MEDICAL SECOND OPINION
What is Cancer?


Cells, which are the building blocks of the body, come together to form tissues, and tissues to form organs. In this cycle, cancer begins at the cellular stage, not in organs and tissues. 


Normally, these cells form, grow, divide according to the body's needs, and produce the new cells needed. When they get old, they die and are replaced by new ones. 


Sometimes this cycle is broken and too many cells are formed beyond the body's control, or old cells do not die when they should. The tissue mass formed as a result of the uncontrolled growth of these abnormal cells is called a tumor. Tumors can be benign or malignant. Malignant ones, namely cancers; 



    seriously threaten life, 



    sometimes they can be removed from the body but can regrow, meaning they can recur. 


    Cancer cells can spread to and damage neighboring organs and tissues. They can jump not only to neighboring but also distant organs and form new tumors. 


Causes of Cancer (Risk of Cancer)  


What Factors Cause Cancer? 


Cancer development occurs after a very complex set of mechanisms. Today, it is accepted that cancer is a genetic disease. This means that it is not possible for cancer to develop without changes in the genetic makeup of a normal cell. The development of cancer is the result of successive carcinogenic effects. Each of the disorders observed in cancer development is corrected by different defense mechanisms, and our immune system also plays an active role in the recognition and elimination of such disorders. However, cancer can still develop despite these. Among the main reasons for this are the ineffectiveness of defense mechanisms and deficiencies in the immune system. As a result, cells that have gained the quality of cancer find the opportunity to multiply in excessive amounts and cause the disease tables we know as cancer. 


Scientific studies show that factors such as the following increase the risk of developing cancer. 


External Factors (85%):Smoking, alcohol, chemicals, radiation, some infections, unhealthy diet, air pollution, lack of activity and being overweight 


Internal Factors (15%):Hereditary causes, changes, immune deficiencies, hormonal and metabolic disorders. 


These factors can initiate cancer formation by acting together or sequentially. 


Cancer Stages


Cancer Staging


In the light of the results of many scientific studies, various stagings have been made in cancer diseases as it is important to know whether cancer patients will receive treatment or not, to determine the most effective treatment methods if they will receive treatment, to obtain information about the possible expected life expectancy of cancer patients. 


In cancer, staging is done in solid organ cancers as stage 1-2-3-4 according to tumor characteristics such as tumor diameter, which is called TNM for short, lymph node involvement, M= distant metastasis, and staging as four stages and subgroups. In addition to this staging, another staging system called the FIGO staging system is also used in gynecological cancers. 


In addition to staging in solid organ cancers, another important form of tumor grading is grading from 0 to 4 according to the degree of differentiation (differentiation) of the tumor from the best to the worst. Patients with good grade (0-1 grade) tumor types in this type of evaluation and stage 1-2 early stage cancer in TNM staging have a much higher rate of cure with treatments, and the survival time and rates of these early stage cancer patients are also very high. 


Surgery or sometimes radiotherapy alone is sufficient for most early-stage cancers. Chemotherapy is often added to treatments in intermediate and advanced cancers with stage 3-4 and/or grade 2-4 cancers. The treatment of these moderate-advanced cancer patients is more difficult, and their survival rates and rates seem to be lower than those with early-stage cancer. 


The Ann Arbor Staging system is used for lymph node cancers, and the world health organization staging system, often called WHO, is used for blood cancers. According to the stages in the lymph node and blood cancer staging system, the disease is evaluated as early-moderate-advanced stage, and treatment planning is made accordingly. 


In addition, grading is performed from first to fourth degree in brain cancers, and it is planned to add radiotherapy and chemotherapy treatments in addition to surgery according to the grade of the tumor. 


As a result, staging in cancer is a very important process for planning the treatments in cancer disease, estimating the survival times brought by the disease, and evaluating the cancer in the most accurate way by all relevant physicians in a multidisciplinary manner and making the most accurate decisions. 


In cancer patients, the most important action that an oncologist should do at the time of cancer diagnosis should be the staging evaluation. 


