referat cancer engleza

8/12/2019 Referat Cancer Engleza

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Ovidius University of ConstantaGeneral Medicine Faculty

ESSAY

Student

Moca Alexandra

Year I, group 12

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radiographicimaging anormalities" Most cancers can e treated and some forcedinto remission, depending on the specific type, location, and stage" Oncediagnosed, cancer is usually treated with a comination of surgery, chemotherapyand radiotherapy" 9s research develops, treatments are ecoming more specific fordifferent varieties of cancer" #here has een significant progress in the development

of targeted therapydrugs that act specifically on detectale molecular anormalitiesin certain tumors, and which minimi%e damage to normal cells" #he prognosis ofcancer patients is most influenced y the type of cancer, as well as the stage, oretent of the disease" /n addition, histologic gradingand the presence of specificmolecular mar&ers can also e useful in estalishing prognosis, as well as indetermining individual treatments"

Cancers are classified y the type of cell that resemles the tumor and,therefore, the tissue presumed to e the origin of the tumor" #hese are the histologyand the location, respectively" amples of general categories include:

Carcinoma: Malignant tumors derived from epithelial cells" #his grouprepresents the most common cancers, including the common forms ofreast, prostate, lungand colon cancer"

Sarcoma:Malignant tumors derived from connective tissue, or mesenchymalcells"

Lymphomaand leukemia:Malignancies derived from hematopoietic (lood$forming) cells

Germ cell tumor:#umors derived from totipotentcells" /n adults most oftenfound in the testicleand ovary+ in fetuses, aies, and young children mostoften found on the ody midline, particularly at the tip of the tailone+ inhorses most often found at the poll (ase of the s&ull)"

Blastic tumor or blastoma:9 tumor (usually malignant) which resemlesan immature or emryonic tissue" Many of these tumors are most common inchildren"

Malignant tumors (cancers) are usually named using -carcinoma,-sarcomaor -blastomaas a suffi, with the ;atin or Gree& word for the organ oforigin as the root" For instance, a cancer of the liver is called hepatocarcinoma+acancer of the fat cells is called liposarcoma" For common cancers, the nglishorgan name is used" For instance, the most common type of reast canceris calledductal carcinoma of the breastor mammary ductal carcinoma"


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common sites of tumour formation include the chest and along the spinal columninthe nec& or pelvis" 8isease may e etensive and metastatic (spreading to otherareas of the ody) at diagnosis, with cancerous cellstypically found throughout theonesand in the one marrow" 2eurolastoma is uni1ue to pediatric tumours in itsgenetic and clinical heterogeneity+ tumours of infants may spontaneously regress

without any therapy, whereas tumours of older children are very difficult to cure"Much is &nown aout the genetics and iology of neurolastoma, and thedevelopment of therapies targeting the underlying iological mechanismsresponsile for tumour growth is promising"

#here are no symptoms of neurolastoma that are common to all children withthe disease" #he symptoms are related to the location of the tumor" Commonlocations for neurolastoma include the adomen, the nec& and chest" 0ome of themore common symptoms include:

9dominal selling, pain, constipation or difficulty urinating if tumor is presentin the adomen"

>one pain Fatigue, if the disease has spread to the one marrow, causing a decrease in

red lood cells (anemia)"

>leeding and ruising, if the disease has spread to the one marrow, causing

a decrease in platelets"

8rooping of the eyelid with a small pupul, and lac& of sweating on the same

side of the face"

;ess fre1uent symptoms caused y hormones released y the neurolastoma cells

include: Fever

?ersistent diarrhea


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these molecules in asymptomatic young children was an attractive prospect forearly detection, numerous screening studies have shown that this test was not aneffective clinical tool" /t routinely identified children with neurolastoma that wasdestined for spontaneous regression, and it was not associated with a decrease inmortality for older children diagnosed with aggressive forms of the disease" 9s a

result, urine metaolite analysis is used only to aid diagnosis and monitor diseasestatus"

#he first symptomsof neurolastoma are often vague ma&ing diagnosis difficult"Fatigue, loss of appetite,fever, and !oint pain are common" 0ymptoms depend onprimary tumor locations and metastases if present:

/n theadomen, a tumor may cause a swollen ellyand constipation"

9 tumor in the chestmay cause reathing prolems"

9 tumor pressing on the spinal cord may cause wea&ness and thus aninaility

to stand, crawl, or wal&" >one lesions in the legs and hips may cause pain and limping"

9 tumor in the ones around the eyes or oritsmay cause distinct ruisingand

swelling"

/nfiltration of the one marrow may cause pallor from anemia"

2eurolastoma often spreads to other parts of the ody efore anysymptoms are apparent and 6 to 43 of all neurolastoma cases present withmetastases"

#he most common location for neurolastoma to originate (i"e" the primary tumor) ison the adrenal glands" #his occurs in =3 of locali%ed tumors and in 43 of casesof widespread disease" 2eurolastoma can also develop anywhere along thesympathetic nervous system chain from the nec& to the pelvis" Fre1uencies indifferent locations include: nec& ('3), chest ('53), adomen (3 non$adrenal), orpelvis ('3)" /n rare cases, no primary tumor can e discerned"

@are ut characteristic presentations include transverse myelopathy (tumorspinal cord compression, 63 of cases), treatment$resistant diarrhea (tumorvasoactive intestinal peptide secretion, =3 of cases),


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2eurolastoma has een lin&ed to prolems with the gene 2>?F' inrelation to copy$numer variantswhich cause the '1*'"' deletion syndrome and'1*'"' duplication syndrome"

0everal ris& factors have een proposed and are the su!ect of ongoingresearch" 8ue to characteristic early onset many studies have focused on parental

factors around conceptionand during gestation" Factors investigated have includedoccupation (i"e" eposure to chemicals in specific industries), smo&ing, alcoholconsumption, use of medicinal drugs during pregnancy and irth factors+ however,results have een inconclusive"

Other studies have eamined possile lin&s with atopyand eposure to infectionearly in life, use of hormones and fertility drugs, and maternal use of hair dye"

More than years of neurolastoma research has demonstrated that thereare several important iological and genetic mar&ers that define aggressivedisease" Children under ' months or with tumours that have not disseminated(spread) tend to have a etter prognosis and thus re1uire relatively mild forms of

therapy compared with children with aggressive disease" #umours associated withgenetic anormalities, such as amplification of an oncogene (a cancer$inducinggene) &nown as MYCNon chromosome * or loss of a part of chromosome' or '',have een correlated with poor prognosis compared with tumours without thesegenetic changes" /t is thought that these anormalities are responsile, at least inpart, for the development and progression of neurolastoma"

/n *6 data from , neurolastoma patients was analy%ed to develop acomprehensive classification system ased on age, etent of disease (or stage),MYCNstatus, and several other iological and genetic factors" #his classificationsystem allows clinicians to predict the progression and ris& of relapse ofneurolastoma and to tailor therapy to individual patients"

On microscopy, the tumor cells are typically descried as small, round andlue, and rosettepatterns (


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mitosis$&aryorrheis inde (ME/)" #his pathology classification system descriesHfavoraleH and HunfavoraleH tumors y the /nternational 2eurolastoma ?athologyCommittee (/2?C, also called 0himada system) which was estalished in '555 andrevised in *"

