What is Cancer ?

When the body's cells become abnormal and duplicate out of control a tumour is formed, these may be cancerous (spreading) or benign (non-cancerous). Normal body cells divide in a controlled and relativly slow rate, in malignant cells the duplication is uncontrolled and often at a very rapid rate. If the tumour (also refered to as a growth or neoplasm) is malignant (spreading) the disease may develop in other parts of the body where secondary tumours may form (known as metastasis).

Cancer is not a single disease but a wide range of different diseases of which there well over a hundred types. Cancers can be classified into two broad types: haematological (malignancies of the blood) or solid tumours. The name of the cancer depends on the type of tissue and/or site it develops in. For example a sarcoma is a cancer arising from bone, muscle or connective tissue. Carcinoma is cancer arising from epithelial tissue (cells of the glands and the outer layer of skin that lines blood vessels, hollow organs and the body's orifices).

What causes cancer ? The cause of most cancers remains unknown. A minority of cancers are known to be hereditary (inherited). For example some breast cancers, retinoblastomas, and Wilms' tumours are thought to be hereditary. In rare cases the family may have a history of cancers (Li-Fraumeni Syndrome) [1]. However most cancers have no obvious hereditary cause. Carcinogens are chemicals or enviromnental factors that may cause normal cells to become abnormal and cancerous by damage or mutate a cells genetic material (DNA and RNA). For example smoking is known to increase a persons risk of lung cancer, likewise over-exposure to ultraviolet sun light increases the risk of melanoma, and inhilation of asbestos dust can cause mesophelioma (cancer of the lining of the lungs). Some viruses are known to be carcinogens, for example the HTLV-1 virus is associated with leukaemia. Radiation exposure has also been linked with cancer incidence. Other factors such as diet and excercise may influence cancer incidence.

One or more 'insults' (exposure to carcinogens) may result in damage or modifications to a cells DNA. Oncogenes are genes present in the DNA of every cell and carry out normal functions but have the potential to make a normal cell turn cancerous. These genes help regulate normal growth and development, but an abnormal change may cause them to produce irregular or excessive amounts of chemical signals. These may stimulate extreme or abnormal cell growth. On the other hand some genes are thought to be protective against cancer and viruses causing badly damaged cells to self-destruct (apoptosis). If these such genes are damaged or absent then the risk of cancer may increase. For example deletion of the P53 gene has been identified in a range of cancers.

Childhood Cancers - Paediatric Oncology

Childhood cancer is rare, about 1 in every 600 children aged under 15 develop cancer, still very little is known about it's causes [2]. Childhood cancers represent around 1% of all cancers, though in terms of life years that may be saved by curing children with cancer this proportion is much higher. Compared with adult cancers they tend to have different histologies and occur in different sites of the body [3]. Common adult cancers such as lung, breast, colon, and stomach are extremely rare among children. On the other hand some types of cancer are almost exclusively found in children, especially embryonal tumours which arise from cells associated with the foetus, embryo, and early postnatal period. Treating children requires different considerations compared with adult oncology, for example potential treatment side effects may be different to those in adults. Because of these differences between childhood and adult cancers most children are treated in specialist paediatric oncology units, in the UK about 80% of children are treated at a UKCCSG centre. The overall cure rate for childhood cancer has drastically improved over the last 2 decades in association with clinical trials and the development of new treatments [4,5].

Leukaemia is the most common type of childhood cancer, representing about one third of all cancers in under 15 year olds. Leukaemia is a condition where too may underdeveloped white blood cells are found in the blood and bone marrow. Four fifths of childhood leukaemia's are acute lymphatic leukaemias (ALL), other types include acute myeloid leukaemia (AML) and chronic myeloid leukaemia (CML). Brain tumours are the most common solid tumours in childhood, and make up about a fifth of all children's cancers. There are many different types of brain tumours; medulloblastoma, astrocytoma and brainstem glioma are the most common.

Neuroblastoma (sympathetic nervous system), retinoblastoma (eye), Wilms' tumour (kidneys), and hepatobalstoma (liver) are most usually found in infants or young children. Other malignancies found in children and young adults include Lymphomas (Hodgkin's and Non-Hodgkins lymphoma), soft tissue sarcomas (including rhabdomyosarcoma), bone cancer (osteosarcoma and Ewing's sarcoma), plus a number of less common childhood cancers. Histiocytocis is rare; it is not a true cancer, but in many respects behaves like one.

Adult Cancers - Medical Oncology

About one in three people will have cancer during their lifetime, and after heart disease cancer is now the most common cause of death in western countries. [7] Adult cancer is a diverse range of different diseases. The chart below shows the distribution of different cancer sites for Kentucky (USA) in 1993 based on data provided by the Kentucky Cancer Registry[8].

The incidence and types of cancer varies between and also within different countries. It will depend on demographic (population), environmental and other factors. For example there are differences in cancer incidence between different racial groups, diet and climate may also influence cancer incidence [9]. In particular the age distribution of the population will influence the incidence of different types of cancer. The peak incidence of many adult cancers is after the age of 45 (eg. lung, breast and prostate cancer). Other cancers such as bone tumours, Hodgkin's disease, and cervical cancer are more common in younger adults. Leukaemia is found in people of all ages and is one of the most common type of cancers in adults aged under 35. Age specific cancer incidence rates are shown below (for all types of cancer combined).

This guide aims to introduce the main types of cancer in the context of the body system to which they most closely identify. For example in the respiratory system (breathing) lung cancer is a common neoplasm. Overall this is one of the most common types of cancer and smoking is known to increase a persons risk for this disease. In the digestive system colorectal cancer (colon / rectum) is another common tumour. Other cancers of the digestive system include those of the pancreas, stomach, esophagus, and other organs. For the cardiovascular system (heart and blood) cancers include leukaemia and plasma cell tumours. In the lymphatic system tumours are classified as either Hodgkin's or non-Hodgkin's Lymphoma. Thyroid cancer is the most common type of tumour in the endocrine system (hormones), while brain and spinal tumours are found in the central nervous system.

