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

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 pregnancy – the cervix opens up and the columnar epithelium of the endocervical canal is exposed to the acidic uterine fluids 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

Define dysplasia

Answer 4

Abnormal growth pattern where some of the cellular and architectural features of malignancy are present. pre-invasive stage with an intact basement membrane

Question 5

State some features of cancer that are seen in dysplasia.

Answer 5

All in places wouldn’t expect:
Large nuclei (and hyperchromatic) 
Increased mitoses  
Abnormal mitoses
Increased nucleo-cytoplasmic ratio  
Loss of architectural orientation 
Loss of uniformity of individual cells

Question 6

Common sites of dysplasia

Answer 6

Cervix- HPV infection
Oesophagus- acid reflux
Bronchioles- smoking
Stomach- pernicious anaemia

Question 7

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

Answer 7

They both show changes of dysplasia but the changes are more severe in high-grade dysplasia
High-grade has a high risk of progression to cancer

Question 8

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

Answer 8

They do not metastasise
They do not invade
They also are usually encapsulated
Slow growing and have normal mitoses

Question 9

Under what conditions can benign tumours be dangerous?

Answer 9

If they are in a dangerous location - meninges, pituitary
If they secrete something dangerous - insulinoma
If they get infected - bladder
If they bleed - stomach
If they rupture - liver
If they become twisted - ovaries

Question 10

What are the features of malignant tumours?

Answer 10

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

Question 11

Define metastasis.

Answer 11

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

Question 12

What are the two different types of benign epithelial tumour?

Answer 12

Papilloma – of the surface epithelium

Adenoma – of glandular epithelium

Question 13

Define carcinoma.

Answer 13

Malignant tumour derived from the epithelium

Question 14

What are the different types of carcinoma?

Answer 14

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

Question 15

State some different types of benign soft tissue tumour.

Answer 15

Osteoma –bone
Lipoma - fat
Leiomyoma – smooth muscle

Question 16

Define sarcoma.

Answer 16

Malignant tumour derived from connective tissue (mesenchymal) cells

Question 17

How can sarcomas be distinguished for fat bone and cartilage

Answer 17

Fat- liposarcoma
Bone- osteosarcoma
Cartilage- chondrosarcoma

Question 18

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

Answer 18

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

Question 19

Define leukaemia.

Answer 19

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

Question 20

Define lymphoma.

Answer 20

Malignant tumour of lymphocytes (usually) in lymph nodes

Question 21

Define teratoma.

Answer 21

A tumour derived from germ cells, which has the potential to develop into tumours of all three germ layers
Ectoderm
Mesoderm
Endoderm

Question 22

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

Answer 22

Gonadal teratomas in men are almost always malignant

Gonadal teratomas in women are almost always benign

Question 23

Define hamartoma.

Answer 23

Localised overgrowth of cells and tissue native to the organ

Question 24

Which group of the population is hamartoma common in?

Answer 24

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

Question 25

What is the difference between grading and staging?

Answer 25

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

Question 26

What is meant by the ‘degree of differentiation’?

Answer 26

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

Question 27

What are the grading systems for breast and prostate cancer?

Answer 27

Breast –Nottingham scoring system

Prostate – Gleason classification

Question 28

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

Answer 28

Anaplastic

Question 30

What do metastasis depend on

Answer 30

Vascularity and lymph drainage

Question 31

What gives metastasis a worse prognosis

Answer 31

Lymph node involvement