Cancer 1: Cellular pathology of cancer

Question 1

Define Metaplasia

Answer 1

• reversible change in which one adult cell type is replaced by another adult cell type
  e. g squamous –> columnar epithelium (barrett’s esophagus)

Question 2

Define Dysplasia

Answer 2

• abnormal pattern of growth in which some of the cellular + architectural features of malignancy is present
• pre-invasive stage with intact basement membrane
• IT IS NON INVASIVE

Question 3

What happens in dysplasia?

to the:

a) architectural orientation
b) uniformity in individual cells
c) nuclei
d) mitotic figures

Answer 3

• loss of architectural orientation
• loss of uniformity in individual cells
• nuclei: hyper chromatic enlarged
• mitotic figures: abundant + abnormal

(INCREASE MITOSIS
INCREASE in NUCLEAR-CYTOPLASMIC RATIO)

Question 4

When/ where might you find dysplasia?

Answer 4

CERVIX - HPV infection
BRONCHUS - Smoking
COLON - UC
LARYNX - Smoking
STOMACH -Pernicious anaemia
OESOPHAGUS- Acid reflux

Question 5

How would you distinguish benign/malignant tumors?

i.e how does it differ from malignant tumors ?

Answer 5

BENIGN

1. doesn’t invade/ metastasise (local tissue) –> cant spread
2. encapsulated
3. well differentiated
   (i. e they look like the tissue from which they come from)
4. slowly growing
5. normal mitosess

MALIGNANT

1. invades surrounding tissues
2. spread to distant sites
3. no capsule
4. poorly differentiated
5. rapidly growing
6. abnormal mitoses

Question 6

When might benign tumor be fatal?

Answer 6

• if its in a dangerous place
  (e. g pituitary/meninges)
• if it secretes something dangerous
  (e. g insulinoma- tumor of beta cells of pancreas)
• if it gets infected
  (e. g bladder)
• if it bleeds
  (e. g stomach)
• if it ruptures
  (e. g liver adenoma)
• if it gets twisted/torsion
  (e. g ovarian cyst)

Question 7

define metastasis

Answer 7

discontinuous growing colony of tumour cells, at some distance from the primary cancer

Question 8

What factors does metastasis depend on?

Answer 8

depends on:
lymphatic + vascular drainage of primary site

e.g breast cancer can –> axillary lymph nodes

Question 9

What do you call benign epithelial tumors of surface epithelium?

give some examples

Answer 9

Papilloma

e.g skin/ bladder

Question 10

What do you call glandular epithelial tumors of surface epithelium?

give some examples

Answer 10

Adenoma

e.g stomach, thyroid, colon, kidney, pituitary, pancreas

Question 11

What do you call malignant tumors of the epithelium?

Answer 11

Carcinoma

note: qualified/classified by “kind” of epithelium

Question 12

What do you call malignant tumor derived from connective tissue (mesenchymal) cells

Answer 12

Sarcoma

Question 13

what do you call sarcoma of the

a) fat
b) bone
c) cartilage
d) muscle
e) nerve sheath

Answer 13

what do you call sarcoma of the
a) fat = liposarcoma

b) bone = osteosarcoma
c) cartilage = chondrosarcoma
d) muscle = (striated) Rhabdomyosarcoma // (smooth) leiomyosacoma
e) nerve sheath = malignant peripheral nerve sheath tumor

Question 14

Distinguish between Leukemia + Lymphoma

Answer 14

• Leukaemia = malignant tumour of bone marrow derived cells which circulate in the blood
• -> mainly blood based
• Lymphoma = malignant tumour of lymphocytes (usually) in lymph nodes
• -> mainly tissue based

Question 15

define a teratoma

Answer 15

• 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
• -> any tissue can be found in a teratoma
• -> large mixture of tissues

(common in ovaries/ testes)

Question 16

Gonadal teratomas in male =
malignant/ benign

Gonadal teratomas in female = malignant / benign

Answer 16

Gonadal teratomas in male = ALL malignant

Gonadal teratomas in female = mostly benign

Question 17

Define hamartoma

Answer 17

localised overgrowth of cells and tissues native to the organ, which are normally found in the organ.

• -> cytologically normal
• -> arrangement/ architecture is abnormal
  e. g bile duct hamartomas/ bronchial hamartomas

Question 18

How would you differentiate malignant tumors?

i.e whats the criteria

Answer 18

Evidence of normal function still present production of:

- keratin, 
- mucin
- bile
- hormones

Question 19

TNM - Stage/ grade is more important when determining prognosis

Answer 19

Stage is more important when determining prognosis

Question 20

In TNM system ,

what is meant by:

a) grade
b) stage

Answer 20

TNM system (tumor, node, metastasis)

a) grade = degree of differentiation of tumour

b) stage = how far it has spread
- -> invades other structures

Question 21

define neoplasia

Answer 21

any new growth benign or malignant

Question 22

Lymph node / vascular involvement has worse prognosis with reference to metastasis

Answer 22

Lymph node has worse prognosis with reference to metastasis

Question 23

note:

dysplasia - lowest nuclear cytoplasmic ratio
benign tumors - lower nuclear cytoplasmic ratio
malignant tumors - higher nuclear cytoplasmic ratio

Answer 23

-

Question 24

Lymphoma = almost always malignant / benign

Answer 24

Lymphoma = almost always malignant

Question 25

What is anaplastic carcinoma?

Answer 25

no differentiation at all