Neoplasia 1 Flashcards
What are the two patterns of neoplastic growth?
Benign and Malignant
Malignant tumor metastasis?
cellular event and grading + staging
tumor progression
dysplasia and carcinoma in situ
What are the terms involved with neoplastic disease?
- adaptive responses vs. neoplasia
- neoplasm
- tumor
- oncology
- cancer
- oncogene
What are adaptive responses?
- cellular growth pattern responds normally to signals that control growth
- stimulus can lead to hyperplasia
- ex: callouses on the hand, working out and getting big muscles
What is neoplasia?
- the failure of the normal mechanisms, that control cellular proliferation and maturation
- permanent alteration of the normal cellular growth pattern
What is an example of neoplasia?
verruca vulgaris (Warts)
What is the definition of neoplasia?
- a state of poorly regulated cell growth
- neoplastic cells are “transformed”
What does neoplasm mean?
“new growth” (benign or malignant)
What is a tumor?
It is a “swelling” or a mass of neoplastic cells
What is oncology?
clinical study of neoplasia
What is an oncogene?
It is the key gene that controls cell growth.
It turns on and off neoplastic diseases.
What is cancer?
A malignant tumor
( latin “crab” bc it has pincer like outgrowth).
It does not describe biological behavior
(slow growing and indolent vs. rapid spread to many parts of the body and cause rapid death)
*What do genetic alterations in neoplastic cells result in?
-permanent alterations of the normal cellular growth pattern (growth in absence of any continued external stimulus)
-majority of tumors have alterations in oncogenes
(these genetic changes are transmitted to each new generation of cells within the cytoplasm)
What are 2 main patterns of neoplastic growth
benign and maligant
*What is a benign neoplastic growth?
- origin of cell type is clear
- margins of tumor are well defined
- neoplastic cells grow only locally
- generally have a good prognosis and only rarely lead to death
*What is a malignant neoplastic growth?
- cell origin may be difficult to determine
- margins of tumor are poorly defined
- neoplastic cells growing into and destroying surrounding tissues
- major cause of death (mortality)
What tumor has cells can migrate to different areas of the body (metastasis)?
malignant
malignant tumor
- growth is not confined to the site of origin
- cells grow into normal tissues (invasion)
What are the variable degrees of differentiation for malignant neoplasms?
- well differentiated (closely resemble tissue of origin)
- poorly differentiated (only a passing resemblance to tissue of origin)
- anaplastic malignant neoplasm (not possible to identify the cell of origin by microscopic examination of cell morhology)
*What are the 4 ways of failure of differentiation in neoplasia (cytologic atypia)?
- cellular pleomorphism
- nuclear pleomorphism
- nuclear hyperchromatism
- increased nuclear: cytoplasmic ratio
*What is cellular pleomorphism?
increased variation in shape and size of cells (dark vs. clear cells)
What is nuclear pleomorphism?
increased variation in shape and size of nuclei
*What is nuclear hyperchromatism?
increase in density of staining and nuclei (cell has a great big nucleus!)
*What is an increased nuclear: cytoplasmic ratio?
disproportionately large increase in the size of nuclei rleative to the size of the cell cytoplasm
*A tumor is composed of genetically abnormal neoplastic cells and a normal support tissue component
- poorly differentiated lesions
- -> induction of stroma may be poor and outstripped by proliferation of neoplastic cells–> leads to necrosis of cells in the center of a tumor mass
- desmoplasia
*What is desmoplasia?
tumor induced stromal response disproportionate to the number of tumor cells (collagen becomes very thick and dense)
*What are the two angiogenic factors
Vascular endothelial growth factor (VEGF) and Basic fibroblastic growth factor (BCGF)
*What is the Vascular Endothelial Growth Factor?
acts on endothelial receptors to induce endothelial cell growth, migration and vessel formation
*What is the basic fibroblastic growth factor (BFGF)?
induces endothelial cell growth, migration
What are angiopoietins ?
protein growth factors that promote angiogenesis, the formation of blood vessels
What are the factors of growth rate of neoplasms?
- proportion of cells in cell cycle (proliferating ) vs. those in G0 of cell cycle (non-proliferating)
- Death rate of cells in the tumor–> if genetic change allows cell to escape from growth control by programmed cell death (apoptosis) then they tend to grow rapidly
- adequacy of supply of nutrients to the tumor derived from induction of the stroma
*What are the most frequent systemic effects of metastasis?
