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Pathological Processes > 8. Neoplasia 1 & 2 > Flashcards

8. Neoplasia 1 & 2 Flashcards

1
Q

Define neoplasia

A

An abnormal growth of cells that persists after initial stimulus is removed

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2
Q

Define dysplasia

A

Abnormal maturation of cells within a tissue - disordered. Preneoplastic.

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3
Q

What is a malignant neoplasm?

A

Cancer - abnormal growth of cells that persists after initial stimulus is removed…and invades surrounding tissue with potential to spread to distant sites.

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4
Q

What is the difference between a benign neoplasia and a malignant neoplasm?

A

Benign remain at site of origin

Malignant have metastasise potential

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5
Q

What does anaplastic mean and when is it seen?

A

No resemblance of tissue, in very poorly differentiated cancers cells.

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6
Q

How would you expect a benign neoplasm to look macroscopically?

A

Pushing outer margin

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7
Q

How would you expect a malignant neoplasm to look macroscopically?

A

Irregular outer margin
Ulceration
Necrosis

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8
Q

How would you expect benign and malignant tumours to differ microscopically?

A

Benign - well-differentiated

Malignant - worsening differentiation, anaplasia

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9
Q

What is an in situ malignancy, how does it differ from invasive?

A

In situ = no invasion of basement membrane

Invasive = penetrated basement membrane

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10
Q

What does the grade of a tumour measure?

A

Differentiation

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11
Q

What 3 things are considering when determining the grade of a tumour?

A

Nuclear size
Nuclear:cytoplasmic ratio
Mitotic figures

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12
Q

What will a high grade tumour look like?

A 
Poorly differentiated.
Large nuclei
High NC ratio
Hyperchromasia (increased nuclear staining)
More mitotic figures
Pleomorphic
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13
Q

What is another name for mutagenic agents.

A

Initiators

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14
Q

In addition to initiators, what else is required to cause neoplasia?

A

Promotors over a period of time

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15
Q

What type of expansion is seen in neoplasia?

A

Monoclonal - from same founding cell

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16
Q

Why might some mutations have no effect?

A

Non-coding regions, unimportant genes

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17
Q

What is an example of an internal promotor?

A

Inflammation

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18
Q

What is progression?

A

The accumulation of further mutations which leads to the emergence of a neoplasm from monoclonal population

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19
Q

Which genes become abnormally activated in neoplasms?

A

Proto-oncogenes

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20
Q

Which genes become inactivated in neoplasms?

A

Tumour suppressor genes

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21
Q

Which genes only require one allele to be affected in order to promote neoplasia?

A

Proto-oncogenes - one allele activate will be enough to drive the cell cycle and promote growth

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22
Q

If one allele of a TSG is mutated, what effect will it have?

A

None. Both alleles must be inactivated in order to result in increased growth.

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23
Q

What is an adenoma?

A

benign glandular neoplasm

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24
Q

What is a papilloma?

A

Benign neoplasm of squamous epithelium- skin and mucosa

Finger-like projections

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25
Q

What is an adenocarcinoma?

A

Cancer of glandular tissue

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26
Q

What 3 steps must a tumour go through in order to metastasise?

A
  1. Grow and invade at primary site
  2. Enter a transport system and lodge at a secondary site
  3. Grow at the secondary time to form a new tumour
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27
Q

Explain why the process is inefficient?

A

Many cancer cells are destroyed in the blood stream by shear forces while others reach the secondary site but are unable to grow there.

28
Q

What 3 important alterations are needed for tumour invasion?

A
  1. Altered adhesion
  2. Altered proteolysis
  3. Altered motility
29
Q

What is the name given to the process which changes a carcinoma phenotype to appear like a mesenchymal cell?

A

Epithelial-to-mesenchymal transition (EMT)

30
Q

Explain how adhesion alters in a cancer cell to promote metastases.

A

Reduction in E-cadherin expression (cell-cell) and changes in integrin expression (to stroma)

31
Q

Which protease is expressed by cancer cells to degrade basement membranes and stroma?

A

Matrix metealloproteinases (MMPs)

32
Q

What is a cancer ‘niche’ and how can it be advantageous to the cancer cells?

A

The cancer cells take advantage of nearly non-neoplastic cell types which produce some growth factors and proteases.

