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Semester 2-PP > Session 8-Neoplasia 1&2 > Flashcards

Session 8-Neoplasia 1&2 Flashcards

1
Q

What is a neoplasm?

A

Abnormal growth of cells that persists after an initial stimulus is removed

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2
Q

What is a 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

What is the difference between a tumour and a neoplasm?

A

Tumour = any clinically detectable lump or swelling

Neoplasm = just one type of tumour

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4
Q

What is cancer in terms of a neoplasm?

A

Any malignant neoplasm

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5
Q

What is a metastasis?

A

Malignant neoplasm that has spread from its original site to a new non-contiguous site

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6
Q

What is the original location of a malignant neoplasm called?

A

Primary site

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7
Q

What is the place to which the neoplasm has spread to called?

A

Secondary site

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8
Q

What is dysplasia in terms of neoplasm?

A

Pre-neoplastic alteration in which cells show disordered tissue organisation

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9
Q

Why is dysplasia not neoplastic?

A

Change is reversible

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10
Q

Give examples of a non-neoplastic tumour?

A

Abscess

Haematoma

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11
Q

How are benign and malignant neoplasms different in terms of metastasis?

A

Benign neoplasms remain confined to their site of origin so don’t produce metastases

Malignant neoplasms can metastasise

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12
Q

Why are benign tumours so rarely dangerous?

A

Grow in a confined local area and so have a pushing outer margin

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13
Q

Describe the appearance of malignant tumours

A

Irregular outer margin and shape and may show areas of necrosis and ulceration

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14
Q

How do benign and malignant neoplasms differ in terms of differentiation?

A

Benign neoplasm has cells that closely resemble parent tissue ie well differentiated

Malignant neoplasms range from well to poorly differentiated

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15
Q

What are anaplastic cells?

A

No resemblance to any tissue

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16
Q

Describe the characteristics of cells with worsening differentiation

A
  • increasing nuclear size
  • increasing nuclear to cytoplasmic ratio
  • increased nucleus staining (hyperchromasia)
  • more mitotic figures
  • increasing variation in size and shape of cells and nuclei (pleomorphism)
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17
Q

What does a high ‘grade’ indicate?

A

Poor differentiation

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18
Q

What causes neoplasia?

A

Accumulated mutations in somatic cells

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19
Q

What causes the mutations in somatic cells?

A 
Initiators = mutagenic agents
Promoters = cause cell proliferation
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20
Q

Complete the sentences:

In combination, initiators and promoters result in an expanded, ___________ population of mutant cells. Chemicals, ____________ and radiation are the main _____________ but some of these agents can also act as ____________.

A

Monoclonal
Infections
Initiators
Promoters

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21
Q

True or false: in some neoplasms, mutations can be inherited rather than from an external mutagenic agent

A

TRUE

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22
Q

How does a neoplasm emerge from a monoclonal population?

A

Process called progression, characterised by accumulation of more mutations

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23
Q

What are monoclonal cells?

A

A collection of cells that originate from a single founding cell

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24
Q

Where did evidence that neoplasms are monoclonal come from?

