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MFM > Cancer > Flashcards

Cancer Flashcards

1
Q

smallest clinically detectable tumor?

A

1g, 109 cells, had already undergone 30 population doublings

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2
Q

what is the max size of a tumor compatible with life?

A

1kg (10 additional doublings from a 1g tumor)

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3
Q

what is the clinical significance of the size of a clinically detectable tumor?

A

by the time the 1g tumor is detected, it has already competed a major portion of its lifespan

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4
Q

what determines the growth rate of a tumor?

A
  1. the doubling time of the tumor cells
  2. the fraction of tumor cells that are in the replicative pool
  3. the rate at which cells are shed or die
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5
Q

relationship of effectiveness of chemotherapeutic drugs and replicative pool size?

A

tumors with a large percentage of cells in the replicative pool will respond better to chemo than those with a low percentage of replicating cells (chemo targets actively cycling cells)

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6
Q

difference between malignant and benign tumors with regard to level of differentiation

A

malignant tumors tend to be LESS differentiated than benign tumors, so they grow more rapidly than benign tumors

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7
Q

what does multistep carcinogenesis mean

A

the cancer results from the accumulation of multiple mutations over time, ex. colorectal cancer

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8
Q

mechanism of CRC development

A
  1. first hit is a mutation (germ line or somatic) in APC
  2. second hit is the inactivation of other APC allele via abnormal methylation
  3. proto-oncogene K-RAS converts to oncogenic form of K-RAS
    COULD LEAD TO CELLS SENESCE WITH JUST ADENOMA POLYPS, IF P53 MUTATES, TELOMERASE AFFECTED AT THE END
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9
Q

what is hyperplasia

A

accumulation of excessive numbers of normal appearing cells within normal appearing tissue

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10
Q

what is dysplasia

A

disordered growth resulting in disordered architecture of the tissue

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11
Q

what is anaplasia

A

tissue and cellular architecture lacking the differentiated characteristics of an identifiable tissue of origin

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12
Q

what is pleomorphism

A

variation in size and shape of both cells and nuclei of the cells

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13
Q

what is abnormal nuclear morphology

A

atypical mitosis which leads to tripolar, multipolar mitotic spindles (cell trying to divide into three cells or more)

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14
Q

what could be an effect of abnormal nuclear morphology?

A

chromosomes not split up correctly, loss of function/tumor suppressor genes in one daughter cell

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15
Q

characteristic of anaplasia

A
  1. pleomorphism
  2. abnormal cell morphology
  3. disorganized tissue structure
  4. tumor giant cells present
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16
Q

what is a tumor giant cell

A

large cell with either one large polymorphic nucleus or multiple nuclei

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17
Q

characteristic of benign tumor

A

mass of cells lacks ability to metastasize, cells within this mass resemble their parent tissue, surrounded by a fibrous capsule

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18
Q

characteristic of malignant tumors

A

tumor invades surrounding tissues, capable of producing metastases that may recur after attempted removal, cells within this mass diverge significantly from the parent tissue in morphology

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19
Q

how are cancers named

A

for the site of the body where they first develop

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20
Q

what are carcinomas

A

cancers of epithelial origin (ex. adeno)

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21
Q

what are sarcomas

A

cancers of connective tissue origin (ex. osteo, chondro, myo, lympho)

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22
Q

what is the most common type of cancer in adults

A

carcinoma, 90%

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23
Q

what is a lymphoma

A

solid tumor of lymphoid cells, 4% of cancer in adults, 8% of cancer in children

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24
Q

what is leukemia

A

tumor comprised of any of a variety of hematopoietic cell types dispersed through circulation, 4% of cancer in adults, 30% of cancer in children (ALL)

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25
Q

what are sarcomas

A

a rare type of cancer in adults, 1% in adults, 7% of cancers in children, originates from mesenchymal cells

