NEOPLASIA

Marlon M. Maramion, MD, DPSP

Neoplasia
Nomenclature Characteristics of Benign and malignant neoplasm Epidemiology Molecular Basis of Cancer Molecular Basis of Multistep Carcinogenesis Carcinogenic agents and their Cellular Interactions Host Defense against Tumors Tumor Immunity Clinical Aspects of Neoplasia

Nomenclature
Neoplasia- new growth Tumor- swelling caused by inflammation -non neoplastic usage Cancer- malignant tumor Latin for crab because a cancer adhere to any part

Definition of Neoplasia
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 - Willis Genetic changes Autonomous Clonal

Neoplasia
All tumors have two basic components 1. Parenchyma 2. Stroma - blood supply - framework - growth influence Desmoplasia Scirrhous

Nomenclature Benign Tumors

-oma = benign neoplasm

Mesenchymal tumors chrondroma: cartilaginous tumor fibroma: fibrous tumor osteoma: bone tumor

Nomenclature Benign Tumors

Epithelial tumor adenoma: tumor forming glands papilloma: tumor with finger like projections papillary cystadenoma: papillary and cystic tumor forming glands polyp: a tumor that projects above a mucosal surface

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Tumor

Stalk

Colonic Polyp: Tubular Adenoma

Nomenclature Malignant Tumors

Sarcomas: mesenchymal tumor chrondrosarcoma: cartilaginous tumor fibrosarcoma: fibrous tumor osteosarcoma: bone tumor

Nomenclature Malignant Tumors

Carcinomas: epithelial tumors adenocarcinoma: gland forming tumor squamous cell carcinoma: squamous differentiation undifferentiated carcinoma: no differentiation

 Tumors with mixed differentiation derived from one germ cell layer that differentiates into more than one parenchymal cell type mixed tumors: e.g. pleomorphic adenoma of salivary gland carcinosarcoma Teratoma tumor comprised of cells from more than one germ layer arise from totipotent cells (usually gonads) benign cystic teratoma of ovary is the most common teratoma

Nomenclature

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 July 2005 03:41 PM) 2005 Elsevier

 Aberrant differentiation (not true neoplasms) Hamartoma: disorganized mass of tissue whose cell types are indiginous to the site of the lesion Choristoma: ectopic focus of normal tissue (heterotopia) Misnomers hepatoma: malignant liver tumor melanoma: malignant skin tumor seminoma: malignant testicular tumor lymphoma: malignant tumor of lymphocytes

Nomenclature

Characteristics of Benign and Malignant Neoplasms

The distinction between benign and malignant tumors is based on 1. appearance (morphology) 2. behavior (clinical course)

If cells LOOK BAD, they are probably going to BEHAVE

BAD

If cells LOOK GOOD, they are probably going to BEHAVE GOOD

Characteristics of Benign and Malignant Neoplasms

Basis for distinction 1. Differentiation and anaplasia 2. Rate of growth 3. Local invasion 4. Metastases

Differentiation and Anaplasia

Differentiation- resemblance to the normal Anaplasia- lack of differentiation 1. pleomorphism 2. abnormal nuclear morphology 3. mitosis 4. loss of polarity 5. tumor giant cells, necrosis dysplasia (disordered growth) - loss of uniformity & architecture

Dysplasia

Carcinoma in situ

Rate of Growth
Factors affecting tumor growth 1. Doubling time of tumor cells 2. Fraction of tumor cells that are in replicative pool 3. Rate at which cells are shed or die

Schematic Representation Of Tumor Growth

Factors affecting growth of benign & malignant neoplasms

Hormonal stimulation Adequacy of blood supply Other unknown influences

Fast Growing Tumors

High cell turnover Susceptible to chemotherapy

GROWTH RATE correlates with level of DIFFERENTIATION

Local Invasion

Metastasis
-single most important feature distinguishing malignant from benign neoplasm. Three routes 1. Seeding of body cavities 2. Lymphatics 3. Hematogenous

Comparison between Benign and Malignant Tumors

Characteristics
Differentiation/anapla sia

Benign

Malignant

-well differentiated, -some lack of structure maybe typical of differentiation with tissue origin anaplasia, structure is often atypical -usually progressive and slow, mitotic figures are rare and normal Usually cohesive and expansile, well demarcated masses that do not invade or infiltrate surrounding normal tissue absent -erratic and maybe slow to rapid, mitotic figures maybe numerous and abnormal -locally invasive, infiltrating the surrounding normal tissues, sometimes seemingly cohesive and expansile -frequetly present, the larger and more undifferentiated the primary the more likely are metastases

Rate of growth

Local Invasion

Metastasis

EPIDEMIOLOGY

Geographic & Environmental Factors

Genetic Predisposition to Cancer

3 categories 1. Autosomal dominant inherited cancer syndromes 2. Defective DNA-repair syndrome 3. Familial cancers characterized by familial clustering but the transmission pattern is not clear -e.g CA breast, colon, brain and ovary