Neoplasm 
is an abnormal mass of tissue as a result of neoplasia. by oncologists orsurgeons. Therefore, its inclusion among the
Neoplasia (new growth in Greek) is the abnormal proliferation of cells. The
growth of the cells exceeds, and is uncoordinated with that of the normal
tissues around it. The growth persists in the same excessive manner even
after cessation of the stimuli. It usually causes a lump or tumor. Neoplasms
may be benign, pre-malignant or malignant.
carcinoma in situ: Cancer that involves only the place in which it began
and that has not spread. Carcinoma in situ is an early-stage tumor.
For example, squamous cell carcinoma in situ (Bowen's disease) is an early
cancer of the skin. It develops from squamous cells which are flat, scalelike
cells in the outer layer of the skin (the epithelium).
The term "in situ" (borrowed from the Romans) means "in the natural or
normal place" and, in the case of cancer, it means that the tumor cells are
still confined to the site where they originated and they have neither invaded
neighboring tissues nor metastasized afar. The tumor is curable.
 Many bladder cancers are CIS.
 Cervical cancer is often predated by cervical squamous
intraepithelial lesion (SIL, previously CIN, a form of dysplasia).
The term CIS is not used for the cervix. Instead, the term high
grade SIL (HSIL) is used, essentially a synonym. It is this lesion
that is detected with the pap smear.
 Ductal carcinoma in situ (DCIS) of the breast is a rather
frequent disease with a high probability of transforming into
true breast cancer if untreated.
 Bowen's disease is squamous carcinoma in situ of the skin.
 Colon polyps often contain areas of CIS that will almost
always turn into colon cancer if left untreated.
 High grade Prostatic intraepithelial neoplasia is equivalent to
CIS of the prostate.
 Bronchioloalveolar carcinoma of the lung is the only form of
CIS that can kill because it fills the lungs and prevents breathing.
Thus, it ismalignant, but not invasive. For this reason, this
unusual form of carcinoma is seen as CIS by pathologists, not
CIS category is controversial.
What is a fibrosarcoma?
A fibrosarcoma is a malignant (cancerous) tumor that originates in the
connective fibrous tissue found at the ends of bones of the arm or legs, and
then spreads to other surrounding soft tissues. Soft tissues include fat,
muscles tendons (bands of fiber that connect bones to muscle) nerves, joint
tissue, blood vessels and other fibrous tissue. It most commonly affects
either a lower leg or arm There are generally two forms of this disease:
 Infantile or congenital fibrosarcoma: this type of tumor is the most
common soft tissue sarcoma found in children under one year of
age. It presents as a rapidly growing mass at birth or shortly after.
This form of fibrosarcoma is usually slow-growing, and tends to be
more benign than fibrosarcoma in older children, which behaves
more like the type found in adults.
 Adult form fibrosarcoma: The adult form of this disease can occur in
older children and in adolescents, roughly between the ages of 10
and 15. It is more aggressive than the infantile form and generally
involves more complex treatment.
What causes fibrosarcoma?
The exact cause of fibrosarcoma and other soft tissue tumors is not entirely
understood, however, studies have indicated that genetic alterations may
play a role. Researchers have studied a small number of families that
contain several members from one generation who have developed soft
tissue sarcomas. In addition, limited studies have shown a possible link
between soft tissue sarcomas and the development of other types of cancer.
A chromosomal rearrangement has been found in some fibrosarcomas.
What are the symptoms of fibrosarcoma?
The following are the most common symptoms of fibrosarcomas. However,
each child may experience symptoms differently. The symptoms of
fibrosarcoma vary depending on size, location and spread of the tumor.
Symptoms may include:
 A painless or tender mass in an extremity or trunk
 Pain or soreness caused by suppressed nerves and muscles
 Limping or other difficulty using legs, feet, arms hands
The symptoms of fibrosarcoma may resemble other conditions or medical
problems. Always consult a physician for a diagnosis.
How is fibrosarcoma diagnosed?
