neoplasia

Question 1

is a term that refers to a large group of diseases
characterized by uncontrolled cell proliferation and spread
of abnormal cells

Answer 1

Cancer
Other terms used:
◦ Malignant neoplasm; tumour; malignancy; carcinoma

Question 2

normal maturation process in which cell specializes into
different physiological function of standard size and shape
Associated with activation and suppression of certain genes

Answer 2

Differentiation
In malignant cells, differentiation is altered and may be lost
(the malignant cell may not be recognizable from it’s parent
cell)
Complete loss of identity = undifferentiated =
“anaplastic” –difficult to determine its origin at that point
The less differentiated a tumor becomes, the faster it
spreads (metastasis) and the worse the prognosis

Question 3

Used to denote uncontrolled growth of cells whose
proliferation cannot be adequately controlled by normal
regulatory mechanisms operating in normal tissues.
◦ do not achieve same level of differentiation

Answer 3

Neoplasia
Literally means “new growth”
◦ “neo” = new
◦ “plasia” = growth

Neoplastic Cells
In contrast to tightly regulated cell growth in normal cells,
tumor cells:◦ Autonomous
◦ Excessive
◦ Disorganized

Question 4

The most advanced form of dysplasia, with complete loss of differentiation, and is a characteristic of malignant cells
only

Answer 4

anaplasia

Question 5

the process by which a normal cell

undergoes malignant transformation

Answer 5

carcinogenesis’
Carcinoma in situ = cancer that has stayed in the place
where it began and has not spread to neighboring tissues
Several genetic changes are required along the pathway to result in malignant cancer

Question 6

= Abnormal growths of new tissue that serve no useful purpose,
and may harm the host by competing for blood supply/nutrients

Answer 6

Tumor
◦ Benign or Malignant
◦ Primary or Secondary
• Primary tumor – arise from cells normally local to the given structure
• Secondary tumor – arise from cells that have metastasized from another part of body

Question 7

well-differentiated, closely resembling tissue of

origin; slow growth, usually encapsulated; no metastasis (suffix =oma)

Answer 7

Benign tumor

Question 8

lack capsule, capable of invasion into
adjacent structures and metastasis
• Usually less differentiated than benign tumors + large,
pleomorphic nuclei

Answer 8

Malignant tumor (cancer)

Question 9

implantation of cancerous cells into

non-contiguous sites

Answer 9

Metastasis

Question 10

Benign

-Growth Slow,Expansive
metases-no
External surface Smooth 
capsule Yes 
Necrosis No 
Hemorrhage No 
Architecture Resembles normal tissue of origin
Cells Well differentiated
Nuclei-Normal size and shape; uniform
Mitoses- Few Many; irregular

Answer 10

malignant

- fast,invasive
metases-yes
External surface- Irregular
capsule-no
necrosis-yes 
hemorrhage-yes
architecture-Does not resemble normal tissue of origin
cells well-Poorly differentiated
Nuclei- Pleomorphic
Mitoses-irregular

Question 11

Mechanisms of Metastasis

Three main pathways:

Answer 11

• Via blood
• Via lymph
• Via seeding of the surface of body cavities
99% of circulating cells that could be tumour-causing are killed
in the blood vessels before reaching their target
◦ Due to NK cells, T-cells and macrophages

Question 12

• blood vessels from surrounding tissue

grow into the solid tumor – significant factor in its survival and growth

Answer 12

tumor angiogenesis

Question 13

Common sites of Metastasis

Answer 13

Lymph nodes
Liver
Lung
Bone
Brain

Question 14

Benign usually “oma”
Malignant usually “sarcoma”
Cell Type/Tissue of Origin
• Epithelial
• Benign here = ‘adenoma’
• Malignant here = ‘carcinoma’
• From glandular tissue = ‘adenocarcinoma’

• Connective tissue and muscle=Elastic, fibrous, collagenous tissue

Answer 14

• Nerve=Tumors named here for type of cell, i.e. astrocytoma
• Lymphoid-‘lymphoma’
• Hematopoietic- Leukemia, multiple myeloma, myelodysplasia, myeloproliferative

