Week 5: Neoplasia workshop Flashcards
What is the system used for naming benign tumours?
suffix -oma to cell type of origin (fibroma, chondroma)
Epithelial origin is more complicated
1. Adenoma - from glandular epithelium
Papillomas - large finger like projections
cystadenomas - large cystic mass
Polyp - visible projection above mucosa
What is terminology order of caner development?
- Oncogene/loss of TSG
- Hyperplasia
- dysplasia
- neoplasia
-Carcinoma in situ
-Invasvie carcinoma
-Metastasis
What is the nomenculture of malignant tumours?
Sarcomas - from solid mesenchymal tissue (connective or supportive)
Luekemias - cancer of white blood cells, starts in tissue that makes blood cells such as bone marrow
Lymphomas and myeloma - cancers begin in the cells of the immune system.
Brain and spinal cord cancers - known of a central nervous system cancers
Adenocarcinoma - glandular pattern
Sqaoumous cell carcinoma - resemble stratified squamous epithelium
Suffix carcinoma or sarcoma tends to indicate malignancy
What is pleomorphic adenoma?
Arise from cell capable of becoming two different cell types e,f epithelial and mesenchymal
Commonly benign salivary gland.
What are the microscopic features of dysplastic cells?
Pleomorphism
large hyperchromatic nuclei with a high nuclear to cytoplasmic ration
Architectureal disarray and loss of orderly differentiation
What are the benefits of capsulation of benign tumours?
Tumour discretes
Readily palpable
Movable
Easily excisable by surgery
What is the treatment priority for malignant tumours?
Chemotherapy or radiotherpay
Surgery afterwards - often need to remove large amount fo surrounding tissue to ensure all removed due to invasive manner of tumour and no cpaulse/clear boundaries
How can cancers spread by seeding into body cavities? (transcoelomic)
Enters an area lacking physical barriers
Commonly the peritoneal cavity - can expand to fill the cavity
Characteristic of ovarian carcinoma.
May penetrate within the cavity to remain lining to organs
What tumours tend to spread hematogenously?
Sarcomas mainly
Some carcinomas
What is the mechanism of metastasis?
Low importance for exam
Describe the relationship between dysplasia and cancer?
Prolonged hyperplasia, metaplasia and cell damage can become - Low grade dysplasia - becomes benign is not identified
If develops into high grade dysplasia - becomes malignant
Green = reversible
Orange = irreversible
What is a cervical smear?
Method of screening to detect precancerous or cacnerous cells in the cervix, if positive indicates an increased risk of these cells and more specific diagnostic tests are required.
HPV cervical screening tests for HPV virus then looks for cellular changes, prioritising those HPV positive.
Requires the use of a speculum and disposable spatula device to collect cells first from the external os of the cervix then repeat to collect cells from the fornix of the cervix
Cells will be placed on a glass slide and fixed.
Detects early changes in cells.
What is taken for a cervical smear?
Those with a cervix between age 25 yo 64 yrs, every 3 to 5 yrs depending on age and where you live.
What is the difference between cytology and histology?
Histology - looks at tissue (many cell types) - microscopic anatomy of biological tissues
Cytology - looks as individual cells or clusters of cells - microscopic appearance of cells
Is a pap smear cytology or histology?
Cytology
What is colposcopy?
Uses a specialised light microscope (Coloscope) to examin the female internal and external genitalis specifically the cervix.
Allows to identify the most abnormal areas which may then want to be sampled and taken for histology for diagnosis.
Images the degree of the disease
What chemicals may be used in a colposcopy to help identify abnormalities?
Acetic acid - used on the cervix and the vulva - causes simple columnar cells to swell - helps identify dysplasia
**Lugols Iodine solutions - stains normal cervical tissue dark brown/black as contain lots of glycogen in stratified squamous, cancerous will turn yellow/white
Saline - wipe away any cervical mucus before the exam begins
What are some tests that are similar to a colposcopy?
Live imaging techniques in the body
Colonoscopy, gastroscopy, laporaoscpy (pelvis) and cystoscopy (Bladder)
What is a loop biopsy? How is it relevant to a pap smear?
Insert a thin wire to remove abnormal sample from the cervix
Wire is hot and has an electrical current running through it that allows it to cut through tissue and steel the wound at the same time.
Can be used to remove precancerous/cancerous tissue for treatment or for diagnosis.
Requires local anaesthetic.
Follow cervical smear abnormality.
What are some different types of biopsy?
Fine needle aspiration biopsy - fine hollow needle inserted into area, syringe attached to needle sucks out cell sample. Minimally invasive to remove a small amount of tissue.
