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Pathological Processes > Neoplasia > Flashcards

Neoplasia Flashcards

1
Q

What is a neoplasm?

A

A neoplasm is, “An abnormal growth of cells that persists after the initial stimulus is removed”.

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2
Q

What is a tumour?

A

A tumour is any clinically detectable lump or swelling. A neoplasm is just one type of tumour.

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3
Q

What is a malignant neoplasm?

A

For malignant neoplasms: “an abnormal growth of cells that persists after the initial stimulus is removed AND invades surrounding tissue with potential to spread to distant sites”. A cancer is any malignant neoplasm.

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4
Q

What is a metastasis?

A

A metastasis is a malignant neoplasm that has spread from its original site to a new non-contiguous site. The original location is the primary site and the place to which it has spread is a secondary site.

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5
Q

What is dysplasia?

A

Dysplasia is a pre-neoplastic alteration in which cells show disordered tissue organisation. It is not neoplastic because the change is reversible.

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6
Q

How are benign and malignant neoplasms different in their behaviour?

A

Benign neoplasms remain confined to their site of origin and do not produce metastases. Malignant neoplasms have the potential to metastasise

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7
Q

How do being and malignant neoplasms differ in their appearance to the naked eye?

A

Benign tumours grow in a confined local area and so have a pushing outer margin. This is why they are so are rarely dangerous. Malignant tumours have an irregular outer margin and shape and may show areas of necrosis and ulceration (if on a surface)

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8
Q

How do being and malignant neoplasms differ in their appearance microscopically?

A

A benign neoplasm has cells that closely resemble the parent tissue, i.e. they are well differentiated. Malignant neoplasms range from well to poorly differentiated.

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9
Q

What are the characteristics of poorly differentiated cells?

A

With worsening differentiation individual cells have increasing nuclear size and nuclear to cytoplasmic ratio, increased nuclear staining (hyperchromasia), more mitotic figures and pleomorphism.

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10
Q

What are anaplastic cells?

A

Cells with no resemblance to any tissue.

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11
Q

What is pleomorphism?

A

Increasing variation in size and shape of cells and nuclei.

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12
Q

What is meant by the term ‘grade’?

A

Clinicians use the term grade to indicate differentiation, high grade being poorly differentiated.

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13
Q

What does dysplasia represent?

A

Dysplasia also represents altered differentiation. Mild, moderate and severe dysplasia indicates worsening differentiation

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14
Q

How is neoplasia caused?

A

Accumulated mutations in somatic cells. The mutations are caused by initiators, which are mutagenic agents, and promoters, which cause cell proliferation. In combination initiators and promoters result in an expanded, monoclonal population of mutant cells.

In some neoplasms mutations can be inherited rather than from an external mutagenic agent.

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15
Q

What are the main initiators of neoplasia?

A

Chemicals, infections, and radiation are the main initiators but some of these agents can also act as promoters.

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16
Q

How does a neoplasm embers from a monoclonal population?

A

A neoplasm emerges from a monoclonal population through a process called progression, characterised by the accumulation of yet more mutations.

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17
Q

What are monoclonal cells?

A

A collection of cells is monoclonal if they all originated from a single founding cell.

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18
Q

How do genetic alterations lead to neoplasm formation?

A

Genetic alterations affect proto-oncogenes and tumour suppressor genes.

  • Proto-oncogenes become abnormally activated (when they are then called oncogenes), favouring neoplasm formation.
  • Tumour suppressor genes, which normally suppress neoplasm formation, become inactivated.
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19
Q

What is the ending given to benign neoplasms?

A

Benign neoplasms ends in –oma.

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20
Q

What is the ending give to malignant neoplasm?

A

Malignant neoplasms end in:
– carcinoma if it is an epithelial malignant neoplasm, which constitute 90% malignant tumours, or
–sarcoma if it is a stromal malignant neoplasm.

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21
Q

What are the two types of carcinomas?

A

Carcinomas can be in-situ (no invasion through epithelial basement membrane) or invasive (penetrated through basement membrane).

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22
Q

What is leukaemia?

A

Leukaemia is a malignant neoplasm of blood-forming cells arising in the bone marrow

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23
Q

What are lymphomas?

A

Lymphomas are malignant neoplasms of lymphocytes, mainly affecting lymph nodes.

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24
Q

What is a myeloma?

A

Myeloma is a malignant neoplasm of plasma cells.

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25
Q

How do germ cell neoplasms arise?

A

Germ cell neoplasms arise from pluripotent cells, mainly in the testis or ovary.

26
Q

How do you neuroendocrine tumours arise?

A

Neuroendocrine tumours arise from cells distributed throughout the body.

27
Q

What are ‘blastomas’?

A

Some neoplasms are called “-blastomas”, which occur mainly in children and are formed from immature precursor cells, e.g. nephroblastoma.

28
Q

What is a papilloma?

A

Any tumour with finger-like projections e.g. skin, buccal mucosa

29
Q

What is an adenoma?

A

Benign tumour formed from glandular structures in epithelial tissue

30
Q

What is the name given to a benign neoplasm in smooth muscle?

A

Leiomyoma

31
Q

What is the name given to a benign neoplasm in fibrous tissue?

A

Fibroma

32
Q

What is the name given to a benign neoplasm in bone?

A

Osteoma

33
Q

What is the name given to a benign neoplasm in the cartilage?

A

Chondroma

34
Q

What is the name given to a benign neoplasm in fat?

A

Lipoma

35
Q

What is the name given to a benign neoplasm in a nerve?

A

Neuroma

36
Q

What is the name given to a benign neoplasm in a nerve sheath?

A

Neurofibroma

37
Q

What is the name given to a benign neoplasm in glial cells?

