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2a - pathology lectures > cancer > Flashcards

cancer Flashcards

1
Q

define a tumour

A

any abnormal swelling

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2
Q

define a neoplasm

A

a new lesion resulting from the abnormal growth of cells which persists after the initiating stimulus has been removed

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3
Q

list 6 key features of a neoplasm

A
  • autonomous (not normally controlled, can grown on its own regardless of hormones)
  • abnormal
  • removing the stimulus won’t stop its growth (eg. stopping smoking won’t make it go away)
  • new
  • persistent
  • made of neoplastic cells and stroma
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4
Q

what are the 3 types of neoplasm (behavioural classification)

A

bening

borderline eg. looks benign but behaves malignant

malignant

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5
Q

how do benign and malignant neoplasms differ in terms of their:

  • invasiveness
A

benign - does not invade the BM

malignant - does invade the BM and has the potential to spread around the body (metastases)

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6
Q

how do benign and malignant neoplasms differ in terms of their:

  • growth
A

benign - Grows upwards and outwards (exophytic) and has a slower growth rate (and slow mitotic activity)

malignant - Grows inwards (endophytic) and rapidly (high mitotic activity)

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7
Q

how do benign and malignant neoplasms differ in terms of their:

  • resemblance to normal tissue
A

benign - often look similar to normal tissue

malignant - Variable resemblance to normal tissue . The less it resembles it, the worse the prognosis (higher grade neoplasm)

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8
Q

how do benign and malignant neoplasms differ in terms of their:

  • confinement to a limited area
A

benign - often well circumscribed or encapsulated

malignant - poorly circumscribed, poorly defined border therefore difficult to remove it all

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9
Q

how do benign and malignant neoplasms differ in terms of their:

  • necrosis and ulceration likelihood
A

benign - rare (because grows slowly)

malignant - common (because grows rapidly, outgrows its blood supply)

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10
Q

how do benign and malignant neoplasms differ in terms of their:

  • nuclei
A

benign - normal

malignant - darker than normal (hyper-chromatic) and vary in shape (pleomorphic)

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11
Q
  • risk of causing morbidity and mortality
A

both can

benign - exert pressure on adjacent structures and obstruct flow. can produce hormones eg. hyperthyroidism and can become malignant

malignant - destroy adjacent tissue, metastases, obstruct flow, produce hormones, have paraneoplastic effects

both can cause anxiety

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12
Q

histogenic classification of neoplasms:

what are the 3 broad types of cells the body is made up of and can have cancers ?

A

Epithelial cells
Connective tissues
Lymphoid

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13
Q

histological grading :

what are the 3 different grades a tumour can be ?

A

Grade 1 – Well differentiated (most closely resembles parent tissue)

Grade 2 – Moderately differentiated

Grade 3 – Poorly differentiated

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14
Q

how do you name a benign epithelial tumour?

A

prefix - cell type of origin

suffix - papilloma or adenoma

eg. squamous cell papilloma , colonic adenoma

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15
Q

what is the difference between a papilloma and adenoma?

A

Papilloma: benign tumour of non-glandular epithelium.

Adenoma: benign tumour of glandular epithelium,

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16
Q

how do you name a malignant epithelial tumour?

A

prefix - cell type of origin + Adeno if glandular

suffix - carcinoma

eg. urothelial carcinoma

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17
Q

define a carcinoma

define a sarcoma

A

carcinoma = malignant tumour of epithelial cells

sarcoma= Malignant connective tissue neoplasm.

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18
Q

how do you name a benign connective tissue tumour?

A

prefix - cell origin

suffix - oma

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19
Q

how do you name a malignant connective tissue tumour?

A

prefix - cell origin

suffix - sarcoma

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20
Q

naming connective tissue tumours:

  • name a benign and malignant tumour of adipocytes
A

benign - lipoma

malignant - liposarcoma

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21
Q

naming connective tissue tumours:

  • name a benign and malignant tumour of striated muscle
A

benign - rhabdomyoma

malignant - Rhabdomyosarcoma

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22
Q

naming connective tissue tumours:

  • name a benign and malignant tumour of smooth muscle
A

benign - Leiomyoma

malignant - Leiomyosarcoma

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23
Q

naming connective tissue tumours:

  • name a benign and malignant tumour of cartilage
A

benign - chondroma

malignant - chondrosarcoma

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24
Q

naming connective tissue tumours:

  • name a benign and malignant tumour of bone
A

benign - osteoma

malignant - osteosarcoma

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25
Q

naming connective tissue tumours:

  • name a benign and malignant tumour of blood vessels
A

bengin - angioma

malignant - angiosarcoma

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26
Q

what is staging?

A

further classification of neoplasms

Measures level of tumour spread throughout body

Example: TNM (Tumour, Node, Metastasis) staging

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27
Q

what is it called when the cell type of origin of the tumour is unknown?

A

anaplastic tumour

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28
Q

how do you name a malignant tumour of lymphoid tissue?

