Neoplasia vs. Tumor Overview
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What distinguishes neoplasia from a tumor in medical terminology?

  • Neoplasia is a new growth while tumor serves as a non-specific term for swelling. (correct)
  • Neoplasia refers to increased cell size while tumor refers to cellular swelling.
  • Neoplasia always involves mutation, while tumor does not necessarily have a genetic basis.
  • Neoplasia is a type of benign tumor, whereas tumor can only refer to malignant growths.

    • Which statement best defines hyperplasia?

  • A growth that only occurs in response to cellular damage.
  • Increase in cell size without any change in the number of cells.
  • Increase in cell number due to physiological or pathological stimuli. (correct)
  • An irreversible change where one cell type is replaced by another.

    • What is the primary difference between hypertrophy and hyperplasia?

  • Hypertrophy results from increased protein production within cells, while hyperplasia does not involve protein changes. (correct)
  • Hypertrophy involves cell division, whereas hyperplasia does not.
  • Hypertrophy is related to muscle growth, while hyperplasia can occur in any tissue.
  • Hypertrophy refers to an increase in the number of cells, while hyperplasia refers to the size of cells.

    • In which situation is metaplasia most likely to occur?

    <p>In association with tissue damage or regeneration.</p> Signup and view all the answers

    What best describes a characteristic of both hypertrophy and hyperplasia?

    <p>Both lead to an increase in the size of the organ affected.</p> Signup and view all the answers

    Which of the following accurately characterizes stem cells in adults?

    <p>They are present in all tissues that continue to divide.</p> Signup and view all the answers

    What occurs during the process of hypertrophy?

    <p>Cells increase in size without division.</p> Signup and view all the answers

    Which condition is most likely to induce metaplasia in a tissue?

    <p>Chronic irritation or inflammation leading to a change in cell type.</p> Signup and view all the answers

    What distinguishes neoplasia from hyperplasia and repair?

    <p>Neoplasia is unregulated, irreversible, and clonal.</p> Signup and view all the answers

    Which feature is NOT typically associated with benign neoplasms?

    <p>Invasive and destructive behavior.</p> Signup and view all the answers

    What is a defining characteristic of malignant neoplasms?

    <p>They grow rapidly and are often asymmetrical.</p> Signup and view all the answers

    What does it mean for a tumor to be classified as clonal?

    <p>It is composed of genetically identical cells from a single ancestor.</p> Signup and view all the answers

    Which type of neoplasm is most likely to require complicated treatment due to its invasive nature?

    <p>Osteosarcoma</p> Signup and view all the answers

    Which of the following statements is true regarding malignant tumors?

    <p>Approximately 30% of tumors present as metastatic disease.</p> Signup and view all the answers

    What are the main features commonly found in benign neoplasms?

    <p>Nodular, pedunculated, and usually not painful.</p> Signup and view all the answers

    Which statement regarding the growth characteristics of neoplasms is true?

    <p>Malignant neoplasms can be asymmetrical and destructive.</p> Signup and view all the answers

    Which type of neoplasm is characterized by its ability to spread to distant sites?

    <p>Malignant neoplasms</p> Signup and view all the answers

    Which statement about basal cell carcinoma is correct?

    <p>It can often be treated simply or conservatively.</p> Signup and view all the answers

    What characteristic is indicative of malignant cells compared to benign cells?

    <p>Frequent, abnormal mitoses</p> Signup and view all the answers

    What defines a teratoma?

    <p>A benign tumor containing cells from multiple tissue types</p> Signup and view all the answers

    What is the primary purpose of cancer screening?

    <p>To decrease cancer-specific mortality</p> Signup and view all the answers

    Which of the following is NOT accounted for in the 'big 4' cancers responsible for approximately 50% of US cancer diagnoses and deaths?

    <p>Skin cancer</p> Signup and view all the answers

    Which of the following is a key feature of dysplasia?

