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Year 2 EMS MoD > Tumour characteristics > Flashcards

Tumour characteristics Flashcards

1
Q

What is cancer?

A

The uncontrolled growth of cells, which can invade and spread to distant sites.

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2
Q

What is a tumour?

A

An abnormal swelling.

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3
Q

What is a neoplasm?

A

Lesion resulting from autonomous growth of cells that persists in the absence of the initiating stimulus.

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4
Q

What is histogenesis?

A

The differentiation of cells into specialised tissues/organs during growth from undifferentiated cells (germ layers).

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5
Q

What is the histogenic classification of tumours that arise from epithelial cells?

A

Carcinomas.

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6
Q

What is the histogenic classification of tumours that arise from connective tissue?

A

Sarcomas.

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7
Q

What is the histogenic classification of tumours that arise from lymphoid/haematopoietic organs?

A

Lymphomas / leukaemias.

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8
Q

What was the epidemiology of cancer worldwide in 2008?

A
  1. 7 million new cases.
  2. 6 million deaths.

-expected to increase

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9
Q

What causes geographical variation in specific cancers? (2)

A
  • Exposure to environmental carcinogens

- Screening programmes

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10
Q

How has the incidence of cancer changed since 1975?

A

Steady increase in incidence, slower rate now due to awareness/screening.

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11
Q

How has the mortality of cancer changed since 1975?

A

Overall decrease.

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12
Q

What are the most common cancers in males? (3)

A
  • Prostate
  • Lung
  • Colon / rectum
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13
Q

What are the most common cancers in females? (3)

A
  • Breast
  • Lung
  • Colon / rectum
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14
Q

How are tumours characterised? (4)

A
  • Differentiation
  • Rate of growth
  • Local invasion
  • Metastasis
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15
Q

Do malignant tumour tumour grow faster than benign tumours?

A

Not necessarily - many exceptions.

-rapidly-growing malignant tumours tens to be lethal faster

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16
Q

What is differentiation?

A

The extent that neoplastic cells resemble normal parenchymal cells.
-both morphologically and functionally

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17
Q

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

A
  • BENIGN - well-differentiated (resemble parenchymal cells), mitoses rare
  • MALIGNANT - wide-range of differentiation, most have morphological change
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18
Q

What does morphology mean in terms of tumours?

A

Shape/structure of cells.

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19
Q

What is aanaplasia?

A

Poor cellular differentiation, don’t resemble normal.

-usually malignant

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20
Q

What are the main morphological changes that occur in tumours? (4)

A
  • Neoplasm
  • Abnormal nuclear morphology
  • Mitoses
  • Loss of polarity
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21
Q

What is pleomorphism?

A

Variation in size/shape of cells and their nuclei.

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22
Q

List some examples of abnormal nuclear morphology. (4)

A
  • Nuclei too large for cell
  • Variable nuclear shape
  • Clumped chromatin distribution
  • Hyperchromatin
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23
Q

What is the nuclear to cytoplasmic ratio of most cells?

A

1: 4 to 1:6.

- can&raquo_space; 1:1 in tumour cells

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24
Q

What is mitoses?

A

A method of cell division, indication proliferation.

  • seen in normal tissues with high turnover rate
  • seen in malignancy
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25
Q

What are the abnormal mitotic processes seen in malignancy?

A

Tripolar, Quadripolar, etc.

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26
Q

What is loss of polarity?

A
  • Orientation of cells disturbed
  • Disorganised growth
  • nuclei move to bottom
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27
Q

What does well-differentiated mean?

A

Closely resembles normal tissue of origin.

  • little/no anaplasia
  • benign (occasionally malignant)
28
Q

What does poorly differentiated mean?

A

Little resemblance to normal tissue of origin.

-very anaplastic

29
Q

What does undifferentiated / anaplastic mean?

A

Very poor differentiation, cannot be identified by morphology alone.
-molecular techniques required

30
Q

What is grade a measure of?

A

How well differentiated a tumour is.

  • 1/low = well differentiated
  • 3/high - poorly differentiated
31
Q

What is stage a measure of?

A

The severity and prognosis of a disease.

32
Q

What does better differentiation lead to?

A

Better retention of normal function.

33
Q

What are the main features of endocrine tumours? (3)

A
  • Benign and well-differentiated
  • Often secrete hormones characteristic of origin
  • Increased hormone levels can be used for diagnosis
34
Q

What is local invasion?

A

When tumours spread to healthy tissue immediately surrounding them.

