Patient with Cancer Neoplasia – Pathophysiology Notes Description: This SlideShare presentation provides a detailed overview of the pathophysiology of cancer neoplasia. It is designed for nursing and healthcare students seeking to understand the mechanisms behind abnormal cell growth, tumor formation, and the progression of malignant neoplasms. Key topics include: Definition and classification of neoplasia Cellular changes in cancer Mechanisms of carcinogenesis Tumor markers and lab investigations Clinical manifestations Nursing and medical management principles These notes are ideal for academic revision, classroom teaching, or exam preparation.

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Patient with Cancer – Pathophysiology Notes
1. Definition of Cancer
Cancer is an abnormal and uncontrolled growth of cells that can invade nearby tissues and
spread to other parts of the body (metastasis).
“Cancer is a group of diseases characterized by the uncontrolled growth and spread of
abnormal cells. If the spread is not controlled, it can result in death. The abnormal cells
may invade surrounding tissues and can metastasize to distant organs through the blood
and lymphatic systems.”
Reference:
American Cancer Society. (2022). What Is Cancer? Retrieved from https://www.cancer.org
2. Characteristics of Cancer Cells
• Uncontrolled cell division (Pattern less)
• Loss of apoptosis (programmed cell death)
• Angiogenesis (formation of new blood vessels)
• Invasion and metastasis
• Altered cell structure and function

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Characteristics of Cancer Cells
Cancer cells differ from normal cells in several key ways that enable them to grow uncontrollably
and spread. The major characteristics include:
1. Uncontrolled Cell Division
Cancer cells bypass the normal regulatory mechanisms that control cell growth and division. They
continue dividing even when not needed, leading to tumor formation.
2. Loss of Apoptosis (Cell Death)
Normal cells undergo apoptosis (programmed cell death) when they are damaged or no longer
needed. Cancer cells ignore these signals and become "immortal," living much longer than normal.
3. Genetic Mutations
Cancer cells usually have damaged or mutated DNA, which can affect genes that control growth,
such as oncogenes (promote growth) or tumor suppressor genes (inhibit growth).
4. Ability to Invade and Metastasize
Cancer cells can break away from their original site and invade nearby tissues. Through blood and
lymph vessels, they can metastasize to distant organs (e.g., lungs, liver, bones).
5. Angiogenesis (Formation of New Blood Vessels)
To support their rapid growth, cancer cells stimulate the formation of new blood vessels that supply
oxygen and nutrients to the tumor.
6. Altered Cell Structure
Cancer cells often appear abnormal under the microscope. They may have:
• Irregular shapes and sizes
• Large, abnormal nuclei
• Disorganized arrangement
7. Evading the Immune System
Cancer cells can avoid detection or destruction by the immune system by producing substances
that suppress immune responses or mimic normal cells.
8. Metabolic Changes
Cancer cells often shift to anaerobic metabolism (even in oxygen presence) – known as the Warburg
effect – allowing faster energy production for rapid growth.

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3. Types of Tumors
• Benign Tumor: Non-cancerous, slow growing, encapsulated
• Malignant Tumor: Cancerous, fast growing, invasive, can metastasize
4. Common Causes and Risk Factors
• Genetic factors: Mutations in oncogenes and tumor suppressor genes
• Environmental exposure: Radiation, carcinogens (e.g., tobacco smoke)
• Lifestyle: Poor diet, obesity, lack of exercise
• Infections: HPV (cervical cancer), H. pylori (gastric cancer)
• Immunosuppression: HIV, organ transplant patients
5. Pathophysiology of Cancer
• DNA s → Abnormal cell → Uncontrolled proliferation
• Cells evade apoptosis → Immortal cells
• Secrete enzymes → Tissue invasion
• Angiogenesis → Nutrient supply to tumor

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• Spread through lymphatic or blood vessels → Metastasis
6. Clinical Manifestations
• Unexplained weight loss
• Fatigue and weakness
• Pain (often late sign)
• Fever or night sweats
• Anemia or bleeding
• Lump or mass
• Skin changes or non-healing sores
7. Diagnosis
• Biopsy: Confirm cancer histologically
• Imaging: CT, MRI, PET scans
• Blood tests: Tumor markers (e.g., PSA, CA-125)
• Endoscopy or bronchoscopy (site-specific)

