CANCER

Cancer is classified based on the type of cells that grow uncontrollably. Here are the major types of
cancer:

1. Carcinomas (Epithelial Cell Cancers)

 Most common type of cancer.

 Originate in the epithelial cells (skin or tissue lining organs).
 Includes cancers of the breast, lung, colon, prostate, pancreas, and skin.
 Examples:
o Adenocarcinoma – Develops in mucus-secreting glands (e.g., lung, breast, pancreas).
o Squamous Cell Carcinoma – Forms in the flat epithelial cells (e.g., skin, esophagus).
o Basal Cell Carcinoma – A common type of skin cancer.

2. Sarcomas (Connective Tissue Cancers)

 Arise in the bones, muscles, fat, cartilage, and blood vessels.

 More common in children than adults.
 Examples:
o Osteosarcoma – Bone cancer.
o Liposarcoma – Cancer of fat tissue.
o Chondrosarcoma – Cartilage cancer.
o Leiomyosarcoma – Smooth muscle cancer.

3. Leukemias (Blood and Bone Marrow Cancers)

 Cancer of blood-forming tissues, such as bone marrow.

 Leads to excessive production of abnormal white blood cells.
 Does not form solid tumors.
 Examples:
o Acute Lymphoblastic Leukemia (ALL) – Common in children.
o Chronic Myeloid Leukemia (CML) – Affects adults.
o Acute Myeloid Leukemia (AML) – Rapidly progressing blood cancer.

4. Lymphomas (Lymphatic System Cancers)

 Cancer of the lymph nodes and immune system cells (lymphocytes).

 Divided into two main types:
o Hodgkin’s Lymphoma (HL) – Characterized by Reed-Sternberg cells.
o Non-Hodgkin’s Lymphoma (NHL) – More common, with many subtypes.

5. Myelomas (Plasma Cell Cancers)

  Cancer of plasma cells in the bone marrow.
 Leads to abnormal antibody production.
 Example:
o Multiple Myeloma – Causes bone damage and immune system problems.

6. Brain and Spinal Cord Cancers (CNS Tumors)

 Originate in the central nervous system (CNS).

 Can be benign (non-cancerous) or malignant (cancerous).
 Examples:
o Glioblastoma – Aggressive brain tumor.
o Meningioma – Develops in the meninges (brain and spinal cord lining).
o Astrocytoma – Originates from astrocyte cells in the brain.

7. Germ Cell Tumors

 Develop from reproductive cells (sperm or egg cells).

 Can be found in the testes, ovaries, or even other body parts.
 Examples:
o Testicular Cancer (Seminoma, Non-seminoma).
o Ovarian Germ Cell Tumors.

8. Neuroendocrine Tumors

 Arise from neuroendocrine cells, which have both nerve and hormonal functions.
 Can be benign or malignant.
 Example:
o Carcinoid Tumor – Often affects the gastrointestinal (GI) tract or lungs.

9. Melanoma (Skin Pigment Cell Cancer)

 Cancer of melanocytes, the cells that produce melanin (skin pigment).

 Highly aggressive if untreated.
 Can also develop in the eyes and mucous membranes.
CARCINOMA
Carcinoma – A Detailed Explanation

Carcinoma is a type of cancer that originates in epithelial cells, which are the cells that line the surface of the body
and its organs. These cancers can develop in various tissues, including the skin, lungs, colon, breast, and prostate.
Carcinomas are the most common type of cancer and generally grow slowly but can spread to other parts of the
body if not treated.

What Are Epithelial Cells?

 Epithelial cells are the lining cells that cover the outer surfaces of the body (skin) and line internal organs
(lungs, digestive tract, etc.).

 They also form glands (like sweat glands or mucous glands), responsible for secretions like mucus,
hormones, and digestive enzymes.

 Squamous Epithelial Cells

 Cuboidal Epithelial Cells
 Columnar Epithelial Cells
 Transitional Epithelial Cells
 Ciliated Epithelial Cells
 Stratified Epithelial Cells
 Glandular Epithelial Cells

Types of Carcinoma

Carcinomas are classified based on the type of epithelial cell from which they arise. There are two primary
categories: adenocarcinomas and squamous cell carcinomas, among others.

