Carcinoma

Carcinoma is the most common type of cancer. It begins in the epithelial tissue of the skin, or in the tissue that lines internal organs, such as the liver or kidneys. Carcinomas may spread to other parts of the body, or be confined to the primary location. The disease has various forms, including:

• Carcinoma in situ: This early-stage cancer is confined to the layer of tissue from which it started, and has not spread to surrounding tissue or other parts of the body.
• Invasive carcinoma: This is cancer that has spread beyond the primary tissue layer to surrounding tissue.
• Metastatic carcinoma: This is cancer that has spread throughout the body to other tissues and organs.

Types of carcinoma

Carcinomas may occur in many parts of the body. Some common types of carcinoma include:

Basal cell carcinoma is the most common type of skin cancer. Cancerous cells develop in the basal cell layer of the skin, or the lowest part of the epidermis. Basal cell cancers usually grow slowly, and they rarely spread, or metastasize, to nearby lymph nodes or more distant parts of the body.

Squamous cell carcinoma is the second most common type of skin cancer. Cancerous cells develop from the flat, squamous cells that are the primary cell type making up the outermost layer of the skin, the epidermis. Squamous cell cancers usually grow slowly, and it is uncommon for them to spread, or metastasize, but they are more likely than basal cell carcinomas to invade fatty tissue beneath the skin or to spread even further.

Renal cell carcinoma is the most common type of kidney cancer. The cancerous cells typically develop in the lining of very small tubes in the kidney, called tubules. Over time, these cells may grow into a mass and cause an obstruction. The cancer may form in one or both kidneys.

Ductal carcinoma in situ is the most common type of breast cancer. Cancerous cells are confined to the lining of the milk ducts, and haven’t spread through the duct walls into surrounding breast tissue.

Invasive ductal carcinoma occurs when cancerous cells grow in the duct lining, break through the wall of the duct and invade local breast tissue. From there, the cancer may spread, or metastasize, to other parts of the body

Carcinoma risk factors

While it’s impossible to know for sure who may develop cancer, certain factors may increase the risk. For example, people with a family history of cancer or an inherited genetic mutation may be at greater risk.

Across all types of carcinoma, risk increases with:

• Age
• Alcohol use
• Tobacco use
• Exposure to ultraviolet (UV) radiation from the sun or tanning beds
• Exposure to chemical or environmental irritants

These factors may also raise the risk of cancer:

• Obesity
• Diet
• Physical inactivity
• History of certain viral infections, such as human papillomavirus (HPV) 

Other risk factors are specific to cancer type:

Basal and squamous cell carcinoma risk factors. Exposure to UV rays is the main risk factor for both basal and squamous cell carcinoma. People with light-colored skin that easily burns or freckles are at greater risk than those who have darker skin, because they don’t have as much melanin, a skin pigmentation that serves as protection against the sun. Men are also more likely to get basal and squamous cell carcinoma. The risk increases with:

• Blue or green eyes
• Red or blond hair
• Exposure to radiation or arsenic
• History of long-term skin inflammation caused by burns or infections
• UV treatment for psoriasis
• Conditions such as xeroderma pigmentosum, Gorlin syndrome, a weakened immune system or a history of HPV infection

Renal cell carcinoma. According to the American Cancer Society (ACS), men are two times as likely to develop renal cell carcinoma as women, and Black people have a greater chance than white people do of developing it. The over-the-counter pain reliever acetaminophen may be linked to increased risk. Additionally, the following conditions increase the risk of developing this type of cancer:

• Advanced kidney disease
• Familial renal cancer
• Von Hippel-Lindau disease
• Cowden syndrome
• Birt-Hogg-Dube (BHD) syndrome
• Tuberous sclerosis
• Hereditary papillary renal cell carcinoma
• Hereditary leiomyoma-renal cell carcinoma

Ductal carcinoma in situ and invasive ductal carcinoma. These types of breast cancer are most common in women who:

