Learning tasks

Define Neoplasia and Neoplasm, carcinogenesis

Describe tumor classification, characteristics and
nomenclature.
Explain risk factors for cancer development.
Explain aetiology and associated factors for tumour.
Outline effects of neoplasms on host.
Describe basic principles of cancer prevention and
control.
 DEFINITION.
 Neoplasia literally means "new growth.“
 Neoplasm is an abnormal mass of tissue of which the
growth exceeds and is uncoordinated with that of the
normal tissues and persists in the same excessive
manner after the cessation of the stimuli which evoked
the change."
 Neoplasm is often referred to as a tumor.
 The study of tumors is called oncology (from oncos,
"tumor," and logos, "study of").
 TUMOR CLASSIFICATION

 Tumors categorization is based on a neoplasm's

potential clinical behaviour.
 Of which are categorized into
a. Benign
b. Malignant
o The term cancer is commonly used as synonymous
of a malignant neoplasm,
o Cancer is a common term for all malignant tumors.
 Characteristics of tumors
 Benign and malignant tumors can be
distinguished on the basis of :
[Link] degree of differentiation
[Link] of growth
[Link] invasiveness
[Link] spread (metastasis)
 Difference between benign and
malignant tumor
Benign Malignant
I. Well differentiated I. poorly or completely
( resemble the tissue of undifferentiated
origin) (anaplastic)
II. Slow growing II. Generally grow faster
III. well circumscribed and III. poorly circumscribed and
have a capsule invade the surrounding
[Link] localized to the normal tissues
site of origin( no [Link] invasive and they
metastasis) metastasize to distant
sites
 Nomenclature of tumors
 Benign tumors
– Suffix “–oma” is added to the cell type
• Fibrous: fibroma
• Cartilage: chondroma
• Bone: osteoma
• Adipose tissue: lipoma
• Smooth muscle: leiomyoma
• Skeletal muscle: rhabdomyoma
• Blood vessels: hemangioma
• Epithelial: adenoma (cystadenoma, papilloma)
 NOMENCLATURE CONT…..
Malignant tumors
– Mesenchymal: sarcoma
• Fibrous: fibrosarcoma
• Cartilage: chondrosarcoma
• Bone: osteosarcoma
• Adipose: liposarcoma
• Smooth muscle: leiomyosarcoma
• Skeletal muscle: rhabdomyosarcoma
• Blood vessels: angiosarcoma
 NOMENCLATURE CONT…….
– Epithelial: carcinoma
• Gland forming: adenocarcinoma
• Squamous: Squamous cell carcinoma
• Transitional cell: Transitional cell carcinoma
(urothelial carcinoma)
 Mixed tumors:
– Pleomorphic adenoma of salivary gland
– Fibroadenoma of breast
 Teratoma: more than one germ-cell layer
– Teratoma contains: bone, epithelium, muscle, fat,
nerve….
 NOMENCLATURE CONT….
 Exceptions:
– Malignant tumors
• Lymphoma, melanoma, mesothelioma, seminoma,
hepatoma
o Hamartoma: not neoplastic, it is rather a malformation.
Hamartoma contain mixture of mature (adult-type) tissue
in abnormal distribution and arrangement
 RISK FACTORS FOR CANCER
DEVELOPMENT
 Usually not possible to know exactly why one person
develops cancer and another doesn’t.
o But researches has shown that certain risk factors may increase
a person’s chances of developing cancer.
 The incidence of cancer varies with
Age: Cancers are most common at the two
extremes of age
 Race:
Geographic factors: exposure to radiation or
other chemicals
Genetic backgrounds: breast cancer
Smoking ; lung, larynx, oral cavity
RELATIONSHIP BETWEEN DIET AND
CANCER
 Overweight/obesity increases the risk for cancers of the
oesophagus (adenocarcinoma), colorectum, breast
(postmenopausal), endometrium and kidney;

 Alcohol causes cancers of the oral cavity, pharynx,

oesophagus and liver, and a small increase in the risk for
breast cancer;

