10 Questions a GP Must Know
Manoj Sharma, MBBS, Ph.D., MCHES®
Professor, School of Public Health, Jackson State University
University Research Reviewer, College of Health Sciences, Walden University
President, Health for All
R.Srinivasa Murthy, MD, Professor of Psychiatry (Retired)
Question #1: What are cancers?
Answer #1: Cancers are a diverse group of diseases which have in common an uncontrolled growth of cells and spread of these cells. Growth of cells can be benign or malignant. Benign is not harmful but malignant is another name for cancer and denotes uncontrolled growth of cells. The tendency of these abnormal cells to spread to different parts of the body is known as metastasis. Cancers are classified according to their organ or tissue of origin and according to their histological features. There are hundreds of types of cancers as there are 22 major sites and 88 major histological types of cancers. The most common cancers in men are those of prostate, lung, colon, and rectum while in women breast, lung, colon, and rectum are the most common.
Question #2: What causes cancers?
Answer #2: There is no single cause for all types of cancers. Actual “cause” of most cancers is largely unknown but there are several risk factors that can lead to cancers. According to Harvard Center for Cancer Prevention, the proportion of cancer deaths attributed to various factors include tobacco which is responsible for 30%, diet which is also responsible for an another 30%, infective processes(e. g. Cervical cancer) which are responsible for 5%, occupation which contributes 5%, family history accounts for 5%, reproductive and sexual history which is responsible for 3%, sedentary lifestyle accounts for 5%, perinatal factors (larger birth weight) 5%, geophysical location (exposure to radiation and sunlight) 2%, alcohol intake 3%, socioeconomic status 3%, pollution 2%, medication and medical procedures 1% and food additives, salt, and other contaminants 1%. Cancers are just like other biological chronic diseases with multifactorial etiology consisting of genetics, psychosocial factors, environmental stressors, autoimmune factors, and spiritual dimensions that require management in all these spheres. They affect the triune of body, mind, and spirit.
Question #3: What is health promotion for cancers?
Answer #3: It consists of three aspects: (1) Primary prevention that refers to those preventive actions that are taken prior to the onset of a disease or injury with the intention of removing the possibility of their ever occurring. For health promotion of cancers these include modification of lifestyles. (2) Secondary prevention that refers to actions that block the progression of an injury or disease at its incipient stage. When the early diagnosis of cancers is undertaken then these measures can be considered as secondary prevention. (3) Tertiary prevention that refers to those actions taken after the onset of disease or an injury with the intention of assisting diseased or disabled people. When the above behaviors are practiced by people who have been diagnosed with a cancer and practice these behaviors to prevent relapses then these can be considered as tertiary prevention.
Question #4: What are common primary prevention measures for cancers?
Answer #4: The most important modification of lifestyle risk factors are (1) exposure to tobacco use and environmental tobacco smoke. Tobacco causes 80-90% of lung cancer deaths. (2) Dietary modification is another important measure for cancer prevention — consuming fruits and vegetables offers protection against cancers and avoiding saturated fats particularly red meat also protects against colorectal cancer. (3) Regular physical activity is helpful in preventing a number of cancers. (4) Avoiding drinking of alcohol is also important in prevention of cancers of liver, oral cavity, esophagus, and breast. (5) Reducing exposure to sun rays, especially in western countries.
There are some cancers caused by infective agents. Liver cancer is caused by viral hepatitis B and C. Cervical cancer is caused by human papilloma virus (HPV). The chances of stomach cancer are increased by infection from the bacterium Helicobacter pylori. Bladder cancer risk is increased by parasitic flat worm infection schistosomiasis. Cancer of the bile ducts is related to infestation by liver fluke. There are vaccines available for some of these maladies such as HPV vaccine while general preventive measures need to be instituted for other infections.
There are some cancers caused by exposure to occupational hazards. Examples of some occupational carcinogens include asbestos which can lead to lung cancer, coal tar which can lead to skin cancers, aniline dyes which can cause bladder cancer and benzene which can lead to leukemia. Specific protection against carcinogens is a useful prevention measure. Excessive exposure to ultraviolet (UV) radiation in sunlight is responsible for skin cancers (squamous and basal cell carcinomas). Avoiding excessive exposure to sun, wearing sun screens and protective clothing are some measures to prevent such cancers from occurring. General practitioners can play an important role in educating patients and their families about cancer prevention.
