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Pathological Processes > Session 8 > Flashcards

Session 8 Flashcards

1
Q

Define neoplasia

A

An abnormal growth of cells that persists after the initial stimulus is removed

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2
Q

Define malignant neoplasm

A

An abnormal growth of cells that persists after the initial stimulus is removed and invades surrounding tissue with potential to spread to distant sites

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3
Q

Define tumour

A

Any clinically detectable lump or swelling

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4
Q

Define cancer

A

Any malignant neoplasm

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5
Q

Define metastasis

A

A malignant neoplasm that has spread from its original site (primary site) to a new non-contiguous site (secondary site)

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6
Q

Define dysplasia

A

A pre-neoplasticism alteration in which cells show disordered tissue organisation (reversible)

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7
Q

Compare dysplasia and neoplasia

A

Neoplasia = irreversible

Dysplasia = reversible

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8
Q

Do benign neoplasms produce metastases?

A

No - remain confined to their site of origin

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9
Q

Describe the appearance of a benign neoplasm to the naked eye with regards to its outer margin in particular

A

Has a regular ‘pushing’ outer margin and grows in a confined area

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10
Q

Benign neoplasms may push on local structures causing…

A

Inflammation

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11
Q

Describe the appearance of cells of a benign neoplasm under the microscope

A

Cells closely resemble the parent tissue - well differentiated

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12
Q

Do malignant neoplasms have the potential to metastasise?

A

Yes, by definition

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13
Q

Describe the appearance of a malignant neoplasm to the naked eye

A

Irregular outer margin and shape

May show necrosis/ulceration

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14
Q

Describe the appearance of the cells of a malignant neoplasm under a microscope

A

Cells range from well to poorly differentiated

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15
Q

What is meant by the term anaplastic?

A

Cells have no resemblance to any tissue

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16
Q

Compare the cells seen in malignant neoplasms with the cells seen in benign neoplasms

A

Benign - well differentiated cells (resemble parent tissue)

Malignant - poorly to well differentiated (a range)

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17
Q

Describe the varying degrees of differentiation seen in benign and malignant neoplasms under the microscope

A

Benign - cells well differentiated, closely resemble parent tissue

Malignant - cells range from well to poorly differentiated

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18
Q

Name 5 changes seen in cells due to worsening differentiation as seen in malignant neoplasms

A

Nuclear hyperchromasia

Increased nuclear:cytoplasm ratio

Increased mitoses (mitotic figures)

Larger nucleus

Cellular and nuclear size variation (pleomorphism)

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19
Q

What is nuclear hyperchromasia?

A

Increased nucleus staining due to increased DNA content

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20
Q

Clinicians use the term __________ to indicate differentiation

A

Grade

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21
Q

Clinicians use the term grade to indicate differentiation.

High grade = _________ differentiated

A

Poorly

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22
Q

Neoplasm is caused by an accumulation of _____________ in somatic cells

A

Mutations

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23
Q

What sort of factors are the most important causes of mutations?

A

Extrinsic/Environmental Factors

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24
Q

Mutations are caused by initiators and promoters.

What is the function of an initiator?

What is the function of a promoter?

A

Mutagenic agent - introduces mutation

Causes cell proliferation

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25
Q

Mutations are caused by initiators and promoters. In combination they result in…

A

An expanded, monoclonal population of mutant cells

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26
Q

Name the three main initiators of neoplasia

A

Infections
Chemicals
Radiation

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27
Q

A neoplasm emerges from a monoclonal population through a process called _______________ where there is an accumulation of ______________

A

Progression

Mutations

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28
Q

What is meant by the term monoclonal with regards to a cell population?

A

A collection of cells that all originated from a single founding cell

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29
Q

What is evidence that neoplasms are monoclonal?

A

From the study of x-linked gene for the enzyme G6PD in tumour tissue from women

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30
Q

Evidence from the study the of x-linked gene for the enzyme _________ in tumour tissue from women supports the theory that neoplasms are monoclonal

A

G6PD

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31
Q

Describe how the study of the x-linked gene for G6PD in tumour tissue from women provides evidence that neoplasms are monoclonal

A

Gene has several alleles encoding different isoenzymes

Early in embryogenesis one allele is randomly inactivated in EACH cell (lyonisation)

In women that have alleles coding for different isoenzymes, normal tissue will be a patchwork of each

In neoplastic tissues only one isoenzyme is expressed —> indicating monoclonal group

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32
Q

What is lyonisation? With regards to G6PD?

