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| {{otheruses}} | |||
| ]; cancer cells, however, avoid apoptosis.]] | |||
| '''Cancer''' is a group of diseases characterized by uncontrolled ] division and the ability of these cells to invade other ] and spread to other areas of the body where the cells are not normally located (]). Cancer is caused by damage to ] (genetic material) through ] and ], leading to aberrant growth ] of cells. | |||
| Cell multiplication (''proliferation'') is a normal physiologic process that occurs in almost all tissues and under many circumstances, such as response to injury, immune responses, or to replace cells that have ] or have been shed as a part of their lifecycle (in tissues such as ] or the ] of the ]). Normally the balance between proliferation and cell death is tightly regulated to ensure the integrity of organs and ]. Mutations in ] that lead to cancer appear to disrupt these orderly processes. | |||
| The uncontrolled and often rapid proliferation of cells can lead to either a ] ] or a ] tumor (cancer). Benign tumors do not spread to other parts of the body or invade other tissues, and they are rarely a threat to life. Malignant tumors can invade other organs, spread to distant locations (]) and become life-threatening. | |||
| ==Signs and symptoms== | |||
| While advanced cancer may cause ], it is not always the first symptom. Roughly, cancer symptoms can be divided into three groups: | |||
| * ''Local symptoms'': unusual swelling ('']'' in ] means swelling), ] (bleeding), ]ation or ]. | |||
| * ''Symptoms of ] (spreading)'': enlarged ]s, ] and ], ] (enlarged ]), bone pain, ] of affected bones and ] symptoms. | |||
| * ''Systemic symptoms'': ], ] and ] (wasting), excessive ] (]), ], and specific ], i.e. specific conditions that are due to an active cancer, such as ] or hormonal changes. | |||
| Every single item in the above list has a substantial ] (it may be associated with unrelated diseases). Often, cancer is an unexpected finding during investigation for much more common symptoms, while others are diagnosed through ] (see below). | |||
| ==Types of cancer== | |||
| Cancers originate within a single cell. Hence, cancers can be classified by the type of cell in which it originates and by the location of the cell. | |||
| ]s originate in ]s, e.g. ], ] or ]s. ] starts in the ] ]s. ] is a cancer originating in ]. ] arises in ]s. ] begins in the ] of ] or ]. ] begins within ]s. | |||
| ===Adult cancers=== | |||
| Adult cancers are usually formed in epithelial tissues and are believed often to be the result of a long biological process related to the interaction of exogenous exposures with genetic and other endogenous characteristics among susceptible people. Examples include: ], ] (and ]) - ], ], ], ], ], ], ], ], ], ] - in the ], ], ], or ], ], ] - in the ], ] - in the ], ] (GIST), ], ], ] - in the ] or ], ], ] - in ]s, ], ], ], ] - in the ]s, ] - in ]s, ] (including benign ]), ], ], and ]. | |||
| ===Childhood cancers=== | |||
| Cancer can also occur in young children, particularly infants. Here, the aberrant genetic processes that fail to safeguard against the clonal proliferation of cells with unregulated growth potential occur very early in life and progress very quickly. | |||
| The age of peak incidence of cancer in children occurs during the first year of life. ] is the most common infant malignancy, followed by the ]s and the central nervous system cancers. Female infants and male infants have essentially the same overall cancer incidence rates, but white infants have substantially higher cancer rates than black infants for most cancer types. Relative survival for infants is very good for neuroblastoma, ] and ], but not for most other types of cancer. Childhood cancers include, from most frequently occurring to least: ], ], central nervous system, ], ], germ cell, ]s, hepatic, ]s (such as ]), epithelial. | |||
| ==Diagnosing cancer== | |||
| ===Biopsy=== | |||
| A ] leads to the definitive diagnosis of most malignancies. It requires the removal of cells and/or pieces of tissue for examination by a ]. The tissue diagnosis indicates the type of cell that is proliferating, its severity (degree of ]), its extent and size, and - sometimes with help from ] and ] - prognostic and therapeutic determinants. | |||
| Biopsy can be curative if the whole lesion is removed; in this case, the borders of the sample are examined closely to see if all malignant tissue has truly been excised. | |||
| The nature of the biopsy depends on the organ that is sampled. Many biopsies (such as those of the skin, breast or liver) can happen on an outpatient basis. Biopsies of other organs are performed under ] and require ]. | |||
| ===Screening=== | |||
