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Semester 2-PP > Session 8-Neoplasia 1&2 > Flashcards

Session 8-Neoplasia 1&2 Flashcards

1
Q

What is a neoplasm?

A

Abnormal growth of cells that persists after an initial stimulus is removed

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2
Q

What is a malignant neoplasm?

A

An abnormal growth of cells that persists after the initial stimulus is removed and invades surrounding tissue with potential to spread to distant sites

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3
Q

What is the difference between a tumour and a neoplasm?

A

Tumour = any clinically detectable lump or swelling

Neoplasm = just one type of tumour

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4
Q

What is cancer in terms of a neoplasm?

A

Any malignant neoplasm

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5
Q

What is a metastasis?

A

Malignant neoplasm that has spread from its original site to a new non-contiguous site

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6
Q

What is the original location of a malignant neoplasm called?

A

Primary site

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7
Q

What is the place to which the neoplasm has spread to called?

A

Secondary site

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8
Q

What is dysplasia in terms of neoplasm?

A

Pre-neoplastic alteration in which cells show disordered tissue organisation

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9
Q

Why is dysplasia not neoplastic?

A

Change is reversible

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10
Q

Give examples of a non-neoplastic tumour?

A

Abscess

Haematoma

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11
Q

How are benign and malignant neoplasms different in terms of metastasis?

A

Benign neoplasms remain confined to their site of origin so don’t produce metastases

Malignant neoplasms can metastasise

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12
Q

Why are benign tumours so rarely dangerous?

A

Grow in a confined local area and so have a pushing outer margin

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13
Q

Describe the appearance of malignant tumours

A

Irregular outer margin and shape and may show areas of necrosis and ulceration

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14
Q

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

A

Benign neoplasm has cells that closely resemble parent tissue ie well differentiated

Malignant neoplasms range from well to poorly differentiated

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15
Q

What are anaplastic cells?

A

No resemblance to any tissue

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16
Q

Describe the characteristics of cells with worsening differentiation

A
  • increasing nuclear size
  • increasing nuclear to cytoplasmic ratio
  • increased nucleus staining (hyperchromasia)
  • more mitotic figures
  • increasing variation in size and shape of cells and nuclei (pleomorphism)
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17
Q

What does a high ‘grade’ indicate?

A

Poor differentiation

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18
Q

What causes neoplasia?

A

Accumulated mutations in somatic cells

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19
Q

What causes the mutations in somatic cells?

A 
Initiators = mutagenic agents
Promoters = cause cell proliferation
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20
Q

Complete the sentences:

In combination, initiators and promoters result in an expanded, ___________ population of mutant cells. Chemicals, ____________ and radiation are the main _____________ but some of these agents can also act as ____________.

A

Monoclonal
Infections
Initiators
Promoters

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21
Q

True or false: in some neoplasms, mutations can be inherited rather than from an external mutagenic agent

A

TRUE

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22
Q

How does a neoplasm emerge from a monoclonal population?

A

Process called progression, characterised by accumulation of more mutations

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23
Q

What are monoclonal cells?

A

A collection of cells that originate from a single founding cell

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24
Q

Where did evidence that neoplasms are monoclonal come from?

A
  • X-linked gene for G6PDH enzyme in tumour tissue in women, several alleles for different isoenzymes
  • early in female embryogenesis, one allele randomly inactivated in each cell
  • in heterozygous women that have one allele for heat stable and one for heat labile isoenzymes, normal tissue is patchwork of each type
  • neoplastic tissues only express one isoenzyme so monoclonal
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25
Q

What is lyonisation?

A

Process by which one copy of X chromosome present in female mammals is inactivated

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26
Q

How do genetic alterations affect proto-oncogenes?

A

Become abnormally activated and then called oncogenes, favouring neoplasm formation

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27
Q

How do genetic alterations affect tumour suppressor genes?

A

Become inactivated and no longer able to suppress neoplasm formation

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28
Q

What do benign neoplasms end in?

A

-oma

29
Q

What do malignant neoplasms end in?

A

-carcinoma if epithelial malignant neoplasm (90%)

OR

-sarcoma if stromal malignant neoplasm

30
Q

What are the two types of carcinomas?

A

1) in-situ = no invasion of epithelial basement membrane

2) invasive = penetrated through basement membrane

31
Q

What is leukaemia?

A

Malignant neoplasm of blood-forming cells arising in bone marrow

32
Q

What are lymphomas?

A

Malignant neoplasms of lymphocytes, mainly affecting lymph nodes

33
Q

What do germ cell neoplasms arise from?

A

Pluripotent cells, mainly in testis or ovary

34
Q

Which neoplasms end in -blastoma?

A

Mainly occur in children and formed from immature precursor cells

35
Q

What is a tumour with finger-like protections called?

A

Squamous papilloma

36
Q

What type of neoplasm is in bladder mucosa?