A

Random inactivation of the allele from one x chromosome

Early in embryogenesis, one allele coding for G6PD is randomly inactivated

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33
Q

Genetic alterations in neoplasms affect which two types of genes?

A

Proto-oncogenes

Tumour suppressor genes

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34
Q

Proto-oncogenes become abnormally activated forming…

A

Oncogenes

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35
Q

The formation of oncogenes from proto-oncogenes favours…

A

Neoplasm formation

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36
Q

In neoplasia, tumour suppressor genes which normally suppress neoplasm formation become…

A

Inactivated

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37
Q

The system for naming neoplasms can take into account (4)

A

Site of origin
Malignant or benign
Type of tissue that the tumour forms
Gross morphology (cyst or papilloma)

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38
Q

Benign neoplasms end in…

A

-oma

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39
Q

Malignant neoplasms end in -carcinoma if it is…

A

Epithelial

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40
Q

Malignant neoplasms end in -sarcoma if it is…

A

Stromal

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41
Q

-blastomas mainly occur in ____________ and are formed from…

A

Children

Immature precursor cells

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42
Q

The majority of malignant neoplasms are of which type? Give a rough percentage.

A

Carcinomas (epithelial origin)

~90%

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43
Q

Why are carcinomas more common than sarcomas?

A

Epithelial cells are at the surface and rapidly turnover so are more likely to be mutated

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44
Q

Carcinomas can be either… (2)

A

In-situ

Invasive

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45
Q

Compare an in-situ carcinoma with an invasive carcinoma

A

In-situ - no invasion of epithelial basement membrane

Invasive - penetrated through basement membrane

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46
Q

Is leukaemia malignant or benign?

Is lymphoma malignant or benign?

A

Malignant

Malignant

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47
Q

What type of cancer is leukaemia? Which cells are affected? Where does it arise?

A

MALIGNANT neoplasm affecting BLOOD-FORMING CELLS arising in the BONE MARROW

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48
Q

What type of cancer is lymphoma? What cells does it affect? What part of the body does it mainly affect?

A

MALIGNANT neoplasm affecting lymphocytes. Mainly affects lymph nodes.

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49
Q

Germ cell neoplasms arise from…

What parts of the body do they mainly affect?

A

Pluripotent cells

In the testis or ovary

50
Q

Neuroendocrine tumours arise from…

A

Specialised neuroendocrine cells

51
Q

‘Papillomas’ refers to any tumour with…

A

Finger-like projections

52
Q

What name is given to a benign neoplasm of the stratified squamous epithelium? Where can this cancer be seen?

A

Squamous papilloma

Skin

53
Q

What name is given to a benign neoplasm of the transitional epithelium? Where in the body can this be seen?

A

Transitional cell papilloma

Bladder mucosa

54
Q

What is the name given to a benign tumour of glandular epithelium?

A

Adenoma

55
Q

Give an example of an adenoma you might see in the body

A

Adenomatous polyp of the COLON

56
Q

What name is given to a malignant neoplasm of the stratified squamous epithelium?

A

Squamous cell carcinoma

57
Q

Name two parts of the body you may see squamous cell carcinoma

A

Skin
Larynx
Oesophagus
Lung

58
Q

What name is given to a malignant neoplasm of the transitional epithelium?

A

Transitional cell carcinoma

59
Q

Name two parts of the body where you may see a transitional cell carcinoma

A

Bladder

Uterus

60
Q

What is the name given to a malignant neoplasm of glandular epithelium?

A

Adenocarcinoma

61
Q

Name two locations you may see an adenocarcinoma

A

Stomach
Colon
Pancreas

62
Q

What is the name given to a benign neoplasm of the…

Smooth muscle
Fibrous tissue
Bone 
Cartilage
Fat
Nerve
Nerve sheath 
Glial cells
A

Leiomyoma

Fibroma

Osteoma

Chondroma

Lipoma

Neuroma

Neurofibroma

Glioma

63
Q

What is the name given to a malignant neoplasm of the…

Smooth muscle
Bone
Fibrous tissue
Cartilage
Fat
Glial cells
A

Leiomyosarcoma

Osteosarcoma

Fibrosarcoma

Chondrosarcoma

Liposarcoma

Malignant glioma

64
Q

Lymphoid and haematopoietic neoplasms are all regarded as…

A

Malignant

65
Q

Lymphoid neoplasms are called…

A

Lymphoma

66
Q

Haematopoietic neoplasms are called…

Where in the body do they arise?

