What is Cancer?

Cancer is a term used for diseases in which abnormal cells divide

without control and are able to 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. Most cancers are named for the
organ or type of cell in which they start - for example, cancer that
begins in the colon is called colon cancer; cancer that begins in
basal cells of the skin is called basal cell carcinoma.

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.

However, 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.

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Numbers and Cancer
169,000 cancer deaths expected to be caused by tobacco use in
2009.

562,340 cancer deaths expected to occur in 2009 due to conditions

of obesity, physical inactivity, and nutrition issues.

1,000,000 number of skin cancers diagnosed in 2009 that could

have been prevented by protection from the rays of the sun or other
ultra violiet light (such as indoor tanning beds).

77% of all cancers that are diagnosed in people that are 55 years
old and older.

Men have about a 1 in 2 chance of developing some form of cancer.

Women have a 1 in 3 chance.

A male smoker is likely 23 times to get cancer over a non-smoking

male.

11,100,000 of Americans that have had or have cancer and were

alive in 2005.

1,479,350 of new cancer cases that will be diagnosed in 2009.

562,340 of Americans are expected to die of cancer (this calculates

to be more than 1500 people every day).

The ranks a cancer-causing diseases have in the deaths of people in

the US is second only to heart disease.

25% percentage of all deaths in the United States that were caused
by cancer.

66% of five year survival rate for all cancers diagnosed between the
years of 1996 and 2004. Please note, this is up from 50% in the mid-
1970s.

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$228,100,000,000 — the overall cost in US dollars of cancer in the
year 2008. $93,200,000,000 of that are direct medical costs
incurred by individuals with cancer. $18,800,000,000 are the
indirect costs due to lost productivity caused by the illness.
$116,100,000,000 is the US dollar amount of lost productivity due to
premature death.

What cause cancer?

Cancer-causing substances (carcinogens)

A 'carcinogen' is something that can help to cause cancer. Tobacco

smoke is a powerful carcinogen. But not everyone who smokes gets
lung cancer. So there must be other factors at work as well as
carcinogens.

Age

Most types of cancer become more common as we get older. This is

because the changes that make a cell become cancerous in the first
place take a long time to develop. There have to be a number of
changes to the genes within a cell before it turns into a cancer cell.
These changes can happen by accident when the cell is dividing. Or
they can happen because the cell has been damaged by
carcinogens and the damage is then passed on to future 'daughter'
cells when that cell divides. The longer we live, the more time there
is for genetic mistakes to happen in our cells.

Genetic make up

There need to be a number of genetic mutations within a cell before

it becomes cancerous. Sometimes a person is born with one of these
mutations already. This doesn't mean they will definitely get cancer.
But with one mutation from the start, it makes it more likely

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statistically that they will develop cancer during their lifetime.
Doctors call this 'genetic predisposition'.

The BRCA1 and BRCA2 breast cancer genes are examples of genetic
predisposition. Women who carry one of these faulty genes have a
higher chance of developing breast cancer than women who do not.

The BRCA genes are good examples for another reason. Most
women with breast cancer do not have a mutated BRCA1 or BRCA 2
gene. Less than 5% of all breast cancer is due to these genes. So
although women with one of these genes are individually more likely
to get breast cancer, most breast cancer is not caused by a high risk
inherited gene fault.

This is true of other common cancers where some people have a

genetic predisposition - for example, colon (large bowel) cancer.

Researchers are looking at the genes of people with cancer in a

study called SEARCH. They also hope to find out more about how
other factors might interact with genes to increase the risk of
cancer. Information about this study is on our clinical trials
database.

The immune system

People who have problems with their immune systems are more
likely to get some types of cancer. This group includes people who

• Have had organ transplants and take drugs to suppress their

immune systems to stop organ rejection
• Have HIV or AIDS
• Are born with rare medical syndromes which affect their
immunity

The types of cancers that affect these groups of people fall into two,
overlapping groups

• Cancers that are caused by viruses, such as cervical cancer

and other cancers of the genital or anal area, some
lymphomas, liver cancer and stomach cancer
• Lymphomas

Chronic infections or transplanted organs can continually stimulate

cells to divide. This continual cell division means that immune cells

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are more likely to develop genetic faults and develop into
lymphomas.

