8. PATHOLOGY OF TUMORS - PT2
2. DIGNITY name the histological and histocytological appearances typical for malignant tumours:
- (de-) differentiation - structural + cytological / atypias, anaplasia
DIGNITY AND GRADING - biological properties of sacroma (soft tissue tumors) Intermediary rarely metastazing tumour in soft tissues
- +/- potential of MTS (LU, lungs, risk <2%) - MTs potential
2. DIGNITY Growth patterns; macro-appearance describe capsules in malignant tumors?
- Absent/rarely encapsulated - because they infiltrate the tissue
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES - global consequences Name paraneoplastic syndromes?
- Acanthosis of CNS (brain atrophy) - Acanthosis nigricans - peripheral neuritis, disorders of CNS ( brain atrophy) - Dermatomyositis - Increased blood coagulability - Endocarditis (non-bacterial) - Herpes zoster - changes of the blood picture (leukocytosis, cytopenia, anemia, pancytopenia) - connective tissue disease - endocrinopathies (hypoglycemia, hypercalcemia)
3. GRADING OF MALIGNACIES Grading for carcinomas?
- CaG1 = well differentiated carcinoma (grows slow, they develop metastasis later or not at all - prognosis of patient is much better) CaG2 = moderately differentiated carcinoma CaG3 = poorly differentiated carcinoma CaG4 = undifferentiated carcinoma (anaplastic carcinoma) - (metastasing quickly and prognosis are generally poor)
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES Example of global consequences?
- Cachexy - Fever - anemia - Depression of immunity: - Production of hormones - Paraneoplastic syndromes: - Changes of the blood picture: - Connective tissue disease - Endocrinoptahies "Face - ppccd"
2. DIGNITY Growth patterns; micro-appearance What general features of malignant tumor cells can be seen in electron microscope? (8)
- Cell junctions, their presence and type. - Cell surface, e.g. presence of microvilli - Cell shape and cytoplasmic extensions - Shape of the nucleus and features of nuclear membrane. - Nucleoli, their size and density. - Cytoplasmic organelles—their number is generally reduced. - Dense bodies in the cytoplasm - Any other secretory product in the cytoplasm e.g. melanosomes in melanoma and membrane-bound granules in endocrine tumours.
2. DIGNITY Histocytological apperance of atypias name hallmarks of changed histological and functional changes in atypias
- Cells - Nuclei - Chromatin - Cystoplasmic changes - Enzymes - genes
DIGNITY AND GRADING - biological properties of sacroma (soft tissue tumors) Benign tumour in soft tissues characteristics?
- Cured by a complete resection - Local recidive not, if+, then without destruction - Exceptional distant MTS = histologically no features
3. GRADING OF MALIGNACIES Example of grading partially "incroporated" in histological classificatio
- DFS protuberans = low grade (Dermatofibrosarcoma Protuberans) - aRMS = high grade (Alveolar rhabdomyosarcoma)
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES - global consequences Deperssion of immunity leads to?
- Decreased nourishment = hypoproteinemia hypogammaglobulinemia (low serum immunoglobulin or antibody levels) - Infections (candidate, HVS) + iatrogenic (cytostatic Th, corticosteroids)
2. DIGNITY Histological / histocytological apperance - the differentiation + dedifferentiation Characteristic of benign tumors?
- Duplicate the structural patterns of the normal tissue so well, that they are unrecognizable as tumours - Are composed of well differentiated tissue (not only cells) that closely resemble their normal coutnerparty - the same is true for individual cells
2. DIGNITY Growth patterns; macro-appearance describe the growth in benign tumors?
- Espansive growth - Merely push aside the surrounding normal tissue and compress adjacent tissue / stroma (by this the mesenchymal structures often make a capsule)
2. DIGNITY Growth patterns; macro-appearance describe the growth in malignant tumors:
- First grow also by expansion but soon invasive ability = infiltrate, invade and destroy the adjacent normal tissue = characteristics of malignancy - Peculiar growth patterns e.g. stenosing, diffuse, ulcerated, solic, cystic
what does typing consist of ?
