Lecture 4: pathology of cancer Flashcards
what is a lesion
modification of tissue or organ from injury or disease, often resulting in impairment of normal function
what is a tumor/masslump/nodule/polyp
a swelling caused by an abnormal growth of tissue
true or false: a cancer is a malignant neoplasm
true
what is oncology
a branch of medecine that deals with the study, treatment, diagnosis and prevention of cancer
what is a polyp
a growth with a stalk
name some malformations
-choristoma
-hamartoma
-vascular malformation
what is a choristoma
misplaced normal tissues in abnormal location
what is a hamartoma:
a benign disorganized growth of cells and tissues notmally found in the area
what can cause a keloid
repair if excessive healing
what is hypertrophy
increase in cell size
what is hyperplasia
increase in cell number in response to a stimulus, physiological or pathological; mediated by hormones and growth factors
give examples of hyperplasia
-in epithelial cells in the female breast during pregnancy
-hepatocytes to regenerate liver parenchyma after oartial resection
-
what cause prostatic hyperplasia?
androgens
what can cause endometrial hyperplasia in postmenopausal women
they receive estrogens
true or false: hyperplasia differs from neoplasia
true
why is hyperplasia different from neoplasia
-the cells are genotypically and phenotypically normal
-the organs involved is usually but not always diffusely enlarged aka it does nor form a localized mass
-the hyperplasia ends when the stimulus ends and is usually reversible
true or false: hyperplasia may be a precursor of neoplasia
true
ex: endometrial hyperplasia may become carcinoma
what is metaplasia
replacement of one type of normal adult cell/tissue with another type
-in response to tissue damage, repair and regeneration
-in epithelial tissues, often mediated by inflammation
give examples of metaplasia
-squanmous metaplasia in bronchial epithelium from smoking or endocervix
-glandular: intestinal metaplasia in stomach caused by h pilory and intestinal metaplasia in gastro esophageal junction caused by acid reflux
true or false; metaplasia is prone to ,malignant transformation
true
what is a neoplasm
-a new growth of cells and stroma
-a genetic disorder of cell growth trigerred by aquired or less commonly inherited mutations
-characterized by an excessive and unceasing proliferation of cells, independant of physiologic growth signals and controls
what happens with the neoplastic cells
-the abnormal neoplastic cells with variable degrees of differenciation
-a non neoplastic stroma of connective tissue , inflammatory cells and blood vessela
where are the characteristics of neoplastic cells
they are in the dna transmitted genetically to progeny cells
true or false: there is heterogeneity within and between neoplasm
true
true or false: you are either a malingnat neoplastic cell or you are not
false there is a spectrum in the neoplastic cells whether they are benign or not
what is the difference between the cells whether they are cancerous or nor
-beningn: they are fully differenciated
-malingnant: they are undifferenciated
morphologic changes of cancer cells
-pleomorphism: variation in cell size and shape
-abnormal nuclear morphology; dark, thick, irregular, conspicuous nuclei, coarsely clumped chromatin
-mpre nuclei than citoplasm
-more mitose
-loss of polarity
-ischemic necrosis
what is dysphasia
-disorganized growth aka pre malingnant
-cytologic features of malignancy, partically involving the epithelium
-may be the precursor to malingnant transformation but not always to progress to cancer aka reversible
what is carcinoma in situ
-severe dysphasia involving the full thickness of the epithelium
-considered pre malingnat or pre invasive
-has the biological genotype and phenotype of a malingnancy but has not yet invaded through the basal malingnacy
-
true or false: carcinoma in situ has no probability of progression to cancer
false it has a high probability of progression to invasive cancer if untreated
what are the pathways of spread of metastases
-direct of seeding of body cavities/surfaces like peritoneum, pleura and pericardium
-lymphatic spread: most common in carcinoma/ folllows the natuiral routes of lymphatic drainage
-hematogenous spread: typical in sarcoma but also in carcinoma/lung and liver is most frequently involved
true or false: benign lesions do not infiltrate or infiltrate the normal tissues
true
what is the difference between carcinoma and sarcoma
-carcinoma is of epithelial origin
-sarcoma is of mesenchymal origin
what do you add at the end of a cancer name of mesebchynmal origin
sarcoma
what do you add at the end of epithelial origin
carcinoma
what are mixed tunours
more than one neoplastic cekkl type, derived from one germ cell layer
-found in salivary gland and renal anlage
what is the name oftumor that has more than one neoplastic cell type derived from more tyhan one germ cell layer
teratogenous
-ex: totipotential cells in gonads or in embryonic rests
What is the paradigm shift un therapeutic targets in cancer
-cancer classification according to therapeutic targets rather than cell origin and morphology
cancer cachexia is found in …% of cancer patients
50%
what is cancer cachexia
-hypercatabolic state: extreme weight loss, fatigue, muscle atrophy, anemia, anorexia
cancer cachexia is responsible for ….% of all cancer deaths
30%
due to the consequences of the atrophy of the diaphram and other respiratory muscles
what are the vcauses of cancer cachexia