1. ADENOCARCINOMA,
Adenocarcinomas arise from glandular epithelial cells, which are specialized in secreting substances such as mucus,
digestive enzymes, and hormones. Adenocarcinomas are the most common type of carcinoma in many organs,
including the lungs, colon, breast, pancreas, and prostate.

a) Lung Adenocarcinoma

 Most common type of non-small cell lung cancer (NSCLC).

 Often arises in the outer regions of the lungs and is typically linked to smoking and air pollution but can
also occur in non-smokers.

 Symptoms: Persistent cough, chest pain, shortness of breath, coughing up blood.

 Diagnosis: CT scan, biopsy, and molecular testing for targeted therapies like EGFR inhibitors.

 Treatment: Surgery (lobectomy), chemotherapy, radiation, and targeted therapies (e.g., EGFR inhibitors).

b) Colorectal Adenocarcinoma

 Arises from the lining of the colon or rectum.

 Often starts as a benign polyp, which can develop into cancer over time.

 Symptoms: Blood in stool, changes in bowel habits (diarrhea/constipation), unexplained weight loss,
abdominal discomfort.

 Diagnosis: Colonoscopy, biopsy, blood tests (CEA levels), CT scan.

 Treatment: Surgery (colectomy), chemotherapy, radiation, targeted therapies (e.g., EGFR inhibitors).

c) Breast Adenocarcinoma
  The most common form of breast cancer, arising from the milk-producing glands (lobules) or milk ducts.

 Symptoms: Lump in the breast, skin changes (redness, dimpling), nipple discharge.

 Diagnosis: Mammography, biopsy, ultrasound, and molecular testing (e.g., HER2 status).

 Treatment: Surgery (mastectomy or lumpectomy), chemotherapy, radiation, hormone therapy (if ER-
positive), targeted therapy (e.g., Herceptin for HER2-positive cases).

d) Prostate Adenocarcinoma

 Most common type of prostate cancer; arises from the glandular tissue of the prostate.

 Symptoms: Difficulty urinating, blood in urine, frequent urination, pain in the pelvic area or lower back.

 Diagnosis: Prostate-specific antigen (PSA) test, digital rectal exam (DRE), biopsy.

 Treatment: Surgery (prostatectomy), radiation, hormone therapy, chemotherapy, and targeted therapies
(e.g., enzalutamide for castration-resistant prostate cancer).

e) Pancreatic Adenocarcinoma

 Most common form of pancreatic cancer; originates in the pancreatic duct cells or exocrine glands.

 Symptoms: Jaundice (yellowing of the skin), unexplained weight loss, abdominal pain, nausea, and
vomiting.

 Diagnosis: CT scan, MRI, biopsy, blood tests (CA19-9).

 Treatment: Surgery (Whipple procedure), chemotherapy (e.g., FOLFIRINOX), radiation, and targeted
therapies.

f) Gastric Adenocarcinoma (Stomach Cancer)

 Most common type of stomach cancer, originating in the gastric mucosa (lining of the stomach).

 Symptoms: Indigestion, nausea, vomiting, weight loss, loss of appetite, and blood in stool.

 Diagnosis: Endoscopy, biopsy, CT scan, blood tests.

 Treatment: Surgery (gastrectomy), chemotherapy, radiation, and targeted therapy.

2. SQUAMOUS CELL CARCINOMA

Squamous cell carcinomas originate from squamous epithelial cells, which are flat and scale-like cells that form the
outer layer of the skin and line several organs. These carcinomas tend to grow rapidly and are more likely to spread
than adenocarcinomas.

a) Skin Squamous Cell Carcinoma

 Second most common type of skin cancer (after basal cell carcinoma).

 Typically occurs on sun-exposed areas like the face, ears, neck, hands, and forearms.

 Symptoms: Firm, red nodule, or a scaly, crusted patch that may bleed or ulcerate.

 Diagnosis: Physical exam, biopsy.

 Treatment: Surgical excision, Mohs surgery, cryotherapy, radiation therapy.

b) Lung Squamous Cell Carcinoma

 One of the types of non-small cell lung cancer (NSCLC), originating in the squamous epithelial cells of the
lung.

 Symptoms: Chronic cough, chest pain, coughing up blood, difficulty breathing.

 Diagnosis: Chest X-ray, CT scan, biopsy.

 Treatment: Surgery, chemotherapy, radiation therapy, and targeted therapy (e.g., EGFR inhibitors).
c) Esophageal Squamous Cell Carcinoma

 Arises from the squamous cells in the lining of the esophagus.