- Imaging - Sampling of the tumor (biopsy) - Laboratory examination of the tumor - Gene analysis of the tumor = this will give us further information about the disease and helps us to determine if it is malignant or benign
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES Hormonal and metabolic abnormalities of primary cachexy? (7)
- Increased glucose production - Increased proteocatabolism - Increased lipolysis - Oxidation of fat acids - Insulin resistence - Catabolic hormonal changes - Necrosis - release of toxins / factors
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES name all of local consequences from tumour:
- Infiltration, invasion, destructiveness - Angioinvasivity - Local pressure on vessels - Local destruction - Perforation causing bleeding - penetration into adjacent tissue/organ - Exophytic growth - Infiltration of nerves
2. DIGNITY Growth patterns; micro-appearance Invasivity patterns of malignant tumors?
- Local invasion - Vascular invasion (lymphatic channels, blood vessels) - Neural, perineural invasion
DIGNITY AND GRADING - biological properties of sacroma (soft tissue tumors) Intermediaty tumour in soft tissues
- Locally aggressive: local recidives + - Always locally infiltrated/destructive growth - No MTS potential, wide excision necessary
4. STAGING - pTNM system describe the parameters M0: M1:
- M0: no distant metastasis - M1: metastasis to distant organs (beyond regional lymph nodes)
how do tumour cells metastasize? (3)
- Malignant tumour cells invade vessels, local tissue space - May detach and migrate, be transported or transplanted to distant place - Lodge and grow in a new location to form secondary tumour mass
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES Consequences of cachexy? (8)
- Muscle weakness - Decreased resistence to infections (respiratory, urinary) - Decubites - Thromboses - Slow wound healing - Tired - Global - Physical weakness
DIGNITY AND GRADING - biological properties of sacroma (soft tissue tumors) Malignant tumour in soft tissues
- Potentially locally destructive + recurrence - significant increased risk of MTS (20-100%)
other parameters in staging beside pTNM system
- R: (0-2): the completeness of the operation, resection-boundaries free of cancer cells or not
2. DIGNITY Growth patterns; macro-appearance describe the appearance/shape of malignant tumors? (3)
- Shape is irregular - poorly demarcater - projections to the surroundings - "fixation" ("cancer") = crab like - Different of color and consistency from surroundings
3. GRADING OF MALIGNACIES we can find out the grading with the help of these criterias:
- Size - Localization - Mitotic activity index - Histoly. type - Cellularity, PM = degree of differentiation - Necrosis (typical for malignancy) - Depth of invasion:
2. DIGNITY Growth patterns; macro-appearance - describe the growth rate of benign tumors? - how long time does it take to acquire a large size? - does it undergo mitosis ?
- Slow growth rate, - often requires a year to attain a large size (reflexted by mitosis -> infrequent in benign) - a large size (e.g. intraabdominally) - NO or few mitotic cells
4. STAGING - pTNM system - describe these parameters - T1? - T2? - T3? - T4?
- T1: tumour is 3cm or smaller in size and starts invasion into nearby tissues - T2: tumour is larger than 3 cm but less than 5cm in size and invades deeper into nearby tissues - T3: size of tumour is larger than 5cm but smaller than 7cm and invasion into nearby tissues is getting greater - T4: tumour is larger than 7cm and invasion is high
4. STAGING - pTNM system describe the parameters: - Tx? - T0?
- T: describes the size of the original tumour and wether it has invaded nearby tissue - Tx: tumour cannot be estimated - T0: no evidence of tumour
2. DIGNITY Growth patterns; macro-appearance describe the appearance/shape of benign tumors? (3)
- Usually rounded, oval - Encapsulated in majority or at least well circumscribes - Freely movable, often firm - uniform in gross app.
how can we read the typing results from the nomenclature of the tumour ? from fx. adenoma
- adeno- is from glandular epithelium, which is the histologenetical classification of the tumour
2. DIGNITY What are border line tumors
- atypical tumors = low grade malignant tumours - absence of stromal invasion, but spread + atypias
DIGNITY AND GRADING - biological properties of sacroma (soft tissue tumors) What are the 4 biological categories? (to avoid confusion)
- benign tumor - intermediary - intermediary, rarelly metastazing - malignant tymor
2. DIGNITY Histological / histocytological apperance - what are the histological or histocytological appearances we are looking form in malignant and benign tumours ?
