What is Cancer?

Cancer Explained

Cancer is the growth of abnormal cells in a part of the body that begin to grow out of control. There are many different types of cancers but this is how they all begin. Healthy normal body cells grow, divide, and die. The early years of a person’s life the normal cells will divide rapidly until the person reaches adulthood. During adulthood cells in most parts of the body will divide in order to only replace worn-out, dying, or to repair injuries. Cancer cells are different from normal healthy cells because they continue to grow and divide. Cancer cells do not die; they outlive the normal cells and will continue to form new abnormal cells.

Types

There are many different types of cancer but all cancers can be grouped into one of four categories. There are several factors that determine how cancer is diagnosed such as location and how the cancerous cells appear under the microscope. A good example is breast cancer, there are several forms and each is classified according to where the tumors originate within the breast, and the tendency of the tumors to invade the surrounding organs and tissues.

Categories

• Carcinomas: 80% of cancers are this. Carcinomas are tumors that arise in the tissues that line the body’s organs.
• Sarcomas: Tumors that start in bone, muscle, cartilage, fibrous tissue or fat.
• Leukemias: Cancers of the blood or blood-forming organs.
• Lymphomas: This affects the lymphatic system which is a network of vessels and nodes that acts as a filter. The lymphatic system distributes nutrients to blood and tissue. This prevents bacteria and other foreign “invaders” from entering into the bloodstream.

Causes

Cancer cells will begin to develop because of damage to DNA. DNA is a substance in every cell that directs all activities. Normally when DNA is damaged the cell will either die or the DNA will repair on its own. With cancer cells the damaged DNA is unable to be repaired. In some cases people can inherit damaged DNA which accounts for inherited cancers. A person’s DNA is more likely to become damaged because of exposure to environmental factors such as smoking.

Cancer normally forms as a tumor. In some cancers such as leukemia, tumors do not form. Leukemia forms cancer cells that involve the blood and blood-forming organs and circulate through other tissues where they grow.

Not all tumors are cancerous. Tumors are classified as either benign (non-cancerous) or malignant (cancerous). Benign tumors do not spread to other parts of the body (metastasize) and with very rare exceptions are not life-threatening.

Metastasis is the process where cancer cells often travel to other parts of the body where they will begin to grow and replace healthy normal tissue. This occurs as the cancer cells get into the bloodstream or lymph vessels of the body. When the cells from a cancer like lung cancer spread to other organs like the liver, the cancer is still called lung cancer, not liver cancer.

Cancer is different depending upon the type. For example, lung and breast cancer are very different diseases. Each grows at different rates and responds to different treatments. For this reason, it is important that people with cancer need treatment that is aimed at their particular type of cancer.

The second leading cause of death in the United States is cancer. Approximately half of all men and one-third women in the United States will develop cancer during their lifetimes. Today there are millions of people that are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changing lifestyles such as eating a healthy, well-balanced diet and quitting smoking.

Today there are many treatments available that are increasing the cancer survivor rate. The earlier that cancer is found, the sooner treatment will begin, and the chances for living for many years are increased.

Symptoms

Many types of cancer do not produce obvious symptoms or cause pain until the disease has progressed. Early-stage cancer symptoms tend to mimic less-threatening diseases. For example, difficulty urinating is a symptom of prostate cancer and flu-like symptoms are symptoms of acute leukemia.

There are seven warning signs to watch for but it is important to note that just because you have a symptom that does not mean that you have cancer. Some symptoms are specific to certain types of cancer, it is important to note any changes. It is important to make an appointment with your physician to determine if further testing is needed if you have a symptom. Do not be afraid to discuss unusual symptoms to your physician. It could save your life!

The seven warning signs to watch for can be remembered by the word “caution”.

• Change in bowel or bladder habits
• A sore that does not heal
• Unusual bleeding or discharge
• Thickening or lump in the breast or any other part of the body
• Indigestion or difficulty swallowing
• Obvious change in a wart or mole
• Nagging cough or hoarseness

Certain cancers have specific symptoms. Below is what to watch for if you or a loved one suspect cancer.

