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NEOPLASIA

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Skin cancer is the most common human cancer and one of the most preventable. What Is NEOPLASIA ' ... skin. Acute Myeloid Leukemia. Pedunculated colon cancer ... – PowerPoint PPT presentation

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Title: NEOPLASIA


1
NEOPLASIA
  • Asima Arslan, M.D.
  • Department Of Pathology Laboratory Medicine
  • RWJMS-UMDNJ
  • January
  • 2006

2
Facts
  • ONE OUT OF FIVE (OR FOUR) PERSONS IN THE US WILL
    DIE OF CANCER ( 500,000 A YEAR)
  • 1.5 million NEW cases a year (not including a
    million cases of skin cancers a year and
    pre-cancerous conditions)
  • THE SECOND TO IHD ATHEROSCLEROSIS AS A CAUSE OF
    DEATH IN THE US
  • 1 in 2 lifetime risk for men, 1 in 3 lifetime
    risk for women
  • SOME OF TUMORS ARE PREVENTABLE, SOME ARE EVEN
    CURABLE.
  • Skin cancer is the most common human cancer and
    one of the most preventable

3
What Is NEOPLASIA
  • "A neoplasm is an abnormal mass of tissue, the
    growth of which exceeds and is uncoordinated with
    that of the normal tissues and persists in the
    same excessive manner after cessation of the
    stimuli which evoked the change"

4
Benign vs Malignant
  • Slow growing
  • Encapsulated
  • Expansile growth
  • No Metastasis
  • Well Differentiated
  • Rapidly growing
  • Non encapsulated
  • Infilterative growth
  • Metastasis
  • Well-Poorly differentiated

5
GRADEand STAGE
6
  • WHY WE CAN NOT USE THE ETIOLOGY TO CLASSIFY
    TUMORS?

7
Classification and Nomenclature
  • Benign add suffix oma to tissue of origin
  • Malignant
  • Carcinoma
  • Sarcoma
  • Leukemia

8
Variations in terminology
  • Lymphomas
  • Skin tumors
  • Melanocytes
  • Keratinocytes

9
Nomenclature
  • ADENO CA
  • SQUAMOUS CA
  • ADENOMA
  • LYMPHOMA
  • LEUKEMIA
  • MULTIPLE MYELOMA
  • SARCOMA

10
  • Adenomatous polyp,
  • Colon

11
Tubular adenoma, colon
12
Squamous cell carcinoma, skin
13
SCC
14
  • Melanoma, skin

15
SCC, invasive, cevix
16
Osteosarcoma, femur
17
SCC, skin
18
Acute Myeloid Leukemia
19
Pedunculated colon cancer
20
Teratoma (Dermoid cyst), Ovary
21
Teratoma, ovary
22
Teratoma, ovary
23
Multiple Myeloma
24
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25
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26
Causes of Cancer
  • Environmental vs. Hereditary Cancers
  • About 85 of cancers are estimated to be
    environmentally induced
  • Exposure to environmental carcinogens (chemical,
    radiation, viral)
  • Remainder of cancers inherited predisposition
  • Mutation??

27
HEREDITARY FACTORS AND TUMORS
  • Play a small role in some tumors by genetic
    differences in
  • Hormones
  • Metabolizing capacity
  • DNA repair mechanisms
  • Immune Systems

28
Geographical and Ethnic Differences in Cancer
Incidence
29
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30
Pre Cancerous Conditions
  • Is Different from the In Situ concept
  • Actinic Keratosis
  • Lentigo Maligna
  • Leukoplakia
  • Villous adenoma of the GI

31
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32
Why Tumors Are Different From Organs And Normal
Tissue?
  • FUNCTION
  • RATE OF GROWTH
  • PARANEOPLASTIC SYNDROME

33
What Are The Final Complications Of Malignancy
(Causes Of Death)
  • PNEUMONIA
  • PNEUMONIA
  • PNEUMONIA
  • CACHEXIA
  • RENAL FAILURE
  • BLEEDING
  • SEVERE ANEMIA, THROBOCYTOPEINA
  • INFECTIONS
  • HYPERCOAGULABILITY
  • DIC
  • PAIN MORE OF DEVASTATING SYMPTOM THAN A
    COMPLICATIONHAS TO BE CONTROLED

34
Paraneoplastic Syndromes
  • Remote effects not due to local effects of
    primary tumor or its metastases
  • Fever
  • Anorexia/weight loss
  • Hypercalcemia
  • Neurologic
  • Hypercoagulable State

35
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36
Some Explanation Of Why???
  • ONCOGENE ACTIVATION
  • Point mutations, translocations, gene
    amplification
  • TUMOR SUPRESSOR GENE
  • DNA REPAIR GENES
  • GENES REGULATING APOPTOSIS
  • FAILURE OF IMMUNOLOGICAL DEFENCE MECHANISMS

37
Retinoblastoma
38
Retinblastoma
39
Tumor ANGIOGENESIS
  • VEGF, BFGF, TNF

40
Tumor Dormancy
  • Tumors can recur years after treatment
  • Breast cancer is especially noted for long
    periods of dormancy

41
Carcinogen
  • Chemical carcinogens
  • Physical carcinogens (UV, radiation, asbestos)
  • Hormones
  • Oncogenic microbes (mainly viruses)
  • Sometime our weapon to kill the beast is a double
    edge sword

