This document provides information on tumours and oncology. It discusses disturbances of cell growth such as hyperplasia, hypertrophy, dysplasia, neoplasia, and anaplasia. It defines a neoplasm as an abnormal mass of tissue that grows in an uncontrolled manner. Neoplasms can be benign or malignant, and there are several challenges with classifying tumours based on etiology, embryology, morphology, function, histogenesis, and behavior. The currently used classification system is based on the tissue of origin (histogenesis) and behavioral pattern. Carcinomas arise from epithelial tissue and sarcomas arise from mesenchymal tissue. Differences between benign and malignant tumours include age of

1. TUMOURS
&
Oncology
• BY
• DR. U.S. PANDEY
• PROFESSOR & HOD,
• DEPTT OF PATHOLOGY,
• GOVT MEDICAL COLLEGE,
• BETTIAH-845438 (West Champaran )

2. Disturbances Of Growth Of Cells

3. Disturbances Of Growth Of Cells

5. The Vocabulary
• Hyperplasia – increased number of cells
• Hypertrophy – increased size of cells
• Dysplasia – disorderly proliferation
• Neoplasia – abnormal new growth
• Anaplasia – lack of differentiation
• Tumor – originally meant any swelling,
but now equated with neoplasia
• Metastasis –growth at a distant site

6. ONCOLOGY (ONCOS-TUMOUR,LOGOUS-DISCOURSE/STUDY)
ONCOLOGY IS SCIENTIFIC STUDY OF TUMOURS OR
NEOPLASMS
TUMOUR=TUMOR-
NEOPLASM –
NEOPLASIA-
LOCALISED SWELLING OR LUMP LIKE HAEMATOMA,
INFLAMMATORY SWELLING,NEOPLASMS
GREEK-- NEO=NEW,
PLASSEIN= A THING FORMED or
=NEW GROWTH OR NEW KIND OF GROWTH
PATHOLOGICAL process underlying theformation of a neoplasm
BUT TODAY TUMOURS OR NEOPLASM USED
SYNONYMOUSLY but conventionally,
TUMOUR IS RESTRICTED TO A SPECIFIC KIND
OF SWELLING---- THE NEOPLASM

7. DEFINITION OF NEOPLASM OR TUMOUR
1) POWELL WHITE’S
DEFINITION ( adopted
by ADMI & KETTLE)
2)EWING:
3)WILLIS:
“A MASS OF CELLS OR TISSUES OR ORGANS
RESEMBLING THOSE NORMALLY PRESENT IN THE
BODY BUT ARRANGED ATYPICALLY, WHICH GROWS
AT THE EXPENCE OR ORGANISM WITHOUT, AT THE
SAMETIME, SUBSERVING ANY USEFUL PURPOSE
THEREIN” N.B.: but fails to distinguish tumors
from malformation
AN AUTONOMOUS NEW GROWTH OF
TISSUE NOT REGULATED BY EXTERNAL
SIGNALS
AN ABNORMAL MASS OF TISSUE, THE
GROWTH OF WHICH IS PROGRESSIVE,
PURPOSELESS, IRREGULAR, INVASIVE,
EXCESSIVE AND IS UNCO-ORDINATED
WITH THAT OF THE NORMAL TISSUE
AND PERSISTING THE SAME EXCESSIVE
MANNER AFTER THE CESSATION OF
THE STIMULI WHICH EVOKED THE
CHANGE

8. Neoplasm & Neoplasia
• Definition: Neoplasm
– is an abnormal mass of tissue,
– the growth of which is
excessive,irregular,invasive,progressive, purposeless,
– & (the growth of which) is uncoordinated with that of
normal tissues,
– & that persists in the same excessive manner after the
cessation of the stimulus which evoked the change”
– With the loss of responsiveness to normal growth controls
– Different from hyperplasia, metaplasia and dysplasia.
& the pathological process underlying the formation of neoplasm is
Neoplasia.

