Patient Education

What is Cancer?

Cancer describes a range of diseases in which abnormal cells proliferate and spread (metastasise) to other parts of the body. If the spread is not controlled, it can result in death. Other terms for Cancer are Tumours and neoplasms, although these terms can also be used for non-Cancerous growths.

Difference between a malignant and a benign tumour?

Tumours can be benign (not a Cancer) or malignant (a Cancer). Benign Tumours do not invade together tissues or spread to other parts of the body, although they can expand to interfere with health structures. The main features of a malignant tumour (Cancer) are its ability to grow in an uncontrolled way and to invade and spread to other parts of the body (metastasise).

Most common Cancers in India

In males, Oral Cancer is the most common registered Cancer, followed by ,Lung cancer and Oesophageal Cancer and Gastric Cancer. These four Cancers account for 60% of all registered Cancers in males. In females, Cervical cancer is the most common registered Cancer, followed by Breast Cancer, Oral cavity Cancer and Lung Cancer . these four cancers account for 58% of all registered Cancers in females.

Major types of cancer

Although there are hundreds of different Cancers, there are five major categories: Carcinoma, Sarcoma, Myeloma, Leukemia and Lymphoma. There are also some Cancers of mixed types.
Carcinoma: Malignancy (ie Cancer) of the internal or external lining of the body. For example, squamous or epidermoid carcinoma of skin, lip, tongue, cervix.
Sarcoma :Malignancy of connective tissue origin. For example, bone, cartilage, skeletal muscle, fibrous tissue, neurongenic connective tissue.
Myeloma: Malignancy of plasma cell series (cells which produce some of the proteins found in the blood). These cells are generally found in the bone marrow.
Lymphoma: Cancer of cells of the lymph nodes or of similar cells which may occur elsewhere.
Leukemia: Malignancy of the blood-forming elements of the bone marrow.

Mixed types: Cancer composed of different tissue types. The type components may be within one category or from different categories.

Cancer registry

Cancer registry can be defined as an organised system for the collection, storage, analysis and interpretation of data on persons with Cancer. Each state and territory in India maintains a Cancer registry. In Kerala we have such registries at Thiruvananthapuram and Karunagapally.

How is Cancer treated?

Cancer treatment is done by the following modalities-Surgery, Radiation or Chemotherapy. These modalities may be used either as a single modality or combination of more than one, for eg: Acute Myeloid Leukemia is treated mainly by Chemotherapy alone where as Breast Cancer very often requires combination of Surgery, radiation and Chemotherapy.
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What is Chemotherapy?

Chemotherapy is drug treatment which is used to kill Cancer cells or stop them spreading. Sometimes Chemotherapy is used to treat non-Cancerous conditions but often the doses are lower and the side effects may be reduced. This section does not cover the use of Chemotherapy for conditions other than Cancer. Different Cancer cells respond to different drugs, so not all Chemotherapy is the same.

chaemotherapy Sometimes as many as eight different drugs is employed to get the best effect, and doctors are constantly trying out new combinations to improve treatment. Chemotherapy is often associated with debillitating side effects, but many types of modern Chemotherapy cause only mild problems.

Who gets Chemotherapy?

Because Chemotherapy drugs are usually injected into the blood, they travel around the body and can attack Cancer cells regardless of where they find them. For this reason, doctors will use them when they think there might be Cancer cells in more than one part of the body.

If some Cancers have been growing for a while undetected, bits of them can break away from the main Tumour and travel to either nearby tissue, or to more distant organs like the liver and lungs - and start growing there. A surgeon can only cut out the a main Cancer Tumour, and nearby tissues which may be involved.

Radiotherapy, which uses radiation to destroy Cancer cells, can only be given to small areas of the body or it will cause damage to too many healthy cells. Often, after an operation to remove Cancer, Chemotherapy will be given to "mop up" any remaining cells. Some Cancers, such as leukaemia, need Chemotherapy because they involve cells which are found throughout the body. Chemotherapy can be given to shrink a Tumour to make it easier for the surgeon to remove. It can also ease the symptoms of patients whose Cancer is not curable.

