We Should Be Aware of Cancer (Sept 20, 2009)
Everyone should be aware of Cancer.
Nearly 70,000 new cancer cases were diagnosed among Malaysians in Peninsular Malaysia between 2003 and 2005, This is according to a report released in early 2008 on the incidence of the disease in West Malaysia.
According to The Cancer Incidence in Peninsular Malaysia 2003-2005 report published by the National Cancer Registry (NCR), a total of 67,792 new cases were diagnosed; among these new cases, 43.7% was male (29,596) and 56.3% female (38,196). The annual crude rate for males was 100.2 per cent per 100,000 population, and 132.1 per cent per 100,000 for females. A crude rate is defined as the number of cause-specific events (e.g. deaths, disease cases, individuals at risk) over a specified period of time (e.g. a year) divided by the total population.
Breast cancer ranked highest in the list at 18% in term of incidence followed by large bowel cancer (11.9%) and lung cancer (7.4 %). According to the National Cancer Registry 2002 report, 1 in 5.5 Malaysians are expected to get cancer in their lifetime (1 in 4 for Chinese, 1 in 5 for Indians and 1 in 7 for Malays).
Cancer is defined as the uncontrolled or unregulated growth of cells. The word is derived from "crab" in Latin. In general, one billion cells are required for a cancer lump to reach 1cm diameter or to weigh 1g. This is the limit of detection by imaging techniques.
We usually begin by seeing general practioners (GP) who will ask questions about symptoms that we might have, examine us, and ask us to have some tests done such as blood tests and x-ray. If the GP suspects that we may have cancer, an urgent referral will be made to a specialist. There is guideline to help GPs identify what symptoms could be due to cancer or some other condition.
An urgent referral usually means that the specialist will see us within two weeks. The specialist can carry out other investigations, such as a biopsy or various scans to find out the cause of our symptoms and to plan any necessary treatment.
If our GP thinks those symptoms are not caused by cancer they may still refer us to a specialist for advice but the referral is likely to be non-urgent and it will take longer for us to be seen by the specialist referred.
Knowledge of cancer biology has progressed by leaps and bounds in the last 20 years. The improved understanding of the diseases process of cancer has led to the development of various methods of screening and targeted treatments. Cancer is not one disease but many although there are some striking similarities in how all cancers develop. Cancer is a monoclonal disease; all the cells in a tumor come from only ancestral cell. The tissues and organs of the body are made up of tiny building blocks called cells. Cancer is a disease of these cells. Cells in different parts of the body may look and work differently but most of them reproduce themselves in the same way. Cells are constantly becoming old and dying, and new cells are produced to replace them. Normally, cells divide in an orderly and controlled manner. If for some reason the process gets out of control, the cells carry on dividing, developing into a lump which is called a tumour.
Tumours can be either benign or malignant. Cancer is the name given to a malignant tumour. Doctors can tell if a tumour is benign or malignant by examining a small sample of cells under a microscope. This is called a biopsy.
In a benign tumour, the cells do not spread to other parts of the body and so are not cancerous. However, if they continue to grow at the original site, they may cause a problem by pressing on the surrounding organs.
A malignant tumour consists of cancer cells that have the ability to spread beyond the original area. If the tumour is left untreated, it may spread to and destroy surrounding tissues. Sometimes cells break away from the original (primary) cancer.
They may spread to other organs in the body through the bloodstream or lymphatic system.
When cancer cells reach a new area they may go on dividing and form a new tumour. This is known as a secondary cancer or metastasis.
The lymphatic system is part of the immune system - the body's natural defence against infection and disease. It is a complex system made up of organs, such as bone marrow, the thymus, the spleen, and lymph nodes. Lymph nodes (or glands) throughout the body are connected by a network of tiny lymphatic ducts.
It is important to realise that cancer is not a single disease with a single type of treatment. There are more than 200 different kinds of cancer, each with its own name and treatment.
Cancer can be managed more easily when it is diagnosed in the early stages. Being aware of our body and what is 'normal' for us. Reporting any symptoms of concern early to our family doctors can help to make sure that a proper diagnosis is done.
If unfortunately we are diagnosed with cancer, it can be treated as early as possible.
There are some common signs and symptoms that may alert us to the fact that something not right has happened to us.
