A cancerous tumor is a neoplasm that is formed from abnormally growing cells. It is able to affect any organs and tissues of the body. Basically, such formations grow rapidly, capture more and more new areas, grow into other tissues.
Malignant tumors have the ability to produce metastases. So called secondary foci that arise in a particular organ or lymph node due to the movement of atypical cells through blood or lymph.
When the metastasis process starts, the prognosis for life becomes unfavorable. It is impossible to save a patient who has malignant cells spreading throughout the body. In this case, doctors can only prolong the patient's life and eliminate the symptoms of the disease.
The ability to grow into other organs and give metastases is the malignant nature that distinguishes such neoplasms from benign tumors. Many patients are interested in whether a malignant tumor is cancer or not? In most cases, such formations are oncology, but there are non-cancerous forms.
Malignant tumors come in different types, depending on the structure of the formation, the characteristics of the course and other characteristics. In medical practice, the following types of pathology are found:
- Carcinoma. The most common form of the disease. It affects various organs: the prostate, mammary glands, lungs, intestines and others. A neoplasm is formed from epithelial cells, has a different appearance. Basically, a carcinoma is a nodule with a lumpy or smooth surface, dense or soft structure.
- Sarcoma. It is formed from connective tissue and muscles. Diagnosed quite rarely. It can affect bones, skin, uterus and other organs. It is characterized by rapid growth, early metastasis, frequent relapses.
- Glioma This type of malignant tumor arises in the brain from glial nervous system cells. Causes severe headaches, dizziness.
- Melanoma. It develops from cells called melanocytes. The pathology affects the skin, differs in early metastasis. It is very rare in medical practice.
- Lymphoma It is formed from the tissues of the lymphatic system.
- Leukemia Grows from bone marrow stem cells that are responsible for blood formation.
- Teratoma. The structure of this type of cancer tumor is made up of embryonic cells, therefore, pathology occurs even with intrauterine development. It most often affects the brain, testicles, ovaries.
- Choriocarcinoma. It is formed from placental tissues.
When the doctor examines the patient, it is important for him to accurately determine how the type of disease develops in the patient. Treatment tactics and disease prediction will depend on this.
Causes of Tumor Development
A cancerous tumor results from abnormal cell division. Why the process of reproduction and growth of cell structures is disturbed is still unknown. But thanks to scientific research and medical practice, doctors were able to identify several factors that, with prolonged exposure, can disrupt the functioning of cells.
Similar phenomena include:
- Hereditary predisposition. If there are people with oncology in the family history, then there is a high risk of getting it.
- Smoking. This includes both active and passive smoking. The formation of cancerous tumors in smokers causes inhaled cigarette smoke, which contains many harmful substances that inhibit the state of cells.
- Alcohol abuse. Alcohol, like cigarette smoke, is very harmful to the body, as it can cause mutations in cellular elements.
- Work in hazardous industries. People who are constantly exposed to chemicals and poisons are more likely to develop malignant pathologies.
- Viral diseases. Often in the body of cancer patients, the human papillomavirus is found.
- The effect on the body of radiation or ultraviolet radiation. Regular exposure to the sun or living in an area with high levels of radiation poses a considerable danger to human health.
In addition to external factors, other diseases often lead to the development of malignant tumors of soft tissues and bones. These can be inflammatory processes, benign neoplasms, infectious pathologies.
Cancerous tumors do not show any signs for a long time. This creates great difficulty for the timely detection of pathology. Manifestations begin to bother when the formation reaches a large size and gives metastases.
Symptoms of malignant tumors are not the same. They vary depending on the location of the lesion. For example, with lung pathology, cough, hemoptysis, chest pain, and digestive organs - disorders of the stool, blood in the stool are observed.
But there are common signs with any localization. These include a sharp weight loss, deterioration of appetite, a constant feeling of weakness, loss of working capacity, depression, fever.
A cancer tumor is detected using a number of instrumental methods. Different diagnostics are prescribed depending on the location of the lesion. The list of activities may include the following:
- Ultrasound procedure.
- CT scan.
- Magnetic resonance imaging.
- Diagnostic laparoscopy.
In addition to instrumental methods, laboratory ones are prescribed. Patients are required to donate blood for a general clinical, biochemical study, as well as for tumor markers. It is also necessary to examine urine, in some cases feces.
To determine the malignancy of the neoplasm, a biopsy is performed, during which cells are taken for further histological examination under a microscope.
Treatment of a malignant tumor is carried out in a complex way, since the disease is difficult to treat. Atypical cells are aggressive, develop rapidly, so therapy is required as quickly as possible. The main way to treat neoplasms is surgery, the volume of which depends on the area of the lesion.
In combination with the operation, chemical and radiation therapy is used. They help suppress the division of atypical cells, reduce the size of the tumor. Also, these methods are used for pathology inoperability in order to prolong the patient's life.
The prognosis for malignant tumors can be different depending on the stage of the pathology, the age of the patient, the presence of concomitant diseases. Most people manage to recover completely only in the treatment of education in the early stages.
