Cancer Affects Everyone

Yet more evidence of a link between the body and mind comes in a new study of elderly people with severe depression.

Those who were assigned a ‘depression coach’ were far less likely to die during the five years of the study. And, inexplicably, deaths from cancer were 60 per cent lower than the group who were given standard care for depression.

The study looked at the impact of a ‘depression coach’, or depression care manager, on elderly people with severe depression who were registered with one of 20 practices in the USA that participated in the trial.

Overall, the death rate over the five years of the trial fell by 45 per cent among those who had a personal manager, but the most impressive improvement was in the reduction of deaths from cancer, which fell from 20.6 deaths per 1000 person years to just 8.9 deaths.

Researchers are baffled by the sudden improvement. Perhaps it’s simply that the elderly had someone to talk to, and the manager gave them a reason to live.

Just a thought.

(Source: Annals of Internal Medicine, 2007; 146: 689-98).

We all know that exercise is good for us, and a gentle version of it is especially beneficial for anyone with a heart condition. But now researchers have discovered that it can also help people with cancer.

A research team put a small group of women with early-stage breast cancer through a 12-week exercise programme, which included fast walking. All the women reported greater mobility in their shoulders, and the quality of their life had improved. These improvements carried on for six months after completing the exercise programme.

But earlier studies suggest an even more exciting possibility. In a review of 48 studies, researchers found that postmenopausal women who exercised reduced their risk of breast cancer by 80 per cent, while it had a 20 per cent protective effect among women who had not reached menopause.

(Source: British Medical Journal, 2007; 334: 484-5; Epidemiology, 2007; 18: 137-157).

Women who supplement with vitamin D – or who do a little sunbathing once or twice a week – reduce their chances of developing breast cancer.

Researchers found that the vitamin, coupled with calcium, helps protect women, and especially from more aggressive breast tumours.

This was the first major human study into the protective effects of vitamin D. It was based on the findings from the Women’s Health Study, and involved 10,578 pre-menopausal, and 20,909 post-menopausal, women, whose health was monitored for 10 years.

The researchers found that the supplements’ main protective effect was among the pre-menopausal women.

(Source: Archives of Internal Medicine, 2007; 167: 1050-9).

Mobile phones may cause a cancer explosion in the years ahead, just as smoking was finally linked to lung cancer, experts have admitted this week.

At the moment nobody is sure of the impact of mobile phones on our health because people haven’t been using them long enough – but early signs are worrying.

A UK health research group has discovered an increase of brain and acoustic neuroma (ear) cancers, and the figures are almost “statistically significant”, which means the figures are nearly high enough to suggest a definite link.

The group, the UK Mobile Telecommunications and Health Research Programme (MTHRP), said it was vital to carry out more research, otherwise people were in danger of falling into the same trap when cigarettes were not initially linked to lung cancer.

Programme chairman Prof Lawrie Challis comments: “We can’t rule out the possibility at this stage that cancer could appear in a few years’ time. With smoking there was no link of any lung cancer until after 10 years.”

Cancers usually do not appear until 10 to 15 years after exposure.

Aside from the longterm concerns, Prof Challis said that mobile phones do not appear to have an immediate impact on health.

(Source: MTHRP website).

Leukaemia or blood cancer is amongst the ten most common cancers seen in India.

Cancer is an abnormal growth of cells that grow uncontrollably to form a lump or tumour. Cancer cells have two properties that make them dangerous, they can invade into neighbouring tissues, and they can spread to distant areas of the body, forming secondary tumors or metastases.

Blood is made up of plasma and three types of blood cells -

* Red Blood cells (RBC) which carries oxygen from the lung to the body tissues.

* White Blood Cells (WBC) which help in defending the body against infections.

* Platelets which help in blood clotting and control bleeding.

White blood cells are of five types - lymphocytes, granulocytes, monocytes, eosinophils and basophils. Blood cells are produced in the bone marrow in an orderly fashion and only mature cells are released.

What is Leukemia?

Leukemia or blood cancer is a cancer of the white blood cells (WBC). In leukemia a large number of white blood cells are produced in the stem cells of the bone marrow. These immature cells are incapable of normal functions. Cancer starts in the bone marrow but can spread to the blood, lymph nodes, the spleen, liver, central nervous system (the brain and spinal cord), testes (testicles), or other organs.

Leukemia can be acute (rapid growing) or chronic (slowly growing). It can further be classified as myelogenous or lymphocytic, depending on which white blood cell type is affected. Thus, the four major types of leukemia are:

* Acute Lymphocytic Leukemia (ALL) - the most common type of leukemia in young children. It also affects adults, especial those older than 65 years.

