4. Cancer I Flashcards
• ____ can tell you about risk factors, about what to look for and trends
○ Informs healthcare decisions
• ____ is the process that the cell goes through from being normal to being cancerous
• Cancer designates a ____ growth (an invasive form versus the benign growths)
○ ____ - a new mass
epidemiology
carcinogenesis
malignant
neoplasm
Fundamental Characteristics of Cancer
Change in cellular genetic material
____, epigenetic
____, induced, and/or inherited
• Mutations ○ A change in AA, or a change in the bigger part of gene that affects function • Epigenetic signatures that control genes can be affected ○ Considered to be a change in \_\_\_\_ material ○ Changes that are on the DNA that will dictate whether a gene will be turned on or silent § \_\_\_\_ § \_\_\_\_ that bind DNA and compacted into chromatin - can be modified ○ Change in epigenetics in a gene will result in it being activated or silenced • Inherited - comes from the \_\_\_\_ (sperm/egg) ○ Not a majority of cancers (\_\_\_\_%) • Spontaneous/induced - 90% ○ Somatic cells can accumulate mutations (spontaneous) Or, in the presence of UV light, tobacco, alcohol use (\_\_\_\_)
mutations
spontaneous
genetic methylation histones germline 10 induced
Fundamental Characteristics of Cancer
Changes are heritable by daughter cells
____ selection
Tumors are ____
• Cancer can be passed down onto daughter cells ○ An initial cell has change in genetic material, and upon dividing it passes it on § Inheritable change § Darwinian selection - the most \_\_\_\_ survive; cancer cells survive indefinitely □ Mutation that allows cell to survive under low \_\_\_\_; manipulate the oxygen supply to cancer to overcome the advantage the cancer has ○ Tumors are clonal § Tumor doesn't mean bad/malignant, just that there is \_\_\_\_ § There was one initial cell that acquired a mutation/epigenetic change that allowed it to survive □ Clonal □ Especially true early during growth period; however, later on there can be subclones that develop (arise by accumulating more mutations, etc.) ® Will eventually become a \_\_\_\_ grouping of cells
darwinian
clonal
fit
O2
growth
heterogeneous
Hallmarks of Cancer
Independence of ____
Resistance to growth inhibition
Evasion of ____
Limitless replicative potential
Acquired ____ potential
Transplantability and invasion
Switch to ____ despite O2
Immune evasion
• Cell acquires mutations so it's not hindered by external cues: • Somatic cell has limited number of cell divisions ○ 25-28 divisions - enters \_\_\_\_ ○ Cancer cells devise a way around this by modulating telomere lengths § Become immortal • Angiogenic potential ○ Not a \_\_\_\_ process - it's imperfect • The last three hallmarks are more critical in context of \_\_\_\_ potential • Switch to glycolysis ○ Usually it's anaerobic, but cancer cells switch in the presence of O2 • Normally recognized as foreign, but cancer cells find a way to hide from the immune system
growth factors
cell death
angiogenic
glycolysis
senescence
physiological
malignant
• Neoplasia
○ New ____
○ Nothing about it being benign/malignant
• Transformed cell
○ Changing ____ type
○ Tobacco smokers
§ Bronchial epi changes from columnar to ____ epi
• Tumor and neoplasm can be used ____
• Benign tumor
○ Can be fairly certain that upon removal it won’t come back
○ Contained within a ____, or a capsule-like border from the surrounding tissue
§ Reason why upon removal you can be pretty sure it can be ____
§ Some tumors do not have capsules: ____
□ Smooth muscle benign tumor in uterus
□ There is still a zone that is visible by eye
• Malignant tumor
○ Will not have any ____
○ Cells begin infiltrating surrounding tissue
§ Not only to lymph node, but even local invasion is considered a sign of malignancy
growth cell squamous interchangeably capsule removed leiomyoma capsule
• Benign tumor
○ Grows locally, cannot spread by invasion/metastasis
• Malignant tumor
○ Can invade neighboring tissue, and rare cases it will go to distant organs
§ Can occur via BV, local spread, or lymphatics
• Benign growths can turn ____
○ A single mutation will join by other mutations, and the cells will gain additional advantages that will allow them to proliferate further
• Is a benign tumor always precancerous?
○ Not always!
