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My perceptions about cancer
• Be in a group of 4. Prepare ½ crosswise paper.
Select 1 (one) question and discuss your
perc...
Neoplasia
Neoplasia
• “new growth”
• Neoplasm or tumor
• Refer to abnormal masses of tissue, the
growth of which is virtually autono...
According to clinical behavior
• Benign
- localized lesion without spread to other
sites and amenable to surgical resectio...
Components
• Clonal expansion of neoplastic cells
constituting the tumor parenchyma
• Supporting stroma composed of nonneo...
Benign tumors
•
•
•
•

Adenomas
Cystadenomas
Papillomas
Polyps
Malignant tumors
•
•
•
•

Carcinomas
Sarcomas
Mixed tumors
Teratomas
Characteristics
• Differentiation – refers to how closely tumor
cells histologically resemble their normal cell
counterpar...
• Pleomorphism – variation in the shape and
size of cells and/or nuclei
• Abnormal nuclear morphology
- hyperchromatism
- ...
• Tumor giant cells
• Ischemic necrosis
• Dysplasia - loss of cellular uniformity and
architectural organization
- can occ...
- when dysplastic changes are marked and
involve the entire thickness of an
epithelium it is referred to as carcinomain-si...
Rates of Growth
• Fast growing tumors can have a high cell
turnover, that is rates of proliferation and
apoptosis are both...
Cancer Stem Cells and Cancer Cell
Lineages
• A clinically detectable tumor is a
heterogenous population of cells originati...
Local Invasion
• Most benign tumors grow as cohesive,
expnsile masses that develop a surrounding
rim of condensed connecti...
Metastasis
• Invsion of lymphatics, blood vessels or body
cavities by tumor followed by transport and
growth of secondary ...
Pathways of Spread
• Seeding of body cavities and surfaces
• Lymphatic spread
• Hematogenous spread
•
•
•
•
•
•
•
•
•
•

10 Causes of Death in the Philippines
(2009) -DOH
Diseases of the heart
Diseases of the vascular syst...
10 Causes of Cancer Deaths in the
Philippines (2010) - DOH
•
•
•
•
•
•
•
•
•
•

Breast cancer
Lung cancer
Liver cancer
Cer...
Genetic Predisposition
• Inherited Cancer Syndromes (Autosomal
Dominant)
- Retinoblastoma, Li-Fraumeni syndrome,
Melanoma,...
• Inherited Autosomal Recessive Syndrome of
Defective DNA Repair
- Xeroderma pigmentosum, Ataxiatelangiectasia, Bloom synd...
Nonhereditary Predisposing
Conditions
• Proliferation – regenerative, metaplastic,
hyperplastic or dysplastic – all increa...
• Chronic Inflammation:
- increases the pool of stem cells that can
be subject to the effects of mutagens
- produces cytok...
Molecular Basis of Cancer
• Non-lethal genetic damage underlies
carcinogenesis
• Tumors develop as clonal progeny of a sin...
• Four classes of normal regulatory genes are
the targets of genetic damage:
- growth promoting proto-oncogenes
- growth i...
Essential Alterations for Malignant
Transformation
•
•
•
•
•
•

Self sufficiency in growth signals
Insensitivity to growth...
• Ability to invade and metastasize
• Ability to escape immune recognition and
regulation
• Oncogenes – are genes that pro...
Proto-oncogenes, Oncogenes and
Oncoproteins
• Mutations convert proto-oncogenes into
constitutively active oncogenes that ...
Oncogenes
• Growth factors
- PDGF-β-chain (astrocytoma,
osteosarcoma)
- Fibroblast growth factors (Stomach,
bladder, breas...
• Growth factor receptors
- EGF-receptor family (squamous cell
carcinoma of the lungs, gliomas, breast
and ovarian cancers...
• Proteins involved in signal transduction
- GTP-binding (RAS) (Colon, Lung,
Pancreatic, bladder and kidney tumors,
melano...
• Nuclear Regulatory Proteins
- Transcriptional activators (MYC) (Burkitt
lymphoma, neuroblastoma, small cell
carcinoma of...
Carcinogenic Agents
• Chemical
- initiation (direct acting and indirect
acting agents)
- promotion
• Radiation (UV and ion...
Host Defense Against Tumors
• Tumor antigens
• Antitumor Effector Mechanisms
• Immune Surveillance and Escape
Clinical Aspects of Neoplasia
• Location and impingement on adjacent
structures
• Functional activity (hormone production)...
Grading and Staging
• Grading – based primarily on the degree of
differentiation (how well the tumor resembles
its normal ...
Laboratory Diagnosis
•
•
•
•

