4 Diet and Cancer Risk

There is strong evidence that dietary patterns, foods, nutrients, and other dietary constituents are closely associated with the risk for several types of cancer. It has been estimated that 35 percent of cancer deaths may be related to dietary factors. Currently available research shows that diets low in fat and high in fiber, fruits, vegetables, and grain products are associated with reduced risks for many cancers.

Dietary Fats: Diets high in fat have been linked to increased risk of various cancers, particularly breast, colon, prostate, and possibly pancreas, ovary, and endometrium. Studies of populations in countries consuming high-fat diets compared to low-fat diets have consistently shown higher incidence and mortality rates for breast, colon, and prostate cancer. There is evidence that the international association between fat intake and the risk of breast and colon cancer is much stronger for total fat intake compared to the specific type of fat, i.e., saturated, monounsaturated, or polyunsaturated fat. However, some studies showed a significant positive association between breast cancer risk and saturated fat intake in postmenopausal women. Recent studies in the same population of U.S. women reported that increased intakes of total saturated and monounsaturated fats were associated with increased colon cancer but not breast cancer.

Because dietary fat intake is highly correlated with calorie intake, the question has been raised as to whether fat intake or calorie intake is the major dietary factor affecting cancer risk. However, dietary fat is the most concentrated source of energy of all the nutrients and supplies nine calories per gram compared to four calories per gram from either carbohydrate or protein. In general, a reduction in dietary fat intake is accompanied by a decrease in total calorie intake and body weight.

Dietary Fiber:Dietary fiber falls into two categories, water-soluble fiber and water-insoluble fiber, and is generally defined as those components of food plants resistant to the enzymes produced by the human digestive tract.

Diets high in fiber-containing foods are associated with a reduced risk for cancer, especially cancer of the colon. A few studies have also shown a reduced risk for cancers of the breast, rectum, oral cavity, pharynx, stomach, and other sites with diets rich in fruits, vegetables and grain products. Because these foods contain other nutrients as well as fiber, and are usually lower in fat, it has not been possible to determine whether the protective effect is attributable to dietary fiber.

Fruits and Vegetables:Populations consuming diets high in fruits and vegetables tend to have a lower cancer risk. Fruits, vegetables, and grains contain a number of nutrients, including carotenoids, vitamin A, and vitamin C. The cancers for which there is evidence of a protective effect include those of the lung, colon and rectum, breast, oral cavity, esophagus, stomach, pancreas, uterine cervix, and ovary. For most cancer sites, especially epithelial cancers of the respiratory and digestive tracts, persons with low fruit and vegetable intake had about twice the risk of cancer as those with high intake.

Carotenoids and Vitamin A:Carotenoids reduce the risk of some cancers. The evidence is particularly strong for lung cancer, even after taking smoking into account. Some studies found reduced lung cancer risk with higher intake. Persons with higher levels of blood carotenoids had reduced risk of lung cancer.

Carotenoids are found in dark yellow/orange vegetables and fruits such as carrots, sweet potatoes, and cantaloupe and in deep green leafy vegetables such as broccoli, spinach, and collard greens. There are many different carotenoids in such foods, including beta-carotene, alpha-carotene, and lutein. Current dietary recommendation is for five servings of fruit and vegetables a day.

Vitamin C:Vitamin C is found in fruits, particularly citrus fruits and juices, and in green vegetables, as well as in some fortified foods. Epidemiologic studies found that vitamin C, or fruit rich in vitamin C, provides significant protection. The evidence is most consistent for cancers of the esophagus, oral cavity, and stomach, but protective effects have been reported for cancers of the pancreas, rectum, and cervix.

Other Nutrients: Fruits, vegetables, and grains contain other vitamins and minerals associated with a protective effect against cancer. Vitamin E has inhibited tumors in experimental animals and been linked to reduced risks of oral, stomach, and other cancer in epidemiologic studies. Selenium also may have a protective effect. In a recent randomized large-population trial among persons in high risk areas of China, those who received daily supplements with a combination of beta-carotene, vitamin E, and selenium for 5 years had a significantly lower cancer death rate. The findings do not automatically translate to Western populations, but offer a hopeful sign that certain vitamins and minerals may lower risk of some cancers. In the study of the effect of beta-carotene or alpha-tocopherol on lung cancer among smokers, dietary intake of these nutrients from foods was associated with a reduced risk for lung cancer. Some studies suggest that calcium may play a protective role in colon cancer. A 19-year prospective study in men showed the risk for colon cancer was lower in those with the highest calcium intake. In addition to dairy products, certain vegetables are good sources of calcium, notably roots, okra, and dark green leafy vegetables such as collard greens.

5 Smoking and cancer (1)

It is estimated that one in three people will develop cancer at some stage in their lives and that one in four will die from the disease.

Cigarette smoking is an important cause of cancers of the lung, larynx (voice box), pharynx (throat), oesophagus, bladder, kidney and pancreas. Cigarette smoke contains dangerous chemicals that are a hazard when inhaled --either directly or indirectly. Carbon monoxide, which is found in smoke, starves your blood of oxygen and increases the work your heart must perform. Nicotine raises your blood pressure and heart rate, and tar, which also builds up in your lung tissue, contains cancer-causing substances. These dangerous chemicals increase your risk of heart disease, heart attack, and chronic respiratory illness and disease, especially several kinds of cancer.

Lung cancer: Lung cancer is the most common cancer in the world with 1.2 million new cases diagnosed every year. Lung cancer is the cancer most commonly associated with smoking: around 90% of all lung cancers are caused by smoking, either directly or through indirect exposure. It is estimated that smoking causes some 106,000 premature deaths every year, of which about a quarter are from lung cancer and around one fifth are from chronic obstructive lung disease ? bronchitis and emphysema. The respiratory system is vital to life and anything which prevents it functioning can result in death. Because of its poor prognosis, often cancers of these organs are not discovered until it is too late to cure them: 93% of lung cancer patients die within five years of diagnosis and 75% die within the first year. Lung cancer is still the most common cause of cancer death in the world.

The risk of lung cancer increases directly with the number of cigarettes smoked.  In a study, deaths from lung cancer in smokers and non?smokers were as follows:

Age at time of starting to smoke is important.  The younger a person is when he or she starts smoking, the greater the risk of developing lung cancer.  A study found that smoking during the teenage years causes permanent genetic changes in the lungs and forever increases the risk of lung cancer, even if the smoker subsequently stops.In smokers, the most important parameter of smoking that affects lung cancer risk is the duration of smoking, although, as noted above, risk also increases with the number of cigarettes smoked per day.

The risk of lung cancer, like all other cancers, increases steeply with advancing age.  When smokers give up, their risk of getting lung cancer starts decreasing so that after 10 years an ex?smoker's risk is about a third to half that of continuing smokers.  A longitudinal study found that if people stop smoking, even well into middle age, they avoid most of their subsequent risk of lung cancer. Stopping smoking before the age of 30 avoids more than 90% of the risk attributable to smoking.

Pulmonary function is a strong predictor of mortality and smoking reduces pulmonary function. A study found that middle aged smokers across the entire range of pulmonary function may increase their expectation of lifespan by giving up smoking. Smokers with chronic obstructive lung disease who stop smoking while still young can expect their lung function to improve.

Cancers of the mouth and throat: Smoking cigarettes, pipes and cigars is a risk factor for all cancers associated with the larynx, oral cavity and oesophagus.  Over 90% of patients with oral cancer use tobacco by either smoking or chewing it. The risk for these cancers increases with the number of cigarettes smoked and those who smoke pipes or cigars experience a risk similar to that of cigarette smokers. Heavy smokers have laryngeal cancer mortality risks 20 to 30 times greater than non-smokers. People who drink alcohol and smoke have a much higher risk of oral and pharyngeal (throat) cancers than those only using tobacco or alcohol. A study revealed that among consumers of both products the risk of these cancers was increased more than 35-fold among those who smoked forty or more cigarettes a day and took more than four alcoholic drinks a day. It has been estimated that tobacco smoking and alcohol drinking account for about three quarters of all oral and pharyngeal cancers.