A
  • X-linked gene for G6PDH enzyme in tumour tissue in women, several alleles for different isoenzymes
  • early in female embryogenesis, one allele randomly inactivated in each cell
  • in heterozygous women that have one allele for heat stable and one for heat labile isoenzymes, normal tissue is patchwork of each type
  • neoplastic tissues only express one isoenzyme so monoclonal
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25
What is lyonisation?
Process by which one copy of X chromosome present in female mammals is inactivated
26
How do genetic alterations affect proto-oncogenes?
Become abnormally activated and then called oncogenes, favouring neoplasm formation
27
How do genetic alterations affect tumour suppressor genes?
Become inactivated and no longer able to suppress neoplasm formation
28
What do benign neoplasms end in?
-oma
29
What do malignant neoplasms end in?
-carcinoma if epithelial malignant neoplasm (90%) OR -sarcoma if stromal malignant neoplasm
30
What are the two types of carcinomas?
1) in-situ = no invasion of epithelial basement membrane | 2) invasive = penetrated through basement membrane
31
What is leukaemia?
Malignant neoplasm of blood-forming cells arising in bone marrow
32
What are lymphomas?
Malignant neoplasms of lymphocytes, mainly affecting lymph nodes
33
What do germ cell neoplasms arise from?
Pluripotent cells, mainly in testis or ovary
34
Which neoplasms end in -blastoma?
Mainly occur in children and formed from immature precursor cells
35
What is a tumour with finger-like protections called?
Squamous papilloma
36
What type of neoplasm is in bladder mucosa?
Transitional cell papilloma
37
True or false: tumour suppressor gene is dominant
FALSE - recessive so need to inactivate both alleles for abnormal growth
38
True or false: proto-oncogenes are dominant
TRUE
39
Where can squamous cell carcinoma occur?
Skin Larynx Oesophagus Lung
40
Where can transitional cell carcinoma occur?
Bladder | Ureters
41
Where can adenocarcinoma occur?
``` Stomach Colon Lung Prostate Breast Pancreas Oesophagus (Any glandular) ```
42
What is stage one of tumour burden?
Cancer remains at primary site (small)
43
What is stage two of tumour burden?
Locally advanced but hasn't spread
44
What is stage three of tumour burden?
Spread regionally
45
What is stage four of tumour burden?
Distant metastasis - advanced cancer
46
What are the most lethal features of malignant neoplasm?
Invasion | Metastasis
47
True or false: ability of malignant cells to invade and spread to distant sites leads to increased tumour burden
TRUE
48
How do malignant cells get from a primary site to a secondary site?
1) grow and invade primary site 2) enter transport system and lodge at secondary site 3) grow at secondary site to form new tumour (colonisation)
49
What must malignant cells evade if they are to get from a primary site to a secondary site?
Destruction by immune cells
50
What does invasion into surrounding tissues by carcinoma cells require?
1) altered adhesion 2) stromal proteolysis 3) motility
51
What is epithelial-to-mesenchymal transition (EMT)?
Three alterations needed for invasion create a carcinoma cell phenotype that appears more like a mesenchymal cell than an epithelial cell -> EMT
52
Describe altered adhesion
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
53
Describe proteolysis
Cells must degrade basement membrane and stroma to invade. Involves altered expression of proteases, notably matrix metalloproteinases (MMPs)
54
What is a cancer niche?
Malignant cells take advantage of nearby non-neoplastic cells, which together form a cancer niche. These normal cells provide some growth factors and proteases
55
Describe altered motility
Involves changes in actin cytoskeleton. Signalling through integrins is important and occurs via small G proteins such as members of Rho family
56
What are the routes of transport of malignant cells to distant sites?
1) blood vessels via capillaries and venules 2) lymphatic vessels 3) fluid in body cavities (pleura, peritoneal, pericardial and brain ventricles) - known as transcoelomic spread
57
Complete the sentences: At a secondary site, malignant cells must get out of a vessel (______________) and then grow (_______________). Many malignant cells lodge at secondary sites but these tiny cell clusters either die or fail to grow into clinically detectable tumours. Surviving microscopic defects that fail to grow are called _________________.
Extravasation Colonisation Micrometastases
58
What is tumour dormancy?
When an apparently disease-free person may harbour many micrometastases
59
Why can a malignant neoplasm relapse years after an apparent cure?
Due to one or more micrometastases starting to grow
60
What can lead to tumour dormancy?
- immune attack - reduced angiogenesis - hostile secondary site
61
What determines the site of a secondary tumour?
1) regional drainage of blood, lymph or coelomic fluid | 2) "seed and soil" phenomenon
62
What is the "seed and soil" phenomenon?
Interactions between malignant cells and local tumour environment (ie niche) at the secondary site
63
True or false: carcinomas spread via blood stream
FALSE - via lymphatics first, sarcomas spread via blood stream
64
What is the likelihood of metastasis related to?
The size of primary neoplasm
65
What are paraneoplastic syndromes?
Indirect systemic effects of neoplasms, including increasing tumour burden, secreted hormones and miscellaneous effects
66
What are the local effects of primary and secondary neoplasms due to?
- direct invasion and destruction of normal tissue - ulceration at a surface leading to bleeding - compression of adjacent structures - blocking tubes and orifices
67
What can increased tumour burden lead to?
Parasitic effect and secreted factors such as cytokines contributes to reduced appetite, weight loss (cachexia), malaise, immunosuppression and thrombosis
68
What are some miscellaneous systemic effects of neoplasms?
- neuropathic affecting brain and peripheral nerves - skin problems such as pruritus and abnormal pigmentation - fever - myositis
69
What is the name given to benign connective tissue neoplasms in: 1) smooth muscle 2) fibrous tissue 3) bone 4) cartilage 5) fat 6) nerve 7) nerve sheath 8) glial cells?
1) leiomyoma 2) fibroma 3) osteoma 4) chondroma 5) lipoma 6) neuroma 7) neurofibroma 8) glioma

Semester 2-PP (13 decks)

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