Knowing how our body normally looks and feels can help us spot any early changes that could be caused by cancer. We should see our family doctors if we notice a lump anywhere in our body. It can be useful to tell them how long it has been there and whether it is getting bigger or causing any discomfort. Cancerous lumps are often (but not always) painless.
It can be difficult to tell what a lump is just by feeling it, but if our doctors suspect that we might have cancer, they will refer us to the appropriate specialists for further tests.
It is important to remember that lumps and bumps often occur in the body, and most of them might not be cancer.
If we have lost a lot of weight over a short period of time (a couple of months) which cannot be explained by changes in our diet, increased exercise or stress, it is important to tell our doctors. Other symptoms, such as sickness, pain and fatigue also tend to occur when a person experiences weight loss due to cancer.
Symptoms of bowel cancer may include blood in stools (bowel motion).
The stools would usually be dark but they can be bright red in colour. Fresh, bright red blood is usually a sign of piles (haemorrhoids).
We may notice a change in our normal bowel pattern (such as diarrhea or constipation) for no obvious reason.
We might have a feeling of not having emptied our bowel properly after a bowel motion. Some people also notice that they have pain in the abdomen or back passage (rectum).
Changes in bowel habits are not always caused by cancer, but they can be caused by changes in diet, medicines, anxiety, and other medical conditions.
If any changes last for more than a few weeks it is important not to rule out cancer as a possible cause and we should consult our doctors.
There are many medical conditions that can cause 'chesty' symptoms like coughing and breathlessness (for example, infections and inflammations), but in some cases these symptoms may be a sign of lung cancer.
If we have a cough or feel breathless for more than two weeks we should see our doctors. We should also tell them if we have any blood in our sputum (phlegm) when we cough. Laryngitis (inflammation of the larynx) is common and can cause a hoarse voice.
In a small number of people, a hoarse voice may be a sign of cancer of the larynx (Voice box). If hoarseness continues for longer than two weeks, do consult our family doctor.
Any unexplained bleeding is a sign that there is something wrong. As previously mentioned, bleeding from the back passage is most commonly caused by piles but sometimes it can be due to cancer of the bowel or rectum.
Cancer of the worm or cervix causes women to bleed between periods or after sex.
Women who have any vaginal bleeding after they have had their menopause should see their family doctors who will refer them to a gynecologist.
Blood in our urine may be caused by bladder or kidney cancer. It can also be caused by infection. If we notice blood in our urine it is important to go for a check-up. Blood in our sputum may be caused by serious chest infections but can sometimes be a sign of lung cancer. Vomiting blood can be a sign of stomach cancer, although it can also be due to a stomach ulcer. Therefore, it is important to have this checked out.
Malignant melanoma is a type of skin cancer that often starts with a change in the appearance of normal skin. This can look like an abnormal new mole. Less than a third of melanomas develop in existing moles.
It can be difficult to tell the difference between a mole and a melanoma, but any of the changes like colour, asymmetry, border, size, itching, crusting or bleeding should be checked out. Moles tend to be a single brown.
Melanomas often have more than one colour. They may be varying shades of brown mixed with black, red, pink, white or a bluish tint.
Moles are usually regular and symmetrical in shape. Melanomas are likely to be irregular or asymmetrical.
Moles usually have a well-defined regular border. Melanomas are more likely to have an irregular border with jagged edges. Moles are normally no bigger than the blunt end of a pencil (about 6mm (1/4 inch) across). Melanomas are usually more than 7mm in diameter. Itching, crusting or bleeding may also occur in melanomas – these are less common signs but should not be ignored.
It is important to see our family doctors if we have any unusual marks on the skin that last more than a few weeks, or an existing mole which shows any of the above signs.
If necessary they will arrange for us to see a doctor who specializes in skin conditions (a dermatologist) or a surgeon.
This section has been complied using information from a number of reliable sources including; Souhami and Tobias. Cancer and its Management (5th edition). Blackwell Scientific Publications. Oxford. 2005. DeVita, Vincent T. et al. Cancer: Principles and Practice of Oncology (6th edition). Lippincott. Philadelphia. 2001.Clinical Guidelines CG027: Referral for Suspected Cancer. National Institute for Clinical Excellence (NICE). June 2005. Souhami et al. Oxford Textbook of Oncology (2nd edition). Oxford University Press. Oxford. 2002.
