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Neoplasms

Neoplasms. Tumor Nomenclature. Key: carcinoma vs. sarcoma. Leading sites of new cancer cases & deaths. Benign vs. Malignant Tumors. Key differences: Encapsulation vs. infiltration Differentiated cells vs. undifferentiated cells. Benign vs. Malignant. Malignant Tumors -- Pathophysiology.

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Neoplasms

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  1. Neoplasms

  2. Tumor Nomenclature • Key: carcinoma vs. sarcoma

  3. Leading sites of new cancer cases & deaths

  4. Benign vs. Malignant Tumors • Key differences: • Encapsulation vs. infiltration • Differentiated cells vs. undifferentiated cells

  5. Benign vs. Malignant

  6. Malignant Tumors -- Pathophysiology • Staging vs. grading • Staging = describes the extent of the disease at the diagnosis time • In-situ = malignant cells in pre-invasive stage • Usually I through IV ( higher = worse) • T, N, M system • T = tumor; N = involvement of lymph nodes; M = metastasis • Grading = describes the degree of differentiation of the malignant cells • Usually I through IV (higher = more undifferentiated)

  7. Local Effects • Pain • Not an early sx • Infection • From tissue necrosis and ulceration • From destruction of normal flora • Obstruction • When growth of the tumor compresses a duct or passageway

  8. Systemic effects • Weight loss • Cachexia = severe tissue wasting • Anemia • Causes = anorexia, chronic bleeding, & bone marrow depression • Infections • Especially pneumonia • Reason = stasis of secretions & weaker cough efforts • Paraneoplastic syndromes • Substances released from certain tumors have effects on: • Endocrine system (e.g. ACTH-like effect & ADH-like effect)

  9. Diagnostic tests • Blood tests • General = CBC (esp. when undergoing chemo or radiation) • Specific = called tumor markers • Exp = PSA • Imaging techniques • CAT, MRI, nuclear scanning (includes PET) • Exfoliative cytology • Biopsies

  10. Spread of malignant tumors • Primary tumor = parent tumor; initial site & cell type • Secondary tumor =other sites of identical tumor cells • 3 basic mechanisms • (1) invasioninto adjacent tissue • (2) metastasis via blood and/or lymphatics • (3) seeding = spread of tumor cells along serous membranes and in body fluids within serous body cavities

  11. Staging correlates with degree of spread

  12. Etiology of Cancer • Carcinogenesis = process when normal cells transformed into cancer cells • Factors in carcinogenesis are multiple & include: • Changes in DNA (mutations) • Genetic oncogenic factor • Radiation (gamma rays, X-rays, & ultraviolet rays) • Chemicals --- called carcinogens • Biological factors • Chronic irritation • Hormonal excess • Diet • Pathogens --- primarily viruses • Host defenses • Immune system has 3 types of cells that are “killers” (cytotoxic) • NK lymphocytes (NK = natural killer) • Killer T-lymphocytes • Macrophages

  13. Stages in carcinogenesis: • Initiating factors --- get irreversible DNA changes • Promoters ----repeated exposure to carcinogens • Promoters ---- continued exposure to carcinogens

  14. Cancer Treatment • 3 basic modalities • (1) surgery (2) chemotherapy (3) radiation • Curative treatment • Palliative treatment • Prophylactic adjunct therapy • Radiation therapy • Especially affects cells that rapidly reproduce • Epithelium, bone marrow, gonads • Adverse effects • Bone marrow depression • Epithelial tissue inflammation & ulceration --- get stricture & fibrosis • Ovarian or testicular damage • Non-specific fatigue & lethargy • Chemotherapy’s adverse effects • Hair loss, breakdown of mucus membranes, N&V, bone marrow depression

  15. Newer treatment modalities • Angiogenesis inhibitor drugs • These block endothelial cell regeneration • Anti- telomerase • Immunotherapy (biologic response modifiers) • Radioimmunotherapy (monoclonal antibodies & radioactive isotopes • Prognosis • Cure = 5 year survival without recurrence • Follow-up for metastasis • Key = Bone, Brain, Liver, & Lungs

  16. Treatments • Curative • Palliative • Prophylactic • Adjuvant therapy

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