Path: Neoplasia

Question 1

More than any other attribute, the property of _________ identifies a neoplasm as malignant.

Answer 1

Metastasis

Question 2

Next to metastasis, what attribute of a neoplasm identifies it as malignant rather than benign?

Answer 2

Local invasiveness rather than containment

Question 3

Short of preventing the cancer in the first place, what is the best thing you can do to improve the prognosis of a cancer patient?

Answer 3

Prevent metastasis of already-existing cancer

Question 4

Name the 3 ways malignant neoplasms disseminate and describe them.

Answer 4

1. SEEDING WITHIN BODY CAVITIES: characteristic of ovarian cancer, only invading the body cavity without invading the organ tissues under the peritoneum.
2. LYMPHATIC SPREAD -favored by carcinomas, but all forms of cancer can disseminate this way.
3. HEMATOGENOUS SPREAD - Favored pathway for sarcomas, but carcinomas use it too. Veins that drain the area of the primary tumor carry malignant cells.

Question 5

The pattern of malignant metastasis via lymphatic dissemination is governed by what?

How does this relate to breast cancer?

Answer 5

The location of the original neoplasm determines which lymph channels are taken, therefore where the next metastatic site will be.

Breast cancer originating on the upper outer quadrant will metastasize in the axillary lymph nodes (following lymph drainage)

Medial breast lesions will drain through chest wall to nodes surrounding the internal mammary artery.

Question 6

What are “skip metastases?”

Answer 6

Neoplastic cells carried by the lymph system that do not metastasize in any lymph tissue, but continues through the THORACIC DUCT into the VASCULATURE before metastasizing.

Question 7

There are 2 enlarged lymph nodes nearby a known site of cancer in a patient. Are these malignant? How can you tell?

Answer 7

They may or may not be. Neoplastic conditions elicit immune responses so it may just be lymphadenitis (hyperplasia of follicles), or they may be SENTINEL LYMPH NODES (the first regional lymph node that receives lymph flow from a primary tumor).

Determine by BIOPSY.

Question 8

What are the 2 most common sites of secondary metastasis via Hematogenous spread? WHy?

Answer 8

LIVER - all of the portal system drains here

LUNGS - all of the caval system drains here.

Question 9

Name all 4 ways to differentiate benign from malignant tumors:

Answer 9

1) Metastasis (benign tumors don’t metastasize)
2) Invasiveness (Benign tumors are well-demarcated with no invasion of surrounding tissue)
3) Degree of cellular differentiation (the more differentiated the cells within a tissue are, the more benign it is)
4) Growth rate (Benign = slow, Malignant = fast)

Question 10

Completely undifferentiated tissue is termed _____________ tissue.

Answer 10

Anaplastic