Neoplasia ( 5% ) Flashcards
- Dysplasia
- a. Is a feature of mesenchymal cells.
- b. Inevitably progresses to cancer.
- c. Is characterized by cellular pleomorphism
- d. Is the same as carcinoma in situ.
- e. Is not associated with architectural abnormalities.
- a. Can be a feature of any cell type
- b. may, but not necessarily, progresses to cancer.
- c. Is characterized by cellular pleomorphism
- d. Is a potential precurser to carcinoma in situ.
- e. Is associated with architectural abnormalities.
- Metastasis
- a. Unequivocally proves malignancy
- b. Is the most common presentation of melanoma.
- c. Is proven by lymph node enlargement adjacent to a tumour
- d. Of breast is usually to supraclavicular nodes.
- e. All of the above
- a. Unequivocally proves malignancy
- b. Skin lump Is the most common presentation of melanoma.
- c. Is proven by lymph node enlargement adjacent to a tumour
- Multiple causes including infection - does not mean it has spread past the node.
- d. Of breast is usually to axillary nodes - hence why axillary node dissections/SNB are performed for breast cancer
- e. All of the above
- Anaplasia is not characterized by
- a. Pleomorphism
- b. Abundant nuclear DNA
- c. A nuclear-cytoplasmic ratio of 1:6.
- d. Coarsely clumped chromatin
- e. Lack of differentiation
c. A nuclear-cytoplasmic ratio of 1:6.
This is normal
Anaplasia has a ratio closer to 1:1
- To which two organs do tumours most commonly spread haematogenously?
- a. Lungs and brain
- b. Liver and lungs
- c. Liver and bone
- d. Bone and brain
- e. Lung and bone
b. Liver and lungs
- With regard to characteristics of benign and malignant neoplasia
- a. Cells of benign tumours are poorly differentiated.
- b. Mitotic figures in benign tumours are common.
- c. Malignant tumours can be slow growing
- d. Malignant tumours are usually cohesive and expansile
- e. Malignant tumours often display structures typical of originating tissue.
- a. Cells of benign tumours maintain differentiation
- b. Mitotic figures in benign tumours are uncommon, as they grow slowly
- c. Malignant tumours can be slow growing (or fast growing. Up to the mutation)
- d. Malignant tumours are usually cohesive and expansile
- ?loosely bound and invasive
- e. Malignant tumours often lose structures typical of originating tissue - poorly differentiated
- With regard to malignant disease
- a. Arterial invasion by tumours is more frequent than venous.
- b. Ovarian carcinoma may spread transperitoneally to the liver
- c. The brain is a major site of lymphatic tumour spread
- d. Basal cell carcinomas frequently metastasise to bone.
- e. The most distinguishing feature of malignant disease is local tissue destruction.
- a. Arterial invasion by tumours is less frequent than venous.
- b. Ovarian carcinoma may spread transperitoneally to the liver
- c. The brain is largely spared from lymphatic tumour spread, as there are few lymphatics in the brain
- d. Basal cell carcinomas infrequently metastasise
- e. The most distinguishing feature of malignant disease is Metastasis
- Malignant neoplasms
- a. Are independent of hormonal influence.
- b. Are always composed of homogenous cell lines
- c. Arise from differentiated cells by a process of anaplasia.
- d. Display abnormal nuclei with pale nucleoli.
- e. Typically grow more rapidly than benign
- a. Are dependent on hormonal influence
- Different cells in the tumour may respond differently to growth factors etc. Breast cancer is under hormonal influnce, hence the use of tamoxifen etc
- b. Often have genetic variation with each division due to a high rate of mutations
- c. Anaplasia = loss of differentiation, not the process that gets there
- d. Display abnormal nuclei with dark nucleoli.
- e. Typically grow more rapidly than benign
- Regarding metastasis
- a. All carcinomas have the ability to metastasise
- b. Highly invasive carcinomas rarely metastasise.
- c. Carcinomas typically spread via lymphatics compared with haematogenous spread
- d. Tumour cells develop increased cohesiveness of their cell surface in the formation of cancer cell emboli.
- e. Cells involved in lymphatic dissemination release degradative enzymes
- a. All carcinomas have the ability to metastasise
- Typically, the use of the word ‘all’ in medicine often precludes an answer from being right
- b. Highly invasive carcinomas often metastasise.
-
c. Carcinomas typically spread via lymphatics compared with haematogenous spread
- Carcinoma = epithelial cell derived
- Sarcoma = mesenchymal derivation
- d. Tumour cells develop decreased cohesiveness of their cell surface in the formation of cancer cell emboli.