#raditional treatment for high$ris& (aggressive) neurolastoma includes

intensive, high$dose chemotherapy,surgery, and radiotherapy" Children receive upto si treatments with multidrug chemotherapy regimens" #he side effectsof thesetreatments include hair loss, nausea, vomiting, and a decrease in lood cellsproduced y the one marrow" 9lthough red lood cells(erythrocytes) and plateletscan e replaced y lood transfusion, the infection$fighting white lood cells(leu&ocytes) cannot, and their loss leads to the ris& of serious and even life$threatening infections" 0urgery is usually delayed until several cycles ofchemotherapy have een completed in order to allow for the tumour to shrin&"?atients often enefit from receiving high$dose chemotherapy treatments followedy one marrow transplantusing their own stem cells, which are isolated and storedprior to undergoing chemotherapy"

9fter recovery from the stem cell transplant, patients are treated withradiation, followed y administration of '$cisretinoic acid, an agent that is capaleof differentiating neurolastoma cells and therefore of preventing the cellsA aility toform tumours" 8espite this aggressive approach to treatment, more than half of allchildren with high$ris& neurolastoma will eventually die from their disease" Childrenwith low$ and intermediate$ris& neurolastoma tend to fare much etter with surgeryalone or with surgery and moderate$dose chemotherapy" 0ome infants with smalllocali%ed tumours do not need surgical removal of their tumour, since these tumoursusually spontaneously regress"

#raditional chemotherapy targets general cellular mechanisms, affecting

normal cells as well as tumour cells"


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Japan egan screening si$month olds for neurolastoma via analysis of thelevels of homoanillic aci!and anilman!elic aci!in '5=" 0creening washalted in *= after studies in Canada and Germany showed no reduction indeaths due to neurolastoma, ut rather caused an increase in diagnoses thatwould have disappeared without treatment, su!ecting those infants to

unnecessary surgery and chemotherapy" >etween *3 and 63 of high$ris& cases do not respond ade1uately toinduction high$dose chemotherapy and are progressive or refractory" @elapse aftercompletion of frontline therapy is also common" Further treatment is availale inphase / and phase // clinical trials that test new agents and cominations of agentsagainst neurolastoma, ut the outcome remains very poor for relapsed high$ris&disease"

Most long$term survivors alive today had low or intermediate ris& disease andmilder courses of treatment compared to high$ris& disease" #he ma!ority of survivorshave long$term effects from the treatment" 0urvivors of intermediate and high$ris&treatment often eperience hearing loss" Growth reduction, thyroid functiondisorders, learning difficulties, and greater ris& of secondary cancers affect survivorsof high$ris& disease" 9n estimated two of three survivors of childhood cancer willultimately develop at least one chronic and sometimes life$threatening healthprolem within * to years after the cancer diagnosis"

#hese results were confirmed in a 2ational Cancer /nstitute pulicationreleased July *5 comparing outcomes of neurolastoma survivors to silings"#he study reported that survivors are more li&ely than silings to develop chronicneurological, sensory, endocrine, and musculos&eletal complications and less li&elyto e married or have a high income !o"

>ased on a series of =5 neurolastoma samples, it has een reported that

overall genomic pattern, as tested y array$ased &aryotyping, is a predictor ofoutcome in neurolastoma:

#umors presenting eclusively with whole chromosome copy numerchanges were associated with ecellent survival"

#umors presenting with any &ind of segmental chromosome copy numerchanges were associated with a high ris& of relapse"

7ithin tumors showing segmental alterations, additional independentpredictors of decreased overall survival were 2$myc amplification, 'p and''1 deletions, and '1 gain"

arlier pulications categori%ed neurolastomas into three ma!or sutypesased on cytogenetic profiles:

0utype ': favorale neurolastoma with near triploidy and a predominanceof numerical gains and losses, mostly representing non$metastatic 2> stages', * and =0"

0utypes *9 and *>: found in unfavorale widespread neurolastoma,stages and =, with ''1 loss and '-1 gain without 2$myc amplification

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http://en.wikipedia.org/wiki/Homovanillic_acidhttp://en.wikipedia.org/wiki/Vanilmandelic_acidhttp://en.wikipedia.org/wiki/Virtual_Karyotypehttp://en.wikipedia.org/wiki/N-mychttp://en.wikipedia.org/wiki/Homovanillic_acidhttp://en.wikipedia.org/wiki/Vanilmandelic_acidhttp://en.wikipedia.org/wiki/Virtual_Karyotypehttp://en.wikipedia.org/wiki/N-myc


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same total dose" #en$year event free survival was *-3 and '3 respectively withnon$aggressive surgical approach, no radiotherapy, and melphalan$only autologousone marrow or stem cell transplant for oth groups"

'55'$'554: ?hase /// trial with two se1uential randomi%ations for -5 high$

ris& 2> patients was carried out y the ChildrenBs Cancer Group (CCG$5') whichdemonstrated improved survival with myeloalative therapy (with total odyirradiation) and '$cis$retinoic acid (9ccutane) with 6 patients in each of the fourarms of the study",

'554$*: #he German (G?O5- compared outcomes of *56

high$ris& 2> patients randomi%ed for stem cell transplant or consolidationchemotherapy" @esults showed increased survival with transplant"

*$*4: #he recent study (COG$95-) 1uestioned the need for purged

stem cells for CM$;/ (caroplatin, etoposide, melphalan, with local irradiation)transplant, and accrued =4 patients" ?urging stem cells was not found to improve

survival

*$*'*: 9 concurrent study (COG$92>;*) determined in earlyreview that the antiody ch'="' with interleu&in * and GMC0F (studiedretrospectively in German G?O< 2>5 and 2> 5- at a lower dose and withoutcyto&ines --D ) improved survival, and will accrue a total of =* patients" 9 follow on?hase /// study COG$92>;5' opened Jan *' to accrue '6 patients togather further safety and efficacy data for F89 approval"

**$*: 0/O? (/nternational 0ociety of ?aediatric Oncology) formed the

uropean 0/O? 2eurolastoma Group (0/O? 2>) in '55= and activated a phase

/// high$ris& 2> protocol in ** (0/O?$U@O?$;$') using Lrapid COJC( cycles of chemotherapy given at '$day intervals) followed y transplantrandomi%ation to CM (caroplatin, etoposide, melphalan) or >uMel (usulfan,melphalan) and the study has een recently amended to randomi%e children toch'="' antiody treatment with or without sucutaneous /;* (without GM$C0F asgiven in the COG)" #his study recently reported the enefit of growth factors(GC0F), and all patients receive retinoic acid" #his trial will accrue ' patients('-6 per year)"

*6$*': #he current German 2>*= randomi%ation will include M/>G

therapy and randomi%e topotecan use in up$front therapy and will accrue a total of4=* for all ris& groups (roughly half will e high$ris&)" 9fter transplant, the high$ris&protocol includes si months of cis$retinoic acid, a three month rea&, and anotherthree months of retinoic acid"

*-: #he COG phase /// 92>;6* trial opened 8ecemer *- for accrual

of =56 and will compare single versus tandem transplants, and induction eginswith two cycles of topotecan"

/n addition to these phase /// studies, some research institutions offer pilot treatmentprotocols" For eample, 0t JudeBs recently finished (*-) testing a new up$front

