Chapter 5 Neoplasia

1. Chapter 5Neoplasia

2. Cell Growth • Growth categories • Labile • Stable • Permanent • Growth regulators • Proto-oncogenes • Tumor suppressor genes • Apoptosis regulating genes • DNA repair genes

3. Neoplastic Growth Malignant Benign • Variable growth rate, depends on the level of cell differentiation • Invades surrounding tissues by infiltration, not encapsulated • Undifferentiated cells may not resemble cells of origin. • Metastasizes to distant tissues • Slow growth • Expands into tissues, usually encapsulated • Cells are well differentiated. • Do not metastasize

4. Neoplastic Growth (cont.) Benign Malignant

5. Carcinogenesis • Defined • Most common targets for genetic damage • Proto-oncogenes • Tumor suppressor genes • DNA repair genes • Apoptosis regulating genes

6. Carcinogenesis (cont.) • Etiology of genetic damage (carcinogenic agents) • Inherited traits/influences • Chemicals • Environmental insults/agents • Viral infections • Immune system defects

7. Local Growth and Distant Metastasis • Local growth • Carcinoma in situ • Local spread • Mechanical pressure, enzymes, lack of adhesion • Metastasis • Lymph system • Blood system • Seeding

8. Diagnosis • Symptoms • Screening • Physical exams (visual/palpation) • Radiographs (mammography) • Pap smear • Oral screening devices (brush biopsy and others) • Laboratory • Biopsy • Excisional/incisional • Aspiration

9. Diagnosis (cont.) • Benign • Well differentiated • No extension into or fixation to surrounding tissues • No metastasis • Malignant • Variable levels of differentiation (anaplasia) • Atypical cells • Extend into and are fixed to surrounding tissues • Lymph node and distant metastasis

10. Anaplastic Changes

11. Tumor Grading and Staging • Cancer grading • Level of differentiation • Systems • UICC—TMN • AJCC—TNM/anatomic stage/prognostic groups • Molecular diagnosis • Molecular profiling

12. Systemic Effects • Paraneoplastic syndromes • Fever • Anorexia • Endocrine imbalances • Anemia • Thrombocytosis • Hypercoagulability • Neurologic problems

13. Cancer Therapies • Surgery • Radiation therapy • Chemotherapy • Hormone/antihormone therapy • Immunotherapy • Targeted therapy • Complementary and alternative therapies

14. Side Effects of Therapy Mucositis • Mucositis • Anemia • Leukopenia • Xerostomia • Others

15. Prevention • Stop the use of tobacco products. • Proper nutrition • Eat a variety of fruits and vegetables every day. • Reduce the amount of refined grains and sugars consumed. • Reduce the amount of high-fat red meat consumed. • Maintain a healthy weight throughout life. • Stay physically active. • Limit alcohol consumption. • Limit sun exposure, use sunscreen or other protection.

16. Oral Metastatic Cancers • Metastatic cancer from any primary cancer site • Breast, lung, prostate, renal cell, and colorectal cancers most likely • Mandible more commonly affected than maxilla • May be the first sign of cancer in 30% of cases • Usually presents as poorly defined radiolucent defects • May cause pathologic jaw fractures • Paresthesia of associated soft tissues is common. • Be suspicious of this type of lesion in patients with a history of cancer

17. Oral Metastatic Cancers (cont.)

18. Skin Cancers • Basal cell • Squamous cell • Melanoma

19. Basal Cell Carcinoma • Etiology—UV light, genetic factors • Epidemiology—most common form of skin cancer (approximately 80%) • Pathogenesis—UV exposure causes accumulation of genetic defects over time; lesion exhibits slow growth. • Characteristics—most found in head and neck area, appears nodular with depressed center and rolled pearly borders often with capillaries seen throughout the border area

20. Basal Cell Carcinoma (cont.)

21. Squamous Cell Carcinoma • Etiology—UV light, burned areas, genetics, EBV, and HPV • Epidemiology—second most common skin cancer (approximately 20%) • Pathogenesis—begins in keratinocytes of outer dermis, has a prolonged in situ stage, may metastasize in @2% of cases • Characteristics—painless, nonhealing, rough, red scaly papule that eventually becomes ulcerated and crusted as it enlarges

22. Squamous Cell Carcinoma (cont.)

23. Breast Cancer • Epidemiology—almost 300,000 women and 2,000+ men will be diagnosed with breast cancer in 2011. • Most occur in upper outer quadrant of the breast and around the nipple. • Local lymph node involvement usually begins in axial nodes; may extend to nodes around the clavicle and sternum. • Common metastatic sites include lungs, kidneys, liver, adrenal glands, ovaries, bones of the spine, ribs, pelvis, and skull, including the maxilla and the mandible. • 70 to 80% are estrogen receptor positive.

24. Risk Factors Associated with Breast Cancer

25. Prostate Cancer • Risk factors—age over 65 and African American descent • Approximately 250,000 cases in 2011, second leading cause of death in men • Early detection • PSA • Physical examination

26. Lung Cancer • Leading cause of death in both men and women • Tobacco smoke is the #1 risk factor. • Symptoms are usually ignored until the disease has progressed to an advanced stage. • Small cell carcinoma may present with Cushing syndrome–like symptoms. • All stages combined 1 year survival rate 43% • Diagnosed in early stage 5-year survival rate 53%

27. Colorectal Cancer • Risk factors: increasing age (90% over 50), family history, IBD, smoking, inactivity, obesity, type 2 diabetes, etc. • Associated with colorectal polyps and disorders such as FAP and Peutz-Jeghers • Suggest a referral if the patient presents with melanotic macules and other signs of GI problems • 5-year survival rate if caught early is 90%.