That is why doctors urge to regularly check the condition of the body. Only preventive examinations can help in the timely detection of malignant disease and its successful treatment.
It is accepted that tumors developing from epithelial cells are called cancer or carcinoma, while those developing from connective tissue are called sarcoma. The development of a malignant tumor can occur in any organ or tissue of the body. Certain negative factors create favorable conditions for the appearance of a tumor, and it gets its development.It begins with a specific area of tissue or organ, as the cells divide, the tumor grows into neighboring tissues and organs, malignant cells spread through the bloodstream throughout the body - metastasis begins. Unlike benign, a malignant tumor is characterized by aggressive growth, is able to penetrate the lymphatic and blood vessels, give metastases, which lead to the development of new malignant tumors in tissues and organs. Metastasis is a certain interaction between the body and the tumor, which consists of several stages: the separation of malignant cells from the mother’s tumor, penetration into the bloodstream or lymph vessels, the movement of cells through vessels, and the engraftment of malignant cells in distant lymph nodes or organs. Rapid growth malignant tumors often undergo necrosis - the tumor tissue softens, cavities form, and purulent tissue inflammation begins. As a result of this process, perforation of the organ (most often cavity) of the tumor affected occurs.
A malignant tumor consists of specific and non-specific tissue - parenchyma and tissue with vessels, nerves, connective tissue stroma. A tumor consisting only of tumor cells is called a histoid tumor, a tumor with a pronounced stroma - an organoid tumor.
Tumors are mature (homologous and homotypic) and immature (heterologous and heterotypic). The stroma is the supporting base of the tumor (skeleton), consists of connective tissue penetrated by the blood vessels that feed the tumor. In their appearance, tumors are divided into:
Nodular, round shape.
Papillary, villous tumors.
Diffuse, differing from normal tissue in color and consistency.
Malignant tumors formed like a mushroom cap.
One of the signs of a malignant process is infiltrative growth. A malignant tumor destroys neighboring tissue, creating a motionless formation with blurred borders. A malignant tumor consisting of parenchyma grows rapidly, mature and tumors with stroma grow slowly. The growth of a malignant tumor depends on a number of factors - trauma, the inflammatory process, pregnancy, and puberty can affect rapid growth.
Types of Malignant Tumors
Adenocarcinoma (mucous, tubular, acinous, papillary, colloid), trabecular cancer, medullary cancer, fibrous cancer, epidermoid cancer, undifferentiated cancer - basal cell carcinoma.
Cancer of the integumentary epithelium is a cancer of the skin, bronchi, lips, esophagus, bladder and vaginal part of the cervix. Cancer of the glandular epithelium is a cancer of the breast, liver, uterus, bronchi, pancreas, intestines, salivary glands.
Epithelial tumors take first place among tumors of the organs of the oral cavity. About 95% is squamous cell carcinoma, keratinized squamous cell carcinoma is most often found. The development of cancer of the organs of the oral cavity is promoted by bad habits - smoking, chewing tobacco, poor oral care, cariosis, dentures that cause frequent injuries of the oral cavity - cheeks, tongue, gum mucosa, precancerous diseases - leukkeratosis, untreated oral ulcers, leukoplakia (caused by hormonal disruptions in the body, anemia). The main cause of an epithelial tumor of the cheek are prostheses that injure the mucous membrane of the cheeks for a long time.
Uterine epithelial tumors include carcinoma in situ (not extending beyond the organ), which is defined as intraductal carcinoma, a non-invasive carcinoma. Various precancerous diseases contribute to the development of cancer of the uterus in case of insufficient treatment or late detection.
About 90% of ovarian tumors are epithelial tumors.Diagnosis of malignant ovarian tumors is very difficult, so for the most part they are found in the late stages.
Malignant tumors of epithelial origin predominantly metastasize by the lymphogenous and lymphohematogenous pathways, unlike other types of tumors that predominantly metastasize by the hematogenous pathway.
Types of malignant tumors of the lymphatic and blood vessels
Angiosarcoma, lymphangioendothelioma, hemangioendothelioma belong to malignant tumors of the tissues of blood and lymph vessels.
Angiosarcoma is a malignant tumor that is easily metastatic. It comes from the perithelium and vascular endothelium. It is rare, the frequency of the disease in men and women is the same.
Lymphangioendothelioma - comes from the endothelium of the lymphatic and blood vessels. The tumor tends to grow rapidly and metastasize. Tumor metastases primarily affect the lymph nodes of the neck, then the lungs and liver. Primary angiosarcoma affects the elderly, secondary occurs in chronic lymphatic edema.
A lymph node affected by a malignant tumor can provoke the spread of malignant cells through the lymphatic and circulatory systems to other organs, where the cell can begin to divide and give rise to a new tumor. A tumor of the lymph nodes can provoke malignant processes in the liver, bones, lungs. Most often, a malignant tumor of the lymph nodes develops in the neck.
