Cancer Flashcards
1
Q
Define Carcinogenesis
A
The transformation of normal cells to neoplastic cells through permanent genetic alterations or mutations
2
Q
What is difference between something that is carcinogenic and oncogenic?
A
Carcinogenic - cancer causing
Oncogenic - tumour causing
3
Q
Name a carcinoma that only invades locally and never spread to other parts of the body
A
Basal Cell Carcinoma of Skin
cured by complete local excision
4
Q
Where do most/all cancers generally spread?
A
Lymph node(s) that drain the site of that carcinoma
5
Q
What cancers commonly spread to the bone?
A
Breast Prostate Lung Thyroid Kidney
6
Q
What lymph node can breast cancers often spread to?
A
Axillary node
need axillary node clearance
7
Q
Define Adjuvant therapy
A
Extra treatment given after surgical excision
8
Q
Give example of cancer that naturally moves around while body
A
Leukaemia
generally need chemo
9
Q
what type of tumours does carcinogenesis apply to?
A
Malignant Neoplasms
10
Q
What types of tumours does oncogenesis apply to?
A
Benign and Malignant
11
Q
Define carcinogens
A
agents known or suspected to cause tumours
12
Q
What is meant by carcinogens being mutagenic?
A
act on DNA
13
Q
WHat percentage of cancer risk is environmental?
A
85%
14
Q
What problems arise in identifying carcinogens?
A
- Latent interval may be decades
- Complexity of the environment
- Ethical constraints (in exposed humans to things thought to cause cancer)
15
Q
Name the classes of carcinogens
A
Chemical Viral Ionising and non-ionising radiation Hormones, Parasites and Mycotoxins Miscellaneous
16
Q
Give examples of chemical carcinogens
A
Polycyclic aromatic hydrocarbons
Aromatic amines
Nitrosamines
Alkylating agents
17
Q
What tumours associate with polycyclic aromatic hydrocarbons
A
Lung and Skin
e.g. smoking or mineral oils
18
Q
what cancer does aromatic amines associate with?
A
Bladder cancer
e.g. rubber/dye workers
19
Q
What cancer does nitrosamines associate with?
A
Gut cancer
animal testing
20
Q
What cancer does alkylating agents associate with?
A
Leukaemia
small risk
21
Q
What biological agents can cause cancer?
A
Hormones
Mycotoxins
Parasites
22
Q
Examples of hormones that can cause cancer
A
- Higher Oestrogen increase chance of endometrial cancer
- Anabolic steroids linked with Hepatocellular carcinoma
23
Q
Example of mycotoxins that can cause cancer
A
Alfatoxin B1 -> hepatocellular carcinoma
24
Q
Examples of parasites that can cause cancer
A
Chlonorchis sinensis ->cholangiocarcinoma
Shistosoma ->Bladder cancer
25
Name 2 miscellaneous carcinogens
Asbestos
Metals (nickel, chromium etc)
(?mechanism of action)
26
Name 5 host factors that can affect cancer development
```
Race
Diet
Constitutional factors e.g. age, gender etc
Premalignant lesions
Transplacental exposure
```
27
Give examples of race (host factor) affecting cancer incidence
- Increased oral cancer in India/SE asia (reverse smoking)
| - Decreased skin cancer in blacks as more melanin protecting them from UV
28
Give examples of constitutional factors (host factor) that can affect cancer development
- Inherited predisposition e.g. familial polyposis coli (chr 5) or retinoblastoma (chr 13)
- Age (incidence increases with age)
- Gender (Breast cancer 200xs more common in women)
29
Give examples of premalignant conditions and define what is meant be the term
Identifiable local abnormality associated with increased malignancy risk at that site e.g. Colonic Polyps
Cervical Dysplasia
Ulcerative Colitis
Undescended testis
30
Give example of transplacental host factor leading to carcinogenesis
Diethylstiboestrol (old oestrogen medication) leads to increase in vaginal cancer
31
How can Herceptin improve cancer prognosis (what receptor does it act on)
HER2 receptors
| herceptin eliminates these so less intracellular signalling and less cell replication or decreased apoptosis
32
Give two methods of comparing normal cells to cancerous cells
Gene arrays
| Tissue microarrays
33
What gene/protein monitors DNA changes and if mutation has occurred, triggers apoptosis
p53
34
Define tumour
Any abnormal swelling e.g. neoplasm, inflammation, hypertrophy, hyperplasia
35
What is most common cancer in men?
Prostate
36
What is most common cancer to cause death in men and/or women?
