Neoplasm: Definition, Types, Symptoms and Diagnosis

Neoplasm is a new tissue growth that occurs as a result of abnormal and uncontrolled proliferation of cells. These formations can be benign (non-cancerous) or malignant (cancerous). Neoplasm is used synonymously with the term tumor and is the result of a pathological process.

Neoplasms can develop as a result of genetic mutations, environmental factors, infections, immune system disorders, or hormonal imbalances. Disruption of the mechanisms that regulate the cell cycle prepares the ground for this uncontrolled cell growth.

The diagnosis of neoplasm usually begins with the examination of a suspected lesion based on clinical findings using imaging methods. The structure of the lesion is evaluated with techniques such as ultrasound, MRI, and CT; for definitive diagnosis, a biopsy is performed and histopathological examination is required.

The most important step in the detection process is determining whether the mass is benign or malignant. The pathology report evaluates the structure of the cells, their proliferation rate, and invasion characteristics to ensure accurate classification. This guides the treatment process.

How and why does neoplasm occur in the body?

Our body is actually like a massive factory that functions flawlessly. In this factory, there are billions of workers, that is, our cells. When each cell will be born, how long it will work, when it will divide and multiply, and when it will die after completing its duty are all written in our genetic code. In a healthy body, this order functions perfectly. Aging cells die in a programmed manner (this is called apoptosis in medical terminology) and are replaced by new ones. However, when the process we call neoplastic begins, the “control mechanism” in this factory breaks down.

Damage or mutations occurring in the genetic material within cells prevent the “stop” command from reaching the cell. These damages are sometimes triggered by inherited genetic traits and sometimes by external factors we are exposed to throughout life.

The main factors causing cellular deterioration are:

• Tobacco products
• Radiation exposure
• Some viruses
• Harmful chemicals
• Chronic inflammation
• Genetic predisposition

Under the influence of these factors, cells that do not receive the “stop” signal continue to divide and multiply even though the body does not need them. This uncontrolled accumulation of cells eventually turns into a mass, that is, a neoplasm. The biggest problem with these structures is that they do not comply with the general rules of the body. They can form their own feeding vessels and disrupt the structure of the organ in which they are located.

What are the types of neoplasms and how are they classified?

When a neoplasm is detected in a patient, the first task is to determine the nature of this mass. Because not every neoplasm means cancer and not every mass is treated the same way. Doctors divide these masses into three main groups according to their behavior under the microscope and the damage they cause to the body.

Benign Neoplasms

This group represents the “docile” side of neoplasms. They usually grow slowly and respect the surrounding tissue. In other words, they do not invade neighboring organs; they simply push them aside to make space. Their most important feature is that they do not spread (metastasize) to other parts of the body through the blood or lymph. They are generally not considered dangerous unless they exert pressure on a vital organ.

Common examples of benign neoplasms include:

• Lipomas
• Fibroadenomas
• Hemangiomas
• Myomas
• Nevi

Malignant Neoplasms

This is the group commonly known as “cancer.” These cells are highly aggressive. They do not only grow where they are located but also invade and destroy neighboring tissues by crossing their boundaries. More importantly, cells that break away from the main mass can enter the circulatory system and travel to distant organs to establish new colonies. If left untreated, they seriously threaten life.

Premalignant (Precancerous) Neoplasms

These structures have not yet become cancer but carry the potential to turn into cancer over time. Detecting them at this stage is a great advantage for the patient because preventive measures can be taken before cancer develops.

Examples of premalignant conditions include:

• Colon polyps
• Cervical dysplasia
• Actinic keratosis
• Atypical hyperplasia

Which methods are used to diagnose neoplasm?

Suspicion of neoplasm in a person usually arises in two ways: either the patient notices a swelling by touch or a mass is incidentally detected during general examinations performed for another reason. After this stage, imaging methods come into play. Imaging devices create an internal map of the body and show us where the mass is located.

The main imaging methods used during the diagnostic phase are:

• Ultrasonography
• Computed Tomography
• Magnetic Resonance Imaging
• PET scan

These devices tell us the size, shape, and location of the mass. However, it is not always possible to say “this is definitely cancer” or “this is definitely benign” based solely on imaging. Imaging tells us that there is a “structure” there but cannot explain the identity of that structure. For a definitive diagnosis, that is, to name the neoplasm, a sample must be taken from the tissue and examined under a microscope. At this point, interventional radiology, one of the most important fields of modern medicine, comes into play.

How is a neoplasm biopsy performed?

In the past, obtaining a tissue sample from a mass required taking the patient to the operating room and surgically opening that area. Today, this approach has largely changed. With the method we call “percutaneous biopsy,” it is now possible to reach even the deepest masses through a tiny needle entry without making an incision in the skin.

