GENPATH Cancer Pots Flashcards
A 55-year-old woman has felt an enlarging lump in her left breast for the past year. A hard, irregular 5-cm mass fixed to the underlying chest wall is palpable in her left breast.
What are the clues that tells you this may be a malignant tumour?
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A 55-year-old woman has felt an enlarging lump in her left breast for the past year. A hard, irregular 5-cm mass fixed to the underlying chest wall is palpable in her left breast.
What are the clues that tells you this may be a malignant tumour?
**Hard (desmoplastic reaction, fibrosis)
Irregular (not well encapsulated)
Fixed (broke through ECM)
So benign ones are normally tender, regular, and mobile.
A 55-year-old woman has felt an enlarging lump in her left breast for the past year. A hard, irregular 5-cm mass fixed to the underlying chest wall is palpable in her left breast.
An enlarged, non-tender left axillary lymph node is noted.
Describe the pot and microscopy, and suggest whether the lump is benign or malignant. (vvvv IMPT!!!)
Descriptions:
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Descriptions:
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Benign or Malignant? […]
A 55-year-old woman has felt an enlarging lump in her left breast for the past year. A hard, irregular 5-cm mass fixed to the underlying chest wall is palpable in her left breast.
An enlarged, non-tender left axillary lymph node is noted.
Describe the pot and microscopy, and suggest whether the lump is benign or malignant. (vvvv IMPT!!!)
Descriptions:
***- poorly circumscribed
- Invasive
- metastasis into adjacent lymph node
- nipple retraction (desmoplastic reaction)
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Descriptions:
**- Hyperchromatism
- Pleomorphism
- High N/C ratio
- Abnormal mitosis
- Central necrosis (indicative of aggressive cancer)
Benign or Malignant? Malignant!!
A 55-year-old woman has felt an enlarging lump in her left breast for the past year. A hard, irregular 5-cm mass fixed to the underlying chest wall is palpable in her left breast.
An enlarged, non-tender left axillary lymph node is noted.
The diagnosis is invasive ductal carcinoma.
How is invasive ductal carcinoma different from ductal carcinoma in situ (CIS)?
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A 55-year-old woman has felt an enlarging lump in her left breast for the past year. A hard, irregular 5-cm mass fixed to the underlying chest wall is palpable in her left breast.
An enlarged, non-tender left axillary lymph node is noted.
The diagnosis is invasive ductal carcinoma.
How is invasive ductal carcinoma different from ductal carcinoma in situ (CIS)?
Invasive = spread beyond basement membrane, can metastasize
CIS = yet to break beyond basement membrane, cannot metastasize
The KEY difference between invasive carcinoma and CIS is always **BASEMENT MEMBRANE **integrity!!! Broke through = can metastasis = malignant = invasive carcinoma (no longer CIS)
A 55-year-old woman has felt an enlarging lump in her left breast for the past year. A hard, irregular 5-cm mass fixed to the underlying chest wall is palpable in her left breast.
An enlarged, non-tender left axillary lymph node is noted.
The diagnosis is invasive ductal carcinoma.
MRI shows multiple liver nodules.
CXR shows multiple lung nodules.
A left breast biopsy is performed, and on microscopic examination shows high-grade infiltrating ductal carcinoma.
How did the tumour get to the liver and lungs?
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Other than liver and lungs, which is the other major organ that tends to accept haematogenous matastases?
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A 55-year-old woman has felt an enlarging lump in her left breast for the past year. A hard, irregular 5-cm mass fixed to the underlying chest wall is palpable in her left breast.
An enlarged, non-tender left axillary lymph node is noted.
The diagnosis is invasive ductal carcinoma.
MRI shows multiple liver nodules.
CXR shows multiple lung nodules.
A left breast biopsy is performed, and on microscopic examination shows high-grade infiltrating ductal carcinoma.
How did the tumour get to the liver and lungs?
**metastasis to liver via portal venous drainage system
metastasis to lungs via caval venous drainage system
Other than liver and lungs, which is the other major organ that tends to accept haematogenous matastases?
Brain
Arteries have thicker walls and are less readily penetrated than venous vessels. then how tumour cells spread to the brain by arteries???
