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Pathology > Chapter 6 - Neoplasms > Flashcards

Chapter 6 - Neoplasms Flashcards

1
Q

Neoplasm

A
  • An autonomous cellular proliferation occurring without respect to the needs of the host
    • Benign or malignant
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2
Q

Oncology

A

Study of neoplasms

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3
Q

Tumor

A

Mass or lump, usually referring to a neoplasm

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4
Q

Malignant

A

A process that will probably kill the patient if left alone

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5
Q

For cardinal features of malignant neoplasm

A
  • Undifferentiated cells: abnormal maturation (anaplasia)
  • Uncontrolled cell growth: unchecked proliferation
  • Invasive: nonencapsulated
  • Meta-stasis: spread too distant sites (multiple tumors)
    • Blood vessels, lymphatic vessels
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6
Q

Cancer

A

Non-specific term that refers to a malignant neoplasm

  • Carcinoma: malignant tumors of epithelial origin
  • Sarcoma: malignant tumors from mesenchymal (non-epithelial, except for mesenchymal endothelium and mesothelium)
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7
Q

Cancer exceptions

A
  • Fibrosarcoma: easily curable by surgically resection – noninvasive
  • Basal cell carcinoma: invades aggressively, but very rarely metastasize
  • Carcinoid tumor: neuroendocrine, mainly G.I. and a long
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8
Q

Benign

A

Any process that is not malignant

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9
Q

Benign features

A
  • Semi differentiated cells: more closely resemble their tissue of origin (slight anaplasia)
  • Encapsulated: tumors with well defined borders, grow locally do not invade or metastasize
  • One tumor: usually
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10
Q

Benign exception

A
  • Can kill if in critical location:
    • Meningeoma - exert pressure on brain
    • Ependymoma - block CSF circulation
    • Myxoma - block mitral valve and orifice in left atrium
    • Insulinomas - cause lethal hypoglycemia
    • Pleomorphic adenoma - aggressive growth that defies surgical cure
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11
Q

Tumor prefixes

A

Refer to the tumor tissue of origin

  • Squamous: resembling squamous epithelium
  • Adeno: with glandular configurations
  • Hemangio: endothelial cell origin (blood vessels) – mesenchymal
  • Leiomyo: smooth muscle origin
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12
Q

Tumor suffixes

A

Identify tumor as benign or malignant

  • Oma: benign tumor of glandular origin (adenoma - tumor of glandular origin)
  • Carcinoma: malignant tumor of epithelial origin (adenocarcinoma - malignant tumor of glandular origin)
  • Sarcoma: malignant tumor of mesenchyme origin (fibrosarcoma - malignant tumor of fibrous CT)
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13
Q

Carcinogenesis

A

The cause of all cancer is damage DNA

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14
Q

Normal cell cycle

A
  • Resting: normal, nondividing function
  • Preparation for division: synthesizing DNA
  • Mitosis: division into two daughter cells
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15
Q

Density dependent reproduction of cells

A

Only enough new cells are made to meet body needs

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16
Q

Neoplasia

A

Density independent cell reproduction, is not controlled by body needs

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17
Q

Growth fraction

A

Proportion of cells that are reproducing at any one time

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18
Q

Doubling time

A

Amount of time it takes a tumor to double it cell population

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19
Q

Abnormal cellular changes in neoplasia

A
  • Loss of cell recognition
  • Loss of cell adhesion
  • Loss of contact inhibition
  • Last of differentiation
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20
Q

Loss of cell recognition

A
  • Neoplastic cells may lose a normal anti-genic qualities

- Neoplastic cells may develop new antigens (neoantigens)

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21
Q

Loss of cell adhesion

A

Neoplastic cells tend not to stick together

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22
Q

Loss of contact inhibition

A

Neoplastic cells will pile up on top of each other

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23
Q

Loss of differentiation

A
  • Normal cells have specialized differentiated for a particular function
  • Neoplastic cells usually lose some of this specialization
    • Well differentiated cells – still resemble the cell of origin (benign tumors)
    • Poorly differentiated or undifferentiated cells appear immature (anaplasia) and may not resemble their cell of origin (malignant tumor)
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24
Q

Carcinogen

A

Something that increases the risk of developing a cancer

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25
Q

Co-carcinogen

A

Something that increases the activity of a carcinogen

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26
Q

Pro – carcinogen

A

Something that must be changed (activated, modified, metabolized) before it becomes a carcinogen

