COURSE TITLE

Pathology
Course Code: 514-T(REGULAR SESSION 2023)
(CHAPTER 04: SPECIFIC DISEASES)
Leukemia or Blood Cancer (Malignant Carcinoma, Sarcoma &
Lymphomas), Diagnosis and treatment of Cancer in general,
fate, survival and prognosis with tumors)
COURSE INCHARGE:
Ms Asma Eraj
Chapter outline
INTRODUCTION ABOUT
CANCER,TERMINOLOGIES
CLASSIFICATION OF CANCER
PROGNOSIS, DIAGNOSIS TREATMENT
FATE AND SURVIVAL
Learning objectives
Students will be able to classify the tumors on
the basis of origin, on the basis of their spread
in different tissues, on the basis of type of
organ
Cancer staging and prognosis general
diagnosis treatment
INTRODUCTION
 Neoplatic disease/malignancy
 Neoplasia
 The term neoplasm (‘new growth’) describes this tendency to
excessive, uncontrolled growth.
It is synonymous with the less technical ‘tumor’ (swelling).
 Benign tumors enlarge but do not invade surrounding tissue. They
are generally much less dangerous than malignant tumors, which
do invade local tissues and also spread to distant sites (metastasis).
 However, the term ‘benign’ can be misleading because a large
growth, even if not disseminated, can nevertheless be fatal by
interfering locally with a vital organ or function, e.g. tumors in the
brain or endocrine glands, or those obstructing a major blood
vessel.
Classification & nomenclature of
cancers
The nomenclature of cancer is complex and
inconsistent (Table 10.1).
It attempts to classify
three characteristics, all of which have a
bearing
on prognosis and treatment:
• The tissue of origin (in the histological
sense).
• The organ of origin.
• Whether it is benign or malignant.
Nomenclature
 The suffix -oma simply denotes a tumour, e.g.
osteoma (bone tumor), adenoma (gland
tumor).
 Malignant tumors are predominantly
carcinomas (epithelial origin, e.g. adenocarcinoma),
 sarcomas (connective tissue, e.g. osteosarcoma)
 leukemia's (hematological).
Most malignant human tumors are carcinomas,
partly because epithelia have the greatest exposure to
potentially carcinogenic environmental agents and partly
because they usually have a high cell turnover, with an
attendant greater likelihood of neoplastic mutation.
EPIDEMIOLOGY
AGE
GENDER
SITE
OCCUPATION
GEOGRAPHICAL & ETHINIC BELIEFS AND
VARIATIONS
AETIOLOGY
GENETIC FACTORS
ENVIRONMENTAL
FACTORS
CHEMICALS
RADIATIONS
TRAUMA
INFECTIONS
PSYCOSOCIAL
IMMUNOLOGICAL
Investigation and diagnosis
The diagnosis of malignancy is ultimately
histological. However, the whole panoply of
modern investigative techniques are
exploited. The aims of investigation may
include:
• screening;
• locating a suspected lesion;
• obtaining a biopsy and characterizing it;
• ‘staging’ the illness;
• monitoring the patient’s progress.
The three priorities in dealing with cancer are,
in order of importance:
• Prevention.
• Early detection.
• Total eradication.
Pathogenesis
PROGNOSIS OF CANCER
 A prognosis is like a prediction of how the diagnosis will affect you.
The following categories of prognoses are typically used:
 Excellent:
 Good: Implies that.
 Fair:
 Poor:
 Guarded: A mental health professional may use this term when they
don't have enough information to predict the outcome.

 Some of the factors that affect prognosis include:

 The type of cancer and where it is in your body.
 The stage of the cancer, which refers to the size of the cancer and if
it has spread to other parts of your body.
 The cancer's grade, which refers to how abnormal the cancer cells
look under a microscope.
Staging in Cancer
 An important part of treating a patient’s cancer is to
first find out how far it has spread - or what “stage” it
has reached
 Staging is a system that is used to classify the extent
of cancer
 This information is vital to decide what treatment is
appropriate
 When do you stage cancer?
 Usually, the cancer is staged at the time of diagnosis
 This may not be possible if patient present as an
emergency
 After surgery, a pathologist studies tissue the surgeon
removed and assigns it a “pathological stage”
 In general, the pathological stage is the most
important one in making treatment decisions
stages of cancer
 In situ cancer
 Early cancer that has not invaded the
basement membrane of tissue in which it
developed.
Invasive cancer Cancer that has spread
beyond the BM and is growing into
surrounding healthy tissues.
It is usually divided into 4 stages.
Local disease is cancer limited to its primary site.
Regional disease is cancer spreading to regional
lymph nodes.
Distant disease is cancer spreading to the
systemic organs like bone, brain, lung and liver.
What is the TNM system?
 Standard system for staging most cancer
 Based on the tumour, lymph node, and metastasis (TNM)
 The American Joint Committee on Cancer (AJCC) developed
the TNM system and maintains and updates it
 The TNM system serves as a “common language” in cancer
care
 What is the TNM system? • The “T” in TNM relates to tumor. It
indicates tumour size, extent, or penetration (depth) of the
tumor.
 The “N” stands for node. It indicates the number of lymph
nodes with cancer or the location of the cancer-involved
lymph nodes.
 The “M” stands for distant metastasis, or spread of the cancer
to other parts of the body.
 What is the TNM
system?
 Different tumors may spread to different parts
of the body. It is important to test whether the
tumor has spread to other organs
 Patients can have tests such as computed
tomography (CT scans), magnetic resonance
imaging (MRI), positron emission tomography
(PET scans) and/or laparoscopy to stage cancer
 After staging of the cancer, the patient and
the doctor can then make a treatment plan
 The most common cancers that doctors stage
using the TNM system are breast, colorectal,
stomach, oesophagus, pancreas, and lung
 Other cancers staged with the TNM system
include soft tissue sarcoma and melanoma
 Staging systems exist for 52 sites or types of
cancer
Cancer using other staging
system
 Some cancers are not staged using the TNM system.
Cancers of the blood, bone marrow, brain, and other
sites do not use the TNM staging
 Gynaecological cancers use another staging system
(FIGO) – The International Federation of Gynaecology
and Obstetrics, usually just FIGO as the acronym of
its French name Fédération Internationale de
Gynécologie et d'Obstétrique
 Other Pathological Staging • Dukes staging of
colorectal cancer • Based on histological examination
of the resected colorectal cancer specimen

What does stage grouping mean?
Once the TNM categories have been
determined, they can place the cancer into a
“stage group”
Stage grouping uses Roman numeral I, II, III, or
IV
 The larger the stage number, the more
advanced the stage of cancer
• Staging information is useful to: – guide
adjuvant treatment such as chemotherapy /
radiotherapy – determine prognosis and
survival
 MALIGNANCIES

Lymphomas
Carcinomas Sarcomas Leukemia
(Lymphocytes)
(epithelial tissues) (mesenchymal tissues) (WBC S)

(Acute Myeloid Leukemia)AML

(Chronic Myeloid
Leukemia)CML HODGKIN cell
Fibosarcomas
Adenomas (Acute Lymphocytic leukemia Non Hodgkin cell
Rhabdomyosarcoma Leukemia)ALL
(Chronic lymphocytic
Leukemia)CLL
HEMATOGENESIS
HEMATOGENESIS
What is leukemia?
 Leukemia is a type of cancer that affects the blood and bone marrow,
where blood cells are produced.
 It is characterized by the abnormal production of white blood cells.

 WBCs are a vital part of your immune system. They protect your
body from invasion by bacteria, viruses, fungi, abnormal cells ,
foreign substances
 In leukemia, the WBCs do not function like normal WBCs.
They can also divide too quickly and eventually crowd out
normal cells.
 WBCs are mostly produced in the bone marrow, but certain types of
WBCs are also made in the lymph nodes, spleen, thymus gland
 Once formed, WBCs travel through your bloodstream and lymphatic
vessels to fight infection in the body’s tissues.
Types of leukemia
The onset of leukemia can be acute (sudden onset) or
chronic (slow onset). In acute leukemia, cancer cells
multiply quickly. In chronic leukemia, the disease
progresses slowly and early symptoms may be very
mild.
Leukemia is also classified according to the type of cell
that’s affected.
Leukemia involving myeloid cells is called myeloid or
myelogenous leukemia. Myeloid cells are immature
blood cells that would normally become granulocytes or
monocytes.
Leukemia involving lymphocytes is called lymphocytic
leukemia.
 Types of leukemia
 Lymphocytic leukemia (also known as lymphoid or lymphoblastic leukemia) develops in the white blood
cells called lymphocytes in the bone marrow.
 Myeloid leukemia (also known as myelogenous leukemia) may also start in white blood cells other than
lymphocytes, as well as red blood cells and platelets.
 In terms of how quickly it develops or gets worse, leukemia is classified as either acute (fast-growing) or
chronic (slow-growing):