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1. Genetic Factors
• Some people inherit mutations in certain genes that increase cancer risk.
• Oncogenes (promote cell growth) and tumor suppressor genes (control cell division)
are commonly involved.
• Examples: BRCA1 and BRCA2 mutations in breast and ovarian cancers.
2. Environmental Exposure
• Repeated exposure to carcinogens (cancer-causing agents) increases the risk.
• Radiation: UV rays (linked to skin cancer), X-rays
• Chemical Exposure: Tobacco smoke (lung cancer), asbestos (mesothelioma)
3. Lifestyle Factors
• Unhealthy diet, obesity, and physical inactivity can lead to hormonal and metabolic
changes that increase cancer risk.
• Excessive alcohol intake is also a known risk factor for several types of cancer (e.g.,
liver, breast, esophagus).
4. Infections
Certain infections are directly linked to cancer development:
• HPV (Human Papillomavirus): Linked to cervical, anal, and oropharyngeal cancers.
• H. pylori: Chronic infection can lead to gastric ulcers and stomach cancer.
• Hepatitis B and C viruses: Can cause liver cancer.
5. Immunosuppression
• A weakened immune system reduces the body's ability to detect and destroy abnormal
cells.
• Seen in:
o HIV/AIDS patients
o Organ transplant recipients (due to immunosuppressive drugs)
o Patients receiving long-term chemotherap

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8. Staging and Grading
• TNM System:
o T = Tumor size
o N = Lymph node involvement
o M = Metastasis
• Grading: Based on cell differentiation (Grade I to IV)

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Grade I (Low Grade)
• Well-differentiated cells (look similar to normal cells)
• Tumor grows slowly
• Less likely to spread
• Better prognosis
Grade II (Intermediate Grade)
• Moderately differentiated cells (some abnormal features)
• Moderate growth and spread potential
• Intermediate prognosis
Grade III (High Grade)
• Poorly differentiated cells (look very abnormal)
• Fast-growing and more likely to invade nearby tissues
• Poorer prognosis
Grade IV (High Grade)
• Undifferentiated or anaplastic cells (do not resemble normal tissue at all)
• Very aggressive growth
• High potential for metastasis
• Worst prognosis

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9. Treatment Modalities
• Surgery: Remove localized tumor
• Radiation therapy: Kill cancer cells locally
• Chemotherapy: Systemic drugs to kill rapidly dividing cells
• Immunotherapy: Boost immune system to fight cancer
• Targeted therapy: Block specific molecules involved in cancer growth
• Palliative care: Manage symptoms and improve quality of life
10. Nursing Considerations
• Monitor for treatment side effects (e.g., nausea, fatigue, neutropenia)
• Provide emotional support and education
• Manage pain and comfort
• Monitor nutritional status
• Maintain infection prevention precautions
• Educate about follow-up and rehabilitation
11. Complications of Cancer
• Metastasis to other organs
• Cachexia (extreme weight loss)
• Anemia and immunosuppression

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• Organ failure
• Psychological impact (anxiety, depression)

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Premalignant (Precancerous Lesions
Premalignant lesions are a group of conditions which predispose to the subsequent
development of cancer Certain clinical conditions are well recognized predisposition to the
development of malignant neoplasia. It is important to recognize premalignant condition
because it is possible at this stage to complete eradicate the lesion.
Premalignant (Precanerous) Lesions
Premalignant lesions cancer

