S.
M Jawwad Ali Naqvi
Department of Physiology, University of Karachi
Neoplasia
Neoplasia
A neoplasm is a type of abnormal and excessive growth,
called neoplasia, of tissue.
The growth of a neoplasm is uncoordinated with that of the
normal surrounding tissue, and persists in growing
abnormally, even if the original trigger is removed.
This abnormal growth usually forms a mass, when it may be
called a tumor.
Neoplasia
ICD-10 classifies neoplasms into four main groups:
1. Benign neoplasms
2. In situ neoplasms
3. Malignant neoplasms
4. Neoplasms of uncertain or unknown behavior
Malignant neoplasms are also simply known as cancers and
are the focus of oncology.
Prior to the abnormal growth of tissue, as
neoplasia, cells often undergo an abnormal pattern of
growth, such as metaplasia or dysplasia.
However, metaplasia or dysplasia does not always
progress to neoplasia and can occur in other conditions
as well.
Types of Neoplasia
A neoplasm can be benign, potentially malignant, or malignant
(cancer).
Benign tumours include uterine
fibroids, osteophytes and melanocytic nevi (skin moles). They
are circumscribed and localized and do not transform into
cancer.
Potentially-malignant neoplasms include carcinoma in
situ. They are localised, do not invade and destroy but in time,
may transform into a cancer.
Malignant neoplasms are commonly called cancer. They
invade and destroy the surrounding tissue, may
form metastases and, if untreated or unresponsive to
treatment, will generally prove fatal.
Secondary neoplasm refers to any of a class of cancerous
tumor that is either a metastatic offshoot of a primary
tumor, or an apparently unrelated tumor that increases in
frequency following certain cancer treatments such
as chemotherapy or radiotherapy.
Rarely there can be a metastatic neoplasm with no
known site of the primary cancer and this is classed as
a cancer of unknown primary origin
Causes of Neoplasia
Genetics
Age
Hormones
Smoking
Drinking
Obesity
Sun overexposure
Immune disorders
Classification of the Tumor
Tumors are classified as follows
Malignant
Benign
Properties of the Benign tumor
Benign neoplasms are well-differentiated tumors
Benign neoplasms are well-differentiated tumors
These resemble the tissues of origin
These have loss of control of cell proliferation.
They grow by expansion,
These are enclosed in a fibrous capsule, and do not cause
death unless their location is such that it interrupts vital
body functions.
Properties of the Malignant tumors
These are less well-differentiated
These have lost the ability to control both cell
proliferation and differentiation.
They grow in a disorganized and uncontrolled manner to
invade surrounding tissues, tissues,
These have cells that break loose and travel to distant
sites to form metastases,
And inevitably cause suffering and death unless their
growth can be controlled through treatment.
Cancer
Cancer is a group of diseases characterized by uncontrolled or
abnormal cell division. When cells in a part of the body divide
without control, the excess tissue that develops is called a tumor or
neoplasm.
The study of tumors is called oncology.
Tumors may be cancerous and often fatal, or they may be harmless.
A cancerous neoplasm is called a malignant tumor or malignancy.
One property of most malignant tumors is their ability to undergo
metastasis, the spread of cancerous cells to other parts of the
body.
A benign tumor is a neoplasm that does not metastasize. An
example is a wart. Most benign tumors may be removed surgically if
they interfere with normal body function or become disfiguring.
Some benign tumors can be inoperable and perhaps fatal.
Types of Cancer
The name of a cancer is derived from the type of tissue in
which it develops.
Most human cancers are carcinomas, malignant tumors that
arise from epithelial cells.
Melanomas, for example, are cancerous growths of
melanocytes, skin epithelial cells that produce the pigment
melanin.
Sarcoma is a general term for any cancer arising from muscle
cells or connective tissues. For example, osteogenic sarcoma,
the most frequent type of childhood cancer, destroys normal
bone tissue.
Leukemia is a cancer of blood-forming organs characterized by
rapid growth of abnormal leukocytes (white blood cells).
Lymphoma is a malignant disease of lymphatic tissue—for
example, of lymph nodes.
Growth and Spread of Cancer
Cells of malignant tumors duplicate rapidly and continuously. As malignant
cells invade surrounding tissues, they often trigger angiogenesis, the growth
of new networks of blood vessels.
Proteins that stimulate angiogenesis in tumors are called tumor
angiogenesis factors (TAFs).
The formation of new blood vessels can occur either by overproduction of
TAFs or by the lack of naturally occurring angiogenesis inhibitors.
As the cancer grows, it begins to compete with normal tissues for space
and nutrients. Eventually, the normal tissue decreases in size and dies.
Some malignant cells may detach from the initial (primary) tumor and
invade a body cavity or enter the blood or lymph, then circulate to and
invade other body tissues, establishing secondary tumors.
Malignant cells resist the antitumor defenses of the body. The pain
associated with cancer develops when the tumor presses on nerves or
blocks a passageway in an organ so that secretions build up pressure, or as
a result of dying t issue or organs.
