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PRESENTATION

“WHAT IS NEOPLASMS”
BY

RASHID HUSSAIN

Post R.N B.Sc Nursing

SUBJECT: ADVANCE NURSING CONCEPTS-II

Khyber Medical University


Post Graduate College of Nursing Peshawar
23-01-2010
Introduction
Gradual increase in the number of dividing cells creates a

growing mass of tissue called a "tumor" or "neoplasm." If

the rate of cell division is relatively rapid, and no "suicide"

signals are in place to trigger cell death, the tumor will

grow quickly in size; if the cells divide more slowly, tumor

growth will be slower. But regardless of the growth rate,

tumors ultimately increase in size because new cells are

being produced in greater numbers than needed. As more

and more of these dividing cells accumulate, the normal

organization of the tissue gradually becomes disrupted. 2


AIM: To share the knowledge among the
participants about the Basic concept of
Neoplasm.
OBJECTIVES:
At the end of presentation the participants will be able to:

 Define Neoplasia, Dysplasia, Meteplasia, Anaplasia and


Differetiation.
 Describe the pathogenesis of neoplasia.
 Enlist the difference b/w Benign & Malignant tumors.
 Describe the nomenclature of tumors.
 Explain the characteristics and staging criteria of tumor.
 Discuss the clinical features, diagnosis and treatment of
neoplasms.
Neoplasia

 Neoplasia means new growth and is characterized


by unceasing abnormal and excessive proliferation
of cells.
 The neoplasm (commonly called tumor) is defined
as “The abnormal mass of tissue, the growth
which exceeds and is uncoordinated with that of
the normal tissue, and persists in the same
excessive manners after the cessation of the
stimuli which evoked the change.
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Controls of Growth

 Cytokines: Cyclins, Cyclin dependent kinases


(CDK).
 Growth factors – PDGF, FGF
 Growth Inhibitors.
 Cancer suppressor genes – p53
 Oncogenes – c-onc, p-onc, v-onc etc.

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Dysplasia

 Dysplasia is an alteration in an adult cells


characterized by variation in their size, shape and
organization.
 Associated with Ch. Inflammation.
 Non-neoplastic proliferation
• Pleomorphism: variation in size and shape.

• Hyperchromasia: abnormally large and deep nuclei

• Increased mitotic figure, but pattern is normal.

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Metaplasia

 The process whereby one tissue type is replaced


by another, i.e., cervical metaplasia, where
glandular epithelium becomes stratified
squamous epithelium.

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Anaplasia

 Irreversible loss of differentiation is called naplasia.


Components of neoplasm:
• Parenchyma: it constitutes the proliferating part of the
neoplasm.

• Stroma: It is made up of connective tissue, blood vessels


and lymphatics. It provides support for the growth of
parechymal cells.

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Differentiation:

 The extent to which the neoplastic


parenchymal cells resemble to their
normal parent cells, both morphologically
and functionally is called differentiation.

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Non-Neoplastic Proliferation:
Controlled & Reversible
 Hypertrophy – Size
 Hyperplasia – Number
 Metaplasia – Change
 Dysplasia – Disordered

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Neoplastic Proliferation:
Uncontrolled & Irreversible
 Benign
• Localized, non-invasive.
 Malignant (Cancer)
• Spreading, Invasive.

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Pathogenesis of Neoplasia:
 Normal Hyperplasia Metaplasia (DNA
damage)  Dysplasia  (DNA damage)  (DNA damage)

Anaplasia (DNA damage) Infiltration  (DNA damage)


 Metastasis….
 Progressive DNA Damage – features of
neoplasia.

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Mechanism of Neoplams
Normal Adaptation Benign Malignant

Non-Neoplastic Neoplastic
(Polyclonal) (Monoclonal)
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Benign Malignant
 Slow growing,  Fast growing,
 capsulated,  non capsulated,
 Non-invasive  Invasive &
 do not Infiltrate
metastasize,  Metastasize.
 well  poorly
differentiated, differentiated,
 suffix “oma”  Suffix
eg. Fibroma. “Carcinoma” or
“Sarcoma” 17
Difference b/w Benign and Malignant Tumors
Characteristics Benign Malignant

1. Differentiation Well differentiated Ranges from well-


differentiated to un-
differentiated
2. Anaplasia No Anaplasia Certainly present

3. Metastasis No Metastasis Metastasize to the


regional lymph nodes
and distant organs
4. Rate of Growth Usually slow except Usually rapid except
leiomyoma of uterus, cancer of cervix grows
which rapidly grows slowly
during pregnancy
5. Encapsulation Enclosed within a capsule Capsule is never
which separates it from present
host tissue. Except
leiomyoma of uterus 18
Difference Conti…

Characteristics Benign Malignant

7. Gross Appearance. Degeneration, necrosis Degeneration, necrosis


ulceration, ulceration,
hemorrhage, less hemorrhage, more
frequent frequent
8. Clinical effects. They do not endanger Acts as parasite and
the life unless a vital tends to kill the
organ is involved. patient-whenever it
grows
9. Recurrence. Easily local removal – Recurrence common.
no recurrence.

