This is an accepted version of this page
127-469: Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors , which do not spread. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight loss, and a change in bowel movements . While these symptoms may indicate cancer, they can also have other causes. Over 100 types of cancers affect humans. Tobacco use
254-534: A CT scan appears as good as standard colonoscopy for detecting cancers and large adenomas but is expensive, associated with radiation exposure, and cannot remove any detected abnormal growths as standard colonoscopy can. Stool DNA screening test looks for biomarkers associated with colorectal cancer and precancerous lesions, including altered DNA and blood hemoglobin . A positive result should be followed by colonoscopy . FIT-DNA has more false positives than FIT and thus results in more adverse effects. Further study
381-402: A benign tumor , often in the form of a polyp , which over time becomes cancerous . Colorectal cancer may be diagnosed by obtaining a sample of the colon during a sigmoidoscopy or colonoscopy . This is then followed by medical imaging to determine whether the disease has spread. Screening is effective for preventing and decreasing deaths from colorectal cancer. Screening, by one of
508-460: A cancer precursor or cancer of the colon over 30 years. Those with a family history in two or more first-degree relatives (such as a parent or sibling) have a two to threefold greater risk of disease, and this group accounts for about 20% of all cases. A number of genetic syndromes are also associated with higher rates of colorectal cancer. The most common of these is hereditary nonpolyposis colorectal cancer (HNPCC, or Lynch syndrome) which
635-488: A " great imitator ". People may become anxious or depressed post-diagnosis. The risk of suicide in people with cancer is approximately double. Local symptoms may occur due to the mass of the tumor or its ulceration. For example, mass effects from lung cancer can block the bronchus resulting in cough or pneumonia ; esophageal cancer can cause narrowing of the esophagus , making it difficult or painful to swallow; and colorectal cancer may lead to narrowing or blockages in
762-404: A combination of sufficient exercise and eating a healthy diet . Current research consistently links eating more red meat and processed meat to a higher risk of the disease. Starting in the 1970s, dietary recommendations to prevent colorectal cancer often included increasing the consumption of whole grains , fruits and vegetables, and reducing the intake of red meat and processed meats . This
889-470: A concern. This includes that studies have not found a consistent link between mobile phone radiation and cancer risk. The vast majority of cancers are non-hereditary (sporadic). Hereditary cancers are primarily caused by an inherited genetic defect. Less than 0.3% of the population are carriers of a genetic mutation that has a large effect on cancer risk and these cause less than 3–10% of cancer. Some of these syndromes include: certain inherited mutations in
1016-645: A correspondingly higher level of prostate cancer. Men of Asian ancestry, with the lowest levels of testosterone-activating androstanediol glucuronide , have the lowest levels of prostate cancer. Disease A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury . Diseases are often known to be medical conditions that are associated with specific signs and symptoms . A disease may be caused by external factors such as pathogens or by internal dysfunctions. For example, internal dysfunctions of
1143-512: A deactivating mutation in at least half of colorectal cancers. Sometimes TGF-β is not deactivated, but a downstream protein named SMAD is deactivated. DCC commonly has a deleted segment of a chromosome in colorectal cancer. Approximately 70% of all human genes are expressed in colorectal cancer, with just over 1% of having increased expression in colorectal cancer compared to other forms of cancer. Some genes are oncogenes : they are overexpressed in colorectal cancer. For example, genes encoding
1270-523: A description of the microscopical characteristics of the tumor tissue, including both tumor cells and how the tumor invades into healthy tissues and finally if the tumor appears to be completely removed. The most common form of colon cancer is adenocarcinoma , constituting between 95% and 98% of all cases of colorectal cancer. Other, rarer types include lymphoma , adenosquamous and squamous cell carcinoma . Some subtypes are more aggressive. Immunohistochemistry may be used in uncertain cases. Staging of
1397-612: A disease can alter the affected person's perspective on life. Death due to disease is called death by natural causes . There are four main types of disease: infectious diseases, deficiency diseases , hereditary diseases (including both genetic and non-genetic hereditary diseases ), and physiological diseases. Diseases can also be classified in other ways, such as communicable versus non-communicable diseases. The deadliest diseases in humans are coronary artery disease (blood flow obstruction), followed by cerebrovascular disease and lower respiratory infections . In developed countries,
SECTION 10
#17327657720761524-424: A disease or other health problems. In the medical field, therapy is synonymous with the word treatment . Among psychologists, the term may refer specifically to psychotherapy or "talk therapy". Common treatments include medications , surgery , medical devices , and self-care . Treatments may be provided by an organized health care system , or informally, by the patient or family members. Preventive healthcare
1651-463: A distinct set of genetic events, hypermutated tumors display mutated forms of ACVR2A , TGFBR2 , MSH3 , MSH6 , SLC9A9, TCF7L2 , and BRAF . The common theme among these genes, across both tumor types, is their involvement in Wnt and TGF-β signaling pathways, which results in increased activity of MYC , a central player in colorectal cancer. Mismatch repair (MMR) deficient tumours are characterized by
1778-403: A follow-up colonoscopy examination. When done once every 1–2 years, FOBT screening reduces colorectal cancer deaths by 16% and among those participating in screening, colorectal cancer deaths can be reduced up to 23%, although it has not been proven to reduce all-cause mortality. Immunochemical tests are accurate and do not require dietary or medication changes before testing. However, research in
1905-496: A malignant tumor. They include: The progression from normal cells to cells that can form a detectable mass to cancer involves multiple steps known as malignant progression. When cancer begins, it produces no symptoms. Signs and symptoms appear as the mass grows or ulcerates . The findings that result depend on cancer's type and location. Few symptoms are specific . Many frequently occur in individuals who have other conditions. Cancer can be difficult to diagnose and can be considered
2032-447: A minority of these patients. When local recurrence occurs, periodic follow up can detect it when it is still small and curable with salvage surgery. In addition, MRI tumor regression grades can be assigned after chemoradiotherapy which correlate with patients' long-term survival outcomes. The histopathologic characteristics of the tumor are reported from the analysis of tissue taken from a biopsy or surgery. A pathology report contains
2159-399: A number of methods, is recommended starting from the age of 45 to 75. It was recommended starting at age 50 but it was changed to 45 due to increasing amount of colon cancers. During colonoscopy, small polyps may be removed if found. If a large polyp or tumor is found, a biopsy may be performed to check if it is cancerous. Aspirin and other non-steroidal anti-inflammatory drugs decrease