9. CLASSIFICATION
( TAXONOMY & NOMENCLATURE)
MANY CLASSIFICATIONS OF TUMOURS PROPOSED-
1) AETIOLOGICAL
2) EMBRYOGENIC
3) MORPHOLOGICAL(NAKED EYE APPEARANCE)
4) FUNCTIONAL
5) HISTOGENETIC
6) HISTOLOGICAL
7) BEHAVIOURAL
8) CURRENTLY USED CLASSIFICATION

10. 1.AETIOLOGICAL CLASSIFICATION
CLASSIFICATION BASED ON AETIOLOGY IS A COMMON PRACTICE FOR
CLASSIFICATION OF PATHOLOGIC PROCESS OR DISEASE, BUT IT IS
IMPRACTICAL FOR TUMOR BECAUSE---
1) CAUSE OF MOST TUMOURS IS UNKNOWN
2) NO SINGLE AGENT INDUCE NEOPLASM
3) SAME AGENTS MAY PRODUCE TUMOURS OF SEVERAL DIFFERENT TYPES
4) TUMOURS EXACTLY ALIKE MORPHOLOGICALLY & CLINICALLY MAY BE INDUCED BY COMPLETELY
DIFFERENT AGENTS
5)ONCE TUMOUR HAS ARISEN,THE AGENTS USUALLY NO LONGER NECESSARY FOR ITS CONTINUED
GROWTH
2.EMBRYIONIC CLASSIFICATION
AT ONE TIME IT WAS BELIEVED THAT MOST NEOPLASMS DERIVED FROM EMBRYONIC
CELLS OR CELLS THAT HAS REVERTED TO EMBRYONIC STATE
SUFFIX – BLASTOMA WAS USED FOR EMBRYONIC CELLS
NEPHROBLASTOMA----IN KIDNEY
NEUROBLASTOMA-----ADRENAL
RETINOBLASTOMA-----EYE
HEPATOBLASTOMA-----LIVER

11. 3.NAKED EYE APPEARANCE(MORPHOLOGICAL)
CLASSIFICATION & SITE CLASSIFICATION
UNSATISFACTORY BECAUSE THIS CONCEPT IS NO LONGER ACCEPTABLE
1) FUNGATING--- CAULIFLOWER LIKE GROWTH
2) ANNULAR --- ROUND- COIN –SHAPED
3) SCIRRHOUS--- HARD DUE TO ABUNDENT FIBROUS STROMA
4) ENCEPHALOID OR MEDULARY --- SOFT BRAIN LIKE DUE
TO SPARSE STROMA
5) MUCOID--- MUCOUS OR MUCIN LIKE
6) SIGNET RING
ALL ORGANS CONSIST OF A VARIETY OF TISSUES
AND EACH OF THESE TISSUE CAPABLE TO GIVE ONE OR
MORE TYPE OF TUMOURS. TUMOURS ARISING FROM
DIFFERENT TISSUES OF THE SAME ORGAN TEND TO
BEHAVE DIFFERENTLY

12. 4.FUNCTIONAL CLASSIFICATION
MANY TUMORS PRODUCE VARIOUS SUBSTANCES IN EXCESS NAMED
ACCORDINGLY
• INSULINOMA - produce INSULIN
• GLUCAGONOMA – produce GLUCAGON
• MUCOID – produce MUCOUS OR MUCIN
• CARCINOID – produce SEROTONIN
DRAWBACK :- It is not satisfactory because materials may be formed by
many of different tumors of widely different biologic behavior.
Moreover a tumor may produce multiple substances,eg.Medullary
carcinoma of thyroid secret calcitonin,histaminase,ACTH, serotonin.
Hence, a complete diagnosis must indicate- 1. Type of tumor
2.Tissue of origin
3.Degree of differentiation
4.Finally its functional status

13. 5.HISTOGENETIC CLASSIFICATION
CELLS OF ORIGIN- important feature of modern classification.
Conventionally, body has been divided into—1. EPITHELIUM
2. CONNECTIVE TISSUE
Hence tumors--- 1. TUMORS OF EPITHELIAL ORIGIN
2. TUMORS OF CONNECTIVE TISSUE ORIGIN
6 DIFFICULTIES-----
1. NATURE OF ENDOTHELIUM,MESOTHELIUM ,synovium not clear cut
2. UNDIFFERENTIATED TUMOR- cells of origin not recognised to allow
comparision with normal tissue . Several techniques employed in detection
of differentiation– EM, IHC
3. IN TUMOR METAPLASIA
4. DEBATABLE ORIGIN OF TISSUE
5. ORIGINE OF HIGHLY SPECIALISED TISSUE LIKE NERVOUS SYSTEM
INCLUDED IN broad groups of CONNECTIVE TISSUE but different features
like --- MALIGNANT MELANOMA,LEUKAEMIA,PHAEOCHROMOCYTOMA,GLIOMAS etc
6. ORIGIN OF EMBRYOGENIC TISSUE like
GERM CELLS—RETINOBLASTOMA,NEUROBLASTOMA
PLACENTAL TISSUE

