What is a Neoplasm Tumor?
New and abnormal development of cells that are unresponsive to normal growth control mechanisms.
Not all neoplasms (tumors) are cancer.
Benign Neoplasms
Commonly called a tumor, remain localized and are slow growing, seldom kill their hosts if they are removed before they compress vital organs
Malignant Neoplasms
Composed of cells that are invasive and spread to remote regions of the body (metastasis); show altered function, altered appearance, and uncontrolled growth, they invade surrounding tissue first.
Characteristics of a Benign Neoplasm
Slow Growth
Encapsulated
Non-Invasive
Well Differentiated (conforming)
Low mitotic rate
Do NOT Metastasize
Characteristics of a Malignant Neoplasm
Rapid Growth
Non-encapsulated
Invade local structures and tissues
Poorly Differentiated
High mitotic rate
Metastasize
Tumor Terminology
Tumors are named according to their tissues of origin with the suffix "-oma"
Benign Tumors have simpler names
EG Lipoma, Myoma, Adenoma,
Chondroma
Names of tumors which have these modifiers
blast
multiple
malignant
carci-
sarc-
are almost always malignant
Lipoma
A lipoma is a benign tumor composed of adipose tissue. It is the most common form of soft tissue tumor.[1] Lipomas are soft to the touch, usually movable, and are generally painless.
Myoma
A benign tumor of smooth muscle in the wall of the uterus. A myoma of the uterus is commonly called a fibroid.
Adenoma
A benign tumor that arises in or resembles glandular tissue. If it becomes cancerous, it is called an adenocarcinoma.
Chondroma
Tumor (benign) of cartilage.
Carcinomas
Malignant tumors that arise from EPITHELIAL tissue
EG Adenocarcinoma, Squamous cell carcinoma
Adenocarcinoma
Malignant Neoplasm that originates in glandular tissue
EG distal esophagus ? colon, kidney, liver, pancreas, prostate, breast, lung, endometrium
Squamous Cell Carcinoma
Malignant Neoplasm that may occur in many different organs, including the skin, mouth, esophagus, prostate, lungs, and cervix. It is a malignant tumor of epithelium that shows squamous cell differentiation.
Sarcoma
A malignant neoplasm that arises from connective tissues, including hard tissues, soft tissues, and liquid tissues
AKA Connective Tissue Sarcoma
Chondrosarcoma
Malignant, cancerous neoplasm of cartilage
Osteosarcoma
A malignant neoplasm usually involving the upper shaft of long bones, the pelvis, or knee
Lymphosarcoma
MALIGNANT NEOPLASM OF LYMPHOID TISSUE
Retinoblastoma
Malignant tumor of the retina of the eye; childhood malignancy.
Neuroblastoma
A highly malignant tumor of the sympathetic nervous system.
Benign Tumors
Fibroma (fibrous)
Chondroma (cartilage)
Osteoma (bone)
Lipoma (fatty)
Hemangioma (vessel)
Pailloma (squamous)
Meningioma (meninges)
Malignant Tumors
Fibrosarcoma (fibrous)
Chondrosarcoma (cartilage)
Osteosarcoma (bone)
Liposarcoma (fatty)
Hemangiosarcoma (vessel)
Squamous carcinoma (squamous cells)
Glioblastoma (forms from glial cells in the brain ie brain tumor)
Retinoblastoma (retinal eye tumor in k
What is Carcinoma in situ?
Describes carcinomas confined to the epithelium that haven't yet penetrated the basement membrane. Can remain "in situ" indefinitely.
Pre-invasive epithelial malignant tumors
Localized neoplasm
Transformation
The conversion of a normal animal cell to a cancerous cell.
Not a single event
Anaplasia
A change in the structure and orientation of cells, characterized by a loss of differentiation and reversion to a more primitive form.
Anchorage-Independence
State when cells no longer require attachment to a surface for proliferation and survival.
Cancer Autonomy
The condition of being self-governing; independence from normal cellular controls.
Tumor Markers
Biologic markers produced by cancer cells found on tumor plasma membranes or in blood, spinal fluid, or urine
Often lack specificity, sensitivity, predicatbility and feasibility so there are few ideal tumor markers.
What are tumor markers used for?
Screening, diagnosis, establishing prognosis, monitoring treatment and detecting recurrent disease
Tumor Marker Examples
Hormones - Ectopic hormone production is the production of hormones by Tumors on NON-ENDOCRINE ORIGIN.
EG ACTH, HCG, HGH, ADH,
Enzymes - Cancers do not produce new or unique enzymes instead there are abnormal levels of normal enzymes.
Usually only detecte
Protein Tumor-Specific Antigens
Function in proliferation, enzymatic processes, as receptors, and cellular structures. PSA, a glycoprotien produced by the prostate in relation to prostate mass. TCM is used as a screening test for prostate cancer.
