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40 Cards in this Set

  • Front
  • Back
What suffix generally indicated a benign tumor?
-oma
Describe benign tumors of epithelial origin
1. Arise from ectoderm or endoderm
2. Example: tubular adenoma (adenomatous polyp) arising from gland in the colon
Describe benign tumors of connective tissue origin
1. Arise from mesoderm
2. Examples- lipoma from adipose
What types of tumors are usually benign?
-Mixed tumors
-Teratomas
Describe mixed tumors
1. Neoplastic cells have two different morphologic patterns but derive from the same germ cell layer
2. Example: pleomorphic adenoma of the parotid gland
Describe teratomas
1. Tumors that derive from more than one germ cell layer
-Contain tissue derived from ectoderm, endoderm, and mesoderm
2. Sites
-Ovaries, testes, anterior mediastinum, and pineal gland
Describe carcinomas
1. Malignant tumors
2. Derive from epithelial tissue- squamous, glandular, transitional
Describe the sites of squamous cell carcinoma
1. Oropharynx
2. Larynx
3. Upper/middle esophagus
4. Lung
5. Cervix
6. Skin
Describe the sites of adenocarcinoma (glandular epithelium)
1. Lung
2. Distal esophagus to rectum
3. Pancreas
4. Liver
5. Breast
6. Endometrium
7. Ovaries
8. Kidneys
9. Prostate
Describe the sites of transitional cell carcinoma
1. Urinary bladder
2. Ureter
3. Renal pelvis
Describe sarcomas
1. Malignant tumors
2. Derive from connective tissue
3. Examples: osteogenic sarcoma in bone
What are tumor-like conditions?
-Hamartoma
-Choristoma (heterotopic rest)
Describe Hamartomas
1. Non-neoplastic overgrowth of disorganized tissue indigenous to a particular site
2. Examples: Bronchial hamartoma (contains cartilage), Peutz-Jeghers polyp
Describe Choristomas (heterotopic rest)
1. Non-neoplastic normal tissue in a foreign location
2. Examples: panceatic tissue in the stomach wall; parietal cells in Meckel diverticulum
Describe the components of benign and malignant tumors
1. Parenchyma
-Neoplastic component that determines the tumor's biologic behavior
2. Stroma
a. Non-neoplastic supportive tissue
b. Most infiltrating carcinomas induce production of a dense, fibrous stroma
Describe the differentiation of benign tumors
Usually well differentiated (resemble parent tissue)
Describe the differentiation of malignant tumors
1. Well differentiated or low grade
a. Resemble parent tissue
b. Examples: produce keratin pearls or glandular lumens with secretions
2. Poorly differentiated, high grade, or anaplastic
-No distinguishing features
3. Intermediate Grade
-Features are between low and high grade cancer
Describe the nuclear features of benign tumors
1. Nuclear/cytoplasmic ratio is close to normal
2. Mitoses have normal mitotic spindles
Describe the nuclear features of malignant tumors
1. Nuclear/cytoplasmic ration is increased and nucleoli are prominent
2. Mitoses have normal and atypical mitotic spindles
Describe the growth rate of benign tumors
Usually have a slow growth rate
Describe the growth rate of malignant tumors
-Have a variable growth rate
a. Correlates with the degree of differenttiation
b. Anaplastic (high-grade) cancers have an increased growth rate
When does a tumor become clinically evident?
