Neoplasms Flashcards

1
Q

What is a neoplasm?

A

Is composed of cells that grow in a poorly regulated manner.
There is a failure of the normal mechanisms that control cellular proliferation

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2
Q

What is Anaplasia?

A

Totally undifferentiated neoplastic parenchyma
Biochemically, anaplastic cells resemble other anaplastic cells more than they do their tissue of origin.

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3
Q

What is Hamartoma?

A

Is a benign, focal malformation that resembles a neoplasm in the tissue of its origin. This is not a malignant tumour, and it grows at the same rate as the surrounding tissues. It is composed of tissue elements normally found at that site, but which are growing in a disorganized mass.

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4
Q

What are the 2 types of neoplasm?

A

Benign
Malignant

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5
Q

What is a benign neoplasm?

A

The margins of the tumour are well defined
The neoplasm only grow locally
Tend to have a good prognosis
Cells are not cancerous and won’t spread

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6
Q

What is a Malignant neoplasm?

A

Margins of the tumor are poorly defined
The neoplastic cells grow into, and destroy the surrounding tissues
A major cause of mortality
Cells are cancerous and can spread to other organs

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7
Q

How do neoplastic cells form?

A

Normally,
following cell division from a stem cell or precursor cell, normal cells will assume a specific function > known as differentiation.

Neoplastic Cells however,
will fail to achieve a highly differentiated state (seen in histology).

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8
Q

How do benign neoplasms cells change?

A

These cells are differentiated, but correspond fairly closely from which cells they were derived.

This can mean that functional attributes (from the original tissue) may remain e.g. a benign tumour still secretes hormones which has endocrinological effects.

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9
Q

What are Well Differentiated Malignant Neoplasm?

A

the neoplastic cells closely resemble the original tissues.

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10
Q

What are Poorly Differentiated Malignant Neoplasm?

A

the neoplastic cells show only a passing resemblance to the original tissues.

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11
Q

What are Anaplastic Malignant Neoplasm?

A

Not possible to identify the cell origin on a morphological observation.

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12
Q

Do benign tumours grow fast or slow?

A

Slow

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13
Q

Do benign tumours compress local tissues?

A

Yes

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14
Q

What is the growth of a malignant tumour?

A

Most significant > growth is not confined to one space, and grows into adjacent tissues, termed invasion.
As they invade local tissues, cause damage & destruction.

Most sinister property, of a malignant tumour is when the primary tumour becomes detached and moves to another part of the body
this is called METASTASES.
Just like the primary, metastases will grow into local tissue and cause tissue destruction.

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15
Q

If neoplastic cells are to grow, they must obtain what?

A

adequate nutrient by developing an adequate set of support tissues

In particular, they require an adequate vascular supply.

The ability for a tumour to induce and maintain a vascular supply is a key factor in its growth.

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16
Q

Growth of a Neoplasm is determined by different factors. What are they?

A

Vascularity
& therefore the adequacy of nutrient supply to the tumour
If cell proliferation exceeds cell death

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17
Q

Primary malignancy can metastasize in 4 main ways. What are they?

A

Local Invasion
Lymphatic spread
Vascular Spread
Transcoelomic Spread

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18
Q

What is local invasion?

A

most common pattern; spread of tumour into adjacent tissue. Can also spread along natural tissue planes e.g. nerves

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19
Q

What is lymphatic spread?

A

Frequently will spread via draining lymphatic vessels & are conducted to local lymph nodes where they grow as secondary tumours.

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20
Q

What is Vascular spread?

A

Tumour can spread via the veins draining the primary lesion.
GI tumours are frequently conducted via the portal vein, giving rise to mets in the liver.
Tumor cells that enter systemic veins most frequently spread to the lung, bone marrow, brain & adrenal glands.

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21
Q

What is Transcoelomic Spread?

A

Primary tumors in the abdominal cavity or the thorax can spread directly across coelomic spaces e.g. the peritoneal or pleural cavities.

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22
Q

True or False. Neoplastic Cells have to acquire special attributes to invade & metastasize.

A

True

Within a primary tumor, it is likely that only a proportion of cells acquire these attributes by developing additional genetic mutations as part of their further abnormalities in cell growth.
To grow through the basement membrane into the extracellular matrix & then enter a vessel
neoplastic cells must express surface molecules for adhesion.

