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Mechanisms of Disease Exam #2 > Neoplasia I > Flashcards

Neoplasia I Flashcards

1
Q

All tumors have which 2 basic components?

A
  1. Neoplastic cells that constitute the parenchyma.

2. A reactive stroma made of CT, vessels, and immune cells.

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2
Q

Tumors are classified based on the biologic behavior of the…

Which component allows tumors to grow and spread?

A

Parenchyma

Stroma

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3
Q

Adenoma definition:

A

A benign epithelial neoplasm derived from glands, although they may or may not form glandular tissue.

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4
Q

What is a polyp?

A

A benign or malignant neoplasm that is a visible projection above a mucosal surface and projects into a lumen or space.

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5
Q

What is a sarcoma?

A

A neoplasm arising from solid mesenchymal tissues (CT).

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6
Q

If a malignant neoplasm occurs within the stroma, what is it generally termed?

A

A sarcoma

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7
Q

If a malignant neoplasm occurs within the parenchyma, what is it generally termed?

A

A carcinoma

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8
Q

What is a carcinoma?

A

A malignant neoplasm from epithelial cell origin derived from any of the 3 germ layers.

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9
Q

What is an adenoma of the colon?

A

A neoplasm that has parenchyma resembling the glands of the colon.

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10
Q

What is a mixed tumor?

A

A tumor composed of divergent differentiations of a single neoplastic clone from the same germ layer.

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11
Q

What might exist in a mixed tumor of the salivary gland?

A

Epithelial components scattered with myxoid stroma and cartilage and/or bone.

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12
Q

What is the preferred designation of a mixed tumor of the salivary gland?

A

Pleomorphic adenoma

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13
Q

What is a teratoma?

What cells do they originate from?

A

A tumor containing cells from more than 1 germ layer.

Totipotent stem cells.

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14
Q

What is the most common teratoma?

A

Ovarian cystic teratoma (dermoid cyst).

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15
Q

What is tumor differentiation?

A

The extent that a neoplastic parenchymal cell resembles its corresponding normal cells.

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16
Q

What is anaplasia?

A

Lack of differentiation. It is associated with malignancies.

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17
Q

Which tumors are well-differentiated?

Which are poorly differentiated?

A

Benign tumors are well-differentiated.

Malignant tumors are poorly differentiated.

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18
Q

What is the grading scale for malignancies?

A

Well: closely resembles parental cells.

Moderately: features of parent tissue are identifiable, but is not the dominant pattern, with associated atypia.

Poorly: a small minority of parental cells; associated with anaplasia.

Undifferentiated: tissue of origin cannot be determined. Almost always associated with anaplasia.

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19
Q

What are the histopathologic criteria used when “anaplasia” is employed?

A

Pleomorphism: variation in size and shape

Abnormal nuclear morphology: nuclei are generally larger w/ less cytoplasm (1:4 or 1:6 ratio) and the cell shape is unusual with a heterochromatin-type disbursement of DNA.

Mitoses: suggests that there might be a high degree of cell division in an area where it should not occur.

Loss of Polarity: orientation of anaplastic cells is disturbed.

Other changes: possibly and area of necrosis due to inadequate blood supply.

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20
Q

What is dysplasia?

A

Disordered growth. It is usually encountered in the epithelia and characterized by changes including loss of uniformity and architectural orientation.

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21
Q

How does squamous epithelium become dysplastic?

A

Instead of the normal progression of tall basal cells to flattened apical cells, the epithelia may replace its epithelium with basal-appearing cells w/ hyperchromatic nuclei. There may also be more mitotic figures visible.

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22
Q

How does carcinoma in situ (CIS) occur?

A

When dysplastic changes involve the full thickness of the epithelium, but the lesion does not penetrate the basement membrane. It is not yet invasive until the basement membrane has been compromised.

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23
Q

What key pathological features accompany malignant tumors and help differentiate from benign tumors?

A

Progressive infiltration, invasion and destruction of surrounding tissues suggests malignancy.

Benign tumors generally grow cohesively, remain localized and lack capacity to infiltrate, invade or metastasize.

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24
Q

What is the “unequivocal criterion of malignancy”?

A

Metastasis

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25
Q

How do benign tumors grow and expand?

How do malignant tumors grow and expand?

A

They grow and expand slowly and usually develop a fibrous capsule produced by fibroblasts and the stroma due to hypoxia from compression from the tumor.

Malignancies grow in a poorly demarcated fashion and do not have well-defined cleavage plane.

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26
Q

What are the most common places for metastases?

A

Liver, lung, bone and brain.

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27
Q

What are the 3 ways in which a cancer can disseminate?

A
  1. Direct seeding of body cavities or surfaces.
  2. Lymphatic spread.
  3. Hematogenous spread.
28
Q

How does seeding of body cavities and surfaces occur?

What is a classic example?

A

By a malignancy penetrates into a natural “open field” lacking a physical barrier. It occurs most frequently in the peritoneal cavity, but can happen in others.

A classic example is ovarian carcinomas which can spread into the peritoneal surfaces.

29
Q

How does lymphatic spread?

What cancer does this occur with most?

A

Through transport through lymphatics of the host. Tumors do not have functional lymphatics.

This is classic of carcinomas.

30
Q

How does hematogenous spread?

What cancer does this occur with most?

A

The mats travel through the venous system usually. This explains why mets to the liver and lungs are common.

This is typical of sarcomas.

31
Q

What is a sentinel lymph node?

A

“The first node in a regional lymphatic basin that receives lymph from the primary tumor”.

32
Q

Does enlargement of lymph nodes in the proximity to a cancer mean it has disseminated to that node? How or how not?

A

No, because it may be caused by spread to other tissues or reactive hyperplasia. It should arouse suspicion, however.

33
Q

What are some examples of hematogenous spread of cancer and what do they spread into?

A
  1. Hepatocellular carcinoma: penetrate the portal and hepatic radicles to reach the main venous channels.
  2. Renal cell carcinoma: invades branches of renal v. and can travel through the IVC and sometimes reach the right heart.
  3. Cancers of the vertebral column (or near to it): may embolize though the paravertebral plexus and metastasize to the prostate or thyroid.
34
Q

Incidence:

Prevalence:

A

A measure of the probabilty of occurrence of a disease.

The proportion of a particular population found to be affected by a medical condition. Usually expressed as a ratio or x of y, etc.

35
Q

How many new cancer cases were presented in 2008?

How many cancer deaths occurred in 2008?

By 2030, how many cancer cases are estimated?

By 2030, how many cancer deaths are estimated?

A
  1. 7 mil.
  2. 6 mil.
  3. 4 mil.
  4. 2 mil.
36
Q

What cancer is most common in men and women?

What is the most common COD?

A

Prostate cancer for men and breast cancer for women.

Lung/bronchus cancer for both genders.

37
Q

When do most carcinomas develop?

At what period in a man’s and woman’s life is cancer the most common COD?

A

> 55 y/o.

60-79 y/o for men and 40-79 y/o for women.

38
Q

What is the rising incidence of cancer with age attributed to?

A

The accumulation of somatic mutations and decline in immune function.

39
Q

What 2 cancer types make up approximately 60% of childhood cancer deaths?

A

Acute leukemia and neoplasms of the CNS.

40
Q

What is the morphology of the most common tumors of infancy and childhood?

What are some?

A

Small, round blue cell tumors.

Neuroblastoma, Wilms tumors, Retinoblastoma, Acute leukemia, Rhabdomyomas.

41
Q

What are 6 chemical agents associated with lung carcinomas?

A 
Arsenic
Asbestos
Beryllium
Chromium
Nickel
Radon
42
Q

Mesothelioma, lung carcinoma can be from what precursor lesions?

A

Asebstos, silicosis

43
Q

Colorectal carcinoma can be from what precursor lesions?

A

IBD

44
Q

Vulvar squamous cell carcinoma can be from what precursor lesions?

A

Lichen sclerosis

45
Q

Pancreatic carcinoma can be from what precursor lesions?

A

Pancreatitis

46
Q

Gallbladder cancer can be from what precursor lesions?

A

Chronic cholecystitis

47
Q

Esophageal carcinoma can be from what precursor lesions?

A

GERD, Barrett’s esophagus

48
Q

MALT lymphoma can be from what precursor lesions?

A

Sjogren syndrome

49
Q

Hepatocellular carcinoma can be from what precursor lesions?

A

Hepatitis

50
Q

Carcinoma of the draining sinuses can be from what precursor lesions?

A

Osteomyelitis

51
Q

Cervical carcinoma can be from what precursor lesions?

A

Chronic cervicitis

52
Q

Bladder carcinoma can be from what precursor lesions?

A

Chronic cystitis

53
Q

What are 2 noninflammatory hyperplasias that are precursor lesions to malignancy?

A

Endometrial hyperplasia due to unopposed estrogen.

Leukoplakia (a thickening of squamous epithelium of oral cavity, penis or vulva) may give rise to squamous carcinoma.

54
Q

What is the classic example of malignant transformation of a benign neoplasm?

A

Colonic villous adenoma

55
Q

In women born after 1940, what is the risk for females who inherit mutated copies of BRCA1 and BRCA2 tumor suppressors?

A

They have a 3x greater risk for breast cancer.

56
Q

A polymorphism in one of CYP-450 loci can do what?

A

It can confer an inherited susceptibility to lung cancers in smokers, because it can metabolize procarcinogens into its active carcinogenic form.

57
Q

The most common cancers overall occur in which 5 organs?

A 
Lung
Colon
Prostate
Breast
Skin
58
Q

What are the 4 major types of lung cancers?

A

Adenocarcinoma (38%)
Squamous cell carcinoma (20%)
Small cell carcinoma (14%)
Large cell carcinoma (3%)

Other (25%)

59
Q

What is a driver mutation?

A

Mutations that contribute to the development of the malignant phenotype. Many driver mutations may be needed to progress to malignancy.

60
Q

What is a common early step in malignancy?

A

Loss-of-function mutations.

61
Q

What are passenger mutations?

A

Mutations that have no phenotypic consequence but are associated with cancer cells.

62
Q

Cancers grow by which biological basis?

A

Darwinism and survival of the fittest.

63
Q

What is DNA methylation?

What is histone modification?

A

DNA methylation is a way to silence expression.

Histone modification can be associated with gene silencing or activation.

64
Q

What are the 8 fundamental changes in cell physiology which are hallmarks of cancer?

A
  1. Self-sufficiency in growth signals
  2. Insensitivity to growth-inhibitory signals
  3. Altered cellular metabolism
  4. Evasion of apoptosis
  5. Limitless replicative potential (immortality)
  6. Sustained angiogenesis
  7. Ability to invade and metastasize
  8. Ability to evade the host immune system
65
Q

What is an oncogene vs. a proto-oncogene?

A

A gene that promotes autonomous cell growth in cancer cells.

A proto-oncogene is an unmutated oncogene.

66
Q

How do cancer cells become non-reliant on internal regulation via oncoproteins?

A

Oncoproteins resemble their normal counterpart, but bear mutations that can often inactivate internal regulatory elements, so their activity does not rely on external signals.

Mechanisms of Disease Exam #2 (10 decks)

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