Cancer

If cytotoxic substances (cytostatica or radionuclides) are attached to those polymers therapy of solid tumors shows promising results in some cases. This may become a catalyst for better and more environmentally friendly sanitation in the country. Both effects together are coined the EPR (enhanced permeability and retention) effect and leads to accumulation of macromolecules within some solid tumors. Indian Railways is currently considering Eco-san toilets for its trains. In addition, the lymphatic drainage of tumor tissue is ineffective leading to poor clearance of substances from tumoral interstitium. Due to the number of users, the toilets are often in bad condition. Due to (often) damaged vascular structure of tumor supplying blood vessels, intravenously administered large molecules (size differs in various sources, typically M > 25 - 45 kDa, may depend on chemical structure, solubility, charge, etc.) can preferably leave the bloodstream into tumor tissue while normal blood vessels display a significant barrier for those big molecules (this is not true within glomeruli of the kidney). This causes an accumulation of human waste on the tracks in places where the train stands still, such as in large stations.

Another approach to target solid tumors is to apply macromolecules. a hole in the floor), without any effluent storage tanks on board. RGDs) eventually kill the cancer cell if the nuclide decays in the vicinity of the cell (vide supra Radiation therapy). The toilets on Indian Railways trains are of the direct-vent type (i.e. Radionuclides which are attached to this peptides (e.g. Due to the size of the network and low speeds, journeys can last many days. Targeted therapy can also involve small peptidic structures as ´homing device´ which can bind to cell surface receptors or affected extracellular matrix surrounding the tumor. Sanitation is a significant problem on Indian Railways.

Small molecules (such as the tyrosine kinase inhibitors imatinib and gefitinib) and monoclonal antibodies have proven to be a major step in oncological treatment. In rural areas, cattle and other animals may stray onto the tracks, posing a much more serious safety hazard to fast-moving trains. This constitutes the use of agents specific for the deregulated proteins of cancer cells. Most railway land in India is not fenced or restricted in any way, allowing free trespass. Targeted therapy in the late 1990s was considered a major breakthrough. Reasons given are that suitable bridges or level crossings over the tracks are non-existent or inconveniently placed. While understanding of cancer has increased exponentially since the last decades of the 20th century, radically new therapies are only discovered and introduced gradually. In many places, pedestrians, vehicles or cyclists may cut across the tracks to save time, causing a safety hazard to the railways.

Cancer research is the intense scientific effort to understand disease processes and discover possible therapies. This therefore imposes a strong constraint on the pace at which Indian railways can expand or modernize itself. Palliative care solutions may include permanent or "respite" hospice nursing. As a public utility, the government subsidises the prices as increasing ticket prices often translates into widespread discontent and most often political damage. In the advanced stages of cancer, many patients need extensive care, affecting family members and friends. Railway ticket prices are particularly affected by the fact that India in general is a price-sensitive market. Progressive and disseminated malignant disease has a substantial impact on a cancer patient's quality of life, and many cancer treatments (such as chemotherapy) may have severe side-effects. During this season the reserved compartments are swamped by many without a reserved ticket.

Some types of cancer have a prognosis that is substantially better than nonmalignant diseases such as heart failure and stroke. During the holiday seasons, reserved tickets have to be booked two months in advance, to avoid a generally static waiting list. While this certainly applies to certain particular types, the truths behind the historical connotations of cancer are increasingly being overturned by advances in medical care. Overcrowding is a big issue, with the General compartment often being packed beyond capacity. Once referred to as "the C-word," cancer has a reputation for being a deadly disease. Aging colonial-era bridges and century-old tracks also require regular maintenance and upgrading. Examples include: American Cancer Society, Lance Armstrong Foundation, BC Cancer Agency, Macmillan Cancer Relief , the Terry Fox Foundation, Cancer Research UK, Canadian Cancer Society, International Agency for Research on Cancer and the National Cancer Institute (US). Contributing to the Railways' problems are the antiquated communication, safety equipment and signalling systems.

These organizations often are involved in cancer prevention, cancer treatment, and cancer research. The Konkan Railway route suffers from landslides in the monsoon season, which has caused fatal accidents in the recent past. Many governmental and charitable organizations have been established to help patients cope with cancer. Human error is the primary cause (83%)^[10] blamed for mishaps. Different types of counseling include individual, group, family, self-help (sometimes called peer counseling), bereavement, patient-to-patient, and sexuality. Indian Railways have accepted that given the size of operations, eliminating accidents is a chimerical idea, and at best they can only minimise the accident rate. Counseling can also provide emotional support to cancer patients and help them better understand their illness. Although accidents such as derailment and collisions are less common in recent times, many are run over by trains, especially in crowded areas.

While some people are reluctant to seek counseling, studies show that having someone to talk to reduces stress and helps people both mentally and physically. The main problem plaguing the Railways is the high accident rate which stands at about three hundred^[9] a year. Neighborhood organizations, local health care providers, or area hospitals are a good place to start looking. In a cost cutting move, the Railways plans to minimise unwanted cessations, and scrap unpopular routes. Support can take the form of support groups, counseling, advice, financial assistance, transportation to and from treatment, or information about cancer. A new concern faced by Indian Railways is competition from low cost airlines that has recently made its début in India. Many local organizations offer a variety of practical and support services to people with cancer. In the first two months of India's fiscal year 2005-06 (April and May), the Railways registered a 10% growth in passenger traffic, and a 12% in passenger earnings^[8].

^[7]. The overall passenger traffic grew 7.5% in the previous year. As of October 2005, researchers found that an experimental vaccine for HPV types 16 and 18 was 100% successful at preventing infection with these types of HPV and, thus, are able to prevent the majority of cervical cancer cases. Around 20% of the passenger revenue is earned from the upper class segments of the passenger segment (the air-conditioned classes). No cancer vaccines are presently in use, and most of the research is still in its initial stages. The freight growth was pegged at 7.67% raised from 580 to 600 million tonnes^[7]. Considerable research effort is now devoted to the development of vaccines (to prevent infection by oncogenic infectious agents, as well as to mount an immune response against cancer-specific epitopes) and to potential venues for gene therapy for individuals with genetic mutations or polymorphisms that put them at high risk of cancer. (US$91.8 million).

