Disorders of Growth & Cancer 2

Question 1

Neoplasia

1. Definition? [1]
2. What is the difference between neoplastic excessive growths and non-neoplastic excessive growths? [2]

Answer 1

1. An abnormal tissue mass the growth of which is excessive (i.e. not an adaptation to physiological demands) and uncoordinated compared to adjacent normal tissue, which persists even after cessation of the stimuli that caused it
2. Neoplastic growths are uncontrolled & irreversible
3. Non-neoplastic growths are controlled & reversible

Question 2

Benign Neoplasm

1. Definition? [1]
2. Typical Appearance? [1]
3. Examples of benign neoplasms? [7]

Answer 2

1. neoplasm that grows without invading adjacent tissue or spreading to distant sites
2. usually well-circumscribed due to the lack of invasion of surrounding tissues
3. usually end with the suffix -oma:
   
   • Fibroma
   • Chondroma
   • Osteoma
   • Lipoma
   • Adenoma
   • Cystadenoma
   • Papillary cystadenoma

Question 3

Malignant Neoplasm

1. Definition? [1]
2. Typical Appearance? [1]
3. Examples of malignant neoplasms? [5]

Answer 3

1. neoplasm that invades the surrounding normal tissue and can spread to distant sites (metastasise)
2. usually is not well circumscribed
3. Examples:
   
   • Carcinoma = epithelial origin (squamous cell carcinoma, basal cell carcinoma, renal cell carcinoma, adenocarcinoma)
   • Sarcoma = mesenchymal origin (osteosarcoma, liposarcoma, pleomorphic sarcoma)
   • Melanoma = melanocytic origin
   • Lymphoma = haemopoietic origin (Hodgkin or non-Hodgkin lymphoma, high grade or low grade)
   • Germ cell tumours

Question 4

Grade, Differentiation and Staging of Tumours

1. Differentiation
   
   • Definition? [1]
   • Ranges? [4]
2. Grade
   
   • Definition? [1]
3. Stage
   
   • The stage of a tumour is based on what 4 factors? [4]
   • What does the TMN system stand for? [3]

Answer 4

1. Differentiation:
   
   • the tissue type represented by the tumor and the extent to which the tumor cell resembles the original cell
   • ranges from well, moderately, poorly, to undifferentiated
2. Grade:
   
   • As tumours become more poorly differentiated, the higher the grade becomes
3. Stage:
   
   • based on:
     
     • size of the primary tumour
     • extent of invasion into surrounding tissue
     • spread to regional lymph nodes
     • the presence or absence of metastases
   • The TNM system:
     
     • Tumour – how big is the tumour? Has it locally invaded?
     • Nodes – are nodes involved? How many?
     • Metastasis – distant metastases?

Question 5

What is the definition of anaplasia? [1]

Answer 5

lack of differentiation of a tumour (synonymous with undifferentiated)

Question 6

Dysplasia

1. Definition? [2]
2. Name the 4 identifiable features of dysplasia [4]

Answer 6

1. disordered growth in which cells fail to differentiate fully, but are contained by the basement membrane, i.e. non-invasive
2. Recognised by alterations in the appearance of cells:
   
   • cell nuclei become hyperchromatic
   • nuclear membranes become irregular
   • nuclear to cytoplasmic ratio increases
   • dysplasia may regress, persist or progress

Question 7

Metastasis can occur by 3 methods

1. Lymphatic Spread
   
   • Typical of which type of tumour? [1]
   • Describe the spread [1]
2. Haematogenous Spread
   
   • Typical of which type of tumour? [1]
   • Describe the spread [1]
   • What organs are frequently involved? [2]
3. Transcoelomic Spread
   
   • Typical of which types of tumours? [2]
   • Describe the spread [1]

Answer 7

1. Lymphatic spread:
   
   • most common pathway for dissemination of carcinomas (although sarcomas can also use this route)
   • the pattem of lymph node involvement follows the natural routes of drainage
2. Haematogenous spread
   
   • typical of sarcomas
   • arteries are more difficult for tumour to penetrate than veins. with venous invasion, the blood-borne cells follow the venous flow draining the site ofthe tumor.
   • liver and lungs are frequently involved
3. Seeding of body cavities (transcoelomic spread)
   
   • typical of:
     
     • ovarian carcinoma
     • gastric carcinoma
   • occurs when a malignant neoplasm penetrates into a natural ‘open field’ such as peritoneal cavity, pleural space, pericardial cavity, etc.

Question 8

What is the typical presentation of METS? [6]

Answer 8

1. Multiple skin lesions
2. Brain - CNS symptoms
3. Lungs - breathlessness/haematemesis
4. Liver - jaundice, masses
5. Bones - pathological fracture
6. Lymph nodes - e.g. neck (gastric, lung Ca)