1. Dr. Salma Mansoor Lecturer, DCOP, DUHS
NEOPLASIA
Dr. Salma Mansoor
Lecturer,
DCOP,
DUHS

2. Definitions Neoplasia = new growth Tumor= swelling due to inflammation
Oncology= oncos is tumor, logy is study
Cancer= malignant tumors (crab)

3. NEOPLASM
"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"

4. Facts 2000: US: 1.5 million new CA diagnosis 10 million new cases CA
6 million CA deaths worldwide
US: 1.5 million new CA diagnosis
2003, 23% deaths (1500 CA deaths/d)
Second COD in US (IHD & atherosclerosis)

5. Proliferating neoplastic
Nomenclature
Stroma
Connective tissue and
blood vessels
Parenchyma
Proliferating neoplastic
cells

6. Benign vs. Malignant Slow growing Encapsulated No Metastasis
Well Differentiated
Rapidly growing
Non encapsulated
Metastasis
Well-Poorly differentiated

7. Benign Tumors Cell of origin + OMA Fibroma, chondroma, osteoma
Tubular adenoma, colon
Cell of origin + OMA
Fibroma, chondroma, osteoma
Adenoma: derived from glands/ glandular pattern

8. Papillomas: architecture  finger like projections

9. Polyp: macroscopic  projection of mucosal surface

10. Malignant tumors
Mesenchymal = sarcomas ( sar, fleshy). Fibrosarcoma, liposarcoma, leiomyosarcoma
Epithelial = carcinomas, glandular – adenocarcinoma, squamous – squamous cell carcinoma

11. Mixed: epithelial and stromal component, same origin, i. e
Mixed: epithelial and stromal component, same origin, i.e. pleomorphic adenoma

13. Teratomas: more than one germ layer
Teratoma, ovary
Teratoma, ovary
Teratomas: more than one germ layer

14. Choristoma: ectopic rest of normal tissue

15. Hamartoma: mass of disorganized but mature specialized cells or tissue native to the particular site

16. Tissue of origin
Benign
Malignant
Mesenchymal/ connective tissue
Fibroma
Lipoma
Chondroma
Osteoma
Fibrosarcoma
Liposarcoma
Chondrosarcoma
Osteogenic sarcoma
Endothelial and related tissues
Hemangioma
Lymphangioma
Meningioma
Angiosarcoma
Lymphangiosarcoma
Synovial sarcoma
Mesothelioma
Invasive meningioma
Hematopoietic
Leukemias
Lymphomas
Muscle
Leiomyoma
Rhabdomyoma
Leiomyosarcoma
Rhabdomyosarcoma
Epithelial
Squamous papilloma
Adenoma
Papilloma
Cystadenoma
Bronchial adenoma
Renal tubular adenoma
Liver cell adenoma
Transititonal cell papilloma
Hydatiform mole
SCC or epidermoid CA
BCC
Adenocarcinoma
Papillary carcinoma
Cystadenocarcinoma
Bronchogenic carcinoma
Renal cell carcinoma
Transitional cell carcinoma
Choriocarcinoma
Seminoma
Embryonal CA
Melanocytes
Nevus
Malignant melanoma

17. More than one neoplastic cell- MIXED
Salivary gland
Pleomorphic adenoma
Malignant mixed tumor of salivary gland origin
Renal
Wilms tumor
Teratogenous ( from more than one germ cell layer
Totipotential cells
Mature teratoma/ dermoid cyst
Immature teratoma, teratocarcinoma

18. 1. Anaplasia Lack of differentiation
Hallmark of malignant transformation
Numerous morphologic changes

19. Pleomorphism: variation in size and shape

20. Abnormal nuclear morphology: hyperchormatic (abundant DNA), increased N:C ratio (normal 1:4- 1:6)

21. Mitoses: increased, bizarre

22. Loss of polarity

23. Tumor giant cells

24. Dysplasia: disordered growth
Loss of uniformity
Loss of architecture
Pleomorphism
Hyperchromasia
Abnormal located mitosis

25. Obesity & Cancer

27. Relationship b/w BMI & cancer

28. Mechanism

29. Hyperinsulinemia
IGF
Steroid hormones
adiponectin

30. Diet & Cancer

31. With respect to carcinogenesis 3 aspects of diet are of major concern:
The content of exogenous carcinogens
The endogenous synthesis of carcinogens fro dietary components
Lack of protective factors

32. Exogenous Substances

33. Endogenous synthesis

34. Protective factors

35. Rates of Growth
How long does it take to produce a clinically overt tumor mass……?????

36. TUMOR CELL KINETICS

37. Rate of Growth of Tumor

38. Growth Fraction

39. Clinical aspects of neoplasia
Local & Hormonal Effects
Cancer Cachexia
Paraneoplastic Syndrome

40. Cachexia

42. PARANEOPLASTIC SYNDROMES
Infrequent but important to recognize.
Endocrinopathies
Neuromyopathic Paraneoplastic syndromes
Dermatologic disorders
Osseous, articular & soft tissue changes
Vascular & hematologic changes

43. Endocrinopathies
Cushing syndrome
Hypercalcemia

44. Neuromyopathic PS Peripheral neuropathies
Cortical cerebellar degeneration
Polymyopathy
Myasthenia syndrome

45. Dermatologic Disorders
Acanthosis nigricans

46. Osteoarthropathy

47. Vascular & Hematologic
DIC

48. STAGING OF CANCER American Joint Committee on Cancer Staging TNM
T0, T1-T4
N0, N1, N2, N3
M0, M1, M2

49. DIAGNOSIS OF CANCER Histologic & Cytologic methods Immunochemistry
Flow cytometry
Molecular diagnosis

50. Histology & Cytology

51. Sample Collection
Adequate
Representative
Properly preserved

52. Sample Collection Techniques
excision or biopsy

53. Fine-needle aspiration

54. Cytologic (Pap) smears

58. ANTICANCER DRUGS

59. Principles of Cancer Chemotherapy
Lethal cytotoxic event  arrest tumor progression

60. Treatment Strategies Goal of treatment [cure &/or palliation]
Indications for treatment [dissminated, supplemental]
Tumor susceptibility & the growth cycle:
i. cell-cycle specificity of drugs
ii. Tumor growth rate

61. Treatment Regimens & Scheduling
Log kill (1st order kinetice)
Pharmacologic Sanctuaries
Treatment protocols:
i. Combination of drugs
ii. Advantages of drug combinations
iii. Treatment protocols (POMP for ALL)

62. Problems associated with Chemotherapy
Resistance
Toxicity
Common adverse effects
Minimizing adverse effects
3. Treatment-induced tumors

63. Anticancer drugs Antimetabolites Antibiotics Alkylating agents
Methotrexate, 6-Mercaptopurine, 6-Thioguanine, 5-Fluorouracil, Cytarabine, Gemcitabine
Antibiotics
Dactinomycin, Doxorubicin, Daunorubicin, Bleomycin
Alkylating agents
Mechlorethamine, Cyclophosphamide, ifosfamide,Nitrosoureas (carmustine, lomustine)
Microtubule Inhibitors
Vincristine, Vinblastine, TAXOL (Paclitaxel), Docetaxel
Steroid Hormones/Antagonist
Prednisone, Tamoxifen, Aromatase Inhibitors
Monoclonal Antibodies
Rituximab, Cetuximab
Miscellaneous
Platinum complexes, TOPOISOMERASE INHIBITORS (irinotecan, topotecan, etoposide), Interferons

64. References
Kumar V, Abbas A, Fausto N. Robbins and Cotran pathologi Basis of Disease. 7th edition. El Servier. 2004; pg