Principles or Tumours and Presentations of Malignancy Flashcards Preview

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Flashcards in Principles or Tumours and Presentations of Malignancy Deck (32)
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1
Q

What is neoplasia and neolpasm?

A

Cell proliferation occurring in the absence of any continuing external stimuli

A neoplasm is an abnormal mass of tissues which shows uncoordinated growth and serves no useful purpose

Tumour is a synonym for neoplasm that applies to both benign or malignant masses

2
Q

What is the behaviour and macroscopic appearance of a benign tumour?

A
  • Slow growing
  • Well circumscribed
  • Encapsulated by a layer of compressed fibrous tissue
  • Not locally invasive
  • NO METASTATIC POTENTIAL
3
Q

What is the behaviour and macroscopic features of malignant tumours?

A
  • Fast growing
  • Poorly circumscribed
  • Non-encapsulated
  • INVASIVE GROWTH with destruction of adjacent tissue
  • METASTATIC POTENTIAL
4
Q

How is a malignant tumour defined?

A

Invasive growth + metastatic potential

5
Q

What are the microscopic features of benign tumours?

A
  • Very well differentiated
  • Cells are uniform throughout tumour
  • Few mitoses
  • Normal nuclear:cytoplasmic ratio
6
Q

What are the microscopic features of malignant tumours?

A
  • Variable/poor differentiation
  • Cells and nuclei vary in size and shape throughout tumour
  • High nuclear:cytoplasmic ratio
7
Q

What are epithelial cells and the different types of epithelium found in the body?

A

Cells that line the surfaces of the body

Squamous epithelium => skin and oesophagus
Grandular epithelium => respiratory and GI tract
Urothelium => urinary tract

8
Q

How are epithelial malignancies named?

A

Benign epithelial tumours => end in -oma
Malignant epithelial tumours => end in =carcinoma

NOT ALL CELLS ENDING IN -OMA ARE TUMOUR eg. granulomas (aggregation of activated macrophages)

Adenocarcinoma = malignant glandular epithelium

9
Q

What are the defining features of Adenocarcinoma and Squamous cell carcinoma?

A

=> Adenocarcinoma:

  • Gland formation
  • Mucin production
  • Nucleas completely displaced to the side in cells

=> Squamous cell carcinoma:

  • Keratin formation
  • Intercellular bridges between cells
10
Q

Through what route do carcinomas and adenocarcinomas metastasise?

A

Carcinomas through the lymphatic system

Adenocarcinomas though the blood

11
Q

What is grading and staging of tumours?

A

Grading => aggressiveness of behaviour of a cancer (how differentiated it is)

Staging => extent of anatomical spread

12
Q

In general, what is the grading system for most tumours?

A

Grade 1 or well differentiated => less aggressive behaviour
Grade 2 or moderately differentiated => intermediate
Grade 3 or poorly differentiated => more aggressive

13
Q

What is the grading system specifically for carcinomas?

A

Most carcinomas graded 1-3

Exceptions:

Renal cell carcinoma - Fuhrman system (4 tier system)
Prostatic carcinoma - Gleason system (5 tier system)

14
Q

What is the grading system for lymphomas?

A

Hodgkin’s - not graded

Non Hodgkin’s - Low or high grade

15
Q

Why is staging important?

A

Most important prognostic factor of cancer

16
Q

What system is most commonly used for staging of most cancers and how does it work?

A

TNM staging

T - Tumour spread
N - Regional lymph node spread
M - Presence of distant metastases

T N and M or put together to give an overall stage of I to IV

17
Q

How is the T stage determined for primary tumours?

A
  • Cancers arising from a hollow viscus are staged according to how deep they invade the wall of the viscus and whether they invade adjacent structures
  • Cancers arising at other sites often staged by measuring their maximum dimension
18
Q

What are the other staging systems of specific cancers?

A

FIGO system => Gynacological cancers
ANN ARBOR system => Lymphomas
DUKES system => Colorectal carcinoma

19
Q

How are the symptoms of cancer categorised?

