Pathogenesis

Question 1

What cancers are classified as head and neck?

Answer 1

mouth
oropharynx
nasopharynx
hypopharynx
nose
paranasal sinuses
larynx
salivary glands
ear

Question 2

what pathology are most cancers of the head and neck?

Answer 2

squamous cell carcinomas arising from lining mucosa

Question 3

what are the main aetiologies for head and neck cancer?

Answer 3

tobacco
alcohol
hight risk HPV
EBV

Question 4

What term describes a genetic disease (abnormal growth that may or may not be cancerous)?

Answer 4

neoplasia

Question 5

can tumours run in families?

Answer 5

yes

Question 6

what are the 2 steps in the theory of carcinogens?

Answer 6

initiation - DNA damage and mutation
promotion - clonal expansion of abnormal cells leading to cancer

Question 7

what type of cells are neoplastic?

Answer 7

• blood vessels
• inflammatory cells
• fibroblasts
• stroma

Question 8

tumour cells lacking normal control mechanisms leads to?

Answer 8

clone expansion due to uncontrolled proliferation
- replication
- escape from senescence
- evasion of apoptosis
- limitless replicative potential

Question 9

what is senescence?

Answer 9

growth arrest

Question 10

what is there a reduction of in invasive growth?

Answer 10

cell-cell adhesion

Question 11

what is there an invasion of in invasive growth?

Answer 11

basement membrane and stroma

Question 12

for invasive growth, what must tumour cells be?

Answer 12

motile

Question 13

what do groups of cells need?

Answer 13

cell-cell adhesion and communication

Question 14

where do groups of cells predominate?

Answer 14

differentiated carcinomas

Question 15

in groups of cells, what are inner cells protected from?

Answer 15

immunological assault

Question 16

what factors do groups of cells require?

Answer 16

autocrine pro-migratory factors and proteolytic enzymes

Question 17

what is angiogenesis?

Answer 17

formation of new blood vessels

Question 18

why does a rich blood supply form around a tumour?

Answer 18

loss of control of angiogenic switch

Question 19

how are tumour blood vessels formed?

Answer 19

outgrowth of endothelial cells from post capillary venules into tumour mass.

Question 20

what is a critical step in the progression of a small localised tumour to a bigger one with metastatic potential?

Answer 20

angiogenesis

Question 21

what is metastasis?

Answer 21

tumour implants that are discontinuous with the primary lesions

Question 22

what event affects tumour stage?

Answer 22

metastasis

Question 23

where are common sites for metastatic disease?

Answer 23

• Regional lymph nodes
• Liver
• Lung
• Bone
• Brain
• Skin
• Unusual sites – renal cancer, thyroid cancer, melanoma

Question 24

what are routes of metastasis?

Answer 24

• Lymphatic (carcinoma)
• Haematogenous (sarcoma)
• Across body cavities (serous cavities, meninges/ ventricles/ spinal canal)
• Direct implantation

Question 25

how do tumour cells reach the site of metastasis?

Answer 25

breach the basement membrane of vessel and enter vessel lumen

bind to endothelial cells, penetrate BM, move out of vessel

Question 26

what organs are effective at arresting circulatory cancer cells?

Answer 26

lung and liver

Question 27

what happens before invsive growth?

Answer 27

dysplasia

Question 28

where does dysplasia occur?

Answer 28

epithelial (squamous and glandular)

Question 29

what does dysplasia indicate?

Answer 29

risk of developing carcinoma

Question 30

where are atypical epithelial alterations limited to?

Answer 30

surface squamous epithelium

Question 31

what are types of atypical epithelial alterations?

Answer 31

architectural and cytological

Question 32

what is architectural change in epithelial cells?

Answer 32

maturation and differentiation

Question 33

what is cytological change in epithelial cells?

Answer 33

change in cells

Question 34

at the point of dysplasia are cells cancerous?

Answer 34

they show features of cancer cells but arent able to invade adjacent normal tissues

Question 35

what are the histological features of epithelial dysplasia?

Answer 35

• nuclear and cellular pleomorphism
• increase in nuclear/ cytoplasmic ratio
• nuclear hyper chromatism
• prominent nucleoli
• increased and abnormal mitoses
• loss of polarity of basal cells
• basal cell hyperplasia
• drop-shaped rete pegs
• irregular epithelial stratification
• abnormal keratinisation (cells start to keratinize before reaching the surface)
• loss/ reduction of intercellular adhesion

Question 36

according to WHO 2017 grading, describe mild dysplasia?

Answer 36

disorganisation, increased proliferation, atypia of basal cells

Question 37

according to WHO 2017 grading, describe moderate dysplasia?

Answer 37

more layers of disorganised basaloid cells, atypia, suprabasal mitoses

Question 38

according to WHO 2017 grading, describe severe dysplasia?

Answer 38

very abnormal, affects full thickness of epithelium

Question 39

what does a dyskeratotic cell look like?

Answer 39

hyperchromatic nuclei and/or irregular nuclear chromatin