2286-416: A number of positive and negative effects on the financial and other responsibilities of governments, corporations, and institutions towards individuals, as well as on the individuals themselves. The social implication of viewing aging as a disease could be profound, though this classification is not yet widespread. Lepers were people who were historically shunned because they had an infectious disease, and
2413-422: A partly or completely genetic basis (see genetic disorder ) and may thus be transmitted from one generation to another. Social determinants of health are the social conditions in which people live that determine their health. Illnesses are generally related to social, economic, political, and environmental circumstances . Social determinants of health have been recognized by several health organizations such as
2540-563: A persistent fever . Shortness of breath, called dyspnea , is a common symptom of cancer and its treatment. The causes of cancer-related dyspnea can include tumors in or around the lung, blocked airways, fluid in the lungs, pneumonia, or treatment reactions including an allergic response . Treatment for dyspnea in patients with advanced cancer can include fans , bilevel ventilation, acupressure / reflexology and multicomponent nonpharmacological interventions . Some systemic symptoms of cancer are caused by hormones or other molecules produced by
2667-458: A person's life was shortened due to a disease. For example, if a person dies at the age of 65 from a disease, and would probably have lived until age 80 without that disease, then that disease has caused a loss of 15 years of potential life. YPLL measurements do not account for how disabled a person is before dying, so the measurement treats a person who dies suddenly and a person who died at the same age after decades of illness as equivalent. In 2004,
SECTION 20
#17327657720762794-474: A process of progressive genetic mutation. Central to the polyp to CRC sequence are gene mutations, epigenetic alterations, and local inflammatory changes. The polyp to CRC sequence can be used as an underlying framework to illustrate how specific molecular changes lead to various cancer subtypes. The term "field cancerization" was first used in 1953 to describe an area or "field" of epithelium that has been preconditioned (by what were largely unknown processes at
2921-399: A quarter of all cases are preventable. Increasing surveillance, engaging in physical activity, consuming a diet high in fiber, quitting smoking and limiting alcohol consumption decrease the risk. Lifestyle risk factors with strong evidence include lack of exercise, cigarette smoking, alcohol, and obesity. The risk of colon cancer can be reduced by maintaining a normal body weight through
3048-458: A relatively high amount of poly-nucleotide tandem repeats . This is caused by a deficiency in MMR proteins – which are typically caused by epigenetic silencing and or inherited mutations ( e.g. , Lynch syndrome ). 15 to 18 percent of colorectal cancer tumours have MMR deficiencies, with 3 percent developing due to Lynch syndrome. The role of the mismatch repair system is to protect the integrity of
3175-738: A role in the development of colorectal cancer. Ashkenazi Jews have a 6% higher risk rate of getting adenomas and then colon cancer due to mutations in the APC gene being more common. Colorectal cancer is a disease originating from the epithelial cells lining the colon or rectum of the gastrointestinal tract , most frequently as a result of genetic mutations in the Wnt signaling pathway that increases signaling activity. The Wnt signaling pathway normally plays an important role for normal function of these cells including maintaining this lining. Mutations can be inherited or acquired , and most probably occur in
3302-539: A role. Oncoviruses (viruses that can cause human cancer) include: Bacterial infection may also increase the risk of cancer, as seen in Parasitic infections associated with cancer include: Radiation exposure such as ultraviolet radiation and radioactive material is a risk factor for cancer. Many non-melanoma skin cancers are due to ultraviolet radiation, mostly from sunlight. Sources of ionizing radiation include medical imaging and radon gas. Ionizing radiation
3429-450: A tumor suppressor, normally inhibits PI3K, but can sometimes become mutated and deactivated. Comprehensive, genome -scale analysis has revealed that colorectal carcinomas can be categorized into hypermutated and non-hypermutated tumor types. In addition to the oncogenic and inactivating mutations described for the genes above, non-hypermutated samples also contain mutated CTNNB1 , FAM123B , SOX9 , ATM , and ARID1A . Progressing through
3556-443: Is a common metaphor for addictions : The alcoholic is enslaved by drink, and the smoker is captive to nicotine. Some cancer patients treat the loss of their hair from chemotherapy as a metonymy or metaphor for all the losses caused by the disease. Some diseases are used as metaphors for social ills: "Cancer" is a common description for anything that is endemic and destructive in society, such as poverty, injustice, or racism. AIDS
3683-498: Is a way to avoid an injury, sickness, or disease in the first place. A treatment or cure is applied after a medical problem has already started. A treatment attempts to improve or remove a problem, but treatments may not produce permanent cures, especially in chronic diseases . Cures are a subset of treatments that reverse diseases completely or end medical problems permanently. Many diseases that cannot be completely cured are still treatable. Pain management (also called pain medicine)
3810-412: Is about 2. The corresponding relative risk is 1.5 for lung cancer, and 1.9 for prostate cancer . For breast cancer, the relative risk is 1.8 with a first-degree relative having developed it at 50 years of age or older, and 3.3 when the relative developed it when being younger than 50 years of age. Taller people have an increased risk of cancer because they have more cells than shorter people. Since height
3937-419: Is an enemy that must be feared, fought, battled, and routed. The patient or the healthcare provider is a warrior , rather than a passive victim or bystander. The agents of communicable diseases are invaders ; non-communicable diseases constitute internal insurrection or civil war . Because the threat is urgent, perhaps a matter of life and death, unthinkably radical, even oppressive, measures are society's and
Cancer - Misplaced Pages Continue
4064-425: Is associated with a modest reduction in colon but not rectal cancer risk. High levels of physical activity reduce the risk of colon cancer by about 21%. Sitting regularly for prolonged periods is associated with higher mortality from colon cancer. Regular exercise does not negate the risk but does lower it. Aspirin and celecoxib appear to decrease the risk of colorectal cancer in those at high risk. Aspirin
4191-485: Is associated with colorectal cancer. Some strains of Streptococcus bovis/Streptococcus equinus complex are consumed by millions of people daily and thus may be safe. 25 to 80% of people with Streptococcus bovis/gallolyticus bacteremia have concomitant colorectal tumors. Seroprevalence of Streptococcus bovis/gallolyticus is considered as a candidate practical marker for the early prediction of an underlying bowel lesion at high risk population. It has been suggested that
