Cancer Pathology

Question 1

Neoplasia Means ”New Growth”

Answer 1

They proliferate to form new tissue
They do not wait for signals from the body that the new tissue is needed
They ignore signals to stop dividing
They often do not mature normally (differentiate) to do the “job” the tissue is supposed to do
They do not die off (apoptosis) to keep the number of total cells

Question 2

Cell Mutation

Answer 2

When differentiated, “working” cells mutate, they form differentiated “working” tumors— benign tumors
When undifferentiated, rapidly dividing cells mutate, they form rapidly dividing tumors—malignant tumors. Malignant metastasizes
Anaplasia: hallmark of cancer cells. Loss of differentiation.

Question 3

When a well-differentiated cell mutates, is it more or less likely to become a malignant tumor?

Answer 3

Less

Question 4

Four basic features that differentiate a cancer cell

Answer 4

Uncontrolled cell proliferation
Decreased cellular differentiation
Inappropriate ability to invade surrounding tissue
Ability to establish new growth at ectopic sites

Question 5

Angiogenesis

Answer 5

Is the growth of new vessels.
Is also called neovascularization.

Advanced cancers can secrete angiogenic factors to facilitate feeding of the tumor.
Vascular endothelial growth factor (VEGF)
Platelet-derived growth factor (PDGF)
Basic fibroblast growth factor (bFGF)

Question 6

Carcinoma

Answer 6

Epithelial tissue

Question 7

Adenocarcinoma

Answer 7

From ductal or glandular tissue

Question 8

Sarcoma

Answer 8

Mesenchymal tissue

Question 9

Lymphoma

Answer 9

Lymphatic tissue

Question 10

Leukemia

Answer 10

Blood-forming cells

Question 11

Carcinoma in situ (CIS):

Answer 11

hasn’t escaped yet, scoop out of the body

Three prognoses:
Can remain stable for a long time.
Can progress to invasive and metastatic cancers.
Can regress and disappear.

Question 12

Benign

Answer 12

Slow growth
Well-defined capsule
Not invasive
Well differentiated
Low mitotic index
Does not metastasize

Question 13

Malignant

Answer 13

Rapid growth
Not encapsulated
invasive
Poorly differentiated: Anaplasia
High mitotic index
Can spread distantly (metastasis)

Question 14

Benign Tumors

Answer 14

Contain cells that look like normal tissue cells
May perform the normal function of the tissue (like secreting hormones)
This may lead to oversecretion
Usually have a capsule around them
Usually do not invade neighboring tissues
But they can damage nearby organs by compressing them

Question 15

A nurse hears in a report that an individual has benign tumors. What does this mean?
The tumors:

Answer 15

Are encapsulated.

Question 16

Tumor markers are found:

Answer 16

By examination of serum

Question 17

Cancer Invasion and Metastasis

Answer 17

Invasion: Local spread
Is a prerequisite for metastasis and the first step in the metastatic process.
Cancer often spreads first to regional lymph nodes through the lymphatic system and then to distant organs through the bloodstream.
Invasion then requires that the cancer attach to specific receptors and survive in the specific environment.

Question 18

Metastasis

Answer 18

Secondary tumor in a location distant from the primary tumor

Lymphatic Spread: Sentinel Node

Question 19

Clinical Manifestations of Cancer

Answer 19

Stage 1
Is confined to its organ of origin.
Stage 2
Is locally invasive.
Stage 3
Has advanced to regional structures, i.e. lymph nodes
Stage 4
Has spread to distant sites.

Question 20

A patient has been diagnosed with prostate cancer that has metastasized to the bone. The stage of this cancer is:

Answer 20

4

Question 21

Manifestations of Cancer

Answer 21

Changes in organ function (organ damage, inflammation, and failure)
Local effects of tumors (e.g., compression of nerves or veins, gastrointestinal obstruction)
Ectopic hormones secreted by tumor cells (paraneoplastic disorders)
Nonspecific signs of tissue breakdown (e.g., protein wasting, bone breakdown)

Question 22

Paraneoplastic syndromes

Answer 22

Symptom complexes are triggered by a cancer but are not caused by direct local effects of the tumor mass.
Are caused by biologic substances released from the tumor (e.g., hormones) or by an immune response triggered by the tumor.
Can be life threatening.

Question 23

Pain

Answer 23

Little or no pain is associated with early stages of malignancy.
Is associated with the late stage of cancer.
Mechanisms
Pressure, obstruction, invasion of sensitive structures, stretching, tissue destruction, and inflammation

Question 24

Fatigue

Answer 24

Is the most frequently reported symptom of cancer and cancer treatment.

