Cancer is a word we are generally taught to fear in today’s society. We see it as a curse; a dead end street or just bad luck. However, education about cancer itself is scarce and people learn everything they know about cancer from reality T.V. and blatant scare tactic advertising. Therefore, education is of primary importance when dealing with a patient. However, what actually is cancer?

The simplest way to describe cancer is ‘abhorrent cell growth’.  It is the uncontrolled division of abnormal cells. These cells have lost the ability to self-destruct (apoptosis) due to their own mutations. Malignant cells grow until a mass of cells become a tumor and interfere with the normal functioning of that part of the body.

There are believed to be six main alterations in cell physiology that indicate malignant cell growth.

  • Self-sufficiency in growth signals
  •  Insensitivity to growth inhibitory (antigrowth) signals
  • Evasion of programmed cell death (apoptosis)
  • Limitless replicative potential
  • Sustained vascularity (angiogenesis)
  • Tissue invasion and metastasis
  • Genetic mutation is considered a common denominator in all the above characteristics.

Why cancer cells originate has been a hot topic from the day cancer was first discovered. Unfortunately, even today we are still unsure of the exact reason cancer cells are formed. Three of the most common theories are explained bellow.

Cancer as a metabolic disease

The cellular mitochondrial energy metabolism of a cell is vastly different in a cancerous cell and a healthy cell. Normal cells produce the majority of their energy through aerobic respiration while cancerous cells produce energy through anaerobic respiration. One of the characteristics of a cancer cell is that it performs anaerobic respiration (glycolysis) in an aerobic environment. Therefore, when approaching cancer as a metabolic disease, it is in fact linked to impaired mitochondrial function.  Although the reason of malignant transformation is not fully understood, there are a large number of unspecific influences which can initiate the disease including radiation, chemicals, viruses, inflammation, etc. In fact, almost any prolonged exposure to a stimulating or provocative agent can lead to the development of cancer.

Dr. Warburg’s theory states that cancer cells arise from normal body cells through a gradual and irreversible damage to their respiratory capacity. They perform anaerobic glycolysis due to a damaged respiration and it is the single most common abnormality found in cancer.

The theory has been mostly disregarded on the premises that it is too simplistic and doesn’t address many phenomenon tumour cells present with, including metastasis. The debated idea was that the development of cancer is a mutation of gene expression. In recent times, cancer as a metabolic disease has been reconsidered as the many treatments work around the fundamental anaerobic energy production a cancer cell performs.

The new theory believes that damage to cellular respiration precedes and underlies the genome instability that accompanies tumor development. Once cancer has been established there is a worsening of genome instability, which causes further respiratory impairment, genome mutability, and tumor progression. This theory is based on evidence that the nuclear genomes integrity is largely dependent on mitochondrial energy homeostasis.

Stem Cell theory

The theory of cancer cells arising from ‘trophoblasts’, ‘stem cells’ or ‘germ cells’ is an old theory. In the early 1900s John Beard formulated the idea that cancer cells are similar to embryonic trophoblast cells. Embryonic trophoblast cells, which grow in the placenta, grow fast, create their own blood supply and are invasive, all characteristics of cancer cells. His theory stated that tumours are established due to misplaced trophoblastic cells. However, the missing component in Beard’s hypothesis was that while placental cells exhibit all these characteristics, they stop growing after a time and are a very benign tissue.

Due to advances in science since the 1900s, there have been numerous advances in Beard’s theory. The most current theory states that cancer cells originate from stem cells. Stem cells are used to replace dead or dying cells in the body’s natural turnover, aging, disease or injury. This theory explains that cancer cells retain key components of stem cells. These include the capacity for self-renewal, the ability to differentiate, active telomerase expression, loss of apoptosis, increased membrane transporter activity, and the ability to migrate and metastasise. Therefore it is believed that cancer cells originate directly from stem cells or their immediate offspring.