6 Smoking and cancer (2)

 Oesophageal cancer: Tobacco smoking is a cause of cancer of the oesophagus (gullet) and the risk increases with the number of cigarettes smoked and duration of smoking. The risk also remains elevated many years after smoking cessation.

Bladder cancer: Tobacco smoking is the principal preventable risk factor for bladder cancer in both men and women. It is estimated that current smokers are two to five time more likely to develop bladder cancer than non-smokers. As for lung cancer, the risk is associated with both the dose and duration of smoking, while cessation of smoking reduces the risk. 

Kidney cancer: Kidney cancer has consistently been found to be more common in smokers than in non-smokers and there is now sufficient evidence to show that smoking is a risk factor for the two principal types of kidney cancer. There is a dose-response relationship with increasing numbers of cigarettes per day and risk appears to drop after smoking cessation.  Approximately 24% of kidney cancer cases in men and 9% in women can be attributed to smoking.

Pancreatic cancer: Cancer of the pancreas is a rapidly fatal disease with a five?year survival rate of only 4%.  Cigarette smoking is a strong and consistent predictor of pancreatic cancer although the risk diminishes to that of a non-smoker ten years, on average, after cessation.  Risk of the disease is related to consumption and duration of smoking.  Smokers have about twice as high a risk for this cancer as non-smokers.

Stomach cancer: Studies have shown a consistent association between cigarette smoking and cancer of the stomach in both men and women.  Risk increases with duration of smoking and number of cigarettes smoked, and decreases with increasing duration of successful quitting.   

Liver cancer: Large case-control studies have demonstrated an association between smoking and risk of liver cancer. In many studies, the risk increases with duration of smoking or number of cigarettes smoked daily. Confounding from alcohol can be ruled out in the best case-control studies, by means of careful adjustment for drinking habits.

Cervical cancer: Cancer of the cervix has been found to be associated with cigarette smoking in many case-control studies. Until recently, scientists had been unable to decide whether the relationship was causal or due to confounding factors such as the number of sexual partners. A study in Sweden investigated whether environmental factors such as smoking, nutrition and oral contraceptive use were independent risk factors for cervical cancer and found that smoking was the second most significant environmental factor after human papilloma virus (HPV). The review concludes that there is now sufficient evidence to establish a causal association of squamous-cell cervical carcinoma with smoking. 

Breast cancer: Some studies have demonstrated a link between both active and passive smoking and breast cancer. Most epidemiological studies have found no association between active smoking and breast cancer but since its publication a new study found that among women who had smoked for 40 years or longer the risk of breast cancer was 60% higher that that of women who had never smoked. Among those who smoked 20 cigarettes or more a day for 40 years, the risk rose to 83%.

Although most people today are aware of these dangers, many continue to smoke, and, as a result, nonsmokers may be forced into situations that bring them in contact with bothersome tobacco smoke. Here are some tips that will help you on your way to a smoke-free environment:

1. If a family member smokes, consider setting aside one well-ventilated room in your home where smoking will be permitted. Not only will this help to confine the smoke to a limited area, but it may help the smoker in your house to think twice before lighting up.
2. Patronize restaurants with designated nonsmoking areas, and express your appreciation to the management. Not only will this provide you with a smoke-free environment, but it may encourage other businesses and eating establishments to create these special sections when they see a demand.
3. In a theater or restaurant, if someone near you lights up a cigarette, it isn't wrong to ask them to extinguish it. A polite, "Excuse me, your smoke is drifting my way. Could I ask you to please not smoke?" is all that's needed. Most smokers will gladly comply.
4. Encourage your employer to restrict or to ban smoking in your workplace. Suggest that cessation programs be offered to smoking employees and that incentives be offered to those who quit.

7 Heredity and Cancer

Cancer is not considered an inherited illness because most cases of cancer, perhaps 80 to 90 percent, occur in people with no family history of the disease. However, a small number of cancers are hereditary and all cancers are the result of genetic (DNA) errors. This means they are related to a specific gene that is passed down in a family.

Theodor Boveri, a German scientist, hypothesised in 1914 that alteration in the genome of a cell lead to genesis of cancer. He proposed that cancer is caused by exchange of genetic material at cellular level. In 1961, Peter Nowell and David Hungerford of the Institute for Cancer Research in Philadelphia observed specific chromosomal abnormalities in patients suffering from the chronic myeloid leukaemia. This altered chromosome was named Philadelphia chromosome (Ph chromosome). Later, it was found that most of the cancers exhibit chromosomal abnormalities such as translocation, deletion, insertion and duplication.

Most of genetic (DNA) errors accumulate over time in single cells, eventually resulting in the change of a normal cell to a cancerous state. Some types of DNA errors are inherited, exist in all of the body’s cells, and can lead to an increased risk of developing cancer. A person's chances of developing cancer can be influenced by the inheritance of certain kinds of genetic alterations. These alterations tend to increase an individual's susceptibility to developing cancer in the future.

Hereditary predisposition to a specific cancer is linked to the specific molecular events within the genes. Genetic mutations are commonly associated with the breast and ovarian cancers. Studies have shown that more than 40 per cent of breast cancers occurring below the age of 30 years are due to inheritance of the abnormal gene known as BRCA-1, which is located on chromosome 17. This gene was first identified in 1990. The BRCA-1 gene is found in the members of those families, who have the tendency to develop breast and ovarian cancers at early age. Studies have revealed that inheritance of the BRCA-1 gene confers a lifelong risk of the breast cancer (85 per cent) and ovarian cancer (50 per cent). It has been observed that the members of those families who are predisposed to a particular cancer, have one or more activated oncogenes in their inherited genome. Therefore fewer additional mutations are required in these persons for the cancer to development.

People who inherit specific gene mutations have a higher risk of developing certain forms of cancer as compared to the general population. Inherited gene mutations help to explain why in some families we see more people than expected with certain kinds of cancer. These mutations are rare however and account for only a very small proportion (5-10%) of all cancers. Specific gene mutations may be passed down in a family from parent to child. Each child has a 50-50 chance of inheriting the gene mutation. Inheriting the gene mutation does not mean the child inherits cancer. It means that the child inherits a higher risk of developing cancer sometime during his or her life.

Sometimes it seems that genetics is the reason, especially when certain types of cancers run in families, but it's really not clear whether shared genes or a shared environment are to blame. Studying identical and non-identical twins is the ideal way, at this stage, to separate genetic factors from environmental factors in the development of disease. Identical twins share the exact same genes, while non-identical twins share around half. If, for example, a disease is caused by genetic factors alone, then it could be assumed that identical twins will develop the disease in the same part of their body at around the same time. Therefore, if genes play a significant role in cancer, then cancer rates should be higher among identical twins. The major study of cancer rates in twins supports the current belief that most cancers are caused by environmental factors, such as diet and smoking. For many years it was believed that genes were the major factor involved in a person's risk of developing cancer. However, new evidence suggests that environmental factors - such as tobacco, diet, infection, alcohol, drugs, chemicals and radiation - may play a larger role.

