Biological Effects of Ionizing Radiation

Simulation of 1945 A-bombing; Hiroshima Bombing. The United States detonated two
nuclear weapons over the Japanese City of Hiroshima in 1945. After detonating the bomb,
there’s a contamination. Those who are affected are experiencing the late effects of
radiation.
How do biological effects develop?
• The DNA will be hit. Once the DNA has been hit, it'll go to the cell to the
organ/tissue then to the human body.
The severity of biological effects depends mainly upon
• Linear Energy Transfer (LET)
• Relative Biological Effectiveness (RBE)
o These 2 are the quantities that measure biological effects
Linear Energy Transfer (LET)
• Density of energy deposition along the path traversed by radiation across a
material
• Formula: Average energy transferred (keV) ÷ unit track length of radiation (um)
• Depends on
o How much energy (keV)
o The radiation quality (alpha, beta, x-ray and gamma)
▪ Alpha and beta are low energies, high energy transfer
▪ Gamma or x-rays are high energies, low energy transfer
 o Density of the absorbing material
▪ Less dense, low energy transfer
• The higher the energy, the lower the linear energy transfer; the lower the energy,
the higher the linear energy transfer.
o Inversely proportional

The illustration shows how different radiation qualities may differ in their LET
Note: Gamma and x-rays have low energy transfer because of high energy or
penetration. This can penetrate paper and aluminum. Lead is needed in order to block x-
rays and gamma rays. Alpha and beta particles have a finite range of matter. That means
to say, an alpha particle can be absorbed by thin paper and a beta particle can be
absorbed by aluminum.
Relative Biological Effectiveness (RBE)
• It’s a measure of the efficiency of a particular radiation for producing a given
biological endpoint.
• For radiation protection and occupational exposure purposes, the Equivalent Dose
(Sv) is used to compare the biological effectiveness of different types of radiation
to tissues.
• Equivalent Dose = absorbed dose × radiation quality factor
• Other factors that influence radiobiological effects
o Penetration or range of radiation
o Total dose received (dose rate × time of exposure)
▪ The higher the dose rate, the lesser exposure time
• indirect relationship
o Tissue involved
o Area or volume involved
▪ The bigger the part, the greater the tolerance
• Direct relationship
 o Strength of radiation
▪ The greater the dose, the greater the damage
• Direct relationship
o Age
▪ Increase age, higher resistance
▪ Younger age (baby) = radiosensitive
o Sex
▪ Females are more resistant than males
▪ Males are more radiosensitive than females
• Take note that if same dose of radiation, there’s a possibility
that biological effects of males are higher than the females.
Classification of Radiation Health or Biological Effects

The sequence of events after radiation exposure of humans can lead to several
radiation responses. At nearly every step, mechanisms for recovery and repair are
available.
Note: If the radiation response increases in severity with increasing radiation dose, it is
called a deterministic effect and occurs within days after the radiation exposure; early
effect. On the other hand, if the incidence of the radiation response increases with
increasing radiation dose, it is called a stochastic effect and is not observed for months
or years; late effect of radiation.
Note: Consideration is to be given to whether any health effects arise after radiation
exposure and what effects, if any, the amount of radiation, parts exposed to radiation
(whole body exposure or local exposure) and exposure modes (acute, chronic or
fractionated exposure)

Deterministic effects (with

the threshold value)

Acute disorders (symptoms

appear within several
Fetal disorders
weeks; actively dividing
cells are affected)

Skin Erythema
Embryo-fetal disorders
Acute radiation syndromes Hair Loss
Mental retardation
Sterility

Bone marrow disorders

Gastrointestinal tract
disorders
Central nervous system
disorders

Cataract
Glaucoma
Late onset disorders
(symptoms appear after the
lapse of several months to
Stochastic effects (assuming several years or more)
Leukemia
that there is no thereshold
value) Cancer
Hereditary effects (increase in
incidence of ordinary hereditary
disorders)

