1. DR.ROOPA Pathophysiology Premed 3
NEOPLASIA
DR.ROOPA
Pathophysiology
Premed 3

2. Neoplasia Means new growth.
Is the uncontrolled, disorderly proliferation of cells, resulting in a benign or malignant tumor or neoplasm.

3. A neoplasm , as defined by Willis , is
“an abnormal mass of tissue the growth of which exceeds and is uncordinated with that of the normal tissues and persists in the same manner after the cessation of the stimuli which evoked the change”.

4. Dysplasia- is a reversible change.
Often precedes malignancy.
Morphologically manifests by disorderly maturation and spatial arrangement of cells, marked variability in nuclear size and shape and increased, often abnormal , mitosis .

5. nomenclature
A neoplasm is often referred to as a tumor, and the study of tumors is called oncology.
Oncos – tumor, logos –study of
Types
Benign tumor
Malignant tumor( cancer)

6. Benign tumors: In general , benign tumors are designated by attaching the suffix –oma to the cell type from which the tumor arises.
Eg.fibrous tissue tumor is a fibroma.
Malignant tumors:
Mesenchymal tissue or its derivatives are called sarcomas.
Eg fibrosarcoma
Epithelial tissue origuin are called carcinoma.
Eg:adenocarcinoma

9. Malignant vs Benign (+) invasion: spread to nearby structures
(+)metastasis: spread to distant structures
(+)anaplasia :
cells are very different from the normal cells
(poorly differentiated)
(-) invasion
(+) capsule
(-)metastasis
Resemble the tissue of origin (well differentiated)

10. Tumor characteristics
Differentiation and anaplasia
Rate of growth
Local invasion
metastasis

11. Anaplasia A state of complete un differentiation
Anaplastic cells show:
Pleomorphism
Hyperchromatism (dark nuclei)
Increased nuclear-cytoplasm ratio
Abnormal mitosis
Prominent nucleoli

15. Basic underlying cause of cancer
4 kinds of genes are damaged:
Genes that promote growth
Genes that inhibit growth
Genes that regulate apoptosis
Genes involved in DNA repair
Cancers develop in multiple steps.

16. “cancer genes “cause bad things in cells
Autonomous growth
Insensitivity to growth – inhibitory signals
Evasion of apoptosis
Limitless replication
Sustained angiogenesis
Invasion and metastasis

19. Forms of Malignant tumors
Carcinoma: malignant tumor of epithelial origin
1. squamous cell carcinoma
cancer of the skin
cancer of the esophagus
2. adenocarcinoma: glands
cancer of the breast
cancer of the pancreas
3. transitional cell carcinoma
cancer of the bladder

20. Forms of Malignant tumors
Sarcoma: of mesenchymal origin
osteosarcoma
rhabdomyosarcoma
leiomyosarcoma
liposarcoma
Teratoma: from all 3 germ layers
skin, bone, cartilage, teeth,
ovaries and testis: most common
may also be benign

21. teratomas consist of bits of bone,INTESTINAL epithelium, muscle, fat, nerve, tooth, etc.

24. Osteosarcoma

25. Liposarcoma

26. Teratoma

29. Forms of Benign tumors Papilloma: Adenoma: glandular epithelium
-ovary, breast
Mesenchymal origin
-leiomyoma, lipoma, fibroma, chondroma

30. epithelium of skin, larynx and tongue; fingerlike projections
Papilloma
epithelium of skin, larynx and tongue; fingerlike projections

36. Properties of Neoplasms
Monoclonality
the neoplasm comes from a single precursor cell
Invasion
enters the blood vessels and lymphatics
Metastases
blood vessels: sarcomas
lymphatic: carcinoma

38. Properties of Neoplasms
Common sites of metastases
liver, lung, brain,
adrenal glands, lymph nodes
bone marrow

39. Clinical signs of malignancy
Cachexia
wasting, weakness, weight loss, anemia, infection
.- Endocrine abnormalities
prolactinoma
ovarian tumors
Paraneoplastic syndrome is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells.they commomnly presented with cancers of the lung, breast, ovaries or lymphatic system.
eg:ectopic production of hormones
lung cancer : ACTH

41. summary :Risk factors Chemical agents Physical agents Viruses
Activation of cancer-promoting genes
Inhibition of cancer-suppressing genes

42. Carcinogenesis and carcinogens
Cigarette smoking : lung CA, laryngeal CA
Excessive sun: Skin CA
Asbestos: Mesothelioma
Nitrosamines: Gastric CA
Alcohol: Esophageal CA
Low-fiber diet: Colon CA

43. Carcinogenesis and carcinogens
High-fat diet: Breast CA
Aniline dyes: bladder Ca
Aflatoxin: liver CA
PVC: Angiosarcoma of the liver
DES: Clear cell adenocarcinoma of the vagina
Nickle, chromium, uranium: lung CA

44. Carcinogenesis and carcinogens
HTLV – 1: Adult T cell leukemia
HPV: cervical CA
EBV: Nasopharyngeal CA, Burkitts lymphoma
HBV: Hepatocellular CA
HHV-8: Kaposi sarcoma
Helicobacter pylori: Gastric CA

45. Cancer suppresor genes (anti oncogene)
p53: “ guardian of the genome” ,gatekeeper gene
mutated in 50% of all malignant tumors
causes cell cycle arrest in G1, time for DNA repair
unsuccessful repair: apoptosis
LI-FRAUMENI SYNDROME
familial cancers of the breast, soft tissue sarcomas, brain tumors, leukemias

47. Cancer suppresor genes (anti oncogene)
WT-1 and WT-2: Wilms tumor( Wilms tumour of the kidney)
BRCA -1: breast and ovarian CA
*BRCA – 2: breast CA
RB codes for pRB protein, master brake on cell cycle (retinoblastoma, bone, bladder, lung, and breast cancer)

49. Grading: degree of differentiation of the cells
Staging: spread of the tumor or degree of localisation
-uses the TNM system
Tumor size
Lymphonode involvement
Metastasis

50. CANCER TREATMENT CHEMOTHERAPY CYTOTOXIC DRUGS+BODY DEFENSES
SINGLE AGENT
COMBINATION CHEMOTHERAPY
_AVOIDS SINGLE AGENT RESISTANCE
CAN USE LOWER DOSE
BETTER REMISSION AND CURE RATE
RADIATION
TARGETS DNA
KILL TUMOR WITHOUT DAMAGE TO SURROUNDING TISSUES
TUMOR MUST BE ACCESSIBLE

51. SURGERY METHOD OF CHOICE,CAN REMOVE ENTIRE TUMOR,DEBULKING
ADJUVANT CHEMOTHERAPY OR RADIATION
IMMUNOTHERAPY
.ELIMINATES CANCER CELLS ONLY
.PROVIDES PROTECTION AGAINST RECURRENCE
.T_CELL BASED OR ANTIBODY RESPONSES
.CONJUGATED ANTIBODIES
.NONSPECIFIC ENHANCEMENT OF THE IMMUNE SYSTEM