1. Introduction to Cancer

2. Definitions The word “cancer” comes from the latin word for crab.
The Greek word oncos means swelling and where we get the word oncology or oncologist.
What is the Latin word for swelling?
Tumor

3. Neoplasia (Gk. new growth)
“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.”
--Dr. R. A. Willis

4. Benign vs. malignant
Well-differentiated - when cancer cells resemble normal surrounding cells.
benign
Poorly-differentiated – when cancer cells do not resemble normal surrounding cells.
malignant

5. benign – well-differentiated.

6. malignant-poorly differentiated

8. Benign: grow slowly low mitotic rate well differentiated
not invasive; well-defined borders
remain localized; do not metastasize

9. Malignant
Grow rapidly high mitotic index poorly differentiated do not have a capsule invade surrounding structures; can metastasize

10. Nuclei of cells Have an abundance of DNA and are therefore large.
Hyperchromatic- stain darkly

12. In contrast, this hepatocellular carcinoma is not as well circumscribed (note the infiltration of tumor off to the lower right) nor as uniform in consistency. It is also arising in a cirrhotic (nodular) liver.

13. Malignant neoplasms are also characterized by the tendency to invade surrounding tissues. Here, a lung cancer is seen to be spreading along the bronchi into the surrounding lung.

14. This is an example of metastases to the liver
This is an example of metastases to the liver. Note that the tan-white masses are multiple and irregularly sized. A primary neoplasm is more likely to be a solitary mass. Metastasis is the best indication that a neoplasm is malignant.

15. Stages of cancer spread:
Stage 1 – confined to site of origin
Stage 2- cancer is locally invasive
Stage 3 – cancer has spread to regional structures
Stage 4- cancer has spread to distant sites

16. TNM system:
tumor spread
node involvement
presence of distant metastasis
Staging may influence choice of treatment

17. Staging TNM system
Size of tumor – T0, T1, T2,T3
Degree of local invasion – lymph node involvement
Extent of spread – metastasis

18. Patterns of spread: Metastasis
Direct or continuous extension
By lymphatics or blood stream
As clumps or as single cells
Lymphatics most common

19. Distribution and common sites of distant metastases
often occurs in the first capillary bed encountered
Others show “organ tropism”
Due to:
Local growth factors or hormones
Preferential adherence to the surface
Presence of chemotactic factors

20. Clinical manifestations of Cancer
Pain
Usually not in early stages
60 – 80 % of terminally ill
Psychogenic, cultural and physiologic components
Due to pressure, obstruction, stretching, tissue damage or inflammation

21. Clinical manifestations of Cancer
Cachexia – wasting
anorexia
early satiety
weight loss
anemia
marked weakness
taste alterations
altered metabolism

22. Clinical manifestations of Cancer
Anemia
chronic bleeding
malnutrition
medical therapies
malignancy in blood forming organs
Administer erythropoietin

23. Clinical manifestations of Cancer
Leukopenia and thrombocytopenia
tumor invasion of bone marrow
chemotherapy or radiation

24. Cancer Treatment Chemotherapy Cytotoxic drugs + body defenses
Single agent
Combination chemotherapy
Avoids single agent resistance
Can use lower dose
Better remission and cure rate

25. Cancer Treatment Radiation targets DNA
kill tumor without damage to surrounding tissues
tumor must be accessible

26. Cancer Treatment Surgery method of choice can remove entire tumor
debulking
adjuvant chemotherapy or radiation palliation