PATHOLOGY- Neoplasia Flashcards
Name the 4 most common types of cancers
Breast
Prostrate
Lung
Bowel
Which age group is more prone to developing cancers
Mostly over 60
How many deaths are due to cancer in the uK?
1 in 4 deaths (1 death every 3 mins)
How many deaths are caused by cancer annually
165,000 per year
As a dentist at which stages of examining a patient should you more diligently check for cancers
- Soft tissue exam for oral cancers
2. External exam can flag up malignancies especially in the lymph nodes
As a GDP name some tumours you nay be first in line screening for presentation of
- Oral squamous cell tumour
- Salivary gland tumour
- Odontogenic tumours
- Benign soft tissue tumours
- Sarcomas
- Lymphomas
- Melanomas
Define neoplasia
A new formation/new growth
What is another term for neoplasm
Tumour
What is a tumour
A swelling associated with inflammation
What is oncology
The study of tumours
Define neoplasm
An abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the change
What is the persistent growth of a tumour after the stimulus has been removed caused by?
- Non lethal genetic alterations in key genes
- Passed down to the progeny of the tumour cells
- Excessive and unregulated proliferations
- Autonomous (independent of physiological growth stimuli)
Define benign
An entity that has features suggesting indolent behaviour
Define malignant
An entity that is invasive and has potential to metastasise
What can malignant tumours be split into
Primary
Secondary
What is a primary tumour
The original tumour present at the origin site
What is a secondary tumour
A tumour that has metastasised and migrated to a different part of the body
What does carcinogenesis require?
- Self sufficiency in growth signals
- Insensitivity to growth inhibitory signals
- Altered cellular metabolism
- Evasion of apoptosis (cell death)
- Limitless replicative potential
- Sustained angiogenesis (own blood supply)
- Ability to invade/ metastasise
- Ability to evade host immune response
What causes cancer?
- Carcinogenic substances
- Radiation exposure
- Pathogens
- Genetic predisposition
- Other factors eg age, obesity
Give examples of some oncogenic pathogens
- HPV
- EBV
- HEP C and B
- HEP B
- HHV8
- HTLV1
Give examples of some carcinogenic substances
- Tobacco
- Ethanol
- Coal
- Drugs
- Air pollution
- Silica dust
- Arsenic
In older patients what is the origin of most of their cancers?
Epithelial in origin (carcinomas)
Why are cancers more common in older people
- Increasing somatic genetic mutations
- Loss of immune competence
Are epithelial cancers in children common?
No
Which cancers are more common in children?
Acute leukaemia
Primitive CNA neoplasms
Small blue cell tumours (retinaoblastoma etc)
What is obesity defined as?
A BMI of over 30
Name the 2 biggest preventable causes of cancer in the uK
- Smoking
- Obesity
Which cancers are highly associated with obesity
- Breast
- Bowel
- Endometrial
- Oesophageal
- Pancreatic
- Kidney, liver and stomach
Why is there a link between obesity and cancers
Excess fat leads to increase in hormones and growth factors which increase cell division
Increased rate of cell division increases the opportunity for genomic instability
Alongside environmental factors name another factor that causes cancer
Hereditary factors
Name the 4 distinguishing features we use to describe neoplasia
- Differention
- Rate of growth
- Local invasion
- Metastasis
What is anaplasia
Poor differentiation
Give some features of anaplasia
- Nuclear pleomorphism
- Abnormal nuclear features
- Increases mitotic activity
- Loss of cellular polarity/ order
- Tumour giant cells
- Necrosis
- Haemorrhage
What is nuclear pleomorphism
Variability in nuclear size
List some abnormal nuclear features
- High nuclear: cytoplasmic ratio
- Clumped chromatin
- Prominent nucleoli
Name the 3 terms we use to categorise tumours in terms of differentiation
- Well differentiated
- Poorly differentiated
- Undifferentiated/ anaplastic
Describe a well differentiated tumour
- Closely resembles normal tissue of origin
- Little of no evidence of anaplasia
- BENIGN and occasional malignant
Describe a poorly differentiated tumour
- Little resemblance to tissue of origin
- Highly anaplastic appearance
Describe an undifferentiated/ anaplastic tumour
Cannot be identified by morphology alone so you need to carry out molecular tests to identify the tumour
When we are talking about the classification of a tumour what are we referring to?
The name of the tumour decided by the WHO
When we are talking about the GRADE of a tumour what are we referring to?
Referring to how bad the tumour is based on differentiation and clinical features
What is the grade of a tumour a measure of?
