PATHOPHYSIOLOGY BASICS D.
pathogenesis of a diseases may be explained in terms
Objectives/Rationale
Pathology is a result of disease and changes in
homeostasis. The student will understand the
mechanisms of pathology.
I. FUNDAMENTALS OF DISEASE
A. Homeostasis
The human body strives to maintain internal stability.
The process of maintaining normal balance within the
body is called homeostasis.
B. Disease
When homeostasis is not maintained, disease ensues.
Medical professionals who study diseases are called
pathologists.
II. PATHOLOGISTS ARE
PRACTITIONERS WHO
FREQUENTLY SPECIALIZE IN THE
FIELD.
A. Two common specialties are:
1. anatomic pathology – pathologists who perform
autopsies to determine cause of death
2. clinical pathology – pathologists who review lab
specimens to determine evidence of abnormal tissue,
presence of chemicals
B. Pathophysiology – the study of abnormal functions
in the body and how disease processes work.
III. PATHOGENESIS
A. The development of a disease is referred to as
pathogenesis (-genesis = origin or development).
B. The sequence of events that leads from cause of
disease to structural and functional abnormalities, to how
the disease manifests itself and finally to the resolution
or recovery of the disease.
C. Example: common cold
1. Cause = exposure and inoculation of cold virus
2. Incubation time = virus multiplies
3. Manifestation = host begins to have signs and
symptoms (sore throat, itchy eyes, runny nose, etc.)
4. Recovery = return to previous state of health
of time:
1. acute disease – disease of sudden onset which runs a
severe but short course
2. chronic – long-term (sometimes reoccurring) illness
IV. PREDISPOSING FACTORS (RISK
FACTORS)
Factors that increase probability of a person’s becoming
ill
1. Age
Newborn babies
 immature immune system
 liver enzymes necessary for detoxification of
some substances are often lacking
 fewer nutritional reserves
 less body fat to insulate against cold
Elderly
 decrease in immune function
 decline in homeostatic mechanisms
 depression; isolation; malnutrition
2. Sex - some diseases are more prone to one gender
than the other
 men more likely to develop gout
 women more likely to develop osteoporosis
3. Genetic makeup (familial tendencies for: diabetes,
asthma, migraines, etc.)
4. Stress - increases body’s production of
corticosteroids, which decreases immune system
function.
5. Lifestyle - personal habits in regard to diet, exercise,
weight control, smoking, alcohol consumption, sexual
practice
6. Occupation - exposure to loud noises, pollutants,
repetitive movements, heavy equipment, high places,
etc.
7. Preexisting illness
1. illnesses can lower body’s resistance and make
individuals more susceptible to other diseases
2. chronic illness interferes with proper function of
some body systems, therefore complicating disease
 many have a genetic or organic basis (on a biochemical
level).

8. Environmental exposure

 prolonged exposure to cold or heat can lower the

body’s resistance
 exposure to allergens
 long-term exposure to sunlight
 long-term exposure to occupational chemicals

V. TWO MAIN DISEASE CATEGORIES

Disease processes can be categorized into one of two

groups: structural or functional
1. Structural Disease (sometime called Organic
Disease)
a. involves physical and biochemical changes within the
cells
b. structural changes in cells are initiated by two types
of agents:
i. Exogenous - those that are external, i.e. trauma,
chemical injury, and microbial infections.
ii. Endogenous - those that are internal, i.e. vascular
insufficiency, immunological/ autoimmune reactions,
and diseases that are a result of abnormal metabolism.
B. The hallmark characteristic of structural disease is
the lesion.
The word lesion comes from Latin language and means
“to hurt.”
Lesion is a widely used term to describe many types of
cellular changes that result in tissue abnormalities. (cuts,
fractures, masses, etc.)
Lesions are primarily detected by observation with the
naked eye or with a microscope.
2. Functional Disease (sometimes called
physiological disease)
1. Diseases in which the onset begins without the
presence of any lesion.
2. The basic change is physiologic and is referred to as a
pathophysiologic change.
VI. Closer Look at Causes of Disease
A. To better understand and identify different structural
diseases and their cause, they are commonly sub-
classified:
1. Infectious Diseases
 those diseases that are caused by invasion and
colonization of pathogenic microorganisms
 examples of pathogenic infection: fungal
infection, bacterial infection, and viral infection
2. Neoplasms (“new growth”)
 the uncontrolled growth of abnormal cells
 growth may be benign or malignant (cancerous)
3. Immunologic Diseases
Three immunologic categories:
1. overreaction by immune system (hypersensitivity)
2. underreaction by immune system (immune deficiency
disease such as AIDS).
3. autoimmune disease – destruction of one’s own
tissues by antibodies produced by
one’s own immune system
4. Nutritional Diseases
- diseases created by insufficient resources for the body