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http://en.wikipedia.org/wiki/Interleukin_2http://en.wikipedia.org/wiki/GMCSFhttp://en.wikipedia.org/wiki/Cytokineshttp://en.wikipedia.org/wiki/Cytokineshttp://en.wikipedia.org/wiki/Neuroblastoma#cite_note-titleConsolidation_Treatment_With_Chimeric_Anti-GD2-Antibody_ch14.18_in_Children_Older_Than_1_Year_With_Metastatic_Neuroblastoma_--_Simon_et_al._22_.2817.29:_3549_--_Journal_of_Clinical_Oncology-76%23cite_note-titleConsolidation_Treatment_With_Chimeric_Anti-GD2-Antibody_ch14.18_in_Children_Older_Than_1_Year_With_Metastatic_Neuroblastoma_--_Simon_et_al._22_.2817.29:_3549_--_Journal_of_Clinical_Oncology-76http://en.wikipedia.org/wiki/Neuroblastoma#cite_note-titleConsolidation_Treatment_With_Chimeric_Anti-GD2-Antibody_ch14.18_in_Children_Older_Than_1_Year_With_Metastatic_Neuroblastoma_--_Simon_et_al._22_.2817.29:_3549_--_Journal_of_Clinical_Oncology-76%23cite_note-titleConsolidation_Treatment_With_Chimeric_Anti-GD2-Antibody_ch14.18_in_Children_Older_Than_1_Year_With_Metastatic_Neuroblastoma_--_Simon_et_al._22_.2817.29:_3549_--_Journal_of_Clinical_Oncology-76http://en.wikipedia.org/wiki/Interleukin_2http://en.wikipedia.org/wiki/GMCSFhttp://en.wikipedia.org/wiki/Cytokineshttp://en.wikipedia.org/wiki/Neuroblastoma#cite_note-titleConsolidation_Treatment_With_Chimeric_Anti-GD2-Antibody_ch14.18_in_Children_Older_Than_1_Year_With_Metastatic_Neuroblastoma_--_Simon_et_al._22_.2817.29:_3549_--_Journal_of_Clinical_Oncology-76%23cite_note-titleConsolidation_Treatment_With_Chimeric_Anti-GD2-Antibody_ch14.18_in_Children_Older_Than_1_Year_With_Metastatic_Neuroblastoma_--_Simon_et_al._22_.2817.29:_3549_--_Journal_of_Clinical_Oncology-76


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chemotherapy regimen in * children which included irinotecanand gefitiniwith '4months of maintenance chemotherapy after stem cell transplant with alternating oral'$cis$retinoic acid and topotecan" Memorial 0loan$Eettering Cancer Center in 2ew.or& offers treatment that includes a mouse$derived monoclonal antiody, F,used in protocols since the mid '5s" #his antiody is used for treating minimal

residual disease or consolidation instead of stem cell transplant" 9 new pilotprotocol COG$92>;5?' availale for newly diagnosed (high$ris&) children atseveral ChildrenBs Oncology Group (COG) centers will offer M/>G radiotherapy andchemotherapy for the transplant regimen"

0ome children (particularly in high$ris& cases) do not respond completely tofrontline treatment (with a complete response or very good partial response) andare laeled refractory" #hese children are removed from the frontline therapy(clinical trial) and are eligile for clinical trials using new therapies" Many high$ris&children have a good response to frontline therapy and achieve a remission, utlater the disease recurs (relapse)" #hese children are also eligile for new therapieseing tested in clinical trials"

Chemotherapy with topotecan and cyclophosphamide is fre1uently used inrefractory setting and after relapse" 9 randomi%ed study (*=) with ''5 patients(comparing topotecan alone to topotecan and cyclophosphamide) revealed a '3complete or partial response rate with two$year progression$free survival at 43 inthe topotecan and cyclophosphamide group" /rinotecan (intravenous or oral) andoral temo%olomide are also used in refractory and recurrent neurolastoma" Manyphase / and phase // trials are currently testing new agents against neurolastomain children who have relapsed or are resistant to initial therapy" /nvestigators arestudying targeted therapy, anti$angiogenesis agents, and new monoclonalantiodiessuch as hu'="'$/;*"

/n * the ?hase //a trial of 9%edra opened" #his uses the /$'' M/>Gmolecule radiolaeled using Molecular /nsightBs proprietary Ultratrace technology,which removes unnecessary nonradioactive molecules (or Hcold contaminantsH)" 9group of '6 childrenAs hospitals in the United 0tates &nown as the 2ew 9dvances in2eurolastoma #herapy (292#) consortium coordinates the /$'' M/>G radiationtherapy trials" #he 292# consortium also offers trials using an oral powderformulation of fenretinide, intravenous fenretinide, isphosphonate (Nometa) withother agents, and comining /$'' M/>G with chemotherapy"

9 0wedish study reported in *- that a common pain&illermight inhiit thedevelopment of neurolastoma and help ma&e treatment of the disease moreeffective" Celecoi, an analgesic, anti$inflammatory agent that inhiits the

inflammatory en%yme Co$*which is re1uired for neurolastoma cells growth andproliferation" Clinical studies are now planned+ research to date has een done onlyin animals and cell cultures"

#he protein p6is elieved to play a role in the development of resistance tochemotherapy" 9 2ovemer *5 study in mice shows that activating the tumorsuppressor p6 with a new drug, nutlin$, may slow tumor growth" /n this study,physician #om Kan Maer&en of Ghent University elgium and hiscolleagues used nutlin$ to neutrali%e M8M*, a protein that inds to the p6 protein

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http://en.wikipedia.org/wiki/Irinotecanhttp://en.wikipedia.org/wiki/Gefitinibhttp://en.wikipedia.org/wiki/Topotecanhttp://en.wikipedia.org/wiki/3F8http://en.wikipedia.org/wiki/Targeted_therapyhttp://en.wikipedia.org/wiki/Angiogenesishttp://en.wikipedia.org/wiki/Monoclonal_antibodieshttp://en.wikipedia.org/wiki/Monoclonal_antibodieshttp://en.wikipedia.org/wiki/Fenretinidehttp://en.wikipedia.org/wiki/Intravenoushttp://en.wikipedia.org/wiki/Bisphosphonatehttp://en.wikipedia.org/wiki/Painkillerhttp://en.wikipedia.org/wiki/Celecoxibhttp://en.wikipedia.org/wiki/Cox-2http://en.wikipedia.org/wiki/P53_(protein)http://en.wikipedia.org/wiki/Irinotecanhttp://en.wikipedia.org/wiki/Gefitinibhttp://en.wikipedia.org/wiki/Topotecanhttp://en.wikipedia.org/wiki/3F8http://en.wikipedia.org/wiki/Targeted_therapyhttp://en.wikipedia.org/wiki/Angiogenesishttp://en.wikipedia.org/wiki/Monoclonal_antibodieshttp://en.wikipedia.org/wiki/Monoclonal_antibodieshttp://en.wikipedia.org/wiki/Fenretinidehttp://en.wikipedia.org/wiki/Intravenoushttp://en.wikipedia.org/wiki/Bisphosphonatehttp://en.wikipedia.org/wiki/Painkillerhttp://en.wikipedia.org/wiki/Celecoxibhttp://en.wikipedia.org/wiki/Cox-2http://en.wikipedia.org/wiki/P53_(protein)


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and ostructs p6As aility to trigger programmed cell death" arlier studies haveshown that nutlin$ can specifically prevent M8M* from disaling p6"

Benign tumors("hich are not cancers)are named using -omaas a suffiwith the organ name as the root" For instance, a enign tumor of the smooth muscleof the uterus is called leiomyoma (the common name of this fre1uent tumor is

fibroid)" Unfortunately, some cancers also use the -oma suffi, eamples eingmelanomaand seminoma"

0ymptoms of cancer metastasis depend on the location of the tumor"

@oughly, cancer symptoms can e divided into three groups:

Local symptoms: unusual lumps or swelling (tumor), hemorrhage(leeding),pain andor ulceration" Compression of surrounding tissues may causesymptoms such as!aundice(yellowing the eyes and s&in)"

Symptoms of metastasis spreading!: enlarged lymph nodes, cough and

hemoptysis, hepatomegaly (enlarged liver), one pain, fractureof affectedones and neurologicalsymptoms" 9lthough advanced cancer may causepain, it is often not the first symptom"

