1. Definitions and nomenclature 1.Tumor 2.Neoplasia 3.Oncology 4.cancer a)Study of tumors b)Swelling c)Malignant d)New growth

2. Benign epithelial tumors 1.Adenoma 2.Papilloma 3.Polyp 4.Cystadenoma a)Begin tumor with Finger-like projections b)Adenoma with cyst formation c)Raised mucosa d)Begin tumor of Glandular grigin

3. colon

5. Cell of origin Benign tumor 1.Bone 2.Skeletal musle 3.Fibroblast 4.Cartilage 5.Melanocyte 6.Smooth musle 7.Blood vessel 8.Gland 9.Adipocyte 10.Squamous cellwith finger like projection a)Papilloma b)Adenoma c)Lipoma d)Fibroma e)Chondroma f)Leiomyoma g)Rhabdmyoma h)hemangioma i)osteoma j)melanocytic nevus

6. 1.Lipoma 2.Fibrosarcoma 3.Chondroma 4.Mesothelioma 5.Leiomyosarcoma 6.lymphoma 7.Rhabdmyoma 8.Melanoma 9.melanocytic nevus 10.Hepatoma a)Bengin b)Malignant

7. 1.Contain elements of all three germ layers 2.A mass composed of cells native to the organ 3.Contain brain, respiratory and intestinal mucosa, cartilage, bone, skin, teeth, or hair 4.A mass composed of normal cells in a wrong location Hamartoma Choristoma Teratoma

8. – Leiomyoma

9. Malignant tumors. Glandular tissues Squamous cells Mesenchymal (connective tissue) tissues. Nomenclature Sarcoma Carcinoma

12. Malignant tumors arising in mesenchymal tissues Fibroblasts Skeletal muscle Smooth muscle Adipose tissue Bone blood vessels Cartilage Sarcoma liposarcoma chondrosarcoma rhabdomyosarcoma leiomyosarcoma fibrosarcoma angiosarcomas osteosarcoma

13. Neoplasia nomenclature (“… -oma’s” any growth ) examples : benign - malignant Malignant tumorBenign tumor Squamous (SC) epithelium Glandular epithelium Fat Bone Muscle

14. Neoplasia nomenclature (“… -oma’s” any growth ) examples : benign - malignant Malignant tumorBenign tumor SC carcinomaPapilloma Squamous (SC) epithelium AdenocarcinomaAdenomaGlandular epithelium LiposarcomaLipomaFat OsteosarcomaOsteomaBone Rhabdomyosarcoma RhabdomyomaMuscle

15. Glioma: CNS glial tissue (astrocytoma, glioblastoma)

16. Neoplasia nomenclature - historic eponyms – “first described by…” Hodgkin ’ s disease Burkitt lymphoma Ewing sarcoma

17. Dysplasia premalignant condition Increased N/C ratio Irregular nuclear membrane Hyperchromasia Nuclear abnormality

18. Dysplasia Differences between dysplasia and cancer.  lack of invasiveness.  Reversibility

19. Carcinoma in situ - cervix BM Ly Mitoses

20. Benign and Malignant tumor

21. Malignant tumors Pleomorphism, Increased nuclear cytoplasmic ratio Hyperchromatism Giant nucleoli Cells Rate of growth Mitotic figures Mode of growth Invasion Metastasis Spread of tumors to places non contiguous with primary lesion

23. Grading and staging of cancer

24. Staging of tumor Grading of tumor Neoplasia biology: features of malignancy – clinical biology Risk factors Prognostic factors Influence treatment modalities

25. Definition TisIn situ, non-invasive (confined to epithelium) T1Small, minimally invasive within primary organ site T2Larger, more invasive within the primary organ site T3Larger and/or invasive beyond margins of primary organ site T4Very large and/or very invasive, spread to adjacent organs N0No lymph node involvement N1Regional lymph node involvement N2Extensive regional lymph node involvement N3More distant lymph node involvement M0No distant metastases M1Distant metastases present

27. Definition IWell differentiated IIModerately differentiated IIIPoorly differentiated IVNearly anaplastic

28. Epidemiology & aetiology

29. CANCER INCIDENCE The number of new cases of specific cancer registered over a specific period in a defined population.