 Symptoms: Difficulty swallowing, weight loss, chest pain, regurgitation of food.

 Diagnosis: Endoscopy, biopsy, CT scan.

 Treatment: Surgery, radiation, chemotherapy.

d) Head and Neck Squamous Cell Carcinoma

 Common in the mouth, throat, and larynx, typically linked to smoking and alcohol consumption.

 Symptoms: Sores in the mouth, hoarseness, difficulty swallowing, ear pain, and persistent cough.

 Diagnosis: Physical exam, biopsy, CT/MRI.

 Treatment: Surgery, radiation, chemotherapy, and immunotherapy (e.g., nivolumab).

3. Transitional Cell Carcinoma

Transitional cell carcinoma (TCC) originates in transitional epithelial cells, which are unique cells that can stretch
and contract, found in organs like the bladder, ureters, and renal pelvis.

a) Bladder Transitional Cell Carcinoma

 Most common type of bladder cancer.

 Symptoms: Blood in the urine, frequent urination, pain during urination, and lower abdominal pain.

 Diagnosis: Urine tests, cystoscopy, biopsy, CT scan.

 Treatment: Surgery (cystectomy), chemotherapy, immunotherapy (e.g., BCG vaccine), and radiation.

4. Basal Cell Carcinoma

Although technically a non-melanoma skin cancer, basal cell carcinoma (BCC) is a

type of carcinoma that arises from the basal cells in the epidermis. It is the most
common form of skin cancer and tends to grow slowly.

 Symptoms: Shiny, pearly bump or a red patch of skin, often on sun-

exposed areas like the face and neck.

 Treatment: Surgical excision, Mohs surgery, cryotherapy, and topical

treatments.

5. Rare Carcinomas

There are also rare types of carcinomas, including:

 Renal Cell Carcinoma (Kidney Cancer): Arises from the renal tubules of the kidneys.

 Endometrial Adenocarcinoma: Arises from the lining of the uterus.

 Cervical Squamous Cell Carcinoma: Often caused by HPV infection.

SARCOMA
Sarcomas are a rare and diverse group of cancers that originate in connective tissues, such as muscle,
bone, fat, cartilage, blood vessels, and other supportive tissues. These cancers are different from
carcinomas, which arise from epithelial cells. Sarcomas can occur anywhere in the body but are most
commonly found in the arms, legs, and torso. They are classified based on the type of tissue from which
they arise.

1. Types of Sarcoma
Sarcomas are broadly categorized into two groups: soft tissue sarcomas and bone sarcomas. Within these
two groups, there are several specific subtypes, each associated with a particular type of tissue.

a) Soft Tissue Sarcomas

These sarcomas arise in the soft tissues of the body, such as muscles, fat, blood vessels, nerves, and deep
skin tissues. They account for approximately half of all sarcomas.

Common Subtypes of Soft Tissue Sarcomas:

 Liposarcoma
o Originates in fat cells.
o Most commonly found in the abdomen, thigh, or retroperitoneum (area behind the abdominal
cavity).
o Symptoms: A painless lump or swelling.
o Treatment: Surgery, radiation, and sometimes chemotherapy.

 Leiomyosarcoma
o Arises from smooth muscle tissue (involuntary muscles found in organs like the intestines or blood
vessels).
o Often found in the uterus, stomach, or blood vessels.
o Symptoms: Abdominal pain, swelling, and gastrointestinal issues.
o Treatment: Surgery, chemotherapy, and radiation.

 Rhabdomyosarcoma
o Develops in skeletal muscle tissue (voluntary muscles used for movement).
o More common in children and adolescents.
o Symptoms: A painless lump, swelling, or pain depending on the location.
o Treatment: Surgery, chemotherapy, and radiation.

 Angiosarcoma
o Originates in the blood vessels or lymphatic vessels.
o Commonly affects the skin, liver, and breast.
o Symptoms: Bruising, swelling, or a purple-colored skin lesion.
o Treatment: Surgery, chemotherapy, and radiation.

