| Deals with tumors, including the origin, development,
diagnosis, and treatment of benign and malignant
neoplasms | oncology |
| Study of Cancer; – rapid, uncontrolled cell
proliferation converting a cell into a more primitive
and undifferentiated state | oncology |
| cell that is formed once first and second
line of defense of the body fails; leads to formation of
neoplasms/cancer | Oncocyte |
| any gene that is a causative factor in the
initiation of cancerous growth | oncogene |
| generation/creation of tumors | Oncogenesis |
| capability of inducing tumor
formation | oncogenicity |
| A new, often uncontrolled growth of abnormal tissue | neoplasms |
| Parasitic, abnormal mass of cells which grows more or
less progressively unless excised or controlled by
therapeutic intervention | neoplasms |
| 2 general characteristics of neoplasms | Behave as Parasites
Autonomy |
| neoplasms compete with normal tissues and cells for
their metabolic needs | behave as parasites |
| all neoplasms are critically dependent on an adequate
blood supply derived from the host | behave as parasites |
| It more or less steadily increases in size regardless of
their local environment and the nutritional status of
the host | Autonomy |
| A diagnostic word referring to a swelling | tumor |
| Maybe due to an inflammation, a reparative process,
malformation, or neoplasm | tumor |
| slow growing neoplasm, remains localized,
and usually does little harm to the host | benign |
| a neoplasm with the ability to invade
other tissues and can cause death; more aggressive
and rapidly growing | malignant |
| transference of disease-producing
organisms or of malignant or cancerous cells to other parts
of the body by way of blood or lymphatic vessels or
membranous surfaces | metastasis |
| It is an organism’s ability to replace body parts | REGENERATION |
| A specific method of healing that is noted for its ability
to regrow lost limb, severed nerve, and other wounds | Regeneration |
| Quantitative increase in the NUMBER of cells | Hyperplasia |
| No significant alteration in cell structure and function | Hyperplasia |
| No significant alteration in cell structure and function | Hyperplasia |
| Adaptive substitution by one type of adult or fully
differentiated cell | Metaplasia |
| Protective or adaptive response | Metaplasia |
| Almost always
reversible | Epithelial |
| Those that form bone
are usually irreversible
and leave permanent
marks at site of injury | Connective |
| Forerunner of a Cancer – precedes a cancer | DYSPLASIA |
| loss of structural differentiation within a cell or group of cells often with increased capacity for multiplication, as in a malignant tumor | ANAPLASIA |
| 2 PRINCIPAL CRITERAI IN DIAGNOSING CANCER | Anaplasia and evidence of invasion |
| malignant transformation wherein
the entire thickness of the epithelium is involved with
dysplastic changes | Carcinoma in Situ |
| BENIGN (Differentiation) | Resembles tissue
of origin |
| BENIGN (ANAPLASIA) | Absent |
| BENIGN (ENLARGEMENT) | Usually
progressive |
| BENIGN (GROWTH) | SLOW GROWING |
| BENIGN (SPREAD) | Expansile
Localized
Encapsulated |
| BENIGN (PROGNOSIS) | Amenable to
surgical removal
Patient survival is
good |
| MALIGNANT (DIFFERENTIATION) | Less differentiated
Often atypical |
| MALIGNANT (ANAPLASIA) | PRESENT |
| MALIGNANT (ENLARGEMENT) | FAST GROWING |
| MALIGNANT (SPREAD) | Invasive
Metastatic
Unencapsulated |
| MALIGNANT (PROGNOSIS) | Immediate treatment
needed or progressive
spread follows
Poor prognosis |
| Most are composed of parenchymal cells closely
resembling the tissue of origin | BENIGN NEOPLASMS |
| tumors that arise from fibrous tissue,
composed of fibrocytes | Fibroma |
| tumor of cartilaginous tissue | Chondroma |
| Epithelial neoplasms producing gland
patterns or derived from glands | Adenoma |
| epithelial neoplasms growing on any surface,
producing finger-like wart growths or microscopic
projections | Papilloma |
| Also arise from all 3 germ layers
o All skin cancers arising from renal tubular
epithelium (mesoderm)
o Skin (ectoderm)
o Lining epithelium of gut (endoderm) | CARCINOMA |
| any stratified
squamous epithelium of the body | Squamous cell carcinoma |
