Understanding Cancer

Cancer is a disease characterized by uncontrolled cell growth, which has the ability to infiltrate and destroy healthy cells in the body.
Each cell of the body has a central control called the nucleus. The nucleus consists of a series of DNA chains that act as regulators of the nature and function of each cell, including to divide.

Normally, the cells will divide according to the prescribed time and with the genetic properties of normal cells. But at the time of mutation in the cell, the genetic information of cells in the DNA chain is damaged, imprinted or even lost, during the process of cell division. In cancer, mutations occur where cells will divide too much so that it will form a tumor tissue.
Based on the type of cells affected, cancer can be divided into 5 groups, namely:

• Carcinoma, cancer originating from skin tissue or tissue of the outer layer of internal organs. Carcinoma is divided into several subtypes including adenocarcinoma, basal cell cancer, squamous cell cancer, and transitional cell cancer.
• Sarcoma, cancer originating from connective tissue such as bone tissue, cartilage tissue, fat tissue, muscle tissue, and blood vessel tissue. 
• Leukemia, a cancer derived from blood-forming tissue such as bone marrow. This type of cancer causes excessive production of blood cells that will then be released into the bloodstream. 
• Lymphoma and myeloma, cancer originating from cells in the immune system. 
• Cancer in the brain and spinal cord, a cancer originating from the central nervous system network.

In addition to these groupings, cancer is also divided according to the organ where the origin of cancer tissue develops such as lung cancer or breast cancer .

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Causes of Cancer

The main cause of cancer is the mutation of DNA in the cell, so the cell breaks itself at a speed exceeding normal. Finally, there is accumulation of new cells that are not needed by the body. This new cell will continue to grow to maturity and then divide again, and so on.
In addition, mutations also occur in genes responsible for repairing DNA damage. Normally, this gene serves to see what abnormalities occur in the cell's DNA, then correct them. Because the gene is mutated, this gene is not able to correct the abnormalities in the cell until the cells become malignant.
There are several factors that can cause mutations in normal cells, and can come from within and outside the cell.
Mutations derived from within cells are generally obtained genetically from the elderly. While the external cause of the cell, the most common is exposure by substances that can trigger mutations (mutagens). Some of the substances belonging to mutagenic groups include:
•    Cigarettes
•    Radiation
•    Virus
•    Carcinogenic chemicals
•    Hormone
Mutation due to external factors can also be caused by other factors such as obesity , chronic inflammation and lack of physical activity. In general, external factors are more risky to cause the cell to undergo mutation than by internal factors.

Risk factors that can increase a person's chances of getting cancer are as follows:

• Age. The development of cancer in a person can occur in a very long time, therefore most cancer patients are elderly people over the age of 65 years. However, cancer can also be experienced by anyone regardless of age.
•  Family history. Genetic mutations can be inherited from parents. If a person has a family member who becomes a cancer patient, there is a possibility that the person is at risk of being exposed to the same condition. It is recommended for people who have a family history of cancer to undergo genetic testing to check for genetic mutations in that person. 
• Chronic health conditions. Some chronic diseases can increase the risk of cancer. Such as ulcerative colitis can increase the risk of colon cancer in a person. 
• Environment. Environmental factors can increase the risk of cancer in a person. Examples are harmful chemical compounds such as asbestos or benzene. Smoking also increases the risk of kanke r, especially lung cancer. 
• Infection. Some viruses can be a cause or an increased risk of cancer. Examples are hepatitis B and C viruses that can cause liver cancer . In addition, infection with HPV virus ( human papilloma virus ) in women can cause cervical cancer . 
• Immune system disorders. Patients with immune system disorders or people with weak immune systems are more susceptible to cancer than healthy people. Immune system disorders can come from infections such as HIV / AIDS or drugs that suppress the immune system

Cancer Symptoms

The symptoms that arise due to cancer vary widely depending on the type of cancer experienced and the organs of the cancer. Some of the common symptoms experienced by cancer sufferers are:

• Exhausted and feeling weak.
• Unwanted weight loss, can be a decrease or gain in weight. 
• The appearance of a lump or thickening that feels under the skin. 
• Changes to the skin, such as yellowing, darkening, or flushing. Can also be a painful abnormality or injury and does not heal. 
• Fever and night sweats in the long term. 
• Bleeding and bruising are not clear why.

If you experience any of these symptoms, especially long-term persistent symptoms, it is advisable to consult your doctor immediately. Risk factors and family history of cancer also need to be consulted for routine screening, so that cancer can be diagnosed early.

