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Year 2 > Invasion and Metastasis > Flashcards

Invasion and Metastasis Flashcards

1
Q

What is the role of the cell stroma

A

Provides:

  1. Mechanical support
  2. Intercellular signalling
  3. Nutrition to neoplastic cells
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2
Q

How does the stroma form

A
  1. Desmoplastic reaction caused by fibroblast proliferation
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3
Q

How does the storm assist in neoplasm formation

A
  1. Blood vessels contained in storm perfuse the tumour
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4
Q

What factor determines how quickly the neoplasm develops

A

Ability of blood vessels in the storm to persuade it

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5
Q

Why would neoplastic tumours be limited in growth If not vascularised properly

A
  1. Only relies on nutrient diffusion into it
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6
Q

When does a tumour stop expanding

A

Once it reaches 1-2 mm in diameter

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7
Q

When is angiogenesis induced

A

By VEGF

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8
Q

What factors oppose the effect of VEGF

A

Angiostatin and endostatin

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9
Q

What are the characteristics of tumours with a polypoid shape

A

Benign

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10
Q

HOW CAN ULCERATED TUMOURS BE DISTINGUISHED FROM NON-NEOPLASTIC UCLERS

A

THE FORMER HAS HEAPED-UP IRREGULAR EDGES

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11
Q

What are benign tumours capsulated by

A

Connective tissue

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12
Q

How does a polyp form

A

When a benign tumour arises in epithelial or mucosal surfaces, it grows away from the surface as it can’t invade

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13
Q

Define a sessile polyp

A

Sits on surface and is FLAT

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14
Q

Define a pedunculate polyp

A

When a poly grows away from mucosal surface to form a stalk structure

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15
Q

Why would a benign tumour still cause problems

A
  1. Pressure on adjacent tissues
  2. Obstruction of flow
  3. Production of a hormone
  4. Anxiety
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16
Q

What are patients with widespread metastases called

A

Carcinomatosis

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17
Q

Define an endophytic tumour

A

Inwards direction of growth into underlying tissue

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18
Q

Define histogenesis

A

Specific cell or tissue of origin of an individual tumour

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19
Q

What cells form sarcomas

A

Connective tissues

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20
Q

What cells form carcinomas

A

Epithelial cells

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21
Q

What cells form leukaemia

A

Lymphoid organs

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22
Q

What is the tumour grade

A

The extent to which the tumour resembles histologically to the tissue of origin (degree of differentiation)

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23
Q

Define dysplasia

A

Immature cells escape from basal cell layer

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24
Q

Define in situ carcinoma

A

Total loss of stratification, immature cells throughout + basement membrane intact

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25
Q

What is a cyst

A

Fluid-filled space lined by epithelium

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26
Q

What is a pleomorphic nuclei

A

Where nuclei can vary in shape and size

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27
Q

Define the three grades of malignant tumours

A
  1. Grade 1 - Well differentiated
  2. Grade 2 - Moderately differentiated
  3. Grade 3 - Poorly differentiated
28
Q

Why do neoplastic cells proliferate so much

A

They are immortal due to:
Autocrine growth: Abnormal expression of oncogenes
Intracellular signalling proteins
Inactivation of genes (tumour suppressor genes) that inhibit growth pathways
Reduced apoptosis due to abnormal expression of apoptosis inhibiting genes
Telomerase prevents telomeric shortening

29
Q

What are oncogenes

A

Genes capable of both initiation and continuation of malignant transformation of normal cells

30
Q

Define carcinogens

A

An environmental agent participating in the causation of tumours

31
Q

What are mutagenic

A

Acting on DNA

32
Q

What favours viral oncogenesis

A

Immunosuppression

33
Q

What aged people tend to be effected by viral tumours

A

Younger people

34
Q

What is the most important criterion for malignancy

A

Invasion

35
Q

Why do we take a wide margin around the tumour out as well during surgery

A

So that tumour cells do not remain there which can result in local recurrence

36
Q

What three factors effect tumour invasion

A
  1. Decreased cellular adhesion
  2. Secretion of proteolytic enzymes
  3. Abnormal or increased cellular motility
37
Q