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26
Q

what is retinoblastoma

A

cancer of retina, 2% of childhood cancers

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27
Q

what is wilms tumor

A

cancer of the kidney, 5% of childhood cancers

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28
Q

what is neuroblastoma

A

adrenal gland tumors, 6% of pediatric cancers

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29
Q

most common sarcomas in children

A

rhabdomyosarcoma, osteosarcoma, Ewing’s sarcoma

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30
Q

most common brain and CNS tumors in children

A

astrocytomas, medulloblastoma, ependymoma, 25% of childhood cancers

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31
Q

most common cancer in the US

A

melanoma and non-melanoma skin cancer

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32
Q

most common cancer in the world

A

lung cancer

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33
Q

4 types of lung cancer

A

adenocarcinoma, squamous cell carcinoma, small cell carcinoma, large cell carcinoma

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34
Q

2 subtypes of non-melanoma skin cancer

A
  1. squamous cell carcinoma

2. basal cell carcinoma

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35
Q

what does short periods of intense UV exposure increase the risk of

A

melanoma

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36
Q

what does chronic sun exposure increase risk of

A

non-carcinoma skin cancer

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37
Q

what is melanoma

A

aggressive form of skin cancer with poor prognosis and multiple sites of metastasis

38
Q

median survival for metastaic melanoma

A

6-12 months

39
Q

common sites of metastasis for melanoma

A

lung, brain, bone, liver

40
Q

where does melanoma develop?

A

melanocytes, which are pigmented cells found in the basal layer of epidermis

41
Q

what is familial melanoma

A

melanoma associated with mutations in CDKN2A locus

42
Q

what does CDKN2A encode

A

p16Ink4a and p15Ink4b CDK inhibitors and p14Arf p53 activator

43
Q

what does mutation in the CDKN2A locus infer

A

CDK will not be inhibited and p53 will not be activated, leading to cell survival and proliferation

44
Q

what is sporadic melanoma

A

melanoma arising from sun-exposed sun due to mutations in B-Raf, Ras and p16, sometimes epigenetic silencing of PTEN

45
Q

what sporadic melanoma is associated with non-sun exposed skin

A

mutations in RTKinase c-Kit, sometimes epigenetic silencing of PTEN

46
Q

what is the most common form of skin cancer

A

basal cell carcinoma

47
Q

characteristics of basal cell carcinoma

A

originates from cells in basal layer of skin, rarely metastasize, good prognosis, can be removed surgically

48
Q

characteristics of squamous cell carcinoma

A

arises from keratinocytes in epidermis, can become metastatic, can be removed surgically if NOT metastatic

49
Q

risk factors for squamous cell carcinoma versus basal cell and melanomas

A

squamous cell carcinoma can develop due to industrial chemical exposure and tobacco chewing in addition to sun exposure

50
Q

what mutations cause basal cell carcinoma

A

inactivating mutations (LOF, tumor suppressor) in PTCH and activating mutations (GOF, oncogene) in SMO

51
Q

what would mutation in PTCH and SMO lead to

A

increased GLI1-mediated gene transcription and increased expression of cyclinD, leading to increased gene expression and unregulated cell division and abnormal growth

52
Q

what is Gorlin syndrome

A

inherited form of basal cell carcinoma, inherited mutations in PTCH (mutation in PTCH where it does not inhibit SMO)

53
Q

drugs to treat basal cell carcinoma

A

cyclopamine, vismodegib, both inhibit SMO

54
Q

pathology of squamous cell carcinoma

A

inactivating (loss of function, tumor suppressor) mutation in p53, also oncogenic mutation in RAS (Ras activated)

  1. UV damage to DNA, but absence of functional p53 does not initiate cell cycle arrest (via binding to p21, which inhibits Cdk)
  2. lack of cell cycle arrest allows proliferation of cells that have undergone UV induced mutations
55
Q

how is early stage squamous cell carcinoma treated

A

5-fluorouracil cream

56
Q

what is SCLC

A

small cell carcinoma lung cancer, is a central, aggressive, (early) metastatic cancer but is sensitive to chemo