 Aflatoxin in foods causes liver cancer

Preserved meat and red meat probably increase
the risk for colorectal cancer.
Very hot drinks and foods probably increase the
risk for cancers of the oral cavity, pharynx and
oesophagus; drinks and foods should not be
consumed when they are scalding hot.
RELATIONSHIP BETWEEN DIET AND
CANCER CONT…..
 Salt preserved foods and high salt intake probably
increase the risk for stomach cancer.
 Physical activity, the main determinant of energy
expenditure, reduces the risk for colorectal cancer and
probably reduces the risk for breast cancer; regular
physical activity should be taken
 Fruits and vegetables reduce the risk for cancers of the
oral cavity, oesophagus, stomach and colorectum, and
diets should include at least 400 gm/d of total fruits and
vegetables.
 Carcinogenesis
 Carcinogenesis is a multi-step process at both
the phenotypic and the genetic levels, resulting
from the accumulation of multiple mutations.
 Carcinogen is a substance which cause
mutation changes in the cell.
 Three classes of carcinogenic agents includes;
 Chemicals
 Radiant energy
 Microbial agents
 Chemical Carcinogens
 Chemical carcinogens have highly reactive eletrophile
groups that directly damage DNA, leading to mutations
and eventually cancer.
 Following exposure of a cell to a mutagen or an initiator,
tumorigenesis can be enhanced by exposure to
promoters, which stimulate proliferation of the mutated
cells.
o Examples of chemicals carcinogens include
 direct-acting (e.g., alkylating agents used for
chemotherapy),
 indirect-acting (e.g., benzopyrene, azo dyes, and
aflatoxin), and promoters/agents that cause
pathologic hyperplasias of liver, endometrium
 Radiation Carcinogen.
 Ionizing radiation causes chromosome breakage,
translocations, and, less frequently, point mutations,
leading to genetic damage and carcinogenesis.
 Ultra Violet rays induce the formation of pyrimidine
dimers within DNA, leading to mutations.
 Therefore UV rays can give rise to squamous cell carcinomas in
albinos and melanomas of the skin.
 Microbial agents
 Human papilloma viruses- benign warts, types 16,18
cervical cancer, penile carcinoma. (oncogenic)
 Ebstein Barr Virus -Burkitt lymphomas,
 Hodgkin Lymphoma, nasopharyngeal carcinoma in
immunosuppressed individuals with HIV infection
 hepatocellular carcinoma – Hepatitis B Virus or Hepatitis
C Virus
 Human herpes virus 8- Kaposi sarcoma
 Bacteria; Helicobacter pylori - gastric cancer
 Schistosoma haematobium – squamous cell carcinoma
of the urinary bladder.
 Carcinogenesis
(Oncogenesis or tumorigenesis)
• Carcinogenesis is a multistep process resulting from
the accumulation of multiple genetic alterations that
collectively give rise to the transformed phenotype.
– It literally means mechanism of induction of tumours
(pathogenesis of cancer).
• Nonlethal genetic damage lies at the heart of
carcinogenesis.
– Such genetic damage (or mutation) may be acquired by
the action of environmental agents, such as chemicals,
radiation, or viruses, or it may be inherited in the germ
line.

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 Molecular pathogenesis of cancer
(Genetic mechanisms of cancer)
• Monoclonality of tumours.
– There is strong evidence to support that most human
cancers arise from a single clone of cells by genetic
transformation or mutation.
• Multi-step process of cancer growth and
progression.
– Carcinogenesis is a gradual multi-step process
involving many generations of cells.
– The various causes may act on the cell one after another
(multi-hit process).
– The same process is also involved in further progression of
the tumour.
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 Genetic regulators of normal and
abnormal mitosis.
1. Genes-growth-promoting proto-oncogenes.
2. Growth-inhibiting tumour suppressor genes.
3. Genes that regulate programmed cell death (i.e.
apoptosis).
4. Genes involved in DNA repair.
• In cancer, the transformed cells are produced by
abnormal cell growth due to genetic damage to
these normal controlling genes.

