Neoplasia Epidemiology, Nomenclature, Tumor Growth, and Tumor Features

True

Neoplasia literally means "new growth"

Neoplasm is the new growth

Tumor is now equated with Neoplasm
(it was originally applied to the swelling caused by inflammation)

The Parenchyma is the proliferating neoplastic cells of a tumor

Supportive Stroma of atumor is made up of connective tissue and blood vessels

Choristoma is a congenital anomaly composed of a heterotopic rest of cells; example: pancreatic tissue found in the submucosa of the stomach.
(Choristoma is confusing nomenclature)

FALSE
A Hamartoma is a malformation not a neoplasm (the rest of the statement is correct though)

Teratoma

Oncology is the study of tumors or neoplasms (Greek oncos means tumor)

1. Cells of origin
2. Microscopic architecture
3. Macroscopic patterns
Benign tumors of mesenchymal cells generally have the suffix -OMA appended

Malignant Tumors

Cancer (Latin for Crab) is the common term for ALL MALIGNANT TUMORS

Carcinomas are malignant neoplasms of epithelial origin arising from any of the three germ layers

Malignant tumor arising in mesenchymal tissue is called sarcoma
(Greek Sar means fleshy)

Stem cells undergo divergent differentiation, creating mixed tumors. These are composed of cells from a SINGLE germ layer
i.e. mixed tumor of salivary gland origin

Most carcinomas occur in the later years of life (55 years and older)

>10% of deaths in children are due to cancer

New Zealand 6x > Iceland

Japan

True

False
most cancers are sporadic, but some are familial

True

Autosomal Dominant

Autosomal Recessive

Familial clustering of cases, but role of inherited predisposition not clear for each individual
1. Breast cancer (not linked to BRCA1 or BRCA2)
2. Ovarian cancer
3. Pancreatic cancer

1. Xeroderma Pigmentation
2. Atazia-telangiectasia
3. Bloom syndrome
4. Fanconi Anemia

RB
p53
p16INK4A
APC
NF1, NF2
BRCA1, BRCA2
MEN1, RET
MSH2, MLK1, MSH6
PATCH

Retinoblastoma

Melanoma

Familial adenomatous polyposis/colon cancer

Neurofibromatosis 1 &2

Breast & Ovarian Tumors

Multiple endocrine neoplasia 1 & 2

Hereditary nonpolyposis colon cancer

Nevoid basal cell carcinoma syndrome

Neoplasm

the parenchyma of the tumor

Desmoplasia

Benign mesenchymal cells

A benign tumor from fibroblastic cells

A benign tumor of osteoblasts

Benign cartilaginous tumor

Adenoma

Papillomas

Cystadenomas

POLYP

True

Fibrosarcoma

Osteosarcoma

Adenocarcinoma

Squamous Cell Carcinoma

a poorly differentiated or undifferentiated malignant tumor

False
Melanoma is a malignant tumor of melanocytes and should be called a melanocarcinoma

Hamartoma has a mass of tissue indigenous to that site ( nodule in lung containing cartilage, bronchi, blood vessels)
Choristoma has cells that are not normally found in that region (pancreatic tissue in stomach)

1. Differentiation and Anaplasia
2. Rate of Growth
3. Local Invasion
4. Metastasis

Differentiation

Well-differentiated tumors are composed of cells resembling the mature normal cells of the tissue of origin of the neoplasm

Poorly or Undifferentiated tumors have primitive appearing unspecialized cells

In general, Benign tumors are Well Differentiated

Malignant tumors range from Well Differentiated to Undifferentiated

Anaplastic
Lack of differentiation or anaplasia is considered a hallmark of malignant transformation
{anaplasia literally means to form backward, but lack of differentiation is not the consequence of dedifferentiation}

1. Pleomorphism
2. Hyperchromatism
3. Large Numbers of Mitoses
4. Atypical, Bizarre Mitotic Figures
5. Tumor Giant Cells
6. Orientation is disturbed

Pleomorphism

Hyperchromatism

Anaplastic tumors usually possess large Numbers of Mitoses

True

More important as a morphologic feature of malignant neoplasia is the presence of Atypical, Bizarre mitotic figures

True

1. Mimic the structure of their parent origin
2. Resemble their cells of origin
3. Show a remarkable uniformity in size shape and nuclear configuration
4. Show evidence of normal function even if useless
5. Have relatively infrequent mitotic figures

1. Generally show a haphazard arrangement
2. Bear little resemblance to the cells of origin
3. Tend to vary widely in size, shape and nuclear configuration
4. Provide little evidence of normal function
5. Show frequent mitoses often of abnormal type

Generally most Benign tumors grow Slowly over a period of years, whereas most Cancers grow Rapidly, sometimes at an erratic pace. (in general, the growth rate of tumors correlates with their level of differentiation and thus most malignant tumors grow more rapidly than do benign ones

Nearly all benign tumors grow as cohesive expansile masses that remain localized.
Because benign tumors typically grow slowly, they usually develop a rim of compressed connective tissue which may be called a fibrous capsule.