Question 15

microscopic evaluation based on degree of cellular differentiation Classifies degree of malignancy

Answer 15

Grading
Grades 1-3
◦ Lower grade-cells more closely resemble normal cells
◦ Higher grade- poor differentiation

Question 16

Etiology
Cause of most cancers is unknown
Exogenous : Many carcinogens have been identified
◦ “carcinogens”= agents capable of effecting malignant
transformation
◦ Chemical – alcohol, drugs, tar, soot, hydrocarbons, nickel,
arsenic, xenoestrogens (HRT BR CA) etc.
◦ Viral –
◦ HPV –
◦ EBV –
◦ HBV –
◦ Physical – asbestos, radiation (UV light, X-ray)

Answer 16

Etiology Cont’d…
Endogenous
◦ Genetics
◦ Human oncogenes (human cancer genes) – mutated normal genes
◦ Inherited
◦ Lack of tumor suppressor genes
◦ Breast CA gene
◦ Familial pattern – indicated in prostate, breast, ovarian, colon cancer
◦ Hormones
◦ High estrogen conditions related to increased risk of Estrogen dependent
cancers.
Multifactorial – environmental, viral, genetic –
disruption of the immune system + aging immune system = less ability to recognize and kill abnormal cells

Question 17

small segments of DNA that have ability to transform normal cells into malignant cells
◦ possibly activated by carcinogens – could be in concert
with viruses
◦ Hyperactivated versions of normal cellular growthpromoting genes
◦ Antioncogenes (tumour suppressor genes)-inhibits
cancer
◦  tumor suppressor gene activity  aggressive cancer

Answer 17

•Oncogenesis Theory

◦Oncogenes (cancer causing genes or protooncogenes)-

Question 18

10 modifiable risk factors

Answer 18

1. Tobacco
2. Alcohol
3. Obesity
4. Inactivity
5. Diet/nutrition
6. Unsafe sex
7. Sun exposure
8. Urban air pollution
9. Indoor smoke from household fuels
10. Contaminated injections in health care

Question 19

• weakness and wasting of the body due to

severe chronic illness

Answer 19

• Cachexia

Question 20

◦Pulmonary – Most Common site for
Metastasis
◦starts asymptomatic until malignant cells have
obstructed the bronchi, or expanded in the
pleural cavity  pain, persistent dry cough,
dyspnea, coughing blood

◦Hepatic (Liver) – common metastasis site
◦ RUQ pain, malaise, fatigue, anorexia, jaundice, 
liver enzymes (AST, ALT)

◦ Skeletal –
◦ PAIN–deep, worse w activity/wt bearing
◦ Hypercalcemia is common complication

Answer 20

◦ CNS
◦ Brain –
◦  Intra Cranial Pressure  pain, Headache, disequilibria, 
coordination,  sensory/motor
◦ Spinal Cord –
◦ spinal cord + nerve root compression  earliest Sx: distal
weakness, tingling, numbness; vertebra compression fx
◦ Lymphatic system – lymphadenopathy / lymphedema
◦ Colon – melena (dark black tarry stool)
◦ Uterus – dysfunctional uterine bleeding
◦ Breast – lump
◦ Prostate – difficulty starting urination, change in stream

Question 21

A. Prevention
i. Primary
◦ Risk reduction
◦ chemoprevention (e.g. antioxidants in the diet, NSAIDs)
◦ Cancer vaccines-current research

Answer 21

ii. Secondary
◦ Early detection  morbidity and mortality
◦ Breast exams, mammogram
◦ Pap smear
◦ Prostate exam
◦ Fecal occult blood test, sigmoidoscopy, colonoscopy
iii. Tertiary
◦ Management of symptoms and complications

