If you, or someone you love, have been diagnosed with cancer, you may not know what to do. Here’s a list of tips and ways to cope with a cancer diagnosis.
What is Cancer?
Cancer is not a single disease. It is the general name for a group of more than 100 diseases in which cells in a part of the body begin to proliferate, or grow, wildly and invade other cells, which is something that normal cells are unable to do.
Cancer is the name given to a collection of related diseases. In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues.
Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and divide to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place.
When cancer develops, however, this orderly process breaks down. As cells become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells can divide without stopping and may form growths called tumors.
Many cancers form solid tumors, which are masses of tissue. Cancers of the blood, such as leukemia’s, generally do not form solid tumors.
Cancerous tumors are malignant, which means they can spread into or invade nearby tissues. In addition, as these tumors grow, some cancer cells can break off and travel to distant places in the body through the blood or the lymph system and form new tumors far from the original tumor.
Unlike malignant tumors, benign tumors do not spread into or invade nearby tissues. Benign tumors can sometimes be quite large, however. When removed, they usually don’t grow back, whereas malignant tumors sometimes do. Unlike most benign tumors elsewhere in the body, benign brain tumors can be life-threatening.
What Are The Differences Between Cancer Cells and Normal Cells?
Cancer cells differ from normal cells in many ways that allow them to grow out of control and become invasive. One important difference is that cancer cells are less specialized than normal cells. That is, whereas normal cells mature into very distinct cell types with specific functions, cancer cells do not. This is one reason that, unlike normal cells, cancer cells continue to divide without stopping.
In addition, cancer cells are able to ignore signals that normally tell cells to stop dividing or that begin a process known as programmed cell death, or apoptosis, which the body uses to get rid of unneeded cells.
Cancer cells may be able to influence the normal cells, molecules, and blood vessels that surround and feed a tumor—an area known as the micro-environment. For instance, cancer cells can induce nearby normal cells to form blood vessels that supply tumors with oxygen and nutrients, which they need to grow. These blood vessels also remove waste products from tumors.
Cancer cells are also often able to evade the immune system, a network of organs, tissues, and specialized cells that protects the body from infections and other conditions. Although the immune system normally removes damaged or abnormal cells from the body, some cancer cells are able to “hide” from the immune system.
Tumors can also use the immune system to stay alive and grow. For example, with the help of certain immune system cells that normally prevent a runaway immune response, cancer cells can actually keep the immune system from killing cancer cells.
What Causes Cancer To Grow?
The genetic changes that contribute to cancer tend to affect three main types of genes—proto-oncogenes, tumor suppressor genes, and DNA repair genes. These changes are sometimes called “drivers” of cancer.
- Proto-oncogenes are involved in normal cell growth and division. However, when these genes are altered in certain ways or are more active than normal, they may become cancer-causing genes (or oncogenes), allowing cells to grow and survive when they should not.
- Tumor suppressor genes are also involved in controlling cell growth and division. Cells with certain alterations in tumor suppressor genes may divide in an uncontrolled manner.
- DNA repair genes are involved in fixing damaged DNA. Cells with mutations in these genes tend to develop additional mutations in other genes. Together, these mutations may cause the cells to become cancerous.
As scientists have learned more about the molecular changes that lead to cancer, they have found that certain mutations commonly occur in many types of cancer. Because of this, cancers are sometimes characterized by the types of genetic alterations that are believed to be driving them, not just by where they develop in the body and how the cancer cells look under the microscope.
When Cancer Spreads
Cancer that has spread from the place where it first started to another place in the body is called metastatic cancer. The process by which cancer cells spread to other parts of the body is called metastasis.
Metastatic cancer has the same name and the same type of cancer cells as the original, or primary, cancer. For example, breast cancer that spreads to and forms a metastatic tumor in the lung is metastatic breast cancer, not lung cancer.
Under a microscope, metastatic cancer cells generally look the same as cells of the original cancer. Moreover, metastatic cancer cells and cells of the original cancer usually have some molecular features in common, such as the presence of specific chromosome changes.
Treatment may help prolong the lives of some people with metastatic cancer. In general, though, the primary goal of treatments for metastatic cancer is to control the growth of the cancer or to relieve symptoms caused by it. Metastatic tumors can cause severe damage to how the body functions and most people who die of cancer die of metastatic disease.
Cancer results from a process of altered cell differentiation and growth. The resulting tissue is called neoplasia.
