Cancer 1: cellular pathology

Question 1

Define metaplasia

Answer 1

Reversible change in which one adult cell (usually epithelial) is replaced by another adult cell type
Adaptive–like change with pH
(can be physiological-normal-as in puberty)\
eg: barrets oesophagus (acid reflux make squamous become columnar

Question 2

Define neoplasia, tumour, malignancy

Answer 2

Abnormal, autonomous proliferation of cells, u responsive to normal growth mechanism
Divided between benign and malignant tumours

Question 3

What is the difference bewteen benign and malignant tumours

Answer 3

Benign-does not invade-cannot metastase (cannot spread)
usually encapsulated-fibrious ridges demark it
Usually well differentiated (look like original tissue)
Slowly growing
normal mitosess

the first one is the absolute one, but the others are just way the can be recognised-not diagnostic

Beninign does not mean harmless-in meninges-block CSF, pituary-bad (press of bad structures or secrete)
or secrete something bad-insulinoma
Rarely fatal BUT can bleed, get infected, ruptire, torts

Question 4

Define dysplasia

Answer 4

Abnormal growth pattern of growth i which soome cellular and architectural of malignancy are present BUT NON-INVASIVE (increased mitosis, weird mitosis, increased nuclear/cytoplasmic ratio, loss of uniformity of individual cells, loss of achitecture)
Pre-invasive stage-intact basement membrane
if can find it then-easy to treat and 100% no spread if treated
common in: cervix-hpv, bronchus (smoking), colon-UC, stomach-pernicious aneamia, oesophagus-acid reflux
(can get metaplasia leading to dysplasia)

Question 5

What are dysplasia grades?

Answer 5

Low grade and high grade- (high grade closer to invasive cancer)
Low grade-tends to be more reversible and lesser chances of invasive
high grade tend to look darker as the nucleus is larger

Question 6

Are benign tumours harmless?

Answer 6

Beninign does not mean harmless-in meninges-block CSF, pituary-bad (press of bad structures or secrete)
or secrete something bad-insulinoma

Rarely fatal BUT can bleed, get infected, ruptire, torts

Question 7

What are the defining charactestics of malignant tumours?

Answer 7

Invade sourrounding tissues -main one
spread, no capsule, poorly differentiated, rapidly growing, abnormal mitoses
(again not all of them have that, but way to recognise them)

Question 8

Define metastasis?

Answer 8

Discontinous growing colony of tumour cells, at some distance from the primary cancer
Can go via blood, lymph, large cavities

Usually follow venous and lymphatic drainage-so depends of the affected organ (like prostate-to aortic nodes)
Lymph node involvment makes it worse

Question 9

What is a benign epithelial tumour?

Answer 9

On surface epithelium-papilloma (skin, bladder)

If of glandular epithelium-adenoma (stomach, thyroid, colon, kidney, pit, pancreas)

Question 10

What is a carcinoma?

Answer 10

malignant tumour derives from epithelium-

Squamous carinima, adenocarcinoma, transitional cell carcinoma, basal cell carcinoma

Question 11

What are benign soft tissue tumours? what are the malignant version?

Answer 11

depends on origin-
bone-oesteomas, lympomas-fat, leiomyomas-SMC, chondroma, rhabdomyoma (striated muscle), nerve shearth-malignant peripheral sheath tumour

Malignant version-sarcoma
(eg: osteosarcoma, liposarcoma, chondrosarcoma, etc)

Question 12

What are leukemias and lymphomas?

Answer 12

Leukemias-tumours of bone marrow cells which circulate in blood
Lymphoma-tumours of lymphomas that are usually tissue based (lymph nodes, tonsils)
exceptions exist and both can spread to look like the other

Question 13

What is a teratoma?

Answer 13

derived from germ cells-pluripotent cells-can develop in any 3 cell layers –can develop into any tissue of the body

tend to happen where you have germ cells

in males, nearly always malignant, in females, nearly always beninign (originate from gonades)

Question 14

What is a hamartomas?

