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Neoplasia Flashcards

1
Q

What is a neoplasm?

A

an abnormal growth of cells that persists after initial stimulation is removed

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2
Q

What is a malignant neoplasm?

What is a benign neoplasm?

A
  • it invades surrounding tissues and has potential to grow to distant sites (a cancer)
  • it remains localised and will not spread to other sites
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3
Q

What is a tumour

A

a clinically detectable lump or swelling

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4
Q

What is dysplasia?

A

a premalignant state where cells have disordered tissue organisation but not yet neoplastic- it is reversible (unlike neoplasms which are irreversible)

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5
Q

Give an example of a nonneoplastic tumour?

A

haematoma

abcess

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6
Q

Is neoplasia reversible?

A

no never :(

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7
Q

Describe the microscopic appearance of a benign vs maligant tumour?

A

benign: grow in confined area, have a pushing but defined outer margin, well differentiated (look like parent tissue)
malignant: irregular outer margin and shape and may show areas of necrosis and ulceration (if on surface), can be very well or very poorly differentiated

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8
Q

Describe the microscopic appearance of cells with poor differentiation (do not resemble parent tissue)

A
  • increasing nuclear size
  • decreasing cytoplasmic space
  • more mitotic figures (mercedes benz sign)
  • irregular shapes and sizes (pleomorphism)
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9
Q

What is the difference in appearance and prognosis or high vs low grade cancers?

A

high grade= poorly differentiated and worse prognosis

low grade= good differentiation and better prognosis

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10
Q

can dysplasia be asessed by level of differentiation?

A

yes - CIN1 to CIN3

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11
Q

What genes need to be mutated for a neoplasm to arise?

A
  • a tumor suppressor gene needs to be inactivated
    or
  • a proto- onco gene needs to be mutated to an oncogene (activated)
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12
Q

What is the difference between an initiator and a promotor?

A

initiator: substance that causes mutations - e.g.: smoking
promotor: substance that causes cell proliferation and so you get an expanded population of cells

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13
Q

How does a cancer arise/progress over time?

What 4 classes of regulatory genes are affected by these mutations?

A
  • Stepwise accumulation of complimentary mutations over time.
    1) Proto-oncogenes - mutated to oncogenes and encode oncoproteins which promote cell growth in absence of growth promoting signals (gain of function mutations)
    2) Tumour supressor genes - normally stop cell proliferation, mutations required to both alleles to cause loss of function (failure of growth inhibition)
    3) Apoptosis regulating genes - may lead to enhanced survival of cells
    4) DNA repair genes - loss of function mutations, inability to recognise and repair non-lethal genetic damage.
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14
Q

What features of a neoplasm does the new naming system take account of?

A

origin, benign or malignant, type of tissue formed and morphology

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15
Q

What tissue is affected if the prefix is:

  • leiomyo
  • osteo
  • fibro
  • chondro
  • lipo
  • glio
  • neuro
  • neurofibro
A
  • smooth muscle
  • bone
  • fibrous tissue
  • cartilage
  • fat
  • glial cells
  • neurones
  • nerve sheaths
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16
Q

What is the suffix for a benign neoplasm?

A
  • oma
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17
Q

What is the name for a benign neoplasm of epethilia?

A

papilloma

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18
Q

What is an adenoma?

A

benign neoplasm of a gland

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19
Q

What is the name for a malignant epithilal neoplasm?

A

carcinoma

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20
Q

What is the name for a malignant neoplasm of a gland?

A

adenocarcinoma

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21
Q

when is the suffix ‘-sarcoma’ used?

A

for a malignancy of connective tissue (chondrosarcoma, fibrosarcoma)

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22
Q

What is the difference between a leukaemia and a lymphoma?

A

leukaemia is malignancy of blood forming cells in bone marrow
lymphoma is malignancy of lymphocytes, mainly affecting lymph nodes

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23
Q

What is a myeloma?

A

malignancy of plasma cells

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24
Q

Where do germ line neoplasms arise?

