CH 8-NEOPLASIA--3 Q'S

Question 1

_______: abnormal swelling

________: new growth (Neos=new; Plasia=growth)

_______: denotes malignant growth (Karkinos=crab)

Oncology: study of tumors (oncos=tumor; logos=study of)

Answer 1

Tumor

Neoplasia

Cancer

Question 2

Neoplasia
- _________ cell proliferation i.e. escapes normal control mechanisms of cell growth

• Autonomous (Auto=self; Nomas=self governing) functions independently, replicated steadily and competes with _____ cells for their metabolic needs

Answer 2

Uncontrollable

normal

Question 3

Tumor Shape and Texture

1–Polypoid is usually benign

2–_______ is more associated with aggressive behavior

Answer 3

Ulcerated

Question 4

All tumors have 2 basic components:
1- the parenchyma “______ or neoplastic cells”
2- the supporting stroma (of non-transformed elements) as connective tissue & blood vessels

Answer 4

transformed

Question 5

Nomenclature of tumors depends on:

1. Cell of ______
2. Behavior of tumor (benign or malignant)

Answer 5

origin

Question 6

_______ Tumor:
Cell type from which tumor arises
e.g. fibroma, chondroma

Answer 6

Benign

Question 7

______ Tumor: (often called cancer)
I. Carcinomas
- arises from epithelial cells
- named by type of epithelium

Answer 7

Malignant

Question 8

I I . Sarcomas

• arises from _______ tissues
• named by cell component of tumor
  e. g. fibrosarcoma, chondrosarcoma

Answer 8

mesenchymal

Question 9

Mixed Tumor:

• composed of cells arising from _____ & mesenchymal tissues
  e. g. fibroadenoma, teratoma - either benign or malignant

Answer 9

epithelial

Question 10

Benign tumors that arise from germ cells and contain derivatives of different germ layers are labeled ____________

Answer 10

teratoma

Question 11

1. Hepatoma suggests benign tumor arising from hepatocytes, but is definitely
   __________
2. melanoma: suggests _____ tumor arising from melanocytes, but is highly malignant
3. Hamartoma:suggests tumor but is a mass of mature disorganized tissue related to an organ

Answer 11

malignant

benign

Question 12

A ______
is a neoplasm in an organ that is composed of tissue elements normally found at that site, but growing in a haphazard mass.

Answer 12

hamartoma

Question 13

Benign:
Histologically :
- fully differentiated cells,\_\_\_\_\_\_\_ very closely normal ones
- rare mitoses
- normal structural pattern 
Functionally :
- well differentiated

Answer 13

resemble

Question 14

Malignant:
Histologically:
Wide range of cell differentiation, either:
i. differentiated
ii. completely undifferentiated , cells have NO
morphologic resemblance to normal tissue (anaplastic):
1. pleomorphism
2. giant cells
3. loss of normal orientation
4. Nuclei:- high nuclear cytoplasmic ratio
- variable size & shape
5. 5. mitosis:- numerous & - atypical

Answer 14

Know

Question 15

Squamous cell carcinoma, differentiated,

=”keratin pearls”

Answer 15

Know

Question 16

Pleomorphism

cells are highly pleomorphic (vary in size & shape) , with hyperchromatic nuclei

Answer 16

Know

Question 17

Rate of Growth

Benign: - grow slowly over several years
Malignant: - grow rapidly, growth rate correlates with degree of malignancy (and differentiation)
- angiogenesis factor stimulates growth of new capillaries

Answer 17

Know

Ex. This adenoma is a well- differentiated neoplasm because it closely resemble normal tissue

Question 18

Encapsulation and invasiveness

Benign:= - Encapsulated:

i. NO invasion or active destruction of surrounding
ii. movable
iii. easily enucleated during surgical removal
iv. NO spread to distant sites
- –Capsule derived from tumor & surrounding CT

Answer 18

Know no no

Question 19

Malignant:

• Never develop capsules!!
• -Infiltrate & destroy tissue around (not clearly separated from normal tissue)

Answer 19

Never caps

Question 20

metastasis—–Transfer of malignant cells from one site to another not directly connected with it.
–Most important difference from benign tumors!!!

Major cause of death (difficult to eradicate)

Answer 20

Transfer is bad!!

Question 21

Routes of Spread:

1. Direct seeding of body cavities
   - -Tumors invade serous sacs
   - -Tumors of C.N.S. cells carried by C.S.F. re-implant on meningeal surface of brain & spinal cord
2. Lymphatic spread—Most common route of metastasis for carcinomas (sarcomas spread mainly by blood)
3. Hematogenous spread–Sarcomas metastasize earlier and more readily by blood than carcinomas
   - –VEINS are more readily penetrated than arteries = malignant cells follow VENOUS flow to reach liver, lung

Answer 21

Know

Question 22

Grading Detects level of malignancy based on:

i. degree of cell differentiation
ii. number of mitoses

Answer 22

Know

Question 23

TYPES OF GRADING

_________: graded numerically :I,II,III,IV in order of increasing anaplasia

______ : graded descriptively:
low, intermediate, or high-grade malignancy

Answer 23

Carcinoma

Sarcoma

Question 24

Grading is imperfect because: x 2

Answer 24

• different parts of the same tumor may display different degrees of differentiation
• the grade of the tumor may change as the tumor grow

Question 25

Staging:

- Detects stage of cancer = indicates course of treatment & prognosis of the condition

Answer 25

Know

Question 26

Size of primary lesion:

Answer 26

T1

Question 27

Extent of regional ______ to lymph nodes:
N0 = not involved
N1 = involved, mobile
N2 = involved, fixed

Answer 27

Spread

Question 28

Presence or absence of distant metastases:

M0 = absent
M1 = present (one organ)
M2 = present (more than one organ)

Answer 28

Distant!!

Question 29

1. Geographic, environmental, & regional factors:
   - The 2nd leading cause of death in USA (22% of all deaths):
   Male: lung (_____%), prostate and colon (10%) Female: lung (_____%), breast (15%), colon (11%)
2. Age:
   —More common between 55-75 years
   –Some types are common in children e.g. acute leukemia and WILMS TUMOR
3. Heredity:
4. Pre-neoplastic disorders:
   e.g. liver cirrhosis & hepatocellular carcinoma,
5. Carcinogenic agents:
6. Oncogenes—genes whose products are associated with neoplastic transformation.

Answer 29

31

25

Question 30

Clinical effects of tumors–1

1. Obstruction– of lumen of hollow organs e.g. bronchial wall, bile duct
2. Destruction –of tissue due to local invasiveness
3. Bleeding –from ulcerated area or eroded vessel

Answer 30

4. Erosion & ulceration
5. Infarction
   - compression of blood supply
   - torsion of pedicle of organ e.g. testis or ovary

Question 31

Clinical effects of tumors–2

6. Space-occupying lesion
   - raised intracranial tension by brain tumor
   - anemia due to replacement of hemopoietic

Answer 31

7. Hormone production by tumors of endocrine glands e.g. insulinoma in tumors of pancreas
8. Cachexia:

Progressive loss of weight & profound weakness:

• loss of appetite
• bleeding
• repeated infections (immunosuppression)
• production of cachectin (by activated
  macrophages) = depletion of fat depot

Question 32

Paraneoplastic disorders

Manifestations distant from primary lesion that are not directly related to metastases:

Answer 32

Ex.

i. ectopic production of hormones
e. g. ACTH by oat cell carcinoma of lung
ii. hypercalcemia:osteolytic bone tumors
iii. hypertrophic pulmonary osteoarthropathy in lung cancer: clubbing of fingers, subperiosteal bone deposition & arthritis.