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L18 Characteristics of tumours


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Cancer
uncontrolled growth of cells, which can invade and spread to distant sites of the body
Neoplasm
Lesion resulting from the autonomous growth or relatively autonomous abnormal growth of cells that persists in the absence of the initiating stimulus
Histogenesis
The differentiation of cells into specialised tissues and organs during growth from undifferentiated cells
Histogenic classification
Classification of the tumour by the specific cell or tissue of origin - e.g. carcinoma, sarcoma, lymphoma/ leukaemia
Rate of Growth
Tumour characteristic: doubling time of tumour cells, fraction of cell in replicative pool, rate at which cells are shed or die
Differentiation
Tumour characteristic: the extent that neoplastic cells resemble the corresponding normal parenchymal cells, morphologically and functionally
well
benign tumours are always ______ differentiated
anaplastic
neoplasms comprised of poorly-differentiated cells - "telltale sign of malignancy"
Morphological changes
Tumour characteristics (differentiation): pleomorphism, abnormal nuclear morphology, mitoses, loss of polarity, other changes
pleomorphism
Morphological change: variation in size & shape of cell
abnormal nuclear morphology
Morphological change: nuclei appear 'too large' for cell; variability in nuclear shape & chromatin distribution; hyperchromatism; abnormally large nucleoli
mitoses
Morphological change: indication of proliferation (seen in normal tissues with rapid turnover and hyperplasia); atypical, bizarre figures in malignly (tri/qudri-polar, multipolar spindles)
loss of polarity
Morphological change: orientation of cells disturbed, disorganised growth
GRADE
closely related to differentiation/ clinical behaviour (high ______ = poor differentiation)
STAGE
measure of extent of disease
Local invasion
May be malignant (infiltration, invasion or destruction) or Benign (cohesive expansile masses but localised with no capacity to infiltrate, invade or metastasise)
Encapsulation
In bengin tumours, formation of rim of compressed fibrous tissue (discrete, moveable, easily palpable, easily excised)
METASTASIS
Spread of a tumour to sites physically discontinuous with the primary tumour
Direct seeding
Metastatic pathway: neoplasm penetrates direct open filed without physical barriers; e.g. peritoneal cavity, pleural, pericardial, subarachnoid, joint spaces
Lymphatic spread
Metastatic pathway: most common pathway, pattern of node involvement follows route of lymphatic drain - e.g. breast Ca
Sentinel lymph node
hypothetical first lymph node or group of nodes draining a cancer
Haematogenous spread
Metastatic pathway: blood borne cells follow venous flow draining site of neoplasm - often come to rest at first capillary bed (liver or lungs)
Stroma
connective tissue framework that neoplastic cells are embedded in
Desmoplastic reaction
fibrous stroma formation due to induction of connective tissue fibroblast proliferation by growth factors from tumour cells
Compression
Clinical complication of tumours - local: e.g. Pancoast tumour in lung causing Horner's syndrome or pituitary adenomas causing VFDs
Destruction
Clinical complication of tumours - local: ulceration of mucosal surfaces - e.g. GI -> anaemia
Metabolic
Clinical complications of tumours - __________: general *hromones, cytokines, cachexia, neuropathy, myopathy) or specific (Lambert-Eaton myasthenia syndrome, SIADH, Polycythaemia)