Note: The reason why you can have a deterministic effect is the possibility of a high dose
in a very short period of time. On the other hand, the reason why you can have a
stochastic effect is because of the possibility of a low dose over a longer span of time.
Note: The hematopoietic system is the most radiosensitive system. There’s a higher
chance that they can have deterministic effects.
Deterministic Effects
• Hair loss, cataract, skin injury, etc.
• When a number of people were exposed to the same dose of radiation and certain
symptoms appear in 1% of them, said dose is considered to be threshold dose.
• Biological effects that are observed as tissue reactions in the exposed organ.
• A dose threshold value
o (Below this dose, the effect on the tissue/organ is not observable; above
which the probability and severity of effect to tissue/organ increases to
100% as the dose increases); exceed.
• Basis of dose threshold values
• The longer the dosage, the higher the effect

Note: No deterministic effect doesn’t mean you can’t have stochastic effect. Still, there’s
a possibility that a person can have a late effect of radiation.
 Deterministic Effects and Threshold Values
Deterministic Effects
Organ or Tissue Dose in less than
2 days, Gy Type of Effect Time of
occurrence
Whole body (bone 1 Death 1-2 months
marrow)
Skin 3 Erythema 1-3 weeks
Thyroid 5 Hypothyroidism 1st – several years
Lens of the eye 2 Cataract 6 months – several
years
Gonads 3 Permanent sterility Weeks
Fetus 0.1 Teratogenesis -

Deterministic: Radiation burns

• Photo of pioneer medical radiologist. The
first injury to this radiologist was seen in
1899, namely 3 years after the discovery of
X-rays was announces. The hand was
amputated in 1932 and death from cancer
occurred in 1933.
• Massive cell killing leads to health effects
• Massive cell killing can occur only after
high doses
 Deterministic effects in eye
• Eye lens is highly radiosensitive; it is surrounded by highly
radiosensitive cuboid cells.
• Coagulation of proteins occur with doses greater than 2 Gy
• There are 2 basic effects:
o Detectable opacities effect
▪ Sv single brief exposure: 0.5-2.0
▪ Sv/year for many years: > 0.1
o Visual impairment (cataract) effect
▪ Sv single brief exposure: 5.0
▪ Sv/year for many years: > 0.15
Eye injuries

Deterministic: Acute Radiation Syndrome (ARS)

• Most notable deterministic health effect of ionizing exposure
• Signs and symptoms are not specific for radiation injury but collectively highly
characteristic for ARS.
• Combination of symptoms occurring hours to week after exposure
• Extent and severity of symptoms are determined by:
o Total radiation dose received
o Dose rate
o Exposed part of the body (whole body or local exposure)
Upon exposure
Time when acute radiation syndrome appear

Lapse of time

Prodromal Incubation Onset Phase Convalescent

Phase (48 phase (0 – 3 phase (or
hours) weeks) death)
Nausea and
vomiting (1 Gy or
more) Hematopoietic disorders (infection,
bleeding)

Increase un exposure doses

Headache (4 Gy
or more) Gastrointestinal tract disorders

Diarrhea (6 Gy or No symptom Skin injury

more)
Nerve and blood vessel disorders
Fever (6 Gy or
more)

Disturbance of
consciousness (8
Gy or more)

Note: Acute radiation syndromes observed in the case of whole-body exposure to

radiation exceeding 1 Gy (1,000 mGy) at one time.
Syndrome
• Collection of signs and symptoms characterizing the response of an organism to
radiation stimulus.
• Hematopoietic Syndrome
o Low blood counts especially white blood cells
o Resulting from doses in the range of 1-10 Gy
▪ Chief determining organ – bone marrow
▪ Syndrome threshold – 1 Gy
▪ Syndrome latency – 2 to 3 weeks
▪ Death time – If occurs, between 3rd and 6th week
• Gastrointestinal Syndrome
o Diarrhea, electrolyte imbalance (dehydrate)
o Resulting from doses between 10 to 20 Gy
▪ Chief determining organ – small intestine
▪ Syndrome threshold – 10 Gy
 ▪ Syndrome latency – 3 to 5 days
▪ Death time – 3 days to 2 weeks
• Central Nervous System Syndrome
o Nausea, vomiting edema resulting from intracranial pressure
o Resulting from doses above 50 Gy
▪ Chief determining organ – brain
▪ Syndrome threshold – 20 Gy
▪ Syndrome latency – 1/4 to 3 hours
▪ Death time – within 2 days
Whole body Exposure and Local Exposure

