Cell Growth and Neoplasia

Question 1

different tissue have different homeostatic states (3)

Answer 1

continously dividing

quiescent

non-dividing

Question 2

continuously dividing tissues?

Answer 2

e.g. skin, gut, epithelium, hematopoietic system

constant cell turnover

Question 3

quiescent tissues?

Answer 3

e.g. hepatocytes

normally little to no turnover

capacity for proliferation if needed

Question 4

non-dividing tissues?

Answer 4

e.g. CNS neurons

little to no capacity for proliferation

Question 5

4 levels involved in homeostatic balance?

Answer 5

external environment interaction (physical environment / infectious agents / inhaled and ingested substances)

cell-extrinsic - macroenvironment (circulating factors e.g. cytokines / hormones)

cell extrinsic - microenvironment (ECM / stroma / GF and inflammatory milieu)

cell instrinsic (e.g. differentiation program / age of cell)

Question 6

Physiological and pathological examples of hypertrophy?

Answer 6

physiological - uterus in pregnancy (actually combo of hypertrophy and hyperplasia)

pathological - heart in hypertension (high bp)

Question 7

Physiological and pathological examples of hyperplasia?

Answer 7

physiologic - mammary gland during puberty / pregnancy

pathologic - endometrium - known risk factor for endometrial neoplasia (epithelial shifts to outnumbering stroma)

Question 8

metaplasia?

Answer 8

change from one benign, differentiated cell type to another - usually in response to injury (e.g. inflammation)

Question 9

bronchus and esophagus example of metaplasia

Answer 9

bronchus - columnar to squamous metaplasia - due to smoking - known risk for bronchopulmonary neoplasia

esophagus - squamous to columnar (Barrett) - due to acid reflux - risk factor for esophageal neoplasia

Question 10

neoplasia =

Answer 10

new formation
progressive increase in cell number
clonal
irreversible

Question 11

global mechanistic hallmarks of neoplasia

cell autonomous

Answer 11

diruption of normal homeostatic mechanisms
- altered cell autonomous mechanisms - activation of oncogenes / inactivation of tumor suppressor
-

Question 12

global mechanistic hallmarks of neoplasia (cell-nonautonomous)

Answer 12

altered microenvironment - surrounding tissue, including stroma, blood vessels, and immune cells
altered macroenvironment -
circulating cells (immune cells) and factors (hormones / cytokines)

Question 13

benign neoplasms vs malignant
gross features
sequestration and necrosis

Answer 13

benign - circumscribed / encapsulated - necrosis uncommon

malignant - invasive into adjacent tissue - necrosis common

Question 14

benign vs malignant neoplasms
microscopic pathological features

differentiation?
turnover?
uniformity?
boundary?

Answer 14

benign

• well differentiated
• low rate of turnover
• cytologic uniformity (cells similar to each other)
• boundary maintained

malignant

• variable differentiation
• higher rate turnover
• cytologic pleomorphism - cells different from each other
• lose boundary

Question 15

neoplasias are generally classified by?

Answer 15

tissue of origin

Question 16

benign epithelial neoplasia?

Answer 16

adenoma

Question 17

osteoma / chondroma / fibroma are examples of

Answer 17

benign mesenchymal neoplasia

Question 18

malignant epithelial neoplasia

Answer 18

carcinoma

Question 19

malignant mesenchymal neoplasia

Answer 19

sarcoma

Question 20

malignant hematopoietic neoplasia -

Answer 20

lymphoma / leukemia

Question 21

what is adenocarcinoma

Answer 21

malignant carcinoma with formation of glandular structures

Question 22

clinical correlates of benign neoplasia
treatment?
recurrence?
malignancy progression?

Answer 22

treated by surgical resection alone
may recur (especially if incompletely excised)
generally do not progress to malignant - important exception - benign, but premalignant neoplasms (e.g. colonic adenoma)

Question 23

what molecular pathways are involved in benign neoplasms?

