CARINOMAS

Definition of terms
Carcinoma.
It’s a cancer arising in the epithelial tissue of the skin or of the lining of the internal organs.
Tumor:
It’s a swelling of a part of the body, generally without inflammation, caused by an abnormal
growth of tissue, whether benign or malignant.

Types of tumors

 Benign.
 Premalignant.
 Malignant.

Benign tumor

Benign tumor

Other names non-cancerous tumor

A benign tumor is a mass of cells (tumor) that lacks the ability either to invade
neighboring tissue or metastasize (spread throughout the body).
When removed, benign tumors usually do not grow back, whereas malignant tumors are
cancerous and sometimes do. Unlike most benign tumors elsewhere in the body,
benign brain tumors can be life-threatening.
Benign tumors generally have a slower growth rate than malignant tumors and the tumor
cells are usually more differentiated (cells have more normal features).
They are typically surrounded by an outer surface (fibrous sheath of connective tissue) or
stay contained within the epithelium.
Examples of benign tumors include:

 Adenomas
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Adenomas develop in glandular epithelial tissue, which is the thin membrane that covers
glands, organs, and other structures in the body.

Examples include:

 polyps in the colon

 fibroadenomas, a common form of benign breast tumor
 hepatic adenomas, which occur on the liver

Adenomas do not start as cancer. However, some can change and become
adenocarcinomas, which are cancerous.

 Fibroids

Fibroids, or fibromas, are benign tumors that can grow on the fibrous or connective tissue
of any organ.

Uterine fibroids are common and can cause:

 vaginal bleeding
 pelvic pain or discomfort
 urinary incontinence

They can be “soft” or “hard,” depending on the proportion of fibers to cells.

 Hemangiomas

Hemangiomas are benign tumors that form when blood vessels grow excessively.

 Lipomas
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Share on PinterestLipomas are most common in people from 40–60 years old.

Lipomas are a form of soft tissue tumor and consist of fat cells.

Although benign tumors will not metastasize or locally invade tissues, some types may be
harmful to health.

The growth of benign tumors produces a "mass effect" that can compress tissues and may
cause;
 Nerve damage.
 Reduction of blood flow to an area of the body (ischaemia).
 Tissue death (necrosis) and organ damage.
The health effects of the tumor may be more prominent if the tumor is within an enclosed
space such as;
 the cranium,
 respiratory tract,
 sinus or inside bones.
Tumors of endocrine tissues may overproduce certain hormones.
Examples include;
 Thyroid adenomas.
 And adrenocortical adenomas.
Although most benign tumors are not life-threatening, many types of benign tumors have
the potential to become cancerous (malignant) through a process known as tumor
progression.
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Signs and symptoms.
Benign tumors are very diverse; they may be asymptomatic or may cause specific symptoms,
depending on their anatomic location and tissue type. They grow outward, producing
large, rounded masses which can cause what is known as a "mass effect".
 This growth can cause compression of local tissues or organs, leading to many
effects, such as blockage of ducts, reduced blood flow (ischaemia), tissue death
(necrosis) and nerve pain or damage.

 Some tumors also produce hormones that can lead to life-threatening

situations. Insulinomas can produce large amounts of insulin,
causing hypoglycemia. Pituitary adenomas can cause elevated levels of hormones
such as growth hormone and insulin-like growth factor-1, which
cause acromegaly; prolactin; ACTH and cortisol, which cause Cushings
disease; TSH, which causes hyperthyroidism; and FSH and LH.
 Bowel intussusception can occur with various benign colonic tumors
 Cosmetic effects can be caused by tumors, especially those of the skin, possibly
causing psychological or social discomfort for the person with the tumor.
 Vascular tissue tumors can bleed, in some cases leading to anemia.

Malignant tumor
Malignancy (from Latin male 'badly', and -gnus 'born') is the tendency of a medical
condition to become progressively worse.
A malignant tumor contrasts with a non-cancerous benign tumor in that a malignancy
is not self-limited in its growth, is capable of invading into adjacent tissues, and may be
capable of spreading to distant tissues.
Malignancy in cancers is characterized by anaplasia, invasiveness, and metastasis.
Malignant tumors are also characterized by genome instability, so that cancers, as assessed
by whole genome sequencing.

Different types of malignant tumor originate in different types of cell.

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Examples include:
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  Carcinoma:
These tumors form from epithelial cells, which are present in the skin and the tissue
that covers or lines the body’s organs. Carcinomas can occur in the stomach,
prostate, pancreas, lung, liver, colon, or breast. They are a common type of
malignant tumor.
 Sarcoma:
These tumors start in connective tissue, such as cartilage, bones, fat, and nerves.
They originate in the cells outside the bone marrow. Most sarcomas are malignant.
 Germ cell tumor:
These tumors develop in the cells that produce sperm and eggs. They usually
occur in the ovaries or testicles, but they may also appear in the brain, abdomen, or
chest.
 Blastoma:
These tumors form from embryonic tissue or developing cells. Blastomas are much
more common in children than in adults. They can lead to tumors in the brain, eye,
or nervous system.

Signs and symptoms

When malignant cells form, symptoms do not typically appear until there has been a
significant growth of the mass.
Once signs and symptoms do arise, they are dependent on the location, size and type of
malignancy.
Usually, it is quite general and can be associated with other illnesses or diseases and thus,
can be difficult to diagnose or can be misdiagnosed.
General Signs and symptoms include:
 Observable or measurable aspects such as weight loss (without trying).
 A fever.