| lesion where neoplastic epithelial
cells grown in gland patterns; malignant counterpart
of adenoma | Adenocarcinoma |
| Arise from mesenchymal tissue or derivatives | SARCOMA |
| Parenchyma
Stroma | TWO BASIC COMPONENTS OF TUMORS |
| Proliferating neoplastic cells | PARENCHYMA |
| Extremely well
differentiated. – cells
resemble very closely
the normal | BENIGN (PARENCHYMA) |
| Wide range in
parenchymal cell
differentiation | MALIGNANT (PARENCHYMA) |
| Supporting layer of connective tissue, blood vessels,
and lymphatics | STROMA |
| “fleshy tumor” | Sarcoma |
| Gritty hardness due to a very strong stromal
proliferative reaction | Desmoplasia |
| TRUE OR FALSE
Neoplasms may increase in size because of
prolongation of the life cycle of the cells; neoplastic
cells live longer than normal cells | TRUE |
| 4 PATHWAYS OF INVASION AND METASTASIS | Seeding of Cancers
Transplantation
Lymphatic Drainage
Blood Vessel Invasion |
| Example: Cancer of mucosa at wall of gut + visceral
peritoneum | Seeding of Cancers |
| Transport of tumor cell fragments by surgical
instruments or surgeon’s gloved hands to sites away
from the origin of the cancer | Transplantation |
| Most common pathway | Lymphatic Drainage |
| Most important other than lymphatic drainage | Blood Vessel Invasion |
| Protein of extracellular matrix | Laminin molecule |
| thin fibrous extracellular matrix that
separates the external and internal surface
underlying connective tissue; always
contains laminin molecule | Basal lamina (basement membrane) |
| MECHANISM OF INVASION | Laminin molecule >
Attachment of tumor cell to Laminin molecule >
Attachment of tumor cell to basement
membrane via laminin molecule >
Dissolution >
Invasion |
| Triggers to the formation of cancer | PREDISPOSITION TO CANCER |
| PREDISPOSITION TO CANCER | Geographic and Racial Factors,
Environmental and Cultural Influences,
Environmental and Cultural Influences
Heredity ,
Acquired Preneoplastic disorders |
| Caucasians are prone to skin cancer due to lack of
melanin pigments; thus they want to sunbathe | Geographic and Racial Factors |
| carcinoma of the skin;
most rampant type of cancer among Caucasians | Xeroderma Pigmentosum |
| Habits in provinces or cultures e.g., chewing betel nut;
develops squamous cell carcinoma in the oral cavity Habits in provinces | Environmental and Cultural Influences |
| Pediatric and geriatric patients are more prone to
cancers due to low immune system | Age and Childhood Cancer |
| Genetics | Heredity |
| Having a precancerous disorder that leads to the
formation of cancer | Acquired Preneoplastic disorders |
| 1. Chemical Carcinogens
2. Radiation
3. Oncogenic Viruses | CARCINOGENIC AGENTS |
| Anti-cancer drugs but regrettably have been
documented to induce lymphoid neoplasms, leukemia,
and other forms of cancer | Direct-Acting Alkylating Agent |
| Most potent carcinogens | Polycyclic Aromatic Hydrocarbons |
| Carcinogenicity of these substances were exerted
mainly in the liver where the ultimate carcinogen is
formed by the intermediation of the cytochrome P
450 oxygenase systems | Aromatic Amines and Azo dyes |
| causes bladder cancer
(aniline dye and rubber industries | Beta-naphthylamine |
| widely used as precursor to
pesticides and dyes | Aromatic amines – |
| Produced by plants and microorganisms | Naturally occurring carcinogens |
| Formed in the GI tract of humans | Nitrosamines and Amides |
| ultimate carcinogen | Alkyl diazonium ions |
| carcinogen from
microwave | D-nitrosodienthanolamines |
| causes bronchogenic carcinomas,
mesotheliomas, GI cancers; called miracle mineral
because it doesn’t burn | Asbestos |
| causes hemangiosarcoma of liver;
used in making plastic products | Vinyl chloride |
| inhalation
of metal dust causes cancer of the lungs | Chromium, nickel, and other metals |
| agents that changes or alters the
genetic material | Mutagens |
| Can transform virtually all cell types in vitro (outside
the cell) and induce neoplasms in vivo (inside the cell)
in both humans and experimental animals | RADIATION |
| Derived from the sun | RADIATION |
| DEGREE OF RISK OF THE ULTRAVIOLET RAYS DEPENDS ON THE : | - Intensity of exposure
