Know about cancer diseases details

What Is Cancer?

Cancer is the general name for a group of more than 100 diseases. Although there are many kinds of cancer, all cancers start because abnormal cells grow out of control. Untreated cancers can cause serious illness and death.

Normal cells in the body

The body is made up of trillions of living cells. Normal body cells grow, divide to make new cells, and die in an orderly way. During the early years of a person’s life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries.

How cancer starts

Cancer starts when cells in a part of the body start to grow out of control. Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues, something that normal cells can’t do. Growing out of control and invading other tissues are what makes a cell a cancer cell.

Cells become cancer cells because of DNA (deoxyribonucleic acid) damage. DNA is in every cell and it directs all its actions. In a normal cell, when DNA is damaged the cell either repairs the damage or dies. In cancer cells, the damaged DNA is not repaired, but the cell doesn’t die like it should. Instead, the cell goes on making new cells that the body doesn’t need. These new cells all have the same damaged DNA as the first abnormal cell does.

People can inherit abnormal DNA (it’s passed on from their parents), but most often DNA damage is caused by mistakes that happen while the normal cell is reproducing or by something in the environment. Sometimes the cause of the DNA damage may be something obvious like cigarette smoking or sun exposure. But it’s rare to know exactly what caused any one person’s cancer.

In most cases, the cancer cells form a tumor. Over time, the tumors can replace normal tissue, crowd it, or push it aside. Some cancers, like leukemia, rarely form tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow.

Origins of Cancer

All cancers begin in cells, the body's basic unit of life. To understand cancer, it's helpful to know what happens when normal cells become cancer cells.
The body is made up of many types of cells. These cells grow and divide in a controlled way to produce more cells as they are needed to keep the body healthy. When cells become old or damaged, they die and are replaced with new cells.
However, sometimes this orderly process goes wrong. The genetic material (DNA) of a cell can become damaged or changed, producing mutations that affect normal cell growth and division. When this happens, cells do not die when they should and new cells form when the body does not need them. The extra cells may form a mass of tissue called a tumor.

Not all tumors are cancerous; tumors can be benign or malignant.

• Benign tumors aren't cancerous. They can often be removed, and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body.
• Malignant tumors are cancerous. Cells in these tumors can invade nearby tissues and spread to other parts of the body. The spread of cancer from one part of the body to another is called metastasis.

Some cancers do not form tumors. For example, leukemia is a cancer of the bone marrow and blood.

How cancer spreads

Cancer cells often travel to other parts of the body where they can grow and form new tumors. This happens when the cancer cells get into the body’s bloodstream or lymph vessels. The process of cancer spreading is called metastasis.

No matter where a cancer may spread, it’s always named based on the place where it started. For example, colon cancer that has spread to the liver is called metastatic colon cancer, not liver cancer. In this case, cancer cells taken from the liver would be the same as those in the colon. They would be treated in the same ways too.

How cancers differ

Different types of cancer can behave very differently. For instance, lung cancer and skin cancer are very different diseases. They grow at different rates and respond to different treatments. This is why people with cancer need treatment that’s aimed at their kind of cancer.

Tumors that are not cancer

A tumor is an abnormal lump or collection of cells, but not all tumors are cancer. Tumors that are n’t cancer are called benign. Benign tumors can cause problems – they can grow very large and press on healthy organs and tissues. But they can’t grow into (invade) other tissues. Because they can’t invade, they also can’t spread to other parts of the body (metastasize). These tumors are seldom life threatening. 

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Side effects of asthma treatments

Side effects of relievers and presenters

Relievers are a safe and effective medicine and have few side effects, as long as they are not used too much. The main side effects include a mild shaking of the hands, headache and muscle cramps. These usually only happen with high doses of reliever inhaler and usually only last for a few minutes.

Presenters are very safe at usual doses, although they can cause a range of side effects at high doses, especially over long-term use. The main side effect of presenter inhalers is a fungal infection (oral candidacies) of the mouth or throat. You may also develop a hoarse voice. Using a spacer can help prevent these side effects. Also, rinse your mouth or clean your teeth after taking your presenter inhaler.

Your doctor or nurse will discuss with you the need to balance control of your asthma with the risk of side effects, and how to keep side effects to a minimum.

