neoplasia - whats cancer

Question 1

what is neoplasia?

Answer 1

a lesion resulting from the autonomous or relatively autonomous abnormal growth of cells which persists after initialising stimulus removed
-literally means new growth
- can be benign or malignant

Question 2

what is tumour?

Answer 2

just means swelling

Question 3

how do tumours arise?

Answer 3

due to accumulation of genetic alterations & epigenetic changes

Question 4

what are neoplasms usually comprised of?

Answer 4

neoplastic cells & connective tissue stroma (vascular supply important)

• pseudo neoplasms & other abnormal growths also exist

Question 5

what does malignant mean?

Answer 5

a neoplasm with potentially lethal, abnormal characteristics which has the ability to invade and metastasise

Question 6

what does benign mean?

Answer 6

neoplasm which doesn’t have the ability to invade & metastasise (they’re not necessarily harmless)

Question 7

what are the 4 factors to tell how bad a neoplasm is?

Answer 7

1. differentiation (how different it looks from original tissue)
2. rate of growth (look for rate of mitosis, necrosis etc)
3. local invasion (how much it invades all the tissue & vessels around it)
4. metastasis (is it eating into lymphatics & vessels - as if that happens more likely to spread through body)

Question 8

what is differentiation in context of neoplasms?

Answer 8

extent to which neoplastic tissue resemble their corresponding normal tissue of origin

-> it has levels of well, moderate, poor and anaplastic (where well looks similar and anaplastic looks completely different)

• any level can be benign or malignant
• anaplastic may need special stains/molecular technique to diagnose

Question 9

what are features of poorly differentiated tumours?

Answer 9

• nuclear pleomorphism (variability in nuclear size & shape)
• abnormal nuclear features
• increased mitotic activity
• loss of cellular polarity/order
• tumour giant cells
• necrosis

Question 10

what are some examples of abnormal nuclear features in poorly differentiated tissues?

Answer 10

• high nuclear : cytoplasmic ratio
• clumped chromatin
• prominent nucleoli (dots in nucleus)

Question 11

what is classification of the tumour?

Answer 11

name = grade & stage

Question 12

what is grade in classification of tumour?

Answer 12

• measure of how differentiated the tumour appears
  well = grade 1
  moderately = grade 2
  poorly = grade 3

Question 13

what is stage in classification of tumour?

Answer 13

a measure of extent of spread of a tumour
= prognostication/therapeutic decisions

(lower the number = better for the patient)

Question 14

what is metaplasia?

Answer 14

change in phenotype of differentiated cells, often response to chronic irritation

Question 15

what is hypertrophy?

Answer 15

increased cell and thus organ size, often in response to increased workload e.g. cardiac hypertrophy

Question 16

what is hyperplasia?

Answer 16

increased cell numbers in response to stimulus e.g. hormones / growth factors e.g. endometrial

Question 17

what is dysplasia?

Answer 17

term used to describe confined neoplastic change (mostly epithelia)

Question 18

what are some features of dysplasia?

Answer 18

• cytomorphological features of malignancy (all features - big nucleus, lots of mitosis →if all in epithelium but not invading then dysplasia, so not malignant yet but like gearing up)
• confined within basement membrane
• nuclear pleomorphism/architectural disruption

Question 19

what is carcinoma- in situ?

Answer 19

really bad dysplasia
= cytomorphological features of malignancy but without invasion
= full thickness of epithelium
= basement membrane of dysplastic epithelium not penetrated (basement membrane separates blood/lymphatic vessels)

Question 20

does dysplasia always lead to malignancy?

Answer 20

no, sometimes it can regress

Question 21

what is the rate of growth like for malignant and benign neoplasms?

Answer 21

• malignant neoplasms are often fast growing
• benign neoplasms are usually slow growing

Question 22

what are some features of rapid growth and why are they associated?

Answer 22

mitoses = because lots of cells are dividing rapidly
&
necrosis = because the tumour is growing so fast that the blood supply can’t keep up

Question 23

what are some characteristics of benign tumours?

