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Pathological Processes > Neoplasia > Flashcards

Neoplasia Flashcards

1
Q

What is the general definition of a neoplasm?

Is it reversible?

A

An abnormal growth of cells that persists after the initial stimulus is removed
No, it is irreversible

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2
Q

What is the definition of a “malignant neoplasm”

A

An abnormal growth of cells that persists after the initial stimulus is removed AND invades surrounding tissue with potential to spread to distant sites

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3
Q

Any malignant neoplasm is known as what more commonly?

A

Cancer

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4
Q

What is a metastasis?

A

A malignant neoplasm that has spread from its original site to a new NON-CONTIGUOUS site

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5
Q

How can metastases spread around the bodywork new sites?

A

In the blood, lymphatics or in fluid body cavities (pleura, peritoneal/ pericardial cavities)

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6
Q

What is dysplasia?

Is it reversible?

A

Dysplasia is a PRE-neoplastic alteration in which cells show disordered tissue organisation or altered differentiation
Yes it is reversible- makes it different from neoplasia

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7
Q

How do benign and malignant neoplasms appear different to the naked eye?

A

Benign tumours: grow in confined local area and so have a pushed outer margin

Malignant tumours: irregular outer margin and shape, may show areas of necrosis and ulceration on the surface

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8
Q

How do benign neoplasms differ from malignant neoplasms under a microscope?

A

Benign neoplasms:
Cells closely resemble parent tissue i.e. They ware well differentiated

Malignant neoplasms:
Range from well to poorly differentiated

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9
Q

What is the name given to cells with no resemblance to any tissues?

A

Anaplastic

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10
Q

In terms of differentiation, benign tumours are what compared to malignant?

A

Benign tumours are well differentiated

Malignant tumours range from well to poorly differentiated

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11
Q

Worsening differentiation causes individual cells to have what features?

A

Increasing nuclear size
Increasing nuclear o cytoplasmic ratio
Increased nuclear staining (hyperchromasia)
More mitotic figures
Increasing variation in size and shape of cells and nuclei (pleomorphism)

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12
Q

In terms of differentiation, what is the difference between a high grade and a low grade tumour?

A

High grade- poor differentation

Low grade- well differentiated

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13
Q

What are three features of poorly differentiated tissue and the grades that they relate to?

A

Grade 1. Tubules
Grade 2. Mitoses
Grade 3. Nuclear pleomorphism

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14
Q

Neoplasia is caused by an accumulation of what?

A

Mutations in somatic cells

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15
Q

Approximately how much of cancer risk is determined by external factors?

A

85%

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16
Q

Mutations in somatic are caused by what?

Cell proliferation in these mutated cells is caused by what?

A

Initiators

Promotors

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17
Q

Name some main initiators of mutations

Can these initiators ever act as promotors?

A

Chemicals
Infections
Radiation

Yes

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18
Q

What process is followed by initiation and promotion during the formation of a neoplasm?

What happens during this process?

A

Progression

Expansion of monoclonal populations and the accumulation of yet more mutations

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19
Q

How do we know that neoplasms are monoclonal?

A

From a study of C-linked gene for G6P- one heat stable and one heat liable version

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20
Q

What do we mean when we say that a cell colony is monoclonal?

A

We mean that all the cells originate from a single founding cell

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21
Q

Genetic alterations affect what type of genes?

A

Proto-oncogenes

Tumour suppressor genes

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22
Q

When proto- oncogenes become abnormally activated they are called what?

What formation do these genes favour?

A

Oncogenes

Neoplastic formation

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23
Q

The organised system for naming neoplasms take into account what?

A

The neoplasm’s site of origin

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24
Q

Benign neoplasms end in what?

A

-oma

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25
Q

Malignant neoplasms end in what?

A
  • carcinoma (epithelial)

- sarcoma (stromal)

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26
Q

Malignant neoplasm of blood-forming cells is called what?

A

Leukaemia

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27
Q

Malignant neoplasm of lymphocytes is known as what?

A

Lymphoma

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28
Q

What is the name given to malignant neoplasms of plasma cells?

A

Myeloma

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29
Q

What does the “stage” of neoplasms relate to?

Give the meaning of stages I-IV

A

Stage is a measure of tumour burden

I- small, at primary stage
II- bigger but still at primary stage
III-regional spread
IV- wide spread, enormous tumour burden

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30
Q

What are the two most lethal features of a malignant neoplasm?

A

Invasion

Metastasis

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31
Q

What 3 things (+ one bonus) must malignant cells do to get from a primary site to a secondary site?

