Week 10 - Neoplasia
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Questions and Answers

What is the primary characteristic of benign tumors?

  • They are localized and amenable to surgical removal. (correct)
  • They metastasize to distant sites.
  • They cause death in most patients.
  • They invade surrounding tissues aggressively.

    • Which suffix is commonly used to name benign tumors?

  • -carcinoma
  • -itis
  • -oma (correct)
  • -sarcoma

    • What does the term neoplasm refer to?

  • A localized tumor that can be removed surgically.
  • An abnormal mass of tissue with uncontrolled growth. (correct)
  • A type of malignant tumor.
  • Any swelling in the body.

    • What is a defining feature of malignant tumors?

    <p>They invade nearby tissues and can metastasize.</p> Signup and view all the answers

    Which of the following best describes the focus of oncology?

    <p>The study and treatment of tumors.</p> Signup and view all the answers

    How can malignant tumors ultimately arise?

    <p>From inherited or spontaneous genetic alterations.</p> Signup and view all the answers

    Which of the following sarcomas originates from connective tissues?

    <p>All of the above</p> Signup and view all the answers

    What term is used to describe tumors originating from blood-forming cells?

    <p>Leukemias</p> Signup and view all the answers

    Which characteristic does NOT differentiate benign tumors from malignant tumors?

    <p>Nutritional deficiency</p> Signup and view all the answers

    Which factor is associated with an increased risk of developing skin cancer?

    <p>Sun exposure</p> Signup and view all the answers

    What type of cancer is Burkitt's lymphoma associated with?

    <p>EBV infection</p> Signup and view all the answers

    Which group is more likely to develop acute leukemias?

    <p>Young children (under age 5)</p> Signup and view all the answers

    Which type of cancer is least likely to appear in children aged 5-9?

    <p>Thyroid carcinoma</p> Signup and view all the answers

    What is a common cancer associated with chronic liver conditions?

    <p>Hepatocellular carcinoma</p> Signup and view all the answers

    Which precancerous condition is associated with the development of adenocarcinoma of the esophagus?

    <p>Barrett's esophagus</p> Signup and view all the answers

    Which cancer type is most commonly seen in young adults?

    <p>Acute myeloid leukemia</p> Signup and view all the answers

    Which type of cancer is commonly linked to dysplasia of epithelial tissues?

    <p>Carcinomas</p> Signup and view all the answers

    Which condition is classified as an autosomal recessive syndrome that leads to defective DNA repair?

    <p>Pre-neoplastic disorders</p> Signup and view all the answers

    Which cancer is most frequently diagnosed in older adults?

    <p>Chronic lymphocytic leukemia</p> Signup and view all the answers

    What is the correct suffix to add to a cell type to form a malignant tumor of mesodermal origin?

    <p>-sarcoma</p> Signup and view all the answers

    What type of tumors are leukemia and lymphoma?

    <p>Free, non-aggregated tumors of hematopoietic cells</p> Signup and view all the answers

    What is the typical cell type found in Hodgkin's lymphoma?

    <p>Reed-Sternberg cell</p> Signup and view all the answers

    What is a characteristic feature of Burkitt's lymphoma?

    <p>Found in the bones of the jaw</p> Signup and view all the answers

    What is the origin of Ewing's sarcoma?

    <p>Neural crest cells</p> Signup and view all the answers

    What type of tumor is a Brenner tumor?

    <p>A tumor of the stroma of the ovary</p> Signup and view all the answers

    Which of the following is NOT a characteristic of tumors of primordial cells?

    <p>They are derived from mature, differentiated cells.</p> Signup and view all the answers

    What type of tumor is characterized by the presence of mature tissue from all germ layers?

    <p>Teratoma</p> Signup and view all the answers

    Which of the following is TRUE about tumors of differentiated cells?

    <p>They account for a significant majority of cancer-related deaths.</p> Signup and view all the answers

    Which of the following is a TRUE statement regarding the stroma of a tumor?

    <p>It provides structural support for the tumor.</p> Signup and view all the answers

    Which of the following is a potential marker produced by tumors derived from totipotential cells?

