Various factors have been identified that are known to cause the changes in cell DNA. These include lifestyle factors such as tobacco use, diet, and physical inactivity; certain types of infections; environmental exposures to different types of chemicals and radiation and genetic factors.

Tobacco use: Tobacco use in any form is very harmful. On a lighter note, one has the freedom to choose the type of cancer he or she wants. If one preffers lung cancer, smoking is the best option, if oral and throat cancer is needed one can chew tobacco regularly. Pipes, Cigars, beedis, shisha, Hans, shanku etc are all different models of vehicles waiting to pull you on a dangerous journey, away from life.

Smoking: Smoking is the most important preventable cause of cancer in the world. Giving up smoking completely is the best thing you can do for your health.

How does smoking cigarettes causes cancer? : Tobacco smoke contains as many as 400 different chemicals that damage your cells’ DNA. these chemicals interfear with bodys normal immune and prevent to functions. The Poisonous in products of tobacco damages lung and urinary bladder and causes Cell changes leading to Cancer. This is why smoking causes so many diseases, including at least 14 types of cancer, heart disease and various lung diseases.

The main way that smoking causes cancer is by damaging our DNA, including key genes that protect us against cancer. Many of the chemicals found in cigarettes have been shown to cause DNA damage, including benzene, polonium-210, benzo (a) pyrene and nitrosamines.

This is already bad news, but it’s made worse by other chemicals in cigarettes. For example chromium makes poisons like benzo (a) pyrene stick more strongly to DNA, increasing the chances of serious damage. And chemicals like arsenic and nickel interfere with pathways for repairing damaged DNA. This makes it even more likely that damaged cells will eventually turn cancerous.

How does smoking weaken the body’s defences? Smokers are also less able to handle toxic chemicals than those with healthy lungs and blood.

We all have special cleaner proteins called ‘detoxification enzymes’ that mop up harmful chemicals and convert them into harmless ones. But the chemicals in smoke, such as cadmium, can overwhelm these cleaners.

Other chemicals like formaldehyde and acrolein kill cilia, the small hairs that clean toxins from your airways.

Cigarette smoke also impacts the immune system – increasing cells which can encourage tumour growth in the lungs and suppressing the ones which kill cancer cells.

How long does it take for smoking to cause cancer? It usually takes many years, or decades, for the DNA damage from smoking to cause cancer. Our bodies are designed to deal with a bit of damage but it’s hard for the body to cope with the number of harmful chemicals in tobacco smoke.

Each cigarette can damage DNA in many lung cells, but it is the build-up of damage in the same cell that can lead to cancer. However research has shown that for every 15 cigarettes smoked there is a DNA change which could cause a cell to become cancerous. This is why it’s better to give up smoking sooner rather than later.

Hence, one should not take pride in smoking for several years just because he is currently not the victim of his habit.

Why is smoking so addictive? Smoking is very addictive because tobacco contains a powerful drug called nicotine. Cigarettes are deliberately designed to give you a fast nicotine hit. It takes less than 20 seconds for the drug to reach your brain from inhaled cigarette smoke.

Nicotine causes addiction in much the same way as heroin or cocaine. It is just as addictive as these ‘harder’ drugs.

This is the reason why most smokers say they want to quit but find it so difficult. If you start smoking, you may find it very hard to stop later on.

Passive smoking : Breathing in other people's smoke, also called second-hand smoke, can cause cancer. Passive smoking can increase a non-smoker's risk of getting lung cancer by a quarter, and may also increase the risk of cancers of the larynx (voice box) and pharynx (upper throat).

Second-hand smoke can cause other health problems too, including heart disease, stroke and breathing problems.

Does second-hand smoke contain dangerous chemicals?

There are 2 types of tobacco smoke:

• Mainstream smoke, which is directly inhaled through the mouth end of the cigarette.
• Sidestream smoke, which comes from the burning tip of the cigarette.

Second-hand smoke is made up of side stream smoke and exhaled mainstream smoke, mixed with the surrounding air.

Sidestream smoke is about 4 times more toxic than mainstream smoke, although people inhale it in a more diluted form. This is because side stream smoke contains much higher levels of many of the poisons and cancer-causing chemicals in cigarettes, including:

• At least 3 times as much carbon monoxide
• 10-30 times more nitrosamines
• Between 15–300 times more ammonia

How does second-hand smoke affect children?
Second-hand smoke is particularly dangerous for children. Children exposed to passive smoke are at higher risk of respiratory infections, asthma, bacterial meningitis and cot death.