In addition to a complete medical history and physical examination of your
child, diagnostic procedures for fibrosarcoma may include:
 Multiple imaging studies of the tumor and sites of possible
metastasis, such as
o x-rays - a diagnostic test which uses invisible
electromagnetic energy beams to produce images of
internal tissues, bones, and organs onto filmX-rays are
very useful in the diagnosis of bone tumors and frequently
x-rays allow the physician to distinguish between benign
and malignant tumors. An x-ray is usually the first
diagnostic study and it often gives the doctor information
regarding the need for further testing.
o magnetic resonance imaging (MRI) - a diagnostic
procedure that uses a combination of large magnets,
radiofrequencies, and a computer to produce detailed
images of organs and structures within the body.. This test
is used to assess the size and extent of the mass and its
relationship to surrounding muscle, bone, nerves and
blood vessels.
o computerized tomography scan (also called a CT or CAT
scan) - a diagnostic imaging procedure that uses a
combination of x-rays and computer technology to
produce cross-sectional images (often called slices), both
horizontally and vertically, of the body. A CT scan shows
detailed images of any part of the body, including the
bones, muscles, fat, and organs. CT scans are more
detailed than general x-rays. They are used primarily to
assess the chest and lung for metastatic tumors.
o bone scans - a nuclear imaging method used to detect
bone and metastatic tumors. It can determine if there are
abnormalities in other bones. This test does not
distinguish between tumor,infection or fractures.
 complete blood count (CBC) - a measurement of size, number, and
maturity of different blood cells in a specific volume of blood
 blood tests (including blood chemistries)
 biopsy of the tumor - a small tissue sample of the tumor is
surgically removed. The appearance of the tumor under a
microscope establishes the diagnosis and distinguishes a
fibrosarcoma from other sarcomas. Biopsy also helps doctors
determine how aggressive the tumor is.
How is fibrosarcoma staged?
Once fibrosarcoma has been diagnosed, the tumor is staged. This process
indicates how far the tumor has spread from its original location. The stage
of a tumor suggests which form of treatment is most appropriate, and gives
some indication of prognosis.
A fibrosarcoma may be localized, meaning it has not spread beyond the
bone where it arose or beyond nearby tissues, or metastatic, meaning it has
spread to lungs, bones other than the bone that the tumor originated in, or to
other organs or structures of the body. Tumors found during infancy are
usually not metastatic.
Treatment for fibrosarcoma
Specific treatment for fibrosarcoma will be determined by your child's
physician based on:
 your child's age, overall health, and medical history
 extent of the disease
 your child's tolerance for specific medications, procedures, or
therapies
 how your child's physician expects the disease may progress
 your opinion or preference
Surgery
Surgery may be all that is indicated for an infant with this condition, and limb-
sparing surgery is often opted for, rather than amputation, since a local
recurrence of congenital fibrosarcoma is not believed to worsen a child's
prognosis. Radiation (explained further below) is not generally used for
tumors in the extremities because it may interfere with proper bone growth.
Chemotherapy(also discussed below), which is very effective on this type of
tumor, may be used in infants if appropriate resection of the tumor with wide

surrounding margins of healthy tissue is not possible.
Older children with this condition are more likely to undergo a combination or
surgery, chemotherapy and/or radiation treatment.
Surgery for fibrosarcoma involves the biopsy, surgical removal of the tumor,
bone/skin grafts, limb salvage procedures, amputation, and/or
reconstruction, all performed by a surgeon. The type of surgery will depend
on the size and location of the tumor, and whether the cancer has spread.
Types of Surgery
 Limb-salvage surgery: It is sometime necessary to remove all or
part of a limb. In most cases, however, limb-sparing surgery,
sometimes referred to as limb-salvage surgery, is used to avoid
amputation. This however is considered only if the orthopaedic
surgeon determines that it is possible to remove the tumor along
with wide margins of healthy tissue surrounding the tumor. Through
limb-sparing surgery, all of the tissues involved with the tumor,
including some degree of muscle surrounding it, is removed, while
nearby tendons, nerves and vessels are saved. If bone is removed,
it is replaced with a bone graft or with a metal rod. Subsequent
surgery may be needed to repair or replace rods, which can
become loose or break. Patients who have undergone limb-salvage
surgery need intensive rehabilitation. It may take as long as a year
for a patient to regain full use of a leg following limb-salvage
surgery. Some patients who have this operation may eventually
have to undergo amputation. Radiation therapy and/or
chemotherapy (usually not needed in treatment of infants) are given
either before surgery to shrink the tumor, or after surgery to kill
remaining cancer cells.