8 Emotion and Cancer

Many studies show that emotional problems go hand in hand with physical illness. For example, major depression is seen in 11 percent of hospital in-patients, compared to 3 percent of the general population. And some form of depression or other emotional illness appears in anywhere from 4.5 percent to 50 percent of cancer patients, depending on whose research you believe. This is not to say that depressed patients get cancer, but rather that cancer patients get depressed, which in turn increases the likelihood of pain and disability. It's a feedback mechanism that degrades both mental and physical health. "Although depression and other psychiatric disorders may amplify pain, it is likely that persistent pain contributes to depression." We have found that several fundamental issues need attention in the life of a cancer patient:

Courage and Hope: Plato said that courage is knowing when to be afraid. Many people faced sickness, but were not overtaken by it. Just because one part of them became ill, they did not give up on all fronts. Their bodies may have suffered, but their spirits remained strong. Indeed, serious illness is a reminder that life is not infinite. Those who respond creatively to a life-threatening illness hear it as a wake-up call, a reminder of how time is short and life is precious. They do what matters most while they can, experience the joys of living and loving, and let the people around them know how much they are loved and appreciated. They trivialize the trivial, drop useless commitments, eliminate relationships that are taxing and not worth the trouble and just say no to doing things they think they should do rather than what they want to.

Learn methods to control pain and anxiety: Simple techniques like self-hypnosis can be used to reduce or even eliminate pain and other symptoms. You have to pay attention to pain for it to hurt. You can learn to focus your attention elsewhere, to teach your body to float rather than fight the pain. You can imagine that the part of your body that hurts is warmer or cooler, lighter or heavier, and in this way alter how it feels. The strain in pain lies mainly in the brain. Addressing these seven issues can help you to enrich your life as you cope better with cancer. Cancer is not so much a death sentence as a wake-up call. Heed the call and mobilize your personal and social resources to live beyond the limitations imposed by the illness.

Fortify your family: Use the time you have to enrich family relationships, impart life values to children, and enjoy the people you love. Discuss problems openly, and be clear with your family about what you need and want from them. At the same time, be prepared to offer help to them in dealing with your illness.

Express emotion: Cancer inevitably stirs strong feelings: fear, anger, sadness, among others. Allow yourself to deal with these feelings directly. Avoiding them only makes them harder to deal with, although many think that they can control the disease by controlling how they feel about it. There is no evidence that expressing sadness or fear allows cancer to progress. Indeed, if anything the opposite is the case. Those who honestly deal with their feelings about illness seem to do better rather than worse. And they become closer with those who share those feelings with them.

Build bonds of social support: Cancer can be a very isolating experience. Friends and family may feel awkward about discussing cancer with someone who has the disease. Cancer patients are often removed from the flow of life, spending time getting treatment rather than at work or with family. Find new ways to connect with others: get help from friends, reach out to family, and join a good support group.

Reorder life priorities: Cancer changes your life: your body image, energy, time, future plans. Take the realities of the disease into account in planning your life. Live as fully as you can, while you do what you can to mitigate the damage it does. Trivialize the trivial, get rid of unnecessary obligations, and extract the most joy and satisfaction you can out of what matters to you in your life: important projects, people who matter, helping others. Hope for the best but prepare for the worst.

9 Exercise and Cancer (1): General knowing

Exercise has significant effects on several functions of the human body that may influence cancer risk. These effects include changes in the following:

• cardiovascular capacity,
• pulmonary capacity,
• bowel motility,
• hormone levels,
• energy balance,
• immune function,
• antioxidant defence,
• DNA repair.

Evidence seems to support the benefits of exercise as a treatment for cancer. Several studies have examined the relationship between exercise, rehabilitation and quality of life in cancer patients and reported positive findings.

In the past decade alone, over 200 population based studies have linked physical activities to cancer risk. The most researched cancers are those of the: bowelbreast, endometrium, prostate, testes, and lungs.

Bowel Cancer

Cancer of the large bowel is the most commonly investigated cancer in relation to physical activity with physically active men and women experiencing around half the risk of their sedentary counterparts.

Plausible mechanisms of protection include the beneficial effects of exercise on levels of the some substances, such as insulin, prostaglandins and bile acid, which influence the growth and proliferation of cells in the colon.

In addition, exercise reduces bowel transit time and thereby the duration of contact between fecal carcinogens and the mucosal lining of the colon.

Breast and Endometrial Cancer

Both are strongly hormone-dependent cancers. Endogenous sex hormones are strongly implicated in the development of breast and endometrial cancer. Physical activity may modulate the production, metabolism, and excretion of these hormones, so an association with these cancers is biologically possible.

Physical activity may also reduce the risk of cancer through its normalising effect on body weight and composition. Evidence from population based studies suggests that occupational, leisure, and household activities are associated with about a 30% reduction in breast cancer rates. Those studies that have explored the link between physical exertion and the risk of endometrial cancer suggest a negative association.

Prostate Cancer

Since athletes show lower levels of circulating testosterone than non-athletes, and testosterone influences the development of prostate cancer, this has led to the hypothesis that physical activity may protect against this cancer. Most, but not all, studies suggest a protective effect .

Lung Cancer

Although physical activity improves pulmonary ventilation and perfusion, which may reduce both the concentration of carcinogenic agents in the airways and the duration of agent-airway interaction, the association of activity with lung cancer has received relatively little attention. Findings from most, but not all, studies suggest a negative relation.

Exercise as a Cancer Treatment

The studies have found that overall, exercise had a positive effect on physical and psychological functioning of cancer patients while in treatment. These benefits include the following objective and self-reported findings:

• increased functional capacity
• decreased body fat
• increased lean muscle mass
• decreased nausea and fatigue
• improved natural defense mechanisms
• improved sense of control
• improved mood
• improved self-esteem
• self reported improved quality of life

Other studies found that exercising cancer patients had improved work capacity, lower heart rates at given exercise intensity, increased maximum workloads and time to exhaustion than did non-exercising cancer patients.

Psychological changes, including a decrease in total mood disturbances, decrease in depression and fewer problems sleeping were noted between the exercise and non-exercise groups.

In conclusion, since exercise seems to have protective effects against some types of cancers and does not increase the risk of any cancer, it should be more actively encouraged. In light of the decreasing population prevalence of total physical activity, doctors should advocate moderate endurance-type activity, such as walking and cycling. As well as reducing the risk of chronic diseases such as coronary heart disease and non-insulin dependent diabetes, such physical activity does seem to protect against some cancers."

10 Exercise and Cancer (2):

Exercise as a preventive measure

It is estimated that approximately one-third of cancer cases could be attributed to smoking, one-third to lack of exercise and a poor diet, and one-third to genetic or other factors.

There is a growing evidence that regular exercise can have in minimizing the risk of cancer and other diseases.

At the recent annual meeting of the AmericanCollege of Sports Medicine in Indianapolis, researchers from the Cooper Institute reported on two studies which concluded that men's cardiovascular fitness-regardless of weight-was a key factor in whether they eventually died of cancer.

In one study, Dr. Carolyn Barlow and colleagues followed more than 22,700 men aged 20 to 85 for ten years. Men who were classified as "unfit" based on treadmill tests were 80 percent more likely to die of cancer than those in better condition. Interestingly, they found that if a man was fit, being overweight did not raise his cancer risk.

In a second presentation, Dr. Larry Gibbons and colleagues noted that previous research had linked fitness to a higher risk of colon cancer. Yet, little research had been done on lung cancer patients. To study this link, they evaluated nearly 26,000 men for an average of 10 years.

After adjusting for smoking and certain other risk factors, they found that the 20 percent who had the lowest fitness levels were about 2.5 times more likely than the most-fit men to die of lung cancer. The 40 percent of men classified as moderately fit were 1.5 times more likely to die of the disease.

A recent statement by the Food and Nutrition Science Alliance (FANSA) reiterated such findings. It noted that cancer will strike one in three Americans at some point in their lives. But the number of cancers could be cut by as much as one third if Americans adopted simple lifestyle changes such as moderate exercise and a healthier diet.

Latest research has again confirmed a link between exercising and the prevention and survival rates of certain cancers, and showed that exercise reduces risk of endometrial and breast cancer.

