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Cellular pathology > Principles of tumours > Flashcards

Principles of tumours Flashcards

1
Q

What is neoplasia

A

A state of AUTONOMOUS cell division - ie. cell proliferation occuring in the absence of any continuing external stimulus (this is what distinguishes neoplasia from hyperplasia). It is a CLONAL PROLIFERATION
(originates from a single cell).

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2
Q

What is a neoplasm

A

An abnormal mass of tissue which shows uncoordinated growth and shows no useful purpose.

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3
Q

Describe the macroscopic appearance of a benign tumour

A
  • Slow growing
  • Well circumscribed
  • Often encapsulated by a layer of fibrous tissue
  • Not locally invasive
  • No metastatic potential
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4
Q

Describe the macroscopic appearance of malignant tumours

A
  • faster growing
  • poorly circumscribed
  • non-encapsulated
  • INVASIVE GROWTH = with destruction of adjacent normal tissue
  • METASTATIC POTENTIAL
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5
Q

What is the definition of cancer

A

A malignant tumour.

There is invasive growth and metastatic potential

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6
Q

Describe the microscopic appearance of benign tumours

A
  • Tumour cells closely resemble cell of origin (well differentiated)
  • Cells are uniform throughout the tumour
  • Few mitoses
  • Tumour cells have a normal nuclear:cytoplasmic ratio
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7
Q

Describe the microscopic appearance of malignant tumours

A
  • May or may not closely resemble the cell of origin - ie. variable differentiation
  • cells and nuclei vary in shape and size (pleiomorphism)
  • many mitoses
  • high nuclear:cytoplasmic ratio
  • nuclear staining (hyperchromatism)
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8
Q

What are the defining features of malignancy?

A

Invasive growth and ability to metastasise

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9
Q

What are the different types of epithelium, and where are they found?

A

1) squamous epithelium = skin and oesophagus
2) glandular epithelium = respiratory and GIT
3) urothelium = urinary tract

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10
Q

What is a squamous cell papilloma

A

A benign tumour of the squamous epithelium (skin and oesophagus)

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11
Q

What is a squamous cell carcinoma

A

A malignant tumour of the squamous epithelium (skin and oesophagus)

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12
Q

What is an adenoma

A

A benign tumour of the glandular epithelium (respiratory and GIT)

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13
Q

What is an adenocarcinoma

A

A malignant tumour of the glandular epithelium (respiratory and GIT)

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14
Q

What is a urothelial papilloma

A

A benign tumour of the urothelium (urinary tract)

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15
Q

What is a urothelial carcinoma

A

A malignant tumour of the urothelium (urinary tract)

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16
Q

What is a carcinoma

A

A malignant tumour arising from epithelia

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17
Q

What is the most common type of malignant tumour

A

Carcinoma

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18
Q

How do carcinomas typically metastasise

A

Lymphatics

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19
Q

What are the most common types of carcinomas

A

Adenocarcinoma and squamous cell carcinoma

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20
Q

What are the defining features of adenocarcinomas

A
  • Gland (acinus) formation

- mucin production

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21
Q

What are the defining features of squamous cell carcinomas

A
  • keratin formation

- intercellular bridges between cells

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22
Q

What is a sarcoma

A

A malignant tumour arising from connective tissue

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23
Q

Where do leiomyomas / leiomyosarcomas arise from?

A

Smooth muscle

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24
Q

Where do rhabdomyomas / rhabdomyosarcomas arise from?

A

Skeletal muscle

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25
Q

Where do lipomas / liposarcomas arise from?

A

Adipose tissue

26
Q

Where do angiomas / angiosarcomas arise from?

A

Blood vessels

27
Q

Where do osteomas / ostesarcomas arise from?

A

Bone

28
Q

Where do chondromas / chondrosarcomas arise from?

A

Cartilage

29
Q

How do sarcomas metastasise?

A

Bloodstream

30
Q

What is grade

A

GRADE IS THE AGGRESSIVENESS OF BEHAVIOUR OF A CANCER.
Reflects how closely the tumour resembles the normal tissue. Assessment of differentiation.
Tumour grade correlates with aggressiveness of behaviour (how quickly it is growing, and how likely it is to spread)

31
Q

What does grade 1 cancer mean

A

Well differentiated - less aggressive behaviour

32
Q

What does grade 3 cancer mean

A

Poorly differentiated - more aggressive behaviour

33
Q

How are carcinomas graded

A

Usually 1-3, but some exceptions:

  • Renal cell carcinoma = Fuhrman
  • Prostatic carcinoma = Gleason
  • some are not graded eg. small cell lung cancer / BCC
34
Q

How are lymphomas graded

A
  • Hodgekin lymphoma = not graded clinically

- Non-hodgkin lymphoma = not formally graded; informally classified as low/high grade

35
Q

What is stage

A

STAGE IS THE EXTENT OF ANATOMICAL SPREAD BY A CANCER.

Determining how much cancer there is in the body and where it is located.