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27
Q

Mutagen

A

Substance that can change the genetic material of the cell

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28
Q

Chemical carcinogen

A
  • Polycyclic aromatic amines
  • Aromatic amines
  • Nitrosamines
  • Dioxin
  • Aflatoxin
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29
Q

Polycyclic aromatic amine

A

Products of combustion

  • Cigarette smoke (benzopyrene)
  • Automobile exhaust or smog (benzene)
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30
Q

Aromatic amines

A

Guys, moth repellent (napthalene), insecticides

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31
Q

Nitrosamines

A

Produced in the body from nitrates; nitrates are in some preservatives and other food additives

32
Q

Dioxin

A

1 most carcinogenic chemicals

33
Q

Aflatoxin

A

1 most carcinogenic biological substance (aspergillus flavum)

  • And contaminated peanuts and grain, causes hepatocarcinoma
34
Q

Physical carcinogens

A
  • Ionizing radiation
  • Ultraviolet radiation
  • Asbestos fibers
35
Q

Ionizing radiation

A
  • Survivors of the atom bomb and nuclear accident

- Excess x-ray exposure

36
Q

Ultraviolet radiation

A

From excess sun exposure

37
Q

Absestos fibers

A

Exposure causes mesothelioma

  • Once widespread as an insulator in construction
  • Concrete workers, heavy construction workers may risk exposure
38
Q

Oncogenic viruses

A

Viruses that cause tumor formation

  • HPV
  • Herpes type 2
  • Hepatitis B
  • EBV (Epstein-Barr virus)
  • Retrovirus
39
Q

HPV

A

A papilloma is a type of epithelioma

  • Causes common warts and venereal warts
  • Some HPV subgroups that cause venereal warts increased risk of developing squamous cell carcinoma of cervix, penis, anus and now
40
Q

Herpes type 2

A

Causes cervical cancer – cervical carcinoma

41
Q

Hepatitis B

A

Causes serum hepatitis

  • Increases risk of developing carcinoma of the liver: Hepatocarcinoma
42
Q

Epstein – barr virus (EPV)

A

Causes infectious mononucleosis

  • Associated with:
    • Burkitt lymphoma and Africa
    • Nasopharyngeal carcinoma and Asia
43
Q

Retroviruses

A

RNA core - must be transcribed into DNA to enter host cells genetic material

  • Associated with some leukemias
  • HIV (AIDS) virus is a retrovirus, but doesn’t cause cancer
44
Q

Other carcinogenic risk factors

A
  • Diet
    • High fat low fiber diet = colon carcinoma
    • Nitrates in water and food = stomach cancer
  • Sexual activity: early sexual activity with multiple partners = cervical carcinoma
  • Hormones: increased estrogen = carcinoma breast or endometrium
  • Habits or substance-abuse:
    • Alcohol = esophageal carcinoma
    • Tobacco = long, throat, kidney, bladder cancer
  • Family history or genetics
    • Breast and colon carcinoma’s
    • neurofibromatosis (NF or von Recklinghausen dz) 5% neurofibrosarcomas
    • Identical twin: develop tumor of the same type at same time if they live together
45
Q

Signs and symptoms of malignancy “Caution”

A 
C - hange in bowel or bladder habits
A - non healing store
U - nusual bleeding or discharge
T - hickening or lump
I - ndigestion (persistent)
O - bvious change and mall
N - agging hoarseness or cough
46
Q

Diagnosis of malignancy

A
  • History and physical examination
  • Radiological examination
  • Laboratory tests
47
Q

History and physical examination

A

About 70% of causes can be diagnosed this way

48
Q

Radiological examination

A
  • X-ray: chest, G.I. tract (barium studies), mammography

- CT scans and MRI

49
Q

Laboratory tests

A
  • Blood counts, blood smears, bone marrow examination
  • Urinanalysis, stool examination
  • Chemical studies: increased levels of some chemicals during tumor formation
  • Psychology: pap smears, etc.
  • Biopsy: allows one to determine invasiveness of cancer
50
Q

Criteria of malignancy

A
  • Invasiveness

- Ability to metastasize

51
Q

Invasiveness

A

Tumor extends into surrounding normal tissues and may eventually replace and destroy those tissues

  • Carcinoid tumor is our invasive, but very slow growing
52
Q

Ability to metastasize

A

Spread distantly

  • Hematogenous/vascular spread
  • Lymphatic spread
  • Implantation “seeding”
53
Q

