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AC1 > Neoplasia 1 > Flashcards

Neoplasia 1 Flashcards

1
Q

Define neoplasia

A

Abnormal mass of tissue, growth of which exceeds and is uncoordinated with that of normal tissues and persists after cessation of initiating stimulus.

Benign: confined to site of origin

Malignant: invasion and metastasis

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2
Q

Describe the difference between benign and malignant neoplasms

Give examples of each

A

Benign:

  • Cells grow as a compact mass and remain at their site of origin
  • E.g. lipoma

Malignant:

  • Growth of cells is uncontrolled
  • Cells can invade surrounding tissue and spread to distant tissues
  • Malignant tumour = cancer
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3
Q

What are the two basic components of tumours?

A

Parenchyma:

  • Neoplastic cells
  • Determines the biological behaviour of the neoplasm and the name of the neoplasm.

Reactive stroma:

  • Connective tissue, blood vessels, supporting tissue
  • Determines rate of growth of tumour.
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4
Q

How are neural tumours named?

A

Benign:

  • Nerve: neuroma
  • Nerve sheath: schwannoma

Malignant:

  • Nerve: neurofibrosarcoma
  • Nerve sheath: malignant peripheral NST
    *
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5
Q

How are cartilaginous tumours named?

A

Benign: Chondroma

Malignant: Chondrosarcoma

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6
Q

What are the key macroscopic, microscopic and behaviour differences between benign and malignant tumours?

A

Behaviour:

Benign:

  • No invasion
  • No metastasis
  • Retain function
  • Growth rate- variable but often slow

Malignant:

  • Invasion, infiltration
  • Metastasis
  • Loss of function
  • Variable growth rate- often higher than benign tumours

Macroscopic features:

Benign:

  • Well defined edge
  • Can be encapsulated

Malignant:

  • Poorly defined edge
  • Haemorrhage
  • Necrosis

Microscopic features:

  • Differentiation
    • Malignant: poorly differentiated
    • Benign: well differentiated
  • Organisation
    • Benign: organised
    • Malignant: not organised
  • Growth pattern
    • Benign: expansile, cohesive growth
    • Malignant: local invasion beyond normal boundary
  • Pleomorphism:
    • Benign: minimal
    • Malignant: variable
  • Nuclear to cytoplasmic ratio:
    • Benign: Normal (1:4-1:6)
    • Malignant: increased (1:1)
  • Mitotic count
    • Benign: low count, normal mitoses
    • Malignant: low-high count, abnormal mitoses
  • Polarity (orientation):
    • Benign: not disturbed
    • Malignant: lost cell to ECM, adhesion disturbed, nucleus can be located anywhere
  • Nuclear morphology:
    • Benign: round/oval with smooth outline and chromatin, +/- nucleoli
    • Malignant: bizarre in shape and size; hyperchromatic; course; clumped chromatin; prominent (possible multiple) nucleoli
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7
Q

Outline the differences in differentiation/anaplasia between benign and malignant tumours

A

Benign:

  • Well differentiated
  • Structure sometimes typical of tissue of origin

Malignant:

  • Some lack of differentiation
  • Structure usually atypical of tissue of origin
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8
Q

What are the differences in organisation between benign and malignant tumours?

A

Benign: well organised

Malignant: not organised

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9
Q

What are the differences in growth pattern between benign and malignant tumours?

A

Benign: expansile cohesive growth

Malignant: Local invasion beyond normal boundary

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10
Q

What are the differences in pleomorphism between benign and malignant tumours?

A

Benign: minimal

Malignant: minimal to marked, often variable

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11
Q

What are the differences in nuclear to cytoplasmic ratio between benign and malignant tumours?

A

Benign: Normal (1:4 - 1:6)

Malignant: increased (1:1)

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12
Q

What are the differences in mitotic count between benign and malignant cells?

A

Benign: low, normal mitoses

Malignant: low to high, abnormal mitoses

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13
Q

What are the differences in polarity between benign and malignant cells?

A

Benign: Not disturbed

Malignant: Lost cell to ECM adhesion disturbed, nucleus can be located anywhere

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14
Q

What are the differences in nuclear morphology between benign and malignant cells?

A

Benign: Round to oval with smooth outline and chromatin, nucleoli +/-

Malignant: Bizarre in shape and size; hyperchromatic, coarse, clumped chromatin; prominent nucleoli, may be multiple.

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15
Q

How are malignant neoplasms graded?

What does grading mean?

A

Grading: how differentiated the cells are to the tissue of origin (how similar).

  • Grade 1: Well differentiated
  • Grade 2: Moderately differentiated
  • Grade 3: Poorly differentiated
  • Undifferentiated: total lack of differentiation and abscence of specialisation
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16
Q

Define metastasis

A

Spread of a tumour to sites which are physically discontinuous with the primary tumour.