Almost all physicians recommend against using these modalities as sole treatment for potentially fatal conditions such as cancer. Fund balances was at a figure of Rs. 6,963 cr (US$1,600 million) while the working expenses rose by Rs. 400 cr. An extensive, explanatory catalog of these treatments is available at Quackwatch ^[6]. Freight earnings increased from Rs. 28,745 cr (US$6,600 million) to Rs. 30,450 cr (US$7,000 million) from the previous year. Collectively they are referred to by skeptics as cancer quackery. 466,350 million or US$10,700 million), Rs. 1,838 cr (US$421.8 million) higher than budget estimates. Some of these treatments meet all the criteria for fraud. As per the 2005 budget, Indian Railways earned Rs. 46,635 crores^[6] (Rs.

Alternative treatments have included special diets or dietary supplements (e.g., the "grape diet" or megavitamin therapy), electrical devices (e.g., "zappers"), specially formulated compounds (e.g., laetrile, and homeopathic remedies), unconventional use of conventional drugs (e.g., insulin), purges or enemas, physical manipulations of the body, various herbs or herbal preparations such as essiac. The formation of policy and overall control of the railways is vested in Railway Board comprising the Chairman, Financial Commissioner and other functional Members for Traffic, Engineering, Mechanical, Electrical and Staff matters. Proponents of these therapies are unable or unwilling to demonstrate effectiveness by conventional criteria. This document serves as a balance sheet of operations of the Railways during the previous year and lists out plans for expansion for the current year. The appeal of alternative cures arises from the daunting risks, costs, or potential side effects of many conventional treatments, or in the limited prospect for cure. Though the Railway Budget is separately presented to the Parliament, the figures relating to the receipt and expenditure of the Railways are also shown in the General Budget, since they are a part and parcel of the total receipts and expenditure of the Government of India. A wide range of alternative treatments have been offered for cancer over the last century. As per the Separation Convention, 1924, the Railway Budget is presented to the Parliament by the Union Railway Minister, two days prior to the General Budget, usually around 26 February.

Other complementary approaches include traditional medicine like Traditional Chinese Medicine. The dividends from the railways accrue to the state, and the subsidies and losses are also borne by it. Many people feel these approaches benefit them, but most have not been scientifically proven and therefore face skepticism. Indian Railways are subject to the same audit control as other government revenue and expenditures. Common complementary measures include prayer or psychological approaches such as "imaging" or meditation to aid in pain relief, or improve mood. The comments of the Rajya Sabha (Upper House) are non binding. Some non-conventional treatment methods are used to "complement" conventional treatment, to provide comfort or lift the spirits of the patient, while others are offered as alternatives to be used instead of conventional treatments in hope of curing the cancer. The budget needs to be passed by a simple majority in the Lok Sabha (India's Lower House).

Complementary and alternative medicine (CAM) treatments are the diverse group of medical and health care systems, practices, and products that are not presently considered to be effective by the standards of conventional medicine. The Parliament discusses the policies and allocations proposed in the budget. New treatments also may have unknown risks, but if a new treatment proves effective or more effective than standard treatment, study patients who receive it may be among the first to benefit. The Railway Budget deals with the induction and improvement of existing trains and routes, the modernisation and most importantly the tariff for freight and passenger travel. Of course, there is no guarantee that a new treatment being tested or a standard treatment will produce good results. Some of these PSU's are:. They get up-to-date care from cancer experts, and they receive either a new treatment being tested or the best available standard treatment for their cancer. Apart from these zones, a number of Public Sector Undertakings (PSU) are under the administrative control of the ministry of railways.

Patients who take part may be helped personally by the treatment(s) they receive. Further down the hierarchy tree are the Station Masters who control individual stations and the train movement through the track territory under their stations' administration. Studies are done with cancer patients to find out whether promising treatments are safe and effective. The divisional officers of engineering, mechanical, electrical, signal & telecommunication, accounts, personnel, operating, commercial and safety branches report to the respective Divisional Manager and are in charge of operation and maintenance of assets. Of course, treatments that work well in the lab or in animals do not always work well in people. The zones are further divided into divisions under the control of Divisional Railway Managers (DRM). If an approach seems promising, the next step may be testing a treatment in animals to see how it affects cancer in a living being and whether it has harmful effects. Each of the sixteen zones is headed by a General Manager (GM) who reports directly to the Railway Board.

The search for new treatments begins in the laboratory, where scientists first develop and test new ideas. Reporting to them is the Railway Board, which has six members and a chairman. A clinical trial is one of the final stages of a long and careful cancer research process. Rathwa. Clinical trials test many types of treatment such as new drugs, new approaches to surgery or radiation therapy, new combinations of treatments, or new methods such as gene therapy. Velu and Naranbhai J. The goal of this research is to find better ways to treat cancer and help cancer patients. The ministry is currently headed by Lalu Prasad Yadav, the Union Minister for Railways and assisted by two junior Ministers of State for Railways, R.

Clinical trials, also called research studies, test new treatments in people with cancer. Indian Railways is a publicly-owned company controlled by the Government of India, via the Ministry of Railways. Pain medication, such as morphine and oxycodone, and antiemetics, drugs to suppress nausea and vomiting, are very commonly used in patients with cancer-related symptoms. The fastest speed attained by any train is 184 km/h (114 mph) in 2000 during test runs. Although all practicing doctors have the therapeutic skills to control pain, nausea, vomiting, diarrhea, hemorrhage and other common problems in cancer patients, the multidisciplinary specialty of palliative care has arisen specifically in response to the symptom control needs of this group of patients. The Bhopal Shatabdi Express is the fastest train in India today having a maximum speed of 140 km/h (87 mph) on the Faridabad-Agra section. Although the control of the symptoms of cancer is not typically thought of as a treatment directed at the cancer, it is an important determinant of the quality of life of cancer patients, and plays an important role in the decision whether the patient is able to undergo other treatments. The Trivandrum Rajdhani travels non-stop between Vadodara and Kota, covering a distance of 528 km (328 miles) in about 6.5 hours, and has the longest continuous run on Indian Railways today.

Removing or blocking estrogen, testosterone, or TSH, respectively, is often an important additional treatment. It covers 3,745 km (2,327 miles) in about 74 hours and 55 minutes. Common examples of hormone-sensitive tumors include certain types of breast, prostate, and thyroid cancers. The Himsagar Express, between Kanyakumari and Jammu Tawi, has the longest run in terms of distance and time on Indian Railways network. This allows an additional method of treatment for many cancers. The shortest named station is Ib and the longest is Sri Venkatanarasimharajuvariapeta. The growth of nearly all tissues, including cancers, can be accelerated or inhibited by providing or blocking certain hormones. There are a total of 6,853 stations; 300 yards; 2,300 goods-sheds; 700 repair shops and a total workforce of 1.54 million^[5].

