1: Cellular Pathology of Cancer Flashcards
1
Q
Metaplasia
A
- A reversible change in which one adult cell type (usually epithelial)is replaced by another adult cell type
- Adaptive (e.g. to change in pH, reverts when the circumstances change)
- e.g. columnar epithelium to squamous
2
Q
Dysplasia
A
- an abnormal pattern of growth in which some of the cellular and architectural features of malignancy are present
- pre-invasive stage with INTACT BASEMENT MEMBRANE
- this is the step between normal cells and cancerous cells (normal epithelium becomes dysplastic before it becomes cancer)
- increased nucleus-cytoplasmic ratio
- If we can diagnose “cancer” at the stage of dysplasia it is easy to treat and treatment is 100% effective because no spread (INTACT BM)
- loss of architectural orientation
- loss in uniformity of individual cells
- nuclei: hyperchromatic, enlarged
mitotic figures: abundant, abnormal, in places where not usually found
3
Q
Where is dysplasia common and what causes it?
A
CERVIX - HPV infection BRONCHUS - Smoking COLON - UC LARYNX - Smoking STOMACH -Pernicious anaemia OESOPHAGUS- Acid reflux
4
Q
Dysplasia - low grade and high grade
A
- previously there was also moderate
- low grade: risk of progresion is low, more likely to reverse easily
- high grade: less likely to reverse spontaneously, high risk of progression
- a high grade slide may be darker because the nucleocytoplasmic ratio is higher and the cells appear darker.
5
Q
Neoplasia, Tumour, Malignancy
A
An abnormal, autonomous proliferation of cells unresponsive to normal growth control mechanisms
6
Q
What are the features of benign tumours?
A
- do not invade do not metastasise
- encapsulated (if you can move the mass around i.e. it is not attached to skin or muscle it is a good sign)
- usually well differentiated
- slowly growing
- normal mitoses
=> the first one is key, it is functional; the first one is absolute, the other ones are just characteristics how we recognise benign tum ours.
7
Q
Are benign tumours alsways harmless?
A
NO!
- their location is also very important; also whether they secrete anything.
- i.e. in the Brain
- in the meninges, it may cause hydrocephalus due to blocking of CSF flow between the lateral ventricles and the 3rd ventricle. This is very serious and could kill you.
- i.e. pituitary tumours may cause visual defects as well as secretion of hormones
- Secreting something dangerous: Insulinoma
- can get infected, cause bleeds, rupture, torts
=> adenomas are benign but not necessarily good.
8
Q
What may make a benign tumour fatal?
A
- In a dangerous place: meninges, pituitary
- Secretes something dangerous: insulinoma
- Gets infected: bladder
- Bleeds: stomach
- Ruptures: liver adenoma
- Torts (twisted): ovarian cyst
9
Q
What are characteristics of malignant tumours?
A
- invade surrounding tissues
- spread to distant sites
- no capsule
- well to poorly differentiated
- rapidly growing
- abnormal mitoses
=> the first 2 are about behaviour. The other 4 are how we recognise them.
10
Q
What is a metastasis?
A
- A metastasis is a discontinuous growing colony of tumour cells, at some distance from the primary cancer
- makes local treatment impossible / not enough
- These depend on the lymphatic and vascular drainage of the primary site
- Lymph node involvement has a worse prognosis
11
Q
Where do testicular cancer metastasise?
A
- aortic lymph nodes
12
Q
Benign and malignant tumours are distinguished from each other by all of the following except:
- Degree of differentiation
- Speed of growth
- Capsulation
- Invasiveness
- Site
A
- Site
13
Q
Well differentiated tumours are characterised by all of the following, except:
- A small numbers of mitoses.
- Lack of nuclear pleomorphism
- A high nuclear-cytoplasmic ratio.
- Relatively uniform nuclei
- Close resemblance to the corresponding normal tissue
A
- A high nuclear-cytoplasmic ratio.
14
Q
What is nuclei polymorphism?
A
Nuclei look different from one another
15
Q
What are benign epithelial tumours called?