This procedure is performed entirely under the guidance of technological devices. In other words, when the doctor inserts the needle into the body, they do not proceed “blindly.” On one hand, they monitor the location of the mass and the tip of the needle millimeter by millimeter on the screen, and on the other hand, they create a safe route to reach the target without damaging vessels or nerves.

The types of biopsy needles used are:

• Fine needle
• Cutting needle
• Vacuum needle

Fine Needle Aspiration: These are generally even thinner than blood-drawing needles. Instead of removing a piece of tissue, they draw cells by vacuum effect. They are especially preferred in sensitive areas such as thyroid nodules or fluid-filled cysts.

Core Needle Biopsy: It is the gold standard in cases with suspected cancer. It is applied using special gun-like mechanisms. The needle enters the tissue and, within a very short fraction of a second, obtains a worm-like tissue sample of millimetric thickness. This sample not only allows pathologists to answer the question “is there cancer or not” but also enables them to map the genetic profile of the tumor. Today, whether smart drugs can be used in lung or breast cancers is determined based on the genetic analysis of the samples obtained with these needles.

Why are imaging methods important during biopsy?

The success of a biopsy procedure actually depends on how clearly we can see the tip of the needle. Interventional radiologists use different imaging tools like navigation devices depending on the location of the lesion.

Commonly used guidance methods include:

• Ultrasonography
• Computed Tomography
• Fluoroscopy
• MRI imaging

For example, in organs close to the skin or those that can be well visualized with sound waves such as the breast, thyroid, or liver, ultrasonography is the first choice. Its lack of radiation and the ability for the doctor to track the needle in real time like a live broadcast are major advantages.

However, in masses hidden deep within the lungs or behind bones, ultrasound may be insufficient. In such cases, Computed Tomography (CT) is used. The coordinates of the mass are determined with millimetric slices and the needle is advanced according to these coordinates. In small nodules that move with breathing, CT fluoroscopy devices that provide real-time imaging can be used to hit the target precisely.

What are the accuracy rates and risks of neoplasm biopsy?

One of the most common questions patients ask is “Could the result be wrong?” or “Can the needle spread the tumor?” First of all, it should be clarified that scientific studies show that the accuracy rate of biopsies performed under imaging guidance is over 90%. Especially when performed by experienced hands and with proper equipment, the diagnostic success rate is close to perfect.

As for risks, every medical procedure has risks, but interventional biopsies are much safer compared to surgical biopsies.

Possible side effects include:

• Mild pain
• Minor bleeding
• Risk of infection
• Pneumothorax

In lung biopsies, a condition called “pneumothorax” (lung collapse) may occur, but the rate is low and in most cases it resolves on its own with only oxygen support without the need for intervention. The common belief among the public that “if a knife or needle touches cancer, it spreads” is a myth that has lost its validity in modern medicine. Thanks to the “coaxial technique,” biopsy needles pass through a protective sheath to obtain samples, thus reducing the risk of tumor cells spreading along the needle tract to almost zero.

What is interventional oncology in the treatment of neoplasm?

After the diagnosis is made, it is time for treatment. In the past, when cancer treatment was mentioned, only three options came to mind: surgery, chemotherapy, and radiation therapy. However, in recent years, a fourth and very powerful pillar has been added to this trio: Interventional Oncology.

This field offers “knife-free,” that is, minimally invasive treatment options for cancer patients. Especially if the patient is elderly, has comorbidities (heart disease, diabetes, hypertension) that prevent them from tolerating major surgery, or if the tumor is located in a place that the surgeon cannot easily reach, interventional oncology plays a life-saving role. The basic philosophy is to destroy the tumor in place without cutting the body.

The main treatment strategies of interventional oncology include:

• Burning the tumor
• Freezing the tumor
• Blocking vessels
• Delivering drugs

How is neoplasm burning (ablation) performed?

The burning procedure is referred to as “thermal ablation” in medical terminology. In this procedure, a special needle is placed directly into the center of the tumor under the guidance of imaging devices.

The main ablation technologies used are:

• Radiofrequency
• Microwave
• Laser

In the radiofrequency ablation (RFA) method, the energy delivered from the tip of the needle vibrates the molecules within the tissue and generates high heat (approximately 60–100 degrees) through friction. This heat kills tumor cells by “cooking” them (coagulative necrosis). Microwave ablation, on the other hand, produces heat by activating water molecules in a way similar to microwave ovens. It is faster and can treat larger areas. After the procedure, the needle is removed, leaving behind dead tumor tissue. The body gradually clears this dead tissue or converts it into harmless scar tissue.

How is neoplasm freezing (cryoablation) performed?

Not every tumor is treated by burning; for some, cold is more effective. In this method called cryoablation, argon gas is passed through needles placed into the tumor. This gas cools the tip of the needle to minus 140 degrees within seconds.

The mechanism of cryoablation consists of the following stages:

• Ice ball formation
• Cell membrane rupture
• Vascular occlusion
• Thawing and refreezing

This lethal ice ball formed in and around the tumor can be clearly visualized on imaging devices. In this way, the doctor can see how far the ice has reached and protect surrounding healthy organs. It is frequently preferred especially in kidney tumors and for pain relief in bone metastases.