A

Leukaemia (acute/chronic)

Bone marrow

67
Q

Give two examples of germ cell neoplasms in the testis

A

Seminoma

Malignant teratoma

68
Q

Is seminoma malignant?

A

Yes

69
Q

Give an example of a benign neoplasm affecting the ovary?

A

Benign teratoma

70
Q

What is the colloquial name for a benign teratoma of the ovary?

A

Dermis cyst

71
Q

______________ and _____________ metastasis are the most lethal features of a malignant neoplasm

A

Invasion

Metastasis

72
Q

How does invasion and metastasis of a malignant neoplasm to distant sites affect the tumour burden of a patient?

A

Greatly increases tumour burden

73
Q

Do benign tumours metastasise?

A

No

74
Q

What are the 3 steps that malignant cells must undergo to get from a primary site to a secondary site?

At which steps do the inefficiencies of malignant cells to form metastases mainly lie?

A

Grow and invade at the primary site
Enter a transport system and lodge at a secondary site
Grow at the secondary site (colonisation)

Steps 2 & 3

75
Q

Is the process of forming metastases generally efficient or inefficient?

A

Inefficient - number of viable cells able to form metastases is very low

76
Q

Name three reasons why the process of forming metastases from malignant cells is inefficient

A

The cells must evade destruction by immune cells through all the steps of the process

Many cancer cells are sheared in capillaries and cannot survive in blood vessels

Many cannot grow at secondary site and instead form micro deposits of cancer cells

77
Q

Invasions into surrounding tissues by carcinoma cells requires altered… (3)

A

Adhesion
Stromal proteolysis
Motility

78
Q

The altered adhesion, stromal proteolysis and motility shown by cancer cells that invade surrounding tissues result in…

A

Carcinoma cells that appear more like mesenchymal cells than an epithelial cell

79
Q

What are mesenchymal cells?

A

Multi-potent stromal cells

80
Q

The process of altered adhesion, stromal proteolysis and motility that causes carcinoma cells to appear as mesenchymal cells rather than epithelial cells is called…

A

Epithelial-to-Mesenchymal Transition (EMT)

81
Q

Describe what is involved in the altered ADHESION allowing carcinoma cells to invade surrounding tissue

A

Altered adhesion BETWEEN malignant cells involves a reduction in E-Cadherin expression

Altered adhesion between malignant cells and stromal proteins involves changes in Integrin expression

82
Q

Altered adhesion between malignant cells involves…

A

A reduction in E-Cadherin expression

83
Q

Altered adhesion between malignant cells and stromal proteins involves…

A

Changes in Integrin expression

84
Q

Describe what is involved in the altered STROMAL PROTEOLYSIS which allows carcinoma cells to invade surrounding tissues

A

Cells degrade basement membrane/stroma to invade with altered expression of proteases - especially matrix metalloproteinases (MMPs)

85
Q

How is the basement membrane/stoma degraded to allow carcinoma cells to invade surrounding tissue?

A

Through altered expression of proteinases (especially MMPs)

86
Q

Which protease is particularly involved in the degradation of the basement membrane/stroma that allows carcinoma cells to invade surrounding tissue?

A

Matrix Metalloproteinases - MMPs

87
Q

What is meant by a cancer niche?

A

Where malignant cells take advantage of nearby non-neoplastic cells that provide the malignant cells with some growth factors and proteases

88
Q

Describe what is involved in the altered MOTILITY that allows the invasion of surrounding tissues by carcinoma cells

A

Changes in the actin cytoskeleton

89
Q

Signalling through integrins allows changes in the actin cytoskeleton resulting in altered motility. Signalling occurs via…

A

Small G proteins such as members of the Rho family

90
Q

In cancer niches the non-neoplastic cells supply the malignant cells with… (2)

A

Growth factors

Proteases

91
Q

Transport of malignant cells to distant sites can occur via which 3 routes?

A

Blood vessels via capillaries/venules

Lymphatic vessels

Fluid in body cavities

92
Q

What is the name given to spread/transport of malignant cells via fluid in body cavities?

