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Neoplasia (1 of 6)

Neoplasia (1 of 6). Ali Al Khader, M.D. Faculty of Medicine Al-Balqa’ Applied University Email: ali.alkhader@bau.edu.jo. Introduction. = new growth Oncology = study of neoplasia Genetic/epigenetic basis Neoplasms are clonal Accumulation of mutations…more are accumulated in malignant ones.

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Neoplasia (1 of 6)

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  1. Neoplasia(1 of 6) Ali Al Khader, M.D. Faculty of Medicine Al-Balqa’ Applied University Email: ali.alkhader@bau.edu.jo

  2. Introduction = new growth • Oncology = study of neoplasia • Genetic/epigenetic basis • Neoplasms are clonal • Accumulation of mutations…more are accumulated in malignant ones See next slide

  3. With accumulation of mutations, features of malignancy are produced • More dysregulated autonomous growth (self-sufficiency in growth signals) • More lack of response to inhibitory signal • Evasion of apoptosis • Limitless replicative potential • More development of angiogenesis • Ability to invade surrounding tissues • Reprograming metabolic pathways • Evasion of the immune system With more mutations more genomic instability vicious cycle

  4. Nomenclature

  5. Hamartomas and choristomas

  6. Well-differentiated Anaplastic -more N/C ratio -more nuclear pleomorphism -more hyperchromasia -more mitoses -more abnormal mitoses -more large (giant) cells -more bizarre cells -less structures resembling original tissue -more coarse clumped chromatin What is dysplasia?

  7. Metastasis and dissemination • Basal cell carcinomas…almost always non-metastatic …also primary tumors of the central nervous system • Bone sarcomas…usually already spread to lungs at diagnosis • with differentiation and size…with exceptions • 3 ways of dissemination

  8. Metastasis and dissemination, cont’d • Medulloblastoma or ependymoma…through CSF in ventricles to meningeal surfaces of brain/spinal cord • Carcinoma…lymphatics, not only through lymphatics • Sarcoma…blood, not only through blood • Lung carcinomas regional bronchial lymph nodes tracheobronchial and hilar nodes

  9. Metastasis and dissemination, cont’d • Breast: …usually upper outer quadrant axillary lymph nodes …medial breast lesions nodes along internal mammary artery • Sentinel lymph node??? • Enlargement of nodes near cancer are not necessarily involved by the cancer both may seed supraclavicular or infraclavicular nodes

  10. Metastasis and dissemination, cont’d • Veins are penetrated easier than arteries • The liver and lungs are the most frequently involved secondary sites in hematogenousdissemination • Vertebral metastases of thyroid and prostate cancers…through the paravertebral plexus • Renal cell carcinoma…renal vein…may then spread through IVC • Prostatic carcinoma…bone • Lung…adrenals and brain • Neuroblastoma…liver and bones • Skeletal muscles are rare sites for metastasis

  11. Epidemiology of cancer Cervical cancer deaths markedly Started to decline

  12. Epidemiology of cancer, cont’d Environmental more than genetic • Some geographic areas are with high incidence of smoking & alcoholism • Dietary fat and fibers colon cancer…differences between the West & Africa • Death rates from breast cancer are about four to five times higher in the United States and Europe than in Japan • The death rate for stomach carcinoma in men and women is about seven times higher in Japan than in the United States • Liver cell carcinoma is relatively infrequent in the United States but is the most lethal cancer among many African populations • Cervical cancer and its risk factors

  13. Epidemiology of cancer, cont’d • Most cancer deaths occur between ages 55 and 75 • The major lethal cancers in children are leukemias, tumors of the central nervous system, lymphomas, and soft tissue and bone sarcomas …also retinoblastoma occurs mainly in pediatric age group

  14. Epidemiology of cancer, cont’d Occupational hazards

  15. Epidemiology of cancer, cont’d no more than 5% to 10% of all human cancers fall into one of these three categories 40% of retinoblastoma cases are hereditary Inherited predisposition to cancer -early age at onset -tumors arising in two or more close relatives of the index case -sometimes multiple or bilateral tumors -not associated with specific marker phenotypes

  16. Epidemiology of cancer, cont’d • Acquired preneoplasticlesions …some are due to chronic tissue injury or inflammation …their removal or reversal may prevent the development of a cancer …examples: -Squamous metaplasia and dysplasia of the bronchial mucosa…smokers -Endometrial hyperplasia -Leukoplakia of the oral cavity, vulva, or penis -Adenomas of the colon

  17. Thank You

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