- benign: well differentiated cells - malignant: dedifferentiated cells
2. DIGNITY Histocytological apperance of atypias Outline of the cells?
- bizarre forms - show phelomorphism (variation in size, shape from another) = anisocytosis
2. DIGNITY Growth patterns; macro-appearance - name the effect of benign tumors on surrouding tissue - are caused by:
- bleeding, infarction, infection - rapid size increase
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES Local consequences - What is local pressure on vessels cause? - Grading of the tumor?
- circulating disturbances (venostasis, necrosis) - benign, semimalignant, malignant
2. DIGNITY Growth patterns; macro-appearance describe the cells in benign tumor?
- composed of well differentiated tissue (not only cells) that closely resemble their normal counterparts - the same is true for individual cells e.g. lipoma (lipoma cells resemble their normal mature fat cells)
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES What are local impacts of tumours?
- compressing, invading, and destroying normal tissues - tumours may produce hormones that get released and interfere with surroundings or bloodstream
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES All tumors may cause? - usually worst by?
- consequences - malignant
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES - global consequences Anemia leads to?
- decreased lifetime of RBCs - occult hemorrhage - massive metastasis to the bone marrow
Tumor microenvironment - how can the balance in the immune system be lost? - what happens then?
- due to aging, loosing nutrition, developing chronic disorder - immune system cannot block the tumor growth arising within the body and the tumor is showing clinical manifestations
1. TYPING Example of location of epithelial cell tumors of superficial?
- epidermis - multiple stratified epithelium of many different mucosa membranes - respiratory membranes
Why can etiologic classification for neoplastic diseases not be used?
- etiology of many tumors is unknown - same etiologic agent may cause origin of different tumors - morphologically identical tumors (adenocarcinomas) might be caused by different factors (NSCLC = smoking, CRC = diet)
Characteristics of neoplasia (Wills definition) The growth of tumor/neoplasia is?
- excessive/abnormal - autonomous - independent in the regulatory mechansim - never ending
2. DIGNITY - all tumours grow first by? - Resulting in? - But malignant grow also by?
- expansion, with gradual increase in bulk - compression of the surrounding tissue - infiltration - that is the difference
1. TYPING Type of mesenchymal tumors?
- fibrous - adipose - cartilage - bones - muscle cells - vasoformative cells
1. TYPING - Characteristics of malignant tumors? - effect on supporting tissue? - malignant tumors commonly show?
- growing very fast - commonly the supportive tissue cannot grow so fast with the tumor - regressive changes (necrosy, atrophy, dystrophy)
2. DIGNITY name the growth patterns of tumour for dignity evaluation:
- growth patterns: expansion vs infiltrative growth - growth rate - capsule or not - cells of the tumour - shape and appearance - Regressive changes "GG CC Solla Rolla"
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES What is secondary cachexy?
- if person has cancer on a place that causes pain to eat then person does not want to eat - chemotherapy that has negative effect on tissues
3. GRADING OF MALIGNACIES Grading is ONLY used?
- in the praetherapeutical period - for a representative material (cave: crush artefacts, etc) - for malignant tumours (some exceptions - tumors of CNS, benign tumors G1 always because they are well differentiated but later )
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES the impact of tumours are divided into:
- local - distant (metastasis) - global
Routes of metastasis dissemination can be through?