• Are older than 50
• Have dense breast tissue
• Began menstruating early, notably before age 12
• Started menopause after age 55
• Have genetic mutations BRCA1 or BRCA2
• Have had prior radiation therapy
• Used the drug diethylstilbestrol (DES)
• Never carried a full-term pregnancy
• Become pregnant after age 30
• Did not breastfeed
• Take hormone replacement drugs and birth control pills that are linked to increased risk

Carcinoma causes

Common causes of cancer include:

• Alcohol use
• Tobacco use
• Physical inactivity
• Extra weight or obesity
• Diet high in sugar and processed foods or red meat
• Exposure to UV or other forms of radiation
• History of certain viruses and infections

The following causes are specific to cancer type:

Basal and squamous cell carcinoma. UV radiation from the sun or tanning beds is the most common cause of these types of skin cancer.

People who have had certain types of HPV may also be at increased risk.

These genetic changes and conditions may increase the likelihood of developing basal or squamous carcinoma:

• Altered TP53 tumor suppressor genes
• Mutations to the PTCH1 or PTCH2 genes
• The genetic condition xeroderma pigmentosum

Renal cell carcinoma. People with the following conditions are at increased risk of developing kidney cancer:

• Horseshoe kidneys (when kidneys are fused together at the bottom)
• Von Hippel-Lindau disease
• Adult polycystic kidney disease
• Kidney failure

Additionally, the genes PRC, TFE 3 and VHL may be linked to renal cell carcinoma, but more research is underway to assess these and other genetic links.

Ductal carcinoma in situ and invasive ductal carcinoma. Changes to the DNA of breast cells may cause them to become cancerous. These mutations are inherited (passed down from relatives) or acquired (occurring during a person’s lifetime). Acquired changes to proto-oncogenes and tumor suppressor genes are the most common cause of breast carcinoma.

The following inherited gene mutations may lead to breast cancer:

• BRCA1
• BRCA2
• PALB2
• ATM
• CHEK2

Carcinoma diagnosis

If a patient is experiencing symptoms, or the results of a screening test suggest cancer, the doctor will gather personal and family medical history and order more testing. A biopsy, or tissue sample, will likely be collected because it’s the only definitive way to diagnose cancer.

Basal and squamous cell carcinoma tests. The doctor may conduct a close visual examination of the patient’s skin called a dermoscopy, a test in which a dermatoscope (a magnifying lens and light) is used to inspect the appearance (size, shape, color and texture) of any suspicious areas on the skin and to see whether there’s bleeding, crusting or oozing.

Because basal and squamous cell carcinomas may spread to the lymph nodes, doctors may check them for lumps.

Magnetic resonance imaging (MRI) or computed tomography (CT) scans of the area may be necessary.

One or more of these skin biopsies may also be collected:

• Shave biopsy. The skin’s top layers are shaved with a surgical blade.
• Punch biopsy. A cookie-cutter-like tool is used to remove a small-but-deep skin sample so that all layers of the skin may be tested.
• Excisional and incisional biopsies. A portion of the tumor (incisional) or the full tumor (excisional) is removed using a surgical knife.
• Fine needle aspiration biopsy. Doctors may use a syringe to remove a small portion of a lymph node.
• Surgical lymph node biopsy. The entire lymph node may be surgically removed if cancer is suspected.

Renal cell carcinoma: If a patient is experiencing symptoms, or the doctor finds an abdominal mass during a physical examination, blood tests (complete blood count and blood chemistry) may be ordered to check on kidney function and other enzymes and cell counts.

Urine tests (urinalysis and urine cytology) to look for blood or cancer cells also may be performed. If a patient has renal cell cancer, there’s about a 50 percent chance blood will be present in the urine, according to the ACS.