The higher the dosage, the greater the exposure

Radiosensitivity of Organs and Tissue
Actively dividing cells that are less differentiated
tend to show higher radiosensitivity. For
example, hematopoietic stem cells in bone
marrow are differentiated into various blood
cells, while dividing actively. Immature
(undifferentiated) hematopoietic cells that have
divided (proliferated) from stem cells are highly
sensitive to radiation and die due to a small
amount of radiation more easily than
differentiated cells.
As a result, the supply of blood cells is
suspended and the number of various types of
cells in blood decreases. In addition, the
epithelium of the digestive tract is constantly
metabolized and is also highly sensitive to radiation. On the other hand, nerve tissues
and muscle tissues, which no longer undergo cell division at the adult stage, are known
to be resistant to radiation.
Deterministic Effects on the Fetus
Deterministic effects include
fetal effects for which the
threshold dose is especially low.
When a pregnant woman is
exposed to radiation and
radiation passes through her
womb or radioactive materials
migrate into her womb, her
unborn baby may also be
exposed to radiation; it is known
that fetuses are highly sensitive
to radiation and incidence of
effects has time specificity.
Radiation exposure exceeding
0.1 Gy at an early stage of pregnancy (pre-implantation period) may lead to miscarriage.
After this period, the possibility of miscarriage decreases, but radiation exposure
exceeding 0.1 Gy during the period when important organs are formed (organogenesis
period) may cause dysplasia (malformation). Radiation exposure exceeding 0.3 Gy during
the period when the cerebrum is actively growing (early fetal period) poses risks of mental
retardation.
The period when fetuses are highly sensitive to radiation coincides with the period during
which pregnant women are advised not to take drugs carelessly. During this period before
the stable period, fetuses are vulnerable to both drugs and radiation. Fetal effects are
caused by radiation exposure exceeding 0.1 Gy. Therefore, the International Commission
on Radiological Protection (ICRP) states in its 2007 Recommendations that a fetal
absorbed dose less than 0.1 Gy should not be considered as a ground for abortion.
Exposure to 0.1 Gy of radiation is equivalent to exposure to 100 mSv of γ-rays or X-rays
at one time. Incidentally, fetuses' exposure doses are not always the same as their
mothers' exposure doses. Risks of stochastic effects such as cancer or hereditary
disorders also increase depending on exposure dose levels.
Effects of antenatal exposure (1)
• As post-conception time increases RS decreases
• It is not easy to establish a cause-effect relationship because there are a lot of
teratogenic agents, effects are unspecific and not unique to radiation.
• There are 3 kinds of effects: lethality, congenital anomalies and large delay
effects (cancer and hereditary effects).

Effects of antenatal exposure (2)

• Lethal effects can be induced by relatively small doses (such as 0.1 Gy) before or
immediately after implantation of the embryo into the uterine wall. They may also
be induced after higher doses during all the stages of intrauterine development.
Effects of Antenatal Exposure (3)
• Mental retardation
• ICRP establishes that mental retardation can be induced by radiation (Intelligence
Quotient score < 100)
• It occurs during the most RS period: 8-25 week of pregnancy
• Risks of antenatal exposure related to mental retardation are:
o 8-15 weeks
▪ Severe mental retardation with a risk factor of 0.4/Sv
o 15-25 weeks
▪ Severe mental retardation with a risk factor of 0.1/Sv
Mental Retardation
• Time specificity in fetal effects was made clear through health surveys on a group
of people who were exposed to radiation in their mothers' wombs due to the atomic
bombing.
• This figure shows the relationship between ages in weeks at the time of the atomic
bombing and its effects on fetuses' mental development.

• Those aged 8 to 15 weeks show high radiosensitivity and the threshold value for
exposure doses in mothers' wombs seems to be between 0.1 Gy and 0.2 Gy. In
the range above this level, the incidence rate of a severe intellectual disability
increases as doses increase, as observed in the figure.
• On the other hand, a severe intellectual disability is not observed among those
who were aged 16 to 25 weeks and were exposed to radiation at doses around 0.5
Gy, but radiation exposure exceeding 1 Gy caused mental disorders at a significant
frequency.
 • In other words, the incidence rates of disorders differ depending on whether
radiation exposure occurred at the age of 8 to 15 weeks or at the age of 16 to 25
weeks, even if the total exposure doses were the same.
Stochastic effects
• Health effects for which no threshold values exist
• Probability of the effect increases with dose
o The higher the dose, the higher the possibility of effect
• Described in terms of risks
• Linear and No Threshold Model
• For example: Cancer, Leukemia, Hereditary effects
• Effects of radiation exposure under certain doses are not clear because effects of
other cancer-promoting factors such as smoking and drinking habits are too large.
However, the ICRP specifies the standards for radiological protection for such low-
dose exposure, assuming that they may have some effects as well.
o Shield distance and time
• Risks of Cancer (Radiation)
Radiation doses (mSv) Relative risks of cancer