- lymphatic vessels - blood vessels (as thrombi) - serous cavities - transport in cerebrospinal fluid - hollow structures
1. TYPING Mesenchymal tumors include?
- lymphoid and hematopoetic cell
4. STAGING - used only for? - what system do we use in staging ?
- malignant - pTNM system
2. DIGNITY name the different types of tumour behavior
- malignant or benign = simple - semimalignant - tumor of incertain behavior - borderline tumors
4. STAGING - pTNM system - describe these parameters - in lung cancer stage T4 tumour invades into
- mediastium - diaphragm - heart - great vessels - trachea - recurrent laryngeal nerve - esophagus - vertebral body - cardina or separate tumor nodule or nodules in different lobe of the same lung
1. TYPING Types of neuroectodermal tumors
- of central/periheral nervous system - of neural, ganglionic or supportive cells or melanocytes
1. TYPING Types of epithelial cell tumors?
- of superficial epithelium - of glandular epithelium: exo+endocrine glands
4. STAGING - pTNM system - in lung cancer stage T3 tumour invades into:
- parietal pleura - chest wall - phrenic nerve - parietal pericardium or separate tumor nodule or nodules in the same lobe
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES Types of cachexy?
- primary - secondary
2. DIGNITY Pheochromacytoma characteristics? (veit ekki hvort maður þurfi að kunna)
- produces vasoconstrictive agents like adrenaline and noradrenalin in cytoplasm and released to peripheral blood in perioids - patient feels normal and the suddenly develops hypertension then substances are metabolized and BP goes down
2. DIGNITY Histocytological apperance of atypias - describe how the ratio between cytoplasm and nucleus in exocrine cell in gastric mucosa can be different in atypias:
- production of mucin in cytoplasm of these cells is noraml - in atypias/tumour cells they do not need to produce mucin - organelles which are important for the proteosyntehsis of mucin will therefore dissappear resulting in smaller cytoplasm is smaller = ratio between nucleus and cytoplasm is changes
4. STAGING - pTNM system describe these parameters - NX - N0:
- regional lymph nodes cannot be assessed - no regional lymph node metastasis
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES possible results from therapy of tumour ?
- remission: no disease after treatment -> can be complete or partial - latent: active or minimal residual disease - recurrence: reappearance of the tumor following remission
2. DIGNITY Pheochromacytoma treatment? (veit ekki hvort maður þurfi að kunna)
- removed by surgery and it is not possible to say weather it is benign or malignant - after surgery the patient needs to have constant follow up for up to 3 months to see if there are developing metastasis by imaging methods and checking BP
2. DIGNITY Histological / histocytological apperance - the differentiation + dedifferentiation - alls cells arise from? - majority of the tumors are arising by? - when this tumor differentiates by the same way as is the differentiation of the normal cell linage we call it? - If they do not we call it?
- stem cells - neoplastic hit of this original stem cells - well differentiated tumor - undifferentiated tumor
2. DIGNITY Key word for functional properties?
- their loss - Ag (abberant pehnotype)
1. TYPING What is parenchyma?
- tumor cells - determine the type = histiogenetical classification
1. TYPING How to see that the tumor is malignant on X rays, CT or MRI
- tumor with necrotic field - typical that regressive changes are only showing in malignant tumors
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES effects on untreated malignant tumour - what happens ?
- tumour continues to grow - metastasis continues to extend with systemic effects
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES Local consequences - What does local destruction cause?
- ulceration - fistulation (vesico-rectal)
Tumor microenvironment - are tumor cells continuously arising in the body? - what happens to them?
- yes - the immune system is able to react the stromal cells and kill tumor cell and the person will not develop cancer -
4. STAGING pTNM system - what do these mean: - p? - T? - N? - M? - indexes?
-P: postoperative state - T: describes the size of the original (primary) tumour and whether it has invaded nearby tissue - N: degree of spread to regional lymph nodes - M: describe distant metastasis - 0, 1, 2, 3, 4, x = added to each of this
typing is dependant on histiogenetical classification 1. name the most common histiogenetical classification: (3) 2. name the less common: (5)
1. - epithelial cell tumors - mesenchymal: mesodermal cells - neuroectodermal tumors 2. - mixed tumors - germ cell tumors - tumors of placenta - mesothelial cell tumors - blastomas (embryonic tissue)
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES - global consequences Production of hormones 1. caused by? 2. leads to?
