a thorough study on neoplasm and its prevalence in the world

1. Annotation on the Basic Concept of
Neoplasm & Whole Scenario
Surrounding Cancer
Dr. Muhammad Shahriar Hossen
Lecturer, Pathology

2. Contents
Definition Components Classification
Difference
between benign &
malignant tumor
Characteristics Grading & staging
Molecular basis of
cancer
Epidemiology
Lab diagnosis
Errors we find in
laboratory

3. What is Neoplasm….
A 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 after the cessation
of the stimuli which evoked the change . - (defined by Willis)
Modern definition – A neoplasm can be defined as a disorder
of cell growth that is triggered by a series of acquired
mutations affecting a single cell and its clonal progeny.

4. Components
All tumors have two
basic components:
1. Parenchyma : Made up of transformed or
neoplastic cells.
2. Stroma: The supporting, non-neoplastic tissue
made up of connective tissue, blood vessels.

5. Classification
According to
behavior
Benign
Malignant
According to
cell of origin
Epithelial
origin
Mesenchymal
origin
Mixed
tumors
Teratogenic
Neoplasm
Adenoma
Adenocarcinoma
Osteoma
Osteosarcoma
Teratoma

6. Benign tumor
Its gross & microscopic appearances
are relatively innocent,
it remain localized, not spread to
other sites
Amenable to local surgical removal

7. Malignant
Tumors that invade and destroy adjacent
structures & spread to distant sites .
Malignant neoplasm of epithelial tissue origin is
called carcinomas. e.g Squamous cell carcinoma
, adenocarcinoma.
Malignant neoplasm arising from mesenchymal
tissue or its derivatives are called sarcomas. e.g.
– Osteosarcoma,Leiomyosarcoma.

8. Benign vs Malignant

9. Criteria of a Malignant Tumor
Criteria of a Malignant Tumor
Anaplasia
Rapid rate of growth
Local invasion
Metastasis

10. Criteria of a Malignant cell
Criteria of a malignant cell
Pleomorphism
Increased nuclear:cytoplasm= 1:1
Hyperchromatic nuclei and prominent nucleoli
Clumped chromatin
Irregular nuclear membrane
Frequent mitosis
Atypical mitotic figure

11. Hallmark of Cancer
Hallmark of cancer
1.Self-sufficiency in growth signals.
2. Insensitivity to growth-inhibitory signals due to inactivation of tumor suppressor
genes.
3. Altered cellular metabolism.
4. Evasion of apoptosis. Tumors are resistant to programmed cell death.
5. Limitless replicative potential (immortality).
6. Sustained angiogenesis.
7. Ability to invade and metastasize.
8. Ability to evade the host immune response.

12. Differentiation
It denotes the degree to which a
neoplastic cell resembles the normal
mature cells of the tissue.
Benign neoplasms: well differentiated
(closely resemble to normal tissue)
Malignant neoplasms: (well to poorly
differentiated or undifferentiated),
Anaplastic (lack of differentiation).
Differentiation denotes grading of
tumor

13. Invasion
Tumor invasion is the capacity of
tumor cells to disrupt the basement
membrane and penetrate underlying
stroma,
Invasion requires major changes in cell
morphology and phenotype, in
particular for epithelial cells that
represent the precursors to over 90%
of human cancers.

14. Metastasis
It is the spread of a tumor to
sites that are physically
discontinuous with the
primary tumor
Unequivocally marks a
tumor as malignant, as by
definition benign neoplasms
do not metastasize.

15. Dysplasia
Carcinoma in situ: Dysplastic changes
that involve entire thickness of
epithelium
Severe dysplasia usually progresses to
CIS.
It is a non-neoplastic process but a
premalignant condition.
Dysplasia: means loss of uniformity of
individual cells and loss of their
architectural orientation.

16. Dysplasia
1.Disorganized cell growth
2.Non-neoplastic and can
be reversible
3.Epithelial origin
Neoplasia
1.Abnormal cell growth
2.Neoplastic and irreversible
Both epithelial &
mesenchymal origin

17. Grading
Grading of a tumor denotes aggressiveness or behavior of the
tumor.
Grading is done by the histopathologist by microscopic
examination. The cancer may be classified as grade:
Well, moderately or poorly differentiated.
Grade 1,2,3.
Grade 1, II, III, IV.

18. Cont.
Grade 4: <25% cells differentiated.
Grade 3: 25-50% cells differentiated.
Grade 2: 50-75% cells differentiated.
Grade 1: >75% cells differentiated.
Broder Grading System:

19. Two methods of
staging are currently
in use
TNM method
• T = Tumor size
(Tx,T0,Tis,T1-4)
• N =Regional lymph node
involvement (Nx,N0,N1-3)
• M = Metastasis
(Mx,M0,M1)
AJC method

20. Grading systems
Other different types of grading system:
Viz. Gleason system of prostate cancer.
Bloom-Richardson system for breast cancer.
Nottingham system for breast cancer.
Fuhrman system for kidney cancer.
WHO system for CNS tumors.
Working formulation for NHL.

21. Staging
Staging is done by clinician
by clinical, radiological and
histopathological results.
Staging denotes the extent
of tumor spread to other
tissues (metastasis).

22. What causes
Cancer?
Cancer is caused
by
Alterations or
mutations in the
genetic code
• -Carcinogenic chemicals
• -Radiation
• -Some viruses
Can be induced in
somatic cells by
Heredity - 5%

23. Molecular basis of cancer
What is the molecular basis of cancer?
Cancer is a genetic disease.
 Mutations in genes result in altered proteins
-During cell division
-External agents
-Random event
Most cancers result from mutations in somatic cells
Some cancers are caused by mutations in germ line cells

24. Standard Dogma
• Proto-oncogenes
(Ras-melanoma)
• Tumor suppressor
genes (p53 – various
cancers)
Modified Dogma
• Mutation in a DNA
repair gene leads to the
accumulation of
unrepaired mutations
(Xeroderma
pigmentosum)
Early-Instability Theory
• Master genes required
for adequate cell
reproduction are
disabled, resulting in
aneuploidy(Philadelphia
chromosome)
Cont.

