This document provides information on cancer of definite organs, including gastric carcinoma, lung carcinoma, and breast cancer. It discusses the definition, risk factors, symptoms, diagnostic tests, staging, and common treatments for each type of cancer. Gastric carcinoma most commonly affects men aged 40-60 and starts in the gastric canal. Lung carcinoma is a leading cause of cancer death worldwide and often metastasizes to nearby lymph nodes. Breast cancer risk is influenced by factors like age, family history, obesity, and alcohol use, and is typically diagnosed via mammogram or biopsy before being treated with surgery, radiation, hormone therapy and/or chemotherapy.

1. Cancer of definite organs

2. Gastric carcinoma
• Gastric cancer, commonly referred to as stomach cancer, can develop in
any part of the stomach and may spread throughout the stomach and to
other organs; particularly the esophagus, lungs, lymph nodes, and the
liver. Stomach cancer causes about 800,000 deaths worldwide per year.
• Gastric carcinoma comprises more that 90% of all gastric malignant
tumors. Men at the age of 40-60 suffer more often than women.
• Gastric carcinoma is most commonly located in the region of the gastric
canal, less common localization are the body, cardiac and fundus.

3. Pre-cancer changes:
• Chronic atrophic
gastritis
• Adenoma
(adenomatous polyps)
of the stomach

4. Classification:
According to the deepness of the lesion in the gastric wall:
• Early gastric carcinoma: only mucous layer
• Advanced gastric carcinoma: penetrates mucous layer and
beyond
According to location:
1. Pyloric gastric carcinoma
2. Lesser curvature
3. Cardial gastric carcinoma
4. Fundal carcinoma
5. Total gastric carcinoma

5. Macroscopic (anatomical) forms:
1.Carcinoma with exopthytic growth:
a) Superficial spreading type
b) Polypoid type
c) Fungating (fungiform) type
d) Ulcerative type
2.Carcinoma with endophytic growth:
a)Ulcerative-invasive
b)Diffuse
3.Carcinoma with exophytic and endophytic growth (mixed)
Microscopic (histological) types:
-Adenocarcinoma
-Poorly-differentiated: signet ring carcinoma, scirrhous carcinoma, solid carcinoma
-Squamous cell carcinoma
-Adenosquamous carcinoma

7. Early gastric carcinoma
• Early gastric carcinoma is a term used to describe
cancer limited to the musoca and submucosa.
• Macroscpically, the lesions of early gastric carcinoma
may have 3 patterns: superficial,polypoid and ulcer
associated. The superficial type may furthur be of
flat, elevated to depressed types.
• Microscpically, early gastric carcinoma is atypical
granula adenocarcinoma, usuaally well
differentiated.

8. Advanced gastric carcinoma
• When the carcinoma crosses the basement membrane
into the muscular propria or beyond.
• Ulcerative carcinoma(common). Tumor appears to be flat,
infiltrating and ulcerative growth. Macroscopically
ulcerative carcinomas are pooorly diferentiated
adenocarcinomas, which invade deeply inot stomach wall
• Fungating(polypoid) carcinoma. Cauliflower growth
projection into the lumen. Microscopically fungating or
polypoid carcinomas are well-differentiated
adenocarcinomas, coomonly papillary type.
• Scirrhous carcinoma. Stomach wall is thickened due to
extensive desmoplasia giving the appearcance as leather
bottle stomach or linitis plastica Microscopically it may be
an adenocarcinoma or signet ring cell carcinoma.
• Colloid carcinoma. Commonly in fundus, tumor grows like
masses having gelitinous appearnce due to secretion of
large quantities of mucus.
• Ulcer-cancer. Majority of ulcer-cancers are malignant
lesions from the beginning.

9. Metastasis can be:
• Lymphogenic:
1. Orthograde(with the lymph flow): lymph.nodes
along lesser and greter curvature
2. Retrograde (against the lymph flow):
- Krukenberg (in the ovari),
- Virchows (in the left supraclavicular
lymph.node),
- Shnitslers (lymph.nodes of pararectal fat tissue)
• Hematogenic metastases are carried with the blood
flow to the liver,lungs,brain,bones,kidneys and
adrenal glands.
• Implantation, when the carcinoma disseminates
throught the peritionieum or penetrate to the
pancreatic glands.

10. Complications
• Mortality 1-2%
• Anastamotic leak, bleeding, ileus, transit
failure, cholecystitis, pancreatitis, pulmonary
infections, and thromboembolism.
• Late complications include dumping
syndrome, vitamin B-12 deficiency, reflux
esophagitis, osteoporosis.

