Pathology

Front 1

Dysplasia

Back 1

Abnormal cytological appearance and abnormal tissue architecture (precancerous associations)

Front 2

Clinical features of malignancy

Back 2

• Definition of mass
• Characteristic of mass (hard, irregular)
• Involvement of nearby tissues

• Change in character / size

• Involvement of distant tissues / organs

• Presence / absence of pain

Front 3

Triple approach to examining a mass

Back 3

1. clinical examination

2. radiological examination

3. pathological examination

Front 4

Malignant features on histology

Back 4

• loss of architecture

• necrosis

• mitosis

• nuclear pleomorphism

Front 5

What information is acquired from pathological examination?

Back 5

• Tumour type
• Tumour grade (how closely a tumor resembles tissue of origin)
• Tumours stage
• Excision margins
• Other features of prognostic value (i.e. vascular invasion, staining -ER, HER-2)

Front 6

primary vs. secondary tumor

Back 6

• primary - arose from the tissue that the tumor is located in

• secondary - arose from other tissue (metastasized to new location)

Front 7

Tumor Staging Classification

Back 7

TNM classification:

* size and/or extent (reach) of the primary tumor (T),
* whether cancer cells have spread to nearby (regional) lymph nodes (N),
* and whether metastasis (M), or the spread of the cancer to other parts of the body, has occurred.

Front 8

carcinoma

Back 8

cancer arising from epithelia

Front 9

sarcoma

Back 9

cancer arising from mesenchymal tissues

Front 10

Leiomyosarcoma

Back 10

Cancer of smooth muscle (i.e. fibroid)

Front 11

Cancer of the CNS (e.g. glial cells)

Back 11

Glioma

Front 12

Cancer of germ cells

Back 12

Teratoma

Seminoma/dysgerminoma

Front 13

Cancer of plasma cells

Back 13

Plastocytoma

Front 14

Cancer of placenta

Back 14

Choriocarcinoma

Front 15

Peak age for testicular cancer

Back 15

30s

Front 16

Common age for leukemia

Back 16

Children and old people (60+)

Front 17

Common age for bone cancer

Back 17

20s and old age (60+)

Front 18

Which cancers are most commonly associated with old age?

Back 18

Breast (40+), colon (50+), lung (50+)

Front 19

What are some examples of cancers strongly associated with genetics?

Back 19

- Retinoblastoma (autosomal dominant - loss of tumor suppressor genes)

- Familial Adenomatous Polyposis Coli - FAP

Front 20

What causes mesothelioma?

Back 20

Asbestos

Front 21

How do causes of hepatocellular carcinoma differ across the globe?

Back 21

Africa- due to Hep B

Western countries - due to alcohol

Front 22

What kinds of cancers are associated with radiation?

Back 22

• Leukemia

• Thyroid Cancer

• Lung, Breast, etc

Front 23

What virus is associated with Burkitt's lymphoma?

Back 23

EBV

Front 24

What kind of cancer can be described on histological appearance as having a "starry sky"?

Back 24

Burkitt's lymphoma (8-14 translocation)

Front 25

Theories of metastatic spread

Back 25

1. Seed and soil: tumor will spread to tissue that is most conducive to its growth

2. Blood supply: tumor will spread to areas that it can access through nearby blood vessels

Front 26

The Metastatic Cascade

Back 26

Clonal expansion, growth, diversification, angiogenesis

→ Metastatic subclone

→ Adhesion to and invasion of basement membrane

→ Passage through ECM

→ Intravasation

→ Interaction with host lymphoid cells

→ Tumor cell embolus

→ Adhesion to BM

→ Extravasation

→ Metastatic deposit

→ Angiogenesis

→ Growth

Front 27

How do cancer cells invade the ECM?

Back 27

down regulation of cell adhesion (e.g. epithelial cadherins)

attachment of tumour cells to matrix through expression of matrix binding receptors (e.g. receptors for laminin, fibronectin)

degradation of extracellular matrix through secretion of proteases (e.g. collagenase 4 which degrades basement membrane)

Front 28

Are renal cell carcinomas likely to metastasize?

