NEOPLASIA

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					NEOPLASIA
   Neoplasia: Cancer Facts and
             Figures
• The American Cancer Society estimates
  there will be 1,220,100 new cases of cancer
  diagnosed in the U.S.A. in 2000
• They also estimate there will by 552,200
  cancer deaths in 2000
• Only cardiovascular diseases cause more
  deaths than cancer
   Neoplasia: Cancer Facts and
             Figures
• Recently there has been a decline in cancer
  mortality but the problem is still mammoth
• With many forms of malignancy, most
  notably the leukemias and lymphomas,
  there are now dramatic improvements in the
  5 year survival rates
• Today a greater proportion of cancers are
  being cured or arrested than ever before
       Neoplasia: Definitions
• NEOPLASIA literally means “new growth”
• The new growth is called a NEOPLASM
• The term tumor was originally applied to
  the swelling caused by inflammation; now
  TUMOR is equated with neoplasm
• ONCOLOGY is the study of tumors or
  neoplasms (Greek oncos means tumor)
       Neoplasia: Definitions
• Cancer (Latin for crab) is the common term
  for ALL MALIGNANT tumors
• A NEOPLASM is an “abnormal mass of
  tissue, the growth of which exceeds and is
  uncoordinated with that of the normal
  tissues and persists in the same excessive
  manner after cessation of the stimuli which
  evoked the change” (Willis, 1952)
     Neoplasia: Nomenclature
• All tumors, benign and malignant, have two
  basic components:
• 1) proliferating neoplastic cells that
  constitute their PARENCHYMA
• 2) SUPPORTIVE STROMA made up of
  connective tissue and blood vessels
     Neoplasia: Nomenclature
• It is the parenchyma of the tumor that
  largely determines its biologic behavior and
  is the component from which the neoplasm
  derives its name
     Neoplasia: Nomenclature
• On occasions the parenchymal cells of a
  tumor stimulate the formation of abundant
  collagenous stroma which is referred to as
  DESMOPLASIA
   Benign Tumor Nomenclature
• In general, benign tumors are designated by
  attaching the suffix -OMA to the cell of
  origin
• Tumors of mesenchymal cells generally
  follow this rule
   Benign Tumor Nomenclature
• For example, a benign tumor arising from
  fibroblastic cells is called a FIBROMA
• A OSTEOMA is a benign tumor of
  osteoblasts, while a benign cartilaginous
  tumor is called a CHONDROMA
   Benign Tumor Nomenclature
• The terminology of benign epithelial tumors
  is more complex with some being classified
  based on the cells of origin while others are
  classified by microscopic architecture and
  still others on their macroscopic patterns
   Benign Tumor Nomenclature
• ADENOMA is the term applied to the
  benign epithelial neoplasm that forms a
  glandular pattern or to a tumor arising from
  glands but not reproducing glandular
  patterns
   Benign Tumor Nomenclature
• Benign epithelial neoplasms producing
  microscopically or macroscopically visible
  finger-like or warty projections from
  epithelial surfaces are referred to as
  PAPILLOMAS
• Tumors forming large cystic masses in
  organs such as the ovary are called
  CYSTADENOMAS
   Benign Tumor Nomenclature
• When a benign, or malignant, neoplasm
  produces a macroscopically visible
  projection above a MUCOSAL surface and
  projects into a lumen, as in the GI tract, it is
  termed a POLYP
• It is preferred that the term polyp be used
  only with benign tumors as malignant
  polyps are better called polypoid cancers
Malignant Tumor Nomenclature
• Malignant tumors arising in mesenchymal
  tissue are usually called SARCOMAS
  (Greek sar means fleshy)
• A malignant tumor arising from fibroblastic
  cells would be called a FIBROSARCOMA
  while one developing from osteoblastic
  cells would be termed an
  OSTEOSARCOMA
Malignant Tumor Nomenclature
• Malignant neoplasms of epithelial origin
  arising from any of the three germ layers
  are called CARCINOMAS
• Carcinomas can be further qualified: One
  with a glandular growth pattern
  microscopically is termed an
  ADENOCARCINOMA
Malignant Tumor Nomenclature
• A malignant tumor producing recognizable
  squamous cells arising in any epithelium of
  the body is termed a SQUAMOUS CELL
  CARCINOMA
• Not infrequently, a cancer is composed of
  undifferentiated cells and must be
  designated as a poorly differentiated or
  undifferentiated malignant tumor
 Malignant Tumor Nomenclature
• The parenchymal cells in a neoplasm
  usually more or less resemble each other
• Occasionally the stem cell may undergo
  divergent differentiation, creating the so-
  called mixed tumor, example: mixed tumor
  of salivary gland origin
• However, these mixed tumors are composed
  of cells representative of a single germ layer
       Tumor Nomenclature
• In contrast, the TERATOMA is made up of
  a variety of parenchymal cell types
  representative of MORE than one germ and
  usually all three germ layers
  Inconsistent, Inappropriate and
     Confusing Nomenclature
• A malignant tumor of melanocytes has for
  years been called a MELANOMA when it
  is better termed a MELANOCARCINOMA
• A HAMARTOMA is a malformation (not a
  neoplasm) that presents as a mass of
  disorganized tissue indigenous to a
  particular site; example: nodule in lung
  containing cartilage, bronchi, blood vessels
 Inconsistent, Inappropriate and
    Confusing Nomenclature
• Another misnomer is the CHORISTOMA,
  which is a congenital anomaly composed of
  a heterotopic rest of cells; example:
  pancreatic tissue found in the submucosa of
  the stomach
 CHARACTERISTICS OF
BENIGN AND MALIGNANT
       TUMORS
Differences Between Benign and
       Malignant Tumors
•   These can be discussed under the headings:
•   1) Differentiation and Anaplasia
•   2) Rate of Growth
•   3) Local Invasion
•   4) Metastasis
  Differentiation and Anaplasia
• DIFFERENTIATION refers to the extent to
  which parenchymal cells resemble
  comparable normal cells, both
  morphologically and functionally
• WELL-DIFFERENTIATED tumors are
  composed of cells resembling the mature
  normal cells of the tissue of origin of the
  neoplasm
  Differentiation and Anaplasia
• POORLY OR UNDIFFERENTIATED
  tumors have primitive-appearing,
  unspecialized cells
• In general, BENIGN tumors are WELL-
  DIFFERENTIATED
• In contrast, MALIGNANT tumors range
  from WELL-DIFFERENTIATED to
  UNDIFFERENTIATED
  Differentiation and Anaplasia
• Malignant neoplasms composed of
  undifferentiated cells are said to be
  ANAPLASTIC; lack of differentiation or
  ANAPLASIA is considered a hallmark of
  malignant transformation
• Anaplasia literally means “to form
  backward”; however lack of differentiation
  is not the consequence of dedifferentiation
  Differentiation and Anaplasia
• Anaplasia is marked by a number of
  morphologic and functional changes which
  include:
• 1) PLEOMORPHISM: variation of size and
  shape of the cells and their nuclei
• 2)Nuclei contain an abundance of DNA are
  are extremely dark staining which is termed
  HYPERCHROMATISM
  Differentiation and Anaplasia
• 3) Anaplastic tumors usually possess large
  NUMBERS of mitoses
• The presence of mitoses does not
  necessarily indicate that a tumor is
  malignant or that the tissue is neoplastic
• 4) More important as a morphologic feature
  of malignant neoplasia is the presence of
  ATYPICAL, BIZARRE mitotic figures
  Differentiation and Anaplasia
• Other features of anaplasia include:
• 5) TUMOR GIANT CELLS
• 6) ORIENTATION of anaplastic cells is
  markedly disturbed
  Differentiation and Anaplasia
• Generally, the more rapidly growing and the
  more anaplastic a tumor, the less likely it is
  that there will be specialized functional
  activity. The cells in benign tumors are
  almost always well differentiated and
  resemble their normal cells of origin; the
  cells in cancer are more or less
  differentiated but some loss of
  differentiation is always present
             Rate of Growth
• Generally most BENIGN tumors grow
  SLOWLY over a period of years, whereas
  most CANCERS grow RAPIDLY,
  sometimes at an erratic pace
• In general, the growth rate of tumors
  correlates with their level of differentiation
  and thus most malignant tumors grow more
  rapidly than do benign ones
            Local Invasion
• Nearly all benign tumors grow as cohesive
  expansile masses that remain localized
• Because benign tumors typically grow
  slowly, they usually develop a rim of
  compressed connective tissue, which may
  be called a fibrous capsule
             Local Invasion
• The growth of malignant tumors is
  accompanied by progressive infiltration,
  invasion and destruction of surrounding
  tissue leaving them poorly demarcated
• Next to the development of metastases,
  invasiveness is the most reliable feature that
  differentiates malignant from benign tumors
               Metastasis
• METASTASES are tumor implants that are
  DISCONTINUOUS with the primary tumor
• Metastasis unequivocally marks a tumor as
  malignant because benign neoplasms do not
  metastasize
• With few exceptions, all cancers can
  metastasize; malignant glial cell tumors and
  basal cell carcinomas rarely metastasize
               Metastasis
• In general, the more aggressive, the more
  rapidly growing and the larger the primary
  neoplasm, the greater the likelihood it has
  or will metastasize
• Approximately 30% of the newly diagnosed
  patients with solid tumors (excluding most
  skin tumors) present with metastases
 Metastasis: Pathways of Spread
• Dissemination of cancers may occur
  through one of three pathways:
• 1) direct seeding of body cavities or
  surfaces
• 2) lymphatic spread
• 3) hematogenous spread
 Metastasis: Pathways of Spread
• Seeding of Body Cavities and Surfaces:
  may occur whenever a malignant tumor
  penetrates into a natural “open field”
• The peritoneal cavity is most often involved
  but pleural, pericardial, subarachnoid and
  joint spaces may be affected
 Metastasis: Pathways of Spread
• Lymphatic spread is the most common
  pathway for the initial dissemination of
  carcinomas but sarcomas may use this route
• The pattern of lymph node involvement
  follows the natural routes of drainage
• Nodal enlargement in proximity to a cancer
  does not necessarily mean dissemination of
  the primary tumor
 Metastasis: Pathways of Spread
• Hematogenous spread is typical of sarcomas
  but carcinomas may also use this route
• The liver and lungs are most frequently
  involved secondarily in such hematogenous
  dissemination
• Veins are more easily invaded by tumors
  and certain cancers, such as renal cell
  carcinomas have a propensity for them
   Clinical Features of Tumors
• Tumors are essentially parasites with some
  only causing mischief while others are
  catastrophic
• ALL tumors, even benign ones, can cause
  morbidity and mortality
• Every new growth requires careful appraisal
  lest it be cancerous; with a few exceptions,
  all masses require anatomic evaluation
    Clinical Features of Tumors
• The following will be discussed under this
  heading:
• 1) the effects of a tumor on the host
• 2) the grading and clinical staging of cancer
• 3) the laboratory diagnosis of tumors
     Effects of Tumor on Host
• Certainly cancers are for more threatening
  than benign tumors but both types can cause
  problems because of:
• 1) location and impingement on adjacent
  structures
• 2) functional activity such as hormone
  synthesis
     Effects of Tumor on Host
• 3) bleeding and secondary infections when
  they ulcerate
• 4) initiation of acute symptoms caused by
  either rupture or infarction
Effects of Tumor on Host: Local
     and Hormonal Effects
• Location of a tumor may be critical as for
  example a pituitary adenoma. While this
  tumor is benign and even though a
  particular one may not produce hormone, a
  pituitary adenoma can destroy the
  remaining gland and cause serious
  endocrinopathy; benign and malignant
  tumors of the gut may cause obstruction
   Local and Hormonal Effects
• Neoplasms arising in endocrine glands may
  produce manifestations by elaboration of
  hormones
• The erosive destructive growth of cancers
  or the expansile pressure of a benign tumor
  on any surface may cause ulcerations,
  secondary infections and bleeding
     Effects of Tumor on Host:
         Cancer Cachexia
• Cancer patients commonly suffer
  progressive loss of body fat and lean body
  mass accompanied by profound weakness,
  anorexia and anemia. This wasting
  syndrome is termed CACHEXIA
• The causes of cachexia are obscure but
  cachexia is NOT caused by the nutritional
  demands of the neoplasm
           Cancer Cachexia
• Current evidence indicates that cachexia
  results from the action of soluble factors
  such as cytokines (TNF-alpha and IL-1)
  either produced by the tumor or the host
• Reduced food intake alone is not sufficient
  to explain the cachexia of malignancy
     Effects of Tumor on Host:
     Paraneoplastic Syndromes
• Symptom complexes in cancer patients that
  cannot readily be explained, either by the
  local or distant spread of the tumor or by the
  elaboration of hormones indigenous to the
  tissue from which the tumor arose, are
  known as PARANEOPLASTIC
  SYNDROMES
    Paraneoplastic Syndromes
• Paraneoplastic syndromes are important for
  three reasons:
• 1) they may represent the earliest
  manifestation of an occult tumor
• 2) they may represent significant clinical
  problems and may even be lethal
• 3) they may mimic metastatic disease and
  therefore confound treatment
           Endocrinopathies
Clinical      Underlying       Causal
Syndromes     Cancer           Mechanism
Cushing       Small cell CA-   ACTH or
syndrome      lung; neural;    ACTH-like
              pancreatic CA    substance
Syndrome of Small cell CA-     ADH or atrial
inappropriate lung; intra-     natriuretic
ADHsecretion cranial tumors    hormones
            Endocrinopathies
Clinical      Underlying       Causal
Syndromes     Cancer           Mechanism
Hyper-        Sq. cell CA-     Parathyroid
calcemia      lung; breast,    hormone-
              renal, ovarian   related
              CA; adult T-     peptide, TGF-
              cell leukemia/   alpha, TNF-
              lymphoma         alpha, IL-1
         Endocrinopathies
Clinical     Underlying       Causal
Syndromes    Cancer           Mechanism
Hypoglycemia Fibro- & other   Insulin or
             sarcomas; CA     insulin-like
             of liver         substance
Carcinoid    Bronchial        Serotonin,
syndrome     adenoma; CA-     bradykinin, ?
             pancreas/GI      histamine
            Endocrinopathies
Clinical      Underlying    Causal
Syndromes     Cancer        Mechanism


Polycythemia Renal &        Erythropoietin
             hepatocellular
             CA; cerebellar
             hemangioma
  Nerve and Muscle Syndromes
Clinical       Underlying   Causal
Syndromes      Cancer       Mechanism
Myasthenia     Bronchogenic Immunologic
               carcinoma
Disorders of Breast         Immunologic
central/periph. carcinoma
nervous syst.
      Dermatologic Disorders
Clinical     Underlying    Causal
Syndromes    Cancer        Mechanism
Acanthosis   Gastric, lung ?Immunologic
nigricans    & uterine CA ?epidermal
                           growth factor
Dermato-     Bronchogenic ?Immunologic
myositis     & Breast CA
    Vascular and Hematologic
            Changes
Clinical       Underlying     Causal
Syndromes      Cancer         Mechanism
Venous         CA of lung &   Tumor
thrombosis     pancreas       products
NBT            Advanced       Hyper-
endocarditis   cancers        coagulability
Anemia         Thymic         Unknown
               neoplasms
Other Paraneoplastic Syndromes
Clinical    Underlying   Causal
Syndromes   Cancer       Mechanism


Nephrotic   Various      Tumor
syndrome    cancers      antigens and
                         immune
                         complexes
 Grading and Staging of Tumors
• Comparison of the end results of various
  forms of cancer treatment, particularly
  between clinics, requires some degree of
  comparability of neoplasms being assayed
• To this end, systems have been derived to
  express these results
 Grading and Staging of Tumors
• To accomplish this goal, at least in
  semiquantitative terms, the level of
  differentiation, or GRADE, and the extent
  of spread of a cancer within the patient, or
  STAGE, serve as parameters of the clinical
  gravity of the disease
 Grading and Staging of Tumors
• GRADING of a cancer is based on the
  degree of differentiation of the tumor cells
  and the number of mitoses within the tumor
  as presumed correlates of the neoplasm’s
  aggressiveness
• Cancers are classified as grades I to IV with
  increasing anaplasia
 Grading and Staging of Tumors
• Criteria for the individual grades vary with
  each form of neoplasia; some of these will
  be discussed later and in other courses
• In general, and with few exceptions,
  grading of cancers has proven to be of less
  clinical value than has staging
 Grading and Staging of Tumors
• The STAGING of cancers is based on the
  size of the primary lesion, its extent of
  spread to regional lymph nodes, and the
  presence or absence of blood-borne
  metastases
• There are two major staging systems: 1)
  Union International Contre Cancer (UICC)
  and 2) American Joint Committee (AJC) on
  Cancer Staging
 Grading and Staging of Tumors
• The UICC uses the TMN system
• T for primary tumor: T0 (in situ); T1 to T4
  with increasing size
• N for regional lymph node involvement:
  NO(none); N1 to N3 denotes involvement
  of an increasing number and range of nodes
• M for metastases: MO(none); M1 and M2
  indicates the presence of mets and number
 Grading and Staging of Tumors
• The AJC employs a different nomenclature
  and divides all cancer into stages 0 to IV,
  incorporating within each of these stages
  the size of the primary lesion as well as the
  presence of nodal spread and distant
  metastases
• The use of these systems will be described
  later in consideration of specific tumors
 Laboratory Diagnosis of Cancer
• Every year the approach to laboratory
  diagnosis of cancer becomes more complex,
  more sophisticated and more specialized
• Importance of Clinician in diagnosis: 1)
  clinical data; 2) adequate, representative
  and properly preserved specimen
 Laboratory Diagnosis of Cancer
• Sampling approaches for histologic and
  cytologic methods: 1) excision or biopsy;
  2) fine-needle aspiration; and 3) cytologic
  smears
 Laboratory Diagnosis of Cancer
• Immunocytochemistry: Availability of
  specific monoclonal antibodies has greatly
  facilitated the identification of cell products
  or surface markers
• The utility of immunohistochemistry
  includes:
• 1) Categorization of undifferentiated
  malignant tumors; ex. keratin in tumors of
  epithelial origin
 Laboratory Diagnosis of Cancer
• 2) Categorization of leukemias and
  lymphomas; ex. classification of T and B
  cell tumors
• 3) Determination of site of origin of
  metastatic tumors; ex. prostate-specific
  antigen in a tumor
 Laboratory Diagnosis of Cancer
• 4) Detection of molecules that have
  prognostic or therapeutic significance; ex.
  detection of hormone (estrogen and/or
  progesterone) receptors in breast cancer
  cells
        Molecular Diagnosis
• 1) Diagnosis of malignant tumors; ex.
  molecular techniques used in differentiating
  benign (polyclonal) proliferations of T or B
  cells from malignant (monoclonal)
  proliferations
• 2) Prognosis of malignant neoplasms; ex.
  N-myc gene and deletions of 1p bode
  poorly for patients with neuroblastoma
         Molecular Diagnosis
• 3) Detection of minimal residual disease;
  ex. PCR-based amplification gives a
  measure of residual leukemia cells in
  treated pts. with chronic myeloid leukemia
• 4) Diagnosis of hereditary predisposition to
  cancer; ex. germ line mutation in cancer-
  suppressor genes is associated with an
  extremely high risk of developing specific
  cancers
           Flow Cytometry
• Flow cytometry can rapidly and
  quantitatively measure several individual
  cell characteristics, such as membrane
  antigens and DNA content of tumor cells
• Cell surface antigens can be used for
  classification; ex. leukemias/lymphomas
• Relationship between DNA content and
  prognosis; ex. aneuploidy-poorer prognosis
           Tumor Markers
• Tumor markers are biochemical indicators
  of the presence of a tumor
• Tumor markers include: cell surface
  antigens, cytoplasmic proteins, enzymes
  and hormones
• Example: Carcinoembryonic antigen
  (CEA) is found in carcinomas of colon,
  pancreas, lung, stomach and breast
            Tumor Markers
• CEA assays lack both specificity and the
  sensitivity required for the detection of
  early cancers
• Alpha-fetoprotein (AFP) is associated with
  liver cell cancer and nonseminomatous
  germ cell tumors of the testis
• AFP can be seen in non-neoplastic
  conditions such as cirrhosis and hepatitis
SUPPLEMENTAL TABLES
     Paraneoplastic Syndromes
        (Endocrinopathies)
Cushing         Small cell        ACTH or
Syndrome        carcinoma-lung;   ACTH-like
                pancreatic        substance
                carcinoma;
                neural tumors
Syndrome of     Small cell        ADH or atrial
inappropriate   carcinoma-lung;   natriuretic
ADH secretion   intracranial      hormones
                neoplasms
     Paraneoplastic Syndromes
        (Endocrinopathies)
Hypercalcemia   Lung (sq. cell),   PTH-related
                breast, ovarian,   peptide, TGF-
                renal carcinoma;   , TNF-,
                T-cell leukemia/   IL-1
                lymphoma
Carcinoid       Bronchial          Serotonin,
Syndrome        adenoma;           bradykinin, ?
                pancreatic &       Histamine
                gastric
                carcinomas
     Paraneoplastic Syndromes
        (Endocrinopathies)
Hypoglycemia   Fibrosarcoma & Insulin or
               other sarcomas; insulin-like
               hepatocellular  substances
               carcinoma

Polycythemia   Renal &          Erythropoietin
               hepatocellular
               carcinomas;
               cerebellar
               hemangioma
   Paraneoplastic Syndromes
 (Nerve and Muscle Syndromes)
Myasthenia      Bronchogenic   Immunologic
                carcinoma



Disorders of the Breast        Immunologic
central and      carcinoma
peripheral
nervous systems
     Paraneoplastic Syndromes
     (Dermatologic Disorders)
Acanthosis   Gastric, lung &   ?Immunologic, ?
nigricans    uterine           Secretion of
             carcinomas        epidermal
                               growth factor

Dermato-     Bronchogenic & ?Immunologic
myositis     breast
             carcinomas
     Paraneoplastic Syndromes
(Osseous, Articular, Soft Tissue Change)
Hypertrophic     Bronchogenic   Unknown
osteoarthropathy carcinoma
and clubbing of
fingers
   Paraneoplastic Syndromes
(Vascular/Hematologic Changes)
Venous          Pancreatic &    Tumor products
thrombosis      Bronchogenic    (mucins that
(Trousseau      carcinomas;     activate clotting)
phenomenon)     other neoplasms

Non-bacterial   Many advanced Hyper-
thrombotic      cancers       coagulability
endocarditis
     Paraneoplastic Syndromes
Anemia      Thymic          Unknown
            neoplasms



Nephrotic   Various cancers Tumor antigens,
syndrome                    immune
                            complexes
Comparison Between Benign and
     Malignant Tumors
FEATURE            BENIGN              MALIGNANT

Differentiation/   Well                Some lack of
anaplasia          differentiated;     differentiation
                   structure may be    with anaplasia;
                   typical of tissue   structure is often
                   of origin           atypical
Comparison Between Benign and
     Malignant Tumors
FEATURE          BENIGN               MALIGNANT

Rate of Growth   Usually              Erratic and may
                 progressive and      be slow to rapid;
                 slow; may come       mitotic figures
                 to a standstill or   may be
                 regress; mitotic     numerous and
                 figures are rare     abnormal
                 and normal
Comparison Between Benign and
     Malignant Tumors
FEATURE          BENIGN             MALIGNANT
Local invasion   Usually            Locally invasive
                 cohesive and       Infiltrate the
                 expansile, well-   surrounding
                 demarcated         normal tissue;
                 masses that do     sometimes may
                 not invade or      be seemingly
                 infiltrate         cohesive and
                 surrounding        expansile
                 normal tissue
Comparison Between Benign and
     Malignant Tumors
FEATURE      BENIGN          MALIGNANT

Metastasis   Absent (Do Not Frequently
             Metastasize)   present; the
                            larger and more
                            undifferentiated
                            the primary, the
                            more likely are
                            metastases
         TUMOR MARKERS
            (Hormones)
MARKERS           CANCERS

Human chorionic   Trophoblastic tumors;
gonadotropin      non-seminomatous
                  testicular tumors


Calcitonin        Medullary carcinoma of
                  thyroid
        TUMOR MARKERS
           (Hormones)
MARKERS             CANCERS

Catecholamine and   Pheochromocytoma and
metabolites         related tumors

Ectopic hormones    Tumors of the
                    Paraneoplastic Syndrome
                    group
        TUMOR MARKERS
        (Oncofetal Antigens)
MARKERS            CANCERS

-fetoprotein      Liver cell cancer; non-
                   seminomatous germ cell
                   tumors of testis


Carcinoembryonic   Carcinomas of colon,
antigen            pancreas, lung, stomach
                   & breast
         TUMOR MARKERS
           (Isoenzymes)
MARKERS                   CANCERS

Prostatic acid            Prostate cancer
phosphatase

Neuron-specific antigen   Small cell cancer of lung,
                          neuroblastoma
         TUMOR MARKERS
          (Specific Proteins)
MARKERS                     CANCERS

Immunoglobulins             Multiple myeloma and
                            other gammopathies


Prostate-specific antigen   Prostate cancer
    TUMOR MARKERS
(Mucins & Other Glycoproteins)
MARKERS        CANCERS

CA-125         Ovarian cancer

CA-19-9        Colon, pancreatic cancer

CA-15-3        Breast cancer
 OCCUPATIONAL CANCERS
AGENT     CANCER          TYPICAL USE

Arsenic   Lung,skin,hem- By-product of
          angiosarcoma   smelting;
                         medications,
                         herbicides,
                         fungicides and
                         animal dips
 OCCUPATIONAL CANCERS
AGENT      CANCER           TYPICAL USE

Asbestos   Lung,            Formerly used
           mesothelioma, for fire, heat and
           GI tract cancers friction
                            resistance; still
                            in many
                            buildings, etc.
 OCCUPATIONAL CANCERS
AGENT     CANCER      TYPICAL USE

Benzene   Leukemia;   Principal
          Hodgkin’s   component in
          disease     light oil;
                      printing, paint,
                      dry cleaning,
                      adhesives,
                      rubber, etc.
 OCCUPATIONAL CANCERS
AGENT         CANCERS    TYPICAL USE

Cadmium and   Prostate   Used in yellow
cadmium                  pigments,
compounds                batteries,
                         solders, metal
                         plating, etc.
 OCCUPATIONAL CANCERS
AGENT            CANCERS   TYPICAL USE

Radon and its    Lung      From decay of
decay products             minerals
                           containing
                           uranium;
                           quarries, mines,
                           etc.
 OCCUPATIONAL CANCERS
AGENT            CANCERS         TYPICAL USE

Vinyl chloride   Angiosarcoma,   Refrigerant,
                 liver           monomer for
                                 vinyl polymers,
                                 formerly “inert”
                                 aerosol
                                 propellant in
                                 pressurized cans
 HEREDITARY NEOPLASMS
NEOPLASM         INHERITANCE FEATURES

Retinoblastoma   AD         Often bilateral,
                            susceptible to
                            second tumors
 HEREDITARY NEOPLASMS
NEOPLASM         INHERITANCE FEATURES

Familial         AD         Multiple
adenomatous                 adenomatous
polyposis coli              polyps & adeno-
                            carcinomas of
                            colon
 HEREDITARY NEOPLASMS
NEOPLASM      INHERITANCE FEATURES

Multiple      AD         Adenomas of
endocrine                pituitary,
neoplasia I              parathyroid and
                         pancreatic islet
                         cells
  HEREDITARY NEOPLASMS
NEOPLASM       INHERITANCE FEATURES

Multiple       AD         Medullary
endocrine                 carcinoma of the
neoplasia II              thyroid, pheo-
                          chromocytoma
                          and parathyroid
                          tumors
 HEREDITARY NEOPLASMS
NEOPLASM      INHERITANCE FEATURES

Neuro-         AD        Gliomas of
fibromatosis             brain and optic
type I (von              nerve, acoustic
Recklinghausen           neuroma,
Disease)                 meningioma,
                         pheo-
                         chromocytoma
HEREDITARY PRENEOPLASTIC
       CONDTIONS
CONDITION     INHERITANCE FEATURES

Xeroderma      AR        Basal and
pigmentosum              squamous cell
(defective DNA           carcinomas of
repair)                  skin; malignant
                         melanomas in
                         patients exposed
                         to UV light

				
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posted:10/3/2012
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