Cancer ​

Essay written by Pasat Liliana​

Cancer is a collection of related diseases where some cells divide without

stopping and spread into surrounding tissues. Cancer can start almost anywhere in
the body. Normally, our cells grow and divide to form new cells as our body needs
them. When cells grow old or become damaged, they die, and new cells take their
place. When cancer develops, however, this orderly process breaks down. Cells
become more and more abnormal. Old or damaged cells survive when they should
die, and new cells form when they are not needed. These extra cells can form
growths called tumours. Cancerous tumours are malignant, which means they can
invade nearby tissues. In addition, as these tumours grow, some cancer cells can
break off and travel to distant places in the body through the blood or the lymph
system and form new tumours far from the original. Solid tumours are masses of
tissue named for the type of cells they formed from. Liquid tumours, such as
leukemias, are cancers of the blood and bone marrow. Unlike malignant tumours,
benign tumours do not spread into nearby tissues and often don’t grow back when
they are removed. Benign tumours can sometimes be quite large and, in the case of
benign brain tumours, can be life threatening. ​
​
​ Cancer cells differ from normal cells in many ways that allow them to grow
out of control and become invasive:​
• Unlike normal cells that mature into very distinct types with specific functions,
cancer cells are less specialized, which helps them divide without stopping. ​
• Cancer cells ignore signals that would otherwise stop them dividing or that begin
the process known as “programmed cell death,” or “apoptosis.” ​
• Cancer cells influence surrounding normal cells, molecules, and blood vessels —
an area known as the microenvironment. For instance, cancer cells can induce
nearby normal cells to form blood vessels that supply tumours with oxygen and
nutrients and remove waste products.​
• Cancer cells often evade or hide from the immune system that would normally
remove them. They can even co-opt the immune system to help them grow and
stay alive.
 Cancer is a genetic disease—that is, it is caused by changes to genes that
control the way our cells function, especially how they grow and divide. ​
Cancer:​
• can be inherited ​
• can arise because of errors that occur as cells divide ​
• can be caused when DNA is damaged by exposure to environmental factors
including chemicals in tobacco smoke and ultraviolet radiation from the sun. ​
• can be caused by epigenetic alterations, which affect the behaviour of genes
without affecting the genetic structure itself. Epigenetic "marks" switch genes on
or off in response to diet, stress, prenatal nutrition and a wide range of other
environmental influences. Some epigenetic changes can be passed from one
generation to the next.​
​ Each person’s cancer involves a unique combination of genetic changes. As
a cancer continues to grow, additional changes occur. A single tumour may contain
many different genetic variations. In general, cancer cells exhibit more genetic
changes than normal cells. Some changes may be the result of the cancer rather
than its cause.​
​ The genetic origins of cancer tend to arise in two main types of
genes—oncogenes and tumour suppressor genes. These mutations are sometimes
called “drivers” of cancer. Altered oncogenes stop regulating cell division,
allowing cells to grow and survive when they should not. Tumour suppressor
genes, which would normally stop cancer, are altered and enable cells to divide
uncontrollably.​
​ In metastasis, cancer cells break away from where they first formed (primary
cancer), travel through the blood or lymph system, and form new tumours
(metastatic tumours) in other parts of the body. Under a microscope, metastatic
cancer cells generally share molecular features with the original cancer, including
specific chromosome changes. For this reason, the original and metastatic tumours
are considered the same type of cancer. For instance, breast cancer that
metastasizes in the lung is metastatic breast cancer, not lung cancer. Metastatic
tumours can severely damage how the body functions. Most people who die of
cancer die of metastatic disease. Most treatments for metastatic cancers are
designed to relieve symptoms and control the size of tumours and their further
spread. But reducing cancer deaths requires curing metastatic disease outright.
 Not every change in the body’s tissues is cancer, though many may develop
into cancer if they are not treated. The diagram on the next page shows the
progression of cellular changes that may lead to cancer. Hyperplasia occurs when
cells within a tissue divide faster than normal and build up or proliferate. The cells
and the way the tissue is organized look normal under a microscope. Hyperplasia
can be caused by chronic irritation or several other factors. Dysplasia is more
serious than hyperplasia. Dysplasia also involves a buildup of extra cells, but the
cells look abnormal and there are changes in how the tissue is organized. In
general, the more abnormal the cells and tissue look, the greater the chance that