Lung cancer
37
What is most common cancer in women?
Breast
38
What 2 things comprise the structure of a neoplasm?
Neoplastic cells
| Stroma
39
Why can you often get central necrosis in a malignant neoplasm?
As malignant neoplasm often outgrows its blood supply leaving infarcted cells in the centre
40
What is the stroma of a neoplasm and what are the 2 functions of it
Connective Tissue Framework
Mechanical Support and Nutrition
41
Why does hepatitis increase your risk of hepatocellular carcinoma
Virus causes cirrhosis of the liver
| therefore increased cell turnover and higher carcinoma risk
42
Give an example of a tumour that is borderline between benign and malignant
some Ovarian lesions
43
Why can many people get found to have cancer later?
Pain is often a late feature of cancer
44
What is the purpose of classifying neoplasms
Determine appropriate treatment
| Provide prognostic information
45
Give 2 methods of classification for neoplasms
Behavioural (Benign/malignant)
| Histogenic ( specific cell of origin of tumour)
46
Describe features of benign neoplasms
- Localised, non-invasive
- Slow growth rate
- Low mitotic activity
- Close resemblance to normal tissue (Nuclear morphometry often normal)
- Circumscribed or encapsulated
- Necrosis rare
- Ulceration rare
- Growth on mucosal surfaces often exophytic
47
How do benign neoplasms cause morbidity and mortality?
- Pressure on adjacent structures
- Obstruct flow
- Production of hormones
- Transformation to malignant neoplasm
- Anxiety
48
What is meant by exophytic and what is opposite?
grow outward beyond the surface epithelium from which it originates
endophytic
49
In notation, how would a benign neoplasm be named?
ends in -oma (no sarco or carcin before)
| e.g. adenoma is benign tumour of glandular epithelium, but adenocarcinoma is malignant
50
Describe features of malignant neoplasms
- Invasive
- Metastases
- Rapid growth rate (increased mitotic activity)
- Variable resemblance to normal tissue
- Poorly defined or irregular border
- Necrosis common
- Ulceration common
- Hyperchromatic nuclei
- Pleomorphic nuclei
- Growth on mucosal surfaces and skin often endophytic
51
How do malignant neoplasms cause morbidity and/or mortality
```
Destruction of adjacent tissue
Metastases
Blood loss from ulcers
Obstruction of flow
Hormone production
Paraneoplastic effects
Anxiety and pain
```
52
Whats purpose of histogenetic classifaction?
specific cell of origin of tumour specified via histopathological examination to give tumour type
53
Where can neoplasms arise from?
Epithelial cells
Connective tissues
Lymphoid/haemopoietic organs
54
Define papilloma
Benign tumour of non-glandular, non-secretory epithelium e.g. squamous cell papilloma (prefix with cell type of origin)
55
Define an adenoma
Benign tumour of glandular or secretory epithelium
| e.g. colonic adenoma or thyroid adenoma (prefix with cell type of origin)
56
Define carcinoma
Malignant tumour of epithelial cells
| e.g. transtitional cell carcinoma (prefixed by name of epithelial cell
57
What is a malignant carcinoma of glandular epithelium called?
Adenocarcinoma
58
Give 4 examples of benign connective tissue neoplasms
Lipoma
Chondroma
Osteoma
Angioma
59
What is a benign neoplasm of adipocytes called?
lipoma
60
What is a benign neoplasm of bone called?
osteoma
61
What is a chondroma?
benign neoplasm of cartilage
62
What is an angioma?
benign neoplasm of vascular system
63
What is a benign neoplasm of striated muscle called?
Rhabdomyoma
64
What is a benign neoplasm of smooth muscle called?
Leiomyoma
65
What suffix is given to malignant connective tissue neoplasms
sarcoma
66
What is a malignant neoplasm of blood vessels called?
Angiosarcoma
67
What is an osteosarcoma
malignant neoplasm of bone
68
What is a malignant neoplasm of cartilage called?
Chrondrosarcoma
69
What is a liposarcoma
malignant neoplasm of adipose tissue
70
What is a malignant neoplasm of smooth muscle called?
Leiomyosarcoma
71
What is a malignant neoplasm of striated muscle called?
Rhabdomyosarcoma
72
When the cell-type of origin is unknown, what is the tumour called?
Anaplastic
73
Give 3 examples of conditons that end in 'oma' but are NOT neoplasms
Granuloma
Mycetoma
Tuberculoma
74
Give 3 examples of malignant tumours that do not end in carcinoma or sarcoma
Melanoma
Mesothelioma
Lymphoma
75
What is a melanoma
MALIGNANT neoplasm of melanocytes
76
What is a malignant neoplasm of lymphoid cells called?
