65-709: The Royal Sussex County Hospital is an acute teaching hospital in Brighton , England. Together with the Princess Royal Hospital , it is administered by the University Hospitals Sussex NHS Foundation Trust . The services provided at the hospital include an emergency department , cancer services at the Sussex Cancer Centre, cardiac surgery , maternity services, and both adult and neonatal intensive care units. The hospital
130-507: A residency program to educate qualified physicians, podiatrists , dentists , and pharmacists who are receiving training after attaining the degree of MD , DO , DPM , DDS , DMD, PharmD , BDS , BDent , MBBS, MBChB, or BMed . Those that attend a teaching hospital or clinic would practice medicine under the direct or indirect supervision of a senior medical clinician registered in that specialty, such as an attending physician or consultant . The purpose of these residency programs
195-490: A " great imitator ". People may become anxious or depressed post-diagnosis. The risk of suicide in people with cancer is approximately double. Local symptoms may occur due to the mass of the tumor or its ulceration. For example, mass effects from lung cancer can block the bronchus resulting in cough or pneumonia ; esophageal cancer can cause narrowing of the esophagus , making it difficult or painful to swallow; and colorectal cancer may lead to narrowing or blockages in
260-474: A concern. This includes that studies have not found a consistent link between mobile phone radiation and cancer risk. The vast majority of cancers are non-hereditary (sporadic). Hereditary cancers are primarily caused by an inherited genetic defect. Less than 0.3% of the population are carriers of a genetic mutation that has a large effect on cancer risk and these cause less than 3–10% of cancer. Some of these syndromes include: certain inherited mutations in
325-681: A cost of £485 million. The building is named after Louisa Martindale , a physician, surgeon and writer who worked in Brighton. In 2024 the building won two awards at the European Healthcare Design Awards, winning the 'Healthcare Design' category and the 'Interior Design and Arts' award. In June 2023 it was announced that demolition of the 195-year-old Barry Building, thought to be the oldest acute hospital building still in use in England, would take place in 2024. The demolition and clearing of
390-564: A lump, abnormal bleeding, prolonged cough, unexplained weight loss, and a change in bowel movements . While these symptoms may indicate cancer, they can also have other causes. Over 100 types of cancers affect humans. Tobacco use is the cause of about 22% of cancer deaths. Another 10% are due to obesity , poor diet , lack of physical activity or excessive alcohol consumption . Other factors include certain infections, exposure to ionizing radiation , and environmental pollutants. Infection with specific viruses, bacteria and parasites
455-443: A new cancer centre, and Stage 3 will be a new service yard. The project is being carried out in three stages to ensure that all clinical service can continue to run during construction. As of September 2022, work is currently on Stage 1 and the helideck. According to BSUH , there is about a year to go until Stage 1 of the redevelopment is complete. The 11-storey Louisa Martindale Building opened to patients on 12 June 2023, at
520-566: A persistent fever . Shortness of breath, called dyspnea , is a common symptom of cancer and its treatment. The causes of cancer-related dyspnea can include tumors in or around the lung, blocked airways, fluid in the lungs, pneumonia, or treatment reactions including an allergic response . Treatment for dyspnea in patients with advanced cancer can include fans , bilevel ventilation, acupressure / reflexology and multicomponent nonpharmacological interventions . Some systemic symptoms of cancer are caused by hormones or other molecules produced by
585-539: A role. Oncoviruses (viruses that can cause human cancer) include: Bacterial infection may also increase the risk of cancer, as seen in Parasitic infections associated with cancer include: Radiation exposure such as ultraviolet radiation and radioactive material is a risk factor for cancer. Many non-melanoma skin cancers are due to ultraviolet radiation, mostly from sunlight. Sources of ionizing radiation include medical imaging and radon gas. Ionizing radiation
650-584: A teaching hospital in the 1990s, and offers a 6-year MBBS degree. Chris Hani Baragwanath Hospital is a teaching hospital affiliated with the University of the Witwatersrand Medical School, and is the third-largest hospital in the world. Another academic hospital, University of Cape Town 's Groote Schuur Hospital , was the site of the first human-to-human heart transplant . Aga Khan University Hospital (Aga Khan Hospital and Medical College)
715-481: A teaching hospital to be affiliated with a medical school, but plans fell through until 1928, when Royal Prince Alfred Hospital became Australia's first teaching hospital, to educate students of the University of Sydney . Cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors , which do not spread. Possible signs and symptoms include
