ONCOLOGY

Oncology is the science dealing with tumour

or neoplasms. The word tumour and the
suffix (- oma) both mean the presence of a
mass of tissue or swelling.
The Alternative term neoplasm literally
mean new growth of cells without relation to
the needs of the body. It serves no useful
purpose and is not controlled by the laws
normal growth.
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 Regeneration
is growth of new cells but
1.serve a useful purpose
2.it obeys the laws of normal growth.
e.g. Regeneration of epithelium .

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 Hyperplasia
It is the increase in size of an organ due to an
increase in number of its constituent
specialized normal cells. This happens in
response to a specific stimulus and exists
so long as this is applied.
Hypertrophy
Increase in size of cells and not the number of
cells. E.g. Uterus in pregnancy.
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 TYPES OF NEOPLASMS

The most important subdivision of neoplasms

is:
1.benign
2. malignant.
This distinctions is often made on the basis of
histological criteria but it is an essentially
clinical subdivision.

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 Table (1) : differences between benign and malignant tumors

Characters Benign Malignent

Rate of growth Slow
Localization Circumscribed and possess a
capsule (encapsulated)
Recurrence Does not recur after removal,
Metastasis Does not metastasised
Differentiation Well differentiated i.e. tends to
copy the original tissue
Ulceration and haemorrhage Rare
Rapid
Invasive infiltrate surrounding
tissues and sends claw like
crab
Tendency to reappear recur
unless removed a safety
margin.
Metastasis i.e. spread to distant
organ or tissue by lymph or
blood stream.
Fails to reproduce the structure
of the tissue i.e. lack of
differentiation
Common

Prognosis (result) Does not kill unlessaffects a fatal

vital organ. 5
Nature of neoplasia
The two main functions of a cell are:
(1) Work, which depends on the activity of
cytoplasm, and
(2) Reproduction which depends on the activity of
the nucleus.
A cancer cell spends most of its energy on
reproduction and little on work or function.
The more rapid the growth, the more primitive the
cell in structure and specialized function on what
we call anaplasia. Anaplasia means lack of
differentiation, or the cells fail to reproduce the
structure of tissue from which it grow.

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Thus the two main features of cancer are:
1- anaplasia
2- autonomy, or escape from the control of normal laws of
growth
characteristics of cancer cells
This can be studied by means of the light microscope which
gives more information on the nucleus, and the electron
microscope which gives information on the cytoplasm.
Cancer cell differs from a normal cell in the following:
1) Increased basophilia i.e. The cell is hyperchromatic and
stained deeply with haematoxylin .
2) Decreased cytoplasm / nucleus ratio i.e., a big nucleus
and little cytoplasms (as the nucleus is concerned with
reproduction and the cytoplasm is concerned with work)

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3) Increased mitosis which denotes active
reproduction.
4) Loss of normal polarity.
5) By electron microscope.
(a) Mitochondria: In the tumour cell the
mitochondria are reduced in number and vary
in size. The cristea are irregular and the
constituents of the mitochondria necessary for
the active functioning of the cell are largely
depressed.
(b) Endoplasmic reticulum: In the tumour cell
vesicles are reduced in number & ribosornes
not predominant & are free in the cytoplasm.

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Classification of tumour:
The pathological classification is given in the
following table:

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Cell of origin Benign Malignant
Epithelial cells:
Squamous Papilloma Carcinoma
Glandular Adenoma Adenocarcinoma
Transitional papilloma Carcinoma
Pigmented cells. Benign melanoma Malignantmelanoma
Connective tissue cells:
Fibrous tissue Fibroma Fibrosarcoma
Smooth muscle Leiomyoma Leiomyosarcoma
Striated muscle Rhabdomyoma Rhabdomyosarcoma
Cartilage Chondroma Chondrosarcoma
Bone Osteoma Osteogenicsarcoma
Fat Lipoma Liposarcoma
Haemopoietic tissue:
Lymphoid cells Lymphoma Lymphosarcoma
Plasma cells --------------- Mgelomatosis
Erythroid cells ----------------- Primary Polycythaemia
Nerve cells Ganglioneuroma Neuroblastoma
Germ cells Teratoma Teratocarcinoma

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Spread of tumours:
Spread of tumours is a character of malignancy while
benign turn remains localized. The most common sites
at which metastasis are found are: lung, liver, bone,
brain, lymph nodes and skin. Tumour cells can be
carried along any tubular structure in the body which
contains fluid.
The most common routes by which metastasis are spread
are:
1 - Infiltration of tissue space
2 - lymphatics
3 - blood vessels
4 - along natural passage
5 - through serous cavities
6 - by inoculation

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1) Infiltration of tissue spaces:
The cells of normal tissue and benign tumours are
incapable of movement because they are firmly
attached to each other by
cell adhesiveness. Cancer cells are free because
of a greatly reduced adhesiveness due to a
deficiency of calcium in cell membrane.
2) Lymph spread:
All organ and tissues except the central nervous
system are served by elements of the lymphatic
system The tumour cells are particularly prove to
invade the lymph vessels and to spread first to
the local lymph nodes where they are seen in
the peripheral sinuses & later to other groups
else where in the body.