In a study conducted researchers gathered results from nearly 850 women with endometrial cancer, aged 30 to 69. Participants were asked about the level of exercise activity during their adolescent and adult years. Results show women who exercised in both these stages of life were up to 40 percent less likely to develop endometrial cancer than those who were not active.

Exercise was defined as moderate activity, such as household chores or 30 minutes of walking, and higher levels of activity, such as 60 minutes or more of a cardiovascular regimen.

Results from another study conducted by researchers from Brigham support the theory that exercise benefits at-risk cancer patients. After studying the exercise regimen of nearly 3,000 women diagnosed with breast cancer, researchers confirmed that the risk of death from breast cancer decreased with every level of physical activity as opposed to being sedentary.

Thus specialists said, "The effect of exercise on inflammatory markers may help to explain in part the associations observed between increased physical activity and reduced risk for cancer and other chronic disease."

“This much exercise can reduce the risk of colon cancer by almost half and breast cancer by a third,” McTiernan Anne McTiernan of Fred Hutchinson Cancer Research Center in Seattle said,” exercise reduces circulating levels of estrogen, which has been linked to higher breast cancer risk in postmenopausal women. Exercise reduces other hormones that can raise the risk of colon cancer, and speeds material through the bowel before any cancer-causing agents can linger against the bowel wall.”

Information wasn't presented on the degree to which exercise reduced the risk of breast cancer recurrence, but "the magnitude of benefit is about the same, according to Holmes.

Researchers from the VanderbiltUniversityMedicalCenter in Nashville and the Shanghai Cancer Institute in China also showed that regular exercise, as well as routine activities such as walking and household chores, may reduce a woman's risk of endometrial cancer by as much as 30 to 40 percent. A total of 832 women with endometrial cancer, aged 30 to 69 years, identified through the Shanghai Cancer Registry was evaluated. The control population, matched according to age, was randomly selected from female residents of Shanghai. Result showed that women who reported exercise participation in both adolescence and adulthood were 30 to 40 percent less likely to develop endometrial cancer than women who reported no exercise in either life-period. Common activities, including household chores and daily walking, were also found to reduce risk by about 30 percent. Reductions in risk were evident for women who reported walking for 60 minutes each day compared to women reporting less than 30 minutes of walking per day; likewise for women who reported four or more hours per day of household activity, compared to women reporting two hours or less each day. Engaging in higher levels of overall physical activity appeared to minimize some of the adverse effects of body weight on endometrial cancer risk.

11 Exercise and Cancer (3): Exercise improves course and prognosis

After a diagnosis of cancer, exercise has a positive effect on physical, functional, psychological, and emotional well-being.

"Our research shows that exercise improves quality of life, regardless of cancer site, even among people who were previously inactive," says lead study researcher Kerry Courneya, PhD, a professor of physical education at the University of Alberta in Edmonton, Canada.

Courneya and colleagues analyzed 12 new studies on the effects of exercise among cancer patients and survivors. The studies focused on aerobic exercise and strength training, initiated after the start of cancer treatment.

All 12 studies showed significant improvements in physical functioning, muscle strength, fatigue, anxiety, depression, and how the patients felt about themselves. For this reason and because people with cancer are now living longer, the authors conclude that doctors should prescribe exercise for cancer patients.

Physicians usually recommend customized programs for cancer patients. "According to the AmericanCollege of Sports Medicine, adults should exercise moderately for 20-30 minutes, three to five times a week." John Mackey, MD, a cancer specialist and assistant professor of medicine at the University of Alberta said.

"But based on their response to treatment, cancer patients should modify how hard, how long, and how often they exercise," Mackey said. "During chemotherapy, alternating short bouts of exercise and rest is a great way to accumulate 30 minutes a day. It's also a good approach for cancer patients who were previously inactive."

Mackey considered that walking and riding a stationary bicycle are safe for most cancer patients, but he advises close medical supervision. Patients with bone involvement should avoid high-impact exercise and contact sports. Similarly, those with urinary tubes and low white blood cell counts should avoid swimming.

It is important to discover that exercise can promotes survival of patient with cancer.

Michelle Holmes, a physician at Harvard University-affiliated Brigham and Women's Hospital, presented the study about exercise and cancer to the American Association for Cancer Research, a conference of 13,500 cancer experts, and showed that exercise can not only prevent the risk of developing breast cancer and a host of other diseases, but also promotes survival.

The conclusion came from the Nurses' Health Study, which enrolled 122,000 nurses from around the country in 1976 and has been following their health ever since. The exercise habits of 2,167 breast cancer survivors were compared at least two years after their diagnosis so that results wouldn't be biased by the effects of cancer treatment.

There were 346 deaths, 209 of them from breast cancer. Those who did the equivalent of one to three hours of walking a week cut their risk of dying of breast cancer by 23% compared with breast cancer survivors who didn't exercise. Three to five hours a week cut risk by 54%, and five to eight hours reduced it 51%.

But more than eight hours of exercise cut risk only 27%. Holmes considered that the lower benefit might be because this group of women included more heavy smokers and women with more advanced breast cancers.

The similar results were showed in UK. According to early results at a University of Bristol conference on Exercise and Cancer Rehabilitation, women should aim for half an hour's gentle exercise three times a week to aid their recovery from breast cancer.Thefindings from a Cancer Research UK trial has shown that exercise therapy and lifestyle counselling could hasten recovery and improve the long-term physical and mental well being of women who are recovering from breast cancer.

Launched in late 2002 the trial was designed to follow over 150 women, randomly divided into three separate groups, through an eight week programme. The first group took part in an exercise programme designed to suit their physical ability. The second group following a body conditioning programme but were given no encouragement to do more physical activity, while the third were offered only currently available standard treatment. Those women who took part in the fully tailored exercise plan showed the most positive results, reporting lower depression, an increases satisfaction with their lives and a reduction in their weight.

12 Exercise and Cancer(4): Exercise boost recovery

A lot of studies highlighted the significant impact that simple exercises can have on cancer patients recovering from surgery.

Researchers from the Inje University College of Medicine in South Korea reported on a study of patients recovering from stomach cancer surgery. They found that those who began minimal exercising just two days after surgery showed stronger immune function than those who did not exercise. Two weeks after their surgery, those that exercised had significantly more natural killer cells compared with their sedentary counterparts. Natural killer cells in the immune system attack tumor cells and help ward off infection.

The exercises involved simple movements while lying in bed during the first few days after surgery. The patients gradually moved on to aerobic exercises on stationary bikes.

Dr. Young-Moo Na and his colleagues noted that other factors, such as nutrition and cancer therapy itself, might also affect natural killer cells. But they concluded that exercise is certainly one definitive way to boost a cancer patient's immunity.

Furthermore, the Korean study is just the most recent addition to a growing body of evidence demonstrating that exercise, even on a minimal scale, can have a profound impact on recovery in cancer patients-not only in terms of physical recuperation but also for overall emotional well-being.

A study by Canadian researchers found that physical exercise can have a dramatic impact on a cancer patient's quality of life, as measured by a wide range of physical, functional, psychological, and emotional factors.

Dr. Kerry Courneya of the University of Alberta and Dr. Christine Friedenreich of the Alberta Cancer Board analyzed 24 major studies of exercise in cancer patients published between 1980 and 1997. They noted that some of the most prevalent physical benefits of exercise included increased lung capacity, muscle strength and overall energy levels; reduced nausea and fatigue; and lower pain levels.

They wrote that many oncologists still recommend that patients take it easy and rest during chemotherapy. But they suggested that this might contribute even more to the fatigue factor. They did caution, though, that a patient's ability to exercise can vary at different times during treatment and recovery.

Courneya and Friedenreich also found that certain psychological measures of well-being improved dramatically as a result of exercise during and after treatment. These included increased feelings of competence, control and self-esteem; and reduced symptoms of depression and anxiety.