Lymphoma
77
What is a mesothelioma?
MALIGNANT neoplasm of mesothelial cells
| *can result from asbestos exposure*
78
How does radon gas cause lung cancer?
Alpha particle emitter
| if inhaled, can damage DNA
79
What exceptions are there to conventional neoplasm naming
Granuloma, Mycetoma, Tuberculoma
Melanoma, Mesothelioma, Lymphoma
```
Teratoma
Blastomas
mixed tumours
APUDomas (Amine content and/or Precusor Uptake and Decarboxylation)
Carcinosarcomas
```
80
What are blastomas
Embryonal tumours
81
What is a teratoma
Tumour made up of several different types of tissue, such as hair, muscle, or bone. They typically form in the ovaries, testicles, or tailbone and less commonly in other areas.
(cause of prostate cancer in women)
82
Where can you get carcinosarcomas?
Mix or carcinoma and sarcoma
Can arise in diverse organs, such as the skin, salivary glands, lungs, the oesophagus, pancreas, colon, uterus and ovaries
83
Where are leiomyomas common
Myometrium
| benign smooth muscle neoplasm
84
*What is an angiolipoma
Tumour made of adipose and blood vessels that develops under skin
85
Where would you often find an angiomyolipoma?
Kidneys
| Although benign, they can grow to impair kidney function or the blood vessels may dilate and burst, leading to bleeding
86
How could a benign neoplasm of fibroid/smooth muscle kill a patient
While don't invade tissue, can push outwards
| Can then damage local BVs such as aorta
87
*What is meant by carcinoma in situ?
cancer dividing but hasn't broken through basement membrane (so hasn't spread)
88
What is meant by a micro-invasive carcinoma
Carcinoma that has invaded past basement membrane but hasnt spread far (<1mm)
(therefore local treatment still usually fine)
89
How can cancerous cells invade/pass the basement membrane?
Proteases - matrix metalloproteinases
| Cell motility
90
Give 3 examples of matrix metalloproteinases that allow invasion of basement membrane by cancerous cells
Collagenase
Cathepsin D
Urokinase-type plasminogen activator
91
**Describe the process of metastasis
- Invasion of basement membrane by mutated cancerous cell by proteases and cell motility
- Intravasation
- Evasion of host immune system and movement around body
- Extarvasation
- Growth at metastatic site (distant target organ) to form metastases (growth factors often present)
- Angiogenesis of metastases
92
How is tumour cell motility increased?
Tumour cell derived motility factors
| Breakdown of products of extracellular matrix (e.g. CTissue also)
93
What features of tumour cell allow intravasation?
Collagenases
| Cell motility
94
How do tumour cells evade the immune system?
Aggregation with platelets
Shedding of surface antigens
Adhesion to other tumour cells
95
What allows extravasation?
Adhesion receptors
Collagenases
Cell motility
96
What promotes angiogenesis?
Vascular endothelial growth factor
Basic fibroblast growth factor
(can be produced by tumour cells)
97
What inhibits angiogenesis?
Angiostatin
Endostatin
Vasculostatin
98
Give an example of a drug that inhibits angiogenesis
Avastin
99
How does avastin inhibit angiogenesis
Interaction between VEGF (VEGF-A) and VEGFR-2 (receptor) is a key drive of angiogenesis.
Avastin specifically binds to and inhibits VEGF extracellularly
100
What are other uses of avastin
```
Macular degeenration (check)
injected into eye to stop leaking BV
```
101
Why are lung metastases often
Any tumour invading lymph or veins drains into vena cava, which drains into right side of heart. From heart blood is pumped into lung and metastases can get lodged in capillary filter.
102
Why can lung cancers metastasise to many parts of the body?
Any metastases that move into BVs will go into left side of heart, from which they could be pumped to anywhere the aorta supplies blood to.
103
Why does colorectal cancer not often metastasise to many parts of the body?
Venous drainage of colon and rectum go to liver and metastases can get lodged in capillary filter here. Causes LIVER metastases.
