Neoplasm- Definition, Symptoms, Diagnosis and Treatment

 

Definition

A neoplasm is an abnormal mass of tissue that results from excessive cell division. It is a general term that includes both benign (non-cancerous) tumours and malignant (cancerous) tumours. In this blog post, we will explore neoplasms in more depth, covering their causes, types, diagnosis, treatment and prognosis.

 Causes of Neoplasms

 The exact causes of most neoplasms are not fully understood, but certain risk factors can increase the likelihood of developing one:

1. Age - The risk of developing a neoplasm increases with age, as DNA damage accumulates in cells over time. Most cancers are diagnosed in people over the age of 60.
2. Genetics - Some neoplasms run in families, indicating a genetic predisposition. Genetic conditions like hereditary breast and ovarian cancer syndrome (BRCA1/BRCA2) increase cancer risk.
3. Lifestyle factors - Smoking is linked to lung cancer and other cancers. Excessive alcohol use increases liver and digestive tract cancer risk. Obesity is associated with several cancer types.
4. Environmental exposures - Asbestos, certain chemicals, and radiation exposure can damage DNA and lead to mutations over time. Outdoor air pollution and radon gas in homes also impact cancer risk.
5. Viruses and bacteria - Infections from some viruses and bacteria are known to cause cancer. This includes HPV and cervical cancer, Hepatitis B and liver cancer, and H. Pylori infection and stomach cancer.
6. Inflammation - Chronic inflammation from conditions like ulcerative colitis has been tied to colorectal cancer due to the production of free radicals and growth factors.

While risk factors provide clues, the exact cause of any individual neoplasm is difficult to determine, as cancer is a complex disease with many contributing factors. Both external exposures and internal DNA changes over a lifetime contribute to abnormal cell growth.

 Types of Neoplasms

Neoplasms can be broadly classified as either benign or malignant:

Benign Neoplasms

1. Tend to be self-limited and non-invasive
2. Rarely spread to other areas of the body
3. Can often be surgically removed with a low risk of recurrence

Common benign neoplasms include:

1. Lipomas - Benign fatty tumors under the skin
2. Moles - Benign growths of pigment-producing cells
3. Uterine fibroids - Non-cancerous growths in the uterus
4. Adenomas - Benign glandular or epithelial tumors

 Malignant Neoplasms (Cancers)

1. Have the potential to invade and destroy surrounding healthy tissue
2. Can metastasize or spread to distant areas of the body via the bloodstream or lymphatic system
3. Often require aggressive treatment like surgery, chemotherapy or radiation therapy
4. Carry a risk of recurrence even after treatment

The main types of malignant neoplasms are carcinomas, sarcomas, lymphomas, leukaemias and melanomas:

1. Carcinomas - Cancers of epithelial tissues like the breast, lung, prostate, etc. Account for 80-90% of all cancers.
2. Sarcomas - Cancers arising from connective tissues like bone, cartilage, fat or muscle.
3. Lymphomas - Cancers of the lymph system, either Hodgkin's or non-Hodgkin's lymphoma.
4. Leukemias - Cancers of the blood or bone marrow with abnormal white blood cell growth.
5. Melanomas - Cancers from pigment-producing melanocytes, most commonly skin melanoma but also occult melanoma.

Diagnosing Neoplasms

When a neoplasm is suspected based on symptoms or screening results, doctors utilize several diagnostic tests to determine if it is benign or malignant:

1. Physical exam - Check for lumps, enlarged lymph nodes or other abnormalities.
2. Medical imaging - X-rays, CT scans, MRI or ultrasound can locate and characterize masses. Positron emission tomography (PET) scans identify metabolically active tumours.
3. Biopsy - Surgical removal and microscopic examination of tumour cells is needed for a definitive diagnosis. Biopsies may be incisional, excisional or needle aspiration.
4. Blood tests - Can check for tumour markers like PSA, CEA or CA-125 that may be elevated with certain cancers. Complete blood count checks for anaemia or infection.
5. Endoscopy/colonoscopy - Used to visualize and biopsy masses in internal organs like the oesophagus, stomach, and colon.
6. Molecular testing - Specialized tests of tumour tissue look for genetic mutations that can guide targeted therapy choices.