3. Examples of functional disease are tension headaches 1. protein deficiency – difficulty in healing or formation
and functional bowel syndrome. of new body tissue; decrease in antibody production

4. Although mental illnesses have been considered 2. vitamin or mineral deficiencies – may lead to
functional disorders, present research now indicates that interference in biochemical reactions of metabolism
3. Obesity a. To treat a patient, a physician must first know the
manifestations of a disease.
b. Manifestation refers to how a disease “presents or
shows itself”.
5. Metabolic Diseases
c. Manifestation is also called clinical presentation and
a. an upset in the biochemical reactions that govern includes both signs and symptoms.
body processes or metabolism
1. Signs
b. Sub-classified as nutritional because the upset is
i. objective physical observations as noted by the person
often connected to carbohydrate, fat, or protein
who examines the patient
metabolism
ii. this examination is called a physical or the physical
6. Genetic Diseases
examination
a. inherited or hereditary diseases due to transmission of
iii. during the physical, the health professional may use
defective gene(s) or chromosome(s) from one or both
techniques such as:
parents
-ausculation (use of stethoscope to listen to body
b. examples of genetic diseases might be: diabetes,
cavities)
Down Syndrome, hemophilia, cleft lip
-palpation (feeling lightly or pressing firmly on
7. Congenital Disease (also referred to an anomaly or
internal organs or structures)
defect)
-percussion (tapping over various body areas to
a. a defect in fetal development that may create a
produce vibrating sound that is indicative of air, fluid,
functional (physiologic) or structural (physical)
size of organ)
abnormality which presents itself at birth
iv. examples of signs are: temperature, blood
b. these defects may be genetic; they may be exposure to
pressure, respiratory rate, abnormal heart sounds, mass,
chemicals, drugs, or viruses during the pregnancy; they
enlarged organs, edema
may be a spontaneous event
2. Symptoms refer to the patient’s awareness of
8. Trauma
abnormalities or discomfort. Symptoms are not
a. physical force that mechanically disrupts the structure measurable and are based on the patient’s subjective
of the body (therefore, disrupts body function) perception, i.e. pain, nausea, weakness, fatigue, dizziness

b. result of trauma is generally referred to as an injury d. The written description of symptoms in the patient’s
record is referred to as the patient history.
c. results of trauma include bruises, abrasions, cuts,
fractures, burns, etc. B. CARE OF THE PATIENT

9. Physical Agents a. Caring for the patient involves three major steps:

- diseases that result from physical agents such as 1. obtaining a history to ascertain the patient’s
temperature extremes, electrical shock, radiation, and symptoms and to review any past or present medical
poisons problems that might relate