* Chronic Lymphocytic Leukemia (CLL) - most often affects adults over the age of 55. It sometimes occurs in young adults, but it almost never affects children.

* Acute Myelogenous Leukemia (AML) - occurs in both adults and children. This type of leukemia is sometimes called acute nonlymphocytic leukemia (ANLL).

* Chronic Myelogenous Leukemia (CML) - occurs mainly in adults. Very rarely children may develop this disease.

What are the signs and symptoms of Leukemia?

In leukemia the marrow is busy producing abnormal white cells and not enough red blood cells are produced resulting in anemia. Patients look pale, feel weak and tired. Reductions in number of healthy platelets cause patients to bruise and bleed easily. Leukemia cells are functionally abnormal, hence the body cannot fight infections and thus patients often get infections and fevers.

Like all blood cells, leukemia cells travel throughout the body. Depending on the number of abnormal cells and where these cells collect, patients with leukemia may have a number of symptoms. In acute leukemia, symptoms appear and get worse quickly. People with this disease visit their doctor because they feel sick.

In acute leukemia, the abnormal cells may collect in the brain or spinal cord (also called the central nervous system or CNS). The result may be headaches, vomiting, confusion, loss of muscle control and seizures. Leukemia cells also can collect in the testicles and cause swelling. Also, some patients develop swelling in the eyes or on the skin. Leukemia affects the digestive tract, kidneys, lungs or other parts of the body.

Common symptoms seen in Leukemia are:

* Tiredness and lethargy (as a result of anemia)

* Pale complexion

* Frequent, prolonged or severe infections (as a result of impaired white cell function)

* Frequent bruising and bleeding (as a result of platelet deficiency)

* Tiny red spots (called petechiae) under the skin

* Swollen or bleeding gums

* Sweating , especially at night

* Bone or joint pain

* Loss of appetite and/or weight

* Swollen or tender lymph nodes, liver, or spleen

Some of the symptoms mentioned above are quite common in everyday illnesses and do not necessarily indicate cancer. Nevertheless, it is wise to pay heed to these symptoms and seek advice from your doctor. If symptoms persist consult a specialist and get a full check up done. Early detection gives the best chance of cure.

How is Leukemia diagnosed?

When we visit a doctor with a problem, the doctor first listens to our complaints in detail and then examines us. In some cases it may be very easy to rule out cancer, using this simple measure but at other times, the doctor recommends tests to be carried out to enable him to confirm or disprove his suspicion.

After history taking and clinical examination, routine examination of the blood, urine, and stool is often the starting point. Depending on circumstances of the case, the doctor may then also recommend other special tests.

The only way to make the diagnosis of cancer is to examine cells or tissues from the suspected lesion under a microscope. Merely establishing the diagnosis of cancer is not enough to select appropriate treatment.

Although a simple blood smear examination may reveal that a patient has leukemia, it may not show what type of leukemia it is. To check further for leukemia cells or to decide the type of leukemia, the doctor examines a sample of bone marrow under a microscope. The doctor withdraws the sample by inserting a needle into a large bone (usually the hip) and removing a small amount of liquid bone marrow. This procedure is called bone marrow aspiration. A bone marrow biopsy is performed with a larger needle and removes a small piece of bone and bone marrow.

If leukemia cells are found in the bone marrow sample, the doctor orders other tests to find out the extent of the disease. A spinal tap (lumbar puncture) checks for leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord (cerebrospinal fluid). Chest X-rays can reveal signs of disease in the chest.

How is Leukemia treated?

Treatment for leukemia is complex. The treatment depends not only on the type of leukemia, but also on certain features of the leukemia cells, the extent of the disease, and whether the leukemia has been treated before. It also depends on the patient's age, symptoms and general health.

The aim of treatment for acute leukemia is cure. Complete remission means no evidence of cancer. The primary treatment for acute leukemia is chemotherapy. Radiation therapy may be used in certain cases. Presently in some cases bone morrow transplantation is also done.

Chronic leukemia patients who do not have symptoms may not require immediate treatment. However, they should have frequent checkups to see how the disease is progressing. Treatment can often control the disease and its symptoms. However, chronic leukemia can seldom be cured.

Chemotherapy is treatment of cancer by drugs. Cancer chemotherapy employs cytotoxic drugs capable of arresting fast cellular growth. Chemotherapy also affects other fast growing normal cells in the body. Anti cancer drugs are normally given by injection into a vein. Chemotherapy is also given into the muscle, under the skin, cerebrospinal fluid (CSF), or taken by mouth. The treatment is given in cyclic form once in 3 to 4 weeks or weekly regimens to allow for adequate recovery of normal tissues and to ensure that cancer cells are killed at the same time. In general, AML treatment will use higher doses of chemotherapy over a shorter period of time, and ALL will take chemotherapy over a longer period of time.

