Cancer 1: Cellular pathology of cancer

Question 1

Define metaplasia

Answer 1

A reversible change in which one adult cell type (usually epithelial) is replaced by another adult cell type
Adaptive

Barrett’s oseophagus - squamous epithelium to columnar epithelium

Question 2

Define dysplasia

Answer 2

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
Increased nuclei cytoplasmic ratio as a cancer goes through metaplasia, dysplasia, neoplasia etc - darker

Question 3

What is typically seen in dysplasia?

Answer 3

• Loss of architectural orientation
• Loss in uniformity of individual cells
• Nuclei: hyperchromatic enlarged
• Mitotic figures: abundant, abnormal, in places where not usually found

Question 4

Where is dysplasia common in?

Answer 4

CERVIX - HPV infection
BRONCHUS - Smoking
COLON - UC (ulcerative colitis)
LARYNX - Smoking
STOMACH -Pernicious anaemia
OESOPHAGUS- Acid reflux

Question 5

What is the difference between low grade and high grade?

Answer 5

Low grade = risk of progression is slow, more likely to be reversible
High grade = more likely to progress and less likely to be reversible

Question 6

Define neoplasia?

Answer 6

Tumour, malignancy

An abnormal, autonomous proliferation of cells unresponsive to normal growth control mechanisms

Question 7

Describe benign tumours

Answer 7

1 ) do not invade local tissue = do not metastasise

encapsulated
usually well differentiated
slowly growing
normal mitosess

Question 8

When do benign tumours become fatal?

Answer 8

Usually not fatal unless:

• In a dangerous place: meninges, pituitary. Blockage of CSF in the lateral ventricles
• Secretes something dangerous: insulinoma
• Gets infected: bladder
• Bleeds: stomach
• Ruptures: liver adenoma
• Torts (twisted): ovarian cyst = ischaemic death

Question 9

Describe malignant tumours

Answer 9

• invade surrounding tissues

spread to distant sites
no capsule
well to poorly differentiated
rapidly growing
abnormal mitoses

Question 10

Define metastasis

Answer 10

A metastasis is a discontinuous growing colony of tumour cells, at some distance from the primary cancer

Dependent on lymphatic and vascular drainage of the primary site. Lymph node involvement has a worse prognosis. e.g colon

Tumour in the lateral aspect of the breast –> axillary lymph nodes

Question 11

Describe benign epithelial tumours

Answer 11

Of the surface of epithelium = PAPILLOMA e.g skin, bladder

Of the glandular epithelum = ADENOMA e.g stomach, thyroid, colon, kidney, pituitary, pancreas

Question 12

Describe carcinoma

Answer 12

A malignant tumour derived from epithelium

Question 13

What are the types of carcinomas?

Answer 13

squamous cell
adenocarcinoma
transitional cell (come from the bladder)
basal cell carcinoma

Question 14

Give an example of a benign soft tissue tumour?

Answer 14

Osteoma

Question 15

Define sarcoma

Answer 15

A malignant tumour derived from connective tissues (mesenchymal) cells

Question 16

What are the different types of sarcoma?

Answer 16

Fat = liposarcoma
Bone = osteosarcoma
Cartilage = chondrosarcoma
Muscle:
             Striated = Rhabdomyosarcoma
             Smooth = Leiomyosarcoma
Nerve sheath = Malignant Peripheral Nerve Sheath Tumour

Question 17

Define Leukaemia

Answer 17

A malignant tumour of the bone marrow derived cells which circulate in the blood

Tumour of white blood cells

Question 18

Define Lymphoma

Answer 18

A malignant tumour of lymphocytes usually in lymph nodes

Question 19

Define teratoma

Answer 19

Is a tumour derived from germ cells, which have the potential to develop into tumours of all three germ cell layers

1. ectoderm
2. mesoderm
3. endoderm

Question 20

What are the difference between male and female gonadal teratomas?

Answer 20

Males = all malignant
Females = most are benign

Question 21

Define hamartoma

Answer 21

Localised overgrowth of cells and tissues native to the organ

Cells are mature (so normal) but architecturally abnormal. They way they are arranged is abnormal.

Common in children, and should stop growing when they do,
e.g. bile duct hamartomas, bronchial hamartomas,

Question 22

How do you differentiate tumours?

Answer 22

Criteria for assessing differentiation of a malignant tumour:

1) Evidence of normal function still present production of:
keratin,
mucin
bile
hormones
2) Various grading systems - for Ca breast, prostate, colon
3) no differentiation, ANAPLASTIC carcinoma - no idea what it is

Question 23

Describe the grading of tumours?

Answer 23

The grade of a tumour describes its degree of differentiation. How much does it look like the tissue from which its derived and how much does it do like from the tissue its derived.

Question 24

What is the stage of a tumour?

Answer 24

The stage describes how far it has spread. Stage is more important than grade in determining prognosis. Its about progression.

High grade tumours tend to be higher stage.

TNM system - Tumour, Node, Metastasis

Stage is more important that grade in determining prognosis