Mechanisms of Cancer Spread and Staging

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Questions and Answers

What is the primary clinical application of prostate-specific antigen (PSA) in cancer diagnosis?

PSA is used as a tumor marker to indicate possible malignancy when elevated levels are detected.

How do molecular methods improve the prognosis assessment of malignancy?

Molecular methods identify genetic alterations associated with poor prognosis, aiding in treatment stratification.

What role does fine-needle aspiration play in tumor diagnosis?

Fine-needle aspiration allows for the extraction of cells and fluids for cytologic examination of tumors.

How does the detection of residual disease inform treatment efficacy in cancer patients?

Detecting small numbers of malignant cells can assess treatment effectiveness and monitor for tumor recurrence. Signup and view all the answers

What is the significance of BRCA-1 and BRCA-2 analysis in cancer risk assessment?

BRCA-1 and BRCA-2 analysis identifies hereditary predisposition to breast cancer, enabling family screening. Signup and view all the answers

What are the three primary routes of cancer dissemination?

Direct spread, lymphatic spread, and hematogenous spread. Signup and view all the answers

How does lymphatic spread differ from hematogenous spread in cancer?

Lymphatic spread typically involves transport to regional lymph nodes, while hematogenous spread occurs through the bloodstream to distant sites. Signup and view all the answers

Why is the biopsy of the sentinel lymph node significant in cancer staging?

It allows for accurate assessment of tumor metastasis to help determine the stage of the cancer. Signup and view all the answers

What is transcoelomic spread, and which cancer is commonly associated with it?

Transcoelomic spread is the dispersion of cancer into body cavities, commonly associated with ovarian carcinoma. Signup and view all the answers

Describe the role of angiogenesis in tumor growth.

Angiogenesis is the process by which tumors induce new blood vessel growth to access nutrients and facilitate waste removal. Signup and view all the answers

How does perineural spread present clinically?

Perineural spread typically presents as pain due to the invasion of nerves by tumor cells. Signup and view all the answers

Which organs are the most common sites for hematogenous metastases, and why?

The lung and liver are the most common sites for hematogenous metastases due to their vascular nature. Signup and view all the answers

What distinguishes new tumor vessels from normal vasculature?

New tumor vessels are typically dilated, leaky, and have slow, abnormal flow. Signup and view all the answers

What is the significance of tumor differentiation in tumor grading?

Tumor differentiation indicates how much a malignant tumor resembles its normal counterpart, influencing its growth rate and treatment response. Signup and view all the answers

Explain the components of the TNM staging system.

The TNM staging system includes T for tumor size and local invasion, N for regional lymph node involvement, and M for distant metastases. Signup and view all the answers

How does cancer cachexia affect patients physically?

Cancer cachexia leads to loss of body fat and lean mass, profound weakness, and is driven by inflammatory cytokines from tumor-related processes. Signup and view all the answers

What are the differences between Grade I and Grade III tumors?

Grade I tumors are well-differentiated (75% or more differentiated cells) and grow slowly, while Grade III tumors are poorly differentiated (less than 25% differentiated cells) and grow rapidly. Signup and view all the answers

What role do cytokines play in cancer cachexia?

Cytokines, mainly TNF, contribute to cancer cachexia by affecting appetite, fat metabolism, and muscle catabolism. Signup and view all the answers

What laboratory methods are primarily used for cancer diagnosis?

Histologic and cytologic methods are the primary laboratory techniques used for diagnosing cancer. Signup and view all the answers

Identify one paraneoplastic syndrome and its associated hormonal effect.

Hypoglycemia can occur due to insulin production by certain tumors, representing a paraneoplastic syndrome. Signup and view all the answers

Why is the histological examination essential in cancer diagnosis?

Histological examination is essential as it provides detailed information about tumor morphology, differentiation, and potential behavior. Signup and view all the answers

What clinical aspects may tumors of the GI tract cause?

