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Neoplasm

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A neoplasm is a type of abnormal and excessive tissue growth. The term comes from Ancient Greek words meaning "new formation."

Hidradenoma
Hidradenoma

This process, called neoplasia, occurs when tissue grows in an uncoordinated way. It does not follow the normal patterns of the surrounding healthy tissue. Even if the original trigger for the growth is removed, the neoplasm continues to grow abnormally. These growths often form a mass, which is frequently called a tumor.

Fibroids
Fibroids

While the words are often used as synonyms, a tumor can be a solid or fluid-filled cystic lesion. A mass is a term used when a lesion is at least 20 mm in diameter. A nodule is a term for a lesion smaller than 20 mm.

Neoplasms are classified into four main groups by the ICD-10 system. The first group is benign neoplasms, which are non-cancerous. These are circumscribed and localized, meaning they stay in one place. Examples include uterine fibroids, osteophytes, and melanocytic nevi, which are skin moles.

Fibroids
Fibroids

The second group is in situ neoplasms, such as carcinoma in situ. These are localized and do not invade or destroy nearby tissue, but they may transform into cancer over time. The third group is malignant neoplasms, which are commonly known as cancers. These invade and destroy surrounding tissue and may form metastases. If left untreated, malignant neoplasms are generally fatal. The fourth group includes neoplasms of uncertain or unknown behavior.

Many neoplasms are monoclonal, meaning they originate from a single cell. This single population of cells carries the same genetic or epigenetic anomaly. This characteristic is known as clonality. In lymphoid neoplasms, such as lymphoma or leukemia, scientists prove clonality through specific tests. For B cell lesions, they look for the amplification of a single immunoglobulin gene rearrangement. For T cell lesions, they examine the T cell receptor gene. Proving clonality is now a necessary step to identify a lymphoid cell proliferation as neoplastic.

Tumors occur because of accumulated genetic and epigenetic alterations within single cells. These changes cause cells to divide and expand uncontrollably. DNA damage is the primary cause of malignant neoplasms. On average, a single human cell experiences more than 10,000 new damages every day due to cellular metabolism. External factors can increase this rate. Tobacco smoke increases DNA damage, which is a likely cause of lung cancer. UV light from solar radiation causes damage that contributes to melanoma. The infection Helicobacter pylori produces reactive oxygen species that damage DNA, contributing to gastric cancer.

Diagram Damage to Cancer Wiki 300dpi
Diagram Damage to Cancer Wiki 300dpi

Scientists also study the mechanics of how these growths expand. Vascular tumors, like hemangiomas or lymphangiomas, are made of blood or lymph vessels. Researchers model these as an amalgam of a solid skeleton of sticky cells and an organic liquid. This liquid fills the spaces where cells grow. Studies using this model show that active growth is often restricted to the outer edges of the tumor. They also found that the stiffening of underlying normal tissue can inhibit tumor growth.

Most malignant neoplasms are "sporadic cancers," meaning they have no hereditary component. About 70% of cancers fall into this category. While many sporadic cancers do not have a mutation in a DNA repair gene, many have epigenetic alterations. Epigenetic alterations can silence the expression of genes that are supposed to repair DNA. For example, in many colorectal cancers, the MGMT gene is not mutated but is silenced by methylation. This methylation of the MGMT promoter region reduces the gene's expression. When DNA repair gene expression is reduced, DNA damages accumulate at much higher levels.

Image of resected colon segment with cancer & 4 nearby polyps plus schematic of field defects with sub-clones
Image of resected colon segment with cancer & 4 nearby polyps plus schematic of field defects with sub-clones

This accumulation of damage leads to increased frequencies of mutation. These mutations and epigenetic alterations can create "field defects." A field defect is a patch of normal-appearing tissue that already contains multiple alterations. These defects serve as precursors to the disordered growth seen in malignant neoplasms. Once a cancer is established, it often possesses genome instability. This instability allows the cancer to continue evolving and producing sub-clones within the tumor.

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File:Hidradenoma.jpg
Hidradenoma.jpg
File:Fibroids.jpg
Fibroids.jpg
File:Diagram Damage to Cancer Wiki 300dpi.svg
Diagram Damage to Cancer Wiki 300dpi.svg
File:Image of resected colon segment with cancer & 4 nearby polyps plus schematic of field defects with sub-clones.jpg
Image of resected colon segment with...
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