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CPAT > Cancer 1 > Flashcards

Cancer 1 Flashcards

1
Q

T/F:

often the cause of death is the primary location of the tumor

A

False

E.g breast cancer= abnormal tissue can grow quite large, becomes a problem when it spreads to OTHER parts of the body

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2
Q

In cancer, why do cells grow in an uncoordinated manner?

A

They start to lose the capacity to talk to each other because they have suffered genetic damage

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3
Q

The cause of cancer is often from _____ damage

A

Genetic

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4
Q

T/F:

A malignant cancer is a cancer that has spread

A

False

A malignant cancer doesn’t have to have spread however it must have the CAPACITY to do so

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5
Q

Describe what a benign neoplasm of the breast may look like

A

o Differentiated epithelial cells arranged in distinctive glandular patterns
o Embedded in a dense fibrous connective tissue stroma
o It is demarcated from the surrounding tissues
Appearance= well demarcated, benign tumours just push aside adjacent tissue and can’t invade (usually), often have a capsule

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6
Q

There are 2 pieces of info you need to know when you want to classify a tumour
what are they?

A

Histogenesis= tissue of origin

Behaviour=benign or malignant?

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7
Q

T/F:

Benign tumours often have the suffix ‘sarcoma’

A

False
benign tumours often have the suffix ‘oma’
Malignant tumours often have the suffix carcinoma or sarcoma

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8
Q

T/F:

Melanoma is benign

A

False

despite ending in ‘oma’ it is very malignant

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9
Q

Why are epithelial tissues at risk of developing cancers?

A

Because they divide really quickly because they are usually in areas of high abrasion
- this causes risks for genetic mistakes

They are also often exposed to carcinogens e.g. the air

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10
Q

Which tissue do most neoplasms arise from?

A

Epithelial tissues

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11
Q

What are the types of tissues of origin?

A

One cell type- epithalial or mesenchymal

Mixed- more than one cell type

Teratogenous- totipotent cell s in gonads or embryonic cell rests

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12
Q

List some mesenchymal tissues

A

Connective
Muscle
Endothelial and related
Haemo(lympho)poetic

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13
Q

T/F:

Carcinomas and sarcomas are both MALIGNANT tumours that arise in epithelial tissue

A

False

both malignant BUT carcinoma is in epithelial tissues and sarcomas are in mesenchymal tissues

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14
Q

Where do teratogenous tumours arise?

A

In the gonads
90% in women are benign
90% in men are malignant

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15
Q

What is it meant when the cells in a cancer are arranged in a glandular pattern?

A

They are trying to arrange themselves around a lumen ie. attempting to form a gland

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16
Q

Often in squamous cell carcinoma of the skin, flattened cells on the inside are described as exhibiting keratin ‘pearls’. What does this mean?

A

They are attempting to produce keratin

Attempting to make skin inside of us

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17
Q

What is a naevus?

A

Freckle

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18
Q

What is a microcapillary haemangioma?

A

Blood vessels have proliferated
Results in a stain
Hamartoma

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19
Q

What is Hodgkin’s lymphoma?

A

Tumour of white cells
Enlarged, rubbery lymph nodes= lymphoma, (white cells are proliferating in the lymph nodes)

Solid malignant tumour of white cells that initially grows within lymph nodes

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20
Q

Where would a teratoma arise from?

A

Arises from a pluripotent stem cell

Stem cell differentiates into different types of sophisticated tissues

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21
Q

T/F:

often necrosis/haemorrhage is seen in benign tumours

A

False

absent

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22
Q

T/F:

Malignant tumours often have pleomorphic nuclei, increased/abnormal structure of mitoses and basophilic cytoplasm

A

True

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23
Q

T/F:

often necrosis/haemorrhage is seen in malignant tumours

A

True

prominent necrosis/haemorrhage

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24
Q

Why are malignant tumours poorly demarcated?

A

Because they invade surrounding tissue

poorly defined

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25
Q

T/F:

benign tumours have a faster growth rate than malignant tumours

A

False

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26
Q

T/F:

functional activity of the tissue containing a benign tumour is lost

A

False

often function and morphology is retained

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27
Q

What is anaplasia?

A

condition of cells with poor cellular differentiation, losing the morphological characteristics of mature cells and their orientation with respect to each other and to endothelial cells

POORLY DIFFERENTIATED

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28
Q

Benign tumours grow by ____ and malignant tumours grow by ___ and ___

A

Benign tumours grow by expansion and malignant tumours grow by expansion and invasion

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29
Q

T/F:

benign tumours often have a capsule

A

True

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30
Q

T/F:

Malignant tumours often have regular margins

A

False

often irregular

31
Q

T/F:

malignant tumours often have variable texture and colour, often due to haemorrhage and necrosis

A

True

32
Q

T/F

ulcers in benign tumours occur regularly

A

False

rarely occur

33
Q

Describe a malignant ulceration

A

tend to have rolled edges and tend to feel hard; are irregular in shape and may be irregularly indurated

34
Q

What is a polyp?