11. Outcome
• 5-year survival for a curative resection is 30-
50% for stage II disease, 10-25% for stage III
disease.
• Adjuvant therapy because of high incidence of
local and systemic failure.
• A recent Intergroup 0116 randomized study
offers evidence of a survival benefit
associated with postoperative
chemoradiotherapy

12. Lung Carcinoma
• Lung cancer is a disease that consists of
uncontrolled cell growth in tissues of the
lung. This growth may lead to metastasis,
which is the invasion of adjacent tissue
and infiltration beyond the lungs. The vast
majority of primary lung cancers are
carcinomas, derived from epithelial cells.
Lung cancer, the most common cause of
cancer-related death in men and women,
is responsible for 1.3 million deaths
worldwide annually, as of 2004. The most
common symptoms are shortness of
breath, coughing (including coughing up
blood), and weight loss.

13. Precanceromatous processes
• Chronic inflammatory diseases (chronic
bronchitis, bronchoectasis, pneumosclerosis)
• Precancer changes of epithelium
- hyperplasia,
- metaplasia,
- dysplasia

14. Location
• Bronchogenic (central) or Peripheral
• Central type: (common), arises in the main bronchus or
one of its segmented branches in the hilar parts of the
lung, more often the right side. The tumor grows into a
friable spherical mass 1-5cm in diameter, narrowing
and occluding the lumen. The tumor spreads within the
lungs by direct extention or by lymphatics.
• Peripheral type: Small proportion of the lung cancers,
chiefly adenocarcinomas including bronchoalveolar
carcinomas, originate from small peripheral bronchiole
but the exact site of origin may not bediscernible. The
tumore may be single nodule or multiple nodules in
the periphery producing pneumonia like consolidation.

15. Classification
According to pecularities of growth:
-Exophytic (endobrochial type)
-Endophytic (exobronchial type, and peribronchial type)
According to macroscopical signs
-Superficial
-Polypoid
-Endobronchial
-Nodular
-Branching type
-Nodular-Branching type
Accoridng to the WHO
-Squamous cell carcinoma
-Adenocarcinoma
- Poorly-differentiated (large-cell, smal-cell carcinomas)
- Rare forms (adenosquamous, bronchoalveolar, carcinoma of bronchial glands)

16. Localization of the first metastases
• - peribronchial l.n.
• - bifurcative l.n.

17. Causes of death
• 1. Generalisation of tumor.
• 2. Pulmonary complications (bleeding,
suppuration, pneumothorax)
• 3. Cachexia

18. Breast Cancer
• Breast cancer (malignant breast
neoplasm) is cancer originating from
breast tissue, most commonly from the
inner lining of milk ducts or the lobules
that supply the ducts with milk. Cancers
originating from ducts are known as ductal
carcinomas; those originating from lobules
are known as lobular carcinomas. The size,
stage, rate of growth, and other
characteristics of the tumor determine the
kinds of treatment. Treatment may
include surgery, drugs (hormonal therapy
and chemotherapy), radiation and/or
immunotherapy

19. Risk FactoR
• Primary – sex, age, lack childbearing/
breastfeeding, higher hormone level, race,
economy, dietary iodine deficiency.
• Age- advanced age (50 and above more likely to
be affected). risk for breast cancer is increased if
she starts menstruating before age 12, has her
first child after 30, stops menstruating after 55,
or has a menstrual cycle shorter or longer than
the average 26-29 days.
.

20. • Smoking, later age at first birth, not having
children, family history, past hormone
replacement therapy .
• Genetic, high fat diet, alcohol intake, obesity,
tobacco use, radiation, endocrine distruptor.
• Personal (1 of the breast had cancer), family
(at least 2 close relatives with breast or
ovarian cancer ).
• Weight gain as the aged.

21. PRevention
• Exercise, prevent smoking
• Avoiding alcohol and obesity
• Prevention bilateral mastectomy in patient
with BRCA1 and BRCA2
• Breastfeeding
• Do monthly self breast exam
• Have yearly exam by doctor after 40
years,may have mammogram.

22. • Diet control
- eating five or more servings of vegetables and
fruits each day, choosing wholegrains over
processed (refined) grains, and limiting
consumption of processed and red meats.
- fat and red meat has to be taken in
moderation. It is also recommended that to
maintain a desirable body weight, eat more
high-fibre foods such as whole grains, cereals,
breads, vegetable and soya, and limit the
consumption of salt-cured, smoked, and
preserved foods.