1. - tumors arising from endocrine glands - benign or malignant especially well differentiated 2. unregulated production of hormones - hyperinsulinsim - acromegaly - hyperparathyroidism
3. GRADING OF MALIGNACIES 1. Only used for? 2. exceptions?
1. - malignant tumors not benign - in pretherapeutical perioid - repesentative material 2. tumors of CNS
2. DIGNITY tumor behavior is estimated by looking into:
1. growth patterns 2. histiological and histiocytological appearance
1. TYPING Treatment of tumors?
1. killing parenchymal cells by chemotherapy and radiotherapy 2. targeted therapy - recognizing the oncogenetical drivers to block oncogenesis - blocking stromal cells and by blocking the communication between the tumor and stromal cells the tumor stops growing
Classification of tumors (muna fyrir exam)
1. typing (histiogenetical classification) 2. dignity (benign/malignant) 3. grading (how bad is it?) 4. staging (when it is bad, to which extent) 5. biological consequences of neoplastic disorder)
3. GRADING OF MALIGNACIES Grading of sarcoma and lymphoma?
2 grades little more complicated (explained in mesenchymal tumors)
4. STAGING - pTNM system ATH töflu bls 102 - mjög detailað um lung tumors
??
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES What is primary cachexy?
All the consequences of mediators and cytokines (TNF, IL-1, interferons) released by the tumor itself
What can you see on the picture?
Colorectal carcinoma - tumor cells are brought bia portal vein to the liver (common complication) - here is neural and perineural invasion = fibers of peripheral nerve and tumor cells infiltrating it
3. GRADING OF MALIGNACIES ???
Failure of differentiation rather than dedifferentiation of specialized cells accounts for undifferentiated appearance.
1. TYPING Example of mixed tumor? - composed of?
Fibroadenoma (tumor of the female breast) - cells belonging to fibrous cell linage and epithelial cell linage
2. DIGNITY Growth patterns; macro-appearance Do all malignant tumors NOT have a capsule? - explain?
No - when malignant tumors is growing relatively slow it may develop capsule but it still shows infiltration and invasion into the surrounding tissue
2. DIGNITY Example of tumor with incertain behaviour?
Pheochromacytoma - tumor of medulla of suprarenal gland
Can benign tumors metastatize?
Principally NOT property of benign tumors except leiomyoma of uterus
Can malignant tumors metastatize?
Property of many but not all malignant tumors
3. GRADING OF MALIGNACIES describe the differences in depth of invasion of tumours
Sarcoma - Superficial: above the fascia, no invasion - Deep: either + fascial invasion, or under the f. or mediastinum, retroperitoneum, pelvis
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES - global consequences Fever is mostly due to?
TNF
DIGNITY AND GRADING New trends in tumor biology assessment include?
The risk of an aggressive behaviours not benign vs malignant - low, intermediate and high risk of malignancy
2. DIGNITY Histological / histocytological apperance - the differentiation + dedifferentiation Definition of: poorly differentiated, /undifferentiated / dedifferntaited ?
This means that the tumor cells don't look like normal cells. They're disorganized under the microscope and tend to grow and spread faster than grade I tumors
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES - global consequences Paraneoplastic syndrome: Endocarditis (non-bacterial) can indicate?
advanced cancer
2. DIGNITY Example of semimalignant tumor?
basal cell carcinoma
Most common route for metastasis spread of sarcoma is?
blood vessels (hematogenous)
2. DIGNITY Histological / histocytological apperance - the differentiation + dedifferentiation
byrja a bls 88
2. DIGNITY Growth patterns; macro-appearance describe capsules in benign tumors?
capsules of tumours are indicating that the tumour is benign - no invasion / infiltration
1. TYPING Depends on?
cell lineage/origin of the tumor cells - epithelial - mesenchymal - neuroectodermal
what is infiltrative growth of tumours ?
characteristics for malignant tumours - Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES - global consequences Paraneoplastic syndrome: Herpes zoster can indicate?