• Bladder & Kidney:  Pain & burning while urinating. Blood in urine and an increase in frequency of urinating.
• Breast: Lump(s), thickening or any changes. An increase in redness, itching, and soreness that is not associated with menstrual periods, pregnancy, or breast feeding.
• Cervical, Uterine, & Endometrial:  Unusual discharge, very painful periods, heavy periods, bleeding between periods.
• Ovarian: Normally no apparent symptoms until the later stages of the disease.
• Testicular:  Enlargement of a testicle, mild ache in the lower abdomen or groin, thickening of the scrotum, pain and discomfort in a testicle or in the scrotum, & a sudden collection of fluid in the scrotum.
• Prostate:  Constant pain in the pelvis, upper thighs, or lower back. Weak and interrupted urine flow. Frequent urination.
• Colon: Changes in bowel habits such as frequent diarrhea or constipation. Rectal bleeding & blood in the stool.
• Laryngeal:  Hoarse throat & persistent cough.
• Lung: Sputum with blood, heavy chest, chest pain, & persistent nagging cough that does not go away.
• Leukemia:  Bone & joint pain, fatigue, weight loss, loss of appetite, easy bruising, bleeding gums, repeated infections, & paleness.
• Lymphoma:  Unexplained fever, itchy, night sweats, unexplained weight loss, enlarged & rubbery lymph nodes.
• Mouth & Throat:  An ulcer in the mouth, tongue, or throat that does not heal or reappears.
• Skin:  Moles that change color or size. Tumor or lump under the skin that never heals that might resemble a wart or ulceration.
• Stomach:  Frequent & persistent heartburn after eating that never goes away. Weight loss and blood in vomit.

The discovery of any of these symptoms should be followed by a visit to your physician. Do not be afraid to see your physician, be concerned about not seeing your physician.

Diagnosis

Cancer is a diagnosis that no one wants to hear. Fortunately we are living in an age of technological advances and constant research.

Today there are several diagnostic methods available for physicians to detect and diagnose cancer. Technological advances have allowed cancer to not be a “death sentence” but in many cases treatable. It is important for an individual to know their body and be aware of changes and symptoms that occur.

Early detection is the key to saving lives. When an individual develops symptoms that are not normal an appointment to their primary care physician must be made. If the physician suspects cancer he or she will refer the patient to an oncologist. The oncologist will coordinate the tests needed for the diagnosis and determine a treatment plan. A detailed patient history will be taken along with lab work and diagnostic tests (such as CAT scan, P.E.T. scan or the Fusion of the two.

Diagnostic Imaging

There are several techniques that are used. These images produce internal pictures of the structures of the body.

Methods:

• X-Rays: The most common method that physicians use to get pictures of the inside of the body. Radiologists (physicians trained in the reading of x-rays) can spot abnormal areas that might indicate the possibility of cancer.
• CAT scan: (Computerized axial tomography) this method uses a special machine that utilizes radiographic beams that create detailed computerized pictures of the body. This provides a clear image and is more precise than a regular x-ray.
• MRI: (Magnetic Resonance Imaging) This method uses a powerful magnetic field to capture detailed computer images of the body’s major organs, large blood vessels, and soft tissues. This procedure is expensive but accurate. During the procedure, which normally lasts about 30 minutes, patients must lay completely still in order to get accurate results.
• Ultrasound: High-frequency sound waves are used to determine if there is a suspicious tumor or lump and if it is solid or fluid.
• P.E.T. scan: (Positron Emission Tomography) This method produces images of the body’s biological functions. Physicians are able to evaluate the metabolic function of tumors; meaning the P.E.T. scan can show if certain lesions are benign or malignant. P.E.T. shows the progress of the disease and how the body is responding to treatment. This is available at Ashland Bellefonte Cancer Center.
• CT-P.E.T. Fusion: The combination of the two technologies that enables the physician to view the metabolic changes in the proper anatomical context of the body.

Blood Tests:

Blood tests are another method that physicians use when diagnosing cancer, these tests give important information that could indicate a problem. If the cancer is present the lab results may show the effects of the disease on the body.

• In certain cases, special tests are utilized to measure the amount of certain substances in the blood, urine, other body fluids, and tumor tissue. When certain cancers are present the levels of these substances may become abnormal.
• Tumor markers are a substance that certain tumors release indicating a presence of cancer. Tumor markers can be detected through blood tests.
• PSA blood test is used for determining prostate cancer. This test determines the amount of the prostate specific antigen. Results that show higher than normal levels of PSA can indicate cancer.
• Recently a blood test for ovarian cancer has been made available, CA-125.
• Blood tests alone can be inconclusive and other methods should be utilized in order to diagnose cancer.

Pathology:

It is important to understand that a diagnosis can not be made until a biopsy has been taken from the mass. The oncologist will perform a biopsy and send to a pathologist. A biopsy is the removal of living cells, tissues, or fluid in order to make a diagnosis. A pathologist is a medical physician that has specialty training in the examination of diagnosing tissues and cells and is the only physician that can actually make a diagnosis of cancer.