How differentiated the tumour appears
How many grades are there when we are looking at tumours and what do they mean
3 grade:
Grade 1 (low)= well differentiated
Grade 2 (intermediate) = moderately differentiated
Grade 3 (high)= Poorly differentiated
When we are talking about the STAGE of a tumour what are we referring to?
Referring to how much the Tumour has spread
What is the stage of a tumour a measure of?
The spread of the tumour
What is the significance of the stage of a tumour
It determines the prognosis of the tumour
What does a low stage tumour mean?
Means the tumour hasn’t spread that much so has a better prognosis
What do we mean by differentiation when referring to tumours?
Differentiation is the extent to which neoplastic tissues resemble their corresponding normal tissue of origin
What is a lack of differentiation called?
Anaplasia
Define metaplasia
Change in the phenotype of undifferentiated cells often in response to chronic irritation
Are metaplasia and neoplasia the same thing?
NO
But often sites of metaplasia can be less stable and so are more vulnerable to accumulate genetic changes that LEAD to neoplasia
Define hypertrophy
Increased cells and thus organ size often in response to increased work load
What is hypertrophy usually a response to?
Increased work load
Define hyperplasia
Increased cell numbers in response to a stimulus eg hormones
What is hyperplasia usually a response to ?
A stimulus such as hormones or growth factors
Give an example of a common hypertrophy
Cardiac hypertrophy (increased work load on the heart)
What is dysplasia
It is a term used to describe confined neoplastic changes
Define dysplasia
Abnormal growth
What can epithelial dysplasia lead to?
Potentially malignant lesions
Is epithelial dysplasia a malignant tumour
No the process has not yet tipped over into being malignant and the lesion is still confined with in the basement membrane
What conditions must a tumour fulfil to be termed invasive malignant?
Needs to breach the basement membrane
What is the difference between dysplasia and carcinoma in situ
A carcinoma has breached the basement membrane, cytomorpholigcal features of malignancy but without invasion. Basement membrane of dysplastic epitheloum not penetrated
a dysplasia has not
Do dysplasia always lead to malignant/ invasive tumours
no sometimes they can regress
What does the growth rate of a tumour correlate with?
Correlates with level of differentiation
Do malignant tumours have a fast or slow rate of growth?
Usually fast as you can see increased mitosis
Do benign tumours have a fast or slow rate of growth?
Slow
Give some features of a rapidly growing tumour
- Mitosis
- Necrosis
- Ulceration
Why do tumours with a fast growth rate lead to necrosis and ulceration
As the tumour is growing faster than the vascular supply can repair at
List 4 features of benign tumours
- Cohesive and expansile masses
- Localised
- Cannot invade or metastasize
- Grow and expand slowly
What is a grade 1 tumour
A low grade well differentiated tumour
What is a grade 2 tumour
An intermediate grade moderately differentiated tumour
What is a grade 3 tumour
A high grade poorly differentiated tumour
Do benign tumours have a high or low mitotic activity and what does this suggest about their growth rate?
They have low mitotic activity leading to a slow growth rate
Are benign tumours well or poorly differentiated
Well differentiated
Describe the nuclear morphology of benign tumours
Normal
Describe the border of a benign tumour
It is circumscribed and or encapsulated
* Rim of compressed connective tissue= fibrous capsule
Describe the growth direction of benign tumours
Exophytic
Do malignant tumours have a high or low mitotic activity and what does this suggest about their growth rate?
They have high mitotic activity leading to a rapid growth rate
Are malignant tumours well or poorly differentiated
Often poor
Describe the nuclear morphology of malignant tumours
Pleomorphic
Are malignant tumours invasive
Yes and they frequently metastasise
Describe the growth direction of malignant tumours
Endophytic
How are tumours usually classified
Based on their tissue of tumour origin
Give the 2 broad classification all tumours are first split into
Epithelial origin (carcinomas)
Non epithelial origin
What is the suffix associated with benign tumours
OMA (but their are several exceptions)
What are benign tumours of glandular/ secretory epithelium called?
Adenoma
Glands may or may not be present in the tumour
What are benign tumours of non glandular/ surface epithelium called?
Papilloma
papilloma describes fingerlike or warty projections but most benign non-
After identifying a non glandular surface benign epithelial tumour what is the tumour further classified by?
Further identified by name of the cell type of origin (eg squamous cell)
After identifying a glandular benign epithelial tumour what is the tumour further classified by?
