RADIATION THERAPY

Malignancies and
Cancer Staging
BY: ROS E N DO R . DAC U YA N JR . , R RT, M S RT
Cancer
Cancer - 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 cancer.
Benign Tumor
Characteristic of a benign tumor:
◦ Grow quite slowly
◦ Do not spread to other parts of the body
◦ Usually have a covering made up of normal cells

Benign tumors are made up of cells that are quite similar to normal cells. They will only cause a
problem if they:
◦ Grow very large
◦ Become uncomfortable or unsightly
◦ Press on the other organs
◦ Take up space inside the skull (such as brain tumor)
◦ Release hormones that affect how the body works
Malignant Tumor
Malignant tumors are made up of cancer cells

◦Characteristics
◦Grow faster than benign tumors
◦Spread into and destroy surrounding tissues
The Cancer Cell
Characteristics of normal cells
1. Reproduce themselves exactly
2. Stop reproducing at the right time
3. Stick together in the right place
4. Self-destruct if they are damaged
5. Become specialized or mature
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 and:
◦Cancer cells don`t stop reproducing
◦Cancer cells don`t obey signals from the other cells
◦Cancer cells don`t stick together
◦Cancer cells don`t specialize, but stay immature
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:
◦ Pressure from the growing tumor
◦ Using enzymes
◦ Cancer cells moving through the tissue
1. Pressure from the growing tumor
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.
2. Using enzymes
Many normal blood cells produce chemicals called enzymes that break down cells and tissues.
The blood cells use their enzymes to attack invading bacteria and viruses. They also use them to
break down 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.
Many cancers contain larger amounts of these enzymes than normal tissues. Some cancers also
contain a lot of normal white blood cells.
3. Cancer cells moving through the tissue
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?
Primary and Secondary cancer
◦ The main reason cancer can be difficult to cure is that it can spread to a different part of the
body from where it started. The cancer that grows where it first started in the body is called
the 'primary cancer'. The place a cancer spreads to and then starts growing is called the
'secondary cancer' or 'metastasis.
◦ 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
Three main ways a cancer spreads
Local spread
Through the blood circulation
Though lymphatic system
 Local Spread
The cancer grows directly into nearby body tissues.

Through the blood circulation

• 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
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 grow
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.

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.
 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.
Why staging is important?
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 treats only one area
of the body.
 Two main type of staging systems
The 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 part 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 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 positive nodes)

'M' refers to whether the cancer has spread to another part of the body - it can either be 0 (the cancer
hasn't spread) or 1 (the cancer has spread)
Number Staging
Cancer Classification
Carcinoma
Sarcoma
Myeloma
Leukemia
Lymphoma
Mixed Types
Carcinoma
Carcinoma refers to a malignant neoplasm of epithelial origin or cancer of
the internal or external lining of the body. Carcinomas, malignancies of epithelial tissue, account for 80
to 90 percent of all cancer cases.
Epithelial tissue is found throughout the body. It is present in the skin, as well as the covering and lining
of organs and internal passageways, such as the gastrointestinal tract.
Carcinomas are divided into two major subtypes: adenocarcinoma, which develops in
an organ or gland, and squamous cell carcinoma, which originates in the squamous epithelium.
Adenocarcinomas generally occur in mucus membranes and are first seen as a thickened plaque-like
white mucosa. They often spread easily through the soft tissue where they occur. Squamous
cell carcinomas occur in many areas of the body.
Most carcinomas affect organs or glands capable of secretion, such as the breasts, which produce milk,
or the lungs, which secrete mucus, or colon or prostate or bladder.
 Sarcoma
Sarcoma refers to cancer that originates in supportive and connective tissues such as bones, tendons, cartilage, muscle,
and fat. Generally occurring in young adults, the most common sarcoma often develops as a painful mass on the bone.
Sarcoma tumors usually resemble the tissue in which they grow.
Examples of sarcomas are:
• Osteosarcoma or osteogenic sarcoma (bone)
• Chondrosarcoma (cartilage)
• Leiomyosarcoma (smooth muscle)
• Rhabdomyosarcoma (skeletal muscle)
• Mesothelial sarcoma or mesothelioma (membranous lining of body cavities)
• Fibrosarcoma (fibrous tissue)
• Angiosarcoma or hemangioendothelioma (blood vessels)
• Liposarcoma (adipose tissue)
• Glioma or astrocytoma (neurogenic connective tissue found in the brain)
• Myxosarcoma (primitive embryonic connective tissue)
• Mesenchymous or mixed mesodermal tumor (mixed connective tissue types)
 Myeloma
Myeloma is cancer that originates in the plasma cells of bone marrow. The plasma cells produce
some of the proteins found in blood.
Leukemia
Leukemias ("liquid cancers" or "blood cancers") are cancers of the bone marrow (the site of
blood cell production). The word leukemia means "white blood" in Greek. The disease is often
associated with the overproduction of immature white blood cells. These immature white
blood cells do not perform as well as they should, therefore the patient is
often prone to infection. Leukemia also affects red blood cells and can cause poor blood
clotting and fatigue due to anemia. Examples of leukemia include:
◦ Myelogenous or granulocytic leukemia (malignancy of the myeloid and granulocytic white blood cell
series)
◦ Lymphatic, lymphocytic, or lymphoblastic leukemia (malignancy of the lymphoid and lymphocytic
blood cell series)
◦ Polycythemia vera or erythremia (malignancy of various blood cell products, but with red cells
predominating)
Lymphoma
Lymphomas develop in the glands or nodes of the lymphatic system, a network of vessels,
nodes, and organs (specifically the spleen, tonsils, and thymus) that purify bodily fluids and
produce infection-fighting white blood cells, or lymphocytes. Unlike the leukemias which are
sometimes called "liquid cancers," lymphomas are "solid cancers." Lymphomas may also
occur in specific organs such as the stomach, breast or brain. These lymphomas are referred
to as extranodal lymphomas. The lymphomas are subclassified into two categories: Hodgkin
lymphoma and Non-Hodgkin lymphoma. The presence of Reed-Sternberg cells in
Hodgkin lymphoma diagnostically distinguishes Hodgkin lymphoma from Non-Hodgkin
lymphoma.
Mixed Types
The type components may be within one category or from different categories. Some
examples are:
•adenosquamous carcinoma
•mixed mesodermal tumor
•carcinosarcoma
•teratocarcinoma