Path - Neoplasia (Tumor basics) Flashcards
Pg. 229-231 in First Aid 2014 Sections include: -Neoplastic progression -P-glycoprotein - -plasia definitions -Tumor grade vs. stage -Tumor nomenclature -Tumor differences
What are 7 hallmarks of cancer?
Hallmarks of cancer - (1) evasion of apoptosis (2) growth signal self sufficiency (3) anti-growth signal insensitivity (4) sustained angiogenesis (5) limitless replicative potential (6) tissue invasion and (4) metastasis
What kind of differentiation is seen in normal cells (that is later loss in neoplastic progression)?
Normal cells with basal => apical differentiation
What are the 3 cellular phases/stages of neoplastic progression from normal cells?
Normal => (1) Hyperplasia (2) Carcinoma in situ/Preinvasive (3) Invasive carcinoma (with metastatic focus in blood or lymphatic vessel)
What occurs in hyperplasia?
Cells increase in number
What is dysplasia, and what losses define it?
Abnormal proliferation of cells with loss of size, shape, and orientation
What are 3 properties used to define the carcinoma in situ/preinvasive stage of neoplastic progression?
(1) Neoplastic cells have not invaded basement membrane (2) High nuclear/cytoplasmic ratio and clumped chromatin (3) Neoplastic cells encompass entire thickness
What 2 properties define the invasive carcinoma stage of neoplastic progression?
(1) Cells have invaded basement membrane using collagenases and hydrolases (metalloproteinases) (2) Can metastasize if they reach a blood or lymphatic vessel
In what stage of neoplastic progression is the basement membrane invaded? What proteins are used for such invasion?
Invasive carcinoma; Cells have invaded basement membrane using collagenases and hydrolases (metalloproteinases)
What is metastasis?
Spread to distant organ
What must tumor cells that metastasize survive?
Must survive immune attack
What is the “seed and soil” theory of metastasis?
Seed = tumor embolus; Soil = target organ - liver, lungs, bone, brain, etc. (Per Firecracker: The “seed and soil” theory of metastasis attempts to explain why certain tumor types tend to metastasize to specific organs by stating that a tumor embolus, “the seed”, has a specific organ that it spreads to “the soil”, which stimulates its growth better than other organs.)
What is another name for P-glycoprotein?
Also known as multidrug resistance protein 1 (MDR1)
In general, what cells express P-glycoprotein, and what is its function? Give 2 examples of cells that express this.
Expressed by some cancer cells (e.g., colon, liver) to pump out toxins, including chemotherapeutic agents (one mechanism of decreased responsiveness or resistance to chemotherapy over time)
What is important to know about P-glycoprotein as it relates to chemotherapy?
Expressed by some cancer cells (e.g., colon, liver) to pump out toxins, including chemotherapeutic agents (one mechanism of decreased responsiveness or resistance to chemotherapy over time)
Define Hyperplasia.
Increase in number of cells
Define Metaplasia.
One adult cell type is replaced by another.
What are 2 causes of Metaplasia? Give an example of each.
Often secondary to irritation (e.g., Barrett esophagus) and/or environmental exposure (e.g., smoking-induced tracheal/bronchial squamous metaplasia)
Define Dysplasia.
Abnormal growth with loss of cellular orientation, shape, and size in comparison to normal tissue maturation
What is the relationship of dysplasia to cancer, if any?
Commonly preneoplastic
Name 6 types of “-plasia”. Distinguish between reversible and irreversible types of -plasia.
REVERSIBLE: (1) Hyperplasia (2) Metaplasia (3) Dysplasia; IRREVERSIBLE: (1) Anaplasia (2) Neoplasia (3) Desmoplasia
Define Anaplasia.
Loss of structural differentiation and function of cells, resembling primitive cells of same tissue
With what other cell type are anaplastic cells often equated, and why?
Loss of structural differentiation and function of cells, resembling primitive cells of same tissue; Often equated with undifferentiated malignant neoplasms.
