Chapter 1

Introduction

Page | 1
 INTRODUCTION

Egyptians and Indians were known to have been afflicted by some malignant growth,
presumably cancer, over four thousand years ago. These rapidly growing swellings were named
'Karkinomas' by Hippocrates, the father of modem medicine, around 400 BC. And it is from this
(Karkinoma) that the modem term 'Carcinoma' has originated. The term 'Cancer' was coined by
Galen, personal physician to the emperor Marcus Aurelius. The term literally means 'a crab'. He
observed over 1,800 years ago that just as a crab's feet are extended from every part of its body,
so is this disease: the veins (later observed to be the lymphatic vessels) are distended and form a
similar figure (Marron, 1969)

Cancer and its treatment have a tremendous effects on the patient and their family: financial,
psychological, social as well as physical. Right from the moment a physician makes the
diagnosis of cancer and throughout the progressive stages of the illness, the patient along with
the family members go through a lot of trauma. The shocks of being afflicted with one of the
most dreaded illnesses, of enduring physical pain, the disability caused by the disease, of having
to face the possibility of death, of losing the loved ones and, of changing relationships,
equations, and of changing status etc.

Diagnosis of cancer, in the earlier part of the century, brought along with it a social stigma that
both the patient and the family endured. It caused the person and the family to feel stigmatized,
isolated and humiliated (Holland, 1989) Giving a historical perspective of the psychosocial
concerns in cancer, he traces that throughout the ninth century, family’s largely managed most of
the cancer patients. Many others were taken care of by compassionate sisters who received
support from the church. This marked the beginnings of the hospice movement in Europe. It was
from these homes for people dying with cancer that many perceptions of humanistic and comfort
care took shape. With the development of chemotherapy in early 1950's, there was more scope
for stability of care, psychosocial support and greater attention to supportive and palliative care.
It was the pediatric oncology which was familiar to psychosocial issues well in advance of the
adult oncology. In the 1950's, psychosocial support for cancer patients began to increase. Social
workers in the United States were trained to assist patients with cancer, thus providing the first
professional discipline to take care of these concerns in cancer.
Page | 2
Meanwhile, significant contributions were made in the field of cancer, by psychiatrists
concerning patients' quality of life. With the change in attitude and increased awareness,
psychosocial factors and aspects associated to quality of life have received greater attention from
the disciplines of oncology, psychiatry, social work, psychology, and nursing.

What is cancer?

Cancer, also called malignancy, is an abnormal growth of cells. There are more than 100 types of
cancer, including breast cancer, skin cancer, lung cancer, colon cancer, prostate cancer, and
lymphoma. Symptoms vary depending on the type. Cancer treatment may include chemotherapy,
radiation, and surgery (Esponal, 2013)

Cancer can start almost anywhere in the human body, which is made up of trillions of cells.
Normally, human cells grow and divide to form new cells as the body needs them. When cells
grow old or become damaged, they die, and new cells take their place (Esponal, 2013)

When cancer develops, however, this orderly process breaks down. As cells become more and
more abnormal, old or damaged cells survive when they should die, and new cells form when
they are not needed. These extra cells can divide without stopping and may form growths called
tumors (Esponal, 2013)

Cancerous tumors are malignant, which means they can spread into, or invade, nearby tissues. In
addition, as these tumors grow, some cancer cells can break off and travel to distant places in the
body through the blood or the lymph system and form new tumor’s far from the original tumors.
(Esponal, 2013)

Unlike malignant tumors, benign tumors do not spread into, or invade, nearby tissues. Benign
tumors can sometimes be quite large, however. When removed, they usually don’t grow back,
whereas malignant tumors sometimes do. Unlike most benign tumors elsewhere in the body,
benign brain tumors can be life threatening. (Esponal, 2013)

How Is Cancer Diagnosed?

The earlier cancer is diagnosed and treated, the better the chance of its being cured. Some types
of cancer -- such as those of the skin, breast, mouth, testicles, prostate, and rectum, may be

Page | 3
detected by routine self-exam or other screening methods before the symptoms become serious.
Most cases of cancer are perceived and diagnosed after a tumor can be felt or when other
symptoms develop. In a few cases, cancer is diagnosed incidentally as a result of evaluating or
treating other medical conditions.

Cancer diagnosis begins with a detailed physical exam and a complete medical history.
Laboratory studies of blood, urine, and stool can detect abnormalities that may show cancer.
When a tumor is suspected, imaging tests such as X-rays, computed tomography (CT), magnetic
resonance imaging (MRI), ultrasound, and fiber-optic endoscopy examinations help doctors
determine the cancer's location and size. To approve the diagnosis of most cancers, a biopsy
needs to be performed in which a tissue sample is removed from the suspected tumor and studied
under a microscope to check for cancer cells.

If the diagnosis is positive other tests are performed to provide precise information about the
cancer. This essential follow-up phase of diagnosis is called staging. The most important thing
doctors need to know is whether cancer has spread from one area of the body to another. If the
initial diagnosis is negative for cancer and symptoms persist, further tests may be needed. If the
biopsy is positive for cancer, be sure to seek a confirming opinion by a doctor who specializes
in cancer treatment before any treatment is started.

Types of Cancer

Cancer is not a single disease. There are over hundred types of cancer classified according to
their site of origin and their appearance. All cancers are classified into four subgroups, each
indicating the type of body tissue from which the cancer originated.