10. Inflammatory Diseases 2. performing a physical examination on the patient

- diseases that are usually secondary to primary disease 3. laboratory tests, radiologic, and clinical procedures
such as infection or autoimmune disease. to detect chemical and physiologic abnormalities to aid
in establishing the diagnosis
VII. The Disease Process
C. ETIOLOGY AND RELATED TERMS
A. MANIFESTATIONS OF DISEASE
a. The etiology of disease is its cause (term literally
means the study of causes).
1. If the cause of a disease has never been discovered
(disease is unknown), the cause is referred to as
idiopathic.
2. One may also refer to an idiopathic disease as
“unknown etiology”.
b. Iatrogenic disease (-iatro = medicine, physician)
means that the disease arose as a result of a prescribed
treatment
Examples:
i. Cushing-like Syndrome as a result of steroid therapy
ii. immunosupression and/or anemia as a result of
chemotherapy
C. A nosocomial disease is one that was acquired from
a clinical setting (e.g. hospital; physician’s office; clinic).
1. postoperative patient develops staph infection from
surgical instrument that wasn’t properly sterilized
2. child develops cold after being exposed to other sick
children at the pediatrician’s office
D. DIAGNOSIS
a. Process of assigning a name to a patient’s condition.
b. When clusters of findings with more than one disease
are found, they are called syndromes.
c. Diagnosis is needed to determine the treatment and
potential outcome of a disease.
E. TREATMENT (THERAPY)
a. Treatment of a disease should be as precise as
possible in order to attempt a cure.
b. Treatment interventions may include: exercise,
nutritional modifications, physical therapy, medications,
surgery, and education
C. Three Common Therapies Are:
1. Supportive therapy – conservative therapy that
includes rest, optimal nutrition, fluids, possible
antibiotics to prevent a secondary infection while the
immune system is recovering
2. Palliative therapy – not a curative therapy; provides
relief from signs and symptoms of their disease
a. Examples of this therapy might include: steroids, pain
relievers, possible surgery (removal of tumor, etc.)
b. This treatment used for terminal illnesses and other
serious chronic conditions for which there is no cure
3. Preventive therapy – care that is given to prevent
disease, i.e.
Examples of preventive therapy might include:
mammograms, blood pressure screenings, routine dental
care, colon cancer tests
F. PROGNOSIS
The prognosis is the predicted or expected outcome of
the disease
Prognosis is often listed as:
1. Good (full recovery)
2. Guarded (full recovery may or may not occur)
3. Poor (not expected to recover)
VIII. ADDITIONAL TERMINOLOGY
 Communicable disease – a disease that can be
transmitted from one person to another
 Epidemic – a disease that affects many people in
a given region at the same time
 Endemic – a disease that appears to be
indigenous to a particular area or region (not of
epidemic proportions)
 Localized disease – disease is confined to one
area of body.
 Systemic (generalized) disease – disease that
spreads throughout the body or to many systems
 Asymptomatic (Sub-clinical) disease– a disease
in which symptoms are not noticeable to the
patient; presence of disease (signs) is detected
by routine physical or tests
 Self-limiting disease – a disease that does not
require treatment to be cured; it will resolve on
its own.
ACTH Adreno Cortico Trophic Hormone
ADH Anti Diuretic Hormone
AIDS Acquired Immuno Deficiency Syndrome
AMI Acute Myocardial Infarction
ATP Adenosine Tri Phosphate
AUB Abnormal Uterine Bleeding
BBB Blood Brain Barrier
BPH Benign Prostatic Hyperplasia PPD PUD Purified Protein Derivative Peptic Ulcer
Disease
CAH Congenital Adrenal Hyperplasia
RBC Red Blood Cells
CHF Congestive Heart Failure
RES RHD Reticule Endothelial System Rheumatic
CNS COP Central Nervous System Cardiac Out Put
Heart Disease
COP COPD Collid Osmotic Pressie Chronic
RHF Right Sided Heart Failure
Obstructive Pulmonary Disease
RNA Ribonucleic Acide
CSF Cerebro Spinal Fluid
SIADH Syndrome Of Inappropriate Secretion Of Anti
CT Computed Tomography
Diuretic Hormone
DI Diabetes Insipidus
SLE Systemic Lupus Erythematous
DNA Deoxyribonucluic Acid
STD Sexually Transmitted Diseases
DUB Dysfunctional Uterine Bleeding
TH Thyroid Hormone
EBV Epstein Bar Virus
TLC Total Lymphocyte Count
FSH Follicle Stimulating Hormone
TSH Thyroid Stimulating Hormone
GH Growth Hormone
UTI Urinary Tract Infection
GIT Gastro Intestinal Truct
WBC White Blood Cells
GTD HIV Gestatimal Trombo Plastic Disease Human
BASICS IN CANCER
Immuno Deficiency Virus
Cancer is a disease characterized by DNA damage that
HMD Hyaline Membrane Disease
causes abnormal cell growth and development.
HPV Human Papiloma Virus
ABNORMAL CELL GROWTH
HSV Hepes Simplex Virus
Cancer classified by the tissues or blood cells in which it
HZV Herpes Zoster Virus originates.