- tumour cells form metastatic nodules in the first capillary bed they encounter (explaining for the frequency of metastases in the liver and lung)
- but some tumour cells may survive passage through the microcirulation, cross pulmonary microcirculation and reach distant organs like the brain
- also can be due to arteriovenous shunts
- **Primary lung tumours **can directly infiltrate pulmonary venous system and enter systemic arterial circulation
A 55-year-old woman has felt an enlarging lump in her left breast for the past year. A hard, irregular 5-cm mass fixed to the underlying chest wall is palpable in her left breast.
An enlarged, non-tender left axillary lymph node is noted.
The diagnosis is invasive ductal carcinoma.
MRI shows multiple liver nodules.
CXR shows multiple lung nodules.
A left breast biopsy is performed, and on microscopic examination shows high-grade infiltrating ductal carcinoma.
Using TNM staging for breast cancer, which stage is this patient at?
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A 55-year-old woman has felt an enlarging lump in her left breast for the past year. A hard, irregular 5-cm mass fixed to the underlying chest wall is palpable in her left breast.
An enlarged, non-tender left axillary lymph node is noted.
The diagnosis is invasive ductal carcinoma.
MRI shows multiple liver nodules.
CXR shows multiple lung nodules.
A left breast biopsy is performed, and on microscopic examination shows high-grade infiltrating ductal carcinoma.
Using TNM staging for breast cancer, which stage is this patient at?
T = size/depth of tumour, invasiveness = cant be sure (T2-T4?)
N = lymph node involvement = 1 = N1
M = metastasis = yes = M1
A 55-year-old woman has felt an enlarging lump in her left breast for the past year. A hard, irregular 5-cm mass fixed to the underlying chest wall is palpable in her left breast.
An enlarged, non-tender left axillary lymph node is noted.
The diagnosis is invasive ductal carcinoma.
What is the most likely pathology in the lymph node and what is the pathogenesis?
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A 55-year-old woman has felt an enlarging lump in her left breast for the past year. A hard, irregular 5-cm mass fixed to the underlying chest wall is palpable in her left breast.
An enlarged, non-tender left axillary lymph node is noted.
The diagnosis is invasive ductal carcinoma.
What is the most likely pathology in the lymph node and what is the pathogenesis?
metastasis of invasive ductal carcinoma to lymph node via lymphatics
a pot that shows encapsulated/well circumscribed tumor usually means the tumor is […]
a pot that shows encapsulated/well circumscribed tumor usually means the tumor is * benign*
Applying the concept of modes of cancer spread, how can colon cancer spread?
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Applying the concept of modes of cancer spread, how can colon cancer spread?
- Local (through bowel wall, to adjacent organs, through serosa to peritoneal cavity)
- Lymphatics
- Haematogenous
Impt concept. alw think blood, lymph, local.
Benign vs Malignant (vvvvvvvvvvv IMPT!!!)
Gross appearance
1. Surface –> […]
2. Capsule –> […]
3. Necrosis –> […]
Benign vs Malignant (vvvvvvvvvvv IMPT!!!)
Gross appearance
1. Surface –> smooth vs irregular
2. Capsule –>* fibrotic capsule, well circumscribed vs no capsule, poorly circumscribed*
3. Necrosis –> unlikely vs necrosis & haemorrhage
Cancer cachexia is an indication of […] cancer
Cancer cachexia is an indication of aggressive cancer
Cancer cachexia is a wasting syndrome characterized by weight loss, anorexia, asthenia and anemia.
How to see muscle wasting? See **back of hands **or temples
Cervical Intraepithelial Neoplasm (CIN) is a type of CIS.
How is CIN classified?
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How do cases of CIN usually present?
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What is the major aetiological factor? Which subtype number?
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Cervical Intraepithelial Neoplasm (CIN) is a type of CIS.
How is CIN classified?
by thickness of epithelial tissue affected. CIN 1 = dysplasia affecting 1/3 of thickness of epithelial tissue, CIN 2 = 2/3, CIN 3 = 3/3
How do cases of CIN usually present?
Asymptomatic, as CIS usually are.
What is the major aetiological factor? Which subtype number?
**HPV16/18 mainly, but other HPV strains also can.
Describe these 2 pots of the thyroid and decide if they are benign or malignant.
Descriptions:
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Benign or Malignant? […]
Descriptions:
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Benign or Malignant? […]
Describe these 2 pots of the thyroid and decide if they are benign or malignant.
