Anatomy of Cancer: Understand Its Development

Blip, Blip, Blip, Blip - blipped the ECG machine erratically as his dad floated in and out of consciousness, lying comatose in bed for the better part of a month. “Shit”, muttered Rayomand, who had gotten special permission to see him. Such visits were few and far between. Even though meeting his dad was something that was expected of him, Rayo visited him very less.

The reason being - who wants to see someone you love, barely conscious, hooked up to 150 tubes entering him from his nose and mouth while the ventilator steadily worked and did its job keeping this vegetable of a human being alive?

When he was active, Sourav’s dad and he were inseparable. They would play the piano; they would go on walks together, during which Rayo would run into random shops and pick up things, with Dad slowly walking behind, clearing the bill. Cancer did not look good on his father, wondered Rayo, as he stared at a shell of a human being, barely being kept alive by the ventilator.

Non-Hodgkin’s Lymphoma - said the doctor - is a very rare kind of blood cancer.

Cancer kills. Unless you’re very, very lucky and your therapy is spot on, cancer kills.

And it’s a sad, messy end, as the person descends into a personal hell, the only saving grace being that they’re barely conscious most of the time, so they don’t feel the pain. And you know the worst part, it's still growing. In 2022 alone, Cancer killed 9.7 million people, and researchers believe the toll will grow to 15.4 million by 2040.

You can get cancer anywhere. Gall bladder, uterus, liver, colon, rectum - you name the body part, and it’s got a corresponding cancer that can wreak havoc.

That’s what usually happens. However, sometimes a little chaos is introduced into the order. Such cells form tumours - nothing but lumps of tissue. These tumours might be cancerous or non-cancerous.

When tumours are plucked out of us, they don’t usually grow back – that’s exactly where cancerous tumours are different. They grow back, keep on growing, and then they spread and rot the whole body from the inside out.

How this disease develops is by genetics. It is caused by genes that change the way our cells function - with respect to growing and dividing.

Genetic alterations that result in cancer can occur because of the following reasons.

1. Errors that happen when cell division occurs.

2. DNA damage caused by harmful substances like carcinogens.

3. Inherited from our parents.

The body usually gets rid of cells that exhibit damaged DNA before they become cancerous. However, this ability decreases with age - which is why there is a much higher risk of cancer occurring later in life.

Kinds of Cancer-Causing Genes

The genetic alterations that result in cancer impact three main kinds of genes - proto-oncogenes, tumour suppressant genes and DNA repair genes - such changes are called cancer drivers.

Proto-oncogenes take part in regular cell growth and division - sometimes these genes are altered in some ways or are more active than usual - they might morph into cancer-causing genes, also known as oncogenes - which permit cells to grow and survive when they really shouldn’t.

Cells with certain changes in tumour suppressor genes might divide uncontrollably.

DNA repair genes fix damaged DNA. Cells with mutations in such genes develop further mutations in other genes and chromosome changes like the copying and deleting of certain chromosome parts - all these mutations cause cells to turn cancerous.

As The Disease Spreads

A cancer that has populated a different place from where it first formed is known as metastatic cancer - indeed, the process by which cancerous cells spread to other body parts is called metastasis.

For instance, colon cancer that has formed a metastatic tumour in the colon is called metastatic colon cancer. However, these cells have some molecular features in common like the presence of certain chromosome changes.

In certain cases, treatment might lengthen the lives of people with metastatic cancer. Metastatic tumours are devastating to bodily functions, and people who die of cancer do so because of metastatic disease.

There are more than 200 types of cancer named after the organs or tissues where these cancers form. For instance, brain cancer starts in the brain, and lung cancer starts in the lung.

Here are some types of cancers that start in particular kinds of cells.

Carcinoma

These cancers are formed by epithelial cells. There are several types of epithelial cells, and you can easily recognise them under a microscope - they have a column-like shape.

Carcinomas that start in different epithelial cells have particular names.

Adenocarcinoma - This cancer originates in epithelial cells conjuring up fluids or mucus. Tissues with such varieties of epithelial cells are also known as glandular tissues. Look at any cancer of the breast, colon and prostate - they are adenocarcinomas. Then, there are basal cell carcinomas, which are cancers that originate in the lower or base layers of a person’s skin.

Following this is squamous cell carcinoma - this cancer originates in squamous cells, which are epithelial cells just below the surface of our skin. These cells line organs like the stomach, lungs, kidneys and bladder. Looking like fish scales under a microscope, they are called epidermoid carcinomas.

Then comes transitional cell carcinoma - this cancer forms in a particular type of epithelial tissue, also called transitional epithelium or urothelium. This tissue is formed of different kinds of epithelial cells varying in size, which can also be found in the linings of the bladder, certain areas of the kidney and some other organs.

