**1.1 Generalities**

Cancer is a generic term to describe over 200 distinct disease forms that, nonetheless, share three distinguishing characteristics, namely uncontrolled cellular proliferation, invasion of the abnormal cells into adjacent tissues, and their spread to distant organs via blood and lymph vessels [1]. The biological events fundamental to the development of cancer involve the transformation of normal cells

to a precancerous lesion which subsequently progresses to a malignant tumor in a multistage process [1]. These changes are the result of the interaction between an individual's genetic make-up and external agents including physical, chemical, and biological carcinogens [2].

 Recognized physical carcinogens are ultraviolet and ionizing radiation which have been linked to skin cancer as well as leukemia and a number of solid tumors, respectively [2]. Well-studied chemical carcinogens are asbestos that has mainly been associated with lung cancer and mesothelioma; components of tobacco smoke which have been linked not only to breast and lung cancer but also to a host of other malignancies; aflatoxins produced by certain molds in improperly stored staple commodities which have been related to liver cancer; and the drinking water contaminant arsenic that has particularly been associated with lung, bladder, and kidney cancer [2]. Examples of biological carcinogens are the human papillomavirus, the hepatitis B virus, the hepatitis C virus, and the Epstein-Barr virus, the causative factors of cervical cancer, liver cancer, and certain lymphomas, respectively; the stomach bacterium *Helicobacter pylori* that has been implicated in the development of stomach cancer; and certain fish-parasitic flatworms associated with cholangiocarcinoma and urinary bladder cancer [2].

 Molecular insights have revealed that the development of cancer—including its capacity to proliferate in an uncontrolled fashion, escape apoptosis, invade neighboring tissues, and disseminate to distant organs—involves aberrations in molecular networks that include oncogenes, tumor suppressor genes, and repair genes [1]. These changes occur in a multistep manner and often take place over many years [1]. This is an important reason that cancer usually manifests at older age, when sufficient carcinogenic mutations have accumulated to cause cancer and innate defense and cellular repair mechanisms have become less effective [1].

#### **1.2 Worldwide epidemiology**

 According to GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, cancer will represent the leading cause of death throughout the world in the twenty-first century [3]. In 2018, there were an estimated 18.1 million new cancer cases and 9.6 million cancer deaths globally [3]. Lung cancer and female breast cancer were the most commonly diagnosed malignancy (each 11.6% of total overall cases), followed by cancer of colon and rectum (10.2%), prostate (7.1%), stomach (5.7%), and liver (4.7%) [3]. The most deadly cancers in that year were lung, colorectal, stomach, liver, and breast cancer accounting for 18.4, 9.2, 8.2, 8.2, and 6.6%, respectively, of the total number of cancer fatalities [3]. The most frequent cancers in males were lung, prostate, colorectal, stomach, and liver cancer with incidence rates of 14.5, 13.5, 10.9, 7.2, and 6.3%, respectively, and mortality rates of 22.0, 6.7, 9.0, 9.5, and 10.2%, respectively [3]. And in females, the most common cancers were those of the breast, colon and rectum, lung, and cervix uteri, with incidence rates of 24.2, 9.5, 8.4, and 6.6%, respectively, and mortality rates of 15.0, 9.5, 13.8, and 7.5%, respectively [3].

There were substantial variations among countries with respect to the most frequently diagnosed cancers and the leading causes of cancer death [3]. For instance, for many cancers, incidence rates were generally two- to threefold higher in industrialized countries than in transitioning economies [3]. However, differences in mortality were smaller, as relatively more patients in developing countries died from their disease, probably because of low screening rates as well as less advanced screening services and diagnostic methods in these regions [3]. Furthermore, cancers related to a westernized lifestyle such as lung, breast, and colorectal cancer were (much) more common in industrialized regions than in developing/

*Anticancer Activity of Uncommon Medicinal Plants from the Republic of Suriname: Traditional… DOI: http://dx.doi.org/10.5772/intechopen.82280* 

transitioning regions, even though these neoplasms were among the most common malignancies in both regions [3]. On the other hand, oral cancer and cervical cancer were much more frequent in (certain) developing/transitioning countries than in industrialized countries [3]. These differences are probably for an important part attributable to differences in associated risk factors and screening facilities, respectively, resulting in the former malignancy accounting for almost 50% to the burden of cancer in south-central Asia [4] and the latter occurring at incidence rates between 13.0 and 43.1 per 100,000 in Central America, South America, and the Caribbean, as well as in the parts of Africa [5].

