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1. What is Cancer?

Cancer is a common name for a group of diseases characterised by uncontrolled proliferation of abnormal cells. Cell division is the mainstay of human life. Human body is made up of several organs like brain, lung, liver, stomach etc. and each organ is made up of cells. Organs and tissues are constituted by cells characteristic of that organ. Cells divide for growth of an organ, for repairing tissue damage and to maintain functions of the organ. The divided cells are the exact replica of the parent cell. Sometimes due to some faulty mechanism or due to factors which are unknown yet, the divided cells are abnormal i.e., their structure is not the same as that of its parent cells. They cannot discharge the functions like the normal cells but requires the same food as the normal cells. These cells start dividing and a large number of abnormal cells are produced. As a result of the proliferation of abnormal cells the body organs do not function normally and the persons nutrition is impaired rapidly. These cells cluster to form lumps, swellings, and sometimes produce ulcers in the respective organs. However in the case of blood cancer -- Leukaemia - the abnormal cells start circulating throughout the blood streams so, no visible lump or swellings are observed. (Cancer is known by its different types like sarcoma, lymphoma, leukaemia, myeloma, carcinoma etc.). The most important characterisitc of cancer is that the cancer cells breakaway from the tissue or organ of origin and starts spreading to other parts of the body through lymphatic channels or cavities or blood vessels. They then deposit themselves in other parts of the body where it grows again. This is known as the metastasis. Because of this unique characterisitc it becomes difficult to cure or to control cancer when it has spread.

2. How does Cancer start?

The exact mechanism of transformation of normal cells to become cancerous is still not known. However, several factors are known to produce cancer-like tobacco in the form of smoking and chewing, alchohol, radiation, asbestos, certain chemicals, excessive fat consumption, viruses etc.

3. Does a lump always mean Cancer?

No. A lump can occur in any part of the body which may or may not contain cancer cells. Some of these lumps may grow to large sizes and produce ulcers. Because of this, they interfere with normal functions of nearby organs. However, they will not cause death and they can easily be removed by surgery and usually will not recur. They donot spread to other parts of the body. Such tumours are known as Benign tumours ie. harmless tumours. Cancer also can occur asa lump or tumour. A cancer is known as a malignant tumour. It is characterised specially by its potential to spread to other sites and to infiltrate the organ.

4. What are the most common Cancers seen in Indians?

Cancer affects different body organs due to a variety of factors and in India there are variations in the occurence and pattern of cancer. However, in our men, the majority of all cancers are found in mouth and throat, lung, stomach, gullet etc. and in women, they are found in large numbers in uterus[cervix], breast, mouth and throat.

5. Is Cancer increasing in our country?

In all Western countries where accurate statistics are available, cancer is seen to increase during the past 40 to 50 years. In our country also this should be true. As more people live upto old ages and with control of other diseases, more people would get cancer. Further, changes to Western life style and environmental pollution due to industrialisation etc. are also likely to contribute to an increase in cancer.

The occurence of cancer is measured, in absolute terms, by the incidence rate. This is a population based measure and indicates the number of new cancer cases that occur every year in 100,000 population. In India, such population based rates are not available for the entire country. However they are available for the some large city's populations. According to these annually around 70 new cancer cases will develop per 100, 000 population. This may appear to be a low rate but we consider 80 years as a life span, almost 16% of population will develop cancer if they all live upton this age. Based on these, it is estimated that almost 5 lakhs of persons will develop cancer every year in the country and in any given year there will be almost 15 lakhs cancer patients. As the population increases, this number also will increase. In order to study the cancer occurences in our country, and to monitor its trends, cancer registries have been started in several places by the Indian Council of Medical Research. These registries study not only the occurences and pattern of cancer in the community but also the factors that are associated with the disease. Such information are used for formulating and implementing the National Cancer Control plan of India.