Descriptions:
- Well encapsulated/circumscribed
- Homogenous appearance
-* No necrosis, no cystic change, no other nodules*
Benign or Malignant? Benign
Descriptions:
- Not well circumscribed, invasive borders
- Multifocal nodules of varying sizes
- Metastasis
- Haemorrhage
Benign or Malignant?* Malignant*
Do tumours need to be malignant to cause hormonal effect?
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Do tumours need to be malignant to cause hormonal effect?
NO!!** Paraneoplastic syndrome yo.
“Paraneoplastic syndrome are symptom complexes in cancer patients not attributable to local or distant spread of the tumour or hormonal effects indigenous to the tissue from which the tumour arose”
TLDR, this tumour is in this place but produces something that another places produces. e.g small cell carcinoma of lung
or u can think of it as this cancer cell is so damn lost that it forgot who it was supposed to be and started differentiating into another cell (that secretes hormones)
How can squamous cell carcinoma (SCC) of the lung develop when the lung is lined by ciliated pseudostratified columnar epithelium?
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How can squamous cell carcinoma (SCC) of the lung develop when the lung is lined by ciliated pseudostratified columnar epithelium?
columnar epithelium irritated by smoke, undergo metaplasia into stratified squamous epithelium
How do cancers actually kill?
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How do cancers actually kill?
- Metastasis to key organs, leading to multiple organ failure
- But can also be simply cancer cachexia causing infection that kills the patient
How to identify malignancy under microscope? (vvvvvvvvvvvvvv. IMPT)
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How to identify malignancy under microscope? (vvvvvvvvvvvvvv. IMPT)
- ***Hyperchromasia
- pleomorphism
- high/abnormal mitosis
- high N/C ratio*
- Infiltrative growth
- Metastasis
- Anaplasia
- necrosis & haemorrhage
- Poorly formed/leaky blood vessels
Is an ovarian teratoma benign or malignant?
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Is an ovarian teratoma benign or malignant?
Benign. No invasion, no metastasis, no microscopic features of cancer. It just looks like a mess.
Is it only malignant cancers can cause local effects?
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Is it only malignant cancers can cause local effects?
NO
What are some exceptions to cancer nomenclature?
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What are some exceptions to cancer nomenclature?
Blood derived tumours, melanoma (malignant), blastomas, germ cell tumours
What are some histological features that indicate cancer of squamous differentiation? **(IMPT!!!) **
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What are some histological features that indicate cancer of squamous differentiation? (IMPT!!!)
Keratin pearls, desmoplastic reaction
What are some important paraneoplastic syndromes to know?
- Cushing syndrome can be caused by […]
- SIADH can be caused by […]
- Hypercalcemia can be caused by […]
- Acanthosis nigricans can be caused by […]
- Dermatomyositis can be caused by […]
- Venous Thrombosis (Trousseau phenomenon) can be caused by […]
What are some important paraneoplastic syndromes to know?
- Cushing syndrome can be caused by SCLC, pancreatic carcinoma, neural tumours
- SIADH can be caused by SCLC, intracranial neoplasms
- Hypercalcemia can be caused by SCC of lung, breast carcinoma, renal carcinoma, adult T-cell leukemia/lymphoma, ovarian carcinoma
- Acanthosis nigricans can be caused by gastric, lung, uterine carcinoma
- Dermatomyositis can be caused by bronchogenic, breast carcinoma
- Venous Thrombosis (Trousseau phenomenon) can be caused by Pancreatic carcinoma, bronchogenic carcinoma & others
What are the local effects of gastric cancer?** (IMPT)**
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What are the local effects of gastric cancer?** (IMPT)**
- Bleeding leading to maelena, haematemesis
- Perforation
- gastric outlet obstruction
- linitis plastica
What are the modes of breast cancer spread?
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What are the modes of breast cancer spread?
- Local
- Lymphatics
- Haematogenous
What is the difference between carcinoma in situ (CIS) and cancer?
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What is the difference between carcinoma in situ (CIS) and cancer?
CIS havent breach basement membrane
What is the difference between staging and grading?
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A high grade tumour exhibits […] degree of anaplasia, […] degree of differentation and […] degree of mitotic activity
What is the difference between staging and grading?
**Staging = how advanced tumours are (size and invasiveness)
Grading = how much tumour resemble its normal counterparts (malignancy)
A high grade tumour exhibits high **degree of anaplasia, low degree of differentation and* high*** degree of mitotic activity
What is the histological feature that indicate malignancy?
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What is the histological feature that indicate malignancy?
**Invasion into stroma **
