Introduction to Neoplasia Flashcards
What is the definition of neoplasia?
A tumor:
An abnormal mass of tissue, where the growth exceeds normal tissues, is uncoordinated, and persists in this pattern even after growth stimuli are removed
What are the two types of neoplasia? What is cancer?
- Benign
2. Malignant - maligant neoplasias are cancer
What are the two components of a neoplasm?
- Parenchymal cells - the actual neoplastic tissue
2. Stoma - the supportive connective tissue which also supplies the blood vessels
What is desmoplasia and what type of malignancy frequently utilizes this?
Dense, collagenous connective tissue most commonly induced by carcinomas (epithelial malignancies)
- > i.e. the dense breast tissue which can be palpated with breast cancer
- > reactive fibroblasts in response to malignancy
What are the normal suffixes for benign and malignant neoplasms? What type of malignancy are endothelial cells?
Benign = -oma
Malignant:
Epithelial (endoderm / ectoderm) = -carcinoma
Mesenchymal (mesoderm) = -sarcoma
Endothelial cells are part of blood vessels -> mesoderm / mesenchymal origin
What do prefixes and suffixes denote?
Prefixes - Differentiating parenchymal cell type
Suffixes - biological potential of parenchymal cells
What prefix is used for glandular epithelium?
adeno-
What prefix is used for squamous epithelium?
squamous cell
What prefix is used for fibrous tissue?
Fibro-
What prefix is used for adipose tissue?
Lipo-
What prefix is used for smooth muscle?
Leiomyo-
What prefix is used for skeletal muscle?
Rhabdomyo-
What prefix is used for mesenchymal neoplasm of blood vessels? Lymphatic vessels?
Blood vessels: Hemangio-
Lymphatic vessels: Lymphangio-
What prefix is given to tumors which form cystic structures?
Cyst-
What prefix is given to tumors which form multiple finger-like projections extending into a cystic space?
Papillary
What prefix is given to neoplastic cells which form a mass projecting above a mucosal surface?
Polyploid
like Polyps, extending over the surface of the GI lumen
What name would you give a benign neoplasm showing differentiation towards glandular epithelium in a cystic growth pattern?
Cystadenoma
What name is given for a malignancy showing differentiation towards melanocytic cells?
Melanoma
What name is given for a malignancy showing differentiation toward lymphocytic cells?
Lymphoma
What is a seminoma?
A malignancy of germ cells in the testis
What is the name for a malignancy of hematopoietic cells?
Leukemia
What is a mixed tumor? Give an example.
Neoplasm showing differentiation towards more than one cell type
-> fibroadenoma of the breast, would contain both fibrous connective tissue and glandular tissue
What is a teratoma? Is it benign or malignant?
A germ cell neoplasm comprised of elements from more than one germ cell layer, usually formed by tissues usually not found at the site of the neoplasm.
Can be benign or malignant.
What is the most common example of a teratoma?
Strange cellular components / maturation of cells in the gonads due to picking up some other germ cell layer during embryological development.
May manifest as fat and hair growing in the ovaries (fat = mesoderm, hair = ectoderm)
What is a choristoma?
Ectopic rest of normal tissue somewhere where it shouldn’t be
-> i.e. small nodule of pancreatic tissue developing on bowel
What is a hamartoma? Is it benign or malignant? Give an example.
A disorganized mass of mature tissue composed of cell types normally seen in that area
Benign
I.e. a jumble of cartilage, respiratory epithelium, and blood vessels seen in the lungs
What is the definition of differentiation for neoplasms?
Extend to which parenchymal cells of the tumor resemble their comparable normal cells, including morphology / function
At what state are benign neoplasms?
Well-differentiated, always
What are the four possible states of differentiation for malignant neoplasms?
- Well-differentiated - show a considerable degree of maturation towards normal tissue
- Moderately-differentiated - moderate maturation towards normal tissue type
- Poorly differentiated - very little maturation towards normal tissue type
- Undifferentiated - neoplastic cells do not seem to show any differentiation towards a normal tissue type
What is anaplasia?
The MORPHOLOGICAL alterations in malignant cells seen with loss of differentiation
Give eight changes that can occur in anaplasia (im so sorry matty).
- Pleomorphism
- Hyperchromatic nuclei
- Increased nuclear to cytoplasmic (N:C) ratio
- Abnormal nuclei - large or irregular
- Atypical mitotic activity
- Tumor giant cells
- Disorganized tissue architecture / cell orientation
- Ischemic / coagulative necrosis
What is pleomorphism?
