A neoplasm and malignant tumour are other familiar names for cancer, the second leading cause of death globally, accounting for an estimated 9.6 million people. Cancer, also called malignancy, is the uncontrolled growth of abnormal cells anywhere in a body. These abnormal cells are termed cancer cells, malignant cells, or tumor cells and can infiltrate normal body tissues. There are more than 100 types of cancer. Many cancers and the abnormal cells that compose the cancer tissue are further identified by the name of the tissue that the abnormal cells originated from (for example, breast cancer, skin cancer, lung cancer, colon cancer, prostate cancer, lymphoma). It has been found that primary tumors in the following locations are associated with a relatively high prevalence of pain: (a) Head and neck (67 to 91 percent) (b) Prostate (56 to 94 percent) (c) Uterus (30 to 90 percent) (d) The genitourinary system (58 to 90 percent) (d) Breast (40 to 89 percent) (e) Pancreas (72 to 85 percent) and (f) Esophagus (56 to 94 percent). Cancer is not confined to humans; animals and other living organisms can get cancer. The Figure attached shows normal cell division and how when a cell is damaged or altered without repair to its system, the cell usually dies. Also shown is what occurs when such damaged or unrepaired cells do not die and become cancer cells and show uncontrolled division and growth — a mass of cancer cells develop. Frequently, cancer cells can break away from this original mass of cells, travel through the blood and lymph systems, and lodge in other organs where they can again repeat the uncontrolled growth cycle. This process of cancer cells leaving an area and growing in another body area is termed metastatic spread or metastasis. For example, if breast cancer cells spread to a bone, it means that the individual has metastatic breast cancer to bone. This is not the same as “bone cancer,” which would mean the cancer had started in the bone. The symptoms of cancer vary depending on the type. There are many causes of cancer, and some are preventable. In addition to smoking, risk factors for cancer include: heavy alcohol consumption, excess body weight, physical inactivity and poor nutrition. Other causes of cancer are not preventable. Currently, the most significant unpreventable risk factor is age. According to the American Cancer Society, doctors in the U.S. diagnose 87 percent of cancer cases in people ages 50 years or older. The Genetic factors can contribute to the development of cancer. A person’s genetic code tells their cells when to divide and expire. Changes in the genes can lead to faulty instructions, and cancer can result. Genes also influence the cells’ production of proteins, and proteins carry many of the instructions for cellular growth and division. Some genes change proteins that would usually repair damaged cells. This can lead to cancer. If a parent has these genes, they may pass on the altered instructions to their offspring. Some genetic changes occur after birth, and factors such as smoking and sun exposure can increase the risk. Other changes that can result in cancer take place in the chemical signals that determine how the body deploys, or “expresses” specific genes. Finally, a person can inherit a predisposition for a type of cancer. A doctor may refer to this as having a hereditary cancer syndrome. Inherited genetic mutations significantly contribute to the development of 5–10 percent of cancer cases. Cancer causes about 1 in every 6 deaths worldwide, more than AIDS, tuberculosis, and malaria combined. Today, it is the second-leading cause of death (following cardiovascular diseases) worldwide and in high- and very high Human Development Index (HDI) countries. By 2040, the global burden is expected to grow to 27.5 million new cancer cases and 16.3 million cancer deaths simply due to the growth and aging of the population. Innovative research has fueled the development of new medications and treatment technologies. Doctors usually prescribe treatments based on the type of cancer, its stage at diagnosis, and the person’s overall health. The side effects of chemotherapy include hair loss. However, advances in treatment are improving the outlook for people with cancer. Below are examples of approaches to cancer treatment: (a) Chemotherapy aims to kill cancerous cells with medications that target rapidly dividing cells. The drugs can also help shrink tumors, but the side effects can be severe (b) Hormone therapy involves taking medications that change how certain hormones work or interfere with the body’s ability to produce them. When hormones play a significant role, as with prostate and breast cancers, this is a common approach (c) Immunotherapy uses medications and other treatments to boost the immune system and