Carcinoma: What is Carcinoma? Definition, Pictures, Symptoms, Causes, Treatments

Carcinoma Definition

car·ci·no·ma

[kahr-suh-noh-muh]

noun, plural car·ci·no·mas, car·ci·no·ma·ta [kahr-suh-noh-muh-tuh]

Pathology. a malignant and invasive epithelial tumor that spreads by metastasis and often recurs after excision; cancer.

  — n  , pl -mas , -mata 1. any malignant tumour derived from epithelial tissue 2. another name for cancer   [C18: from Latin, from Greek karkinōma,  from karkinos cancer ]   carci'nomatoid   — adj   carci'nomatous   — adj

Carcinoma: What is Carcinoma

A carcinoma is any malignant cancer that arises from epithelial cells. Carcinomas invade surrounding tissues and organs and may metastasize, or spread, to lymph nodes and other sites.

''Carcinoma in situ'' (CIS) is a pre-malignant condition, in which some cytological signs of malignancy are present, but there is no histological evidence of invasion through the epithelial basement membrane.

Carcinoma, like all neoplasia, is classified by its histopathological appearance. Adenocarcinoma and squamous cell carcinoma, two common descriptive terms for tumors, reflect the fact that these cells may have glandular or squamous cell appearances respectively. Severely anaplastic tumors might be so undifferentiated that they do not have a distinct histological appearance (undifferentiated carcinoma).

Sometimes a tumor is referred to by the presumptive organ of the primary (eg carcinoma of the prostate) or the putative cell of origin (hepatocellular carcinoma, renal cell carcinoma).

Metastatic carcinoma can be diagnosed through biopsy, including fine-needle aspiration, core biopsy, or subtotal removal of single node.

What is the Difference Between Cancer and Carcinoma?

A carcinoma is a type of cancer, which alludes to the cell origin of the cancer. Carcinoma means that the cancer originated from an epithelial cell origin. There are other types, such as sarcomas, which come from the muscle cell origin, or melanoma, which is from melanocytes of the skin, or astrocytoma, which is a growth from a type of brain cell.

It is important for the cancer doctors to know this, because different types of cancer respond to treatments differently.

The most common type of cancer in humans is carcinoma. Carcinoma is a cancer that begins in tissue that lines the inner or outer surfaces of the body. Generally, carcinoma arises from cells originating in the endodermal or ectodermal germ layer during embryogenesis. Specifically, carcinoma is tumor tissue derived from putative epithelial cells whose genome has become altered or damaged, causing the cells to transform and show abnormal malignant properties.

Malignant tumors made up of transformed cells whose origin or developmental lineage is unknown but have specific molecular, cellular and histological characteristics typical of epithelial cells are also characterized as carcinoma.

Carcinoma in situ is the term for a small, localized carcinoma that has not invaded through the epithelial basement membrane restricting the carcinomatous cells from adjacent normal cells. This type of carcinoma is pre-invasive but not pre-malignant. Carcinoma in situ almost always continues to grow and progress until it infiltrates and penetrates into and through the basal membrane or other structures. Once the basal membrane or other structures are penetrated, these lesions are no longer considered carcinoma in situ, but invasive carcinomas. Cure rates for carcinoma in situ may be 100% if lesions can be removed using surgical resection, cryotherapy, laser ablation or other local treatment before metastasis.

Types of carcinomas include:

  • Adenocarcinoma (glandular).

  • Squamous cell carcinoma (carcinoma with observable features indicative of squamous differentiation).

  • Adenosquamous carcinoma (a mixed tumor with adenocarcinoma and squamous cell carcinoma).

  • Anaplastic carcinoma (a heterogeneous group of high-grade carcinomas featuring cells that lack distinct histological or cytological evidence of more specifically differentiated neoplasms).

  • Large-cell carcinoma (large, monotonous rounded or polygonal-shaped cells with abundant cytoplasm).

  • Small-cell carcinoma (round cells three times the diameter of a resting lymphocyte and little evident cytoplasm).

Organ sites frequently affected by carcinoma include:

  • Lung.

  • Breast.

  • Prostate.

  • Colon and rectum.

  • Pancreas.