Staging is also important to determine how much the cancer has grown and if it has spread. The most commonly used system is the TNM staging criteria of the American Joint Committee on Cancer.

Treating Neoplasms

Treatment depends on whether the neoplasm is benign or malignant, as well as factors like the cancer type, stage, location and the patient's overall health:

For benign neoplasms:

1. Surgical excision is often curative to remove the mass
2. Some may be monitored with follow-up imaging if completely removing would be risky

 For malignant neoplasms:

1. Surgery - Often the primary or adjuvant treatment to remove all visible tumour tissue. May involve organ resection.
2. Radiation therapy - High-energy rays are used to kill cancer cells and shrink tumours. May be external beams or internal radiation sources.
3. Chemotherapy - Anti-cancer drugs that work throughout the body to kill rapidly dividing cells. May be given alone or with other therapies.
4. Targeted therapy - Drugs that target specific cancer-driving mutations, pathways or proteins. Examples include Herceptin for HER2+ breast cancer.
5. Immunotherapy - Medications that boost the immune system's ability to fight cancer cells, such as checkpoint inhibitors.
6. Hormone therapy - For hormone-receptor-positive cancers, these drugs block hormone stimulation of tumour growth. Used in breast and prostate cancers.
7. Stem cell transplant - High-dose chemotherapy with stem cell rescue can deliver very high, potentially curative doses in some blood cancers and selected solid tumours.
8. Palliative care - Focuses on pain relief and symptom management for advanced cancers when a cure is no longer possible. May involve radiation, drugs, and interventional procedures.

 Prognosis and Follow-Up

The prognosis or expected outcome after treatment varies greatly depending on the cancer type, stage at diagnosis, patient's health factors and their response to initial therapy.

For malignant neoplasms that have been treated, lifelong follow-up is important to monitor for recurrence or spread. This may involve:

1. Periodic physical exams and imaging tests
2. Blood tests to check tumour markers
3. Addressing any new symptoms promptly

While a cure is not always possible, early detection and treatment advances have greatly improved survival rates for many cancer types over the past few decades. A multidisciplinary team approach individualizes care to maximize quality of life and longevity.

 Supportive and Palliative Care

A cancer diagnosis takes a tremendous physical and emotional toll. Supportive care seeks to prevent or treat complications and side effects to improve comfort and quality of life during and after cancer treatment. This includes:

1. Nutritional support for weight loss, appetite changes or malabsorption
2. Pain management with medications, nerve blocks or other interventional techniques 
3. Physical/occupational therapy to maintain function and mobility
4. Counselling/support groups to address psychological impacts
5. Palliative care focuses on symptom relief and goals of care discussions for advanced disease
6. Hospice care provides end-of-life comfort and dignity for those choosing not to pursue curative treatment

Integrative therapies like acupuncture, massage, yoga or meditation can also help patients cope with side effects, reduce stress and boost wellbeing during their cancer journey. A supportive care team approach is crucial.

 Prevention and Screening

While not all cancers can be prevented, modifying certain risk factors and adhering to screening guidelines can significantly reduce cancer incidence and mortality:

1. Don't use tobacco and limit alcohol intake
2. Maintain a healthy weight through diet and exercise 
3. Practice sun safety like using sunscreen and avoiding tanning beds
4. Get recommended vaccinations like HPV and hepatitis B vaccines
5. Screen regularly based on age and risk factors - mammograms, colonoscopies, Pap tests, prostate exams, lung cancer screening CTs for smokers, etc.

 Neoplasms represent a broad category of abnormal cell growth that includes both benign and malignant tumours. While the causes are multifactorial, diagnostic testing and staging help determine appropriate treatment and prognosis. A combination of therapies aims to cure cancer or prolong good quality of life. Supportive care and screening/prevention strategies are also important components of comprehensive cancer management. Overall, advancements continue to improve our understanding and management of these complex diseases.

Author

Dr. Maajid Mohi Ud Din Malik (M.Sc. Ph. D.)