30. MORTALITY The number of death from a given form of cancer during a specified period of time.

31. AGE Most carcinoma occur in the later year of life (55-74 years). Children are affected by certain neoplasms, e.g.: Leukemias and neoplasm of CNS Retinoblastoma Neuroblastoma Nephroblastoma Rhabdomyosarcoma Leukemias and neoplasm of CNS Retinoblastoma Neuroblastoma Nephroblastoma Rhabdomyosarcoma

32. Aetiology of cancer CARCINOGENS

33. Major carcinogens

34. Direct-Acting Agents Require no metabolic conversion to become carcinogenic e.g., alkylating agents (Anticancer drugs ) Indirect-Acting Agents Chemicals that require metabolic conversion to an ultimate carcinogen before they become active. Chemicals carcinogens

35. Found everywhere in our environment. Occupational, e.g: *Beryllium *arsenic component *benzene *nickel يستخدم البيريليوم لإنتاج سبائك النحاس مما يجعلها تستخدم بشكل واسع بسبب موصليتها الحرارية والكهربائية العالية. زرنيخ قبل عام 1920 كان البنزين يستخدم كمذيب صناعي لإزالة الشحوم من المواد مادة تضاف للوقود السائل ( البنزين المستخدم كوقود ) تم استبدال البنزين الحلقي بالتيترا إيثيل رصاص, عنصرالنيكل من العناصر المكونة لـ السبائك المعدنية بالإضافة إلى أنه مكون أساسي للفولاذ المقاوم للصدأ Chemicals carcinogens

36. Geographic Environmental factors include: *Asbestos يستخدم الأسبست في مجال البناء وتسقيف المنازل والعوازل الداخلية والخارجية وأنابيب صرف المياه والأدخنة والتهوية، mesothelioma

38. Smoking

39. RADIATION CARCINOGENESIS Radiation, whatever its source, UV rays of sunlight, x-rays, nuclear fission, radionuclides is an established carcinogen. Miners of radioactive elements have suffered a ten-fold increased incidence of lung cancers.

40. Radiation Follow-up of survivors of the atomic bombs dropped in Hiroshima and Nagasaki developed: Leukemia Thyroid, breast, colon and pulmonary carcinomas. Ionizing radiation causes chromosome breakage, translocations, and less frequently point mutations.

41. Radiation (contd) The oncogenic effect of UV. UV radiation derived from the sun can cause skin cancers (melanomas, squamous cell carcinomas and basal cell carcinomas). UV radiation damage DNA by forming pyrimidine dimers. This type of DNA damage is repaired by a complex set of proteins that affect nucleotide excision repair.

42. Viral and Microbial Oncogenesis RNA Viruses DNA Viruses

43. Oncogenic viruses Hepatitis C Virus Human papilloma virus Epstein-Barr Virus Human T-cell leukemia virus-1 (HTLV-1) Hepatitis B Virus Human herpes virur 8  Nasopharyngeal carcinoma.  Benign warts  Burkitt lymphomas,  Hepatocellular carcinoma  Uterine cervical cancer  T-cell leukemia  Kaposi sarcoma

44. Bacteria Gastric adenocarcinomas and gastric lymphomas. Helicobacter pylori

45. Molecular basis of cancer “Pathogenesis of cancer” “Carcinogenesis” Molecular basis of cancer “Pathogenesis of cancer” “Carcinogenesis” NEOPLASIA

46. Primary or environment (75%) Alterations to the human genome First hitSecond hit Normal genome Normal genome Cancer genome TIME Carcinogenesis is a multistep event with somatic mutations

47. Four classes of normal regulatory genes are the principal targets of genetic damage 1.Growth-promoting proto-oncogenes, 2.Growth-inhibiting tumor suppressor genes, 3.Genes that regulate apoptosis 4.Genes involved in DNA repair.

48. a)Oncogenes b)Tumor suppressor genes, c)Genes that regulate apoptosis d)Genes involved in DNA repair. 1.Maintain the integrity of the genome 2.Inhibit growth 3.bcl-2 4.Stimulate growth

49. a)oncogenes, b)tumor suppressor genes, c)Genes that regulate apoptosis d)Genes involved in DNA repair. e)Neuroblastomas f)the most common transformed gene in human cancer 1.RAS gene 2.p53, 3.MYC gene 4.bcl-2 5.Retinoblastoma gene 6.ABL gene 7.Xeroderma pigmentosum

50. A 45-year-old man from southern China is diagnosed with a nasopharyngeal tumor. Histologically, this neoplasm is composed of anaplastic cells immunoreactive for cytokeratin admixed with abundant lymphocytes. Which of the following factors is most likely implicated in the pathogenesis of this neoplasm? A. Cigarette smoking B. Epstein-Barr virus infection C. Ionizing radiation D. Overexpression of the bcl-2 gene