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cancer - Google News
cancer - Google News
Excessive cell phone use may lead to cancer: expert - Hindu Business Line
CTV.ca
Excessive cell phone use may lead to cancer: expert
Hindu Business Line, India - 4 hours ago
NEW YORK: Excessive use of cell phones may lead to possible health hazards, including cancer, a US expert has warned. Director of the University of ...
Cancer expert rings alarm over kids' cellphones Vancouver Sun
Prominent cancer doctor warns of cellphone risks CTV.ca
Cancer doc urges cell phone precaution CNET News
WebMD - ABC News
all 842 news articles
McCain Addresses Cancer Summit, Goes After Congress - FOXNews
Boston Globe
McCain Addresses Cancer Summit, Goes After Congress
FOXNews - 23 minutes ago
(AP Photo) By Shushannah Walshe John McCain spoke about an old foe Thursday evening ? not a political opponent but cancer. The Arizona senator addressed the ...
Former smoker McCain talks cigarettes, cancer with Lance Armstrong Reuters
McCain Veers Off Script, Talks About His Cancer Battle Wall Street Journal Blogs
Barack Obama misses a cancer forum Los Angeles Times
10TV - FOXNews
all 117 news articles
Apple's future without Steve Jobs - BBC News
BBC News
Apple's future without Steve Jobs
BBC News, UK - 1 hour ago
It was no secret that he had pancreatic cancer and four years ago underwent surgery which was hailed a success. But the topic took centre stage again this ...
Apple up on report Jobs is cancer-free San Francisco Chronicle
Apple Rises After NY Times Says Jobs Is Cancer-Free (Update1) Bloomberg
Steve Jobs is 'cancer-free' Register
ITP.net - SYS-CON Media
all 273 news articles
Father of Mets pitcher Martinez dies at 79 after cancer battle - The Canadian...
CBC.ca
Father of Mets pitcher Martinez dies at 79 after cancer battle
The Canadian Press, Dominican Republic - 21 hours ago
Martinez's father, Pablo Jaime, died early Thursday at age 79 after battling a form of brain cancer for more than a year. Martinez, had gone home just ...
Pedro's father loses battle with cancer MLB.com
Martinez working on return when father dies of cancer - MLB ESPN
Pedro Martinez scratched after dad's death SportingNews.com
Dominican Today - New York Daily News
all 164 news articles
Cases of prostate cancer have gone up but a cure is on the way - Daily Nation
Daily Nation
Cases of prostate cancer have gone up but a cure is on the way
Daily Nation, Kenya - 16 hours ago
Kenyan men should brace for bad news ? it has been confirmed that cases of prostate cancer are highest among Africans compared to other races. ...
Prostate cancer drug trials to start in Belfast Belfast Telegraph
New Drug Brings Advanced Cancer Patients Back to Life ABC News
New prostate cancer drug shows promise for patients Dubbo Daily Liberal
ACS News Center - New Scientist (subscription)
all 491 news articles
Cancer Vaccine From Tobacco Plants? - CollegeOTR
Joy Online
Cancer Vaccine From Tobacco Plants?
CollegeOTR, NY - 9 hours ago
By saycheese (Chief Contributor) An experimental cancer vaccine made from genetically altered tobacco plants has been proven to work as a helpful cure for a ...
Using Tobacco to Fight Cancer HealthNews
Tobacco Plants Can Become An Important Ally In Fight With Cancer eFluxMedia
Tobacco Plants Used As Basis For Cancer Vaccine Evening Bulletin
FierceBioResearcher - Scientific American
all 173 news articles
Moffitt Cancer Center joins Delcath System clinical trial - Bizjournals.com
Moffitt Cancer Center joins Delcath System clinical trial
Bizjournals.com, NC - 17 hours ago
Delcath (NASDAQ: DCTH), based in Stamford, Conn., is a developmental stage company testing a proprietary technology for the delivery of the anti-cancer ...
Delcath Expands Phase III Trial for Metastatic Melanoma to Florida CNNMoney.com
all 16 news articles
Nexavar Improves Liver Cancer Survival Rates - eMaxHealth.com
TopNews
Nexavar Improves Liver Cancer Survival Rates
eMaxHealth.com, NC - 27 minutes ago
A joint team of researchers from Hospital Clinic of Barcelona and Barcelona Clinic Liver Cancer (BCLC) Group has examined 602 advanced liver cancer patients ...
Sorafenib increases life expectancy in liver cancer patients Nursing Times
Targeted Drug Boosts Survival Among Liver Cancer Patients Washington Post
Anti-cancer drug extends life of liver cancer patients CTV.ca
Cancer Consultants - Wall Street Journal Blogs
all 41 news articles
Swimmer with cancer cleared for Beijing - San Jose Mercury News
Swimmer with cancer cleared for Beijing
San Jose Mercury News, USA - Jul 24, 2008
By Elliott Almond Eric Shanteau, the swimmer who learned last month that he has testicular cancer, has been cleared to travel to Beijing for the Summer ...
