{"id":6259,"date":"2026-05-27T21:18:17","date_gmt":"2026-05-28T01:18:17","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/?post_type=chapter&#038;p=6259"},"modified":"2026-06-04T22:06:01","modified_gmt":"2026-06-05T02:06:01","slug":"cellular-change-in-disease","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/chapter\/cellular-change-in-disease\/","title":{"raw":"Section 4 Cellular Change in Disease","rendered":"Section 4 Cellular Change in Disease"},"content":{"raw":"Biopsies allow for the microscopic analysis of cells and tissues - known as <strong>cell morphology<\/strong> or the study of structure, shape, and arrangement of cells.\u00a0 This is essential for detecting signs of disease and determining the cause and extent of disease progression.\u00a0 Each of the 200+ human cell types has a typical diameter, shape, and set of organelles within the normal, healthy range.\r\n<h3><span style=\"color: #1f5c99\"><strong>Atrophy<\/strong><\/span><\/h3>\r\nAtrophy is the shrinkage of cells below their normal size.\u00a0 The prefix <strong>a-<\/strong> means 'without' and <strong>tropy<\/strong> means 'growth'.\u00a0 At least seven causes of skeletal muscle atrophy have been identified:\r\n<ul>\r\n \t<li><strong>Bed rest:<\/strong>\u00a0 Muscles not used due to prolong immobility begin to shrink - a 'use it or lose it' phenomenon.<\/li>\r\n \t<li><strong>Casting:<\/strong>\u00a0 Restraint of a limb (e.g., when a bone is broken) prevents muscle use, leading to atrophy visible when the cast is removed.<\/li>\r\n \t<li><strong>Low-gravity environments: <\/strong> Astronauts experience muscle atrophy because their muscles are nor required to generate as much force in microgravity.<\/li>\r\n \t<li><strong>Reduced neural input:<\/strong>\u00a0 Nerve damage such as in spinal cord injuries (e.g., paraplegia or quadriplegia) severs the neural connections to muscles, which then atrophy without stimulation.<\/li>\r\n \t<li><strong>Poor nutrition \/ starvation: <\/strong> Without adequate dietary nutrients, cells lack the building blocks for growth and maintenance.<\/li>\r\n \t<li><strong>Ischemia:<\/strong>\u00a0 Poor blood flow (from the Greek <strong>ischein<\/strong> 'hold back' + <strong>haima<\/strong> 'blood') means reduced nutrient and oxygen delivery, coupled with lowered waste removal, impairs cell function and maintenance.<\/li>\r\n \t<li><strong>Reduced hormones:<\/strong>\u00a0 With aging, the body produces less estrogen, testosterone, and growth hormone, leading to reduced cellular stimulation and noticeable atrophy of muscle, bone, and other tissues.<\/li>\r\n<\/ul>\r\n<h3><span style=\"color: #1f5c99\"><strong>Hypertrophy:\u00a0 Physiologic vs. Pathologic<\/strong><\/span><\/h3>\r\n<strong>Hypertrophy<\/strong> is the opposite of atrophy - it refers to an increase in cell size.\u00a0 The prefix <strong>hyper-<\/strong> means 'more'.\r\n<table class=\"grid landscape\" style=\"border-collapse: collapse;width: 100%;height: 46px\" border=\"0\">\r\n<tbody>\r\n<tr style=\"height: 31px\">\r\n<td class=\"border\" style=\"width: 18.2111%;height: 31px\"><span style=\"color: #032c80\"><strong>Physiologic Hypertrophy<\/strong><\/span><\/td>\r\n<td style=\"width: 81.7889%;height: 31px\">Normal, healthy cell growth in response to increased demand.\u00a0 Example:\u00a0 skeletal muscle hypertrophy during exercise training, as cells produce more contractile proteins (myosin, actin) and increase in diameter and strength.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td class=\"shaded\" style=\"width: 18.2111%;height: 15px\"><span style=\"color: #032c80\"><strong>Pathologic Hypertrophy<\/strong><\/span><\/td>\r\n<td class=\"shaded\" style=\"width: 81.7889%;height: 15px\">Cell enlargement caused by disease.\u00a0 Example:\u00a0 in heart disease and hypertension, the heart's ventricular muscle must work harder to pump blood through damaged or narrowed vessels, leading to ventricular wall hypertrophy.\u00a0 Unlike physiologic hypertrophy, this change is detrimental - the heart's shape becomes less efficient at pumping blood, signalling deterioration.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n[caption id=\"attachment_358\" align=\"alignnone\" width=\"293\"]<img class=\"wp-image-358 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/fig-3-full-293x300.png\" alt=\"\" width=\"293\" height=\"300\" \/> Figure: Skeletal muscle physiologic hypertrophy[\/caption]\r\n\r\n[caption id=\"attachment_3784\" align=\"alignnone\" width=\"300\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/09\/1025_Atrophy-2.png\" target=\"_blank\" rel=\"noopener\"><img class=\"wp-image-3784 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/09\/1025_Atrophy-2-300x178.png\" alt=\"\" width=\"300\" height=\"178\" \/><\/a> Difference between a normal muscle and an atrophied muscle[\/caption]\r\n\r\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\"><strong>Athlete's Heart:\u00a0 Exercise-Induced Cardiac Remodeling<\/strong><\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nBoth resistance and cardiovascular training cause beneficial <strong>cardiac remodeling,<\/strong> but in distinct ways:\r\n\r\n<strong>Resistance training:<\/strong>\u00a0 Ventricular wall thickness increases (without major increase in fill volume), helping the heart generate more pressure to pump blood through compressed vessels during weightlifting.\r\n\r\n<strong>Cardiovascular (aerobic training):<\/strong>\u00a0 Both wall thickness and fill volume increase, allowing the heart to send larger volumes of blood per beat - reducing the need for a rapid heart rate during long-duration events like marathons.\r\n\r\nIn both forms of training, progenitor cells are activated, meaning <strong>hyperplasia<\/strong> (increased cell number through cell division) in addition to the cellular <strong>hypertrophy<\/strong> is contributing to heart enlargement (physiologic cardiac hypertrophy).\u00a0 Importantly, both adaptions are <strong>reversible<\/strong> - if training stops, the cellular changes reverse.\r\n\r\n<\/div>\r\n<\/div>\r\n&nbsp;\r\n\r\n[caption id=\"attachment_327\" align=\"alignnone\" width=\"300\"]<img class=\"wp-image-327 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Exercise-induced_cardiac_growth_-_Cardiac_remodeling_from_Aerobic_and_Resistance_exercise-300x300.jpg\" alt=\"\" width=\"300\" height=\"300\" \/> Figure: Exercise-induced cardiac growth. Aerobic and resistance exercise elicit different forms of physiological cardiac remodeling. Hypertrophic responses are primarily eccentric in nature for aerobic exercise and concentric in nature for resistance exercise.\u00a0 Heart remodeling is beneficial in athletes in that it helps to deliver more blood to the working tissues of the body per minute during exercise.\u00a0 Blood delivery of oxygen and nutrients supports increased ATP production required during muscle activity. LA, left atrium; LV, left ventricle; LVWT, left ventricular wall thickness; RA, right atrium; RV, right ventricle.[\/caption]\r\n\r\n[caption id=\"attachment_362\" align=\"alignleft\" width=\"225\"]<img class=\"wp-image-362 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Blausen_0166_Cardiomyopathy_Hypertrophic-225x300.png\" alt=\"\" width=\"225\" height=\"300\" \/> Figure: Pathologic hypertrophy of the heart due to cardiomyopathy (a disease that affects the myocardium).[\/caption]\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n<h3><span style=\"color: #1f5c99\"><strong>Hyperplasia<\/strong><\/span><\/h3>\r\n<strong>Hyperplasia<\/strong> refers to an increase in cell number due to mitosis (cell division).\u00a0 The suffix <strong>-plasis<\/strong>, comes from the Greek word meaning 'formation'.