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Cancer is a group of more than 100 different diseases. It can develop almost anywhere in the body. It can affect any age group.

How cancer begins

Cells are the basic units that make up the human body. Cells grow and divide to make new cells as the body needs them. Usually, cells die when they get too old or damaged. Then, new cells take their place.

Cancer begins when genetic changes interfere with this orderly process. Cells start to grow uncontrollably. These cells may form a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

Some types of cancer do not form a tumor. These include leukemias, most types of lymphoma, and myeloma.

Types of cancer

Doctors divide cancer into types based on where it begins. Four main types of cancer are:

• Carcinomas. A carcinoma begins in the skin or the tissue that covers the surface of internal organs and glands. Carcinomas usually form solid tumors. They are the most common type of cancer. Examples of carcinomas include prostate cancer, breast cancer, lung cancer, and colorectal cancer.
• Sarcomas. A sarcoma begins in the tissues that support and connect the body. A sarcoma can develop in fat, muscles, nerves, tendons, joints, blood vessels, lymph vessels, cartilage, or bone. 
• Leukemias. Leukemia is a cancer of the blood. Leukemia begins when healthy blood cells change and grow uncontrollably. The 4 main types of leukemia are acute lymphocytic leukemia, chronic lymphocytic leukemia, acute myeloid leukemia, and chronic myeloid leukemia.
• Lymphomas. Lymphoma is a cancer that begins in the lymphatic system. The lymphatic system is a network of vessels and glands that help fight infection. There are 2 main types of lymphomas: Hodgkin lymphoma and non-Hodgkin lymphoma.

There are many other types of cancer.

 

How cancer spreads

As a cancerous tumor grows, the bloodstream or lymphatic system may carry cancer cells to other parts of the body. During this process, the cancer cells grow and may develop into new tumors. This is known as metastasis.

Metastasis means that cancer has spread to a different part of your body part than where it started. When this happens, doctors say the cancer has “metastasized.”

Any type of cancer can spread. Whether this happens depends on several factors, including:

• The type of cancer
• How fast the cancer is growing
• Other factors about the behavior of the cancer that your doctor may find

One of the first places a cancer often spreads is to the lymph nodes. Lymph nodes are tiny, bean-shaped organs that help fight infection. They are located in clusters in different parts of the body, such as the neck, groin area, and under the arms.

Cancer may also spread through the bloodstream to distant parts of the body. These parts may include the bones, liver, lungs, or brain. Even if the cancer spreads, it is still named for the area where it began. For example, if breast cancer spreads to the lungs, it is called metastatic breast cancer, not lung cancer.

The terms “metastatic cancer,” “advanced cancer,” and “stage 4 cancer” can also be used to describe metastasis, but these terms can have somewhat different meanings. The term advanced cancer can also be used to describe large cancers that have not spread to other parts of the body. If you are unsure, your doctor can help you understand the terms they are using to describe the cancer you have.

What are the most common cancers in Ethiopia?

GLOBOCAN 2020 has indicated that the top four cancers identified in Ethiopia are: Breast cancer, Cervical cancer, Colorectal cancer and Leukemia.

Breast cancer

Breast cancer is a disease in which abnormal breast cells grow out of control and form tumours. If left unchecked, the tumours can spread throughout the body and become fatal.

Breast cancer cells begin inside the milk ducts and/or the milk-producing lobules of the breast. The earliest form (in situ) is not life-threatening. Cancer cells can spread into nearby breast tissue (invasion). This creates tumours that cause lumps or thickening.

Invasive cancers can spread to nearby lymph nodes or other organs (metastasize). Metastasis can be fatal.

Treatment is based on the person, the type of cancer and its spread. Treatment combines surgery, radiation therapy and medications.

Who is at risk?

Female gender is the strongest breast cancer risk factor. Approximately 0.5–1% of breast cancers occur in men. The treatment of breast cancer in men follows the same principles of management as for women.

Certain factors increase the risk of breast cancer including increasing age, obesity, harmful use of alcohol, family history of breast cancer, history of radiation exposure, reproductive history (such as age that menstrual periods began and age at first pregnancy), tobacco use and postmenopausal hormone therapy. Approximately half of breast cancers develop in women who have no identifiable breast cancer risk factor other than gender (female) and age (over 40 years). 

Family history of breast cancer increases the risk of breast cancer, but most women diagnosed with breast cancer do not have a known family history of the disease. Lack of a known family history does not necessarily mean that a woman is at reduced risk.

Certain inherited high penetrance gene mutations greatly increase breast cancer risk, the most dominant being mutations in the genes BRCA1, BRCA2 and PALB-2. Women found to have mutations in these major genes may consider risk reduction strategies such as surgical removal of both breasts.

Signs and symptoms

Breast cancer can have combinations of symptoms, especially when it is more advanced. Most people will not experience any symptoms when the cancer is still early.