encourage it to fight cancerous cells. Two examples of these treatments are checkpoint inhibitors and adoptive cell transfer (d) Precision medicine, or personalized medicine, is a newer, developing approach. It involves using genetic testing to determine the best treatments for a person’s particular presentation of cancer. Researchers have yet to show that it can effectively treat all types of cancer, however (e) Radiation therapy uses high-dose radiation to kill cancerous cells. Also, a doctor may recommend using radiation to shrink a tumor before surgery or reduce tumor-related symptoms (f) Stem cell transplant can be especially beneficial for people with blood-related cancers, such as leukemia or lymphoma. It involves removing cells, such as red or white blood cells, that chemotherapy or radiation has destroyed. Lab technicians then strengthen the cells and put them back into the body (g) Surgery is often a part of a treatment plan when a person has a cancerous tumor. Also, a surgeon may remove lymph nodes to reduce or prevent the disease’s spread (h) Targeted therapies perform functions within cancerous cells to prevent them from multiplying. They can also boost the immune system. Two examples of these therapies are small-molecule drugs and monoclonal antibodies. Doctors will often employ more than one type of treatment to maximize effectiveness. The origin of the word cancer is credited to the Greek physician Hippocrates (460-370 BC), who is considered the “Father of Medicine.” The earliest known descriptions of cancer appear in several papyri from Ancient Egypt. The world’s oldest documented case of cancer hails from ancient Egypt in 1500 BC. The details were recorded on papyrus, documenting eight cases of tumors occurring on the breast. The Edwin Smith Papyrus was written around 1600 BC (possibly a fragmentary copy of a text from 2500 BC) and contains a description of cancer, as well as a procedure to remove breast tumours by cauterization, wryly stating that the disease has no treatment. However, cancer incidents were rare. In a study by the University of Manchester, only one case was found “in the investigation of hundreds of Egyptian mummies, with few references to cancer in literary evidence.” Hippocrates (ca. 460 BC – ca. 370 BC) described several kinds of cancer, referring to them by the term karkinos (carcinos), the Greek word for crab or crayfish, as well as carcinoma. This comes from the appearance of the cut surface of a solid malignant tumour, with “the veins stretched on all sides as the animal the crab has its feet, whence it derives its name”. Since it was against Greek tradition to open the body, Hippocrates only described and made drawings of outwardly visible tumors on the skin, nose, and breasts. Treatment was based on the humor theory of four bodily fluids (black and yellow bile, blood, and phlegm). According to the patient’s humor, treatment consisted of diet, blood-letting, and/or laxatives. Celsus (ca. 25 BC – 50 AD) translated karkinos into cancer, the Latin word for crab or crayfish. The Greek physician Galen in the 2nd century AD used oncos (Greek for swelling) to describe all tumours, reserving Hippocrates’ term carcinos for malignant tumours. He also used the suffix -oma to indicate cancerous lesions. It is from Galen’s usage that we derive the modern word oncology. Through the centuries it was discovered that cancer could occur anywhere in the body, but Hippocrates’ humor-theory based treatment remained popular until the 19th century with the discovery of cells. It became more acceptable for doctors to dissect bodies to discover the cause of death in the 16th and 17th centuries. Wilhelm Fabry, German professor believed that breast cancer was caused by a milk clot in a mammary duct while Francois de la Boe Sylvius, Dutch professor a follower of Descartes, believed that all disease was the outcome of chemical processes, and that acidic lymph fluid was the cause of cancer. Nicolaes Tulp, his contemporary believed that cancer was a poison that slowly spreads, and concluded that it was contagious. In 1775 the first cause of cancer was identified by British surgeon Percivall Pott, who discovered that cancer of the scrotum was a common disease among chimney sweeps. In the 18th century with the widespread use of the microscope, it was discovered that the ‘cancer poison’ eventually spreads from the primary tumor through the lymph nodes to other sites (“metastasis”). This view of the disease was first formulated by the English surgeon Campbell De Morgan between 1871 and 1874. The use of surgery to treat cancer had poor results due to problems with hygiene but in the 19th century, asepsis improved surgical hygiene and as the survival statistics went up, surgical removal of the tumor became the primary treatment for cancer.