 Fibrosarcoma
o Arises from fibrous tissue (the tissue that forms tendons, ligaments, and muscles).
o Most often found in the legs, arms, or trunk.
o Symptoms: A painless, firm lump that can grow over time.
o Treatment: Surgery and chemotherapy.
  Synovial Sarcoma
o Typically occurs in the joint spaces or tendons of the arms or legs, most commonly in adolescents
and young adults.
o Symptoms: Painful swelling near a joint, limited range of motion.
o Treatment: Surgery, radiation, and chemotherapy.

 Malignant Peripheral Nerve Sheath Tumor (MPNST)

o Arises in the nerves or their coverings.
o Associated with neurofibromatosis (a genetic condition).
o Symptoms: Pain, swelling, or neurological issues like numbness or tingling.
o Treatment: Surgery, chemotherapy, and radiation.

b) Bone Sarcomas

Bone sarcomas are cancers that develop in the bones of the body. These sarcomas are relatively rare and
tend to affect younger individuals, although they can occur at any age.

Common Subtypes of Bone Sarcomas:

 Osteosarcoma
o The most common type of bone sarcoma, typically affecting children and young adults.
o Often found in the long bones (arms and legs), especially around the knee.
o Symptoms: Pain, swelling, or a noticeable lump near a bone.
o Treatment: Surgery (amputation or limb-sparing surgery), chemotherapy, and sometimes radiation.

 Chondrosarcoma
o Originates in cartilage cells and is more common in adults (especially over 40 years of age).
o Typically found in the pelvis, legs, or arms.
o Symptoms: Pain, swelling, or limited movement in the affected area.
o Treatment: Surgery (sometimes with radiation or chemotherapy).

 Ewing Sarcoma
o A highly aggressive bone cancer that usually affects children and adolescents.
o Most commonly found in the pelvis, legs, and arms.
o Symptoms: Bone pain, swelling, and tenderness.
o Treatment: Surgery, chemotherapy, and radiation.

 Fibrosarcoma (Bone)
o A rare type of sarcoma that originates in fibrous tissue in bones.
o Symptoms: Swelling, pain, and sometimes fractures.
o Treatment: Surgery, chemotherapy, and radiation.
LEUKEMIA – DETAILED EXPLANATION
Leukemia is a type of cancer that originates in the blood-forming tissues of the body, primarily the bone
marrow and lymphatic system. It involves the uncontrolled production of abnormal white blood cells,
which are crucial for fighting infections. These abnormal cells crowd out normal blood cells, leading to
problems with infection control, bleeding, and oxygen transport.

Leukemia can be categorized into different types based on its speed of progression and the type of blood
cells affected. Below is a detailed look at the disease:

1. Types of Leukemia
a) Acute Leukemia

Acute leukemia progresses rapidly and requires immediate treatment. It involves the rapid accumulation of
immature blood cells, preventing the bone marrow from producing healthy blood cells.

 Acute Lymphocytic Leukemia (ALL)

o Affects the lymphoid cells (immature white blood cells).
o Most common in children, but it can occur at any age.
o Symptoms: Fatigue, fever, easy bruising or bleeding, frequent infections, pale skin, and swollen
lymph nodes.
o Treatment: Chemotherapy, stem cell transplant, and sometimes targeted therapies.
 Acute Myeloid Leukemia (AML)
o Involves the myeloid cells (cells that normally develop into red blood cells, white blood cells, and
platelets).
o More common in adults, especially those aged 65 and older.
o Symptoms: Fever, fatigue, pallor, easy bruising or bleeding, and frequent infections.
o Treatment: Chemotherapy, stem cell transplant, and sometimes targeted therapies.
b) Chronic Leukemia

Chronic leukemia progresses more slowly, allowing the body to function normally for a period before
symptoms arise. The abnormal white blood cells mature more slowly.

 Chronic Lymphocytic Leukemia (CLL)

o Involves the lymphoid cells, similar to ALL but progressing much more slowly.
o Most common in older adults, particularly those over the age of 60.
o Symptoms: Swollen lymph nodes, fatigue, weight loss, fever, and frequent infections.
o Treatment: Chemotherapy, targeted therapy, and sometimes stem cell transplant.

