neoplasm general considarations, neoplasm overview, neoplasm basics

1. NEOPLASM
By
Dr Ritesh Dhanbhar

2. Definition
Neoplasm is an abnormal mass of tissue, the growth of
which exceeds and is uncoordinated with that of the normal
tissues and persists in the same excessive manner even after
cessation of the stimuli.

3. Classification
Benign Malignant
Well-differentiated Lack of differentiation
Smooth, slow, progressive rate of
growth
Erratic, rapid growth
Well localised and capsulated Not capsulated
Do not infiltrate surrounding
normal tissues
Infiltrate the surrounding
tissues
No metastasis Metastasise through
lymphatics or blood
Curable May not be completely
curable
No recurrence Recurrence can occur

4. Fibroadenoma( Benign) SCC (Malignant)

5. AETIOLOGIC FACTORS
 Alkylating agents
 Hydrocarbons
 Smoking—lung, aerodigestive system, bladder cancer
 Asbestos—lung cancer
 Alcohol—liver cancer
 Amides, Azo dyes—bladder cancer
 Aflatoxin B1
 Arecoline, collagenases and tannins (present in Betel nuts)
 Nitrosoamines, vinyl chloride, insecticides
 UV rays, ionising radiation.

6. AETIOLOGIC FACTORS
 Human papilloma virus—carcinoma cervix
 Epstein-Barr virus—Burkitt’s lymphoma, nasopharyngeal
carcinoma
 Hepatitis ‘B’ virus—liver cancer
 Human T cell leukaemia virus Type I
 Helicobacter pylori can cause carcinoma of stomach and is
associated with lymphomas [Mucosa Associated with
Lymphoid Tissue (MALT)]

7. SPREAD OF MALIGNANT TUMOURS
• 1. Local spread: Into adjacent structures like soft tissues,
vessels, bone.
• 2. Lymphatic spread
By permeation: Here malignant cells proliferate
throughlymphatic vessels up to lymph node level.
By embolisation: Here cells get dislodged from
lymphaticvessels and freely travel to spread into further level
of lymph nodes.
Retrograde lymphatic spread occurs once lymph vessel
get blocked by malignant infiltration.

8. SPREAD OF MALIGNANT TUMOURS
• 3. Blood spread
Occurs through veins, as veins are thin-walled and
infiltration is easier (Arteries contain elastic fibres in their wall,
which resist malignant infiltration). Blood spread is commonly
to lungs, bone (upper end of femur and humerus, ribs, skull),
liver, brain, adrenals
. 4. Transcoelomic spread: Krukenberg tumour

9. STAGING OF THE TUMOUR
 It is based on the
1. size of the primary tumour,
2. nodal spread and
3. blood spread.
 It is called as ‘TNM’ staging.

11. INVESTIGATIONS FOR NEOPLASM
1) Biopsy
 Incision biopsy—wedge biopsy
 Excision biopsy
 Trucut biopsy
 Pap smear
 FNAC
 Frozen section biopsy
 Punch biopsy

12. Excision biopsy
FNAC
Punch biopsy

13. INVESTIGATIONS FOR NEOPLASM
 U/S guided biopsy
 Laparoscopic biopsy
 CT guided biopsy
 Thoracoscopic biopsy
 Endoscopic biopsy (gastroscopic or colonoscopic or through
 ERCP or through cystoscopy)
 Proctoscopic biopsy
 Open biopsy either laparotomy or thoracotomy or craniotomy
using Dandy’s brain cannula

14. INVESTIGATIONS FOR NEOPLASM
2) Immunohistochemistry :
It is detection of specific antigen using an antibody. Antibody
labelled with a dye, binds to antigen in a section of tissue causing
specific colours like brown, and determines its presence and distribution
in the tissues.
Usefull for detection of:
1) To confirm, to find differentiation, to detect metastases; to plan type
of therapy.
2) To categorise leukaemias or lymphomas
3) To find out site of origin of metastatic tumours.
4) Detection of receptors or molecules, e.g. estrogen receptors
[ER] in breast cancer.

15. INVESTIGATIONS FOR NEOPLASM
3) Tumar marker

16. INVESTIGATIONS FOR NEOPLASM
4) Other methods
Electron Microscopy: It is visualisation of tissue in very high
magnification of 1000 × 500 000 in difficult deciding cases.
In Situ Hybridisation: It is determination of presence or absence of a
specific gene and its location in a fresh/fixed tissue sections using an
oligonucleotide probe, targeting at specific DNA or RNA sequence.
Polymerase Chain Reaction (PCR): DNA is amplified using this special
method and detected by technique like electrophoresis.

17. MANAGEMENT STRATEGY FOR NEOPLASM
1. Diagnosis is confirmed by biopsy from primary usually.
2. Evaluations for staging—metastatic work up.
3. Approaches for primary—
surgery/radiotherapy/chemotherapy.
4. Approaches for secondary.
5. Palliation in advanced stage—palliation of distressing
symptoms.

18. Treatment of tumours
1. Surgery—wide excision/radical
2. Radiotherapy—curative/palliative
3. Chemotherapy
4. Immunotherapy
5. Gene therapy

19. Curable Malignancies
1. Basal cell carcinoma
2. Adamantinoma
3. Verrucous carcinoma
4. Marjolin's ulcer
5. Papillary carcinoma of thyroid
6. Carcinoma colon