SUMMER BIOLOGY

PROJECT

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carcinoma
arcinomas are cancers or malignancies that begin in the epithelial
tissues. Epithelial cells are the cells that line the entire surface of the body
as well as the internal structures and cavities. When cells of the body at a
particular site start to grow out of control, they may become cancerous.
Cancer cell growth is different from normal cell growth. Instead of dying,
cancer cells continue to grow and form new, abnormal cells. In addition,
these cells can also invade other tissues, a property that normal cells do not
possess. DNA is in every cell and directs all of the cell's actions such as growth,
death and protein synthesis. When DNA in a normal cell is damaged, the cell either
repairs the damage or dies. In cancer cells, the damaged DNA is not repaired, and
the cell does not die.

Instead, it gives rise to more of the abnormal cells containing abnormal

DNA. These new cells all have the same defective DNA of the original cancer
cell.
Six characteristics of cancer should be noted:

self-sufficiency in growth signaling

insensitivity to anti-growth signals

evasion of apoptosis

enabling of a limitless replicative potential

induction and sustainment of angiogenesis

Activation of metastasis and invasion of tissue.

Let us discuss some of the most widely occurring carcinomas, covering their
symptoms, diagnoses and possible treatment.

Ductal carcinoma is a type of cancer that starts in the milk ducts of the breast.
There are two types of ductal carcinoma:

Ductal carcinoma in situ, which is also referred to as intra-ductal carcinoma

Invasive ductal carcinoma

What is ductal carcinoma in situ?

One out of every five new breast cancer diagnoses each year is ductal carcinoma in situ (DCIS).
This is an uncontrolled growth of cells within the breast ducts. The phrase "in situ" means "in its
original place." This cancer is noninvasive and has not yet made it to breast tissue outside of the
ducts. Ductal carcinoma in situ is the earliest stage at which breast cancer can be diagnosed. It's
known as Stage 0 breast cancer. The prognosis for women diagnosed with this form of
breast cancer is excellent. The vast majority of women diagnosed with ductal carcinoma in situ
are cured.
Even though ductal carcinoma in situ is noninvasive, it is imperative that women with the disease
receive medical treatment because it can be a precursor of invasive cancer. Experts believe that
25% to 50% of women with DCIS will later develop an invasive breast cancer within 10 years of
the DCIS diagnosis. The invasive cancer usually develops in the same breast and in the same
quadrant of the breast that the DCIS first occurred.

How is ductal carcinoma in situ diagnosed?

Ductal carcinoma in situ does not usually cause the formation of a lump in the breast that can be
felt upon examination. Signs and symptoms of DCIS include breast pain and/or a bloody
discharge from the nipple. About 80% of cases are found by mammograms. Mammograms
detect tiny bits of calcium that develop in dead cancer cells. As more and more cancer cells age
and die, these calcifications grow. On the mammogram, they appear as a shadowy area.
If a mammogram suggests a ductal carcinoma in situ, the doctor should recommend a biopsy.
The purpose of the biopsy is to analyze the cells in the suspicious area for cancer and confirm the
diagnosis.

What is invasive ductal carcinoma?

Invasive ductal carcinoma accounts for about 80% of all invasive breast cancers in women and
90% in males with breast cancer.
Like ductal carcinoma in situ, it begins in the milk ducts of the breast. But unlike DCIS, invasive
ductal carcinoma is not contained. Instead, it grows through the duct walls and into the
surrounding breast tissue. And it can metastasize. That means it can spread to other areas of
your body.

How is invasive ductal carcinoma diagnosed?

Invasive ductal carcinoma may cause a hard, immovable lump with irregular edges to form in
your breast. That lump can be felt during a breast examination. In some cases, the cancer causes
the nipple to become inverted. A mammogram may show areas of calcification
where calcium has collected in old cancer cells.
If your physical exam and mammogram indicate you may have invasive ductal carcinoma, your
doctor may order a biopsy to obtain cells for analysis. The results of this test will help confirm
your diagnosis. They will also help determine what treatment will be most effective for you.
Since invasive ductal carcinoma often spreads, your doctor should recommend additional tests
to look for cancer cells in other areas of your body. These tests may include:

CT scan
MRI
PET scan
Bone scan
Chest X-ray

Axillary lymph node sampling (surgery to check the lymph nodes in the armpits for cancer) is
always performed in the presence of invasive ductal carcinoma.
Using the results from these tests, your doctor will be able to determine the stage of your breast
cancer. The stage will help guide your treatment.

How is invasive ductal carcinoma treated?

