A Miracle and A Privilege: RECOUNTING A HALF CENTURY OF SURGICAL ADVANCE by Francis D. Moore M.D

Author:Francis D. Moore, M.D.
Language: eng
Format: epub
Tags: Explore Science
Publisher: NATIONAL ACADEMY PRESS
Published: 1995-05-03T00:00:00+00:00

Bad Actors: The Solid Tumors

The word tumor literally means “swelling” and is indicated by the Latin suffix -oma (as in carcinoma, sarcoma, lymphoma). If, under the microscope, that swelling consists of rapidly duplicating cells, it is called a “neoplasm,” meaning “new tissue growth.” Some (but not all) neoplasms are malignant, which means they tend to spread to other organs and, if left to their own devices, will kill their host (the patient). Thus, all cancers are tumors, but not all tumors are cancers. The word “cancer” is derived from the Greek and Latin terms for crab, because of the crablike growth of some of these cancers, noted even by the most ancient physicians, the more precise term being “carcinoma” (crab-tumor). The crab is the astronomical symbol for the Tropic of Cancer. In this chapter we are using the broad term “solid tumor” to include a large but special group of cancers.

The group of solid tumors includes most of the familiar cancers. They have several characteristics in common. For one thing, they start as small cellular growths—lumps—localized to one microscopic place. The malignant process often seems to start in a single cell or in two or three neighboring cells probably subjected to the same influences and possibly communicating with each other chemically. As the solid tumors grow in size, some cells (the malignant tumor cells) begin to migrate elsewhere (metastasize), where they form additional solid masses of tumor that may be as tiny as half a pinhead or as big as an orange. Most cancer cures today are achieved by total surgical removal of very early solid tumors. Most solid tumors are amenable to early surgical removal. Thus the solid tumors are the surgical tumors.

Four of the commonest cancers in the United States are solid tumors: cancers of the lung, breast, large intestine (colon), and skin. The group of solid tumors also includes cancer of prostate, uterus, pancreas, ovary, testicle, kidney, liver, thyroid, esophagus, stomach, tongue, and bone. If the cancer originates in the liver, it is considered a primary (rather than metastatic) solid tumor of the liver (hepatoma). Cancer of the skin may be of the skin-colored type, usually a hollowed-out ulcer (squamous cell carcinoma, caused in some cases by exposure to the ultraviolet rays of the sun), or it may be a jet-black mole-like tumor (malignant melanoma). Basal cell skin cancer (also related to sun exposure) is generally a harmless small lump. A biopsy, or removal with microscopic examination, is essential for differentiating these three very different types of skin cancers. Most brain tumors are also classified as solid tumors.

By contrast, there are the nonsolid tumors. These affect the blood and lymphatic systems and bone marrow and include the leukemias (cancer of the leukocytes or white cells), lymphomas (arising in the lymph nodes or lymphocytes), and some rare cancers of the bone marrow elements. Although these tumors are not usually amenable to early surgical removal, many are sensitive to radiation and to chemotherapy (treatment with drugs and chemicals). In fact, some of the best results of radiation and chemotherapy are achieved in these tumors.

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