To grow into adjacent tissues & vessels,
they must be able to be motile and capable of migration

Once the neoplastic cell is anchored to the basement membrane,
it secretes enzymes which are able to degrade extracellular matrix  this appears to be an important factor in metastasis.

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23
Q

A patient with a neoplasm, will frequently have systemic symptoms; the most frequent being?

A

Unexplained Weight Loss
Loss of appetite
Fever
General Malaise
Anaemia

The cause of these symptoms are uncertain, but it is believed to be due to the effects of secreted cytokines such as Tumour Necrosis Factor and IL-1  these are released from inflammatory cells present in tumour areas.

24
Q

What is CACHEXIA?

A

Unintentional weight loss

25
Q

Malignant tumours often lead to the death of a patient, main reasons being?

A
  1. CACHEXIA and the development of poor nutrition from the effects of widespread metastases.
    Progressive weakness and death result, often from a secondary infection such as pneumonia.
    Tumor cachexia is believed to be mediated by the activation of cytokines from tumor and inflammatory cells responding to the tumour.
  2. Obliteration of a vital organ / system by either primary or mets cancer.
26
Q

True or false? Staging of a Tumour offers an indication of how far it has spread

A

True

27
Q

What determines the chance of survival once a neoplasm has been diagnosed?

A

The size of a primary tumour
The degree to which is has locally invaded
and the extent to which it has spread

28
Q

What is the TNM system?

A

(grading of tumours)
This is a system based on the extent of a local tumour spread, regional lymph node involvement and the presence of distant metastases.

29
Q

What does the T stand for in the TNM system?

A

refers to the primary tumour
the accompanying number denotes the size & local extent

30
Q

What does the N stand for in the TNM system?

A

refers to lymph node involvement.
A high number denotes increases extent of involvement

31
Q

What does the M stand for in the TNM system?

A

refers to the extent of distant metastasis.

32
Q

What is an example of using the TNM system for staging malignant breast neoplasms?

A

T0 - breast free of tumour
T1- Lesions <2cm in size
T2- Lesion 2-5cm
T3- Chest &/or chest wall involved by invasion

N0- No axillary lymph nodes involved
N1- Mobile nodes involved
N2- Fixed nodes involved

M0- No metastases
M1- Demonstrable mets
M2- Suspected mets

33
Q

What does ‘in situ mean in regards to neoplasms?

A

The term “in situ” relates to epithelial neoplasms which have features of malignancy.
They are usually confined
These types are most commonly encountered in epithelial tissues:
Squamous cells of the cervix, skin & breast
Malignant cells may be confined to the ducts

A diagnosis of “in situ” is important, as if left, is likely to progress to become invasive > Importance of early detection & treatment in this pre- invasive stage.

34
Q

What is METAPLASIA?

A

Conversion of a mature, differentiated cell into another form of a mature cell type

usually following injury
Occurs in various types of tissues
An adaptive process that occurs due to an extremal stimuli
Reversible Process
Does not lead to the formation of cancer

35
Q

What are Causes of Metaplasia?

A

H. Pylori
Tobacco Smoke (chronic)
HPV Infection
Chronic Acid Reflux (GERD)
Endometriosis
Alcohol Consumption

36
Q

What is Dysplasia?

A

Development of abnormal types of cells within a tissue
These may signify a stage preceding the development of cancer
Mainly occurs in the epithelium
Occurs due to the alteration of genetic material
An irreversible process
May cause Cancers
”in situ” dysplasia – surgery to remove abnormal cells.

Note - Dysplasia is not always cancer.
Is a term to describe abnormal cells.

37
Q

We can name a tumour based on its?

A

Cell of origin
It’s likely behaviour

However, this is a constantly developing field so you will come across inconsistencies

Some may be names on :
Histological appearance
Behavioural observations

It’s not unusual for a singe tumour to have many synonyms.

38
Q

What is Papillomata (papilloma – single) ?

A

Benign neoplasms of surface epithelia (such as skin), e.g. squamous cell papilloma of the skin

39
Q

What is Adenomata (adenoma- single) ?

