nursing neoplasia.pptx nursing nursing nursing nursing

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1. Neoplasia - Dr Rohan

2. According to British Oncologist Willis- “A neoplasm is an abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of normal tissues and persist in the same excessive manner after cessation of stimuli which evoked the change” In modern molecular pathology: A neoplasm can be defined as a disorder of cell growth that is triggered by a series of acquired mutations affecting a single cell and its clonal progeny.

3. Neoplasia : Components All neoplasm have two basic component: 1) Parenchyma: Made up of tumor neoplastic cells. 2) Reactive Stroma : The connective tissue, blood vessels and cells of the adaptive and innate immune system.

4. Classification on Biological behavior On the basis of biological behaviour and morphologic characteristics tumor is divided into: i . Benign tumor ii. Malignant tumor

5. Benign Tumor A tumor is benign when: Tumours gross and microscopic appearances are innocent remain localized will not spread to other sites local surgical removal is possible. • The patient having benign tumour generally survives. • Benign tumors are designated by attaching the suffix - oma to the name of the cell type from which the tumor originates. Cell type+ OMA example: fibroma , chondroma , lipoma

6. • Adenoma : Benign epithelial neoplasms derived from columner epithelium or glands. • Papilloma : Benign epithelial tumor producing microscopically or macroscopically visible finger-like projection from the epithelial surfaces. • Polyp: A non neoplastic or neoplastic macroscopically visible projection above a mucosal surface is termed a polyp.

7. Malignant Tumors • Malignant tumors are collectively referred to as cancer. • Malignant tumors invade and destroy adjacent structures and spread to distant sites (metastasize) to cause death.

8. Malignant Tumors: nomenclature • Malignant tumors arising in mesenchymal tissues are usually called sarcoma. e.g. fibrosarcoma , chondrosarcoma , leiomyosarcoma , rhabdomyosarcoma . • Malignant tumors arising cells from blood-forming cells are designated leukemia or lymphoma. • Malignant tumors arising from epithelial cell origin are called carcinoma. E.g : Squamous cell carcinoma, adenocarcinoma .

9. Mixed tumor • Tumor arising from a single clone of cell capable of forming epithelial, myoepithelial cells, myxoid stroma containing cartilage and bone is called mixed tumour .

10. • Teratoma is a tumor arising from more than one germ layer, usually all three. Teratoma is seen in the ovary and testis (ovarian dermoid cyst). • Choristoma is the heterotopic (abnormal place) rest of normal cells. • Hamartomas are disorganized masses of cells composed of cells native to that sit

11. Benign tumor VS Malignant tumor Neoplastic cell criteria 2) Rate of growth 3) Size of the tumor 4) Haemorrhage and necrosis 5) Capsulated or not 6) Local invasion present or not 7) Metatasis 8) Clinical effects

12. • Some tumor which has “ oma ” but are not benign: Lymphoma, Melanoma, Seminoma . • Some benign tumor without capsule: Haemangioma , leiomyoma . • Locally invasive/ Locally malignant tumor: Tumor have local invasion but no tendency to metastasize. i . Basal cell carcinoma of skin. ii. Giant cell tumor of bone.

13. Differentiation and Anaplasia Differentiation refers to the extent to which neoplastic tumor cells resembles the corresponding normal parenchymal cells, both morphologically and functionally. Lack of differentiation is called Anaplasia . Lack of differentiation or anaplasia is considered as hallmark of malignancy. Anaplastic features are found in malignant tumors

14. Features of Anaplasia Anaplasia is associated with cellular feature like: 1. Pleomorphism 2. Abnormal nuclear morphology(increased N:C ratio, variable nuclear shape and hyperchromasia ) 3. Mitosis(atypical , bizarre mitotic figures) 4. Loss of polarity 5. Other changes(ischemic necrosis)

15. Dysplasia • Dysplasia means “disordered growth.” • Dysplasia is the loss of uniformity of the individual cells and loss of their architectural orientation. • Dysplasia may be a precursor to malignant transformation, but it does not always progress to cancer.

16. Dysplastic cells may exhibit pleomorphism and large hyperchromatic nuclei with a high nuclear-to-cytoplasmic ratio. Mitotic figures are more abundant than in the normal tissue and may be seen at all levels including surface epithelial cells.

17. Carcinoma in Situ (CIS) • When dysplastic changes are marked and these atypical dysplastic cells involve the full thickness of the epithelium it is called carcinoma in situ. • Carcinoma in situ is limited to the basement membrane and do not cross the basement membrane.

