Module 5 – Neoplasia
Key Terms
Adenocarcinomas: cancers arising from ductal or glandular epithelium
Adjuvant chemotherapy: refers to the use of these drugs after local
treatment or removal of the primary tumour.
Benign tumours: are not called cancers. However, some benign tumours
can progress to cancer. They are usually well-encapsulated, the cells and
tissues appear normal in structure, and they do not spread to regional lymph
nodes or distant locations.
Biopsy: Tissue can be obtained by diverse means, including brushings (e.g.
Pap smear), fine needle aspirations (e.g. of a breast mass), core needle or
open biopsies that sample a small part of a mass, or complete excision of a
mass (e.g. for melanoma).
Cachexia: is severe tissue wasting (extensive weight loss) and emaciation
(loss of fat stores and muscle causing an individual to appear excessively
thin) that can occur with cancer.
Cancer: is an uncontrolled proliferation (growth and multiplication) of cells
that can arise from virtually any cell type in the body. It refers to any
malignant tumour or neoplasm that grows rapidly
Carcinogens: substances that cause cancer are known as
Carcinomas: cancers arising in epithelial tissue
Chronic inflammation: is a form of immune response that has been
recognised since the 1860s as an important contributing factor to the
development of cancer. For example, people with ulcerative colitis (chronic
inflammation of the large intestine) have a substantially higher risk of
developing colon cancer
Colorectal cancer (or bowel cancer): is the term used to encompass
cancers of the large intestine (colon) and through to the rectum.
Combination chemotherapy: is the synergistic use of several agents, each
of which individually has an effect against a certain cancer. This is to avoid
drug resistance associated with using just one drug
Fatigue: is persistent tiredness and is the most frequently reported symptom
of cancer and cancer treatment.
Leukaemias: cancers of blood-forming cells
Malignant tumours: are distinguished from benign tumours by their more
rapid growth rates and alterations in microscopic appearance, such as loss of
cell differentiation and absence of normal tissue organisation. Malignant
tumours are not enclosed in a capsule; can undergo invasion into blood
vessels, lymphatics and surrounding structures; and can spread to distant
locations (metastasis).
Metastasis: is the spread of cancer cells from the site of the original tumour
to distant tissues and organs throughout the body.
Neoplasm: An abnormal growth that may be benign or malignant.
Primary tumour: The original site of the cancer when metastasis occurs
Relapse: reappearance of cancer
Remission: Cancers that are treated effectively may go into remission (no
current evidence of cancer)
Staging: Diverse schemes are employed for staging different tumours, but a
general classification using the TNM system is used for many cancers. This
defines the tumour size (T), involvement of lymphatic nodes (N) and degree
of metastasis (M).
Therapeutic index: that is, the relative effective dose needed to kill cancer
cells as compared to the dose that would be harmful to normal cells.
Thrombocytopenia: is a low platelet count and is a major cause of
haemorrhage in persons with cancer.
Tumour markers: are substances produced by cancer cells that are
detectable in the blood, spinal fluid or urine.
Tumour: A growth of tissue caused by the uncontrolled replication of cells.
Cancer characteristics and terminology
¨ Cancer is a chronic disease
¨ Cancers arise from alterations in genes.
¨ Chronic disease with a 5-year survival rate of 60%.
¨ Remission: Cancer is no longer evident
¨ Relapse: Cancer reappears
Tumour Characteristics –
¨ Cancer: type of tumour that usually grows fairly rapidly
¨ Tumour: New growth
Benign tumours:
- Grow slowly
- Localized
- surrounded by a capsule
Malignant tumours:
- are cancerous
- grow more rapidly than benign
- consist of different cell and tissue structures
- invade surrounding tissues
- metastasize (spread) to distant tissues and organs.
Carcinomas:
- Arise from epithelial tissue (e.g., breast, gastric cancer)
Adenocarcinomas:
- Arise from glandular epithelium (e.g., lung adenocarcinoma)
The Genetic Basis of Cancer –
¨ Cancers arise from alterations in genes.
¨ Cancers occur mainly in older age groups
¨ These may be triggered by the genes themselves, or by external influences
such as the environment.
¨ Cancer cells can avoid apoptosis (programmed cell death), so that
abnormalities do not cause death of the cells.
¨ Cancers can spread to different regions of the body from the primary site by
metastasis through the blood vessels or lymphatic system.