Nearly 70,000 new cancer cases were diagnosed among Malaysians in Peninsular Malaysia between 2003 and 2005, This is according to a report released in early 2008 on the incidence of the disease in West Malaysia.
According to The Cancer Incidence in Peninsular Malaysia 2003-2005 report published by the National Cancer Registry (NCR), a total of 67,792 new cases were diagnosed; among these new cases, 43.7% was male (29,596) and 56.3% female (38,196). The annual crude rate for males was 100.2 per cent per 100,000 population, and 132.1 per cent per 100,000 for females. A crude rate is defined as the number of cause-specific events (e.g. deaths, disease cases, individuals at risk) over a specified period of time (e.g. a year) divided by the total population.
Breast cancer ranked highest in the list at 18% in term of incidence followed by large bowel cancer (11.9%) and lung cancer (7.4 %). According to the National Cancer Registry 2002 report, 1 in 5.5 Malaysians are expected to get cancer in their lifetime (1 in 4 for Chinese, 1 in 5 for Indians and 1 in 7 for Malays).
Cancer is defined as the uncontrolled or unregulated growth of cells. The word is derived from "crab" in Latin. In general, one billion cells are required for a cancer lump to reach 1cm diameter or to weigh 1g. This is the limit of detection by imaging techniques.
We usually begin by seeing general practioners (GP) who will ask questions about symptoms that we might have, examine us, and ask us to have some tests done such as blood tests and x-ray. If the GP suspects that we may have cancer, an urgent referral will be made to a specialist. There is guideline to help GPs identify what symptoms could be due to cancer or some other condition.
An urgent referral usually means that the specialist will see us within two weeks. The specialist can carry out other investigations, such as a biopsy or various scans to find out the cause of our symptoms and to plan any necessary treatment.
If our GP thinks those symptoms are not caused by cancer they may still refer us to a specialist for advice but the referral is likely to be non-urgent and it will take longer for us to be seen by the specialist referred.
Knowledge of cancer biology has progressed by leaps and bounds in the last 20 years. The improved understanding of the diseases process of cancer has led to the development of various methods of screening and targeted treatments. Cancer is not one disease but many although there are some striking similarities in how all cancers develop. Cancer is a monoclonal disease; all the cells in a tumor come from only ancestral cell. The tissues and organs of the body are made up of tiny building blocks called cells. Cancer is a disease of these cells. Cells in different parts of the body may look and work differently but most of them reproduce themselves in the same way. Cells are constantly becoming old and dying, and new cells are produced to replace them. Normally, cells divide in an orderly and controlled manner. If for some reason the process gets out of control, the cells carry on dividing, developing into a lump which is called a tumour.
Tumours can be either benign or malignant. Cancer is the name given to a malignant tumour. Doctors can tell if a tumour is benign or malignant by examining a small sample of cells under a microscope. This is called a biopsy.
In a benign tumour, the cells do not spread to other parts of the body and so are not cancerous. However, if they continue to grow at the original site, they may cause a problem by pressing on the surrounding organs.
A malignant tumour consists of cancer cells that have the ability to spread beyond the original area. If the tumour is left untreated, it may spread to and destroy surrounding tissues. Sometimes cells break away from the original (primary) cancer.
They may spread to other organs in the body through the bloodstream or lymphatic system.
When cancer cells reach a new area they may go on dividing and form a new tumour. This is known as a secondary cancer or metastasis.
The lymphatic system is part of the immune system - the body's natural defence against infection and disease. It is a complex system made up of organs, such as bone marrow, the thymus, the spleen, and lymph nodes. Lymph nodes (or glands) throughout the body are connected by a network of tiny lymphatic ducts.
It is important to realise that cancer is not a single disease with a single type of treatment. There are more than 200 different kinds of cancer, each with its own name and treatment.
Cancer can be managed more easily when it is diagnosed in the early stages. Being aware of our body and what is 'normal' for us. Reporting any symptoms of concern early to our family doctors can help to make sure that a proper diagnosis is done.
If unfortunately we are diagnosed with cancer, it can be treated as early as possible.
There are some common signs and symptoms that may alert us to the fact that something not right has happened to us.