Diagnosis and Division of Cancer

The earlier the cancer is diagnosed, the greater the chance of recovery for the sufferer. Therefore it is highly recommended to people who have risk of cancer to consult with doctors related to risk factors. Some of the most common cancer diagnostic steps are:

• Physical examination. Physical examination done to show signs of cancer can be examination of lumps under the skin, skin discoloration, and swelling of organs.
• Laboratory test. Blood and urine tests can be performed to check for abnormal body condition. An example is in the case of leukemia , where doctors can perform laboratory tests in the calculation of the number of complete blood cells to diagnose the number of cells leukosit increased abnormally. 
• Imaging test (imaging test). This test serves to map the internal organs and bones without surgery. Imaging tests performed can be a CT scan , bone scan , MRI, PET scans , ultrsound examination, X-rays, and others. 
• Biopsy. This examination is done by taking samples of tissue suspected of having cancer to be observed using a microscope in the laboratory. Through a microscope, the structure of the tissue sample can be observed more clearly. Normal cells are usually seen as cells of uniform size and neatly arranged. While on the cancer cells, the size will look different and the arrangement is not neat. Biopsy is the most accurate examination in determining whether a person has cancer or not.

After the tests are performed and the patient is confirmed to have cancer, the doctor will determine the stage (stage) of cancer. In general, the division of cancer stage is as follows:

• Stage 1. Indicates that the cancer is small and remains in the organ where the cancer started.
• Stage 2. Indicates that the cancer has not spread to the surrounding tissue, but the size of the cancer has been greater than stage 1. In some types of cancer, stage 2 means cancer cells have spread to the lymph nodes closest to the organ of the cancer. 
• Stage 3. The size of the cancer has been greater than stage 2 and cancer cells have begun to spread to other tissues or organs, as well as to the lymph nodes around the cancer. 
• Stage 4. Indicates that the cancer has spread to other organs or tissues.

In addition to the stage level system, also known as the TNM level system whose details are as follows:

• T (Tumor). Describe the size of cancer and the spread of cancer to surrounding tissues. To describe the size of cancer used the number 1, 2, 3, 4, with the number 1 indicating the smallest size and 4 the largest.
• N (Node). It describes the spread of cancer to the lymph nodes (lymph nodes) around the cancer. To illustrate the spread of cancer used the numbers 0, 1, 2, 3 with 0 indicates the cancer has not spread to the lymph node and 3 indicates that many lymph nodes are affected by cancer. 
• M (Metastasis). Describe the spread of cancer to other organs. The number 0 indicates the cancer has not spread to other organs and the number 1 indicates the cancer has spread to other organs.

In the case of cancer diagnosed in the early stages, a condition can be found in the form of abnormal cells in the body. The collection of cells can develop into cancer in the future, but is too small to form a tumor. This condition is called dysplasia or carcinoma in situ which in the division level of cancer is called cancer stage 0.

Some doctors call this condition as non-invasive cancer. In situ carcinoma is generally difficult to detect due to its very small size, except in a place that is easily visible (eg in the skin). Some types of screening tests can also detect carcinoma in situ in the breast or cervix.
Determination of cancerous malignancy and spread is a very important part in the diagnosis of cancer because it will determine the most effective type of treatment for the patient.

Cancer Treatment

Various types of cancer treatment have been found and used for patients with cancer. The type of treatment that the doctor will apply depends on several things, such as the type of cancer, the stage of cancer, the location of the cancer, the patient's general health condition, and the patient's request. Doctors will give consideration regarding the advantages and risks of each treatment.
The main goals of cancer treatment are as follows:

• Healing the patient. Healing is the main goal of various cancer treatments. Achieving this goal or not depends on many factors, such as the type and extent of cancer malignancy as well as the general state of the patient.
• Primary treatment. The goal of primary treatment is to remove or kill cancerous tissue in the body as a whole without any cells left behind. Different types of treatment can be used in order for cancer cells to be removed from the patient, but surgery is commonly used. If the cancer type of the patient has sensitivity to radiotherapy or chemotherapy, both types of treatment may be used as a primary treatment. 
• Adjuvant treatment / additional . The purpose of adjuvant treatment is to remove the remnants of cancer cells that are still present in the patient's body after the primary treatment. Adjuvant treatment can also be done to prevent the cancer from reappearing in the patient. The commonly used adjuvant treatment is chemotherapy treatment , radiotherapy and hormone therapy. 
• Palliative care. The goal of palliative treatment is to relieve symptoms and side effects of primary and adjuvant treatment, not to cure.

There are various methods of cancer treatment, which are selected based on the type and level of cancer malignancy suffered by the patient. The commonly used methods are as follows:

• Surgery. The goal of surgery is to remove the cancer tissue in the body as much as possible.
• Chemotherapy is a cancer treatment using chemical compounds in the form of drugs. 
• Radiotherapy is a cancer treatment by using high-energy rays to kill cancer cells. Radiotherapy can use radiation rays from outside the body (external siner radiation) or implanted in the patient's body (brachytherapy). 
• Stem cell transplantation. Stem cell transplants are also called bone marrow transplants that play a role in producing blood cells. Transplanted stem cells may come from patients or from stem cell donors. In addition to replacing bone marrow with malignancy or malignancy, stem cell transplantation may also be performed to provide an opportunity for physicians to use chemotherapy at higher doses of other cancers. 
• Immunotherapy . Immunotherapy is also known as biological therapy that aims to help the immune system in recognizing cancer cells and then kill it. Cancer cells when not fought by the immune system can spread uncontrollably and harm patients. 
• Hormone therapy. Some cancers can occur by being triggered by hormones such as breast and prostate cancers. Lowering or eliminating these hormone levels in the body can stop the growth of cancer tissue. 
• Targeted drug therapy . Giving a drug-abatan capable of killing abnormal cells only, without attacking healthy cells.