- Normal tissues dont just break off into the low pressure of lymph or veins
- e. Cells involved in lymphatic dissemination release degradative enzymes
- ???
- Neoplasia
- a. Shows nuclear pleomorphism
- b. Shows decreased nuclear-cytoplasmic ratio.
- c. Results when protogenes are activated.
- d. Involves proto-oncogenes in their natural form.
- e. Is initiated by a single genetic alteration.
- a. Shows nuclear pleomorphism
- b. Shows increased nuclear-cytoplasmic ratio
- 1:6 -> 1:1
- c. Results when protogenes are activated.
- Proto-oncogenes are involved, but it is not a one-step process to neoplasia
- d. Involves proto-oncogenes in their mutated form.
- e. Is initiated by multiple genetic alterations.
- Regarding the spread of cancers
- a. The pleural cavity is the most commonly affected body cavity
- b. Haematogenous spread is the most common pathway for the initial dissemination of carcinomas.
- c. Lymphatic spread is typical of sarcoma.
- d. Renal cell carcinoma often invades branches of the renal vein
- e. Nodal enlargement in proximity to a cancer always means dissemination of the primary lesion
- a. The pleural cavity is the most commonly affected body cavity
- Havent looked this up, but I assume peritoneum due to the number of organs in it
- b. Lymphatic spread is the most common pathway for the initial dissemination of carcinomas
- c. Haematogenous spread is typical of sarcoma.
- d. Renal cell carcinoma often invades branches of the renal vein
- e. Nodal enlargement in proximity to a cancer always means dissemination of the primary lesion
- Always/never = never the right fucking answer.
- Regarding benign versus malignant tumours
- a. Benign tumours are generally less differentiated.
- b. Large prominent nucleoli and a high nuclear-cytoplasmic ratio are characteristics of a malignant cell
- c. Benign tumours metastasise haematogenously.
- d. Malignant tumours always proliferate rapidly.
- e. Malignant tumours always metastasise
- a. Benign tumours are generally well differentiated.
- b. Large prominent nucleoli and a high nuclear-cytoplasmic ratio are characteristics of a malignant cell
- c. Benign tumours dont metastasis. Like, by definition.
- d. Malignant tumours may proliferate rapidly.
- e. Malignant tumours may metastasise.
Which of the following tumour is benign
- Chondrosarcoma
- Osteochondroma
- Chondroblastoma
- Ewing’s tumour
- None of the above
Osteochondroma
Which of the following is malignant
- Squamous cell papilloma
- Hydatidiform mole
- Chondroma
- Mature teratoma
- Bronchial carcinoid
Bronchial carcinoid
with regard to tumours
- dysplasia always progresses to cancer
- cystic teratomas are malignant
- squamous papillomas are benign
- the presence of mitoses indicates neoplasia
- hypochromasia is characteristic of anaplasia
squamous papillomas are benign
Features that help differentiate benign from malignant tumours include all except
- The degree of both morphological and functional differentiation of the cells
- The number of mitoses
- The presence or absence of a capsule
- The number of cells per unit area
- The formation of multinucleate giant cells
The number of cells per unit area
malignant neoplasms
- are undifferentiated
- almost always exhibit rapid growth
- are proven by discovery of metastases
- do not commonly exhibit mitotic figures
- are not locally invasive
Nick thinks ‘are proven by discovery of metastases’, but you do not need metastases to have a malignant neoplasm (are pathgnomonic though)
I think ‘are undifferentiated’, though they can range to ‘poorly differentiated’
The commonest cause of thyroid carcinoma is
- Medullary
- Follicular
- Papillary
- Anaplastic
- Squamous
Papillary
Regarding malignant neoplasms
- Breast cancer is the commonest cause of death in females 55-74yo
- There is no familial clustering of ovarian cancer
- There is reasonable evidence available linking benzene with lung cancer
- Rates of lung cancer have doubled in the last 40 years
- Brain tumours are the most common cancerous cause of death in the under 15yo
Rates of lung cancer have doubled in the last 40 years
Which is correct
- Spontaneous mutation is the most common process leading to tumour formation
- Genes that regulate apoptosis are not involved in tumour formation
- Some organs liberate chemoattractants that tend to recruit tumour cells to the site
- Substances which are highly mutagenic are labeled tumour promoters.
