Table of Content

1) What is Cancer?
2) Cancer And Its Molecular Basis
3) What are common Cancers of human
body ?
4) What are common causes of cancer ?
5) Screening of cancer
6) How Is cancer treated ?
7) Prevention Of Cancer
 What Is Cancer ??

Cancers are a group of diseases associated with abnormal growth of cells. Without any
check, the disease may keep on progressing ultimately leading to pre-mature death. They
can arise anywhere in the body and can affect people from all age groups, socio-economic
strata and race. Cancer is the leading cause of morbidity and mortality in the world.
According to data by International Agency for Research on Cancer, there were 141 lakh new
cancer cases, 82 lakh cancer deaths and 326 lakh people living with cancer in 2012
worldwide. In our own country, about 4.7 lakh new cases of cancer are detected annually.
Cancer is responsible for death of about 3.5 lakh people annually in India itself.

Lung cancer is the most common cause of death from cancer worldwide, estimated to be
responsible for nearly one in five deaths (15.9 lakhs deaths, 19.4% of the total). Amongst
women, breast cancer is the commonest cause of death and is responsible for 5.2 lakh
deaths annually. These figures are just a numerical representation of the vast damage
caused by cancer worldwide.

One might want to assume that with recent rapid developments in medical sciences, the
incidence and prevalence of cancer may be coming down. Sadly, that isn't so. According to
WHO, within next two decades annual incidence of cancer may increase up to 220lakhs.
With increase in adoption of modern lifestyle with unhealthy habits like lack of physical
activity, decreased intake of fruit and vegetables, increasing use of tobacco, fast
food,alcohol, etc. the incidence of cancer is expected to further increase.
 Cancer and its Molecular Basis
.

Cancer refers to unregulated and unrestricted proliferation of cells. Clinically it is seen in

the form of a growth. Neoplasm is an abnormal mass of tissue growing in an uncoordinated
way and persisting even when the stimuli responsible for growth has been removed. A
tumour is said to be benign when its characteristics are considered relatively harmless
suggesting that it wouldn't spread to near-by or distant areas, can be operated easily and
doesn't risk the patient's life significantly. Malignant tumours are collectively referred to as
cancers, derived from the Latin word for crab, because they involve the tissues in a manner
similar to a crab. Malignant tumour can invade and destroy adjacent structures and spread
to distant sites (metastasize) to cause death. Not all cancers cause death, if detected early
and treated properly, some cancers can be cured.

Cancers result from certain changes at the molecular level in response to various external
or internal stimuli (Figure 1).
.
Such genetic vegetables, increasing use of tobacco, * fast food, change (or
mutation ) may be acquired by the action of environmental agents or it may be
inherited in the germ line. Environmental agents include….

Physical carcinogens - ultraviolet and ionizing radiation

Chemical carcinogens- components of tobacco smoke, aflatoxin, asbestos,

arsenic etc.

Biological carcinogens - viruses, bacteria or parasites.

Malignant neoplasms have features, such as excessive growth, local

invasiveness, and the ability to form distant metastases (Figure 2, Table 1).The
various key changes that occur in a cancer cell are-capacity to proliferate
without any growth signals, resistance to growth inhibiting signals, resistance to
regular cell death mechanisms, formation of new blood supply ability to involve
surrounding tissues, metastasis to distant organs (Figure 3) and failure in repair
of damaged DNA.

..
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.
 What are the Common Cancers
of Human Body?

Worldwide, the commonest cancers amongst men are lung, prostate, colo-
rectum, stomach, and liver cancer. Among women the most common sites
diagnosed are breast, colo-rectum, lung, cervix, and stomach cancer. In India,
amongst males common cancers in decreasing frequency are oral, lung,
stomach and colo-rectal cancers. In females, breast, cervix, colo-rectal, ovary
and oral cancers are the commonest cancers in decreasing frequency.

The incidence of these cancers varies according to the geographical area,

prevalent social customs and the socio-economic strata. For example, oral
cancers are common in Indian sub-continent and not that common in western
countries. This is because of higher consumption of chewable forms of tobacco
in the form of gutkha, paan, paan masala, khaini, supari etc. Cervical cancers are
commoner in women from lower socio-economic strata because of poor genital
hygiene. Colo-rectal cancers occur with higher frequency in those consuming
more of fatty food and less of fibres in their diet.
.

