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Pathophysiology > 10. Biology of Cancer > Flashcards

10. Biology of Cancer Flashcards

1
Q

6 characteristics of benign tumors

A
  • grow slowly - well-defined capsule - non invasive (don’t grow past capsule) - well differentiated (similar to original cells) - low mitotic index - don’t metastasize
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2
Q

6 characteristics of malignant tumors

A
  • grow rapidly - not encapsulated - invasive - poorly differentiated (anaplasia) - high mitotic index - can spread distantly (metastasize)
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3
Q

malignant epithelial tumors

A

carcinomas

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4
Q

malignant connective tissue tumors

A

sarcomas

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5
Q

marked variability of size and shape

A

pleomorphic (malignant tumors)

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6
Q

lymphatic tissue cancers

A

lymphomas

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7
Q

cancers of blood-forming cells

A

leukemias

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8
Q

pre-invasive epithelial malignant tumors of glandular or epithelial origin that have not broken through the basement membrane or invaded surrounding stroma

A

carcinoma in situ (CIS

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9
Q

type of CIS that occurs in the breast

A

ductal carcinoma in situ (DCIS)

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10
Q

3 fates of CIS

A
  • remain stable for long time - progress to invasive and metastatic cancers - regress and disappear
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11
Q

What type of benign tumor does cause problems?

A

brain tumors -> limited space to grow so will affect the functions of surrounding tissues

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12
Q

primary vs secondary sites

A
  • primary site: where cancer started - secondary site: where cancer spread (metastatic site)
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13
Q

biologic markers produced by cancers cells or found on plasma cell membranes in the blood, CSF, or urine

A

tumor markers

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14
Q

2 types of tumor markers

A

hormones and antigens

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15
Q

increase in catecholamines indicates what?

A

adrenal medullary tumor (ex. pheochromocytoma)

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16
Q

increase in ACTH indicates what?

A

adrenal, pituitary, or hypothalamic tumors

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17
Q

increase in b-HCG indicates what?

A

germ cell and hepatic cancers

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18
Q

3 ways tumor markers are used

A
  • screen and identify individuals at high risk for cancer - help dx specific type of tumor in pts w/ clinical manifestations - follow the clinical course of a tumor
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19
Q

increase in carcinoembryonic antigen (CEA) indicates what?

A

colon, lung, pancreas, or breast cancer

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20
Q

alpha fetoprotein (AFP) is used to monitor what types of cancers?

A

hepatic and germ cell (testicular and ovarian)

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21
Q

CA-125 is used to monitor what type of cancer?

A

ovarian

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22
Q

What problem has been found with prostate specific antigen (PSA)?

A

many false positives -> approximately 75% of men w/ increased PSA don’t have prostate cancer on biopsy

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23
Q

cancer is mainly a disease of what?

A

aging

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24
Q

as a result of mutation, a cell acquires characteristics that allow it to have a selective advantage over it neighbors (increased growth rate/decreased apoptosis)

A

clonal proliferation or expansion

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25
Q

T/F: cancer can occur from a single mutation

A

False; multiple mutations are required before cancer can develop

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26
Q

4 types of gene mutations related to cancer

A
  • secretion of growth factors - increased GF receptors - signal on cell-surface receptor is mutated in the “on” position - Intracellular signaling protein to promote replication
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27
Q

genes that regulate normal cellular proliferation

A

proto-oncogenes

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28
Q

mutation gained in proto-oncogene so that it can’t slow down

A

oncogene

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29
Q

genes that normally inhibit the cell cycle and proliferation

A

tumor-suppressor genes

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30
Q

the “guardian of the genome” - signal to undergo apoptosis

A

p53

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31
Q

Explain how cancer causing genes can transmit from one generation to the next

A
  • inactivation of tumor-suppressor genes requires 2 mutations (1 per allele) - single germ-cell mutation transmits a mutation to the child (inherited) - only requires 1 somatic cell mutation to completely inactivate tumor-suppressor genes
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32
Q

How do cancers participate in angiogenesis

A

secrete angiogenic factors such as vascular endothelial growth factor (VEGF)

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33
Q

drug that inhibits VEGF

A

Avastan

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34
Q

protective caps on end of each chromosome that become smaller w/ each division

A

telomeres

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35
Q

what is used to place and maintain telomeres

A

telomerase

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36
Q

Explain how cancer cells use telomeres to become immortal

A

cancer cells can secrete telomerase to restore and maintain telomeres -> allow for continuous division without stop

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37
Q

List the 6 hallmarks of cancer

A
  • Self-sufficiency (in growth signals) - Evading growth suppressors - Tissue invasion and metastasis - Replication immortality - Induce angiogenesis - Resist cell death (apoptosis
38
Q

genes tested for breast cancer

A

BRCA1/BRCA2

39
Q

hereditary nonpolyposis colorectal cancer (no polyps present -> requires regular screenings)

A

Lynch syndrome

40
Q

familial adenomatous polyposis is cancer of the colon/rectum caused by mutations in what gene?

A

APC

41
Q

gene associated w/ thyroid cancer

A

RET

42
Q

gene associated w/ retinoblastoma

A

RB1

43
Q

benefits of genetic testing (4)

A
  • possible relief in knowing - fewer checkups - informed decisions - interventions can be made
44
Q

limitations of genetic testing (3)

A

mutation may be present but: - may be acquired, not inherited - may never lead to disease - may go undetected

45
Q

T/F: most cancer is inherited

A

False: most is NOT inherited

46
Q

encode for proteins that are involved in repairing damaged DNA

A

caretaker genes

47
Q

Ex. of caretaker gene

A

p53

48
Q

KSHV

A

kaposi’s sacroma herpesvirus

49
Q

HTLV

A

human t cell leukemia-lymphoma virus (retrovirus)

50
Q

chronic infections w/ H. pylori are associated w/ what?