The origination of cancerous stem cells is thought to be due to one or a mixture of the following risks: fat and water soluble toxins/heavy metals, nutritional deficiencies, radiation, inflammation, acidity, anaerobic environment and bacterial or viral infection. These known causes for stem cell alteration are often complexly intermingled and difficult to differentiate.

Mature cell mutation theory

The final theory addressed here is most commonly understood in conventional medicine. It simply believes in the mutation of adult healthy cells into cancerous cells due to an accumulation of genetic mutations. Generally it is thought to be idiopathic, however, the medical field does acknowledge the presence of carcinogenic substances and the ability for radiation to cause genetic mutation. This theory limits the believer’s angle of approach as treatment is often not designed to address the root cause.

Cancer is a fungus theory

There is a large body of evidence to link cancer with microbes and fungus. Some say that microbes are a causative factor in cancer; some say they take residence in sick cancerous cells only because a weakened body invites them. The debate goes way back to the 18th century where Claude Bernard and Antoine Bechamp argued that the inner terrain was more important because bacteria could not invade a healthy host and create disease on their own. It was only when the body - the inner terrain- was run down that germs would find a hospitable enough environment to set up housekeeping and do further damage to the body.

In any case we know now that germs and fungus are part of cancer and need to be addressed and eliminated from the body for healing to take place.

Cancer is a systemic disease

All the above theories are based around the presence of a negative stimulus. This stimulus initiates the mutation of the cell. Fat and water soluble toxins/heavy metals, nutritional deficiencies, radiation, inflammation, acidity, anaerobic environment and bacterial or viral infections, stress, unhealthy lifestyle, are the most common of these ‘negative stimulus’. In today’s world the presence of these toxins are unavoidable and everybody is exposed to one form or another of these cancer-causing stimulus every day of their lives. Therefore, everybody has the potential to form cancer cells every day. In fact, we all have mutated cells in our body at this very moment. However, our body is very efficient in cleaning away these mutated cells and the immune system plays a leading role in this process. This is why many of the treatments for cancer are based around immune boosting/modulating. Of the above theories, it is a general consensus in the alternative medical industry that overburdening of the immune system is the cause for cancer proliferation. The simplest way to understand this is to consider our immune system as an army. Every day we fight invaders and every day we have casualties. The immune system becomes overburdened when the casualties are higher than our ability to create new soldiers.

So now we’ve established that we all have cancer cells in our body and we all have an immune system that keeps them in check, it leads us to the understand that although cancer may seem to a be localised occurrence (tumour), it is in fact a systemic disease that requires a destabilisation of our entire system to unfold.

Treatment is therefore divided into three main categories. Finding the negative stimuli / causes and removing them, treatments to increase the vitality, function and homeostasis of the entire system, and treatments that work by directly killing cancer cells. By increasing the systemic vitality of the body, it enables the body’s innate ability to deal with cancerous cells. It also aids in the maintenance of homeostasis, which is still being bombarded by ‘negative stimulus’ every day. Treatments that cause the direct necrosis of cancer cells are called for when the burden and number of cancer cells has passed the bodies capacity for self-regeneration. These treatments can be quite aggressive and appropriate management of the side-effects, and unwanted outcomes must be addressed appropriately and with full understanding by both the practitioner and patient.

How is cancer classified?

When a patient receives a cancer diagnosis the definition of the cancer can often be daunting and difficult to understand. Therefore, it is important to be able to inform a patient how cancer is classified and what the complicated terms/abbreviations on their diagnosis actually mean. Different types of cancer act in different ways and the classification determines appropriate treatment and helps determine the prognosis.

Cancer classification is made according to:

  • The site of origin
  • The degree of mutation (grading)
  • The extent of the disease (staging).

Site of Cancer Origin

This classification describes the type of tissue in which the cancer cells begin to develop.

Carcinoma: Carcinoma refers to a malignant neoplasm of epithelial origin or cancer of the internal or external lining of the body. Carcinomas, malignancies of epithelial tissue, account for 80 to 90% of all cancer cases.

Adenocarcinoma:  Develops in an organ or gland.

Squamous cell carcinoma: Originates in the squamous epithelium.

