Tumour pathology 1-3

Question 1

What are the 3 most important rules that a cell must obey?

Answer 1

differentiate - specialised cell
grow when instructed
die when instructed

Question 2

What can a cell do if its going to grow abnormally?

Answer 2

more or less cells
bigger or smaller cells
different types of cells

Question 3

What abnormalities indicate disease?

Answer 3

doesn’t differentiate
grows without regulation
doesn’t die when instructed

Question 4

What does hyperplasia mean?

Answer 4

increase in the no. cells

Question 5

What does hypertrophy mean?

Answer 5

cells getting bigger, in response to physiological stimulus or pathological

Question 6

What does atrophy mean?

Answer 6

decrease in the number and or size of cells
physiological

Question 7

What is epithelium?

Answer 7

lining surface of various different sorts of organs and on surface of skin, oesophagus, gut and making up most of internal organs.

Question 8

Describe glandular epithelium?

Answer 8

more complicated than squamous epithelium because rather than just cells piled up on top of each other, forms structures like glands and secretes a substance.
Makes up organs with complex functions

Question 9

What does mucosa mean?

Answer 9

combination of epithelium on surface
and supporting connective tissue beneath epithelium.

Question 10

What type of tissue does cancer commonly arise from?

Answer 10

epithelial type tissue

Question 11

What is metaplasia?

Answer 11

changing from one cell type into another cell type

Question 12

What does a tumour fundamentally mean?

Answer 12

some sort of mass or swelling

Question 13

What could a tumour be classified into?

Answer 13

benign disorder of cell growth
malignant tumour like cancer
inflammatory swelling - due to trauma

Question 14

What is neoplasia?

Answer 14

an abnormal growth of tissue
due to uncoordinated proliferation
it persists even after cessation of the stimuli

Question 15

What are the two categories that neoplasms can be classified into?

Answer 15

benign - CONFINED BY BASEMENT MEMBRANE, don’t grow very quickly, smooth in shape, well differentiated, surgery treatment, low recurrence

malignant- INVASIVE LOCALLY AND DISTANT SPREAD, cells grow pretty rapidly, irregular in shape , poorly differentiated, surgery, radio ,chemo, immunotherapy, high recurrence if not fully removed ,

Question 16

What is a benign neoplasm?

Answer 16

abnormal growth of cells but does not invade nearby tissue

Question 17

What is cancer?

Answer 17

a non specific term for a malignant neoplasm

Question 18

How do we name benign etc..?

Answer 18

First part of cell- about what type of tissue the abnormal cell is trying to differentiate into
e.g. glandular tissue-adeno
squamous- squamous
bone-osteo
rhabdo- skeletal muscle

Suffix tells us if benign or malignant
benign tumour- oma

Examples: adenoma, papilloma, osteoma

Question 19

How do we name malignant?

Answer 19

adenocarcinoma
carcinoma- malignant and epithelial
adeno- glandular

squamous cell carcinoma

Question 20

What does the word sarcoma indicate?

Answer 20

connective tissue type malignant neoplasm

Question 21

What are the exceptions to all ‘oma’ being neoplasia?

Answer 21

granuloma
xanthoma
atheroma

Question 22

Venn diagram of this to summarise?

Answer 22

not all tumours are neoplasms
neoplasms can be benign or malignant
malignant can be split into what cells are trying to differentiate into

Question 23

What are oncogenes?

Answer 23

mutations that enable growth of tumour cells

Question 24

What is the most common tumour found in bone?

Answer 24

osteosarcoma

Question 25

Give physical characteristics of cancer cells?

Answer 25

-pleomorphic- adopt all different sizes and shapes -hyperchromatic- can have various shapes and sizes of the nucleus and chromatin much denser. Much denser because more chromosomes due to cells replicating so much- far too much DNA within cell. Form small nuclei within nucleus. -Highly mitotic (divide rapidly) and abnormal forms -disorganized structure

Question 26

Give behaviours of normal epithelial cells

Answer 26

Replicate when required Stick together and stay put (desmosomes allow them to stick together) Specialise to a specific role Die when instructed

Question 27

Give behaviours of cancer cells?

Answer 27

Unregulated growth Loss of cohesion (helps them invade e,g, basement membrane damage and invade tissues below) Immaturity Immortality

Question 28

Give all the ways that tumour cells can survive, grow and stay alive?

Answer 28

-avoid immune destruction (they produce programmed death ligand on surface of cell and these attach to immune cells and switch immune system off) -enable replicative immortality (can replicate forever- to avoid becoming old) -active invasion and metastasis -induce angiogenesis- not a native blood supply where the tumour is growing so have to somehow produce growth factors to allow blood vessels to grow new tumours (VEGF) -resist cell death (switches off BCL 2 ) -deregulate cellular energetics - can survive in environments where there is a lack of oxygen -sustain proliferative signaling- Constitutive activation of growth factor mechanisms A lot of oncogenes fall into this category -evade growth suppressors- evade negative feedback -possess genome instability and mutation -mediate a tumor-associated inflammatory response - inflammation associated with angeogenesis and block apoptosis - tumour cells switch that off

Question 29

Describe angeogenesis?

