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Tutorial 5 - neoplasisa & common cancers

Terms in this set (17)

nvasive, infiltrative, pale, necrotic, obstructive Severe acute abdominal pain and abdominal distension: from bowel obstruction Lethargy and pallor: from iron deficiency anaemia (slow, chronic bleeding) Change in bowel habit (constipation or diarrhoea): altered bowel motility or a mild degree of bowel obstruction Jaundice: from liver metastases General weight loss & anorexia: related to extensive metastases and release of cytokines
What descriptive terms might one use for the appearances of the tumours? How might these patients present clinically?
Transmural tumour infiltration & damage of local blood vessels blood loss iron deficiency anaemia.
Explain how colorectal carcinomas (and various other lesions of the GIT) cause iron deficiency anaemia.
Fistula - formation of an abnormal passage/communication between 2 hollow organs or a hollow organ & skin
What may happen if the tumour infiltrates into other hollow organs? (e.g. Specimen 23991 has infiltrated the bladder wall).
Local lymph nodes in mesocolon Liver via portal vein
Where do colorectal cancers metastasise?
diet low in fibre, high in animal fats, high in refined carbohydrates reduced intake of certain protective nutrients e.g. some vitamins adenomatous/dysplastic polyps: sporadic and familial (familial adenomatous polyposis) long standing inflammatory bowel disease, especially ulcerative colitis
What are the risk factors for colorectal carcinoma? What features affect the prognosis of colorectal adenocarcinoma?
Benign tumours are non-invasive, well circumscribed/demarcated, well differentiated & non-metastatic Malignant tumours are invasive with poorly defined margins, poorly differentiated & often associated with necrosis and haemorrhage & metastatic Biopsy and pathological assessment. left beinign and right malignant
in each specimen pair, label the benign tumour and the malignant tumour. What macroscopic features would help you to decide? How would you make the diagnosis definitive?
Primary has only one lesion with ill-defined margins whereas secondary tumours have multiple lesions of varying sizes with the same colour and consistency. Breast in women, prostate in men, bowel, lung and non-melanoma skin cancers
In each specimen pair, label the primary tumour and the other secondary/metastatic tumour. What macroscopic features would help you to decide? What are the common sites of primary malignancies in developed countries?
Vascular spread; lymphatic spread Transcoelomic (body cavities)
In these specimens, what two routes would the cancer cells have taken to reach the sites of metastases? What is one more metastatic route?
lung, liver, bone, brain
What are the commonest sites of metastases?
No, the tumour retains its initial differentiation from its primary site thus it does not become an osteosarcoma.
Is a metastasis in bone from a primary cancer in the lung called a bone cancer? Why or why not?
Malignant neoplasm Degree of differentiation of a tumour and the number of cells undergoing mitosis
What does the term 'cancer' mean? What does "grading" refer to in terms of a malignant tumour?
"Adeno" refers to glandular differentiation. Adenoma = benign tumour showing glandular differentiation Adenocarcinoma = malignant tumour showing glandular differentiation
What is the difference between an "adenoma" and an "adenocarcinoma"?
Change in differentiation from one adult cell type to another adult cell type. Oesophagus (from acid reflux) and Lung (response to toxins) Lacking differentiation
What is metaplasia? Name two sites where metaplasia commonly occurs and give reasons as to why it occurs there. What does the term 'anaplastic' mean?
Disordered growth and maturation of the cellular components of a tissue found in epithelia. Histological features: loss of uniformity of individual cells and their architectural orientation (pleomorphic); large hyperchromic nuclei; mitotic figures Limited to the epithelium and thus cannot penetrate the basement membrane for metastasis
Explain what dysplasia (as a pre-malignant condition) is. What abnormalities are seen histologically? Why can't dysplastic lesions metastasise?
Squamous dysplasia occurs in the lungs due to cigarette smoke Glandular (columnar) dysplasia occurs in the oesophagus due to GERD
Name one site where squamous dysplasia commonly occurs and one site where glandular dysplasia commonly occurs, with reasons as to why they occur there.
Specific type and size of tumour (pathology) Grade (differentiation microscopically) Stage (size of the primary tumour and spread macroscopically) Extent of invasion - local, lymph nodes, vascular Distant metastases (radiology)
What features are important in the prognosis of carcinoma?
In situ carcinomas are not yet invasive i.e. the atypical cells haven't invaded from the epithelium through the basement membrane into the underlying stroma. They thus cannot access blood and lymph vessels in the stroma by which to metastasise. If left unmonitored, they may develop the potential to acquire more mutations which could result in the cells being able to invade the basement membrane & metastasise.
Why is a carcinoma in-situ (DCIS) incapable of metastasis? Why do they require monitoring?
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