A

Glioma

38
Q

What are the most lethal features of a malignant neoplasm?

A

The ability of malignant cells to invade and spread to distant sites leads to a greatly increased tumour burden. Untreated, this results in a vast numbers of “parasitic” malignant.

39
Q

What are the stages of invasion and metastasis?

A

For malignant cells to get from a primary site to a secondary site they must: (1) grow and invade at the primary site; (2) enter a transport system and lodge at a secondary site; (3) grow at the secondary site to form a new tumour (colonisation). At all points the cells must evade destruction by immune cells.

40
Q

What are the three requirements for invasion?

A

Invasion into surrounding tissue by carcinoma cells requires: altered adhesion, stromal proteolysis and motility.

41
Q

What is epithelial-to-mesenchymal transition (EMT)?

A

Altered adhesion, stromal proteolysis and motility create a carcinoma cell phenotype that sometimes appears more like a mesenchymal cell than an epithelial cell, hence this is called epithelial-to-mesenchymal transition (EMT)

42
Q

What causes a reduction in E-cadherin expression?

A

Altered adhesion between malignant cells.

43
Q

What causes changes in Integrin expression?

A

Altered adhesion between malignant cells and stromal proteins

44
Q

How do cells invade?

A

The cells must degrade basement membrane and stroma to invade. This involves altered expression of proteases, notably matrix metalloproteinases (MMPs). Malignant cells take advantage of nearby non-neoplastic cells, which together form a cancer niche. These normal cells provide some growth factors and proteases. Altered motility involves changes in the actin cytoskeleton. Signalling through integrins is important and occurs via small G proteins such as members of Rho family.

45
Q

How do malignant cells reach distant sites?

A

Malignant cells can reach distant sites by entering: (1) blood vessels via capillaries and venules; (2) lymphatic vessels; (3) fluid in body cavities (pleura, peritoneal, pericardial and brain ventricles), which is known as transcoelomic spread.

46
Q

What is colonisation of malignant cells?

A

Secondary site malignant cell growth

47
Q

Why is failed colonisation considered to be the greatest barrier to successful formation of metastasis?

A

Because many malignant cells lodge at secondary sites but these tiny cell clusters either die or fail to grow into clinically detectable tumours.

48
Q

What is tumour dormancy?

A

An apparently disease-free person may harbour many micrometastases, a phenomenon known as tumour dormancy. When a malignant neoplasm relapses years after an apparent cure it is typically due to one or more micrometastases starting to grow.

49
Q

What are micrometastases?

A

Surviving microscopic deposits that fail to grow (form colonies) are called micrometastases

50
Q

What determines the site of a secondary tumour?

A

The site of a secondary neoplasm depends on:

(1) Regional drainage of blood, lymph or coelomic fluid.
(2) The “seed and soil” phenomenon, which may explain the seemingly unpredictable distribution of blood-borne metastases

51
Q

Describe how regional drainage determines the site of a secondary tumour

A

For lymphatic metastasis this is very predictably to draining lymph nodes. For transcoelomic spread this is predictably to other areas in the coelomic space or to adjacent organs. For blood-borne metastasis this is sometimes (but not always) to the next capillary bed that the cells encounter.

52
Q

What is the ‘seed and soil’ phenomenon?

A

Is due to interactions between malignant cells and the local tumour environment (i.e. the niche) at the secondary site

53
Q

How do carcinomas typically spread?

A

Carcinomas typically spread first to draining lymph nodes and then to blood-borne distant sites.

54
Q

What are the common sites of blood borne metastasis?

A

Common sites of blood borne metastasis are lung, bone, liver and brain.

55
Q

How do sarcomas typically spread?

A

Via the blood stream

56
Q

What is meant when malignant neoplasms are described as having ‘personalities’?

A

Some malignant neoplasms are more aggressive and metastasise very early in their course, e.g. small cell bronchial carcinoma. Others almost never metastasise, e.g. basal cell carcinoma of the skin. The likelihood of metastasis is related to the size of the primary neoplasm. This is the basis of cancer staging

57
Q

What are the effects of a neoplasm on the host?

A

The effects a neoplasm has on the host can be classified as those that are due to the direct local effects, which can be due to the primary neoplasm and/or the secondary neoplasm(s), and those due the indirect systemic effects. The latter include effects of increasing tumour burden, secreted hormones and/or miscellaneous effects. These are sometimes referred to as paraneoplastic syndromes. For benign neoplasms, local effects from the primary and hormonal effects are most relevant

58
Q

What causes the local effects of a neoplasm?

A

The local effects of primary and secondary neoplasms are due to (1) direct invasion and destruction of normal tissue; (2) ulceration at a surface leading to bleeding; (3) compression of adjacent structures and (4) blocking tubes and orifices

59
Q

What are the systemic effects of a neoplasm?

A

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), malaise, immunosuppression (can also be due to direct bone marrow destruction) and thrombosis.

Benign neoplasms of endocrine glands are well differentiated so typically produce hormones, e.g. a thyroid adenoma produces thyroxine. Malignant tumours sometimes also produce hormones; e.g. bronchial small cell carcinoma can produce ACTH or ADH while bronchial squamous cell carcinoma can produce a PTH-like hormone.

60
Q

What are the miscellaneous systemic effects of a neoplasm?

A

Miscellaneous systemic effects include neuropathies affecting the brain and peripheral nerves, skin problems such as pruritis and abnormal pigmentation, fever, finger clubbing and myositis. Many other signs and symptoms can also occur and the pathogenesis is poorly understood

61
Q

Which neoplasms most commonly spread to bone?

A

The neoplasms that most frequently spread to bone are breast, bronchus, kidney, thyroid and prostate.

Pathological Processes (13 decks)

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