Carcinoma: Cancer

Carcinoma
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Carcinoma
Classification and external resources
Micrograph of a lung primary small cell carcinoma, a
type of carcinoma. The clustered cancerous cells
consist primarily of nucleus (purple); they have only
a scant rim of cytoplasm. The surrounding pale
staining, discoid cells are red blood cells.
Cytopathology specimen. Field stain.
ICD-O: 8010-8580
MeSH D002277
Carcinoma (Gk. karkinos, or "crab", and -oma, "growth") is the medical term for the most common type
of cancer occurring in humans. Put simply, a carcinoma is a cancer that begins in a tissue that lines the
inner or outer surfaces of the body, and that generally arises from cells originating in the endodermal or
ectodermal germ layer during embryogenesis.
[1]
More specifically, a carcinoma is tumor tissue derived
from putative epithelial cells whose genome has become altered or damaged to such an extent that the
cells become transformed, and begin to exhibit abnormal malignant properties.
Contents
1 Carcinoma of unknown primary (CUP)
2 Pathogenesis of cancer
3 Pathogenesis of carcinoma
4 Epidemiology of carcinoma
5 In situ
6 Classification of carcinomas
7 Histological types and variants of carcinoma
8 Frequent organ sites of carcinoma
9 Invasion and metastasis of carcinomas
10 Diagnosis
11 Types of carcinoma (by ICD-O code)
12 Staging
13 Grading
14 See also
15 References
16 External links
[edit] Carcinoma of unknown primary (CUP)
The term carcinoma has also come to encompass malignant tumors composed of transformed cells whose
origin or developmental lineage is unknown (see CUP), but that possess certain specific molecular,
cellular, and histological characteristics typical of epithelial cells. This may include the production of one
Carcinoma - Wikipedia, the free encyclopedia file:///C:/Documents and Settings/admin/Desktop/Carcinoma.htm
1 of 11 10/02/2013 1:22 PM
or more forms of cytokeratin or other intermediate filaments, intercellular bridge structures, keratin pearls,
and/or tissue architectural motifs such as stratification or pseudo-stratification.
[2][3]
[edit] Pathogenesis of cancer
Cancer occurs when a single progenitor cell accumulates mutations and other changes in the DNA,
histones, and other biochemical compounds that make up the cell's genome. The cell genome controls the
structure of the cell's biochemical components, the biochemical reactions that occur within the cell, and
the biological interactions of that cell with other cells. Certain combinations of mutations in the given
progenitor cell ultimately result in that cell (also called a cancer stem cell) displaying a number of
abnormal, malignant cellular properties that, when taken together, are considered characteristic of cancer,
including:
the ability to continue to divide perpetually, producing an exponentially (or near-exponentially)
increasing number of new malignant cancerous "daughter cells" (uncontrolled mitosis);
the ability to penetrate normal body surfaces and barriers, and to bore into or through nearby body
structures and tissues (local invasiveness);
the ability to spread to other sites within the body (metastasize) by penetrating or entering into the
lymphatic vessels (regional metastasis) and/or the blood vessels (distant metastasis).
If this process of continuous growth, local invasion, and regional and distant metastasis is not halted via a
combination of stimulation of immunological defenses and medical treatment interventions, the end result
is that the host suffers a continuously increasing burden of tumor cells throughout the body. Eventually,
the tumor burden increasingly interferes with normal biochemical functions carried out by the host's
organs, and death ultimately ensues.
[edit] Pathogenesis of carcinoma
Carcinoma is but one form of cancer - one composed of cells that have developed the cytological
appearance, histological architecture, or molecular characteristics of epithelial cells.
[2][3]
A progenitor
carcinoma stem cell can be formed from any of a number of oncogenic combinations of mutations in a
totipotent cell,
[citation needed]
a multipotent cell,
[citation needed]
or a mature differentiated
cell.
[citation needed]
[edit] Epidemiology of carcinoma
Demography (Age, Race, Gender, etc.)
While cancer is generally considered a disease of old age, children can also develop cancer.
[4]
In contrast
to adults, carcinomas are exceptionally rare in children.
[citation needed]
.
Causes
Smoking, environment, etc.
[edit] In situ
The term Carcinoma in situ (or CIS) refers to a small, localized carcinoma that has not yet invaded
through the epithelial basement membrane delimiting the carcinomatous cells from adjacent normal cells.
CIS is a pre-invasive cancer, and not a pre-malignant entity.