Viral Tumor-Specific Antigens
Produced and expressed by virally-transformed cells.
Oncofetal Tumor-Specific Antigens
Expressed by cells during embryonic development but are low or absent or low in normal adult cells.
Alpha-fetoprotein in hepatic, pancreatic and epithelial cancers.
Carcinoembryonic antigen (CEA) in colonic pancreatic and breast tumors.
Cytogenetics
The branch of biology that studies the cellular aspects of heredity (especially the chromosomes)
Oncogenes
Genes that cause cancer by blocking the normal controls on cell reproduction.
A proto-oncogene that has been altered (mutated) by a carcinogenic agent
Philidelphia Chromosome
Abnormal chromosome produced by a translocation bt 9 & 22
linked to CML (chronic myelogenous leukemia)
Chromosomal breaks can convert proto-oncogenes to oncogenes
Contributors to Cancer Growth
Autocrine stimulation
-Cancers acquire the ability to secrete and respond to their own growth factors
-Increased expression of growth-factor receptors
Gene amplification allows cancer cells to create numerous copies of genes and expression of gene product
Immortality
Normally the only cells in the body that are immortal are stem cells.
Ohter cells can only divide a given number of times.
Telomeres are protective end-caps of chromosomes, maintained by telomerase
As the telomeres are lost, a cell loses its ability to di
What is Angiogenesis?
- Physiological process involving the growth of new blood vessels from pre-existing vessels
- A normal and vital process in growth and development, as well as in wound healing and ingranulation tissue.
- Fundamental step in the transition of tumors from a
p53 Gene
The guardian of the genome. Dysfunctional in approximately 50% of human cancers. Role is to maintain the integrity of the cell genome. Upon DNA damage is arrests cell cycle, initiates repair effort, and may induce apoptosis.
In many cancers, the p53 gene
Proto-oncogenes
Unaltered, normal healthy alleles of genes that control/regulate cellular growth and differentiation.
Tumor-suppressor Genes
A gene whose protein products inhibit cell division, thereby preventing uncontrolled cell growth (cancer)
Cancer can occur due to the activation of oncogenes or the inactivation of tumor-suppressor genes.
Point Mutations
Mutations that occur at a single point in the DNA sequence.
A small base-pair change can result in a normal proto-oncogene becoming an unregulated oncogene.
Translocation
A piece of one chromosome breaks off and reattaches to a nonhomologous chromosome
Burkitt Lymphoma
75% patients have translocated c-myc proto-oncogene from chromosome 8 to 14. --> leads to emergence of dominant clone of B cells.
Chronic Myelocytic Leukemia
CML
Translocation of chromosomes 9 and 22
A disease in which a cell in the bone marrow becomes cancerous and produces a large number of abnormal granulocytes.
Gene Amplification
Duplication of a proto-oncogene into multiple copies, causing excessive amounts of its encoded protein and stimulating cell proliferation.
Loss of Heterozygosity
Patient inherits or develops a mutation in a tumor suppressor gene, complementary allele must be deleted/mutated before cancer develops.
Chronic Inflammation
Inflammation of prolonged duration or slow progress marked histologically by an infiltration of mononuclear cells (lymphocytes, macrophages, plasma cells) often with proliferation of fibroblasts and fibrosis
Associated risk factor for many types of cancer
Oncogenic Viruses
Viruses that change the genetic make-up of cells which result in the alteration of the daughter cells.
Epstein Barr Virus (EBV)
A member of the herpes virus family that causes infectious mononucleosis, Burkitt lymphoma, and other lymphoproliferative diseases, especially in transplanted patients (B lymphocytes)
Hodgkin Lymphoma
Human Papilloma Virus
Most important cause of invasive cervical cancer,
A group of viruses that can cause genital warts in males and females and can cause cervical cancer in females
Kaposi Sarcoma
Form of skin cancer frequently seen in acquired immunodeficiency syndrome (AIDS) HIV patients. Consists of brownish-purple papules that spread from the skin and metastasize to internal organs.
Associated with immunosuppression and human herpesvirus 8
Hepatitis B Virus
A DNA virus associated with hepatocellular carcinoma.
Viral DNA integrates into cell and then expands clonally in the tumor. Chronic liver energy and regeneration encourages mutation. Protein may bind to and inactivate p53- the guardian of the genome. May
Helicobacter pylori
Oncogenic Bacterium, Bacteria that causes cancer; attacks the stomach and releases free radicals
Think chronic inflammation
Chronic infections are associated with:
~Peptic ulcer disease
~Gastric carcinoma
~Gastric lymphomas
~Mucosa-associated lyphoid tiss
Metastasis
Literally meaning, beyond control, this is the transfer of disease from one organ or tissue to another that is not directly connected to it.
Invasion
~(pathology) the spread of pathogenic microorganisms or malignant cells to new sites in the body.