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Carcinoma In Site Intraepithelial Neoplasia
When the cytological features of malignancy are present but the malignant cells are
confined to epithelium without invasion across the basement membrane (Le basement
membrane is intact), it is called as carcinoma in sim or intraepithelial neoplasia (CIN). It
may regress and return to normal or may develop into invasive cancer Carcinoma in cite is
a true neoplasm with all features of malignancy except invasiveness The common sites are
the following: uterine cervix, oral leukoplakia and intralobular and intraductal carcinoma of
breast. Examples: Bowen's disease of skin, actinic or solar keratoses, crythroplasia of
Queyrat, leukoplakia with dysplasia, cervical dysplasia, Paget's disease of skin.
Dysplasia
Dysplasia is an abnormality of both differentiation and maturation of cells. It is an
alteration in adult cells characterized by variation in their size, shape and organization. It is
a loss of uniformity of cells and loss in their structural orientation Dysplasia is encountered
principally in epithelium. The dysplastic cells show
1. Pleomorphism, Variation in size and shape.
2. Increased nuclear cytoplasmic ratio Increased size of nucleus causes increased
nuclear: cytoplasmic ratio.
3. Hyperchromasia, increased chromatin content resulting in deeply stained nuclei
4. Increased mitotic figure, but pattern is normal.
5. Cytoplasmic abnormalities:
lack of keratinization in squamous cells and lack of mucin in glandular epithelium.
6. Disorderly arrangement of cells from basal layer to the surface layer.
Dysplasia is associated with chronic inflammation or irritation. This is non-neoplastic
proliferation which differs from neoplasia in that the growth of dysplastic cell is controlled
and stops when inciting stimulus ceases while the growth of neoplastic cell is uncontrolled
that persists even after the cessation of the stimulus. Hyperplasia and metaplasia are not
directly premalignant conditions, but if they are severe and sustained, they may progress to
dysplasia which carries the risk of conversion to malignancy. Dysplasia carries high risk of
conversion to malignant neoplasm
Common sites:
a) Cervix
b) Lung

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c) Oral cavity
d) Gall bladder.
Clinical significance
1. Dysplasia is reversible when inciting stimulus it removed.
2. Higher chances of neoplastic transformation.
Neoplasia
Neoplasia means new growth and is characterized by unceasing abnormal and excessive
proliferation of cells.
Neoplasm
The neoplasm (commonly called tumor) is defined as the abnormal mass of tissue, the
growth of which exceeds and is uncoordinated with that of the normal tissue, and persists
in the same excessive manners after the cessation of the stimuli which evoked the change.
Oncology
The study of neoplasm (tumor) is called oncology
Differentiation
The extent to which the neoplastic parenchymal cells resemble their normal parent cells,
both morphologically and functionally is called differentiation.
Anaplasia
Irreversible loss of differentiation is called anaplasia.
Components of neoplasm
Parenchyma: It constitutes the proliferating part of the neoplasm
Stroma: It is made up of connective tissue blood vessels and lymphatics It provides
support for the growth of parenchymal cells.
Desmoplasia
The excess of stromal component in a tumor is called desmoplasia and such a tumor is
called scirrhous tumor
Types Of Neoplasms (Tumors)
A) Benign tumors

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B) Malignant tumors
Benign tumor
It is the tumor characteristics of which are relatively innocent such as:
It will remain localized.
It cannot spread to other sites.
Amenable to local surgical removal.
Patient survives.
Malignant tumor
It is also called cancer. The malignant tumor is destructive and dangerous, having
characteristics such as:
It can invade and destroy adjacent structures.
It spreads to distant sites (metastasis).
Patient dies.
Nomenclature Of Tumors
The tumor is named on the basis of
Cell or tissue of origin.
Whether it is benign or malignant
BENIGN TUMORS
In general. These are designated by attaching the suffix "oma" to the cell of origin
Examples:
a) Benign tumor arising from fibroblastic cells is called Fibr-oma (Fibroma)
b) Benign tumor arising from meninges is called meningi-oma (meningioma).
Important note
Benign tumors of mesenchymal cells generally follow the above rule of just attaching
"oma" to the cell of origin Nomenclature of benign tumors of epithelial cell is more
complex. They are named on multiple basis e.g.
• Cell of origin
• Microscopic architecture

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• Macroscopic patterns.
Examples of benign epithelial cell tumors.
Adenoma:
The benign epithelial neoplasm that forms glandular pattern as well as those derived from
gland although not necessarily reproducing glandular pattern is called adenoma e.g.
benign epithelial neoplasm that arises from renal tubular cells growing in the form of
glands would be termed as adenoma, while epithelial tumors arising from adrenal gland
even not grow in gland pattern would also be called adenoma.
Papilloma
The benign epithelial neoplasms producing microscopically or macroscopically visible
finger like projections from epithelial surfaces are called papillomas.
Cystadenoma
When retention of secretion is marked, a cyst forms in adenoma and such tumor is called
cystadenoma.
Polyp
The tumor that produces macroscopically visible projection above a mucosal surface (e.g.
into gastric or colonic lumen) is called polyp.
Examples of benign mesenchymal cell tumors
Fibroma
This benign tumor arises in subcutaneous tissues, fascia, periosteum, kidney and ovary..
This benign tumor is a variant of fibroma and represents a degenerative changes
characterized by accumulation of ground substances in mature tissues.
Myxoma
A myxoma is a benign tumor composed of primitive connective tissue, primarily found in
the heart but also occurring in other locations. It's the most common primary cardiac
tumor in adults, usually located in the left atrium near the fossa ovalis. Myxomas can also
develop in other heart chambers.
Lipoma
This benign tumor arises from fat of cells in subcutaneous tissue arises from cartilage.
Chondroma
This benign tumor arises from cartilage.