Name of the glandular tissue of origin
e.g. colonic
Give examples of some origin tissues for benign epithelial tumours
- Stratified squamous epithelium (eg skin, anus, cervix)
- Transitional epithelium of the bladder
- Glandular epithelium of colon
- Glandular epithelium of thyroid
What is the nomenclature of a Stratified squamous benign epithelium tumour
Squamous cell papilloma
What is the nomenclature of a Transitional epithelium benign tumour of the bladder
Transitional cell papilloma
What is the nomenclature of a benign tumour on the Glandular epithelium of the colon
Colonic adenoma
What is the nomenclature of a benign tumour on the Glandular epithelium on the thyroid
Thyroid adenoma
What are malignant epithelial tumours called
Carcinomas
What are malignant epithelial tumours derived from glandular ductular epithelium called?
Adenocarcinomas
How are malignant epithelial tumours derived from surface glandular epithelia names
Named by prefixing carcinoma with the cell of origin
Give examples of some origin tissues for malignant epithelial tumours
- Stratified squamous epithelium (eg skin, anus, cervix)
- basal cells of the skin
- Glandular epithelium of colon
- Glandular epithelium of breast
- Transitional epithelium of the body
What is the nomenclature of a Stratified squamous malignant tumour
Squamous cell carcinoma
What is the nomenclature of a basal cell malignant tumour
Basal cell carcinoma
What is the nomenclature of a malignant tumour on the transitional epithelium of the bladder
Transitional cell carcinoma
What is the nomenclature of a malignant tumour on the glandular epithelium on the colon
Colonic adenocarcinoma
What is the nomenclature of a malignant tumour on the glandular epithelium on the breasts
breast adenocarcinoma
all beingn mesenchymal tumours have what suffix
-oma
What is the prefix for benign mesenchymal tumours affecting smooth muscle
Leiomyo
What is the prefix for benign mesenchymal tumours affecting skeletal muscle
Rhabdomyo
What is the prefix for benign mesenchymal tumours affecting adipose tissue
LIPO
What is the prefix for benign mesenchymal tumours affecting blood vessel
Haemangio
What is the prefix for benign mesenchymal tumours affecting bone tissue
Osteo
What is the prefix for benign mesenchymal tumours affecting cartilage tissue
Chondro
What is the prefix for benign mesenchymal tumours affecting fibrous tissue
Fibro
What is a benign tumour affecting smooth muscle called?
Leiomyoma
What is a benign tumour affecting striated muscle called?
Rhabdomyoma
What is a benign tumour affecting adipose tissue called?
Lipoma
What is a benign tumour affecting blood vessels called?
Haemangioma
What is a benign tumour affecting bone tissue called?
Osteoma
What is a benign tumour affecting cartilage tissue called?
Chondroma
What is a benign tumour affecting fibrous tissue called?
Fibroma
malignant mesenchymal tumours are called what
sarcomas
What is a malignant tumour affecting smooth muscle called?
Leiomyosarcoma
What is a malignant tumour affecting striated muscle called?
Rhabdomysarcoma
What is a malignant tumour affecting adipose tissue called?
Liposarcoma
What is a malignant tumour affecting blood vessels called?
Angiosarcoma
What is a malignant tumour affecting bone tissue called?
Osteosarcoma
What is a malignant tumour affecting cartilage muscle called?
Chondrosarcoma
What is a malignant tumour affecting fibrous tissue called?
Fibrosarcoma
What are teratomas
Germ cell tumours
Why are teratomas strange
As they can contain cells reprising all three germ cell layers
Name the 3 germ cell layers
Endoderm
Mesoderm
Ectoderm
What can benign teratomas affect
Teeth
Hair
Muscle
Cartilage
describe ovarian teratomas
benign/cystic
describe testicular teratomas
malignant/solid
Give examples of some brain tumours
- Glioblastoma multiforme
- Meningioma
- Neurinoma
- Ependynoma
- Medulloblastoma
- Oligoendroglioma
- Astrocytoma
What are hamartomas
NON NEOPLASTIC disordered overgrowth of normal tissue (NOT TUMOURS)
What are hamartomas indigenous to?
The sire of occurrence
What are Choristomas
Bengin normal tissue but seen in an abnormal location
What is another term for Choristomas
Heterotropic rests
Give an example of a Choristomas
A normal pancreas module found in the stomach
Give examples of malignant tumours with benign sounding names
- Melanoma
- Mesothelioma
- Myeloma
- Lymphoma
What is a melanoma
A malignant tumour of melanocytes
What is a Mesothelioma
A malignant tumour in the lungs
What is a Myeloma
A type of blood cancer
Lymphoma
A type of blood cancer
