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Anatomic And Molecular Pathology > Neoplasia-Overview of Cancer and Carcinogenesis > Flashcards

Neoplasia-Overview of Cancer and Carcinogenesis Flashcards

1
Q

Briefly describe:

  1. Hyperplasia
  2. Metaplasia
  3. Dysplasia
A

Hyperplasia- excessive proliferation of cells due to a stimuli

Metaplasia- replacement of one mature epithelium type with a more resistant type due to chronic irritation

Dysplasia- loss of uniformity of individual cells and architectural orientation

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2
Q

What are the differences and similarities between hyperplasia and neoplasms❓

A 
Differences:
Hyperplasia:
•follows normal stimuli
•Growth : Degree of stimulation
•Regress with cessation of stimulation 
•eg endometrial hyperplasia (⬆️estrogen)

Neoplasm:
•spontaneous
•growth without stimulus
•continues indefinitely

Similarities:

  1. Both involve cellular proliferation
  2. Sites of excessive mitosis often serve as fertile soil for genetic mutation
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3
Q

Give a few examples of metaplasia stating:

  1. Location
    a. Normal epithelium
    b. Metaplasic epithelium
    c. Cause
A
  1. Bronchus
    a. Pseudostratified ciliated columnar
    ⬇️
    b.Squamous
    c. Cigarette smoking
  2. Oesophagus
    a. Squamous
    ⬇️
    b. Columnar mucous with goblet cells(Barrett’s)
    c. Reflux
  3. Stomach
    a. Simple columnar
    ⬇️
    b. Intestinal with goblet cells
    c. H. pylori
  4. Urinary bladder
    a. Transitional epithelium
    ⬇️
    b. Squamous
    c. Stones, schistosoma infection
  5. Cervix
    a. Simple columnar
    ⬇️
    b. Squamous
    c. HPV, low PH
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4
Q

Metaplasia and dysplasia may be premalignant.

True or false

A

True

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5
Q

What features do dysplasia and neoplasia have in common❓

A
  • Disorderliness
  • ⬆️nucleocytoplasmic ratio
  • Enlarged hyperchromatic nuclei
  • Pleomorphism
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6
Q

The 3 grades of dysplasia include❓

A
  1. Mild
    •lower 1/3rd of epithelium
    •Reversible
  2. Moderate
    •lower 2/3rd of epithelium
    •May be reversible
  3. Severe
    •full thickness of epithelium
    •irreversible
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7
Q

List a few tumors that start with dysplasia

A 
Bronchus 
Urinary bladder 
Cervix 
Vulva
Penis
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8
Q

List a few pre-neoplastic lesions you know and their malignancy

A

PML: Bronchial dysplasia
M: Carcinoma

PML: Leukoplakia➡️Erythroplakia
M: Squamous cell carcinoma

PML: Dysplasic squamous papilloma
M: Squamous cell carcinoma

PML: Chronic atrophic gastritis
M: Gastric carcinoma

PML: Chronic ulcerative gastritis
M: Adenocarcinoma

PML: cervical dysplasia
M: Squamous cell carcinoma

PML: Endometrial hyperplasia
M: Endometrial carcinoma

PML: Liver cirrhosis
M: Hepatocellular carcinoma

PML: Solar keratosis
M: SCC of skin

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9
Q

Define “neoplasm”

A
  • Abnormal mass of tissue
  • Growth exceeds and is uncoordinated with that of normal tissues
  • Persists in the same excessive manner after cessation of stimuli
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10
Q

The 5 properties of a neoplastic mass

A
  • Autonomous
  • Parasitic
  • Purposeless
  • Progressive
  • Benign/Malignant
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11
Q

Define cancer

A
  • Overgrowth of cells
  • Acquired cumulative of genetic damage
  • which confers growth advantage over normal cells
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12
Q

Malignant cells have three important features

List them

A
  • Immortality
  • Invasion
  • Metastasis
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13
Q

What are the differences between normal and malignant cells❓

A 
In malignant cells:
•🚫Contact inhibition 
•⬆️Growth factor secretion 
•⬆️oncogene expression 
•🚫tumor suppressor genes
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14
Q

