pathology of neoplasia Flashcards
tumor
non-specific swelling- neoplasm means what we think tumor is- can be bening or malignant
neoplasm
New growth.
(The words neoplasms and tumors are often used interchangeably)
cancer
Neoplasms can be benign or malignant.
A malignant neoplasm is CANCER.
oncology
Branch of medicine devoted to treating cancer
CLONALITY
All neoplasms derive from one cell. Arise from cells capable of cell division
is cancer a molecular desease
yesFundamental defect: DNA damage in dividing cells.
DNA Damage: acquired or inherited.
cancer is the second leading cause in
men over 40, in 20 years will be #1 in words, becasue of urbanisation- lifestyle: smoking, virus, delayed pregnancies- lead to breast cancer
Benign tumors:
Grow slowly, resemble the organ of origin, do not spread to distant sites, usually do not kill!!!!!! recite in our sleep!!! where ever it growths it looks like the organ. does not spread
but in pituitary gland it could grow and kill the person, or the heart next to nodes- can kill due to location
Malignant tumors:
Grow relatively faster (days, weeks,months), may not resemble the organ of origin, spread to distant sites (metastasis- defining feature), usually - but not always - kill (with or without ( doesnt look like organ), travel and colonise otherstreatment)
SYSTEMIC EFFECTS
PARANEOPLASTIC SYNDROMES
Distant / systemic feature relatively specific to a neoplasm but having lots of other causes as well
Ectopic hormone secretion by the tumor cells or an unknown mechanism
May be the first indication of malignancy
CLINICAL FEATURES: SYSTEMIC EFFECTS SYSTEMIC FEATURES
what is the signs of cancer not the masses
FEVER ANOREXIA WEIGHT LOSS CACHEXIA NIGHT SWEATS !!!!!!!!!!!!!!
7 Warning Signs: CAUTION
Change in Bowel or Bladder A Sore that does not heal Unusual bleeding or discharge Thickening of lump in Breast Indigestion or difficulty swallowing Obvious change in wart or mole Nagging cough or hoarseness
how do we distinguish bening from malignant
?
if growth has multiple different colours
it is malignant
choristoma heterotpia
diferent location- cells stat dimrating which is normal nad get to where their are suppose to go- but sometimes they dont and grow and develop- abnormal location of normal tissue - heterotopia
example pancreatic tissue in the stomach- had the swelling
what cancause a sweeling that is not cancer
cyst, lymph nodes, muscle damage- bruise,
endoscopy
swallow camera
painless bumbs
cancer- painfull ones are not
cancer cells only come from cells that cant devide, which one cannot
cardiac muscle, neurons cant devide- but you can have cancer of the heart and brain from the stem cells- which can divide
although from single cell but they are like siblings becasue are slightly different
so there will affect the scanning and the treatment
smallpox- has been eliminated becasue only has 3 genes so vaccine can target all thesevs HIV which has 9 genes- lots of recombinations
cancer is genetic deasease
all same genes but express different ones- cancer has access to alllll our genes (1000s)
why is cancer incurable most of the time
so many genes, all different
dna is damaged by
radiation, viruses, oxydative stress, replicatoin error, chemicals
inherite defective dna
some babies are born with cancer-
cancer is a series of mini evolution
the devisioit takes time for cancer to devoplp depnblood cancer is very vast , other are sloww it all depends on how fast they devide
cancer has defeated the most robuste and complicated system-
grows in hostole enviro- very aggresive- hard to cure
- APPEARANCE OF TUMORS
Sometimes, the appearance (naked eye or microscopic) of a tumor may be used to
define it further e.g. Papillary carcinoma
(fronds)
EXCEPTIONS TO THE NOMENCLATURE RULES
The suffix “ – oma” can also be applied to non- neoplastic conditions; e.g. granuloma, hematoma, xanthoma.
Following are malignant tumors with the suffix “oma”, “emia”: Melanoma: Cancer of melanocytes Lymphoma: Cancer of lymphocytes Leukemia: Cancer of hemopoietic cells.
CONCEPT: BENIGN VS MALIGNANT TUMOR
Why do we need to distinguish?
Different clinical behavior
Malignant tumor will kill, unless treated
Different treatment.
Features helpful in distinguishing Benign from Malignant tumors
Feature Benign Malignant
Differentiation Well diff. Well-poorly diff.
