2 The Diagnosis and Treatment of Cancer
In the day-to-day operations of the registry, ing) .-algia which is derived from the Greek the cancer registry personnel deal mostly with word algo (pain). Thus arthralgia means pain cases of cancer. They will encounter various in the joint. terms that refer to symptoms or signs of the The root, also known as stem, of a medical illness, describe the tumour and refer to the term is usually the main part of the word and site of origin, as well as the methods and refers to the organ or place where the illness results of diagnosis and treatment. It is not originated. It is generally derived from a Greek necessary to know the exact definition of all or Latin noun or verb. The root may be found: these terms, but the worker should be able to - at the beginning, as in: osteoma, decide whether they relate to the diagnosis or lingual, leukaemia treatment of cancer, or whether they are used - in the middle: intercostal, hyper- to describe the site or type of the tumour. This chromatic, prognosis chapter provides general information on symptoms of cancer, methods of detection - at the end: anuria, neoplasm, and forms of treatment. Common medical hypogastric, mesoderm terms are presented and defined. The Medical The meaning of a medical term is modified by Terminology Course at the end of this manual the addition of a prefix (at the beginning) or a should also be studied. suffix (at the end). The prefix is often a preposition or an adverb 2.1 and it consists of one or two syllables added in Medical terminology front of the root of the word which alters its meaning. Examples are given below: 2.1.1 Word roots, suffixes and prefixes Medical term Prefix Definition of prefix In the process of cancer registration, particu- larly during collection of information on submandibular sub- below cases, personnel will meet medical terms hypogastric hypo- beneath, under, which may refer to symptoms, to diagnostic deficient procedures or to treatments. Registry workers aphoma a- without do not have to memorize all these different anencephalic an- without terminologies. However, it is important that endocardium endo- inside they learn the meaning of the more common bilateral bi- two word roots (or origins), prefixes (beginnings) contralateral contra- against, opposite and suffixes (endings) (the parts of words which are combined to make up medical A suffix refers to a syllable or group of syllables terms) to help in understanding difficult attached to the end of the root to modify its terms. This is especially useful as most medical meaning. Suffixes, as prefixes, modify the records are handwritten with varying degrees meaning of a root element. Examples are: of legibility. A simple medical dictionary is Medical term Suffix ofsuffl.x very helpful. Examples of suitable dictionaries Definition on the market are given in the list of suggested Appendicitis -itis inflammation further reading at the end of the Manual. Histology ...ology study of Most medical terms are derived from lan- Leukopema -penia deficiency guages such as Latin, Greek, French or Ger- Carcinoid } -oid form, resembling man. As an example, let us take the word Ovoid -oid form, like, arthralgia which is based on the Greek word resembling arthron (joint) as a root, and the suffix (end- Hepatomegaly -.megaly enlargement 2 Manual for Cancer Registry Personnel
Hepatic -ic condition of EXERCISES Erythrocytosis -osis abnormal increase, disease, morbid The answers to the exercises are given at the status end of this chapter. Nephropathy -pathy morbid condition (non-inflammatory) Question 2(a):
Often, a root will be combined with a suffix In the list below different word roots are used and put after another root, so forming the to describe the origin of the tumour or pri- word ending, for example: mary site. These word roots are usually, although not always, derived from Greek or Root rn = blood) + - Leukaemia - (ae Latin. Look them up in your dictionary and suffix condition), added to (-ia = match the word roots with the sites. another root (leuk- = white), to form the word leukaemia. -a. Gastr- 1. Skin Carcinogenic Genic is composed - - b. Nephr- 2. Breast of a root forming, produc- (gen = c. Hepat- 3. Spleen ing) + a suffix (-ic = condition of). - _d. Rhin- 4. Lung In summary, the basic forms of medical terms -e. Cerebr- 5. Kidney are: -f. Bronch- 6. Brain Root plus suffix: -g. Mamm- 7. Nose - Hepatorna: (hepa = liver) + (-orna = -h. Card- 8. Liver