Types of cancer
 

NCT studies on breast cancer

The NCT is investigating breast cancer in the following studies:

• CATCH
• LION-1

About the disease

Breast cancer is a condition in which cells in the breast gland multiply uncontrollably and form a malignant tumour. The technical term for this is ‘mammary carcinoma’.

Like many malignant tumours, breast cancer can spread throughout the body. Cancer cells can break away from the original tumour and travel via tissue fluid, lymph or the bloodstream to other parts of the body. There, it can form what is known as a metastasis.

Breast cancer is by far the most common form of cancer in Germany. According to the Robert Koch Institute, around 76,000 women are diagnosed with it each year. Around one in eight women will develop the disease during their lifetime. Men are very rarely affected: in Germany, around 750 men are diagnosed with breast cancer each year.

Experts distinguish between:

• locally confined (early-stage) breast cancer:
  The tumour is confined to the breast. It may already have spread to nearby lymph nodes. It is usually treatable and often curable.
• locally advanced or metastatic breast cancer:
  The cancer has spread to neighbouring areas of the body and/or formed secondary tumours (metastases) in other organs. Metastatic breast cancer is generally not curable, but can often be managed effectively over a long period.

Key facts about breast cancer:

• There are different types of breast cancer.
• Breast cancer does not progress in the same way in all patients.
• The biological characteristics of the tumour can vary greatly from patient to patient: these characteristics influence the course of the disease, the treatment options and the prognosis.

NCT studies on CLL

The NCT is investigating CLL in the following studies:

• LION-1

Chronic lymphocytic leukaemia, or CLL for short, is a malignant disease of the lymphatic system. This includes, amongst other things, the lymph nodes, the spleen and the bone marrow. 

In CLL, certain white blood cells, known as mature B-lymphocytes, are affected. This is why the disease is also referred to as B-CLL. These altered cells multiply slowly and can displace healthy blood cells.

Why is the disease called leukaemia? CLL is not actually classified as a classic leukaemia, but rather as a slow-growing (indolent) lymphoma. The word ‘leukaemia’ translates as ‘white blood’. The term ‘leukaemia’ is used because, in CLL, the abnormal lymphocytes are not found primarily in the organs of the lymphatic system, but are always detectable in large numbers in the blood.

CLL is the most common form of blood cancer. In Germany, an estimated 5,000 people are newly diagnosed with it each year. Men are affected slightly more often than women.

Key facts about CLL:

• In many patients, CLL remains stable over a long period and usually progresses very slowly.
• Not every patient requires treatment.
• Treatment is only started when the disease causes symptoms and becomes active, i.e. when blood test results deteriorate or the spleen and lymph nodes become significantly enlarged.
• The course of the disease and the prognosis can vary greatly from person to person.
• In the early stages, life expectancy is often hardly affected.

NCT studies on colorectal cancer

The NCT is investigating colorectal cancer in the following studies:

• Hi-STEP1

About the disease

Colorectal cancer develops in the large intestine (the colon and rectum) which refers to the final sections of the digestive system. 

In most cases, colorectal cancer develops from glandular cells in the lining of the bowel. These tumours are called adenocarcinomas. As the disease progresses, the tumour can invade deeper layers of tissue and spread to neighbouring organs. Metastases occur primarily in the liver, lungs and peritoneum.

Colorectal cancer is one of the most common types of cancer: it is the second most common cancer in women and the third most common in men. Around 55,000 people are diagnosed with it in Germany every year. Many people are already older when they develop colorectal cancer, but there are also younger patients. In some cases, there is a hereditary form of bowel cancer in the family.

Key facts about colorectal cancer:

• Colorectal cancer often develops from benign precursors (polyps). If these are detected during screening via a colonoscopy and removed, it is possible to prevent them from developing into bowel cancer.
• If colorectal cancer is detected early, the prospects of recovery are good.
• Various treatments are available, such as surgery, chemotherapy, radiotherapy, targeted drugs and immunotherapy.
• The most suitable treatment depends on the stage of the disease, the characteristics of the tumour, the patient’s state of health and the patient’s personal preferences.

NCT studies on ovarian cancer

The NCT is investigating ovarian cancer in the following studies:

• LION-1

About the disease

Ovarian cancer is a malignant tumour of the female reproductive organs. The cancer can develop in the ovaries, but also in the fallopian tubes or the peritoneum. Every year, around 7,000 women in Germany are diagnosed with ovarian cancer, and 1 in 74 women will develop the disease during lifetime.

The ovaries and fallopian tubes consist of different types of tissue and cells from which cancer can develop. This is why there are different forms of ovarian cancer. Around 9 out of 10 malignant tumours originate in the outermost layer of cells of the ovaries or fallopian tubes. This most common form is also known as ovarian carcinoma.

