Cancer

Question 1

What is a tumour?

Answer 1

Any kind of mass forming lesion, may be neoplastic, hamartomatous or inflammatory

Question 2

What is a neoplasm?

Answer 2

Autonomous growth of tissue which have escaped normal constraints on cell proliferation

• a non neoplastic tumour would only be organised in an abnormal way

Question 3

What are cancers?

Answer 3

Malignant neoplasms

Question 4

What are the differences between benign and malignant neoplasms?

Answer 4

benign : not attached to skin, must not invade locally

Malignant : irregular margin, invaded tissues locally

Question 5

Why may benign cancers be more dangerous than malignant ones?

Answer 5

Due to their location, e.g a benign tumour in the brain can press on vital structures.

Question 6

What are hamartomas?

Answer 6

Localised benign growth of one or more mature cells types

Represent Architectural abnormalities

E.g. lung hamartomas ( composed of cartilage and bronchial tissue )

Question 7

What are Heterotopias?

Answer 7

Normal tissue found in parts of the body not normally present e.g. pancreas found in wall of large intestine

Tumours

Question 8

How are neoplasms defined?

Answer 8

Primary description : cell origin

Secondary description : benign or malignant

Question 9

What is a benign tumour of cartilage called and a malignant tumour?

Answer 9

Chondroma

Chondrosarcoma

Question 10

Give examples of epithelial neoplasms?

Answer 10

Squamous: squamous papilloma / squamous carcinoma found in skin oesophagus and cervix

Glandular : Adenoma / Adenocarcinoma found in breast, colon, pancreas, thyroid

Transitional : Transitional papilloma / transitional cell carcinoma found in bladder

Question 11

Give examples of connective tissue neoplasms?

Answer 11

Smooth muscle : leiomyoma / leiomyosarcoma found in uterus and colon

Bone : osteoma / osteosarcoma found in arm and leg

Question 12

Give examples of Haematological Neoplasms?

Answer 12

Lymphocytes : benign uncommon / lymphoma

Bone marrow : benign uncommon / leukaemia e.g. ALL, CML

Question 13

What are Teratomas?

Answer 13

Tumours derived from germ cells and can contain cells for all 3 germ cell layers

Can have mature, immature or cancer tissue

Question 14

What is special about Hepatomas, Melanomas, teratomas?

Answer 14

They end in -oma but they are malignant

Question 15

What is invasion?

Answer 15

Direct extension into adjacent connective tissue or other structures

Can distinguish between dysplasia and carcinoma from cancer

• severe dysplasia still not cancer

Question 16

What is Metastasis?

Answer 16

Spread via blood vessels to other parts of the body

• all malignant tumours have capacity to do so

Question 17

What is differentiation?

Answer 17

How much do the cells resemble cells from which they are derived

Question 18

How do tumour cells look different?

Answer 18

• larger nuclei
• more mitoses
• abnormalities mitoses e.g. tripolar
• nuclear pleomorphism
• Loss of normal features

Question 19

What is growth pattern?

Answer 19

How much the arrangement of tumour resembles the tissue from which it is derived

Tumours have less well defined architecture

Question 20

What is the Gleason grading system?

Answer 20

Architecture changes towards a less well differentiated tumour. ( grade 1-5 for aggresive prostate cancer )

Question 21

How may benign tumours become malignant?

Answer 21

Hyperproliferation –> adenomatous polyps –> severe dysplasia –> carcinoma –> invasive cancer

Question 22

Why which routes do tumours spread?

Answer 22

Direct extension
Haematogenous
Lymphatic
Transcoelomic
Perinerual

Question 23

What are examples of direct extension?

Answer 23

Associated with stromal response

Fibroblastic proliferation
Vascular proliferation

Question 24

Which blood vessels are usually used during haematogenous?

Answer 24

Invaded vessels are venules and capillaries because they have thinner walls

• most sarcomas metastasise first via blood vessels

Question 25

Which cancers metastasise first via the lymphatics?

Answer 25

Epithelial

Pattern of spread dictated by normal lymphatic drainage of organ in question

Question 26

Which cavities are involved in transcoelomic spread?

Answer 26

Pleural cavities for intra-thoracic cancers and peritoneal cavites for intra-abdominal cancers

Question 27

What is the TNM system?

Answer 27

T - tumour ( size/extent of local invasion ) [ 0,1,2,3 ]
N - nodes ( lymphs involved ) [ 0, 1, 2 ]
M - metastases ( How many ) [ 0, I, X ]

Question 28

What is the difference in grade and stage?

Answer 28

Grade : how differentiated the tumour is

Stage : how far has the tumour spread - TNM

• stage is more important