Tumor

From Wikipedia, the free encyclopedia A tumor or tumour is the name for a neoplasm or a solid lesion formed by an abnormal growth of cells (termed neoplastic) which looks like a swelling. Tumor is not synonymous with cancer. A tumor can be benign, pre-malignant or malignant, whereas cancer is by definition malignant.

Etymology
he term tumour!tumor is deri"ed from the #atin word for $swelling$ tumor and has come to the %nglish language "ia the &ld French tumour (contemporary French' tumeur). (n the )ommonwealth the spelling $tumour$ is commonly used, whereas in the *.+. it is usually spelled $tumor$. (n its medical sense it originally meant an abnormal swelling of the flesh. )elsus (ca ,.)/ ,0 A1) described four cardinal signs of acute inflammation as tumor, dolor, calor and rubor (swelling, pain, increased heat and redness). .ut in contemporary %nglish, tumor is synonymous with solid neoplasm, all other forms of swelling being called swelling.2,3 his usage is common also in medical literature, where the nouns tumefaction and tumescence, deri"ed from the ad4ecti"e tumefied, are the current medical terms for non-neoplastic swelling. +welling is most often caused by inflammation caused by trauma, infection, etc.

Cause
A. 5ormal pathway. .. 1aughter cell fails to proliferate causing a tumor. ). +tem cell fails to create a daughter cell and keeps de"iding causing a tumor. A neoplasm is an abnormal proliferation of tissues, usually caused by genetic mutations. 6ost neoplasms cause a tumor, with a few e7ceptions like leukemia or carcinoma in situ. he nature of the tumor is determined by a pathologist after e7amination of the tumor tissues from a biopsy or a surgical e7cision specimen and is then 8ualified as benign, pre-malignant or malignant.

his page was last modified on 9: 1ecember ;-9- at 99'<=.

Cancer
From Wikipedia, the free encyclopedia Cancer (medical term' malignant neoplasm) is a class of diseases in which a cell, or a group of cells display uncontrolled growth through di"ision beyond the normal limits, invasion that

intrudes upon and destroys ad4acent tissues, and sometimes metastasis, which spreads the cells to other locations in the body "ia lymph or blood. hese three malignant properties of cancers differentiate them from benign tumors, which are self-limited, and do not in"ade or metastasi>e. 6ost cancers form a tumor but some, like leukemia, do not. he branch of medicine concerned with the study, diagnosis, treatment, and pre"ention of cancer is oncology. )ancer can affect people at all ages with the risk for most types increasing with age.(t caused about 9,? of all human deaths in ;--=(=.@ million). )ancers are primarily an en"ironmental disease with :--:A? of cases due to lifestyle and en"ironmental factors and A-9-? due to genetics. )ommon en"ironmental factors leading to cancer death include' tobacco (;A-,-?), diet and obesity (,--,A?), infections (9A-;-?), radiation, stress, lack of physical acti"ity, and en"ironmental pollutants. hese en"ironmental factors cause abnormalities in the genetic material of cells. Benetic abnormalities found in cancer typically affect two general classes of genes. )ancerpromoting oncogenes are typically acti"ated in cancer cells, gi"ing those cells new properties, such as hyperacti"e growth and di"ision, protection against programmed cell death, loss of respect for normal tissue boundaries, and the ability to become established in di"erse tissue en"ironments. umor suppressor genes are then inacti"ated in cancer cells, resulting in the loss of normal functions in those cells, such as accurate 15A replication, control o"er the cell cycle, orientation and adhesion within tissues, and interaction with protecti"e cells of the immune system. 1efiniti"e diagnosis re8uires the histologic e7amination of a biopsy specimen, although the initial indication of malignancy can be symptomatic or radiographic imaging abnormalities. 6ost cancers can be treated and some forced into remission, depending on the specific type, location, and stage. &nce diagnosed, cancer is usually treated with a combination of surgery, chemotherapy and radiotherapy. As research de"elops, treatments are becoming more specific for different "arieties of cancer. here has been significant progress in the de"elopment of targeted therapy drugs that act specifically on detectable molecular abnormalities in certain tumors, and which minimi>e damage to normal cells. he prognosis of cancer patients is most influenced by the type of cancer, as well as the stage, or e7tent of the disease. (n addition, histologic grading and the presence of specific molecular markers can also be useful in establishing prognosis, as well as in determining indi"idual treatments.

Classification
)ancers are classified by the type of cell that resembles the tumor and, therefore, the tissue presumed to be the origin of the tumor. hese are the histology and the location, respecti"ely. %7amples of general categories include' )arcinoma:6alignant tumors deri"ed from epithelial cells. his group represents the most common cancers, including the common forms of breast, prostate, lung and colon cancer. +arcoma:6alignant tumors deri"ed from connecti"e tissue, or mesenchymal cells. #ymphomaand leukemia: 6alignancies deri"ed from hematopoietic (blood-forming) cells

 Berm cell tumor: umors deri"ed from totipotent cells. (n adults most often found in the testicle and o"aryC in fetuses, babies, and young children most often found on the body midline, particularly at the tip of the tailboneC in horses most often found at the poll (base of the skull). Blastic tumor or blastoma:A tumor (usually malignant) which resembles an immature or embryonic tissue. 6any of these tumors are most common in children. 6alignant tumors (cancers) are usually named using -carcinoma, -sarcoma or -blastoma as a suffi7, with the #atin or Breek word for the organ of origin as the root. For instance, a cancer of the li"er is called hepatocarcinomaC a cancer of the fat cells is called liposarcoma. For common cancers, the %nglish organ name is used. For instance, the most common type of breast cancer is called ductal carcinoma of the breast or mammary ductal carcinoma. Dere, the ad4ecti"e ductal refers to the appearance of the cancer under the microscope, resembling normal breast ducts. .enign tumors (which are not cancers) are named using -oma as a suffi7 with the organ name as the root. For instance, a benign tumor of the smooth muscle of the uterus is called leiomyoma (the common name of this fre8uent tumor is fibroid). *nfortunately, some cancers also use the -oma suffi7, e7amples being melanoma and seminoma.

