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General Pathology > Exam #2: Neoplasia III > Flashcards

Exam #2: Neoplasia III Flashcards

1
Q

Generally, how does local invasion occur?

A

Invasion & penetration of basement membrane leading to:

  • Invasion of adjacent organs
  • Penetration of the body cavity
  • Penetration of lymphatics
  • Penetration of small venules or capillaries
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2
Q

What are the four steps to the invasion of the ECM?

A

1) Detachment of the tumor cells from each other
2) Attachment to the matrix component
3) Degradation of ECM
4) Migration of tumor cells

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3
Q

Describe the process of detachment. What molecules normally mediate attachment?

A

E-cadherins attach tumor cells to each other; in many malignancies, E-cadherin is NOT produced

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4
Q

How do invasive tumor cells attach to the matrix?

A

Laminin & laminin receptors present

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5
Q

What enzymes facilitate degradation of the ECM?

A

Tumor cells release or fibrobasts/ inflammatory cells release collagenases (MMP) to degrade type IV–basement membrane– collagen i.e. the type IV collagenases

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6
Q

What facilitates migration of tumor cells?

A
  • Tumor binding to fibronectin

- Autocrine motility factors produced by tumor cells

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7
Q

What is the definition of metastasis?

A

Discontinuous tumor implantation to different sites, from the site of origin

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8
Q

Outline the four general steps of metastasis.

A

1) Invasion of basement membrane
2) Movement through ECM
3) Vascular dissemination
4) Homing

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9
Q

List the factors that facilitate vascular dissemination.

A
  • CD44 expression on tumor cells seems to favor metastasis

- Platelets protect the tumor cells in the blood

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10
Q

Describe how metastasis by lymphatic vessels occurs.

A

1) Passage to regional lymph nodes
2) Slow growth and passage along the lymph node chain
3) Embolism and drainage to the thoracic duct
4) SVC–>Blood stream
5) Circulation of cancer cells in the blood
6) Logement in capillaries at distant sites

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11
Q

What are the three routes of metastasis?

A

1) Seeding of body cavities
2) Lymphatic spread
3) Hematogenous spread

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12
Q

What cancers seed to the peritoneal cavity?

A

Ovarian cancer
Colorectal cancer
Pancreatic carcinoma

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13
Q

What cancers seed to the pleural cavity?

A

Primary lung cancer

Metastatic lung cancer

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14
Q

What cancers seed to the sub-arachnodid space?

A

Glioma

Glioblastoma

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15
Q

What is the most common method of metastasis? What types of cancer is this method of metastasis most commonly seen in?

A

Lymphatic spread

*****Note that this is more common in carcinoma rather than sarcoma

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16
Q

Describe the clinical presentation of lymphadeopthy associated with cancer.

A
  • Enlarged lymph nodes
  • Hard
  • NON-TENDER i.e. painless

**Tenderness is associated with inflammatory processes & is a good sign

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17
Q

How do carcinomas and sarcomas typically spread?

A

Carcinoma= lymphatic spread

Sarcoma= hematogenous

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18
Q

What are the exceptions to the lymphatic spread of carcinomas?

A

1) Folliclar carcinoma (local invasion)
2) Renal cell carcinoma (hematogenous)
3) Hepato-cellular carinoma (hematogenous)

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19
Q

What is the exception to the hematogenous spread of sarcomas?

A

Rhabdomyosarcoma

*****Note that this is malignant striated muscle neoplasm

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20
Q

What are the sites commonly involved in hematogeouns spread?

A

Tumor typically prefer to metastasize to low pressure areas in the veins, especially in the liver & lungs

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21
Q

What is the difference between an organ with a single mass vs. multiple gross masses?

A

Single= unlikely metastasis

Multiple= likely metastasis

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22
Q

What is central mass umbilication?

A

Central ischemic necrosis

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23
Q

What is the sentinel lymph node?

A

The first regional lymph node that receives flow from a primary tumor

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24
Q

How are sentinel lymph nodes detected?

A

Radio labeled tracers or blue dyes

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25
Q

What is the most common site for bony metastasis? Why?

A

Vertebral column b/c of a direct connection to the vena cava via the “Batson paravertebral venous plexus”

26
Q

What is the most common symptom of bone metastasis? How is this symptom best relieved?

A
  • Pain is the most common symptom experienced with bony metastasis
  • This pain is best treated with radiation therapy, NOT opoids
27
Q

What are the two types of bony mets?