Excision biopsy - surgical removal of a complete skin lesion , often alongside some surrounding normal tissue
Core needle - often used on breast, fine hollow needle, may be attached to a suction device (vacuum-assisted core biopsy) or spring loaded to move the needle in and out of the tissue quickly to collect lots of cells. Removes a larger sample
What are the two types of epithelium normally present in the cervix?
Endocervix - simple columnar epithelium
Exocervix - stratified sqaoumous epithelim
The squamo/columnar junction is also referred to as the transition zone.
What are some important features of the cervix histologically?
Endocervix - very glandular, nabothian cysts (gland obstructed)
transformation zone - external os changes from SS to SC, this is most likely site of cervical carcinomas.
What are the features of normal cervical sqaoumous epithelium?
Well differentiated
Mitotic figures (few in number) in the basal layer - where stem cells reside
Nucleus is euchromatic and regular shape
Nuclear cytoplasmic ratio tend to be high in the basal layer but then nucleus is lost in upper half of differentiated cells in epithelium
Based on the histological image and diagragmatic representation from the cervix suggest is this is normal, abnormal then what grade of tumour?
Abnormal
Carcinoma in situ
Some differentiations particulary in the lower image
Mitotic figures are abnormal - increased in number and located at the basal layer and higher up in the epithelium
Nucleus features - hyperchromatic nuclei extend further than the basal layer, pleomorphic
Nucleo-cytoplasmic ration - high compared to normal particularly closer to the surface epithelium
Top image is more progressed than the bottom image (dysplasia)
What are the different gradings of CIN?
CN1 - 1/3 of epithelium covered
CN2 - 2 thirds of epithelium covered
CN3 - 3 thirds = all covered
What is the clinical significanct of carcinoma in situ being identified from a cervical smear?**
Increased risk of cervical cancer
Urgent cancer referall pathway - Treatment aims to stop progression to malignancy such as invasive cervical cancer
How does treatment of cervical abnormalities effect the natural history of the disease?**
Prevent progression to greater grade of tumour
Halt development of malignancies
Hopefully restore normal epithelium
Define carcinoma
neoplasm originating in epithelial tissue - cells that line or cover internal organs.
Different subtypes - adenocarcinoma, basal cell carcinoma, sqaoumous cell carcinoma and transitional cell carcinoma
What feature may be shown when a sqaoumous cell carcinoma inviades the underlying tissue?
Desmoplastic response - firbous tissue grows around cancerous tissue
may have keratin pearls
What is CIN in relation to cancer?
Cervical intraepithelial neoplasia - described changes in cells that line the cervix, typically changes in the sqaoumous epithelium
Is graded 1 ,2 and 3 based on the size of abnormality across the epithelial layer.
Is NOT cancer
but can develop into cancer is left untreated
What is the cause of CIN?**
Long term HPV infection (STI) - commonly strain 16 and 18 (90% of cases are HPV caused)
Risk also increased by HIV and smoking
Leads to changes in DNA or gene expression (epigenetics)
What are some common causes of tumours?
Cervical - HPV
Lung - smoking
Melanoma - UV radiation from sun beds
Breast - oral oestrogen containing contraceptives
All - obesity, alcohol conumption
What structures are present in the axilla that could give rise to a lump? (differential diagnosis)
Lymphadenopathy - hyperplasic, inflammatory, neoplastic or metastatic.
Accessory breast tissue - fibroadenoma, fibrocystic or breast cancer
Blocked hair follicles/glands
Muscle - overstretching or trauma from a collision, intramuscular neoplasms
Skin lesions - lipomas, rash, irritation from shaving
Post operative fluid collections
Haematoma - an abnormal collection of blood outside the bv.
What are the key features on the skin of the breast that can identify between a malignant and a benign lump?
Malignant tends to have dimpling around the skin
Benign does not
How do neoplastic and stromal cells tend to compare in histological imaging or cancer?
Neoplastic - more purple
Stromal - more pink
Is this tumour malignant or benign?
How can you tell?
Malignant
Gross - not capsulated, no clear boundaries, invades surrounding tissue
Histology - increased nuclear to cytoplasmic ration, pleomorphic nuclei, does not resemble tissue of origin, loss of differentiation, Cells vary in shape and size, loss of tissue architecture
Is this tumour malignant or benign?
Why?
Malignant
No clear boundaries, is invasiive and no capusle - does not resemble tissue of origin is a different colour
Is this tumour malignant or benign?
Why?
Benign
Clear boundaries, encapsulated, resembles tissue of origin
What are the differences between a primary and secondary malignant tumour?
Primary - in tissue of oriring
Secondary - metastasied to new organ
What are the four modes of spread of malignant tumours?