1. Carcinoma, a malignant tumor of epithelial or lining tissue. (Skin, various

2. Sarcoma, a malignant tumor of connective tissue (Bone muscle and other

3. Lymphoma, malignant tumor of lymphatic tissue (Hodgkin's disease and lymph

Page | 4
 4. Leukemia, a malignant disease of the blood-forming tissues (often referred to as
the cancer of the blood) (Marron, 1969)

Signs and Symptoms of Cancer

The following signs and symptoms have been established over a period of time as indications of
the onset of cancer:

1. Loss of appetite, loss of weight, an apparently undue amount of tiredness (Hodgkina K

2. Troublesome and persistent cough.

3. Lump in breast

4. Jaundice, constipation and diarrhea, blood or a mucous like discharge in faces or urine.

5. Extreme changes of mood and mental attitude, epileptic-type of fits.

6. Hematuria.

7. Menorrhagia, irregular bleeding per vaginum or discharge per vaginum

What Are the Treatments for Cancer?

Depending on the type and stage of cancer, treatments to eliminate the tumor or slow its growth
may comprise some combination of surgery, radiation, chemotherapy, hormone therapy or
immunotherapy.

Cancer Support

Supportive care from nurses and other professionals would accompany cancer treatment. The
goal is to relieve pain and other symptoms, maintain general health, improve quality of life, and
deliver emotional, psychological, and logistical support to patients and their families. Similar
supportive treatment is available to rehabilitate patients after curative treatment. Supportive
therapy such as hospice care for cancer patients nearing the end of their lives provides relief from
pain and other irreversible symptoms. Most mainstream care is geared toward providing

Page | 5
supportive treatment through the broad resources of a cancer treatment center. Complementary
cancer therapies, which are generally provided outside a hospital, can also provide supportive
care.

Exercise and Cancer

Exercise can help control fatigue, muscle tension, and anxiety in those with cancer. Patients tend
to feel better if they do exercises such as walking, swimming, jogging and yoga. Exercise has
also been shown to progress the outcomes associated with cancer treatment.

Mind/Body Medicine for Cancer

Some mind/body therapies increase quality of life for cancer patients through behavior
modification; others encourage expression of emotions. Behavior therapies such as guided
imagery, progressive muscle relaxation, hypnotherapy, and biofeedback are used to alleviate
pain, nausea, vomiting, and the anxiety that may happen in anticipation of or after cancer
treatment. Individual or group counseling allows patients to confront problems and emotions
caused by cancer and receive support from fellow patients in a group setting. Patients who
pursue these types of therapies tend to feel less lonely, less anxious about the future, and more
optimistic about recovery.

Nutrition, Diet, and Cancer

Scientific evidence suggests that nutrition may play a role in cancer prevention. Observational
studies have shown that cancer is more common in some individuals with certain dietary habits;
such as colorectal in people who have diets rich in meat products. So far, data has not supported
the use of any vitamins or supplementary to reduce the risk of cancer. In fact, studies show
some supplements may increase cancer risk, such as lung cancer risk in smokers taking beta
carotene and prostate cancer risk in men taking high doses of vitamin. No diet has been revealed
to slow, reverse, or cure cancer. Also, experts don't recommend stopping standard treatment in
place of complementary but many therapies can help people with cancer feel better.

Social Support and Spirituality

Page | 6
Having the support of friends and family can benefit the patient’s deal with the depression, fear,
and anxiety that accompany cancer. In some cases, a strong support network can even affect the
length of survival of cancer patients. Studies have shown that men who experience partial social
contact have a shorter survival time, while women with good social support survive longer from
their cancers. Prayer can relieve stress, create a sense of meaning and purpose, and provide
comfort.

Psychological Implications of Cancer

One of the most critical impact of concern is the acute psychological distress as the patient
confronts the implications of cancer: possible death, dependence on others disability, disfiguring
changes in the body and loss of function. (Ledersberg MS, 1993)

Cancer like any other serious and chronic disease stands as a symbol for the unknown and
dangerous, for suffering and pain, for guilt and shame, for isolation and abandonment, for chaos
and anxiety. It is often seen as a personal disaster, a crisis for both the patient and the family.
(Bolund C, 1990) It is a crisis that evokes psychological responses from those affected. The
initial response, according to (Ledersberg MS, 1993) of an individual diagnosed having cancer is
that of disbelief, a feeling of numbness. The next stage is that of anxiety and depression. The
patient is pre-occupied with the implications of the illness, thoughts about the future and sense of
helplessness. Attention and concentration are impaired, sleeping and eating patterns are
disrupted. The two distinct phases involved are the shock phase and the reaction phase. The next
phase is that of working through, where the patient with their coping skills tries to deal with the
crisis. (Chaturvedi SK, 1991) (Ledersberg MS, 1993) (Holland, 1989) Have studied psychiatric
morbidity in cancer patients and it is seen that anxiety and depression are the commonest
psychiatric problems seen among cancer patients. Cancer patients have the same frequency of
depression as other medically ill patients, when the level and severity of physical illness are
controlled. Anxiety appears in cancer in all stages of the disease right from diagnosis, relapse
and treatment failure, usually mixed with depression. Patients feel persistently on the edge, tense
and are unable to relax. Panic attacks, irritability and poor concentration and autonomic
symptoms are also present.

Page | 7