4318-748: Is determined by a CT scan of the chest, abdomen and pelvis. Other potential imaging tests such as PET and MRI may be used in certain cases. MRI is particularly useful to determine local stage of the tumor and to plan the optimal surgical approach. MRI is also performed after completion of neoadjuvant chemoradiotherapy to identify patients who achieve complete response. Patients with complete response on both MRI and endoscopy may not require surgical resection and can avoid unnecessary surgical morbidity and complications. Patients selected for non-surgical treatment of rectal cancer should have periodic MRI scans, receive physical examinations, and undergo endoscopy procedures to detect any tumor re-growth which can occur in
4445-507: Is effective for both early detection and for prevention. Diagnosis of cases of colorectal cancer through screening tends to occur 2–3 years before diagnosis of cases with symptoms. Any polyps that are detected can be removed, usually by colonoscopy or sigmoidoscopy , and thus prevent them from turning into cancer. Screening has the potential to reduce colorectal cancer deaths by 60%. The three main screening tests are colonoscopy, fecal occult blood testing, and flexible sigmoidoscopy . Of
4572-708: Is evidence that more than 80% of the somatic mutations found in mutator phenotype human colorectal tumors occur before the onset of terminal clonal expansion." Similarly, Vogelstein et al. pointed out that more than half of somatic mutations identified in tumors occurred in a pre-neoplastic phase (in a field defect), during growth of apparently normal cells. Likewise, epigenetic alterations present in tumors may have occurred in pre-neoplastic field defects. An expanded view of field effect has been termed "etiologic field effect", which encompasses not only molecular and pathologic changes in pre-neoplastic cells but also influences of exogenous environmental factors and molecular changes in
4699-548: Is far more common in societies in which most members live until they reach the age of 80 than in societies in which most members die before they reach the age of 50. An illness narrative is a way of organizing a medical experience into a coherent story that illustrates the sick individual's personal experience. People use metaphors to make sense of their experiences with disease. The metaphors move disease from an objective thing that exists to an affective experience. The most popular metaphors draw on military concepts: Disease
4826-534: Is generally not a transmissible disease . Exceptions include rare transmissions that occur with pregnancies and occasional organ donors . However, transmissible infectious diseases such as hepatitis B , Epstein-Barr virus , Human Papilloma Virus and HIV , can contribute to the development of cancer. Exposure to particular substances have been linked to specific types of cancer. These substances are called carcinogens . Tobacco smoke , for example, causes 90% of lung cancer. Tobacco use can cause cancer throughout
4953-411: Is genetically determined to a large extent, taller people have a heritable increase of cancer risk. Some substances cause cancer primarily through their physical, rather than chemical, effects. A prominent example of this is prolonged exposure to asbestos , naturally occurring mineral fibers that are a major cause of mesothelioma (cancer of the serous membrane ) usually the serous membrane surrounding
5080-889: Is known. The most known and used classification of diseases is the World Health Organization 's ICD . This is periodically updated. Currently, the last publication is the ICD-11 . Diseases can be caused by any number of factors and may be acquired or congenital . Microorganisms , genetics, the environment or a combination of these can contribute to a diseased state. Only some diseases such as influenza are contagious and commonly believed infectious. The microorganisms that cause these diseases are known as pathogens and include varieties of bacteria, viruses, protozoa, and fungi. Infectious diseases can be transmitted, e.g. by hand-to-mouth contact with infectious material on surfaces, by bites of insects or other carriers of
5207-644: Is more common in developed countries , where more than 65% of cases are found. It is less common in women than men. The signs and symptoms of colorectal cancer depend on the location of the tumor in the bowel , and whether it has spread elsewhere in the body ( metastasis ). The classic warning signs include: worsening constipation , blood in the stool , decrease in stool caliber (thickness), loss of appetite, loss of weight, and nausea or vomiting in someone over 50 years old. Around 50% of people who have colorectal cancer do not report any symptoms. Rectal bleeding or anemia are high-risk symptoms in people over
Cancer - Misplaced Pages Continue
5334-647: Is more common in Japan due to its high-salt diet while colon cancer is more common in the United States. Immigrant cancer profiles mirror those of their new country, often within one generation. Worldwide, approximately 18% of cancer deaths are related to infectious diseases . This proportion ranges from a high of 25% in Africa to less than 10% in the developed world. Viruses are the usual infectious agents that cause cancer but bacteria and parasites may also play
5461-399: Is mutated in most colon cancers, some cancers have increased β-catenin because of mutations in β-catenin (CTNNB1) that block its own breakdown, or have mutations in other genes with function similar to APC such as AXIN1 , AXIN2 , TCF7L2 , or NKD1 . Beyond the defects in the Wnt signaling pathway , other mutations must occur for the cell to become cancerous. The p53 protein, produced by
5588-460: Is no reliable evidence that a diet started in adulthood that is low in fat and meat and high in fiber, fruits, and vegetables reduces the risk of CRC by a clinically important degree." Consuming alcoholic drinks and consuming processed meat both increase the risk of colorectal cancer. The 2014 World Health Organization cancer report noted that it has been hypothesized that dietary fiber might help prevent colorectal cancer, but that most studies at
5715-400: Is not inherited , such as lifestyle, economic, and behavioral factors and not merely pollution. Common environmental factors that contribute to cancer death include tobacco use (25–30%), diet and obesity (30–35%), infections (15–20%), radiation (both ionizing and non-ionizing, up to 10%), lack of physical activity , and pollution. Psychological stress does not appear to be a risk factor for
5842-471: Is not a particularly strong mutagen . Residential exposure to radon gas, for example, has similar cancer risks as passive smoking . Radiation is a more potent source of cancer when combined with other cancer-causing agents, such as radon plus tobacco smoke. Radiation can cause cancer in most parts of the body, in all animals and at any age. Children are twice as likely to develop radiation-induced leukemia as adults; radiation exposure before birth has ten times
5969-421: Is predominantly used in the production of Teflon , is known to cause two kinds of cancer. Chemotherapy drugs such as platinum-based compounds are carcinogens that increase the risk of secondary cancers Azathioprine , an immunosuppressive medication , is a carcinogen that can cause primary tumors to develop. Diet, physical inactivity , and obesity are related to up to 30–35% of cancer deaths. In
6096-443: Is present in about 3% of people with colorectal cancer. Other syndromes that are strongly associated with colorectal cancer include Gardner syndrome and familial adenomatous polyposis (FAP). For people with these syndromes, cancer almost always occurs and makes up 1% of the cancer cases. A total proctocolectomy may be recommended for people with FAP as a preventive measure due to the high risk of malignancy. Colectomy, removal of