Cancer in Turkey and the World


Cancer is the most common cause of death after cardiovascular diseases in Turkey and in the world. Lung cancer in men and breast cancer in women are the most common cancers worldwide. Certain cancers are more prominent in different geographies of the world. An increase in cancer types such as stomach cancer in East Asian communities, HPV-related cervical cancer in South Asia, hepatitis, HIV, HPV, etc. virus-related cancers in African communities, and breast and colon cancers in developed western societies have been detected. There is an increasing trend in stomach, colon and breast cancers all over the world and in Turkey. When we look at the frequency of cancer in Turkey, lung-bronchial and prostate cancers are observed most frequently in men, while breast and thyroid cancers are prominent in women. Prostate and colon cancers, which are increasing in developed western societies, have started to be an increasing type of cancer in our country. Differences in the incidence of cancer types have been revealed in the world and in Turkey according to the increase in life expectancy, diet, exposure to environmental carcinogenic substances and the frequency of cancer-related virus infections. 


What is Oncology?


The branch of medicine that studies tumors is called Oncology. It is an idiom formed by the combination of the Latin words oncos (= swelling) and logos (). 


What are the Disciplines Dealing with Oncology? 


These are surgical oncology, medical oncology and radiation oncology. With joint work, the treatment and follow-up of patients can be monitored more closely. Surgical oncology is very effective in diagnosing the disease and removing the existing tumor in the patient. Many surgical disciplines are in this group (General Surgery, Otorhinolaryngology, Neurosurgery, Thoracic Surgery, orthopedics, etc.). Treatment is continued with cancer drugs and radiotherapy in patients who are diagnosed after surgical treatment or in those who have a disease that has spread beyond surgery. Drug treatment of cancer diseases is carried out by Medical Oncology (Pediatric Oncology for children), and radiotherapy is performed by Radiation Oncology. As it can be understood from all these processes, cancer requires more than one medical discipline to work together. 


Frequently Asked Questions



    What should I do when cancer is suspected or diagnosed?


A medical oncology specialist, who is a specialist in the follow-up and treatment management of cancer patients, should be consulted. 



    There are so many recommendations, how should I decide on my treatment?


When it comes to a serious disease such as cancer, the suggestions coming from other patients can be very diverse and confusing, even demoralizing. At this point, getting a second opinion from another specialist physician may be helpful in increasing the accuracy of treatment and comfort. 



    What will happen to me in cancer treatment?


During the treatment process, patients may encounter surgery, radiotherapy, chemotherapy, radioactive drug treatments or some interventional radiological methods. 



    What are the units involved in cancer treatment?


Surgical branches (organ-specific tumor surgery units, for example; gynecological oncology, surgical oncology), radiation oncology and medical oncology. 



    Is it necessary to apply surgery, radiotherapy, and chemotherapy all?


No. The treatment method that should be applied varies according to the organ where the cancer originates, the cell type and the stage of the disease. 



    Is it dangerous to have surgery to treat cancer?


Contrary to this popular saying, surgery cures the disease if it is done by expert and experienced surgeons. 



    How is the order of treatment determined?


The current treatment method for the oncology patients are decided with the treatment methods to be applied and their order with a multidisciplinary approach organized with the participation of the relevant branches in the oncology councils formed in the relevant centers. 



    Is chemotherapy necessary?


It would not be right to say that it is absolutely necessary. As mentioned before, the methods to be applied for the patient vary according to the organ, cell type and stage of the cancer. Some cancer types cannot be treated without chemotherapy (for example, leukemia, lymphoma). 



    When and how should the surgery be performed?


Surgery is the curative treatment option for some types of cancer in the early stages (for example, breast cancer, colon cancer, etc.). However, in some advanced cancers, surgical treatment can be applied if certain conditions are met. 



    What is radiotherapy and how is it applied?


It is applied in order to destroy the tumor in a region by using some radioactive elements and directing the generated radiation to the cancerous areas by means of special devices. 



    How can I use integrative medicine, ie. complementary therapies?


Since this subject is a field that is prone to abuse, it is recommended to apply to medical doctors who are certified in the field of integrative, ie. complementary medicine, that have knowledge and experience in this field. 



    What does smart medicine mean, how is its application decided?


With the increase in molecular discoveries in recent years, molecular targets have been found in some cancer types. As a result of long researches, drugs targeting these molecular points have been developed and new ones are added to them every day. Thus, targeted drugs that hit cancer more precisely are developed for different types of cancer. In order for them to be used, cancer cells must have these targets (biomarkers). These biomarkers should be examined during the pathological examination of cancer cells by special staining methods or by subjecting them to special genetic examinations. 



    Why is genetic testing done for treatment, and at what stage is it necessary? 


The reason for applying genetic tests was also explained in the previous question. These genetic tests are required at the stage of applying systemic chemotherapy to the patient. 

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