\u00a0 As with hypertrophy, hyperplasia can be physiologic or pathologic.\r\n<table class=\"grid landscape\" style=\"border-collapse: collapse;width: 100%;height: 46px\" border=\"0\">\r\n<tbody>\r\n<tr style=\"height: 31px\">\r\n<td class=\"border\" style=\"width: 18.2111%;height: 31px\"><span style=\"color: #032c80\"><strong>Physiologic Hyperplasia<\/strong><\/span><\/td>\r\n<td style=\"width: 81.7889%;height: 31px\">Normal growth occurring, for example, during childhood development (from embryo through to adulthood), or during pregnancy (growth of the uterus, breasts, and other supportive tissues).<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td class=\"shaded\" style=\"width: 18.2111%;height: 15px\"><span style=\"color: #032c80\"><strong>Pathologic Hyperplasia<\/strong><\/span><\/td>\r\n<td class=\"shaded\" style=\"width: 81.7889%;height: 15px\">Usually caused by a disease creating a hormonal imbalance that drives excess cell division.\u00a0 It can also lead to the formation of a benign tumor, which may be surgically removed if it causes clinical manifestations.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h3><span style=\"color: #1f5c99\"><strong>Metaplasia<\/strong><\/span><\/h3>\r\n<strong>Metaplasia<\/strong> (from Greek: 'change form') occurs when one cell type replaces another in response to chronic irritation, producing a more resilient but less functional tissue.\r\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\"><strong>Examples: Smoker's Trachea<\/strong><\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nUnder normal conditions, the <strong>trachea<\/strong> (windpipe) is lined with <strong>simple pseudostratified columnar ciliated epithelial cells<\/strong> and mucus-secreting <strong>Goblet cells<\/strong>.\u00a0 Cilia sweep mucus and trapped pathogens upward to be swallowed and eliminated.\r\n\r\nIn a long-term smoker, this tissue is perpetually damaged by smoke and remodels itself into <strong>stratified squamous epithelium<\/strong> with <strong>no cilia<\/strong> and <strong>fewer Goblet cells<\/strong>.\u00a0 This new tissue is more resistant to smoke, but far less functional:\u00a0 mucus production decreases and cilia are absent, requiring the smoker to rely on coughing to clear the airway - the well-known 'smoker's cough'.\u00a0 Metaplasia is thought to be <strong>reversible<\/strong> if the irritant is removed.\r\n\r\n<\/div>\r\n<\/div>\r\n&nbsp;\r\n\r\n[caption id=\"attachment_281\" align=\"alignnone\" width=\"300\"]<img class=\"wp-image-281 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Non-neoplastic_changes.svg_-300x168.png\" alt=\"\" width=\"300\" height=\"168\" \/> In the figure, the artist has illustrated some of the non-cancerous (non-neoplastic) cell morphology and growth pattern changes that can occur.\u00a0 So let's go through them one at a time. First of all, you will notice that the normal cells have been drawn to resemble stratified (many layer) cuboidal epithelial cells.\u00a0 Each of these cells contains one purple nucleus. Okay, notice this is our starting point. Each human cell type has a typical diameter, shape, and set of organelles which would be considered to fall in the normal, healthy range. If a biopsy was taken and the cells examined were much smaller than expected, we would conclude that these cells had shrunk, and would say that there has been some atrophy.[\/caption]\r\n<h3><span style=\"color: #1f5c99\"><strong><span style=\"color: #1f5c99\">Dysplasia,<\/span> Anaplasia, and Neoplasia<\/strong><\/span><\/h3>\r\n<table class=\"grid landscape\" style=\"border-collapse: collapse;width: 100%;height: 76px\" border=\"0\">\r\n<tbody>\r\n<tr style=\"height: 31px\">\r\n<td class=\"border\" style=\"width: 18.2111%;height: 31px\"><span style=\"color: #032c80\"><strong>Dysplasia<\/strong><\/span><\/td>\r\n<td style=\"width: 81.7889%;height: 31px\">Literally 'bad growth' <strong>(dys-<\/strong> = bad).\u00a0 Cell shapes change and cells become less functional and de-differentiated (more immature).\u00a0 Dysplastic cells are considered<strong> pre-cancerous<\/strong>.\u00a0 If the irritant is removed and normal gene expression resumes, dysplastic cells may revert to normal.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td class=\"shaded\" style=\"width: 18.2111%;height: 15px\"><span style=\"color: #032c80\"><strong>Anaplasia<\/strong><\/span><\/td>\r\n<td class=\"shaded\" style=\"width: 81.7889%;height: 15px\">Completely de-differentiated, non-functional cells that have entered a state of uncontrollable, continuous cell division.\u00a0 Anaplastic cells are often <strong>immortal.<\/strong><\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td class=\"border\" style=\"width: 18.2111%;height: 15px\"><span style=\"color: #032c80\"><strong>Neoplasia<\/strong><\/span><\/td>\r\n<td style=\"width: 81.7889%;height: 15px\">A 'new growth' or tumor produced by the accumulation of anaplastic cells\u00a0 Can be <strong>benign<\/strong> (non-cancerous, confined within the basement membrane) or <strong>malignant<\/strong> (cancerous, capable of breaching the basement membrane, spreading through blood or lymph vessels and infiltrating other tissues.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td class=\"shaded\" style=\"width: 18.2111%;height: 15px\"><span style=\"color: #032c80\"><strong>Carcinoma <em>in situ<\/em><\/strong><\/span><\/td>\r\n<td class=\"shaded\" style=\"width: 81.7889%;height: 15px\">A pre-malignant state in which the basement membrane remains intact.\u00a0 Most carcinomas <em>in situ<\/em> eventually progress to become malignant.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<span style=\"text-align: initial;font-size: 1em\">The typical sequence of changes is:\u00a0 <strong>Normal<\/strong> \u2192 <strong>Dysplasia<\/strong> (reversible if the irritant is removed) \u2192 <strong>Anaplasia \u2192 Neoplasm<\/strong> (benign or malignant).\u00a0 If malignant cancerous cells breach the basement membrane, they can enter blood or lymph vessels, spread to distant sites, form secondary cancers, and if untreated, cause multi-organ failure.\u00a0\u00a0<\/span>\r\n\r\n&nbsp;\r\n\r\n[caption id=\"attachment_341\" align=\"alignnone\" width=\"300\"]<img class=\"wp-image-341 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/5971147bf2f20018315cd3b0_figure-21crop-300x85.png\" alt=\"\" width=\"300\" height=\"85\" \/> Figure: Cell morphology changes during the development of a tumor, which may be benign (noncancerous and non-spreading) or malignant (cancerous).[\/caption]\r\n\r\n[caption id=\"attachment_306\" align=\"alignnone\" width=\"300\"]<img class=\"wp-image-306 size-medium\" style=\"color: #373d3f;font-weight: bold;font-size: 1em\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Tumor_Types_MTK-300x169.jpg\" alt=\"\" width=\"300\" height=\"169\" \/> Figure: Benign Tumour consists of dysplastic cells contained within a capsule, with cells not breaching through the basement membrane. Malignant Tumour consists of anaplastic cells that have breached the basement membrane and are spreading into neighbouring tissues.[\/caption]\r\n\r\n&nbsp;\r\n\r\n[caption id=\"attachment_297\" align=\"alignnone\" width=\"300\"]<img class=\"wp-image-297 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cancer_progression_from_NIH-300x188.png\" alt=\"\" width=\"300\" height=\"188\" \/> Figure: Cell morphology and cell number changes during the development of cancer.