Chapter 7 Pt 1 Flashcards
What is cancer?
Cancer is a malignant neoplasm.
A group of insults to the tissue that form a tumor. It is a genetic disease, in the aspect that cancers are formed by alterations in genes that cause a tumor to form
What is a neoplasm?
New tissue growth (aka tumor) that is unregulated, irreversible, autonomous (does not rely on physiologic stimuli) and MONOCLONAL. Can be benign or malignant
What are the 2 components of neoplasms, both malignant and benign?
- Tumor parenchyma: where the monoclonal, neoplastic cell divides. This tissue is looked at to to classify the neoplasm as benign or malignant
- Stroma (non-neoplastic): structural components of the tumor (BV, CT, adaptive and innate immune cells) that allow the tumor to grow and spread.
If the stroma has alot of collagen, what is it called?
Alot of collagen => desmoplasia and the tumor will become ROCK hard (scirrhous)/
A malignancy that occurs in the parenchyma is usually ______, whereas a tumor that occurs in the stroma is usually ________
carcinoma
sarcoma
Difference difference between metaplasia and metastasize
Metaplasia: change in cell type
Malignancy: spreading of a cancer
What cells do undergo metaplasia and metastasize?
What cells do not?
Do: precursor stem cells
Do not: mature differentiated cells, heart cells and nerve cells
Describe benign neoplasms
Localized
Do not metastasize (spread)
Easier to remove than malignant, but still problematic
What is the suffix for benign tumors
-oma
What benign tumors occurs in mesenchymal tissue?
Lipoma
What is a benign epithelial neoplasm that arises in glands or forms glandular like patterns
Adenoma
What is a benign epithelial neoplasm that has visible finer-like warty projections
Papilloma
What is a benign epithelial neoplasm that arises in glands or forms glandular like patterns and FORMS LARGE CYTSTIC MASSES
Cystadenomas
What is tumor that produces papillary patterns and protrudes into cystic spaces?
Papillary cystenadenomas
What is a polyp?
a bengin OR malignant neoplasm that protrudes from mucosal surface => gastric or colonic lumen.
When should we look for a polyp, because they may be malignant.
during colonscopy
What is are 3 exceptions to the rule that benign tumors end in oma?
Following are malignant:
- melanoma:
2, lymphomas
3, mesothelioma - Seninoma
Describe malignant neoplasms
Invade locally
Aggressive
Metastasize
What is the ABSOLUTE difference between malignant and benign neoplasms?
Benign tumors CANNOT metastisize
What are the categories of malignant neoplasms
- Sarcoma => malignant tumor that is derived from mesenchyme
- Lymphoma: a mesenchymal malignant tumor that is from lymphocytes (B and T cells )
- Leukemia: a mesenchymal malignant tumor that is from blood forming cellls (neutrophils, basophils and eosinophils) or hematopoeitc cells (primary lymphocytes of myeloid cells)
- Carcinomas => malignant tumors from 3 germ cell layers (mainly endoderm and ectoderm though)
What is the most common cancer in kids?
acute lymphocyte leukemia
What is the most common general category of cancer that occurs in adults, BUT IS RARE IN KIDS?
carcinomas
Most carcinomas affect what?
epithelium
Cancer where tumor cells look like stratified squamous epithelium
squamous cell carcinoma
What malignant tumors INVADE early, but rarely metastasize?
- Gliomas
2. Basal cell carcinoma of the skin
What is a malignant neoplasm where the epithelial cells grows in a glandular pattern?
Where does this most often occur
What is unique about this?
Adenocarcinoma, which can occur in the breast and colon
IT can common in mutliple sites)
If a patient presents with thrombocytopenia (decrease in BCs), what cancer should we suspect?
Acute lymphocyte leukemia
Benign tumors:
Differentiation: Function of cells: Rate of growth: Local invasiveness: Distant spread:
Benign tumors resemble the tissue they originated from, thus, they are WELL differentiated
- Cells retain their original function
- Benign tumors often progress slowly and they can stop or even regress
- Benign tumors are usually well-circumscribed and surrounded by a capsule; cohesive; expandable, well-demarcated, they are do not invade or metastasize
- localized to where orinated
Malignant tumors
Differentiation: Function of cells: Rate of growth: Local invasiveness: Distant spread:
Malignant tumors are UNDIFFERENTIATED (heterogenous)
Function of cells has altered
-Rate of growth varies from slow=> fast. Thus, has MANY mitotic spindles
Malignant tumors are POORLY circumscribed (confined) to a certain area, invade and infiltrate
Which are more circumscribed: malignant or benign tumors?