Bone Marrow Transplant

Bone marrow transplantation is a newer type of treatment. First, high doses of chemotherapy with or without radiation therapy are given to destroy all of the bone marrow in the body. Healthy marrow is then taken from another person (a donor) whose tissue is the same as or almost the same as the patient's. The donor may be a twin (the best match), a brother or sister, a parent or another person not related. The healthy marrow from the donor is given to the patient through a needle in a vein, and the marrow replaces the marrow that was destroyed. It is a very complicated and costly procedure. The procedure is reserved for relapsed cases or very aggressive cases.

There are generally four phases of treatment for acute leukemia. The first phase uses chemotherapy to kill as many of the leukemia cells as possible to cause the cancer to go into remission. Once a patient goes into remission and there are no signs of leukemia, a second phase of high-dose chemotherapy is given to attempt to kill any remaining leukemia cells. The third phase is preventive therapy, here high-dose systemic chemotherapy is given to the central nervous system (CNS) to kill any leukemia cells present there, or to prevent the spread of cancer cells to the brain and spinal cord, even if no cancer has been detected there. Radiation therapy to the brain may also be given, in addition to chemotherapy, for this purpose. The fourth phase of treatment uses chemotherapy for 2 years to maintain the remission.

Leukemia and its treatment can cause a number of complications and side effects. Patients need supportive care to prevent or control these problems and to improve their quality of life during treatment. Because leukemia patients get infections very easily, they may receive antibiotics and other drugs to help protect them from infections.

Anemia and bleeding are other problems that often require supportive care. Transfusions of red blood cells may be given to help reduce the shortness of breath and fatigue that anemia can cause. Platelet transfusions can help reduce the risk of serious bleeding. Leukemia and chemotherapy can make the mouth sensitive, easily infected and likely to bleed. Doctors often advise patients to have a complete dental exam before treatment begins.

What will happen after treatment for leukemia?

Every leukemia patient needs close monitoring following treatment. This is referred to as "follow-up". Follow-up is an integral part of cancer treatment and is usually done by physical examination, blood examination, x-ray tests. Cancer patients need life long follow-up. Cancer treatment is never complete theoretically because cancer can occur at the primary site or anywhere else in the body at a later date. For several years after treatment, regular follow-up examination will be very important. The doctors will continue to watch for signs of disease, as well as for short-term and long-term side effects of treatment.

Can leukemia be prevented?

Although many cancers of adults can be prevented by lifestyle changes, which reduce certain risk factors, there is currently no known way to prevent childhood cancers, particularly leukemia.

Are there any tests for early detection of leukemia?
At present, there are no special tests recommended for the early detection of leukemia. The best policy for early diagnosis is prompt attention to the signs and symptoms of this disease. Close follow-up is important for children with a known genetic abnormality which might increase their risk of leukemia, children who have had another cancer treated with chemotherapy or combined chemotherapy and radiation therapy and children who have received organ transplants and are taking immune system-suppressing drugs.

What are the chances of cure in acute leukemia?

In ALL of children, the long-term survival (cure) is almost in the range of 70-80% (in western countries). In our country it is in the range of 50-55%.

Adult ALL-Adults do not fare as well as children. The long-term survival is in the range of 40-45%.

AML-the outcome is very dismal for children and adults, the long-term survival in the range of 20%. With high dose chemotherapy & BMT, the maximum long-term survival, which has been achieved is around 35-40%.

CML-the only curative treatment is allogenic BMT. Other treatment only increases the survival.

CLL-there is no curative treatment, but it is a disease of elderly people, who can maintain good quality of life up to 10 years with proper treatment.

CANCER OF THE CERVIX

Cancer of the cervix, also called cervical cancer, is the leading cause of cancer amongst women in India. There are more than 70,000 cases of cancer of the cervix to be found in the country.
Cancer is an unwanted purposeless and unchecked growth of any body tissue, with a capability of spreading to other areas. Most cervical cancers are squamous cell carcinomas. Squamous cells are thin, flat cells that form the surface of the cervix.

The cervix is the lower, narrow part of the uterus (womb). The uterus, a hollow, pear-shaped organ, is located in the lower abdomen. The cervix forms a canal that opens into the vagina, which leads to the outside of the body.

Who is at risk in developing cancer of the cervix?

Researchers have identified certain risk factors that increase the chance that cells in the cervix will become abnormal or cancerous. Initiation of sexual intercourse before age 18, many sexual partners, early age of marriage, first pregnancy at an early age, four or more number of pregnancies and women with poor personal hygiene, have an increased risk of cervical cancer.