Breast cancer is one of the most common neoplasms, predominantly found in women (less than 1% are in males). Associated with the female reproductive system are cervical, ovarian, and other genealogical cancers. In males prostate cancer is one of the major neoplasms, other cancers of the male reproductive system iclude testis and penile cancer. Associated with the urinary system are bladder and kidney cancers. Sarcomas (bone, soft tissue, or connective tissue tumours) are related to the musculoskeletal system. Skin cancers include melanoma and basal cell carcinoma. Head and neck cancers include those of the oral and nasal cavities.

The cancers mentioned above are some of the more common types, they are introduced in more detail throughout this guide together with other less frequent types.

Diagnosis

This is the removal of a small section of the tumour, the sample will be analysed by a histopathologist in order to establish a precise diagnosis. Surgical procedure. This may be a needle biopsy, where a very fine needle is used to take a tiny sample of the tumour. Occasionally a surgeon may remove the whole tumour prior to diagnosis; a resection biopsy.

Haematology

is the branch of medicine that specialises in the study and treatment of blood and blood tissues (including bone marrow). A blood count is where the various types cells in the blood are measured. This may aid diagnosis and will be used during treatment to monitor toxicity. The Haematologist may also examine samples from a bone marrow aspiration (needle into the bone) and samples of spinal fluid from a lumbar puncture (needle between the vertebra of the spine).

Histopathology

the study of cells relating to the disease. (Histology is the microscopic study of cells and tissues, Pathology is the study of the disease). The histopathologist will determine a precise diagnosis by laboratory tests and microscopic examination of the cells.

Differentiation

is where normal cells go through physical changes in order to form the different specialised tissues of the body. Malignant cells may range from well-differentiated (closely resembling the tissue of origin) or undifferentiated or anaplastic (bearing little similarity to the tissue of origin). In general it is the undifferentiated or anaplastic histologies which are more aggressive.

Tumour Markers

A substance in the body that may indicate the presence of cancer. Markers may be secreted by the tumour itself or produced by the body in response to the cancer. Tumour markers may aid diagnosis or give an indicator of how treatment is progressing. These markers are usually specific to certain types of cancer. For example neuron-specific enolase (NSE) is associated with a number of types of cancers, in particular neuroblastoma. Also alphafetoprotein (AFP) levels are often abnormally high in patients with Germ cell tumours.

Medical Imaging types of medical imaging include:

• X-ray Examination of X-ray films may indicate the site and extent of the tumour and aid in the detection of metastatic spread.
• CT Computed tomography (CT or CAT scan) makes a cross-sectional x-ray picture of a "slice" of the body. The machine rotates around the patient taking x-rays from different angles, the images are then processed by a computer.
• MRI Magnetic resonance imaging. This is used to determine if the biochemical activity of a tissue responds normally to magnetic forces, tumours may give an abnormal signal.
• Ultrasound The use of sound waves to image the underlying structures of the body. Ultrasonic waves are reflected differently depending on the type of tissue they pass through, aiding the detection of abnormal tissues.

Staging and Prognosis

Benign

Not spreading, usually a more mild disease.

Malignant

Cancerous, where the tumour grows uncontrollably and may spread.

In-situ / Invasive

Localised

A tumour restricted to a single site.

Metastases

Where the tumour has spread to other parts of the body beyond the primary site. Metastatic sites (secondaries) my be regional or distant from the original tumour.

Staging

Staging is where the disease is categorised as to how far it has spread. The precise staging system used will depend on the type of cancer the patient has. In general low stage patients are those with localised tumours that are easily resectable, whilst high stage patients are those with widespread metastases. The treatment given may largely depend upon which stage the patient is at diagnosis.

Prognosis

is the expected outcome of a disease and it's treatment, this may be influenced by a variety of factors such as stage, age, site etc. depending on the particular type of cancer. For example, in general a patient with localised disease may have a more favourable prognosis compared to a patient with widespread disease which may be less favourable.

Remission

is where the symptoms of cancer are no longer present. There is no longer any evidence of the disease using the available investigations.

Relapse

This is when the disease reoccurs after a period in remission.

Refractory

This is where the cancer is resistant to treatment, patient may nevergo into remission, possibly with stable or progressive disease.

Restaging

This is where the patient is staged again after a period of treatment to access the response to therapy.

Follow-up

When treatment is complete the periodic visits to the physician are needed to monitor the patient and ensure there has been no recurrence of the disease.

Treatment

Curative treatment - treatment to destroy the cancer.

Palliative treatment treatment which relieves the symptoms and pain.

Surgery

• Pre-operative chemotherapy - drugs given to shrink the tumour before surgery.
• Complete resection this is where all of the tumour has been totally removed during surgery, as opposed to an incomplete resection. The surgical specimen may be examined by a pathologist to determine if it is likely to have removed all of the primary tumour. If there is any tumour left after surgery this may be macroscopic (visible to the eye) or microscopic, in either case radiotherapy may be needed to kill the remaining tumour cells.
• Prosthesis - an artificial replacement e.g. for an amputated limb.
• Endoprosthesis - a prosthesis which fits inside the body e.g. replacing the thigh bone.

Radiotherapy

• External radiotherapy - radioactivity from a source outside the body.
• Internal radiotherapy - placing radioactive source within the body in or near to the tumour to kill the cancer cells (Brachytherapy).
• Fractions - the radiotherapy dose is divided into a number of smaller doses to reduce the risk of side effects. There is normally one fraction per day.
• Hyperfractionated radiotherapy - more than one fraction is given per day.
• Radiotherapy field - the area towards which the radiotherapy was directed.
• Total Body Irradiation (TBI) - radiation to the whole body e.g. to destroy all malignant cells prior to bone marrow transplant (BMT).

Chemotherapy

Since the 1960's the development and use of drugs has dramatically improved the prognosis for many types of cancer. Chemo- means chemicals, for most types of cancer chemotherapy will consist of a number of different drugs, this is known as combination chemotherapy. Chemotherapy may be given in a variety of ways; Intravenously (IV) -into a vein is the most common, Intramuscularly (IM) -injection into a muscle, Orally -by mouth, Subcutaneously (SC) -injection under the skin, Intralesionally (IL) -directly into a cancerous area, Intrathecally (IT)-into the fluid around the spine, Topically -medication will be applied onto the skin.

