Pathology - Neoplasia 2 Flashcards

1
Q

What are the steps of malignant cells moving from a primary site to a secondary site?

A

1) growth and invading the primary site
2) entering the transport system and lodging at the secondary site
3) growing at the secondary site to form a new tumour (colonisation)

Immune attack occurs at all stages

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2
Q

What are the three changes that allow a carcinoma cell to enter the surrounding tissue?

A
  • altered adhesion
  • stromal proteolysis
  • motility
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3
Q

What is epithelial-to-mesenchymal transition?

A

The changes that allow carcinoma cells to enter surrounding tissues can make them appear more like a mesenchymal cell than an epithelial cell

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4
Q

How are the three changes of epithelial-to-mesenchymal transition carried out?

A
ALTERED ADHESION:
- reduction in E-cadherin expression
- changes in integrin expression
STROMAL PROTEOLYSIS:
- altered expression of matrix metalloproteinases which degrade basement membrane and stroma
MOTILITY:
- changes in actin cytoskeleton
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5
Q

What is a cancer niche?

A

This occurs when malignant cells take advantage of nearby non-neoplastic cells, which provide growth factors and proteases

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6
Q

How do cancer cells signal each other?

A

Through integrins, using small G proteins such as members of the Rho family

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7
Q

How can malignant cells reach distant sites?

A
  • entering blood vessels via capillaries and venules
  • entering lymphatic vessels
  • entering fluid in body cavities (transcoelomic spread)
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8
Q

What is a micrometastases?

A

A microscopic deposit of cells that made it to a secondary site but failed to grow. These may stay in the body for years without causing symptoms ‘tumour dormancy’)

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9
Q

What factors can cause a tumour to fail to grow in a secondary location?

A

Immune attack, reduced angiogenesis, hostile site

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10
Q

Why are we often able to predict the location of a secondary neoplasm?

A
  • we can tell where the fluid that the cells are in is likely to go, eg lymphatic fluid goes to the regional lymph node.
  • however, the ‘seed and soil’ effect (interactions of malignant cells and local tumour environment) can mess with our predictions
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11
Q

Where do carcinomas typically spread first?

A

To draining lymph nodes, then to blood-borne distant sites such as lung, bone, liver and brain. These neoplasms frequently spread to bone - breast, bronchus, kidney, thyroid and prostate

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12
Q

True or false - the size of the primary neoplasm does not affect the likelihood of metastasis?

A

False - it is directly related

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13
Q

How are the effects that a neoplasm has on the host classified?

A
  • those that are due to the direct local effects (primary and/or secondary neoplasm)
  • those due to indirect systemic effects (effects of increasing tumour burden, secreted hormones, miscellaneous effects = ‘paraneoplastic syndromes’)
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14
Q

What causes the local effects of primary and secondary neoplasms?

A
  • direct invasion and destruction of normal tissue
  • ulceration at a surface leading to bleeding
  • compression of adjacent structures
  • blocking tubes/orifaces
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15
Q

What symptoms do increasing tumour burden and cytokines cause on the body?

A

Reduced appetite and weight loss, malaise, immunosuppression, thrombosis, neuropathies affecting brain and nerves, pruritus and abnormal pigmentation of skin, fever, finger clubbing and myositis

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16
Q

Can benign neoplasms produce hormones?

A

Yes, if they are well differentiated eg a thyroid adenoma will produce thyroxine