ONCOLOGY. Csaba Bödör. Department of Pathology and Experimental Cancer Research november 19., ÁOK, III.
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1 ONCOLOGY Csaba Bödör Department of Pathology and Experimental Cancer Research november 19., ÁOK, III.
2 ONCOLOGY Characteristics of Benign and Malignant Neoplasms Carcinogenesis, Etiology of Neoplasia Ability to Invade and Metastasize Preneopastic Disorders Treatment of Cancer
3
4 Second leading cause of death in western world When will there be a cure for cancer? Complex disease group, characterized by abnormal cell growth Curable versus very aggressive cancer types Targeted therapy and importance of pathogenesis
5 Neoplasia = tumor Oncology (oncos=tumor, logos=study of) Benign and malignant tumors o based on the tumor s potential clinical behaviour Benign will remain localized, can be removed surgically affected patients generally survive Malignant Collectively termed as cancer (from latin word for crab) Can invade and destroy adjacent and distant structures (metastasis) Not all cancers pursue a deadly course
6 Two main components Parenchyma (transformed neoplastic cells = tumor) Stroma (non-neoplastic cells, conective tissue and blood vessels) o dense fibrous stroma (desmoplasia) scirrhous tumours Active dynamic relationship between the tumor cells and the stroma!
7 Nomenclature of benign tumors oma suffix to the cell type from which they originate o fibroma, chondroma, lipoma o haemangioma, lymphangioma, meningeoma o leiomyoma, rhabdomyoma Based on macroscopic or microscopic features: o adenoma: derived from glands or showing glandular growth pattern o papilloma: benign epithelial tumor with finger-like fronds o polyp: mass that projects above a mucosal surface (e.g. in the gut) o cystadenoma: hollow cystic masses that typically arise in the ovary
8 Nomenclature of malignant tumors similar to benign tumors (with exceptions and additions) o Sarcoma (mesenchymal origin): pl. fibrosc, chondrosc., osteosc. o Carcinoma (epithelial origin) adenocarcinoma (growing in glandular pattern) squamous carcinoma (produce squamous cells) poorly differentiated, undifferentiated
9 Mixed tumors (in terms of origin) divergent differentiation o pleomorphic adenoma (mixed tumor of salivary gland) tumor cells of epithelial and myoepithelial origin, islands of cartilage or bone Teratoma tumor arising from totipotent germ cells (from ovary and testis) o capacity to differentiate into any cell type
10 Important exceptions in the nomenclature lymphoma, melanoma, mesothelioma, seminoma, glioma!! malignant lymphoma is incorrect!! Unfortunately for students, these exceptions are firmly entrenched in medical terminology.
11
12 Distinction between benign and malignant tumor is not always straightforward Four important criteria for malignant/benign Differentiation Anaplasia Growth rate Local invasion and metastasis
13 Differentiaton and anaplasia the extent to which the tumor cell resemble their cell of origin (morph./funct.) Benign well differentiated cells closely resembling their normal counterparts rare and normal mitoses Malignant undifferentiated, so called. anaplastic tumors wide range of cell differentiation well differentiated tumors Well-differentiated tumor cells are likely to retain the functional capabilities of their normal counterparts Anaplasia (dedifferentiation, backward formation ) indicator of malignancy
14 Features of the anaplastic cells Pleomorphy: variability in size and shape Rhabdomyosarcoma Aberrant nuclear morphology (size, shape, chromatin) Aberrant mitoses (tri- quadripolar divisions) Loss of polarity (loss of patterns, communal strc.) Dysplasia: aberrant, but not neoplastic proliferation! o Loss of uniformity and architectural orientation o Marks tissues at cancer risk (not necessarily) o if in entire thickness of the epithelium: carcinoma in situ
15 Growth rate slow (benign) vs fast (malignant), but hormonal effects and circulation poorly differentiated tumors usually grow faster often growth for many years before clinical manifestation cancer stem cells (tumor initiating cells) Invasion Bening tumors remain local, no invasion, no metastases Often surrounded by a fibrous capsule
16 Growth of malignant tumors (local invasion) infiltration and destruction of adjacent tissues do not form a capsule resection with clear margins invasiveness is the feature that most reliably distinguishes cancers rom benign tumors
17 Growth of malignant tumors: development of metastases spread of a tumor to sites that are physically discontinuous with the primary tumor unequivocally marks a tumor as malignant metastatic capacity of the tumors is highly variable (glioma vs osteosc.) severe limitation of the successful therapy Pathways of dissemination: Seeding within body cavities: e.g. ovarian carcinoma, peritoneal surface Lymphatic spread: Hematogenous spread: (+artificial)
18 Pathways of dissemination: Seeding within body cavities: e.g. ovarian carcinoma, peritoneal surface Lymphatic spread: mainly carcinomas, sentinel lymph node, skipping mets Hematogenous spread: mainly through veins portal circ.: drained by the liver vena cava circ.: drained by the lungs pararavertebral plexus: vertebral metastases of prostate cancer certain tumors may grow within veins. e.g. renal cell carcinoma
19 Metasztatikus kaszkád Detachment of tumor cells ECM and BM destruction Migration of the tumor cells Vascular dissemination Extravasation
20
21 Oncology I. : Summary
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