Connective tissue malignant tumor
These include: generalized reticulosis, reticulosarcoma, hemacitoblastosis, lymphogranulomatosis, myelosis, lymphadenosis, as well as neoplasms from unformed connective tissue: cytoblastoma (squamous cell sarcoma), polymorphic and epithelioid cell, spindle cell sarcoma, fibro. Malignant formations of formed connective tissue: osteosarcoma, chondrosarcoma, malignant chordoma.
Fibrosarcoma is a malignant tumor that begins to develop from the periosteum, tendon tissues, from the connective membranes (fascia). Most often, young people and people of mature age are ill, fibrosarcoma most often affects the limbs.
Malignant tumors of muscle tissue include: myosarcomas (rhabdomyosarcoma, leiomyosarcoma, granular cell myoblastoma, malignant.).
Malignant tumors of muscle tissue develop from the muscles that raise the hair, the muscles of the sweat glands (cutaneous leyosarcomas), smooth muscles of arterioles and saphenous veins (subcutaneous leyosarcomas).
Rhabdomyoblastoma comes from the striated (skeletal) muscle, often develops in children. The tumor grows quickly, there is no dysfunction, no pain. Often the skin grows, forms nodes that bleed.
Malignant tumors of the nervous system
Tumors affecting the nervous system: ependymoblastoma, astroblastoma, malignant neurinoma, neurofibrosarcoma, sympathogonioma, malignant paraganglioma, medulloblastoma, meningeal sarcoma, glioblastoma, sponioblastoma.
Malignant tumors of the nervous system develop in various parts of the brain. Malignant pathology occurs at any age, from early childhood to senile age. Some types of tumors affect mainly children.
Malignant skin disease - melanoma, is pigmented and pigmentless. A malignant tumor develops from melanocytes. It appears in the form of formations of small sizes on the skin. Pigmented melanoma is more common than nonpigmented melanoma. Pigmentless melanoma is a dangerous type of cancer, grows quickly, aggressively, metastasizes in the early stages of its development.
The most important task of clinical diagnosis is the diagnosis of a malignant tumor in the early stages of its development. Improving diagnostic methods significantly increased the percentage of cancer detection in the early stages, which allows not to use radical treatment.
What types of cancer are there?
To date, more than 100 types of malignant tumors are known. As a rule, they are called by the organ from which they originate, for example, the primary lung tumor will be called "lung cancer." Sometimes additional refinements are applied, depending on the specific type of tissue from which the tumor originated. For example, “squamous cell lung cancer” is a subtype of lung cancer that has developed from the squamous epithelium lining the lumen of the bronchi. This is important when choosing a treatment method.
In addition, tumors can be divided into solid ("solid"), the cells of which form the tumor mass and tumors of the hematopoietic and lymphatic system (hemoblastoses), which initially proceed as systemic diseases, i.e. involving more than one organ. For example, with leukemia, tumors originate from bone marrow cells, enter the bloodstream and circulate through the body with a blood stream.
Classically, the word "cancer" refers to tumors originating from the epithelium of the skin or mucous membranes. Tumors originating from other types of tissues, such as muscles, tendons, nerves, fat, bones, etc. called "sarcomas." Malignant tumors also include:
- leukemia and multiple myeloma (primary bone marrow tumors),
- lymphomas - tumors originating from the peripheral organs of the immune system, for example, lymph nodes,
- melanoma - a tumor that develops from melanocytes, special cells that normally protect the body from the harmful effects of sunlight, they also form “moles”,
- neuroendocrine and carcinoid tumors - tumors with hormonal activity.
What is the difference between malignant and benign tumors?
One should distinguish between benign and malignant tumors, their main differences are presented in Table 1. It should be noted that in some cases, benign tumors can reach significant sizes. Benign tumors, as a rule, do not pose a direct threat to the patient’s life, with the exception of tumors growing in the brain and spinal cord — these tumors can squeeze critical structures in these organs and lead to death or irreparable harm to the patient’s health.
|Table 1. The main differences between malignant and benign tumors|
|Benign tumors||Malignant tumors|
|Growth pattern||“Push” surrounding tissue||The surrounding tissue sprouts|
|Ability to metastasize||Not||Yes|
|Growth form||Right |
How does cancer arise and how do tumor cells differ from normal ones?
Many normal cells have the ability to divide, however, these processes occur in concert and stop or slow down when the need for the formation of new cells disappears. So, for example, skin wounds stimulate the acceleration of cell division processes that form the skin. As soon as the wound is healed, the cell division rate again slows down to the level necessary only for the renewal of aging cells.
With the development of the tumor, everything changes. Its cells divide almost independently of external signals (autonomously), with the accumulation of mutations, they become less and less like normal ones, their previous functions are lost, instead, only one thing remains - reproduction. Tumor cells begin to actively absorb nutrients, grow and multiply.Over time, they begin to displace normal cells, acquire the ability to invasive growth (which means germination in other tissues and blood vessels) and metastasis (spread throughout the body with blood flow, lymph, along the vessels and nerves, and so on).
The cause of tumor cells (oncogenesis) is the appearance of certain mutations in the DNA - violations in the genetic code of the cell that occur under the influence of external factors (for example, carcinogens, oncogenic viruses, etc. - see below) or in the process of natural cell division.
