Cancer Listeni/knsr/, known medically as malignant neoplasia, is a broad group of di

seases involving unregulated cell growth. In cancer, cells divide and grow uncon
trollably, forming malignant tumors, which may invade nearby parts of the body.
The cancer may also spread to more distant parts of the body through the lymphat
ic system or bloodstream. Not all tumors are cancerous; benign tumors do not inv
ade neighboring tissues and do not spread throughout the body. There are over 20
0 different known cancers that affect humans.[1]
The causes of cancer are diverse, complex, and only partially understood. Many t
hings are known to increase the risk of cancer, including tobacco use, dietary f
actors, certain infections, exposure to radiation, lack of physical activity, ob
esity, and environmental pollutants.[2] These factors can directly damage genes
or combine with existing genetic faults within cells to cause cancerous mutation
s.[3] Approximately 510% of cancers can be traced directly to inherited genetic d
efects.[4] Many cancers could be prevented by not smoking, eating more vegetable
s, fruits and whole grains, eating less meat and refined carbohydrates, maintain
ing a healthy weight, exercising, minimizing sunlight exposure, and being vaccin
ated against some infectious diseases.[2][5]
Cancer can be detected in a number of ways, including the presence of certain si
gns and symptoms, screening tests, or medical imaging. Once a possible cancer is
detected it is diagnosed by microscopic examination of a tissue sample. Cancer
is usually treated with chemotherapy, radiation therapy and surgery. The chances
of surviving the disease vary greatly by the type and location of the cancer an
d the extent of disease at the start of treatment. While cancer can affect peopl
e of all ages, and a few types of cancer are more common in children, the risk o
f developing cancer generally increases with age. In 2007, cancer caused about 1
3% of all human deaths worldwide (7.9 million). Rates are rising as more people
live to an old age and as mass lifestyle changes occur in the developing world.[
6]

Signs and symptoms

Main article: Cancer signs and symptoms
Symptoms of cancer metastasis depend on the location of the tumor.
When cancer begins, it invariably produces no symptoms. Signs and symptoms only
appear as the mass continues to grow or ulcerates. The findings that result depe
nd on the type and location of the cancer. Few symptoms are specific, with many
of them also frequently occurring in individuals who have other conditions. Canc
er is the new "great imitator". Thus it is not uncommon for people diagnosed wit
h cancer to have been treated for other diseases to which it was assumed their s
ymptoms were due.[11]
Local effects
Local symptoms may occur due to the mass of the tumor or its ulceration. For exa
mple, mass effects from lung cancer can cause blockage of the bronchus resulting
in cough or pneumonia; esophageal cancer can cause narrowing of the esophagus,
making it difficult or painful to swallow; and colorectal cancer may lead to nar
rowing or blockages in the bowel, resulting in changes in bowel habits. Masses i
n breasts or testicles may be easily felt. Ulceration can cause bleeding which,
if it occurs in the lung, will lead to coughing up blood, in the bowels to anemi
a or rectal bleeding, in the bladder to blood in the urine, and in the uterus to
vaginal bleeding. Although localized pain may occur in advanced cancer, the ini
tial swelling is usually painless. Some cancers can cause build up of fluid with
in the chest or abdomen.[11]
Systemic symptoms