ICP Intra Cranial Pressure Most cancers derive from:

IUCD Intra Uterine Contraceptive Device  epithelial tissues

 Glandular tissues
LH Leutenizing Hormone  Connective, muscle and bone tissues
LHF Left Sided Heart Failure  Supportive tissue of brain/spinal cord
 Pigmented cells
MI MRI Mycardial Infarction Magnetic Resonance  Plasma cells
Imaging  Lymphatic tissues
 Leukocytes
MPS MSH Mononuclear Phagocytic System
 Erythrocytes
Melanocyte Stimulating Hormone
OI Opportunistic Infections Most cancers derive from:

PCP Pnuemo Cystic Carnii Pneumonia epithelial tissues. CARCINOMA

PID Pelvic Inflammatory Disease Glandular tissues ADENOCARCINOMAS

PKU Phenyl Ketone Uria Connective, muscle and bone tissues SARCOMAS

PMN Poly Morpho Nuclear Supportive tissue of brain/spinal cord GLIOMAS

Pigmented cells MELANOMAS
Plasma cells MYELOMAS • Radiation Exposure – may induce TUMOR
Lymphatic tissues LYMPHOMAS SOMETHING IN THE ENVIRONMENT
Leukocytes LEUKEMIA • Tobacco
Erythrocytes ERYTHROLEUKEMIA • Asbestos (airborne aromatic hydrocarbons)
UNCONTROLLED GROWTH • Alkylating agents

 Cancer cells grow without the control that
characterizes normal cell growth.
 At certain stage of development, the cancers
cells fail to mature.
 Cancers cells have the capability to spread from
site of origin. PROCESS IS CALLED
METASTASIS
• Tobacco – lung, pancreatic, kidney, bladder,
esophageal cancer
• Asbestos – lung cancer
• Alkylating Agents - Leukemia
DANGER AT THE DINER

3 Ways to Metastasized: • High CHON and High fats

 by circulation through blood and lymphatic • Food Additives

system • Food prep
 by accidental transplantation during surgery
 by spreading to adjacent organs or tissues GENETIC FACTOR