Most women with invasive ductal carcinoma have surgery to remove the cancer. In seven out of
10 cases, breast-conserving lumpectomies -- instead of mastectomies -- are an effective

treatment option. This will depend upon the size of your tumor and the extent of its spread
throughout your breast and the surrounding lymph nodes.
In addition to surgery, most doctors will recommend treating invasive ductal carcinoma
with chemotherapy, endocrine therapy, radiation therapy, or a combination of all of these
treatments. Chemotherapy and endocrine therapy are systemic treatments, which targets
cancer cells throughout your entire body. Radiation specifically focuses on the area around your
breast cancer. The use of radiation will depend on the type of surgery you have (lumpectomy or
mastectomy), the size of the tumor, and whether it has spread, and the presence and number of
lymph nodes involved.

Squamous cell carcinoma (SCC) is the second most common form of skin cancer.
SCC is a fairly slow-growing skin cancer. Unlike other types of skin cancer, it can
spread to the tissues, bones, and nearby lymph nodes, where it may become hard
to treat. When caught early, its easy to treat.

Symptoms
SCC usually begins as a dome-shaped bump or a red, scaly patch of skin. Its usually rough and
crusty, and can bleed easily when scraped. Large growths may itch or hurt. It may also pop
through scars or chronic skin sores.

Diagnosis
Squamous cell carcinomas detected at an early stage and removed promptly are almost always
curable and cause minimal damage. However, left untreated, they eventually penetrate the
underlying tissues and can become disfiguring. A small percentage even metastasize to local
lymph nodes, distant tissues, and organs and can become fatal. Therefore, any suspicious growth
should be seen by a physician without delay. A tissue sample (biopsy) will be examined under a
microscope to arrive at a diagnosis. If tumor cells are present, treatment is required.
Fortunately, there are several effective ways to eradicate squamous cell carcinoma. The choice
of treatment is based on the tumors type, size, location, and depth of penetration, as well as the
patient's age and general health.

Treatment Options
Treatment can almost always be performed on an outpatient basis in a physician's office or at a
clinic. A local anesthetic is used during most surgical procedures. Pain or discomfort is usually
minimal, and there is rarely much pain afterwards.
Mohs Micrographic Surgery
Using a scalpel or curette (a sharp, ring-shaped instrument), a physician trained in Mohs surgery
removes the visible tumor with a very thin layer of tissue around it. It is often used on tumors
that have recurred, are poorly demarcated, or are in hard-to-treat, critical areas around the
eyes, nose, lips, ears, neck, hands and feet. After tumor removal, the wound may be allowed to
heal naturally or may be reconstructed immediately; the cosmetic outcome is usually excellent.
Excisional Surgery
The physician uses a scalpel to remove the entire growth, along with a surrounding border of
apparently normal skin as a safety margin. The wound around the surgical site is then closed with
sutures (stitches).
Curettage and Electrodessication (Electrosurgery)
This technique is usually reserved for small lesions. The growth is scraped off with a curette (an
instrument with a sharp, ring-shaped tip), and burning heat produced by an electrocautery
needle destroys residual tumor and controls bleeding. This procedure is typically repeated a few
times, a deeper layer of tissue being scraped and burned each time to help ensure that no tumor
cells remain. It can produce cure rates approaching those of surgical excision for superficially
invasive squamous cell carcinomas without high-risk characteristics. However, it is not
recommended for any invasive or aggressive SCCs, those in high-risk or difficult sites, such as the
eyelids, genitalia, lips and ears, or other sites that would be left with cosmetically undesirable
results, since the procedure leaves a sizable, hypopigmented scar.
Cryosurgery
The physician destroys the tumor tissue by freezing it with liquid nitrogen, using a cotton-tipped
applicator or spray device. There is no cutting or bleeding, and no anesthesia is required. The
procedure may be repeated several times at the same session to help ensure destruction of all
malignant cells. The growth becomes crusted and scabbed, and usually falls off within weeks.
Redness, swelling, blistering and crusting can occur following treatment, and in dark-skinned
patients, some pigment may be lost. Inexpensive and easy to administer, cryosurgery may be the
treatment of choice for patients with bleeding disorders or intolerance to anesthesia.

Radiation
X-ray beams are directed at the tumor, with no need for cutting or anesthesia. Destruction of the
tumor usually requires a series of treatments, administered several times a week for one to four
weeks, or sometimes daily for one month.
Photodynamic Therapy (PDT)
PDT can be especially useful for growths on the face and scalp. A chemical agent that reacts to
light, such as topical 5-aminolevulinic acid (5-ALA) or methyl aminolevulinate (MAL), is applied to
the growths at the physician's office; it is taken up by the abnormal cells. Hours later, those
medicated areas are activated by a strong light. The treatment selectively destroys squamous
cell carcinomas while causing minimal damage to surrounding normal tissue.