    <p>Cells are genetically altered but stay within the epithelium</p> Signup and view all the answers

    Which suffix is typically associated with malignant epithelial neoplasms?

    <p>-carcinoma</p> Signup and view all the answers

    What percentage risk of developing cancer do males have over their lifetime?

    <p>40%</p> Signup and view all the answers

    Which of the following correctly describes a hamartoma?

    <p>A benign proliferation of cells native to the involved site</p> Signup and view all the answers

    Which of the following cancers has the highest incidence in adults?

    <p>Breast/prostate cancer</p> Signup and view all the answers

    Which cancer is the leading cause of cancer mortality in adults?

    <p>Lung cancer</p> Signup and view all the answers

    What does a high nuclear/cytoplasmic ratio indicate in a cell?

    <p>Potential malignancy of the cell</p> Signup and view all the answers

    What trend has been observed in cancer death rates over the last 20-25 years?

    <p>They have decreased</p> Signup and view all the answers

    Which of these neoplasm types is specifically described as having a benign but highly differentiated nature?

    <p>Hamartoma</p> Signup and view all the answers

    Which of the following factors has contributed to the decrease in cancer death rates?

    <p>Better therapy options</p> Signup and view all the answers

    What term describes a neoplasm that occurs in a tissue where it is not normally found?

    <p>Choristoma</p> Signup and view all the answers

    How many million cases of basal cell carcinoma are diagnosed per year in the US?

    <p>3-4 million</p> Signup and view all the answers

    What percentage of total cancer cases are estimated to have a hereditary component?

    <p>5-10%</p> Signup and view all the answers

    Which screening method is used specifically to detect changes before cervical cancer develops?

    <p>Pap smear</p> Signup and view all the answers

    What common environmental factor contributes to approximately 80% of lung cancer deaths?

    <p>Tobacco use</p> Signup and view all the answers

    Which factor explains the higher risk of cancer due to the accumulation of genomic alterations?

    <p>Increased stem cell divisions</p> Signup and view all the answers

    How does chronic inflammation increase the risk of cancer?

    <p>By generating reactive oxygen species</p> Signup and view all the answers

    Which of the following is the main cause of death from cancer in men aged 60-79?

    <p>Lung cancer</p> Signup and view all the answers

    What percentage of cancer deaths is attributed to obesity?

    <p>10%</p> Signup and view all the answers

    Which factor has a synergistic effect on increasing the risk of cancers in the upper aerodigestive tract?

    <p>Tobacco use</p> Signup and view all the answers

    What is the result of DNA replication errors during stem cell division?

    <p>Accumulation of genomic alterations</p> Signup and view all the answers

    Which of the following is linked to the increased risk of colorectal carcinoma?

    <p>Inflammatory bowel disease</p> Signup and view all the answers

    What is the primary infectious agent responsible for a significant number of cancer cases in developing countries?

    <p>Hepatitis C virus</p> Signup and view all the answers

    What reproductive factor significantly reduces the risk of breast cancer?

    <p>First full-term pregnancy before age 20</p> Signup and view all the answers

    Which cancer screening method is effective in detecting prostate carcinoma before it spreads?

    <p>Digital rectal exam</p> Signup and view all the answers

    Which of the following cancers is not primarily associated with tobacco use?

    <p>Liver cancer</p> Signup and view all the answers

    Study Notes

    Neoplasia vs. Tumor

    • Neoplasia literally means new growth.
    • Tumor literally means swelling, is non-specific but often used synonymously with neoplasm.
    • Not all new growth is neoplastic.