Carcinoma is diagnosed using biopsy, such as fine-needle aspiration, core biopsy or subtotal removal of a single node. A pathologist then analyzes the sample under a microscope to identify molecular, cellular or tissue architectural characteristics of epithelial cells.

What Causes Carcinoma Cancer?

Carcinoma, cancer that begins in the skin or tissues that line or cover internal organs, can strike throughout the body. Basal cell carcinoma--the most common cancer in the world, according to The Skin Cancer Foundation--occurs most often on parts of the body routinely exposed to the sun like the face, ears, neck, scalp, shoulders and back. Causes of carcinoma vary depending on the affected body.

Ultraviolet Light

Ultraviolet light can cause skin cancer, or carcinoma, and wrinkling. Physicians recommend avoiding light from the sun and tanning beds, instead endorsing sunless self-tanning products and the use of broad-spectrum, water-resistant sunscreen with a sun protection factor, or SPF, of 30 or more on all exposed skin. Those who are exposed to ultraviolet light from the sun or tanning beds should carefully check over skin for growths or changes that may indicate a carcinoma.

Therapeutic Radiation

Therapeutic radiation in the form of X-rays and psoralen plus ultraviolet A, or PUVA, treatments may cause squamous cell carcinoma and melanoma, both skin cancers. Whether therapeutic radiation patients are more apt to develop carcinoma depends on various factors including skin pigmentation, the dose of radiation received and medical status. Carcinomas caused by this type of radiation may develop over decades and may stem from childhood treatments.

Immunosuppressant Drugs

A weakened immune system increases the risk of contracting carcinomas, making immunosuppressant drugs a factor in the cause of some skin cancers. According to MayoClinic.com, up to 80 percent of organ transplant patients taking medications to stop organ rejection develop squamous cell carcinoma sometime over the course of their lives. Heart transplant patients show the most risk due to the need to take higher dosages of organ rejection medications. Infection by the human papillomavirus, or HPV, may also cause carcinoma, both from the immunosuppressant drugs and the virus itself.

Carcinoma Cancers

Most cancers are carcinomas, which are malignant tumors that occur in the cells, called epithelial cells, that line the organs and body cavities, as well as the outer layer of skin. Carcinomas can also attack the organs and tissues that surround the originally affected areas and spread to the lymph nodes and other sites in the body.

Carcinoma Symptoms & Causes

Symptoms of carcinomas generally depend on the type of tumor and the location. But there are some common symptoms among all cancers that include fatigue, fever, chills, loss of appetite, weight loss and night sweats. The treatment is also dependent on the type of cancer and what stage it is in. Cancer’s “stage” means how much the tumor has developed and if it has spread beyond the initial location.

It is difficult to pinpoint causes of cancer. Cancer cells come from normal cells in the body and the cancer occurs when the cell growth is happening too quickly and cells split too quickly. There are many things that can cause this to happen.

Common Carcinomas

Breast cancer begins in the tissues of the breast, either in the ducts that move the milk to the nipple or in the lobules, or the part of the breast that produces milk. Unfortunately, in its early stages, breast cancer has no detectable symptoms. As it grows, however, symptoms include: a lump in the armpit; changes in shape and size of the breast, or the way it feels; and fluid from the nipples.

Treatments for breast cancer include low dose chemotherapy and insulin potentiation therapy (IPT), chemotherapy or radiation, removal of the cancerous tissue, and hormonal therapy.

Prostate cancer grows in the prostate gland. It is the most common type of cancer other than skin cancers. Because of regular testing, most prostate cancer is detected before the symptoms begin. Symptoms include pain with urination, difficulty urinating, pain with ejaculation, and lower back and abdominal pain.

The treatment given usually depends on what stage the carcinoma is in. Removal of the prostate gland itself is considered if the cancer is contained within the prostate and can be removed with very low risk of spread. Impotence and incontinence are the two primary potential side effects. Some other options are radiation and hormone therapy. Chemotherapy is used when the cancer has spread beyond the prostate.

Gastrointestinal cancer affects any of the parts of the digestive system like the esophagus, gallbladder, liver, pancreas, intestines, stomach, or colon. Symptoms and treatment are different, depending upon which part of the gastrointestinal tract is affected.

Lung cancer in its most common form is called small cell carcinoma. This type of cancer spreads very quickly. Its symptoms include chest pain, blood in the sputum, coughing, shortness of breath, and weight loss.