Both cancer and cancer treatment can weaken one's immune system. Cancer can weaken the immune system if cancer cells spread to the bone marrow where white blood cells are produced. Generally the type of leukemia and lymphoma can weaken the immune system but some other can also participate weaken the immune system.

Like other disease treatments, cancer treatment has side effects on the body. One side effect is to reduce the amount of blood cells in the body and slow the production of blood. At the beginning of treatment, the number of white blood cells will decrease. Under normal conditions, the white blood cells that die will be replaced with new white blood cells for a week or two weeks. However, cancer treatment that is being undertaken can slow the regeneration process of white blood cells. This condition can weaken the patient's immune system so that patients are more susceptible to secondary infections due to weakness of the immune system.

Red blood cells normally have a age of about three months so that the red blood cell regeneration process is slower than white blood cells. Treatment of cancer, especially chemotherapy can reduce the number of red blood cells so that people who do not have anemia risk can be affected by anemia. If the number of red blood cells is very small, blood transfusion can be performed for the patient.
Platelets (blood clots) may also decrease as a result of cancer treatment. Symptoms of decreasing blood chips can be observed from the occurrence of nosebleeds , bruises, or red rash on the skin. These side effects can be overcome by giving platelet transfusions to the patient. Generally after patients receive chemotherapy in the long term, platelets take longer to increase to normal amounts than other blood cells.

How Cancer Can Reappear (Recurrence)

Cancer can reappear to someone after treatment in cancer patients. Some incidences of cancer recurrence are described as follows:

• Relapse after surgery. Cancer may reappear in cancer patients who have undergone surgical treatment due to the following:

• Some cancer cells are still left in the body after the removal of cancer tissue.
• Cancer cells have spread from the organs of cancer origin before surgery performed.

The surgeon who carries out the cancer in the patient will make every effort to eliminate all cancer cells. But there is still the possibility of a small portion of cancer cells left in the patient so that it can reappear and cause relapse. To overcome this the doctor will recommend additional post-surgical treatment for all cancer cells can be killed. Additional treatments may include chemotherapy, radiotherapy, immunotherapy, and hormone therapy.

• Relapse post-chemotherapy. The working principle of chemotherapy treatment is to kill cells that are in the phase of cell division. Chemotherapy is given at regular intervals with the aim of killing all cancer cells present in patients despite having different time-splitting phases.

However, such as surgical removal of cancer, chemotherapy can not kill cancer cells thoroughly. A small percentage of cancer cells will be left behind after the last chemotherapy so there is the possibility of cancer to recur. To overcome this possibility the doctor will make every effort possible so that some cancer cells can be killed through chemotherapy. The rest of the cancer cells will be killed through the patient's immune system or will die by itself.

• Relapse post-radiotherapy. In the implementation of radiotherapy, healthy cells around the cancer tissue will also be damaged even though it will return to healthy by itself. The same thing happens with cancer cells especially if there are some cells that are not killed through radiotherapy.
• Relapse post-biological therapy. Several types of biological therapies serve to kill cancer cells but some just shrink the size of the cancer without killing it. Like other therapies, biological therapy can also leave a small portion of post-treatment cancer cells that can grow and reappear in the future.

In order for cancer treatment given to patients to kill cancer cells to the maximum extent possible, patients will generally be given a combination of several therapies.
In some cases, cancer cells can be resistant to cancer treatments making it more difficult to treat. Cancer cell resistance occurs due to mutations that occur in cancer cells on a continuous basis so that cell genetic properties change. If this happens, the doctor will give some kind of combination of treatment to the patient. It will remain in some rarer cases, after any combination of treatments, the cancer still has resistance. The condition is called multi drug resistance .

Cancer Prevention

Some things that can be done to prevent cancer are as follows:

• Stop smoking . Smoking can increase a person's risk of developing various types of cancer, especially lung cancer .
• Avoid excessive sun rays. Ultraviolet rays are harmful from the sun can increase the risk of skin cancer. Avoid sunburn by staying in the shade, using closed clothes, or using sunscreen (sunscreen). 
• Set a healthy diet. Expand to eat fruits, vegetables, grains (eg wheat), and foods rich in protein. 
• Exercise regularly every week. Regular exercise affects the decreased risk of cancer in a person. 
• Maintain weight. Having an obese or overweight condition can increase a person's risk of cancer. To keep the weight to stay ideal can be through maintaining a healthy diet and exercise routine. 
• Reduce and stop drinking alcohol. If you are active in consuming alcohol, limit consumption to 1-2 times each day. 
• Schedule regular cancer screening checks. 
• Consult a vaccination with a doctor. Some types of cancer are caused by viruses so it can be avoided by vaccination. Examples of cancers that can be avoided by vaccination are cervical cancer caused by HPV infection and liver cancer caused by viral hepatitis infection.

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