Neoplasm is also called a tumor, although the two are not exactly the same.
Tumor: A swelling that can be caused by a number of conditions, including trauma and inflammation. They are named by adding an –oma to the tissue type that the growth originated from.
Metastasis: Development of a secondary tumor in a location distant from the primary tumor.
The type of cancer is named by its point of origin.
The ability to cure cancer varies widely and depends upon the type of cancer and the extent of the disease when the cancer is diagnosed.
There are two types of neoplasms: benign and malignant
Cell Characteristics: Well-differentiated cells that resemble cells from the origin of the tumor.
Mode of Growth: Grows through expansion, usually contained in a fibrous capsule, and does not invade surrounding tissues.
Rate of Growth: Slow, progressive growth rate.
Metastasis: Does not spread by metastasis.
General Effects: Because the tumor is localized, it does not cause generalized effects unless the location interferes with vital functions.
Ability to Cause Death: Typically does not involve death unless the location of the tumor interferes with vital functions.
Tissue Destruction: Typically does not cause tissue damage unless the location of the tumor obstructs blood flow.
Cell Characteristics: Cancerous cells are undifferentiated and often bear no resemblance to the tissue from which they originated.
Mode of Growth: Grows at the periphery and sends out processes that infiltrate and differentiate surrounding tissues.
Rate of Growth: Variable. The more atypical the cells, the more rapid the growth.
Metastasis: Accesses the blood and lymph systems and metastasizes to other parts of the body.
General Effects: Anemia, weight loss, and weakness.
Ability to Cause Death: Usually causes death unless the tumor is controlled.
Tissue Destruction: Extensive tissue damage when the tumor outgrows its blood supply or cuts off blood supply to the area. May produce substances that cause cell death.
Categories of Cancer:
1) Solid Tumors – initially confined to a single organ or tissue. As the cancerous tumor spreads, cells from the initial mass travel through the blood and lymphatic systems to create metastasis in distant sites of the body.
2) Hematologic Cancers – involve the blood-forming cells. Hematologic Cancers naturally migrate to the blood and lymph systems, causing them to disseminate from the get-go.
Carcinogens and Causes of Cancer:
Because cancer is not a single disease, but a group of diseases, it is likely that cancer does not have a single cause. It is more likely that cancer occurs due to a complex interaction between multiple risk factors, or exposure to a carcinogen.
Oncogenesis: genetic mechanism that transforms normal cells into cancer cells.
Carcinogens: a cancer-causing agent.
What Are The Types of Cancer?
There are more than 100 types of cancer. Types of cancer are usually named for the organs or tissues where the cancers form. For example, lung cancer starts in cells of the lung, and brain cancer starts in cells of the brain. Cancers also may be described by the type of cell that formed them, such as an epithelial cell or a squamous cell. Here are some categories of cancers that begin in specific types of cells:
Carcinomas are the most common type of cancer. They are formed by epithelial cells, which are the cells that cover the inside and outside surfaces of the body. There are many types of epithelial cells, which often have a column-like shape when viewed under a microscope.
- Carcinomas that begin in different epithelial cell types have specific names:
- Adenocarcinoma is cancer that forms in epithelial cells that produce fluids or mucus. Tissues with this type of epithelial cell are sometimes called glandular tissues. Most cancers of the breast, colon, and prostate are adenocarcinomas.
- Basal cell carcinoma is cancer that begins in the lower or basal (base) layer of the epidermis, which is a person’s outer layer of skin.
- Squamous cell carcinoma is cancer that forms in squamous cells, which are epithelial cells that lie just beneath the outer surface of the skin. Squamous cells also line many other organs, including the stomach, intestines, lungs, bladder, and kidneys. Squamous cells look flat, like fish scales, when viewed under a microscope. Squamous cell carcinomas are sometimes called epidermoid carcinomas.
- Transitional cell carcinoma is cancer that forms in a type of epithelial tissue called transitional epithelium, or urothelium. This tissue, which is made up of many layers of epithelial cells that can get bigger and smaller, is found in the linings of the bladder, ureters, and part of the kidneys (renal pelvis), and a few other organs. Some cancers of the bladder, ureters, and kidneys are transitional cell carcinomas.
Sarcomas are cancers that form in bone and soft tissues, including muscle, fat, blood vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments). Osteosarcoma is the most common cancer of the bone. The most common types of soft tissue sarcoma are leiomyosarcoma, Kaposi sarcoma, malignant fibrous histiocytoma, liposarcoma, and dermatofibrosarcoma protuberans.