 Chronic Myeloid Leukemia (CML)

o Involves the myeloid cells and is characterized by the presence of a specific genetic mutation
known as the Philadelphia chromosome.
o More common in adults.
o Symptoms: Fatigue, weight loss, swollen spleen or liver, night sweats, and a feeling of fullness.
o Treatment: Targeted therapy (such as tyrosine kinase inhibitors like imatinib), chemotherapy, and
stem cell transplant.
LYMPHOMA
1. Introduction to Lymphoma
Lymphoma is a type of cancer that originates in the lymphatic system, which is part of the body's
immune system. It involves the uncontrolled growth of abnormal lymphocytes (a type of white blood cell)
that form in the lymph nodes, spleen, bone marrow, and other lymphoid tissues. (The lymphatic system
includes your lymph nodes, bone marrow, thymus, spleen, tonsils, and lymphoid tissue in the digestive
tract.)

Lymphoma is different from leukemia, as it primarily affects solid tissues like lymph nodes rather than
circulating blood cells. It can also spread to other organs, a process known as extranodal involvement.

Types of Lymphoma
A) Hodgkin Lymphoma (HL)

 Characterized by Reed-Sternberg cells.

 Common in young adults (15–35) and older adults (55+).
 Risk Factors: Epstein-Barr virus (EBV), family history, weakened immune system.
 Symptoms: Painless swollen lymph nodes, fever, night sweats, weight loss, fatigue.
 Treatment:
o Chemotherapy (ABVD regimen)
o Radiation therapy
o Targeted therapy (Brentuximab Vedotin)
o Stem cell transplant (for relapsed cases)
 Prognosis: Highly curable; 5-year survival rate ~87%.

B) Non-Hodgkin Lymphoma (NHL)

 More common and diverse than HL (60+ subtypes).

  Does not have Reed-Sternberg cells.
 Types:
o B-cell Lymphomas (80–85%): Diffuse Large B-Cell Lymphoma (DLBCL), Follicular Lymphoma, Burkitt
Lymphoma.
o T-cell Lymphomas (15–20%): Peripheral T-cell lymphoma, Cutaneous T-cell lymphoma.
 Risk Factors: Older age (50+), immunosuppression (HIV/AIDS), infections (H. pylori, EBV), chemical
exposure.
 Symptoms: Painless swollen lymph nodes, fever, night sweats, weight loss, fatigue, organ involvement
(chest, abdomen, skin).
 Treatment:
o Chemotherapy (CHOP regimen)
o Immunotherapy (Rituximab – anti-CD20)
o Targeted therapy (Ibrutinib, CAR-T therapy)
o Radiation therapy & Stem cell transplant (for aggressive cases)
 Prognosis: Varies; indolent types are manageable, aggressive types are curable if treated early.

3. Diagnosis
 Physical exam (lymph node swelling).
 Biopsy (lymph node, bone marrow).
 Blood tests (CBC, LDH levels).
 Imaging (CT, MRI, PET scan).

4. Key Differences Between HL & NHL

Feature Hodgkin Lymphoma (HL) Non-Hodgkin Lymphoma (NHL)

Cell Type Reed-Sternberg cells No Reed-Sternberg cells

Spread Predictable, node-to-node Random, can involve organs

Age Group Young adults & elderly Mostly older adults (50+)

Common Treatment ABVD chemo, radiation CHOP chemo, immunotherapy

Curability Highly curable (87%) Depends on type (60–90%)

Myeloma – Definition and Types
Definition of Myeloma
Myeloma, also known as multiple myeloma, is a hematologic (blood) cancer that arises from plasma
cells in the bone marrow. Plasma cells are a type of white blood cell responsible for producing antibodies
that help fight infections. In myeloma, these cells become cancerous and produce abnormal antibodies
(paraproteins), leading to bone damage, weakened immunity, kidney dysfunction, and anemia.

Types of Myeloma
1. Multiple Myeloma (Most Common Type)

 Affects multiple areas of the bone marrow.

 Characterized by widespread plasma cell proliferation and production of abnormal immunoglobulins.
 Causes bone pain, fractures, kidney damage, anemia, and frequent infections.

2. Solitary Plasmacytoma

 A single, localized tumor of plasma cells, usually in bone or soft tissue.

 Patients may not show widespread bone marrow involvement.
 Treated with radiation therapy, but may progress to multiple myeloma over time.

3. Smoldering (Asymptomatic) Myeloma

 A precancerous stage with abnormal plasma cells but no symptoms.

 Patients have higher-than-normal paraprotein levels but do not yet experience organ damage.
 Regular monitoring is needed, as it may develop into active multiple myeloma.