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#1733093825408780-441: Is a 721-bed teaching hospital that trains doctors and hospital administrators with support from American and Canadian universities. The hospital also coordinates a network of over 100 health care units primarily in rural or remote areas. In France, the teaching hospitals are called "CHU" ( Centre hospitalier universitaire ). They are regional hospitals with an agreement within a university, or possibly several universities. A part of
845-416: Is about 2. The corresponding relative risk is 1.5 for lung cancer, and 1.9 for prostate cancer . For breast cancer, the relative risk is 1.8 with a first-degree relative having developed it at 50 years of age or older, and 3.3 when the relative developed it when being younger than 50 years of age. Taller people have an increased risk of cancer because they have more cells than shorter people. Since height
910-446: Is an environmental factor causing approximately 16–18% of cancers worldwide. These infectious agents include Helicobacter pylori , hepatitis B , hepatitis C , human papillomavirus infection , Epstein–Barr virus , Human T-lymphotropic virus 1 , Kaposi's sarcoma-associated herpesvirus and Merkel cell polyomavirus . Human immunodeficiency virus (HIV) does not directly cause cancer but it causes immune deficiency that can magnify
975-570: Is divided into small groups of hospitals and universities which are commonly called CHU as if they were separate CHU: There are 32 teaching hospitals in France. Amongst these are 30 University hospitals and only two Regional teaching hospitals. The first teaching hospital in the United States was founded at the College of Philadelphia (now the University of Pennsylvania ) in 1765, when medical students at
1040-537: Is generally not a transmissible disease . Exceptions include rare transmissions that occur with pregnancies and occasional organ donors . However, transmissible infectious diseases such as hepatitis B , Epstein-Barr virus , Human Papilloma Virus and HIV , can contribute to the development of cancer. Exposure to particular substances have been linked to specific types of cancer. These substances are called carcinogens . Tobacco smoke , for example, causes 90% of lung cancer. Tobacco use can cause cancer throughout
1105-413: Is genetically determined to a large extent, taller people have a heritable increase of cancer risk. Some substances cause cancer primarily through their physical, rather than chemical, effects. A prominent example of this is prolonged exposure to asbestos , naturally occurring mineral fibers that are a major cause of mesothelioma (cancer of the serous membrane ) usually the serous membrane surrounding
1170-581: Is more common in Japan due to its high-salt diet while colon cancer is more common in the United States. Immigrant cancer profiles mirror those of their new country, often within one generation. Worldwide, approximately 18% of cancer deaths are related to infectious diseases . This proportion ranges from a high of 25% in Africa to less than 10% in the developed world. Viruses are the usual infectious agents that cause cancer but bacteria and parasites may also play
1235-403: Is not inherited , such as lifestyle, economic, and behavioral factors and not merely pollution. Common environmental factors that contribute to cancer death include tobacco use (25–30%), diet and obesity (30–35%), infections (15–20%), radiation (both ionizing and non-ionizing, up to 10%), lack of physical activity , and pollution. Psychological stress does not appear to be a risk factor for
1300-474: Is not a particularly strong mutagen . Residential exposure to radon gas, for example, has similar cancer risks as passive smoking . Radiation is a more potent source of cancer when combined with other cancer-causing agents, such as radon plus tobacco smoke. Radiation can cause cancer in most parts of the body, in all animals and at any age. Children are twice as likely to develop radiation-induced leukemia as adults; radiation exposure before birth has ten times
1365-427: Is predominantly used in the production of Teflon , is known to cause two kinds of cancer. Chemotherapy drugs such as platinum-based compounds are carcinogens that increase the risk of secondary cancers Azathioprine , an immunosuppressive medication , is a carcinogen that can cause primary tumors to develop. Diet, physical inactivity , and obesity are related to up to 30–35% of cancer deaths. In
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#17330938254081430-632: Is served by Brighton & Hove bus routes 1 , 7 , 14B, 14C , 23 , 27C , 71 , 73 and 94A . The main building was designed by Charles Barry , who was later architect for the Houses of Parliament , and is still called the Barry Building. The foundation stone was laid by the Earl of Egremont on 16 March 1826, and the hospital was opened as the Sussex County Hospital on 11 June 1828. The Victoria Wing