Cancers that begin in the blood-forming tissue of the bone marrow are called leukemias. These cancers do not form solid tumors. Instead, large numbers of abnormal white blood cells (leukemia cells and leukemic blast cells) build up in the blood and bone marrow, crowding out normal blood cells. The low level of normal blood cells can make it harder for the body to get oxygen to its tissues, control bleeding, or fight infections. There are four common types of leukemia, which are grouped based on how quickly the disease gets worse (acute or chronic) and on the type of blood cell cancer starts in (lymphoblastic or myeloid).
Lymphoma is cancer that begins in lymphocytes (T cells or B cells). These are disease-fighting white blood cells that are part of the immune system. In lymphoma, abnormal lymphocytes build up in lymph nodes and lymph vessels, as well as in other organs of the body. There are two main types of lymphoma:
- Hodgkin lymphoma – People with this disease have abnormal lymphocytes that are called Reed-Sternberg cells. These cells usually form from B cells.
- Non-Hodgkin lymphoma – This is a large group of cancers that start in lymphocytes. The cancers can grow quickly or slowly and can form from B cells or T cells.
Multiple myeloma is cancer that begins in plasma cells, another type of immune cell. The abnormal plasma cells, called myeloma cells, build up in the bone marrow and form tumors in bones all through the body. Multiple myeloma is also called plasma cell myeloma and Kahler disease.
Melanoma is cancer that begins in cells that become melanocytes, which are specialized cells that make melanin (the pigment that gives skin its color). Most melanomas form on the skin, but melanomas can also form in other pigmented tissues, such as the eye.
Brain and Spinal Cord Tumors
There are different types of brain and spinal cord tumors. These tumors are named based on the type of cell in which they formed and where the tumor first formed in the central nervous system. For example, an astrocytic tumor begins in star-shaped brain cells called astrocytes, which help keep nerve cells healthy. Brain tumors can be benign (not cancer) or malignant (cancer).
Other Types of Tumors
Germ Cell Tumors
Germ cell tumors are a type of tumor that begins in the cells that give rise to sperm or eggs. These tumors can occur almost anywhere in the body and can be either benign or malignant.
Neuroendocrine tumors form from cells that release hormones into the blood in response to a signal from the nervous system. These tumors, which may make higher-than-normal amounts of hormones, can cause many different symptoms. Neuroendocrine tumors may be benign or malignant
Carcinoid tumors are a type of neuroendocrine tumor. They are slow-growing tumors that are usually found in the gastrointestinal system (most often in the rectum and small intestine). Carcinoid tumors may spread to the liver or other sites in the body, and they may secrete substances such as serotonin or prostaglandins, causing carcinoid syndrome.
Risk Factors For Developing Cancer:
Cancer is a genetic disease—that is, it is caused by changes to genes that control the way our cells function, especially how they grow and divide.
Genetic Risk Factors: There is a hereditary predisposition to certain types of cancers, including breast cancer. Genetic changes that cause cancer can be inherited from our parents. They can also arise during a person’s lifetime as a result of errors that occur as cells divide or because of damage to DNA caused by certain environmental exposures. Cancer-causing environmental exposures include substances, such as the chemicals in tobacco smoke, and radiation, such as ultraviolet rays from the sun.
Each person’s cancer has a unique combination of genetic changes. As the tumor continues to grow, additional changes will occur. Even within the same tumor, different cells may have different genetic changes.
In general, cancer cells have more genetic changes, such as mutations in DNA, than normal cells. Some of these changes may have nothing to do with cancer; they may be the result of cancer, rather than its cause.
Environmental Risk Factors: The effects of carcinogenic agents are typically dose-dependent. The larger the dose/longer duration of exposure, the greater the risk of developing cancer. Environmental Carcinogens include ionizing radiation, tobacco, tars, oils, certain foods, insecticides, fungicides, benzene, and other industrial agents.
Oncogenic Viruses: Some viruses, such as HPV (human papillomavirus) and T-Cell Leukemia Virus 1, are known to either cause cancer or to increase the risks of developing certain types of cancer.
Immunologic Defects: It has long been suspected that the development of cancer may be associated with an impairment of the immune system or a weakness in the immune system.
