Cancer: The Emperor of all Maladies

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by Safeeya Wahid 

Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems. There are more than 100 different types of cancer. Most cancers are named for the organ or type of cell in which they start e.g,, cancer that begins in the colon is called colon cancer; cancer that begins in melanocytes of the skin is called melanoma.

Cancer types can be grouped into broader categories. The main categories of cancer include:

Carcinoma– cancer that begins in the skin or in tissues that line or cover internal organs. There are a number of subtypes of carcinoma, including adenocarcinoma, basal cell carcinoma, squamous cell carcinoma, and transitional cell carcinoma.

Sarcoma– cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.

Leukemia– cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood.

Lymphoma and myeloma– cancers that begin in the cells of the immune system.

Central nervous system cancers– cancers that begin in the tissues of the brain and spinal cord.

Safeeya Wahid, Author

All cancers begin in cells, the body’s basic unit of life. To understand cancer, it’s helpful to know what happens when normal cells become cancer cells. The body is made up of many types of cells. These cells grow and divide in a controlled way to produce more cells as they are needed to keep the body healthy. When cells become old or damaged, they die and are replaced with new cells. However, sometimes this orderly process goes wrong. The genetic material (DNA) of a cell can become damaged or changed, producing mutations that affect normal cell growth and division. When this happens, cells do not die when they should and new cells form when the body does not need them. The extra cells may form a mass of tissue called a tumor. Cancer is one of the most dreaded diseases in the modern contemporary world. Of the ten million new cases diagnosed every year, more than half are from developing countries.

According to the latest statistics, over10 million people will die annually by the year 2020 due to cancer, and 70% of them from the developing world. The incidence of cancer is rising every year, and this is attributed to the changes in lifestyle and increase in life expectancy. Cancer profile varies in different parts of the world, and an epidemiological study will help us to know about the common cancer types prevalent in particular segments of a population, and the risk factors involved.

As per the National Cancer Registry Programme (NCRP) report, the incidence of stomach Cancer is leading in Bangalore and Chennai in India and is less common in Bhopal, Mumbai, and Delhi. Similarly, cancer of the gallbladder is leading cancer in women in Bhopal and Delhi and is hardly seen in Chennai and Bangalore. Kashmir valley is distinct from rest of India with respect to its geography, climate, dietary habits, and social culture, norms, values etc. More than 90% of the population follows the Muslim religion. As the Regional Cancer Centre (RCC) in Kashmir is the only center maintaining the cancer registry in this area for the last few years, it is worthwhile to analyze the incidence of the different types of cancers in this part of the world, which is socially and culturally different from the rest of the world.

A cross-sectional study was conducted between January 1, 2009, and December 31, 2011, at (skims) Sher-Kashmir Institute of medical sciences, which is a cancer referral center for the entire Kashmir valley, and has recently, acquired the status of a regional cancer center through the National Cancer Control Program (NCCP). Also, presently it is the largest hospital-based cancer registry in Jammu and Kashmir, with a catchment of all the districts of Kashmir valley comprising of a population of around 7 million people. Only the cases historically confirmed as cancer were included and studied in the premier cancer institute of the valley. Descriptive statistics were obtained from well-maintained files of patients from the Hospital Based Cancer Registry; Medical records of all these patients were analyzed. All patients were assigned a Regional Cancer Centre number. The history, results of physical examination and investigations were recorded for these patients. Baseline investigations like the hologram, kidney function tests, liver function tests, and radiograph chest was done in every patient. In all the patients, relevant investigations for cancer staging were performed. After proper staging, the patients were either subjected to surgery, chemotherapy or radiation therapy or were put on palliative treatment depending on the individual case. In most of the cases, a combination of these modalities was used. All such patients were enrolled in this study.

The incidence and pattern of cancer vary from country to country. Developed countries have a high incidence of cancer because of their diet patterns, lifestyle and affluent living conditions. Increase in the life expectancy is one of the major factors for an increased incidence of cancer. Cancer is predominantly a disease of middle and old age, although no age is immune. Genetic factors may significantly alter the cancer risk caused due to environmental exposure to genotoxins. Infection with viruses and bacteria contributes to the increased risk of cancer, especially in developing countries. Twenty-five percent of cancers in the developing countries are associated with chronic infection. We observed that esophageal cancer was the most common cancer in both sexes combined, with a male to female ratio of 1.33:1, and remained the most common cancer in females and second most common in males. This cancer has a very high incidence in Kashmir valley, which is comparable to the Iranian cancer belt. This is probably Because of the peculiar food habits of the people of Kashmir and Iran. Most Kashmiris take hot tea called “Noon-Chai” (hot beverage boiled in samovar) both in the morning and at supper, and this has been proposed as responsible for the high incidence of this carcinoma in the valley. (Hukka) a traditional Kashmiri smoking bowel is also considered to be a causative factor and is practiced commonly by both, the males and females in rural Kashmir. This is the first study indicating that lung cancer is the most common cancer type the male population of the valley.

Sameer Koul on Cancer in Kashmir

The National Cancer Registry Programme (NCRP) of the Indian Council of Medical Research (ICMR), collected data from six different parts of the country and reported that cancer of the trachea, bronchus, and lungs was the most common type of malignancy in males in 1989 from Bombay, Delhi and Bhopal. It was the second most common cancer in Madras (Chennai) and third most in Bangalore, and was most unusual in Barshi, a rural area. Lung cancer was reported as the second most common malignancy in an earlier hospital-based study from the Kashmir Valley of the Indian subcontinent. However, a recent study conducted at (Skims) reported that Srinagar, the summer capital of Jammu and Kashmir, has the highest incidence of lung cancer among males in India. Cancer of the stomach is also amongst the first five cancers in the valley, with a male preponderance.

The conclusion suggests that the differences in the pattern of various cancers in the Kashmir valley have not been well researched, and no large population-based epidemiological study has been done so far. Few studies have however suggested that the pattern of high esophageal and low cervical cancers are seen in this a readme to the differences in the lifestyle and characteristic socio-cultural and religious practices of this region. Further, smoking-related tumors have a high incidence in the valley, such as lung cancers. Due to increasing smoking rates in children and young adults, the incidence of such cancers may further rise in near future. Furthermore, site-specific epidemiological studies will throw a light upon the differences in the epidemiological profile, and may also suggest preventive measures in tackling such cancers.

(Safeeya Wahid is Health councilor at Chandoosa hospital Baramulla. Ideas expressed are her own)                       

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