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116 Cards in this Set
- Front
- Back
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What is a tumor?
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Any swelling, including inflammatory masses
However, more restricted to neoplasms |
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What is a neoplasm?
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New growth of cells
Not coordinated with normal tissue growth Not regulated by the organism |
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How can we say that a neoplasm is a cancer?
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Neoplasm need to exhibit the 'hallmarks of cancer'
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What are the 8 hallmarks of cancer?
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1. Self-sufficiency in growth signals
2. Lack response to growth inhibitory signals 3. Evasion of cell death 4. Limitless replicative potential 5. Development of angiogenesis 6. Ability to invade local tissues and spread 7. Reprogramming of metabolic pathways 8. Ability to evade the immune system |
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Benign and malignant tumors of connective tissue?
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Benign
- Fibroma - Lipoma - Chondroma - Osteoma Malignant - Fibrosarcoma - Liposarcoma - Chondrosarcoma - Osteogenic sarcoma |
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What endothelial and related tissues may there grow tumours from?
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- Blood vessels
- Lymph vessels - Mesothelium - Brain coverings |
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Benign and malignant tumors of blood vessels?
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Benign
- Hemangioma Malignant - Angiosarcoma |
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Benign and malignant tumors of lymph vessels?
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Benign
- Lymphangioma Malignant - Lymhpangiosarcoma |
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Benign and malignant tumors of mesothelium?
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Benign
- No benign mesothelial tumors! Malignant - Mesothelioma (exception) |
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Benign and malignant tumors of brain coverings?
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Benign
- Meningioma Malignant - Invasive meningioma |
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From what blood cell tissues may there arise tumors?
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- Hematopoietic cells
- Lymphoid tissues |
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Tumors of hematopoietic cells?
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Only malignant:
- Leukemias |
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Tumors of lymphoid tissues?
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Only malignant:
- Lymphomas (exception) |
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Benign and malignant tumors of smooth muscle?
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Benign
- Leiomyoma Malignant - Leiomyosarcoma |
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Benign and malignant tumors of skeletal muscle?
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Benign
- Rhabdomyoma Malignant - Rhabdomyosarcoma |
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What cells may tumors of epithelial origin arise from?
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- Stratified squamous cells
- Basal cells of skin or adnexa - Epithelial lining of glands or ducts |
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Tumors of stratified squamous cells?
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Benign
- Squamous cell papilloma Malignant - Squamous cell carcinoma - Epidermoid carcinoma |
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Tumors of basal cell of skin or adnexa?
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Only basal cell carcinoma
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Tumors of epithelial lining of gland or ducts?
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Benign
- Adenoma - Papilloma - Cystadenoma Malignant - Adenosarcoma - Papillary carcinoma - Cystadenocarcinoma |
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Epithelial tumors of respiratory passages?
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Benign
- Bronchial adenoma Malignant - Bronchogenic carcinoma |
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Epithelial tumors of renal epithelium?
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Benign
- Renal tubular adenoma Malignant - Renal cell carcinoma |
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Epithelial tumors of liver cells?
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Benign
- Liver cell adenoma Malignant - Hepatocellular carcinoma |
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Epithelial tumors of urinary tract epithelium?
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Transitional tumors
Benign - Urothelial papilloma Malignant - Urothelial carcinoma |
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Epithelial tumors of placental epithelium?
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Benign
- Hydatiform mole Malignant - Choriocarcioma |
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Epithelial tumors of germ cells? (testicular epithelium)
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Only malignant:
- Seminoma - Embryonal carcinoma |
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Tumors of melanocytes?
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Benign
- Nevus Malignant - Malignant melanoma |
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Locations of tumors of more than one neoplastic cell type?
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- Salivary glands
- Renal anlages (embryonal primordium) |
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Pleomorphic tumors of salivary gland?
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Benign
- Pleomorphic adenoma (mixed salivary gl. tumor) Malignant - Malignant mixed tumor of salivary gland |
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Tumor of the renal anlages?
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Wilms tumor
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Where may tumors from all 3 germ cell layers arise?
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Totipotent cells in gonads
Embryonic rests |
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Tumors of more than 1 germ cell layer in gonads?
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Benign
- Mature teratoma / dermoid cyst Malignant - Immature teratoma - Teratocarcinoma |
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What are the exceptional -oma's which actually are malignant?