Cindy Carmack of the University of Texas M.D. Anderson Cancer Center in Houston, considered that regular exercise can also help protect against the physical effects of daily stress.

In a study involving 135 college students, Carmack found that during periods of high stress, those who reported exercising less frequently had 37 percent more physical symptoms than their counterparts who exercised more often. In addition, highly stressed students who exercised less often reported 21 percent more anxiety than those who exercised more frequently.

Now in many countries the patients with cancer have been organized to participate regular exercise for promotion of recovery. Dr Lesley Walker, Director of Cancer Information at Cancer Research UK, said, “We continue to see encouraging results at the end of the trial, many thousands of women with breast cancer could benefit. The next step would be to then see exercise included in the follow up treatment for as many women as possible, with a personalised exercise routine becoming standard.”

The workshop has been organised by BristolUniversity's Department of Exercise and Health Sciences in response to the growing interest in the potential value of exercise during cancer rehabilitation. He said, “although the field is in its infancy, research activity is increasing rapidly worldwide.”

13 Early Detection of Cancer

The incidence of cancer has risen alarmingly in the last few decades. A hundred year ago, cancer was not so common, but now every third person is having lifetime risk of cancer. The most important step to fight out cancer is its early detection, which can be achieved by creating awareness among the people and by conducting mass cancer screening programmes.

Cancer presents with a variety of generalized and localized symptoms. General symptoms of cancer include loss of appetite, loss of weight, fatigue, pain, malaise, drowsiness, fever, haemorrhage, anaemia and cachexia. Local symptoms vary in different cancers. There may be dysphagia in oesophageal cancer; cough in lung cancer; abdominal pain in ovarian cancer; bowel obstruction in colorectal cancer; haematuria in bladder cancer; headache in brain tumors; and paralysis in the spinal cord tumors. There are various other local symptoms depending on the site of cancer.

In East Asian, carcinoma of the oesophagus, stomach, liver, large bowel, lungs and nasopharynx are common in men, whereas carcinoma of the cervix and breast are common among women.

To detect a cancer in an early stage, regular medical check-ups including Physical examination, Biochemistry (tumor markers), Endoscopy, X-rays, Ultrasound, Computed Tomography (CT scan) and Imaging (MRI) are recommended to all the high-risk persons.

Endoscopic examination is recommended to those patients of gastric diseases (gastritis and ulcer), especially to those patients who develop dysplasia, abdominal pain and haematemesis or start losing weight, to detect any sign of stomach cancer. Endoscopy is of important value for detection of oesophageal cancer.

Digital rectal examination is recommended to all the persons above forty years of age to detect cancer of the rectum. It is to be repeated every year thereafter. Feces examination for occult blood should be done in all the persons above fifty years of age to detect colorectal cancer. A person having complaints of unusual rectal bleeding and resistant diarrhoea or constipation should undergo digital rectal examination, colonscopy and barium enema to detect the colorectal cancer.

Lung cancer remains the most common fatal malignancy in both men and women around the world. The latest technologies for early detection of the cancer include spiral CT imaging and high-quality sputum cytologic examination.

Liver cancer may be got early detection by serum alpha-fetoprotein examination and imaging study especially ultrasound. Combination of above both techniques may result in early detection rate as high as 90% for “small” liver cancer.

Carcinoma of the breast can be detected by self-examination of the breast. All the women above 30 years of age are advised to learn self-examination of the breast. Self-examination of the breast is recommended every month immediately after the menstrual period, when the breasts are soft. If a lump is found in the breast, the lady must consult an oncologist. Mammography is recommended every year to all the women above forty years of age to detect breast cancer at an early stage.

All the women above 35 years of age are advised to undergo Pap test every year to detect cancer of the cervix. This is a simple test, in which microscopic examination of the cervical cells is conducted. Pap test has already saved the lives of thousands of women all over the world.

Endometrial tissue biopsy is recommended to all the high-risk women at the age of menopause to detect cancer of the uterus.

To detect cancer of the ovaries, annual pelvic examination is recommended to all women during the childbearing age to detect cancer of the ovary.

Cancer of the oral cavity is common among tobacco-chewers & smokers. Any non-healing ulcer on the tongue or in the mouth (especially in tobacco-chewers & smokers) should be suspected of cancer.

Prostate Specific Antigen (PSA) and Prostatic Acid Phosphatase (PAP) estimations are recommended to all the men above fifty years of age (to be repeated every year) to detect cancer of the prostate. Digital rectal examination is also helpful in detecting the prostatic cancer and is advised to all the men above fifty years of age.

Cystoscopy is recommended to all the patients having haematuria to detect any sign of urinary bladder cancer.

Haemogram and bone marrow cytology should be performed in all the suspected cases of leukaemia.

14 What is the 'Stage' and 'Grade' of Cancer?

More than forty million new cases of cancer are estimated worldwide annually. Cancers can occur at any age, but it mainly occurs in the later years of life the risk of developing cancer increases with age. Over 70% of all newly diagnosed cancers occur in people aged 60 years or more.

Some cancers are very common and others are very rare. The most recent statistics for the European show that for men the most common cancer is lung cancer, followed by prostate cancer ,large bowel cancer and bladder cancer . For women the figures are breast cancer , large bowel cancer, lung cancerand cancer of the ovary.In East Asian,the common cancer are esophageal cancer,gastric cancer,liver cancer,lung cancer, large bower cancer and breast cancer.

Clinicaly cancer is often classified in “stages” and “grades”,that do help doctors to predict how that cancer might behave, how it might respond to treatment, and what the chance of cure might be.

The stage of a cancer is a measure of how far it has progressed. So, a cancer that is small and in a single site is at an early stage, whereas one that has spread to many different parts of the body is at an advanced stage.

Over the years doctors have worked out staging systems for all the different types of cancer. Some of these are quite simple whilst others are very complicated. As an example, one of the simpler systems is the one used for bowel cancer. This is divided into four stages, A to D, with A being the earliest stage. The four stages are:

• A - the cancer is confined to the wall of the bowel
• B - the cancer has spread through the wall of the bowel
• C - the cancer has spread to the nearby lymph glands
• D - the cancer has spread to other organs, such as the liver or lungs.

Some staging systems use the numbers 1 to 4 for the various stages (often subdividing each stage into a, b or c), whilst another system uses the initial T, N and M, followed by a number to describe the primary tumour (T), any involved lymph nodes (N) and the presence or absence of any spread to other organs, or metastases (M). The situation is further complicated by the fact that there are often several different staging systems for a particular cancer and different doctors may use different systems.

Doctors use the results of tests and operation findings to decide the stage of a person's cancer. Sometimes the stage will change as more results become available. For example, someone with bowel cancer might have examinations, x-rays and scans which suggest the tumour is confined to the bowel wall (stage A) but when an operation is done, and the tissues examined under a microscope, small seedlings of tumour may be found in the lymph glands, making it a stage C cancer.

Using a staging system has two main benefits. Firstly it gives an idea of how advanced a cancer is and so helps predict what the likely outcome of treatment will be. Secondly, 'staging' the cancer determines what the treatment should be, since often the treatment for an early stage cancer will be different from that for a more advanced tumour.

The grade of a cancer refers to the appearances of the tumour under the microscope. Depending on the appearances cancers may be given one of three grades.

• A 'low' grade is where the cancer cells look very like normal cells, with only slightly abnormal changes (these cancers are called 'well-differentiated'.
• A 'high' grade is where the cells look very abnormal and show little or no resemblance to normal tissue (these cancers are called 'poorly differentiated').
• An 'intermediate' grade is somewhere between the high and low grades (these cancers are called 'moderately differentiated').

