cellular pathology of cancer Flashcards by Emily Southall

define metaplasia *

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

adaptive - cells sensitive to stress eg acid are replaced by cells that can cope

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physiological example of metaplasia

cervix in puberty - go from columnar to squamous epithelium when exposed to acid of vagina

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pathological example of metaplasia

barret’s oesophagus - squamous epithelium to columnar - because of change in pH - exposure to acid from acid reflux

respiratory columnar ciliated epithelium changes to squamous

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definition of dysplasia *

an abnormal pattern of growth in which some of the cellular, architectural, molecular and genetic features are present that associate with cancer

but not invasive

pre-invasive stage with intact basement membrane

it is the step between normal cells and cancer

reversible

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what can be seen in dysplasia *

more mitosis and abnormal mitosis

big nuclei

loss of architectural orientation - lose sequence from basement cells to maturing to keratinisation ie cells arent maturing in the normal way

loss of uniformity of individual cells

hyperchromatic nuclei - dark becasue contain more DNA

mitotic figures - abundant, abnormal and in places that they shouldnt be found

increased nuclear:cytoplasmic ratio - increase in size of nuclei but the cells dont get bigger - nuclei take up a greater proportion of the cell

enlarged nuclei

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where is dysplasia common

cervix - HPV infection

bronchus - smoking

colon - ulcerative colitis

larynx - smoking

stomach - pernicious anaemia (chronic inflamm process)

oesophagus - acid reflux (have metaplasia, that progresses to dysplasia, which progressses to adenocarcinoma)

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what is the difference between low and high grade dysplasia *

low - risk of progression is less, more likely ti be reversible

high - higher risk of invasion, closer to develop invasive cancer, nucleocytoplasmic ratio high so darker

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what is a neoplasia, tumour or malignacy *

an abnormal, autonomous proliferation of cells, unresponsive to normal growth contriol mechanisms and persists even when whatever started the growth mechanism has stopped

(from yr1 - tumour is any mass forming lesion)

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what are characteristics of benign tumour *

DO NOT INVADE/METASTISE - do not invade bv or spread - this is the functional characteristic

encapsulated - in fibrous capsule, easy to remove

usually well differentiated - look like tissue from where they come from

slowly growing - low mitotic rates

normal mitosess

(these are ways recognise benign tumours but dioesnt diagnose them as benign except for the 1st one)

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benefit of tumour being benign *

easier to treat

treatment is 100% effective - no chance that it ahs spread

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how would you test if a tumour had invaded tissue *

eg on chest - if you can move it, it is not attached to the skin/pec major =benign

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when can a benign tumour be fatal *

in dangerous place eg meninges (if block frow between ventricles = hydrocephaly/increased intracranial pressure = death), or pit (press on important things like optic canal, also secrete hormones)

secretes something dangerous eg insulinoma (tumour of B cells)

gets infected eg bladder

ruptures eg liver adenoma - bleeds into the peritoneal cavity

bleeds - stomach (if presses on an artery which bleeds)

torts (twisted) - block blood supply - infarction eg ovarian cyst

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characteristics of a mialignat tumour *

invades surrounding tissues

spreads to distant sites - via bv, nerve and lymphatics (if catch early might not have spread, doesnt mean that it is not malignant) prognosis depends on how far spread/invaded

no capsule

well to poorlyu differentiated

rapidly growing

abnormal mitoses

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define metastasis *

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

in these cases local treatment is not enough

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what determines metastasis *

lymphatic and vascular drainage of the site

lymph node involvement has a worse prognosis

eg colon - Dukes A = 90% - only in bowel wall, Dukes C = 30% - in lymph nodes

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which lymph nodes to the testicles drain to

aortic

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which nodes does the breast drain to

lateral - axillary

medial - internal mammary nodes

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what is nuclear polymorphism *

when nuclei all look different from each other

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how does nuclear cytoplasmic ratio change as cancer progresses *

