Neoplasia - Epidemiology

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most common site of cancer incidence in males and females

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males: prostate
females: breast

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most common site of cancer deaths in males and females

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males: lung
females: lung

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most dramatic increase in 5 year survival rates have occurred in what types of malignancies

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leukemias and lymphomas

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skin cancer deaths are largely caused by

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melanomas

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death rate for stomach carcinoma is higher in

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japan than in the us

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most carcinomas occur in what age group

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55 and older

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what percentage of deaths of children younger than 15 is attributed to cancer

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10%

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neoplasia literally means

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'new growth'

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the new growth is called a

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neoplasm

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the term tumor was originally applied to

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swelling caused by inflammation

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now: tumor = ?

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neoplasm

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oncology

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study of tumors or neoplasms

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oncos

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greek for tumor

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cancer

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common term for all malignant tumors (not for benign tumors!)

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neoplasm

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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

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two basic components of all tumors (benign and malignant)

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1- proliferating neoplastic cells that constitute their PARENCHYMA
2- SUPPORTIVE STROMA

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supportive stroma is made up of

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connective tissue and blood vessels

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which portion of the tumor largely determines its biologic behavior

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parenchyma

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the _______________ is the component from which the neoplasm derives its name

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parenchyma

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desmoplasia

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occur when parenchymal cells stimulate the formation of abundant dense collagenous stroma

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suffix for benign tumors of mesenchymal cells

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-OMA

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how are names of benign tumors of epithelials cells derived

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- some based on the cells of origin
- some based on microscopic architecture
- some based on macroscopic patterns

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term applied to benign epithelial tumors that form glandular patterns or arise in glandular tissue without reproducing glandular patterns

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adenoma

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benign epithelial neoplasms producing microscopically or macroscopically visible finger-like projections from epithelial surfaces are referred to as:

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papillomas

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benign tumors forming large cystic masses in organs (such as ovaries) are referred to

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cystadenomas

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the term used for neoplasms (benign or malignant) that produce a macroscopically visible projection above the mucosal surface into a lumen

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polyp

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it is preferred that the term polyp be used only with

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benign tumors

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malignant polyps are better called

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polypoid cancers

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benign tumor arising from fibroblasts is called a ___________________.
(hint: remember the origin of fibroblasts)

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fibroma

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benign tumor of an osteoblast

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osteoma

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benign cartilagenous tumor

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chondroma

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suffix for malignant tumors from mesencymal origin

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-SARCOMA

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term for malignant tumors of epithelial origin (from any of the 3 germ layers)

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CARCINOMA

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a malignant epithelial tumor with a microscopic glandular growth pattern

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ADENOCARCINOMA

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term for a malignant tumor producing recognizable squamous cells arising in any epithelium of the body is termed

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squamous cell carcinoma

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malignant tumors composed of undifferentiated cells must be designated as

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poorly differentiated or undifferentited

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squamous cell carcinoma is the most common malignant tumor of the ______________

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oral cavity

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basal cell carcinoma is the most common malignant tumor of the _______________

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skin

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usually parenchymal cells of a neoplasm resemble

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each other

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mixed tumor

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the stem cells of a tumor undergo divergent differentiation, but these cells are from the same germ layer

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teratoma

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made up of a variety of parenchymal cell types representative of more than one germ layer, usually all 3

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teratoma: benign or malignant?

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can be either

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malignant tumor of melanocytes

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melanoma

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hamartoma

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a malformation that presents as a mass of disorganized tissue indigenous to a particular site - not a neoplasm!

