AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

What is Cancer

By:
Prof.(Dr.) Rita Kumar
Amity Institute of Psychology and Allied Sciences
Amity University Uttar Pradesh, Noida
 What is cancer? AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Definition
– a term used for diseases in which abnormal cells divide
without control and are able to invade other tissues
• Cancer cells spread to other parts of the body through the blood
and lymph systems
• Cancer is not just one disease but many diseases
• More than 100 different types of cancer

Source: National Cancer Institute

 A Collection of Related
Diseases
AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• In all types of cancer, some of the body’s cells begin to divide without stopping
and spread into surrounding tissues.
• Cancer can start almost anywhere in the human body, which is made up of trillions
of cells.
• Normally, human cells grow and divide to form new cells as the body needs them.
• When cells grow old or become damaged, they die, and new cells take their place.
• When cancer develops, however, this orderly process breaks down.
• As cells become more and more abnormal,
1. old or damaged cells survive when they should die, and
2. new cells form when they are not needed.
3. These extra cells can divide without stopping and may form growths called
tumors.
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• Many cancers form solid tumors, which are masses of tissue.

• Cancers of the blood, such as leukemias, generally do not form solid tumors.
• Cancerous tumors are malignant, which means they can spread into, or invade, nearby
tissues.
• In addition, as these tumors grow, some cancer cells can break off and travel to distant
places in the body through the blood or the lymph system and form new tumors far
from the original tumor.
• Unlike malignant tumors, benign tumors do not spread into, or invade, nearby tissues.
Benign tumors can sometimes be quite large, however.
• When removed, they usually don’t grow back, whereas malignant tumors sometimes
do. Unlike most benign tumors elsewhere in the body, benign brain tumors can be life
threatening.
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 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Differences between Cancer Cells and Normal Cells

• Cancer cells differ from normal cells in many ways.
• For instance, cancer cells: grow in the absence of signals telling them to grow.
• Normal cells only grow when they receive such signals.
• ignore signals that normally tell cells to stop dividing or to die (a process
known as programmed cell death, or apoptosis).
• invade into nearby areas and spread to other areas of the body. Normal cells
stop growing when they encounter other cells, and most normal cells do not
move around the body.
• tell blood vessels to grow toward tumors. These blood vessels supply tumors
with oxygen and nutrients and remove waste products from tumors.
• hide from the immune system. The immune system normally eliminates
damaged or abnormal cells.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• trick the immune system into helping cancer cells stay alive and grow. For
instance, some cancer cells convince immune cells to protect the tumor
instead of attacking it.
• accumulate multiple changes in their chromosomes, such as duplications
and deletions of chromosome parts. Some cancer cells have double the
normal number of chromosomes.
• rely on different kinds of nutrients than normal cells. In addition, some
cancer cells make energy from nutrients in a different way than most normal
cells. This lets cancer cells grow more quickly.
• Many times, cancer cells rely so heavily on these abnormal behaviors that
they can’t survive without them. Researchers have taken advantage of this
fact, developing therapies that target the abnormal features of cancer cells.
For example, some cancer therapies prevent blood vessels from growig
toward tumors, essentially starving the tumor of needed nutrients.
 How Does Cancer Develop?
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• Cancer is a genetic disease—that is, it is caused by changes to genes that

control the way our cells function, especially how they grow and divide.
• Genetic changes that cause cancer can happen because: of errors that occur
as cells divide.
• of damage to DNA caused by harmful substances in the environment, such as
the chemicals in tobacco smoke and ultraviolet rays from the sun. (Our Cancer
Causes and Prevention section has more information.)
• they were inherited from our parents.
• The body normally eliminates cells with damaged DNA before they turn
cancerous. But the body’s ability to do so goes down as we age. This is part of
the reason why there is a higher risk of cancer later in life.
• Each person’s cancer has a unique combination of genetic changes. As the
cancer continues to grow, additional changes will occur. Even within the same
tumor, different cells may have different genetic changes.
AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Cancer is caused by
certain changes to
genes, the basic
physical units of
inheritance. Genes are
arranged in long strands
of tightly packed DNA
called chromosomes.