Ovarian cancer is classified according to how far the tumour has spread:

• A localised tumour (stage I–II) affects one or both ovaries or is confined to the organs and tissues within the pelvis.
• An advanced tumour (stage III–IV) has spread to organs and tissues outside the pelvis or to more distant organs.

Key facts about ovarian cancer:

• Ovarian cancer often causes no symptoms at first.
• As a result, the disease is often only detected at an advanced stage: around 3 in 4 tumours are diagnosed at stage III or IV.
• The definitive diagnosis is only confirmed during surgery, which also marks the start of treatment.
• Chemotherapy usually follows the operation. Targeted cancer drugs may also form part of the treatment.

About the disease

Liver cancer is a malignant tumour that develops directly in the liver (primary liver tumour). The most common form is hepatocellular carcinoma (HCC). It develops from liver cells and accounts for the majority of all liver cancers. 

In addition, there are tumours of the bile ducts within the liver, known as intrahepatic bile duct carcinomas, as well as rarer forms such as sarcomas. 

It is important to distinguish this from liver metastases: these are tumours that have spread from other organs and are not classified as primary liver tumours. They are much more common than primary liver tumours. For treatment, it is important to know whether the patient has liver cancer or liver metastases.

Liver cancer is rare. In Germany, around 9,700 people are diagnosed with a primary liver tumour every year. 

Key facts about liver cancer:

• Various types of tumours can occur in the liver.
• In almost all patients, liver cancer develops in a pre-damaged liver. In around 9 out of 10 patients, there is an underlying long-standing liver condition.
• If liver cancer is detected very early, there is a chance of a cure.
• If the disease is advanced or liver function is severely impaired, a cure is usually no longer possible. However, doctors can slow down tumour growth and alleviate symptoms. In addition to local therapies in the liver, immunotherapy or targeted therapies are the main options for this situation.

NCT studies on lymphomas

The NCT is investigating lymphomas in the following studies:

• LION-1

About the disease

The term ‘malignant lymphoma’ covers various malignant diseases of the lymphatic system. Colloquially, it is also referred to as lymph node cancer. Literally, lymphoma means ‘swelling of the lymph nodes’. 

The lymphatic system is distributed throughout the body. This system comprises vessels, organs and cells that are important for defending against pathogens. In the primary lymphatic organs – the thymus and bone marrow – lymphocytes mature, a subgroup of white blood cells. In malignant lymphomas, mature lymphocytes or their precursors (lymphoblasts) become abnormal and multiply uncontrollably.

There are over 30 different forms of lymphoma: the World Health Organisation now classifies lymphomas primarily according to the altered cell type. Examples include Hodgkin’s lymphoma, follicular lymphoma, diffuse large B-cell lymphoma, mantle cell lymphoma and chronic lymphocytic leukaemia (CLL). 

It is important to distinguish this from lymph node metastases: These are secondary tumours that have spread from other primary tumours to the lymph nodes, and do not constitute malignant lymphoma. For example, in breast cancer, tumour cells can spread through the lymphatic system and settle in the lymph nodes.

Key facts about malignant lymphomas:

• In practice, the term ‘non-Hodgkin’s lymphoma’ is still often heard. This refers to all lymphomas that are not Hodgkin’s lymphoma. However, specialists rarely use this term anymore, preferring instead to classify lymphomas more precisely, depending on the type of cell affected.
• In addition, so-called plasma cell disorders are classified separately. Plasma cells are mature B cells with specific functions. Multiple myeloma is one such plasma cell disorder.
• There are types of lymphoma that progress very slowly and others that progress very rapidly.
• Aggressive forms must be treated immediately and intensively. In such cases, the chances of recovery are good.
• Slow-growing lymphomas often only require treatment once symptoms appear. They can usually be effectively controlled with treatment. They are generally not curable in the long term.
• The exact subtype determines the treatment.

NCT studies on stomach cancer

The NCT is investigating stomach cancer in the following studies:

• Hi-STEP1

About the disease

Stomach cancer is a malignant tumour of the stomach. It develops when cells in the stomach wall grow and multiply uncontrollably. The tumour can spread into the surrounding tissue and damage it. 

In most cases, stomach cancer develops from the glandular cells of the stomach lining. Experts refer to this as adenocarcinoma of the stomach. Other types of cancer in the stomach are less common. Examples include undifferentiated carcinomas or squamous cell carcinomas. If the tumour is located at the junction between the oesophagus and the stomach, it is referred to as an adenocarcinoma of the oesophagogastric junction (AEG for short).

As the disease progresses, individual cells may break away from the tumour and form metastases. In stomach cancer, metastases usually form in the peritoneum, lungs or liver.