[\/caption]\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n[caption id=\"attachment_318\" align=\"alignnone\" width=\"283\"]<img class=\"wp-image-318 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Metastasis-283x300.png\" alt=\"\" width=\"283\" height=\"300\" \/> Figure: Cancer invasion is the first step of the metastatic cascade. Tumour cells penetrate the basement membrane and invade the surrounding tissues using two modes of movement\u2014individual and collective invasion. Invading tumour cells reach the blood vessel, enter the blood flow and disseminate, eventually giving rise to secondary tumours.[\/caption]\r\n\r\n<header class=\"textbox__header\">\r\n<h3 class=\"textbox__title\"><span style=\"color: #1f5c99\"><strong>Causes of Dysplasia and Cancer:\u00a0 Three Examples<\/strong><\/span><\/h3>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<strong><span style=\"color: #2e75b6\">1. Smoking and Lung Cancer<\/span><\/strong>\r\n\r\n<\/div>\r\nSmoking causes persistent irritation to cells within the respiratory tract and is the leading cause of <strong>lung cancer.<\/strong>\u00a0 It is also a risk factor for several other cancers.\r\n\r\n&nbsp;\r\n\r\n<strong><span style=\"color: #2e75b6\">2. UV Light and Skin Cancer<\/span><\/strong>\r\n\r\nUltraviolet <strong>(UV)<\/strong> light causes DNA mutations in skin cells and is the leading risk facto for the most common forms of <strong>skin cancer<\/strong>, including basal cell carcinoma, squamous cell carcinoma and melanoma\r\n\r\n&nbsp;\r\n\r\n<strong><span style=\"color: #2e75b6\">3. Human Papilloma Virus (HPV) and Cervical Cancer<\/span><\/strong>\r\n\r\nSeveral strains of <strong>Human Papilloma Virus (HPV)<\/strong> are known <strong>oncoviruses<\/strong> (viruses that can cause cancer).\u00a0 Some HPV strains are risk factors for <strong>cervical cancer<\/strong>, <strong>penile cancer<\/strong> and cancers of the mouth, throat, anus, and vagina; other stains cause <strong>genital or skin warts<\/strong>.\u00a0 HPV is transmitted skin-to-skin contact, including sexually.\r\n\r\n[caption id=\"attachment_6178\" align=\"alignnone\" width=\"300\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2026\/05\/Metaplasia-Dysplasia-Lung-Modified-ZS-scaled.png\"><img class=\"size-medium wp-image-6178\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2026\/05\/Metaplasia-Dysplasia-Lung-Modified-ZS-300x122.png\" alt=\"Figure 1. Stages of morphological cellular adaptations and molecular changes leading to lung cancer. Representative illustration highlighting morphological alterations of the epithelial cells during the gradual transition towards lung cancer and key molecular alterations contributing to this process.\" width=\"300\" height=\"122\" \/><\/a> Figure 1. Stages of morphological cellular adaptations and molecular changes leading to lung cancer. Representative illustration highlighting morphological alterations of the epithelial cells during the gradual transition towards lung cancer and key molecular alterations contributing to this process.[\/caption]\r\n\r\n&nbsp;\r\n\r\n[caption id=\"attachment_313\" align=\"alignnone\" width=\"300\"]<img class=\"wp-image-313 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/UV-skin-cancer-300x253.jpg\" alt=\"\" width=\"300\" height=\"253\" \/> Figure: The skin is comprised of 3 main layers: the epidermis, dermis and subcutaneous fat. UV light from the sun can penetrate the skin and damage DNA in the nucleus of skin cells. If the cells are not able to repair this damage, or repair it improperly, it can lead to uncontrolled cell growth and formation of a tumor. A tumor is considered cancerous when it is able to metastasize, or grow outside of its normal tissue. Developing skin cancer is more likely to happen with more or more frequent sun exposure, sunburns, or with age, as the cells lose their ability to repair DNA because there is too much or too repeated damage. Wearing sunscreen can help shield your skin cells from UV light and can help prevent skin cancer[\/caption]\r\n\r\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\">HPV Vaccination and Cervical Screening in Canada<\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nIn Canada, the <strong>HPV vaccine<\/strong> is available for youth and is ideally given prior to sexual activity - when the risk of viral exposure is lowest.\u00a0 Early detection of cervical cancer is critical for a better prognosis and the following screening protocol is recommended:\r\n\r\n<strong>Pap smear (Papanicolaou test)<\/strong>: Cervical cells are scraped and examined under a microscope for abnormal morphology.\u00a0 Recommended every 2-3 years after an individual becomes sexually active (as per physician recommendation).\u00a0 Named after Dr. Georgios Papanikolaou, who developed this test in 1923.\r\n\r\n<strong>HPV testing:<\/strong>\u00a0 An emerging approach adds <strong>Primary HPV testing<\/strong> (a highly sensitive DNA test for high-risk HPV stains) as a first step, followed by the Pap smear <strong>(cytology),<\/strong> and then <strong>colposcopy<\/strong> (a specificity test) when abnormal cells are detected.\u00a0 Colposcopy utilizes a lighted magnifying instrument, allowing the physician to examine the cervix, vagina and vulva for abnormal areas which can be biopsied and sent to the lab for testing.\r\n\r\n<\/div>\r\n<\/div>\r\n&nbsp;\r\n\r\n[caption id=\"attachment_304\" align=\"alignnone\" width=\"300\"]<img class=\"wp-image-304 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/HPVcervicalcancer-300x177.png\" alt=\"\" width=\"300\" height=\"177\" \/> Figure 1. Classification of normal squamous epithelial cells and human papillomavirus (HPV) infections in normal precancerous lesions (cervical intraepithelial neoplasia grades 1, 2, and 3 \u201cCIN 1, CIN 2, and CIN 3\u201d) and cervical cancer.[\/caption]\r\n\r\n<span style=\"text-align: initial;font-size: 1em\">\u00a0\u00a0<\/span>\r\n\r\n[caption id=\"attachment_339\" align=\"alignnone\" width=\"255\"]<img class=\"wp-image-339 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cervix-255x300.png\" alt=\"\" width=\"255\" height=\"300\" \/> Anatomy of the uterus, including the lower end of the uterus termed the cervix which connects the uterus to the vagina via the opening called the external orifice (or external os).[\/caption]\r\n\r\n[caption id=\"attachment_338\" align=\"alignnone\" width=\"300\"]<img class=\"wp-image-338 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Pap-Test-300x159.png\" alt=\"\" width=\"300\" height=\"159\" \/> Pap (Papanicolaou) Test or Pap Smear:\u00a0 Cervical cells are collected from the outer opening of the cervix and examined under a microscope to look for abnormalities. The Bethesda system classifies cells into multiple diagnostic categories ranging from: normal, dysplastic\/pre-cancerous, to anaplastic\/cancerous.\u00a0 The categories specifically include (but are not limited to) Negative for Intraepithelial Malignancy (NILM, normal, no abnormal cells), Low Grade Squamous Intraepithelial Lesion (LSIL, mild dysplasia), High Grade Squamous Intraepithelial Lesion (HSIL, indicating moderate or severe dysplasia, that doesn't necessarily progress to cancer), and Squamous Cell Carcinoma (SCC, cancer).[\/caption]","rendered":"<p>Biopsies allow for the microscopic analysis of cells and tissues &#8211; known as <strong>cell morphology<\/strong> or the study of structure, shape, and arrangement of cells.\u00a0 This is essential for detecting signs of disease and determining the cause and extent of disease progression.\u00a0 Each of the 200+ human cell types has a typical diameter, shape, and set of organelles within the normal, healthy range.<\/p>\n<h3><span style=\"color: #1f5c99\"><strong>Atrophy<\/strong><\/span><\/h3>\n<p>Atrophy is the shrinkage of cells below their normal size.