Shanteau, despite cancer, continues Games preparation USA Today
Swimmer with cancer cleared to head to Beijing The Associated Press
Shanteau battles cancer while training for Olympics in Beijing The Auburn Plainsman
KPTM-TV - Arizona Republic
all 118 news articles
IU cancer center hopes to put patients at ease - Indianapolis Star
IU cancer center hopes to put patients at ease
Indianapolis Star, United States - 7 hours ago
You're now in the middle of what Indiana University hopes will be the future of cancer care. The fancy touches and posh chemotherapy clinics at the new IU ...
Bold new front in war against killer disease Indianapolis Star
all 3 news articles
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news disease cancer - Google News
news disease cancer - Google News
Blogs help cancer patients cope with disease - Seattle Post Intelligencer
Blogs help cancer patients cope with disease
Seattle Post Intelligencer - 6 hours ago
By CHERIE BLACK One of the first things people do when they are diagnosed with cancer is go online and look up their disease. The Internet has become a ...
How living well could save your life - Coventry Telegraph
How living well could save your life
Coventry Telegraph, UK - 22 minutes ago
But after a relapse a few years later, he began researching other ways to fight the disease. "Cancer lies dormant in all of us," Servan-Shreiber says. ...
McCain Addresses Cancer Summit, Goes After Congress - FOXNews
Boston Globe
McCain Addresses Cancer Summit, Goes After Congress
FOXNews - 23 minutes ago
... the Lance Armstrong Foundation that focused on all issues surrounding cancer: treatment, health insurance, funding, care and eradication of the disease. ...
McCain holds small events in a key state: Ohio Los Angeles Times
McCain In Columbus To Help Fight Cancer WHIOtv.com
Hundreds Descend On Columbus To Re-arm War On Cancer NewsRadio 610 WTVN
Columbus Dispatch - Dayton Daily News
all 117 news articles
Bold new front in war against killer disease - Indianapolis Star
Bold new front in war against killer disease
Indianapolis Star, United States - 7 hours ago
"If we don't cure cancer," he said this week in a meeting with The Star's Editorial Board, "we will make it a chronic (that is, managed) disease. ...
IU cancer center hopes to put patients at ease Indianapolis Star
all 3 news articles
Cases of prostate cancer have gone up but a cure is on the way - Daily Nation
Daily Nation
Cases of prostate cancer have gone up but a cure is on the way
Daily Nation, Kenya - 16 hours ago
He said that most men who report with prostate cancer for treatment did so when the disease has progressed too far. This was true for about 85000 patients ...
Prostate cancer drug trials to start in Belfast Belfast Telegraph
Friday Wisdom: The good, the bad and the ugly Malta Independent Online
New Drug Brings Advanced Cancer Patients Back to Life ABC News
The Punch - Scotsman
all 491 news articles
Sixth-form girls to be given sex-disease cancer jab - Times Online
ITV.com
Sixth-form girls to be given sex-disease cancer jab
Times Online, UK - Jul 19, 2008
... the two strains of the human papilloma virus that cause 70% of cases of cervical cancer, the second most common form of the disease in women worldwide. ...
Hillsborough County offers free HPV vaccine Tampa Bay's 10
Cancer drug hope for teenage girls Norwich Evening News
Britain planning cervical cancer efforts United Press International
Times Online
all 61 news articles
Excessive cell phone use may lead to cancer: expert - Hindu Business Line
CTV.ca
Excessive cell phone use may lead to cancer: expert
Hindu Business Line, India - 4 hours ago
... experts say that the warning is premature as studies have not conclusively proved that excessive use of c ell phone leads to cancer or other disease. ...
Cell Phones: Cancer Link? WRBL
US Cancer Authority Says Cell Phone Cancer May Be Real PR-Inside.com (Pressemitteilung)
Mobiles warning The Sun
MedPage Today
all 842 news articles
Targeted Drug Boosts Survival Among Liver Cancer Patients - Washington Post
TopNews
Targeted Drug Boosts Survival Among Liver Cancer Patients
Washington Post, United States - Jul 23, 2008
About 18410 people will die because of liver cancer during 2008, reports the ACS. The disease is much more common in men and is more likely to occur in ...
Nexavar Improves Liver Cancer Survival Rates eMaxHealth.com
NEJM Publishes NexavarŽ (sorafenib) Study Demonstrating Major ... Medical News Today (press release)
Nexavar Works for Liver Cancer, But It Isn?t Cheap Wall Street Journal Blogs
TopNews - Cancer Consultants
all 41 news articles
Gene Responsible For Rare Childhood Disease Identified - Science Daily (press...
Gene Responsible For Rare Childhood Disease Identified
Science Daily (press release) - 14 minutes ago
"By understanding the role of EpCAM in the intestine, it may also lead to better understanding of diseases such as colon cancer and inflammatory bowel ...
Skin cancer fears may increase risk of bone thinning disease - Cancer Researc...
Skin cancer fears may increase risk of bone thinning disease
Cancer Research UK - News & Resources, UK - 46 minutes ago
British people may not be not getting enough sunlight to generate sufficient levels of vitamin D, as they are worried about the possibility of skin cancer, ...
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Cancer Information
Cancer is a group of diseases in which cells are aggressive
(grow and divide without respect to normal limits), invasive
(invade and destroy adjacent tissues), and/or metastatic (spread
to other locations in the body). These three malignant
properties of cancers differentiate them from benign tumors,
which are self-limited in their growth and do not invade or
metastasize (although some benign tumor types are capable of
becoming malignant). Cancer may affect people at all ages, even
fetuses, but risk for the more common varieties tends to
increase with age.[1] Cancer causes about 13% of all deaths.[2]
Apart from people, forms of cancer may affect animals and
plants.