Histologic and cytologic method
Immunohistochemistry
Flow cytometry
Molecular diagnosis
Neoplasia
Neoplasia
Neoplasia
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Transcript of "Neoplasia"

  1. 1. My perceptions about cancer • Be in a group of 4. Prepare ½ crosswise paper. Select 1 (one) question and discuss your perception. Questions: • How does it develop? • How will it affect my patient? • How is it diagnosed? • How is it treated?
  2. 2. Neoplasia
  3. 3. Neoplasia • “new growth” • Neoplasm or tumor • Refer to abnormal masses of tissue, the growth of which is virtually autonomous and exceeds that of normal tissues • The growth persists after cessation of the initiating stimulus
  4. 4. According to clinical behavior • Benign - localized lesion without spread to other sites and amenable to surgical resection, the patient typically survives although there are exceptions • Malignant - aggressive behavior including invasion and destruction of adjacent tissues and spread to other sites
  5. 5. Components • Clonal expansion of neoplastic cells constituting the tumor parenchyma • Supporting stroma composed of nonneoplastic connective tissue and blood vessels, abundant collagenous stroma (desmoplasia) and such tumors are rock hard (scirrhous)
  6. 6. Benign tumors • • • • Adenomas Cystadenomas Papillomas Polyps
  7. 7. Malignant tumors • • • • Carcinomas Sarcomas Mixed tumors Teratomas
  8. 8. Characteristics • Differentiation – refers to how closely tumor cells histologically resemble their normal cell counterparts • Anaplasia – lack of differentiation • Benign – well differentiated • Malignant – well differentiated to undifferentiated
  9. 9. • Pleomorphism – variation in the shape and size of cells and/or nuclei • Abnormal nuclear morphology - hyperchromatism - irregularly clumped chromatin - prominent nucleoli - increased nuclear to cytoplasmic ratios • Abundant and/or atypical mitoses • Loss of polarity
  10. 10. • Tumor giant cells • Ischemic necrosis • Dysplasia - loss of cellular uniformity and architectural organization - can occur next to a frank malignancy and in many cases antedates the development of cancer - dysplasia do not equate to malignancy and dysplastic cells do not necessarily progress to cancer
  11. 11. - when dysplastic changes are marked and involve the entire thickness of an epithelium it is referred to as carcinomain-situ and this lesion can be a forerunner to invasive carcinoma
  12. 12. Rates of Growth • Fast growing tumors can have a high cell turnover, that is rates of proliferation and apoptosis are both high • The portion of tumor cells that is actively proliferating is called the growth fraction • In general but not always, the growth rate of tumors inversely correlates with the level of differentiation; better differentiated tumors grow more slowly
  13. 13. Cancer Stem Cells and Cancer Cell Lineages • A clinically detectable tumor is a heterogenous population of cells originating from the clonal expansion of a single cell • Tumor stem cells can be derived by mutation of normal stem cells or from differentiated precursors that acquire the symmetric division properties of stemness (the ability to sustain persistent growth of the larger tumor
  14. 14. Local Invasion • Most benign tumors grow as cohesive, expnsile masses that develop a surrounding rim of condensed connective tissue or capsule • Malignant neoplasms are typically invasive and infiltrative, destroying normal tissues
  15. 15. Metastasis • Invsion of lymphatics, blood vessels or body cavities by tumor followed by transport and growth of secondary tumor masses discontinuous from the primary tumor • This is the single most important feature distinguishing benign from malignant tumors
  16. 16. Pathways of Spread • Seeding of body cavities and surfaces • Lymphatic spread • Hematogenous spread
  17. 17. • • • • • • • • • • 10 Causes of Death in the Philippines (2009) -DOH Diseases of the heart Diseases of the vascular system Malignant neoplasms Pneumonia Accidents TB, all forms Diabetes mellitus Chronic lower respiratory disease Nephritis, nephrotic and neoplasia Certain conditions originating in the perinatal area
  18. 18. 10 Causes of Cancer Deaths in the Philippines (2010) - DOH • • • • • • • • • • Breast cancer Lung cancer Liver cancer Cervical cancer Colon cancer Thyroid cancer Rectal cancer Ovarian cancer Prostate cancer Non-Hodgkin’s Lymphoma