Common symptoms of breast cancer can include:

• a breast lump or thickening, often without pain
• change in size, shape or appearance of the breast
• dimpling, redness, pitting or other changes in the skin
• change in nipple appearance or the skin surrounding the nipple (areola)
• abnormal or bloody fluid from the nipple.
• Non healing wound/sores on the breast

People with an abnormal breast lump should seek medical care, even if the lump does not hurt.

Most breast lumps are not cancer. Breast lumps that are cancerous are more likely to be successfully treated when they are small and have not spread to nearby lymph nodes.

Breast cancers may spread to other areas of the body and trigger other symptoms. Often, the most common first detectable site of spread is to the lymph nodes under the arm although it is possible to have cancer-bearing lymph nodes that cannot be felt.

Over time, cancerous cells may spread to other organs including the lungs, liver, brain and bones. Once they reach these sites, new cancer-related symptoms such as bone pain or headaches may appear.

Treatment

Treatment for breast cancer depends on the subtype of cancer and how much it has spread outside of the breast to lymph nodes (stages II or III) or to other parts of the body (stage IV).

Doctors combine treatments to minimize the chances of the cancer coming back (recurrence). These include:

• surgery to remove the breast tumor
• radiation therapy to reduce recurrence risk in the breast and surrounding tissues
• medications to kill cancer cells and prevent spread, including hormonal therapies, chemotherapy or targeted biological therapies.

Treatments for breast cancer are more effective and are better tolerated when started early and taken to completion. Partial treatment is less likely to lead to a positive outcome.

Can breast cancer be prevented?

There is no sure way to prevent breast cancer. But there are things you can do that might lower your risk. This can be especially helpful for women with certain risk factors for breast cancer, such as having a strong family history or certain inherited gene changes.

For all women,

• Get to and stay at a healthy weight
• Be physically active
• Avoid or limit alcohol intake
• Other factors that might lower risk: Women who choose to breastfeed for at least several months after childbirth may also get an added benefit of reducing their breast cancer risk.

For women at increased risk of breast cancer

If you are at increased risk for breast cancer (for instance, because you have a strong family history of breast cancer, a known inherited gene mutation that increases breast cancer risk, such as in the BRCA1 or BRCA2 gene, or you have had DCIS or LCIS), there are some things you can consider that might help lower your chances of developing breast cancer (or help find it early):

• Close observation to look for early signs of breast cancer

For women at increased breast cancer risk who don’t want to take medicines or have surgery, some doctors might recommend close observation. This approach might include:

• More frequent doctor visits (such as every 6 to 12 months) for breast exams and ongoing risk assessment
• Starting breast cancer screening with yearly mammograms at a younger age
• Possibly adding another screening test, such as breast MRI

While this approach doesn’t lower breast cancer risk, it might help find it early, when it’s likely to be easier to treat.

Your health care provider can help you determine your risk of breast cancer, as well as which, if any, of these options might be right for you.

Cervical cancer

Cervical cancer, or cancer of the cervix, begins on the surface of your cervix. It happens when the cells on your cervix begin to change to precancerous cells. Not all precancerous cells will turn to cancer, but finding these problematic cells and treating them before they can change is critical to preventing cervical cancer.

Most cervical cancers are caused by the virus HPV, a sexually transmitted infection. HPV spreads through sexual contact (anal, oral or vaginal) and can lead to cancer. Most people will get HPV at some point in their lives and not realize it because their bodies fight the infection. However, if your body doesn’t fight the infection, it can cause the cells of your cervix to change to cancerous cells.

Who’s at risk?

In many cases, cervical cancer can be linked with known risk factors for the disease. Some risk factors can be avoided, while others cannot. Some risk factors within your control are:

• Screening history: Those who haven’t had Pap tests are regular intervals are at increased risk of cervical cancer.
• HPV infection: Certain types of HPV are linked to cervical cancer. Lowering your risk for HPV can also lower your risk for cervical cancer.
• Sexual history: Having sexual intercourse before the age of 18 and having many sexual partners puts you at higher risk of HPV infection and chlamydia. Preventing these diseases reduces your risk of cervical cancer.
• Smoking: Cigarette smoking is associated with an increased risk of cervical cancer.
• HIV infection: Those who’ve been infected with HIV have a higher-than-average risk of developing cervical cancer.
• Birth control pills: There is evidence that long-term use of oral contraceptives can increase your risk of cervical cancer.
• Multiple children: Having three or more full-term pregnancies may increase your risk for developing cancer of the cervix.
• Having a weakened immune system: Having a weak immune system makes your body unable to fight infections.

Some risk factors you can’t change are:

• Family history: Cervical cancer may have a genetic component.

Common signs and symptoms

Early stages of cervical cancer don’t usually involve symptoms and are hard to detect. The first signs of cervical cancer may take several years to develop. Finding abnormal cells during cervical cancer screenings is the best way to avoid cervical cancer.

