CSIM 1.5 Neoplasia 2

Question 1

What is a mixed neoplasm?

Give an example.

Answer 1

A neoplasm wth a combination of cell types.

Fibroadenoma

Question 2

Which neoplasms have misleading names?

Answer 2

All the following are MALIGNANT (despite not ending in sarcoma or carcinoma):
  •  Hepatoma
  •  Malanoma
  •  Seminoma
  •  Lymphoma

Question 3

What is a teratoma?

Answer 3

A neoplasm derived from a germ cell and so shows differentiation along multiple different pathways

Question 4

What are blastomas?

Answer 4

Primitive undifferentiated/unmatured (‘-blast’) neoplasms

Question 5

What can types of lymphomas be divided into?

Answer 5

Hodgkin and non-Hodgkin lymphoma

Question 6

What type of neoplasia is seen in:

1) Lung cancer
2) Prostate cancer
3) Breast cancer
4) Colorectal cancer
5) Oesophageal cancer
6) Pancreatic cancer
7) Ovarian cancer
8) Bladder cancer
9) Stomach cancer
10) Cervical cancer
11) Laryngeal cancer

Answer 6

1) Squamous cell carcinoma (due to the metaplasia of respiratory epithelium into squamous epithelium)
2) Adenocarcinoma
3) Adenocarcinoma
4) Adenocarcinoma
5) Squamous cell carcinoma (unless in Barrett’s oesophagus where adenocarcinoma is present due to metaplasia of stomach glandular tissue)
6) Adenocarcinomas
7) Adenocarcinoma
8) Urothelial carcinoma or transitional cell carcinoma
9) Adenocarcinoma
10) Squamous cell carcinoma (due to metaplasia of glandular -> squamous)
11) Squamous cell carcinoma (same rationale as lung)

Question 7

What is the difference between leukaemia and lymphoma?

Answer 7

Leukaemia is derived from cells from the bone marrow

Lymphoma is derived from white blood cells

Question 8

What is the difference between dysplasia and benign neoplasm?

Answer 8

A benign neoplasm forms a mass visible to the naked eye, however dysplasia can only be identified down a microscope

Question 9

What factors is invasion facilitated by?

Answer 9

• Abnormal cell motility
  
  • Decreased cell adhesion
  • Secretion of proteolytic enzymes

Question 10

Which proteolytic compounds are produced by invasive cells?

Answer 10

• Metalloproteinase
  
  • Type IV collagenase
  • Plasmin
  • Non-specific proteinases

Question 11

What barrier needs to be broken for invasion to occur? Which protein produced by invasive cells facilitates this?

Answer 11

Basement membrane (IMG 27)

Type IV collagenase

Question 12

What is meant by the phrase ‘carcinoma in situ’ (CIS)?

Which CIN is an example of this?

Answer 12

An abnormal EPITHELIUM (NB: ‘carcinoma’) that has all the cellular features of a malignancy (such as severe dysplasia) but has not invaded through the basement membrane

CIN3

Question 13

What cancers can the following indicate:

1) Hoarse voice
2) Indigestion at old age

Answer 13

1) Laryngeal cancer

2) Oesophageal cancer

Question 14

What are the three main pathways of metastasis?

Answer 14

• Lymphatic
  
  • Haematogenous
  • Transcoelomic (across body cavities)

Question 15

Describe the origin and destination of metastasis which travel through the lymphatics

What characteristic symptom does this cause?

Answer 15

• Carcinomas NOT sarcomas
  
  • Travel to local lymph nodes, and then distant lymph nodes

Enlarged, firm lymph nodes

Question 16

How can foreign metastasised cells of unknown origin be traced/identified?

Answer 16

With immunohistochemistry by pathologists (using antibodies)

Question 17

Describe the origin and destination of metastasis which travel through the blood (haematogenous spread)

Answer 17

Carcinomas AND sarcomas

Travels to:
  •  Liver
  •  Lungs
  •  Brain
  •  Bone
FOLLOWS DIRECTION OF VENOUS DRAINAGE

Question 18

Which cavities can transcoelomic spread through?

Answer 18

Pericardial sac
Pleural cavity
Peritoneal cavity

Question 19

What medium do transcoelomic metastasising cells create and travel through?

What diagnostic value has this got?

Answer 19

Effusions:
• Pericardial effusion (pericardial sac)
• Pleural effusion (pleural cavity)
• Ascites (peritoneal cavity)

Removal of fluid can be biopsied

Question 20

What are the prognostic factors of malignant neoplasms?

Answer 20

• Type of neoplasm (location, cell type, etc) e.g. lymphoma
  
  • Grade of neoplasm (how closely the neoplasm is related to parent tissue)
  • Stage of neoplasm (how far the neoplasm has spread ‘SS: Stage = Spread’)

Question 21

How is type of neoplasm determined

Answer 21

Immunohistochemistry or electron microscopy

Question 22

What does the grade of neoplasm depend on?

Answer 22

Histological assessment of:
  •  Mitotic activity
  •  Nuclear size
  •  Pleomorphism 
  •  Degree of differentiation

Question 23

What systems are used for neoplasm staging?

Answer 23

Colorectal cancer:
• Duke’s staging

Other:
• TNM staging

Question 24

Describe the Duke’s stages of colorectal cancer, and the survival rate for each.

Answer 24

Stage A - 90%
• Adenocarcinoma starting in the epithelium invades into the bowel wall but has not gone all the way through, and is confined to the wall

Stage B - 75%
• Neoplasm invasion has emerged on the other side of the bowel wall

Stage C - 50%
• Neoplasm has metastasised to the local lymph nodes

Question 25

Describe the TNM staging of carcinomas

Answer 25

T = Tumour: • Number 1 to 4 • Depends on how deeply the neoplasm has invaded its tissue of origin N = Lymph Nodes: • 0 to 2 • 1 = local lymph node metastases • 2 = distant lymph node metastases M = Distant Metastases: • 0 or 1 • Depends on presence of distant metastases (in tissues other than lymph)