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Anatomic And Molecular Pathology > Neoplasia-Overview of Cancer and Carcinogenesis > Flashcards

Neoplasia-Overview of Cancer and Carcinogenesis Flashcards

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1
Q

Briefly describe:

  1. Hyperplasia
  2. Metaplasia
  3. Dysplasia
A

Hyperplasia- excessive proliferation of cells due to a stimuli

Metaplasia- replacement of one mature epithelium type with a more resistant type due to chronic irritation

Dysplasia- loss of uniformity of individual cells and architectural orientation

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2
Q

What are the differences and similarities between hyperplasia and neoplasms❓

A 
Differences:
Hyperplasia:
•follows normal stimuli
•Growth : Degree of stimulation
•Regress with cessation of stimulation 
•eg endometrial hyperplasia (⬆️estrogen)

Neoplasm:
•spontaneous
•growth without stimulus
•continues indefinitely

Similarities:

  1. Both involve cellular proliferation
  2. Sites of excessive mitosis often serve as fertile soil for genetic mutation
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3
Q

Give a few examples of metaplasia stating:

  1. Location
    a. Normal epithelium
    b. Metaplasic epithelium
    c. Cause
A
  1. Bronchus
    a. Pseudostratified ciliated columnar
    ⬇️
    b.Squamous
    c. Cigarette smoking
  2. Oesophagus
    a. Squamous
    ⬇️
    b. Columnar mucous with goblet cells(Barrett’s)
    c. Reflux
  3. Stomach
    a. Simple columnar
    ⬇️
    b. Intestinal with goblet cells
    c. H. pylori
  4. Urinary bladder
    a. Transitional epithelium
    ⬇️
    b. Squamous
    c. Stones, schistosoma infection
  5. Cervix
    a. Simple columnar
    ⬇️
    b. Squamous
    c. HPV, low PH
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4
Q

Metaplasia and dysplasia may be premalignant.

True or false

A

True

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5
Q

What features do dysplasia and neoplasia have in common❓

A
  • Disorderliness
  • ⬆️nucleocytoplasmic ratio
  • Enlarged hyperchromatic nuclei
  • Pleomorphism
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6
Q

The 3 grades of dysplasia include❓

A
  1. Mild
    •lower 1/3rd of epithelium
    •Reversible
  2. Moderate
    •lower 2/3rd of epithelium
    •May be reversible
  3. Severe
    •full thickness of epithelium
    •irreversible
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7
Q

List a few tumors that start with dysplasia

A 
Bronchus 
Urinary bladder 
Cervix 
Vulva
Penis
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8
Q

List a few pre-neoplastic lesions you know and their malignancy

A

PML: Bronchial dysplasia
M: Carcinoma

PML: Leukoplakia➡️Erythroplakia
M: Squamous cell carcinoma

PML: Dysplasic squamous papilloma
M: Squamous cell carcinoma

PML: Chronic atrophic gastritis
M: Gastric carcinoma

PML: Chronic ulcerative gastritis
M: Adenocarcinoma

PML: cervical dysplasia
M: Squamous cell carcinoma

PML: Endometrial hyperplasia
M: Endometrial carcinoma

PML: Liver cirrhosis
M: Hepatocellular carcinoma

PML: Solar keratosis
M: SCC of skin

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9
Q

Define “neoplasm”

A
  • Abnormal mass of tissue
  • Growth exceeds and is uncoordinated with that of normal tissues
  • Persists in the same excessive manner after cessation of stimuli
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10
Q

The 5 properties of a neoplastic mass

A
  • Autonomous
  • Parasitic
  • Purposeless
  • Progressive
  • Benign/Malignant
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11
Q

Define cancer

A
  • Overgrowth of cells
  • Acquired cumulative of genetic damage
  • which confers growth advantage over normal cells
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12
Q

Malignant cells have three important features

List them

A
  • Immortality
  • Invasion
  • Metastasis
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13
Q

What are the differences between normal and malignant cells❓

A 
In malignant cells:
•🚫Contact inhibition 
•⬆️Growth factor secretion 
•⬆️oncogene expression 
•🚫tumor suppressor genes
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14
Q

Cancer is among the 3 leading causes of death in developing counties

True or false

A

True

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15
Q

The five most common cancers in Nigeria include:

A
  1. Breast- 26.7%
  2. Cervix- 13.8%
  3. Liver- 11.8%
  4. Prostate- 11.7%
  5. Colorectal- 4.1%
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16
Q

