What Is Cancer?

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 A Collection of Related Diseases

 Differences between Cancer Cells and Normal Cells
 How Cancer Arises
 "Drivers" of Cancer
 When Cancer Spreads
 Tissue Changes that Are Not Cancer
 Types of Cancer

A dividing breast cancer cell.

Credit: National Cancer Institute / Univ. of Pittsburgh Cancer Institute

A Collection of Related Diseases

Cancer is the name given to a collection of related diseases. In all types of cancer, some of the
body’s cells begin to divide without stopping and spread into surrounding tissues.

Cancer can start almost anywhere in the human body, which is made up of trillions of cells.
Normally, human cells grow and divide to form new cells as the body needs them. When cells
grow old or become damaged, they die, and new cells take their place.

When cancer develops, however, this orderly process breaks down. As cells become more and
more abnormal, old or damaged cells survive when they should die, and new cells form when
they are not needed. These extra cells can divide without stopping and may form growths called
tumors.

Many cancers form solid tumors, which are masses of tissue. Cancers of the blood, such as
leukemias, generally do not form solid tumors.

Cancerous tumors are malignant, which means they can spread into, or invade, nearby tissues. In
addition, as these tumors grow, some cancer cells can break off and travel to distant places in the
body through the blood or the lymph system and form new tumors far from the original tumor.

Unlike malignant tumors, benign tumors do not spread into, or invade, nearby tissues. Benign
tumors can sometimes be quite large, however. When removed, they usually don’t grow back,
whereas malignant tumors sometimes do. Unlike most benign tumors elsewhere in the body,
benign brain tumors can be life threatening.

Differences between Cancer Cells and Normal Cells

Cancer cells differ from normal cells in many ways that allow them to grow out of control and
become invasive. One important difference is that cancer cells are less specialized than normal
cells. That is, whereas normal cells mature into very distinct cell types with specific functions,
cancer cells do not. This is one reason that, unlike normal cells, cancer cells continue to divide
without stopping.

In addition, cancer cells are able to ignore signals that normally tell cells to stop dividing or that
begin a process known as programmed cell death, or apoptosis, which the body uses to get rid of
unneeded cells.
Cancer cells may be able to influence the normal cells, molecules, and blood vessels that
surround and feed a tumor—an area known as the microenvironment. For instance, cancer cells
can induce nearby normal cells to form blood vessels that supply tumors with oxygen and
nutrients, which they need to grow. These blood vessels also remove waste products from
tumors.

Cancer cells are also often able to evade the immune system, a network of organs, tissues, and
specialized cells that protects the body from infections and other conditions. Although the
immune system normally removes damaged or abnormal cells from the body, some cancer cells
are able to “hide” from the immune system.

Tumors can also use the immune system to stay alive and grow. For example, with the help of
certain immune system cells that normally prevent a runaway immune response, cancer cells can
actually keep the immune system from killing cancer cells.

How Cancer Arises

ENLARGE
Cancer is caused by certain changes to genes, the basic physical units of inheritance. Genes are
arranged in long strands of tightly packed DNA called chromosomes.
Credit: Terese Winslow

Cancer is a genetic disease—that is, it is caused by changes to genes that control the way our
cells function, especially how they grow and divide.

Genetic changes that cause cancer can be inherited from our parents. They can also arise during a
person’s lifetime as a result of errors that occur as cells divide or because of damage
to DNA caused by certain environmental exposures. Cancer-causing environmental exposures
include substances, such as the chemicals in tobacco smoke, and radiation, such as ultraviolet
rays from the sun. (Our Cancer Causes and Prevention section has more information.)

Each person’s cancer has a unique combination of genetic changes. As the cancer continues to
grow, additional changes will occur. Even within the same tumor, different cells may have
different genetic changes.

In general, cancer cells have more genetic changes, such as mutations in DNA, than normal cells.
Some of these changes may have nothing to do with the cancer; they may be the result of the
cancer, rather than its cause.

