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MoD > L22 - Behaviour of tumours > Flashcards

L22 - Behaviour of tumours Flashcards

1
Q

what is neoplasia?

A

● An autonomous proliferation of cells

● Loss of normal growth control

● Tumour: literally any swelling

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2
Q

what does benign mean?

A

No local invasion; no metastasis

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3
Q

what does malignant mean?

A

Local invasion and metastasis

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4
Q

what is hypertrophy?

A

enlargement in individual cell size

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5
Q

what is hyperplasia?

A

increase in number of cells

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6
Q

what is metaplasia?

A

replacement of mature tissue types/change from one type to another

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7
Q

what is dysplasia?

A

abnormality indicating precursor change of malignancy

cell types not where they’re supposed to be

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8
Q

what is anaplasia?

A

failure to differentiate

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9
Q

how do malignant tumours behave?

A
  • invasion
  • metastasis
  • angiogenesis
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10
Q

what is invasion?

A
  • invades adjacent structures

- destroys normal tissue

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11
Q

what is metastasis?

A

spread to distant sites/forms new tumours in new areas

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12
Q

what can cause a tumour to undergo invasion?

A

➢ Increased motility [from solid tissue to a mesenchymal]
➢ Decreased adhesion [lose tissue component]
➢ Production of proteolytic enzymes [to lose the fixed components keeping them in place]
➢ Mechanical pressure [can also cause local invasion]

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13
Q

what are the adhesion molecules that attach cell to cell?

A

cadherins

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14
Q

what are the adhesion molecules that attach cell to extracellular matrix?

A

integrins

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15
Q

what would happen if a mutation of e-cadherins was to occur?

A

loss of cell-cell adhesion and contact inhibition

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16
Q

what would happen if changes in integrin expression was to occur?

A

lead to decreased cell-matrix adhesion (cell would be mobile)

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17
Q

In cancer epithelial cells gain mesenchymal properties, what does this mean?

A

they can become loosely connected, able to migrate

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18
Q

which enzyme degrades collagen type I, II, III?

A

interstitial collagenases

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19
Q

which enzyme degrades collagen type IV and gelatin?

A

gelatinases

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20
Q

which enzyme degrades collagen type IV and proteoglycans?

A

stomolysins

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21
Q

collagen type I is the main component of what?

A

skin

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22
Q

collagen type II is the main component of what?

A

hyaline and cartilage

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23
Q

collagen type III is the main component of what?

A

bone

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24
Q

collagen type IV is the main component of what?

A

basement membrane

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25
Q

what are Proteolytic Enzymes?

A

Matrix Metalloproteinases

degrade extracellular matrix (allows local invasion)

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26
Q

how can benign tumours cause damage?

A

mechanical pressure

  • Pressure occludes vessels
  • Pressure atrophy

[Even though not malignant, surrounding tissues can be destroyed due to
compression of feeding vessels causing atrophy]

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27
Q

in metastasis which is often the most damaging tumour - the primary or secondary site?

A

Secondary tumour burden is often greater than that of the primary site

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28
Q

list routes of metastasis

A
  • lymphatic
  • blood
  • transcoelomic
  • implantation
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29
Q

what is meant by the transcoelomic route of metastasis?

A

Across peritoneal, pleural, pericardial cavities or in CSF

30
Q

what is meant by the implantation route of metastasis?

A

Spillage of tumour during biopsy/surgery [tumour can spread along the
needle tract]

31
Q

what are the stages of metastasis?

A 
➢ Detachment invasion 
➢ Intravasation 
➢ Survival against host defences 
➢ Adherence extravasation 
➢ Growth 
➢ Angiogenesis
32
Q

in the stages of metastasis, what is meant by intravasation?

A

[go into the blood stream]

33
Q

in the stages of metastasis, what is meant by adherence extravasation?

A

[gain pathway outside the blood vessel into a new host tissue]

34
Q

what route of metastasis do carcinomas usually take?

A

lymphatic spread first

35
Q

what route of metastasis do sarcomas usually take?

A

blood spread first

36
Q

where do bone mets often come from?

A 
breast 
prostate
 lung 
kidney 
thyroid
37
Q

which type of cancer commonly performs transcoelomic metastasis?

38
Q

brain and adrenal secondary sites are usually a result of which primary site?