• Cytotoxic - cytotoxic drugs kill or damage cells. The normal cells of the body grow and die in a controlled way, but cancer cells keep growing and multiplying. Chemotherapy destroys cancer cells by stopping them from growing or multiplying at one or more points during the life cycle of the cell.
• Central line - a thin plastic line into a vein in the chest used for the delivery of chemotherapy e.g. HICKMAN® catheter.
• Drug resistance is where tumour cells become resistant to chemotherapy. Some tumour cells will be chemo-sensitive and are killed by anticancer drugs; the cells that remain are likely to be more resistant. Thus by selection it is the most resistant cells survive and divide, they may be resistant to a particular drug, a class of drugs, or all drugs.

Bone Marrow Transplantation (BMT)

The bone marrow is destroyed by high dose chemotherapy and possibly radiotherapy which has been given to kill malignant cells in the body. Healthy matching marrow is then transplanted into the patient.

• Allogeneic BMT Healthy marrow is taken from a matched donor and used to replace the patients bone marrow which has been destroyed by high dose chemotherapy. The donor may be a relative, if the patient has a twin this may be the best match, otherwise a brother, sister, or another unrelated person may donate marrow.
• Autologous BMT In an autologous bone marrow transplant the marrow is first taken from the patient. The marrow is usually then purged with chemicals to kill any malignant cells in it, and may then be frozen to preserve it. High dose chemotherapy is given to the destroy the patient's remaining marrow. The frozen marrow is then thawed and transplanted back into the patient.
• Peripheral Blood Stem Cell Rescue (PBSC)

New approaches - Gene therapy / Immunotherapy

In the future patients might be immunised against their own cancers by injecting them with their own tumour cells after they have been genetically modified. The gene-modified tumour cells may encourage the patients own immune system to destroy the cancer cells. Tumour necrosis factor (TNF) and interleukin-2 (IL-2) are substances associated with the immune system which encourage anititumour activity.

Toxicity and Late Effects

Acute Transient. Some side effects may be of short duration. May be sudden or severe.

Chronic Long lasting. Some side effects may be long lasting e.g. kidney damage.
Immuno-suppressive - Drugs may dampen the immune system making the patient prone to infections.

Neutropenia reduced levels of white cells in the blood. Febrile neutropenia -with fever.

WHO toxicity gradings World Health Organisation toxicity grading guidelines. In general these range from grade 0 (none) to grade 4 (life threatening).

Late effects It is possible that treatment may have delayed effects e.g. on fertility and growth.

Cancer Research (i) Basic Science

two general approaches include a) the mass screening of thousands of natural substances to see if they have any anti cancer potential; or b) making new compounds in the laboratory e.g. creating analogues of existing drugs (slightly modified chemical structures) designed to make the drug more potent.

Pre-clinical testing of drugs.

New drugs may be tested on animals to indicate the maximum doses, toxicities and anti cancer potential before they are tested on humans (see phase I trials).

In vitro / in vivo

experiments may be in vitro (in the test tube) or in vivo (in the body). Much laboratory work uses cell cultures (cells grown in the lab); either from established cell lines or from material collected at biopsy/surgery.

Biochemistry.

There is a great deal of research investigating the mechanisms of how drugs are metabolised and absorbed by the body's cells. Growing knowledge in this field provides the foundations for improving the anticancer potential for existing drugs and for developing new 'designer' drugs. Other work includes research into the machanisms of drug resistance.

Tumour biology

cytogenetics. During recent years there has been rapid advances in the understanding of tumour biology at the genetic level. Research into the genes associated with different cancers include the identification of oncogenes, tumour supressor genes. This is a key area of cancer research, providing a basis for the development of new treatments and new diagnostic tools. In the future treatment may be more tailored to the biological features of the cancer rather than the standard clinical features.

Cancer Research (ii) Clinical Trials and Epidemiology

Types of study

Some Studies are experimental which make in intervention e.g. clinica l trials, others are observational in which no medical intervention is made. Studies may also be prospective ie. ongoing into the future, or retrospective ie. looking at historical data. In general studies aim to test a hypothesis (theory) by disproving null hypothesis (the opposite theory) e.g. in a trial of a new drug the null hypothesis might be that the new drug has no effect on survival.

Phase I clinical trials

Tests new types of treatment and aim to define a safe dose that will be used for further studies. This is usually the first testing of a treatment on humans after extensive laboratory work. Recruitment for Phase I trials are usually from patients for whom no other effective therapy is known.

Phase II clinical trials

Test the anti cancer effects of the new treatment, and include very detailed toxicity investigations. If there is effective antitumour activity, it may be incorporated in a future phase III study.

Phase III clinical trials

Compare one or more treatments of proven efficacy. Often patients will be randomised between an established 'standard' treatment and a new 'experimental' treatment - it is not known which is the better treatment.

Randomisation Treatment is randomly allocated to ensure there is no systematic bias in the results.

Ethical approval all new trials have to first be approved by an independent ethics committee.

Informed consent is where patients agree to a treatment / randomisation having a reasonable understanding of it.

Morbidity Looking at the incidence or prevalence of a disease in a population.

Mortality Looking at the death rates caused by a disease.

Epidemiology

The study of populations. Regional and National cancer registries record all cancers enabling population based studies in cancer to be carried out. Knowing how many people get a type of cancer out of the overall population provides the information needed to calculate incidence rates.

Longitudanal Studies are studies where individuals are followed over time. A fixed population (cohort) may be monitored over a number of years.

Cross-sectional Studies are studies that are carried out at just one point in time.

Case Control Studies are where cases are compared to controls, in order to avoid bias the controls are matched for factors such as age and sex. The aim is to investigate possible associations between certain factors and risk of disease. For example a study investigating smoking and the risk of lung cancer.

Meta Analysis is where data from a number of studies are lumped together in order to provide evidence for or against a hypothesis.