Anaplasia Minimal Minimal-marked
Rate of growth Generally slow Usually fast
Local invasion Usually not Invasive
Metastasis Never Almost always
clinical features
LOCAL MASS LESIONS METASTASES SYSTEMIC EFFECTS ON THE HOST PARANEOPLASTIC SYNDROMES SYSTEMIC FEATURES OF MALIGNANCY INCIDENTAL DETECTION lots of cytokines are coming to fight- - systemic effect of cancer- weightloss lots of sweat
paraneoplasmic syndrom
possible for silent gene in the lung to get activated- hyper adreanal function paraneoplasmic innapropriate expression of gene which are normally silent in the organ system !!!!!! exam
most common feature of cancer
non-movable lump
second way that cancers appear
non healing ulcers- destroys normal tissue- not also malignants, example smoking cigarettes
diabetes can cause ulsers, edges are quite thick - EVERTED EDGES!!!!!!!- thick becasue caused by cancer, if thin then it is not cancer,
infection
mass lesion plus bleeding, plus lost appetite and weight
cancer
painless
when at start but at stage 4 cancer patients have intense pain- give up the fight
hypercoagulable state
coagulated factors are all used up , excissive amount of normal molecules can casue a symptom
finger clubbin
paraneoplasmic symptomes- thick fibrous tissue under nail- looks rounded
cachexia
muscle waisting-
symptom free for 10 years
pretty much cured,
to diagnose need
a sample must be taken
how to answer the question Distinguish benign from malignant tumors
cell of origin, bening/malignant, naked eye or microscopic apeareance- this
cell of origin: teratoma
A majority of tumors arise from unipotential stem cells
ex teratome- bening fonud in opvary- constitutes all cell of human body had skin and hair
leukimia: pluripotantial
any type of blood cell- plueripotential means more than one - very rare, usually unipotential
what do these all have in common Carcinomas
Cancer of epithelial tissues (e.g. Renal cell carcinoma)
Sarcomas
Cancer of mesenchymal tissues (e.g. Osteosarcoma)
Blastomas
Cancers resembling fetal tissues
all malignant- these 3 words- but there are others
- APPEARANCE OF TUMORS
leaf like appearance: Sometimes, the appearance (naked eye or microscopic) of a tumor may be used to
define it further e.g. Papillary carcinoma
(fronds)
EXCEPTIONS TO THE NOMENCLATURE RULES
lots of exception but tumor is malignancy not a sign of inflammation
Features helpful in distinguishing Benign from Malignant tumors!!!!!! know very well
Feature Benign Malignant
Differentiation Well diff. Well-poorly diff.
Anaplasia Minimal Minimal-marked
Rate of growth Generally slow Usually fast
Local invasion Usually not Invasive
Metastasis Never Almost always!!!!!! cant wait to see this or else too late- realy on other 4 feautures
- DIFFERENTIATION
how much the tumor (its cells and its histologic
architecture) resembles the normal tissue.
if in liver and doesnt look like liver cell than poorly development
Benign Malignant
Great resemblance to Varies: well differentiated
normal tissues to poorly diff. tumors.
cancer with malignancy- well diferencial tumors- better chance of surviving
The degree of differentiation tells us whether
a tumor is of low grade (well differentiated)
or high grade (poorly differentiated).
Patients with well differentiated tumors usually do well.
know
- RATE OF GROWTH
Benign tumors tend to grow slowly, while the malignant tumors have a faster growth rate.
- THERE ARE EXCEPTIONS.
Some malignant tumors actually grow slower than highly active normal tissues.
comparing from hair, endothelial and bone marrow (they are the fastest)
time frame for acute inflammation
few hours- days so doesnt have to be cancer
growth
No. OF CELLS IN CELL CYCLE (Stain for Ki-67) BENIGN: Rare MALIGNANT Numerous MITOSES BENIGN: Rare MALIGNANT: Rare- Numerous Abnormal shapes
Side effects of chemotherapy:
Hair loss
Diarrhea
Bone marrow suppression: Infections, Hemorrhage
effects of normally fasting growing tissue
Very fast growing cancers may have necrotic areas
Outgrown the blood supply focally
Vascular thrombosis
active indeveloping new blood vessels so you canblock that blood vessel to kill it
can give drugs to stop new blood vessels forming
DYSPLASIA!!!!!!!!!!!!!!!!!!
DYSPLASIA: ALTERED ARCHITECTURE AND CELLULAR ABNORMALITIES CONFINED TO WITH IN THE BASEMENT MEMBRANE.
CONSIDERED A PRENEOPLASTIC CHANGE
SEQUENTIAL PROGRESSION TO CANCER
NOT ALL DYSPLASIAS WILL PROGRESS TO CANCER
cell abnormality, altered architechture, basement membrane intact- no cells bellow the basal membrane (remember these 3)
BASED UPON THE THICKNESS OF THE EPITHELIUM AFFECTED AND ATTENDENT CELLULAR CHANGES (CERVIX)CIN- Cervical Intraepithelial neoplasia
MILD CIN-1 MODERATE CIN-II SEVERE CIN-III CARCINOMA-IN- SITU
local invasion
SHAPE AND MARGINS:
Benign tumors remain localized while malignant tumors invade adjacent tissues. Benign- grow by pushing and are usually spherical
Malignant: Appear to have an
irregular shape
- LOCAL INVASIONResponse of stroma to local invasion
MALIGNANT
No capsule as such
may give an impression of a “pseudocapsule”
Stromal Reaction
Fibrosis (when extensive called Desmoplasia) - makes it gritty to cut
Inflammation
Granulation tissue
grows faster- not enough time for body to grow around it- the normal tissue instead just lays down sporatic tissue (stromal reaction)- when cut on them they are hard- like a scar because of fibrous tissu
BENIGN
Often encapsulated
- gives time for normal tissue to grow around it
malignency
hard to touch- like a scar- malignity itself
bening
resemble in feel and texture
what is the exception to benign tumors being spherical
hemangioma
desmoplasia!! compare to displasia
extensive fibrous tissue laying down- need saw to cut open
what is exophylic,
cauliflower
diffuse thickening
example in stomach just grows a little thicker all around stomach- find it very late
benign
firm, mobile- move around with hand, smooth!!!!!!!!!!!!!!!!!!! look for these key words
malignant
hard fibrous tissue, fixed, irregular
malignant
hard fibrous tissue, fixed, irregular !!!!!!!!!!!!! key words
colours
BENIGN Usually flesh colored\MALIGNANT Variegated in appearance Hemorrhage (Red) Necrosis (Yellow) Desmoplasia (Whitish and hard)
METASTASIS
- METASTASISUnequivocal evidence of malignancy Successful transplantation of a malignant
tumor to a new site.
