Carcinoma

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

The content of the article:

Causes and risk factors
Forms of the disease
Degrees
Symptoms
Diagnostics
Treatment
Possible complications and consequences
Forecast
Prevention

Carcinoma is a malignant neoplasm originating from epithelial tissue. It is carcinoma that is usually referred to when talking about cancer.

For the first time, the term "carcinos", that is, "cancer" in his writings was mentioned by Hippocrates (ancient Greek. Καρκίνος - "crab", -ωμα from ὄγκωμα - "tumor") because of the external similarity of a growing malignant neoplasm with an arthropod.

Changes in the color and size of moles are possible signs of carcinoma

Unlike benign neoplasms, carcinoma is characterized by violent uncontrolled growth with penetration into nearby tissues, metastasis (screening out of atypical cells) both to neighboring structures and organs, and to distant ones.

The annual incidence of cancer exceeds 10 million people: lung cancer ranks first (about 1.3 million people a year), followed by breast cancer (just over 1 million) and colon cancer (more than 900 thousand). In Russia, carriers of the diagnosis "cancer" are about 2% of the country's population.

More than 8 million people die from various forms of cancer in the world every year.

Causes and risk factors

The formation of a malignant neoplasm is designated by the term "carcinogenesis", and harmful environmental or internal (endogenous) factors that can provoke the process of carcinogenesis are "carcinogens".

Currently, there are several theories explaining the triggering of carcinogenesis:

a physicochemical theory that assigns a leading role in the development of cancer to aggressive physical (ultraviolet radiation, extreme temperatures, ionizing radiation, mechanical action, etc.) or chemical (pesticides, epoxides, nitroso compounds, aflatoxins, chloroethylamines, a number of products of their own metabolism organism, etc.) provocateurs;
the dysontogenetic theory assumes a failure of cell proliferation at the stage of embryogenesis, when an excess amount of poorly differentiated cells continues to exist in the body of an adult in an inactive state; in case of exposure to stress factors, their uncontrolled reproduction is started;
the immunological theory considers an immune failure as a leading factor in carcinogenesis, in which the body's defense system ceases to recognize and promptly remove foreign agents and its own defective cells;
the viral-genetic theory explains the formation of cancer by the influence of oncogenic viruses, which include herpes viruses, human immunodeficiency viruses, papillomaviruses, etc., provoking a restructuring of the genetic apparatus of healthy cells of the body with their subsequent malignant transformation;
the polyetiological theory of carcinogenesis assumes the role of all of these factors in the development of carcinoma.

There are several theories of carcinoma

Under the influence of provoking factors, the body's natural anti-cancer defense is weakened, the genetic apparatus is damaged at the nuclear level, malignant atypical cells accumulate, and the degeneration of normal tissues progressively increases.

Forms of the disease

Depending on the morphological characteristics of the cells from which the malignant process occurs, the following forms of carcinoma are distinguished:

squamous (formed on the basis of keratinizing or non-keratinizing epithelium);
adenocarcinoma (originating from glandular structures).

According to the degree of differentiation (malignancy increases as the differentiation of the neoplasm decreases):

highly differentiated cancer (these tumors are characterized by structural similarity with the cells from which they originate);
medium differentiated;
poorly differentiated;
undifferentiated (in this case, the degree of differentiation is sometimes so small that it is not possible to find out the origin of the tumor; the most malignant and most rapidly progressive variant).

In accordance with the predominant structural elements in the tumor:

simple carcinoma (elements of connective tissue and cancer cells are presented in approximately equal proportions);
medullary cancer (the volume of tumor cells significantly exceeds the amount of the connective tissue stroma);
skirr or fibrous cancer (connective tissue prevails in the composition of the neoplasm).

Depending on the number of foci that have arisen simultaneously in unchanged tissues, uni- and multicentric cancers are isolated.

If a neoplasm grows into the wall of an organ, they talk about endophytic (infiltrative) cancer, if into the lumen - about exophytic.

In addition to the above criteria, malignant neoplasms are also classified according to the localization of the pathological focus: stomach cancer, lung cancer, bowel cancer, thyroid cancer, etc.

Degrees

The severity of the pathological process is determined on the basis of a comprehensive assessment of the prevalence of the process, the presence of interested lymph nodes and metastases according to the TNM system (tumor, nodulus, metastasis).

The degree of development of the main focus is indicated by "T" (tumor) with the corresponding index:

T _is or T ₀ - the so-called "cancer in situ" ("cancer in place"), when the altered cells are located intraepithelially, without growing into the underlying tissues;
T _1-4 - the degree of development of a malignant tumor, from minimal (T ₁) to maximum (T ₄), respectively.

Involvement of regional lymph nodes in the pathological process (local metastasis) is designated as "N" (nodulus):

N _x - examination of nearby lymph nodes was not performed;
N ₀ - no changes were found during examination of regional lymph nodes;
N ₁ - the study confirmed metastasis to nearby lymph nodes.

The presence of metastases - "M" (metastasis) - indicates the involvement of other organs, damage to nearby tissues and distant lymph nodes:

M _x - detection of distant metastases was not carried out;
M ₀ - distant metastases were not detected;
M ₁ - distant metastasis was confirmed.