6223-518: Is recommended in those who are 50 to 60 years old, do not have an increased risk of bleeding, and are at risk for cardiovascular disease to prevent colorectal cancer. It is not recommended in those at average risk. There is tentative evidence for calcium supplementation, but it is not sufficient to make a recommendation. Vitamin D intake and blood levels are associated with a lower risk of colon cancer. As more than 80% of colorectal cancers arise from adenomatous polyps , screening for this cancer
6350-557: Is that branch of medicine employing an interdisciplinary approach to the relief of pain and improvement in the quality of life of those living with pain. Treatment for medical emergencies must be provided promptly, often through an emergency department or, in less critical situations, through an urgent care facility. Epidemiology is the study of the factors that cause or encourage diseases. Some diseases are more common in certain geographic areas, among people with certain genetic or socioeconomic characteristics, or at different times of
6477-400: Is that diseases often cannot be defined and classified clearly, especially when cause or pathogenesis are unknown. Thus diagnostic terms often only reflect a symptom or set of symptoms ( syndrome ). Classical classification of human disease derives from the observational correlation between pathological analysis and clinical syndromes. Today it is preferred to classify them by their cause if it
SECTION 50
#17327657720766604-764: Is the cause of about 22% of cancer deaths. Another 10% are due to obesity , poor diet , lack of physical activity or excessive alcohol consumption . Other factors include certain infections, exposure to ionizing radiation , and environmental pollutants. Infection with specific viruses, bacteria and parasites is an environmental factor causing approximately 16–18% of cancers worldwide. These infectious agents include Helicobacter pylori , hepatitis B , hepatitis C , human papillomavirus infection , Epstein–Barr virus , Human T-lymphotropic virus 1 , Kaposi's sarcoma-associated herpesvirus and Merkel cell polyomavirus . Human immunodeficiency virus (HIV) does not directly cause cancer but it causes immune deficiency that can magnify
6731-409: Is the development of cancer from the colon or rectum (parts of the large intestine ). Signs and symptoms may include blood in the stool , a change in bowel movements , weight loss, abdominal pain and fatigue. Most colorectal cancers are due to lifestyle factors and genetic disorders. Risk factors include diet, obesity , smoking, and lack of physical activity . Dietary factors that increase
6858-454: Is then typically further investigated by medical imaging and confirmed by biopsy . The risk of developing certain cancers can be reduced by not smoking, maintaining a healthy weight, limiting alcohol intake, eating plenty of vegetables, fruits, and whole grains , vaccination against certain infectious diseases, limiting consumption of processed meat and red meat , and limiting exposure to direct sunlight. Early detection through screening
6985-468: Is unknown. Approximately half of the genes that show age-related methylation changes are the same genes that have been identified to be involved in the development of colorectal cancer. These findings may suggest a reason for age being associated with the increased risk of developing colorectal cancer. Epigenetic reductions of DNA repair enzyme expression may likely lead to the genomic and epigenomic instability characteristic of cancer. As summarized in
7112-402: Is useful for cervical and colorectal cancer . The benefits of screening for breast cancer are controversial. Cancer is often treated with some combination of radiation therapy , surgery, chemotherapy and targeted therapy . Pain and symptom management are an important part of care. Palliative care is particularly important in people with advanced disease. The chance of survival depends on
7239-478: The Hmong people . Sickness confers the social legitimization of certain benefits, such as illness benefits, work avoidance, and being looked after by others. The person who is sick takes on a social role called the sick role . A person who responds to a dreaded disease, such as cancer , in a culturally acceptable fashion may be publicly and privately honored with higher social status . In return for these benefits,
7366-562: The MD Anderson Cancer Center additionally considers race to be a risk factor; however, there are equity issues concerning whether this might lead to inequity in clinical decision making. Approximately 10% of cases are linked to insufficient activity. The risk from alcohol appears to increase at greater than one drink per day. Drinking five glasses of water a day is linked to a decrease in the risk of colorectal cancer and adenomatous polyps. Streptococcus gallolyticus
7493-689: The TP53 gene, normally monitors cell division and induces their programmed death if they have Wnt pathway defects. Eventually, a cell line acquires a mutation in the TP53 gene and transforms the tissue from a benign epithelial tumor into an invasive epithelial cell cancer . Sometimes the gene encoding p53 is not mutated, but another protective protein named BAX is mutated instead. Other proteins responsible for programmed cell death that are commonly deactivated in colorectal cancers are TGF-β and DCC ( Deleted in Colorectal Cancer ). TGF-β has
7620-451: The World Health Organization calculated that 932 million years of potential life were lost to premature death. The quality-adjusted life year (QALY) and disability-adjusted life year (DALY) metrics are similar but take into account whether the person was healthy after diagnosis. In addition to the number of years lost due to premature death, these measurements add part of the years lost to being sick. Unlike YPLL, these measurements show
7747-470: The acute phase ; after recovery from chickenpox, the virus may remain dormant in nerve cells for many years, and later cause herpes zoster (shingles). Diseases may be classified by cause, pathogenesis ( mechanism by which the disease is caused), or by symptoms . Alternatively, diseases may be classified according to the organ system involved, though this is often complicated since many diseases affect more than one organ. A chief difficulty in nosology
SECTION 60
#17327657720767874-402: The bowel , affecting bowel habits. Masses in breasts or testicles may produce observable lumps. Ulceration can cause bleeding that can lead to symptoms such as coughing up blood (lung cancer), anemia or rectal bleeding (colon cancer), blood in the urine (bladder cancer), or abnormal vaginal bleeding (endometrial or cervical cancer). Although localized pain may occur in advanced cancer,
8001-582: The immune system and endocrine system . More than half of the effect from the diet is due to overnutrition (eating too much), rather than from eating too few vegetables or other healthful foods. Some specific foods are linked to specific cancers. A high-salt diet is linked to gastric cancer . Aflatoxin B1 , a frequent food contaminant, causes liver cancer. Betel nut chewing can cause oral cancer. National differences in dietary practices may partly explain differences in cancer incidence. For example, gastric cancer
8128-809: The immune system can produce a variety of different diseases, including various forms of immunodeficiency , hypersensitivity , allergies , and autoimmune disorders . In humans, disease is often used more broadly to refer to any condition that causes pain , dysfunction , distress , social problems , or death to the person affected, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries , disabilities , disorders , syndromes , infections , isolated symptoms, deviant behaviors , and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. Diseases can affect people not only physically but also mentally, as contracting and living with
