Cancer Flashcards
Difference between hyperplasia and neoplasia
Hyperplasia stops when stimulus removed
Neoplasia continues even when stimulus removed
Why is differentiation in cancer very important ?
Failure to achieve cellular differentiation is a particular feature of malignant neoplasms
Allows to predict the likely behaviour of a tumour
Differentiation is the term used to describe how different in appearance the cells of a tumour are to the cell type from which they are derived.
Define these terms :
Well differentiated tumour
Poorly differentiated tumour
Undifferentiated/anaplastic tumour
What are the common metastatic sites of lung cancer?
Adrenal gland, bone, brain, liver, other lung
Compare benign and malignant tumours
Benign : stay at their site of origin and do not spread ; compress adjacent tissue and grow by expansion; well circumscribed (spherical mass within solid organs and papillary outgrowth on epithelial surfaces)
Malignant - can spread to distant sites ; grow by expansion and infiltration ; compress adjacent tissues; irregular outline
Are all benign tumours harmless?
No - some can even be fatal due to compression of adjacent tumours
What are the common metastatic sites of lung cancer?
Adrenal gland, bone, brain, liver, other lung
Complete the table for the different naming of epithelial tumours
Complete the table for the different naming of mesenchymal tumours
Describe 3 common tumour markers
HCG- from testicular cancer
AFP - released in liver cancer and germ cell tumours
PSA - prostate specific antigen
How is the grade of tumour determined
Pleomorphism - variation in size and shape of tumour cells
Mitotic index
TNM system
Used to classify the extent of the spread of cancer
T (TUMOUR) describes the size of the tumor and any spread of cancer into nearby tissue;
N (NODES) describes spread of cancer to nearby lymph nodes;
M (METASTASIS) describes metastasis (spread of cancer to other parts of the body).
Tumours with excellent prognosis
Thyroid
Tumours with moderate prognosis
Kidney
Prostate
Cervix
Breast
Tumours with very poor prognosis
Pancreas
Brain
Oesophagus
Grade vs stage of cancer
Stage looks at how far a tumour has grown
Grade looks at differentiation and proliferation
Define dysplasia
cells that appear abnormal; often increased nuclear to cytoplasmic ratio and loss of features of differentiation. Not always cancer but can be ; often invasive if cancerous
Describe the 4 cell cycle checkpoints
G1 - main checkpoint for cell size, nutrients, GFs, and DNA damage ; where it is decided if cell will divide or not ; if cell proceeds past G1 , it is committed to division
G2 - further checks for DNA damage and completion of DNA replication (done during S phase)
Metaphase - spindle attachment checkpoint
Telomere shortening and cancer
Inactivation of tumour suppressor genes allows bypass of senescence in response to telomere shortening which should happen in healthy cells
Telomeres shortening leads to chromosome instability :
End to end fusion of unprotected chromatid ends - sister chromatids can’t be separated during mitosis
There may also be pairing of non homologous chromosomes = genetic catastrophe
In cancer, TERT gene is reactivated allowing cells to continue to proliferate with severely damaged chromosomes; inactivation of tumour suppressor gene p53 or Rb may occur
Fucntion of TERT gene
Gene for making telomerase
Telomerase counteracts the shortening of telomeres by adding small repeated segments of DNA to the ends of chromosomes each time the cell divides. It is active in highly proliferating cells such as stem cells, germ line cells, haemopoietic cells
Symptoms of lung cancer
a persistent cough
coughing up blood
persistent breathlessness
unexplained tiredness and weight loss
an ache or pain when breathing or coughing
voice hoarseness
Adenocarcinoma
Adenocarcinoma is a type of cancer that starts in mucus-producing glandular cells of your body. Many organs have these glands, and adenocarcinoma can occur in any of these organs. Common types include breast cancer, colorectal cancer, lung cancer, pancreatic cancer, and prostate cancer.
