December 4, 2023

All of us have experienced the pain or have heard about people belonging to our family or the neighbourhood suffering from a cancer. When we hear the word “cancer”, some form of fear comes into our mind. This article is planned to give a basic idea about cancer and its terminologies.

Based on the statistics from ICMR (Indian Council of Medical Research) and Cancer India, as of 2020, around 2.7 million estimated people are suffering from cancer in India. Every year 13,90,000 new cancer cases get registered in India with 8,50,000 are cancer-related deaths in India. Cancers of the oral cavity, stomach and lungs account for over 25% of cancer related deaths in males every year and cancer of cervix, breast and oral cavity account for 25% cancer related deaths in females.

But what exactly is the term cancer referred to? How does a cancer in a human body behave? Friends, in the human body there are various types of cells which combine to form a tissue and the type of the cell depends on its function it has to perform. Every cell in the human body has definite life cycle and those cells are continuously generated, matured according to the requirement of the tissue function. These cells are repaired if it occurs any degeneration in the course of its maturation and later the cell get destroyed once it completes its finite life cycle. These cells are later replaced by the new matured cell and this cycle continues as long as a patient is alive. All these growth process in the cell is governed by certain enzymes, hormones or growth signals working continuously and synchronously, so that the normal function of that individual is not hampered. Everyone must have heard about the terminology “Tumour”. Tumour is basically, a cell has lost its contact or control from these growth controlling mechanisms. The cell would behave similarly how a student would behave in absence of a teacher in the class. Tumour refers to the cell which grows rapidly, in a disorganised way without responding to the growth signals generated by the relevant organ. At this juncture, this is called a benign tumour. But when a disorganised cell undergoes uncontrolled growth and starts to involve or infiltrate normal surrounding tissues is called “Malignancy” or a “Cancer”. These cancer cells hampers the normal tissue’s function and later take a control of the blood or lymphatics to spread elsewhere.

For the ease of identification of cancer, it is generally named on two terminologies. The first word would be based on the organ or the system of involvement and the second word would be origin of cells. As I had mentioned, earlier there are various cell types to form a tissue and it’s based on the function. So there are cells who function as “epithelial” cells or in simple terms external covering to the organs and human skin; soft tissue which forms an internal layers like connective tissue and finally a blood cells from blood components.

• Cancer arising from these epitheial cells are named as carcinoma.
• Soft tissue connective tissue cancers are called as sarcoma
• Cancer arising from blood cells are called leukemia/lymphoma.

After we understood this aspect, as an example, a cancer arising from oral cavity like tongue would be termed tongue carcinoma or carcinoma tongue and cancer arising from thyroid would be termed as thyroid carcinoma. Within these cancers there are further subtypes which would be too much in detail and probably in future based on the cancer, we will discuss. As we know, cancer spreads to various further sites in our body which is called as Metastasis or like how people term it as Stage 4. One might ask, how this tumour spreads to different organs of the body and is there any significance to it. My answer would be, Yes it does! As a rule and most of the occasions, all the carcinomas spreads through the lymphatics to various nodes and after few months due to extensive involvement of lymphatics it will go into the blood stream and deposit into lungs and liver. For example, tongue carcinoma initially would spread to the neck lymph nodes and then after few months to chest lymph nodes and then finally into lung. But sarcomas function differently, only few varieties spread via lymph nodes, majority of them through blood vessels. So, it’s not uncommon for the sarcoma to have early lung or liver metastasis! So, if the patient has a tongue carcinoma, then we have to treat of both tongue cancer and the neck nodes.

But how does one get a cancer? There are various causes for a normal cell to turn into a cancer. The main reason is mutation. Mutation refers to some form change in the genetic or DNA of the individual which hampers normal growth controlling mechanisms. Humans harbour various genes responsible for growth promotion, maturation, repair of defective genes or cells and then destruction of the old cells. Mutations can occur in an step either due to genetic defect or due to other causes like smoking leading to the defect in the genes. Genetic defect can lead to cancer in a particular organ or it can affect multiple organs simultaneously like Hereditary Breast and Ovarian Carcinoma as in BRCA gene, Hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome). If not genetic, there are various other causes that can lead to cancer.

