1 - Introduction Flashcards
Cell Lineage - 2 main categories
Myeloid
Lymphoid
Lymphoid Malignancies - 2 main kinds
Blood - Leukemia
Nodes - Lymphoma
Growth Rate - 2 main categories
Indolent (Chronic)
Aggressive (Acute)
Maturity - 2 main kinds
Normal(ish)
Immature (Dysplastic)
3 important large concepts
Cell Lineage
Growth Rate
Maturity
Indolent Growth
Tend to look very similar to the normal cells they arose from. Won’t kill you right away.
Aggressive Growth
Cells look dysplastic. Don’t look like their cell of origin. Will kill you right away.
Process Flaws - 2 main categories
Proliferation (how quickly cells divide)
Maturation (how much the malignant cells resemble normal cells)
Multipotent Stem Cells give rise to
Myeloid Progenitors
Lymphoid Progenitors
Myeloid Progenitors give rise to
Myeloid Precursors
Erythroid Progenitors
Megakaryocytes
Megakaryocytes give rise to
Platelets
Erythroid Progenitors give rise to
Reticulocytes
Reticulocytes give rise to
Erythrocytes
Myeloid Precursors give rise to
Neutrophils
Eosinophils
Basophils
Monocytes
Monocytes give rise to
Macrophages
Hematologic malignancies - where is the genetic mutation?
In the Multipotent stem cells in the bone marrow.
Lymphoid Progenitors give rise to
T Cells
B Cells
Natural Killer Cells
B Cells give rise to
Plasma Cells
T Cell Malignancies - Indolent
Cutaneous T Cell Lymphoma
Large Granular Lymphocyte Leukemia
T Cell Malignancies - Aggressive
T-ALL
Peripheral T-Cell Lymphoma
B Cell Malignancies - Indolent
CLL
Follicular Lymphoma
B Cell Malignancies - Aggressive
B-ALL
Burkitts Lymphoma
DLBCL
Plasma Cell Malignancies
Multiple Myeloma
Normal Proliferation, Immature Maturation
MDS
Increased Proliferation,
Immature Maturation
ALL
AML
High Grade Lymphomas (eg Burkitts and DLBCL)
Increased Proliferation,
Normal Maturation
CLL CML MPNs Multiple Myeloma Indolent Lymphomas
Prostate Cancer Rates
Haven’t Changed
Lung Cancer Rates
Peaked in 1995, then came down with smoking cessation
Liver Cancer Rates
Haven’t Changed
Gastric Cancer - Country
Japan - High
US - Low
Breast Cancer - Country
Japan - Low
US - High
Colon Cancer - Country
Japan - Low
US - High
Cancer Genetics - 2 Kinds of Mutation
Germ Line Mutations (Hereditary) Somatic Mutations (Acquired)
Cancer Genetics - Exposure & Lifestyle Factors
Tobacco Alcohol Obesity UV Exposure Infection
Common Inherited Genetic Abnormalities
FAP
HNPCC
Breast Cancer
Li-Fraumeni
APC deletion (Chromosome 5) leads to
Familial Adenomatous Polyposis (FAP) - Colon Cancer
DNA Repair Gene mutation (specifically the mismatch repair gene) leads to
Hereditary NonPolyposis Colorectal Cancer (HNPCC) - Colon Cancer
BRCA 1 or BRCA 2 mutation leads to
Breast Cancer
TP53 mutation (Chromosome 17) leads to
Li-Fraumeni - Breast Cancer, Leukemia, Sarcoma
Environmental Carcinogens - Tobacco
Lung Cancer
Head & Neck Cancer
Bladder Cancer
Pancreas Cancer
Environmental Carcinogens - Alkylating Agents
Leukemia
Bladder Cancer
Environmental Carcinogens - Asbestos
Lung Cancer
Pleural Cancer
Peritoneal Cancer
Environmental Carcinogens - Ultraviolet Light
Skin Cancer
Environmental Carcinogens - Ionizing Radiation
Leukemia
Thyroid Cancer
Sarcoma
Environmental Carcinogens - Hepatitis B/C
Liver Cancer
Environmental Carcinogens - HPV
Cervical Cancer
Anal Cancer
Oropharyngeal Cancer
Environmental Carcinogens - H. Pylori
Gastric Cancer
Path Morphology - 2 Categories
Benign
Malignant
Morphological Prognostic Features
Histology
Grade
Pathology - 3 Main Concerns
Morphology
Mechanisms of metastasis
Effect on organ function
Manifestations - Anatomy/Physiology
Growth at primary site
Patterns of metastatic spread
Remote or paraneoplastic effects
Routes of metastatic spread
Direct extension into adjacent tissues (Lung, Gynecologic)
Lymphatic (Breast, Lung, Colorectal, Prostate)
Hematogenous (Sarcomas, Kidney Cancer)
Common sites of metastasis
Brain (Lung, Breast, Melanoma)
Lung (Breast, Colorectal, Sarcoma)
Liver (Colorectal, Pancreatic, Breast, Lung)
Bone (Breast, Lung, Kidney, Prostate)
Cancers that metastasize to bone
BLT with a Kosher Pickle:
Breast
Lung
Thyroid
with a
Kidney
Prostate
Complication of bone metastasis in the vertebral column
Cord Compression
Paraneoplastic or Remote Effects
Anorexia/Cachexia Syndrome
Anemia
Neurologic
Paraneoplastic - Anorexia / Cachexia Syndrome caused by
Interleukins
Cachectin/TNF
Paraneoplastic - Anemia
Anemia of chronic disease
Paraneoplastic - Cerebellar Atrophy
Small Cell Lung Cancer
Paraneoplastic - Eaton Lambert Syndrome
Small Cell Lung Cancer
Paraneoplastic - Hypercalcemia
PTHrP - Non small cell lung cancer
Paraneoplastic - Cushing’s Syndrome
ACTH - Small Cell Lung Cancer
Paraneoplastic - Syndrome of Inappropriate ADH (SIADH)
Small Cell Lung Cancer
Treatment - Local
Surgery
Radiation
Treatment - Systemic Medical Treatment Condsiderations
Class of Agents
Mechanisms of Action
Effects
Toxicities
Surgical Treatment - Pros & Cons
Pro - Removes Tumor Rapidly
Con - No effect on distant disease
Leaves microscopic cancer deposits
Functional and cosmetic limits on the extent of resection
Radiation Treatment - Pros & Cons
Pro - Effective against microscopic tumors
Con - No effect on distant disease
Large tumor masses may not effectively be treated
Damage to normal tissues within radiation field
Drug Treatment - Pros & Cons
Pro - Systemic Distribution
Con -
Often non-specific effects, can damage normal cells
Large masses may contain resistant cells
Drug delivery limited to some tissues (eg BBB)