For some cancers, such as breast cancer, the three different grades are often given numbers, so a low grade breast cancer is called Grade I, whereas a high grade breast cancer is called Grade III.

The grade of a cancer is considered to be a guide to how aggressive the tumour is: an intermediate grade cancer is likely to be more aggressive than a low grade and a high grade cancer is likely to be more aggressive than an intermediate grade tumour.

Taken together the stage and grade of a cancer may be helpful for making strategy of treatment and estimation of severity and prognosis. But the stage and grade are only guides to what might happen and cancers do not always behave in the way that might be expected from their stage and grade.

15 Surgery for Cancer: 1. Why Is Surgery Used for Cancer?

Surgery is the oldest form of treatment for cancer and offers the greatest chance for cure for many types of cancer, especially those that have not yet spread to other parts of the body. Most people with cancer will have some type of surgery.

Surgery also has an important role in diagnosing and staging (finding the extent) of cancer.

Advances in surgical techniques have allowed surgeons to successfully operate on a growing number of patients. Today, more limited (less invasive) operations are often done to remove tumors while preserving as much normal function as possible.

Surgery can be done for any of several reasons. It is often done to achieve more than one of these goals:

Preventive (prophylactic) surgery is done to remove body tissue that is not malignant (cancerous) but is likely to become malignant. For example, this type of surgery may be used if you have a precancerous condition such as polyps in the colon.

Sometimes preventive surgery is used to remove an entire organ when a person has an inherited condition that makes development of a cancer very likely. For example, some women with a strong family history of breast cancer are found to have a change (mutation) in their DNA in a breast cancer gene (BRCA1 or BRCA2). Because their risk of getting breast cancer is high, these women may want to consider prophylactic mastectomy (breast removal).

Diagnostic surgery is used to get a tissue sample to tell whether or not it is cancerous or to tell what type of cancer it is. The diagnosis of cancer often can be confirmed only by looking at the cells under a microscope. Several surgical techniques can be used to obtain a sample.

Staging surgery helps determine the extent and the amount of disease. While the physical exam and the results of lab and imaging tests can help determine the clinical stage of the cancer, surgical staging is usually a more accurate assessment of how far the cancer has spread.

Curative surgery is the removal of a tumor when it appears to be confined to one area. It is done when there is hope of taking out all of the cancer. Curative surgery is thought of as primary treatment of the cancer. It may be used alone or along with chemotherapy or radiation therapy, which can be given before or after the operation. In some cases, radiation therapy is actually used during an operation (intraoperative radiation therapy).

Debulking (cytoreductive) surgery is done when removing a tumor entirely would cause too much damage to an organ or surrounding areas. In these cases, the doctor may remove as much of the tumor as possible and then try to treat cancer tissue left with radiation therapy or chemotherapy. Debulking surgery is commonly used for advanced cancer of the ovary.

Palliative surgery is used to treat complications of advanced disease. It is not intended to cure the cancer. It can also be used to correct a problem that is causing discomfort or disability. For example, some cancers in the abdomen may grow large enough to obstruct (block off) the intestine. This may require surgery for effective relief. Palliative surgery may also be used to treat pain when it is hard to control by other means.

Supportive surgery is used to help with other types of treatment. For example, a vascular access device such as a catheter port can be surgically placed into a large vein. The catheter can then be used to deliver chemotherapy treatments or draw blood for testing, reducing the number of needle sticks needed.

Restorative (reconstructive) surgery is used to restore a person’s appearance or the function of an organ or body part after primary surgery. Examples include breast reconstruction after mastectomy or the use of tissue flaps, bone grafts, or prosthetic (metal or plastic) materials after surgery for oral cavity cancers.

16 Surgery for Cancer: 2. Knowing of Peri-Surgery

A person’s experience with surgery can depend on many factors, including the disease being treated, the type of operation being performed, and the person’s overall health. There are probably as many different surgical techniques as there are diseases to treat, so each case is different.

Still, some aspects of the surgical experience are common to most operations. They include preoperative testing and preparation, the surgery itself (usually including some type of anesthesia).

Planning and Preparation: Both you and your doctor need to prepare before surgery to make sure you have the best chance for a good outcome. For your part, this involves knowing what to expect (as much as possible) and being comfortable that the decision you have made is the best one for you.

It is not unusual for patients to wait several weeks from the time they receive a cancer diagnosis to have surgery. You have time - time to educate yourself about your cancer, time to talk to others who have been through it, time to explore your treatment options, time to organize your thoughts, and time to find the right medical team for you. You may want a second opinion. Scheduling surgery requires all the team members from various disciplines to have input about the procedure. In almost all cases, a slight delay in surgery should have no impact on the positive outcome of the surgery. If you have some type of urgent medical symptom, surgery will be scheduled as soon as possible.

Informed consent: Informed consent is one of the most important parts of your preparation for surgery. It is a process during which you give your written permission for your doctor to perform surgery, after you have been informed of all aspects of the treatment.

Your signature means that you have received this information and that you are willing to have the surgery. It is important that you read the consent form and understand each of the above issues before signing.

Preoperative testing: Several tests are usually needed in the days or weeks before your surgery, especially if a major operation is planned. These are done to make sure your body is able to endure surgery and anesthesia, and may also be done to assess your condition and help plan the surgery. The tests commonly used include: Blood tests, Urine test (urinalysis), Chest x-ray and EKG (electrocardiogram) and other tests, such as CT scans .

In addition, your doctor will ask you questions about high blood pressure, heart disease, diabetes, and other conditions (any allergic reactions) that could affect surgery.

Preparing for surgery: You may need to do more or less in terms of preparation. Emptying your digestive tract is important if you will be asleep during surgery. Vomiting under anesthesia can be very dangerous because the material could enter the lungs and cause an infection. For this reason, you will be asked not to eat or drink anything starting the night before the surgery. You may also be asked to use a laxative or an enema to ensure your intestines are empty.

You may need to have an area of your body shaved to keep hair from entering the incision site. The area will be cleaned thoroughly before the operation to reduce the risk of infection.

The Operation At first anesthesia will be performed. Depending on the type and extent of the operation, it may or may not involve having you asleep. In some cases, you may have an option as to which type of anesthesia you prefer.

Local anesthesia is often used for minor surgeries, such as biopsies near the body surface. You remain awake and usually feel only slight pressure during the procedure. Topical anesthesia is a type of local anesthesia that is rubbed or sprayed onto a body surface instead of being injected.

Regional anesthesia (a "nerve block") affects a larger area of the body while still allowing you to remain awake. It usually involves injecting an area around the spinal cord, which affects certain nerves coming out of it, but may also involve injecting around nerves in the arms or legs. While you remain awake, you may be given something to help you relax.

General anesthesia puts you into a deep sleep for the surgery. It is commonly started by having you breathe into a facemask or injecting a drug into a vein in your arm. Once you are asleep, an endotracheal (ET) tube is placed in your throat to continue giving the medicine and to allow your doctor to monitor your vital signs (heart rate, breathing rate, and blood pressure). A doctor or nurse who specializes in giving anesthesia watches you throughout the procedure and until you wake up.

17 Surgery for Cancer: 3. Risks and Side Effects

There are risks associated with any type of medical procedure, and surgery is no exception. Of course, there are risks with almost everything we do in life. What is important is whether or not the risk is outweighed by the possible benefits.

Advances in surgical techniques and in our understanding of how to prevent infections have made surgery safer and less invasive than it has ever been. But there is always an element of risk involved, no matter how small.

Before you decide to undergo any medical procedure, it is important that you understand the risks. Different procedures may have different kinds and levels of risks and side effects.

During Surgery Possible complications during surgery may be due to the surgery itself, to the anesthesia, or to an underlying disease. Generally speaking, the more complex the surgery, the greater the risk is.

Pain at the site of the incision is the most common problem. Infections at the site and reactions to local anesthesia are also possible.