What are early signs of Cancers?

Early identification of cancer is essential for proper treatment. Cancer may

present in a variety of ways. Ten common signs of cancers are:

.
What are the common causes of
cancers?

 Common causes of cancer are as shown in Figure 4 and are as

follows:


1) Tobacco Consumption is the single most important avoidable risk factor for
cancer mortality worldwide. According to WHO, it causes an estimated 22% of cancer
deaths per year. Majority of the lung cancers are associated with smoking. Passive
smoking has also been associated with cancers in non-smoking adults. Risk increases
with increasing quantity of smoking. In Indian subcontinent use of smokeless tobacco
is more prevalent. These include use of gutkha, pan masala, masheri, raw tobacco,
betel quid etc. Tobacco is associated with cancers of lung, oral cavity, throat,
oesophagus, urinary bladder, pancreas, kidney, liver, stomach, bowel, cervix, ovary,
nose and sinus as well as some types of leukaemia (Figure 5).Tobacco contains over
4000 types of chemicals. Out of these, around 200 are harmful for human body and
about 70 different chemicals have been found to be carcinogenic (Figure 6). Various
studies have shown that those who quit tobacco have a better survival than those
who don't. About 50% of tobacco users die because of some form of tobacco related
disease. Over the counter preparations are available for nicotine replacement and
these have been marketed as solution for tobacco addiction. The safety of such
preparations is dubious. They have not been found to be that efficacious in curbing
tobacco addiction. They themselves contain chemicals like nicotine which may cause
cancer itself. Anew trend, is that of the use of e-cigarettes. They are battery operated
LED light containing devices which light up when used and release nicotine. They
have been falsely advertised as safer alternative to cigarettes. Many studies have
been conducted upon the safety of these e-cigarettes.
.
 Alcohol: Alcohol itself is associated with several cancers, the risk
of which increases with increasing quantity of alcohol consumed. It
has synergistic action along with smoking and if a person consumes
alcohol and tobacco then the risk of developing cancer is much
higher than the risk associated with consuming them independently.
Alcohol use is a risk factor for many cancer types including cancer of
the oral cavity, pharynx, larynx, oesophagus, liver, colo-rectum and
breast (Figure 5)

 Areca Nut : It is also called as supari in India. It may be chewed

alone or in combination with betel leaf, catechu and slaked lime –
called as Pan or betel quid. Powdered areca nut in ready to eat
mixtures with other ingredients is called Pan Masala. If tobacco is
added to these then it is called Gutkha. It is associated with Sub
Mucous Fibrosis which is a precancerous condition where the mouth
opening of the chewer decreases gradually. It has been included as a
group I carcinogen by The International Agency for Research into
Cancer (IARC). It use has been found to lead to oral cancer. It may
also result in cancers of liver and pancreas.

 Obesity – It refers to excessive fat accumulation. If body mass

index (BMI) is above 25 the person is called overweight. Those
having BMI over 30 are called obese. It is associated with increased
risk of heart diseases, diabetes and cancer like those of
endometrium, colon, breast, oesophagus, pancreas etc. Besides
increasing the risk of developing such cancers, obesity is also
associated with increased chances of deaths due to such cancers.
Proper healthy diet and regular exercise are required to curb the
menace of obesity.
 Screening for Cancer.
 Screening refers to identification of a disease in an individual who
has not yet developed its signs and symptoms. In this, simple tests
are conducted on general population or a high risk group to
identify the individuals harbouring the disease. In this way, the
affected individual can be identified before he/she presents with
the symptoms of the disease. Screening helps in early
identification and diagnosis of several cancers. Identifying these
cancers early means a better possibility of control over the
disease. Screening is a useful tool in early detection of cancers of
breast, cervix, oral cavity and colo-rectum.

 Breast cancer: Screening for breast cancer is done with mammography.

Mammography refers to taking an x-ray image of the breast. Its efficacy as a
screening test has been proven in several studies and it helps in reducing the
morbidity and mortality associated with breast cancer. It should be done regularly in
individuals having family history of breast cancer. Self-examination of breast can also
help the woman to become aware about swelling in breast.