    <p>Human chorionic gonadotropin (hCG)</p> Signup and view all the answers

    What type of tumor is a papilloma classified as?

    <p>A benign tumor of epithelial origin</p> Signup and view all the answers

    What type of tumor is associated with a concomitant infection with HHV-8?

    <p>Kaposi's sarcoma</p> Signup and view all the answers

    Which tumor is characterized by its origin in embryology and is typically found in young children?

    <p>Wilm's tumor</p> Signup and view all the answers

    Which tumor is specifically linked to cigarette smoking and other carcinogens?

    <p>Grawitz's tumor</p> Signup and view all the answers

    Which tumor affects the stroma of the thyroid gland?

    <p>Hürthle cell tumor</p> Signup and view all the answers

    Which tumor represents a secondary carcinoma of the ovary originating from a primary gastric carcinoma?

    <p>Krukenberg's tumor</p> Signup and view all the answers

    Which of the following tumors is NOT a primary tumor of the organ it affects?

    <p>Krukenberg's tumor</p> Signup and view all the answers

    What is the primary distinction between Grawitz's tumor and Wilm's tumor?

    <p>The age group they typically affect</p> Signup and view all the answers

    Which tumor exhibits adenocarcinoma cells with a characteristic appearance similar to gastric carcinoma?

    <p>Krukenberg's tumor</p> Signup and view all the answers

    What does the term 'anaplastic' describe in tumor grading?

    <p>Cells that have lost their normal structure and function</p> Signup and view all the answers

    What is the primary reason for the necrotic center in rapidly growing malignant tumors?

    <p>The tumor's rapid growth outpaces the development of adequate blood supply</p> Signup and view all the answers

    What is the primary characteristic of 'local invasion' in the context of tumor spread?

    <p>Tumor cells directly infiltrating and destroying surrounding tissues</p> Signup and view all the answers

    How does the TNM classification system categorize tumors based on 'T'?

    <p>The size and local extent of the primary tumor</p> Signup and view all the answers

    What is the primary role of angiogenesis factors in tumor growth?

    <p>Stimulating the production of new blood vessels to provide nourishment to the tumor</p> Signup and view all the answers

    Which statement best describes the concept of 'clonal expansion' in tumor development?

    <p>The process of a single cell undergoing multiple rounds of division, forming a population of identical cells</p> Signup and view all the answers

    What does the M designation represent in tumor staging?

    <p>The presence of metastases</p> Signup and view all the answers

    Which staging stage is characterized by carcinoma in situ?

    <p>Stage 0</p> Signup and view all the answers

    What does N1 indicate in lymph node staging?

    <p>Metastasis present in a small number of regional lymph nodes</p> Signup and view all the answers

    Which type of spread is mainly associated with sarcomas?

    <p>Hematogenous spread</p> Signup and view all the answers

    Which stage of cancer typically involves aggressive treatment such as chemotherapy, radiation, or surgery?

    <p>Stage II</p> Signup and view all the answers

    In tumor staging, what does T0 signify?

    <p>No evidence of cancer</p> Signup and view all the answers

    What size range defines a T1b tumor?

    <p>Larger than 5 mm but 10 mm or smaller</p> Signup and view all the answers

    Which classification indicates a tumor that has invaded the chest wall?

    <p>T4a</p> Signup and view all the answers

    What does the classification N0 represent in lymph node involvement?

    <p>No cancer or smaller than 0.2 mm in the lymph nodes</p> Signup and view all the answers

    What is the maximum size for a T1c tumor?

    <p>20 mm</p> Signup and view all the answers

    In which scenario would a tumor be classified as T3?

    <p>Larger than 50 mm</p> Signup and view all the answers

    What does the classification N2 indicate regarding lymph node spread?

    <p>Spread to 4 to 9 axillary lymph nodes or internal mammary lymph nodes</p> Signup and view all the answers

    Which classification represents inflammatory breast cancer?

    <p>T4d</p> Signup and view all the answers

    If a tumor is classified as T2, what can be inferred about its size?

    <p>It is larger than 20 mm but not larger than 50 mm</p> Signup and view all the answers

    Which of the following viruses is associated with hepatocellular carcinoma?