tumour). -j. Derrn- 9. Heart - Leukorrhea: (leuko = white) + (- j. Lieno- 10. Stomach rrhea = flow). Prefix plus root: Question 2(b): - Neoplasm: (neo- = new) + (plasm = In the list below word roots are used to fluid substance of cells). describe the different body tissues. These are combined with other word elements to - Biology: (bio- = life, living) + (logy describe the histological type of the neoplasm. = study of). Look up these word roots in your dictionary - Pathology: (patho- = relating to and match them with the correct definition. disease) + (logy = study of). Prefix plus root plus suffix: _a. Angi- 1. Gland - Epigastric: (epi- = on or upon) + b. Fibr- 2. Threadlike (gastr = stomach) + (-ic = condition -c. Oste- 3. Marrow of), relates to the epigastrium at the _d. Lei- 4. Fat upper middle region of the abdo- -e. Aden- 5. Slime men. -f. Cyst- 6. Membrane - Dyspneic: (dys- = difficult) + (pne = -g. Lip- 7. Sac, Cyst breathing) + (-ic = condition of), h. Myel- 8. Smooth describes difficulty in breathing. -i. Mening- 9. Vessel - Tachycardic: (tachy- = rapid) + —j. Rhabdo- 10. Rod (card = heart) + (-ic = condition of), _k. Hem- 11. Cartilage describes rapid heart rate. 1. Chondr- 12. Bone _m.Myx- 13. Skin Two roots: n. Demi- 14. Blood - Carcinogen: (carcin(o) = cancer, crab) + (gen = forming). Question 2(c): - Scieroderma: (scler(o) = hard) + (derma = skin). In the list below are prefixes commonly used The vowel is in brackets because it has been with medical terms. Match the prefix with the introduced to combine the two root words. correct definition: The Diagnosis and Treatment of Cancer KI
a. Poly- 1. Half Figure 2.1 Cell Structure -b. Infra- 2. After _c. Hemi- 3. New Cell Membrane -d. Ect- 4. Back ,.... e. Hyper- 5. One Cytoplasm -f. Ad- 6. To, toward -g. Pen- 7. Outside h. Oligo- 8. Abnormal enlarge- Nucleus ment _i. Dys- 9. Bad Tissue fluid _j. Pre- 10. Above surrounds -k. Inter- 11. Difficult cell _1. Supra- 12. Below, beneath -m.Post- 13. Before may ultimately result in the malfunction of -n. Mono- 14. Around any or all of these. Tumour formation begins -o. Ex- 15. Between at the cellular level. -p. Ne(o)- 16. Many The study of the functional changes in tissues q. Megal- 17. Excessive and organs of the body which cause or are _r. Micr- 18. Small caused by disease is known as pathology. -s. Mal- 19. To take away from Most cells are able to reproduce themselves in t. Dors- 20. Scanty order to grow and to replace worn-out or injured cells: the exception is the cells of the 2.1.2 Tumour formation and pathology brain. Tissues normally grow by increasing the The human body is composed of millions of number of cells through a process of cell divi- microscopic units called cells. These are of dif- sion or mitosis. Certain normal tissues replace ferent types and are arranged in different their cells at regular intervals, for example the ways. A typical cell is enclosed in a cell mem- intestinal epithelium is replaced every 2-6 brane and contains a nucleus and cytoplasm. days. Other tissues have the capacity to Groups of cells performing the same function undergo mitosis but rarely do so unless there form tissues. The epithelial tissue or epithe- is a stimulus. Yet other tissues, such as the lium lines the body cavities and provides pro- muscle tissue, do not undergo mitosis once tection and lubrication; connective tissue adult life has been reached. supports and holds other tissues together; The process of tissue growth is normally con- muscle tissue is for movement and nervous trolled by the body. In some persons, however, tissue carries messages between the brain and this normal life process gets out of control and spinal cord and the rest of the body. the cells proliferate rapidly and uncontrolla- Several tissues operating together form organs, bly, in a haphazard way, forming a 'neoplasm', such as the heart, lungs, liver, stomach, colon 'new growth' or 'tumour which serves no use- and kidneys. Different organs work together ful purpose for the body. in a unit called an organ system each of which In the strict sense, 'tumour' can mean any has a particular function in sustaining life. For swelling of body tissues. However, this term is example, the digestive system or alimentary frequently used to denote abnormal tissue tract is composed of the mouth, pharynx, growth or neoplasia characterized by abnor- oesophagus, stomach, small intestine, colon mal and excessive division of cells, which usu- and anus. Together, these