Complications in major surgical procedures are not common, but can include:

• Bleeding during surgery that may require blood component transfusions. Doctors try to minimize this risk by checking your blood counts beforehand and being careful near surrounding blood vessels during the operation. Still, some operations often involve a certain amount of controlled blood loss.
• Damage to internal organs and blood vessels during surgery.
• Reactions to anesthesia or other medicines. Although rare, these can be serious because they can result in lowering of blood pressure.
• Problems with other organs, such as the lungs, heart, or kidneys, these are very rare but can also occur and can be life-threatening.

After Surgery Some problems after surgery are fairly common, but are not usually life-threatening.

Pain is probably the most common side effect. Almost without exception, people experience some level of pain after surgery. As with any kind of trauma, your body lets you know loud and clear when it has been cut. Some pain is normal, but it should not be allowed to interfere with your recovery. There are many ways of dealing with surgical pain. Medications for pain range from aspirin and acetaminophen (Tylenol) to stronger agents such as opioids.

Infection at the site of the wound is another possible problem. Antibiotics, either in pill form or given through a vein in your arm, are able to treat most infections.

Pneumonia can occur, especially among patients with reduced lung function to begin with, such as smokers. Performing deep breathing exercises as soon as possible after surgery helps lessen this risk.

Other infections can develop within the body, especially if the digestive tract was opened during the operation. If it does, powerful antibiotics may be used to treat it.

Bleeding, either internally or externally, can occur if a blood vessel was not sealed off during surgery, or if a wound was reopen. Serious cases may require a return to the operating room to find the source of the bleeding and stop it.

Blood clots can form in the deep veins of the legs after surgery, especially if a person remains in bed for a long time. Such a clot could become a serious problem if it were to travel to another part of the body, such as a lung. This is why you will be encouraged to get out of bed and sit, stand, and walk as soon as possible.

Slow recovery of other body functions, such as movement in the intestines, can occasionally become serious problems as well.

Does Surgery Cause Cancer to Spread? In nearly all situations, the answer is no. But there are some important exceptions, and doctors who are experienced in taking biopsies of cancers and treating them with surgery are very careful to avoid these situations.

One common myth about cancer is that it will spread if it is exposed to air during surgery. Some people may believe this because they often feel worse after the operation than they did before. It is normal to feel this way when beginning to recover from any surgery. Cancer does not spread because it has been exposed to air. If you delay or refuse surgery because of this myth, then you may be cheating yourself by passing up effective treatment.

18 Surgery for Cancer: 4. Postoperative Recovery

Recovery in the period of right after surgery depends on many factors, including your state of health before the operation and how extensive the operation was. If you have received only a local anesthetic, you may be allowed to go home shortly after the procedure. Those receiving regional or general anesthesia are taken to the recovery room to be monitored while the effects of the anesthesia wear off. This may take several hours. Waking up from general anesthesia, people often feels "out of it" for some time. Things may seem hazy or dreamlike for a while, and you may not feel like you are fully awake until the following day.

You will continue to receive medicine for pain while in the hospital, and beyond if needed. Throughout your hospital stay, be aware that there are many different medicines available to help you control your pain. If you continue to have pain that is interfering with your recovery, be sure to let your health care team know.

Your throat may be sore for a time as a result of having had the ET tube in place. You may also notice that you have a catheter (tube) leading out from your bladder, which allows urine to exit your body. This may be removed shortly, but may need to be put back in for a few days if you are having trouble urinating on your own.

You may also have a tube or tubes ("drains") coming out of the incision site. Drains allow the excess fluid that collects at the site of the surgery to leave the body. Your doctor will likely remove them once they stop collecting fluid, usually a few days after the operation.

You may not feel much like eating or drinking, but this is an important part of the recovery process. Your health care team may start you out with ice chips or water at first. They will check that you are urinating normally at this time, and may want to measure the amount of urine you produce by having you go in a special container.

The digestive tract (stomach and intestines) is one of the last parts of the body to recover from the effects of anesthesia, and things need to be moving down there before you will be allowed to eat. In addition to checking your surgical scar and other parts of your body, your doctor will listen with a stethoscope for bowel sounds in your abdomen, and will ask if you have passed gas. You will likely be on a clear liquid diet until this happens. Once it does, you may be allowed to try solid foods.

Your nurse will probably try to have you moving, maybe even out of bed and walking, as soon as possible, even the day after your surgery. While this may be difficult at first, it helps speed your recovery by getting the digestive tract moving. It also helps get your circulation going and prevents blood clots from forming in your legs. Again, be sure to let your team know if you are experiencing a lot of pain, as this can be controlled with medicine.

Your health care team may also encourage you to do deep breathing exercises. This helps fully inflate the lungs and reduces the risk of pneumonia.

Once you are eating and walking, you may be considered for discharge home. Of course, this will depend upon other factors as well, such as the results of the surgery and tests done afterward. Your doctor will want to make sure you are well enough to be home. Before leaving, be sure that you understand the following:

• what is expected of you in terms of caring for the wound
• what to look for that might require attention right away
• what your physical limitations are (driving, working, etc.)
• other restrictions (diet, etc.)
• what medicines to take and how often to take them, including pain medicines
• who to call with questions or problems that arise
• whether you should be doing anything in terms of rehabilitation (exercises, etc.)
• when you are due to see your doctor again

You may require help at home for a while after surgery. If family members or friends are unable to do all that is needed, your team may be able to arrange to have a nurse visit you at home on a regular basis.

Other aspects of recovery may be more long term in nature. Wounds heal at different rates in different people. Some operations, such as a mastectomy (breast removal), may result in permanent changes to your body. Others, such as a limb amputation or an ostomy (opening in the abdomen connected to the end of your intestine) affect how your body functions, and may require that you learn new ways of doing things.

Understanding beforehand what the result of the operation will be is an important part of helping you adjust to your new body. Be sure that all of your questions are answered up front. Get as specific as you need to with your questions, and make sure your health care team gives specific answers, as well.

19 Surgery for Cancer: 5.Less Invasive Techniques

When most people think of surgery, they picture a doctor using a scalpel and other surgical instruments to remove, repair, or replace parts of the body affected by disease. But newer techniques, using different types of instruments, have expanded the concept of what surgery is. Most of these newer techniques are less or micro-invasive compared with traditional techniques.

Laser Surgery: A laser is a highly focused and powerful beam of light energy, which can be used in medicine for very precise surgical work such as repairing a damaged retina in the eye. It can also be used to cut through tissue (instead of using a scalpel) or to vaporize cancers of the cervix, larynx (voice box), liver, rectum, or skin.

Some surgeries can be made less invasive by using laser light. For example, with fiber optics the light can be directed to parts of the body without having to make a large incision.

Laser surgery is also called photo-ablation or photocoagulation. This type of surgery is often used to relieve symptoms, such as when large tumors press on the windpipe or esophagus, causing problems with breathing or eating.

Cryosurgery: Cryosurgery involves the use of a liquid nitrogen spray or a very cold probe to freeze and kill abnormal cells. This technique is sometimes used to treat precancerous conditions such as those affecting the cervix. Cryosurgery is also being studied as a treatment of some cancers such as those of the prostate.

Electro-surgery: High-frequency electrical current can be used to destroy cells. It is used for some cancers of the skin and mouth.

Mohs Surgery: Mohs micrographic surgery, also called microscopically controlled surgery, is a technique to remove certain skin cancers by shaving off one layer at a time. After each layer is removed, a specially trained dermatologist (skin doctor) or pathologist looks at the tissue layer under a microscope. When all the cells look normal under the microscope, the surgeon stops removing layers of tissue.

This technique is used when the extent of the cancer is not known or when as much healthy tissue as possible needs to be preserved (as in cancers around the eye). It is performed under local anesthesia by a specially trained surgeon.

