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Proficiency Badges – notes

Substances and exposures that can lead to cancer are
called carcinogens.
We come across many carcinogens in real life such as:
 Tobacco smoke( both smoking and second-hand)
 UV Rays
 Engine exhaust
 Polluted air and water
 Processed Meats
 Trans Fats
 Makeup and beauty products
 Areca nut
 Hot beverages above 65 degree Celsius
 Refined sugars and flours
 Fast foods and soft drinks
 Plastic products made of polystyrene
The oncologist will decide what treatment is ideal based on the type
of cancer, where it is located, and how far it has spread (the stage of
But in general, there are a few types of treatment that work for many
different kinds of cancer:

Most people with cancer will have some type of surgery. The main
goal is to remove tumours, tissue, or areas with cancer cells, such as
lymph nodes. Doctors also may do it to diagnose the disease or find
out how serious it is.
In many cases, surgery offers the best chance of getting rid of the
disease, especially if it hasn’t spread to other parts of the body.
Along with a traditional operation, doctors can also fight some types
of cancer with:

 Laser surgery (beams of light)

 Electrosurgery (electric currents)
 Cryosurgery (very cold temperatures to freeze cancer cells)

Medications such as antibiotics and painkillers are also provided to

lower the risk of infection and block pain before and after surgery.

Chemotherapy uses drugs to kill cancer cells. There are two ways to
get it:
“Traditional” Chemotherapy
Most chemo medications are given through an injection into a vein.
But some types can be given as a shot in the muscle, under the skin,
or as an ointment or cream to put on your skin.
The side effects vary from person to person, even if one have the
same type of cancer and gets the same treatment as someone else.
Some of the most common issues are:

 Fatigue
 Vomiting
 Nausea
 Diarrhoea
 Hair loss
 Mouth sores
 Pain

Chemotherapy can sometimes cause long-lasting side effects,

like infertility and nerve damage. Such effects cannot be avoided but
can be palliated to some extent by using other medications.

Oral (a.k.a. “No Needle”) Chemotherapy

With this type of treatment, one swallows a drug in liquid, tablet, or
capsule form at home. It works as well as other forms of
chemotherapy for some types of cancer, but not all chemo drugs can
be taken by mouth. There are some that the stomach can’t absorb,
and others can be harmful if swallowed. Oral drugs can be more
expensive than traditional chemotherapy too.
Again, the side effects can vary, but they’re similar to regular chemo.

This common treatment uses high-energy particles or waves to
destroy or damage cancer cells to keep them from spreading. It might
be the only treatment, or it might be given along with surgery or
Radiation itself isn't painful, but afterward it may cause pain, fatigue,
and skin rashes around the location of treatment. Side effects depend
on location of cancer. For example, if you’re having head or neck
radiation, you may get a dry mouth.

Other Cancer Treatments

Other cancer treatments include:

 Targeted therapy, in which drugs work against specific parts of

cancer cells to keep them from growing or spreading.
 Immunotherapy, also called biologic therapy, gets the body’s
immune system to fight cancer.
 Hormone therapy, also called hormone treatment or hormonal
therapy, treats cancers that use hormones to grow (such
as breast cancer and prostate cancer).
 Stem cell transplants. Doctors use chemo or radiation to destroy
as many cancer cells as possible, then try to replace them with
healthy stem cells from bone marrow or blood.
 Photodynamic therapy. Doctors inject a special drug into the
bloodstream, then use a specific type of light to make it kill
cancer cells.


Cancer and its treatment can cause physical symptoms and side
effects. They can also cause emotional, social, and financial effects.
Treating these effects is called palliative care or supportive care.

Palliative care is also called comfort care, supportive care,

and symptom management.
It can also be used to reduce or control the side effects of cancer
treatments. In advanced cancer, palliative treatment might help
someone to live longer and to live comfortably, even if they cannot be

The goal is to prevent or treat, as early as possible, the symptoms

and side effects of the disease and its treatment, in addition to any
related psychological, social, and spiritual problems.
Research shows that palliative care can improve the quality of your
life and help you feel more satisfied with the treatment you receive.

Palliative care is provided when:

 One is receiving cancer treatment with the goal of slowing,

stopping, or curing the cancer.