How does it work?

Chemotherapy, in its traditional sense, is a chemical which is poisonous to Cancer cells and kills them. This is called a cytotoxic chemical - one very early Chemotherapy was produced from mustard gas, which was used as chemical weaponry during the First World War. However, anything which is poisonous to Cancer cells may also be poisonous to the body's healthy cells, which it needs to survive

The trick with Chemotherapy is to find a chemical which kills as many Cancer cells as possible, and as few healthy cells. Doctors have been getting increasingly successful at developing such chemicals, by spotting the differences between the Cancer cells and neighbouring normal cells, and exploiting them.

The principle difference between many Cancer cells and normal cells is the speed at which they reproduce, or divide. Cancers tend to be dividing and growing faster than other cells in the body - which is why lumps or Tumours sometimes appear. Other Cancer cells may become more or less active in response to natural chemicals called hormones produced by the body. Some Chemotherapy harnesses this reaction to control the growth of the Cancer cells, so rather than poisoning the cells, they starve them of something they need to grow and multiply.

Cancer cells are not attacked by the body's own immune defence system because the immune system does not recognise them as foreign. Some Chemotherapies try to programme the immune system to see the Cancer cells as foreign so they can be attacked and destroyed.

What about side-effects?

Because some Chemotherapy targets fast-growing, or fast-dividing cells, it is more likely to harm similar cells in the body. These include the cells in the hair follicles, which is why Cancer treatment is often associated with hair loss, although hair does regrow once treatment has ended. Other fast-dividing cells can be found in the stomach and bowel lining, which leads to nausea and diarrhoea. There are, however, drugs which help control this, and timing meals to avoid having a full stomach when the drugs take effect can also help in some cases.
Other types of normal cell that can suffer are the blood cells. Red cells are important to carry oxygen to keep other cells alive. Other blood cells help stave off infection. As a result, Chemotherapy patients may be more prone to infections, and find them harder to fight off. >

Hospitals will take regular blood tests to monitor the levels of different cells. This is called a full blood count. Generally, patients on Chemotherapy can be expected to have less energy than usual, or perhaps even feel extreme fatigue. Chemotherapy can also affect the fertility of both men and women, and both can now freeze their sperm and eggs with the hope of using them to produce a test-tube baby. The thawing of eggs is a relatively new technique becoming popular all over the world. Goto Top

What is Radiotherapy?

Treatment of Cancer using Radiation is Radiotherapy where the cancer cells are killed by ionizing radiation. Ionizing radiation - similar to x-rays - can penetrate tissue, and alter the part of the cell which regulates its growth and reproduction.

Normal cells can recover from this damage, while Cancer cells cannot. There are two types of Radiotherapy - delivered from outside the body by a machine, and using radioactive implants placed inside the body. Researchers are working to increase the effectiveness of Radiotherapy by targeting the beam of energy more precisely, and making the Cancer cells more sensitive to it.

Who gets Radiotherapy?

The principal use of Radiotherapy is to tackle solid Tumours found in just one location, for example skin, brain, breast or uterine Cancers. Sometimes radiation is used to shrink a Tumour so that a subsequent operation will be more effective.

In some cases, for example in invasive bladder Cancer, Radiotherapy is considered as the first option, as an alternative to Surgery that would have permanent effects on the lifestyle of the patient. But although Radiotherapy alone can cure many Cancers, in other cases the Radiotherapy is given after Surgery over the surrounding area to "mop up" any remaining cells which have spread from the original Cancer site. If there is a suspicion or firm evidence that cells could have spread further afield, then Chemotherapy may be the preferred option

What form does the treatment take?

If the Radiotherapy is delivered by a machine, then the patient will normally be given repeated treatments over a brief period. Although treatment timing varies depending on the type of Cancer, its location, size, and the dose chosen by the doctors, it is not unusual to be given treatments every day for a few weeks.
If the therapy involves inserting a radioactive implant near a Tumour, then a brief hospital stay is normally needed.

What are the side-effects?

