Neoplasia Definitions and nomenclature General features of
benign and malignant neoplasm Epidemiology Clinical behavior,
grading and staging Carcinogenesis and etiology of cancer
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Definitions and nomenclature Definition Neoplasia new growth
Tumors means swelling Oncology is a study of tumors Cancer is a
malignant neoplasm
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Oncology is a study of tumors Neoplasm Non-Neoplasm
MalignantBenign like crab adheres to any part Cancer
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Neoplasm consists of: 1. Tumor cells: 2. Stroma (gr =
mattress): framework of tumors More differentiated (better
prognosis) Less differentiated (worst prognosis
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Nomenculature of the neoplasm Neoplasm can be classified
according to: 1. Cell of origin (histogenic classification) 2.
Biological behavior 3. gross appearance 4. microscopic
appearance
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Neoplasm can be classified according to Cell of origin and
biological behavior Benign tumors: cell oma e.g. lipoma Malignant
tumors: Epithelium cell carcinoma Connective tissue cell sarcoma
e.g. Squamous cell carcinoma Liposarcoma Nomenculature of the
neoplasm
Nomenclature other descriptive terms may be added such as :
papillary adenocarcinoma cystadenocarcinoma teratocarcinoma
Papillary Cystadenocarcinoma of the Ovary
Glioma: from CNS glial tissue (astrocytoma, glioblastoma)
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Benign fibroadenoma breast Mixed tumors
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Fibroadenoma of Breast EpithelialDifferentiation
StromalDifferentiation Example of Example of Mixed tumors
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Nomenclature Unfortunately, some malignant tumors also have the
oma suffix: hepatoma - malignant tumor of hepatocytes lymphoma -
malignant tumor of lymphoid cells hypernephroma - malignant kidney
tumor melanoma - malignant skin tumor of melanocyte origin seminoma
- malignant testicular tumor In these cases one simply has to
remember the exceptions.
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Neoplasia nomenclature - historic eponyms first described by A
type of Malignant lymphomaHodgkin s disease A type of B cell
lymphoma Burkitt lymphoma A type Bone tumorEwing sarcoma
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Teratomas Teratomas Hamartoma Choristoma
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Teratomas Contain elements of all three germ layers: endoderm,
ectoderm, and mesoderm. Thus, brain, respiratory and intestinal
mucosa, cartilage, bone, skin, teeth, or hair may be seen in the
neoplasm. Teratomas could be benign (mature cystic teratoma) or
malignant (immature teratoma and teratocarcinoma) Cystic Teratoma
Teratoma
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Hamartoma: a mass composed of more than one type of cells
native to the organ e.g. pulmonary hamartoma..there is respiratory
epithelium and cartilage. Choristoma: a mass composed of normal
cells in a wrong location e.g. pancreatic tissue located in liver
or stomach. Malformation and not neoplasm.
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Classification according to biological behavior benign
malignant borderline
Dysplasia Differences between dysplasia and cancer. lack of
invasiveness. Reversibility
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Carcinoma in situ: epithelial malignancy which do not cross
(destroy) basement membrane Carcinoma in situ
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Carcinoma in situ - cervix BM Ly Mitoses
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Benign Dysplasia Carcinoma in situ malignant
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Neoplasia general criteria MalignantBenign Grow by invasion
Infiltrate surrounding tissue Have indistinct borders No capsule
formed Grow by expansion Compress surroundings Encapsulated Gross
Edges are poorly demarcated Individual cells infiltrate
surroundings Invade lymphatic/blood vessels Shows anaplasia Shows
lack of differentiation Numerous mitosis Uniform population No
anaplasia No invasion/infiltration Few mitotic figures Capsule (not
always) Histology
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Malignant tumors Pleomorphism, Increased nuclear /cytoplasmic
ratio Hyperchromatism Giant nucleoli Cells Rate of growth Mitosis
Mode of growth Invasion Metastasis Spread of tumors to places non
contiguous with primary lesion Also in dysplasia and carcinoma
insitu Not seen in dysplasia and carcinoma insitu
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Adenocarcinoma metastatic to lymph node
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Colon carcinoma metastases to the liver
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Bone marrow breast cancer metastasis Adenocarcinoma metastatic
to bone
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CLINICAL FEATURES OF TUMORS
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Effect of a tumor on the host. Grading and staging of cancer.