 Amputation - In certain cases, if your child's orthopaedic surgeon
determines that the tumor cannot be removed because, for
example, it involves the nerves and blood vessels, amputation is
the only option. During the operation, doctors ensure that muscles
and skin form a cuff around the amputated bone. A cast is applied
in the operating room which permits a temporary artificial leg
(prosthesis) to be applied during the first few post-operative days
for walking. Crutches are used for several weeks. As the swelling
decreases (10 to 14 days) the patient is fitted for a plastic,
temporary socket and prosthesis, which is used for 3 to 4 months
until the stump is healed sufficiently to accept a permanent artificial
leg. The advantages of an amputation are that it is a simple
operation with minimal chances of surgical complication and it
definitively removes the local tumor. The functional outcome is
good with the modern prostheses available today and with
"immediate-fit" prostheses applied in the operating room. Although
the patient will probably have a limp with above-the-knee
amputations, the procedure is functional and stable. He/she will be
able to walk, climb stairs, swim (with the prosthesis on or off) and
participate in many sports such as skiing, basketball, baseball, and
tennis although running will be limited. The functional limitations are
left to the imagination and determination of the patient.
Chemotherapy
Chemotherapy is a drug treatment that works by interfering with the cancer
cell's ability to grow or reproduce. Different groups of drugs work in different
ways to fight cancer cells and shrink tumors. Chemotherapy may be used
alone for some types of cancer or in conjunction with other therapy such as
radiation or surgery. Often, a combination of chemotherapy drugs is used to
fight a specific cancer. Certain chemotherapy drugs may be given in a
specific order depending on the type of cancer it is being used to treat. While
chemotherapy can be quite effective in treating certain cancers, the agents
do not differentiate normal healthy cells from cancer cells. Because of this,
there can be many adverse side effects during treatment. Being able to
anticipate these side effects can help the care team, parents, and child
prepare, and, in some cases, prevent these symptoms from occurring, if
possible.
Chemotherapy is systemic treatment, meaning it is introduced to the
bloodstream and travels throughout the body to kill cancer cells.
Chemotherapy can be given:
 as a pill to swallow
 as an injection into the muscle or fat tissue
 intravenously (directly to the bloodstream; also called IV)
 intrathecally - chemotherapy given directly into the spinal column
 with a needle symptoms
 Cough
Radiation Therapy  Cough with blood
 Shortness of breath
Radiation uses high-energy rays from a specialized machine to damage or
 Chest pain
kill cancer cells and shrink tumors
 Hoarseness
Rehabilitation
 Appetite loss
Rehabilitation includes physical and occupational therapy and psychosocial
 Weight loss
adapting
Supportive care
Supportive care refers to any type of treatment to prevent or treat infections,
How diagnosis is made
side effects of treatments, and complications, and to keep your child  Examination may be normal or lung exam may reveal areas of
comfortable during treatment crackles or decreased breaths sounds.
Continuous Follow-Up Care  Chest X-ray shows a mass, pleural effusion (fluid, blood,
A schedule of follow-up care will be determined by your child's physician and cancer cells or a combination) or an infiltrate.
other members of your care team to monitor ongoing response to treatment  CAT scan may provide a better picture of the mass.
and possible late effects of treatment  Examination of sputum or pleural fluid may confirm diagnosis. 
What is the long-term outlook for patients with fibrosarcoma? Negative test results do not rule out cancer.
Prognosis for fibrosarcoma greatly depends on:  Lung biopsy obtained with a needle, CAT
 the extent of the disease. scan,bronchoscopy (scope passed from mouth into lungs),
 the size and location of the tumor. and surgical biopsy (open lung surgery to obtain a tissue
sample) are diagnostic tests that may be used, depending on
 presence or absence of metastasis. the location of the tumor.
