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Cancer
Cancer occurs when abnormal cells grow out of control. Normal cells in the body grow, divide, and die, and as we become older, our cells divide at a decreasing rate. Cancer cells, however, continue to grow and divide unchecked by the body, and they outlive normal cells. Cancers are capable of both invasion, or spreading into adjacent tissue, and metastasis, or traveling and settling into new, noncontiguous parts of the body. Cancer cells commonly form a tumor, or mass of cells, but they may also circulate in the bloodstream. Carcinogenesis describes the transformation of normal cells to neoplastic cells or abnormal cells that grow uncontrollably. Neoplasia is the process by which neoplasms develop from normal tissue. Cancers generally develop from a single neoplastic cell, commonly referred to as clonal expansion. Dysplasia refers to the early stages of neoplasia in which clonal expansion of abnormal cells occur.
Cancers are usually named for the site in which the neoplastic cells originated, even in cases of metastasis to other organs. Cancers are also usually named for their histology or morphologic features. Carcinomas are cancers of the epithelium and consist of cells found on external surfaces, internal cavity linings, and glandular linings, with cancers named squamous cell carcinoma, transitional cell carcinoma, and adenocarcinoma, respectively. Sarcomas are cancers of the mesenchyme, from which supporting tissue, including connective tissue, bone, cartilage, and muscle, is derived, andareoftenusedwithaprefixdenotingthe tissue of origin. Some cancers are given eponymous names, including Hodgkin lymphoma and Burkitt lymphoma.
Multistage Process of Carcinogenesis
Carcinogenesis involves two major phases, initiation and promotion. Initiation is the first stage and usually involves the interaction between a carcinogen (cancer-causing agent) and DNA that is permanent and irreversible. The promotion phase, on the other hand, is generally reversible and instable; it progresses when the abnormal cell is stimulated to grow and divide. Initiation and promotion generally occur as a multistage process that involves a series of genetic and molecular alterations and events.
Cancers arise as a result of damage to the DNA—mutations of critical genes involved in the regulation of cell growth and division. Often, the body has the capability of repairing DNA; the process of carcinogenesis begins when the body is unable to repair the damage. Two major classes of genes involved in carcinogenesis are oncogenes and tumor suppressor genes. Oncogenes generally have important roles in cell growth and differentiation. When a single copy of an oncogene is altered, leading to inappropriate or overexpression, neoplasia may result. The function of tumor suppressor genes is to prevent the development of cancers, generally by maintaining the integrity of the genome through cell cycle control and apoptosis, or signaled cell death; carcinogenesis, however, may occur on the loss or damage of both copies of the genes. A cancer develops generally when several mutations have occurred in the same cell. In addition to being caused by exposure to carcinogens, some critical mutations may be inherited, giving the individual a genetic predisposition for cancer.
Staging Classification
Tumors are classified by stage, which defines the extent to which a particular cancer has grown and spread. Staging is useful in indicating the potential prognosis of an individual case of cancer and helps in the selection of the most appropriate treatment methods. Many different staging methods are in use to describe tumors, but the one most commonly used is the TNM system. This system assesses tumor size (T), involvement of lymph nodes (N), and distant metastasis (M). Tumors are then classified into Stage I (early-stage tumor), II, III, or IV (advanced tumor) based on the TNM description. Tumors may also be described as in situ (no invasion), localized, invasive, or distant (distant metastasis present).
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