Medicine (MD/DO)
First Aid
First Aid for the USMLE Step 1 (2023)
Page 215-
Neoplastic Progression

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Neoplastic Progression

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Neoplastic Progression

Neanderthal-growth Progression
Components: Parenchyma and Supporting Stroma
Pear and Straw-man

There are two components involved in neoplastic progression: the parenchyma, which is the neoplastic cell, and the supporting stroma, which is the non-neoplastic cell—supporting stroma such as connective tissues and blood vessels.

Benign vs Malignant
Bunny vs Malignant-man

Carcinoma can be seen as benign or malignant. Benign is seen as well-differentiated, with no metastases, necrosis, and low mitotic activity. Malignant is seen as poorly differentiated, with metastases.

Normal Cells
Normal Cell-phone

The presence of basal membrane characterizes normal cells with apical polarity.


Dysplasia is characterized by a loss of uniformity in cell size and shape, called pleomorphism, loss of tissue orientation, and nuclear changes.


Dysplasia is often reversible.

Carcinoma in Situ
Car-gnome Seat (2)

Carcinoma in situ is a type of severe dysplasia. It affects the entire thickness of the epithelium and does not infiltrate the basement membrane. This makes it different from invasive carcinoma, which invades the basement membrane.


Carcinoma in situ is irreversible.

Entire Thickness of the Epithelium
Thick E-pick

Carcinoma in situ affects the entire thickness of the epithelium and does not infiltrate the basement membrane.

Invasive Carcinoma
Invading Car-gnome

Invasive carcinoma invaded the basement membrane. This makes it different from carcinoma in situ, which does not invade the basement membrane.

Invaded Basement Membrane
Invading Basement Membrane

Invasive carcinoma has the ability to invade the basement membrane using collagenases and hydrolases (metalloproteinases).

Loss of E-Cadherin
Loss of E-CAD-Heron

The loss and inactivation of e-cadherin occur in invasive carcinoma, resulting in cell connection loss.


Metastasis is characterized by the ability of cancer cells to surpass the basement membrane and enter lymphatics or blood. It can spread to distant organs.


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