Neoplasia

Question1: How many types of Tumor are there based on histogenesis?(Marks 2)

Introduction
Neoplasia refers to the abnormal growth of cells that can occur in any tissue
or organ of the body. These abnormal growths can be either benign or
malignant.

A neoplasm is a term used to describe any abnormal growth or mass of

tissue that arises due to uncontrolled cell proliferation. The term is often
used interchangeably with tumor, although a tumor can refer to both benign
and malignant growths.

Benign tumors are non-cancerous growths that typically do not spread to

other parts of the body. They are often slow-growing and may not require
treatment unless they are causing discomfort or interfering with normal
organ function.

Malignant tumors, on the other hand, are cancerous growths that can invade
nearby tissues and spread to other parts of the body through the
bloodstream or lymphatic system. They can cause serious health problems
and require prompt medical attention.
 Question 2

Causes of Neoplasia
Neoplasia, or the development of tumors, can have various causes.

● Environmental factors such as chemicals, oncogenic viruses, and radiation can all lead to the formation of
tumors.
● Chemical carcinogenesis has two steps: Initiation, where a carcinogenic agent damages cell DNA
irreversibly, and promotion, where a promoting agent causes the proliferation of a neoplastic cell clone.
● Hereditary factors, such as absent or defective anti-oncogenes, obscure defects, and aging, can also
contribute to neoplasia.
● Alterations to DNA, such as mutations involving tumor suppressor genes or proto-oncogenes, can lead to
neoplastic growth. Oncogenic viruses may bring viral oncogenes with them. DNA repair mechanisms can
be affected by mutations in DNA excision repair genes, leading to genomic instability and a greater
likelihood of oncogenesis (the development of tumor). Growth factors, such as EGF, PDGF, and TGF-alpha,
can assist oncogene activity.
Benign Tumor
Definition: A benign tumor is a mass or growth of abnormal cells that does not have the ability to spread to other parts
of the body (metastasize) or invade nearby tissues.

Characteristics: Benign tumors tend to have well-defined borders, and the cells within them tend to look similar to
normal cells. They grow at a slow and predictable rate, and are often discovered incidentally during routine medical
exams or imaging tests. Unlike malignant tumors, benign tumors do not usually cause systemic symptoms such as
weight loss, fever, or night sweats.

Examples: Some examples of benign tumors include:

● Lipoma: A benign tumor made of fat cells

● Fibroma: A benign tumor made of fibrous tissue
● Adenoma: A benign tumor that arises from glandular tissue
● Osteoma: A benign tumor of bone tissue
● Hemangioma: A benign tumor made of blood vessels.

Some benign tumors may also increase the risk of developing cancer later in life.
Benign Tumor
Example of Benign Tumor: Lipoma
Lipoma is a type of benign tumor that develops from fat cells. It is one of the most common soft tissue tumors,
and it can occur at any age but is most commonly seen in middle-aged adults. Lipomas are generally
slow-growing and painless, and they can occur anywhere in the body where fat cells are present.

Lipomas are typically small, ranging from a few millimeters to a few centimeters in size. They can occur as single
or multiple tumors, and they are usually round or oval-shaped with a soft, rubbery texture. Lipomas are usually
located just beneath the skin, but they can also develop in deeper tissues such as the muscle, bone, or internal
organs.

The exact cause of lipomas is not known, but they are thought to be caused by a combination of genetic and
environmental factors. Some people may be predisposed to developing lipomas due to a family history of the
condition.

Lipomas are usually diagnosed through physical examination and imaging tests such as ultrasound, MRI, or CT
scans. In most cases, lipomas do not require treatment and can be left alone. However, if they cause discomfort
or are located in a cosmetically sensitive area, they can be removed through a simple surgical procedure.

In rare cases, lipomas can become malignant and turn into a type of cancer called liposarcoma.
Benign Lipoma
Here is a benign lipoma on the serosal surface of the small
intestine. It has the characteristics of a benign neoplasm: it
is well circumscribed, slow growing, non-invasive, and
closely resembles the tissue of origin (fat).
Example of Benign Tumor: Fibroma
Definition: Fibroma is a type of benign tumor that develops from fibrous tissue. It is a relatively common type of
tumor that can occur in different parts of the body, including the skin, oral cavity, and reproductive organs.

