introduction to neoplasia
TRANSCRIPT
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INTRODUCTION TO
NEOPLASIA
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Nomenclature of various
growth processes (“Plasias”)
• Hyperplasia
• Metaplasia
• Dysplasia
• Neoplasia
• Desmoplasia
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Metaplasia
an adaptive substitution of one type of adult tissue to another type of adult tissue
under stress a more vulnerable type of tissue will be replaced by another more capable of withstanding stress
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Dysplasia
An abnormality in cell size,
appearance, with or without a
disorganized growth pattern
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Neoplasia
A disease of cells characterized by alteration of normal
growth regulatory mechanisms
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Desmoplasia
The formation and proliferation of connective tissue in response to neoplastic growth
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Neoplastic progression
• Benign or malignant neoplasms can acquire increasingly aggressive features
• Most malignant neoplasms arise de novo
• Some malignant neoplasms are thought to be preceded by preneoplastic conditions
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Definitions
Neoplasm - (new growth) abnormal mass of tissue, the growth of which exceeds and is uncoordinated with the normal tissues
Tumor - a non-specific term meaning lump or swelling. Often syn. for neoplasm
Cancer - any malignant neoplasm or tumor
Metastasis - discontinuous spread of a malignant neoplasm to distant sites
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Cancer (L. Crab)
• Any malignant growth of cells (clonal)
• Second most common cause of death in
US
• One in 3 Americans will die of cancer
Gross features Microscopic features
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Classification - Approach
Terminology which is used to describe a
mass is based on the clinical, gross and
microscopic features-which in
combination are a reflection of the
predicted/expected biologic behavior
Benign Malignant ?
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Classification Criteria
• Growth Characteristics
• Rate of Proliferation and Cell Death
• Differentiation
• Metastasis
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Classification Criteria and
Associated Biologic Behavior
Characteristics Benign Malignant
Growth pattern expansive infiltrative
rate of slow fast
growth
differentiation nl, good atypical, poor
metastasis absent typical
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Growth pattern
Benign Malignant
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Rate of Growth
Rapid
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Classification - Differentiation
• According to biologic behavior and
histogenesis or cellular features
– Benign
• Adenoma - benign epithelial neoplasm
• Lipoma -benign mesenchymal neoplasm
– Malignant
• CARCINOMA - malignant epithelial neoplasm
• SARCOMA - malignant mesenchymal neoplasm
• LYMPHOMA/LEUKEMIA - malignant neoplasm of
lymphoid cells
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Classification According to
behavior
Fibroadenoma Adenocarcinoma
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Classification According to
Cellular Features Squamous-
Eosinophillic (pink)
abundant cytoplasm
Keratin, keratin pearl
Hyperchromatic
(dark) nucleus
Lack of differentiation
Intercellular clear spaces
Normal epithelium
Squamous cell carcinoma
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Lung Cancer
x-ray Squamous carcinoma
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Classification According to
Cellular Features Adenocarcinoma Normal
Gland-like spaces
Mucin production,
secretory activity
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Colon Cancer
X-ray Gross Microscopic
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Classification According to
Cellular Features
Lymphoma
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Classification According to
Cellular Features
Recapitulation of normal features
Differentiation along mesenchymal pathways
Osteogenic sarcoma
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Invasion and Metastasis
• Characteristics that are unique to
malignant neoplasms (cancer)
• The major cause of morbidity and
mortality
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Invasion
• Associated with activated motility
and local tissue independence in
vitro
• Balance between tissue destruction
and synthesis
• Cell surface and extracellular matrix
play important roles
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Metastasis
• Require acquisition of additional
tumor characteristics beyond those
necessary for invasion
• Multiple lesions
• Organ specificity
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Metastasis
Mechanisms of Spread:
•Hematogenous
•Lymphatics
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Other mechanisms of
spread
• Direct extension
• Seeding
• Surgical or procedural
transplantation (iatrogenic)
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Prognosis
• Prediction of Outcome
– Criteria are different for each cancer type
– Grade, stage, histology routine criteria
– Patient characteristics are important
– Treatment considerations critical
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Prognostic Factors
• Grade
• Stage
• Tumor type
• Biomarkers (slide based and
molecular techniques)
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Cancer Grade
• Alternate term “tumor grade”
• Based on microscopic features
(cytology or histology)
low grade moderate high
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Cancer Stage • Reflects degree of spread, for an
individual cancer patient
• Assigned at the time of diagnosis, may be
updated as patient progresses T Tumor characteristics
N Nodal involvement
M Metastasis
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Morbidity and Mortality • Metastases
• Rupture into major vessels, structure
• Starvation
• Infection
• Compression of vital organs
• Organ failure
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Summary
• Cancer is synonymous with malignant
neoplasia
• Precursor/precancerous lesions exist
• Invasion and metastasis are the hallmark
of malignancy
• Cancer typing and subtyping is pre-
requisite for patient treatment