Tumor

Clinical method therapeutics

1. Tumor By Dr. Laraib Jameel Rph Find me on slideshare.net https://www.slideshare.net/

2. Tumor Definition: A tumor is a mass or lump of tissue that may resemble swelling. a mass of abnormal tissue that arises without obvious cause from preexisting body cells , has no purposeful function , and is characterized by a tendency to independent and unrestrained (uncontrolled) growth . Synonym : Neoplas m

3. Clinical manifestation:  Abnormal cells—the kind that generally make up tumors—differ from normal cells in having undergone one or more of the following alterations: ( 1)  hypertrophy Hyper= increase Trophy= suffix-growth an increase in the size of individual cells ; this feature is occasionally encountered in tumors but occurs commonly in other conditions ; ( 2)  hyperplasia , or an increase in the number of cells within a given zone ; in some instances it may constitute the only criterion of tumor formation ; ( 3)  anaplasia , Ana= backward Plasia = formation Loosing morphological characteristics of mature cells this is an almost constant feature of malignant tumors ,

4. Tumor nomenclature The human body is composed of two major classes of tissue : parenchymal or epithelial tissues mesenchymal tissues, comprising connective tissues, muscle and blood vessel. Benign tumors of most tissues are usually simply designated the suffix - oma . Malignant tumors of the parenchyma are designated the term carcinoma, while malignant tumors of mesenchymal tissues are designated the term sarcoma Carcinoma & sarcoma ---- Malignant

5. Types of tumors Tumors are groups of abnormal cells that form lumps or growths. They can start in any one of the trillions of cells in our bodies. Tumors grow and behave differently, depending on whether they are cancerous (malignant), non-cancerous (benign) or precancerous . Non-cancerous tumors/ Benign: Tumors that aren’t cancerous are called non-cancerous tumors. Non-cancerous tumors: stay in one place and don’t spread to other parts of the body don’t usually come back after they are removed may be moved easily with in the tissue However, they can cause pain or other problems if they press against nerves or blood vessels or if they trigger the overproduction of hormones, as in the endocrine system.

6. All  benign tumors  tend to remain localized at the site of origin . Why they remain localized? tend to have a regular and smooth shape and have a covering called a capsule Many benign tumors are enclosed by a capsule consisting of connective tissue derived from the structures immediately surrounding the tumor . Well-encapsulated tumors are not anchored(resides) to their surrounding tissues. These benign tumors enlarge by a gradual buildup , pushing aside the adjacent tissues without involving them intimately (closely). Malignant tumors , by contrast, do not usually possess a capsule; they invade the surrounding tissues, making surgical removal more difficult or risky.

7. Premalignant : In these tumors, the cells are not yet cancerous, but they have the potential to become malignant. Cancerous tumors/ Malignant : Cancer can start in any part of the body. When cancer cells form a lump or growth, it is called a cancerous tumor . A tumor is cancerous when it : grows into nearby tissues has cells that can break away and travel through the blood or lymphatic system and spread to lymph nodes and distant parts of the body Cancer that spreads from the first place it started (called the primary tumor) to a new part of the body is called  metastatic cancer . When cancer cells spread and develop into new tumors, the new tumors are called metastases.

8. Metastasis: is thus the outstanding characteristic of malignancy. Metastasis is the tendency of tumor cells to be carried from their site of origin by way of the  circulatory system and other channels, which may eventually establish these cells in almost every tissue and organ of the body. In contrast, the cells of a benign tumor invariably remain in contact with each other in one solid mass centered on the site of origin. Because of the physical  continuity of benign tumor cells, they may be removed completely by  surgery  if the location is suitable. But the dissemination of malignant cells, each one individually possessing (through cell division) the ability to give rise to new tumors in new and distant sites, requires complete eradication by a single surgical procedure in all but the earliest period of growth.

9. Examples of benign tumors include: Adenomas Adenomas develop in glandular (stomach, intestine, colon) epithelial tissue, which is the thin membrane that covers glands, organs, and other structures in the body . Examples include: polyps in the colon (abnormal growth protruding from mucous membrane) Fibro adenomas , a common form of benign breast tumor hepatic adenomas , which occur on the liver Adenomas do not start as cancer. However, some can change and become adenocarcinomas, which are cancerous .

10. Fibroids Fibroids, or fibromas, are benign tumors that can grow on the fibrous or connective tissue of any organ. Uterine fibroids are common and can cause : vaginal bleeding pelvic pain or discomfort They can be "soft" or "hard," depending on the proportion of fibers to cells. There are many types of fibroma, including: A ngiofibromas , Angio - composed of blood vessels & lymphatic vessels which can appear as small red bumps on the face D ermatofibromas , which appear on the skin, often on the lower legs Some fibromas can cause symptoms and may need surgery. In rare cases, fibroids can change and become fibrosarcomas . These are cancerous.

11. Hemangiomas Hemangiomas are congenital benign vascular, infantle tumor, that form when blood vessels grow excessively. They can appear as red "strawberry marks" on the skin or they can develop inside the body. They are often present at birth and disappear during childhood. Hemangiomas do not usually need treatment, but laser surgery and other options are available if they do not go away.

12. Lipoma Lipoma are most common in people from 40–60 years old. Lipoma are a form of soft tissue tumor and consist of fat cells. Most lipoma are small, painless, rubbery, soft to the touch, and movable. Location: They often appear on the back, shoulders, arms, buttocks, and the tops of the legs. they are unlikely to become cancerous.

