Introduction:

A tumour is a new growth of cells which fulfills no useful function.The term does

not include inflammatory swellings such as Potts Puffy Tumour. Cells are arranged atypically. Abnormal behaviour & autonomy are the haulmarks of tumour.The tumour continues to grow even after withdrawl of stimulus(in contrast to Hyperplasia)

Eteiological Factors :
Malignancies arise because of mutations in the DNA of at least one cell which no longer behaves normally. Any kind of external irritation can cause cancer e.g Kangari cancer in Kashmiris,Chimney sweep cancer & countryman lip.Renal stones causing Metaplasia.Kissing cancers as seen in lips & Valva.

 Regeneration of tissues with awakening of erstwhile dormant embryonic cells may encourage malignant change.Primary carcinoma of Liver is common in cirrhosis from the liver cells trying to regenerate. Same holds true for Squamous cell cancer devolping on chropnic ulcer or scar (Marjolin ulcer)

 Viruses causes nuclear instability & are implicated to cause Burkitts Lymphoma,Kaposi sarcoma,HPV causing cancer of the cervix. Predisposing factors like tobaco chewing,cigratte smoking,alcohal, Bowel habits,Parity of the patient,Family history of the disease esp in Ca Cervix & breast,Radiation effects.

Classification of Tumours.
1.Naked Eye Appearance & site of Tumour: common presentation is that of a lump.Tumour of Brain or meninges is more dangerous than that of Skin.Annular & fungating T usually seen in the intestine.Scirrhous tumours are hard due to large amount of fibrous tissue in the stroma..Encephaliod T are soft due to less stromal reation.

 2.Hisogenic classification: A.T of Epithelial origin- Carcinomas (ectodermal or endodermal in origin) usually squamous,basal cell or glandular . B.T of Connective tissue origin(mesodermal)Sarcomas. Squamous cell ca-Radiosensitive. Adenocarcinoma-Radioresitant. Electron microscopy & IHC of great help in identification of type of malignancy.

 3.Histological Classification:depends on the degree of differentiation. More differentiated tumour-better prognosis. 4.Classification according to Behaviour: a.Benign or Inocent T:Non invasive,Encapsulated,can cause pressure effects,closely resemble parent tissue

 B.Malgnant T:Invasion,Pleomorphism & Irregularity are the haulmark of Malignant Tumours. C Intermediate(Locally Malignant T) As seen in Basal Cell Carcinomas,Ammeloblastomas,Pleom orphic Adenoma of Salivary Glands.

d.Latent Cancer:clinically silent with no metastasis as in Carcinoma Prostate. E.Carcinoma in Situ:Stage of preinvasive proliferation. F.Spontaneous Regression:Malignant Melanomas,Clear cell ca of Kidney,Neuroblastomas,Chondrosarcomas, Burkits Lymphomas. Mechanism:Hormonal or Immunological. G.Dormant Cancer:Late appearance of Metastasis after the primary has been treated.

5.AetiologicalClassification:Puitfall,single agent like Radiation can cause Ca Skin,Osteosarcoma or Chondrosarcoma. 6.Functional Classification;Tumours known to secrete Hormones so named accordingly as Insulinomas,Glucagonomas.

BENIGN TUMOURS.
ADENOMAS: Origin Secretory glands like Breast,Thyriod,Parathyriod & Pancreas. If they arise from superficial glands of mucous membranes they are called Polyps. Always Encapsulated & sometime secrete Hormones.

 PAPILLOMAS: Central axis of connective tissue ,blood vessel & lymphatics covered by Epithelium.

 FIBROMA: True firoma is rare. Usually combined with other mesodermal tissue like muscle,fat,Nerve sheath. Can be soft or hard depending on the proportion of fibrous tissue.

LIPOMA:Diffuse or Encapsulated. UNIVERSAL OR UBIQUITOUS TUMOUR. Sites:Head & Neck,abdominal wall& thighs. Can be Fibrolipoma or Naevolipoma. Classified according to site like subcutaneous,subfascial,subsynovial, intraarticular,Paraosteal,subserous(Pleura,retroperiton eum),submucous,extradural,intraglandular. Treatment:Excision esp if pain,or on account of size,site or appearance.Perfect Haemostasis with removal of all projections

 NEUROMAS:arise in connection with Sympthetic Nervous System A.Ganglioneuromas. B.Neuroblastomas.

 NEUROFIBROMAS: Local: Painful subcutaneous nodule,can also arise from sheath of a peripheral nerve also like Acoustic Neuromas. Generalised Neurofibromatosis or Von Recklinghausen disease

 HAMARTOMA: Devolpmental malformation consisting of overgrowth of tissues proper to that part

MALIGNANT TUMOURS:
Can be carcinomas or sarcomas. Carcinomas can be Squamous cell,Basal celled or Glandular.

SPREAD OF MALIGNANT TUOMOURS:

Direct Spread(Local Invasion). Lymphatic Spread: Lymphatic permeation & Embolism Blood Stream:esp in Renal cell carcinoma,T growing in to Inferior Vena Cava.also seen in Thyriod,Breast & Bronchial Cancer. Seedling as in lip & valval cancer,also sen in colloid carcinoma of Stomach(Transcoelomic spread)

GRADING & STAGING OF TUMOURS:

TNM CLASSFICATION: mostly used in Breast Carcinomas. T1N0 M0 is better than T2N2 M1.

SARCOMAS:
Usually seen in young patients. Grow rapidly,diseminate early(CANNON BALL APPEARANCE OF METASTASIS) Spread hastened by local excision,Always do wide excision may amount to amputation even

BENIGNT TO MALIGNANT CHANGE.

1.Increase in Size. 2.Increase in Vascularity. 3.Fixity due to Local Invasion. 4.Involvement of Local Structures eg Facial N involvement in Pleomorhic Adenoma 5.Disemination esp in Head & Neck cancers.

PREVENTION & EARLY TREATMENT OF CANCER:

Identify Risk factors,persons at risk,deduct ealy,look for warning signs.