What Are The Types Of Carcinomas

Introduction

The breast, lung, prostate, and gastrointestinal tract like the colon, rectum, pancreas, stomach, and oesophagus, are some of the common places where adenocarcinoma develops. Additionally, adenocarcinomas account for 70% of cancers with no known cause. 

Definition of carcinoma¹

Carcinoma is a type of cancer that develops from epithelial cells, which are the cells that line the organs and tissues of the body. It is the most common type of cancer and can occur in various parts of the body, including the skin, lungs, breasts, colon, and prostate, among others. 

Carcinoma is a cancer

Carcinoma is a term used to describe a type of cancer. Cancer is a condition where cells in the body start to grow in an abnormal and uncontrolled way. These cells can form a mass or tumour, which can invade nearby tissues and spread to other parts of the body. 

Importance of understanding the types of carcinomas

It helps you to guide treatment decisions, manage expectations for treatment outcomes, empower active participation in healthcare decisions, and support research. By understanding the types of carcinomas, you can make informed treatment decisions, comprehend prognosis, actively engage in their healthcare, and contribute to raising awareness and supporting advancements in carcinoma treatment. 

Types of carcinomas

Adenocarcinoma²

Definition

Adenocarcinoma is a tumour that arises from the cells of glands and glandular structure in your body. 

Common sites

The breast, lung, prostate, and gastrointestinal tract like the colon, rectum, pancreas, stomach, and oesophagus, are some of the common places where adenocarcinoma develops. Additionally, adenocarcinomas account for 70% of cancers with no known cause. 

Risk factors

Cancer development has been associated with a variety of environmental and lifestyle risk factors. There are several carcinogens and risk factors in various locations. Tobacco use appears to be a significant factor in the majority of them.

Symptoms

Breast cancer - symptoms include sudden onset pain following trauma, nipple discharge, new persistent skin changes, and a palpable breast mass that may be discovered incidentally or during a normal physical examination. 

Prostate cancer- symptoms like frequent need to urinate, blood in urine, difficulty in urination, incomplete bladder emptying and chronic back pain.  

Colorectal (colon) cancer- Unintentional weight loss, tiredness, generalised weakness, stomach pain, and intestinal blockage 

Lung cancer- persistent cough, shortness of breath, chest pain, coughing up blood, fatigue, weight loss, loss of appetite, hoarseness, recurring infections and wheezing. 

Pancreatic cancer- symptoms like nausea, vomiting, heartburn, jaundice, and feeling bloated. 

Treatment options 

Adenocarcinomas occur in different body locations and require personalised treatment. Surgery removes the tumour and surrounding tissue. Chemotherapy targets cancer cells locally or systemically. Radiation therapy, combined with other treatments, targets adenocarcinoma while sparing healthy tissues.  

Squamous cell carcinoma³

Definition

Squamous cell carcinoma (SCC) is a type of skin cancer that starts in the thin, flat cells on the surface of the skin.

Common sites 

SCC commonly occurs on sun-exposed areas of the body, such as the face, ears, lips, scalp, neck, hands, and arms. 

Risk factors 

Risk factors for SCC include prolonged UV exposure to ultraviolet radiation from the sun or tanning bed, fair skin, light-coloured eyes and hair, older age, history of precancerous lesions, weakened immune system, and exposure to certain chemicals. 

Symptoms 

Symptoms of skin cancer can include a firm, red nodule or flat lesion that may be scaly or crusty, a persistent non-healing sore or ulcer, rough, scaly patches or bleeding warts, changes in the size, shape, or colour of existing skin lesions, and itching, tenderness, or pain in the affected area. 

Treatment options 

Treatment options for SCC include surgical excision to remove the tumour with healthy tissue, Mohs surgery for layer-by-layer removal and examination, radiation therapy for difficult-to-treat tumours, topical medications for early-stage SCC, cryotherapy to freeze and remove the tumour, photodynamic therapy using light-sensitive medication, and targeted therapy or immunotherapy for advanced or metastatic SCC. 