- weight loss
- loss of appetite
- fever
- general malaise
- anemia
What is paraneoplastic sydrome (a symptom of metastasis) ?
-NOT the result of direct effects of the tumor or of metastases
-ectopic hormone secretion (certain tumors derived from non-endocrine cells can secrete hormones)
e.g. production of a parathormone-related product
(occurs in lung tumors derived from squamous epithelium results in hypercalcemia)
Grading
- analysis of degree of differentiation and growth pattern of the tumor
- determined by histologic assessment of cellular morphology
staging
evaluation of how far a tumor has spread
*Grading
- degree of differentiation compared to tissue of origin
- pleommorphism
- mitotic index= number of cells containing mitotic figures; crude indication of rate of cell proliferation (X/10 HPF)
What structure are exhibited in well differentiated carcinomas of the breast?
resemble small ducts or gland- like spaces and has small number of mitosis
What structures are exhibited in poorly differentiated carcinomas of the breast?
would not exhibit any glandular pattern but has many mitoses
*What is staging?
- the most important indicator of likely prognosis and of appropriate therapy
- different staging schemes for individual tumor types-in general, T,N,M system is applied
*TNM system
T= size and extend of primary tumor (number varies according to site) N= lymph node involvement; the higher the number the greater the extent of involvement M= extent of distant metastasis
*tumor progression
normal-> dysplasia-> in situ neoplasm (full thickness)-> invasive neoplasm
*dysplasia progression
over time MAY proceed from milkd–> moderate–> severe–> in situ–> invasive neoplasia
Is dysplasia a neoplastic condition?
NO, removal of the adverse environmental stimulus responsible often allows restoration of the normal cell growth pattern
malignant
tissue of origin takes the suffix
- sarcoma
- chrondrosarcoma-malignant tumor of cartilage
What does staging do?
Predicts survival and determines treatment
indolent
wanting to avoid activity
Why are neoplastic cells immortal?
they don’t respond to normal regulations that kick cells out
What kind of neoplastic growth is difficult to differentiate its cell line?
malignant
What neoplastic growth looks like the cell it came from?
benign
What neoplastic growth have a good prognosis and rarely lead to death?
benign
what neoplastic growth have neoplastic cells that grow locally?
benign
What neoplastic growth has well defined margins?
benign
What neoplastic growth have poorly defined margins?
malignant
What neoplastic growth has neoplastic cells growing into and destroying surrounding tissues?
malignant
what neoplastic growth is the major cause of death?
malignant
Is the degree of malignant neoplasm differentiation related to its behavior?
Yes, if it is poorly differentiated, it is more aggressive
WHAT EPITHELIAL GROWTH PATTERN IS EXOPHYTIC (grows outward?
benign
what epithelial growth tumor grows edophytic (inwardly)
malignant
what tumor has many mitoses?
malignant
What are other tumors related to weakness of muscles, malfunction of peripheral nerves, or cerebella ataxia
paraneoplastic syndomes
- due to autoantibodies generated to tumor cells
- antibodies cross react with normal tissues and cause immune mediated damage
What 3 factors are we assessing during staging?
- size of primary tumor
- degree of local invasion (has to do with lymphoid spread)
- extend of metastasis
How are dysplastic conditions usually treated?
surgical removal or ablation of affected tissue to minimize the risk of subsequent malignancy
What is dysplasia?
cells exhibit an increased rate of cell division and incomplete maturation
What tends to exhibit increased cytologic atypia (increased N/C ratio and number of mitosis)
dysplasia
What are the epithelial tissues subject to chronic irritation that dysplasia most frequently arises in?
lung, bladder, colon, oral mucosa
-if stimulus removed, it is reversible up to a certain point
Epithelial neoplasm of Carcinoma-in-situ
shows cytological features of malignancy
-not invasive upon histological exam
What represents a very early stage of neoplasia?
carcinoma-in-situ
-molecularly genetic abnormalities for invasion/metastasis have not yet developed
At what stage is it important to diagnose?
carcinoma-in-situ
- if left alone, CIS will become invasive
- treatment at this stage may cure