#### **1.3 Treatment modalities**

 The treatment modalities for cancer depend on the type of cancer as well as its stage and grade [6]. Some cases require only one form of treatment, but most patients need a combination of therapeutic modalities such as surgery with chemotherapy and/or radiation therapy. Surgery is applied for removing localized solid tumors or debulking large solid tumors in order to improve the efficacy of, for instance, chemotherapy [6]. Radiation therapy—external beam radiation therapy, brachytherapy, or systemic radioisotope therapy—uses high doses of radiation to kill cancer cells by damaging their DNA [6]. Chemotherapy is a systemic treatment with mostly combinations of antineoplastic drugs and is intended to kill cancer cells by stopping or slowing their growth or division, but it is also applied as an adjuvant to prevent disease recurrence after surgery or radiation therapy and as a neoadjuvant therapy to decrease the size of a tumor before surgery or radiation therapy [6].

 Other cancer treatment modalities are immunotherapy, hormonal therapy, and angiosuppressive therapy. Immunotherapy can make use of adoptive cell transfer involving the infusion of engineered autologous or allogeneic T cells into a patient which can attack the cancer directly; monoclonal antibodies directed at cancer cellspecific antigens; or immunomodulating substances such as cytokines and Bacillus Calmette-Guérin vaccine which stimulate the immune system in a more general way [6]. Hormonal therapy slows or stops the growth of hormone-dependent tumors such as breast and prostate cancers, or reduces or prevents the symptoms in patients suffering from these cancers who do not qualify for surgery or radiation therapy [6]. Hormonal therapy can also be used in the adjuvant or neoadjuvant setting [6]. Angiosuppressive or antiangiogenic therapy interrupts the angiogenic signals that a tumor emits to its surroundings for recruiting a blood supply and causes tumors to shrink [6].

 Despite this respectable array of antineoplastic agents and therapeutic modalities most cancers remain fatal, particularly when detected at an advanced stage. This implies a need for more efficacious forms of treatment of neoplastic disease. Many efforts are being dedicated to this goal, including improved early diagnosis, the development of highly specific targeted therapies, and the identification of more efficacious antineoplastic drugs. It is generally agreed that the application of ancient wisdom and folk medicine represents an important strategy to discover and develop new anticancer drugs [7–10]. This approach has led to breakthrough anticancer drugs such as the tubulin-interfering agents vincristine from the periwinkle plant *Catharanthus roseus* (L.) G. Don (Apocynaceae) [11] and paclitaxel from the Pacific yew *Taxus brevifolia* Peattie 1950 (Taxaceae) [12]; the topoisomerase I and II inhibitors irinotecan [13] and etoposide [14], respectively, from *Podophyllum* plant species (Berberidaceae) and the Chinese happy tree *Camptotheca acuminata* Decne. (Nyssaceae), respectively; as well as a host of other plant-derived compounds [7, 10]. Notably, almost half of the anticancer drugs that have been granted approval in the United States of America between 1981 and 2014 were from natural origin [9].

So far, only a relative handful of the plant kingdom has been evaluated for pharmacologically active plant substances with potential efficacy against cancer. Therefore, it is likely that further exploration of the rain forests along with other less explored environments such as deserts, tundras, as well as freshwater and marine ecosystems [15], will help identify many structurally novel and mechanistically unique compounds for fighting cancer. This chapter first reviews a few aspects of cancer throughout the world, then focuses on cancer in the Republic of Suriname, subsequently addresses in detail nine medicinal plants that are used for treating cancer in the country, and concludes with some remarks about their potential usefulness against this disease.