Systemic symptoms: weight loss, poor appetite, fatigue and cacheia(wasting), ecessive sweating (night sweats), anemia and specificparaneoplastic phenomena, i"e" specific conditions that are due to an activecancer, such as thromosisor hormonal changes"

very symptom in the aove list can e caused y a variety of conditions (alist of which is referred to as the differential diagnosis)" Cancer may e a commonor uncommon cause of each item"

CausesCancers are primarily an environmental disease with 5$563 of cases due to

lifestyle and environmental factors and 6$'3 due to genetics" Commonenvironmental factors that lead to cancer death include: toacco(*6$3), diet andoesity ($63), infections ('6$*3), radiation, stress, lac& of physical activity,environmental pollutants" #he virtual asence of cancerous malignancies in ancienthuman remains suggests that cancer is mainly a man$made disease of the/ndustrial 9gecaused y environmental changes and the modern diet"

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http://en.wikipedia.org/wiki/Benign_tumorhttp://en.wikipedia.org/wiki/Melanomahttp://en.wikipedia.org/wiki/Seminomahttp://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/Hemorrhagehttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Ulcer_(dermatology)http://en.wikipedia.org/wiki/Jaundicehttp://en.wikipedia.org/wiki/Symptoms_of_metastasishttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Hemoptysishttp://en.wikipedia.org/wiki/Hepatomegalyhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Fracturehttp://en.wikipedia.org/wiki/Neurologyhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/Anorexia_(symptom)http://en.wikipedia.org/wiki/Fatigue_(medical)http://en.wikipedia.org/wiki/Cachexiahttp://en.wikipedia.org/wiki/Wastinghttp://en.wikipedia.org/wiki/Sweatinghttp://en.wikipedia.org/wiki/Sleep_hyperhidrosishttp://en.wikipedia.org/wiki/Anemiahttp://en.wikipedia.org/wiki/Paraneoplastic_phenomenonhttp://en.wikipedia.org/wiki/Thrombosishttp://en.wikipedia.org/wiki/Differential_diagnosishttp://en.wikipedia.org/wiki/Tobaccohttp://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Infectionshttp://en.wikipedia.org/wiki/Radiationhttp://en.wikipedia.org/wiki/Physical_activityhttp://en.wikipedia.org/wiki/Environmental_pollutantshttp://en.wikipedia.org/wiki/Industrial_Agehttp://en.wikipedia.org/wiki/File:Symptoms_of_cancer_metastasis.svghttp://en.wikipedia.org/wiki/Benign_tumorhttp://en.wikipedia.org/wiki/Melanomahttp://en.wikipedia.org/wiki/Seminomahttp://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/Hemorrhagehttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Ulcer_(dermatology)http://en.wikipedia.org/wiki/Jaundicehttp://en.wikipedia.org/wiki/Symptoms_of_metastasishttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Hemoptysishttp://en.wikipedia.org/wiki/Hepatomegalyhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Fracturehttp://en.wikipedia.org/wiki/Neurologyhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/Anorexia_(symptom)http://en.wikipedia.org/wiki/Fatigue_(medical)http://en.wikipedia.org/wiki/Cachexiahttp://en.wikipedia.org/wiki/Wastinghttp://en.wikipedia.org/wiki/Sweatinghttp://en.wikipedia.org/wiki/Sleep_hyperhidrosishttp://en.wikipedia.org/wiki/Anemiahttp://en.wikipedia.org/wiki/Paraneoplastic_phenomenonhttp://en.wikipedia.org/wiki/Thrombosishttp://en.wikipedia.org/wiki/Differential_diagnosishttp://en.wikipedia.org/wiki/Tobaccohttp://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Infectionshttp://en.wikipedia.org/wiki/Radiationhttp://en.wikipedia.org/wiki/Physical_activityhttp://en.wikipedia.org/wiki/Environmental_pollutantshttp://en.wikipedia.org/wiki/Industrial_Age


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Chemicals

Cancer pathogenesis is traceale ac& to 829 mutations that impact cellgrowth and metastasis" 0ustances that cause 829 mutations are &nown asmutagens, and mutagens that cause cancers are &nown as carcinogens" ?articularsustances have een lin&ed to specific types of cancer" #oacco smo&ing is

associated with many forms of cancer, and causes 53 of lung cancer"D?rolongedeposure to asestosfiers is associated with mesothelioma"

Many mutagens are also carcinogens, ut some carcinogens are notmutagens"9lcoholis an eample of a chemical carcinogen that is not a mutagen"0uch chemicals may promote cancers through stimulating the rate of cell division"Faster rates of replication leaves less time for repair en%ymes to repair damaged829 during 829 replication, increasing the li&elihood of a mutation"

8ecades of research has demonstrated the lin& etween toaccouse andcancer in the lung, laryn, head, nec&, stomach, ladder, &idney, oesophagusandpancreas" #oacco smo&e contains over fifty &nown carcinogens, including

nitrosaminesand polycyclic aromatic hydrocarons"#oacco is responsile for aout one in three of all cancer deaths in the

developed world, and aout one in five worldwide" /ndeed, lung cancerdeath ratesin the United 0tates have mirrored smo&ingpatterns, with increases in smo&ingfollowed y dramatic increases in lung cancer death rates and, more recentlydecreases in smo&ing followed y decreases in lung cancer death rates in men"arr virus (>$celllymphoproliferative disease and nasopharyngeal carcinoma), EaposiBs sarcomaherpesvirus (EaposiBs 0arcomaand primary effusion lymphomas), hepatitis >andhepatitis Cviruses (hepatocellular carcinoma),


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perimental and epidemiological data imply a causative role for viruses andthey appear to e the second most important ris& factor for cancer development inhumans, eceeded only y toacco usage" #he mode of virally induced tumors cane divided into two, acutely transforming or slowly transforming" /n acutelytransforming viruses, the virus carries an overactive oncogene called viral$

oncogene (v$onc), and the infected cell is transformed as soon as v$onc isepressed" /n contrast, in slowly transforming viruses, the virus genome is insertednear a proto$oncogene in the host genome"

#he viral promoter or other transcription regulation elements then causeoverepression of that proto$oncogene" #his induces uncontrolled cell division">ecause the site of insertion is not specific to proto$oncogenes and the chance ofinsertion near any proto$oncogene is low, slowly transforming viruses will causetumors much longer after infection than the acutely transforming viruses"

and hepatitis C, can induce a chronicviral infection that leads to liver cancer in "=-3 of hepatitis >patients per year(especially in 9sia, less so in 2orth 9merica), and in '"=3 of hepatitis Ccarriers peryear" ;iver cirrhosis, whether from chronic viral hepatitis infection or alcoholism, isassociated with the development of liver cancer, and the comination of cirrhosisand viral hepatitis presents the highest ris& of liver cancerdevelopment" 7orldwide,liver canceris one of the most common, and most deadly, cancers due to a hugeurden of viral hepatitistransmission and disease"

9dvances in cancer research have made a vaccine designed to preventcancer availale" /n *4, the U"0" Food and 8rug 9dministration approved ahuman papilloma virusvaccine, called Gardasil"

#he vaccine protects against four


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organism of that species, as long as they share the same histocompatiilitygenes,proven using mice+ however this would never happen in a real$world setting eceptas descried aove"

/n non$humans, a few types of transmissile cancerhave een descried,wherein the cancer spreads etween animals y transmission of the tumor cells

themselves" #his phenomenon is seen in dogs with 0tic&erBs sarcoma, also &nownas canine transmissile venereal tumor, as well as 8evil facial tumour disease in#asmanian devils"

athophysiology

Cancers are caused y a series of mutations" ach mutation alters theehavior of the cell somewhat"