Bodyweight, diet and physical activity

Cancer experts estimate that maintaining a healthy bodyweight,

making changes to our diet and taking regular physical activity
could prevent about one in three deaths from cancer in the UK. In
the western world, many of us eat too much red and processed
meat and not enough fresh fruit and vegetables. This type of diet is
known to increase the risk of cancer. Drinking alcohol can also
increase the risk of developing some types of cancer. There is more
information about this in the page on diet causing cancer.

Sometimes foods or food additives are blamed for directly causing

cancer and described as 'carcinogenic'. This is often not really true.
Sometimes a food is found to contain a substance that can cause
cancer but in such small amounts that we could never eat enough of
it to do any harm. And some additives may actually protect us.
There is more about food additives in the page on diet causing
cancer.

Day to day environment

By environmental causes we mean what is around you each day

that may help to cause cancer. This could include

• Tobacco smoke
• The sun
• Natural and man made radiation
• Work place hazards
• Asbestos

Some of these are avoidable and some aren't. Most are only
contributing factors to causing cancers - part of the jigsaw puzzle
that scientists are still trying to put together. There is more about
this in the page on causes of cancer in the environment.

Viruses

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Viruses can help to cause some cancers. But this does not mean
that these cancers can be caught like an infection. What happens is
that the virus can cause genetic changes in cells that make them
more likely to become cancerous.

These cancers and viruses are linked

• Cervical cancer, and other cancers of the genital and anal

area, and the genital wart virus, HPV
• Primary liver cancer and the Hepatitis B and C viruses
• Lymphomas and the Epstein-Barr Virus
• T cell leukaemia in adults and the Human T cell leukaemia
virus
• HPV also probably leads to oropharyngeal cancer and non
melanoma skin cancers in some people

There will be people with primary liver cancer and with T cell
leukaemia who haven't had the related virus. But infection increases
their risk of getting that particular cancer. With cervical cancer,
scientists now believe that everyone with an invasive cervical
cancer has had an HPV infection beforehand.

Many people can be infected with a cancer causing virus, and never
get cancer. The virus only causes cancer in certain situations. Many
women get a high risk HPV infection, but never develop cervical
cancer. Another example is Epstein-Barr virus (EBV). These are some
facts about EBV

• It is very common - most people are infected with EBV

• People who catch it late in life get glandular fever and have an
increased risk of lymphoma
• In sub-Saharan Africa, EBV infection and repeated attacks of
malaria together cause a cancer called Burkitt's lymphoma in
children
• In China, EBV infection (together with other unknown factors)
causes nasopharyngeal cancer
• In people with AIDs and transplant patients EBV can cause
lymphoma
• About 4 out of 10 cases of Hodgkin's lymphoma and a quarter
of cases of Burkitt lymphoma (a rare type of non Hodgkin's
lymphoma) seem to be related to EBV infection

Bacterial infection

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Bacterial infections have not been thought of as cancer causing
agents in the past. But studies have shown that people who have
helicobacter pylori infection of their stomach develop inflammation
of the stomach lining, which increases the risk of stomach cancer.
Helicobacter pylori infection can be treated with a combination of
antibiotics.

Research is also looking at whether substances produced by

particular types of bacteria in the digestive system can increase the
risk of bowel cancer or stomach lymphomas. Some researchers
think that particular bacteria may produce cancer causing
substances in some people. But research into this issue is at an
early stage.

If bacteria do play a part in causing cancer this could be important

in cancer prevention. Bacterial infections can often be cured with
antibiotics, so getting rid of the infection could be a way to reduce
the risk of these types of cance

What are some general cancer signs

and symptoms?
You should know some of the general signs and symptoms of cancer.
But remember, having any of these does not mean that you have
cancer -- many other things cause these signs and symptoms, too. If
you have any of these symptoms and they last for a long time or get
worse, please see a doctor to find out what is going on.

