Healthy cells in our body, divide and increase in number as a normal part of the growth process. If cells divide in spite of the fact that new cells are not needed, a mass of extra tissues (tumour)is formed. This tumour may be benign(harmless) or malignant(cancerous). Benign tumours do not lead to cancer. In most cases, once removed, they do not reappear. A malignant tumour, on the other hand, contains cells that multiply in an abnormal and uncontrolled manner, and eventually interfere with the normal, healthy functioning of the body. This is cancer.

Depending on where the abnormal multiplication of cells takes place, we have different types of cancers (bone, skin, blood, etc.). There are about a hundred types of cancers.

As the cells multiply, the tumour begins to invade nearby parts of the body, preventing these parts from working normally. It starts spreading through the blood stream and lymphatic system to distant parts of the body causing metastasis or a transference of the disease from its place of origin to a secondary part of the body (ultimately affecting vital organs like the liver, brain, lungs and bones). The eight leading cancer killers worldwide are those affecting the :

lungs stomach breast colo-rectal

mouth liver cervix oesophagus

Causes Of Cancer

The nucleus, the control centre for each cell in our body instructs the cell how it should behave. It contains a blue print for all those instructions, written in a special code. Each coded instruction is called a gene. A fault in the gene causes mistakes in the cell's instruction. These genetic faults can either be inherited from parents or may be due to cancer causing agents ( carcinogens.) like :

• tobacco
• viruses
• excessive exposure to sunlight
• dietary factors encountered in day to day life.

Repeated assaults of such carcinogens may turn a healthy cell into a cancerous one. As we grow older, we are likely to accumulate these assaults. That is why we see a higher incidence of cancers in the elderly. An excessively sedentary lifestyle could also be a causative factor in the development of this disease.

More than 10 million people develop cancer around the world every year and another 6 million, who already have the disease, die of it.

The Genetic Factor

The main points to indicate that cancer runs in a family are :

• Several incidences of the same type of cancer are found in the family
• The occurrence of cancer in the younger age group of the family
• Several incidences of cancer on the same side of the family

Just because one of the parents carries a faulty gene, it does not follow that the children will inherit it.

Can We Prevent Or Reduce the Risk of Cancer?

As of now, there is no known single method to prevent cancer totally.However, maintaining a healthy, active, toxin-free lifestyle can significantly reduce the probability of getting cancer.

Fruits and vegetables go a long way in protecting from cancer. A diet rich in fibre and starch and low in fat may help to reduce the risk of bowel cancer.

Smoking, and the use of tobacco in any other form, should be avoided at all costs. 90% of lung cancers are due to smoking. Chewing and sniffing of tobacco are responsible for most of the cheek cancers, cancer of mouth, throat and larynx. This is why an aggressive campaign against smoking and use of tobacco is absolutely essential.

Educating the public, especially women and the younger generation, is very important. Not mere awareness, but the implementation of such awareness is the key. An intensive and sustained global campaign should make the public aware of :

• the hazards of using tobacco,
• the benefit of hepatitis-B virus vaccination with regard to cancer
• how to conduct oral and breast self examination
• the significance of regular exercise and dietary control
• the crucial role of healthy development of children and adolescents, and
• the risk factors in various types of diet.

The Role of Screening Clinics

Developed countries provide numerous screening clinics where the public are screened for cancer. These clinics facilitate early detection and create an awareness about prevention methods. With the detection of more cases in early stages of the disease, patients have far brighter prospects of getting cured, and mortality due to cancer is drastically reduced. In industrialised countries, screening for cervical cancer and breast cancer has yielded dramatic decline in mortality from these types of cancer. In developing countries, breast cancer is almost as common as cervical cancer, the leading female cancer in the developing world. However, screening facilities are scarce. United Kingdom was the first country in Europe to have a nationwide program for breast cancer screening.

Screening programs target cancers that have a reliable way of detection. The method should neither miss possible cases nor generate too many false positives. Once detected, there should be effective ways of treating the disease.

Some cancers are asymptomatic in early stages rendering them impervious to early detection. Even in industrialised countries, where screening facilities are adequately available, about one third of cases are detected in advanced stages. Most cancers, if detected early, are curable.

Does Early Detection Help ?

It is an established fact that most cervical cancer can be detected at the pre-cancerous stage ( a stage much before it turns to be cancer ) if a Pap smear is routinely done. This is a painless test done in the gynaecological clinic during routine examination of the patient. In many cases, the sooner the cancer is diagnosed and treated, the better a person's chance for a full recovery.

Regular medical check ups and self-examination can improve the chances of early detection. The following are some health problems drawn by experts, which may indicate cancer :

• A change in bowel and bladder habit (constipation or diarrhoea that lasts two weeks or more or blood in the stool appearing as bright red or black stool)
• Unusual vaginal bleeding or discharge
• Thickening or lump in the breast or elsewhere
• Indigestion or difficulty in swallowing
• Obvious change in a mole or a wart
• A nagging cough or hoarseness of voice which lasts longer than usual

If you have any of the above symptoms, you should consult a doctor. It should, however, be borne in mind that although the above symptoms may be caused by cancer, they are often also caused by a variety of other medical problems that are far less serious than cancer.

Due to the screening program available for cervical cancer, mortality rate due to cervical cancer is steadily falling. Many cases are detected in the pre-cancerous stage and their progression to cancer is prevented. Two major studies on colo-rectal cancer screening in UK (by using occult blood testing in the stool) proved to be effective in reducing the death rate from colon cancer. A national program of screening for colo-rectal cancer is now being considered in UK.