• Credit: Terese Winslow

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 Drivers" of Cancer AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• The genetic changes that contribute to cancer tend to affect three main types of genes
—proto-oncogenes, tumor suppressor genes, and DNA repair genes. These changes
are sometimes called “drivers” of cancer.
• Proto-oncogenes are involved in normal cell growth and division. However, when
these genes are altered in certain ways or are more active than normal, they may
become cancer-causing genes (or oncogenes), allowing cells to grow and survive
when they should not.
• Tumor suppressor genes are also involved in controlling cell growth and division.
Cells with certain alterations in tumor suppressor genes may divide in an uncontrolled
manner.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• DNA repair genes are involved in fixing damaged DNA. Cells with mutations in these
genes tend to develop additional mutations in other genes. Together, these mutations
may cause the cells to become cancerous.
• As scientists have learned more about the molecular changes that lead to cancer, they
have found that certain mutations commonly occur in many types of cancer. Because
of this, cancers are sometimes characterized by the types of genetic alterations that
are believed to be driving them, not just by where they develop in the body and how
the cancer cells look under the microscope.
 When Cancer Spreads AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• In metastasis, cancer cells break away from where they first formed (primary cancer),
travel through the blood or lymph system, and form new tumors (metastatic tumors)
in other parts of the body. The metastatic tumor is the same type of cancer as the
primary tumor.
• A cancer that has spread from the place where it first started to another place in the
body is called metastatic cancer. The process by which cancer cells spread to other
parts of the body is called metastasis.
• Metastatic cancer has the same name and the same type of cancer cells as the original,
or primary, cancer. For example, breast cancer that spreads to and forms a metastatic
tumor in the lung is metastatic breast cancer, not lung cancer.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Under a microscope, metastatic cancer cells generally look the same as cells of the
original cancer. Moreover, metastatic cancer cells and cells of the original cancer
usually have some molecular features in common, such as the presence of
specific chromosome changes.
• Treatment may help prolong the lives of some people with metastatic cancer. In
general, though, the primary goal of treatments for metastatic cancer is to control the
growth of the cancer or to relieve symptoms caused by it. Metastatic tumors can
cause severe damage to how the body functions, and most people who die of cancer
die of metastatic disease.
 Main Categories AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Carcinoma - cancer that begins in the skin or in tissues that line or cover
internal organs. There are a number of subtypes of carcinoma:
adenocarcinoma, basal cell carcinoma, squamous cell carcinoma,
transitional cell carcinoma.
• Sarcoma - cancer that begins in bone, cartilage, fat, muscle, blood
vessels, or other connective or supportive tissue.
• Leukemia - cancer that starts in blood-forming tissue such as the bone
marrow and causes large numbers of abnormal blood cells to be produced
and enter the blood.
• Lymphoma and myeloma - cancers that begin in the cells of the
immune system.
• Central nervous system cancers - cancers that begin in the tissues of the
brain and spinal cord.
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Causes
Cancer Consequences
- Cigarette smoking
- High health care
- Poor diet
costs for treatment
- Physical inactivity
- Lost work
- Occupational
productivity
exposures High risk - Insurance denial
- Viruses and other populations - Disability
biological agents - Poor
- Psychosocial
- Reproductive factors - Less educated
- Racial and ethnic problems
- Alcohol
- Treatment
minorities
- Persons with a complications (eg.
Increased risk of
family history of
second cancers)
cancer - Premature mortality
- Elderly

Cancer: causes, consequences, and high-risk

populations
Source: Chronic disease epidemiology and
control
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Symptoms of Cancer

• Cancer can cause many symptoms, but these symptoms are most often
caused by illness, injury, benign tumors, or other problems. If onehave
symptoms that do not get better after a few weeks, see The doctor so
that problems can be diagnosed and treated as early as possible. Often,
cancer does not cause pain, so do not wait to feel pain before seeing a
doctor.
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Cancer can cause many different symptoms.

• Most often these symptoms are not caused by cancer, but by benign tumors
or other problems.
• If someone have symptoms that last for a couple of weeks, doctor will do a
physical exam and order tests or other procedures to find out what is
causing your symptoms.
• If someone find out that he/she have cancer, doctor will order another set of
tests or procedures to figure out its stage. Stage refers to the extent of
cancer and is based on factors such as how large the tumor is and if it has
spread.
• Once doctor knows the stage of cancer, he will be able to suggest
treatment and discuss prognosis. Understanding cancer and knowing what
to expect can help patie and the loved ones feel more in control and cope
with diagnosis.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Some of the symptoms that cancer may cause include:

Breast changes
• Lump or firm feeling in your breast or under your arm
• Nipple changes or discharge
• Skin that is itchy, red, scaly, dimpled, or puckered
• Bladder changes
• Trouble urinating
• Pain when urinating
• Blood in the urine
• Bleeding or bruising, for no known reason
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• Bowel changes
• Blood in the stools
• Changes in bowel habits
• Cough or hoarseness that does not go away
• Eating problems
• Pain after eating (heartburn or indigestion that doesn’t go away)
• Trouble swallowing
• Belly pain
• Nausea and vomiting
• Appetite changes
• Fatigue that is severe and lasts
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• Fever or night sweats for no known reason

