Cancer Control Tookit

Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells. The cancer cells form tumors that destroy normal tissue. If cancer cells break away from a tumor, they can travel through the blood stream or the lymph system to other areas of the body, where they might form new tumors (also known as Metastases). If this growth is not controlled, cancer might be fatal.

Not all irregular growths of abnormal cells lead to cancer. A tumor can be either benign (non-cancerous) or malignant (cancerous). Benign tumors do not metastasize and, with very rare exceptions, are not life threatening. Benign tumors usually grow slowly, remain localized, and do not destroy surrounding normal tissue.

All cancers develop because of damage or mutation of the genes that control cell growth and division. These genetic changes can be caused by exposure to external factors (for example, tobacco, poor diet, alcohol, chemicals, sunlight, radiation, and infectious organisms) or internal factors (for example, inherited mutations, hormones, immune conditions, and mutations that occur from metabolism). Approximately five to 10 percent of cancers are caused by various inherited gene mutations that predispose people to developing certain cancers.

External and internal factors often act together on in sequence to initiate or promote cancer development. Many years often pass between exposures or mutations and detectable cancer. Because of this, it is often difficult to directly identify causes of specific cancer cases.

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Who gets Cancer?

Anyone can get cancer at any age; however, middle and older aged people are most likely to develop cancer. In Indiana, during 2013, 71 percent of all cancers cases occurred among people ages 55–84, including 24 percent among people ages 55-64, 28 percent among people ages 65-74, and 19 percent among people ages 75-84. And, individuals who have been exposed to certain external and internal risk factors have an increased risk of developing cancer. For example, according to the American Cancer Society (ACS), the risk of developing lung cancer is about 25 times higher in men and women who smoke than those who are nonsmokers.

How is Cancer Staged?

A cancer’s stage is based on the primary tumor’s size and location in the body, and whether it has spread to other areas of the body. There are two main staging systems used to classify tumors.

  • TNM staging system — This system assesses tumors in three ways: extent of the primary tumor (T), absence or presence of regional lymph node involvement (N), and absence or presence of distant metastases (M). Once the T, N and M are determined, a stage of I, II, III or IV is assigned, with stage I being early stage and IV being advanced.
  • Summary staging — This is useful for descriptive and statistical analyses of cancer data. An in situ tumor is at the earliest stage when it has not invaded surrounding tissue; it can only be diagnosed by microscopic examination. A localized tumor has not spread beyond the primary organ. A regional or distant tumor has spread to other parts of the body, either through the blood or lymph systems. With an unstaged/unknown tumor, there is insufficient information available to determine the stage of the disease.

Staging is essential in determining treatment and assessing prognosis. It is a strong predictor of survival; generally, the earlier the stage, the better the prognosis. Locally and nationally, about half of newly diagnosed cases are either in situ or localized.

How is Cancer Treated?

Treatment depends on the cancer type and stage, specific diagnosis, and overall health of the individual. Cancer is treated by one or more of the following therapies:

  • Surgery removes the tumor by cutting out the cancerous mass; it is mostly used for localized tumors.
  • Chemotherapy uses either intravenous or oral drugs to destroy cancer cells. It is used with the intention of curing or inducing remission in cancers in early stages.
  • Hormone therapy might be given to block the body’s natural hormone and to slow or stop the growth of certain cancers.
  • Immunotherapy (or biologic therapy) is used to stimulate and strengthen a person’s own immune system to destroy the cancer cells.
  • Radiation or radiotherapy uses high-energy rays to destroy or slow the growth of cancer cells. It can be done with the intention of curing some cancers that have not spread too far from their site of origin or to relieve symptoms.

Can Cancer be Cured?

Many cancers can be cured if detected and promptly treated. For most types of cancer, if a person’s cancer has been in remission (which means that all signs and symptoms of the disease are absent) for five years, the cancer is considered cured. However, the length of remission at which a person is considered cured differs by cancer type. Certain skin cancers, such as a basal cell carcinoma, are considered cured as soon as the lesion is removed. For other cancers (for example, pancreatic cancer), eight to 10 years must pass before the person is considered cured.

