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Pathological Processes > 8. Neoplasia 1 & 2 > Flashcards

8. Neoplasia 1 & 2 Flashcards

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1
Q

Define neoplasia

A

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

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2
Q

Define dysplasia

A

Abnormal maturation of cells within a tissue - disordered. Preneoplastic.

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3
Q

What is a malignant neoplasm?

A

Cancer - abnormal growth of cells that persists after initial stimulus is removed…and invades surrounding tissue with potential to spread to distant sites.

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4
Q

What is the difference between a benign neoplasia and a malignant neoplasm?

A

Benign remain at site of origin

Malignant have metastasise potential

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5
Q

What does anaplastic mean and when is it seen?

A

No resemblance of tissue, in very poorly differentiated cancers cells.

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6
Q

How would you expect a benign neoplasm to look macroscopically?

A

Pushing outer margin

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7
Q

How would you expect a malignant neoplasm to look macroscopically?

A

Irregular outer margin
Ulceration
Necrosis

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8
Q

How would you expect benign and malignant tumours to differ microscopically?

A

Benign - well-differentiated

Malignant - worsening differentiation, anaplasia

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9
Q

What is an in situ malignancy, how does it differ from invasive?

A

In situ = no invasion of basement membrane

Invasive = penetrated basement membrane

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10
Q

What does the grade of a tumour measure?

A

Differentiation

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11
Q

What 3 things are considering when determining the grade of a tumour?

A

Nuclear size
Nuclear:cytoplasmic ratio
Mitotic figures

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12
Q

What will a high grade tumour look like?

A 
Poorly differentiated.
Large nuclei
High NC ratio
Hyperchromasia (increased nuclear staining)
More mitotic figures
Pleomorphic
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13
Q

What is another name for mutagenic agents.

A

Initiators

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14
Q

In addition to initiators, what else is required to cause neoplasia?

A

Promotors over a period of time

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15
Q

What type of expansion is seen in neoplasia?

A

Monoclonal - from same founding cell

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16
Q

Why might some mutations have no effect?

A

Non-coding regions, unimportant genes

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17
Q

What is an example of an internal promotor?

A

Inflammation

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18
Q

What is progression?

A

The accumulation of further mutations which leads to the emergence of a neoplasm from monoclonal population

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19
Q

Which genes become abnormally activated in neoplasms?

A

Proto-oncogenes

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20
Q

Which genes become inactivated in neoplasms?

A

Tumour suppressor genes

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21
Q

Which genes only require one allele to be affected in order to promote neoplasia?

A

Proto-oncogenes - one allele activate will be enough to drive the cell cycle and promote growth

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22
Q

If one allele of a TSG is mutated, what effect will it have?

A

None. Both alleles must be inactivated in order to result in increased growth.

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23
Q

What is an adenoma?

A

benign glandular neoplasm

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24
Q

What is a papilloma?

