Osteosarcoma

The most common primary bone tumor affecting children and young adults. Boys between ages 13 and 16 years are at higher risk. In children, the tumor occurs most frequently at the metaphyses of long bones such as the distal femur, proximal tibia and proximal humerus
Constitutional symptoms such as fever, weight loss, and malaise are usually absent. On physical examination, the most important finding is a tender soft-tissue mass. Characteristics x-ray findings include a spiculated ''sunburst'' pattern and periosteal elevation known as Codman triangle.
Alkaline phosphatase and lactate dehydrogenase are elevated from turnover of damaged osteocytes; high levels may correlate with adverse prognosis. Increased ESR rate is a non-specific marker of inflammation.

Treatment :

includes tumor excision and chemotherapy

Radical abdominal hysterectomy (RAH)

• Radical abdominal hysterectomy specimen with fetus in situ performed at 18 weeks of gestation for stage IB cervical cancer.

Carcinoma of Prostate

 Epidemiology

•  Most common cancer in men
•  Second most common cause of cancer death in men
•  Incidence increases with age
•  Highest rate in African Americans

Gross

• ill-defined, firm, yellow mass
• Commonly arises in the posterior aspect of the peripheral zone

Micro

• Adenocarcinoma
• Gleason grading system

Spread

1.Local spread

• Tends to grow upwards to involve seminal vesicles, bladder neck, trigone, lower end of ureter.

2. Hematogenous

• Bone esp, pelvic bone and lower lumber vertebrae.( osteoblastic)
• Femoral head, rib cage and skull are other common sites.

3. Lymphatic

• Commonly goes to the obturator and pelvic lymph nodes

TNM Staging

1. T1a, T1b, T1c: incidentally found tumor.

T1a : tumor involving less than 5% of the resected specimen

T1b: Tm involving greater than 5% of the resected specimen

        T1c: impalpable tumor found following a raised PSA.

2. T2a: suspicious nodule on rectal examination confined within prostate capsule involving one lobe.

T2b: involves both lobes

3. T3: extends beyond the capsule

T3a: U/L or B/L extension

T3b: seminal vesicle extension

4. T4: tm which is fixed or invading adjacent structures other than seminal vesicles- rectum or pelvic side wall

Clinical Presentation

• Often clinically silent
• May present with lower back pain secondary to metastasis
• Advanced localized disease may present with urinary tract obstruction or UTIs

Investigations

• Digital rectal exam (induration)
• Serum PSA levels
• Transrectal U/S and biopsy
• Alkaline phosphatase elevated with metastasis
• Bone scan

Treatment

Local disease (T1 and T2):
 prostatectomy and/or external beam radiation

• Metastatic disease (T3 and T4): B/L Orchidectomy

• Estrogens or androgen receptor blockade (flutamide or leuprolide)
• Monitor with PSA levels

Proto-oncogenes (tumor promoters) versus Anti-oncogenes (tumor suppressors)

Abnormal growth of neoplastic cells can arise secondary to mutation of either proto-oncogenes or anti oncogenes. Proto-oncogenes stimulate cell proliferation. Overexpression or amplification of a proto-oncogene leads to increased cellular proliferation and neoplastic growth. Anti-oncogenes, in contrast, are tumor suppressors in that they inhibit cellular proliferation. Inactivation of anti-oncogenes contributes to tumor development.