Cancer is among the 3 leading causes of death in developing counties

True or false

A

True

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15
Q

The five most common cancers in Nigeria include:

A
  1. Breast- 26.7%
  2. Cervix- 13.8%
  3. Liver- 11.8%
  4. Prostate- 11.7%
  5. Colorectal- 4.1%
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16
Q

List the common childhood cancers

A
  1. Burkitt’s lymphoma
  2. Retinoblastoma
  3. Nephroblastoma
  4. Sacromas
  5. Leukaemias
  6. Neuroblastomas
  7. Rhabdomyosarcoma
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17
Q

Tumors are classified based on behavior (benign or malignant) or based on its cell if origin

True or false

A

True

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18
Q

The difference between a benign and a malignant tumor is based on:

  1. Spread
  2. Growth rate
  3. Boundaries
  4. Relations
  5. Effects

Briefly draw contrasts

A
  1. Spread:
    B: localized
    M: Metastasize
  2. Growth rate:
    B: Slow
    M: Rapid
  3. Boundaries:
    B: Circumscribed and encapsulated
    M: Irregular, ill-defined, no capsule
  4. Relations:
    B: Compresses
    M: Invades and destroys
  5. Effects:
    B: pressure effect
    M: Destroys➡️Death
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19
Q

Tumors can be classified broadly into:

Benign epithelial
Malignant epithelial
Benign mesenchyma
Malignant mesenchyma

True or false

A

True

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20
Q

Benign tumors are generally named by attaching -oma to the cell of origin.

True or false
Give examples of benign mesenchyma tumors

A

True

Fibroma
Osteoma 
Lipoma 
Haemagioma (blood vessel)
Lymphangioma 
Chondroma
Meningioma
Neuroma 
Leiomyoma (smooth muscle)
Rhabdomyoma (skeletal muscle)
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21
Q

Benign tumors are generally named by attaching -oma to the cell of origin.

True or false
Give examples of benign epithelial tumors

A

True

  • Papilloma- raised above an epithelial surface
  • Adenoma- forms glandular structures (parenchymal organs)
  • Cystadenoma- forms glands and cystic spaces
  • Nevus- benign tumor of melanocytes
  • Trophoblastic tumor- hydratidiform mole (placenta)
  • Polyps- in hollow organs, raised above mucosa
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22
Q

Malignant mesenchymal tumors are generally referred to as❓

List a few that you know

A

Sarcomas

Liposarcoma 
Osteosarcoma 
Chondrosarcoma
Haemangiosacroma/Angiosacroma 
Leiomyosacroma 
Fibrosarcoma
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23
Q

Malignant epithelial tumors are generally referred to as❓

List a few that you know

A

Carcinomas

Adenocarcinoma
Squamous cell carcinoma
Melanocarcinoma/Melanomas
Choriocarcinoma (placenta)

*organ of origin should be specified eg SCC of cervix

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24
Q

Mixed tumors are tumors that have more than one neoplastic cell type.

List some examples

A

Pleomorphic adenoma of salivary gland (epithelial and mesenchymal components)

Fibroadenoma of breast (glandular epithelial and fibrous components)

Wilm’s Tumor of kidney (malignant) commonly affecting children

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25
Q

The difference between a carcinoma and a sarcoma is based on:

  1. Cell type
  2. Stroma
  3. Spread
  4. Metastasis
  5. Hemorrhage and necrosis
  6. Fatality

Briefly draw contrasts

A
  1. Cell type:
    C: Epithelial
    S: Mesenchymal
  2. Storma:
    C: Abundant
    S: Scanty, fleshy
  3. Spread:
    C: Lymphatics 1st
    S: Blood 1st
  4. Metastasis:
    C: Late
    S: Early
  5. Hemorrhage and necrosis:
    C: Less frequent
    S: Frequent
  6. Fatality:
    C: Relatively less
    S: more fatal
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26
Q

