An introduction to neoplasia

Question 1

What is the clonal evolution model

Answer 1

• this is the idea that tumours are from clones
• but as they grow they gain more mutations
• they have different shapes, size and molecular biology
• each new mutation adds a new characteristic
• autonomous or normal growth signals
  those with a growth advantage are dominant

Question 2

what is the cancer stem cell hypothesis

Answer 2

• idea that a normal stem cell leads to mutated stem cells which lead to cancer stem cells
• normal progenitor cell leads to a mutated progenitor cell which leads to cancer stem cell
• normal differentiated cell leads to a muted differentiated cell which leads to a cancer stem cell

Question 3

what is a property of cancer stem cells

Answer 3

they are self renewal

Question 4

what is a neoplasm

Answer 4

A neoplasm is an abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues, and persists in the same excessive manner after cessation of the stimulus which evoked the change.”

Question 5

what are the various types of growth

Answer 5

• Benign
• precancerous
• carcinoma in situ
• malignant (cancerous tumours)

Question 6

what does the initial development and growth depend on

Answer 6

• depends on a population of a single type of neoplastic or transformed cells that are derived from a progenitor cell, these cells are identical and are clonal cells

Question 7

neoplasms often contain …

Answer 7

more than one cell type

Question 8

what is hyperplasia and what does it result in

Answer 8

this is an increase in overall muscle mass due to corresponding increase in the size of cells
- leads to benign tumour forming

Question 9

what is dysplasia what does it lead to

Answer 9

• this is an increase in the number of cells present, abnormality in growth and maturation of cells within tissues
• often an indication of an early neoplastic process
• pre-cancerous

Question 10

what is carcinoma in situ

Answer 10

• this is when the cells become primitive in capability

- invasive potential, may result in the formation of a malignant tumour

Question 11

what is invasive cancer

Answer 11

this is when cells have the ability to invade nd metastasis

Question 12

what are the stages of tumour development

Answer 12

• hyperplasia
• dysplasia
• carcinoma in situ
• invasive cancer

Question 13

what is hyper plastic cells

Answer 13

these are a excessive number of cells that can assemble into tissue which appears reasonably normal

Question 14

what are examples of hyper plastic cells

Answer 14

Examples:
Benign prostatic hyperplasia (BPH)
Atypical lobular hyperplasia (breast)
Atypical ductal hyperplasia (breast

Question 15

what is metaplasia

Answer 15

this is when a normal layer is replicated by a cell type that is not normally found in that location

• invading cells are microscopically normal
• often occurs in epithelial transition zones (e.g. junction of cervix and uterus and oesophagus and stomach)

Question 16

what is an example of metaplasic tumours

Answer 16

Example: Barrett’s oesophagus
(30x increased risk developing
oesophageal adenocarcinomas).

Question 17

describe dysplasia

Answer 17

abnormal growth

• some but not all of the features in malignancy are present
• transitional state between benign and pre=malignant
• dysplasia may develop into malignancy

Question 18

what are example of dysplasia cacners

Answer 18

Colonic polyps

Uterine cervix

Question 19

how do you grade dysplasia

Answer 19

• depends on the thickness of the involved epithelium

Question 20

what is the grading system of the epitheium

Answer 20

-Cervix - normal stratified squamous epithelium
- CIN I - disease confined to the lower third of the epithelium - this is mild
CIN II - diseased confined to the lower and middle thirds of the epithelium - moderate
CIN III - affecting the full thickness of the epidermis this is severe

Question 21

what are the grade dysplasia in bronchial epithelium

Answer 21

(A) Normal two-layered epithelium; 
(B) squamous metaplasia;
(C) mild dysplasia;
(D) moderate dysplasia; 
(E) severe dysplasia;
(F) carcinomain situ.