• Acute (fast-growing):
 Acute leukemia is rapidly progressing and results in the accumulation of immature, functionless blood
cells in the bone marrow. With this type of leukemia, cells reproduce and build up in the marrow,
decreasing the marrow’s ability to produce enough healthy blood cells.
 Chronic leukemia (slow progression) progresses more slowly and results in the accumulation of
relatively mature, but still abnormal, white blood cells. It tends to take longer to start causing noticeable
problems than acute leukemia. However, chronic, slower-growing leukemia may be more difficult to
treat.
 What are the common types of leukemia?
 Acute(fast progression)
•Acute Lymphoblastic Leukemia (ALL)
•Acute Myeloid Leukemia (AML)
•Chronic (slow-growing):
•Chronic Lymphocytic Leukemia (CLL)
•Chronic Myeloid Leukemia (CML)
Acute lymphocytic leukemia (AL
L)
 progresses rapidly, replacing healthy cells that produce functional lymphocytes with leukemia cells that
can't mature properly.
 The leukemia cells are carried in the bloodstream to other organs and tissues, including the brain, liver,
lymph nodes and testes, where they continue to grow and divide. The growing, dividing and spreading
of these leukemia cells may result in a number of possible symptoms, some of which may resemble the
flu. They include fatigue, shortness of breath, fever, and easy bruising or bleeding, among other
symptoms.
 ALL develops when changes in DNA (mutations) cause the bone marrow to produce too many abnormal
lymphocytes (a type of white blood cell). Lymphocytes are supposed to help fight infections, but the
ones produced in people with ALL are unable to do so properly. The proliferation of these abnormal cells
also crowds out other types of healthy blood cells.
 It’s unknown what exactly causes the mutations that lead to ALL, but certain factors may increase
one’s risk. Risk factors for ALL include:
 Being male, white and older than 70 years old
 Having a history of chemotherapy or radiation exposure .
 ALL may be diagnosed with blood tests and a bone marrow aspiration and biopsy, which involve
extracting a sample of bone marrow and a tiny piece of bone, then studying the cells under a
microscope.
 Some of the common treatment options for ALL include:
 Chemotherapy
 Radiation therapy
 Stem cell transplant
 Targeted therapy
Acute myeloid leukemi
a (AML)
 It is also known as acute myelogenous leukemia, acute myeloblastic leukemia, acute
granulocytic leukemia or acute nonlymphocytic leukemia, is a fast-growing form of
blood and bone marrow cancer.
 Like ALL, AML causes the bone marrow to overproduce abnormal white blood cells,
crowding healthy blood cells and affecting the body’s ability to fight infections.
 Risk factors for AML include:
 Being male
 Smoking
 Having past chemotherapy treatment or radiation exposure
 Some symptoms may resemble the flu—such as fever, fatigue and night sweats.
Others include easy bruising or bleeding and weight loss. Blood tests and bone
marrow aspiration and biopsy are among the tests that may be done to diagnose this
cancer.
 Treatment may include:
 Chemotherapy
 Radiation therapy
 Stem cell transplant
 Targeted therapy
Chronic lymphocytic leukemia (CLL)
 is a typically slow-growing cancer that begins in lymphocytes in the bone marrow and extends into the blood. It may also
spread to lymph nodes and organs such as the liver and spleen. CLL develops when too many abnormal lymphocytes
grow, crowding out normal blood cells and making it difficult for the body to fight infection.
 About 25 percent of all cases of leukemia are CLL, and approximately one in every 175 people may develop CLL in their
lifetime, according to the American Cancer Society (ACS). CLL is like ALL, but it’s chronic instead of acute, meaning that
it’s more slow-growing and takes longer to start causing symptoms.
 When it does cause symptoms, these may include swelling in the lymph nodes (neck, underarm, stomach or groin),
