The question posed is interesting but I reverse the question. there is of course cancer more aggressive and other less but everybody has his cancer. A cancer in one person even if aggressive may grow slowly in another person may grow faster. The agressiveness may depend from many factors and not less important in primis in the environment where they grow and the resistance to drugs. On the other part sarcomas are aggressive as carcinomas but their treatment may be more hard and generally strike young persons.

This question is quite tricky, when it comes to aggressiveness. Carcinoma is the most common type of cancer and hence quite well explored and easily diagnosed. Sarcoma is rare and hard to detect and diagnose and not well explored due to its rareness. So, for a cancer patient, it is more dangerous to have a news of being diagnosed with sarcoma rather than carcinoma.

The aggressiveness can be rated on metastasis scale. Grading system looks very good in books but when it comes to treatment, till date surgery is the best option opted for cancer patients.

This question is too big to be a question. It can not be a research project and review title. They are different, and both include many different types which have different behaviors. If you want one clear answer, it is impossible.

Carcinomas are more common than sarcomas...Since sarcomas are pretty rare, their diagnosis also happens at a delayed stage. Therefore the treatment option becomes pretty limited due to this delay. However, it cannot be said if sarcomas are more aggressive than carcinomas or vice versa, as that depends on the level of differentiation and other histopathological factors, which can apply to both, i.e. carcinomas and sarcomas.

Thank you everyone for your insights. I wanted to know if I can address the aggressiveness of cancers on a broader scale...but it seems difficult actually.

I agree with Baronzio and Gupta, the malignant tumour cells (Sarcomas or Carcenomas) enable to invade the neighbouring tissue and grow to establish a new distant secondary tumour need a unique set of genes to be involved in these complicated steps. These genes were isolated as being implicated in promotion of metastatic diseases. The malignant tumour cells enable to invade the neighbouring tissue and grow to establish a new distant secondary tumour need a unique set of genes to be involved in these complicated steps. Among them is S100A4 (also known mts1, p9Ka) gene a member influencing several steps in the metastatic cascade, including migration, invasiveness, and angiogenesis.

It is meaningless to divide cancers as carcinoma vs sarcoma when talking about prognosis - there are over 50 histotypes of soft tissue sarcoma and many different types of carcinoma. Some types of sarcoma are extremely aggressive and definitionally high grade, whereas others are much more indolent and have a fairly good outlook even if diagnosed fairly late. The same is essentially true for carcinoma - a basal cell carcinoma of the skin is a quite different story from adenocarcinoma of pancreas!

Carcinomas

There is much beyond classifying cancers into carcinomas and sarcomas, and then looking into their prognosis. Several groups of cancers like lymphomas, leukemias, malignant histiocytomas, malignant melanomas, malignant teratomas,cancers of the nervous tissue origin do not fall into either of carcinoma or sarcoma categories, and in addition, some of them may have worse prognosis than both of these. Moreover, there are many sub-types within many cancer type( for example breast cancer is a congregation of many heterogenous variants) depending upon expression of bio-markers, grade, stage, molecular and genetic profiling and cancer biology in-toto that determine the prognosis. The host factors such as his/her overall immune status, age,genetic polymorphism, inherited mutations of gatekeeper and caretaker genes, habits and habitat, including environment, micro-environment, location of the cancer and its hemodynamics coupled with response to therapy, all play a subtle role in deciding the final outcome in cancer patients. Therefore, it seems impossible to address this question as such.

Thank you everyone for your insights.Which one is the most aggressive ?.sometimes basal cell carcinoma,sometimes melanoma . I think that the aggressiveness depends on the patient's nature and the treatment modality at the beginning !

The accurate answer for this question is that this depends on the exact type of the sarcoma or the carcinoma.There are some types of sarcomas which are locally aggressive and can be cured by good excision.Early carcinomas can also be cured by resection.So, it depends on the type of the tumor, grade, and stage and the organ involved.

To my mind, the question asked can join the point of the prognosis of a tumor in a defined person.

That's an initial scoring (most often clinical) based onthe determination of factors involved in this prognosis: histoloy , comprising cell type, invasion of narrow tissues, pass through the basal membrane is one of the factor used in scoring. But we see that different colleagues spoke about "interaction" of the tumor with the patient, and his/her immune system. Often, the problem is that we cannot exactly defined a "weight" of each risk factor based on objective data (in most of scoring, "one point" given to each one). So, consequently the impression we can have that a same tumor (cytologically) seems to have not the same evolution according to the patient, and also, evidently, the step of diagnosis. In fact, the earlier the diagnostic is made, the better is the prognosis. And a rare tumor, with a less use to be diagnosed, are discovered at a more late stage than the most frequent, with a poor prognosis independently of the cell type . "Agressiveness" is a general term not only linked to cellular data.

Regards

Didier

Carcinomas and sarcomas cover a spectrum on sub-types and some carcinomas are more aggressive than sarcomas and vice versa. Top dog in aggressiveness probably goes to anaplastic carcinoma of the lung but post-radiation sarcoma probably comes a close second. In terms of the least aggressive it would be difficult to pick between basal cell carcinoma of the skin and secondary chondrosarcoma from an exostosis.

I agree with Mark considering cytologic prognosis factors.

As we spoke about carcinomna and sarcoma, I had not underlined the case of malgnant hemopathies (my field), but it's the same for "primary and secondary leukemia": undifferentiated leukemia versus differentiated ones ; which could be compared to anaplastic tumors versus others.

Leukemia occuring secondary to myelodysplasic syndrom (MDS), or secondary to solid tumors treated by alkylated drug or radiations, have a less good prognosis than primary acute leukemia, with much more accumulated mutations than "primary" tumors.

Regards

Didier

I agree with Didier and Thamir genetics plays an important role in aggressivness but also epigenetics (effects of microenvironment: nutritional status (i.e. deficiency in Se, Zn, etc., high glucose intake), immune status with high inflammatory status may favor agressivness ? Do you agree?

From the End Results that can be obtained from Therapy or by the Natural History in Carcinomas -epithelial origin tumor cells, and in Sarcomas -mesenchimal origin tumor cells, it won't be very temerary saying that Sarcomas are worse Cancers than Carcinomas, however, in this, as in everything, the thing that touches you is the type of Cancer you got, the rest is not much important.

There was an old Spanish children's tale, about two rabbits, that, while being pursued by hunting dogs, engaged in a discussion about if the dogs were greyhounds or hounds. Of course, dogs caught the rabbits, something similar was the case of the 'Three blind mice'

Generalizations tend to be unaccurate, be it for the large degree of statistical dispersion in the distribution of a feature considered, or used to qualify a tumor, classically Sarcomas are graded from their hystology 0 to 4, with some peculiar inclusions as Desmoids, considered 0.5 grade tumors, i.e. a bit more dangerous than a bening tumor, these last inducing just mechanical symptoms from its bulky nature, when having it.

Epithelial tumors are also graded, and several malignancy markers exist, such as Ki-67 proliferation index.

As the prognostic and predictive factors are better known everyday, class assesments tend to loss value, and any grading, or consideraion about aggressivenes is done about the tumor present in the person in your office, at this period of time.

From data such as the 'Cancer statistics', published on a yearly basis in: 'Ca, a cancer journal for clinicians', an image of the prognosis and natural history of different tumors, from Leukemias to Carinomas to Sarcomas can be obtained. Salut