PRESENTATION

“WHAT IS NEOPLASMS”
BY RASHID HUSSAIN Post R.N B.Sc Nursing
SUBJECT: ADVANCE NURSING CONCEPTS-II

Khyber Medical University Post Graduate College of Nursing Peshawar 23-01-2010

Introduction
Gradual increase in the number of dividing cells creates a growing mass of tissue called a "tumor" or "neoplasm." If the rate of cell division is relatively rapid, and no "suicide" signals are in place to trigger cell death, the tumor will grow quickly in size; if the cells divide more slowly, tumor growth will be slower. But regardless of the growth rate, tumors ultimately increase in size because new cells are being produced in greater numbers than needed. As more and more of these dividing cells accumulate, the normal organization of the tissue gradually becomes disrupted.
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participants about the Basic concept of Neoplasm.
OBJECTIVES: At the end of presentation the participants will be able to:

AIM: To share the knowledge among the

Define Neoplasia, Differetiation.

Dysplasia,

Meteplasia,

Anaplasia

and

    

Describe the pathogenesis of neoplasia. Enlist the difference b/w Benign & Malignant tumors. Describe the nomenclature of tumors. Explain the characteristics and staging criteria of tumor. Discuss the clinical features, diagnosis and treatment of neoplasms.

Neoplasia

Neoplasia means new growth and is characterized by unceasing abnormal and excessive proliferation of cells.

The neoplasm (commonly called tumor) is defined as “The abnormal mass of tissue, the growth which exceeds and is uncoordinated with that of the normal tissue, and persists stimuli which evoked the change.
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in the same

excessive manners after the cessation of the

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Controls of Growth

Cytokines: Cyclins, Cyclin dependent kinases (CDK).

   

Growth factors – PDGF, FGF Growth Inhibitors. Cancer suppressor genes – p53 Oncogenes – c-onc, p-onc, v-onc etc.

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Dysplasia

Dysplasia is an alteration in an adult cells characterized by variation in their size, shape and organization.

 

Associated with Ch. Inflammation. Non-neoplastic proliferation
• Pleomorphism: variation in size and shape. • Hyperchromasia: abnormally large and deep nuclei • Increased mitotic figure, but pattern is normal.

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Metaplasia
The process whereby one tissue type is replaced by another, i.e., cervical metaplasia, where glandular epithelium becomes stratified squamous epithelium.

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Anaplasia

Irreversible loss of differentiation is called naplasia. Components of neoplasm:
• Parenchyma: it constitutes the proliferating part of the neoplasm. • Stroma: It is made up of connective tissue, blood vessels and lymphatics. It provides support for the growth of parechymal cells.

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Differentiation:

The

extent

to

which

the

neoplastic to their

parenchymal

cells

resemble

normal parent cells, both morphologically and functionally is called differentiation.

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Non-Neoplastic Proliferation:
   

Controlled & Reversible Hypertrophy – Size Hyperplasia – Number Metaplasia – Change Dysplasia – Disordered

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Neoplastic Proliferation:

Uncontrolled & Irreversible Benign • Localized, non-invasive. Malignant (Cancer) • Spreading, Invasive.

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Pathogenesis of Neoplasia:

Normal Hyperplasia Metaplasia (DNA damage)  Dysplasia  (DNA damage)  (DNA damage) Anaplasia (DNA damage) Infiltration  (DNA damage)  Metastasis…. Progressive DNA Damage – features of neoplasia.

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Mechanism of Neoplams
Normal Adaptation Benign Malignant

Non-Neoplastic
(Polyclonal)

Neoplastic
(Monoclonal)
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Benign
   

Malignant
  

Slow growing, capsulated, Non-invasive do not metastasize, well differentiated, suffix “oma” eg. Fibroma.

 

Fast growing, non capsulated, Invasive & Infiltrate Metastasize. poorly differentiated, Suffix “Carcinoma” or “Sarcoma”

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Difference b/w Benign and Malignant Tumors
Characteristics
1. Differentiation

Benign
Well differentiated

Malignant
Ranges from welldifferentiated to undifferentiated Certainly present Metastasize to the regional lymph nodes and distant organs Usually rapid except cancer of cervix grows slowly Capsule is never present
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2. Anaplasia 3. Metastasis

No Anaplasia No Metastasis

4. Rate of Growth

Usually slow except leiomyoma of uterus, which rapidly grows during pregnancy Enclosed within a capsule which separates it from host tissue. Except leiomyoma of uterus

5. Encapsulation

Difference
Characteristics
7. Gross Appearance.

Conti…
Benign Malignant

Degeneration, necrosis Degeneration, necrosis ulceration, ulceration, hemorrhage, less hemorrhage, more frequent frequent They do not endanger the life unless a vital organ is involved. Easily local removal – no recurrence. Acts as parasite and tends to kill the patient-whenever it grows Recurrence common.