A

Benign Neoplasms of both solid & surface epithelium
(will be prefixed by the origin of tissue) e.g. Thyroid Adenoma, renal adenoma, colonic adenoma.

40
Q

What is a carcinoma?

A

A malignant tumour of any epithelial origin is termed Carcinoma.
Tumours of the glandular epithelium (including the lining of the gut) are termed adenocarcinoma’s.
Usually to classify it further, the tissue of origin is added: e.g. prostate adenocarcinoma, adenocarcinoma of the breast

41
Q

How are Nomenclature of Mesenchymal Tissues names?

A

if Benign > -Oma apart from lymphoma and malignant melanoma
if Malignant > -Sarcoma

42
Q

What is LYMPHOMA?

A

Tumors of the lymphoid system
Neoplastic lymphocytes
Vary in grade of malignancy, from mild to highly aggressive

43
Q

What is malignant melanoma?

A

Highly malignant tumours derived from melanocytes
usually identified by their melanin content

44
Q

What is Leukemia?

A

Malignant tumours derived from hemopoietic elements in bone marrow which circulate in the blood.

45
Q

What are EMBRYONAL TUMOURS?

A

Group of malignant tumors seen predominantly in childhood.
Derived from embryonic blastic tissue
Most common: Neuroblastoma of the adrenal medulla.

46
Q

What are GLIOMAs?

A

Tumours derived from the non- neural support tissues of the brain
May be benign or malignant
Named according to the cell of origin: astrocytoma, oligodendroglioma.

47
Q

What is Ewing’s Sarcoma?

A

Malignant tumor of bone seen in young people

48
Q

What is Hodgkin’s Lymphoma (and Non-Hodgkin’s) ?

A

Malignant proliferation of lymphoid tissues
classified as a sub-group of lymphoma

49
Q

What causes neoplasms?

A

GENETIC
expression of genes resulting in inappropriate activity – over expression or loss of activity.
ONCOGENs
A mutated type of gene which is involved in cell division.
Absence of tumour suppressor genes
Damage genes that regulate DNA repair

CHEMICAL CARCINOGENs
Tar > found in cigarette smoke
Industrial Exposure > Rubber or dye industry

PHYSICAL AGENTS
Asbestos

VIRUSES
Epstein-Barr Virus > Burkitt’s lymphoma
Hepatitis B >Hepatocellular Carcinoma
HPV> Cervical Carcinoma

DIETARY FACTORS
Low Fibre
High Fat
not black & white, but there appear to be associations

CHRONIC INFLAMMATION
Chronic Gastritis, Chronic Colitis

50
Q

What are Paraneoplastic syndromes?

A

this includes many signs and symptoms that arise from local tumour effects,
- Hypercalcaemia (secretion of osteoclast stimulating factors (including IL-1, IL-6 and TNF) which cause calcium to be leached from bones: multiple myeloma, some Ca lung)
DIC (disseminated intravascular coagulation) from excess tumour antigen/tumour related vascular occlusion
Migratory thrombophlebitis (esp. pancreatic, lung, stomach Ca) due to massive antigen release into circulation
Ectopic hormone secretion e.g. small cell Ca of lung – which secrete ectopic antidiuretic hormone (causing over hydration) and AdrenoCorticoTropicHormone ACTH (causing Cushing’s Syndrome).

51
Q

What is TSA?

A

tumour specific antigens cause an immune response

52
Q

What is TAA?

A

tumour associated antigens may be on tumour and normal cells so do not cause an immune response but can help diagnosis or therapeutics, e.g. PSA and prostate Ca.

53
Q

What are considered the first line of defence against most tumours?

A

NK cells

NK cells are lymphocytes (non-T, non-B) that can destroy tumour cells but need to be sensitised first; activated by IL-2.
Considered the first line of defence against most tumours. Innate system. They also participate in Antigen dependant cell mediated cytotoxity - where they can bind the Fc portion of IgG attached to cells and lyses them.

54
Q

What are Cytotoxic T cells? ( neoplasms)

A

(antibody dependent) can be sensitized specifically to attack neoplastic cells (this happens especially in HPV induced cancers).

55
Q

What are Macrophages? (neoplasms)

A

can attack tumour cells when activated by IFN-gamma released by T cells.
Macrophages secrete TNF-alpha