-precise causes unknown but inflammatory mediators like tnf, il1 and 6 appear to have important roles
what is a paraneoplastic syndromes
basically symptoms that are not associated to ur cancer`
what can endocrinopathies cause
neoplastic cells lose og functions but have weird functions insead
what is possibly assocuated with cancer induced immunologic attack on normal tissues
neuromyopathic paraneoplastic syndromes
can neoplasms cause hypercoagulability
yeah
name 2 paraneiplastic syndromes
-acanthosis nigrantis aka skin discoloration
-hypertrophoc osteoarthropathy: fucked up joints
what is cancer diagnosis
integration of clinical and imaging features with a pathological assessment by biopsy or rekated techniques
aka there are so many things that can be done
what are the tumor markers clinically used
psa, cea, afp, hcg, ca125 and monoclonal ig
macroscopic findings of neoplasms
-mass, swelling and diffuse enlargement
-often pale or white
what are the secondary changes of neoplasms
-ulceration
-bleeding
-necrosis
pathologic or tissue diagnosis necessary and defenite aka them slay mathods
-cythopathology and biopsy/histopathology
what is cytologuc mathods aka cythopathology:
-rapid and less invasive; examines exfoliative cell changed
-direct smears; aka pap smears for cervical cancer
-analysis of fluids
-fine needle aspiration frok solid organs like breast, lung, pancreas etx
what is a biopsy/histopathology methods
-assessing individual cells and architecture
-variable biopsies(core, incisional or excisional
-resection
what is quick frozen sections
-establish rapid diagnosis within minutes mostrly during an operayion
-tissue quickfrosen in a cryostat and prepared for a microscopy
-good to determine nature of lesion, eval of margins of an excised tumour
-deciding addictional studies other than histology
what is immunohistochemistry
-hostolpgic xategorization of malignant tumours
-determination of site of origin of metastati tumopus
-detection of molecules that have pronostic or therapeutic significance like receptors
what is flow used for in cancer detectiopn
mostly for immunophenotyping of lymphomas/leukemias
can u use pcr to detect cancer
yeah you can also use molecular/cytogenic analyses like fish, ngs and chromosomal analysis
Molecular/cytogenetic analyses in Neoplasm is used for….
- Diagnosis of malignant neoplasms.
- Prognosis of malignant neoplasms.
- Detection of minimal residual disease.
- Diagnosis of hereditary predisposition to cancer: BRCA1, BRCA2, RET proto-oncogene
- Guiding therapy with oncoprotein-directed drugs: BRAF, EGFR, ALK, BCR-ABL, PML-RARA
- Identifying mechanisms of drug resistance: liquid biopsies.
Next-generation DNA sequencing of cancer genome:
rapidly transitioning to standard clinical practice and routinely performed for
targeted sequencing to identify therapeutically actionable gene
Parameters to determine how well or poorly a patient with cancer will do?
grading and staging
what is grading in malignant neoplasms
-degree of differenciation aka how closely the neoplastic cells resemble to their normal counterparts
aka low grade is grade one and is the closest to parent tissie
how is grading done in in malignant neoplasms
-light microscopy based on:
cytology; nuclear and cytoplasmic changes
histology; architecture of cells, gland formation and mitotic figures
true or false: grading is organ specific
yes especially for breast, prostate and sarcome
shit gland formation=////
cancer
Nottingham grading system for breast carcinoma
- Tubule formation
– Majority of tumor, > 75%: 1
– Moderate degree, 10-75%: 2
– Little or none, < 10%: 3 - Mitotic count
– 0-9 mitoses/HPF: 1
– 10-19 mitoses/HPF: 2
– ≥ 20 mitoses/HPF: 3 - Nuclear pleomorphism (grade)
– Nuclei small compared with normal cells, regular outlines, chromatin, little variation in size: 1
– Cells larger than normal, open vesicular nuclei, visible nucleoli, moderate variation in size and shape: 2
– Vesicular nuclei, large nucleoli, marked variation size, shape: 3
what is the grading for prostate adenocarcinoma:
gleason grading
what is the grading for colon adenocarcinoma
degreee of gland formation
TROJANI Grading System/the French Federation of Cancer Centers Sarcoma Groups (FNCLCC) is based on what
based on points
Differentiation:
a) Resembles normal cell type: 1
b) Easily recognized sarcoma: 2
c) Undifferentiated sarcoma: 3
Mitotic activity per mm²:
a) 0-9: 1
b) 10-19: 2
c) ≥ 20: 3
Necrosis:
a) No necrosis: 0
b) Necrosis < 50%: 1
c) Necrosis > 50%: 2
Grade I: 2-3
Grade II: 4-5
Grade III: 6-8
what is staging
-extent of a malingnant neoplasm
true or false: grading is of greater clinical value than staging
flase staging is more importantw
what is staging done
-done by examination of a resected syrgical specimen and integration of other infos like imaging and clinical lan
what is staging based on
- TNM system(American Joint Committee on Cancer
Staging)
– T for Primary tumor characteristics
– N for regional lymph node involvement
– M for distant metastases
true or false: TNM staging varies for specific forms of cancer
true
what are the cancer treatment goals
- Curative
- Debulking
- Adjuvant,neo-adjuvant
-palliative
what are the modalitioes of cancer treatment
- Surgery
- Radiation therapy
- Chemotherapy
- Immunotherapy
- Targeted molecular
therapy
what are Prognostic Factors in Neoplasia
(chances of survival(survival rate)) based on
- Histological type of neoplasm
- Location
- Staging, grading
- Biological/molecular properties
- Degree of angiogenesis
- State of the host