13. Premalignant This type of tumor is not cancerous, but it needs close monitoring in case it changes. Examples include: Actinic keratosis Also known as solar keratosis , It is more likely to affect fair-skinned people , and sun exposure increases the risk . Appearance: is a rough, scaly patch on your skin that develops from years of exposure to the sun. Location: It's most commonly found on your face, lips, ears, back of your hands, forearms, scalp or neck Sometimes, actinic keratosis will transform into squamous cell carcinoma, so doctors usually recommend treating it.

14. 3- Malignant Malignant tumors are cancerous. They develop when cells grow uncontrollably. If the cells continue to grow and spread, the disease can become life threatening. Malignant tumors can grow quickly and spread to other parts of the body in a process called metastasis. The cancer cells that move to other parts of the body are the same as the original ones, but they have the ability to invade other organs. If lung cancer spreads to the liver, for example, the cancer cells in the liver are still lung cancer cells. Different types of malignant tumor originate in different types of cell.

15. Examples include: Carcinoma : These tumors form from epithelial cells, which are present in the skin and the tissue that covers or lines the body's organs. Carcinomas can occur in the stomach, prostate, pancreas, lung, liver, colon, or breast. They are a common type of malignant tumor. Sarcoma : These tumors start in connective tissue, such as cartilage, bones, fat, and nerves . They originate in the cells outside the bone marrow. Most sarcomas are malignant

16. Mechanism: The total number of cells composing the human body is determined not only by the rate of proliferation of cells but also by the rate of cell loss . Excess cells and those that are aged or have sustained damage that impairs normal functioning are eliminated to prevent accumulation of abnormal numbers of cells. The mechanism for regulating the removal of excess and impaired cells is known as apoptosis . Apoptosis: Also referred to as cell suicide or programmed cell death, apoptosis is an orderly process during which internal cellular structures are progressively dismantled, the impaired cell shrinks and finally is rapidly destroyed by immune cells.

17. While some cell types, such as those that compose the skin and bone marrow, continue to proliferate throughout life, other types including bone and muscle cells cease active proliferation when a human reaches adulthood. Most normal cells remain in a non-proliferative state unless they are stimulated to divide to replace lost cells. Abnormal regulation of the cell cycle can lead to the over proliferation of cells and an accumulation of abnormal cell numbers. Cancer cells arise from one cell that becomes damaged, and when divided, the damage is passed on to the daughter cell and again to the granddaughter cells and so on. Such uncontrolled, abnormal growth of cells is a defining characteristic of cancer

18. Cause: In a healthy body, cells grow, divide, and replace each other in the body. As new cells form, the old ones die. When a person has  cancer: 1- new cells form when the body does not need them . If there are too many new cells, a group of cells, or tumor, can develop. A neoplasm/tumor can be caused by an abnormal proliferation of tissues, which can be caused by genetic mutations . a mutation occurs near or around tumor suppressor Tp53 gene (Tumor protein) that normally inhibits the growth of tumors) resulting in inability to stop uncontrolled cell division .

19. Diagnosis: A person can sometimes see or feel a tumor, but others will only show up on imaging tests , such as a mammogram or an MRI. However, these tests can only detect whether a lump is present . A biopsy is necessary to determine the type of lump . The doctor will take a small sample of tissue and send it to a laboratory where technicians will examine it under a microscope. The doctor may take the sample either in their office, using a needle, or during a surgical procedure to remove the tumor. They may decide that a person needs surgery first if they suspect that a tumor is malignant or if it is pressing on a nerve or causing other problems . Mammography is the process of using low-energy X-rays to examine the human breast for diagnosis and screening. 

20. Once diagnosis has been done we grade them Grading schemes classify tumors according to the structure, composition, and function of tumor tissue—in clinical terms, the histological features of the tumour . The histological grade of a tumor refers to the degree of tissue differentiation or to an ensemble of tissue features that have been found to be a good predictor of the aggressiveness of the tumor . Most grading schemes classify a type of cancer into three or four levels of increasing malignancy .

21. Different stages of cancer: Example: esophageal cancer Stage 0  . Abnormal cells (not yet cancer) are found only in the layer of cells that line the esophagus. Stage I  . Cancer cells are found only in the layer of cells that line the esophagus. Stage II  . The cancer has reached the muscle layer or the outer wall of the esophagus. In addition, the cancer may have spread to 1 to 2 nearby lymph nodes (small glands that are part of the immune system ). Stage III  . The cancer has reached deeper into the inner muscle layer or the connective tissue wall. It may have spread beyond the esophagus into surrounding organ and/or has spread to more lymph nodes near the esophagus. Stage IV  . This is the most advanced stage. The cancer has spread to other organs in the body and/or to lymph nodes far from the esophagus.

22. Treatment: Squamous cell carcinoma can usually be treated with minor surgery. doctor may choose to use any of the following techniques to remove it : Excision: cutting out the cancer spot and some healthy skin around it, then stitching up the wound. Mohs surgery: excision and then inspecting the excised skin using a microscope; this requires stitching up the wound. Precautions: not used for non-melanoma skin & less than 1cm in size. Lymph node surgery: remove a piece of the lymph node; uses general anesthesia Dermabrasion : "sanding" your affected area of skin with a tool to make way for a new layer Cryosurgery: freezing of the spot using liquid nitrogen. apply a cold liquid to cancerous cells. The cells are allowed to warm up and then are frozen again. The cycle of freezing and thawing damages the abnormal cells.

23. Topical chemotherapy: a gel or cream applied to the skin , these are Powerful drugs that attack cancer cells throughout the body sometimes with microneedling . Targeted drug treatment: Newer treatments that target specific aspects of a cancer to curb cancer growth and spread. Photodynamic therapy (a photosensitizing solution applied to your skin then activated with a light or daylight, or sometimes with intense pulsed light. Targets cancer cells with a special laser light. Solution uses: improves efficiency of procedure, selectivity, targeted method