Characteristics: Fibromas are usually small, round or oval-shaped tumors that are well-defined and have a firm,
rubbery texture. They are typically slow-growing and painless, and may be located just beneath the skin or deeper
within tissues. Fibromas can occur as single or multiple tumors, and can affect people of all ages and genders.

The exact cause of fibromas is not known, but they are thought to be caused by genetic and environmental
factors. Some types of fibromas may be associated with hormonal imbalances, and fibromas can also develop as
a result of trauma or inflammation.

Fibromas are usually diagnosed through physical examination and imaging tests such as ultrasound, MRI, or CT
scans. In most cases, fibromas do not require treatment and can be left alone. However, if they cause discomfort
or are located in a cosmetically sensitive area, they can be removed through a simple surgical procedure.
Fibroadenoma

Here is a small, round fibroadenoma of the

breast, a benign neoplasm most commonly
diagnosed in younger women of reproductive
age. The blue dye was injected during a
radiographic procedure to mark the location of
Fibroadenomas in the male breast
the neoplasm so the surgeon could find and
remove it. Neoplasms this small may be
difficult to detect. Imaging techniques such as
ultrasound or mammography may aid in
diagnosis.
Malignant Tumor
Definition: A malignant tumor is a mass or growth of abnormal cells that have the ability to invade nearby tissues
and spread to other parts of the body through the bloodstream or lymphatic system. They also known as
cancerous tumors.

Characteristics: Malignant tumors tend to have irregular borders, and the cells within them look different from
normal cells. They grow quickly and can invade nearby tissues, causing damage and impairing organ function.
Malignant tumors can also spread to other parts of the body, a process known as metastasis. Unlike benign
tumors, malignant tumors can cause systemic symptoms such as fatigue, weight loss, and night sweats.

Examples: Some examples of malignant tumors include:

● Carcinoma: A cancer that arises from epithelial cells, which are the cells that line the body's organs and
tissues. Examples include lung cancer, breast cancer, and colon cancer.
● Sarcoma: A cancer that arises from connective tissue, such as bone, muscle, or cartilage. Examples
include osteosarcoma and chondrosarcoma.
● Leukemia: A cancer that affects the blood and bone marrow, where blood cells are produced.
● Lymphoma: A cancer that affects the lymphatic system, which is a part of the immune system that helps to
fight infection
Malignant Tumor
Example of Malignant Tumor: Carcinoma
Carcinoma is a type of cancer that arises from epithelial cells, which are the cells that make up the body's lining and cover
its organs and tissues. These cells are responsible for forming the skin, glands, and other tissues throughout the body.
Carcinomas are the most common type of cancer and can occur in various organs, including the lungs, breasts, colon, and
prostate, among others.

Characteristics: Carcinomas are characterized by the uncontrolled growth and division of epithelial cells, which can form a
mass or tumor that can invade nearby tissues and organs, and even spread to other parts of the body.

One example of the pathogenesis of carcinoma is breast cancer: In breast cancer, the initial genetic mutation or alteration
is believed to occur in the DNA of epithelial cells, which causes these cells to divide and grow uncontrollably, forming a
mass or tumor. These mutations may be caused by various factors, such as exposure to radiation, hormones, or certain
chemicals, or they may be inherited.

As the tumor grows, it may start to invade nearby tissues, such as the chest wall or lymph nodes. The tumor may also
develop its own blood supply through a process called angiogenesis. The tumor may accumulate additional mutations or
alterations, which can make it more aggressive and resistant to treatment.

In some cases, the tumor may also shed cancerous cells into the bloodstream or lymphatic system, which can travel to
other parts of the body and form new tumors, a process known as metastasis. This can make the cancer much more
difficult to treat and can significantly reduce the person's chances of survival.
Carcinoma: Breast Cancer
This infiltrating ductal carcinoma of the breast is
definitely infiltrating (enter or gain access to) the
surrounding breast. The central white area is
very hard and gritty, because the neoplasm is
producing a desmoplastic reaction (Causing or
forming adhesions within a tumour) with lots of
collagen. This is often called a "scirrhous"
appearance. There may also be focal dystrophic
calcification giving the cut surface a gritty
texture.