A
  • PUD - stomach carcinoma (most stomach cancers) - MALT lymphomas
51
Q

3 ways tumors spread

A
  • direct invasion (local spread) - metastasis (via lymphatics and blood) - metastasis through implantation (accidentally during procedures)
52
Q

Describe the steps of direct invasion (8)

A
  • tumor attaches to other cell - degrade matrix using enzymes - locomotion of tumor cell into matrix (invadopodia) - cellular multiplication/growth - mechanical pressure - release of lytic enzymes - decreased cell-to-cell adhesion - increased motility
53
Q

entry of tumor cells into circulation

A

intravasation

54
Q

exit of tumor cells from circulation

A

extravasion

55
Q

Describe the steps of metastasis (5)

A
  • direct/continuous extension - penetration into lymphatics, blood vessels, or body cavities - transport into lymph/blood - arrive at secondary site - entry and growth
56
Q

where does metastasis often occur first

A

in the first capillary bed encountered by circulating tumor cells

57
Q

preferential growth of cancer cells in certain organs

A

organ tropism

58
Q

Most common metastasis sites

A

brain, bone, liver, and lung

59
Q

TNM staging

A
  • Tumor: # equals size of tumor and local extent - Node: higher # means more nodes involved - Metastasis: # indicates extent of metastasis
60
Q

increase in ____ comes from mutations of proto-oncogenes -> oncogenes

A

pro-growth signals

61
Q

decrease in ____ comes from mutations in tumor-suppressor genes

A

anti-growth signals

62
Q

cancer cell develops ability to secrete GF that stimulate itself for cellular replication

A

autocrine stimulation

63
Q

What happens if there is an increased number of GF receptors?

A

the cell will replicate in response to very low levels of GF

64
Q

examples of oncogenes

A
  • c-ras - myc - fos - jun
65
Q

most common genetic defects found in human cancers

A

mutations of tumor-suppressor genes

66
Q

when both tumor-suppressor gene alleles become mutated

A

loss of heterozygosity

67
Q

What is another way to lose heterozygosity of tumor-suppressor genes other than mutation

A

alleles become hypermethylated (gene silencing)

68
Q

How is a PET scan used to find cancer metastases?

A

able to locate metastases that are using up more glucose than normal cells (up-regulated glucose transport)

69
Q

What triggers the extrinsic pathway of apoptosis?

A

Fas - “death receptor”

70
Q

What is one of the most important activators of the Fas receptor

A

TNF-a

71
Q

What influences pain in cancer?

A
  • fear/anxiety - sleep loss/fatigue - overall physical deterioration
72
Q

T/F: pain is one of the first signs of cancer

A

False; little/no pain is associated w/ early stage of cancer

73
Q

What is the most frequently reported symptom of cancer and cancer treatment?

A

fatigue

74
Q

most severe form of malnutrition that is present in 80% of cancer pts at death

A

cachexia

75
Q

What is included in cachexia (5)?

A
  • anorexia - early satiety - weight loss - taste alternation - altered metabolism
76
Q

Causes of anemia in cancer (4)?

A
  • chronic bleeding due to iron deficiency - severe malnutrition - medical therapies (chemo) - malignancy in blood forming organs
77
Q

Causes of leukopenia and thrombocytopenia in cancer?

A
  • direct tumor invasion to the bone marrow - chemo drugs are toxic to the bone marrow
78
Q

symptom complexes triggered by cancer but not caused by direct local effects of the tumor; commonly due to biologic substances released from the tumor or by immune responses triggered by the tumor

A

paraneoplastic syndrome

79
Q

in what cancers are paraneoplastic syndromes most often seen?

A

breast, lung, and ovarian cancer

80
Q

What system is most affected by paraneoplastic syndromes?

A

nervous system (can cause various neurological disorders that precede other cancer symptoms)

81
Q

obstruction of blood flow through the SVC

A

superior vena cava syndrome

82
Q

What type of cancer is most common w/ SVC syndrome

A

adenocarcinoma of the right lung

83
Q

Most common symptom of SVC syndrome

A

dyspnea

84
Q

Other major symptoms of SVC syndrome

A

cough, chest pain, headache, head fullness, and facial swelling

85
Q

single-agent vs combination chemotherapy

A
  • single agent: usually shrinks cancer but rare provides cure - combination: attacks cancer from several weak points at the same time (limits dose and toxicity of drugs)
86
Q

chemo given before localized (surgical or radiation) treatment of cancer -> seeks to shrink tumor so that surgery many spare more normal tissue

A

neoadjuvant chemotherapy

87
Q

chemo given after surgery with the goal of eliminating micrometastasis

A

adjuvant chemotherapy

88
Q

chemo that seeks to cause shrinkage and disappearance of tumors

A

induction chemotherapy

89
Q

targeted method used to kill cancer without excessive toxicity and avoid damage to normal structures

A

ionizing radiation

90
Q

How does ionizing radiation destroy cancer?

A

damages cancer cell’s DNA

91
Q

the first lymph node to which cancer cells are most likely to spread from a primary tumor

A

sentinel node

92
Q

4 tissue types affected by cancer treatment

A

mainly includes labile cells (continuous replication) - GI tract - bone marrow - hair and skin - reproductive tract

Pathophysiology (20 decks)

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