What is cancer ?

Cancer is a clonal expansion of a single genetically

abnormal cell that acquire the ability to grow without the
limitations of its normal environment, tissue and organ

Cancer is not a unique pathological entity. It presents a

variety of features, such as a simple cell outgrowth or an
aggressive invasive and metastatic behavior
 Cancer may arise in any tissue and organ

However, the most common types of cancer arise

from the epithelium of the various tissues
General pattern of cell organization in a specialized organ
1. A layer (sometime multiple layers) of tissue specific epithelial cells
2. A basement membrane
3. Supporting mesenchime, which consists of connective tissue (collagen)
and fibroblasts (which produce collagen)
4. Blood vessels, lymphaticc vessels and nerves passing through the
connective tissue
5. Bone and/or muscle
 Il tumore si sviluppa in
fasi progressive

Le cellule tumorali
possono invadere i vasi
e metastatizzare in altri
distretti anatomici
 Benign, malignant and metastatic cancer
1. Benign tumors, which may arise in any tissue. They do not
spread, but may cause damage by local pressure or obstruction.
A benign tumor originating from the epithelium is usually
small and remains in the epithelial layer, without penetrating
basement membrane and mesenchyme
2. Malignant tumors are characterized by the capacity to invade
and destroy sorrounding tissues. Carcinomas penetrate
basement and mesenchyme, where new vessels are formed to
support its own growth
3. Metastatic tumors are secondary tumors in a different organ
that originate from the spreading of a primary malignant
tumors via lymphatic and blood vessels. It is unclear why
certain organs, liver, lung and bone marrow, more frequently
allow the seeding of metastasis, while other, kidney, spleen and
muscle, rarely do.
 Tumor staging TNM
T0: no evidence of tumor
T1: tumor less than 2 cm with no vascularization
T2: tumor less than 2 cm with vascularization
T3: tumor more than 2 cm with vascularization
T4: multiple tumors with invasion of adjacent organs

N0: no local lymph nodes involvement

N1: local lymph nodes involvement

M0: evidence of distal metastasis

M1: evidence of distal metastasis

Stage groupings
Stage I: T1 N0 M0
Stage II: T2 N0 M0
Stage IIIA: T3 N0 M0
Stage IIIB: T1 N1 M0 or T2 M1 N0 or T3 M1 N0
Stage IVA: T4 N0-1 M0
Stage IVB: T1-4 N0-1 M1
 Tumor grading
A phenotypic feature identifying the grade of cell differentiation
Grade I or Low grade: tumor is composed of well-differentiated
cells

Grade III or IV or High grade: tumor is composed of non-

differentiated cells (anaplastic)
 Cancer diagnosis is based on
histological evidence

Squamous carcinoma of the skin

a. Normal skin: mesenchime covered by a normal epitelium (basal cells and
differentiated superficial cells, covered by layers of keratin
b. Dysplastic skin: increase in basal cells with irregular organization
c. Cell overgrowth: abnormal in shape and size
d. Centre of the tumor: a mass of irregular spindle-shaped cells, an anaplastic ca
 Tumor types are classified according to their
benign/malignant features and their tissue and organ of origin
 Leukemias and Lymphomas
• Leukemia is a cancer of the blood in which blood cells mature
abnormally or incompletely. These abnormal or immature cells
accumulate in the body. They are not able to carry out the functions of
normal blood cells.
• The first step in the process of stem cell maturation is differentiation into
2 groups: myeloid stem cells and lymphoid stem cells.

• The myeloid stem cells, or lineage, develop into red blood cells,
platelets, and certain types of white blood cells (granulocytes or
monocytes).
• The lymphoid stem cells, or lineage, develop into another type of white
blood cells (lymphocytes).

• Either lineage can be affected by leukemia. Leukemias that affect the

myeloid lineage are called myelogenous (or myelocytic) leukemias.
Leukemias that affect the lymphoid lineage are called lymphocytic
leukemias.
 Leukemias and Lymphomas
• Each of the 2 major types of leukemia, myelogenous and lymphocytic, comprise both
acute and chronic forms.

• Acute means rapid onset. In leukemia, this means that the abnormal cells are fast
growing. Although the cells grow rapidly, they do not mature. They reproduce faster
than healthy cells and thus accumulate, but they do not carry out the functions of
healthy white blood cells.

• Chronic means developing slowly over the long term. In leukemia, this means that the
cells look mature but are not completely normal. They do not fight infections or help
heal wounds as well as healthy white blood cells. The cells do not die like normal cells
and thus collect in certain areas of the body.

• There are 4 main types of leukemia

• Acute lymphocytic leukemia

• Chronic lymphocytic leukemia
• Acute myelogenous leukemia
• Chronic myelogenous leukemia