These side effects include temporary (reversible) or permanent side effects (irreversible damage). The Ghum station along the Toy Train route is the second highest railway station in the world to be reached by a steam locomotive.^[4] Indian Railways operates 7,566 locomotives; 37,840 Coaching vehicles and 222,147 freight wagons. Thus, as with every form of treatment, radiation therapy is not without its side effects. Kharagpur railway station also has the distinction of being the world's longest railway platform at 1072 m (3,517 ft). Radiation dose to each site depends on a number of factors, including the radiosensitivty of each cancer type and whether there are tissues and organs nearby that may be damaged by radiation. Among the famous locomotives, the Fairy Queen is the oldest running locomotive in the world today, though the distinction of the oldest surviving locomotive belongs to John Bull. Radiation is also used to treat leukemia and lymphoma. The train travels around the country, staying at a location for about two months before moving elsewhere.

Radiation therapy may be used to treat almost every type of solid tumor, including cancers of the brain, breast, cervix, larynx, lung, pancreas, prostate, skin, stomach, uterus, or soft tissue sarcomas. This train has a compartment that serves as an operating room, a second one which serves as a storeroom and an additional two that serve as a patient ward. Hence, it is given in many fractions, allowing healthy tissue to recover between fractions. The Lifeline Express is a special train popularly known as the "Hospital-on-Wheels" which provides healthcare to the rural areas. The goal of radiation therapy is to damage as many cancer cells as possible, while limiting harm to nearby healthy tissue. It was reopened when the hostilities subsided in 2004. Although radiation damages both cancer cells and normal cells, most normal cells can recover from the effects of radiation and function properly. However, hostilities between the two nations in 2001 saw the line being closed.

In addition, they cut off the blood supply to the cancer cells causing them to die in a process called necrosis. The Samjhauta Express was a train that ran between India and Pakistan. Radiation therapy injures or destroys cells in the area being treated (the "target tissue") by damaging their genetic material, making it impossible for these cells to continue to grow and divide. The Maharashtra government did try and introduce the Deccan Odyssey along the Konkan route, but it did not enjoy the same success as the Palace on Wheels. The effects of radiation therapy are localised and confined to the region being treated. The Palace on Wheels is a specially designed train, lugged by a steam engine, for promoting tourism in Rajasthan. Radiation therapy can be administered externally via external beam radiotherapy (EBRT) or internally via brachytherapy. The Chatrapati Shivaji Terminus (formerly Victoria Terminus) railway station in Mumbai is another World Heritage Site operated by Indian Railways.

Radiation therapy (also called radiotherapy, X-ray therapy, or irradiation) is the use of ionizing radiation to kill cancer cells and shrink tumors. The Nilgiri Mountain Railway, in the Nilgiri Hills in southern India, is also classified as a World Heritage Site by UNESCO.^[3] It is also the only cog railway in India. The agents are monoclonal antibodies directed against proteins that are characteristic to the cells of the cancer in question, or cytokines that modulate the immune system's response. The highest station in this route is Ghum. These are used in various forms of cancer, such as breast cancer (trastuzumab/Herceptin®) but also in leukemia (gemtuzumab ozogamicin/Mylotarg®). The route starts at Siliguri in the plains in West Bengal and traverses tea gardens en route to Darjeeling, a hill station at an elevation of 2,134 metres (7,000 ft). Immunotherapy is the use of immune mechanisms against tumors. The Darjeeling Himalayan Railway, a narrow gauge train with a steam locomotive is classified as a World Heritage Site by UNESCO.

A variation upon this method uses allogenic samples (samples donated by a different donor) instead of the patient's own tissue^[5]. The highest speed notched up for a freight train is 100 km/h (62 mph) for a 4,700 tonne load. The samples are expanded using tissue engineering techniques, and are then re-implanted following high dose chemotherapy in order to recolonise the damaged and somewhat destroyed tissue. Recently Indian Railways introduced the special 'Container Rajdhani' or CONRAJ, for high priority freight. These tissues samples are screened to ensure they do not contain cancerous cells. The "Green Van" is a special type used to transport fresh food and vegetables. A novel technique involves taking samples of the patient's tissue before chemotherapy. Refrigerated vans are also available in many areas.

This is called "combination chemotherapy"; most chemotherapy regimens are given in a combination. Trucks that carry goods to a particular location are hauled back by trains saving the trucking company on unnecessary fuel expenses. Because some drugs work better together than alone, two or more drugs are often given at the same time. Indian Railways also transports vehicles over long distances. These cells usually repair themselves after chemotherapy. Most of its freight earnings come from such rakes carrying bulk goods such as coal, cement, foodgrains and iron ore. intestinal lining). Since the 1990s, Indian Railways has switched from small consignments to larger container movement which has helped speed up its operations.

Hence, chemotherapy has the potential to harm healthy tissue, especially those tissues that have a high replacement rate (e.g. However, competition from trucks which offer cheaper rates has seen a decrease in freight traffic in recent years. Most forms of chemotherapy target all rapidly dividing cells and are not specific for cancer cells. Indian Railways makes 70% of its revenues and most of its profits from the freight sector, and uses these profits to cross-subsidise the loss-making passenger sector. with the duplication of DNA or the separation of newly formed chromosomes. Many important freight stops have dedicated platforms and independent lines. It interferes with cell division in various possible ways, e.g. Ports and major urban areas have their own dedicated freight lines and yards.

Chemotherapy is the treatment of cancer with drugs ("anticancer drugs") that can destroy cancer cells. IR carries a huge variety of goods ranging from mineral ores, agricultural produce, petroleum, milk and vehicles. This is referred to as palliative treatment. The Kolkata metro has the administrative status of a zonal railway, though it does not come under the seventeen railway zones. Occasionally, surgery is necessary to control symptoms, such as spinal cord compression or bowel obstruction. It has three lines, one managed by the WR and other two managed by the Central Railway. Staging is a major determinant of prognosis and of the need for adjuvant therapy. Mumbai's rail transport is jointly managed by the Central and Western Railways.

determining the extent of the disease and whether it has metastasized to regional lymph nodes. A standard coach is designed to accommodate 96 sitting passengers, but the actual number of passengers can easily double or triple with standees during rush hour. In addition to removal of the primary tumor, surgery is often necessary for staging, e.g. The rakes in Mumbai run on direct current, while those elsewhere use alternating current. For this reason, the pathologist will examine the surgical specimen to determine if a margin of healthy tissue is present, thus decreasing the chance that microscopic cancer cells are left in the patient. Thus a nine coach EMU is made up of three units having one power car at each end and one at the middle. A single cancer cell is invisible to the naked eye but can regrow into a new tumor, a process called recurrence. One unit of an EMU train consists one power car and two general coaches.