Nearly all cancers are caused by abnormalities in the genetic
material of the transformed cells. These abnormalities may be
due to the effects of carcinogens, such as tobacco smoke,
radiation, chemicals, or infectious agents. Other
cancer-promoting genetic abnormalities may be randomly acquired
through errors in DNA replication, or are inherited, and thus
present in all cells from birth. Complex interactions between
carcinogens and the host genome may explain why only some
develop cancer after exposure to a known carcinogen. New aspects
of the genetics of cancer pathogenesis, such as DNA methylation,
and microRNAs are increasingly being recognized as important.
Genetic abnormalities found in cancer typically affect two
general classes of genes. Cancer-promoting oncogenes are often
activated in cancer cells, giving those cells new properties,
such as hyperactive growth and division, protection against
programmed cell death, loss of respect for normal tissue
boundaries, and the ability to become established in diverse
tissue environments. Tumor suppressor genes are often
inactivated in cancer cells, resulting in the loss of normal
functions in those cells, such as accurate DNA replication,
control over the cell cycle, orientation and adhesion within
tissues, and interaction with protective cells of the immune
system.
Cancer is usually classified according to the tissue from which
the cancerous cells originate, as well as the normal cell type
they most resemble. These are location and histology,
respectively. A definitive diagnosis usually requires the
histologic examination of a tissue biopsy specimen by a
pathologist, although the initial indication of malignancy can
be symptoms or radiographic imaging abnormalities. Most cancers
can be treated and some cured, depending on the specific type,
location, and stage. Once diagnosed, cancer is usually treated
with a combination of surgery, chemotherapy and radiotherapy. As
research develops, treatments are becoming more specific for
different varieties of cancer. There has been significant
progress in the development of targeted therapy drugs that act
specifically on detectable molecular abnormalities in certain
tumors, and which minimize damage to normal cells. The prognosis
of cancer patients is most influenced by the type of cancer, as
well as the stage, or extent of the disease. In addition,
histological grading and the presence of specific molecular
markers can also be useful in establishing prognosis, as well as
in determining individual treatments.
Adult cancers
In the U.S. and other developed countries, cancer is presently
responsible for about 25% of all deaths.[3] On a yearly basis,
0.5% of the population is diagnosed with cancer. The statistics
below are for adults in the United States, and may vary
substantially in other countries:
Male Female
most common cause of death[3] most common cause of death[3]
prostate cancer (33%) lung cancer (31%) breast cancer (32%) lung
cancer (27%)
lung cancer (13%) prostate cancer (10%) lung cancer (12%) breast
cancer (15%)
colorectal cancer (10%) colorectal cancer (10%) colorectal
cancer (11%) colorectal cancer (10%)
bladder cancer (7%) pancreatic cancer (5%) endometrial cancer
(6%) ovarian cancer (6%)
cutaneous melanoma (5%) leukemia (4%) non-Hodgkin lymphoma (4%)
pancreatic cancer (6%)
Childhood cancers
Cancer can also occur in young children and adolescents, but it
is rare. Some studies have concluded that pediatric cancers,
especially leukemia, are on an upward trend.
The age of peak incidence of cancer in children occurs during
the first year of life. Leukemia (usually ALL) is the most
common infant malignancy (30%), followed by the central nervous
system cancers and neuroblastoma. The remainder consists of
Wilms' tumor, lymphomas, rhabdomyosarcoma (arising from muscle),
retinoblastoma, osteosarcoma and Ewing's sarcoma. Teratoma is
the most common tumor in this age group, but most teratomas are
surgically removed while still benign.
Female and male infants have essentially the same overall cancer
incidence rates, but white infants have substantially higher
cancer rates than black infants for most cancer types. Relative
survival for infants is very good for neuroblastoma, Wilms'
tumor and retinoblastoma, and fairly good (80%) for leukemia,
but not for most other types of cancer.
Signs and symptoms
Roughly, cancer symptoms can be divided into three groups:
Local symptoms: unusual lumps or swelling (tumor), hemorrhage
(bleeding), pain and/or ulceration. Compression of surrounding
tissues may cause symptoms such as jaundice.
Symptoms of metastasis (spreading): enlarged lymph nodes, cough
and hemoptysis, hepatomegaly (enlarged liver), bone pain,
fracture of affected bones and neurological symptoms. Although
advanced cancer may cause pain, it is often not the first
symptom.
Systemic symptoms: weight loss, poor appetite and cachexia
(wasting), excessive sweating (night sweats), anemia and
specific paraneoplastic phenomena, i.e. specific conditions that
are due to an active cancer, such as thrombosis or hormonal
changes.
Every symptom in the above list can be caused by a variety of
conditions (a list of which is referred to as the differential
diagnosis). Cancer may be a common or uncommon cause of each
item.
Diagnosis
Most cancers are initially recognized either because signs or
symptoms appear or through screening. Neither of these lead to a
definitive diagnosis, which usually requires the opinion of a
pathologist.
Investigation
Chest x-ray showing lung cancer in the left lung.People with
suspected cancer are investigated with medical tests. These
commonly include blood tests, X-rays, CT scans and endoscopy.
