Neoplasia I

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Neoplasia

Nomenclature,
Epidemiology
Benign & Malignant tumours
Everything one does to gain
livelihood or for pleasure is
fattening, immoral, illegal or
even worse oncogenic.
Cancer = Latin for “crab”
Introduction

 Cancer is the second leading cause of


death in the United States
 #1 is cardiovascular diseases
 More important than the mortality
rates are the emotional and physical
components
 Will there ever be a cure?
Definitions-I
 Oncology: study of or science of
neoplastic growth
 Neoplasia: new growth
 Neoplasm: mass of cells composing the
new growth
 Tumor: any swelling (currently used
almost exclusively to refer to a
neoplastic growth) 
Definitions-II
 Cancer: common term used for all malignant
neoplasms
 Benign neoplasm: a neoplasm that tends to
grow slowly, is well differentiated, does not
metastasize, and is usually non-life threatening
 Malignant neoplasm: a neoplasm that tends
to grow rapidly, is poorly differentiated, often
metastasizes, and frequently causes death of
the host
Definitions
 Hypertrophy
– Increase in cell size
– Therefore increase in organ size
– Occurs in cells incapable of dividing (permanent)
 Atrophy
– Decrease in cell size
– Decrease in organ size
– Cells with diminished function but not dead
 Hyperplasia
– Increase in cell number in a controlled fashion
– Increase in organ size
– Occurs in cells capable of replicating (labile and stable)
– Reversible if the stimulus is removed
– If control is lost, may become a cancer
Definitions
 Metaplasia
– One adult cell type is replaced by another adult cell type
– Reversible
– Examples – cigarettes, Vitamin A deficiency
 Dysplasia
– Disorderly but non-neoplastic proliferation
– Loss of cell uniformity and normal architecture
– Reversible but higher possibility to become cancer
– Cell size and shape varies, more mitosis, organelles
– PAP smear
CARCINOMA-IN-SITU
 Morphologically malignant cells have fully occupied a site
(usually an epithelium) but have not yet invaded into the
underlying or adjacent tissue.

 Often becomes an invasive carcinoma after a period of time


(usually years).
A NEOPLASM is an abnormal mass of
cells which:

Exhibits uncontrolled proliferation

Persists in its growth after the


stimulus which originally produced the
growth has stopped
Neoplasia
 Means “new growth”
 Growth exceeds and is uncoordinated with
normal tissue even after the stimulus that
caused the change is removed
 Due to heritable (genetic) changes that
allow excessive and uncontrolled
proliferation independent of growth-
regulatory stimuli
FEATURES OF NEOPLASIA
 An irreversible process

 Does not respond to normal growth controls

 The cell has undergone a fundamental and


permanent modification (DNA damage)

 End result is uncontrolled (autonomous)cell


growth
Neoplasia
 Neoplasm
– Also called a tumor
– Two types
 Benign
– Relatively innocent, but depends on location
– Slow growing, remains localized, no metastasis
– Local surgical removal
– Patient survives
 Malignant
– Referred to as cancers
– Can invade and destroy adjacent structures
– Rapid growing, can metastasize
– Can cause death
Nomenclature

Neoplasm

Benign Malignant

Carcinoma Sarcoma
BENIGN
 A neoplasm which does not invade
adjacent tissues or spread to distant sites.
 Usually not lethal.
 However, may be life-threatening if:
 it forms in a critical location
 it grows to a large size

 it obstructs important channels in the body

 it ulcerates or bleeds

 it produces endocrine disturbances


MALIGNANT
A neoplasm which:
 Invades normal adjacent tissues (including
blood vessels or lymphatic)
and
 may spread to distant sites (metastasize),
setting up secondary neoplastic masses.
 Usually shows cytologic differences from the
parent tissue
 Usually less functionally differentiated.
Neoplasms
 Benign and malignant tumors
– Two components
 Parenchyma
– Transformed or neoplastic cells
– Determines behavior of tumor
– Used to name tumor
 Stroma
– Supporting tissue of tumor
– Non-neoplastic
– Connective tissue, blood vessels, inflammatory cells
– However, crucial to tumor growth
Mixed Tumors

 “Mixed” tumors show divergent differentiation


 Examples
• pleomorphic adenoma – glands + fibromyxoid stroma
• fibroadenoma – glands + fibrous tissue
 Not to be confused with teratomas
NAMING (CLASSIFICATION) OF
NEOPLASMS:

 The word TUMOR is a non-specific term


which originally meant swelling or local
enlargement. Now the term is used
almost exclusively to mean neoplasm.

 Neoplasms are generally named


according to their cell of origin or by
some characteristic of their growth.
Benign neoplasms end with the suffix
“oma”. e.g. a benign neoplasm of
smooth muscle is called a leiomyoma
 leio = smooth

 my = muscle

 oma = benign
 CARCINOMA
A malignant neoplasm which arises from
an epithelial cell.

