The role of pathology in diagnosis and treatment of cancer
11 important questions on The role of pathology in diagnosis and treatment of cancer
What is tumor budding?
What are passenger mutations?
What are the 4 different morphologies in cancer development?
Hyperplasia: increase number of cells
Dysplasia: disordered growth and maturation of cellular components
Carcinoma in situ: severe dysplasia
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What describes the TNM classification of cancer?
T: size of tumor and any spread of cancer into nearby tissue
N: spread of cancer to nearby lymph nodes
M: metastasis, spread of cancer to other parts of the body.
T, N and M are subdivided in stages, whereby I is the beginning and stage IV is an advanced stage
What are the steps that are needed for invasion and metastasis of cancer?
- Binding of components of the extracellular matric
- Epithelial-mesenchymal transition (EMT)
- Extracellular matrix degradation by proteolytic enzymes
- Intravasation
- Survival in blood vessels or lymphatics
- Extravasation
- Establishment of micrometastases
- Growing out
Explain the 'homing' phenomenon in cancer
What is the 'mechanical hypothesis' in cancer?
What is the 'seed and soil' hypothesis in cancer?
Why is the timing of metastases important?
What are the two distinct mechanisms of colon cancer metastases + explain them
- Common origin: organ metastases descends from a cancerous lymph node deposit or that both originate from a common subclone disseminated from the primary tumor (35% of cases).
- Distinct origins: Organ metastases and lymph node deposits each directly descend from a different parental subclone within the primary tumor (65% of cases).
What are the histopathological risk factors that could be used to indicate metastasis?
- Perineural growth
- Grade (does the tumor still look like the original tissue or is it differentiating, tells something about aggresiveness
- Histological subtype (e.g. Mucus production)
- Growth pattern/tumor budding (where does the tumor grow into other tissue, is this in one strand or multiple individual tumor cells (buds)).
- Infiltrating lymphocytes (is the immune system responding?).
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