Benign => more confined
Which has more mitotic spindles: malignant or benign?
Malignant: they grow slow => fast and often do not halt; thus more mitotic spindles bc keep growing
What are mixed tumors?
Mixed tumors come from 1 germ cell => differentiated into more than 1 cell type
What are teratomas?
benign or malignant?
What kind of cells do they arise from?
Where do they occur most often?
Often, they are what?
Teratomas are benign or malignant tumors derived from a totipotenital germ cell => makes that have cells from MULTIPLE germ cell layers: endoderm, ectoderm or mesenchyme
Ovary and testis
Often, they are cystic
What is a type of mixed tumor?
Mixed salivary gland tumor (pleimorphic adenoma).
A tumor with epithelial and myoepithelial cells in a stroma of bone and CT
What is a type of teratoma
What lines does it differentiate from?
Ovarian cystic teratoma (dermoid cyst)
ectodermal
What is differentiation?
Comparision of neoplastic parachymal cells with normal parenchymal cells, morpho and functionally. This will tell us if a cell if benign or malignant
2 factors for differentiation
- nucleus and cytoplasm of the neoplastic cells
2. Architectural differences BETWEEN neoplastic cells and non-neoplastic stroma
If a tumor is has lack of differentiation, what is it called?
Aneuplastic
What is pleimorphism?
the variation in the size and shape of cells in a SINGLE TUMOR
Benign neoplasms
- Differentiation
- Polarity
- Pleiomorphism
- Nuclei:cytoplasm ratio
- Nuclei
- Mitosis
- Metastatic potential
very well differentiated
increased polarity: very well organized
not pleimorphic: cells will resemble each other
low nuclei:cytoplasm ratio
nuclei are uniform (exist in a 1:4/1:6 ratio)
Mitosis actibity is low: no mitotic spindles
no metastatic potential
Malignant neoplasms
- Differentiation
- Polarity
- Pleiomorphism
- Nuclei:cytoplasm ratio
- Nuclei
- Mitosis
- Metastatic potential
Aneuplastic (very poorly differentiated)
Low polarity => disorganized growth
Pleiomorphic (cells within the tumor look different from each other)
High nuclei:cytoplasm ratio: (1:1)
Hyperchromatic (stains dark blue), condensed and pushed off to side; look different from one another
Increased mitosis: increased mitotic spindles
yes metastatic potential
How do we differentiate normal cells that rapidly divide (GI cells) from those that are malignant?
Malignant tumors will have a lot of mitotic spindles.
What happens if a cancer cell cannot grow blood fast enough?
it will undergo central necrosis
Atypical cells will have a:
\_\_\_\_ cytoplasm \_\_\_\_\_ nuclei \_\_\_\_\_\_ nucleoli \_\_\_\_\_\_ chromatin \_\_\_\_\_ polarity \_\_\_\_ in size of cells
small large and multiple multiple dark staining (pyknosis) no polarity: disorganized cells difference in size of cells
How do we grade malignant neoplasms?
- Well differentiated: neoplastic parenchymal cells look like parent
- Moderately differentiated: you can identify features of the parent tissue, but it is NOT the dominant pattern and there is atypicallity
- Poorly differentiated: only a small number of cells look like the parent tissue and is assx with anaplasia
- Undifferentiated: original tissue cannot be discerned and assx with anaplasia
in undifferentiated malignancies, what are the cells able to do?
- Get new functions
- Revert to fetal protein
- Make proteins that are very different from adult cells
- Less likely to have a functional activiyu
Compare and contract metaplasia and dysplasia.
Metaplasia: stress causes cells to change types by stem cell programming that are better able to handle the stress. Metaplasia is always seen with tissue damage, repair and regeneration
Dysplasia: disorganized cell growth that usually occurs in epithelia => cells begin to look different from one another => pleimorphism and hyperchromatic nuclei
Metaplasia is always seen with what?
Tissue damage, repair and regeneration
What do metaplasia and dysplasia have in common?
Metaplastic cells can become dysplastic or cancerous
Dysplastic cells can become cancerous, however it is reversible if stressor is removed
What is the potential dysplasia that can occur in squamous epithelium?
Normally, cells in the epithelium mature from [tall cells in the basal layer => flattened squamous cells].
In dysplastic squamous epithelium, this does not occur and the epithelium is made up of basal-appearing cells with hyperchromatic nuclei
What is carcinoma in-situ
Abnormal dysplastic cells in the FULL THICKENESS of the epithelium in a spot in the epithelium, however they have NOT gone through the basement membrane (not invaded). Thus, it can be removed.