Signs and symptoms

 +ymptoms of cancer metastasis depend on the location of the tumor. Eoughly, cancer symptoms can be di"ided into three groups' symptoms' Local unusual lumps or swelling (tumor), hemorrhage (bleeding), pain and!or ulceration. )ompression of surrounding tissues may cause symptoms such as 4aundice (yellowing the eyes and skin). +ymptoms of metastasis (spreading)' enlarged lymph nodes, cough and hemoptysis, hepatomegaly (enlarged li"er), bone pain, fracture of affected bones and neurological symptoms. Although ad"anced cancer may cause pain, it is often not the first symptom. Systemic symptoms' weight loss, poor appetite, fatigue and cache7ia (wasting), e7cessi"e sweating (night sweats), anemia and specific paraneoplastic phenomena, i.e. specific conditions that are due to an acti"e cancer, such as thrombosis or hormonal changes. %"ery symptom in the abo"e list can be caused by a "ariety of conditions (a list of which is referred to as the differential diagnosis). )ancer may be a common or uncommon cause of each item.

Causes
)ancers are primarily an en"ironmental disease with :--:A? of cases due to lifestyle and en"ironmental factors and A-9-? due to genetics. )ommon en"ironmental factors that lead to cancer death include' tobacco (;A-,-?), diet and obesity (,--,A?), infections (9A-;-?), radiation, radon e7posure, stress, lack of physical acti"ity, and en"ironmental pollutants

Chemicals
he incidence of lung cancer is highly correlated with smoking. +ource'5(D. )ancer pathogenesis is

traceable back to 15A mutations that impact cell growth and metastasis. +ubstances that cause 15A mutations are known as mutagens, and mutagens that cause cancers are known as carcinogens. Farticular substances ha"e been linked to specific types of cancer. obacco smoking is associated with many forms of cancer, and causes :-? of lung cancer. Frolonged e7posure to asbestos fibers is associated with mesothelioma. 6any mutagens are also carcinogens, but some carcinogens are not mutagens. Alcohol is an e7ample of a chemical carcinogen that is not a mutagen. +uch chemicals may promote cancers through stimulating the rate of cell di"ision. Faster rates of replication lea"es less time for repair en>ymes to repair damaged 15A during 15A replication, increasing the likelihood of a mutation. 1ecades of research has demonstrated the link between tobacco use and cancer in the lung, laryn7, head, neck, stomach, bladder, kidney, oesophagus and pancreas. obacco smoke contains o"er fifty known carcinogens, including nitrosamines and polycyclic aromatic hydrocarbons. obacco is responsible for about one in three of all cancer deaths in the de"eloped world, and about one in fi"e worldwide. (ndeed, lung cancer death rates in the *nited +tates ha"e 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. Dowe"er, the numbers of smokers worldwide is still rising, leading to what some organi>ations ha"e described as the tobacco epidemic. )ancer related to ones occupation is belie"ed to represent between ;-;-? of all cases

Ionizing radiation
+ources of ioni>ing radiation, such as radon gas, can cause cancer. Frolonged e7posure to ultra"iolet radiation from the sun can lead to melanoma and other skin malignancies. &ne report estimates that appro7imately ;: --- future cancers could be related to the appro7imately =million ) scans performed in the *+ in ;--=. (t is estimated that -.<? of current cancers in the *nited +tates are due to ) s performed in the past and that this may increase to as high as 9.A-;? with ;--= rates of ) usage. 5on-ioni>ing radio fre8uency radiation from mobile phones and other similar EF sources has also been proposed as a cause of cancer, but there is currently little established e"idence of such a link.

Infection
+ome cancers can be caused by infection. his is especially true in animals such as birds, but also in humans, with "iruses responsible for up to ;-? of human cancers worldwide. hese include human papilloma"irus (cer"ical carcinoma), human polyoma"iruses (mesothelioma, brain tumors), %pstein-.arr "irus (.-cell lymphoproliferati"e disease and nasopharyngeal carcinoma), GaposiHs sarcoma herpes"irus (GaposiHs +arcoma and primary effusion lymphomas), hepatitis . and hepatitis ) "iruses (hepatocellular carcinoma), and Duman -cell leukemia "irus-9 ( -cell leukemias). .acterial infection may also increase the risk of cancer, as seen in Delicobacter pylori induced gastric carcinoma.

