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Foundations Week 8 > Neoplasia I > Flashcards

Neoplasia I Flashcards

0
Q

What is the leading cause of death in children & young adults?

A

cancer

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1
Q

What is first 3 leading causes of death in the US?

A
  1. heart disease
  2. cancer
  3. respiratory illnesses
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2
Q

What is neoplasm?

A

new growth; abnormal mass of tissue, growth of which exceed & is uncoordinated with that of normal tissues
- loss of responsiveness to normal growth controls

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3
Q

Most neoplasms persist in the same excessive manner after cessation of stimuli which evoke change (ex - smoking). What type of cell adaptation is this similar to?

A

hyperplasia - but hyperplasia is usually reversible

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4
Q

what is the order usually to neoplasia?

A

normal bronchial epithelium – (stimulus - tobacco) –> squamous metaplasia –(stimulus - tobacco) –> squamous dysplasia –> squamous cell carcinoma

Autonomous growth - continues despite removal of stimulus

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5
Q

What are the 2 basic tissue types that neoplasms are composed of? What do they contain?

A

Parenchyma

  • neoplastic cells
  • neoplasms classifed based on parenchymal cell type

Stroma

  • reactive to neoplasm
  • supportive
  • composed of - CT (desmoplastic response), inflammatory cells & blood vessels
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6
Q

What are 3 broad categories of neoplasms?

A

1 parenchymal cell type derive from a single germ cell layer
More than 1 parenchymal cell type derived from single germ cell layer
More than 1 parenchymal cell type derived from more than 1 germ cell layer

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7
Q

What are the 3 germ cell layers?

A

Ectoderm, endoderm & mesoderm

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8
Q

What is the most common type of neoplasm - which category? What’s an example?

A

1 parenchymal cell type derived from single germ cell layer

ex - adenocarcinoma

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9
Q

What are mixed tumors?

A

More than 1 cell type but from 1 germ cell layer
Ex - mixed tumor of salivary gland (pleomorphic adenoma)
- contains cartilage & epithelial elements
- cells of origin undergoes divergent differentiation creating “mixed tumor”

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10
Q

What is an example of more than 1 cell type derived from more than 1 germ layer

A

Teratoma!! - originate from totipotent cells

Found in ovary & testis

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11
Q

What are the 2 main categories of neoplasms?

A

benign vs. malignant

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12
Q

What are characteristics of benign neoplasms?

A

microscopic & gross features are relatively indolent

Remain localized

  • don’t invade adjacent organs/structures
  • don’t spread to other sites
  • generally amenable to local surgical removal

Patient generally survives

*There are exceptions - depend on location - brain

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13
Q

What are characteristics of malignant neoplasms?

A

can invade & destroy adjacent structures & spread to distant sites

  • malignant neoplasms with finger-like invasive components resemble crab
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14
Q

Define adenoma, lipoma, chondroma, fibroma, osteoma, leiomoma, rhabdomyoma.

A

Oma - benign tumor

adenoma - glands
lipoma - adipose 
chondroma - cartilage
fibroma - fibroblasts
osteoma - bone
leiomoma - smooth muscle
rhabdomyoma - skeletal muscle
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15
Q

Define fibrosarcoma, chondrosarcoma, rhabdomyosarcoma, leiomyosarcoma

A

sarcoma - malignant neoplasm of mesenchyme origin

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16
Q

What is carcinoma?

A

malignant neoplasm of EPITHELIAL origin

adenocarcinoma - cells grow in gland pattern
squamous cell carcinoma - derived from squamous epithelium

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17
Q

What are MALIGNANT neoplasms ending in just -oma?

A

melanoma, lyphoma, seminoma, mesothelioma, astrocytoma

Eponyms - Wilms tumor, Hodgkin lymphoma

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18
Q

What are some features you look into to determine if neoplasm is benign or malignant?

A

microscopic features - differentiation
rate of growth
local invasion
metastasis

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19
Q

What is differentiation?

A

extent to which neoplastic cells resemble their normal counterparts?
- morphologically & functionally

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20
Q

How much differentiation occurs in benign & malignant neoplasms?

A

benign - typically well-differentiated

malignant - vary from well to poorly differentiated

  • well differentiated can be difficult to distinguish from benign
  • poorly differentiated malignancy - can be difficult to determine tissue of origin
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21
Q

What is anaplasia?

A

lack of differentiation; “to form backward”

cells are failing to differentiate

22
Q

What are features of anaplastic cells?

A

pleomorphism - variation in size & shape of nucleus & cell; tumor giant cells
hyperchromatic nuclei
increased nuclear:cytoplasm ratio
mitosis - increased & atypical forms
loss of normal polarity/cell orientation
loss of normal structure formation - glands, etc; prominent nucleoli

23
Q

What do you see in adenocarcinoma histologically?

A 
nuclear enlargement 
mitotic figures
loss of polarity; crowding
nuclei stratified
decreased mucus production
24
Q

Look at slide 32

A

do it!

25
Q

What characteristics are seen in dysplasia, benign neoplasms & malignant neoplasms

A

More typical of malignant neoplasms…but

  • pleomorphism
  • abnormal nuclear morphology
  • increased mitosis
  • loss of polarity
26
Q

Rate of growth is another characteristic to distinguish benign vs. malignant. How are they different?