23. • Beans are also recommended as they are a
high-fibre, low-fat, vitamin-packed source of
protein. Beans are full of antioxidants. Black
beans offer the most benefit, followed by
lentils, soya beans and red kidney beans.

24. Diagnosis
• Screening technique- to detect lump (whether it
is cance or simple cyst in benign)-need futher
test.
-for earlier diagnosis
-self breast exam – feeling lumps or other
abnormalities.
-mammography- xray (frequent use can cause
radiation)
• Ultrasound, MR imaging, mammography.

25. • Fine Needle Aspiration and Cytology (FNAC)-
extract fluid from lump.
• Biopsy- remove breast lump (section or
entire).
• Vacuum-assisted breast biopsy (VAB)

26. tReatment
• Surgery, chemotherapy, radiation.
• Surgery- to remove as much cancer as possible.
mastectomy – removal the whole breast
lumpectomy – a part of breast
reconstruction surgery- to create the
look of a normal breast
• Hormone blocking (or hormone positive cancer)
• Hormone therapy- medicine in pill form taken to
work against estrogen in the body. The most
common side effect is signs of menopause.
• Stage 1- lumpectomy, radiation, HER2+- treated
with trastuzumab regime.

27. • The treatment is depending on the stage of
the disease.
• Stage 1- surgery- lumpectomy tumor removal
with some surrounding tissues
• radiation- after lumpectomy, kill missed
cancer cell, usually not necessary after
mastectomy.
• HER2+- treated with trastuzumab regime.

28. • Stage 2- surgery (lumpectomy or mastectomy-with
or without removal of lymph node),
chemotherapy, radiation.
. Stage 4- metastasis- surgery, radiation,
chemotherapy, targeted therapy.
• Medication- nolvadex (tablet)
• - adjuvant therapy (addition to
surgery)- hormone blocking therapy(estrogen-block
receptor(tamoxifen) or its production
(aromatose inhibitor-suitable for menopause
patient), chemotherapy monoclonal
antibodies.

29. • Chemotherapy- medicine given in an IV
(intravenous) tube in a vein or as a pill. The
medicine kills cancer cells. - stage 2-4,
cyclophosmide with adriamycin (AC), destroy
fast growing/replicating cancer by damage
DNA. Sometimes added with docetaxel to
attack microtubule in cancer cell. Can use
cyclophosphamide, methotrexate, and
fluorouracil (CMF).
• Lower the risk of cancer of coming back.

30. • Common side effects include feeling tired, hair
loss and nausea. These side effects are often
temporary.
• Monoclonal antibodies- HER2+ cancer
treatment (because stimulated by growth
factor make it overexpressed)- trastuzumab.
Aspirin may be used.

31. • Radiotherapy- after surgery to destroy
microscopic tumor that escaped surgery.,
external beam radiotherapy or brachytherapy
(internal).can used intraoperatively. Can
reduce recurrence, essential if the surgery
only remove lump. Can be done 4 to 6 weeks
after surgery.

32. PRognosis
• Important for treatment decision
• Less invasive for a good prognosis one
( lumpectomy, radiation, hormone therapy)
• Poor prognosis (extensive mastectomy,
chemotherapy drugs)
• Prognosis factor – staging ( tumor size (invasive),
grade, metastasis, local involvement, lymph node
status), recurrence of disease, age. Stage raised
by invasiveness and aggressiveness, lowered by
cancer-free zone and close to normal cell
behaviour (grading).

33. • Good prognosis- 1
• Poor prognosis – 3@4
• Grading criteria- tubule formation (1 point-in
>75% of tumor, 2 points- in 10- 75% of tumor,
3 points- in , 10% of tumor), nuclear
pleomorphism (1 point-minimal variation, 2-
moderate, 3- marked variation)and mitotic
count (1,2,3. count only at the periphery of
tumor and begin at the most mitotic active
area).
• Younger patient have poorer prognosis than
menopausal one (firm lumpy tissue can hide a
small lump and make it hard to feel)

34. • Patient without positive hormone R not be
able to response to hormonal therapy.
• Presence of cell surface protein can effect the
treatment and prognosis (HER2-more
aggressive and have to be treated with
targeted therapy)

35. Precancer processes
• 1. Fibroadenomatosis (mastopathy)
• 2. Ductal papilloma

36. • Sclerosing Adenosis of Breast
Comments: Some cases of sclerosing adenosis don't have lobulocentric
architecture and may have infiltrative edges. This may lead to the mistaken
diagnosis of well-differentiated ductal carcinoma, especially in limited needle
core biopsy specimens.