Benign tumours have the suffix
-oma
Malignant epithelial tumours are usually known as
Carcinomas
Malignant mesenchymal tumours are usually known as
Sarcomas
What allows tumour cells to become self sufficient of growth signals (this means they do not rely on growth signals for proliferation to occur)
Through mutations that cause :
Increased secretion of growth factors
Upregulation of growth factor receptor
Activation of growth factor receptors
How can tumour cells evade apoptosis
Up-regulation of anti-apoptotic factors
Down-regulation of pro-apoptotic factors
Loss of function of pro-apoptotic factors
c-Kit mutations (GIST) activate the tyrosine kinase domain. This can be inhibited by …
the tyrosine kinase inhibitor, Gleevec
only glioblastomas showing methylation of the MGMT gene are responsive to
Temozolamide
Malignant tumours of the oesophagus
Squamous carcinoma
Adenocarcinoma
Symptoms of oesophageal cancer and clinical features
Difficulting in swallowing solids and thick fluids
voice hoarseness
Weight loss
Occasional regurgitation after swallowing
supraclavicular lymphadenopathy, or any signs of metastatic disease (such as jaundice, hepatomegaly, or ascites)
Identify the morphological change in this oesophageal biopsy taken from an area of Barrett’s oesophagus
Glandular metaplasian in squamous epithelium of esophagus
This is an oesophageal biopsy from a structured area
Describe the type of cancer shown here
Moderately differentiated adenocarcinoma
What is Barrett’s oesophagus ? What causes it?
Barrett’s oesophagus is the term used for a potentially pre-cancerous condition
where the normal cells lining the oesophagus, also known as the gullet or food
pipe, have been replaced with abnormal cells.
Although the exact cause remains unknown, it is strongly associated with long-term Gastro-Oesophageal Reflux Disease (GORD), which can cause the symptom of heartburn.
GORD involves reflux of acidic and non-acidic stomach (gastric) contents into the oesophagus, which irritates (inflames) and injures the lining (epithelial cells).
Clinical features and symptoms of carcinoma of stomach
Mild jaundice - dry, earthy coloured skin
Liver enlarged ; tender in epigastrium
Gastroscopy - abnormal mucosa with loss of rural pattern ; stomach non-distensible
- heartburn or acid reflux
- having problems swallowing (dysphagia)
- feeling or being sick
- symptoms of indigestion, such as burping a lot
- feeling full very quickly when eating
- loss of appetite or losing weight without trying to
- a lump at the top of your tummy
- pain at the top of your tummy
- fluid filling stomach
Poorly differentiated adenocarcinoma(stomach cancer) often have a ___ ___ ___ pattern
Signet ring cell
Carcinoma of colon/stomach is nearly always ____
Adenocarcinoma
Clinical presentation of colon cancer
change in bowel habit, rectal bleeding, weight loss, abdominal pain, and symptoms of iron-deficiency anaemia (fatigue, dyspnoea, heart palpitations, pale skin). Palpable mass in either side of iliac fossa
Describe the biopsy of this rectosigmoid tumour
Well differentiated colo-rectal adenocarcinoma
Give one example of neoplasi involving permanent activation of growth factor receptors
Mutation in the TK domain of c-Kit (receptor for Stem Cell Factor) in GISTs
2 main types of non small cell lung cancer
Squamous cell carcinoma, Adenocarcinoma
Describe this slide showing a lung cancer tumour
Moderately differentiated keratinising squamous cell carcinoma
A patient has moderately differentiated squamous cell carcinoma ; should radiotherapy be given ?
Yes
Symptoms of Pancoast tumour
Arm, shoulder and neck pain
may be weakening of hand muscle, droopy eyelid or blurred vision
Difference between non-small cell lung cancer and small-cell Lung cancer
Non-small cell lung cancer is the most common type of lung cancer. It grows and spreads more slowly than small cell lung cancer.