A
  1. Grow and invade at primary site
  2. Enter a transport system and lodge at secondary site
  3. Colonisation: Grow at secondary site and form a new tumour

(4.at all points the cells must evade immune destruction)

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32
Q

What three important alterations dues invasion into surrounding tissue involve?
What are these three changes together called?

A

Adhesion
Proteolysis (stromal)
Motility

Epithelial-to-mesenchymal transition (EMT)

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33
Q

Which cells contribute to the “cancer niche” to aid the invasion by neoplastic cells?

A

Stroma
Fibroblasts
Endothelial cells
Inflammatory cells

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34
Q

What is the name given to the spread of neoplastic cells via fluid in body cavities?

A

Transcoelomic spread

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35
Q

What is considered to be the greatest barrier to successful formation of metastasis?

A

Colonisation (many malignant cells lodge at secondary sites but die or faint to grow into clinically detectable tumours)

36
Q

What is the name given to surviving microscopic deposits that fail to grow?

A

Micrometastases

37
Q

Why do relapses occur in clinically “disease free” patients?

A

Micrometastases can lay dormant for years for a change in the micro environment and a chance to then proliferate

38
Q

What determines the site of the secondary tumour?

A
  1. Regional drainage- can predict based on anatomy

2. “Seed and soil” phenomenon - the niche at the secondary site

39
Q

Blood bourne metastases are often spread where?

Why?

A

Lung, bone, liver and brain

These organs have a rich blood supply

40
Q

Which neoplasms most frequently spread to bone?

A 
Breast 
Bronchus 
Kidney 
Thyroid  
Prostate
41
Q

The likelihood of a metastasis is related to what?

A

The size of the primary neoplasm

42
Q

How can the effects a neoplasm has on the host be defined?

A

Local (benign)

  • Primary
  • Secondary

Systemic

  • Burden
  • Hormones
  • Miscellaneous
43
Q

Name four local effects of primary and secondary neoplasms

A
  1. Direct invasion and destruction of normal tissue
  2. Ulceration at a surface leading to bleeding
  3. Compression of adjacent structures
  4. Blocking tubes and orifices
44
Q

Name some systemic effects of neoplasms on the host

A

Tumour burden- weight loss, decreased appetite, malaise, immunosuppression

Hormone secretion-
Hyperthyroidism
Cushing’s disease

Miscellaneous:
Skin problems
Fever
Finger clubbing

45
Q

The cause of neoplasia is based on both ________ and _________ factors

A

Intrinsic

Extrinsic

46
Q

Malignant neoplasms caused by 2-napthylamine showed what three things in relation to carcinogenesis?

A
  1. There is a long delay (sometimes years) between exposure and malignant neoplasm onset
  2. The risk of cancer depends on the total carcinogen dosage
  3. There is sometimes organ specificity
47
Q

Is the sequence in which carcinogens are administered relevant/important?
Why?

A

Yes, it is critical

Initiators must be given first, followed by promoters- need both for long periods, not just one or both for short period

48
Q

What does the Ames test show?

A

That initiators are mutagens while promoters cause prolonged proliferation in target tissues

49
Q

In the Ames test, how does the number of colonies relate to the mutagenicity of carcinogens?

A

The greater the number of colonies, the more mutanogenic the carcinogen

50
Q

Why does the Ames test require the addition of rat liver extract?

A

For the cleavage of pro-carcinogens into carcinogens by Cytochrome P450

51
Q

A compound that acts as an initiator and a promotor is known as what?

A

A complete carcinogen

52
Q

What is radiation (broadly)?

A

Any type of energy passing through space

53
Q

Give some examples of radiation

A

UV light

Ionising radiation- X-rays, nuclear radiation (alpha,beta,gamma)

54
Q

Does radiation damage DNA directly or indirectly?

How?

A

Both

Direct:
Altered bases
misreading- point mutations

single/double strand DNA breaks - chromosomal abnormalities

Indirect:
Free radicals

55
Q

How do infections act as carcinogens both directly and indirectly?

A

Directly:
Affect genes that control cell growth

Indirect:
Chronic tissue injury (regenerated tissue acts as promoter or causes new mutations from replication errors)

56
Q

Give an example of an infection that is directly carcinogenic
How does it has this effect?

A

HPV

Expresses E6 and E7 proteins that inhibit p53 and pRb

57
Q

Give an example of an infection that is an indirect carcinogen
How does it have this effect?

A

Hepatitis (B and C)

Cause chronic cell injury ad regeneration

58
Q

How can the “two hit” hypothesis be used to explain the difference between familial cancers and those in the general population?