Question #5: What are common measures for secondary prevention of cancers?
Answer #5: Secondary prevention of cancers requires effective screening programs for early identification. Earlier the identification and treatment, better the outcome. . General practitioners are in the best position to influence this level of prevention. The early warning signs of cancers are
(i) any lump in any part of the body,
(ii) abnormal bleeding,
(iii) sores that fail to heal,
(iv) persistent indigestion
(v) difficulty in swallowing
(vi) change in bowel movements, and
(vii) chronic hoarseness.
Regular breast self-examination and periodic mammography are helpful in detecting breast cancers. Likewise having regular Papanicolaou (Pap) test for screening of cervical cancer is another example of secondary prevention. Another screening test is prostate specific antigen (PSA) blood test for detecting prostate cancer. For colorectal cancer a combination of fecal occult blood test, flexible sigmoidoscopy, double contrast barium enema, and colonoscopy are recommended.
Question #6: What is tertiary prevention of cancers or common treatments of cancers?
Answer #6: Interventions are required which are of four broad types (1) medical/surgical/palliative, (2) psychological, (3) social, and (4) spiritual (meditational). It is ideal for the interventions to be a combination of all four.
Question #7: Does having social support in the form of family and friends work for cancers?
Answer #7: Social support is crucial. House (1981) classified social support into four types: (1) emotional support, which entails providing understanding, love, caring, and reliance; (2) informational support, which entails providing information, guidance, and counsel; (3) instrumental support, which entails providing concrete assistance and support; and (4) appraisal support, which entails providing evaluative assistance. Social support can be naturally occurring, in the form of parents, spouse, other family members, and friends, or it can be created artificially by the health professionals and through support groups.
Question #8: What psychological interventions are available to help cope with cancers?
Answer #8: Cancer is a crisis for most of the people. The overall goals of psychological interventions are to harmonize personal emotions and thoughts. There are different modalities that can be broadly classified as (1) behavior therapy in which maladaptive behaviors are corrected; (2) cognitive behavioral therapy (CBT) in which dysfunctional emotions, behaviors and cognitions are addressed through a goal-oriented, systematic approach; (3) psychotherapy in which past conflicts are resolved; (4) dialectical behavior therapy (DBT) that combines CBT with distress tolerance, acceptance, and mindfulness; (5) interpersonal therapy that improves relationships; (6) client centered therapy that uses positive regard to the patient; (7) transactional analysis that improves relationships.
Question #9: Is spirituality important in cancers?
Answer #9: Each person has a spiritual orientation of his/her own. It is energizing these which is vital to addresses the multiple challenges of living with cancer. For example, prayers are like the first generation interventions in spiritual paradigm and suitable for children. However, spiritual interventions have moved from first generation prayer-based interventions (bhakti yoga) to knowledge-based (gyana yoga) to action-based (selfless service – karma yoga) to meditation-based (raja yoga) precision interventions. There is a growing body of literature on the utility of meditational techniques in management of emotional distress and promote emotional health. A combinational approach of all four modalities is also very effective.
Question #10: Do the four modalities of treatment apply only to cancers?
Answer #10: These apply to all illnesses because the triune of body, mind and spirit is not separate but only artificially separated because of fragmented knowledge of health professionals.
In conclusion, it is relevant to everyone diagnosed with cancer, to recognize the multiple causes of cancer, the wide variety of changes that occur in life following the diagnosis, as part of treatment and in the phase of recovery. There are a wide range of interventions within the reach of each of us to take steps to minimize the impact and to regain emotional health.
House, J. S. (1981). Work, stress and social support. reading, MA: Addisson-Wesley.
Sharma, M. (2018). Introspective meditations for complete contentment (Santosha). Omaha, NE:
Health for All.
Sharma, M., & Atri, A. (2010). Essentials of international health. Sudbury, MA: Jones and
Sharma, M., Branscum, P., & Atri, A. (2014). Introduction to community and public health. San
Srinivasa Murthy, R. (2018). My emotional health, my choice. [Online Blogpost]. Retrieved
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