General symptoms occur due to distant effects of the cancer that are not related
to direct or metastatic spread. These may include: unintentional weight loss, f
ever, being excessively tired, and changes to the skin.[12] Hodgkin disease, leu
kemias, and cancers of the liver or kidney can cause a persistent fever of unkno
wn origin.[11]
Some cancers may cause specific groups of systemic symptoms, termed paraneoplast
ic phenomena. Examples include the appearance of myasthenia gravis in thymoma an
d clubbing in lung cancer.[11]
Metastasis
Main article: Metastasis
Metastasis is the spread of cancer to other locations in the body. The symptoms
of metastatic cancers depend on the location of the tumor, and can include enlar
ged lymph nodes (which can be felt or sometimes seen under the skin and are typi
cally hard), enlarged liver or enlarged spleen, which can be felt in the abdomen
, pain or fracture of affected bones, and neurological symptoms.[11]
Causes
Cancers are primarily an environmental disease with 9095% of cases attributed to
environmental factors and 510% due to genetics.[2] Environmental, as used by canc
er researchers, means any cause that is not inherited genetically, not merely po
llution.[13] Common environmental factors that contribute to cancer death includ
e tobacco (2530%), diet and obesity (3035%), infections (1520%), radiation (both io
nizing and non-ionizing, up to 10%), stress, lack of physical activity, and envi
ronmental pollutants.[2]
It is nearly impossible to prove what caused a cancer in any individual, because
most cancers have multiple possible causes. For example, if a person who uses t
obacco heavily develops lung cancer, then it was probably caused by the tobacco
use, but since everyone has a small chance of developing lung cancer as a result
of air pollution or radiation, then there is a small chance that the cancer dev
eloped because of air pollution or radiation.
Chemicals
Further information: Alcohol and cancer and Smoking and cancer
The incidence of lung cancer is highly correlated with smoking.
Particular substances have been linked to specific types of cancer. Tobacco smok
ing is associated with many forms of cancer,[14] and causes 90% of lung cancer.[
15]
Many mutagens are also carcinogens, but some carcinogens are not mutagens. Alcoh
ol is an example of a chemical carcinogen that is not a mutagen.[16] In Western
Europe 10% of cancers in males and 3% of cancers in females are attributed to al
cohol.[17]
Decades of research has demonstrated the link between tobacco use and cancer in
the lung, larynx, head, neck, stomach, bladder, kidney, esophagus and pancreas.[
18] Tobacco smoke contains over fifty known carcinogens, including nitrosamines
and polycyclic aromatic hydrocarbons.[19] Tobacco is responsible for about one i
n three of all cancer deaths in the developed world,[14] and about one in five w
orldwide.[19] Lung cancer death rates in the United States have mirrored smoking
patterns, with increases in smoking followed by dramatic increases in lung canc
er death rates and, more recently, decreases in smoking rates since the 1950s fo
llowed by decreases in lung cancer death rates in men since 1990.[20][21] Howeve
r, the numbers of smokers worldwide is still rising, leading to what some organi
zations have described as the tobacco epidemic.[22]
Cancer related to one's occupation is believed to represent between 220% of all c

ases.[23] Every year, at least 200,000 people die worldwide from cancer related
to their workplace.[24] Most cancer deaths caused by occupational risk factors o
ccur in the developed world.[24] It is estimated that approximately 20,000 cance
r deaths and 40,000 new cases of cancer each year in the U.S. are attributable t
o occupation.[25] Millions of workers run the risk of developing cancers such as
lung cancer and mesothelioma from inhaling asbestos fibers and tobacco smoke, o
r leukemia from exposure to benzene at their workplaces.[24]
Diet and exercise
Diet, physical inactivity, and obesity are related to approximately 3035% of canc
er deaths.[2][26] In the United States excess body weight is associated with the
development of many types of cancer and is a factor in 1420% of all cancer death
s.[26] Physical inactivity is believed to contribute to cancer risk not only thr
ough its effect on body weight but also through negative effects on immune syste
m and endocrine system.[26] More than half of the effect from diet is due to ove
rnutrition rather than from eating too little healthy foods.
Diets that are low in vegetables, fruits and whole grains, and high in processed
or red meats are linked with a number of cancers.[26] A high-salt diet is linke
d to gastric cancer, aflatoxin B1, a frequent food contaminate, with liver cance
r, and Betel nut chewing with oral cancer.[27] This may partly explain differenc
es in cancer incidence in different countries. For example, gastric cancer is mo
re common in Japan due to its high-salt diet[28] and colon cancer is more common
in the United States. Immigrants develop the risk of their new country, often w
ithin one generation, suggesting a substantial link between diet and cancer.[29]
Infection
Main article: Infectious causes of cancer
Worldwide approximately 18% of cancer deaths are related to infectious diseases.
[2] This proportion varies in different regions of the world from a high of 25%
in Africa to less than 10% in the developed world.[2] Viruses are the usual infe
ctious agents that cause cancer but bacteria and parasites may also have an effe
ct.
A virus that can cause cancer is called an oncovirus. These include human papill
omavirus (cervical carcinoma), EpsteinBarr virus (B-cell lymphoproliferative dise
ase and nasopharyngeal carcinoma), Kaposi's sarcoma herpesvirus (Kaposi's sarcom
a and primary effusion lymphomas), hepatitis B and hepatitis C viruses (hepatoce
llular carcinoma), and Human T-cell leukemia virus-1 (T-cell leukemias). Bacteri
al infection may also increase the risk of cancer, as seen in Helicobacter pylor
i-induced gastric carcinoma.[30] Parasitic infections strongly associated with c
ancer include Schistosoma haematobium (squamous cell carcinoma of the bladder) a
nd the liver flukes, Opisthorchis viverrini and Clonorchis sinensis (cholangioca
rcinoma).[31]
Radiation
Main article: Radiation-induced cancer
Up to 10% of invasive cancers are related to radiation exposure, including both
ionizing radiation and non-ionizing ultraviolet radiation.[2] Additionally, the
vast majority of non-invasive cancers are non-melanoma skin cancers caused by no
n-ionizing ultraviolet radiation.
Sources of ionizing radiation include medical imaging, and radon gas. Radiation
can cause cancer in most parts of the body, in all animals, and at any age, alth
ough radiation-induced solid tumors usually take 1015 years, and can take up to 4
0 years, to become clinically manifest, and radiation-induced leukemias typicall
y require 210 years to appear.[32] Some people, such as those with nevoid basal c
ell carcinoma syndrome or retinoblastoma, are more susceptible than average to d
eveloping cancer from radiation exposure.[32] Children and adolescents are twice
as likely to develop radiation-induced leukemia as adults; radiation exposure b