Diagnosis of Cancer:
Cancer is nearly always diagnosed by an expert who has looked at cell or tissue samples under a microscope. In some cases, tests done on the cells’ proteins, DNA, and RNA can help tell doctors if there’s cancer. These test results are very important when choosing the best treatment options.
If you have a symptom or your screening test result suggests cancer, the doctor must find out whether it is due to cancer or some other cause. The doctor may ask about your personal and family medical history and do a physical exam. The doctor also may order lab tests, scans, or other tests or procedures.
Tests of cells and tissues can find many other kinds of diseases, too. For instance, if doctors are not sure a lump is cancer, they may take out a small piece of it and have it tested for cancer and for infections or other problems that can cause growths that may look like cancer.
The procedure that takes out a piece of the lump or a sample for testing is called a biopsy.
The tissue sample is called the biopsy specimen.
The testing process is sometimes referred to as pathology.
Lumps that could be cancer might be found by imaging tests or felt as lumps during a physical exam, but they still must be sampled and looked at under a microscope to find out what they really are. Not all lumps are cancer. In fact, most tumors are not cancer.
High or low levels of certain substances in your body can be a sign of cancer. So, lab tests of the blood, urine, or other body fluids that measure these substances can help doctors make a diagnosis. However, abnormal lab results are not a sure sign of cancer. Lab tests are an important tool, but doctors cannot rely on them alone to diagnose cancer.
Imaging procedures create pictures of areas inside your body that help the doctor see whether a tumor is present. These pictures can be made in several ways:
- CT Scan:
An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive a dye or other contrast material to highlight areas inside the body. Contrast material helps make these pictures easier to read.
- Nuclear scan:
For this scan, you receive an injection of a small amount of radioactive material, which is sometimes called a tracer. It flows through your bloodstream and collects in certain bones or organs. A machine called a scanner detects and measures the radioactivity. The scanner creates pictures of bones or organs on a computer screen or on film. Your body gets rid of the radioactive substance quickly. This type of scan may also be called a radionuclide scan.
An ultrasound device sends out sound waves that people cannot hear. The waves bounce off tissues inside your body like an echo. A computer uses these echoes to create a picture of areas inside your body. This picture is called a sonogram.
A strong magnet linked to a computer is used to make detailed pictures of areas in your body. Your doctor can view these pictures on a monitor and print them on film.
- PET scan:
For this scan, you receive an injection of a tracer. Then, a machine makes 3-D pictures that show where the tracer collects in the body. These scans show how organs and tissues are working.
X-rays use low doses of radiation to create pictures of the inside of your body.
In most cases, doctors need to do a biopsy to make a diagnosis of cancer. A biopsy is a procedure in which the doctor removes a sample of tissue. A pathologist then looks at the tissue under a microscope to see if it is cancer. The sample may be removed in several ways:
- With a needle: The doctor uses a needle to withdraw tissue or fluid.
- With an endoscope: The doctor looks at areas inside the body using a thin, lighted tube called an endoscope. The scope is inserted through a natural opening, such as the mouth. Then, the doctor uses a special tool to remove tissue or cells through the tube.
- With surgery: Surgery may be excisional or incisional.
- In an excisional biopsy, the surgeon removes the entire tumor. Often some of the normal tissue around the tumor also is removed.
- In an incisional biopsy, the surgeon removes just part of the tumor.
How Is Cancer Staged?
Stage refers to the extent of your cancer, such as how large the tumor is, and if it has spread. Knowing the stage of your cancer helps your doctor:
- Understand how serious your cancer is and your chances of survival
- Plan the best treatment for you
- Identify clinical trials that may be treatment options for you
Cancer is always referred to by the stage it was given at diagnosis, even if it gets worse or spreads. New information about how cancer has changed over time gets added on to the original stage. So, the stage doesn’t change, even though the cancer might.
How Stage Is Determined
To learn the stage of your disease, your doctor may order x-rays, lab tests, and other tests or procedures.
Systems that Describe Stage
There are many staging systems. Some, such as the TNM staging system, are used for many types of cancer. Others are specific to a particular type of cancer. Most staging systems include information about:
- Where the tumor is located in the body
- The cell type (such as adenocarcinoma or squamous cell carcinoma)
- The size of the tumor
- Whether cancer has spread to nearby lymph nodes
- Whether cancer has spread to a different part of the body
- Tumor grade, which refers to how abnormal the cancer cells look and how likely the tumor is to grow and spread
The TNM Staging System
The TNM system is the most widely used cancer staging system. Most hospitals and medical centers use the TNM system as their main method for cancer reporting. You are likely to see your cancer described by this staging system in your pathology report unless you have a type of cancer for which a different staging system is used. Examples of cancers with different staging systems include brain and spinal cord tumors and blood cancers.