1,000 ~ 2,000 1.8 (estimated to be 1.5 times

per 1,000 mSv)
500 ~ 1,000 1.4

200 ~ 500 1.19

100 ~ 200 1.08

Less than 100 Difficult to detect

Note: mSv is radiation absorbed dose

Note: There’s an annual dose limited when working at radiation. The annual dose limit of
radiation worker is 50 mSv annually.
• Public workers (non-radiation workers) – 5 mSv
 • Risks of Cancer (Life habits)
Lifestyle factors Relative risks of cancer

Smokers 1.6
Heavy drinking (450 g or more/weeks) 1.6
Heavy drinking (300 to 449 g or 1.4
more/weeks)

Obese (BMI greater than or equal to 30) 1.22

Underweight (BMI < 19) 1.29

Lack of exercise 1.15 ~ 1.19

High-salt foods 1.11 ~ 1.15

Lack of vegetable intake 1.06

Passive smoking (nonsmoking females) 1.02 ~ 1.03

A simple generalized scheme for multistage oncogenesis

Damage to chromosomal DNA of a normal target cell
Failure to correct DNA repair
Appearance of specific neoplasia-initiation mutation
Promotional growth of pre-neoplasm
Conversion to overtly malignant phenotype
Malignant progression and tumor spread
Note: neoplasm – new growth
• Hereditary effects (Stochastic effect)
o A radiation-induced health effect that occurs in a descendant of the exposed
person
▪ The less precise term “genetic effect” is also used, but hereditary
effect is preferred.
▪ Hereditary effects are normally stochastic effects
▪ Not enough studies to support this
Other Epidemiological Surveys of Children of Atomic Bomb Survivors
• Deaths from leukemia or possibility hereditary tumors, etc., developed by the age
of 20
o The follow-up survey of 41,066 subjects revealed no correlation between
parent’s gonadal doses (0.435 Sv on average) and their children’s deaths.
• Deaths from cancer (1958-1997)
o As a result of the follow-up survey of 40,487 subjects, development of solid
tumors and blood tumors was found in 575 cases and 68 cases,
 respectively but no correlation with parent’s doses was observed (the
survey is still underway)
• Incident rate of lifestyle-related diseases (2002-2006)
o The clinical cross-sectional survey of approximately 12,000 subjects
revealed no correlation between parent’s doses and their children’s rates
of lifestyle-related diseases
Thyroid Cancer Cases in Children after the Chernobyl Accident

Thyroid Cancer Cases in Children after the Chernobyl Accident

Region Number of Cases
Before the accident After the accident
Belarus 1977-1985 (7) 1986-1994 (390)
Ukraine 1981-1985 (24) 1986-1995 (220)
Russia (Bryansk and 1986-1995 (62)
Kaluga region only)
• The data represent incidences (not mortality) and are preliminary results
• Most excess cancers occurred since 1993
• Thyroid cancer has a high rate of cure >90% but many of the cancers found are of
the aggressive papillary type.
Breast Cancer in Women Exposed to Fluoroscopy

Thyroid Tumors in Irradiation Children

Risk Estimated from Occupational Exposure

Study Excess relative risk per sV
All cancer Leukemia
UK National Registry Radiation 0.47 (-0.12-1.20) 4.3 (0.4-13.6)
Workers (1,218,000 person
years; 34 mSv average dose)
US Workers (705,000 person -1.0 (<0-0.83) <0(<0-3.4)
years; 32 mSv average dose)
Atomic Bomb Survivors 0.33 (0.11-0.6) 6.2 (2.7-13.8)
(2,185,000 person years; 251
mSv average dose)