37. • Blunt Duct Adenosis (Columnar Cell Change)
Comments: The luminal columnar epithelial cells have basally-oriented
oval nuclei and prominent apical snouts. When the lining epithelium is
more than 2 layers thick, the term columnar cell hyperplasia is applied.

38. • Intraductal Papilloma of Breast : Solid type
Comments: Another case of a solid intraductal papilloma. Fusion of
papillary fronds creates secondary lumens. Myoepithelial cells are clearly
seen at the periphery of the lumens.

39. • Intraductal Papilloma of Breast : Solid type
Comments: Florid epithelial hyperplasia has filled up virtually all the space
between fibrovascular stalks imparting a solid appearance.

40. Macroscopic forms
• 1. Nodular
• 2. Diffused
• 3. Cancer of nipple and nipples area (rare)

41. • Infiltrating Ductal Carcinoma
Comments: In more advanced cases of infiltrating ductal carcinoma, the
overlying skin may be invaded (as seen here). Fortunately, such cases are
rarely seen these days.

42. • Infiltrating Ductal Carcinoma
Comments: In a typical invasive ductal carcinoma, NOS, the tumor is firm
and poorly circumscribed with a yellowish gray cut surface. It cuts with a
gritty sensation. It may show strands radiating into the surrounding fat.

43. • Mucinous Carcinoma of Breast
Comments: Another example of mucinous carcinoma of breast. The tumor
has ill-defined margins as compared to the previous case. This is seen more
often in tumors with mixed mucinous and ductal differentiation.

44. • Mucinous Carcinoma of Breast
Comments: Mucinous carcinoma is more common in post-menopausal
women. Pure mucinous carcinomas comprise up to 2% of all breast
cancers. Focal mucinous differentiation is seen in additional 2% of breast
cancers. For prognostic reasons, the term mucinous carcinoma should be
applied to pure mucinous tumors. Grossly, the tumor is generally well-circumscribed
and has a gelatinous or jelly-like cut surface.

45. • Medullary Carcinoma of Breast
Comments: Medullary carcinoma is usually seen in patients under age 50. It
is common in Japanese women and in carriers of BRCA1 mutations. The
tumor is well-circumscribed and may be partially cystic (as seen here). The
cut surface is solid and uniform and may have areas of hemorrhage or
necrosis.

46. • Phyllodes Tumor : High-grade
Comments: This specimen of high-grade phyllodes tumor shows a
circumscribed tumor with areas of hemorrhage and necrosis. The sections
showed infiltrative borders, stromal overgrowth with considerable
cytologic atypia and frequent mitoses. The histologic features were those
of sarcoma, NOS. Clear-cut distinction between benign and malignant
phyllodes tumor may not always be possible.

47. • Phyllodes Tumor : High-grade
Comments: High-grade (malignant) phyllodes tumor of the breast in a 35
y/o female. The specimen weighed 1166 grams and measured 18 x 14 x 10
cm.

48. According to WHO, breast carcinomas are divided into
Non-Invasive and Invasive ones.
Non-Invasive carcinomas. Characterized by
histologically by the prescence of tumor cells within the
ducts or lobules without evidence of invasion. Two
types are describes: Intraductal carcinoma or lobular
carcinoma in situ.
Intraducatal carcinoma (in situ): confined within the larger
mammary ducts. Tumor initially begins with atypical
hyperplasia of the ductile epithelium followed by filling
of the duct with tumor cells. Macroscopically the tumor
may vary from a small poorly defined focus to 2.5-
5.5cm diameter in mass. Microscopically the
proliferating tumor cells within the ductile Lumina may
have 4 types of patterns in different combinations:
solid, comedo, papillary and cribriform.
Intralobular carcinoma (in situ): identified only
microscopically. Characterized by filling up of terminal
ducts and ductile or acini by rather uniform cells which
are loosely cohesive and have small, rounded nuclei
with indistinct cytoplasm margins.

49. Invasive carcinomas:
Infiltrating ductal carcinoma is the classic breast cancer.
Macroscopically, the tunor is irregular, 1-5cm in
diameter, hard cartillage like mass that cuts with grating
sounds.
Infiltrating lobular carcinoma: invasive cancers in being more
frequently bilateral and within the same breast, may have
multicentric origin.Macroscopically, appearance is
scirroius.
Rare (speshial) forms:
Medulary carcinoma has a singificantly better prognosisi that
the usual infiltrating duct carcinoma probably due to
good host immune response.
Colloid carcinoma contains large amount of extracellular
epithelial mucin and acini filled with mucin. Cuboidal to
tal columnar cells, some showing mucus vacuolation, are
see floating in large takes of mucin.