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Osteoma
This benign tumor arises from bones.
Myoma
It arises from muscles and is divided into:
Leiomyoma: It is benign tumor of smooth muscles. It can occur wherever there is smooth
muscle present but is especially common in uterus (mostly) and media of blood vessels. It
also occurs in GIT, ovary and kidney.
Rhabdomyoma: This is a rare benign tumor of skeletal and heart muscles.
Malignant Tumors
The nomenclature of malignant tumors follows the same rules as for benign tumors with
certain additions. There are two types of malignant tumors:
Carcinoma
The malignant tumors of epithelial cell origin are called carcinoma. The word carcinoma is
attached to the type of tissue e.g. malignant epithelial tumor of renal cell is called renal cell
carcinoma.
Sarcomas
The malignant tumors arising in mesenchymal tissues are called sarcomas. The word
sarcoma is attached to the type of tissue e.g. malignant tumor of fibroblastic cells is called
fibro-sarcoma (Fibrosarcoma).
Differences between carcinoma and sarcoma
Carcinoma
Epithelial origin.
More common.
Metastasis preferably via lymphatics in early stages.
Necrosis common.
Hemorrhages less frequent.
Sarcoma
Mesenchymal origin.
Less common.
Metastasis preferably via blood vessels (veins).

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Necrosis less common.
Hemorrhages more frequent.
Examples of carcinoma
Adenocarcinoma
The carcinoma in which neoplastic epithelial cells grow in gland- pattern is called
adenocarcinoma. Tissue of origin is also specified e.g. adenocarcinoma of renal cell,
stomach, colon, breast, gall bladder, prostate and uterus.
Squamous cell carcinoma
The carcinoma in which neoplastic cells resemble stratified squamous epithelium is called
squamous cell carcinoma. The carcinoma arising from the area either covered by stratified
squamous epithelium (e.g. skin, oral cavity, esophagus) or from the epithelium which has
undergone metaplasia from columanar to squamous type as seen in gall bladder, bronchi
and cervix.
Some variations
Lymphoma, mesothelioma, melanoma and seminoma are malignant tumors although they
have suffix "oma" a characteristic of benign tumors.
Examples of sarcoma
Fibrosarcoma
This tumor arises most commonly from fascia, intermuscular septa, subcutaneous tissues
and periosteum.
Chondrosarcoma:
This malignant tumor arises in the cartilage, most commonly at the ends of long bones.
Osteogenic sarcomas:
This malignant tumor arises in the bones usually in the upper end of tibia, lower end of
femur and upper end of humerus.
Giant cell tumor of bone (osteoclastoma)
This malignant tumor arises in the multinucleated giant cell in the spindle cell stroma.
Leiomyosarcoma:
This malignant tumor arises in smooth muscles, and almost all of them occur in the uterus.