Distinction from other tumours of the stomach
Not every cancer in the stomach is stomach cancer in the strict sense. Other types of tumours can also develop there, such as soft tissue sarcomas like gastrointestinal stromal tumours (GIST), MALT lymphomas or neuroendocrine tumours.

Key facts about stomach cancer:

• Infection with the bacterium Helicobacter pylori is the most significant known risk factor for stomach cancer.
• Initially, the disease often causes no symptoms or only non-specific symptoms.
• The prospects of successful treatment depend heavily on the stage of the disease.
• If the tumour is detected early, the chances of recovery are good.
• In around 4 out of 10 people affected, metastases are already present at the time of diagnosis.

NCT studies on mantle cell lymphomas

The NCT is investigating lymphomas in the following studies:

• LION-1

Mantle cell lymphoma is a malignant disease of the lymphatic system and is classified as a malignant lymphoma. The lymphatic system comprises vessels, organs and cells that are important for defending against pathogens. 

The disease originates from certain white blood cells, the mature B lymphocytes. In mantle cell lymphoma, these cells multiply uncontrollably. Often, it is not just individual lymph nodes that are affected. In many patients, the disease also spreads to the bone marrow and other organs, such as the gastrointestinal tract. 

Mantle cell lymphoma is one of the rarer types of lymphoma. In Europe, around 1 to 2 in 100,000 people are diagnosed with it each year. In Germany, this equates to approximately 1,100 new cases per year.

Key facts about mantle cell lymphoma:

• Mantle cell lymphoma is a type of aggressive non-Hodgkin’s lymphoma.
• In 80 out of 100 people affected, the disease progresses rapidly and requires prompt treatment. In around 10 to 15 out of 100 people affected, however, it progresses more slowly.
• Thanks to modern treatments, mantle cell lymphoma can often be kept in check for many years.
• However, relapses of the disease occur in many patients.

NCT studies on oral cancer

The NCT is investigating oral cancer in the following studies:

• NAVIGATORR

About the disease

Oral cancer is a malignant tumour in the head and neck region. The oral cavity is bounded at the front by the lips, at the sides by the cheeks, at the top by the palate and at the bottom by the floor of the mouth. At the back, it merges into the throat. The entire oral cavity is lined with a mucous membrane. This consists of squamous epithelium.

Around 95 out of 100 malignant tumours of the oral cavity arise from these mucosal cells. They are therefore referred to as squamous cell carcinomas. In principle, any area of the oral cavity can be affected. However, tumours occur particularly frequently on the tongue or the floor of the mouth. In some cases, several tumours occur simultaneously: in the oral cavity or in other head and neck areas such as the pharynx or larynx.

Oral cancer is relatively common. In cancer statistics, it is grouped together with throat cancer and salivary gland cancer. According to the Robert Koch Institute, around 13,000 adults in Germany were diagnosed with these tumours in 2023. 

Key facts about oral cancer:

• The most significant risk factors include tobacco and alcohol consumption. When both factors are present, the risk of developing the disease increases significantly.
• In rare cases, infections with human papillomavirus (HPV) may also play a role.
• Oral cancer often spreads initially to the lymph nodes in the neck. Less commonly, the tumour spreads via the bloodstream, for example, to the lungs, liver or bones.

NCT studies on adrenal cortex cancer

The NCT is investigating adrenal cortex cancer in the following studies:

• LION-1

About the disease

The adrenal gland is a hormone-producing organ located next to the kidney. It consists of the medulla and the cortex, which have different functions. The adrenal cortex produces hormones that regulate blood pressure and mineral balance, sex hormones, and the stress hormone cortisol. 

There are benign and malignant tumours of the adrenal cortex. The majority of these tumours are benign, do not produce hormones and are discovered by chance during other investigations. Such incidental tumours are called incidentalomas. Malignant tumours of the adrenal cortex are called adrenal cortical carcinomas.

Adrenal cortical carcinomas are rare. In Germany, experts estimate around 80 to 120 new cases per year. Adrenal cortical carcinoma can occur at any age. However, it most commonly affects pre-school children or adults aged between 40 and 60. 

Key facts about adrenal cortical carcinoma:

• There are no known specific risk factors for adrenal cortical carcinoma.
• In some patients, the condition is linked to hereditary tumour syndromes. These are genetic changes that can increase the risk of certain types of cancer.
• The tumour usually grows rapidly. In the early stages, it rarely causes symptoms. For this reason, the condition is often only diagnosed at an advanced stage.
• Whether symptoms occur depends mainly on whether the tumour produces hormones or is large enough to press on surrounding structures.
• Around half of adrenal carcinomas produce an excess of hormones, which leads to symptoms.

