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Nuclear Oncology pp 3–19Cite as

The Cancer Biology of Molecular Imaging

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Abstract

Cancer is a complex series of stepwise genetic alterations resulting in common biologic changes in the transformed cells. Distinguishing features of cancer include rapid proliferation of cells, immortality, resistance to apoptosis, resistance to suppression of proliferation, metastatic behavior, characteristic changes in metabolism, and resistance to immunologic attack. Cancer cells recruit normal host tissues to support growth of the tumor mass. Fibrocytes and collagen producing cells provide structure for the tumor cells. Endothelial cells are recruited to form blood vessels. Tumor blood vessels have incomplete endothelium, making the vessels leaky. This allows large molecules to leak into the tumor interstitium. The middle of the tumor mass has few, if any, lymphatic vessels. The combination of vessel leakiness and few lymphatics results in an increased interstitial pressure in the tumor, making it difficult for chemotherapy to diffuse into the tumor mass.

A common anatomic approach to measure tumor response (RECIST) employs measurements of the size of the mass on CT before and 4 weeks after therapy. Total disappearance of the lesion is required for a complete response, a 30% reduction in the sum of long dimensions defines a partial response, and >20% increase in the sum of long diameters identifies progressive disease. Adding metabolic information recorded with [18F]FDG-PET/CT and the PERCIST criteria may refine these measurements. In addition to [18F]FDG, radiopharmaceuticals are available to measure other attributes of the tumor. Depending on the radiopharmaceutical, images can provide information on tumor hypoxia, expression of integrins, or specific tumor markers that are overexpressed by the lesion, such as carbonic anhydrase, expressed by renal cell cancer, or receptors, such as somatostatin, expressed on neuroendocrine tumors.

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Author information

Authors and Affiliations

  1. Nuclear Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Steven M. Larson MD

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  1. Steven M. Larson MD
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Correspondence to Steven M. Larson MD .

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Editors and Affiliations

  1. Dept. Radiology, Div. Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, York Ave. 1275, New York, 10021, New York, USA

    H. William Strauss

  2. Centro Regionale di Medicina Nucleare, Universita di Pisa, Via Roma 67, Pisa, 56100, Italy

    Giuliano Mariani

  3. Centro Regionale di Medicina Nucleare, Universita di Pisa, Via Roma 67, Pisa, 56100, Italy

    Duccio Volterrani

  4. Cancer Center, Department of Radiology, Memorial Sloan-Kettering, York Ave. 1275, New York, 10021, New York, USA

    Steven M. Larson

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Larson, S.M. (2013). The Cancer Biology of Molecular Imaging. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-48894-3_1

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  • DOI: https://doi.org/10.1007/978-0-387-48894-3_1

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