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Tissues > T25 - Tumor Growth > Flashcards

T25 - Tumor Growth Flashcards

1
Q

What five factors are used to assess tumors?

A

demarcation

induration

differentation

rate of growth

distant spread (metastasis)

[DIDRM]

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2
Q

Grossly and by palpation, what are the features of benign tumors? (4)

A

sharp, distinct margins

freely movable by palpation

visible boundary between normal tissue and tumor

encapsulated

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3
Q

Describe how benign tumors grow. (2)

A

slow expansile growth

compresses surrounding tissue as it grows

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4
Q

Describe the capsule of benign tumors.

A

consists of dense type I collagen produced by fibroblasts

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5
Q

The capsule of benign tumors is produced in response to

A

pressure from adjacent masses

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6
Q

The presence of a capsule implies

A

slow and non-invasive tumor growth

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7
Q

Grossly, what are the features of malignant tumors? (4)

A

ill-defined margins

indistinct boundary between normal tissue and tumor

jagged/stellate configuration

fixed to surrounding tissue

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8
Q

There are exceptions to the notion that malignant tumors are not well circumscribed. How can malignant tumors be definitively identified on a microscopic scale?

A

malignant tumors almost always exhibit small foci of penetration through capsule w/ invasive growth into vasculature or surrounding tissue

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9
Q

Define induration.

A

firmess of tumor on palpation

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10
Q

Fibroblasts in tumors often produce

A

abnormal, densely collagenous stroma that gives tumor firm/rock-hard/indurated texture

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11
Q

Define desmoplasia. (2)

A

abnormal stroma production by tumor leading to induration on palpation

“lots of cancer stuff + fiber stuff” [from tutoring]

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12
Q

The finding of induration in a mass suggests

A

the mass is an invasive cancer.

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13
Q

What is a tumor stroma?

A

tumor (with neoplastic cells) + recruited “normal” cells such as fibroblasts

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14
Q

Define differentiation.

A

degree to which a tumor resembles the normal tissue cells from which it arose

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15
Q

What is the relationship between differentiation and malignancy? (2)

A

benign tumors are very well-differentiated

in other words, degree of differentiation is inversely correlated with tumor aggressiveness

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16
Q

Describe the key architectural indicator of differentiation in epithelial cells. (2)

A

epithelial cells are polarized → basal and apical have different functions

malignant tumors show loss of polarity → increased stratification of epithelium

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17
Q

What is the key indicator of morphologic differentiation in adenocarcinomas?

A

loss of ability to make well-formed glands

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18
Q

What is cellularity?

A

density of cells, seen in tissue section as number of cells per unit area

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19
Q

What is the relationship between cellularity and differentiation? (4)

A

poorly-differentiated = more malignant → smaller cells → increased cellularity → increased density of nuclei

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20
Q

Describe nuclear morphology in tumors.

A

greater variability in size/shape = pleomorphism

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21
Q

What causes nuclear pleomorphism?

A

variations in DNA content (aneuploidy) in tumor cells

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22
Q

How do tumor nuclei stain by H&E?

A

stain more darkly = hyperchromasia

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23
Q

What is the significance of the nuclear to cytoplasmic ratio?

A

cytoplasm reduced in poorly-differentiated cells → increased DNA content → higher nuclear to cytoplasmic (NC) ratio

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24
Q

How does abnormal DNA content in tumor cells manifest?

A

manifested as abnormal mitotic figures, such as tripolar mitoses

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25
Q

Describe the nucleoli of tumor cells.

A

prominent nucleoli due to need for increased metabolic activity and protein synthesis

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26
Q

What is functional differentiation?

A

degree to which cells produce normal cellular products

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27
Q

Give four examples of cellular products that can be used to assess functional differentiation.

A

mucin (glandular cells)

keratin (squamous cells)

hormones (endocrine cells)

extracellular matrix (bone/cartilage cells)

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28
Q

List four key morphologic characteristics that can be used to assess malignancy.

A

polarity

gland formation

cellularity

pleomorphism

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29
Q

What is anaplasia?

A

extreme degree of loss of differentiation

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30
Q

What is a synonym for anaplasia?

A

de-differentiation

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31
Q

What are the four primary features of anaplasia?

A

total lack of tissue organization

extreme cell/nuclear pleomorphism

large/hyperchromatic/bizzare nuclei

abnormal mitotic figures

[TELA]

32
Q

What is the relationship between rate of growth and differentiation?

A

rate of growth inversely correlated with degree of differentiation

33
Q

Give two examples of tumors that are metastatic at an early stage.

A

melanoma

small cell carcinoma of the lung

34
Q

What are the four primary routes of metastasis?

A

direct seeding

lymphatic spread

hematogenous spread

transplantation

35
Q

What is direct seeding?

