L29: Cancer Pathology Flashcards
What is neoplasia?
“new growth”
Not useful for us (eg. not hyperplasia) = mutation trying to take over body or area
But unlike new growth in normal tissues (eg. in repair), this involves mutations in the DNA and, at the very least, is not a useful growth for the body.
_____ a key part of pathogenesis?
Genetics
Apart of breast and prostate cancer it is quite similar in _____ incidence.
- Relates to professions
- Eg melanoma (eg. both genders the same = both exposure to the sun)
- Kidney cancer more in men
- Incidence was high in males than females in lung cancer (in the past)
- eg. more males smoke –> now equal
- Deaths by melanoma = more in males (different to incidences)
What is the role of the therapist for rehabilitation and management of cancer and palliative care needs?
Essential member of multi-disciplinary team
“Absence of therapy intervention would be detrimental to patient care and ability of the patient/family to cope with effects of cancer or its treatment on their functional capacity and quality of life.”
What is meosthelioma?
malignant cancer of pleural lining of lung, often after exposure to asbestos.
Note sub-clones (metastases) in lung tissue.
What is the physiotherapy and mesothelioma treatment?
The non-pharmacological breathlessness management programmeappears to offer a wide range of benefits to patients, including improving functional capacity, coping strategies and self-control.
Such benefits are most likely to be due to a combination of breathing control, activity management and the therapist qualities.
What is adaptation?
Cells have a certain ability to adapt to change before a disease state forms
What are 6 processes for cel growth?
Which of the 6 processes for cell growth are reversible?
All these processes are reversible:
- Hyperplasia
- Hypertrophy
- Metaplasia
- Atrophy
- Dysplasia
- Eg. cut out part of liver
- Able to start proliferation process
Which or the 6 processes for cell growth are irreversible?
Neplasia
What does the progression from hyperplasia to dysplasia to neoplasia look like?
What is cancer development?
a step-wise process that involves mutations in many genes
Only ______ is needed for transformation to cancer cell
one cell
How does cancer form?
clonal expansion
What is the proliferation with cancer?
Proliferation can be balanced by natural regression (apoptosis, dotted circles).
Some cells become quiescent (G0), some differentiate to metastatic clones (purple shapes)
Need vasculature to allow growth (cause deletion of cells)
How are cells “transformed” to a cancer phenotype?
(methylation, acetylation, deacetylation, etc)
What are 3 characteristics of Carcinogen?
- Chemical carcinogen –cigarette smoke, hydrocarbons, aflatoxin, urethane
- Biological –viruses like EBV
- Physical –radiation, ionizing or UV Initiation and then promotion
What are carcinogen?
agent that can transform cells
_____ hits for transition from normal cell to cancer (and metastasis). What is an example?
Multiple molecular
What are the 6 molecular pathways of cancer?
- Faulty cell cycle genes
- Faulty genes that control apoptosis
- Faulty DNA repair genes
- Gain of function of oncogenes
- Loss of function of tumour suppressor genes
- Mutations in growth factors/receptors controlling growth and differentiation
What is Burkitt’s lymphoma?
- Translocations activate some oncogenes
- Associated with Ebstein Barr virus infection.
- First described in Africa.
What are the 2 classifications of cancer?
- Benign
- Malignant
How do you classify benign tumours?
have suffix “oma” eg fibroma
What are 3 ways to classify malignant tumours?
have suffix
- “sarcoma” (fleshy –little connective tissue)
- “carcinoma” (epithelial)
- “adenocarcinoma” (glandular)
Sar/carcin/adenocarcin: site of mutation
Not localised
Some cancers are always ______. Give 3 examples.
malignant
eg.
- leukaemia
- lymphomas
- germ cell tumours such as seminomas
What are 3 cellular characteristics of benign growth?
- Cells look like cell of origin
- Cells are well-differentiated
- Growth is encapsulated, expansive
What is the only situation where benign tumours are dangerous?
Can be dangerous but not as much –> only when it restricts blood flow
What is a Adenomatous polyp?
an abnormal growth of tissue projecting from a mucous membrane
What is an example of a benign colorectal polyps?
What is the difference between a benign and a malignant tumour?
- Benign(non-invasive, “innocent”)
- malignant(invasive, “evil”) in form
- (also -transitional)
What is benign?
non-invasive, “innocent”`
What is malignant?
invasive, “evil” in form
New tissue mass grows independently of controls of cells of _____ Growth serves _____ (no/a) useful purpose to body
origin; no
What are the 3 cellular characteristics of malignancy?
- Cellular pleiomorphism –increased variation in size and shape of cells
- Nuclear pleiomorphism –increase in size and shape of nucleus
- Nuclear hyperchromatism –increased density of chromatin
Increased nuclear to cytoplasm ratio
What is cellular pleiomorphism?
increased variation in size and shape of cells
What is nuclei pleiomorphism?
increase in size and shape of nucleus
What is nuclear hyperchromatism?
increased density of chromatin
What is anaplasia?
differing morphologically and functionally from cell of origin
What are the characteristics of begin vs malignant cancers ?
