Aetiology and Management of Cancer

Aetiology and Management of Cancer

Understanding the aetiology and management of cancer in Biopsychosocial perspective

Cancer is one of the most common diseases in the world today and unfortunately, there are more than 200 different types of cancers that can affect human beings across all walks of life. Though it is more common among older people, it also affects children, teenagers and young adults. In the UK alone, more than 309,500 people are being diagnosed with cancer every year and this is roughly about 850 people a day. It is estimated that one in every three people will develop some kind of cancer in their lifetime and in the UK alone, someone is diagnosed with it every two minutes (Cancer Research UK, 2011).

Cancer is one of the biggest fears facing most people today and rightly so, because it contributed to the death of 156,090 people in 2009 alone (Cancer Research UK, 2011). More than half these people died due to breast, lung, colorectal and prostrate cancer while the other forms of cancer contributed to the remaining half. Prostrate cancer is the number one killer among men while for women, it is breast cancer.

With the high prevalence of cancer, many researchers are looking into the reasons that cause it because this is the logical step forward. Preventing cancer in the first place may end up being easier than treating it with advanced forms of treatment such as chemotherapy. Aetiology is the study of the causes of cancer and this is where a lot of effort is going into now. This is because cancer is neither a contagious disease nor is it hereditary always. Research has shown that all human beings have a genetic predisposition to cancer due to the presence of certain genes that cause cancer and these genes are known as proto-oncogenes. Many factors such as the environment, diet, lifestyle and other biopsychosocial factors act on these genes and mutate them into active cancer-causing oncogenes. These agents that trigger the mutation of these genes are known as agents and when this happens, it leads to the growth of tumors and abnormal cell divisions. Some of the broad factors, including the chemical and physical agents, that play a role in the occurrence of cancer has been discussed below.

One of the factors that we tend to ignore is the environment because in today's fast-paced life, we have no time to stop and look around what's happening around us. Unfortunately, environment is one of the major causes of cancer today because of the vast number of physical and chemical pollutants that have the potential to induce cancer in human beings.

The environmental factors of cancer are those that are outside the body and have some role in causing the tumor or growing it within the human body. These outside factors enter the body through a variety of ways and interact with the normal and malignant cells to cause cancer. According to cancer.gov (2011), 2 out of every 3 cancer cases are related to some kind of environmental factor such as tobacco, pollution, alcohol, food, radiation, waste and chemicals. Out of this, tobacco accounts for about 29% to 31% of cancer cases, diet accounts for 20% to 50%, bacterial and viral infections contribute to 10% to 20%, radiation causes 5% to 7%, of cancer cases and finally, pollution is linked to 1% to 5% of cases respectively.

Firstly, we will deal with the factors that are related to the environment in a general sense such as pollution, exposure to radiation and harmful chemicals. One of the most prominent kinds of cancer is the lung cancer and the most important agent for the occurrence of this form of cancer is bronchogenic carcinoma. Exposure to asbestos is considered to be one of the top reasons for lung cancer. In the UK, there was a sharp rise in the number of lung cancer patients who lived or worked near ship yards and were exposed to varying amounts of asbestos over a certain number of years (Stine & Miller, 2006). This study shows that the substances present in asbestos enter the lung through prolonged inhalation and this causes a variety of problems, from blockages to lung cancer.

In another study, there was a positive correlation between environmental contaminants and breast cancer. One of the primary contaminant was organochlorines that are freely present in the atmosphere today and include polychlorinated biphenyls (PCBs), chlorinated dioxins and furans, polycyclic aromatic hydrocarbons (PAH) and pesticides such as DDT. These contaminants were found in human breast milk and they exhibit estrogenic and antiadrogenic activity that boosts the chances of breast cancer (Salehi et al., 2008).

The PCBs are found in a variety of things today including flame retardants and paints and is used extensively in the electrical industry. Most of these contaminants enter the body through diet, especially fish that is caught off contaminated waters. The PAHs are another potential contaminant found in the environment due to fossil fuel extraction, transportation, industrial processes, cigarettes and even smoked and grilled foods. The Environment Canada and Health Canada (1994) identified five particles of PAHs that were regarded as dangerous to human beings. They explained that when these particles entered the human body, they are stored in fat tissues and they inhibit the regulatory proteins. These protein help in DNA repair and detoxification and when these proteins do not play the role, it makes the body more susceptible to diseases such as breast cancer (Salehi et al., 2008).

