Oncology

The Study of Tumours and their

treatment
Outline of presentation
Definitions
Incidence of cancer
Neoplasm/tumours
Aetiology
Nomenclature
Pathophysiology
Carcinogenesis
Definitions
1. Oncology: study of tumors.
2. Neoplasm: an abnormal mass of tissue as a result
of neoplasia or cell multiplication.
3. Neoplasia is the abnormal proliferation of cells
4. Cancer: A malignant growth. Related terms:
malignant tumours & neoplasms
Terminologies
5. Anaplasia: cells that lack normal cellular
characteristics.
6. Hyperplasia: an abnormal increase in the
number of cells
7. Metaplasia: transformation of one tissue to
another
8. Dysplasia: an abnormality in development
Incidence
A leading cause of death worldwide,
accounting for 7.6 million deaths (WHO, 2008)
Affect all ethnic groups and all ages
common in the aged (above 65 yrs).
More men die of cancer than women.

The 10 leading cancer types
(American Cancer Society, 2005)
Tumors:Neoplasms
Definition
A neoplasm is an abnormal mass of tissue, the growth
of which exceeds and is uncoordinated with that of
the normal tissues and persists in the same excessive
manner after cessation of the stimuli which evoked
the change - Willis
Types of Neoplasm
There are two major types:
Benign
Malignant neoplasm

Benign Tumors
















If cells LOOK GOOD, they are probably going to BEHAVE
GOOD
Malignant Tumors
If cells LOOK BAD, they are probably going to BEHAVE BAD
Malignant tumors
Aka cancer
Cancer is derived from the
Greek word for crab
Cancers are examples of
tumors

Aetiology /Carcinogens
Physical agents e.g. tobacco and radiation
Chemicals e.g. Alcohol & soot
Genetic factors
Infectious agents e.g. hepatitis B,
Dietary factors like fats & red meat.
Hormonal factors e.g. oral contraceptives
(Brunner and Suddarth pp. 339-342)
Naming Tumors: Benign Tumors
Named according to the
tissues from which they
originate and include
the suffix oma
i.e. type of tissue plus
oma
Examples include:
1. Chondroma: cartilaginous tumor
2. Fibroma- fibrous tumor
3. Osteoma-bone tumor
4. Lipoma-tumor of the fat tis.
5. Glioma-?
6. Leimyoma-?
Some tricky ones
Epithelial lining -papilo
Glands-adeno
e.g. Adenoma
Naming of tumors: malignant
Sarcomas: mesenchymal tumor
chrondrosarcoma: cartilaginous tumor
fibrosarcoma: fibrous tumor
osteosarcoma: bone tumor
Carcinomas: epithelial tumors
adenocarcinoma: gland forming tumor
Pathophysiology of cancer
Characteristics of Normal Matured Cells
Cells normally
differentiate, grow,
mature and divide.
These are regulated
processes, balanced in
a healthy system such
that cell birth is nearly
equal to cell death


Pathophysiology
Characteristics of Cancer cells
Differ from normal cells
Ignore normal growth-
regulating signals, proliferate
and grow uncontrollably.
The cells become invasive,
infiltrate adjacent structures
destroying surrounding tissues
and organs.
Pathophysiology
There are two major dysfunctions associated
with the process of cancer:
Defective cellular proliferation
Defective cellular differentiation.

1. Defective cellular proliferation
Normal physiology
Stem cells proliferate and differentiate to
produce various cells of the body
A state of dynamic equilibrium maintained
Proliferation occurs only:
in cellular death
In increased physiologic need for more cells.

1. Defective cellular proliferation
In the case of cancer cells, there is:
A. Loss of Contact Inhibition
Normal cells respect the boundaries of cells. This is known as
contact inhibition
Malignant cells have no contact inhibition
B. Respond differently to the signals that regulate the
state of dynamic equilibrium
Cancer cells therefore divide indiscriminately and
may produce more than 2 cells at a time.

2. Defective cellular differentiation

Cellular differentiation
All Body cells derived from
fertilized ova (STEM CELL)
They have potential to
differentiate to perform all
body functions.
This potential is repressed
by differentiation process
Matured cells only perform
specific functions.
2. Defective cellular differentiation
Proto-oncogenes
Normal genes that regulate cell growth and
differentiation
May become oncogenes by mutation
Oncogenes have potential to cause cancer
Tumor suppressor genes.
Tumor suppressor genes suppress growth.
Mutations can turn these normal genes into
tumour inducing genes.
Carcinogenesis

CARCINOGENESIS

Tumor development goes through 3 stages;
1. Initiation
2. Promotion
3. progression

1.Initiation
Alteration of cells genetic structure
resulting from:
1. An inherited mutation
2. exposure to carcinogens.
Altered cells may develop into a clone of
neoplastic cells.

Promotion
Characterized by reversible proliferation of the
altered cells.
Activities of promoters (e.g. cigarette smoking)
are reversible
Some carcinogens (Complete carcinogens) are
capable of initiating and promoting cancer eg is
cigarette smoke.
Latent Period: The period between the initial
genetic alteration and the actual clinical
evidence


PROGRESSION
The final stage of tumor development
Characterized by:
Increased growth rate of the tumor,
increased invasiveness and
metastasis (spread of cancer to distant organs).
Classification of cancer
Classified according to
Anatomic site
histology/grading
extent of disease/staging.

Anatomic site
Two classes identified:
1. Carcinomas originate from embryonic
ectoderm (skin and glands) and embryonic
endoderm (mucus membranes lining the GIT,
GU tract and RT).
2. Sarcomas originate from embryonic
mesoderm (connective tissue, muscles,
bones and fat).

Histological classification
Based on appearance of cells and the degree of differentiation
1. GRADE I
Cells differ slightly from normal cells (i.e. mild dysplasia) and are well differentiated.
2. GRADE II
Cells are more abnormal (moderate dysplasia) and moderately differentiated.
3. GRADE III
Cells are very abnormal (severe dysplasia) and poorly differentiated.
4. GRADE IV
Cells are immature and primitive ( i.e. anaplasia) and undifferentiated. Cell of origin is
difficult to determine.

Classification by extent of disease/staging