\u00a0 The prefix <strong>a-<\/strong> means &#8216;without&#8217; and <strong>tropy<\/strong> means &#8216;growth&#8217;.\u00a0 At least seven causes of skeletal muscle atrophy have been identified:<\/p>\n<ul>\n<li><strong>Bed rest:<\/strong>\u00a0 Muscles not used due to prolong immobility begin to shrink &#8211; a &#8216;use it or lose it&#8217; phenomenon.<\/li>\n<li><strong>Casting:<\/strong>\u00a0 Restraint of a limb (e.g., when a bone is broken) prevents muscle use, leading to atrophy visible when the cast is removed.<\/li>\n<li><strong>Low-gravity environments: <\/strong> Astronauts experience muscle atrophy because their muscles are nor required to generate as much force in microgravity.<\/li>\n<li><strong>Reduced neural input:<\/strong>\u00a0 Nerve damage such as in spinal cord injuries (e.g., paraplegia or quadriplegia) severs the neural connections to muscles, which then atrophy without stimulation.<\/li>\n<li><strong>Poor nutrition \/ starvation: <\/strong> Without adequate dietary nutrients, cells lack the building blocks for growth and maintenance.<\/li>\n<li><strong>Ischemia:<\/strong>\u00a0 Poor blood flow (from the Greek <strong>ischein<\/strong> &#8216;hold back&#8217; + <strong>haima<\/strong> &#8216;blood&#8217;) means reduced nutrient and oxygen delivery, coupled with lowered waste removal, impairs cell function and maintenance.<\/li>\n<li><strong>Reduced hormones:<\/strong>\u00a0 With aging, the body produces less estrogen, testosterone, and growth hormone, leading to reduced cellular stimulation and noticeable atrophy of muscle, bone, and other tissues.<\/li>\n<\/ul>\n<h3><span style=\"color: #1f5c99\"><strong>Hypertrophy:\u00a0 Physiologic vs. Pathologic<\/strong><\/span><\/h3>\n<p><strong>Hypertrophy<\/strong> is the opposite of atrophy &#8211; it refers to an increase in cell size.\u00a0 The prefix <strong>hyper-<\/strong> means &#8216;more&#8217;.<\/p>\n<table class=\"grid landscape\" style=\"border-collapse: collapse;width: 100%;height: 46px\">\n<tbody>\n<tr style=\"height: 31px\">\n<td class=\"border\" style=\"width: 18.2111%;height: 31px\"><span style=\"color: #032c80\"><strong>Physiologic Hypertrophy<\/strong><\/span><\/td>\n<td style=\"width: 81.7889%;height: 31px\">Normal, healthy cell growth in response to increased demand.\u00a0 Example:\u00a0 skeletal muscle hypertrophy during exercise training, as cells produce more contractile proteins (myosin, actin) and increase in diameter and strength.<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td class=\"shaded\" style=\"width: 18.2111%;height: 15px\"><span style=\"color: #032c80\"><strong>Pathologic Hypertrophy<\/strong><\/span><\/td>\n<td class=\"shaded\" style=\"width: 81.7889%;height: 15px\">Cell enlargement caused by disease.\u00a0 Example:\u00a0 in heart disease and hypertension, the heart&#8217;s ventricular muscle must work harder to pump blood through damaged or narrowed vessels, leading to ventricular wall hypertrophy.\u00a0 Unlike physiologic hypertrophy, this change is detrimental &#8211; the heart&#8217;s shape becomes less efficient at pumping blood, signalling deterioration.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_358\" aria-describedby=\"caption-attachment-358\" style=\"width: 293px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-358 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/fig-3-full-293x300.png\" alt=\"\" width=\"293\" height=\"300\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/fig-3-full-293x300.png 293w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/fig-3-full-1000x1024.png 1000w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/fig-3-full-768x786.png 768w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/fig-3-full-1500x1536.png 1500w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/fig-3-full-2000x2048.png 2000w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/fig-3-full-65x67.png 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/fig-3-full-225x230.png 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/fig-3-full-350x358.png 350w\" sizes=\"auto, (max-width: 293px) 100vw, 293px\" \/><figcaption id=\"caption-attachment-358\" class=\"wp-caption-text\">Figure: Skeletal muscle physiologic hypertrophy<\/figcaption><\/figure>\n<figure id=\"attachment_3784\" aria-describedby=\"caption-attachment-3784\" style=\"width: 300px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/09\/1025_Atrophy-2.png\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-3784 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/09\/1025_Atrophy-2-300x178.png\" alt=\"\" width=\"300\" height=\"178\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/09\/1025_Atrophy-2-300x178.png 300w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/09\/1025_Atrophy-2-768x455.png 768w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/09\/1025_Atrophy-2-65x38.png 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/09\/1025_Atrophy-2-225x133.png 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/09\/1025_Atrophy-2-350x207.png 350w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/09\/1025_Atrophy-2.png 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-3784\" class=\"wp-caption-text\">Difference between a normal muscle and an atrophied muscle<\/figcaption><\/figure>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Athlete&#8217;s Heart:\u00a0 Exercise-Induced Cardiac Remodeling<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>Both resistance and cardiovascular training cause beneficial <strong>cardiac remodeling,<\/strong> but in distinct ways:<\/p>\n<p><strong>Resistance training:<\/strong>\u00a0 Ventricular wall thickness increases (without major increase in fill volume), helping the heart generate more pressure to pump blood through compressed vessels during weightlifting.<\/p>\n<p><strong>Cardiovascular (aerobic training):<\/strong>\u00a0 Both wall thickness and fill volume increase, allowing the heart to send larger volumes of blood per beat &#8211; reducing the need for a rapid heart rate during long-duration events like marathons.<\/p>\n<p>In both forms of training, progenitor cells are activated, meaning <strong>hyperplasia<\/strong> (increased cell number through cell division) in addition to the cellular <strong>hypertrophy<\/strong> is contributing to heart enlargement (physiologic cardiac hypertrophy).\u00a0 Importantly, both adaptions are <strong>reversible<\/strong> &#8211; if training stops, the cellular changes reverse.<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_327\" aria-describedby=\"caption-attachment-327\" style=\"width: 300px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-327 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Exercise-induced_cardiac_growth_-_Cardiac_remodeling_from_Aerobic_and_Resistance_exercise-300x300.jpg\" alt=\"\" width=\"300\" height=\"300\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Exercise-induced_cardiac_growth_-_Cardiac_remodeling_from_Aerobic_and_Resistance_exercise-300x300.jpg 300w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Exercise-induced_cardiac_growth_-_Cardiac_remodeling_from_Aerobic_and_Resistance_exercise-150x150.jpg 150w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Exercise-induced_cardiac_growth_-_Cardiac_remodeling_from_Aerobic_and_Resistance_exercise-768x768.jpg 768w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Exercise-induced_cardiac_growth_-_Cardiac_remodeling_from_Aerobic_and_Resistance_exercise-65x65.jpg 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Exercise-induced_cardiac_growth_-_Cardiac_remodeling_from_Aerobic_and_Resistance_exercise-225x225.jpg 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Exercise-induced_cardiac_growth_-_Cardiac_remodeling_from_Aerobic_and_Resistance_exercise-350x350.jpg 350w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Exercise-induced_cardiac_growth_-_Cardiac_remodeling_from_Aerobic_and_Resistance_exercise.jpg 800w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-327\" class=\"wp-caption-text\">Figure: Exercise-induced cardiac growth. Aerobic and resistance exercise elicit different forms of physiological cardiac remodeling. Hypertrophic responses are primarily eccentric in nature for aerobic exercise and concentric in nature for resistance exercise.