 Cervical Cancer: Pap smear is used to screen women for cervical cancer
(Figure 7). In this a smear taken from the cervix is evaluated under microscope to
look for pre-cancerous or cancer cells. It is a cost effective method of screening. It is
advisable for all women above the age of 35-40 years to undergo Pap smear
examination. Besides this, visual inspection of the cervix with acetic acid application
is also done at several places.
 Oral cancers: Screening for oral cavity cancers is relevant because of easy
accessibility of oral mucosa for visual inspection without requiring any special
equipment or expertise and the fact that most of the oral carcinomas are preceded
by visible pre-cancerous lesions. Commonly seen pre-cancerous lesions include
leukoplakia and erythroplakia (Figure 8). Leukoplakia refers to a whitish patch in oral
cavity, for the presence of which no other cause can be found. A similar reddish
patch is called erythroplakia. Biopsy from these suspicious areas may be taken to rule
out malignancy.
 How is cancer treated?
 Clinical examination -A patient with cancer has to be evaluated with a
thorough history of symptoms and clinical examination. Endeavour is made to assess
the extent of the disease and its relationship with surrounding vital structures. If
required, endoscopy may be required to assess the lesion. Presence of any other
disease which may affect the treatment of cancer is also looked for. Presence of any
distant metastases is also evaluated.

 Radiologic assessment: - Clinical examination is supplemented with radiologic

imaging. This may include X-ray, Ultrasonography, CT scan, MRI scan or PET scan as
clinically applicable. They help in better evaluation of the lesion, its extent and
presence of loco-regional or distant metastasis.

 Pathologic assessment: Along-with clinical evaluation, a small part of the

lesion is biopsied and sent for histopathological examination. If required aspiration
from the lesion is sent for cytological examination. In both these tests, microscope
and some special stains are used to assess the presence of and type of cancer cells.
Once proper clinic - radiological assessment has been done, the cancer is staged as
per the existing staging guidelines. Further treatment will depend upon the type of
cancer and its stage. Various modalities available are surgery, radiotherapy and
chemotherapy. These may be used individually or in combination with each other as
per disease status.
 Radiotherapy : – It involves the use of ionizing radiation for treatment of cancer. It
may be used as a primary modality or as an additional therapy following or preceding
surgery. Ionizing radiation acts by formation of free radicals which cause DNA
damage and cell death. Radiation beam is shaped in such a way so as to cause
minimum damage to surrounding normal tissues. When the source of radiation is
present outside the body, it is called external beam radiotherapy (Figure 10). In some
cases the source may be placed at the tumour site, in such cases it is called
brachytherapy

 Chemotherapy – A wide range of drugs are used to treat cancer.These

drugs have a variety of action and act on different stages of cell cycle to cause cell
death. The detail of their mechanism of action and activity is beyond the scope of this
chapter. These may be used in different settings for cancer treatment. It may be the
primary modality used along with radiation or may be used in adjuvant setting or also
as a palliative therapy
 Prevention Of Cancer.
Towards the end of this chapter, we come onto a very important topic – prevention of cancer.
What can you do to prevent cancer?

 First and foremost comes – cessation of tobacco consumption. Tobacco is the

single most important cause of deaths related to cancer in upto 20% of people. One
should stay away from both chewable as well as non-chewable forms of tobacco

 Alcohol cessation – alcohol itself is carcinogenic and also has increased

carcinogenic effect when consumed along with tobacco.

 Healthy lifestyle – regular physical activity along with diet rich in fruits and
vegetables help in reducing the chances of developing cancer.

 Family history – those with a family history of breast, thyroid, colo-rectal cancer
should be aware of risk associated with their developing cancer. They should have
themselves examined by a doctor and should be aware of the early signs of cancer.

 Hepatitis B Virus infection can result in liver cancer. Proper precautions should
be taken to prevent the spread of infection through infected blood products.
Vaccination against Hepatitis B virus is also available and its full dose should be taken.
 Certificate Of Completetion.
This is to certify that the project report ‘Cancer’, term-,2,
English Core is bonafide work carried out and successfully
completed by Sahil ,Tanishq, Rudraksh Upen, Vedaan And Yash
of class 12-A of D.A.V Public School, Sec. 49, Faridabad For the
fulfilment of the ASL project Work

Thank You

(Teacher’s Signature)