WHAT CAUSES CANCER? • Autosomal recessive, X-linked, ot autosomal

dominant disorders
• Virus factor
• Increased incidence –bilateral cancer in paired
• Over exposure of cells organs (B, A, K)
• Something in the environment • Increased incidence of multiple primary
cancers in NON-Paired organs
• Danger at the diner
• Abnormal chromosome – complement in
• Genetic factor
Tumor cells
• Hormones: helping or hurting?
HORMOMES: HELPING OR HURTING?
• The best defense
• he role of HORMONES play in cancer is
A cell’s transformation from normal to cancerous is controversial.
called CARCINOGENESIS
• Excessive use of hormone use – esp
VIRUS ESTROGEN Cancer (while reducing the risk of
other forms).
 Epstein-Barr Virus
 Burkett’s Lymphoma THE BEST DEFENSE
 Nasopharyngeal cancer
• BODY develops cancer cells continuously but
 Human Papilloma Virus – cervical cancer
the immune system recognizes them as foreign
 Hepatitis B Virus – Hepatocellular Carcinoma
body and destroys them.
 HTLV-1 Virus – adult T-cell leukemia
A Mechanism that:
OVEREXPOSED CELLS
 Promotes antibody production
• Excessive exposure to sun’s UV rays- Skin  Cellular immunity
Cancer  Immunologic memory
• Damaged caused by UV light and subsequent  Defense Mechanism called
sunburn – Melanoma IMMUNOSURVEILLANCE
  THEREFORE, any interruption in the
mechanism “Immunosurveillance” can lead into
overproduction of cancer cells. TUMOR
ALTERATIONS IN CELL FUNCTION AND
GROWTH
1.1 Cell injury and Cellular Adaptive Changes
The life cycle of a cell exists on continuum that includes
normal activities and adaptation, injury or lethal
changes.
Adaptation is a normal life cycle adjustment like in
growth during puberty; changes during pregnancy or
aging and stressful life style produce physiologic
changes that may lead to adaptation or disease.
The cell constantly makes adjustments to a changing,
hostile environment to keep the organism functioning in
normal steady state which is necessary to ensure the
survival of the organism. Prevention of disease by the
body depends on the capacity of the affected cells to
undergo self-repair and regeneration i.e. adaptive-
changes.
When cells are confronted to one of the following
stimulus, they may undergo adaptive changes. The
common stimuli are:-
a) Physical agents
Trauma, Burn, pressure, irradiation, etc
b) Chemical agents
Poisons, drugs, simple compounds, etc.
c) Micro organisms
- Bacteria
- Virus
- Fungus
- Parasites
d) Hypoxia
- Is the most common stimuli (cause)
- Is because of inadequate oxygen in the blood or
decreased tissue Perfusion.
e) Genetic defects
- Can affect cellular metabolism through inborn errors of
metabolism or gross malformation
f) Nutritional imbalances
Under nutrition or over nutrition causes cellular injury or
changes.
g) Immunologic reaction
E.g. - Hypersensitivity reaction.
Types of cellular Adaptive-changes
When cells are exposed to one of the above noxious
stimulus they will undergo one or more of the following
types of adaptive changes:
i. Increased concentrations of normal cellular
constituents.
ii. Accumulate abnormal substances
iii. Change the cellular size or number or
iv. Undergo a lethal change.
Abnormal and normal accumulation of intracellular
substances
Intracellular accumulations often result from
environmental changes or an inability of the cell to
process materials (substances) that cannot be
metabolized by the cells. These substances may
accumulate in the cytoplasm. As a result common
changes include:-
- Cellular swelling Lipid accumulation (Fatty change
process in the cytoplasm of cells).
- Glycogen depositions (Excess deposition of glycogen
in organs).
- Calcification (precipitation of calcium in dead or
Chronic inflammation area)
- Hyaline infiltration ( characteristic alteration within
cells or in the Extra-cellular spaces that appear as
inclusion on stained histology).
Changes to cellular size or numbers
- Changes in size and numbers of the cells are usually as
a result of response to adapt to harmful agents.
The changes include: -
I) Atrophy - Atrophy refers to a decrease in cell size.
Causes: - Decreased work load (Disuse atrophy)
 Loss of nerve supply
 Decreased blood supply
 Inadequate nutrition
 Loss of hormonal stimulation
Eg. - Uterine atrophy after menopause.
- Physiologic Atrophy
Eg. - Loss of muscle bulk with ageing.
II) Dysplasia: - Dysplasia refers to the appearance of
cells that have undergone some atypical changes in
response to chronic irritation.
- It is not a true adaptive process in that it serves no
specific functions.
- It is controlled reproduction of cells, but closely related
to malignancy in that it may transform into uncontrolled,
rapid reproduction.
- It is complete loss of normal architectural orientation of
one cell with the next both in shape and size.
- Epithelial cells are common sites for dysplastic
changes.
Eg: -Bronchial epithelium,
- Cervical epithelium, etc.
III) Hyperplasia: - It is defined as increase of tissue
mass due to an increase in the number of cells.
- It occurs in cells that are under increased physiologic
workload or stimulations. I.e. the cells are capable of
dividing thus increasing their numbers.
Types of Hyperplasia
a) Physiologic Hyperplasia:
 occurs when there hormonal stimulation
 Occurs in puberty and pregnancy
b) Compensatory-Hyperplasia
 Occurs in organs that are capable of regenerating
lost tissues.
 When part of liver is destroyed.
c) Pathologic Hyperplasia
 Is seen in abnormal stimulation of organs with
cells that are capable of regeneration.
 Enlargement of Thyroid gland due to TSH from
pituitary gland.
IV) Hypertrophy
- Is an increase in the size of individual cells, resulting in
increased tissue mass without an increase in the number
of cells.
- It is usually response of a specific organ to an increased
demand for work.
Example: - Enlargement of muscles in Athletes
V) Metaplasia