A

Familial cancers:
1st hit- germline mutation
2nd hit: somatic mutation

Sporadic cancer:
1st hit: somatic mutation
2nd hit: somatic mutation

59
Q

How many “hits” are needed in order for tumoursupressor genes to cause neoplastic growth?

A

Two hits- inactivate both alleles

60
Q

How many “hits” are needed for proto-oncogenes to cause neoplastic growth?

A

One hit

Only one allele needs to be activated

61
Q

Which was the first human oncogene to be discovered?

A

RAS

62
Q

What does the RAS proto-oncogene encode?

A

A small G protein that relays signals into the cell and eventually pushes the cell past the cell cycle restriction point

63
Q

How does mutant RAS exert its damaging effects?

A

By encoding a protein that is always active and therefore produces a constant signal to pass though the cell cycle’s restriction point

64
Q

Give some examples of proto-oncogenes

A 
HER2
PDGF
RAS
BCL2 
CYCLIN D
65
Q

Give an example of a tumour suppressor gene

A

TP53

66
Q

Xeroderma Pigmentisum (XP) is due to mutations in what genes?

A

DNA repair - Nucleotide Excision Repair (NER)

67
Q

What genes are mutated in the inherited cancer syndrome HNPCC?

What does this lead to?

A

Mismatch repair genes

Microsatellite instability

68
Q

Which genes are mutated in the inherited cancer syndrome that promotes breast and ovarian cancer development?
What does this lead to?

A

Double-strand break repair genes

Chromosomal instability

69
Q

Cancer evolves by what three stages?

A

Initiation
Promotion
Progression

70
Q

Cancer mutations affect which six hallmark cellular behaviours?

A
  1. Self-sufficiency in growth factors
  2. Resistance to growth stop signals
  3. No limit to no. Of cell divisions
  4. Sustained ability to induce new blood vessels
  5. Resistance to apoptosis
  6. Ability to invade and produce metastases
71
Q

Which four cancers account for 50% of all new cancers worldwide?

A

Breast
Lung
Bowel
Prostate

72
Q

Tumour stage is a measure of what?

What is the commonest way of measuring tumour stage?

A

The malignant neoplasm’s overall burden

TNM staging system

73
Q

Explain how the TNM staging system works and how this corresponds to stages I,II,III and IV

A

T= Tumour size
N=Lymph node metastases (regional)
M=Metastasise in the blood (distant)

Stage I = local disease
Stage II = advanced local disease
Stage III= regional mets.
Stage IV= advanced disease, distant mets.

74
Q

What is the name of the staging system used for lymphoma?

A

Ann Arbor

75
Q

Explain the staging used in the Ann Abor system for classifying lymphoma

A

Stage I- lymphoma in a single node region
Stage II- two separate regions node regions on the same side of the diaphragm
Stage III- two separate node regions on different sides of the diaphragm
Stage IV- diffuse/disseminated lymphoma, involving one or more extra-lymphatic organ(s)

76
Q

Staging is a powerful indicator of what?

A

Survival

77
Q

Give an example of a staging system used for colorectal cancer and how it is classified based on these stages

A

Dukes
Dukes’ A- Invasion into but not through the bowel
Dukes’ B- Invasion through the bowel wall
Dukes’ C- Involvement of lymph nodes
Dukes’ D- Distant metastases

78
Q

What is meant by tumour “grade”?

A

Tumour grade is the degree of differentiation in a neoplasm

79
Q

Typically, how does grading correspond to differences in the differentation of neoplams?

A

G1: well-differentiated
G2: moderately differentiated
G3: poorly differentiated
G4: undifferentiated, anaplastic

80
Q

Staging of cancer is important for what?

A

Planning treatment and estimating progress

81
Q

What is the name given to the system that is used to stage breast carcinoma?

A

Bloom-Richardson system

82
Q

How does the Bloom-Richardson system categorise different stages of breast cancer?

A

Uses 3 criteria:
1- Tubule formation
2- Number of mitoses
3- Nuclear pleomorphism

83
Q

What are the broad treatment methods for cancer?

A

Surgery!!!!! this is the curative treatment
Radiotherapy
Chemotherapy
Hormone therapy
Treatment targeted to molecular alterations
Immune therapy

84
Q

What is the purpose of using fractionated doses of radiation during radiotherapy?

A

To minimise damage to healthy/surrounding tissue

85
Q

How does radiotherapy work?

A

The ionising radiation targets cells that are rapidly proliferating (especially in G2) by causing DNA damage and triggering apoptosis

Pathological Processes (9 decks)

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