A

Tumour tissue protruding from the skin or from a mucosal surface

35
Q

Compare and contrast a polyp in benign and malignant tumours

A

Benign polyps: usually pedunculated (have a stalk) and have a uniform texture.

Malignant polyps: usually sessile (flat); may ulcerate & bleed; often have an indurated base

36
Q

Tumour cells often organise themselves into…..

A

organised into structures that resemble their tissue of origin, for example, glandular tumours often form glandular (acinar) tumour structures
• The more regular and ordered these structures, the less likely that they are malignant

37
Q

Compare and contrast arrangement of individual cells in benign vs malignant tumours

A

Benign: nuclei remain basal but usually enlarged, may be higher density of cells, but remain regularly related to each other, may be slight increase in mitotic rate with normal mitoses.

Malignant:

  1. Markedly enlarged central nuclei (loss of polarity and increase in nuclear:cytoplasmic ratio to greater than 50%), 

  2. Cells variable in size and shape (pleomorphic), and haphazardly arranged “don’t stand up straight” (loss of polarity), 

  3. Cells may become stratified into two or more layers. 

  4. Noticeably increased mitotic rate with abnormal mitoses. 

  5. Cells may become multinucleate. 

38
Q

What type of tumours are likely to retain the function of the tissue?

A

Benign and well differentiated malignant tumours

39
Q

What type of tumours are likely to lose the function of the tissue?

A

Anaplastic malignant tumours

poorly differentiated

40
Q

What are some typical cellular functions that may be affected by the presence of tumours?

A

(i) Synthesis of mucin: occurs in well differentiated adenocarcinomas but not in anaplastic adenocarcinomas 

(ii) Synthesis of keratin: may occur in abnormal locations (keratin pearls) or not at all in anaplastic tumours 

(iii) Synthesis of melanin: a primary melanoma usually is pigmented but occasionally a metastasis from a primary lesion may lose its pigmentation, suggesting more anaplastic change in that subclone of metastatic cells 


(iv) Synthesis of normal or abnormal hormones: the tumour may produce large amounts of normal or abnormal hormones, e.g.:

(a) phaeochromocytoma produces excess normal catecholamines (adrenalin & noradrenaline); many tumours may produce abnormal “hormones”

(b) tumour secretion of abnormal parathyroid hormone resulting in hypercalcaemia

41
Q

T/F:

benign tumours are very vascular

A 
False
very avascular (except a haemangioma)
42
Q

T/F:

necrosis and ulceration is common in malignant tumours and not in benign tumours

A

True

43
Q

What is desmoplasia and is it found in benign or malignant tumours?

A 
strong fibrous (collagenous) response 
Often seen in malignant tumours
44
Q

T/F:

Inflammatory responses are often seen around malignant tumours

A

True

45
Q

Why is the first cause of action to cure a cancer to surgically remove it rather than fix the cause?

A

The cause is often genetic damage

You can’t really fix this

46
Q

List some factors that increase the chance of metastasis

A

(1) The larger the tumour 

(2) The older the tumour 

(3) The less differentiated the tumour 

(4) Certain cell types are more likely to metastasise e.g. sarcomas (when patients present with a sarcoma usually > 50% already have metastases) 


47
Q

What is the first mechanism of metastasis?

A

Travelling through the lymphatic system

Lymphatics are designed to let cells come in and out= it is an express way to allow the cancer to go along the channel and go to a lymph node

48
Q

Breast cancer often spreads to ____ nodes

A

axillary

49
Q

What is reactive hyperplasia

A

Regional lymph nodes may initially enlarge due to the inflammatory response generated by a tumour (reactive hyperplasia), prior to tumour cell spread

Normal response

50
Q

What is the sentinal lymph node?

A

the first node in a regional lymphatic basin that receives lymph flow from the primary tumour. Radioactive or coloured tracers can be used to define sentinel nodes

51
Q

What is an adenocarcinoma?

A

a malignant tumour formed from glandular structures in epithelial tissue

52
Q

What is haematogenous spread? which type of cancer often uses this route?

A

Tumour cells infiltrate into blood vessels (post capillary venules) and spread through the circulation to a distant site. This mode of spread is typical of sarcomas. Tumour cells may form distant secondary deposits by passing through:


(a) the systemic veins and/or pulmonary arteries: usually end up in the capillaries of the lung,
(b) the portal veins: (i.e. from cancers of the 
stomach and bowel) usually end up in 
the liver, 

(c) the pulmonary veins and/or systemic 
arteries: (e.g. cancers of the lung) may end up anywhere in the body. 