Suggested causes
Sleep disturbance, biochemical changes that are secondary to the disease and its treatment, psychosocial factors, level of activity, nutritional status, and environmental factors

Question 25

Cachexia

Answer 25

Is the most severe form of malnutrition.
Leads to protein-calorie malnutrition and progressive wasting.

Manifestations
Anorexia, early satiety, weight loss, anemia, asthenia, taste alterations, and altered protein, lipid, and carbohydrate metabolism

Question 26

Anemia

Answer 26

Is a decrease of hemoglobin in the blood.

Mechanisms
Chronic bleeding that results in iron deficiency, severe malnutrition, chemotherapy, radiation, or malignancy in blood-forming organs

Question 27

Leukopenia and thrombocytopenia

Answer 27

Chemotherapy drugs and radiation are toxic to bone marrow.

Question 28

Infection, GI, Hair Loss

Answer 28

Infection
Is the most significant cause of complications and death.

GI tract
Oral ulcers (stomatitis), malabsorption, diarrhea

Hair loss (alopecia)
Is a result of the chemotherapeutic effects on hair follicles.
Is usually temporary
Hair may initially regrow with a different texture.

Question 29

Induction chemotherapy

Answer 29

Causes shrinkage or the disappearance of tumors.

Question 30

Adjuvant chemotherapy

Answer 30

Is administered after the surgical excision with a goal of eliminating micrometastases.

Question 31

Neoadjuvant chemotherapy

Answer 31

Is administered before localized (surgical or radiation) treatment.

Question 32

Radiation Therapy

Answer 32

Is used to kill cancer cells while minimizing the damage to normal structures.

Ionizing radiation
Damages cells by imparting enough ionizing radiation to cause molecular damage to the DNA.
Causes irreversible damage to normal cells.
Lifetime radiation dose

Brachytherapy
Seeds are implanted
Can cause fertility problems since radiation affects gametes

Question 33

Surgery

Answer 33

Is a definitive treatment of cancers that do not spread beyond the limits of surgical excision.
Palliative: Is indicated for the relief of symptoms.
In selected high-risk diseases, surgery plays a role in the prevention of cancer.

Question 34

1. ) Cancer is a disorder of altered cell differentiation and growth
2. ) Surgery, radiation, and chemotherapy are the only identified treatment modalities for cancer
3. ) The Papanicolaou test is a cytologic method used to detect cancer cells.
4. ) Cell differentiation is the process whereby proliferating cells are transformed into different and more specialized cell types.
5. ) Benign neoplasms are less differentiated tumors that grow in a crab like manner to invade surrounding tissues, have cells that break loose and travel to distant sites to form metastases, and inevitably cause suffering and death unless their growth can be controlled through treatment

Answer 34

1. ) T
2. ) F
3. ) T
4. ) T
5. ) F

Question 35

Genomics

Answer 35

The study of patterns of DNA changes (or mutations) is called genomics. We know that most cancers have changes in their DNA, the molecules that direct the functions of all cells. It’s these changes that turn a normal cell into a cancer cell. Such gene changes, called somatic mutations, may arise as a natural consequence of aging or when a cell’s DNA has been damaged.

Question 36

Inflammation as a Cause

for Cancer

Answer 36

Chronic inflammation: Is an important factor in the development of cancer.

Active inflammation predisposes a person to cancer.
By stimulating a wound-healing response that includes proliferation and new blood vessel growth

Susceptible organs
Gastrointestinal (GI) tract, pancreas
Thyroid gland
Prostate, urinary bladder
Pleura, skin

Question 37

Obesity

Answer 37

Is associated with endometrial, colorectal, kidney, esophageal, breast (postmenopausal), and pancreatic cancers.
Correlates with the body mass index (BMI) .
Increases insulin resistance–producing hyperinsulinemia.
Circadian disruptions may affect cancer growth.

Question 38

Alcohol consumption

Answer 38

Is classified as a human carcinogen.
Increases the risk for oral cavity, pharynx, larynx, esophageal, liver, colorectal, and breast cancers.
A combination of cigarette smoking and alcohol consumption increases a person’s risk for cancer.

Question 39

Physical activity

Answer 39

Decreases the risk of cancer.
Decreases insulin and insulin-like growth factors.
Decreases obesity.
Decreases inflammatory mediators.
Improves immune function.
Increases gut motility.
Reduces the risk for breast, colon, and endometrial cancers, independent of weight changes.

Question 40

Ionizing radiation

Answer 40

Is emitted from x-ray machines, radioisotopes, and other radioactive sources.
Is associated with acute leukemias; increased frequencies of thyroid and breast carcinomas; lung, stomach, colon, esophageal, and urinary tract cancers, and multiple myeloma.

Question 41

Which information is correct regarding ultraviolet light?

Ultraviolet light causes:

Answer 41

Basal cell carcinoma