Biopsy
A cancer may be suspected for a variety of reasons, but the
definitive diagnosis of most malignancies must be confirmed by
histological examination of the cancerous cells by a
pathologist. Tissue can be obtained from a biopsy or surgery.
Many biopsies (such as those of the skin, breast or liver) can
be done in a doctor's office. Biopsies of other organs are
performed under anesthesia and require surgery in an operating
room.
The tissue diagnosis indicates the type of cell that is
proliferating, its histological grade and other features of the
tumor. Together, this information is useful to evaluate the
prognosis of this patient and choose the best treatment.
Cytogenetics and immunohistochemistry may provide information
about future behavior of the cancer (prognosis) and best
treatment.Treatment Cancer can be treated by surgery,
chemotherapy, radiation therapy, immunotherapy, monoclonal
antibody therapy or other methods. The choice of therapy depends
upon the location and grade of the tumor and the stage of the
disease, as well as the general state of the patient
(performance status). A number of experimental cancer treatments
are also under development.
Complete removal of the cancer without damage to the rest of the
body is the goal of treatment. Sometimes this can be
accomplished by surgery, but the propensity of cancers to invade
adjacent tissue or to spread to distant sites by microscopic
metastasis often limits its effectiveness. The effectiveness of
chemotherapy is often limited by toxicity to other tissues in
the body. Radiation can also cause damage to normal
tissue.Because "cancer" refers to a class of diseases, it is
unlikely that there will ever be a single "cure for cancer" any
more than there will be a single treatment for all infectious
diseases.
Surgery
In theory, cancers can be cured if entirely removed by surgery,
but this is not always possible. When the cancer has
metastasized to other sites in the body prior to surgery,
complete surgical excision is usually impossible. In the
Halstedian model of cancer progression, tumors grow locally,
then spread to the lymph nodes, then to the rest of the body.
This has given rise to the popularity of local-only treatments
such as surgery for small cancers. Even small localized tumors
are increasingly recognized as possessing met static potential.
Examples of surgical procedures for cancer include mastectomy
for breast cancer and prostatectomy for prostate cancer. The
goal of the surgery can be either the removal of only the tumor,
or the entire organ. A single cancer cell is invisible to the
naked eye but can regrow into a new tumor, a process called
recurrence. For this reason, the pathologist will examine the
surgical specimen to determine if a margin of healthy tissue is
present, thus decreasing the chance that microscopic cancer
cells are left in the patient.
In addition to removal of the primary tumor, surgery is often
necessary for staging, e.g. determining the extent of the
disease and whether it has metastasized to regional lymph nodes.
Staging is a major determinant of prognosis and of the need for
adjuvant therapy.
Occasionally, surgery is necessary to control symptoms, such as
spinal cord compression or bowel obstruction. This is referred
to as palliative treatment.
Radiation therapy
Main article: Radiation therapy
Radiation therapy (also called radiotherapy, X-ray therapy, or
irradiation) is the use of ionizing radiation to kill cancer
cells and shrink tumors. Radiation therapy can be administered
externally via external beam radiotherapy (EBRT) or internally
via brachytherapy. The effects of radiation therapy are
localised and confined to the region being treated. Radiation
therapy injures or destroys cells in the area being treated (the
"target tissue") by damaging their genetic material, making it
impossible for these cells to continue to grow and divide.
Although radiation damages both cancer cells and normal cells,
most normal cells can recover from the effects of radiation and
function properly. The goal of radiation therapy is to damage as
many cancer cells as possible, while limiting harm to nearby
healthy tissue. Hence, it is given in many fractions, allowing
healthy tissue to recover between fractions.
Radiation therapy may be used to treat almost every type of
solid tumor, including cancers of the brain, breast, cervix,
larynx, lung, pancreas, prostate, skin, stomach, uterus, or soft
tissue sarcomas. Radiation is also used to treat leukemia and
lymphoma. Radiation dose to each site depends on a number of
factors, including the radiosensitivity of each cancer type and
whether there are tissues and organs nearby that may be damaged
by radiation. Thus, as with every form of treatment, radiation
therapy is not without its side effects.
Chemotherapy
Chemotherapy is the treatment of cancer with drugs ("anticancer
drugs") that can destroy cancer cells. In current usage, the
term "chemotherapy" usually refers to cytotoxic drugs which
affect rapidly dividing cells in general, in contrast with
targeted therapy (see below). Chemotherapy drugs interfere with
cell division in various possible ways, e.g. with the
duplication of DNA or the separation of newly formed
chromosomes. Most forms of chemotherapy target all rapidly
dividing cells and are not specific for cancer cells, although
some degree of specificity may come from the inability of many
cancer cells to repair DNA damage, while normal cells generally
can. Hence, chemotherapy has the potential to harm healthy
tissue, especially those tissues that have a high replacement
rate (e.g. intestinal lining). These cells usually repair
themselves after chemotherapy.
Because some drugs work better together than alone, two or more
drugs are often given at the same time. This is called
"combination chemotherapy"; most chemotherapy regimens are given
in a combination.
The treatment of some leukaemias and lymphomas requires the use
of high-dose chemotherapy, and total body irradiation (TBI).