Inside the cell's nucleus, DNA is tightly twisted and packed into 23 pairs of chromosomes (one chromosome in each pair comes from each parent).

There are 46 human chromosomes which are estimated to contain about 100,000 individual genes that determine each person's inherited human characteristics. Each gene is a segment of double-stranded DNA which holds the information for making a specific molecule, usually a protein. This information (or code) lies in varying sequences of vast numbers of pairs of the four chemical bases that make up the DNA. A change in the sequence (a mutation), or missing sequences (deletion) of these bases may result in an altered protein that does not work properly, or a failure to produce that protein altogether.

Roots, suffixes, and prefixes

Overview of Skin Cancer
 

Skin cancer is the most common type of cancer and accounts for half of all new cancers in Western populations. It occurs more often in people with light coloured skin who have had a high exposure to sunlight. The two most frequent types of skin cancer are Basal Cell Carcinomas and Squamous Cell Carcinoma (often grouped under "non-melanoma skin cancer"). The third most frequent skin cancer is Melanoma, this is a malignancy of the cells which give the skin it's colour (melanocytes). In addition there are a number of other, less common cancers starting in the skin including Merkel cell tumours, cutaneous lymphomas, and sarcomas (see the pages on sarcoma and lymphoma in this guide).

Internet Resources for Skin Cancer

Melanoma
 

Melanoma is a malignancy of the skin in which melanocytes (the cells which give the skin it's colour) become cancerous. Melanoma occurs most frequently in white people, and is rare in people with dark skin; it is usually found in adults, though occasionally melanoma may develop in children and adolescents. Over exposure to sunlight can cause skin changes which can lead to melanoma. Half of all melanomas are thought to arise in a benign (non-cancerous) pigmented nevus (a mole). Moles are very common and normally change only slightly over time; however in melanoma there may be a more rapid increase in size - symptoms include a darker or variable discoloration, itching, and possibly ulceration and bleeding.

Internet Resources for Melanoma

Basal Cell Carcinoma (BCC)
 

This is where the basal cells become cancerous; basal cells are found in the epidermis (the outermost layer of skin). This is the most common type of skin cancer which is usually highly curable when detected early.

Internet Resources for Basal Cell Carcinoma

Squamous Cell Carcinoma (SCC)
 

A type of skin cancer arising in squamous cells (the flat, scaly cells on the surface of the skin). Cure rates are very hight when detected and treated early.

Internet Resources for Squamous Cell Carcinoma (skin)

Merkel cell cancer
 

Merkel cell cancer (also known as trabecular cancer, or neuroendocrine cancer of the skin) is a rare type of malignancy developing on or just beneath the skin. These tumours can develop at any age, but the peak incidence is between ages 60 - 80. They are more frequent in white people, the most common sites of diseases are the face or scalp and other areas of high sun exposure.

Internet Resources for Merkel Cell Cancer

Related Abbreviations and Acronyms:

BCC	Basal Cell Carcinoma
BMR	Basal Metabolic Rate
LMM	Lentigo Maligna Melanoma
MM	Malignant Melanoma
NBCCS	Nevoid basal cell carcinoma syndrome
NM	Nodular Melanoma
NMSC	Non Melanoma Skin Cancer
SC	Subcutaneous
SCC	Squamous Cell Carcinoma
SSM	Superficial Spreading Melanoma
UVR	Ultra Violet Radiation

Osteogenic Sarcoma
 

Osteogenic Sarcoma (osteosarcoma) is a bone forming cancer. It is the most frequent type of bone tumour and is most common between the ages of 15 to 25. Over 90% of tumours are located in the metaphysis (the growing ends of the bone), the most common sites are the long bones of the legs. Most tumours are solitary, around 2% are multifocal (2 or more bones). It is known that osteosarcoma can be radiation induced. Osteosarcomas vary greatly in radiological and pathological features and therefore needs careful diagnosis to differentiate this from other bone tumours. Most are high grade intramedullary osteosarcomas, about 5% are low grade lesions, some are secondary osteosarcomas (for example those caused by radiation therapy).

Internet Resources for Osteosarcoma

Ewing's Sarcoma
 

Ewing's sarcoma is most common in children and young adults. The most frequent sites are the pelvis, femur, tibia, and fibula, around a fifth of patients have metastases at diagnosis usually in the lungs or other other bones. Ewing's tumours are more frequently found in the diaphysis (mid-shaft) part of the bone. Ewing's sarcoma can sometimes be restricted to soft tissue (Extraosseos Ewing's sarcoma). There is a spectrum of pathology ranging from 'classical' Ewing's which are negative for neural markers; to PNET (peripheral neuroectodermal tumours) which are strongly positive.

Internet Resources for Ewing's Sarcoma

Chrondrosarcoma
 

Chondrosarcoma is a cancer arising in cartilage cells, it occurs mostly in adults, it is rare in those aged under 20 with 70% of cases occurring between ages 50-75. Rare sub-types include mesenchymal chondrosarcoma which is more common in those aged under 40; Clear cell chondrosarcoma (around 2% of cases); and Dedifferenting chondrosarcoma (a rare tumour which transforms from low grade to a high grade sarcoma).

Internet Resources for Chondrosarcoma

Other Primary Bone Tumours
 

Malignant Fibrous Histiocytoma (MFH) account for 10% of bone tumours, they arise from histiocytes that have fibroblastic potential.
Chondoma is rare occurring mostly between ages 30 -70. This is a low grade malignancy which is arises from the remnants of the notochord (cells in the embryo which cause the formation of cartilage).
Fibrosarcoma and desmoid tumours vary in malignant potential.
Giant cell tumours some are benign, others may be malignant e.g. giant cell osteosarcoma, giant cell fibrosarcoma.
Neurogenious tumours of bone These include neuroepithelioma and malignant schwannoma.
Intraosseous liposarcoma is very rare. Liposarcoma arises from fat cells, these tumours are common in muscle but in rare cases are found in bone. Similarly extraosseous osteosarcoma (osteosarcoma found in soft tissue) is very rare with less than 300 cases reported world wide.