Women who have had many sexual partners or whose partners have had many sexual partners may have an increased risk of cervical cancer at least in part because they are more likely to get a sexually transmitted virus. Scientist believes that some of these viruses may cause the growth of abnormal cells in the cervix and may play a role in cancer development.

What are the symptoms of cervical cancer?

* Bleeding after sexual intercourse

* Bleeding in between menses or post menopausal bleeding

* Excessive white discharge (leucorrhea)

How can cancer of the cervix be diagnosed?

When we visit a doctor with a problem, the doctor first listens to our complaints in detail and then examines us. In a pelvic exam, the doctor checks the uterus, vagina, ovaries, fallopian tubes, bladder and rectum. The doctor feels these organs for any abnormality in their shape or size. An instrument called a speculum is inserted into the vagina. This holds the walls of the vagina apart so that the doctor can see the upper part of the vagina and the cervix. The doctor may then recommend certain tests such as Pap smears, colposcopy, biopsy etc. The pelvic exam and Pap test allow the doctor to detect abnormal changes in the cervix. If these examinations show that an infection is present, the doctor treats the infection and then repeats the Pap test at a later time. If the examinations or Pap test suggests something other than an infection, the doctor may do other tests to find out what the problem is.

Pap Smear
The Pap smear test is an easy way to detect early changes in cells of the cervix, the lower end of the uterus or womb. A Pap smear is taken during an internal examination of the vagina. A speculum is inserted into the vagina and some cells are then taken from the cervix using a small spatula and smeared on a glass slide and sent to a medical laboratory to be checked for abnormality. It is important that all women have a Pap smear test every two years.

Colposcopy is a widely used method to check the cervix for abnormal areas.

These tests may not show for sure whether the abnormal cells are present only on the surface of the cervix. In that case, the doctor will remove a larger, cone-shaped sample of tissue. This procedure, called conization or cone biopsy, allows the pathologist to see whether the abnormal cells have invaded tissue beneath the surface of the cervix. Conization also may be used as treatment for a pre cancerous lesion if the entire abnormal area can be removed.

Early detection

If all women had pelvic exams and pap tests regularly, most pre cancerous conditions would be detected and treated before cancer develops. Abnormal Pap smear test does not necessarily mean patient is suffering from cancer, but may indicate a pre cancerous stage. Scientists believe that some abnormal changes in cells on the cervix are the first step in a series of slow changes that can lead to cancer years later. Appropriate treatment at this time can prevent development of cancer. The patient then needs to be closely followed. That’s why it is recommended to have a Pap smear done every two years. That way, most invasive cancers could be prevented. Any invasive cancer that does occur would likely be found at an early, curable stage.

How can cancer of the cervix be treated?

Treatment depends on a number of factors, age, location and size of the tumor, including the stage of the disease and the general health of the patient. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. Many different treatments and combination of treatments are used to treat cancer of the cervix. The three common modes of cancer treatment are surgery, radiation therapy and chemotherapy. Radiation therapy is the mainstay in the treatment of the cancer of the cervix.

Radiation therapy involves subjecting the cancer-bearing region to radiation. Ionizing radiation damages or destroys the cancer cells and prevents them from growing and multiplying. Normally the treatment is divided over a period of one month, during which fixed doses of radiation are delivered each day. Radiation affects both normal as well as abnormal tissues while ensuring sustained tumor destruction. Usually most of the radiation treatment is given as an outpatient procedure. Radiotherapy treatment in itself is painless just like an X-ray, and may take anything from a few seconds to several minutes.

The different radiation therapies involve delivering radiation either from close quarters or from a distance. Radiation therapy where the source of radiation is close to the tumor is referred to as ‘Brachytherapy’. Therapy, where the radiation source is located away from the tumor is referred to as ‘Teletherapy’. Brachytherapy is mostly delivered by directly implanting radioactive wires or seeds into the tumor, while Teletherapy is given by using fixed machines.

Surgery is one of the commonly used modes of cancer treatment, wherein the surgeon removes a localized tumor.
Chemotherapy is treatment of cancer by drugs. Cancer chemotherapy employs cytotoxic drugs capable of arresting fast cellular growth. Chemotherapy also affects other fast growing and dividing normal cells in the body. The treatment is given in cyclic form once in 3 to 4 weeks, to allow for adequate recovery of normal tissues and to ensure that cancer cells are killed at the same time. Chemotherapy and Radiation therapy may cause side effects, but most side effects of radiotherapy and chemotherapy are reversible after treatment is over.

Follow-up care

Regular follow-up examinations including a pelvic exam, a Pap test, and other laboratory tests are very important for any woman who has been treated for pre cancerous changes or for cancer of the cervix. The doctor will do these tests and exams frequently for several years.