A

lymphomas

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29
Q

how do you name a malignant tumour of haemopoietic tissue?

A

leukaemia

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30
Q

list some exceptions to the naming of tumour rules:

A
  1. there are some -omas that are not neoplasms eg. granulomas
  2. not all malignant tumours are carcinomas/sarcomas eg. melanoma (malignant neoplasm of melanocytes)
  3. some are eponymously named eg. burkitts lymphoma
  4. teratomas - neoplasms contains tissues from all 3 embryological layers
  5. mixed tumours
  6. carcinosarcomas - both epithelial and stromal element are malignant
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31
Q

what is a carcinoma in situ?

A

a malignant epithelial neoplasm that has not yet invaded through the original basement membrane

BM is intact

can treat by removal

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32
Q

what is an invasive carcinoma?

A

a carcinoma that has breached the basement membrane – it can now spread elsewhere

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33
Q

what is a Micro-invasive carcinoma:

A

carcinoma has breached the basement membrane but hasn’t invaded very far away from the original carcinoma

Pragmatic term to use when it has invaded but not very far

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34
Q

what is the difference between invasion and metastasis ?

A

invasion is the initial spreading of a malignant neoplasm to nearby tissues

metastasis is the process by which a malignant tumour spreads from its primary site to produce secondary tumours at distant sites. It happens after invasion, breaking off from primary tumour to spread further and establish secondary tumours

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35
Q

what are the 8 main steps in the metastatic cascade?

A

Detachment

Invasion

Intravasation (getting into vessels or lymphs to spread by)

Evasion of host defences (within vessels, avoids WBCs)

Arrest

Extravasation - leaving vessel

Growth at metastatic site

Vascularisation

36
Q

what are some factors that aid the metastatic cascade ?

A

Abnormal cell motility

uses proteases to get through collagen of BMs

Use aggregation with platelets, shedding of surface antigens and adhesion to other tumour cells in order to evade host immune response

Growth factors to help growth at new site

37
Q

what is angiogenesis? when does it happen?

A

formation of new blood vessels

After Metastatic cascade, the tumour is at a new metastatic site
It starts to grow
Once the tumour reaches 1 mm in diameter, it begins to grow its own blood vessels (angiogenesis).

38
Q

what are the different routes of metastasis that can be taken?

A
  1. Haematogenous - spread via the blood stream
  2. lymphatic - spread via lymph channels
  3. Trans-coelomic – spread through the pericardial and peritoneal cavities
39
Q

which tumours commonly metastasis to the lungs?

A

any common cancer

40
Q

which tumours commonly metastasis to the liver?

A

colon,
stomach,
pancreas,
carcinoid tumours of intestine

41
Q

which tumours commonly metastasis to the bone?

A

Breast
Lung
Thyroid
Kidney
Prostate

(BLT KP)

42
Q

define Carcinogenesis

A

= the transformation of normal cells to neoplastic cells (mostly malignant) through permanent genetic alterations or mutations.
is a multistep process

43
Q

define Oncogenesis

A

Oncogenesis = formation of a tumour which could be benign or malignant

44
Q

what’s the difference between carcinogenic and oncogenic ?

A

Carcinogenic = causes cancer (malignant)

Oncogenic = tumour (benign or malignant) causing

45
Q

what are the 5 classes of carcinogens?

A
  1. Chemical
  2. Viral
  3. Ionising and non-ionising radiation
  4. Biological agents (Hormones, parasites, Mycotoxins)
  5. Miscellaneous (eg. Asbestos and arsenic )
46
Q

give an example of a chemical carcinogen and the cancer(s) it can cause?

A

exposure to polycyclic aromatic hydrocarbons (in smoke, in car pollution) increases likelihood of lung and skin cancer

47
Q

give an example of a viral carcinogen and the cancer(s) it can cause?

A

Hepatitis B Virus associated with Hepatocellular carcinoma

48
Q

give an example of a non-ionising radiation carcinogen and the cancer(s) it can cause?

A

Exposure to UVA or UVB increases the risk of developing all types of skin cancer (BCC, melanoma and SCC)

49
Q

give an example of a ionising radiation carcinogen and the cancer(s) it can cause?

A

Lung cancer in uranium miners

50
Q

give an example of a hormonal carcinogen and the cancer(s) it can cause?

A

Increase oestrogen increases chance of mammary/endometrial cancer

51
Q

give an example of a parasitic carcinogen and the cancer(s) it can cause?

