92 - Neoplasia 1 Flashcards

1
Q

Cancer deaths vs cardiovascular deaths in Australia

A

33% of deaths cardio, 30% are from malignancy per year.

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2
Q

Age group where most cancers are diagnosed

A

68% in people aged 60 and older.

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3
Q

Proportion of people over 85 diagnosed with cancer

A

1/2 males, 1/3 females.

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4
Q

Cancers accounting for over 60% of cancers diagnosed

A

Prostate, colorectal, breast, melanoma of the skin, lung

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5
Q

Most common cancers

A

Basal cell cancer, squamous cell carcinoma of the skin.

Very rarely lead to death. Not very aggressive.

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6
Q

Most common cancers in Australia

A

Basal cell cancer, squamous cell carcinoma of the skin.

Very rarely lead to death. Not very aggressive.

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7
Q

Neoplasia

A

Excessive and unregulated cell proliferation.

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8
Q
Features of neoplasia
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A

1) Multistep process beginning in a single cell.
2) Aberrant genetic, epigenetic control mechanisms affecting cell cycle, apoptosis, DNA repair
3) Acquire other features that allow neoplastic growth to progress
4) Comprise neoplastic cells and reactive stroma.
5) Can be benign or malignant

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9
Q

Examples of cells in reactive stroma

A

Inflammatory cells, fibroblasts, blood vessels

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10
Q

Tumour

A

Any mass lesion. Commonly used to describe neoplastic lesions, but this is very broad.

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11
Q
Characteristics of malignant cells
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A
Sustaining proliferative signalling
Evade growth suppressors
Activating invasion and angiogenesis
Enabling replicative immortality
Inducing angiogenesis
Resisting cell death
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12
Q

Most common cancers in males and females

A

Prostate in males, breast in females.

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13
Q

Most common cancers in males and females in Victoria

A

Prostate in males, breast in females.

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14
Q

Leading causes of cancer death in males and females in Victoria

A

Lung cancer leading cause in both.

Prostate and breast are second-most.

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15
Q

Who diagnoses a cancer?

A

A pathologist.

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16
Q

Most common cancer globally

A

Lung

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17
Q

Why is liver cancer more common globally than in Australia?

A

Prevalence of hepatitis B and C

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18
Q
Examples of paediatric cancers
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A

Certain leukaemias.
Neuroblastomas
Wilm’s tumour
Certain lymphonmas

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19
Q

What can paediatric cancers be referred to as?

A

Blastomas

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20
Q
Features of benign cells 
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A
• Local expansile, generally slow growth, often (not always) well circumscribed (+/-
encapsulated)
• Well differentiated cells
• Unable to metastasise
• Rarely life threatening
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21
Q
Features of malignant cells
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  • Locally invasive, destructive growth, often (not always) poorly circumscribed
  • Frequently induce ‘desmoplasia’ in stroma as they invade
  • Sometimes necrosis: from tumour outgrowing blood supply
  • Variable differentiation: well, moderate, poor or anaplastic
  • Potential to metastasise: spread and grow at a site separate to the primary tumour
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22
Q

Ways in which tumours can metastasise

A
  • Lymphatic
  • Haematogenous
  • Transcoelomic
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23
Q

