Neoplasia Flashcards
Metastasis
spread to distant sites
Invasive
tumor capable of destroying structures
Cancer
is a malignant neoplasm
Proliferatation:
Cell division
Differentiation
: Functional and structural maturity of cells
Growth
: Increase in size due to synthesis of tissue components
Controls of Growth
Growth factors – PDGF, FGF Growth Inhibitors. Cyclins, Cyclin dependent kinases (CDK). Cancer suppressor genes – p53 Oncogenes – c-onc, p-onc, v-onc etc.
Growth factors
PDGF , FGF
Cancer suppressor genes
P53
Oncogenes
c-onc, p-onc, v-onc etc.
Non-Neoplastic Proliferation
Controlled & Reversible processes:
Hypertrophy – increase in cell size
Hyperplasia – increase in cell number
Metaplasia – change of cells type
Dysplasia – disordered cells
Neoplastic Proliferation characteristics
Uncontrolled & Irreversible
Progressive, purposeless, pathologic, proliferation of cells characterized by loss of control over cell division.
DNA damage at growth control genes is central to development of neoplasm.
How do we get cancer
Damage to genetic material Affects different sites in the genome Evolution of more aggressive clones ( Carcinogens (Chemical, radiation, viruses) DNA damage Neoplasm)
Neoplasm definition:
“An abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues, and persists in the same excessive manner after cessation of the stimuli which evoked the change”
Neoplasm normal and abnormal properties
Normal properties loss: Increased proliferation. Decreased cell death. Failure to differentiate. Abnormal properties develop: Invasion. Metastasis.
Tumors have two basic components:
1) Parenchyma: made up of neoplastic cells from which the tumor derives its name 2) Stroma: supporting, host-derived, non-neoplastic made up of connective tissue and blood vessels provides support for the growth of parenchyma crucial to the growth of the neoplasm
The classification of neoplasm
Behaviour- benign and malignant Extent of spread- Primary and secondary The cell of origin or histogenesis: epithelial mesodermal/connective tissue hematopoietic nervous system germ cells embryonic tissue
Localized, non-invasive, patient usually survives
Benign
Spreading, Invasive, may result in early death of the patient
Malignant cancer
Malignant characteristics
Large size Not encapsulated Poorly circumscribed Loss of differentiation Cells lose normal functions Invasion of normal tissue Necrosis Many mitosis potentially lethal Metastasising
Benign characteristics
Small size maybe encapsulated well circumscribed well differentiated tissues Cells retain normal functions no invasion no necrosis few mitosis nonlethal non metastasizing
Tumours invade lymphatics, blood vessels or through peritoneal or other surfaces to form
secondary tumours (metastasis)
Papilloma tissue origin
Squamous or transitional (epithelial )
What is the malignant name of Adenoma Papilloma Fibroma Lipoma Osteoma Chondroma Leiomyoma Rhabdomyoma Hemangioma
Adenocarcinoma (Squamous cell carcinoma or Transitional cell carcinoma) Fibrosarcoma Liposarcoma Osteosarcoma Chondrosarcoma Leiomyosarcoma Rhabdomyosarcoma Angiosarcoma
is a benign neoplasm growing on any surface, composed of epithelial cells forming finger like projections.
Papilloma
Adenoma
Applied to benign epithelial neoplasms producing gland patterns.
E.g. Surface epithelium (stomach, small intestine & colon)
Applied to benign neoplasms derived from glands but not necessarily exhibiting gland patterns.
E.g. Solid glandular epithelium (endocrine and exocrine) and ducts (Thyroid, kidney, liver)
Germ cell tumor
Malignant*
Teratoma
Seminoma
Pediatric tumors
Malignant*
Hepatoblastoma
Nephroblastoma
Retinoblastoma
Hematopoietic
Malignant*
Leukemias
Lymphomas
Brain tumors
Malignant*
Glioma
Tumors can be distinguished by:
Differentiation and anaplasia
Rate of growth
Local invasion
Metastasis
Well-differentiated tumors:
contain cells that resemble the normal cells of origin and retains its functional capacity
Poorly-differentiated or undifferentiated tumors:
contain cells that do not resemble their normal cells of origin
Differentiation: extent to which parenchymal neoplastic cells resemble normal cells morphologically and functionally, while ……. does not aid in the separation of benign from malignant.
Stroma
Tumor composed of well-differentiated cells.
Benign
tumors are characterized by a wide range of cellular differentiation (well, moderate, poor, undifferentiated).
Malignant
: malignant neoplasms that are composed of undifferentiated cells
Anaplasia
Histological Features of anaplasia:
Cellular pleomorphism Giant cells Hyperchromatic nuclei Nuclear- cytoplasmic ratio may approach 1:1 Nuclear pleomorphism Mitosis is numerous and/or atypical Loss of cell polarity
a non-neoplastic proliferation
Dysplasia
is an abnormal type of excessive cell proliferation characterized by loss of normal tissue arrangement and cell structure in epithelium.
Dysplasia
Dysplasia may or may not…
Progress to cancer
In epithelia, represents a state between hyperplasia and carcinoma in situ (pre-invasive neoplasia)
*Pleomorphism & mitoses are more prominent than in the normal
Dysplasia
……have a slower rate of growth than moderately-differentiated and poorly-differentiated malignant tumors.
