Cancer

Cancer , known medically as a malignant neoplasm, is a broad group

of various diseases, all involving unregulated cell growth. In
cancer, cells divide and grow uncontrollably, forming malignant
tumors, and invade nearby parts of the body. The cancer may
also spread to more distant parts of the body through the lymphatic
system or bloodstream. Not all tumors are cancerous. Benign
tumors do not grow uncontrollably, do not invade neighboring tissues,
and do not spread throughout the body. There are over 200 different
known cancers that afflict humans.[1]
Determining what causes cancer is complex. Many things are known
to increase the risk of cancer, including tobacco use,
certain infections, radiation, activity, obesity, and environmental
pollutants.[2] These can directly damage genes or combine with
existing genetic faults within cells to cause the disease.
[3]
Approximately five to ten percent of cancers are entirely hereditary.

Cancer can be detected in a number of ways, including the presence

of certain signs and symptoms, screening tests, or medical imaging.
Once a possible cancer is detected it is diagnosed by microscopic
examination of a tissue sample. Cancer is usually treated with
chemotherapy, radiation therapy and surgery. The chances of
surviving the disease vary greatly by the type and location of the
cancer and the extent of disease at the start of treatment. While
cancer can affect people of all ages, and a few types of cancer are
more common in children, the risk of developing cancer generally
increases with age. In 2007, cancer caused about 13% of all human
deaths worldwide (7.9 million). Rates are rising as more people live to
an old age and as mass lifestyle changes occur in the developing
world
Signs and symptoms
Cancer signs and symptoms

Symptoms of cancer metastasis depend on the location of the tumor.

When cancer begins it invariably produces no symptoms with signs

and symptoms only appearing as the mass continues to grow
or ulcerates. The findings that result depends on the type and
location of the cancer. Few symptoms are specific, with many of them
also frequently occurring in individuals who have other conditions.
Cancer is the new "great imitator". Thus it is not uncommon for
people diagnosed with cancer to have been treated for other
diseases to which it was assumed their symptoms were due. []
Local effects
Local symptoms may occur due to the mass of the tumor or its
ulceration. For example, mass effects from lung cancer can cause
blockage of the bronchus resulting
in cough orpneumonia; esophageal cancer can cause narrowing of
the esophagus, making it difficult or painful to swallow; and colorectal
cancer may lead to narrowing or blockages in the bowel, resulting in
changes in bowel habits. Masses of breast or testicles may be easily
felt.Ulceration can cause bleeding which, if it occurs in the lung, will
lead to coughing up blood, in the bowels to anemia or rectal bleeding,
in the bladder to blood in the urine, and in the uterus to vaginal
bleeding. Although localized pain may occur in advanced cancer, the
initial swelling is usually painless. Some cancers can cause build up
of fluid within the chest or abdomen.[5]

Systemic symptoms
General symptoms occur due to distant effects of the cancer that are
not related to direct or metastatic spread. These may include:
unintentional weight loss, fever, being excessively tired, and changes
to the skin.[6] Hodgkin disease, leukemias, and cancers of the liver or
kidney can cause a persistent fever of unknown origin.[5]

Specific constellations of systemic symptoms, termed paraneoplastic

phenomena, may occur with some cancers. Examples include the
appearance of myasthenia gravis in thymoma and clubbing in lung
cancer.]
Causes
Cancers are primarily an environmental disease with 9095% of
cases attributed to environmental factors and 510% due to genetics.
[2]
Environmental, as used by cancer researchers, means any cause
that is not inherited genetically, not merely pollution.[7] Common
environmental factors that contribute to cancer death
include tobacco (2530%), diet and obesity (3035%), infections (15
20%),radiation (both ionizing and non-ionizing, up to 10%), stress,
lack of physical activity, and environmental pollutants.[]

Chemicals
Further information: Alcohol and cancer and Smoking and cancer

The incidence of lung cancer is highly correlated with smoking.