Only occurs in malignant tumours

17
Q

What macroscopic and microscopic features increase the chance of tumour metastasising?

A

Lack of differentiation

Local invasion

Rapid growth

Larger size

18
Q

Name some infrequently metastasising neoplasms

A

Glioma

Basal cell carcinoma

19
Q

What are the possible pathways of spread of metastatic cancer?

Which types of neoplasm are more common with each pathway?

Which organs are most frequently involved?

A

Blood vessels (haematogenous):

  • Typically sarcomas, also carcinomas
  • Venous > arterial, capillary beds
  • Liver and lung most frequently involved (portal system → liver, systemic circulation → lung)
  • Prostate and thyroid: cancers in close proximity to vertebral column→ vertebral metastasis

Lymphatics:

  • Carcinomas (less commonly sarcomas)
  • Breast carcinoma → axillary lymph node spread
  • Lung carcinoma → tracheobronchial and mediastinal lymph nodes

Body cavities (transceolomic) and surfaces:

  • Peritoneal, pleural, pericardial, subarachnoid, joint spaces
20
Q

What is a sentinal lymph node?

A

The first lymph node in a regional lymphatic basin that receives lymph flow from the primary tumour.

21
Q

What is the molecular procedure for the sentinal lymph node

A

One-step nucleic acid amplification (OSNA) assay for the intraoperative assessment of sentinal lymph node metastases in breast cancer.

Measures cytokeratin 19 (CK19) mRNA copy number.

High sensitivity and specificity.

22
Q

Name some common malignant tumours in paediatrics

A
  • Kidney: Wilms tumour
  • Eye: retinoblastoma
  • Liver: hepatoblastoma
  • CNS: meduloblastoma
  • Blood: leukaemia
  • Lymph: lymphoma
  • Connective tissue and bone: neuroblastoma, rhabdomyosarcoma, osteogenic sarcoma, Ewing sarcoma
23
Q

What are the precursor lesions for neoplasia?

A

Metaplasia: replacement of one type of cell with another type (associated with tissue damage, repair, regeneration)

Dysplasia: disordered growth: loss of uniformity of individual cells. Loss in architectural orientation.

In-situ carcinoma/ in-situ malignancy

24
Q

What is the single most important precursor lesion and risk factor for oesophageal adenocarcinoma?

A

Barrett’s oesophagus

25
Q

What are the features of dysplasia?

What are the common sites?

A
  • Premalignant condition
  • Usually describes epithelium
  • Increased cell growth
  • Cellular atypia
  • No invasion
  • Graded as low/high grade, mild/mod/severe

Common sites:

  • Cervix
  • GI tract
  • Respiratory tract
  • Bladder
  • Skin
26
Q

What are the precursor lesions for cervical carcinoma?

A

Cervical intraepithelial neoplasia (CIN): CIN 1, 2 and 3 (thickness of cervix involved)

Cervical glandular intraepithelial neoplasia (CGIN)

27
Q

Which cancers are caused by the human papilloma virus?

A

Cervical

Anal

Oropharyngeal

28
Q

What cancers can be caused by the EBV virus?

A

Burkitt lymphomas

B-Cell lymphomas in patients with T-cell immunosuppression (HIV infection, transplant recipients)

29
Q

What cancers can hepatitis B and C cause?

A

Hepatocellular carcinoma

30
Q

What cancers can be caused by HTLV-1 virus?

A

Adult T-cell leukaemia/lymphoma

31
Q

What cancers does the H. Pylori virus cause?

A

Gastric adenocarcinoma

MALT lymphoma

32
Q

What actions can be taken to reduce risk of cancer in the UK?

A
  • Smoking cessation
  • Reduction in alcohol intake
  • High fibre diet
  • Maintain healthy weight
  • Avoid sun exposure (use SPF)
  • Protect against HPV and H. Pylori infections
  • Avoid processed meat
  • Breastfeed
  • Exercise
  • Minimise use of HRT
33
Q

Smoking cessation can reduce the risk of which types of cancer?

A
  • Lung
  • Mouth
  • Nose and sinuses
  • Upper throat
  • Larynx
  • Oesophagus
  • Liver
  • Stomach
  • Kidney
  • Pancreas
  • Bowel
  • Bladder
  • Cervix
  • Leukaemia
34
Q

Reducing alcohol intake can reduce risk of which types of cancer?

A
  • Bowel
  • Liver
  • Breast
  • Oesophagus
  • Larynx
  • Mouth
35
Q

Obesity can lead to which types of cancer?

A
  • Breast
  • Bowel
  • Kidney
  • Uterus
  • Pancreas
  • Oesophagus
  • Thyroid
  • Myeloma
  • Ovary
  • Gallbladder
  • Brain and CNS
36
Q

Asbestos exposure increases risk of which 2 types of cancer most commonly?

A
  • Lung cancer
  • Mesothelioma
37
Q
A

AC1 (32 decks)

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