organs allow an ally results in distortion or destruction of the individual to ingest, digest and absorb food normal anatomy (anatomy is the structure of and to excrete waste products. Other organ the body and the inter-relation of its parts). systems are the nervous system, the respira- Neoplasm is derived from the word root tory system, the genito-urinary system and "plasm" which means fluid substance of cells the circulatory system. plus the prefix "neo-" meaning new. Thus neo- Since the cell is the basic structural unit of the plasm is a 'new growth'. human body, any abnormality in the cell can The terms 'tumour' and 'neoplasm' are often result in abnormalities being carried through- used inter-changeably. There are two general out the tissues, organs and organ systems and types of tumours or neoplasms: benign (non- 4 Manual for Cancer Registry Personnel cancerous) and malignant (cancerous) tem and are frequently involved in tumours. the spread of malignant tumours. They may be either regional (the (1) Benign tumours (non—cancerous) lymph nodes are located close to the These are usually slow—growing tumour site), or distant (the lymph tumours. They may become quite nodes are located in some other part large and create pressure on neigh- of the body). bouring structures. The neoplasm or Other parts. This refers to any organ or tumour displaces the surrounding tis- tissue of the body. However, malig- sue but does not invade or infiltrate it. nant tumours typically spread to or- Such tumours do not spread to other gans such as the bone, liver, and lung; parts of the body. They do not invade metastasis takes place more frequently parts of the body located elsewhere. to these organs than to others. They remain in the part of the body in Microscopically, malignant tumours which they originate. are characterized by cells with nuclei An important feature of the benign showing numerous mitoses (cell divi- tumour is 'encapsulation'. The tumour sions) and varying degrees of anaplasia is usually very clearly separated from (loss of normal differentiation) or lack the surrounding tissues by a protective of differentiation when compared to sheath or envelope, or a small rim of the tissue from which they originated. fibrous tissue. Malignant tumours begin in the same Microscopically, the tumour cells look way as benign tumours, i.e. as a local very similar to their tissue of origin. For growth. At this stage, they can be example, a lipoma is a benign tumour eradicated from the body by surgery of the fatty tissue. The tumour cells look or destroyed by radiotherapy. If left very similar to the fat cells of origin, but untreated, the tumour grows and infil- they are greatly increased in number to trates the surrounding tissues, or form a tumour. metastasizes to distant organs, and Usually, benign tumours cause no seri- may eventually kill the host. ous difficulties if properly managed. A tumour has two basic characteristics: However, if left untreated, they may cause problems such as obstruction or - it is a mass of new cells bleeding (haemorrhage). - it has no known purpose in the normal function of the body (2) Malignant tumours (cancerous) Malignant tumours or cancer possess These tumours are frequently charac- these two characteristics plus a third, terized by rapid growth, and they the capacity of the uncontrolled divid- destroy the part of the body in which ing cells to invade and spread to dis- they originate. They invade the sur- tant parts of the body by way of the rounding tissues and may spread to blood stream or lymphatic system. other parts of the body (distant organs). Cells that break away from the original tumour may be carried by EXERCISE the blood stream or the lymphatic sys- tem to other areas of the body where Question 2(d): they settle and form 'secondary' or Which of the following three statements best 'metastatic' tumours. The process of describes the difference between a malignant spreading to different organs of the and a benign tumour— body is called metastasis. The second- ary sites are known as metastatic sites. i Malignant tumours grow more rapidly The tumour can metastasize or spread than benign tumours to lymph nodes, or to other parts of ii Malignant tumours attain a much larger the body: size than benign tumours. Lymph nodes. These are small glands, iii Malignant tumours can metastasize to which form part of the lymphatic sys- other organs while benign tumours The Diagnosis and Treatment of Cancer 5