25. Cont.

30. Paraneoplastic syndromes :Symptoms complexes that
occur in patients with cancer & that can’t be readily
explained by local or distant spread of the tumor or by the
elaboration of hormones indeginous to the tissue of origin
of the tumor are referred to as Paraneoplastic syndromes.

32. As we know…
Malignant transformation of neoplasm is called Cancer .

33. Every life is valuable….

34. Why we are afraid of cancer….

35. We have 10 million Reasons…

36. Epidemiology

38. Cancer occurrence worldwide…

41. Why this million reasons…

42. In Bangladesh.…
Cancer is the sixth common
cause of mortality.
60% of the cancer patients
die within five years of
diagnosis.
Among them, Lung cancer in
male, and cervical and breast
cancer in female constitute
38% of all cancer cases in
Bangladesh.

43. According to a latest World Health Organization (WHO) report,
there are around 1.5 million cancer patients in Bangladesh with
150,000 dying each year.
The report shows that every year two lakh people are attacked by
cancer
However, the exact number of people suffering from cancer in the
country is hard to get as there are no population-based data on the
prevalence of cancer.

44. It has observed that
cervical cancer is the
most common cancer of
women especially
reproductive age in
Bangladesh.
Most patients are
diagnosed at the late
stages

45. Male vs Female Scenario…
Lip & oral
cavity
11.9%
Colorectal
6.5%
Stomach
4.7%
Prostate
2.3%
Esophageal
4.1%
Lung
13.1%
Cervical
26.1%
Lip & oral
cavity
6.6%
Ovarian
3.3%
Colorectal
2.7%
Lung
2%
Breast
32.8%

46. In Chittagong
Cancer patients
are increasing day
by day in
Chittagong.
Especially
women’s breast &
uterine cancer
and men’s lung
cancer are
increasing year by
year.
Two-thirds of total
cases are among
men in
Chittagong. In last
2 years 65% cases
are male cases.
Matter of concern
is out of the new
cases breast
cancer is
commonest in
women under 50
years.
Men are affected
by lung and oral
cancer most.

47. In last 2 years admitted patient
Male Female
Others
53%
Oral
cancer
19%
Lung
cancer
17%
Oesopha
geal
cancer
11%
Others
48%
Breast
cancer
24%
Cervical
cancer
16%
Oral
cancer
~12%

48. How to overcome
this…
Need to take some
calculated measures
First of all……..

49. Be aware of......

51. Maximum awareness
Regular screening
Healthier behaviours
Early detection
Timely treatment
Go with all guns blazing……

52. Until today total death from
covid 19 in Bangladesh is
29,395 and last year nearly
1 lakh people died from
cancer.
When we were starting this
session there were 10 more
people in the country, who
are now dead after this
session…………..

53. But first we need to
treat them timely
For timely treatment
we have to detect
first
And again in order to
detect it we have to
diagnose properly in
a proper way…

54. Laboratory diagnosis…
Cytopathology : (FNAC, Exfoliative cytology, Brushing cytology, Scrap cytology,
Imprint cytology).
Histopathology: (Excisional biopsy, Incisional biopsy, Punch biopsy, Cone biopsy,
Radical excision, Core biopsy).
Tumor marker: (Hormones, Oncofetal Antigen, Isoenzymes, Mucin and other
glycoproteins).
Immunohistochemistry.
Flow Cytometry.
Molecular diagnosis: (PCR, DNA Sequencing, DNA microarray analysis).

55. Errors we find in the lab
Receipt of sample Data entry Tissue dissection
No tissue received in specimen container Sample and request form allocated wrong
number
Request form and
specimen match not
performed
Specimen received without formalin Sample and request form given different
laboratory numbers
Specimen containers
wrongly numbered
Tissue samples received in wrongly sized
containers
Number of samples not consistent with request
form
Incomplete or incorrectly labeled request form or
specimen
Labeling on sample and request for not matching

56. Requisition form…
 Proper identification and orientation of the specimen are imperative for the adequate pathologic evaluation of a
case.
 An ideal requisition form contains….
 Patient identification
 Age
 Sex
 Essential clinical data
 Type of Operation
 Surgical findings.
 Differential diagnosis.

57. Condition of jar
Whenever the formalin is used, the volume of fixative
should be at least 10 times that of the tissue.
The container should have an opening large enough so
that the tissue can be removed easily after it has been
hardened by the fixation.

58. Wide bore, whole tissue submerged in formalin, 10
times more than the specimen, with matched labeling
and requisition form.

59. Cont.
Large Specimen that float on a fixative should be covered
by a thick layer of gauze.
Do not freeze the specimen with fixative.

60. Checklist investigation should be
precise…

61. Error in sending specimen
Every specimen should be
send in a separate jar….
Or else specimens can’t be
identified solely…

62. Some more errors…

63. Ideal prescription writing…

64. Exfoliative cytopathology…

65. Pap’s smear procedure…

66. VIA tray & findings…

67. FNAC from different site…

68. Aspiration
cytology
Ultrasound guided FNAC
CT guided FNAC

69. Pleural fluid aspiration & cytology

70. Immunohistochemistry

71. All this thing will not be mattered if we can not save the
precious lives of the human race
So what we say to the Angel of death
NOT TODAY

72. We can defeat cancer….

73. Just close the gap….