Objectives

‫ورم‬ • Dentition
Nomenclature & Types
Neoplasia •
•
‫اسباب الورم‬
Eitology
• Carcinogenesis ( mechanism)
• Metastasis
• Tumor markers & Paraneoplastic
Syndrome
‫علم األوبئة‬
• Epidemiology

‫تسميه االورام‬

NEOPLASIA Nomenclature and classification

It is according to tissue of origin and behavior:
• Definition:- ‫اوما‬
‫حميد‬
Has no useful function or benefit
• Benign-!OMA ‫ كذا يعتبر الورم حميد‬Carcinoma ‫نهاية مقطع الكلمه مثل‬
• Neoplasia--!New growth ‫نمو خاليا جديدة بدون وظيفة لها‬

َ
‫خبيث‬
• Neoplasm--!Is an abnormal mass of tissue.
• Malignant!
‫ميزينكيمال‬
The growth of which exceed and is unco-ordinated with that of the normal tissue and persist after 1-Of mesenchymal origin!Sarcoma
the cessation of the stimuli which evoked the change.

2-Of epithelial origin!Carcinomas

Definition of tumour
‫مشتق من طبقة واحدة من الخاليا الجرثومية‬
3-Mixed!Derived from one germ cell layer
growth of cell exceed normal range and is unco-
ordinated with normal tissue and persist after the ‫مركب‬
cessation of the stimuli which evoked the change
4-Compound
 More than one cell type but arise from single germ layer only
singl germ layer ‫يعني خاليا بتتحول لخاليا ثانية لكن منشأة من‬
COMPONENT
Tumors composed of !
•Mixed tumors : divergent differentiation of single line of parenchymal cells into
‫نوع واحد من الخاليا البارنشميه‬ another cells. ‫ورم حميد متعدد األشكال‬
• -One parenchymal cell type These cells arise from a single germ layer (Pleomorphic Adenoma).

• -More than one neoplastic cell type:- • Teratoma : made of multiple parenchymal layer, arise from more than single germ
layer. Which arise from multiple potent cells (totipotent cells) (Dermatocycst, or
ovarian Teratoma)
Zygote and spore
• 1-Mixed :-Derived from one germ cell layer Reproductive

• 2-Compound:-Derived from more than one germ cell layer

‫مونو كلونال‬ ‫الورم ناتج عن تغير خليه وحده‬ : ‫سوال‬
Do mixed tumor have multiply type of neoplastic cell
• Monoclonal, a tumor is one single cell has incurred genetic changes

‫مسببات السرطان‬

Etiology ‫ة‬of cancer

‫عوامل مسرطن‬
• 2-Indirect acting agents: procarcinogen

Carcinogenic agents • *Polycyclic and heterocyclic aromatic

• hydrocarbons
• -Chemical carcinogenesis
• *Aromatic amines ,amides and azo dyes
• -Radiation carcinogenesis
• *Natural plants and microbial products i.e. Aflatoxin B,Griseo-fulvin –Betel
• -Viral and microbial carcinogenesis nuts

• Chemical carcinogenesis:- • Others:

• 1-Direct acting agents • Nitrosamine and amides-Venyl chloride-Nickle-Chromium-Insecticides-Fungisides

• *Alkylating agents i.e.anticancer drugs • Polychlorinated biphenyls-Arsenic Asbestos

• *Alkylating agents i.e. I-acetyl-imidazole and Dimethylcarbamyl chloride

 Viral and microbial oncogenesis

RNA ONCOGENIC VIRUSES:-

• Acute transforming viruses(v-onc)

• Slow transforming viruses

DNA oncogenic viruses:-

•
‫بابي لوما‬
Human papiloma virus(HPV)
Mechanism
• Human herpes virus

Bacteria

Helicobacter pylori:-

• Gastric lymphoma

• Gastric carcinoma

Carcinogenesis Steps of carcinogenesis

• It is a process by which normal cells are transformed into cancer cells. • Initiation, mutation diploid
• It is characterized by a progression of changes on cellular and genetic
level that ultimately reprogram a cell to undergo uncontrolled cell
division, thus forming a malignant mass.
• Promotion, clonal expasion

• Progression, clonal evolution, aneuploidy

 ‫خلل التنسج‬
Dysplasia
‫ مما قد يدل على مرحلة تسبق تطور السرطان‬،‫ داخل الغشاء القاعدي‬،‫وجود خاليا من نوع غير طبيعي داخل األنسجة‬
• The presence of cells of an abnormal type within a tissue, within the
basement membrane, which may signify a stage preceding the
development of cancer

