User talk:CCDANTA

"USE OF CLINICALLY RELEVANT MODERN TECHNIQUES FOR THE IMAGING NOVEL SYSTEMATIC DIAGNOSIS AND TREATMENT OF CANCER PATIENTS"-AN ESSAY

Keywords:-Clinically relevant, modern techniques, best diagnosis, safe, cancer patient treatment Cancer- a historical overview: The origin of the word cancer is credited to the Greek physician Hippocrates (460-370 B.C.), considered the "Father of Medicine." He used the terms carcinos and carcinoma to describe non-ulcer forming and ulcer-forming tumors. In Greek these words refer to a crab, most likely applied to the disease because the finger-like spreading projections from a cancer called to mind the shape of a crab. Carcinoma is the most common type of cancer. Our oldest description of cancer (although the term cancer was not used) was discovered in Egypt and dates back to approximately 1600 B.C. The Edwin Smith Papyrus, or writing, describes 8 cases of tumors or ulcers of the breast that were treated by cauterization, with a tool called "the fire drill." The writing says about the disease, "There is no treatment." In 1761, Giovanni Morgagni of Padua was the first to do something considered routine today. He performed autopsies to relate the patient's illness to the pathologic findings after death. This laid the foundation for scientific oncology, the study of cancer. The famous Scottish surgeon John Hunter (1728-1793) suggested that some cancers might be cured by surgery and described how the surgeon might decide which cancers to operate on. If the tumor had not invaded nearby tissue and was "moveable," he said, "There is no impropriety in removing it." Today, the Greek term carcinoma is the medical term for a malignant tumor derived from epithelial cells. It is Celsus who translated carcinos into the Latin cancer, also meaning crab. Galen used "oncos" to describe all tumours, the root for the modern word oncology. The 19th century saw the birth of scientific oncology with the discovery and use of the modern microscope. Rudolf Virchow, often called the founder of cellular pathology, provided the scientific basis for the modern pathologic study of cancer. As Morgagni had correlated the autopsy findings observed with the unaided eye with the clinical course of illness, so Virchow correlated the microscopic pathology. Definitions and modern concept of cancer: Cancer is a disease characterized by a shift in the control mechanisms that govern cell survival, proliferation, and differentiation. Cells that have undergone neoplastic transformation usually express cell surface antigens that may be of normal fetal type, may display other signs of apparent immaturity, and may exhibit qualitative or quantitative chromosomal abnormalities, including various translocations and the appearance of amplified gene sequences. Such cells proliferate excessively and form local tumors that can compress or invade adjacent normal structures. A small subpopulation of cells within the tumor can be described as tumor stem cells. They retain the ability to undergo repeated cycles of proliferation as well as to migrate to distant sites in the body to colonize various organs in the process called metastasis. Such tumor stem cells thus can express clonogenic or colony-forming capability. Tumor stem cells are characterized by chromosome abnormalities reflecting their genetic instability, which leads to progressive selection of subclones that can survive more readily in the multicellular environment of the host. Quantitative abnormalities in various metabolic pathways and cellular components accompany this neoplastic progression. The invasive and metastatic processes as well as a series of metabolic abnormalities resulting from the cancer cause illness and eventual death of the patient unless the neoplasm can be eradicated with treatment. Cancer is clearly associated with an increase in cell number, alterations in mechanisms regulating new cell birth, or cell proliferation, are only one facet of the mechanisms of cancer. Decreased rates of cell death, or apoptosis, are now known to contribute to certain types of cancer. Cancer is distinctive from other tumor-forming processes because of its ability to invade surrounding tissues. Cancer is a major human health problem worldwide and is the first leading cause of death in the United States. Over the past 30 years, significant progress has been achieved in understanding the molecular basis of cancer. The accumulation of this basic knowledge has established that cancer is a variety of distinct diseases and that defective genes cause these diseases. Further, gene defects are diverse in nature and can involve either loss or gain of gene functions. A number of inherited syndromes associated with increased risk of cancer have been identified. Anticancer drug treatments: The practice of cancer medicine has changed dramatically in the past four decades, as curative treatments have been identified for a number of previously fatal malignancies such as testicular cancer, lymphomas, and leukemia. New drugs have entered clinical use for disease presentations that were previously either untreatable or amenable only to local therapies such as surgery and irradiation. At present, adjuvant chemotherapy routinely follows local treatment of breast, colorectal, and lung cancer, and chemotherapy is employed as part of a multimodal approach to the initial treatment of many other tumors, including locally advanced stages of head and neck, lung, and esophageal cancer, soft tissue sarcomas, and pediatric solid tumors. Genetic therapies, vaccines, and other manipulations of the immune system are under active investigation, and drugs now are in common use for restoring bone marrow function after chemotherapy, induction of differentiation in tumor tissues, and inhibition of