Exam 3/Lecture 1 Flashcards
- What is a tumor?
- What is neoplasm?
- What is cancer?
- What is benign?
- What is oncology?
- Tumor: A swelling of any sort but modern usage equates this term with a neoplastic mass.-> does not tell you if it is benign or mal.
- Neoplasm (from Greek “new growth”): An abnormal mass the growth of which is purposeless, autonomous
- Cancer: Synonymous with malignant neoplasm
- Benign: Not life threatening
-
Oncology (from Greek “mass or tumor”): The study of
neoplasms
Tissue of origin: Epithelium
* What is it called when surface epithelium (non-gland) and glandular tissue is benign or malignant?
Label and explain
Label and explain
What is exophytic and endophytic growth?
- Exophytic: projecting above a mucosal lining (into lumen/outward)
- Endophytic: growing inward into a submucosal stroma (into tissue)
How do polyps grow?
- Polyps can grow as flat or ‘sessile’ structures, single mass
- Polyps can also grow as pedunculated polyps having a stalk
What does the stalk contain in polyps?
Stalk contains a ‘fibrovascular core’ (red arrow) consisting of fibrous tissue for support and vascular blood supply
T/F: Most polyps are benign, but some can become malignant
True
- What are papillomas?
- What does it consist of?
- What is not found?
- Papillomas are outward wart-like growths
- Consist of extensions of epithelial layer into fingerlike projections
- No fibrovascular core as found in polyps ⭐️
Clinical-Pathological Features of Neoplasia
What is the different btwn a benign tumor and malignant tumor?
Benign Tumor Capsule vs Malignant Tumor Edge
What does benign tumor of salivary gland do?
Benign tumor of salivary gland (top) is smooth, regular. It doesn’t destroy neighboring tissue
Malignant cancer of palate does what?
irregular, destroys local tissues resulting in ulceration and bleeding
By destroying neighboring tissues, cancers cause what?
ulceration, bleeding and tissue death (necrosis)
What does a benign tumor of the breast?
Benign tumor of breast (top, red arrow) is smooth, regular. It doesn’t destroy neighboring tissue, may just push against it.
What does malignant cancer of breast look like?
Malignant cancer of breast (bottom, blue arrow) is irregular, destroys local tissues resulting in ulceration and bleeding that leads to tissue death/necrosis)
Benign tumors are _ & _
Benign tumors are circumscribed & mobile
While malignant cancers invade tissue and metastasize (travel) to distant sites, this is not what?
While malignant cancers invade tissue and metastasize (travel) to distant sites, this is not ‘tumor mobility’. If you tried to grab this malignant skin cancer, you would not be able to hold it and ‘wiggle’ it. Therefore, it is not mobile.
you would be able to grab hold of this benign skin tumor (bottom) and what? Then the benign tumor is mobile
In contrast, you would be able to grab hold of this benign skin tumor and ‘wiggle’ it. Therefore, this benign tumor is mobile.
Note that all benign skin moles are what?
well circumscribed, uniform and homogenous in appearance & color
all malignant skin cancers (melanomas) are what?
are irregular in shape, heterogeneous in pattern & color
- Compared to normal cells, malignant breast cancer cells (below) are more what?
- Malignant cells often appear what?
- Compared to normal cells, malignant breast cancer cells (below) are more ‘atypical’ in appearance
- Malignant cells often appear heterogeneous (pleomorphic )
In support of their enhanced proliferative & metabolic capacities, malignant cells typically present with what?
increased numbers of nucleoli and mitotic figures (metaphase mitotic spindles – bottom right)
What are the microscopic features of neoplasia?
* Nuclear-cytoplasmic ratio, is relative size of nucleus to cytoplasm (N/C)-> Key to mal cancer cells
* As cells progress from normal to malignant morphology, N/C ratio increases because nucleus enlarges amount of cytoplasm decreases
* NC ratio is a better predictor of malignancy than increased nuclear size
What are morphological/proliferative changes with malignant progression
Morphological/proliferative changes with malignant progression Following physiologic stresses, pathologic stimuli or genetic changes cells undergo morphologic changes (adaptive changes):
* Hypertrophy, Atrophy, Hyperplasia, Metaplasia, Dysplasia, Anaplasia
What morphological and proliferative changes are reversible and nonreversible?
