Tumour

The body is made up of cells. The cells group together to form tissues, which in turn form organs like liver, brain, etc. These organs work together to perform one or more functions called as organ systems, such as digestion, circulation, and respiration, that we are so familiar with.

In a healthy body, the cells grow, divide and replace each other on a continuous basis. As new cells are formed, the old ones die. When this process is disrupted, trouble starts; new abnormal cells keep cropping up but the old cells do not die. These cells then group up and form a mass or tumour. Tumours can occur anywhere in the body where cells have the potential to replicate.

Tumours can be divided primarily into three categories:

1. Benign Tumour

These are also known as non-cancerous tumours. These tumours are rarely life-threatening. They are well localised, i.e. they do not infiltrate or spread to the surrounding tissues. They are slow-growing and are often non-symptomatic.

Most benign tumours do not require treatment unless they show symptoms. Examples of such tumours are

• Benign bone tumours (osteomas)
• Brain tumours, such as meningiomas and schwannomas
• Gland tumours, such as pituitary adenomas
• Benign soft tissue tumours, such as lipomas
• Uterine fibroids

2. Malignant Tumours

Also known as cancerous tumours. These tumours have the ability to spread and invade the surrounding tissues. They are rapidly growing and aggressive. Hence, one of the common presenting symptoms of malignant tumours is pain. These tumours have the ability to metastasize (i.e., spread to various parts of the body).

These tumours require medical attention and need to be treated early to prevent complications. Even after adequate treatment, these tumours are known to recur. Examples of such tumours are:

• Bone tumours, such as osteosarcoma and chordomas
• Brain tumours, such as glioblastomas and astrocytoma
• Malignant soft tissue cancers, such as liposarcoma
• Organ cancers, such as lung cancer
• Skin cancers, such as basal cell carcinoma (BCC)

3. Precancerous Tumours

These are benign tumours which have a high tendency to become malignant if left untreated. Examples of such tumours are:

• Actinic keratosis (a skin condition) that may lead to malignant skin cancer
• Cervical dysplasia, if untreated may lead to cervical cancer
• Colon polyps, which may turn into colon cancer
• Ductal carcinoma in situ which may become malignant

Tumours can present with a variety of symptoms. The symptoms depend on the type of tumour, the size and how aggressive the tumour is. However, certain general symptoms of tumours include:

• Generalised fatigue
• Fever associated with chills
• Lack of appetite
• Unexplained weight loss
• Night sweats
• Pain (this is one of the symptoms which may indicate that the tumour is either malignant or may have malignant potential)

Besides these general symptoms, all tumours have certain specific symptoms. For example, cervical cancers will present with bleeding and foul-smelling discharge, lung cancer may present with coughing up blood (haemoptysis), prostate cancer may present with difficulty in passing urine or blood in urine, etc.

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There is no definite cause for a tumour to form. It can be present in all age groups and genders. However, it is confirmed that a tumour occurs due to an alteration in the genetic composition (DNA) of the cell. Certain factors that can cause such alteration include:

• Mutations of specific genes, for example, a mutation of the BRCA gene causes breast cancer
• Inherited conditions or autoimmune disorders: For example, Hashimoto's thyroiditis (a hypothyroid condition caused due to the body’s own immune system attacking the thyroid) later develops into thyroid cancer
• Family history: certain cancers such as breast cancer or prostate cancer have a pattern of running in families
• Consumption of tobacco or smoking: they lead to cancers of the mouth and lung
• Excessive alcohol consumption can lead to cirrhosis of the liver, which can cause hepatocellular carcinoma
• Prolonged exposure to toxins can increase the risk of malignancy. For example, prolonged asbestos exposure can lead to lung cancer
• Excessive radiation exposure: excess radiation (such as UV radiation from the sun) has the ability to cause mutations in the genes of cells
• Viral infections: certain viruses such as HPV (cervical and other cancers), Epstein-Barr virus (Nasopharyngeal carcinoma), hepatitis B and hepatitis C (liver cancer), etc. are associated with causing cancer
• Unhealthy lifestyles and obesity increase the risk of cancers

Some general measures that can be taken to prevent a tumour include:

• Controlled intake of alcohol and cessation of consumption of tobacco
• Adhere to a healthy lifestyle, which includes regular exercise and a nutritious diet. This helps maintain good natural immunity.
• Limit occupational exposure to toxins and radiation by wearing safety gear and adhering to safety protocols.
• Tumours caused due to infection, for example, HPV, can be prevented by vaccinating with the HPV vaccine and using condoms.
• In individuals with a family history or history of genetic mutations, preventive surgery can be done before any tumour develops. For example, in females with BRCA mutations, prophylactic mastectomy is done to reduce the risk of breast cancer.