Local invasion
Lymphatic spread
Transcoelomic spread
Vascular spread
Perineural
Example of local invasion for metastatic spread.
Spead into surrounding tissue often by binding down and degrading ECM
Breast invading overlying skin
Cervical cancer to the rectum or bladder
What are an example of lymphatic spread of cancer?
Follows patterns of lymph drainage
Breast to axilla
What are some examples of transoceanic spread?
Through fluid filled cavities
Ovarian cancer and the peritoneum.
What are some examples of vascular spread?
Often via veins as thinner walls than arteries
Gastric to liver
What cancers commonly metastasis through the nervous system?
Pancreatic and prostate
often contribute to tumour associated pain.
What is immunohistochemistry?
Take a cell sample - antigen present on cell (potentially)
Design an antibody that will bind to this antigen as carries a signal (enzyme or coloured bead etc) in order to detect if bound and potentially quantify the amount bound.
Exploits the binding between antibody and antigen to detect and localise specific antigens in cells and tissues
What are the main cell types that give rise to malignant neoplasms?
Epithelial
Melanocytes
Lymphocytes
Germ cells
Soft tissue
What are the immune biomakers used to identify cells of metastatic origin?
Epithelia Cam 5.2
Melanocytes S100
Lymphocytes LCA
Germ cells Oct 3/4
Soft tissue Vimentin
Describe the characteristics of melanoma skin lesion.
Asymettrical
Colour varies throughout - no clear pigmentation
Evolving - change in appearance
Borders - are irregular or blurred
Diameter greater than 6mm.
What are the principle of treatment for patient with benign tumours?
Surgical removal of the tumour
Continue monitoring to see is relapse
watchful waiting - leave untreated and monitor for further changes.
Medication - oestrogen blockers to prevent growth of fibroadenomas
Cryotherapy
Thermotherapy
These are all localised treatments
What are the principle of treatment for patients with malignant tumours?
Rapid referal - aim to treat urgently to prevent (further) metastasis
Often require chemotherapy, radiotherpay then surgery, often remove large amount of surrounding normal tissue due to invasive nature of tumour - ensures all tumour has been removed.
Targeted therapeutics
All systemic treatments.
Do all tumours respons to all treatment modalities in the same way?
Why?
No
Genetic variation between tumour - more susceptible or resistant to certain drugs and treatments
Intratumour heterogenicity - different populations in same tumour specimen
Intertumour heterogenicity - between patients or between tumours
Give an example of a benign glandular cancer?
Pleomorphic adenomas - salivary glands
Thyroid adenomas
Give an example of a benign musle tumour?
Leiomyoma - smooth
Straited - rhabdomyoma
Give an example of a maligna t tumour in gland tissue?
Wilms tumour (renal)
Malignant mixed tumour of the salivary gland
Pituitary carcinomas
Give an example of a malignant cancer in muscle.
Smooth - leiomyosarcoma
Striated - rhabdomyosarcoma
Give an example of benign tumour in the blood
None
Note sickle cell disease and anemia may be treated at blood cancer clinics due to access to hematology experts
Given an example of malignant tumour in the blood
Leukemias
Lymphomas
Give an example of malignant tumour in the blood vessels
Angiosarcoma
Give an example of a benign tumour in the blood vessels
Hemongioma
Give and example of a benign and malignant tumour in the bone
Osteoma
Osteogenic sarcoma
Give an example of a benign and malignant tumour in stratified sqaoumous epithelium
Squamous cell papiloma - benign found in mouth
Sqaoumous cell carcinoma - malignant, cervical cancer
Give an example of a benign and malignant tumour in the transitional epithelium
Cells that can undergo a change in their shape and function - e.g in the uterus, urethra and urinary bladder, change from domed to distended
Benign - transitional cell papilloma
Malignant - transitional cell carcinoma
What do the different grading of Cervical intra-epithelail Neoplasia mean?
1 - mild changes, 1/2 of thickness of epithelial layer, not cancerous and in most cases will no lead to cancer
2 - moderate changes, 2/3 of epithelium affected
3- more severe changes, afftec full thickness of the layers of the cervix
What are the largest risk factors for adult cancer?
Largest - Age
Then
Cigarette smokin
Alcohol
obesity
Virus - epstein barri virus for nasopharangeal and HPV for cervical
Define malignant neoplasm.
A tumour composed of atypical neoplastic, often pleomorphic cells, that invade others tissues. Often metastasis and reoccur after excision
Define benign neoplasm
Collection of hyperplastic cells, that may grow large but do not spread into nearby tissues.
What is the most common cell type to give rise to malignant tumours?
Epithelial tissue (90% of cancers)