Carcinogenesis
A Multistep Process Carcinogenesis is a multistep process of cancer
development in which as many as 10 distinct mutations may have to
accumulate in a cell before it becomes cancerous.
The progression of genetic changes leading to cancer is best
understood for colon (colorectal) cancer. Such cancers, as well as
lung and breast cancer, take years or decades to develop.
In colon cancer, the tumor begins as an area of increased cell
proliferation that results from one mutation. This growth then
progresses to abnormal, but noncancerous, growths called
adenomas.
After two or three additional mutations, a mutation of the tumor-
suppressor gene p53 occurs and a carcinoma develops. The fact that
so many mutations are needed for a cancer to develop indicates that
cell growth is normally controlled with many sets of checks and
balances. Thus, it is not surprising that a compromised immune
system contributes significantly to carcinogenesis.
Carcinogenesis
The process by which carcinogenic (cancer-causing) agents cause
normal cells to become cancer cells is hypothesized to be a
multistep mechanism that can be divided into three stages:
Initiation:(involves the exposure of cells to appropriate doses of a
carcinogenic agent that makes them susceptible to malignant
transformation.)
Promotion:(involves the induction of unregulated accelerated
growth in already initiated cells by various chemicals and growth
factors. Promotion is reversible if the promoter substance is
removed) various chemicals and growth factors. Promotion is
reversible if the promoter substance is removed)
Progression:(the process whereby tumor cells acquire malignant
phenotypic changes that promote invasiveness, metastatic
competence, autonomous growth tendencies, and
increasedkaryotypic instability)
Carcinogenesis
There are following predisposing factors,
Heredity(A hereditary predisposition to approximately 50
types of cancer has been observed in families. Breast cancer,
for example, occurs more frequently in women whose
grandmothers, mothers, aunts, or sisters also have experienced
a breast malignancy)
Hormones(Hormones have received considerable research
attention with respect to cancer of the breast, ovary, and
endometrium in women and of the prostate and testis in men)
Immunological mechanisms(There is substantial evidence for
the immune system’s participation in resistance against the
progression and spread of cancer. The central concept, known
as theimmune surveillance hypothesis)
Carcinogenesis
Chemical agents(chemical carcinogens can be divided into
two groups)
(1) direct-reacting agents, which do not require activation
in the body to become carcinogenic.
(2) indirect-reacting agents, calledprocarcinogensor
initiators, which become active only after metabolic
conversion
Radiations (The effects of ionizing radiation in
carcinogenesis have been well documented in atomic
bomb survivors, in patients diagnostically exposed, and in
industrial workers, scientists, and physicians who were
exposed during employment).
Proto oncogenes
“Proto-oncogenes are a group of genes that cause normal cells
to become cancerous when they are mutated “ (Adamson,
1987; Weinstein & Joe, 2006)
Mutations in proto-oncogenes are typically dominant in nature,
Mutated version of a proto-oncogene is called an oncogene.
Often, proto-oncogenes encode proteins that function to
stimulate cell division,
Often, proto-oncogenes encode proteins that function to
stimulate cell division, inhibit cell differentiation, and halt cell
death.
All of these processes are important for normal human
development and for the maintenance of tissues and organs.
Oncogenes
Oncogenes, however, typically exhibit increased
production of these proteins,
Thus leading to increased cell division, decreased cell
differentiation, and inhibition of cell death; taken together,
these phenotypes define cancer cells.
Thus, oncogenes are currently a major molecular target
for anti-cancer drug design.
TNM staging system
• It is the system that classifies the various cancers into
different anatomical forms, its regional lymph node
involvement and distant metastasis.
• T: It is defined as the size of the primary tumor
• N: It tells the presence or absence of the tumor in the
regional lymph nodes and lymph node drainage.
• M: It is the absence or presence to the distant spread or
metastasis
TNM staging system
“T” Primary tumor:
T0:No evidence of primary tumor
T.is: Carcinoma in situ
T1:Tumor < 2mm
T2:Tumor >20 mm but less than 50mm
T3: >50mm
T4:tumor of any size /to the chest wall or skin
Tx:Primary tumor can not be assessed
TNM Staging system
“N” Regional lymph nodes
N0:no regional lymph nodes involvement
N1:Movable level( axiliary involvement)
N2:Mammary lymph nodes,( not palpable axillary)
N3:additionally supraclavical lymph nodes are involved
Nx:can not be assessed
TNM staging system
“M” Distant Metastasis
M0: No distant metastasis
M1:Metastasis present
Treatment
Treatments include
1. Chemotherapy
2. Radiation therapy
3. Surgery
4. Immunotherapy
References
Porth, C., Matfin, G., & Porth, C. (2009). Pathophysiology:
Concepts of altered health states (8th ed.). Philadelphia,
PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
purpose and principles of cancer staging. (2009,
September 7). Retrieved from September 7). Retrieved
from
http://www.kliinikum.ee/ho/images/stories/attachments/
102_Purpose%20and%20Principles%20of%20Cancer%
20Staging.pdf
Tumor node staging for breast cancer. (2010). Retrieved
from
http://www.sapycc.org/descarga/2010/UTD_Tumor_nod
e_metastases.pdf
