cancer notes-- patho Flashcards
malignant growth
cancer cells invades adjacent tissues and travels in lymphatic system and bloodstream
benign growth
do not invade other tissues, more closely resemble cell of origin
etiology of cancer: genetic basis
cancer is a disease caused by a small number of mutations in a single cell
minimum number of mutations is ___ for cancer
2
carcinomas
tumors of epithelial origin
sarcomas
malignant cancers of bones, nerves, muscles
leukemias
malignant growths of WBC’s, only in blood
lymphomas
cancer of WBC’s and lymph tissue, usually start in lymph
adenocarcinomas
cancers of ductal or glandular tissue
tumor suppressor genes
inhibit tumor formation and cell proliferation, usually function to switch off cell division
there are ___ genes in each pair of tumor suppressor genes
2
one gene in each pair of tumor suppressor genes can be absent or damaged, loss of the second gene leads to ________ division.
uncontrollable
BRCA 1
chromosome 17; tumor suppressor gene that is autosomal dominant inheritance , 85% of women with mutation will develop breast cancer, also increased risk for ovarian cancer
BRCA 2
chromosome 13, accounts for 10-15% of all breast cancer cases
proto-oncogenes
normally act to turn on or maintain cell division
oncogenes
tumor causing genes that increase rate of cell proliferation
how do oncogenes increase the rate of cell proliferation?
they become permanently active or overproduce their products with mutations and disrupt intracellular communication pathways that regulate cell proliferation.
oncogene activation
virus or retirovirus, has a mutagenic effect= changes structure and function
cellular effects of oncogene
promote cell proliferation, growth factor, second messengers, abnormal gene transcription begins
caretaker genes
genes responsible for dna repair, mutation does not directly lead to tumor formation, increases mutation rate of all genes, does not lead directly to formation of cancer
pathogenesis of cancer
initiation– genetic mutation, carcinogen applied to cell. If no repair before cell division= cells are damaged
promotion
mutant cell induced to proliferate, reversible proliferation of altered initiated cells, promoting factors in proliferation
progression
cells acquire properties that allow mallignant behavior
progression properties
-increased growth rate and invasiveness of tumor
-tumors produce own growth factor
-lack contact inhibition
-able to metastasize
metastasis
ability to spread to distant parts of the body, spread through blood or lymph pathways. Seeding is needed to kill all cells. Characteristics of primary site are retained
grading of cancer
microscopic anatomy (what cell looks like), number system is used
staging
location and pattern of spread
TNM classification
T describes the size of the tumor and any spread of cancer into nearby tissue; N describes spread of cancer to nearby lymph nodes; and M describes metastasis (spread of cancer to other parts of the body).
anatomical site classification–skin and glands
carcinomas
anatomical site classification– connective tissue, muscle, bone, fat
sarcomas
warning signs of effect of cancer on host
change in bowel or bladder habits, a sore throat that does not heal, unusual bleeding or discharge from any body orifice, thickening or lump in breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart or mole, nagging cough or hoarseness
late signs of effect of cancer on host
pain, weight loss and weakness, bone marrow suppression (anemia, thrombocytopenia, leukopenia), loss of function of involved organ, obstruction, deficits in immune system competence
tumor markers are
produced by cancer cells, presence may indicate possibility of cancer
Carcinoembryonic antigen
CEA, colorectal or breast cancer
alpha-fetoprotein
testicular, liver cancer
human chorionic gonadotropin
HCG, testicular
prostatic specific antigen
PSA, prostate cancer
CA125
ovarian cancer
other tests used to diagnose cancer
X-ray, CT, ultrasound, MRI, PET, nuclear medicine studies, endoscopic exams
biopsy
definitive diagnosis test for cancer, only way to truly diagnose
surgery treatment for cancer
used to remove solid tumors
radiation treatment for cancer
kills cells that are not resectable due to location or that have escaped after surgery
immunotherapy treatment for cancer
boost immune system’s ability to locate and destroy cancer cells
gene and molecular therapy
enhance tumor suppressor genes
risk factors for cancer
smoking, sunlight, alcohol, smokeless tobacco, estrogen, radiation, occupational hazards, high fat diet, obesity
common neoplastic disorders of bone marrow and lymphoid tissues
Lymphoma, plasma cell myeloma, leukemia
where is lymphoma located?
lymph nodes
where is plasma cell myeloma located, what is it?
malignant transformation of B-cell plasma cells, likes to form tumors on bony structures
where is leukemia located?
blood and bone marrow
Myeloid Neoplasms properties
myoproliferative (bone marrow makes too many RBC’s)
Myeloid Neoplasms Cancers
Chronic Myeloid Leukemia, Acute Myeloid Leukemia, Polycythemia Vera, Essential Thrombocytopenia
Lymphoid Neoplasm properties
B cell neoplasm
Lymphoid Neoplasm Cancers
Chronic Lymphoid Leukemia, Acute Lymphoblastic Leukemia, Plasma Cell Myeloma, Hodgkin’s Disease
Non-Hodgkin’s Lymphoma properties
lymphomas of B cell, T cell and NK cell origin. Includes a large and diverse group of mallignancies
etiology of hematologic (myeloid and lymphoid) neoplasms
Exact cause of hematologic neoplasms is unknown.