Answer 23

don’t know - no funding

Question 24

malignant neoplasia =

Answer 24

cancer

Question 25

ratio americans get cancer

Answer 25

1/2

Question 26

ratio american die cancer

Answer 26

1/5

Question 27

6 hallmarks of cancer pathobiology

Answer 27

1. sustained angiogenesis 2. limitless replicative potential 3. tissue invasion / metastasis 4. insensitivity to anti-growth signaling 5. self sufficiency in growth signaling 6. evading apoptosis

Question 28

what are the most common cancers?

Answer 28

carcinomas (cancer of epithelia)

Question 29

what is dysplasia?

Answer 29

disordered growth

Question 30

dyplasia in epithelia is hallmark of?

Answer 30

early premalignant neoplasia

Question 31

characteristic histological features of dysplasia? (3)

Answer 31

loss of cytologic uniformity loss of normal histologic maturation loss of architectural orientation

Question 32

marked / extensive dysplasia =

Answer 32

carcinoma in-situ

Question 33

non-genetic factors influencing cancer etiology (6)

Answer 33

``` age lifestyle (etoh / tobacco) occupation (carcinogens) radiation infection (oncogenic) inflammation (IBD / UC) ```

Question 34

Type of heritable cancers (3)

Answer 34

dominant tend to be oncogene recessive tend to be tumor suppressor there are also familial clustering familial cancers

Question 35

Histological grade

Answer 35

degree of tumor histologic differentiation (i.e. resemblance of normal tissue counterpart)

Question 36

grade vs stage?

Answer 36

grade is less reliable than stage

Question 37

Tumor Stage TNM T = N = M =

Answer 37

Tumor - invasion extent N - lymph node involvement M - distance of metastasis

Question 38

T1 or T2 N0 M0

Answer 38

Stage 1 (93)

Question 39

T3 N0 M0

Answer 39

Stage 2A (85)

Question 40

T4 N0 M0

Answer 40

Stage 2B (72)

Question 41

T1 or T2 N1 M0

Answer 41

Stage 3A (83)

Question 42

T3 or T4 N1 M0

Answer 42

Stage 3B (64)

Question 43

Any T N2 M0

Answer 43

Stage 3C (44)

Question 44

Any T Any N M1

Answer 44

Stage 4 (8)

Question 45

Tis

Answer 45

tumor in situ

Question 46

T1

Answer 46

tumor invades submucosa

Question 47

T2

Answer 47

Tumor invades into, but not through, muscularis propria

Question 48

T3

Answer 48

Tumor invades through muscularis propria

Question 49

T4

Answer 49

Tumor invades adjancent organs

Question 50

NX

Answer 50

Lymph nodes cannot be assessed

Question 51

N0

Answer 51

No lymph node

Question 52

N1

Answer 52

Metastasis to 1-3 regional lymphnodes

Question 53

N2

Answer 53

Metastasis to >3 regional lymph nodes

Question 54

M0

Answer 54

No distant metastasis

Question 55

M1

Answer 55

Distant metastasis / seeding or abdominal organs

Question 56

what makes sarcoma unique from carcinoma in initial presentation?

Answer 56

no pre-malignant lesion and no in-situ state

Question 57

what makes CNS neoplasms unique from carcinoma in initial presentation?

Answer 57

no pre-malignant nor in-situ phase

Question 58

does the carcinoma cancer progression paradigm apply to other cancer? (sarcoma / heme / cns?)

Answer 58

no

Question 59

what makes cns neoplasms metastasis unique?

Answer 59

rare outside neuraxis

Question 60

where do pediatric neoplasms tend to originate?

Answer 60

developmental precursors

Question 61

what behavior do pediatric neoplasms tend to recapitulate?

Answer 61

aspects of developmental program of tissue of origin

Question 62

latency and metastasis in pediatric cancer

Answer 62

short latency | early metastasis

Question 63

mutations in pediatric neopalsms?

Answer 63

fewer mutations | prominent role for oncogenic fusions and epigenetic dysregulation