Neoplasia Flashcards
What is a carcinoma
Malignant epithelial tumour
How does a carcinoma start off?
Intra epithelial neoplasia
What is the most common tumour
Carcinoma
Name the different carcinomas
Breast, lung, colorectal, prostate
Is melanoma epithelial?
No
Intra epithelial neoplasia
Can be treated before it becomes invasive
What is the term for a group of cells whose nucleus varies in size and shape?
Pleomorphic
Are nucleoli of neopplastic cells larger or smaller than regular cells?
Larger - more activity plus the genome may enlarge
What is dysplasia?
It is the same as intra-epithelial neoplasia and is regarded as being pre-malignant. These can become carcinomas.
What is an in situ neoplasm/carcinoma
This occurs when there are severe changes during the dysplasia phase. At this point there is some architectural disorganisation and cytological atypia.
Invasive neoplasm
Accumulation of more mutation which allows the cell to invade through the basement membrane into the surrounding stroma. The lose there cohesiveness (down-regulation of integrins). Cells can detach and develop a blood supply
Does an in situ neoplasm metastasise?
No - called pre malignant
What is a common lace for a dysplastic gland to occur?
The colon
What sort of dysplatic lesions form a poly?
Glandular dysplastic lesions
What is hyperplasia?
Controlled cell proliferation (not neoplastic and no genetic changes)
What is metaplasia?
Change of a mature cell into another cell type - usually epithelium.
What drives metaplasia and hyperplasia?
Cytokine and growth factor changes - due to changes in environment or changes in hormones. Could be pathological or physiological. In some cases malignancy can develop in hperplastic or metaplastic cell.
Are hyperplasia and metaplasia pre malignant?
No, but they may become pre malignant
Symptoms of metastatic cancer
weight loss and anorexia - believed to be due to TNF-a or IL-1 which are produced by the tumour cells or those in the tumour environment.
Symptoms of metastatic cancer
weight loss and anorexia - believed to be due to TNF-a or IL-1 which are produced by the tumour cells or those in the tumour environment.
(raise the basal metabolic rate)
What are paraneoplastic effects:
These are hormonal changes (endocrine) which the tumour cells do not normally produce. One can also get various immunologic changes. Also clubbing and other effects
Lung cancer symptoms
Cough, wheeze, heamoptysis, dyspnoea, pneumonia, Pancoast’s syndrome
Investigation when a patient is suspected of having cancer.
Should look at heamoglobin levels because the patient could be anaemic.
Tumour markers - proteins which are released by tumours into the blood and may be indicative of cancer (not diagnostic but used in follow up).
Radiology
Endoscopy and biopsy
When is alpha fetoprotein elevated?
Some testicular cancers and in primary hepatocellular carcinoma of the liver.
what does an anatomic pathologist do?
Looks at tissues under a microscope
What are the two main ways of sampling tissue ?
Histopathology - stain and view under a microscope
Cytology - thin needle aspirate (stain) do not see relationship to other cells.
Molecular and cytogenetic - DNA and chromosomal rearrangements
Two main groups of carcinomas of the lung?
- Non small cell carcinoma
- Neuroendocrine carcinoma
- small cell carcinomas are very aggressive forms
- carcinoids are not as aggressive (but still malignant)
What type of lung cancer are non smokers most likely to get?
adenocarcinoma
What types of cancers are smokers particularly prone to?
Small cell or squamous, but they can get any type
What type of differentiation to adenocarcinomas show?
Glandular
What are some epithlial changes that occur in smokers with squamous cell carcinoma?
They get stratified squamous epithelium in the lung
What colour is a cancerous mass and what shape?
Pale mass with an irregular shape
Where do squamous cell and small cell carcinomas arise?
In the main bronchi
Where are adenocarcinomas usaully located?
They are more peripheral - not centred on a main bronchus and arise in alveolar or bronchiolar cells
What is the word used to describe firmness of a tumour?
Desmoplastic
What is always observed histologically with squamous cell carcinoma?
Keratin pearls
Some cancers are undifferentiated, how can one determine what they are?
Using immunohistochemistry - can do specific stains to determine the origin of the tissue (i.e. where the metastis originated)
What protein do melanocytes produce?
S100 this is classically present in melanoma
What is LCA
Lymphocyte common antigen (classically used for lymphoma cells)
What is CAM5.2?
It is an epithillial marker
How are tumour cells graded?
well differentiated - lots of features of normal cells
moderately differentiated
poorly differentiated - hard to tell what cell type it is
Poorly differentiated tumour are generally more aggressive than well differentiated ones.
How is a cancer staged?
Staging is done by a combination of radiological and pathological assessment.
The TNM system is usually used
Progression
Size or depth of primary tumour (i.e. has it gone to nodes or more distantly to brain liver etc)
How does the TNM system work?
T= extent of primary tumour T0-T4
N= regional lymph node metastases N0-N3
M=absence or presence of distant metastases M0-M1
X indicates cannot be assessed
It is combined to give a stage
What are predictive factors?
These are factors which can inform treatment
eg if the cancer has oestrogen receptors can use anti-oestrogen drugs
HER2 is a mutation present in some breast cancers if it is present then the drug may respond to anti HER2 drugs.