There are many mechanisms in the body that block the formation and growth of tumor cells. So, in any cell there are special control proteins that monitor the process of its division and, if something goes wrong, they stop the further reproduction of the cell and start the process of its natural death (apoptosis). A cell can receive a similar signal from the external environment, for example, from other cells of the body. In a tumor cell, the mechanisms of death upon injury are “turned off” and they do not respond to such stimuli and continue to divide.
The continuous monitoring of such cells is carried out by the immune system, recognizing and destroying those cells that may be dangerous to the body. However, in some cases, a tumor may acquire the ability to “deceive” the immune system and evade its influence.
With a combination of the above factors, in the absence of control over the integrity of the genetic code in the tumor, the accumulation of mutations continues, as a result of which it becomes less and less like a normal cell and acquires the features of malignancy.
Thus, cancer is a genetic disease, which means that it arises as a result of the development of damage in certain genes. These injuries can be inherited from parents - modern oncology knows cases of the development of family cancer of the breast, ovaries, colon and so on. However, most often they occur by chance ("sporadic mutations") in the process of human life. Many environmental factors have a damaging effect on the cell and its genetic code, including:
- industrial hazards, such as constant contact with asbestos, coal dust, a number of dyes, and so on,
- chronic infections caused by viruses, bacteria and parasites. So, in most cases, cervical cancer develops against a background of chronic infection caused by human papillomavirus (HPV),
- exposure to radioactive radiation.
Be sure to tell your doctor if your relatives have had cases of cancer, including - other than yours. This can have a big impact on your treatment. Ask your loved ones if you are not sure or do not know.
Under the influence of these and other factors, DNA damage to the cell constantly occurs. Normally, these abnormalities are eliminated by special proteins that eliminate such damage (repair system). However, if critical structures are damaged, such damage can lead to malignant degeneration of the cell. These structures include:
- Proto-oncogenes - structures that are responsible for the normal growth and division of the cell. With certain injuries, they can become hyperactive, allowing the cell to survive under those conditions in which it should normally die,
- Genes that suppress tumor growth (tumor suppressors), as well as proto-oncogenes, are responsible for cell growth and reproduction, but unlike the former, they suppress these processes. In violation of the functions of these genes, the cell acquires the ability to uncontrolled growth and reproduction,
- Genes responsible for the normal functioning of the repair system.If they do not fulfill their tasks, mutations accumulate in the cell, which over time can lead to its malignant transformation.
What is metastasis?
As the tumor mass grows, its cells change, and genetic “breakdowns” accumulate in them. Over time, the tumor grows into the blood and lymph vessels. The cells that enter the vessels are carried throughout the body with a blood or lymph flow, and enter the distant organs or nearby lymph nodes where secondary (metastatic) tumors form.
This process is called the process of metastasis, in tumors of various locations it proceeds unequally and depends on the characteristics of the blood supply to the tumor and some of its biological properties. For example, distant colon cancer metastases are most often found in the liver, lungs, and brain, while prostate cancer is most commonly metastasized in skeleton bone. This is the most advanced stage of the tumor process (IV), which is characterized by the least favorable prognosis. Nevertheless, the achievements of modern medicine in some cases allow to achieve a significant extension and improve the quality of life in patients with metastatic tumors.
Secondary tumors, as a rule, have the same histological picture as the primary lesion, and similar molecular genetic disorders. It follows that metastases of rectal cancer in the liver are treated in the same way as rectal cancer itself, not like liver cancer.
An oncological disease is based on a violation of tissue growth regulation processes.
An oncological disease is based on a violation of tissue growth regulation processes. The cells of our body are constantly updated. In the process of their division, there is always the possibility of errors in genes (mutations). This happens normal, but their frequency increases significantly when exposed to such unfavorable factors as carcinogens, ionizing radiation, etc.
There are various mechanisms for preventing and correcting mutations. If they do not work, a cell with damaged DNA develops and divides repeatedly, not obeying the body's controlling systems. As a result, a formation is formed, which is commonly called the term "malignant tumor."
Malignant tumors are characterized by three key differences from benign:
- Uncontrolled endless growth.
- Germination (invasion) in neighboring tissues and organs with a violation of their functioning.
- The ability to metastasize - the process of migration of cancer cells with blood or lymph flow to other parts of the body
It is these characteristics that determine the aggressiveness of the process and its malignancy.
A tumor can consist of dense tissue and then they talk about a solid formation. However, it may have a liquid consistency, as with leukemia and lymphoma.
Difficulties in the treatment of oncology
Cancer can occur in any living organism at any age. However, this risk increases with age. It is estimated that more than 64% of cases are diagnosed in people over 65 years of age. However, oncologists are currently talking about rejuvenating such patients. Increasingly, the disease is diagnosed before the age of 40 years.
There are two main problems in the treatment of this pathology:
- The prevalence of the tumor process, which limits the possibilities of radical surgical treatment.
- Heterogeneity of the cellular composition of the tumor. You can choose drugs that will kill 99% of the tumor cells, but if at least a few of them survive, they will again divide, and a relapse of the disease will develop.
