You are on page 1of 30

Outline

1. Overview
2. Nomenclature
• Benign
• Malignant
3. Characteristics of Benign and Malignant Tumors
• Differentiation and Anaplasia
• Rate of Growth
• Local Invasion
• Metastasis
4. Epidemiology
• Cancer Incidence
• Geographic and Environmental Variables
• Age
• Heredity

3
Overview
 Definitions
 Literally, neoplasia means new growth.

 In common medical usage, a neoplasm is often referred to as a


tumor, and the study of tumors is called oncology (from oncos,
"tumor,“ and logos, "study of")

2
Overview
 Growth Disorders

Non-neoplastic Neoplastic (Tumor)


(secondary) (primary)
Controlled and reversible Uncontrolled and irreversible

• Hypertrophy
• Hyperplasia
• Metaplasia Benign Malignant
• Dysplasia? Localized, noninvasive Spreading, invasive

3
Overview
 What is Dysplasia?
Dysplasia is a disordered but non-neoplastic proliferation of epithelia
It is a loss in the uniformity of individual cells and in their architectural orientation

Features of dysplastic cells:


• Considerable pleomorphism (variation in size and shape)
• Hyperchromatic nuclei, abnormally large for the size of the cell
• Mitotic figures are more abundant than usual and appear in abnormal locations
(In dysplastic stratified squamous epithelium, mitoses are not confined to the basal layers)
• Considerable architectural anarchy
The term dysplasia without qualifications does not indicate cancer, and dysplasia does
not necessarily progress to cancer.

Mild-to-moderate changes that do not involve the entire thickness of epithelium may be
reversible, and with removal of the putative inciting causes, the epithelium may
revert to normal.
4
Overview
 From Dysplasia to Cancer

5
Overview
 Carcinoma in situ

A, Low-power view shows the entire thickness of B, High-power view of another region shows failure of
the epithelium is replaced by atypical dysplastic normal differentiation, marked nuclear and cellular
cells. There is no orderly differentiation of pleomorphism, and numerous mitotic figures extending
squamous cells. The basement membrane is intact, toward the surface
and there is no tumor in the subepithelial stroma.

When dysplastic changes are marked and involve the entire thickness of the epithelium,
the lesion is referred to as carcinoma in situ, a pre-invasive stage of cancer 9
Overview
 Benign vs. Malignant

Benign Malignant
• Will remain localized • Can invade
• Cannot spread to other sites • Can destroy adjacent structures
• Amenable to local surgical removal • Can spread to distant sites (metastasize)
• The patient generally survives • Can cause death

Microscopic and gross characteristics Cancers


are relatively innocent derived from the Latin word for “crab”

7
Overview
 Tumor Components

Transformed or neoplastic cells, from


Parenchyma which tumor derives its name and
determines its biologic behavior

Tumor
- Host-derived, non-neoplastic
- Connective tissue, blood vessels and host
Stroma inflammatory cells
- Crucial to the growth of the neoplasm

8
Nomenclature
Fibrous tissue Fibroma
Cartilage Chondroma
Benign tumors Tissue of origin-oma Bone Osteoma
Glands Adenoma
Epithelium Papilloma

Liver Hepatocellular carcinoma


Tissue of origin-carcinoma Renal epithelium Renal cell carcinoma
(epithelial cells) Glands Adenocarcinoma
Glandular epithelium Adenocarcinoma
Appearance
Squamous epithelium Squamous cell carcinoma
Malignant tumors
Fibrous tissue Fibrosarcoma
Cartilage Chondrosarcoma
Tissue of origin-sarcoma Bone Osteosarcoma
(mesenchymal cells) Fat tissue Liposarcoma
Blood vessels Angiosarcoma 13
Nomenclature

14
Characteristics of Benign & Malignant
Neoplasms

There are four fundamental features by which benign and malignant tumors can
be distinguished: differentiation and anaplasia, rate of growth, local invasion,
and metastasis. 15
Characteristics of Benign & Malignant
Neoplasms
1. Differentiation & Anaplasia
The differentiation of parenchymal tumor cells refers to the extent to which they
resemble their normal forebears morphologically and functionally.