Biopsies can be performed several ways depending upon the size, type, and location of the tumor.

Types of Biopsies

• Fine-needle aspiration: a fine needle is used with a syringe to remove (suction) clumps of cells from a mass or tumor. To qualify for this procedure, the tumor must be large and not located near a hollow organ or blood vessel. This can often be performed without anesthesia.
• Needle Biopsy: A small core of tissue is obtained through a large-bore needle and local anesthetic.
• Incisional Biopsy: The surgical removal of a small area of tissue. This can be performed with local anesthesia and on an outpatient basis.
• Excisional Biopsy: The removal of an entire tumor for analysis through surgical removal. This procedure requires local or general anesthetic. Normally used for breast tumors that are less than an inch in diameter, procedure called a lumpectomy. Before undergoing a biopsy there are questions that you should ask your physician. Below are samples of the types of questions that you should ask.

Prior to undergoing a biopsy

• How long will the procedure take?
• Will I be awake and will it hurt?
• After the procedure how soon will the results be back?
• If the results come back indicating cancer who will talk to me about treatment?
• When will treatment begin? Should treatment begin immediately?

In some cases the true extent of a tumor’s development is not known until the patient undergoes surgery. Surgery will be performed by a surgical oncologist who can determine the size of the tumor and the extent that it has spread. This is known as tumor staging.

Tumor staging is important because it plays a vital role in determining a patient’s prognosis, what treatment and therapy is appropriate and if it is successful or not. After the pathologist has determined the classification of the tumor the diagnosis begins.

The physician will determine the “stage” or the extent of the cancer. This is how the physician determines the best treatment for a specific type of tumor. The physician may order more tests to determine if the cancer has spread and if so, to what parts of the body. Lymph nodes near the tumor may be removed to check for cancer cells. If cancer is present in the lymph nodes this may indicate that the cancer has spread to other areas of the body and to other organs. The earlier cancer is diagnosed the greater the opportunity for survival and a cure.

Cancer Stages

• Stage I: This is the simplest form and indicates that the tumor is small and confined to the area that it originated. When a tumor is diagnosed in this stage, the chance for a cure is high.
• Stage II: The tumor has spread to the surrounding tissues
• Stage III: The tumor has spread into the surrounding tissues and lymph nodes.
• Stage IV: Indicates an extensive spread, normally to many organs and other parts of the body.

Grades

This is one of the most important elements of a patient’s diagnosis. The cancer grade specifies how aggressive the cancer is and is determined by the pathologist. There are three major components when determining the grade.

• First: How the individual cells appear, are they very different from normal cells?
• Second: What is the tissue pattern? Does the pattern of cells mimic the normal makeup of tissue in that area of the body?
• Third: What is the cells’ mitotic rate? What proportions of the cells are actively dying?

The pathologist will then classify the cancer in order of low grade to high grade or aggressive. The grades are 1-4, 1 being low grade and least aggressive with 4 being high grade and most aggressive.

When your physician talks about the grade of the cancer there are certain terms that he/she might use such as differentiated, well differentiated, moderately differentiated, and poorly differentiated. These terms describe how mature the cancer cells are and how different there are from normal healthy cells that are taken from the same tissue. For example, well differentiated Grade 1 tumor means slower growth and less likely to spread unlike an undifferentiated Grade 4 tumor.

Other Indicators

Analytical Indicators (often called prognostic) such as molecular and genetic have been identified as tests for physicians to use in determining a diagnosis. An indicator that is often used in diagnosing breast cancer is hormone receptors. If a cancer is found to be ER-positive, the surface of breast cancer cells is studded with molecules that attach to estrogen. Estrogen Receptors (ER) are found to stimulate cancer cell growth. Another indicator is PR or progesterone receptors. All breast cancer tumor tissue today is tested for the presence of ER and PR. Once the oncologist has diagnosed cancer it is important to have a full understanding of your diagnosis. It is important that you have the full name of the cancer, which should include the type and the grade (shows how the cancer cells are likely to act). If you do not have all this information, it is important that you ask your physician.

Basic questions to ask your physician concerning your diagnosis:

• What is the medical name of the cancer?
• Is there a type and subtype? If so what is the type?
• What stage is the cancer in?
• What is the grade of the cancer?
• What is my prognosis?
• Are there any characteristics that could affect the course of the disease or affect the treatment options?
• What should I expect during the course of the treatment?

After the diagnosis the treatment phase will begin.