Neoplasia

Question 1

How do you classify neoplasms

Answer 1

• on cell origin
  E.g epithelial
• on tumour behaviour
  E.g malignant

Question 2

How do you classify tumours

Answer 2

1. Epithelial - carcinoma
2. Mesenchymal - liposarcoma
3. Neuroectoderm - astrocytoma
4. Haemopoietic - lymphoma
5. Germ cells - teratoma

Question 3

Benign vs malignant tumour

Answer 3

Question 4

Cell growth of tumour cell

Answer 4

See abnormal mitosis in malignant cells

Question 5

Gross description of tumour

Answer 5

Size

Shape

Number

Consistency

Site

Special features

Question 6

Grading tumours - how it looks

Answer 6

Grade 1 - well differentiated

Grade 2 - moderately differentiated

Grade 3 - poorly differentiated

Question 7

Tumour morphology

Answer 7

Question 7

Tumour staging

Answer 7

The extent of the tumour in the body,
How it has spread

Question 8

What’s does grade 1 squamous cell carcinoma look like

Answer 8

Tumour resembles normal squamous epithelium and contains proportion of differentiated keratinocyte-like squamous cells.

Intercellular bridges are always present.

Keratin pearls are frequently found.

Mitoses are scanty.

Question 9

What does grade 2 squamous cell carcinoma look like

Answer 9

Tumour cells exhibits more nuclear pleomorphism.

There is usually less keratinisation.

Increased number of mitoses, including abnormal mitoses.

Question 10

What does grade 3 squamous cell carcinoma look like

Answer 10

Non-keratinsed basal-type cells predominate.

Barely discernible intercellular bridges,
and minimal
keratinisation.

High mitotic rate, including abnormal mitoses.

Question 11

Effects of benign tumours

Answer 11

1. discomfort
2. production of active substance, e.g. hormone (thyroid adenoma)
3. Pressure effect on adjacent tissue, e.g. intracranial or intrauterine

Question 12

Direct effects of malignant tumours

Answer 12

• Pain, rapidly growing infiltrative mass
• Blood loss, ulceration, haemorrhage, anaemia
• Mechanical effect, stenosis or obstruction

Question 13

What are paraneoplastic syndromes

Answer 13

• Paraneoplastic syndromes are symptoms that occur at sites distant
from a tumour or its metastasis.

• Pathogenesis unclear, but symptoms may be secondary to substances
secreted by the tumour or a result of antibodies directed against
tumours that cross-react with other tissue.

• Up to 20% of cancer patients experience paraneoplastic syndromes.

Question 14

What is tumour grade

Answer 14

biological nature of tumor, based on histological analysis: differentiation, mitotic activity, pleomorphism

Question 15

What is tumour stage

Answer 15

extent of tumour: size and spread, after pathological and radiological analysis

Question 16

5 main modes of tumour spread

Answer 16

• Local invasion.
• Lymphatic spread.
• Vascular spread.
• Other ways of spread: Transcoelomic spread or Intraepithelial spread.

Question 17

What is local invasion

Answer 17

Tumour spread into surrounding tissues by the direct route. Examples: carcinoma of the breast invading overlying skin and
carcinoma of the cervix invading rectum or bladder

Question 18

What is lymphatic spread

Answer 18

• Cancer spread via lymphatic vessels
draining the site of primary tumour.

• Neoplastic cells are conducted to local
lymph nodes where they may form
secondary tumours, e.g. breast cancer
spreading to axilla lymph nodes, or
tongue cancer spreading to neck
nodes.

• Form the basis of N (lymph node)

Question 19

What is vascular spread

Answer 19

• Tumour spread via the veins
draining the primary site.

• Gut tumours tend to spread via
the portal vein to the liver.

• In the systemic circulation,
neoplastic cells may be trapped
in the lung to form pulmonary
metastases.

• The basis of M staging (metastasis)

Question 20

What is Transcoelomic spread

Answer 20

• Tumours can spread across
coelomic spaces, e.g. across the
peritoneal or pleural cavities.

• Carcinoma of the ovary may
spread transcoelomically to
produce large numbers of
metastatic deposits on the
peritoneal surfaces

Question 21

What is intraepithelial spread

Answer 21

Question 22

How to use TNM classification to stage tumours

Answer 22

T- tumour
N- node
M- metastasis

Question 23

Dysplasia is…

Answer 23

Disordered development of epithelium

It may be pre-malignant

Question 24

What are proto-oncogenes

Answer 24

• Genes commonly used during normal growth and development.
• Usually under-control.
• Without control, they have the potential to produce neoplasms through
their excessive expression.

Question 25

What are oncogenes

Answer 25

• Genes that have made the transition , i.e. activated proto-oncogenes.
• Capable of producing neoplasms.
• Most oncogenes cause unregulated cell growth through promotion of cellular division, which results in further mutations.

Question 26

Conversion of proto-oncogene to oncogene

Answer 26

• Overexpression of the gene.
• Amplification of the gene.
• Point mutation in the gene.
• Translocation of the gene to another region with resultant
overexpression of the gene, or resultant production of protein with
oncogenic activity.

Question 27

What are genes p53 and rb1 does

Answer 27

They are tumour suppressor genes

Question 28

What does nitric oxide do to vessels

Answer 28

Causes vasodilation

Question 29

What mediator causes b cells to plasma cells

Answer 29

IL-6