Question 22

what are the characteristics in dysplasia

Answer 22

- Variability nuclear size and 
shape
- > nuclear: cytoplasmic ratio
- Increased mitotic activity
- Change in the relative  numbers 
of specific cell types

these are major changes in the cytoarchitecture

Question 23

what is the epithelia layer derived from

Answer 23

• all three germ layers in the embryo, these are the ectoderm, mesoderm, and endoderm

Question 24

What makes up the ectoderm

Answer 24

Skin epidermis

Glandular tissue of breast

Question 25

what makes up the mesoderm

Answer 25

ovaries

Question 26

what makes up the endoderm

Answer 26

``` Lungs Liver Gall bladder Pancreas Stomach Intestine ```

Question 27

what is epithelia called in term of tumours

Answer 27

- carcinoma

Question 28

what do lining and covering epithelia cover

Answer 28

Forms the surface of the skin and some internal organs. It forms the inner lining of ducts and body cavities and the interior of the respiratory, digestive, urinary and reproductive systems – stratified squamous

Question 29

what does the glandular epithelium cover

Answer 29

Are found in organs such as the thyroid, adrenal glands and sweat glands. And glands in breast and prostate. Specialised polarised cells which secrete into ducts or cavities –simple cuboidal and simple columnar.

Question 30

what are most human cancers

Answer 30

they are epithelial in origin and are carcinomas

Question 31

what are two common types of epithelial cancers

Answer 31

1. Producing recognizable squamous cells: squamous cell carcinoma (nasal cavity, larynx, lung, cervix, skin). 2. Glandular growth pattern: adenocarcinoma (lung, colon, breast, pancreas, stomach prostate).

Question 32

what is the difference between normal prostate glands and malignant prostate glands in prostate adenocarcinoma

Answer 32

``` Normal Columnar and some cuboidal luminal cells Pale cytoplasm Inconspicuous nucleoli Basal cells Flattened/cuboidal ``` ``` Malignant note size of nucleus: cytoplasm and prominent nucleoli absence of basal cell layer hyperchromasia ```

Question 33

what is abnormal nuclear morphology

Answer 33

``` Hyperchromasia Chromatin clumping Prominent nucleoli Little cytoplasm Increased nuclear: cytoplasmic ratio (>1:5 to 1:1) Frequent mitosis (yellow arrows) ```

Question 34

what happens in abnormal mitosis

Answer 34

- proliferative activity is high (mitotic rate is high) | - increased number of mitotic figures

Question 35

what are the different spindles

Answer 35

- tripolar - quardripolar - multipolar spindles

Question 36

what is pleomorphism

Answer 36

variation in cell shape and size often larger than normal

Question 37

what are the different types of pleomorphism

Answer 37

Cellular pleomorphism Nuclear pleomorphism Hyperchromatic nuclei Tumour giant cells

Question 38

what are the features of anaplasia

Answer 38

pleomorphism abnormal nuclear morphology mitoses (abnormal Loss of polarity Normal cells are anchored and oriented to the basement membrane Anaplastic cells lose this orientation and grow in a disorganised way Other things Tumour giant cells Ischemic necrosis (as tumour outgrows its blood supply)

Question 39

where are sarcomas derived from

Answer 39

mesodermal tissues

Question 40

what are the two main types of sacromas

Answer 40

bone | soft tissue

Question 41

describe the sarcomas in the soft tissue

Answer 41

``` Muscle (skeletal and smooth) Cartilage Fat Nerves Fibrous tissue, such as ligaments and connect tissue Blood vessels Lymph vessels ```

Question 42

what are the types o f blood cancers

Answer 42

- leukaemia - lymphoma - multiple myeloma

Question 43

where are blood cancers derived from

Answer 43

haematopoietic and lymphoid tissues

Question 44

what is leukaemia and which cells does it affect

Answer 44

``` – malignancies of the bone marrow (abnormal white blood cells) Lymphoid Myeloid Acute Chronic ```

Question 45

what is lymphoma and what are the type types

Answer 45

malignancies of the lymphoproliferative system Hodgkin- lymph nodes, the spleen and liver Non-Hodgkin - lymph nodes and extra-nodal including the gastrointestinal tract, skin and bone

Question 46

what is multiple myeloma and where does it effect

Answer 46

neoplastic proliferation of B cells in bone marrow - plasma cells producing a characteristic paraprotein (abnormal antibody).