1495-457: Is then typically further investigated by medical imaging and confirmed by biopsy . The risk of developing certain cancers can be reduced by not smoking, maintaining a healthy weight, limiting alcohol intake, eating plenty of vegetables, fruits, and whole grains , vaccination against certain infectious diseases, limiting consumption of processed meat and red meat , and limiting exposure to direct sunlight. Early detection through screening
1560-564: Is to create an environment where new doctors can learn to practice medicine in a safe setting which is supervised by physicians that provide both oversight and education. The first teaching hospital where students were authorized to methodically practice on patients under the supervision of physicians was reportedly the Academy of Gundishapur in the Persian Empire during the Sassanid era. Some of
1625-409: Is useful for cervical and colorectal cancer . The benefits of screening for breast cancer are controversial. Cancer is often treated with some combination of radiation therapy , surgery, chemotherapy and targeted therapy . Pain and symptom management are an important part of care. Palliative care is particularly important in people with advanced disease. The chance of survival depends on
1690-661: The COVID-19 pandemic , but now is due to fears that helicopters may blow the cladding off the hospital's walls. Plans to launch it in November 2022 were shelved after surveys found aircraft could damage the tower it sits on. Teaching hospital A teaching hospital is a hospital or medical center that provides medical education and training to future and current health professionals . Teaching hospitals are almost always affiliated with one or more universities and are often co-located with medical schools . Teaching hospitals use
1755-731: The Provisional IRA bombed the Grand Hotel where members of the Government were staying during the Conservative Party annual conference, the hospital received many of the injured. In 2005 an episode of the BBC investigative programme Panorama featured secretly filmed material taken by a nurse and an undercover journalist. The programme highlighted serious failings in the standards of care and procedures and showed scenes that were described by
1820-402: The bowel , affecting bowel habits. Masses in breasts or testicles may produce observable lumps. Ulceration can cause bleeding that can lead to symptoms such as coughing up blood (lung cancer), anemia or rectal bleeding (colon cancer), blood in the urine (bladder cancer), or abnormal vaginal bleeding (endometrial or cervical cancer). Although localized pain may occur in advanced cancer,
1885-584: The immune system and endocrine system . More than half of the effect from the diet is due to overnutrition (eating too much), rather than from eating too few vegetables or other healthful foods. Some specific foods are linked to specific cancers. A high-salt diet is linked to gastric cancer . Aflatoxin B1 , a frequent food contaminant, causes liver cancer. Betel nut chewing can cause oral cancer. National differences in dietary practices may partly explain differences in cancer incidence. For example, gastric cancer
1950-452: The lungs , liver , brain, and the bones . While some cancers can be cured if detected early, metastatic cancer is more difficult to treat and control. Nevertheless, some recent treatments are demonstrating encouraging results. The majority of cancers, some 90–95% of cases, are due to genetic mutations from environmental and lifestyle factors. The remaining 5–10% are due to inherited genetics . Environmental refers to any cause that
2015-576: The six hallmarks of cancer . These characteristics are required to produce a malignant tumor. They include: The progression from normal cells to cells that can form a detectable mass to cancer involves multiple steps known as malignant progression. When cancer begins, it produces no symptoms. Signs and symptoms appear as the mass grows or ulcerates . The findings that result depend on cancer's type and location. Few symptoms are specific . Many frequently occur in individuals who have other conditions. Cancer can be difficult to diagnose and can be considered
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2080-460: The tumor microenvironment . Oncogenes build up an inflammatory pro-tumorigenic microenvironment. Hormones also play a role in the development of cancer by promoting cell proliferation . Insulin-like growth factors and their binding proteins play a key role in cancer cell proliferation, differentiation and apoptosis , suggesting possible involvement in carcinogenesis. Hormones are important agents in sex-related cancers, such as cancer of
2145-535: The Barry and Jubilee buildings as part of a £300m redevelopment scheme. On 1 May 2014, £420 million of public investment was approved for redevelopment works starting in late 2014 and expected to last until 2024. In the early 2020s, the 3Ts Redevelopment began at the hospital, which is a three-stage project that is replacing all of the buildings on the front half of the hospital, some of which are almost 200 years old. The three Ts stand for trauma, teaching and tertiary care. It