Cancer is fundamentally a disease of regulation of tissue growth" /n order fora normal cell to transforminto a cancer cell, geneswhich regulate cell growth anddifferentiation must e altered" Genetic changes can occur at many levels, fromgain or loss of entire chromosomes to a mutation affecting a single 829 nucleotide"#here are two road categories of genes which are affected y these changes"Oncogenes may e normal genes which are epressed at inappropriately highlevels, or altered genes which have novel properties" /n either case, epression ofthese genes promotes the malignant phenotype of cancer cells" #umor suppressorgenesare genes which inhiit cell division, survival, or other properties of cancercells" #umor suppressor genes are often disaled y cancer$promoting geneticchanges" #ypically, changes in many genes are re1uired to transform a normal cellinto a cancer cell"

#here is a diverse classification scheme for the various genomic changeswhich may contriute to the generation of cancer cells" Most of these changes are

mutations, or changes in the nucleotidese1uence of genomic 829"9neuploidy, thepresence of an anormal numer of chromosomes, is one genomic change which isnot a mutation, and may involve either gain or loss of one or more chromosomesthrough errors in mitosis"

;arge$scale mutations involve the deletion or gain of a portion of achromosome" Genomic amplificationoccurs when a cell gains many copies (often* or more) of a small chromosomal locus, usually containing one or moreoncogenes and ad!acent genetic material" #ranslocationoccurs when two separatechromosomal regions ecome anormally fused, often at a characteristic location" 9well$&nown eample of this is the ?hiladelphia chromosome, or translocation ofchromosomes 5 and **, which occurs in chronic myelogenous leu&emia, and

results in production of the >C@$alfusion protein, an oncogenic tyrosine &inase"

0mall$scale mutations include point mutations, deletions, and insertions,which may occur in the promoterof a gene and affect its epression, or may occurin the geneBs coding se1uence and alter the function or staility of its proteinproduct"

8isruption of a single gene may also result from integration of genomicmaterialfrom a 829 virusor retrovirus, and such an event may also result in theepression of viral oncogenes in the affected cell and its descendants"

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and is the most affective when cancer is diagnosed at an early stage"Chemotherapy and @adiation #herapycan e affective in many cases ut it doesnot always &ill all the cells" Currently there are no asolute cures for cancer"

emission o% Cancer

@emission is a period of time when the cancer is responding to treatment oris under control" @emission can e partial or complete" 7hen cancer is in completeremission, all the signs and symptoms of the disease disappear"

?artial remission is when the cancer shrin&s ut does not completelydisappear" @emissions can last anywhere from several wee&s to many years"Complete remissions may continue for years and e considered cures" /f cancerreturns, another remission often can occur with further treatment"

Mo!i%iable %actors

#he vast ma!ority of cancer ris& factors are environmental or lifestyle$related,

leading to the claim that cancer is a largely preventale disease" amples ofmodifiale cancer ris& factors include alcohol consumption (associated withincreased ris& of oral, esophageal, reast, and other cancers), smo&ing (3 ofwomen with lung cancer have smo&ed in the past, and 53 of men physicalinactivity (associated with increased ris& of colon, reast, and possily othercancers), and eing overweight oese(associated with colon, reast, endometrial,and possily other cancers)"

>ased on epidemiologic evidence, it is now thought that avoiding ecessivealcohol consumption may contriute to reductions in ris& of certain cancers+however, compared with toacco eposure, the magnitude of effect is modest orsmall and the strength of evidence is often wea&er"

Other lifestyle and environmental factors &nown to affect cancer ris& (eithereneficially or detrimentally) include certain seually transmitted diseases (such asthose conveyed y the human papillomavirus), the use of eogenous hormones,eposure to ioni%ing radiationand ultravioletradiation from the sun or from tanningeds, and certain occupational and chemical eposures"

very year, at least *, people die worldwide from cancer related totheir wor&place" Millions of wor&ers run the ris& of developing cancers such as lungcancer and mesothelioma from inhaling asestos fiers and toacco smo&e, orleu&emia from eposure to en%eneat their wor&places" Currently, most cancerdeaths caused y occupational ris& factors occur in the developed world" ='D /t is

estimated that approimately *, cancer deaths and =, new cases ofcancer each year in the U"0" are attriutale to occupation"

#here are three main types of cancer treatment doctors perform withpatients" 0urgery, radiation therapy, and drug therapy have all proven to esomewhat effective in the attle against cancer" /n most cases a comination of twoor three of these methods are used for treatment"

0urgery is most often used to treat cancers of the reast, colon, lungs,stomach, and the uterus" 9lthough surgery may not cure the cancer completely it

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0cientists may not &now right now why cancer affects certain people ut they do&now that it has nothing to do with age or gender" Cancer is simply the outcome ofanormal cell reproduction that can happen to anyone" #his anormal reproduction cane inherited or caused y a cancer$causing agent"

9lthough cancer does not have a specific target the people who are most

susceptile are middle$aged individuals and the elderly" #his is mainly in partecause their immune systems are not as strong as younger people and that theyhave een in contact with many of the cancer causing agents long efore anyone&new that these agents could cause cancer" Cancer does not strictly affect men orwomen+ in fact it occurs aout e1ually etween the sees (;e0han =)" Cancer is ahuge prolem that affects everyone and it will continue to e one until doctors andscientists discover a cure to stop it"

/n the United 0tates aout "= million 9mericans alive today have a history ofthe cancer virus" #hese people may e survivors of cancer or may have developedthe cancer virus" 9n estimated one out of every three of these people has eensaved from the cancer virus and is now in remission" 7hen comparing this with the

early '5As, where anyone who had cancer died, cancer research anddevelopment has come a long way (9ltman Q 0ang 5)" 7ith the hope that cancerresearch and development will continue to grow the hope that a cure will soon efound will continue to flourish"

9lmost 66*, 9mericans will develop cancer in the net year" 0ome ofthese people may e saved where as others will fall victim to the virus and die" 7ithhopes that these people discover they have cancer early on, the death rate of thesepeople will not rise to etreme heights" Many of these people could have avoidedthe cancer virus y not smo&ing, avoiding cancer causing agents, and ta&ing ettercare of themselves (0ilverstein 4-)" 7hen thought aout the ma!ority of these

people could have avoided the cancer virus completely or even eat it !ust y ta&ingan etra step and watching their health and ta&ing note of cancer causes and theirsymptoms"

#here are several things a person can do to reduce his or her ris&s of gettingcancer" ven though these suggestions hold no guarantee that a person who usesthem will not get the cancer virus they are a smart way to stay fit and reduce the ris& ofthe development of the disease" #hese suggestions include+ a significant inta&e ofvitamins 9, C, and , eating certain foods such as whole grain reads, cereals,seafoodAs, roccoli, cauliflower, caage, spinach, and carrots, avoiding a significantcontact with cancer causing agents such as Ultraviolet rays, prolonged eposure to thesun, tanning eds, avoiding smo&ing, and having tests done yearly if cancer is in yourfamily (9uerach *6)" ?eople who use these suggestions are less li&ely to develop

cancer and will not only e preventing cancer ut will e healthy and preventing otherlife threatening diseases and viruses"

#here are still many unanswered 1uestions aout cancer, its causes, and itseffects" Until these 1uestions are all answered there can and will not e a cure"Cancer will go on to affect people in this world as it has for many years" /t will alterthe lives of every person involved and it will change their lives forever"

#he people with cancer are not the only victims+ their friends, families, co$wor&ers, or anyone else associated with them are also victims" 0ometimes the people