8. Clinical effects.

9. Recurrence.

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Nomenclature of Tumors

The tumor is named on the basis of:
1. Cell or tissue of origin.(epithelial or mesenchymal) 2. Whether it is benign or malignant.

Benign tumors
• By attaching the suffix “oma” to the cell of origin.

Epithelial
Adenoma Papilloma Cystoaenoma Polyp

mesenchymal
Fibroma Lipoma Osteoma Leiomyoma
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Malignant tumors

There are two types of malignant tumors:
1. Carcinoma: The malignant tumors of epithelial cell origin are called carcinoma. E.g. Renal cell carcinoma, adenocarcinoma, squamous cell carcinoma etc. 2. Sarcomas: The malignant tumors arising in mesenchymal tissues are called sarcomas. E.g. Fibrosarcoma. Chondrosarcoma, Osteogenic sarcoma, Liposarcoma etc.
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Nomenclature: Cell of origin +
Suffix - oma  Fibroma  Osteoma  Adenoma  Papilloma  Chondroma

Suffix

Carcinoma / Sarcoma  Fibrosarcoma  Osteosarcoma  Adencarcinoma  Squamous cell carcinoma  Chondrosarcoma

Exceptions: Leukemia, Lymphoma, Glioma,
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Characteristics of malignant neoplasms
A.

Differentiation and anaplasia:
1. Pleomorphyism. 2. Hyperchromasia. 3. Disturbed neculear-cytoplasmic ratio.
1.

Normal ratio is 1:6, In anaplasia ratio becomes 1:1

4. Mitotic figures. 5. Loss of orientation.

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Conti…

A.

Invasion:
Mechanism that make cancer invasive are: Physical pressure. Reduced adhesiveness of tumor cells. Increased motility of tumors cells. Loss of contact inhibition. Release of destructive enzymes. E.g. collagenase, plasminogen activators etc.

1. 2. 3. 4. 5.

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Conti…

Spread:
Malignant tumors spreads by two ways:

1.

Infiltration: Malignant cells infiltrate the surrounding
tissues.

Metastasis :
Is a process in which malignant tumor cells invade vessels or tissue in such a manner that they detach, migrate and are translocated to a distant site.

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Factors essential for metastasis
1. 2. 3.

Liberation of viable tumor cells. Presence of suitable environment. Availability of spreading pathways:
A. Lymphatic pathway. B. Blood stream. C. Seeding of body cavities and surfaces. D. Transplantation.

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Staging
The STAGING of cancers is based on the size of the primary lesion, its extent of spread to regional lymph nodes, and the presence or absence of bloodborne metastases There are two major staging systems: 1) Union International Against Cancer (UICC) and 2) American Joint Committee (AJC) on Cancer Staging

Staging
The UICC uses the TMN system

T for primary tumor: T0 (in situ); T1 to T4 with
increasing size

N for regional lymph node involvement: N0
(none); N1 to N3 denotes involvement of an increasing number and range of nodes

M for metastases: M0 (none); M1 and M2
indicates the presence of mets and number

Staging

The AJC employs a different nomenclature and divides all cancer into stages 0 to IV, incorporating within each of these stages the size of the primary lesion as well as the presence of nodal spread and distant metastases.

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Grading

GRADING of a cancer is based on the degree of differentiation of the tumor cells and the number of mitoses within the tumor as presumed correlates of the neoplasm’s aggressiveness

Cancers are classified as grades I to IV with increasing anaplasia.

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Clinical features of neoplasia
1. 2. 3. 4. 5. 6. 7. 8. 9.

Effects according to tumor location. Hormone production. Obstruction. Irritation of serous membrane. Tissue destruction. Infection. Fever. Anaemia. Malignant cachexia: cachexia.
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The progressive weakness and loss of

weight in the presence of malignant tumor is called malignant

Tumor Diagnosis:
      

History and Clinical examination Imaging - X-Ray, US, CT, MRI Tumor markers Laboratory analysis Cytology –Pap smear, FNAB Biopsy - Histopathology, markers. Serological examination: tumor markers Molecular Tech – Gene detection.
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Treatment
    

Surgery. Chemotherapy. Radiation therapy. Hormonal therapy. Immunotherapy.

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summary

The prognosis of a patient with any type of neoplasm depends on a number of factors including: the rate of growth of the tumor, the size of the tumor, the tumor site, the cell type and degree of differentiation, the presence of metastasis, responsiveness to therapy, and the general health of the patient.
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References:

Dr. M. Danish, Inam; Short text Book of Pathology, third edition (2000), Danish publication, Karachi.

   

www.utmem.edu/obgyn/res_pres/PathologyandNeoplasia.ppt http://cancer.about.com/od/cancerglossary/g/neoplasm.htm http://www.cancer.gov/cancertopics/understandingcancer/cancer www.bd.com/tripath/patients/glossary.asp

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