%7perimental and epidemiological data imply a causati"e role for "iruses and they appear to be the second most important risk factor for cancer de"elopment in humans, e7ceeded only by tobacco usage. he mode of "irally induced tumors can be di"ided into two, acutely transforming or slowly transforming. (n acutely transforming "iruses, the "irus carries an o"eracti"e oncogene called "iral-oncogene ("-onc), and the infected cell is transformed as soon as "-onc is e7pressed. (n contrast, in slowly transforming "iruses, the "irus genome is inserted near a proto-oncogene in the host genome. he "iral promoter or other transcription regulation elements then cause o"ere7pression of that proto-oncogene. his induces uncontrolled cell di"ision. .ecause the site of insertion is not specific to proto-oncogenes and the chance of insertion near any proto-oncogene is low, slowly transforming "iruses will cause tumors much longer after infection than the acutely transforming "iruses. Depatitis "iruses, including hepatitis . and hepatitis ), can induce a chronic "iral infection that leads to li"er cancer in -.<=? of hepatitis . patients per year (especially in Asia, less so in 5orth America), and in 9.<? of hepatitis ) carriers per year. #i"er cirrhosis, whether from chronic "iral hepatitis infection or alcoholism, is associated with the de"elopment of li"er cancer, and the combination of cirrhosis and "iral hepatitis presents the highest risk of li"er cancer de"elopment. Worldwide, li"er cancer is one of the most common, and most deadly, cancers due to a huge burden of "iral hepatitis transmission and disease. Ad"ances in cancer research ha"e made a "accine designed to pre"ent cancers a"ailable. (n ;--@, the *.+. Food and 1rug Administration appro"ed a human papilloma "irus "accine, called Bardasil. he "accine protects against @,99,9@,90 strains of DFI, which together cause =-? of cer"ical cancers and :-? of genital warts. (t also lists "aginal and "ul"ar cancers as being protected. (n 6arch ;--=, the *+ )enters for 1isease )ontrol and Fre"ention ()1)) Ad"isory )ommittee on (mmuni>ation Fractices (A)(F) officially recommended that females aged 99/9; recei"e the "accine, and indicated that females as young as age : and as old as age ;@ are also candidates for immuni>ation. here is a second "accine from )er"ari7 which protects against the more dangerous DFI 9@,90 strains only. (n ;--:, Bardasil was appro"ed for protection against genital warts. (n ;-9-, the Bardasil "accine was appro"ed for protection against anal cancer for males and re"iewers stated there was no anatomical, histological or physiological anal differences between the genders so females would also be protected. (n addition to "iruses, researchers ha"e noted a connection between bacteria and certain cancers. he most prominent e7ample is the link between chronic infection of the wall of the stomach with Delicobacter pylori and gastric cancer. Although only a minority of those infected with Helicobacter go on to de"elop cancer, since this pathogen is 8uite common it is probably responsible for most of these cancers. D(I is associated with a number of malignancies, including GaposiHs sarcoma, non-DodgkinHs lymphoma, and DFI-associated malignancies such as anal cancer and cer"ical cancer. A(1+-defining illnesses ha"e long included these diagnoses. he increased incidence of malignancies in D(I patients points to the breakdown of immune sur"eillance as a possible etiology of cancer.2;A3 )ertain other immune deficiency states (e.g. common "ariable immunodeficiency and (gA deficiency) are also associated with increased risk of malignancy.

Heredity

6ost forms of cancer are sporadic, meaning that there is no inherited cause of the cancer. here are, howe"er, a number of recognised syndromes where there is an inherited predisposition to cancer, often due to a defect in a gene that protects against tumor formation. Famous e7amples are' certain inherited mutations in the genes .E)A9 and .E)A; are associated with an ele"ated risk of breast cancer and o"arian cancer tumors of "arious endocrine organs in multiple endocrine neoplasia (6%5 types 9, ;a, ;b) #i-Fraumeni syndrome("arious tumors such as osteosarcoma, breast cancer, soft tissue sarcoma, brain tumors) due to mutations of pA, urcot syndrome(brain tumors and colonic polyposis) Familial adenomatous polyposisan inherited mutation of the APC gene that leads to early onset of colon carcinoma. Dereditary nonpolyposis colorectal cancer(D5F)), also known as #ynch syndrome) can include familial cases of colon cancer, uterine cancer, gastric cancer, and o"arian cancer, without a preponderance of colon polyps. Eetinoblastoma, when occurring in young children, is due to a hereditary mutation in the retinoblastoma gene. 1own syndromepatients, who ha"e an e7tra chromosome ;9, are known to de"elop malignancies such as leukemia and testicular cancer, though the reasons for this difference are not well understood.

Other causes
%7cepting the rare transmissions that occur with pregnancies and only a marginal few organ donors, cancer is generally not a transmissible disease. he main reason for this is tissue graft re4ection caused by 6D) incompatibility.2;=3 (n humans and other "ertebrates, the immune system uses 6D) antigens to differentiate between $self$ and $non-self$ cells because these antigens are different from person to person. When non-self antigens are encountered, the immune system reacts against the appropriate cell. +uch reactions may protect against tumour cell engraftment by eliminating implanted cells. (n the *nited +tates, appro7imately ,,A-- pregnant women ha"e a malignancy annually, and transplacental transmission of acute leukaemia, lymphoma, melanoma and carcinoma from mother to fetus has been obser"ed.2;=3 he de"elopment of donor-deri"ed tumors from organ transplants is e7ceedingly rare. he main cause of organ transplant associated tumors seems to be malignant melanoma, that was undetected at the time of organ har"est.though other cases e7ist. (n fact, cancer from one organism will usually grow in another organism of that species, as long as they share the same histocompatibility genes, pro"en using miceC howe"er this would ne"er happen in a real-world setting e7cept as described abo"e. (n non-humans, a few types of transmissible cancer ha"e been described, wherein the cancer spreads between animals by transmission of the tumor cells themsel"es. his phenomenon is seen in dogs with +tickerHs sarcoma, also known as canine transmissible "enereal tumor, as well as 1e"il facial tumour disease in asmanian de"ils.

athophysiology
)ancers are caused by a series of mutations. %ach mutation alters the beha"ior of the cell somewhat. )ancer is fundamentally a disease of regulation of tissue growth. (n order for a normal cell to transform into a cancer cell, genes which regulate cell growth and differentiation must be altered. Benetic changes can occur at many le"els, from gain or loss of entire chromosomes to a mutation affecting a single 15A nucleotide. here are two broad categories of genes which are affected by these changes. &ncogenes may be normal genes which are e7pressed at inappropriately high le"els, or altered genes which ha"e no"el properties. (n either case, e7pression of these genes promotes the malignant phenotype of cancer cells. umor suppressor genes are genes which inhibit cell di"ision, sur"i"al, or other properties of cancer cells. umor suppressor genes are often disabled by cancer-promoting genetic changes. ypically, changes in many genes are re8uired to transform a normal cell into a cancer cell. here is a di"erse classification scheme for the "arious genomic changes which may contribute to the generation of cancer cells. 6ost of these changes are mutations, or changes in the nucleotide se8uence of genomic 15A. Aneuploidy, the presence of an abnormal number of chromosomes, is one genomic change which is not a mutation, and may in"ol"e either gain or loss of one or more chromosomes through errors in mitosis. #arge-scale mutations in"ol"e the deletion or gain of a portion of a chromosome. Benomic amplification occurs when a cell gains many copies (often ;- or more) of a small chromosomal locus, usually containing one or more oncogenes and ad4acent genetic material. ranslocation