The growth of malignant tumors is accompanied by progressive infiltration, invasion, and destruction of surrounding tissue leaving them poorly demarcated. (next to development of metastases, invasiveness is the most reliable feature that differentiates malignant from benign tumors)

Metastases & Invasiveness

Metastases

30%

1. Direct seeding of body caivities or surfaces
2. Lymphatic seeding
3. Hemtogenous spread

Seeding of Body Cavities and Surfaces may occur whenever a malignant tumor penetrates into a natural open field.
Peritoneal cavity is most often involved, but pleural, pericardial, subarachnoid and joint spaces may be affected

Lymphatic spread (sarcomas may also use this route)

Follows the natural routes of drainage

True

Hematogenous Spread

Liver and Lungs

Veins are more easily invaded

FALSE
ALL tumors, even benign ones, can cause morbidity and mortality

1. Location and impingement on adjacent structures
2. Functional activity such as hormone synthesis
3. Bleeding and secondary infections when they ulcerate
4. Initiation of acute symptoms caused by either rupture or infarction

True

CACHEXIA
*************

NO

No

Cachexia results from the action of soluble factors such as cytokines TNF-ALPHA & IL-1 either produced by the tumor or the host

PARANEOPLASTIC SYNDROMES
************************************

1. They may represent the earliest manifestation of an occult tumor
2. They may represent significant clinical problems and may even be lethal
3. They may mimic metastatic disease and therefore confound treatment

Grade is the level of differentiation
Stage is the spread of a cancer within the patient

Grading is based on the degree of differentiation of the tumor cells and the number of mitoses within the tumor as presumed correlates of the neoplasm's aggressiveness
(Cancers are classified as grades I-IV with increasing anaplasia)

Stagin is based on the
1. size of the primary lesion
2. extent of spread to regional lymph nodes
3. presence or absence of blood-borne metastases

1) UICC Union International Contre Cancer
2) AJC American Joint Committee on Cancer Staging

T
Primary tumor: T0 (in situ), T1-T4 with increasing size

M
Metastases: MO (none), M1 & M2 indicates the amount of metastases

N
Regional lymph node involvement: NO (none), N1-N3 denotes involvement of an increasing number and range of nodes

divides all cancers into stages 0-IV
Incorporating within each of these stages the size of the primary lesion as well as the presence of nodal spread and distant metastases

1. Excision or biopsy
2. Fine-needle aspiration
3. Cytologic smears

1. Categorization of undifferentiated malignant tumors; ie keratin in tumors of epithelial origin
2. Categorization of Leukemias and Lymphomas; ie classification of T and B cell tumors
3. Determination of site of origin of metastatic tumorsl ie prostate-specific antigen in a tumor
4. Detection of molecules that have prognostic or therapeutic significance; ie detection of hormone (estrogen and/or progesterone) receptors in breast cancer cells

1. Diagnosis of malignant tumors
2. Prognosis of malignant neoplasms
3. Detection of minimal residual disease
4. Diagnosis of hereditary predisposition to cancer

Molecular techniques used in differentiating benign (polyclonal) proliferations of T or B cells from malignant (monoclonal) proliferations

N-myc gene and deletions of 1p bode poorly for patients with neuroblastoma

PCR-based amplification gives a measure of residual leukemia cells intreated patients with chronic myeloid leukemia

Germ line mutation in cancer suppressor genes is associated with an extremely high risk of developing specific cancers

Flow cytometry can rapidly and quantitatively measure several individual cell characteristics, such as membrane antigens and DNA content of tumor cells.
Cell surface antigens can be used for classification; ie Leukemias.lymphomas
Relationship between DNA content and prognosis; ie aneuploidy-poorer prognosis

Tumor markers are biochemical indicators of the presence of a tumor

Cell surface antigen
Cytoplasmic proteins
Enzymes and hormones
ie CEA carcinoembryonic antigen is found in carcinomas of colon, pancreas, lung, stomach and breast

CEA assays

Alpha-fetoprotein AFP

FALSE
AFP can be seen in non-neoplastic conditions such as cirrhosis and hepatitis

?

Well-differentiated
Expansile
Slow growth
Mitotic figures which are normal

Lymphoma
Pleomorphic Adenoma

Lung Cancer

Cachexia

A & C

Think that
Rhabdomyoma is correct & Adenocarcinoma is correct

All of the above