Benign neoplasms are composed of well-differentiated cells that closely resemble their
normal counterparts.
Lipoma: mature fat cells laden with cytoplasmic lipid vacuoles
Chondroma: mature cartilage cells that synthesize their usual cartilaginous matrix
Mitoses are usually rare and are of normal configuration.

Malignant neoplasms are characterized by a wide range of parenchymal cell


differentiation: well differentiated- moderately well differentiated- undifferentiated.
Undifferentiated cells are called anaplastic cells and are considered a hallmark of
malignancy!
12
Characteristics of Benign & Malignant
Neoplasms
 Anaplasia literally means “backward formation”
Dedifferentiation or failure of differentiation??

Recent studies indicate that dedifferentiation of apparently mature cells does


occur during carcinogenesis

Dedifferentiation

However

It is now known that at least some cancers arise from stem cells in tissues

Failure of differentiation 13
Characteristics of Benign & Malignant
Neoplasms
 Features of Anaplasia

• Marked pleomorphism (variation in size and shape)


• Nuclei are extremely hyperchromatic (dark-staining) and large resulting in
an increased nuclear-to-cytoplasmic ratio that may approach 1 : 1 instead
of the normal 1 : 4 or 1 : 6.
• Giant cells that are considerably larger than their neighbors may be
formed and possess either one enormous nucleus or several nuclei.
• Anaplastic nuclei are variable and bizarre in size and shape. The
chromatin is coarse and clumped, and nucleoli may be of astounding size.
• Mitoses often are numerous and distinctly atypical
• Anaplastic cells usually lose normal polarity: fail to develop recognizable
patterns of orientation to one another.

14
Characteristics of Benign & Malignant
Neoplasms

A. Nests of anaplastic tumor cells are seen with round to oval eccentric nuclei, coarse chromatin, prominent
nucleoli and moderate homogeneous cytoplasm (×1000). B. Single giant malignant cells with similar morphology
are also seen (×1000).

Bilic et al. CytoJournal 2005 2:16 doi:10.1186/1742-6413-2-16

15
Characteristics of Benign & Malignant
Neoplasms
 Features of Anaplasia

High-power detail view of anaplastic tumor cells shows cellular and nuclear variation in size and
shape. The prominent cell in the center field has an abnormal tripolar spindle (atypical mitosis)

16
Characteristics of Benign & Malignant
Neoplasms
2. Rate of Growth
Most benign tumors grow slowly, with some exceptions:
- Leiomyomas of the uterus are influenced by circulating estrogen level: increase in size
during pregnancy and cease growing after menopause.

Most cancers grow much faster, eventually spreading locally and to distant sites
(metastasizing) and causing death, with some exceptions:
- Some grow slowly for years and then enter a phase of rapid growth.
-Others grow relatively slowly and steadily; in exceptional instances, growth may come
almost to a standstill.

17
Characteristics of Benign & Malignant
Neoplasms
3. Local Invasion
A benign neoplasm remains localized at its site of origin. It does not have the capacity to
infiltrate, invade, or metastasize to distant sites.
- Most benign neoplasms are encapsulated (separated from the host tissue by a fibrous
capsule). The capsule probably derives from the stroma of the host tissue and the stroma of
the tumor itself.
- Not all benign neoplasms are encapsulated: leiomyoma of the uterus is discretely
demarcated from the surrounding smooth muscle by a zone of compressed normal
myometrium.

Cancers grow by progressive infiltration, invasion, destruction, and penetration of the


surrounding tissue
- They do not develop well-defined capsules
-Occasionally, a slowly growing malignant tumor appears to be encased by the stroma of the
surrounding host tissue. But microscopic examination usually reveals tiny crablike feet
penetrating the margin and infiltrating adjacent structures.
-It is necessary to remove a wide margin of surrounding normal tissue when surgical excision
of a malignant tumor is attempted (clean margins). 22
Characteristics of Benign & Malignant
Neoplasms
 Local Invasion

Fibroadenoma of the breast. The tan-colored, encapsulated Cut section of invasive ductal carcinoma of the breast.
small tumor is sharply demarcated from the whiter breast The lesion is retracted, infiltrating the surrounding
tissue. breast substance, and was stony-hard on palpation

Next to the development of metastases, local invasiveness is the most reliable


feature that distinguishes malignant from benign tumors.
19
Characteristics of Benign & Malignant
Neoplasms
4. Metastasis
 Metastasis are secondary implants of a tumor that are discontinuous
with the primary tumor and located in remote tissues