Topical Medications
5-fluorouracil (5-FU) and imiquimod, both FDA-approved for treatment of actinic keratoses and
superficial basal cell carcinomas, are also being tested for the treatment of some superficial
squamous cell carcinomas. Successful treatment of Bowen's disease, a noninvasive SCC, has
been reported. However, invasive SCC should not be treated with 5-FU. Some trials have shown
that imiquimod may be effective with certain invasive SCCs, but it is not yet FDA-approved for
this purpose. Imiquimod stimulates the immune system to produce interferon, a chemical that
attacks cancerous and precancerous cells, while 5-FU is a topical form of chemotherapy that has
a direct toxic effect on cancerous cells.
Because most treatment options involve cutting, some scarring from the tumor removal should
be expected. This is most often cosmetically acceptable with small cancers, but removal of a
larger tumor often requires reconstructive surgery, involving a skin graft or flap to cover the
defect. Mohs surgeons are trained in reconstructive surgery, so visit to a plastic surgeon is
usually unnecessary.

NOT TO BE IGNORED
Squamous cell carcinomas usually remain confined to the epidermis (the top skin layer) for some
time. However, the larger these tumors grow, the more extensive the treatment needed. They
eventually penetrate the underlying tissues, which can lead to major disfigurement, sometimes
even the loss of a nose, eye or ear. A small percentage spread (metastasize) to distant tissues
and organs. When this happens, squamous cell carcinomas frequently can be life-threatening.
Metastases most often arise on sites of chronic inflammatory skin conditions and on the ear,
nose, lip, and mucosal regions, including the mouth, nostrils, genitals, anus, and the lining of the
internal organs.

What Is Basal Cell Carcinoma?

Basal cell carcinoma is a cancer that grows on parts of your skin that get a lot of sun. If one
catches it early, it can be cured. This cancer is unlikely to spread from the skin to other parts of
your body, but it can move nearby into bone or other tissue under the skin. The tumors start off
as small shiny bumps, usually on your nose or other parts of your face. If you've got fair skin,
you're more likely to get this skin cancer. Basal cell carcinoma usually grows very slowly and
often doesn't show up for many years after intense or long-term exposure to the sun.

Causes
Ultraviolet (UV) rays from the sun or from a tanning bed are the main cause of basal cell carcinoma.
When UV rays hit your skin, over time, they can damage the DNA in your skin cells. The DNA holds the
code for the way these cells grow and over time, damage to the DNA can cause cancer to form.

Symptoms
Basal cell carcinoma can look like a fleshy skin growth in a dome shape that has blood vessels in it. It can
be pink, brown, or black. Sometimes these growths can look dark. Or you may also see shiny pink or red
patches that are slightly scaly. Another symptom to watch out for is a waxy, hard skin growth.
Basal cell carcinomas are also fragile and can bleed easily.
Your doctor will take a sample, or biopsy, of the growth. He will numb the area and remove some of the
skin. Then he sends it to a lab, where it will be tested for cancer cells.

Treatment
To choose the best treatment, a doctor will consider the size and place of the cancer, and how long one
has had it. He'll also take into account the chance of scarring, as well as the patients overall health.
These are some of the treatment options the doctor may suggest:
Cutting out the tumor: ("excision")

Scraping the tumor away and using electricity to kill cancer cells ("curettage and desiccation")
Freezing your cancer cells ("cryosurgery"): killing your cancer cells by freezing them with liquid nitrogen.
Radiation treatment. This treatment uses X-rays to destroy your cancer cells. It's done over several weeks.
Mohs surgery. The surgeon removes the tumor layer by layer. He takes out some tissue, then looks at it
under a microscope to see if it has cancer cells, before moving on to the next layer. This may be
recommended if the tumour is:

Large
In a sensitive area of the body
there for a long time
back after the patient had had other treatments

Creams and pills. Two creams that you put on your skin are:

fluorouracil (5-FU)
imiquimod

There is also a pill that the doctor might prescribe called Erivedge (vismodegib). This drug is for cases
where the basal cell carcinoma has spread to other parts of the body.
Taking Care of Yourself
After one has been treated for basal cell carcinoma, the following steps might lower your chance of
getting cancer again.

Check your skin. Keep an eye out for new growths. Some signs of cancer include areas of skin that
are growing, changing, or bleeding. Check your skin regularly with a hand-held mirror and a fulllength mirror so that you can get a good view of all parts of your body.
Avoid too much sun. Stay out of sunlight between 10 a.m. and 2 p.m., when the sun's UVB
burning rays are strongest.
Use sunscreen. The suns UVA rays are present all day long -- thats why you need daily
sunscreen. Make sure you apply sunscreen with at least a sun protection factor of 30 to all parts
of the skin that aren't covered up with clothes every day. You also need to reapply it every 1 to 2
hours when outside.
Dress right. Wear a broad-brimmed hat and cover up as much as possible, such as long-sleeved
shirts and long pants.

Basal cell carcinoma rarely spreads to other parts of the body, and the treatment is almost always
successful, especially if it's caught early.
Sometimes new carcinomas can grow, so it's important to check your skin for any unusual-looking
growths and get them checked by your doctor.