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Rhabdomyosarcoma:
This malignant tumor arises in striated muscles usually in children. Skeletal muscles are
rarely affected as compare to bladder and uterus.
Liposarcoma:
This malignant tumor arises in fat cells in subcutaneous tissue of arm shoulder and
buttocks.
Tables
Characteristic
Tables Benign Tables TUMORS Malignant
1. Differentiation. Well differentiated.
Ranges from well-differentiated to
undifferentiated.
2. Anaplasia. No anaplasia. Certainly present.
3. Spread. Remains localized.
Invades and penetrates the
surrounding tissue.
4. Metastasis. No metastasis.
Metastasizes to the regional lymph
nodes and distant organs.
5. Rate of growth.
Uterine fibroids, also known as leiomyoma
of uterus, which rapidly grows during
pregnancy.
Usually rapid except cancer of
cervix grows slowly.
6. Encapsulation.
Enclosed within a capsule which separates
it from host tissue. Except leiomyoma of
uterus. Capsule is never present.
7. Gross
appearance.
Degeneration, necrosis ulceration,
haemorrhage less frequent.
Degeneration, necrosis ulceration,
haemorrhage more frequent
8. Clinical effects.
Thye do not endanger the life unless a vital
organ is involved.
Acts as parasite and tends to kill
the patient-whenever it grows.
9. Recurrence. Easily local removal - no recurrence. Recurrence common.
Nomenclature Of Tumors
Tables Tissues of Origin Tables Benign Tables
Malignant
1. Composed of one parenchymal cell type Fibroma Fibrosarcoma
Tumors of mesenchymal origin Lipoma Liposarcoma
Chondroma
Chondrosarcom
a
Osteoma
Osteogenic
sarcoma
Connective tissue and derivative Hemangioma
Lymphangioma
Meningioma Angiosarcoma

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Endothelial and related tissues
Lymphangiosarc
oma
Synovial
sarcoma
Blood vessels Lymph vessesl Mesothelioma
Synovium
Invasive
meningioma
Mesothelium Brain coverings
Lukemias
Malignant
lymphomas
Blood cells and related cells Hematopoietic cells Lymphoid
tissue
Leiomyosarcom
a
Muscle Leomyoma
Rhabdomyosarc
oma
Smooth Striated · Rhabdomyoma
Tumors of epithelial origin
Squamous cell
epidermoid
Squamous cell
papilloma carcinoma
Stratified squamous
Basal cell
carcinoma
Basal cells of skin or adenexa
Adenocarcinom
a
Epithelial lining Adeoma
Papillary
carcinomas
Gland or ducts
Papilloma
Cyctadenoma
Cystadenocarcin
oma
Bronchogenic
carcinoma
Respiratory passages
Ronchial
adenoma
Malignant
melanoma
Nevus
Renal cell
carcinoma
Neuroectodern
Renal tubular
edenoma
Hepatocellular
carcinoma
Renal epithelium
Liver call
adenoma
Transitional cell
carcinoma
Liver cells
Transitional cell
papilloma
Urinary tract epithelim (transitional)
Placenal epithelium Testicular epithelium (gems
Hydatidiform
mole
Chorioccarcino
ma
cells) Seminoma

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Embryonal
carcinoma
2. More than one neoplastic cell type-mixed tumors, usually derived from one
germ layer
Salivary glands
Pleomorphic
adenoma
(mixed tumor
Malignant
mixed tumor of
salivery
lof salivary
origin gland origion
Breast Fibroadenoma
Malignant
cyctosarcoma
phyllodes
Renal anlage Wilms' tumor
3. More than one neoplastic cell type derived from more than
one germ layer teratogenous Totipotential cells in gonads or in
embryonies resis.
Mature
teratoma,
demoid cyst.
Immature
teratoma,
teratocarcinoma
Mixed Tumors
The tumors containing more than one cell type (mesenchymal or epithelial) are called
mixed tumors c.g.
Benign: Pleomorphic adenoma of salivary gland, fibroadenoma of breast.
Malignant: Malignant mixed tumor of salivary gland, Wilm's tumor of kidney, malignant
cystadenoma phyllodes of breast.
Teratoma
These are the tumors containing mature or immature cells or tissues representative of
more than one germ layer and sometimes of al three (ectoderm, mesoderm and
endoderm). They originate from differentiation of totipotential cells. (the cells more
commonly present in ovary and testes having capacity to differentiate into all cell types to
be found in the adult body). The teratoma may be benign or malignant. The benign tumor is
called mature teratoma or dermoid cyst while the malignant tumor is called immature
teratoma. The vast majority of teratomas occur in gonads, more common in ovary then
testis. Less frequently teratomas are found in anterior mediastinum, retroperitoneal tissue,
and intracranially.
Embryonic Tumors Of Infancy (Tumors In Childhood)
Some of these tumors are present at birth, but most develop within the first 5 years of life.

