Neoplasia
Neoplasia
Neoplasia is the process of uncontrolled, abnormal cell growth that leads to the formation of a
mass or tumor. This growth persists even after the initial stimulus that caused it is removed.
Neoplasia is a pathological process and can be either benign or malignant.
Neoplasm
A neoplasm is an abnormal mass of tissue resulting from neoplasia. It arises due to uncontrolled
cell proliferation and does not respond to normal regulatory signals. A neoplasm can be:
Benign (non-cancerous), or
Malignant (cancerous)
Benign Tumor: A benign tumor is a type of neoplasm that:
Grows slowly
Remains localized
Does not invade surrounding tissues
Does not metastasize (spread to other parts of the body)
Usually has well-defined borders and resembles normal cells histologically
Although benign tumors are not cancerous, they can cause problems depending on their size or
location (e.g., brain tumors pressing on vital structures).
Malignant Tumor: A malignant tumor is a type of neoplasm that:
Grows rapidly
Invades and destroys surrounding tissues
Has the potential to metastasize (spread to distant organs through blood or lymphatic
systems)
Shows poor cellular differentiation (anaplasia)
Malignant tumors are cancerous and can be life-threatening
Cancer: Cancer refers to malignant neoplasms. It is a group of diseases characterized by
uncontrolled cell growth, invasion of surrounding tissues, and potential spread (metastasis) to
distant sites. Examples include breast cancer, lung cancer, and leukemia.
Oncology: Oncology is the branch of medicine that deals with the prevention, diagnosis,
treatment, and study of cancer. A physician who specializes in this field is called an oncologist.
Characteristics of Benign And Malignant Tumors
• Benign and malignant tumors can be distinguished from one another based on the degree of
differentiation,rate of growth, local invasiveness, and distant spread.
• Benign tumors resemble the tissue of origin and are well differentiated; malignant tumors are
poorly or completely undifferentiated (anaplastic).
Neoplasia
• Benign tumors tend to be slow growing, whereas malignant tumors generally grow faster.
• Benign tumors are well circumscribed and have a capsule; malignant tumors are poorly
circumscribed and invade the surrounding normal tissues.
• Benign tumors remain localized to the site of origin, whereas malignant tumors are locally
invasive and metastasize to distant sites
Spread of Tumor (Tumor Dissemination)
1. Local (Direct) Invasion
Tumor grows and invades adjacent tissues.
This is the initial stage of spread for all malignant tumors.
Involves destruction of the basement membrane, ECM (extracellular matrix), and normal
tissue architecture.
Facilitated by enzymes like collagenases and matrix metalloproteinases (MMPs).
2. Lymphatic Spread
Common in carcinomas (e.g., breast, lung, prostate).
Tumor cells enter lymphatic vessels and travel to regional lymph nodes.
Lymph node involvement is often used for staging of cancer (e.g., TNM system).
Sentinel lymph node biopsy can help detect early metastasis.
3. Hematogenous Spread (via Blood Vessels)
Common in sarcomas and some carcinomas (e.g., renal cell carcinoma, hepatocellular
carcinoma).
Tumor cells enter veins, survive in circulation, and settle in organs with rich blood
supply, such as:
o Liver (via portal vein)
o Lungs (via vena cava)
o Bones and brain (via systemic circulation)
Pathogenesis of Metastasis
Metastasis is the process by which malignant tumor cells spread from the primary site to distant
organs or tissues, forming secondary tumors. It is a hallmark of cancer and a major cause of
cancer-related death.
The pathogenesis of metastasis involves a multistep process, often called the metastatic cascade:
1. Local Invasion
Cancer cells detach from the primary tumor mass.
They lose cell-cell adhesion.
They degrade the extracellular matrix (ECM) using enzymes like matrix
metalloproteinases (MMPs).
Tumor cells migrate through the stroma (connective tissue) toward nearby blood vessels
or lymphatics.
2. Intravasation
Neoplasia
Tumor cells invade nearby blood vessels (capillaries) or lymphatic vessels.
They cross the endothelial barrier to enter the circulation.
They must evade immune detection, often by associating with platelets or forming emboli
(cell clusters).
3. Survival in Circulation
Circulating tumor cells (CTCs) must survive shear stress, immune surveillance, and
oxidative stress in the bloodstream.
Platelets may protect CTCs by forming a “cloak” around them.
4. Extravasation
CTCs adhere to the endothelium of distant capillaries (often at specific organs with
favorable environments).
They penetrate the vessel wall and migrate into the surrounding tissue (parenchyma).
5. Colonization
Tumor cells proliferate at the new site to form a secondary (metastatic) tumor.
This step often requires adaptation to the new microenvironment and is the most
inefficient and limiting step in metastasis.
6. Angiogenesis (New Blood Vessel Formation)
Metastatic tumors stimulate angiogenesis to ensure oxygen and nutrient supply.
VEGF (Vascular Endothelial Growth Factor) plays a key role.
Neoplasia
Grading and Staging of Cancer
• The grading system differs depending on the type of cancer.
The generalized one used is:
• G1:- Well differentiated (Low grade)—Grows slowly
• G2:- Moderately differentiated (Intermediate grade)
• G3:- Poorly differentiated (High grade)—Grows rapidly
• G4:- Undifferentiated (High grade)
The TNM Staging System
• TNM stands for: T= Primary Tumor, N= Regional Lymph Node and M=Metastases.
This system uses number to describe the cancer.
• T-is characterized as T1-T4 based on the increasing size of the tumor with 1 being small
and 4 being large.
• N-refers to whether it has spread to the lymph nodes. N0 means no nodal involvement,
N1-N3 would denote involvement of an increasing number and range of nodes.
• M- M0 signifies no distant metastasis whereas M1 or M2 indicates the presence of
metastases.
Importance of staging
• Staging is important to help us know the type of treatment to give.
• If cancer is in just one place, a local treatment such as surgery or radiotherapy could get
rid of it completely.
• But if it has spread, systemic treatment such as chemotherapy, hormone therapy &
biological therapy that circulates throughout the body will be needed.
