Neoplasia 2

Question 1

Describe the 3 steps of invasion and metastasis

Answer 1

Grow and invade at primary site
Enter a transport system and lodge at a secondary site
Grow at the secondary site to form a new tumour (colonisation)

Question 2

When is metastasis most likely to fail?

Answer 2

Entering a vessel and lodging at a distant site
OR
Growing at the secondary site

Question 3

Invasion involves which 3 important alterations?

Answer 3

Altered adhesion
Stromal proteolysis
Motility

Question 4

In carcinomas, what change happens upon invasion?

Answer 4

Epithelia-to-mesenchymal transition

Question 5

How is adhesion altered between malignant cells for invasion?

Answer 5

Reduction in E-Cadherin expression

Question 6

How is adhesion altered between malignant cells and stromal proteins in invasion?

Answer 6

Changes in integrin expression

Question 7

Which enzymes are used to degrade the basement membrane and stroma?

Answer 7

Matrix metalloproteinases

Question 8

What do we call the surrounding cells in the microenvironment that help with cancer invasion?

Answer 8

Niche

Question 9

How do we change motility?

Answer 9

Changes in actin cytoskeleton

Question 10

How does signalling through integrins occur?

Answer 10

Via small G proteins such as members of Rho family

Question 11

What are the 3 routes of transport for metastasis?

Answer 11

Blood vessels (capillaries and venules)
Lymphatic vessels
Body cavities - transcoelomic spread

Question 12

What are the 2 stages that malignant cells must achieve at the secondary site?

Answer 12

Extravasation (get out of the vessel)

Colonisation

Question 13

Define micrometastases

Answer 13

Surviving microscopic deposits of malignant cells that fail to grow

Question 14

Why might someone who has just has an organ transplant develop cancer?

Answer 14

They are taking immunosuppressant drugs

Any micrometastases in their/the donor organ(s) may begin to develop with the compromised immune system

Question 15

Tumour dormancy is usually due to which 3 things?

Answer 15

Immune attack
Reduced angiogenesis
Hostile secondary site

Question 16

What are the 2 most common sites of blood-borne metastases?

Answer 16

Lung
Liver
(Next capillary bed encountered)

Question 17

Describe the seed and soil phenomenon

Answer 17

Interactions between malignant cells and local tumour environment at the secondary site
There are patterns to where many cancers spread
Different cancers ‘prefer’ different areas

Question 18

How do carcinomas typically spread?

Answer 18

Lymphatics

Question 19

How do sarcomas typically spread?

Answer 19

Blood stream

Question 20

What are the 4 most common sites of blood-borne metastases?

Answer 20

Lung
Bone
Liver
Brain

Question 21

Cancers of which origins most commonly metastasise to bone?

Answer 21

Breast 
Bronchus
Kidney 
Thyroid 
Prostate

Question 22

What effect does prostate cancer have on bone?

Answer 22

Increases bone production

Question 23

Give an examples of an aggressive tumour that often metastasises early

Answer 23

Small cell bronchial carcinoma

Question 24

Give an example of a tumour that almost never metastasises

Answer 24

Basal cell carcinoma of skin

Question 25

What is the likelihood of metastasis related to?

Answer 25

Size of the primary neoplasm

Question 26

Describe some local effects of tumours

Answer 26

Direct invasion and destruction of normal tissue Ulceration at a surface, leading to bleeding Compression of adjacent structures Blocking tubes or orifices

Question 27

Give examples of some of the systemic effects that an increased tumour burden can have

Answer 27

Reduced appetite and weight loss Malaise Immunosuppression Thrombosis

Question 28

What do we call extreme weight loss and loss of appetite?

Answer 28

Cachexia

Question 29

Which hormones are most commonly secreted by tumours?

Answer 29

ACTH ADH PTH like hormone

Question 30

Name some of the miscellaneous systemic effects of tumours

Answer 30

``` Neuropathies Skin problems Fever Myositis Clubbing ```

Question 31

Describe some features of astrocytomas

Answer 31

More common in children Most common glioma Unlikely to metastasise Locally aggressive

Question 32

Are malignant melanomas likely to metastasise?

Answer 32

Yes | Early

Question 33

What are the most common sites for malignant melanoma to metastasise to?

Answer 33

Skin Brain GI tract

Question 34

What is another name for a carcinoid tumour?

Answer 34

Neuron doctrine/endocrine tumour

Question 35

What is the most common and 2nd most common sites of carcinoid tumours?

Answer 35

Most common = appendix | 2nd = small bowel

Question 36

What is carcinoid syndrome?

Answer 36

``` Effects of extensive metastasis of neuroendocrine tumours Tachycardia Sweating Skin flushing Anxiety Diarrhoea ```

Question 37

Which chemical mediators are responsible for carcinoid syndrome?

Answer 37

Serotonin | Prostaglandins

Question 38

What is a very important risk factor for carcinoma of the pancreas?

Answer 38

Cigarette smoking

Question 39

Why does carcinoma of the pancreas usually have a poor prognosis?

Answer 39

Symptoms occur at a late stage therefore not detected until late on (Weight loss and obstructive jaundice)

Question 40

What is Trousseau's sign?

Answer 40

With carcinoma of the pancreas, often patients develop venous thromboses

Question 41

Name 3 symptoms of lung cancer

Answer 41

Breathlessness Pain on breathing Hoarseness

Question 42

Which 3 sites are most likely to lead to secondary lung tumours?

Answer 42

Breast Kidney GI tract