How is the blood supply of a neoplasm cut off?

Tumors require much more blood and nutrients than normal tissues to grow and survive. Therefore, they build their own complex vascular network. Interventional radiologists can use this vulnerability to attack tumors.

With thin catheters inserted through the artery in the groin or wrist (similar to angiography), a journey is made through the vascular map of the body and the main vessel feeding the tumor is directly identified:

The treatments applied with this method include:

• Chemoembolization
• Radioembolization
• Portal vein embolization

Transarterial Chemoembolization (TACE): A high dose of chemotherapy drug is delivered into the vessel feeding the tumor and then the vessel is blocked. Thus, the tumor both starves and becomes trapped with the drug. Since the drug cannot escape from the tumor, side effects such as hair loss or severe nausea are much less common.

Transarterial Radioembolization (TARE): Millions of tiny radioactive beads (Yttrium-90) are sent into the vessel. These beads settle inside the tumor and emit radiation from within. With this method, which can be described as “internal targeted radiotherapy,” doses much higher than those that can be delivered with external radiation therapy can be applied to the tumor without damaging healthy tissue.

In which organs is neoplasm treatment applied?

The field of application of interventional radiology is quite broad. It is possible to reach neoplasms almost anywhere in the body, but in some organs these methods have become standard treatment.

The most commonly treated organs include:

• Liver
• Lung
• Kidney
• Bone
• Soft tissue

The liver is the organ where these procedures are most frequently performed. Both in primary liver cancers and in metastases that spread to the liver from organs such as the intestine or breast, ablation or embolization can be life-saving. In the kidney, especially for tumors smaller than 4 cm, it is possible to preserve kidney function by destroying only the tumor through burning or freezing without removing the entire kidney.

How are thyroid neoplasms treated?

Thyroid nodules are very common in the population. Most are benign, but sometimes they cause visible swelling in the neck or exert pressure on the trachea. In the past, patients had to undergo surgery for these nodules and carry a permanent scar on their neck.

With the ablation treatment applied today, the process works as follows:

• Local anesthesia is applied.
• The nodule is entered with a thin needle.
• The nodule is destroyed with heat.
• The body gradually shrinks the nodule.

This procedure takes approximately 20–30 minutes. The patient returns home the same day and no surgical scar remains on the neck. In addition, the risk of nerve damage affecting the vocal cords is much lower compared to surgery.

Who decides on neoplasm treatment?

Cancer and neoplasm treatment is not a burden that a single doctor can carry alone. In modern medicine, a “Multidisciplinary Approach” is essential. Hospitals have “Tumor Boards” that meet regularly:

The specialties involved in this board include:

• Medical Oncology
• Radiation Oncology
• General Surgery
• Interventional Radiology
• Pathology
• Nuclear Medicine

All imaging, laboratory tests, and pathology reports of the patient are reviewed together. Each specialist evaluates from their own perspective and the most appropriate treatment plan for the patient is determined by consensus. For some patients, surgery is the best option, while for others, ablation or intravascular treatment may be more appropriate. The interventional radiologist is a critical player at this table, evaluating the suitability of minimally invasive options.

What are the advantages of interventional radiology in neoplasm treatment?

From the patient’s perspective, the comfort and safety of interventional methods stand out. The burdens associated with open surgeries performed with large incisions are not present in these procedures.

The main advantages include:

• Possibility of local anesthesia
• No incision scars
• Short hospital stay
• Fast recovery
• Low risk of complications

The fact that general anesthesia is not required is of vital importance, especially for elderly patients and those with heart or lung problems. Procedures are usually performed on an outpatient basis; the patient arrives in the morning, undergoes the procedure, and returns home walking after a few hours of observation. The time to return to work and social life is much shorter compared to surgery. In addition, since surrounding tissues are not damaged, there is no loss of organ function.

What should be considered before and after neoplasm procedures?

If an interventional procedure is planned, the preparation process is quite simple, but there are rules that must be followed:

Things to do before the procedure include:

• Stopping blood thinners
• Complying with fasting period
• Reporting current medications
• Checking blood tests

Blood-thinning medications (such as aspirin) usually need to be stopped under medical supervision about 5 days before the procedure. A fasting period of 6–8 hours is required on the day of the procedure. After the procedure, slight pressure is applied to the entry site to prevent bleeding. In the first 24–48 hours after discharge, the patient is advised not to exert themselves too much or lift heavy objects.

Things to monitor after the procedure include:

• Cleanliness of the entry site
• Pain monitoring
• Fever control
• Monitoring for sudden swelling

If unexpected fever, redness, or severe pain occurs, a doctor should be consulted without delay. However, in general, these processes are well tolerated by patients and do not negatively affect quality of life.

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