NEOPLASIA I: WHAT IS CANCER?
Ed Friedlander, M.D., Pathologist
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BIBLIOGRAPHY / FURTHER READING

More of Ed's Notes: Ed's Medical Terminology Page

Perspectives on Disease
Cell Injury and Death
Accumulations and Deposits
Inflammation
Fluids
Genes
What is Cancer?
Cancer: Causes and Effects
Immune Injury
Autoimmunity
Other Immune
HIV infections
The Anti-Immunization Activists
Infancy and Childhood
Aging
Infections
Nutrition
Environmental Lung Disease
Violence, Accidents, Poisoning
Heart
Vessels
Respiratory
Red Cells
White Cells
Coagulation
Oral Cavity
GI Tract
Liver
Pancreas (including Diabetes)
Kidney
Bladder
Men
Women
Breast
Pituitary
Thyroid
Adrenal and Thymus
Bones
Joints
Muscles
Skin
Nervous System
Eye
Ear
Autopsy
Lab Profiling
Blood Component Therapy
Serum Proteins
Renal Function Tests
Adrenal Testing
Arthritis Labs
Glucose Testing
Liver Testing
Porphyria
Urinalysis
Spinal Fluid
Lab Problem
Quackery
Alternative Medicine (current)
Preventing "F"'s: For Teachers!
Medical Dictionary

Courtesy of CancerWEB

LEARNING OBJECTIVES

Define "tumors" and "neoplasms". Tell why they are important. Define "oncology". Tell how tumors are like organs, and how they are different.

Distinguish "benign tumors" and "malignant tumors" by their gross and microscopic appearances and their behaviors. Tell what "well-differentiated" and "poorly differentiated" mean. Tell how benign tumors can cause problems.

Define "cancer", "malignant", and "metastasis". Tell what any cancer will ultimately do to the patient if it is not cured. Recognize the typical appearances of cancers. Distinguish "carcinomas" and "sarcomas".

Tell how and where various cancers tend to metastasize. Describe patterns for invasion and metastasis by various malignant tumors.

List the three most common cancers in men and in women, and the three most common fatal ones.

Given a tumor name, name the cell of origin and describe the behavior. Given the cell of origin (or a hint) and the behavior (or a hint), name the tumor.

Distinguish "grade" and "stage" of a cancer. Tell why these numbers are important.

Recognize, under the microscope, a squamous cell carcinoma, an adenoma, an adenocarcinoma, a tumor of hematologic origin, and a spindle cell sarcoma. Recognize anaplasia, and generally tell benign from malignant tumors.

Critique the following statement, overheard on a cancer ward: "Cancer cells grow faster than normal cells and are not under the body's control. Therefore, the treatment for cancer involves giving anti-mitotic drugs that kill fast-growing cells."

KCUMB Students
"Big Robbins" -- Neoplasia
Lectures follow Textbook

QUIZBANK: See next handout

LEARN FIRST

Neoplasia
Photo Library of Pathology
U. of Tokushima

Neoplasia
Taiwanese pathology site
Good place to go to practice

Cytopathology
Surgical Pathology Atlas
Nice photos, hard-core

Neoplasia

Chaing Mi, Thailand

Neoplasia
Photos, explanations, and quiz
Indiana U.

Neoplasia I
From Chile
In Spanish

Neoplasia II
From Chile
In Spanish

Neoplasia III
From Chile
In Spanish

Neoplasia IV
From Chile
In Spanish

Neoplasia V
From Chile
In Spanish

Neoplasia VI
From Chile
In Spanish

Neoplasia VII
From Chile
In Spanish

Neoplasia VIII
From Chile
In Spanish

Neoplasia IX
From Chile
In Spanish

Growth Disturbances / Neoplasia
Iowa Virtual Microscopy
Have fun

One out of about every five persons in the US who die this year will die of tumors (about 500,000 total).

For the foreseeable future, all tumor diagnoses will be made by us anatomic pathologists, using conventional light microscopy as our primary tool.

