Basic Concepts of Cancer

Mohamad Bayu Sahadewa

 NEOPLASIA

• Disease of cell growth, division, and

differentiation

• Benign tumors
– Localized, clear margins (encapsulated), non-
invasive, slow growing, well differentiated
 Classifications of malignancies
• Carcinoma--epithelial
• Sarcoma—CT or muscle
• Glioma--glial cells
• Neuroblastoma--neurons
• Lymphoma
• Leukemia
 Cancer is a genetic disorder, but it is rarely inherited

• p53 protein—guardian of the

genome
– Errors in p53 show up in
~50% of all cancers
• Telomerase—prevents normal
shortening of telomeres at
end of chromosomes
– Absent in most somatic cells,
present in 85% of cancers
– Allows for infinite number of
divisions
 Changes in proto-oncogenes oncogenes

• Point mutations—always dominant (ras

gene, telomerase gene)
• Gene amplification
• Chromosomal rearrangement
• Viral insertion and activation
– human papillomavirus, hepatitis B and C,
Epstein Barr (?)
 Chemical damage to DNA
• Epigenetic modifications, base substitutions
• Aromatic hydrocarbons, aromatic amines
• Insecticides, asbestos
• Anti-neoplastic drugs
• Aflatoxins
• Nitrosamines and nitrosamides in food,
water
 Physical damage to DNA
• Breaks, deletions, translocations
• Sunlight (ultraviolet)
• Radiation--therapy or diagnostic use
Clinical Manifestations of Cancer
• Fatigue is the #1 complaint
– Starts early, for unknown reasons
– May last months after tumor is gone
– Causes most severe decrease in quality of life
• Pain—may not arise until late stages
– caused by compression local tissue,
inflammation, or nerve injury (therapy)
 Cachexia
Malnutrition from metabolic demands of
tumor, release of cachectin (TNF)
– anorexia, weight loss
– weakness, anemia
 Prognosis
• Tumor Grading System—based on
microscopic exam of cells by pathologist

–I Well differentiated
– II Moderately well differentiated
– III Poorly differentiated
– IV Undifferentiated
 Prognosis
• TNM Classification System
– Tumor 1-4 (based on size)
– Tx—cannot be assessed
– Tis—carcinoma in situ
– Nodes 0-3
– Metastasis 0-1
• Etiology of cancer—various cancers have
specific progressions
Musculoskeletal Tumors
 How to diagnose?
» Age
» Site
» Growth time

» X ray
» CT Scan /MRI/Bone scan etc
» BIOPSY !!!!
 Site of the lesion.
Distribution of various lesions Distribution of various lesions in a
in a long tubular bone in a long tubular bone after skeletal
growing skeleton maturity
 Metastatic neoplasms
• Metastatic neoplasms primary origin can be in
descending frequency :
1. Prostate
2. Breast.
3. Lung.
4. GIT.
5. Kidney.
6. Thyroid.
 Periosteal Reactions

Solid Sunburst onion-peel Codman’s

triangle
Less malignant More malignant
What are these?
 Osteochondroma

• The most common benign bony

tumor
• Most are located at the metaphyseal
portion of long bones, particularly the
distal femur and proximal tibia.
• May be solitary and idiopathic or
multiple and genetic (called
hereditary multiple exostosis).
• Solitary osteochondroma has a male-
to-female ratio of 2:1
• Patients are generally in the
2ed decade
• Seek medical advice because
of a bony mass.
• Activity-related pain occurs
because the mass irritates
surrounding muscles.
• Compression of an adjacent
nerve causes radicular pain
or paresthesia .
Giant Cell Tumor
osteosarcoma
Ewing’s Sarcoma

Mind the site :

Epiphysis
Metaphysis
Or Diaphysis?
Chondrosarcoma
Tendon and Ligament
 Roles of Ligaments and
Joint Capsules
• Assist in Stabilization of
Joint

• Restrict Movement

• Prevent Excessive

Motion
 Roles of Tendons
• Attach muscle to bone

• Transmit tensile loads

• MOVE THE JOINT

 Mechanical Behavior of Tendons and
Ligaments
• Both are viscoelastic tissues
• Visco - a small amount of load results in quite
a bit of deformation (relative)
• Elastic - refers to Elastic Region
• Importance of viscoelastic qualities?
Ruptures of what?