\u00a0 Heart remodeling is beneficial in athletes in that it helps to deliver more blood to the working tissues of the body per minute during exercise.\u00a0 Blood delivery of oxygen and nutrients supports increased ATP production required during muscle activity. LA, left atrium; LV, left ventricle; LVWT, left ventricular wall thickness; RA, right atrium; RV, right ventricle.<\/figcaption><\/figure>\n<figure id=\"attachment_362\" aria-describedby=\"caption-attachment-362\" style=\"width: 225px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-362 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Blausen_0166_Cardiomyopathy_Hypertrophic-225x300.png\" alt=\"\" width=\"225\" height=\"300\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Blausen_0166_Cardiomyopathy_Hypertrophic-225x300.png 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Blausen_0166_Cardiomyopathy_Hypertrophic-65x87.png 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Blausen_0166_Cardiomyopathy_Hypertrophic-350x467.png 350w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Blausen_0166_Cardiomyopathy_Hypertrophic.png 768w\" sizes=\"auto, (max-width: 225px) 100vw, 225px\" \/><figcaption id=\"caption-attachment-362\" class=\"wp-caption-text\">Figure: Pathologic hypertrophy of the heart due to cardiomyopathy (a disease that affects the myocardium).<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h3><span style=\"color: #1f5c99\"><strong>Hyperplasia<\/strong><\/span><\/h3>\n<p><strong>Hyperplasia<\/strong> refers to an increase in cell number due to mitosis (cell division).\u00a0 The suffix <strong>-plasis<\/strong>, comes from the Greek word meaning &#8216;formation&#8217;.\u00a0 As with hypertrophy, hyperplasia can be physiologic or pathologic.<\/p>\n<table class=\"grid landscape\" style=\"border-collapse: collapse;width: 100%;height: 46px\">\n<tbody>\n<tr style=\"height: 31px\">\n<td class=\"border\" style=\"width: 18.2111%;height: 31px\"><span style=\"color: #032c80\"><strong>Physiologic Hyperplasia<\/strong><\/span><\/td>\n<td style=\"width: 81.7889%;height: 31px\">Normal growth occurring, for example, during childhood development (from embryo through to adulthood), or during pregnancy (growth of the uterus, breasts, and other supportive tissues).<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td class=\"shaded\" style=\"width: 18.2111%;height: 15px\"><span style=\"color: #032c80\"><strong>Pathologic Hyperplasia<\/strong><\/span><\/td>\n<td class=\"shaded\" style=\"width: 81.7889%;height: 15px\">Usually caused by a disease creating a hormonal imbalance that drives excess cell division.\u00a0 It can also lead to the formation of a benign tumor, which may be surgically removed if it causes clinical manifestations.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><span style=\"color: #1f5c99\"><strong>Metaplasia<\/strong><\/span><\/h3>\n<p><strong>Metaplasia<\/strong> (from Greek: &#8216;change form&#8217;) occurs when one cell type replaces another in response to chronic irritation, producing a more resilient but less functional tissue.<\/p>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Examples: Smoker&#8217;s Trachea<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>Under normal conditions, the <strong>trachea<\/strong> (windpipe) is lined with <strong>simple pseudostratified columnar ciliated epithelial cells<\/strong> and mucus-secreting <strong>Goblet cells<\/strong>.\u00a0 Cilia sweep mucus and trapped pathogens upward to be swallowed and eliminated.<\/p>\n<p>In a long-term smoker, this tissue is perpetually damaged by smoke and remodels itself into <strong>stratified squamous epithelium<\/strong> with <strong>no cilia<\/strong> and <strong>fewer Goblet cells<\/strong>.\u00a0 This new tissue is more resistant to smoke, but far less functional:\u00a0 mucus production decreases and cilia are absent, requiring the smoker to rely on coughing to clear the airway &#8211; the well-known &#8216;smoker&#8217;s cough&#8217;.\u00a0 Metaplasia is thought to be <strong>reversible<\/strong> if the irritant is removed.<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_281\" aria-describedby=\"caption-attachment-281\" style=\"width: 300px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-281 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Non-neoplastic_changes.svg_-300x168.png\" alt=\"\" width=\"300\" height=\"168\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Non-neoplastic_changes.svg_-300x168.png 300w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Non-neoplastic_changes.svg_-768x431.png 768w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Non-neoplastic_changes.svg_-65x36.png 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Non-neoplastic_changes.svg_-225x126.png 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Non-neoplastic_changes.svg_-350x196.png 350w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Non-neoplastic_changes.svg_.png 896w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-281\" class=\"wp-caption-text\">In the figure, the artist has illustrated some of the non-cancerous (non-neoplastic) cell morphology and growth pattern changes that can occur.\u00a0 So let&#8217;s go through them one at a time. First of all, you will notice that the normal cells have been drawn to resemble stratified (many layer) cuboidal epithelial cells.\u00a0 Each of these cells contains one purple nucleus. Okay, notice this is our starting point. Each human cell type has a typical diameter, shape, and set of organelles which would be considered to fall in the normal, healthy range. If a biopsy was taken and the cells examined were much smaller than expected, we would conclude that these cells had shrunk, and would say that there has been some atrophy.<\/figcaption><\/figure>\n<h3><span style=\"color: #1f5c99\"><strong><span style=\"color: #1f5c99\">Dysplasia,<\/span> Anaplasia, and Neoplasia<\/strong><\/span><\/h3>\n<table class=\"grid landscape\" style=\"border-collapse: collapse;width: 100%;height: 76px\">\n<tbody>\n<tr style=\"height: 31px\">\n<td class=\"border\" style=\"width: 18.2111%;height: 31px\"><span style=\"color: #032c80\"><strong>Dysplasia<\/strong><\/span><\/td>\n<td style=\"width: 81.7889%;height: 31px\">Literally &#8216;bad growth&#8217; <strong>(dys-<\/strong> = bad).\u00a0 Cell shapes change and cells become less functional and de-differentiated (more immature).\u00a0 Dysplastic cells are considered<strong> pre-cancerous<\/strong>.\u00a0 If the irritant is removed and normal gene expression resumes, dysplastic cells may revert to normal.<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td class=\"shaded\" style=\"width: 18.2111%;height: 15px\"><span style=\"color: #032c80\"><strong>Anaplasia<\/strong><\/span><\/td>\n<td class=\"shaded\" style=\"width: 81.7889%;height: 15px\">Completely de-differentiated, non-functional cells that have entered a state of uncontrollable, continuous cell division.\u00a0 Anaplastic cells are often <strong>immortal.