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- Lymphoma
- Mesothelioma - Melanoma - Seminoma |
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Definition papilloma?
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Benign epithelial neoplasm
Grow on any surface Micro- & macroscopic fingerlike projections |
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Definition polyp?
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Mass projecting above mucosal surface
Form macroscopical visible structure |
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Definition metaplasia?
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Reversible change in which one adult cell type (epithelial or mesenchymal) is replaced by another adult cell type
It´s a cellular adaptation - so a cell sensitive to a stress develops to a cell that can withstand it |
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Causes of metaplasia?
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Chronic irritation
Cellular adaption |
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3 epithelial metaplasias?
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- Acid reflux & barrett´s esophagus
- Squamous cell metaplasia (cirarettes) - Vitamin A deficiency |
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Cellular adaptations in Barret´s esophagus?
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Stratified squamous ep. of esophagus
--> Gastric or intestinal columnar To be able to withstand high acidity |
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Cellular adaptations in squamous cell metaplasia of respiratory tract?
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Resp. ep (Ciliated pseudostratified columnar with goblet cells) --> Stratified squamous.
To withstand chronic exposure to toxins and gases |
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Definition hypertrophy?
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Increased cell and organ size - in response to mechanical stress or other stimuli
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Definition hyperplasia?
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Increased cell number in response to hormones and other growth factors
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Definition atrophy?
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Decreased cell and organ size - due to low nutrient supply or disuse
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Examples of mesenchymal metaplasia?
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- Bone replacement of mesenchymal tissue (myositis ossificans)
- Cancerous transformations |
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What is myositis ossificans?
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Presence of metaplastic bone in proximal muscles of extremities after trauma
Develop to a painless, hard mass. Excision curable. Must be distinguished from extraskeletal osteosarcoma |
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Why does benign tumors like lipomas or leiomyomas usually not develop to be malignant?
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Genetically stable, changing little in genotype over time
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What is a 'scirrhous' tumor?
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A hard tumor
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What is desmoplasia?
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The dense, abundant fibrous stroma that some cancers produce - making them hard so called 'scirrohus' tumors
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What is anaplasia?
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Means 'backwards formation'
A hallmark for malignancy Imply - Dedifferentiation - Loss of structural or functional differentiation - Failure of differentiation |
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What is pleomorphism?
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Variation in size and shape of cells
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What is dysplasia?
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A disorderly but non-neoplastic growth
'Loss of uniformity of individual cells and their architectural orientation' NOT synonymous with cancer! |
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How is the cell morphology of dysplastic cells?
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- Pleomorphic
- Hyperchromatic nuclei - Larger than usual - Mitotic figures Seen at all levels e.g. in str.sq.ep |
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When is dysplasia called 'carcinoma in situ'?
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When the dysplastic changes involve entire thickness of epithelium
This is a precancerous lesion / preinvasive stage |
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Typical location of epithelial dysplasia?
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Uterine cervix - at the junction of ecto and endocervix
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Epithelial changes in uterine cervix metaplasia?
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Columnar glandular ep --> Squamous cell ep.
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What is CIN?
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Cervical intraepithelial neoplasia
A grading of the severity of the dysplasia |
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CIN I?
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Mild dysplasia
Thickening with moderate loss of differentiation Not precancerous |
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CIN II?
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Intermediate between 2 & 3
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CIN III?
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Carcinoma in situ
- No stratification - Undifferentiated cells |
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Definition cyst?
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A pathological cavity with a distinct epithelial lining
Majority benign - although some may be malignant |
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What is the classification of cysts according to content?
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- Fluid cyst
- Horny cyst - Gaseous cyst |
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What types of fluids may a cyst contain?
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- Sereous fluid (watery)
- Mucus - Hemorrhagic - Sebaceous |
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Classification of cysts according to number?
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1. Solitary
2. Several 3. Multiple |
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Classification of cysts according to origin?
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There are maybe 50 different types but:
- Bone cysts - Brain cysts - Breast cysts - Ovarian cysts - Pancreatic duct cysts - Renal cysts - Hydatid cysts - Dermoid cysts |
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Bone cysts?
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Simple bone cyst
- Metaphysis of children Aneurysmal bone cysts - Expanding and blood-filled |
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What is a hydatid cyst?
