Neoplasia: An Overview (1)

Question 1

What is a tumor (neoplasm)?

Answer 1

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.

Question 2

Name three things that differentiate neoplasia from hyperplasia.

Answer 2

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.

Question 3

What distinguishes a malignant neoplasm from a benign one?

Answer 3

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.

Question 4

What determines how a benign or malignant neoplasm is named?

Answer 4

presumed tissue of origin or morphologic appearance

Question 5

What is a benign tumor of epithelial origin called? Malignant?

Answer 5

Adenoma = benign
Carcinoma = malignant

Question 6

What is a malignant tumor of connective tissue +

vessels (mesenychmal) origin called?

Answer 6

Sarcoma

Question 7

What is the difference between lymphoma and leukemia?

Answer 7

Both are cancers of hematologic (blood cells). Lymphoma = solid, leukemia =intravascular

Question 8

What is a benign tumor of melanocytic (neural crest) origin called? Malignant?

Answer 8

benign = nevus
malignant = melanoma

Question 9

What differentiates metaplasia and dysplasia? What three letter term do we use to define dysplasia?

Answer 9

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”

Question 10

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 ____.

Answer 10

basement membrane, in-situ carcinoma

Question 11

How do we classify dysplasia?

Answer 11

grade on severity: extent of abnormal cell population, morphology of abnormal cells.

Question 12

What is a de novo cancer, and which types of cancers may fit this category?

Answer 12

neoplasm that originates as malignant neoplasm, already with the genetic alterations without precursor lesions

many sarcomas (mesenchymal), lymphomas (hematologic)

Question 13

When a tumor is secreting compounds not normally made in that organ, what is this called?

Answer 13

Paraneoplastic syndrome

Question 14

What are the symptoms associated with a pancoast tumor? Where is this tumor located?

Answer 14

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

Question 15

If someone is having:

1. amenorrhea
2. milk discharge
3. weight gain
4. skin thinning
5. glucose intolerance

What is associated with this? What is a possible risk?

Answer 15

Pituitary adenoma: functional/benign, but excess prolactin (first two) and ACTH (3-5)

May compress the optic chiasm!

Question 16

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?

Answer 16

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.

Question 17

57 yo male presents with trouble climbing stairs, dry mouth, slurred speech, and double vision.
Anti-voltage gated calcium channel antibodies, hemoptysis sometimes

Answer 17

“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

Question 18

Bone shows estrogen, progesterone receptors, mammaglobin. Diagnosis?

Answer 18

Metastatic breast carcinoma

Question 19

Bony metastases can be blastic or lytic (or mixed). What is the difference, and which cancers are associated with which ones?

Answer 19

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

Question 20

What are three ways metastasis can occur?

Answer 20

1. hematogenous: travel via blood vessels to organs (generally sarcoma)
2. lymphatic: travel via lymphatic vessels to lymph nodes (generally carcinoma)
3. bone cavity: release into cavity, seeding into surface

Question 21

What are the top three organs affected by hematogenous metastasis?

Answer 21

1. lung
2. liver
3. bone

Question 22

What is cachexia?

Answer 22

loss of muscle, fat, due to elevated metabolism and a severe GLOBAL effect of cancer

Question 23

Why do we screen for colon cancer every ten years?

Answer 23

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

Question 24

If you have a fixed mass, does that indicate malignant or benign?

Answer 24

Malignant (could be invading)