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ancer is a major health problem in the United States
and many other parts of the world. It is estimated
that 1.66 million Americans were newly diagnosed with
cancer in 2013 and 580,350 died of the disease.
1
Cancer
affects all age groups, and is the second leading cause
of death among children ages 1 to 14 years.
1
As age-
adjusted cancer mortality rates increase and heart dis-
ease mortality decreases, it is predicted that cancer will
soon become the leading cause of death. The good news,
however, is that the survival rates have improved to the
extent that almost 64% of people who develop cancer
each year will be alive 5 years later.
Cancer is not a single disease. It can originate in
almost any organ, with skin cancers being the most com-
mon site in persons in the United States. Excluding skin
cancers, the prostate is the most common site in men and
the breast is the most common site in women (Fig. 7-1).
The ability of cancer to be cured varies considerably and
depends on the type of cancer and the extent of the disease
at the time of diagnosis. Cancers such as acute lympho-
blastic leukemia, Hodgkin disease, testicular cancer, and
osteosarcoma, which only a few decades ago had poor
prognoses, are cured in many cases today. However, lung
cancer, which is the leading cause of death in men and
women in the United States,
1
remains resistant to therapy.
This chapter is divided into five sections: characteris-
tics of benign and malignant neoplasms, etiology of can-
cer, clinical manifestations, diagnosis and treatment, and
childhood cancers and late effects on cancer survivors.
Hematologic malignancies (lymphomas and leukemias)
are presented in Chapter 11.
Characteristics of Benign
and Malignant Neoplasms
Cancer is a disorder of altered cell differentiation and
growth. The resulting process is called
neoplasia,
and
the new growth is called a
neoplasm
. Unlike the pro-
cesses of hypertrophy and hyperplasia that are discussed
in Chapter 2, the cell changes that occur with neoplasia
tend to be relatively uncoordinated and autonomous,
lacking normal regulatory controls over cell growth and
division.
Normal renewal and repair involves two components:
cell proliferation and differentiation (see Chapter 4).
Proliferation,
or the process of cell division, is an inherent
C
Neoplasia
7
C h a p t e r
Characteristics of Benign and Malignant Neoplasms
Terminology
Biology of Benign and Malignant Tumors
Benign Neoplasms
Malignant Neoplasms
Tumor Cell Characteristics
Tumor Growth
Invasion
Metastatic Spread
Etiology of Cancer
Genetic and Molecular Basis of Cancer
Cancer-Associated Genes
Epigenetic Mechanisms
Molecular and Cellular Pathways
Tumor Cell Transformation
Host and Environmental Factors
Heredity
Hormones
Obesity
Immunologic Mechanisms
Chemical Carcinogens
Radiation
Viral and Microbial Agents
Clinical Manifestations
Local and Regional Manifestations
Systemic Manifestations
Anemia
Anorexia and Cachexia
Fatigue and Sleep Disorders
Paraneoplastic Syndromes
Screening, Diagnosis, and Treatment
Screening
Diagnostic Methods
Tumor Markers
Cytologic, Histologic, and Gene-Profiling
Methods
Staging and Grading of Tumors
Cancer Treatment
Surgery
Radiation Therapy
Chemotherapy
Hormone and Antihormone Therapy
Biotherapy
Targeted Therapy
Childhood Cancers and Late Effects on Cancer
Survivors
Incidence and Types of Childhood Cancers
Biology of Childhood Cancers
Diagnosis and Treatment
Survivors of Childhood Cancers