Cancer pathogenesis is traceable back to DNA mutations that impact

cell growth and metastasis. Substances that cause DNA mutations
are known as mutagens, and mutagens that cause cancers are
known as carcinogens. Particular substances have been linked to
specific types of cancer. Tobacco smoking is associated with many
forms of cancer,[] and causes 90% of lung cancer.[]

Many mutagens are also carcinogens, but some carcinogens are not
mutagens. Alcohol is an example of a chemical carcinogen that is not
a mutagen. In Western Europe 10% of cancers in males and 3% of
cancers in females are attributed to alcohol.
Decades of research has demonstrated the link between tobacco use
and cancer in thelung, larynx, head, neck, stomach, bladder,
kidney, esophagus and pancreas.[12] Tobacco smoke contains over
fifty known carcinogens, including nitrosamines and polycyclic
aromatic hydrocarbons. Tobacco is responsible for about one in three
of all cancer deaths in the developed world, [] and about one in five
worldwide. Lung cancer death rates in the United States have
mirrored smoking patterns, with increases in smoking followed by
dramatic increases in lung cancer death rates and, more recently,
decreases in smoking rates since the 1950s followed by decreases in
lung cancer death rates in men since 1990. However, the numbers of
smokers worldwide is still rising, leading to what some organizations
have described as the tobacco epidemic.[]

Cancer related to one's occupation is believed to represent between

220% of all cases.[17] Every year, at least 200,000 people die
worldwide from cancer related to their workplace. [18] Most cancer
deaths caused by occupational risk factors occur in the developed
world.[18] It is estimated that approximately 20,000 cancer deaths and
40,000 new cases of cancer each year in the U.S. are attributable to
occupation.[19] Millions of workers run the risk of developing cancers
such as lung cancer and mesothelioma from inhaling asbestos fibers
and tobacco smoke, or leukemia from exposure to benzene at their
workplaces.

Radiation
Main article: radiation-induced cancer

Up to 10% of invasive cancers are related to radiation exposure,

including both ionizing radiation and non-ionizing radiation.
[2]
Additionally, the vast majority of non-invasive cancers are non-
melanoma skin cancers caused by non-ionizing ultraviolet radiation.

Sources of ionizing radiation include medical imaging, and radon gas.

Radiation can cause cancer in most parts of the body, in all animals,
and at any age, although radiation-induced solid tumors usually take
1015 years, and can take up to 40 years, to become clinically
manifest, and radiation-induced leukemias typically require 210
years to appear.[26] Some people, such as those with nevoid basal cell
carcinoma syndrome or retinoblastoma, are more susceptible than
average to developing cancer from radiation exposure. [26]Children and
adolescents are twice as likely to develop radiation-induced leukemia
as adults; radiation exposure before birth has ten times the effect.
[26]
Ionizing radiation is not a particularly strong mutagen.
[26]
Residential exposure to radon gas, for example, has similar cancer
risks as passive smoking.[26] Low-dose exposures, such as living near
a nuclear power plant, are generally believed to have no or very little
effect on cancer development.[26] Radiation is a more potent source of
cancer when it is combined with other cancer-causing agents, such
as radon gas exposure plus smoking tobacco.[26]

Heredity
Main article: Cancer syndrome

The vast majority of cancers are non-hereditary ("sporadic

cancers"). Hereditary cancers are primarily caused by an inherited
genetic defect. Less than 0.3% of the population are carriers of a
genetic mutation which has a large effect on cancer risk and these
cause less than 310% of all cancer.[31] Some of
these syndromes include: certain inherited mutations in the
genes BRCA1 and BRCA2 with a more than 75% risk of breast
cancer and ovarian cancer,[31] and hereditary nonpolyposis colorectal
cancer (HNPCC or Lynch syndrome) which is present in about 3% of
people with colorectal cancer,[ among others.

Hormones
Some hormones play a role in the development of cancer by
promoting cell proliferation.[35] Hormones are important agents in sex-
related cancers such as cancer of the breast, endometrium, prostate,
ovary, and testis, and also of thyroid cancer and bone cancer.

