NeoplasmsNeoplasms

Cell TermsCell Terms► Atrophy-Atrophy-

Decrease in the SIZE of cells Decrease in the SIZE of cells resulting in reduced tissue massresulting in reduced tissue mass

► Hypertrophy-Hypertrophy- Increase in the SIZE of cells Increase in the SIZE of cells

resulting in enlarged tissue resulting in enlarged tissue massmass

► Hyperplasia-Hyperplasia- Increase in the NUMBER of cells Increase in the NUMBER of cells

resulting in enlarged tissue resulting in enlarged tissue mass.mass.

► Rapidly growing cellsRapidly growing cells► Can be indication of cancer.Can be indication of cancer.

► Neoplasm-Neoplasm- ””new growth” commonly known new growth” commonly known

as a tumor. Can be either:as a tumor. Can be either:► Malignant=Cancer. They can Malignant=Cancer. They can

spread.spread.► Benign-Typically harmless since Benign-Typically harmless since

they do not spread.they do not spread. They can become malignantThey can become malignant

NeoplasmsNeoplasms

► NeoplasmNeoplasm- class of - class of diseasesdiseases in which a group of in which a group of cellscells display uncontrolled growth display uncontrolled growth

► Invasion that intrudes upon and destroys adjacent Invasion that intrudes upon and destroys adjacent tissues, tissues,

► And sometimes And sometimes metastasismetastasis, or spreading to other , or spreading to other locations in the body via locations in the body via lymphlymphatic and circulatory atic and circulatory system. system. It is growth that is no longer responding to normal body It is growth that is no longer responding to normal body

controls keeping it in homeostasis.controls keeping it in homeostasis. These cells become atypical, meaning they do not function These cells become atypical, meaning they do not function

as normal tissues.as normal tissues. They also begin to deprive other cells of nutrients They also begin to deprive other cells of nutrients Every tumor is differentEvery tumor is different

DifferentiationDifferentiation

► DifferentiationDifferentiation It is the specialization It is the specialization

required for a particular cell’s required for a particular cell’s functionfunction

► Myocardium and Neurons are Myocardium and Neurons are highly developed and highly developed and specializedspecialized

► When cells become When cells become disorganized, or disorganized, or undifferentiated, or their growth undifferentiated, or their growth becomes uncontrolled, their becomes uncontrolled, their specialized function is lost.specialized function is lost.

Nomenclature (“Nom” means Nomenclature (“Nom” means ?)?)

► OncologyOncology-study of cancer-study of cancer► Tumor names are first Tumor names are first

based on their originbased on their origin Chondro, Nephro, Hepato, Chondro, Nephro, Hepato,

etcetc ““oma” is standard suffix for oma” is standard suffix for

tumortumor Special termsSpecial terms

► CarcinomaCarcinoma-malignant -malignant epithelial tissue.epithelial tissue.

► SarcomaSarcoma-malignant -malignant connective tissue.connective tissue.

► LipomaLipoma-benign fatty tissue-benign fatty tissue► AdenoAdeno- Gland- Gland

VocabularyVocabulary► To don (v) – to put something onTo don (v) – to put something on► To doff (v)- to take something ofTo doff (v)- to take something of► To besmirch (v)- to stain someone’s reputationTo besmirch (v)- to stain someone’s reputation► To prevaricate (v) (prevarication)- to stray or evade To prevaricate (v) (prevarication)- to stray or evade

from the truth; to liefrom the truth; to lie► To befuddle (v) befuddled (adj)- to confuseTo befuddle (v) befuddled (adj)- to confuse► Enigma (n)- something/something that is puzzling, Enigma (n)- something/something that is puzzling,

riddle-like, or mysteriousriddle-like, or mysterious► To propagate (v) (propagation)- to spread or multiplyTo propagate (v) (propagation)- to spread or multiply► Prerogative (n) – a special right or privilege given to a Prerogative (n) – a special right or privilege given to a

person/organizationperson/organization► To augment (v) – to make larger in size; to grow To augment (v) – to make larger in size; to grow

