Behaviour of Tumours (22)

Question 1

Invasion (Local disease)

Answer 1

Invades adjacent normal tissue, destroys normal tissue (Increased motility, decreased adhesion, production of proteolytic enzymes)

Question 2

Metastasis (Systemic disease)

Answer 2

Spreads from site of origin to distant sites and forms new tumours in these areas

Question 3

Less adhesion/more motility

Answer 3

Mutations of E-cadehrin leads to loss of cell-cell adhesion and contact inhibition, changes to integrin expression lead to decrease cell-matrix adhesion, epithelial-mesenchymal transition

Question 4

Proteolytic enzymes

Answer 4

Matrix metalloproteinases - degrade extracellular matrix e.g. Interstitial collagenases, gelatinases, stomolysins

Question 5

Mechanical pressure

Answer 5

Uncontrolled proliferation forms mass, pressure occludes vessels, pressure atrophy, spread along lines of least resistance

Question 6

Metastasis

Answer 6

Often the presenting tumour, often worse than primary, unknown primary site, early/late relapse, increased metabolic demand (cachexia)

Question 7

Metastasis routes

Answer 7

Lymphatic, blood (liver, lungs, bone, brain), transcoelomic, implantation

Question 8

Metastasis stages

Answer 8

1. Intravasation
2. Detachment invasion
3. Survival against host defences
4. Adherence extravasation
5. Growth

Question 9

Carcinomas and metastasis

Answer 9

(Epithelial cells) Lymphatic spread first

Question 10

Sarcomas and metastasis

Answer 10

(Mesenchymal) Blood spread first

Question 11

Patterns of metastasis

Answer 11

Bone mets - breast, prostate, lung, kidney, thyroid

Transcoelomic - ovarian

Brain and adrenal - lung

Question 12

Bone metastases

Answer 12

Lytic - spaces in bone (lung)

Sclerotic - dense (prostate)

Question 13

Seed and soil hypothesis

Answer 13

Stephen Paget, seeds only live and growth if they fall on congenial soil

Question 14

Angiogenesis

Answer 14

Derives from existing vessels, role in development - healing, essential if metastases are to grow larger than 1-2mm

Question 15

Promoters of angiogenesis

Answer 15

VEGF (tumour cells), PDGF (stromal cells), TGFB (inflammatory cells)

Question 16

Inhibitors of angiogenesis

Answer 16

ECM proteins, thrombospondin, canstatin, endostatin

Question 17

Stage

Answer 17

How advanced? How it spread and to what extent

Question 18

Grade

Answer 18

How aggressive/fast? Differentiation

Question 19

Staging TMN

Answer 19

Tumour (size and extent)
Metastases (presence and extent)
Nodes (presence and number)

Question 20

Breast cancer staging T

Answer 20

Tis in-situ disease
T1 5cm
T4 Involving skin/chest wall

Question 21

Breast cancer staging N

Answer 21

N0 No nodes
N1 Ipsilateral nodes
N2 >Node involvement

Question 22

Breast cancer staging M

Answer 22

M0 No distant mets

M1 Distant mets

Question 23

Dukes Staging is for what?

Answer 23

Colorectal cancer

Question 24

Dukes staging for colorectal cancer

Answer 24

A= invades into, not though bowel wall
B = invades through bowel wall but with no lymph node metastases
C = local lymph nodes involved
D = distant metastases

Question 25

Grading

Answer 25

Differentiation, nuclear pleomorphism and size, mitotic activity, necrosis (subjective)

Question 26

Grade 1

Answer 26

Near normal (well-differentiated)

Question 27

Grade 4

Answer 27

Far from normal (poor-differentiated)