Tumour Behaviour and Spread

Question 1

Answer 1

Benign Tumour in Organ
Well circumscribed
They grow evenly in all directions, giving a spherical mass

Question 2

Answer 2

Benign TIssue in Epithelial Surface
Papillary outgrowths growing in the direction of least resistance.
Because of their papillary shape they are called papillomas

Question 3

Answer 3

Malignant Tumour

Irregular in outline, with indistinct edges.

Question 4

How to identify malignant tumours

Answer 4

Is there any clinical evidence of invasion or spread to distant sites?
Is there imaging evidence of invasion or spread to distant sites?

ANSWER TO BOTH OR EITHER MAY BE “YES”, BUT
OFTEN ONLY IN ADVANCED TUMOURS

Question 5

How to accurately and confidently identify malignant tissue

Answer 5

Biopsy and histological examination of a sample of tumour cells or tissue

Question 6

Benign vs Malignant Tumours

Answer 6

Question 7

Cellular Pleomorphism

Answer 7

Variation in size and shape of cells in tumour

Question 8

NUCLEAR PLEOMORPHISM

Answer 8

variation in size and shape of nuclei in tumour cells

Question 9

NUCLEAR HYPERCHROMATISM

Answer 9

very dark-staining nuclei

due to increased nuclear DNA

Question 10

HIGH MITOTIC COUNT

Answer 10

increased numbers of cells in mitosis, including abnormal mitotic forms

Question 11

Cytological characteristics of malignancy

Answer 11

Poor Differentiation
Pleomorphism & Abnormal Mitoses
High Mitotic Count
Nuclear Hyperchromatism
High nucleus to Cytoplasm Ratio

Question 12

Features of dysplastic cells that lead to their abnormal structure

Answer 12

Loss of differentiation
Pleomorphism
Nuclear hyperchromatism
High nucleus/cytoplasm ratio
High mitotic activity

Question 13

Does dysplasia in tumour cells always mean invasive behaviour?

Answer 13

Usually but not always

Question 14

Carcinoma-in-situ

Answer 14

Epithelium showing the cytological Characteristics of malignancy, but no evidence of invasion

**Non-invasive Dysplasia

Question 15

What happens to dysplastic cells

Answer 15

Sometimes dysplasia regress but more often turns into invasive malignancy

Question 16

What happens when a malignant tumour invades the lumen of a lymphatic vessel

Answer 16

Bits of it break off and pass to the lymph nodes draining the area

Question 17

How do the tumour cells proliferate to replace the whole lymph node

Answer 17

They reach the lymph node and are trapped in the subcapsular sinus where they proliferate to replace the whole node

Question 18

Blood Stream Spread of Cancer

Answer 18

When a tumour invades the wall of a small vessel, clumps of it break off and pass in the circulation until they meet a vessel too small to let it pass
- Causes tumour embolism

The tumour cells may grow to cause a distant metastasis

Question 19

Common Sites of Blood-Borne Metastasis

Answer 19

Brain/CSF
Lung
Liver
Adrenals
Bone

Question 20

Where do liver metastases often originate

Answer 20

GI Tract, Pancrease, Breast, Lung/Bronchus, Kidney

Question 21

Where do bone metastases often originate

Answer 21

Breast
Bronchus/Lung
Kidney
Thyroid
Prostate

Question 22

How can benign tumours cause death/illness

Answer 22

Bleeding - e.g. gut/bladder
Pressure on adjacent vital structures - e.g. Brain
Obstruction - e.g. Brain, bronchus
Hormone secretion - e.g. pituitary adenoma
Conversion to a malignant tumour