Since lung cancer does spread so rapidly, it is normally treated with chemotherapy combined with radiation. Surgery is rarely used, and when it is used, there is usually one small carcinoma involved that has not spread.

Skin cancer is the most common type of cancer with at least 1 million new cases each year. Basal cell carcinoma is the most common form of skin cancer and is referred to as a nonmelanoma skin cancer. It usually looks like a small bump on the skin that can be textured and translucent. These cancers almost never spread to other parts of the body and are normally treated by scooping out the carcinoma.

Melanoma is the most severe type of skin cancer, causing the most skin cancer-related deaths. The cancer occurs in melanin, the cells that produce skin pigment. It usually manifests in the form of a mole, sore, or other growth on the skin. A warning sign may also be altered appearance over time of a skin lesion. Melanoma can spread and is treated by surgically removing the cancerous skin tissue, followed by chemotherapy and/or radiation.

Squamous cell carcinoma (SCC) is an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin’s upper layers (the epidermis). SCCs often look like scaly red patches, open sores, elevated growths with a central depression, or warts; they may crust or bleed. SCC is mainly caused by cumulative UV exposure over the course of a lifetime. It can become disfiguring and sometimes deadly if allowed to grow. An estimated 700,000 cases of SCC are diagnosed each year in the US, resulting in approximately 2,500 deaths.

SCCs may occur on all areas of the body including the mucous membranes and genitals, but are most common in areas frequently exposed to the sun, such as the rim of the ear, lower lip, face, bald scalp, neck, hands, arms and legs. Often the skin in these areas reveals telltale signs of sun damage, such as wrinkling, changes in pigmentation, and loss of elasticity.

How Is Basal Cell Carcinoma Treated?

There are many ways to successfully treat a basal cell carcinoma. The doctor's main goal is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment for each patient, the doctor considers the location and size of the cancer, the risk of scarring, and the person's age, general health, and medical history.

Methods used to treat basal cell carcinomas include:

  • Curettage and desiccation: Dermatologists often prefer this method, which consists of scooping out the basal cell carcinoma by using a spoon like instrument called a curette. Desiccation is the additional application of an electric current to control bleeding and kill the remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in non-crucial areas such as the trunk and extremities.

  • Surgical excision: The tumor is cut out and stitched up.

  • Radiation therapy: Doctors occasionally use radiation treatments for skin cancer occurring in areas that are difficult to treat with surgery, particularly in elderly patients. Obtaining a good result generally involves many treatment sessions, perhaps 15 to 20.

  • Cryosurgery: Some doctors trained in this technique achieve good results by freezing basal cell carcinomas. Typically, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.

  • Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this technique of removing skin cancer is better termed, "microscopically controlled excision." The surgeon meticulously removes a small piece of the tumor and examines it under the microscope. This sequence of cutting and microscopic exam is repeated in a painstaking fashion so that the basal cell carcinoma can be mapped and taken out without having to estimate or guess the width and depth of the lesion. This method removes as little of the healthy normal tissue as possible. The cure rate is very high, exceeding 98%. Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment, or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. Such body parts include the scalp, ears, and the corners of the nose. In cases where large amounts of tissue need to be removed, the Mohs surgeon sometimes works with a plastic (reconstructive) surgeon to achieve the best possible post-surgical appearance. 

  • A new drug, vismodegib, has recently been approved by the FDA for locally recurrent or advanced basal cell carcinoma.

How Is Basal Cell Carcinoma Prevented?

Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer, including basal cell carcinoma. Regular surveillance of susceptible individuals, both by self-exams and regular physical exams, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.

Common sense preventive techniques include:

  • Limiting recreational sun exposure

  • Avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon)

  • Wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun

  • Regularly using a waterproof or water-resistant sunscreen with UVA and UVB protection and SPF number of 30 or higher

  • Undergoing regular checkups and bringing any suspicious-looking or changing lesions to the attention of the doctor

Invasive Ductal Carcinoma (IDC)

Invasive ductal carcinoma (IDC), also known as infiltrating ductal carcinoma, is cancer that began growing in the duct and has invaded the fatty tissue of the breast outside of the duct. IDC is the most common form of breast cancer, representing 80 percent of all breast cancer diagnoses.

