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Pathology 205 > pathology of neoplasia > Flashcards

pathology of neoplasia Flashcards

1
Q

tumor

A

non-specific swelling- neoplasm means what we think tumor is- can be bening or malignant

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2
Q

neoplasm

A

New growth.

(The words neoplasms and tumors are often used interchangeably)

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3
Q

cancer

A

Neoplasms can be benign or malignant.

A malignant neoplasm is CANCER.

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4
Q

oncology

A

Branch of medicine devoted to treating cancer

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5
Q

CLONALITY

A

All neoplasms derive from one cell. Arise from cells capable of cell division

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6
Q

is cancer a molecular desease

A

yesFundamental defect: DNA damage in dividing cells.

DNA Damage: acquired or inherited.

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7
Q

cancer is the second leading cause in

A

men over 40, in 20 years will be #1 in words, becasue of urbanisation- lifestyle: smoking, virus, delayed pregnancies- lead to breast cancer

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8
Q

Benign tumors:

A

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

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9
Q

Malignant tumors:

A

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)

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10
Q

SYSTEMIC EFFECTS

PARANEOPLASTIC SYNDROMES

A

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

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11
Q

CLINICAL FEATURES: SYSTEMIC EFFECTS SYSTEMIC FEATURES

what is the signs of cancer not the masses

A 
FEVER
ANOREXIA
WEIGHT LOSS
CACHEXIA
NIGHT SWEATS
!!!!!!!!!!!!!!
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12
Q

7 Warning Signs: CAUTION

A 
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
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13
Q

how do we distinguish bening from malignant

A

?

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14
Q

if growth has multiple different colours

A

it is malignant

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15
Q

choristoma heterotpia

A

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

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16
Q

what cancause a sweeling that is not cancer

A

cyst, lymph nodes, muscle damage- bruise,

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17
Q

endoscopy

A

swallow camera

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18
Q

painless bumbs

A

cancer- painfull ones are not

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19
Q

cancer cells only come from cells that cant devide, which one cannot

A

cardiac muscle, neurons cant devide- but you can have cancer of the heart and brain from the stem cells- which can divide

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20
Q

although from single cell but they are like siblings becasue are slightly different

A

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

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21
Q

cancer is genetic deasease

A

all same genes but express different ones- cancer has access to alllll our genes (1000s)

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22
Q

why is cancer incurable most of the time

A

so many genes, all different

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23
Q

dna is damaged by

A

radiation, viruses, oxydative stress, replicatoin error, chemicals

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24
Q

inherite defective dna

A

some babies are born with cancer-

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25
Q

cancer is a series of mini evolution

A

the devisioit takes time for cancer to devoplp depnblood cancer is very vast , other are sloww it all depends on how fast they devide

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26
Q

cancer has defeated the most robuste and complicated system-

A

grows in hostole enviro- very aggresive- hard to cure

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27
Q
  1. APPEARANCE OF TUMORS
A

Sometimes, the appearance (naked eye or microscopic) of a tumor may be used to
define it further e.g. Papillary carcinoma
(fronds)

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28
Q

EXCEPTIONS TO THE NOMENCLATURE RULES

A 
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.
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29
Q

CONCEPT: BENIGN VS MALIGNANT TUMOR

A

Why do we need to distinguish?
Different clinical behavior
Malignant tumor will kill, unless treated
Different treatment.

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30
Q

Features helpful in distinguishing Benign from Malignant tumors

A

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

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31
Q

clinical features

A 
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
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32
Q

paraneoplasmic syndrom

A

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

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33
Q

most common feature of cancer

A

non-movable lump

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34
Q

second way that cancers appear

A

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

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35
Q

mass lesion plus bleeding, plus lost appetite and weight

A

cancer

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36
Q

painless

A

when at start but at stage 4 cancer patients have intense pain- give up the fight

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37
Q

hypercoagulable state

A

coagulated factors are all used up , excissive amount of normal molecules can casue a symptom

38
Q

finger clubbin

A

paraneoplasmic symptomes- thick fibrous tissue under nail- looks rounded

39
Q

cachexia

A

muscle waisting-

40
Q

symptom free for 10 years

A

pretty much cured,

41
Q

to diagnose need

A

a sample must be taken

42
Q

how to answer the question Distinguish benign from malignant tumors

A

cell of origin, bening/malignant, naked eye or microscopic apeareance- this

43
Q

cell of origin: teratoma

A

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

44
Q

leukimia: pluripotantial

A

any type of blood cell- plueripotential means more than one - very rare, usually unipotential

45
Q

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

A

all malignant- these 3 words- but there are others

46
Q
  1. APPEARANCE OF TUMORS
A

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)

47
Q

EXCEPTIONS TO THE NOMENCLATURE RULES

A

lots of exception but tumor is malignancy not a sign of inflammation

48
Q

Features helpful in distinguishing Benign from Malignant tumors!!!!!! know very well

A

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

49
Q
  1. DIFFERENTIATION
A

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

50
Q

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.
A

know

51
Q
  1. RATE OF GROWTH
A

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)

52
Q

time frame for acute inflammation

A

few hours- days so doesnt have to be cancer

53
Q

growth

A 
No. OF CELLS IN CELL
CYCLE (Stain for Ki-67)
BENIGN: 
Rare
MALIGNANT
Numerous
MITOSES
BENIGN:
Rare
MALIGNANT:
Rare- Numerous
Abnormal shapes
54
Q

Side effects of chemotherapy:

A

Hair loss
Diarrhea
Bone marrow suppression: Infections, Hemorrhage
effects of normally fasting growing tissue

55
Q

Very fast growing cancers may have necrotic areas

A

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

56
Q

DYSPLASIA!!!!!!!!!!!!!!!!!!