 One just learned that he/she has cancer, are receiving

treatment, or has finished treatment but still has side effects or

The physical and emotional effects of cancer and its treatment may
be very different from person to person. Palliative care can address a
broad range of issues, integrating an individual’s specific needs into
care. A palliative care specialist will take the following issues into
account for each patient:
 Physical. Common physical symptoms include pain, fatigue, loss
of appetite, nausea, vomiting, shortness of breath, and
 Emotional and coping. Palliative care specialists can provide
resources to help patients and families deal with the emotions
that come with a cancer diagnosis and cancer treatment.
Depression, anxiety, and fear are only a few of the concerns that
are addressed.
 Spiritual. With a cancer diagnosis, patients and families often
look more deeply for meaning in their lives. Some find the
disease brings them closer to their faith or spiritual beliefs,
whereas others struggle to understand why cancer happened to
them. An expert in palliative care can help them find a sense of
peace or reach a point of acceptance that is appropriate for
their situation.
 Caregiver needs. Family members are an important part of
cancer care. Like the patient, they have changing needs. It’s
common for family members to become overwhelmed by the
extra responsibilities placed upon them. Many find it hard to
care for a sick relative while trying to handle other obligations.
Uncertainty about how to help their loved one with medical
situations, inadequate social support, and emotions such as
worry and fear can also add to caregiver stress. These
challenges can compromise caregivers’ own health. Palliative
care specialists can help families and friends cope and give them
the support they need.
 Practical needs. Palliative care specialists can also assist with
financial and legal worries, insurance questions, and
employment concerns. Discussing the goals of care is also an
important component of palliative care. This includes talking
about advance directives and facilitating communication among
family member, caregivers, and members of the oncology care
The balance between anti-tumour therapy and palliative care in
the continuum of cancer care. Pic description


Signs and symptoms are both signals of injury, illness, disease –

signals that something is not right in the body.

A sign is a signal that can be seen by someone else – maybe a loved

one, or a doctor, nurse, or other health care professional.

A symptom is a signal that’s felt or noticed by the person who has it,
but may not be easily seen by anyone else.

Cancer is a group of diseases that can cause almost any sign or

symptom. The signs and symptoms will depend on:

 where the cancer is,

 how big it is, and
 How much it affects the organs or tissues.
If a cancer has spread (metastasized), signs or symptoms may appear
in different parts of the body.

As a cancer grows, it can begin to push on nearby organs, blood

vessels, and nerves. This pressure causes some of the signs and
symptoms of cancer. If the cancer is in a critical area, such as certain
parts of the brain, even the smallest tumour can cause symptoms.

A cancer may also cause symptoms like fever, extreme tiredness

(fatigue), or weight loss. This may be because cancer cells use up
much of the body’s energy supply, or they may release substances
that change the way the body makes energy from food.

Change in bowel or bladder:

Sudden or gradual shift in this routine such as:

 frequency,
 constipation,
 diarrhoea,
 change in shape or colour,
 bloody stools and rectal bleeding

These are often signs of colorectal cancer or even cancer of the

large intestine.

A lesion that does not heal:

Lesions or sores that do not heal for over three months are
considered as chronic wounds.

 don't seem to be getting better over time

 are getting bigger
 getting more painful
 are starting to bleed
 are rough and scaly

These might also include growths or lumps and development of

crusts. Lesions caused due to constant trauma on a certain area must
not be neglected too. For example, ‘sari cancer’ that occurs on the
waistline is caused by pigmentation and scaling of the skin which is
caused by persistent pressure at a single point when the sari is

Unusual bleeding or discharge:

The most common is bleeding from the breasts, indicating breast

cancer. Breast cancer is not limited to women alone; 1% of breast
cancer cases reflect amongst men, they should be careful too.
Unusual bleeding or discharge from the bladder, vagina or rectum are
signs of colorectal, cervical or prostate cancer and must not be

Thickening or lump in breasts or elsewhere:

Lumps in breasts or the testicles point to breast and testicular cancer.

However, not all lumps may be cancerous. People are often
misguided that a lump if painless might not be malignant; however,
both painless and painful lumps are a cause of concern.

Indigestion or difficulty in swallowing:

 constant difficulty to swallow,

 have a jammed feeling in your throat
 constant bouts of indigestion,
 Feeling full without food or with a small amount of food

These are signs of mouth, oesophageal, stomach or throat cancer.

Obvious changes in warts or moles:

Moles that change in colour, size and appearance must be shown to a
specialist immediately. This symptomatic change is an indication of
skin cancer.

Nagging cough or persistent hoarseness:

Hoarseness in your voice can be caused by a number of reasons; if

persistent or if its stops and reappears for at least four weeks thus
developing a pattern, help must be sought. This could be an indicator
of lung or throat cancer.


