3: Some Basic Terms for Oncology

Increased hormone levels can lead to excessive cell proliferation which can accumulate genetic abnormalities 3. Breast cancer is the most common cancer in women, and is driven by hormones. Germline mutations in breast epithelial cells, such as those in the BRCA1 gene, predisposes cells to genetic mutations 3. Estradiol or estrogen produced in the ovaries further drives cell proliferation and following the cell proliferation model, leads to an accumulation of genetic abnormalities. Eventually, these abnormalities produce a malignant phenotype consistent with breast cancer. Hormone driven cancers can be managed by controlling endogenous hormone levels.

Hormonal anticancer pharmacotherapy is currently a major method of control.


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Examples include hormonal antagonists to block target receptors, or hormonal analogues which mimic hormones and induce negative feedback reduction of hormone production. Pharmacotherapy can also block enzymes in hormone synthesis pathways such as aromatase inhibitors required for estrogen production 3. Surgical removal of the hormone-producing organ is the final option in hormone therapy. Thus, hormone therapy is a specific form of treatment and can be used to predict treatment success in certain cancers.

Fundamentals of Oncology

For example, estrogen and progesterone receptor statuses direct the management algorithm in breast cancer. Various molecular markers exist to indicate the presence of cancer. These markers mainly aid diagnosis and assess prognosis 2. As well, the presence of certain markers offer insight into possible treatment. For example, hormone epidermal receptor 2 proteins HER2 are present in approximately one-fifth of breast cancers 6. Family history is a major determinant of risk for developing and having certain cancers. However, it is interesting that only five percent of cancers have hereditary relationships.

Various genes exist in the body to suppress cancer development. One example is a type called the tumor suppressor gene. Recall that genes in a cell exist as two copies two alleles with one copy from each parent. Patients with a hereditary syndrome have one hit already, and are born with only one normal allele. They are predisposed to cancer since they only require one additional hit to result loss of both genes. Carcinogens are substances which induce malignancy by altering normal cellular genetics.

They can be classified in three general categories: Chemicals and radiation cause biochemical damage and alterations to normal DNA. Common chemical carcinogens include cigarette smoke and asbestos, and common radiation carcinogens include UV radiation from the sun and radiation therapy. Viruses act differently by introducing new genetic material to a cell.

The new genetic material may alter existing genetic material leading recombination which may be malignant 5.

LearnOncology

Staging and grading of cancers are different classification methods. The grade of a neoplasm refers to the histological and pathological features of the cells in a neoplasm. Recall that dysplasia is the abnormal proliferation of deregulated cells.

Molecular Biology

As dysplasia develops, the neoplastic cells lose features of their tissue of origin, become less differentiated, and are presumed to be of higher grade. The stage of a neoplasm provides a sense for how advanced a cancer is.

Description

Many but not all cancers are staged using the TNM staging system. This system is divided into three components: The TNM status will be different for each patient depending on their tumor and cancer. We stage cancers for the following reasons: Stage I cancers are early cancers that are often curable. Stage IV cancers are usually incurable. The TNM and staging differ for each tissue of origin and thus, specifically predict the management and prognosis of individual cancers 2.

TNM staging provides a universal classification of tumor description. Confirmatory diagnosis of cancer often requires direct histological analysis of tissue. With cancer, suspicious regions of tissue are often biopsied for analysis; these could include abnormal lumps or regions identified by imaging.

Negative pressure through suction provides the force to remove the tissue. Deep tissues such as the lungs or liver may require radiological guidance. However, more complicated procedures may require a radiologist or trained surgeon in the hospital. Superficial tissues such as the prostate or breast do not require additional guidance 7.

This provides a larger sample of tissue to analyze than fine needle aspiration biopsies. Similarly, simple procedures may be performed in the office setting by a non-specialist 7. There are two types of surgical biopsy: Incisional surgical biopsies removes parts of abnormal tissue, similar to fine needle and core biopsies but in a larger amount.

Oncology Training | ASCO Practice Central

Excisional surgical biopsies removes the entire abnormal area or tumor, and may additionally excise normal tissue around it. Excisional biopsies may very well be curative intents to remove affected parts of an organ or the entire organ itself, with tissue analysis following the excision. Surgical biopsies are typically performed in the hospital with local or general anesthesia depending on the extent of analysis 7.

Benign tumors grow slowly, resemble the tissue of origin, and do not invade other tissues. Thus, benign tumors are localized and can be cured by removal. Some benign tumors may develop into malignant tumors cancer , which grow much faster, do not resemble the tissue of origin, and invade other tissues. Malignant tumors metastasize and spread to other parts of the body, making them more dangerous and less curable 2.

Cancer spread is classified into three mechanisms: The TNM staging mimics these three patterns of spread. Local spread is the spread of a cancer within an organ or structure. The cancer is still considered malignant since it has likely broken the basement membrane and has disseminated within intra-organ passages. The tumor may now exist as a direct extension of the original tumor, or appear as multiple, discrete tumors throughout the organ 2. This corresponds with the T stage of the TNM. Recall that the lymphatic system is a network of circulatory vessels to collect and redistribute excess fluid in the body.

Superficial channels in the skin and subcutaneous tissues drain into deeper channels which ultimately collect into large ducts that drain into the vascular system.

Introduction to Cancer

Along the way are lymph nodes, which are accumulations of lymphoid tissue, which play a role in the immune system. Lymphatic invasion correlates with the N stage of the TNM. Cancers often disseminate into the lymph pathways and follow the drainage of lymph into lymph nodes. This may allow detection and localization of cancers through physical exam, as cancerous lymph nodes are often hard, tender, and matted-down.

Surgery may be the only treatment for some patients. For many people, surgery is used along with other treatments. These can be chemotherapy, biologic, targeted or immune therapies, radiation therapy, and hormone therapy. Other surgeries, such as those used in interventional specialties, may be used too.

Objectives

Each cancer surgery is different. Your surgeon will talk with you about the risks and benefits of your surgery.


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ASCO "What is cancer surgery? Surgery can help cancer care team members: Surgery in cancer care is used to: Diagnose and stage a cancer. Remove some, but not all of the tumor. A surgeon may not be able to safely remove all of the cancer because it could harm other parts of the body. This is often called a debulking surgery.

Ease symptoms caused by the cancer. This is called palliative surgery. This is called reconstructive or restorative surgery. Examples of this type of surgery are breast reconstruction or reversal of colostomy. How is surgery used with other treatments? You may hear surgery called: Neoadjuvant — This means the surgery is done after some other treatment..

In some cases, more treatment will also be given after the surgery.