Side effects of add on therapy

Long-acting relievers may cause similar side effects to short-acting relievers, including a mild shaking of the hands, headache and muscle cramps. Your GP can discuss the risks and benefits of this drug with you. You should be monitored at the beginning of your treatment and reviewed regularly. If you find there is no benefit to using the long-acting reliever, it should be stopped.

Theophylline tablets have been known to cause side effects in some people, including headaches, nausea, insomnia, vomiting, irritability and stomach upsets. These can usually be avoided by adjusting the dose.

Leukotriene receptor agonists do not generally cause side effects, although there have been reports of stomach upsets, feeling thirsty and headache.

Side effects of steroid tablets

Oral steroids carry a risk if they are taken for more than three months or if they are taken frequently (three or four courses of steroids a year). Side effects can include:

• osteoporosis (fragile bones)  
• high blood pressure (hypertension)  
• diabetes 
• weight gain  
• cataracts and glaucoma (eye disorders)  
• thinning of the skin  
• easy bruising  
• muscle weakness

To minimize the risk of taking oral steroids:

• Eat a healthy, balanced diet with plenty of calcium. 
• Maintain a healthy body weight. 
• Stop smoking (if you smoke). 
• Do regular exercise.

You will also need regular appointments to check for high blood pressure, diabetes and osteoporosis.

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Do you know asthma treatment? All treatment of asthma patients

Personal asthma action plan

As part of your initial assessment, you should be encouraged to draw up a personal asthma action plan with your GP or asthma nurse. If you have been admitted to hospital because of an asthma attack, you should be offered an action plan (or the opportunity to review an existing action plan) before you go home.

The action plan should include information about your asthma medicines and will help you recognize when your symptoms are getting worse and what steps to take. You should also be given information about what to do if you have an asthma attack.

Your personal asthma action plan should be reviewed with your GP or asthma nurse at least once a year, or more frequently if your symptoms are severe.

As part of your asthma plan, you may be given a peak flow meter. This will give you another way of monitoring your asthma, rather than relying only on symptoms.

Taking asthma medicines

Inhalers

Asthma medicines are usually given by inhalers, which are devices that deliver the drug directly into the airways through your mouth when you breathe in. Inhaling a drug is an effective way of taking an asthma medicine as it goes straight to the lungs, with very little ending up elsewhere in the body. However, each inhaler works in a slightly different way. You should have training from your GP or nurse in how to use your device. This should be checked at least once a year.

Spacers

Some inhalers emit an aerosol jet when pressed. These work better if given through a spacer, which can increase the amount of medication that reaches the lungs and reduces the side effects. Some people find using inhalers difficult, and spacers can help them. However, spacers are often advised even for people who use inhalers well as they improve the distribution of medication in the lungs. Spacers are plastic or metal containers with a mouthpiece at one end and a hole for the inhaler at the other. The medicine is 'puffed' into the spacer by the inhaler and then breathed in through the spacer mouthpiece. Spacers are also good for reducing the risk of thrush in the mouth or throat, which can be a side effect of inhaled asthma medicines.

Reliever inhalers

Reliever inhalers are taken to relieve asthma symptoms quickly. The inhaler usually contains a medicine called a short-acting beta2-agonist. It works by relaxing the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again. Examples of reliever medicines include salbutamol and terbutaline. They are generally safe medicines with few side effects, unless over used. However, they should rarely be necessary if asthma is well controlled, and anyone needing to use them three or more times a week should have their treatment reviewed.

Everyone with asthma should be given a reliever inhaler, also known simply as a reliever. It is often blue.

Preventer inhalers

Preventer inhalers work over time to reduce the amount of inflammation and 'twitchiness' in the airways and prevent asthma attacks occurring. You will need to use the preventer inhaler daily for some time before you gain the full benefit. You may still occasionally need the reliever inhaler (usually blue) to relieve symptoms, but if you continue to need them often, your treatment should be reviewed.

The preventer inhaler usually contains a medicine called an inhaled corticosteroid. Examples of preventer medicines include beclometasone, budesonide, fluticasone and mometasone. Preventer inhalers are often brown, red or orange.

Preventer treatment is normally recommended if you:

• have asthma symptoms more than twice a week
• wake up once a week due to asthma symptoms
• have to use a reliever inhaler more than twice a week

Smoking can reduce the effects of preventer inhalers.

Inhaled corticosteroids can occasionally cause a mild fungal infection (oral thrush) in the mouth and throat, so rinse your mouth thoroughly after inhaling a dose. For more information on side effects, see below.