fatigue, fever, infection, weight loss and more. Various blood tests may be used to help diagnose CLL.
 CLL may not need to be treated immediately, but rather monitored for any problems and changes, at which point the
need for treatment may be reassessed.
Treatment options include:
 Targeted therapy
 Chemotherapy
 Radiation therapy
 Immunotherapy
 Learn more about CLL
 Chronic myeloid leukemia (CML), also known as chronic myelogenous leukemia, begins in the blood-forming cells of
the bone marrow and then, over time, spreads to the blood. Eventually, the disease spreads to other areas of the body.
 CML is slow-growing, but once it starts causing symptoms, these may include fatigue, fever, weight loss and an enlarged
spleen. Around half of CML cases are diagnosed by a blood test before symptoms have begun. About 15 percent of
leukemias are CML, according to the ACS.
 Treatment options include:
 Targeted therapy
 Chemotherapy
 Immunotherapy
 Stem cell transplant
Types of leukemia
 There are four main types of leukemia:
 Acute myeloid leukemia (AML)
 Acute myeloid leukemia (AML) can occur in children and adults. According to the Surveillance,
Epidemiology, and End Results Program of the National Cancer Institute (NCI)Trusted Source,
about 20,000 new cases of AML are diagnosed each year in the United States. This is the most
common form of leukemia. The 5-year survival rate for AML is 29.5 percent.
 Acute lymphocytic leukemia (ALL)
 Acute lymphocytic leukemia (ALL) occurs mostlyTrusted Source in children. The NCITrusted
Source estimates about 6,000 new cases of ALL are diagnosed annually. The 5-year survival
rate for ALL is 69.9 percent.
 Chronic myeloid leukemia (CML)
 Chronic myeloid leukemia (CML) affects mostly adults. About 9,000 new cases of CML are
diagnosed annually, according to the NCITrusted Source. The 5-year survival rate for CML is
70.6 percent.
 Chronic lymphocytic leukemia (CLL)
 Chronic lymphocytic leukemia (CLL) is most likely to affect people over age 55. It’s very rarely
seen in children. According to the NCITrusted Source, about 21,000 new cases of CLL are
diagnosed annually. The 5-year survival rate for CLL is 87.2 percent.
 Hairy cell leukemia is a very rare subtype of CLL. Its name comes from the appearance of the
cancerous lymphocytes under a microscope.
 Lymphoma
 Lymphoma is cancer that begins in infection-fighting cells of the immune
system, called lymphocytes. These cells are in the lymph nodes, spleen,
thymus, bone marrow, and other parts of the body. When you have
lymphoma, lymphocytes change and grow out of control.
 There are two main types of lymphoma:
 Non-Hodgkin: Most people with lymphoma have this type.
 Hodgkin
 Non-Hodgkin and Hodgkin lymphoma involve different types of
lymphocyte cells. Every type of lymphoma grows at a different rate and
responds differently to treatment.
 Lymphoma is very treatable, and the outlook can vary depending on the
type of lymphoma and its stage.
 Lymphoma is different from leukemia. Each of these cancers starts in a
different type of cell.
 Lymphoma starts in infection-fighting lymphocytes.
 Leukemia starts in blood-forming cells inside bone marrow.
ETIOLOGY
 Causes of lymphomas are still unclear,You might be more at risk if you:
 Ages 60s or older for non-Hodgkin lymphoma
 Ages 15 and 40 or older than 55 for Hodgkin lymphoma
 male, although certain subtypes may be more common in females
 Have a weak immune system from HIV/AIDS, an organ transplant, or because you were born with an immune disease
 Have an immune system disease such as rheumatoid arthritis, Sjögren's syndrome, lupus, or celiac disease
 Have been infected with a virus such as Epstein-Barr, hepatitis C, or human T-cell leukemia/lymphoma (HTLV-1)
 Have a close relative who had lymphoma
 Were exposed to benzene or chemicals that kill bugs and weeds
 Were treated for Hodgkin or non-Hodgkin lymphoma in the past
 Were treated for cancer with radiation