2210-525: The Chief Executive of the Brighton and Sussex University Hospitals NHS Trust , which was responsible for the hospital, as "very disturbing images". The Millennium Building was completed in 2000 and the Audrey Emerton Building, built to accommodate clinical medical students of Brighton and Sussex Medical School , was opened by Baroness Emerton in 2005. In 2009 there was a proposal to demolish
2275-691: The United States beginning the early 1900s and they largely resembled those established by Johns Hopkins University , the University of Pennsylvania and the Lakeside Hospital in Cleveland. The hospitals that followed the example of these universities were all very large, technologically sophisticated and aimed to have a global impact through both patient care and scientific research. Additionally, these hospitals had large patient bases, abundant financial resources, and renowned physicians, advisors and staff. Many of
2340-745: The United States have mirrored smoking patterns, with increases in smoking followed by dramatic increases in lung cancer death rates and, more recently, decreases in smoking rates since the 1950s followed by decreases in lung cancer death rates in men since 1990. In Western Europe, 10% of cancers in males and 3% of cancers in females are attributed to alcohol exposure, especially liver and digestive tract cancers. Cancer from work-related substance exposures may cause between 2 and 20% of cases, causing at least 200,000 deaths. Cancers such as lung cancer and mesothelioma can come from inhaling tobacco smoke or asbestos fibers, or leukemia from exposure to benzene . Exposure to perfluorooctanoic acid (PFOA), which
2405-479: The United States, excess body weight is associated with the development of many types of cancer and is a factor in 14–20% of cancer deaths. A UK study including data on over 5 million people showed higher body mass index to be related to at least 10 types of cancer and responsible for around 12,000 cases each year in that country. Physical inactivity is believed to contribute to cancer risk, not only through its effect on body weight but also through negative effects on
2470-414: The body (such as through inhalation) and require years of exposure to produce cancer. Physical trauma resulting in cancer is relatively rare. Claims that breaking bones resulted in bone cancer, for example, have not been proven. Similarly, physical trauma is not accepted as a cause for cervical cancer, breast cancer or brain cancer. One accepted source is frequent, long-term application of hot objects to
2535-404: The body including in the mouth and throat, larynx , esophagus , stomach, bladder, kidney, cervix, colon/rectum, liver and pancreas . Tobacco smoke contains over fifty known carcinogens, including nitrosamines and polycyclic aromatic hydrocarbons . Tobacco is responsible for about one in five cancer deaths worldwide and about one in three in the developed world. Lung cancer death rates in
2600-401: The body. It is possible that repeated burns on the same part of the body, such as those produced by kanger and kairo heaters (charcoal hand warmers ), may produce skin cancer, especially if carcinogenic chemicals are also present. Frequent consumption of scalding hot tea may produce esophageal cancer. Generally, it is believed that cancer arises, or a pre-existing cancer is encouraged, during
2665-527: The breast, endometrium , prostate, ovary and testis and also of thyroid cancer and bone cancer . For example, the daughters of women who have breast cancer have significantly higher levels of estrogen and progesterone than the daughters of women without breast cancer. These higher hormone levels may explain their higher risk of breast cancer, even in the absence of a breast-cancer gene. Similarly, men of African ancestry have significantly higher levels of testosterone than men of European ancestry and have
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2730-533: The college began taking bedside instruction at the Pennsylvania Hospital (an institution that predated the medical school by several years). Following that were King's College of New York in 1768, Harvard University in 1783, Dartmouth College in 1798, and Yale University in 1810 to begin the history of notable university-affiliated teaching hospitals in America. Teaching hospitals rose to prevalence in
2795-465: The developing world. The global total economic costs of cancer were estimated at US$ 1.16 trillion (equivalent to $ 1.62 trillion in 2023) per year as of 2010 . The word comes from the ancient Greek [καρκίνος] Error: {{Transliteration}}: transliteration text not Latin script (pos 1) ( help ) , meaning 'crab' and 'tumor'. Greek physicians Hippocrates and Galen , among others, noted the similarity of crabs to some tumors with swollen veins. The word
2860-733: The earliest teaching hospitals were the Islamic Bimaristans , which included the Al-Adudi Hospital founded in Baghdad in 981 and the Al-Fustat Hospital in Cairo founded in 872. The following definitions are commonly used in connection with teaching hospitals: Many teaching hospitals and medical centers are known for the medical research that is performed in their hospitals. Close association with medical colleges and universities enhances
