Neoplasm Classification Flashcards by Jade Fellows

Define neoplasm

Mass of cells which have undergone an irreversible change from normality, causing them to proliferate in an uncoordinated manner and are partially or completely independent of the factors which control normal cell growth

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Tumours can be classified according to … factors

Behavioural
Histogenic
Histological
Functional

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Behavioural classification

Benign or malignant
Determined by the capacity of the tumour invade the surrounding tissue
Spread to distant sites to form secondary deposits (metastases) - occurs via 2 main routes lymphatic and haematogenous

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Cancer is used to describe

All types of malignant neoplasm

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What is the extent of the spread described by

Staging 
Common staging system: 
TNM system 
Tumour 
Nodes 
Metastasis 
Specific staging systems - dukes in colon cancer

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What is staging important for

Prognosis

This determines therapeutic options - local resection versus chemo/radio

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Difficult distinction benign / malignant

Some have an intermediate manner - basal cell carcinoma of skin - invade local tissues, but doesn’t metastasise

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Histogenic classifies neoplasms according to ?

the tissue of origin - epithelial or mesenchymal

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What is the term differentiation used to describe?

Used to describe the degree to which a neoplasm histologically resembles its tissue of origin

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In benign tumours is the degree of differentiation a lot or a little

A lot

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Malignant what is the degree of differentiation

Variable

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Term grading is used to describe

The degree of differentiation e.g.
1 = well differentiated
2= moderately differentiated
3= poorly differentiated

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What does the tumours grade have implications for?

Prognosis and treatment
Well differentiated may be managed conservatively
Some malignant tumours are so poorly different tested it is impossible to determine their histogenesis - called anaplastic tumours

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What are the two most important features used in classicising neoplasms

Behavioural and histogenesis

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Some tumour types can be further classifies according to special … characteristics

Histological
E.g. Thyroid
Have histological subtypes which impacts the prognosis and route of spread
- papillary highest frequency route of spread is lymphatic (lymph node mets) and prognosis is very good
- follicular 10-20% frequency, spread route haematogenous (bone) good survival
- anaplastic <5% frequency, local invasion and poor survival

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Some tumours classified according to a substance or substances produced. This is called

Functional classification
Applies particularly to endocrine tumours which secrete functionally active hormones
Such as pancreatic islet cell tumours
Pituitary tumours

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What is a teratoma

Neoplasms derived from embryonic germ cells. Have the capacity to form all 3 germ cell layers - totipotent

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Where do teratomas occur

Ovary - usually benign
Testis - usually malignant
Midline structures - behaviour variable

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What are embryonic tumours

Arise from neoplastic transformation occurring in the developing organs
Derived from multi potent embryonic blast cells giving the suffix blastoma
Frequently have divergent differentiation - epithelial and mesenchymal
Majority present at or soon after birth
Most are highly malignant but may respond well to aggressive treatment

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What are hamartomas

Not genuine neoplasms but tumour like malformations

Many present at birth and stop growing when the host stops growing unlike a neoplasm which continues to grow

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Benign or malignant

Invade and metastasise

Malignant

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Shape or benign

Well circumscribed

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Shape malignant

Irregular

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Which bigger benign or malignant

Usually malignant

Sometime benign can be huge too

Haemorrhage common in B or M

Malignant

Necrosis common in B or M

Ulceration common in B or M

Size of nucleus in benign

Normal

Size of nucleus in malignant

Larger

Nucleoli in benign and malignant

B- small/inconspicuous | M- prominent

Pleomorphism B or M

Mitoses m or b

Infrequent b | Frequent m

Differentiation in benign

Good

Differentiation in malignant

Variable

Growth in B and M

B - slow | M - fast

Spontaneous arrest ? B and M

B common | M rare

Classification of Breast lumps benign

``` Fibroadenoma Comment benign Mostly occur in <30 women Smooth Well circumscribed lump Highly mobile on palpation ```

Classification of breast lump malignant

``` Breast carcinoma Commonest malignant Commonest cause of death in women >50 Irregular Poorly circumscribed lumps Rarely mobile on palpation die to invasion ```

Caecum cancer/ascending colon

Often polyploid Rarely cause bowel obstruction Insidious presentation- anaemia, weight loss

Sigmoid colon

Often stenosing Frequently cause bowel obstruction Typically present with alteration in bowel habit

Types of specimens obtained for psychological assessment

``` Biopsies - small pieces of tissue Endoscopic biopsies (upper, lower GIT, bronchus) Needle biopsies (radiologically guided Punch biopsies (skin) ``` ``` Cytology specimens - cells individual or groups Smears -cervical Endoscopic brushings Body fluids Fine needle aspiration specimens ``` Surgical resection specimens

Biopsies usually taken to

Confirm a diagnosis. Identify a malignancy and identify the histological type Info gained can be used to plan further treatment Surgical resection vs non surgical Decisions relating to therapeutic options are frequently made in MDT

Limitations to biopsying tumours

Tumour heterogeneity - mixed pattern of differentiation Targeting the lesion accurately - small lesions - inaccessible or potentially dangerous sites - surrounding stromal tissue reaction

Cytology specimens are used to

Diagnose in a less invasive way Bladder cancer Fine needles much thinner than biopsy needles - may enable access to areas a biopsy needle can't reach Smaller tissue samples provided (individual cells or groups of cells rather than tissue cores) Interpretation in biopsy may be more difficult due to larger tissue being obtained

Surgical resection specimens used to

Resection intended to be curative some cases palliative Confirm diagnoses of malignancy Determine the aggressiveness of a tumour -histological grade Assess the extent of spread -histological stage Examine completeness of excision Used as a basis for determining further treatment

Grading of malignant neoplasms

Well differentiated - grade1 Moderately differentiated -grade2 Poorly differentiated (anaplastic) - grade3

Staging

Extent of spread

What are the 3 components of staging

Tumour - size or extent of spread of the primary lesion e.g. 1-4 Nodes - extent of spread to lymph nodes 0-3 Metastasis - presence or absence of distant metastasis 0 or 1

What are the stages e.g. Breast cancer

T1 - <2cm T2- 2-5cm T3 - >5cm T4- any size with direct extension into chest wall and/or skin

Wharton is the stage system used for colorectal cancer

Dukes

What are the stages used in dukes

A - confined to submucosa/muscle B - through muscle to serosa C - lymph node involvement D- distant metastasis

Macroscopic assessment of tumour resection specimens

Size Shape(well circumscribed) Extent of local spread Proximity to surgical resection margins Identification of lymph nodes (imp for staging) Other macroscopic features where relevant - colour, haemorrhage, necrosis

Tumour resection assessment microscopic assessment

Confirms or establishes a diagnosis of cancer Histological type - glandular, squamous Degree of differentiation- histological grade Frequency of mitoses Local invasion - presence important for determining malignancy - extent important in staging Vascular invasion Examination of lymph nodes (for metastases)

Immunohistochemistry in tumour pathology is used for:

Establishing diagnosis of malignancy Clonality in lymphoid neoplasms - reactive (inflammatory) infiltrates have mixed population of cells - neoplastic infiltrates have a 'pure' population of cells

Immunohistochemistry test for prognostic markers -types tested for

Markers of cell turnover | Determine high or low grade metastatic potential

What type of labelling is used to determine grading potential

Ki 67 labelling index

Immunihistichemisty can be used to determine

Prognosis and treatment factors | In tumours which are known to be malignant

How can it determine treatment options

Markers such as HER2 in breast cancer

Insitu hybridisation detected what

Recognise specific RNA and DNA sequences in tissue sections