- Melanin quantity in the skin |
| EFFECTS OF RADIATION ON CELLS : | - Inhibition of cell division
- Inactivation of enzymes
- Induction of mutation
- Sufficient dosage kills the cell |
| molecular lesions
formed from thymine or cytosine bases via
photochemical reaction; leads to
transcriptional errors | Pyrimidine dimers |
| Radiant energy that causes chromosomal breakage,
translocation, and point mutations | Ionizing Radiation |
| disease of miners of radioactive elements
in central Europe and Rocky Mountain USA | Lung cancer |
| disease of survivors of a bomb
dropped in Nagasaki and Hiroshima | Leukemia, thyroid, breast, colon, and
pulmonary carcinoma |
| Causes neoplastic transformation | DNA viruses |
| allow complete viral replication but
die upon release of newly formed virus; a.k.a. willing
cells | Permissive cells |
| - Can develop benign epithelial tumors or papillomas of
the skin | Human Papilloma virus |
| - Can cause Burkitt’s lymphoma and undifferentiated
nasopharyngeal carcinoma | Epsteinn-Barr Virus |
| - form of non-Hodgkin’s lymphoma; cancer
starts from the immune cells (B cells) | Burkitt’s lymphoma |
| Develops liver cancer | Hepatitis B Virus |
| The virus may have acted with the regenerative
activity of liver cirrhosis | RNA viruses |
| - Retrovirus-induced neoplastic transformation by
insertional mutagenesis; | RNA viruses |
| production of the genetic
mutation; normal cells becomes oncogene
when altered | MUTAGENESIS |
| - Helps the immune system to function better | Biologic Therapy |
| Main treatment for Leukemias and Aplastic anemia | Bone Marrow Transplants |
| Treats almost all metastatic cancer | Chemotherapy |
| attacks the negatively charged
sites on the DNA (oxygen, nitrogen, phosphorus,
sulfur) | Alkylating agent |
| an antimetabolite that inhibits a
crucial enzyme required for DNA synthesis and
therefore exerts its effect on the S phase of the cell
cycle | Methotraxate |
| work by the formation of free
oxygen radicals | Anthracyclines |
| these radicals result in DNA strand
breakdown and subsequent inhibition of DNA
synthesis and function; they also inhibit the enzyme
topoisomerase by forming a complex with the
enzyme and DNA | FREE OXYGEN RADICALS |
| form free oxygen radicals
that result in DNA breakdown leading to cancer cell
death | Antitumor Antibiotics |
| also called Topoisomerase I inhibitors | Camptothecan analogs |
| epidodophyllotoxin chemotherapy agents;
a.k.a. topoisomerase II inhibitors | Etoposide and Teniposide |
| these chemotherapeutics bind to the tubulin
and lead to the disruption of the mitotic
spindle apparatus | Vincristine, vinblastine, Vinorelbine |
| treatment of choice for
leukemia, Hodgkin’s disease, lung cancers | Vincristine |
| treatment of choice for brain
cancer, bladder, melanoma, testicular cancer | Vinblastine |
| Treatment of choice for breast
cancer, lung cancer | Vinorelbine |
| include paclitaxel and docetaxel; bind
with high affinity to the microtubules and inhibit their
normal function | Taxanes |
| natural metal derivatives; | Platinums |
| Complementary and alternative medicine can be
broken down into two broad categories; | CAM I and
CAM II |
| those that are ingested or injected | CAM I |
| those that require a practitioner or therapist | CAM II |
| Targets a mutated or damaged gene and converts it
into normal | Gene Therapy |
| can be used to prevent blood vessels from
forming, thus starving the tumor to death
(antiangiogenesis) | GENE |
| Blocking the action of these hormones could stop the
cancer from growing | Hormone Therapy |
| A novel cancer treatment which works by exposing a
photosensitizing drug to specific wavelengths of light
to kill cancer cells | Photodynamic Therapy (PDT) |
| Radiation therapy that uses high energy x-rays to
damage the DNA of cells, thereby killing the cancer
cells, or at least stopping them from reproducing | Radiation Oncology |
| Various surgical procedures used to treat many types
of cancer | Surgical Oncology |
| for diagnostic purposes; incision and
excision of damaged tissue | Biopsy |
| removal of the tumor as a whole | Enucleation |
| cutting a slit into an abscess or
