94 - Neoplasia 3 Flashcards by Jack Cuthbertson

*Four appearances of intraepithelial neoplasia

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Process that precedes many carcinomas

Intraepithelial neoplasia

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Most-common cancers

Carcinomas/epithelial cancers

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Stages of intraepithelial neoplasia 1 2 3 4

1) Normal 2) Dysplasia (EG: simple columnar cell takes on several mutations) 3) In situ neoplasm 4) Invasive neoplasm

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Stages of intraepithelial neoplasia 1 2 3 4

1) Normal 2) Dysplasia (EG: simple columnar cell takes on several mutations, increased mitotic activity, pleiomorphic nuclei. Changes are restricted to epithelial cells) 3) In situ neoplasm 4) Invasive neoplasm

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Stages of intraepithelial neoplasia 1 2 3 4

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Appearance of dysplasic cells

Increased mitotic activity. Pleiomorphic nuclei Large nucleoli Premalignant.

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What is in situ carcinoma?

When dysplasic cells become malignant.

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Dysplasia

Abnormality of development; alteration in size, shape and organisation ofcells

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Meaning of grades of dysplasia

Higher the grade -> more likely to progress to malignancy (grades 1, 2 and 3)

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Grade 3 dysplasia

In situ carcinoma. Non-invasive.

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Differences between normal stratified squamous epithelium and squamous dysplasia

Dysplasic: Enlarged nuclei, pleomorphic nuclei, disorganised cells, increased proliferation, incomplete cellular maturation (should only have mitosis in basal layer)

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Differences between normal stratified squamous epithelium and squamous dysplasia

Dysplasic: Enlarged nuclei, pleomorphic nuclei, disorganised cells, increased proliferation, incomplete cellular maturation (should only have mitosis in basal layer)

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What do glandular dysplastic lesions arising from lining epithelium often form?

Polyps (protuberances of tissue into the lumen)

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Difference between hyperplasia and neoplasia

Hyperplasia is controlled.

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When can hyperplasia predispose to cancer?

Hyperplasia in certain situations can confer increased risk of malignancy (risk of mutations developing). NOT premalignant.

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When can metaplasia predispose to neoplasia?

Influences that lead to pathologic metaplasia can also predispose to malignant transformation of metaplastic epithelium

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Risk of intraepithelial neoplasias to become malignant

Reasonable risk (therefore considered premalignant). Greater risk than most other benign lesions

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Risk of intraepithelial neoplasias to become malignant

Reasonable risk (therefore considered premalignant). Greater risk than most other benign lesions

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Lymphadenopathy

Enlarged lymph nodes

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Examples of effects of metastases 1 2 3 4

– Local lymphadenopathy (draining to local lymph node) – Bone pain or features related to hypercalcaemia – Jaundice (to liver) – Seizures (if in brain)

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Examples of effects of metastases 1 2 3 4

– Local lymphadenopathy (draining to local lymph node) – Bone pain or features related to hypercalcaemia – Jaundice (to liver) – Seizures (if in brain)

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Malignancies often associated with weight loss, fever

Late-stage

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Where do TNFa and IL-1 come from in some cancers?

Produced by either tumour cells or cells in the tumour microenvironment (EG: macrophages)

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Paraneoplastic effects

Effects of malignancy, not caused directly by tumour mass

Examples of paraneoplastic endocrine effects 1 2 3 4 5

1) Cushing's syndrome 2) Inappropriate ADH syndrome 3) Hypercalcaemia 4) Hypoglycaemia 5) Polycythaemia

Cushing's syndrome

ACTH (adrenocorticotropic hormone) release.

Hypercalcaemia in cancer

Squamous cell carcinoma releases parathyroid hormone-like substance.

Hypercalcaemia in cancer

Squamous cell carcinoma releases parathyroid hormone-like substance. Can lead to excessive breakdown of bone (increase osteoclast activity)

Immunological paraneoplastic effects 1 2 3 4

1) Dermatologic (rashes, lesions) 2) Neuropathy (injuries to nerves) 3) Inflammation of muscle (weakness) 4) Nephrotic syndrome

Paraneoplastic effects of lung cancer 1 2 3 4

Clubbing Hypertrophic osteoarthropathy Venous thrombosis Non-bacterial thrombotic endocarditis

Paraneoplastic effects 1 2 3 4

1) Clubbing 2) Hypertrophic osteoarthropathy 3) Venous thrombosis 4) Non-bacterial thrombotic endocarditis

Local effects of primary lung cancer 1 2 3 4 5 6

1) Cough 2) Haemoptysis 3) Wheeze 4) Dyspnoea 5) Pneumonia 6) Pancoast's syndrome

Cancer that can lead to anaemia

Colon cancer (lose blood into colon)

Tests that can be useful in diagnosing cancers

1) Haemoglobin level 2) Liver function tests 3) Radiology (CXR, CT scan) 4) Endoscopy

Prostate specific antigen

Can be elevated in prostate, pancreatic cancer. Can also be elevated in non-malignant tumours, non-cancer conditions. Used in diagnosis, but is hard to use because of some non-specificity.

What can CXR be used for? 1 2 3

1) Investigation of primary cancer 2) Staging of cancer (progression) 3) Follow up (to see if there is remission, relapse, etc)

Tests that can be useful in diagnosing cancers 1 2 3 4

1) Haemoglobin level 2) Liver function tests 3) Radiology (CXR, CT scan) 4) Endoscopy

What can CXR be used for? 1 2 3

1) Investigation of primary cancer 2) Staging of cancer (progression) 3) Follow up (to see if there is remission, relapse, etc)

Uses of endoscopy

Visualisation and biopsy of suspicious-looking lesions

Anatomical pathologist

Specialises in looking at biopsy results under a microscope, diagnosing cancers.