53
Q

How do cancers that spread get to the liver?

A

Haematogenous spread through portal vein

54
Q

Malignant tumours may be well demarcated due to a ______

A

pseudo capsule

55
Q

T/F:
Malignant tumours may spread through the peritoneal cavity, pleural cavity, pericardial space, subarachnoid space
This type of spread is termed transcoelomic seeding across a body cavity

A

True

56
Q

What is pagetoid growth/spread?

A

Upward spread of abnormal cells from the epidermis

May spread via ducts e.g. paget’s disease of the nipple

57
Q

What is perineural spread?

A

Tumour cells may spread along a nerve in the perineural space. This may cause consider- able pain in the distribution of the nerve, which may require surgical ablation of the nerve

Cancer can get under the sheath and get onto the nerve
Not effective way of moving around, however can press on the nerve and cause ‘radikula’ pain
Common in prostate cancer

58
Q

What is implantation spread (aitrogenic)?

A

Cells may be “transplanted” by the surgeon’s knife (or other medical implements) to a second site.
This concept in part underlies the argument that a cancer should be resected at the time of surgical biopsy if a frozen section of the tumour shows malignancy e.g. surgical biopsy of a breast lump

59
Q

Describe the clonal theory of metastasis

A
  • Over a period of time malignant tumours tend to become more aggressive and acquire greater malignant potential - tumour progression 

  • Individual subclones of a malignant tumour progressively evolve 

  • The phenotypic attributes of these subclones include a greater ability to metastasise successfully 

60
Q

What qualities does tumour heterogeneity provide?

A

makes them more aggressive, more chance of spreading and survive to a bigger size

61
Q

What is the soil theory of metastasis?

A

Metastatic malignant cells may initially be dormant. The type of tissue the metastatic cell finds itself in may or may not allow the cells to grow: the soil theory of metastasis

o Prostatic carcinoma preferentially spreads to bone

o Bronchogenic carcinomas tend to involve the adrenals and the brain
o Neuroblastomas spread to the liver and bones
On the other hand metastasis is rare in skeletal muscle and less common in the spleen

Cancers tend to home into particular tissues- Why??

62
Q

T/F:

Patterns of metastasis correspond with relative volumes of vascular bed or relative proportional blood flow

A

False
Does not correspond
ie. rare to see metastasis to the skin and skeletal muscle

63
Q

Why are some cancers more deadly than others?

A

Late diagnosis
Difficult to treat at this point in time
ie. lung, pancreas, brain, liver

64
Q

T/F:

There are higher rates of cancer in men than women

A

True

Differences may be due to smoking rates, workplace exposure to carcinogens

65
Q

List some reasons for increased survival over the last decade

A
  • Improved treatments
  • Early diagnosis
  • Awareness
  • Screening
    (brain cancer hasn’t improved much because it’s difficult to diagnose and treat)
66
Q

The observed geographic differences in cancer are almost certainly due to _____

A

environmental influences

67
Q

List some environmental and cultural elements that may increase rates of cancer

A

Smoking is related to certain jobs and is associated with cancers of the mouth, larynx, oesophagus, pancreas, bladder and cervix. 

Alcohol abuse increases risk of carcinomas of larynx, oesophagus and, by the development of alcoholic cirrhosis, hepatocellular carcinoma. 

Obesity in the US increases the risk of cancer by about 50-60% 

Asbestos exposure in miners, pipe laggers etc. can cause mesothelioma of the pleura.


Metal exposure increases a range of cancers:
• Arsenic – lung, skin, haemangiosarcoma (smelting, electricals, herbicides) 

• Beryllium – lung (aerospace light weight metals) 

• Cadmium - prostate (batteries, metal 
platings, some solders) 

• Chromium & nickel – lung (metal alloys, paints, ceramics and batteries) 


68
Q

Why are cancers often found more in older age groups?

A

Cells have had more time to undergo genetic mutations
Decreased immunity as you age
Longer time exposed to low levels of carcinogens

69
Q

T/F:

All forms of radiation are carcinogenic

A

True

70
Q

T/F:

Radiation damaged cells are more susceptible to other carcinogens

A

True

71
Q

T/F:

Rapidly dividing cells are less susceptible to radiation damage

A

False

More susceptible

72
Q

Why do some chemicals cause cancer?

A

They cause cell damage because they are highly reactive electrophiles that remove electrons from DNA, RNA or proteins.

73
Q

What are the two stages that result in chemicals causing cancer?

A

Intiation:
• The first chemical carcinogen causes permanent DNA damage 

• Mutation is “remembered” but will not of itself cause neoplastic change 

• Only requires a single exposure to the initiator 


Promotoion:
• A second chemical carcinogen causes reversible damage to the initiated cell, which induces 
neoplastic change; usually requires multiple exposures to the promoter 


CPAT (9 decks)

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