• Stages of Dysplasia are

IN I (mild dysplasia)

IN II (moderate to marked dysplasia)

IN III (severe dysplasia to carcinoma in situ)

Characteristics of benign and malignant tumors

Differentiation and Anaplasia:-

‫مدى تشابه الخاليا مع الخلية األصلية شكليا ووظيفيا‬
1- Differentiation ! The extent to which cells resemble the cell of origin
morphologically and functionally
de differentiation
2- Anaplasia ! To form backwords!loss of the functional and structural
characteristics of the normal cell!failure of differentiation
‫تفقد التشابه مع الخليه االصليه‬
 Features of malignant tumors
Features of benign tumors:-
‫فيه تشابه بينها و بني الخليه االصليه‬ Anaplasia:-Characterised by changes in
-Differentiated cells
-Cell shape
-Low mitotic activity

-Cell size
-Low growth rate

-Nuclear size
-Preserved functional activity

-Nuclear shape
-Circumscribed or capsulated

-Nuclear chromatism
-No invasion

-Relation of cells to each other !architecture and polarity

-N0 infiltration

-No metastasis

Grading Criteria of malignancy

Grading is a histopathological

• Cellular changes which have anaplasia, increased mitosis, abnormal mitosis

• Well differentiated tumors
• Population changes which have hypercellularity, disorganized pattern, invasion
• Moderately differentiated tumors • Other criteria known as indirect which are, necrosis , dedifferentiaition

• Poorly differentiated tumors • Mitosisi, nuclear changes

• Undifferentiated(anaplastic) tumors

• Rate of growth Correlates with the level of differentiation

Staging, clinical involvement
 Molecular basis of cancer

• DNA damage & repair

• Apoptosis & cell senescence
• Cancer genes

Cancer genes Classes of cancer genes

• Cancer genes are normal DNA sequences which when altered will initiate or They are classified into
complement the malignant transformation
Oncogenes •
• The genetic basis of cancer is supported by two facts mainly
Tumor suppressor genes •
• Carcinogenic agents also known as mutagenic

• Gene mutation & chromosomal abnormalities

Imbalance between these genes •

result in malignant transformation

• When the area of cancer cells at the originating site
becomes clinically detectable, it is called a Primary tumor.
• Some cancer cells also acquire the ability to penetrate and
infiltrate surrounding normal tissues in the local area,
forming a new tumor.
• The newly formed "daughter" tumor in the adjacent site
within the tissue is called a Local metastasis. Invasion
Cancer metastasis
It is the spread of a cancer from one organ or part
to another non-adjacent organ or part.
Some cancer cells acquire the ability to penetrate the walls of
lymphatic and/or blood vessels,after which they are able to
circulate through the bloodstream (circulating tumor cells) to
other sites and tissues in the body.
This process is known (respectively) as lymphatic or
hematogeneous spread.
 Mechanism

• Human tissues are organized into a series of compartments

seperated by ECM

• ECM is of two types which are basement membrane & intrestitial

connective tissue.

• Invasion of ECM is an active process that is accomplished in 4 steps

• 1- Intravasation of tumor cells from each other

• 2- Dissemination of tumor cells to matrix component

• 3-Extravasion of ECM

• 4-Colonization of tumor cells

Clinical Features
 It results from the production and release of physiologically active substances by the tumor.

Tumors may produce hormones, hormone precursors, a variety of enzymes, or cytokines.

Or proteins that are physiologically expressed in utero by embryonic and fetal cells but not
expressed by normal adult cells. These substances may serve as tumor markers

(eg, carcinoembryonic antigen [CEA], alpha-fetoprotein [AFP], carbohydrate antigen 19-9 [CA 19-9]).

Paraneoplastic syndrome

Tumor markers

Tumor markers : sometimes diagnostic or prognostic can be helpful in

monitoring effectiveness of therapy or in detecting relapses/recurrences
 Home message
Epidemiology
Most common cancer are Lung Carcinoma, Breast, Prostate, Colon, Liver • Definition
For the Male, common cancers are, Prostate, Lung, Colon\Rectum • Etiological factors
For Female the common cancers are, Breast, Cervix, Ovaries, Lung • Different between benign and malignant
Due to allchoho; are , Oropharynx, Larynx, Esophagus, Liver • Mechanism & genetic role
In childern, neurological tumors are more common, Rhabdomyosarcoma, Neuroblastoma, Wilm”s Tumors • Invasion & metastasis
• paraneoplastic syndrome & tumor markers