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A cyst formed by the embryoes of 'echinococcus granulosis' - a small tapeworm
Ingested from sheep, gastric juices release ova which goes to liver and or systemic circulation From there spread to - Lungs - Muscles - Kidneys - Spleen - Brain |
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Cysts of the ovaries?
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Follicular cysts
Theca lutein cysts Sereous cysts: - Sereous cystadenoma - Papillary (serous) cystadenocarcinoma Mucinous cysts - Mucinous cystadenoma - Mucinous cystadenocarcinoma |
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What are follicular cysts?
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Single or multiple, lined by granulosa cells
Graafian follicles overgrowing to several cm If bilateral - often it is polycystic ovarian disease |
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Characteristics associated with polycystic ovarian disease?
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- Obesity
- Hirsutism - Oligomenorrhea If accompanied by more signs of virilism - it may be sign of more severe underlying cause of hyperandrogenism |
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What are theca-lutein cysts?
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Ovarian cysts from where granulosa cells have disappeared
Lined by theca lutein cells |
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Cysts in pancreas is caused by?
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Cystic fibrosis - due to viscid mucus
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Cysts in kidneys are?
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Polycystic kidney disease
- Adult - Infant |
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What is a dermoid cyst?
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Mature cystic teratoma of ovaries
Lined by stratified squamous ep. with malignant potential |
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Definition hamarthoma?
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An excessive focal overgrowth of normal tissue - growing at normal location - but with some degree of abnormal architecture.
Often seen as the linkage between - Developmental malformation - Neoplasm |
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Some other neoplasms that have been considered to be hamarthomas?
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- Hemangiomas
- Lymphangiomas - Rhabdomyomas of heart - Adenomas of liver |
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Example of hamarthoma?
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Liver:
- Mass of disorganized hepatic cells, bile ducts and blood vessels Lung: - Nodule containing islands of cartilage, bronchi and blood vessels |
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Definition hyperplasia?
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Increased controlled proliferation of normal cells
Physiological or pathological |
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Physiological hyperplasia?
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Hormonal
- Proliferation of glandular ep of breast at puberty Compensatory - Residual tissue grow to replace removed / lost organ |
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Pathological hyperplasia?
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Hormonal
- Excessive estrogen lead to endometrial hyperplasia & abnormal menstrual bleeding Growth factors - Wound healing |
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In what features may we distinguish a benign and malignant tumor?
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- Differentiation and anaplasia
- Rate of growth - Local invasion - Spread / metastasis |
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Anaplastic changes of malignant tumors?
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- Undifferentiated cells
- Bizarre architecture - Pleomorphism - Large hyperchromatic nucleus with nucleloi! - Giant cells - Increased mitotic figures |
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How can tumors speed up their growth?
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Hormones, e.g.
- Endometrium - Breast - Prostate |
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What happens with tumors if they grow too fast?
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Central necrosis
Since blood supply cannot keep up - and they suffer from lack of nutrition |
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How to sometimes treat breast carcinoma which is accelerated by increased hormone production?
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Remove source of hormone:
- Ovarectomy - Hyophysectomy - Irradiation |
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Hallmarks of cancer:
- How does cancer cell ensure self-sufficiency in growth signals? |
Through oncogenes:
- Stimulus-independent expression of growth factor - Mutations in genes encoding signaling molecules - Overproduction of transcription factors |
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Hallmarks of cancer:
- How does cancer cell become insensitive to growth inhibitory signals? |
1. Inherit one defective tumor suppressor gene
2. Get a somatic mutation in the other one = 'Two-hit hypothesis' - Normally they´re job is to regulate the cell cycle thus inhibit cellular proliferation |
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Examples of defective tumor suppressor genes?