A

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)

57
Q

BASED UPON THE THICKNESS OF THE EPITHELIUM AFFECTED AND ATTENDENT CELLULAR CHANGES (CERVIX)CIN- Cervical Intraepithelial neoplasia

A 
MILD
CIN-1
MODERATE
CIN-II
SEVERE
CIN-III
CARCINOMA-IN- SITU
58
Q

local invasion

SHAPE AND MARGINS:

A

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

59
Q
  1. LOCAL INVASIONResponse of stroma to local invasion
A

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

60
Q

malignency

A

hard to touch- like a scar- malignity itself

61
Q

bening

A

resemble in feel and texture

62
Q

what is the exception to benign tumors being spherical

A

hemangioma

63
Q

desmoplasia!! compare to displasia

A

extensive fibrous tissue laying down- need saw to cut open

64
Q

what is exophylic,

A

cauliflower

65
Q

diffuse thickening

A

example in stomach just grows a little thicker all around stomach- find it very late

66
Q

benign

A

firm, mobile- move around with hand, smooth!!!!!!!!!!!!!!!!!!! look for these key words

67
Q

malignant

A

hard fibrous tissue, fixed, irregular

68
Q

malignant

A

hard fibrous tissue, fixed, irregular !!!!!!!!!!!!! key words

69
Q

colours

A 
BENIGN
Usually flesh colored\MALIGNANT
Variegated in appearance
Hemorrhage (Red)
Necrosis (Yellow)
Desmoplasia (Whitish and hard)
70
Q

METASTASIS

A
  1. 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.

71
Q

Pathways of spread!!!!!!!!!!! 5

A 
Local infiltration
Seeding of body cavities
Lymphatic spread
Hematogenous spread
Iatrogenic spread
!!!!!!!!!!!!
72
Q

pagets disease

A

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

73
Q

METASTASIS:SEEDING OF BODY CAVITIES

A

Cytologic examination for diagnosis
Instillation of drugs for treatment
example bone cancer to stomach because of space in abdomin

74
Q

METASTASIS:LYMPHATIC SPREAD

A

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

75
Q

lung cancer

A

if in lymphnodes its too late so no surgery

76
Q

METASTASIS:HEMATOGENOUS SPREAD

A

Usually for sarcomas
Invasion of veins, usually
Renal cell carcinoma - to lungs
Prostate cancer - to vertebral column via paravertebral plexus

77
Q

METASTASIS:IATROGENIC SPREAD

A

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

78
Q

COMMONEST SITES OF METASTATIC SPREAD

A 
LYMPH NODES
LUNG
LIVER
BONE
BRAIN
LEAST COMMON SITES ARE:
MUSCLES, GONADS & SPLEEN
79
Q

resection

A

take a big chunk out

80
Q

exfoliative cytology

A

natural cell shedding

81
Q

LIGHT MICROSCOPY

A 
H&E slide (The pink & blue slide)
Architecture
Cytologic details
HISTOCHEMISTRYSPECIAL  STAINS
Mucin in adenocarcinoma
82
Q

GENETICS

A 
Cytogenetics:
Conventional cytogenetics
Karyotype
Interphase cytogenetics
Molecular genetics
SPECIFIC Genetic abnormalities
CLONALITY
ANTIGEN RECEPTOR GENE REARRANGEMENTS
MUTATIONAL ANALYSIS
DETECTION OF ONCOGENIC VIRUSES
83
Q

EARLY DIAGNOSIS SCREENING

A

PAP smear
Mammography
Investigating early symptoms in patients with a high risk for cancer e.g melanoma- e.g. changes in a mole

84
Q

OBJECTIVE 6: WHAT DO PATHOLOGISTS TELL ABOUT THE SPECIMEN?

A

. DIAGNOSIS AND PROGNOSIS
DIAGNOSIS
PROGNOSTIC FACTORS
PREDICTIVE FACTORS

E.g estrogen receptor expression in breast cancer cells (Patients are candidates for Tamoxifen therapy)

85
Q

prognosis

A

how will the patient do with it- the stage(most important)!!- how far it has spread
size !!
performance status!!

86
Q

2nd most important

A

size of the tumor

87
Q

performance status

A

normal activity- if cant then

88
Q

predictor factor

A

if excissive estrogen receptor than can give drugs

89
Q

personalized medicine

A

dont treat the disease treat the patient

90
Q

OBJECTIVE 7: WHAT HAPPENS WHEN A DEFINITIVE DIAGNOSIS OF NEOPLASM IS ESTABLISHED

A

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)

91
Q

OBJECTIVE 8: PRINCIPLES OF TREATMENT

A

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….

Pathology 205 (23 decks)

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