NCT trials on throat cancer

The NCT is investigating cancer of the back of the throat in the following trials:

• DELPHI

About the disease

Specialists refer to malignant tumours in the throat (pharynx) as throat cancer. The throat is a tubular muscle that connects the oral cavity, the nasal cavity, the larynx and the oesophagus. It is lined with squamous epithelium and forms part of the digestive and respiratory tracts. Specialists divide the throat into three areas: 

• the nasopharynx
• the oropharynx
• the hypopharynx

Throat cancer can develop in any of these areas. Oropharyngeal cancer (oropharyngeal carcinoma) frequently occurs at the base of the tongue or on the palatine tonsils. If the tumour develops in the nasopharynx behind the nasal cavity, doctors refer to it as nasopharyngeal cancer or nasopharyngeal carcinoma. If the tumour develops in the lower section of the throat, the hypopharynx, it is referred to as hypopharyngeal cancer or hypopharyngeal carcinoma.

Throat cancer is one of the more common tumour diseases in the head and neck region. In cancer statistics, it is recorded alongside oral cavity cancer and salivary gland cancer. According to the Robert Koch Institute, around 13,000 adults in Germany were diagnosed with these tumours in 2023. 

Key facts about throat cancer:

• Smoking and heavy alcohol consumption increase the risk of developing the disease. The risk is particularly high among people who smoke heavily and drink a lot of alcohol at the same time.
• Human papillomaviruses (HPV) can play a role, particularly in the development of oropharyngeal cancer.
• In cases of oropharyngeal and hypopharyngeal cancer, lymph nodes are often already affected at the time of diagnosis.

The course of the disease and treatment depend on various factors, including the size of the tumour, how aggressively it is growing and how far the disease has already spread in the body.

NCT studies on salivary gland cancer

The NCT is investigating salivary gland cancer in the following studies:

• NAVIGATORR

About the disease

Salivary gland cancer is a malignant tumour of the salivary glands. These glands produce saliva, which moistens the mouth and is important for digestion. 

There are large and small salivary glands in the head region. 

• The major salivary glands are located on the left and right sides of the head. These include the parotid glands, the submandibular glands and the sublingual glands.
• In addition, there are numerous small salivary glands in the mucous membrane of the oral cavity, for example in the palate, cheeks, lips or on the tip of the tongue. They are also found in the mucous membrane of the throat.

Salivary gland cancer can develop in any of these glands.

Salivary gland cancer is a rare disease. In Germany, just under 1,000 people are diagnosed with cancer of the major salivary glands each year. Cancer can also develop in the minor salivary glands, but exact figures for this are not known. 

Key facts about salivary gland cancer:

• Salivary gland cancer most commonly develops in the parotid gland.
• There are more than 20 different types of salivary gland cancer.
• The different types differ primarily in terms of their cell type.
• There are no clear-cut symptoms. However, signs of the disease may include swelling of the salivary glands, swollen lymph nodes in the neck area or changes to the lining of the mouth.

NCT studies on soft tissue sarcomas

The NCT is investigating subtypes of soft tissue sarcomas in the following studies:

• PAMSARC

About the disease

The term ‘sarcoma’ covers two groups of tumours: soft tissue sarcomas and bone sarcomas.

Soft tissue sarcomas are malignant tumours that arise in fatty, muscular and connective tissue. They can also develop in blood vessels or lymphatic vessels. Consequently, soft tissue sarcomas can occur anywhere in the body.

Soft tissue sarcomas are among the rarer forms of cancer. According to statistics, around 4,500 people in Germany were diagnosed with the condition in 2023. The more common subtypes include liposarcomas, leiomyosarcomas and undifferentiated pleomorphic sarcomas.

Key facts about soft tissue sarcomas:

• Soft tissue sarcomas must be distinguished from benign tumours in the soft tissues. They are at least 100 times more common than sarcomas.
• Experts distinguish between more than 100 different subtypes of soft tissue sarcoma.
• Sarcomas most commonly occur in the arms and legs (around 43 out of 100 soft tissue sarcomas). One third affect internal organs in the abdomen or behind the peritoneum.
• Sarcomas can form metastases and do so frequently in the lungs. Depending on the subtype, metastases can also occur in the liver, bones or lymph nodes.

How the disease develops and how it is treated depends on various factors. These include the exact subtype, the size of the tumour and how far the disease has spread in the body. The patient’s general state of health also plays an important role.

Information on the types of cancer is taken from the medical treatment guidelines in the Oncology Guidelines Programme or the Onkopedia guidelines of the German Society for Haematology and Medical Oncology (DGHO), as well as from the Robert Koch Institute’s ‘Cancer in Germany 2021–2023’.