The goal of the surgery can be either the removal of only the tumor, or the entire organ. They usually have nine coaches or sometimes twelve to handle rush hour traffic. Examples of surgical procedures for cancer include mastectomy for breast cancer and prostatectomy for prostate cancer. Suburban trains that handle commuter traffic are mostly electric multiple units. When the cancer has metastasized to other sites in the body prior to surgery, complete surgical excision is usually impossible. New Delhi and Kolkata have their own metro networks, namely the New Delhi Metro and the Kolkata metro, respectively. In theory, cancers can be cured if entirely removed by surgery, but this is not always possible. Hyderabad and Pune do not have dedicated suburban tracks but share the tracks with long distance trains.

Because "cancer" refers to a class of diseases, it is unlikely that there will ever be a single "cure for cancer" any more than there will be a single treatment for all infectious diseases. Currently, suburban networks operate in Mumbai (Bombay), Chennai (Madras), Kolkata (Calcutta), Delhi, Hyderabad and Pune. Radiation can also cause damage to normal tissue. Many cities have their own dedicated suburban networks to cater to commuters. The effectiveness of chemotherapy is often limited by toxicity to other tissues in the body. Ticket-less travel, which results in large losses for the IR, is also an additional problem faced. Sometimes this can be accomplished by surgery, but the propensity of cancers to invade adjacent tissue or to spread to distant sites by microscopic metastasis often limits its effectiveness. In the holiday seasons or on long weekends, trains are usually packed more than their prescribed limit.

Complete removal of the cancer without damage to the rest of the body is the goal of treatment. Overcrowding is the most widely faced problem with Indian Railways. A number of experimental cancer treatments are also under development. Air conditioned coaches are also attached, and a standard train may have between three and five air-conditioned coaches. The choice of therapy depends upon the location and grade of the tumor and the stage of the disease, as well as the general state of the patient (performance status). Up to nine of these type coaches are usually coupled. Cancer can be treated by surgery, chemotherapy, radiation therapy, immunotherapy or other methods. Each coach has different accommodation class; the most popular being the sleeper class.

Canine cancer detection has shown promise, but is still in the early stages of research. Freight trains use a large variety of wagons. There is a significant risk of detection of what has been recently called an incidentaloma - a benign lesion that may be interpreted as a malignancy and be subjected to potentially dangerous investigations. The coaches in use are vestibules, but some of these may be dummied on some trains for operational reasons. Use of medical imaging to search for cancer in people without clear symptoms is similarly marred with problems. Coaches are designed to accommodate anywhere from 18 to 72 passengers, but may actually accommodate many more during the holiday seasons and on busy routes. For these reasons, it is important that the benefits and risks of diagnostic procedures and treatment be taken into account when considering whether to undertake cancer screening. A standard passenger train consists of eighteen coaches, but some popular trains can have up to 24 coaches.

Moreover, the test itself is easy to perform and relatively cheap. In South India and North-East India however, buses are the preferred mode of transport for medium to long distance transport. Cervical cancer screening via the Pap smear has the best cost-benefit profile of all the forms of cancer screening from a public health perspective as, being a cancer, it has clear risk factors (sexual contact), and the natural progression of cervical cancer is that it normally spreads slowly over a number of years therefore giving more time for the screening program to catch it early. The passenger division is the most preferred form of long distance transport in most of the country. This is because screening of women in the general population will result in a large number of women with false positive results which require extensive follow-up investigations to exclude cancer, leading to having a high number-to-treat (or number-to-screen) to prevent or catch a single case of breast cancer early. Sikkim is the only state not connected. Similarly, for breast cancer, there have recently been criticisms that breast screening programs in some countries cause more problems than they solve. Indian Railways operates 8,702 passenger trains and transports around five billion annually across twenty-seven states and three union territories (Delhi, Pondicherry and Chandigarh).

Prostate cancer treatment may cause incontinence (inability to control urine flow) and erectile dysfunction (erections inadequate for intercourse). There are a total of sixty-seven divisions. Follow up procedures used to diagnose prostate cancer (prostate biopsy) may cause side effects, including bleeding and infection. Each zonal railway is made up of a certain number of divisions, each having a divisional headquarters. This situation, called overdiagnosis, puts men at risk for complications from unnecessary treatment such as surgery or radiation. It is administratively considered to have the status of a zonal railway. For example: when screening for prostate cancer, the PSA test may detect small cancers that would never become life threatening, but once detected will lead to treatment. The Calcutta Metro is owned and operated by Indian Railways, but is not a part of any of the zones.

The controversy arises when it is not clear if the benefits of screening outweigh the risks of follow-up diagnostic tests and cancer treatments. †Konkan Railway (KR) is constituted as a separately incorporated railway, with its headquarters at Belapur CBD (Navi Mumbai), although it still comes under the control of the Railway Ministry and the Railway Board.. Screening for cancer is controversial in cases when it is not yet known if the test actually saves lives. For administrative purposes, Indian Railways is divided into sixteen zones . Prostate cancer can be screened for by a digital rectal exam along with prostate specific antigen (PSA) blood testing. The entire railway reservation system was streamlined with computerisation in 1995. Testicular self-examination is recommended for men beginning at the age of 15 years to detect testicular cancer. By 1985, steam locomotives were phased out in favour of diesel and electric locomotives.

Over time, such testing has been followed by a dramatic reduction of cervical cancer incidence and mortality. As the economy of India improved, almost all railway production units were indigenised. Similarly, cervical cytology testing (using the Pap smear) leads to the identification and excision of precancerous lesions. The existing rail networks were abandoned in favour of zones in 1951 and a total of six zones came into being in 1952. Colorectal cancer can be detected through fecal occult blood testing and colonoscopy, which reduces both colon cancer incidence and mortality, presumably through the detection and removal of premalignant polyps. A total of forty-two separate railway systems, including thirty-two lines owned by the former Indian princely states, were amalgamated as a single unit which was christened as the Indian Railways. Screening by regular mammograms detects tumors even earlier than self-examination, and many countries use it to systematically screen all middle-aged women. At the time of independence in 1947, a large portion of the railways went to the then newly formed Pakistan.