Production of connective tissue stroma by a

neoplasm is often what makes it appear firm on
palpation. With invasion, this stroma may attach
the cancer to surrounding structures so that it
does not move freely with palpation.
Example of Malignant Tumor: Sarcoma
Sarcoma is a type of cancer that arises from connective tissue, which is the tissue that supports and connects different
structures in the body, including bones, muscles, cartilage, and fat. Sarcomas are relatively rare, accounting for less than
1% of all cancers diagnosed in adults.

Sarcomas are classified based on the type of tissue from which they arise. For example, osteosarcoma arises from bone
tissue, while chondrosarcoma arises from cartilage tissue.

One example of the pathogenesis of sarcoma is osteosarcoma. In osteosarcoma, the initial genetic mutation or alteration
is believed to occur in the DNA of osteoblasts, which causes these cells to divide and grow uncontrollably, forming a mass
or tumor. These mutations may be caused by various factors, such as exposure to radiation or certain chemicals, or they
may be inherited.

As the tumor grows, it may start to invade nearby tissues, such as muscle or cartilage, and it may also develop its own
blood supply through a process called angiogenesis.

In some cases, the tumor may also shed cancerous cells into the bloodstream or lymphatic system, which can travel to
other parts of the body and form new tumors, a process known as metastasis.
Osteosarcoma
Here is an osteosarcoma of
bone. The large, bulky mass
arises in the cortex of the bone
and extends outward.
Question 3

Common Features
While there are many different types of cancer, they all share some common features. These include:

● Uncontrolled cell growth: Cancer cells grow and divide rapidly, without the normal mechanisms that control cell
growth and division.

● Invasion and metastasis: Cancer cells can invade nearby tissues and spread to other parts of the body through the
bloodstream or lymphatic system.

● Genetic mutations: Cancer cells have genetic mutations that can cause them to behave abnormally and resist
normal cell death mechanisms.

● Abnormal cell metabolism: Cancer cells have altered metabolism that allows them to grow and survive in harsh
conditions.
Pathogenesis of Neoplasia Question 4

1. Initiation: The first stage of neoplasia is initiation, which involves DNA damage and mutations. This damage
can be caused by exposure to carcinogens, such as tobacco smoke, radiation, or chemicals. The mutations
can cause cells to divide uncontrollably, leading to the development of a neoplasm.

2. Promotion: The next stage of neoplasia is promotion, which involves cell proliferation and growth. In this
stage, the mutated cells continue to divide and multiply, leading to the formation of a small neoplasm. This
stage can be influenced by lifestyle factors such as diet, exercise, and exposure to environmental toxins.

3. Progression: The third stage of neoplasia is progression, which involves invasion and angiogenesis. In this
stage, the neoplasm grows and invades nearby tissues, and it can also develop its own blood supply
through the process of angiogenesis. This stage can be influenced by factors such as the immune system's
ability to recognize and attack cancer cells, as well as the tumor microenvironment.

4. Metastasis: The final stage of neoplasia is metastasis, which involves the spread of cancer cells to distant
sites in the body. This can occur through the bloodstream or lymphatic system, and it can lead to the
development of secondary tumors in other parts of the body. This stage is often the most challenging to
treat, as it requires systemic therapies to target cancer cells throughout the body.
Pathogenesis of Neoplasia
Multistep Carcinogenesis

● The process typically begins with an

initiation event: a mutation in a key
gene that regulates cell growth or DNA
repair.

● This mutation may be caused by

exposure to environmental factors,
such as radiation or chemicals.

● The mutated cell may then undergo

clonal expansion, in which cells
proliferate with the same mutation.

● Additional mutations may accumulate

leading increased cell growth,
differentiation, and decreased
apoptosis.

● As the number and complexity of

mutations increases, the cells may
progress from benign tumors to
invasive and metastatic cancers.
Growth Factor signaling pathway in Cancer
● Growth factor signaling pathways are critical for regulating cell growth,
differentiation, and survival.