Benign and well-differentiated malignant tumors
##There are exceptions. Malignant tumors sometimes grow slowly for years and suddenly enter a phase of rapid growth
Factors that can affect the growth rate of tumor:
Blood supply
Site
hormonal stimulation
Leiomyomas: influenced by………, increase during pregnancy, and cease growing or atrophy after menopause
Estrogen
Some induce formation of dense fibrous stroma (desmoplasia)
Malignant
Next to metastases, …….. is the most reliable feature that distinguishes malignant from benign tumors.
Local invasiveness
Not all cancers have equivalent ability to metastasize, e.g
Basal cell carcinoma
“rodent ulcer.”
Basal cell carcinoma (BCC): skin cancer that is common and slow growing. Grossly, the tumor begins as papules with rolled margins but can ulcerate and locally invade underlying structures and bone. Hence, the name “rodent ulcer.”
~ 30% of newly diagnosed patients with solid tumors present with …
clinically evident metastases. #In general, the more anaplastic and the larger the primary neoplasm, the more likely is metastatic spread
Methods of spread
Direct Spread
Seeding of body cavities: ovarian tumors
Hematogenous spread: favored pathway for sarcomas. The liver and lung are the most frequently involved secondary sites.
Lymphatic spread: is more typical of carcinomas
Invasion and Metastasis sequence
Invasion of the basement membrane
Movement through extracellular matrix
Penetration of vascular or lymphatic channels
Survival and arrest within the circulating blood or lymph
Exit from the circulation into new site
Survival and growth as a metastasis
Seeding of body cavities
Occurs when neoplasms invade a natural body cavity.
Examples:
Carcinoma of the colon may penetrate the wall of the gut and reimplant at distant sites in the …… cavity.
Lung cancers in the ……. cavities.
Cancers of the ovary in the …….. cavity.
Peritoneal
Pleural
Peritoneal
It is the most feared consequence of a cancer.
It is the favored pathway for sarcomas
Hematogenous spread
In hematogenous spread
arteries are penetrated ….. than veins.
Liver & lungs are the most frequently involved secondary sites
Less
Hematogenous Spread
Examples:
Renal cell carcinoma to the ..... Hepatocellular carcinomas to the .... Colon cancer to the .... Prostatic carcinoma preferentially spreads to the.... Bronchogenic carcinomas to the.... Neuroblastomas spread to the .....
Renal cell carcinoma to the lung
Hepatocellular carcinomas to the lung
Colon cancer to the liver
Prostatic carcinoma preferentially spreads to bone
Bronchogenic carcinomas to the adrenals and the brain
Neuroblastomas spread to the liver and bone
Lymphatic spread
Idk wtf, just read the other side
Example: Lung and breast carcinoma
Skip metastases:
The cancer cells seem to traverse the lymphatic channels within the immediately proximate nodes to be trapped in subsequent lymph nodes
The cells may traverse all of the lymph nodes to reach the blood via the thoracic duct.
The necrotic products of the neoplasm and tumor antigens often evoke reactive changes in the lympth nodes:
Lymphadenitis
Sinus histiocytosis
Indicates how aggressive it is
How much different it looks from the tissue of origin
Grading (microscopic)
How advanced the cancer is
How far it has spread
Staging (clinical)
….. usually has prognostic value.
Staging
Malignant neoplasms Grading
Low grade, is relatively non-aggressive high grade, likely to grow and spread quickly. 1 well differentiated 2 moderately differentiated 3 poorly differentiated 4 undifferentiated (anaplastic)
Features used to grade malignant neoplasms
- Degree of tissue differentiation.2. Number of mitoses.3.Host response in terms of lymphocytic infiltration.4.Invasive margin of the tumor.5.Degree of nuclear pleomorphism
Why do we grade & stage cancer?
To estimate the prognosis
i.e. how long the patient may survive
To decide how to treat the tumor
More advanced/ aggressive tumors are given more radical treatment
To compare treatments or prognostic factors in research
Do males die earlier of a certain tumour than females?
Tumours are staged using ?..
TNM System T Extent of primary Tumour N Regional lymph Node metastasis M Distant Metastases An overall stage is allocated I to IV Each organ has different staging
T staging of breast cancer
Tis in situ disease T1.. <2c T2 ...2 – 5 cm T3.. > 5cm T4.. Involving skin or chest wall
N staging for breast cancer
N0 ..no node
N1 .. ipsilateral nodes
N2.. contralateral notes
M staging for breast cancer
M0 no distant metastasis
M1 distant metastasis
The Dukes staging system for colorectal cancer
Four stages A Confined to bowel wall B Through bowel wall C Regional lymph node metastases D Distant metastases
Smoking is a factor for cancer in
Mouth, pharynx, oesophagus, lip,
larynx, lung, bladder
Alcohol is a factor for cancer in
Mouth, pharynx, larynx,
oesophagus, colorectal
Cancer iatrogenic factors and where
Estrogens..
Androgens..
Radiotherapy..
Endometrium, vagina, breast
Prostate
carcinoma of breast & Bronchus
Liver (hepatocellular carcinoma)
Is associated with
Hepatitis B or C virus
Burkitt’s lymphoma
Hodgkin’s lymphoma
Associated with
Epstein–Barr virus
Stomach (gastric cancer)
Associated with
Helicobacter pylori
Breats cancer is associated with
High fat diet
Environmental Carcinogens
Drugs: immune suppressing etc..
Organic chemicals: Insecticides, herbicides, aromatic hydrocarbons, etc..
Cigarette Smoke
Ethanol
Heavy Metals
Sexually transmitted viruses: Herpes simplex, Human papilloma virus
Radiation: Ultraviolet light
Inherited Cancer Syndromes
Autosomal Dominant
Autosomal Recessive Syndromes
Familial Cancers