gets worse from dysplasia to benign to malignant

features of well differentiated tumours *

a small number of mitosess

lack of nuclear polymorphism

relatively uniform nuclei

close resembalence to the corresponidning normal tissue

what does the suffix -oma mean *

benign

what is papilloma *

benign tumour on surface of epi

eg skin/bladder/colon

what is adenoma *

benign tumour of glandular epi

eg stomach, thyroid, colon, kidney, pit, pancreas, mucin, kidney, breast

define carcinoma *

a malignant tumour derived from epi

example of carcinoma \*

squamous cell adenocarcinoma - of glandular tissue transitional cell - bladder basal cell carcinoma - skin

how are carcinoma's named \*

have carcinoma and before this - state what type of epi come from

examples of benign soft tissue tumours \*

oestoma (pic) lipoma - fat chondroma - cartilage leiomyoma - fat

define sarcoma \*

a malignant tumour derived from connective tissue - mesenchymal cells

examples of sarcoma \*

osteosarcoma - pic (see swelling and darker areas) liposarcoma - rare but can occur osteosarcoma chondrosarcoma striated muscle - rhabdomyosarcoma leiomyosarcoma - sm malignant peripheral nerve sheath tumour

feature of sarcoma \*

larger nuclear:cytoplasmic

what are leukaemia and lymphoma \*

tumours of white blood cells - they are different but can spread into each other

define leukaemia \*

a malignant tumour of bone marrow derived cells that circulate in blood

define lymphoma \*

a malignant tumor (even though called -oma) of lymphocytes that usually proliferate in lymph nodes tissue based eg lymph nodes, spleen, tonsils

exceptions of the -oma rule \*

lymphoma melanoma

define teratoma \*

a tumour derived from germ cells, have the potentila to develop into tumours of all 3 germ layers - ectoderm, mesoderm, endoderm totipotent so can differentiate into any type of tissue occur mainly where you find germ cells ie ovaries and testes can occur outside the gonads (Pituitary, pineal, mediastinum, sacrococcygeal areas)

image of mesoderm, endoderm teratoma

middle right - mesoderm bottom L - endoderm (colonic) bottom R - endoderm - bronchi

are teratomas benign or malignant \*

male gonadal are all malignant female gonadal are mainly benign `

image of female tertatoma &

benign ovarian teratoma - has cyst and hair growing in it

define a hamartoma \*

localised overgrowth if cells and tissues native to the organ cells are mature but architecturally are abnormal common in children and should stop growing when they do Common ones are haemangiomas (tumour of bv), bronchial hamartomas, Peutz-Jegher polyps in the gut. eg bile duct or bronchial (in bronchial have cartilage, sm and epi like as normal just arranged differently) image - bile duct - normal bile duct is round, abnormal is spikey

what are the criteria for assessing the differentiation of a malignant tumour \*

evidence of normal function still present eg production of keratin (squamous cell), mucin (adenoma), bile (liver), hormones (endo) eg image - top not glandular (random arrangement of cells), bottom looks like glandular tissue)

what is an anplastic carcinoma \*

no differentiation doesnt do anything any cells do very agressive

describe TNM scale \*

the grade of tumour describes its degree of differentiation stage - how far it has spread - all malignant are locally invasive, stage asks how deep (into mucosa, submucosa, muscularis externa, adventitia, peritoneal cavity) tumours of a higher grade tend to be of a higher stage overall the stage is more important than grade in determining prognosis TNM - tumour (how far invaded and size), nodes, metastasis

define carcinogen \*

any substance that when exposed to living tissue may cause the production of cancer

5 morphological features that allow assessment for the differentiation of a tumour \*

1. number of mitoses 2. nuclear polymorphism 3. shape of nuclei 4. resembalnce to normal tissue 5. evidence of normal function

how can you get squamous carcinoma in lung when there is no normal squamous cells\*

metaplasia occurs 1st - forming the sqaumous cells which then develop into sydplasia and invasive cancer

what does the screening test for cervical cancer look for \*

moving away from looking for dysplasia - now looking for HPV genenomes associated with a higher risk