36
Q

How is staging performed

A
  • Clinical (physical examination)
  • Radiological (CT scans, MRI scans, PET scans, radiographs, USS)
  • Surgical - EUA
  • Pathological (microscopic examination of tissues)
37
Q

Why is staging performed

A
  • Usually the single most important prognostic factor
  • Helps to plan tx
  • Allows doctors to easily communicate
  • Clinical trial suitability for patient
38
Q

What is the most common staging system

A

TNM
Local tumour spread = how deep they invade the wall of the viscus and whether they invade adjacent structures (colorectum, endometrium, bladder)
Regional lymph node metastasis
The presence of distant metastases

39
Q

What is the staging system for gynaecological cancers

A

FIGO

40
Q

What is the staging system for colorectal cancer

A

Dukes

41
Q

What is the staging system for lymphomas

A

Ann-Arbor

42
Q

Patient presents to GP with suspected cancer- what should be done

A

Urgent referral to relavant hospital clinic, usually ‘two week rule’: clinical assessment, investigations (blood tests, imaging, biopsy/FNA)

43
Q

A patient has been referred to you from GP under 2 week rule. You think cancer is likely- what must be done

A

A definate diagnosis of cancer requires a ‘tissue’ diagnosis - usually a biopsy for histology. This will also provide the grade.

44
Q

A patient has just had a biopsy that confirms the diagnosis of cancer. What further investigation is needed?

A

Staging e.g. CT/MRI

45
Q

How is a cancer patient managed

A

All patients are discussed at a cacner MDT meeting and a cancer plan is agreed.
Low stage = curative intent
High stage = palliative intent

46
Q

List common sites of metastases and their symptoms

A

Lung = haemoptysis, pneumonia, pleural effusion
Liver = jaundice, hepatic failure
Brain = seizures, stroke
Bone marrow = anaemia, leukopaenia, thrombocytopaenia
bone = pain, fracture, spinal cord compression

47
Q

What are the categories for types of symptoms a patient may experience

A

Local symptoms - related to the tissue destruction at the site of the cancer
Metastatic symptoms - related to secondary deposits of the cancer in distant organs
Systemic symptoms - as a result of cytokine release form tumour cells

48
Q

What systemic symptoms may patients experience

A

Prolonged fever
Weight loss
Loss of appetite
Decreased immunity

49
Q

What is a paraneoplastic syndrome

A

A syndrome caused by substanced produced by the tumour cells which act remotely from the tumour or its metastases

50
Q

What causes paraneoplastic syndrome

A

substances released from tumour cells - hormones / cytokines / other factors

OR it can be caused by Abx produced by the body to fight the tumour, but unfortunately cross-react with normal tissues and damage them

51
Q

List examples of paraneoplastic syndromes

A

1) Endocrine = hypercalacaemia (PTH secretion) / cushings (ACTH secretion)
2) neuromuscular = eaton-lambert myasthenic syndrome
3) Haematological = PE (release of tumour procoagulants)
4) Renal = nephrotic syndrome (immune complex deposition in glomeruli)

52
Q

What are the 4 ways cells adapt to their environment

A

1) atrophy = reduction in the size of an organ
2) hypertrophy = increase in size of cells
3) hyperplasia = increase in number of cells
4) metaplasia = one mature cell type is replaced by another mature cell type

53
Q

What is metaplasia

A

one mature cell type is replaced by another mature cell type (change in pattern of differentiation).
It is seen almost exclusively in epithelial cells, usualy as a response to chronic injury.
May progress to dysplasia.

54
Q

Explain the possible metaplastic change in acidic environment of the vagina

A

Columnar (glandular) epithelium of the cervix becoming squamous epithelium

55
Q

Explain the possible metastatic change with cigarette smoking

A

Columnar (glandular) epithelium of the bronchial tree becoming squamous epithelium

56
Q

Explain possible metastatic change with gastric acid in the oesophagus

A

Squamous epithelium of the oesophagus becoming columnar (glandular) epithelium
(BARRETT’S OESOPHAGUS)

57
Q

What is dysplasia

A

Disordered growth or differentiation. It may progress to become a malignant tumour (pre-malignant).

58
Q

How is dysplasia categorised microscopically

A

By varying degrees of decreased differentiation, more mitoses, high nuclear:cytoplasmic ratio; cellular/nuclear pleomorphism.

Ie. beggining to show the microscopic features associated with malignancy

59
Q

How is dysplasia categorised

A

“graded” according to the severity of the changes seen on histology.
mild / moderate / severe
OR
low / high

60
Q

What is carcinoma in situ

A

At some anatomical sites, severe dysplasia is called carcinoma in situ.
This is not cancer becuase the cells have not yet invaded through the basement membrane.

61
Q

What is the basement membrane

A

A specialised sheet of ECM which lies between parenchymal cells and mesenchymal tissues.

Parenchymal = perform the main function of a tissue, in this context the epithelium.
Support (mesenchymal) cells = provide the structural scaffold of a tissue.

Cellular pathology (8 decks)

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