Tumour Pathology Flashcards
A tumour (or neoplasm) is
an abnormal growing mass of tissue
Its growth is uncoordinated with that of surrounding normal tissue
Its growth continues after the removal of any stimulus which may have caused the tumour
It is an irreversible change
two types of tumours:
Benign
Malignant = Cancer
A fundamental property of cancer (or malignant tumour) is:
its ability to invade into adjacent tissue and to metastasise (spread)
grow at other sites within the body (secondary tumours)
Secondary sites of a tumour is where
the original tumour spreads and leads to the growth at other sites within the body.
If there are multiple tumours at multiple sites its not feasible to remove all of the tumours even if they are benign.
what can cause cancer
genetic and environmental factors.
males are more likely to get cancer than women.
cancer has a multi-step process of
progression and development
sarcoma =
cancer of connective tissue
features of benign tumours:
- Non-invasive growth pattern
- Usually encapsulated
- No evidence of invasion
- No metastases
- Cells similar to normal
- Benign tumours are “well-differentiated”
- Function similar to normal tissue
- Rarely cause death
Most common types of cancers in the UK:
- Overall
Breast Lung Prostate Colon Melanoma (skin cancer)
highest cancer survival rate after 5 years is
melanoma with 90%.
followed by breast and prostate by 85%
lowest cancer survival rate after 5 years is
lung cancer with 10%.
followed by kidney and colon cancer at 60%
uterus cancer survival rate after 5 years is
80%
classification of tumours are useful for:
- Understanding tumour behaviour
- Determining outcome (prognosis)
- Selecting therapy.
Adeno-
= gland
-oma
= abnormal growth (tumour)
Carcinoma =
cancer in epithelial tissue of skin or lining of internal organs.
Squamous
= very thin flattened cells
epithelial tumour in glandular tissue
benign = adenoma malignant = adenocarcinoma
epithelial tumour in squamous tissue
benign = squamous papilloma
epithelial tumour in squamous tissue
benign = squamous papilloma malignant = squamous carcinoma
connective tissue tumour in bone tissue
benign = osteoma malignant = osteo sarcoma
connective tissue tumour in fat tissue
benign = lipoma malignant = lipo-sarcoma
connective tissue tumour in fibrous tissue
benign = fibroma malignant = fibro- sarcoma
malignant tumours=
cancer
malignant tumours=
cancerous tumours
neural tumour of the central nervous system
only malignant = astrocytoma
neural tumour of the central nervous system
only malignant = astrocytoma
neural tumour of the peripheral nervous system
only benign = Schwannoma
tumour of white blood cell
only malignant = leukaemia
tumour of lymphoid tissue
only malignant = lymphoma
tumour of melanocytes
benign = naevus malignant = melanoma
tumour of germ cells - various tissue
benign = ovarian teratomas (usually) malignant = testicular teratomas (usually)
features of malignant tumours:
- Invasive growth pattern
- No capsule or capsule breached by tumour cells
- Cell appears abnormal
- Cancer cell is often poorly differentiated
- Loss of normal function
- Often evidence of spread of cancer
- Frequently causes death
Lymphoid tissue includes
white blood cells, spleen, bone marrow, thymus and lymph nodes
describe the properties of cancer cells
- Loss of tumour suppressor genes
- Gain of function of oncogenes
- Altered cellular function
- Abnormal morphology
- Cells capable of independent growth
- But no single feature is unique to cancer cells
- Tumour biomarkers
Tumour suppressor genes include:
Adenomatous polyposis (APC)
Retinoblastma (Rb)
BRCA1
oncogenes include:
B-raf Cyclin D1 ErbB2 c-Myc K-ras and N-ras
loss if cellular function includes:
- loss of cell-to-cell function
- altered cell-to-matrix function