The most severe degree, respectively, will be T ₄ N ₁ M ₁ (the maximum severity of the oncological process with the involvement of lymph nodes and the presence of distant metastases).

The degree of carcinoma on the example of cervical cancer

There are 4 stages of oncological pathology:

The formation is small, limited, does not grow outside the organ, there are no metastases.
The formation is of significant size, does not grow outside the organ, it is possible to involve single lymph nodes.
Formation of significant size, with foci of decay, extending beyond the organ or formation of small size with multiple lesions of regional lymph nodes.
Significant spread of the neoplasm outside the organ, inoperable germination into neighboring organs and tissues (including vital ones), the presence of distant metastasis.

Symptoms

Malignant neoplasm manifests itself in two groups of symptoms. First, it is a systemic effect on the body due to intoxication. Secondly, local manifestations caused by dysfunction and restructuring of the damaged organ.

Local symptoms of carcinoma are highly individual and vary widely depending on the location of the tumor:

changes in the skin and mucous membranes (swelling, redness, changes in the color and size of moles, induration, ulceration, etc.);
palpable nodules in soft tissues;
stomach and intestinal bleeding;
foreign body feeling or difficulty swallowing;
persistent cough not associated with acute respiratory illness;
hemoptysis;
pains of various localization;
soreness during intercourse, smearing intermenstrual discharge or heavy bleeding in women;
delay and painful urination, erectile dysfunction in men;
hoarseness of voice;
prolonged diarrhea, not associated with a violation of the diet, in the absence of gastrointestinal diseases;
persistent headaches, dizziness, flashing flies before the eyes, loss of visual fields, etc.;
the appearance of traces of blood in the urine; and etc.

General non-specific signs:

lack of appetite up to complete refusal of food;
a progressive decrease in body weight with an unchanged dietary stereotype;
perversion of taste;
weakness, rapid fatigability, intolerance to habitual physical activity, drowsiness;
decreased performance;
prolonged subfebrile condition;
sweating, etc.

Diagnostics

Depending on the localization of the process, the following methods are used to diagnose carcinoma:

laboratory detection of tumor markers;
radiography (if necessary, with a contrast agent);
endoscopic examination (fibrogastroduodenoscopy, colonoscopy, sigmoidoscopy, hysteroscopy, etc.);
Ultrasound examination;
magnetic resonance and computed tomography;
positron emission tomography;
electroencephalography; etc.

MRI, CT, PET-CT are the most informative types of carcinoma diagnostics

Despite a wide range of possible research methods, the main diagnostic technique that reliably confirms the presence of atypical malignant cells is a targeted biopsy followed by cyto- and histological examination of the obtained sample.

Treatment

The scope and methods of treatment in each case are determined individually. The choice of medical tactics depends on the size and location of the tumor, its effect on nearby structures and vital functions of the body, the presence of damage to the lymph nodes, metastasis and other criteria.

Conservative treatment methods:

chemotherapeutic effect (drug suppression of uncontrolled proliferation of malignant cells or their direct destruction, destruction of micrometastases);
immunostimulation;
radiotherapy (impact on the tumor with X-rays and γ-rays);
cryotherapy (effect on atypical cells with low temperatures);
photodynamic therapy;
experimental methods of influence, for the assessment of which a sufficient evidence base has not yet been collected.

In most cases, in addition to conservative treatment, surgical removal of a malignant tumor with nearby tissues, lymph nodes, surgical removal of distant metastases is indicated.

The most favorable treatment for carcinoma is its complete removal followed by chemotherapy and radiotherapy.

If the patient is at the terminal stage of the disease (a large lesion that cannot be localized or removed surgically, multiple metastases, tumor disintegration, etc.), the so-called palliative treatment is prescribed, that is, therapy aimed at reducing suffering in case of impossibility of cure (for example, narcotic analgesics, sedatives).

Possible complications and consequences

Complications of carcinoma are diverse and severe, they are the reason for the high mortality rate of the disease:

bleeding;
perforation of hollow organs;
germination into adjacent organs;
peritonitis;
pulmonary edema;
swelling of the brain;
obstruction of the intestines, ureters, bronchi;
compression of large blood, nerve and lymph trunks;
respiratory and heart failure;
multiple organ failure;
metastasis;
recurrence;
depletion of the body;
coma; etc.

Forecast

The prognosis of the disease is individual and depends on many factors:

the age and general health of the patient;
type of cancer;
location of the neoplasm;
the degree of tumor differentiation;
severity of the process (stage);
the presence of metastases;
response to ongoing therapy;
the presence of complications.

The prognosis is favorable for differentiated cancer diagnosed at an early stage. The favorable prognosis worsens with a low or undifferentiated process, massive damage to the lymph nodes, metastasis, multicentric (multiple) nature of the pathology.

The survival time is individual for individual forms of cancer.

Prevention

Regular preventive examinations.
Timely complete treatment of precancerous conditions.
Rejection of bad habits.
Regular physical activity.
Maintaining an optimal body weight along with a healthy diet.

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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author

Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!