Breast cancer screening can be done by breast self-examination. The Second World War severely crippled the railways as trains were diverted to the Middle East, and the railway workshops were converted into munitions workshops. A number of different screening tests have been developed. The government took over the management of the Railways and removed the link between the financing of the Railways and other governmental revenues in 1920, a practice that continues to date with a separate railway budget. Early diagnosis may lead to extended life. By the end of the First World War, the railways had suffered immensely and were in a poor state. Screening for cancer can lead to earlier diagnosis. With the arrival of the First World War, the railways were used to meet the needs of the British outside India.

If signs of cancer are detected, more definitive and invasive follow up tests are performed to confirm the diagnosis. The following year, the first electric locomotive appeared. Screening tests suitable for large numbers of healthy people must be relatively affordable, safe, noninvasive procedures with acceptably low rates of false positive results. In 1907, almost all the rail companies were taken over by the government. Cancer screening is an attempt to detect unsuspected cancers in the population. For the first time in its history, the Railways began to make a tidy profit. Cytogenetics and immunohistochemistry may provide information about future behavior of the cancer (prognosis) and best treatment. The Railway Board operated under aegis of the Department of Commerce and Industry and had three members: a government railway official serving as chairman, a railway manager from England and an agent of one of the company railways.

Together, this information is useful to evaluate the prognosis of this patient and choose the best treatment. A Railway Board was constituted in 1901, but decision-making power was retained by the Viceroy, Lord Curzon. The tissue diagnosis indicates the type of cell that is proliferating, its histological grade and other features of the tumor. Soon various independent kingdoms built their own rail systems and the network spread to the regions that became the modern-day states of Assam, Rajasthan and Andhra Pradesh. Biopsies of other organs are performed under anesthesia and require surgery in an operating room. By 1895, India had started building its own locomotives, and in 1896 sent engineers and locomotives to help build the Uganda Railway. Many biopsies (such as those of the skin, breast or liver) can be done in a doctor's office. The route mileage of this network was about 14,500 km (9,000 miles) by 1880, mostly radiating inward from the three major port cities of Bombay, Madras and Calcutta.

Tissue can be obtained from a biopsy or surgery. Once established, the company would be transferred to the government, with the original company retaining operational control. A cancer may be suspected for a variety of reasons, but the definitive diagnosis of most malignancies must be confirmed by histological examination of the cancerous cells by a pathologist. The British government encouraged new railway companies backed by private investors under a scheme that would guarantee an annual return of five percent during the initial years of operation. Cancer may be a common or uncommon cause of each item. Covering a distance of 34 km (21 miles), it formally heralded the birth of railways in India. Every single item in the above list can be caused by a variety of conditions (a list of which is referred to as the differential diagnosis). A year and a half later, on 1853-04-16, the first passenger train service was inaugurated between Bori Bunder, Bombay and Thana.

Roughly, cancer symptoms can be divided into three groups:. The first train in India became operational on 1851-12-22, and was used for the hauling of construction material in Roorkee. Neither of these lead to a definitive diagnosis, which usually requires the opinion of a pathologist. Interest from investors in the UK led to the rapid creation of a rail system over the next few years. Most cancers are initially recognized either because signs or symptoms appear or through screening. Two new railway companies were created and the East India Company was asked to assist them. Genetic testing for high-risk individuals, with enhanced surveillance, chemoprevention, or risk-reducing surgery for those who test positive, is already available for certain cancer-related genetic mutations. In 1844, the Governor-General of India Lord Hardinge allowed private entrepreneurs to set up a rail system in India.

Other examples of drugs that show promise for chemoprevention include COX-2 inhibitors (which inhibit a cyclooxygenase enzyme involved in the synthesis of proinflammatory prostaglandins). A plan for a rail system in India was first put forward in 1832, but no further steps were taken for more than a decade. Finasteride, a 5-alpha reductase inhibitor, has been shown to lower the risk of prostate cancer. . Cis-retinoic acid also has been shown to reduce risk of second primary tumors among patients with primary head and neck cancer. Indian Railways operates both long distance and suburban rail systems. Daily use of tamoxifen, a selective estrogen receptor modulator, for up to 5 years, has been demonstrated to reduce the risk of developing breast cancer in high-risk women by about 50%. In 1951 the systems were nationalised as one unit, becoming one of the largest networks in the world.

In fact, the risk of lung cancer was slightly, but not significantly, increased by beta-carotene, leading to an early termination of the study^[4]. By 1947, the year of India's independence, there were forty-two rail systems. Contrary to expectation, these tests found no benefit of beta-carotene supplementation in reducing lung cancer incidence and mortality. Railways were first introduced to India in 1853. This study provided about 80,000 smokers or former smokers with daily supplements of beta-carotene or placebos. As of 2005 IR owns a total of 216,717 wagons, 39,936 coaches and 7,339 locomotives and runs a total of 14,244 trains daily, including about 8,002 passenger trains^[2]. This hypothesis led to a series of large randomized trials conducted in both Finland and the United States (CARET study) during the 1980s and 1990s. The railways traverse through the length and width of the country covering a total length of 63,940 km (39,230 miles).

This effect was particularly strong in lung cancer. IR is the world's largest commercial or utility employer, with more than 1.6 million employees^[1]. Epidemiologists studying both diet and serum levels observed that high levels of beta-carotene, a precursor to vitamin A, were associated with a protective effect, reducing the risk of cancer. It is also one of the largest and busiest rail networks in the world, transporting just under five billion passengers and almost 350 million tonnes of freight annually. The case of beta-carotene provides an example of the necessity of randomized clinical trials. Indian Railways has a monopoly on the country's rail transport. Public health recommendations cannot be made on the basis of these studies until they have been validated in an observational (or occasionally a prospective interventional) trial in humans. Indian Railways (IRY) is the state-owned railway company of India.

These reports are often based on studies in cultured cell media or animals. – Construction Division. Despite frequent reports of particular substances (including foods) having a beneficial or detrimental effect on cancer risk, few of these have an established link to cancer. IRCON International Ltd. Studies have shown that immigrants develop the risk of their new country, suggesting a link between diet and cancer rather than a genetic basis. – Consulting Division of Indian Railways. gastric cancer is more common in Japan, while colon cancer is more common in the United States). RITES Ltd.

