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http://sandymillin.wordpress.com/iateflwebinar2024
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2. • Neoplasia literally means "new growth
• “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 cessation of the stimuli which evoked
the change”
• Its often referred to as a tumor, and the study
of tumors is called oncology.
• Neoplasms can be of two types i.e. benign and
malignant
3. Basic Structure
• All tumors, benign and malignant, have two basic
components:
Parenchyma: made up of transformed or neoplastic cells,
• Largely determines its biologic behavior,
• Tumor derives its name.
Stroma: supporting, host-derived, non-neoplastic, made
up of connective tissue, blood vessels, and host-derived
inflammatory cells
• crucial to the growth of the neoplasm
- carries the blood supply
• provides support for the growth of parenchymal cells
5. Benign Tumors
• A tumor is said to be benign when its
microscopic and gross characteristics are
considered to be relatively innocent, remain
localized, non-metastatic and can be surgically
removed; the patient generally survives.
• Designated by attaching the suffix –oma
• Fibrous tissue: fibroma
• Cartilaginous tumor: chondroma
6. Benign Tumors
Adenoma
• benign epithelial neoplasms producing gland patterns
• derived from glands but not necessarily exhibiting gland
patterns
Papillomas
• Benign epithelial neoplasms, growing on any surface,
• Produce microscopic or macroscopic finger-like fronds
Polyp
• a mass that projects above a mucosal surface, as in the
gut, to form a macroscopically visible structure
Cystadenomas
• hollow cystic masses; typically they are seen in the ovary
7. Malignant Tumors
• lesion that can invade and destroy adjacent
structures and spread to distant sites
(metastasize) to cause death
Malignant neoplasms arising in
• Mesenchymal tissue : sarcomas
• Epithelial cell origin: carcinomas
• Glandular pattern: adenocarcinomas
9. CHARACTERISTICS OF TUMORS
The characteristics of tumors are described
under the following headings
• Rate of growth
• Cancer stem cells
• Clinical and gross features
• Microscopic features
• Local invasion (Direct spread)
• Metastasis (Distant spread)
10. Rate of growth
• Generally proliferate more rapidly than the
normal cells.
• Benign tumors grow slowly and malignant
tumors rapidly
• Many exceptions to this generalization are
there.
• Rapidly growing tumors tend to be poorly
differentiated
12. Cancer Stem Cells
• Cancer cell – heterogeneous population of cell
which may contain Cancer Stem Cells
• It has been hypothesized that these cells -
capacity to initiate and sustain the tumor
• So killing of these cells may be the principle of
certain therapies.
• Whether cancer stem cells exist in all tumors
is not yet clear
14. Clinical Features
Benign
• Generally slow growing
• Depending upon the location
• Asymptomatic: subcutaneous lipoma
• Symptomatic: meningioma in the nervous
system
15. Malignant
• malignant tumors grow rapidly
• may ulcerate on the surface
• invade locally into deeper tissues
• may spread to distant sites (metastasis)
• systemic features such as weight loss, anorexia
and anemia
• cardinal clinical features : invasiveness and
metastasis
16. Gross appearance
Benign
• spherical or ovoid in shape
• encapsulated or well-circumscribed
• freely movable
• more often firm and uniform, unless secondary changes
like hemorrhages or infarction supervene
Malignant
• Irregular in shape
• poorly-circumscribed and extend into the adjacent tissues
• Secondary changes like hemorrhage, infarction and
ulceration are seen more often.
18. Microscopic Features
Its of greatest importance for recognizing and
classifying the tumors.