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who are still here after the cancer patient has passed on are the ones that will suffermore than anyone else" #hese people are the people who will not stop until there is acure and this deadly disease is stopped" #his may e the only way for them to eassured that their loved ones did not die for no apparent reason, ut died to perhapslight the path for further research and development for a cure"

@ecently, medical research has made great progress in understanding howcancerstarts and develops" Eey features for cancer growth and spread have alsoeen identified" 0ome new therapies get in the way of these features" #hey arecalled Ltargeted therapies, and have the potential to loc& the growth and spread ofcancer cells"

Monoclonal antiodies are an eample of a targeted cancer therapy" #heseare antiodies made in the laoratory that recogni%e and attach themselves tospecific proteins on cancer cells" Once attached they may prevent &ey signals fromreaching the cell" #hey can even e lin&ed with drugs, to guide the drug to thecancer"

Many of the new approaches to cancer treatmentcurrently eing developedare targeted therapies" 7hen the feature it targets is well defined, immunotherapymay also e considered a targeted therapy"

*iet

#he consensus on diet and cancer is that oesity increases the ris& ofdeveloping cancer" ?articular dietary practices often eplain differences in cancerincidence in different countries (e"g" gastric canceris more common in Japan, whilecolon canceris more common in the United 0tates" /n this eample the precedingconsideration of


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9 *6 secondary prevention study showed that consumption of a plant$ased diet and lifestyle changes resulted in a reduction in cancer mar&ers in agroup of men with prostate cancer who were using no conventional treatments atthe time" #hese results were amplified y a *4 study" Over *,= women werestudied, half randomly assigned to a normal diet, the other half assigned to a diet

containing less than *3 calories from fat" #he women on the low fat diet werefound to have a mar&edly lower ris& of reast cancer recurrence, in the interimreport of 8ecemer, *4"

@ecentstudies have also demonstrated potential lin&s etween some formsof cancer and high consumption of refined sugars and other simple carohydrates"

9lthough the degree of correlation and the degree of causality is still deated,someorgani%ations have in fact egun to recommend reducing inta&e of refined sugarsand starches as part of their cancer prevention regimens"

/n 2ovemer *-, the 9merican /nstitute for Cancer @esearch(9/C@), incon!unction with the 7orld Cancer @esearch Fund (7C@F), pulished )ood* Nutrition* 'hysical Activity and the 'revention of Cancer+ a ,lobal 'erspective , Hthemost current and comprehensive analysis of the literature on diet, physical activityand cancerH" #he 7C@F9/C@ pert @eport lists ' recommendations that peoplecan follow to help reduce their ris& of developing cancer, including the followingdietary guidelines: (') reducing inta&e of foods and drin&s that promote weight gain,namely energy$dense foods and sugary drin&s, (*) eating mostly foods of plantorigin, () limiting inta&e of red meat and avoiding processed meat, (=) limitingconsumption of alcoholic everages, and (6) reducing inta&e of salt and avoidingmouldy cereals (grains) or pulses (legumes)"

0ome mushrooms offer an anti$cancer effect, which is thought to e lin&ed totheir aility to up$regulate the immune system" 0ome mushrooms &nown for this

effect include, @eishi,Agaricus bla-ei,Maita&e,and Trametes versicolor-D

" @esearchsuggests the compounds in medicinal mushrooms most responsile for up$regulating the immune system and providing an anti$cancer effect, are a diversecollection of polysaccharidecompounds, particularly eta$glucans" >eta$glucans are&nown as Hiological response modifiersH, and their aility to activate the immunesystem is well documented" 0pecifically, eta$glucans stimulate the innateranch ofthe immune system" @esearch has shown eta$glucans have the aility to stimulatemacrophage, 2E cells, # cells, and immune system cyto&ines" #he mechanisms inwhich eta$glucans stimulate the immune system is only partially understood" Onemechanism in which eta$glucans are ale to activate the immune system, is yinteracting with the Macrophage$' antigenreceptoron immune cells"

+itamins

9s of *' vitamins have not een found to e effective at preventingcancer" 7hile low levels of vitamin 8 is correlated with increased cancer ris&"7hether this relationship is causal and vitamin 8 supplementation is protective isyet to e determined" >eta$carotenesupplementation has een found to increaseslightly, ut not significantly ris&s of lung cancer" Folic acidsupplementation has noteen found effective in preventing colon cancer and may increase colon polyps"

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numer of women with false positive results which re1uire etensive follow$upinvestigations to eclude cancer, leading to having a high numer$to$treat (ornumer$to$screen) to prevent or catch a single case of reast cancer early"

Cervical cancer screening via the ?ap smearhas the est cost$enefit profileof all the forms of cancer screening from a pulic health perspective as, largely

caused y a virus, it has clear ris& factors (seual contact), and the naturalprogression of cervical cancer is that it normally spreads slowly over a numer ofyears therefore giving more time for the screening program to catch it early"Moreover, the test is easy to perform and relatively cheap"

For these reasons, it is important that the enefits and ris&s of diagnosticprocedures and treatment e ta&en into account when considering whether tounderta&e cancer screening"

Use of medical imaging to search for cancer in people without clearsymptoms is similarly marred with prolems" #here is a significant ris& of detectionof what has een recently called an incidentaloma$ a enign lesion that may e

interpreted as a malignancy and e su!ected to potentially dangerousinvestigations" @ecent studies of C# scan$ased screening for lung cancer insmo&ers have had e1uivocal results, and systematic screening is not recommendedas of July *-" @andomi%ed clinical trialsof plain$film chest P$raysto screen forlung cancer in smo&ers have shown no enefit for this approach"

Canine cancer detectionhas shown promise, ut is still in the early stages ofresearch"

*iagnosis

Chest -ray sho"ing lung cancer in the le%t lung.

Most cancers are initially recogni$e! either because signs o r symptomsappear or through screening" 2either of these lead to a definitive diagnosis, whichusually re1uires the opinion of a pathologist,a type of physician (medical doctor)who speciali%es in the diagnosis of cancer and other diseases" ?eople withsuspected cancer are investigated with medical tests" #hese commonly includelood tests, P$rays, C# scansand endoscopy"

athology

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9 cancer may e suspected for a variety of reasons, ut the definitivediagnosis of most malignancies must e confirmed y histological eamination ofthe cancerous cells y a pathologist" #issue can e otained from a iopsy orsurgery" Many iopsies (such as those of the s&in, reast or liver) can e done in adoctorBs office" >iopsies of other organs are performed under anesthesia and

re1uire surgeryin an operating room"#he tissue diagnosisgiven y the pathologist indicates the type of cell that is

proliferating, its histological grade, genetic anormalities, and other features of thetumor" #ogether, this information is useful to evaluate the prognosisof the patientand to choose the est treatment" Cytogenetics and immunohistochemistry areother types of testing that the pathologist may perform on the tissue specimen"#hese tests may provide information aout the molecular changes (such asmutations, fusion genes, and numerical chromosomechanges) that has happenedin the cancer cells, and may thus also indicate the future ehavior of the cancer(prognosis) and est treatment"

#ypical macroscopicappearance of cancer" #hisinvasive ductal carcinomaof the reast (pale area at

the center) shows an ovaltumor surrounded y spi&esof whitish scar tissue in thesurrounding yellow fattytissue" #he silhouettevaguely resemles a cra"

9n invasive

colorectal carcinoma(top center) in acolectomyspecimen"

9s1uamouscell

carcinoma(the whitishtumor) neartheronchiina lungspecimen"

9 large invasive

ductal carcinomain a mastectomyspecimen"

Management

Many management options for cancer eist including: chemotherapy,radiation therapy, surgery,immunotherapy, monoclonal antiody therapyand other

methods" 7hich are used depends upon the location and grade of the tumor andthe stage of the disease, as well as the general state of a personBs health"perimental cancer treatmentsare also under development"