Smoke can spread throughout the home, even if you open the windows. Almost 85% of tobacco smoke is invisible and smoke particles might also build up on surfaces and clothes, although the impact of this is not yet clear. If you are a smoker, smoking outside can help reduce your child’s exposure.

Is smoking in cars bad for passengers’ health?
Second-hand smoke can reach very high levels inside cars because it is a small enclosed space.

During your journey, children in the backseat will be exposed to average smoke levels around three times the recommended air pollution standard. But the level varies depending on how much you smoke, if you have all the windows fully open or air con on. Peak levels can reach as much as 35 times this recommended level.

Quiting smoking
The best way for smokers to reduce their risk of cancer is to give up smoking completely. It takes time to see the benefit but giving up smoking saves lives.

If you are a smoker, giving up smoking is the best gift you can give yourself, your friends and family. Quitting greatly reduces the risk of smoking-related cancers, as well as other diseases such as heart and lung disease, compared to continuing to smoke. The earlier you give up, the better. But equally it is never too late to gain valuable years of life by giving up smoking.

Share your story on how you quit smoking! Let the smoking friends get help and inspired to quit smoking with your true story. Mail your success story on “How I won over the evil tobacco” to info@cochincancersoceity.org

Key Take aways:

• Tobacco is the single biggest cause of cancer
• Many types of cancer are caused by smoking
• Lung cancer risk increases dramatically among smokers
• Even light or occasional smoking damages health
• Quitting smoking can reduce cancer risk
• Cutting down is a good start, but the big benefits come from quitting
• Tobacco smoke contains many dangerous chemicals
• Chemicals in smoke damage the body in many ways
• Nicotine is a highly addictive drug
• Filtered or ‘low-tar’ cigarettes also cause cancer
• Alcohol worsens the effect of smoking
• Passive smoking causes cancer
• Pipes, cigars, bidis and shisha also cause cancer
• Smokeless tobacco can cause cancer
• E-cigarettes have not yet been proven to support smoking cessation

How does body weight affect cancer risk?

Excess body weight may affect cancer risk through a number of mechanisms, some of which may be specific to certain cancer types. Excess body fat might affect:

Immune system function and inflammation
Levels of certain hormones, such as insulin and estrogen
Factors that regulate cell division, such as insulin-like growth factor-1 (IGF-1)
Proteins that influence how the body uses certain hormones, such as sex hormone-binding globulin

Being overweight or obese is clearly linked with an increased risk of many cancers, including cancers of the:

• Breast (in women past menopause)
• Colon and rectum
• Endometrium (lining of the uterus)
• Esophagus
• Kidney
• Pancreas

Being overweight or obese also likely raises the risk of other cancers, such as:

• Gallbladder
• Liver
• Non-Hodgkin lymphoma
• Multiple myeloma
• Cervix
• Ovary
• Aggressive forms of prostate cancer

In addition, having too much belly fat (that is, a larger waistline), regardless of body weight, is linked with an increased risk of colon and rectal cancer, and is probably linked to a high some research suggests that women who are overweight as teenagers (but not those who gain weight as adults) may be at higher risk for developing ovarian cancer before menopause.

How to choose a healthy diet:
No single food can reduce your risk of cancer, but the right combination of foods may help make a difference.

The principles of a cancer-preventative diet are summed up by balance, variety, colour and moderation. Eat a good balance of the different food groups and vary the foods you eat from within those groups – the colour of your food is a good indication of its nutritional value. The more colour variety the more nutrient value.

Ideal Plate:
It’s possible that your plate may look quite different from what you have been used to. A large portion of your healthy-eating plate should be made up of vegetables and it will include some other plant foods (fruit, whole grains, pulses, nuts and seeds) too. There will be some protein, either in the form of animal products or pulses. You need protein to build and maintain every cell in your body, and protein in your food also helps to regulate the release of sugar into your bloodstream. You also need to eat healthy fats, so they should be included on the plate too, in the form of vegetable oils, nuts and seeds, or butter. And finally, if you add some herbs and spices to your plate, you’ll boost the flavour of your food and benefit from their powerful health enhancing properties.