LUNG CANCER

Lung cancer is the most common cancer amongst men in India, with approx. 33,000 new cases every year. The lung, a part of the respiratory system, helps us to breathe. Lungs are a pair of sponge like cone shaped organs in the chest cavity. The right lung has 3 sections called lobes; it is larger than the left lung, which has only 2 lobes. When we breathe in, the lung takes in oxygen and when we breathe out, carbondioxide, which is a waste product of the body, is expelled.

What is lung cancer?
Cancer is an unwanted purposeless and unchecked growth of any body tissue, with a capability of spreading to other areas. Cancer that begins in the lung is called lung cancer. There are four major types of lung cancer, which fall under 2 broad groups.

* Small cell lung cancer or oat cell cancer (less common)

* Non small cell lung cancer (more common)

* Squamous cell (epedermoid cancer)

* Adenocarcinoma

* Large cell carcinoma

Who is at risk?

Researchers have discovered several causes for lung cancer, most are related to the use of tobacco.

* Smoking- Cigarettes, Beedies, Cigars and Pipe. Harmful substances (carcinogens) in tobacco damage cells in the lungs, the damaged cells may become cancerous. Over a period of time stopping smoking greatly reduces a person’s risk from developing lung cancer.

* Environmental Tobacco Smoke or passive smoking also increases the chance of developing lung cancer.

* Asbestos is the name of a group of minerals that occur naturally as fibers and are used in certain industries. Asbestos fibers tend to break easily into particles that can float in the air. When the particles are inhaled, they can lodge in the lungs, damaging cells and increasing the risk of lung cancer.

* Radon is an invisible, odourless and tasteless radioactive gas that occurs naturally in soil and rocks. It can cause damage to the lungs and may cause lung cancer. People who work in mines may be exposed to radon.

* Pollution – Researchers have found a link between lung cancer and exposure to certain air pollutants, such as by-products of the combustion of diesel and other fossil fuels.

* Lung Disease – Certain lung diseases, such as tuberculosis (TB), increase a person’s chance of developing lung cancer. Lung cancer tends to develop in areas of the lung that are scarred form TB.

* Personal Medical and Family History – A person who has had lung cancer once is more likely to develop a second lung cancer compared to a person who has never had lung cancer. Brothers, sisters and children of those who have had lung cancer have a slightly higher risk of lung cancer. However, it is difficult to say how much of this excess risk is due to inherited factors and how much is due to environmental factors.

* Other Mineral Exposures-People with silicosis and berylliosis (lung diseases caused by breathing in certain minerals) also have an increased risk of lung cancer.

* Researchers continue to study the cause of lung cancer and try to find ways to prevent it .We already know that the best way to prevent lung cancer is to quit (or never start) smoking.

What are the symptoms of lung cancer?

* Unexplained chronic cough

* Repeated attacks of lung infection

* Breathlessness, wheezing, hoarseness

* Sputum mixed with blood

* Constant chest pain

* Loss of appetite or weight loss

* Fatigue

Treating non small cell lung cancer

Patients with non-small cell lung cancer may be treated in several ways. The choice of treatment depends mainly on the extent of the disease. Surgery is the most common way to treat this type of lung cancer. Radiation therapy and chemotherapy may also be used to slow the progress of the disease and to manage symptoms.

Treating small cell lung cancer

Small cell lung cancer spreads quickly. In many cases, cancer cells have already spread in other parts of the body when the disease is diagnosed. In order to reach cancer cells throughout the body, doctors almost always use chemotherapy. Treatment may also include radiation therapy aimed at the tumor in the lung or tumors in other parts of the body (such as in the brain). Some patients have radiation therapy to the brain even though no cancer is found there. This treatment, called prophylactic cranial irradiation (PCI), is given to prevent tumours from forming in the brain. Surgery is part of the treatment plan for a small number of patients with small cell lung cancer.

The importance of follow-up care

Follow-up care after treatment for lung cancer is very important. Regular checkups ensure that changes are quickly noticed, and if the cancer returns or a new cancer develops, it can be treated as soon as possible. Checkups may include physical exams, chest X-rays or lab tests.

Some of the symptoms mentioned above are quite common in everyday illnesses and do not necessarily indicate cancer. Nevertheless, it is wise to pay heed to these symptoms and seek advice from your doctor. Early detection gives the best choice of cure.

How can lung cancer be diagnosed?

To help find the cause of symptoms, a doctor evaluates a person’s medical history, smoking history, exposure to environmental and occupational substances and family history of cancer. After clinical examination, x-ray of the chest is the starting point. If this does not help special x-ray examination called Tomography is undertaken. To confirm the presence of lung cancer, the doctor must examine tissue from the lung. The only way to make the diagnosis of cancer is to examine cells or tissues from the suspected lesion under a microscope by a pathologist; a procedure referred to as biopsy.