Unusual bleeding.
 Fatigue.
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
Changes in appetite.
  Pain (headaches or bone aches).
 Skin changes (new moles or bumps).
 Coughing.
 Unusual bleeding.
There are also signs and symptoms specific to females including
 Belly pain.
 Bloating.
 Breast changes i.e. the formation of a lump.
Signs and symptoms specific to men include
 Pain.
 Growths in the scrotum.
 Difficulty urinating.
Causes
Malignant cells often evolve due to a combination of reasons rather than one definitive
reason. Reasons which can explain their development include
 Genetics.
 Family history.
 Infectious diseases.
 And exposure to risk factors.

Risk factors
Traditional risk factors of developing malignancy include
 Smoking.
 Sun exposure.
 Having a history of cancer in the family.
 Developing post-transplant malignancy which occurs subsequent to solid organ
transplantations.
Management
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There are various treatment forms available to help manage malignancy.

Common treatments include:
 Chemotherapy.
 Radiation.
 Surgical procedures.
 Photoradiation.
 Hyperthermia are also used as treatment forms to kill or reduce malignant cells.
Surgery
Surgery can help manage or treat malignancy by either removing the tumour, localising it
and/or determining whether there has been a spread to other organs. When undertaking
surgery for malignancy, there are six major objectives which are considered.
These include:
1. Prevention of cancer.
2. Diagnosis and staging of disease.
3. Disease cure.
4. Tumour debulking.
5. Symptom palliation.
6. And patient rehabilitation.
Surgical procedures.
Surgical prevention of cancer.
This largely consists of removing the organ at risk of developing malignancy. This would
occur if an individual is predisposed to the formation of malignant cells as a result of
inherited genetic mutations and, acquired diseases.[13]
Surgical diagnosis of malignancy.
This involves completing a biopsy. This process requires a sufficient amount of tissue to
make a confident diagnosis and, the handling of specimen to expand information provided
from testing.
Biopsies are categorised into four different processes:
1. Fine-needle aspirate (FNA).
2. Core needle.
3. Incisional.
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4. And, excisional.
Curative surgery (also known as primary surgery)
This can be conducted when the malignant tumour has only invaded one area of the body.
The objective is to remove the entirety of the malignant cells without violating the
tumour; if the tumour is violated, the risk of both tumour spillage and wound
implantation would increase.
Premalignant tumours
In these tumors, the cells are not yet cancerous, but they have the potential to become
malignant

Examples include:

 Actinic keratosis

Also known as solar keratosis, this growth involves patches of crusty, scaly, and thick skin.

It is more likely to affect fair-skinned people, and sun exposure increases the risk.

Sometimes will transform into squamous cell carcinoma

 Cervical dysplasia

In cervical dysplasia, a change occurs in the cells that line the cervix.

The cells are not cancerous, but they may become malignant later, resulting in cervical
cancer.

 Metaplasia of the lung

These growths occur in the bronchi.

The lining of the bronchi contains glandular cells. In some people, including smokers, these
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can change and become squamous cells, or cancer.

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  Leukoplakia

Leukoplakia causes thick white patches to form in the mouth.

These patches:

 Are painless.
 Have an irregular shape.
 Are slightly raised.
 Are not possible to scrape off.

Mechanism

Benign (L) vs Malignant tumor (R).

Benign vs malignant

Diagram showing two epithelial tumors.

The upper tumor is a benign tumor that is non-invasive. Benign tumors are usually round
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in shape and encapsulated by fibrous connective tissue. The lower picture depicts a
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malignant tumor. It is irregularly shaped, vascular, and it is invasive, crossing
the basement membrane.
One of the most important factors in classifying a tumor as benign or malignant is its
invasive potential.
If a tumor lacks the ability to invade adjacent tissues or spread to distant sites by
metastasizing then it is benign, whereas invasive or metastatic tumors are malignant.
For this reason, benign tumors are not classed as cancer. Benign tumors will grow in a
contained area usually encapsulated in a fibrous connective tissue capsule.
The growth rates of benign and malignant tumors also differ; benign tumors generally
grow more slowly than malignant tumors. Although benign tumors pose a lower health
risk than malignant tumors, they both can be life-threatening in certain situations.
There are many general characteristics which apply to either benign or malignant tumors,
but sometimes one type may show characteristics of the other. For example, benign tumors
are mostly well differentiated and malignant tumors are often undifferentiated. However,
undifferentiated benign tumors and differentiated malignant tumors can occur.
Although benign tumors generally grow slowly, cases of fast-growing benign tumors have
also been documented. Some malignant tumors are mostly non-metastatic such as in the
case of basal cell carcinoma.

Cysts vs. tumors

 A cyst is a sac of tissue that can form anywhere on the body.

 A cyst is a sac of tissue that is filled with another substance, such as air or fluid.
Tumors are solid masses of tissue.
 Cysts can form anywhere on the body, including on the bones and soft tissues.
 Most cysts are noncancerous, although there are some exceptions. Cysts can feel
tender to the touch, and a person may be able to move one easily.
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 Tumors can also grow almost anywhere in the body. They tend to grow quickly
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and are usually firm to the touch.

 It is possible to have cysts and tumors in the same organ.

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