Causes of Cancer
The causes of cancer are very diverse, but all of them lead to the fact that a mutation occurs in the cells of the body, which leads to their uncontrolled reproduction. The following factors can provoke the formation and reproduction of such cells:
- Malnutrition. It is one of the main reasons. the occurrence of cancer. And there are several aspects. Firstly, many foods that people consume daily contain a certain amount of food carcinogens. Such products include smoked meats, marinades and other canned and fried foods, vegetables and fruits grown with the use of chemical fertilizers and pesticides, etc. Secondly, a balanced diet is important. For example, there is evidence that an excess of meat in the diet leads to an increased risk of colorectal cancer, while a large amount of plant fiber and fiber reduces these risks. An unbalanced diet can lead to the development of obesity, which is a risk factor for such malignant neoplasms as pancreatic cancer.
- Aging. In the vast majority of cases, malignant tumors occur in people older than 50 years. This is associated with the accumulation of the action of risk factors and the weakening of the mechanisms of protection and destruction of mutated cells.
Heredity. When they talk about the hereditary causes of oncology, they mean two aspects - a genetic predisposition and hereditary forms of malignant neoplasms. In general, the probability of getting some form of cancer during life is 5-10%. However, if there are cases of malignant neoplasms in the family, this probability increases by more than two times. This is called a genetic predisposition.
In addition, there are hereditary forms of cancer in which there are mutations in certain genes. As an example, we can cite mutations in BRCA genes, in the presence of which the probability of developing breast or ovarian cancer is about 80%.
Cancer incidence statistics in the world and in Russia
Cancer Research UK, the British Cancer Research Society, reported that in 2012, more than 14 million new cases of cancer were diagnosed worldwide. In the same year, more than 8 million people died from cancer. In general, the prevalence of malignant tumors in different countries is growing, and this is due to many factors (increased incidence, improved diagnostic methods, increased life expectancy).
According to statistics provided by the Moscow Research Cancer Institute. P.A. Herzen, in 2016, almost 600 thousand new cases of malignant tumors were first detected among the inhabitants of Russia. Among primary patients, there were fewer men than women. More than 300 thousand patients died in a year.
The prevalence of cancer in our country is growing steadily. For example, indicators of 2016 compared to 2015 increased by 1.7%, and compared to 2006 - by 20.6%. This does not necessarily mean that people began to get sick more often. Partly, such negative dynamics is associated with the fact that life expectancy is increasing (in old age, as you know, the risk of developing many types of cancer increases), and partly with the fact that tumors are better to diagnose earlier.
At the moment, oncology is one of the most rapidly developing areas of medicine. In recent years, quite a few drugs and techniques have appeared that help to more effectively fight the disease, extend the life expectancy and improve its quality.
The European Oncology Clinic uses modern treatment regimens according to the latest protocols, which allows us to provide all the necessary assistance that the patient needs.
What types of cancer do people in Russia most often get? The ten most common oncological diseases include:
- mammary cancer,
- large intestine
- tumors of lymphatic and hematopoietic tissue,
- cervical cancer,
- thyroid gland,
- the stomach.
These types of cancer account for almost 70% of all cases of cancer.
Do Russian doctors often detect cancer at an early stage?
According to all the same statistics in 2016, doctors were able to diagnose malignant tumors at the first stage in 28.6% of cases, at the second stage - in 26.1% of cases. In total, this accounts for more than half of all primary patients. As a rule, the disease is well treated, the prognosis is favorable. In 19.1% of patients, cancer was diagnosed in stage III, in 20.5% in stage IV.
What causes most often lead to cancer?
Factors contributing to the development of malignant neoplasms are discussed above. Some of them are related to lifestyle, and we can influence them. Others, such as genetics and age, cannot be changed.
According to Cancer Research UK, the leading role belongs to factors from the first group:
- Up to 33% of deaths from smoking are attributable to cancer.
- About 6% of all deaths are responsible for alcohol, one in eight of them from cancer.
- For the development of 18% of malignant tumors, viral infections are responsible.
- A significant role belongs to obesity, malnutrition with a predominance of fatty, fried meat and processed foods, lack of vegetables, fruits, dietary fiber.
Is cancer a deadly diagnosis?
Many people perceive the diagnosis of cancer as a sentence. This is far from the case. Depending on the prognosis, all oncological diseases can be divided into two conditional groups:
- Treatable cancer. Such tumors can be removed surgically or otherwise, after which remission occurs. Usually this is stage I and II cancer (as we mentioned above, at this stage, more than half of Russians diagnose tumors) and partially stage III.
- Non-curable cancer. Typically, these are stage IV tumors with distant metastases or growing into vital organs, large nerves or blood vessels. Modern medicine does not know a cure for such a tumor, however, there are effective methods of palliative treatment. Doctors can extend the patient's life, improve his condition, relieve him of excruciating pain. Such a process is regarded as a chronic disease.
There are other formally incurable diseases, but you can live with them for a long time and feel quite well. Of course, the prognosis is individual, it depends on the type and location of the tumor, the number and location of metastases, other factors. But the patient can always be helped. Improving the quality of life or prolonging it even for a short period of time is the result that can be considered satisfactory.
