Benign or Malignant?

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Benign or Malignant? by Mind Map: Benign or Malignant?

1. Benign

1.1. Nomenclature / Classification

1.1.1. ___oma

1.1.1.1. benign epithelial neoplasms

1.1.1.1.1. squamous = papilloma

1.1.1.1.2. transitional = transitional/urothelial papilloma

1.1.1.1.3. glandular = adenoma

1.1.1.2. benign connective tissue neoplasms

1.1.1.2.1. lipoma (fat)

1.1.1.2.2. neuroma (neural tissue)

1.1.1.2.3. chondroma (cartilage)

1.2. Features

1.2.1. well circumscribed

1.2.2. encapsulated

1.2.3. slow growth

1.2.3.1. may spread locally into adjacent tissues

1.2.4. well differentiated (resembles tissue of origin)

1.2.5. cannot metastasise, but can become malignant over time

1.2.5.1. colon adenoma --> carcinoma (loss of p53 tumour suppressor)

1.3. Clinical Presentation

1.3.1. bleeding

1.3.1.1. haematemesis (vomiting blood), haemoptysis( coughing up blood), malaena (dark stool)

1.3.1.1.1. upper GI bleeding (oesophagus, stomach, small intestine)

1.3.2. lump

1.3.3. mass effect

1.3.3.1. cerebral stroke

1.3.3.2. GIT obstruction

1.3.3.2.1. may present with diarrhoea as stool must be made more fluid to get past obstruction --> excessive peristalsis

1.3.4. pain

1.4. Treatment & Prognosis

1.4.1. surgery is generally curative unless growth is in an inoperable site

1.4.2. may cause death if associated with severe blood loss

2. Malignant

2.1. Nomenclature / Classification

2.1.1. carcinoma (epithelium)

2.1.1.1. in-situ

2.1.1.1.1. no invasion beyond collagen basement membrane --> unable to metastasise

2.1.1.2. invasive

2.1.1.3. squamous cell carcinoma

2.1.1.3.1. resemblance + keratin production

2.1.1.3.2. skin, mouth, oesophagus, cervix

2.1.1.4. adenocarcinoma

2.1.1.4.1. resemblance +/- mucin or glandular production

2.1.1.4.2. GIT, breast, thyroid, uterus

2.1.1.5. small cell carcinoma

2.1.1.5.1. most lethal, commonly in the lung

2.1.1.5.2. associated with hormonal and paraneoplastic effects

2.1.1.5.3. high grade neuroendocrine carcinoma

2.1.1.6. transitional cell carcinoma

2.1.1.7. basal cell carcinoma

2.1.1.8. anaplastic carcinoma

2.1.1.8.1. undifferentiated --> classify by tumour markers (immunohistochemistry)

2.1.2. sarcoma

2.1.3. lymphoma

2.1.3.1. nodal or extranodal

2.1.3.2. hodgkin's lymphoma

2.1.3.2.1. RS cells not present

2.1.3.2.2. excellent prognosis

2.1.3.3. non-hodgkin's lymphoma

2.1.3.3.1. reed-sternberg cells

2.1.4. leukaemia

2.1.4.1. malignancy of bone marrow cells

2.1.4.2. malignancy of bone marrow cells

2.2. Features

2.2.1. macroscopic

2.2.1.1. haemorrhage and necrosis

2.2.1.1.1. leaky vessels formed by neoplasm-induced angiogenesis --> haemorrhagic + necrotic due to ischaemia and resulting hypoxia

2.2.1.2. metastasis (capable of spreading)

2.2.2. microscopic

2.2.2.1. hyperchromasia (dark nuclei)

2.2.2.2. increased mitotic activity

2.2.2.3. increased nucleus:cytoplasm ratio

2.2.2.3.1. normally around 1:4 --> nears 1:1 in malignant cell

2.2.2.4. pleomorphism (variation in nuclear shape + cell size)

2.3. Clinical Presentation

2.3.1. effect of primary

2.3.1.1. lump

2.3.1.2. obstruction

2.3.1.3. bleeding

2.3.1.4. loss of function

2.3.2. effect of metastasis (see above)

2.3.3. effect of hormone secretion

2.3.3.1. examples

2.3.3.1.1. ACTH release from small cell carcinoma -- Cushing's syndrome

2.3.3.1.2. oestrogen from testicular tumour -- gynaecomastia

2.3.4. paraneoplastic effects

2.3.4.1. peripheral neuropathy

2.3.4.1.1. motor or sensory, often associated w/ lung carcinoma

2.3.4.2. dermatomyositis

2.3.5. general effects of malignancy

2.3.5.1. weight loss

2.3.5.2. fatigue

2.3.5.3. anorexia

2.3.5.4. lassitude

3. Borderline

4. Neoplasm

4.1. Uncontrolled cell proliferation leading to a mass or nodule

4.1.1. autonomous, uncontrolled, purposeless, progressive, parasitic

4.2. A tumour is any type of lump/mass from any cause

5. Diagnosis

5.1. History

5.2. Clinical Examination

5.3. Special Tests

5.3.1. referral to radiology to check for metastasis -- CT, MRI, PET (uncommon as expensive)

5.3.2. pathology

5.3.2.1. fine needle aspirate

5.3.2.2. Bx

5.3.2.3. aspirate

5.3.2.4. resection