List the common childhood cancers

A
  1. Burkitt’s lymphoma
  2. Retinoblastoma
  3. Nephroblastoma
  4. Sacromas
  5. Leukaemias
  6. Neuroblastomas
  7. Rhabdomyosarcoma
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17
Q

Tumors are classified based on behavior (benign or malignant) or based on its cell if origin

True or false

A

True

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18
Q

The difference between a benign and a malignant tumor is based on:

  1. Spread
  2. Growth rate
  3. Boundaries
  4. Relations
  5. Effects

Briefly draw contrasts

A
  1. Spread:
    B: localized
    M: Metastasize
  2. Growth rate:
    B: Slow
    M: Rapid
  3. Boundaries:
    B: Circumscribed and encapsulated
    M: Irregular, ill-defined, no capsule
  4. Relations:
    B: Compresses
    M: Invades and destroys
  5. Effects:
    B: pressure effect
    M: Destroys➡️Death
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19
Q

Tumors can be classified broadly into:

Benign epithelial
Malignant epithelial
Benign mesenchyma
Malignant mesenchyma

True or false

A

True

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20
Q

Benign tumors are generally named by attaching -oma to the cell of origin.

True or false
Give examples of benign mesenchyma tumors

A

True

Fibroma
Osteoma 
Lipoma 
Haemagioma (blood vessel)
Lymphangioma 
Chondroma
Meningioma
Neuroma 
Leiomyoma (smooth muscle)
Rhabdomyoma (skeletal muscle)
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21
Q

Benign tumors are generally named by attaching -oma to the cell of origin.

True or false
Give examples of benign epithelial tumors

A

True

  • Papilloma- raised above an epithelial surface
  • Adenoma- forms glandular structures (parenchymal organs)
  • Cystadenoma- forms glands and cystic spaces
  • Nevus- benign tumor of melanocytes
  • Trophoblastic tumor- hydratidiform mole (placenta)
  • Polyps- in hollow organs, raised above mucosa
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22
Q

Malignant mesenchymal tumors are generally referred to as❓

List a few that you know

A

Sarcomas

Liposarcoma 
Osteosarcoma 
Chondrosarcoma
Haemangiosacroma/Angiosacroma 
Leiomyosacroma 
Fibrosarcoma
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23
Q

Malignant epithelial tumors are generally referred to as❓

List a few that you know

A

Carcinomas

Adenocarcinoma
Squamous cell carcinoma
Melanocarcinoma/Melanomas
Choriocarcinoma (placenta)

*organ of origin should be specified eg SCC of cervix

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24
Q

Mixed tumors are tumors that have more than one neoplastic cell type.

List some examples

A

Pleomorphic adenoma of salivary gland (epithelial and mesenchymal components)

Fibroadenoma of breast (glandular epithelial and fibrous components)