- Early hyperplasia, metaplasia and dysplasia can be reversible, but in prolonged states can lead to malignant transformation
- Anaplasia is not reversible
- What is hyperplasia, dysplasia and anaplasia?
- What does it look like in cervical epithelium?
- Hyperplasia (potential precursor of dysplastic lesions): organ/tissue enlargement by increased orderly & normal cellular proliferation
- Dysplasia: disorderly cellular proliferation with loss of maturation, architectural orientation and polarity, with acquisition of nuclear changes of malignancy
- Anaplasia: Loss of structural differentiation, correlates with tumor aggressiveness
- Increased N/C ratio with disease progression
Label and explain
Label the different tissues of the respiratory tract
What is a grade and stage of tumors?
- Level of differentiation, or grade (what it looks like histo), and extent of spread of cancer within the patient, or stage (anatomically, how it spreads), are parameters of clinical gravity of disease
- Grading of cancer is based on degree of histologic differentiation of tumor cells and, in some cancers, number of mitoses or architectural features
- Grading (I-III) is indicative of tumor aggressiveness/patient prognosis
Tumor Grading (Colon Adenocarcinoma)
- Cancer >1-2mm3 requires what?
- What is a major player of this?
- Cancer >1-2mm3 requires blood vessel support
- Vascular endothelial growth factor (VEGF) as a major playe
With invasion and metastasis for cancer stages, Cell-cell connections are lost by what?
Cell-cell connections are lost by the inactivation of E-cadherin through a variety of pathways
What happens to the basement mebrane with Invasion and Metastasis?
Basement membrane and interstitial matrix degradation is mediated by tumor secreted proteases (Matrix metalloproteinases and cathepsin D, and urokinase plasminogen activator).
– MMP9 Gelatinase (IV collagenase)
What degrades IV collagen
– MMP9 Gelatinase (IV collagenase)
Proteolytic enzymes of metastasis also releases what?
Proteolytic enzymes also release growth factors into the ECM that are angiogenic, growth promoting and chemotactic
What are the cancer stages?
- Stage 0: carcinoma in situ (cervical epithelium)
- Stage 1: cancer limited within organ/tissue of origin (cervix)
- Stage 2: regional spread of cancer (pelvis)
- Stage 3: greater than regional anatomical cancer spread (abdomen)
- Stage 4: cancer spread to distant organs (colon, lung, brain)
What is dysplasia and carcinoma in situ?
- Dysplasia: disorderly cellular proliferation with loss of maturation, architectural orientation and polarity, with acquisition of nuclear changes of malignancy, basement membrane intact
- Carcinoma in situ or intraepithelial neoplasia: neoplastic cells involving the full thickness of an epithelium, does not invade basement membrane
Officially designated ‘cancer’ when malignant cells do what?
traverse (break through) basement membrane
What is Cancer Staging: Progression of Cervical Intraepithelial Neoplasm (CIN)?
- Growth (red) limited to basal layer of normal squamous stratified cervical epithelium
- CIN1 – mild changes; bottom-third of epithelium, ‘low grade’, not cancer
- CIN2 – moderate changes; 2/3 of thickness of epithelium, ‘high grade’, not cancer
- CIN3 – more severe changes, full thickness of epithelium, ‘high grade’, not cancer
- CIN1-3 all Cervical Intraepithelial Neoplasia (CIN) bz basement membrane intact ‘Carcinoma in situ’ or ‘Intraepithelial neoplasm’ = Stage 0
T/F: Tumor nomenclature alone is enough to predict tumor biology and behavior
FALSE: It is NOT enough
A patient with prostate carcinoma may live several years, but the survival of patients with pancreatic carcinomas is usually measured in what?
Months
Molecular defect of similar tumors may not be identical and, thus what needs to happen?
Molecular defect of similar tumors may not be identical and, thus, each tumor must be thought as a potential different disease probably both at the molecular and clinical level