L16 - neoplasm 2

Question 1

What’s a glioma?

Answer 1

A tumour that starts in the glial cells of the CNS

Question 2

Describe the 3 major stages that lead to metastasis.

Answer 2

1) Tumour cells must grow and invade at the primary site 2) enter a transport system and lodge at a secondary site (e.g/ lymph/blood) 3) Grow at a secondary site to form a metastasis

Question 3

What are thre three alterations to carcinoma cells required for invasion, these changes are described as the epithelial-to-mesenchymal transition

Answer 3

Altered adhesion/altered proteolysis/altered motility

Question 4

What specifically is responsible for the altered adhesion in malignant cells?

Answer 4

A reduction in E-Cadherin expression and altered integrin expression

Question 5

What is responsible for the altered protelysis by malignant cells?

Answer 5

An upregulation of expression of metalloproteinases which can degrade the stroma to invade.

Question 6

What is responsible for the altered motility of malignant cells?

Answer 6

Changes in actin in the cytoskeleton

Question 7

What are the three routes through which cancers can metastasise?

Answer 7

Blood vessels via capillaries and venules
lymphatic vessels
Transcoelomic - through the fluid in the body cavities e.g. peritoneal, pleua, pericardial, brain ventricles

Question 8

Define colonisation

Answer 8

This describes the stage of metastasis which is growth of the metastasis at the secondary site

Question 9

What are micrometastases?

Answer 9

Surviving microscopic deposits of malignant cells that fail to grow.

NOTE - when a malignant neoplasm relapses years later it is typically due to the micrometastases starting to grow

Question 10

Name and describe the two things that determine the site of a metastasis

Answer 10

1) Regional drainage - of blood, lymph or coelomic fluid.
2) The ‘seed and soil’ phenomenon - site of metastasis is dependent on interactions between the malignant cells and the local tumour environment (niche) at the secondary site

Question 11

Carcinomas typically spread via the ______ first. Whereas sarcomas tend to spread via the ______

Answer 11

lymphatics/bloodstream

Question 12

distinguish between a carcinoma and a sarcoma

Answer 12

Carcinomas are epithelial

Sarcomas grow in connective tissue

Question 13

Name two common sites of blood born metastases.

Answer 13

Brain/lung/bone/liver (all have good blood supply)

Question 14

The effects of a neoplasm can be classified as direct local effects of the neoplasm or its metastases. What is meant by indirect effects?

Answer 14

Effects as the result of indirect systemic effects caused by the neoplasm e.g. Secreted hormones or other miscellaneous effects NOTE - these are commonly referred to as paraneoplastic syndromes

Question 15

Give two of the four local effects of neoplasms

Answer 15

Compression of organs and adjacent strucutres/blocking of tubes and ducts/ulceration at the surface leading to bleeding/destruction of normal tissue

Question 16

Describe the systemic effects of neoplasms (paraneoplastic syndromes)

Answer 16

Hormone release and related effects

General effects - Increasing tumour burder can lead to cachexia (reduced appetite and weight loss), malaise,

Haematological - e.g. anaemia, immunosuppression, thrombosis, DIC

Neuropathies - affecting the brain and peripheral nerves

Dermatological - abnormal pigmentation, finger clubbing, pruritis (itchy skin)

Question 17

What is exophytic growth and what does it indicate?

Answer 17

Growth out from the surface - indicates that the tumour is non-invasive (benign).

Endophytic growth suggests invasion of the surrounding tissue and thus malignancy