<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td class=\"border\" style=\"width: 18.2111%;height: 15px\"><span style=\"color: #032c80\"><strong>Neoplasia<\/strong><\/span><\/td>\n<td style=\"width: 81.7889%;height: 15px\">A &#8216;new growth&#8217; or tumor produced by the accumulation of anaplastic cells\u00a0 Can be <strong>benign<\/strong> (non-cancerous, confined within the basement membrane) or <strong>malignant<\/strong> (cancerous, capable of breaching the basement membrane, spreading through blood or lymph vessels and infiltrating other tissues.<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td class=\"shaded\" style=\"width: 18.2111%;height: 15px\"><span style=\"color: #032c80\"><strong>Carcinoma <em>in situ<\/em><\/strong><\/span><\/td>\n<td class=\"shaded\" style=\"width: 81.7889%;height: 15px\">A pre-malignant state in which the basement membrane remains intact.\u00a0 Most carcinomas <em>in situ<\/em> eventually progress to become malignant.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"text-align: initial;font-size: 1em\">The typical sequence of changes is:\u00a0 <strong>Normal<\/strong> \u2192 <strong>Dysplasia<\/strong> (reversible if the irritant is removed) \u2192 <strong>Anaplasia \u2192 Neoplasm<\/strong> (benign or malignant).\u00a0 If malignant cancerous cells breach the basement membrane, they can enter blood or lymph vessels, spread to distant sites, form secondary cancers, and if untreated, cause multi-organ failure.\u00a0\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_341\" aria-describedby=\"caption-attachment-341\" style=\"width: 300px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-341 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/5971147bf2f20018315cd3b0_figure-21crop-300x85.png\" alt=\"\" width=\"300\" height=\"85\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/5971147bf2f20018315cd3b0_figure-21crop-300x85.png 300w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/5971147bf2f20018315cd3b0_figure-21crop-1024x290.png 1024w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/5971147bf2f20018315cd3b0_figure-21crop-768x218.png 768w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/5971147bf2f20018315cd3b0_figure-21crop-65x18.png 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/5971147bf2f20018315cd3b0_figure-21crop-225x64.png 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/5971147bf2f20018315cd3b0_figure-21crop-350x99.png 350w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/5971147bf2f20018315cd3b0_figure-21crop.png 1214w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-341\" class=\"wp-caption-text\">Figure: Cell morphology changes during the development of a tumor, which may be benign (noncancerous and non-spreading) or malignant (cancerous).<\/figcaption><\/figure>\n<figure id=\"attachment_306\" aria-describedby=\"caption-attachment-306\" style=\"width: 300px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-306 size-medium\" style=\"color: #373d3f;font-weight: bold;font-size: 1em\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Tumor_Types_MTK-300x169.jpg\" alt=\"\" width=\"300\" height=\"169\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Tumor_Types_MTK-300x169.jpg 300w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Tumor_Types_MTK-1024x576.jpg 1024w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Tumor_Types_MTK-768x432.jpg 768w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Tumor_Types_MTK-1536x864.jpg 1536w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Tumor_Types_MTK-65x37.jpg 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Tumor_Types_MTK-225x127.jpg 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Tumor_Types_MTK-350x197.jpg 350w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Tumor_Types_MTK.jpg 1920w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-306\" class=\"wp-caption-text\">Figure: Benign Tumour consists of dysplastic cells contained within a capsule, with cells not breaching through the basement membrane. Malignant Tumour consists of anaplastic cells that have breached the basement membrane and are spreading into neighbouring tissues.<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_297\" aria-describedby=\"caption-attachment-297\" style=\"width: 300px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-297 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cancer_progression_from_NIH-300x188.png\" alt=\"\" width=\"300\" height=\"188\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cancer_progression_from_NIH-300x188.png 300w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cancer_progression_from_NIH-65x41.png 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cancer_progression_from_NIH-225x141.png 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cancer_progression_from_NIH-350x219.png 350w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cancer_progression_from_NIH.png 423w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-297\" class=\"wp-caption-text\">Figure: Cell morphology and cell number changes during the development of cancer.<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_318\" aria-describedby=\"caption-attachment-318\" style=\"width: 283px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-318 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Metastasis-283x300.png\" alt=\"\" width=\"283\" height=\"300\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Metastasis-283x300.png 283w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Metastasis-65x69.png 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Metastasis-225x239.png 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Metastasis-350x371.png 350w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Metastasis.png 685w\" sizes=\"auto, (max-width: 283px) 100vw, 283px\" \/><figcaption id=\"caption-attachment-318\" class=\"wp-caption-text\">Figure: Cancer invasion is the first step of the metastatic cascade. Tumour cells penetrate the basement membrane and invade the surrounding tissues using two modes of movement\u2014individual and collective invasion. Invading tumour cells reach the blood vessel, enter the blood flow and disseminate, eventually giving rise to secondary tumours.<\/figcaption><\/figure>\n<header class=\"textbox__header\">\n<h3 class=\"textbox__title\"><span style=\"color: #1f5c99\"><strong>Causes of Dysplasia and Cancer:\u00a0 Three Examples<\/strong><\/span><\/h3>\n<\/header>\n<div class=\"textbox__content\">\n<p><strong><span style=\"color: #2e75b6\">1. Smoking and Lung Cancer<\/span><\/strong><\/p>\n<\/div>\n<p>Smoking causes persistent irritation to cells within the respiratory tract and is the leading cause of <strong>lung cancer.<\/strong>\u00a0 It is also a risk factor for several other cancers.<\/p>\n<p>&nbsp;<\/p>\n<p><strong><span style=\"color: #2e75b6\">2. UV Light and Skin Cancer<\/span><\/strong><\/p>\n<p>Ultraviolet <strong>(UV)<\/strong> light causes DNA mutations in skin cells and is the leading risk facto for the most common forms of <strong>skin cancer<\/strong>, including basal cell carcinoma, squamous cell carcinoma and melanoma<\/p>\n<p>&nbsp;<\/p>\n<p><strong><span style=\"color: #2e75b6\">3. Human Papilloma Virus (HPV) and Cervical Cancer<\/span><\/strong><\/p>\n<p>Several strains of <strong>Human Papilloma Virus (HPV)<\/strong> are known <strong>oncoviruses<\/strong> (viruses that can cause cancer).\u00a0 Some HPV strains are risk factors for <strong>cervical cancer<\/strong>, <strong>penile cancer<\/strong> and cancers of the mouth, throat, anus, and vagina; other stains cause <strong>genital or skin warts<\/strong>.\u00a0 HPV is transmitted skin-to-skin contact, including sexually.