Cancer

Causes of Cancer
Cancer has many causes, there are about 200 different types of cancer affecting all the different body tissues. What affects one body tissue may not affect another. For example, tobacco smoke that you breathe in may help to cause lung cancer. Over exposing your skin to the sun could give you a melanoma on your leg. But the sun won't give you lung cancer and smoking won't give you melanoma.
Apart from infectious diseases, most illnesses are 'multifactorial'. Cancer is no exception. Multifactorial means that there are many factors involved. In other words, there is no single cause for any one type of cancer.
-Carcinogens
A "carcinogens" is something that can help to cause cancer. Tobacco smoke is apowerful carcinogen. But not everyone who smokes got a lung cancer. So tha must be other factors at works
- Age
Most Types of cancer becomes more.....[read more]
-Genetic Make Up
There have to be anumber of....[read more]
-The Immune System
People who have problem with...[read more]
- Diet
Cancer experts estimate that changes to our diet....[read more]
- Day to Day environment
by this we mean....[read more]
- Viruses
Viruses can help to [read more]

The Major Cause of Cancer
John Gofman is a medical doctor with a Ph.D. degree in nuclear and physical chemistry. He is professor emeritus of molecular and cell biology at University of California, Berkeley, and a member of the faculty at University of California Medical School at San Francisco. During his long career, he has pursued two separate fields of research -- heart disease, and the health effects of low-level radiation. He has won several awards for original research into the causes of atherosclerosis, which is the growth of fatty "plaque" inside the blood vessels, often causing fatal heart attacks. In 1974, the American College of Cardiology selected him as one of the 25 leading researchers in cardiology of the past quarter-century.[read more]

Cancer In Indonesia
Historically, the first major effort aimed at cancer control in Indonesia was initiated by the Dutch Colonial Government in the early 1920s (1). The first organization for cancer control which coordinated the activities for research and prevention was established in Bandung in 1933, called the ‘Nederlands Indische Kanker Institute’, which was closed during the Japanese occupation between 1942 and 1945 (1). After independence of the Republic of Indonesia, the first Indonesian Foundation for Cancer Control was established in 1962 in Jakarta. This was followed by several Cancer Foundations in several cities such as Surabaya, Solo, Yogyakarta and Bandung. The Coordinating Foundation of all these cancer societies was then established in Jakarta on April 17, 1977, named the Indonesian Cancer Society. Research Institutions have also been established such as the National Cancer Research Institute in Jakarta in 1965, under the supervision of the Department of National Research, which was closed in 1966. In 1974, a Research Center for Cancer and Radiology was established under the National Health Research Institute of the Ministry of Health.

In 1993, a new comprehensive Cancer Center Hospital was established in Jakarta which is also affiliated to the Medical Faculty University of Indonesia for the purpose of teaching and training for medical postgraduates and also for research on basic oncology.

Since the incidence of cancer goes up with increasing of life expectancy and better control of communicable diseases, the cancer load in developing countries such as Indonesia can soon be expected to be formidable (2–4). It is currently estimated that there will be at least 170–190 new cancer cases annually for each 100 000 people (5,6) and therefore cancer has risen to become sixth in rank among deaths after infectious diseases, cardiovascular diseases, traffic accidents, nutritional deficiency and congenital diseases (1,5–7). However, most cancer patients (60–70%) seek medical treatment when it is already too late (1,6).

Cancer in Indonesia, Present and Future
Cancer control has been in effect in Indonesia since the early 1920s. It was the Dutch Colonial Government who started with the Institution for Cancer Control, which was closed by the Japanese Occupation Administration between 1942 and 1945. After the independence of the Republic of Indonesia, a Cancer Control Foundation was established in 1962. At present, clinical and non-clinical departments in government teaching hospitals (there are 13 teaching hospitals) usually handle all cancer problems. In 1993, Dharmais Cancer Center in Jakarta was established and has become the top referral cancer hospital for Indonesia. Until now, there have been no nationwide accurate data on cancer registration, owing to a lack of funds and manpower. Cancer data collection is usually provided as a relative frequency study from several departments of the teaching hospitals. It is currently estimated that there will be at least 170–190 new cancer cases annually for each 100 000 people. The most frequent and primary cancers are cervix, breast, lymph node, skin and nasopharynx. Since Indonesia is now in a transition phase and has many problems concerning the economy and health care, we suggested a well-planned cancer control program. It includes the primary, secondary and tertiary prevention of cancer in cities, where inhabitants can afford to subsidize a certain proportion of the budgets for the implementation of this program.