Basic mechanisms involve cell mutation that disrupts growth control
& differentiation pathways.
Malignant Disorders of WBC’s typical signs and symptoms
Malaise, weakness, Unexplained fever, night sweats, Recurrent infections, Lymphadenopathy with lymphoma & some leukemias, Very high total WBC count or the presence of abnormal cell
types
leukopenia common clinical manifestations
lymphadenopathy, joint swelling and pain, weight loss, anorexia, hepatomegaly, splenomegaly
anemia common clinical manifestations
pallor, fatigue, malaise, shortness of breath, decreased activity tolerance
thrombocytopenia common clinical manifestations
platelet count below 20,000 cells/microliter, petechiae, easy bruising, bleeding gums, occult hematuria, retinal hemorrhages
neutropenia common clinical manifestations
absolute neutrophil count less than 500 cells per microliter, evaluation of peripheral blood sample is a key aspect of diagnosis. Definitive diagnosis is made after bone marrow aspiration or lymph node biopsy
Prevention and management of mallignant WBC disorders
bone marrow transplantation, peripheral stem cell transplantation, autologous transplantation, allogenic transplantation, graft vs. leukemia
bone marrow transplantation
transplantation of multipotent hematopoietic stem cells, usually derived from bone marrow, peripheral blood, or umbilical cord blood in order to replicate inside of a patient
peripheral stem cell transplantation
allows stem cells to be harvested from circulating bloodstream
autologous transplantation
stem cells from patient’s own blood to be reinfused
allogenic transplantation
stem cells from closely matched relative
graft v. leukemia
transplanted cells in allograft that detect & kill
leukemic cells.
myeloid neoplasms result from..
proliferation of an abnormal cell in bone marrow and overproduction of more than 1 cell type, offspring of abnormal cells build up and are released into bloodstream. Results in myoproliferative disease
chronic myeloid leukemia
myeloid neoplasm– malignant granulocytes carrying Philadelphia chromosome
cml clinical presentation
high granulocyte count on CBC, splenomegaly
cml symptoms
fatigue, weight loss, sweats, bleeding, abdominal discomfort (enlarged spleen)
cml prognosis and treatment
does not respond well to chemo; poor overall survival time. untreated= median survival is 2 years, blast stage cml prognosis= 4 months
Acute Myeloid Leukemia
associated with transformation of myeloid stem cell, bone marrow aspirate must have greater than 20% blasts.
AML symptoms
bone pain, anemia, thrombocytopenia, increased infection succeptibility
AML common infection sites
skin, GI, GU, respiratory
AML prognosis
less than 50% and less than 30% of adults survive long term
chronic lymphoid leukemia symptoms
fatigue, weight loss, anorexia, increased susceptibility to infections
cll progression of cells
Malignant lymphocytes invade lymph tissues & bone marrow; disrupt
function and cause enlarged, painless lymph nodes (lymphadenopathy) Enlarged spleen
cll prognosis and treatment
Certain genetic mutations present better/worse diagnosis.
Chemotherapy used to induce remission.
Stem cell transplantation to prolong remission.
acute lymphoblastic leukemia/lymphoma
Malignant transformation of lymphoblasts, 80% B-cells; 20%-T
cells
Lymphoblastic neoplasms: leukemia
lymphoblastic lymphomas: same disease at a different stage
acute lymphoblastic leukemia/lymphoma symptom onset
abrupt; bone pain, bruising, fever, infection, loss of appetite, fatigue, abdominal pain, enlarged spleen, enlarged liver, enlarged lymph nodes
Plasma Cell Myeloma (multiple myeloma)
malignancy of mature, antibody-secreting b lymphocytes
plasma cell myeloma progression of cells
Malignant plasma cells invade bone & form multiple tumor sites;
Bone destruction releases Ca+ into bloodstream (hypercalcemia).
Pathologic fractures common.Excessive identical monoclonal antibodies made up of Bence Jones
Proteins, accumulate in blood and urine.
diagnosis of plasma cell myeloma is based on:
Presence of Bence Jones protein
Hypercalcemia
Evidence of bone lesions. Bone marrow biopsy confirms diagnosis.
Hodgkin Disease
Malignant disorder of the lymph nodes
Hodgkin Disease cell progression
Malignant transformation of B cells in lymph nodes called Reed-
Sternberg cells
Grow/spread predictable, usually metastasizes along lymphatic
pathways. Sets HD apart from other lymphomas
Hodgkin Disease (Hodgkin’s Lymphoma) clinical manifestations
Early stages: often asymptomatic
Painless lymphadenopathy; possibly with fever, night sweats,
pruritus, weight loss, malaise.
Lymph node enlargement above diaphragm, cervical nodes most
common site.
hodgkin’s disease prognosis and treatment
Localized tumors: radiation therapy (most common)
Disseminated disease: chemotherapy
Non-Hodgkin’s Lymphomqa (B cell, T cell and NK cell lymphoma)
DO NOT HAVE REED STERNBERG CELLS, majority arise in lymph nodes, tumor cells derived from one single mutant precursor cell
non-hodgkins lymphoma symptoms
Painless lymphadenopathy, fever, night sweats, weight loss,
malaise, pruritus
combination therapy type of treatment
primary
stem cell transplant type of treatment
primary