Note: The greater the LET, the greater the RBE, thus, resulting to more severe bio effect
Note: LET is influenced by energy, radiation quality and density of absorbing material
Note: RBE is influenced by absorbed dose and Radiation Quality Factor (RQF)
Note: Deterministic effect occurs when exposed to dose threshold value
Note: Deterministic effect: Acute Radiation Syndrome (ARS), erythema, cataract,
hypothyroidism, sterility, etc.
Note: Stochastic effect – no linear threshold model (cancer)
Lethal dose (50/30)
• Dose which would cause death to 50% of the population in 30 days
• Its value is about 2-3 Gy for human for whole body irradiation.
Proportion of Fetal cancers Attributable to Different Agents
Agent or Class Percentage of all Cancer Disease
Best estimate Range
Smoking 31 29-33
Alcoholic beverages 5 3-7
Diet 35 20-60
Natural hormones 15 10-20
Infection 10 5-15
Occupation 3 2-6
Medicines, medical practices 1 0.5-2
Electromagnetic radiation 8 5-10
Ionizing (85%) from natural radiation 4.5
Ultraviolet 2.5
Lower frequency <1
Industrial products <1 <1 - 2
Pollution 2 <1 – 4
Other ? ?
Systemic Effects
• Effects may be morphological and/or functional
• Factors
o Which organ
o How much dose
• Effects
o Immediate (usually reversible): < 6 months
▪ For example: Inflammation, bleeding
o Delayed (usually irreversible): > 6 months
▪ For example: atrophy, sclerosis
• Categorization of dose
o < 1 Gy: Low dose
o 1-10 Gy: Moderate Dose
o > 10 Gy: High dose
• Regeneration means replacement by the original tissue while repair means
replacement by connective tissue.
Skin effects
• Following the Radiosensitivity (RS) laws of Bergonie and Tribondeau, the most
radiosensitive cells are those from the basal stratum of the epidermis.
• Effects
o Erythema: 1 to 24 hours after irradiation of about 3-5 Gy
o Alopecia: 5 Gy is reversible; 20 Gy is irreversible
o Pigmentation: Reversible, appears 8 days after irradiation
o Dry or moist desquamation: traduces epidermal hypoplasia (dose  20
Gy)
o Delayed effects: telangiectasia, fibrosis
Whole body response: Adult
• Chronic irradiation syndrome
o Whole body clinic of a partial-body irradiation
o Mechanism: neurovegetative disorder
o Similar to a sick feeling
o Quite frequent in fractionated radiotherapy

Indicators of relative organ tissue risk (Tissue Weighing Factor or WT)

Tissue or Organ Tissue Weighing Factor
Red bone marrow 0.12
Colon 0.12
Lung 0.12
Stomach 0.12
Breast 0.12
Gonads 0.08
Bladder 0.04
Liver 0.04
Esophagus 0.04
Thyroid 0.04
Skin 0.01
Salivary glands 0.01
Bone surface 0.01
Brain 0.01
Remaining tissue* 0.12

Note: Remaining Tissues: Adrenals, extra thoracic region, gallbladder, heart, kidneys,
lymphatic nodes, muscles, oral mucosa, pancreas, prostate, small intestines, spleen,
thymus, uterus, cervix.
Note: Blister or Blistering is a deterministic effect