* "Tumor"--literally any swelling. Galen distinguished tumors that are:

The ancient medical writings show an awareness of cancer, and Morgagni remarked that by his era, most physicians were aware that tumors were not treatable except by surgery.

"Oncology" is the study of tumors. In current usage, an oncologist is an internist or surgeon who specializes in the administration of cancer chemotherapy.

In modern usage, a TUMOR/NEOPLASM (the words are exact synonyms) may be thought of as an attempt by the body under some stimulus to make some new sort of organ. It develops in the wrong shape, in the wrong place, and it persists after the initiating stimulus is removed.

Tumors are LIKE organs:

Tumors are DIFFERENT from organs:

We have already learned a few essential terms:

Now learn these terms:

A tumor is either BENIGN or MALIGNANT.

{08800} benign colonic polyp; recapitulates colon
{08796} benign colonic polyp; recapitulates colon
{08940} benign ovarian tumor; recapitulates endocervix

Liver adenoma
WebPath Photo

Leiomyoma
Electron micrographs
VCU Pathology

Benign lipoma
Round and smooth
WebPath Photo

Benign lipoma
WebPath Photo

Benign lipoma
WebPath Photo

Benign leiomyomas
WebPath Photo

Benign leiomyoma
Normal-looking smooth muscle
WebPath Photo

{14165} benign ovarian cystic tumor; it weighed approximately 30 lb
{17488} benign fibroadenoma of breast

Invasive cervix cancer
WebPath Photo

Breast cancer
WebPath Photo

Anaplastic cancer cells
David Barber MD -- KCUMB

Anaplasia / dysplasia developing
in a columnar epithelium
David Barber MD -- KCUMB

Bone sarcoma

WebPath Photo

Cutaneous leiomyosarcoma
Pittsburgh Pathology Cases

Metaphase
Cancer cell in division
Dave Barber MD, KCUMB

{10085} squamous cell carcinoma
{10088} squamous cell carcinoma, sort-of-good desmosomes
{08977} squamous cell carcinoma, sort-of-good pearls
{09157} squamous cell carcinoma, good desmosomes
{09159} squamous cell carcinoma, electron micrograph, tonofilaments in the cell on the right
{10987} squamous cell carcinoma, very good pearls
{12596} squamous cell carcinoma, keratin is very pink, sort-of pearls
{15424} squamous cell carcinoma, good pearls

Squamous Cell Carcinoma
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Squamous cell carcinoma
Good pearl
Dave Barber MD, KCUMB

Squamous cell carcinoma
Right cheek
Pittsburgh Pathology Cases

Squamous cell carcinoma
Good photos
Pittsburgh Pathology Cases

Squamous cell carcinoma
Eye pathology site

Invasive squamous carcinoma
Below squamous epithelium
Dave Barber MD, KCUMB

Squamous carcinoma
Good pearls
WebPath Photo

Squamous cell carcinoma
Well-differentiated
WebPath Photo

Squamous cell carcinoma
Not-so-well differentiated
WebPath Photo

Squamous cell carcinoma
Nice desmosomes
WebPath Photo

Squamous cell carcinoma
Electron micrograph -- desmosomes
WebPath Photo

Squamous cell carcinoma
Electron micrographs
VCU Pathology

Adenocarcinoma
Pittsburgh Pathology Cases

Adenocarcinoma
Anaplastic cells making clear glands
Urbana Atlas of Pathology

Colon adenocarcinoma
Not so well differentiated
Urbana Atlas of Pathology

Colon adenocarcinoma
Fairly well differentiated
Urbana Atlas of Pathology

Colon adenocarcinoma
Urbana Atlas of Pathology

Breast adenocarcinoma
WebPath Photo

Adenoid cystic carcinoma
Breast primary
Pittsburgh Pathology Cases

"Glands within glands"
Adenocarcinoma
Photo by Ed

Adenocarcinoma
Prostate
ERF/KCUMB

Adenocarcinoma
Prostate
ERF/KCUMB

Adenocarcinoma
Prostate
ERF/KCUMB

Colon adenocarcinoma
Invading glands
WebPath Photo

Signet ring carcinoma
Bile duct origin
KCUMB Team

Signet ring carcinoma
Bile duct origin
KCUMB Team

Signet ring carcinoma
Bile duct origin
KCUMB Team

Signet ring carcinoma. Compare
nuclei to those in normal islet (right)
KCUMB Team

Microvilli
From an adenocarcinoma
WebPath Photo

{00129} adenocarcinoma, apocrine
{08806} adenocarcinoma of colon; low-power shot shows it arising from the mucosa and pushing toward the muscularis propria
{08852} adenocarcinoma of the pancreas; find some odd glands and some signet-ring cells
{08865} prostate adenocarcinoma; some swiss cheese
{08866} prostate adenocarcinoma; some swiss cheese

Metastatic adenocarcinoma
Pittsburgh Pathology Cases


{16671} leiomyosarcoma (smooth muscle cells, slightly high N/C ratio)

Abnormal pap smear
High NC ratio
Dave Barber MD, KCUMB

Leiomyosarcoma
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Sarcoma
Trust us.
WebPath Photo

Spindle-cell sarcoma

WebPath Photo

Spindle-cell sarcoma

WebPath Photo

Spindle-cell sarcoma

WebPath Photo

{23776} acute leukemia, basophils predominate

Acute Lymphoblastic Leukemia
Peripheral smear
KU Collection

Carcinoma in lymph node
Can you spot the cancer cells?
KCUMB Team

Carcinoma
Keratin stain
WebPath Photo

Sarcoma
Vimentin stain
WebPath Photo

Benign tumors may cause problems:

{00221} meningioma compressing brain
{01855} craniopharyngioma

Malignant tumors in the U.S (American Cancer Society, 2011):

What do cancers look like?

Exophytic cervix cancer
WebPath Photo

{05801} fibrosarcoma; here and below, we'll want microscopy for confirmation
{05831} fibrosarcoma
{05834} liposarcoma
{05958} chondrosarcoma
{08437} uterine adenocarcinoma ("cottage cheese in the uterine cavity")
{08916} uterine adenocarcinoma
{10208} colon adenocarcinoma
{10211} colon adenocarcinoma, in section
{10435} bronchogenic carcinoma
{17511} gastric adenocarcinoma
{11087} squamous cell carcinoma of larynx

{09810} esophageal carcinoma
{10436} lip cancer
{12169} lip cancer

{01573} brain cancer (glioblastoma)
{01596} same; microscopy
{01599} same; microscopy

Carcinoma with necrosis
Classic drawing
Adami & McCrae, 1914

Hemorrhage in a high-
grade colon cancer
Dave Barber MD, KCUMB

Tripolar mitosis
This was a breast cancer
Wikimedia Commons

Tripolar mitosis
Bronchial washing -- looks squamous
Wikimedia Commons

Bizarre mitotic figures
One is a classic "tripolar"
KU Collection

Mitotic figures

WebPath Photo

Bizarre mitotic figures

WebPath Photo

Cancer cells, smear
Urbana Atlas of Pathology

Cancer cells, smear
Urbana Atlas of Pathology

Bizarre mitotic figure
Ed Lulo's Pathology Gallery

Bizarre mitotic figure
Tom Demark's Site

Tripolar mitosis
Photomicrograph, nice spindles
New England Journal of Medicine

{00132} bizarre mitotic figure

{10478} squamous cell carcinoma invading; be sure you can recognize the tentacles ("tumor cords") cut in cross section

{08845} cholangiocarcinoma invading around a nerve ("perineural invasion")

Cancer around a nerve
WebPath Photo

{08912} carcinoma in situ, endocervix (junction with normal, i.e., the "carcino-columnar junction")

Carcinoma in situ
Urbana Atlas of Pathology

{21051} carcinoma in lymphatics (small intestinal mesentery)
{21052} carcinoma in lymphatics

Carcinoma metastatic in lymph node
Great labels
Romanian Pathology Atlas

Lymphatic with carcinoma
Uterus
ERF/KCUMB

Carcinoma Metastatic in Lymph Node
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

{08443} "liver mets"
{08444} "liver mets"

Liver metastases
WebPath Photo

Lymph node metastasis
WebPath Photo

Cancer in pulmonary lymphatics
WebPath Photo

Peritoneal metastases
WebPath Photo

Pleural metastasis
WebPath Photo

Liver Metastases
Tom Demark's Site

Cancer of the pancreas
Primary and liver metastases
KU Collection

Metastases to Liver
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Metastases to Lung
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Metastatic Melanoma, Lung
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Malignant tumors: Grade and Stage:

High-grade carcinoma

WebPath Photo

Flow cytometry

WebPath Photo

Tumor Nomenclature

I. To assign a name to a tumor that you have examined, begin by writing the suffix -OMA. Most tumor names end in this way. (Unfortunately, the suffix simply means "swelling", and some non-neoplasms also use the suffix, i.e., GRANULOMA, HEMATOMA, XANTHOMA, traumatic NEUROMA, and "gossypiboma" for a sponge left in after surgery Am. J. For. Med. Path. 33: 54, 2012).

II. If the tumor is MALIGNANT, write the root CARCIN- ("crab") if the tumor is of epithelial origin, or SARC- ("flesh") if the tumor is of mesenchymal origin, before -OMA. If the tumor is BENIGN, do not write anything.

III. Now choose one or more roots to describe the cell of origin.

If the tumor originated in GLANDULAR epithelium, use the root ADENO-. (It probably makes little glands and/or mucin.)

If the tumor originated in SQUAMOUS or UROTHELIUM (formerly called "transitional epithelium"), is BENIGN, and protrudes above the epithelial surface, use the root PAPILLO-. If it meets the first two criteria but does not protrude, the pathologist knows the name but you don't need to just now.

If the tumor originated in NON-GLANDULAR EPITHELIUM and is MALIGNANT, name it for the cell of origin.

If the tumor originated from a NON-EPITHELIAL cell, look for a root in the following list. (We do not consider endothelium and mesothelium to be epithelium for this purpose.)

There are a few epithelial roots you will have to learn. For example:

If the neoplastic cell types are MIXED, use a compound, for example, fibroadenoma.

Some tumors arise in "totipotential cells" and contain a variety of different mature and/or immature tissues from different germ layers, and these are given names with the root TERATO- ("monster").

Nasopharyngeal teratoma
WebPath Photo

Nasopharyngeal teratoma
WebPath Photo

Ovarian Teratoma
Australian Pathology Museum
High-tech gross photos

Immature skeletal muscle
from a teratoma
ERF/KCUMB

IV. You can add adjectives as appropriate.

V. A handful of tumors that are thoroughly malignant have "benign" names. You will just have to learn these.

VI. A HAMARTOMA is "not a tumor, but is a developmental anomaly" (?) that contains the same tissues as the organ in which it is found, but in the wrong proportions.

A CHORISTOMA ("ectopia") is a mass of normal tissue in an abnormal location.

A tumor that ends in BLASTOMA is composed of cells that resemble those seen in a developing organ. Most blastomas are malignant (but it depends on the site).

A few tumors of uncertain histogenesis are named EPONYMOUSLY: Ewing's sarcoma, Hodgkin's disease, Pindborg tumor, Wilms' tumor, Enzinger's sarcoma.

A POLYP describes a gross appearance rather than what's actually happening. It might be a cancer, a benign tumor, a hamartoma, a choristoma, or a hyperplasia such as a singer's vocal cord polyp. The term won't appear without a clarifier on a pathology report.

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