Neoplasia part II

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Neoplasia part II

• By
• Dr. Mohsen Dashti
• Clinical Medicine Pathology
• 3rd lecture

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Lecture outline

• Diagnosis of cancer.
• Symptoms of cancer.
• Cancer therapy.

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Diagnosis of cancer

• Is visual examination enough for diagnosing
  cancer?
• Off course not. Final diagnosis of cancer
  requires medical laboratory tests.
• Laboratory tests can be done in number of
  methods
• Biopsy.
• Following a surgical operation the tumor is sent
  to the laboratory to check whether or not the
  lesion is malignant.
• In some cases, particularly breast cancer, the
  surgeon might ask for a quick report on the
  nature of the lesion while the patient is still
  under the knife so appropriate action can be
  taken.
• The report bares extreme responsibility since
  surgeons depend heavily on its outcome.

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Diagnosis of cancer

• Exfoliative cytology.
• Casting or shedding cells from the body surface
  since cancer cells tend to lose adhesiveness
  characteristic of normal cells.
• Although this method is loosely inaccurate, it
  opened doors for early diagnosis.
• It is routinely used in vaginal testing and
  considered the early method of smear test.
• Fine needle aspiration cytology.
• Small cell clumps are aspirated through a long
  needle attached to a syringe to obtained cells
  deeply located organs. Example?
• Thyroid gland, lymph nodes, or pancreas.

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Diagnosis of cancer

• Chemical tests.
• It is an ultimate dream to come up with some sort
  of chemical tests for the diagnosis of cancer
  without the need for previously mentioned
  methods. Do dreams come true?
• Some of them do. Example?
• Some tests may be of clinical value, as in
  carcinoma of the prostate, in which increased
  acid phosphatase levels suggests that diagnosis.
• The production of alpha-fetoprotein by the
  abnormal cells of the liver can indicate
  cancerous cells and may be detected chemically.
• CEA or carcinoembryonic antigen can also be
  detected chemically to indicate cancer of the
  large bowel.

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Diagnosis of cancer
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Symptoms of cancer

• How painful is cancer in the early stages?
• Not painful at all and thats a major problem.
  Why?
• If it were as painful as toothache, far fewer
  people would die from the disease.
• So what are the general symptoms of cancer?
• Weakness, loss of weight, anemia, and pain late
  in the disease. Do they differ in various region
  of the body?
• Yes. Example?
• Lip or breast, a lump may be felt.
• If the affected organ communicates with the
  surface, there may be a discharge or bleeding as
  in cancer of the uterus.
• Lost of appetite as in cancer of the stomach.
• Blood in the urine as in cancer of the kidneys.

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Symptoms of cancer

• It should be noted that a malignant tumor of some
  size may be discovered incidentally at autopsy
  and may not present any pain.
• It must be remembered that the symptoms may not
  be due to the primary tumor, which may remain
  latent, but due to metastases. Example?
• A silent carcinoma of the lung that metastasizes
  to the brain, so that the patient comes to the
  doctor with symptoms of brain tumor, but no
  cough, shortness of breath, pain in the chest, or
  spitting of blood.

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Symptoms of cancer
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Symptoms of cancer

• The previously mentioned symptoms are considered
  clinical effects of cancer due to a local lesion
  or metastases however, there are other symptoms
  known as systemic manifestations.
• These include various inflammation of the skin,
  vascular effects, hormonal disturbances, and
  neuromuscular symptoms suggesting lesions of the
  nerves and muscles.

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Cancer therapy

• What are the common ways in cancer therapy?
• Surgical removal.
• Radiotherapy.
• Chemotherapy.
• It should be clearly understood that malignant
  cancer can not be cured entirely especially if it
  metastasizes.
• 1. Surgical removal
• Innocent tumors (benign) are treated with
  complete success by local removal, that is to
  say, only the tumor itself needs to be removed
  and none of the surrounding tissue. How about
  malignant tumors?
• With malignant tumors not only the tumor is
  removed, but also as much as is feasible of the
  surrounding tissue as well.

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Cancer therapy

• In some cases and depending on the part of the
  body affected, the regional lymph nodes also may
  have to be removed.
• The removal of the lymph nodes may not be
  necessary in all malignant tumors and depends on
  the regional location.
• A good example is with breast cancer compared to
  a lip cancer where the latter doesnt require
  lymph nodes removal.
• Radiotherapy
• How can radiation differentiate between cancer
  and non cancer cells in radiotherapy?
• Radiations have a greater destructive action on
  rapidly growing cells than on normal cells,
  therefore they have a selective action on cancer
  cells compared with that on surrounding tissue.

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Cancer therapy

• Does radiotherapy require special skills how
  does it work?
• Yes it does.
• Either gamma rays or x-rays are used in radiation
  therapy.
• X-rays may be generated by low voltage (50,000 to
  100,000 volts) or high voltage (220,000 volts).
  The low voltage rays are known as soft, whereas
  the higher voltage rays called hard.
• Soft rays have light penetration power and mainly
  suitable for surface tumors.
• Hard rays have higher penetration power and
  suitable for deep-seated tumors.

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Cancer therapy

• It should be clearly understood that
  understanding tumor pathology and its associated
  manifestations is extremely important prior to
  any radiotherapy plan.
• Some tumors are highly radiosensitive, whereas
  others are highly radioresistant.
• Radiation therapy is employed in the treatment of
  localized neoplastic lesions that are not
  surgically accessible or in situations where
  surgery would be impractical.
• Chemotherapy
• It employs a wide variety of powerful metabolic
  inhibitors and other cell-killing chemicals that
  are often used on various combinations for
  treatment of different cancers.
• They work on cancer cells in a similar way that
  radiations do.

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Cancer therapy

• Chemotherapy has been most successful for certain
  types of leukemias and lymphomas.
• Other treatment options in cancer therapy
  include hormonal therapy used in breast and
  prostate cancers, and protein therapy that kills
  selective cells.

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Cancer free