A

Schistosoma

increased risk of squamous cell carcinoma of the bladder

52
Q

give an example of an occupation that has been associated with increased cancer risk

A

aniline dye and rubber industries

increased risk of Bladder cancer

53
Q

give an example of an environment that has been associated with an increased risk of cancer

A

Hepatocellular carcinoma is common in areas with mycotoxins

54
Q

host factors:

  • how does race/ethnicity affect risk of cancer?
A

Decreased skin cancer in black people (melanin)

Increased oral cancer in India, SE Asia (reverse smoking - when they smoke from the lit end of the cigarette)

55
Q

host factors:

  • how does diet and lifestyle affect risk of cancer?
A

Excess alcohol and Obesity increases risk

Unprotected sex increases risk of HPV-related cancer (cervix, penis, oropharyngeal)

Exercise reduces risk

56
Q

host factors:

  • how do constitutional factors affect risk of cancer?
A

Inherited disposition

Age – incidence increases with age (longer been exposed to environment, longer you have had to acquire the mutation)

Gender

57
Q

host factors:

  • how do pre malignant conditions affect risk of cancer?
A

Identifiable local abnormality associated with increased risk of malignancy at that site e.g. colonic polyps, undescended testis, cervical dysplasia

So if you have a polyp, there is a chance it could become cancer

58
Q

host factors:

  • how does transplacental exposure affect risk of cancer?
A

Transmitted via placenta

Morning sickness medication (diethylstiboestrol) cross the placenta, caused increase in vaginal carcomas in unborn child

59
Q

give 2 examples of inherited predispositions to colorectal cancer?

A

Hereditary nonpolyposis colorectal cancer (HNPCC) and Familial adenomatous polyposis (FAP)

60
Q

what kind of prevention is cancer screening?

A

secondary prevention

61
Q

which cancers are screened for in the UK?

A

breast

cervical

bowel

62
Q

how is breast cancer screened for?

A

every three years for all women aged 50 to 70 with a mammogram

63
Q

how is cervical cancer screened for?

A

All women between the ages of 25 and 64 are eligible for a free cervical screening test every three to five years with a Liquid based cytology

64
Q

how is bowel cancer screened for?

A

every two years to all men and women aged 60 to 69 with a faecal occult blood (FOB) test kit

65
Q

Why can excision be used as a cure for basal cell carcinoma?

A

Because BCC doesn’t metastasise.

66
Q

Suggest a treatment that could be used for leukemia?

A

Chemotherapy. Leukemia is systemic, it circulates all around the body, therefore excision can’t be used.

67
Q

Give an example of a carcinoma that can spread to the axillary lymph nodes.

A

Breast carcinomas.

68
Q

Why is adjuvant therapy often used in the treatment of carcinomas?

A

Micrometastes are possible even if a tumour is excised and so adjuvant therapy is given to suppress secondary tumour formation.

69
Q

Give an advantage and a disadvantage of conventional chemotherapy.

A
  • Advantage: works well for treatment against fast dividing tumours e.g. lymphomas.
  • Disadvantage: it is non selective for tumour cells, normal cells are hit too; this results in bad side effects such as diarrhoea and hair loss.
70
Q

What kind of carcinomas would targeted chemotherapy be most effective against?

A

Slower dividing tumours e.g. lung, colon and breast.

71
Q

What is the theory behind targeted chemotherapy?

A

It exploits the differences between cancer cells and normal cells; this means it is more effective and has less side effects

72
Q

What kind of drugs can be used in targeted chemotherapy?

A

Monoclonal antibodies (MAB) and small molecular inhibitors (SMI).

73
Q

What is required for a tumour to invade through a basement membrane?

A
  1. Proteases.
  2. Cell motility.
74
Q

What is required for a tumour to enter the blood stream (intravasation)?

A
  1. Collagenases.
  2. Cell motility.
75
Q

What is required for a tumour to exit the blood stream (extravasation)?

A
  1. Adhesion receptors.
  2. Collagenases.
  3. Cell motility.
76
Q

Give 2 promoters of tumour angiogenesis.

A
  1. Vascular endothelial growth factors.
  2. Fibroblast growth factors.
77
Q

Give 3 inhibitors of tumour angiogenesis.

A
  1. Angiostatin.
  2. Endostatin.
  3. Vasculostatin.
78
Q

What 3 mechanisms do tumour cells use to evade host immune defence in the blood?

A
  1. Platelet aggregation.
  2. Adhesion to other tumour cells.
  3. They shed surface antigens so as to ‘distract’ lymphocytes.
79
Q

What percentage of cancer risk is due to environmental factors?

A

85% environmental, 15% genetic.

80
Q

Chemical carcinogens: what types of cancer do aromatic amines cause?

A

Bladder cancer.

81
Q

Chemical carcinogens: what type of cancer do nitrosamines cause?

A

Gut cancer.

82
Q

Describe neoplastic cells.

A

Neoplastic cells are derived from nucleated cells. They’re usually monoclonal and their growth is related to the parent cell.

83
Q

Describe the stroma of a neoplasm.

A

Connective tissue composed of fibroblasts and collagen; it is very dense. There is a lot of mechanical support and blood vessels provide nutrition for the neoplastic cells.

84
Q

Why does necrosis often occur in the centre of a neoplasm?

A

The neoplasm grows quickly and outgrows its vascular supply.

85
Q

What are the two ways in which neoplasms can be classified?

A
  1. Behavioural classification.
  2. Histogenetic classification.

2a - pathology lectures (9 decks)

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