{{Short description|Condition or cell change indicating increased cancer risk}} {{More citations needed|date=March 2021}} {{Infobox medical condition | synonyms = Premalignant condition, precancer, premalignancy, dysplasia, intraepithelial neoplasm, carcinoma in situ | name = Precancerous condition | image = High-grade squamous intraepithelial lesion.jpg | caption = Micrograph of high grade squamous intraepithelial lesion, a precancerous condition of the uterine cervix. Pap stain. | pronounce = | field = Oncology | width = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} A '''precancerous condition''' is a condition, tumor or lesion involving abnormal cells which are associated with an increased risk of developing into cancer.<ref name="NCI Dictionary of Cancer Terms">{{cite web|url=https://www.cancer.gov/publications/dictionaries/cancer-terms|title=NCI Dictionary of Cancer Terms|website=National Cancer Institute|language=en|access-date=2018-03-28|date=2011-02-02}}</ref><ref name="urlCanadian cancer society: Precancerous conditions of the colon or rectum">{{cite web |url=http://www.cancer.ca/en/cancer-information/cancer-type/colorectal/colorectal-cancer/precancerous-conditions/?region=on |title= Precancerous conditions of the colon or rectum |work= Canadian cancer society |access-date=2018-03-19}}</ref><ref name="urlCanadian cancer society: Precancerous conditions of the esophagus">{{cite web |url=http://www.cancer.ca/en/cancer-information/cancer-type/esophageal/esophageal-cancer/precancerous-conditions/?region=qc |title= Precancerous conditions of the esophagus |work= Canadian cancer society|access-date=2018-03-19}}</ref> Clinically, precancerous conditions encompass a variety of abnormal tissues with an increased risk of developing into cancer. Some of the most common precancerous conditions include certain colon polyps, which can progress into colon cancer, monoclonal gammopathy of undetermined significance, which can progress into multiple myeloma or myelodysplastic syndrome,<ref name="Korde_2011">{{cite journal | vauthors = Korde N, Kristinsson SY, Landgren O | title = Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM): novel biological insights and development of early treatment strategies | journal = Blood | volume = 117 | issue = 21 | pages = 5573–5581 | date = May 2011 | pmid = 21441462 | pmc = 3316455 | doi = 10.1182/blood-2011-01-270140 }}</ref> and cervical dysplasia, which can progress into cervical cancer.<ref name="urlCanadian cancer society: Precancerous conditions of the cervix">{{cite web |url=http://www.cancer.ca/en/cancer-information/cancer-type/cervical/cervical-cancer/precancerous-conditions/?region=sk |title= Precancerous conditions of the cervix |work= Canadian cancer society |access-date=2018-03-19}}</ref> Bronchial premalignant lesions can progress to squamous cell carcinoma of the lung.<ref>{{cite journal | vauthors = Beane J, Mazzilli SA, Tassinari AM, Liu G, Zhang X, Liu H, Buncio AD, Dhillon SS, Platero SJ, Lenburg ME, Reid ME, Lam S, Spira AE | display-authors = 6 | title = Detecting the Presence and Progression of Premalignant Lung Lesions via Airway Gene Expression | journal = Clinical Cancer Research | volume = 23 | issue = 17 | pages = 5091–5100 | date = September 2017 | pmid = 28533227 | pmc = 7404813 | doi = 10.1158/1078-0432.CCR-16-2540 }}</ref>
Pathologically, precancerous tissue can range from benign neoplasias, which are tumors which don't invade neighboring normal tissues or spread to distant organs, to dysplasia,<ref name="NCI Dictionary of Cancer Terms"/> a collection of highly abnormal cells which, in some cases, has an increased risk of progressing to anaplasia and invasive cancer which is life-threatening. Sometimes, the term "precancer" is also used for carcinoma in situ, which is a noninvasive cancer that has not grown and spread to nearby tissue, unlike the invasive stage. As with other precancerous conditions, not all carcinoma in situ will become an invasive disease but is at risk of doing so.
