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13.02.14 Pathology teaching - neoplasia

Metaplasia
  • Replacement of one cell type with another
  • Examples:
    • Smoking: Columnar => Squamous
    • Barrett's oesophagus: Squamous => Columnar
    • Cervix: Columnar => Squamous


Cancer definition

  1. Invasive growth
  2. 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
    • Widespread metastases


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
    • Benign
  • 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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