Hematogenous/vascular spread

A

By way of blood vessels

  • Usually first mode of metastatic spread by sarcomas
54
Q

Lymphatic spread

A

By way of lymphatic vessels and lymph nodes

  • Usually first mode of metastatic spread by carcinomas
55
Q

Implantation “seeding”

A

On surfaces of body cavities

  • Carcinoma of ovary: spreads five fluid and abdominal cavity to other surfaces in abdomen
56
Q

Factors promoting invasion and metastasis

A
  • Rapid growth rate
  • Greater mobility of neoplastic cells
  • Decreased adherence to adjacent cells: normal cells usually stick to their neighbors; malignant cells break away
  • Decreased contact inhibition: normal cells generally stop growing when they run into an adjacent cells; malignant cells don’t
57
Q

Histologic characteristics of malignancy

A

Microscopic appearance is often useful to determine malignancy

  • Dysplasia
  • Anaplasia
  • Evidence of abnormal growth
58
Q

Dysplasia

A

Premalignant

59
Q

Anaplasia

A

Abnormal appearance of cells reflecting failure of maturation

  • Irregular shape (pleomorphism)
  • Variation in size
  • Increased amounts of chromosomal material (hyperchromatism)
60
Q

Evidence of abnormal growth

A
  • Increased numbers of mytotic figures
  • Necrosis
  • Infiltrated growth pattern (invasion)
61
Q

Prognosis of malignancy

A
  • Grading

- Stages

62
Q

Grading

A

Appearance of tumor; a microscopic judgment by pathologist

  • Grade I: well differentiated, low-grade malignancy, mostly mature cells, good prognosis
  • Grade II: moderately differentiated
  • Grade III: moderately differentiated
  • Grade IV: poorly differentiated, high-grade malignancy, immature cells, poor prognosis
63
Q

Stages

A

Anatomic extent of tumor, a clinical judgment by pathologist

  • Stage 0: non-invasive, can cure by surgery
  • Stage I: tumor still localized to one region or organ
  • Stage II: intermediate spread, depends on location of tumor
  • Stage III: intermediates spread, depends on location of tumor
  • Stage IV: tumor has metastasized and is widespread
64
Q

Treatment of malignancy

A
  • Surgery
  • Radiation
  • Chemotherapy
  • Immunotherapy
65
Q

Surgery

A

Mainstay of treatment

  • # 1 choice: get rid of as much as the tumor as possible
66
Q

Radiation

A
  • Shrink large tumors before operating on them
  • Kill tumor left behind after surgery
  • Treat inoperable tumor is, including unresectable metastatic site
  • An adjunct with other modalities
67
Q

Chemotherapy

A
  • Treat metastatic tumors

- An adjunct with other modalities for some primary tumors

68
Q

Immunotherapy

A
  • Attempt to improve immunity (interferon, BCG)

- Magic bullet: toxic agents attached to antibodies directed against tumor

69
Q

Effects of malignancies

A
  • Metabolic competition
  • Mechanical obstruction
  • Destruction of vital tissues
  • Hemorrhage
  • Infections
  • Others
70
Q

Metabolic competition

A

Tumor competes with normal tissues for nutrients resulting in malnutrition of the patient (cachexia)

71
Q

Mechanical obstruction

A

Tumor occludes vital passageways (trachea, colon, bile duct)

72
Q

Hemmorhage

A

Leads to anemia and susceptability to infection due to:

  • Decreased platelets (marror replaced by tumor)
  • Decreased coagulation factors (liver replaced by tumors)
  • Disseminated intravascular coagulation (DIC: tumor emboli in blood activate coagulation)
  • Ulceration: increased hemorrhageing
73
Q

Others

A
  • Depression

- Hormonal imbalance (carcinoid tumors: neuroendocrine, secrete serotonin)

74
Q

Total cancer deaths

A

20% of all deaths in USA, 2nd to cardiovascular

75
Q

Cancer death rate

A 
Male:
#1 Lung
#2 Prostate
#3 Colon
Female:
#1 Lung
#2 Breast
#3 Colon
76
Q

Cancer incidence

A 
Male:
#1 Prostate
#2 Lung
#3 Colon
Female:
#1 Breast
#2 Lung
# 3 Colon
77
Q

Dropping death rate

A
  • Stomach and colon cancer

- Female: breast and uterine cancer as well

Pathology (6 decks)

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