Metaplasia- Replacement of one cell type with another
- Examples:
- Smoking: Columnar => Squamous
- Barrett's oesophagus: Squamous => Columnar
- Cervix: Columnar => Squamous
Cancer definition
- Invasive growth
- Metastatic potential
Epithelial cancers
- Most common type
- All called carcinoma
- Subtypes:
- Squamous cell carcinoma
- Keratin production
- Intracellular bridges
- Adenocarcinoma
- Acini (glands)
- Mucin production
Dukes staging
- Dukes' A
- Invasion into but not through the bowel wall - i.e. Not below muscularis propria
- 90% 5-y survival
- Dukes' B
- Invasion through the bowel wall (i.e. into or through subserosa) but not involving lymph nodes
- 70% 5-y survival
- Dukes' C
- Any primary tumour invasion with involvement of lymph nodes
- 30% 5-y survival
- Dukes' D
Dysplasia/CIS
- Presence of abnormal cells
- But ABOVE basement membrane
- => No metastatic potential, as no access to blood or lymph
- => NOT cancer (fails criteria 2)
Breast lumps
- Fibrocystic change / fibroadenosis
- Common (50% of women)
- Usually most obvious in the week before period
- Quickly goes when period starts
- More common in women aged 30-50
- Fibroadenoma
- Benign
- Common in women <40
- Result of excess growth of the glands and connective tissue in the breasts
- Round, firm, rubbery, mobile lumps
- Not usually painful
- Cyst
- More common in women approaching menopause
- Usually oval or round lumps that are smooth and firm
- Slightly mobile
- Common for them to appear within two weeks prior to period and then resolve soon after the period
- Breast abscess
- Fat necrosis
- From injury or trauma
- Usually self-limiting
- Lipoma
- Breast cancer
Breast cancer
- Types
- Invasive ductal carcinoma (75%)
- Invasive lobular carcinoma (10%)
- DCIS
- NOT cancer - Still in the duct
- Usually no lump; Asymptomatic
- Causes calcification, which is detected by screening
- Receptors
- ER +ve
- 80%
- Normally less aggressive
- Respond to hormone therapy
- HER2 +ve
- 15%
- Normally more aggressive
- But respond to herceptin
Eaton–Lambert syndrome - Autoimmune disorder that is characterised by muscle weakness of the limbs
- Antibodies vs presynaptic voltage-gated Ca channels in NMJ
- Paraneoplastic phenomenon
- 60% have an underlying malignancy, most commonly small cell lung cancer
- Direct treatment of the cancer often relieves the symptoms
- Signs and symptoms
- Weakness typically involves the legs and arms
- Primarily proximal muscles
- Leg involvement is more striking than in myasthenia gravis
- Physical exercise and high temperatures can worsen the symptoms
- Three quarters have disruption of the autonomic nervous system
- Lambert's sign
- Strength improves further with repeated testing, e.g. improvement of power on repeated hand grip
- At rest, reflexes are typically reduced; with muscle use, reflex strength increases
Notes
- Hyperplasia vs Neoplasia
- One has a stimulus, one doesn't
- Viscus = Hollow organ with muscular wall
- "Clinically benign" can mean two things
- Dysplasia/CIS (which is a ticking bomb and must be sorted)
- Benign tumour (which is actually benign)
- You want to be ER+ve, HER2 -ve
- Paraneoplastic = Anything other than mass effect
- In colon cancer, invasion (i.e. cancer) corresponds to invasion through the muscularis mucosa (i.e. into the submucosa)
- EVEN THOUGH the basement membrane is underneath the epithelial layer
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