==Classification== The term precancerous or premalignant condition may refer to certain conditions, such as monoclonal gammopathy of unknown significance, or to certain lesions, such as colorectal adenoma (colon polyps), which have the potential to progress into cancer (see: Malignant transformation). Premalignant lesions are morphologically atypical tissue which appear abnormal when viewed under the microscope, and which are more likely to progress to cancer than normal tissue.<ref name=":0" /> Precancerous conditions and lesions affect a variety of organ systems, including the skin, oral cavity, stomach, colon, lung, and hematological system. Some authorities also refer to hereditary genetic conditions which predispose to developing cancer, such as hereditary nonpolyposis colorectal cancer, as a precancerous condition, as individuals with these conditions have a much higher risk of developing cancer in certain organs.<ref name="urlCanadian cancer society: Precancerous conditions of the esophagus"/>
==Signs and symptoms== The signs and symptoms of precancerous conditions differ based on the organ affected. In many cases, individuals with precancerous conditions do not notice any symptoms. Precancerous conditions of the skin or oral cavity can appear as visible lesions without associated pain or discomfort,<ref name=":0">{{cite journal | vauthors = Yardimci G, Kutlubay Z, Engin B, Tuzun Y | title = Precancerous lesions of oral mucosa | journal = World Journal of Clinical Cases | volume = 2 | issue = 12 | pages = 866–872 | date = December 2014 | pmid = 25516862 | pmc = 4266835 | doi = 10.12998/wjcc.v2.i12.866 | doi-access = free }}</ref> while precancerous conditions of the hematological system are typically asymptomatic, and in the case of monoclonal gammopathy of unknown significance, it may only rarely cause numbness and tingling in the hands and feet or difficulty with balance<ref>{{Cite news|url=https://www.themmrf.org/multiple-myeloma/what-is-multiple-myeloma/plasma-cell-neoplasms/mgus/|title=MGUS - MGUS Multiple Myeloma - MGUS Myeloma -Monoclonal Gammopathy|work=Multiple Myeloma Research Foundation|access-date=2018-03-28|language=en-US|archive-url=https://web.archive.org/web/20170710060058/https://www.themmrf.org/multiple-myeloma/what-is-multiple-myeloma/plasma-cell-neoplasms/mgus/|archive-date=2017-07-10}}</ref> (see: peripheral neuropathy).
==Causes== {{main|Causes of cancer}} In most cases, many risk factors for precancerous conditions and lesions are the same risk factors that determines individuals vulnerable to a specific cancer. For example, individuals with cervical or anal infection with oncogenic, or cancer causing, strains of the human papilloma virus (HPV) are at higher risk for cervical and anal cancers,<ref name=":1">{{cite journal | vauthors = Roberts JR, Siekas LL, Kaz AM | title = Anal intraepithelial neoplasia: A review of diagnosis and management | journal = World Journal of Gastrointestinal Oncology | volume = 9 | issue = 2 | pages = 50–61 | date = February 2017 | pmid = 28255426 | pmc = 5314201 | doi = 10.4251/wjgo.v9.i2.50 | doi-access = free }}</ref> as well as for cervical and anal dysplasia.<ref name=":1" /> Similarly, sun or especially UV exposure is an important risk factor for both actinic keratosis which can progress into melanomas<ref>{{cite web | url = https://www.mayoclinic.org/diseases-conditions/actinic-keratosis/symptoms-causes/syc-20354969 | title = Actinic keratosis - Symptoms and causes|work=Mayo Clinic|access-date=2018-03-28 }}</ref> as well as skin cancer. Smoking is a risk factor for premalignant (as well as malignant) lung lesions. Hereditary conditions that are risk factors to cancer can also be risk factors to premalignant lesions. However, in many cases, precancerous conditions or lesions can be sporadic and idiopathic in nature, meaning that they are not associated with a hereditary genetic risk factor to the particular cancer, nor with a direct causative agent or other identifiable cause.<ref name=":2">{{cite journal | vauthors = Willimsky G, Czéh M, Loddenkemper C, Gellermann J, Schmidt K, Wust P, Stein H, Blankenstein T | display-authors = 6 | title = Immunogenicity of premalignant lesions is the primary cause of general cytotoxic T lymphocyte unresponsiveness | journal = The Journal of Experimental Medicine | volume = 205 | issue = 7 | pages = 1687–1700 | date = July 2008 | pmid = 18573907 | pmc = 2442645 | doi = 10.1084/jem.20072016 }}</ref>
