What Is Cancer?

Despite the dramatic events that were transpiring, it still never occurred to me that she would have cancer. In fact, even after I found out about this in the United States, I didn’t completely comprehend what it meant; I was only seven years old. I knew that cancer was an infamous deadly disease, but I didn’t have any idea of what it actually was and what caused it to be lethal. I also didn’t know what chemotherapy was and how it was used to treat the disease. But I wasn’t alone in this, even my parents didn’t understand chemo until the doctors explained it to them before the treatment began. One of the most crucial things when dealing with any calamity is being able to recognize and understand its nature or behavior in order to come up with the best solutions for dealing with it. The same applies for cancer; it is extremely difficult to cope with the disease without knowing what it actually is and how it causes damage to the body. When a person sees their child or sibling constantly under drugs and injections for months without knowing how they help, it causes self distress and a sense of powerlessness. Gaining knowledge on the disease makes things easier for the patient and their family as it makes them aware of what is happening and what to expect. Specific details of the disease will be mentioned to help understand what Cancer is in general and what my sister’s disease (Lymphoma) was in hopes that less people will be placed in the position of oblivion I was in.

Cancer is when abnormal cells grow and divide in an uncontrollable manner. It can start from a single cell that multiplies to billions of cancerous cells. The reason that a cell may become abnormal is related to its genetic composition. Our bodies contain more than a hundred trillion (100,000,000,000,000) cells that continuously divide. Each cell produces signals to control how much and how often they divide. If any of these signals are erroneous or missing, cells may start to grow and multiply too fast and form a lump which we identify as a "tumor". For such errors to occur and cause a cancer, certain changes in the genes of a cell take place. Every cell in our body has a nucleus that contains chromosomes made up of DNA. DNA contains thousands of genes (coded messages) that control how the cell behaves. They make sure that cells grow and divide in a controlled way. On very rare occasions, a change in the genes occurs during division. Known as a mutation, this change can mean that a gene has been damaged, lost, or copied twice. It causes the cell to misinterpret the instructions and start going out of control. Mutations in particular genes could mean that too many proteins that trigger a cell to divide are produced, or proteins that normally tell a cell to stop dividing may not be produced. Before a normal cell turns into a cancerous cell, there usually needs to be at least half a dozen mutations in that cell. Mutations occur by chance, but there are risk factors that increase its likelihood such as the chemicals found in tobacco. Some mutations can also be inherited, which explains why family members with a history of cancer are at a higher risk of developing it.

Once a cell becomes cancerous, it will not stop dividing and starts forming a malignant tumor (not to be confused with benign tumors, which do not attack nearby cells). If left untreated, the tumor begins to spread into nearby tissues, and then to other body organs in a process called metastasis. What makes cancer cells lethal is that the tumors disrupt the function of organs, leading to organ failure, and feed on our own cells. Since cancer cells are ultimately our own body cells, the immune system has difficulty in differentiating them from normal cells, which is why they are very hard to get rid of and many side effects come as a result of treatment due to collateral damage to our normal body cells. This is why doctors urge people to regularly have their bodies tested for early detection because it is easier to eliminate the tumor before it spreads. A good analogy of this is dropping ink (tumor) on water (normal cells) and trying to extract it. When you pull the ink off immediately after it is dropped, a little water will come off with it as “collateral damage”. But when you wait and the ink spreads, it will be almost impossible to get rid of it. Cancers become very detrimental once they reach Stage IV (metastasis) and spread to other parts of the body, during which it becomes very difficult to cure them but not impossible.

Doctors use a number system to categorize the “stage” of the cancer based on how big it is and how far it has spread. I had a hard time understanding what doctors meant when they said “Stage I” or “Stage II” cancer, but they were referring to the following number staging system:

Stage I means that a cancer is relatively small and contained within the organ it started in.

Stage II means the cancer has not started to spread into surrounding tissue but the tumor is larger than in stage I. Sometimes stage II means that cancer cells have spread into lymph nodes close to the tumor. Lymph nodes are responsible for the production of lymphocytes, a type of white blood cells that fight against harmful objects in the body.

Stage III means the cancer is larger. It may have started to spread into surrounding tissues and there are cancer cells in the lymph nodes in the area.

Stage IV means the cancer has spread from where it started to another body organ. This is also called secondary or metastatic cancer.

There are numerous types of cancer, but they are generally classified into five main group categories according to the type of cell they start in:

Carcinoma – cancer that begins in the skin or in tissues that line or cover internal organs.

Sarcoma – cancer that begins in the connective or supportive tissues such as bone, cartilage, fat, muscle, or blood vessels

Leukaemia – cancer that starts in blood forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and go into the bloodstream

Lymphoma and myeloma –-cancers that begin in the cells of the immune systems (Lymphoma-lymphocytes; Myeloma-plasma cells)

Brain and spinal cord cancers – these are known as central nervous system cancers

Dalal’s cancer was a subcategory of Lymphoma known as T-cell Non-Hodgkin’s Lymphoma. This means that the T-cells were the ones affected. Our bodies have two types of lymphocytes (immune system cells), which are Bone marrow lymphocytes (B-cells) and Thyroid lymphocytes (T-cells). B-cells are responsible for humoral immunity, also known as antibody mediated immunity (AMI). This type of immunity defends against viruses and bacteria that enter the blood and lymph by releasing antibodies. On the other hand, T-cells are responsible for cell mediated immunity. This type of immunity does not involve the release of antibodies and defends against pathogens including protists and fungi that enter the cells. The reason why Dalal’s cancer was Non-Hodgkin’s is because all Hodgkin’s lymphomas have a type of cell called a Reed Sternberg cell. This is a relatively giant cell that may contain more than one nucleus and is only found in patients with Hodgkin’s Lymphoma. Once a cancer is identified and diagnosed by an oncologist, the type of therapy the patient receives is then determined.