These should be considered under
• Microscopic pattern
• Differentiation and anaplasia
• Tumor angiogenesis and stroma
• Inflammatory reaction
19. LOCAL INVASION (DIRECT SPREAD)
BENIGN TUMORS
• Form encapsulated or circumscribed masses
• Expand and push aside the surrounding normal tissues
• Without actually invading, infiltrating or metastasizing
MALIGNANT TUMORS
• Initially enlarge by expansion and some well-
differentiated tumors may be partially encapsulated as
well
• But later they can be distinguished by invasion,
infiltration and destruction of the surrounding tissue
20. METASTASIS (DISTANT SPREAD)
• Defined as the development of secondary
implants (metastasis) discontinuous with the
primary tumor, in remote tissues
• Benign tumors do not show metastasis
• Approximately 30% of newly diagnosed patients
with solid tumors (excluding skin cancers other
than melanomas) present with clinically evident
metastases
• An additional 20% have occult (hidden)
metastases at the time of diagnosis
21. Genetic theory of cancer: various gene regulate the
normal mechanism of growth in human body like
• Proto-oncogenes: growth-promoting genes
• Anti-oncogenes: growth-inhibiting or growth
suppressor genes.
• Apoptosis regulatory genes control the programmed
cell death.
• DNA repair genes
In cancer cell these are replaced by
• Activation of growth-promoting oncogenes
• Inactivation of cancer-suppressor genes
• Abnormal apoptosis regulatory genes
• Failure of DNA repair genes
23. PHYSICALCARCINOGENESIS
• Radiation
– ultraviolet light and ionising radiation like X-rays, α-,
β- and γ-rays, radioactive isotopes, protons and
neutron
– Higher dose and with high LET(linear energytransfer)
causedcarcinogenic effect
• Non-radiation
– Continous mechanical injury to thetissues such
as from intrinsicstone
– implants of inert materials suchasplastic, glassetcin
prostheses
24. Chemical carcinogens and chemical
carcinogenesis
• Chemical carcinogens can be classified into
DIRECT-ACTING CARCINOGENS: do not require
metabolic activation
• Alkylating agents: various drugs (e.g.
cyclophosphamide, chlorambucil, busulfan,
melphalan, nitrosourea etc), β-propiolactone
and epoxides.
• Acylating agents: acetyl imidazole and
dimethyl carbamyl chloride
26. BIOLOGICCARCINOGENESIS
Various studies have proved the direct role of
microorganisms in causing cancer.
• Parasites: Schistosoma haematobium - squamous
cell carcinoma of the urinary bladder
• Clonorchis sinensis, the liver fluke -
cholangiocarcinoma.
• Fungus: Aspergillus flavus (in certain grains) -
hepatocellular carcinoma.
• Bacteria: Helicobacter pylori - chronic gastritis
and peptic ulcer; its prolonged infection may
lead to gastric lymphoma and gastric carcinoma
27. Viral: most important organism
• Oncogenic RNA Viruses : human T-cell leukemia
virus-1 (HTLV-1) , retrovirus that has been
demonstrated to cause cancer in humans
• Oncogenic DNA Viruses : -human papillomavirus
(HPV), Epstein-Barr virus (EBV), Kaposi sarcoma
herpesvirus (KSHV) also called human
herpesvirus 8), and hepatitis B virus (HBV)
28. Clinical Implications
Local effects
1.Compression of nearby structures
Example includes pancreatic carcinoma on bile
duct leading to obstruction
2.Ulceration/bleeding
• Colon
• Gastric
• Renal cell carcinoma
29. 3.Infection (often due to obstruction)
• Pneumonia
• Urinary infection
4.Rupture or infarction
• Ovarian
• Bladder
• Colon
30. Clinical Significance
Cancer Cachexia
• Progressive weakness, loss of appetite,
anemia and profound weight loss (>20%),
often correlate with tumor mass and spread.
• Probably related to macrophage production of
TNF-gamma.
31. Treatment of Cancer
• Most anti-cancer treatment is directed
towards killing actively dividing cells.
• Newer drugs target tumor cells by immune
mechanisms or hormones.
32. Treatment approaches
• Surgical therapy –early stage
• Chemotherapy
• Radiotherapy
• Neoadjuvant therapy –therapy in which
radiotherapy is applied first to reduce mass of
cells, once cells shrink it becomes easy to
remove them by surgical procedure.
