Session 8 Lecture 2

Question 1

What are the most lethal features of malignant neoplasm?

Answer 1

Invasion and metastasis

Question 2

What increases tumour burden?

Answer 2

Ability of malignant cells to invade and spread to distant sites

Question 3

What will happen if a malignant neoplasm is left untreated?

Answer 3

Vast number of parasitic malignancies

Question 4

What do malignant cells need to do in order to get from a primary site to a secondary site?

Answer 4

1) grow and invade at primary site 2) enter a transport system and lodge at secondary site 3) grow at secondary site to form a new tumour

Question 5

What is colonisation?

Answer 5

When malignant cells grow at secondary site to form a new tumour

Question 6

Is the process of a malignant cell getting from a primary site to a secondary site efficient?

Answer 6

No

Question 7

Why is the process of inefficient?

Answer 7

1. Malignant cells can get damages in the transport system

2. Malignant cell might be unable to grow at secondary site

Question 8

Invasion into surrounding tissue by carcinoma cells requires…

Answer 8

Altered adhesion, strongly proteolysis and motility.

Question 9

What does EMT stand for?

Answer 9

Epithelial to mesenchymal transition

Question 10

What is EMT?

Answer 10

After a carcinoma cell has undergone changes (so it can invade), its phenotype appears more like a mesenchymal cell than a epithelial cell.

Question 11

What three things lead to EMT?

Answer 11

Changes in: adhesion, proteolysis and motility

Question 12

How is adhesion altered?

Answer 12

Changes in integrin expression. Reduction in E-Cadherin expression

Question 13

How is stromal proteolysis affected?

Answer 13

Cell must degrade basement membrane and stoma to invade therefore altered expression of proteases esp MMPs

Question 14

What does MMP stand for?

Answer 14

Matrix metalloproteinases

Question 15

How is motility altered?

Answer 15

Altered motility involves changes in the actin cytoskeleton.

Question 16

What is a cancer niche?

Answer 16

Small environment where cells are binding.

Question 17

How is a cancer niche formed?

Answer 17

Malignant cells take advantage of nearby non-neoplastic cells which together form cancer niche

Question 18

How are malignant cells transported to distant sites?

Answer 18

• Blood vessels - capillaries and venues
• lymphatic vessels
• fluid in body cavities - pleura

Question 19

What is transcoelomic spread?

Answer 19

Transmission of malignant tumour through fluid in body cavities - pleura, peritoneal, pericardial and brain ventricles.

Question 20

What is colonisation?

Answer 20

The growth of malignant cells at a secondary site

Question 21

What is the greatest barrier to successful formation of metastasis?

Answer 21

Failed colonisation

Question 22

Why do you get failed colonisation?

Answer 22

Many malignant cells lodge at secondary site but these tiny clusters either die or fail to grow into tumour

Question 23

What are miccometastases?

Answer 23

Surviving microscopic deposits of that fail to grow

Question 24

What is tumour dormancy?

Answer 24

An apparently disease-free person may harbour many many micrometastases.

Question 25

What determines the site of a secondary tumour?

Answer 25

• Regional drainage of blood, lymph or coelomic fluid.

- The ‘seed and soil’ phenomenon

Question 26

What is the ‘seed and soil’ phenomenon?

Answer 26

Embolus of tumour cells will settle down when its finds its niche

Question 27

What does the ‘seed and soil’ phenomenon explain?

Answer 27

The seemingly unpredictable distribution of of blood-borne metastasis.

Question 28

How do carcinomas first typically spread?

Answer 28

Via lymphatics

Question 29

After spreading through lymphatics, how do carcinomas then spread?

Answer 29

Blood

Question 30

What are the common sites of blood borne metastasise?

Answer 30

Lung, bone, liver and brain

Question 31

The neoplasms that most frequently spread to bone are…

Answer 31

Breast, bronchus, kidney, thyroid and prostrate

Question 32

How do sarcomas tend to spread?

Answer 32

Via blood system

Question 33

Give an example of a neoplasm that is more aggressive and metastasise very early

Answer 33

Small cell bronchial carcinoma

Question 34

Give an example of a neoplasm that never metastasises

Answer 34

Basal cell carcinoma of the skin

Question 35

What is the likelihood of metastasis related to?

Answer 35

The size of the primary neoplasm

Question 36

How can we classify the effects neoplasms have on the body?

Answer 36

Local and systemic effects

Question 37

What are direct local effects?

Answer 37

Due to the primary neoplasm and/or secondary neoplasm

Question 38

What are systemic effect?

Answer 38

Indirect. Includes effects of increasing tumour burden, secreted hormones etc

Question 39

What are paraneoplastic syndromes?

Answer 39

Clinical syndromes involved in nonmetastatic systemic effects that accompany malignant disease

Question 40

For benign neoplasms, what effects are the most relevant?

Answer 40

Local effects form the primary and hormonal effects

Question 41

What are local effects of primary and secondary neoplasms due to?

Answer 41

1) direct invasion and destruction of normal tissue 2)ulceration at a surface leading to bleeding 3)compression of adjacent structures 4)blocking tubes and orifices

Question 42

What effects does increasing tumour burden have?

Answer 42

Leads to parasitic effects on host. Reduced appetite, weight loss, malaise, immunosuppression and thrombosis

Question 43

What effects doe benign neoplasms of endocrine glands have?

Answer 43

The neoplasms are well differentiated so typically produce hormones

Question 44

What miscellaneous systemic effects can neoplasms have?

Answer 44

Neuropathic affecting the brain and peripheral nerves, skin problems and abnormal pigmentation.