Transitional cell carcinoma⁴

Definition 

Transitional cell carcinoma (TCC), also known as urothelial carcinoma, is a type of cancer that typically develops in the urothelial cells lining the urinary tract. The urinary tract includes organs such as the bladder, ureters (tubes connecting the kidneys to the bladder), urethra (a tube through which urine is expelled from the body), and renal pelvis (part of the kidney where urine collects). 

Common sites 

TCC commonly affects the bladder, where it originates in the urothelial cells lining the bladder wall. However, it can also occur in the ureters, renal pelvis, and urethra. In some cases, TCC may involve multiple sites within the urinary tract. 

Risk factors

Risk factors include smoking, occupational exposure to chemicals, older age (particularly in men), chronic bladder inflammation, and prior radiation or chemotherapy. 

Symptoms 

Blood in the urine (haematuria), Frequent urination, pain or burning during urination, Urgency to urinate, Lower back or abdominal pain, Pelvic pain 

Treatment options 

TCC treatment options include surgery (tumour or bladder removal), intravesical therapy (bladder medication), radiation therapy, chemotherapy, and immunotherapy. 

Basal cell carcinoma⁵

Basal cell carcinoma (BCC) is a type of skin cancer that arises from the basal cells, which are found in the lower part of the epidermis, the outermost layer of the skin. BCC is the most common type of skin cancer, and it usually develops in areas exposed to the sun or ultraviolet (UV) radiation. 

Common sites 

Basal cell carcinoma most commonly occurs on sun-exposed areas of the body, including the face (especially the nose and around the eyes), ears, scalp, neck, shoulders, and back. However, it can also develop in other areas that receive less sun exposure. 

Risk factors 

Risk factors for basal cell carcinoma (BCC) include long-term and repeated sun exposure, especially with intense exposure or sunburns, fair skin, older age, family history of BCC or other skin cancers, previous radiation exposure, and weakened immune system. 

Symptoms 

Common signs of basal cell carcinoma (BCC) include small pearly or waxy bumps, flesh-coloured or pinkish patches, non-healing or repeatedly crusting and bleeding sores, shiny or translucent bumps or nodules, smooth and shiny scar-like areas, and pink or red patches of irritated skin. 

Treatment options 

Treatment options for basal cell carcinoma (BCC) include surgical excision, Mohs surgery, curettage and electrodesiccation, cryotherapy, radiation therapy, and topical medications. 

Small cell carcinoma⁶

Definition

Small cell carcinoma (SCLC) is a type of fast-growing cancer that typically arises in the lungs, although it can also occur in other areas of the body. 

Common sites 

The most common site for small cell carcinoma is the lungs, where it is often referred to as small cell lung cancer.  

Risk factors 

Primary risk factors for small cell lung cancer (SCLC) include smoking, especially with long duration and high intensity. Occupational exposure to carcinogens like asbestos, arsenic, nickel, and radon also increases the risk. Having a family history of lung cancer or small cell carcinoma slightly raises the risk. SCLC is more prevalent in older individuals and males. 

Symptoms 

• Coughing, often accompanied by blood-tinged sputum
• Shortness of breath and wheezing
• Chest pain or discomfort
• Trouble swallowing
• Fatigue and unexplained weight loss
• Loss of appetite

Treatment options 

Treatment for small cell carcinoma (SCC) includes chemotherapy to kill cancer cells, radiation therapy to target chest area cancer cells and surgery for limited-stage SCC. Prophylactic cranial irradiation (PCI) reduces brain spread risk. Immunotherapy shows promise for advanced SCC. 

Large cell carcinoma⁷

Definition 

Large cell carcinoma, also known as large cell lung cancer, is a type of non-small cell lung cancer (NSCLC) that accounts for a small percentage of lung cancer cases.  

Common sites  

Large cell carcinoma primarily develops in the lungs, although it can grow anywhere in the lungs, it is most frequently detected around the borders of the lung. 

