CANCER

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	CANCER
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CANCER

Cancer

All the cells contain the same genetic code that is the one in charge, depending on the part of the same one who expresses itself, to control the growth and differentiation of the diverse cellular types.

Most of the cells has a life limited with a cycle where they are generated, they grow and they die, on the contrary others like which comprise of the nervous system do not have the capacity to regenerate once they have been different. A series of control mechanisms exists that make possible the ordered growth of the cells to maintain the correct operation of all the systems that form our organism. Sometimes these mechanisms are incapable to control the growth of a cell or a cellular group (clone) beginning to grow of uncontrolled way, giving rise to a neoplásico process or tumor.

All the neoplásicos processes are not of characteristics you vitiate, some of them appear like a small tumoración without clinical repercussion. The problem arises when that group of cells acquires a capacity of proliferation and continuous growth with loss of the cellular differentiation (anaplasia). These neoplásicas cells you vitiate can grow and invade adjacent structures desestructurando them, simultaneously that are able to extend to other areas different from the affluent organism by lymphatic and/or hematógena route, producing sowings at a distance denominated metástasis. The cancer is one neoplasia malignant.

Causes

When we spoke of cancer we cannot speak of an only cause, we have to think that the causes are multiple and varied with a imbricación between all of them, whose final result will be that a certain cellular group alters its normal cycle of growth and is uncontrolled.

Fundamentally in the cancer endogenous factors coexist, determined by the genetic dowry and other exogenous, half-full ones by the environmental exhibition. In some types of neoplasias these factors can act separately and in others jointly.

1. Environmental factors. By means of studies epidemiologists one has studied the causal relation between diverse factors and certain classes of tumors. Some of the factors are not able by single himself to cause the tumor but they act like helping elements (cocarcinogen). Here they are most important:

Tobacco: considered the first cancerigenic agent, related to the cancers of lung, esophagus, buccal cavity, urinary larynx and vejiga. One attributes responsibility in 35% of all the tumors in men and 10-15% to him in women. The relation tobacco-cancer follows a progression linear.

Diet: studies do not exist definitive epidemiologists, but it is known who a rich fiber diet diminishes the incidence of cancer of Columbus. The food ingestion contaminated with aflotoxinas is cause of hepático cancer.

Alcohol: 3% of the deaths by neoplasias are attributed to him you vitiate. The tobacco and the alcohol harness their effects.

Solar light: the ultraviolet fraction can produce injuries in the genetic material of the epithelial cells. It is the main factor of risk for the skin cancers, including melanoma. It fundamentally affects to subjects of clear skin and with prolonged exhibition the sun.

Ionizing radiations: almost all the weaves are susceptible, break cellular chemical connections. The most sensible weaves are breast, thyroid and bony marrow.

Yatrogénicos factors: the carcinogen capacity of some drugs and hormones has been verified. The estrogen taking, for example, seems to increase the risk of endometrium cancer.

Microorganisms: it exists association between the concrete infection by certain virus and parasites and risk of developing neoplasias. Virus hepatitis B and C=carcinoma to hepatocelular. Virus papiloma=carcinoma of cervix. Virus Epstein-Barr=linfoma Burkitt, nasofaríngeo carcinoma.

Reproductive factors: the nuliparidad favors endometrium carcinomas, sucks and ovary, on the contrary the multiparity and the promiscuity favor the cervix cancer.

Chemical factors: many substances act like carcinogen. The relation between the asbestos and mesotelioma is classic, a pulmonary type of neoplasia.

2. Genetic factors. The essential paper that diverse genetic alterations carry out in the oncogénesis shows through a series of known phenomena, like the paper of the familiar antecedents like factor of risk for the development of several neoplasias, specially observed in the cancer of breast and colorrectal, or the association between certain cancers and certain chromosomic anomalies or defects in the repairing mechanisms of the genetic code.

Independently of these stated phenomena the existence of factors is accepted that would act on zones of genetic code which they control the growth and cycle of the cells, changing same by means of the inadequate mutations or activations.

Incidence

The cancer has greater incidence in developed countries. In Spain it is the second cause of death (22% of the deaths). The independent communities with smaller rate of mortality are Madrid, Castile-Leon, Castile-The Mancha and Galicia; on the contrary, Cantabria and Catalonia present/display the highest numbers.

The incidence more is elevated in men than in women, in the man must to the tumors of the respiratory apparatus mainly (lung and larynx), followed of digestives (stomach, colon and rectum, esophagus); in the woman the greater proportion corresponds to the cancer of breast, followed like in the man of digestives (colon and rectum, stomach, esophagus). These data make reference to which happens in Spain, since a great variability exists; for example, in the United States the lung cancer surpasses already to the one of breast in women.