    <p>Hepatitis B virus (HBV)</p> Signup and view all the answers

    What is a common clinical manifestation of neoplasia?

    <p>Fever</p> Signup and view all the answers

    Which of the following paraneoplastic syndromes is associated with small cell carcinoma of the lungs?

    <p>All of the above</p> Signup and view all the answers

    What is a local manifestation of neoplasia?

    <p>Mass effect</p> Signup and view all the answers

    Which of the following viruses is associated with Kaposi's sarcoma?

    <p>HHV-8</p> Signup and view all the answers

    Which of the following is a type of chemical carcinogen that directly damages DNA?

    <p>Alkylating and acylating agents</p> Signup and view all the answers

    Which type of cancer is associated with exposure to cigarette smoke?

    <p>Lung cancer</p> Signup and view all the answers

    Which of the following is NOT a known human carcinogen?

    <p>Vitamin C</p> Signup and view all the answers

    What is the primary mechanism by which carcinogens lead to cancer?

    <p>Promoting cell growth and division</p> Signup and view all the answers

    Which of the following is a potential consequence of exposure to alkylating and acylating agents?

    <p>Leukemia</p> Signup and view all the answers

    What type of cancer is associated with aflatoxins?

    <p>Hepatocellular carcinoma</p> Signup and view all the answers

    Which of the following is a viral carcinogen associated with a human malignancy?

    <p>HTLV-1</p> Signup and view all the answers

    What is a key effect of UV radiation exposure?

    <p>Development of skin cancer</p> Signup and view all the answers

    Which of the following conditions is NOT associated with nuclear fallout?

    <p>Liver cancer</p> Signup and view all the answers

    Which physical carcinogen is associated with skin cancer in individuals exposed to it?

    <p>X-ray radiation</p> Signup and view all the answers

    What type of cancer is associated with hypertrophic pulmonary osteoarthropathy?

    <p>Lung cancer</p> Signup and view all the answers

    Which of the following is a clinical sign of advanced malignancy that is specifically associated with carcinoma of the pancreas?

    <p>Venous thrombosis</p> Signup and view all the answers

    What is the mechanism by which cerebral and cerebellar degeneration occurs in certain types of cancer?

    <p>Autoantibodies against tumor proteins cross-reacting with neural proteins</p> Signup and view all the answers

    Which of the following conditions is NOT associated with an increased risk of developing cancer?

    <p>Clubbing of the fingers</p> Signup and view all the answers

    Which of the following conditions is characterized by cytotoxic T cells targeting an unknown autoantigen?

    <p>Dermatomyositis/polymyositis</p> Signup and view all the answers

    HPV (Human papilloma), EBV (Epstein-Barr), and HBV (Hepatitis B) are classified as which kind of viral carcinogen?

    <p>Oncogenic DNA viruses</p> Signup and view all the answers

    Study Notes

    Neoplasia

    • Neoplasia literally means "the production of new growth" and produces a neoplasm.
    • A neoplasm is an abnormal mass of tissue that grows excessively and uncontrollably, even after the initial stimulus is removed.

    Classification of Neoplasms

    • Benign tumors:
      • Stay localized and do not spread to other sites
      • Can be removed surgically and rarely cause death
      • Designated by attaching the suffix "-oma" to the name of the cell type from which the tumor originates (e.g., fibroma, chondroma)
    • Malignant tumors:
      • Progressively invade and infiltrate surrounding tissue
      • Capable of metastasizing and causing death
      • Caused by genetic alterations (mutations or epigenetic modifications) in key genes regulating cellular processes

    Characteristics of Benign and Malignant Tumors

    • Tissue differentiation
    • Rate of growth
    • Local effects
    • Distant spread

    Epidemiology of Neoplasms

    • Distribution and patterns of disease conditions
    • Incidence
    • Mortality