Once tumor cells breach the basement membrane they are said to be?
invasive
What changes are often found near the foci of invasive cancer?
Dysplastic changes
Severe epithelial dysplasia often precedes the appearance of cancer.
long time smoker in someone with Barrots ESO.
Most cervical cancers are …
squamous cells cancers
How do we prevent Benign tumor cells from invading?
The are surrounded by a capsule that is made of compressed fibrous tissue (with ECM, stromal cells and fibroblasts), separating them from host.
But they can still cause damage bc hypoxia will + the components of the capsule
Does the capsule benign tumors form hinder its growth?
no. it just makes it easier to locate, move and remove.
What benign tumors do NOT have a capsule around them. which prevents invasion
hemangiomas
Do malignant tumors have a capsule?
they are pseudoencapsulated but can still invade
What is the difference between metastasis and invasion?
Metastasis: spreading of the tumor to discontinuous sites
Invasion: penetration through the BM
Metastasis is the ABSOLUTE criterion for malignancy.
What is the 2nd best reliable feature?
Invasion.
If invasive => BM, lymph, body cavities => spread => harder to cure
What cancncers are more likely to invade via carcinoma in siute
skin
breast
cervix
Can we say leukemia/lymphoma metastasize?
No. Metastasis only applies to SOLID tumors. These are liquid tumors in the blood and are called “systemic neoplasms”
Does invasion = metastasize?
No.
Basal cell carcinomas and gliomas both invade, but do not metastisize.
Liklihood whether a cancer with metasize is correlated with what?
- Lack of differentiation
- Aggressive local invasion
- Rapid growth
- Large size
Do all malignant tumors metasisize?
no; only 30%
skin melanoms
What are pathways of metastasis?
- Direct seeding into body cavity=> malignant neoplasm directly go into body cavity bc no boundary
- Lymphatics: via surrounding lymphatics bc tumors do not have lymphatics
- Hematologic (blood)
Where do malignant neoplasms usually metastasize if they do via direct seeding?
peritoneal cavity, but can be any potential space
What cancers usually metasttsize via direct seeding?
- Ovarian carcinomas
2. Mucus secreting appendecial carcinomas (pseudomyxomas peritonei)
In direct seeding of body cavities, sometimes appendiceal carcinomas or ovarian carcinomas fill the peritoneal cavity with what?
Pseudomyxoma peritonei
What is the most common pathway for the initial dissemination (metastasis) of carcinomas?
Lymphatic spread=> spread follows lymph drainage => regional LN, which may serve as barriers to further spreading by + an immune response
Where do carcinomas of the breast in the upper outer quadrant disseminate 1st to?
what about cancers in Inner quadrants?
- Axillary LNs
- internal LN => clavicle LN via internal mammary a
Where do carcinomas of the lung in the major respiratory passages metastasize first to?
Perihilar tracheobronchial and mediastinal LN
When taking out a cancer that spread through lymphatics, what is important?
Biopsy the LN and take out only ones affected
how can we remove only LN affected?
- locate sentinal LN: the first LN in the area that receives lymph from tumor
- Map it via tracers and examin frozen section to help guide surgeon.
If a cancer spreads through LN, surrounding LN can increase in size HOW?
Does nodal enlargement = cancer metastized there?
- Reactive hyperplasia
- Dissemination (metastasis)
NO; that is why it is important to biospy
What cancers typically metasize via blood?
Sarcomas
but some carcinomas (renal cell carcinoma and hepatocellular carcinoma), thyroid and prostate
Where does metastasis most often occur: arterial or venous flow?
Where does metastasis then go?
Venous flow because the walls of arteries are thicker.
Venous flow => first capillary bed it finds (usually LIVER, from portal drainage, or LUNGS caval drainage)
How do malignant cancers spread through arterial flow?
They must pass through
- Pulmonary capillary beds
- Pulmonary AV shunts
- If pulmonary tumors gives off bb emboli
Cancers arising in close proximity to the vertebral column often embolize through where?
This pathway is involved in the frequent vertebral metastases of carcinomas of?
- Paravertebral plexus
- Thyroid and prostate
how does renal carcinoma and hepatocellular carinoma spread
VENOUSLY
Renal cell carcinoma => renal vein => IVC => sometimes go to heart
Hepatocellular carcinoma=> penetrate portal and hepatic radicles => venous channels
Does anatomic location often explain how cancer spreads?
Breast cancer:
Bronchiogenic cancers: Neuroblastomas:
NOOOO
breast cancer => bone
bronchiogenic caners => adrenal glands and brain
Neuroblastomas => liver and bones
What two areas of the body RARELY have secondary deposits of tumor?