Other treatments and 'add on' therapy

Long-acting reliever inhaler

If your asthma does not respond to treatment, the dose of preventer inhaler can be increased in discussion with your healthcare team. If this does not control your asthma symptoms, you may be given an inhaler containing a medicine called a long-acting reliever (long-acting bronchodilator/long acting beta2-agonist or LABA) to take as well. Or you may be given an inhaler combining an inhaled steroid and a long-acting bronchodilator in the one device, called a 'combination' inhaler. These work in the same way as short-acting relievers, but they take longer to work and can last up to 12 hours. Examples of long-acting reliever inhalers include formoterol and salmeterol

Only use your long-acting reliever inhaler in combination with the preventer inhaler and never by itself. Studies have shown that using only a long-acting reliever can increase the chance of an asthma attack and can even increase the risk of death. Examples of combination inhalers include Seretide, Symbicort and Fostair. These are usually purple, red and white, or maroon.

Preventer medicines

If treatment of your asthma is still not successful, additional preventer medicines will be tried. Two possible alternatives include:

• leukotriene receptor antagonists (montelukast): tablets that block part of the chemical reaction involved in inflammation of the airways
• theophyllines: tablets that help widen the airways by relaxing the muscles around them

If your asthma is still not under control, you may be prescribed regular oral steroids (steroid tablets). This treatment is usually monitored by a respiratory specialist (a specialist in asthma). Long-term use of oral steroids has possible serious side effects, so they are only used once other treatment options have been tried. See below for more information on the side effects of steroid tablets.

Occasional use of oral steroids

Most people only need to take a course of oral steroids for one or two weeks. Once your asthma is under control, you can be 'stepped-down' to your previous treatment.

Omalizumab (Xolair)

Omalizumab, also known as Xolair, is the first of a new category of drugs. It binds to one of the proteins involved in the immune response and reduces its level in the blood. This reduces the chance of an immune reaction happening. The National Institute for Heath and Clinical Excellence (NICE) recommends that omalizumab can be used in people with frequent severe asthma attacks which require visits to A&E or hospital admission.

Omalizumab is given as an injection every two to four weeks. It should only be prescribed in a specialist centre. If omalizumab does not control asthma symptoms within 16 weeks, the treatment should be stopped.

Bronchial thermoplasty

Bronchial thermoplasty is a relatively new procedure not yet widely available. In some cases it may be used to treat severe asthma by reducing airway narrowing.

The procedure is carried out either with sedation or under general anesthetic. A bronchoscope (a type of hollow tube) containing a probe is inserted through the mouth or nose into the airway and expanded so it touches the airway wall and heated. Three treatment sessions are usually needed with at least three weeks between each session.

There is some evidence to show this procedure may reduce asthma attacks and improve the quality of life of someone with severe asthma. However, the long-term risks and benefits are not yet fully known.

You should discuss this procedure fully with your clinician if the treatment is offered.

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What causes asthma, common triggers, treating asthma, diagnosing asthma

What causes asthma?

The cause of asthma is not fully understood, although it is known to run in families. You are more likely to have asthma if one or both of your parents has the condition.

Common triggers

A trigger is anything that irritates the airways and brings on the symptoms of asthma. These differ from person to person and people with asthma may have several triggers.

Common triggers include house dust mites, animal fur, pollen, tobacco smoke, exercise, cold air and chest infections.

Read more about the causes of asthma.

Asthma can also be made worse by certain activities, such as work. For example, some nurses develop asthma symptoms after exposure to latex. This is often referred to as work-related asthma or occupational asthma.  

Treating asthma

While there is no cure for asthma, there are a number of treatments that can help effectively control the condition. Treatment is based on two important goals:

• relieving symptoms 
• preventing future symptoms and attacks from developing

Treatment and prevention involves a combination of medicines, lifestyle advice and identifying and then avoiding potential asthma triggers.

Read more about living with asthma.

Who is affected?

In the UK, 5.4 million people are currently receiving treatment for asthma. That is 1 in every 12 adults and 1 in every 11 children. Asthma in adults is more common in women than men.

Symptoms of asthma

The symptoms of asthma can range from mild to severe. When asthma symptoms get significantly worse, it is known as an asthma attack.