8255-462: The incubation period is the time between infection and the appearance of symptoms. The latency period is the time between infection and the ability of the disease to spread to another person, which may precede, follow, or be simultaneous with the appearance of symptoms. Some viruses also exhibit a dormant phase, called viral latency , in which the virus hides in the body in an inactive state. For example, varicella zoster virus causes chickenpox in
8382-640: The intestinal crypt stem cell . The most commonly mutated gene in all colorectal cancer is the APC gene, which produces the APC protein. The APC protein prevents the accumulation of β-catenin protein. Without APC, β-catenin accumulates to high levels and translocates (moves) into the nucleus , binds to DNA, and activates the transcription of proto- oncogenes . These genes are normally important for stem cell renewal and differentiation, but when inappropriately expressed at high levels, they can cause cancer. While APC
8509-448: The lungs , liver , brain, and the bones . While some cancers can be cured if detected early, metastatic cancer is more difficult to treat and control. Nevertheless, some recent treatments are demonstrating encouraging results. The majority of cancers, some 90–95% of cases, are due to genetic mutations from environmental and lifestyle factors. The remaining 5–10% are due to inherited genetics . Environmental refers to any cause that
8636-455: The tumor microenvironment . Oncogenes build up an inflammatory pro-tumorigenic microenvironment. Hormones also play a role in the development of cancer by promoting cell proliferation . Insulin-like growth factors and their binding proteins play a key role in cancer cell proliferation, differentiation and apoptosis , suggesting possible involvement in carcinogenesis. Hormones are important agents in sex-related cancers, such as cancer of
8763-588: The Public Health Agency of Canada and the World Health Organization to greatly influence collective and personal well-being. The World Health Organization's Social Determinants Council also recognizes Social determinants of health in poverty . When the cause of a disease is poorly understood, societies tend to mythologize the disease or use it as a metaphor or symbol of whatever that culture considers evil. For example, until
8890-627: The UK has found that for these immunochemical tests, the threshold for further investigation is set at a point that may miss more than half of bowel cancer cases. The research suggests that the NHS England's Bowel Cancer Screening Programme could make better use of the test's ability to provide the exact concentration of blood in faeces (rather than only whether it is above or below a cutoff level). Other options include virtual colonoscopy and stool DNA screening testing (FIT-DNA). Virtual colonoscopy via
9017-739: The United States have mirrored smoking patterns, with increases in smoking followed by dramatic increases in lung cancer death rates and, more recently, decreases in smoking rates since the 1950s followed by decreases in lung cancer death rates in men since 1990. In Western Europe, 10% of cancers in males and 3% of cancers in females are attributed to alcohol exposure, especially liver and digestive tract cancers. Cancer from work-related substance exposures may cause between 2 and 20% of cases, causing at least 200,000 deaths. Cancers such as lung cancer and mesothelioma can come from inhaling tobacco smoke or asbestos fibers, or leukemia from exposure to benzene . Exposure to perfluorooctanoic acid (PFOA), which
9144-400: The United States was around 65% in 2014. The individual likelihood of survival depends on how advanced the cancer is, whether or not all the cancer can be removed with surgery, and the person's overall health. Globally, colorectal cancer is the third most common type of cancer, making up about 10% of all cases. In 2018, there were 1.09 million new cases and 551,000 deaths from the disease. It
9271-477: The United States, excess body weight is associated with the development of many types of cancer and is a factor in 14–20% of cancer deaths. A UK study including data on over 5 million people showed higher body mass index to be related to at least 10 types of cancer and responsible for around 12,000 cases each year in that country. Physical inactivity is believed to contribute to cancer risk, not only through its effect on body weight but also through negative effects on
9398-452: The age of 50. Weight loss and changes in a person's bowel habit are typically only concerning if they are associated with rectal bleeding. 75–95% of colorectal cancer cases occur in people with little or no genetic risk. Risk factors include older age, male sex, high intake of fat, sugar , alcohol , red meat , processed meats , obesity , smoking , and a lack of physical exercise . The Rectal Cancer Survival Calculator developed by
9525-520: The articles Carcinogenesis and Neoplasm , for sporadic cancers in general, a deficiency in DNA repair is occasionally due to a mutation in a DNA repair gene, but is much more frequently due to epigenetic alterations that reduce or silence expression of DNA repair genes. Epigenetic alterations involved in the development of colorectal cancer may affect a person's response to chemotherapy. Consensus molecular subtypes (CMS) classification of colorectal cancer
9652-412: The bacterial cause of tuberculosis was discovered in 1882, experts variously ascribed the disease to heredity , a sedentary lifestyle , depressed mood , and overindulgence in sex, rich food, or alcohol, all of which were social ills at the time. When a disease is caused by a pathogenic organism (e.g., when malaria is caused by Plasmodium ), one should not confuse the pathogen (the cause of
9779-410: The body (such as through inhalation) and require years of exposure to produce cancer. Physical trauma resulting in cancer is relatively rare. Claims that breaking bones resulted in bone cancer, for example, have not been proven. Similarly, physical trauma is not accepted as a cause for cervical cancer, breast cancer or brain cancer. One accepted source is frequent, long-term application of hot objects to
9906-399: The body including in the mouth and throat, larynx , esophagus , stomach, bladder, kidney, cervix, colon/rectum, liver and pancreas . Tobacco smoke contains over fifty known carcinogens, including nitrosamines and polycyclic aromatic hydrocarbons . Tobacco is responsible for about one in five cancer deaths worldwide and about one in three in the developed world. Lung cancer death rates in
10033-399: The body. It is possible that repeated burns on the same part of the body, such as those produced by kanger and kairo heaters (charcoal hand warmers ), may produce skin cancer, especially if carcinogenic chemicals are also present. Frequent consumption of scalding hot tea may produce esophageal cancer. Generally, it is believed that cancer arises, or a pre-existing cancer is encouraged, during
10160-525: The breast, endometrium , prostate, ovary and testis and also of thyroid cancer and bone cancer . For example, the daughters of women who have breast cancer have significantly higher levels of estrogen and progesterone than the daughters of women without breast cancer. These higher hormone levels may explain their higher risk of breast cancer, even in the absence of a breast-cancer gene. Similarly, men of African ancestry have significantly higher levels of testosterone than men of European ancestry and have