Risk factors 

Smoking is a primary risk factor. Prolonged exposure to carcinogens like asbestos, radon, second-hand smoke and occupational chemical risk. Family history of lung cancer.

Symptoms

Symptoms include a persistent cough that becomes worse with time, breathing difficulty, having a blood or mucus cough, a hoarse voice, difficulty swallowing, chest discomfort, wheezing, reduced appetite, loss of weight, persistent tiredness, recurring pneumonia or bronchitis episodes.  

Treatment options 

Lung surgery to remove tumour and affected lobe. Chemotherapy, radiation, immunotherapy, and targeted therapies fight cancer. 

Diagnosis of carcinomas⁸

Physical exam

The doctor will conduct a thorough physical examination, focusing on the area of concern and checking for any abnormal growths, lumps, or changes in the skin or tissues. 

Imaging tests 

Various imaging tests may be performed to visualise the internal structures and detect any suspicious areas. These tests can include X-rays, CT scans, MRI scans, ultrasound, or PET scans, depending on the specific needs of the patient. 

Biopsy 

A biopsy is a crucial step in the diagnosis of carcinomas. It involves the removal of a tissue sample from the suspected area for laboratory analysis. There are different types of biopsies, such as needle biopsy, core biopsy, or surgical biopsy, depending on the location and size of the tumour. The tissue sample is examined by a pathologist who analyses it under a microscope to determine if cancer cells are present and identifies the specific type of carcinoma. 

Treatment of Carcinomas⁸

The treatment of carcinomas typically involves a combination of different approaches tailored to the specific type, stage, and individual factors of the cancer. 

Surgery  

Surgical removal of the tumour and surrounding tissues is a common treatment for carcinomas. The necessity of surgery depends on the location and stage of the cancer. In some cases, minimally invasive techniques or robotic-assisted surgery may be used. 

Radiation therapy 

High-energy radiation is used to target and destroy cancer cells. It can be delivered externally or internally. Radiation therapy may be used as the primary treatment or in combination with other modalities like surgery or chemotherapy. 

Chemotherapy 

Chemotherapy involves the use of powerful medications that circulate throughout the body to kill cancer cells. It can be administered orally or intravenously. Chemotherapy is often used in advanced stages of carcinomas or in cases where the cancer has spread to other parts of the body (metastatic cancer). 

Targeted therapy 

Targeted therapy utilises drugs that specifically target certain molecules or pathways involved in the growth and spread of cancer cells. These treatments aim to disrupt specific abnormalities present in cancer cells while sparing normal cells. Targeted therapy may be used in cases where specific genetic or molecular alterations are identified in the carcinoma. 

Immunotherapy 

Immunotherapy functions by boosting the natural capabilities of the immune system to identify and combat cancer cells. It includes different strategies, such as immune checkpoint inhibitors, adoptive cell transfer, and cytokines, among others.

Immunotherapy has shown significant success in treating certain types of carcinomas, particularly those with specific biomarkers or immune-related characteristics. 

Prevention of Carcinomas⁹

• Lifestyle changes
• Avoid tobacco/smoking and limit second-hand smoke exposure
• Maintain a healthy diet with fruits, vegetables, whole grains, and lean proteins
• Be physically active and keep a check on your weight
• Limit alcohol consumption
• Protect skin from sun exposure
• Screening and early detection
• Follow recommended screening guidelines for different types of carcinomas
• Examples include mammograms, Pap tests/HPV testing, colonoscopy, CT scans, and skin examinations

Summary

Carcinomas are common cancers that develop from epithelial cells lining various organs and tissues. Subtypes like adenocarcinoma, squamous cell carcinoma, and large cell carcinoma have distinct features and treatments. Diagnosis involves physical exams, imaging, and biopsies. Treatments include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. Preventing carcinomas entails a healthy lifestyle, avoiding tobacco, a balanced diet, exercise, sun protection, and regular screenings for early detection.