- production of tumour-related proteins (tumour biomarkers)
tumour biomarkers include:
- onco-fetal protein
- oncogenes
- growth factors and receptors
- immune checkpoint inhibitors
tumour biomarkers include:
- onco-fetal protein
- oncogenes
- growth factors and receptors
- immune checkpoint inhibitors (slide 7)
Clinical Utility of Tumour Biomarkers include:
- Screening
- Diagnosis
- Prognostic
- Identifying patients with a specific outcome
- Predictive
- Identifying patients who will respond to a particular therapy
Clinical Utility of Tumour Biomarkers:
Alpha-fetoprotein is used for
- Teratoma of testis
- Hepatocellular carcinoma
Clinical Utility of Tumour Biomarkers:
Carcino-embryonic antigen (CEA) is used for
- Colorectal cancer
Clinical Utility of Tumour Biomarkers:
Oestrogen receptor is used for
- Breast cancer
Clinical Utility of Tumour Biomarkers:
Prostate specific antigen is used for
- Prostate cancer
Biomarker Kras
Colorectal cancer
Biomarker Braf
Melanoma
Biomarker PD-L1
Lung cancer
Biomarker EGFR
Lung cancer
Biomarker Her2
- Breast cancer
- Gastric cancer
Morphology Of Cancer Cells
Cellular and nuclear pleomorphism
- Marked variation in size and shape
Mitoses present and often abnormal
Tumour growth is
the imbalance between cell growth and cell death
- Angiogenesis (new blood vessel formation)
- Apoptosis
Tumour Angiogenesis is
- New blood vessel formation by tumours
- Required to sustain tumour growth
- Provides route for release of tumour cells into circulation
- More blood vessels in a tumour = poorer prognosis
Apoptosis is
- Mechanism of programmed single cell death
- Active cell process
- Regulates tumour growth
- Involved in response to chemotherapy and radiotherapy
Fundamental property of cancer is
Invasion and metastasis
- Multi-step process
- Increased matrix degradation by proteolytic enzymes
- Altered cell-to-cell and cell-to- matrix adhesion
Clinical Significance Of Spread Of Cancer
- Major clinical problem of cancer is formation of metastatic (secondary) tumours
- Prognosis depends on extent of cancer spread
Modes Of Spread Of Cancer
- Local spread
- Lymphatic spread
- Blood spread
- Trans-coelomic (across the peritoneal cavity) spread
Tumour Metastasis Via Lymphatics
- Adherence of tumour cells to lymph vessels
- Invasion from lymphatics
- Invasion into lymph node
- Formation of metastasis in lymph node
- Clinical evidence of metastasis
Tumour Metastasis Via Blood
- Adherence of tumour cells to blood vessels
- Invasion from blood vessels
- Invasion into tissue
- Formation of metastasis
- Clinical evidence of metastasis
Trans-coelomic Spread
- Special form of local spread
- Spread of tumour cells across body cavities e.g. pleural or peritoneal cavities
What tumours show trans-coelomic spread
lung, stomach, colon and ovary
Sites of metastasis not related to
tissue blood flow
Metastatic niche depends on
tumour and tissue related factors
Common Sites Of Metastasis
- Liver
- Lung
- Brain
- Bone
- Axial skeleton
- Adrenal gland
- Omentum/ peritoneum
Uncommon Sites Of Metastasis
Spleen
Kidney
Skeletal muscle
Heart
where does a tumour on the breast usually spread to?
bone
where does a tumour on the prostate usually spread to?
bone
where does a tumour on the colorectal usually spread to?
liver
where does a tumour on the ovary usually spread to?
Omentum(sheet of fatty tissue that stretches over the abdomen)/peritoneum
loss of cell to cell adhesion means
the cells can move to another site in the body (metastasis)
Local effects of malignant tumours (cancer)
Pressure Obstruction Tissue destruction Bleeding Pain Effects of treatment
Systemic effects of cancer
- Weight loss-cancer cachexia (weakness and wasting of body)
- Secretion of hormones
- Paraneoplastic syndromes
- Effects of treatment