 gs and weeds
Symptoms
Warning signs of lymphoma include:
Swollen glands (lymph nodes), often in the neck, armpit,
or groin that are painless
Cough
Shortness of breath
Fever
Night sweats
Fatigue
Weight loss
Itching
Many of these symptoms can also be warning signs of
other illnesses.
Hodgkin Lymphoma?
 Hodgkin lymphoma, also known as Hodgkin's disease, is a type of
lymphoma, a cancer of the lymphatic system.
 The lymphatic system is a network of nodes (knots of tissue)
connected by vessels that drain fluid and waste products from the
body. The lymph nodes act as tiny filters, straining out foreign
organisms and cells.
 The lymphatic system also is involved in producing important white
blood cells called lymphocytes that help protect you against various
infections caused by bacteria, viruses, and fungi. When the lymphatic
system is fighting an active infection, you may notice that some of
your lymph nodes and tissue in the area of the infection become
swollen and tender. This is the body's normal reaction to infection.
 Lymphoma occurs when the lymph node cells or the lymphocytes
begin to multiply uncontrollably, producing malignant cells that have
the abnormal ability to invade other tissues throughout your body.
STAGING OF LYMPHOMA’S
 STAGING OF LYMPHOMA’S
 Staging for Hodgkin lymphoma is based on the Ann Arbor staging system.
Each stage is subdivided and assigned to category A, B or E.
 Hodgkin Lymphoma Stages
 Stage I
 Involvement of one lymph node or a group of adjacent nodes.
 Stage II
 Involvement of two or more lymph node regions on the same side of the
diaphragm (a thin muscle below the lungs)
 Stage III
 Involvement of lymph node groups on both sides of the diaphragm (for
example, neck, chest and abdomen)
 Stage IV
 Involvement of lymph nodes on both sides of the diaphragm and/or
involvement of organs such as the lungs, spleen, liver, bones or bone
marrow
CATEGORIES
Categories A, B and E
Each stage of Hodgkin lymphoma is subdivided and
assigned to category A, B, E, or S. :
Category A indicates no symptoms are present
Category B indicates the presence of "B symptoms:"
 Unexplained fevers (higher than 100.4°F)
 Drenching night sweats
 Unexpected weight loss of more than 10 percent of body
weight within 6 months prior to diagnosis
Category E indicates involvement of organs or tissues
beyond the lymph system.
Category S indicates involvement of the spleen.
For example, staging for Hodgkin lymphoma based
on the Ann Arbor staging system means that a
patient with stage IIB Hodgkin lymphoma has
Involvement of two lymph node sites near each
other (for example, enlarged lymph nodes in the
neck and near the collarbone, or in the neck and
the armpit)
Fever, excessive sweating and weight loss.
Your treatment depends on your stage and
category. Patients who fall into the B category
usually need more aggressive treatment than A
category patients do
 Hodgkin cell lymphoma subtypes
 The World Health Organization (WHO) divides Hodgkin
lymphoma into two main subtypes. They are:
 Classical Hodgkin lymphoma
 Nodular lymphocyte-predominant Hodgkin lymphoma
 Classical Hodgkin lymphoma is characterized by the
presence of both Hodgkin and Reed-Sternberg cells.
Nodular lymphocyte-predominant Hodgkin lymphoma
is characterized by the presence of lymphocyte-
predominant cells, sometimes termed “popcorn cells,”
which are a variant of Reed-Sternberg cells.
 It is important to know your subtype since it plays a
large part in determining the type of treatment you will
receive.
Classical Hodgkin Lymphoma
About 95 percent of people with Hodgkin
lymphoma have classical Hodgkin lymphoma.
This subtype is further divided into four distinct
subtypes shown in the table below.
Types on the basis of Histology
Nodular Lymphocyte-Predominant Hodgkin Lymphoma
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL)
affects about 5 percent of Hodgkin lymphoma patients. The
following are some characteristics of NLPHL:
•Most common in 30 to 50-year-old age group
•More common in males
•Slow growing and can relapse many years later
•Highly curable.
Small risk of transformation to aggressive non-Hodgkin lymphoma
(7 % of cases)
SUMMARY
 The term neoplasm (‘new growth’) describes this tendency to excessive,
uncontrolled growth.
It is synonymous with the less technical ‘tumor’ (swelling).
 Hodgkin lymphoma, also known as Hodgkin's disease, is a type of
lymphoma, a cancer of the lymphatic system.
 LYMPHOMAS staged as I,II,III,IV
 Warning signs of lymphoma include:
 Swollen glands (lymph nodes), often in the neck, armpit, or groin that are
painless
 Cough,Shortness of breath,Fever,Night sweats,Fatigue, Weight
loss,Itching
 the common types of leukemia?
 Chronic lymphocytic leukemia
 Acute myeloid leukemia
 Chronic myeloid leukemia
 Acute lymphocytic leukemia
REFERENCES
Walter GB. Walters and Israel General
Pathology. 7th Ed. Churchill Livingstone;
1996
Kumar V, Cotran RS, Robbins SL. Robbin’s
Basic Pathology. 8th Ed. W. B. Saunders
Publishers; 2007
https://www.stlouischildrens.org/health-
resources/pulse/medical-animation-non-
hodgkins-lymphoma