<\/p>\n<figure id=\"attachment_6178\" aria-describedby=\"caption-attachment-6178\" style=\"width: 300px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2026\/05\/Metaplasia-Dysplasia-Lung-Modified-ZS-scaled.png\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-6178\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2026\/05\/Metaplasia-Dysplasia-Lung-Modified-ZS-300x122.png\" alt=\"Figure 1. Stages of morphological cellular adaptations and molecular changes leading to lung cancer. Representative illustration highlighting morphological alterations of the epithelial cells during the gradual transition towards lung cancer and key molecular alterations contributing to this process.\" width=\"300\" height=\"122\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2026\/05\/Metaplasia-Dysplasia-Lung-Modified-ZS-300x122.png 300w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2026\/05\/Metaplasia-Dysplasia-Lung-Modified-ZS-1024x418.png 1024w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2026\/05\/Metaplasia-Dysplasia-Lung-Modified-ZS-768x313.png 768w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2026\/05\/Metaplasia-Dysplasia-Lung-Modified-ZS-1536x626.png 1536w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2026\/05\/Metaplasia-Dysplasia-Lung-Modified-ZS-2048x835.png 2048w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2026\/05\/Metaplasia-Dysplasia-Lung-Modified-ZS-65x27.png 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2026\/05\/Metaplasia-Dysplasia-Lung-Modified-ZS-225x92.png 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2026\/05\/Metaplasia-Dysplasia-Lung-Modified-ZS-350x143.png 350w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-6178\" class=\"wp-caption-text\">Figure 1. Stages of morphological cellular adaptations and molecular changes leading to lung cancer. Representative illustration highlighting morphological alterations of the epithelial cells during the gradual transition towards lung cancer and key molecular alterations contributing to this process.<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_313\" aria-describedby=\"caption-attachment-313\" style=\"width: 300px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-313 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/UV-skin-cancer-300x253.jpg\" alt=\"\" width=\"300\" height=\"253\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/UV-skin-cancer-300x253.jpg 300w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/UV-skin-cancer-65x55.jpg 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/UV-skin-cancer-225x190.jpg 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/UV-skin-cancer-350x296.jpg 350w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/UV-skin-cancer.jpg 765w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-313\" class=\"wp-caption-text\">Figure: The skin is comprised of 3 main layers: the epidermis, dermis and subcutaneous fat. UV light from the sun can penetrate the skin and damage DNA in the nucleus of skin cells. If the cells are not able to repair this damage, or repair it improperly, it can lead to uncontrolled cell growth and formation of a tumor. A tumor is considered cancerous when it is able to metastasize, or grow outside of its normal tissue. Developing skin cancer is more likely to happen with more or more frequent sun exposure, sunburns, or with age, as the cells lose their ability to repair DNA because there is too much or too repeated damage. Wearing sunscreen can help shield your skin cells from UV light and can help prevent skin cancer<\/figcaption><\/figure>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">HPV Vaccination and Cervical Screening in Canada<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>In Canada, the <strong>HPV vaccine<\/strong> is available for youth and is ideally given prior to sexual activity &#8211; when the risk of viral exposure is lowest.\u00a0 Early detection of cervical cancer is critical for a better prognosis and the following screening protocol is recommended:<\/p>\n<p><strong>Pap smear (Papanicolaou test)<\/strong>: Cervical cells are scraped and examined under a microscope for abnormal morphology.\u00a0 Recommended every 2-3 years after an individual becomes sexually active (as per physician recommendation).\u00a0 Named after Dr. Georgios Papanikolaou, who developed this test in 1923.<\/p>\n<p><strong>HPV testing:<\/strong>\u00a0 An emerging approach adds <strong>Primary HPV testing<\/strong> (a highly sensitive DNA test for high-risk HPV stains) as a first step, followed by the Pap smear <strong>(cytology),<\/strong> and then <strong>colposcopy<\/strong> (a specificity test) when abnormal cells are detected.\u00a0 Colposcopy utilizes a lighted magnifying instrument, allowing the physician to examine the cervix, vagina and vulva for abnormal areas which can be biopsied and sent to the lab for testing.<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_304\" aria-describedby=\"caption-attachment-304\" style=\"width: 300px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-304 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/HPVcervicalcancer-300x177.png\" alt=\"\" width=\"300\" height=\"177\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/HPVcervicalcancer-300x177.png 300w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/HPVcervicalcancer-1024x604.png 1024w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/HPVcervicalcancer-768x453.png 768w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/HPVcervicalcancer-1536x906.png 1536w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/HPVcervicalcancer-2048x1208.png 2048w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/HPVcervicalcancer-65x38.png 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/HPVcervicalcancer-225x133.png 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/HPVcervicalcancer-350x206.png 350w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-304\" class=\"wp-caption-text\">Figure 1. Classification of normal squamous epithelial cells and human papillomavirus (HPV) infections in normal precancerous lesions (cervical intraepithelial neoplasia grades 1, 2, and 3 \u201cCIN 1, CIN 2, and CIN 3\u201d) and cervical cancer.<\/figcaption><\/figure>\n<p><span style=\"text-align: initial;font-size: 1em\">\u00a0\u00a0<\/span><\/p>\n<figure id=\"attachment_339\" aria-describedby=\"caption-attachment-339\" style=\"width: 255px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-339 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cervix-255x300.png\" alt=\"\" width=\"255\" height=\"300\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cervix-255x300.png 255w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cervix-65x76.png 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cervix-225x264.png 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cervix-350x411.png 350w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Cervix.png 648w\" sizes=\"auto, (max-width: 255px) 100vw, 255px\" \/><figcaption id=\"caption-attachment-339\" class=\"wp-caption-text\">Anatomy of the uterus, including the lower end of the uterus termed the cervix which connects the uterus to the vagina via the opening called the external orifice (or external os).