AP10: ST Flashcards by S F

MCQ - What are the two major causes of cancer-related morbidity and mortality? Options: A. Hyperplasia and Dysplasia B. Atrophy and Metaplasia C. Invasion and Metastasis D. Inflammation and Necrosis

C. Invasion and Metastasis

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Fill in the blank - The process known as the metastatic cascade is divided into two phases: invasion of the ______ and vascular dissemination.

Extracellular matrix (ECM)

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MCQ - Which of the following is considered the single most important clinicopathological criterion of malignancy? Options: A. Tumour size B. Invasion C. Rate of mitosis D. Cellular pleomorphism

B. Invasion

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FFQ - Describe the four steps involved in the active process of invading the extracellular matrix (ECM).

Loosening of intercellular junctions, degradation of ECM by proteolytic enzymes (MMPs), attachment to remodelled ECM components, and migration and invasion.

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Fill in the blank - Invasion within epithelial structures that does not bridge the basement membrane is referred to as ______ infiltration.

Pagetoid

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MCQ - At which sites does local tumour invasion typically occur most readily? Options: A. Areas of dense fibrous tissue B. Bone and cartilage C. Tissue planes offering the least resistance (perineurial and perivascular) D. Heavily keratinised epithelial surfaces

C. Tissue planes offering the least resistance (perineurial and perivascular)

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MRQ - Which factors influence the ability of a neoplastic cell to invade local tissues? Options: A. Secretion of proteolytic enzymes B. Decreased cellular adhesion C. Increased cellular apoptosis D. Abnormal or increased cell motility

A, B, D

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FFQ - Why is invasion relatively easy to recognise in epithelial tumours compared to connective tissue tumours?

Epithelial tumours have a basement membrane as a clear boundary; connective tissue tumours require evidence of vascular or lymphatic permeation.

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Fill in the blank - Matrix ______ (MMPs) are the primary enzymes responsible for the degradation of the ECM during tumour invasion.

Metalloproteinases

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MCQ - Tumour fixation to the skin or underlying tissue is a clinical sign of: Options: A. Benign growth B. Local spread and invasion C. Systemic cachexia D. Paraneoplastic syndrome

B. Local spread and invasion

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MCQ - Which term describes the preference of particular tumours to metastasise to specific tissues? Options: A. Anaplasia B. Tropism C. Desmoplasia D. Carcinogenesis

B. Tropism

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Fill in the blank - Most metastases occur in the first ______ available to the tumour, which explains the high frequency of spread to the liver and lungs.

Capillary bed

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MRQ - Identify the sequential steps in the metastatic sequence. Options: A. Detachment of tumour cells B. Intravasation into vessel lumens C. Immediate apoptosis in the bloodstream D. Evasion of host defences (NK and T cells)

A, B, D

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FFQ - Explain how the anatomic location and vascular drainage of a primary tumour influence the site of metastasis.

Spread is determined by venous or lymphatic drainage; e.g., bowel tumours spread to liver via portal vein.

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MCQ - Which type of malignancy preferentially spreads via the haematogenous (bloodborne) route? Options: A. Carcinomas B. Sarcomas C. Papillomas D. Adenomas

B. Sarcomas

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MCQ - Which route of metastasis is most common for carcinomas (epithelial malignancies) at an early stage? Options: A. Haematogenous spread B. Implantation C. Lymphatic spread D. Transcoelomic spread

C. Lymphatic spread

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Fill in the blank - In lymphatic spread, tumour cells enter the node via an ______ channel and typically settle and grow in the periphery of the node first.

Afferent

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MRQ - What are the common sites of primary tumours that metastasise to bone? Options: A. Breast and Prostate B. Lung and Kidney C. Ovary and Spleen D. Thyroid

A, B, D

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FFQ - What is transcoelomic spread, and what is its most common clinical manifestation?

Spread across pleural, pericardial, or peritoneal cavities; leads to neoplastic effusion such as ascites.

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Fill in the blank - The accidental spillage of tumour cells during the course of surgery can lead to metastasis via ______.

Implantation

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MRQ - Benign tumours may cause significant clinical problems due to: Options: A. Pressure on adjacent tissues B. Rapid distant metastasis C. Production of hormones D. Obstruction to fluid flow

A, C, D

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Fill in the blank - Signs and symptoms that cannot be explained by the anatomic distribution of a tumour or indigenous hormone production are called ______ syndromes.

Paraneoplastic

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MCQ - What is the most common paraneoplastic endocrinopathy? Options: A. Hypoglycaemia B. Hypercalcaemia C. Cushing syndrome D. Hyperthyroidism

B. Hypercalcaemia

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FFQ - List three reasons why it is important to recognise paraneoplastic syndromes.

They may be early signs of cancer, cause serious complications, or mimic metastasis.

