Overall - cancers Flashcards
Histology Tips
- look at____, then look at____
- with worst differentiation…
- Architecture – shape and crowding
- Then focus on individual cells
With worst differentiation:
- Increasing nuclear size
- Increased nuclear to cytoplasmic size
- Increased nuclear staining (hyperchromasia)
- Increased mitotic figures
- Abnormal mitotic figures (Mercedes Benz)
- Variation in size and shape of cells and nuclei (pleomorphism)
Recap:
- Most common cancer
- Young people and children cancer
- Survival rates
Most common cancer:
Men: 1. Prostate 2. Lung 3. Bowel
Women: 1. Breast 2. Lung 3. Bowel
Young people and children: Leukaemia, Lymphoma, CNS, teratomas
Survival rates:
Best to worse: 10 yr
Testes (98%), Malignant melanoma (90%), Prostate (84%), Breast (78%), Bowel (58%), Lung (5%), Pancreas (1%)
General rules about metastasis:
- Types of cancer that spreads via blood
- Types of cancer that spreads via lymph
- Types of metastases that most commonly spread to the bone
= Osteolytic lesion
= Osteosclerotic lesion
General rule about metastasis
- *Sarcoma** – spread via blood. Common sites of blood borne metastasis are: Lungs, bone, liver, brain
- *Carcinoma** – spread via lymph (carcinoma is cancer of the epithelium -> remember it with toy car, Alice, Tenerife)
- *Types of metastases that most commonly spread to the bone:**
- Osteolytic lesions: Breast, Thyroid, Bronchus, Kidney
- Osteosclerotic lesions: Prostate
Note – Adenocarcinomas don’t tend to produce ectopic hormones
Lung cancer
- Types of lung cancer
- Risk factors for lung cancer
Lungs are a common place for metastasis due to it being highly vascular - very rich capillary supply, so often ‘next capillary site to be reached’ (except – not for stomach or abdomen primary neoplasms -> these metastasis to the liver usually)
- *1. Small cell lung carcinoma** – lots of blue as lots of small cells
- *2. Lung Squamous cell carcinoma** – lots of pink (keratin)
- Often produces PTH
- *3. Lung Adenocarcinoma** – glands
Risk Factors
- Smoking
- Radon gas
Abestos -
Cancers associated - Malignant mesothelioma, adenocarcinomas
Why does asbestos cause cancer?
Causes chronic inflammation and fibrosis. The effect of regeneration and rapid mitosis. The fibres may contain chemicals that are carcinogenic
Malignant mesothelioma – any of the mesothelial cells (pleura, peritoneal, pericardial, tunica vaginalis)
Perls stain – asbestos fibres covered in iron and stains blue
Prostate cancer
- One prostate condition…
- Risk factors
Benign Prostatic Hyperplasia (BPH)
Does not increase risk of prostatic carcinoma
Risk factors
- Age
- Obesity
- Family history
- Ethinicity
Breast cancer
- Mutation
Condition – BRCA1 or BRCA2 gene (mutations in either) – Affects repair of double strand DNA breaks.
Colorectal cancer (colon) BOWEL
- Condition 1 and mutation
- Condition 2 and mutation
– differences between them…
Colorectal cancer - Large intestine (colon): BOWEL
Condition – Hereditary Non-Polyposis Colorectal Cancer (Lynch Syndrome)
– Affects DNA mismatch repair genes, autosomal dominant condition
Usually less polyps than FAP
Condition – Familial adenomatous polyposis (FAP)
– Affects APC gene
Autosomal dominant, young patient, 100s of adenomatous polyps (benign but likely to become malignant)
Risk factors:
HNPCC and FAP
Uterus cancer
- spectrum…
- Histology of adenocarcinoma
- 2 other types of uterus cancer
- Risk factors
Endometrial hyperplasia:
(Spectrum it is in: Normal -> Endometrial hyperplasia -> Endometrial adenocarcinoma)
- In histology: Can clearly see increased number of glands and cells (when the glands start merging and become even more packed -> endometrial adenocarcinoma)
Risk factor: OESTROGEN -
- Overweight
Fat – conversion of adrenal androgen into oestrogen in fat, more fat you have, the greater this conversion of adrenal androgen into oestrogen. More fat -> greater oestrogen -> more oestrogen, more stimulated endometrium -> endometrial adenocarcinoma
— post-menopausal women who are very fat, have higher levels of oestrogen post menopause compared to normal healthy size and menstruating.