cyst and suturing the edges to form a continuous
surface from the exterior to the interior | Marsupialization |
| marginal, en bloc, hemisection,
composite | Resection |
| removal of the gross
tumor with 1 cm of normal surrounding soft
tissue and 2 to 3 cm of normal surrounding
bone tissue | Marginal resection |
| surgical removal of the
entirety of a tumor without violating its
capsule | En bloc resection |
| surgical separation of a
multirooted tooth, through the furcation | Hemisection |
| removal of part of
the lining of the mouth and lower jaw; | Composite resection |
| Cancer vaccines are designed to teach the immune
system to attack and destroy cancer cells | Vaccine Therapies |
| Tumors that originate during the formation or
development of the tooth (odontogenesis) | ODONTOGENIC TUMORS |
| AMELOBLASTOMA (ETIOLOGY) | Originates from the enamel organ,
odontogenic
rests,
reduced
enamel
epithelium, epithelial lining of odontogenic
cyst especially dentigerous cyst |
| AMELOBLASTOMA (LOCATION) | o Maxilla or mandible
o Mandibular molar areas – most common
o Extraosseous peripheral ameloblastoma -
found in the gingiva |
| AMELOBLASTOMA (CLINICAL FEATURES) | o Benign, non-aggressive course
o Asymptomatic jaw expansion
o Occasionally, there is tooth movement or
malocclusion due to jaw expansion |
| AMELOBLASTOMA (RADIOGRAPHIC APPEARANCE) | o Appear as osteolytic/osteoclastic process
(radiolucent)
o Unilocular or multilocular
o Well-defined sclerotic margins |
| AMELOBASTOMA (Histopathology ) | o Polarization of cells around the proliferating
rests
o Loosely arranged cells in the center (stellate
reticulum)
o Budding of tumor cells from neoplastic foci |
| Ameloblastoma (Differential Diagnosis) | o Calcifying epithelial odontogenic tumor,
odontogenic myxomas, dentigerous cyst,
odontogenic keratocyst
o Young individuals: central giant cell
granuloma, ossifying fibroma, central
hemangioma, idiopathic histiocytosis
o Microscopically:
adenocarcinomas,
squamous cell carcinomas of maxillary sinus
origin |
| Ameloblastoma (Treatment and Prognosis ) | o Surgical excision for solid multicystic lesion
o Enucleation for unicystic lesions
o radiotherapy |
| Calcifying Epithelial Odontogenic Tumor (CEOT) | also known as Pindborg tumor |
| Calcifying Epithelial Odontogenic Tumor (location) | mandible twice affected as maxilla; in the
molar-ramus region |
| Calcifying Epithelial Odontogenic Tumor (clinical features) | - Age – ranges from second to the tenth
decade
- produced jaw expansion |
| Calcifying Epithelial Odontogenic Tumor (radiographic features) | Can be radiolucent, but more
characteristically mixed lucent and opaque
foci with which is a reflection of calcified
islands |
| Calcifying Epithelial Odontogenic Tumor (histopathology) | Sheets of large polygonal epithelial cells |
| Calcifying Epithelial Odontogenic Tumor (ddx) | Dentigerous cyst, odontogenic keratocyst,
ameloblastoma,
odontogenic
myxoma,
calcified odontogenic cyst, adenomatoid
odontogenic
tumor,
fibroodontoma,
osteoblastoma |
| Calcifying Epithelial Odontogenic Tumor (treatment and prognosis) | Surgery like enucleation to resection |
| Adenomatoid Odontogenic Tumor (etiology) | presence of unusual duct-like or gland-like
structure has given its name as “adeno” |
| Adenomatoid Odontogenic Tumor (location) | Anterior maxillary jaw |
| Adenomatoid Odontogenic Tumor (clinical features) | Age range between 5 and 30 years, most
cases is in 2nd decade |
| Adenomatoid Odontogenic Tumor (radiographic features) | o Well-circumscribed unilocular lesion around
impacted teeth
o May have small opaque foci, representing the
presence of enameloid islands
o Causes divergence of root |
| Adenomatoid Odontogenic Tumor (Histopathologic features) | Presence of rosettes or duct-like structures
of columnar epithelial cells |
| Adenomatoid Odontogenic Tumor (Differential Diagnosis ) | o Dentigerous cyst
o Lateral root cyst
o Calcifying odontogenic cyst
o CEOT |
| Adenomatoid Odontogenic Tumor (treatment and prognosis) | o Conservative treatment – enucleation
o Totally benign encapsulated lesion that does
not recur |
| Squamous Cell Odontogenic Tumor (etiology) | Involves the alveolar process and it is