2925-455: The effect. Medical use of ionizing radiation is a small but growing source of radiation-induced cancers. Ionizing radiation may be used to treat other cancers, but this may, in some cases, induce a second form of cancer. It is also used in some kinds of medical imaging . Prolonged exposure to ultraviolet radiation from the sun can lead to melanoma and other skin malignancies. Clear evidence establishes ultraviolet radiation, especially
2990-445: The genes BRCA1 and BRCA2 with a more than 75% risk of breast cancer and ovarian cancer , and hereditary nonpolyposis colorectal cancer (HNPCC or Lynch syndrome), which is present in about 3% of people with colorectal cancer , among others. Statistically for cancers causing most mortality, the relative risk of developing colorectal cancer when a first-degree relative (parent, sibling or child) has been diagnosed with it
3055-479: The initial tumor is usually painless. Some cancers can cause a buildup of fluid within the chest or abdomen . Systemic symptoms may occur due to the body's response to the cancer. This may include fatigue, unintentional weight loss, or skin changes. Some cancers can cause a systemic inflammatory state that leads to ongoing muscle loss and weakness, known as cachexia . Some cancers, such as Hodgkin's disease , leukemias , and liver or kidney cancers , can cause
3120-441: The lungs. Other substances in this category, including both naturally occurring and synthetic asbestos-like fibers, such as wollastonite , attapulgite , glass wool and rock wool , are believed to have similar effects. Non-fibrous particulate materials that cause cancer include powdered metallic cobalt and nickel and crystalline silica ( quartz , cristobalite and tridymite ). Usually, physical carcinogens must get inside
3185-525: The medical schools that ensued the prospect of being associated to a nearby hospital tended to be private institutions that received philanthropic support. While some funding comes from Medicaid for the GME process, teaching hospitals must consider paying residents and fellows within their budgets. These additional costs vary between hospitals based on funding by Medicaid and their general salary for residents and fellows. Despite these costs, they are often offset by
3250-708: The medical staff are both medical practitioners and teachers under the two institutions agreement, and receive dual compensation. There are at least one per French administrative region. In the city of Paris and its suburbs, the Greater Paris , it is the local public hospital system called the Greater Paris University Hospitals (in French: Assistance publique - Hôpitaux de Paris , AP-HP) which has an agreement with 5 major universities in Paris. However, it
3315-496: The non-ionizing medium wave UVB , as the cause of most non-melanoma skin cancers , which are the most common forms of cancer in the world. Non-ionizing radio frequency radiation from mobile phones, electric power transmission and other similar sources has been described as a possible carcinogen by the World Health Organization 's International Agency for Research on Cancer . Evidence, however, has not supported
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#17330938254083380-462: The onset of cancer, though it may worsen outcomes in those who already have cancer. Environmental or lifestyle factors that caused cancer to develop in an individual can be identified by analyzing mutational signatures from genomic sequencing of tumor DNA. For example, this can reveal if lung cancer was caused by tobacco smoke, if skin cancer was caused by UV radiation, or if secondary cancers were caused by previous chemotherapy treatment. Cancer
3445-425: The original is called the primary tumor. Almost all cancers can metastasize. Most cancer deaths are due to cancer that has metastasized. Metastasis is common in the late stages of cancer and it can occur via the blood or the lymphatic system or both. The typical steps in metastasis are: Different types of cancers tend to metastasize to particular organs. Overall, the most common places for metastases to occur are
3510-869: The previous decade increases of 26% and 21%, respectively. The most common types of cancer in males are lung cancer , prostate cancer , colorectal cancer , and stomach cancer . In females, the most common types are breast cancer , colorectal cancer, lung cancer, and cervical cancer . If skin cancer other than melanoma were included in total new cancer cases each year, it would account for around 40% of cases. In children, acute lymphoblastic leukemia and brain tumors are most common, except in Africa, where non-Hodgkin lymphoma occurs more often. In 2012, about 165,000 children under 15 years of age were diagnosed with cancer. The risk of cancer increases significantly with age, and many cancers occur more commonly in developed countries. Rates are increasing as more people live to an old age and as lifestyle changes occur in
