Welcome to John Theurer Cancer Center at Hackensack University Medical Center
A Leader in Cancer Care and Innovation
At the John Theurer Cancer Center, part of Hackensack University Medical Center and the Hackensack Meridian Health network, we are proud to be one of the most renowned cancer treatment centers in the United States. Recognized for our advanced technology, research excellence, and compassionate patient care, we offer comprehensive oncology services that are tailored to each individual.
Whether you're seeking cutting-edge therapies, personalized cancer treatment, or access to clinical trials, our center remains at the forefront of cancer innovation, in collaboration with institutions like the National Cancer Institute (NCI) and the American Cancer Society.
What is Cancer?
Cancer is not a single disease, but a group of related diseases characterized by the uncontrolled division of abnormal cells in the body. These cells can invade and destroy surrounding healthy tissue, and sometimes spread to other parts of the body through a process known as metastasis.
At its core, cancer begins with changes in the DNA within cells. These genetic mutations may be triggered by environmental factors (such as smoking, UV exposure, or chemicals), inherited genetic predispositions, or random errors during cell replication.
Cancer can develop in virtually any tissue or organ and can remain localized or become invasive and systemic.
Cancer symptoms vary depending on the type and location of the disease. However, some general signs to watch for include:
- Unexplained weight loss
- Persistent fatigue
- Lumps or masses that can be felt through the skin
- Changes in skin (darkening, yellowing, redness)
- Changes in bowel or bladder habits
- Difficulty swallowing or persistent indigestion
- Chronic cough or hoarseness
- Unusual bleeding or discharge
Early detection significantly improves treatment outcomes. Therefore, recognizing and acting on these symptoms is crucial.
Cancer is not caused by a single factor, but by a complex interaction of genetic, environmental, and lifestyle elements. Understanding the root causes of cancer is essential for prevention, early detection, and treatment. At leading institutions like the John Theurer Cancer Center at Hackensack University Medical Center, cutting-edge research continues to explore how these various factors contribute to the onset and progression of cancer.
1. Genetic Mutations: The Core of Cancer Development
At the cellular level, cancer begins when genetic material (DNA) in a cell becomes damaged or mutated. These mutations disrupt the normal control mechanisms that regulate cell growth, division, and apoptosis (programmed cell death).
Mutations can be:
- Inherited: Passed from parents (e.g., BRCA1/BRCA2 mutations in breast and ovarian cancers)
- Acquired: Caused by external exposures or errors during cell replication
Once enough mutations accumulate, a normal cell may transform into a cancerous (malignant) cell, capable of growing uncontrollably and invading other tissues.
3. Biological Agents and Infections
Certain viruses, bacteria, and parasites are known to cause cancer by inserting their genetic material into human cells or causing chronic inflammation.
Examples include:
- Human Papillomavirus (HPV) – Linked to cervical, anal, and throat cancers
- Hepatitis B and C : Associated with liver cancer
- Epstein-Barr Virus (EBV) – Connected to some lymphomas and nasopharyngeal cancer
- Helicobacter pylori – A bacteria that increases the risk of stomach cancer
- HIV/AIDS – Weakens the immune system and increases susceptibility to certain cancers
Vaccination and infection control can dramatically reduce the risk of infection-related cancers.
2. Environmental and Occupational Exposures
Environmental carcinogens are a leading cause of preventable cancers. Exposure to certain chemicals, radiation, and toxins can damage DNA or alter gene expression.
Key environmental causes include:
- Tobacco smoke – Responsible for ~22% of cancer deaths worldwide
- Asbestos : Linked to mesothelioma and lung cancer
- Air pollution – Increases the risk of lung and other cancers
- Pesticides and industrial chemicals – Can cause mutations over time
- Ionizing radiation : X-rays, gamma rays, and radioactive substancesRead more
Occupational exposures (e.g., benzene, formaldehyde) are also important, especially in certain industries.
4. Lifestyle and Behavioral Factors
Your daily habits and choices have a powerful impact on your cancer risk. These include:
These include:
- Smoking – A major cause of lung, oral, throat, pancreatic, and bladder cancersRead more
- Alcohol consumption – Associated with liver, breast, colon, and esophageal cancersRead more
- Unhealthy diet – High intake of processed/red meats, sugar, and low fiberRead more
- Obesity and physical inactivity – Raise risk for colorectal, endometrial, kidney, and breast cancersRead more
- Sun exposure and tanning beds – Primary cause of skin cancers like melanomaRead more
Adopting a healthy lifestyle can prevent up to 40% of all cancers, according to the World Health Organization (WHO).
6. Hormonal and Reproductive Factors
Hormones can stimulate cell division in certain tissues, increasing cancer risk.
Examples include:
- Estrogen and progesterone : Linked to breast and endometrial cancersRead more
- Testosterone – May contribute to prostate cancer developmentRead more
- Reproductive history – Early menstruation, late menopause, and not having children can influence riskRead more
Hormonal therapies (such as birth control or hormone replacement) may slightly affect risk and should be used under medical guidance.
