Cancer and Tumor Characteristics Quiz

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Questions and Answers

What type of cancer is primarily associated with exposure to arsenic?

Nose

Leukemia

Prostate

Lung, skin, and hemangiosarcoma (correct)

Which oncogenic pathogen is associated with liver cancer?

Hepatitis B (correct)

HTLV1

HPV

Schistosoma haematobium

What is a known risk associated with vinyl chloride exposure?

Prostate cancer

Angiosarcoma of the liver (correct)

Mesothelioma

Lung cancer

Which age group has a predominant incidence of epithelial cancers?

Adults over 60 years Signup and view all the answers

Which of the following is NOT listed as a carcinogenic substance?

Caffeine Signup and view all the answers

What is the term for the lack of differentiation in neoplastic tissues?

Anaplasia Signup and view all the answers

Which of the following is NOT a feature of anaplasia?

Well-defined cellular structure Signup and view all the answers

How are poorly differentiated tumors characterized?

Little resemblance to the tissue of origin Signup and view all the answers

Which of the following statements about benign tumors is true?

They closely resemble normal tissue. Signup and view all the answers

Which of the following features would classify a tumor as an aplastic tumor?

It shows complete loss of differentiation. Signup and view all the answers

What distinguishes malignant tumors from benign tumors regarding differentiation?

Malignant tumors possess anaplastic features. Signup and view all the answers

Which method is typically used to identify totally undifferentiated tumors?

Molecular techniques Signup and view all the answers

What does a well-differentiated tumor indicate?

It is associated with a low grade. Signup and view all the answers

Which statement about the stage of a tumor is true?

The stage is a measure of the extent of spread of a tumor. Signup and view all the answers

What characterizes hypertrophy in cellular adaptations?

Increased cell size due to increased workload. Signup and view all the answers

What does dysplasia indicate?

Confined neoplastic change with specific cytomorphological features. Signup and view all the answers

Which statement is true about carcinoma in-situ?

It shows cytological features of malignancy without invasion. Signup and view all the answers

What is metaplasia?

A reversible change in phenotype of differentiated cells. Signup and view all the answers

What is the significance of the basement membrane in dysplasia?

It serves as a barrier preventing invasion by dysplastic cells. Signup and view all the answers

What best describes hyperplasia?

Increased cell numbers in response to physiological stimuli. Signup and view all the answers

Which type of tumor grade indicates a high level of differentiation?

Grade 1 Signup and view all the answers

What is the main difference in growth rate between benign and malignant tumors?

Malignant tumors grow rapidly while benign tumors grow slowly. Signup and view all the answers

Which statement about the invasiveness of tumors is true?

Malignant tumors invade surrounding tissues. Signup and view all the answers

What suffix is typically used to denote benign tumors?

-OMA Signup and view all the answers

Which type of tumor is described as having pleomorphic nuclear morphology?

Malignant tumor Signup and view all the answers

What is a common characteristic of necrosis in tumors?

Common in malignant tumors Signup and view all the answers

In terms of metastasis, how are benign and malignant tumors differentiated?

Malignant tumors often metastasize while benign tumors do not. Signup and view all the answers

What distinguishes benign epithelial tumors from malignant ones regarding differentiation?

Benign tumors are well differentiated. Signup and view all the answers

Which tumor type is specifically described as having a compressive effect in the skull?

Meningioma Signup and view all the answers

What does the histiogenic classification of tumors depend on?

The tissue of tumor origin Signup and view all the answers

Study Notes

Neoplasia

Neoplasia is the uncontrolled growth of cells, forming a new mass of tissue
The terms "tumour" and "neoplasm" are now synonymous
Neoplasia is a significant health concern globally
In the UK, approximately 363,000 new cases of cancer are diagnosed annually
About 990 cases of cancer are diagnosed in the UK daily (every 90 seconds).
Most cancers occur in individuals over 60
Approximately 1 in 4 deaths in the UK are attributed to cancer, with over 165,000 deaths annually (or ~450 per day)

Learning Objectives

Understanding the extent of the problem of neoplasia
Knowledge of general principles of benign and malignant neoplasia
Identifying benign versus malignant morphologies and behaviours
Differentiating between in situ and invasive malignancies
Recognizing histological types of neoplasms
Understanding tumour nomenclature

Basic Concepts

Benign features suggest slow growth and a lack of invasion, while malignant tumours exhibit fast growth as well as invasion and the potential to spread (metastasis)
Primary tumours originate at the site of initial growth, while secondary (metastatic) tumours have spread from a primary site
Tumours arise from different tissues/tissues, including epithelial and non-epithelial types
Epithelial tumours include those derived from endoderm, mesoderm, or ectoderm, while non-epithelial tumours encompass mesenchymal, haematopoietic, neuroectodermal, and germ cell types, as well as various embryonal/mixed tumour types

What is Neoplasia?