    Not all new growth is neoplastic

    • Wound repair and healing: granulation tissue
    • Hyperplasia:
      • Increase in the number of cells in an organ/tissue.
      • Occurs in response to stimulus.
      • Can be physiologic or pathologic.
      • Ends when the stimulus is removed.
      • Example: thickness of endometrium during the menstrual cycle.
    • Hypertrophy:
      • Increase in cell size.
      • No cell division, no change in the number of cells.
      • Increased production of proteins inside the cell
      • Can be physiologic or pathologic.
      • Example: muscle hypertrophy.
    • Metaplasia:
      • Reversible change in which one differentiated cell type is replaced by another.
      • Almost always found in association with tissue damage/repair/regeneration.
      • Typically replacing cell type better suited to alterations in the local environment.
      • Underlying stem cells reprogrammed to differentiate along a new pathway.
      • Stem cells: self-renewing cells present in all tissues that continue to divide.
      • Example: Normal columnar cells of trachea/bronchi replaced by stratified squamous epithelium in smokers.

    Neoplasia Definition

    • Disorder of cell growth triggered by a series of genomic alterations.
    • Excessive proliferation is independent of and uncontrolled by physiologic growth signals.
    • Alterations give neoplastic cells a survival and growth advantage.
    • Alterations affect a single cell and its clonal progeny.

    Neoplasms: Benign and Malignant

    • Benign neoplasms stay localized, do not spread/metastasize to other sites.
    • Benign neoplasms are usually well-circumscribed and non-infiltrative.
    • Benign neoplasms can often be removed surgically.
    • Malignant neoplasms = cancer.
    • Malignant neoplasms exhibit "invasive growth," destroying adjacent tissues.
    • Malignant neoplasms can spread to distant sites (metastasize).
    • Malignant neoplasm treatment is complicated, especially in advanced disease.
    • Malignant neoplasm prognosis may be questionable.

    Caveats for Benign and Malignant Neoplasms

    • Benign neoplasms may behave aggressively, cause significant morbidity, or be fatal.
    • Cancers may occasionally be quite small and require high levels of clinical skill to suspect and identify.
    • Some cancers, like basal cell carcinoma, have low metastatic potential and can be treated quite simply/conservatively.

    General (but not 100% reliable) features of Benign and Malignant Neoplasms

    • Benign:
      • Slow growth (months/years).
      • Expansile (pushing) growth.
      • Not metastasizing.
      • Symmetrical, well-circumscribed.
      • Nodular, pedunculated.
      • Yellow, pink, blue.
      • Less specific features: movable or fixed, firm or soft, can be ulcerated if traumatized, +/- pain.
    • Malignant:
      • Rapid growth (days/weeks).
      • Invasive, destructive growth.
      • Metastasizing.
      • Asymmetrical.
      • Exophytic.
      • Black, brown, red.
      • Less specific features: fixed, can be ulcerated with no hx of trauma, +/- pain.

    Benign vs. Malignant: Microscopic Features

    • Well-differentiated (resembling normal tissue) versus poorly-differentiated (not resembling normal tissue).
    • Typical tissue organization versus atypical tissue structure.
    • Rare, normal mitoses versus frequent, abnormal mitoses.
    • Histologic features of malignancy:
      • Pleomorphism: variable size and shape of cells/nuclei.
      • High nuclear/cytoplasmic ratio of cells.
      • Loss of identifiable differentiation.

    Neoplasm Nomenclature

    • Beginning of the name identifies tissue of origin.
      • Myo- muscle:
        • Leiomyo- smooth muscle.
        • Rhabdomyo- skeletal muscle.
      • Neuro/schwanno- neural tissue.
      • Lipo- adipose tissue (= fat).
      • Fibro- fibrous connective tissue.
      • Angio- vessel:
        • Hemangio- blood vessel.
        • Lymphangio- lymph vessel.
    • Ending of the name:
      • oma = tumor.
        • Usually means neoplasm.
        • Usually benign.
    • Certainly Malignant:
      • Carcinoma (epithelial malignancy).
        • Adenocarcinoma- glandular features.
      • Sarcoma (mesenchymal malignancy).
    • Exceptions:
      • Fibroma: not a neoplasm.
      • Lymphoma: solid malignancy of lymphocytes.
      • Leukemia: malignancy of peripheral blood.
      • Melanoma: malignancy of melanocytes.
      • Mesothelioma: malignancy of mesothelium.