Other testing includes:

• CT scans are used along with a contrast dye that makes the area stand out. A CT scan helps determine the size, shape and location of a tumor, as well as whether or not it has spread. A CT-guided needle biopsy may also be done at this time.
• MRI scans are conducted if the patient is allergic to the contrast dye used in CT scans or has poor kidney function. MRI scans also provide a clear picture of blood vessels, which is helpful in finding out whether cancer has spread there.
• Ultrasound images are helpful in locating a kidney mass, as well as determining whether the tumor is benign or malignant. A biopsy may also be taken using the ultrasound as a guide.
• Angiography is a type of X-ray that examines blood vessels using a contrast dye to help map out blood vessels that may be feeding a tumor. This test is usually done to help plan for surgery.
• Chest X-rays are done to check for abnormal areas and see whether cancer has spread to the lungs.
• Bone scans are done if bone pain is present or blood tests indicate an increased calcium level. Low-level radioactive material is injected into the bloodstream, and a bone scan is performed to determine whether cancer has spread to the bones.
• Kidney biopsy may be done if imaging alone does not provide enough information or diagnosis.

Ductal carcinoma in situ and invasive ductal carcinoma: Testing to diagnose these types of breast cancer are often performed by a breast specialist or surgeon.

Tests include:

• Breast ultrasound. Pictures of the breast, acquired using sound waves, provide information about areas of concern.
• Diagnostic mammogram. Any lumps or abnormal areas may be closely investigated using this tool, which provides a detailed X-ray of the breast.
• MRI. This test may be done to take detailed images of areas inside of the breast.
• Biopsy. A fluid or tissue sample may be taken for additional testing.

Carcinoma staging

The extent to which cancer has spread is called its stage. It’s important for doctors to determine the cancer stage in order to design the best course of treatment.

Cancer stage is determined during diagnosis and depends on the size, type and location of the cancer. Tumor grade is a term used to refer to the appearance and behavior of cancer cells (how likely they are to grow and spread).

TNM is the most common tumor staging system used to describe cancer. In general:

• T—Tumor represents the size and magnitude of the primary tumor and has the following subsets:
  • TX. The primary tumor is unmeasurable.
  • T0. A primary tumor isn’t detected.
  • T1, T2, T3, T4: These denote the size and progression of the primary tumor, increasing in progression with each number, and may be further broken down into subsets.
• N—Node represents the specific number of lymph nodes that also have cancer. and it has the following subsets:
  • NX. Presence of cancer in nearby lymph nodes is unmeasurable.
  • N0. Cancer isn’t detected in nearby lymph nodes.
  • N1, N2, N3. These denote the number and location where cancer-containing lymph nodes have been detected, increasing in progression with each number.
• M—Metastasis represents distant metastasis, or whether or not the cancer has spread to other areas, and it includes the following subsets:
  • MX. Rate of metastasis is unmeasurable.
  • M0. Cancer has not metastasized to other areas.
  • M1. Cancer has metastasized to other areas.

Doctors may simplify the above data using cancer stage grouping:

• Stage 0 refers to cancer in situ, or cancer that’s limited to the place it started.
• Stage 1 cancer hasn’t spread far into nearby tissues or other parts of the body.
• Stage 2 is used to designate larger tumors and those that have spread deeply into nearby tissues and lymph nodes.
• Stage 3 is similar to stage 2, but with increased severity.
• Stage 4 is an advanced stage of metastatic cancer in which the primary cancer has spread to distant organs and areas of the body.

Carcinoma treatment and therapy options

Treatment for carcinoma varies depending on the type, location and extent of the disease, but may include:

Surgery: Depending on the type of cancer, carcinoma may be treated with the surgical removal of cancerous tissue, as well as some surrounding tissue. Minimally invasive surgical treatment methods may help to reduce healing time and reduce the risk of infection after surgery.

Radiation therapy: Radiation therapy may be used in combination with surgery and/or chemotherapy. Advanced radiation therapies use image guidance before and during treatment on target tumors, and are designed to help spare healthy tissues and surrounding organs.

Chemotherapy: Chemotherapy treats carcinoma with drugs designed to destroy cancer cells, either throughout the whole body, or in a specific area. In some cases, chemotherapy may be used in combination with other treatments, such as radiation therapy or surgery.