• lung
• prostate
• colorectal
• hematopoeitic (leukemia, lymphoma)
• UT
• pancreas

• lung
• breast
• colorectal
• hematopoietic
• ovary
• pancreas

• death rates increasing for men (lung cancerfallen slightly for women
• fallen slightly for women

• improved screening and early detection (mammography and Pap smears)

• heriditary
• age
• social habits (alcohol, smoking)
• environment/occupation
• pre-existing disease states (ex: chronic ulcerative colitis, cirrhosis)
• chemoradiation therapy

• reducing smoking prevelance
• environmental tobacco smoke exposure

Esp. in women

• inherited cancer syndromes
• familial cancers
• autosomal recessive syndromes of defective DNA repair

• includes cancers in which inheritance of a single mutant gene increase risk of tumor dev.
• inherited mut. occurs in allele of tumor suppressor gene
• autosomal dominant with variable penetrance
• shows specific tissue involvment
• assoc. w/specific marker phenotype (ex: polyp preceding a cancer, cafe au lait spots)

• NF1 (chrom 17q)
• NF2 (chrom 22q)

• cancers which occur in higher freq in certain families
• transmission probably autosomal dominant, possibly multifactorial
• no marker phenotype
• early age of onset (younger than 40)
• multiple, bilat. tumors
• family history of cancer in two or more close relatives (first or second degree)

• abnormal growth of tissue projecting from a mucosal surface (like colon or larynx)
• often attached to surface by stalk

• abnormal growths or "swellings"
• clonal prolif. of genetically unstable cells growing in an uncoordinated and autonomous fashion

• proliferative neoplastic parenchyma
• supportive fibrovascular stroma

• seen in assoc. with malignant tumors
• sign of invasion into ECM
• as cancer cells invade surrounding tissue, incite a change in collagen
• morphologic appearance
  • faint bluish or lavender on low power OR
  • appears dens, pink fibrotic

• benign epithelial neoplasm producing microscopic or macroscopic finger like projections from the surface
• projections are exophytic since they show outward growth to surface

• slow growing with low mitotic activity
• localized
• circumscribed with pushing margins (bulging)
• well differentiated low grade
• for the most part, no metastases
• usually follows benign clinical course (but no absolutes)
  • capillary hemangiomas have invasive margins
  • pituitary adenomas can cause visual disturbances
  • benign reactive lesions can be mitotically active

• carcinoma (epithelial tumor derived from any of the three germ layers)
  • adenocarcinoma (gland forming epithelial tumor)
  • squamous cell carcinoma (carcinoma with recognizable squamous differentiation)
• sarcoma (mesenchymal origin)
• melanoma
• lymphoma/leukemias

• rapidly growing (higher mitotic rate)- infiltrative growth
• capable of invasion and distant metastases
• spectrum of differentiation from well to undifferentiated
• infiltrative margins
• desmoplastic stroma

• lack of differentiation that is characterized by:
  • pleomorphism (variation in size, shape)
  • hyperchromasia (dark nuclei)- due to increased nuclear DNA
  • increased nuclear:cytoplasmic ratio (large nucleoli)
  • loss of organized growth
  • abnormal mitotic figures
  • tumoral necrosis

• disordered growth
• seen primarily in epithelial
• char
  • loss of uniformity of cells and architectural orientation
  • mitoses appear in abnormal locations
  • dysplasia may be precursor to cancer, but does not invariably progress to cancer
  • full thickness dysplasia is carcinoma in situ

• growth rate of tumors correlates with level of differentiation
• most malignant tumors have high growth fraction and so have a rapid clinical course

• invasiveness
• metastatic

• more aggressive, rapidly growing, large tumor is more likely to metastasize
• malignant tumors can spread by various means
• metatasis marks tumor as malignant

• direct seeding in body cavity (ex: peritoneal, pleural, pericardial)
• lymphatic spread (most common for carcinomas)
• hematogenous spread (most common for sarcomas)

• invasion of ECM
  1. tumor cells detach
  2. adhere to matrix components
  3. degrade BM
  4. pass through ECM
  5. move into circulation
• vascular dissemination of tumor cells
  1. tumor cells form clumps and bind with blood cells
  2. bind to endothelium
  3. pass through BM
  4. extravaste at a distant site
• colonizataion of tumor cells
  1. metastatic deposit
     • some tumor cells lie dormant
     • others prolif, establish vascular supply

• anatomic (breast carcinoma to axillary lymph nodes)
• tumor cells may also have tropism for certain organs (endothel. adhesion molecules for specific vascular bed)

• lung, breast, kidney, GI, and melanoma can spread to BRAIN
• GI, pancreato-biliary, breast, lung spread to LIVER
• prostate, breast, lung, kidney, thyroid, testes spread to BONE