The environment also plays a role in the growth and development of a fetus inside a mother's body. When a mother is exposed to certain agents in the environment such as pollution and cigarette smoke, it reaches the fetus and is metabolized by its body (McAllister, 2004). Thus, the interaction between different environmental agents can increase the chances of cancer even before birth. Though this research is in its nascent stages, researchers are fairly confident on the effect of chemicals on the replication and differentiation of different kinds of cells in the fetus and embryo present inside the mother's body.

The good news is that it is possible to contain exposure to these harmful ingredients through proper understanding, abstinence and conscious health choices. Staying away from harmful pollutants such as lead and asbestos is sure to decrease the chances of cancer. This is because the chemical pollutants will have little contact with the human genes and this means, the chances for mutation is greatly reduced. This is a key aspect of cancer management and the only way to help people from going through the pain and treatment of cancer is to spread awareness about the presence of these harmful chemicals and educating the public to stay away from it. In the meantime, the Government can work with private companies to clean up this environmental mess so that the presence of these harmful agents can be reduced to a large extent.

Other than the environment, another major factor that causes cancer is the lifestyle factors. Smoking, lack of proper diet that includes appropriate servings of whole grain, fruits and vegetables and a sedentary lifestyle are known to contribute to cancer in a big way.

Smoking is related to a myriad of cancers and some of the most prominent ones are lung cancer, prostate cancer and bladder cancer. The carcinogens present in cigarettes cause these numerous kinds of cancers as they interfere with the body's functioning and metabolism.

Bladder cancer is the most important tumor in the urinary system and it accounts for one in 28 cases of cancer in the UK. In fact, it is the fourth most prevalent cancer among males and eighth among females (Anderson, 2009). The most important cause of bladder cancer is smoking. Tobacco smoke contains more than 60 different carcinogens and out of these, 4-aminobiphenyl (4ABP), benzidine and 2-naphthylamine are classified as human bladder carcinogens and they have been positively correlated with bladder cancer (Anderson, 2009). It is estimated that current smokers have three times chance than non-smokers to get bladder cancer while ex-smokers have double the chance of non-smokers when it comes to bladder cancer.

The same risks are also applicable for passive smokers. Passive smokers are those who do not smoke tobacco on their own, but are exposed to the fumes of tobacco when their spouse, father or any other member of the family is an active smoker. One group that is most vulnerable to second hand smoke is children. In the UK alone, more than 25% of men and women smoke and this is more prevalent among low-income groups. This also means they live in poor housing conditions in some of the poorest neighborhoods in the UK. As a result, a huge 40% of children are believed to be exposed to second hand smoke. Children from birth to five years are the most affected because they stay at home with their parents and also, their lungs are small and immature and their rapid breathing forces them to inhale more carcinogens than adults. This is related to bronchitis, asthma and long-term conditions such as lung cancer and bladder cancer (Robinson, 2009).

It is estimated that the chances of getting bladder cancer is high for ex-smokers and passive smokers even after thirty years later. This brings us to the question of management of bladder cancer for current and ex-smokers as well as passive smokers.

The management of bladder cancer is a three-pronged approach that involves reducing the progression of the disease, protecting the bladder and increasing the chances of survival. The course of treatment depends to a large extent on the stage of the cancer. During the earlier stages, surgery, trans urethral resection, intravesical chemotherapy and immunotherapy are used to contain the disease and prevent it from progressing further. The malignant areas are treated with one of the above procedures to remove the tumor. In the case of a more advanced stage, radical cystectomy or the complete removal of bladder is done to remove it completely from the system. Though the bladder cancer treatments are effective in most cases, it nevertheless has some side effects such as frequency of urination and severe pain during urination.

In short, bladder cancer is a preventable and treatable disease provided people understand the problems associated with smoking and refrain from it all together. More importantly, the smoke should be kept away from young children because of their increased vulnerability to second-hand smoke.

Another cancer caused by smoking is prostate cancer. It is estimated to have caused 28,000 deaths in 2008 and adds 186,000 new cases every year (Huncharek et al., 2010). Smoking is considered to be one of the major causes of prostate cancer because it contains a carcinogen called N-nitroso. Among male smokers, this carcinogen disrupts the hormonal balance and causes an increase in andosterone and testosterone. As a result, this increases the chances of prostate cancer and also helps the disease to progress faster. A study shows that prostate cancer progressed consistently faster at a rate between 9% to 30% among male smokers who were diagnosed with it. It also showed that the disease progressed faster among smokers than non-smokers. Mortality studies also show that smoking increased serum estrogen metabolites that induced an aggressive tumor phenotype and in turn, this increased the speed of prostate cancer and its resultant death (Huncharek et al., 2010).