6. Are the frequent cancer types similar in different countries?

No there are great variations in the occurence and pattern of cancer in different parts of the world. In India, the occurence  of mouth and throat cancer is highest when compared to other regions of the world. Stomach cancers occur with high frequency in Japan and some East European countries. Liver cancer is the frequent cancer in Africa. The predominant cancer in certain areas of China is oesophageal cancer, in other places it is Nasopharynx or Liver cancer. Lung, colon and breast cancers predominate in the United States of America.

There is no scientific proof yet that cancer is a contagious disease.

7. Is Cancer Hereditary?

Certain cancers are seen to occur in families. This does not mean that the disease has been transmitted from parent to children through genetic material. The same life style usually run in families and this could as well be the reason.Scientists believe that if there is a hereditary component, its effect is indeed very little.

8. Do Viruses cause Cancer?

There is good evidence to suspect that viruses may cause cancer in humans - leukaemia, nasopharyngeal cancer, liver and cervix cancer are considered now as being caused by viruses.

9. Is Radiation a cause for Cancer?

Radiation is widely used to diagnose many diseases. Radiation is also a very successful method to treat cancer. These are absolutely proper and safe uses. However Radiation is extremely dangerous and can cause cancer when not  properly handled. Over exposure to X-rays, or byproducts of atomic radiation can contribute to the development of cancer especially leukaemia.

10.Does Tobacco Chewing or Smoking cause Cancer?

Tobacco chewers develop cancer of cheek, tongue, gums etc. They are chronic chewers, often starting the habit at a young age of 15 or 18 years. They keep the tobacco quid [pan] in the mouth for a long time and often keep the quid even while asleep. Smoking cigarettes is the cause of 75% of all lung cancers and 25% of all cancers in the Western countries. Smokers are also likely to develop cancer of the mouth, pharynx, oesophagus [Gullet] pancreas and urinary bladder. In our country, almost 50% of all cancer in men are caused by heavy tobacco chewing and smoking; rather it is worse. The bidi contains more toxic harmful chemicals than in cigarette which produces cancer.

Tobacco smoking is also the major cause of heart disease, gastric ulcers, chronic bronchitis, emphysema and often the smoker dies young.

Due to the husband's smoking habits, his wife [passive smoking] is also at a high risk for developing cancer of various organs. In closed environments like bus, theatre, office, train and meeting halls smoking is dangerous to non smokers also.

11.Does heavy Alchohol consumption cause Cancer?

Heavy alchohol consumption especially in the presence of smoking increases the risk of certain cancers like cancer of tongue, throat, gullet, stomach and liver.

12.How is Cancer Diagnosed?

The diagnosis of cancer can be made only after a careful clinical examination and several laboratory tests ate required  to accurately know the primary site of origin of cancer, type of cancer and to learn the extent of spread of the disease.These are necessary for planning effective treatment. Identifying cancer cells with the help of a microscope in an aspirate of body issue or scrapings of fluids aspirated by a needle and syringe is called cytology. The examination of a piece of body tissue after processing is called biopsy and histopathology examination. Endoscopes passed in to the body are used to diagnose cancer of deep seated internal organs like oesophagus, stomach, intestines, thoracic and abdominal cavities. For diagnosing leukamia, blood examination is essential. Plain X-ray pictures are used to diagnose cancers of bone. Some times special X-rays like Barium X-rays, angiograms etc. are taken. Ultrasound scanning, CT scanning, NMR scanning and scanning by radio isotopes are also used depending the site of cancer. Certain biochemical tests are undertaken to diagnose mulriple myeloma. Generally, the doctor will do two or three tests for a suspected cancer.

13.How is an early cancer detected?

One should know the warning signals of cancer. These need not always be due to cancer, but when a symptom is  noted, promptly undergo a through medical examination by a competent physician or cancer specialist. Secondly, self examination methods and periodic self examination of mouth and breast can detect many cancers in early or precancerous stages. In case of ulterine cervix a simple cervical smear test high early detection.

14.How does early diagnosis help?

When cancer has not spread beyond its site of origin a complete cure is often possible. When a cervix cancer is localised, almost 100% cure is possible but when it has spread to nearby bladder or rectum, not even 20% will live upto 5 years. Similarly, an early breast cancer when treated adequately, would have a more than 85% chance of surviving more than 5 years whereas when it is spread to lungs less than 10% would survive 5 years. Thus early diagnosis ensure a better cure rate.