    Geographic and Environmental Influences

    • Sun exposure and skin cancer (higher in white populations in Australia, Northern Europe, US, and Canada)
    • EBV and malaria (associated with Burkitt's lymphoma)
    • Hepatocellular carcinoma (associated with HepB virus, aflatoxin, and other factors)
    • Young children (under 5): acute leukemias and malignancies of primordial cells
    • Children (5-9): leukemias, neuroblastomas, retinoblastomas, hepatomas, soft tissue sarcomas, and osteogenic sarcoma
    • Children (9-14): hepatosarcomas, osteogenic sarcomas, thyroid carcinoma, and Hodgkin's lymphoma
    • Young adults: Hodgkin's lymphoma, acute myeloid leukemia, and seminoma of the testis
    • Middle-aged adults: carcinomas, chronic myeloid leukemia, and lymphomas
    • Older adults: carcinomas, chronic lymphocytic leukemia, lymphoma, and osteogenic sarcoma

    Inherited Predisposition to Cancer

    • Familial cancers
    • Autosomal recessive syndromes (defective DNA repair)
    • Pre-neoplastic disorders (e.g., gastric atrophy, actinic dermatitis, Barrett's esophagus, cirrhosis of the liver, Paget's disease of bone)
    • Dysplasias of epitheliums (precursors to carcinomas)
    • Immunodeficiency states and autoimmune diseases (associated with lymphomas)

    Components of Neoplasms

    • Neoplasms consist of two basic components: parenchyma and stroma
    • Parenchyma is made up of transformed or neoplastic cells, determines biologic behavior, and is the basis for the tumor's name
    • Stroma includes non-neoplastic supporting cells, connective tissue, host-derived blood vessels, and host-derived inflammatory cells

    Classification of Cells by Differentiation Potential

    • Totipotential cells: can produce all differentiated cells in an organism, only present in zygotes, can be reprogrammed
    • Pluripotential cells: can produce cells from all germ layers
    • Differentiated cells: specialized cells with specific functions
    • Permanent cells: fully differentiated cells that can no longer divide

    Neoplasms of Totipotential Cells

    • Malignant, slow-growing, and may metastasize retroperitoneally
    • Produce pregnancy-type markers like placental alkaline phosphate and hCG
    • Account for 95% of testicular tumors and 25% of ovarian tumors
    • Types:
      • Benign: dermoid cyst, mature tissue from all germ layers
      • Immature: malignant, minimally differentiated
      • Sacrococcygeal and cervical tumors in fetus and newborns

    Tumors of Primordial Cells

    • Highly malignant
    • Manifest clinically under the age of 5 years
    • Linked to mutations in tumor suppressor genes
    • Types:
      • Blastoma: tumors of primitive organ anlage cells

    Tumors of Differentiated Cells

    • Epithelial origin:
      • Benign: papilloma, polyp, or adenoma
      • Malignant: carcinoma, accounts for over 80% of cancer-related deaths
    • Mesodermal origin:
      • Benign: add -oma to cell type
      • Malignant: add sarcoma to cell type
    • Hematopoietic origin:
      • Leukemia: free, non-aggregated tumors
      • Lymphoma: aggregated tumors of lymphoid cells in lymph nodes
      • Plasmocytoma and multiple myeloma: tumors of plasma cells in bone marrow
    • Neuroectodermal origin:
      • Glioblastoma multiforme: multiple distinct neuroectodermal cell types

    Exceptions to Naming of Neoplasms

    • Benign tumors with malignant-sounding names: osteoblastoma, chondroblastoma
    • Malignant tumors with benign-sounding names: lymphoma, glioma, melanoma, plasmacytoma

    Eponymous Neoplasms

    • Ewing's sarcoma: tumor of bone, likely of neural crest origin
    • Hodgkin's lymphoma: malignant tumor of lymphocytes in lymph nodes, likely of T cell origin
    • Brenner tumor: tumor of the ovarian stroma, not of germ cells or germinal epithelium
    • Burkitt's lymphoma: B cell lymphoma, associated with Epstein-Barr virus and chronic malaria
    • Kaposi's sarcoma: angiosarcoma of vessels in the dermis, associated with HIV infection and HHV-8
    • Wilms' tumor (nephroblastoma): malignant tumor of the kidney, seen in young children
    • Grawitz's tumor (hypernephroma): malignant tumor of the kidney, seen in older individuals, associated with carcinogens
    • Hürthle cell tumor: tumor of the thyroid gland stroma
    • Krukenberg's tumor: secondary carcinoma of the ovary, originated from a primary gastric carcinoma

