Cancer

 

The Disease

Cancer is a term used for diseases characterised by the uncontrolled growth of abnormal cells beyond the usual boundaries; and the ability of these cancerous cells to migrate or spread from the original site to other sites in the body. Cancer has been reported to be the leading cause of death worldwide, accounting for approximately 13% of total deaths in 2007.

There are more than 100 different types of cancer, and most are named according to the organ or type of cell where the cancer first started. For example, cancer that begins in the lung is known as lung cancer; cancer that begins in basal cells of the skin is called basal cell carcinoma; and cancer that starts in blood-forming tissue in the bone marrow is known as leukaemia.

Diagnosis & Screening

If you have a symptom or your screening test result suggests cancer, the doctor may order lab tests, x-rays, or other tests for confirmation.

Lab Test - Tests of the blood, urine, or other fluids can help doctors make a diagnosis as high amounts of some substances (tumour markers) may be a sign of cancer. However, doctors may need to conduct other tests as they cannot rely on lab tests alone to diagnose cancer.

Imaging procedure – Imaging create pictures of areas inside your body that help the doctor see whether a tumour is present. These pictures can be made in several ways:

  • X-rays
  • CT scan
  • Radionuclide scan
  • Ultrasound
  • MRI
  • PET scan

Biopsy - In most cases, doctors need to do a biopsy by removing a sample of tissue and sends it to a lab to make a diagnosis of cancer. The sample may be removed by several ways:

  • With a needle: The doctor uses a needle to withdraw tissue or fluid.
  • With an endoscope: The doctor uses a thin, lighted tube (an endoscope) to look at areas inside the body. The doctor can remove tissue or cells through the tube.
  • With surgery: Surgery may be excisional or incisional.
    - In an excisional biopsy, the surgeon removes the entire tumour. Often some of the normal tissue around the     tumour also is removed.
    - In an incisional biopsy, the surgeon removes just part of the tumour.

Treatment

Treatment is the choice of interventions that is conducted or administered with the aim of curing the disease or prolonging life while improving patients’ quality of life. The choice of treatment is usually dependent on the type of cancer, stage of the disease, and the patients’ general health.

Chemotherapy
Chemotherapy literally means ‘drug treatment’. Chemotherapy has been the hallmark of medical treatment for cancer for many decades and remains to be the treatment of choice for many cancer types. Chemotherapy agents work on cells which rapidly divide, which include cancer cells. However, normal tissues are also affected by chemotherapy, resulting in the classic toxicities of chemotherapy such as alopecia (hair loss), gastrointestinal symptoms, and myelosuppression. There are more than 90 different chemotherapy drugs currently available and new agents are constantly being developed.

For decades, the hallmark of medical treatment for cancer has been intravenous cytotoxic chemotherapy. These drugs target rapidly dividing cells, including cancer cells and certain normal tissues. As a result, many patients experience the classic toxicities of alopecia, gastrointestinal symptoms, and myelosuppression. In the past decade, however, a dramatic shift in cancer therapy has occurred.

Although traditional cytotoxic chemotherapy remains the treatment of choice for many malignancies, targeted therapies are now a component of treatment for many types of cancer, including breast, colorectal, lung, and pancreatic cancers, as well as lymphoma, leukaemia, and multiple myeloma. Of the new anticancer drugs approved by the U.S. Food and Drug Administration (FDA) since 2000, 15 have been targeted therapies, compared with only five traditional chemotherapeutic agents.

Targeted Therapies
In recent years, much research has been conducted with the aim of developing new anti-cancer treatment agents. The new, ‘targeted therapies’ are agents that block the growth and spread of cancer by interfering with specific molecules involved in tumour growth and progression. By targeting cellular processes specific to the growth of cancer cells, targeted therapies may be more effective than other types of treatment, and less harmful to non-cancerous normal cells.

Presently, targeted therapies have expanded the concept of personalised cancer treatment and are an established component in the treatment choice of many cancer types including breast, colorectal, lung and pancreatic cancers, as well as lymphoma, leukaemia, and multiple myeloma.

What's next? The future of cancer immunotherapy
As our understanding of the immune system and tumour biology expands, so does our hope for developing treatments that may change people’s lives.  In recent years progress has been made in developing cancer immunotherapies that target specific aspects of an individual’s tumour. In the future, and even in some cases today, combinations of different treatments will hopefully advance this even further. The future of cancer immunotherapy is an exciting one.  

Personalised Healthcare – Comprehensive Genomic Profiling

Our understanding of cancer genomics is dramatically changing cancer diagnostics, leading the way to personalised cancer care

Cancer is no longer seen as just one disease, but a collection of hundreds of diseases, each with unique characteristics and its own genetic make-up (genomic profile). For example, lung cancer was once thought of as a single disease, but we now know it can be categorized into at least 12 distinct subtypes based on the molecular alterations (mutations) that drive its growth.

How did we go from categorizing cancer types based exclusively on anatomy and histology (the study of human tissues) to understanding the genetic drivers of cancer with such detail and creating a whole new method of cancer classification in a matter of few years? The emergence of molecular information, made possible by advances in the field of DNA sequencing and the ability to collect and process larger amounts of data quickly, has already played a crucial role in the evolution of cancer research in recent years