 Metaplasia is a reversible change in which one
type of adult cell is replaced by another type.
 It is an adaptive substitution of one cell type
more suitable to the hostile environment for
another.
 Replacement of the normal columnar, ciliated
goblet cells of the bronchial mucosa by
Stratified squamous epithelial cells in chronic
smokers.
CELL DEATH
Cell injury can be sub lethal or lethal. Sub lethal injury
alters functions with out causing cell death. The changes
caused by this type of injury are potentially reversible if
the injuring stimuli are removed.
Causes of cell injury: - Causes of cell injury are the
same causes of cellular adaptive changes as mentioned
above.
Classification of cell injury: - Cellular injury can be
reversible or it may progress to irreversible change
(Lethal change).
1. Reversible cell injury: - Is cell injury which can be
reversed when the stimulus or the cause of injury is
removed.
Example
Ischemia:
 Ischemia refers to a critical lack of blood supply
to a localized area.
 It is reversible in that tissues are restored to
normal function when oxygen is again supplied
to them, but if late progress to ischemic
infraction It usually occurs in the presence of
atherosclerosis in the major arteries.
  The classic conditions resulting from ischemia is
Angina pectoris.
2. Irreversible Cell injury
It is cellular injury that can not be corrected (reversed)
after the stimulus or cause has been removed.
Example:
a. Infarction
 Is localized area of tissue death due to lack of
blood supply.
 It is also called Ischemic Necrosis.
 It is due to occlusion of blood vessels by
thrombus or embolus. Septic Infarction is added
when there is evidence of infection in the area.
 It is irreversible cellular death due to lack of
blood supply, when ischemia is persistent or
late.
Example: - Acute myocardial infarction (AMI)
b. Necrosis:
 The term necrosis refers to cell or tissue death
characterized by structural vidence of this death.
 T h e s t r u c t u r a l c h a n g e s a r e
mitochondrial swelling, rupture of cell
membrane, shrinking of nucleus or fragmenting,
and release of lysozomalenzymes, etc.
Based on the structural changes, Necrosis is classified in
to two main classes:
1. Coagulative-Necrosis
 Usually results from lack of blood supply to an
area.
 The cell structure and its architectural outline is
preserved, but the nucleus is lost (structureless
necrosis)
 Caseouse Necrosis: - is a good example of
structureless necrosis. It is common in
tuberculosis and is characterized by central area
of necrosis which is soft, friable and surrounded
by an area with a cheesy, crumbly appearance.
2. Colliquative- Necrosis (liquefactiveNecrosis)
 It frequently occurs in brain tissues and results
from break down of neurons by released
lysosomal enzymes resulting in formation of
pockets of liquid, debris and cyst like structures
in the brain tissue.
 Example: - Wet gangrene.
1.2. Neoplasm
New abnormal growth because of abnormal cellular-
reproduction. It is synonymously used with tumor.
Aberrant cellular growth: - An alteration in normal cell
growth
Tumor: - A growth of Neoplastic cells clustered together
to form a mass. It can be benign or malignant.
Benign tumor: - Is characterized by abnormal cell
division but no metastasis or invasion of the surrounding
tissues.
Malignant tumor: - Abnormal cell division
characterized by ability to invade locally, metastasize
and reoccur. It is cancer cells.
Carcinogenesis: - production or origination of cancer
cells.
Sarcoma: - Malignant growth from mesodermal tissues
I.e. connective tissues, blood-vessels, organs, etc.
Metastasis: - Ability to establish secondary tumor
growth at a new location away from the primary tumor.
Carcinoma: - Malignant growth originating in epithelial
tissues
Benign and Malignant Neoplasia
The capacity of undergoing mitosis is inherent in all
cells. Mitosis is repressed or controlled until specific
stimulation for growth occurs. Every time a normal cell
passes through a cycle of division, the opportunity exists
for it to become Neoplastic.
N.B. Cancer cells lack repression or lode control of
Mitosis I.e. cancer cells are crazy cells.
Epidemiology
Neoplastic-disease affects 1 in 4 persons in the world.
Cancer can strike at any age but the chance increase with
age. It is the leading cause of children death aged 3-14
years old.
The three leading death producing cancer in men are
cancer of the lung, colo-rectal and prostatic gland. For
women the most common cancers are those of the breast,
lung, and colorectal respectively.
Classifications of Neoplasms
Neoplasms are classified according to their cells of There are some neoplasms that are named exceptionally
origin and their behavior of growth as benign or to the above rules.
malignant.
Examples:
Benign Malignant
Similar to cell of origin Dissimilar from cell of  Hepatoma: - malignant tumors of the liver cells.
origin It is also called Hepato-cellular carcinoma
Edges move word smoothly Edges move out ward  Hodgkin’s disease: - Malignant tumors of the
irregularly lymphoid tissues.
Compress locally Rapid ro very rapid growth  Multiple myeloma: - malignant tumors from the
rate plasma cells.
Slow growth rate Frequently recur after  Others: Leukemia, Ewing’s sarcoma, etc.
removal
Seldom recur after removal Necrosis and ulceration
Mechanisms of carcinogenesis
of surgery common
Necrosis and ulceration is Systemic effect common There are large numbers of research done in the world to
uncommon
know the etiology of cancer but none of the theories that
Systemic effect is
uncommon attempt to explain the peculiarities of the cancer cells
Nomenclature of Neoplasms have been completely successful. The following are
some of the theories on carcinogenesis:
Naming of Neoplasia based on two main important
features of the tumor. These are: a. Genetic Instability: -