The biological definition of neoplasm (Willis, 1952) describes excess growth not coordinated with normal tissues, persisting after cessation of the initial stimuli
Another definition (Underwood) describes a lesion arising from autonomous or relatively autonomous abnormal cell growth that persists after removal of the initiating stimulus

Neoplasia is a Genetic Disease

The persistence of tumour growth after stimulus removal stems from non-lethal genetic alterations in key genes (proto-oncogenes, tumour suppressor genes, apoptosis, DNA repair)
Tumour cells become autonomous and exhibit excessive, uncontrolled proliferation independent of physiological growth stimuli.
Tumours originate from a single precursor cell.

Carcinogenesis Requirements

Self-sufficiency in growth signals
Insensitivity to growth-inhibitory signals
Altered cellular metabolism
Evasion of apoptosis
Limitless replicative potential
Sustained angiogenesis/metastasis
Ability to evade the host immune response

Hallmarks of Cancer

Sustaining proliferative signaling
Avoiding immune destruction
Evading growth suppressors
Enabling replicative immortality
Tumor-promoting inflammation
Activating invasion and metastasis
Inducing angiogenesis
Genomic instability (mutator phenotype)

Tumour Components

Tumour epithelial cells (originating from tissue linings)
Tumour-associated stroma (surrounding supportive tissues)
Non-tumoural cells (endothelial, fibroblasts, platelets, NK cells, T cells, mast cells, and parenchymal cells); as well as the extracellular matrix

Tumour Stroma Ratio

Intratumoral stromal morphometry predicts recurrence in colorectal cancers
The tumour stroma ratio is important for predicting disease recurrence but not response to 5-fluorouracil treatment

Common and Fatal Cancers (2014)

Leading cancer types by incidence and mortality, with data broken down by sex.

Who Gets Tumours?

Environmental and geographical factors greatly influence cancer development
Cancer incidence varies considerably across different populations

Oncogenic Pathogens

HPV, H. pylori, EBV, HHV8, Schistosoma hematobium, Hepatitis B and C viruses, and HTLV1 are all associated with increased cancer risk

Carcinogenic Substances

A range of substances, like formaldehyde, wood dust, nickel, asbestos, tobacco, benzene, coal/alcohol, and other pollutants are associated with cancer risk

Radiation

FISSIONS products, RADIO-IODINES, background radiation (RADON), UVA, UVB, UVC, PLUTONIUM, SOLAR, and ionizing radiation (X-rays) all contribute to cancer risk

Age as a Factor in Tumour Development

Most cancers occur in people aged over 60 years
Reasons for higher cancer rates in older age include increased somatic genetic mutations and a decline in the immune response

Inheritance and Cancer

Environmental and hereditary factors contribute to cancer risk
Specific inherited cancer syndromes increase the risk of cancer development

Benign/Malignant Neoplasia

Distinguishing characteristics used to classify neoplasms include differentiation, rate of growth, local invasion, and metastasis

Differentiation

Well-differentiated tumours resemble their normal tissue of origin closely; while poorly or undifferentiated tumours exhibit significant variations and abnormalities
A lack of differentiation is called anaplasia.

Features of Anaplasia

Nuclear pleomorphism (variation in nuclear size and shape)
Abnormal nuclear features (high nuclear-cytoplasmic ratio, clumped chromatin, and prominent nucleoli)
Increased mitotic activity
Loss of cellular polarity/order
Presence of tumour giant cells
Necrosis
Haemorrhage/ulceration

Differentiation Summary

Benign tumours exhibit well-defined differentiation, while malignant tumours generally exhibit poorer differentiation with often significant anaplastic features

Classification, Grade, and Stage

Classification assigns a name to the tumour based on the tissue of origin, as determined by established systems (e.g., WHO)
Grade is a measure of how differentiated a tumour is, ranging from low-grade to high-grade (1 to 3)
Stage assesses the extent and spread of the tumour determining prognostication and treatment planning

Metaplasia, Hypertrophy, and Hyperplasia

Metaplasia refers to the change in the type of differentiated cell, often in response to chronic irritation
Hypertrophy describes an increase in the size of individual cells, and hyperplasia involves an increase in the number of cells in response to a stimulus
These are usually responsive to a stimulus, not neoplastic

Dysplasia and Carcinoma In-Situ

Dysplasia is a term used to describe confined neoplastic changes, mostly in epithelial tissues
Carcinoma in situ is a stage of dysplasia where cells exhibit malignant features. All cells are confined within the basement membrane but not the surrounding tissue
Dysplasia does not necessarily progress to invasion
Basement membrane integrity is significant as it prevents spread of abnormal cells

Rate of Growth

Malignant tumours exhibit fast growth, while benign tumours grow slowly
Features of rapid growth include frequent mitosis, necrosis, and ulceration

Local Invasion

Benign tumours are cohesive, expansile masses, localised, and cannot invade or metastasize
On the other hand, malignant tumours are invasive and aggressively spread into surrounding tissues

Metastasis

Metastasis refers to the spread of cancer cells from the primary tumour site to distant locations
It's a hallmark of malignant tumours.