occurs when two separate chromosomal regions become abnormally fused, often at a characteristic location. A well-known e7ample of this is the Fhiladelphia chromosome, or translocation of chromosomes : and ;;, which occurs in chronic myelogenous leukemia, and results in production of the .)E-abl fusion protein, an oncogenic tyrosine kinase. +mall-scale mutations include point mutations, deletions, and insertions, which may occur in the promoter of a gene and affect its e7pression, or may occur in the geneHs coding se8uence and alter the function or stability of its protein product. 1isruption of a single gene may also result from integration of genomic material from a 15A "irus or retro"irus, and such an e"ent may also result in the e7pression of "iral oncogenes in the affected cell and its descendants. Anything which replicates (li"ing cells) will probabilistically suffer from errors (mutations). *nless error correction and pre"ention is properly carried out, the errors will sur"i"e, and might be passed along to daughter cells. 5ormally, the body safeguards against cancer "ia numerous methods, such as' apoptosis, helper molecules (some 15A polymerases), possibly senescence, etc. Dowe"er these error-correction methods often fail in small ways, especially in en"ironments that make errors more likely to arise and propagate. For e7ample, such en"ironments can include the presence of disrupti"e substances called carcinogens, or periodic in4ury (physical, heat, etc.), or en"ironments that cells did not e"ol"e to withstand, such as hypo7ia (see subsections). )ancer is thus a progressive disease, and these progressi"e errors slowly accumulate until a cell begins to act contrary to its function in the organism. he errors which cause cancer are often self amplifying, e"entually compounding at an e7ponential rate. For e7ample' A mutation in the error-correcting machinery of a cell might cause that cell and its children to accumulate errors more rapidly A mutation in signaling (endocrine) machinery of the cell can send error-causing signals to nearby cells A mutation might cause cells to become neoplastic, causing them to migrate and disrupt more healthy cells A mutation may cause the cell to become immortal (see telomeres), causing them to disrupt healthy cells fore"er hus cancer often e7plodes in something akin to a chain reaction caused by a few errors, which compound into more se"ere errors. %rrors which produce more errors are effecti"ely the root cause of cancer, and also the reason that cancer is so hard to treat' e"en if there were 9-,---,---,--cancerous cells and one killed all but 9- of those cells, those cells (and other error-prone precancerous cells) could still self-replicate or send error-causing signals to other cells, starting the process o"er again. his rebellion-like scenario is an undesirable sur"i"al of the fittest, where the dri"ing forces of e"olution work against the bodyHs design and enforcement of order. (n fact, once cancer has begun to de"elop, this same force continues to dri"e the progression of cancer towards more in"asi"e stages, and is called clonal e"olution. Eesearch about cancer causes often falls into the following categories' Agents (e.g. "iruses) and e"ents (e.g. mutations) which cause or facilitate genetic changes in cells destined to become cancer. he precise nature of the genetic damage, and the genes which are affected by it. he conse8uences 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 e"ents which lead

to further progression of the cancer.

re!ention
)ancer pre"ention is defined as acti"e measures to decrease the incidence of cancer. Breater than ,-? of cancer is pre"entable "ia a"oiding risk factors including' tobacco, o"erweight or obesity, low fruit and "egetable intake, physical inacti"ity, alcohol, se7ually transmitted infection, air pollution. his can be accomplished by a"oiding carcinogens or altering their metabolism, pursuing a lifestyle or diet that modifies cancer-causing factors and!or medical inter"ention (chemopre"ention, treatment of pre-malignant lesions). he epidemiological concept of $pre"ention$ is usually defined as either primary pre"ention, for people who ha"e not been diagnosed with a particular disease, or secondary pre"ention, aimed at reducing recurrence or complications of a pre"iously diagnosed illness. .ut the %F() study published in ;-9-, tracking the eating habits of <=0,--- %uropeans suggested that consuming lots of fruits and "egetables has little if any effect on pre"enting cancer.

"odifiable factors
+ee also' Alcohol and cancer he "ast ma4ority of cancer risk factors are en"ironmental or lifestyle-related, leading to the claim that cancer is a largely pre"entable disease. %7amples of modifiable cancer risk factors include alcohol consumption (associated with increased risk of oral, esophageal, breast, and other cancers), smoking (0-? of women with lung cancer ha"e smoked in the past, and :-? of men), physical inacti"ity (associated with increased risk of colon, breast, and possibly other cancers), and being o"erweight ! obese (associated with colon, breast, endometrial, and possibly other cancers). .ased on epidemiologic e"idence, it is now thought that a"oiding e7cessi"e alcohol consumption may contribute to reductions in risk of certain cancersC howe"er, compared with tobacco e7posure, the magnitude of effect is modest or small and the strength of e"idence is often weaker. &ther lifestyle and en"ironmental factors known to affect cancer risk (either beneficially or detrimentally) include certain se7ually transmitted diseases (such as those con"eyed by the human papilloma"irus), the use of e7ogenous hormones, e7posure to ioni>ing radiation and ultra"iolet radiation from the sun or from tanning beds, and certain occupational and chemical e7posures. %"ery year, at least ;--,--- people die worldwide from cancer related to their workplace.6illions of workers run the risk of de"eloping cancers such as lung cancer and mesothelioma from inhaling asbestos fibers and tobacco smoke, or leukemia from e7posure to ben>ene at their workplaces.)urrently, most cancer deaths caused by occupational risk factors occur in the de"eloped world. (t is estimated that appro7imately ;-,--- cancer deaths and <-,--- new cases of cancer each year in the *.+. are attributable to occupation.

