1. Clinical Aspects of Neoplasia

2. Effects of Tumors on Host.location -pituitary tumor (pressure) -pituitary tumor (pressure) -gut tumor (obstruction) -gut tumor (obstruction).functional activity (endocrine tumor).bleeding (skin, melena, hematuria) & infections in ulcerated tumors.symptoms due to rupture or infarction.cachexia-loss of body fat & lean body mass>weakness, anorexia, & anemia

3. .paraneoplastic syndromes -symptom complexes in cancer-bearing patient, unexplained by local or distant spread of tumor, or release of hormones indigenous to tissue from which the tumor arose -symptom complexes in cancer-bearing patient, unexplained by local or distant spread of tumor, or release of hormones indigenous to tissue from which the tumor arose -seen in 10% of cancer-bearing persons -seen in 10% of cancer-bearing persons -important to recognize.may represent an occult neoplasm -important to recognize.may represent an occult neoplasm.may be lethal.may mimic metastatic disease.may be lethal.may mimic metastatic disease

4. -include.endocrinopathies (Cushing syndrome- small cell carcinoma of lung).hypercalcemia (carcinomas of lung, breast, kidney, & ovary).neuromyopathic syndromes (peripheral neuropathies, cortical cerebellar degeneration, polymyopathy myasthenic syndrome).dermatologic disorders (acanthosis nigricans) -include.endocrinopathies (Cushing syndrome- small cell carcinoma of lung).hypercalcemia (carcinomas of lung, breast, kidney, & ovary).neuromyopathic syndromes (peripheral neuropathies, cortical cerebellar degeneration, polymyopathy myasthenic syndrome).dermatologic disorders (acanthosis nigricans)

5. .hypertrophic osteoarthropathy -periosteal new bone formation, at distal ends of long bones, metatarsals, metacarpals, & proximal phalanges -arthritis of adjacent joints -clubbing of the digits.vascular & hematologic manifestations -migratory thrombophlebitis (Trousseau syndrome) in association with deep-seated cancers -DIC (acute leukemia, prostatic carcinoma).hypertrophic osteoarthropathy -periosteal new bone formation, at distal ends of long bones, metatarsals, metacarpals, & proximal phalanges -arthritis of adjacent joints -clubbing of the digits.vascular & hematologic manifestations -migratory thrombophlebitis (Trousseau syndrome) in association with deep-seated cancers -DIC (acute leukemia, prostatic carcinoma)

6. Grading and Staging of Tumors.are methods to assess clinical aggressiveness of a given neoplasm & aggressiveness of a given neoplasm & its extent & spread in individual patient its extent & spread in individual patient.are necessary for making an accurate prognosis prognosis.are needed for comparing results of various treatment protocols various treatment protocols

7. Grading.based on degree of differentiation of tumor cells, & in some tumors number of mitoses & architectural features -well differentiated, (grade I) -moderately differentiated, (grade II) -poorly differentiated, (grade III) -undifferentiated, (grade IV)

8. Staging.based on -size of primary lesion -size of primary lesion -extent of spread to regional lymph nodes -extent of spread to regional lymph nodes -extent of blood-born metastases -extent of blood-born metastases American Joint Committe for Cancer Staging uses TNM classification system -To-T4, (primary tumor) -To-T4, (primary tumor) -No-N3, (regional lymph node involvement) -No-N3, (regional lymph node involvement) -Mo-M2, (metastases) -Mo-M2, (metastases)

9. Laboratory Diagnosis of Cancer.histologic methods -type of specimen.excisional.incisional.wide-bore needle -optimal requirements.clinical data.specimen must be -adequate -representative -properly preserved (formalin)

10. -additional techniques. refrigeration (hormone, receptor, or molecular analysis).“quick-frozen section” diagnosis for -determining the nature of lesion (benign or malignant) -evaluating the margins of an excised cancer for completeness of excision -additional techniques. refrigeration (hormone, receptor, or molecular analysis).“quick-frozen section” diagnosis for -determining the nature of lesion (benign or malignant) -evaluating the margins of an excised cancer for completeness of excision

11. .cytologic methods -type of sample.fine needle aspiration, used in -readily palpable lesions (breast, thyroid, lymph nodes) -deep-seated structures advantages (least invasive, rapidly performed, avoids surgery & its risks).smear, type of sample -surface epithelium -cavity fluid (abdomen, pleura, joint, pericardium, sub-arachnoid)

13. .immunohistochemistry -specific antibodies for identification of cell products or surface markers -utility in.categorization of undifferentiated cancer.categorization of leukemias & lymphomas.determination of site of origin of metastatic tumor.detection of molecules that have prognostic or therapeutic significance

15. .flow cytometry -measurement of membrane antigens & DNA content of tumor cells -measurement of membrane antigens & DNA content of tumor cells -identification & classification of lymphomas & leukemias -identification & classification of lymphomas & leukemias

16. .molecular diagnosis -diagnosis of cancer.differentiation between monoclonal (neoplastic) & polyclonal (reactive) proliferations in lymphomas.detection of specific translocations in hematopoietic neoplasms & sarcomas -prognosis of cancer -detection of minimal residual disease (leukemias, lymphomas)

17. -diagnosis of hereditary predisposition to cancer.detection of these mutated alleles may allow for screening program in form of prophylactic surgery & counseling of relatives at risk.examples(mutations in tumor suppressor genes-BRCA1, BRCA2) -diagnosis of hereditary predisposition to cancer.detection of these mutated alleles may allow for screening program in form of prophylactic surgery & counseling of relatives at risk.examples(mutations in tumor suppressor genes-BRCA1, BRCA2)

18. .tumor markers -biochemical assays for tumor- associated markers in body fluids (blood, stool, sputum, saliva, urine) for.detection of cancer.determination of the effectiveness of therapy.detection of cancer recurrence

19. -types of markers -types of markers.hormones.hormones -HCG (trophoblastic & testicular tumors) -HCG (trophoblastic & testicular tumors) -calcitonin (thyroid) -calcitonin (thyroid).oncofetal antigens.oncofetal antigens -α-fetoprotein (liver cell carcinoma, testicular germ cell tumors) -carcinoembryonic antigen (CEA) (carcinomas of colon, pancreas, lung, stomach) -α-fetoprotein (liver cell carcinoma, testicular germ cell tumors) -carcinoembryonic antigen (CEA) (carcinomas of colon, pancreas, lung, stomach)

20. .isoenzymes -prostatic acid phosphatase (prostatic cancer) -neuron-specific enolase (cancer of lung, neuroblastoma).specific proteins -immunoglobulins (plasma cell tumors) -prostate-specific antigen & prostate- specific membrane antigen (prostatic carcinoma).isoenzymes -prostatic acid phosphatase (prostatic cancer) -neuron-specific enolase (cancer of lung, neuroblastoma).specific proteins -immunoglobulins (plasma cell tumors) -prostate-specific antigen & prostate- specific membrane antigen (prostatic carcinoma)

21. .glycoproteins -CA-125 (ovarian cancer).new molecular markers -APC, p53, RAS, (cancer of colon) -p53, (cancers of lung, salivary gland, pancreas, urinary bladder).glycoproteins -CA-125 (ovarian cancer).new molecular markers -APC, p53, RAS, (cancer of colon) -p53, (cancers of lung, salivary gland, pancreas, urinary bladder)

22. .molecular profiles of tumors -DNA microarray technology, measuring expression of all genes simultaneously -proteomics, obtain profiles of proteins contained in tissues, serum, or other body fluids