Bone sarcomas associated with Paget's disease
 

Paget's disease is the most common bone disorder characterised by irregular thickening and softening of the bones. The disease is more common after the age of 40, and is frequent in those of European descent but rare in Asians. These is an association with this (non malignant) disease and bone cancer, up to 10% of those with Paget's disease will have a 'sarcomatous transformation' of affected bones giving rise to bone sarcoma. This may be osteosarcoma, fibrosarcoma, chondrosarcoma, or other bone sarcomas.

Pathologic Fracture
 

- caused by a disease, growth of the tumour may cause stress leading to a fracture.

Scintigraphy
 

Scintigraphy (bone scan) - e.g. used to see if a cancer has metastasised to the bone. Primary bone cancers are relatively rare, but many other types of cancer can metastasise to the bone.

Related Abbreviations and Acronyms:

C1 - C7	Cervical vertebrae (spine eg. C7 = seventh cervical vertebra)
EICESS	European Intergroup Ewing's Sarcoma Study
EOI	European Osteosarcoma Intergroup
GCT	Giant Cell Tumour Context: bone tumours
IESS	Intergroup Ewing's Sarcoma Study (USA)
L1 - L5	Lumbar vertebrae 1 - 5 (spine eg. L1 = 1st lumbar vertebra)
OS	Osteogenic sarcoma (context bone tumours)
PNET	Peripheral neuroectodermal tumour Context: Bone tumours - see Ewing's tu
T1 - T12	Thoracic vertebrae 1-12 (spine eg. T10 = tenth thoracic vertibra)

More Cancer Related Abbreviations

Roots, suffixes, and prefixes

Rhabdomyosarcoma
 

Rhabdomyosarcoma is a malignant tumour of striated muscle found in children and young adults. Rhabdomyosarcoma accounts for about two thirds of childhood soft tissue sarcomas. There are 3 broad histological sub-types:

1. Embryonal rhabdomyosarcoma occurs maily in infants and young children, usually arising in the head, neck or genitourinary system (especially the testis, prostate, vagina, and bladder).
2. Alveolar rhabdomyosarcoma is most common in adolescents and young adults, mostly found in peripheral muscles.
3. Pleomorphic rhabdomyosarcoma is most common in adults, usually found in the muscles of the extremities in adults.

Internet Resources for Rhabdomyosarcoma

Other types of Soft Tissue Sarcoma
 

Other types of cancer affecting muscles and soft tissues in children include:
fibrosarcoma (begins in fibrous tissue in the arms and legs)
neurofibrosarcoma (begins in nerves near the surface of arms, legs, and trunk)
leiomyosarcoma (muscles in the trunk)
liposarcoma (begins in fat in the arms and legs)
synovial sarcoma (begins in linings of joint cavities and tendon sheaths)
hemangiopericytoma (begins in blood vessels in the arms, legs, trunk, head,and neck).
alveolar soft part sarcoma (begins in nerves of the muscles in the arms and legs)
malignant fibrous histiocytoma (begins in fibrous tissue).

Internet Resources for Soft Tissue Sarcoma

Potential Side Effects of Radiotherapy on Muscles
 

Muscles can be damaged by radiotherapy which can cause fibrosis, muscle shortening and atrophy. Any potential side effects will depend on the site of the tumor, the patients age, and the dose of radiotherapy. For example high dose radiotherapy in may result in footdrop which is a condition where the anterior muscles of the leg are paralyzed. Second malignancies particularly fibrosarcomas can also develop in previously irradiated sites.

Related Abbreviations and Acronyms:

 

ARMS	Alveolar rhabdomyosarcoma
IM	Intramuscular - into a muscle
MPNST	Malignant Peripheral Nerve Sheath Tumour
NRSTS	Non-Rhabdomyosarcoma Soft Tissue Sarcoma
RMS	Rhabdomyosarcoma

More Cancer Related Abbreviations

Roots, suffixes, and prefixes

Overview of Haematological Malignancies
 

The most common haematological malignancy is leukaemia - cancer of the white blood cells. There are many types of leukaemia; Acute types progress rapidly, while Chronic types develop more slowly. Leukaemia is often accompanied by anaemia because the red oxygen carrying cells in the blood are crowded out by the cancerous white cells. There are a number of malignancies and disorders affecting other types of blood cells.

Internet Resources for Leukaemia

Acute Lymphoblastic Leukaemia (ALL)
 

Acute lymphoblastic leukaemia (also known as acute lymphocytic leukaemia or ALL) is a disease where too many immature lymphocytes (a type of white blood cell) are found in the blood and bone marrow. Symptoms can include persistent fever, weakness or tiredness, achiness in the bones or joints, or swollen lymph nodes. Adult ALL and its treatment is usually different to childhood ALL. Almost a third of adult patients have a specific chromosome translocation; "Philadelphia Positive" ALL.

Internet Resources for Acute Lymphocytic Leukaemia

Acute Myeloid Leukaemia (AML)
 

Acute myeloid leukemia (AML) is a disease in which too many immature granulocytes (a type of white blood cell) are found in the blood and bone marrow. There are a number of subtypes of AML including acute myeloblastic leukemia, acute promyelocytic leukemia, acute monocytic leukemia, acute myelomonocytic leukemia, erythroleukemia, and acute megakaryoblastic leukemia.

Internet Resources for Acute Myeloid Leukaemia

Other Types of Leukaemia
 

Chronic Lymphocytic Leukaemia
Chronic Myelogenous Leukaemia
Hairy Cell Leukaemia

Internet Resources for Leukaemia

Childhood Leukaemia
 

Childhood leukaemias tend to have different characteristics and treatments compared to adult leukaemias. There is a "childhood peak" of Acute Lymphoblastic Leukaemia, there is a lower proportion of Acute Myeloid Leukaemias compared to adult patients. Clinical prognostic factors include age, White Blood Cell count (WBC) at presentation, and Central Nervous System (CNS) involvement. Infants less than 1 year and adolescents over 10 years of age, WBC greater than 50,000, or CNS involvement are associated with a less favourable prognosis.

