Neoplasms and Disturbances of growth Flashcards
an abnormal mass of cells produced by excessive growth of new tissue.
neoplasm/tumor
tumor cells do not invade tissues, are non-
metastatic and usually exhibit “self-limiting” patterns of growth. These tumors are generally well differentiated and most spare the host (with certain exceptions).
benign tumor
Tumor cells that are invasive with high potential for distant spread (metastasis). They are difficult to treat and tend to be a serious threat to the life of the host.
malignant tumor
a study of the “science” of neoplasms including etiology and pathogenesis
oncology
term refers to all types of malignancy.
cancer
Non-neoplastic alterations of cell growth in tissue and organs is called _____.
malformations
inadequate or incomplete development
hypoplasia
lack of development
aplasia
a benign tumor-like mass consisting of an overgrowth of
differentiated cells and tissues that are normally present in the affected location
hamartoma
______ are not necessarily neoplastic but are likely precursors to cancer in certain circumstances.
Dysplasias
What kinds of cell growth are associated with increased cell proliferation which contributes to an elevated cancer risk?
- hyperplasia
- metaplasia
- regeneration
- dysplasia
What are some characteristics of neoplasms?
- tumor cells exhibit increased capacity to survive and reproduce
- monoclonal: arise from single cell
- parasitic in nature and do not contribute to body homeostasis
- all malignant tumors are invasive
- some malignant tumors have metastatic potential
Virtually all tumors consist of what two essential types of tissue?
- transformed (neoplastic) cells that determine specific tumor characteristics
- non-transformed (normal) connective tissues and blood vessels that comprise the tumor stroma
Malignant neoplasms of epithelial and glandular tissues characterized by irregular infiltrating, no-encapsulating masses of neoplastic cells that extend into the surrounding tissues
Carcinoma
What is the most common cancer category encountered in adults?
carcinoma
Two main types of tumors:
- single transformed cell type
- more than one transformed cell type
tumors with single cell type
- benign tumors
- malignant tumors
- sarcomas
- carcinomas
benign glandular tumor
adenoma
benign polypoid tumor
papilloma
benign epithelial tumor
epithelioma or papilloma
benign fibroblast tumor
fibroma
benign adipose tumor
lipoma
benign cartilaginous tumor
chondroma
benign blood tumor
angioma
malignant tumors of mesenchymal (supportive) tissues that produce irregular bulky growths that are sometime encapsulated
sarcoma
malignant growth of carcinoma extends through the _____
basement membrane
tumor derived from germ cells or other totipotential cells and consists of mixed tissue types derived from any (usually all) of the embryonic germ layers
teratoma
Where do teratomas usually arise?
gonads
- also develop in other sites where totipotential cells persist (e.g. notochord remnants, retroperitoneum)
rhabdo means
shaped like a rod
leio means
smooth muscle
malignant glandular tumor
adenocarcinoma
malignant epithelial tumor
melanoma, squamous cell carcinoma, etc.
malignant adipose tumor
liposarcoma
malignant fibroblast tumor
fibrosarcoma
malignant skeletal muscle tumor
rhabdomyosarcoma
bening skeletal muscle tumor
rhabdomyoma
What kind of tumors appear at a young age, are poorly differentiated and grow rapidly?
embryonic tumors
Wilm’s tumor of the kidney and retinoblastoma are examples of what?
embryonic tumors
malignant tumor of leukocytes and related cell types that arise in the marrow and infiltrate the peripheral blood, bone marrow and other structures
leukemia
malignant tumors consisting of lymphocytes, macrophages and related cells that originate in lymph nodes and other lymphoid tissues and occasionally in certain organs
lymphoma (Hodgkin’s disease)
Malignant tumor of plasma cells characterized by production of abnormal immunoglobulins (antibodies)
multiple myeloma
Malignant tumor of melanocytes in skin
malignant melanoma
As a group, benign tumors do not _____
metastasize
______ tumor cells differ from the parent tissue morphologically and
functionally
malignant
What are the typical histological characteristics of malignant tumor cells include the following:
- pleomorphism (variations in size and shape)
- enlarged nuclei
- atypical (polyploidy) chromosomes
- increased nucleoli size and number
What are some cell surface changes seen on neoplastic cells?