What may be seen upon histology of anaplastic cells?
May see “giant cells” with single large nucleus or several nuclei
Define Neoplasia.
A clonal proliferation of cells that is uncontrolled or excessive.
What are 2 types major kinds of Neoplasia?
Neoplasia may be benign or malignant.
Define Desmoplasia. Give an example.
Fibrous tissue formation in response to neoplasm (e.g., linitis plastica in diffuse stomach cancer.
What determines tumor grade?
Determined by degree of cellular differentiation and mitotic activity on histology
On what scale are tumors usually graded, and what does the scale mean?
Usually graded 1-4; 1 = low grade, well differentiated; 4 = high grade, poorly differentiated, anaplastic
Of grade versus stage, which usually has more prognostic value?
Stage usually has more prognostic value than grade
What determines/defines the stage of a tumor?
Degree of localization/spread based on site and size of primary lesion, spread to regional lymph nodes, and presence of metastases
On what findings is stage of a tumor based? Give an example of how such findings may be reported.
Based on clinical (c) or pathology (p) findings (e.g., cT3N1M0)
What is the staging system used for tumors? Define each variable in the system.
TNM staging system (Stage = Spread); T = Tumor size, N = Node involvement, M = Metastases
Which part of the TNM staging system, if any, has prognostic value?
TMN each has independent prognostic value
What do the terms carcinoma versus sarcoma imply? Compare/contrast them in terms of origin, type of neoplasia, and method of spread.
The term carcinoma implies epithelial origin, whereas sarcoma denotes mesenchymal origin. Both terms imply malignancy. Most carcinomas spread lymphatically, whereas most sarcomas spread hematogenously
How do most carcinomas spread? What are 4 exceptions to this rule, and how do those spread?
Most carcinomas spread lymphatically, whereas most sarcomas spread hematogenously; Notable exceptions to carcinomas that spread lymphatically include (1) renal cell carinoma (often invades renal vein), (2) hepatocellular carcinoma (often invades hepatic vein), (3) follicular carcinoma of the thyroid, and (4) choriocarcinoma, all of which may spread hematogenously
What are 2 terms used for benign epithelium tumors? What are 2 terms used for malignant epithelium tumors?
BENIGN: Adenoma, papilloma; MALIGNANT: Adenocarcinoma, papillary carcinoma
What are 7 cell/tissue types of mesenchyme?
(1) Blood cells (2) Blood vessels (3) Smooth muscle (4) Striated muscle (5) Connective tissue (6) Bone (7) Fat
What are 2 terms used for malignant blood cell tumors?
Leukemia, lymphoma
What term is used for benign versus malignant blood vessel tumors?
BENIGN: Hemangioma; MALIGNANT: Angiosarcoma
What term is used for benign versus malignant smooth muscle tumors?
BENIGN: Leiomyoma; MALIGNANT: Leiomyosarcoma
What term is used for benign versus malignant striated muscle tumors?
BENIGN: Rhabdomyoma; MALIGNANT: Rhabdomyosarcoma
What term is used for benign versus malignant connective tissue tumors?
BENIGN: Fibroma; MALIGNANT: Fibrosarcoma
What term is used for benign versus malignant bone tumors?
BENIGN: Osteoma; MALIGNANT: Osteosarcoma
What term is used for benign versus malignant fat tumors?
BENIGN: Lipoma; MALIGNANT: Liposarcoma
What 5 properties usually define benign tumors?
Usually (1) well differentiated, (2) low mitotic activity, (3) well demarcated, (4) no metastasis, (5) no necrosis
What 5 properties may define malignant tumors?
May be (1) poorly differentiated, (2) erratic growth, (3) locally invasive/diffuse, (4) may metastasize, (5) decreased apoptosis (upregulation of telomerase prevents chromosome shortening and cell death).
What change may malignant cells have in terms of apoptosis, and what causes this?
Decreased apoptosis (upregulation of telomerase prevents chromosome shortening and cell death).