Internet Resources for Childhood Leukaemia

Other Haematological Malignancies
 

- Myelodysplastic Syndromes

Myelodysplastic syndromes, sometimes called "pre-leukaemia" are a group of diseases in which the bone marrow does not produce enough normal blood cells. Common symptoms are anaemia, bleeding, easy bruisability, and fatigue. These Myelodysplastic syndromes can occur in all age groups but are more common in people aged over 60. Myelodysplastic syndromes may develop spontaneously or be secondary to treatment with chemotherapy / radiotherapy. There is an association with Myelodysplastic syndromes and acute myeloid leukaemia.

- Myeloproliferative Disorders

Myeloproliferative disorders are diseases in which too many blood cells are made by the bone marrow, there are 4 main types of myeloproliferative disorders: chronic myelogenous leukaemia, polycythemia vera, agnogenic myeloid metaplasia, and essential thrombocythemia. Chronic myelogenous leukaemia is where an excess of granulocytes (immature white blood cells) are found in the blood and bone marrow. Polycythemia vera is where red blood cells become too numerous often resulting in a swelling of the spleen. Agnogenic myeloid metaplasia is a condition in which certain blood cells do not mature properly, this may result in a swelling of the spleen and anaemia. Essential thrombocythemia is a disease in which the body produces excessive numbers of platelets (cells in the blood that make it clot) which impedes the normal circulation of blood.

- Aplastic Anaemia

Anaplastic Anemia is not a cancer. AA is a rare disease in which the bone marrow is unable to produce adequate blood cells; leading to pancytopenia (deficiency of all types of blood cells). AA may occur at any age, but there is a peak in adolescence / early adulthood, and again in old age. Slightly more males than females are diagnosed with AA, also the disease is more common in the Far East. Patients successfully treated for aplastic anemia have a higher risk of developing other diseases later in life, including cancer.

- Fanconi Anaemia

Fanconi Anaemia is not a cancer, it is a rare disorder found in children that involves the blood and bone marrow. The symptoms include severe aplastic anemia, hypoplasia of the bone marrow, and patchy discoloration of the skin. Recent research has shown an association between Fanconi anaemia and leukaemia.

- Waldenstrom's Macroglobulinemia

This is a rare malignant condition, involving an excess of beta-lymphocytes (a type of cell in the immune system) which secrete immunoglobulins (a type of antibody). WM usually occurs in people over sixty, but has been detected in younger adults.

Internet Resources for Haematological Malignancies

French-American-British (FAB) Classification Scheme
 

Leukaemia can be classified using the French-American-British (FAB) criteria. for cell morphology:

L1 - ALL: small lymphoid cells, regular nuclei
L2 - ALL: large lymphoid cells, irregualr nuclei
L3 - ALL: large homogeneous cells with prominent nucleolus
M1 - Myeloblastic leukemia without maturation
M2 - Myeloblastic leukemia with maturation
M3 - Promyelocytic leukemia
M4 - Myelomonocytic leukemia
M5 - Monocytic leukemia
M6 - Erythroleukemia
M7 - Megakaryoblastic leukemia
M0 - AML with minimal differentiation

CNS Prophylaxis
 

Leukemia can sometimes spread to the spinal cord and brain (Central Nervous System). Intrathecal chemotherapy (injection into the fluid around the spine) may be given to combat or prevent CNS relapse.

Blood Counts
 

Blood counts are done to test the number of each of the different kinds of cells in the blood. This may be an aid to diagnosis or done to monitor toxicity after each course of chemotherapy. The next course of chemotherapy may be delayed until white cells, neutrophils, and platelets have recovered to a safe level.

Cardiotoxicity
 

Cardiotoxicity (damage to the heart) is associated with certain anti cancer drugs, especially Adriamycin. As such the total dose of these drugs may be limited to reduce the risk of cardiotoxicity.

Echocardiagram
 

An Echocardiogramis where an image of the heart is formed when high frequency sound waves are reflected from the muscles of the heart. An echocardiogram may be done before treatment starts to establish a baseline from which to compare future tests.

Metastases through the cardivascular system
 

The network of blood vessels reach all parts of the body and may provide one of the routes for cancer cells to spread to secondary sites.

Related Abbreviations and Acronyms:

AA	Anaplastic Anaemia
ALL	Acute lymphoblastic leukaemia
AML	Acute Myeloid leukaemia
ANC	Absolute neutrophil count
ANLL	Acute non-lymphatic leukaemia
ASH	American Society for Hematology
B-ALL	B-cell Acute Lymphoblastic Leukaemia
BP	Blood pressure
CALGB	Cancer and Leukemia Group B (USA)
cALL	Common ALL
CGL	Chronic Granulocytic Leukaemia
CHF	Congestive heart failure
CLL	Chronic lymphocytic Leukaemia
CML	Chronic myeloid leukaemia
CMML	chronic myelomonocytic leukemia
CPR	Cardio pulmonary resuscitation
CVA	Cardiovascular Accident (stroke)
CVC	Central venous catheters
ECG	Electrocardiogram - heart scan
FAB	French American and British classification scheme for leukaemia
FBC	Full Blood Count
G-CSF	Granulocyte colony stimulating factor promotes production of white blood cells
GM-CSF	Granulocyte and macrophage colony stimulating factor
Hb	Haemoglobin
HCL	Hairy Cell Leukaemia
HD	Hodgkin's Disease (lymphoma)
HTLV	Human T-cell leukemia-lymphoma virus
IV	Intravenous - into a vein
LRF	Leukaemia Research Fund (UK)
LVEF	Left Ventricular Fjection Fraction - a heart function test
LVSF	Left Ventricular Shortening Fraction - a heart function test
MM	Multiple Myeloma
RBC	Red blood cell / red blood count
WBC	White blood cell count
WCC	White cell count

More Cancer Related Abbreviations

Roots, suffixes, and prefixes

Colorectal (Bowel) Cancer
 

Colorectal cancer (or bowel cancer) is one of the most common types of cancer in both men and women. Approximately four fifths of these cancers are found in the colon (large intestine), and one fifth in the rectum. Prevention and early detection of colorectal cancer is important. Some of most common symptoms include a change in bowel habit (eg. constipation, and bleeding), mucus discharge, and discomfort or pain in the lower abdomen. The vast majority of colon and rectum cancers are adenocarcinomas, around 10% of these are mucinous (protein contained in mucus). The median age at diagnosis is 70, age adjusted incidence rates are slightly higher in males compared to females. A substantial proportion of cases are in those with a genetic predisposition to colorectal cancer. Diet may also have an influence on the incidence of colorectal cancer, diatry fibre, retinoids, and calcium are thought to be protective, while high intake of animal fats may increases risk. Colorectal cancer may develop from benign polyps (a polyp is a tumour on a stem most commonly found on mucous membranes). World-wide about 782,000 people are diagnosed with colorectal cancer each year.