    Dysplasia

    • Intraepithelial neoplasia: genetically altered cells stay within epithelium.
    • Basement membrane acts as a barrier between epithelium and connective tissue.
    • Dysplasia cannot grow aggressively or metastasize (yet).
    • The patient can be cured by surgical excision.
    • Dysplasia is a precursor to carcinoma.
      • Once dysplasia invades through the basement membrane into connective tissue, it becomes carcinoma.

    Carcinoma in Situ

    • Dysplasia involving full thickness of epithelium, but still confined by basement membrane.
    • The patient can still be cured by complete surgical excision.

    Teratoma

    • Benign tumor containing cells/tissues from more than one tissue type and more than one germ layer.
    • Germ layers: endoderm, mesoderm, ectoderm.
    • Nearly all other neoplasms consist of cells of one tissue type.
    • Originates from germ cells.
      • Totipotential stem cells normally present in testes and ovaries.

    Hamartoma

    • Benign proliferation of cells/tissues native to the involved site.
    • Considered a benign, highly differentiated neoplasm.

    Choristoma

    • Benign proliferation of cells/tissues in a non-native site.
    • Should not be there!
    • Considered a benign, highly differentiated neoplasm.

    Cancer Epidemiology

    • 2nd leading cause of death in adults and children.
    • Leading causes of death in adults: (1) cardiovascular disease, (2) cancer, (3) chronic respiratory disease.
    • Leading causes of death in children: (1) accidents, (2) cancer, (3) congenital defects.
    • Most common cancers by incidence in adults: (1) breast/prostate, (2) lung, (3) colorectal cancer.
    • Most common causes of cancer mortality in adults: (1) lung, (2) breast/prostate, (3) colorectal.

    Lifetime Cancer Risk

    • Males:
      • 40% risk of developing cancer.
      • 21% risk of dying from cancer.
    • Females:
      • 39% risk of developing cancer.
      • 18% risk of dying from cancer.

    Cancer Incidence

    • Approximately 50% of US cancer diagnoses/deaths are accounted for by the big 4: lung, breast, prostate, colorectal.
    • Some cancers are more aggressive than others.

    Basal Cell Carcinoma and Squamous Cell Carcinoma of the Skin

    • Most common human cancers by far.
    • BCC: 3-4 million cases per year in the US.
    • SCC: 2-3 million cases per year in the US.
    • Not included in cancer registries or epidemiology statistics.
    • So much more common than other cancers that their inclusion would markedly skew statistics.
    • A lot more indolent and treatable.

    Cancer Death Rates

    • In the last 20-25 years, overall cancer death rates have decreased.
    • Changes in risk factors (e.g., smoking).
    • Increased screening (e.g, Pap smears, mammograms, colonoscopies).
    • Better therapy (e.g., immunotherapy, biologics, targeted therapy).

    Cancer Screening

    • Seeks to catch dysplasia (precancerous change) before it becomes carcinoma; or carcinoma before clinical symptoms arise.
    • Purpose is to decrease cancer-specific mortality.
    • Cancers that do not produce symptoms until late in the disease will have undergone additional divisions and, hence, additional mutations.
    • Cancers that are detected late tend to have a poor prognosis.
    • Common screening methods:
      • Pap smear - detects cervical dysplasia (CIN) before it becomes carcinoma.
      • Mammography - detects in situ breast cancer (e.g., DCIS) before it invades or invasive carcinoma before it becomes clinically palpable.
      • Prostate-specific antigen (PSA) and digital rectal exam - detect prostate carcinoma before it spreads.
      • Hemoccult test (for occult blood in stool) and colonoscopy - detect colonic adenoma before it becomes colonic carcinoma or carcinoma before it spreads.