#iet
he consensus on diet and cancer is that obesity increases the risk of de"eloping cancer. Farticular dietary practices often e7plain differences in cancer incidence in different countries (e.g. gastric cancer is more common in Japan, while colon cancer is more common in the *nited

+tates. (n this e7ample the preceding consideration of Daplogroups are e7cluded). +tudies ha"e shown that immigrants de"elop the risk of their new country, often within one generation, suggesting a substantial link between diet and cancer. Whether reducing obesity in a population also reduces cancer incidence is unknown. 1espite fre8uent reports of particular substances (including foods) ha"ing a beneficial or detrimental effect on cancer risk, few of these ha"e an established link to cancer. hese reports are often based on studies in cultured cell media or animals. Fublic health recommendations cannot be made based on these studies until they ha"e been "alidated in an obser"ational (or occasionally a prospecti"e inter"entional) trial in humans. Froposed dietary inter"entions for primary cancer risk reduction generally gain support from epidemiological association studies. %7amples of such studies include reports that reduced meat consumption is associated with decreased risk of colon cancer, and reports that consumption of coffee is associated with a reduced risk of li"er cancer. +tudies ha"e linked consumption of grilled meat to an increased risk of stomach cancer, colon cancer, breast cancer, and pancreatic cancer, a phenomenon which could be due to the presence of carcinogens such as ben>opyrene in foods cooked at high temperatures. A recent study analysed the correlation between many factors and cancer and concluded that the ma4or contributory dietary factor was animal protein, whereas plant protein did not ha"e an effect. Animal studies confirmed the mechanism by showing that reducing the proportion of animal protein switched off both the initiation and promotion stages. A ;--A secondary pre"ention study showed that consumption of a plant-based diet and lifestyle changes resulted in a reduction in cancer markers in a group of men with prostate cancer who were using no con"entional treatments at the time. hese results were amplified by a ;--@ study. &"er ;,<-- women were studied, half randomly assigned to a normal diet, the other half assigned to a diet containing less than ;-? calories from fat. he women on the low fat diet were found to ha"e a markedly lower risk of breast cancer recurrence, in the interim report of 1ecember, ;--@. Eecent studies ha"e also demonstrated potential links between some forms of cancer and high consumption of refined sugars and other simple carbohydrates. Although the degree of correlation and the degree of causality is still debated, some organi>ations ha"e in fact begun to recommend reducing intake of refined sugars and starches as part of their cancer pre"ention regimens. (n 5o"ember ;--=, the American (nstitute for )ancer Eesearch (A()E), in con4unction with the World )ancer Eesearch Fund (W)EF), published Food, 5utrition, Fhysical Acti"ity and the Fre"ention of )ancer' a Blobal Ferspecti"e, $the most current and comprehensi"e analysis of the literature on diet, physical acti"ity and cancer$. he W)EF!A()E %7pert Eeport lists 9recommendations that people can follow to help reduce their risk of de"eloping cancer, including the following dietary guidelines' (9) reducing intake of foods and drinks that promote weight gain, namely energy-dense foods and sugary drinks, (;) eating mostly foods of plant origin, (,) limiting intake of red meat and a"oiding processed meat, (<) limiting consumption of alcoholic be"erages, and (A) reducing intake of salt and a"oiding mouldy cereals (grains) or pulses (legumes). +ome mushrooms offer an anti-cancer effect, which is thought to be linked to their ability to upregulate the immune system. +ome mushrooms known for this effect include, Eeishi,Agaricus bla>ei, 6aitake, and rametes "ersicolor. Eesearch suggests the compounds in medicinal mushrooms most responsible for up-regulating the immune system and pro"iding an anti-cancer effect, are a di"erse collection of polysaccharide compounds, particularly beta-glucans. .eta-

glucans are known as $biological response modifiers$, and their ability to acti"ate the immune system is well documented. +pecifically, beta-glucans stimulate the innate branch of the immune system. Eesearch has shown beta-glucans ha"e the ability to stimulate macrophage, 5G cells, cells, and immune system cytokines. he mechanisms in which beta-glucans stimulate the immune system is only partially understood. &ne mechanism in which beta-glucans are able to acti"ate the immune system, is by interacting with the 6acrophage-9 antigen ()190) receptor on immune cells.

$itamins
As of ;-9- "itamins ha"e not been found to be effecti"e at pre"enting cancer, while low le"els of "itamin 1 is correlated with increased cancer risk. Whether this relationship is causal and "itamin 1 supplementation is protecti"e is yet to be determined. .eta-carotene supplementation has been found to increase slightly, but not significantly risks of lung cancer. Folic acid supplementation has not been found effecti"e in pre"enting colon cancer and may increase colon polyps.

Chemopre!ention
he concept that medications could be used to pre"ent cancer is an attracti"e one, and many high8uality clinical trials support the use of such chemopre"ention in defined circumstances. 1aily use of tamo7ifen, a selecti"e estrogen receptor modulator (+%E6), typically for AK years, has been demonstrated to reduce the risk of de"eloping breast cancer in high-risk women by about A-?. A recent study reported that the selecti"e estrogen receptor modulator ralo7ifene has similar benefits to tamo7ifen in pre"enting breast cancer in high-risk women, with a more fa"orable side effect profile. Ealo7ifene is a +%E6 like tamo7ifenC it has been shown (in the + AE trial) to reduce the risk of breast cancer in high-risk women e8ually as well as tamo7ifen. (n this trial, which studied almost ;-,--- women, ralo7ifene had fewer side effects than tamo7ifen, though it did permit more 1)(+ to form. Finasteride, a A-alpha-reductase inhibitor, has been shown to lower the risk of prostate cancer, though it seems to mostly pre"ent low-grade tumors. he effect of )&L-; inhibitors such as rofeco7ib and celeco7ib upon the risk of colon polyps ha"e been studied in familial adenomatous polyposis patients and in the general population. (n both groups, there were significant reductions in colon polyp incidence, but this came at the price of increased cardio"ascular to7icity.

