Neoplasia and Cancer Pathology

Question 1

What is the difference between neoplasia and cancer?

Answer 1

Neoplasm can be benign (eg. BPH) or malignant (Cancer)

Question 2

True or False. Tumours are often accompanied by blood vessels and connective tissue.

Answer 2

True

Question 3

How can benign tumours complicate?

Answer 3

1) Site (eg. meningioma –> ^ intracranial pressure)
2) f(x) (eg. insulinoma –> hypoglycaemia)

Question 4

What are the 4 main characteristic of benign tumours?

Answer 4

1) slow growth rate (by compression of surrounding tissue)
2) no infiltration, vascular invasion, or metastasis
3) High px survival rate after surgical excision
4) well-differentiated, resembling normal tissue of origin (uniform appearance)

Question 5

Are all “-omas” benign?

Answer 5

No.
eg. Sarcoma, Carcinoma, Lymphoma, Hepatoma, Melanoma

Question 6

Are malignant tumours well or poorly differentiated?

Answer 6

Poorly differentiated –> less resemblance to parent tissue

Question 7

What are the 4 main characteristics of malignant tumours?

Answer 7

1) rapid growth rate (by invasion of surrounding tissue)
2) metastasizing
3) poor px survival rate after surgical excision + tendency for recurrence (local or distant
4) poorly-differentiated, irregular structures

Question 8

What do multiple necrotic or discoloured circles in resected organs usually indicate?

Answer 8

Tumour metastasis

Question 9

What are Blastomas?

Answer 9

Generally aggressive malignant tumours

Question 10

What are the distinctive histological features of Blastomas?

Answer 10

Rosettes (primitive looking structures) which are small round cell tumours

Question 11

What are Teratomas?

Answer 11

Tumours arising from totipotent germ cells in gonads

Question 12

Where are Teratomas usually form?

Answer 12

Gonads (eg. testes, ovaries)

Question 13

What are some local effects that can result from GIT-related tumours?

Answer 13

Obstruction, Perforation, Ulceration

Question 14

How can a tumour result in a non-healing ulcer?

Answer 14

Destruction of epithelial surfaces (eg. GIT, mouth, bronchi)

Question 15

Why do tumours cause pain and when would they not?

Answer 15

When tumours form/invade sites with sensory nerve endings.
They are initially painless only when in the brain and viscera.

Question 16

What are the 3 broad clinical effects of Cancer?

Answer 16

1) Local/mechanical
2) Endocrine
3) Cancer cachexia

Question 17

What are some possible endocrine effects of tumours?

Answer 17

1) Endocrine tumours producing excessive hormones
2) Paraneoplastic syndrome
3) Loss of f(x) by compression/destruction

Question 18

What is cancer cachexia/wasting syndrome?

Answer 18

1) Cytokine-related (TNF, IL-1) progressive fat loss due to proteolysis-inducing factor
2) Anorexia due to excessive cytokine release
3) Anaemia w weakness due to autoimmunity or excessive bleeding

Question 19

How can tumours cause edema?

Answer 19

Venous or lymphatic obstruction (eg. tumour embolism)

Question 20

What is “paraneoplastic syndrome”?

Answer 20

Symptom complexes that are not attributable to:
(i) local or (ii) distant spread
(iii) hormonal effects indigenous to tissue of origin

Question 20

What are some examples of paraneoplastic syndromes?

Answer 20

1) Endocrinopathies (eg. Cushing’s syndrome, SIADH, HyperCa2+)
2) Nerve and Muscle Syndromes (eg. Myasthenia, CNS/PNS disorders)
3) Dermatologic disorders (eg. Dermatomyositis, Acanthosis nigricans)
4) Osteoarthropathy and finger clubbing
5) Hematologic changes (eg. Anaemia, Thrombosis, non-bacterial thrombotic endocarditis)

Question 21

What are tumour markers?

Answer 21

They are enzymes, hormones, oncofetal Ag that are used in biomarker assays in the screening of cancers.

Question 21

Can tumour markers be used for definitive diagnosis?

Answer 21

No

Question 22

What are the uses of tumour biomarker assays?

Answer 22

1) Detection of cancers
2) monitoring residual/reccurent tumours post therapy

Question 23

What are the types of tumour markers?

