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A tumour, also called a neoplasm, is a mass of tissue that results when abnormal cells divide without control. A cancer is a tumour that has the biological potential to invade adjacent tissues and spread via the blood or lymphatic system to other parts of the body; a cancer can also be called an invasive or malignant tumour or neoplasm. If the tumour does not have the potential to spread, i.e. it simply grows in its original location without being capable of piercing surrounding tissues, it is called benign. There is another kind of tumour, called an in situ tumour, which, unfortunately, is known by conflicting terminology. Some authorities describe it as non-invasive cancer while others state that it is not cancer. In any case, in situ tumours are usually treated as if they were very early stage cancer because some can undergo further change and become invasive.
A tumour’s behaviour refers to whether it is invasive, benign or in situ. Tumours are usually named according to the tissue or organ in which they develop (site) and are further characterised based on the type of cell that has become neoplastic (histology) and the specific mutations involved (genetics) (Table 1).
Sources: National Cancer Institute <http://www.cancer.gov/dictionary/>; Cortes J et al 2014. New approach to cancer therapy based on a molecularly defined cancer classification. CA: A Cancer Journal for Clinicians. 64(1): 70–74; Catalogue of somatic mutations in cancer (COSMIC) 2014 <http://cancer.sanger.ac.uk/cancergenome/projects/census/>.
For most cancers the causes are not fully understood. However, some factors that increase the risk of developing cancer (risk factors) are well-recognised, and include:
It should be noted that having a risk factor does not mean that a person will develop cancer. Many people have at least one cancer risk factor but will never get cancer, while others with this disease may have had no known risk factors. The risk of developing cancer generally increases with increasing exposure to these factors.
Cancer prevention can mean a number of things. It can mean preventing cancer ever developing, or preventing disease progression, complications, recurrence or death once cancer has developed.
Preventing cancer developing is an area where the greatest gains in controlling and reducing cancer can be made, and can include:
More information on risk factors and cancer prevention:
Detecting and diagnosing cancer can be a complicated process. There are a number of commonly used tests and processes to detect the presence of cancers, including imaging, endoscopy, blood and lymph tests, and screening tests. A definitive diagnosis of cancer can only be made through pathological examination of cells or tissue under a microscope, by a Pathologist. However, the increased use of specialised radiological or other imaging techniques and biochemical tests now permits more definite diagnoses to be made without the use of invasive pathology tests, in many cases.
The tests used to detect or diagnose cancer may be:
These terms are described in Table 2.
Source: National Cancer Institute <http://www.cancer.gov/dictionary/>.
Cancer screening involves the use of a single test to identify individuals at risk of cancer. Population-based screening is an organised, integrated process with strict assessment criteria. In Australia, these criteria are defined in the Australian Population-based Screening Framework (APHDPC Screening Subcommittee 2008), which advises:
In Australia, three cancers (breast, cervical and bowel cancers) meet these criteria, and have organised, national population screening programs. While other cancers, such as prostate cancer and lung cancer, are also important health problems for which treatment is available, they do not meet the other criteria for population-based screening programs. Testing for these cancers, and others, are available as opportunistic screening (see, Table 2: Detecting and diagnosing cancer: common terms). Data on the number of tests requested or carried out may be available, however these are not collected or compiled nationally, and the results are not reportable.
Treatment and management options after a diagnosis of cancer are dependent on:
Terms are described in Table 3. In Australia, there are clinical guidelines promoting best-practice management of a number of cancers, including breast, lung, testicular, prostate, bladder cancers and mesothelioma.
Source: National Cancer Institute <http://www.cancer.gov/dictionary/>.
There are comprehensive national data on treatments provided through admitted patient hospitalisations. These include surgery (such as mastectomy), and non-surgical care (such as radiotherapy and chemotherapy). In some instances, data from MBS or PBS claims can be used to infer treatment and management of cancers. For example, radioactive seed implantation of the prostate (MBS items 15338 and 37220) or use of antineoplastic agents (PBS group L01).
However, these data are not a complete source for treatment or management of cancer. Treatments in day clinics or private consulting rooms, management by general practitioners, complications from treatments, and the frequency of recurrence of cancer after treatment are not available at a national level. Pilot projects to collect these data on a small scale are currently underway, with the aim of expanding the methodology to national data collection if feasible.
More detailed definitions of cancer and related terminology: