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Chapter 5 Neoplasia. Cell Growth. Growth categories Labile Stable Permanent Growth regulators Proto-oncogenes Tumor suppressor genes Apoptosis regulating genes DNA repair genes. Neoplastic Growth. Malignant. Benign. Variable growth rate, depends on the level of cell differentiation
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Cell Growth • Growth categories • Labile • Stable • Permanent • Growth regulators • Proto-oncogenes • Tumor suppressor genes • Apoptosis regulating genes • DNA repair genes
Neoplastic Growth Malignant Benign • Variable growth rate, depends on the level of cell differentiation • Invades surrounding tissues by infiltration, not encapsulated • Undifferentiated cells may not resemble cells of origin. • Metastasizes to distant tissues • Slow growth • Expands into tissues, usually encapsulated • Cells are well differentiated. • Do not metastasize
Neoplastic Growth (cont.) Benign Malignant
Carcinogenesis • Defined • Most common targets for genetic damage • Proto-oncogenes • Tumor suppressor genes • DNA repair genes • Apoptosis regulating genes
Carcinogenesis (cont.) • Etiology of genetic damage (carcinogenic agents) • Inherited traits/influences • Chemicals • Environmental insults/agents • Viral infections • Immune system defects
Local Growth and Distant Metastasis • Local growth • Carcinoma in situ • Local spread • Mechanical pressure, enzymes, lack of adhesion • Metastasis • Lymph system • Blood system • Seeding
Diagnosis • Symptoms • Screening • Physical exams (visual/palpation) • Radiographs (mammography) • Pap smear • Oral screening devices (brush biopsy and others) • Laboratory • Biopsy • Excisional/incisional • Aspiration
Diagnosis (cont.) • Benign • Well differentiated • No extension into or fixation to surrounding tissues • No metastasis • Malignant • Variable levels of differentiation (anaplasia) • Atypical cells • Extend into and are fixed to surrounding tissues • Lymph node and distant metastasis
Tumor Grading and Staging • Cancer grading • Level of differentiation • Systems • UICC—TMN • AJCC—TNM/anatomic stage/prognostic groups • Molecular diagnosis • Molecular profiling
Systemic Effects • Paraneoplastic syndromes • Fever • Anorexia • Endocrine imbalances • Anemia • Thrombocytosis • Hypercoagulability • Neurologic problems
Cancer Therapies • Surgery • Radiation therapy • Chemotherapy • Hormone/antihormone therapy • Immunotherapy • Targeted therapy • Complementary and alternative therapies
Side Effects of Therapy Mucositis • Mucositis • Anemia • Leukopenia • Xerostomia • Others
Prevention • Stop the use of tobacco products. • Proper nutrition • Eat a variety of fruits and vegetables every day. • Reduce the amount of refined grains and sugars consumed. • Reduce the amount of high-fat red meat consumed. • Maintain a healthy weight throughout life. • Stay physically active. • Limit alcohol consumption. • Limit sun exposure, use sunscreen or other protection.
Oral Metastatic Cancers • Metastatic cancer from any primary cancer site • Breast, lung, prostate, renal cell, and colorectal cancers most likely • Mandible more commonly affected than maxilla • May be the first sign of cancer in 30% of cases • Usually presents as poorly defined radiolucent defects • May cause pathologic jaw fractures • Paresthesia of associated soft tissues is common. • Be suspicious of this type of lesion in patients with a history of cancer
Skin Cancers • Basal cell • Squamous cell • Melanoma
Basal Cell Carcinoma • Etiology—UV light, genetic factors • Epidemiology—most common form of skin cancer (approximately 80%) • Pathogenesis—UV exposure causes accumulation of genetic defects over time; lesion exhibits slow growth. • Characteristics—most found in head and neck area, appears nodular with depressed center and rolled pearly borders often with capillaries seen throughout the border area
Squamous Cell Carcinoma • Etiology—UV light, burned areas, genetics, EBV, and HPV • Epidemiology—second most common skin cancer (approximately 20%) • Pathogenesis—begins in keratinocytes of outer dermis, has a prolonged in situ stage, may metastasize in @2% of cases • Characteristics—painless, nonhealing, rough, red scaly papule that eventually becomes ulcerated and crusted as it enlarges
Breast Cancer • Epidemiology—almost 300,000 women and 2,000+ men will be diagnosed with breast cancer in 2011. • Most occur in upper outer quadrant of the breast and around the nipple. • Local lymph node involvement usually begins in axial nodes; may extend to nodes around the clavicle and sternum. • Common metastatic sites include lungs, kidneys, liver, adrenal glands, ovaries, bones of the spine, ribs, pelvis, and skull, including the maxilla and the mandible. • 70 to 80% are estrogen receptor positive.
Prostate Cancer • Risk factors—age over 65 and African American descent • Approximately 250,000 cases in 2011, second leading cause of death in men • Early detection • PSA • Physical examination
Lung Cancer • Leading cause of death in both men and women • Tobacco smoke is the #1 risk factor. • Symptoms are usually ignored until the disease has progressed to an advanced stage. • Small cell carcinoma may present with Cushing syndrome–like symptoms. • All stages combined 1 year survival rate 43% • Diagnosed in early stage 5-year survival rate 53%
Colorectal Cancer • Risk factors: increasing age (90% over 50), family history, IBD, smoking, inactivity, obesity, type 2 diabetes, etc. • Associated with colorectal polyps and disorders such as FAP and Peutz-Jeghers • Suggest a referral if the patient presents with melanotic macules and other signs of GI problems • 5-year survival rate if caught early is 90%.