==Pathophysiology== {{main|Carcinogenesis}} thumb|Stepwise progression from normal tissue to precancerous lesion to invasive cancer The pathophysiology of precancerous lesions is thought to be similar to that of cancer, and also varies depending on the disease site and type of lesion.<ref>{{cite journal | vauthors = Hyndman IJ | title = Review: the Contribution of both Nature and Nurture to Carcinogenesis and Progression in Solid Tumours | journal = Cancer Microenvironment | volume = 9 | issue = 1 | pages = 63–69 | date = April 2016 | pmid = 27066794 | pmc = 4842185 | doi = 10.1007/s12307-016-0183-4 }}</ref> It is thought that cancer is always preceded by a clinically silent premalignant phase during which many oncogenic genetic and epigenetic alterations accumulate before it is truly malignant. The duration of this premalignant phase can vary from cancer to cancer, disease site to site and from individual to individual.<ref name=":2" /> Increasing evidence suggests that the evasion of the immune system occurs in premalignant lesions,<ref>{{cite journal | vauthors = Mascaux C, Angelova M, Vasaturo A, Beane J, Hijazi K, Anthoine G, Buttard B, Rothe F, Willard-Gallo K, Haller A, Ninane V, Burny A, Sculier JP, Spira A, Galon J | display-authors = 6 | title = Immune evasion before tumour invasion in early lung squamous carcinogenesis | journal = Nature | volume = 571 | issue = 7766 | pages = 570–575 | date = July 2019 | pmid = 31243362 | doi = 10.1038/s41586-019-1330-0 | s2cid = 195657244 | url = https://dipot.ulb.ac.be/dspace/bitstream/2013/291316/4/Mascaux_et_al-2019-Nature.pdf }}</ref> and that the nature of the first immune response to these lesions may determine if they progress to cancer or regress to normal tissue.<ref>{{cite journal | vauthors = Maoz A, Merenstein C, Koga Y, Potter A, Gower AC, Liu G, Zhang S, Liu H, Stevenson C, Spira A, Reid ME, Campbell JD, Mazzilli SA, Lenburg ME, Beane J | display-authors = 6 | title = Elevated T cell repertoire diversity is associated with progression of lung squamous cell premalignant lesions | journal = Journal for Immunotherapy of Cancer | volume = 9 | issue = 9 | article-number = e002647 | date = September 2021 | pmid = 34580161 | pmc = 8477334 | doi = 10.1136/jitc-2021-002647 }}</ref><ref>{{cite journal | vauthors = Beane JE, Mazzilli SA, Campbell JD, Duclos G, Krysan K, Moy C, Perdomo C, Schaffer M, Liu G, Zhang S, Liu H, Vick J, Dhillon SS, Platero SJ, Dubinett SM, Stevenson C, Reid ME, Lenburg ME, Spira AE | display-authors = 6 | title = Molecular subtyping reveals immune alterations associated with progression of bronchial premalignant lesions | journal = Nature Communications | volume = 10 | issue = 1 | page = 1856 | date = April 2019 | pmid = 31015447 | pmc = 6478943 | doi = 10.1038/s41467-019-09834-2 | bibcode = 2019NatCo..10.1856B }}</ref>
==Examples== ===Skin=== * actinic keratosis<ref name="urlActinic Keratosis">{{cite web |url=https://www.skincancer.org/skin-cancer-information/actinic-keratosis |title=Actinic Keratosis |work= skincancer.org |access-date=2018-03-19}}</ref> * Bowen's disease (intraepidermal carcinoma/squamous carcinoma ''in situ'') * dyskeratosis congenita
===Breast=== * ductal carcinoma in situ * lobular carcinoma in situ * Sclerosing adenosis * Small duct papilloma
===Head and neck/oral=== * oral submucous fibrosis * erythroplakia * lichen planus (oral) * leukoplakia * proliferative verrucous leukoplakia<ref name=":0" /> * stomatitis nicotina<ref>{{cite journal | vauthors = Neville BW, Day TA | title = Oral cancer and precancerous lesions | journal = CA: A Cancer Journal for Clinicians| volume = 52 | issue = 4 | pages = 195–215 | date = July 2002 | pmid = 12139232 | doi = 10.3322/canjclin.52.4.195 | s2cid = 3238352 | doi-access = free }}</ref>
===Gastrointestinal=== * Barrett's esophagus * atrophic gastritis * colon polyp * Plummer-Vinson syndrome (sideropenic dysphagia)<ref name=":0" /> * hereditary nonpolyposis colorectal cancer<ref name=":0" /> *Ulcerative colitis *Crohn's disease '''<big>Respiratory</big>'''
* Bronchial premalignant lesions
===Gynecological=== * cervical dysplasia (cervical intraepithelial neoplasm, CIN) * vaginal intraepithelial neoplasm (VAIN)<ref>{{Cite web|url=https://www.cancer.org/cancer/vaginal-cancer/about/what-is-vaginal-cancer.html|title=What Is Vaginal Cancer?|website=www.cancer.org|language=en|access-date=2018-03-28}}</ref> * anal dysplasia (also see: anal cancer) * lichen sclerosus * Bowen's disease (penile or vulvar)<ref name=":3">{{cite journal | vauthors = Arya M, Kalsi J, Kelly J, Muneer A | title = Malignant and premalignant lesions of the penis | journal = BMJ | volume = 346 | article-number = f1149 | date = March 2013 | pmid = 23468288 | doi = 10.1136/bmj.f1149 | s2cid = 33771829 }}</ref> * erythroplasia of Queyrat<ref name=":3" />
===Urological=== * bladder carcinoma ''in situ''<ref>{{Cite web|url=https://www.cancer.org/cancer/bladder-cancer/detection-diagnosis-staging/staging.html|title=Bladder Cancer Staging {{!}} Bladder Cancer Stages|website=www.cancer.org|language=en|access-date=2018-03-28}}</ref>
===Hematological=== * monoclonal gammopathy of unknown significance
== References == {{Reflist}}
== External links == {{wiktionary|premalignant|precancerous}}
{{Medical resources | DiseasesDB = | ICD10 = | ICD9 = | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = D011230 }}
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Category:Oncology Category:Medical terminology