Neoplasia: An Overview (1) Flashcards
What is a tumor (neoplasm)?
a disorder of cell growth triggered by a series of acquired mutations affecting a single cell and its clonal progeny, resulting in excessive proliferation independent of physiologic growth signals.
Name three things that differentiate neoplasia from hyperplasia.
Neoplasia: derived from a single progenitor cell–it’s monoclonal, instead of hyperplasia which is polyclonal.
Neoplasia occurs in response to genetic alterations giving a “growth advantage,” as opposed to physiologic signals that cause hyperplasia.
Neoplasia can proliferate independently of normal physiologic signals.
What distinguishes a malignant neoplasm from a benign one?
It’s tricky, but generally–ability to travel (metastasize), cause severe illness (morbidity), and cause death (mortality).
Cancers are clonal proliferations with the potential to kill.
What determines how a benign or malignant neoplasm is named?
presumed tissue of origin or morphologic appearance
What is a benign tumor of epithelial origin called? Malignant?
Adenoma = benign Carcinoma = malignant
What is a malignant tumor of connective tissue +
vessels (mesenychmal) origin called?
Sarcoma
What is the difference between lymphoma and leukemia?
Both are cancers of hematologic (blood cells). Lymphoma = solid, leukemia =intravascular
What is a benign tumor of melanocytic (neural crest) origin called? Malignant?
benign = nevus malignant = melanoma
What differentiates metaplasia and dysplasia? What three letter term do we use to define dysplasia?
Metaplasia is a change to cell type, histologically normal, bc of STRESS
Dysplasia is disordered growth of cells, histologically abnormal, bc of GENETIC anomaly
Dysplasia is “intra-epithelial neoplasia”
An invasive carcinoma requires additioanl mutations to let it invade stroma, blood vessels, and travel. Before those mutations, a carcinoma is proliferating within the confines of the ______ and is called ____.
basement membrane, in-situ carcinoma
How do we classify dysplasia?
grade on severity: extent of abnormal cell population, morphology of abnormal cells.
What is a de novo cancer, and which types of cancers may fit this category?
neoplasm that originates as malignant neoplasm, already with the genetic alterations without precursor lesions
many sarcomas (mesenchymal), lymphomas (hematologic)
When a tumor is secreting compounds not normally made in that organ, what is this called?
Paraneoplastic syndrome
What are the symptoms associated with a pancoast tumor? Where is this tumor located?
at the apex of the lung
- > compress brachial plexus (shoulder/arm pain)
- > compress sympathetic ganglia (facial sweating)
- > compress subclavian vessels (facial congestion)
- > cough/hemoptysis INFREQUENT bc of the non-central location
If someone is having:
- amenorrhea
- milk discharge
- weight gain
- skin thinning
- glucose intolerance
What is associated with this? What is a possible risk?
Pituitary adenoma: functional/benign, but excess prolactin (first two) and ACTH (3-5)
May compress the optic chiasm!
A 65 yo smoker presents with nausea, increased urination, muscle weakness, and cough – endoscopic exam, diabetic exam are normal, but has mass in left lung. What is wrong?
Paraneoplastic syndrome:
“Hypercalcemia of malignancy” due to increased secretion of PTHrP (PTH related protein), due to lung squamous cell carcinoma.
The lung squamous cells are secreting a compound similar to PTH, which activates normal PTH-receptors and causes hypercalcemia.
Excess calcium in your blood means your kidneys have to work harder to filter it out. This can cause excessive thirst and frequent urination.
Hypercalcemia can cause stomach upset, nausea, vomiting and constipation.
In most cases, the excess calcium in your blood was leached from your bones, which weakens them, sometimes muscles.
57 yo male presents with trouble climbing stairs, dry mouth, slurred speech, and double vision.
Anti-voltage gated calcium channel antibodies, hemoptysis sometimes
“Lambert-Eaton myasthenic syndrome”: paraneoplastic syndrome where antibodies against tumor antigens cross react with neuronal antigens
this is sometimes an occurrence in lung small cell neuroendocrine carcinoma
Bone shows estrogen, progesterone receptors, mammaglobin. Diagnosis?
Metastatic breast carcinoma
Bony metastases can be blastic or lytic (or mixed). What is the difference, and which cancers are associated with which ones?
Blastic: bone-forming, you see radio-opacity – Prostate and Breast cancer
Lytic: bone-destroying, you see radio-lucent – Lung, Kidney, and Thyroid cancers
Mixed: breast
BLT & Kosher Pickle
Breast, lung, thyroid, kidney, prostate typically go to bone
What are three ways metastasis can occur?
- hematogenous: travel via blood vessels to organs (generally sarcoma)
- lymphatic: travel via lymphatic vessels to lymph nodes (generally carcinoma)
- bone cavity: release into cavity, seeding into surface
What are the top three organs affected by hematogenous metastasis?
- lung
- liver
- bone
What is cachexia?
loss of muscle, fat, due to elevated metabolism and a severe GLOBAL effect of cancer
Why do we screen for colon cancer every ten years?
It is this adenoma to carcinoma process, as opposed to dysplasia to carcinomas (cervical cancer is a general example?)
Thus it goes from a benign mass, genetic abnormalities accumulate
This process takes ten years
If you have a fixed mass, does that indicate malignant or benign?
Malignant (could be invading)