cancer will form. Some types of dysplasia may need to be monitored or treated. For
example, an abnormal skin mole called a dysplastic may turn into melanoma. An
even more serious condition is carcinoma in situ. Carcinoma in situ is not invasive
cancer because the abnormal cells do not spread beyond the original tissue. But,
because some carcinomas in situ become invasive, they are usually treated.
​
​ There are more than 100 types of cancer. Cancers are usually named for the
organs or tissues where they form. For example, lung cancer starts in lung cells,
and brain cancer in brain cells. Cancers also may be described by the type of cell
that formed them, such as an epithelial cell or a squamous cell. Carcinomas are the
most common type of cancer. They are formed by epithelial cells, which are the
cells that cover the inside and outside surfaces of the body. There are many types
of epithelial cells, which often have a column-like shape when viewed under a
microscope.
Carcinomas that begin in different epithelial cell types have specific names:
• Adenocarcinoma forms in epithelial cells that produce fluids or mucus. Tissues
with this type of epithelial cell are sometimes called glandular tissues. Most
cancers of the breast, colon, and prostate are adenocarcinomas. • Basal cell
carcinoma begins in the lower or basal (base) layer of the epidermis, or outer layer
of skin.
• Squamous cell carcinoma forms in squamous cells, which grow just beneath the
outer surface of the skin. They also line many other organs, including the stomach,
intestines, lungs, bladder, and kidneys. Under a microscope, Squamous cells look
flat, like fish scales. Squamous cell carcinomas are sometimes called epidermoid
carcinomas.
• Transitional cell carcinoma forms in a type of epithelial tissue called transitional
epithelium, or urothelium. This tissue, made up of many layers of epithelial cells,
lines the bladder, ureters, a part of the kidneys called the renal pelvis, and other
organs. Some cancers of the bladder, ureters, and kidneys are transitional cell
carcinomas.
Sarcomas are cancers that form in bone and soft tissues, including muscle,
fat, blood vessels, lymph vessels, and fibrous tissue (such as tendons and
ligaments). Osteosarcoma is the most common bone cancer. Common soft-tissue
sarcomas include leiomyosarcoma, Kaposi sarcoma, malignant fibrous
histiocytoma, liposarcoma, and dermatofibrosarcoma protuberans.
Leukemias are cancers that begin in the blood-forming tissue of the bone
marrow (also called liquid tumours). Large numbers of abnormal white blood cells
(leukemia cells and leukemic blast cells) build up in the blood and bone marrow,
crowding out normal blood cells, and making it harder for the body to deliver
oxygen, control bleeding, and fight infections. The four common categories of
leukemia are based on how quickly they progress (acute or chronic) and the type of
blood cell they start in (lymphoblastic or myeloid).
Lymphoma begins in lymphocytes (T cells or B cells). These
disease-fighting white blood cells are part of the immune system. With lymphoma,
abnormal lymphocytes build up in lymph nodes and vessels, as well as in other
organs. There are two main types of lymphoma:
• Hodgkin lymphoma: People with this disease have abnormal lymphocytes
called Reed-Sternberg cells. These cells usually form from B cells.
Multiple myeloma is a cancer that begins in plasma cells, which are another
type of immune cell. Abnormal plasma cells called myeloma cells build up in the
bone marrow and form tumours in bones all through the body. Multiple myeloma is
also called plasma-cell myeloma or Kahler disease.
Melanoma begins in cells that become melanocytes, which make melanin
(the pigment that gives skin its color). Most melanomas form on the skin, but they
can also form in other pigmented tissues, such as the eye (intraocular melanoma).
Brain and spinal cord tumours have different types. These tumours are
named for the type of cell in which they form and for the place where the tumour
first forms. For example, an astrocytic tumour begins in star-shaped brain cells
called astrocytes, which help keep nerve cells healthy. Brain tumours can be benign
(not cancerous) or malignant (cancerous). But because of the confined space of the
skull, even benign brain tumours can be life-threatening.
Germ-cell tumours are a type of tumour that begins in the cells that give rise
to sperm or eggs. These tumours can occur almost anywhere in the body and can
be either benign or malignant.
Neuroendocrine tumours form from cells that release hormones into the
blood in response to a signal from the nervous system. These tumours, which may
make higher-than-normal amounts of hormones, can cause many different
symptoms. Neuroendocrine tumours may be benign or malignant. Carcinoid
tumours are a type of neuroendocrine tumour. They are slow-growing tumours in
the gastrointestinal system (most often in the rectum and small intestine).
Carcinoid tumours may spread to the liver or other sites in the body, and
may secrete substances such as serotonin or prostaglandins, causing carcinoid
syndrome.