This treatment ablates the bone marrow, and hence the body's
ability to recover and repopulate the blood. For this reason,
bone marrow, or peripheral blood stem cell harvesting is carried
out before the ablative part of the therapy, to enable "rescue"
after the treatment has been given. This is known as autologous
stem cell transplantation. Alternatively, hematopoietic stem
cells may be transplanted from a matched unrelated donor (MUD).
Targeted therapies
Main article: Targeted therapy
Targeted therapy, which first became available in the late
1990s, has had a significant impact in the treatment of some
types of cancer, and is currently a very active research area.
This constitutes the use of agents specific for the deregulated
proteins of cancer cells. Small molecule targeted therapy drugs
are generally inhibitors of enzymatic domains on mutated,
overexpressed, or otherwise critical proteins within the cancer
cell. Prominent examples are the tyrosine kinase inhibitors
imatinib and gefitinib.
Monoclonal antibody therapy is another strategy in which the
theraputic agent is an antibody which specifically binds to a
protein on the surface of the cancer cells. Examples include the
anti-HER2/neu antibody trastuzumab (HerceptinŽ) used in breast
cancer, and the anti-CD20 antibody rituximab, used in a variety
of B-cell malignancies.
Targeted therapy can also involve small peptides as "homing
devices" which can bind to cell surface receptors or affected
extracellular matrix surrounding the tumor. Radionuclides which
are attached to this peptides (e.g. RGDs) eventually kill the
cancer cell if the nuclide decays in the vicinity of the cell.
Especially oligo- or multimers of these binding motifs are of
great interest, since this can lead to enhanced tumor
specificity and avidity.
Photodynamic therapy (PDT) is a ternary treatment for cancer
involving a photosensitizer, light, tissue oxygen and often use
of lasers. PDT can be used for a treatment for example basal
cell carcinoma (BCC) or lung cancer; also PDT can be useful in
removing traces of malignant tissue after surgical removal of
large tumors.
Immunotherapy
Main article: Cancer immunotherapy
Cancer immunotherapy refers to a diverse set of therapeutic
strategies designed to induce the patient's own immune system to
fight the tumor. Contemporary methods for generating an immune
response against tumours include intravesical BCG immunotherapy
for superficial bladder cancer, and use of interferons and other
cytokines to induce an immune response in renal cell carcinoma
and melanoma patients. Vaccines to generate specific immune
responses are the subject of intensive research for a number of
tumours, notably malignant melanoma and renal cell carcinoma.
Sipuleucel-T is a vaccine-like strategy in late clinical trials
for prostate cancer in which dendritic cells from the patient
are loaded with prostatic acid phosphatase peptides to induce a
specific immune response against prostate-derived cells.
Allogeneic hematopoietic stem cell transplantation ("bone marrow
transplantation" from a genetically non-identical donor) can be
considered a form of immunotherapy, since the donor's immune
cells will often attack the tumor in a phenomenon known as
graft-versus-tumor effect. For this reason, allogeneic HSCT
leads to a higher cure rate than autologous transplantation for
several cancer types, although the side effects are also more
severe.
Hormonal therapy
Main article: Hormonal therapy (oncology)
The growth of some cancers can be inhibited by providing or
blocking certain hormones. Common examples of hormone-sensitive
tumors include certain types of breast and prostate cancers.
Removing or blocking estrogen or testosterone is often an
important additional treatment. In certain cancers,
administration of hormone agonists, such as progestogens may be
therapeutically beneficial.
Symptom control
Although the control of the symptoms of cancer is not typically
thought of as a treatment directed at the cancer, it is an
important determinant of the quality of life of cancer patients,
and plays an important role in the decision whether the patient
is able to undergo other treatments. Although all practicing
doctors have the therapeutic skills to control pain, nausea,
vomiting, diarrhea, hemorrhage and other common problems in
cancer patients, the multidisciplinary specialty of palliative
care has arisen specifically in response to the symptom control
needs of this group of patients.
Pain medication, such as morphine and oxycodone, and antiemetics,
drugs to suppress nausea and vomiting, are very commonly used in
patients with cancer-related symptoms. Improved antiemetics such
as ondansetron and analogues, as well as aprepitant have made
aggressive treatments much more feasible in cancer patients.
Chronic pain due to cancer is almost always associated with
continuing tissue damage due to the disease process or the
treatment (i.e. surgery, radiation, chemotherapy). Although
there is always a role for environmental factors and affective
disturbances in the genesis of pain behaviors, these are not
usually the predominant etiologic factors in patients with
cancer pain. Furthermore, many patients with severe pain
associated with cancer are nearing the end of their lives and
palliative therapies are required. Issues such as social stigma
of using opioids, work and functional status, and health care
consumption are not likely to be important in the overall case
management. Hence, the typical strategy for cancer pain
management is to get the patient as comfortable as possible
using opioids and other medications, surgery, and physical
measures. Doctors have been reluctant to prescribe narcotics for
pain in terminal cancer patients, for fear of contributing to
addiction or suppressing respiratory function. The palliative
care movement, a more recent offshoot of the hospice movement,
has engendered more widespread support for preemptive pain
treatment for cancer patients.