    Cancer and Age

    • Most cancers occur over 55 years of age.
    • Main cause of death in men aged 60-79.
    • Main cause of death in women aged 40-79.
    • Explained by:
      • Accumulation of pathogenic genomic alterations in (stem) cells over a lifetime.
      • Decline in immune system competence.
    • Cancer accounts for 10% of all childhood deaths.
      • 80% of childhood cancers are cured.
      • Most common pediatric cancers are leukemia/lymphoma and brain/CNS tumors.

    Carcinogenesis

    • Results from the accumulation of complementary genomic alterations.
    • These alterations must be accumulated in a stem cell (or a cell that acquires stem-like properties).
    • Genomic (genetic and epigenetic) alterations come from three sources:
      • DNA replication errors during (stem) cell division.
        • Approximately 65-70% of mutations in human cancers.
        • ~3 mutations and an unknown number of epigenetic alterations occur every time a normal human stem cell divides.
      • Environmental factors.
      • Inherited/hereditary genetic mutations.
        • 5-10% of cancers have a hereditary component.

    Stem Cells and Cancer

    • Stem cells in different adult tissue types undergo different numbers of cell divisions.
    • There is a strong correlation (0.8) between the average number of stem cell divisions per tissue and the rate/risk of cancer in that tissue.

    Environmental Factors

    • Remarkable geographic variation in cancer incidence provides evidence of the role of environmental carcinogens.
    • Environmental influences appear to be dominant risk factors for many cancers.
    • Approximately 20-40% of cancers may be preventable.

    Environmental Carcinogens

    • Tobacco:
      • World's single greatest preventable cause of death.
      • Single most important factor contributing to premature death in the US.
      • Implicated in 80% of 140,000 annual lung cancer deaths.
      • 4000-7000 deaths due to secondhand smoke.
      • Also implicated in cancers of the oral cavity, pharynx, larynx, esophagus, pancreas, colon, and bladder.
    • Obesity:
      • Strongly associated with cancer risk.
      • 10% of cancer deaths attributed to obesity.
      • Linked with more than 10 cancers: colon, rectum, postmenopausal breast cancer, prostate.
      • More than two-thirds of Americans are overweight/obese.
      • 20% of children/adolescents are obese.
    • Alcohol:
      • Contributes to 5% of cancer deaths.
      • Increased risk of cancers of: oral cavity, pharynx, larynx, esophagus, liver, colon, breast.
      • Alcohol and tobacco synergistically increase the risk of cancers in the upper aerodigestive tract.
    • Infectious agents:
      • 15% of cancers worldwide.
      • 30-45% of cancers in the developing world.
      • Example: Many individuals infected with hepatitis C virus (HCV) may develop hepatocellular (liver) carcinoma.
      • Human papillomavirus (HPV):
        • Cause of cervical carcinoma.
        • Cause of an increasing fraction of head and neck cancers.
        • Oropharynx, in particular.
        • Incidence of HPV-positive oropharyngeal cancer has now surpassed the incidence of cervical carcinoma.
    • Reproductive history:
      • Cumulative exposure to estrogen stimulation increases the risk of breast and endometrial cancer.
      • Halves the risk of breast cancer with the age at first full-term pregnancy less than 20 years compared to more than 35 years.
      • Postmenopausal hormone replacement therapy increases the risk of breast cancer.
    • Other environmental carcinogens:
      • In the environment: UV rays, smog.
      • In the workplace: asbestos.
      • In the diet: grilled meat, fat, alcohol.

    Acquired Predisposing Conditions

    • Chronic inflammation (infectious or non-infectious):
      • Increased cell proliferation to repair damage --> increased opportunity for genetic mutations.
      • Presence of activated immune cells in inflamed tissue produces reactive oxygen species that are directly genotoxic.
      • Examples:
        • Gastric reflux: increased risk of esophageal carcinoma.
        • Alcoholism: increased risk of pancreatic carcinoma.
        • Inflammatory bowel disease: increased risk of colorectal carcinoma.
    • Autoimmune diseases (e.g., type 1 diabetes): increased risk of some cancers.

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