Answer 23

• cohesive & expansile (not invading but just squishing)
• localised
• don’t metastasise
• usually slow growth
• may be encapsulated (rim of compressed connective tissue = fibrous capsule)

Question 24

what are some characteristics of malignant tumour?

Answer 24

• invasive
• penetrate organ walls/tissues/ epithelial surfaces
• next to metastases, invasiveness is the most reliable feature that differentiates malignant from benign tumours

Question 25

what is metastasis?

Answer 25

spread of tumour to a site discontinuous from the source organ/tissue

Question 26

what is growth rate for benign & malignant tumours?

Answer 26

benign = slow malignant = fast

Question 27

what is mitotic activity for benign & malignant tumours?

Answer 27

benign = low malignant = high

Question 28

what is differentiation for benign & malignant tumours?

Answer 28

benign = well malignant = often poor

Question 29

what is nuclear morphology for benign & malignant tumours?

Answer 29

benign = normal malignant = pleomorphic

Question 30

is there invasion for benign & malignant tumours?

Answer 30

benign = no malignant = yes

Question 31

what is border like for benign & malignant tumours?

Answer 31

benign = circumscribed and/or encapsulated malignant = poorly defined/invasive

Question 32

what is necrosis like for benign & malignant tumours?

Answer 32

benign = rare malignant = common

Question 33

what is ulceration like for benign & malignant tumours?

Answer 33

benign = rare malignant = common

Question 34

what is growth direction for benign & malignant tumours?

Answer 34

benign = exophytic malignant = endophytic

Question 35

are benign tumour always harmless?

Answer 35

no - some can be very locally destructive e.g. meningioma, benign tumour of meninges, compressive effects in skull

Question 36

what is histogenic classification & nomenclature?

Answer 36

based upon tissue of tumour origin

Question 37

what are the different types of tissue of tumour origin?

Answer 37

epithelium: - non glandular epithelia (protection) - glandular epithelia (glands & ducts, secretion) non epithelium: - mesenchymal - hematopoietic - Neuroectodermal - Germ cells - Embryonal (blastomas) - Mixed tumours

Question 38

what is the suffix of benign tumours and what are the exceptions?

Answer 38

OMA -> melanoma, lymphoma, seminoma, mesothelioma etc

Question 39

what is adenoma?

Answer 39

type of benign tumour of glandular/secretory epithelium (glands may or may not be present in the tumour)

Question 40

what is papilloma?

Answer 40

benign tumour of non-glandular/surface epithelium (it actually describes fingerlike or warty projections but most benign non-glandular epithelial tumours do this)

Question 41

what is squamous cell papilloma?

Answer 41

benign tumour of squamous epithelium (skin)

Question 42

what is colonic adenoma?

Answer 42

benign tumour of glandular epithelium of the colon

Question 43

how can you classify benign epithelial tumours?

Answer 43

first by if glandular or non-glandular (adenoma or papilloma) and then by name of cell type origin, epithelium source or cell type (e.g. squamous cell or colonic)

Question 44

what is thyroid adenoma?

Answer 44

benign tumour of a glandular epithelium of thyroid

Question 45

what is nomenclature for benign mesenchymal tumours?

Answer 45

cell of origin + OMA

Question 46

what is prefix & benign nomenclature for smooth muscle?

Answer 46

prefix = leiomyo benign nomenclature = leiomyoma

Question 47

what is prefix & benign nomenclature for skeltal muscle?

Answer 47

prefix = Rhabdomyo benign nomenclature = Rhabdomyoma

Question 48

what is prefix & benign nomenclature for adipose tissue?

Answer 48

prefix = lipo benign nomenclature = lipoma

Question 49

what is prefix & benign nomenclature for blood vessel?

Answer 49

prefix = haemangio benign nomenclature = haemangioma

Question 50

what is prefix & benign nomenclature for bone?

Answer 50

prefix = osteo benign nomenclature = osteoma

Question 51

what is prefix & benign nomenclature for cartilage?

