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Pathology > P4 +5 - Disorders of growth and neoplasia 2/3 > Flashcards

P4 +5 - Disorders of growth and neoplasia 2/3 Flashcards

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1
Q

What are the 2 classifications of tumours?

A
  1. Behaviour

2. Histogenesis

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2
Q

what are the 2 behaviours of tumours?

A

Benign v Malignant

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3
Q

what is the growth patten of benign tumours?

A

Expand and Remain localised
Typically well-circumscribed
Often encapsulated

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4
Q

what is the growth rate of benign tumours?

A

slower

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5
Q

what are the clinical effects of benign tumours?

A

local pressure effects: hormone secretion

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6
Q

what is the treatment for benign tumours?

A

local excision

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7
Q

what is the histology of benign tumours?

A

Resembles tissue of origin

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8
Q

what is the nuclei of benign tumours?

A

small, regular, uniform

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9
Q

what are the mitoses of benign tumours?

A

few, normal

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10
Q

what is the growth patten of malignant tumours?

A

Infiltrate locally, metastasize (spread to distant sites)

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11
Q

what is the growth rate of malignant tumours?

A

Faster

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12
Q

what is the clinical effects of malignant tumours?

A

Local pressure and destruction,
Inappropriate hormone secretion
Distant metastases

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13
Q

what is the treatment for malignant tumours?

A

Excision and additional therapy if metastases

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14
Q

what is the histology of malignant tumours?

A

Variable, many differ from tissue of origin

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15
Q

what is the nuclei of malignant tumours?

A

Larger, pleomorphic

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16
Q

what are the mitoses of malignant tumours?

A

Numerous, including abnormal forms

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17
Q

How can tumours be further classified?

A
  • the cell type they resemble, ie their differentiation

- Most tumours resemble to some extent the tissue from which they arise

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18
Q

what is the benign tumour of covering epithelia?

A

papilloma

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19
Q

what is the malignant tumour of covering epithelia?

A

Carcinoma

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20
Q

what is the benign tumour of Glandular epithelia?

A

Adenoma

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21
Q

what is the malignant tumour of glandular epithelia?

A

adenocarcinoma

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22
Q

What are the benign tumours of smooth muscle, skeletal. muscle, bone forming, cartilage fibrous, blood vessels , adipose?

A 
SM- leiomyoma
Skeletale muscle-Rhabdomyoma 
BF- osteoma
C- Chondroma
F- Fibroma 
BV- (Haem)angioma 
A- Lipoma
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23
Q

What are the malignant tumours of smooth muscle, skeletal. muscle, bone forming, cartilage fibrous, blood vessels , adipose?

A 
SM- leiomyosarcoma
Skeletale muscle-Rhabdomyosarcoma
BF- osteosarcoma 
C- Chondrosarcoma
F- Fibrosarcoma
BV- Angiosarcoma
A- Liposarcoma
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24
Q

what may some highly malignant tumours be?