3575-655: The prices of procedures which are elevated in comparison to most non-teaching hospitals. Teaching hospitals often justify this additional cost factor by boasting that their quality of care rises above non-teaching hospitals, or ensuring the patient that they are improving medicine of the future by having their procedure done with medical trainees present. According to the Medical Journal of Australia , Australian teaching hospitals typically receive less funding for research than they do in similarly situated countries. The late 1800s and early 1900s saw several attempts at instituting
3640-403: The process of healing, rather than directly by the trauma. However, repeated injuries to the same tissues might promote excessive cell proliferation, which could then increase the odds of a cancerous mutation. Chronic inflammation has been hypothesized to directly cause mutation. Inflammation can contribute to proliferation, survival, angiogenesis and migration of cancer cells by influencing
3705-399: The research programs at teaching hospitals. Some of the more notable teaching hospitals include: The Algerian Ministry of Health, Population and Hospital Reform maintains 15 public university teaching hospital centres (French: Centre Hospitalo-Universitaire or CHU ) with 13,755 beds and one public university hospital (EHU) with 773 beds. Edward Francis Small Teaching Hospital became
3770-618: The risk due to other infections, sometimes up to several thousand fold (in the case of Kaposi's sarcoma ). Importantly, vaccination against hepatitis B and human papillomavirus have been shown to nearly eliminate risk of cancers caused by these viruses in persons successfully vaccinated prior to infection. These environmental factors act, at least partly, by changing the genes of a cell. Typically, many genetic changes are required before cancer develops. Approximately 5–10% of cancers are due to inherited genetic defects. Cancer can be detected by certain signs and symptoms or screening tests. It
3835-631: The site was begun in February 2024 and well under way by April. Stage 1 is also providing a much needed helideck for air ambulances on top of the Thomas Kemp Tower, from which the most severe patients can be taken directly to A&E via a dedicated lift. Air ambulances taking patients to the hospital currently have to land at East Brighton Park , almost a mile away. The helideck was originally expected to be in use by 2019, but as of March 2023 it still hasn't been used. The first delays were due to
3900-400: The tumor, known as paraneoplastic syndromes . Common paraneoplastic syndromes include hypercalcemia , which can cause altered mental state , constipation and dehydration, or hyponatremia , which can also cause altered mental status, vomiting, headaches, or seizures. Metastasis is the spread of cancer to other locations in the body. The dispersed tumors are called metastatic tumors, while
3965-461: The type of cancer and extent of disease at the start of treatment. In children under 15 at diagnosis, the five-year survival rate in the developed world is on average 80%. For cancer in the United States, the average five-year survival rate is 66% for all ages. In 2015, about 90.5 million people worldwide had cancer. In 2019, annual cancer cases grew by 23.6 million people, and there were 10 million deaths worldwide, representing over
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#17330938254084030-605: Was added in 1839, and the Adelaide Wing was opened in 1841. The Sussex County Hospital became the Royal Sussex County Hospital in about 1911. On New Year's Day 1872, a fire broke out on the top floor of the Adelaide Wing of the hospital, in Ward 6. Initially this fire threatened to destroy the building, but the efforts of volunteer firefighters and a detachment of the 19th Hussars saved the building. The Jubilee Building
4095-512: Was added to the hospital in 1887 and the Sussex Eye Hospital (one of local architect John Leopold Denman 's many Neo-Georgian buildings) opened in 1935. The main and tallest building of the hospital, the Thomas Kemp Tower, started construction in the late 1960s. It is the 8th tallest structure in Brighton and Hove and is prominent on the city's skyline, reaching 15 floors, at a height of 58.9 m (193 ft). In October 1984, after
4160-407: Was expected to cost £485 million when it was approved, but by 2021 was significantly delayed and over budget. The whole project is expected to be completed by 2026. In the old buildings' place will be two brand new clinical buildings, which will cover around 40 new wards and departments. The Stage 1 building is the first of the two, and covers 13 floors, 11 of which are above ground. Stage 2 will be
4225-477: Was introduced in English in the modern medical sense around 1600. Cancers comprise a large family of diseases that involve abnormal cell growth with the potential to invade or spread to other parts of the body. They form a subset of neoplasms . A neoplasm or tumor is a group of cells that have undergone unregulated growth and will often form a mass or lump, but may be distributed diffusely. All tumor cells show
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