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Neoplasia > Neoplasia II and III > Flashcards

Neoplasia II and III Flashcards

1
Q

How do we obtain material for Dx?

A
  • Fine needle aspiration (FNA)
  • Tru-cut Core Needle Bx
  • Incisional Biopsy
  • Complete removal lump
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2
Q

what are the steps to prepare biopsied tissue for microscopic examination?

A

Preservation of tissue in formalin, processing, cutting of section, placing on the slide, staining with H&E

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3
Q

FNA shows both cells and stroma. True/False.

A

False.

A fine needle aspirate contains cells only. There is no stromal tissue so architecture cannot be assessed

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4
Q

FNA can assess tissue architecture. T/F

A

False.

A fine needle aspirate contains cells only. There is no stromal tissue so architecture cannot be assessed

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5
Q

Tru-cut core needle biopsy shows both cells and stroma. True/False

A

True.
A tru-cut core needle biopsy shows cells and stroma. Therefore architecture can be assessed. Also more tissue for tumor marker

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6
Q

which is preferred by pathologists: FNA or tru-cut biopsy?

A

Tru-cut core needle biopsy which will give us 2 important things – architecture and tissue for immunohistochemistry

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7
Q

list the factors used in cancer prognosis

A
  • Grade
  • Stage (level of spread of tumor)
  • Size
  • Site
  • Type
  • Host response
  • Adequacy of therapy
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8
Q

which one is the most important predictor stage or the grade?

A

The stage which will show as the extent of the spread of the tumor

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9
Q

treatment of the tumor is based on the stage or grade?

A

stage, eg node-negative breast carcinoma if <2cm usually does not get chemotherapy. Node positive breast carcinoma does get chemotherapy

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10
Q

staging is done before or after resection of tumor?

A

after resection

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11
Q

what international staging system we use?

A

TNM
–T- Size of the tumour (T is subdivided on size) or level of involvement of the wall e.g. Colon, bladder by ca. = size and/or level of invasion
–N-Number of nodes (1 doesn’t mean one lymph node- it means a category of nodes)
–M-Number of Mets (Mx means you don’t know metastasis because can’t determine from just specimen- surgeon checks in with radiologist)
e.g. T1, N1, M0

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12
Q

how is lymph node involvement assessed by TNM?

A

N-Number of nodes (1 doesn’t mean one lymph node- it means a category of nodes)

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13
Q

what is the grade of the tumors?

A

histological assessment of the degree of differentiation of the tumor
Three grades
•Well-differentiated/Low grade
•Moderately differentiated / Intermediate grade
•Poorly differentiated/ High grade (poor prognosis)

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14
Q

What does tumor differentiation mean?

A

The degree to which the tumor resembles mature tissue and the degree of nuclear abnormality.

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15
Q

the tumor grade is assessed by?

A

1) Cytological Features

2) Architectural Features

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16
Q

what are the cytological features used to grade tumors?

A
  1. Hyperchromasia (inc)
  2. Pleomorphism (inc)
  3. Nuclear/Cytoplasmic Ratio (inc)
  4. Mitotic Activity (inc)
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17
Q

which one is not involved in cytological features used to grade tumors?

1) degree of gland formation (adenoma)
2. Pleomorphism (inc)
3. Nuclear/Cytoplasmic Ratio (inc)
4. Mitotic Activity (inc)

A

1-degree of gland formation, which is an architectural feature used to grade tumor

ARCHITECTURAL FEATURES
Degree of gland formation - Adenoma
Degree of maturation of the epithelium

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18
Q

what is the sentinel node?

A

The sentinel lymph node is the node to which the tumor first spreads.

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19
Q

in what tumors sentinel node is commonly examined?

A

breast carcinoma and malignant melanoma

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20
Q

do you need still dissect the nodes if the sentinel node is negative?

A

no

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21
Q

how the sentinel node is identified?

A
  • Blue dye and/or an isotope is injected into the site where the tumor is
  • This dye/isotope will drain first to the sentinel node
  • The Surgeon will see the blue color in the node and he or she will remove this
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22
Q

If the tumour spreads to the sentinel node, it will always be positive for tumour. True/False

A

False,
it can be false-negative if a biopsy is taken from the side not involved by tumor or if the lymphatic is blocked by tumor cells so the dye does not reach the node!!!!!!!!!!!

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23
Q

melanomas > 2 mm deep in the skin have good or bad prognosis?

A

bad prognosis, as tumor goes down into the skin the probability of metastasization increases (as it approaches blood vessels in the deep dermis)

24
Q

Basal Cell carcinoma 2mms deep into the skin have a good or bad prognosis?

A

BCC always have a good prognosis

25
Q

why skin neoplasms generally have a better prognosis than for example abdominal neoplasms?

A

because because they present clinically at a much earlier stage, however in abdomen there is a vast space to grow

26
Q

lymphocytic infiltrate in tumor reflect good or bad prognosis?

A

good prognosis
–This reflects the ability of the body to generate an immunological response against the tumor.
–Examples: seminoma
(seminomas have significant lymphocytic infiltration)

27
Q

why the margins of the tumor are inked by pathologists?

A

Demarcate true margins to give a marginal measurement of the tumor (and for orientation of tissue)

  • Complete removal is most important.
  • Margins of a tumour are inked in the pathology department so that the pathology report will give a measurement of the margin of excision of the tumor.
28
Q

what factor of a patient with malignancy affects the prognosis?

A
  • General health status of a patient

- He/she fit to withstand treatment

29
Q

what are the routes by which tumors metastasize?

A
  1. Direct to adjacent tissues (local invasion)
  2. Lymphatic (most common for carcinoma and melanoma)
  3. blood vessel (hematogenous-sarcomas)
  4. Transcoelomic (via serous sacs)
  5. Perineural (along nerve passages)
  6. Along natural passages (may occur where carcinoma develops in a gland or its duct eg. Breast such as Paget’s disease of the nipple)
30
Q

carcinomas commonly metastasize hematogenously or by lymphatics?

A

by lymph channels

31
Q

name important carcinomas that metastasize hematogenously?

A

renal cell carcinoma, follicular thyroid carcinoma, hepatocellular carcinoma, choriocarcinoma

32
Q

which carcinoma commonly leads to seeding into body cavities and peritoneum?

A

Ovarian carcinoma

33
Q

what are the clinical examples of lymphatic spread of tumors?

A

• Lymphadenopathy (commonest)
Generalized lymphadenopathy can be defined as an enlargement of more than two non-contiguous lymph node groups. (breast cancer spreading to lymph nodes)

• Lymphangitis carcinomatosis(lung).
Dilated obstructed lymphatics (embolised) due to tumor is seen on x-ray.
= term given to tumor spread through the lymphatics of the lung and is most commonly seen secondary to adenocarcinoma.

•	Peau D'orange(breast).  Dilated dermal lymphatics.
Edematous skin (like the skin of an orange)- this is due to lymphatics being full of tumor emboli - blocking lymphatic drainage leading to edema

• Lymphedema Dilated limb due to obstructed lymphatics.

34
Q

define generalized lymphadenopathy

A

Generalized lymphadenopathy can be defined as an enlargement of more than two non-contiguous lymph node groups. Can be seen also in some infectious diseases (eg infectious mononucleosis)

35
Q

what is Peau D’orange?

A

seen in inflammatory type breast cancer, is due to obstruction of breast lymph vessels by tumor cells, breast resembles orange.

36
Q

what are the most common sites of hematogenous spread of the tumor?

A

1) Lung
2) Liver
3) Bone
4) Brain

37
Q

give an example of tanscoelomic spread (spread across the peritoneum) serous sacs

A

Krukenberg Tumour= signet cell carcinoma (gastric cancer that spreads to the ovary)

38
Q

the extent of the spread of the tumor is assessed by?

A

staging

39
Q

list the steps of tumor metastasization

A
  1. Enzyme degradation of the basement membrane and connective tissue by collagenases (break down laminin and basement membrane (collagenase IV).
  2. Reduced cell to cell adhesion between tumour cells (allows cells to separate) such as e-cadherin.
  3. Increased cell to cell adhesion between tumour cells and endothelial cells (attaches cells to vessel wall)
  4. Tumour embolization (carries cells from one part of the blood or lymphatic stream to another.
  5. Increased vessel formation - VEGF (supplies oxygen the tumor).
40
Q

Loss of E-cadherin expression predisposes to?

A

metastasization,tumour cells detach and metastasize

41
Q

why do tumor cells need to overexpress proteases such as collagenase and matrix metalloproteinases?

A

required to degrade basement membrane and interstitial matrix

42
Q

Autocrine signaling via tumor-produced cytokines and paracrine signaling by cleaved matrix components and extracellular growth factors is required for

A

tumor cell locomotion towards vasculature or lymphatics.

43
Q

why tumor cells require to express VEGF (vascular Endothelial Growth Factor)

A

Increased vessel formation-spread of tumor cells to distant sides

44
Q

what are the clinical effects of metastasis?

A

• Lymphadenopathy
• Jaundice
• Bone Pain or Fracture
• Cerebral Stroke
• Cachexia, Anorexia, Lassitude (due to demand of neoplasm on the body). Excess in proinflammatory cytokines (IL-1, IL-6, IFN-γ, and TNF-α) as a result of tumor growth → ↑ basal metabolic rate and catabolism
Proteasomal activation and breakdown of myosin in skeletal muscle + loss of adipose tissue
Negative nitrogen balance
Clinical features: weight loss, poor appetite, ↓ adipose tissue, muscle wasting, fatigue

45
Q

name common neoplasms that metastasize to bone

A 
•	Breast Cancer
•	Prostate Cancer
•	Thyroid Cancer
•	Renal Cancer
mainly osteolytic meaning destruction of bone-hypercalcemia
46
Q

give an example of tumors that produce osteoblastic metastasis

A 
Prostate cancer
breast cancer (mixed).
47
Q

what is the significance of Batson’s plexus?

A

Batson’s plexus (a network of valveless veins that connect deep pelvic veins and thoracic veins to the internal vertebral plexus) provides a series of venous passageways by which cancer cells can be directly seeded into bones, bypassing the liver and lungs.
Blood flow is sluggish and subject to arrest and even reversal.
Neoplastic cells disseminate through the vertebral vein system.

48
Q

what are the treatment options of malignancy?

A
  • Surgery: Cut it out
  • Radiotherapy: Use radiation to kill cells
  • Chemotherapy: Drugs to kill cells
  • Growth receptor blocking agents: Tamoxifen (estrogen receptor-blocking)
  • Small Molecule inhibitors: Inhibit aberrant cellular pathways: Imatinib
  • Anti-angiogenic Tx: Destroys new vessel growth so that tumour will not have nutrients via blood
  • Immunotherapy: Stimulate the immune response to full tumour cells or remove the “brake” on lymphoid cells ignoring tumour cells e.g. checkpoint inhibitors
  • Immunotherapy: Stimulate the immune response against the tumour or reduce the immune cells that suppress the immune response e.g. BCG or checkpoint inhibitors
49
Q

what drug is used to block estrogen receptors on breast cancer cells halting tumor growth?

A

tamoxifen. Whether the cancer is estrogen receptor-positive or not are determined by immunohistochemistry

50
Q

what is imatinib

A

is a monoclonal antibody against Tyrosine kinase used in CML

51
Q

example of immunotherapy used for the treatment of cancer?

A

intravesical injection of BCG for urothelial bladder cancer

52
Q

what is trastuzumab?

A

monoclonal antibody against EGF (epidermal growth factor), used in Her2 positive (member of EGF) breast cancer, the trade name is Herceptin (side effect–heart failure)

53
Q

what is tyrosine kinase

A

intracellular component of a transmembrane receptor for cell signaling for example for growth. Phosphorylation of TK activates cell proliferation and growth. Inhibited by monoclonal antibodies ending with ib (imatinib)

54
Q

what are the side effects of cancer radiation?

A

Necrosis and Fibrosis and second malignancy e.g. breast carcinoma in females post-radiotherapy for lymphomas of the mediastinum. Radiation in childhood significantly increases the risk of papillary thyroid carcinoma

55
Q

what are the side effects of chemotherapy?

A

immunosuppression due to killing of Bone marrow cells-infections, reactivation of TB

56
Q

some chemotherapy drugs are carcinogenic.True/False

A

True.

Neoplasia (3 decks)

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