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FOUNDATION OVERVIEW

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Modern medical science has led to significant improvement in the survival and quality of life for individuals with neoplastic (neoplasm) conditions (benign or malignant tumors). Neoplasm (tumor or cancer) is an abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of normal tissues and persists after cessation of the stimuli which evoked the change. The key feature of cancer is unregulated cell division and growth, secondary to the loss of normal control mechanisms that govern cell survival, proliferation, and differentiation. Benign tumors are limited to the tissue of origin and do not invade surrounding tissue. Their dangerous counterpart, malignant tumors can invade local tissues and undergo distant spread (metastasis). Malignant tumors (often referred to as cancer) are predominantly of three types and are divided based on the tissue type of origin. They are the carcinomas (of epithelial origin), the sarcomas (of connective tissue origin, mesenchymal origin) or leukemia’s (of hematological origin). The first two types are referred to as solid tumors.

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The impact of a particular cancer on a population can be assessed by calculating the life time risk of developing that cancer, the median age at diagnosis and five year probability of survival after diagnosis (Table 12-1). The five year probability of survival for an individual with prostate cancer is nearly 100%, while the five year survival probability for pancreatic cancer and lung cancers are 6.4% and 16.2% respectively. Several internal (eg, genetic predisposition, race, sex) and external (eg, environmental exposures like ionizing radiation, chemical carcinogens, viral infections) factors have been implicated as the cause of various types of cancer and are beyond the scope of this chapter. The current recommendations for cancer screening are summarized in Table 12-2.

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TABLE 12-1Top 10 United States Invasive Cancer Statistics
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TABLE 12-2Cancer Detection and Screening Recommendations for Average Risk Asymptomatic Individuals

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