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Nomenclature of Tumors

 The tumor is named on the basis of:


1. Cell or tissue of origin.(epithelial or mesenchymal)

2. Whether it is benign or malignant.

 Benign tumors
• By attaching the suffix “oma” to the cell of origin.

Epithelial mesenchymal
Adenoma Fibroma
Papilloma Lipoma
Cystoaenoma Osteoma
Polyp Leiomyoma 20
Malignant tumors

 There are two types of malignant tumors:

1. Carcinoma: The malignant tumors of epithelial cell


origin are called carcinoma.

E.g. Renal cell carcinoma, adenocarcinoma, squamous


cell carcinoma etc.

2. Sarcomas: The malignant tumors arising in


mesenchymal tissues are called sarcomas.

E.g. Fibrosarcoma. Chondrosarcoma, Osteogenic


sarcoma, Liposarcoma etc.
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Nomenclature: Cell of origin + Suffix

Suffix - oma Carcinoma / Sarcoma


 Fibroma  Fibrosarcoma

 Osteoma  Osteosarcoma

 Adenoma  Adencarcinoma

 Papilloma  Squamous cell carcinoma

 Chondroma  Chondrosarcoma

Exceptions: Leukemia, Lymphoma, Glioma,


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Characteristics of malignant neoplasms

A. Differentiation and anaplasia:


1. Pleomorphyism.

2. Hyperchromasia.

3. Disturbed neculear-cytoplasmic ratio.


1. Normal ratio is 1:6, In anaplasia ratio becomes 1:1

4. Mitotic figures.

5. Loss of orientation.

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Conti…

A. Invasion:
Mechanism that make cancer invasive are:

1. Physical pressure.

2. Reduced adhesiveness of tumor cells.

3. Increased motility of tumors cells.

4. Loss of contact inhibition.

5. Release of destructive enzymes.

E.g. collagenase, plasminogen activators etc.

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Conti…

 Spread:
Malignant tumors spreads by two ways:
1. Infiltration: Malignant cells infiltrate the surrounding
tissues.

 Metastasis :
Is a process in which malignant tumor cells invade vessels
or tissue in such a manner that they detach, migrate and
are translocated to a distant site.

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Factors essential for metastasis

1. Liberation of viable tumor cells.

2. Presence of suitable environment.

3. Availability of spreading pathways:


A. Lymphatic pathway.

B. Blood stream.

C. Seeding of body cavities and surfaces.

D. Transplantation.

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Staging

The STAGING of cancers is based on the size of the


primary lesion, its extent of spread to regional
lymph nodes, and the presence or absence of blood-
borne metastases

There are two major staging systems:

1) Union International Against Cancer (UICC) and


2) American Joint Committee (AJC) on Cancer
Staging
Staging
The UICC uses the TMN system

T for primary tumor: T0 (in situ); T1 to T4 with


increasing size

N for regional lymph node involvement: N0


(none); N1 to N3 denotes involvement of an
increasing number and range of nodes

M for metastases: M0 (none); M1 and M2


indicates the presence of mets and number
Staging

 The AJC employs a different nomenclature and


divides all cancer into stages 0 to IV,
incorporating within each of these stages the size
of the primary lesion as well as the presence of
nodal spread and distant metastases.

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Grading

 GRADING of a cancer is based on the degree of


differentiation of the tumor cells and the number
of mitoses within the tumor as presumed
correlates of the neoplasm’s aggressiveness
 Cancers are classified as grades I to IV with
increasing anaplasia.

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Clinical features of neoplasia

1. Effects according to tumor location.

2. Hormone production.

3. Obstruction.

4. Irritation of serous membrane.

5. Tissue destruction.

6. Infection.

7. Fever.

8. Anaemia.

9. Malignant cachexia: The progressive weakness and loss of


weight in the presence of malignant tumor is called malignant
cachexia.
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Tumor Diagnosis:

 History and Clinical examination


 Imaging - X-Ray, US, CT, MRI
 Tumor markers Laboratory analysis
 Cytology –Pap smear, FNAB
 Biopsy - Histopathology, markers.
 Serological examination: tumor markers
 Molecular Tech – Gene detection.

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Treatment

 Surgery.
 Chemotherapy.
 Radiation therapy.
 Hormonal therapy.
 Immunotherapy.

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summary
 The prognosis of a patient with any type of

neoplasm depends on a number of factors

including: the rate of growth of the tumor, the


size of the tumor, the tumor site, the cell type

and degree of differentiation, the presence of

metastasis, responsiveness to therapy, and the

general health of the patient.


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References:

 Dr. M. Danish, Inam; Short text Book of Pathology, third edition (2000),
Danish publication, Karachi.
 www.utmem.edu/obgyn/res_pres/PathologyandNeoplasia.ppt
 http://cancer.about.com/od/cancerglossary/g/neoplasm.htm
 http://www.cancer.gov/cancertopics/understandingcancer/cancer
 www.bd.com/tripath/patients/glossary.asp

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