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Year 2 MCD - Cancer > Cellular Pathology of Cancer > Flashcards

Cellular Pathology of Cancer Flashcards

1
Q

What is metaplasia?

A

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

Metaplasia is adaptive

Squamous epithelium changed into columnar epithelium (Barrat’s Oesophagus)

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2
Q

What are the types of metaplasia?

A

Gastric Metaplasia – stratified squamous to simple columnar

Intestinal Metaplasia – goblet cells appear

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3
Q

What are examples of pathological and physiological metaplasia?

A

Pathological metaplasia: gastro-oesophageal reflux causes the oesophageal epithelium to change from squamous to columnar (Barrett’s oesophagus) – shouldn’t be columnar epithelium in the oesophagus

Physiological metaplasia: In pregnancy the cervix opens up and the columnar epithelium of the endocervical canal is exposed to the acidic uterine fluids making it become squamous - when the cervix closes up again, the cell type changes back to normal (metaplasia is REVERSIBLE)

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4
Q

What is dysplasia?

A

Abnormal pattern of growth in which some cellular and architectural features of malignancy are present

PRE-INVASIVE stage with intact basement membrane

*Dysplasia is used to screen for cancer, to pick up high risk individuals before they get full-blown cancer

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5
Q

What are the features of dysplasia?

A

Shows an INCREASED NUCLEO-CYTOPLASMIC RATIO

Loss of architectural orientation

Loss in uniformity of individual cells (pleomorphism)

Nuclei: hyperchromatic, enlarged

Mitotic figures: abundant (mitotic figures more common), abnormal, in places where not usually found

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6
Q

Where is dysplasia common?

A
  • cervix – HPV infection
  • bronchus – Smoking (pseudostratified columnar -> squamous)
  • colon – UC associated with IBD (UC -> dysplasia -> cancer)
  • larynx – Smoking
  • stomach – Pernicious anaemia (chronic stomach inflammation)
  • oesophagus – Acid reflux (Barrett’s oesophagus)
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7
Q

What are the types of dysplasia?

A

low grade (unlikely to go on to cancer) and high grade (very likely to develop into cancer)

The high-grade dysplasia is darker (higher nucleo-cytoplasmic ratio)

Both show changes of dysplasia, but the changes are more severe in high-grade dysplasia. The nuclei are bigger and the nucleo-cytoplasmic ratio is higher in high-grade dysplasia

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8
Q

Define malignancy

A

An abnormal, autonomous proliferation of cells unresponsive to normal growth control mechanisms. These cells grow ON THEIR OWN

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9
Q

What is a neoplasm?

What is a tumour?

A

Neoplasia = any new growth, benign or malignant

Tumour = swelling (e.g. nasal polyps are also considered tumours)

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10
Q

What are the differences between benign and malignant tumour?

A

Benign:

  1. Do not invade (so do not metastasise)
  2. Encapsulated (have a compressed capsule around them; they HAVE invaded through the basement membrane, but are encapsulated)
  3. Usually well differentiated (they look like the tissues that they come from)
  4. Slowly growing
  5. Normal mitoses

Malignant:

  1. Invade surrounding tissues (via blood vessels, lymphatics, nerves)
  2. Spread to distant sites
  3. Have no capsule
  4. Well to poorly differentiated (more likely) – harder to determine which cells they originally derived from
  5. Rapidly growing
  6. Abnormal mitoses
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11
Q

Are benign tumours fatal?

A

Benign tumours are not often fatal unless…

  • In a dangerous place: a benign tumour in the meninges (-> epilepsy) or pituitary (-> secrete hormones)
  • Secretes something dangerous: insulinoma – leads to hypoglycaemic episodes
  • Gets infected: a benign tumour in the bladder may obstruct the ureters -> INFECTION of tumour
  • Bleeds: stomach tumours -> haemorrhage
  • Ruptures: liver adenoma (can cause massive haemoperitoneum)
  • Torts (twisted): ovarian cyst -> infarction due to lost blood supply (ischaemic necrosis)
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12
Q

What is a metastisis?