Unexplained weight loss

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Most people with cancer will lose weight at some point. When you
lose weight with no known reason, it's called an unexplained weight
loss. An unexplained weight loss of 10 pounds or more may be the
first sign of cancer. This happens most often with cancers of the
pancreas, stomach, esophagus, or lung.

Fever

Fever is very common with cancer, but it more often happens after
cancer has spread from where it started. Almost all patients with
cancer will have fever at some time, especially if the cancer or its
treatment affects the immune system. This can make it harder for
the body to fight infection. Less often, fever may be an early sign of
cancer, such as blood cancers like leukemia or lymphoma.

Fatigue

Fatigue is extreme tiredness that does not get better with rest. It
may be an important symptom as cancer grows. It may happen
early, though, in cancers like leukemia. Some colon or stomach
cancers can cause blood loss. This is another way cancer can cause
fatigue.

Pain

Pain may be an early symptom with some cancers like bone cancers
or testicular cancer. A headache that does not go away or get better
with treatment may be a symptom of a brain tumor. Back pain can
be a symptom of cancer of the colon, rectum, or ovary. Most often,
pain due to cancer is a symptom of cancer that has already spread
from where it started (metastasized).

Skin changes

Along with cancers of the skin, some other cancers can cause skin
symptoms or signs that can be seen. These signs and symptoms
include:

• Darker looking skin (hyperpigmentation)

• Yellowish skin and eyes (jaundice)

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 • Reddened skin (erythema)
• Itching (pruritis)
• Excessive hair growth

Change in bowel habits or bladder function

Long-term constipation, diarrhea, or a change in the size of the stool

may be a sign of colon cancer. Pain when passing urine, blood in the
urine, or a change in bladder function (such as needing to pass
urine more or less often than usual) could be related to bladder or
prostate cancer. Report any changes in bladder or bowel function to
a doctor.

Sores that do not heal

Skin cancers may bleed and look like sores that do not heal. A long-
lasting sore in the mouth could be an oral cancer. This should be
dealt with right away, especially in people who smoke, chew
tobacco, or often drink alcohol. Sores on the penis or vagina may
either be signs of infection or an early cancer, and should be
checked by a doctor.

Some examples of cancer

• 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.

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How to prevent cancer?

Avoid Smoking and Exposure to Smoke

Smoking is the most significant cancer risk factor that we can

reduce. It is responsible for not only lung cancer, but many other
types of cancer. One of the best ways to prevent cancer is to quit
smoking or never start. As soon as you quit, and it's never too late,
your body reaps the benefits of being tobacco-free.

Avoiding secondhand smoke is also a way to prevent cancer.

Secondhand smoke is the smoke exhaled from a smoker or a lit
cigarette, pipe or cigar. This smoke contains more than 60 known
carcinogens". These carcinogens interrupt normal cell development.
This interference is what ignites cancer development.

Eat Your Fruits and Veggies

A well-balanced diet is advantageous for many reasons. A diet rich

in fruits and vegetables greatly reduces your risk of developing
cancer and many other conditions.

Fruits and vegetables contain antioxidants, which help repair our

damaged cells. Green, orange and yellow fruits and vegetables are
your best bet to help prevent cancer. Studies also show that dark
fruits, like blueberries and grapes, may also have anti-cancer
properties.

Cruciferous vegetables such as broccoli and cauliflower appear to

pack a powerful punch at preventing cancer, according to numerous
studies. Other cruciferous vegetables include bok choy, Brussel
sprouts, and cabbage.

Limit Red Meat and Animal Fat

Numerous studies show that a diet high in animal fat increases the
risk for several types of cancer, particularly colon cancer. Red meat
contains much more fat than poultry and fish, so reducing the
amount of red meat in your diet may help to prevent cancer. A diet
high in fat also is major cause of obesity, which is a risk factor for
many types of cancer.