More than any other attribute, the property of metastasis identifies a neoplasm as
malignant

Not all cancers have equivalent ability to metastasize

Basal cell carcinomas of the skin and most primary tumors of the CNS are
highly invasive locally but rarely metastasize

Osteogenic sarcomas, usually have metastasized to the lungs at the


time of initial discovery

20
Characteristics of Benign & Malignant
Neoplasms

A liver studded with metastatic cancer

 Approximately 30% of patients with newly diagnosed solid tumors present with
clinically evident metastases
 An additional 20% have occult (hidden) metastases at the time of diagnosis
21
Characteristics of Benign & Malignant
Neoplasms
 Metastasis occur by one of three pathways:

Seeding within body cavities


cancers of the ovary often cover the peritoneal surfaces widely

Lymphatic spread
more typical of carcinomas

Hematogenous spread
favored by sarcomas, most frequently liver and lungs (venous return)

In general, the more anaplastic and the larger the primary neoplasm, the more likely is
metastatic spread, but as with most rules, there are exceptions.

22
Summary of Characteristics of
Benign & Malignant Neoplasms
• Benign and malignant tumors can be distinguished from one another based on the
degree of differentiation, rate of growth, local invasiveness, and distant spread.

• Benign tumors resemble the tissue of origin and are well differentiated; malignant
tumors are poorly or completely undifferentiated (anaplastic).

• Benign tumors are slow-growing, whereas malignant tumors generally grow faster.

• Benign tumors are well circumscribed and have a capsule; malignant tumors are
poorly circumscribed and invade the surrounding normal tissues.

• Benign tumors remain localized to the site of origin, whereas malignant tumors
are locally invasive and metastasize to distant sites.

23
Summary of Characteristics of
Benign & Malignant Neoplasms

24
Epidemiology
 Incidence
 Overall, it is estimated that about 1.5 million new cancer cases occurred in 2011, and
569,000 people died of cancer in the United States that year.

 The overall death rate among women has fallen slightly, mostly as a result of the
decline in death rates for cancers of the uterine cervix, stomach, and large bowel.

 The declining death rate from cervical cancer is directly related to widespread use of
cytologic smear studies for early detection of this tumor and its precursor lesions.

 There is a striking climb in the rate of lung cancer in women, which not long ago
was a relatively uncommon form of neoplasia in this sex.

25
Epidemiology
 Incidence

Cancer incidence and mortality by site and sex


(Adapted from Jemal A, Siegel R, Xu J, Ward E: Cancer statistics, 2010. CA Cancer J Clin 60:277–300, 2010.)

26
Epidemiology
 Geographic Variables
Environmental factors are the predominant cause of the most common sporadic
cancers.

 Death rates from breast cancer are about four to five times higher in the United
States and Europe than in Japan.

 Liver cell carcinoma is relatively infrequent in the United States but is the most
lethal cancer among many African populations.

 Death rate for stomach carcinoma in men and women is about seven times
higher in Japan than in the United States.

27
Epidemiology
 Environmental Variables
There is no paucity of environmental carcinogens

 Can be as universal as sunlight (melanoma)

 Can be found particularly in urban settings (e.g., asbestos in building and


construction industries )

 Certain features of diet have been implicated as possible predisposing influences

 Cigarette smoking (lung cancer)

 Chronic alcohol consumption

 The risk of cervical cancer is linked to age at first intercourse and the number of
sex partners (pointing to a causal role for transmission of the oncogenic virus
HPV).

28
Epidemiology
 Age
In general, the frequency of cancer increases with age.
Most cancer deaths occur between ages 55 and 75.
The rate declines, along with the population base, after age 75.

By age, there is:


accumulation of somatic mutations & decline in immune competence

Cancer causes slightly more than 10% of all deaths among children younger
than 15 years.

The major lethal cancers in children are:


Leukemias, tumors of CNS, lymphomas, and soft tissue and bone sarcomas

Study of several childhood tumors, such as retinoblastoma, has provided


fundamental insights into the pathogenesis of malignant transformation.

29
Epidemiology
 Hereditary

The evidence now indicates that for many


types of cancer, including the most common
forms, there exist not only environmental
influences but also hereditary predispositions

30