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