Smita

UNIT VI

ETIOLOGIES AND RISK FACTORS:

1. Tobacco: Tobacco is mainly consumed in the form of cigarettes not only in India but also
across the world.
Around 90% of all cancers are attributable to smoking cigarettes.
Smokeless tobacco products including chewing tobacco, gutkha, moist snuff (khaini) and
pan and areca nut. Tobacco smoking and chewing are associated with cancers of the gums,
cheeks, and inner surface of the lips.
2. Alcohol: Drinking alcohol increases the risk of developing cancers of oral cavity and
oropharynx. Smoking or chewing tobacco alongside drinking alcohol together multiplies
the risk of these cancers by 30 times.
3. Viruses: Infectious agents including viruses, bacteria and parasites are thought to to be the
causative agents for approximately 20% of all human cancers.
-Hepatitis B (HBV) is spread through infected blood, semen and other body fluids.HBV
is a leading cause of liver cancer.
-Hepatitis C (HCV) is spread through infected blood. HCV is a leading cause of liver
cancer and Hodgkin’s lymphoma.
-Human Immunodeficiency virus (HIV) is spread through infected semen, vaginal fluids,
food and breast milk. HIV associated cancers are Kaposi’s sarcoma, cervical cancer,
cancers of the anus, liver, mouth, throat and lung and lymphoma.
-Human Papillomavirus (HPV) has at least 12 strains that can cause cancer in humans
including anus, cervix, penis, throat, vagina, vulva and oral cavity.
-Epstain Barr Virus (EPV) is a herpes virus that’s spread through saliva. EBV infection
increases the risk of many types of lymphomas.

4. Certain chemicals: Chemicals like radon, asbestos, formaldehyde, engine exhaust etc. can

contribute to the risk of developing cancers. Radiation from various sources are well known
universal carcinogens.

a) Radon
b) Asbestos
c) Crispy,brown foods- When some vegetables like potatoes are heated to high
temperature ;they can give off a chemical called acrylamide.
d) Formaldehyde
cUNIT VI
ETIOLOGIES AND RISK FACTORS:

1. Tobacco: Tobacco is mainly consumed in the form of cigarettes not only in India but also
across the world.
Around 90% of all cancers are attributable to smoking cigarettes.
Smokeless tobacco products including chewing tobacco, gutkha, moist snuff (khaini) and
pan and areca nut. Tobacco smoking and chewing are associated with cancers of the gums,
cheeks, and inner surface of the lips.
2. Alcohol: Drinking alcohol increases the risk of developing cancers of oral cavity and
oropharynx. Smoking or chewing tobacco alongside drinking alcohol together multiplies
the risk of these cancers by 30 times.
3. Viruses: Infectious agents including viruses, bacteria and parasites are thought to to be the
causative agents for approximately 20% of all human cancers.
-Hepatitis B (HBV) is spread through infected blood, semen and other body fluids.HBV
is a leading cause of liver cancer.
-Hepatitis C (HCV) is spread through infected blood. HCV is a leading cause of liver
cancer and Hodgkin’s lymphoma.
-Human Immunodeficiency virus (HIV) is spread through infected semen, vaginal fluids,
food and breast milk. HIV associated cancers are Kaposi’s sarcoma, cervical cancer,
cancers of the anus, liver, mouth, throat and lung and lymphoma.
-Human Papillomavirus (HPV) has at least 12 strains that can cause cancer in humans
including anus, cervix, penis, throat, vagina, vulva and oral cavity.
-Epstain Barr Virus (EPV) is a herpes virus that’s spread through saliva. EBV infection
increases the risk of many types of lymphomas.

4. Certain chemicals: Chemicals like radon, asbestos, formaldehyde, engine exhaust etc. can

contribute to the risk of developing cancers. Radiation from various sources are well known
universal carcinogens.

a) Radon
b) Asbestos
c) Crispy,brown foods- When some vegetables like potatoes are heated to high
temperature ;they can give off a chemical called acrylamide.
d) Formaldehyde
e) Organophosphate and organochlorine pesticides
f) Ultraviolet rays
g) Engine exhaust
h) Pollution
i) Radiation- Multiple survivors of the Hiroshima and Nagasaki bombing have
developed multiple cancers over the time. This was contributed to the radiation
 exposure ,there by cementing the place of radiation as a universal carcinogen in that it
will induce cancer in most tissues of most species at all ages including the foetus.
 Exposure to radiation in the form of X-rays, CT scans or as a part of cancer treatment
may lead to cancers in later life.

5. Dietary factors-

a) Consumption of red meat

b) Consumption of smoked meat

c) Consumption of processed meat

d) Less consumption of fruits and vegetables

e) Dairy products- Few studies have shown increase risks of breast and ovarian cancer with high
intake of dairy products.

f) Consumption of low fiber and high fatty foods

6. Obesity and physical inactivity

7. Other factors- Besides,there are many factors that can act as risk factors for cancers. Those
are:

a) late pregnancies and obesity can induce breast cancer

b) lack of sexual hygiene may induce cervical cancer

c) long term consumption of groundwater arsenic can lead to lung cancer.

8. Genetics- 5-10% of adult cancers arise due to hereditary factors.

9. Hormones- Endogenous hormones are linked with the cancers of breast, ovary and
endometrium in women and prostate and testes in men.

10. Immune mechanisms-The occurrence of particular types of cancer under various conditions
of immunologic impairment supports the general concept that normal mechanisms of immune-
surveillance are important for control of carcinogenesis. Certain cancers, especially non
Hodgkin`s lymphoma (NHL), Kaposi`s sarcoma, cancer of cervix, anal cancer etc are linked with
suppressed immunity in the individuals.

PATHOPHYSIOLOGY OF CANCER CAUSATION:

Carcinogenesis or oncogenesis is the process by which normal cells transform into cancerous or
malignant cells.

Development of cancer is a complex process that despite decades of research, is still not
completely understood.

Theories of carcinogenesis-

A) Berenblum theory- This theory was first proposed in 1947.

o Tumor Initiation stage

o Tumor Promotion stage
o Malignant Conversion stage
o Tumor Progression stage.

Tumor initiation stage-

Initiation, the first stage is when initial cell mutation occurs. It may involve one or more cellular
changes that are either spontaneous or started by exposure to a carcinogen. A disruption in the
cell development cycle can be caused by a response to the activation of cellular genes known as
oncogenes and the process of DNA damage starts.

Mutation occurs in oncogenes and tumor suppressor genes allow cells to grow beyond
normal body needs. The new cell exhibit uncontrolled division and loses “apoptosis”.

Tumor promotion stage-

Promotion is the second stage where the transformed cells are stimulated to divide.

Malignant conversion stage-

Malignant conversion is the transformation of a preneoplastic cell into one that expresses the
malignant phenotype. This process requires further genetic changes.

Tumor promotion contributes to the process of carcinogenesis by the expansion of a

population of initiation cells that will then be at risk for malignant conversion. This process may
be mediated through the activation of protooncogenes and inactivation of tumor suppressor
genes.

Tumor progression-

During progression, tumor cells complete with one another to survive leading to more mutations
that make the cells more aggressive. As the tumor increases in size, the cells undergo further
mutations