Question 22

B. Diagnosis
◦ Clinical - medical history and physical exam
◦ Imaging - endoscopy, X-ray, ultrasound, CT, MRI
◦ Laboratory – tissue biopsy (single best test);
– blood tests tumor blood markers-substances
produced by tumour cells (PSA, CEA, LDH)
*Carcinoembryonic antigen (CEA)—a marker for adenocarcinoma of
colon and also other sites
Alpha-fetoprotein (AFP)—a marker for hepatocellular carcinoma and
certain germ cell tumors that contain yolk sac components
PSA (Prostate Specific Antigen)
LDH (Lactic Dehydrogenase)

Answer 22

C. Treatment
◦ Surgery
◦ Chemotherapy
◦ Radiation therapy
◦ Biotherapy (eg. bone marrow or stem cell transplant,
hormone tx, immunotherapy)
◦ Treatment for treatment related toxicity ex. anti-nausea
◦ Pain control
◦ Diet
D. Prognosis - depends on:
◦ Type of cancer
◦ Stage at diagnosis
◦ Treatment availability
◦ Response to treatment/Susceptibility

Question 23

– MC type
paediatric CA
• Etiology: unknown but radiation, chromosomal
abnormalities, viruses, congenital immune-deficiency
associated

Answer 23

Acute Lymphoblastic Leukemia (ALL)

Question 24

• An exaggerated or inappropriate immune response may lead to various hypersensitivity disorders.
  Overreaction to a substance, or hypersensitivity, is often
  referred to as an allergic response, and although the term allergy is widely used, the term hypersensitivity is more appropriate.

Answer 24

Hypersensitivity Disorders
-designates an increased immune response
to the presence of an antigen (allergen) that results in tissue destruction The damage and suffering actually comes from the immune response itself rather than from the substance that provoked it.

Question 25

is a severe allergic reaction that occurs
rapidly and causes a life-threatening response involving the whole body.
This reaction can lead to:
difficulty breathing
Shock
Death
It is a severe response to an allergen leading to systemic histamine release causing:
systemic vasodilation
bronchospasm,
mucus & edema in airways and tissues

Answer 25

Anaphylactic shock 
Triggers:
◦ bee sting
◦ Penicillin
◦ foods
Treatment: Administration of IM epinephrine  vasoconstriction

Question 26

-genetically predisposed condition where IgE Antibodies produced to common environmental allergens

Answer 26

Atopy

Question 27

= the process by which a normal cell undergoes malignant transformation

Answer 27

Carcinogens-

Question 28

(cancer causing genes or protooncogenes)-small segments of DNA that have ability to transform normal cells into malignant cells

Answer 28

Oncogenes

Question 29

Differentiation vs undifferentiated cells

Answer 29

In malignant cells, differentiation is altered and may be lost (the malignant cell may not be recognizable from it’s parent cell) Complete loss of identity = undifferentiated = “anaplastic” – difficult to determine its origin at that point
The less differentiated a tumor becomes, the faster it spreads (metastasis) and the worse the prognosis

Question 30

possible reversible change that often precedes malignancy, characterized by
◦ altered morphology – disorderly maturation, spatial arrangement
◦ Disorganization of cells
◦ marked variability in nuclear size/shape (pleomorphism)
◦ increased, often abnormal mitosis eg. dysplasia of cervical squamous cells (abnormal Pap smear

Answer 30

Dysplasia – characteristics

Question 31

Tumor – Types - (Primary, Secondary, Benign, Malignant) − Properties of malignant tumors

Answer 31

• Primary tumor – arise from cells normally local to the given structure
• Secondary tumor – arise from cells that have metastasized from another part of body
• Benign tumor – well-differentiated, closely resembling tissue of origin; slow growth, usually encapsulated; no metastasis (suffix = oma)
• Malignant tumor (cancer) – lack capsule, capable of invasion into adjacent structures and metastasis
• Usually less differentiated than benign tumors + large, pleomorphic nuclei

Question 32

◦Neoplasia originates in a single cell by acquired genetic change
◦ Tumor cells characterized by chromosomal abnormalities (numeral, and structural)
◦‘cytogenetics’ = the study of chromosomes in cancer Theories of Cancer Development