10287-457: The burden imposed on people who are very sick, but who live a normal lifespan. A disease that has high morbidity, but low mortality, has a high DALY and a low YPLL. In 2004, the World Health Organization calculated that 1.5 billion disability-adjusted life years were lost to disease and injury. In the developed world, heart disease and stroke cause the most loss of life, but neuropsychiatric conditions like major depressive disorder cause
10414-472: The cancer is based on both radiological and pathological findings. As with most other forms of cancer, tumor staging is based on the TNM system which considers how much the initial tumor has spread and the presence of metastases in lymph nodes and more distant organs. The AJCC 8th edition was published in 2018. It has been estimated that about half of colorectal cancer cases are due to lifestyle factors, and about
10541-566: The challenge of defining them. Especially for poorly understood diseases, different groups might use significantly different definitions. Without an agreed-on definition, different researchers may report different numbers of cases and characteristics of the disease. Some morbidity databases are compiled with data supplied by states and territories health authorities, at national levels or larger scale (such as European Hospital Morbidity Database (HMDB)) which may contain hospital discharge data by detailed diagnosis, age and sex. The European HMDB data
10668-469: The colon, may not suffice as a preventive measure because of the high risk of rectal cancer if the rectum remains. The most common polyposis syndrome affecting the colon is serrated polyposis syndrome , which is associated with a 25-40% risk of CRC. Mutations in the pair of genes ( POLE and POLD1 ) have been associated with familial colon cancer. Most deaths due to colon cancer are associated with metastatic disease. A gene that appears to contribute to
10795-464: The developing world. The global total economic costs of cancer were estimated at US$ 1.16 trillion (equivalent to $ 1.62 trillion in 2023) per year as of 2010. The word comes from the ancient Greek καρκίνος , meaning 'crab' and 'tumor'. Greek physicians Hippocrates and Galen , among others, noted the similarity of crabs to some tumors with swollen veins. The word was introduced in English in
10922-617: The disease were portrayed in literature as having risen above daily life to become ephemeral objects of spiritual or artistic achievement. In the 20th century, after its cause was better understood, the same disease became the emblem of poverty, squalor, and other social problems. Signs and symptoms Syndrome Disease Medical diagnosis Differential diagnosis Prognosis Acute Chronic Cure Eponymous disease Acronym or abbreviation Remission Colorectal cancer Colorectal cancer ( CRC ), also known as bowel cancer , colon cancer , or rectal cancer ,
11049-530: The disease) with disease itself. For example, West Nile virus (the pathogen) causes West Nile fever (the disease). The misuse of basic definitions in epidemiology is frequent in scientific publications. Many diseases and disorders can be prevented through a variety of means. These include sanitation , proper nutrition , adequate exercise , vaccinations and other self-care and public health measures, such as obligatory face mask mandates . Medical therapies or treatments are efforts to cure or improve
11176-510: The disease, and from contaminated water or food (often via fecal contamination), etc. Also, there are sexually transmitted diseases . In some cases, microorganisms that are not readily spread from person to person play a role, while other diseases can be prevented or ameliorated with appropriate nutrition or other lifestyle changes. Some diseases, such as most (but not all ) forms of cancer , heart disease , and mental disorders, are non-infectious diseases . Many non-infectious diseases have
11303-444: The diseases that cause the most sickness overall are neuropsychiatric conditions , such as depression and anxiety . The study of disease is called pathology , which includes the study of etiology , or cause. In many cases, terms such as disease , disorder , morbidity , sickness and illness are used interchangeably; however, there are situations when specific terms are considered preferable. In an infectious disease,
11430-642: The documentation of results for submission to peer-reviewed journals. Epidemiologists also study the interaction of diseases in a population, a condition known as a syndemic . Epidemiologists rely on a number of other scientific disciplines such as biology (to better understand disease processes), biostatistics (the current raw information available), Geographic Information Science (to store data and map disease patterns) and social science disciplines (to better understand proximate and distal risk factors). Epidemiology can help identify causes as well as guide prevention efforts. In studying diseases, epidemiology faces
11557-451: The effect. Medical use of ionizing radiation is a small but growing source of radiation-induced cancers. Ionizing radiation may be used to treat other cancers, but this may, in some cases, induce a second form of cancer. It is also used in some kinds of medical imaging . Prolonged exposure to ultraviolet radiation from the sun can lead to melanoma and other skin malignancies. Clear evidence establishes ultraviolet radiation, especially
11684-443: The genes BRCA1 and BRCA2 with a more than 75% risk of breast cancer and ovarian cancer , and hereditary nonpolyposis colorectal cancer (HNPCC or Lynch syndrome), which is present in about 3% of people with colorectal cancer , among others. Statistically for cancers causing most mortality, the relative risk of developing colorectal cancer when a first-degree relative (parent, sibling or child) has been diagnosed with it
11811-516: The genetic material within cells ( i.e. , error detecting and correcting). Consequently, a deficiency in MMR proteins may lead to an inability to detect and repair genetic damage, allowing for further cancer-causing mutations to occur and colorectal cancer to progress. The polyp to cancer progression sequence is the classical model of colorectal cancer pathogenesis . In this adenoma-carcinoma sequence , normal epithelial cells progress to dysplastic cells such as adenomas , and then to carcinoma, by
11938-469: The hypermethylated genes, 10 were hypermethylated in 100% of colon cancers, and many others were hypermethylated in more than 50% of colon cancers. In addition, 11 hypermethylations and 96 hypomethylations of miRNAs were also associated with colorectal cancers. Abnormal (aberrant) methylation occurs as a normal consequence of normal aging and the risk of colorectal cancer increases as a person gets older. The source and trigger of this age-related methylation
12065-476: The initial tumor is usually painless. Some cancers can cause a buildup of fluid within the chest or abdomen . Systemic symptoms may occur due to the body's response to the cancer. This may include fatigue, unintentional weight loss, or skin changes. Some cancers can cause a systemic inflammatory state that leads to ongoing muscle loss and weakness, known as cachexia . Some cancers, such as Hodgkin's disease , leukemias , and liver or kidney cancers , can cause
12192-1000: The local microenvironment on neoplastic evolution from tumor initiation to death. Epigenetic alterations are much more frequent in colon cancer than genetic (mutational) alterations. As described by Vogelstein et al., an average cancer of the colon has only 1 or 2 oncogene mutations and 1 to 5 tumor suppressor mutations (together designated "driver mutations"), with about 60 further "passenger" mutations. The oncogenes and tumor suppressor genes are well studied and are described above under Pathogenesis . In addition to epigenetic alteration of expression of miRNAs, other common types of epigenetic alterations in cancers that change gene expression levels include direct hypermethylation or hypomethylation of CpG islands of protein-encoding genes and alterations in histones and chromosomal architecture that influence gene expression. As an example, 147 hypermethylations and 27 hypomethylations of protein coding genes were frequently associated with colorectal cancers. Of