AbbreviationsAbbreviations

► cxr- Chest X-raycxr- Chest X-ray► KUB- Abdominal X-rayKUB- Abdominal X-ray► ASA- AspirinASA- Aspirin► APAP – Acetaminophen (Tylenol)APAP – Acetaminophen (Tylenol)► BP – blood pressureBP – blood pressure► OS- left eyeOS- left eye► OD- right eyeOD- right eye► BS- blood sugarBS- blood sugar► gtt- drop (gtts-drops)gtt- drop (gtts-drops)► po – by mouthpo – by mouth

Benign vs. MalignantBenign vs. Malignant► Neoplasms are classified into 2 major groups.Neoplasms are classified into 2 major groups.► Benign-Benign- usually are still differentiated cells, but begin producing at a higher usually are still differentiated cells, but begin producing at a higher

rate. It is encapsulated but does not spread.rate. It is encapsulated but does not spread. Only one place in body where benign can kill you.Only one place in body where benign can kill you.

► Brain!Brain!► MalignantMalignant-usually are undifferentiated, non-functioning cells and are NOT -usually are undifferentiated, non-functioning cells and are NOT

encapsulated. They grow at a faster rate and may invade nearby cells and encapsulated. They grow at a faster rate and may invade nearby cells and later metastasize to other organs.later metastasize to other organs.

► Neoplasms=Malignant=Cancer “crab-like”Neoplasms=Malignant=Cancer “crab-like”

Benign vs MalignantBenign vs Malignant

EtiologyEtiology► Carcinogenesis-Carcinogenesis-process by process by

which normal cells transform which normal cells transform into cancer onesinto cancer ones

► Etiology for many cancers is Etiology for many cancers is unknown (ideopathic)unknown (ideopathic)

► However, certain risk factors However, certain risk factors increase chancesincrease chances GeneticGenetic Radiation (medical, solar, Radiation (medical, solar,

terrestial, cell phones)terrestial, cell phones) Chemicals (smoking, asbestos, Chemicals (smoking, asbestos,

plastics)plastics) Diet (high fat, low fiber, MSGs, Diet (high fat, low fiber, MSGs,

sugar-free items, sugar-free items, AgeAge VirusVirus

► HPV (Cervical)HPV (Cervical)► Hepatitis (Lung Cancer)Hepatitis (Lung Cancer)

Tumor ProgressionTumor Progression► Malignant cells begin growingMalignant cells begin growing► They compress against nearby blood They compress against nearby blood

vessels, thus leading to necrosis of nearby vessels, thus leading to necrosis of nearby tissuetissue

► This leads to increased inflammation of This leads to increased inflammation of the organ, thus leading to reduction of the organ, thus leading to reduction of organ functionorgan function

► Some cancers stimulate Some cancers stimulate angiogenesisangiogenesis The development of new blood vessels The development of new blood vessels

in the tumor thus promoting more in the tumor thus promoting more tumor growthtumor growth

► While some neoplastic cells metastizise While some neoplastic cells metastizise quickly others remain in situ for a long quickly others remain in situ for a long timetime In SituIn Situ- neoplastic cells that remain in a - neoplastic cells that remain in a

pre-invasive stage for months to yearspre-invasive stage for months to years

Effects of TumorsEffects of Tumors► PainPain

Typically not an early symptom of cancer.Typically not an early symptom of cancer. Due to increased pressure on sensory nerves by growing tumor.Due to increased pressure on sensory nerves by growing tumor.