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MRQ - Which of the following are examples of paraneoplastic syndromes? Options: A. Acanthosis nigricans (Dermatologic) B. Myasthenia gravis (Nerve/Muscle) C. Clubbing (Hypertrophic osteoarthropathy) D. Direct compression of the spinal cord

A, B, C

MCQ - Surface ulceration caused by malignant tumours often leads to: Options: A. Hormone overproduction B. Bleeding and infection C. Distant tropism D. Improved prognosis

B. Bleeding and infection

Fill in the blank - The systemic wasting or loss of body mass associated with malignancy is known as ______.

Cachexia

MCQ - What is the basis for the grading of a cancer? Options: A. The size of the primary lesion B. The presence of lymph node involvement C. The degree of differentiation of the tumour cells D. The extent of distant metastases

C. The degree of differentiation of the tumour cells

Fill in the blank - The Gleason grading system is specifically used to evaluate ______ adenocarcinoma.

Prostate

MCQ - The staging of solid cancers is based on which of the following? Options: A. Resemblance to normal tissue B. The number of mutations in the DNA C. Size of primary lesion, node involvement, and blood-borne metastases D. The patient's age and ethnicity

C. Size of primary lesion, node involvement, and blood-borne metastases

Fill in the blank - The standard staging system used by the AJCC is the TNM system, where N stands for regional ______ involvement.

Lymph node

MCQ - A tumour staged as T2 N1 M0 indicates: Options: A. Small tumour, no node involvement, distant metastasis B. Medium tumour, regional node involvement, no distant metastasis C. Large tumour, multiple node involvements, multiple metastases D. In situ tumour, no nodes, no metastases

B. Medium tumour, regional node involvement, no distant metastasis

FFQ - Contrast the utility of morphological methods (biopsy) versus biochemical assays (tumour markers) in cancer management.

Morphology confirms diagnosis; tumour markers are used for screening, monitoring therapy, or detecting recurrence.

MRQ - Which of the following are morphological methods used for cancer diagnosis? Options: A. Fine Needle Aspiration (FNA) B. Immunohistochemistry C. Vanillyl mandelic acid blood assay D. Cytology (e.g., Pap smear)

A, B, D

MCQ - Which tumour marker is associated with hepatocellular carcinoma and certain germ cell tumours? Options: A. Carcinoembryonic antigen (CEA) B. Alpha-fetoprotein (AFP) C. Human chorionic gonadotrophin (hCG) D. Vanillyl mandelic acid

B. Alpha-fetoprotein (AFP)

Fill in the blank - The tumour marker used for monitoring gastrointestinal adenocarcinomas is ______.

Carcinoembryonic antigen (CEA)

MCQ - In urine, the presence of Bence Jones protein (immunoglobulin light chains) is a marker for: Options: A. Choriocarcinoma B. Myeloma C. Neuroendocrine tumours D. Phaeochromocytoma

B. Myeloma

MRQ - Which factors are used as prognostic indices for malignant tumours? Options: A. Tumour type B. Grade and Stage C. Molecular pathological features D. The laboratory location

A, B, C

Fill in the blank - Human chorionic gonadotrophin (hCG) is a marker found in the blood or urine of patients with ______ or germ cell tumours.

Choriocarcinoma

FFQ - Briefly summarise the steps tumour cells must take to survive in the vasculature during metastasis.

Evade immune cells, adhere to endothelium, extravasate into tissue and survive.

Fill in the blank - The preferred route of metastasis of carcinomas is via the ______.

Lymphatics

Fill in the blank - In the TNM staging system, T refers to ______.

Tumour size

MCQ - Metastasis to bone via the haematogenous route is unlikely to originate from which primary organ: Lung, Breast, Prostate, or Brain?

Brain

Sequencing - Arrange the steps of the metastatic cascade in the correct sequence.

1. Detachment, 2. Invasion of connective tissue, 3. Intravasation, 4. Evasion of host defense, 5. Adherence to endothelium, 6. Extravasation, 7. Growth

MCQ - What does pagetoid spread of a tumour refer to?

Invasion of epithelial structures without breaching the basement membrane

MCQ - Which of the following is a prognostic factor in most neoplasms?

Degree of differentiation (grade)

MCQ - Which statement regarding the clinical presentation of tumours is FALSE?

Exophytic, ulcerated and fungating tumours are usually benign

MCQ - Which of the following does NOT form part of the metastatic sequence?

Invasion of cells into the vessel lumen at a distant site

MCQ - Which statement regarding lymphatic metastases is INCORRECT?