Malignancy
Cancer
• It is a disease caused by normal cells changing so that they grow in an uncontrolled
way. The uncontrolled growth causes a lump called a tumor to form.
Benign and malignant tumors
• Tumors (lumps) can be benign or malignant. Benign means it is not a cancer.
Characteristic of a benign tumor
1. Grow quite slowly
2. Do not spread to other parts of the body
3. Usually have a covering made up of normal cells
Note: Benign tumors are made up of cells that are quite similar to normal cells. They will
only cause a problem if they:
1. Grow very large
2. Become uncomfortable or unsightly
3. Press on the other organs
4. Take up space inside the skull (such as brain tumor) – Once you have a brain
tumor, we need to shrink it in order for the brain's function to remain unaffected.
5. Release hormones that affect how the body works
Malignant tumors
• They are made up of cancer cells
• Characteristics
o Grown faster than benign tumors
o Spread into and destroy surrounding tissues
 Cancer Cell
Characteristics of normal cells
• Reproduce themselves exactly
• Stop reproducing at the right time
• Stick together in the right place
• Self-destruct if they are damaged
• Become specialized or mature
Characteristics of cancer cells (how cancer cells are different)
• Cancer cells are different to normal cells in several ways. They don’t die if they
move to another part of the body;
o Cancer cells don’t stop reproducing;
o Cancer cells don’t obey signals from the other cells;
o Cancer cells don’t stick together
o Cancer cells don’t specialize but stay immature
Note: In order for you, make the cancer cells die, you need chemotherapy (a systemic
therapy that uses chemo drugs), surgery (a localize treatment) and radiation therapy.
How a cancer grows?
• As a tumor gets bigger, it takes up more and more room in the body. Soon, it
begins to grow into the body structures nearby. This is called local invasion.
• 3 ways that the tumor grows into surrounding normal body tissues
o Pressure from the growing tumor
o Using enzymes
o Cancer cells moving through the tissue
• Pressure from the growing tumor
o As the tumor grows and takes up more space, it begins to press on the
normal body tissue nearby. The tumor growth will force itself through the
normal tissue, as in the diagram below.
As the cancer grows, it will squeeze and
block small blood vessels in the area. Due
to low blood and oxygen levels, some of the
normal tissue will begin to die off. This
makes it easier for the cancer to continue to
push its way through.
 • Using enzymes (how normal enzymes used)
o Many normal blood cells produce chemicals called enzymes that
breakdown cells and tissues. The blood cells use their enzymes to attack
invading bacteria and viruses. They also use them to breakdown and clear
up damaged areas in the body. The damaged cells have to be cleared away
so that the body can replace them with new ones. This is all part of the
natural healing process.
o Many cancers contain larger amounts of these enzymes than normal
tissues. Some cancers also contain a lot of normal white blood cells.
• Cancer cells moving through the tissue
o One of the things that make cancer cells different to normal cells is that they
can move about more easily. So, it seems likely that one of the ways that
cancers spread through nearby tissues is by the cells directly moving.
How a cancer spreads?
• The main reason cancer can be difficult to cure is that it can spread to a different
parts of the body from where it started.
• Primary and Secondary Cancer
o Primary cancer
▪ The cancer that grows where it first started in the body; local
o Secondary cancer or metastasis
▪ The place a cancer spreads to and then starts growing; systemic
• In order to spread, some cells from the primary cancer must break away, travel to
another part of the body and start growing there. Cancer cells do not stick together
as well as normal cells do. They also may produce substances that stimulate them
to move.
• 3 main ways a cancer spreads
1. Local spread
2. Through the blood circulation
3. Through lymphatic system
• Local spread
o The cancer grows directly into nearby body tissues.
• Through the blood circulation
o In order to spread, the cancer cell must first become detached from the
primary cancer. It must then move through the wall of a blood vessel to get
into the bloodstream.
• Through the lymphatic system
o The way a cancer spreads through the lymphatic system is very similar to
the way it spreads through the bloodstream. The cancer cell must become
detached from the primary tumor. Then it travels in the circulating lymph
fluid until it gets stuck in the small channels inside a lymph node. There, it
begins to grown into a secondary cancer.
Grade and cancer cells
• A low-grade cancer cell looks more like a normal cell
• A high-grade cancer cell looks more abnormal and is less well developed than a
normal cell.
Note: Grading and Staging are not similar.
Note: Grading is important because they are basically the baseline on what radiation
therapy technique we are going to use
Note: Grading refers to a differentiation
• Cells can be well-differentiated, moderately differentiated or poorly differentiated.
This is the same as low, medium, or high grade. It is also called grades 1, 2, or 3