Tumors of the GI tract may cause bowel obstruction, ulceration leading to bleeding, and pain. Signup and view all the answers

What is the impact of poorly differentiated tumors on cancer treatment?

Poorly differentiated tumors (Grade III) are usually more aggressive, faster-growing, and tend to be more radiosensitive. Signup and view all the answers

What role do proteases play in the process of angiogenesis?

Proteases release preformed angiogenic mediators, such as bFGF, from the extracellular matrix. Signup and view all the answers

How does downregulation of E-cadherins contribute to cancer metastasis?

Downregulation of E-cadherins reduces cellular cohesion, allowing tumor cells to dissociate and invade the extracellular matrix. Signup and view all the answers

What is the function of matrix metalloproteinase 9 (MMP9) in tumor invasion?

MMP9 degrades type IV collagen in the epithelial and vascular basement membrane, aiding in ECM degradation. Signup and view all the answers

Describe the significance of tumor cell adherence during vascular dissemination.

Tumor cell adherence to circulating leukocytes and platelets in the bloodstream aids in their embolization and eventual lodging in new sites. Signup and view all the answers

What factors influence where tumor cell emboli will lodge after dissemination?

Factors include vascular and lymphatic drainage from the primary tumor and interaction with specific receptors on tumor cells. Signup and view all the answers

How do chemotactic factors influence tumor cell migration?

Tumor cells migrate in response to chemotactic factors released by stromal cells and degraded ECM components. Signup and view all the answers

What is the primary purpose of grading and staging malignant tumors?

Grading and staging provide estimates of clinical gravity and prognostication for therapy planning. Signup and view all the answers

In what ways can the microenvironment of an organ affect tumor cell penetration?

The microenvironment can resist tumor cell penetration if it is rich in protease inhibitors. Signup and view all the answers

What is the relevance of high endothelial venules in lymph nodes to tumor metastasis?

Certain tumor cells express adhesion molecules that allow them to bind to high endothelial venules in lymph nodes. Signup and view all the answers

What is the relationship between ECM attachment and invasion by tumor cells?

Invading tumor cells must express adhesive molecules to interact with the ECM for successful invasion. Signup and view all the answers

Study Notes

Mechanisms of Cancer Spread, Grading, and Staging

ILOS: Students will be able to delineate pathways of spread related to tumor subtypes and correlate tumor grading/staging with prognosis.

Pathways of Cancer Spread

Direct spread: Tumors invade nearby structures due to lack of a capsule.
Lymphatic spread: Tumor cells travel to regional lymph nodes (and throughout the body) through lymphatic vessels. Lymph nodes draining tumors are often enlarged, potentially from metastatic cells or reactive hyperplasia. Biopsy of the sentinel lymph node can assess metastasis. Carcinomas commonly metastasize via lymphatics before hematogenous spread.
Hematogenous spread: Common in sarcomas and some carcinomas (e.g., renal). Tumor cells travel through the bloodstream, often preferentially through veins due to thinner walls compared to arteries. Common metastatic sites include lungs and liver, following venous flow patterns.
Seeding of body cavities and surfaces (Transcoelomic spread): Cancer cells disperse into the peritoneal, pleural, pericardial, or joint spaces. Often seen in ovarian cancer. Pseudomyxoma peritonei is a mucus-secreting appendiceal carcinoma that can fill the abdominal cavity with a gelatinous mass.
Perineural spread: Cancer cells invade nerve tissue, often causing pain.

Mechanisms of Spread

Angiogenesis: Tumors require nutrients and waste removal, requiring new blood vessels (angiogenesis). Tumor vessels are often more dilated and permeable than normal blood vessels. Endothelial growth factors like VEGF and bFGF are involved in tumor angiogenesis.

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Description

This quiz covers the mechanisms of cancer spread, grading, and staging. Students will learn about direct invasion, lymphatic, hematogenous spread, and how these pathways relate to tumor prognosis. Understanding these mechanisms is crucial for correlating tumor characteristics with patient outcomes.