The symptoms of asthma include:

• feeling breathless (you may gasp for breath)
• a tight chest, like a band tightening around it 
• wheezing, which makes a whistling sound when you breathe
• coughing, particularly at night and early morning
• attacks triggered by exercise, exposure to allergens and other triggers

You may experience one or more of these symptoms. Symptoms that are worse during the night or with exercise can mean your asthma is getting worse. Talk to your doctor or asthma nurse about this.

Asthma attack

A severe asthma attack usually develops slowly, taking 6 to 48 hours to become serious. However, for some people, asthma symptoms can get worse quickly.

As well as symptoms getting worse, signs of an asthma attack include:

• you get more wheezy, tight-cheated or breathless
• the reliever inhaler is not helping as much as usual
• there is a drop in your peak expiratory flow (see diagnosing asthma for more information)

If you notice these signs, do not ignore them. Contact your GP or asthma clinic or consult your asthma action plan, if you have one.

Signs of a severe asthma attack include:

• the reliever inhaler, which is usually blue, does not help symptoms at all
• the symptoms of wheezing, coughing, tight chest are severe and constant
• you are too breathless to speak
• your pulse is racing
• you feel agitated or restless
• your lips or fingernails look blue

Causes of asthma

There is no single cause of asthma, but certain things may increase the likelihood of developing it. These include genetics and the environment.

Who is at risk of developing asthma?

Things known to increase the likelihood of developing asthma include:

• a family history of asthma or other related allergic conditions (known as atopic conditions), such as eczema, food allergy or hay fever 
• developing another atopic condition such as a food allergy
• having bronchiolitis as a child (a common lung infection among children) 
• being exposed to tobacco smoke as a child, particularly if your mother smoked during pregnancy 
• being born prematurely (especially if you needed a ventilator) 
• being born with a low birth weight (less than 2kg or 4.5 pounds)

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Asthma triggers

The symptoms of asthma can have a range of triggers, but they do not affect everyone in the same way. Once you know your asthma triggers, you can try to avoid them.

Triggers include:

• Airway and chest infections. Upper respiratory infections, which affect the upper airways, are often caused by cold and flu viruses and are a common trigger of asthma. 
• Allergens. Pollen, dust mites, animal fur or feathers, for example, can trigger asthma.
• Airborne irritants. Cigarette smoke, chemical fumes and atmospheric pollution may trigger asthma.
• Medicines. The class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen, can trigger asthma for some people, although are fine for most. Children under 16 years of age should not be given aspirin. 
• Emotional factors. Asthma can be triggered by emotional factors, such as stress or laughing.
• Foods containing sulphites. Sulphites are naturally occurring substances found in some food and drink. They are also sometimes used as a food preservative. Food and drinks high in sulphites include concentrated fruit juice, jam, prawns and many processed or pre-cooked meals. Most people with asthma do not have this trigger, but some may. Certain wines can also trigger asthma in susceptible people.
• Weather conditions. A sudden change in temperature, cold air, windy days, poor air quality and hot, humid days are all known triggers for asthma.
• Indoor conditions. Mould or damp, house dust mites and chemicals in carpets and flooring materials may trigger asthma.
• Exercise. Sometimes, people with asthma find their symptoms are worse when they exercise.
• Food allergies. Although uncommon, some people may have allergies to nuts or other food items, known as an anaphylactic reaction. If so, these can trigger severe asthma attacks.

What happens during an asthma attack?

During an asthma attack:

• the bands of muscles around the airways tighten
• there is increased inflammation in the linings of the airways, which swell
• the airways produce sticky mucus or phlegm, which can further narrow the airways

The passages of the airways narrow, making it more difficult for the air to pass through and, therefore, more difficult to breathe. This can cause the characteristic wheezy noise, although not everyone with asthma will wheeze. In a life-threatening attack, there may not be a wheezy sound.

An asthma attack can happen at any time. However there are usually warning signs for a couple of days before. These include symptoms getting worse, especially during the night, and needing to use the reliever inhaler more and more.

If you or someone else is having a severe asthma attack and cannot breathe, dial 999 immediately for emergency medical treatment.

Diagnosing asthma

If you have typical asthma symptoms, your GP is likely to be able to make a diagnosis. Your GP will want to know when your symptoms happen and how often, and if you have noticed anything that might trigger them.

A number of tests can be carried out to confirm the diagnosis.