- Tamoxifen – this acts as an anti-oestrogen in breast tissue, but acts like an osteogenesis in other tissues like the uterus (and bones)
Leiomyoma of the uterus:
Picture - attached
Leiomyosarcoma of the uterus:
Picture - attached
Risk factors:
- HPV – virus infects cells, produces a protein called E6 that inhibits p53, also produces E7 protein which inhibits apoptosis (allowing cells to get through checkpoints), also activates cyclins. Not all HPV strains have this risk, HPV 16 and 17 particularly do
- Multiple sexual partners, pregnancy and birth under 17 yrs as cervix is immature
Ovary cancer
Benign teratoma of the ovary: Also called a Dermoid cyst
Testes cancer
- name one type
Malignant teratoma of the testes
Teratomas are malignant in the testes
Brain cancer
- Examples of brain cancer
- How can benign brain cancers kill?
Neoplasms include:
Gliomas (glioblastoma, astrocytoma)
Meningiomas
Germ cell tumours
- Benign tumours – death will be caused by pressure increase and brain pushing through the foramen magmen, causing brain stem injury. This causes death as it compresses the cardio and respiratory centres in the medulla oblongata
Pancreas
- Example of cancer
- Looks like
Pancreas adenocarcinoma: (glands present)
- Atypical looking glandular structure
- Poorly differentiated glandular tissue
- Hyperchromatic
- Variation in size and shape of nuclei
Liver cancer
- which type of metastasis and why
- number of lesions
- when does this type of cancer usually occur?
- Risk of liver cancer
Common place for metastasis due to it being highly vascular – common for stomach and abdomen area primary neoplasm.
Multiple lesions – likely to be metastatic deposits (secondary site)
One lesion – more likely to be primary lesion
Heptocellular carcinoma
Only really occurs in a background of liver cirrhosis – rare to get primary liver carcinoma. However, is a very common location for metastasis due to capillary beds
Risks for liver cancer:
- High alcohol intake – damages the liver, leading to inflammation and scarring (leads to lots of regeneration), also acetaldehyde can damage DNA and stops cells from repairing the samge
- Hepatitis B and C (promoter) – Can cause chronic tissue injury (chronic inflammation, hepatocyte death) and the result of regeneration acts either as a promoter or can cause new mutations from DNA replication errors
- Aflatoxins (initiator) – Family of toxin that are produced by certain fungi, the toxins can induce mutations in the hepatocytes
Skin cancer
- Conditions linked to skin cancer
- Name and describe the main 3 types of skin cancer, histology
Condition – Xeroderma pigmentosa – autosomal recessive, due to mutation in one of the genes affecting DNA nucleotide excision repair. Very sensitive to UV, develop skin cancer young
Melanoma:
Brown pigment
Risk – UV radiation
Where? Usually skin, but can be anywhere on a mucosal surface
Squamous cell carcinoma:
Pink (keratin)
Basal cell carcinoma:
lots of blue
Lymphoma
- Risk factors
Burkitt’s lymphoma
Risk factors:
- EBV - infects the B lymphocytes, promotes their cell survival and proliferation (divide rapidly for long periods of time - the virus itself doesn’t cause a mutation, it just increases the likelihood of a mutation occurring as it allows the cells to divide rapidly for long periods of time and acquire mutation through this process)
- HIV – duration and degree of immunosuppression
Bladder cancer
- Type
- Risk factors
Bladder
Squamous cell carcinoma
Risk factors:
- Schistosomiasis infection
- Chronic irritational inflammation (irritation leading to inflammation and metaplasia) e.g. from catheter use, neuropathic bladder, recurrent UTI
Stomach cancer
- Name
- Risk factors
Stomach
Gastric adenocarcinoma
Risk factors:
- Helicobacter pylori infection – Chronic inflammation, results in metaplasia, can become dysplastic and malignant
- Smoked food- food rich in nitrate (nitrates are initiators)