No pain is not a symptom of early cancer, it is a symptom of advanced cancer.

15.Is it possible to prevent cancer?

It is recognised that some cancers can be prevented. Most mouth cancers can be prevented by not chewing tobacco  and most lung and throat cancers can be prevented by not smoking. Certain cancers are produced by chemicals used in industry. If workers are protected against contact with such occupational factors, some cancers can be prevented.

A well balanced diet with less fat and more green leafy vegetables, citrus fruits, milk etc.can protect people. Above all, eventhough not all cancers are preventable, many deaths due to cancer can be prevented by early detection and proper treatment. A knowledge of the warning signals of cancer helps one to get an early diagnosis and a successful treatment.

16.Can diet cause for prevent cancer?

Many scientists are now studying this factor to establish a cause - effect relationship. It is generally suggested that a high fat diet can cause cancer of Intestine, Colon, Rectum, Prostate, Uterus and Breast. In Japan the use of salted pickles, is believed to be the cause for the high stomach cancer rate. By the use of grilled meat reached oil, one consumes significant quantities of certain chemicals that can produce cancer. Certain food additives and colouring agents are also highly suspected to cause cancer. Diet with plenty of fibre is shown to be protective against Intestinal cancer. Studies in Japan and other western countries have established that there is a strong protective effect for green leafy vegetables, carrot, milk, citrus fruits etc. against many forms of cancers. The American Cancer Society is now propagating the use of fresh green leafy vegetables and fruits in their campaign against cancer.

17.What are the symptoms of mouth cancer and how can we detect the early mouth cancer?

Mouth cancer is the commonest cancer in our country. The disease can arise in one of the several structures with in the mouth like the inside lining of cheek [commonest] tongue, gums, roof of mouth etc. It is commonly observed that a mouth cancer starts as a pearly white patch in the mouth which cannot be scraped off. Very often this is caused by chronic tobacco chewing. All such white patches [leukoplakia] will not develop into cancer, but some will certainly. So it is most essential such patches are regularly observed and treated by competent doctors. One can learn to examine the mouth using a mirror himself/herself to see clearly the inside of cheek, tongue, sides and undersurface, floor of mouth, the gums and areas joining the gums and cheek, the roof of mouth and lips. Any red discolouration or white patches or in fact any deviation from normal should be shown to the doctor for his advice. An ulcer caused by sharp teeth, repeated injuries to the tongue and cheek, an ill fitting denture producing constant irritation and injury are also found to progress into cancer if left untreated.

18.How is lung cancer detected?

The symptoms of lung cancer only appear in a late stage. These are persistent cough, blood in sputum, chest pain etc. The most prominent method for detecting lung cancer is by routine chest x-rays. Sputum examination may also reveal a lung cancer. It is to be noted that a lung cancer detected is never an early cancer. Even with the best methods of treatment, whether it is surgery, radiation or chemotherapy the survival rate is very poor. The most effective way to control lung cancer is by preventing its occurence by not smoking.

19.What are the Symptoms of cervix cancer?

White discharge, unusual or excessive bleeding during menses or between menstrual cycles especially after sexual inter course or during postmenopausal years are symptoms of cancer cervix. These need not always mean that cancer is present, however, an expert medical examination is necessary when such symptoms are present.

20.How is Uterine Cancer detected?

There are very effective and simple ways of detecting cancer of the uterus. Curretings [scrapings from the inner lining of  the uterus] and the neck of the uterus [cervix] can be examined under a microscope to detect cancer. Tissue is sometimes removed from the suspected cancer area for biopsy. Colposcope is an instrument used to examine the uterus and to identify the correct areas for taking a biopsy.