| Cancer screening is the widespread uses of tests to detect cancers in the population. It is often an inexpensive, noninvasive procedure. If signs of cancer are detected, more definitive and invasive followup tests are performed to confirm the diagnosis. | |||
| Screening for cancer can lead to earlier diagnosis. Early diagnosis may lead to extended life. A number of different screening tests have been developed. Colon cancer can be detected through ]ing and ], which reduces both colon cancer incidence and mortality, presumably through the detection and removal of precancerous polyps. Similarly, cervical cytology testing (using the ]) leads to the identification and excision of precancerous lesions. Over time, such testing has been followed by a dramatic reduction of ] incidence and mortality. Breast cancers can be detected by ] and regular screening ]s. ] – is recommended for men from the age of 15 years to detect ]. Prostate cancer can be screened for by a ] along with annual ] blood testing. | |||
| Screening for cancer is controversial in cases when it is not yet known if this test actually saves lives. The controversy arises when it is not clear if the benefits of screening outweigh the risks of follow-up diagnostic tests and cancer treatments. For example: when screening for ], the ] test may detect small cancers that would never become life threatening, but once detected will lead to treatment. This situation, called ], puts men at risk for complications from unnecessary treatment such as surgery or radiation. Followup procedures used to diagnose prostate cancer (]) may cause side effects, including bleeding and infection. Prostate cancer treatment may cause ] (inability to control urine flow) and ] (erections inadequate for intercourse). For these reasons, it is important that the benefits and risks of diagnostic procedures and treatment be taken into account when considering whether to undertake cancer screening. | |||
| Use of ] to search for cancer in people without clear symptoms is similarly marred with problems. There is a significant risk of detection of an ] - a benign lesion that may be interpreted as a malignancy and be subjected to potentially dangerous investigations. | |||
| ==Causes and pathophysiology== | |||
| ===Molecular biology=== | |||
| ''Carcinogenesis'' (meaning literally, the creation of cancer) is the process of derangement of the rate of ]. | |||
| ] | |||
| Cancer is, ultimately, a disease of ]s. Typically, a series of several ]s is required before a cell becomes a cancer cell. The process involves both ]s and ]s. Oncogenes promote cancer when "switched on" by a mutation, whereas ]s prevent cancer unless "switched off" by a mutation. ], such as the ], is a special type of mutation and may involve oncogenes or tumor suppressor genes. In general, mutations in both types of genes are necessary, as a mutation limited to an oncogene would be suppressed by normal mitosis control. | |||
| Mutations can have various causes. Particular causes have been linked to specific types of cancer. ] is associated with ]. Prolonged exposure to ], particularly ] from the ], leads to ] and other skin malignancies. Breathing ] fibers is associated with ]. In more general terms, chemicals called ]s and ]s are known to cause mutations. Chronic ] may induce malignancy, as ]s secrete free radicals. | |||
| Mutations can also be inherited. Inheriting certain mutations in the ] gene renders a woman much more likely to develop ] and ]. | |||
| Some types of viruses can cause mutations. They play a role in about 15% of all cancers. ''Tumor viruses'', such as some ]es, ]es and ]es, usually carry some oncogene or tumor suppressor inactivating gene in their ]. | |||
| It is impossible to tell the initial cause for any specific cancer. However, with ], it is now possible to characterize the mutations within a tumor, and to a certain extent predict its behavior. For example, up to half the tumors are deficient in the ] ], also known as "the guardian of the genome". This mutation is associated with poor ], since those tumor cells are less likely to go into ] (]) when damaged by therapy. There are more mutations that make a tumor more malignant. ] mutations remove additional barriers, extending the number of times a cell can divide. Other mutations enable the tumor to ] to feed it, or to detach from the surrounding tissue, spreading to other parts of the body. | |||
| Malignant tumors cells, such as in ], ], ] or ], have distinct properties: | |||
| * evading ] | |||
| * unlimited growth potential (immortalitization) | |||
| * self-sufficiency of ]s | |||
| * insensitivity to anti-growth factors | |||
| * increased ] rate | |||
| * altered ability to ] | |||
| * no ability for ] | |||
| * ability to invade neighbouring ]s | |||