colon cancer
2. DIGNITY Growth patterns; macro-appearance - describe the regressive changes in malignant tumors?
common, may alter the appearance
2. DIGNITY Histocytological apperance of atypias Chromatin?
condenced or increased (more DNA) - nucleoli prominent
1. TYPING Characteristics of mixed tumors?
contain more than one cell linage component
what does N stand for in pTNM staging system ?
degree of spread to regional lymph nodes
what does T stand for in pTNM staging system ?
describes the size of the original tumour and wether it has invaded nearby tissue
1. TYPING What is typing?
determination of the tumor type depending on the cell lineage/origin of tumour cells
Definition of metastasis?
development of secondary implants which is discontinuous with primary tumor
2. DIGNITY Histocytological apperance - histological appearance of nuclei in atypias - what about in benign tumour cells? - what about in malignant tumour cells?
deviation from normal - identical to normal - enlargement + pleomorphism (PM) = anisonucleosis (diff. in size and shape and chromatin structure)
3. GRADING OF MALIGNACIES Malignant tumors may show? - how?
different degree of differentiation / anaplasia - insufficient differentiation or it's loss (dedifferentiation) - can be differentiated, less differentiated or undifferentiated
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES What are distant impacts of tumour?
distant consequences are only for malignant tumours - dissemination through the body that is only malignant
2. DIGNITY Growth patterns; macro-appearance what does lack of capsule in benign tumors indicate? - example?
does not imply the malignancy - leiomyoma uteri: discretelly demarcated from the surrounding smooth muscle by a zone of compressed myometrium, but no real capsule
2. DIGNITY Histocytological apperance of atypias What is anisonucleosis ?
enlargment and pleomorphism of nucleus - differnent in size and shape and chromatin strucutre - alterations in nuclei:cytoplasmic ratio
what is dignity used for ?
evaluation of the biological properties and behavioral pattern of the tumour
3. GRADING OF MALIGNACIES Degree of differentation is reflected by?
expressing the degree of malignancy
2. DIGNITY Histological / histocytological apperance - the differentiation + dedifferentiation Definition of differentiation?
extent of morphological and functional similarity of parenchymal tumour cells to corresponding normal cells
2. DIGNITY Growth patterns; micro-appearance describe the growth pattern "micro-apperance" of benign tumour
fibrous capsule of the tumour separates the tumor from the host tissue
2. DIGNITY Characteristics of basal cell carcinoma?
has features of benign and malignant - no metastasis - grow invasive locally - destroy the face
2. DIGNITY Histocytological apperance of atypias What leads to loss of functional features? - example?
increasing anaplasia - unusual for cancer cells from bronchial epithelium to show cilia
what is meant with semimalignant tumour ?
it has good and bad properties - no metastasis - but bad grow, invasive locally and destroying surrounding tissue
2. DIGNITY Histological / histocytological apperance - the differentiation + dedifferentiation What does Anaplasia mean? - it is characteristic for:
lack of differentiation, losing the morphological characteristics of mature cells - characteristic feature of most malignant tumours
2. DIGNITY Histocytological apperance of atypias Cells are?
larger than normal and pleomorphic (variation in size)
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES - global consequences Paraneoplastic syndrome: Acanthosis of CNS can indicate?
lung cancer
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES - global consequences Paraneoplastic syndrome: Peripheral neuritis, disorders of CNS (brain atrophy) can indicate?
lung carcinoma
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES - global consequences Paraneoplastic syndrome: Increased blood coagulability can indicate?
lung or pancreas cancer
Most common route for metastasis spread of carcinoma is?
lymphatic vessels - regional and distant lymph nodes
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES What is cachexy? - characteristics? - represents? - etiology?
malignant atrophy - final stage of cancer - extreme weightloss of the whole body in 50-80% of all oncological patients - bad prognostic factor - not completely known and is multifactorial
When we are talking about tumors we should be talking about? (skil ekki alveg)
neoplastic disorders (conditions that cause tumor growth) because tumor is only a part of the disease, the whole body is disease
3. GRADING OF MALIGNACIES Most cancer arise from?
neoplastic transformation of the stem cell
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES Local consequences - What does infiltration of nerves cause?
