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Pathology Applied To Nursing > 8 Disorders of Growth 1 and 2 > Flashcards

8 Disorders of Growth 1 and 2 Flashcards

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1
Q

Disorders of Growth 1 and 2

Objectives:

A

Definition of neoplasia

Classification of tumours

Characteristics of Benign vs Malignant tumours

Effects and complications of tumours

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2
Q

DEFINITIONS

A

“A NEOPLASM is an abnormal mass of tissue, the growth of which exceeds and is unco-ordinated with that of normal tissues, and which persists in the same excessive manner after cessation of the stimuli which evoked the change.”

    - Sir Rupert Willis, 1960
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3
Q

DEFINITIONS

A

NEOPLASIA is the process by which a neoplasm is formed.

TUMOUR literally means swelling, but conventionally is used as a synonym for neoplasm

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4
Q

CLASSIFICATION OF CLASSIFICATIONS

A 
behaviour: benign v. malignant
  naked eye appearance
site; conformation
  histological
what tissue does it resemble?
how close is the resemblance?
  histogenesis: cell of origin
  aetiological: 
inheritance v. environmental
  functional
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5
Q

BEHAVIOUR

A

A benign tumour grows by expansion, displacing adjacent tissue
A malignant tumour grows by infiltration of local tissues, and spreads to other parts of the body
Primary tumour
original malignant tumour
Secondary tumours
“offspring” of a primary malignant tumour

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6
Q

SPREAD OF MALIGNANT TUMOURS

A

Local - direct invasion
Distant – metastasis

METASTASIS is a word used in two ways:
a secondary tumour
process by which secondary tumour is formed

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7
Q

ROUTES OF METASTASIS

A 
lymphatics
  blood
  transcoelomic
  along epithelial-lined spaces
  within epithelium
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8
Q

ROUTES OF METASTASIS

A

METASTASIS VIA LYMPHATICS
tumour may directly invade lymphatics
tumour emboli filtered out, then grow, in lymph nodes
typical of epithelial malignancy

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9
Q

ROUTES OF METASTASIS

A

METASTASIS VIA BLOOD
tumour may invade blood vessels
emboli filtered out by capillary beds, eg liver, lung
typical of stromal malignancy and later stages of epithelial malignancy

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10
Q

ROUTES OF METASTASIS

A 
TRANSCOELOMIC SPREAD
   peritoneal, pleural
   EPITHELIAL-LINED SPACES
   bronchiolo-alveolar carcinoma of lung
   WITHIN EPITHELIUM
   Paget's disease of nipple, vulva and anus
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11
Q

PARTICULAR SITES OF METASTASES

A

lymph nodes

liver: GIT carcinomas, GUS, bronchus, breast
lungs: sarcoma; carcinoma of thyroid, breast, kidney, bronchus, etc.
bone: carcinoma of breast, thyroid, bronchus, prostate, uterus
brain: carcinoma of bronchus
endocrines: carcinoma of bronchus often goes to adrenals
skin: malignant melanoma; clear cell carcinoma of kidney

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12
Q

TUMOUR TERMINOLOGY or NAMING NEOPLASMS

A

The names given to individual lesions depend upon
site
behaviour
histogenesis

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13
Q

BENIGN EPITHELIAL TUMOURS

A

Adenoma
Papilloma
Cystadenoma

Polyp - a mass attached to a surface, which may or may not be a neoplasm

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14
Q

MALIGNANT TUMOURS

A

Cancer - any malignant tumour

Carcinoma - a malignant tumour of epithelial tissue

Sarcoma - a malignant tumour of stromal tissue

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15
Q

MESENCHYMAL TUMOURS

A

are named according to the cell type, with a suffix

- oma    		if benign
	- sarcoma		if malignant

e.g. lipoma and liposarcoma

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16
Q

THOSE ARE THE RULES

A

but THERE ARE ALSO EXCEPTIONS which are
deeply entrenched
sometimes silly
typically confusing

17
Q

LEUKAEMIA

A

neoplastic proliferation of haemopoietic stem cells
neoplastic cells spill over into the blood stream
all regarded as
malignant

18
Q

LYMPHOMA

A

malignant proliferation of cells of lymphoid tissue

Two types
Hodgkin’s disease
mixture of cells, including Reed-Sternberg cells
non-Hodgkin’s lymphoma
lacks the cellular mixture of Hodgkin’s disease

19
Q

TERATOMA

A

arises from “totipotential” cells, producing tissues representing all three germ cell layers
ovary (usually benign)
testes (usually malignant)
midline (sequestered primitive cells)

20
Q

PRECURSORS OF MALIGNANCY

A

PREMALIGNANT CONDITIONS
lesions with an increased risk of the development of invasive tumour
can be non-neoplastic or neoplastic