How does gene expression play a role in metastasis

A

Altered expression of adhesion molecules can allows decreased cell-cell adhesion in carcinomas thereby allowing them to escape from sites of origin

38
Q

How is cellular motility of neoplasms abnormal

A

They are more motile and show a loss of normal mechanism that arrests or reverses normal cellular migration

39
Q

What proteinases are most important in neoplastic invasion

A

Matrix metalloproteinases

40
Q

What secretes matrix metalloproteinases

A

Malignant neoplastic cells, enabling them to digest the surrounding connective tissues

41
Q

What three major families of metalloproteinases are there

A
  1. Interstitial collagenases
    Gelatinises
    Stromelysins
42
Q

Role of interstitial collagenases

A

Degrade types I, II and III collagen

43
Q

Role of gelatinases

A

Degrade IV collagen and gelatin

44
Q

Role of stromelysins

A

Degrade type IV collagen and proteoglycans

45
Q

What are metalloproteinases inhibited by

A

TIMPs

46
Q

How is the net effect of metalloproteinases determined

A
  1. Balance between metalloproteinases and their inhibitors
47
Q

Where does invasion of metalloproteinases take place

A

Along tissue planes offering less resistance to tumour growth such as perineurial and vascular lamina

48
Q

What tissues are extremely resistant to neoplastic invasion

A

Cartilage and fibrocartilage of intervertebral discs

49
Q

Why is invasion easy to recognise in epithelial tumours

A

Because the basement membrane serves as a clear line of demarcation between tissue boundaries

50
Q

Why is invasion less easy to recognise in connective tissue tumours

A

Because you need a clear evidence for vascular or lymphatic permeation OR histological features such as mitotic activity

51
Q

Define metastases

A

Process where malignant tumours spread from their site of origin (primary tumours) to form other tumours (secondary tumours) at distant sites

52
Q

What is carcinomatosis

A

Extensive metastatic disease

53
Q

Does basal cell carcinoma metastasise

A

No

54
Q

Where does liposarcoma tend to metastasise to

A

Lung

55
Q

How is the survival rate of anapaestic carcinoma of the thyroid

A

LOW

56
Q

What are the steps involved in forming a successful metastatic tumour

A
  1. Detachment of tumour cell from neighbours
  2. Invasion of surrounding connective tissue to reach conduits of metastasis (blood vessels or lymphatics)
  3. Intraasation into lumen of vessels
  4. Evasion of host defence mechanisms, such as natural killer cells in the blood
  5. Adherence to endothelium at a remote location
  6. Extravasation of cells from vessel lumen into surrounding tissue
  7. Angiogenesis of tumour
57
Q

Describe haematogenous metastasis

A
  • Blood stream to form secondary tumours in organs perfused by blood that has drained from a tumour
58
Q

What carcinomas are favoured via bone in haematogenous metastases

A
  1. Lung
  2. Breats
  3. Kidney
  4. Thyroid
  5. Prostate
59
Q

How common is metastases of solid tumours to skeletal muscle or spleen

A

RARE

60
Q

How does metastases spread through the lymphatic system

A

1, Secondary tumours in regional lymph nodes

  1. Tumour cells reach the lymph nodes through afferent lymphatic channel
  2. Lymph nodes involved by metastatic tumours are firmer and larger than normal
  3. Lymph node metastases may interrupt lymphatic flow causing oedema in the territory they drain
61
Q

How is transcoelomic metastases caused

A
  1. In pleural, pericardial and peritoneal cavities where this results in a neoplastic effusion
  2. Fluid is rich in protein and may contain fibrin
  3. Fluid also contains neoplastic cells causing effusion
  4. Peritoneal effusions may be due to involvement of any abdominal tumour
62
Q

What is a neoplastic effusion

A

An abnormal amount of fluid collecting between pleura, caused by a tumour)

63
Q

What organ carcinomas are pleural and pericardial effusions common consequences of

A

Breast and lung

64
Q

Where do carcinomas tend to spread

A

Lymphatic over vessels

65
Q

Where do sarcomas tend to spread

A

Vessels over lymphatics

Year 2 (155 decks)

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