Particular dietary practices often explain differences in cancer incidence in different countries (e.g. Railtel Corporation of India – Telecommunication Networks. The consensus on diet and cancer is that obesity increases the risk of developing cancer. Mumbai Rail Vikas Corporation. Other lifestyle and environmental factors known to affect cancer risk (either beneficially or detrimentally) include certain sexual and reproductive practices, the use of exogenous hormones, exposure to ionizing radiation and ultraviolet radiation, certain occupational and chemical exposures, and infectious agents. Centre for Railway Information System. Based on epidemiologic evidence, it is now thought that avoiding excessive alcohol consumption, being physically active, and maintaining recommended body weight may all contribute to reductions in risk of certain cancers; however, compared with tobacco exposure, the magnitude of effect is modest or small and the strength of evidence is often weaker. Indian Railway Finance Corporation.

Examples of modifiable cancer risk include alcohol consumption (associated with increased risk of oral, esophageal, breast, and other cancers), physical inactivity (associated with increased risk of colon, breast, and possibly other cancers), and being overweight (associated with colon, breast, endometrial, and possibly other cancers). Konkan Railway Corporation. Evidence is now emerging from randomized controlled trials designed to test whether interventions suggested by the epidemiologic studies, as well as leads based on laboratory research, actually result in reduced cancer incidence and mortality. Indian Railways Catering and Tourism Corporation. Much of the promise for cancer prevention comes from observational epidemiologic studies that show associations between modifiable life style factors or environmental exposures and specific cancers. This can be accomplished by avoiding carcinogens or altering their metabolism, pursuing a lifestyle or diet that modifies cancer-causing factors and/or medical intervention (chemoprevention, treatment of premalignant lesions).

Cancer prevention is defined as active measures to decrease the incidence of cancer. Similarly, with tobacco smoking becoming more common in various Third World countries, lung cancer incidence has increased in a parallel fashion. Hepatocellular carcinoma (liver cancer) is rare in the West but is the main cancer in China and neighboring countries, most likely due to the endemic presence of hepatitis B and aflatoxin in that population. Cancer epidemiology closely mirrors risk factor spread in various countries.

With the increased control over malaria and tuberculosis in some Third World countries, incidence of cancer is expected to rise; this is termed the iceberg phenomenon in epidemiological terminology. In many Third World countries cancer incidence (insofar as this can be measured) appears much lower, most likely because of the higher death rates due to infectious disease or injury. In some Western countries, such as the USA^[1] and the UK^[3], cancer is overtaking cardiovascular disease as the leading cause of death. Up to half of all cancer cases can be attributed to smoking, diet, and environmental pollution.

Further support comes from the fact that lung cancer death rates in 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 followed by decreases in lung cancer death rates in men. Hundreds of epidemiological studies have confirmed this association. The most consistent finding, over decades of research, is the strong association between tobacco use and cancers of many sites. Examples are:.

There are, however, a number of recognised syndromes of cancer with a hereditary component. Most forms of cancer are "sporadic", and have no basis in heredity. Nevertheless, carcinoma in situ may develop into an invasive malignancy and is usually removed surgically, if possible. The most severe cases of dysplasia are referred to as "carcinoma in situ." In Latin, the term "in situ" means "in place", so carcinoma in situ refers to an uncontrolled growth of cells that remains in the original location and shows no propensity to invade other tissues.

Often such cells revert back to normal behavior, but occasionally, they gradually become malignant. Dysplasia is an abnormal type of excessive cell proliferation characterized by loss of normal tissue arrangement and cell structure. Hyperplasia can be a normal tissue response to an irritating stimulus, for example callus. This process is considered reversible.

Biopsy and microscopical examination can also distinguish between malignancy and hyperplasia, which refers to tissue growth based on an excessive rate of cell division, leading to a larger than usual number of cells but with a normal orderly arrangement of cells within the tissue. Immunohistochemistry and other molecular methods may characterise specific markers on tumor cells, which may aid in diagnosis and prognosis. Among the distinguishing traits are a large number of dividing cells, variation in nuclear size and shape, variation in cell size and shape, loss of specialized cell features, loss of normal tissue organization, and a poorly defined tumor boundary. Cancer tissue has a distinctive appearance under the microscope.

Cells that divide at a high rate, such as epithelials, show a higher risk of becoming tumor cells than those which divide less, for example neurons. Also, the DNA methylation pattern of the cell changes, activating and deactivating genes without the usual regulation. The instability can increase to a point where the cell loses whole chromosomes, or has multiple copies of several. A first step in the development of a tumor cell is usually a small change in the DNA, often a point mutation, which leads to a genetic instability of the cell.

This process is called clonal evolution. A cell that degenerates into a tumor cell does not usually acquire all these properties at once, but its descendant cells are selected to build them.
Malignant tumors cells have distinct properties:. Other mutations enable the tumor to grow new blood vessels to provide more nutrients, or to metastasize, spreading to other parts of the body.

Telomerase mutations remove additional barriers, extending the number of times a cell can divide. This mutation is associated with poor prognosis, since those tumor cells are less likely to go into apoptosis or programmed cell death when damaged by therapy. For example, up to half of all tumors have a defective p53 gene. However, with the help of molecular biological techniques, it is possible to characterize the mutations or chromosomal aberrations within a tumor, and rapid progress is being made in the field of predicting prognosis based on the spectrum of mutations in some cases.

It is impossible to tell the initial cause for any specific cancer. Because viral genome insertion is not specific to proto-oncogenes and the chance of insertion near that proto-oncogene is low, slowly-transforming viruses have very long tumor latency compared to acutely-transforming viruses, which already carry the viral-oncogene. The viral promoter or other transcription regulation elements in turn cause overexpression of that proto-oncogene, which in turn induces uncontrolled cellular proliferation. In contrast, in slowly-transforming viruses, the virus genome is inserted, especially as viral genome insertion is an obligatory part of retroviruses, near a proto-oncogene in the host genome.

In acutely transforming viruses, the viral particles carry a gene that encodes for an overactive oncogene called viral-oncogene (v-onc), and the infected cell is transformed as soon as v-onc is expressed. The mode of virally-induced tumors can be divided into two, acutely-transforming or slowly-transforming. Furthermore, many cancers originate from a viral infection; this is especially true in animals such as birds, but less so in humans, as viruses are only responsible for 15% of human cancers. A mistake made during mitosis can lead to the daughter cells receiving the wrong number of chromosomes, which leads to aneuploidy and may lead to cancer.