 SARCOMA
A malignant neoplasm which arises from
a mesenchymal cell.
MALIGNANT NEOPLASMS

Named according to cell of origin.


ending
“carcinoma”denotes epithelial origin
or
“sarcoma”denotes mesenchymal origin.

Ex:
 squamous carcinoma - malignant neoplasm arising

from squamous epithelium


 chondrosarcoma - malignant neoplasm arising

from cartilage.
Exceptions to
nomenclature rules
 Historically names for malignant
 neoplasms which have been carried over into
current use BUT,end with the suffix “oma”.

 Ex:
 Melanoma: a malignant neoplasm arising from
melanocytes in the skin
 lymphoma: a malignant neoplasm arising in lymph
nodes
 hepatoma: a malignant neoplasm arising in the liver
Confusing Terms
 Malignant tumors that sound benign
• lymphoma
• mesothelioma
• melanoma
• seminoma
 Non-tumors that sound like tumors
• hamartoma – mass of disorganized indigenous tissue
• choristoma – heterotopic rest of cells
 Names that seem to come out of nowhere
• nevus
• leukemia
• hydatidiform mole
Know these names!
Tissue of origin Benign Malignant
Fibrous tissue Fibroma Fibrosarcoma
Fat Lipoma Liposarcoma
Cartilage Chondroma Chondrosarcoma
Bone Osteoma Osteogenic sarcoma
Blood vessels Hemangioma Angiosarcoma
Mesothelium Mesothelioma
Hematopoietic cells Leukemia
Lymphoid cells Lymphoma
Squamous epithelium Squamous cell papilloma Squamous cell carcinoma
Glandular epithelium Adenoma Adenocarcinoma
Papilloma Papillary adenocarcinoma
Cystadenoma Cystadenocarcinoma
Smooth muscle Leiomyoma Leiomyosarcoma
Skeletal muscle Rhabdomyoma Rhabdomyosarcoma
Melanocytes Nevus Melanoma
Nomenclature of tumors

Tissue of Origin Benign Malignant

Composed of One parenchymal cell    


Type    
Mesenchymal tumors Fibroma Fibrosarcoma
Lipoma Liposarcoma
Connective tissue and derivatives
Chondroma Chondrosarcoma
Osteoma Osteogenic sarcoma
Endothelial and related tissues  
Blood vessels Hemangioma Angiosarcoma
Lymph vessels Lymphangioma Lymphangiosarcoma
Synovium   Synovial sarcoma
Mesothelium   Mesothelioma
Brain coverings Meningioma Invasive meningioma
Nomenclature of tumors

Tissue of Origin Benign Malignant

Blood cells and related cells


Hematopoietic cells
Lymphoid tissue
Muscle
Leiomyoma Leiomyosarcoma
Smooth
Striated Rhabdomyoma Rhabdomyosarcoma
Epihelial tumors
 
Stratified squamous
Squamous cell papilloma
Basal cells of skin or adnexa  
Epithelial lining  
Glands or ducts Adenoma
Papilloma
Cystadenoma
Nomenclature of tumors

Tissue of Origin Benign Malignant

Epihelial tumors
Stratified squamous
  Squamous cell or epidermoid
Squamous cell papilloma
Basal cells of skin or adnexa carcinoma Basal cell carcinoma
 
Epithelial lining
 
Glands or ducts
Adenoma
Adenocarcinoma
Papilloma
Papillary carcinoma
Cystadenoma
Cystadenocarcinoma
Nomenclature of tumors

Tissue of Origin Benign Malignant

Respiratory passages Bronchogenic carcinoma


Bronchial adenoma
Nevus (carcinoid)
Neuroectoderm
Renal tubular adenoma Malignant melanoma
Renal epithelium
Liver cell adenoma Renal cell carcinoma
Liver cells
Transitional cell papilloma Hepatocellular carcinoma
Urinary tract epithelium (transitional)
Placental epithelium (trophoblast)
Hydatidiform mole Transitional cell carcinoma
Testicular epithelium (germ cells) Choriocarcinoma
Seminoma
Embryonal carcinoma
Nomenclature of tumors