Knowing how our body normally looks and feels can help us spot any early changes that could be caused by cancer. We should see our family doctors if we notice a lump anywhere in our body. It can be useful to tell them how long it has been there and whether it is getting bigger or causing any discomfort. Cancerous lumps are often (but not always) painless.
It can be difficult to tell what a lump is just by feeling it, but if our doctors suspect that we might have cancer, they will refer us to the appropriate specialists for further tests.
It is important to remember that lumps and bumps often occur in the body, and most of them might not be cancer.
If we have lost a lot of weight over a short period of time (a couple of months) which cannot be explained by changes in our diet, increased exercise or stress, it is important to tell our doctors. Other symptoms, such as sickness, pain and fatigue also tend to occur when a person experiences weight loss due to cancer.
Symptoms of bowel cancer may include blood in stools (bowel motion).
The stools would usually be dark but they can be bright red in colour. Fresh, bright red blood is usually a sign of piles (haemorrhoids).
We may notice a change in our normal bowel pattern (such as diarrhea or constipation) for no obvious reason.
We might have a feeling of not having emptied our bowel properly after a bowel motion. Some people also notice that they have pain in the abdomen or back passage (rectum).
Changes in bowel habits are not always caused by cancer, but they can be caused by changes in diet, medicines, anxiety, and other medical conditions.
If any changes last for more than a few weeks it is important not to rule out cancer as a possible cause and we should consult our doctors.
There are many medical conditions that can cause 'chesty' symptoms like coughing and breathlessness (for example, infections and inflammations), but in some cases these symptoms may be a sign of lung cancer.
If we have a cough or feel breathless for more than two weeks we should see our doctors. We should also tell them if we have any blood in our sputum (phlegm) when we cough. Laryngitis (inflammation of the larynx) is common and can cause a hoarse voice.
In a small number of people, a hoarse voice may be a sign of cancer of the larynx (Voice box). If hoarseness continues for longer than two weeks, do consult our family doctor.
Any unexplained bleeding is a sign that there is something wrong. As previously mentioned, bleeding from the back passage is most commonly caused by piles but sometimes it can be due to cancer of the bowel or rectum.
Cancer of the worm or cervix causes women to bleed between periods or after sex.
Women who have any vaginal bleeding after they have had their menopause should see their family doctors who will refer them to a gynecologist.
Blood in our urine may be caused by bladder or kidney cancer. It can also be caused by infection. If we notice blood in our urine it is important to go for a check-up. Blood in our sputum may be caused by serious chest infections but can sometimes be a sign of lung cancer. Vomiting blood can be a sign of stomach cancer, although it can also be due to a stomach ulcer. Therefore, it is important to have this checked out.
Malignant melanoma is a type of skin cancer that often starts with a change in the appearance of normal skin. This can look like an abnormal new mole. Less than a third of melanomas develop in existing moles.
It can be difficult to tell the difference between a mole and a melanoma, but any of the changes like colour, asymmetry, border, size, itching, crusting or bleeding should be checked out. Moles tend to be a single brown.
Melanomas often have more than one colour. They may be varying shades of brown mixed with black, red, pink, white or a bluish tint.
Moles are usually regular and symmetrical in shape. Melanomas are likely to be irregular or asymmetrical.
Moles usually have a well-defined regular border. Melanomas are more likely to have an irregular border with jagged edges. Moles are normally no bigger than the blunt end of a pencil (about 6mm (1/4 inch) across). Melanomas are usually more than 7mm in diameter. Itching, crusting or bleeding may also occur in melanomas – these are less common signs but should not be ignored.
It is important to see our family doctors if we have any unusual marks on the skin that last more than a few weeks, or an existing mole which shows any of the above signs.
If necessary they will arrange for us to see a doctor who specializes in skin conditions (a dermatologist) or a surgeon.
This section has been complied using information from a number of reliable sources including; Souhami and Tobias. Cancer and its Management (5th edition). Blackwell Scientific Publications. Oxford. 2005. DeVita, Vincent T. et al. Cancer: Principles and Practice of Oncology (6th edition). Lippincott. Philadelphia. 2001.Clinical Guidelines CG027: Referral for Suspected Cancer. National Institute for Clinical Excellence (NICE). June 2005. Souhami et al. Oxford Textbook of Oncology (2nd edition). Oxford University Press. Oxford. 2002.
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