Sarcomas

Such cancers occur in the bone and soft tissues, including muscle, lymph vessels, fat, fibrous tissues and blood vessels.

Osteosarcoma - this is the most common kind of bone cancer. When we say soft tissue sarcoma, it is a broad term for cancers that begin in soft tissues (muscles, fat, tendons, blood vessels, lymph and nerves. You can have soft tissue sarcoma literally anywhere in the body, but common places where they occur are the arms, abdomen, chest and legs.

Leukaemia

Leukaemia - a type of cancer that affects the blood and bone marrow, where cells are made. What happens is that white blood cells usually grow uncontrollably, interfering with the production of normal blood cells, resulting in issues like anaemia, infections and bleeding. There are many types of leukaemia, classified by whether they are acute or chronic and the kind of blood cell affected, namely, lymphocytic or myeloid.

Acute leukaemia - Progresses further quickly, requires immediate treatment, and can lead to severe complications if left untreated.

Acute lymphocytic leukaemia - Primarily affects lymphocytes, a kind of white blood cell.

Acute myelogenous leukaemia - This one affects myeloid cells, which are responsible for producing red blood cells, platelets, and certain varieties of white blood cells. The bone marrow produces an excessive number of abnormal white blood cells called myeloblasts.

Chronic lymphocytic leukaemia - This usually involves the accumulation of abnormal lymphocytes.

Chronic myelogenous leukaemia - Involves an overproduction of myeloid cells.

Why does leukaemia happen - no one knows; however, factors like genetics, exposure to radiation and a weak immune system can compound the risk. Symptoms include fatigue, unexplained weight loss, bleeding and joint and bone pain. Diagnosis happens through blood tests and bone marrow biopsies.

Lymphoma

Lymphoma is a cancer that starts in the T or B cells, also known as lymphocytes. These refer to disease-combating white blood cells that are part of the immune system.

Lymphomas are a kind of cancer that starts in the lymphatic system, part of our body’s immune system. What happens is basically the uncontrolled growth of abnormal lymphocytes, a kind of white blood cell that can happen in lymph nodes, the spleen, bone marrow, and other organs.

You have two varieties - Hodgkin’s Lymphoma and Non-Hodgkin’s lymphoma - the first variety is less common and happens in young or older adults and is characterised by the presence of Reed-Sternberg cells. NHL has a variety of subtypes based on the kind of lymphocyte affected and its behaviour.

Symptoms include swollen lymph nodes, night sweats, fever, fatigue and weight loss. Diagnosis happens through a biopsy, blood tests and imaging studies.

Multiple Myeloma

Multiple myeloma is a cancer that starts in plasma cells, another kind of immune cell. The abnormal plasma cells, also known as myeloma cells, accumulate in the bone marrow and form tumours in bones throughout the body. Multiple myeloma is also known as plasma cell myeloma and Kahler disease.

Plasma cell neoplasms happen when abnormal plasma cells form cancerous tumours in bone or soft tissue. If the tumour is singular, the disease is called a plasmacytoma. If there are multiple tumours, it is known as multiple myeloma.

In multiple myeloma, abnormal plasma cells multiply uncontrollably, so there’s no space for healthy cells, and those abnormal cells start interfering with the body’s ability to fight infections. The cancerous cells produce abnormal proteins that can ruin organs.

Common symptoms of multiple myeloma are bone pain, infections, anaemia and elevated calcium levels that can result in confusion, weakness and constipation, leading to kidney dysfunction and fractures.

Why this happens - no one knows but risk factors include age, genetic abnormalities, family history and exposure to radiation or chemicals.

If you have to diagnose this, you need a blood test, bone marrow biopsy, urine test, and imaging study to determine bone damage. Treatment depends on the stage of the cancer and involves chemo, targeted therapy, stem cell transplants and immunotherapy. Multiple myeloma is currently incurable. However, patients have been successful in managing it for long periods.

Melanoma

This is a kind of skin cancer that begins from melanocytes - cells that produce melanin- the pigment that gives our skin its colour. Melanoma isn’t as common as other skin cancers, yet it is dangerous because it can spread to other body parts.

Melanoma starts as a new or changing mole or spot on the skin. It may also form in areas that aren’t exposed to the sun, such as the eyes or internal organs. Melanoma happens because of exposure to UV radiation or tanning beds.

There are four types of melanoma - superficial spreading, nodular melanoma, lentigo malignant melanoma and acral lentiginous melanoma. The most common variety is superficial spreading melanoma, which is an irregularly shaped multicoloured mole. For melanoma, the ABCDE rule is great for recognising them.