Answer 32

Somatic Mutation Theory

Question 33

– tumor produces signs and symptoms at a site distant from tumor
• Eg. Small cell cancer of lung can secrete ACTH leading to Cushing’s syndrome (high cortisol)
• Hypercalcemia—squamous cell carcinoma of the lung
• Polycythemia—renal cell carcinoma
• Venous thrombosis—pancreatic carcinoma
• Myasthenia gravis—thymoma

Answer 33

•Paraneoplastic syndromes

Question 34

is a severe allergic reaction that occurs rapidly and causes a life-threatening response involving the whole body. This reaction can lead to: difficulty breathing Shock Death It is a severe response to an allergen leading to systemic histamine release causing: systemic vasodilation bronchospasm, mucus & edema in airways and tissues

Answer 34

Anaphylactic shock
Triggers: ◦ bee sting ◦ Penicillin ◦ foods
Treatment: Administration of IM epinephrine  vasoconstriction

Question 35

a condition in which red blood cells are destroyed and removed from the bloodstream before their normal lifespan is up ◦ RBC antigens of these patients become antigenic and are recognized as foreign by the body’s own immune system

Answer 35

o Hemolytic anemia -

Question 36

◦ Form of hyperthyroidism in women with antibody (Ab) against the TSH receptor on thyroid
 goiter

Answer 36

o Grave’s disease

Question 37

-◦ Severe muscle weakness ◦ Antibody (Ab) for Acetylcholine receptor on striated muscle

Answer 37

o Myasthenia gravis

Question 38

Antibodies in patients blood react to antigens of tranfused blood cells.

Answer 38

o Incompatible blood transfusions◦

Question 39

Ag-Ab complex formation
 instead of being cleared by the body, they deposit in tissues around small blood vessels
This leads to vasculitis
◦ inflammation of a blood vessel or blood vessels

Answer 39

− Vasculitis
Vasculitis leads to:
◦ Wheals (inflammation of skin)
◦ Synovitis (inflammation of joints)
Ex. RA ◦ Nephritis (inflammation of kidneys)
◦ Pleuritis (inflammation of pleura surrounding lungs)
◦ Pericarditis (inflammation of pericardium)

Question 40

◦ results from the injection of heterologous or foreign protein or serum. ◦ Currently, the most common cause of serum sickness is hypersensitivity reaction to drugs.

Answer 40

− Serum sickness
◦ Ag-Ab complexes deposit in blood vessel walls and tissues, where they induce vascular and tissue damage resulting from activation of complement and granulocytes ◦ Sxs include: Fever/malaise, Cutaneous eruptions, Arthralgias, Gastrointestinal complaints, HA  self-limiting resolves is days

Question 41

◦ Autoimmune disease of unknown origin ◦ Antigen is person’s own nucleus of cells ◦ Antinuclear antibodies (ANAs) which form complexes and deposit in varying organ systems
◦ Can affect any organ system ◦ Kidney disease, arthritis, skin disease (malar rash)
◦ Classic presentation is the triad of fatigue, joint pain and malar rash in women of childbearing age

Answer 41

− Systemic lupus erythematous

◦ Dx by immunofluorescence microscopy

Question 42

◦ Medium sized arteries  focal necrosis and acute inflammation  destruction of vessel wall and microaneurism formation  thromboses  infarcts (blockage)

Answer 42

Ex. Polyarteritis Nodosa

Question 43

◦ Typically follows URTI caused by certain streptococci ◦ The offending organisms are virtually always group A streptococci (S. Pyogenes)

◦ Usually short-lived and resolves without serious sequelae

Answer 43

Post-streptococcal glomerulonephritis (PSGN)

◦ In PSGN an immune complex containing a streptococcal antigen is deposited in the affected glomeruli.

Question 44

idiopathic granulomatous disease ◦ most commonly the lungs, lymph nodes, eyes and skin.