Complementary and alternative
Complementary and alternative medicine (CAM) treatments are the
diverse group of medical and health care systems, practices, and
products that are not part of conventional medicine. Oncology,
the study of human cancer, has a long history of incorporating
unconventional or botanical treatments into mainstream cancer
therapy. Some examples of this phenomenon include the
chemotherapy agent paclitaxel, which is derived from the bark of
the Pacific Yew tree, and ATRA, all-trans retinoic acid, a
derivative of Vitamin A that induces cures in an aggressive
leukemia known as acute promyelocytic leukemia. Many
"complementary" and "alternative" medicines for cancer have not
been studied using the scientific method, such as in
well-designed clinical trials, or they have only been studied in
preclinical (animal or in-vitro) laboratory studies. Many times,
"complementary" and "alternative" medicines are supported by
marketing materials and "testimonials" from users of the
substances. Frequently, when these treatments are subjected to
rigorous scientific testing, they are found not to work. A
recent example was reported at the 2007 annual meeting of the
American Society of Clinical Oncology: a Phase III clinical
trial comparing shark cartilage extract to placebo in non-small
cell lung cancer demonstrated no benefit of the shark cartilage
extract,
"Complementary medicine" refers to methods and substances used
along with conventional medicine, while "alternative medicine"
refers to compounds used instead of conventional medicine. A
study of CAM use in patients with cancer in the July 2000 issue
of the Journal of Clinical Oncology found that 69% of 453 cancer
patients had used at least one CAM therapy as part of their
cancer treatment.
Some complementary measures include botanical medicine, such as
an NIH trial currently underway testing mistletoe extract
combined with chemotherapy for the treatment of solid tumors,
acupuncture for managing chemotherapy-associated nausea and
vomiting and in controlling pain associated with surgery,
psychological approaches such as "imaging" or meditation to aid
in pain relief or improve mood.
A wide range of alternative treatments have been offered for
cancer over the last century. The appeal of alternative cures
arises from the daunting risks, costs, or potential side effects
of many conventional treatments, or in the limited prospect for
cure. No alternative therapies have been shown in any scientific
study to effectively treat cancer.
Treatment trials
Clinical trials, also called research studies, test new
treatments in people with cancer. The goal of this research is
to find better ways to treat cancer and help cancer patients.
Clinical trials test many types of treatment such as new drugs,
new approaches to surgery or radiation therapy, new combinations
of treatments, or new methods such as gene therapy.A clinical
trial is one of the final stages of a long and careful cancer
research process. The search for new treatments begins in the
laboratory, where scientists first develop and test new ideas.
If an approach seems promising, the next step may be testing a
treatment in animals to see how it affects cancer in a living
being and whether it has harmful effects. Of course, treatments
that work well in the lab or in animals do not always work well
in people. Studies are done with cancer patients to find out
whether promising treatments are safe and effective.
Patients who take part may be helped personally by the
treatment's they receive. They get up-to-date care from cancer
experts, and they receive either a new treatment being tested or
the best available standard treatment for their cancer. Of
course, there is no guarantee that a new treatment being tested
or a standard treatment will produce good results. New
treatments also may have unknown risks, but if a new treatment
proves effective or more effective than standard treatment,
study patients who receive it may be among the first to benefit.
Prognosis
Cancer has a reputation for being a deadly disease. While this
certainly applies to certain particular types, the truths behind
the historical connotations of cancer are increasingly being
overturned by advances in medical care. Some types of cancer
have a prognosis that is substantially better than nonmalignant
diseases such as heart failure and stroke
Progressive and disseminated malignant disease has a substantial
impact on a cancer patient's quality of life, and many cancer
treatments (such as chemotherapy) may have severe side-effects.
In the advanced stages of cancer, many patients need extensive
care, affecting family members and friends. Palliative care
solutions may include permanent or "respite" hospice nursing.
Cancer patients, for the first time in the history of oncology,
are visibly returning to the athletic arena and workplace.
Patients are living longer with either quiescent persistent
disease or even complete, durable remissions. The stories of
Lance Armstrong, who won the Tour de France after treatment for
metastatic testicular cancer, or Tony Snow, who was working as
the White House Press Secretary as of June, 2007 despite
relapsed colon cancer, continue to be an inspiration to cancer
patients everywhere.
Emotional impact
Many local organizations offer a variety of practical and
support services to people with cancer. Support can take the
form of support groups, counseling, advice, financial
assistance, transportation to and from treatment, films or
information about cancer. Neighborhood organizations, local
health care providers, or area hospitals may have resources or
services available.While some people are reluctant to seek
counseling, studies show that having someone to talk to reduces
stress and helps people both mentally and physically. Counseling
can also provide emotional support to cancer patients and help
them better understand their illness. Different types of
counseling include individual, group, family, self-help
(sometimes called peer counseling), bereavement,
patient-to-patient, and sexuality.
Many governmental and charitable organizations have been
established to help patients cope with cancer. These
organizations often are involved in cancer prevention, cancer
treatment, and cancer research.
Causes
Cancer is a diverse class of diseases which differ widely in
their causes and biology. The common thread in all known cancers
is the acquisition of abnormalities in the genetic material of
the cancer cell and its progeny. Research into the pathogenesis
of cancer can be divided into three broad areas of focus. The
first area of research focuses on the agents and events which
cause or facilitate genetic changes in cells destined to become
cancer. Second, it is important to uncover the precise nature of
the genetic damage, and the genes which are affected by it. The
third focus is on the consequences of those genetic changes on
the biology of the cell, both in generating the defining
properties of a cancer cell, and in facilitating additional
genetic events, leading to further progression of the cancer.
