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LO 1: Recognise the dysplasia neoplasia pathway of malignancy, esp those related to the
oesophagus and colon
Underwood Ch.10 Carcinogenesis & neoplasia
Tumour (neoplasm) = lesion resulting from the autonomous abnormal growth of cells that persists in the absence of
an initiating stimulus
Structure of tumours
Solid tumours consist of neoplastic cells and stroma (supportive connective tissue framework)
- Mechanical support
- Intercellular signalling
- Provides nutrition
Process of stroma formation = desmoplastic reaction
- V. fibrous due to induction of connective tissue fibroblast proliferation by GF
NB: stroma always contains blood vessels which perfuse the tumour angiogenesis stimulated by factors
secreted e.g. vascular endothelial growth factor (VEGF)
(this is counteracted by factors e.g. angiostatin & endostatin which slow down angiogenesis)
Tumour morphology
Gross appearance Behaviour Features
Polypoid Benign Clearly defined borders
Papillary (irregular, well-differentiated solid mass) Benign Firmer than surrounding tissue
Structure of chromatin in Finely granular chromatin evenly Coarse granular chromatin unevenly distribution
Normal amount of chromatin for Chromatin often increased but the amount and
Chromatin content of
diploid cells evenly distributed in all distribution of chromatin varies from one nucleus to
interphase nucleus
cells. another due to abnormal cell division.
Dysplastic changes form a mild severe spectrum; dysplasia = progression to malignancy (carcinoma in situ)
NB: dysplasia only occurs in the epithelium; carcinoma in situ = malignancy that hasnt crossed the basement
membrane
Barretts Oesophagus
Caused by GORD
Characterised by metaplastic change from flat squamous epithelium tall columnar epithelium with goblet
cells & tall mucin-secreting cells
Epithelial dysplasia (pre-cancer) detected in 0.2-2% of pt
Colonic adenocarcinoma
Adenoma carcinoma sequence occurs in >80% of patients
Proximal colon tumours = exophytic, rarely obstructive
Distal colon tumours = annular luminal narrowing (napkin ring constriction)
May result in Fe2+ deficiency anaemia due to silent bleeding (NB: fresh blood in stools)
Treatment:
Non-small cell lung carcinoma with EGFR mutations (adenocarcinomas) = EGFR-targeting drugs e.g. erlotinib,
gefitinib
Invasion
Easy to recognise in epithelial tumours basement membrane serves as line of demarcation b/w tissue
boundaries (pagetoid infiltration)
Malignant neoplastic cells secrete matrix metalloproteinases which digest surrounding connective tissue
I. Interstitial collagenases
II. Gelatinases
III. Stromelysins
- Perineural spaces
- Vascular lumina
Transcoelomic = via pleural, pericardial & peritoneal cavities with malignant effusion
- Effusion is rich in protein (i.e. exudate) and may contain fibrin
- Peritoneal effusions (ascites) may be due to involvement of any abdominal tumour but most common
with ovarian cancer
- Pleural & pericardial effusions often caused by breast & lung carcinomas
Metabolic
Tumour-specific
Well-differentiated (i.e. low grade) tumours often retain functional properties of the parent cell will often
enhance physiological effects of parent cell. E.g.
Normal cells have relatively low rate of glycolysis accompanied by oxidation of pyruvate in mitochondria
Cancerous cells display the Warburg effect high rate of glycolysis with fermentation of lactic acid
- can be used to image tumours by PET using FDG, as Warburg Effect FDG in tumours
LO 8 Discuss some of the pathogenic mechanisms for the development of tumours in the body
Carcinogenesis
Neoplasms arise from single cells that transform following cumulative mutational events
- Require 3 6 genetic mutations to transform into a neoplastic cell
- Self-exacerbating changes account for:
o Intratumoural heterogeneity
o Competing cell-clones
o Malignant evolution
o Drug resistance
Approximately 85% of cancers are due to environmental agents i.e. 10 15% of cancers are inherited
NB: Due to a latent interval, exposure to carcinogen and appearance of signs/symptoms may be decades apart
Inherited
Environmental
1. Chemical
a) Alkylating agents
b) Polycyclic hydrocarbons
c) Benzopyrenes
2. Radiation
a) UVL UVB > UVA
- Melanoma, SCC, BCC
b) Ionising radiation
- Myeloid leukaemia, thyroid cancer
- Particularly sensitive tissues:
o Thyroid
o Breast
o Bone
o Haemopoietic tissue
NB: Melanin has a protective effect against UVL darker skin = < chance of skin cancer
3. Viruses
4. Bacterial
- H. Pylori gastric MALT lymphoma & gastric adenocarcinoma
5. Fungal
- Aspergillus flavus mycobacteria leads to hepatocellular carcinoma
6. Familial/non-modifiable
- Familial Hx, age, gender, race
Common genetic molecular sequence
1. Mutation latency
2. Genomic instability
- Initiation = carcinogen induces genetic change that gives rise to neoplastic potential
- Promotion = stimulation of clonal proliferation of transformed cell
- Progression = accumulation of malignant characteristics
6. Secretion of autocrine GF
Activation of oncogenes
1. Chromosomal translocations
2. Point mutation
Neoplasm Mutation
Bladder carcinoma Ras gene
Pancreatic cancer K-Ras gene
Neoplasm Mutation
Small cell (Oat cell) carcinoma Myc-family
Breast & ovarian cancer Erb-B
Neuroblastoma n-Myc
Tumour suppressor genes
Further categorised according to their mechanism of action:
Caretaker = genes that maintain the integrity of the genome by repairing DNA damage
Gatekeeper = genes that inhibit proliferation/promote cell death of cells with damaged DNA
e.g. Retinoblastomas
Second hit = acquired mutational LoF of the remaining normal copy of the TSG