Internet Resources for Bowel cancer

Polyps
 

A benign growth protruding from a mucous membrane, commonly found in the nose, uterus, and rectum. Certain polyps, particularly those found in the colon, can become cancerous and may require surgical removal.

Screening for Colorectal Cancer
 

Prevention and early detection of colorectal cancer is important, many patients do not show symptoms until the disease has reached an advanced stage; screening may help detect changes before they become cancerous, or catch the cancer at an early stage. Screening may by targeted at populations thought to have a higher risk of developing colorectal cancer (for example those over age 50, particularly those with a 1st degree relative dignosed with colorectal cancer, or familial predispostion to adenomatous polyposis).

Anal Cancer
 

Anal cancer is an uncommon cancer, in which malignant cells are found in the anus (the opening at the end of the rectum through which the body passes waste). Cancer in the outer anus is more frequent in men, whilst cancer in the inner part of the rectum (the anal canal) is more frequent in women.

Internet Resources for Anal cancer

Gastric Cancer
 

Gastric cancer (cancer of the stomach) is a disease in which malignant cells arise in the tissues of the stomach. Early symptoms can include indigestion, feeling bloated after eating, mild nausea, loss of appetite, or heartburn. In more advanced stages symptoms may include blood in the stool, vomiting, weight loss, or pain in the stomach. Known risk factors include prior stomach infection by Helicobacter pylori, smoking, frequent diet of dry salted foods, Menetrier's disease, and familial polyposis. Most cancers of the stomach are adenocarcinomas of which there are many sub-types.

Internet Resources for Gastrointestinal Cancers

Esophageal Cancer
 

Internet Resources for Esophageal Cancer

Small Intestine Cancer
 

Internet Resources for Small Intestine Ca.

Adult Liver Cancer
 

Primary liver cancer is a disease in which the cells of liver become cancerous (malignant). Primary liver cancer is different from cancer that has spread from another place in the body to the liver. The liver is found in the upper right side of the abdomen. It is an an important organ which is involved in digesting food and converting it to energy and it also filters and stores blood. Liver cancer is relatively rare, known risk factors for liver cancer are prior hepatitis B or C infections or cirrhosis of the liver. There are two main types of liver cancer in adults: hepatocellular carcinoma and cholangiocarcinoma. Hepatoblastoma is another type of liver cancer which mostly occurs in children. Some types of liver cancer produce abnormaly high levels of alpha-fetoprotein (AFP) which can aid diagnosis.

Internet Resources for Liver Cancer

Childhood Liver Cancer
 

Childhood liver tumours are rare. There are two main types of liver cancer; hepatoblastoma and hepatocellular carcinoma. Liver cancer can be found in children of all ages; Hepatoblastomas are more common in patients aged under 3 years, while hepatocellular carcinomas are usually found in patients aged under 4 or between the ages of 12 and 15.

Extra-Hepatic Bile Duct Cancer
 

Internet Resources for Extra-Hepatic Bile Duct Ca.

Gall Bladder Cancer
 

Internet Resources for Gall Bladder Cancer

Kidney Cancer
 

Renal cell cancer (kidney cancer) is a disease in which malignant cells arise from tissues of the kidney. This is one of the less common types of cancer and it occurs more frequently in men compared to women. The vast majority of renal cell cancers are histologically classed as adenocarcinomas, these may be subdivided into clear cell and granular cell types (in some cases the 2 types can occur together in the same tumour). There are other less common types of non-adenocarcinoma kidney cancers including transitional cell carcinoma of the renal pelvis. Wilms' tumour is another type of kidney cancer, which is almost exclusively found in children.

Internet Resources for Kidney Cancer

Wilms' Tumour
 

Wilms' tumour is a cancer of the kidney which is very different to adult kidney cancer. Most patients are under 5 years of age at diagnosis, though Wilms' tumour is sometimes seen in older children and occasionally in young adults. In most cases only one kidney has disease (unilateral-Wilms' Tumour); but in some cases both kidneys are affected (bilateral-Wilms' tumour). A small minority of cases are known to be hereditary. Other less common kidney cancers in children include malignant rhabdoid tumours and clear cell sarcoma. Treatment for these is usually similar to that for Wilms' tumour.

Internet Resources for Wilms' Tumour

Nephrotoxicity following Chemotherapy
 

Some anti cancer drugs may have the side effect of damaging the kidneys, for example ifosfamide is known to be nephrotoxic. There are two categories; glomerular and tubular toxicity relating to the two main areas of the nephron. In studies of ifosfamide the degree of nephrotoxicity is thought to be related to the cumulative dose, but there is a good deal of variability between patients.

Bladder Cancer
 

Bladder cancer is a disease in which malignant cells arise in the bladder. Symptoms can include blood in the urine, pain during urination, increased frequency of passing urine, or feeling the need to urinate but with nothing coming out. The bulk of bladder cancers are histlogically classed as transitional cell carcinomas which arise in the uroepithelium (lining of the bladder). Other types include squamous cell carcinomas, and adenocarcinomas. Treatment will depend on how far the tumour has invaded the surrounding tissues, and if it has spread to other parts of the body. World-wide about 260,000 people are diagnosed with bladder cancer each year.

Internet Resources for Bladder Ca.