Lung cancer and smoking are closely related. Lung cancer is the most common form of cancer and it causes the most number of deaths in the U.S. every year. Most of these lung cancer deaths occur due to smoking or exposure to second hand smoke.

In the U.S., many states have taken considerable measures to discourage smoking, encourage cessation and many communities have provided support for those who are looking to quit. Tobacco excise rates have been consistently rising in all the states and smoke-free laws in public places have been implemented successfully by most states. It is estimated that the states will collect a total of $25.3 billion in tobacco excise taxes This has worked well because the U.S. has seen a reduction in the overall rate of cancer with significant improvements in the western states of the U.S. (Henley et al., 2011).

Nicotine is a habit that is hard to break, but not impossible. It depends to a large extent on spreading awareness about the negative effects of smoking so that people know what they are subjecting their body to. They should be encouraged to take steps to live a healthier life and the Government as well as the local community should join hands to provide support to the people who are looking to break out of this habit. Through these practices, it is possible to change the smoking habits of a good percentage of smokers.

While the environment including smoking is one part of the aetiology of cancer, improper diet and a sedentary lifestyle are another. It is estimated that human beings eat two to three pounds of food every day and this makes it one of the biggest forms of contact with the environment.

Three food ingredients are associated with human cancer and they are alcoholic beverages, salted foods and aflatoxins. The alcoholic beverages cause a wide range of cancers such as those of the oral cavity, larynx, pharynx, oesophagus and liver. Aflatoxin causes Hepatocellular carcinoma while salted and preserved foods contribute to gastric cancer. The salted fish, primarily consumed in Chinese cuisine, leads to nasopharyngeal cancer (Montesano and Hall, 2001).

One of the best ways to manage cancer is to consume fruits and vegetables in the right proportions because they have the natural vitamins and minerals needed to protect the body from cancer. It boosts the immunity system and helps the body to stave off malignant tumors before they become harmful. Research has shown that each of the foods found in nature have the power to protect against certain forms of cancer.

So, how do fruits and vegetables protect us from cancer? The growth of a cancerous tumor has three broad stages and they are initiation, promotion and progression. In the first stage, some agents act on the cancerous cells found in our DNA and this makes them active. Active cancerous cells thrive fast and this initiates the tumor in the body. The presence of these agents and their impact on the DNA cells can be limited by antioxidants found in fruits and vegetables. Lycophene in tomatoes, polyphenols in green tea and beta-carotene in carrots have the power to break this initiation phase.

The second step in cancer is the promotion of the cancerous cells formed in the first phase. When the body's defense mechanism fails, the cells divide rapidly and one of the foods that accelerate this growth is the omega-6 fatty acids. Oil, meat, salad dressing, mayonnaise, butter, shortening, and pork contain omega-6 and so, excessive intake of these foods can trigger the growth of cancerous cells. Research has shown that tumor cells thrive on these omega-6 fatty acids. One way to cut back on the promotion and division of these cells is to reduce omega-6 foods and instead consume large amount of omega-3 fatty acids found mainly in fish and flax seeds. Also, omega-6 causes estrogen to multiply rapidly in women and this means a higher chance of breast cancer.

Soy foods are one of the best foods in nature and they weaken estrogen, the primary hormone that is known to increase the incidence of breast cancer. All soy foods contain isoflavones -- the component that bonds with cell receptors and reduces cell division, thereby reducing the chances of cancerous tumors. The best part about these foods is that it is all natural and there are no side-effects associated with it. In a case study conducted among Chinese women, half of them were given foods rich in soy while the other half were given foods low in soy and it was found that women who consumed high soy diet had a lower chance of breast cancer than the other group (Cowley et al., 2008).

The third step in cancer is progression where the tumor rapidly spreads and invades the healthy tissues. The tumor cells also promote the growth of new blood vessels in a process known as angiogenesis. To limit the damage in this step, cox-2 inhibitors and curcumin found in turmeric are known to help. The super foods found in nature such as rosemary, carrots and grapes contain a substance called Cox-2 inhibitors that have shown to reduce the incidence of cancer. They eliminate the factors that induce tumorous growth and this means, the chances for the progression of any kind of tumor is greatly reduced. High fiber fights against colon cancer and this is present in large amounts in beans while sulforophane, the substance found in vegetables such as broccoli has cancer-fighting enzymes that can keep this disease at bay. In short, these foods are an example of how fruits and vegetables found in nature have the power to fight against all kinds of cancer.

