BASIC ONCOLOGY

Department of Surgery
Medical School of Hasanuddin University
2012 2015
 Oncology
Oncos = Mass or lump
Logos = Science

Oncology
- The study of neoplastic disease
- The study of a large variety of malignant
tumors
with lethal potential
 Tumor is general term for an abnormal
mass in the body

There are many causes of a tumor,

include :
- Infection
- Trauma
- Neoplasma
 Neoplasma
Neos = new
Plasein = abnormal tissue

Tumor is divided into :

- Neoplasm Tumor
* Benign Tumor
* Malignant Tumor = Cancer

- Non Neoplasm Tumor

 Tumor Cell
Self cell transformed to an autonomic
cell and uncontrolled in growth.

Tumor cells can be divided into :

- Benign Cell
- Malignant Cell ( Cancer Cell )

The induction time from 1 normal cell to

become a malignant cell : 15 30 years
 The induction time can be divided into 3
phases :
- In situ phase = 5 10 years
- Invasion phase = 1 5 years
- Dissemination phase = 1 5 years
 Initiation
Time
Promotion

15 30 years
Normal Cell Malignant
Cell

1. Environment : a. Chemical Agents

( 70 85%) b. Ionisation (radiation / ultraviolet)
c. Virus
d. Hormone
e. Chronic Iritation
2. Genetic ?
3. Others ?
 Differentiatio
Normal Cell n Cancer Cell

Chemical Oncogen
agents
UV Gene Transformation
Virus
Hormone
Chronic Proto oncogen
Irritation

Process : -
Inisiation
- Promotion
-
Progression
 Cancer cells growth exponentially
The doubling time is various in different type
of cancer
After 30 doubling time : a cancer cell can
reach 1cm in diameter = 109 Cells
If 1 doubling time is 3 month

1 malignant cell to reach 1 cm 30 x 3

month
90 month ( 7 8 years )
 Malignant Tumor Cells ( Cancer )
- Polymorphic ( various in size and morphologic )
- Hyperchromation and polychromation
- The nucleus is relative larger compare to
cytoplasmic volume
- Highly mitosis
- Uncontrolled growth
- Infiltration to the adjacent normal tissue
- Impaired the structure and function of an organ

Cancers grow by progressive infiltration, invasion,

destruction, and penetration of the surrounding tissue
 The growth of Cancer
- Locally invasive
- Distant Metastasis
* to regional lymph node
* to organ far from the primary tumor
site
 Cancer cells can disseminate by
- Percontinuatatum
- Lymphogen
- Hematogen
- Transluminal
- Transerosa / trancoelum
- Iatrogen
 Factors that influence the growth of Cancer Cells
- The cell cycle
- The degree of the differentiation
- The size of component clone of the Cancer
* Active divided cell clone
* Non divided clone
* Apoptosis / death cells clone
- Location of the tumor
- Blood supply
- Type of Barrier ( Mechanic barrier or
Immunologic
Barrier )
 Etiology of Cancer
- The mechanism of carcinogenesis still unclear
- There are more than 17 theory about
carcinogenesis
- Carcinogenesis is influenced by multifactorial
and
different from one to another person.
Internal factors :
Hormones
Immune conditions
Inherited conditions

External factors :
Lifestyle habits (smoking, diet, alcohol)
Viruses, chemicals, radiation
 Factors that influence the carcinogenesis are
called : Carcinogen

Type of carcinogen
- Natural Carcinogen
- Carcinogen from the human activity
- X Rays
- Virus
- Hormone
- Chronic Irritation ( the mechanism is still
unclear )

All of these carcinogen have impact on the gene

 Gene is a functional unit of a cell that
regulate the cell growth and differentiation

Gene can be impaired by carcinogen, called

mutation cause uncontroll cells growth
and differentiation carcinogenesis
Cancer
 Pathology of Cancer
- Macroscopic
- Microscopic

Type of malignant tumors

- Macroscopically have several clinical
features :
- Plaque
- Nodular
- Erosion : ulcer
- Mixed type
- Non visible features : Leukemia
- Microscopically ( histologic type )
depend on the cell type
* From Ephitel Carcinoma
* From mesenchymal Sarcoma
 Features of Malignant Tumors
- Irregular shape
- Hard in consistency
- No clear or no capsule
- No define border
- Hypervascularisation or
neovascularisation
- Fragile and hemorrhagic
- There is a part of tumor with necrosis or
ulcer
- Infiltration to the adjacent normal tissue
THE GENERAL PRINCIPLE OF CANCER
MANAGEMENT

The steps in Cancer Management :

- Establish the diagnosis of cancer
- Show the Stadium of the cancer by TNM
system
- Performance status of cancer patient
- Treatment setting
- Implementation of the treatment
- Evaluation and follow-up
 Modalities of treatment
Local therapy:
Surgery.
Radiation therapy.

Systemic treatment:
Chemotherapy.
Hormonal therapy.
Monoclonal antibodies.
Radioactive material
 Principle in Surgical Oncology
- Sharp
- En-bloc
- Bloodless
- No Touch
- Large operation field
- Previous operation scar or FNA must include
in the excision field
Thank You
KARNOFSKY PERFORMANCE STATUS SCALE DEFINITIONS RATING (%) CRITERIA

100 Normal no complaints; no evidence of disease.

Able to carry on normal activity and to Able to carry on normal activity; minor signs or
work; no special care needed. 90
symptoms of disease.
Normal activity with effort; some signs or
80
symptoms of disease.
Cares for self; unable to carry on normal activity
70
or to do active work.
Unable to work; able to live at home and
Requires occasional assistance, but is able to
care for most personal needs; varying 60
care for most of his personal needs.
amount of assistance needed.
Requires considerable assistance and frequent
50
medical care.

40 Disabled; requires special care and assistance.

Severely disabled; hospital admission is indicated

30
although death not imminent.
Unable to care for self; requires equivalent
of institutional or hospital care; disease Very sick; hospital admission necessary; active
20
may be progressing rapidly. supportive treatment necessary.

10 Moribund; fatal processes progressing rapidly.

0 Dead