Cancer Flashcards
1
Q
What are the 4 cancers of highest incidence for men?
for women?
A
- Men: Prostate > lung and bronchus > colon and rectum > urinary/bladder
- Women: Breast > lung and bronchus > colon and rectum > uterine
2
Q
What are the 4 cancers of highest deaths for men?
Women?
A
- Men: lung/bronchus > prostate > colon and rectum > pancreas
- Women: Lung/bronchus > breast > colon and rectum > pancrease
3
Q
Why is cancer increase markedly with age?
A
- takes years from the time you are exposed to a carcinogen to the time when you present with the disease
- you get exposed to more carcinogens throughout life
- as you get older, immune system gets weaker
4
Q
What are stroma/stromal cells?
A
- support cells in the tissue
- connective tissue
- blood vessels
- etc
5
Q
What are parenchyma/parenchymal cells?
A
- Special cells, uniquely adapted to perform function of organ
- cardiomyocytes
- hepatocytes
6
Q
What are mesenchyme/mesenchymel cells?
A
- Cells of mesodermal or neural crest origin that give rise to connective tissue, blood, muscle
7
Q
-oma
A
benign tumor
8
Q
-carcinoma
A
malignant tumor of epithelial origin
9
Q
-adenocarcinoma
A
malignant tumor of glandular tissue
10
Q
-sarcoma
A
malignant tumor of mesenchymal origin
11
Q
-blastoma
A
malignant tumor of precursor cells
(more common in children)
12
Q
Invasive neoplasia
A
enlarged growth that has acquired the ability to get through the basement membrane
13
Q
What does grading measure?
A
- I: the cell still looks like the cell it is supposed to
- IV: the cell looks nothing like the cell it is supposed to be
14
Q
How are tumors staged?
A
- Tumor: T0-T4
- T0- no penetration of basement membrane
- T1- penetrated through basement membrane but still local
- T4- Invasion into other organs/neighboring tissue
- Lymph: N0-N4
- N0- no lymph node involvement
- N1- local lymph node involvement
- N4- existensive lymph no
- Metastasis (M0-M1)
- M0- no metastasis
- M1- metastasis
15
Q
What are the ways cancer can spread?
A
- Direct contact- grows right on through to the neighbor
- lymph nodes- drain cancer cells through lymph nodes
- directly by blood- cancer cell in vein, whole body is accessible
- biopsy- as needle goes in and comes out cancer cells can be deposited all along needle pathway
16
Q
Benign Vs Malignant
A
- Benign (Leiomyoma)
- small, slow growing and well demarcated (can see where good cells end and bad cells begin
- noninvasive
- nonmetastic
- well differentiated (still looks like the cell type it should be)
- Malignant (Leiomyosarcoma)
- Large
- poorly demarcated
- rapidly growing with hemorrhage and necrosis
- locally invasive
- metastatic
- poorly differentiated
17
Q
What are the stages of cancer progression?
A
- Transformation- some kind of carcinogenic induced mutation that gets everything started
- Progression- the mutated cell had more daugther cells.
- Proliferation- over time the mutated cells mutate again and again as they continue to grow
- with all the mutations the tumor has all the special skills required for a cancer to thrive
18
Q
What are the 6 hallmarks of cancer?
A
- Self sufficiency in growth signals
- insensitivity to antigrowth signals
- evading apoptosis
- limitless replicative potential
- must be able to turn on telomerase
- can now double infinite number of times
- sustained angiogenesis
- as it gets bigger, it will need its own blood supply
- tissue invation and metastasis
19
Q
What is a proto-oncogene?
A
- It is a pre-tumor gene
- with two copies of everything
- a normal cell that once it gets one mutation, it can start to proliferate into cancer
20
Q
What is a tumor supressor gene?
How can it change?
A
- Suppress tumors by negatively regulating the cell
- If one of the copies of the TSG is mutated, we tend to be ok, it will still function
- Two inactivating mutations are required for it to no longer function
- a person born with one TSG already mutated will have a very high rate of cancer
21
Q
What are the proto-oncogenes listed?
(5)
A
- bcl-2
- HER2/neu
- N-myc
- C-myc
- Ras
22
Q
What happens if a person is born with an active abnormal proto-oncogene?
A
A person would not be born with this mutation because they would not develop properly
23
Q
What is the significance of chromosome translocation?
How are they oncogenic?
A
- the transcriptional change affects how the genes are controlled
- the control regulations for one gene are now controlling a different gene
- Combine to make a new protein. A new protein is never good
24
Q
What are the listed tumor supressor genes?