Fundamentals of Cancer
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Cancer cells can break away from the original tumor and travel through the blood or lymph system to distant
locations in the body, where they exit the vessels to form additional tumors. This is called metastasis.
Cancer is a disease caused when cells divide uncontrollably and spread into surrounding tissues.
Cancer is caused by changes to DNA. Most cancer-causing DNA changes occur in sections of DNA called genes.
These changes are also called genetic changes.
A DNA change can cause genes involved in normal cell growth to become oncogenes. Unlike normal genes,
oncogenes cannot be turned off, so they cause uncontrolled cell growth.
 In normal cells, tumor suppressor genes prevent cancer by slowing or stopping cell growth. DNA changes that
inactivate tumor suppressor genes can lead to uncontrolled cell growth and cancer.
Within a tumor, cancer cells are surrounded by a variety of immune cells, fibroblasts, molecules, and blood
vessels—what’s known as the tumor microenvironment. Cancer cells can change the microenvironment, which in
turn can affect how cancer grows and spreads.
Immune system cells can detect and attack cancer cells. But some cancer cells can avoid detection or thwart an
attack. Some cancer treatments can help the immune system better detect and kill cancer cells.
Each person’s cancer has a unique combination of genetic changes. Specific genetic changes may make a person’s
cancer more or less likely to respond to certain treatments.
Genetic changes that cause cancer can be inherited or arise from certain environmental exposures. Genetic changes
can also happen because of errors that occur as cells divide.
Most often, cancer-causing genetic changes accumulate slowly as a person ages, leading to a higher risk of cancer
later in life.
Cancer cells can break away from the original tumor and travel through the blood or lymph system to distant
locations in the body, where they exit the vessels to form additional tumors. This is called metastasis.
Cancer is a disease caused when cells divide uncontrollably and spread into surrounding tissues.
Cancer is caused by changes to DNA. Most cancer-causing DNA changes occur in sections of DNA called genes.
These changes are also called genetic changes.
A DNA change can cause genes involved in normal cell growth to become oncogenes. Unlike normal genes,
oncogenes cannot be turned off, so they cause uncontrolled cell growth.
 In normal cells, tumor suppressor genes prevent cancer by slowing or stopping cell growth. DNA changes that
inactivate tumor suppressor genes can lead to uncontrolled cell growth and cancer.
Within a tumor, cancer cells are surrounded by a variety of immune cells, fibroblasts, molecules, and blood
vessels—what’s known as the tumor microenvironment. Cancer cells can change the microenvironment, which in
turn can affect how cancer grows and spreads.
Immune system cells can detect and attack cancer cells. But some cancer cells can avoid detection or thwart an
attack. Some cancer treatments can help the immune system better detect and kill cancer cells.
Each person’s cancer has a unique combination of genetic changes. Specific genetic changes may make a person’s
cancer more or less likely to respond to certain treatments.
Genetic changes that cause cancer can be inherited or arise from certain environmental exposures. Genetic changes
can also happen because of errors that occur as cells divide.
Most often, cancer-causing genetic changes accumulate slowly as a person ages, leading to a higher risk of cancer
later in life.
Cancer cells can break away from the original tumor and travel through the blood or lymph system to distant
locations in the body, where they exit the vessels to form additional tumors. This is called metastasis.

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"Drivers" of Cancer
The genetic changes that contribute to cancer tend to affect three main types of genes—proto-
oncogenes, tumor suppressor genes, and DNA repair genes. These changes are sometimes called
“drivers” of cancer.

Proto-oncogenes are involved in normal cell growth and division. However, when these genes
are altered in certain ways or are more active than normal, they may become cancer-causing
genes (or oncogenes), allowing cells to grow and survive when they should not.

Tumor suppressor genes are also involved in controlling cell growth and division. Cells with
certain alterations in tumor suppressor genes may divide in an uncontrolled manner.
DNA repair genes are involved in fixing damaged DNA. Cells with mutations in these genes
tend to develop additional mutations in other genes. Together, these mutations may cause the
cells to become cancerous.

As scientists have learned more about the molecular changes that lead to cancer, they have found
that certain mutations commonly occur in many types of cancer. Because of this, cancers are
sometimes characterized by the types of genetic alterations that are believed to be driving them,
not just by where they develop in the body and how the cancer cells look under the microscope.

When Cancer Spreads

ENLARGE
In metastasis, cancer cells break away from where they first formed (primary cancer), travel
through the blood or lymph system, and form new tumors (metastatic tumors) in other parts of
the body. The metastatic tumor is the same type of cancer as the primary tumor.