● Abnormalities in these pathways can lead to uncontrolled cell growth and

division, a hallmark of cancer.

● The RAS/MAPK pathway is a signaling pathway that plays a critical role in

cell growth and proliferation.

● The pathway is activated when a growth factor binds to a receptor on the

cell surface, which triggers the activation of the RAS protein.

● Once activated, RAS activates a series of downstream kinases, including

MAPK, which increases cell proliferation.

● Activated RAS, also activated the mTOR pathway which is a signaling

pathway that plays a critical role in cell growth and proliferation.

● Key regulator of the mTOR pathway is the protein kinase AKT and leads to
the activation of mTOR.

● Activation of mTOR leads to increased cell growth and proliferation

● PTEN (phosphatase and tensin homolog) is a tumor suppressor gene.

Diagnosis of Neoplasia
1. Physical Examination: The first step in diagnosing neoplasia is a physical examination. The doctor will
check for any lumps or abnormal growths in the body. They will also observe the skin, eyes, and mucous
membranes for signs of cancer.

2. Imaging Techniques: Imaging techniques such as X-rays, CT scans, MRI, and PET scans are used to
identify the location and extent of neoplasia. These techniques can provide detailed images of the internal
organs and tissues, and they can help doctors determine the size, shape, and characteristics of the
neoplasm.

3. Biopsy: Biopsy involves removing a small sample of tissue from the neoplasm for microscopic
examination. This can be done using a needle, endoscope, or during surgery. The tissue sample is
analyzed by a pathologist to determine if it is benign or malignant and what type of cancer it is.

4. Laboratory Tests: Laboratory tests are used to measure the levels of certain substances in the blood, such
as tumor markers, which can indicate the presence of neoplasia. These tests can also be used to monitor
the progress of treatment and detect any recurrence of the neoplasm.
Treatment of Neoplasia
1. Surgery: Surgery is often the first treatment option for neoplasia, and it involves the removal of the tumor and
surrounding tissue. The goal of surgery is to remove as much of the cancer as possible while minimizing damage to
surrounding healthy tissue. Depending on the size and location of the tumor, different surgical techniques may be
used, such as open surgery or minimally invasive surgery.

2. Chemotherapy: Chemotherapy involves the use of drugs to kill cancer cells. These drugs can be given orally or
intravenously and circulate throughout the body, killing cancer cells wherever they are. Chemotherapy is often used
in combination with other treatments, such as surgery or radiation therapy, and is used to shrink tumors before
surgery or to kill any remaining cancer cells after surgery.

3. Radiation Therapy: Radiation therapy uses high-energy radiation, such as X-rays or proton beams, to destroy cancer
cells. It is often used in combination with other treatments, such as surgery or chemotherapy. Radiation therapy can
be delivered externally or internally, depending on the location and size of the tumor.

4. Immunotherapy: Immunotherapy is a type of treatment that uses the body's immune system to fight cancer. It can
boost the immune system's ability to recognize and attack cancer cells, or it can use engineered immune cells to
target and kill cancer cells. Immunotherapy is used to treat several types of neoplasia, including melanoma, lung
cancer, and bladder cancer.
Prevention
● Lifestyle Changes: A healthy lifestyle can reduce the risk of developing neoplasia. This includes
maintaining a healthy weight, eating a balanced diet rich in fruits, vegetables, and whole grains, and
engaging in regular physical activity. Smoking is a major risk factor for several types of neoplasia,
including lung, bladder, and pancreatic cancer, and quitting smoking can reduce the risk of
developing these cancers.

● Vaccinations: Vaccinations can protect against certain types of neoplasia. The HPV vaccine can
prevent several types of HPV that can cause cervical, anal, and other types of cancer. The hepatitis B
vaccine can prevent liver cancer, which is associated with chronic hepatitis B infection.

● Screening Programs: Early detection through screening programs can lead to better outcomes for
individuals with neoplasia. Mammograms can detect breast cancer in its early stages, and
colonoscopies can detect and remove pre-cancerous polyps in the colon. Pap tests can detect early
signs of cervical cancer, and regular skin checks can detect early signs of skin cancer.