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*Medicine: Cellular Pathology > Principles of Tumours > Flashcards

Principles of Tumours Flashcards

1
Q

What is neoplasia?

A
  • Autonomous cell proliferation in absence of any continuing external stimulus
  • It is a clonal proliferation, ie it originates from a single cell which has acquired genetic mutations enabling it to divide autonomously
  • A neoplasm (“new growth”) = abnormal mass of tissue which shows uncoordinated growth and serves no useful purpose
  • Neoplasms AKA tumours (benign or malignant)
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2
Q

What are characteristics and behaviour of a benign tumour?

A
  • slower growing
  • well circumscribed
  • often encapsulated by a layer of compressed fibrous tissue
  • not locally invasive (although tumour may push + compress the adjacent normal tissue as size increases)
  • no metastatic potential
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3
Q

What characterises a malignant (cancerous) tumour?

A
  • faster growing
  • poorly circumscribed
  • non-encapsulated
  • invasive growth with destruction of adjacent normal tissue
  • metastatic potential
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4
Q

What are the 2 main characteristics of cancer then?

A
  • INVASIVE GROWTH
  • METASTATIC POTENTIAL
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5
Q

What is the microscopic appearance of benign tumours?

A
  • tumour cells very closely resemble cell of origin
  • well differentiated
  • cells are uniform throughout tumour
  • few mitoses
  • tumour cells have a normal nuclear:cytoplasmic ratio
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6
Q

What is the microscopic appearance of malignant tumours?

A
  • may or may not closely resemble cell of origin
  • variable differentiation
  • cells and nuclei vary in shape + size (pleomorphism)
  • many mitoses
  • high nuclear:cytoplasmic ratio
  • nuclear staining (hyperchromatism)
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7
Q

What are different types of epithelium cell linings?

A
  • Squamous epithelium eg. skin + oesophagus
  • Glandular epithelium eg. resp and GI tract
  • Urothelium eg. urinary tract
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8
Q

What are the benign and malignant names for squamous epithelium tumours?

A
  • Benign = squamous cell papilloma
  • Malignant = squamous cell carcinoma
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9
Q

What are the benign and malignant names for tumours of glandular epithelium?

A
  • Benign = adenoma
  • Malignant = adenocarcinoma
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10
Q

What are the benign and malignant names of tumours relating to urothelium?

A
  • Benign = urothelial papilloma
  • Malignant = urothelial carcinoma
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11
Q

What are carcinomas?

A
  • Malignant tumours arising from epithelia
  • Most common type of malignant tumour
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12
Q

What are the 2 most common types of carcinomas?

A

Adenocarcinomas and squamous cell carcinomas

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13
Q

How do carcinomas most commonly metastasize?

A

via lymphatic system

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14
Q

What are defining features of adenocarcinoma?

A
  • Gland (acinus) formation
  • Mucin production
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15
Q

What are defining features of squamous cell carcinoma?

A
  • Keratin formation
  • Intercellular bridges between cells
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16
Q

What do malignant connective tissue tumours often end in?

A

-sarcoma - they are all rare, most commonly metastasise via the blood stream

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17
Q

Are all tumours ending in just -oma benign?

A

No eg. the following are malignant tumours:

  • Melanoma
  • Mesothelioma
  • Glioma
  • Lymphoma / Leukaemia
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18
Q

Is a granuloma a tumour?

A

No - it is an aggregate of activated macrophages

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19
Q

What is tumour grade?

A
  • Reflects how closely it resembles the normal tissue from which it is believed to have arisen
  • An assessment of differentiation
  • Correlate with aggressiveness of behaviour
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20
Q

Tumour staging: What does differentiation refer to in terms of well-differentiated and poorly-differentiated?

A
  • Well differentiated: tumour cells closely resemble normal tissue
  • Poorly differentiated: tumour cells poorly resemble normal tissue
21
Q

How is grading assessed/who by?

A
  • Histopathological assessment
  • Can only be done by pathologist
22
Q

What are the tumour grades?

A
  • Grade 1 (or well diff) - less aggressive behaviour
  • Grade 2 (or mod diff) - intermediate behaviour
  • Grade 3 (or poorly diff) - more aggressive behaviour

So grade 3 is the worst and grade 1 is the best

Most carcinomas are graded using a 3 tier system (1-3)

23
Q

What is meant by aggressiveness?

A

How quickly a cancer is growing and how quickly it is likely to spread

24
Q

What does tumour staging determine?

A
  • How much cancer there is in the body + where
  • Assessment of extent of anatomical spread by tumour
25
Q

Why do we stage patients?

A
  • Stage is usually the single most important prognostic factor for cancer
  • Knowing stage helps plan most appt treatment
  • Staging provides a common language with which doctors can communicate about a case
  • Knowing stage is important in identifying clinical trials that may be suitable for a particular patient
26
Q

How do we stage patients/who by?

A
  • Clinical (physical exam)
  • Radiological (CT, MRI, PET, radiographs, US)
  • Surgical (exam under anaesthesia)
  • Pathological (microscopic examination of tissues)
27
Q

What is the most commonly used staging system?

A
  • TNM system
    • local Tumour spread
    • regional lymph Node metastases
    • presence of distant Metastases

The T, N and M are combined and an overall ‘Stage’ is assigned: I, II, III or IV.

Other staging systems: FIGO, Dukes’, Ann Arbor

28
Q

What is meant by local symptoms of cancer? Eg?

A

Related to tissue destruction at the site of the cancer eg. lung carcinoma may cause cough, haemoptysis and chest wall pain

29
Q

What is meant by metastatic symptoms of cancer? Examples?