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example of a hamartoma

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nodule in the lung containing cartilage, bronchi, blood vessels

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ABC's of melanoma

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A: assymetry
B: borders - irregular
C: coloration varies
D: diameter

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where can melanomas be found

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skin, mucosa

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choristoma

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congenital anomaly composed of a heterotopic rest of cells

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example of a choristoma

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pancreatic tissue found in submucosa of the stomach

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mesothelioma: benign or malignant

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malignant! (due to asbestos exposure in lungs)

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differentiation

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refers to the extent to which parenchymal cells resemble normal comparable cells, both morphologically and functionally

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well-differentiated tumors

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composed of cells resembling the mature normal cells of the tissue of origin of the neoplasm

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poorly or undifferentiated tumors

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have primitive-appearing unspecialized cells

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contrast the differentiation of benign and malignant tumors

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benign --> well differentiated
malignant --> range from well-differentiated to undifferentiated (sometimes you can't even tell what the cell of origin was)

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malignant neoplasms of undifferentiated cells are said to be ___________

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anaplastic

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Anaplasia is considered a hallmark of _________________

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malignant transformation

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anaplasia is a result of _________________ not _________________ (as the word's meaning would imply)

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improper cell differentiation; dedifferentiation

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morphologic and functional changes which mark anaplasia

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1- pleomorphism
2- hyperchromatism
3- large number of mitoses
4- atypical, bizarre mitotic figures (more important than the number of mitoses)
5- tumor giant cells
6- disturbed orientation

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pleomorphism

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variation of size and shape of the cells and their nuclei

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hyperchromatism

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anaplastic cells stain extremely dark due to an abundance of DNA

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the more rapidly growing and the more anaplastic a tumor, the less like that _______________________________

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there will be specialized functional activity

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characteristics of differentiated cells

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1- mimic the structure of the parent organ
2- resemble cells of origin
3- uniformity in size and shape and nuclear configuration
4- evidence of normal function even if useless
5- relatively infrequent mitotic figures

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characteristic of undifferentiated cells

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1- haphazard arrangement
2- little resemblance to cells of origin
3- vary widely in size shape and nuclear orientation
4- little evidence of normal function
5- frequent mitoses of abnormal type

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what are the main differences between benign and malignant tumors

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1- differentiation and anaplasia
2- rate of growth
3- local invasion
4- metastasis

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contrast rate of growth between benign and malignant tumors

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benign --> usually grow slowly over a number of years
malignant --> grow rapidly, sometimes at an erratic pace

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rate of growth correlates with ____________________________

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level of differentiation

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nearly all benign tumors grow as _____________________ and remain _________________

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cohesive, expansile masses; localized

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what is a fibrous capsule

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a rim of compressed connective tissue, developed by BENIGN tumors because of their slow growth

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growth of malignant tumors is accompanied by _______________________________

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progressive infiltration, invasion and destruction of surrounding tissue, leaving them poorly demarcated

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what is the most reliable figure in differentiated benign and malignant tumors

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development of metastases (invasiveness is the second most reliable)

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what are metastases

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tumor implants that are DISCONTINUOUS with the primary tumor

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metastasis is an unequivocal mark of

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malignancy

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name 2 cancers that rarely metastasize

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malignant glial cell tumors, basal cell carcinomas

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what might increase the likelihood of metastasis

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1- aggressiveness
2- rapid growth
3- large size of primary tumor

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what percentage of patients with newly discovered solid tumors present with metastases

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30% (except most skin cancers)

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what are the possible pathways of spread of a tumor

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1- direct seeding of body cavities or surfaces
2- lymphatic spread
3- hematogenous spread

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when may seeding of body cavities and surfaces occur

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whenever a malignant tumor penetrates into a natural 'open field'

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which body cavity is most often involved in spread of cancers

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peritoneal cavity (but pleural, pericardial, subarachnoid and joint spaces may be affected)

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most common pathway for initial dissemination of carcinomas

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lymphatic spread (sarcomas may also use this route)

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the pattern of lymph node involvement follows ____________________

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natural routes of drainage

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hematogenous spread is typical of ________________

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sarcomas (carcinomas may also use this route)

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what organs are most frequently involved secondarily in hematogenous spread