Faster rates of mitosis increasingly leave less opportunities for repair enzymes to repair damaged DNA during DNA replication, increasingly the likelihood of a genetic mistake. These are thought to promote cancers through their stimulating effect on the rate of cell mitosis. Examples of carcinogens that are not mutagens include alcohol and estrogen. Many mutagens are also carcinogens, but some carcinogens are not mutagens.

Chromosomal translocations, such as the Philadelphia chromosome, are a special type of mutation that involve exchanges between different chromosomes. Other types of mutations can be caused by chronic inflammation, as neutrophil granulocytes secrete free radicals that damage DNA. In more general terms, chemicals called mutagens and free radicals are known to cause mutations. Breathing asbestos fibers is associated with mesothelioma.

Prolonged exposure to radiation, particularly ultraviolet radiation from the sun, leads to melanoma and other skin malignancies. Tobacco smoking is associated with lung cancer. Particular substances have been linked to specific types of cancer. Substances that cause these mutations are known as mutagens, and mutagens that cause cancers are known as carcinogens.

Cancer is ultimately due to accumulation of genetic damage, which are fundamentally mutations in the DNA. Similarly, mutations in the adenomatous polyposis coli gene are linked to adenopolyposis colon cancer, with thousands of polyps in colon while young, while mutations in BRCA1 and BRCA2 lead to early onset of breast cancer. For instance, individuals who are heterozygous for p53 mutations are often victims of Li-Fraumeni syndrome, and those who are heterozygous for Rb mutations develop retinoblastoma. Because mutations in tumor suppressers act in a recessive manner (note, however, there are exceptions), the loss of the normal copy creates the cancer phenotype.

The mode of inheritance of mutant tumor suppressors is that affected member inherits a defective copy from one parent, and a normal copy from another. Members within these families have increased incidence and decreased latency of multiple tumors. Mutation of tumor suppressor genes that are passed on to the next generation of not merely cells, but their offspring can cause increased likelihoods for cancers to be inherited. This is observed in many p53 mutations.

However, cases exist in which one loss of function copy of a tumor suppressor gene can render the other copy non-functional, and this is called dominant negative effect. Each cell has two copies of a same gene, one from each parent, and under most cases gain of function mutation in one copy of a particular proto-oncogene is enough to make that gene a true oncogene, while usually loss of function mutation need to happen in both copies of a tumor suppressor gene to render that gene completely non-functional. Usually, oncogenes are dominant, as they contain gain of function mutations, while mutated tumor suppressors are recessive, as they contain loss of function mutations. Often, because these genes regulate the processes that prevent most damage to genes themselves, the rate of mutations increase as one gets older, because DNA damage forms a feedback loop.

It is only when enough proto-oncogenes have mutated into oncogenes, and enough tumor suppressor genes deactivated or damaged, that the signals for cell growth overwhelm the signals to regulate it, that cell growth quickly spirals out of control. A mutation to only one tumor suppressor gene would not cause cancer either, due to the presence of many "backup" genes that duplicate its functions. For example, a mutation limited to one oncogene would be suppressed by normal mitosis control and tumor suppressor genes, which was first hypothesised by the Knudson hypothesis. In general, mutations in both types of genes are required for cancer to occur.

The invariable consequence of this is that DNA repair is hindered or inhibited: DNA damage accumulates without repair, inevitably leading to cancer. However, a mutation can damage the tumor suppressor gene itself, or the signal pathway which activates it, "switching it off". Canonical tumor suppressors include the p53 gene, which is a transcription factor activated by many cellular stressors including hypoxia and ultraviolet radiation damage. The functions of such genes is to arrest the progression of cell cycle in order to carry out DNA repair, preventing mutations from being passed on to daughter cells.

Often DNA damage will cause the presence of free-floating genetic material as well as other signs, and will trigger enzymes and pathways which lead to the activation of tumor suppressor genes. Generally tumor suppressors are transcription factors that are activated by cellular stress or DNA damage. Tumor suppressor genes code for anti-proliferation signals and proteins that suppress mitosis and cell growth. It is only when they become mutated, that the signals for growth become excessive.

The chance of cancer cannot be reduced by removing proto-oncogenes from the genome as they are critical for growth, repair and homeostasis of the body. When this happens, they become oncogenes, and thus cells have a higher chance to divide excessively and uncontrollably. Mutations in proto-oncogenes can modify their function, increasing the amount or activity of the product protein. They often produce mitogens, or are involved in transcription of DNA in protein synthesis, which create the proteins and enzymes is responsible for producing the products and biochemicals cells use and interact with.

Some are responsible for the signal transduction system and signal receptors in cells and tissues themselves, thus controlling the sensitivity to such hormones. Many can produce hormones, a "chemical messenger" between cells which encourage mitosis, the effect of which depends on the signal transduction of the receiving tissue or cells. Proto-oncogenes, promote cell growth through a variety of ways. Typically, a series of several mutations to these genes are required before a normal cell transforms into a cancer cell.

Proto-oncogenes are genes which promote cell growth and mitosis, a process of cell division, and tumor suppressor genes discourage cell growth, or temporarily halts cell division from occurring in order to carry out DNA repair. In order for cells to start dividing uncontrollably, genes which regulate cell growth must be damaged. Cancer is, ultimately, a disease of genes. Carcinogenesis (meaning literally, the creation of cancer) is the process of derangement of the rate of cell division due to damage to DNA.

Malignant tumors can invade other organs, spread to distant locations (metastasize) and become life-threatening. Benign tumors do not spread to other parts of the body or invade other tissues, and they are rarely a threat to life unless they extrinsically compress vital structures. The uncontrolled and often rapid proliferation of cells can lead to either a benign tumor or a malignant tumor (cancer). Mutations in DNA that lead to cancer disrupt these orderly processes.

Normally the balance between proliferation and cell death is tightly regulated to ensure the integrity of organs and tissues. Cell division (proliferation) is a physiological process that occurs in almost all tissues and under many circumstances. Relative survival for infants is very good for neuroblastoma, Wilms' tumor and retinoblastoma, and fairly good (80%) for leukemia, but not for most other types of cancer. Female infants and male infants have essentially the same overall cancer incidence rates, but white infants have substantially higher cancer rates than black infants for most cancer types.