The World Health Organization recommends wider application of existing cost-effective methods of disease detection and management, including improved screening methods. The WHO report stresses the need for improving the ability :

(1)to prevent, treat, rehabilitate and where possible, cure major diseases,
(2 to reduce the enormous suffering and disability that they cause,
(3)to alleviate pain, and provide palliative care for those who cannot be cured.

How is Cancer Treated?

Depending on the type of cancer and the extent of the disease, cancer may be treated with :

• Surgery
• Chemotherapy
• Radiotherapy
• Hormone therapy
• Immunotherapy
or
• Biological therapy

Cancer patients are often treated by a team of specialists, which may include a medical oncologist, a surgical oncologist, a radiotherapist and others. In some cases an operation to remove the tumour is enough.

Surgery

Surgery is the local treatment to remove the tumour. Tissue around the tumour and nearby lymph nodes are removed during the operation. In certain cases other type of treatment such as chemotherapy or radiotherapy or both may be recommended after the surgery to ensure that all cancer cells are killed.

Chemotherapy

Chemotherapy means treating the cancer cells with drugs to destroy them. The drug, or a combination of drugs, is carried by the blood stream to different parts of the body.

Radiotherapy

In radiotherapy, a direct beam of radiation is given to the area of the body where the cancer cells are situated. Like surgery, radiation therapy is a local treatment which can affect cancer cells only in the treated area. This is to kill or inactivate cancer cells and stop the tumour from recurring. Sometimes, radiotherapy is given to a tumour to reduce its size prior to surgery.

Hormone therapy

Hormone therapy is a form of systemic treatment for invasive breast cancer. Hormones are substances that are produced normally in your body. While these hormones are essential to reproductive functions, they may also stimulate breast cancer. Hormone therapy will stop the breast cancer cells from growing. Hormone therapy is most effective for the kinds of breast cancer that are affected by hormones.

Immunotherapy

Immunotherapy is still a highly experimental form of cancer treatment. In immunotherapy, treatment is directed towards increasing the efficiency of immune responses which may be either deficient or inappropriate in cancer patients. Immune therapy, used mostly in conjunction with other forms of treatment, appears to work most effectively when the quantity of the tumour is minimal. The agents with the widest clinical application are those that act against a multiple of tumour-associated antigens rather than against just a specific one, and which also stimulate the patient's own immune system(active immunotherapy) while at the same time counteracting the immunity damaging effects of other treatments and of the disease itself.

Biological therapy

There are prospects for using actual tumour cells or their products and cultured human tumour cell clones for inducing specific types of immune activity. Such agents are called biological response modifiers because they alter the biological responses between the organism and its tumour. Biological therapy is the exploitation of such biological substances like interferons and interleukins (both products of activated lymphocytes), monoclonal antibodies, other forms of antisera, and antigen products, etc. Immunotherapy and biological therapy are used either alone, or in conjunction with other modalities such as surgery, radiation and chemotherapy. These treatments repair, stimulate and increase the body's natural ability to fight infections and cancer.

Most cancer treatments have some side effects. The cancer treatment specialist should explain the pros and cons of each treatment and its possible side effects to the patient and close relatives before starting the treatment. Cancer should be treated by specially trained personnel only.

What is Palliative Care?

Palliative care is the active total care of patients whose disease is not responsive to curative treatment. Each year in India about one million new cancer cases are detected. Unfortunately about 80% of them are detected at an advanced stage, and a complete cure is beyond reach. Palliative care is the more appropriate form of treatment for such patients.

Palliative care emerged and developed as a new specialty in the sixties and seventies. Palliative care is a philosophy which :

• affirms life and regards dying as a normal process
• neither hastens nor postpones death
• provides relief from pain and other distressing symptoms
• integrates the psychological, social and spiritual aspects of patient care, so that patients may come to terms with their own death.
• offers a support system, that helps the patient to live as actively as possible until death
• offers a support system to help the family cope during the patient's illness and in their own bereavement.

The goal of palliative care is to provide support and care for patients in the last phases of their illness, so that they can live as fully and comfortably as possible. Many aspects of palliative care are also applicable earlier in the course of the illness, or in conjunction with anti-cancer treatment.

How does Palliative Care help?

Control of pain, of psychological, social and spiritual problems and attendant symptoms is paramount. It has been estimated that 50% of patients with advanced cancer suffer from severe pain while 20% experience moderately severe pain. In cases of terminal cancer, 90% of patients suffer from severe pain.

Other harmful consequences of pain are :

• sleeplessness
• reduced ability to concentrate
• physical and social isolation, which affect the patient's quality of life.

Apart from the actual suffering of pain, uncontrolled pain is harmful to the body and may cause impaired lung functions, increased load on circulation together with elevated metabolism and oxygen consumption. Immobilisation due to pain, results in loss of bone and muscle mass and leads to risk of thrombo-embolism.

Pain acts as a reminder of the ongoing cancer process. It fuels increased anxiety, which in turn leads to a more intensified experience of pain. Thus, a vicious cycle is created. The intense and pervasive emotional and social components contribute to the total suffering of the patient.

Today, acceptable pain control is possible with analgesics. Unfortunately, more than 10% of patients with severe pain do not respond to this and have to seek other options such as palliative radiotherapy and use of hormones.

The goal of pain treatment is pain-free nights with uninterrupted sleep, pain-free days and pain-free movements.

Palliative care includes rehabilitation. It seeks to help patients achieve and maintain their maximum potential physically, psychologically, socially and spiritually, however limited these may have become owing to the progress of the disease.

"Inevitably, each human life reaches an end. Ensuring that life ends in the most dignified, caring and least painful way that can be achieved, is equally a priority. It is a priority not merely for the medical profession, the health sector or the social services but also for each society, community and family and individual."