Most important features of malignant cells

A

Invasive, can metastasise

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24
Q

Transcoelomic

A

Metastasis via body cavities

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25
``` Features of benign cells 1 2 3 4 ```
* Local expansile, generally slow growth, often (not always) well circumscribed (+/- encapsulated - capsule not v common) * Well differentiated cells * Unable to metastasise * Rarely life threatening
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Transcoelomic
Metastasis via body cavities
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``` Features of malignant cells 1 2 3 4 ```
* Locally invasive, destructive growth, often (not always) poorly circumscribed * Frequently induce ‘desmoplasia’ in stroma as they invade * Sometimes necrosis: from tumour outgrowing blood supply * Variable differentiation: well, moderate, poor or anaplastic * Potential to metastasise: spread and grow at a site separate to the primary tumour
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Transcoelomic
Metastasis via body cavities
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Uncertain malignant potential/borderline
Neoplastic cells with an appearance betwween benign and malignant. Often non-aggressive with a slow course, but can metastasise. Uncertain. EG: In ovary
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One of the most common benign lesions
Leiomyoma. | Smooth muscle benign growth in the uterus.
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One of the most common benign lesions
Leiomyoma. | Smooth muscle benign growth in the uterus.
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Main route of cancer metastasis
Lymphatic. | Move to local lymph nodes. Often grow in the first lymph node in the lymphatic drainage pathway.
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Main route of cancer metastasis
Lymphatic. Move to local lymph nodes. Often grow in the first lymph node in the lymphatic drainage pathway. Can then get into the blood by draining from the lymph.
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Difference between tumour growth and metastasis
Metastasis must be tumour cells growing completely separately from the primary tumour.
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``` Common sites of metastases 1 2 3 4 5 ```
``` Local lymph nodes Bone Lung Brain Liver ```
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``` Common sites of metastases 1 2 3 4 5 ```
``` Local lymph nodes Bone Lung Brain Liver ```
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Common sites of distant metastases
``` Bone Lung Brain Liver (local lymph node is not considered 'distant') ```
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Common sites of distant metastases
``` Bone Lung Brain Liver (local lymph node is not considered 'distant') ```
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Name for metastasis in lung where there is a diffuse pattern of malignancies in the lung, from spreading through the lymph
Lymphangitis carcinomatosis
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``` Cytological histopathological appearance of neoplasia 1 2 3 4 5 6 ```
Larger nuclei Pleomorphic nuclei Coarser nuclear chromatin Hyperchromatic nuclei (can be from extra copies of chromosomes, therefore stain more intensely with haemotoxylin) Larger, more prominent nuclei More mitotic activity, +/- abnormal mitotic figures.
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Mitotic figures
Evidence of cells about to divide | EG: Separate sets of chromosomes
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Desmoplastic stroma
Abnormal stroma in benign and malignant neoplastic lesions
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Desmoplastic stroma features
Many more fibroblasts, fibroblast proliferation Many more inflammatory cells More collagen deposition Contributes to tumour firmness
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What contributes to the firmness of a tumour?
Desmoplastic stroma
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How can malignant cell lineage be determined?
Histologically, by looking at the phenotype of the cells. Often resembles that of the cells where malignancy originated
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Features of glandular cell-lineage malignancies 1 2 3
Form a lumen. Signet ring cells Formation of mucin
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Signet ring cells
Cells with mucus within the cells. | Classical of EG: cancers from stomach cells
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``` Features of squamous cell-lineage malignancies 1 2 3 4 ```
Show features of stratified squamous epithelium. Eosinophilic cytoplasm Intercellular bridges (spikes of cytoplasm between cells, where desmosomes hold cells together). Keratinisation.
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How does keratinisation appear histologically?
A swirl of anucleate cells (circular)
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Features of smooth muscle cell-lineage malignancies 1 2
Elongated nuclei, with rounded ends. | Looks like smooth muscle
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Differential diagnosis of a mass lesion
Neoplastic or non-neoplastic? If neoplastic: Benign or malignant? Type: mesenchymal, epithelial, etc If malignant: primary or metastatic?
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``` Differential diagnosis of a mass lesion 1 2 3 4 ```
Neoplastic or non-neoplastic? If neoplastic: Benign or malignant? Type: mesenchymal, epithelial, etc If malignant: primary or metastatic?
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Clinical course of action if there is a suspected malignancy
Biopsy
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``` Things that a pathologist looks for in a biopsy of a possible malignancy 1 2 3 4 ```
Cytological features Architecture +/- necrosis Stroma Cell lineage
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Prefixes in cancer naming
* Adeno: glandular * Squamous cell * Leiomyo: smooth muscle * Osteo: osteobastic (osteoid forming)
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Suffixes in cancer naming
• Benign: -oma • Malignant: – Carcinoma: epithelial – Sarcoma: mesenchymal
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Suffixes in cancer naming
• Benign: -oma • Malignant: – Carcinoma: epithelial – Sarcoma: mesenchymal
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Seminoma
A malignant testicular lesion (breaks rule of -oma for a benign lesion)
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What does the 'grade' of a cancer refer to?
Degree of differentiation
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Features of well-differentiated lesions 1 2 3
• More closely resemble mature cells • Less cytologic atypia (smaller more uniform nuclei, inconspicuous nucleoli), less mitotic activity • Architecturally more organised
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Features of poorly-differentiated lesions 1 2 3
• Poorly resemble mature cells • More cytologic atypia (enlarged pleomorphic nuclei, prominent nucleoli, nuclear hyperchromasia or coarse nuclear chromatin), more mitotic activity +/- atypical mitoses • Architecturallly less organised
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What does the 'grade' of a malignant tumour refer to?
Degree of differentiation
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Well-differentiated vs poorly-differentiated malignancies
Well-differentiated are less-aggressive than poorly-differentiated (in general)
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Example of poorly-differentiated vs well-differentiated malignancies
Well-diff adenocarcinoma will have lumens, as is a glandular cancer. Loses these as it becomes less diff. Well-diff squamous cell carcinoma has keratinisation. More atypia in poorly-differentiated nuclei
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Example of poorly-differentiated vs well-differentiated malignancies 1 2 3
Well-diff adenocarcinoma will have lumens, as is a glandular cancer. Loses these as it becomes less diff. Well-diff squamous cell carcinoma has keratinisation. More atypia in poorly-differentiated nuclei
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Which cell types do malignancies arise from?
Potentially adult stem cells.
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Which cell types do malignancies arise from?
Potentially adult stem cells.