A cancer that has spread from the place where it first started to another place in the body is
called metastatic cancer. The process by which cancer cells spread to other parts of the body is
called metastasis.

Metastatic cancer has the same name and the same type of cancer cells as the original, or
primary, cancer. For example, breast cancer that spreads to and forms a metastatic tumor in the
lung is metastatic breast cancer, not lung cancer.

Under a microscope, metastatic cancer cells generally look the same as cells of the original
cancer. Moreover, metastatic cancer cells and cells of the original cancer usually have some
molecular features in common, such as the presence of specific chromosome changes.

Treatment may help prolong the lives of some people with metastatic cancer. In general, though,
the primary goal of treatments for metastatic cancer is to control the growth of the cancer or to
relieve symptoms caused by it. Metastatic tumors can cause severe damage to how the body
functions, and most people who die of cancer die of metastatic disease.

Tissue Changes that Are Not Cancer

Not every change in the body’s tissues is cancer. Some tissue changes may develop into cancer if
they are not treated, however. Here are some examples of tissue changes that are not cancer but,
in some cases, are monitored:

Hyperplasia occurs when cells within a tissue divide faster than normal and extra cells build up,
or proliferate. However, the cells and the way the tissue is organized look normal under a
microscope. Hyperplasia can be caused by several factors or conditions, including chronic
irritation.

Dysplasia is a more serious condition than hyperplasia. In dysplasia, there is also a buildup of
extra cells. But the cells look abnormal and there are changes in how the tissue is organized. In
general, the more abnormal the cells and tissue look, the greater the chance that cancer will form.
Some types of dysplasia may need to be monitored or treated. An example of dysplasia is an
abnormal mole (called a dysplastic nevus) that forms on the skin. A dysplastic nevus can turn
into melanoma, although most do not.

An even more serious condition is carcinoma in situ. Although it is sometimes called cancer,
carcinoma in situ is not cancer because the abnormal cells do not spread beyond the original
tissue. That is, they do not invade nearby tissue the way that cancer cells do. But, because some
carcinomas in situ may become cancer, they are usually treated.

Normal cells may become cancer cells. Before cancer cells form in tissues of the body, the cells
go through abnormal changes called hyperplasia and dysplasia. In hyperplasia, there is an
increase in the number of cells in an organ or tissue that appear normal under a microscope. In
dysplasia, the cells look abnormal under a microscope but are not cancer. Hyperplasia and
dysplasia may or may not become cancer.
Credit: Terese Winslow

Types of Cancer
There are more than 100 types of cancer. Types of cancer are usually named for the organs or
tissues where the cancers form. For example, lung cancer starts in cells of the lung, and brain
cancer starts in cells of the brain. Cancers also may be described by the type of cell that formed
them, such as an epithelial cell or a squamous cell.
You can search NCI’s website for information on specific types of cancer based on the
cancer’s location in the body or by using our A to Z List of Cancers. We also have collections of
information on childhood cancers and cancers in adolescents and young adults.

Here are some categories of cancers that begin in specific types of cells:

Carcinoma
Carcinomas are the most common type of cancer. They are formed by epithelial cells, which
are the cells that cover the inside and outside surfaces of the body. There are many types of
epithelial cells, which often have a column-like shape when viewed under a microscope.

Carcinomas that begin in different epithelial cell types have specific names:

Adenocarcinoma is a cancer that forms in epithelial cells that produce fluids or mucus.
Tissues with this type of epithelial cell are sometimes called glandular tissues. Most cancers
of the breast, colon, and prostate are adenocarcinomas.

Basal cell carcinoma is a cancer that begins in the lower or basal (base) layer of the
epidermis, which is a person’s outer layer of skin.

Squamous cell carcinoma is a cancer that forms in squamous cells, which are epithelial cells
that lie just beneath the outer surface of the skin. Squamous cells also line many other organs,
including the stomach, intestines, lungs, bladder, and kidneys. Squamous cells look flat, like
fish scales, when viewed under a microscope. Squamous cell carcinomas are sometimes
called epidermoid carcinomas.

Transitional cell carcinoma is a cancer that forms in a type of epithelial tissue called
transitional epithelium, or urothelium. This tissue, which is made up of many layers of
epithelial cells that can get bigger and smaller, is found in the linings of the bladder, ureters,
and part of the kidneys (renal pelvis), and a few other organs. Some cancers of the bladder,
ureters, and kidneys are transitional cell carcinomas.