A
  • Related to secondary deposits of the cancer in distant organs
  • Common sites of mets and their effects:
    • lung - haemoptysis, pneumonia, pleural effusion
    • liver - jaundice, hepatic failure
    • brain - seizures, stroke
    • bone marrow - anaemia, leukopaenia, thrombocytopaenia
    • bone - pain, fracture, spinal cord compression
30
Q

What are examples of systemic symptoms of cancer? What causes them?

A
  • Prolongued fever, weight loss, loss of appetite, decreased immunity
  • Due to release of cytokines from tumour cells eg. IL-1, TNF-a
31
Q

As well as local, metastatic and systemic, symptoms of malignant cancer can be described as paraneoplastic. What does this mean?

A
  • Paraneoplastic syndrome: a syndrome (collection of symptoms/signs) caused by substances produced by the tumour cells which act remotely from the tumour or its metastases
  • May be caused by hormones, cytokines or other factors produced by tumour cells
  • May be caused by antibodies produced by the body to ‘fight’ the tumour but which unfortunately cross-react with normal tissues and damage them
32
Q

What are examples of paraneoplastic syndromes?

A
  • Endocrine - hypercalcaemia, Cushing’s
  • Neuromuscular - Eaton-Lambert myaesthenic syndrome
  • Haematological - thromboembolism, PE
  • Renal - nephrotic syndrome
33
Q

Cells need to be able to adapt to a constantly changing environment. There are 4 main ways which cells can adapt, all of which are potentially reversible following removal of the stimulus which caused the change in the first place. What are these 4 main ways? (just list them)

A
  • Atrophy
  • Hypertrophy
  • Hyperplasia
  • Metaplasia
34
Q

What is atrophy?

A
  • Reduction in the size of a tissue or organ
  • May occur by a reduction in cell number (apoptosis) and/or a reduction in cell size
35
Q

What is hypertrophy?

A

Increase in size of cells, leading to an overall increase in size of the tissue or organ

36
Q

What is hyperplasia?

A

Increase in number of cells, leading to an overall increase in size of tissue or organ

37
Q

What is metaplasia and why is it important?

A
  • one mature cell type is replaced by another mature cell type
  • a change in pattern of differentiation
  • seen almost exclusively in epithelial cells, often in response to chronic injury
  • replacement cell type is often better able to withstand change in environment
  • can be physiological or pathological
  • metaplasia is important bc it may develop into epithelial dysplasia
38
Q

What is dysplasia and why is it important?

A
  • Disordered growth or differentiation (of epithelial cells in this year’s course)
  • Important bc it is a pre-malignant condition
  • Decreased differentiation, more mitoses, high nuclear:cytoplasmic ratio, cellular/nuclear pleomorphism
39
Q

How is dysplasia classified?

A

Normal, mild, moderate, severe

40
Q

At some anatomical sites, what is severe dysplasia also known as?

A

Carcinoma in situ

41
Q

What is the difference between carcinoma in situ and carcinoma?

A
  • Carcinoma in situ = severe dysplasia

The difference centres around the relationship of the lesion to the basement membrane. In carcinoma in situ, the cells have NOT yet invaded through the basement membrane. It does not have access to potential routes of metastases, progression to invasion is not inevitable.

  • Carcinoma however, has invaded through basement membrane and has metastatic potential.
42
Q

The basement membrane is a specialised sheet of extracellular matrix which lies between parenchymal cells and support (mesenchymal) tissues. What is meant by parenchymal and mesenchymal cells?

A
  • Parenchymal cells - perform main function of tissue, in this context the epithelium
  • Support/mesenchymal cells - provide structural scaffold of tissue
43
Q

Why is the distinction between Precancer and Cancer important?

A
  • Pre-cancer: doesn’t show invasive growth and metastatic potential. Therefore, removing a precancerous lesion w/ a clear margin around it should be curative
  • Cancer: shows invasive growth + metastatic potential. Excision of cancer may or may not be curative. Key determining factor is stage (extent of spread). Once tumour has metastasised, excision of primary tumour unlikely to be curative.

Better to treat patient during pre-cancer phase

44
Q

What is the terminology used for premalignancy for different anatomical sites? (cervix, endometrium, bladder, prostate, colorectum, breast, skin)

A
45
Q

What is meant by the metaplasia-dysplasia-carcinoma sequence?

A
  • For some carcinomas there is a well recognised sequence:
  • Metaplasia -> dysplasia (pre-cancer) -> carcinoma (cancer)
  • progression through this sequence not inevitable
  • dysplasia and carcinoma may develop without preceding metaplasia
  • metaplasia is not usually regarded as being premalignant
46
Q

Describe the metaplasia-dysplasia-carcinoma sequence using Barrett’s oesophagus as an example

A
  • Squamous mucosa –gastro-oeseophageal reflux (metaplasia)–> glandular mucosa
  • -> dysplasia
  • -> adenocarcinoma
47
Q

Describe the metaplasia-dysplasia-carcinoma sequence using the cervix as an example

A
  • columnar mucosa —-vaginal acid (metaplasia)—> squamous mucosa
  • persistent HPV infection results in –> CIN (dysplasia)
  • -> squamous cell carcinoma

the metaplasia is physiological, occurring in all females

48
Q

Describe the metaplasia-dysplasia-carcinoma sequence using the lung as an example

A
  • columnar mucosa —tobacco smoke (metaplasia)—> squamous mucosa
  • -> dysplasia/CIS
  • -> squamous cell carcinoma

*Medicine: Cellular Pathology (16 decks)

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