39
Q

what are the two types of bone mets?

A

lytic (lung)

or

sclerotic (prostate)

40
Q

what is the mechanical hypothesis?

A

idea that cancer metastasis is dictated by anatomy

e.g. lymphatic drainage. Liver mets in GI cancer

41
Q

what is the seed and soil?

A

organ-preference patterns of tumor metastasis are the product of favorable interactions between metastatic tumor cells (the “seed”) and their organ microenvironment (the “soil”)

42
Q

what is angiogenesis?

A

New vessel formation

  • roles in development and healing
43
Q

what factors promote angiogenesis?

A

VEGF
PDGF
TGFβ

44
Q

what factors inhibit angiogenesis?

A

ECM proteins
Thrombospondin
Canstatin
Endostatin

45
Q

why do we stage and grade cancer?

A
  • determine prognosis (survival time, quality of life)
  • decide how to treat tumour
  • research
46
Q

what is meant by the stage of a cancer?

A

the extent of
spread

Stage = How far along the arrow the tumour is

47
Q

what is meant by the grade of a cancer?

A

how aggressive is the tumour?

Grade = How quickly the tumour progresses along the arrow

48
Q

what system is used to stage tumours?

A

TNM system

● T = TUMOUR
● M = METASTASES
● N = NODES

49
Q

with reference to TNM staging, what would you measure for T stage?

A

T = Size +/- extent of primary tumour

50
Q

with reference to TNM staging, what would you measure for M stage?

A

M0 - no distant mets

M1 - distant mets.

51
Q

with reference to TNM staging, what would M1 mean?

A

distant mets

52
Q

with reference to TNM staging, what would M0 mean?

A

no distant mets

53
Q

with reference to TNM staging, what would T4 mean?

A

tumour involves skin or chest wall

54
Q

with reference to TNM staging, what would T3 mean?

A

tumour is >5cm in size

55
Q

with reference to TNM staging, what would T2 mean?

A

tumour is 2-5cm in size

56
Q

with reference to TNM staging, what would T1 mean?

A

tumour is < 2cm in size

57
Q

with reference to TNM staging, what would Tis mean?

A

in situ disease (hasn’t spread yet)

58
Q

with reference to TNM staging, what would you measure for N stage?

A

N0 - no nodes
N1 - Ipsilateral nodes
N2 - >node involvement

59
Q

describe stage 0 breast cancer with reference to the TNM system?

A

Tis

treatment: surgery

60
Q

describe stage I breast cancer with reference to the TNM system?

A

T1, N0, M0

treatment: surgery and RT

61
Q

describe stage II breast cancer with reference to the TNM system?

A

T1-2, N1 or T3

treatment: surgery and chemo

62
Q

describe stage III breast cancer with reference to the TNM system?

A

T(any)
N2 or T4

treatment: chemo

63
Q

describe stage IV breast cancer with reference to the TNM system?

A

T(any)
N(any)
M1

treatment: chemo

64
Q

what is the treatment for stage 0 breast cancer?

A

surgery only.

65
Q

what is the treatment for stage I breast cancer?

A

surgery and RT

66
Q

what is the treatment for stage II breast cancer?

A

surgery and chemo

67
Q

what is the treatment for stage III and onwards breast cancer?

68
Q

with reference to dukes staging for colorectal cancer, what does A mean?

A

A = invades into, but not through bowel wall

A = >90% 5 year survival

69
Q

with reference to dukes staging for colorectal cancer, what does B mean?

A

B = invades through the bowel wall but with no lymph node metastases

B = 70% 5 year survival

70
Q

with reference to dukes staging for colorectal cancer, what does C mean?

A

C = Local lymph nodes involved

C = 30% 5 year survival

71
Q

with reference to dukes staging for colorectal cancer, what does D mean?

A

D = Distant metastases

D = 5-10% 5 year survival

72
Q

what factors is grading a tumour based on?

A

➢ Differentiation – how much does the tumour resemble tissue it originates from

➢ Nuclear pleomorphism and size

➢ Mitotic activity

➢ Necrosis [a sign of aggressive tumour i.e. tumour is outgrowing its own vascular supply]

NB: Grading performed by histopathologists - it is subjective

MoD (19 decks)

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