○ Varying ____ to become malignant, but for some the risk is high (in ____ users, for example; in lyomyoma, it rarely ever becomes malignant)
○ Can be considered precancerous with various degrees to become malignant
malignant
potentials
tobacco
• Left: benign tumor
○ Cannot based on size, small can be ____, and vice versa
○ Fibrous growth - ____
• Middle: ____
○ Under skin there are BV that make it look pink
○ Benign tumor; if excise it’s ____
• Right: ____
malignant fibroma hemangioma curative lipoma
• Large benign tumors can still lead to issues
○ Benign doesn’t mean that it’s not going to lead to complications
• Abdominal mass from a 10 y/o patient
○ ____, upon removal the patient will be ____
○ Can still lead to clinical problems
encapsulated
cured
• Benign tumor pathology
○ ____
○ These examples are colon polyps
○ Well structured and ____
capsules
bordered
Malignant tumors
• The edge is not \_\_\_\_ • Middle: malignant melanoma ○ \_\_\_\_ borders • Right: malignant melanoma ○ Scar tissue on the top
clear
irregular
Benign Tumor Nomenclature
Normally end with –____ Lipoma
Leiomyoma
Exceptions
____ can be either
Lymphoma, melanoma, mesothelioma, seminoma are ____
Epithelial tumors are even more complex \_\_\_\_ – gland patterns/gland origins \_\_\_\_ - fronds \_\_\_\_ – mass above a mucosa \_\_\_\_- - hollow masses
• Mesenchymal tissue - ends with -oma • Blood cancers are all malignant • \_\_\_\_ tumors based on how it looks to eye ○ Papilloma - extensions, finger-like projections • Sometimes depends on histological pictures ○ Adenoma - glandular patterns • Polyp ○ Benign tumor ○ Distinctive \_\_\_\_ that's attached to base
oma astrocytoma malignant adenoma papilloma polyp cystadenomas
epithelial
stalk
Malignant Tumor Nomenclature
Solid mesenchymal tumors
____
Tumors from blood cells
Leukemias
____
Epithelial tumors
____ (regardless of ____ origin)
— Adenocarcinoma
— Squamous cell carcinoma
• Leiomyosarcoma - from the muscle
sarcoma
lymphomas
carcinoma
tissue
Mixed Tumor
\_\_\_\_ differentiation Mixture of different \_\_\_\_ types Pleomorphic adenoma -- Epithelial \_\_\_\_ tissue -- Fibromyxoid \_\_\_\_
• Usually tumors arise from one germ cell type (mesencymal, etc.) ○ But can differentiate, and include other cell types within themselves § Mixed tumor of parotid or salivary glands □ Duct-like structures - suggest epithelial components (containing mucin) (cancerous?) □ Fibroid like stroma § Firboadenoma □ Within the breast □ Fibrous structure (cancerous) and adenoma epithelial structure (stroma) • Parenchyma vs. stroma ○ Parenchyma: \_\_\_\_ cell ○ Stroma: surrounding \_\_\_\_ cells
divergent
cell
duct
stroma
cancer
supporting
Mixed tumor
Teratoma
____ and ____ cells or tissues from more than one ____ layer
Originate from ____ germ cells
• Teratoma ○ The original cell had the potential to develop into any type of germ cell § Totipotent germ cell (a stem cell) ○ Occurs during \_\_\_\_, but may not be noticed until later in life § Ovaries, etc., noticed due to \_\_\_\_ ○ Can be benign or malignant § Mature teratoma: \_\_\_\_ § Immature teratoma: \_\_\_\_ § If cell growth shows immature, it means it is more aggressive • Tooth, fat tissue, may be some muscle ○ All from different germ layers
mature
immature
germ
totipotent
development
mass effect
benign
malignant
• Kidney
○ Ectopically there are ____
○ An example of a teratoma
○ Cannot say whether it’s mature or immature at this level
teeth
Other Terms
Hamartoma
____ tissue mass within the tissue of ____
Choristoma
Normally ____ cells reflective of a tissue, but found in a distinct anatomic ____
• Hamartoma ○ Occurs in 70% of \_\_\_\_ tumors ○ See all components that make up lung tissue (alveolar walls, macrophages etc.), but not in usually architectural arrangement § Still in lung • Choristoma ○ Not in it's normal location ○ Someone cut off a piece of pancreas and put it in the colon
disorganized origin organized location lung benign
Feature Distinguishing Benign from Malignant
Well differentiated/Anaplastic
Rate of growth
Local ____
____
• Presence of only one doesn't mean that it is benign or malignant • If have local invasion or metastasis ○ Makes you feel most \_\_\_\_ that a tumor is malignant
invasion
metastasis
confident
Well Differentiated vs Anaplasia
Well differentiated Characteristic of \_\_\_\_ neoplasms Tissue organization is \_\_\_\_ \_\_\_\_ are rare Can occur in \_\_\_\_ tumors Retain tissue \_\_\_\_
Anaplasia Loss of cellular \_\_\_\_ Nuclei exhibit = \_\_\_\_ = hyperchromatism = \_\_\_\_ shape = nuclear to cytoplasmic ratio approaching \_\_\_\_ Numerous, atypical mitoses \_\_\_\_ tumor cells
• Anaplasia - complete lack of differentiation ○ Nuclei changes - one of these proves an anaplastic state § Pleomorphism: varying \_\_\_\_ of nuclei § Hyperchromatism: \_\_\_\_ nuclei; chromatin is condensed (a sign of a genetic problem) § Aberrant shape § Normal N:C ratio is \_\_\_\_ □ Nuclei is 1/5 of whole cell □ Cancer cells - huge nucleus
benign retained mitoses malignant function
polarity pleomorphism aberrant 1:1 giant
sizes
dark
1:5-6
• Anaplastic lesion on right: ○ Atypical \_\_\_\_ § Tripod nucleus (third arrow) □ \_\_\_\_ ○ Hyperchromatic nucleus ○ N:C approaching 1:1
• Well-differentiated lesion on left: ○ Glandular structures § \_\_\_\_ being produced (arrow) ○ Cells organized in parallel to each other ○ N:C is around \_\_\_\_
mitoses
tripod
mucin
1:5-6
Desmoplasia
Fibrous ____ associated with certain cancers
• Given to the name of the \_\_\_\_ that surrounding certain cancers ○ Not the parenchyma! • Neoplastic growth is supported by fibrous stroma ○ Common in \_\_\_\_ cancer • Gives a tough, rubbery appearance
stroma
stroma
breast
