NEOPLASIA

Abnormal mass of tissue the growth of

which exceeds and is uncoordinated with
that of normal tissue and persists in the
same excessive manner after cessation of
stimuli which evoked the change].
NEOPLASM - New Growth
DIFFERENTATION normal parenchymal
ANAPLASIA without differentiation
METAPLASIA - replaement
DYSPLASIA - disordered growth
METASTASIS - spread of malignant tumor
ETIOLOGY
Virus factors
Overexposed cells
Environmental factors
Immune actors
Food factors
Genetic factors
PATHOPHYSIOLOGY
6 fundamental physiological changes
(SALISED)
- Self sufficiency in growth signals
- Ability to invade and metastasize
- Limitless replicative potential
- Insensitivity to growth-inhibitory
signals
- Sustained angiogenesis
- Evasion of APOPTOSIS
- Defects in DNA repair
P53
-

Tumor suppressor genes

Flowchart of pathophysiology of CA

SIGNS & SYMPTOMS OF CANCER

(CAUTION)
1. Change in bowel or bladder habits
2. A sore that doesnt heal
3. Unusual bleeding or discharge
4. Thickening or lump in the breast,
testicles, or elsewhere
5. Indigestion or difficulty in swallowing
6. Obvious change in the size, color,
shape, or thickness of a mole
7. Nagging cough or hoarseness
RED FLAG SYMPTOMS
Tumor more than 1 month
Bleeding due to:
(1) Rupture of blood vessel
(2) Ulceration of tumor
Persistent cough or hoarseness
Change in the appearance of a mole
Sore that doesnt heal
Persistent change in bowel
movements
Persistent difficulty in swallowing
Persistent change in bladder habits
Unexplained lump

do not come back. Cells in benign tumours

do not spread to other parts of the body.
Characteristic of benign and malignant
tumors
CHARACTERI
STICS
capsulation

BENIGN

DIFFERENTIA
TION/
ANAPLASIA

Well differentiated
Structure sometimes
typical of tissue of
origin

RATE OF GRO
WTH

Usually progressive an
d SLOW
-May come to a
standstill or regress
-Mitotic figures RARE
and normal

LOCAL INVAS
ION

METASTASIS

capsulated

Usually COHESIVE
expansile WELLDEMARCATED masses
that do not invade or
infiltrate surrounding
normal tissues

ABSENT

MALIGNAN
T
uncapsulat
ed
- Some lack
differentiati
on with
anaplasiaStructure
often
atypical
Erratic and
may be slow
to rapid
Mitotic
figures may
be
numerous
and
abnormal
Locally
invasive,
infiltrating
surrounding
tissueSometimes
may be
seemingly
cohesive
and
expansile
Frequently
present- The
larger and
more
undifferenti
ated
theprimary,
the more
likely are
metastases

Tumor: is a pathologic disturbance of

growth, characterized by excessive
and unnecessary proliferation of cell.
2 Types of Tumor
o Benign
o Malignant

Benign tumors arent cancerous. They can

often be removed, and, in most cases, they

Malignant tumors are cancerous and are

made up of cells that grow out of control.
o Sometimes cells move away from the
original (primary) cancer site and
spread to other organs and bones
where they can continue to grow and
form another tumour at that site. This
is known as metastasis or secondary
cancer.
o Metastases keep the name of the
original cancer location. e.g.
pancreatic cancer that has spread to
the liver is still called pancreatic
cancer.
NOMENCLATURE
Benign tumors
For Tumors of Mesenchymal origin:
root word + oma

For Tumors of epithelial origin - cell of

origin, microscopic pattern, or
macroscopic architecture

CELL OF ORIGIN
Adenoma = derived from glands
Benign tumors
MICROSCOPIC PATTERN
Papilloma = producing microscopally (or
macro) visible finger-like projection
Benign tumors
MACROSCOPIC ARCHITECTURE
Cystadenomas = form large cystic masses
Malignant tumors
For Tumors of Mesenchymal origin
root word + sarcoma
Example:
Osteosarcoma
Ewings sarcoma
Rhabdomyosarcoma
Osteosarcoma
Most common in:
(1)Lower end of femur
(2)Upper end of tibia
usually affects the large bones of the
arm or leg.

occurs most commonly in young

people and affects more males than
females.

Rhabdomyosarcoma (RMS)
cancer made up of cells that normally
develop into skeletal muscles.
it is much more common in children,
although it does sometimes occur in
adults.
(2) Main Types of rhabdomyosarcoma:
1. Embryonal rhabdomyosarcoma
2. Alveolar rhabdomyosarcoma
Ewing's sarcoma
Primary bone cancer
most commonly occurs in the long
bones, ribs, pelvis and spine (vertebral
column)
Primitive neuroectodermal tumor.
Askin tumor (chest wall).
Extraosseous Ewing sarcoma (tumor
growing in tissue other than bone).
Radiologic findings: ONION SKIN
Malignant tumors
For Tumors of Epithelial origin
root word + carcinoma
Example:
BCC
SCC
Melanoma
BCC

SCC

are abnormal, uncontrolled growths or

lesions that arise in the skins basal
cells, which line the deepest layer of
the epidermis.
is an uncontrolled growth of abnormal
cells arising in the squamous cells,
which compose most of the skins
upper layers (the epidermis).

MELANOMA
most dangerous form of skin cancer
and have a high probability of
metastasizing and become lethal.
Blood/Lymph related
Leukemia

Lymphoma

Leukemia
Abnormal proliferation and maturation
of lymphocytes and nonlymphocytic
cells suppression of N cells
Symptoms:
pain in the bones or joints,
swollen lymph nodes that usually don't hurt,
fevers or night sweats,
feeling weak or tired,
bleeding and bruising easily,
frequent infections,
discomfort or swelling in the abdomen,
weight loss or loss of appetite
Lymphoma
Cancer on the lymphatic system
It is often very treatable, and most
people live for a long time after being
diagnosed.
Lymphoma
1.