Thirty doubling times are required for a tumor to be clinically evident
-Equivalent to 10^9 cells, 1 g of tissue, volume of 1 L
Describe the types of neoplastic cells that are targeted by chemotherapy
-Malignant cells in the cell cycle are primarily targeted by chemotherapy
1. DNA is exposed an is susceptible to damage by drugs and radiation causing the cells to die
2. Loss of the cells causes more cancer cells to go into the cell cycle; hence debulking the tumor as these cells also get destroyed
Describe the monoclonality of neoplasms
1. Benign and malignant tumors derive from a single precursor cell
2. Non-neoplastic proliferations derive from multiple cells (polyclonal)
Describe the monoclonal origin of neoplasms
-Have been shown by studying glucose-6-phosphate dehydrogenase (G6PD) isoenzymes A and B in selected neoplasms(eg leiomyoma of the uterus)
-All the neoplastic smooth muscle cells in uterine leiomyomas have either the A or the B G6PD isoenzyme
-Non-neoplastic smooth muscle proliferations in the uterus (eg pregnant uterus) have some cells with the A isoenzyme and others with the B isoenzyme, indicating their polyclonal origin
Describe telomerase activity in neoplasms
1. Telomerase
a. Preserves length of telomeres
-Sequences of nontranscribed DNA at the ends of chromosomes
b. Prevent gene loss after multiple cell divisions
2. Benign tumors have normal telomerase activity
3. Malignant tumors have upregulation of telomerase activity
-They do not lose genetic material after multiple cell divisions
Describe local ingestion
1. Benign tumors
a. They do not invade
b. They are usually enclosed by a fibrous capsule
-Exception- uterine leiomyomas do not have a fibrous tissue capsule
2. Malignant tumors invade tumors
3. Some tissues resist invasion
-Examples: mature cartilage, elastic tissue in arteries
Give examples of tissues that are resistant to invasion
Mature cartilage, elastic tissues in arteries
Describe the sequence of invasion by malignant tumors
1. Loss of intercellular adherence
-E-cadherin (intercellular adhesion agent) is not produced
2. Cell invasion occurs
a. Cell receptors attach to laminin (glycoprotein in the basement membrane)
b. Cells release type IV collagenase (metalloproteinase containing zinc)
-Dissolves the basement membrane
c. Cell receptors attach to fibronectin in the extracellular matrix
d. Cells produce cytokines (stimulate locomotion) and proteases (dissolve connective tissue)
e. Cells produce factors that stimulate angiogenesis
-Secrete vascular endothelial growth factor and basic fibroblast growth factor
Describe what tumors metastasize
1. Benign tumors do not metastasize
2. Malignant tumors metastasize
Describe the pathways of dissemination
1. Lymphatic spread to lymph nodes
2. Hematogenous spread
3. Seeding
Describe the lymphatic spread of metastasis to lymph nodes
Usual mechanism of dissemination of carcinomas
Describe the hematogenous of metastasis
1. Usual mechanism of dissemination for sarcomas
2. Cells entering the portal vein metastasize to the liver
3. Cells entering the vena cava metastasize to the lungs
Describe seeding dissemination of metastasis
-Malignant cells exfoliate from a surface and implant and invade tissue in a body cavity
1. Primary surface-derived ovarian cancers (eg, serous cystadenocarcinoma) commonly seed the omentum
2. Peripherally located lung cancers commonly seed the parietal and visceral pleurae
3. Glioblastoma multiforme commonly seeds the CSF causing spread to the brain and spinal cord
Describe bone metastasis to the vertebral column
1. Most common metastatic site in bone
2. Due to the Batson paravertebral venous plexus
-It has connections with the vena cava and the vertebral bodies
Describe osteoblastic metastases
1. Increased serum alkaline phosphatase indicated reactive bone formation
2. Radiodensities are seen on radiographs
Describe osteolytic metastases
1. Radiolucencies are seen on radiographs (eg lung cancer)
2. Potential consequences of osteolytic metastases
a. Pathologic fractures
b. Hypercalcemia
Describe the pathogenesis of osteolytic metastases
1. Tumor may produce substances that locally activate osteoclasts producing lytic lesions
-Example: PGE2, IL-1
2. Tumor produces parathyroid hormone (PTH)- related protein; no lytic lesions due to generalized increase in osteoclast activity
-Examples: Squamous cell carcinoma in the lung, renal cell carcinoma
How is pain in bone metastasis treated?
Local radiation therapy
Where is metastasis more common than primary cancer?
1. Lymph nodes (eg metastatic breast and lung cancer)
2. Lungs (eg metastatic breast cancer)
3. Liver (eg metastatic lung cancer)
4. Bone (eg metastatic breast cancer)
5. Brain (eg metastatic lung cancer)