| * ability to build ] at distant sites | |||
| * ability to promote blood vessel growth (]) | |||
| A cell that degenerates into a tumor cell does usually not acquire all these properties at once, but its descendant cells are ] to build them. This process is called ]. A first step in the development of a tumor cell is usually a small change in the DNA, often a ], which leads, among other things, to a genetic instability of the cell. The instability increases to a point where the cell loses whole ]s, or has double ones. Also, the ] pattern of the cell changes, activating and deactivating ]s more or less at random. Cells that divide at a high rate, such as ]s, show a higher risk of becoming tumor cells than those which divide less, for example ]s. | |||
| In ''cellular model systems'', cells are exposed to carcinogenic influences (chemicals, radiation). In these systems, the first signs of a cell developing into a tumor cell are: | |||
| # Immortality. The usual number of cell divisions for a mammalian cell is 50-60 (]), then it ceases to divide. Tumor cells keep dividing forever. | |||
| # Altered ]. | |||
| # Building of cellular clusters (''foci''). | |||
| # Loss of ]. | |||
| # Low or no need for ]s. | |||
| Items 2-4 (above) can sometimes be traced to mutations in genes that result in a disruption of ]. Some cell adhesion proteins are ]s. | |||
| ===Morphology=== | |||
| ] | |||
| Cancer tissue has a distinctive appearance under the ]. Among the distinguishing traits are a large number of dividing cells, variation in ] size and shape, variation in cell size and shape, loss of specialized cell features, loss of normal tissue organization, and a poorly defined tumor boundary. | |||
| Instead of finding a benign or malignant tumor, microscopic examination of a biopsy specimen will sometimes detect a condition called "hyperplasia". ] refers to tissue growth based on an excessive rate of cell division, leading to a larger than usual number of cells. Nonetheless, cell structure and the orderly arrangement of cells within the tissue remain normal, and the process of hyperplasia is potentially reversible. Hyperplasia can be a normal tissue response to an irritating stimulus. For example, a ] that may form on your hand when you first learn to swing a tennis racket or a golf club is produced by hyperplasia. | |||
| In addition to hyperplasia, microscopic examination of a biopsy specimen can detect another type of noncancerous condition called "dysplasia." ] is an abnormal type of excessive cell proliferation characterized by loss of normal tissue arrangement and cell structure. Often such cells revert back to normal behavior, but occasionally, they gradually become malignant. Because of their potential for becoming malignant, areas of dysplasia should be closely monitored by a health professional. Sometimes they need treatment. | |||
| The most severe cases of dysplasia are sometimes referred to as "]." In Latin, the term "in situ" means "in place", so carcinoma in situ refers to an uncontrolled growth of cells that remains in the original location. However, carcinoma in situ may develop into an invasive, metastatic malignancy and, therefore, is usually removed surgically, if possible. | |||
| ===Heredity=== | |||
| Most forms of cancer are "sporadic", and have no basis in heredity. There are, however, a number of recognised ]s of cancer with a hereditary component. Examples are: | |||
| * ] and ] in female carriers of ] | |||
| * tumors of various endocrine organs in ] (MEN types 1, 2a, 2b) | |||
| * ] (various tumors such as ], breast cancer, ], ]s) due to mutations of ] | |||
| * ] (]s and colonic polyposis) | |||
| * ] an inherited mutation of the ''APC'' gene that leads to early onset of ]. | |||
| ===Environment and diet=== | |||
| ] | |||
| The most consistent finding, over decades of research, is the strong association between ] use and cancers of many sites. Hundreds of epidemiologic studies have confirmed this association. Further support comes from the fact that ] death rates in the United States have mirrored ] patterns, with increases in smoking followed by dramatic increases in lung cancer death rates and, more recently, decreases in smoking followed by decreases in lung cancer death rates in men. Up to half of all cancer cases can be attributed to smoking, diet, and environmental pollution. | |||
| ]s. Source:NIH.]] | |||
| ==Treatment of cancer== | |||
| Cancer can be treated by ], ], ], ] or other methods. The choice of therapy depends upon the location and grade of the tumor and the stage of the disease. | |||
| ===Surgery=== | |||