► ObstructionObstruction Occurs when tumor compresses a duct or passagewayOccurs when tumor compresses a duct or passageway

► InfectionInfection Normally seen in digestive tractNormally seen in digestive tract Tumor cuts off blood to neighboring tissues; tissue necrotizes and then becomes infected, typically by the flora Tumor cuts off blood to neighboring tissues; tissue necrotizes and then becomes infected, typically by the flora

that is already inhabiting the digestive tractthat is already inhabiting the digestive tract► Macro EffectsMacro Effects

Weight lossWeight loss Anemia and FatigueAnemia and Fatigue Bleeding (GI)Bleeding (GI)

Diagnostic TestingDiagnostic Testing

► The early the betterThe early the better► Most are not 100% reliable except for Most are not 100% reliable except for

which one?which one? Blood workBlood work

► Low RBC and WBC may reveal leukemiaLow RBC and WBC may reveal leukemia Tumor markings-substances produced by Tumor markings-substances produced by

the tumor that circulate in the blood the tumor that circulate in the blood streamstream

► PSA-prostate cancerPSA-prostate cancer► BRAC-1-breast cancerBRAC-1-breast cancer► CA125-ovarian cancerCA125-ovarian cancer

Diagnostic Imaging (Xray, CT, MRI)Diagnostic Imaging (Xray, CT, MRI) Cytologic/Histologic testsCytologic/Histologic tests

► Biopsy!Biopsy!► The only guaranteed testThe only guaranteed test► Pap SmearPap Smear

Lymphatic SystemLymphatic System

► The sister system to the The sister system to the Cardiovascular.Cardiovascular. Wherever there is a blood Wherever there is a blood

vessel, there is a lymph one vessel, there is a lymph one too.too.

► Picks up cellular debris and Picks up cellular debris and delivers it back to the delivers it back to the Subclavian veins through its Subclavian veins through its own network of lymph vesselsown network of lymph vessels

► Lymph nodes-”stations” along Lymph nodes-”stations” along the way where WBCs hang out the way where WBCs hang out

Spreading of CancerSpreading of Cancer► Primary-origin sitePrimary-origin site► Secondary-where it spreadsSecondary-where it spreads► 1. Invasion-(see Figure 1)1. Invasion-(see Figure 1)

Local spreading normally in Local spreading normally in adjacent tissueadjacent tissue

► 2. Metastasis2. Metastasis Spreading of cancer to different Spreading of cancer to different

sites in the body through CV sites in the body through CV and lymphatic systemsand lymphatic systems

First, they appear in the local First, they appear in the local lymph nodeslymph nodes

► Liver, Brain, and Lungs Liver, Brain, and Lungs common 2common 2ndnd sites. Why? sites. Why?

► 3. Seeding (See Figure 2)3. Seeding (See Figure 2) Spreading of cancer within the Spreading of cancer within the

same body cavity.same body cavity.► Abdominal cavityAbdominal cavity

Stages of CancerStages of Cancer► Staging system based on 3 factors:Staging system based on 3 factors:

(T)-Size of Tumor, (N) Involvement of Lymph Nodes, and (T)-Size of Tumor, (N) Involvement of Lymph Nodes, and (M) How much has it metastasized. (M) How much has it metastasized.

► Stage 1Stage 1 Tumor <2 cm, no lymph nodes involved N-0, and no Tumor <2 cm, no lymph nodes involved N-0, and no

metastasis M-0metastasis M-0► Stage 2Stage 2

T0-T2 <5 cm, nodes involved N-1, no meta M-0T0-T2 <5 cm, nodes involved N-1, no meta M-0► Stage 3Stage 3

T-3 >5 cm, nodes involved, tumor present in them N1-2, T-3 >5 cm, nodes involved, tumor present in them N1-2, no metastasize M-0no metastasize M-0

► Stage 4Stage 4 T-4 tumor any size but fixed to chest wall or skinT-4 tumor any size but fixed to chest wall or skin N-3- multiple tumors in nodes and spreadingN-3- multiple tumors in nodes and spreading M-1-metastasis presentM-1-metastasis present

TreatmentTreatment► Treatment may be either curative or palliative Treatment may be either curative or palliative