Samples essential for diagnosis of cancer

Histopathological specimens

Two principle ways to biopsy a tumour

1) Histopathology 2) Cytology

Histopathology

Take a piece of tissue, stain it (HE, immunohistochemistry). Can see tissue architecture.

Cytology

Take fine needle aspiration, exfoliative cytology (scrape cells from a surface). Place cells onto a slide. Can't see stroma, tissue architecture.

Examples of molecular, cytogenic techniques for diagnosing cancers 1 2 3 4

1) In situ hybridisation 2) PCR 3) Chromosomal rearrangements 4) Flow cytometry

Cytologic tissue sampling in lung tumours 1) 2) 3) 4)

• Sputum • Bronchial brush and wash at bronchoscopy • Endobronchial ultrasound transbronchial aspiration (EBUS-TBNA) • FNA under radiological guidance for more peripheral lesions

Tissue/histopathology specimens for diagnosing lung tumours 1) 2) 3) 4)

• Tissue core biopsy for peripheral lesions • Surgical resection specimen (if performed) • H&E • Immunohistochemistry: may help distinguish primary from metastatic lesions

Things we need to know once diagnosis of malignancy is made 1 2 3 4

• Specific tumour type and subtype (cell lineage) • Grade • Stage • Presence of lymphovascular invasion

Two broad groups of lung cancers

Non-small cell Neuroendocrine

Neuroendocrine carcinomas

Show features of neuroendocrine cells.

Small cell carcinoma

Very aggressive neuroendocrine cardcinoma

Main types of non-small cell carcinomas

Squamous cell carcinoma, adenocarcinoma, large-cell (undifferentiated) carcinoma

Most-common cancer in smokers and non smokers

Adenocarcinomas

Pre-neoplastic changes in squamous cell carcinoma (lung) 1 2 3 4

Stratified squamous cell epithelium present (in smokers) Large, pleomorphic nuclei. Necrosis Invasive

Pre-neoplastic changes in squamous cell carcinoma (lung) 1 2 3 4

Stratified squamous cell epithelium present (in smokers) Large, pleomorphic nuclei. Necrosis Invasive

Name for pre-malignancy of squamous cell carcinoma

Dysplasia-carcinoma sequence

Gross appearance of squamous cell carcinoma

Pale mass. Arise in main bronchi. Can form cavities.

Location of adenocarcinomas

In bronchiolar epithelial cells. More peripheral. Not in main airways.

Desmoplasia

When a lot of the tumour isn't actually neoplastic cells, but stroma.

What determines how hard a tumour is?

Degree of desmoplasia (amount of stroma)

Classic histological feature of adenocarcinoma

Form ducts

Classic histological feature squamous cell carcinoma

Keratinisation

Degrees of cancer differentiation

Well-differentiated (resemble mature cells) Moderately-differentiated Poorly-differentiated (only poorly resemble mature cells, more aggressive)

Stage of cancer

Refers to progression of malignancy (in terms of local spread, metastasis)

What is used to determine stage of cancer?

Radiological and pathological assessment

TNM

T: Extent of primary tumour (1 - 4) N: Regional lymph node metastases (0 - 3) M: Presence or absence of metastases (0 or 1) These are combined to give a score out of four.

Histological suggestion of metastasis

Lympho-vascular invasion (even if can't see metastases radiologically). Gives a poorer prognosis

Examples of predictive factors in breast cancers

HER2 amplification in breast cancer Oestrogen and progesterone receptors Predictive factors can suggest potential therapies

Examples of predictive factors in breast cancers

HER2 amplification in breast cancer Oestrogen and progesterone receptors Predictive factors can suggest potential therapies

Management of a tumour 1 2 3 4 5

1) Surgery 2) Radiotherapy 3) Chemotherapy 4) Targeted therapy 5) Immunotherapy, bone marrow transplant (these are less-widely applicable)

Things on a path report for a cancer 1 2 3 4 5 6

• Confirmation/further information on type and subtype of malignancy • Grade • Size of tumour/depth of invasion • Presence/absence of microscopic vascular invasion • Completeness of excision • Presence and number of lymph node metastases (which may only be microscopic so histologic examination is necessary)

Targeted therapy

Targeted therapies block the growth of cancer cells by interfering with the function of specific molecules (e.g. oncoproteins) resulting from genetic alterations that drive carcinogenesis and tumour growth

Advantages of targeted therapies

Less damaging to normal cells, target neoplastic cells

Two broad types of targeted therapies

Monoclonal antibodies Small molecules

Most important mutations in non-small cell carcinomas

EGFR ALK

EGFR

Transmembrane tyrosine kinase receptors Growth factor receptor. When stimulated, causes cell to divide.

Examples of anti-EGFR therapies

Gefitinib Erlotinib Both inhibit EGFR tyrosine kinase.

Examples of anti-EGFR therapies 1 2

Gefitinib Erlotinib Both inhibit EGFR tyrosine kinase.

Causes of death in cancer 1 2 3

1) Cachexia 2) Secondary infection from poor nutrition, effects of treatment (pneumonia is common) 3) Damage to vital organ or system by either primary or secondary tumour

94 - Neoplasia 3 Flashcards

(80 cards)