| If the tumor is localized, ] is often the preferred treatment. Example procedures include ] for breast cancer and ] for prostate cancer. The goal of the surgery can be either the removal of only the tumor, or the entire organ. Since a single cancer cell can grow into a sizeable tumor, removing only the tumor leads to a greater chance of recurrence. A margin of healthy tissue is often resected to make sure all cancerous tissue is removed. | |||
| In addition to removal of the primary tumor, surgery is often necessary for staging, e.g. determining the extent of the disease and whether there has been ] to regional ]s. Staging determines the prognosis and the need for adjuvant therapy. | |||
| Occasionally, surgery is necessary to control symptoms, such as ] or ]. | |||
| ===Chemotherapy=== | |||
| ] is the treatment of cancer with ] ("anticancer drugs") that can destroy cancer cells. It interferes with ] in various possible ways, e.g. with the duplication of ] or the separation of newly formed ]s. Most forms of chemotherapy target all rapidly dividing cells and are not specific for cancer cells. Hence, chemotherapy has the potential to harm healthy tissue, especially those tissues that have a high replacement rate (e.g. intestinal lining). These cells usually repair themselves after chemotherapy. | |||
| Because some drugs work better together than alone, two or more drugs are often given at the same time. This is called ]; most chemotherapy regimens are given in a combination. | |||
| ===Radiation therapy=== | |||
| ] (also called radiotherapy, X-ray therapy, or irradiation) is the use of a certain type of energy (called ]) to kill cancer cells and shrink tumors. Radiation therapy injures or destroys cells in the area being treated (the "target tissue") by damaging their genetic material, making it impossible for these cells to continue to grow and divide. Although radiation damages both cancer cells and normal cells, most normal cells can recover from the effects of radiation and function properly. The goal of radiation therapy is to damage as many cancer cells as possible, while limiting harm to nearby healthy tissue. | |||
| Radiation therapy may be used to treat almost every type of solid tumor, including cancers of the brain, breast, cervix, larynx, lung, pancreas, prostate, skin, spine, stomach, uterus, or soft tissue sarcomas. Radiation can also be used to treat leukemia and lymphoma (cancers of the blood-forming cells and lymphatic system, respectively). Radiation dose to each site depends on a number of factors, including the type of cancer and whether there are tissues and organs nearby that may be damaged by radiation. | |||
| ===Immunotherapy=== | |||
| ] is the use of the ] against tumors. These are used in various forms of cancer, such as ] (]) but also in ] (]). The agents are ] directed against proteins that are characteristic to the cells of the cancer in question, or ]s that modulate the immune system's response. | |||
| ===Clinical trials=== | |||
| ]s, also called research studies, test new treatments in people with cancer. The goal of this research is to find better ways to treat cancer and help cancer patients. Clinical trials test many types of treatment such as new drugs, new approaches to surgery or radiation therapy, new combinations of treatments, or new methods such as ]. | |||
| A clinical trial is one of the final stages of a long and careful cancer research process. The search for new treatments begins in the laboratory, where scientists first develop and test new ideas. If an approach seems promising, the next step may be testing a treatment in animals to see how it affects cancer in a living being and whether it has harmful effects. Of course, treatments that work well in the lab or in animals do not always work well in people. Studies are done with cancer patients to find out whether promising treatments are safe and effective. | |||
| The patients who take part may be helped personally by the treatment(s) they receive. They get up-to-date care from cancer experts, and they receive either a new treatment being tested or the best available standard treatment for their cancer. Of course, there is no guarantee that a new treatment being tested or a standard treatment will produce good results. New treatments also may have unknown risks, but if a new treatment proves effective or more effective than standard treatment, study patients who receive it may be among the first to benefit. | |||
| ===Experimental cancer treatments=== | |||
| ''Main article: ].'' | |||
| There are several experimental treatments under research, including: | |||
| * ] use drugs which prevent tumor to generate new blood ]s, without them the tumor cells die. | |||
| * ] use anaerobic bacteries which destroy the central part of a tumor, while the external part of a tumor is destroyed by chemotherapy. | |||
