Tumour Structure and Nomenclature. Paul Edwards. Department of Pathology and Cancer Research UK Cambridge Institute, University of Cambridge

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1 Tumour Structure and Nomenclature Paul Edwards Department of Pathology and Cancer Research UK Cambridge Institute, University of Cambridge

2 Malignant Metastasis Core idea of cancer Normal Cell Slightly Abnormal More Abnor mal mutations

3 1. Malignancy and Metastasis the central problem of cancer research, both clinically and intellectually

4 1. Malignancy and Metastasis the central problem of cancer research, both clinically and intellectually Metastasis is when a cancer forms additional tumours secondaries elsewhere in the body. A metastasis is also a secondary tumour, plural metastases Malignancy definition: the ability to form metastases (it doesn t have to have metastasized yet)

5 Metastasis

6 Malignancy malignant tumour (melanoma)

7 Malignancy Benign tumour (mole) NOT capable of metastasis malignant tumour (melanoma) capable of metastasis

8 Malignancy can be identified down the microscope benign malignant

9 Benign smooth muscle tumour of uterus (common)

10 Malignant smooth muscle tumour of uterus (v. rare)

11 Malignant smooth muscle tumour of uterus (v. rare) invasive tumour cells spread

12 Malignancy can be identified down the microscope benign invasion = local metastasis? malignant (Heresy?)

13 Nomenclature not entirely consistent but roughly speaking: Benign tumours: tissue name + - oma e.g. lipoma =benign fat tumour Leiomyoma = benign smooth muscle tumour Papilloma = wart, adenoma = benign glandular lump, including glandular polyp Malignant tumours from mesenchyme -[name of tissue] sarcomas E.g - osteosarcoma (malignant bone tumour), - leiomyosarcoma (malignant smooth muscle) Malignant tumours from epithelium [name of tissue] carcinoma e.g. breast carcinoma may include adeno- or squamous, e.g.oesophageal adenocarcinoma; squamous carcinoma of oesophagus Some Exceptions to the above rules: malignant melanoma Neuroblastoma, medulloblastoma (both malignant)

14 Leukaemias Myeloid Lymphocytic Acute AML ALL Chronic CML CLL Leukaemias are liquid, mainly in blood. Lymphomas are related proliferations of lymphocytes as solid masses mainly in lymph nodes

15 Loss of function Cause of illness and death e.g. failure of normal bone marrow in leukaemia (see also spleen) Liver overwhelmed by metastatic colon cancer etc etc

16 Benign versus malignant: benign tumours can kill e.g. meningioma, pituitary adenomas

17 Incidence Benign tumours: very common all tissues Leiomyoma of uterus, lipoma, wart, mole. Malignant tumours from mesenchyme generally rare but often rapidly lethal -E.g osteosarcoma (malignant bone tumour), Malignant tumours from epithelium Common - most important cancers e.g. breast carcinoma, colorectal lung, ovary prostate Liver (low in West, high elsewhere, HBV + aflatoxin) Cervix (HPV) Nasopharyngeal (chinese, EBV)) main virus-associated cancers

18 Half of all cases The 20 Most Common Cancers New Cases, UK,

19 Malignant Metastasis Core idea of cancer Normal Cell Slightly Abnormal More Abnor mal some of these intermediates can be seen mutations

20 Cancer develops in multiple stages Normal Benign Malignant

21 Colon cancer precursor: benign adenoma or polyp

22

23 Colon/rectum cancer: malignant

24 Colon carcinoma: malignant Cancer Invasion

25 colon carcinoma following slides zoom in on invasion

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33 Normal muscle With tumour

34 Vogelstein model of colon cancer - a classic example of stages in cancer development

35 Cervical Cancer: Second Classic multistep example Illustrates: -multiple stages -Benign to malignant transition -Metaplasia -Virus infection -screening

36 Cervix and cervical Cancer uterus * * Columnar epithelium Squamous epithelium vagina Virus infection (HPV)

37 Cervix at low power uterus, glandular vagina, squamous

38 Cervix at low power glandular * * squamous

39 Very dysplastic but still benign cervix epithelium CINIII uterus, glandular vagina, squamous

40 Very dysplastic but still benign cervix epithelium CINIII normal glandular squamous metaplasia + severe dysplasia CINIII normal squamous

41 Very dysplastic but still benign cervix epithelium CINIII normal glandular squamous metaplasia + severe dysplasia (note mitoses circled) CINIII normal squamous

42 Malignant - Carcinoma

43 Presentation and screening

44 e.g. Colon/rectum cancer: pain, bleeding, strictures...

45 Best example of screening Cervical Cancer

46 Screening: cervix is ideal uterus vagina

47 Precursor - detect by screening

48 Screening: cervix is ideal uterus vagina Scrape sample

49 Cervical smears - normal abnormal: large pleomorphic nuclei

50 Miscell Hereditary predisposition - polyposis (vs HNPCC) Benign Teratoma

51 hereditary predisposition NOT QUITE Normal Cell Slightly Abnormal More Abnormal Malignant Gene changes / mutations

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