Breast Cancer

K.V. Ramani, Hemalatha Ramani, Shirish Alurkar, B.S. Ajaikumar, Riri G. Trivedi

• Publisher: Momentum Press
• Year: 2017
• ISBN:
  9781946646217
• Topic: Medicina
• Subtopic: Oncología

A cancer prognosis has the tendency to knock patients and their family off their feet. Nothing can prepare people for the big "C" and it often feels like they are losing control over their own life, where nothing will be the same again. This book takes readers through the journey of Prema (diagnosed with breast cancer) and Prem (her caregiver) and covers the whole gamut of processes in cancer treatment and care in a simple language: diagnosis, medical treatment options, physical and psychosocial side effects, complementary therapies, and the importance of patient-centric care to improve the quality of life of breast cancer survivors. We hope future breast cancer patients and their families will benefit from our book and prepare themselves to face the challenges of dealing with breast cancer.

CHAPTER 1

Understanding Cancer

What is Cancer?

We often hear people say, “Fight cancer,” but not “Fight diabetes” or “Fight heart diseases.” Is there any specific reason to be afraid of cancer, as opposed to other diseases? Not really. Cancer is like any other chronic¹ disease (such as heart disease, respiratory disease, kidney failure, diabetes, and so on) with one major difference: Cancer is a disease of both the body and mind.

Cancer is a disease of the body because cancer is diagnosed when some cells in the body turn into cancerous cells. Medical treatment (a combination of surgery, chemotherapy, and radiotherapy) is necessary to kill the cancer cells and minimize their chance of recurrence. There is no other scientifically proven approach to kill cancer cells.

Cancer is also a disease of the mind. Emotional sufferings (such as fear of cancer) start in the mind and cascade through our body via stress responses in many forms (Rankin 2013).² Stress symptoms can affect the body (such as tiredness and sleeplessness), mood (such as anxiety and depression), and even behavior (such as angry outbursts and social withdrawal)³ and thereby affect the mind–body balance. Complementary therapies (like yoga and meditation) do help in recovering and establishing the mind–body balance. The old saying “State of the mind dictates the state of the body” cannot be better illustrated elsewhere.

The human body is made up of trillions of cells. Each cell contains 23 pairs of chromosomes in its nucleus, each pair having one chromosome from the father and one from the mother. Each chromosome contains hundreds to thousands of genes, made up of a chemical DNA. The Human Genome Project⁴ estimated about 25,000 protein-coded genes in our body. Proteins are required for the structure, function, and regulation of the body’s activities.

Cells form tissues, tissues form organs (heart, lungs, breasts etc.), and organs form organ systems (cardiovascular system, respiratory system, etc.). The process of cells forming tissues and tissues forming organs is the result of each cell growing in size and dividing into two identical cells, two cells into four identical cells, four cells into eight, and so on. The DNAs in each cell control the process of division and multiplication of cells into identical cells in a controlled manner.⁵

At times, some cells get “injured” (e.g., by chemicals in tobacco smoke). Each cell has the ability to repair the damages to the DNA before it divides and multiplies, but sometimes a cell’s ability to make these repairs fails. As the cell injuries, known as cell mutations,⁶ build up over time, some of the damaged cells become malignant⁷ and grow in an uncontrolled manner. Cancer therefore develops because of mutations (changes) that take place in an uncontrolled manner in a person’s DNA, the genetic blueprint.

Cancer is thus a complex disease and can be broadly classified into three categories:

i. Carcinomas are cancers that develop in epithelial cells.⁸ About 80 to 90 percent of cancers, mostly lung, breast, prostate, and bowel cancers are carcinomas.

ii. Sarcomas are cancers that develop in the connective tissues.⁹

iii. Leukemia and lymphomas are cancers that develop in the blood or lymphatic system.¹⁰

Mind–Body Connection

As mentioned earlier, cancer is a disease of the mind and body. Cancer and cancer treatments have an impact on the mind–body connection. The state of mind changes the state of the body by working through three important systems¹¹ in our body, namely, the endocrine system, the immune system, and the central nervous system.

The impact of mind–body connection is manifest in the form of physical side effects, emotional issues, and social problems. Physical side effects include loss of an organ, fatigue, pain, loss of appetite, loss of interest in sex, sleeping problems, and so on. Emotional issues include fear, worry, depression, anger, sadness, and anxiety. Social life changes include financial stress, workplace identity issues, stigma, and isolation. It is important to note that both the patients and their caregivers face emotional issues and social life changes during and even after treatment.

Cancer and its treatment are unique in that they impact the body, the mind, and thus, emotions. Coping with cancer is not about coping with the illness alone. The physical side effects are intrinsically interwoven/ linked to emotional, psychological, and social issues, which can show up even many years after treatment is completed.

Burden of Cancer

As per the World Health Organization (WHO) World Cancer Report 2014,¹² the number of new cancer cases globally has gone up from 10 million in 2008 to approximately 14 million new cases of cancer by 2012, and the number is projected to be around 20 million new cancer cases each year by 2025. The highest rates of new cancer cases per year are associated with high-income countries of North America and Western Europe, along with Japan, Australia, and New Zealand. However, the total number of cancer cases is high in Asia, Africa, and Central and South America; these countries have large population and probably cancer is typically diagnosed at more advanced stages of the disease.

Almost 90 to 95 percent of all cancer cases can be attributed to the environment and lifestyle;¹³ lifestyle factors include cigarette smoking, diet (fried foods, red meat), alcohol, sun exposure, environmental pollutants, infections, stress, obesity, and physical inactivity. Cancers are age related,¹⁴ much more frequent in the old than in the young. As per a recent study by the National Cancer Institute¹⁵ of the National Institutes of Health, U.S.A., about 50 percent of all new cancer cases (all cancer sites) are diagnosed in the age group 55 to 74 years. This phenomenon may change over a period of time as a result of changes in lifestyle.

The economic burden of cancer is very significant. The economic burden has two components, namely, direct costs and indirect costs. Direct costs include hospitalizations, consultations, surgery, chemotherapy, radiotherapy, and prescription drugs. The Agency for Healthcare Research and Quality (AHRQ),¹⁶ American Cancer Society, estimated that the direct medical cost (total of all health care cost) for cancer in the United States in 2011 was $88.7 billion. About 50 percent of the cost is for hospital outpatient or doctor office visits, 35 percent of the cost is for inpatient hospital stays, and 11 percent of the cost is for prescription drugs. Indirect costs are associated with the impact of the disease on the patient, caregivers, and the society. The national economy suffers from productivity loss through lost wages of the patients and their caregivers, as well as from premature deaths. As per the WHO fact sheet on cancer, an estimated 169.3 million years of healthy life were lost globally in 2008. It is important to realize that the economic cost of cancer in developing countries will be much higher due to the higher number of cancer patients and delayed diagnosis.

Cancer Prevention

Cancer prevention is action taken to lower the chance of getting cancer. In addition to the physical problems and emotional distress caused by cancer, the high costs of care are also a burden to patients, their families, and to the public. By preventing cancer, the number of new cases of cancer is lowered. Hopefully, this will reduce the burden of cancer and low...