A
- p53- most commonly mutated
- BRCA1, BRCA2
- APC
- RBI
- MSH2
- NFI, NF2
25
What is Li Fraumeni?
* Mutated p53 at birth
* only need one other mutation for the tumor supressor gene to no longer function properly
* Very high cancer rates
26
How does the G-protein coupled receptor (RAS) become cancerous?
* Normally, the RAS is activated when growth hormone hits the receptor
* after the second signal is completed, normally RAS can convert GTP into GDP, inactivating the pathway until another growth hormone hits the receptor
* If the RAS cannot convert GTP to GDP, it will remain active and continue to grow
* RAS is a proto-oncogene, so it only needs one mutation
27
What is an example of insensitivity to anti-growth signals that could cause a tumor to grow?
* RB is a tumor suppression gene
* If it gets TWO mutations, it could grow uncontrollably into a tumor, causing retinablastoma
* wont happen until later in life
* If pt is born with one mutation, they will likely get retinablastoma within 1st year of life because it is relatively easy to get one mutation
28
What is an example of how a cancer can **evade apoptosis**?
* p53 protects DNA and kills any cell with bad DNA
* if there are two mutations to the p53 gene, it will no longer work and there will be nothing to kill the cells with bad DNA
* this is great for a cancer that is trying to acquire mutations.
29
What is an example of how a cancer can have **limitless replicative potential**?
* if the cancer can "turn on" telomerase, it can replicate infinitely
* telomerase lengthens DNA telomere caps every time it replicates
30
How does the tumor get **sustained angiogenesis**?
* Once the tumor becomes too big, it needs its own blood supply
* The tumor needs VEGF (**vascular endothelial growth factor**), which determines where blood vessels will grow
31
How is a tumor able to **invade tissue and metastasize**?
* Normal epithelial cells are tightly bound together but have contact inhibition (down outgrow their position)
* a tumor cell first has to detatch itself from neighbors
* then it has to get through the basement membrane
* has to dissolve the collagen
* has to grab something and pull itself through
* this is not normal, must have a superpower
32
What are the ways cancer can spread?
what happens once it escapes its original home?
* direct contact
* lymph nodes
* blood
* extravates (leaves vessel to go into tissue) and will grow in the new environment
* different cancers will tend to land in different spots, usually somewhere with a similar climate to where they started
33
What are the two main sites of blood borne metastasis?
What are the specific examples he gave?
* Lung- all blood goes through the lungs and there are lots of capillaries--\> greater chance of landing there
* liver- Especially from abdominal cancers because the blood from the abdominal organs all drains through the liver
* Colon --\> liver
* breast & prostate--\> bone
34
What is the difference between primary and secondary metastatic cancer?
* Primary: starts in one place and just becomes one continuous growth
* Secondary: like sprinkling seeds in a garden
* each spot starts a new colony, this is why metastatic cancer is so hard to treat
35
How does HPV work?
How does the vaccine work?
* cancer causing HPV has E6 and E7 proteins which attach to p53 and RB, inhibiting their function
* these are two of the most powerful tumor supressor genes
* Now there is nothing to kill messed up cells, so mutations occur and those cells survive
* rate of mutations increases dramatically
* HPV is responsible for 100% of cervical cancer
* Vaccine is agains the virus, not cancer
* causes the body to produce memory cells against the virus, so the body can clear it faster if exposed
36
What HPV types does the HPV vaccine protect against?
* HPV 16 & 18
* cause about 70% of cervical cancer
* HPV 6 & 11
* genital worts
37
Describe the relationship between the tumor cell burden and the phases of cancer treatment. (graph)
* In order for the tumor to get as big as 1mm, the telomerase will have been "turned on" and the cancerous cells will have slipped through the immune system
* It will be big enough for diagnosis at 1 cm
* Surgical removal will significantly decreas the tumor cell burden, but might not remove *all*
* the cells that remain could be killed with chemo therapy, or if left without treatment, will continue to proliferate
38
What are the adverse effects of cancer chemotherapies?
* Target any kind of rapidly dividing cells, so they will damage other tissues as well
* GI: esp mucosa of small intesting--N/V
* Bone marrow: all hematopoetic cells affected
* anemia (expected); neutropenia is the biggest problem
* anemia means that the chemo is working (good thing)
* neurtopenia is dangerous bc you'll prob get an infection
* Hair: follicles on head are rapidly replicating, but arent on eyebrows
* Skin: decreased epidermal renewal rate--will see skin leasions
* Fetus: chemo is strictly contraindicated in pregnancy