Back 28

Yes

Front 29

Routes of tumor spread

Back 29

• Direct Extension

• Lymphatic Spread

• Vascular Spread
• Transcoelomic
• CNS Spread

• Field Effect

Front 30

Transcoelomic spread

Back 30

The dissemination of malignant tumors throughout the surfaces and organs of the abdominal and pelvic cavity covered by peritoneum. For example, ovarian tumors can spread transperitoneally to the surface of the liver.

Front 31

Common type of spread for:

-Ovarian/gastric cancer

- Rhabdosarcoma

- Breast

- Lung

Back 31

- Ovarian/gastric cancer: transcoelomic

- Rhabdosarcoma: hematologic

- Breast: lymphatic

- Lung: direct extension

Front 32

CNS spread

Back 32

usually doesn't spread outside of CNS; travels within CSF

Front 33

Field effect

Back 33

Several sites experience cancerous growth due to exposure to the same carcinogen

Front 34

General cancer symptoms

Back 34

Weight loss, malaise, lethargy

Arise due to a combination of

• metabolic and hormonal influences

• Malnutrition
• Infection
• Anaemia

Front 35

Local effects

Back 35

» Compression

» Obstruction
» Ulceration (eg GI tract)
» Haemorrhage (eg intracerebral tumor)

» Perforation (eg GI tumors)

» Infarction

Front 36

Examples of tumors that cause compression

Back 36

- Pituitary adenoma compresses optic nerve resulting in bitemporal hemianopia

- Meningioma, astrocytoma, oligodendroglioma cause rise in intracranial pressure

Front 37

Paraneoplastic Effects

Back 37

Symptoms not readily explained by local or metastatic disease:

- Clubbing

- Hypercalcaemia

- Peripheral neuropathy

- Cerebellar degeneration

Front 38

Driver mutation

Back 38

A mutation that confers selectional advantage to that cell over its neighbors, initiating early stages of neoplastic development

Front 39

Passenger mutation

Back 39

A mutation that confers little to no growth advantage to a cell

Front 40

3 types of cancer genes

Back 40

1. Oncogenes

2. Tumor suppressor genes

3. Genome stability/DNA repair genes

Front 41

Products of tumor suppressor genes are involved in controlling

Back 41

- Growth factor signalling

- Cell cycle

- Cell division

- DNA replication, repair and genome surveillance

Front 42

Cyclins and CDKs

Back 42

oncogenes

Front 43

Guardian of the genome

Back 43

TP53

Front 44

ABL

Back 44

dominant oncogene; CML

Front 45

BRAF

Back 45

dominant oncogene; melanoma/thyroid cancer

Front 46

APC

Back 46

Tumor suppressor gene; colon cancer

Front 47

BRCA1/2

Back 47

Tumor suppressor gene; breast/ovarian cancer

Front 48

RAS

Back 48

dominant oncogene; thyroid/colon cancer

Front 49

ERBB-2

Back 49

dominant oncogene; breast/ovarian carcinoma

Front 50

NF1

Back 50

Tumor suppressor gene; neurofibromatosis

Front 51

WT1

Back 51

Tumor suppressor gene; Wilm's tumor

Front 52

RET

Back 52

dominant oncogene; thyroid carcinoma

Front 53

c-MYC

Back 53

dominant oncogene; Burkitt's lymphoma

Front 54

BCL2

Back 54

dominant oncogene; follicular lymphoma

Front 55

What kind of genetic defect is associated with Burkitt's lymphoma?

Back 55

translocation of c-myc gene from 8 to 14

Front 56

What are some of the hallmarks of cancer?

Back 56

- Sustaining proliferative signaling

- Evading growth suppressors

- Avoiding immune destruction

- Enabling replicative immortality

- Tumor-promoting inflammation

- Activating invasion and metastasis

- Inducing angiogenesis

- Genome instability and mutation

- Resisting cell death

-Deregulating cellular energetics