The remainder consists of Wilms' tumor, lymphomas, rhabdomyosarcoma (arising from muscle), retinoblastoma, osteosarcoma and Ewing's sarcoma^[1]. Leukemia (usually ALL) is the most common infant malignancy (30%), followed by the central nervous system cancers and neuroblastoma. The age of peak incidence of cancer in children occurs during the first year of life. Cancer can also occur in young children and adolescents, but it is rare.

These statistics vary substantially in other countries. The statistics below are for adults in the United States. On a yearly basis, 0.5% of the population is diagnosed with cancer. In the USA and other developed countries, cancer is presently responsible for about 25% of all deaths^[2].

neuroblastoma and lymphoma. This nomenclature is however somewhat inconsistent, since several "malignant" tumor growths also have this suffix in their names, e.g. For instance, a benign tumor of the smooth muscle of the uterus is called leiomyoma (the common name of this frequent tumor is fibroid). Benign tumors are named using -oma as a suffix.

Here, the adjective ductal refers to the appearance of the cancer under the microscope, resembling normal breast ducts. For instance, the most common type of breast cancer is called ductal carcinoma of the breast or mammary ductal carcinoma. For common cancers, the English organ name is used. For instance, a malignant tumor of liver cells is called hepatocarcinoma; a malignant tumor of the fat cells is called liposarcoma.

Malignant tumors are usually named using the Latin or Greek root of the organ as a prefix and the above category name as the suffix. The following general categories are usually accepted:. Cancers are classified by the type of cell that resembles the tumor and, therefore, the tissue presumed to be the origin of the tumor. The following closely related terms may be used to designate abnormal growths:.

Galen used "oncos" to describe all tumours, the root for the modern word oncology.^[1]. It is Celsus who translated carcinos into the latin cancer, also meaning crab. Today, carcinoma is the medical term for a malignant tumour derived from epithelial cells. He later added the suffix -oma, Greek for swelling, giving the name carcinoma.

This strange choice of name probably comes from the appearance of the cut surface of a solid malignant tumour, with a roundish hard center surrounded by pointy projections, vaguely resembling the silhouette of a crab. He called benign tumours oncos, Greek for swelling, and malignant tumours carcinos, Greek for crab or crayfish. Hippocrates described several kinds of cancers. .

Some of these can be avoidable, and public health and vaccination programmes are important on a global scale. Many forms of cancer are associated with exposure to environmental factors, such as tobacco smoking, alcohol, and certain viruses. Most cancers can be treated and many cured, especially if treatment begins early. Cancer is mainly a disease of later years, and is one of the leading causes of death in developed countries.

If untreated, cancers may eventually cause death. Once diagnosed, cancer is usually treated with surgery, chemotherapy, or radiation. This tissue is obtained by biopsy or surgery. A definitive diagnosis usually requires the histologic examination of tissue by a pathologist.

Cancer may be painless. Cancer can cause many different symptoms, depending on the site and character of the malignancy and whether there is metastasis. Some mutations occur spontaneously, or they can be inherited (germ line mutations.). These mutations are often caused by chemicals or physical agents called carcinogens.

Several mutations may be required to transform a normal cell into a malignant cell. This unregulated growth is caused by damage to DNA, resulting in mutations to genes that control cell division. Cancer is a class of diseases characterized by uncontrolled division of cells and the ability of these cells to invade other tissues, either by direct growth into adjacent tissue (invasion) or by implantation into distant sites (metastasis). specific conditions that are due to an active cancer, such as thrombosis or hormonal changes.

Systemic symptoms: weight loss, poor appetite and cachexia (wasting), excessive sweating (night sweats), anemia and specific paraneoplastic phenomena, i.e. Although advanced cancer may cause pain, it is often not the first symptom. Symptoms of metastasis (spreading): enlarged lymph nodes, cough and hemoptysis, hepatomegaly (enlarged liver), bone pain, fracture of affected bones and neurological symptoms. Compression of surrounding tissues may cause symptoms such as jaundice.

Local symptoms: unusual lumps or swelling (tumor), hemorrhage (bleeding), pain and/or ulceration. Retinoblastoma in young children is an inherited cancer. Familial adenomatous polyposis an inherited mutation of the APC gene that leads to early onset of colon carcinoma. Turcot syndrome (brain tumors and colonic polyposis).

Li-Fraumeni syndrome (various tumors such as osteosarcoma, breast cancer, soft-tissue sarcoma, brain tumors) due to mutations of p53. tumors of various endocrine organs in multiple endocrine neoplasia (MEN types 1, 2a, 2b). certain inherited mutations in the genes BRCA1 and BRCA2 are associated with an elevated risk of breast cancer and ovarian cancer. ability to promote blood vessel growth (angiogenesis).

ability to build metastases at distant sites. ability to invade neighbouring tissues. no ability for contact inhibition. altered ability to differentiate.

increased cell division rate. insensitivity to anti-growth factors. self-sufficiency of growth factors. unlimited growth potential (immortalitization) due to overabundance of telomerase.

evading apoptosis. Choriocarcinoma: malignant tumors derived from the placenta. germ cell tumours: tumors derived from germ cells, normally found in the testicle and ovary. Glioma: tumors derived from brain cells.

Mesothelioma: tumors derived from the mesothelial cells lining the peritoneum and the pleura. Sarcoma: malignant tumors derived from connective tissue, or mesenchymal cells. Lymphoma and Leukemia: malignant tumors derived from blood and bone marrow cells. This group represent the most common cancers, including the common forms of breast, prostate, lung and colon cancer.

Carcinoma: malignant tumors derived from epithelial cells. This is inaccurate since some neoplasms usually do not form tumors, for example leukemia or carcinoma in situ. In common language, however, it is synonymous with 'neoplasm', either benign or malignant. Tumor in medical language simply means swelling or lump, either neoplastic, inflammatory or other.

Because of its overwhelming popularity relative to 'neoplasia', it is used frequently instead of 'neoplasia', even by scientists and physicians, especially when discussing neoplastic diseases as a group. Occasionally, it is used instead of carcinoma, a sub-group of malignant neoplasms. Cancer is a widely used word that is usually understood as synonymous with malignant neoplasm. Neoplasms can be benign or malignant.

This group contains a large number of different diseases; the usual classification is listed below. Neoplasia and neoplasm are the accurate, scientific names for this group of diseases as defined in the first paragraph above.