angiogenesis. Cancer gene therapy is aimed at correcting genetic mutations found in malignant cells or delivering biologically active material against cancer cells. In recent years, great progress has been made in the treatment of cancer, and so the life expectation of cancer patients has been improved remarkably. Furthermore, during the past 5 years the global effort of sequencing human genome has provided us with an enormous number of potential targets associated with cancer. With the development of molecular pharmacology, molecular oncology and chemo informatics, together with the technologies of chemo genomics, the pattern of new drug discovery (NDD) is converting from pharmacology mode of “drugs-receptor gene” to retro-molecular pharmacology mode of “gene receptor- drugs”. So the oncologists are more and more aware of the fact that NDD must target to the developing mechanism of tumorigenesis to improve the therapeutic efficiency. Given the drawbacks of traditional cytotoxic anticancer drugs, such as their toxicity to normal cells: bone marrow depression, the adverse effect to the gastrointestinal tract and so on, the trend of anticancer drug studies has been oriented to target the multi-links of the mechanism of the tumorigenesis, such as targeting interrelated enzymes, interrupting cell signal transduction pathway, cell apoptosis, cell metabolism as well. The drugs designed are expected to have high affinity to the novel targets. They can inhibit the proliferation and differentiation of tumor cells and speed up their death. Systematic attempts by the physicians for the well being of cancer patients: As per by my best knowledge the physicians of the whole world should take in mind for the best treatment of the cancer patients seriously because now in whole world cancer is the number one cause of death surpassing the death rate by cardiovascular diseases. First attempt could be taken that the best understanding of the cancer pathophysiology including etiology and what could be happened if do the late treatment. What is the stage of cancer attack in the patient and what could be the best approach for the treatment. The physicians’ approach of treatment should be based on the type, size and stage of cancer. After using modern diagnosis techniques,  systematic process of treatment can be followed as - 1.	Benign tumor: as it is not a true form of cancer, it can be simply removed by incision or the cells can be killed by radiation therapy. 2.	Malignant tumor: as it is the true, very complex and dangerous form of cancer, it can be treat by following methods as a.	Radiation therapy/radiation oncology (XRT): it’s a curative, palliative or adjuvant type of treatment method. In this case Total Body Irradiation (TBI) technique is used to prepare the body to receive bone marrow transplantation. It uses high energy radiations (X-rays, γ-rays and charged particles) to shrink tumors and kill cancer cells. It is of three types as- (i) external radiation therapy accomplished by machines, (ii) internal radiation therapy (brachy therapy) and (iii) systemic therapy done by using radiolabelled injection element like I131 b.	Surgery: It is used to remove cancerous growths or cells. It depends upon the location, size and stage of cancer. When removing a tumor the surgeon should try to remove as much of the as possible and often examine by pathologist to clear the edge of invasion-“clean margin” and all visible tumor has been removed. c.	Immunotherapy: it is used to reject cancer by using monoclonal antibodies. It is a best option for the treatment of leukemia, lymphoma and multiple myeloma. d.	By T cells: cytotoxic T lymphocytes (CTL) use to destroy target cancer cells. e.	Cancer vaccines: Its purpose is to elicit a more powerful active immunity in the cancer patients. It can done by the following approaches- 	Patient-specific-cancer vaccines 	Dendritic-cell vaccines 	Patient-specific-tumor antigen vaccines 	Tumor- antigen specific vaccines f.	Herbal therapy: This approach is best if the cancer is only diagnosed to be in initial or primary stage. Many anticancer plants and their chemical constituents have been reported from research as anticancer agents like podophyllotoxins, chemtothesin and vincristine and vinblastine. Its semi- synthetic derivatives are also useful as potential anticancer agents. Including these, the Ayurvedic and Homeopathic approaches are useful in primary stage of cancer. g.	Recent developed miscellaneous techniques: 	Angiogenesis Inhibitors Therapy 	Bone marrow Transplantation and Peripheral Blood Stem Cell Transplantation 	Gene Therapy 	Hyperthermia in cancer Therapy 	Photodynamic Therapy 	Targeted cancer Therapy h.	Chemotherapy: It includes the use of many classes of synthetic, semi- synthetic and antibiotic anticancer agents. Major problems in these cases are their severe toxicities and side effects like bone marrow depression and attack normal cells due to higher dose. It can be solved by the update clinical knowledge of all the anticancer drugs and their formulations, and pharmacokinetic and pharmacodynamic data. From this cumulative knowledge the physician can design the dose regimens. He must know the t ½ of the drug. For example, if a best anticancer drug is toxic at higher dose, then the sustained release formulation form like nano particles, micro encapsulations, microspheres, β-cyclo dextrin or liposomal formulations of that drug is the best option. Overall worldwide the government must have the sufficient support for the best treatment served by the cancer patients, mainly financial and well facilitate hospitals. Patients should be well aware of the etiology of cancer like – not to use cigarettes. Hence it would be a better option that-“prevention is better than cure”. As a result whole world be of cancer free.