efore birth has ten times the effect.[32] Ionizing radiation is not a particular
ly strong mutagen.[32] Residential exposure to radon gas, for example, has simil
ar cancer risks as passive smoking.[32] Low-dose exposures, such as living near
a nuclear power plant, are generally believed to have no or very little effect o
n cancer development.[32] Radiation is a more potent source of cancer when it is
combined with other cancer-causing agents, such as radon gas exposure plus smok
ing tobacco.[32]
Heredity
Main article: Cancer syndrome
The vast majority of cancers are non-hereditary ("sporadic cancers"). Hereditary
cancers are primarily caused by an inherited genetic defect. Less than 0.3% of
the population are carriers of a genetic mutation which has a large effect on ca
ncer risk and these cause less than 310% of all cancer.[37] Some of these syndrom
es include: certain inherited mutations in the genes BRCA1 and BRCA2 with a more
than 75% risk of breast cancer and ovarian cancer,[37] and hereditary nonpolypo
sis colorectal cancer (HNPCC or Lynch syndrome) which is present in about 3% of
people with colorectal cancer,[38] among others.
Physical agents
Some substances cause cancer primarily through their physical, rather than chemi
cal, effects on cells.[39] A prominent example of this is prolonged exposure to
asbestos, naturally occurring mineral fibers which are a major cause of mesothel
ioma, which is a cancer of the serous membrane, usually the serous membrane surr
ounding the lungs.[39] Other substances in this category, including both natural
ly occurring and synthetic asbestos-like fibers such as wollastonite, attapulgit
e, glass wool, and rock wool, are believed to have similar effects.[39] Non-fibr
ous particulate materials that cause cancer include powdered metallic cobalt and
nickel, and crystalline silica (quartz, cristobalite, and tridymite).[39] Usual
ly, physical carcinogens must get inside the body (such as through inhaling tiny
pieces) and require years of exposure to develop cancer.[39]
Prevention
Cancer prevention is defined as active measures to decrease the risk of cancer.[
72] The vast majority of cancer cases are due to environmental risk factors, and
many, but not all, of these environmental factors are controllable lifestyle ch
oices. Thus, cancer is considered a largely preventable disease.[73] Greater tha
n 30% of cancer deaths could be prevented by avoiding risk factors including: to
bacco, overweight / obesity, an insufficient diet, physical inactivity, alcohol,
sexually transmitted infections, and air pollution.[74] Not all environmental c
auses are controllable, such as naturally occurring background radiation, and ot
her cases of cancer are caused through hereditary genetic disorders, and thus it
is not possible to prevent all cases of cancer.
Dietary
Main article: Diet and cancer
While many dietary recommendations have been proposed to reduce the risk of canc
er, the evidence to support them is not definitive.[5][75] The primary dietary f
actors that increase risk are obesity and alcohol consumption; with a diet low i
n fruits and vegetables and high in red meat being implicated but not confirmed.
[76][77] Consumption of coffee is associated with a reduced risk of liver cancer
.[78] Studies have linked consumption of red or processed meat to an increased r
isk of breast cancer, colon cancer, and pancreatic cancer, a phenomenon which co
uld be due to the presence of carcinogens in meats cooked at high temperatures.[
79][80] Dietary recommendations for cancer prevention typically include an empha
sis on vegetables, fruit, whole grains, and fish, and an avoidance of processed
and red meat (beef, pork, lamb), animal fats, and refined carbohydrates.[5][75]
Medication