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 Genetic regulators of normal and
abnormal mitosis.
• Thus, corresponding abnormalities in these four
(4) cell regulatory genes are:
i. Activation of growth-promoting oncogenes causing
transformation of cell (mutant form of normal
protooncogene in cancer is termed oncogene).
ii. Inactivation of tumor-suppressor genes.
iii. Abnormal apoptosis regulatory genes which may act
as oncogenes or anti-oncogenes.
iv. Failure of DNA repair genes and thus inability to
repair the DNA damage resulting in mutations.

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 Cancer-related genes and cell
growth (Hallmarks of cancer)

[Link] to growth inhibitory signals.

[Link] of cell death.
[Link] replicative potential.
[Link] of sustained angiogenesis.
[Link] to invade and metastasize.
[Link] of energy metabolism.
[Link] of the immune system.

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 Clinical aspects of Neoplasia
• Indeed, both malignant and benign tumors may
cause problems because of:
1. Location and impingement on adjacent structures.
2. Functional activity such as hormone synthesis or
the development of paraneoplastic syndromes.
3. Bleeding and infections when the tumor ulcerates.
4. Cachexia or wasting.
5. Tumor lysis syndrome.
6. Anemia.

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CLINICAL ASPECTS OF TUMORS
 Cachexia, progressive loss of body fat and lean body
mass, accompanied by profound weakness, anorexia,
and anemia, is caused by release of cytokines by the
tumor or host.
 Paraneoplastic syndromes, is a systemic symptoms
that cannot be explained by tumor spread or by
hormones appropriate to the tissue, are caused by the
ectopic production and secretion of bioactive
substances, such as ACTH, PTHrP, or TGF-α.
 Symptoms include; difficulty walking, maintaining balance, loss
of muscle coordination,tone or weakness etc
 Tumour Marker
 Tumour marker is a substance, usually detected in the
serum, whose concentration can be related to the
presence of tumour.
 Clinically useful serum markers include:
o Human Chorionic Gonadotrophin (HCG) for Chorionic
carcinoma.
o Alpha feto-protein (AFP) for Hepatoma.
o Carcino-embyonic antigen (CEA) for Colo-rectal cancer.
o Prostatic acid phosphatase for prostatic cancer.
o Paraproteins (monoclonal immunoglobulins) for
Myeloma.
 These markers are of value in the diagnosis and/or follow –up of the
above tumours.
 PREVENTION AND CONTROL OF
CANCER
 Dietary: obesity , alcohol, low fruits and vegetable, high
red meat.
 Physical activity : Regular physical activity helps to
reduce up to 30% the risk of a variety of cancer types,
such as colon cancer, breast cancer, lung cancer and
endometrium cancer.
 Vaccination
 Human papillomavirus vaccine (Gardasil and Cervarix)
decreases the risk of developing cervical cancer
 The hepatitis B vaccine, prevents infection with
hepatitis B virus and thus decreases the risk of liver
cancer.
 Key Points
 Tumour nomenclature is important in recognizing the
type and classification.
 The tumour markers are essential in early diagnosis and
prevention of tumour occurrence.
 The pathology of tumours is responsible for clinical
presentation of neoplasia.
 The aetiology and pathogenesis of tumours involves
chemicals, radiant energy and microbial agents.
 Evaluation
1. What are neoplasms?
2. List types of neolasms
3. What is the difference between benign and
malignant tumours?
4. Name groups of carcinogens
5. List 4 oncogenic viruses
6. List are four tumour markers and their
corresponding tumours?
 References
 Kumar, A. et al (2004). Robbins Basic
Pathology. WB: Saunders.
 Spector, T.D. & Axford, J. S. (1999). Introduction
to General Pathology. Edinburgh: Churchill
Livingstone.
 Walter, J.B, & Talbot, I. C. (1996). General
Pathology. New York: Churchill Livingstone.