A) Based on its Behavior of growth:
i) Benign:
 Add “oma” at the end for connective tissue
origin tumors.
 Add “papiloma” for epithelial origin.
 Add “adenoma” for glandular origin.
ii) Malignant:
 Add: - “sarcoma” at the end for malignant
tumors of Connective tissues origin.
 Add “carcinoma” at the end for malignant
tumors of epithelial origin.
 Add “adenocarcinoma” at the end for malignant
tumors of glandular origin.
The theory of somatic cell mutation supports the concept
that mutational carcinogenic agents and heredity
susceptibility can induce genetic abnormalities.
b. Carcinogens
Carcinogens are those substances that are capable of
inducing neoplastic growth. They are also called
oncogenes. Some substances induce neoplastic growth at
higher doses and exposure rates while others can be
carcinogenic at lower doses and exposure rate.
The three commonly encountered carcinogens are:
1. Chemical carcinogens
Many chemical agents are capable of causing Neoplasms
in either humans or animals.

B) Based on cells of origin: Neoplasms are named at
their prefix by their cells of origin and their suffixes are
added at the end to show whether they are benign or
malignant.
Example: - Behavior of growth
Cells of origin Benign Malignant
- Fatty cells - Lipoma - Liposarcoma
- Bone cells - Osteoma - Osteosarcoma
- Blood vessels - Hemangioma - Hemangiosarcoma
- Fibrous tissues - Fibroma - Fibrosarcoma
Chemical carcinogens are grouped as:
a. Polycyclic aromatic hydrocarbons:
They are common carcinogens; present in tobacco
smoke or automobile exhaust, usually cause cancer of
lips, oral-cavity, lungs, neck, pancreases,
b. Aromatic amines
 Commonly found in insecticides, certain foods
and Naphthalene.
 Usually related with cancer of the bladder.
c. Alkylating agents

C) Exceptional Naming (Malignant Misnomers)

They can cause cancer when given in large dose. Are
usually used as therapeutic agents.
Example: Nitrogen mustard - Mustard gas
d. Others
Like aflatoxines, nitrosamides, drugs, etc.
2. Physical carcinogenic agents
Ionizing radiation is a recognized cause of cellular
mutations. Damage to DNA may be direct or indirect. A
long latent period often exists between exposure and
development of clinical disease.
Example: leukemia and skin
cancers became very common long years later in
Hiroshima and Nagasaki, Japan; after atomic bomb
detonation.

3. Viral carcinogens (oncogenic viruses)

Viruses are thought to cause some human and Animals
malignant neoplasms. Current evidence shows that
viruses alter the genome of the infected cells, which then
alter the offspring of the host cells. Some of the
oncognic viruses are:-
1. EBV (Epstein-Barr virus) associated with Burkett’s
lymphoma.
2. HPV (Human-papilloma-virus) associated with
cervical cancer and skin-papilloma.
4. Other Factors in carcinogenesis
Epidemiologic studies have revealed other factors in the
occurrence of neoplasms besides chemical, physical and
viral-carcinogens. Some of these factors are dietary
habits, sexuality, and other personal habits like smoking,
alcohol consumption etc.