• Smoking tobacco is known to cause cancer to all the body organs except ovary and prostate. Presently people smoke e-cigarettes, this is equally dangerous as the tobacco content in it, is available in an aerosol form and helps tobacco to be better absorbed in all the corners of lungs.
• Chewing tobacco in form of pan, gutkha leads to oral cavity cancers. As a tobacco cessation specialist, I would recommend all of you to discontinue any form of tobacco intake. Currently in India, tobacco is considered as the top carcinogen!
• Alcohol is another culprit. Based on the amount of consumption and duration of intake, it can affect liver, esophagus, oral cavity, larynx, stomach, colon, rectum and lead to cancer.
• Continuous intake of fast food with rich in oil and high calorie content along with reduced physical activity can lead to obesity. Obesity is known to cause esophagus, gastric, colon, rectum, liver, gall bladder, breast, ovary and renal cancer.
• People who take excessive amounts of red meat and spices in their diet are also prone to develop stomach, colon and rectum cancer.
• Individuals once affected with viral infections like Hepatitis B, Human Papilloma virus (HPV) and HIV are prone for malignancies as the virus keep multiplying their body. HIV positive individuals are prone for various skin related and blood related malignancies. Likewise, Hepatitis B can lead to liver cancer and HPV infections lead to cervical, head and neck cancer respectively.
• Women who take hormonal pills for invitro fertilization (IVF) may be prone for ovarian cancer. There are various other causes which can lead to cancer and this would be discussed in the future articles.

During initial stages, malignancies might be difficult to be detected. But, generally a person should be careful after age of 40 years where symptoms as listed below should encourage them to undergo further examination and evaluation.

• Long standing non healing ulcers in the oral cavity or in the skin or swelling in the skin which keeps increasing in size or any change.
• Swelling in the thyroid, axilla, groin, neck should be evaluated with basic ultrasound scanning and FNAC (Fine needle aspiration cytology) or biopsy to rule out cancer.
• Lumps in the breast, bloody/pus discharge from the nipple should raise suspicion of cancer.
• People having gastritis symptoms for month’s together, vomiting blood, blood in the stools, jaundice are all possible signs of gastrointestinal tract malignancies.
• Long standing cough with blood in sputum, breathlessness can occur in lung cancer.

Nowadays, many of the individuals possess health insurance which encourage to do a health check up every year. So I would suggest to avail such facilities and plan regular health check after age of 40 years. This would also serve a basic screening modality. People who have got family history of malignancy should be cautious and keep a check for those familial malignancies before 40 years of age.

Early detection of these malignancies can have good chances for cure. So it’s important to keep close vigilance on the symptoms. Usually ultrasound and CT/MRI scan can help a doctor to analyse the cancer. To assess the staging and spread to other organs usually PET-CT scan is helpful. There are several blood tests and markers based on the individual cancers which help us to during diagnosis and later follow up after completion of the treatment. Once these diagnostic tests are done, needle tests like FNAC or biopsy would be preferred where we get tissues to analyse the type of cancer and its aggressiveness. For cancers in the skin, breast, thyroid, oral cavity and lymph nodes usually FNAC or biopsy would suffice. But for the cancers in the lung, colon, stomach, rectum usually requires endoscopy based biopsy for the diagnosis.

Based on these tests, an oncologist (surgical oncologist, medical oncologist or radiation oncologist) would be able to plan the treatment for a patient. Cancer treatment is usually combined efforts of these three fields who would be able to provide individualised treatment protocol based on the symptoms and reports of the patients. So, I request you all to kindly take opinions from them to avoid any confusions and relying on any other form of treatment. There are many patients who have approached us in advanced stages after taking such treatment. It always wise to approach before complications occur or before it’s locally advanced where the cure is impossible. There is a popular proverb in Konkani, please intervene before rice could turn into a porridge.

Presently we live in an era where science and technology has made sure that almost all the malignancies can be offered a treatment. Most of cancers in the initial stages usually undergoes surgical treatment by a surgical oncologist. Presently open and key hole (laparoscopic and robotic) surgical options are available in Mangalore. Chemotherapy and immunotherapy are being provided by the medical oncologist. Earlier due to chemotherapy, the veins used to get damaged and people used to lose hair. But now, to avoid injury and damage to the veins by the chemotherapy drug, chemoport is available.

There are therapies available to reduce hair loss during chemotherapy. Facilities like focussed and advanced SRS radiotherapy options are provided by radiation oncologist, to minimise radiation induced complications. So friends, this article was aimed to provide basic idea of cancer and hopefully in future, in this space, I intend to give more insight and awareness on various cancers and their treatment options.

Thank you for patiently going through the article!