PM NEOPLASIA
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Transcript PM NEOPLASIA
NEOPLASIA
DR.ROOPA
Pathophysiology
Premed 2
Neoplasia
Neoplasm is an abnormal mass of tissue
as a result of neoplasia.
Uncontrollable or abnormal proliferation of
cells.
Types
A neoplasm can be benign, potentially
malignant (pre-cancer), or malignant
(cancer).
Benign neoplasms include uterine fibroids
and melanocytic nevi (skin moles). They
do not transform into cancer.
Potentially malignant neoplasms include
carcinoma in situ. They do not invade and
destroy but, given enough time, will
transform into a cancer.
Malignant neoplasms are commonly called
cancer. They invade and destroy the
surrounding tissue, may form metastases
and eventually kill the host.
Metastasis sometimes abbreviated mets,
is the spread of a disease from one organ
or part to another non-adjacent organ or
part.
cancer cells can break away, leak, or spill
from a primary tumor, enter lymphatic and
blood vessels, circulate through the
bloodstream, and be deposited within
normal tissue elsewhere in the body.
Malignant
(+) invasion: spread
to nearby structures
(+)metastasis: spread
to distant structures
(+)anaplasia :
cells are very different
from the normal cells
(poorly differentiated)
vs
Benign
(-) invasion
(+) capsule
(-)metastasis
Resemble the tissue
of origin (well
differentiated)
Anaplasia
Pleomorphism
Hyperchromatism (dark nuclei)
Increased nuclear-cytoplasm ratio
Abnormal mitosis
Prominent nucleoli
The more anaplastic, the more aggressive the
cancer
The more anaplastic, the more responsive to
chemo and radiotherapy
Forms of Malignant tumors
Carcinoma: malignant tumor of epithelial origin
1. squamous cell carcinoma
cancer of the skin
cancer of the esophagus
2. adenocarcinoma: glands
cancer of the breast
cancer of the pancreas
3. transitional cell carcinoma
cancer of the bladder
Forms of Malignant tumors
Sarcoma: of mesenchymal origin
osteosarcoma
rhabdosarcoma
leiomyosarcoma
liposarcoma
Teratoma: from all 3 germ layers
skin, bone, cartilage, teeth, intestinal
ovaries and testis: most common
may also be benign
Osteosarcoma
Liposarcoma
Teratoma
Forms of Benign tumors
Papilloma: Adenoma: glandular epithelium
-ovary, breast
Mesenchymal origin
-leiomyoma, lipoma, fibroma, chondroma
Papilloma
epithelium of skin, larynx and tongue; fingerlike
projections
Properties of Neoplasms
Monoclonality
the neoplasm comes from a single
precursor cell
Invasion
enters the blood vessels and
lymphatics
Metastases
blood vessels: sarcomas
lymphatic: carcinoma
Properties of Neoplasms
Common sites of metastases
liver, lung, brain,
adrenal glands, lymph nodes
bone marrow.
Clinical signs of malignancy
Cachexia
wasting, weakness, weight loss, anemia, infection
cause: CACHECTIN
Endocrine abnormalities
prolactinoma
ovarian tumors
Paraneoplastic syndromes
ectopic production of hormones
lung cancer : ACTH
Carcinogenesis and carcinogens
Chemical agents
Physical agents
Viruses
Activation of cancer-promoting genes
Inhibition of cancer-suppressing genes
Carcinogenesis and carcinogens
Cigarette smoking : lung CA, laryngeal CA
Excessive sun: Skin CA
Asbestos: Mesothelioma
Nitrosamines: Gastric CA
Alcohol: Esophageal CA
Low-fiber diet: Colon CA
Carcinogenesis and carcinogens
High-fat diet: Breast CA
Aniline dyes: bladder Ca
Aflatoxin: liver CA
PVC: Angiosarcoma of the liver
DES: Clear cell adenocarcinoma of the
vagina
Nickle, chromium, uranium: lung CA
Carcinogenesis and carcinogens
HTLV – 1: Adult T cell leukemia
HPV: cervical CA
EBV: Nasopharyngeal CA, Burkitts
lymphoma
HBV: Hepatocellular CA
HHV-8: Kaposi sarcoma
Helicobacter pylori: Gastric CA
An oncogene is a gene that, when
mutated or expressed at high levels, helps
turn a normal cell into a tumor cell.
Oncogenes
bcl-2: inhibits apoptosis
Follicular lymphoma
c-myc : Burkitts lymphoma
Cancer suppresor genes
(anti oncogene)
A tumor suppressor gene, or anti-oncogene, is a gene
that protects a cell from one step on the path to cancer.
When this gene is mutated to cause a loss or reduction
in its function, the cell can progress to cancer, usually in
combination with other genetic changes.
p53: “ guardian of the genome”
mutated in 50% of all malignant tumors
causes cell cycle arrest in G1, time for DNA repair
unsuccessful repair: apoptosis
LI-FRAUMENI SYNDROME
familial cancers of the breast, soft
tissue sarcomas, brain tumors,
leukemias.
Cancer suppresor genes
(anti oncogene)
WT-1 and WT-2: Wilms tumor
BRCA -1: breast and ovarian CA
BRCA – 2: breast CA
The stage of a cancer is a descriptor
(usually numbers I to IV) of how much the
cancer has spread.
Grading: degree of differentiation of the
cells
Staging: spread of the tumor
-uses the TNM system
TNM staging system
Cancer staging can be divided into a
clinical stage and a pathologic stage. In
the TNM (Tumor, Node, Metastasis)
system, clinical stage and pathologic stage
are denoted by a small "c" or "p" before
the stage.
CANCER TREATMENT
CHEMOTHERAPY
CYTOTOXIC DRUGS+BODY DEFENSES
SINGLE AGENT
COMBINATION CHEMOTHERAPY
_AVOIDS SINGLE AGENT RESISTANCE
CAN USE LOWER DOSE
BETTER REMISSION AND CURE RATE
RADIATION
TARGETS DNA
KILL TUMOR WITHOUT DAMAGE TO SURROUNDING
TISSUES
TUMOR MUST BE ACCESSIBLE
SURGERY
METHOD OF CHOICE,CAN REMOVE ENTIRE
TUMOR,DEBULKING
ADJUVANT CHEMOTHERAPY OR RADIATION
IMMUNOTHERAPY
.ELIMINATES CANCER CELLS ONLY
.PROVIDES PROTECTION AGAINST RECURRENCE
.T_CELL BASED OR ANTIBODY RESPONSES
.CONJUGATED ANTIBODIES
.NONSPECIFIC ENHANCEMENT OF THE IMMUNE
SYSTEM