35
Q

What are the invasive features of benign tumours? (2)

A
  • Localised to site of origin

- No capacity to infiltrate / invade / metastasise

36
Q

What are the invasive features of cancerous tumours? (3)

A
  • Infiltration
  • Invasion
  • Destruction
37
Q

What is encapsulation in relation to benign tumours?

A

Rim of compressed fibrous tissue surrounds benign tumours.

-ECM is deposited by stromal cells activated by hypoxia

38
Q

What is the tissue plane of a benign tumour?

A

Moveable, easily palpable and easily excised.

-due to capsule

39
Q

What often surrounds malignant tumours?

A

Pseudo-encapsulation.

-slow-growing, rows of cells penetrate margin

40
Q

Why is surgical resection of malignant tumours often difficult?

A

Often penetrate organ surfaces and invade.

- requires resection of adjacent normal tissue

41
Q

What is metastasis?

A

The spread of tumour to sites physically discontinuous with primary tumour.
-indicates malignancy

42
Q

Do benign tumours metastasise?

A

No.

43
Q

What proportion of non-skin malignancies have metastasised at diagnosis?

A

30%.

44
Q

What are the general features of tumours that have metastasised? (4)

A
  • Lack of differentiation
  • Local invasion
  • Rapid growth
  • Large size
45
Q

What are the main pathways for metastasis? (3)

A
  • Direct seeding
  • Lymphatic spread
  • Haematogenous spread
46
Q

What are the general features of metastasis due to direct seeding?

A

Neoplasm penetrates an open field, without physical barriers (e.g. peritoneal cavity, joint spaces).
-can remain confined to surfaces without penetrating

47
Q

Give an example of a malignancy in the abdomen that spreads via direct seeding?

A

Pseudomyxoma peritonei.

-often spreads before penetrating bowel wall

48
Q

What are the main features of lymphatic spread?

A
  • Tumours spread within lymphatic vessels

- Follows route of lymphatic drainage

49
Q

How does breast cancer spread, and where does it normally spread to first?

A

Via the lymphatic system.

-axillary nodes first

50
Q

What is the sentinel node?

A

The first lymph node that receives flow from the primary tumour.

51
Q

How are sentinel nodes identified?

A

Injection of tracers / coloured dyes.

52
Q

What are regional lymph nodes?

A

A lymph node that drains lymph from the region around the tumour.

53
Q

How are regional lymph nodes used to prevent further tumour spread?

A

Tumour cells stop within regional nodes and can be destroyed by a tumour-specific immune response.

54
Q

What type of tumour is haematogenous spread more common in?

A

Sarcomas.

-also seen in carcinomas

55
Q

What type of blood vessels are more easily penetrated by tumours?

A

Veins.

-thinner walls

56
Q

Where do tumour often metastasise to via haematogenous spread?

A

First encountered capillary bed.

-liver (portal) and lungs (caval) are most common

57
Q

How does the rate of growth differ between malignant and benign tumours?

A

Benign tumours tend to be slow-growing, malignant tend to be faster.
-variable

58
Q

What is a stroma?

A

Connective tissue framework that neoplastic cells (and organs) are embedded in.

59
Q

What 3 things does a stroma provide?

A
  • Mechanical support
  • Intercellular signalling
  • Nutrition
60
Q

What is a desmoplastic reaction?

A

Fibrous stroma formation around the tumour due to induction of connective tissue fibroblast proliferation by growth factors.

61
Q

What do stroma surrounding tumours contain?

A
  • Cancer-associated fibroblasts
  • Myofibroblasts
  • Blood vessels
  • Lymphocytic infiltrate
62
Q

What are the main types of clinical complications of tumours? (3)

A
  • Local
  • Metabolic
  • Due to metastases
63
Q

What are the local clinical complications of tumours?

A
  • Compression (displacement of surrounding structures)

- Destruction (invasion)

64
Q

What is thyrotoxicosis?

A

Hyperthyroidism.

-well differentiated, large tumour&raquo_space; increase thyroid hormones

65
Q

What are non-specific metabolic effects of tumours?

A
  • Cachexia (weight loss)
  • Warburg effect
  • Neuropathies
  • Myopathies
  • Venous thrombosis
66
Q

What is the Warburg effect?

A

Cancer cells predominantly produce energy by a high rate of glycolysis followed by lactic acid fermentation.
-increased glucose uptake on scan

Year 2 EMS MoD (20 decks)

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