21
Q

PREMALIGNANT CONDITIONS - EXAMPLES

A 
NON-NEOPLASTIC 
   chronic inflammation 
  varicose leg ulcers can lead to skin cancer 
   cirrhosis of the liver 
   hepatocellular carcinoma
   chronic ulcerative colitis 
   adenocarcinoma of the large intestine
   xeroderma pigmentosum 
   squamous cell carcinoma of the skin
22
Q

PREMALIGNANT CONDITIONS - EXAMPLES

A 
NEOPLASTIC 
   familial polyposis coli
   autosomal dominant 
   1000s of large intestinal adenomas
	 carcinoma inevitable
   intra-epithelial neoplasia:
	nuclear changes of carcinoma, without breaching basement membrane - "dysplasia" or "carcinoma-in-situ" - important in uterine cervix, vulva, bronchus, etc.
23
Q

PREMALIGNANT CONDITIONS - EXAMPLES

A

Cervical intra-epithelial neoplasia

  • Normal
  • CIN i
  • CIN ii
  • CIN iii
24
Q

TUMOUR STAGING AND GRADING

A

Grading
how bad it looks
Staging
how far its got

25
Q

TUMOUR GRADING

A

an assessment of the degree of differentiation of a tumour
correlates with how aggressive the tumour behaves
only relevant for malignant tumours
usually define 3 or 4 grades

26
Q

PROBLEMS WITH TUMOUR GRADING

A

very subjective
poor reproducibility
appearances vary from area to area within most tumours
need different criteria for each histogenesis
only modest predictor of outcome

27
Q

TUMOUR STAGING

A 
based on three main features
   size of primary tumour
   extent of lymph node disease
   any blood-borne metastasis
   sometimes quoted as "TNM"
28
Q

TUMOUR STAGING

A

The TNM system
T = size of tumour (T1 to T4)
N = extent of lymph node involvement (N0 to N3)
M = distant metastasis (M0 to M1)
criteria different for each tumour
better prediction of outcome than grade, for most tumours

29
Q

THE EFFECTS OF TUMOURS

A

displacement or destruction of normal structures
excess “normal” function
paraneoplastic phenomena

30
Q

EFFECTS OF BENIGN TUMOURS

A 
EXAMPLES
   Mechanical pressure
   meningioma compressing brain
   ovarian cystadenoma compressing ureter
   Obstruction
   atrial myxoma
   leiomyoma in GIT
  Ulceration
   mucosa over gastric leiomyoma
31
Q

EFFECTS OF BENIGN TUMOURS

A 
Meningioma compressing brain
MORE EXAMPLES
   Infarction of pedunculated tumour
   subserosal leiomyoma of uterus
   Infection
   bladder papilloma
Rupture of cystic neoplasm
   mucinous cystadenoma of appendix causing pseudomyxoma peritonei
   Hormone production
   islet cell tumour of pancreas
Malignant change 
Rupture of mucinous cystadenoma of appendix causing pseudomyxoma peritonei
32
Q

EFFECTS OF MALIGNANT TUMOURS

A

EXAMPLES
All the physical effects of benign tumours
Tissue destruction
cancer of the cervix infiltrating ureter
cancer of the stomach infiltrating pancreas
Haemorrhage
any cancer breaching a vessel wall

33
Q

EFFECTS OF MALIGNANT TUMOURS

A 
MORE EXAMPLES
   Secondary infection
   bacterial invasion of necrotic tumour
   Cachexia
   severe weight loss
   increased metabolic rate
  tissue necrosis factor, etc
34
Q

EFFECTS OF MALIGNANT TUMOURS

A 
MORE EXAMPLES
   Pain
   Anaemia
   haemorrhage
   bone marrow replacement
   haemolysis
   Paraneoplastic syndromes
35
Q

PARANEOPLASTIC SYNDROMES

A

Ectopic hormone production
carcinoma of bronchus may cause Cushing’s syndrome, inappropriate ADH secretion, secretion of PTH analogue
fibrosarcoma can produce hypoglycaemia
renal carcinoma can release erythropoetin

36
Q

PARANEOPLASTIC SYNDROMES

A

Peripheral neuropathy, cerebellar degeneration, myopathy
Thrombophlebitis migrans
carcinoma of bronchus (5%) and pancreas (30%)
Acanthosis nigricans
caused by epidermal growth factor analogue

37
Q

PARANEOPLASTIC SYNDROMES

A

Nephrotic syndrome
proteinuria, hypoalbuminaemia, generalised oedema
complexes of tumour antigen and host antibody deposited in glomerulus
Finger clubbing
Hypertrophic pulmonary osteoarthropathy
Non-bacterial thrombotic endocarditis

Pathology Applied To Nursing (23 decks)

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