    Classification of Tumors

    • Grading of tumors based on differentiation of cells: Grade 1 (well-differentiated) to Grade 4 (anaplastic)
    • Tumor cells are monoclonal, descended from a single ancestor cell
    • Multiple cofactors contribute to transformation of normal cell line into malignant cell
    • Clonal expansion leads to uncontrolled proliferation and tumor cell variation

    TNM Classification

    Tumor Growth (T)

    • Local tumor size: measured in millimeters
    • Tumor growth factors: fast and slow growth
    • The Nourishment of Tumors: angiogenesis factors produce new blood vessels
    • Benign tumors grow slowly, malignant tumors grow rapidly and outgrow blood supply

    Tumor Spread

    • Local invasion: direct spread of tumor
    • Lymphatic spread: typical of carcinomas, metastasis to lymph nodes and organs
    • Hematogenous spread: typical of sarcomas, metastasis to lungs, liver, bones, brain, and peritoneum
    • Transcoelomic spread: through cavities, mostly peritoneal or pleural

    Lymph Node Involvement (N)

    • Nx: lymph nodes cannot be assessed
    • N0: no regional lymph node metastasis
    • N1: regional lymph node metastasis present, sentinel node
    • N2: tumor spread to an extent between N1 and N3 (not used at all sites)
    • N3: tumor spread to more distant or numerous regional lymph nodes

    Metastases (M)

    • M0: no metastases
    • M1: metastases are present

    Staging of Tumors

    • Stage 0: carcinoma in situ, abnormal cells growing in their normal place
    • Stage I: localized to one part of the body, attempt surgical removal (if small enough and N0 or excisable N1)
    • Stage II: locally advanced, chemotherapy, radiation, or surgery
    • Stage III: locally advanced with extended N, chemotherapy, radiation, surgery combo
    • Stage IV: cancers have metastasized

    Example: Breast Cancer

    Tumor Size (T)

    • T0: no evidence of cancer in the breast
    • Tis: carcinoma in situ, confined within ducts of breast tissue
    • T1: < 20 mm in size at its widest area, subcategories: T1mi, T1a, T1b, T1c
    • T2: larger than 20 mm but not larger than 50 mm
    • T3: larger than 50 mm
    • T4: tumor has grown into chest wall or skin, inflammatory breast cancer

    Node (N)

    • NX: lymph nodes were not evaluated
    • N0: no cancer or smaller than 0.2 mm in lymph nodes
    • N1: cancer has spread to 1 to 3 axillary lymph nodes and/or internal mammary lymph nodes
    • N2: cancer has spread to 4 to 9 axillary lymph nodes or internal mammary lymph nodes
    • N3: cancer has spread to 10 or more axillary lymph nodes or infra- or supra-clavicular lymph nodes

    Human Carcinogens

    • Human carcinogens lead to inheritable gene mutations that affect cell cycle or apoptosis
    • Types of human carcinogens: Clinical studies, Epidemiological studies, Experimental studies

    Chemical Carcinogens

    • Polycyclic hydrocarbons: associated with scrotal cancer in chimney sweeps, produces problems at local site only
    • Alkylating and acylating agents: direct DNA damage, produce leukemia later on, used as anticancer drugs
    • Cigarette smoke: associated with oral, laryngeal, lung, bladder, and pancreatic cancer
    • Aromatic amines: produce problems at distant sites, such as bladder cancer
    • Cyclamates: some artificial sweeteners, like saccharin
    • Azodyes: usually occupational, produce bladder and liver cancer, e.g., "Butter yellow" food additive
    • Nitrosamines: may be associated with stomach cancer
    • Aflatoxin: naturally occurring, associated with hepatocellular carcinoma, produced by mold on grain and peanuts
    • Betel nut: chewed in Sri Lanka and India, produces oral cancer
    • Safrole: found in sassafras oil, brown camphor oil, anise, nutmeg, cinnamon, and black pepper
    • Vinyl Chloride, Ni, Cr: chemical carcinogens

