 Evil-acting tumor

NEOPLASM LECTURE NOTES

TWO BASIC COMPONENTS
NEOPLASM  Parenchyma - proliferating neoplastic cell
 Neoplasia - process of new growth  Stroma - connecting tissue and blood vessels
 Neoplasm - new growth  Some tumors (sarcoma) stroma is scanty so
 Oncology (Greek oncos = tumor) means study neoplasm is soft and scanty
of TUMOR or NEOPLASM  Desmoplasia - abundant collagenous
 Cancer - common term of all malignant tumors stroma
 Schirrhous - stony hard
DEFINITION
 A neoplasm is an abnormal mass of tissue, the THREE BASIC GROUPS OF TUMORS
growth of which exceeds and is uncoordinated I. Composed of one parenchymal cell type
with that of normal tissue II. Composed of more than one parenchymal cell
 It persist in the same excessive manner after type arising from same germ layer
cessation of the stimuli which evoke the change. III. Composed of more than one germ layer arising
from totipotential cells.
WHY DOES NEOPLAM OCCUR?
> Due to heritable genetic changes that are passed NEOPLASM NOMENCLATURE
down from the 'changed' (neoplastic) cell to the  Oma  Tumour
progeny of tumor cells  Carcin-oma  Hard Tumour
> The genetic change allows these group of cells to  Sarc-oma  Soft Tumor
have excessive and unregulated proliferation that Cell of Origin Benign Malignant
becomes almost completely autonomous. Glandular Adenoma Adenocarcinoma
epith.
1. Genetics Lining Epith Papilloma Squamous cell ca
2. Age Fibroblast Fibroma Fibrosarcoma
3. Hormones Osteoblast Osteoma Osteosarcoma
4. Smoking Chondrocyte Chondroma Chondrosarcoma
5. Drinking Lipocyte Lipoma Liposarcoma
6. Obesity Smooth Leiomyoma Leiomyosarcoma
7. Sun overexposure muscle
Skeletal Rhabdomyoma Rhabdomyosarcoma
8. Immune disorder
muscle
9. Viruses
10. Radiation and chemicals

TUMORS ARE MONOCLONAL

 The entire population of cells within a tumor are
one single cell that has incurred genetic change
and hence tumor are said to be "clonal"
 Clone - a group of cells arising from one single
cell by asexual division and having the same
structure and function as that of the parent cell.

THE 5 P's OF NEOPLASIA

1. Persistent
2. Purposeless BENIGN TUMORS
3. Parasitic  Benign tumors are named using - OMA as a
4. Progressive suffix with the organ name as the root.
5. PROLIFERATION o a benign tumor of smooth muscle
cells is called leiomyoma
TYPES OF NEOPLASMS (TUMOR) o Epithelia origin - adenoma,
Benign tumors cystadenoma, papilloma, polyps
 remain localized  Confusingly, some types of malignant tumors
 cannot spread to other sites also use the OMA suffix.
 amenable to local surgical removal, thus o e.g. melanoma and seminoma
patient survives.  Benign tumors are encapsulated and has
 Innocent-acting tumor. well-differentiated margins.
Malignant tumors  Benign tumor of the thyroid is called
 They invade and destroys adjacent structures adenoma Note the normal-looking (well-
 spread to distant sites (Metastasis) differentiated), colloid-filled thyroid follicles.
 causes high mortality to the patient
MALIGNANT TUMORS
 Cancer are classified by the type of cells that the
tumor resembles and is therefore presumed to SQUAMOUS CELL CARCINOMA
be the origin of the tumor.  demonstrates enough differentiation. The
 Carcinoma cells are pink and polygonal in shape with
- cancer derived from epithelial cells, the intercellular bridges.
breast, lung, prostate, pancreas and colon.  The neoplastic cells shows pleomorphism
- Malignant neoplasm of epithelial cell origin with large hyperchromatic nuclei. Mitotic
derived from any of the three germ layers figures are also observed.
called CARCINOMA.
o Ectodermal origin - arising from
ectodermis
o Mesodermal origin - arising from
cells of renal tubules
o Endodermal origin - derived from
cells lining the gastrointestinal
tract.
ADENOCARCINOMA
 The cancerous glands are irregular shape
and size and do not resemble the normal
colonic glands.
 The malignant glands has a surrounding
fibrous stroma and invades the muscular
layer of the colon.