[5]
2 of 11 10/02/2013 1:22 PM
Nearly all cases of CIS will continue to grow and progress until they begin to infiltrate and penetrate into
and through the basal membrane or other/adjacent structures. Once invasion occurs, they are no longer
considered CIS lesions, but truly invasive carcinomas. If the lesion can be completely removed via
surgical resection, cryotherapy, laser ablation, or some other locally-targeted treatment modality before
frank invasion and metastasis develops, cure rates for CIS approach 100%.
In some cases, CIS lesions may gradually re-assume more normal-looking cytological and histological
characteristics, thereby becoming lower-grade neoplasms. Biologically, this can very often result in less
aggressive, slower-growing neoplasms. Indeed, the appearance of the component cells and local tissue
architecture at the local site of the CIS may eventually normalize to the point where the transformed cells
no longer meet the consensus requirements necessary for it to be classified as a carcinoma. Therefore, this
abnormality would no longer qualify as a true cancer.
These changes are also usually accompanied by decreases in surface area and/or volume of the abnormal
area. In some not-insignificant proportion of cases, the abnormal cells/tissue may disappear entirely, with
the resulting local area containing only normal-appearing tissue. The process is often referred to by
oncologists and pathologists as regression of the CIS lesion. Regression of CIS effectively results in the
progressive conversion of a malignant neoplasm to a benign one, to a localized area of normal or
near-normal tissue, with or without associated scar tissue, which often forms secondary to apoptosis,
necrosis, and fibrosis.
Regression is most often manifested after exposure to prolonged changes in the quality and intensity of
environmental and/or immunological stimuli.
A very common example is the regression in some lesions of CIS located in the main central and
segmental bronchi of the lung. Many pre-invasive lesions in cases of squamous cell carcinoma often
regress after long-term reduced exposure of the affected cells and tissues to the original environmental
carcinogenic stimulus, such as that seen after long-term abstention from tobacco smoking.
[6]
Another
relatively common example is the immunologically-driven clearing of Human Papilloma Virus HPV from
transformed epithelial cells of the uterine cervix, which results in regression of cervical CIS lesions.
[edit] Classification of carcinomas
Malignant neoplasms are exceptionally heterogeneous entities, reflecting the wide variety, intensity, and
potency of various carcinogenic promoters.
[7]
To date, no simple and comprehensive method for classifying them has yet been devised and accepted
within the scientific community.
[3]
Traditionally, however, malignancies have generally been classified into various taxa using a combination
of criteria, including:
[2]
One commonly used classification scheme classifies these major cancer types on the basis of cell genesis,
specifically:
Their (putative) cell (or cells) of origin
Epithelial cells => carcinoma 1.
Non-hematopoietic mesenchymal cells => sarcoma 2.
Hematopoietic cells
bone marrow-derived cells that normally mature in the bloodstream => Leukemia 1.
bone marrow-derived cells that normally mature in the lymphatic system =>
Lymphoma
2.
3.
Germ cells => Germinoma 4.
1.
3 of 11 10/02/2013 1:22 PM
Other criteria that play a role in a cancer diagnosis include:
The degree to which the malignant cells resemble their normal, untransformed counterparts
the appearance of the local tissue and stromal architecture
the anatomical location from which tumors arise
genetic, epigenetic, and molecular features
[edit] Histological types and variants of carcinoma
Adenocarcinoma
(adeno = gland) Refers to a carcinoma featuring microscopic glandular-related tissue cytology,
tissue architecture, and/or gland-related molecular products, e.g., mucin.
Squamous cell carcinoma
Refers to a carcinoma with observable features and characteristics indicative of squamous
differentiation (intercellular bridges, keratinization, squamous pearls).
Adenosquamous carcinoma
Refers to a mixed tumor containing both adenocarcinoma and squamous cell carcinoma, wherein
each of these cell types comprise at least 10% of the tumor volume.
Anaplastic carcinoma
Refers to a heterogeneous group of high-grade carcinomas that feature cells lacking distinct
histological or cytological evidence of any of the more specifically differentiated neoplasms. These
tumors are referred to as Anaplastic or Undifferentiated carcinomas.
Large cell carcinoma
Composed of large, monotonous rounded or overtly polygonal-shaped cells with abundant
cytoplasm.
Small cell carcinoma
Cells are usually round and are less than approximately 3 times the diameter of a resting
lymphocyte and little evident cytoplasm. Occasionally, small cell malignancies may themselves have
significant components of slightly polygonal and/or spindle-shaped cells.
