9_Neoplasia

Question 1

neoplastic cells:

define, regulation

Answer 1

• def: Transformed cells as they continue to replicate
• regulation
  
  • Certain degree of autonomy
  • Oblivious to regulatory influences that control normal growth

Question 2

neoplasm/neoplasia:

define, growth, regulation

Answer 2

• define: an abnormal mass of tissue,
• growth of which is uncoordinated with that of normal tissues,
• regulation:
  
  • persists in the same excessive manner after the cessation of the stimulus which evoked the change
  • with the loss of responsiveness to normal growth controls

Question 3

tumor:

other name; & benign vs malignant

Answer 3

• commonly used to refer to neoplasms
• types based on clinical behavior:
  
  • Benign: Relatively innocent,
    
    • implying that it will remain localized and is amenable to local surgical removal
  • Malignant: “Cancers”,
    
    • implies that the lesion can invade and destroy adjacent structures and spread to distant sites

Question 4

basic components of tumor:

define parenchyma and stroma

Answer 4

• Parenchyma: proliferating neoplastic cells
• Stroma: supportive tissue composed of connective tissue and blood vessels

(These 2 interact)

Question 5

desmoplasia:

define

Answer 5

a¡dense collagenous stromal reaction to invasive tumor

Question 6

nomenclature of benign tumors:

suffix, mesenchymal, and epithelial

Answer 6

Question 7

describe the presentation of the following benign tumors:

adenoma

papilloma

cystadenoma

Answer 7

• adenoma - glandular pattern (shows glands histologically)
• papilloma - finger-like or warty surface projections
• cystadenoma - tumors forming large cystic masses

Question 8

define:

hyperchromasia

dysplasia

Answer 8

• hyperchromasia: dark staining nuclei which is usually due to increased DNA content.
• dysplasia: abnormal development of cells within tissues or organs

Question 9

polyp:

histology; term is assoc. w/ which tumors?

Answer 9

• Macroscopically visible projection above the mucosal surface
• Preferably restricted to benign tumors; malignant ones better designated as polypoid carcinomas

Question 10

nomenclature of malignant tumors

origin, mesenchymal, epithelial

Answer 10

• Organ of origin is usually specified
• Undifferentiated
• Mesenchymal: sarcomas
• Epithelial cell origin: carcinomas
  
  • Adenocarcinoma (glandular pattern)
  • Squamous carcinoma (Squamous cells)

Question 11

mixed tumors:

define

Answer 11

derived from divergent differentiation of a single line of parenchymal cells from a single germ cell layer

• Pleomorphic adenoma

Question 12

teratomas:

define

Answer 12

composed of cell types from multiple germ cell layers

Question 13

name the benign and malignant names for the following:

Answer 13

Question 14

what are the benign and malignant names for the following?

Answer 14

Question 15

match the benign and malignant name for the following tissues of origin

Answer 15

Question 16

non-neoplastic masses are sometimes confused w/ neoplasms:

what are the following?

1. ectopic rest of normal tissue
2. mass of disorganized but mature specialized cells or tissue indigenous to the particular site
3. localized collection of blood in tissues or a body

Answer 16

1. Choristoma: ectopic rest of normal tissue
2. Hamartoma: mass of disorganized but mature specialized cells or tissue indigenous to the particular site
3. Hematoma: localized collection of blood in tissues or a body

Question 17

what are the 4 fundamental features by which benign and malignant tumors can be distinguished?

Answer 17

1. differentiation and anaplasia
2. rate of growth
3. local invasion
4. metastasis

Question 18

differentiation:

• define,*
• benign vs. malignant*

Answer 18

—extent to which neoplastic cells resemble comparable normal cells, morphologically and functionally

• Benign tumors are usually well differentiated
• Malignant tumors range from well to undifferentiated

Question 19

which type of tumor cells are typically WELL-DIFFERENTIATED?

Answer 19

benign cells are usually well differentiated

(meaning they well-differentiated cancer cells look more like normal cells and tend to grow and spread more slowly than poorly differentiated or undifferentiated cancer cells)

Question 20

anaplasia:

• define*
• morphological changes*

Answer 20

• the lack of differentiation; hallmark of malignancy
  
  • malignant tumors are typically UNDIFFERENTIATED
• morphologic changes
  
  • (Pleomorphism) variation in cell size and shape
  • Atypical, bizarre mitotic figures
  • Loss of polarity
  • Nuclear changes
    
    • Hyperchromasia
    • Increased nuclear/cytopasmic ratio
    • Variable nuclear shape
    • Coarse, clumped or unevenly distribute chromatin
    • Large/ multiple nucleoli

Question 21

dysplasia:

where does this occur, characterized by?