18. • Carcinoma in Situ (CIS) is a malignant condition but the malignant cells do not cross the basement membrane. • Once the tumor cells cross the basement membrane, it is called invasive carcinoma. • Management of CIS is same like invasive carcinoma.

19. Metaplasia It is the replacement of one type of cell with another type. It is usually associated with tissue damage, repair and regeneration. The metaplastic tissue is prone to malignant transformation.

20. Local invasion The growth of cancers is accompanied by progressive invasion, destruction of surrounding tissue, and eventually systemic spread, whereas nearly all benign grow as cohesive, expansile masses that remain localized to their site of origin and the lack of capacity to invade or metastatize to distant sites. Benign tumors are usually surrounded by capsule, which consists of extracelular matrix(deposited by fibroblasts) [exception- hemangiomas ] After metastases, invasiveness is the most reliable discriminator of malignant and benign tumors.

21. Metastasis • Metastasis is the spread of a tumor to sites that are discontinuous with the primary tumor site. Metastasis marks a tumor malignant. • The invasiveness of cancers permits them to penetrate blood vessels, lymphatics and body cavities, causing distant spread All malignant tumors can metastasize(although some rarely do that e.g. glioma , basal cell carcinoma) The properties of invasiveness and metastasis are separable.

22. Pathways of metastasis Pathways of metastasis are: 1.Lymphatic spread (Usually Carcinoma) 2.Haematogenous spread (Usually Sarcoma) 3. Direct seeding of body cavities or surfaces ( Pseudomyxoma peritonei )

23. Epidemiology

24. Environmental factors Although both genetic and environmental factors contribute, environmental influences are dominant risk factors for most cases. Infections : HPV – Cervical carcinomas, juvenile papilloma HBV, HCV – Liver cancer EBV – Hodgkin’s Lymphoma 2. Smoking : cancer of Lung, mouth, larynx, pharynx, esophagus, pancreas and bladder 3. Alcohol consumption : Ca of oropharynx(excluding lip), larynx, esophagus and HCC(by development of cirrhosis)

25. Diet : e.g. colorectal carcinoma Obesity : increases the mortality Reproductive history : estrogen may lead to the cancers of breast and endometrium 7. Environmental Carcinogens : Asbestos, smoked meat, dry fish, etc.

26. The Warburg Effect Even in the presence of ample oxygen, cancer cells demonstrate a distinctive form of cellular metabolism characterized by high levels of glucose uptake and increased conversion of glucose to lactose (fermentation) via the glycolytic pathway. This phenomenon, called the Warburg effect and also known as aerobic glycolysis, has been recognized for many years (Otto Warburg received the Nobel Prize in 1931 for discovery of the effect that bears his name). Clinically the “glucose hunger” of tumors is used to visualize them via positron emission tomography (PET) scanning, in which patients are injected with 18F-fluorodeoxyglucose, a nonme - tabolizable derivative of glucose that is preferentially taken up into tumor cells (as well as normal, actively dividing tissues such as bone marrow) It happens because Aerobic glycolysis provides rapidly dividing tumor cells with metabolic intermediates that are needed for the synthesis of cellular components, whereas mitochondrial oxidative phosphorylation does not. Pure oxidative phosphorylation in mitochondria only provides abundant ATP Many oncoproteins (RAS, MYC, mutated growth factor receptors) induce or contribute to Warburg metabolism, and many tumor suppressors (PTEN, NF1, p53) oppose it.

27. Angiogenesis • Vascularization of tumors is essential for their growth and is controlled by the balance between angiogenic and anti- angiogenic factors that are produced by tumor and stromal cells. • Hypoxia triggers angiogenesis through the actions of HIF1α on the transcription of the pro- angiogenic factor VEGF. • Many other factors regulate angiogenesis; for example, p53 induces synthesis of the angiogenesis inhibitor thombospondin-1, while RAS, MYC, and MAPK signaling all upregulate VEGF expression and stimulate angiogenesis. • VEGF inhibitors( bevacizumab ) are used to treat a number of advanced cancers and prolong the clinical course, but are not curative.

28. Laboratory Diagnosis of Cancer 1.Histologic and Cytologic method: (a) Biopsy followed by Histopathology (b) Fine Needle aspiration cytology (FNAC) (c) Cytologic smear (Cervical smear). 2.Molecular diagnosis. 3.Tumor marker.

29. Immunohistochemistry - Categorization of undifferentiated malignant tumors - Determination of site of origin of metastatic tumors - Detection of molecules that have prognostic or therapeutic significance Flow Cytometry FISH

30. Thank You