Although the treatment itself is painless at the time, the culmulative effect of many sessions does produce side effects. The radiation can produce a sunburn-like effect on the skin as it passes through. The extent of this depends on the number and intensity of treatments. There can be hair loss in the area being treated - which is usually temporary. The treatment can also leave the patient feeling fatigued and generally lethargic.

Are there any long-term health risks?

Ionizing radiation produces changes within the genetic structure of the body's cells, and there is a small risk that an increased Radiation dose leads to changes in healthy cells which can cause Cancer. However, the dose is lessening steadily as modern Radiotherapy equipment targets Tumours more precisely. The risks of medical radiation exposure are miniscule when compared to the risks to the patient's health of not having the treatment. Old-fashioned Radiotherapy equipment tends to give the patient a slightly higher dose, but the UK government is now investing in the latest machines. What is the future of radiotherapy?
Researchers in India and all over the world are fine-tuning Rradiotherapy to improve the outcomes for patients.
The main efforts focus on delivering a more powerful Radiotherapy beam accurately to smaller and smaller targets. Some drugs seem to make Cancer cells more vulnerable to radiation, which means less powerful Radiotherapy, or fewer sessions, are needed. Another field of research is looking at heating cells in a specific area to make them more sensitive to Radiotherapy.
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Surgery for Cancer

Among the different treatment modalities, Surgery is the oldest and most commonly used form of therapy. Specifically, Surgery means the cutting away of tissues. Surgery is used for complete removal of aTumour, partial removal of a Tumour, or exploration of a particular area to obtain a sample of Tumour tissue and evaluate the extent of normal tissue involvement. In all cases, any tissue removed by Surgery is submitted for biopsy (i.e., given to a pathologist to obtain a specific diagnosis).

096b9e How is cancer surgery used in treatment? Cancer Surgery may be used to achieve one or more goals. Common reasons you might undergo Surgery include:

Cancer prevention - If your doctor suspects you'll develop Cancer in certain tissues or organs, he or she may recommend removing those tissues or organs before Cancer develops. For example, if you have a genetic condition called familial polyposis, your doctor may use Cancer Surgery to remove your colon and rectum because you have a high risk of developing colon Cancer in the future.

Diagnosis - Your doctor may use a form of Cancer Surgery to remove (biopsy) all or part of a Tumour — allowing the Tumour to be studied under a microscope — to determine whether the growth is Cancerous (malignant) or non Cancerous (benign)

Staging. Cancer Surgery helps your doctor define how advanced your Cancer is, called its stage. Surgery allows your doctor to evaluate the size of your Tumour and determine whether it's traveled to your lymph nodes. Additional tests might be used to gauge your Cancer's stage.

Primary treatment. For many Tumors, Surgery is the best chance for a cure, especially if the Cancer is localized and hasn't spread. If your doctor believes your Cancer hasn't spread, he or she may recommend Surgery to remove the cancerous Tumour as your primary treatment.

Debulking. When it's not possible to remove all of a Cancerous Tumour — for example, because doing so may severely harm an organ — your doctor may remove as much as possible (debulking) in order to make Chemotherapy or Radiation more effective.
Relieving symptoms or side effects. Sometimes Surgery is used to improve your quality of life rather than treat the Cancer itself — for example, to relieve pain caused by a Tumor that's pressing on a nerve or bone. Another example might include removing a Tumor that's obstructing your intestine.
Surgery is often combined with other Cancer Treatments, such as Chemotherapy and Radiation. Whether you opt for additional Cancer Treatment depends on your Cancer type and it’s extent.

What patient and family should know from the cancer doctor?

Before the start of anti Cancer Treatment it is imperative to know the extent of Cancer spread and its origin. One should also be aware of the benefits and risks of treatments and possible consequences if no treatment is taken. It should be clearly known that what will happen if no treatment is taken and how the given treatment choices will change the natural history of Cancer. It should be clarified that how long the patient is going to live with or without treatment. Patient should know cost effectiveness of various treatment possibilities, planned breaks and follow up schedule.
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