A

a discontinuous growing colony of tumour cells, at some distance from the primary cancer. Cells can break off and embolise around the body

Metastasis depends on the lymphatic and vascular drainage of the primary site

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13
Q

How do you name tumours?

A

define tumours according to the cells that we believe they come from. Benign tumours look more like the cells of origin

  • Benign epithelial tumours
  • Malignant epithelial tumours (carcinoma)
  • Benign soft tissue tumours
  • Malignant soft tissue tumours (sarcoma)
  • Leukaemias & lymphoma
  • Teratoma
  • Hamartoma
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14
Q

What is a papilloma?

A

benign epithelial tumour on the surface epithelium e.g. skin, bladder

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15
Q

What is an adenoma?

A

benign epithelial tumour on glandular epithelium e.g stomach, thyroid, colon, kidney, pituitary, pancreas

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16
Q

What are carcinomas?

A

malignant tumour derived from epithelium

  • Squamous cell (if from skin/oesophagus)
  • Adenocarcinoma (if from glandular epithelium)
  • Transitional cell (if from transitional epithelium)
  • Basal cell carcinoma
17
Q

What are examples of benign soft tumours?

A
  • osteoma: a benign tumour of bone
  • chondroma: a benign tumour of bone
  • lipoma: a benign fat tumour
  • leiomyoma: a benign smooth muscle tumour
18
Q

What is a sarcoma?

What are some examples?

A

malignant soft tissue tumour derived from connective tissue

  • Fat = Liposarcoma
  • Bone = Osteosarcoma
  • Cartilage = Chondrosarcoma
  • Striated muscle = Rhabdomyosarcoma (rhabdomyomas if benign)
  • Smooth muscle = Leiomyosarcoma (leiomyomas if benign, FIBROIDS)
  • Nerve sheath = Malignant Peripheral Nerve Sheath Tumour
19
Q

What is leukaemia?

A

a malignant tumour of bone marrow derived cells which circulate in blood (seen in blood)

20
Q

What is lymphoma?

A

a malignant tumour of lymphocytes (usually) in lymph nodes (seen in lymph nodes)

  • lymphocytes are produced by the bone marrow and they are found in lymph nodes so in some cases you can get a mix of both lymphoma and leukaemia
21
Q

What is a teratoma?

A

A teratoma 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
  • These tumours have MULTIPLE COMPONENTS
22
Q

What’s the difference between gonadal teratomas in males and females?

A

Gonadal teratomas in males, they are almost always malignant

Gonadal teratomas in females, almost always benign – (contain hair and teeth)

23
Q

What is a hamartoma?

A

Localised overgrowth of cells and tissues native to the organ

  • Cells are mature but architecturally abnormal
  • Common in children, and should stop growing when they stop
24
Q

How can you assess the differentiation of a malignant tumour?

A

Criteria for assessing differentiation of a malignant tumour:
- High grade tumours generally have a high stage
- If you find a tumour you need to find out whether it is a primary tumour or if it is a secondary - can be done by inspecting the tumour and looking for evidence of normal function still present:
o Keratin is made by squamous cells
o Mucin is produced by glandular epithelium (adenocarcinoma)
o Bile is made by hepatocytes
o Hormones e.g. insulin is made by the pancreas

Various grading systems – for breast (Nottingham scoring system), prostate (Gleason) and colon cancer

25
Q

What is a tumour that shows little/no differentiation called?

A

anaplastic

26
Q

What is TNM?

A

The Tumour, Node, Metastasis (TNM) system can be applied, and individualised, to tumour in all sites

  • The grade of a tumour describes its degree of differentiation (higher grade = poor differentiation)
  • The stage of a tumour describes how far it has spread (higher stage = greater spread)
  • Tumours of higher grade (i.e. more poorly differentiated) tend to be of higher stage (i.e. spread further)
  • Overall, stage is more important than grade in determining prognosis

Year 2 MCD - Cancer (15 decks)

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