Department of:

HERE
UNIVERSITY OF MOSUL
COLLEGE OF DENTISTRY

Neoplasia 2020-2021

Lect. II

Department of:
Oral &
Ass.Prof.Dr.Nadwa Alazzo Maxillofascial
Surgery
Department of: UNIVERSITY OF MOSUL
OBJECTIVES :
HERE COLLEGE OF DENTISTRY

 Methods of tumor spread

 Mechanism of spread

 Tumor grading & staging (tumor

grading)
 Department of: UNIVERSITY OF MOSUL

COLLEGE OF DENTISTRY
HERE
SPREAD OF MALIGNANT TUMOURS

• Local spread

• Lymphatic spread

• Blood (haematogenous spread)

• Transcoelomic spread

• Intraepithelial spread
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COLLEGE OF DENTISTRY

Local Spread
 Malignant cells have the ability to emerge
themselves between adjacent normal cells 020-2021
and invade the surrounding tissues ( first
loose connective tissue).

 For epithelial tumors the first step should

break the basement membrane
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COLLEGE OF DENTISTRY

Lymphatic Spread
 This is the principal mode by
which carcinomas spread. 020-2021

 The very thin walls of

lymphatics are readily
penetrated by tumour cell ,
which is carried along in the
lymph to the first lymph node
in the lymph node chain
 UNIVERSITY OF MOSUL

COLLEGE OF DENTISTRY

Blood (Haematogenous) Spread

 Tumour cells are able to invade thin walled veins and grow along the
Department
venous system of: into the blood stream.
or embolize
HERE

 The site of initial metastasis (first-pass organ)

depends on the venous drainage of the location of the
tumour.
 Lung , liver and brain are the main organs of hematogenous spread for
cancers.

 Blood spread is main way for Sarcoma and later for carcinoma
 UNIVERSITY OF MOSUL

COLLEGE OF DENTISTRY

Transcoelomic Spread

It means spread across body cavities, the peritoneal, pleural and pericardial
spaces. Department of:
HERE

e.g: Gastric carcinoma can spread in a similar fashion, to involve the

peritoneal cavity, often seeding in the ovaries. known as Krukenberg’s
tumours
Intraepithelial Spread UNIVERSITY OF MOSUL

COLLEGE OF DENTISTRY

This is the process by which tumour cells can

infiltrate between the cells of a normal
epithelium, without invading the underlying
stroma.
Department of:
HERE
It is best seen in Paget’s disease of the nipple in
which the cells of ductal carcinoma in situ of
breast grow into the nipple skin giving an
appearance resembling eczema.
MECHANISMS OF TUMOUR SPREAD

I/ Direct Spread and Invasiveness

Tumour Cell Motility

Invasion of Basement The cells extrude pseudopodia at the front and attach to stromal

Reduction in Cell: Cell Membrane and Stroma

proteins
(cytoskeleton)

Adhesion 1.cancer cells have altered

(low production of c- integrin molecule expression
2. production of proteolytic
cadherin by enzymes by cancer
malignant cells
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II/ Angiogenesis COLLEGE OF DENTISTRY

New blood vessels formation occur normally during tissue healing and chronic
inflammation
In recent years they found it is important step in tumor growth and metastasis ,
which involve: Department of:
HERE
 proteolytic digestion of basement membrane by plasminogen activators and matrix
metalloproteinases

 migration of endothelial cells, initially as a solid cord

 proliferation of endothelial cells

 organization of the cords of endothelial cells into new blood vessels with lumens.
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COLLEGE OF DENTISTRY

III / vascular Invasion

The thin walls and poorly formed basement membranes of
newly formed blood vessels allow the tumor cells to penetrate.
Department of:
HERE
Once tumour cells are free within the lumen of the blood vessel
they are carried into the circulation and lodge in a capillary bed.
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COLLEGE OF DENTISTRY

IV/ Establishment of a New Colony

This involves cell proliferation and the development of a tumour blood

Department
supply by stimulation of:
of angiogenesis as previously described.
HERE
TRANSFORMATION
GROWTH
BM INVASION
ANGIOGENESIS
INTRAVASATION
EMBOLIZATION
ADHESION
EXTRAVASATION
METASTATIC GROWTHetc.
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COLLEGE OF DENTISTRY

TUMOUR STAGING AND GRADING

Department of:
HERE
Methods are used to asses the aggressiveness of malignant tumors
and the spread of them
necessary for prognosis of the malignant tumor and choice the proper
treatment
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COLLEGE OF DENTISTRY

Grading of malignant tumors

Grading of a cancer is based on the degree of differentiation of the
tumor cells & the resemblance of cancer cells to tissue of origin.
Department of:
HERE
The main parameters that look for :
 mitotic activity
 nuclear pleomorphism
 degree of differentiation
 extent of necrosis
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COLLEGE OF DENTISTRY

Department of:
HERE
GRADING for Squamous Cell Carcinoma
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COLLEGE OF DENTISTRY

Anaplasia : Lack of differentiation of malignant cells

 The features of anaplasia

 PleomorphismDepartment
: differentof:
of size and shape in both cells and nucleus
HERE
 Abnormal nuclear morphology : the nuclear-to-cytoplasm ratio may
approach 1 : 1 instead of the normal 1 : 4 or 1 : 6.
 Mitoses : not only increase in the proliferative rate but atypical,
bizarre mitotic figures
 Tumor Giant cell formation : possessing only a single huge
polymorphic nucleus and others having two or more large,
hyperchromatic nuclei
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COLLEGE OF DENTISTRY

Paragraph

Department of:
HERE
Reference
 UNIVERSITY OF MOSUL

COLLEGE OF DENTISTRY

2020-2021

THE END