information on where the cancer is located, how much the cancer has spread etc.

The basic stages are as follows :-
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– Stage 0 – Indicates a very early stage and that the Cancer is prevalent only in the organ where it has originated. In other words, the Cancer has not spread to other parts of the body;

– Stage 1 – Indicates that the Cancer is located only within the place of its origin is relatively small;

– Stage 2 – Indicates that the Cancer has not begun to spread but its size is larger than in stage I. In some cases, Stage II may also indicate that the cancer has spread to the lymph nodes located near the place of origin of the cancer.

– Stage 3 – Indicates that the cancer has spread to other parts of the body through lymph nodes. It may also indicate a larger tumour size.

– Stage 4 – Indicates that the cancer has spread to another organ or organs. It is also known as secondary cancer. This is a case of metastasis.

In order to make things clearer, a further system of categorization (A, B, C) is used along with the above stages. So, for instance, a patient may be said to be in stage 2A or 3B depending on the nature of his /her case.

What is the process of treatment for cancer?

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Cancer treatment involves surgery, chemotherapy, radiation and other measures. Sometimes these methods are employed singly. Sometimes in conjunction with other methods, depending upon the nature of the individual patient’s case.

– Surgery – In most cases, surgery is the primary option of cancer treatment. By surgery, the part of the organ containing the cancer and nearby tissue is removed. This can be done through open surgery or laparoscopically.

If the cancer has not spread, surgery is often the only solution required.

– Laparoscopic surgery – 7-keyhole-surgery-with-miniature-incisionsis also known as keyhole surgery as in this method, a laparoscope which is a viewing instrument with a light is inserted into the patient’s body through small incisions in the abdomen which is filled with inert gas. The surgeon operates with special tools while viewing the internal parts on a screen before him.
While open surgery requires incisions as large as a ladies finger, a laparoscopic surgery requires smaller incisions often as large as a grain of rice. This translates into lower chances of infection and shorter recovery periods.

Only few centres in India currently perform cancer surgery through laparoscopic methods and it is necessary to select a center where the surgeons are qualified, competent and experienced to perform keyhole surgery for cancer.

– Chemotherapy – Chemotherapy is a method where drugs are used to stop the cancer from spreading. It is done using medicines which kill the cancer cells and stop them from multiplying. This is usually done after surgery.

– Radiation therapy – Radiation is a method that uses high-energy X-ray beams to kill cancer cells. This method is used along with surgery when the surgery alone is not sufficient for treatment.

– Hormone therapy – this is a method of treatment where the levels of hormones in the body are altered with a view to fight the cancer cells.

– Transplants – this is a method used mostly for cancer related to the blood where bone marrow transplants may be done for treatment.

Three years ago, my aunt was treated for cancer and cured. Now she has had a relapse and the cancer has returned. How did that happen?

When cancer returns after the process of treatment and cure has been completed, it is known as Relapse or Recurrence.

In some cases, despite the most thorough examination and treatment, cancer may return. This is because some cancer cells may have remained in the body after the initial treatment. It may also be that the cancer had spread to other parts of the body in the first instance and that had not been noticed as the number of those cells were too small for diagnoses.

It is important to know that a cancer which has relapsed can also be treated.

I have a history of cancer in the family. What can I do to prevent the disease?
In several cases, the origin of the cancer is related to lifestyle or family history. Taking adequate precautions or screening/checking at regular intervals may prevent the onset of cancer.

If you have a history of a particular type of cancer, you can and should take steps to prevent it. For instance, if one has a family history of breast cancer, it is important to get screened after the of 40 and regularly thereafter to enable early detection of cancer cells, if any, in the body. Similarly, in the case of colorectal cancer, those who have had it in the family are at a higher risk. One can get a screening done after the age of 50 to detect the early grown of polyps in the lining of the colon and rectum. If found, these polyps can be removed before they become cancerous.

Screening helps in early detection, which is important for cancer treatment. The earlier the cancer is diagnosed, the higher the chances of treatment and complete recovery.
Lifestyle related measures like regular exercise, a balanced weight, avoiding meat, alcohol and cigarettes may also help in reducing the risk of cancer.

I have been told that a particular food product is carcinogenic. What does that mean?
The term Carcinogenic means the potential to cause cancer. Foods such as processed meat, smoked meat or items with chemical preservatives and certain beverages are considered to be carcinogenic. What it means is that excessive consumption of these food items may result in cancer.

Why are certain types of cancer more common in certain regions?
Depends on genetic pattern and ethnicity. Food habits and exposure to environmental factors also play a role. For instance skin cancer is prevalent in white skinned population. Gall bladder cancer is more common in the Northern part of India, and Colorectal cancer is more common in the Southern part.

Is it true that more men suffer from cancer? If so, why is the incidence higher amongst men?
The incidence of cancer is reported to be higher amongst men than in women. Although there is no evidence to conclusively establish the basis of this statistic, there could be a few indicators.

Firstly, men are more likely to smoke, drink and have other lifestyle related attributes that place them at a higher risk of getting cancer.

Secondly, there is also the issue of gender specific cancer. While women contract breast cancer and ovarian cancer, men are at risk for testicular and prostate cancer. Breast cancer is the most common form of cancer amongst women. Hence, research, diagnoses, awareness and treatment of Breast cancer has moved to a highly advanced stage and that has helped breast cancer become one of the most treatable forms of cancer. This could also be one reason why the incidence is lower amongst women.

Of late, I have been hearing of several instances of people diagnosed with cancer. Has there been a spurt in cases of cancer in recent times?
Cancer has been prevalent for several years, but there was little awareness about it. Also, in India unfortunately, it has and continues to be a taboo subject in some circles. Few people – survivors, their family members – are beginning to talk about it openly and share their stories, which is a positive development.

Having said that, it is also true that the incidence of Cancer is known to be steadily on the rise. This has been attributed to lifestyle related causes like smoking, drinking, increased use of processed food, consumption of smoked and processed meat etc. which are known to be a cause of cancer.

A friend has been diagnosed with cancer. How can I be of help?
Knowing that one has Cancer or that someone dear has been diagnosed with cancer usually results in anxiety, worry and panic. As a friend, you can offer to assist the family of the patient in obtaining accurate and reliable information. Several forms of cancer are now highly treatable. You can assist your friend in gathering accurate information about the methods of treatment available.