Answer 14

Localised overgrowths of cells/tissue native to the organ
cell are normal but architectural abnomal
common in children and stop growing when they do
-like weird looking bile ducts, bronchus, etc

Question 15

How do you assess differentiation of tumours?

Answer 15

Check how much is resembles the tissue of origin-(poorly differentiated (bad) vs highly)
Check what is produces-is it producing what normal cell do (keratin, bile, mucin, hormones, etc)

grading systems in themselves are specific to the tumour and many many exist
if it shows NO differentiation-anaplastic carcinomas (resembles nothing we know)

Question 16

What is the TNM scale?

Answer 16

Grade of a tumour describe its degree of differentiation
Stage of the tumour describe how far its spread
higher grade tends to correlate with higher stage
STAGE IS MORE IMPORTANT for prognosis
generic T-tumour, N-node, M-metastasis can be applied and individualised for all tumour sites-and is specific to all cancer

Question 17

What are polyps?

Answer 17

Just extensions into the the lumen of a hollow organ

Question 18

WHat are the 2 types of adenomas?

Answer 18

Tubular and villous

Tubular more common

Question 19

What would make you worry about an adenma?

Answer 19

Grade-how differentiation (high grade worse)
Size (bigger the worse)
Types-Villous is worse-

all these have a higher chance of becoming carcinoma

Question 20

What is the membrane being invaeded by adenoma to be considered cancer? Why does it matter?

Answer 20

Muscularis mucosae

No lymphatics before the submucosa-cant spread before arrives there
none in lamina propria

Question 21

What is cancer stage and grade?

Answer 21

Stage-how far its spread -main one

Grade- how much it looks compared to original tissue

Question 22

How is staged assessed?

Answer 22

Classification depends purely on the organ-generally how far its gone
But invasion of the wall is nearly always a good point
T2-through muscle
T3-not quite through end layer
t4-out of outer layer
bowel cancer uses Duke’s

Question 23

What is a big clue for breast cancer when palpating if its cancer or adenoma? and other factors that are worrying?

Answer 23

If its fixed, that probably means its invaded tissue
Size is also an issue
age
asymetry-more likely to be cancerous
lymph-if you can feel them (lateral-auxillary nodes, if central-deep mediastanal) -more likely to be lateral

when cut it feels like a gritty pear because it has a lot of elastic tissue
Collagen around the tumour as response -finbrosis. angiogenesis

Question 24

What epithelial tissues do you have in the breast?

Answer 24

Secretory units, and ductal units
So cancers can be lobular carcinomas or ductal carcinomas
lobulat tend bilateral and ductal tend to be unilateral-change mascetomy

need to understand normal structure to understand cancer

Question 25

What does in situ mean for cancer?

Answer 25

In its place
actually means its high grade dysplasia (really high grade) but hasnt invaded yet-
really only happens in the breast

Question 26

How are breast TNM assessesd?

Answer 26

SIze-2cm-T1, T2-5 T2, T3-over 5cm
T4-attatched to tissue
In colon cancer it was about how fat its gone through–
In breast its actually about size (with t4 being hybirid)

M-lymph nodes invades-difficult long scale-

Question 27

What does pT2, cT2 and rT2 (and ypT2) mean?

Answer 27

T2-is stage 2
p is for pathology
c-clinical
r-radiology
yp-after pre operative radiotherapy

Question 28

What are the commonest type of skin cancer?

Answer 28

Squamous cell carcinoma, melanoma, basal cell carcinomas-big three-share sun
angio-sarcoma
rabdo-myoma-skeletal)
lymphoma

(can be fungal infection)

Question 29

What is bowens disease/

Answer 29

Squamous cell carcinoma in tissue (skin cancers/dysplasia) tend to have names

often loss of acrhitecture (loss flat/oragnised)/nuclear ratio
lack of maturation fr skin