Chemical carcinogens
Cancer pathogenesis is traceable back to DNA mutations that
impact cell growth and metastasis. Substances that cause DNA
mutations are known as mutagens, and mutagens that cause cancers
are known as carcinogens. Particular substances have been linked
to specific types of cancer. Tobacco smoking is associated with
lung cancer and bladder cancer. Prolonged exposure to asbestos
fibers is associated with mesothelioma.
Many mutagens are also carcinogens, but some carcinogens are not
mutagens. Alcohol is an example of a chemical carcinogen that is
not a mutagen. Such chemicals are thought to promote cancers
through their stimulating effect on the rate of cell mitosis.
Faster rates of mitosis leaves less time for repair enzymes to
repair damaged DNA during DNA replication, increasing the
likelihood of a genetic mistake. A mistake made during mitosis
can lead to the daughter cells receiving the wrong number of
chromosomes (see aneuploidy above).
The incidence of lung cancer is highly correlated with smoking.
Source:NIH.Decades of research have demonstrated the strong
association between tobacco use and cancers of many sites,
making it perhaps the most important human carcinogen. Hundreds
of epidemiological studies have confirmed this association.
Further support comes from the fact that lung cancer death rates
in the United States have mirrored smoking patterns, with
increases in smoking followed by dramatic increases in lung
cancer death rates and, more recently, decreases in smoking
followed by decreases in lung cancer death rates in men.
Ionizing radiation
Sources of ionizing radiation, such as radon gas, can cause
cancer. Prolonged exposure to ultraviolet radiation from the sun
can lead to melanoma and other skin malignancies.
Infectious diseases
Furthermore, many cancers originate from a viral infection; this
is especially true in animals such as birds, but also in humans,
as viruses are responsible for 15% of human cancers worldwide.
The main viruses associated with human cancers are human
papillomavirus, hepatitis B and hepatitis C virus, Epstein-Barr
virus, and human T-lymphotropic virus. Experimental and
epidemiological data imply a causative role for viruses and they
appear to be the second most important risk factor for cancer
development in humans, exceeded only by tobacco usage.[9] The
mode of virally-induced tumors can be divided into two,
acutely-transforming or slowly-transforming. In acutely
transforming viruses, the viral particles carry a gene that
encodes for an overactive oncogene called viral-oncogene (v-onc),
and the infected cell is transformed as soon as v-onc is
expressed. In contrast, in slowly-transforming viruses, the
virus genome is inserted, especially as viral genome insertion
is an obligatory part of retroviruses, near a proto-oncogene in
the host genome. The viral promoter or other transcription
regulation elements in turn cause over expression of that
proto-oncogene, which in turn induces uncontrolled cellular
proliferation. Because viral genome insertion is not specific to
proto-oncogenes and the chance of insertion near that
proto-oncogene is low, slowly-transforming viruses have very
long tumor latency compared to acutely-transforming viruses,
which already carry the viral ontogeny.
Hepatitis viruses, including hepatitis B and hepatitis C, can
induce a chronic viral infection that leads to liver cancer in
0.47% of hepatitis B patients per year (especially in Asia, less
so in North America), and in 1.4% of hepatitis C carriers per
year. Liver cirrhosis, whether from chronic viral hepatitis
infection or alcoholism, is associated with the development of
liver cancer, and the combination of cirrhosis and viral
hepatitis presents the highest risk of liver cancer development.
Worldwide, liver cancer is one of the most common, and most
deadly, cancers due to a huge burden of viral hepatitis
transmission and disease.
Advances in cancer research have made a vaccine designed to
prevent cancer available. In 2006, the US FDA approved a human
papilloma virus vaccine, called GardasilŽ. The vaccine protects
against four HPV types, which together cause 70% of cervical
cancers and 90% of genital warts. In March 2007, the US CDC
Advisory Committee on Immunization Practices (ACIP) officially
recommended that females aged 11-12 receive the vaccine, and
indicated that females as young as age 9 and as old as age 26
are also candidates for immunization.
In addition to viruses, researchers have noted a connection
between bacteria and certain cancers. The most prominent example
is the link between chronic infection of the wall of the stomach
with Helicobacter pylori and gastric cancer.
Hormonal imbalances
Some hormones can act in a similar manner to non-mutagenic
carcinogens in that they may stimulate excessive cell growth. A
well-established example is the role of hyperestrogenic states
in promoting endometrial cancer.
Immune system dysfunction
HIV is associated with a number of malignancies, including
Kaposi's sarcoma, non-Hodgkin's lymphoma, and HPV-associated
malignancies such as anal cancer and cervical cancer.
AIDS-defining illnesses have long included these diagnoses. The
increased incidence of malignancies in HIV patients points to
the breakdown of immune surveillance as a possible etiology of
cancer.Certain other immune deficiency states (e.g. common
variable immunodeficiency and IgA deficiency) are also
associated with increased risk of malignancy.