<\/figcaption><\/figure>\n<figure id=\"attachment_338\" aria-describedby=\"caption-attachment-338\" style=\"width: 300px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-338 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Pap-Test-300x159.png\" alt=\"\" width=\"300\" height=\"159\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Pap-Test-300x159.png 300w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Pap-Test-1024x543.png 1024w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Pap-Test-768x408.png 768w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Pap-Test-1536x815.png 1536w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Pap-Test-2048x1087.png 2048w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Pap-Test-65x34.png 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Pap-Test-225x119.png 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2023\/06\/Pap-Test-350x186.png 350w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-338\" class=\"wp-caption-text\">Pap (Papanicolaou) Test or Pap Smear:\u00a0 Cervical cells are collected from the outer opening of the cervix and examined under a microscope to look for abnormalities. The Bethesda system classifies cells into multiple diagnostic categories ranging from: normal, dysplastic\/pre-cancerous, to anaplastic\/cancerous.\u00a0 The categories specifically include (but are not limited to) Negative for Intraepithelial Malignancy (NILM, normal, no abnormal cells), Low Grade Squamous Intraepithelial Lesion (LSIL, mild dysplasia), High Grade Squamous Intraepithelial Lesion (HSIL, indicating moderate or severe dysplasia, that doesn&#8217;t necessarily progress to cancer), and Squamous Cell Carcinoma (SCC, cancer).<\/figcaption><\/figure>\n<div class=\"media-attributions clear\" prefix:cc=\"http:\/\/creativecommons.org\/ns#\" prefix:dc=\"http:\/\/purl.org\/dc\/terms\/\"><h2>Media Attributions<\/h2><ul><li about=\"https:\/\/doi.org\/10.7717\/peerj.1462\"><a rel=\"cc:attributionURL\" href=\"https:\/\/doi.org\/10.7717\/peerj.1462\" property=\"dc:title\">fig-3-full<\/a>  &copy;  Vigotsky AD, Contreras B, Beardsley C.    is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY (Attribution)<\/a> license<\/li><li about=\"https:\/\/en.wikipedia.org\/wiki\/Sarcopenia#\/media\/File:1025_Atrophy.png\"><a rel=\"cc:attributionURL\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sarcopenia#\/media\/File:1025_Atrophy.png\" property=\"dc:title\">Private: Atrophy<\/a>  <a rel=\"dc:creator\" href=\"https:\/\/cnx.org\/contents\/FPtK1zmh@8.25:fEI3C8Ot@10\/Preface\" property=\"cc:attributionName\"><\/a>    is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY (Attribution)<\/a> license<\/li><li about=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=121093358\"><a rel=\"cc:attributionURL\" href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=121093358\" property=\"dc:title\">Exercise-induced_cardiac_growth_-_Cardiac_remodeling_from_Aerobic_and_Resistance_exercise<\/a>  &copy;  Kyle Fulghum, Bradford G. Hill    is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/\">CC BY-NC-SA (Attribution NonCommercial ShareAlike)<\/a> license<\/li><li about=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=29294587\"><a rel=\"cc:attributionURL\" href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=29294587\" property=\"dc:title\">Blausen_0166_Cardiomyopathy_Hypertrophic<\/a>  &copy;  Blausen Medical Communications    is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY (Attribution)<\/a> license<\/li><li about=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=15240004\"><a rel=\"cc:attributionURL\" href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=15240004\" property=\"dc:title\">Non-neoplastic_changes.svg<\/a>  &copy;  Dennis Hansen    is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY (Attribution)<\/a> license<\/li><li about=\"https:\/\/www.learnoncology.ca\/modules\/basic-oncology-principles\"><a rel=\"cc:attributionURL\" href=\"https:\/\/www.learnoncology.ca\/modules\/basic-oncology-principles\" property=\"dc:title\">5971147bf2f20018315cd3b0_figure-2[1]crop<\/a>       <\/li><li >Tumor_Types_MTK  &copy;  <a rel=\"dc:creator\" href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=117634562\" property=\"cc:attributionName\">WolfpackBME<\/a>    is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/\">CC BY-NC-SA (Attribution NonCommercial ShareAlike)<\/a> license<\/li><li about=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=658483\"><a rel=\"cc:attributionURL\" href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=658483\" property=\"dc:title\">Cancer_progression_from_NIH<\/a>      is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/publicdomain\/mark\/1.0\/\">Public Domain<\/a> license<\/li><li about=\"https:\/\/doi.org\/10.1038\/s41416-020-01149-0\"><a rel=\"cc:attributionURL\" href=\"https:\/\/doi.org\/10.1038\/s41416-020-01149-0\" property=\"dc:title\">Metastasis<\/a>  &copy;  Novikov, N.M., Zolotaryova, S.Y., Gautreau, A.M. et al    is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY (Attribution)<\/a> license<\/li><li about=\"https:\/\/www.mdpi.com\/2072-6694\/12\/5\/1265\"><a rel=\"cc:attributionURL\" href=\"https:\/\/www.mdpi.com\/2072-6694\/12\/5\/1265\" property=\"dc:title\">Metaplasia-Dysplasia-Lung-Modified-ZS<\/a>  &copy;  Ashraf-Uz-Zaman, M.; Bhalerao, A.; Mikelis, C.M.; Cucullo, L.; German, N.A.  adapted by  Zo\u00eb Soon  is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/\">CC BY-NC-SA (Attribution NonCommercial ShareAlike)<\/a> license<\/li><li about=\"https:\/\/kids.frontiersin.org\/articles\/10.3389\/frym.2022.615634\"><a rel=\"cc:attributionURL\" href=\"https:\/\/kids.frontiersin.org\/articles\/10.3389\/frym.2022.615634\" property=\"dc:title\">UV skin cancer<\/a>  &copy;  Breen I and Richmond J    is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY (Attribution)<\/a> license<\/li><li about=\"https:\/\/doi.org\/10.3390\/cells10030668\"><a rel=\"cc:attributionURL\" href=\"https:\/\/doi.org\/10.3390\/cells10030668\" property=\"dc:title\">HPVcervicalcancer<\/a>  &copy;  Causin, R.L.; Freitas, A.J.A.d.; Trovo Hidalgo Filho, C.M.; Reis, R.d.; Reis, R.M.; Marques, M.M.C.    is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY (Attribution)<\/a> license<\/li><li about=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=1420450\"><a rel=\"cc:attributionURL\" href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=1420450\" property=\"dc:title\">Cervix<\/a>  &copy;  Henry Vandyke Carter - Henry Gray (1918)    is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/publicdomain\/mark\/1.0\/\">Public Domain<\/a> license<\/li><li about=\"https:\/\/doi.org\/10.3390\/diagnostics12081838\"><a rel=\"cc:attributionURL\" href=\"https:\/\/doi.org\/10.3390\/diagnostics12081838\" property=\"dc:title\">Pap Test<\/a>  &copy;  Karasu Benyes, Y.; Welch, E.C.; Singhal, A.; Ou, J.; Tripathi, A. A    is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY (Attribution)<\/a> license<\/li><\/ul><\/div>","protected":false},"author":1370,"menu_order":6,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":["zoe-soon"],"pb_section_license":"cc-by-nc-sa"},"chapter-type":[],"contributor":[60],"license":[57],"class_list":["post-6259","chapter","type-chapter","status-web-only","hentry","contributor-zoe-soon","license-cc-by-nc-sa"],"part":3,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/6259","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/users\/1370"}],"version-history":[{"count":5,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/6259\/revisions"}],"predecessor-version":[{"id":6639,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/6259\/revisions\/6639"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/parts\/3"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/6259\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/media?parent=6259"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapter-type?post=6259"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/contributor?post=6259"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/license?post=6259"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}