 Malignant tumor arise from epithelial tissue

o Adenocarcinoma - malignant tumor
of glandular cells
o Squamous Cell Carcinoma -
malignant tumor of squamous cells

SARCOMA
 Malignant tumor arising from connective tissue
(e.g. bone, cartilage, fat, nerve) developed from
cells originating in mesenchymal cells outside
the bone marrow. A number of mitotic figures
are also noted in sacomatous tumor.
o Chondrosarcoma - malignant tumor
of chondrocytes
o Angiosarcoma - malignant tumor of
blood vessels
o Rhabdomyosarcoma - malignant
tumor of skeletal muscle cells

LYMPHOMA AND LEUKEMIA
 These two classes of cancer arises from the
hematopoietic (blood-forming) cells that leave
the marrow and tend to mature in the lymph
nodes (lymphoma) and blood (leukemia),
respectively.
GERM CELL TUMOR
 Cancers derived from pluripotent cells, most
often presenting in the testicles and ovaries
(seminoma and dysgerminoma, respectively).
SPECIALISED TUMOR
1. Adenosquamoud carcinoma
 demonstrates blended adenoca and scc
within a single tumor.
2. Collision tumor
 two different cancer in the same organ
which do not mix with each other. (SCC
+ Melanoma)
3. Mixed tumor
 often seen in the salivary gland called
pleomorphic adenoma.
 This is a benign tumor having both
epithelial and mesenchymal elements.
 Ex: lipomatous mixed tumor
4. Teratoma
 made up of mix tissue types arising
from the totipotent cells derived from
the three germ layers (ectoderm,
mesoderm, and endoderm).
 Most common sites would be testis and
ovary and few extragonodal sites.
 Teratoma may be Benign or Mature
(mostly ovarian) or Malignant or
Immature (mostly testicular teratoma)
5. Blastoma
 blastomas or embryomas are a group of
malignant tumor which arises from
embryonal or partially differentiated
cells
 form blastoma of the organs and tissue
during embryogenesis.
 Blastomas occurs more frequently in
infants and children under 5 year of
age.
 e.g. hepatoblastoma, neuroblastoma,
retinoblastoma, medulloblastoma,
primary blastoma.
CHARACTERISTICS OF TUMOR
 Majority of neoplasm can be categorized
clinically and morphologically into benign
and malignant on the basis of certain
characteristics:
1. Rate of growth
2. Cancer phenotype and stem cells
3. Clinical and gross features
4. Microscopic features
5. Local invasion (direct spread)
6. Metastasis (distant spread)
Rate of Tumor Growth
 Tumor cells proliferate more rapidly than the
normal cells.
 Rate of growth of tumor depends on:
– Doubling time (mitotic rate) of
tumor cells
– Number of cells remaining in
preoperative form (growth fraction)
– Rate of loss of tumor cells by cell
shedding
 Tumor enlarge rate is dependent upon:
– Rate of cell production, growth
fraction and rate of cell loss
– Degree of differentiation of tumor
 Degree of differentiation
– Rate of growth of malignant tumor is
directly proportionate to the degree
of differentiation
– Poorly-differentiated tumors show
aggressive growth pattern
– Rarely, a malignant tumor may
disappear spontaneously from the
primary site, due to good host
immune attack
Rate of Tumor Growth
 During early phase of cell growth, cells are
in the proliferative pool
 During growth of tumor, tumor cells leave
the proliferative pool and goes non-
proliferative pool to G0
 Most cells within tumor remain in the G0 and
G1 phase
 Leukemia, lymphoma and lung tumors
have high growth fraction
  Colon and breast tumors have low growth differentiated differentiation
fraction
 Other factors which affect growth of tumor
includes: hormones, blood supply and other Cytological Same as marked
unknown influences features normal cells variation in size
and shape
Cancer Phenotype and Stem Cells Mitosis normal increased/
Cancer cells abnormal
1. disobey the growth control – proliferate rapidly Necrosis unusual necrosis and
hemorrhage
2. escape from death signals – immortality
common
3. imbalance bet. cell proliferation and cell death –
excessive growth Metastasis absent present
4. lose differentiation properties – function
5. are unstable – newer mutations Local Invasion (direct spread)
6. overrun their neighboring tissue – invade locally  Benign: expand and push aside without
7. invade to other sites – distant metastasis invading ,infiltrating or metastasizing.
 Malignant: expand, invasion, infiltration and
destruction of surrounding tissue.
DIFFERENCE BETWEEN BENIGN AND MALIGNANT Metastasis (distant spread)
TUMOR  Metastasis Meta = transformation, stasis =
residence): spread of tumor by invasion
Three routes:
1) direct seeding of body cavities or surfaces
2) lymphatic spread – is the most common
pathway for the initial dissemination of
carcinomas, skip metastasis, sentinel lymph
node, e.g. breast CA
3) hematogenous spread - common in
sarcoma, commonly in veins, lung and liver
usually involve

DIFFERENTIATION
 refers to the extent to which neoplastic
parenchymal cells resemble the corresponding
normal parenchymal cells, both
morphologically and functionally;
 lack of differentiation is called ANAPLASIA.
 Well-Differentiated-neoplastic cells
resembling the mature normal cells of the
tissues of origin like most of the benign tumors
 Poorly-Differentiated - primitive appearing
unspecialized cells; malignant tumors range
from well-diff to undifferentiated
 Lack of differentiation, or anaplasia, is
considered a hallmark of malignancy.