| * ] introduces into tumor cells genes which arrest or slows down the tumor growth or makes the cells susceptible to some chemical agents. | |||
| * ] destroys tumor by heating it. | |||
| ===Complementary and alternative medicine=== | |||
| ] (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Many patients experience benefit from these modalities, but many have not been scientifically proven. Almost all physicians would recommend against using these modalities as a sole treatment for potentially fatal conditions such as cancer. In the United States, current trials are underway to test the following: | |||
| * ] to reduce the symptoms of advanced ], | |||
| * combination ] plus ] with or without ] in the treatment of patients who have ] that cannot be removed by ], | |||
| * ] with ] patients (people who have had an operation to remove all or part of the larynx (voice box)), | |||
| * ] for cancer-related fatigue, | |||
| * chemotherapy compared with ] plus specialized diet for the treatment of ], and | |||
| * ] and chemotherapy for the treatment of solid tumors. | |||
| * Identifying areas of ] and correcting them. | |||
| ==Prevention== | |||
| Cancer prevention is defined as the reduction of cancer ] via reduction in the incidence of cancer. This can be accomplished by avoiding a ] or altering its ]; pursuing lifestyle or dietary practices that modify cancer-causing factors or ]; and/or medical intervention (chemoprevention) to successfully treat ] lesions. | |||
| Much of the promise for cancer prevention comes from observational epidemiologic studies that show associations between modifiable life style factors or environmental exposures and specific cancers. Evidence is now emerging from randomized controlled trials designed to test whether interventions suggested by the epidemiologic studies, as well as leads based on laboratory research, result in reduced cancer incidence and mortality. | |||
| Additional examples of modifiable cancer risk factors include ] consumption (associated with increased risk of oral, esophageal, breast, and other cancers), physical inactivity (associated with increased risk of colon, breast, and possibly other cancers), and being overweight (associated with colon, breast, endometrial, and possibly other cancers). Based on epidemiologic evidence, it is now thought that avoiding excessive alcohol consumption, being physically active, and maintaining recommended body weight, may all contribute to reductions in risk of certain cancers; however, compared with tobacco exposure, the magnitude of effect is modest or small and the strength of evidence is often weaker. Other lifestyle and environmental factors known to affect cancer risk (either beneficially or detrimentally) include certain sexual and reproductive practices, the use of exogenous estrogens, exposure to ionizing radiation and ultraviolet radiation, certain occupational and chemical exposures, and infectious agents. | |||
| Food and nutrient intake have been examined in relation to many types of cancer. Fruit and vegetable consumption have generally been found in epidemiologic studies to be associated with reduced risk for a number of different cancers; however, it is not currently known which specific components of fruits and vegetables are responsible for the observed associations or if healthy diets are simply associated with other beneficial interventions, e.g., exercise. Contrary to expectation, randomized trials found no benefit of ] supplementation in reducing lung cancer incidence and mortality; risk of lung cancer was statistically significantly increased in smokers in the beta-carotene arms of 2 of the trials. Similarly, randomized controlled trials have found no reduction in risk of subsequent adenomatous polyps of the colon in individuals who have had polyps resected taking ] supplements compared with those receiving much lower amounts of supplemental ] fiber. On the other hand, there is evidence from at least 1 randomized controlled trial that calcium supplementation does modestly reduce risk of adenoma recurrence. The "chemoprevention database" gives results of all published randomized controlled trials. Consumption of red meat and inadequate ] intake have also been associated with increased risk of ]. A large randomized trial is currently underway to investigate whether men taking daily ] or ] or both experience a reduced incidence of ] in comparison to men taking ] pills. | |||
| Daily use of ], a selective ] modulator, for up to 5 years, has been demonstrated to reduce the risk of developing ] in high-risk women by about 50%. ] also has been shown to reduce risk of second primary tumors among patients with primary ]. ], a ], has been shown to lower the risk of prostate cancer. Other examples of drugs that show promise for chemoprevention include ] (which inhibit a ] enzyme involved in the synthesis of proinflammatory ]s). | |||