An individual's hormone levels are mostly determined genetically, so

this may at least partly explains the presence of some cancers that
run in families that do not seem to have any cancer-causing genes.
[35]
For example, the daughters of women who have breast cancer
have significantly higher levels of estrogen and progesterone than the
daughters of women without breast cancer. These higher hormone
levels may explain why these women have higher risk of breast
cancer, even in the absence of a breast-cancer gene.
Prevention
Cancer prevention is defined as active measures to decrease the risk
of cancer.[45] The vast majority of cancer cases are due to

environmental risk factors, and many, but not all, of these

environmental factors are controllable lifestyle choices. Thus, cancer
is considered a largely preventable disease. [46] Greater than 30% of
cancer deaths could be prevented by avoiding risk factors including:
tobacco, overweight / obesity, an insufficient diet, physical
inactivity, alcohol, sexually transmitted infections, and air pollution.
[47]
Not all environmental causes are controllable, such as naturally
occurring background radiation, and other cases of cancer are
caused through hereditary genetic disorders, and thus it is not
possible to prevent all cases of cancer.
Vaccination
Vaccines have been developed that prevent some infection by some
viruses.[66] Human papillomavirus vaccine (Gardasil and Cervarix)
decreases the risk of developing cervical cancer.[66] The hepatitis B
vaccine prevents infection with hepatitis B virus and thus decreases
the risk of liver cancer.[66]

Chemotherapy

Chemotherapy in addition to surgery has proven useful in a number

of different cancer types including: breast cancer, colorectal
cancer,pancreatic cancer, osteogenic sarcoma, testicular cancer,
ovarian cancer, and certain lung cancers. [88] The effectiveness of
chemotherapy is often limited by toxicity to other tissues in the body.

Systemic symptoms
General symptoms occur due to distant effects of the cancer
that are not related to direct or metastatic spread. These
may include: unintentional weight loss, fever, being
excessively tired, and changes to the skin.[6] Hodgkin
disease, leukemias, and cancers of the liver or kidney can
cause a persistent fever of unknown origin.[5]

Specific constellations of systemic symptoms,

termed paraneoplastic phenomena, may occur with some
cancers. Examples include the appearance of myasthenia
gravis in thymoma and clubbing in lung cancer.[5]

Diagnosis
Most cancers are initially recognized either because of the
appearance of signs or symptoms or through screening.
Neither of these lead to a definitive diagnosis, which requires
the examination of a tissue sample by a pathologist. People
with suspected cancer are investigated with medical tests.
These commonly include blood tests, X-rays, CT
scansand endoscopy.

Classification
Cancers are classified by the type of cell that the tumor cells
resemble and is therefore presumed to be the origin of the
tumor. These types include:

Carcinoma: Cancers derived from epithelial cells. This

group includes many of the most common cancers,
particularly in the aged, and include nearly all those
developing in thebreast, prostate, lung, pancreas,
and colon.
 Sarcoma: Cancers arising from connective
tissue (i.e. bone, cartilage, fat, nerve), each of which
develop from cells originating in mesenchymal cells
outside the bone marrow.
Lymphoma and leukemia: These two classes of cancer
arise from hematopoietic (blood-forming) cells that leave
the marrow and tend to mature in the lymph nodes and
blood, respectively. Leukemia is the most common type
of cancer in children accounting for about 30%.[44]
Germ cell tumor: Cancers derived from pluripotent cells,
most often presenting in the testicle or
the ovary (seminoma anddysgerminoma, respectively).
Blastoma: Cancers derived from immature "precursor"
cells or embryonic tissue. Blastomas are more common in
children than in older adults.

Cancers are usually named using -carcinoma, -sarcoma or -

blastoma as a suffix, with the Latin or Greek word for
the organ or tissue of origin as the root. For example,
cancers of the liver parenchyma arising from malignant
epithelial cells is called hepatocarcinoma, while a
malignancy arising from primitive liver precursor cells is
called a hepatoblastoma, and a cancer arising from fat cells
is called aliposarcoma. For some common cancers, the
English organ name is used. For example, the most common
type of breast cancer is called ductal carcinoma of the
breast. Here, the adjective ductal refers to the appearance of
the cancer under the microscope, which suggests that it has
originated in the milk ducts.

Benign tumors (which are not cancers) are named using -

oma as a suffix with the organ name as the root. For
example, a benign tumor of smooth muscle cells is called
a leiomyoma (the common name of this frequently occurring
benign tumor in the uterus is fibroid). Confusingly, some
types of cancer use the -noma suffix, examples
including melanoma and seminoma.

Some types of cancer are named for the size and shape of
the cells under a microscope, such as giant cell
carcinoma, spindle cell carcinoma, and small cell carcinoma.