Wilm’s Tumor of kidney (malignant) commonly affecting children

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25
The difference between a carcinoma and a sarcoma is based on: 1. Cell type 2. Stroma 3. Spread 4. Metastasis 5. Hemorrhage and necrosis 6. Fatality Briefly draw contrasts
1. Cell type: C: Epithelial S: Mesenchymal 2. Storma: C: Abundant S: Scanty, fleshy 3. Spread: C: Lymphatics 1st S: Blood 1st 4. Metastasis: C: Late S: Early 5. Hemorrhage and necrosis: C: Less frequent S: Frequent 6. Fatality: C: Relatively less S: more fatal
26
What is a choriostoma❓ Is it a true tumor❓
An ectopic rest of normal tissue in an abnormal location No
27
What is a harmatoma❓ Is it a true tumor❓
A mass of disorganized but mature specialized cells indigenous to the site No
28
Seminomas (of the testis) and melanomas are benign tumors True or false
False
29
1. A teratoma is a... 2. What are the common site of teratomas❓ 3. What is a monodermal teratoma called❓
1. •Tumor with >1 neoplastic cell •Derived from >1 germ cell layer •Arise from totipotential cells in the gonads or in embryonic cell rests •Can be mature/benign or immature/malignant 2. Ovary/Testes Mediastinum Sacrococcygium 3. Struma ovarii
30
What are the differences between a benign and a malignant teratoma❓
Tumor components: B: mature, well-differentiated structures M: primitive, undifferentiated structures Grossly: B: Cystic M: Solid Prognosis: B: Good M: fatal outcome
31
Cancer risk increases with age True or false
True
32
H. pylori predisposes one to❓
Gastric adenocarcinoma Mucosal associated lymphoid tissue, MALT lymphoma
33
What microorganism predisposes an individual to hepatocellular carcinoma❓
Hepatitis B/C virus
34
What microorganism predisposes an individual to cervical cancer❓
Human papilloma virus
35
An infection by Epstein Barr virus could lead to which neoplasms❓
Nasopharyngeal carcinoma Burkitt’s lymphoma
36
An infection by HIV could lead to which neoplasms❓
High grade B cell lymphoma
37
An exposure to schistosoma haematobium could lead to ❓
Squamous cell carcinoma of the urinary bladder
38
Exposure to benzene commonly leads to what neoplasm❓
Leukaemia
39
Aniline dyes used in rubber industries could lead to what type of cancer❓
Bladder cancer
40
Ultraviolet and X-ray exposure can lead to❓
Cancer of the: 1. Skin 2. Breast 3. Thyroid
41
Cancer of the lungs can be due to exposure to pollution from burning fuels True or false
True
42
Intake of tobacco can lead to which cancers❓
``` Mouth Lungs Breast Stomach Pancreas Cervix ```
43
Alcohol intake can lead to which cancers❓
Breast Stomach Liver
44
An overweight or obese individual may come down with what type of neoplasms❓
``` Esophagus Breast Colon Kidney Uterus cancers ```
45
Early exposure to sex could predisposed an individual to cancer of the cervix True or false
True
46
Having multiple sexual partners is a rush factor for which cancers❓
Cervix (HPV) | Liver (HBV)
47
Colorectal cancers could be contributed to by high animal protein and fat diet True or false
True
48
Aflatoxin from Aspergillus flavus commonly seen in poorly preserved grains like groundnuts are associated with which cancer❓
Hepatocellular carcinoma (HBV)
49
List factors that could predispose an individual to cervical cancer
``` Multiple sex partners Early exposure to sexual partners Smoking Poverty Immune deficiency (HIV) Poor nutrition Lack of micronutrients ```
50
List factors that could predispose an individual to prostrate cancer
``` ⬆️serum androgen levels Black race >40 years +ve family history Obesity ⬆️fat diet ```
51
List the inherited cancer syndromes that you know
Retinoblastoma Familial adenomatous polyposis Neurofibromatosis Multiple endocrine neoplasm (MEN)
52
List the familial cancers that you know
Breast Colon Ovary Brain
53
Autosomal recessive syndromes of defective DNA repair include:
Ataxia talengiectasia Xeroderma pigmentosum Bloom’s syndrome Fanconi anemia
54
What are the diagnostic methods for tumors❓
1. Histology (paraffin/frozen section) 2. Cytology (FNAC, Pap smear effusions) 3. Immunocytochemistry 4. Molecular (oncogenes) 5. Flow cytometry 6. Tumor markers
55
The prevention of cancer includes:
Primary: •Lifestyle modification •Vaccination against infectious agents ``` Secondary: •Early detection- BSE (breast self examination) Clinical breast examination (1-3yrs age20-39) Mammography screening (annually >40) ``` Prophylaxis Prompt treatment
56
A pap smear should be done annually in women >18yrs or with commencement of sexual activity True or false
True
57
A pap smear should be done mid cycle or second half of the cycle True or false
True
58
No sexual intercourse or douching should occur 24hours before a pap smear True or false
True
59
