L14: Pathology Of Cancer- Management

Question 1

When we classify neoplasms into benign what are the features of benign

Answer 1

Smooth
Well circumscribed
Mobile

Question 2

When we classify neoplasms as malignant what are the features of malignant

Answer 2

Irregular
Poorly defined
Fixed to adjacent structures

Question 3

For example what are the 2 classifications of breast lumps

Answer 3

Fibroadenoma- benign

Breast carcinoma- malignant

Question 4

What are the fibroadenoma features

Answer 4

Smooth
Well circumscribed
Mobile

Question 5

What are the features of breast carcinoma

Answer 5

Irregular
Poorly circumscribed
Rarely moves on palpation
Tethered to other tissue

Question 6

Why does the majority of cancer arise from epithelial cells n the mucosa layer

Answer 6

• It is a region exposed to high concentration of carcinogen
• It has a high rate turnover so the rate of mutation is higher

Question 7

What are the sites of colon carcinoma

Answer 7

Ascending Colon

Sigmoid colon

Question 8

What is the clinical presentation of colon carcinoma at the ascending colon

Answer 8

Often polyploid
Rarely causes bowel obstruction
Anaemia
Weight loss

Question 9

What is the clinical presentation of sigmoid colon carcinoma

Answer 9

Often stenosing
Bowel obstruction
Alteration in bowel habit e.g diarrhoea as only liquid can pass the narrowing

Question 10

What are the 3 types of specimens we can collect

Answer 10

1) biopsy
2) cytology specimen
3) surgical resection specimen

Question 11

What are biopsy

Answer 11

Removing a small piece of tissue

Question 12

What do cytology specimens collect

Answer 12

Cells

Question 13

How are cytology specimens obtained, give examples

Answer 13

Smears
Endoscopic brushing
Body fluid
Fine needle aspiration

Question 14

What does surgically resected specimen O’Brien

Answer 14

Removes all cancer

Question 15

What are the limitations to biopsy

Answer 15

• Tumour heterogeneity- different parts of the tumour may have a different appearance and this may be missed as we collect a small piece
• targeting the lesion accurately is difficult if the lesion is small, inaccessible, surrounding stromal reaction

Question 16

What is surgical resection of tumour also a method of

Answer 16

Treatment of cancer

Question 17

What is the less invasive method for obtaining a specimen

Answer 17

Cytology specimen

Question 18

What are the disadvantages of cytology specimen

Answer 18

Specimen can be small

Question 19

Reminder: what is grading about

Answer 19

The degree of differentiation

Question 20

Reminder: what is staging about

Answer 20

The extend of the spread

Question 21

When we use the TNM staging system, what is T and how is it scored

Answer 21

T- tumour size from 1 to 4 (increasing size)

Question 22

What is N in the TNM staging

Answer 22

Nodes: extent of lymph node spread

Question 23

What is M in the TNM stage and how is it scored

Answer 23

Metastasis scored 0=no metastasis or 1=metastasis

Question 24

When we get a tumour resection sample what do we look

Answer 24

Macroscopic assessment

Microscopic assessment

Question 25

In a macroscopic assessment what do we look at

Answer 25

Size Shape Extent of local spread Identity of lymph nodes

Question 26

In a microscopic assessment what do we look for

Answer 26

``` Historical type Grade Frequency of mitosis Local invasion- to determine benign or malignant Vascular invasion Lymph node ```

Question 27

What is immunohistochemistry

Answer 27

Identifying a specific tumours antigen by developing fluorescently tagged antibodies that bind to the antigens

Question 28

What are the 3 reasons immunohistochemistry can be used

Answer 28

1) Establish a diagnosis malignancy 2) used a prognostic marker 3) identify therapeutic options as expression of a specific antigen can be targeted

Question 29

What is in-situ hybridisation

Answer 29

Applying probes that recognise DNA or RNA sequences

Question 30

When is in situ hybridisation commonly used

Answer 30

EBV related neoplasms

Question 31

Name a EBV repeated neoplasms

Answer 31

Post transplant lymphoproliferative disease

Question 32

What is post transplant lymphoproliferative disease

Answer 32

Patients that receive organ transplant are on immunosuppressive drugs and EBV can therefore affect to the B lymphocytes

Question 33

What are nucleic acid molecular techniques

Answer 33

When you take out a sample of tissue and look at the nucleic acid sequence

Question 34

By looking at the nucleic acid what can be identified

Answer 34

Immunoglobulin genes | Specific gene mutations that allow for personalised medicine