 The tumor's response to therapy.  Laboratory Tests:- Complete blood count, liver function
 The age and overall health of the child. tests,calcium, parathyroid hormone (PTH),
 your child's tolerance of specific medications, procedures, or andelectrolytes should be checked.
therapies.
 new developments in treatment.
Risk factors
 Cigarette smoking
 Asbestos
 Lung cancer is the most common cause of cancer death in
 Heavy metal
both men and women.  Breast cancer is more common in
 Chloromethyl ether
women, but lung cancer is more likely to lead to death.  Lung
cancer occurs in smokers or those exposed to chemical  Radiation exposure, such as from atomic bomb blasts and
carcinogens to the lung.  Non-smokers without other risk radiation used for cancer treatment
factors have a low risk of acquiring lung cancer.
 There are four major cellular types of lung cancer: squamous
cell carcinoma, adenocarcinoma, small cell carcinoma, and treatment
large cell carcinoma.  For treatment purposes, lung cancer is  For non-small cell lung cancer:
usually differentiated according to small cell carcinoma or non-
small cell carcinoma, which includes the three other types. 1. Surgery is recommended if the patient is a viable
candidate (see explanation above).  The stage of the
 lung cancer.  Many options are available for quitting smoking,
lung cancer and general health determine whether a including nicotine patches, nicotine gum, hypnosis, and
patient will be considered for surgery.  Only 25 behavioral techniques.  If you're thinking of quitting smoking,
percent of lung cancer patients are considered to be discuss these options with your physician to determine which
surgical candidates at the time of diagnosis. one may be most effective for you.
2. Chemotherapy and/or radiation may be considered
after surgery for cancer that has progressed to
advanced stages. Similar condition
3. Radiation plus Cisplatin-based chemotherapy are  Carcinoma of the larynx
recommended if the patient is not a surgical  Pulmonary embolism
candidate.  Tuberculosis
 Coccidiomycosis
 For small cell carcinoma:  Lung abscess
 Pneumonia
- Combination chemotherapy is typically used to treat the cancer. 
Surgery is not considered helpful because small cell carcinoma has
usually spread at the time of diagnosis.  The brain is commonly treated miscellaneous
with radiation to treat micrometastases that may have already  Lung Cancer Staging
occurred.
- Lung cancer is staged based on the size or location of the tumor, the
 Palliative treatment: extent of lymph node involvement, if any, and the degree of metastasis
if it has occurred.  The stages are 0, I, II, III, and IV, rated according to
1. This type of treatment may involve radiation therapy how much the disease has spread.  The higher the stage, the more
and is geared toward alleviating symptoms, even if advanced the disease.
the disease is not considered to be curable.
2. Research about alternative therapies, such as  Who is a Surgical Candidate?
vaccines and immunotherapy, are currently in
progress. - Staging indicates whether a person is a candidate for surgical
removal of the cancerous tumor.  The following factors are considered
to determine the likelihood of successful or unsuccessful surgery and
Prognosis degree of surgical difficulty:
 If lung cancer is caught in its early stages, the survival rate is
approximately 50 percent.  The five-year survival rate for all 1. Whether the tumor involves the trachea, carina, or
diagnosed lung cancers is 10 to 15 percent.  proximal main stem bronchus
 If you suspect any symptoms, especially if you are a smoker 2. Metastases outside the lungs and chest cavity
or have other risk factors, consult a physician as soon as 3. Malignant pleural fluid
possible.  The earlier lung cancer is diagnosed, the greater 4. Phrenic nerve or recurrent laryngeal nerve palsy
the chance of survival.
5. Superior vena cava syndrome
6. Tumor involving the esophagus or pericardium
7. Spread of cancer to the lymph nodes on the opposite
prevention side of the mediastinum
 Quitting smoking significantly lowers the risk of developing 8. Extensive involvement of the chest wall
9. Poor general health