Pathology

Endometrial Cancer

Endometrial cancer is the most common type of uterine cancer and originates in the inner layer that lines the uterine cavity. This disease mainly affects postmenopausal women, although it can also occur at younger ages.

In developed countries, it is the most common gynecological cancer, with an incidence of 15.9 cases per 100,000 women and a mortality rate of 2.4 per 100,000. In Portugal, in 2022, endometrial cancer had an incidence of 1,401 new cases and a mortality of 439 cases. The 5-year prevalence is 5,270 cases (98.7 cases per 100,000 inhabitants).

Several factors can increase the risk of developing this condition, such as obesity, type 2 diabetes, prolonged exposure to estrogen without progesterone, late menopause, or a family history of cancer, especially in the context of Lynch syndrome. The most common symptom is abnormal uterine bleeding, particularly in women who have already gone through menopause. Other symptoms may include pelvic pain, unusual vaginal discharge, or unexplained weight loss.

Diagnosis is usually made through transvaginal ultrasound and endometrial biopsy, complemented by imaging studies to assess the extent of the disease.

Treatment depends on the stage and molecular characteristics of the tumor. In most cases, surgery is performed, which may include removal of the uterus, ovaries, and fallopian tubes. Depending on the risk of recurrence, this approach may be complemented with radiotherapy, chemotherapy, hormone therapy, or immunotherapy, especially in tumors with specific genetic alterations.

Most cases are detected at early stages, allowing for a curative approach with high survival rates. In advanced or recurrent stages, treatment is tailored to the individual characteristics of each patient, with an increasingly personalized approach.

Renal Cell Carcinoma

Is a kidney cancer that originates in the lining of the proximal convoluted tubule, a part of the very small tubes in the kidney that transport primary urine. It is the most common type of kidney cancer in adults, responsible for approximately 90-95% of cases. Early or locally advanced kidney cancer is usually treated with surgery and radiotherapy. If the cancer has spread outside the kidney to other parts of the body, surgery will usually be combined with other treatments as targeted therapy.

Renal cell carcinoma accounts for 90% of renal malignancies. Renal cell cancer, which is twice as frequent in men as in women, accounts for 2-3% of all malignancies in the adult population worldwide. Most cases are diagnosed between the 4th and the 6th decade of life (from 50 years of age), but can occur at any age. Approximately half of new cases diagnosed in adults are localized, or limited to the kidney itself. Renal cell carcinoma affects affected 1104 people in 2012 in Portugal, being responsible of the 1.5% of all deaths caused by cancer.

Hepatocellular carcinoma

Liver cancer is the second leading cause of cancer-related deaths globally with 782,000 estimated new cases worldwide in 2012 and a greater incidence in less developed regions. In Portugal, liver cancer incidence is 1004 new cases/year, associated with a high mortality 908 deaths/year.

Hepatocellular carcinoma (HCC) represents 90% of all cases of primary liver cancer and mainly develops in cirrhotic livers related to chronic hepatitis B virus or hepatitis C virus infection. HCC results from the accumulation of somatic genomic alterations and driver cancer genes and its development is a complex multistep process that can originate from various cell types, including mature hepatocytes and stem or progenitor cells. In the context of cirrhosis, HCC starts with pre-cancerous cirrhotic nodules that can transform into malignant early-stage HCC and ultimately progress to more advanced HCC stages.

Differentiated Thyroid Carcinoma

Is a type of cancer originating from the follicular cells of the thyroid gland that is commonly treated with radioactive iodine (RAI) therapy. RAI works by concentrating in thyroid cells and destroying the thyroid tissue and any other thyroid cells (including cancer cells) that take up iodine. Sometimes patients may no longer be able to receive RAI; this could happen if tumours are not taking up RAI, if tumours take up RAI but the cancer is getting worse or if patients have received a lifetime total RAI dose of >600 mCi.

Thyroid cancer is a rare tumour, constituting less than 1% of malignant neoplasms, In Portugal in 2012 were diagnosed 127 new cases in men, and 449 new cases in women. It is the most frequent endocrine neoplasm (90% of all endocrine neoplasms), and the leading cause of death in all endocrine tumours.

Breast Cancer

Is the most common form of cancer in women.  Metastatic or “advanced” breast cancer is cancer that started in the breast tissue but that has spread to other parts of the body. The most common sites where breast cancer can spread are the bones, lungs, liver, and brain. Disease that has spread to other parts of the body is still considered breast cancer because the type of cancer cell remains the same. Although metastatic breast cancer cannot be cured, there are options available to treat the disease.

Breast cancer is the most common cancer in Portuguese women, accounting for 29% of all cancers. In Portugal in 2012, 6.088 breast cancers were diagnosed. Although breast cancer mortality has declined in recent years thanks to early screening programs and improved treatments, breast cancer remains the leading cause of cancer death in women. In 2012, 1.570 women died of breast cancer in Portugal.

Soft Tissue Sarcoma

Is a type of cancer that starts in the soft tissues of the body, including the fat, muscle, nerves, blood vessels, and tissues around the joints. More than 50 different types of STS have been identified. Each of these types is named after the kind of soft tissue cell in which the tumour forms. Some of the most common are gastrointestinal stromal tumours (which form in the gastrointestinal tract, usually in the stomach or small intestine), liposarcoma (which forms in the fat cells), and leiomyosarcoma (which forms in the smooth muscles).

Soft tissue sarcomas are rare tumours. They constitute approximately 1% of all malignant tumours, and are responsible for 2% of cancer mortality. Its estimated incidence in the European Union is about 5 new cases per year per 100.000 inhabitants. Soft tissue sarcoma are slightly more common in men than in women, and can be seen at all ages, including in children and adolescents. However, the highest age in adults is between 40 and 60 year.