Neoplasia 2

Question 1

What are the most lethal features of malignant neoplasms?

Answer 1

Ability to invade and metastasise

Question 2

Outline the multi‐step journey of metastasis and why is this often hazardous for malignant cells

Answer 2

• Must evade destruction by immune cells at all points
• Grow and invade at primary site
• Enter transport system and lodge at a secondary site
• Grow at secondary site to form new tumour (colonisation)

Question 3

What alterations are required of malignant cells for successful invasion?

Answer 3

Altered adhesion - Reduce E-cadherin and changes in integrin expression

Stromal proteolysis - altered expression of proteases, mainly matrix metalloproteinases

Altered motility - changes in the actin cytoskeleton

(Invasion - also called epithelial-to-mesenchymal transition also)

Question 4

What is a niche?

Answer 4

Nearby non-neoplastic cells support malignant cells by providing growth factors and proteases at either the primary or secondary sites

Question 5

What are the different transport mechanisms by which malignant cells can metastasise?

Answer 5

Blood stream, lymphatic vessels, transcoelomic spread

Question 6

What determines the site of secondary tumour formation?

Answer 6

Regional spread‐ lymphatic to regional lymph node, blood to first capillary bed and coelomic to elsewhere in the coelomic cavity

Seed and soil phenomenon‐ depends on interaction between malignant cells and niche at secondary site

Question 7

List the common sites of blood borne metastases?

Answer 7

Lung, liver, brain, bone

Question 8

Where do secondary malignancies of bone often arise from?

Answer 8

Breast, kidney, thyroid, prostate, bronchus

Question 9

What are the potential local effects of neoplasms?

Answer 9

• Compression
• Ulceration, bleeding and perforation
• Invasion and destruction of tissue
• Obstruction or blockage of tubes and orifices

Question 10

What are the main causes of the systemic effects of neoplasms?

Answer 10

Tumour burden, hormones and miscellaneous

Question 11

What are the haematological systemic effects of neoplasms?

Answer 11

Anaemia, thrombus, DIC

Question 12

What are the dermatological systemic effects of neoplasms?

Answer 12

Puritis, change in pigmentation

Question 13

List some other systemic effects of neoplasm on the body

Answer 13

Neurological, fever, clubbing and myositis

Question 14

What is a micrometastasis and what happens when these become activated?

Answer 14

Surviving microscopic collections of malignant cells that have not undergone successful metastasis to form a tumour at a secondary site - Tumour dormancy

Can begin to grow again causing a relapse of a patient in remission as they were previously dormant

Question 15

What are the possible causes tumour dormancy?

Answer 15

• Immune attack
• Hostile niche at secondary tissue site
• Malignant cells not capable of angiogenesis at secondary site

Question 16

What is meant by paraneoplastic syndromes?

Answer 16

A paraneoplastic syndrome is a syndrome (a set of signs and symptoms) that is the consequence of cancer in the body but that, unlike mass effect, is not due to the local presence of cancer cells

Question 17

How does neoplasms lead to cachexia?

Answer 17

Increasing tumour burden leads to a parasitic effect on the host. Together with secreted factors such as cytokines this contributes to reduced appetite and weight loss (cachexia)