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Rb-gene
- Human retinoblastoma p53 - Colon cancers - Breast cancers - Lung cancers |
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Hallmarks of cancer:
- How does cancer cell evade apoptosis? |
Apoptosis usally occur via:
- Cytochrome c --> Bind Apaf-1 --> Caspase 9 = apoptosome Regulation of mitochondrial release of cc is done via pro-apoptotic and anti-apoptotic molecules - Often anti-apoptotic molecules are activated - Or cells autophagy their components, e.g. receptors are internalized |
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Hallmarks of cancer:
- How does cancer cell create limitless replicative potential? |
1. Disable the cell cycle checkpoints
2. Leading to activation of DNA repair to the shortened telomeres 3. Get a mitotic catastrophe and immortality |
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Hallmarks of cancer:
- How does cancer cell develop sustained agniogenesis? |
- Hypoxia trigger angiogenesis trough angiogenic factors secreted by tumor and stromal cells
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Hallmarks of cancer:
- How does cells invade and metastasize? |
4 steps:
1. Loosening of tumor cells (E-cadherin) 2. Degradation of BM and interstitial CT (proteolytic enzmes: Collagenases, MMP's) 3. Changes in attachment of tumor cells to ECM proteins 4. Locomotion (increased ameoboid movement) |
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Hallmarks of cancer:
- How does cancer cells get genomic instability as enabler of malignancy? |
- Mutations in genes involved in DNA repair systems
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Examples of mutations in genes involved in DNA repair systems?
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HNPCC
- Defect in mismatch repair genes --> Colon carcinoma Xeroderma pigmentosum - Nucleotide excision repair defect --> Skin cancers in UV Breast cancers - BRCA1 & 2 are involved in DNA repair |
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Routes of spread of tumor cells?
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1. Local invasion
2. Lymphogenous spread 3. Hematogenous spread 4. Transcoelomic spread 5. Perineural spread 6. Intraepithelial spread 7. Transplantation / surgical equipment |
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Routes of metastasis of tumor cells?
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1. Hematogenous spread
2. Lymphogenic spread 3. Seeding along serous membranes |
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Example of tumor that almost never metastasize?
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Basal cell carcinoma of skin & primary CNS tumors
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Examples of tumors that almost always metastasize?
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Osteogenic sarcomas
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Which tumors have a tendency to spread by lymphogenic route?
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- Carcinomas
- Melanomas |
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To where does tumors spread typically, in the lymphogenic route?
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To the 'sentinel lymph node' - the first regional lymph node.
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What is a 'skip metastasis'?
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When tumor cells have passed sentinel lymph node via lymphogenic route and got trapped in subsequent node(s)
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Which tumors have tendency to spread by hematogenous route?
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Sarcomas
But also some carcinomas |
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Carcinomas of lungs typically metastasize to?
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1. Regional bronchial lymph nodes
2. Hilar lymph nodes 3. Tracheobronchial lymph nodes |
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Carcinomas of upper right lobe of breast usually spread to?
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Axillary nodes
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Carcinoma of medial breast lesions usually spread via what to?
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Via internal mammary artery to chest wall nodes
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What must tumor metastasis to lymph nodes be differentiated from, mostly?
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1. Lymphadenitis
2. Sinus histiocytosis |
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What is lymphadenitis in lymph nodes close to tumor?
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Hyperplasia of follicles - due to necrotic products of antigens from neoplasm
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What is sinus histiocytosis in lymph nodes related to tumor?
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Proliferation of macrophages in subcapsular sinuses
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Most typical vessel for hematogenous spread?
Thus most typical organs? |
Venous
So most typical organs are liver and lungs - since these are the first capillary networks they may be trapped in |
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Does metastasis always depend on anatomical localization?
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No - sometimes tumors show 'organ tropism' - where they typically end up in a particular organ due to adhesion and chemotactic signals
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What is grading of cancer?
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- Done by pathologist
- LM, EM, immunofluorescence - Look at tumor cell differentiation - Number of mitoses - Decide how quickly cancer may progress, thus its agressiveness |
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What is staging of cancer?
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- Done by clinician with the grading info from pathologist
- Decide how big tumor is - Decide how far it has spread in body |
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How many grades of grading?
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I-IV
I = Well differentiated, good prognosis IV = Undifferentiated (anaplastic), bad prognosis |
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How is staging done?
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1. According to TNM:
T = Tumor stages N = (lymph) Node stages M = Metastasis 2. According to AJC 0-IV |
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Stages of tumor stages? (T)
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T0-T4
0 = In situ invasion 1 = Localized 2-3 = Locally advanced 4 = Metastasis |
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Stages of lymph nodes stages? (N)
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N0 - N3
0 = no lymph node involvement 1 = 1 node involvement (<2m) 2 = 1 node but (2-5cm) or bilateral 3 = Any node involvement >5cm |
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Stages of metastasis? (M)
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M0 = No hematogenous metastasis
M1 = Hematogenous metastasis |
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How are the staging examination performed?
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By clinical and radiological examination:
- CT & MRI |