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3).Blood spread:
Many malignant cells have the property of invading the
walls of small blood vessels. The veins are invaded greatly
but arteries very rarely. Four groups of veins are
involved:
1) systemic, 2) portal ,3) pulmonary ,4) vertebral groups
of veins.
The main spread of tumour cells occurs along the first two.
The portal system drains the gastrointestinal tract and
goes to the liver. Thus, tumours of this tract which
involve the stomach, small and large intestine, rectum
and pancreas spread along this system and metastasis
or secondary occur in the liver. The systemic vein drain
the rest of the body and goes to the lung, so most of the
blood metastasis first in the lung. Carcinomas spread
mainly’ along the lymphatics and then the blood vessels,
while sarcomas spread mainly along the blood stream.

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4) Spread by natural passage:
Tumours of the kidney, may spread down the ureter to
form secondary deposits in the bladder.
Cells from carcinoma of the uterus and ovary may pass
along the fallopian to produce secondary deposits in the
ovary aid uterus respectively. Tumours of the liver may
invade the interhepatic bile ducts and spread by way of
the bile duct system to the common bile duct and gall
bladder.
5) Spread through serous cavities:
Tumours may spread through body cavities:
a.the two pleural cavities.
b. the peritoneurn .
c. the pericardial cavity.

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6) Inoculation:
Instrument and gloves which may have
become contaminated with cancer cells
after surgical cancer operations
considered as a way for tumour spread.

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 Etiology of malignant tumours
• General factors:
(1) Age:
Cancer is mainly a disease of old persons,because the various
carcinogenic factors need a long period of time to produce their
effect. There are, however exceptions to this general rules. e.g.
rehinoblastoma, Wilim’s tumour and Sarcoma occurs in children .
(2) Sex:
With the exception of sex organs, carcinoma is commoner in males
than in females, but cancers of the thyroid and gall bladder are
commoner in females.
(3) Race:
There are racial differences as regards the relative frequency of
different types of cancer. This is discussed in geographical
pathology. Cancer of the stomach is much common in Europe;
cancer of the liver is common in Indonesia and cancer of the urinary
bladder is common in Egypt.

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(4) Hereditary and familial predisposition :
There are some tumours in man in which a genetic
factor are important, they are the genetically
dominated tumours. e.g. retinoblastoma, multiple
neurofibroma, congenital multiple polyposis coli
and xeroderma pigmentosoma.
There are also records of so-called (cancer
families) in which tumours of a certain organ
occur in successive generations, e.g., cancer
breast is known to occur more commonly in near
relatives than in the general population.
Nepoleon and his father and three of this sisters
died from cancer of the stomach etc.

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Exogenous carcinogenic factors:
These include:
1. Chemical carcinogens:
These are very important especially in the group of tumours which are
called occupational tumour e .g.
(1) Scrotal cancer which used to occur in chimneysweepers.
(2) cancer of the bladder in workers in aniline dye factories.
(3) Cancer of the lungs which occurs in workers whose occupation
exposes them for a long time to chromium, nickel, ... etc
Amongst the known chemical carcinogens are:
(a) Benzopyrene
(b)Derivatives oLcholanthrene
(c) Benzanthrancene
(d) some of the fluorine compounds used in insecticides
(e) Beta-naphthylamine
(f) Tryptophane metabolites and derivatives.
(g)Mycotoxines e.g. aflatoxin B1

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2) Physical carcinogenic tactors:
Tue majority of these: :
(a) lonising radiation: Many cases of leukaemia developed as a late
result of the atomic radiation in Hiroshima and Nagasaki after the
Second World War.

(b) X-ray workers are liable to develop skin cancer or leukaernia

(d) Radioactive substances are the cause of lung cancer in certain
mines.
3). Parasites.
4). Viruses.

Endoenous factor:
such as bile acids, sterols and sex hormones. Disorders in the
metabolism of these substance may lead to the production of certain
compounds which are similar in structure to some of the known
chemical carcinogenic substances.
Hormones may also play an important role in relation to certain
tumours. These tumours are called hormones dependent tumours
like the ovarian oestrgen. Examples of such tumours are seen in
breast and prostate cancers.
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 Precancerous condition
These are lesions which are not malignant but if left without treatment ,
it becomes malignant. As example we have: senile karatosis,
leukoplakia (as in the vagina ) The papilloma of the urinary bladder
may be regarded as precancerous.

(Two - stage) concept of carcinogenesis

initiator is a cancer-producing agent.
promoter or co-carcinogen is agent that increases the tumorigenic
response to a carcinogen when applied after the carcinogen.
The two stages of initiation and promotion have been demonstrated in
the mouse skin tumour. Administration of a single dose of an
initiator such as 7,12-dimethyl (a) anthracene or of only repetitive
doses of promoters tetra decancylpherbol acetate does not lead to
gross tumour. However, administration of the hydrocarbon -(7, 12-
di) and then repeated doses of the phorbol ester (tetra ...) give rise
to a
papillomas within 3 to 4 months and to- carcinoma in about 1 year.

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 Diagram representation of two-stage concept of
carcinogenesis in skin tumour of mouse
Substance Tumor incidence
I………………………………………………………………. 0

I → P →………………………………………..High

I (interval up to 1 year) → P →……………………….High

P → I → …………………………….0

P ……………………………………………………………..0

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 Histological grade of malignancy
The histological grading of malignancy was
developed to assess the degree of differentiation
of a cancer. Based on this criterion, and others
like it, tumors have been classified as:
 Grade 1 (75 to 100% differentiation).
 Grade 11(50 to 75%),
 Grade III (25 to 50%)
 Grade IV (0 to 25%).
More recent methods of malignancy grading also
take into consideration mitotic activity, amount of
infiltration into surrounding tissue, and amount of
stromal tissue in or around the tumor.

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