- All cell types are equally susceptible to radiation-induced cancer formation
Some organs liberate chemoattractants that tend to recruit tumour cells to the site
Substances which are highly mutagenic are labeled tumour Initiators
- tumour promoters encourage growth of a previously mutated cell*
- Rapidly dividing/highly metabolic cells are more* susceptible to radiation-induced cancer formation
concerning carcinogenesis
- most benign neoplasms, given enough time, will undergo malignant transformation
- anti-oncogenes are growth suppressed proto-oncogenes
- non-lethal genetic damage has little to do with carcinogenesis
- proto-oncogenes may become oncogenes by retroviral transduction (v-oncs) or by influences that alter their behaviour in situ, thereby converting them into cellular oncogenes (c-oncs)
- chromosomal translocation usually results in underexpression of proto-oncogenes
proto-oncogenes may become oncogenes by retroviral transduction (v-oncs) or by influences that alter their behaviour in situ, thereby converting them into cellular oncogenes (c-oncs)
Regarding oncogenes
- Their products are associated with metaplasia
- Proto-oncogenes are involved with normal cell growth and differentiation
- Proto-oncogenes are activated by one of 4 different mechanisms
- 40% of all human tumours carry mutated H-ras or K-ras oncogenes
- fibroblast growth factors play a role in SCC of the lung
Proto-oncogenes are involved with normal cell growth and differentiation
They are a normal part of cell function, but are called proto-oncogenes because a mutation in them can lead to cancer, not that they are inherently involved in cancer
There are 4 classes of gene that can be involved in being an oncogene:
Growth promotion, growth inhibition, DNA repair, or apoptosis inducing
The following viruses are considered to be oncogenic
- Hepatitis B
- Hepatitis C
- EBV
- HPV
- All of the above
All of the above
- Internal carcinoma is associated with which of the following skin disorders
d. acanthosis nigricans
d. acanthosis nigricans
In gastric, lung, uterine cancers
Dermatomyositis can occur in breast and uterine cancer
- All of the following are precancerous EXCEPT:
- a. Chronic gastritis or pernicious anaemia
- b. Solar keratosis
- c. Crohn’s disease
- d. Leukoplakia
- e. Chronic ulcerative colitis
- a. Chronic gastritis or pernicious anaemia - gastric cancer
- b. Solar keratosis - early SCC
-
c. Crohn’s disease - colorectal and small intestine cancer
- as per Nick. All seem to be able to cause cancer, but UC more carcinogenic than Crohns.
- d. Leukoplakia - oral cancers
- e. Chronic ulcerative colitis - colorectal cancer
- Staging of cancer
- a. T1 is insitu
- b. M1 may be blood borne mets
- c. N3 means goes to 3 nodes
- d. Is a universal staging system
- e. Grading more useful for clinical effect.
b. M1 may be blood borne mets
T0 = insitu cancer
N3 = multiple nodes involved, likely in different groups
Multiple staging systems used
Staging more clinically useful than grading (which is a histological diagnosis based on degree of differentiation etc)
- A 50yo woman presents with back pain, Xrays suggest a malignant deposit in T10. The least likely primary would be
- breast
- ovary
- thyroid
- kidney
- colon
kidney.
RCCs tend not to metastasise, but often paraneoplastic
Malignant lymphoma include all of the following except
- Hodgkin’s lymphoma
- Reed-Sternberg giant cell lymphoma
- Mycosis fungoides
- NHL
- Burkitt’s lymphoma
Reed-Sternberg giant cell lymphoma
Reed-Sternberg cells are found in Hodgkins lymphoma, they are not a seperate type
development of metastatic potential in melanoma is heralded by
- change in colour
- change in size
- nodule development
- change in the degree of pigmentation
- development of localized itchin
nodule development
Hypercalcaemia as a paraneoplastic syndrome is most associated with
- a. Small cell carcinoma of lung
- b. Adult B cell leukaemia/lymphoma
- c. Hepatocellular carcinoma
- d. Uterine carcinoma
- e. Renal carcinoma
e. Renal carcinoma
Rarely metastasise, but often cause paraneoplastic syndromes
Lung SCC -> Cushings
T-cell lymphoma/leukaemia -> hypercalcaemia (but B-cell not associated with PNPS)
Hepatocellular -> polycythaemia (as can RCC)
Uterine -> acanthrosis nigricans
- All of the following characterize familial tumours EXCEPT:
- a. Earlier age at onset
- b. Close relatives with same tumour
- c. Multiple or bilateral tumours
- d. Specific marker phenotypes
- e. Increased relative risk in siblings
d. Specific marker phenotypes
Familial tumours typically have a pre-mutated oncogene at birth (or something), so less mutations needed to cause cancer in life.
Thus multiple cancers more likely, and of course siblings and close-relatives more likely to be affected.
Can have earlier onset compared to others as time is not needed to cause the initial mutation.