Sarcoma
 ENLARGE
Soft tissue sarcoma forms in soft tissues of the body, including muscle, tendons, fat, blood
vessels, lymph vessels, nerves, and tissue around joints.
Credit: Terese Winslow

Sarcomas are cancers that form in bone and soft tissues, including muscle, fat, blood
vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments).
Osteosarcoma is the most common cancer of bone. The most common types of soft tissue
sarcoma are leiomyosarcoma, Kaposi sarcoma, malignant fibrous histiocytoma, liposarcoma,
and dermatofibrosarcoma protuberans.
Our page on soft tissue sarcoma has more information.

Leukemia
Cancers that begin in the blood-forming tissue of the bone marrow are called leukemias.
These cancers do not form solid tumors. Instead, large numbers of abnormal white blood cells
(leukemia cells and leukemic blast cells) build up in the blood and bone marrow, crowding
out normal blood cells. The low level of normal blood cells can make it harder for the body to
get oxygen to its tissues, control bleeding, or fight infections.

There are four common types of leukemia, which are grouped based on how quickly the
disease gets worse (acute or chronic) and on the type of blood cell the cancer starts in
(lymphoblastic or myeloid).

Our page on leukemia has more information.

Lymphoma
Lymphoma is cancer that begins in lymphocytes (T cells or B cells). These are disease-
fighting white blood cells that are part of the immune system. In lymphoma, abnormal
lymphocytes build up in lymph nodes and lymph vessels, as well as in other organs of the
body.

There are two main types of lymphoma:

Hodgkin lymphoma – People with this disease have abnormal lymphocytes that are called
Reed-Sternberg cells. These cells usually form from B cells.

Non-Hodgkin lymphoma – This is a large group of cancers that start in lymphocytes. The
cancers can grow quickly or slowly and can form from B cells or T cells.

Our page on lymphoma has more information.

Multiple Myeloma
Multiple myeloma is cancer that begins in plasma cells, another type of immune cell. The
abnormal plasma cells, called myeloma cells, build up in the bone marrow and form tumors in
bones all through the body. Multiple myeloma is also called plasma cell myeloma and Kahler
disease.
Our page on multiple myeloma and other plasma cell neoplasms has more information.

Melanoma
Melanoma is cancer that begins in cells that become melanocytes, which are specialized cells
that make melanin (the pigment that gives skin its color). Most melanomas form on the skin,
but melanomas can also form in other pigmented tissues, such as the eye.

Our pages on skin cancer and intraocular melanoma have more information.

Brain and Spinal Cord Tumors

There are different types of brain and spinal cord tumors. These tumors are named based on
the type of cell in which they formed and where the tumor first formed in the central nervous
system. For example, an astrocytic tumor begins in star-shaped brain cells called astrocytes,
which help keep nerve cells healthy. Brain tumors can be benign (not cancer) or malignant
(cancer).
Our page on brain and spinal cord tumors in adults has more information, as does our
overview of brain and spinal cord tumors in children.

Other Types of Tumors

Germ Cell Tumors
Germ cell tumors are a type of tumor that begins in the cells that give rise to sperm or
eggs. These tumors can occur almost anywhere in the body and can be either benign or
malignant.

Our page of cancers by body location/system includes a list of germ cell tumors with links
to more information.

Neuroendocrine Tumors
Neuroendocrine tumors form from cells that release hormones into the blood in response
to a signal from the nervous system. These tumors, which may make higher-than-normal
amounts of hormones, can cause many different symptoms. Neuroendocrine tumors may
be benign or malignant.

Our definition of neuroendocrine tumors has more information.

Carcinoid Tumors
Carcinoid tumors are a type of neuroendocrine tumor. They are slow-growing tumors that
are usually found in the gastrointestinal system (most often in the rectum and small
 intestine). Carcinoid tumors may spread to the liver or other sites in the body, and they
may secrete substances such as serotonin or prostaglandins, causing carcinoid syndrome.
Our page on gastrointestinal carcinoid tumors has more information.

Related Resources
 Tumor Grade
 Pathology Reports
 Metastatic Cancer
 Common Cancer Myths and Misconceptions
 Updated: February 9, 2015
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