NEOPLASIA-I CANCER Nam Deuk Kim, Ph.D. 1
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Tumor in the hieroglyphics of the Edwin Smith papyrus (1,600 B.C., Breasted s translation 1930) 3
War on Cancer (National Cancer Act, 1971) 4
Cancer Acts in Korea and Japan( 암정복법 ) Korea: 1996년암정복 10개년법제정 국립암센터 (www.ncc.re.kr): 2000년건립원장 : 박재갑박사 Japan: 1986 년제정 5
DEFINITIONS Neoplasia: new growth Tumor: swelling caused by inflammation a. Benign tumor b. Malignant tumor Oncology [oncos = tumor (Greek)]: the study of tumors or neoplasia Cancer [cancrum (Greek)]: the common term for all malignant tumors 6
NOMENCLATURE Benign tumor: -oma a. adenoma b. fibroma c. chondroma d. osteoma Malignant tumor: a. carcinoma: 90% of malignant tumor b. sarcoma: 10% of malignant tumor 7
NOMENCLATUR E OF TUMORS Mesenchymal tumors a. connective tissue origin: fibroma/fibrosarcoma b. smooth muscle origin: leiomyoma/leiomyosarcoma Epithelial tumors a. glandular epithelial origin adenoma/adenocarcinoma 8
Papilloma of the colon with finger-like projections into the lumen 9
Colonic polyp (benign glandular tumor) 10
Mixed tumor or the parotid gland contains epithelial cells forming ducts and myxoid stroma that resembles cartilage 11
Gross appearance of an opened cystic teratoma of the Ovary. Note the presence of hair, sebaceous material, and tooth. Track of Neural tissue 12
CHARACTERISTICS OF BENIGN AND MALIGNANT NEOPLASMS Differentiation and anaplasia Rate of growth Local invasion Metastasis 13
1. Differentiation and anaplasia Differentiation: the extent of which parenchymal cells resemble comparable normal cells, both morphologically and functionally Benign tumor: well differentiated Malignant tumor: range from well differentiated to undifferentiated; some loss of differentiation 14
Leiomyoma of the uterus: benign, well-differentiated tumor 15
Benign tumor (adenoma) of the thyroid: normal-looking (well-differentiated), colloid-filled thyroid follicles 16
Malignant tumor (adenocarcinoma) of the colon: irregular in shape 17
Anaplasia of malignant cells Anaplasia: lack of differentiation Pleomorphism: variation in size and shape Hyperchromatic Nuclear-to-cytoplasmic ratio = 1:1 c.f.: normal cells = 1:4 to 1:6 18
Anaplastic tumor of the skeletal muscle (rhabdomyosarcoma) Tumor giant cells 19
High-power detail of anaplastic tumor cells to show Cellular and nuclear variation in size and shape 20
Well-differentiated squamous cell carcinoma of the skin Arrow: keratin pearl 21
Dysplasia Dysplasia: a loss in the uniformity of the individual cells as well as a loss in their architectural orientation Dysplasia does not necessarily progress to cancer Carcinoma in situ: a. a preinvasive neoplasm b. dysplastic changes involved the entire thickness of the epithelium 22
Carcinoma in situ 23
2. Rate of growth Benign tumor: grow slowly Cancer: grow rapidly, sometimes at an erratic pace Threadlike False Feet Are a Common Feature of Cancerous Cells 24
3. Local Invasion Benign tumors: grow as cohesive expansile masses; capsule Cancers: progressive infiltration, invasion, and destruction of the surrounding tissue 25
Normal Moles Are Common Examples of Benign Growths 26
Fibroadenoma of the breast 27
Cut section of an invasive ductal carcinoma of the breast; The microscopic view of breast carcinoma 28
4. Metastasis Marker of malignant tumor Benign tumor: no metastasis Pathways of spread a. Seeding of body cavities and surfaces b. Lymphatic spread c. Hematogenous spread 29
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A. Seeding of body cavities and surfaces Open field Cavities a. peritoneal cavity b. pleural cavity c. pericardial cavity d. subarachnoid cavity e. joint space Ovarian cancer 31
B. Lymphatic spread The most common pathway for the initial dissemination of carcinomas Enlargement of nodes: a. the spread and growth of cancer cells b. reactive hyperplasia 32
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Axillary lymph node with metastatic breast carcinoma 35
C. Hematogenous spread Typical of sarcomas; also used by carcinomas Liver: all portal area drainage flows to liver Lung: all caval blood flows to the lungs 36
A liver studded with metastatic cancer/microscopic view Of liver metastasis 37
Comparisons between benign and malignant tumors Characteristics Benign Malignant Differentiation/ anaplasia Rate of growth Local invasion Metastasis Well differentiated Usually progressive and slow Usually cohesive and expansile welldemarcated masses that do not invade or infiltrate surrounding normal tissues Absent Some lack of differentiation with anaplasia Erratic and may be slow to rapid Locally invasive, infiltrating the surrounding normal tissues Frequently present 38
Comparison between a benign tumor of the myometrium (leiomyoma) and a malignant tumor of similar origin (leiomyosarcoma) 39