What is the structure, cell characteristics of benign cancers?
Well differnetiated, typical of the tissue of origin Little necrosis, plenty of support tissue (stroma)
What is the structure, cell characteristics of malignant cancers?
Differentiated, does not look like tissue of origin (pleiomorphic) Necrosis is common, loose structure (poorly-formed stroma)
What is the mode of growth of benign cancers?
Expansive, encapsulated
What is the mode of growth of malignant cancers?
Infiltrative, expansive, invasive, not encapsulated
What is the rate of growth for benign cancers?
Slow, little mitosis
What is the rate of growth for malignant cancers?
May be rapid, lots mitosis. Variable
What is the end of growth for benign cancers?
May be sponataneous
What is the end of growth for malignant cancers?
Rare spontaneous stop to growth
What is the metastasis for benign cancers?
Absent
What is the metastasis for malignant cancers?
Diagnostic feature
What is the clinical significance for benign cancer?
Usually not fatal- depends on situation and complications
What is the clinical significance for malignant cancer?
Invasion, secondaries infection, haemorrhage,cachexia (Tumour takes over systemically) Often causes death if growth is uncontrolled
How do you name cancers?
What is Leiomyoma?
- is a benign tumour of the uterine smooth muscle cells, or the myometrium (leio= smooth) . Sometimes called a fibroid.
- Common cause of uterine bleeding and pain.
- Present in approximately 25% of women of during their reproductive lives.
Leiomyomas, even though benign, may very rarely metastasise, predominantly to the ______. This is called ____
lungs; Leiomyosarcoma
How can cell of origin be identified?
What does a Leiomypma in the uterus look like?
How common is fibroids in females?
7 out of 10 women in reproductive years affected
How can fibroids be discovered?
Unidentified back or pelvic pain, fibroids discovered with massage therapy
What is the treatment for fibroids?
Fibroids removed with surgery or reductive treatment Physiotherapy needed in recovery
Why is physio relevant for fibroids?
Physiotherapy needed in recovery
What are 4 characteristics of colorectal carcinoma (CRC)?
- common malignancy(adenocarcinoma) in Western society; one sixth of cancer deaths.
- incidence in Asia, Sth America, Africa approx. 1/50th that of Western society. Dietary factors are involved?
- peak incidence for CRC is in 7thdecade. Multiple mutations needed?
- CRC in patients <40 yo is uncommon, associated with inherited characteristics.
Colorectal carcinoma (CRC) derived from a _______ which undergoes malignant transformation.
benign adenomatous polyp
Pleiomorphism in malignant colon cancer –note high levels of _____ and ____.
mitosis; apoptosis
What is the process that the spread of cancer requires?
metastasis = movement from site of original cancer to a new and different site
What is metastasis?
movement from site of original cancer to a new and different site
What is metastatic melanoma?
- Melanoma in skin –primary site
- Melanoma in liver –secondary site –
What is the primary site of melanoma?
skin
What is an example of a secondary site for melanoma?
Liver
What is the process of metastasis?
What is the lymphatic spread?
- Common
- Pattern of lymph node involvement follows natural lymph node drainage
- Sentinel lymph node
- Nodal enlargement may be caused by local cytokine-induced hyperplasia.
- In this case, it is not dissemination of the primary cancer.
______ will occur after breast surgery/radiotherapy in breast cancer.
Lymphoedema
Fluid from the body’s tissues usually drains into _____ vessels. Draining lymph nodes may be removed from the ____ or ____ region as part of breast surgery. Lymph nodes may also be _____ by radiotherapy. This can stop the lymph from flowing freely and can cause fluid to build up in the arm or breast. This is called _______.
lymphatic; armpit; breast; damaged; lymphoedema
What physiotherapy can be done after breast cancer treatment?
- Exercise has proven to be a safe and essential part of lymphoedema management.
- Compression garments, massage.
What are 6 areas that can be affected with vascular spread (veins and arteries)?
- Liver (any primary tumour)
- Lungs (often breast, bones, kidneys, SCC, malignant melanoma)
- Bones (primary neoplasms of breast and prostate)
- Brain(primary neoplasms of breast, lungs and malignant melanoma)
- Adrenals(breast and lungs)
- Kidney cancers via superior venacava (metastasise to the heart)
What are 2 questions in regards to features for cancer diagnosis?
- Is the tumour local or a metastasis?
- Do the cells look like the cells of origin?
After grading the tumour, to diagnose the stage of development, what should be done?
Tumour biomarkers increasingly important
What are the 4 stages in Duke’s Classification of Colon Cancer?
What are 3 questions to keep in mind in the Tumour-node-metastasis (TNM) system of classifying cancers?
- Tumour size
- Involvement of lymph nodes?
- Are there metastases?
