Cancer (medicine)

I

Introduction

Cancer (medicine), any of more than 100 diseases characterized by excessive, uncontrolled growth of abnormal cells, which invade and destroy other tissues. Cancer develops in almost any organ or tissue of the body, but certain types of cancer are more life-threatening than others. In the United States and Canada cancer ranks as the second leading cause of death, exceeded only by heart disease. Each year, about 1.7 million Americans and more than 150,000 Canadians are diagnosed with cancer, and more than half a million Americans and about 70,000 Canadians die of the disease.

For reasons not well understood, cancer rates vary by gender, race, and geographic region. For instance, more men than women develop cancer, and African Americans are more likely to develop cancer than people of any other racial group in North America. The frequency of certain cancers also varies globally. For example, breast cancer is more common in wealthy countries, and cervical cancer is more common in poor countries.

Although people of all ages develop cancer, most types of cancer are more common in people over the age of 50. Cancer usually develops gradually over many years, the result of a complex mix of environmental, nutritional, behavioral, and hereditary factors. Scientists do not completely understand the causes of cancer, but they know that certain lifestyle choices can reduce the risk of developing many types of cancer. Not smoking, eating a healthy diet, and exercising moderately for at least 30 minutes each day can lower the likelihood of developing cancer.

Just 60 years ago a cancer diagnosis carried little hope for survival because doctors understood little about the disease and how to control it. Today about two-thirds of all Americans diagnosed with cancer live longer than five years. While it is difficult to claim that a cancer patient is disease free, long-term survival significantly improves if the patient has had no recurrence of the cancer for five years after the initial diagnosis. For years, death rates from cancer were rising in developing countries. In 2006 the American Cancer Society reported that the number of cancer deaths in the United States dropped for two years in a row. The decrease was attributed to a decline in smoking, earlier detection, and improved treatment.

---

---

The National Cancer Institute of the United States (NCI) estimates that more than 10 million Americans are living with cancer or have been cured of the disease thanks largely to advances in detecting cancers earlier. The sooner cancer is found and treated, the better a person’s chance for survival. In addition, advances in the fundamental understanding of how cancer develops have reduced deaths caused by certain cancers and hold promise for new and better treatments.

II

How Cancer Develops

A healthy human body is composed of 30 trillion cells, most of which are in constant turnover as cells die and others reproduce to replace them in an orderly fashion. Healthy cells of the skin, hair, lining of the stomach, and blood, for example, regularly reproduce by dividing to form two daughter cells (see Mitosis). This cell division cycle proceeds under the regulation of the body’s intricately tuned control system. Among other functions, this control system ensures that cells only divide when needed, so that organs and tissues maintain their correct shape and size. Should this system fail, a variety of backup safety mechanisms prevent the cell from dividing uncontrollably. In order for a cell to become cancerous, every one of these safety mechanisms must fail.

Cancer begins in genes, bits of biochemical instructions composed of individual segments of the long, coiled molecule deoxyribonucleic acid (DNA). Genes contain the instructions to make proteins, molecular laborers that serve as building blocks of cells, control chemical reactions, or transport materials to and from cells. The proteins produced in a human cell determine the function of each cell, and ultimately, the function of the entire body.

In a cancerous cell, permanent gene alterations, or mutations, cause the cell to malfunction. For a cell to become cancerous, usually three to seven different mutations must occur in a single cell. These genetic mutations may take many years to accumulate, but the convergence of mutations enables the cell to become cancerous.

A

Safety Systems Fail

While each human cell performs its own specialized function, it also exerts influence on the cells around it. Cells communicate with one another via receptors, protein molecules on the cell surface. A cell releases chemical messages, which fit into the surface receptors of cells nearby, much as a key fits into a lock. A cell may instruct other cells in its neighborhood to divide, for example, by releasing a growth-promoting signal, or growth factor. The growth factor binds to receptors on adjacent cells, activating a message within each individual cell. This message travels to the nucleus, where a cell’s genes are located.

A

1

Proto-Oncogenes Become Oncogenes

When the growth factor message reaches the cell nucleus, it activates genes called proto-oncogenes. These genes produce proteins that stimulate the cell to divide. In cancerous cells, mutations in proto-oncogenes cause these genes to malfunction. When a proto-oncogene mutates, it becomes an oncogene—a gene that instructs the cell to grow and divide repeatedly without stimulation from neighboring cells. Some oncogenes overproduce growth factors, causing the cell to divide too often. Other oncogenes stimulate the cell to reproduce even when no growth factor is present. Cancer researchers have identified about 100 different types of proto-oncogenes and their cancer-causing oncogene counterparts.