FEATURES OF LACK OF DIFFERENTIATION

1) Pleomorphism - variation of size and shape of
cell and nuclei
2) Abnormal nuclei morphology - the nuclei are
Characteristics Benign Malignant disproportionately large for the cell and is
Surface Smooth Irregular hyperchromatic (containing abundant
Rate of growth Slow and erratic chromatin and dark staining)
expansile 3) Nuclear-to-cytoplasm ratio is increased;
capsule Well Invasive irregular shape nuclear membrane and
encapsulated presence of large nucleoli (normal NC ratio 1:4
Size Small-very Small -large - 1:6)
large 4) Increased Mitosis - malignant and
Course Rarely fatal Fatal if undifferentiated tumors, many cells are in
untreated
mitosis, reflecting the high proliferative activity
MICROSCOPIC
of the parenchymal cells;
Differentiation Well lack of
  presence of mitoses does not necessarily
indicate that the tumor is malignant or
neoplastic; more important features of
malignancy
 are atypical, bizzare mitotic figures sometime
producing tripolar, quadripolar and or
multipolar forms of mitosis.
5) Loss of polarity - orientation of anaplastic cells
is markedly disturbed. Sheets or large masses
of tumor cells grow in a disorganized fashion
6) Necrosis - many rapidly growing malignant
tumors develop large central areas of ischemic
necrosis

WHAT IS DYSPLASIA
 means disordered growth
 loss in uniformity and architectural
orientation of the individual cells
 Features of dysplasia includes
1. Pleomorphism
2. hyperchromatic nuclei
3. high nuclear-cytoplasmic ratio
4. disorderd architecture
5. abundant mitoses
 Grading of dysplasia:
1. Mild to moderate - usually reversible
2. Severe - usually progress to Carcinoma
In Situ (CIS)
CIS - marked dysplastic change that
involve the entire thickness of the
epithelium but remains confined by the
basement membrane, it is considered a
preinvasive neoplasm.
3. Invasive carcinoma - once the tumor
cells breach the basement membrane, it
said to be invasive.
Staging – progression or spread in the body
Grading – Cell differentiation and Rate of growth
TUMOR GRADING Grading is based on
1. degree of anaplasia
2. rate of growth
 Grade I: Well-differentiated (less than 25%
anaplastic cells)
 Grade II: Moderately-differentiated (25-50%
anaplastic cells)
 Grade III: Moderately-differentiated (50-
75% anaplastic cells)
 Grade IV: Poorly-differentiated or anaplastic
(more than 75% anaplastic cells)
TUMOR STAGING

CLASSIFICATION OF CERVICAL INTRAEPITHELIAL

NEOPLASIA (CIN) AND DYSPLASIA

EPIDEMIOLOGY OF CANCER
 Cancer Incidence Worldwide:
1. Lung Ca
2. Female Breast Ca
3. Prostate Ca
4. Colon/rectal Cal
5. Liver Ca
 Common Tumors in Males
1. Prostate Ca
2. Lung Ca
3. Colon/rectal Ca
 Common Tumors in Females
1. Breast Ca
2. Cervical Ca
 3. Ovarian Tumors
4. Lung Ca
>Common tumors due to chronic alcohol use
1. Oralpharynx Ca
2. Larynx Ca
3. Esophageal Ca
4. Liver Ca
5. Bowel Ca
6. Breast Ca
>Common tumors due to smoking Lung Ca (90%)
1. Mouth Ca
2. Pharyngeal Ca
3. Laryngeal Ca
4. Esophageal Ca
5. Pancreatic Ca
6. Gallbladder Ca
>Common pediatric tumors
1. Acute Lymphoblastic Leukemia (ALL)
2. Neuroblastoma
3. Wilm’s Tumor
4. Retinoblastoma
5. Rhabdomyosarcoma

GEOGRAPHIC AND ENVIRONMENTAL FACTORS

 Sun Exposure
- Melanomas 6x incidence in NZ vs Iceland
- Black have low incidence of melanoma
 Smoking and Alcohol
 Body Mass
- Overweight, 50% inc in cancer
 Environmental vs Racial Factors
 Viral Exposure
- Human Papilloma Virus and Cervical Ca
- Hepatitis B Virus (HBV) and Liver Ca
- Epstein-Barr Virus (EPV) and Lymphoma