1. Neoplasms

2. Tumor Nomenclature
Key: carcinoma vs. sarcoma

3. Leading sites of new cancer cases & deaths

4. Benign vs. Malignant Tumors
Key differences:
Encapsulation vs. infiltration
Differentiated cells vs. undifferentiated cells

5. Benign vs. Malignant

6. Malignant Tumors -- Pathophysiology
Staging vs. grading
Staging = describes the extent of the disease at the diagnosis time
In-situ = malignant cells in pre-invasive stage
Usually I through IV ( higher = worse)
T, N, M system
T = tumor; N = involvement of lymph nodes; M = metastasis
Grading = describes the degree of differentiation of the malignant cells
Usually I through IV (higher = more undifferentiated)

7. Local Effects Pain Not an early sx Infection
From tissue necrosis and ulceration
From destruction of normal flora
Obstruction
When growth of the tumor compresses a duct or passageway

8. Systemic effects Weight loss Anemia Infections
Cachexia = severe tissue wasting
Anemia
Causes = anorexia, chronic bleeding, & bone marrow depression
Infections
Especially pneumonia
Reason = stasis of secretions & weaker cough efforts
Paraneoplastic syndromes
Substances released from certain tumors have effects on:
Endocrine system (e.g. ACTH-like effect & ADH-like effect)

9. Diagnostic tests Blood tests Imaging techniques Exfoliative cytology
General = CBC (esp. when undergoing chemo or radiation)
Specific = called tumor markers
Exp = PSA
Imaging techniques
CAT, MRI, nuclear scanning (includes PET)
Exfoliative cytology
Biopsies

10. Spread of malignant tumors
Primary tumor = parent tumor; initial site & cell type
Secondary tumor =other sites of identical tumor cells
3 basic mechanisms
(1) invasion into adjacent tissue
(2) metastasis via blood and/or lymphatics
(3) seeding = spread of tumor cells along serous membranes and in body fluids within serous body cavities

11. Staging correlates with degree of spread

12. Etiology of Cancer
Carcinogenesis = process when normal cells transformed into cancer cells
Factors in carcinogenesis are multiple & include:
Changes in DNA (mutations)
Genetic oncogenic factor
Radiation (gamma rays, X-rays, & ultraviolet rays)
Chemicals --- called carcinogens
Biological factors
Chronic irritation
Hormonal excess
Diet
Pathogens --- primarily viruses
Host defenses
Immune system has 3 types of cells that are “killers” (cytotoxic)
NK lymphocytes (NK = natural killer)
Killer T-lymphocytes
Macrophages

13. Stages in carcinogenesis:
Initiating factors --- get irreversible DNA changes
Promoters ----repeated exposure to carcinogens
Promoters continued exposure to carcinogens

14. Cancer Treatment 3 basic modalities
(1) surgery (2) chemotherapy (3) radiation
Curative treatment
Palliative treatment
Prophylactic adjunct therapy
Radiation therapy
Especially affects cells that rapidly reproduce
Epithelium, bone marrow, gonads
Adverse effects
Bone marrow depression
Epithelial tissue inflammation & ulceration --- get stricture & fibrosis
Ovarian or testicular damage
Non-specific fatigue & lethargy
Chemotherapy’s adverse effects
Hair loss, breakdown of mucus membranes, N&V, bone marrow depression

15. Newer treatment modalities Angiogenesis inhibitor drugs
These block endothelial cell regeneration
Anti- telomerase
Immunotherapy (biologic response modifiers)
Radioimmunotherapy (monoclonal antibodies & radioactive isotopes
Prognosis
Cure = 5 year survival without recurrence
Follow-up for metastasis
Key = Bone, Brain, Liver, & Lungs

16. Treatments
Curative
Palliative
Prophylactic
Adjuvant therapy