believed to be derived from neoplastic
transformation of the rest of malassez |
| Squamous Cell Odontogenic Tumor (location) | Occurs in the mandible and maxilla with
equal frequency, favoring the anterior region
of the maxilla and the posterior region of the
mandible |
| Squamous Cell Odontogenic Tumor (clinical features) | o Extends from the second through seventh
decade of life
o No symptoms
o Tenderness and tooth mobility |
| Squamous Cell Odontogenic Tumor (radiographic features) | o Well-circumscribed
o Semilunar lesions associated with the roots
of the teeth |
| Squamous Cell Odontogenic Tumor (Histopathology) | o Benign odontogenic neoplasm usually of
anterior maxilla and posterior mandible
o Composed of squamous epithelial nests in
fibrous stroma
o Though to derive from debris of Malassez
o Lacks the columnar peripherally palisaded
layer of epithelial cells
o Proliferating odontogenic rests that are
occasionally seen in periapical cyst |
| Squamous Cell Odontogenic Tumor (Treatment and Prognosis ) | o Curettage or excision
o Has some invasive capacity and infrequently
recurs following conservative therapy |
| Clear Cell Odontogenic Tumor Location | Found both in the maxilla and mandible |
| Clear Cell Odontogenic Tumor Clinical Features | o Rare neoplasm of the jaws
o Found more in women over 60 years of age
o Occasionally painful
o Locally aggressive, metastases to lungs and
regional lymph nodes |
| Clear Cell Odontogenic Tumor Radiographic Features | Poorly circumscribed radiolucency |
| Clear Cell Odontogenic Tumor Histopathology | Composed of sheets of optically clear cells |
| Clear Cell Odontogenic Tumor Differential Diagnosis | Other jaw tumors with clear cells, central
mucoepidermoid carcinoma, metastatic acinic cell carcinoma, metastatic renal cell
carcinoma, ameloblastoma |
| Clear Cell Odontogenic Tumor (treatment and prognosis) | o En bloc resection
o Poor prognosis; high recurrence potential
and metastasis |
| Odontogenic Myxoma (Clinical Features) | o Anywhere in the mandible and maxilla
o Occurs typically in adults (mean age 30
years, range 10-50 years) |
| Odontogenic Myxoma (Radiographic Features) | o Honeycombed, well circumscribed, or
diffused multilocular radiolucency
o Produces cortical expansion rather than
perforation
o Root displacement rather than resorption |
| Odontogenic Myxoma (histopathology) | o Acellular myxomatous connective tissue
o Benign fibroblasts and myofibroblasts with
variable
amounts of collagen in a
mucopolysaccharide matrix
o Scattered bony islands (residual trabeculae)
and capillaries |
| Odontogenic Myxoma (differential diagnosis) | o Central hemangioma (honeycombed)
o Normal dental pulp and follicular connective
tissue surrounding impacted developing or
mature tooth |
| Odontogenic Myxoma (Treatment and Prognosis) | o Surgical excision
o It has moderate recurrence rate
o Good prognosis after surgical intervention |
| Central Odontogenic Fibroma (clinical features) | Seen in the mandible and maxilla |
| Central Odontogenic Fibroma (radiographic feature) | o Multilocular
o Often causes cortical expansion |
| Central Odontogenic Fibroma (histopathology) | Mass of mature fibrous tissue containing few
epithelial rests |
| central odontogenic fibroma (treatment and prognosis) | o Enucleation or excision
o Recurrence is uncommon |
| cementifying fibroma (clinical features) | o Female, around 40 years old
o Mandible
o Tooth movement or cortical expansion |
| cementifying fibroma (radiographic features) | o Lucent with opaque foci or diffusely opaque
o Well-circumscribed, surrounded with
sclerotic margin |
| cementifying fibroma (histopathology) | o Cemental tissue in the form of spherical
masses and curvilined lobules in a fibrous
stroma
o Benign fibroblastic stroma
o Cementum: globules of oval islands of
calcified material frequently surrounded by
eosinophilic cementoid and cementoblasts |
| cementifying fibroma (ddx) | o Cementoblastoma maybe due to the
presence of cementum and bone
o Ossifying fibroma, chronic osteomyelitis,
fibrous dysplasia |
| cementifying fibroma (treatment and prognosis) | Enucleation or excision |