[8]
There are a large number of rare subtypes of anaplastic, undifferentiated carcinoma. Some of the more
well known include the lesions containing pseudo-sarcomatous components: spindle cell carcinoma
(containing elongated cells resembling connective tissue cancers), giant cell carcinoma (containing huge,
bizarre, multinucleated cells), and sarcomatoid carcinoma (mixtures of spindle and giant cell carcinoma).
Pleomorphic carcinoma contains spindle cell and/or giant cell components, plus at least a 10% component
of cells characteristic of more highly differentiated types (i.e. adenocarcinoma and/or squamous cell
carcinoma). Very rarely, tumors may contain individuals components resembling both carcinoma and true
sarcoma, including carcinosarcoma and pulmonary blastoma.
[8]
[edit] Frequent organ sites of carcinoma
Lung: Carcinoma comprises >98% of all lung cancers.
Breast: Nearly all breast cancers are ductal carcinoma.
Prostate: The most common form of carcinoma of the prostate is adenocarcinoma.
Colon and rectum: Nearly all malignancies of the colon and rectum are either adenocarcinoma or
squamous cell carcinoma.
Pancreas: Pancreatic carcinoma is almost always of the adenocarcinoma type and is highly lethal.
Some carcinomas are named for their or the putative cell of origin, (e.g.hepatocellular carcinoma, renal
cell carcinoma).
[edit] Invasion and metastasis of carcinomas
4 of 11 10/02/2013 1:22 PM
The hallmark of a malignant tumor is its tendency to invade and infiltrate local and adjacent structures
and, eventually, spread from the site of its origin to non-adjacent regional and distant sites in the body, a
process called metastasis. If unchecked, tumor growth and metastasis eventually creates a tumor burden
so great that the host succumbs. Carcinoma metastasizes through both the lymph nodes and the blood.
[edit] Diagnosis
Carcinomas can be definitively diagnosed through biopsy, including fine-needle aspiration (FNA), core
biopsy, or subtotal removal of single node,.
[9]
Microscopic examination by a pathologist is then necessary
to identify molecular, cellular, or tissue architectural characteristics of epithelial cells.
[edit] Types of carcinoma (by ICD-O code)
(8010-8045) Epithelial neoplasms, NOS
(8050-8080) Squamous cell neoplasms
(M8070/3) Squamous cell carcinoma, NOS
(8090-8110) Basal cell neoplasms
(M8090/3) Basal cell carcinoma, NOS
(8120-8130) Transitional cell carcinomas
(8140-8380) Adenocarcinomas
(M8140/3) Adenocarcinoma, NOS
(M8142/3) Linitis plastica
(M8155/3) Vipoma
(M8160/3) Cholangiocarcinoma
(M8170/3) Hepatocellular carcinoma, NOS
(M8200/3) Adenoid cystic carcinoma
(M8312/3) Renal cell carcinoma
(M8312/3) Grawitz tumor
(8390-8420) Adnexal and Skin appendage Neoplasms
(8430-8439) Mucoepidermoid Neoplasms
(8440-8490) Cystic, Mucinous and Serous Neoplasms
(8500-8540) Ductal, Lobular and Medullary Neoplasms
(8550-8559) Acinar cell neoplasms
(8560-8580) Complex epithelial neoplasms
[edit] Staging
Staging of carcinoma refers to the process of combining physical/clinical examination, pathological review
of cells and tissues, surgical techniques, laboratory tests, and imaging studies in a logical fashion to obtain
information about the size of the neoplasm and the extent of its invasion and metastasis.
Carcinomas are usually staged with Roman numerals. In most classifications, Stage I and Stage II
carcinomas are confirmed when the tumor has been found to be small and/or to have spread to local
structures only. Stage III carcinomas typically have been found to have spread to regional lymph nodes,
tissues, and/or organ structures, while Stage IV tumors have already metastasized through the blood to
distant sites, tissues, or organs.
In some types of carcinomas, Stage 0 carcinoma has been used to describe carcinoma in situ, and occult
carcinomas detectable only via examination of sputum for malignant cells (in lung carcinomas).
In more recent staging systems, substages (a, b, c) are becoming more commonly used to better define
groups of patients with similar prognosis or treatment options.
5 of 11 10/02/2013 1:22 PM
Carcinoma stage is the variable that has been most consistently and tightly linked to the prognosis of the
malignancy.
The criteria for staging can differ dramatically based upon the organ system in which the tumor arises. For
example, the colon
[10]
and bladder cancer
[11]
staging system relies on depth of invasion, staging of breast
carcinoma is more dependent on the size of the tumor, and in renal carcinoma, staging is based on both the
size of the tumor and the depth of the tumor invasion into the renal sinus. Carcinoma of the lung has a
more complicated staging system, taking into account a number of size and anatomic variables.