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Wilm's tumor (nephroblastoma)
This renal malignancy manifests as an abdominal mass in infancy and early childhood.
Neuroblastoma
The tumor arises from adrenal medulla or one of the sympathetic ganglia. It appears as
abdominal swelling in infancy.
Medulloblastoma
This highly malignant brain tumor is found in the region of the fourth ventricle near the
cerebellum. It occurs predominantly in young children.
Retinoblastoma
This is the highly malignant tumor of retina found in infancy and early childhood.
Characteristics Of Malignant Neoplasms
Differentiation And Anaplasia
Lack of differentiation of tumor cells is called anaplasia. It is a characteristic of cancerous
cells and it constitutes one of the features that mark a tumor as malignant
The anaplastic changes are characterized by:
1) Pleomorphism: (variation in size and shape).Some cells may be many times larger and
other smaller than their neighbors.
2) Hyperchromasia:
The nuclei contain an abundance of DNA and are extremely dark staining.
3) Disturbed nuclear cytoplamic ratio:
Normal ratio is 1:6 but in anaplasia size of the nucleus become larger and ratio between
nucleus and cytoplasm becomes 1:1 Chromatin become clumped and is distributed along
the nuclear membrane.
4) Mitotic figures:
The number of mitotic figures become large, reflecting the proliferating activity of the
parenchymal cells. Higher the number of mitosis, higher is the aggressiveness of a cancer.
The mitotic figures are atypical producing tripolar, quadripolar, or multipolar spindles
instead of bipolar.
5) Tumor giant cell:
Some giant cell contain only a single huge nucleus while other have two or more nuclei.

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6) Loss of orientation:
The normal orientation of one cell to the other is lost, so that they grow in haphazard
fashion. Normal orientation of cells to their basement membrane is also lost (loss of
polarity).
Invasion
Mechanisms that make cancer invasive are:
Physical pressure.
Reduced adhesivencess of tumor cells.
Increased motility of tumor cells.
Loss of contact inhibition.
Release of destructive enzymes e.g. collagenase and plasminogen activator.
All tissues of the body can be invaded by cancer but some are vulnerable and other some
resistant e.g. elastic fibers are more resistant than collagen fibers because malignant
tumors produce elastase in less quantity than collagenase.
Cartilage is the most resistant of all tissues to invasion.
Arteries are much more resistant to invasion than veins and lymphatics due to higher
elastin content in arteries.
Spread
Malignant tumors spread by two ways:
Local spread or Infiltration
By this way malignant cells infiltrate the surrounding tissues usually in the line of least
resistance, like tissue planes. During infiltration the malignant cells may invade the
lymphatics and blood vessels.
Metastasis
Metastasis is a process in which malignant tumor cells invade vessels or tissue spaces in
such a manner that they detach, migrate and are translocated to a distant site, where they
lodge and grow in the new location to form a secondary tumor.

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The malignant tumors which are locally invasive but never metastasize are (i) Basal cell
carcinoma of the skin and (ii) Gliomas of brain.
Factors essential for metastasis
Liberation of viable tumor cells:
Due to deficiency of calcium, the cell loss adhesiveness and this result in the separation of
cells from the main mass. These cells may be carried to some other suitable tissue and
there they start growing as a new tumor.
Presence of suitable environment:
Spleen and skeletal muscles are rarely affected by the metastasis.
Lung, liver, bone marrow and adrenals are most suitable for metastasis.
Availability of spreading pathway:
Metastatic pathways
Lymphatic pathway:
It is the most common pathway for the initial dissemination of carcinomas, but the
sarcomas may also use this route.
Blood stream:
This pathway is typical for sarcomas, but the carcinomas may also use this route. Arteries
are less readily penetrated than veins.
Seeding of body cavities and surfaces:
In this pathway malignant neoplasm penetrates into natural open field e.g. peritoneal
cavity, pleural, pericardial and joint spaces. Such seeding is characteristics of carcinoma
ovary in which all pericardial and joint spaces. Such seeding is characteristics of
carcinoma ovary in which all peritoneal surfaces become coated with heavy layer of
cancerous cells.
Transplantation:
This is a process of mechanical transport of tumor fragments by instruments or gloved
hands.