Sarcoma: Refers to cancer that originates in supportive and connective tissues such as bones, tendons, cartilage, muscle and fat.

  • Osteosarcoma or osteogenic sarcoma (bone)
  • Chondrosarcoma (cartilage)
  • Leiomyosarcoma (smooth muscle)
  • Rhabdomyosarcoma (skeletal muscle)
  • Mesothelial sarcoma or mesothelioma (membranous lining of body cavities)
  • Fibrosarcoma (fibrous tissue)
  • Angiosarcoma or hemangioendothelioma (blood vessels)
  • Liposarcoma (adipose tissue)
  • Glioma or astrocytoma (neurogenic connective tissue found in the brain).

Myeloma: A cancer that originates in the plasma cells of bone marrow.

Leukemia: Liquid cancers or blood cancers are cancers of the bone marrow (the site of blood cell production). The disease is often associated with the overproduction of immature white blood cells.

  • Myelogenous or granulocytic leukemia (malignancy of the myeloid and granulocytic white blood cell series)
  • Lymphatic, lymphocytic, or lymphoblastic leukemia (malignancy of the lymphoid and lymphocytic blood cell series)
  • Polycythemia vera or erythremia (malignancy of various blood cell products, but with red cells predominating).

Lymphoma: Develops in the glands or nodes of the lymphatic system, a network of vessels, nodes and organs (specifically the spleen, tonsils and thymus) that purify bodily fluids and produce infection-fighting white blood cells, or lymphocytes. The presence of Reed-Sternberg cells differentiates the two different types of lymphoma.

  • Hodgkin lymphoma
  • Non-Hodgkin lymphoma.

Mixed Types: These types have characteristics that may be in several of the above categories.

  • Adenosquamous carcinoma
  • Mixed mesodermal tumour
  • Carcinosarcoma
  • Teratocarcinoma.

Tumour Grading

Grading involves examining the abnormality of a cell (biopsy) to determine the grade of the cancer. The grading is from 1–4 and the level of abnormality increases with the number.

Grade 1: Cells slightly abnormal and well differentiated

Grade 2: Cells more abnormal and moderately differentiated

Grade 3: Cells very abnormal and poorly differentiated

Grade 4: Cells immature and undifferentiated.

Cancer Staging

Staging involves classifying the extent of the disease.

Tumour: size (T)

TO = no evidence of tumour

Tis = Carcinoma in situ (limited to surface cells)

T1 to 4 = Increasing tumor size and involvement

Node: the degree of regional spread or node involvement (N)

N0 = No lymph node involvement

N1 to 4 = Increasing degrees of lymph node involvement

Nx = Lymph node involvement cannot be assessed

Metastases: distant metastasis (M)

M0 = No evidence of distant metastases

M1 = Evidence of distant metastases

A numerical system is also used to classify the extent of disease

Stage 0 = Cancer in situ (limited to surface cells)

Stage 1 = Cancer limited to the tissue of origin, evidence of tumour growth

Stage 2 = Limited local spread of cancerous cells

Stage 3 = Extensive local and regional spread

Stage 4 = Distant metastasis.

Breast cancer classification

Breast cancers can be classified according to their hormone responsively. This is mostly found out during an initial biopsy as it is invaluable in determining the most appropriate treatment.

Therefore, breast cancer is categorised as:

  • Endocrine receptor (estrogen or progesterone receptor) positive
  • ER positive (estrogen)
  • PR positive (progesterone)
  • Human epidermal growth factor receptor 2 (HER2)
  • (HER2) positive
  • Triple negative
  • ER negative (estrogen)
  • PR negative (progesterone)
  • HER2 negative
  • Triple positive
  • ER positive (estrogen)
  • PR positive (progesterone)
  • HER2 positive.

About 75% of all breast cancers are “ER positive”. They grow in response to the hormone estrogen. About 65% of these are also “PR positive”. They grow in response to another hormone, progesterone and 20 to 25% of breast cancers produce too much of a protein known as HER2. These breast cancers tend to be much more aggressive and fast growing.