A founding paper of cancer epidemiology was the work of Janet Lane-Claypon, who published a comparative study in 1926 of 500 breast cancer cases and 500 control patients of the same background and lifestyle for the British Ministry of Health. Her groundbreaking work on cancer epidemiology was carried on by Richard Doll and Austin Bradford Hill, who published “Lung Cancer and Other Causes of Death In Relation to Smoking. A Second Report on the Mortality of British Doctors” followed in 1956 (otherwise known as the British doctors study). Richard Doll left the London Medical Research Center (MRC), to start the Oxford unit for Cancer epidemiology in 1968. With the use of computers, the unit was the first to compile large amounts of cancer data. Modern epidemiological methods are closely linked to current concepts of disease and public health policy. Over the past 50 years, great efforts have been spent on gathering data across medical practice, hospital, provincial, state, and even country boundaries to study the interdependence of environmental and cultural factors on cancer incidence. The special day of Cancer awareness observed on 7th November, 2021 is to stress upon the the early detection and cure of cancer. On National Cancer Awareness Day, people are encouraged to report to government hospitals, CGHS and municipal clinics for free screening. To highlight the significance of increased awareness about cancer prevention and early detection among the general public, the ‘National Cancer Awareness Day’ is observed on November 7. The government had initiated the National Cancer Control Program in 1975 with a view to provide cancer treatment facilities in the country and in 1984-85 was given the thrust on prevention and early detection of the disease. The day coincides with the birth anniversary of eminent French-Polish scientist Madame Curie. Curie is known for her discovery of radium and polonium, and her huge contribution to the fight against cancer. Her groundbreaking work led to the development of nuclear energy and radiotherapy for the treatment of cancer. In 2014, Union Health Minister Dr Harsh Vardhan had first announced the National Cancer Awareness Day with an aim to generate awareness on early detection and avoid leading cancer causing lifestyles. In India, nearly 1.1 million new cases are being reported annually. Two-thirds of cancer cases are diagnosed at an advanced stage, reducing patients’ chances of survival. It is estimated that one woman dies of cervical cancer every 8 minutes in India. Tobacco (smoked and smokeless) use accounted for 3,17,928 deaths (approx) in men and women in 2018. Cancers of oral cavity and lungs account for over 25% of cancer deaths in males and cancer of breast and oral cavity account for 25% cancers in females. A Lancet report reveals that the use of tobacco is a risk factor for 14 types of cancer. Other causes include alcohol, drug use, and poor diet. Unsafe sex is also the main risk factor for cervical cancer and is the second most common cancer type in women. High risk of lung cancer is tobacco use and air pollution. How To Observe National Cancer Awareness Day? (a) Get a screening: Early detection of cancer can be life-saving. Every year, make sure to book an appointment to a doctor and get tested. The highest cancer rate is in Australia. The number of cancer cases in India is estimated to be 13.9 lakh this year and may increase to 15.7 lakh by 2025, with its prevalence being marginally higher among women, according to a report. However, the one good thing is that at least one-third of common cancers are preventable. Out of all the types of cancers, breast cancer has become a major health concern across Indian cities. Cancer screening and detection services are available in maximum cities of India such as Ahmedabad, Amritsar, Aurangabad, Bangalore, Bhilai, Bhopal, Bhubaneswar, Chandigarh, Chennai, Dehradun, Delhi-NCR, Ernakulam, Guwahati, Hyderabad, Lucknow, Ludhiana, Indore, Jaipur, Jalandhar, Kannur, Kochi, Kolkata, Kolhapur, Kollam, Kottayam, Madurai, Mohali, Mumbai, Nagpur, Palakkad, Pathankot, Patna, Pondicherry, Pune, Sangli, Surat, Tirunelveli, Trichy and Vellore. (b) Inform friends and family about early detection: National Cancer Awareness Day is all about informing those you love about the prevention of cancer. Look online or give an information booklet to generate awareness on how to avoid getting cancer and how to look for signs of early symptoms of cancer. (c) Read up about Marie Currie: National Cancer Awareness Day is observed on November 7 each year in remembrance of Marie Currie’s birth. The scientist was born in 1867 and is noted for her brilliant work leading to the development of nuclear energy and radiotherapy for the treatment of cancer. Make sure to note Marie Currie’s Nobel Prizes in the field of science. In brief, the cancer-prevention tips are Don’t use tobacco, Eat a healthy diet, Maintain a healthy weight and be physically active, Protect yourself from the sun, Get vaccinated, Avoid risky behaviors and Get regular medical care.
( While Bilkees Nazir is a Research scholar at the Department of Zoology University of Kashmir Hazratbal Srinagar, Dr Bilal A Bhat is Associate Professor at S K University of Agriculture Sciences & Technology –SKUAST Kashmir Srinagar. Views are their own)