A

from pluripotent cells of testis or ovaries

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25
What is a blastoma?
a malignant neoplasm of immature precursor cells, usually occurring in children
26
What is a burkitt lymphoma?
- B cell lymphoma associated with EBV and malaria, most common in africa
27
What is a ewings sarcoma?
malignant tumour of bone, that usually presents in childhood/ adolescence
28
What is hodgkins lymphoma?
a malignant lyphocyte neoplasm characterised by presence of reed- sternberg cells. It is less common and often less aggressive than non hodgkins lymphoma
29
What is kaposi's sarcoma?
a malignant neoplasm derived from vascular endothilium, commonly associated with AIDS and herpes virus 8- presents with red patches
30
What is a tetroma?
a neoplasm of germline origin that forms from ecto, meso or endoderm in embryological development. They most commonly occur in gonads and can have hair and teeth ect
31
What are the 4 steps to a neoplasm metastasising?
1) growth at primary site 2) enter transport system and lodge at secondary site 3) grow at secondary site to form new tumour (colonisation) 4) evade immune systems at all times
32
Describe the process of invasion of a secondary site
- altered adhesion to current location by changing e- cadherin and integrin expression - stromal proteolysis- degradation of basement membrane by expressing MMPs (matrix metalloproteinases) - change cytoskeleton to allow it to move more easily - take advantage of new environment (niche) created by non-neoplastic cells, which will provide proteases and growth factors - The Rho family of G proteins cause differential expression of integrin which helps it adhere later
33
What is a name for a cluster of cells that has managed to lodge at a secondary site but failed to grow into a clinically detectable tumour?
a micrometastesis
34
What is the clinical significance of micrometastases?
they lay dormant in apparently disease free people and they start to grow later on causing a relapse
35
Why may a clump of cells lodged at a secondary site fail to grow?
- immune attack - lack of angiogenesis - hostile secondary site
36
How can malignancies be transported around the body?
1) blood vessels 2) lymphatic vessels 3) fluid in body cavities (pleura, peritoneal, pericardial and brain ventricles)
37
If a metasteses spreads via blood, where will it often end up?
- liver - lungs - first capillary beds - also bone and brain
38
What phenomenon explains unpredictable spread of blood bourne tumours?
the seed- soil phenomenon | - they grow in favourable areas
39
by what systems do carcinomas tend to travel?
- lymphatics first | - then blood
40
by hat systems do sarcomas tend to travel?
- directly into blood stream
41
What neoplasms most commonly spread to the bone?
``` breast bronchus kidney thyroid prostate ```
42
What is meant by tumours having personailities
some are more aggressive and metastasise more early than others
43
Describe the local effects of tumours
- destruction of normal tissue - ulceration at surfaces lead to bleeding - compression of adjacent structures (lymphatics, veins) - blocking of tubes and orifices (bowel) - raised pressure due to growth or swelling (brain)
44
Describe the systemic effects of cancers? (benign neoplasms only have local effects)
- increased tumour burden leads to cytokine release: reduced appetite, weightloss, malaise, immunosurpression, thrombosis - in endocrine glands leading to hormone imbalences: eg prolactinoma - also: - neuropathies - skin problems and puritis - abnormal pigmentation - fever - myosistists (pain and weakness of muscles)
45
Which benign tumours can cause high serum calcium?
- parathyroid adenoma releasing more parathyroid so more bone breakdown, kidney reabsorbtion and GI absorbtion
46
Which cancers can cause high serum calcium?
- squamous cell carcinomas releasing PTHrp | - myeloma, osteosarcoma ect causing increased bone breakdown
47
What tumours can cause anaemia?
- myeloma (bone marrow) - leukaemia - bowel cancer- due to bleeding
48
How do maligancies cause weight loss?
release of cytokines: - loss of appetite - breakdown of muscle - higher metabolic rate
49
What are the risk factors for malignant melanoma?
- women - many naevi (moles/ birth marks) - short sharp bursts of intense sun exposure with severe sunburn especially in childhood - white skin - pesticide exposure - high socioeconomic group
50
How do malignant melanomas present?
- legions on skin that have changed in size, shape, colou - or that inflame, ooze, change in sensation or are larger than 7mm diameter - or that are assymeterical, have irregular boarders, have irregular colour - could present as breast, lymph node, lung or colon metastesis
51
What is a high risk complication of pancreatic adenoma?
- spread to liver causing jaundice and coagulation defects | - presentation will vary depending on glands effected
52
What is a carcinoid tumour?
cancer of neuroendocrine system of intestine | - can be found in appendix but also stomach, pancreas, breast or kidney
53
How do carcinoid tumours commonly present?
- pain on right side of abdomen - weightloss - palpable masses in abdomen - GI obstruction - tricuspid valve regurg fro heart failure - increased fibrosis, often leading to urether obstruction - trypotphan/ niacin deficiency (leads to hypoalbuminaemia) - also hepatomegaly
54
What are common complications of carcinoid tumours?
- appendicitis - bowel obstruction - carcinoid crisis- tumour outgrows blood supply and releases vasoactive substances causing tachycardia, cardiovasular collapse and altered mental state - metastasise - carcinoid syndrome- flushing after some food, diarrhoea, vomiting ect
55
What is a annular tumour?
one that encircles a lumen like a napkin ring
56
What is the difference between exophytic and endophytic growth?
exophytic is growth out from a surface, there are more commonly benign endophytic growth is growth inwards into the tissue
57
What is a kruckenburg tumour?
a tumour metastatic to the ovaries, usually arising from GI tumours- especially from the stomach
58
What is the difference between a polypoid tumour and a papillary tumour?
papillary tumours are finger like projections whereas polyps are exophytic masses on stalks
59
What is the macroscopic appearance of a tumour described as sessile?
they are raised exophytic tumours but flat
60
What is epethilial to mesenchyme transition?
the changes that occur to a neoplasm to allow it to become malignant- changes in cell adhesion, motility and ability to break down stromal tissue
61
What type of proteases do malignant cells secrete to degrade connective tissue?
metalloproteases (MMPs)
62
What does carcinomatosis mean?
extensive metatstatic disease - many carcinomas in many sites due yo
63
In which age group does osteosarcoma occur?
the young (10-20)
64
What are the microscopic differences between benign and malignant neoplasms ?
- benign has smaller nuclei and normal shapes - malignant cells have more nuclei: cytoplasm ratio - malignant has darker cytoplasmic staining as more nuclear stuff in nuclei - malignant has mitotic figures
65
What do reed sternburg cells look like? (From Hodgkin lymphoma)
They look like eggs/ boobs
66
What do squamous cell carcinomas look like?
There will be keratin in middle of islands | . (Circular islands with onion peel like centre )
67
What do adenocarcinoma look like ?
More glands, glands being made wheee they're not meant too be. Other than squamous carcinoma it is one of the one we should really be able to identify so can guess it is this if no keratin
68
What do malignant melanoma look like under microscope?
Skin with lots of more brown stuff in dermis
69
What is a fibroid are they common and what symptoms do they cause
Leimyoma in uterus Very common Cause infertility, pain, bleeding ect
70
Are teratomas often malignant in men and women
In men almost always in women rarely

Pathological processes (8 decks)

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