The HPV/DNA testing should be done for women in what age group❓ A -ve HPV/DNA testing can be repeated after❓
30years of age 5-10years
60
What screening options are available for prostate cancer❓
Digital rectal exam Prostrate Specific Antigen test
61
Characteristics of neoplasms include:
Differentiation/anaplasia Rate of growth Local invasion Metastasis
62
What is differentiation in this context❓
Microscopic resemblance of a tumor to normal cells morphologically and physiologically
63
Anaplasia is a lack of differentiation, hence a poorly differentiated tumor is probably malignant True or false
True
64
A poorly differentiated tumor or an anaplasic tumor is also known as a high grade tumor True or false
True
65
What is a low grade tumor❓ A high grade tumor is❓
A well differentiated tumor A poorly differentiated tumor
66
Will a well differentiated tumor retain its functions❓
Yes. | Or unanticipated functions emerge.
67
What are the histologic features of malignant tumors❓
1. Pleomorphism 2. Hyperchromatism 3. ⬆️nucleocytoplasmic ratio 4. Coarsely clumped chromatin 5. Large, multiple, prominent nucleoli 6. Mitoses (bizarre and numerous) 7. Tumor giant cells 8. Disorderliness/disorientation
68
Most benign tumors are encapsulated except❓
Haemangioma
69
Some malignant tumors may have a pseudocapsule. Give an example
Wilm’s Tumor
70
Metastasis is an important hallmark of malignancy except in ❓
Basal cell carcinoma of skin Malignant glial tumors of the brain
71
1. What are the most common sites of metastasis❓ | 2. What is the most uncommon site of metastasis❓
``` 1. Lungs Liver Bone Brain Kidney ``` 2. Spleen
72
Metastatic cascade is broadly divided into❓
Invasion of extracellular matrix Vascular dissemination and homing of tumor cells
73
Describe the metastatic cascade that occurs in cells that acquire a metastatic potential.
🚫Ability to adhere to each other (get detached) ⬆️Ability to adhere to BM and ECM Degradation of ECM Migration through the ECM Cells form aggregates within vessels Migrate through BM of secondary site Formation of tumor emboli at secondary sites
74
What does a “grade” mean❓
Level of microscopic resemblance of tumor cells to normal similar cells of origin
75
Prostatic carcinoma is graded using❓
Gleason’s system
76
SCC of cervix is graded using❓
Extent of keratin formation
77
How are tumors graded❓
Grade I- Well differentiated Grade II- Moderately differentiated Grade III- Poorly differentiated Grade IV- Nearly anaplastic
78
Staging refers to❓
Extent of tumor spread based on: Size of primary tumor +/-lymphatic spread +/-distant blood borne metastasis
79
The two systems used in staging cancers are❓
``` 1. TNM: Tumor size [0-4] Node [0-3] Distant metastasis [M0/M1] ``` 2. AJC: I-IV
80
Tis stage of a cancer depicts❓
Carcinoma in-situ Tumor limited to the epithelium
81
T2 stage of a cancer depicts❓
Larger, more invasive within the primary organ site
82
T3 stage of a cancer depicts❓
Larger and/or invasive beyond margins of primary organ site
83
N1 N2 N3 stages of cancer depict❓
N1: regional lymph node involvement N2: extensive lymph node involvement N3: More distant lymph node involvement
84
Carcinogenesis refers to❓
Malignant transformation of normal cells by carcinogenic agents (physical, chemical or microbiological)
85
1. Give some examples of physical carcinogens you know 2. What are their effects❓ 3. What cancers could be involved❓
``` 1. Ionization radiation X-ray Radiotherapy UV light Atomic energy ``` 2. Chromosomal changes in cell mutation ``` 3. Melanocarcinoma Basal cell ca SSC of Skin Leukemia Thyroid Breast ```
86
Chemical carcinogens can be: 1. Direct acting 2. Indirect acting 3. Promoters Describe the mechanisms of these three categories in carcinogenesis
1. •Electrophylic region easily forms covalent bonds with DNA •eg alkylating agents like anti cancer drugs 2. •Have to be converted to active metabolites in the liver •eg polycyclic hydrocarbon in the cigarette Beta-naphthylamine in anyline dye 3. Aflatoxin B1
87
The general sequence of chemical carcinogens include:
1. Initiation- DNA alteration and subsequent cell division (mitosis) 2. Promotion- proliferation of initiated cell at the expense of normal cells 3. Effect: progression/dormancy/regression
88
1. An exposure to arsenic could to lead to what cancer❓ | 2. Who are the people most exposed to it❓
1. Lung Liver Skin 2. Mining Pesticide workers
89
1. An exposure to asbestos could to lead to what cancer❓ | 2. Who are the people most exposed to it❓
1. Lung Mesothelioma 2. Construction workers
90
1. An exposure to benzene could to lead to what cancer❓ | 2. Who are the people most exposed to it❓
1. Leukemia 2. Petroleum Rubber Chemical workers
91
1. An exposure to chromium could to lead to what cancer❓ | 2. Who are the people most exposed to it❓
