CSIM 1.4 Neoplasia 1 and Case 39 Launch

Question 1

Which cancer is the most lethal?

Answer 1

Lung cancer

Question 2

Describe colorectal cancer mortality

Answer 2

All mortality occurs in the first 5 years. If patient is alive after 5 years since diagnosis, they’re all good.

Question 3

Recall the adaptations of cells.

Which of these is never physiological

Answer 3

• Atrophy
  
  • Hypertrophy
  • Hyperplasia
  • Metaplasia
  • Dysplasia

All can be pathological or physiological except for dysplasia, which is always pathological

Question 4

What are the types of atrophy?

Define each

Answer 4

Cell atrophy
• Decrease in cell size
Organ atrophy
• Decrease in organ size due to EITHER a decrease in cell size OR a decrease in cell number

Question 5

Loss of supply of what can cause atrophy?

Answer 5

• Innervation
  
  • Oxygen
  • Nutrients
  • Endocrine stimulation

Question 6

What is hypertrophy and hyperplasia?

What are the types of each?

Answer 6

Hypertrophy
• An increase in SIZE of INDIVIDUAL cells

Hyperplasia:
• An increase in NUMBER of cells

Each can be pathological or physiological

Question 7

Is cancer a type of hyperplasia?

Answer 7

No - it is neoplasia

Hyperplasia is the same cell type, e.g. endometrial proliferation in response to oestrogen

Question 8

What is dysplasia?

Answer 8

Abnormal-looking cells and loss of uniformity, characterised by:
• Pleomorphism (varying size and shape)
• Hyperchromasia (darker staining nuclei)
• Increase in nucleus to cytoplasm ratio
• Chaotic, disorderly proliferation which is no longer confined to the basal layer

Question 9

Is dysplasia reversible?

Answer 9

Yes, if the inciting cause is removed and cancer stage has not been reached

Question 10

How is dysplasia graded?

Answer 10

Mild, moderate, severe - depending on likelihood to become a carcinoma

(can also be 2-tiered as well ‘low grade’ and ‘high grade’)

Question 11

What are the gradings of cervical dysplasia called?

Answer 11

Mild is called CIN1
Moderate is called CIN2
Severe is called CIN3

NB: CIN = cervical intra-epithelial neoplasia

Question 12

Which of the adaptations causes an increased risk of cancer?

Answer 12

No increased risk:
• Atrophy
• Hypertrophy

Slight increased risk:
• Hyperplasia
• Metaplasia

Greatly increased risk:
• Dysplasia

Question 13

Why does hyperplasia cause an increased risk of cancer?

Answer 13

Increased number of divisions presents more propensity for some of those divisions to generate errors during copying DNA

Question 14

Why is metaplastic tissue more likely to generate a carcinoma?

Answer 14

The poorly-located cell is more susceptible to insult in the environment it is not designed for

Question 15

What is the strict definition of a tumour

Answer 15

An abnormal swelling (not necessarily a neoplasm, although this is how it is commonly used)

Question 16

What is the definition of a neoplasm?

Answer 16

An abnormal, uncoordinated proliferation of a section of tissue, which persists in the same excessive manner after cessation of the causative stimulus

Question 17

How are neoplasms classified?

Answer 17

Classified by behaviour:
1)Benign
  •  Stay in one place and are non-fatal
2)Malignant
  •  Spread around the body and are aggressive in local behaviour
3)Borderline

Also classified by histogenesis (cell of origin):
• Epithelial
• Mesenchymal (CT)
• Lymphoid

Question 18

Describe the differences between benign and malignant neoplasms

Answer 18

Malignant (brackets represent benign characteristics):
• Faster growth rate
• Numerous mitotic figures (few)
• Variable differentiation (similar differentiation to parent)
• Hypochromic, pleomorphic nuclei (normal)
• Ill-defined border with no capsule (circumscribed and encapsulated IMG 25)
• Invasive (non-invasive)
• Frequently metastasise (do not metastasise)

Question 19

What are the types of benign neoplasms that affect epithelial cells?

Answer 19

Adenoma:
• Benign neoplasm of glandular epithelium

Papilloma:
• Benign neoplasm of non-glandular epithelium

Question 20

What is a localised overgrowth of tissue of benign neoplastic type often called?

Answer 20

A polyp

Question 21

Why are benign adenomas worth removing?

Answer 21

They have a risk of progressing to a malignant neoplasm

Question 22

How can you tell if a benign adenoma of the adrenal gland comes from the medulla or cortex?

Answer 22

Because of the colour (IMG 26 = cortex, for example)

Question 23

Benign neoplasms of what can cause hypertension?

Answer 23

Adrenal cortex (aldosterone production)

Question 24

What are carcinomas?

What are the types of carcinomas?

Answer 24

Malignant neoplasms of EPITHELIA:
  •  Glandular: Adenocarcinoma
  •  Squamous: Squamous cell carcinoma
  •  Transitional: Transitional cell carcinoma
  •  Urothelium: Urothelial carcinoma

Question 25

Describe briefly the cell adaptations in lung cancer caused by cigarette smoke

Answer 25

Metaplasia -> Dysplasia -> Neoplasia

Question 26

Give the name for:

1) A malignant neoplasia of an epithelial tissue
2) A malignant neoplasia of a connective tissue
3) A benign neoplasia of an epithelial tissue
4) A benign neoplasia of a connective tissue

Answer 26

1) Carcinoma
2) Sarcoma
3) Adenoma or papilloma depending on if the tissue is glandular
4) Depends on the specific connective tissue

Question 27

What are the types of benign neoplasms that affect connective tissue?

Answer 27

Fat 
  •  Lipoma
Smooth muscle
  •  Leiomyoma
Striated muscle
  •  Rhabdomyoma
Blood vessel
  •  Haemangioma
Cartilage
  •  Chondroma
Bone
  •  Osteoma

Question 28

What are the types of malignant neoplasms that affect connective tissue?

Answer 28

Fat 
  •  Liposarcoma
Smooth muscle
  •  Leiomyosarcoma
Striated muscle
  •  Rhabdomyosarcoma
Blood vessel
  •  Angiosarcoma
Cartilage
  •  Chondrosarcoma
Bone
  •  Osteosarcoma