What are the symptoms of invasive ductal carcinoma?

As with any breast cancer, there may be no signs or symptoms. A mammogram may reveal a suspicious mass, which will lead to further testing. A woman may also find a lump or mass during a breast self-exam. The following are possible signs of breast cancer and should immediately be reported to your physician for further evaluation:

  • Lump in the breast

  • Thickening of the breast skin

  • Rash or redness of the breast

  • Swelling in one breast

  • New pain in one breast

  • Dimpling around the nipple or on the breast skin

  • Nipple pain or the nipple turning inward

  • Nipple discharge

  • Lumps in the underarm area

  • Changes in the appearance of the nipple or breast that are different from the normal monthly changes a woman experiences

How is invasive ductal carcinoma diagnosed? 

Same Day Results

Doctors know how quickly patients want results from a biopsy or scan if there is a suspicion of breast cancer. Doctors follow strict guidelines for biopsies and pathology reports. Depending on the hospital, patients will receive the probability of cancer immediately following their biopsy procedure and a pathology confirmation within 24 hours.

Learn more about the steps of diagnosis, including:

  • Digital mammography

  • Ultrasound

  • MRI

  • Staging workup

  • Biopsy

  • Pathology

Digital Mammography

Advantages of Digital Mammograms

Mammography remains the gold standard for screening for early stage breast cancer. Many breast centers still use analog mammograms, meaning the images are printed on film. However, digital mammography is now available, allowing for the radiologist to capture and manipulate the images so abnormalities can be seen more easily.

For example, in women with dense fibrocystic breast tissue, their breasts appear white on a mammogram. Complicating this is that tumors are also white. But with digital mammograms, the radiologist can manipulate the contrast of the images, making them darker or lighter, allowing for the masses to be identified. The images can also be enlarged on the computer to focus on areas of concern.

Same Day Results

To reduce your anxiety and keep you informed, some radiologists read and discuss mammogram and ultrasound results while you’re still at the imaging center. This keeps you from having to return for more imaging studies if they know right away whether additional evaluation is needed.

Approximately five to 15 percent of women having a screening mammogram will be called back for additional imaging. You probably don’t need to worry if this happens. Most of the time, findings of additional imaging are benign.

Breast Ultrasound

With breast ultrasound, the breast tissue is viewed using sonography instead of X-ray. This allows your radiologist to differentiate between a solid mass (benign or malignant tumors) and a liquid mass (cyst).

Breast MRI

For most women, mammograms are the only screening technology they will ever need for monitoring their breast health. Women with suspicious masses or fibrous breast tissue can expect to have an ultrasound, and possibly a MRI.

Breast MRI is very sensitive and is useful for assessing invasive carcinomas. It is also used to assess high-risk patients who have more than a 20 percent chance of developing breast cancer in their lifetimes based on genetics (BRCA1 and BRCA2) and strong family history of breast cancer. Since it is such a sensitive technology, benign findings may be detected on MRI. This can cause the patient unnecessary anxiety.

If a MRI detects a suspicious lesion that isn’t recognizable and doesn’t correspond to anything visible on the mammogram, then a second-look ultrasound is recommended. If visible, the lesion may be biopsied under ultrasound guidance; if not, it may need to be biopsied under MRI guidance.

Breast Cancer Staging Workup

The breast cancer staging workup is the critical blueprint for your diagnosis and therefore directly affects your treatment plan. Doctors usually follow specific protocols for breast cancer staging. Staging is the combination of pieces of information that communicate to your treating physicians the size, growth and type of your tumor.

The majority of information for staging is obtained from pathology results of your lumpectomy or mastectomy, and in some cases biopsy. If there is concern that the cancer has spread beyond the breast and axillary lymph nodes, additional staging workup is needed to determine the true stage of the disease. In such cases, the concern is whether the cancer is actually Stage IV disease, meaning the cancer has spread to other organs in the body.

The following tests may be involved in a staging workup:

  • CT scan – CT scan (computerized tomography) uses X-rays that produce images of your body. The way the images are projected on screen gives your physicians more information than with a standard X-ray. This specific type of scan is used to examine the lungs and liver.