57
Q

what is NSCLC

A

non-small cell carcinoma lung cancer, not metastatic, resistant to chemo

58
Q

what are included in NSCLC

A

adenocarcinoma, squamous cell carcinoma, large cell carcinoma

59
Q

risk factors for SCLC

A

smoking

60
Q

common sites of metastasis for SCLC

A

liver, bone marrow, brain, adrenal glands

61
Q

mutations found in SCLC

A

p53 and Rb found in 80% of cases (cannot initiate cell death or stop CDK, cannot halt proliferation)

62
Q

characteristic of cells in SCLC

A

the cells can secrete ACTH and form cushing’s disease

63
Q

what is cushing’s disease

A

hypercortisolism, increased ACTH, fatty deposits around face and upper back, weight gain in midsection but NOT the limbs

64
Q

what is the most common form of NSCLC

A

squamous cell carcinoma

65
Q

usual presentation of squamous cell carcinoma

A

bronchial obstruction

66
Q

what is the most common form of lung cancer found in non-smokers

A

adenocarcinoma of the lung

67
Q

characteristics of adenocarcinoma of the lung

A

mucosal glands in the bronchi, is more peripheral and can be mistaken for metastatic lesions

68
Q

characteristics of large cell carcinoma

A

large peripheral masses, poorly differentiated, grow rapidly, can produce hormones that result in paraneoplastic syndromes

69
Q

what is paraneoplastic syndromes

A

system complexes in cancer-bearing individuals that cannot be explained by the spread of the tumor or by hormones indigenous to tissue from which the tumor arose

70
Q

cell type of acute lymphoblastic leukemia (ALL)

A

immature pre-B or B cells

71
Q

characteristics of ALL

A

rare, affects younger people, aggressive disease that replaces bone marrow and invades tissues

72
Q

diagnosis of ALL

A

characteristic cells on examination of blood or bone marrow, flow cytometry may be required to distinguish from acute myeloid leukemia (AML)

73
Q

cell type affected in CLL (chronic lymphoblastic leukemia)

A

mature B cells

74
Q

characteristics of CLL

A

common in elderly, may be nonagressive

75
Q

diagnosis of CLL

A

lymphocytosis on blood film, CLL lymphocytes express characteristic surface molecules detected by flow cytometry

76
Q

cells affected in lymphoma

A

mature B-cells

77
Q

characteristics of lymphona

A

frequently associated with EBV or infection and chromosomal translocation, cause solid lesions beginning in lymph nodes or mucosa associated lymphoid tissue

78
Q

diagnosis of lymphoma

A

bx of affected tissue, heavy chain rearrangement, chromosomal analysis

79
Q

cells affected in multiple myeloma

A

plasma cells

80
Q

characteristics of MM

A

common in elderly

81
Q

diagnosis of MM

A

detection of monoclonal immunoglobulin in blood or light chains in urine, presence of plasma cells in marrow and osteolytic lesion on radiograph

82
Q

cells affected in T-cell malignancy

A

T-cells

83
Q

characteristics of T-cell malignancy

A

is rare, may be caused by HTLVI infection

84
Q

diagnosis of T-cell malignancy

A

can behave either as leukemia (blood involvement) or lymphoma (solid tissue involvement)

85
Q

what is cancer cachexia

A

progressive loss of body fat and lean body mass accompanied with profound weakness, anorexia, and anemia, that is NOT caused by nutritional demands of the tumor

86
Q

what causes cancer cachexia

A

possibly production of cytokines by the tumor, which results in mobilization of fats from tissue stores and appetite suppression

87
Q

what are the paraneoplastic syndromes?

A
  1. hypercalcemia
  2. cushing syndrome
  3. acanthosis nigricans
  4. clubbing of fingers
88
Q

what causes finger clubbing

A

cardiopulmonary disorders, commonly lung cancer

89
Q

most common paraneoplastic syndrome?

A

hypercalcemia

90
Q

what causes hypercalcemia

A
  1. osteolysis induced by the cancer

2. production of calcemic humoral substances by extraosseous neoplasms

91
Q

what is cushing’s disease associated with

A

small cell carcinoma lung cancer (SCLC)

92
Q

what is acanthosis nigricans

A

gray-black patches in skin folds of neck, groin, and anogenital regions, usually associated with gastrointestinal adenocarcinoma

MFM (39 decks)

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