¨ Cancers can stimulate angiogenesis, which accommodates the increased
metabolic needs of the growth.
Oncogenes: Promote cancer development.
Tumour-suppressor genes: Limit cancer development.
Autonomy: is the ability of cancer to avoid cell controls such as apoptosis
(cell death).
Anaplasia: Loss of normal cell function.
Angiogenesis: Tumour creates its own blood supply.
Metastasis: Cancer spreads through blood/lymphatic system.
Cancer & Immunity –
¨ The immune system can remove early-stage cancers.
¨ Chronic inflammation contributes to cancer development
- inflammatory cells, cytokines and vascular growth are factors
that are involved.
¨ Viral causes of cancers included: hepatitis B and C and human papilloma
virus (HPV)
Gene-Environment Interaction –
Carcinogens: Cancer-causing substances.
Risk Factors:
o Smoking (active/passive).
o Diet: High-fat, low-fibre.
o Obesity
o Alcohol: Linked to upper body cancers, alcoholic cirrhosis is
associated with liver, breast and colorectal cancers.
o UV radiation: skin cancers
o Occupational hazards, air pollution, ionizing radiation,
electromagnetic fields
Protective Factors:
o Physical activity
o High-fibre diet, (fruits and vegetables), antioxidants, carotenoids,
flavonoids, polyphenols
Cancer Diagnosis & Evaluation –
¨ Tumour markers: Found in body fluids for screening.
¨ Imaging: CT, MRI, X-ray.
¨ Biopsy: small sample of cell for Microscopic examination
¨ Staging (TNM system):
T: Tumour size
N: Lymph node involvement
M: Metastasis
Clinical Manifestations –
¨ Fatigue: Due to metabolic demands.
¨ Infection, anaemia, thrombocytopenia: Common effects.
¨ Pain: Common in advanced stages.
¨ Cachexia: Severe muscle wasting.
Cancer Treatments –
¨ Chemotherapy: drug which interfeers with cell processes, cell division to
destroy cancer cells.
¨ Combination chemotherapy involves using more than one chemotherapy
agent at the same time.
¨ Adjuvant chemotherapy: Used post-surgery
¨ Hormonal therapy: Targets hormone-dependent cancers, interact with
hormones and their receptors
¨ Immunotherapy: Uses immune system to attack cancer.
¨ Radiation therapy: eliminate cells or weakens cancer cells to be vulnerable
to other treatments
¨ Complementary and alternative treatments: May interact with standard
treatments.
Side Effects:
o Gastrointestinal side effects – Nausea, vomiting, oral ulcers,
diarrhoea
o Bone marrow suppression, from chemotherapy and radiation
therapy –infection risk, more prone
o Alopecia – hair loss
o Decreased fertility
o Pain management (opioids, anti-inflammatory agents, sometimes
local anaesthesia.
Significant Cancers in Australia & New Zealand –
¨ Lung cancer: Leading cause of cancer death (smoking)
¨ Breast cancer (females) & Prostate cancer (males): High incidence.
¨ Colorectal cancer: High mortality in both genders.
¨ Melanomas: Aggressive but detectable early.
¨ Screening programs: Available for cervical, breast, and colorectal canc
Cancer Across the Life Span –
Men:
o Melanoma: Mid-20s to middle-age.
o Prostate cancer: Common in older age.
Women:
o Breast cancer: Common from 30s-70s.
o Colorectal cancer: More common with age.
Children: Leukaemia most common.
Teenagers:
o Girls: Melanoma.
o Boys: Melanoma, testicular cancer.
Lung Cancer –
¨ Causes: Cigarette smoking
¨ Types:
Small cell carcinoma:
Non-small cell carcinoma:
More aggressive
Squamous, Grows faster
adenocarcinoma, large Spreads to other
cell organs
Grows slower poor prognosis
may not cause more responsive to
symptoms chemotherapy
may not cause
symptoms
Colon Cancer –
Incidence: 13-14% of cases in Australia & New Zealand.
Causes: Genetics, lifestyle (high-fat diet, low fibre, obesity).
Pre-existing polyps are highly associated with adenocarcinoma of the
colon.
Tumours:
o Right (ascending) colon: Large and bulky.
o Left (descending, sigmoid) colon: Small, button-like masses.
Symptoms: Pain, bloody stools, bowel habit changes.
Diagnosis: Faecal occult blood test, colonoscopy.
Treatment: Surgery, chemotherapy, radiotherapy.