Cancer

Overview

General

This leaflet gives a general overview of cancer. Other leaflets in

this series provide details of different types of cancer, treatments,
and other related topics.

What is cancer?
Cancer is a disease of the cells in the body. There are many different types
of cell in the body, and many different types of cancer which arise from
different types of cell. What all types of cancer have in common is that the
cancer cells are abnormal and multiply out of control. Some cancers are
more serious than others, some are more easily treated than others
(particularly if diagnosed at an early stage), some have a better outlook
(prognosis) than others.
So, cancer is not just one condition. In each case it is important to know
exactly what type of cancer has developed, how large it has become,
whether it has spread, and how well it usually responds to treatment.

What are cells?

Normal body cells
The body is made up from millions of tiny cells. Different parts of the body
such as organs, bones, muscles, skin, and blood are made up from
different specialised cells. All cells have a centre called a nucleus. The
nucleus in each cell contains thousands of genes which are made up from
a chemical called DNA. The genes are like codes which control the
functions of the cell. For example, different genes control how the cell
makes proteins, or hormones, or other chemicals. Certain genes control
when the cell should multiply, and certain genes even control when the
cell should die.
Most types of cell in the body divide and multiply from time to time. As old
cells wear out or become damaged, new cells are formed to replace them.
Some cells normally multiply quickly. For example, you make millions of
red blood cells each day as old ones become worn out and are broken
down. Some cells do not multiply at all once they are mature - for
example, brain cells. Normally, your body only makes the right number of
cells that are needed.

Abnormal cells
Sometimes a cell becomes abnormal. This occurs because one (or more)
gene in the cell becomes damaged or altered. The abnormal cell may then
divide into two, then four, then eight, and so on. Lots of abnormal cells
may then develop from the original abnormal cell. These cells do not know
when to stop multiplying. A group of abnormal cells may then form. If this
group of cells gets bigger, it becomes a large clump of abnormal cells
called a tumour.

What are tumours?

A tumour is a lump or growth of tissue made up from abnormal cells.
Tumours are divided into two types: benign and malignant.

Benign tumours
These may form in various parts of the body. Benign tumours grow slowly,
and do not spread or invade other tissues. They are not cancerous and are
not usually life-threatening. They often do no harm if they are left alone.
However, some benign tumours can cause problems. For example, some
grow quite large and may cause local pressure symptoms, or look
unsightly. Also, some benign tumours that arise from cells in hormone
glands can make too much hormone, which can cause unwanted effects.

Malignant tumours (cancers)

Malignant tumours tend to grow quite quickly, and invade into nearby
tissues and organs, which can cause damage. Tumours normally develop
in one original site - the primary tumour. Malignant tumours may also
spread to other parts of the body to form secondary tumours
(metastases). This happens if some cells break off from the primary
tumour and are carried in the bloodstream or lymph channels to other
parts of the body. These secondary tumours may then grow, invade and
damage nearby tissues, and spread again.

Note: not all cancers form solid tumours. For example, in cancer of the
blood cells (leukaemia) many abnormal blood cells are made in the bone
marrow and circulate in the bloodstream.

What causes cancer?

Each cancer is thought to first start from one abnormal cell. What seems
to happen is that certain vital genes which control how cells divide and
multiply are damaged or altered. This makes the cell abnormal. If the
abnormal cell survives it may multiply out of control into a malignant
tumour.
We all have a risk of developing cancer. Many cancers seem to develop for
no apparent reason. However, certain risk factors are known to increase
the chance that one or more of your cells will become abnormal and lead
to cancer. Risk factors include the following:

Chemical carcinogens
A carcinogen is something (chemical, radiation, etc) that can damage a
cell and make it more likely to turn into a cancerous cell. As a general rule,
the more the exposure to a carcinogen, the greater the risk. A list of
known an suspected chemical carcinogens can be found a
http://msds.chem.ox.ac.uk/carcinogens.html and well known examples
include:

Tobacco smoke. Smokers are more likely to develop cancer of the lung,
mouth, throat, oesophagus, bladder and pancreas. Smoking is thought to
cause about a quarter of all cancers. About 1 in 10 smokers dies from lung
cancer. The heavier you smoke, the greater the risk. If you stop smoking,
your risk goes down considerably.