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Limit Your Alcohol Intake

Drinking excessive amounts of alcohol regularly increases your risk

factor for many types of cancer. Studies suggest that men who
consume 2 alcoholic drinks per day and women who have 1
alcoholic drink per day significantly increase their risk factors
for certain types of cancer. 6. Exercise for Cancer Prevention

Did you know that when you are exercise, you are reducing your risk
for many types of cancer? The American Cancer Society
recommends exercising 30 or minutes, at least 5 days a week for
cancer prevention. Exercising doesn't have to mean going to the
gym to lift weights. There are plenty of ways to get exercise into
your day

Get Screened for Cancer Regularly

Cancer screening tests can be useful not only in detecting cancer,

but also helping prevent it. Screening tests like the colonoscopy and
Pap smear can detect abnormal cellular changes before they turn
cancerous. The key to their effectiveness, however, is that they are
done regularly.

Other cancer screening tests are available and may be useful for
early detection, but not necessarily cancer prevention. Prostate
cancer screening through digital rectal exams and PSA tests can
help detect prostate cancer early. Mammograms and other imaging
tools are also recommended to detect breast cancer in women.

How is cancer most commonly

treated?
The three most common types of cancer treatment are surgery,
radiotherapy and chemotherapy. Treatment is aimed at removing
the cancer cells or destroying them in the body with medicines or
other agents.

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Surgery can be very successful in treating some kinds of cancer,
but it isn't an option for all people. If the cancer is in the form of a
malignant tumor and the tumor is in one place (localied), it may be
possible to safely "cut out" the tumor and any surrounding affected
tissue. Surgery may not be possible if the cancer has spread to
other areas of the body or if the tumor cannot be removed without
damaging vital organs, such as the liver or brain.

Radiotherapy uses radiation in the form of a special kind of x-

ray, gamma rays or electrons to damage cancer cells so that they
can't multiply. There is usually no pain during therapy. Radiotherapy
may sometimes be the only treatment needed, or it may be used
with other therapies, such as surgery. A combination of surgery and
radiotherapy may be used for tumors that grow in one place.

Chemotherapy uses medicines to attack the cancer cells. Just

the word "chemotherapy" can cause a lot of fear because the side
effects can be severe. However, not all people experience severe
side effects. The side effects of chemotherapy can often be reduced
with other medicines.

Chemotherapy is usually used when the cancer has spread to other

areas in the body. Chemotherapy can also be used in combination
with surgery and radiation. Sometimes the tumor is surgically
removed and then chemotherapy is used to make sure all the
cancer cells are killed.

Another kind of treatment is biological therapy. This treatment

uses proteins to trigger the body's immune system to produce more
white blood cells (or lymphocytes). Two lymphocytes that can attack
and kill cancer cells are the T-cell and the B-cell. The proteins boost
the ability of the T-cell and B-cell lymphocytes to kill cancer.
Biological therapy can also be used in combination with surgery,
radiation therapy or chemotherapy.

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Hormone therapy is sometimes used to treat breast or prostate
cancer. The hormone estrogen can make breast cancer tumors grow
faster. Similarly, the hormone testosterone can make cancerous
tumors in the prostate grow faster. Drugs that contain other
hormones may be used to block the effects of estrogen and
testosterone. In other cases, surgery to remove the ovaries or the
testicles may be used. Removing these organs reduces the amount
of estrogen or testosterone in the body.

Hormone therapy is often used in addition to chemotherapy or

radiotherapy.

Other specialized treatments may be available. Your doctor may talk

to you about these treatments if they are an option.

How can I decide which treatment option to use?

Your doctor, or a team of doctors, will help you understand your

options and will recommend options for treatment. You may not
have a choice in the treatment. Many factors are involved, including
the stage that your cancer is in, what organs are affected, and the
type of cancer that you have. Some cancers, such as skin cancer,
are easier to treat than others. Your age and health, as well as the
potential side effects of treatment, may also be factors in how much
control you have over your treatment plan.

Helping a Family Member or Friend

With Cancer

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Being There for a Friend/Family member with Cancer

Supporting a loved one or friend with cancer can be an incredible

gift that will help them through a difficult time. In general, almost
any effort you make to reach out and offer support will be
appreciated. Still, there are a few things to keep in mind that will
help you in supporting your loved one that are truly helpful, and will
help you avoid adding additional stress to the situation.