NON-HODGKINs
Most common
B-cells and T-cells
skipping some nodes
CNS involvement
Average age 60
Congenital excessive exposure to
radiation

2.

HODGKINs
Much less common
Reed-Sternberg cells
in order
More localized in cervical and
supraclavicular
Bimodal incedence
Red-Sternberg cells
Cause: Epstein-Barr Virus

Effects on host
Effects often are related to loss of
function, loss of nervous control, pain
and discomfort.
Effects
Tumor impingement on nearby
structures
Ulceration/ bleeding
Infection (often due to obstruction)

 Rupture or infraction
Cancer Cachexia
Progressive weakness, loss of
appetite, anemia and profound weight
loss.
Cushin Syndrome
Caused by CORTISOL
Affects adrenal cortex
Manifestations:
(1)Moon face
(2)Buffalo hump on nape
(3)Pendulum abdomen
(4)Spindley arm (striated arm)
Paraneoplastic syndromes
Endocrinopathies
Neuromypathies
Osteochondral disorders
Vascular phenomena
Fever
Nephrotic syndrome
Endocrinopathies
Cushings syndrome
adrenal carcinoma (cortisol)
Inappropriate ADH syndrome
(hyponatremia)
Hyponatremia
Antidiuretic hormone
Syndrome of Inappropriate
Antidiuretic Hormone
(SIADH)
hypothalamic tumors (vasopressin)
small cell undifferentiated lung cancer
(vassopressin) like hormone.
Hypercalcemia
Hypoglycemia- caused by tumor over
production of insulin or insulin like
activities
Carcinoid syndrome- caused by
serotonin, histamine produced by the
tumor.
Polycythemia- caused by tumor
production of erythropoietins.
WDHA syndrome
Neuromyopatheies
Myasthenia- caused by host
antibodies against the tumor cells that

cross react with neuronal cells or

perhaps caused by toxins.
Carcinomatous myopathy- immune
mediated.

Osteochondral Disorders
Hypertrophic osteoarthropy- clubbing
periosteal new bone, and arthritis.
Paraneoplastic syndromes
vascular phenomena
Altered coagulability caused by
release of tumor products.
Fever
Associated with bacterial infections
common where blockage of drainage
occurs.
decreased immunity.
Nephrotic syndrome
Excessive loss of protein in the urine
- Caused by damage to renal
glomeruli by tumor antigenantibody complexes.
Grading and Staging of Tumor
Grading
Degree of maturity or differentiation of
tumor cells and other neoplasms
(cancer)
Histologic Grading
Resemblance between tumor and
normal cells
How is tumor grade determined?
Type
Benign
Malignant
Tumor Grade
G1 -Well Differentiated (Low Grade)
G2 -Moderately Differentiated
(Intermediate Grade)
G3-Poorly Differentiated (High Grade)
G4-Undifferentiated (High Grade)
Staging

Extentent of the primary tumor and

extent of spread in the body (regional
lymph node)
Base on the size and number of
primary lesion
Presence or Absence of Metastases.

Tumor Stage
Stage 1 : Earliest stage (most
curable)_
Stage 2 : Spread to surrounding tissue,
and nearby lymph node
Stage 3 : Spread to a distant lymph
node
Stage 4 : Spread to a distant organ of
the body
TNM Staging System
Primary Tumor (T)
T0 -used to indicate in situ lesion
T1-T4-base on increasing size
Regional lymph node involvement (N)
N0- no nodal involvement
N1-N3 - denote involvement of an
increase number and range of nodes
Metastases (M)
M0- signifies no distant metastases
M1 (M2) indicates presence of
metastases and some judgement as to
their number
Neoplasm Laboratory Diagnosis and
Treatment
Different kinds of laboratory diagnosis
A. Biopsy
A small tissue is surgically removed and
examine under a microscope for the
presence of cancer cells.
B. Endoscopy
A flexible plastic cable with a tiny camera on
the end is inserted into the body cavities and
organs
Different kinds of laboratory diagnosis
Diagnostic imaging
X-rays the common way make picture
of the inside body.
CAT scan - uses a radiographic beams

MRI - uses a powerful magnetic field

Ultrasound uses high frequency sound
waves to determine if the suspicious
lump is solid or liquid.

Different kinds of Cancer Treatment

A. Chemotherapy
Uses powerful drug that kills cancer cells,
control their growth or to relieve pain.
This is administered in three ways:
1. intravenous
2. orally
3. injection for muscles
Chemotherapy side effects;
Temporary hair loss
Fatigue
Nausea
Pain
Increase risk of
infection
B. Radiation therapy
using high energy beams to pinpoint and
destroy cancerous cell. The therapy uses
high dose of radiation and it has given a long
period of time.
There are two basic type of radiation:
1. external beam
2.internal beam
C. Stem cell transplantation
Stem cell replaces defective cells in the
patient whose normal cell are crowded by
cancerous cells.
Stem cell come from different sources:
Autologeus transplant cell from the
patients own bone marrow
Allogenic transplant cell perfect
match donor
Umbilical cord blood - from placenta
of a mother
D. Surgery
This is the oldest form of cancer treatment.
- Different kind of surgery:
Curative surgery - tumor removal
Reconstruction surgery Preventive surgery remove BENIGN
tumor to avoid progression
Staging surgery -

Supporative surgery support for

other CA Tx
Diagnostic surgery- Biopsy

Palliative surgery used to relieve

pain only