The concept that medications can be used to prevent cancer is attractive, and ev
idence supports their use in a few defined circumstances.[81] In the general pop
ulation, NSAIDs reduce the risk of colorectal cancer however due to the cardiova
scular and gastrointestinal side effects they cause overall harm when used for p
revention.[82] Aspirin has been found to reduce the risk of death from cancer by
about 7%.[83] COX-2 inhibitor may decrease the rate of polyp formation in peopl
e with familial adenomatous polyposis however are associated with the same adver
se effects as NSAIDs.[84] Daily use of tamoxifen or raloxifene has been demonstr
ated to reduce the risk of developing breast cancer in high-risk women.[85] The
benefit verses harm for 5-alpha-reductase inhibitor such as finasteride is not c
lear.[86]
Vitamins have not been found to be effective at preventing cancer,[87] although
low blood levels of vitamin D are correlated with increased cancer risk.[88][89]
Whether this relationship is causal and vitamin D supplementation is protective
is not determined.[90] Beta-Carotene supplementation has been found to increase
lung cancer rates in those who are high risk.[91] Folic acid supplementation ha
s not been found effective in preventing colon cancer and may increase colon pol
yps.[92]
Vaccination
Vaccines have been developed that prevent infection by some carcinogenic viruses
.[93] Human papillomavirus vaccine (Gardasil and Cervarix) decreases the risk of
developing cervical cancer.[93] The hepatitis B vaccine prevents infection with
hepatitis B virus and thus decreases the risk of liver cancer.[93] The administ
ration of human papillomavirus and hepatitis B vaccinations is recommended when
resources allow.[9
Management
Main article: Management of cancer
Many treatment options for cancer exist with the primary ones including surgery,
chemotherapy, radiation therapy, and palliative care. Which treatments are used
depends upon the type, location and grade of the cancer as well as the person's
health and wishes.
Chemotherapy
Chemotherapy is the treatment of cancer with one or more cytotoxic anti-neoplast
ic drugs (chemotherapeutic agents) as part of a standardized regimen. The term e
ncompasses any of a large variety of different anticancer drugs, which are divid
ed into broad categories such as alkylating agents and antimetabolites.[111] Tra
ditional chemotherapeutic agents act by killing cells that divide rapidly, one o
f the main properties of most cancer cells.
Targeted therapy is a form of chemotherapy which target specific molecular diffe
rences between cancer and normal cells. The first targeted therapies to be devel
oped blocked the estrogen receptor molecule, inhibiting the growth of breast can
cer. Another common example is the class of Bcr-Abl inhibitors, which are used t
o treat chronic myelogenous leukemia (CML).[112] Currently, there are targeted t
herapies for breast cancer, multiple myeloma, lymphoma, prostate cancer, melanom
a and other cancers.[113]
The efficacy of chemotherapy depends on the type of cancer and the stage. In com
bination with surgery, chemotherapy has proven useful in a number of different c
ancer types including: breast cancer, colorectal cancer, pancreatic cancer, oste
ogenic sarcoma, testicular cancer, ovarian cancer, and certain lung cancers.[114
] The overall effectiveness ranges from being curative for some cancers, such as
some leukemias,[115][116] to being ineffective, such as in some brain tumors,[1
17] to being needless in others, like most non-melanoma skin cancers.[118] The e

ffectiveness of chemotherapy is often limited by toxicity to other tissues in th

e body. Even when it is impossible for chemotherapy to provide a permanent cure,
chemotherapy may be useful to reduce symptoms like pain or to reduce the size o
f an inoperable tumor in the hope that surgery will be possible in the future.
Radiation
Radiation therapy involves the use of ionizing radiation in an attempt to either
cure or improve the symptoms of cancer. It works by damaging the DNA of cancero
us tissue leading to cellular death. To spare normal tissues (such as skin or or
gans which radiation must pass through to treat the tumor), shaped radiation bea
ms are aimed from several angles of exposure to intersect at the tumor, providin
g a much larger absorbed dose there than in the surrounding, healthy tissue. As
with chemotherapy, different cancers respond differently to radiation therapy.[1
19][120][121]
Radiation therapy is used in about half of all cases and the radiation can be fr
om either internal sources in the form of brachytherapy or external sources. Rad
iation is typically used in addition to surgery and or chemotherapy but for cert
ain types of cancer, such as early head and neck cancer, may be used alone. For
painful bone metastasis, it has been found to be effective in about 70% of peopl
e.[122]
Surgery
Surgery is the primary method of treatment of most isolated solid cancers and ma
y play a role in palliation and prolongation of survival. It is typically an imp
ortant part of making the definitive diagnosis and staging the tumor as biopsies
are usually required. In localized cancer surgery typically attempts to remove
the entire mass along with, in certain cases, the lymph nodes in the area. For s
ome types of cancer this is all that is needed to eliminate the cancer.[114]
Palliative care
Palliative care refers to treatment which attempts to make the person feel bette
r and may or may not be combined with an attempt to treat the cancer. Palliative
care includes action to reduce the physical, emotional, spiritual, and psycho-s
ocial distress experienced by people with cancer. Unlike treatment that is aimed
at directly killing cancer cells, the primary goal of palliative care is to imp
rove the person's quality of life.