Tumours are diagnosed by asking for relevant history, physical examination and investigations. Any doctor can be approached to assess a suspected swelling.

History-taking

This involves asking about the location and size of the swelling. Any associated symptoms, such as pain or sudden increase in the size of the swelling lean towards a malignant swelling. Family history, history of substance use, history of other medical conditions etc. are also noted.

The physical examination involves assessing the general state of the patient. In cases of suspected malignant swelling, the patient may appear lethargic, malnourished and anaemic. Local examination of the swelling also helps assess whether the swelling is benign or malignant.

Investigations

A plethora of investigations are conducted to determine whether a tumour is benign or not and the spread of the tumours. Some of the common investigations include:

• Blood tests: which include CBC (complete blood count), LFT (Liver function tests, and RFT (renal function tests).
• Radiological investigations: these involve X-rays, CT scans, MRIs or PET scans. They help assess the spread of the tumour thereby helping in determining the stage of the tumour.
• Biopsy: a tissue sample of the swelling is sent for pathological examination to see the composition of the tumour and whether it is benign or malignant.
• Tumour markers: these are specific blood tests that measure the level of certain proteins and enzymes. These protein levels are higher in malignant cancers. For example, in liver cancer, there is an elevation of a protein known as alpha foetal protein.

Some tumours are accidentally found especially through investigative tests when a person may come for routine health check-ups.

Benign tumours usually are left alone until they cause symptoms, most commonly compression to the nearby structures.

Premalignant tumours have to be managed or removed as a precaution so that they do not turn cancerous in the future.

Malignant tumours on the other hand need to be treated as soon as they are diagnosed. The need for treatment is important since these tumours rapidly increase in size and can spread to both the surrounding and distant organs, increasing fatality to a great extent.

Various treatment approaches include:

• Surgery: This option involves cutting out the tumour. The complexity and complications of the surgery depend on the size of the tumour, the surrounding structures it has invaded and whether post-surgery is the tumour likely to recur. Often along with the tumour, a margin of healthy tissue is cut to ensure that no remaining malignant cells are present (as is often performed in the case of benign tumours or small malignant tumours). In advanced cancers that have not spread to distant parts of the body, the affected organ along with neighbouring organ tissues are removed (for example, in advanced stomach cancer, part of the stomach and the intestines may be removed). In extremely advanced stages of the disease with distant spread, surgery is used in combination with other therapies.
• Chemotherapy: These are special drugs that kill cancer cells, thereby reducing the size of the tumour. Chemotherapy is usually used before surgery to shrink the tumour or after surgery to kill any remaining tumour cells.
• Radiation therapy: Radiation therapy involves using a high energy focussed beam of radiation that helps kill the cancer cells. In certain cases, for example in cervical cancer, radiation-emitting rods are placed in the cervix that kills the tumour cells (brachytherapy).
• Immunotherapy: Cancer cells are often hiding from the immune system. Immunotherapy enhances the immune system and helps recognise the cancer cell thereby generating a stronger immune response to help kill cancer. This is often used in advanced stages of the disease when other treatments have been ineffective or in recurrent cancers.
• Targeted drug therapy: These are a special range of medications that target certain weaknesses in the cancer cell. Once these abnormalities are targeted, the cancer cells die reducing the size of the tumour.

Apart from the actual treatment for the tumour, be it benign or malignant, counselling and coping mechanisms are advised to both the patient and their family members. Tumours can be a worrisome condition and often require psychological support to avoid depression and anxiety.

The outlook varies greatly for different types of tumours. If the tumour is benign, the prognosis is extremely good. Often, benign tumours do not require any sort of treatment at all (as seen in the case of lipomas). However, some benign tumours may need to be removed since they cause distressing symptoms to the individual (for example, large uterine fibroids need to be removed since they increase bleeding during menses).

If the tumour is found to be malignant, then the prognosis depends on the type and stage of the disease. Cancers diagnosed in the early stages are often curable and have a much higher life expectancy as compared to those cancers that are diagnosed in the advanced stages. Prognosis also depends on the overall general health of the person and whether the person can physically bear the side effects of the treatment.

Tumours can occur in almost any part of the body, in various sizes and shapes. They can be broadly divided into benign and malignant tumours. Patient history, physical examination and investigations help confirm whether the tumour is benign or malignant and the staging of the tumour. Treatment and management depend on the stage and type of the tumour. Prognosis is good if the tumour is benign and less aggressive or if a malignant tumour has been identified and managed in its initial stages.