%enetic testing
Benetic testing for high-risk indi"iduals is already a"ailable for certain cancer-related genetic mutations. )arriers of genetic mutations that increase risk for cancer incidence can undergo enhanced sur"eillance, chemopre"ention, or risk-reducing surgery. %arly identification of inherited genetic risk for cancer, along with cancer-pre"enting inter"entions such as surgery or enhanced sur"eillance, can be lifesa"ing for high-risk indi"iduals. %ene Cancer types &!ailability

.E)A9, .E)A; 6#D9, 6+D;, 6+D@, F6+9, F6+;

.reast, o"arian, pancreatic )olon, uterine, small stomach, urinary tract bowel,

)ommercially a"ailable clinical specimens )ommercially a"ailable clinical specimens

for for

$accination
Frophylactic "accines ha"e been de"eloped to pre"ent infection by oncogenic infectious agents such as "iruses, and therapeutic "accines are in de"elopment to stimulate an immune response against cancer-specific epitopes. As reported abo"e, a pre"enti"e human papilloma"irus "accine e7ists that targets certain se7ually transmitted strains of human papilloma"irus that are associated with the de"elopment of cer"ical cancer and genital warts. he only two DFI "accines on the market as of &ctober ;--= are Bardasil and )er"ari7.20<3 here is also a hepatitis . "accine, which pre"ents infection with the hepatitis . "irus, an infectious agent that can cause li"er cancer. A canine melanoma "accine has also been de"eloped.

Screening
)ancer screening is an attempt to detect unsuspected cancers in an asymptomatic population. (n this sense screening is not a means of pre"ention. Whereas pre"ention is designed to reduce the incidence of cancer, screening is designed to increase the incidence of early cancer which, it is argued, should be more effecti"ely treatable. +creening tests suitable for large numbers of healthy people must be relati"ely affordable, safe, nonin"asi"e procedures with acceptably low rates of false positi"e results. (f signs of cancer are detected, more definiti"e and in"asi"e follow up tests are performed to confirm the diagnosis. +creening for cancer can lead to earlier diagnosis in specific cases. %arly diagnosis may lead to e7tended life, but may also falsely prolong the lead time to death through lead time bias or length time bias. A number of different screening tests ha"e been de"eloped for different malignancies. .reast cancer screening can be done by breast self-e7amination, though this approach was discredited by a ;--A study in o"er ,--,--- )hinese women. +creening for breast cancer with mammograms has been shown to reduce the a"erage stage of diagnosis of breast cancer in a population. +tage of diagnosis in a country has been shown to decrease within ten years of introduction of mammographic screening programs. )olorectal cancer can be detected through fecal occult blood testing and colonoscopy, which reduces both colon cancer incidence and mortality, presumably through the detection and remo"al of pre-malignant polyps. +imilarly, cer"ical cytology testing (using the Fap smear) leads to the identification and e7cision of precancerous lesions. &"er time, such testing has been followed by a dramatic reduction of cer"ical cancer incidence and mortality. esticular self-e7amination is recommended for men beginning at the age of 9AK years to detect testicular cancer. Frostate cancer can be screened using a digital rectal e7am along with prostate specific antigen (F+A) blood testing, though some authorities (such as the *+ Fre"enti"e +er"ices ask Force) recommend against routinely screening all men. +creening for cancer is contro"ersial in cases when it is not yet known if the test actually sa"es

li"es. he contro"ersy arises when it is not clear if the benefits of screening outweigh the risks of follow-up diagnostic tests and cancer treatments. For e7ample' when screening for prostate cancer, the F+A test may detect small cancers that would ne"er become life threatening, but once detected will lead to treatment. his situation, called o"erdiagnosis, puts men at risk for complications from unnecessary treatment such as surgery or radiation. Follow up procedures used to diagnose prostate cancer (prostate biopsy) may cause side effects, including bleeding and infection. Frostate cancer treatment may cause incontinence (inability to control urine flow) and erectile dysfunction (erections inade8uate for intercourse). his situation was summarised in an editorial commenting on recent randomised controlled trials. +imilarly, for breast cancer, there ha"e recently2whenM3 been criticisms that breast screening programs in some countries cause more problems than they sol"e. his is because screening of women in the general population will result in a large number of women with false positi"e results which re8uire e7tensi"e follow-up in"estigations to e7clude cancer, leading to ha"ing a high number-to-treat (or number-to-screen) to pre"ent or catch a single case of breast cancer early. &ne difficulty with demonstrating the benefits of mammography screening is that proof of benefit re8uires not only a reduction in breast cancer mortality among women offered screening compared with those in the control group in randomised controlled trials, but also a reduction in deaths from all causes. (n most screening trials the obser"ed reduction in deaths from the particular cancer was accompanied by a comparable increase in deaths from other causes, presumably as a result of harm caused by post-screening treatments, gi"ing no significant reduction in deaths from all causes. %"en in the large breast and prostate cancer screening trials the power of the trials is inade8uate to confirm the significance of the lack of reduction in o"erall deaths. 1espite the reduction in harm caused by post-screening treatments in recent years there is still a significant number of deaths due to treatment. )er"ical cancer screening "ia the Fap smear has the best cost-benefit profile of all the forms of cancer screening from a public health perspecti"e as, largely caused by a "irus, it has clear risk factors (se7ual contact), and the natural progression of cer"ical cancer is that it normally spreads slowly o"er a number of years therefore gi"ing more time for the screening program to catch it early. 6oreo"er, the test is easy to perform and relati"ely cheap. For these reasons, it is important that the benefits and risks of diagnostic procedures and treatment be taken into account when considering whether to undertake cancer screening. *se of medical imaging to search for cancer in people without clear symptoms is similarly marred with problems. here is a significant risk of detection of what has been recently 2 called an incidentaloma - a benign lesion that may be interpreted as a malignancy and be sub4ected to potentially dangerous in"estigations. Eecent2 studies of ) scan-based screening for lung cancer in smokers ha"e had e8ui"ocal results, and systematic screening is not recommended as of July ;--=. Eandomi>ed clinical trials of plain-film chest L-rays to screen for lung cancer in smokers ha"e shown no benefit for this approach. )anine cancer detection has shown promise, but is still in the early stages of research.