These sites include
a) regional lymph nodes, &
b) distant organs e.g. brain, lungs, liver,
bone marrow.
Pathways of spread!!!!!!!!!!! 5
Local infiltration Seeding of body cavities Lymphatic spread Hematogenous spread Iatrogenic spread !!!!!!!!!!!!
pagets disease
breast cancer- local infliltration Extension into adjacent normal tissue
Intra-epithelial spread (Paget’s disease e.g; Breast cancer)
bad because of the spaces in it available
METASTASIS:SEEDING OF BODY CAVITIES
Cytologic examination for diagnosis
Instillation of drugs for treatment
example bone cancer to stomach because of space in abdomin
METASTASIS:LYMPHATIC SPREAD
Usually for Carcinomas
Along existing lymphatics to regional lymph nodes
Breast to axillary nodes
Lung to mediastinal nodes
Clinical significance
DETERMINES STAGE (N in TNM SYSTEM)
AFFECTS TREATMENT
INTRAOPERATIVE ASSESSMENT OF MEDIASTINAL NODES IN LUNG CANCER
lung cancer
if in lymphnodes its too late so no surgery
METASTASIS:HEMATOGENOUS SPREAD
Usually for sarcomas
Invasion of veins, usually
Renal cell carcinoma - to lungs
Prostate cancer - to vertebral column via paravertebral plexus
METASTASIS:IATROGENIC SPREAD
INCISION BIOPSIES
Suspected melanomas should always be completely excised (NO incisional biopsy)
SEEDING OF FINE NEEDLE ASPIRATION BIOPSY TRACTS (gives access to blood vessels, excemple in moles never do incision through it, instead cut all around it to get it out
Thyroid
Breast
COMMONEST SITES OF METASTATIC SPREAD
LYMPH NODES LUNG LIVER BONE BRAIN LEAST COMMON SITES ARE: MUSCLES, GONADS & SPLEEN
resection
take a big chunk out
exfoliative cytology
natural cell shedding
LIGHT MICROSCOPY
H&E slide (The pink & blue slide) Architecture Cytologic details HISTOCHEMISTRYSPECIAL STAINS Mucin in adenocarcinoma
GENETICS
Cytogenetics: Conventional cytogenetics Karyotype Interphase cytogenetics Molecular genetics
SPECIFIC Genetic abnormalities CLONALITY ANTIGEN RECEPTOR GENE REARRANGEMENTS MUTATIONAL ANALYSIS DETECTION OF ONCOGENIC VIRUSES
EARLY DIAGNOSIS SCREENING
PAP smear
Mammography
Investigating early symptoms in patients with a high risk for cancer e.g melanoma- e.g. changes in a mole
OBJECTIVE 6: WHAT DO PATHOLOGISTS TELL ABOUT THE SPECIMEN?
. DIAGNOSIS AND PROGNOSIS
DIAGNOSIS
PROGNOSTIC FACTORS
PREDICTIVE FACTORS
E.g estrogen receptor expression in breast cancer cells (Patients are candidates for Tamoxifen therapy)
prognosis
how will the patient do with it- the stage(most important)!!- how far it has spread
size !!
performance status!!
2nd most important
size of the tumor
performance status
normal activity- if cant then
predictor factor
if excissive estrogen receptor than can give drugs
personalized medicine
dont treat the disease treat the patient
OBJECTIVE 7: WHAT HAPPENS WHEN A DEFINITIVE DIAGNOSIS OF NEOPLASM IS ESTABLISHED
The Path report is sent to the ordering doctor; to Cancer Centre for malignant diagnoses
Benign diagnosis:
Definitive surgery
Clinical follow-up
Malignant diagnosis:
Assess how far the cancer has spread (STAGE)
OBJECTIVE 8: PRINCIPLES OF TREATMENT
Treatment (for what?)
Benign: Aim - cure
Malignant: Aim - cure to palliation
How is the patient going to do? (Prognosis) Good- Excellent OK ish (Guarded) Poor Prognostic factors TUMOR SITE HISTOLOGIC TYPE / GRADE STAGE (incorporates tumor size) PERFORMANCE STATUS OF THE PATIENT OTHERS….
