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Path - Malignant Neoplasms (Classification (carcinoma (epithelium)…
Path - Malignant Neoplasms
Classification
carcinoma (epithelium)
squamous cell
increased keratin
resemble squamous cells
adenocarcinoma
resemble glandular cells
altered levels of mucin/glandular production
neuroendocrine
e.g. small/oat cell
can be anywhere but usually in lung
high grade
possible hormonal + paraneoplastic effects
most aggressive cancer biologically
transitional cell/urothelial
resembles urothelium
basal cell
anaplastic/undifferentiated
use tumour markers to differentiate
doesn't resemble any cell under the microscope
mixed (e.g. adenosquamous)
NB to differentiate which type
determines best Tx
determines if its primary or a mets (wrong type of epithelial in that location)
lymphoma
nodal
extra nodal (e.g. tonsils/Peyer's patches)
Hodgkin's
non-Hodgkin's
leukaemia (BM, but can occur in nodes)
sarcoma (connective tissue)
osteosarcoma
chondrosarcoma
angiosarcoma
neurofibrosarcoma
leiomyosarcoma
myosarcoma
melanoma
rare forms
mixed (e.g. carcinosarcoma)
embryonic
germ cell (testis + ovary)
glial
in situ
curable if excised @ this stage
not beyond basement membrane (separates mucosa + submucosa) - contains collagen - hard to invade through
incapable of mets (no access to blood/lymphatic vessels)
95% detected @ screening
cartilage in ear can act as a barrier to invasion
invasive (capable of mets)
Clinical Presentation
effect of primary
mass (obstruction)
bleeding
loss of function (e.g. pathologic fractures)
effect of mets
same as primary
effect of hormone secretion
small cell lung cancer -> increased ACTH -> Cushing's
testicular cancer -> increased oestrogen -> gynaecomastia
Paraneoplastic syndrome
consequence of cancer in the body, but not due to the local presence of cancer cells.
peripheral neuropathy
dermatomyositis
General effects of malignancy
cachexia
fatigue/malaise/lassitude
anorexia
Most common sites for blood mets
lung
brain
liver
Dx of malignancy
Hx
clinical exam
radiology (CT/MRI/PET)
pathology (FNA,Bx,resection)
Microscopic features
more pronounced than in benign
necrosis
small black spots (fragments of nuclear remnants)
if late stage: no spots, just cell outline