#iagnosis
)hest 7-ray showing lung cancer in the left lung. 6ost cancers are initially recogni>ed either because signs or symptoms appear or through screening. 5either of these lead to a definiti"e diagnosis, which usually re8uires the opinion of a pathologist, a type of physician (medical doctor) who speciali>es in the diagnosis of cancer and other diseases. Feople with suspected cancer are in"estigated with medical tests. hese commonly include blood tests, L-rays, ) scans and endoscopy.

athology
A cancer may be suspected for a "ariety of reasons, but the definiti"e diagnosis of most malignancies must be confirmed by histological e7amination of the cancerous cells by a pathologist. issue can be obtained from a biopsy or surgery. 6any biopsies (such as those of the skin, breast or li"er) can be done in a doctorHs office. .iopsies of other organs are performed under anesthesia and re8uire surgery in an operating room. he tissue diagnosis gi"en by the pathologist indicates the type of cell that is proliferating, its histological grade, genetic abnormalities, and other features of the tumor. ogether, this information is useful to e"aluate the prognosis of the patient and to choose the best treatment. )ytogenetics and immunohistochemistry are other types of testing that the pathologist may perform on the tissue specimen. hese tests may pro"ide information about the molecular changes (such as mutations, fusion genes, and numerical chromosome changes) that has happened in the cancer cells, and may thus also indicate the future beha"ior of the cancer (prognosis) and best treatment.

ypical macroscopic appearance of cancer. his in"asi"e ductal carcinoma of the breast (pale area at the center) shows an o"al tumor

An

in"asi"e

large

surrounded by spikes of whitish scar tissue in the surrounding yellow fatty tissue. he silhouette "aguely resembles a crab.

colorectal carcinoma center) in colectomy specimen.

(top a

A s8uamous cell carcinoma (the whitish tumor) near the bronchi in a lung specimen.

in"asi"e ductal carcinoma in a mastectomy spec

"anagement
9:,0 poster identifying surgery, 7-rays and radium as the proper treatments for cancer 6any management options for cancer e7ist including' chemotherapy, radiation therapy, surgery, immunotherapy, monoclonal antibody therapy and other methods. Which are used depends upon the location and grade of the tumor and the stage of the disease, as well as the general state of a personHs health. %7perimental cancer treatments are also under de"elopment. )omplete remo"al of the cancer without damage to the rest of the body is the goal of treatment. +ometimes this can be accomplished by surgery, but the propensity of cancers to in"ade ad4acent tissue or to spread to distant sites by microscopic metastasis often limits its effecti"eness. +urgery often re8uired the remo"al of a wide surgical margin or a free margin. he width of the free margin depends on the type of the cancer, the method of remo"al ())F16A, 6ohs surgery, F&6A, etc.). he margin can be as little as 9K mm for basal cell cancer using ))F16A or 6ohs surgery, to se"eral centimeters for aggressi"e cancers. he effecti"eness of chemotherapy is often limited by to7icity to other tissues in the body. Eadiation can also cause damage to normal tissue. .ecause $cancer$ refers to a class of diseases, it is unlikely that there will e"er be a single $cure for cancer$ any more than there will be a single treatment for all infectious diseases.Angiogenesis inhibitors were once thought to ha"e potential as a $sil"er bullet$ treatment applicable to many types of cancer, but this has not been the case in practice.

rognosis
)ancer has a reputation as a deadly disease. While this certainly applies to certain particular types, the truths behind the historical connotations of cancer are increasingly o"erturned by ad"ances in medical care. +ome types of cancer ha"e a prognosis that is substantially better than nonmalignant diseases such as heart failure and stroke. Frogressi"e and disseminated malignant disease has a substantial impact on a cancer patientHs 8uality of life, and many cancer treatments (such as chemotherapy) may ha"e se"ere side-effects. (n the ad"anced stages of cancer, many patients need e7tensi"e care, affecting family members and friends. Falliati"e care solutions may include permanent or $respite$ hospice nursing.

Emotional impact
6any local organi>ations offer a "ariety of practical and support ser"ices to people with cancer. +upport can take the form of support groups, counseling, ad"ice, financial assistance, transportation to and from treatment, films or information about cancer. 5eighborhood organi>ations, local health care pro"iders, or area hospitals may ha"e resources or ser"ices a"ailable. )ounseling can pro"ide emotional support to cancer patients and help them better understand their illness. 1ifferent types of counseling include indi"idual, group, family, peer counseling, berea"ement, patient-to-patient, and se7uality. 6any go"ernmental and charitable organi>ations ha"e been established to help patients cope with cancer. hese organi>ations are often in"ol"ed in cancer pre"ention, cancer treatment, and cancer research.

Epidemiology
1eath rate from malignant cancer per 9--,--inhabitants in ;--<. no data N AA AA-00--9-A 9-A-9,9,--9AA 9AA-9090--;-A ;-A-;,;,--;AA ;AA-;0;0--,-A O ,-A As of ;--<, worldwide cancer caused 9,? of all deaths (=.< million). he leading causes were' lung cancer (9., million deaths!year), stomach cancer (0-,,--- deaths), colorectal cancer (@,:,--- deaths), li"er cancer (@9-,--- deaths), and breast cancer (A9:,--- deaths).2:03 Breater than ,-? of cancer is pre"entable "ia a"oiding risk factors including' tobacco, o"erweight or obesity, low fruit and "egetable intake, physical inacti"ity, alcohol, se7ually transmitted infections, and air pollution. (n the *nited +tates, cancer is responsible for ;A? of all deaths with ,-? of these from lung cancer. he most commonly occurring cancer in men is prostate cancer (about ;A? of new cases) and in women is breast cancer (also about ;A?). )ancer can occur in children and adolescents, but it is uncommon (about 9A- cases per million in the *.+.), with leukemia the most common.