A

Transitional cell papilloma

37
Q

True or false: tumour suppressor gene is dominant

A

FALSE - recessive so need to inactivate both alleles for abnormal growth

38
Q

True or false: proto-oncogenes are dominant

A

TRUE

39
Q

Where can squamous cell carcinoma occur?

A

Skin
Larynx
Oesophagus
Lung

40
Q

Where can transitional cell carcinoma occur?

A

Bladder

Ureters

41
Q

Where can adenocarcinoma occur?

A 
Stomach
Colon
Lung 
Prostate
Breast
Pancreas
Oesophagus 
(Any glandular)
42
Q

What is stage one of tumour burden?

A

Cancer remains at primary site (small)

43
Q

What is stage two of tumour burden?

A

Locally advanced but hasn’t spread

44
Q

What is stage three of tumour burden?

A

Spread regionally

45
Q

What is stage four of tumour burden?

A

Distant metastasis - advanced cancer

46
Q

What are the most lethal features of malignant neoplasm?

A

Invasion

Metastasis

47
Q

True or false: ability of malignant cells to invade and spread to distant sites leads to increased tumour burden

A

TRUE

48
Q

How do malignant cells get from a primary site to a secondary site?

A

1) grow and invade primary site
2) enter transport system and lodge at secondary site
3) grow at secondary site to form new tumour (colonisation)

49
Q

What must malignant cells evade if they are to get from a primary site to a secondary site?

A

Destruction by immune cells

50
Q

What does invasion into surrounding tissues by carcinoma cells require?

A

1) altered adhesion
2) stromal proteolysis
3) motility

51
Q

What is epithelial-to-mesenchymal transition (EMT)?

A

Three alterations needed for invasion create a carcinoma cell phenotype that appears more like a mesenchymal cell than an epithelial cell -> EMT

52
Q

Describe altered adhesion

A

Altered adhesion between malignant cells involves a reduction in E-cadherin expression

Altered adhesion between malignant cells and stromal proteins involves changes in integrin expression

53
Q

Describe proteolysis

A

Cells must degrade basement membrane and stroma to invade. Involves altered expression of proteases, notably matrix metalloproteinases (MMPs)

54
Q

What is a cancer niche?

A

Malignant cells take advantage of nearby non-neoplastic cells, which together form a cancer niche. These normal cells provide some growth factors and proteases

55
Q

Describe altered motility

A

Involves changes in actin cytoskeleton. Signalling through integrins is important and occurs via small G proteins such as members of Rho family

56
Q

What are the routes of transport of malignant cells to distant sites?

A

1) blood vessels via capillaries and venules
2) lymphatic vessels
3) fluid in body cavities (pleura, peritoneal, pericardial and brain ventricles) - known as transcoelomic spread

57
Q

Complete the sentences:

At a secondary site, malignant cells must get out of a vessel (______________) and then grow (_______________). Many malignant cells lodge at secondary sites but these tiny cell clusters either die or fail to grow into clinically detectable tumours. Surviving microscopic defects that fail to grow are called _________________.

A

Extravasation
Colonisation
Micrometastases

58
Q

What is tumour dormancy?

A

When an apparently disease-free person may harbour many micrometastases

59
Q

Why can a malignant neoplasm relapse years after an apparent cure?

A

Due to one or more micrometastases starting to grow

60
Q

What can lead to tumour dormancy?

A
  • immune attack
  • reduced angiogenesis
  • hostile secondary site
61
Q

What determines the site of a secondary tumour?

A

1) regional drainage of blood, lymph or coelomic fluid

2) “seed and soil” phenomenon

62
Q

What is the “seed and soil” phenomenon?

A

Interactions between malignant cells and local tumour environment (ie niche) at the secondary site

63
Q

True or false: carcinomas spread via blood stream

A

FALSE - via lymphatics first, sarcomas spread via blood stream

64
Q

What is the likelihood of metastasis related to?

A

The size of primary neoplasm

65
Q

What are paraneoplastic syndromes?

A

Indirect systemic effects of neoplasms, including increasing tumour burden, secreted hormones and miscellaneous effects

66
Q

What are the local effects of primary and secondary neoplasms due to?

A
  • direct invasion and destruction of normal tissue
  • ulceration at a surface leading to bleeding
  • compression of adjacent structures
  • blocking tubes and orifices
67
Q

What can increased tumour burden lead to?

A

Parasitic effect and secreted factors such as cytokines contributes to reduced appetite, weight loss (cachexia), malaise, immunosuppression and thrombosis

68
Q

What are some miscellaneous systemic effects of neoplasms?

A
  • neuropathic affecting brain and peripheral nerves
  • skin problems such as pruritus and abnormal pigmentation
  • fever
  • myositis
69
Q

What is the name given to benign connective tissue neoplasms in:

1) smooth muscle
2) fibrous tissue
3) bone
4) cartilage
5) fat
6) nerve
7) nerve sheath
8) glial cells?

A

1) leiomyoma
2) fibroma
3) osteoma
4) chondroma
5) lipoma
6) neuroma
7) neurofibroma
8) glioma

Semester 2-PP (13 decks)

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