Lymphatic metastases usually involve the liver, lung and bone

MCQ - A 55-year-old patient with colon cancer presents with multiple nodules in the liver. Which vascular conduit is the most likely route for this specific spread? Options: A. Systemic Arteries B. Portal Vein C. Thoracic Duct D. Inferior Vena Cava

B. Portal Vein

MCQ - Which enzyme family is primarily responsible for the degradation of the extracellular matrix to facilitate local invasion? Options: A. Caspases B. Matrix Metalloproteinases (MMPs) C. Polymerases D. Lipases

B. Matrix Metalloproteinases (MMPs)

True/False - Paraneoplastic syndromes are always caused by the direct anatomic distribution of the tumour or its metastases.

False

True/False - In epithelial tumours, invasion is easier to recognize because the basement membrane serves as a clear demarcation line.

True

Fill in the blank - The systemic wasting and loss of body mass often seen in malignant cancer patients is known as ______.

Cachexia

Fill in the blank - A neoplastic effusion in the peritoneal cavity (ascites) is a classic clinical manifestation of ______ spread.

Transcoelomic

Matching - Match tumour markers with clinical utility. Column A: 1. AFP, 2. hCG, 3. CEA, 4. PSA. Column B: A. Colorectal cancer monitoring, B. Prostate screening, C. Hepatocellular carcinoma, D. Choriocarcinoma

1-C, 2-D, 3-A, 4-B

FFQ - Why are paraneoplastic syndromes clinically significant even if the primary tumour is small?

They may be the earliest manifestation of an occult neoplasm, can cause lethal clinical problems, and can mimic metastatic disease.

Q - What are the two major causes of cancer-related mortality?

Invasion and metastasis

Q - Define the two phases of the metastatic cascade.

1. Invasion of the ECM and 2. Vascular dissemination

Q - Where does local tumour invasion typically occur?

At tissue planes offering the least resistance, such as perineurial and perivascular spaces

Q - What is pagetoid infiltration?

Invasion within epithelial structures without bridging the basement membrane

Q - What clinical sign often results from tumour invasion of body surfaces?

Ulceration

Q - List three factors that determine tumour invasiveness.

1. Decreased cellular adhesion, 2. Secretion of proteolytic enzymes, 3. Increased cell motility

Q - What is the specific role of E-cadherin in tumour spread?

It is an intercellular junction molecule; its loosening is the first step of ECM invasion

Q - What enzymes degrade the ECM during invasion?

Matrix metalloproteinases (MMPs)

Q - Why is invasion harder to identify in connective tissue tumours?

They lack a basement membrane to serve as a line of demarcation

Q - What is the definition of metastasis?

The spread of malignant tumours from a primary site to form secondary tumours at distant sites

Q - What two factors determine the site of metastatic appearance?

1. Anatomic location/vascular drainage and 2. Tropism of the tumour for specific tissues

Q - Step 1 of the metastatic sequence?

Detachment of tumour cells from neighbours

Q - Step 2 of the metastatic sequence?

Invasion of surrounding connective tissue

Q - Step 3 of the metastatic sequence?

Intravasation into vessel lumens

Q - Step 4 of the metastatic sequence?

Evasion of host defences (NK cells and T lymphocytes)

Q - Step 5 of the metastatic sequence?

Adherence to endothelium at a remote location

Q - Step 6 of the metastatic sequence?

Extravasation from the vessel lumen into tissue

Q - Step 7 (final) of the metastatic sequence?

Survival and growth in the new environment

Q - Preferred route of metastasis for Sarcomas?

Haematogenous (Bloodstream)

Q - Preferred route of metastasis for Carcinomas?

Lymphatics

Q - Common primary sites that metastasise to bone?

Lung, Breast, Prostate, Kidney, and Thyroid

Q - What is transcoelomic spread?

Spread across body cavities (pleural, pericardial, peritoneal)

Q - What is the common clinical end result of transcoelomic spread?

Neoplastic effusion (exudate rich in protein and neoplastic cells)

Q - What causes tumour implantation?

Accidental spillage of cells during surgery

Q - What is a paraneoplastic syndrome?

Signs/symptoms not explained by anatomic distribution or indigenous hormone production

Q - Most common paraneoplastic endocrinopathy?

Hypercalcaemia

Q - On what is tumour grading based?

Degree of differentiation (resemblance to normal tissue) and number of mitoses

Q - On what is tumour staging based?

Size of primary lesion, regional lymph node involvement, and distant metastases

Q - What does the T stand for in TNM?

Primary tumour size/extent

Q - What does the N stand for in TNM?

Regional lymph node involvement

Q - What does the M stand for in TNM?

Distant metastases

Q - Can biochemical tumour markers be used for definitive diagnosis?

No, they are used for screening, monitoring therapy, and detecting recurrence

Q - Tumour marker for Hepatocellular carcinoma?

Alpha-fetoprotein (AFP)

Q - Tumour marker for Myeloma in urine?

Bence Jones protein (light chains)

Q - Tumour marker for Gastrointestinal adenocarcinomas?

Carcinoembryonic antigen (CEA)

AP10: ST Flashcards

(92 cards)