(n the first year of life the incidence is about ;,- cases per million in the *.+., with the most common being neuroblastoma. (n the de"eloped world, one in three people will de"elop cancer during their lifetimes. (f all cancer patients sur"i"ed and cancer occurred randomly, the lifetime odds of de"eloping a second primary cancer would be one in nine. Dowe"er, cancer sur"i"ors ha"e an increased risk of de"eloping a second primary cancer, and the odds are about two in nine. About half of these second primaries can be attributed to the normal one-in-nine risk associated with random chance. he increased risk is belie"ed to be primarily due to the same risk factors that produced the first cancer (such as the personHs genetic profile, alcohol and tobacco use, obesity, and en"ironmental e7posures), and partly due to the treatment for the first cancer, which typically includes mutagenic chemotherapeutic drugs or radiation. )ancer sur"i"ors may also be more likely to comply with recommended screening, and thus may be more likely than a"erage to detect cancers.

6ost common cancers in males, by occurrence

in females, occurrence

by

in males, mortality

by

in females, mortality

by

'esearch
)ancer research is the intense scientific effort to understand disease processes and disco"er possible therapies. he impro"ed understanding of molecular biology and cellular biology due to cancer research has led to a number of new, effecti"e treatments for cancer since Fresident 5i7on declared $War on )ancer$ in 9:=9. +ince 9:=9 the *nited +tates has in"ested o"er P;-billion on cancer researchC that total includes money in"ested by public and pri"ate sectors and foundations. 1espite this substantial in"estment, the country has seen a fi"e percent decrease in the cancer death rate (ad4usting for si>e and age of the population) between 9:A- and ;--A. #eading cancer research organi>ations and pro4ects include the American Association for )ancer Eesearch, the American )ancer +ociety (A)+), the American +ociety of )linical &ncology, the %uropean &rganisation for Eesearch and reatment of )ancer, the 5ational )ancer (nstitute, the 5ational )omprehensi"e )ancer 5etwork, and he )ancer Benome Atlas pro4ect at the 5)(.

%lossary
he following closely related terms may be used to designate abnormal growths' umor or tumour:originally, it meant any abnormal swelling, lump or mass. (n current %nglish, howe"er, the word tumor has become synonymous with malignant neoplasm, specifically solid neoplasm. 5ote that some neoplasms, such as leukemia, do not form

tumors. 5eoplasm:the scientific term to describe an abnormal proliferation of genetically altered cells. 5eoplasms can be benign or malignant' o "alignant neoplasmor malignant tumor' synonymous with cancer in e"eryday speech. o Benign neoplasmor benign tumor' a tumor (solid neoplasm) that stops growing, does not in"ade other tissues and does not form metastases. In!asi!etumor is another synonym of cancer. he name refers to in"asion of surrounding tissues. re-malignancy, pre-cancer or non-in!asi!e tumor' A neoplasm that is not in"asi"e but has the potential to progress to cancer (become in"asi"e) if left untreated. hese lesions are, in order of increasing potential for cancer, atypia, dysplasia and carcinoma in situ. he following terms can be used to describe a cancer' Screening' a test done on healthy people to detect tumors before they become apparent. A mammogram is a screening test. #iagnosis' the confirmation of the cancerous nature of a lump. his usually re8uires a biopsy or remo"al of the tumor by surgery, followed by e7amination by a pathologist. Surgical e(cision' the remo"al of a tumor by a surgeon. o Surgical margins' the e"aluation by a pathologist of the edges of the tissue remo"ed by the surgeon to determine if the tumor was remo"ed completely ($negati"e margins$) or if tumor was left behind ($positi"e margins$). %rade' a number (usually on a scale of ,) established by a pathologist to describe the degree of resemblance of the tumor to the surrounding benign tissue. Stage' a number (usually on a scale of <) established by the oncologist to describe the degree of in"asion of the body by the tumor. 'ecurrence' new tumors that appear at the site of the original tumor after surgery. "etastasis' new tumors that appear far from the original tumor. "edian sur!i!al time' a period, often measured in months or years, o"er which A-? of the cancer patients are e7pected to be ali"e. Transformation:the concept that a low-grade tumor transforms to a high-grade tumor o"er time. %7ample' EichterHs transformation. Chemotherapy' treatment with drugs. 'adiation therapy' treatment with radiations. &d)u!anttherapy' treatment, either chemotherapy or radiation therapy, gi"en after surgery to kill the remaining cancer cells. *eoad)u!anttherapy' treatment either chemotherapy or radiation therapy, gi"en before surgery to shrink a tumor to make its resection easier. Falliati"e care' treatment that does other than cure the disease i.e. reduces se"erity of disease, relie"e suffering and impro"es 8uality of life. rognosis' the probability of cure!remission after the therapy. (t is usually e7pressed as a probability of sur"i"al fi"e years after diagnosis. Alternati"ely, it can be e7pressed as the number of years when A-? of the patients are still ali"e. .oth numbers are deri"ed from statistics accumulated with hundreds of similar patients to gi"e a Gaplan-6eier cur"e. Cure' A cancer patient is $cured$ or $in remission$ if they li"e past the time by which

:A? of treated patients li"e after the date of their diagnosis of cancer. his period "aries among different types of cancerC for e7ample, in the case of DodgkinHs disease this period is 9- years, whereas for .urkittHs lymphoma this period would be 9 year. he phrase $cure$ used in oncology is based upon the statistical concept of a median sur"i"al time and disease-free median sur"i"al time. his page was last modified on ;- 1ecember ;-9- at ;-'--.