  19. 19. Genetic Predisposition • Inherited Cancer Syndromes (Autosomal Dominant) - Retinoblastoma, Li-Fraumeni syndrome, Melanoma, Familial adenomatous polyposis (colon cancer), Neurofibromatosis 1 and 2, Breast and ovarian cancer, Multiple endocrine neoplasia 1 and 2, Hereditary nonpolyposis colon cancer, Nevoid basal cell carcinoma syndrome, Cowden syndrome, Peutz-Jegher syndrome, Renal cell carcinoma
  20. 20. • Inherited Autosomal Recessive Syndrome of Defective DNA Repair - Xeroderma pigmentosum, Ataxiatelangiectasia, Bloom syndrome, Fanconi anemia • Familial cancers - Breast cancer, Ovarian cancer, Pancreatic cancer
  21. 21. Nonhereditary Predisposing Conditions • Proliferation – regenerative, metaplastic, hyperplastic or dysplastic – all increase the risk of developing malignancy, since it is proliferating cells that accumulate the genetic lesions necessary for carcinogenesis
  22. 22. • Chronic Inflammation: - increases the pool of stem cells that can be subject to the effects of mutagens - produces cytokines and growth factors to drive cell survival and proliferation - promotes genomic instability by the production of reactive oxygen species • Precancerous conditions
  23. 23. Molecular Basis of Cancer • Non-lethal genetic damage underlies carcinogenesis • Tumors develop as clonal progeny of a single genetically damaged progenitor cell • Carcinogenesis is a multistep process • Although tumors begin as monoclonal proliferations by the time they are clinically evident, they are extremely heterogenous
  24. 24. • Four classes of normal regulatory genes are the targets of genetic damage: - growth promoting proto-oncogenes - growth inhibiting tumor suppressor genes - genes that regulate apoptosis - genes that regulate DNA repair
  25. 25. Essential Alterations for Malignant Transformation • • • • • • Self sufficiency in growth signals Insensitivity to growth-inhibitory signals Evasion of apoptosis Defects in DNA repair Limitless replicative potential Sustained angiogenesis (nutrition and waste removal)
  26. 26. • Ability to invade and metastasize • Ability to escape immune recognition and regulation • Oncogenes – are genes that promote autonomous cell growth in cancer • Proto-oncogenes – unmutated normal counterparts • Oncoproteins – products of oncogenes
  27. 27. Proto-oncogenes, Oncogenes and Oncoproteins • Mutations convert proto-oncogenes into constitutively active oncogenes that endow the cell with growth self-sufficiently • Growth factors • Growth factor receptors • Signal-transducing proteins
  28. 28. Oncogenes • Growth factors - PDGF-β-chain (astrocytoma, osteosarcoma) - Fibroblast growth factors (Stomach, bladder, breast cancers and melanoma) - TGF-α (astrocytoma, hepatocellular cancer) - HGF (thyroid)
  29. 29. • Growth factor receptors - EGF-receptor family (squamous cell carcinoma of the lungs, gliomas, breast and ovarian cancers) - CSF-1 receptor (Leukemia) - receptor for neurotrophic factors (Multiple endocrine neoplasia 2A and 2B), familial meduallry thyroid cancer) - PDGF receptor (Gliomas) - Receptor for stem cell factor (GI and soft tissue tumors)
  30. 30. • Proteins involved in signal transduction - GTP-binding (RAS) (Colon, Lung, Pancreatic, bladder and kidney tumors, melanomas, hematologic) - nonreceptor tyrosine kinase (chronic myeloid and acute lymphoblastic leukemia) - RAS signal transduction (melanomas) - WNT signal transduction (hepatoblastomas and hepatocellular carcinoma)
  31. 31. • Nuclear Regulatory Proteins - Transcriptional activators (MYC) (Burkitt lymphoma, neuroblastoma, small cell carcinoma of lungs) • Cell Cycle Regulators - Cyclins (Mantle cell lymphoma, Breast and esophageal cancers, Breast cancer - Cyclin-dependent kinase (glioblastoma, melanoma, sarcoma)
  32. 32. Carcinogenic Agents • Chemical - initiation (direct acting and indirect acting agents) - promotion • Radiation (UV and ionizing) • Oncogenic viruses and microbes (Heliobacter pylori, HPV, EBV, Hepatitis B and C)
  33. 33. Host Defense Against Tumors • Tumor antigens • Antitumor Effector Mechanisms • Immune Surveillance and Escape
  34. 34. Clinical Aspects of Neoplasia • Location and impingement on adjacent structures • Functional activity (hormone production) • Bleeding and infection • Symptoms from tumor rupture or infarction • Cachexia (wasting)
  35. 35. Grading and Staging • Grading – based primarily on the degree of differentiation (how well the tumor resembles its normal counterpart), architectural features or number of mitoses • Staging – based on size of the primary tumor and the extent of local and distant spread
  36. 36. Laboratory Diagnosis • • • • Histologic and cytologic method Immunohistochemistry Flow cytometry Molecular diagnosis

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