14. 6.HISTOLOGIC CLASSIFICATION
• USED IN—
1. WHEN TUMOR IS SO UNDIFFERENTIATED AS TO DEFY
RECOGNITION OF ITS SITE OF ORIGIN LIKE
GLANDULAR TISSUE TUMOR:ONLY CELLS- POLYGONAL, SPHEROIDAL,ANAPLASTIC
SMALL CELLS
LARGE CELLS
PLEOMORPHIC CELLS
GIANT CELL
SPINDLE CELL
2. OCCURANCE OF TUMOR– METAPLASIA
• USEFUL IN HISTOLOGIC GRADING based on –
1. DEGREE OF DIFFERENTIATION
2.DEGREE OF IRREGULARITY
3.NUMBER OF MITOSIS

15. 7.BEHAVIORAL CLASSIFICATION
• 2 CLASSICAL GROUPS– 1. BENIGN or INNOCENT
• 2. MALIGNANT or CANCER
DIFFICULTIES arises in:
1. INTERMIDIATE TYPES OF BEHAVIOUR THAT DO NOT FALL
IN EITHER OF THOSE ABOVE CATEGORIES
2.LATENT CANCER
3. CARCINIMA IN SITU( cytological features of malignancy)
4. SPONTANEOUS REGRESSION in :
1. MALIGNANT MELANOMA
2.CLEAR CELL CARCINOMA KIDNEY
3.NEUROBLASTOMA
4.CHORIO CARCINOMA
5. BURKITTS LYMPHOMA
6.REGRESSION OF METASTASIS
5.DORMANT TUMOURS

16. 8.CURRENTLY USED CLASSIFICATION
• BASED ON COMBINATION OF 2 APPROACHES
1. HISTOGENETIC( tissue of origin) – Epithelial,
-Connective tissue
2. BEHAVIORAL PATTERN—1. Benign, or 2. Malignant
Supplemented by HISTOLOGICAL DISCRIPTION
N.B. 1. SUFFIX– OMA, denotes TUMOURS like—PAPILLOMA, FIBROMA, ADENO -
. - MA , CARCINOMA, SARCOMA
2.UNFORTUNATELY NON- NEOPLASTIC SWELLINGS ALSO HAVE --
OMA– TERMINOLOGY LIKE HAEMATOMA,GRANULOMA, HAMARTOMA
Thus,
3. MALIGNANT TUMOURS OF EPITHELIUM – CARCINOMA
4. MALIGNANT TUMOURS OF MESENCHYMAL TISSUE –SARCOMA
Thus tumours are named and classified on—
1.SITE (REGIONS OR ORGANS) 2.HISTOGENETIC ( or CYTOGENETIC ) BASIS with
3.BIOLOGIC BEHAVIOUR with
4.ADDITIONAL APPROPRIATE Suffix-oma, &
5.APPENDED BY HISTOLOGIC DESCRIPTION.

19. C l a s s i f i c a t i o n O f T u m o u r s

22. Neoplasia
• All tumors have two basic components:
–Parechyma: made up of neoplastic cells
–Stroma: made up of non-neoplastic, host-
derived connective tissue and blood vessels
The parenchyma:
Determines the
biological behavior of
the tumor
From which the tumor
derives its name
The stroma:
Carries the blood supply
Provides support for the
growth of the
parenchyma

24. Difference Between Benign and Malignant Tumours

25. Age : Younger < 40 Age : Older > 50-60 yrs.
Fixity: Absent Fixity : Present

26. ANAPLASIA: Lack Of Differentiation

28. Cytoplasmic Criteria of Malignancy :
• 1. Scant Cytoplasm
• 2. Abnormal maturation and differentiation.
• 3.Abnormal Vaculation in the Cytoplasm.
• 4.Normal cytoplasmic elements decreased or lost , e.g.,
i) Mitochondria :
ii) Ribosome : (a) Free :
(b) Bound :
iii) E/R :
5 .Acidophilia or Eososnophilia ( Redness) of Cytoplasm
6. Cytoplasmic Inclusions – May be present
i) Mucin – In Acinar cell Ca.
ii) Melanin – In Melanoma, Basal Cell Ca.
iii) Glycogen & Lipids – Clear cell Ca. of -
-Kidney

30. Carcinoma & Sarcoma

34. Carcinomas arising from any epithelium of the body that exhibit
squamous differentiation are termed squamous cell carcinoma.

35. Osteosarcoma
Adrenocortical Carcinoma Osteosarcoma
.

36. Lipoma – Benign Tumour