Variation in size and shape of neoplastic cells and their nuclei
Why do malignant cells develop hyperchromatic nuclei in anaplasia?
Increased DNA in neoplastic cells, due to uncontrolled DNA replication and sometimes even an-euploidy (including at least 1 extra chromosome)
Why does the N:C ratio increase in anaplasia?
Larger nuclei and less cytoplasm due to increased cellular energy going into division rather than cellular function
What is meant by atypical mitotic activity?
Increased or abberrant mitoses -> will actually see multiple cell in a given high power field actively dividing, sometimes with chromosomal errors
What can cause ischemic necrosis in anaplastic malignancies?
Tumor is growing so fast that it loses blood supply -> areas become hypoxic and die of ischemic necrosis
What are some common alterations in function which can occur with loss of differentiation?
- Loss of normal function
- Acquisition of atypical function
-> Aberrant hormone synthesis
or
-> synthesis of fetal proteins
What would be an example of aberrant hormone synthesis by a neoplasm?
I.e. squamous cell carcinoma of the lung produces parathyroid hormone
or
Pancreatic islet tumor starts secreting gastrin
What would be an example of a fetal protein synthesized by a cancer?
Alpha-fetoprotein produced by hepatocellular carcinoma
What is the definition of dysplasia? How can it be classed?
Abnormal growth
-> a premalignant condition characterized by failure of normal maturation, loss of cell polarity, and some features of anaplasia, but confined to an epithelial surface
-> Classes as mild, moderate, or severe
How does dysplasia differ from fullblown cancer?
There is NO invasion yet through the basement membrane (no metastasis)
What is a full-thickness dysplasia called?
Carcinoma in situ (at site)
What influences the rate of neoplastic growth?
Hormone dependence, vascular supply, genetic alterations of tumor cell line (can be a great variation of growth rate even within a tumor subpopulation)
What type of malignancies tend to grow fastest?
Poorly differentiated malignancies grow faster than progressively more well-differentiated. Benign neoplasms tend to grow the slowest.
Why are benign neoplasms easy to remove surgically? Are malignancies the same?
They are cohesive and well-circumscribed, often surrounded by a fibrous capsule.
Malignancies are much more poorly delineated, invasive, and it’s difficult to determine the margins
What is the definition of metastasis?
Tumor implantation distant from the primary neoplasm
What factors determine the probability of metastasis?
- Histologic type of malignancy
- Degree of differentiation -> poorly = worse prognosis
- Level of host immune response to tumor
How do carcinomas typically tend to spread and why? What is the first site of metastasis?
Via lymphatic dissemination, as tumors penetrate into lymphatic vessels in epithelium.
First site of metastasis = regional lymph nodes.
I.e. Lung carcinoma = hilar and medastinal lymph nodes
What are “skip” metastases?
Skipping metastasis to the first lymph node due to alteration in normal drainage (usually due to surgery or radiation)
What will metastasis to a lymph node present?
Lymphadenopathy
What types of tumors spread via hematogenous spread? Do they enter venous or arterial circulation?
Carcinomas -> after lymph nodes
Sarcomas -> directly from mesenchymal cells (do not typically go to lymph nodes first)
Typically enter venous circulation first since walls are thinner
Where do the tumors typically spread in hematogenous involvement? State where colon cancer, breast cancer, renal cancer, osteosarcoma, and prostate cancer tends to spread to.
Via wherever the venous drainage goes to, seeding multiple little cancerous nodules
For example:
Colon cancer / Pancreatic cancer -> spread to liver via portal system
Breast cancer, renal cell carcinoma, osteosarcoma -> spread to lungs via systemic circulation
Prostate cancer -> spreads to vertebral bodies via paravertebral plexus
After cancer has been seeded at these new sites via hematogenous spread, where does it go?
Eventually, when these cancers grow, they seed cancers in arterial circulation (i.e. lung metastasis will seed systemic, multiple-organ involvement)
What cancers tend to seed entire body cavities with cancer?
Ovarian cancer -> peritoneal cavity
Lung cancer -> pleural cavity
Breast cancer -> mediastinum
Medullablastoma -> subarachnoid space
Little cancers all over the surface
What are the clinical features seen with seeding of body cavities?
- Collection of fluid -> ascites, pleural effusion, hydrocephalus, etc due to angiogenesis of tumor
- Accumulation of mucinous material -> for mucous-secreting tumors
What is grading vs staging? Which is of higher clinical prognostic value?
