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1

What proportion of deaths in Australia is due to malignancy?

30% of deaths

2

What group of people account for the 68% of all diagnosed with malignancy?

Aged >60

3

What is meant by Neoplasia?

"New Growth"
An Excessive and Unregulated cell proliferation

4

What is the process of neoplasia?

A multi-step process starting with a SINGLE cell that has abnormalities that develop from aberrant genetic and epigenetic control mechanisms on the
- CELL CYCLE
- APOPTOSIS
- DNA REPAIR

5

What does neoplastic tissue comprise of?

Neoplastic cells and reactive stroma

6

What does the reactive stroma of neoplastic tissue usually include?

Inflammatory cells
Fibroblasts
Endothelial cells
Blood vessels

7

What are the 2 main groups of neoplasia?

Benign and Malignant

8

What is the definition of a tumour?

Any mass lesion
Can be inflammatory, hyperplastic, neoplastic or any accumulation of mass
But it is a VAGUE term that often implies a neoplasm (but not strictly speaking)

9

What is the definition of a tumour?

Any mass lesion
Can be inflammatory, hyperplastic, neoplastic or any accumulation of mass
But it is a VAGUE term that often implies a neoplasm (but not strictly speaking)

10

What are the six classical characteristics/hallmarks that malignant cells possess?

1. Resist Cell Death
2. Induce Angiogenesis
3. Sustain proliferative signalling
4. Evade growth suppression
5. Activate invasion and metastasis
6. Enable a replicative imortality

11

What are some emerging hallmarks of cancer?

Immune system involvement
Metabolism

12

Paediatric Cancer doesn't occur as commonly. They often have a certain characteristic/type called Blastoma. What does this mean?

Blastomas are consistent of primitive and less differentiated cells (called blasts) and these are what form the embryo.

13

List some common paediatric cancers

Certain leukaemias
Certain brain tumours
Neuroblastoma
Certain lymphomas
Retinoblastoma
Certain Bone Cancers
Wilm's Tumour

14

What are the characteristics of a Benign tumour?

LOCAL expansile
SLOW growth
well CIRCUMSCRIBED (sometimes encapsulated)
well DIFFERENTIATED (looks like normal cells)
UNABLE TO METASTASISE
rarely life threatening

These cancers have NO evasion or destruction of surrounding tissue and instead tends to pus it aside

15

What are the characteristics of a Malignant tumour?

LOCALLY INVASIVE
DESTRUCTIVE growth
Often poorly circumscribed with IRREGULAR MARGINS
Frequently induce DESMOPLASIA in the stroma
Sometimes NECROSIS (tumour cells outgrow their blood supply)
Variable DIFFERENTIATION
Potential to METASTASISE

16

What are the three major ways that malignant tumours can metastasise? Describe each one.

Lymphatic: tumour extends along the lymphatic vessels into the draining lymph nodes

Haematogenous (blood): Tumour can enter the draining veins and the systemic circulation (or can also enter via invasion into the bloodstream)

Transcoelomic (through body cavities): the tumour migrates along the body cavity space

17

What are uncertain malignant/ potential/borderline tumours?

Lesions with histologically intermediate features between benign and malignant. Difficult to predict what they are but are often not aggressive and have a slow course (some do metastasise)

18

What are the clinical features of benign tumours?

Benign tumours are rarely symptomatic (depends on where and what it is)
They rarely cause death and rarely become malignant

19

Is local spread considered metastasis?

No - the tumour growth needs to be completely SEPARATE from the original primary cancer

20

What are some common sites of metastasis?

Liver
Brain
Ling
Bone

Note: lymphadenopathy is local metastasis

21

Are metastasise usually multiple of single? What does this mean for treatment?

Usually multiple (sometimes single) and to multiple sites. This means it is very difficult to treat

22

Are metastasise usually multiple of single? What does this mean for treatment?

Usually multiple (sometimes single) and to multiple sites. This means it is very difficult to treat

23

What are the histopathological features of neoplasia?

Cytological atypia
Architectural Disorganisation

24

What is meant by Cytological Aytpia?

Larger Nuclei
Pleomorphic nuclei: varied size and shape
Coarser nuclear chromatin
Hyperchromatic nuclei (more haematoxylin due to more DNA)
Larger, more prominent nucleoli (high activity)
More mitotic activity (sometimes see abnormal mitotic features)

25

Do benign neoplastic cells show more or less atypia?

Less

26

What is a histopathological feature of malignant cells that is rarely seen in benign? Describe this feature

Necrosis
It doesn't fit any pattern (eg. not caseous or coagulative)
The nuclei become shrunken, dark staining, fragmented and condensed nuclear chromatin

27

What does desmoplastic mean?

The growth fibrous or connective tissue: dense fibroblast proliferation and collagen.
The more desmoplastic a tumour, the more firm the cancer is

28

What is meant by Cytological Aytpia?

1. Larger Nuclei
2. Pleomorphic nuclei: varied size and shape
3. Coarser nuclear chromatin
4. Hyperchromatic nuclei (more haematoxylin due to more DNA)
5. Larger, more prominent nucleoli (high activity)
6. More mitotic activity (sometimes see abnormal mitotic features)

29

What does desmoplastic mean?

The growth fibrous or connective tissue: dense fibroblast proliferation and collagen.
The more desmoplastic a tumour, the more firm the cancer is

30

Tumour cells originate from normal cells and generally show a PHENOTYPE that RESEMBLES the normal counterpart histologically. What are the 3 main groups?

1. Epithelial Cells (glandular, squamous, urothelial, endocrine)
2. Mesenchymal Cells (osteoblasts, endothelial, smooth muscle, skeletal, adipocytes)
3. Other (melanocytes, myeloid cells, lymphoid cells, astrocytes)