A
- Of surface epithelium = PAPILLOMA
(e. g. skin, bladder) - Of glandular epithelium = ADENOMA
(e. g. stomach, thyroid, colon, kidney, pituitary, pancreas)
16
Q
What is a carcinoma?
A
A malignant tumour derived from epithelium
17
Q
What are the different types of carcinomas?
A
- squamous cell
- adenocarcinoma,
- transitional cell
- basal cell carcinoma
=> type of cell it is derived from.
18
Q
Where are transitional cells found?
A
- Transitional cells are able to change shape and stretch.
- They make up the lining of the renal pelvis, ureters, bladder and urethra.
- The lining of these organs needs cells that can stretch to expand when urine is stored in or flows through them.
- transitional cell carcinoma exists
19
Q
What is a benign tumour of bone and a malignant tumourr of bone called?
A
- osteoma (b)
- osteosarcoma (m)
20
Q
What is a sarcoma?
A
A malignant tumour derived from connective tissue (mesenchymal) cells
21
Q
Different types of sarcomas + their benign correspondents?
A
- Fat = LipoSARCOMA (vs. lipoma)
- Bone = OsteoSARCOMA (vs. osteoma)
- Cartilage = ChondroSARCOMA (vs. enchondroma?)
- Muscle
- striated = RhabdomyoSARCOMA,
- smooth = LeiomyoSARCOMA (vs lyomyoma) - Nerve sheath = Malignant Peripheral Nerve Sheath Tumour
22
Q
What are the tumours affecting white blood cells?
A
Leukemia and Lymphoma
23
Q
Leukemia and Lymphoma
A
- Tumours of white blood cells:
- Leukaemia a malignant tumour of bone marrow derived cells which circulate in the blood (Leukemia is seen in blood)
- Lymphoma is a malignant tumour of lymphocytes (usually) in lymph nodes -> lymphomas are tissue based (you see them in lymph nodes, spleen, tonsils)
- however, there are many exceptions (and overlaps) of leukemia and lymphoma (this is just how they USUALLY behave)
24
Q
What is a teratoma?
A
- A teratoma is a tumour derived from germ cells, which have the potential to develop into tumours of all three germ cell layers:
- ectoderm,
- mesoderm,
- endoderm
- most common in testes and ovaries (where germ cells are found)
- mature adult type tissues in a tumour (e.g. skin, hair etc.)
25
Teratomas in males and females
- Gonadal teratomas in males, all malignant
| - Gonadal teratomas in females, most are benign
26
HAMARTOMA
- localised overgrowth of cells and tissues native to the organ.
- cells are mature but architecturally abnormal
- common in children, and should stop growing when they do,
- e.g. bile duct hamartomas, bronchial hamartomas,
- Look like normal epithelium but the way they are arranged is abnormal -> architectural issue
- Cytologically normal, architecturally abnormal
27
A benign tumour of glandular tissue is:
1. An adenoma
2. A leiomyoma
3. An adenocarcinoma
4. A squamous papilloma
5. A lymphoma
1. An Adenoma
28
A malignant tumour derived from soft tissue is a:
1. Carcinoma
2. Sarcoma
3. Teratoma
4. Lymphoma
5. Melanoma
2. Sarcoma
29
What is more important? Stage or Grade?
STAGE
30
How do you look at differentiation of tumours?
Criteria for assessing differentiation of a malignant tumour:
- Evidence of normal function still present production of:
keratin,
mucin
bile
- Various grading systems - for Ca breast, prostate, colon
- no differentiation, ANAPLASTIC carcinoma,
31
What are anapaestic tumours?
So poorly differentiated, you don’t know what it is meant to do etc.
32
TNM
- The grade of a tumour describes its degree of differentiation
- The stage of a tumour describes how far it has spread
- Tumours of higher grade (i.e. more poorly differentiated) tend to be of higher stage (i.e. spread further)
- Overall, stage is more important than grade in determining prognosis
- The Tumour, Node, Metastasis (TNM) system can be applied, and individualised, to tumour in all sites
33
Grade vs. stage
- Grade looks at: how much of its normal function does it still have?
- Stage looks at: how far has the tumour spread? How far has it invaded, how big is it?