Exercise for your wellness
Sedentary behaviour, or sitting for extended periods, can increase your body fat. And, too much total body fat can increase your risk for many cancers and heart disease

Regular exercise is one of the best things you can do for your overall health and to lower your risk for many cancers. This includes colon, breast and endometrial cancers. And, if you’re a cancer survivor, exercise also may lower your risk of recurrence.

To reap these health benefits, in a week, you should aim for two-and-a-half hours of moderate physical activity, or an hour and 15 minutes of more vigorous physical activity.

You can get your physical activity in without spending gruelling time in the gym or on the track. Many everyday activities can count as exercise, as long as you do them with at least moderate intensity.

Use these tips to work more activity into your day:

• Take exercise breaks at work.
• Use the stairs instead of the elevators.
• Take a walk after dinner instead of watching TV.
• Join a community sports team.
• Engage in active play with your partner, children or friends.
• Stationary Cycling while watching TV

Alcohol and cancer:
The less alcohol you drink, the lower the risk of cancer. No type of alcohol is better or worse than another, it is the alcohol itself that leads to the damage, regardless of whether it is in wine, beer or spirits. And drinking and smoking together are even worse for you.

Not everyone who drinks alcohol will develop cancer. But on the whole, scientists have found that some cancers are more common in people who drink more alcohol than others. Alcohol causes 7 types of cancer, including breast, mouth and bowel cancers.

Many people are surprised to learn that cancer can be caused by an infection. There are seven major infectious agents for which there has been sufficient evidence from epidemiological, clinical, and biological studies to be classified as human carcinogens by expert panels of the International Agency for Research on Cancer. These are hepatitis B virus, hepatitis C virus , certain strains of the human papilloma virus , Helicobacter pylori , Epstein-Barr virus , human immunodeficiency virus type 1 , and human T-cell lymphotropic virus type I . In addition, the Kaposi’s sarcoma herpes virus (or HHV8) is classified as a probable human carcinogen.

The incidence of these infection-associated cancers is generally higher. Crowding or poor hygiene are favourable conditions for H. pylori. It may be because of increased exposure to blood that is contaminated with agents such as hepatitis C, through reuse of needles for medical procedures or for drug use. It may be because of lack of adequate medical care, such as access to regular cervical screening with prompt follow-up care for abnormalities. Thus, for a variety of reasons, there is an unequal burden of infection-related cancers among our minority and poorer citizens. This is particularly true for cervical cancer caused by certain genital papilloma viruses, liver cancer caused by the hepatitis B and C viruses, and stomach cancer caused by H. pylori..

The most important factor is age of infection. That is a consistent theme. Usually, very early age of infection is associated with subsequent risk of cancer. In addition, factors such as co infections or nutritional state that affect the competency of the immune system can modify the risk of malignancy.

The best prevention is to avoid exposure itself, e.g., by avoiding any contact with blood from another person that might contain viruses with the potential to increase cancer risk. We now have a vaccination against Hepatitis B virus. The most important medical self-care action for prevention of cervical cancer is to have regular cervical screening. Vaccination against HPV is currently available.H. pylori infection can be cured in many cases.

W.H.O's International Agency for Research on Cancer (IARC) has classified 107 agents, mixtures, and exposure situations as carcinogenic to humans. These include all forms of asbestos and a number of agents found in the environment such as benzene, arsenic in water, cadmium, ethylene oxide, benzo[a]pyrene, silica, ionizing radiation including radon, ultraviolet radiation, tanning devices, aluminium and coke production, iron and steel founding and the rubber manufacturing industry.

Cancer screening aims to detect cancer even before symptoms appear. This may involve blood tests, urine tests, other tests, or medical imaging. Early detection is important because when abnormal tissue or cancer is found early, it may be easier to treat and even cure. By the time symptoms appear, cancer may have begun to spread and is harder to treat.

Breast self awarness
Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Breast self-exam (BSE) is an option for women starting in their 20s

Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health Some women – because of their family history, a genetic tendency, or certain other factors may be screened with MRI in addition to mammograms.

5-10% of lumps can be missed on mammogram. Lessthan 1.5cm-2cm lumps are not felt. Ultrasound of the breast is also very good in detecting small tumors and pre-cancerous tumor.

Cervical cancer screening
Cervical cancer screening (testing) should begin at age 21. Women under age 21 should not be tested.