PRESENT SITUATION
The Indonesian archipelago consists of over 17 000 islands, occupying almost 2 x 106 km2 of land. Administratively, Indonesia is divided into 27 provinces, 241 districts, 55 municipalities, 3501 subdistricts and 66 979 villages. Indonesia has a population of more than 200 million people (1974) (7) and is the fifth most populated country in the world after China, India, the Russian Federation and the USA. As there are no population based registries in Indonesia, the exact incidence and prevalence of cancer are not known. However, data collected from hospitals in several regions shows that cancer incidence increased by 2–8% per year during the last decade (1,6).

Data which have been collected from 13 pathological laboratories throughout Indonesia during the period of 1988–91 show that in the combined picture, cervical, breast, lymph node, skin and nasopharynx are the five major anatomical sites for cancer disease (8) (Table 1). Among females, the most common cancers are cervical, breast and ovarian cancer (Table 2), and among males skin, nasopharynx and lymph node cancer (Table 3). The relative proportions between male and female patients can be seen in Table 4, where most cancer patients are female, with a proportion of 65.4% in comparison with 34.5% for males for an observation period of 4 years (1988–91). The incidence rate of various cancer sites in males and females showed an increasing rate each year in every cancer site. Regarding age incidence, the major cancer group were aged between 45 and 54 years (26.19%), followed by the age group 55–64 years (21.84%). The trend showed that our cancer patients are mostly from the aging population (Table 5). The general pattern of cancer occurrence in Indonesia is mostly similar in certain areas, as can be seen in Table 6, where the most common cancers are cervical uterus cancer followed by breast, nasopharynx and skin.

Table 1. The 10 most frequent primary cancers in Indonesia: pathology based 1988–91
Table 2. The 10 most frequent primary cancer in females: pathology based 1988–91
Table 3. The 10 most frequent primary cancer in males: pathology based 1988–91
Table 4. Gender distribution: pathology based 1988–91
Table 5. Age distribution: pathology based 1988–91
Table 6. Relative frequency of the three most frequent primary cancers: site by geographic distribution

Since smoking tobacco is a very common habit among Indonesian men, increasing attention has recently been paid to lung and bronchial cancer (9). Realizing that the primary prevention strategy for tobacco-related cancer would necessarily be a comprehensive anti-tobacco program, the government of the Republic of Indonesia is considering various anti-tobacco legislative measures, and also measures aimed at tobacco product modification to render them less hazardous.

Recently we found that among men, 12% of cancer occurrence is in the liver, which is linked to aflatoxin and also to hepatitis B virus

The facilities for cancer care have improved recently in Indonesia. Efforts at controlling cancer have been undertaken by the government and the private sector, including the professional organizations and non-government organizations (NGOs). These efforts can be .... [Read more]

SUGGESTIONS FOR CANCER CONTROL MEASURES IN THE FUTURE FOR INDONESIA
A well planned cancer control program aimed at improving cure rates to reduce the morbidity and mortality rates and also to improve the quality of life of cancer patients is desirable. In order to achieve these goals, efforts have to be made in the following areas

Primary Prevention of Cancer (11)
More epidemiological studies on risk factors of cancer with high mortality rates, especially factors relating to life style, diet, reproduction and the environment, as well as cross-cultural studies should be encouraged.
Cancer registration should cover all clinics and medical institutions and ensure the validity of the diagnosis.
Education programs should be introduced through institutions and mass media concerning factors related to the common cancers in the population; encouraging behavior and life style that lead to the inhibition or suppression of the risk conditions.
Research is required on understanding the biology of cancer and the clinical, physical or infective agents to which people are likely to be exposed, in order to determine the cancer possibilities today and in the future.
More clinical trials on effective treatment methods should be launched.