Grading - extent of differentiation.
Staging - extent of tumor growth / spread, more prognostically important
How is grading scaled?
grade 1 = well differentiated, grades 3 or 4 = poorly differentatied.
What is the TNM system for malignancy grading?
T = tumor size N = number of lymph nodes involved M = hematogenous metastases (yes or no = 1 or 0)
What is the staging system for malignancy grading?
Takes into account all three TNM variables for one value, stages 0-4, 4 being the worst
What are some examples of local effects of tumors?
Colon cancer obstructs lumen
Basal cell carcinoma leads to ulceration and bleeding of skin
What do malignancies do to the overall metabolic status of the patient?
They cause cachexia -> cytokines produced by macrophages &/or tumor cells = TNF, IL-1 -> decrease appetite and increase fat and muscle metabolism.
This leads to a wasting syndrome
How can tumors have hormonal effects?
Benign malignancies especially can overproduce hormone
I.e. parathyroid adenoma -> increased PTH
or
adrenal adenoma -> increased cortisol
What is a paraneoplastic syndrome?
Symptoms occurring in some patients with malignancies which cannot be accounted for by tumor growth / spread or endogenous hormone synthesis of the tissue
What is an endocrinopathy and give a few examples? What cancer type is notorious for this?
A pathology due to the producton of an ectopic hormone or hormone-like substance by a tumor of origin which shouldn’t have made it.
I.e. cushing syndrome in small cell lung cancer due to ACTH synthesis
ADH secretion in small cell lung cancer
Hypercalcemia due to PTH synthesis of squamous cell lung cancer
What is carcinoid syndrome?
An endocrinopathy with ectopic production of serotonin, leads to serotonin syndrome via cancer “carcinoid syndrome”
What is polycythemia?
Increased red blood cell mass in blood due to ectopic eythropoietin synthesis (normally made by interstital cells of kidney)
What is a neuromyopathy? Give an example
A paraneoplastic syndrome that results from producing antibodies to tumor cells which are cross-reactive
i.e. myasthenia syndrome, Abs against ACh receptor.
Give a dermatologic disorder which is a paraneoplastic syndrome?
Acanthosis nigricans -> metabolic syndrome of malignancy
What is hypertrophic osteoarthropathy?
Periosteal bone formation in distal long bones with arthritis and clubbing of finger tips, a paraneoplastic syndrome
What are some examples in which cancer can cause hypercoagulability paraneoplastic syndromes? Why does this happen?
Some cancers can secrete pro-coagulants
- Migratory thrombophlebitis
- Nonbacterial thrombotic endocarditis (NBTE)
- Disseminated intravascular coagulation (DIC)
What cancer do we always disinclude when talking about cancer incidences?
Skin carcinomas, since they’re so common.
Also carcinoma in situ (Except bladder)
What are the top three cancers in men and women?
Men:
- Prostate
- Lung
- Colon / rectum
Women: Replace prostate with breast
- Breast
- Lung
- Colon / rectum
What are the top three cancers causing death in men and women?
Men:
- Lung
- Prostate
- Colon / rectum
Women:
- Lung
- Breast
- Colon and rectum
Just 1 and 2 switch places for both because Lung cancer is very deadly
What cancer death rates have greatly increased and decreased among men / women in the past century and why?
Increased: Lung carcinoma in both men and women (increased smoking due to wars)
Decreased: Gastric cancer in both men and women (less smoked foods due to refrigeration)
Women alone -> decreased uterine and cervical cancer due to better screening
What is an example of how geographic differences can make a difference in what cancers you have?
Japanese people migrating to California had a much lower risk of gastric and hepatocellular carcinomas (which were endemic cancers in Japan) overtime,
but increased risk of colon and prostate cancers over time (which was were endemic cancers in USA)
What cancers does cigarette smoking increase your risk of?
Kidney Bladder Pancreas Lung Esophagus Head and Neck
What cancers does alcohol abuse increase your risk of?
Head and Neck
Esophagus
Hepatocellular Carcinoma (secondary to cirrhosis)
What environmental exposure increases your risk of cervical carcinoma?
Sexual promiscuity -> higher chance of HPV
What group has the overall highest burden of cancer deaths?
55-74 year olds
What types of malignancies tend to kill young people (<34 year old)?
Hematological / lymphatic malignancies, and especially breast cancer in women (15-34) from inherited cancer syndromes
-> not really the same types of cancer seen in older population