33
Q

What protein is involved in increasing motility of cancer cells?

A

Actin

34
Q

What are the 3 transport routes for cancer cells?

A
  1. Blood vessels via capillaries and venues
  2. Lymphatic vessels
  3. Transcoelomic spread in body cavities - pleura,peritoneal,pericardial
35
Q

What is colonisation?

A

Growth at a secondary site to form a metastasis.

36
Q

What are micro-metastases and why are they significant?

A

Surviving microscopic deposits of cancer cells that fail to grow at secondary site, are sub-clinical and not detected in scans.
= tumour dormancy, can initiate relapse years later

37
Q

What 3 factors are thought to help micro-mets remain dormant?

A

Immune attack
Reduced angiogenesis
Hostile secondary site

38
Q

What 2 theories are there which explain the secondary site of a metastasis?

A
  1. Regional drainage

2. ‘Seed and soil’ phenomenon

39
Q

According to regional drainage, where are blood-borne metastasis likely to spread to?

A

The next capillary bed that the cells encounter - lung and liver

40
Q

According to regional drainage, where are lymphatic metastasis likely to end up?

A

Local lymph nodes

41
Q

Where are cancers that spread by transcoelemic spread likely to end up?

A

Other areas in the coelomic space or adjacent organs

42
Q

What is the ‘seed and soil’ phenomenon?

A

The site of metastasis is due to interaction between malignant cells and the local tumour environment (niche) at the secondary site.

43
Q

Which cancers spread to lymphatics first?

A

Carcinomas

44
Q

Which cancers spread via the blood stream?

A

Sarcomas

45
Q

What are the common sites of blood borne metastasis?

A

Lung, bone, liver and brain

46
Q

Which neoplasms most frequently metastasise to bone?

A

Thyroid, Kidney, Lung, Prostate and breast

47
Q

Which type of lung cancer is very aggressive and tend to metastasise very early?

A

Small cell bronchial carcinoma

48
Q

Which skin cancer almost never metastasises?

A

Basal cell carcinoma

49
Q

What are the local effects of neoplasms (both benign and malignant)?

A
  • Pressure/compression
  • Invasion and destruction
  • Ulceration and bleeding
  • Obstruction/blocking of tubes and orifices
50
Q

What are paraneoplastic syndromes?

A

Systemic effects of neoplasms

51
Q

What are the main categories of systemic effects of neoplasms?

A
  • Tumour burden
  • Endocrine
  • Haematological
  • Neurological
  • Dermatological
  • General
52
Q

What is tumour burden?

A

Increased number of cancer cells results in increased number of metabolically active cells and has a parasitic effect on the host.

53
Q

What symptoms can an increased tumour burden lead to?

A

reduced appetite, cachaxia, malaise, immunosuppression, thrombosis

54
Q

Which tumours typically produce hormones?

A

Benign neoplasms of endocrine glands as they are well differentiated

55
Q

Give an example of a malignant tumour that is known to secrete hormones.

A

Bronchial small call carcinoma may secrete ACTH and ADH

56
Q

What is exophytic growth?

A

Growth outwards e.g protruding into lumen

57
Q

What is endophytic growth?

A

Growth inwards e.g proliferating in the interior of an organ

58
Q

Why are polyps removed?

A

tend to benign adenoma’s initially but demonstrate dysplastia so can accumulate mutations to progress to a carcinoma.

59
Q

What is a common tumour of the uterus smooth muscle cells of the myometrium?

A

Fibroid

60
Q

At what age do osteosarcoma’s commonly present?

A

Teenagers (<20)

61
Q

What is a teratoma, why does it contain such a range of tissues?

A

Germ cell tumour - arises from all 3 germ cell lines: ectoderm, endoderm and mesoderm.

62
Q

How do ovarian and testicular teratomas behave differently?

A

Ovarian tend to be benign, testes tend to be more malignant

63
Q

What are common tumours of soft tissue?

A

Lipomas and leiomyomas

64
Q

What are malignant tumours of soft tissue referred to as?

A

Sarcomas

65
Q

Which organ is recognised as a site of metastasis from gastric cancer?

A

Ovaries

66
Q

What hormone can testicular teratomas produce?

A

HCG

Pathological Processes (12 decks)

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