Listen

Often, the best thing you can do for your loved one or friend with
cancer is to listen. It’s easy to get caught up in trying to find “the
right thing” to say or offering your opinion, but try to refrain from
doing this, especially for someone who’s newly diagnosed. This
person is experiencing a lot of overwhelming feelings and may
simply need to “vent.” If this is what your friend or family member
needs, she'll be incredibly grateful if you can be the one who simply
lends an ear.

Avoid Focusing on “the Answer”

When we learn about a difficult situation that a loved one is facing,

our first tendency may be to try to find the solution to the problem.
With cancer, there is no one right solution. Think of cancer diagnosis
and its treatment as a journey. At different times and places in this
journey, there may be different things your friend needs. By
avoiding problem-solving mode, you will be more flexible and open
to seeing and responding to your loved ones needs.

Offer Information if Asked, But Don’t Overdo It

One invaluable way of supporting a loved one with cancer is to

research the cancer he's faced with. You can search on the Internet
(make sure you use only reputable websites) or contact an agency
such as the American Cancer Society directly and ask that
information be mailed to you. You can also seek out good quality
colon cancer books that your loved one may find helpful when he's
ready to read up.

Avoid dropping a giant stack of papers on the kitchen table. Try to

organize the information from least complex (basic information

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about the type of cancer) to most (what type of clinical trials or
experimental therapies might be available, for example). If you have
the time, you may want to organize the material in a three-ring
binder with label tabs for general topic areas. And finally, don’t
pressure your loved one to read it immediately. You can say
something such as, “I know this looks like a lot of information, but
you can file it away for now and get to it when you’re ready.”

You can also read the material yourself and discuss it with the
individual, if she might find that useful.

Offer Well-Defined Assistance with Everyday Needs

For some people with cancer, asking for help can feel like an
admission of failure. And trying to figure out how to ask for help and
what help is needed can be tough, too. To ease the burden, provide
very specific suggestions for what you can do and follow through on
your offer. For example, you can say, “I’d love to help out. Can I stop
by your house next Tuesday afternoon to mow your lawn?” “Can I
take you to your appointment next Friday?” “Would you like me to
pick up your kids from soccer practice?” “If you give me a list, I’d be
happy to stop by the grocery store to pick up a few necessities for
you.” The examples are endless, but the key is to offer help with
concrete tasks. This type of help is very much appreciated.

Remember: It’s Not About You

Sometimes when we learn of a loved one’s cancer diagnosis, we

have to sort through our own conflicting emotions. It helps to keep
in mind that this person’s cancer diagnosis is not about you. As well,
if you’re supporting someone who’s in active cancer treatment, be
flexible. What this person needs today may be completely different
than what he or she needed yesterday or last week. Avoid getting
caught up in these changes. Do your best to support and keep the
focus on caring for your loved one.

Be Supportive, But Don’t Catastrophize

When learning of another person’s cancer diagnosis, it’s very easy

to fall into saying, “Oh no, that’s so horrible,” over and over again.
Try to avoid this type of catastrophizing. It can be hard to know what

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to say, but sometimes a simple “I don’t know what to say, but I’m
very sorry you’re going through this,” can work wonders.

Allow For Silence

Most people are uncomfortable with silence and this is especially

true when talking about a sensitive topic such as cancer. However,
filling up every lull in the conversation with idle chatter can be
overwhelming to your loved one. Always trying to find the right
thing to say can be emotionally exhausting for you, too. Respect
that your loved on may simply need to sit with a supportive friend in
silence.

Avoid Comparison Stories

People love comparison stories. While one-upping a story can be a

humorous way to connect with people on less serious topics, it’s
usually not helpful when you’re talking to someone with cancer. This
person is coping with a very difficult diagnosis, and mentioning how
your Aunt Joan had the same type of cancer and did “so well”
typically isn’t helpful or appreciated. Even worse? Talking about
others who’ve died of cancer. This is not appropriate

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