12319-671: The longer a person has the disease, and the worse the severity of inflammation. In these high risk groups, both prevention with aspirin and regular colonoscopies are recommended. Endoscopic surveillance in this high-risk population may reduce the development of colorectal cancer through early diagnosis and may also reduce the chances of dying from colon cancer. People with inflammatory bowel disease account for less than 2% of colon cancer cases yearly. In those with Crohn's disease, 2% get colorectal cancer after 10 years, 8% after 20 years, and 18% after 30 years. In people who have ulcerative colitis, approximately 16% develop either
12446-438: The lungs. Other substances in this category, including both naturally occurring and synthetic asbestos-like fibers, such as wollastonite , attapulgite , glass wool and rock wool , are believed to have similar effects. Non-fibrous particulate materials that cause cancer include powdered metallic cobalt and nickel and crystalline silica ( quartz , cristobalite and tridymite ). Usually, physical carcinogens must get inside
12573-470: The modern medical sense around 1600. Cancers comprise a large family of diseases that involve abnormal cell growth with the potential to invade or spread to other parts of the body. They form a subset of neoplasms . A neoplasm or tumor is a group of cells that have undergone unregulated growth and will often form a mass or lump, but may be distributed diffusely. All tumor cells show the six hallmarks of cancer . These characteristics are required to produce
12700-644: The month of Ramadan is exempted from the requirement, or even forbidden from participating. People who are sick are also exempted from social duties. For example, ill health is the only socially acceptable reason for an American to refuse an invitation to the White House . The identification of a condition as a disease, rather than as simply a variation of human structure or function, can have significant social or economic implications. The controversial recognition of diseases such as repetitive stress injury (RSI) and post-traumatic stress disorder (PTSD) has had
12827-482: The most years lost to being sick. How a society responds to diseases is the subject of medical sociology . A condition may be considered a disease in some cultures or eras but not in others. For example, obesity was associated with prosperity and abundance, and this perception persists in many African regions, especially since the beginning of the HIV/AIDS . Epilepsy is considered a sign of spiritual gifts among
12954-427: The non-ionizing medium wave UVB , as the cause of most non-melanoma skin cancers , which are the most common forms of cancer in the world. Non-ionizing radio frequency radiation from mobile phones, electric power transmission and other similar sources has been described as a possible carcinogen by the World Health Organization 's International Agency for Research on Cancer . Evidence, however, has not supported
13081-458: The onset of cancer, though it may worsen outcomes in those who already have cancer. Environmental or lifestyle factors that caused cancer to develop in an individual can be identified by analyzing mutational signatures from genomic sequencing of tumor DNA. For example, this can reveal if lung cancer was caused by tobacco smoke, if skin cancer was caused by UV radiation, or if secondary cancers were caused by previous chemotherapy treatment. Cancer
13208-423: The original is called the primary tumor. Almost all cancers can metastasize. Most cancer deaths are due to cancer that has metastasized. Metastasis is common in the late stages of cancer and it can occur via the blood or the lymphatic system or both. The typical steps in metastasis are: Different types of cancers tend to metastasize to particular organs. Overall, the most common places for metastases to occur are
13335-468: The patient's moral duty as they courageously mobilize to struggle against destruction. The War on Cancer is an example of this metaphorical use of language. This language is empowering to some patients, but leaves others feeling like they are failures. Another class of metaphors describes the experience of illness as a journey: The person travels to or from a place of disease, and changes himself, discovers new information, or increases his experience along
13462-579: The potential for metastatic disease, metastasis associated in colon cancer 1 ( MACC1 ), has been isolated. It is a transcriptional factor that influences the expression of hepatocyte growth factor . This gene is associated with the proliferation, invasion, and scattering of colon cancer cells in cell culture , and tumor growth and metastasis in mice. MACC1 may be a potential target for cancer intervention, but this possibility needs to be confirmed with clinical studies. Epigenetic factors, such as abnormal DNA methylation of tumor suppressor promoters, play
13589-459: The presence of antibodies to Streptococcus bovis/gallolyticus antigens or the antigens themselves in the bloodstream may act as markers for the carcinogenesis in the colon. Pathogenic Escherichia coli may increase the risk of colorectal cancer by producing the genotoxic metabolite , colibactin . People with inflammatory bowel disease ( ulcerative colitis and Crohn's disease ) are at increased risk of colon cancer. The risk increases
13716-858: The previous decade increases of 26% and 21%, respectively. The most common types of cancer in males are lung cancer , prostate cancer , colorectal cancer , and stomach cancer . In females, the most common types are breast cancer , colorectal cancer, lung cancer, and cervical cancer . If skin cancer other than melanoma were included in total new cancer cases each year, it would account for around 40% of cases. In children, acute lymphoblastic leukemia and brain tumors are most common, except in Africa, where non-Hodgkin lymphoma occurs more often. In 2012, about 165,000 children under 15 years of age were diagnosed with cancer. The risk of cancer increases significantly with age, and many cancers occur more commonly in developed countries. Rates are increasing as more people live to an old age and as lifestyle changes occur in
13843-436: The previously introduced consensus molecular subtypes (CMSs) and EpiCs could significantly enhance current treatment strategies. Colorectal cancer diagnosis is performed by sampling of areas of the colon suspicious for possible tumor development, typically during colonoscopy or sigmoidoscopy, depending on the location of the lesion. A colorectal cancer is sometimes initially discovered on CT scan . Presence of metastases
13970-399: The process of healing, rather than directly by the trauma. However, repeated injuries to the same tissues might promote excessive cell proliferation, which could then increase the odds of a cancerous mutation. Chronic inflammation has been hypothesized to directly cause mutation. Inflammation can contribute to proliferation, survival, angiogenesis and migration of cancer cells by influencing
14097-415: The proteins KRAS , RAF , and PI3K , which normally stimulate the cell to divide in response to growth factors, can acquire mutations that result in over-activation of cell proliferation. The chronological order of mutations is sometimes important. If a previous APC mutation occurred, a primary KRAS mutation often progresses to cancer rather than a self-limiting hyperplastic or borderline lesion. PTEN ,