Complete removal of the cancer without damage to the rest of the ody is thegoal of treatment" 0ometimes this can e accomplished y surgery, ut thepropensity of cancers to invade ad!acent tissue or to spread to distant sites ymicroscopic metastasis often limits its effectiveness" 0urgery often re1uired theremoval of a wide surgical marginor a free margin"

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http://en.wikipedia.org/wiki/Histologyhttp://en.wikipedia.org/wiki/Anatomical_pathologyhttp://en.wikipedia.org/wiki/Biopsyhttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Anesthesiahttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Operating_roomhttp://en.wikipedia.org/wiki/Medical_diagnosishttp://en.wikipedia.org/wiki/Histological_gradehttp://en.wikipedia.org/wiki/Prognosishttp://en.wikipedia.org/wiki/Cytogeneticshttp://en.wikipedia.org/wiki/Immunohistochemistryhttp://en.wikipedia.org/wiki/Mutationhttp://en.wikipedia.org/wiki/Fusion_genehttp://en.wikipedia.org/wiki/Chromosomehttp://en.wikipedia.org/wiki/Ductal_carcinomahttp://en.wikipedia.org/wiki/Colorectal_carcinomahttp://en.wikipedia.org/wiki/Colectomyhttp://en.wikipedia.org/wiki/Squamous_cell_carcinomahttp://en.wikipedia.org/wiki/Squamous_cell_carcinomahttp://en.wikipedia.org/wiki/Squamous_cell_carcinomahttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Mammary_ductal_carcinomahttp://en.wikipedia.org/wiki/Mastectomyhttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Radiation_therapyhttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Immunotherapyhttp://en.wikipedia.org/wiki/Monoclonal_antibody_therapyhttp://en.wikipedia.org/wiki/Cancer_staginghttp://en.wikipedia.org/wiki/Experimental_cancer_treatmenthttp://en.wikipedia.org/wiki/Surgical_marginhttp://en.wikipedia.org/wiki/Free_marginhttp://en.wikipedia.org/wiki/File:BreastCancer.jpghttp://en.wikipedia.org/wiki/File:Lung_cancer.jpghttp://en.wikipedia.org/wiki/File:Colon_cancer_2.jpghttp://en.wikipedia.org/wiki/File:Breast_cancer_gross_appearance.jpghttp://en.wikipedia.org/wiki/Histologyhttp://en.wikipedia.org/wiki/Anatomical_pathologyhttp://en.wikipedia.org/wiki/Biopsyhttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Anesthesiahttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Operating_roomhttp://en.wikipedia.org/wiki/Medical_diagnosishttp://en.wikipedia.org/wiki/Histological_gradehttp://en.wikipedia.org/wiki/Prognosishttp://en.wikipedia.org/wiki/Cytogeneticshttp://en.wikipedia.org/wiki/Immunohistochemistryhttp://en.wikipedia.org/wiki/Mutationhttp://en.wikipedia.org/wiki/Fusion_genehttp://en.wikipedia.org/wiki/Chromosomehttp://en.wikipedia.org/wiki/Ductal_carcinomahttp://en.wikipedia.org/wiki/Colorectal_carcinomahttp://en.wikipedia.org/wiki/Colectomyhttp://en.wikipedia.org/wiki/Squamous_cell_carcinomahttp://en.wikipedia.org/wiki/Squamous_cell_carcinomahttp://en.wikipedia.org/wiki/Squamous_cell_carcinomahttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Mammary_ductal_carcinomahttp://en.wikipedia.org/wiki/Mastectomyhttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Radiation_therapyhttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Immunotherapyhttp://en.wikipedia.org/wiki/Monoclonal_antibody_therapyhttp://en.wikipedia.org/wiki/Cancer_staginghttp://en.wikipedia.org/wiki/Experimental_cancer_treatmenthttp://en.wikipedia.org/wiki/Surgical_marginhttp://en.wikipedia.org/wiki/Free_margin


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#he width of the free margin depends on the type of the cancer, the methodof removal (CC?8M9,Mohs surgery, ?OM9, etc")" #he margin can e as little as' mm for asal cell cancerusing CC?8M9 or Mohs surgery, to several centimetersfor aggressive cancers"

#he effectiveness of chemotherapy is often limited y toicity to other tissues

in the ody" @adiation can also cause damage to normal tissue"

>ecause HcancerH refers to a class of diseases, it is unli&ely that there willever e a single Hcure for cancerH any more than there will e a single treatment forall infectious diseases"9ngiogenesis inhiitorswere once thought to have potentialas a Hsilver ulletH treatment applicale to many types of cancer, ut this has noteen the case in practice"

rognosis

Cancer has a reputation as a deadly disease" 7hile this certainly applies tocertain particular types, the truths ehind the historical connotations of cancer areincreasingly overturned y advances in medical care" 0ome types of cancer have aprognosis that is sustantially etter than nonmalignant diseases such as heartfailureand stro&e"

?rogressive and disseminated malignant disease has a sustantial impact ona cancer patientBs 1uality of life, and many cancer treatments (such aschemotherapy) may have severe side$effects" /n the advanced stages of cancer,many patients need etensive care, affecting family memers and friends" ?alliativecaresolutions may include permanent or HrespiteH hospice nursing"

/motional impact

Many local organi%ations offer a variety of practical and support services to

people with cancer" 0upport can ta&e the form of support groups, counseling,advice, financial assistance, transportation to and from treatment, films orinformation aout cancer" 2eighorhood organi%ations, local health care providers,or area hospitals may have resources or services availale"

Counseling can provide emotional support to cancer patients and help themetter understand their illness" 8ifferent types of counseling include individual,group, family, peer counseling, ereavement, patient$to$patient, and seuality"

Many governmental and charitale organi%ations have een estalished tohelp patients cope with cancer" #hese organi%ations are often involved in cancerprevention, cancer treatment, and cancer research"

/pi!emiology9s of *=, worldwide cancer caused '3 of all deaths (-"= million)" #he

leading causes were: lung cancer ('" million deathsyear), stomach cancer(, deaths), colorectal cancer (45, deaths), liver cancer (4',deaths), and reast cancer (6'5, deaths)" Greater than 3 of cancer ispreventale via avoiding ris& factors including: toacco, overweightor oesity, lowfruit and vegetale inta&e, physical inactivity, alcohol, seually transmittedinfections, and air pollution"