With respect to the tumors that occur in the childhood, most frequent they are leucemias followed of the tumors of the nervous system.

Classification

Most of the cancers is classified according to a denominated system TNM, with three parameters:

T: parameter that indicates extension of the tumor.

N: Parameter that it indicates if affectation of the lymphatic ganglia exists and in what degree are affected.

M: it indicates the existence or not of metástasis.

This classification serves to have an idea of which it can be the degree of extension and the treatment to follow, depending on the possibilities that the tumor has of treatment. It is a classification that tries to be pronóstica and diagnóstica.

All the tumors cannot be classified based on these parameters, as it happens to the hematológicos tumors.

Prevention

The prevention plays the most important role in the control of this disease. It is possible to be developed to three levels.

1º primary Prevention: It tries to eliminate the causes that produce the disease. It is not possible to make it in all the types of cancer since in many of them the relation is not known cause-effect. Due to the great amount of studies epidemiologists several factors related directly or indirectly to the appearance of the disease have been identified.

Many of these factors comprise of our daily life. In this sense, he is basic to concienciar to the population by means of education programs that show the necessity to diminish the consumption of alcohol and tobacco, to modify the nourishing guidelines reducing to the fat ingestion, increasing the fiber consumption, fruits and vegetables in the daily feeding. Another factor that would be due to control is the excessive exhibition to solar rays and to advise the protective cream use. Also it will be had to take the measures necessary to avoid the contact with carcinogen physicists or known chemistries, it plays a role important here to fulfill the norms of security in the work.

2º secondary Prevention: One is based on the early detection of the tumor, with which the treatment possibilities more are elevated. It can obtain by means of the knowledge on the part of the population through informative campaigns of those signs or initial symptoms that alert on the appearance of the tumor; it is the case of the skin cancer where the growth, bled change of incipiente coloration or of a spot in the skin can put to us in the track of melanoma, disease that in its initial stages has a high survival.

Another way to carry out a correct secondary prevention is the precocious diagnostic programs (screening) in populations susceptible to suffer a certain type of cancer. To it we must have a suitable and cheap technique able to detect those cases susceptible to be treated successfully, of this form obtains an improvement in the prognosis, an increase of the life expectancy and a reduction of mortality in a determined group of patients. The precocious diagnosis of cancer of breast by means of mamografía in all the greater women of 50 years is recommended; the precocious diagnosis of cancer of endometrium by means of the cytology with tinción of Papanicolau in women over the 30 years, the accomplishment of a colonoscopia for the detection of colon cancer and rectum in patients with familiar predisposition to suffer this type of cancer, etc. Other methods of screening for the detection of other cancers exist but its utility has still not been clarified.

3º tertiary Prevention: Once diagnosed of cancer it is had to obtain the possible most complete reintegration of the patient to his habitual life, helping it to as much surpass his disease from the psychic point of view like physicist.

Treatment

The classic treatment of the cancer is based on three fundamental pillars that they are: surgery, chemotherapy and x-ray. These therapies can be administered separately of joint form or depending on the type of tumor and their prognosis.

1) Surgery. The ideal would be to make a curativa surgery in which extirpated of total and definitive form the tumor, but this surgery unfortunately can only be made in tumors with a precocious diagnosis, that do not affect at a distance to vital zones and without metástasis. The treatment is obtained solely in 60% of the surgery made with curativa intention.

Other types of surgery exist that are:

Preventive or prophylactic surgery: by means of the extirpation of precancerous injuries that can get to malignizar themselves.

Paliativa surgery: to treat by means of the elimination from the tumorlike mass that causes complications and prevents that the patient develops a normal life, to improve its quality of life.

Citorreductora surgery: it consists of diminishing the tumorlike mass, later to apply another treatment that can be chemotherapy and/or x-ray.

Surgery of metástasis: sometimes, when the metástasis is unique and the primary tumor has been extirpated, its extirpation can be tried.

2) Chemotherapy. One is the drug use that of selective form acts on the tumorlike cells preventing their proliferation. Most of them acts on the cellular cycle, interfering in the synthesis of DNA and ARN or inhibiting the cellular machinery that makes possible that new elements are synthesized to form tumorlike cells again. This treatment presents/displays two fundamental problems:

The resistance that many of the cells develop to drugs, reason why in many occasions is necessary to make a treatment with several medicines simultaneously.

Adverse effects: also they are damaged nonneoplásicas cells that they are in phase of proliferation, like are the cells of the bony marrow, those that regenerate the hair or the cells of tracto gastrointestinal. So that to palliate these effects a treatment makes lack of support.

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