104
Name a cancer type that more commonly metastasises to lung
Sarcomas (any common cancer)
105
Name tumours that more commonly metastasise to the liver
Colon
Stomach
Pancreas
Carcinoid tumours of intestine
106
Name tumours which more commonly meastasise to bone
Lung
Kidney
Thyroid
Breast Prostate
107
*Give example of cancer drugs that can stop cell division
Vinblastine
Ifosamide
Cisplatin
Etoposide
also: Cetuximab, Gleevec
108
Which of the following does not commonly metastasise to bone:
Lung, Breast, Liposarcoma, Kidney
Liposarcoma
109
Give an example of a cancer that does not have a screening service in the UK
Lung cancer
110
Give an example of a breast cancer screening service
Mamography for >50 year old women
111
Which of the following is not a known carcinogen in humans:
| Hepatitis C, Ionising radiation, Aromatic amines, Aspergillus niger
Aspergillus niger (black mould like in shower)
112
What type of cancer are aromatic amines linked with?
Bladder cancer
113
What type of cancer is ionising radiation linked with
Thyroid cancer
114
Give an example of a fungus that can cause cancer
Aflatoxin
| increased risk of Hepatocellualr cancer
115
Give 3 features of malignant neoplasms
Vascular invasion
Metastasis
Increased cell division
116
While overall growth rates of cancerous and normal cells are different, give an example of a cancer where they can be similar
Hamartoma
| coin lesions in lung
117
Smoking is the biggest cause of cancer:
| If someone smoked 20 cigarettes a day, what is the increase in risk of cancer
26x more at risk of lung cancer
118
True or False:
| Ovarian cancer often spreads in peritoneum
True
| No barrier between ovaries and peritoneum so easy spread
119
*Give 3 examples of methods to grade cancer
```
TMN classification
Dukes Classification (Colon cancer)
FIGO (gynaecology cancers)
```
120
*In TMN classification, what does each letter stand for
Tumour (size/invasion 1-4)
Nodes (0-2 depending on number of nodes)
Metastasis (0-1)
121
True or false: 1 in 3 people will get cancer in UK
True
122
Give some examples of environmental factors that can cause cancer
UV - skin cancer
Chemicals - Lung cancer
Pathogens - HPV causes cervical cancer; helicobacter causes stomach cancer
123
What % of cancers are inheritable / due to transformation of gremlin cells
<10% (Rb, BRCA1, 2)
124
What % of cancers are non-inheritable / due to transformation of somatic cells
>90%
125
What is meant by the term cancer
Cancer represents a wide spectrum of conditions caused by a failure of the controls that normally govern cell proliferation, differentiation and cell survival
126
What is the purpose of tumour immunology
Goal of tumour immunology is to induce clinically effective anti‐tumour immune responses that would discriminate between tumour cells and normal cells in cancer patients.
127
What is meant by cancer immnosurveillance
Immune system can recognize and destroy nascent transformed cells, normal control
128
Describe Tumour Specific Antigens
Only found on tumours
Result of point mutations or gene rearrangement
Derive from viral antigens
129
Describe Tumour Associated Antigens
Found on both normal and tumour cells but are over expressed on cancer cells
Developmental antigens which become derepressed
Differentiation antigens are tissue specific
Altered modification of a protein could be an antigen
130
**Give examples of antigens that are tumour-specific mutated oncogenes or tumour suppressors
Cyclin-dependent kinase 4
Beta Catenin
Caspase-8
Surface Ig/Idiotype
131
What is nature of antigen 'cyclin-dependent kinase 4' and in what tumour type is this found?
Cell-cycle regulator
| Melanoma
132
What is nature of antigen 'Beta-Catenin' and in what tumour type is this found?
Relay in signal transduction pathway
| Melanoma
133
What is nature of antigen 'Caspase 8' and in what tumour type is this found?
Regulator of apoptosis
| Squamous cell carcinoma
134
What is nature of antigen 'Surface Ig/Idiotype' and in what tumour type is this found?
Specific antibody after gene rearrangements in B cell clone
| Lymphoma
135
What is the class and nature of antigen: MAGE-1 or MAGE-3
```
Class = Germ cell
Nature = Normal testicular proteins
```
136
In what types of tumour do you find the germ cell antigens MAGE-1 or MAGE-3
Melanoma
Breast
Glioma
137
```
What is the class and nature of antigen: Tyrosinase
and what tumour type do you find this antigen in?
```
```
Class = differentiation
Nature= enzyme in melanin synthesis pathway
Tumour = melanoma
```
138
What roles does immune response play in tumour awareness
Immunosurveillance and immunoediting
139
What is meant by immunoediting in cancer pathology
immune responses can change tumours to be hidden from recognition by the immune system and tumours can promote immune suppressor cells: T regs and myeloid-derived suppressor cells (MDSC)