Answer 44

Sarcoidosis

Question 45

-Does not include granuloma but skin contains infiltrates of T cells and macrophages Examples:  latex, poison ivy, “gold” rings containing Nickel

Answer 45

o Contact dermatitis

Question 46

− Etiology & Pathogenesis in general
Etiology Although the autoimmune disorders are regarded as acquired diseases, their causes often cannot be determined
Autoimmune disorders involve disruption of the immunoregulatory mechanism, causing normal cellmediated and humoral immune responses to turn selfdestructive, resulting in tissue damage.

Many autoimmune diseases are associated with characteristic auto-antibodies.
◦ Basically, the body begins to manufacture antibodies directed against the body’s own cellular components or specific organs.

Answer 46

Autoimmune diseases
Some autoimmune diseases affect a single organ (eg. pancreas in type 1 diabetes) whereas others affect a large system or more than one system. (eg. MS) In some cases the autoimmune process overstimulates organ function, as in Grave’s disease, in which excess thyroid hormone is produced.

Question 47

– chronic inflammatory collagen-vascular dz causing ◦ Skin rash (malar “butterfly” over cheeks & nose) ◦ Vascular & joint inflammation
◦ Fibrosis of heart, lungs, kidney (poss renal failure); CNS/PNS problems
◦ Antinuclear-antibody (ANA) production affecting multiple tissues
◦ Anti-DS DNA and anti-Sm + in some people with SLE

Answer 47

Systemic Lupus Erythematosus (SLE)

Believed to be a defect in suppressor T cells  polyclonal activity of B cells (ie uncontrolled cloning of B cells)
More common in young women Antigen-Antibody complexes form in skin and other tissues
 TYPE _______ Hypersensitivity reaction

Question 48

– chronic fibrosis of skin, joints, lungs, esophagus, GI, & kidneys; women

Answer 48

Scleroderma 
C - calcinosis around cuticles 
R - Raynaud’s disease
 E - esophageal dysfunction 
S - sclerodactyly
 T - telangectasia

Question 49

− Congenital (IgA deficiency, severe combined immunodeficiency) vs Secondary (HIV)

Answer 49

Congenital ◦ IgA deficiency – most common – can not produce IgA (reduced resistance to intestinal infections) ◦ Severe combined immunodeficiency – lack T &B cells

Secondary ◦ Acquired immunodeficiency syndrome ◦ Kaposi’s Sarcoma – malignant disease cause by Herpes virus 8

Question 50

-An exaggerated or inappropriate immune response may lead to various hypersensitivity disorders.

Answer 50

Hypersensitivity Disorder

Question 51

benign

Answer 51

fibroma-benign tumor of connective tissue

Aleiomyoma, also known as fibroids, is a benign smooth muscle tumor that very rarely becomes cancer (0.1%). They can occur in any organ, but the most common forms occur in the uterus, small bowel, and the esophagus. Polycythemia may occur due to increased erythropoietin production as part of a paraneoplastic syndrome

adenomasarebenign, they should be treated as pre-cancerous. Over timeadenomasmay transform to becomemalignant, at which point they are called adenocarcinomas. Mostadenomasdo not transform

Question 52

malignant

Answer 52

Fibrosarcoma(fibroblastic sarcoma) is a malignant mesenchymal tumour derived from fibrous connective tissue and characterized by the presence of immature proliferating fibroblasts or undifferentiated anaplastic spindle cells in a storiform pattern. It is usually found in males aged 30 to 40

Leiomyosarcoma, is amalignant(cancerous) smooth muscle tumor. A benign tumor originating from the same tissue is termed leiomyoma.

Carcinoma: These tumors form from epithelial cells, which are present in the skin and the tissue that covers or lines the body’s organs.Carcinomascan occur in the stomach, prostate, pancreas, lung, liver, colon, or breast. They are a common type ofmalignanttumor

Question 53

most common cancers

Answer 53

. ◦ 1 out of 4 Canadians is expected to die from cancer. Lung, breast, colorectal & prostate CA are the most common types of CA in Canada (excluding non-melanoma skin cancer).

Based on 2017 estimates: ◦ These cancers account for over half of all new cancer cases. Prostate CA – Breast CA– Lung CA