1. Lung 2. Metal workers Electroplaters
92
1. An exposure to leader dust could to lead to what cancer❓ | 2. Who are the people most exposed to it❓
1. Nasal Bladder cancers 2. Shoe manufacturers
93
1. An exposure to naphthylamine could to lead to what cancer❓ 2. Who are the people most exposed to it❓
1. Bladder 2. Dye Rubber Chemical workers
94
1. An exposure to radon could to lead to what cancer❓ | 2. Who are the people most exposed to it❓
1. Lung 2. Underground mining
95
1. An exposure to soot, tars and oils could to lead to what cancer❓ 2. Who are the people most exposed to it❓
1. Lung Liver Skin 2. Coal Gas Petroleum workers
96
1. An exposure to vinyl chloride could to lead to what cancer❓ 2. Who are the people most exposed to it❓
1. Liver 2. Rubber PVC manufacturing
97
1. An exposure to wood dust could to lead to what cancer❓ | 2. Who are the people most exposed to it❓
1. Nasal 2. Furniture making
98
Tumors are monoclonal True or false❓ What does this mean❓
True A tumor mass results from a clonal expansion of a single progenitor cell that has incurred genetic change
99
The targets of mutation include❓
Tumor promoter Tumor suppressor Apoptotic genes DNA repair genes
100
An infection by what virus can cause a T-cell leukemia❓
HTLV-1
101
What organism predisposes an individual to cholangiocarcinoma❓
Liver fluke
102
What are proto-oncogens❓
Normal constituents of the cell that promote normal cell growth and differentiation They are also known as tumor promoters
103
What are oncogenes❓
* Gene sequences that can transform normal cell to cancer cells * Derived from proto-oncogenes * Produce onco-proteins (growth factors, membrane products and proteins that control growth and differentiation)
104
Are tumor promoters dominant or recessive❓ What does this mean❓
Dominant Only one mutant allele of the gene need to be present to cause transformation
105
What could lead to the conversion of proto-oncogenes➡️oncogens❓
•Point mutations: ras •Translocation: c-myc in Burkitt’s lymphoma c-abl in CML •Amplification: n-myc in neuroblastoma c-erb in breast carcinoma
106
Are tumor suppressor dominant or recessive❓ What does this mean❓ Abnormalities that can lead to cancer are❓
Recessive Two alleles of the gene must be damaged to transform cells Deletion or inhibition
107
Give examples of the antioncogens you know
Rb p53 APC NF-1, NF-2 BRCA-1, BRCA-2 WF-1 genes
108
Apoptotic genes may be dominant or recessive. A deletion of an apoptotic gene may lead to cancer. True or false Give examples
True p53 c-myc bcl-2 gene in b-cell lymphoma
109
1. DNA repair genes are the care-taker genes. 2. Are they dominant or recessive❓ 3. Inactivation of these genes with lead to❓ 4. Give a few examples
1. Recessive 2. Both alleles must be lost to induce genomic instability 3. Increased mutation of all other genes including those that control cell division 4. BRCA-1, BRCA-2 in breast ca MLH1, MSH2 mutation in HNPCC
110
List some effects of malignant tumors on the host
Compression eg pituitary adenoma on optic chaism Functional activity eg insulinoma Hemorrhage Secondary infection Infarction/Rupture Cancer cachexia Paraneoplastic syndrome
111
What are paraneoplastic syndromes❓ Classify them
A symptom complex that occurs in a cancer patient that cannot be explained by local/distant spread of the tumor ``` Endocrinopathies Dermatological Nerve and muscle Bone and joint Vascular/heamatological ```
112
1. Cushing’s syndrome is a paraneoplastic syndrome that may be observed in which carcinomas❓ 2. What is it’s feature❓
1. Small cell ca of the lungs Pancreatic carcinoma Neural tumors 2. Secretion of ACTH-like substances
113
1. Paraneoplastic Syndrome of Hyponatrimia may be a complication of which cancers❓ 2. What is it’s feature❓
1. Small cell ca Intracranial tumors 2. Inappropriate ADH secretion
114
1. Paraneoplastic Syndrome of Hypoglycemia may be a complication of which cancers❓ 2. What is it’s feature❓
1. Fibrosarcoma HCC 2. Insulin-like substances
115
1. Carcinoid syndrome is a paraneoplastic syndrome that may be a complication of which cancers❓ 2. What is it’s feature❓
1. Bronchial adenoma (carcinoid) Pancreatic ca Gastric ca ``` 2. Secretion of: Serotonin Bradykinin Histamine ```
116
1. Paraneoplastic Syndrome of Hypercalcaemia may be a complication of which cancers❓ 2. What is it’s feature❓
1. Squamous cell carcinoma ``` 2. Secretion of: •Parathormone-like substance •IL-1 •TNF-alpha •TGF-alpha ```
117
1. Paraneoplastic Syndrome of Polycythemia may be a complication of which cancers❓ 2. What are their features❓
1. Renal cell ca HCC Cerebellar haemangioma 2. Erythropoietin

Anatomic And Molecular Pathology (14 decks)

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