5. Age and Cellular Aging
Cancer is more common in older adults because:
- Cells accumulate mutations over time
- The body’s ability to repair damaged DNA decreases with age
- The immune system becomes less effective at eliminating abnormal cells
This is why routine screening for cancers like colorectal, prostate, breast, and cervical is strongly recommended in individuals over 40 or 50.
7. Epigenetic Changes and Gene Regulation
In addition to genetic mutations, epigenetic changes—which alter gene activity without changing the DNA sequence—can play a role in cancer. These include:
These include:
- DNA methylation
- Histone modification
- MicroRNA dysregulation
Such changes can silence tumor suppressor genes or activate oncogenes, contributing to cancer formation. This area is a major focus in cancer epigenetics research today.
Types of Cancer
Cancer is not a single disease but a collection of over 100 distinct diseases, each classified based on the organ, tissue, or cell type from which it originates. Understanding these categories helps in selecting the most effective treatment approach and improving patient outcomes.
Below are the main types of cancer, categorized by the affected tissue or cell origin:
Carcinomas : The Most Common Type of Cancer
Carcinomas are cancers that arise from epithelial cells, which line the internal and external surfaces of the body. These are the most frequently diagnosed cancers, accounting for about 80–90% of all cancer cases.
Common Examples:
- Lung cancer : Often linked to smoking or environmental pollutants
- Breast cancer : Originates in the ducts or lobules of breast tissue
- Prostate cancer : Begins in the prostate gland cells
- Colorectal cancer : Affects the colon or rectum lining
- Skin cancer : Basal cell carcinoma and squamous cell carcinoma
Carcinomas are further divided into:
- Adenocarcinomas : Begin in glandular tissues (breast, colon)Read more
- Squamous cell carcinomas : Arise from flat epithelial cells (skin, esophagus)Read more
Sarcomas : Cancers of the Body’s Supporting Tissues
Sarcomas originate in connective or supportive tissues such as bone, cartilage, fat, muscle, and blood vessels. They are relatively rare compared to carcinomas but can be highly aggressive.
Common Examples:
- Osteosarcoma : Bone cancer, most common in children and adolescents
- Chondrosarcoma : Cancer of cartilage
- Liposarcoma : Arises in fat tissue
- Leiomyosarcoma : Develops in smooth muscle (uterus, GI tract)
Sarcomas are often treated with a combination of surgery, radiation therapy, and chemotherapy due to their ability to spread rapidly.
Leukemias : Blood and Bone Marrow Cancers
Leukemias are cancers that begin in the bone marrow and lead to the overproduction of abnormal white blood cells, which interfere with normal blood cell function.
Unlike other cancers, leukemias usually do not form solid tumors.
Types of Leukemia:
- Acute lymphoblastic leukemia (ALL) : Common in children
- Acute myeloid leukemia (AML) : Affects both adults and children
- Chronic lymphocytic leukemia (CLL) : Develops slowly, often in older adults
- Chronic myeloid leukemia (CML) : Linked to a genetic mutation (Philadelphia chromosome)
Diagnosis often involves blood tests, bone marrow biopsy, and genetic analysis, with treatment including chemotherapy, targeted therapy, and stem cell transplantation.
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Lymphomas : Cancers of the Lymphatic System
Lymphomas affect the lymphatic system, a vital part of the immune system responsible for fighting infections and maintaining fluid balance.
There are two main categories:
- Hodgkin lymphoma (HL) : Characterized by the presence of Reed-Sternberg cells
- Non-Hodgkin lymphoma (NHL) : Includes a broad range of lymphatic cancers, some slow-growing, others aggressive
Symptoms may include swollen lymph nodes, fever, fatigue, and weight loss. Treatment options include immunotherapy, chemotherapy, radiation, and stem cell transplant.
Central Nervous System (CNS) Cancers : Brain and Spinal Cord Tumors
These cancers originate in the brain or spinal cord, and are among the most complex to treat due to their location and impact on neurological functions.
Examples:
- Glioblastoma multiforme (GBM) : Highly aggressive brain tumor
- Meningiomas –:Arise in the protective membranes covering the brain and spinal cord
- Medulloblastomas : Common in children
- Astrocytomas : Arise from star-shaped brain cells called astrocytes
Treatment often involves a combination of surgery, radiotherapy, and chemotherapy, depending on the type, grade, and location of the tumor.
Special Cases of Cancer : Rare and Hereditary Cancers
Some cancers fall outside the standard categories and require specialized diagnostic and treatment strategies:
a. Childhood Cancers
- Examples: Neuroblastoma, Wilms tumor, pediatric leukemia
- Children require unique treatment protocols and long-term care for side effects
b. Rare Cancers
- Includes: Merkel cell carcinoma, adrenal gland tumors, mesothelioma
- Often under-researched and misdiagnosed due to their rarity
c. Hereditary Cancers
- Caused by inherited genetic mutations (e.g., BRCA1/2, Lynch syndrome)
- Genetic counseling and preventive strategies (like prophylactic surgery) are often recommended
Cancer Diagnosis:
Tools and Techniques
From Physical Exams to Advanced Molecular Technologies
Diagnosing cancer accurately and at the earliest possible stage is crucial for successful treatment and improved survival rates. Today, medical science offers a wide range of diagnostic tools from basic clinical exams to cutting-edge molecular biology techniques. Here's a detailed overview of the major tools used to detect, confirm, and classify cancer.