Signs and symptoms of stage 1 cervical cancer can include:

• Watery or bloody vaginal discharge that may be heavy and can have a foul odor.
• Vaginal bleeding after intercourse, between menstrual periods or after menopause.
• Menstrual periods may be heavier and last longer than normal.

If cancer has spread to nearby tissues or organs, symptoms may include:

• Difficult or painful urination, sometimes with blood in urine.
• Diarrhea, or pain or bleeding from your rectum when pooping.
• Fatigue, loss of weight and appetite.
• A general feeling of illness.
• Dull backache or swelling in your legs.
• Pelvic/abdominal pain.

If you experience abnormal bleeding, vaginal discharge or any other unexplained symptoms, you

should have a complete gynecological examination that includes a Pap test.

Treatment

The cervical cancer treatment team includes a gynecologic oncologist (a doctor who specializes in cancers of female reproductive organs). Recommended treatment for cervical cancer is based on many factors including the stage of the disease, your age and general health, and if you want children in the future.

The treatments for cervical cancer are radiation, chemotherapy, surgery, targeted therapy and immunotherapy.

Can cervical cancer be prevented?

There are some things you can do to prevent cervical cancer. Receiving regular gynecological exams and getting Pap tests are the most important steps to take toward preventing cervical cancer. Other things you can do are:

• Get the HPV vaccine (if you are eligible).
• Use condoms or other barrier methods when you have sex.
• Limit your sexual partners.
• Stop smoking and using tobacco products.

How do you get screened for cervical cancer?

Most people should have regular cervical cancer screenings. Screenings include Pap tests, testing for HPV or a combination of both tests.

These are the cervical screening cancer guidelines:

• Cervical cancer screening should begin at age 21 years, regardless of sexual history. Some healthcare providers are willing to delay this until age 25.
• For those 21 to 29 years of age, screening is recommended every three years with only a Pap test (no HPV test).
• For people 30 years and older, co-testing with Pap and HPV should be done every five years, or Pap test alone every three years.
• Routine Pap testing should be discontinued (stopped) in those who have had a total hysterectomy for benign conditions and who have no history of CIN (cervical intraepithelial neoplasia) grade 2 or higher.
• Cervical cancer screening can be discontinued at age 65 in those who have two consecutive normal co-test results or three consecutive normal Pap test results in the past 10 years, with the most recent normal test performed in the past five years.
• People who have been adequately treated for CIN grade 2 or higher will need to continue screening for 20 years, even if it takes them past the age of 65.
• People 65 to 70 years of age or older who have had three or more normal Pap tests in a row and no abnormal Pap test results in the last 20 years should stop having cervical cancer screening. Those with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
• Those who have had a total hysterectomy (removal of the uterus and cervix) should also stop having cervical cancer screening unless they have a history of cervical cancer or precancer. People who have had a hysterectomy without removal of their cervix should continue to follow the guidelines above.

Those with certain risk factors such as HIV infection or a weakened immune system will follow a different schedule.

What is the cervical cancer vaccine?

The HPV vaccine is approved for children and adults ages 9 to 45 and protects against the development of cervical cancer. The vaccine works by triggering your body’s immune system to attack certain human papillomavirus (HPV) types, which have been linked to many cases of cervical cancer. It is best to get the vaccine before the start of sexual activity. The vaccine is given in a series. The number of shots you need varies depending on the age you are at your first dose. Check with your healthcare provider to see if you’re eligible for the vaccine.

Colorectal cancer

Colon and rectal cancer are cancers that involve the lowest part of the digestive system: the large intestine and the rectum

Tests that monitor or screen for colorectal cancer are important tools in finding colon and rectal cancer at an early stage. 

Who’s at risk for colorectal cancer?

• Age. The risk of colorectal cancer increases as people get older. Colorectal cancer can occur in young adults and teenagers, but the majority of colorectal cancers occur in people older than 50. 
• Gender. Men have a slightly higher risk of developing colorectal cancer than women.

• Family history of colorectal cancer. Colorectal cancer may run in the family if first-degree relatives (parents, brothers, sisters, children) or many other family members (grandparents, aunts, uncles, nieces, nephews, grandchildren, cousins) have had colorectal cancer. If a person has a family history of colorectal cancer, their risk of developing the disease is nearly double.

• Rare inherited conditions. Members of families with certain uncommon inherited conditions have a higher risk of colorectal cancer, as well as other types of cancer. 

• Personal history of certain types of cancer. People with a personal history of colorectal cancer previously or a diagnosis of ovarian cancer or uterine cancer are more likely to develop colorectal cancer.

• Physical inactivity and obesity. People who lead an inactive lifestyle, meaning no regular exercise and a lot of sitting, and people who are overweight or obese may have an increased risk of colorectal cancer.