Answer 51

prefix = chondro benign nomenclature = chrondroma

Question 52

what is prefix & benign nomenclature for fibrous tissue?

Answer 52

prefix = fibro benign nomenclature = fibroma

Question 53

what do you call malignant epithelial tumours derived from glandular/ductural epithelium?

Answer 53

adenocarcinoma

Question 54

what do you call malignant epithelial tumour derived from surface non-glandular epithelia?

Answer 54

carcinoma

Question 55

what is squamous cell carcinoma?

Answer 55

malignant nomenclature for stratified squamous

Question 56

what is basal cell carcinoma?

Answer 56

malignant nomenclature for basal cells of the skin

Question 57

what is transitional cell carcinoma?

Answer 57

malignant nomenclature for transitional epithelium of the bladder

Question 58

what is colonic adenocarcinoma?

Answer 58

malignant nomenclature for glandular epithelium of colon

Question 59

what is breast adenocarcinoma?

Answer 59

malignant nomenclature for glandular epithelium of breast

Question 60

what are malignant mesenchymal tumours called?

Answer 60

sarcomas (that's the suffix - like OMA for benign mesenchymal and sarcoma for benign mesenchymal)

Question 61

what is prefix and malignant nomenclature for smooth muscle?

Answer 61

prefix = leiomyo malignant nomenclature = leiomyosarcoma

Question 62

what is prefix and malignant nomenclature for skeletal muscle?

Answer 62

prefix = rhabdomyo malignant nomenclature = rhabdomyosarcoma

Question 63

what is prefix and malignant nomenclature for adipose tissue?

Answer 63

prefix = lipo malignant nomenclature = liposarcoma

Question 64

what is prefix and malignant nomenclature for blood vessels?

Answer 64

prefix = angio malignant nomenclature = angiosarcoma

Question 65

what is prefix and malignant nomenclature for bone?

Answer 65

prefix = osteo malignant nomenclature = osteosarcoma

Question 66

what is prefix and malignant nomenclature for cartilage?

Answer 66

prefix = chondro malignant nomenclature = chondrosarcoma

Question 67

what are teratomas? (other tumour type)

Answer 67

germ cell origin (gonads) = contains cells representing ALL 3 germ layers (endoderm, mesoderm, ectoderm) benign = teeth/hair/muscle/neural/cartilage malignant = tissues more primitive

Question 68

what are precursor cell tumours? (& examples)

Answer 68

= histological resemblance to embryological tissue in which arise - RETINOBLASTOMA - NEPHROBLASTOMA (WILMS) - HEPATOBLASTOMA (often occur in young patients)

Question 69

what is mixed tumours?

Answer 69

epithelial & mesenchymal neoplasia (single clone leads to both types of cells)

Question 70

what is an example of a malignant mixed tumour?

Answer 70

carcinosarcoma (has parts of epithelial & mesenchymal tumour) = makes challenging to treat

Question 71

what is an example of benign mixed tumour?

Answer 71

ameloblastic fibroma

Question 72

what is hamartoma?

Answer 72

- Non-neoplastic disordered overgrowth of normal tissue (benign) - Indigenous to the site of occurrence (don't invade or destroy) - Developmental abnormalities - Port wine stain

Question 73

what is chrostoma?

Answer 73

- Benign normal tissue but seen in abnormal location - E.g. normal (non-neoplastic) pancreas nodule in stomach, heterotropic rests (pancreas cells in weird places in body)

Question 74

what are hematolymphoid malignancies?

Answer 74

Lymphoma = malignancy of T or B cell origin (often begins in lymph nodes but can arise in other places) - hodgkin vs non hodgkin myeloma = malignancy of plasma cells leukaemia = malignancy of white blood cells that begin in bone marrow

Question 75

what are melanocytic neoplasms?

Answer 75

Melanoma - Malignancy of melanocytes - Cells which produce pigment in the skin MELANOCYTIC NAEVUS - Benign proliferation of melanocytes