Women between ages 21 and 29 should have a Pap test every 3 years. HPV testing should not be used in this age group unless it is needed after an abnormal Pap test result. Women between the ages of 30 and 65 should have a Pap test plus an HPV test every 5 years. This is the preferred approach, but it is also OK to have a Pap test alone every 3 years.

Women over age 65 who have had regular cervical cancer testing with normal results should not be tested for cervical cancer. Once testing is stopped, it should not be started again. Women with a history of a serious cervical pre-cancer should continue to be tested for at least 20 years after that diagnosis, even if testing continues past age 65.

A woman who has been vaccinated against HPV should still follow the screening recommendations for her age group.

Colorectal cancer and polyps
Beginning at age 50, both men and women should follow one of these testing schedules:

Tests that find polyps and cancer:
Flexible sigmoidoscopy every 5 years, or
Colonoscopy every 10 years, or
Double-contrast barium enema every 5 years, or
CT colonography (virtual colonoscopy) every 5 years
Tests that primarily find cancer
Yearly guaiac-based faecal occult blood test (gFOBT), or
Yearly faecal immunochemical test (FIT), or
Stool DNA test (sDNA), every 3 years
* If the test is positive, a colonoscopy should be done.

The tests that are designed to find both early cancer and polyps are preferred if these tests are available to you and you are willing to have one of these more invasive tests.Polyps if any can be removed while doing colonoscopy (endoscopy) to prevent the development of cancer. Some people should be screened using a different schedule because of their personal history or family history talk to your doctor about which test is best for you.

Oral and oropharynx cancer screening
Screening for oral cancer may be done during a routine check-up by a dentist or medical doctor. The exam will include looking for lesions, including areas of leukoplakia (an abnormal white patch of cells) and erythroplakia (an abnormal red patch of cells). Leukoplakia and erythroplakia lesions on the mucous membranes may become cancerous. Tobacco chewing, smoking and consumption of alcohol are known to cause oral and oropharynx cancers.

The mouth and oropharynx help us breathe, talk, eat, chew and swallow. The medical term for the mouth is the oral cavity. Mouth cancer includes cancer that starts anywhere in the oral cavity which includes the following;

• Lips
• Front two thirds of the tongue
• Upper and lower gums, (the gingiva)
• Inside lining of the cheeks and lips (the buccal mucosa)
• Floor of the mouth, under the tongue
• Roof of the mouth (the hard palate)
• Area behind the wisdom teeth (called the retromolar trigone)
• Diagram showing the parts of the mouth below and above the tongue

Pharynx is the medical name for the throat. The pharynx is divided into 3 parts, and the oropharynx is one of these parts. The other two parts are the nasopharynx and the laryngopharynx.

The oropharynx connects the mouth to the top of the throat. It is the part of the throat just behind the mouth. Cancers that start in this area are called oropharyngeal cancers.

The areas within the oropharynx include

• The back third of the tongue
• The soft area at the back of the roof of the mouth (the soft palate)
• The tonsils and two ridges of tissue in front of and behind the tonsils (called the tonsillar pillars)
• The back wall of the throat

What throat cancer means

The term throat cancer can be confusing because people use it to mean different things. The throat includes the 3 parts of the pharynx (including the oropharynx). People also use the term to include structures near the pharynx, such as the thyroid gland, the voice box (larynx) or the food pipe (oesophagus). So, throat cancer is not a very precise term.

A physical exam and medical history, especially the history of symptoms, are the first steps in diagnosing cancer. In many instances, the medical caregiver will order a number of tests, most of which will be determined by the type of cancer and where it is suspected to be located in or on the person's body. In addition, most caregivers will order a complete blood count, electrolyte levels and, in some cases, other blood studies that may give additional information.

Imaging studies are commonly used to help physicians detect abnormalities in the body that may be cancer. X-rays, CT and MRI scans, and ultrasound are common tools used to examine the body. Other tests such as endoscopy, which with variations in the equipment used, can allow visualization of tissues in the intestinal tract, throat, and bronchi that may be cancerous. In areas that cannot be well visualized (inside bones or some lymph nodes, for example), radionuclide scanning is often used. The test involves ingestion or IV injection of a weakly radioactive substance that can be concentrated and detected in abnormal tissue.

