Week 10 - Neoplasia

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?

They invade nearby tissues and can metastasize. Signup and view all the answers

Which of the following best describes the focus of oncology?

The study and treatment of tumors. Signup and view all the answers

How can malignant tumors ultimately arise?

From inherited or spontaneous genetic alterations. Signup and view all the answers

Which of the following sarcomas originates from connective tissues?

All of the above Signup and view all the answers

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

Leukemias Signup and view all the answers

Which characteristic does NOT differentiate benign tumors from malignant tumors?

Nutritional deficiency Signup and view all the answers

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

Sun exposure Signup and view all the answers

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

EBV infection Signup and view all the answers

Which group is more likely to develop acute leukemias?

Young children (under age 5) Signup and view all the answers

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

Thyroid carcinoma Signup and view all the answers

What is a common cancer associated with chronic liver conditions?

Hepatocellular carcinoma Signup and view all the answers

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

Barrett's esophagus Signup and view all the answers

Which cancer type is most commonly seen in young adults?

Acute myeloid leukemia Signup and view all the answers

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

Carcinomas Signup and view all the answers

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

Pre-neoplastic disorders Signup and view all the answers

Which cancer is most frequently diagnosed in older adults?

Chronic lymphocytic leukemia 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?

-sarcoma Signup and view all the answers

What type of tumors are leukemia and lymphoma?

Free, non-aggregated tumors of hematopoietic cells Signup and view all the answers

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

Reed-Sternberg cell Signup and view all the answers

What is a characteristic feature of Burkitt's lymphoma?

Found in the bones of the jaw Signup and view all the answers

What is the origin of Ewing's sarcoma?

Neural crest cells Signup and view all the answers

What type of tumor is a Brenner tumor?

A tumor of the stroma of the ovary Signup and view all the answers

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

They are derived from mature, differentiated cells. Signup and view all the answers

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

Teratoma Signup and view all the answers

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

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

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

It provides structural support for the tumor. Signup and view all the answers

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

Human chorionic gonadotropin (hCG) Signup and view all the answers

What type of tumor is a papilloma classified as?

A benign tumor of epithelial origin Signup and view all the answers

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

Kaposi's sarcoma Signup and view all the answers

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

Wilm's tumor Signup and view all the answers

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

Grawitz's tumor Signup and view all the answers

Which tumor affects the stroma of the thyroid gland?

Hürthle cell tumor Signup and view all the answers

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

Krukenberg's tumor Signup and view all the answers

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

Krukenberg's tumor Signup and view all the answers

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

The age group they typically affect Signup and view all the answers

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

Krukenberg's tumor Signup and view all the answers

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

Cells that have lost their normal structure and function Signup and view all the answers

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

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

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

Tumor cells directly infiltrating and destroying surrounding tissues Signup and view all the answers

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

The size and local extent of the primary tumor Signup and view all the answers

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

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

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

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

What does the M designation represent in tumor staging?

The presence of metastases Signup and view all the answers

Which staging stage is characterized by carcinoma in situ?

Stage 0 Signup and view all the answers

What does N1 indicate in lymph node staging?

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

Which type of spread is mainly associated with sarcomas?

Hematogenous spread Signup and view all the answers

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

Stage II Signup and view all the answers

In tumor staging, what does T0 signify?

No evidence of cancer Signup and view all the answers

What size range defines a T1b tumor?

Larger than 5 mm but 10 mm or smaller Signup and view all the answers

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

T4a Signup and view all the answers

What does the classification N0 represent in lymph node involvement?

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

What is the maximum size for a T1c tumor?

20 mm Signup and view all the answers

In which scenario would a tumor be classified as T3?

Larger than 50 mm Signup and view all the answers

What does the classification N2 indicate regarding lymph node spread?

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

Which classification represents inflammatory breast cancer?

T4d Signup and view all the answers

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

It is larger than 20 mm but not larger than 50 mm Signup and view all the answers

Which of the following viruses is associated with hepatocellular carcinoma?

Hepatitis B virus (HBV) Signup and view all the answers

What is a common clinical manifestation of neoplasia?

Fever Signup and view all the answers

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

All of the above Signup and view all the answers

What is a local manifestation of neoplasia?

Mass effect Signup and view all the answers

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

HHV-8 Signup and view all the answers

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

Alkylating and acylating agents Signup and view all the answers

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

Lung cancer Signup and view all the answers

Which of the following is NOT a known human carcinogen?

Vitamin C Signup and view all the answers

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

Promoting cell growth and division Signup and view all the answers

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

Leukemia Signup and view all the answers

What type of cancer is associated with aflatoxins?

Hepatocellular carcinoma Signup and view all the answers

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

HTLV-1 Signup and view all the answers

What is a key effect of UV radiation exposure?

Development of skin cancer Signup and view all the answers

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

Liver cancer Signup and view all the answers

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

X-ray radiation Signup and view all the answers

What type of cancer is associated with hypertrophic pulmonary osteoarthropathy?

Lung cancer 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?

Venous thrombosis Signup and view all the answers

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

Autoantibodies against tumor proteins cross-reacting with neural proteins Signup and view all the answers

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

Clubbing of the fingers Signup and view all the answers

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

Dermatomyositis/polymyositis Signup and view all the answers

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

Oncogenic DNA viruses 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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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.