Prognosis after cancer treatment depends upon final stage of the

lesion. Early stage will have excellent 5 years survival. Also the extent
of treatment of early disease will be limited and will be associated
with minimal deformity and compromise in function. Most of the time
single modality treatment is required - either surgery or radiation. But
question arises how to detect these lesions at early stage.
There are different methods available to detect cancer at early stage.
But, most important things are knowledge and awareness about the
signs and symptoms of different cancers. This does not apply only to
each individual and society but also to the health professionals and
paramedics. Almost 90-99% of cancer patients have a five-year
survival rate if cancer is detected at stages1 or 2.
There are methods available through which cancer can be detected
early. Clinical examination and screening mammogram for more than
50 years old ladies for breast cancer, pap smear for cervical cancer,
stool occult blood for colon cancer, etc. There is an urgent need for
public awareness about early signs and symptoms of cancer so that
cancer can be detected at early stage and life can be saved.

Further avoiding harmful habits such as unhealthy lifestyle,

consumption of tobacco and alcohol etc. can help in the prevention of

 MYTH: Cancer is a death sentence.

FACT: Not all cancers are malignant. Detection of cancer at an
early stage can give a five year survival rate. The five year
survival rate for all cancers combined is 67%.
 MYTH: Cancer is contagious.
FACT: Cancer is not contagious. However, some cancers are
caused by viruses and bacteria that can be spread from person
to person. It is important to remember that while the viruses
and bacteria that cause some cancers can be spread from
person to person, the cancers they cause cannot be spread from
person to person.
 MYTH: If you have a family history of cancer, you will get it too.
FACT: Although having a family history of cancer increases your
risk of developing the disease, it is not a complete prediction of
your future health. 4 out of 10 cancers can be prevented by
making simple lifestyle changes, such as forming healthy eating
habits, maintaining a healthy weight, exercising, limiting
alcoholic beverages, and avoiding tobacco products.
Additionally, if you have inherited certain cancer genes that put
you at high risk for cancer, your doctor may recommend surgery
or medications to reduce the chance that cancer will develop.
 MYTH: Cancer treatment is usually worse than the disease. FACT:
Although cancer treatments, such as chemotherapy and
radiation therapy, can cause unpleasant and sometimes serious
side effects, recent advances have resulted in many drugs and
radiation treatments that are much better tolerated than in the
past. As a result, symptoms like severe nausea and vomiting,
hair loss, and tissue damage are much less common. However,
managing side effects, also called palliative care, remains an
important part of cancer care. Palliative care can help a person
feel more comfortable at any stage of illness and help them to
have a better quality of life.
 MYTH: It is easier to remain unaware you have cancer.
FACT: You should not ignore the symptoms or signs of cancer,
such as a breast lump or an abnormal-looking mole. Although
the thought of having cancer is frightening, talking with your
doctor and getting a diagnosis will give you the power to make
informed choices and seek the best possible care. Because
treatment is usually more effective during the early stages of
cancer, an early diagnosis often improves a person’s chances of
 MYTH: My attitude will have an effect on my cancer.
FACT: There is no scientific evidence that a positive attitude will
prevent cancer, help people with cancer live longer, or keep
cancer from coming back. However, things that promote
positive thinking such as relaxation techniques, support groups,
and a strong network of family and friends may improve a
person’s quality of life and outlook.
 MYTH: Drug companies, the government, and the medical
establishment are hiding a cure for cancer.
FACT: No one is withholding a cure for cancer. The fact is, there
will not be a single cure for cancer. Hundreds of types of cancer
exist, and they respond differently to various types of
treatment. There is still much to learn, which is why clinical trials
continue to be essential for making progress in preventing,
diagnosing, and treating cancer.

 MYTH: Cancer thrives on sugar.

FACT: There is no conclusive evidence that proves eating sugar
will make cancer grow and spread more quickly. All cells in the
body, both healthy cells and cancer cells, depend on sugar to
grow and function. However, eating sugar won’t speed up the
growth of cancer, just as cutting out sugar completely won’t
slow down its growth.
 MYTH: ‘Acidic’ diets cause cancer.
FACT: It is true that cancer cells cannot live in an alkaline
environment, but neither can any of the cells in the body.
There’s no true evidence to prove that an alkaline diet has an
impact on cancer.
 MYTH: Cell phones cause cancer.
FACT: Cancer is caused by genetic mutations, and cell phones
emit a type of low-frequency energy that does not damage