Workplace chemicals such as asbestos, benzene, formaldehyde, etc.

If you have worked with these without protection you have an increased
risk of developing certain cancers. For example, a cancer called
mesothelioma is linked to past exposure to asbestos.

Age
The older you become, the more likely you will develop a cancer. This is
probably due to an accumulation of damage to cells in the body over time.
Also, the body's defences against abnormal cells may become less good
as you become older. For example, the ability to repair damaged cells, and
the immune system which may destroy abnormal cells, may become less

efficient with age. So, eventually one damaged cell may manage to
survive and multiply out of control into a cancer. Most cancers develop in
older people.

Lifestyle factors
Diet and other lifestyle factors can alter the risk of developing cancer. For
example:
If you eat a lot of fruit and vegetables you have a reduced risk of
developing certain cancers. The exact way in which they protect against
cancer is not fully understood. These foods are rich in vitamins and
minerals, and also contain chemicals called antioxidants. They may
protect against damaging chemicals that get into the body. We should all
eat at least five portions of fruit and vegetables per day (some experts
recommend even more).
Eating too much fatty food possibly increases the risk of developing
certain cancers.
The risk of developing certain cancers is increased by: obesity, lack of
regular exercise (physical activity), and drinking a lot of alcohol.
For example, one large research study (cited below) followed up over
55,000 people for 10 years. It looked at lifestyle factors and rates of
cancer. The study concluded that by following recommendations on
keeping physically active, keeping weight in check, not smoking, drinking
alcohol in moderation and having a healthy diet, the risk of developing
bowel cancer could be reduced by as much as 23%. But, the study found
that even improvement in some of these lifestyle factors had some
reduction in risk.

Radiation
Radiation is a carcinogen. For example, exposure to radioactive materials
and nuclear fallout can increase the risk of developing leukaemia and
other cancers. Too much sun exposure and sunburn (radiation from UVA
and UVB) increase the risk of developing skin cancer. The larger the dose
of radiation, the greater the risk of
developing cancer. But note: the risk from small doses such as from a
single X-ray test, is very small.

Infection
Some viruses are linked to certain cancers. For example, people with
persistent infection with the hepatitis B virus or the hepatitis C virus have
an increased risk of developing cancer of the liver. Another example is the
link between the human papillomavirus (HPV) and cervical cancer. Most
(possibly all) women who develop cervical cancer have been infected with
a strain (subtype) of HPV at some point in their life. However, most viruses
and viral infections are not linked to cancer.

Immune system
People with a poor immune system have an increased risk of developing
certain cancers. For example, people with AIDS, or people on
immunosuppressive therapy.

Your genetic make-up

Some cancers have a strong genetic link. For example, in certain
childhood cancers the abnormal gene or genes that may trigger a cell to
become abnormal and cancerous are inherited. Other types of cancer may
have some genetic factor which is less clear-cut. It may be that in some
people their genetic make-up means that they are less resistant to the
effect of carcinogens or other factors such as diet.

Most cancers are probably

combination of factors

due

to

Not everybody who comes into contact with a carcinogen or has an

unhealthy lifestyle will develop cancer. For example, not all smokers
develop cancer of the lung. In fact, we are all probably exposed to low
doses of carcinogens a lot of the time.
The body has certain mechanisms that may protect us from developing
cancer. For example, it is thought that many cells that are damaged by
carcinogens can repair themselves. Also, the body's immune system may
be able to destroy some types of abnormal cells before they multiply into
a tumour. Perhaps one carcinogen may only damage one gene, and two or
more genes may need to be damaged or altered to trigger the cells to
multiply out of control.
In many cases it is likely that a combination of factors such as genetic
make-up, exposure to a carcinogen, age, diet, the state of your immune
system, etc, plays a part to trigger a cell to become abnormal, and allow it
to multiply out of control into a cancer.

How is cancer diagnosed?

1. If a cancer is suspected from your symptoms
Your doctor will examine you to look for abnormalities such as a lump
under the skin, or an enlarged liver. You may be referred for tests such as
X-rays, scans, blood tests, endoscopy, bronchoscopy, etc, depending on
where the suspected cancer is situated. These tests can often find the site
of a suspected cancer. However, a biopsy is often needed to be certain
that the abnormality is a cancer and not something else (such as a benign
tumour).

