Cancer:
signs and treatment options

Cancer is a generic term for many different individual diseases. Experts have now identified between 200 and 300 types of cancer. As unique as these diseases are, they all have one thing in common: they originate from the body’s own cells, which have undergone a malignant change and suddenly begin to proliferate in an uncontrolled way. This displaces the normal tissue, replacing it with the tumour. In theory, every single cell of the body carries the risk of malignancy.

Tumours can be either benign or malignant. However, benign tumours do not damage the surrounding tissue. For this reason, they are not considered cancerous.

Once they have formed, cancer cells can easily travel via the lymphatic system and bloodstream to other organs, where they multiply quickly. As a result, secondary tumours (also known as metastases) develop.

Various malignant tumours can form depending on which organs and cells are affected. Experts distinguish between:

• Carcinomas: this type of tumour grows from cells of the skin or mucosa and the glands, i.e. the inner and outer surfaces of organs (e.g. skin, breast or intestinal cancer).
• Sarcomas: these tumours are mainly formed from connective and adipose tissue, muscles, tendons and nerve and vascular cells (osteosarcoma – bone cancer, liposarcoma – cancer of the soft tissues or fat cells, etc.)
• Blastomas: this tumour usually develops during tissue and organ development, which is why children are often affected (e.g. neuroblastoma – a tumour of the sympathetic nervous system). Glioblastoma (a type of brain tumour) is more common in adults.
• Malignant blood diseases: these conditions involve the uncontrolled proliferation of blood or haematopoietic cells. One example is leukaemia (a type of blood cancer).

At first, most sufferers often have no or only non-specific symptoms. The first signs of cancer may be severe night sweats, fever or elevated temperature and severe weight loss.
Other common signs of cancer include:

• Frequent tiredness
• Loss of fitness
• Pain with no apparent cause
• Dizziness

Depending on the type of cancer, other symptoms may occur, such as blood in the urine or stool, a bloody cough, swollen lymph nodes, loss of appetite, nausea and vomiting, nodules or swelling in the tissue and poor wound healing.

Exactly what causes cancer remains unclear to this day. However, there are some factors that may be involved in the development of a tumour. In addition to genetic predisposition, other triggers may also play a role. Here is a non-exhaustive list:

• Smoking
• Sun or UV radiation
• Environmental toxins (pesticides) and radiation (x-rays, radon)
• Unhealthy diet (high consumption of animal fats)
• Being overweight
• Lack of exercise
• Alcohol consumption
• Stress or psychological strain
• Viral infections (hepatitis B and C, Epstein-Barr virus, etc.)
• Hormone replacement therapy

First of all, the doctor asks the patient medical history questions about their symptoms, possible pre-existing conditions or the family history of the disease as well as their lifestyle. This is followed by a physical examination involving reflex tests, palpation, percussion (tapping) and auscultation (listening to the sounds from the lungs, heart, etc.).
For an exact diagnosis, the doctor can also use other, mainly imaging-based methods:

• Ultrasound
• X-rays
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Scintigraphy: a nuclear medicine-based examination with radioactive substances
• Positron emission tomography (PET): a nuclear medicine-based examination with radioactive substances
• Blood tests
• Urine and stool analysis
• Histology (tissue examination), biopsy (tissue collection)
• Endoscopy

Since tumours differ from one person to the next, treatment depends on their type, location and size. The patient’s age and general health are also taken into account when deciding on treatment measures. The focus of cancer treatment is always on the complete removal of the tumour and the affected tissue. Different methods can be used for this purpose. They can also be combined.

• Surgery
• Radiotherapy
• Chemotherapy with cytostatics (medicines to treat cancer that inhibit tumour cell growth)
• Stem cell or bone marrow therapy: the patient receives their own healthy stem cells (autologous stem cell therapy) or from a suitable donor (allogeneic stem cell therapy).
• Immunotherapy: in this treatment, drugs stimulate the immune system to fight the cancer cells.
• Gene therapy: T-helper cells (immune system defence cells) are taken from the patient and genetically modified to attack the surface structure of the cancer cells.
• Hormone therapy: certain drugs are administered in order to stop the growth of tumour cells, which is controlled by hormone production.
• Targeted therapy: medicines are administered that deliberately target certain properties of tumour cells. The tumour cells are destroyed and healthy cells remain.
• Palliative and pain medicine: opiates are used to relieve pain, and in some cases applications with cold and heat can also help.

The Union internationale contre le cancer (UICC) has established a scale that reflects the stage of tumour development.

• Stage 0: The tumours have not yet penetrated deep into the connective tissue. They have not reached the lymphatic system and therefore have not formed metastases.
• Stage 1: Tumours are small and medium in size, no lymph node involvement and no metastasis.
• Stage 2: The tumours are medium and large in size. No lymph node involvement and no metastasis.
• Stage 3: Tumours of various sizes with involvement of one to four adjacent lymph nodes, no distant metastasis.
• Stage 4: Tumours of various sizes with the involvement of one to four adjacent lymph nodes, with distant metastasis.

The sooner cancer is discovered and treated, the better the chances of a complete cure. Between 2014 and 2018, the five-year survival rate for cancer patients after diagnosis was 67% (68% for women, 65% for men). This is likely to be higher today, as cancer treatment is advancing all the time.