A

Transcoelomic spread

93
Q

Malignant cells must GROW at a secondary site to form a clinical metastasis in a process called…

A

Colonisation

94
Q

What is considered the greatest barrier to successful metastasis formation?

A

Failed colonisation

95
Q

What is the most common reason for failed colonisation?

A

Many malignant cells lodge at secondary sites BUT the tiny clusters of cells either die or fail to grow (micrometastases)

96
Q

What are micrometastases?

A

Microscopic deposits of surviving cancer cells that fail to grow

97
Q

An apparently disease-free person may harbour many micrometastases, this is known as…

A

Tumour dormancy

98
Q

When a malignant neoplasm relapses after years it is typically due to…

A

One or more micrometastases starting to grow

99
Q

Give 3 possible reasons for tumour dormancy

A

Immune Attack
Reduced Angiogenesis
Hostile Secondary Site

100
Q

State two factors that influence the site of a secondary tumour

A

Regional drainage of blood, lymph or coelomic fluid

Seed and soil phenomenon

101
Q

Regional drainage makes the site of metastasis more predictable.

Where is the typical site of lymphatic metastasis?

A

Draining lymph nodes

102
Q

Regional drainage makes the site of metastasis more predictable.

Where is the typical site for transcoelomic spread?

A

Other areas in the coelomic space

Adjacent organs

103
Q

Regional drainage makes the site of metastasis more predictable.

Where is the typical site for blood-borne metastasis?

A

Next capillary bed that the cells encounter (more unpredictable)

104
Q

Describe what is meant by the seed and soil phenomenon

A

States that site of metastasis (secondary site) is due to interactions between malignant cells and the niche (local tumour environment) at the secondary site

105
Q

By which route do carcinomas typically spread?

A

Lymphatics

106
Q

Why which route do sarcoma typically spread?

A

Blood stream

107
Q

State 4 common sites of BLOOD BORNE METASTASIS

A

Brain
Lungs
Liver
Bone

108
Q

Neoplasms that spread to bone are most commonly… (5)

A 
Breast
Bronchus
Kidney 
Thyroid 
Prostate
109
Q

What is meant by tumour personalities?

A

Different characteristics commonly shown by different types of cancer

110
Q

Give an example of a malignant neoplasm that is very aggressive and metastasises very early in its course

A

Small Cell Bronchial Carcinoma (SCLC)

111
Q

Give an example of a malignant neoplasm that almost never metastasises

A

Basal cell carcinoma of the skin

112
Q

The likelihood of metastasis is related to the size of…

A

The primary neoplasm

113
Q

A substantially sized primary tumour is required to form…

A

Metastases

114
Q

Give 4 LOCAL effects of primary/secondary neoplasms

A

Direct invasion/destruction of normal tissue
Ulceration at a surface leading to bleeding
Compression of adjacent structures
Blocking tubes/orifices

115
Q

The systemic effects of neoplasms are as a result of either… (3)

What umbrella term can be given to systemic effects caused by these factors?

A

Increasing tumour burden
Secreted hormones
Miscellaneous systemic effects

Paraneoplastic syndromes

116
Q

What systemic effects are caused by an increasing tumour burden?

A

Parasitic effect on host - cytokines contribute to reduced appetite and weight loss, malaise, immunosuppression and thrombosis

117
Q

Cytokines released as a result of an increasing tumour burden can have a parasitic effect on the host.

State 4 symptoms this can cause in a patient

A

Malaise
Immunosuppression
Thrombosis
Decreased appetite + weight loss

118
Q

Do both benign and malignant neoplasms secrete hormones that can have systemic effects on a host?

Give examples where necessary

A

Benign neoplasms consist of well differentiated cells so typically produce hormones
Thyroid adenoma —> Thyroxine

Malignant neoplasms sometimes produce hormones
Small Cell bronchial carcinoma —-> ACTH/ADH

119
Q

Give 4 examples of a miscellaneous systemic effects of primary/secondary neoplasms

A

Neuropathies affecting the brain and peripheral nerves

Skin problems - e.g. Abnormal pigmentation and pruritus

Fever

Myositis

120
Q

What is pruritus?

What is a neuropathy?

What is myositis?

A

Severe itching of the skin

A problem involving nerves

Inflammation/swelling of the muscles

Pathological Processes (10 decks)

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