Prevention

Many cancers can be prevented through healthy behaviors and getting recommended early detection screenings. According to the ACS, all cancers caused by tobacco use and heavy alcohol consumption could be prevented completely. In 2016, the ACS estimates that 188,800 of the 595,690 cancer deaths in the United States will be caused by cigarette smoking. Additionally, the World Cancer Research Fund estimates that 20 percent of all cancers diagnosed in the United States are related to being overweight or obese, physical inactivity, excess alcohol consumption and/or poor nutrition. Certain cancers are related to infectious agents such as hepatitis B virus, hepatitis C virus, human immunodeficiency virus (HIV), human papillomavirus (HPV) and Helicobacter pylori (H. pylori). Many of these cancers could be avoided through treatment and/or vaccination. In addition, many of the more than 5 million skin cancers diagnosed each year could be prevented by protecting skin from sun exposure and avoiding indoor tanning devices.

Survivorship

Due to advances in treatment and earlier screenings, more and more people are living after a cancer diagnosis. The ACS defines a cancer survivor as any person who has been diagnosed with cancer, from the time of diagnosis through the balance of life. According to the Indiana State Cancer Registry, as of December 31, 2012, there were an estimated 286,973 cancer survivors for all cancers combined; the four highest-burden cancers in the state (breast, colorectal, lung and prostate) account for approximately 56 percent of these survivors. Survivorship, like cancer itself, is complex and can be difficult to navigate.

According to the Indiana Cancer Facts and Figures 2015 report, there are three phases of cancer survival – the time from diagnosis to the end of initial treatment, the transition from treatment to extended survival, and long-term survival. More often than not, the terms “survivor” and “survivorship” are associated with the transitional period after treatment ends; however, survivorship includes a wide range of cancer experiences and paths, including:

  • Living cancer-free for the remainder of life;
  • Living cancer-free for many years, but experiencing one or more serious, late complications of treatment;
  • Living cancer-free for many years, but dying after a late recurrence;
  • Living cancer-free after the first cancer is treated, but developing a second cancer;
  • Living with intermittent periods of active disease requiring treatment; and
  • Living with cancer continuously without a disease-free period.

The preferred path for most cancer patients is to receive treatment and be “cured.” This is the primary goal of all cancer treatment, when possible. For many cancer patients, the initial course of treatment is successful and the cancer does not return.

Many cancer survivors must still cope with the mid- and long-term effects of treatment, as well as any psychological effects – such as fear of returning disease. It is important that cancer patients, caregivers, and survivors have the information and support needed to help minimize these effects and improve quality of life and treatment.

The overall five-year relative survival rate for all cancers diagnosed during 2005-2011 was 69 percent. This is an increase over cancers diagnosed during 1975-1977, which had a survival rate of 49 percent. Improvement in survival is a result of earlier diagnosis of certain cancers, and improvements in treatment. According to the ACS, the five-year relative survival rate varies depending on the cancer type and the cancer stage at diagnosis.

In 2006, the Institute of Medicine (IOM) issued a report titled From Cancer Patient to Cancer Survivor: Lost in Transition. The report recommends that every cancer patient receives an individualized survivorship care plan that includes guidelines for monitoring and maintaining their health. In response to the IOM recommendation, many groups have now developed various types of “care plans” to help improve the quality of care of survivors as they move beyond their cancer treatment.

A treatment summary is critical for cancer survivors. The summary should describe the cancer diagnosis and medical treatments that were received (or that may be needed moving forward). Not only does the treatment summary provide survivors with a record of cancer treatments, but it helps survivors talk with other health care providers who may not have been part of the cancer care team.

According to the ACS, in addition to a treatment summary, a survivorship care plan should include a description of what follow-up appointments and tests will be needed and when they will be needed, a description of preventive measures that can be taken to help stay well, a description of any possible side effects from cancer treatments and ways to manage those side effects, and a description of ways to manage physical and mental health.

There are several organizations that assist with the development of survivorship care plans, including the American Society of Clinical Oncology, Journey Forward and LIVESTRONG Care Plan. A list of additional organizations can be found on the ACS website.

Resources

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