Spirometry

A breathing test called spirometry is carried out to assess how well your lungs work. You will be asked to breathe into a machine called a spirometer.

The spirometer takes two measurements: the volume of air you can breathe out in one second (called the forced expiratory volume in one second or FEV1) and the total amount of air you breathe out (called the forced vital capacity or FVC).

You may be asked to breathe out a few times to get a consistent reading.

The readings are compared with normal measurements for your age, which can show if your airways are obstructed.

Sometimes an initial set of measurements is taken, then you are given a medicine to open up your airways (a reliever inhaler) to see if this improves your breathing. Another reading is taken and, if it is much higher after taking the medicine, this can support the diagnosis.

Peak expiratory flow rate test

A small hand-held device known as a peak flow meter can be used to measure how fast you can blow air out of your lungs in one breath. This is your peak expiratory flow rate (PEFR), and the test is usually called a peak flow test.

You may be given a peak flow meter to take home and a diary to record measurements of your peak flow. Your diary may also have a space to record your symptoms. This will help you recognize when your asthma is getting worse.

Other tests

Some people, but not all, may need more tests. The tests may confirm the diagnosis of asthma or help diagnose a different condition. This will help you and your doctor plan your treatment.

Airway responsiveness tests

This test is used to see how your airways react when they come into contact with a trigger. You will be asked to take a mannitol challenge test which involves breathing in increasing amounts of a dry powder. This deliberately triggers asthma symptoms and cause the airways to narrow. In children, exercise is sometimes used as a trigger.

You then blow into the spriometer to measure how much your FEV1 and FVC have changed in response to breathing in the trigger. If there is a significant decrease in these measurements, you may have asthma.

Testing airway inflammation

• Phlegm sample. The doctor may take a sample of phlegm to check whether you have inflammation in the lungs.
• Nitric oxide concentration. As you breathe out, the level of nitric oxide in your breath is measured. A high level of nitric oxide can be a sign of airway      inflammation.

Allergy tests

Skin testing or a blood test can be helpful to confirm whether your asthma is associated with specific allergies, for example to dust mites, pollen or foods.

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What is asthma, symptoms of asthma, Causes of asthma

Introduction

Asthma is a common long-term condition that can cause a cough, wheezing and breathlessness. The severity of the symptoms varies from person to person. Asthma can be controlled well in most people most of the time.

What is asthma?

Asthma is caused by inflammation of the airways. These are the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal.

When you come into contact with something that irritates your lungs, known as a trigger (see below), your airways become narrow, the muscles around them tighten and there is an increase in the production of sticky mucus (phlegm). This leads to symptoms including:

• difficulty breathing
• wheezing and coughing
• a tight chest

More about the symptoms of asthma

The symptoms of asthma can range from mild to severe. Most people will only experience occasional symptoms, although a few people will have problems most of the time.

The main symptoms of asthma are:

• wheezing (a whistling sound when you breathe)
• shortness of breath
• a tight chest – which may feel like a band is tightening around it 
• coughing

These symptoms are often worst at night and early in the morning, particularly if the condition is not well controlled. They may also develop or become worse in response to a certain trigger, such as exercise or exposure to an allergen. Read our page on the causes of asthma for more information about potential triggers.

Speak to your GP if you think you or your child may have asthma. You should also talk to your doctor or asthma nurse if you have been diagnosed with asthma and you are finding it difficult to control the symptoms.

Causes of asthma

It's not clear exactly what causes asthma, although it is likely to be a combination of factors.

Some of these may be genetic. However, a number of environmental factors are thought to play a role in the development of asthma – these include air pollution, chlorine in swimming pools and modern hygiene standards (known as the "hygiene hypothesis").

There is currently not enough evidence to be certain whether any of these can cause asthma, although a variety of environmental irritants such as dust, cold air and smoke may make it worse.

Who is at risk?

Although the cause of asthma is unknown, a number of things that can increase your chances of developing the condition have been identified. These include:

• having a family history of asthma or other related allergic conditions (known as atopic conditions) – such as eczema, food allergy or hay fever
• having another atopic condition yourself
• having bronchiolitis (a common childhood lung infection) as a child
• being exposed to tobacco smoke as a child – particularly if your mother also smoked during pregnancy 
• being born prematurely – especially if you needed a ventilator to support your breathing after birth

having a low birth weight as a result of restricted growth within the womb

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