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liver and lungs

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what type of blood vessels are more easily invaded by cancers? name a cancer that has a propensity for these vessels

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veins (because they don't have muscular walls like arteries); renal cell carcinoma

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tumors are essentially ____________

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parsites

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what type of tumor may cause morbidity and mortality

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ALL even benign tumors

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possible problems caused by tumors

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both types can cause problems due to:
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 due to rupture or infarction

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examples of local and hormonal effects on host

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- pituitary adenoma (benign) may cause destruction of the rest of the pituitary gland, causing serious endocrinopathy
- benign and malignant tumors of the gut may cause obstruction

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cachexia

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wasting syndrome associated with cancer - progressive loss of body fat and lean body mass, profound weakness, anorexia, anemia

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cause of cachexia

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not entirely known. but it is known that it is not caused by the nutritional demands of the neoplasm - and reduced food intake alone is not a sufficient explanation

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cachexia results from the action of ________________________

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soluble factors such as cytokines (TNF-alpha or IL-1)

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paraneoplastic syndromes

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symptom complexes in cancer patients - cannot readily be explained, either by the local or distant spread of the cancer or by the elaboration of hormones indigenous to the tissue from which the tumor arose

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why are paraneoplastic syndromes important

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1- they may represent the earliest symptoms of an occult tumor
2- may represent significant clinical problems and may be lethal
3- may mimic metstatic disease and confound treatment

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name 2 paraneoplastic syndromes

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1- cushing diseae
2- hypercalcemia

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major forms of cancer involved in cushing disease

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- small cell carcinoma of the lung
- pancreatic carcinoma
- neural tumors

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causal mechanism of cushing disease

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ACTH or ACTH-like substance

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major forms of cancer involved in hypercalcemia

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- squamous cell carcinoma of the lung
- breast carcinoma
- renal carcinoma
- adult t-cell leukemia/lymphoma
- ovarian carcinoma

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causal mechanism of hypercalcemia

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parathyroid hormone-related protein, TGF-alpha, TNF, IL-1

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GRADE

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level of differentiation and number of mitoses within a tumor

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STAGE

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the extent of spread of a cancer within the patient

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grade and stage serve as

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perameters of the clinical gravity of the disease

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grading correlates with

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the neoplasm's aggressiveness

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what are the different grades of tumors

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I-IV with increasing anaplasia

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which is of greater clinical value, grading or staging?

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staging

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staging is based on _________________

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- size of primary lesion
- extent of spread of regional lymph nodes
- presence or absence of blood-borne metastase

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major staging systems

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UICC, AJC

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UICC uses what system

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TMN system

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T =

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primary tumor size

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N =

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regional lymph node involvement

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M =

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metastases

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T0 =

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carcinoma in situ

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N0 =

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no regional lymph node involvement

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M0 =

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no metastasis

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T1-T4 =

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increasing size of primary tumor

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N1-N3 =

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involvement of an increasing range of nodes

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M1-M2 =

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indicates presence of metastasis and number

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describe the imporance of the clinician of diagnosis of cancer

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1- provides clinical data
2- provides adequate, representative properly preserved specimen

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sampling methods

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1- excision or biopsy
2- fine-needle aspiration
3- cytologic smears

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what might the detection of hormone receptors in breast cancer cells indicate?

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favorable prognosis

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the utility of immunohistochemistry includes:

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1- categorization of undifferentiated malignant cells
2- categorization of leukemias and lymphomas
3- determination of site of origin of metastatic tumors
4- detection of molecules that have prognostic or therapeutic significance

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polyclonal proliferation

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benign

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monoclonal proliferation

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malignant

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prognosis of N-myc gene and deletions of 1p in patients with neuroblastoma

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poor

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flow cytometry measures

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cell characteristics such as membrane antigens and DNA of tumor cells

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cell surface antigens can be used for __________________

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classification (leukemias/lymphomas etc)

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what are tumor markers

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biochemical indicators of the presence of a tumor