42
Viral Carcinogenesis
  • Viral infections account for an estimated one in
    seven human cancers worldwide
  • Majority of these are due to infection with two
    DNA viruses
  • HBV linked to hepatocellular carcinonoma
  • HPV linked to cervical carcinoma
  • HTLV-1
  • Kaposi Sarcoma.. HHV-8

43
What Is the Evidence for the Genetic Basis of
Cancer?
  • Some individuals show hereditary predisposition
  • Individuals with impaired DNA repair systems show
    increased cancer incidence
  • Cancer cells contain chromosome
    abnormalities..e.g. translocations in leukemia
    and lymphomas
  • Almost all mutagens are carcinogens
  • Existence of oncogenes

44
Multi-stage Nature of carcinogenesis
  • Initiation
  • Promotion
  • Progression

45
The Good, The Bad The.
  • DIFFERENTIATION
  • SHAPE
  • CAPSULE
  • RATE OF GROWTH
  • MITOSIS
  • N/C RATIO
  • CHROMASIA
  • NUCLEOLUS
  • PLEOMORPHISM
  • INVASION
  • METS

46
B Dysplasia pleiomorphic, large N/C ratio,
hyperchromatic nuclei
A normal pap smear. Cells large, well
differentiated, small N/C ratio
C Invasive squamous cell carcinoma
undifferentiated cells, multinucleated,
hyperchromatic nuclei, dense nucleoli. Large N/C
47
Signs of malignant process..
48
Well differentiated adenocarcinoma of the
endometrium, uterus
49
  • Leiomyosarcoma, uterus

50
Lipoma
51
Abnormal mitotic figures
52
Tripolar mitotic figure (abnormal)
53
Signs of malignant process
54
Benign Tumors
  • SECRETIONS
  • COMPRESSION
  • TRANSFORMATION
  • LOCALLY INVASIVE!!!

55
Meningioma
56
The Most Common
  • CANCER IN MALE?
  • CANCER IN FEMALE?
  • KILLER IN MALE?
  • KILLER IN FEMALE?
  • 50 YS AGO WAS

57
Prostatic adenocarcinoma




58
Prostatic adenocarcinoma
59
Invasive carcinoma of the breast

60
Well differentiated ductal carcinoma, breast
Moderate to poorly differentiated ductal
carcinoma, breast

61
Bronchogenic carcinoma, lung
62
SCC, cervix
63
Normal Squamous cells Malignant squamous
cellsnecrosis
64
George Nicolas Papanicolaou 1883-1962
65
Local Routes, Interstates, Turnpike..Routes Of
Spread
  • WHAT EVER THE WAY, SOME LIKE TO GO TO FLORIDA,
    OTHERS WILL PREFER ALASKA BUT SOME WILL GO
    WHEREVER THEY LIKE. WHY?
  • STILLLLLLLL .?
  • BUT WE KNOW THE MOST COMMON SITESLNS, 2L 2B

66
Metastatic carcinoma , liver
67
Metastatic carcinoma , liver
68
Metastatic carcinoma , lung
69
Biology of Invasion and Metastasis
  • Invasion of the basement membrane
  • Movement through extracellular matrix
  • Penetration of vascular or lymphatic channels
  • Survival and arrest within the circulating blood
    or lymph
  • Exit from the circulation into new site
  • Survival and growth as a metastasis

70
Carcinoma in situ
Cancer cell becomes capable of invasion
(expresses surface adhesion molecules)
Tumor cells release proteolytic enzymes,
disruption of ECM Invade ECM
71
Peritoneal carcinomatosis
72
How Do We Get To The Diagnosis Of Malignancy?
  • TEAM EFFORT
  • CLINICAL ( TUMOR MARKERS, LABS)
  • GROSS
  • CYTOLOGY
  • HISTOLOGY (IHC)
  • Molecular pathologist and cytogenetist
  • MOST IMPORTANT, EARLY DETECTION.
  • LADIESNEVER UNDERESTIMATE THE PAAAAAAAAAAPPPP
    MAMMOGRAMPLEASE

73
Why How Do We Grade And Stage Tumors?
  • 0-V
  • TNM
  • Tx, T0, Tis, T1-4
  • Nx, N0, N1-3
  • Mx, M0, M1

74
Lung mass, CT scan
75
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76
Immunohistochemistry
77
Electron microscopy
78
TREATMNT
  • SURGERY
  • RADIOTHERAPY
  • CHEMOTHERAPY
  • IMMUNOTHERAPY
  • Hormones
  • Gene therapyadvancing
  • BMT
  • CURATIVE VS PALLIATIVE

79
References
  • This lecture would not be possible except with
    the aid of different textbooks, personal and
    online material
  • I am mentioning here some of the web sites I used
    to prepare this lecture
  • www.pathguy.com .very useful for students, its
    funny too
  • www.mdconsult.com huge amount of everything
    about medicine
  • And of course Robbin Cotran Pathologic basis
    of diseases

80
  • THANK YOU
  • WILL HAVE A BREAK FOR 5 MINUTES THEN WE HAVE A
    CASE FOR DISCUSSION..QUICKKKK?
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