[12]
The UICC/AJCC TNM systems are most often used.
[clarification needed]
[1] For some common tumors,
however, classical staging methods (such as the Dukes classification for colon cancer) are still used.
[edit] Grading
Grading of carcinomas refers to the employment of criteria intended to semi-quantify the degree of
cellular and tissue maturity seen in the transformed cells relative to the appearance of the normal parent
epithelial tissue from which the carcinoma derives.
Grading of carcinoma is most often done after a treating physician and/or surgeon obtains a sample of
suspected tumor tissue using surgical resection, needle or surgical biopsy, direct washing or brushing of
tumor tissue, sputum cytopathology, etc. A pathologist then examines the tumor and its stroma, perhaps
utilizing staining, immunohistochemistry, flow cytometry, or other methods. Finally, the pathologist
classifies the tumor semi-quantitatively into one of three or four grades, including:
Grade 1, or well differentiated: there is a close, or very close, resemblance to the normal parent
tissue, and the tumor cells are easily identified and classified as a particular malignant histological
entity;
Grade 2, or moderately differentiated: there is considerable resemblance to the parent cells and
tissues, but abnormalities can commonly be seen and the more complex features are not particularly
well-formed;
Grade 3, or poorly differentiated: there is very little resemblance between the malignant tissue and
the normal parent tissue, abnormalities are evident, and the more complex architectural features are
usually rudimentary or primitive;
Grade 4, or undifferentiated carcinoma: these carcinomas bear no significant resemblance to the
corresponding parent cells and tissues, with no visible formation of glands, ducts, bridges, stratified
layers, keratin pearls, or other notable characteristics consistent with a more highly differentiated
neoplasm.
Although there is definite and convincing statistical correlation between carcinoma grade and tumor
prognosis for some tumor types and sites of origin, the strength of this association can be highly variable.
It may be stated generally, however, that the higher the grade of the lesion, the worse is its prognosis.
[13][14]
[edit] See also
Cancer
Sarcoma
Hematological malignancy
Basal cell carcinoma
[edit] References
6 of 11 10/02/2013 1:22 PM
Notes
^ http://www.medterms.com/script/main/art.asp?articlekey=20677 1.
^
a

b

c
Berman JJ (November 2004). "Tumor taxonomy for the developmental lineage classification
of neoplasms". BMC Cancer 4: 88. doi:10.1186/1471-2407-4-88. PMC 535937. PMID 15571625.
http://www.biomedcentral.com/1471-2407/4/88.
2.
^
a

b

c
Berman JJ (March 2004). "Tumor classification: molecular analysis meets Aristotle". BMC
Cancer 4: 10. doi:10.1186/1471-2407-4-10. PMC 415552. PMID 15113444.
http://www.biomedcentral.com/1471-2407/4/10.
3.
^ Kuriakose MA, Hicks WL, Loree TR, Yee H (August 2001). "Risk group-based management of
differentiated thyroid carcinoma". J R Coll Surg Edinb 46 (4): 21623. PMID 11523714.
http://www.rcsed.ac.uk/journal/vol46_4/4640008.htm.
4.
^ Banerjee AK (April 2009). "Preinvasive lesions of the bronchus". J Thorac Oncol 4 (4): 54551.
doi:10.1097/JTO.0b013e31819667bd. PMID 19279508. http://meta.wkhealth.com/pt/pt-
core/template-journal/lwwgateway/media/landingpage.htm?issn=1556-0864&volume=4&issue=4&
spage=545.
5.
^ Ishizumi T, McWilliams A, MacAulay C, Gazdar A, Lam S (March 2010). "Natural history of
bronchial preinvasive lesions". Cancer Metastasis Rev. 29 (1): 514.
doi:10.1007/s10555-010-9214-7. PMID 20112052.
6.
^ Roggli VL, Vollmer RT, Greenberg SD, McGavran MH, Spjut HJ, Yesner R (June 1985). "Lung
cancer heterogeneity: a blinded and randomized study of 100 consecutive cases". Hum. Pathol. 16
(6): 56979. doi:10.1016/S0046-8177(85)80106-4. PMID 2987102.
7.
^
a

b
Travis, William D; Brambilla, Elisabeth; Muller-Hermelink, H Konrad et al., eds. (2004).
Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. World Health
Organization Classification of Tumours. Lyon: IARC Press. ISBN 92-832-2418-3. http://www.iarc.fr
/en/publications/pdfs-online/pat-gen/bb10/bb10-cover.pdf. Retrieved 27 March 2010.
8.
^ Wagman LD (2008). "Principles of Surgical Oncology". In Pazdur R, Wagman LD, Camphausen
KA, Hoskins WJ. Cancer Management: A Multidisciplinary Approach (11th ed.).
http://www.cancernetwork.com/cancer-management-11/chapter01/article/10165/1399286.
9.
^ Puppa G, Sonzogni A, Colombari R, Pelosi G. TNM staging system of colorectal carcinoma: a
critical appraisal of challenging issues. Arch Pathol Lab Med 2010;134:837-52.
10.
^ Sharir S. Update on clinical and radiological staging and surveillance of bladder cancer. Can J
Urol 2006;13 Suppl 1:71-6.
11.
^ Pepek JM, Chino JP, Marks LB, D'amico TA, Yoo DS, Onaitis MW, Ready NE, Hubbs JL, Boyd
J, Kelsey CR. J Thorac Oncol 2011;6:757-61.
12.
^ Sun Z, Aubry MC, Deschamps C, Marks RS, Okuno SH, Williams BA, Sugimura H, Pankratz VS,
Yang P. Histologic grade is an independent prognostic factor for survival in non-small cell lung
cancer: an analysis of 5018 hospital- and 712 population-based cases. J Thorac Cardiovasc Surg
2006;131:1014-20.
13.
^ "Poorly differentiated carcinoma of unknown primary site". http://www.uptodate.com/patients
/content/topic.do?topicKey=~msksuFa_7KT1FN. Retrieved 2010-04-22.
14.
[edit] External links
Media related to Carcinoma at Wikimedia Commons
v
t
e
7 of 11 10/02/2013 1:22 PM
Glandular and epithelial neoplasms (ICD-O 8010-8589)
Epithelium
Papilloma/carcinoma
(8010-8139)
Small cell carcinoma
Combined small cell carcinoma
Verrucous carcinoma
Squamous cell carcinoma
Basal cell carcinoma
Transitional cell carcinoma
Inverted papilloma
Glands
Adenomas/
adenocarcinomas
(8140-8429)
Gastrointestinal
tract: Linitis plastica
Familial adenomatous polyposis
pancreas
Insulinoma
Glucagonoma
Gastrinoma
VIPoma
Somatostatinoma
Cholangiocarcinoma
Klatskin tumor
Hepatocellular adenoma/Hepatocellular
carcinoma
Urogenital
Renal cell carcinoma
Endometrioid tumor
Renal oncocytoma
Endocrine
Prolactinoma
Multiple endocrine neoplasia
Adrenocortical adenoma/Adrenocortical
carcinoma
Hurthle cell
Other/multiple
Neuroendocrine tumor
Carcinoid
Adenoid cystic carcinoma
Oncocytoma
Clear cell adenocarcinoma
Apudoma
Cylindroma
Papillary hidradenoma
Adnexal and
skin appendage
(8390-8429)
sweat gland
Hidrocystoma
Syringoma
Syringocystadenoma papilliferum
8 of 11 10/02/2013 1:22 PM
Cystic,
mucinous,
and serous
(8440-8499)
Cystic
general
Cystadenoma/Cystadenocarcinoma
Mucinous
Signet ring cell carcinoma
Krukenberg tumor
Mucinous cystadenoma / Mucinous
cystadenocarcinoma
Pseudomyxoma peritonei
Mucoepidermoid carcinoma
Serous
Ovarian serous cystadenoma / Pancreatic serous
cystadenoma / Serous cystadenocarcinoma / Papillary
serous cystadenocarcinoma
Ductal, lobular,
and medullary
(8500-8549)
Ductal
carcinoma
Mammary ductal carcinoma
Pancreatic ductal carcinoma
Comedocarcinoma
Paget's disease of the breast / Extramammary Paget's
disease
Lobular
carcinoma
Lobular carcinoma in situ
Invasive lobular carcinoma
Medullary
carcinoma
Medullary carcinoma of the breast
Medullary thyroid cancer
Acinar cell
(8550-8559)
Acinic cell carcinoma
Other
Complex
epithelial
(8560-8589)
Warthin's tumor
Thymoma
See also
Template:Epithelium and epithelial tissue
Retrieved from "http://en.wikipedia.org/w/index.php?title=Carcinoma&oldid=536893041"
Categories:
Anatomical pathology
Glandular and epithelial neoplasia
Carcinoma
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