~Cellular proliferation
~Barrier destruction by lytic (lysis) enzymes
~Secretion of proteases and protease activators
~Down-regulation of cell-adhesion molec
Intravasation
A part of the process of metastasis, intravasation refers to the invasion of a cancer through the basal membrane and into blood vessels or into lymph.
Lymphatic Spread
Route of metastatic spread. The most common pathway for initial dissemination of carcinomas. (e.g. breast carcinoma through vessels of the deep pectoral fascia to the axillary and supraclavicular nodes). Tumor cells enter these vessels and are carried to
Blood Dissemination
~Intravasation
~Tumor cells can form a leukocyte-fibrin-platelet complex to protect themselves from host defenses and help themselves survive mechanical trauma in the bloodstream.
~The cells eventually lodge in the vascular supply of a target organ and in
Adherence in Favorable Sites
Certain cancerous cells have preferences for specific organs
Organ Tropism
preferential growth of cancerous cells in certain organs. Common sites for distant metastasis: lungs, liver, bones, and brain
Factors encouraging colonization
~Growth factors from target organs
~Hormones
~Presence of tumor receptors on the tissue
~Route
Extravasation
Escape of blood from the blood vessel into the tissue.
Colonization
Establishment in new tissue
Sequence (MUST KNOW)
The sequence of the proliferation of cancer:
-Local transformation and extension
-Motility
-Angiogenesis (blood vessel growth)
-Invasion
-Intravasation (blood/lymph penetration)
-Adherence at a favorable site
-Extravasation
-Colonization
Creation of Neoplasm (know in order)
-Movement through the body
-Growth of blood vessels
-Secreation of Proteases
-Blood Dissemination
-Organ Tropism
-2nd Organ Invasion (Metastisis)
-Colonization in new tissue
Stage 1 Cancer
Cancer confined to organ of origin
Well-differentiated cells (ie they look like their neighbors)
Stage 2 Cancer
Usually means the cancer has not started to spread into surrounding tissue, but the tumor is larger than in stage 1 . sometimes stage 2 means that cancer cells have spread into lymph nodes close to the tumor
Moderately differentiated cells
Stage 3 Cancer
Cells in original site and distant lymphatics
Poorly differentiated cells
Stage 4 Cancer
The cancer has spread from where it started to another body organ. Also called secondary or metastatic cancer
Very poorly differentiated cells
Chemotherapy
Intended to destroy cells that are in a stage of vulnerability.
Mitotically active cells (rapidly dividing) are very vulnerable.
Chemotherapy must eliminate enough cells to allow the immune system to destroy the others.
Usually a cocktail of drugs.
Radiation
(medicine) the treatment of disease (especially cancer) by exposure to radiation from a radioactive substance
Damages the DNA of rapidly dividing neoplastic cells
General and targeted radiation therapy.
Excisional
Removal of an entire tumor for biopsy
Cancer has not gone past stage 3
Debulking
Surgery to cut as much of a tumor as possible. A smaller tumor helps chemotherapy be more effective
Surgery decreases the total number of cancer cells giving the immune system a fighting chance.
Palliative Surgery
Performed to relieve some some of the complications of malignancies that cannot be totally excised. not to cure but to promote comfort.
Systemic Effects of Neoplasms
Vessel invasion - bleeding,
Lymphatic invasion - lymphedema,
Nerve invasion - pain, numbness, tingling, Bone Cortex invasion - pain and fractures, Bone Marrow invasion - pancytopenia (not making blood cells), infection, bleeding,
Liver invasion - hepatic
Pain
Pain is what the patient says it is"
-Little or no pain with early malignancy
-Influenced greatly by fear, anxiety, sleep loss, psychological response.
-Pressure on sensitive structures, obstruction, severe stretching of tissues - all cause pain.
-Pt tha
Fatigue
Due to
-sleep disturbances
-biochemical changes to treatment
-diminished activity level
-nutritional status
Muscle tone loss can be due to lack of activity and/or circulating necrosis factors
Anemia
Reduction in red blood cell numbers
Causes:
-chronic bleeding
-malnutrition
-therapies
-malignancy in blood-forming organs
-Malignancy of the bone marrow can also cause leukopenia and thromboycytopenia.
Infection
-Most common event leading to the demise of patients with malignancy
-Reduction in immunologic functins due to treament regimes.
-Poor wound care
-Compromised patient care.
Cachexia Syndrome
AKA Wasting away
-state of ill health, wasting, emaciation and decreased quality of life.
Symptoms.
-reduced sweet, sour, salty sensations
-depression of appetite (early filling response)
-weight loss and asthenia (marked weakness)
-Altered metabolism (in
Paraneoplastic Syndromes
-Signs and symptoms unrelated to the local effects/presence of the neoplasm
-Caused by substances released from the tumor or an immune response to the tumor.
EG Hypercalcemia in breast and renal carcinomas from PTH-related protein.
Polycythemia in cerebel