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tumor markers include

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cell surface antigens, cytoplasmic proteins, enzymes, hormones

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carcinoembryonic antigen (CEA) is found in what cancers

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carcinomas of the colon, pancreas, breast, lung, stomach

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why are CEA assays not good for detection of early cancers

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lacks specificity and senitivity

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alpha-fetoprotein is associated with

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liver cell cancer, nonseminomatous germ cell tumors of the testis

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AFP can be seen in what non-neoplastic conditions

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cirrhosis, hepatitis

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which of the following is an example of a paraneoplastic syndrome:
- cushing syndrome resulting from an ACTH producing small cell carcinoma of the lung
- hypercalcemia developing as a result of skeletal metastases
- hyper calcemia resulting from a breast carcinoma producing parathyroid hormone
- all of the above
- a and c only

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a and c only

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t/f: grading of a tumor has been more effective than staging as far as clinical value is concerned

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false - staging is more valuable than grading

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tumor markers include which of hte following:
- hormones such as calcitonin
- oncofetal antigens such as CEA
- specific immunoglobulins
- all of the above
- a and c only

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all of the above

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which of the following statements is true
- a malignant tumor of cartliage would be called a chondrocarcinoma
- a benign neoplasm of skeltal muscle would be called a rhabdomyoma
- a malignant tumor arising from the mucous glands of the GI tract would be called an adenocarcinoma
- a benign neoplasm arising from melanocytes would be called melanoma

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2 are true:
- a benign neoplasm of skeltal muscle would be called a rhabdomyoma
- a malignant tumor arising from the mucous glands of the GI tract would be called an adenocarcinoma

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which of the following statements is true?
- carcinoma of the breast is the most common cause of cancer deaths among women in the united states
- when the parenchmal cells of a neoplasm stimulate formation of abundant collagen, this process is termed a choristoma*
- a benign epithelial tumor producing microscopic finger-like projections from the epithelial surface is termed a papilloma
- a benign tumor containing teeth, sebum, hair, thyroid tissue, respiratory epithelium and cartilage is called a teratoma.

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2 are true:
- a benign epithelial tumor producing microscopic finger-like projections from the epithelial surface is termed a papilloma
- a benign tumor containing teeth, sebum, hair, thyroid tissue, respiratory epithelium and cartilage is called a teratoma.
(* this is a desmoplasia not a choristoma)

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which of the following is a malignant tumor
- papilloma
- fibroma
- chondroma
- osteoma
- lymphoma
- pleomorphic adenoma
- hamartoma

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- lymphoma

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which of the following terms apply more to a benign neoplasm than to a malignant one?
- metastasis
- well-differentiated
- expansile
- invasive
- slow growth
- overall rapid growth
- undifferentiated
- mitotic figures which are abundant and abnormal
- mitotic figures which are normal

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- well-differentiated
- expansile
- slow growth
- mitotic figures which are normal

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which of the following is the leading cause of cancer death in women?
- breast
- pancreas
- liver
- lung
- colon
- tongue
- bone

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lung

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initial dissemination of carcinomas is most commonly via which pathway
- direct seeding of body cavities or surfaces
- hematogenous spread
- lymphatic spread

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- lymphatic spread

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the wasting syndrome associated with cancer patients is termed
- choristoma
- CREST syndrome
- craniotabes
- dysplasia
- cachexia

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cachexia

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hormone tumor markers

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- human chorionic gonadotrophin
- calcitonin
- catecholamine and metabolytes
- ectopic hormones

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oncofetal antigen tumor markers

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- alpha-fetoprotein
- carcinoembryonic antigen

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isoenzyme tumor markers

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- prostatic acid phosphatase
- neuron specific enolase

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protein tumor markers

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- immunoglobulins
- prostate-specific antigen
- prostate-specific membrane antigen

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mucin/glycoprotein tumor markers

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- CA-125
- CA-19-9
- CA-15-3