Urethral Ca
 

Internet Resources for Urethral Cancer

Transitional Cell Cancer
 

Internet Resources for Transitional Cell Cancer (bladder)

Related Abbreviations and Acronyms:

CRC	Colorectal carcinoma
CRF	Chronic renal failure
EDTA	ethylendiaminetetraacetic acid - used in measuring kidney function
EMUO	Early Morning Urine Osmolality (evaluating urine concentration)
GFR	Gromerular filtration rate
GI	Gastrointestinal
HCC	Hepatocellular Carcinoma
IVP	Intravenous Pyelogram - type of Xray after injection with iodine dye
NKCA	National Kidney Cancer Association (USA)
PUD	Peri-Urethral Diathermy (associated with superficial bladder cancer)
SGOT	Serum glutamic oxalacetic transaminase - a liver function test
SGPT	Serum glutamic pyruvic transaminase - a liver function test
TCC	Transitional Cell Carcinoma (usually bladder cancer)
U&Es	Urea and Electrolites
UA	Urine analysis
UTI	Urinary Tract Infection

More Cancer Related Abbreviations

Overview of Endocrine System Cancers
 

Tumours can arise in the endocrine system, e.g. pituitary tumours, thyroid cancers and neuroendocrine tumours of the pancreas. As a consequence of the position of these tumours, they may cause destruction of the normal gland and subsequent hormonal deficiency. Occasionally these tumours can also lead to an overproduction or secretion of hormone e.g. some pituitary tumours may lead to precocious puberty. The adrenal medulla is a common site for the development of neuroblastoma.Neuroblastoma may be associated with hypertension as a result of the oversecretion of catecholamines.

Internet Resources for Endocrine Cancers

Adrenocortical Cancer
 

Internet Resources for Adrenocortical Ca.

Pancreas Cancer
 

Pancreatic cancer is a disease in which the cells of the pancreas become malignant. The pancreas has two main functions; (i) it makes juices that help digest food and (ii) produces hormones (including insulin) that conrol how food is used and stored in the body. The vast majority of pancreatic cancers are associated with the part of the pancreas that makes digestive juices - these are known as "exocrine" pancreatic cancers. Only about 1/20 pancreatic cancers start in the hormone producing part of the pancreas ; these are known as "endocrine" pancreatic cancer or "islet cell cancer". There are several types of exocrine pancreatic cancers (based on how the cells appear under the microsope), most are classed as "ductal adenocarcinomas". Pancreatic cancer is rare before the age of 40 years, incidence increases sharply with increasing age.

Internet Resources for Pancreas Cancer

Pituitary Cancer
 

Internet Resources for Pituitary Cancer

Thyroid Cancer
 

Cancer of the thyroid is a disease in which malignant (cancerous) cells are found in the tissues of the thyroid gland. The thyroid gland is located at the base of the throat and produces hormones that help the body function normally. Most patients are between 25 and 65 years old, thyroid cancer is more common in women than in men. It is the most common malignancy of the endocrine (hormone) system. There are four main types of thyroid cancer (depending on the type of cell that the cancer developed in); papillary carcinoma, follicular carcinoma, medullary carcinoma and anaplastic carcinoma. Occasionally other type of cancer (lymphoma, sarcoma and carcinosarcoma) can be found in the thyroid gland. Some thyroid cancers are caused by exposure to radiation and some medullary carcinomas are associated with an inherited condition (multiple endocrine neoplasia). However, in the large majority of cases the cause is unknown.

Internet Resources for Thyroid Cancer

Parathyroid Cancer
 

The parathyroid gland is located at the base of the neck near the thyroid gland. It produces a hormone called parathyroid hormone (PTH), which controls how the body stores and uses calcium. Parathyroid cancer is a condition where the cells of the parathyroid gland become malignant (cancerous). Parathyroid cancers are rare; while problems with the parathyroid gland are common, these are not usually cancer related.

Internet Resources for Parathyroid Cancer

Thymus cancer
 

Internet Resources for Thymus Cancer

Potential Endocrine Side Effects of Treatment for Childhood Cancers
 

Chemotherapy can sometimes affect future fertility, and in children it can have the potential to affect growth in a few cases. In such cases the patient may receive hormone therapy, for example testosterone to stimulate growth for patients with hypogonadism (under developed genitals). Cranial irradiation, particularly in the treatment of brain tumours, frequently causes endocrine abnormalities. The pituitary is particularly sensitive and growth hormone deficiency with short stature can arise. Both delayed and early puberty can also occur and therefore close endocrine monitoring is required. Early intervention with hormone replacement therapy can minimise the side effects.

Radiation therapy given to children may lead to reduced growth in the bones and muscles in the affected area, for example when the patient reaches adulthood one limb might be slightly shorter than the other.

OncoLink manuscript: Effects of Therapeutic Irradiation on Skeletal Growth in Children

 

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Rickets
 

-vitamin D deficiency in childhood where the body does not absorb calcium and the bones may soften and bend.

Related Abbreviations and Acronyms:

 

DI	Diabetes Incipidus
FMTC	Familial Medullary Thyroid Carcinoma
HCG	Human Chorionic Gonadotrophin (hormone)
I-131	Radioactive Iodine
MEN	Multiple Endocrine Neoplasia - (familial) a.k.a. FMEN

More Cancer Related Abbreviations

Components of Medical Words

 

neuro- means nerve

blast- relates to immature cells

-oma means tumour.

Therefore by breaking down a complex word we can see that neuroblastoma literally means a tumour made up of immature nerve cells.

To take another type of tumour: osteogenic sarcoma

 

 

osteo- means bone

-genic means creating / causing

Thus we can see that this is a bone forming tumour.

All medical terms have a root word. They may also have a prefix, a suffix, or both a prefix and a suffix.

Root Words

Suffixes

Prefixes

A

B

C

D

E

F

G

H

I

J

K

L

Leukaemia

Acute Lyphoblastic Leukaemia

Acute Myeloid Leukaemia

Other Types of leukaemia

M

N

O

P

Q

R

S

T

U

V

W