Bronchoscopy - The doctor puts a bronchoscope (a thin, lighted tube) into the mouth and down through the windpipe to look into the breathing passages. Through this tube, the doctor can collect cells or small samples of tissue.

Staging the disease

If the diagnosis is cancer, the doctor wants to know about the stage (or extent) of the disease. Staging is done to find out whether the cancer has spread and if so, to which part of the body. Knowing the stage of the disease helps the doctor plan treatmnet. Some tests used to determine whether the cancer has spread include:

CAT (or CT scan) computed tomographhy- A computer linked to an X-ray machine creates a series of detailed pictures of areas inside the body.

MRI (magnetic resonance imaging)-A powerful magnet linked to a computer makes detailed pictures of areas inside the body.
Radionuclide scanning-Scanning can show whether cancer has spread to other organs, such as the liver. The patient swallows or receives an injection of a mildly radioactive substance. A machine (scanner) measures and records the level of radioactivity in certain organs to reveal abnormal areas.

What are the treatments options for lung cancer?

Treatment depends on a number of factors, including the type of lung cancer (non-small cell or small cell lung cancer), the stage of the disease, and the general health of the patient. Many different treatments and combination of treatments are used to treat lung cancer. The three common modes of cancer treatment are surgery, radiation therapy and chemotherapy.

Surgery is one of the most commonly used modes of cancer treatment, wherein the surgeon removes a localized tumour. When the surgeon removes an entire lobe of the lung, the procedure is called a lobectomy. Pneumonectomy is the removal of an entire lung. The human lung has substantial reserve capacity and removal of a lobe or even one full lung does not severely incapacitate the person.

Chemotherapy is treatment of cancer by drugs. Cancer chemotherapy employs cytotoxic drugs capable of arresting fast cellular growth. Chemotherapy also affects other fast growing and dividing normal cells in the body. The treatment is given in cyclic form once in 3 or 4 weeks, to allow for adequate recovery of normal tissues and to ensure that cancer cells are killed at the same time.

Radiation therapy involves subjecting the cancer-bearing region to radiation. Ionizing radiation damages or destroys the cancer cells and prevents them from growing and multiplying. Normally the treatment is divided over a period of one month, during which fixed doses of radiation are delivered each day (five days/week). Radiation affects both normal as well as abnormal tissues. The schedule for radiation is planned in a way that it helps recovery of the normal tissues while ensuring sustained tumor destruction. Chemotherapy and radiation therapy may cause side effects, but most side effects of radiotherapy and chemotherapy are reversible after treatment is over

Cancer is an unwanted purposeless and unchecked growth of any body tissue with a capability of spreading to other areas. Oral cancer starts in the mouth. The oral cavity includes the lips, the buccal mucosa (inside lining of the lips and cheeks), the teeth, the gums, the front two-thirds of the tongue, the floor of the mouth below the tongue, the hard palate and the area behind the wisdom teeth.

Oropharyngeal cancer develops in the part of the throat just behind the mouth. The oropharynx begins where the oral cavity stops. It includes the base of tongue, the soft palate, the area around the tonsils and the back wall of the throat.

The oral cavity and oropharynx assist with breathing, talking, eating, chewing and swallowing. The saliva keeps the mouth moist and helps digest food.

More than 90% of cancers of the oral cavity and oropharynx are squamous cell carcinoma, also called squamous cell cancer. Squamous cells are flat, scale-like cells that normally form the lining of the oral cavity and oropharynx.

Who is at risk?

Some of the more common risk factors are as follows:

* Tobacco: 90 % of patients with oral cavity and oropharyngeal cancer use tobacco and the risk of developing these cancers increases with the amount smoked or chewed and duration of the habit. Tobacco smoke from cigarettes, cigars or pipes can cause cancers anywhere in the oral cavity or oropharynx, as well as causing cancers of the larynx, lungs, esophagus, kidneys, bladder and several other organs. Patients who persist in smoking after apparent cure of their cancer can develop second cancers of oral cavity, oropharynx or larynx. Chewing tobacco is associated with cancers of the cheek, gums and inner surface of the lips.

* Alcohol: Alcohol consumption strongly increases the risk of oral cavity and oropharyngeal cancer.

* Irritation: Chronic (long-term) irritation to the lining of the mouth caused by poorly fitting dentures or irritation by a broken or jagged tooth is a risk factor for oral cancer.

* Vitamin Deficiency: Vitamin A deficiency is associated with an increased risk of developing cancer of the oral cavity and oropharynx.

What are symptoms of oral cancer?

