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ESA 2- Mechanisms of Disease > Neoplasms 2 > Flashcards

Neoplasms 2 Flashcards

1
Q

What does the ability of malignant cels to invade and spread to distant sites lead to?

A

Greatly increased tumour burden

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2
Q

What does increased tumour burden cause if untreated?

A

A vast number of ‘parasitic’ malignant tumours

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3
Q

Can a patient develop metastases if they are clinically tumour free?

A

Yes

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4
Q

What must happen for malignant cells to get from a primary site to a secondary site?

A

They must grow and invade at the primary site, enter a transport system and lodge at a secondary site and grow at the secondary site to form a new tumour

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5
Q

What are micrometasteses?

A

Microscopic tumour deposits that are clinically undetectable

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6
Q

What is it called when a tumour grows at a second site to form a new tumour?

A

Colonisation

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7
Q

What must happen at all points if a tumour is to metastasise?

A

It must evade destruction by immune cells

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8
Q

Why is the process of tumour metastasis inefficient?

A

As it needs to do all three steps

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9
Q

How do the vast majority of attempted tumour metastasis fail?

A

Due to difficulty transporting and difficulty growing at a secondary site

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10
Q

What have the steps of metastasis be studied in?

A

Mainly carcinomas rather than other types of malignant neoplasms

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11
Q

What does invasion into surrounding tissue by carcinoma cells require?

A

Altered adhesion
Stomal proteolysis
Motility

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12
Q

What are the changes undergone by carcinoma cells when invading surround tissues called?

A

Epithelial-to-mesenchymal transition (EMT)

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13
Q

What does EMT create?

A

A carcinoma cell phenotype that appears more like a mesenchymal cell than an epithelial cell

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14
Q

What does altered cell adhesion between malignant cells involve?

A

A reduction in E-cadherin expression

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15
Q

What does altered adhesion between malignant cells and stromal proteins involve?

A

Changes in Integrin expression

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16
Q

What must cells be able to degrade in order to invade?

A

The basement membrane and stroma

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17
Q

What does invasion degradation of the basement membrane and stoma involve?

A

Altered expression of proteases, notably matrix metalloproteinases (MMPs)

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18
Q

What do malignant cells take advantage of?

A

Nearby non-neoplastic cells

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19
Q

What do malignant cells and nearby non-neoplastic cells together form?

A

A cancer niche

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20
Q

What do the normal cells in a cancer niche do?

A

Provide some growth factors and proteases

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21
Q

What does altered mobility involve?

A

Changes in the actin cytoskeleton

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22
Q

How does signalling through integrins occur?

A

Via small G proteins such as members of the Rho family

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23
Q

What can malignant cells enter?

A

Blood vessels via capillaries and venules
Lymphatic vessels
Fluid in body cavities (pleura, peritoneal, pericardial and brain ventricles)

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24
Q

What is metastasis caused by malignant cells entering fluid in body cavities called?

A

Transcoelomic spread

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25
Q

When do malignant cells need to metastasise by entering blood vessels?

A

If bigger than 1mm

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26
Q

What helps malignant cells travel by the blood stream?

A

The cancer niche

27
Q

What must happen to malignant cells at a secondary site?

A

They must grow

28
Q

What is the growing of malignant cells at a secondary site called?

A

Colonisation

29
Q

How can organ donation cause cancer?

A

Micrometastases can transfer through organ donations, even if the donor never officially had cancer- could still have deposits, which then developed in the immunosuppressed organ receivers

30
Q

What is failed colonisation considered to be?

A

The greatest barrier to successful formation of metastasis

31
Q

Why is colonisation considered to be the greatest barrier to successful formation of metastases?

A

Because many malignant cells lodge at secondary sites, but these tiny cell clusters either die or fail to grow into clinically detectable tumours

32
Q

What are surviving microscopic deposits that fail to grow called?

A

Micrometastases

33
Q

What is tumour dormancy?

A

When an apparently disease-free person may harbour micrometastases

34
Q

What is a malignant neoplasm relapse after many years typically due to?

A

One or more micrometastases starting to grow

35
Q

What does the site of a secondary neoplasm depend on?

A

Regional drainage of blood, lymph and coelomic fluid

The ‘seed and soil’ phenomenon

36
Q

Where do lymphatic metastases spread to?

A

Draining lymph nodes

37
Q

Where do tumours that spread by transcoelomic spread go to?

A

Other areas in the coelomic space or to adjacent organs

38
Q

Where do blood-borne metastases go?

A

Sometimes (but not always) to the next capillary bed that the cells encounter, often the liver and lung

39
Q

What may the ‘seed and soil’ phenomenon explain?

A

The seemingly unpredictable distribution of blood-bourne metastases

40
Q

What is the seed and soil phenomenon due to?

A

Interactions between malignant cells and the local tumour environment (the niche) at the secondary site

41
Q

Where do carcinomas typically spread to first?

A

Draining lymph nodes

42
Q

Where do carcinomas typically spread to after lymph nodes?

A

Distant blood-borne sites

43
Q

What are the common sites of blood borne metastasis?

A

Lung, bone, liver and brain

44
Q

What neoplams are more frequently spread to bone?

A

Breast, bronchus, thyroid and prostate

45
Q

What is meant by malignant tumours having ‘personalities’?

A

Some malignant neoplasms are more aggressive and metastasise very early in their course

46
Q

Give an example of an aggressive tumour?

A

Small cell bronchial carcinoma

47
Q

Give an example of a tumour that almost never metastasises?

A

Basal cell carcinoma in the skin

48
Q

What is the likelihood of metastases related to?

A

The size of the primary neoplasm

49
Q

What is the size of the likelihood of metastasis the basis for?

A

Cancer staging

50
Q

How can the effects of a neoplasm on the host be classified?

A

Those that are due to direct local effects
Those that can be due to the primary neoplasms and/or the secondary neoplasms
Those due to indirect systemic effects

51
Q

What do indirect systemic effects include?

A

Effects of increasing tumour burden, secreted hormones and/or miscellaneous effects

52
Q

What are indirect systemic effects sometimes referred to as?

A

Paraneoplastic syndromes

53
Q

What are the most relevant effects for benign neoplasms?

A

Local effects from the primary and hormonal effects

54
Q

What are the local effects of primary and secondary neoplasms due to?

A

Direct invasion and destruction of normal tissue
Ulceration at surface leading to bleeding
Compression of adjacent structures
Blocking tubes and orifices

55
Q

What does increasing tumour burden lead to?

A

A parasitic effect on the host

56
Q

What does the parasitic effect of increasing tumour burden work with to produce symptoms?

A

Secreted factors such as cytokines

57
Q

What does the parasitic effect of the increased tumour burden have on the host?

A

Reduced appetite and weight loss (cachexia)
Malaise
Immunosupression
Thrombosis

58
Q

Other than increased tumour burden, how can a cancer cause immunosuppression?

A

Due to direct bone marrow destruction

59
Q

What happens in benign neoplasms of the endocrine glands?

A

They are well differentiated, and so typically produce hormones

60
Q

Give an example of a benign neoplasm of an endocrine gland

A

A thyroid adenoma, which produces thyroxine

61
Q

Can malignant tumours produce hormones?

A

Sometimes

62
Q

Give two examples of a malignant tumour that can produce hormones?

A

Bronchial small cell carcinoma can produce ACTH or ADH

Bronchial squamous cell carcinoma can produce PTH-like hormone

63
Q

What are the miscellaneous systemic effects of neoplasms?

A

Neuropathies affecting the brain and peripheral nerves
Skin problems such as pruritus and abnormal pigmentation
Fever
Finger clubbing
Myositis

ESA 2- Mechanisms of Disease (11 decks)

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