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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
Look at slide 32
do it!
25
What characteristics are seen in dysplasia, benign neoplasms & malignant neoplasms
More typical of malignant neoplasms...but - pleomorphism - abnormal nuclear morphology - increased mitosis - loss of polarity
26
Rate of growth is another characteristic to distinguish benign vs. malignant. How are they different?
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
What are characteristics of benign local invasion?
remain localized lack capacity to invade & infiltrate slow expansion may be surround by capsule - fibroadenoma of breast
28
What are characteristics of malignant local invasion?
infiltration & destruction of surrounding tissue - reliable feature that distinguishes malignant from benign tumors carcinoma of breast
29
What is metastasis?
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
What are 3 pathways of metastasis?
Seeding within body cavities lymphatic spread hematogenous spread
31
What is body cavity seeding?
characteristic of ovarian carcinoma lung cancer may extend into pleural space CNS tumors may extend into cerebral ventricles & implant on meningeal surfaces
32
What is lymphatic spread?
``` characteristic of carcinomas pattern of lymph node involvement depends on - site of primary neoplasm - lymphatic drainage of site - breast --> axillary lymph nodes ```
33
What are hematogenous spread?
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
What are features of benign neoplasms?
well-differentiated typically slow growth no local invasion; compression of surrounding tissue no metastasis
35
What are features of malignant neoplasms?
variable differentiation typically more rapid growth invasion & destruction metastasis (retraction of skin)
36
What is the epidemiology include of neoplasms?
``` cancer incidence geographic & environmental factors age genetic predisposition to cancer non-hereditary predisposing conditions ```
37
Top estimated new cases in men & women include...
Men - prostate, lung & bronchus, colon & rectum | Women - breast, lung & bronchus, colon & rectum
38
Top estimated death in men & women include...
Men - lung & bronchus, prostate, colon & rectum Women - lung & bronchus, breast, colon & rectum
39
What is the incidence rate like of lung CA in women?
rate still increasing b/c smoking peaked 20 years later in women than in men
40
What is the incidence like for colon CA?
decrease due to screening for precancerous polyps
41
What is the incidence of prostate CA like?
dramatic increase in incidence b/c PSA screening widely adopted in early 1990s
42
___ are considered more significant than genetic factors in predisposing to malignancy
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
What are some environmental carcinogens?
``` sunlight diet cigarette smoke alcohol asbestos, other occupational carcinogens ```
44
___ is considered the biggest risk factor for cancer
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
For amny cancer types, there are both __ & ___ predispositions
environmental & hereditary predispositions Less than 10% of CA patients have inherited mutation that predispose to CA
46
What are the 3 hereditary forms of CA?
inherited CA syndromes syndromes of defective DNA repair familial cancer
47
What is inherited CA syndrome?
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
What are syndromes of defective DNA repair?
``` 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
What are familial CA?
- 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
What are nonhereditary predisposing conditions?
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
What is chronic inflammation in nonhereditary predisposing condition? What's an example?
cellular proliferation required to repair damage can lead to mutations ex - viral hep - hepatocellular carcinoma - helicobacter pylori gastritis - lymphoma
52
What are precancerous conditions?
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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