No matter how terrible the diagnosis may be, do not give up before your time. It is worth remembering that oncology is constantly evolving. New drugs, approaches, protocols appear. Doctors treat cancer more and more successfully, so patients from the second group are gradually moving into the first.
Even if none of the existing treatments helps, there are still alternative options. Some patients may take part in clinical trials when new drugs are tested that show excellent results in laboratory animals. Doctors at the European Oncology Clinic will tell you where to go if the patient is interested in this option.
Cancer Diagnostic Methods
Due to the fact that in many countries the majority of malignant neoplasms are detected in the late stages, when there is no question of radical treatment, more and more attention is being paid to screening programs. Screening is a screening system for people who are at risk but who do not have symptoms of cancer. This allows you to find the disease in the early stages, before it made itself felt. In such cases, fast, inexpensive diagnostic methods are used:
- Determining PSA levels to assess prostate cancer risk.
- PCR for the detection of human papillomavirus to assess the risk of cervical cancer.
- Hidden blood test and colonoscopy in colorectal cancer screening.
- Mammography for breast examination.
Dermatoscopy is used to detect melanoma and skin cancer. The European Oncology Clinic uses a more modern technique - our doctors compile a “mole map” using the German PhotoFinder device. This helps to track the picture in dynamics, in time to detect minor changes. Blood tests for tumor markers are rarely used and, as a rule, in combination with other methods, since they have low accuracy.
The main problem in oncology is the diagnosis of the disease at an early stage. Screening partly helps to solve it.
When a tumor is detected, the oncologist’s main task is to assess the prevalence of the tumor process and its staging. The following methods are used for this:
- CT scan.
- Magnetic resonance imaging.
- Lab tests.
- Endoscopic methods (FGDS, colonoscopy, bronchoscopy).
The doctor assesses the size of the primary tumor focus and its location relative to the surrounding organs and tissues, the defeat of regional lymph nodes and the presence of distant metastases. The resectability (possibility of removal) of the neoplasm, as well as its stage and, accordingly, prognosis, depends on all these indicators.
Any oncological diagnosis is established only after morphological confirmation. For this, a biopsy is performed, or the material for the study is taken during the operation. As a result of a microscopic examination, the pathologist makes a final diagnosis, which confirms the malignancy of the tumor, indicating the degree of its differentiation and morphological variant (adenocarcinoma, squamous cell carcinoma, sarcoma, etc.).
After the patient has been treated, there is a risk of relapse. In this regard, in this period of time, it is necessary to regularly observe and undergo a certain list of examinations, which is determined individually. When identifying the progression of the disease, it is extremely important to begin treatment as early as possible, while the risk of spreading the tumor throughout the body is minimal.
If the process is common, and the patient is undergoing palliative treatment, he is also periodically examined, his condition, and the behavior of the tumor in dynamics are evaluated. The examination program in each case is individual, taking into account the type, stage, localization.
In oncology, the classification of TNM is generally accepted, which helps to most objectively assess the prevalence and stage of the tumor process. Three letters in the abbreviation indicate respectively: the size and location of the primary tumor - T, the presence of foci in the regional lymph nodes - N and the presence of distant metastases - M. A specific index is added to each letter:
If you want to select a substage, add letters to the numbers. For example, stage T1 can be divided into substages T1a and T1b. The TNM classification is accurate, it covers all possible options. All possible combinations of indicators T, N and M are reduced to four stages, but sometimes additionally distinguish the zero stage - localized cancer:
- 0 - "cancer in place."
- I – III - local cancer. It can be in one organ, spread to surrounding tissues, regional lymph nodes.
- IV - cancer with distant metastases.
This is a general scheme, but it has exceptions. So, for example, there is no stage 4 testicular cancer. Even with distant metastases and indicator M1, stage 3 is set. In addition, this classification assumes the existence of substages. For example, stage II can be divided into IIA and IIB.
A single classification of cancer by stages helps to solve important problems: correctly assess the degree of spread of the tumor process, prognosis, standardize treatment and monitor its effectiveness.
Definition of the disease. Causes of the disease
Malignant neoplasms of the skin (skin tumors, skin cancer) is one of the most common types of cancer, which in most cases appears on the skin exposed to the sun. Skin cancer develops from cells that, as a result of mutations, have acquired the ability to uncontrolled reproduction and have ceased to obey the general regulatory mechanisms.
The key features of malignant neoplasms, in contrast to benign ones, are the ability to grow into surrounding tissues (invasive growth) and spread to various parts of the body with the formation of secondary foci - distant metastases. Malignant skin tumors can develop from different tissues:
- Basal cell carcinoma - The most common variety. It accounts for about 80% of all skin cancers. The tumor develops from the cells of the deepest - basal - layer of the epidermis. Normally, due to the division of basal cells, skin is updated, but in this case this process is pathologized.
- Squamous cell carcinoma makes up about 20% of all skin cancers. It develops from keratinocytes - the main cells of the epidermis.