  • PET scan – Positron emission tomography (PET) scan is a non-invasive test that accurately images the cellular function of the human body. This allows your physicians to pinpoint the spread and growth of cancer. This test is not standard of care; some doctors use it and some do not. Its benefit for staging for breast cancer remains a gray area in medicine.

  • Bone scan – A bone scan is a nuclear scanning test that identifies new areas of bone growth or breakdown. Bone scans can find cancer that has spread (metastasized) to the bones.

  • Chest X-ray – A chest X-ray can help your physicians see how healthy your lungs are.

  • Blood Work – Blood work can be helpful for evaluating if cancer has spread. By monitoring different common measurements within the blood, your physicians can look for markers that predict cancer spread. Blood work is also done in preparation for surgery and periodically during chemotherapy.

  • MUGA – The Multiple Gated Acquisition scan (MUGA) is an extremely useful noninvasive tool for assessing the function of the heart. For women who may have specific chemotherapy drugs, this test is critical, as some chemotherapy drugs for breast cancer treatment can be toxic for your heart. The MUGA scan tells your physicians the health of your heart, so they can plan your chemotherapy accordingly.

It is important to note that there can be cancer cells in other organs that, due to their tiny size, are not yet visible on scans. Usually, cancer has to be at least one centimeter in diameter to be seen on scans.

Breast Biopsy

Diagnostic evaluation results are known same day. Biopsy, if needed, is also done same day with results being available 24-72 hours later.

Only 20 percent of breast lumps are cancerous, but that doesn’t make the experience of getting a breast biopsy any less overwhelming. However, doctors are uniquely sensitive to each woman’s needs during her biopsy. They provide initial opinion immediately after the biopsy and a pathology diagnosis usually within 24 hours.

Specializing in Minimally-Invasive Breast Biopsies

Every breast biopsy is precisely targeted to disrupt only the suspicious breast tissue, leaving the rest of the breast intact. In fact, 90 percent of breast biopsies can be obtained in a minimally-invasive manner without an incision or general anesthesia.

Your physician will recommend the most minimally-invasive procedure possible depending on the size and location of your mass. Having an expert opinion about the type and grade of cancer will affect your treatment from the very beginning.

Breast Pathology

Accurate and Fast Results

Ensuring the accuracy of your pathology results is of utmost importance. Knowing the exact type of breast cancer and the specifics of its prognostic factors is critical to creating a treatment plan that will provide you with the best opportunity for defeating this disease.

What is the treatment for invasive ductal carcinoma?

Treatment for all types of IDC is determined by the exact type of cancer and staging. Depending on the size and spread of the tumor(s), most women will undergo a combination of any of the following treatments:

  • Lumpectomy

  • Mastectomy

  • Sentinel node biopsy

  • Axillary node dissection

  • Breast reconstruction

  • Radiation

  • Chemotherapy

  • Hormonal therapy

  • Biologic targeted therapy

What is the prognosis for invasive ductal carcinoma?

Based on individual markers and prognostic factors, including the staging of your tumor, your physician will work to give you a prognosis.

Additional types of invasive ductal carcinoma

There are four types of invasive ductal carcinoma that are less common:

  • Medullary Ductal Carcinoma – This type of cancer is rare and only three to five percent of breast cancers are diagnosed as medullary ductal carcinoma. The tumor usually shows up on a mammogram and it does not always feel like a lump; rather it can feel like a spongy change of breast tissue.

  • Mucinous Ductal Carcinoma – This occurs when cancer cells within the breast produce mucous, which also contains breast cancer cells, and the cells and mucous combine to form a tumor. Pure mucinous ductal carcinoma carries a better prognosis than more common types of IDCs

  • Papillary Ductal Carcinoma – This cancer looks like tiny fingers under the microscope. It is only in rare cases that this kind of cancer becomes invasive. Common among women age 50 and older, this kind of cancer is treated like DCIS, despite being an invasive cancer.

  • Tubular Ductal Carcinoma – This is a rare diagnosis of IDC, making up only two percent of diagnoses of breast cancer. Tubular ductal carcinoma is more common in women older than 50 and are usually small, estrogen-receptor positive cancers, which means they respond to hormones. The name comes from how the cancer looks under the microscope; like hundreds of tiny tubes.

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