2. Pathology and Clinical Features of Neoplasia Flashcards
What are some features of a neoplasm?
- Not coordinated with normal tissue
- Persists after removal of stimulus
- Result of genetic alterations
Does tumour = neoplasm?
Yus
Major risk factor for cancer?
Age
Where has there been significant advancement in treatment?
Niche cancers
What cancers have seen only moderate advances in treatment?
Breast, prostate, melanoma
Common cancers
What can malignant neoplasms be classified as?
Primary or secondary
What does Aetiology mean?
Cause of a condition/disease
What is the aetiology of cancer?
Genetic predisposition
Environmental factors
Non-genetic predisposition
What are some environmental factors influencing cancer aetiology?
Chemical carcinogens
Viruses
Radiation
Hormones
List pathways commonly involved in cancer pathogenesis.
- Growth promoting genes (proto-oncogenes)
- Growth inhibiting genes (tumour supressor genes)
- Genes regulating apoptosis
- Genes involved in DNA repair
- Telomere maintenance
- Angiogenesis
- Invasion
What mutations are common in lung adenocarcinoma?
EGFR KRAS BRAF MEK1 HER2
These are mutually exlusive
What is a non-invasive precursor?
Epithelial malignancies often have non-invasive precurser
Meaning they have some steps on the multi step model
When is detection of cancer most important?
At the non-invasive precursor stage
How many doublings in 1g of tumour?
30 doublings
How many doublings in 1kg of tumour?
40 doublings
What are tumour kinetics?
Rate of division
Proportion of cells in replicative pool
Rate of cell death
What defines a malignant neoplasm from a benign one?
Local destructive invasion
Capable of metastasis
BONUS: show anaplasia (loss of differentiation) Pleomorphism High mitosis Necrosis
What are the clinical effects of malignancy?
- Local
- Metastatic
- Systemic/Hormonal (Paraneoplastic syndromes, Cachexia)
- Secondary effects (pneumonia etc)
- Effects of therapy
What are the routes of malignancy spread?
- Local invasion
- Lymphatic Spread
- Haematogenous spread
Others: Body cavity Aerogenous Implantation Intraepithelial
What are some of the local effects of malignancy?
- Invasion of vital structures
- Obstruction of viscera (e.g. ureter, bowel, airway)
- Ulceration/Perforation (skin, bowel)
- Mass effects/organ destruction
What are the effects of metastasis?
- Destructive growth in vital organs, liver, brain etc (significant cause of death and morbidity)
What are some paraneoplastic syndromes?
- Hypercalcaemia (PTHrP)
- Endocrinopathies (Cushing, SIADH)
- Coagulopathy
- Neurological
- Haematological
What is Cachexia?
Wasting away to nutin
What are the treatments for malignancy?
Surgery
Chemotherapy
Radiotherapy
What are problems associated with surgery?
Operative risks
Healing
Functional impairment
What are some problems associated with Chemo?
Bone marrow supression
Mucous membrane damage
Severe GI disturbance
Future malignancy
What are some problems associated with radiotherapy?
Marrow supression
Skin toxicity
Brain damage
Post RT malignancy
How is malignancy diagnosed?
- Usually medical algorithm, history, examination etc
- Cytology (fine needle aspiration, pleural fluid)
- Histology (small biopsy, surgical procedure)
What is the major factor affecting prognosis?
Its stage defined by AJCC/UICC TNM system
What does TNM mean?
Tumour
Node
Metastases
The major factor being TNM, what other factors effect tumour prognosis?
Novel IHC/molecular prognostic markers
- Useful mainly in haematolymphoid + paediatric
Most not truly useful
Predictive markers - have value
What are predictive markers?
- Hormone receptors
- HER2
- CD117 in GIST
- EGFR mutations
- BRAF in melanoma
- CD20 in lymphoid malignancy
How can cancer be prevented?
Smoking Diet Sun protection Vaccination Education
Screen specific groups (BRCA1 and FAP)
- Can be motivated
