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30 Cards in this Set
- Front
- Back
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General signs of a benign neoplasm |
- Slow growth - No local invasion/infiltration - "Presses" on adjacent tissue - Capsule/pseudocapsule - Discrete/well demarcated/well circumscribed - Few (normal) mitotic figures - Well differentiated |
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General signs of a malignant neoplasm |
- Frequent metastasis - Rapid, erratic growth - Local invasion/infiltration: edges grow and send tendrils of tumor into adjacent tissues - No capsule/pseudocapsule - Poorly demarcated/circumscribed - Many (bizarre) mitotic figures - Poorly differentiated, possibly anaplastic
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What is the only definitive reason to say a tumor is malignant? |
If it is also metastatic (But a tumor can be malignant without being metastatic.) |
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What is a capsule or pseudocapsule? |
Capsule: rim of fibrous connective tissue Pseudocapsule: rim of normal tissue that has been compressed by the neoplasm - Often makes benign neoplasms movable upon palpation |
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What are mitotic figures? |
- Microscopic evidence of cell division - Presence does not imply neoplasia, but if bizarre and in very high numbers, they may indicate a malignant neoplasm - Also seen often in intestinal epithelium, inflammation, neovascularization and fibroplasia - But remember that not all neoplasms have a high rate of cell replication - Some benign tumors and tumors that spontaneously regress are also characterized by a high mitotic index. - A malignant tumor with high mitotic index may be easier to treat. |
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How can you use cell differentiation to assess neoplasms? |
- Malignant tumors tend to be less differentiated than benign tumors - Loss of morphological differentiation often accompanied by loss of function and aggressive behaviour
* Well differentiated: looks like a normal mature cell |
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What are anaplastic cells? |
Tumor cells that have no resemblance to their cell of origin (or anything). |
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What are some direct effects of a neoplasm? |
Local effects caused by space occupation and impairment of organ function: - Replacement of normal tissue (replacing functional tissue or changing organ position) - Invasion and rupture of normal tissue (organ rupture after wall invasion) - Compression of adjacent tissue (or blood supply) causing necrosis/atrophy - Hemorrhage through vessel invasion/rupture or surface ulceration - Pathological fracture
*Benign or malignant tumors |
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What are paraneoplastic effects? |
Indirect and remote effects caused by tumor cell products (rather than by the primary tumor or its metastases)
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3 reasons why it is important to recognize paraneoplastic effects: |
1. Early tumor diagnosis 2. Assure effective cancer treatment 3. Monitoring paraneoplastic effects may determine response to therapy and identification of tumor recurrence or spread |
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What is cachexia? |
Weight loss and debility associated with cancer. Involves loss of both muscle and fat, without a compensatory decrease in BMR.
Contributing factors: anorexia, impaired digestion, nutritional demands of tumor, nutrient loss in cancer-related effusions/exuates, and a variety of metabolic and endocrine derangements. |
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What is hypercalcemia of malignancy? |
- Often due to the ectopic production of PTH and PTH-rp by neoplastic tissue, from a variety of carcinomas and sarcomas
Eg. adenocarcinoma of the anal sac, lymphoma, multiple myeloma |
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What kind of neoplasm most commonly causes hypertrophic osteopathy? |
- Space-occupying thoracic lesions (whether neoplastic or not) - Cause periosteal proliferation of distal long bones
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4 ways that cancer spreads |
1. Direct invasion 2. Transcoelomically (mesothelioma, ovarian adenocarcinoma) 3. Metastasis via lymphatics (often carcinomas, to regional nodes) 4. Metastasis via blood (often sarcomas, to lung and liver) |
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Why do mesothelioma tumors spread so well? |
When cancer is on the serosal surface of an organ, they encounter few anatomic barriers to spread. They will usually stay within the cavity they arose, but will spread to cover all visceral and parietal surfaces. |
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What is this? |
Metastatic sarcoma - many metastatic nodules randomly distributed through all lung lobes. Primary site unknown. |
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What is this? |
Metastatic hemangiosarcoma - red to dark masses throughout lung parenchyma |
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This is lungs. What is happening? |
- Metastatic lymphoma - Infiltrating the lung and disrupting normal organ function - "Direct effect" |
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What direct effect is occuring with this lipoma? |
The strangulating lipoma is changing position of the organ,causing intestinal obstruction and necrosis. |
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What is this? What effect does it have? |
Meningioma causing compression of the brain parenchyma/left cerebral hemisphere. |
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What is this? |
Mammary fibroadenomas. Benign, but cause severe "local effects" due to their size |
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What is happening here? Hint: intestines |
Intestinal perforation (Direct effect: "organ rupture after wall invasion") |
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What is this? Why does this cause hematuria? |
Ulcerated transitional cell carcinoma in the bladder. It caused surface ulceration, leading to bleeding. |
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What is this? What paraneoplastic effect does it commonly produce? |
It is an adenocarcinoma of the apocrine glands of the anal sac. It commonly causes hypercalcemia of malignancy by producing PTH-like hormone. |
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What paraneoplastic effect is this? |
Hypertrophic osteopathy |
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What is grading? |
- Based on morphology of tumor cells in histological sections - Assigned by the pathologist to provide an indication of how similar or dissimilar neoplastic cells are to their normal counterparts - This provides some indication of biological behaviour - Grading schemes are specific to each tumor type |
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What is staging? |
- Gives an indication of the extent of the tumor growth and spread - Guides the clinical in developing of therapeutic plan and estimating prognosis - TNM system: size of primary tumor, degree of lymph node involvement, extent of metastasis - Done by oncologists! |
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What is leukemia? |
Leukemia is an umbrella term referring to malignant hematopoietic neoplasms that originate in the bone marrow and typically have significant numbers of neoplastic cells in the blood. The term is also sometimes used to refer to neoplasia that has originated from outside of the bone marrow, such as lymphoma, but has progessed to include significant bone marrow and blood involvement. (But these are technically the "leukemic phase" of a primary neoplasm, not leukemia.) |
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What are the 2 classifications of leukemia? |
1. Based on cell of origin: Lymphoid or myeloid 2. Based on degree of differentiation of the neolastic cells and their biological behaviour: Acute or chronic (Note: acute is worse) |
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What is this? |
Acute lymphoid leukemia, with neoplastic large lymphocytes. When you see this, think of the bone marrow! |