Tissue of Origin Benign Malignant

More Than One Neoplastic Cell


Type- Mixed Tumors, Usually
Derived From One Germ Layer

Salivary glands Pleomorphic adenoma (mixed Malignant mixed tumor of


tumor of salivary origin) salivary gland origin

Breast Fibroadenoma Malignant cystosarcoma phyllodes


Renal anlage Wilms tumor
Nomenclature of tumors

Tissue of Origin Benign Malignant

More Than One Neoplastic


Cell Type Derived From
More Than One Germ
Layer- Tera- fogenous

Totipotential cells in gonads Mature teratoma, dermoid Immature teratoma,


or in embryonic rests cyst teratocarcinoma
Cancer Incidence
 1.4 million new cases of cancer last year
 565,000 deaths from cancer last year
 Cancer is 2nd leading cause of death (after
heart disease)
 Most common cancers
• Men: Prostate
• Women: Breast
 Deadliest cancers
• Men: Lung
• Women: Lung
Cancer Incidence
Death rates have changed over past 3 years

 Decrease in death rates for:


• Cervical cancer (pap smears)
• Colon cancer (earlier detection)
• Breast cancer (earlier detection)
• Lung cancer in men (less smokers)
• Some types of leukemia (new treatment)
 Increase in death rates for:
• Lung cancer in women (more smokers)
Epidemiology
 Cigarette smoking
 Dietary differences in countries
– Dietary fat and fiber
 Cancer incidence
– Men – death rate from lung cancer has dropped
– Women – death rate slightly dropped due to
decline in death rate from cervix, stomach and
large bowel cancer. Yet lung cancer has
increased
Predisposition to
Neoplasia
 Heredity
 Age
 Gender
 Pigmentation
 Hormones
 Chronic Irritation
 Parasites
Epidemiology
 Geographic and Environmental Variables
– Predominant cause of most common sporadic
cancers
– Breast cancer higher in US and Europe than
Japan
– Stomach cancer higher in Japan than US
– Liver cell carcinoma higher in Africa
– Cervical cancer linked to age of first intercourse
and number of sex partners
Environmental Variables

 Breast cancer death rate in US is 5x that in Japan!


 Stomach cancer death rate in Japan is 7x that in
US!
 Liver cancer infrequent in US, common in Africa.
 Probably due to environmental (not hereditary)
factors.
 Most sporadic cancers are caused by
environmental factors.
Occupational carcinogens

Asbestos roofing, tiles mesothelioma

Benzene light oil, solvents leukemia

Beryllium missile fuel lung cancer

Ethylene oxide ripening agents, fumigants leukemia

Radon uranium decay, mines lung cancer

Vinyl chloride refrigerants angiosarcoma and liver cancer

Nickel welding, ceramics nose and liver cancers

Cadmium batteries prostate cancer


Environmental Variables
Environmental carcinogens

 Sunlight: skin cancer


 Smoking: lung cancer
 Alcohol: liver, breast cancers
 HPV: cervical carcinoma
Epidemiology
 Age
– Cancer frequency increases with age
– Chance for more mutations and decline in immune
competence
 Heredity (autosomal dominant)
– Inherited Cancer Syndromes
 Retinoblastoma, melanoma, breast and ovarian tumors and
colon cancer
– Familial Cancers
 Clustered in families
 Breast, ovarian and pancreatic
– Defective DNA repair (autosomal recessive)
Age

 Cancer is most frequent at the two extremes of age.


 Elderly
• Frequency of cancer increases with age
• Most cancer deaths occur between 55-75
 Children
• 10% of all childhood deaths
• Leukemia/lymphoma, CNS tumors, sarcoma
Heredity
Three categories of hereditary cancer

 Inherited cancer syndromes


 Familial cancers
 Syndromes of defective DNA repair
Heredity
Three categories of hereditary cancer

 Inherited cancer syndromes


• Dominantly inherited
• Retinoblastoma
• Familial polyposis coli
Heredity
Three categories of hereditary cancer

 Inherited cancer syndromes


 Familial cancers
• Most common sporadic cancers
have familial forms too
• Breast, colon, ovary, brain
• Occur earlier, are often deadlier
Heredity
Three categories of hereditary cancer

 Inherited cancer syndromes


 Familial cancers
 Syndromes of defective DNA repair
• Recessively inherited
• Xeroderma pigmentosum
Epidemiology
 Acquired Preneoplastic Disorders
– Persistent regenerative cell replication
 Long unhealed skin wound
 Cirrhosis of the liver
– Hyperplastic and dysplastic proliferations
 Endometrial carcinoma/bronchogenic carcinoma
– Chronic atrophic gastritis
 Pernicious anemia/Helicobacter pylori
– Chronic ulcerative colitis
– Leukoplakia
 Oral cavity
Acquired Preneoplastic Syndromes
 Persistent regenerative cell replication
• Chronic skin fistula → squamous cell carcinoma
• Cirrhosis → Liver cancer
 Hyperplastic and dysplastic proliferations
• Atypical endometrial hyperplasia → endometrial cancer
• Dysplastic bronchial mucosa → lung cancer
 Chronic atrophic gastritis → stomach cancer
 Chronic ulcerative colitis → colon cancer
 Leukoplakia → squamous cell carcinoma
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