- Melanoma often mistakenly called skin cancer. Strictly speaking, in this case only malignant neoplasms from the cells of the integumentary tissue (epithelium) are attributed to skin cancer. Melanoma develops from melanocytes - cells that produce the melanin pigment, which can be found not only in the skin, but also in the mucous membranes, choroid of the eye, nail bed, and brain membranes.
- Merkel Cancer - A rare aggressive malignant tumor of neuroendocrine origin.
- Rare malignant skin tumors: various types of sarcomas (tumors from connective tissue), Kaposi’s sarcoma, tumors from glandular tissue, lymphoma.
Basal cell and squamous cell carcinomas are quite common in Russia. They make up 9.8% of all malignant tumors in men and 13.7% in women. Every year more and more cases are revealed: from 2005 to 2015, the prevalence of the disease increased by about 10 times.
Melanoma is a rarer malignant tumor. It makes up only 1.4% of all oncological diseases in men and 1.9% in women. However, unlike basal cell and squamous cell cancers, which usually grow very slowly, melanoma spreads rapidly throughout the body, forming metastases, and much more often leads to death of patients.
The prevalence of cancer from Merkel cells among people of Caucasian origin is only 23 cases per 10 million people. Other skin tumors are also rare.
The most significant risk factor is exposure to ultraviolet radiation on the skin. By acting on skin cells, ultraviolet rays can cause changes in DNA, which lead to malignant degeneration. Risks are increased among lovers of beach holidays and tanning salons. The likelihood that a person will develop skin cancer in the future increases whenever he gets sunburn. Sunburn is especially dangerous for children.
The lighter the skin, the more sensitive it is to ultraviolet rays. Six phototypes of the skin are distinguished. The first and second are the most vulnerable, the fifth and sixth are the most stable.
Other skin cancer risk factors:
- Ionizing radiation. Until reliable methods of protection were developed, skin cancer was often found in workers of radiography rooms.
- Chronic injuries, skin burns.
- Contact with carcinogens: coal and briquette dust, arsenic, soot, etc.
- Infection caused by human papillomavirus (HPV) types 16 and 18, in some cases, detected in squamous cell carcinoma of the skin in the fingers and genitals.
- Red hair color often associated with the first skin phototype and cancer risk.
- Age over 50 for basal cell cancer. At the same time, melanoma is the most common type of malignant tumor at a young age.
- Impaired immune and endocrine systems. For example, the risks are increased in people who take drugs that suppress the immune system.
The risk of melanoma is also increased if a person has 10 or more dysplastic nevuses - large moles (usually more than 5 mm) with uneven coloring and uneven edges, more than 100 moles that appeared during life, or a giant pigmented nevus, occupying more than 5% of the body surface .
The likelihood of developing skin cancer increases with some hereditary diseases, for example, Gorlin's syndrome (a rare autoimmune disease, basal cell nevus syndrome).
There is a fairly long list of precancerous skin conditions, such as pigmented scleroderma, actinic keratosis, senile keratoma, skin horn, etc. Pigment xeroderma can lead to melanoma from them.
Heredity is also important - the risk of getting sick increases if malignant skin tumors have already been diagnosed in close relatives.
Symptoms of skin malignancies
Malignant skin tumors are easier to detect than neoplasms in internal organs. Each person is recommended to inspect the entire surface of his skin once a month, use mirrors to ask for inaccessible places and ask for help from relatives. It is necessary to carefully check all moles, age spots and freckles. If a new and unusual neoplasm has appeared or with changes that previously exist, changes should be made to a dermatologist.
Basal and squamous cell carcinomas most often occur in open areas of the body, as a rule, on the skin of the head and neck, less often - on the trunk, arms and legs. Neoplasms can look different. The main forms are presented in the table:
|• Red nodule or plaque.|
• Compaction, coarsening of the skin area (hyperkeratosis).
• A wart-like formation.
• Dilated vessels (telangiectasias) that may bleed.
• Ulceration and germination in the underlying tissue.
Suspicion of squamous cell carcinoma should occur with any neoplasm on the skin that does not heal for a long time.
Melanoma resembles the appearance of a pigmented nevus or mole. There are five signs that a malignant tumor can be suspected, which for convenience are combined into abbreviation abcde:
- A (asymmetry) - asymmetry. Melanoma has an irregular shape. If you mentally fold it in half, the contours will not match.
- B (irregular border) - uneven, fuzzy edges.
- C (color variations) - uneven color. Within one formation, it can range from light brown to almost black.
- D (diameter) - a diameter of more than 6 mm (approximately like an eraser in a pencil).
- E (evolving) - changes in the dynamics: changes in size, color, shape, ulceration, bleeding, weeping.
At Merkel cell cancer a round nodule of pink, red or cyanotic color appears on the skin. Usually it is single and does not exceed 2 cm, but sometimes it grows to large sizes. In some cases, dilated blood vessels (telangiectasias) are visible under the skin, ulceration occurs. This malignant tumor differs in that it spreads rapidly with lymphatic flow. The primary tumor may be asymptomatic for a long time. In some cases, the first sign that helps diagnose the disease is an increase in lymph nodes or distant metastases.
