ONCOLOGY 6

5. TUMOUR GRADING

This histoligic tumour grading is achieved by using criteria of :

* degree of nuclear polymorphism ie. resemble parent cell,

number of mitosis

* Good differentiated areas or poor diffrentiated area

Tumours with predominant poor differentiation have poor

prognosis. The tumours are thus graded as well, moderate or

poorly differentiated.

6. TUMOUR STAGING

Most systems are based on the criteria of:

T - Tumour size

N - Lymph node metastasis

M - Distant metastasis

This TNM staging records the clinical extent of tumour progress

of different cases in different centres and makes possible

comparison of results of treatment protocols. 

For this purpose TNM staging after surgery is more reliable.

 

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ONCOLOGY 5

4. OTHER FACTORS

* The evidence presented as regards aetiology of cancers is

no doubt, incomplete.

* There are many factors of race and geographic differences

that become apparent when cancers are studied regionally.

* It is possible the way of life and environment play a very

large part in deciding what cancers appear in great

frequency in different geographic regions.

* Some of the differences observed, in different parts of the

world are listed below:

1. There is a very low incidence of cancer of the breast

in Japan .

2. There is very low incidence of cancer of the skin in

Negroes.

3. There is high incidence of cancer of the naso- pharynx in

China .

4. There is a high incidence of primary cancer of the

liver in south and west Africa.

5. There is a high incidence of the cancer of the stomach

in Scandinavia Iceland and Japan .

There is thus reason to believe that there are other factors

which influence the incidence of cancer besides the ones

mentioned and it is also likely that more than one of the factors
may be in play in a case of cancer

 

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ONCOLOGY 4

 IMMUNOLOGIC FACTORS

It is correct to assume that considering the large number of cell

divisions that take place within any living organism, there would

be some cell-division that would result in the production of cell

deviates that do not respond to controlling mechanisms.

- These cells  if allowed to multiply could demonstrate  all  the

  characteristics  that  we associate with  malignancy  i.e.rapid

  growth,  invasion  of local tissues and metastasis  to  distant

  organs.

- It is,therefore, surprising that different species  demonstrate

  only a few cases of malignancies. Some explaination needs to be

  considered.

          

   * Burnett  in  1970  put  forth  the  concept  of  an  immune-

     surveillance  system.This  system in  essence,possesses  the

     ability  of  detecting  the  surface  differences  of  these

     deviant  cells  and as a consequence  eliminates  them  from

     within the host.

   * This competence is EXPRESSED through the lymphoid system and

     if their system is alert it would be capable of  eliminating

     relatively  small  number of cells.There  is  evidence  that

     genetic  factors  may  be  responsible  in  determining  the

     effectiveness  of  this  immune  system.   Guinae  pigs  and

     rabbits are resistant to induction of all viral tumours.

   * Failure of this immune surveillance system could occur  when

     there is immunosuppression, this has been demonstrated to be

     true,   in  cases  of  human  renal  transplantation   where

     immunosuppression  is used as a technique to  faciltate  the

     acceptance of the transplant(to depress rejection).

   * Immune  suppression  could occur, naturally in old  age  and

     other inter-current disorders like prolonged illness.

   * Immune  tolerance could be another mechanism for evasion  of

     this surveillance system.

    - It has been shown that experimental animals, if exposed  to

      specific antigens before maturation, can induce a state  of

      immune tolerance to these antigen. 

    - Another  mechanism   could   be a   reduction  or  loss  of

      antigens from the cells-surface of tumour cells.

    - This has been referred to as antigenic modulation

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ONCOLOGY 3

3.2 VIRUSES

There has been evidence in animal experiments since the early

part of this century that tumours can be caused in experimental

animals by the transmission of cell free filtrates from animals

suffering from malignant lesions.

Later viruses have been isolated from animals.

This has led to animal experiments in which DNA and RNA viruses

have produced cancers in experimental animals including primates.

For example, DNA viruses of the herpes group caused renal

adenoma-carcinoma in frogs.

- Similar tumor viruses were looked for in humans, and the

Epstien Barr virus (EBV) also a member of herpes virus group

was shown to cause infectious mononuclosis and is also

associated with Burkitts lymphomas, in Africa .

- Later it was found to be associated with nasophyrangeal

carcinomas in South-East-Asia.

Papilloma is believed to play a part in causing cancer carvix.

The hepatitis-B virus has been implicated in cancer liver.

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ONCOLOGY 2

3. AETIOLOGY

The precise aetiology of human cancers is yet to be explained.

There is evidence that there are four distinct groups of factors

that have been studied and are related to the development of

neoplasia. And they are:

1. Genetic factors

2. Viruses

3. Immunologic factors

4. Chemicals and therapeutic agents

3.1 GENETIC FACTORS

Most positive examples of the action of this factor in the

caustion of malignancy is the appearance of the same type of

cancer, in identical twins.

- This factor, also plays a part in the appearance of cancer

colon in patients with familial polyposis.

- Cancer of the breast is about three times commoner in daughters

of women with breast cancer.

- Neurofibromatosis (Von Recklinghausen 's disease), is

characterised by multiple neuro-fibromas of the skin.

Some of them (10%) undergo malignant change.

In addition, these patients have an increased risk of

Meningiomas, Pheochomocytomas and Glioma of the brain.
In experimental animals chemical carcinogens can cause mutations and appearance
of carcinomas

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ONCOLOGY 1

ONCOLOGY

1. DEFINITION

1.1 Oncology is a study of neoplastic disease.

 

Neoplasms are defined as a cell population showing excessive non-useful

multiplication and have proved non-responsive to normal control

mechanisms, within the organism.

1.2 Benign tumours are slow growing cell masses that do not

invade into surrounding tissues. They also do not spread to

distant sites by metastasis.

1.3 Besides benign tumours there are a number of pre-malignant

conditions recognised. These are :

* Leukoplakia in the oral mucosa

* Barrett's Columnar cell lined oesophagus

* Severe gastric dysplasia

* Ulcerative colitis

In all these conditions malignant cells may be present but they

have not invaded the basement membrane. These are the cases

described as carcinoma in-situ.

1.4 Malignant neoplasm show in addition the ability to interfere

with the function of normal tissue in the neighbourhood by local

invasion (an event achieved by adhesion to adjacent tissue and

release of collagenase) and they also have the ability to

interfere with the function of distant organs by metastasizing

through blood or through lymphatic stream. These tumours are

usually fatal.

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BURNS 20

DONOR AREA

The donor area, is also covered with paraffin gauze and pressure

dressing applied as described for Dressing Techniques of Burns.

 

In seven days's time epithelium grow from the sides of the donor

area, as well as from the open ends of sweat glands and hair

follicles.

 

In three week's time the donor area is once again available for

donating skin

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