(treating symptoms-----death!)(treating symptoms-----death!)► 3 basic types: “cut it,” “burn it,” or “poison it3 basic types: “cut it,” “burn it,” or “poison it.”-All 3 .”-All 3

may be used togethermay be used together

► 1. Surgery1. Surgery Removal of tumor and nearby lymph Removal of tumor and nearby lymph

nodesnodes► LaparoscopyLaparoscopy► Radiofrequency AblationRadiofrequency Ablation

► 2. Radiation Therapy2. Radiation Therapy The radiation stops the mitosis of The radiation stops the mitosis of

the neoplastic cells, the neoplastic cells, or kills the cells altogether,or kills the cells altogether, or kills nearby blood vessels so the or kills nearby blood vessels so the

tumors starves to deathtumors starves to death It also does this to the nearby healthy It also does this to the nearby healthy

cells.cells.► Adverse Effects Adverse Effects (depends on location and dosage)(depends on location and dosage)

AlopeciaAlopecia-hair loss, skin burning-hair loss, skin burning Bone marrow depression-Bone marrow depression- WBCs, WBCs,

RBCs and platelets may decrease RBCs and platelets may decrease thus increasing chance of infectionthus increasing chance of infection

SterilitySterility Epithelium of GI tract is damaged Epithelium of GI tract is damaged

leading to excessive vomiting, leading to excessive vomiting, diarrheadiarrhea

Treatment (cont)Treatment (cont)

► Chemotherapy (Pills)Chemotherapy (Pills) Most effective on rapidly-Most effective on rapidly-

producing tumorsproducing tumors► The drugs interfere with DNA The drugs interfere with DNA

replication in the mitosis of the replication in the mitosis of the neoplastic cell, thus killing it.neoplastic cell, thus killing it.

Different cocktails of drugs Different cocktails of drugs given months apartgiven months apart

► Adverse Adverse Effects-kills healthy cells Effects-kills healthy cells tootoo

AlopeciaAlopecia Bone Marrow DepressionBone Marrow Depression InfectionInfection VomitingVomiting

PrognosisPrognosis► Prognosis is not judged by a Prognosis is not judged by a

cure, only a remission.cure, only a remission.► RemissionRemission-Term used to -Term used to

describe period post-cancer describe period post-cancer when symptoms have when symptoms have disappeared.disappeared. Cancer may return.Cancer may return.

► TerminalTerminal-Cancer is too far -Cancer is too far advanced it will kill the person.advanced it will kill the person.

► ““Cures” are defined as a 5-year Cures” are defined as a 5-year survival ratesurvival rate

► Early diagnoses is CRUCIAL, Early diagnoses is CRUCIAL, regardless some cancers are regardless some cancers are worse than others.worse than others.

► Good onesGood ones Sarcoma, Lymphoma, Sarcoma, Lymphoma,

► Bad onesBad ones Pancreatic, OvarianPancreatic, Ovarian

5-Year Survival Rates (White)5-Year Survival Rates (White)

► Prostate-100%Prostate-100%► Testicular-95%Testicular-95%► Skin- 91%Skin- 91%► Breast-90%Breast-90%► Bladder-78%Bladder-78%► Kidney-71%Kidney-71%► Cervical-69%Cervical-69%► Colorectal-61%Colorectal-61%► Throat-60%Throat-60%► Leukemia- 55%Leukemia- 55%

► Ovarian-43%Ovarian-43%► Spinal Cord (Myeloma)-Spinal Cord (Myeloma)-

40%40%► Brain-32%Brain-32%► Stomach-25%Stomach-25%► Lung-16%Lung-16%► Liver-15%Liver-15%► Pancreas-6%Pancreas-6%

Most Common CancersMost Common Cancers

► Breast-24%Breast-24%► Lung-19%Lung-19%► Uterus/Cervical- 14%Uterus/Cervical- 14%► Prostate-12%Prostate-12%► Ovary-6%Ovary-6%► Bladder-6%Bladder-6%► Thyroid-5%Thyroid-5%► Pancreas-5%Pancreas-5%► Colon-5%Colon-5%► Other-4%Other-4%