2. Biopsy
A biopsy is when a small sample of tissue is removed from a part of the
body. The sample is then examined under the microscope or tested in
other ways to detect abnormal cells. Sometimes it is easy to obtain a
biopsy.
For example, from a lump on the skin, which may be a skin cancer.
However, it can be difficult to obtain a biopsy from deeper tissues and it
may require specialised procedures.

What are the treatment options for cancer?

Treatment options vary, depending on the type of cancer and how far it
has grown and spread. See the separate leaflets on the specific cancers
for more details. There is also another leaflet called Cancer Staging and
Grading Cancer which discuses how a cancer is classified depending on
its type (grading) and how far it has spread in the body (staging). Briefly,
the three most common treatments are:
1. Surgery. It may be possible to cut out a malignant tumour.
2. Chemotherapy. This is a treatment that uses anticancer drugs to kill
cancer cells, or to stop them from multiplying. There are various
different types of drugs used for chemotherapy. The drug or
combination of drugs selected depends on the type of cancer being
treated.
3. Radiotherapy. This is a treatment that uses high-energy beams of
radiation which are focused on cancerous tissue. This kills cancer cells,
or stops cancer cells from multiplying.
4. More recently, other treatments have been introduced which include:
5. Bone marrow transplant. High-dose chemotherapy may damage
bone marrow cells and lead to blood problems. However, if you receive

healthy bone marrow after the chemotherapy then this helps to

overcome this problem.
6. Hormone therapy. This is where drugs are used to block the effects
of hormones. This treatment may be used for cancers that are
hormone-sensitive such as some cancers of the breast, prostate and
uterus (womb).
7. Immunotherapy. Some treatments can boost the immune system to
help to fight cancer. More specific immunotherapy involves injections of
antibodies which aim to attack and destroy certain types of cancer
cells. Research is underway to try to find vaccines that would stimulate
your own immune system to make antibodies against cancer cells.
8. Gene therapy. This is a new area of possible treatments. Research is
underway to find ways of blocking, repairing or replacing abnormal
genes in cancer cells.
9. Special techniques. These can sometimes be used to cut off the
blood supply to tumours. The tumour then dies.
For some cancers, a combination of two or more treatments may be used.
A range of other treatments may also be used to ease cancer-related
symptoms such as pain.

What are the aims of treatment?

The aims of treatment can vary, depending on the cancer type, size,
spread, etc. For example:
Treatment aims to cure the cancer in many cases. With modern drugs and
therapies, many cancers can be cured, particularly if they are treated in
the early stages of the disease. (Doctors tend to use the word remission
rather than the word cured.
Remission means there is no evidence of cancer following treatment. If
you are in remission, you may be cured. However, in some cases a cancer
returns months or years later. This is why doctors are sometimes reluctant
to use the word cured.)
Treatment may aim to control the cancer. If a cure is not realistic, with
treatment it is often possible to limit the growth or spread of the cancer so
that it progresses less rapidly. This may keep you free of symptoms for
some time.

Treatment may aim to ease symptoms in some cases. Even if a cure is not
possible, a course of radiotherapy, an operation, or other techniques may
be used to reduce the size of a cancer, which may ease symptoms such as
pain. If a cancer is advanced then you may require treatments such as
nutritional supplements, painkillers, or other techniques to help keep you
free of pain or other symptoms.

What is the outlook for people with cancer?

Some cancers are more aggressive and grow more quickly than others.
Some cancers are more likely to spread to other parts of the body.
Some cancers respond to treatment better than others.

Therefore, it is not possible give an overall outlook (prognosis). See the

information about the individual types of cancer for further details. As a
general rule, the outlook is usually better the earlier a cancer is detected
and treated.

Some questions you may want to go through

with your doctor
If you have been diagnosed with cancer you will have many questions.
The organisations listed at the bottom of the leaflet are good sources of
further and detailed information. The following are also some suggested
questions that you may wish to go over with your doctor:
What type of cancer have I got?
How large is it and has it spread to other parts of my body?
What are the treatment options for this type of cancer?
What are the risks and possible side-effects of the treatment
options?
How successful is the treatment for my type and stage of cancer? Is
the aim of treatment to cure or to control the cancer?