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Cancer - Definition
Cancer is:
❑an abnormal growth of cells
❑caused by multiple changes in gene expression leading to
❑dysregulated balance of cell proliferation and cell death and
❑ultimately evolving into a population of cells that can invade
tissues and metastasize to distant sites,
❑causing significant morbidity and, if untreated, death of the
host. 1
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Cancer - Types
Malignant tumors are indicted by the terms:
❑Carcinoma (epithelial in origin): Cancer that begins
in the skin or in tissues that line or cover internal
organs - skin, lung, colon, pancreatic, ovarian cancers
etc.
❑Sarcoma (mesenchymal in origin): Cancer that
begins in bone, cartilage, fat, muscle, blood vessels, or
other connective or supportive tissue - bone, soft tissue
cancers, osteosarcoma etc.
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Cancer - Types
❑Leukemia: Cancer that starts in blood-forming tissue
such as the bone marrow and causes large numbers of
abnormal blood cells to be produced and enter the
blood -- leukemia, lymphoblastic leukemias (ALL and
CLL), myelogenous leukemias (AML and CML).
❑Lymphoma: Cancers that begin in the cells of the
immune system – lymphoma, T-cell lymphomas, B-
cell lymphomas, Hodgkin lymphomas, non-Hodgkin
lymphoma.
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Naming Cancers
Cancer Prefixes Point to Location
Prefix Meaning
adeno- gland
chondro- cartilage
erythro- red blood cell
hemangio- blood vessels
hepato- liver
lipo- fat
lympho- lymphocyte
melano- pigment cell
myelo- bone marrow
myo- muscle
osteo- bone 4
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Types of Tumor
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Behavior of tumors
Benign tumors: Malignant tumors:
• are expansive, • are invasive,
compressing replacing adjacent
adjacent tissue tissue
• do not recur when • often recur even if
completely excised completely excised
• do not metastasize • may metastasize
• usually grow slowly • often grow quickly
• do not cause • may cause cachexia
cachexia 6
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Gross features of tumors
Benign: Malignant:
• a solitary mass • Solitary or multiple
• well-demarcated from • indistinct demarcation from adjacent tissues
adjacent normal tissues • usually not encapsulated
• may be encapsulated • cutaneous mass attached to underlying tissue
• cutaneous masses are usually• may have variable consistency due to soft or
easily moveable liquid center
• has a uniform consistency • may have finger-like projections, indicative
of growth into lymphatic vessels
• may have metastasized to lungs, liver, or any
other organ, with masses observed at surgery
necropsy, or by imaging analyses
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Histologic and cytologic features
Benign: Malignant:
• Well-differentiated cells • Poorly-differentiated (anaplasia)
• Uniform cell size and shape • Variable size, shape (pleomorphism)
• Well-demarcated • Poorly demarcated
• Encapsulated • Unencapsulated
• Few mitotic figures • Many mitotic figures
• Mitotic figures normal morphology • Mitotic figures have bizarre shapes
• Uniform nuclei, euploid • Variably sized nuclei, aneuploid
• One nucleus per cell • Occasional multiple nuclei
• Nucleolus single or not visible • Numerous or large nucleoli
• Tumor not within vessels • Invasion of lymphatics and veins
• Uniform appearance • Areas of necrosis and hemorrhage
• Epithelium arranged on basement • Epithelium invades past basement membranes
membranes • Dense, abundant, fibrous supporting stroma
• Orderly supporting stroma (desmoplasia)
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Benign uterine leiomyomas
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Benign Schwannoma
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Benign v. Malignant liver tumors
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Hyperplasia
Hyperplasia refers to tissue growth based on an excessive rate of cell
division, leading to a larger than usual number of cells. Nonetheless,
cell structure and the orderly arrangement of cells within the tissue
remain normal, and the process of hyperplasia is potentially reversible.
Hyperplasia can be a normal tissue response to an irritating stimulus.
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Dysplasia
Dysplasia is an abnormal type of excessive cell proliferation
characterized by loss of normal tissue arrangement and cell structure.
Often such cells revert back to normal behavior, but occasionally they
gradually become malignant. Because of their potential for becoming
malignant, areas of dysplasia should be closely monitored by a health
professional. Sometimes they need treatment. 13
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Carcinoma in situ
The most severe cases of dysplasia are sometimes referred to as
carcinoma in situ. In Latin, the term in situ means in place, so
carcinoma in situ refers to an uncontrolled growth of cells that remains
in the original location. However, carcinoma in situ may develop into
an invasive, metastatic malignancy and, therefore, is usually removed
surgically, if possible.
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Metaplasia, Dysplasia, Neoplasia
• Metaplasia is replacement of one type of cell for another
normally present in tissue
– Stimulated by irritation or hormone
– Reversible upon removal of stimulus
• Dysplasia is loss of cellular uniformity and tissue
architecture
– Stimulated and reversible to a point
• Neoplasia is new growth uncoordinated with normal
tissue
– By definition is NOT reversible
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Metaplasia and dysplasia of esophagus
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Neoplasm of skeletal muscle
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Progression of dysplasia to neoplasia
• Dysplasia is usually applied to epithelium
– abnormal variation in cell morphology (shape, size, nuclear and
cytoplasmic staining)
– minor changes in architectural orientation
• loss of cell polarity adjacent to a basement membrane
• loss of orderly maturation from basal to superficial layers
• Cervical dysplasia in women
– usually associated HPV infection
– may progress to cervical carcinoma
• detected by routine cytological exams (Pap test)
• early detection has led to a dramatic decrease in the incidence of cervical
cancer in US
• Dysplastic changes are often found adjacent to foci of
invasive carcinoma