A

benign - grow slowly

malignant - grow faster

Rate of growth of malignant tumors tend to correlate w/ level of differentiation - poorly differentiated tumor tend to have higher growth rate

27
Q

What are characteristics of benign local invasion?

A

remain localized
lack capacity to invade & infiltrate
slow expansion
may be surround by capsule

  • fibroadenoma of breast
28
Q

What are characteristics of malignant local invasion?

A

infiltration & destruction of surrounding tissue
- reliable feature that distinguishes malignant from benign tumors

carcinoma of breast

29
Q

What is metastasis?

A

secondary implants - discontinuous from primary tumor
unequivocally identifies neoplasm as malignant
not all cancers have equivalent ability to metastasize
- rare mets - basal cell CA of skin, primary CNS tumors
- frequent mets - osteogenic sarcoma

30
Q

What are 3 pathways of metastasis?

A

Seeding within body cavities
lymphatic spread
hematogenous spread

31
Q

What is body cavity seeding?

A

characteristic of ovarian carcinoma
lung cancer may extend into pleural space
CNS tumors may extend into cerebral ventricles & implant on meningeal surfaces

32
Q

What is lymphatic spread?

A 
characteristic of carcinomas
pattern of lymph node involvement depends on
- site of primary neoplasm
- lymphatic drainage of site
    - breast --> axillary lymph nodes
33
Q

What are hematogenous spread?

A

favored pathways for sarcomas but carcinomas use it as well
veins penetrated more easily than arteries
liver & lungs are most frequently involved secondary sites

34
Q

What are features of benign neoplasms?

A

well-differentiated
typically slow growth
no local invasion; compression of surrounding tissue
no metastasis

35
Q

What are features of malignant neoplasms?

A

variable differentiation
typically more rapid growth
invasion & destruction
metastasis

(retraction of skin)

36
Q

What is the epidemiology include of neoplasms?

A 
cancer incidence
geographic & environmental factors
age
genetic predisposition to cancer
non-hereditary predisposing conditions
37
Q

Top estimated new cases in men & women include…

A

Men - prostate, lung & bronchus, colon & rectum

Women - breast, lung & bronchus, colon & rectum

38
Q

Top estimated death in men & women include…

A

Men - lung & bronchus, prostate, colon & rectum

Women - lung & bronchus, breast, colon & rectum

39
Q

What is the incidence rate like of lung CA in women?

A

rate still increasing b/c smoking peaked 20 years later in women than in men

40
Q

What is the incidence like for colon CA?

A

decrease due to screening for precancerous polyps

41
Q

What is the incidence of prostate CA like?

A

dramatic increase in incidence b/c PSA screening widely adopted in early 1990s

42
Q

___ are considered more significant than genetic factors in predisposing to malignancy

A

geographic/environmental factors

Differences in worldwide incidence of specific CA types support this theory

  • gastric CA death rate - 8x higher in Japan than in US (diet, pylori infection)
  • lung CA death rate - 2x higher in US than in Japan
  • skin CA death rate - 6x higher in NZ than in Iceland

Points to environmental & cultural factors

43
Q

What are some environmental carcinogens?

A 
sunlight
diet
cigarette smoke
alcohol
asbestos, other occupational carcinogens
44
Q

___ is considered the biggest risk factor for cancer

A

AGE
frequency of cancer increases w/ age - 77% of all CA occur in persons >55 years

Why? - accumulation of somatic mutations with age & decline in immune surveillance

45
Q

For amny cancer types, there are both __ & ___ predispositions

A

environmental & hereditary predispositions

Less than 10% of CA patients have inherited mutation that predispose to CA

46
Q

What are the 3 hereditary forms of CA?

A

inherited CA syndromes
syndromes of defective DNA repair
familial cancer

47
Q

What is inherited CA syndrome?

A

inheritance of single mutant gene increases risk of developing neoplasm

  • tumor suppressor gene
  • need 2nd mutation to develop malignancy

ex - familial retinoblastoma - mutant Rb gene; 10K fold increased risk of retinoblastoma

need to remove eye & have chemo

48
Q

What are syndromes of defective DNA repair?

A 
causes accumulation of mutations
hereditary nonpolypoid colon cancer (HNPCC)
- most common CA predisposition syndrome
- mutated DNA mismatch repair gene
- increased risk of colorectal CA
  • xeroderma pigmentosum!!
49
Q

What are familial CA?

A
  • cancer may occur at higher frequency in certain families w/o clearly defined pattern of transmission
  • virtually all common types of CA that occur sporadically have been reported to occur in familial forms
    Features - early age; multiple/bilateral tumors; tumors in 2/more close relatives
50
Q

What are nonhereditary predisposing conditions?

A

acquired precancerous disorders

  • acquired conditions that predispose to malignancy
    • proliferating cells at risk for mutations - chronic inflammation; hyperplasia; dysplasia

Increase risk of CA but in most instances CA doesn’t develop

51
Q

What is chronic inflammation in nonhereditary predisposing condition? What’s an example?

A

cellular proliferation required to repair damage can lead to mutations
ex - viral hep - hepatocellular carcinoma
- helicobacter pylori gastritis - lymphoma

52
Q

What are precancerous conditions?

A

disorders with well-defined association with CA but vast majority don’t develop malignancy

non-neoplastic - ulcerative colitis –> colon carcinoma

neoplastic - villous adenoma of colon –> colon carcinoma

Foundations Week 8 (8 decks)

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