• Food/diet. Current research consistently links eating more red meat and processed meat to a higher risk of the disease.

• Smoking. Recent studies have shown that smokers are more likely to die from colorectal cancer than nonsmokers.

Common symptoms of colon and rectal cancer

• Stomach pain or frequent gas pains
• Change in bowel habits (constipation or diarrhea)
• Blood in the bowel movements
• Feeling weak or tired
• Low iron level, commonly with anemia (iron deficiency anemia)
• Black or dark-colored stools

Treatment

The majority of rectal and colon cancers are treated with a combination of surgery, radiation therapy, and chemotherapy; treatment is chosen based on disease stage.

Can Colorectal cancer be prevented?

Although there is no proven way to completely prevent colorectal cancer, you may be able to lower your risk. Talk with your health care team for more information about your personal risk of colorectal cancer.

• Managing your body weight. There is evidence that links higher body weight with a higher risk of developing colorectal cancer. Eating well is one of the best ways to improve your health and lower your cancer risk.
• Being physically active. Being physically active can lower your risk of colorectal cancer.
• Managing your food choices. A diet rich in fruits and vegetables and low in red meat may help reduce the risk of colorectal cancer.

How do you get screened for Colorectal cancer?

Colorectal cancer can often be prevented through regular screening, which can find polyps before they become cancerous. Talk with your doctor about when screening should begin based on your age and family history of the disease.

Because colorectal cancer usually does not cause symptoms until the disease is advanced, it is important for people to talk with their doctor about the pros and cons of each screening test and how often each test should be given.

The tests used to screen for colorectal cancer are described below.

• Colonoscopy. A colonoscopy allows the doctor to look inside the entire rectum and colon while a patient is sedated. A flexible, lighted tube called a colonoscope is inserted into the rectum and the entire colon to look for polyps or cancer. During this procedure, a doctor can remove polyps or other tissue for examination. The removal of polyps can also prevent colorectal cancer.

• Computed tomography (CT or CAT) colonography. CT colonography, sometimes called virtual colonoscopy, is a screening method being studied in some centers. It requires interpretation by a skilled radiologist to provide the best results.

• Sigmoidoscopy. A sigmoidoscopy uses a flexible, lighted tube that is inserted into the rectum and lower colon to check for polyps, cancer, and other abnormalities.

• Fecal occult blood test (FOBT) and fecal immunochemical test (FIT). A fecal occult blood test is used to find blood in the feces, or stool, which can be a sign of polyps or cancer.

• Double contrast barium enema (DCBE). For patients who cannot have a colonoscopy, an enema containing barium is given, which helps make the colon and rectum stand out on x-rays. A series of x-rays is then taken of the colon and rectum. In general, most doctors would recommend other screening tests because a barium enema is less likely to detect precancerous polyps than a colonoscopy, sigmoidoscopy, or CT colonography.

• Stool DNA tests. This test analyzes the DNA from a person’s stool sample to look for cancer. It uses changes in the DNA that occur in polyps and cancers to find out if a colonoscopy should be done.

Leukemia

Leukemia is a type of cancer found in your blood and bone marrow and is caused by the rapid production of abnormal white blood cells. These abnormal white blood cells are not able to fight infection and impair the ability of the bone marrow to produce red blood cells and platelets.

Leukemia are of different types and can be either acute or chronic. Chronic leukemia progresses more slowly than acute leukemia, which requires immediate treatment.

Leukemia occurs in both adults and children. Acute form is more common in children and young adults.

Who’s at risk of Leukemia?

Although experts are uncertain about the causes of leukemia, they have identified several risk factors that include the following:

• Exposure to high levels of radiation
• Repeated exposure to certain chemicals (for example, benzene)
• Chemotherapy
• Down Syndrome
• A strong family history of leukemia

Common symptoms

Symptoms vary depending on the type and stage of leukemia, but they can include the following:

• Fever, chills, night sweats and other flu-like symptoms
• Weakness and fatigue
• Swollen or bleeding gums
• Headaches
• Enlarged liver and spleen
• Swollen tonsils
• Bone pain
• Paleness
• Pinhead-size red spots on the skin
• Weight loss

Treatment

Treatment depends on your age, general health, and type of leukemia. You might receive a combination of treatments that could include chemotherapy, biological therapy, radiation therapy, and stem cell transplantation.

Can leukemia be prevented?

Because the cause of leukemia remains unknown, there is no certain way to prevent it. However, avoiding exposure to solvents, such as benzene and toluene, and unnecessary exposure to x-rays is generally good practice. If you think you may be exhibiting signs of leukemia, being aware of the risk factors and symptoms and talking with your doctor are critical to early diagnosis and treatment. It is especially important for people who have a family history of leukemia to be aware of symptoms and share their family medical history with their doctors.

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