Heredity
Most forms of cancer are "sporadic", and have no basis in
heredity. There are, however, a number of recognised syndromes
of cancer with a hereditary component, often a defective tumor
suppressor allele. Famous examples are:
certain inherited mutations in the genes BRCA1 and BRCA2 are
associated with an elevated risk of breast cancer and ovarian
cancer
tumors of various endocrine organs in multiple endocrine
neoplasia (MEN types 1, 2a, 2b)
Li-Fraumeni syndrome (various tumors such as osteosarcoma,
breast cancer, soft tissue sarcoma, brain tumors) due to
mutations of
Turcot syndrome (brain tumors and colonic polyposis)
Familial adenomatous polyposis an inherited mutation of the APC
gene that leads to early onset of colon carcinoma.
Hereditary nonpolyposis colorectal cancer (HNPCC, also known as
Lynch syndrome) can include familial cases of colon cancer,
uterine cancer, gastric cancer, and ovarian cancer, without a
preponderance of colon polyps.
Retinoblastoma, when occurring in young children, is due to a
hereditary mutation in the retinoblastoma gene.
Down syndrome patients, who have an extra chromosome, are known
to develop malignancies such as leukemia and testicular cancer,
though the reasons for this difference are not well understood.
Other causes
A few types of cancer in non-humans have been found to be caused
by the tumor cells themselves. This phenomenon is seen in
Sticker's sarcoma, also known as canine transmissible venereal
tumor. The closest known analogue to this in humans is
individuals who have developed cancer from tumors hiding inside
organ transplants.
Pathophysiology
Cancers are caused by a series of mutations. Each mutation
alters the behavior of the cell somewhat.Cancer is fundamentally
a disease of regulation of tissue growth. In order for a normal
cell to transform into a cancer cell, genes which regulate cell
growth and differentiation must be altered. Genetic changes can
occur at many levels, from gain or loss of entire chromosomes to
a mutation affecting a single DNA nucleotide. There are two
broad categories of genes which are affected by these changes.
Oncogenes may be normal genes which are expressed at
inappropriately high levels, or altered genes which have novel
properties. In either case, expression of these genes promotes
the malignant phenotype of cancer cells. Tumor suppressor genes
are genes which inhibit cell division, survival, or other
properties of cancer cells. Tumor suppressor genes are often
disabled by cancer-promoting genetic changes. Typically, changes
in many genes are required to transform a normal cell into a
cancer cell.
There is a diverse classification scheme for the various genomic
changes which may contribute to the generation of cancer cells.
Most of these changes are mutations, or changes in the
nucleotide sequence of genomic DNA. Aneuploidy, the presence of
an abnormal number of chromosomes, is one genomic change which
is not a mutation, and may involve either gain or loss of one or
more chromosomes through errors in mitosis.
Large-scale mutations involve the deletion or gain of a portion
of a chromosome. Genomic amplification occurs when a cell gains
many copies (often 20 or more) of a small chromosomal locus,
usually containing one or more oncogenes and adjacent genetic
material. Translocation occurs when two separate chromosomal
regions become abnormally fused, often at a characteristic
location. A well-known example of this is the Philadelphia
chromosome, or translocation of chromosomes 9 and 22, which
occurs in chronic myelogenous leukemia, and results in
production of the BCR-abl fusion protein, an oncogenic tyrosine
kinase.
Small-scale mutations include point mutations, deletions, and
insertions, which may occur in the promoter of a gene and affect
its expression, or may occur in the gene's coding sequence and
alter the function or stability of its protein product.
Disruption of a single gene may also result from integration of
genomic material from a DNA virus or retrovirus, and such an
event may also result in the expression of viral oncogenes in
the affected cell and its descendants.
Epigenetic changes are changes which do not affect chromosomal
number or DNA sequence, but which can be passed on through
generations of cell division, and thus may play a role in
cancer. Known mechanisms of epigenetic change include DNA
methylation, and methylation or acetylation of histone proteins
bound to chromosomal DNA at specific locations.
Oncogenes
Oncogenes promote cell growth through a variety of ways. Many
can produce hormones, a "chemical messenger" between cells which
encourage mitosis, the effect of which depends on the signal
transduction of the receiving tissue or cells. In other words,
when a hormone receptor on a recipient cell is stimulated, the
signal is conducted from the surface of the cell to the cell
nucleus to effect some change in gene transcription regulation
at the nuclear level. Some oncogenes are part of the signal
transduction system itself, or the signal receptors in cells and
tissues themselves, thus controlling the sensitivity to such
hormones. Oncogenes often produce mitogens, or are involved in
transcription of DNA in protein synthesis, which creates the
proteins and enzymes responsible for producing the products and
biochemicals cells use and interact with.
Mutations in proto-oncogenes, which are the normally quiescent
counterparts of oncogenes, can modify their expression and
function, increasing the amount or activity of the product
protein. When this happens, the proto-oncogenes become
oncogenes, and this transition upsets the normal balance of cell
cycle regulation in the cell, making uncontrolled growth
possible. The chance of cancer cannot be reduced by removing
proto-oncogenes from the genome, even if this were possible, as
they are critical for growth, repair and homeostasis of the
organism. It is only when they become mutated that the signals
for growth become excessive.
One of the first oncogenes to be defined in cancer research is
the ras oncogene. Mutations in the Ras family of proto-oncogenes
(comprising H-R |