Answer 23

1) Hormones (eg. HCG, Calcitonin, Catecholamines, metabolites) 2) Oncofetal Ags (eg. AFP, CEA) 3) Isoenzymes (eg. Prostatic acid phosphatase, Neuron-specific enolase) 4) Proteins (eg. Igs, PSA) 5) Glycoproteins (eg. Mucins, CA-125/19-9/15-3) 6) p53, RAS mutations (in serum, sputum, stool, urine)

Question 24

What is Dysplasia?

Answer 24

Premalignant conditions resulting from disordered growth in epithelia

Question 25

Do all dysplasia progress to malignant tumours?

Answer 25

No, but it does predispose to cancer development

Question 26

What is the risk of px with Familial Adenomatous Polyposis (FAP) developing colon cancer?

Answer 26

100%

Question 27

What is the gene that causes FAP

Answer 27

APC gene (AD inheritance)

Question 28

What Virus can cause dysplasia?

Answer 28

Human Papillomavirus (HPV)

Question 29

How are cervical cancers screened for?

Answer 29

PAP smears for dysplastic cells

Question 30

How are tumours staged and graded?

Answer 30

Histologically

Question 31

What is the difference between tumour staging and grading?

Answer 31

Grading refers to the degree of differentiation Staging refers to the degree of metastasis

Question 32

What is the significance of tumour staging

Answer 32

Higher stage cancers are more aggressive and have worse prognosis This is impt for px counselling and treatment (need adjuvant)

Question 33

What is the TNM system?

Answer 33

The staging system to describe the invasiveness of the tumour. T - tumour in primary site N - Lymph nodes, regional M - distant metastases

Question 34

What are the grades of a malignant tumour?

Answer 34

Grade 1: Well differentiated Grade 2: Moderately differentiated Grade 3: Poorly differentiated ## Footnote *Some have grade 4

Question 35

How are tumours disseminated?

Answer 35

1) Local infiltration 2) Spread through body cavities (eg. seeding in body cavities, pagetoid/epithelial linins, Perineural infections) 3) Lymphatic spread 4) Hematogenous spread (eg. GIT--> Liver via portal vein, to Lung vis caval vein, to spine via paraverterbral venous plexus, to brain via arteries)

Question 36

Are enlarged regional lymph nodes indicative of metastatic cancer spread?

Answer 36

No, it could be a reactive hyperplasia to tumour Ags, or some other infection.

Question 37

Are the presence of only isolated cells in regional draining lymph nodes indicative of metastatic cancer spread?

Answer 37

No

Question 38

What type of cells form Carcinomas?

Answer 38

Epithelial Cells

Question 39

What cells form Sarcomas?

Answer 39

Endothelial cells

Question 40

What cells form Melanomas?

Answer 40

Melanocytes

Question 41

What cells form Lymphomas?

Answer 41

Lymphocytes (B or T cells)

Question 42

What cells form Lipomas?

Answer 42

Adipocytes

Question 43

What cells form Chondrosarcomas?

Answer 43

Cartilage

Question 44

What cells form Fibrosarcoma?

Answer 44

Fibrous Tissue

Question 45

What cells form Leiomyoma?

Answer 45

Smooth Muscle cells

Question 46

What cells form Haemangioma

Answer 46

Vascular endothelial cells

Question 47

What is a adenocarcinoma?

Answer 47

A gland forming malignant tumour

Question 48

What is a fibroadenoma?

Answer 48

A benign tumour formed from both fibrous and glandular tissue.

Question 49

What are the key histological features of malignant cells?

Answer 49

Infiltrative growth/Not well-circumscribed Poorly differentiated/Anaplasia High/abnormal mitosis Hyperchromasia w large nucleolus and clumped chromatin Pleomorphism High N/C ratio Metastasis Necrosis and haemorrhage common

Question 50

What are the key histological features of benign tumours?

Answer 50

Non-infiltrative/compressive growth/Well-circumscribed Well-differentiated Few mitoses Rare necrosis and haemorrhage

Question 51

What are the 4 key histological features of a Carcinoma?

Answer 51

1) Keratinisation 2) Keratin pearls 3) Intercellular Bridging 4) Cell Shape + eosinophilic cytoplasm

Question 52

What is the key histological feature of a Adenoma?

Answer 52

Intracellular mucin

Question 53

What differentiates a Carcinoma from a Carcinoma in-situ?

Answer 53

Carcinoma in-situ has yet to breach any basement membrane to invade underlying stroma

Question 54

What does the suffix "-oma" imply?

Answer 54

Epithelial or Mesenchymal origin

Question 55

What does the prefix "Adeno-" imply?

Answer 55

Glandular origin