50. • Ductal Carcinoma-in-situ : Micropapillary
• Comments: The papillae in this case of micropapillary DCIS range from
small bumps or mounds of tumor cells to slender papillary structures. The
nuclear grade is high. Some of the papillary fronds projecting into the
lumen may be cut transversely resulting in appearance of small detached
irregular clusters of tumor cells in the lumen (as seen here). Cellular
debris, usually a feature of cases with high nuclear grade, is also present
in the lumen.

51. • Ductal Carcinoma-in-situ
Comments: The tumor cells with high nuclear grade nearly fill the lumen
in this example of DCIS. The cytoplasmic borders are sharply demarcated.

52. • Lobular Carcinoma-In-Situ
Comments: Following the diagnosis of LCIS, approximately 20% to 30% of
patients will develop invasive carcinoma in the absence of therapy. The
increased risk applies to both breasts, although it is greater on the side of
the diagnostic biopsy. The invasive carcinoma could be either lobular or
ductal type.

53. • Infiltrating Lobular Carcinoma : Signet Ring Type
Comments: High power view of the previous image shows the signet ring
morphology in this infiltrating lobular carcinoma. Elsewhere in the case,
classical Indian filing pattern was seen.

54. • Invasive Papillary Carcinoma of Breast
Comments: The diagnosis of invasion in a papillary carcinoma of the breast
can be quite difficult. Many cases have areas of fibrosis, recent or remote
hemorrhage, inflammation or reaction to previous needle biopsy
procedures. Extension of carcinoma beyond the tumor borders and
desmoplastic stromal reaction generally support the presence of invasion
(as seen in this image).

55. • Intracystic Papillary Carcinoma of Breast
Comments: Higher power view of the previous case shows several papillary
structures with fibrovascular cores. Features favoring carcinoma are
uniformity in the size and shape of epithelial cells, lack of myoepithelial
cells, nuclear hyperchromasia, nuclear enlargement, and high mitotic
activity. Lack of benign proliferative changes in the adjacent breast also
favor carcinoma.

56. • Carcinoma arising in a Fibroadenoma
Comments: Higher power view from the previous case shows clusters of
tumor cells in pools of mucin. In rare cases of malignancy arising in a
fibroadenoma, sarcomatous transformation may be seen.

57. • Medullary Carcinoma of Breast
Comments: The tumor cells grow in clusters or sheets with no evidence of
glandular differentiation. A prominent lymphoplasmacytic infiltrate
within and around the tumor is always present.

58. • Mucinous Carcinoma of Breast
Comments: The nuclei are plump and vesicular with prominent nucleoli.
Mitotic figures are easily found.

59. Medullary Carcinoma of Breast
Comments: Higher magnification view of the previous slide shows the
highly anaplastic tumor cells in a background of lymphoplasmacytic
infiltrate.

60. • Metaplastic Carcinoma of Breast
Comments: Another example of densely cellular metaplastic carcinoma of
breast. The tumor was largely composed of plump spindle cells with vague
storiform pattern. The nuclei showed immunoreactivity for p63.

61. Localization
of the first lymphogenic metastases
• 1. subaxillary l.n.
• 2. anterior pectoral l.n.
• 3. subclavian l.n.
• 4. juxta-pectoral l.n.
• 5. supraclavian l.n.

62. Localization
of the first hematogenic metastases
• 1. bone (spine)
• 2. lung
• 3. liver
• 4. kidney

63. Paget’s nipple disease
• Paget's disease of the breast is a malignant
condition that outwardly may have the
appearance of eczema, with skin changes
involving the nipple of the breast.
• The condition occurs when Paget's cells,
which are large and irregular, form in the
skin of the nipple. Although Paget believed
the cells were not cancerous, it was later
proved that the cells were themselves
malignant, in addition to indicating
underlying breast cancer. Since the
condition is often innocuous and limited to
a surface appearance, it is sometimes
dismissed, despite the fact that it is
indicative of a condition (breast cancer)
that may prove fatal if left untreated.

64. The nipple bears a crusted, scaly eczematoid lesion with a
palpable subareolar mass in about half the cases.
Macroscopically, the skin of the nipple and areaok is crusted ,
fissured and ulcerated with oozing of serosanguineous fluid
from erisions.
Microscopically the skin lesion is charaterized the presnce of
pagents cells singly or in small clusters in the epidermis.
The meatastases are either local or distant, the former to the
lymphatic nodes of the breast base, axilla, subclavicular,
parasternal nodes. Distant metastases are hematogenic ones.
Late metastases and relapses occur 5-20 years after the
operation.

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