Benign vs. Malignant

Benign tumours are classified as having slow growth, lack of invasion, and a non-metastatic nature
Malignant tumours are characterised by rapid growth, prominent invasion, and the significant potential for metastasis

Are Benign Tumours Always Harmless?

Benign tumours, despite being noninvasive, can cause harm from compressive effects leading to consequences like increased intracranial pressure.

Tumour Classification and Nomenclature

Tumours are broadly classified as benign or malignant, also classified by tissue/cell type of origin
Important due to differences in behaviour and clinical outcomes, with a standardised nomenclature crucial for communication and understanding
There is a standardised nomenclature that’s easy to learn and apply, helping ensure consistent classification and reporting in medical fields.

Histogenic Classification and Nomenclature

Tumour classification is based on tissue of origin, including epithelial tissues (endoderm, mesoderm, ectoderm) and non-epithelial tissues (mesenchymal, haematopoietic, neuroectodermal, germ cells, embryonal/mixed).

Epithelial Tumours

Epithelial tumours are classified based on the tissue of origin, with classifications based on the underlying cell structure
Types of epithelial tumours are classified as surface/non-glandular, or glandular/secretory epithelium

Benign Epithelial Tumours

Benign epithelial tumours exhibit naming conventions incorporating the tissue-of-origin suffix "-OMA"
Exceptions include certain cancers (melanoma, lymphoma, seminoma).

Benign Epithelial Tumours (Rules)

Benign tumors are given a name that combines the tissue type of the tumour and a specific naming suffix, often “-oma”

Benign Epithelial Tumours (Recap)

If arising from glandular epithelium, the tumour will be named with an adenoma
If arising from surface/non-glandular epithelial tissue, the tumour will be named using a papilloma

Benign Epithelial Tumor Examples

Names of benign epithelial tumors given by tissue of origin

Benign Mesenchymal Tumours

Benign mesenchymal tumours all have the "-OMA" suffix, preceded by the tissue/cell name
For example, a tumour of bone would be called an osteoma

Benign Mesenchymal Tumours (Examples)

Specific benign mesenchymal tumour examples based on tissue of origin

Malignant Epithelial Tumours

Malignant epithelial tumours are generally given the name "carcinoma" or "adenocarcinoma" depending on tissue of derivation

Malignant Epithelial Tumours (Recap)

Adenocarcinomas are malignant tumours coming from secretory/ductal epithelial lining in glands
Carcinomas are malignant tumours coming from surface/non-glandular epithelial tissue.

Malignant Epithelial Tumours (Examples)

Specific malignant epithelial tumour examples based on tissue of origin

Malignant Mesenchymal Tumours

Malignant mesenchymal tumours are termed sarcomas with prefixes given by the tissue of origin

Malignant Mesenchymal Tumours (Examples)

Specific malignant mesenchymal tumour examples based on tissue of origin

Examples of Other Tumour Types

Other types of tumours include teratomas (embryonic germ cell tumours arising from gonads), embryonal/mixed tumours, neuroectodermal tumours, and tumours with names that confound benign versus malignant classifications

Teratomas

Teratomas derive from germ cells, typically in the gonads, and have cells from all three germ layers (endoderm, mesoderm, and ectoderm).
Benign teratomas often display teeth, hair, or neural/cartilaginous material
Malignant teratomas are more primitive and heterogeneous.

Precursor Cell Tumours

Precursor cell tumours occur in younger individuals and often resemble embryonic tissues
Include retinoblastoma, nephroblastoma (Wilms), and hepatoblastoma

Precursor Cell Tumours (Can be Adult)

Precursor tumours can also occur in adults and have unique prefixes and suffixes based on the tissues of origin and classification.

Mixed Tumours

Mixed tumours are neoplasms containing elements from both epithelial and mesenchymal tissues
They often involve single cells that have a combined epithelial/mesenchymal cell lineage
Pleomorphic salivary adenomas are a benign example, but malignant potential may exist despite a benign classification

Neuroectodermal Tumours

Examples of neuroectodermal brain tumours include glioblastoma multiforme, astrocytoma, meningioma, neurinoma, ependymoma, oligoendroglioma, and medulloblastoma

Hamartomas and Choristomas

Hamartomas are non-neoplastic masses composed of a disordered collection of normal tissues native to the site
Choristomas are non-neoplastic collections of normal tissues not indigenous to the site

Malignant Tumours with Benign Names

Certain malignant tumours are commonly called using terms with benign descriptions

Eponymous Tumours (Examples)

List of a range of eponymously named tumors (tumour names with people's names).

Quick Quiz Answers

Answers to a selection of questions requiring an understanding of tumour nomenclature and definitions

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Description

Test your knowledge on various types of cancer, their risk factors, and tumor characteristics. This quiz covers exposure to carcinogens, differentiation in neoplastic tissues, and the classification of tumors. Dive into important concepts related to cancer biology and pathology.