    Physical Carcinogens

    • U.V. radiation: associated with skin cancer
    • X-ray radiation: associated with leukemias and skin cancer in exposed skin
    • Radio-isotopes: affect response based on penetration, energy, and individual exposure
    • Natural sources: Uranium, Thorium, radon
    • Radioactive iodine: associated with thyroid cancer
    • Nuclear fallout: particularly associated with leukemias and thyroid cancer if radioactive iodine is present

    Viral Carcinogens

    • Oncogenic RNA viruses:
      • HTLV-1: Human T cell Leukemia Virus, associated with T cell leukemia
      • HTLV-3 (HIV)
      • Hepatitis C virus: produces hepatocellular carcinoma
    • Oncogenic DNA viruses:
      • Human papilloma virus (HPV):
        • Benign tumors: warts, condylomas
        • Cancer of the uterine cervix
      • Epstein-Barr virus (EBV, HV-4):
        • Burkitt's lymphoma
        • Nasopharyngeal carcinoma in Chinese
      • HHV-8:
        • Kaposi's sarcoma, particularly in patients with AIDS acquired by homosexual transmission
      • Hepatitis B virus (HBV): Hepatocellular carcinoma in cases of chronic liver infection

    Clinical Manifestations of Neoplasia

    Local Manifestations

    • Mass effect
    • Compression or erosion of normal tissue
    • Ulceration of a surface
    • Erosion of a blood vessel producing a hemorrhage
    • Examples:
      • Pancoast’s tumor: Erosion of lower trunk of brachial plexus
      • Horner’s syndrome: Sympathetic Chain Erosion
      • Obstruction of a tube:
        • Superior Vena Cava Compression
        • Bronchial obstruction

    Systemic Effects

    • Fever
    • Anorexia and weight loss: Cachexia
    • Infections
    • Anemia

    Paraneoplastic Syndromes

    • Endocrinopathies:
      • Cushing’s syndrome: produced by small cell carcinoma of the lungs, pancreatic carcinoma, and neural tumors
      • Inappropriate ADH secretion: produced by small cell carcinoma of the lungs and intracranial neoplasms
      • Hypercalcemia: produced by squamous cell carcinoma of the bronchus, breast carcinoma, and renal carcinoma
      • Carcinoid syndrome: produced by bronchial carcinoid tumors, gastrointestinal carcinoid tumors, and pancreatic carcinoma
      • Polycythemia: produced by renal carcinoma, hepatocellular carcinoma, and cerebellar hemangioma
    • Nerve and Muscle syndromes:
      • Myasthenia Gravis: associated with tumors of the thymus gland
      • Myasthenic (Lambert-Eaton) syndrome: associated with small cell carcinoma of the lungs
      • Peripheral neuropathies: associated with lung carcinomas and some others
      • Cerebral and cerebellar degeneration: associated with a number of different types of malignancy
    • Osseous, articular, and soft tissues:
      • Clubbing of the fingers & fingernails: associated with hypoxia (respiratory or cardiac)
      • Hypertrophic pulmonary osteoarthropathy: associated with bronchogenic carcinoma
    • Hematologic:
      • Venous thrombosis (Trousseau’s sign): associated with carcinoma of the pancreas and other malignancy
      • Non-bacterial thrombotic endocarditis: in many different advanced malignancies

    Cancer Warning Signs

    • C: Change in bowel or bladder habits
    • A: Anemia of unexplained cause
    • U: Unusual bleeding or discharge (breast, intestinal, cervical, uterine)
    • T: Thickening or lump in the breast or elsewhere
    • I: Indigestion or difficulty swallowing
    • O: Obvious changes in a wart or a mole or a sore that doesn’t heal
    • N: Nagging cough or hoarseness of the voice

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    Related Documents

    Neoplasia PDF - Text Book Chapter 6
    Neoplasms Classification PDF
    Tumors PDF
    Human Carcinogens PDF

    Description

    Understand the concepts of neoplasia, including nomenclature, epidemiology, classification, metastasis, molecular genetics, epigenetic changes, carcinogenic agents, clinical aspects, and diagnosis from a pathology textbook.

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