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Section VIII - Neoplasia

I. Basic Principles III. Screening
A. New tissue growth characterized by three properties A. Basics
1. Unregulated 1. Diagnostic tests
2. Irreversible a) Screening (high sensitivity) vs. confirmatory
3. Monoclonal (determined by studying G6PD
(high specificity) tests
isoenzymes)
2. Cancer shows clinical symptoms after
approximately 30 cell divisions
3. With each division → number of mutations
increases
4. Late-presenting cancer → more mutations
B. Role of Screening
1. Early detection of dysplasia (precancerous
change) before it becomes carcinoma
2. Early detection of cancers before clinical
symptoms begin
3. Efficacy is directly related to decrease in cancer-
FIGURE 10.1.37 - Use of G6PD Isoenzymes to Determine specific deaths
Monoclonality
IV. Non-Neoplastic Growths
II. Nomenclature of Tumors A. Hamartoma
A. Depends on 1. Overgrowth of disorganized tissue indigenous
1. Type of tissue from which tumor is derived to a particular site (e.g. birthmarks, pulmonary
2. Nature of tumor (benign or malignant) hamartomas)
B. General Rules B. Choristoma
1. Benign tumors: “-oma” (e.g. fibroma, 1. Normal tissue in a foreign location (e.g.
chondroma) pancreatic tissue in stomach wall)
2. Malignant tumors
a) Mesenchymal: “-sarcoma” (e.g.
fibrosarcoma, chondrosarcoma
b) Blood-forming cells: “leukemia” or
“lymphoma” (e.g. AML, Hodgkin’s
lymphoma)
c) Epithelial origin: “-carcinoma” (e.g.
squamous cell carcinoma, adenocarcinoma)

Screening Test Cancer Comments

Pap smear - Cervical cancer - Detects cervical dysplasia

Mammography - Breast cancer - Detects in situ breast cancer

Digital rectal exam - Prostate carcinoma - Detects benign prostatic hyperplasia

Hemoccult test and colonoscopy - Colorectal carcinoma - Detects colonic adenoma

TABLE 10.1.3 - Screening Tests for Early Detection of Cancer

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REVIEW QUESTIONS
1. A 45-year-old woman with a 25-year history of
chronic alcohol abuse presents with complaints
of fatigue, weight loss, and abdominal pain
with distension. Physical examination reveals
hepatomegaly. Liver ultrasound shows a hyperechoic
mass suggestive of a tumor. A sample is retrieved
for biopsy, and the pathology report reveals that the
tumor is a cancer of the hepatocytes. Using proper
nomenclature, how would this cancer be named?
• The cancer should be named “hepatocellular
carcinoma."
• Based on the path report, the tumor in this
question is cancerous. Hepatocytes have an
epithelial origin and are also known as the
liver epithelial cells. Proper nomenclature
for this cancer would thus require the suffix
“-carcinoma.”
?
2. A 30-year-old woman with no significant medical
history presents to the office with complaints of
weakness, significant weight loss and low-grade fever
for 10 days. G6PD isoenzyme analysis is done and the
number of cells with G6PD-A isoenzymes is found to
be 400,000, while the number of cells with G6PD-B
isoenzymes is found to be 100,000. Which of the
following conditions is similar to the condition that
the patient is suffering from?
A. Prostatic carcinoma
B. Benign prostatic hyperplasia
C. Ventricular hypertrophy
D. Barrett esophagus
• The correct answer is A
• The ratio of G6PD isoenzyme A and B is 4
to 1. Any ratio other than 1 to 1 suggests
monoclonality, which is a feature of neoplastic
cells. The patient must be suffering from a
neoplastic condition. Prostatic cancer is the only
one that signifies neoplastic growth.
• B, C, and D are incorrect because benign prostatic
hyperplasia, ventricular hypertrophy, and Barrett
esophagus are examples of growth adaptations,
and they show polyclonal growth.