* Sore in the mouth that does not heal (most common symptom)

* Non healing ulcer or growth anywhere in the mouth, which bleeds on touch and is relatively painless

* White or reddish-white patches (leukoplakia or erythroplakia) in the oral cavity.

* Pain in swallowing

* Difficulty in moving the jaw or tongue

* A lump or thickening in the cheek

What are the symptoms of Throat Cancer?

* Change in Voice

* Difficulty in swallowing food

* Recurrent unexplained " sore throat"

* Difficulty in breathing

* Unexplained one sided ear-ache

* Lump in the neck

What is Leukoplakia, Erythroplakia?

Leukoplakia is a white area on the mucosa. Erythroplakia is a slightly raised red area that bleeds easily, if scraped. The most frequent causes of these conditions are smoking or chewing tobacco. Poorly fitting dentures rubbing against the mucosa and irritating it can also cause leuko

plakia or erythroplakia.

Some of the symptoms mentioned above are quite common in everyday illnesses and do not necessarily indicate cancer. Nevertheless, it is wise to pay heed to these symptoms and seek advice from your doctor. Early detection gives the best chance of cure.

How can Oral Cancer be diagnosed?

When we visit a doctor with a problem, the doctor first listens to our complaints in detail and then examines us. To help find the cause of symptoms, the doctor evaluates a person's medical history followed by complete head and neck exam including may be, nasopharyngoscopy, pharyngoscopy, or laryngoscopy.

The only way to make the diagnosis of cancer is to examine cells or tissues from the suspected lesion under a microscope-a procedure referred to as biopsy.

Staging the disease

If the diagnosis is cancer, the doctor wants to know about the stage (or extent) or the disease. Staging is done to find out whether the cancer has spread and if so, to which part of the body. Knowing the stage of the disease helps the doctor plan treatment. Some tests used to determine whether the cancer has spread include:

* CAT (or CT Scan) computed tomography - A computer linked to an X-ray machine creates a series of detailed pictures of areas inside the body.

* MRI (magnetic resonance imaging)- A powerful magnet linked to a computer makes detailed pictures of areas inside the body.

* Radio nuclide scanning - Scanning can show whether cancer has spread to other organs, such as the liver. The patient swallows or receives an injection of a mildly radioactive substance. A machine (scanner) measures and records the level of radioactivity in certain organs to reveal abnormal areas.

What are the treatments options for Oral Cancer?

The three common modes of cancer treatment are surgery, radiation therapy and chemotherapy. Surgery is one of the most commonly used modes of cancer treatment, wherein the surgeon removes a localized tumor in the mouth. If there is evidence that the cancer has spread, the surgeon may also remove lymph nodes in the neck. If the disease has spread to muscles and other tissues in the neck, the operation may be more extensive.

Chemotherapy is treatment of cancer by drugs. Cancer chemotherapy employs cytotoxic drugs capable of arresting fast cellular growth. Chemotherapy also affects other fast growing and dividing normal cells in the body. The treatment is given in cyclic form once in 3 to 4 weeks, to allow for adequate recovery of normal tissues and to ensure that cancer cells are killed at the same time.

Radiation therapy involves subjecting the subjecting the cancer-bearing region to radiation. Ionizing radiation damages of destroys the cancer cells and prevents them from growing and multiplying. Normally the treatment is divided over a period of one month, during which fixed doses of radiation are delivered each day. Radiation affects both normal as well as abnormal tissues. The schedule for radiation is planned in a way that it helps recovery of the normal tissues, while ensuring sustained tumor destruction. Usually most of the radiation treatment is given as an outpatient procedure. Radiotherapy treatment in itself is painless (just like an x-ray), and may take anything form a few seconds to several minutes.

Chemotherapy and Radiation therapy may cause side effects. But most side effects of radiotherapy and chemotherapy are reversible after treatment is over. Most oral cavity and oropharyngeal cancers can be prevented by avoiding risk factors whenever possible.

After treatment

Speech Therapy: After surgery or other treatment for oral cavity or oropharyngeal tumor, the patient may develop problems speaking or swallowing. When this occurs, a speech therapist may be consulted.

The importance of follow-up care

Follow up care after treatment for oral cancer is very important. Patients with cancer of the oral cavity and oropharynx are at risk for developing recurrences of new cancers in the head and neck area. Regular checkups ensure that changes in health are quickly noticed and if the cancer returns or a new cancer develops, it can be treated as soon as possible. Between scheduled appointments, people who have had oral cancer should report any health problem to their doctor as soon as it appears.