A

Benign neoplasm of squamous epithelium- skin and mucosa

Finger-like projections

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25
What is an adenocarcinoma?
Cancer of glandular tissue
26
What 3 steps must a tumour go through in order to metastasise?
1. Grow and invade at primary site 2. Enter a transport system and lodge at a secondary site 3. Grow at the secondary time to form a new tumour
27
Explain why the process is inefficient?
Many cancer cells are destroyed in the blood stream by shear forces while others reach the secondary site but are unable to grow there.
28
What 3 important alterations are needed for tumour invasion?
1. Altered adhesion 2. Altered proteolysis 3. Altered motility
29
What is the name given to the process which changes a carcinoma phenotype to appear like a mesenchymal cell?
Epithelial-to-mesenchymal transition (EMT)
30
Explain how adhesion alters in a cancer cell to promote metastases.
Reduction in E-cadherin expression (cell-cell) and changes in integrin expression (to stroma)
31
Which protease is expressed by cancer cells to degrade basement membranes and stroma?
Matrix metealloproteinases (MMPs)
32
What is a cancer 'niche' and how can it be advantageous to the cancer cells?
The cancer cells take advantage of nearly non-neoplastic cell types which produce some growth factors and proteases.
33
What protein is involved in increasing motility of cancer cells?
Actin
34
What are the 3 transport routes for cancer cells?
1. Blood vessels via capillaries and venues 2. Lymphatic vessels 3. Transcoelomic spread in body cavities - pleura,peritoneal,pericardial
35
What is colonisation?
Growth at a secondary site to form a metastasis.
36
What are micro-metastases and why are they significant?
Surviving microscopic deposits of cancer cells that fail to grow at secondary site, are sub-clinical and not detected in scans. = tumour dormancy, can initiate relapse years later
37
What 3 factors are thought to help micro-mets remain dormant?
Immune attack Reduced angiogenesis Hostile secondary site
38
What 2 theories are there which explain the secondary site of a metastasis?
1. Regional drainage | 2. 'Seed and soil' phenomenon
39
According to regional drainage, where are blood-borne metastasis likely to spread to?
The next capillary bed that the cells encounter - lung and liver
40
According to regional drainage, where are lymphatic metastasis likely to end up?
Local lymph nodes
41
Where are cancers that spread by transcoelemic spread likely to end up?
Other areas in the coelomic space or adjacent organs
42
What is the 'seed and soil' phenomenon?
The site of metastasis is due to interaction between malignant cells and the local tumour environment (niche) at the secondary site.
43
Which cancers spread to lymphatics first?
Carcinomas
44
Which cancers spread via the blood stream?
Sarcomas
45
What are the common sites of blood borne metastasis?
Lung, bone, liver and brain
46
Which neoplasms most frequently metastasise to bone?
Thyroid, Kidney, Lung, Prostate and breast
47
Which type of lung cancer is very aggressive and tend to metastasise very early?
Small cell bronchial carcinoma
48
Which skin cancer almost never metastasises?
Basal cell carcinoma
49
What are the local effects of neoplasms (both benign and malignant)?
- Pressure/compression - Invasion and destruction - Ulceration and bleeding - Obstruction/blocking of tubes and orifices
50
What are paraneoplastic syndromes?
Systemic effects of neoplasms
51
What are the main categories of systemic effects of neoplasms?
- Tumour burden - Endocrine - Haematological - Neurological - Dermatological - General
52
What is tumour burden?
Increased number of cancer cells results in increased number of metabolically active cells and has a parasitic effect on the host.
53
What symptoms can an increased tumour burden lead to?
reduced appetite, cachaxia, malaise, immunosuppression, thrombosis
54
Which tumours typically produce hormones?
Benign neoplasms of endocrine glands as they are well differentiated
55
Give an example of a malignant tumour that is known to secrete hormones.
Bronchial small call carcinoma may secrete ACTH and ADH
56
What is exophytic growth?
Growth outwards e.g protruding into lumen
57
What is endophytic growth?
Growth inwards e.g proliferating in the interior of an organ
58
Why are polyps removed?
tend to benign adenoma's initially but demonstrate dysplastia so can accumulate mutations to progress to a carcinoma.
59
What is a common tumour of the uterus smooth muscle cells of the myometrium?
Fibroid
60
At what age do osteosarcoma's commonly present?
Teenagers (<20)
61
What is a teratoma, why does it contain such a range of tissues?
Germ cell tumour - arises from all 3 germ cell lines: ectoderm, endoderm and mesoderm.
62
How do ovarian and testicular teratomas behave differently?
Ovarian tend to be benign, testes tend to be more malignant
63
What are common tumours of soft tissue?
Lipomas and leiomyomas
64
What are malignant tumours of soft tissue referred to as?
Sarcomas
65
Which organ is recognised as a site of metastasis from gastric cancer?
Ovaries
66
What hormone can testicular teratomas produce?
HCG

Pathological Processes (12 decks)

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