Molecular genetic tests are also used to further narrow down the type of cancer. Certain DNA and RNA tests also enable the doctor to decide a treatment that will be more beneficial to the patient.

However, in virtually all patients, the definitive diagnosis of cancer is based on the examination of a tissue sample taken in a procedure called a biopsy from the tissue that may be cancerous, and then analysed by a pathologist. Some biopsy samples are relatively simple to procure (for example, skin biopsy or intestinal tissue biopsy done with a device called an endoscope equipped with a biopsy attachment). Other biopsies may require as little as a carefully guided needle, or as much as a surgery (for example, brain tissue or lymph node biopsy). In some instances, the surgery to diagnose the cancer may result in a cure if all of the cancerous tissue is removed at the time of biopsy.

The biopsy can provide more than the definitive diagnosis of cancer; it can identify the cancer type (for example, the type of tissue found may indicate that the sample is from a primary [started there] or metastatic type of brain cancer [spread from another primary tumor arising elsewhere in the body]) and thereby help to stage the cancer. The stage, or cancer staging, is a way for clinicians and researchers to estimate how extensive the cancer is in the patient's body.

Is the cancer that has been found localized to its site of origin, or is it spread from that site to other tissues? A localized cancer is said to be at an early stage, while one which has spread is at and advanced stage.

The TNM system is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of distant metastasis (M). A number is added to each letter to indicate the size or extent of the primary tumor and the extent of cancer spread (higher number means bigger tumor or more spread).

Staging of cancer is important; it helps the physician to decide on the most effective therapeutic protocols, provides a basis for estimating the prognosis (outcome) for the patient, and provides a system to communicate the patient's condition to other health professionals that become involved with the patients' care

As a rule, a lower stage (such as a Stage I or II) means that the cancer has not spread very much. A higher number (such as a Stage III or IV) means it has spread more.

The most common treatments for cancer are surgery, chemotherapy, and radiation. Surgery is used to remove the cancer when it is confined to the organ where it started. The surgeon might also take part or all of the organ it affects. For breast cancer, part (or all) of the breast might be removed. For prostate cancer, the prostate gland might be removed. But surgery is not used for all types of cancer.

An Oncologist who specialises in surgical treatment of cancer is referred as Surgical Oncologist.

Chemo (which is short for chemotherapy) is the use of drugs to kill cancer cells or to slow their growth. Some chemo is given by IV (put into a vein using a needle), some as a shot, and others are swallowed as a pill. Because chemo drugs travel to nearly all parts of the body, they are useful for cancer that has spread. An oncologist who specialises in the usage of chemotherapy and targeted therapy and managing their side effects to treat patients is referred as Medical Oncologist.

Radiation treatment is also used to kill or slow the growth of cancer cells. It can be used alone or with surgery or chemo. Radiation treatment is like getting x-rays or sometimes it can be given by placing “seeds” that give off radiation inside the tumor. An oncologist who specialises in treating cancer with radiation treatment is referred as Radiation Oncologist.

Each specialist may consult with the others to develop a treatment plan for the particular patient. The treatment choice is based on the type of cancer and the stage of the cancer Aims of cancer treatment can be any of the following:

• Cure
• Extend survival with quality of life
• Provide palliative support

Early detection significantly increases the chance of cure. In some people, diagnosis and treatment may occur at the same time if the cancer is entirely surgically removed when the surgeon removes the tissue for biopsy.

Although patients may receive a unique sequenced treatment, or protocol, for their cancer, most treatments have one or more of the following components: surgery, chemotherapy, radiation therapy, or combination treatments (a combination of two or all three treatments). Patients with cancers that cannot be cured (completely removed) by surgery usually will get combination therapy, the composition determined by the cancer type and stage.

Palliative therapy (medical care or treatment used to reduce disease symptoms but unable to cure the patient) utilizes the same treatments described above. It is done with the intent to extend and improve the quality of life of the terminally ill cancer patient. There are many other palliative treatments to reduce symptoms such as pain medications and anti-nausea medications.

Counselling can help you sort out many different types of problems that you may face when you have cancer. For example, it can help with

• Coping with your reactions to cancer
• Family and relationship issues
• Exploring personal issues
• Dealing with practical issues

A counsellor may help you to find different ways of coping that hadn't occurred to you before. And because counselling is confidential, you can be honest about what is bothering you.