A

undifferentiated ie do not show any definite form of differentiation

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25
Why does tumour type matter?
- Different tumour types behave in different ways - Different benign tumours can behave differently - Not all malignant tumours are equally malignant
26
What is the prognosis?
- Prediction of the probable course and outcome of disease | - Appropriate treatment and estimate survival
27
What does cancer prognosis include?
- Tumour Type - Tumour Grade (Histology) - Tumour Stage (Histology, Clinical, Radiological) - Other Parameters (Patient ,Tumour)
28
What does knowing patterns of spread of tumour types aid?
diagnosis, staging and treatment
29
what is important anatomical knowledge to know for tumours?
Sentinal lymph node biopsy
30
what does tumour type influence?
How patients are investigated, treated and monitored
31
Describe aggressive versus indolent tumours.
- May need to treat before tissue diagnosis - Risk:benefit to consider at all times - Aggressive therapy may be necessary and risks are justifiable - Sometimes appropriate to avoid early active treatment
32
what is tumour grade?
-The degree of malignancy - Usually correlates well with patient survival (tumour grade is how well differentiate the tumour is)
33
Describe tumour grade.
- A histological assessment - How well differentiated the tumour cells are - Well differentiated tumours tend to have a better prognosis
34
what is "Oral cancer" Squamous cell carcinoma graded by?
degree of differentiation
35
what are well- differentiated squamous cell carcinoma?
very obviously squamous with ‘prickles’ and keratinization
36
what are poorly differentiated squamous cell carcinoma?
may be difficult to identify tumour cells as epithelial
37
what is the tumour stage?
how advanced the tumour is
38
Describe tumour stage?
A clinical, radiological and histological assessment: - Clinical examination - Radiology - Other Investigations
39
what is used to identify tumour stage?
TNM system ``` T= greatest diameter of tumour, structures invaded N= lymph node status M= metastasis ``` Eg pT2N1 (pathology)
40
what does tumour stage correlate with?
outcome in most tumour types
41
what does high tumour stage mean?
poorer prognosis
42
what are key elements in cancer development?
``` -Tumour growth: >Replication >Escape from senescence >Evasion of apoptosis >Limitless replicative potential -Angiogenesis -Invasion and metastasis ```
43
What is angiogenesis?
formation of new blood cells to support the needs of the tumour
44
what are the components of a neoplasm?
-Neoplastic cells -Blood Vessels -Inflammatory cells: >Macrophages >Lymphocytes >Polymorphs -Fibroblasts -Stroma
45
what are all neoplastic cells in a lesion derived from?
single common ancestor | -neoplastic cells are monoclonal
46
what is invasive malignancy?
invades the underlying connective tissue
47
Describe the stages of tumour growth?
- normal - intial event - mild dysplasia - severe dysplasia - invasive malignancy
48
What type of process is dysplasia?
a pre-malignant process
49
what is a good example of dysplasia?
epithelia: - squamous - glandular
50
Describe dysplasia (pre-invasive).
-Cells show abnormal features that are also seen in cancer cells …. -They are NOT invasive. -Different degrees of dysplasia: >Mild >Moderate >Severe / carcinoma in situ - The more severe forms have a significant risk of progressing to invasive malignancy.
51
Describe benign neoplasms.
- Benign tumours can progress to become malignant - Evidence for multi-step theory of carcinogenesis - Now reflected in molecular studies of cancer development
52
What is involved in the development of a cancer?
invasive growth, desmoplasia, angiogenesis and metastasis
53
Describe what is involved in invasive growth.
- receptors for connective tissues e.g laminin - adhesion molecules - altered cell division and apoptosis -pressure of growth - proteolytic enzymes e.g collagenases Cathepsin
54
Describe what happens in invasive growth.
-Migration of cells that have detached from the primary tumour mass ``` -Single cells – >Mesenchymal migration (Proteolysis / traction) >Amoeboid movement (pseudopodiaPropulsion / Utilise defects) ``` -Groups of cells >Requires cell-cell adhesion and communication >Predominates in well differentiated carcinomas >Inner cells protected from immunological assault >High levels of autocrine pro-migratory factors and of proteolytic enzymes. >Heterogeneous sets of cells invade together
55
Describe the tumour stroma -desmoplasia.
- Variable – scanty to abundant. - Fibro-connective tissues associated with malignant tumours. - Stimulated by invasive disease - Firm, craggy feel of cancer
56
What happens in angiogenesis?
-Formation of new blood vessels -Under tight physiological control -Control is lost in tumours – the angiogenic switch. -Vessels formed are abnormal -New blood cells formed by outgrowth of endothelial cells from post capillary venules into tumour mass -Stimlulus is increased production of factors by tumour cells: >VEGF, FGF, angiogenin >Inhibition of angiogenesis potential anticancer therapy area
57
What is angiogenesis a pre-requisite for?
tumour progression
58
how are tumours vascularised?
to a different extent
59
what do tumours require?
less oxygen and metabolites than normal cells
60
what does the density of tumour microvasculature need not correlate with?
prognosis
61
what are metastasis?
- Tumour implants that are discontinuous with the primary lesion. - “Secondaries” - Sinister event. - Non-random - Practical implications
62
Name some common sites of metastatic disease.
- Regional lymph nodes - Liver - Lung - Bone - Brain - Skin
63
what are unusual sites of metastatic disease?
think of renal cancer, thyroid cancer, melanoma
64
What spreads through lymphatic metastasis?
carcinoma
65
what spreads haematogenous ?
sarcoma
66
what is the route of metastasis across body cavities?
- serous cavities | - meninges/ventricles /spinal canal
67
what accounts for common metastatic profiles?
circulatory patterns
68
what is effective at arresting circulating cancer cells?
lung and liver
69
Describe the delivery and growth of cancer cells.
Delivery of cancer cells to a potential metastatic site is primarily mechanical – but the growth of metastatic deposits is dependent upon compatability with the “soil”.
70
what are neck nodes divided into?
1-5
71
what are the nodes in 1?
Submental and submandibular
72
what are 2,3 , 4?
cervical chain - associated with sternocleidomastoid
73
what is 5?
posterior triangle
74
what stages do most oral cancers include?
1-4

Pathology (9 decks)

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