Bruce A. Chabner, MD, Director of Clinical Research, Massachusetts General Hospital Cancer Center; Professor of Medicine, Harvard Medical School Elizabeth Chabner Thompson, MD, MPH, Founder, BFFL Co
Cancerous cells develop from healthy cells in a complex process called malignant transformation.
The first step in cancer development is initiation, in which a change in the cell’s genetic material primes the cell to become cancerous. The change in the cell’s genetic material may occur spontaneously or be brought on by an agent that causes cancer (a carcinogen). Carcinogens include many chemicals, tobacco, viruses, radiation, and sunlight. However, not all cells are equally susceptible to carcinogens. A genetic flaw in a cell may make it more susceptible. Even chronic physical irritation may make a cell more susceptible to carcinogens.
The second and final step in the development of cancer is promotion. Agents that cause promotion, or promoters, may be substances in the environment or even some drugs such as sex hormones (for example, testosterone taken to improve sex drive and energy in older men). Unlike carcinogens, promoters do not cause cancer by themselves. Instead, promoters allow a cell that has undergone initiation to become cancerous. Promotion has no effect on cells that have not undergone initiation. Thus, several factors, often the combination of a susceptible cell and a carcinogen, are needed to cause cancer.
Some carcinogens are sufficiently powerful to be able to cause cancer without the need for promotion. For example, ionizing radiation (which is used in x-rays and is produced in nuclear power plants and atomic bomb explosions) can cause various cancers, particularly sarcomas, leukemia, thyroid cancer, and breast cancer.
Cancer can grow directly into surrounding tissue or spread to tissues or organs, nearby or distant. Cancer can spread through the lymphatic system. This type of spread is typical of carcinomas. For example, breast cancer usually spreads first to the nearby lymph nodes in the armpit, and only later does it spread to distant sites. Cancer can also spread via the bloodstream. This type of spread is typical of sarcomas.
Did You Know...
The -oma ending on the name of a cell type describes cancer cells of a particular type. For example, a meningioma is a cancer that develops in the covering of the brain or spinal cord (the meninges), and a hepatoma is a cancer that starts in the liver (hepat).
When cells become cancerous, new antigens—unfamiliar to the immune system—appear on the cell’s surface. These antigens are called tumor antigens. Which of the following may be the immune system’s response to tumor antigens?