Answer 21

• encountered principally in epithelium
• considered PRE-MALIGNANT
• characteristics:
  
  • loss in uniformity of individual cells
  • loss in architectural orientation

Question 22

Carcinoma in-situ:

define, and progression?

Answer 22

• dysplasia in which the changes involve the entire thickness of the epithelium (pre-invasive)
• does not necessarily progress to invasive cancer

Question 23

rate of growth:

benign tumors

Answer 23

• Nearly all grow as cohesive expansile masses that remain localized to their site of origin
  
  • Lack capacity to infiltrate, invade or metastasize
• Usually develop a fibrous capsule
  
  • Remain discrete, readily palpable and easily moveable
• Enucleated surgically

Question 24

rate of growth:

malignant tumors

Answer 24

• Growth is accompanied by progressive infiltration, invasion and destruction of surrounding tissues
• Lack a well-defined boundary
• Invasion is reliable in distinguishing benign from malignant

Question 25

**local invasion:** define, characteristics

Answer 25

* A benign neoplasm **remains localized at its site of origin** * Cancers grow by progressive infiltration, invasion, destruction and penetration of surrounding tissue.

Question 26

**metastasis:** *define, progression*

Answer 26

* Secondary implants of tumor discontinuous with the primary tumor * Unequivocal sign of malignancy * With few exceptions, all cancers can metastasize * Strongly reduces chance for cure

Question 27

**metastasis:** **3 different pathways**

Answer 27

* Direct seeding of body cavities or surfaces * Lymphatic spread * Usually follows natural route of drainage * Typical for carcinomas, but also in sarcomas * Sentinel node * Hematogenous * Typical for sarcomas but also in carcinomas * Usually venous, most frequently to liver and lung

Question 28

compare benign and malignant in the following categories: * **differentiation/anaplasia** * **rate of growth** * **local invasion** * **metastasis**

Answer 28

Question 29

what is the significance of cancer epidemiology?

Answer 29

* Cancer epidemiology **can contribute significantly to knowledge about the origin of cancer** * Major insights into the cause of cancer can be obtained by epidemiologic studies that relate: * particular environmental, * racial and cultural influences to the occurrence of specific neoplasms.

Question 30

4 key factors affecting incidence of cancer:

Answer 30

* Geographic and Environmental * Age * Heredity * Acquired pre-neoplastic disorders

Question 31

**heredity**: 3 different types of heredity

Answer 31

* **inherited cancer syndromes**: Inheritance of a single mutant gene greatly increases the risk of developing neoplasm * E.g. Retinoblastoma in children * **familiar cancer**: all common types of CA occur in familial form; familial cancer usually have unique features. * starts at early age, multiple/bilat, 2+ relatives * e.g. breast, colon, ovary, brain * **autosomal recessibe syndromes of defective DNA repair** * DNA instability; * small group of autosomal recessive disorders

Question 32

**acquired preneoplastic disorders**:

Answer 32

* Some Clinical conditions that predispose to cancer * Dysplastic bronchial mucosa in smokers --\> lung carcinoma * Atypical endometrial hypeplasia --\> endometrial carcinoma * Liver cirrhosis --\> liver cell carcinoma * Margins of chronic skin fistula --\> squamous cell carcinoma

Question 33

describe the **histologic grading of cancer**

Answer 33

* Based upon the degree of tumor differentiation * Classified as grades I to IV, well to poorly differentiated * Criteria within each tumor type varies * Generally, the higher the grade, the more aggressive the tumor

Question 34

how is cancer staged?

Answer 34

* Much more clinically significant * In US, commonly use the system developed by the American Joint Committee on Cancer Staging (AJCC) * Employs the TNM classification system to categorize the cancer into stages 0 to IV * **T for the tumor characteristics,** usually size * **N for lymph node** metastasis * **M for distant metastasis** * Plays a significant role in selecting the best form of therapy for the patient