Chemosurgery is an older name for this surgery and refers to certain chemicals applied to the tissue before it is removed. The procedure does not involve use of cancer chemotherapy drugs.

Laparoscopic Surgery: A laparoscope is a long, flexible tube placed through a small incision to view the inside of the body. It is sometimes used to take biopsy samples. In recent years, doctors have found that by creating several small holes and using special instruments, the laparoscopic technique can be used to perform surgery without the need for a large incision. This can help reduce blood loss during surgery and pain afterwards, and can also shorten hospital stays. It is commonly used today to remove gallbladders and to repair hernias.

Its role in cancer, however, remains less clear. Doctors are now studying whether it is safe and effective in surgeries for cancers of the colon, prostate, and kidney, among others. It may prove to be as safe and effective as conventional surgery while being less invasive. Some studies have hinted at this being the case. But until larger, long-term studies are completed, laparoscopic surgery for most forms of cancer is still considered investigational.

Other Forms of Surgery: Newer ways to remove or destroy cancerous tissue are always being explored. Some are beginning to blur the lines between what we commonly think of as "surgery" and other forms of therapy. Researchers are testing many new techniques, using things such as high intensity focused ultrasound (HIFU); microwaves or radio waves (radiofrequency ablation, or RFA); or even magnets in an attempt to get rid of unwanted tissue. While promising, these techniques are still largely experimental.

As doctors learn how to better control the energy waves used in radiation therapy, some newer radiation techniques are almost at the precision level of surgery. By using radiation sources approaching from different angles, stereo-tactic radiation therapy delivers a large precise radiation dose to a small tumor area. The doses are so precise that the term stereo-tactic surgery is sometimes used, even though no incision is actually made. In fact, the machines used to deliver this treatment have names like Gamma Knife and Cyber-Knife, although no actual knife is involved. The most common site being treated with this technique is the brain, but it is also being used in head, neck, lung, and spine tumors. Researchers are looking for ways to use it with other types of cancer as well.

20 Chemotherapy: 1. What is it?

Chemotherapy, or the use of chemical agents to destroy cancer cells (this is why chemotherapy is often called an anti-cancer agent), is a mainstay in the treatment of malignancies. The possible role in treating illness was discovered when the bone marrow suppressive effect of nitrogen mustard was noted in the early 1900's. Since that time, the search for drugs with anticancer activity has continued, and the goal of treatment with chemotherapy has evolved from relief of symptoms to cure. A major advantage of chemotherapy is its ability to treat widespread or metastatic cancer, whereas surgery and radiation therapies are limited to treating cancers that are confined to specific areas.

An understanding of the normal cell cycle and the behavior of malignant or cancerous cells is necessary in order to comprehend how chemotherapy destroys cancer cells.

The cell cycle is broken up into four phases the G1, S, G2, and M phases. The G1 phase is the phase most active in protein synthesis. The cellular DNA at this phase is tightly coiled and is not actively being transcribed. Few chemotherapy agents are active at this phase of the cell cycle. By contrast, the S phase is the synthetic phase of the cell cycle. DNA replication is most active and many chemotherapeutic agents are most active in this phase. G2 represent a time when mostly RNA, but some protein, is actively produced. Mitosis, actual cell division, occurs during the M phase. There are two major classes of chemotherapy drugs that are most active during this phase of the cell cycle.

The object of all chemotherapy drugs is to kill the cancerous cells and not harm the adjacent healthy cells. To that end, scientists tried to identify characteristics that are unique to cancer cells and are not found on normal tissue. A distinct cancer trait could serve as a potential target for a chemotherapy drugs and thereby fulfill the above goal. One feature that is truly unique for most cancer cells is that they grow at a rate faster than normal cells. Therefore targeting some aspect of the cell growth cycle seems reasonable. Fast growing cells would be affected the most and slow growing cells would be least disturbed. In fact, that is the basis for many chemotherapeutics. This seems obvious when considering the side effect profiles of most chemotherapy drugs. Hair follicles, skin, and the cells that line the gastrointestinal tract are some of the fastest growing cells in the human body, and therefore are most sensitive to the effects of chemotherapy. It is for this reason that patients may experience hair loss, diarrhea, and rashes.

The human body processes and excretes all drugs through either the liver or the kidneys. Therefore, when a patient has kidney or liver damage, giving chemotherapy becomes precarious. Administering the recommended amount of drug may prove to be too toxic in a patient unable to metabolize and excrete it. The pharmacokinetics for cancer patients are very complex and chemotherapy pharmacology is a subspecialty on its own. Unfortunately, kidney and liver damage often result due to cancer invasion, limiting the patient's chemotherapy options.

There are over 50 different chemotherapy drugs and some are given on their own, but often several drugs may be combined (this is known as combination chemotherapy). The type of chemotherapy treatment you are given for your cancer depends on many things, particularly the type of disease you have, where in the body it started, what the cancer cells look like under the microscope and whether they have spread to other parts of the body. Many new drugs now is used as effective therapies for malignancy. These include hormones for breast, prostate and endometrial cancers, monoclonal antibodies, immunotherapy with IL-2 and TNF alpha, and small molecule inhibitors. The process of drug discovery involves much time, effort and resources. New approaches are constantly being developed and modified. The process of testing a new agent in clinical trials begins with the discovery of new compounds, new ideas, new pathways, and new principles.

21 Chemotherapy: 2. Methods and Goals

Chemotherapy can be given in different ways. The five most common methods are: intravenous (IV), oral (PO), intramuscular (IM), intrathecal (IT), intraperitoneal (IP).

The intravenous route or IV is a very common way of giving medicine directly into a vein. A small plastic needle is inserted into one of the veins in the lower arm. There is some discomfort during insertion because a needle stick is required to get into the vein. After that, the administration of the medication is usually painless.

Chemotherapy flows from the IV bag/bottle, through the needle and catheter into the bloodstream. Sometimes a syringe is used to "push" the chemotherapy through the tubing.

The oral method takes the form of either a pill, capsule or liquid taken by mouth. This is the easiest and most convenient method and can usually be done at home. Under certain special circumstances, chemotherapy given by other routes may also be administered at home.

Intramuscular means that the chemotherapy is given by way of an injection into the muscle. There is a slight sting as the needle is placed into the muscle of the arm, thigh or buttocks. Although, this procedure only lasts a few seconds, the effect of the intramuscular chemotherapy may last much longer. This is because the chemotherapy may be absorbed slowly through the muscular tissues and into the bloodstream.

Certain forms of cancer have a tendency to spread to the nervous system. To treat cancer that spreads to the spinal cord or brain, doctors may perform a spinal tap and inject chemotherapy into the spinal fluid. This is known as the intrathecal method of administration.

For some patients, IV insertions can eventually damage the veins in the arm. Some patients have small veins and some have very few accessible veins. Frequent IV insertions and too small or too few veins may prompt the doctor to recommend a permanent type of IV catheter. Permanent catheters allow patients to go home and receive chemotherapy without needing other IV's placed. Along with receiving chemotherapy and IV fluids through this catheter, patients can receive blood products and even have their blood drawn without painful needle sticks.

Another type of permanent catheter to a central vein is known as the implanted intravenous port. It is round in shape and is surgically inserted under the skin surface of the chest wall, between the neck and shoulder area. A nurse will insert a needle through the top skin surface to access the vein. The chemotherapy can then be given through the catheter as if it were an IV in the arm.

Intrathecal chemotherapy can be given into the spinal canal or through an Omaya reservoir. This device is surgically inserted under the scalp for direct injection of chemotherapy throughout the spinal fluid. The drugs are then given through the reservoir, rather than through the back during a spinal tap.

Lastly, chemotherapy may be given via an intraperitoneal (IP) port. This device is si