Laboratory diagnosis of neoplasm.
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EFFECT OF A TUMOR ON THE HOST Benign and malignant neoplasm may
cause problems because of: 1. Location. 2. Ulcerations with
bleeding and secondary infection. 3. Cachexia. 4. Fever, night
sweats 5. Functional activityParaneoplastic syndrome.
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LOCAL EFFECT OF A TUMOR
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EFFECT OF A TUMOR ON THE HOST Cachexia Wasting of the whole
body. Due to tumor necrosis factor ( the result of a host reaction
toward tumor)
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EFFECT OF A TUMOR ON THE HOST Paraneoplastic syndrome: Distant
effects Humoral mechanisms Occur in 10% of patients with malignant
disease May represent the earliest manifestation of an occult
neoplasm.
How Does Cancer Kill? Most cancer patients die from gram
negative sepsis The malignant tumor causes misery to its host: the
host in return does little damage to the tumor
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LABORATORY DIAGNOSIS OF CANCER 1. Histologic and cytologic
methods 1. Excision or biopsy. H&E, immunohistochemistry. 2.
Fine needle aspiration and cytologic smears.
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Histologic methods
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Slide 8.56 cytologic methods
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Immunohistochemistry
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TUMOR MARKERS Biochemical indicators of the presence of tumor
(antigen, enzymes, hormones). Used to support diagnosis of
malignancy. Some markers of value in determining response to
therapy.
Staging of tumor (size and anatomical extent of spread)
performed by: Clinician (TNM) - prior therapy Clinician and
pathologist after surgery Grading of tumor (degree of histologic
resemblance to parent tissue differentiation) performed by:
Pathologist only Neoplasia biology: features of malignancy clinical
biology Prognostic factors Influence treatment modalities TNM
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Staging of Malignant Neoplasms StageDefinition TisIn situ,
non-invasive (confined to epithelium) T1Small, minimally invasive
within primary organ site T2Larger, more invasive within the
primary organ site T3Larger and/or invasive beyond margins of
primary organ site T4Very large and/or very invasive, spread to
adjacent organs N0No lymph node involvement N1Regional lymph node
involvement N2Extensive regional lymph node involvement N3More
distant lymph node involvement M0No distant metastases M1Distant
metastases present
Oat cell carcinima of the lung Undifferenciated carcinoma Grade
IV Adenocarcinoma of the colon Well differenciated carcinoma Higher
grade means: a lesser degree of differentiation and the worse the
biologic behavior A well differentiated neoplasm is composed of
cells that closely resemble the cell of origin. Poorly
differentiated neoplasms have cells that are difficult to recognize
as to their cell of origine
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Poorly differentiated carcinoma: of the lung
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PrognosisPrognosis Prediction of Outcome depend on: 1. Cancer
type 2. Grade 3. Stage
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Cell of origin Benign tumor 1. Bone 2. Skeletal musle 3.
Fibroblast 4. Cartilage 5. Melanocyte 6. Smooth musle 7. Blood
vessel 8. Gland 9. Adipocyte 10. Squamous cellwith finger like
projection a) Papilloma b) Adenoma c) Lipoma d) Fibroma e)
Chondroma f) Leiomyoma g) Rhabdmyoma h) hemangioma i) osteoma j)
melanocytic nevus
1. Contain elements of all three germ layers 2. A mass composed
of cells native to the organ 3. Contain brain, respiratory and
intestinal mucosa, cartilage, bone, skin, teeth, or hair 4. A mass
composed of normal cells in a wrong location Hamartoma Choristoma
Teratoma
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