Why is this ironic?
skeletal muscle and spleen
bc they receive alot of CO
What is the difference between cancer cases and deaths in 2008 vs predictions in 2030?
2008: 12.7 million new cases; 7.6 million deaths
2030: 21.4 million new cases; 13.2 deaths
Is the incidence of cancer increasing or decreasing?
Are cancers more likely to be familial or sporadic?
decreasing
95% are sporadic
DEVELOPED NATIONS (2014)
What are the most common tumors in Men?
Woman?
Men: prostate, lung and colon/rectum
Women: breast, lung and colon/rectum
DEVELOPING NATIONS (2014)
What are the most common tumors in Men?
Woman?
M: Lung, stomach and liver
F: Breast, cervix and lung
The incidence of breast cancer is higher in DEVELOPED nations than developing. Why is this?
- Having less babies => more periods
- longer life span
- diet and excercise
how do infectious agents cause cancer?
directly or by inducing chronic inflammation
What is responsible for a large majority of cervical carcinoma and increasing fraction of head and neck cancers?
HPV
What cancer is associated with benzene (i.e., light oil, paint, printing, dry cleaning, adhsives. etc.)?
Acute myeloid leukemia
what infectious agents are associated with
LUNG CARCINOMA (only)?
- Berrylium (missle fules and space vehicles)
- Chromium (metal alloys)
- Radon and its decay
What cancer is associated with cadmium (i.e., yellow pigments and phosphors; used in batteries, etc.)?
Prostate carcinoma
What cancer is associated with vinyl chloride (i.e., refrigerant, vinyl polymers, plastic adhesives, etc.)?
hepatic angiosarcomas
Nickel?
lung carcinoma
oropharyngeal carcinoma
arsenic?
lung and skin carcinoma
How does age relate to cancer?
Incidence increases with age d/t increasing somatic mutation and decreasing immune fx
Most CARCINOMAS occur when
after 55 YO
Name the 5 neoplasms most common in infancy and childfood
- Acute leukemia
- Retinoblastoma
- Neuroblastoma
- Wilms tumor
- Rhadbadsosarcomas (bhad bb)
Cancer is the main cause of death in W ____ and M ___
W: 40-79
M: 60-79
Deaths after 80 decline d/t less ppl living that long
what are the three types of acquired predispositions to cancer?
- Chronic inflammation
- Precursor lesions
- Immunodeficienies
How do chronic inflamation and precursor lesions increase risk for cancer?
- To repair damaged cells, cell replication increases to attempt to repair the cells => proliferating cells are more prone to mutations => increase risk for cancer
- Precursor lesions are caused by chronic inflammation. They do not cancer, but if detected, can allow us to intervene to prevent the lesions
- Chronic inflammation: releases inflammatory cells => ROS and immune mediators that may help other cells survive
- Increase pool of stem cells
Tumors d/t chronic inflammation are usually what type?
CARCINOMAS,
but can be [mesotheliomas] and lymphomas
What benign neoplasm is at risk to become malignant?
chronic villous adenoma; will lead to cancer if untreated 1/2 time
transportation from b=>m is RARE tho
Patiens who are immunodefieient are more at risk for what kinds of cancers?
Viral cancers
Some cancers are an inherited trait. However, 95% of cancers are sporadic. What does this say about genetics?
Environment/acquired predisposing condition plays a HUGE. Germline mutations, however, could still occur. The lack of familiy history does NOT mean a mutation was not inferited
Give 2 examples of how sporadic cancers can involve an inherited mutation.
- P450 removes carcinogenic compounds from the body.
Mutation in P450 loci => increase susceptibility to lung cancer in smokers - Mutation in BRCA1 and BRCA2: those born after 1940 have 3x higher risk of developing cancer. Maybe d/t changes in reproductive history
How does one mainly acquire lung cancer?
ENVIRONMENTAL
85% of ppl with lung cancer smoked
What are the 4 classes of regulatory genes affected in carcinogenesis?
- Protooncogenes: promote growth (1/2)
- Tumor suprressor genes: inhibit growth (2/2)
- LOF - DNA repair enzymes: LOF => genetic instability
- Genes that regulate apoptosis: LOF or GOF
Whenever we do genetic testing on a tumor cell, what are they 2 types of mutations we see?
What does this imply?
- Mutations that is present in ALL other tumor sites
- Mutation that is present at the site of that particular cell.
This implies that mutations vary between sites and from the original site. Thus, if testicular cancer metastasizes to the lungs, the cancer IS NOT equal.