• Mouth changes
• A white or red patch on the tongue or in your mouth
• Bleeding, pain, or numbness in the lip or mouth
• Neurological problems
• Headaches
• Seizures
• Vision changes
• Hearing changes
• Drooping of the face
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• Skin changes
• A flesh-colored lump that bleeds or turns scaly
• A new mole or a change in an existing mole
• A sore that does not heal
• Jaundice (yellowing of the skin and whites of the eyes)
• Swelling or lumps anywhere such as in the neck, underarm, stomach,
and groin
• Weight gain or weight loss for no known reason
 Cancer staging AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Based on the size or extent of the primary (main) tumor and whether it has
spread to other areas of the body.
• Summary staging (in situ, local, regional, and distant) is used for descriptive
and statistical analysis of tumor registry data.
• Cancer cells are present only in the layer of cells where they developed and
have not spread, the stage is in situ.
• If penetrated beyond the original layer of tissue, the cancer is invasive and
categorized as local, regional, or distant stage based on the extent of spread
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 TNM staging AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Assesses tumors in three ways:

– extent of the primary tumor (T)
– Absence or presence of regional lymph node involvement (N)
– Absence or presence of distant metastases (M).

Once the T, N, and M categories are determined, a stage of 0, I, II,

III, or IV is assigned,
– stage 0 - in situ,
– stage I - early
– stage IV - the most advanced disease.

• Some cancers have alternative staging systems (e.g.,

leukemia).
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 Treatment AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Types: Surgery, chemotherapy, radiation therapy,

targeted therapy, immunotherapy, hyperthermia,
stem cell transplant, photodynamic therapy,
lasers, blood product donation and transfusion
• Complementary and Alternative Medicine: dietary
supplements; mind, body and spirit; herbs,
vitamins and minerals
• Palliative or Supportive Care: focuses on helping
patients get relief from symptoms caused by
serious illness – things like nausea, pain, fatigue,
or shortness of breath
 Side Effects AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Physical: Chemotherapy/Radiation effects; pain; nausea & vomiting; fatigue;

anemia; lymphedema; infection; fertility and sexual side effects
• Emotional: distress, anxiety, fear and depression, coping with loss of a loved
one

Source: American Cancer Society:

http://www.cancer.org/treatment/treatmentsandsideeffects/emotionalsid
eeffects/attitudes-and-cancer
 Costs of cancer AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Hidden costs of cancer: health insurance premiums and

nonmedical expenses (transportation, child or elder care,
housekeeping assistance, wigs, etc.)
• Cancer has the most devastating economic impact of any cause
of death in the world
• Worldwide economic costs of cancer: $895 billion (US)
• Cancer cost the United States an estimated $263.8 billion in
medical costs and lost productivity in 2010 (National Institutes of
Health)
• With the growth and aging of the population, prevention efforts
are important to help reduce new cancer cases, human
suffering, and economic costs

• Source: ACS: Global cancer facts & figures 2nd edition

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• The costs of direct medical care for cancer: estimated to

account for 5% of national health care spending
• UnitedHealthcare, estimated that 11 percent of its costs are
for cancer care (IOM, 2013).
• National expenditures for cancer care
– $72 billion in 2004
– $125 billion in 2010
– Estimated to increase to $158 billion in 2020
 ACA AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Expand public coverage by removing the Medicaid eligibility categories and

raising the income threshold.
• Allow all non-elderly, non-disabled citizens, and legal U.S. residents with
family incomes below 133 percent of the federal poverty level (FPL), or about
$30,000 per year for a family of four, to be eligible for Medicaid benefits.
• Extends coverage to low-income, childless adults, providing them with access
to preventive care such as colon and breast cancer screenings
• Anticipated that more people with cancer can be diagnosed and treated at an
earlier stage, thus increasing their chance for survival.
 Effective Cancer Prevention AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Reduced risk by:_

– avoiding tobacco
– limiting alcohol use
– limiting exposure to ultraviolet rays from the sun and
tanning beds
– eating a diet rich in fruits and vegetables
– maintaining a healthy weight
– being physically active
– seeking regular medical care
• Screening: cervical, breast and colorectal cancers
• Vaccine: HPV, Hepatitis B
– Source: CDC
Guidelines for the Early Detection of Cancer AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Breast cancer
– Yearly mammograms starting at age 40 and continuing for as
long as a woman is in good health
– Clinical breast exam (CBE) about every 3 years for women in
their 20s and 30s and every year for women 40 and over
– Breast self-exam (BSE) is an option for women starting in their
20s
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 Colorectal cancer and polyps AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Beginning at age 50, both men and women should follow

