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Pathology > P4 +5 - Disorders of growth and neoplasia 2/3 > Flashcards

P4 +5 - Disorders of growth and neoplasia 2/3 Flashcards

1
Q

What are the 2 classifications of tumours?

A
  1. Behaviour

2. Histogenesis

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2
Q

what are the 2 behaviours of tumours?

A

Benign v Malignant

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3
Q

what is the growth patten of benign tumours?

A

Expand and Remain localised
Typically well-circumscribed
Often encapsulated

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4
Q

what is the growth rate of benign tumours?

A

slower

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5
Q

what are the clinical effects of benign tumours?

A

local pressure effects: hormone secretion

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6
Q

what is the treatment for benign tumours?

A

local excision

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7
Q

what is the histology of benign tumours?

A

Resembles tissue of origin

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8
Q

what is the nuclei of benign tumours?

A

small, regular, uniform

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9
Q

what are the mitoses of benign tumours?

A

few, normal

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10
Q

what is the growth patten of malignant tumours?

A

Infiltrate locally, metastasize (spread to distant sites)

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11
Q

what is the growth rate of malignant tumours?

A

Faster

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12
Q

what is the clinical effects of malignant tumours?

A

Local pressure and destruction,
Inappropriate hormone secretion
Distant metastases

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13
Q

what is the treatment for malignant tumours?

A

Excision and additional therapy if metastases

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14
Q

what is the histology of malignant tumours?

A

Variable, many differ from tissue of origin

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15
Q

what is the nuclei of malignant tumours?

A

Larger, pleomorphic

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16
Q

what are the mitoses of malignant tumours?

A

Numerous, including abnormal forms

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17
Q

How can tumours be further classified?

A
  • the cell type they resemble, ie their differentiation

- Most tumours resemble to some extent the tissue from which they arise

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18
Q

what is the benign tumour of covering epithelia?

A

papilloma

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19
Q

what is the malignant tumour of covering epithelia?

A

Carcinoma

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20
Q

what is the benign tumour of Glandular epithelia?

A

Adenoma

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21
Q

what is the malignant tumour of glandular epithelia?

A

adenocarcinoma

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22
Q

What are the benign tumours of smooth muscle, skeletal. muscle, bone forming, cartilage fibrous, blood vessels , adipose?

A 
SM- leiomyoma
Skeletale muscle-Rhabdomyoma 
BF- osteoma
C- Chondroma
F- Fibroma 
BV- (Haem)angioma 
A- Lipoma
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23
Q

What are the malignant tumours of smooth muscle, skeletal. muscle, bone forming, cartilage fibrous, blood vessels , adipose?

A 
SM- leiomyosarcoma
Skeletale muscle-Rhabdomyosarcoma
BF- osteosarcoma 
C- Chondrosarcoma
F- Fibrosarcoma
BV- Angiosarcoma
A- Liposarcoma
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24
Q

what may some highly malignant tumours be?

A

undifferentiated ie do not show any definite form of differentiation

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25
Q

Why does tumour type matter?

A
  • Different tumour types behave in different ways
  • Different benign tumours can behave differently
  • Not all malignant tumours are equally malignant
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26
Q

What is the prognosis?

A
  • Prediction of the probable course and outcome of disease

- Appropriate treatment and estimate survival

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27
Q

What does cancer prognosis include?

A
  • Tumour Type
  • Tumour Grade (Histology)
  • Tumour Stage (Histology, Clinical, Radiological)
  • Other Parameters (Patient ,Tumour)
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28
Q

What does knowing patterns of spread of tumour types aid?

A

diagnosis, staging and treatment

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29
Q

what is important anatomical knowledge to know for tumours?

A

Sentinal lymph node biopsy

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30
Q

what does tumour type influence?

A

How patients are investigated, treated and monitored

31
Q

Describe aggressive versus indolent tumours.

A
  • May need to treat before tissue diagnosis
  • Risk:benefit to consider at all times
  • Aggressive therapy may be necessary and risks are justifiable
  • Sometimes appropriate to avoid early active treatment
32
Q

what is tumour grade?

A

-The degree of malignancy
- Usually correlates well with patient survival
(tumour grade is how well differentiate the tumour is)

33
Q

Describe tumour grade.

A
  • A histological assessment
  • How well differentiated the tumour cells are
  • Well differentiated tumours tend to have a better prognosis
34
Q

what is “Oral cancer” Squamous cell carcinoma graded by?

A

degree of differentiation

35
Q

what are well- differentiated squamous cell carcinoma?

A

very obviously squamous with ‘prickles’ and keratinization

36
Q

what are poorly differentiated squamous cell carcinoma?

A

may be difficult to identify tumour cells as epithelial

37
Q

what is the tumour stage?

A

how advanced the tumour is

38
Q

Describe tumour stage?

A

A clinical, radiological and histological assessment:

  • Clinical examination
  • Radiology
  • Other Investigations
39
Q

what is used to identify tumour stage?

A

TNM system

T= greatest diameter of tumour, structures invaded
N= lymph node status
M= metastasis

Eg pT2N1 (pathology)

40
Q

what does tumour stage correlate with?

A

outcome in most tumour types

41
Q

what does high tumour stage mean?

A

poorer prognosis

42
Q

what are key elements in cancer development?

A 
-Tumour growth:
>Replication
>Escape from senescence
>Evasion of apoptosis
>Limitless replicative potential
-Angiogenesis
-Invasion and metastasis
43
Q

What is angiogenesis?

A

formation of new blood cells to support the needs of the tumour

44
Q

what are the components of a neoplasm?

A

-Neoplastic cells
-Blood Vessels
-Inflammatory cells:
>Macrophages
>Lymphocytes
>Polymorphs
-Fibroblasts
-Stroma

45
Q

what are all neoplastic cells in a lesion derived from?

A

single common ancestor

-neoplastic cells are monoclonal

46
Q

what is invasive malignancy?

A

invades the underlying connective tissue

47
Q

Describe the stages of tumour growth?

A
  • normal
  • intial event
  • mild dysplasia
  • severe dysplasia
  • invasive malignancy
48
Q

What type of process is dysplasia?

A

a pre-malignant process

49
Q

what is a good example of dysplasia?

A

epithelia:

  • squamous
  • glandular
50
Q

Describe dysplasia (pre-invasive).

A

-Cells show abnormal features that are also seen in cancer cells ….
-They are NOT invasive.
-Different degrees of dysplasia:
>Mild
>Moderate
>Severe / carcinoma in situ
- The more severe forms have a significant risk of progressing to invasive malignancy.

51
Q

Describe benign neoplasms.

A
  • Benign tumours can progress to become malignant
  • Evidence for multi-step theory of carcinogenesis
  • Now reflected in molecular studies of cancer development
52
Q

What is involved in the development of a cancer?

A

invasive growth, desmoplasia, angiogenesis and metastasis

53
Q

Describe what is involved in invasive growth.

A
  • receptors for connective tissues e.g laminin
  • adhesion molecules
  • altered cell division and apoptosis -pressure of growth
  • proteolytic enzymes e.g collagenases Cathepsin
54
Q

Describe what happens in invasive growth.

A

-Migration of cells that have detached from the primary tumour mass

-Single cells –
>Mesenchymal migration
(Proteolysis / traction)
>Amoeboid movement
(pseudopodiaPropulsion / Utilise defects)

-Groups of cells
>Requires cell-cell adhesion and communication
>Predominates in well differentiated carcinomas
>Inner cells protected from immunological assault
>High levels of autocrine pro-migratory factors and of proteolytic enzymes.
>Heterogeneous sets of cells invade together

55
Q

Describe the tumour stroma -desmoplasia.

A
  • Variable – scanty to abundant.
  • Fibro-connective tissues associated with malignant tumours.
  • Stimulated by invasive disease
  • Firm, craggy feel of cancer
56
Q

What happens in angiogenesis?

A

-Formation of new blood vessels
-Under tight physiological control
-Control is lost in tumours – the angiogenic switch.
-Vessels formed are abnormal
-New blood cells formed by outgrowth of endothelial cells from post capillary venules into tumour mass
-Stimlulus is increased production of factors by tumour cells:
>VEGF, FGF, angiogenin
>Inhibition of angiogenesis potential anticancer therapy area

57
Q

What is angiogenesis a pre-requisite for?

A

tumour progression

58
Q

how are tumours vascularised?

A

to a different extent

59
Q

what do tumours require?

A

less oxygen and metabolites than normal cells

60
Q

what does the density of tumour microvasculature need not correlate with?

A

prognosis

61
Q

what are metastasis?

A
  • Tumour implants that are discontinuous with the primary lesion.
  • “Secondaries”
  • Sinister event.
  • Non-random
  • Practical implications
62
Q

Name some common sites of metastatic disease.

A
  • Regional lymph nodes
  • Liver
  • Lung
  • Bone
  • Brain
  • Skin
63
Q

what are unusual sites of metastatic disease?

A

think of renal cancer, thyroid cancer, melanoma

64
Q

What spreads through lymphatic metastasis?

A

carcinoma

65
Q

what spreads haematogenous ?

A

sarcoma

66
Q

what is the route of metastasis across body cavities?

A
  • serous cavities

- meninges/ventricles /spinal canal

67
Q

what accounts for common metastatic profiles?

A

circulatory patterns

68
Q

what is effective at arresting circulating cancer cells?

A

lung and liver

69
Q

Describe the delivery and growth of cancer cells.

A

Delivery of cancer cells to a potential metastatic site is primarily mechanical – but the growth of metastatic deposits is dependent upon compatability with the “soil”.

70
Q

what are neck nodes divided into?

A

1-5

71
Q

what are the nodes in 1?

A

Submental and submandibular

72
Q

what are 2,3 , 4?

A

cervical chain - associated with sternocleidomastoid

73
Q

what is 5?

A

posterior triangle

74
Q

what stages do most oral cancers include?

A

1-4

Pathology (9 decks)

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