However, a good diet alone is not sufficient to keep cancer away. It is the beginning of a healthy lifestyle that includes consumption of the right foods along with a regular physical exercise. This helps to maintain a healthy weight and also a perfect immunity system and this greatly reduces the chances of the occurrence and progression of any form of cancer. Other healthy lifestyle options such as staying away from smoking and alcohol also help in a big way to fight against cancer.

Other than the environment, smoking and diet, another important and yet often overlooked factor is the mind. The psychological reasons play a big role in causing and managing major diseases such as cancer.

The psychological factors coupled with trauma that the patients had experienced during their childhood play a role in the occurrence of cancer. In a study on breast cancer, psychologists interviewed the patients who were admitted for a breast biopsy and they were able to predict the presence of cancer in more than 96% of cases without knowing the laboratory reports (Harris, 2006).

Graham Gormon has done extensive research in this subject and he has concluded that perinatal memories play a role in the aetiology of cancer. He believes that the fetus is terrorized to the point of extinction and this gets imprinted in their minds and stays there permanently (Gormon, 1997). Later, when any threatening event occurs in life, the mind subconsciously goes back to this imprinted thought. This results in not only low self-esteem and confidence levels, but also a lowering of the immunity system, thereby putting the body in a vulnerable position. In turn, the harmful agents enter the body easily, interact with the dormant genes and activate them to cause cancer.

While analyzing this important connection between childhood trauma and cancer, its important to understand that it is not the memory, but rather the feelings associated with it that causes cancer. In fact, these emotions or feelings are a vital link between the mind and the body and it is this aspect that should be looked into while trying to treat the mental aspect of cancer.

One such emotion is anger in which the child does not get the parental love that he or she needs at a young age and as a result, it leads to repressed anger. This form of anger is the body's defense mechanism to deal with the lack of love and this in turn, leads to chronic stress and a suppression of certain biological mechanisms that reduces the body's immunity to cope with diseases like cancer (Harris, 2006).

Another aspect of mental and emotional suppression is the ability of the person to deal with diseases. For centuries, folklore has suggested that diseases can be limited or regressed with a positive frame of mind and this is true for cancer too. A small percentage of people have seen their tumor regress or even disappear completely and there is no scientific explanation for these occurrences though it was assumed to be due to psychological factors exhibited by the patient. This is possible in people who have a strong mind and have had a pleasant childhood. This not only boosts their body's immunity, but also strengthens their mind and makes it possible for them to cope with any traumatic conditions that occur later in life.

Some of the psychological factors that play a role in coping and management of cancer are discussed below.

Hopelessness

One of the primary psychological factors believed to increase the likelihood of cancer deaths is hopelessness. In a laboratory study, animals were subjected to uncontrollable shock and their response was studied. Due to the process of conditioning, when animals learned that they were helpless against uncontrollable shock, they simply gave up trying to fight or cope with it and succumbed to the shock. On the other hand, when animals were not conditioned to the shock, they tried to move to different parts of the cage and this made it possible for them to survive the shock completely or partially (Friedman, 1990).

The same is applicable to human beings as well. Greer, Pettingale, Morris and Haybittle (1985) interviewed patients who were diagnosed with Stage I and Stage II breast cancers. An assessment was done after ten years and this showed that people who were in a state of denial about their tumor or those who were determined to fight fared better than those who had reconciled to the disease and its eventual impact. This study throws a lot of light on how the psychological and emotional thoughts of a person can affect the way he or she handles diseases. People with this sense of helplessness give up long before the disease consumes their body because they do not believe they have control over the disease. This prevents them from taking the steps that a person in a normal sense of mind would do to fight cancer.

Depression

Depression is another psychological factor that is known to decrease the rate of survival. It is closely related to the feeling of hopelessness and it leads to a more pessimistic view of life as a whole. A helplessness model of depression was formulated by Abrahamson, Seligman and Teasdale (1978) and this model brings to light the mutual relationship between depression and pessimism. Depression is caused because people have a sense of hopelessness and they believe that nothing they do can make a difference to their lives. As this sense of hopelessness increases, it leads to acute depression and even more pessimism and it makes it difficult for the patient to muster any effort to fight cancer.