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

Question 2

Give two examples of metaplasia, one pathological and one physiological.

Answer 2

Barrett’s Oesophagus – gastro-oesophageal reflux can change the stratified squamous epithelium of the distal oesophagus to simple columnar Cervix during puberty – the cervix opens up and the columnar epithelium of the endocervical canal is exposed to the acidic ph of the vagina making it squamous

Question 3

What are the two types of metaplasia that can take place in Barrett’s Oesophagus?

Answer 3

Gastric metaplasia – stratified squamous to simple columnar Intestinal metaplasia – goblet cells begin to appear

Question 4

State some features of cancer that are seen in dysplasia.

Answer 4

• Large, hyperchromatic nucleus
• Increased mitoses
• Abnormal mitoses
• Increased nucleo-cytoplasmic ratio
• Loss of architectural orientation
• Loss of uniformity of individual cells

Question 5

What is the difference between low and high-grade dysplasia?

Answer 5

They both show changes of dysplasia but the changes are more severe in high-grade dysplasia High-grade: High risk of progression to cancer Less chance of reversal

Question 6

What are the main features of benign tumours that separate them from malignant tumours?

Answer 6

They do not metastasise They do not invade They also are usually encapsulated (except for fibroids in the uterus) slow growing normal mitoses

Question 7

Under what conditions can benign tumours be dangerous?

Answer 7

If they are in a dangerous location e.g. csf network leading to hydrocephalus If they secrete something dangerous If they get infected If they bleed If they rupture If they become twisted

Question 8

What are the features of malignant tumours?

Answer 8

Invade surrounding tissues Spread to distant sites They also have no capsule can be well or poorly differentiated, rapidly growing abnormal mitoses

Question 9

Define metastasis.

Answer 9

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

Question 10

What are the two different types of benign epithelial tumour?

Answer 10

Papilloma – of the surface epithelium e.g. skin, bladder Adenoma – of glandular epithelium e.g. stomach, thyroid, colon, kidney, etc

Question 11

Define carcinoma.

Answer 11

Malignant tumour derived from the epithelium

Question 12

What are the different types of carcinoma?

Answer 12

Basal cell carcinoma - skin Squamous cell carcinoma Transitional cell carcinoma (transitional epithelium is found in the bladder) Adenocarcinoma

Question 13

State some different types of benign soft tissue tumour.

Answer 13

Osteoma –bone Lipoma - fat Leiomyoma – smooth muscle Chondroma - cartilage

Question 14

Define sarcoma.

Answer 14

Malignant tumour derived from connective tissue (mesenchymal) cells

Question 15

What are the names given to malignant tumours of striated muscle, smooth muscle and the nerve sheath?

Answer 15

Striated muscle – rhabdomyosarcoma Smooth muscle – leiomyosarcoma Nerve sheath – Malignant peripheral nerve sheath tumour

Question 16

Define leukaemia.

Answer 16

Malignant tumour of bone marrow derived cells, which circulate in the blood

Question 17

Define lymphoma.

Answer 17

Malignant tumour of lymphocytes usually in lymph nodes

Tissue based, commomly in lymph nodes, spleen and tonsil

Question 18

Define teratoma.

Answer 18

A tumour derived from germ cells, which has the potential to develop into tumours of all three germ layers: ectoderm, mesoderm, endoderm

Question 19

What is an important difference between teratomas in men compared to women?

Answer 19

Gonadal teratomas in men are almost always malignant Gonadal teratomas in women are almost always benign

Question 20

Define hamartoma.

Answer 20

Localised overgrowth of cells and tissue native to the organ In other words, the cells and tissues present are cytologically appropriate for that particular location but their structural organisation is inappropriate

Question 21

Which group of the population is hamartoma common in?

Answer 21

It is common in children and the hamartoma usually stops growing when the children stop growing

Question 22

What is the difference between grading and staging?

Answer 22

Grading – how well differentiated the cancer is Staging – how far the cancer has spread Importance: Staging > Grading

Question 23

What is meant by the ‘degree of differentiation’?

Answer 23

How much the tumour cells resemble the cells from which they are derived

Question 24

What are the grading systems for breast and prostate cancer?

Answer 24

Breast –Nottingham scoring system Prostate – Gleason classification

Question 25

What is the term given to tumours that show little or no differentiation?

Answer 25

Anaplastic

Question 26

Define dysplasia

Answer 26

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

Question 27

Define neoplasia

Answer 27

An abnormal, autonomous proliferation of cells unresponsive to normal growth control mechanisms Can be benign or malignant

Question 28

What does TNM stand for?

Answer 28

Tumor Node Metastases