A - Asymmetry - One half of the mole doesn’t resemble the other.

B - Border- Irregular or jagged borders.

C - Colours that differ or uneven shading.

D- Diameter larger than 6 mm.

E - Evolving - the mole changes in parameter over time.

Brain and Spinal Cord Tumours

There are various varieties of brain and spinal cord tumours. For instance, an astrocytic tumour originates in star-shaped brain cells known as astrocytes, whose job is to keep nerve cells healthy. Brain tumours might either be malignant, which can cause cancer, or benign, in which case they do not cause cancer.

Other varieties of tumours

Germ Cell Tumours

These tumours begin in the cells that create sperm or eggs. They can occur almost anywhere in the body and in nature, and they may be either benign or malignant.

Neuroendocrine Tumours

Such tumours come from cells that have released hormones into the blood while responding to the signal from the nervous system. Such tumours, which make more than your regular quantities of hormones, can result in varied symptoms.

Neuroendocrine tumours might either be benign or malignant. Neuroendocrine tumours might be benign or malignant. Some examples of neuroendocrine tumours are carcinoid tumours, pheochromocytomas, medullary thyroid cancer, small cell lung cancer and large cell neuroendocrine carcinoma (an unusual variety of lung cancer).

Carcinoid Tumours

These refer to a type of neuroendocrine tumour. They are slow-growing tumours that are normally localised in the gastrointestinal system, usually in the rectum and small intestine.

Carcinoid tumours might spread to the liver or other sites in the body and might secrete substances like serotonin or prostaglandins, resulting in carcinoid syndrome.

No one is safe - cancer can affect anyone irrespective of age, race and socioeconomic background. However, there are certain factors that can impact its likelihood. While anyone can develop cancer, certain groups are more at risk because of a combination of genetic, environmental and lifestyle factors.

Cancer is more common as we age. The risk of developing cancer goes up with age because of the accumulation of genetic mutations over time. The older you are, the more likely it is that you will develop cancer of some sort.

Smoking, drinking too much, a poor diet, physical inactivity and exposure to carcinogens can increase the risk of cancer. Exposure to environmental pollutants or certain infectious agents increases the likelihood of developing cancer.

Certain cancers have higher incidence rates in particular racial or ethnic groups. For instance, African Americans have a higher incidence of prostate cancer, while Caucasians have higher rates of melanoma.

Symptoms of cancer

Pain

It always starts with pain. Unexplained pain that gets worse and doesn’t go away. If you have chronic pain, you may need to get checked for cancer.

Weight changes

Unexplained weight loss or gain of 10 lbs or more. Sudden loss of weight without explanation could also result in cancer if it goes unchecked.

Fatigue

Severe fatigue that doesn’t get better with rest - you feel tired no matter what. If you feel fatigued, no matter what, get checked.

Lumps

Unusual lumps or swelling, especially in the breast or other parts of the body, could be a sign of cancer.

Skin Changes

Changes to existing moles, new moles, sores that won’t get better, or yellowing of the eyes or skin might be a sign of cancer.

Coughing

A persistent or new cough - a cough that produces blood and that doesn’t go away could be a sign of something worse.

Other symptoms include fever, night sweats, changes in vision, hearing or drooping of the face, weakness in limbs, dizziness, unusual sweating, hoarseness or seizures - all this might be a sign of something worse.

While cancer treatment options are many, your doctor will put you on a particular course of treatment depending on what cancer you are suffering from.

Surgery

This is the primary treatment for most types of cancer - surgery aims to get rid of cancer as much of it as possible.

Radiation therapy

This uses high-energy X-rays or other sources to destroy cancer cells. Radiation therapy can be used prior to surgery to shrink the tumour, after surgery to prevent the cancer from returning, or in combination with chemotherapy.

Chemotherapy

This uses anti-cancer drugs to destroy cancer cells. Chemotherapy can cure or control cancer or help ease its symptoms. However, it poses a threat to healthy cells, causing nasty side effects like nausea, hair loss and mouth sores.

Immunotherapy

This uses the body’s immune system to attack cancer cells. One kind of immunotherapy uses the patient’s own natural killer cells and cytotoxic T cells.

Bone marrow transplant

Also called bone marrow stem cell transplant, this procedure involves replacing damaged cells with healthy bone marrow stem cells.

In conclusion, cancer can strike at any time - whether you are prepared or not doesn’t matter. What you can do to prevent cancer is lead a healthy lifestyle, bereft of bad habits, and follow a diet full of leafy green vegetables so your immune system remains strong and can withstand an attack of cancer, god forbid it happens. While certain cancers are more common than others, they are all deadly and cannot be taken lightly. Cancer kills.