| Considerable research effort is now devoted to the development of ]s (to prevent infection by oncogenic infectious agents, as well as to mount an immune response against cancer-specific epitopes) and to potential venues for ] for individuals with genetic mutations or polymorphisms that put them at high risk of cancer. Meanwhile, genetic testing for high-risk individuals, with enhanced surveillance or prophylactic surgery for those who test positive, is already available for certain types of cancer, including breast and colon cancer. | |||
| ==Coping with cancer== | |||
| There are many local organizations that offer a variety of practical and support services to people with cancer. Support can take the form of ], ], advice, financial assistance, transportation to and from treatment, or information about cancer. Neighborhood organizations, local health care providers, or area hospitals are a good place to start looking. | |||
| While some people are reluctant to seek counseling, studies show that having someone to talk to reduces stress and helps people both mentally and physically. Counseling can also provide emotional support to cancer patients and help them better understand their illness. Different types of counseling include individual, group, family, self-help (sometimes called peer counseling), bereavement, patient-to-patient, and sexuality. | |||
| Many governmental and charitable organizations have been established to help patients cope with cancer. These organizations often are involved in cancer prevention, cancer treatment, and cancer research. Examples include: ], ], ], ], ], ] (US), and ]. | |||
| ==Social impact== | |||
| Cancer has a reputation for being a deadly disease. While this certainly applies to certain particular types, this is otherwise a generalization. Some types of cancer have a prognosis that is substantially better than nonmalignant diseases such as ] and ]. Nonetheless, in the late 1990's cancer overtook heart disease as the leading cause of death in the United Kingdom{{fn|1}}, and in 2002 the same happened in the United States{{fn|2}}. | |||
| Progessive and disseminated malignant disease has a substantial impact on a cancer patient's quality of life, and many cancer treatments (such as ]) may have severe side-effects. In the advanced stages of cancer, many patients need extensive care, affecting family members and friends. ] solutions may include permanent or "respite" ] nursing. | |||
| ==Cancer research== | |||
| ] is the intense scientific effort to understand disease processes and discover possible therapies. While understanding of cancer has ] since the last decades of the 20th century, radically new therapies are only discovered and introduced gradually. Inhibitors of tyrosine kinases (] and ]) in the late 1990 were considered a major breakthrough; these interfere specifically with tumor-specific proteins. | |||
| ==See also== | |||
| {{wiktionary}} | |||
| {{Commons|Cancer (illness)}} | |||
| * ] | |||
| * ] | |||
| * ] | |||
| * ] | |||
| ==References== | |||
| *{{fnb|1}} (9 November, 2000). ''BBC News online''. Retrieved 2005-01-29. | |||
| *{{fnb|2}} Marilynn Marchione (20 January, 2005). ''Associated Press appearing in The Arizona Republic online''. Retrieved 2005-01-29. | |||
| *, National Cancer Institute Fact Sheet. | |||
| *, National Cancer Institute Fact Sheet. | |||
| *, National Cancer Institute Fact Sheet. | |||
| *, National Cancer Institute Fact Sheet. | |||
| *, National Cancer Institute. | |||
| *Ries LAG, Smith MA, Gurney JG, Linet M, Tamra T, Young JL, Bunin GR (eds). Cancer Incidence and Survival among Children and Adolescents: United States SEER Program 1975-1995, National Cancer Institute, SEER Program. NIH Pub. No. 99-4649. Bethesda, MD, 1999. Chapter XII , James G. Gurney, Malcolm A. Smith, and Julie A. Rosa. | |||
| *, National Cancer Institute Fact Sheet. | |||
| *, National Cancer Institute. (NIH Publication No. 03-1136, PDF file) | |||
| ==External links== | |||
| {{wikicities|cancer|Cancer Help Infosite}} | |||
| * Government organization for research and treatment | |||
| * Patient advocate group | |||
| * Textbook | |||
| * - has free guidelines for professionals and many pages of quality information for patients with all types of cancers | |||
| * - purports to be "the leading charity in the field of diet, nutrition and cancer", supporting research into dietary methods for the prevention and treatment of cancer in addition to offering educational resources. | |||
| * - Association of Cancer Online Resources | |||
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Revision as of 08:40, 21 May 2005
Bold texthehehehehehehehehehehehehehehehehehehehehe