one of these testing schedules:
• Tests that find polyps and cancer
– Flexible sigmoidoscopy every 5 years
– Colonoscopy every 10 years
– Double-contrast barium enema every 5 years
– CT colonography (virtual colonoscopy) every 5 years
• Tests that primarily find cancer
– Yearly fecal occult blood test (gFOBT)
– Yearly fecal immunochemical test (FIT) every year
– Stool DNA test (sDNA)***
 Lung cancer AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• If you meet all of the following criteria, might be a

candidate for screening:
– 55 to 74 years of age
– In fairly good health
– Have at least a 30 pack-year smoking history AND are either
still smoking or have quit smoking within the last 15 years
 Prostate cancer AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Starting at age 50, men should talk to a doctor about the pros and cons of
testing so they can decide if testing is the right choice for them.
• If they are African American or have a father or brother who had prostate
cancer before age 65, men should have this talk with a doctor starting at age
45.
• If men decide to be tested, they should have the PSA blood test with or
without a rectal exam.
• How often they are tested will depend on their PSA level.
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Understanding Cancer
Prognosis
If one have cancer, may have questions about how
serious the cancer is and your chances of survival.
The estimate of how the disease will go for you is
called prognosis. It can be hard to understand
what prognosis means and also hard to talk
about, even for doctors.
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Many Factors Can Affect Prognosis

Some of the factors that affect prognosis include:

• The type of cancer and where it is in the body
• The stage of the cancer, which refers to the size of the cancer
and if it has spread to other parts of your body
• The cancer’s grade, which refers to how abnormal the
cancer cells look under a microscope. Grade provides clues
about how quickly the cancer is likely to grow and spread.
• Certain traits of the cancer cells
• age and how healthy one was before cancer
• How one’s body respond to treatment
.
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Understanding Statistics About Survival

Doctors estimate prognosis by using statistics that researchers have collected
over many years about people with the same type of cancer. Several types of
statistics may be used to estimate prognosis. The most commonly used
statistics include:

• Cancer-specific survival
This is the percentage of patients with a specific type and stage of cancer
who have not died from their cancer during a certain period of time
after diagnosis. The period of time may be 1 year, 2 years, 5 years, etc., with
5 years being the time period most often used. Cancer-specific survival is
also called disease-specific survival. In most cases, cancer-specific survival is
based on causes of death listed in medical records.
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• Relative survival
This statistic is another method used to estimate cancer-specific survival that
does not use information about the cause of death. It is the percentage of
cancer patients who have survived for a certain period of time after diagnosis
compared to people who do not have cancer.

• Overall survival
This is the percentage of people with a specific type and stage of cancer who
have not died from any cause during a certain period of time after diagnosis.

• Disease-free survival
This statistic is the percentage of patients who have no signs of cancer during
a certain period of time after treatment. Other names for this statistic are
recurrence-free or progression-free survival.
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A National Action Plan for Cancer Survivorship

• Achieve the cancer survivorship-related objectives in Healthy People 2010 that include benchmarks for
success in measuring improvements for addressing ongoing survivor needs.
• Increase awareness among the general public, policy makers, survivors, providers, and others of cancer
survivorship and its impact.
• Establish a solid base of applied research and scientific knowledge on the ongoing physical, psychological,
social, spiritual, and economic issues facing cancer survivors.
• Identify appropriate mechanisms and resources for ongoing surveillance of people living with, through, and
beyond cancer.
• Establish or maintain training for health care professionals to improve delivery of services and increase
awareness of issues faced by cancer survivors.
• Implement effective and proven programs and policies to address cancer survivorship more comprehensively.
• Ensure that all cancer survivors have adequate access to high-quality treatment and other post-treatment
follow-up services.
• Implement an evaluation methodology that will monitor quality and effectiveness of the outcomes of initiatives.
 Translational Researches AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Intervention Research: Accelerating the Translation of Knowledge to Improve

Cancer Related Fatigue Outcomes
• The Reflected Light of Steve Jobs: A Brighter Future for Pancreatic Cancer
• Viruses, Bacteria, and Cancer, or It’s Not All Smoke and Sunlight
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Understanding the Difference Between Cure and

Remission
• Cure means that there are no traces of cancer after treatment and the
cancer will never come back.
• Remission means that the signs and symptoms of cancer are reduced.
Remission can be partial or complete. In a complete remission, all signs and
symptoms of cancer have disappeared.
• If one remain in complete remission for 5 years or more, some doctors may
say that you are cured. Still, some cancer cells can remain in your body for
many years after treatment. These cells may cause the cancer to come back
one day. For cancers that return, most do so within the first 5 years after
treatment. But, there is a chance that cancer will come back later. For this
reason, doctors cannot say for sure that one is cured. The most they can say
is that there are no signs of cancer at this time.
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• http://www.youtube.com/watch?v=l3XeurTFcy4&feature=youtu.be