Exam #2: Neoplasia III Flashcards
Generally, how does local invasion occur?
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
What are the four steps to the invasion of the ECM?
1) Detachment of the tumor cells from each other
2) Attachment to the matrix component
3) Degradation of ECM
4) Migration of tumor cells
Describe the process of detachment. What molecules normally mediate attachment?
E-cadherins attach tumor cells to each other; in many malignancies, E-cadherin is NOT produced
How do invasive tumor cells attach to the matrix?
Laminin & laminin receptors present
What enzymes facilitate degradation of the ECM?
Tumor cells release or fibrobasts/ inflammatory cells release collagenases (MMP) to degrade type IV–basement membrane– collagen i.e. the type IV collagenases
What facilitates migration of tumor cells?
- Tumor binding to fibronectin
- Autocrine motility factors produced by tumor cells
What is the definition of metastasis?
Discontinuous tumor implantation to different sites, from the site of origin
Outline the four general steps of metastasis.
1) Invasion of basement membrane
2) Movement through ECM
3) Vascular dissemination
4) Homing
List the factors that facilitate vascular dissemination.
- CD44 expression on tumor cells seems to favor metastasis
- Platelets protect the tumor cells in the blood
Describe how metastasis by lymphatic vessels occurs.
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
What are the three routes of metastasis?
1) Seeding of body cavities
2) Lymphatic spread
3) Hematogenous spread
What cancers seed to the peritoneal cavity?
Ovarian cancer
Colorectal cancer
Pancreatic carcinoma
What cancers seed to the pleural cavity?
Primary lung cancer
Metastatic lung cancer
What cancers seed to the sub-arachnodid space?
Glioma
Glioblastoma
What is the most common method of metastasis? What types of cancer is this method of metastasis most commonly seen in?
Lymphatic spread
*****Note that this is more common in carcinoma rather than sarcoma
Describe the clinical presentation of lymphadeopthy associated with cancer.
- Enlarged lymph nodes
- Hard
- NON-TENDER i.e. painless
**Tenderness is associated with inflammatory processes & is a good sign
How do carcinomas and sarcomas typically spread?
Carcinoma= lymphatic spread
Sarcoma= hematogenous
What are the exceptions to the lymphatic spread of carcinomas?
1) Folliclar carcinoma (local invasion)
2) Renal cell carcinoma (hematogenous)
3) Hepato-cellular carinoma (hematogenous)
What is the exception to the hematogenous spread of sarcomas?
Rhabdomyosarcoma
*****Note that this is malignant striated muscle neoplasm
What are the sites commonly involved in hematogeouns spread?
Tumor typically prefer to metastasize to low pressure areas in the veins, especially in the liver & lungs
What is the difference between an organ with a single mass vs. multiple gross masses?
Single= unlikely metastasis
Multiple= likely metastasis
What is central mass umbilication?
Central ischemic necrosis
What is the sentinel lymph node?
The first regional lymph node that receives flow from a primary tumor
How are sentinel lymph nodes detected?
Radio labeled tracers or blue dyes
What is the most common site for bony metastasis? Why?
Vertebral column b/c of a direct connection to the vena cava via the “Batson paravertebral venous plexus”
What is the most common symptom of bone metastasis? How is this symptom best relieved?
- Pain is the most common symptom experienced with bony metastasis
- This pain is best treated with radiation therapy, NOT opoids
What are the two types of bony mets?
Osteoblastic
Osteolytic
How do osteoblastic & osteolytic mets appear on x-ray?
Osteoblastic= radiodense loci noted on x-ray
Osteolytic= radio-lucent
What is the most common cancer to cause osteoblastic metastasis to the bone? How is this diagnosis confirmed?
Prostate
**Confirm with increased serum alkaline phosphatase (elevation is due to reactive bone formation)
What is the most common cancer to cause osteolytic metastasis to the bone? What are common complications of osteolytic metastasis?
- Breast cancer= most common cancer to cause osteolytic metastasis
- Common complications include: 1) pathologic fractures & 2) hypercalcemia
What cancer commonly metastasizes in Virchow’s left supraclavicular node?
Stomach adenocarcinoma
What cancer commonly metastasizes in the lungs & bones?
Breast cancer
What cancer commonly metastasizes in the liver?
Colorectal cancer
What cancer commonly metastasizes in the lung?
Renal adenocarcinoma
What cancer commonly metastasizes in adrenal glands and liver?
Lung cancer
What cancer commonly metastasizes in liver & lung?
Melanoma
What cancer commonly metastasizes in the bones?
Prostate cancer
What cancer commonly metastasizes in para-aortic nodes?
Testicular tumors
What is grading of a tumor? What is more important, grading or staging?
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
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?
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
What is a Grade I tumor?
Well differentiated tumor that has a loss of polarity
What is a Grade II tumor?
Moderately differentiated
What is a Grade III tumor?
Poorly differentiated
What is a Grade IV tumor?
Nearly anaplastic
Outline the TNM system of staging.
T= size of primary tumor N= nodal involvement M= distant metastases
*****The higher the numbers following the T, N, & M–the worse
What is the Duke system for?
Staging colorectal cancer
What is the Ann Arbor system for?
Staging Hodgkin & Non-Hodgkin Lymphoma
What are the three most lethal cancers in men?
1) Lung & bronchus
2) Prostate
3) Colon & rectum
What are the three most lethal cancers in women?
1) Lung & bronchus
2) Breast
3) Colon & rectum
What are the three cancers that have the highest incidence in men?
1) Prostate
2) Lung & bronchus
3) Colon & rectum
What are the three cancers that have the highest incidence in women?
1) Breast
2) Lung & bronchus
3) Colon & rectum
What cancers are associated with geographical areas?
- Gastric= Japan
- Skin= New Zealand & Iceland
What is occupational exposure to arsenic associated with?
Lung cancer
Skin cancer
Hemangiosarcoma
What is occupational exposure to asbestos associated with?
Lung cancer
Mesothelioma
GIT
What is occupational exposure to nickel associated with?
Nose & lung cancer
What is occupational exposure to radon associated with?
Lung cancer
You are treating a patient that works in a textile/ rubber industry & is exposed to aniline dye. What cancer is this associated with?
Bladder cancer
What is carcinoma of the oropharynx & lung associated with?
Cigarette smoking
How does cancer frequency change with age?
Cancer increases with age, esp. carcinoma
What are the tumor seen in young adults?
Leukemia
Lymphoma
CNS & soft tissue
What are the tumors of infancy & childhood?
Blastomas (neuro, retino, nephro)
Acute leukemia
Rhabdomyosarcoma