What is a choriostoma❓

Is it a true tumor❓

A

An ectopic rest of normal tissue in an abnormal location

No

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27
Q

What is a harmatoma❓

Is it a true tumor❓

A

A mass of disorganized but mature specialized cells indigenous to the site

No

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28
Q

Seminomas (of the testis) and melanomas are benign tumors

True or false

A

False

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29
Q
  1. A teratoma is a…
  2. What are the common site of teratomas❓
  3. What is a monodermal teratoma called❓
A

1.
•Tumor with >1 neoplastic cell
•Derived from >1 germ cell layer
•Arise from totipotential cells in the gonads or in embryonic cell rests
•Can be mature/benign or immature/malignant

2.
Ovary/Testes
Mediastinum
Sacrococcygium

  1. Struma ovarii
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30
Q

What are the differences between a benign and a malignant teratoma❓

A

Tumor components:
B: mature, well-differentiated structures
M: primitive, undifferentiated structures

Grossly:
B: Cystic
M: Solid

Prognosis:
B: Good
M: fatal outcome

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31
Q

Cancer risk increases with age

True or false

A

True

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32
Q

H. pylori predisposes one to❓

A

Gastric adenocarcinoma

Mucosal associated lymphoid tissue, MALT lymphoma

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33
Q

What microorganism predisposes an individual to hepatocellular carcinoma❓

A

Hepatitis B/C virus

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34
Q

What microorganism predisposes an individual to cervical cancer❓

A

Human papilloma virus

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35
Q

An infection by Epstein Barr virus could lead to which neoplasms❓

A

Nasopharyngeal carcinoma

Burkitt’s lymphoma

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36
Q

An infection by HIV could lead to which neoplasms❓

A

High grade B cell lymphoma

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37
Q

An exposure to schistosoma haematobium could lead to ❓

A

Squamous cell carcinoma of the urinary bladder

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38
Q

Exposure to benzene commonly leads to what neoplasm❓

A

Leukaemia

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39
Q

Aniline dyes used in rubber industries could lead to what type of cancer❓

A

Bladder cancer

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40
Q

Ultraviolet and X-ray exposure can lead to❓

A

Cancer of the:

  1. Skin
  2. Breast
  3. Thyroid
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41
Q

Cancer of the lungs can be due to exposure to pollution from burning fuels

True or false

A

True

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42
Q

Intake of tobacco can lead to which cancers❓

A 
Mouth
Lungs
Breast 
Stomach 
Pancreas
Cervix
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43
Q

Alcohol intake can lead to which cancers❓

A

Breast
Stomach
Liver

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44
Q

An overweight or obese individual may come down with what type of neoplasms❓

A 
Esophagus 
Breast 
Colon 
Kidney
Uterus cancers
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45
Q

Early exposure to sex could predisposed an individual to cancer of the cervix

True or false

A

True

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46
Q

Having multiple sexual partners is a rush factor for which cancers❓

A

Cervix (HPV)

Liver (HBV)

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47
Q

Colorectal cancers could be contributed to by high animal protein and fat diet

True or false

A

True

48
Q

Aflatoxin from Aspergillus flavus commonly seen in poorly preserved grains like groundnuts are associated with which cancer❓

A

Hepatocellular carcinoma (HBV)

49
Q

List factors that could predispose an individual to cervical cancer

A 
Multiple sex partners 
Early exposure to sexual partners 
Smoking 
Poverty 
Immune deficiency (HIV)
Poor nutrition
Lack of micronutrients
50
Q

List factors that could predispose an individual to prostrate cancer

A 
⬆️serum androgen levels
Black race 
>40 years 
\+ve family history
Obesity 
⬆️fat diet
51
Q

List the inherited cancer syndromes that you know

A

Retinoblastoma

Familial adenomatous polyposis

Neurofibromatosis

Multiple endocrine neoplasm (MEN)

52
Q

List the familial cancers that you know

A

Breast
Colon
Ovary
Brain

53
Q

Autosomal recessive syndromes of defective DNA repair include:

A

Ataxia talengiectasia

Xeroderma pigmentosum

Bloom’s syndrome

Fanconi anemia

54
Q

What are the diagnostic methods for tumors❓

A
  1. Histology (paraffin/frozen section)
  2. Cytology (FNAC, Pap smear effusions)
  3. Immunocytochemistry
  4. Molecular (oncogenes)
  5. Flow cytometry
  6. Tumor markers
55
Q

The prevention of cancer includes:

A

Primary:
•Lifestyle modification
•Vaccination against infectious agents

Secondary:
•Early detection-
BSE (breast self examination)
Clinical breast examination (1-3yrs age20-39)
Mammography screening (annually >40)

Prophylaxis
Prompt treatment

56
Q

A pap smear should be done annually in women >18yrs or with commencement of sexual activity

True or false

A

True

57
Q

A pap smear should be done mid cycle or second half of the cycle

True or false

A

True

58
Q

No sexual intercourse or douching should occur 24hours before a pap smear

True or false

A

True

59
Q

The HPV/DNA testing should be done for women in what age group❓

A -ve HPV/DNA testing can be repeated after❓

A

30years of age

5-10years

60
Q

What screening options are available for prostate cancer❓

A

Digital rectal exam

Prostrate Specific Antigen test

61
Q

Characteristics of neoplasms include:

A

Differentiation/anaplasia

Rate of growth

Local invasion

Metastasis

62
Q

What is differentiation in this context❓

A

Microscopic resemblance of a tumor to normal cells morphologically and physiologically

63
Q

Anaplasia is a lack of differentiation, hence a poorly differentiated tumor is probably malignant

True or false

A

True

64
Q

A poorly differentiated tumor or an anaplasic tumor is also known as a high grade tumor

True or false

A

True

65
Q

What is a low grade tumor❓

A high grade tumor is❓

A

A well differentiated tumor

A poorly differentiated tumor

66
Q

Will a well differentiated tumor retain its functions❓

A

Yes.

Or unanticipated functions emerge.

67
Q

What are the histologic features of malignant tumors❓

A
  1. Pleomorphism
  2. Hyperchromatism
  3. ⬆️nucleocytoplasmic ratio
  4. Coarsely clumped chromatin
  5. Large, multiple, prominent nucleoli
  6. Mitoses (bizarre and numerous)
  7. Tumor giant cells
  8. Disorderliness/disorientation
68
Q

Most benign tumors are encapsulated except❓

A

Haemangioma

69
Q

Some malignant tumors may have a pseudocapsule. Give an example

A

Wilm’s Tumor

70
Q

Metastasis is an important hallmark of malignancy except in ❓

A

Basal cell carcinoma of skin

Malignant glial tumors of the brain

71
Q
  1. What are the most common sites of metastasis❓

2. What is the most uncommon site of metastasis❓

A 
1.
Lungs 
Liver
Bone 
Brain 
Kidney
  1. Spleen
72
Q

Metastatic cascade is broadly divided into❓

A

Invasion of extracellular matrix

Vascular dissemination and homing of tumor cells

73
Q

Describe the metastatic cascade that occurs in cells that acquire a metastatic potential.

A

🚫Ability to adhere to each other (get detached)

⬆️Ability to adhere to BM and ECM

Degradation of ECM

Migration through the ECM

Cells form aggregates within vessels

Migrate through BM of secondary site

Formation of tumor emboli at secondary sites

74
Q

What does a “grade” mean❓

A

Level of microscopic resemblance of tumor cells to normal similar cells of origin

75
Q

Prostatic carcinoma is graded using❓

A

Gleason’s system

76
Q

SCC of cervix is graded using❓

A

Extent of keratin formation

77
Q

How are tumors graded❓

A

Grade I- Well differentiated

Grade II- Moderately differentiated

Grade III- Poorly differentiated

Grade IV- Nearly anaplastic

78
Q

Staging refers to❓

A

Extent of tumor spread based on:

Size of primary tumor
+/-lymphatic spread
+/-distant blood borne metastasis

79
Q

The two systems used in staging cancers are❓

A 
1. 
TNM: 
Tumor size [0-4]
Node [0-3]  
Distant metastasis [M0/M1]
  1. AJC:
    I-IV
80
Q

Tis stage of a cancer depicts❓

A

Carcinoma in-situ

Tumor limited to the epithelium

81
Q

T2 stage of a cancer depicts❓

A

Larger, more invasive within the primary organ site

82
Q

T3 stage of a cancer depicts❓

A

Larger and/or invasive beyond margins of primary organ site

83
Q

N1
N2
N3

stages of cancer depict❓

A

N1: regional lymph node involvement

N2: extensive lymph node involvement

N3: More distant lymph node involvement

84
Q

Carcinogenesis refers to❓

A

Malignant transformation of normal cells by carcinogenic agents (physical, chemical or microbiological)

85
Q
  1. Give some examples of physical carcinogens you know
  2. What are their effects❓
  3. What cancers could be involved❓
A 
1. 
Ionization radiation 
X-ray 
Radiotherapy 
UV light
Atomic energy
  1. Chromosomal changes in cell mutation
3. 
Melanocarcinoma
Basal cell ca
SSC of Skin 
Leukemia 
Thyroid 
Breast
86
Q

Chemical carcinogens can be:

  1. Direct acting
  2. Indirect acting
  3. Promoters

Describe the mechanisms of these three categories in carcinogenesis

A
  1. •Electrophylic region easily forms covalent bonds with DNA

•eg alkylating agents like anti cancer drugs

  1. •Have to be converted to active metabolites in the liver

•eg polycyclic hydrocarbon in the cigarette
Beta-naphthylamine in anyline dye

  1. Aflatoxin B1
87
Q

The general sequence of chemical carcinogens include:

A
  1. Initiation- DNA alteration and subsequent cell division (mitosis)
  2. Promotion- proliferation of initiated cell at the expense of normal cells
  3. Effect: progression/dormancy/regression
88
Q
  1. An exposure to arsenic could to lead to what cancer❓

2. Who are the people most exposed to it❓

A
  1. Lung
    Liver
    Skin
  2. Mining
    Pesticide workers
89
Q
  1. An exposure to asbestos could to lead to what cancer❓

2. Who are the people most exposed to it❓

A

1.
Lung
Mesothelioma

  1. Construction workers
90
Q
  1. An exposure to benzene could to lead to what cancer❓

2. Who are the people most exposed to it❓

A

1.
Leukemia

  1. Petroleum
    Rubber
    Chemical workers
91
Q
  1. An exposure to chromium could to lead to what cancer❓

2. Who are the people most exposed to it❓

A

1.
Lung

  1. Metal workers
    Electroplaters
92
Q
  1. An exposure to leader dust could to lead to what cancer❓

2. Who are the people most exposed to it❓

A
  1. Nasal
    Bladder cancers
  2. Shoe manufacturers
93
Q
  1. An exposure to naphthylamine could to lead to what cancer❓
  2. Who are the people most exposed to it❓
A
  1. Bladder
  2. Dye
    Rubber
    Chemical workers
94
Q
  1. An exposure to radon could to lead to what cancer❓

2. Who are the people most exposed to it❓

A
  1. Lung
  2. Underground mining
95
Q
  1. An exposure to soot, tars and oils could to lead to what cancer❓
  2. Who are the people most exposed to it❓
A
  1. Lung
    Liver
    Skin
  2. Coal
    Gas
    Petroleum workers
96
Q
  1. An exposure to vinyl chloride could to lead to what cancer❓
  2. Who are the people most exposed to it❓
A
  1. Liver
  2. Rubber
    PVC manufacturing
97
Q
  1. An exposure to wood dust could to lead to what cancer❓

2. Who are the people most exposed to it❓

A
  1. Nasal
  2. Furniture making
98
Q

Tumors are monoclonal

True or false❓
What does this mean❓

A

True

A tumor mass results from a clonal expansion of a single progenitor cell that has incurred genetic change

99
Q

The targets of mutation include❓

A

Tumor promoter

Tumor suppressor

Apoptotic genes

DNA repair genes

100
Q

An infection by what virus can cause a T-cell leukemia❓

A

HTLV-1

101
Q

What organism predisposes an individual to cholangiocarcinoma❓

A

Liver fluke

102
Q

What are proto-oncogens❓

A

Normal constituents of the cell that promote normal cell growth and differentiation

They are also known as tumor promoters

103
Q

What are oncogenes❓

A
  • Gene sequences that can transform normal cell to cancer cells
  • Derived from proto-oncogenes
  • Produce onco-proteins (growth factors, membrane products and proteins that control growth and differentiation)
104
Q

Are tumor promoters dominant or recessive❓

What does this mean❓

A

Dominant

Only one mutant allele of the gene need to be present to cause transformation

105
Q

What could lead to the conversion of proto-oncogenes➡️oncogens❓

A

•Point mutations:
ras

•Translocation:
c-myc in Burkitt’s lymphoma
c-abl in CML

•Amplification:
n-myc in neuroblastoma
c-erb in breast carcinoma

106
Q

Are tumor suppressor dominant or recessive❓

What does this mean❓

Abnormalities that can lead to cancer are❓

A

Recessive

Two alleles of the gene must be damaged to transform cells

Deletion or inhibition

107
Q

Give examples of the antioncogens you know

A

Rb

p53

APC

NF-1, NF-2

BRCA-1, BRCA-2

WF-1 genes

108
Q

Apoptotic genes may be dominant or recessive.

A deletion of an apoptotic gene may lead to cancer.

True or false
Give examples

A

True

p53
c-myc
bcl-2 gene in b-cell lymphoma

109
Q
  1. DNA repair genes are the care-taker genes.
  2. Are they dominant or recessive❓
  3. Inactivation of these genes with lead to❓
  4. Give a few examples
A
  1. Recessive
  2. Both alleles must be lost to induce genomic instability
  3. Increased mutation of all other genes including those that control cell division
  4. BRCA-1, BRCA-2 in breast ca
    MLH1, MSH2 mutation in HNPCC
110
Q

List some effects of malignant tumors on the host

A

Compression eg pituitary adenoma on optic chaism

Functional activity eg insulinoma

Hemorrhage

Secondary infection

Infarction/Rupture

Cancer cachexia

Paraneoplastic syndrome

111
Q

What are paraneoplastic syndromes❓

Classify them

A

A symptom complex that occurs in a cancer patient that cannot be explained by local/distant spread of the tumor

Endocrinopathies 
Dermatological 
Nerve and muscle 
Bone and joint 
Vascular/heamatological
112
Q
  1. Cushing’s syndrome is a paraneoplastic syndrome that may be observed in which carcinomas❓
  2. What is it’s feature❓
A
  1. Small cell ca of the lungs
    Pancreatic carcinoma
    Neural tumors

2.
Secretion of ACTH-like substances

113
Q
  1. Paraneoplastic Syndrome of Hyponatrimia may be a complication of which cancers❓
  2. What is it’s feature❓
A
  1. Small cell ca
    Intracranial tumors
  2. Inappropriate ADH secretion
114
Q
  1. Paraneoplastic Syndrome of Hypoglycemia may be a complication of which cancers❓
  2. What is it’s feature❓
A

1.
Fibrosarcoma
HCC

2.
Insulin-like substances

115
Q
  1. Carcinoid syndrome is a paraneoplastic syndrome that may be a complication of which cancers❓
  2. What is it’s feature❓
A
  1. Bronchial adenoma (carcinoid)
    Pancreatic ca
    Gastric ca
2. 
Secretion of:
Serotonin 
Bradykinin 
Histamine
116
Q
  1. Paraneoplastic Syndrome of Hypercalcaemia may be a complication of which cancers❓
  2. What is it’s feature❓
A
  1. Squamous cell carcinoma
2. 
Secretion of: 
•Parathormone-like substance 
•IL-1
•TNF-alpha 
•TGF-alpha
117
Q
  1. Paraneoplastic Syndrome of Polycythemia may be a complication of which cancers❓
  2. What are their features❓
A
  1. Renal cell ca
    HCC
    Cerebellar haemangioma
  2. Erythropoietin

Anatomic And Molecular Pathology (14 decks)

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