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http://en.wikipedia.org/wiki/CCPDMAhttp://en.wikipedia.org/wiki/Mohs_surgeryhttp://en.wikipedia.org/wiki/Basal_cell_cancerhttp://en.wikipedia.org/wiki/CCPDMAhttp://en.wikipedia.org/wiki/Mohs_surgeryhttp://en.wikipedia.org/wiki/Cure_for_cancerhttp://en.wikipedia.org/wiki/Infectious_diseasehttp://en.wikipedia.org/wiki/Infectious_diseasehttp://en.wikipedia.org/wiki/Angiogenesis_inhibitorshttp://en.wikipedia.org/wiki/Silver_bullethttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Palliative_carehttp://en.wikipedia.org/wiki/Palliative_carehttp://en.wikipedia.org/wiki/Cancer_support_grouphttp://en.wikipedia.org/wiki/Counselinghttp://en.wikipedia.org/wiki/Lung_cancerhttp://en.wikipedia.org/wiki/Stomach_cancerhttp://en.wikipedia.org/wiki/Colorectal_cancerhttp://en.wikipedia.org/wiki/Liver_cancerhttp://en.wikipedia.org/wiki/Breast_cancerhttp://en.wikipedia.org/wiki/Tobaccohttp://en.wikipedia.org/wiki/Overweighthttp://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Fruithttp://en.wikipedia.org/wiki/Vegetablehttp://en.wikipedia.org/wiki/Physical_inactivityhttp://en.wikipedia.org/wiki/Alcoholhttp://en.wikipedia.org/wiki/Sexually_transmitted_infectionhttp://en.wikipedia.org/wiki/Sexually_transmitted_infectionhttp://en.wikipedia.org/wiki/Air_pollutionhttp://en.wikipedia.org/wiki/CCPDMAhttp://en.wikipedia.org/wiki/Mohs_surgeryhttp://en.wikipedia.org/wiki/Basal_cell_cancerhttp://en.wikipedia.org/wiki/CCPDMAhttp://en.wikipedia.org/wiki/Mohs_surgeryhttp://en.wikipedia.org/wiki/Cure_for_cancerhttp://en.wikipedia.org/wiki/Infectious_diseasehttp://en.wikipedia.org/wiki/Angiogenesis_inhibitorshttp://en.wikipedia.org/wiki/Silver_bullethttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Palliative_carehttp://en.wikipedia.org/wiki/Palliative_carehttp://en.wikipedia.org/wiki/Cancer_support_grouphttp://en.wikipedia.org/wiki/Counselinghttp://en.wikipedia.org/wiki/Lung_cancerhttp://en.wikipedia.org/wiki/Stomach_cancerhttp://en.wikipedia.org/wiki/Colorectal_cancerhttp://en.wikipedia.org/wiki/Liver_cancerhttp://en.wikipedia.org/wiki/Breast_cancerhttp://en.wikipedia.org/wiki/Tobaccohttp://en.wikipedia.org/wiki/Overweighthttp://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Fruithttp://en.wikipedia.org/wiki/Vegetablehttp://en.wikipedia.org/wiki/Physical_inactivityhttp://en.wikipedia.org/wiki/Alcoholhttp://en.wikipedia.org/wiki/Sexually_transmitted_infectionhttp://en.wikipedia.org/wiki/Sexually_transmitted_infectionhttp://en.wikipedia.org/wiki/Air_pollution


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7ith radiation also came the first signs of multi$disciplinary approaches to cancertreatment" #he surgeon was no longer operating in isolation, ut wor&ed togetherwith hospital radiologists to help patients"

#he complications in communication this rought, along with the necessity ofthe patientBs treatment in a hospital facility rather than at home, also created a

parallel process of compiling patient data into hospital files, which in turn led to thefirst statistical patient studies"

9 founding paper of cancer epidemiology was the wor& of Janet ;ane$Claypon, who pulished a comparative study in '5*4 of 6 reast cancer casesand 6 control patients of the same ac&ground and lifestyle for the >ritish Ministryof ritish 8octorsH followed in '564(otherwise &nown as the >ritish doctors study)" @ichard 8oll left the ;ondonMedical

@esearch Center (M@C), to start the Ofordunit for Cancer epidemiology in '54"7ith the use of computers, the unit was the first to compile large amounts of cancerdata" Modern epidemiological methods are closely lin&ed to current concepts ofdisease and pulic healthpolicy" Over the past 6 years, great efforts have eenspent on gathering data across medical practise, hospital, provincial, state, andeven country oundaries to study the interdependence of environmental andcultural factors on cancer incidence"

Cancer patient treatment and studies were restricted to individual physiciansBpractices until 7orld 7ar //, when medical research centers discovered that therewere large international differences in disease incidence" #his insight drove nationalpulic health odies to ma&e it possile to compile health data across practises and

hospitals, a process that many countries do today"

#he Japanese medical community oserved that the one marrow of victimsof theatomic omings of


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Cancer @esearch UE is the worldBs leading independent charity dedicated tocancer research" Cancer @esearch UE carries out scientific research to helpprevent, diagnose and treat cancer, ensuring that their findings are used to improvethe lives of all cancer patients"

#hey have discovered new ways of eating cancer that together have saved

hundreds of thousands of lives across the world, and wor& in partnership with othersto achieve the greatest impact in the gloal fight against cancer"

Cancer @esearch UE helps people to understand cancer y providing life$changing information to patients, their families and friends+ and runs cancerawareness campaigns to help people reduce their ris& of the disease" #heircampaigning and loying helps &eep cancer at the top of the political agenda"

One in three of us will get cancer at some point in our lives" Cancer@esearch UEBs groundrea&ing wor&, funded overwhelmingly y the general pulic,will ensure that millions more people survive"

#he 2ational Cancer @esearch /nstitute organi%es the 2C@/ CancerConference every yar" #his is the ma!or forum in UE that discusses the advances inresearch made in the country and internationally" #he *' Conference was in;iverpool would focus on enhancing opportunities for networ&ing and sharing&nowledge" very year, it rings together leading eperts and world classresearchers into a common podium"

;eading cancer research organi%ations and pro!ects include the 9merican9ssociation for Cancer @esearch, the 9merican Cancer 0ociety (9C0), the9merican 0ociety of Clinical Oncology, the uropean Organisation for @esearchand #reatment of Cancer, the 2ational Cancer /nstitute, the 2ationalComprehensive Cancer 2etwor&, and #he Cancer Genome 9tlaspro!ect at the 2C/"

34
http://en.wikipedia.org/wiki/American_Association_for_Cancer_Researchhttp://en.wikipedia.org/wiki/American_Association_for_Cancer_Researchhttp://en.wikipedia.org/wiki/American_Association_for_Cancer_Researchhttp://en.wikipedia.org/wiki/American_Cancer_Societyhttp://en.wikipedia.org/wiki/American_Society_of_Clinical_Oncologyhttp://en.wikipedia.org/wiki/European_Organisation_for_Research_and_Treatment_of_Cancerhttp://en.wikipedia.org/wiki/European_Organisation_for_Research_and_Treatment_of_Cancerhttp://en.wikipedia.org/wiki/National_Cancer_Institutehttp://en.wikipedia.org/wiki/National_Comprehensive_Cancer_Networkhttp://en.wikipedia.org/wiki/National_Comprehensive_Cancer_Networkhttp://en.wikipedia.org/wiki/The_Cancer_Genome_Atlashttp://en.wikipedia.org/wiki/American_Association_for_Cancer_Researchhttp://en.wikipedia.org/wiki/American_Association_for_Cancer_Researchhttp://en.wikipedia.org/wiki/American_Cancer_Societyhttp://en.wikipedia.org/wiki/American_Society_of_Clinical_Oncologyhttp://en.wikipedia.org/wiki/European_Organisation_for_Research_and_Treatment_of_Cancerhttp://en.wikipedia.org/wiki/European_Organisation_for_Research_and_Treatment_of_Cancerhttp://en.wikipedia.org/wiki/National_Cancer_Institutehttp://en.wikipedia.org/wiki/National_Comprehensive_Cancer_Networkhttp://en.wikipedia.org/wiki/National_Comprehensive_Cancer_Networkhttp://en.wikipedia.org/wiki/The_Cancer_Genome_Atlas


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Notes

http:00""".cancer.go0templates0!b1alpha.asp2

C!r#*344567http:00"""8.interscience."iley.com0cgi-

bin0%ulltet059587;90*35?S/=>3@

http:00""".ncbi.nlm.nih.go0pubme!05959A4A4

http:00""".ncbi.nlm.nih.go0pubme!0;A@A9@8Masuoka, (pr 9@@4).

Sur%ace glycans o% Can!i!a albicans an! other pathogenic %ungi:

physiological roles, clinical uses, an! eperimental challenges(

referat cancer engleza

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