Neoplasia

Neoplasia: Introduction Definition, causes, Classification, characteristics of neoplasia, Benign and Malignant tumours

1. NEOPLASIA By: Nityanand Upadhyay Associate Professor Department of MLT Integral University, Lucknow

2. The term ‘ neoplasia ’ means new growth. The new growth produced is called ‘neoplasm’ or ‘ tumour ’. However, all ‘new growths’ are not neoplasms . examples of new growth of tissues and cells: processes of embryogenesis, regeneration and repair, hyperplasia and hormonal stimulation. Introduction

3. The proliferation and maturation of cells in normal adults is controlled, Coordinated and having purpose. While neoplastic cells lose control and regulation of replication and form an abnormal mass of tissue.

4. Neoplasm or Tumour is “Mass of tissue formed as a result of abnormal, excessive, uncoordinated, autonomous and purposeless proliferation of cells even after cessation of stimulus for growth which caused it” Definition

5. The branch of science dealing with the study of neoplasms or tumours is called oncology. ( oncos = tumour , logos=study). The word ‘cancer’ means crab Hippocrates (460-377 BC) coined the term karkinos for cancer of the breast.

6. 1. Benign: When they are slow-growing and localised without causing much difficulty to the host. 2. Malignant: When they proliferate rapidly, spread throughout the body and may eventually cause death of the host. Types

7. All tumours , benign as well as malignant, have 2 basic components: 1. Parenchyma’ comprised by proliferating tumour cells. 2. ‘Supportive stroma ’ composed of fibrous connective tissue and blood vessels. Components of Tumour

8. 1. Mixed tumours : When two types of tumours are combined in the same tumour . 2. Teratomas : 3. Blastomas ( Embryomas ): 4. Hamartoma : 5. Choristoma : SPECIAL CATEGORIES OF TUMOURS

9. Classification of tumours is based on the histogenesis . i.e. cell of origin CLASSIFICATION

10. Usually on basis of cell/tissue of origin Main groups are: •Epithelial •Connective tissue ( mesenchymal ) •Lymphoid/ haematological •Mixture of all ( teratomas ) CLASSIFICATION

11. Nomenclature Tissue of origin Epithelial: Cell of origin Benign Malignant • Squamous cell Papilloma Sq C carcinoma •Glandular Adenoma Adenocarcinoma •Transitional TC Papilloma T C carcinoma •Basal Cell BC Papilloma B C carcinoma

12. Non-epithelial ( Mesenchymal ) Tumour : Cell of origin Benign Malignant . Adipose tissue Lipoma Liposarcoma . Adult fibrous Fibroma Fibrosarcoma tissue . Embryonic Myxoma Myxosarcoma Fibrous tissue . Cartilage Chondroma Chondrosarcoma

13. Cell of origin Benign Malignant . Bone Osteoma Osteosarcoma . Smooth muscle Leiomyoma Leiomyosarcoma . Skeletal muscle Rhabdomyoma Rhabdomyosarcom . Mesothelium — Mesothelioma . Blood vessels Haemangioma Angiosarcoma . Lymphoid tissue Pseudolymphoma Malignant lymphomas

14. MIXED TUMOURS: Cell of origin Benign Malignant . Salivary Pleomorphic - Malignant - Glands adenoma mixed salivary - tumour TUMOURS OF MORE THAN ONE GERM CELL LAYER: . Totipotent cells Mature Immature in gonads or teratoma teratoma in embryonal rests

15. I. Rate of growth II. Cancer phenotype and stem cells III. Clinical and gross features IV. Microscopic features V. Local invasion (Direct spread) VI. Metastasis (Distant spread). CHARACTERISTICS OF TUMOURS

16. Feature Benign Malignant CLINICAL AND GROSS FEATURES: 1. Boundaries Encapsulated Irregular 2. Surrounding compressed Invaded 3. Size Small Larger 4. Secondary less often more often changes Difference Between Benign & Malignant Tumor

17. Feature Benign Malignant II. MICROSCOPIC FEATURES : 1. Pattern : Resembles Poorly- Resemblance 2. Pleomorphism : Not present Present 3. N:C ratio Normal Increase 4. Anisonucleosis Absent Present

18. Feature Benign Malignant III . GROWTH RATE: Slow Rapid IV . LOCAL INVASION: Benign: Often compresses the surrounding tissues without invading or infiltrating them Malignant: Usually infiltrates and invades the adjacent tissues.

19. Feature Benign Malignant V . METASTASIS: Absent Present VI . PROGNOSIS: Benign: Local complications. Malignant: Death by local and metastatic complications.

20. Grade I: Well-differentiated (less than 25% anaplastic cells ). Grade II: Moderately-differentiated (25-50% anaplastic cells ). Grade III: Moderately-differentiated (50-75% anaplastic cells ). Grade IV: Poorly-differentiated or anaplastic (more than 75% anaplastic cells). Grading of Cancer:

21. Men Women Children 1. Lung Breast Acute leukaemia (oral cavity- ( cervix in India) in India) 2 . Prostate Lung CNS tumour 3. Colorectal Colorectal Bone sarcoma 4. Urinary Endometrial Endocrine bladder 5. Lymphoma Lymphoma Soft tissue sarcoma Most Common Primary Cancers in the World.

22. 1. FAMILIAL AND GENETIC FACTORS. . Multiple endocrine neoplasia (MEN). . Neurofibromatosis . Cancer of the breast: Female relatives of breast cancer patients have 2 to 6 times higher risk of developing breast cancer . . Etiology of Cancer:

23. 2. RACIAL AND GEOGRAPHIC FACTORS . i ) White Europeans and Americans develop most commonly malignancies of the lung, breast, and colon . ii) Black Africans, on the other hand, have more commonly cancers of the skin, penis, cervix and liver. iii) Japanese have five times higher incidence of carcinoma of the stomach than the Americans.

24. 3. ENVIRONMENTAL AND CULTURAL FACTORS . i ) Cigarette smoking : cancer of the oral cavity , pharynx, larynx, oesophagus , lungs, pancreas and urinary bladder . ii) Alcohol: cancer of oropharynx , larynx, oesophagus and liver . iii ) Alcohol and tobacco: cancer of the upper aerodigestive tract . iv) P aan in a particular place in mouth for a long time.

25. vii ) A large number of industrial and environmental substances are carcinogenic: like arsenic , asbestos, benzene, vinyl chloride, naphthylamine etc . iii ) Certain constituents of diet: Overweight individuals, deficiency of vitamin A and people consuming diet rich in animal fats and low in fibre content.

26. IV Pathogens :  Human papillomavirus  ( HPV ),  EBV  or  Epstein-Barr virus ,  hepatitis   viruses  B and C, Kaposi's sarcoma-associated  herpes  virus (KSHV), Merkel cell polyomavirus ,  Schistosoma  spp., and   Helicobacter pylori ; other bacteria are being researched as possible agents.

27. Fatigue Lump or area of thickening that can be felt under the skin Weight changes, including unintended loss or gain Skin changes, such as yellowing, darkening or redness of the skin, sores that won't heal, or changes to existing moles Changes in bowel or bladder habits Symptoms

28. Persistent cough or trouble breathing Difficulty swallowing Hoarseness Persistent indigestion or discomfort after eating Persistent, unexplained muscle or joint pain Persistent, unexplained fevers or night sweats Unexplained bleeding or bruising

29. Histopathological Cytopathological Haematological Tumour Marker Immunohistochemistry (IHC) Radiological : CT, MRI, PET CT. Diagnosis

30. Thanks…………..