A

spread within body via detachment and subsequent implantation in physically contiguous manner

36
Q

What is peritoneal seeding? (2)

A

when ovarian tumors spread directly into the peritoneal cavity

an example of direct seeding

37
Q

What is the major mode of spread of carcinomas?

A

lymphatic spread

38
Q

What is the likely site of lymph node metastasis for the breast?

A

axillary nodes

39
Q

What is the likely site of lymph node metastasis for the lung? (2)

A

hilar nodes

peribronchial nodes

40
Q

What is the likely site of lymph node metastasis for the testis?

A

paraaortic nodes

41
Q

What is the likely site of lymph node metastasis for leg skin?

A

inguinal lymph nodes

42
Q

What is the major mode of spread for sarcomas?

A

hematogenous spread

43
Q

Hematogenous spread is the major mode of spread for which tumor(s)? (2)

A

major mode for sarcomas

common mode for carcinomas

44
Q

Hematogenous spread occurs through which structure?

A

occurs through venous drainage

45
Q

How do intestinal tumors metastasize to the liver?

A

via the portal system

46
Q

How do prostatic tumors metastasize to the lower spine?

A

via vertebral plexus

47
Q

List two tumors that tend to metastasize in an idiosyncratic/noteworthy manner.

A

lung tumors → adrenals

renal cell carcinoma → renal vein → inferior vena cava → right side of heart

48
Q

Overall, what are the four most common sites of metastasis?

A

lymph nodes

lung

liver

bone

49
Q

Overall, what are the three least common sites of metastasis?

A

skeleta muscle

heart

GI tract

50
Q

Why might transplantation of tumor cells be helpful? (2)

A

give tumor cells access to new territory

rarely done in practice

51
Q

Why are testicular masses never biopsied?

A

testis surrounded by tough fibrous capsule, the tunica albuginea, which if broken would give tumor opportunity to spread into scrotal sac and peritoneal cavity

52
Q

Testicular masses are never biopsied. What is the only option for obtaining diagnostic tissue from a testicular mass?

A

orchiectomy

53
Q

Give an example of a neoplasm that is locally aggressive but does not metastasize.

A

basal cell carcinoma of skin

54
Q

Give an example of a benign tumor that produces stable deposits at distant sites.

A

benign metastasizing leiomyomatosis

55
Q

What are sampling issues?

A

the idea that only a portion of tumor cells are imaged and visualized with any histologic workup — and that there is therefore an upper theoretical limit on the accuracy of the diagnosis

56
Q

What is grading?

A

assessment of level of histologic differentiation

57
Q

What is the relationship between tumor grading and tumor differentiation?

A

lesser differentiation = higher grading = more aggressive

58
Q

What are the tumor grading intervals? (2)

A

low, intermediate, or high grades

-or-

grades I-IV

59
Q

What is staging?

A

assessment of physical extent of disease/tumor spread

60
Q

What is the most common grading/staging scheme?

A

TNM system

61
Q

What is the basis of the TNM system?

A

T = size of primary (T1, T2, T3, T4)

N = regional lymph node involvement (N1, N2, N3)

M = distant metastasis (M0 [not present] or M1 [present])

62
Q

TNM combinations correspond to which five stages?

A

Stage 0

Stage I

Stage II

Stage III

Stage IV

63
Q

Describe what Stage 0 means.

A

carcinoma in situ

64
Q

Describe what Stages I-III mean.

A

more extensive disease

greater tumor size

spread of cancer to nearby lymph nodes

spread to adjacent organ

[progress from Stage I → II → III as severity increases]

65
Q

Describe what Stage IV means.

A

cancer has spread to another organ (distant metastasis)

66
Q

TNM criteria vary based on the tumor. If grading and staging are discrepant, which parameter is used to assess prognosis?

A

staging is more important — in other words, stage is a better predictor of clinical progression than grade

67
Q

Differentiate between embryonic and adult stem cells in terms of potency.

A

embryonic stem cells are totipotent

adult stem cells are multipotent

68
Q

What is a niche?

A

microenvironment composed of adult stem cell + supporting niche cells

69
Q

What is the recent hypothesis relating cancer stem cells? (2)

A

tumors harbor cancer stem cells analogous to adult stem cells

the cancer stem cells are rare undifferentiated cells that are capable of replenishing themselves and differentiating to form a tumor

70
Q

Which three signaling pathways regulate adult stem cells in normal development and tissue homeostasis?

A

Notch

WNT

hedgehog

71
Q

What is the limitation of conventional chemotherapy on cancer stem cells?

A

conventional chemotherapy cannot kill cancer stem cells because cancer stem cells mimic every cell in the body

72
Q

What is renewal?

A

formation of two daughter stem cells

73
Q

What is maintenance?

A

formation of one daughter stem cell + one differentiated cell

74
Q

What is differentiation?

A

formation of 2 differentiated cells

75
Q

The presence of keratin pearls indicates what kind of malignancy?

A

keratin pearls = squamous cell carcinoma

Tissues (23 decks)

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