Disorders of Growth

Question 1

NEOPLASM

Answer 1

“A NEOPLASM is an abnormal mass of tissue, the growth of which exceeds and is unco-ordinated with that of normal tissues, and which persists in the same excessive manner after cessation of the stimuli which evoked the change.”

    - Sir Rupert Willis, 1960

Question 2

NEOPLASIA

Answer 2

NEOPLASIA is the process by which a neoplasm is formed.

Question 3

TUMOUR

Answer 3

TUMOUR literally means swelling, but conventionally is used as a synonym for neoplasm

Question 4

BEHAVIOUR of Tumours

Answer 4

A benign tumour grows by expansion, displacing adjacent tissue
A malignant tumour grows by infiltration of local tissues, and spreads to other parts of the body
Primary tumour
original malignant tumour
Secondary tumours
“offspring” of a primary malignant tumour

Question 5

SPREAD OF MALIGNANT TUMOURS

Answer 5

Local - direct invasion

Distant – metastasis

Question 6

ROUTES OF METASTASIS

Answer 6

lymphatics
  blood
  transcoelomic
  along epithelial-lined spaces
  within epithelium

Question 7

METASTASIS VIA LYMPHATICS

Answer 7

tumour may directly invade lymphatics
tumour emboli filtered out, then grow, in lymph nodes
typical of epithelial malignancy

Question 8

METASTASIS VIA BLOOD

Answer 8

tumour may invade blood vessels
emboli filtered out by capillary beds, eg liver, lung
typical of stromal malignancy and later stages of epithelial malignancy

Question 9

METASTASIS VIA TRANSCOELOMIC SPREAD

Answer 9

peritoneal, pleural

Question 10

METASTASIS VIA EPITHELIAL-LINED SPACES

Answer 10

bronchiolo-alveolar carcinoma of lung

Question 11

METASTASIS WITHIN EPITHELIUM

Answer 11

Paget’s disease of nipple, vulva and anus

Question 12

PARTICULAR SITES OF METASTASES - LIVER

Answer 12

liver: GIT carcinomas, GUS, bronchus, breast

Question 13

PARTICULAR SITES OF METASTASES - LUNG

Answer 13

lungs: sarcoma; carcinoma of thyroid, breast, kidney, bronchus, etc.

Question 14

PARTICULAR SITES OF METASTASES - BONE

Answer 14

bone: carcinoma of breast, thyroid, bronchus, prostate, uterus

Question 15

PARTICULAR SITES OF METASTASES - BRAIN

Answer 15

brain: carcinoma of bronchus

Question 16

PARTICULAR SITES OF METASTASES - ENDOCRINES

Answer 16

endocrines: carcinoma of bronchus often goes to adrenals

Question 17

PARTICULAR SITES OF METASTASES - SKIN

Answer 17

skin: malignant melanoma; clear cell carcinoma of kidney

Question 18

BENIGN EPITHELIAL TUMOURS

Answer 18

Adenoma
Papilloma
Cystadenoma
Polyp - a mass attached to a surface, which may or may not be a neoplasm

Question 19

MALIGNANT TUMOURS

Answer 19

Cancer - any malignant tumour
Carcinoma - a malignant tumour of epithelial tissue
Sarcoma - a malignant tumour of stromal tissue

Question 20

MESENCHYMAL TUMOURS

Answer 20

are named according to the cell type, with a suffix

- oma    		if benign
	- sarcoma		if malignant

e.g. lipoma and liposarcoma

Question 21

LEUKAEMIA

Answer 21

neoplastic proliferation of haemopoietic stem cells
neoplastic cells spill over into the blood stream
all regarded as malignant

Question 22

LYMPHOMA

Answer 22

malignant proliferation of cells of lymphoid tissue
Two types
Hodgkin’s disease
mixture of cells, including Reed-Sternberg cells
non-Hodgkin’s lymphoma
lacks the cellular mixture of Hodgkin’s disease

Question 23

TERATOMA

Answer 23

arises from “totipotential” cells, producing tissues representing all three germ cell layers
ovary (usually benign)
testes (usually malignant)
midline (sequestered primitive cells)

Question 24

PRECURSORS OF MALIGNANCY

Answer 24

PREMALIGNANT CONDITIONS
lesions with an increased risk of the development of invasive tumour
can be non-neoplastic or neoplastic

Question 25

PREMALIGNANT CONDITIONS NON-NEOPLASTIC

Answer 25

``` chronic inflammation varicose leg ulcers can lead to skin cancer cirrhosis of the liver hepatocellular carcinoma chronic ulcerative colitis adenocarcinoma of the large intestine xeroderma pigmentosum squamous cell carcinoma of the skin ```

Question 26

PREMALIGNANT CONDITIONS NEOPLASTIC

Answer 26

``` familial polyposis coli autosomal dominant 1000s of large intestinal adenomas carcinoma inevitable intra-epithelial neoplasia: nuclear changes of carcinoma, without breaching basement membrane - "dysplasia" or "carcinoma-in-situ" - important in uterine cervix, vulva, bronchus, etc. ```

Question 27

TUMOUR GRADING

Answer 27

an assessment of the degree of differentiation of a tumour correlates with how aggressive the tumour behaves only relevant for malignant tumours usually define 3 or 4 grades

Question 28

TUMOUR STAGING

Answer 28

``` based on three main features size of primary tumour extent of lymph node disease any blood-borne metastasis sometimes quoted as "TNM" The TNM system T = size of tumour (T1 to T4) N = extent of lymph node involvement (N0 to N3) M = distant metastasis (M0 to M1) criteria different for each tumour better prediction of outcome than grade, for most tumours ```

Question 29

THE EFFECTS OF TUMOURS

Answer 29

displacement or destruction of normal structures excess “normal” function paraneoplastic phenomena

Question 30

EFFECTS OF BENIGN TUMOURS

Answer 30

Mechanical pressure Obstruction Ulceration Infection Rupture of cystic neoplasm Hormone production Malignant change

Question 31

EFFECTS OF MALIGNANT TUMOURS

Answer 31

All the physical effects of benign tumours Tissue destruction ``` Haemorrhage any cancer breaching a vessel wall Secondary infection bacterial invasion of necrotic tumour Cachexia severe weight loss increased metabolic rate tissue necrosis factor Pain Anaemia haemorrhage bone marrow replacement haemolysis Paraneoplastic syndromes ```

Question 32

PARANEOPLASTIC SYNDROMES

Answer 32

Ectopic hormone production carcinoma of bronchus may cause Cushing's syndrome, inappropriate ADH secretion, secretion of PTH analogue fibrosarcoma can produce hypoglycaemia renal carcinoma can release erythropoetin Peripheral neuropathy, cerebellar degeneration, myopathy Thrombophlebitis migrans carcinoma of bronchus (5%) and pancreas (30%) Acanthosis nigricans caused by epidermal growth factor analogue Nephrotic syndrome proteinuria, hypoalbuminaemia, generalised oedema complexes of tumour antigen and host antibody deposited in glomerulus Finger clubbing Hypertrophic pulmonary osteoarthropathy Non-bacterial thrombotic endocarditis