4. Light Chain Myeloma

 A rare form where cancerous plasma cells only produce light chains (Bence Jones proteins) instead of full
immunoglobulins.
 Can lead to kidney failure and is often more aggressive.

5. Non-Secretory Myeloma

 A very rare type where cancerous plasma cells do not produce detectable paraproteins in the blood or
urine.
 Diagnosed through bone marrow biopsy and imaging.

6. Immunoglobulin D (IgD) and Immunoglobulin E (IgE) Myeloma

 IgD myeloma: Accounts for less than 2% of cases, more aggressive with high risk of kidney damage.
 IgE myeloma: Extremely rare and aggressive form with poor prognosis.
MELANOMA
1. What is Melanoma?
Melanoma is an aggressive type of
skin cancer that originates in the
melanocytes, the pigment-producing
cells responsible for skin color
(melanin). Although it primarily
affects the skin, it can also occur in
the eyes (ocular melanoma) and,
rarely, in internal organs.

Definition of Melanoma

Melanoma is a malignant tumor that arises from melanocytes, the pigment-producing cells found
primarily in the epidermis (outer layer of the skin). These melanocytes produce melanin, the pigment
responsible for skin, hair, and eye color. Melanoma is considered the most aggressive and dangerous
form of skin cancer because of its high potential for metastasis (spreading to other organs) if not
detected early.

Melanoma can develop de novo (on normal skin) or arise from a pre-existing mole (nevus) that
undergoes cancerous changes. It most commonly appears on sun-exposed areas like the face, arms, legs,
and back, but it can also occur on areas with little sun exposure, such as the palms, soles, under nails, or
inside mucosal surfaces (e.g., mouth, eyes, genitals).

Melanoma is classified as a cutaneous (skin) malignancy, but it can also develop in non-cutaneous sites,
such as the eye (ocular melanoma) and internal mucosal surfaces (mucosal melanoma).

Key Characteristics of Melanoma

 Originates from melanocytes in the skin, mucosa, or eyes.

 Can appear as a new lesion or a changing mole.
 Highly aggressive, with a high risk of invading lymph nodes and distant organs.
 Associated with ultraviolet (UV) radiation exposure, but can also occur in sun-protected areas.

2. Causes & Risk Factors

 Excessive UV Radiation Exposure (sunlight, tanning beds).
 Fair Skin, Light Hair, and Light Eyes (less melanin means lower UV protection).
 Family History of Melanoma.
 Having Many Moles (Nevi) or Atypical Moles.
 Weakened Immune System.
 Severe Sunburns (especially in childhood or adolescence).

3. Symptoms – ABCDE Rule of Melanoma

A simple way to identify suspicious moles or skin changes:
  A – Asymmetry: One half of the mole doesn’t match the other.
 B – Border irregularity: Edges are uneven, ragged, or blurred.
 C – Color variation: Multiple colors (brown, black, red, white, or blue) in a single mole.
 D – Diameter: Larger than 6 mm (size of a pencil eraser).
 E – Evolution: Changes in size, shape, or symptoms (itching, bleeding).

4. Types of Melanoma
1. Superficial Spreading Melanoma (Most Common, ~70%)

 Grows outward first (horizontal growth phase) before invading deeper layers.
 Appears as a flat, irregular, multicolored mole.

2. Nodular Melanoma (Aggressive, ~15–20%)

 Grows rapidly and vertically (deep into the skin).

 Appears as a raised, firm, dark-colored or skin-colored lump.

3. Lentigo Maligna Melanoma (Older Adults, ~10%)

 Develops from long-standing sun damage, common in the elderly.

 Begins as a slow-growing, flat brown spot before becoming invasive.

4. Acral Lentiginous Melanoma (Rare, but Common in Dark-Skinned Individuals)

 Occurs on palms, soles, or under nails.

 Not related to sun exposure.

5. Ocular (Uveal) Melanoma

 Affects the eye, particularly the uvea (middle layer of the eye).
 Can cause blurred vision, floaters, or changes in iris color.

5. Stages of Melanoma
 Stage 0 (In situ) – Confined to the epidermis, highly curable.
 Stage I-II – Localized but deeper; treatment depends on thickness.
 Stage III – Spread to nearby lymph nodes.
 Stage IV (Metastatic Melanoma) – Cancer has spread to distant organs (lungs, liver, brain, bones).