Tumour spreads from site of origin to distant sites >> 2 tumour. -systemic disease

Transmembrane proteins. >> cell to cell adhesion

Behaviours of Tumours Flashcards by Eleanor Barnard

What are the main characteristics of malignant tumours? (3)

Invasion
Metastasis
Angiogenesis

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What is invasion?

Tumour invades adjacent tissue and destroys it.

-local disease

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What is metastasis?

Tumour spreads from site of origin to distant sites&raquo_space; 2* tumour.
-systemic disease

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What proportion of metastases lead to death?

50%.

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What causes invasion? (3)

Increased motility
Decreased adhesion
Proteolytic enzyme production

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What are Cadherins?

Transmembrane proteins.

|&raquo_space; cell to cell adhesion

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What does a mutation of E-cadherin lead to?

Loss of cell-cell adhesion and contact inhibition.

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What are integrins?

Proteins that attach cells to extra-cellular matrix.

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What does a change in integrin expression lead to?

Decreased cell-matrix adhesion.

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What are the main properties of epithelial cells? (3)

Tightly connected
Polarised
Restricted movement

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What are the main properties of mesechymal cells? (2)

Loosely connected

- Able to migrate

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What happens to cancer epithelial cells that enables them to have an increased motility?

Epithelial-Mesenchymal properties.

cancer epithelial cells gain mesenchymal properties.
can invade and migrate

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What are metalloproteinases?

Proteolytic enzymes.

|&raquo_space; break down proteins / degrade ECM

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What type of proteolytic enzyme breaks down collagen types I-III?

Interstitial collagenases.

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What type of proteolytic enzyme breaks down collagen type IV and gelatin?

Gelatinases.

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What type of proteolytic enzyme breaks down collagen type IV and proteoglycans?

Stomolysins.

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Proteolytic enzymes; how are they regulated in normal tissues?

Matrix metalloproteinases = tissue inhibitors of metalloproteinases.

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Why do proteolytic enzymes favour ECM breakdown in cancer?

Matrix metalloproteinases > tissue inhibitors of metalloproteinases.

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How do tumours cause mechanical pressure?

Uncontrolled proliferation&raquo_space; mass.

-pressure occludes vessels / tissues

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What are the main metastatic routes of spread? (4)

Lymphatic
Blood
Transcoelomic
Implantation

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What is transcoelomic spread?

Spread across peritoneal / pleural / pericardial cavities, or in CSF.

What is implantation?

Spread of tumour during biopsy / surgery.

What are the main sites that tumours spread to in the blood?

Liver
Lungs
Brain
Bone

Via what route do carcinomas normally spread first?

Lymphatic spread.

Via what route do sarcomas normally spread first?

Blood.

Where do bone metastases tend to originate from?

``` Breast Prostate Lung Kidney Thyroid ```

What are the main types of bone metastases? (2)

- Lytic (lung) | - Sclerotic (prostate)

Where do transcoelomic metastases often originate from?

Ovaries.

Where do lung tumours often metastasise to?

Brain | Adrenal

What is thought to affect sites of metastases?

Tissue environment. | -different tissues are more susceptible

What is angiogenesis?

Formation of new blood vessels. | -essential if metastases are to grow > 1-2mm

An increase in what type of molecule causes angiogenesis?

Promoters.

What type of cells produced promoters >> angiogenesis? (3)

- Tumour cells - Stromal cells - Inflammatory cells

What are the main promoters produced >> angiogenesis? (3)

- VEGF - PDGF - TGF-beta

What normally prevents angiogenesis?

Inhibitors.

What are the main inhibitors that prevent angiogenesis?

- ECM PROTEINS - thrombospondin - Canstatin - Endostatin

What is stage?

How advanced a tumour is. | -whether it has spread, and to what extent

What is grade?

How aggressive a tumour is. - how different it looks from tissue of origin - how fast it develops

What staging system is generally used?

TMN staging (I-IV). - Tumour, Metastasis, Node - differs for each organ

TMN; what does T stand for?

Tumour. | -size +/- extent of 1* tumour

TMN; what does M stand for?

Metastases. | -presence and extent

TMN; what does N stand for?

Nodes. | -presence and number of lymph node metastases

What are the T stages for breast cancer?

``` Tis = in situ T1 = 5cm T4 = involving skin/chest wall ```

What are the M stages for breast cancer?

``` M0 = no distant metastases M1 = distant metastases ```

What are the N stages for breast cancer?

``` N0 = no nodes N1 = ipsilateral nodes N2 = >node involvement ```

What are the simplified stages of breast cancer?

``` 0 = Tis I = T1, N0, M0 II = T1-2 + M1 or T3 III = T(any) + N2, or T4 IV = T(any), N(any), M1 ```

What type of cancer uses Dukes staging?

Colorectal cancer.

What are the Dukes stages? (4)

A - invades into bowel wall B - invades through bowel wall, but no lymph nodes metastases C - local lymph nodes D - distant metastases

What is the 5 year survival for Dukes staging?

``` A = >90% B = 70% C = 30% D = 5-10% ```

What are the main components of grading? (4)

- Differentiation (from tissue of origin) - Nuclear polymorphism and size - Mitotic activity - Necrosis