where grade 1 is low grade.
Note: If tumor is well differentiated, we have to apply the technique called 3D or 2D
technique. The projection of the field if we’re going to treat well differentiated cancer is
AP or PA. If moderately differentiated, we are going to use conventional technique.
Moreover, the projection of the field if we’re going to treat moderately differentiated cancer
is 4 fields (PA, AP, both Right and Left Laterals). However, if the tumor is poorly
differentiated, we’re going to use Intensity-modulated radiation therapy (IMRT) which
means this techniques is going to manipulate photon and proton beams of radiation to
conform to the shape of a tumor.
Note: Intensity-modulated radiation therapy (IMRT) is composed of 7 fields.
The stages of cancer
• Staging is a way of describing the size of a cancer and how far it has grown. This
is different to the grade of cancer, which describes how similar a cancer cell is to
a normal cell.
• Staging is important because it usually tells the specialist which treatments the
patient need. If a cancer is just in one place, then a local treatment such as surgery
or radiotherapy could be enough to get rid of it completely. A local treatment
(surgery or radiation therapy) treats only one area of the body.
o If a cancer has spread, then local treatment alone will not be enough. A
systemic treatment will be needed as well.
▪ Systemic means treating the whole body.
• Chemotherapy, hormone therapy and other drug treatments.
• 2 main types of staging systems
o TNM staging systems
▪ TNM stands for Tumor, Node, Metastasis.
▪ This system can describe the size of a primary tumor, whether the
cancer has spread to the lymph nodes and whether the cancer has
spread to a different parts of the body (metastasized).
 ▪ The system uses numbers to describe the cancer.
▪ “T” refers to the size of the cancer. It can be 1,2,3 or 4 with 1 being
small and 4 being large.
▪ “N” refers to whether the cancer has spread to the lymph nodes. It
can be between 0 (no positive nodes) and 3 (lots of positives nodes)
▪ “M” refers to whether the cancer has spread to another part of the
body. It can be either be 0 (the cancer hasn’t spread) or 1 (the cancer
has spread).
Types of cells and cancer
1. Epithelial tissue cells (carcinoma)
2. Connective tissue cells (sarcoma)
3. Cells of the blood and lymphatic system (leukemia and lymphoma)
Epithelial tissue
• It is basically skin tissue that covers and lines the body. As well as covering the
outside of the body, epithelial cells cover the inside too.
• They cover all the body organs.
o For example, the organs of the digestive system and they line the body
cavities such as the inside of the chest cavity and the abdominal cavity.
• Most cancers are cancers of the epithelial cells. Cancers of the epithelial cells are
called carcinomas.
o Carcinomas make up about 85 out of every 100 cancers (85%)
• Types of epithelial cells that can develop into different types of cancer:
o Squamous cells
▪ Flat, surface covering cells, the skin or the lining of the threat or food
pipe (esophagus).
o Adenomatous cells
▪ Glandular cells. For example, kidney cells or breast cells.
o Transitional cells
▪ Layers of stretchy cells. For example, the lining of the bladder.
Note: You can have squamous cell carcinoma of squamous cells, adenocarcinoma of
glandular cells and transitional cell carcinoma of transitional cells.
Note: Squamous cells and adenomatous cells are found in most body organs. For
example, if the primary cancer is in the rectum, we call it rectal cancer. If the primary
cancer is in the cervix, we call it cervical cancer.
Note: Cancers are named after the body organ they grow in as well as the type of cell.
So, a cancer of the squamous epithelial cells covering the lung would be squamous cell
lung cancer.
Connective tissue
• Connective tissue is the term for the supporting tissues of the body.
o Bones, cartilage, tendons and fibrous tissue support the body organs.
• Connective tissue cancers are called sarcomas.
o Sarcomas can develop from bone, cartilage and muscle.
o Sarcomas are much less common than carcinomas. They are usually
grouped into 2 main types.
▪ Bone sarcomas (osteosarcoma)
▪ Soft tissue sarcomas
• Altogether, these make up less than 1 in every 100 (1%)
cancers diagnosed.
• Cancer of the cartilage is called chondrosarcoma and cancer of a muscle is
called rhabdomyosarcoma.
o These are both rare forms of tissue sarcoma.
Blood and lymphatic tissues
• There are many different types of blood and lymph tissue cells.
• The blood cells are made in the bone marrow in tissue called hematopoietic
tissue; hematopoietic system is the most radiosensitive system
• Blood and lymph tissue can develop into
o Cancers of the blood cells - leukemias
o Cancers of the lymphatic system – lymphomas
• Other body tissues and cancer
o Other body tissue cells can become cancerous but these types of cancer
are very rare.
▪ The biggest group of these rare cancers are brain tumors.
• Most brain tumors develop from social connective tissue
called glial cells that support the nerve cells in the brain.
o These cancers also their names from the cells they
developed from.
o Cancers of the glial cells are called gliomas.