Answer 29

tumours cannot grow unless they develop their own blood supply ability to metastasise if develop a good blood supply to and from tumour then tumours can get into blood cells and get around body- grow at another site

Question 30

What is necrosis?

Answer 30

premature/ unregulated cell death passive process e..g can happen in tumours if outgrow blood supply

Question 31

What are the different genes involved in carcinogenesis?

Answer 31

proto-oncogene (normal oncogenes within body) oncogene (mutated proto oncogene ) tumour suppressor - stop cells from dying

Question 32

How does cancer spread?

Answer 32

Local spread Lymphatic spread Haematogenous spread (able to invade through invade through walls of lymphatic channels or blood vessels and get into circulation of body) - before something triggers adhesion of vessel to organ and then grows and replicates in organ Trans-coelomic spread- spread across a body cavity

Question 33

Describe lymphatic spread?

Answer 33

once got through basement membrane and into sub epithelial connective tissue- interact with lymphatic channels coat lymphatic and disrupt wall of lymphatics and enter lumen of channel and spread through body through lymph nodes in lymph nodes grow and divide and become lymph node metastatic deposit

Question 34

Where are common sites for metastatic deposits?

Answer 34

Liver Lung Brain Bone Adrenal gland Omentum/peritoneum

Question 35

Metastatic disposition sites?

Answer 35

Colorectal tumours go to liver often breast and prostate tumours go to bone tumours of ovary often involve omentum and peritoneum

Question 36

Give characteristics of benign tumours?

Answer 36

regular uniform edge where cells are contained within the tumour mass

Question 37

Give characteristics of malignant tumours?

Answer 37

irregular edge islands of tumour in surrounding connective tissue

Question 38

Describe the direct effect of tumours (at the site)?

Answer 38

-could cause pain -loss of function (motor or sensory) - from compression of nerve signals -haemorrhage- compressing on blood vessels and eventually leading to disruption and rupture bleeding

Question 39

Describe local effects of a tumour? (organ wise)

Answer 39

Brain - contained space. Leads to confusion , coma , seizures Lung- haemoptysis (bleeding into airways and coughing up blood) Dypsnoea (shortness of breath) Liver- jaundice ( blockage of bile ducts and therefore back up of bllirubin ) disruption to coagulation (lead to bleeding or susceptible to clotting) Colon- constipation, haemorrhage, diarrhoea Bone-pain , fracture, anaemia (disrupt bone marrow - which produce red blood cells) Spine- disruption of spinal cord- parathesia, numbness and possibly paralysis

Question 40

Describe cachexia (systemic effect of cancer) ?

Answer 40

Weakness/wasting due to chronic illness Can’t necessarily be fixed by increasing nutrition Usually muscle loss > fat loss

Question 41

Describe paraneoplastic syndromes? (systemic effects of cancer)

Answer 41

Some tumours abnormally or inappropriately produce hormones These hormones have systemic effects

Question 42

Give examples of hormones secreted by paraneoplastic syndromes?

Answer 42

There are some common associations: many lung cancers lead to these syndromes ADH (anti-diuretic hormone) will cause the retention of water (and resulting hyponatraemia) ACTH (adrenocorticotrophic hormone) will cause the adrenal gland to secrete excess cortisol (potentially leading to Cushing syndrome) PTH (parathyroid hormone) will cause hypercalcaemia

Question 43

Describe deep vein thrombosis?

Answer 43

Pressing on blood vessel

Question 44

Describe dysplasia (type of pre cancer)?

Answer 44

Abnormal growth of cells, uncoordinated with normal tissue and continuing even after cessation of stimulus A disorder of cell growth due to multiple acquired mutations A form of “pre-cancer” which may transform into a malignant neoplasm with time (and mutations) A form of “pre-cancer” which may transform into a malignant neoplasm with time (and mutations)

Question 45

Pre cancer venn diagram?

Answer 45

dysplasia can form a benign tumour not all benign tumours are dysplastic -many benign tumours are essentially just uncontrolled growth of normal looking cells

Question 46

What does dysplasia/ intra epithelial neoplasia mean?

Answer 46

refers to morphological changes within an epithelium due to some sort of stimulus, be that genetic or environmental. Benign BUT has potential to be malignant.

Question 47

Difference between neoplasia and dysplasia?

Answer 47

neoplasia- abnormal growth of cells, un coordinated with normal tissue and continuing even after cessation of stimulus. But cells mature and differentiate very similarly to their normal counterparts. OPPOSED TO dysplasia- look different and don't mature and differentiate as they should do in their normal counterparts.

Question 48

How is a malignant neoplasm different to a benign neoplasm?

Answer 48

Malignant: has the ability to invade connective tissue and metastasise around the body whereas a benign neoplasm does not