- altered glycoproteins
- decreased adhesive/cohesiveness
- altered cell junction complexes
- loss of normal antigens
- increased turnover of membrane components
What are some cytoplasmic changes seen in neoplastic cells?
- loss of specialized structures (microtubules, filaments, microvilli)
- loss of normal cell products
- production of new cell products (enzymes, hormones)
What are some nuclear changes seen in neoplastic cells?
- primitive appearance
- enlargement
- large nucleolus
- aneuploidy
- marker chromosomes
what is Aneuploidy?
abnormal number of chromosomes
Most malignant tumors are ______ and present ______ margins
non-encapsulated: irregular
discontinuous spread to distant (secondary) sites. These include lymph nodes, various organs and the skeleton.
Metastases
Common physiological alterations/features observed in cancer cells include:
- loss of specialized functions (contraction, secretion)
- increased capacity for anaerobic glycolysis
- production of enzymes and other cell products that promote tumor cell proliferation
During neoplastic transformation, general antigenic changes that occur are:
- All tumors produced by a specific virus tend to exhibit the same neoantigens.
- Individual tumors produced by a particular carcinogenic chemical generally express sporadically different tumor-cell antigens.
Decreased adhesion of tumor cells, diminished cell junctions and other alterations contribute to metastasis by causing _____
shedding (detachment) of cells from the primary tumor
How do tumor cell proteases contribute to metastasis?
they degrade and invade the basement membrane matrix. The cleavage products of the basement membrane have growth promoting, angiogenic and chemotactic effects of tumor cells
Pathogenic factors that contribute to metastasis includes the following:
- shedding of cells from primary tumor
- attachment of invading cells
- invasion and degradation of basement membrane
- locomotion and infiltration of tumor cells
- degradation of vascular basement membrane
- penetration of lymphatics and blood vessels
- embolization and survival of metastasizing cells in the blood stream and lymph
- exit of tumor cells at site of metastasis
What are the routes of spreading for metastatic tumors?
all pathways available to the tumor are utilized
- local tissue infiltration
- lymphatic vessels
- blood vessels
- “seeding of body cavities” as seen in GI
- transplantation from invasive procedures
Factors influencing the localization of metastases:
- anatomical (vascular and lymphatic drainage patterns)
- local conditions at secondary site
tumors of the G-I tract and pancreas favorably spread to _____
the liver
- poor prognosis if seen
tumor cells (especially sarcomas) that invade systemic veins are carried directly into ____.
the lungs
Paravertebral venous plexuses favor ______ metastasis
vertebral
Common locations for metastasis:
- lymph nodes
- liver
- Lung
- bone
- CNS
Breast cancer commonly spreads to the ____ nodes.
axillary
The ____ and ____ are uncommon sites for metastasis.
spleen and striated muscle
General features of skeletal metastasis
- Cancer cells are carried by circulation to the marrow sinusoids where they undergo invasion
- invading tumor cells destroy and replace bone
- Are likely to form multiple lesions- this contrasts with primary cancers which are typically “unifocal”.
What is osteolytic metastasis?
radiolucent bone defect that is the most common bone metastasis of organ cancers in which the bone proliferates adjacent to sites of lytic metastases due to activation of osteoclasts
What is osteoblastic metastases?
less common, radio dense (sclerotic) bone defect seen in skeletal metastases of prostate cancer and breast cancer where osteoblasts are activated to form bone deposits at site of metastases
What are clinical features of bone metastases?
- pain
- pathological fractures
- signs of hypercalcemia
- nerve compression syndromes due to skeletal deformities
What is a radiation test that is done to establish the extent and location of metastasis to bone and soft tissue by picking up area of increased metabolism?
bone scan
MRI is preferred method
What is the favorable soil hypothesis?
local conditions at a secondary site must be favorable in order for metastasis to be successful.
favorable conditions include: adequate blood supply, tissue compatibility factors
the skeleton is affected in what percentage of late stage breast and prostate cancers?
70%
what percentage of bone metastasis is osteolytic?
70%
What percentage of bone metastasis is osteoblastic?
30%
Residents of the US have about a one in ____ chance of dying of cancer
five (23%)
What are the three most common cancers in men?
- prostate
- lung
- colon/rectum
What is the three most common cancers in women?
- breast (then lung)
- lung
- colon/rectum
What kind of cancer has the highest mortality rate in men and women?
lung
environmental factors are implicated in up to _____ % of cancer
80-90
What are environmental factors that can cause cancer?
- air and water pollution
- occupational exposure to carcinogen
- personal habits such as tobacco or alcohol use
- dietary factors
What is the peak age range for cancer
55-74
What cancers are most commonly seen in children?
- mesenchymal (leukemia and carcoma)
- CNS
- embryonic
Which gender has overall higher mortality?
male, about 10% higher
What are some examples of inherited cancer syndromes?
familial retinoblastoma and familial colon polyposis
Hereditary defects in DNA repair can increase cancer risk. What are some examples?
- Xeroderma pigmentosum with a high incidence of skin cancer
- familial non-polyposis colon carcinoma syndromes
Some hormones act as promotors for tumor cell growth but are not likely to be carcinogenic. Example?
estrogen increasing risk of breast and endometrial cancer
important contributing factor for several cancers including those of the oral cavity, uterine cervix, respiratory tract and skin.
dysplasia (abnormal metaplasia)
What is xeroderma pigmentosum?
a condition where there is increased sensitivity to UV radiation and defective DNA repair. This will cause premature aging and skin cancer
What is familial non-polyposis syndrome
Condition in which the patient is lacking “mismatch repair” mechanism which leads to cancer of the proximal colon
What is leukoplakia?
white plaques that occur in stratified squamous mucosal (non-keratinized) tissues and consist of areas of hyperplasia, keratinization and dysplasia. This condition is associated with increased risk of cancer of the oral mucosa
Focal areas of atypical hyperplasia, scaly (rough) and sometimes discolored plaques and underlying dermal changes that are associated with increased risk of cancer?
keratosis
Mucosal changes including dysplasia, loss of parietal cells, hypochlorhydria and abnormal gastric flora that is associated with increased risk of cancer
atrophic gastritis
can be caused by pernicious anemia or chronic H. pylori
Long-term chronic _____ contributes to an increased risk for colon cancer. These effects are greatest when large segments of the colon are affected.
ulcerative colitis
Scarring of the liver that contributes to hepatocarcinoma, particularly when associated with chronic hepatitis.
cirrhosis
the time required for progression of cells from one mitotic cycle to the next
cell cycle time
the proportion of mitotically active cells
growth fraction (higher percentage in cancer cells)
the time required to double the “tumor volume”
doubling times
Doubling times are affected by:
- tumor cell type
- growth fraction
- blood supply
- cell survival
What are some common chemical carcinogens?
- polycyclic (aromatic) hydrocarbons
- azo dyes and aromatic amines
- aflatoxin
- nitrosamines
- “alkylating agents”
- asbestos
- vinyl chloride
- heavy metals
- insecticides
Chemicals chiefly encountered in industry but also found in food that will undergo conversion to active carcinogen in the liver, be excreted in the urine and contribute to bladder cancer
azo dyes and aromatic amines
Chemical derived from Aspergillus flavus which appears in damp stored grain and some root crops and is a potent hepatocarcinogen
aflatoxin
Dietary nitrates and nitrites react with other dietary components to form ______ which may cause GI cancers
nitrosamines
What chemicals are directly mutagenic and can destroy cancel cells by damaging DNA but have the potential for increasing risk of cancer development in normal cells?
alkylating agents
What two viruses account for about 80% of virus related cancer in the human?
HPV and Hep B
Epstein Bar virus is a close third and contributes to Burkitt’s lymphoma
What is schistosoma hematobium?
A parasite carried by snails in Africa and the Middle East that causes inflammation of the urinary blade that can cause cancer
A tumor can potentially have the following effects on a host:
CAUTION
- C hange in bowel/bladder
- A sore throat
- U nusual bleeding or discharge
- T ickening or lump in tissue
- I ndigestion of difficulty swallowing
- O bvious change in wart or mole
- N agging cough or hoarseness
What are some local effects of a tumor?
- destroy vital structures
- obstruct or perforate hollow organs
- create ulcers and necrosis
- cause hemorrhage
- invade or compress adjacent structures
What are some systemic effects of a tumor?
- fever
- anemia
- sudden weight loss
- decreased resistance to infection
- ectopic or inappropriate production of hormones
Malabsorption and chronic infection in advanced stages of cancer can lead to extreme wasting and weakness known as _____.
Cachexia
What is the purpose of grading and staging of cancer?
to determine prognosis and aid in the selection of treatment options
correlates the degree of malignancy with the histologic appearance of tumor cells and the numbers of mitoses seen
grading of cancer
more useful for superficial tumors
According to Broder’s classification of cancer, Grade I would indicate less than ____% undifferentiated
24
According to Broder’s classification of cancer, Grade II would indicate ____% undifferentiated
25-49
According to Broder’s classification of cancer, Grade III would indicate ____% undifferentiated
50-74
According to Broder’s classification of cancer, Grade IV would indicate greater than ____% undifferentiated
75
What evaluates tumors according to size, the extent of spread and metastases.
staging
more clinically useful
What does TMN stand for?
T - tumor size, spread, etc.
M - metastasis
N - nodes involved
This is the method used to evaluate cancer for staging
What are the basic factors that affect tumor prognosis?
- clinical stage
- type of tumor
- duration
- location and relationship to critical structures
- age of patient
- sensitivity of tumor to treatment
What are the there modes of therapy for cancer?
- surgery
- radiation
- chemotherapy
How does radiation affect a tumor
- directly damages dividing cells (tumor, hair, skin, etc( by formation of reactive free-radicals
- affecting endothelium of blood vessels supplying tumor, thus disrupting blood flow.
neoplasms of the extraskeletal non-epithelial
tissues of body excluding the meninges and the lymphoreticular system
Mesenchymal tumors
AKA soft tissue tumors
benign tumor of fibrous connective tissue
Fibroma
Non-neoplastic reactions to trauma and idiopathic factors that results in a mass with histological features of a sarcoma
Reactive proliferations (pseudosarcomatous proliferations)
Examples of Reactive proliferations (pseudosarcomatous proliferations)
- nodular fasciitis
- myositis ossificans
solitary, rapidly growing and sometimes painful masses; trauma preceding in 10-15%
Nodular fasciitis
metaplastic bone that arises in musculature and subcutaneous tissue of proximal extremities; most commonly
associated with athletic injury
Myositis ossificans
Rounded, lobulated masses (firmness dependent upon amount of collagenous fibers present) found at connective tissue site, most common in extremities and retroperitoneal areas
Fibrosarcoma
Large fibrosarcomas may exhibit ____ action
paraendocrine (produce insulin-like agents, etc.)
nodules or bundles of
mature-appearing fibroblasts surrounded by dense collagen deposits that stabilize and do not progress, some resolve spontaneously but surgery may be required in advanced progressive forms
Superficial Fibromatoses
Examples of superficial fibromatosis
- Dupuytren’s contracture (palmar fibromatosis)
- plantar fasciitis
*adhesions to surrounding strucutures and flexion contractures may appear in both
Deep or aggressive fibromatosis is also called:
Desmoid tumor
Most common soft tissue tumor of adults
Lipoma
benign circumscribed masses of adipose tissue
that are usually lobular in nature
Lipoma
uncommon mesenchymal tumor that
gives rise to a mucoid intercellular substance, when seen is the most common primary tumor of the heart
Myxoma (fibromyxoma)
rare benign tumor of striated muscle
Rhabdomyoma
malignancy of striated muscle
Rhabdomyosarcoma
- Prognosis is variable, those that present in adults are often
difficult to treat and exhibit poor prognoses
benign tumor of smooth muscle
Leiomyoma
Degenerative changes associated with leiomyoma of the uterus
Fibroids
Malignancy of tumor of smooth muscle, most common in uterus
Leiomyosarcoma
notochordal remnants that give rise to lobular
masses of gelatinous tissues
Chordoma
Primary tumors of the skeleton are derived from osteoblasts, chondroblasts, fibroblasts, etc. What are some examples of benign tumors of bone and cartilage?
- Osteoma
- osteoid osteoma
- osteochondroma
- endochondroma
Rare, benign bone tumor that is non invasive but can cause deformity and is commonly seen in the skull as a reactive response to trauma
Osteoma
Small, benign bone tumor of unknown origin that is often painful (relieved by NSAIDs), contains central nidus and affects adolescents
Osteoid osteoma
Uncommon benign tumors of the bone/cartilage that is characterized by a bony protuberance capped with cartilage
Osteochondroma
Type of benign cartilaginous tumor where the mass is embedded within bone causing deformity, pain and fracturing
Endochondroma
Most common primary malignancy of bone
(osseous) tissue
Osteogenic sarcoma (osteosarcoma)
Osteogenic sarcomas usually arise in what region of the bone
Medullary region and then spread and extend through the cortex. This is when clinical signs of pain, swelling and redness first appear
Large, bulky, malignant tumors of the cartilage that have a slow growth pattern
Chondrosarcoma
Uncommon skeletal tumor where Lytic lesions resembling soap bubbles
appear in epiphyseal regions. Most are benign but may become locally
aggressive
Giant cell tumor
Aggressive small cell tumors of marrow origin that are most common in long bones
Ewing’s sarcoma
Types of vascular tumors
Hemangioma
Lymphangioma
Clusters of well differentiated, thin wall capillary-like vessels
Capillary hemangioma
Type of vascular tumor common at birth, that growth rapidly for 1-3 years and then regress
Strawberry hemangioma
masses of large dilated sinusoid-like blood vessels
Cavernous hemangioma
painfully sensitive benign masses derived from glomus bodies (specialized thermoregulatory arteriovenous anastomoses, these structures consist of well-innervated modified smooth muscle cells that surround blood vessels.)
Glomus body tumors (glomangioma)
Benign neoplasm of fibrous connective tissues of nerve sheath
Neurofibroma
If malignant - neurofibrosarcoma
Neoplasm of neurilemmal cells
Neurilemmoma (Schwannoma)
Usually benign, malignancy is rare
What is type 1 Multiple neurofibromatosis (MNF)?
autosomal dominant genetic defect causing multiple neural tumors anywhere in the body
Signs of type 1 MNF?
- Numerous pigmented skin lesions (cafe’ au lait spots)
- Pigmented iris hematomas (Lisch nodules)
- skeletal lesions (Scoliosis, Erosive defects, Cystic bone defects)
- risk of meningeal tumors
- Internal tumor masses, etc.
Signs of type 2 MNF (acoustic neurofibromatosis)
- Bilateral acoustic nerve tumors
- Cafe’ au lait spots present
- NO Lisch nodules
Type of epithelial tumor that arises in ducts and acini glands?
Adenoma
Types of papillary tumors (AKA polyp, papilloma)
- pedunculated
- sessile
The preinvasive stage of an intra- epithelial cancer.
Carcinoma in situ (CIS)
Non melanoma types of skin cancer that are common and have a good prognosis
- basal cell carcinoma
- squamous cell carcinoma
What type of malignant epithelial tumor usually arises in moles
Malignant melanoma
variable quantities of fibrous stroma
appears within this type of tumor
Adenocarcinoma
Type of adenocarcinoma in which stroma and parenchymal elements are present in roughly equal quantities
Carcinoma simplex
Type of adenocarcinoma carcinoma in which soft, brain-like tumor masses
consisting predominantly of parenchymal tumor tissue with small amounts of stroma
Medullary carcinoma
Type of adenocarcinoma in which dense, hard tumor masses containing
extensive deposits of fibrous stroma (in this instance, the tumor stimulates proliferation of collagenous tissues)
Scirrhous
most commonly mucus cell tumors of
the g-i tract
Mucinous (colloid) carcinoma