Secondary Prevention of Cancer (12)
This is aimed at making an early diagnosis of cancer, so that the development of cancer can be interrupted. One of the activities in this program is the referral system, which is categorized as follows:
• the patient is referred to a health unit;
• a specimen is referred to the laboratory or histopathology unit;
• knowledge and ability are referred to health personnel and health units.

Plan of Action
To carry out these objectives, the following action has to be taken. Efforts should be aimed at preventing the occurrence of cancer. This can be achieved by reducing the exposure to carcinogenic substances and increasing the resistance of the population to carcinogenic agents e.g. via tobacco smoking (11).

Early Detection
Efforts should be made to detect cancer at an early stage, e.g.:
• increasing facilities for cytological examination (cervical cancer);
• promoting breast self-examination through public health education, etc. (12).

Diagnostic and Treatment Service for Cancer Patients
All ‘A-class’ hospitals (top referral hospitals; there are only two hospitals, one in Jakarta and the other in Surabaya) must function as cancer centers. They have to carry out tertiary referral services, education and research in the field of cancer.
All 23 ‘B-class’ hospitals and 26 first-class private hospitals must have cancer teams and their facilities should be increased.
All 124 ‘C-class’ hospitals and 41 intermediate-class private hospitals should be equipped with facilities and personnel to carry out early diagnosis and supportive treatment.
Analgesic drugs, including oral morphine, should be readily available at all hospitals and community health centers (14).

Rehabilitation Services
These activities have been performed in all ‘A-’ and ‘B-class’ hospitals.

Cancer Registration
To meet the special needs of cancer incidence, at least a hospital-based cancer registry should be developed, especially in ‘A-class’ and several ‘B-’ and ‘C-class’ hospitals (15). Population-based cancer registries should also be developed in certain areas with a population not more than 2–3 million, such as Yogyakarta, Semarang or Palembang.

Research and Development
R&D should be planned from now on in order to establish the size of cancer problem and to identify high-risk groups, so that we can meet these problems with appropriate technology and treatment (16,17). On November 28th, 1990, the Indonesian Government via the Ministry of Health established a National Cancer Control Action Plan to consolidate and escalate the efforts for a National Cancer Control Program. The success of this effort depends greatly on the effectiveness of the coordination and management by the government institutions concerned and also the active participation of the professional organizations and the public and private sectors.

90% of Cancer Patients Completely Unaware of New Breakthrough Cancer Therapy Which Medical Experts B
Nine out of ten patients battling cancer in Europe have never heard of a major breakthrough in cancer treatment, known as anti angiogenesis, according to a new survey released today. Yet, 70% of cancer specialists who took part in the survey believe that patients and their carers should know more about anti-angiogenic treatment as it marks the dawn of a new era in cancer treatment. In fact, half of the cancer specialists surveyed even believed that the use of anti angiogenic therapy could lead to cancer becoming a treatable illness people can live with, not the death sentence it so often is.

Anti-angiogenic therapy is a novel new therapy that works by starving the tumour of its blood supply to stop its growth. The first anti-angiogenic therapy, Avastin(R) (bevacizumab), was launched a year ago for the treatment of advanced colorectal cancer, and is the only anti-angiogenic agent that has consistently demonstrated survival benefit in the three most common tumour types: colorectal cancer, breast cancer and non-small cell lung cancer (NSCLC).

Professor Nick Thatcher, Professor of Oncology, University of Manchester, Christie Hospital, UK, said: "We are entering a new era in the treatment of cancer with the advent of innovative new cancer therapies and it's important that patients and their medical advisors understand the potential of these new treatments to extend life."

The survey was conducted amongst 500 cancer specialists and patients in the UK, France, Spain, Italy and Germany. It revealed that patient awareness of new cancer treatments is low: 40 percent admitted to feeling completely uninformed about advances in technology which might help them overcome their disease. This knowledge gap is concerning to both patient groups and physicians, who feel it is important that cancer patients are up-to-date on the latest technologies that may help them in their fight against the disease.

Dr. Jesme Baird, director of patient care at The Roy Castle Lung Foundation, part of the Global Lung Cancer Coalition, commented: "Statistics like these expose a major information gap between cancer patients and physicians regarding new advances in treatment, yet we know that people fighting cancer go through so much emotionally that they need to be able to believe in the future. The dialogue between patient and physician is critical in order to make an informed decision."