neurologic disturbances and pain
are atypiias (atypical cells) allways malignant ?
no they can be benign or malignant
1. TYPING Tumor consists of?
parenchyma and stroma
what does M stand for in pTNM staging system ?
presence of distant metastasis
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES - global consequences What are paraneoplastic syndromes? - indicate?
rare disorders that are triggered by an abnormal immune system response to a cancerous tumor - first/early manifestation of tumor
4. STAGING - pTNM system describe the parameters - N1
regional lymph node metastasis present; at some sites, tumor spread to closest or small number of regional lymph nodes
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES What does recurrence indicate?
some of the tumor cells have survived therapy and eventually multiplied to such extent that tumor is again clinically obvious - sometimes late recurrences - dormant tumor cells over years
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES - global consequences Paraneoplastic syndrome: Acanthosis nigricans (skin changes) can indicate?
stomach cancer
1. TYPING What cells are not helpful for the determination of the histogenetical classification?
stromal cells
1. TYPING Tumor cells are speaking with?
stromal cells and exchanging information - the parenchyma cant live without the stroma
1. TYPING What is stroma?
supporting tissue holding the parenchyma together and the tumour cant live without it = blood and nutrition - contains the non-cancer cell and non-immune cell components of tumors
2. DIGNITY What does it mean when tumors have uncertain behavior?
the criteria is insufficient and dont fit it
2. DIGNITY Histological / histocytological apperance - the differentiation + dedifferentiation Characteristic of malignant tumors?
the more malignant tumor = the more the individual cells deviate and become different from the normal = atypias.
2. DIGNITY Growth patterns; macro-appearance characteristics of cells in malignant tumors?
the more malignant tumor the more the individual cells deviate from the normal = atypias
2. DIGNITY Growth patterns; micro-appearance - describe the growth pattern "micro-apperance" of malignant tumors? - occasionally tend to be? - necessary to?
the tumour invades the tissue (no capsule usually) - occasionally they tend to be encapsulated by stroma of surrounding tissue but always contain infiltration of inner capsule layer (local invasion) - remove broad surgical margins!
2. DIGNITY Growth patterns; micro-appearance What type of malignant tumor often have capsule?
thyroid gland carcinoma - because they are growing slowly
what is the first step of dignity ?
to recognize malignant neoplasia vs benign - after we find the malignancy we will try to find out other behavioral patterns
2. DIGNITY Growth patterns; macro-appearance What does examination of capsule in malignant tumors (if they have it) show?
tumor cells infiltrate the capsule (we dont see that in benign tumors)
1. TYPING How do tumor cells communicate with other cells?
tumor cells release a lot of different proteins and cytotoxic T cells, monocytes, histiocytes and macrophages which have a lot of receptor by ehich they can communicate with those tumor cells
4. STAGING - pTNM system describe the parameters - N2
tumor spread to an extent between N1 and N3 (N2 is not used at all sites)
4. STAGING - pTNM system describe the parameters - N3
tumor spread to more distant or numerous regional lymph nodes (N3 is not used at all sites)
IMPACT OF NEOPLASIA ON THE HOST AND ITS CONSEQUENCES - global consequences Paraneoplastic syndrome: Dermatomyositis can indicate?
various cancer types
What can you see on the picture?
vascular lumen in lymph vessels - group of lymphocytes appearing in vascular lumen - that means that it must be malignant becuase the tumor cells have infiltrated into the surrounding tissue and have entered vascular lumen and are entering to regional lymph node where they are producing metastasis
1. TYPING Characteristics of benign tumors? - effect on supportive tissue
very slowly growing - can grow with the tumor cells
2. DIGNITY Histological / histocytological apperance - the differentiation + dedifferentiation Definition of Well-differentiated?
well-differentiated cancer cells look more like normal cells under a microscope and tend to grow and spread more slowly than poorly differentiated or undifferentiated cancer cells.
2. DIGNITY how are the growth patterns of the tumour found out ?
with macro and microscopical approach
