NEOPLASIA/ TUMOR

 Neoplasia literally means “new growth.”

 It is a continuous abnormal proliferation of cells w/o control (no purpose/function)
 In common medical usage, a neoplasm often is referred to as a tumor.
 the study of tumors is called oncology (from oncos, “tumor,” and logos, “study of”).
2 BROAD CATEGORIES OF TUMOR
 MALIGNANT TUMOR
 BENIGN TUMOR

DEFINITION OF TERMS
 Proto-oncogenes:  normal cellular genes whose products promote cell 
proliferation

 Oncogenes:  mutant or overexpressed versions of proto-oncogenes that 
function autonomously without a requirement for normal growth-promoting 
signals.

BENIGN TUMOR
 Common in younger age group, grow slowly.
 if the microscopic and gross characteristics are considered to be relatively
innocent,implying that it will remain localized
 is amenable to local surgical removal
 Not fixed to the tissues
 the patient generally survives.

MALIGNANT TUMORS
 are collectively referred to as cancers, derived from the Latin word for “crab”—that
is, they adhere to any part that they seize in an obstinate manner, similar to a crab’s
behavior.
 can invade and destroy adjacent structures and spread to distant sites (metastasize) to
cause death.
 Common to older age group, growing rapidly.
 More fixed to the tissues, more difficult to remove.

Characteristics of Benign and Malignant Tumors
Benign and malignant tumors can be distinguished from one another 
based on the degree of differentiation, rate of growth, local invasiveness, and 
distant spread.

FEATURE BENIGN MALIGNANT

DEGREE OF Resemble the tissue of origin  poorly or completely 

DIFFENTIATION and are well differentiated; undifferentiated (anaplastic).

RATE OF GROWTH slow-growing generally grow faster

LOCAL well circumscribed and have a  poorly circumscribed and invade 

INVASIVENESS capsule the  surrounding normal tissues.

DISTANT remain  localized  to  the  site of locally invasive and metastasize to 

SPREAD/METASTA origin distant sites.
SIS

(single most important

feature distinguishing
benign from malignant
tumors)

PARTS OF A TUMOR

All tumors, benign and malignant, have two basic components:

(1) the parenchyma (active element) which is made up of transformed or neoplastic

cells
(2) the supporting, host derived, no neoplastic stroma, made up of connective tissue,
blood vessels, and inflammatory cells.

CARCINOMA
 Malignant tumor of epithelial tissue origin which have a less tendecy to produce
stroma.

SARCOMA
 Malignant tumors of connective tissue origin characterized by abundant intercellular
tissue framework.
NOMENCLATURE OF TUMORS

GRADING AND STAGING OF CANCER

It provides a semiquantitative estimate of the clinical gravity of a tumor.
GRADING OF TUMORS
 The grading of a cancer attempts to establish some estimate of its aggressiveness or
level of malignancy based on the cytologic differentiation of tumor cells.
 Differentiated cells = resemble normal cells ; Undifferentiated cells = younger cells
 The cancer may be classified as grade I, II, III, or IV.
 In general, high grade tumor are more agresive than low grade tumors.

Broder’s Classification (Grading)

GRADE DIFFERENTIATED CELLS UNDIFFERENTIATED CEL

LS
I 75-100% 0-25%
 II 50-75% 25-50%

III 25-50% 50-75%

IV 0-25% 75-100%

STAGING OF CANCERS

 Staging, determined by surgical exploration or imaging, is based on size, 
local and regional lymph node spread, and distant metastases. 
 Staging is of greater clinical value than grading.
 Two methods of staging are currently in use: the TNM system (T, primary tumor; N,
regional lymph node involvement; M, metastases) and the AJC (American Joint
Committee) system.

TNM system
 Applicable to all forms of neoplasia
T: Tumor
#: denotes the size of tumor and its local extent
Ta = non-invasive
Tx = cannot be evaluated
T0 = free of tumor
T1 = lesion <2 cm
T2 = lesion 2-5 cm (invasion in muscle)
T3 = skin and/or chest wall involved by invasion
T4 = tumor fixation

N: Regional lymph node involvement

High # denotes increasing extent of involvement
Nx = not evaluable
N0 = no axillary nodes involved
N1 = 1 mobile regional (axillary) node involved
N2 = multiple, mobile regional nodes involved
N3 = fixed regional lymph node involved
N4 = beyond regional lymph node involvement

M: Metastasis
M0 = no evidence of metastases
M1 = distant metastases are present
Mx = distant metastases not evaluable

AJCC method (American Joint Committee on Cancer)

 The cancers are divided into stages 0 to IV, incorporating the size of primary lesions
and the presence of nodal spread and of distant metastases.

Laboratory Diagnosis of Cancer
1. HISTOLOGICAL ANF CYTOLOGIC METHOD
 ROUTINE: fixed and paraffin embedded tissues
 Frozen Section
 Fine Needle Aspiration
 Exfoliative Cytology (Papanicolau Smears)
 Immunocytochemistry/ Immunohistochemistry - involves the detection of cell
products or surface markers by monoclonal antibodies.

2. DNA PROBE ANALYSIS

 Involves Polymerase Chain Reaction and FISH (karyotyping) analysis

3. FLOW CYTOMETRY
4. TUMOR MARKERS
 Tumor derived or tumor associated molecules that can be detected in blood and other
body fluids.

TUMOR ASSOCIATED- ASSOCIATED TUMORS
ANTIGEN
Bence Jones Protein Multiple myeloma
AFP Testicular cancer
HCG Testicular cancer, choriocarcinoma
PSA Prostate cancer
 CEA Tumors of the gastrointestinal tract
CA 19-9 Colonic and Pancreatic cancer
CA 15-3 Breast Cancer
Her-2/neu Breast cancer
Nuclear Matrix Protein (NMP) Urinary bladder cancer