A cancer diagnosis often begins with a routine physical exam, where the doctor checks for:
- Unusual lumps or masses
- Changes in the skin (moles or lesions)
- Abnormal swelling in lymph nodes
- Pain, fatigue, or unexpected weight loss
While not sufficient for a definitive diagnosis, this first step often leads to further testing when suspicion arises.
These tests help evaluate how the body is functioning and whether there are substances that could indicate cancer.
Blood Tests
- Tumor markers like PSA (prostate), CA-125 (ovarian), or AFP (liver)Read more
- Complete blood count (CBC) for blood cancers like leukemiaRead more
Urine and Other Fluids
May reveal abnormal protein levels or cell fragments
Histopathology
- The study of cells and tissues under the microscope after staining
- Can detect abnormal or cancerous cell structures
Imaging Techniques
Modern imaging helps to detect tumors, define their size, and determine their location or spread.
Common Imaging Methods:
X-rays: First-line tool to detect large masses or bone metastases Read more
CT (Computed Tomography): Detailed cross-sectional imaging
MRI (Magnetic Resonance Imaging): Excellent for soft tissues like the brain, spine, and muscles
Ultrasound: Non-invasive, used often in breast, thyroid, and pelvic imaging
PET scans (Positron Emission Tomography): Highlights areas of high metabolic activity, often used to detect metastasis
These tools are often combined to provide a full picture of the cancer’s status and spread (staging).
Biopsy:
The Gold Standard
A biopsy involves collecting a sample of tissue from the suspected tumor and analyzing it under a microscope. It provides the most definitive diagnosis of cancer.
Types of Biopsies:
- Fine-needle aspiration
- Core needle biopsy
- Excisional biopsy (removal of the entire mass)
- Endoscopic biopsy (from internal organs via scopes)
The tissue is analyzed to determine:
- Cancer type
- Grade (how aggressive it is)
- Stage (extent of spread)
- Presence of hormone receptors or specific proteins (for targeted therapy decisions)
Genetic and Molecular Testing
Modern oncology relies heavily on molecular techniques to detect and understand cancer on a genetic level. These tools allow:
- Early detection (even before symptoms)
- Classification of cancer subtypes
- Tailoring of personalized therapies
🔹 PCR (Polymerase Chain Reaction)
-
Amplifies small amounts of DNA/RNA to detect specific gene mutations, such as:
- BRCA1/2 (breast/ovarian cancer)
- KRAS, EGFR, BRAF (colorectal, lung, and melanoma)
- Used in detecting viral oncogenes like HPV or HBV
🔹 RT-PCR (Reverse Transcriptase PCR)
- Used to detect gene expression levels or viral RNA (e.g., HPV or EBV in tumors)
🔹 Western Blot
- Detects specific proteins in a tissue or blood sample
- Confirms presence or absence of tumor-related antigens or receptors
- Often used alongside ELISA to validate protein expression
- Useful for cancers involving abnormal protein signaling pathways
🔹 Next-Generation Sequencing (NGS) Read more
- Offers a full genomic profile of a tumor
- Detects hundreds of mutations at once
- Essential in precision oncology to guide immunotherapy and targeted treatments
Cytogenetic and Flow Cytometry Testing
These are especially important in hematologic cancers like leukemia or lymphoma.
- Cytogenetics: Analyzes chromosomes for large-scale abnormalities (e.g., Philadelphia chromosome in CML)Read more
- Flow Cytometry: Measures cell size, shape, surface proteins; used in leukemia/lymphoma diagnosis and monitoringRead more
Liquid Biopsy (Emerging Tool)
A non-invasive test that detects circulating tumor DNA (ctDNA) or cancer cells in blood. Useful for:
Useful for:
- Monitoring cancer progression
- Detecting minimal residual disease
- Screening in high-risk individuals
Treatment Options
Cancer treatment is personalized and depends on the type, stage, and overall health of the patient.
Common treatment modalities include:
- Surgery : Removal of the tumor and surrounding tissue.
- Chemotherapy : Use of drugs to kill or inhibit cancer cell growth.
- Radiation Therapy : High-energy rays targeting cancer cells.
- Immunotherapy : Boosting the immune system to fight cancer.
- Hormone Therapy : Especially in breast and prostate cancers.
- Targeted Therapy : Drugs that specifically target cancer cell molecules.
- Bone Marrow Transplant : Often used in blood cancers.
In many cases, a multidisciplinary approach combining several therapies is used to increase effectiveness.
Living with Cancer
A cancer diagnosis changes a person’s life, but support, education, and awareness make a difference. Mental health support, nutrition, physical activity, and palliative care are essential aspects of living with cancer. Survivorship and life after treatment are also important focuses of care today.