Pathogenesis of malignant neoplasms of the skin
There is no single reason for the development of malignant skin tumors. The normal cell of the human body becomes malignant when changes occur in certain genes. This can occur as a result of exposure to various factors, the main one of which in skin cancer is ultraviolet radiation.
Human skin is a kind of barrier that protects the body from pathogens, various chemicals and physical factors, so it is constantly exposed to negative effects. To cope with the load, the natural mechanisms of regeneration and restoration work in the skin. When damage occurs in the DNA of a cell, the defenses of the body try to “repair” these failures whenever possible.If this is not possible, the mechanism of programmed cell death is triggered - apoptosis.
But in some cases, damage to the genes responsible for the repair and destruction of defective cells occurs - they are called tumor suppressor genes. For example, often the starting event for the development of skin cancer is a mutation in the p53 gene, which is responsible for triggering the apoptosis mechanism. Another gene, the Fas ligand (FasL), is normally responsible for ensuring that normal cells do not turn into tumors, and its effect triggers the destruction of defective cells. But if the skin is regularly exposed to ultraviolet rays, the activity of this gene is reduced, and it copes with its functions worse. Basal cell carcinoma can result from mutations in the genes of the molecular signaling pathway of the Sonic Hedgehog (SHH) gene, the normal operation of which is necessary for the proper development and reproduction of cells.
In addition to the suppressor genes responsible for the prevention of tumor cell transformations, there are also oncogenes. Mutations in these genes lead to an increase in their activity and uncontrolled proliferation of cells. For example, in melanoma cells, mutations in the BRAF oncogen are often found.
Complications of skin malignancies
The main complication and the logical final stage of development of any malignant tumor is the formation of distant metastases, i.e., secondary foci of cancer in various organs. It is metastases that most often cause the death of cancer patients.
Basal cell carcinoma skin metastasizes very rarely, and in 85% of cases, secondary foci are located in the head and neck. Typically, cancer cells primarily spread to the regional lymph nodes, then bones, lungs, parotid glands are affected.
Squamous cell carcinomas metastasize in about 5% of cases. Secondary foci most often occur in the lymph nodes, bones, liver, and brain. If the tumor is located in the head and neck, it will most likely spread to the parotid salivary gland.
Of all malignant skin tumors, oncologists most often have to deal with metastases. melanomas. As a rule, secondary foci are found in the bones, liver, lungs, and brain.
With bone damage, pains that often become painful, aggravate with exertion and prolonged stay in a uniform pose. Pathological fractures from small loads may occur.
Dangerous complication - hypercalcemia - a condition that occurs with bone metastases due to the fact that it is destroyed, and a large amount of calcium enters the blood.
Metastases in the lungs manifest as persistent chronic cough, in this case sputum with an admixture of blood may go away. Large foci in the liver disrupt its function. With difficulty in the outflow of bile, obstructive jaundice develops. Brain metastases are manifested by headaches, seizures, various neurological symptoms.
Treatment of malignant neoplasms of the skin
For skin cancer (basal cell and squamous) in the early stages, it is preferable surgical treatment. Doctors completely remove the neoplasm, capturing a small area of the surrounding tissue. Sometimes curettage (curettage) with cauterization, photodynamic therapy and cryotherapy is performed.
When a tumor is localized on the face, in the genital area or fingers, preference may be given Mosa Micrographic Technique (MOHS). The tumor is removed in a special way and directly during the operation, the edges of the wound are examined under a microscope for the presence of tumor cells.
If regional lymph nodes are affected, they also need to be removed. In some cases, a postoperative (adjuvant) course is indicated. radiation therapy to the region of regional lymph nodes. If there are contraindications to surgical treatment, a course of radiation therapy is prescribed.
For metastatic skin cancer chemotherapy. The purpose of treatment in this case is not to save the patient from a malignant tumor, but to prolong his life, stop the symptoms, slow down the progression of the disease.
Similar tactics are followed in the treatment of melanoma. Doctors always strive to remove the tumor completely and provide a negative edge of the resection, i.e., according to the results of a biopsy, there should be no malignant cells near the incision line. With metastatic and inoperable melanomas, antitumor drugs are administered.
Currently, there are new classes of drugs that help keep the disease under control for longer and increase patient survival:
- Targeted drugs, which, unlike classical chemotherapy drugs, works more purposefully. Each of them has a specific target: it attacks a molecule, with the help of which tumor cells multiply uncontrollably and maintain their vital functions.
- Immunotherapy from the group of control point inhibitors block molecules that prevent the immune system from recognizing and destroying tumor cells. This is the newest and most promising class of drugs.
Even after the cancer has been completely removed, the risk of relapse remains. Therefore, the patient after discharge should be monitored, periodically visit a doctor.
To assess the prognosis in oncology, a five-year survival rate is usually used. It indicates the proportion of patients who survived five years after they were diagnosed with a malignant tumor.
Five-year survival for different types of malignant skin tumors is presented in the table: