PATH: Neoplasia I/II

Question 1

What is the difference between neoplasm, tumor, and cancer?

Answer 1

A neoplasm is new cellular growth that is abnormal, uncontrolled, excessive, or purposeless, and a tumor is a mass or swelling that can be used to describe any neoplasm. Cancer is the common term for all malignant neoplasms.

Question 2

What is a malignant neoplasm?

Answer 2

A growth that is invasive, destroys surrounding tissue, grows relentlessly, and can metastasize

Question 3

What is metastasis?

Answer 3

The spread of a tumor from its site of origin to a distant site

Question 4

True or False: All cancers that metastasize are malignant, but not all malignant tumors have to metastasize.

Answer 4

True

Question 5

True or False: A benign tumor can metastasize so long as it does not cause tissue injury

Answer 5

False- benign tumors do not metastasize

Question 6

What is anaplasia?

Answer 6

The lack of differentiation/specialization

Question 7

What is the histological appearance of anaplastic cells?

Answer 7

They exhibit cytological and nuclear pleomorphism (variation in size, shape, staining intensity); hyperchromasia (dark staining nucleus due to increased DNA); large nucleoli and abnormal nuclei; variation in nucleoli #; high mitotic rate; high nuclear to cytoplasm ratio

Question 8

What is encapsulation and what type of tumor is it characteristic of?

Answer 8

A peripheral , circumferential fibrous connective tissue rim around benign tumors

Question 9

What is invasion?

Answer 9

Infiltration into adjacent structures, as seen with malignant tumors

Question 10

What is parenchyma? The stroma?

Answer 10

The tissue characteristic of an organ or neoplasm– the functional cells of an organ– as opposed to the connective or supporting tissues (the stroma)

Question 11

What is desmoplasia? What is a desmoplastic tumor?

Answer 11

Desmoplasia is the exuberant production of collegenous stroma induced by tumor cells; A tumor with dense collagenous stroma (fibrosis) induced by the tumor cells which form a firm, hard mass

Question 12

What is a medullary tumor?

Answer 12

A tumor without significant collagenous stroma

Question 13

What is dysplasia?

Answer 13

Variation in the size and shape of cells (pleomorphism) with loss of normal orientation but normal mitoses are present

Question 14

What is the only characteristic that can be used to determine malignancy on its own?

Answer 14

Metastasis

Question 15

What is cachexia?

Answer 15

General wasting related to advanced malignancies; drastic loss of body mass, especially lean muscle mass

Question 16

What are the gross features of malignancy?

Answer 16

Large size, invasion/ lack of encapsulation, necrosis, friability (brittle), multiple lesions, lymph node involvement, metastasis

Question 17

What are the microscopic features of malignancy?

Answer 17

Anaplasia/pleomorphism, cellular crowding/ nuclear overlap, increased mitotic rate, bizarre mitotic figures

Question 18

True or False: Tumor cells always proliferate at a faster rate than normal cells

Answer 18

False

Question 19

What is the proliferative index and what are the different categories?

Answer 19

A measure of what % of cells are in the S phase of the cell cycle; 0-12% is a low/favorable prognosis or a slowly proliferating tumor, 13-35% is intermediate/borderline prognosis; >36%= rapidly proliferating tumor

Question 20

If cancerous cells are immortal then why is necrosis characteristic of malignant tumors?

Answer 20

Because the cells are rapidly dividing they can outgrow their blood supply

Question 21

What is the difference between monoclonal and polyclonal tumors?

Answer 21

Monoclonal tumors arise from one single cell that has undergone a neoplastic transformation; Polyclonal tumors arise from more than one cell

Question 22

Are most tumors monoclonal or polyclonal?

Answer 22

Most tumors start out monoclonally but pick up mutations along the growing process and thusly become polyclonal

Question 23

What are the two major biologic hallmarks of cancer?

Answer 23

Invasion and metastasis

Question 24

What are the major routes of metastatic spread of cancer? What types of cancer are characteristic of each spreading route?

Answer 24

Lymphatic spread- dominant route in most carcinomas; Hematogenous spread- dominant route for sarcomas; or direct extension/ seeding- colonic/ovarian carcinoma

Question 25

What are two most common sites of metastasis?

Answer 25

Liver and lungs

Question 26

What types of cancers are most likely to invade the bone?

Answer 26

Prostate, lung, breast, kidney

Question 27

What types of cancers are most likely to invade the brain?

Answer 27

Lung, breast, and kidney

Question 28

What is carcinoma in situ?

Answer 28

A marked dysplastic change involving the entire thickness of the epithelium but confined by the basement membrane ; it is a preinvasive neoplasm

Question 29

What is the basic general mechanism by which tumor cells invade and metastasize?

Answer 29

1) tumor cells acquire receptors that bind to laminin and fibronectin of extracellular matrix, 2) proteolytic enzymes secreted by the tumor cells lyse the matrix components 3) tumor cells migrate to the degraded zone of the extracellular matrix

Question 30

What is a sentinel node?

Answer 30

The first lymph node into which a primary tumor will drain

Question 31

What is the difference between the grading and staging of a tumor? Which is more beneficial to prognosis and treatment?

Answer 31

Grading is an attempt to predict the aggressiveness of a tumor based on anaplasia; staging is a measurement of tumor size and extent ; Staging generally more critical to prognosis/treatment