• first step in tumor formation
• initiation of tumor growth

• second step in tumor formation
• proliferation/promotion
• abnormal cells get comfy and start to influence the surrounding area
• HAVE to get here successfully to have cancer

• third and final step of tumor formation
• tumor has escaped from its original boundaries
• not all tumors get to this step

• new growth
• an umbrella term

• difficulty in growth
• problems with normal maturation
• normal growth is difficult for the cell

• the characteristic event that takes place during malignant transformation
• start getting a new cell population that is now independent of normal cell controls

1. mutation of proto-oncogenes to oncogenes
2. removal/inhibition of tumor suppressor genes

(BOTH of these must be present to allow for malignant transformation)

tissues of specific grouping lose cellular differentiation characteristics; become like blastic, undifferentiated cells → no longer specialized for a certain tissue

this is significant because when these cells move out of their original boundaries, nothing kicks them out for being different → they are set up to be successful in colonizing

1. cells must separate from each other and the primary tumor
2. cells must pass through the basement membrane
3. cells must jump onto a conduit (transportation) to get where they want to go
4. once they reach their destination, they must succesfully colonize (angiogenesis must occur)

• loss of topoinhibition
• anaplasia
• invasiveness (local)
• metastasis (distant)

• proteins that help our cells anchor to each other
• start breaking down/not working during metastasis which allows freedom of movement to cancer cells

cancer is a disease of the cell.

(not of the tissue)

1. changes in the nucleus
2. changes in the cytoplasm
3. changes in the cell membrane

1. pyknotic (condensed info)
2. diffuse
3. lobed (mostly in neutrophils)
4. multinuclear (each have independent nuclear events)

1. microtubular disorganization
2. rounded mitochondria

1. ↓ number of cell junctions
2. ↑ sialomucoproteins
3. ↑ fibrinolysin/plasmin
4. ↑ receptors
5. change in antigenicity

sialomucoproteins

1. TSA
2. TAA

1. carcinogenic insult must affect the genome
2. the progeny of a malignant cell is also malignant

because they are vulnerable when they are doing all their internal working → vulnerability occurs when machinery is at work

that is why cells in G0 are more resistant (they are in the resting phase)

1. alopecia (hair loss)
2. myelosuppression (suppressing immune system)
3. GI disturbances
4. sterility in males

1. tumor in situ
2. invasive tumor
3. metastatic spread

• a tumor that stays in category 1
• sitting on top of basement membrane
• no metastasis yet → best time to remove it
• best type of tumor to have

• tumor has jumped into the vascular highway (blood, lymph)
• worst type of tumor to have

1. epithelial tissue (carcinomas)
2. non-hematopoietic mesenchymal connective tissue (sarcomas)
3. hematopoietic & lymphoid tissue (leukemias, lymphomas)
4. neural tissues (gliomas, chorid plexus, peripheral nerve, retinal, etc)
5. miscellaneous (melanoma, neuroblastoma, etc)

• malignant tumor of the epithelial tissue
• lung, colon, breast, prostate
• ectoderm/mesoderm

• malignant tumor of the non-hematopoietic mesenchymal connective tissue
• mesoderm

• malignant tumors of the hematopoietic and lymphoid tissue

• carcinomas (endo/ectoderm)
• sarcomas (mesoderm)

1. ↓ cell-to-cell adhesiveness (↓ desmosomes)
2. ↑ cell motility (↑ sialomucoproteins)
3. mechanical forces

1. lymphatic spread
2. hematogenous spread
3. cerebrospinal pathway

1. cells detach from primary and each other
2. cells gain access to a distributive system
3. cells able to survive in distributive system
4. cells adhere to vascular endothelium and secure vascular supply (angiogenesis) and stroma
5. unopposed tumor growth

when all of these things occur = METASTATIC SUCCESS

• the matrix of the tissue
• where the abnormal cell must anchor during tumor establishment

1. cells are less differentiated than primary
2. mets may appear several years after primary
3. a well vascularized area/organ increases the chance of success

1. local modalities
2. systemic modalities

1. surgery
2. radiotherapy (XRT)

• local modality
• damage cell membranes and DNA in nucleus
• works on normal and metastatic cells
• more focal → less fallout

• chemotherapy (CRT)
• immunotherapy

1. tobacco smoking (+85%)
2. occupational and environmental risks
3. synergistic effects

1. non-small cell carcinoma
2. small (oat) cell carcinoma

• completely variable in presentation
• less lethal

• very aggressive
• almost always seen in smokers
• central (hilar), main stem bronchi areas
• round, irregular borders, 2cm
• very rapid hematogenous spread

1. squamous cell (epidermoid carcinoma)
2. adenocarcinoma
3. large cell carcinoma

• central (hilar/perihilar)
• small, nodular, irregular borders
• spreads mostly to lymphatic, local sites
• best type to get

• peripheral areas (alveoli areas)
• small, focal, scar-like
• hematogenous spread to distant sites

• peripheral areas
• large masses ( >4cm)
• hematogenous spread to distant sites (closer to vascular supplies)

common results of immune system being triggered because of the original pathology → syndrome that comes out of something going wrong with the immune system's response to the tumor

ex: fever

1. chronic dry/productive cough
2. dyspnea (trouble breathing) and wheezing
3. fever

1. hemoptysis (blood in saliva)
2. hoarsness (laryngeal nerve impeded)
3. dysphagia
4. pleuritic pain
5. pericardial effusion

1. pulmonary infection (40%)
2. metastatic disease (40%)
3. cardiac involvement (15%)

1. late detection
2. poor response to treatment
3. rapid growth and metastasis

• ↑ growth rate
• moderate metastatic potential

• ↓ growth rate
• ↑ metastatic potential

• ↑ growth rate
• ↑ metastatic potential

1. direct (local)
2. lymphatic (regional)
3. hematogenous (distant)

• curative
• paliative

treatment used only in early stages; surgery, chemo

(surgery not used for oat cell)

treatment used in later stages

ex: XRT, CRT, chemo