Breast cancer is the second most common cancer seen in women. Once thought a disease of the developed countries, the incidence of breast cancer is on the rise in India as well. Breasts are designed to produce milk for the newborn baby after delivery. Breast is made up of milk glands and supporting breast tissue. Milk glands contain milk sacs, where milk is produced and milk ducts carry the milk to the nipples from where it is discharged. The breast tissue extends up to the collarbone on top and the armpits on the side. Traditionally the shape and size of the breasts are associated with femininity and any disease affecting the breasts are psychologically traumatic.

Breast cancer is a tumor (a mass of abnormal tissue) within the breast. The majority of breast cancers begin in the milk ducts, however a small number start in the milk sacs or the lobes. Like other cancers, breast cancer if unchecked also has the ability to spread to different areas. The spread occurs mainly via the lymph ducts.
Who is at risk?
Breast cancer is far more common in women than in men although men can also get breast cancer. Some women are at a particularly higher risk.

* Age-risk of breast cancer increases with age.
* Family history of breast cancer i.e. women whose mother, grandmothers, aunts or sisters have developed breast cancer, are at an increased risk.
* Women, who previously had breast cancer, have a slightly higher chance of having breast cancer in the other breast.
* Women who started their periods (menarche) at an earlier age (before 12 years).
* Delayed childbearing, women who did not breast-feed their infants, or those who never had children.
* Late menopause (after 50 years)
* Obesity
* Diet rich in animal fat.

It is important to mention here that even if several risk factors are present, if does not necessarily mean that cancer will develop in these cases. It is equally important to mention that 75% of women who develop breast cancer have no known risk factors.
What are the signs and symptoms of Breast Cancer?
In a majority of women breast cancer is first noticed as a lump in the breast. There are other important signs and symptoms.

* Discharge from the nipple, particularly if blood stained.
* Change in shape or size of breast.
* Change in appearance of skin in a part of the breast.
* Rash on the nipples or surrounding areas.
* A lump or thickening inside the breast tissue.
* Inversion or turning in of the nipple.
* Swelling on the upper arm
* Swelling in the armpit

How can Breast Cancer be diagnosed?


Being in an area, which is easily accessible, the importance of early detection and diagnosis of breast cancer cannot be over-emphasized. Early detection and treatment can provide an almost 100% cure.

* Breast Self Examination (BSE) is important as it helps the patient to detect any changes occurring in her breast by herself. All women should be taught how to do a breast self-examination. However it is reassuring to note that all lumps in the breast are not cancerous, though one must check out with the doctor, when a lump is suspected.
* A Mammogram is an X-ray of the breast using a specially designed machine and is very useful in early diagnosis.
* Besides BSE every woman over 40 years must have Physical Examination of the breast done by a doctor, as part of the annual check up program.
Dos and Don't - A few simple moves to help you move back to normal

Do’s

* Wear loose rubber gloves when working.
* Protect your arm from pinpricks, scratches, bruises, cuts or burns of any kind.
* Use an electric razor with a narrow head to shave as this decreases the risk of cuts and scratches.
* Use a thimble while stitching.
* Wear loose clothing and jewellery.
* Use insect repellant to avoid insect bites.
* In case you injure yourself, wash with an antiseptic solution and apply a sterile bandage.

Don’ts

* Never take injections or IV fluids or check your blood pressure or draw blood on the affected arm.
* Do not wear glass bangles.
* Do not expose the arm to excessive heat while cooking.
* Do not cut or pull cuticles on the affected arm.

Cancer is a term for diseases in which abnormal cells divide without control and can invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems.

Cancer is not just one disease but many diseases. There are more than 100 different types of cancer. The main categories of cancer include:

* Carcinoma - cancer that begins in the skin or in tissues that line or cover internal organs.
* 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.
All cancers begin in cells, the body's basic unit of life. To understand cancer, it's helpful to know what happens when normal cells become cancer cells.

The body is made up of many types of cells. These cells grow and divide in a controlled way to produce more cells as they are needed to keep the body healthy. When cells become old or damaged, they die and are replaced with new cells.

But sometimes this orderly process goes wrong. The genetic material (DNA) of a cell can become damaged or changed, producing mutations that affect normal cell growth and division. When this happens, cells do not die when they should and new cells form when the body does not need them. The extra cells may form a mass of tissue called a tumor.
Not all tumors are cancerous; tumors can be benign or malignant.

* Benign tumors aren't cancerous. They can often be removed, and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body.
* Malignant tumors are cancerous. Cells in these tumors can invade nearby tissues and spread to other parts of the body. The spread of cancer from one part of the body to another is called metastasis.

Most cancers are named for the organ or type of cell in which they begin. For example, cancer that begins in the stomach is called stomach cancer.

Some cancers do not form tumors. For example, leukemia is a cancer of the bone marrow and blood.