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The Frequent Sites For Metastasis
Liver
• Breast cancer.
• Lung cancer.
• Colon cancer.
• Malignant melanoma.
• Genitrourinary system
• Sarcomas
Lung
Thyroid carcinoma.
Breast carcinoma.
Renal carcinoma.
cell
Sarcomas.
Saminoma
Bones
• Prostate cancer.
• Lung cancer
• Breast cancer
• Renal cancer.
• Neuroblastoma
• Thyroid cancer.
Brain
Lung cancer
Breast cancer
Melanoma
Adrenal Glands
Lung Cancer
Breast Cancer
Ovarian Cancer
Skin
Lung
Breast
Grading And Staging Of Cancer
Grading
It is a method by which the level of differentiation of a cancer is determined. The cancers
are classified as grade-I to grade-IV with increasing Anaplasia.
Staging
It is a method by which the extent of spread of a cancer is determined. It is based on:
Size of primary lesion.
Its extent of spread to regional nodes.
Presence or absence of metastasis.
TNM system
TNM system is used for staging the cancer. It is characterized by:

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T- for primary tumor
N- for regional lymph node
M- for metastasis.
T1, T2, T3 and T4 describe increasing size of the primary tumor.
NO, N1, N2, and N3 indicate progressively advancing lymph node involvement.
M0 and M1 reflect absence or presence of metastasis.
Note: Grading is done on pathological ground while staging is done on clinical ground.
Changes In Cell Due To Malignancy
The changes in a cell when it becomes malignant are the following.
Changes in growth property
The cell escapes from regulatory control, fails to become mature and acquires the apability
of transplantation (can grow in artificial media).
Morphological changes
Variation in size and shape occurs.
Karyotypic changes
Changes occur in genes. e.g. change in the Philadelphia chromosome in chronic
myelogenous leukemia
Antigenic changes
The tumor cells bear antigens that are different from those of normal cells, which are
recognized by host immune system that produces immune response to destroy the tumor.
The tumor antigens may be of three types
Tumor-specific antigent They are only present on tumor cells and not on any normal cells
e.g. melanoma associated antigen-1
Tumor associated antigen. They are present on tumor cells and also on some normal cells
e.g. prostate-specific antigen

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Oncofetal antigens. This group of antigen consists of substances normally produced in
quantity during fetal life but not to any great extent by adult cells ie. they are produced by
tumors eg. carcinoembryonic antigen and alpha fetoprotein.
Metabolic changes:
The more anaplastic and undifferentiated the tumor cell, the greater the deviation from the
enzyme system of the normal cells.
Cell membrane changes
There is loss of adhesiveness to other cells
Synthesis and release of growth factor
Impaired cell-to-cell communication
Elaboration and release of degradative enzymes.
Tumor cell products
The synthesis and secretion of various tumor cell products are important for two reasons.
Their presence may indicate the existence of a neoplasm in the body te. they act as tumor
markers.
They may produce clinical effects called paraneoplastic syndromes
Tumor markers
Oncofetal antigens, These are antigens that are normally expressed only in fetal life, but
may be produced by neoplastic cells, e.g
Carcinoembryonic antigen (normally present in embryonic and fetal endodermal tissue)
is found in most malignant neoplasms arising from tissues that develop from embryonic
endoderm such as colon and pancreatic cancers.
Alpha fetoproteins: They are synthesized by
normal yolk sac and fetal liver-and then by carcinoma of liver and yolk sac carcinoma of
gonads.
Enzymes
Example is increased serum acid phosphatase in carcinoma of prostate.
Immunoglobulins
Raised in multiple myeloma.

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Excessive hormone production In neoplasm of endocrine cells.
Ectopic hormone production.
Clinical Features Of Neoplasia
1) Effects according to tumor location:
Any tumor, benign or malignant may cause morbidity and mortality. Location of the tumor
is of critical importance in both benign and malignant tumors c.g.
A small pituitary adenoma (benign) can compress and destroy surrounding normal gland
and give rise to hypopituitarism.
A small carcinoma within common bile duct (malignant) may induce fatal biliary tract
obstruction.
2) Hormone production:
Hormone production is increased in both benign (mostly) and malignant tumors arising in
endocrine glands e.g.
Tumors of pancreas produce increased amount of hyperinsulinism. insulin causing
Tumors of adrenal cortex produce excessive corticosteroids.
3. Obstruction:
It may be caused in a hollow viscus by tumor in the lumen or pressing on the wall from
outside e.g.
Intestinal obstruction.
Biliary tract jaundice. causing obstructive
Urinary tract --- causing hydronephrosis.
Bronchus pulmonary collapse.
Portal vein--- ascites and varices.
4) Irritation of serous membranes
Deposition of tumor on serous membrane results in formation of inflammatory exudate.
5) Tissue destruction:
Progressive destruction of tissue may produce loss of function, perforation or hemorrhage.
6) Infection:

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Infection may superimpose the ulcerated tumors.
7) Fever:
Certain tumors produce fever directly and some indirectly due to infection.
8) Anemia:
It may occur due to prolonged malnutrition, recurrent blood loss, and long lasting infection
producing marrow depression.
9) Malignant cachexia:
The progressive weakness and loss of weight in the presence of malignant tumor is called
malignant cachexia. It may be induced by the toxin produced by the tumor or by
malnutrition, hemorrhage, ulceration, pain, insomnia and bacterial infection.
10) Paraneoplastic syndromes:
This is a collective term for disorders arising from metabolic effects of cancer on the
tissues remote from the tumor e.g. endocrine, hematologic or neuromuscular disorders.
OR
The symptom complexes other than cachexia that appear in patients with cancer and that
can not be readily explained either by:
• Local or distant spread of tumor or by
• Elaboration of hormones indigenous to the tissue of origin of the tumor, are referred to a
paraneoplastic syndromes. (i.e. there seem no relation between cancer and these
symptoms).
Ectopic Hormone Production By Neoplasm
Tables Hormone Tables Commonly neoplasms associated
Chorionic (HCG) gonadotropin Carcinoma of lung (30%) breast
Parathyroid hormone (PTH)
carcinoma lung, renal adenocarcinoma, Squarmous of other
squamous carcinomas
Adrenocorticotropic hormone
(ACTH) Small-cell carcinoma of lung, pancreatic islet cell neoplasms
Antidiurtic hormone (ADH) Small cell carcinoma of lung
Insulin 1 Hepatocellular carcinoma, retroperitoneal sarcomas
Erythropoietin
Renal adenocarcinoma, cerebellar hemangioblastoma,
hepatocellular carcinoma
Diagnosis Of Tumor
(INVESTIGATIONS)

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1) Screening:
The tests performed on asymptomatic individual to detect tumor in very early stage is
called screening. Unfortunately screening methods do not exist for most types of cancers.
Following are the screening tests that can detect the tumor in early stage.
Cervical smear:
Annual cervical smears in all sexually active women is recommended. Dysplastic
epithelium can be detected and treated to prevent development of cervical cancer.
Mammography:
Self-examination of breasts monthly to detect small lump is recommended.
Mammography to detect pre-clinical breast cancer suggested every 2 or 3 years. is
Sigmoidoscopy:
People aged 50 and above are suggested to undergo sigmoidoscopy to detect early colon
cancer or pre-cancerous adenomas of colon and rectum.
2)Cytological examination:
Cytological examination of cell is a useful and accurate method of diagnosing cancer.
Samples for cytological examination may be obtained by a variety of techniques such as:
Exfoliated cells may be identified in samples of sputum, urine, CSF and body fluids.
Malignant cells may be found in blood and bone marrow.
Brushing or scraping of epithelium or of a lesion that has been visualized by endoscopy
may be performed to obtain cells for examination.
Fine-needle aspiration.
3) Histologic examination:
This is the definitive method of establishing the diagnosis of a neoplasm. The test is based
on examination of the entire neoplasm removed at surgery (excisional biopsy) or incisional
biopsy or with a large bore cutting needle.
Histologic examination reveals type of neoplasm benign or malignant, grade of malignancy
and degree of invasion.

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4) Serological examination (tumor markers)
Substance in serum Cancer type
Carcinoembryonic (CEA) Cancers of GIT especially of colon.
Alpha fetoprotein (AFP Hepatoma, Hepatoma, yolk sac tumors
Human chorionic gonadotropin Choriocarcinoma
Prostatic acid phosphates : Prostate specific antigen Prostate carcinoma
Monoclonal immunoglobulin Myeloma
5) Radiographic examination:
X-rays, CT and MRI scan are helpful in the diagnosis of tumors. As a general rule,
radiographic findings suggestive of cancer must be confirmed by either cytologic or
histologic examination.