In the TNM system:
- The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor.
- The N refers to the number of nearby lymph nodes that have cancer.
- The M refers to whether cancer has metastasized. This means that cancer has spread from the primary tumor to other parts of the body.
When your cancer is described by the TNM system, there will be numbers after each letter that give more details about cancer—for example, T1N0MX or T3N1M0. The following explains what the letters and numbers mean:
Primary tumor (T)
- TX: Main tumor cannot be measured.
- T0: Main tumor cannot be found.
- T1, T2, T3, T4: Refers to the size and/or extent of the main tumor. The higher the number after the T, the larger the tumor or the more it has grown into nearby tissues. T’s may be further divided to provide more detail, such as T3a and T3b.
Regional lymph nodes (N)
- NX: Cancer in nearby lymph nodes cannot be measured.
- N0: There is no cancer in nearby lymph nodes.
- N1, N2, N3: Refers to the number and location of lymph nodes that contain cancer. The higher the number after the N, the more lymph nodes that contain cancer.
Distant metastasis (M)
- MX: Metastasis cannot be measured.
- M0: Cancer has not spread to other parts of the body.
- M1: Cancer has spread to other parts of the body.
Other Ways to Describe Stage
The TNM system helps describe cancer in great detail. But, for many cancers, the TNM combinations are grouped into five less-detailed stages. When talking about your cancer, your doctor or nurse may describe it as one of these stages:
|Stage||What it means|
|Stage 0||Abnormal cells are present but have not spread to nearby tissue. Also called carcinoma in situ or CIS. CIS is not cancer, but it may become cancer.|
|Stage I, Stage II, and Stage III||Cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues.|
|Stage IV||Cancer has spread to distant parts of the body.|
Another staging system that is used for all types of cancer groups each cancer into one of five main categories. This staging system is more often used by cancer registries than by doctors. But, you may still hear your doctor or nurse describe your cancer in one of the following ways:
- In situ—Abnormal cells are present but have not spread to nearby tissue.
- Localized—Cancer is limited to the place where it started, with no sign that it has spread.
- Regional—Cancer has spread to nearby lymph nodes, tissues, or organs.
- Distant—Cancer has spread to distant parts of the body.
- Unknown—There is not enough information to figure out the stage.
The goals for cancer treatment are composed of three things: curative, controlling, and palliative.
Cancer treatment is executed by an interdisciplinary team of specialists, which includes doctors, nurses, oncologists, pharmacists, and surgeons.
Types of Cancer Treatment:
1) Surgery is used for cancer diagnosis, staging of cancer, tumor removal, and palliative care (relieving symptoms).
2) Radiation Therapy can be used alone or in combination with other therapies to target and destroy tumors while causing less normal tissue damage.
3) Chemotherapy can be used alone or in combination with other cancer treatments.
4) Hormone Therapy involves administering hormones or hormone-blocking drugs on tumors dependent upon hormones for growth.
5) Biologic Response Modifiers (MRMs) are used in Biotherapy to change the person’s own biological response to the tumor.
6) Bone Marrow and Peripheral Blood Stem Cell Transplants provide the cancer-killing effects while replenishing the stem cells of a patient.
7) Gene Therapy is the alteration of one’s own genes to fight or prevent disease. May be very important in the future.
Cancer Resources Hotlines:
American Cancer Society: 1-800-227-2345
National Cancer Institute: 1-800-4CANCER
Additional Cancer Resources:
National Cancer Institute – coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients. The website has links to clinical trials and a comprehensive list of cancer-treating drugs.
Stand Up To Cancer – a new initiative created to accelerate groundbreaking cancer research that will get new therapies to patients quickly and save lives. SU2C’s goal is to bring together the best and the brightest in the cancer community, encouraging collaboration instead of competition. By galvanizing the entertainment industry, SU2C creates awareness and builds broad public support for this effort.
Relay For Life – the signature fundraising event of the American Cancer Society. The website gives links to information about how to get involved with the event locally.
Mesothelioma Prognosis – features information on the dangers of asbestos, mesothelioma, and where to find treatment facilities in your area. Patient advocates are also on hand to help get connected with doctor match programs.
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