A

=> LOCALISED:

  • Related to tissue destruction at the site of the cancer
  • Eg lung carcinoma would present with cough, haemoptysis and chest wall pain

=> METASTATIC:
- Related to secondary deposits of the cancer in distant organs

=> SYSTEMIC:

  • Prolonged fever
  • Weight loss
  • Loss of appetite
  • Decreased immunity

=> Paraneoplastic syndrome:

  • Caused by substances produced by the tumour
  • Seen in a range of cancers:

Small cell carcinomas - SIADH, ectopic ACTH production, Lambert Eaton Syndrome

Squamous cell carcinomas - Hypercalcaemia, hyperthyroidism, clubbing

Bronchial carcinoma causes excess seratonin release

Large cell carcinoma - B hCG release

20
Q

What are the common sites of metastases and their presentations?

A

=> Lung

  • Haemoptysis
  • Pneumonia
  • Pleural effusion

=> Liver

  • Jaundice
  • Hepatic failure

=> Brain:

  • Seizures
  • Stroke

=> Bone marrow:

  • Pancytopenia (all three cell lines)
  • Anaemia
  • Leukopenia
  • Thrombocytopenia

=> Bone

  • Pain
  • Fracture
  • Spinal cord compression
21
Q

What is atrophy?

A
  • Reduction in size of a tissue or organ

- May be due to a reduction in cell number or a reduction in cell size or both

22
Q

What is hyperplasia?

A
  • Increase in cell number
23
Q

What is hypertrophy?

A
  • Increase in cell size
24
Q

What is metaplasia?

A
  • When one mature cell type is replaced by another as a way to adapt to the changed environment
  • May be physiological or pathological
  • It MAY turn into dysplasia, a premalignant phase
25
Q

What occurs in the metaplasia of grandular epithelium of the cervix?

A
  • Acid environment of vagina causes change to squamous epithelium
26
Q

What happens in the metaplasia of the grandular epithelium of the bronchial tree?

A
  • Cigarette smoking causes change from grandular to squamous epithelium
27
Q

What happens in the metaplasia of the squamous epithelium of the oesophagus?

A
  • Exposure to gastric acid causes change to Columnar epithelium
28
Q

What is dysplasia?

A
  • Disordered growth or differentiation

- It is a premalignant condition which may progress to becoming a malignant tumour

29
Q

What is another term for severe dysplasia?

A
  • Carcinoma in situ
30
Q

What is the difference between Carcinoma and carcinoma in situ?

A
  • Carcinoma is malignant, showing invasive growth and metastatic potential
  • Carcinoma in situ is a lesion which has the potential to progress into an invasive tumour, but has no yet invaded the basement membrane so has no metastatic potential. PREMALIGNANT
31
Q

What is the premalignant terminology for premalignant tumours of the:

  • Cervix
  • Endometrium
  • Bladder
  • Prostate
  • Colorectum
  • Breast
  • Skin
A

=> Cervix - Cervical Intraepithelial Neoplasia
=> Endometrium - Atypical hyperplasia
=> Bladder - Carcinoma In Situ
=> Prostate - Prostatic Intraepithelial Neoplasia
=> Colorectum - Low and High Grade Dysplasia
=> Breast - Ductal Carcinoma In Situ
=> Skin - Actinic Keratosis

32
Q

Examples of metaplasia-dyslasia-carcinoma sequence progression

A

BARRET’S OESOPHAGUS

Squamous mucosa => Glandular mucosa => Dysplasia => Adenocarcinoma

CERVIX

Columnar mucosa => Squamous mucosa
=> CIN (cervical dysplasia) => Squamous cell carcinoma

LUNG

Columnar mucosa => Squamous mucosa
=> Dysplasia => Squamous cell carcinoma

NOTE THAT COLUMNAR AND GRANDULAR ARE TERMS USED INTER-CHANGEBLY