21.What are the symptoms of mouth cancer

Certain changes in the cells take place years before they turn into cancer. Such changes can be identified examining the cells which are collected from the cervix uterus. The cells which are exfoliated [shred] from the cervix are collected by  a spatula. These are then examined under a microscope. The process is named as Pap Smear test [named after its  inventor Dr. George Papanicolaou]. By this procedure a correct diagnosis is arrived at in more than 95% cases. The procedure is simple painless, takes less than 5 minutes and needs no medication or preparation of the patient. Dysplastic changes, which may turn to cancer, years later, can be identified and the process of cancer information can be stopped. All married women should undergo this test and if two annual consecutive tests are negative, one need to undergo this test only once three years. By using this procedure in the population several western countries have rapidly reduced the cervical cancer incidence in their population.

This is a Cytology test.

22.What are the factors that increase the risk of Uterus Cancer?

Cancer of the uterine cervix [neck of the uterus] is the commonest cancer in Indian women. Early marriage and pregnancy, frequent deliveries, more than one marital partner, poor genital hygiene and HPV virus are observed to increase the risk of  cervix cancer. Infertility, amenorrhoea and certain hormones are observed to be a associated with the occurences of cancer of the body of the uterus.

23.How can we control Cervix Cancer?

Cervix cancer is one of the cancers that can be controlled. This disease can be prevented, can be detected early, and a 100% cure can be achieved if treated in early stages. Certain high risk factors are known for cervix cancer. These are early marriage, poor genital hygiene, and more than one marital partner. Pap smear technique can detect early changes in the cells which may ultimately become cancer if untreated. The technique is simple and can be undertaken in doctor's offices.Smear examination should be made a routine examinations as part of regular health check up for married women. Popularisation of Pap smear technique among the public is thus necessary for cervix cancer control. Early cancer, when detected, should be treated promptly. Appropriate treatment would ensure a hundred percent cure. Periodical physical examination [Gynaecological] is also essential.

24.What is the best method by which cancer is treated now?

The best treatment method for cancer depends on several factors, of which the most important are the site of cancer, type  of cancer, spread of the disease when diagnosed, general health of the patient etc. Some cancers are best removed by operation and are cured by this method. For some other types the best treatment is radiation: given externally,  [Teletherapy] which is administered with Cobalt or Linear accelerator units or by inserting radioactive needles [radium,caesium. Cobalt etc.] into the body [Brachy therapy] or by combining both external and brachy therapy methods. Certain cancers are treated by drugs [chemotherapy] only. Very often some cancers need all the three methods of treatment. The treating doctor choses the best method considering several of the above factors. In some cases surgery will remove a portion of the tumour, then treatment is continued by radiation. Radiation is given also to shrink the tumour so that a removal of the tumour by surgery can be done later.

25.What are the side effects of Radiation and Chemotherapy?

First it has to be understood that all the side effects are temporary and will vanish in course of time. Depending on the site of radiation treatment, the symptoms will vary. Diarrhoea, dryness of mouth, mouth soreness, difficulty in swallowing, loss of appetite and taste and abdominal cramps are some of the side effects due to radiation. Chemotherapeutic drugs also can cause severe discomfort. Loss of hair, nausea, vomiting, diarrhoea, anaemia are some of the severee complaints. As in the case of sickness caused by radiotherapy, the sickness caused by chemotherapy also vanishes 2 to 3 weeks after completion of treatment.  

26.What are the warning signals of cancer?

    A sore or ulcer that does not heal within 3 weeks with antibiotics especially in mouth. Pearly white patches in the mouth. Inability to hold salty food in mouth.

    Unusual bleeding or discharge from any orifice.

    Thickening or lump in breast or elsewhere in the body.

    Repeated abdominal cramps, indigestion. Difficulty in swallowing which lasts more than 3 weeks. Changes in bowel habits [Diarrhoea & Consumption] lasting for more than 3 weeks.

    Hoarseness of voice, nagging cough; persisting even after treatment for 3 weeks.

    Difficulty in urination, blood in urine, especially if you are above 45 years of age.

    Change in wart or mole.

    Listlessness, anaemia, intermittent fever which are not controlled by conversational medication.

    Impairment in vision, white patches the eye, often shining at night.

    These signs need not always be due to Cancer. But consult a specialist doctor if you have any of the above symptoms

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