First place for breast cancer to metastasise
Axillary lymph nodes
features of a malignant breast lump
Irregular and hard
Fixed to the chest wall
Skin above is tethered
Palpable lymph nodes in axilla
Indrawn nipple/ nipple involvement
Bone tenderness/pain
Features of a benign breast tumour
feels Squishy, defined margins, mobile
Mammogram - uniforms, well defined , round or oval
MRI - slow to light up and doesn’t fade
Biopsy - well differentiated
Breast calcification
They may be caused by:
- calcium deposits in a cyst or in milk ducts as women get older
- previous injuries to the breast
- inflammation.
often indicate a benign tumour
HER2 receptor and breast cancer
HER2 proteins are receptors on breast cells. Normally, HER2 receptors help control how a healthy breast cell grows, divides, and repairs itself. But in about 10% to 20% of breast cancers, the HER2 gene doesn’t work correctly and makes too many copies of itself (known as HER2 gene amplification).
Biology of tumour
Grade - how well differentiated
Receptor mutations
growth fraction - time taken for tumour to double
link between grade and prognosis
The higher the grade, the worse the prognosis
Breast Cancer Hormone Receptor Status
Breast cancer cells from biopsies are screened for oestrogen and progesterone receptors ; these hormones promote cell growth
better prognosis for hormone positive cancers as there are drugs available
Triple approach to breast cancer
Clinical exam
imaging
FNA cytology (small sample of lesion removed with needle) or biopsy
How do monoclonal antibodies treat cancer
block molecules cancer cells need to grow, flag cancer cells for destruction by the body’s immune system, or deliver harmful drugs to cancer cells.
breast carcinoma in situ
The normal breast is made of tiny tubes (ducts) that end in a group of sacs (lobules). Cancer starts in the cells lining the ducts or lobules, when a normal cell becomes a carcinoma cell. As long as the carcinoma cells are still confined to the breast ducts or lobules, without breaking out and growing into surrounding tissue
anaplasia definition and features
loss of differentiation of cells and their orientation to each other, a characteristic of most malignant tumor cells
Features of anaplastia
variation in nucleus size and shape (nuclear pleomorphism)
variation of cell shape and size ( cellular pleomorphism)
High nuclear-cytoplasmic ratio
presence of nucleoli
high mitotic index
Benign or malignant ?
Benign
Benign or malignant?
Malignant (invasive lobular carcinoma)
Benign or malignant?
Malignant (invasive lobular carcinoma)
Define these terms :
- Carcinoma
- Sarcoma
- Lymphoma
- Melanoma
- Germ cell tumor
- Adenoma: Benign neoplasm derived from glandular cells within epithelium. (Adrenal, thyroid, prostate or pituitary gland typically)
- Carcinoma: Malignant neoplasm derived from epithelial cells
- Sarcoma: Malignant neoplasm derived from mesenchymal cells (e.g., fat, muscle).
- Lymphoma: Malignant neoplasm derived from lymphocytes.
- Melanoma: Malignant neoplasm derived from melanocytes.
- Germ cell tumor: Malignant neoplasm derived from germ cells.
What are the 2 types of lymphomas
Hodgkins diseasae
non-Hodgkin lymphoma - most common are lymphocytic lymphomas
diagnosis confirmed via histology
Teratomas - describe the 2 most common examples
are tumours derived from primitive germ cells which retain the capacity to differentiate along all 3 primitive embryological lines
Malignant in nature
mainly occur in ovary and testes
teratoma of the ovary - found in young women , benign, many keratinous cysts; good prognosis
teratoma of testes - found in young men, painless swelling of testes, malignant, spreads early
Describe Cachexia
Chronic hypermetabolic state characterised by rapid weight loss and anorexia.
Seen in cancer patients and some infections such as malaria/TB/HIV/CF and chronic alcoholics
prevalent in GI/pancreatic/colorectal and lung cancer
Parenteral and enteral nutrition
When patients have problems with eating or digestion = nutrition with specially formulated food
Enteral nutrition involves delivering the food to the gut via the nose.
Alternatively, the nutrition can be delivered into the blood stream through a drip to bypass the gut, which is known as Parenteral Nutrition.