A

Osteoblastic

Osteolytic

28
Q

How do osteoblastic & osteolytic mets appear on x-ray?

A

Osteoblastic= radiodense loci noted on x-ray

Osteolytic= radio-lucent

29
Q

What is the most common cancer to cause osteoblastic metastasis to the bone? How is this diagnosis confirmed?

A

Prostate

**Confirm with increased serum alkaline phosphatase (elevation is due to reactive bone formation)

30
Q

What is the most common cancer to cause osteolytic metastasis to the bone? What are common complications of osteolytic metastasis?

A
  • Breast cancer= most common cancer to cause osteolytic metastasis
  • Common complications include: 1) pathologic fractures & 2) hypercalcemia
31
Q

What cancer commonly metastasizes in Virchow’s left supraclavicular node?

A

Stomach adenocarcinoma

32
Q

What cancer commonly metastasizes in the lungs & bones?

A

Breast cancer

33
Q

What cancer commonly metastasizes in the liver?

A

Colorectal cancer

34
Q

What cancer commonly metastasizes in the lung?

A

Renal adenocarcinoma

35
Q

What cancer commonly metastasizes in adrenal glands and liver?

A

Lung cancer

36
Q

What cancer commonly metastasizes in liver & lung?

A

Melanoma

37
Q

What cancer commonly metastasizes in the bones?

A

Prostate cancer

38
Q

What cancer commonly metastasizes in para-aortic nodes?

A

Testicular tumors

39
Q

What is grading of a tumor? What is more important, grading or staging?

A

Both grading and staging have a significant impact on the management & prognosis, but staging is typically more important.

Grading= looking at the histological appearance of a tumor under a microscope to

40
Q

What are the conventional methods for grading? What is a newer method of grading with a molecular marker? What a high degree of BrdU uptake indicate?

A

Conventional:

1) determine the degree of differentiation
2) mitotic index

Newer:
- Brdu uptake–high grade tumor and poor prognosis are associated with BrdU uptake

**BrdU is a thymidine analog that is taken up into tumors that are in S-phase

41
Q

What is a Grade I tumor?

A

Well differentiated tumor that has a loss of polarity

42
Q

What is a Grade II tumor?

A

Moderately differentiated

43
Q

What is a Grade III tumor?

A

Poorly differentiated

44
Q

What is a Grade IV tumor?

A

Nearly anaplastic

45
Q

Outline the TNM system of staging.

A 
T= size of primary tumor 
N= nodal involvement 
M= distant metastases

*****The higher the numbers following the T, N, & M–the worse

46
Q

What is the Duke system for?

A

Staging colorectal cancer

47
Q

What is the Ann Arbor system for?

A

Staging Hodgkin & Non-Hodgkin Lymphoma

48
Q

What are the three most lethal cancers in men?

A

1) Lung & bronchus
2) Prostate
3) Colon & rectum

49
Q

What are the three most lethal cancers in women?

A

1) Lung & bronchus
2) Breast
3) Colon & rectum

50
Q

What are the three cancers that have the highest incidence in men?

A

1) Prostate
2) Lung & bronchus
3) Colon & rectum

51
Q

What are the three cancers that have the highest incidence in women?

A

1) Breast
2) Lung & bronchus
3) Colon & rectum

52
Q

What cancers are associated with geographical areas?

A
  • Gastric= Japan

- Skin= New Zealand & Iceland

53
Q

What is occupational exposure to arsenic associated with?

A

Lung cancer
Skin cancer
Hemangiosarcoma

54
Q

What is occupational exposure to asbestos associated with?

A

Lung cancer
Mesothelioma
GIT

55
Q

What is occupational exposure to nickel associated with?

A

Nose & lung cancer

56
Q

What is occupational exposure to radon associated with?

A

Lung cancer

57
Q

You are treating a patient that works in a textile/ rubber industry & is exposed to aniline dye. What cancer is this associated with?

A

Bladder cancer

58
Q

What is carcinoma of the oropharynx & lung associated with?

A

Cigarette smoking

59
Q

How does cancer frequency change with age?

A

Cancer increases with age, esp. carcinoma

60
Q

What are the tumor seen in young adults?

A

Leukemia
Lymphoma
CNS & soft tissue

61
Q

What are the tumors of infancy & childhood?

A

Blastomas (neuro, retino, nephro)
Acute leukemia
Rhabdomyosarcoma

General Pathology (33 decks)

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