14224-614: The risk due to other infections, sometimes up to several thousand fold (in the case of Kaposi's sarcoma ). Importantly, vaccination against hepatitis B and human papillomavirus have been shown to nearly eliminate risk of cancers caused by these viruses in persons successfully vaccinated prior to infection. These environmental factors act, at least partly, by changing the genes of a cell. Typically, many genetic changes are required before cancer develops. Approximately 5–10% of cancers are due to inherited genetic defects. Cancer can be detected by certain signs and symptoms or screening tests. It
14351-408: The risk include red meat , processed meat , and alcohol . Another risk factor is inflammatory bowel disease , which includes Crohn's disease and ulcerative colitis . Some of the inherited genetic disorders that can cause colorectal cancer include familial adenomatous polyposis and hereditary non-polyposis colon cancer ; however, these represent less than 5% of cases. It typically starts as
14478-531: The risk of pain during polyp excision. Their general use is not recommended for this purpose, however, due to side effects. Treatments used for colorectal cancer may include some combination of surgery, radiation therapy , chemotherapy , and targeted therapy . Cancers that are confined within the wall of the colon may be curable with surgery, while cancer that has spread widely is usually not curable, with management being directed towards improving quality of life and symptoms. The five-year survival rate in
14605-402: The sick person is obligated to seek treatment and work to become well once more. As a comparison, consider pregnancy , which is not interpreted as a disease or sickness, even if the mother and baby may both benefit from medical care. Most religions grant exceptions from religious duties to people who are sick. For example, one whose life would be endangered by fasting on Yom Kippur or during
14732-826: The term "leper" still evokes social stigma . Fear of disease can still be a widespread social phenomenon, though not all diseases evoke extreme social stigma. Social standing and economic status affect health. Diseases of poverty are diseases that are associated with poverty and low social status; diseases of affluence are diseases that are associated with high social and economic status. Which diseases are associated with which states vary according to time, place, and technology. Some diseases, such as diabetes mellitus , may be associated with both poverty (poor food choices) and affluence (long lifespans and sedentary lifestyles), through different mechanisms. The term lifestyle diseases describes diseases associated with longevity and that are more common among older people. For example, cancer
14859-432: The three, only sigmoidoscopy cannot screen the right side of the colon where 42% of cancers are found. Flexible sigmoidoscopy, however, has the best evidence for decreasing the risk of death from any cause. Fecal occult blood testing (FOBT) of the stool is typically recommended every two years and can be either guaiac-based or immunochemical . If abnormal FOBT results are found, participants are typically referred for
14986-406: The time had not yet studied the correlation. A 2019 review, however, found evidence of benefit from dietary fiber and whole grains. The World Cancer Research Fund listed the benefit of fiber for prevention of colorectal cancer as "probable" as of 2017. A 2022 umbrella review says there is "convincing evidence" for that association. Higher physical activity is recommended. Physical exercise
15113-523: The time) to predispose it towards development of cancer. Since then, the terms "field cancerization", "field carcinogenesis", "field defect", and " field effect " have been used to describe pre-malignant or pre-neoplastic tissue in which new cancers are likely to arise. Field defects are important in progression to colon cancer. However, as pointed out by Rubin, "The vast majority of studies in cancer research has been done on well-defined tumors in vivo , or on discrete neoplastic foci in vitro . Yet there
15240-399: The tumor, known as paraneoplastic syndromes . Common paraneoplastic syndromes include hypercalcemia , which can cause altered mental state , constipation and dehydration, or hyponatremia , which can also cause altered mental status, vomiting, headaches, or seizures. Metastasis is the spread of cancer to other locations in the body. The dispersed tumors are called metastatic tumors, while
15367-457: The type of cancer and extent of disease at the start of treatment. In children under 15 at diagnosis, the five-year survival rate in the developed world is on average 80%. For cancer in the United States, the average five-year survival rate is 66% for all ages. In 2015, about 90.5 million people worldwide had cancer. In 2019, annual cancer cases grew by 23.6 million people, and there were 10 million deaths worldwide, representing over
15494-454: The way. He may travel "on the road to recovery" or make changes to "get on the right track" or choose "pathways". Some are explicitly immigration-themed: the patient has been exiled from the home territory of health to the land of the ill, changing identity and relationships in the process. This language is more common among British healthcare professionals than the language of physical aggression. Some metaphors are disease-specific. Slavery
15621-430: The year. Epidemiology is considered a cornerstone methodology of public health research and is highly regarded in evidence-based medicine for identifying risk factors for diseases. In the study of communicable and non-communicable diseases, the work of epidemiologists ranges from outbreak investigation to study design, data collection, and analysis including the development of statistical models to test hypotheses and
15748-521: Was based on animal studies and retrospective observational studies. However, large scale prospective studies have failed to demonstrate a significant protective effect, and due to the multiple causes of cancer and the complexity of studying correlations between diet and health, it is uncertain whether any specific dietary interventions will have significant protective effects. In 2018 the National Cancer Institute stated that "There
15875-540: Was first introduced in 2015. CMS classification so far has been considered the most robust classification system available for CRC that has a clear biological interpretability and the basis for future clinical stratification and subtype-based targeted interventions. A novel Epigenome-based Classification (EpiC) of colorectal cancer was proposed in 2021 introducing 4 enhancer subtypes in people with CRC. Chromatin states using 6 histone marks are characterized to identify EpiC subtypes. A combinatorial therapeutic approach based on
16002-409: Was seen as a divine judgment for moral decadence, and only by purging itself from the "pollution" of the "invader" could society become healthy again. More recently, when AIDS seemed less threatening, this type of emotive language was applied to avian flu and type 2 diabetes mellitus . Authors in the 19th century commonly used tuberculosis as a symbol and a metaphor for transcendence . People with
16129-510: Was submitted by European countries to the World Health Organization Regional Office for Europe. Disease burden is the impact of a health problem in an area measured by financial cost, mortality, morbidity, or other indicators. There are several measures used to quantify the burden imposed by diseases on people. The years of potential life lost (YPLL) is a simple estimate of the number of years that
#75924