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High Yield Pathoma > Ch. 3 - Principles of Neoplasia > Flashcards

Ch. 3 - Principles of Neoplasia Flashcards

1
Q

What are 3 important features of neoplasia?

A

unregulated, irreversible, and monoclonal

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2
Q

What does monoclonal refer to?

A

neoplastic cells are derived from a single mother cell

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3
Q

What is clonality determined by?

A

G6PD enzyme isoforms (or androgen receptor isoforms)

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4
Q

What is clonality of B cells determined by?

A

Ig light chain phenotype

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5
Q

What are 3 differentials that can present with an enlarged lymph nodes?

A

metastatic cancer, reactive hyperplasia, lymphoma

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6
Q

What must be the Dx if there is an enlarged lymph node with a light chain ratio k:l of 20:1 and why?

A

lymphoma d/t monoclonal expansion of light chain

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7
Q

What is the normal kappa:lambda ratio of Ig light chains?

A

3:1

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8
Q

What is the normal ratio of active isoforms in cells of any tissue?

A

1:1

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9
Q

What are the benign and melignant tumors of epithelial glands?

A

benign: adenoma
malignant: adenocarcinoma

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10
Q

What are the benign and malignant tumors of epithelial papillary growth?

A

benign: papilloma
malignant: papillary carcinoma

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11
Q

What are the benign and malignant tumors of mesenchyme?

A

benign: lipoma
malignant: liposarcoma

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12
Q

What are the benign and malignant tumors of lymphocytes?

A

benign: does not exist
malignant: lymphoma/leukemia

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13
Q

What are the benign and malignant tumors of melanocytes?

A

benign: nevus (mole)
malignant: melanoma

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14
Q

What are the top three causes of death in adults?

A

1) cardiovascular disease
2) cancer
3) cerebrovascular disease

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15
Q

What are the top three causes of death in children?

A

1) accidents
2) cancer
3) congenital defects

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16
Q

What are the most common cancers in adults by incidence?

A

1) breast/prostate
2) lung
3) colorectal

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17
Q

What are the most common cancers in adults by mortality?

A

1) lung
2) breast/breast/prostate
3) colorectal

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18
Q

What is the screening method for lung cancer?

A

there is none - reason why prognosis is so poor

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19
Q

How many division occur in a mutated cell before the earliest Sx arise?

A

~30 divisions

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20
Q

What occurs with each division of a cancerous cell?

A

increased mutations

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21
Q

What are the 2 goals of screening?

A

1) catch dysplasia before it becomes carcinoma

2) detect carcinoma before clinical Sx arise

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22
Q

What are the goals of mammography?

A

1) detect ductal carcinoma in situ - look for calcification in ducts
2) pick up tumors of 1cm (2cm - clinical Sx)

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23
Q

What are the goals of PSA and DRE?

A

prostate carcinoma only grows on the posterior periphery of the prostate, so it is clinically silent; these two diagnostics can help detect it before it spreads

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24
Q

What are the goals of hemoccult test and colonoscopy?

A

detect colonic adenoma before it becomes colonic carcinoma or carcinoma before it spreads

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25
Q

What is the goal of pap smears?

A

detect cervical dysplasia (CIN) before it becomes carcinoma

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26
Q

What carcinoma is associated with aflatoxins?

A

hepatocellular carcinoma

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27
Q

What do alkylating agents increase the risk of?

A

leukemia/lymhpoma

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28
Q

What carcinomas are associated with alcohol use?

A

squamous cell carcinoma of oropharynx and upper esophagus, pancreatic carcinoma, and hepatocellular carcinoma

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29
Q

What carcinomas are associated with arsenic?

A

squamous cell carcinoma of skin, lung cancer (arsenic is in cigarette smoke), and angiosarcoma of the liver

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30
Q

What carcinomas are associated with asbestos?

A

lung carcinomas&raquo_space;»»> mesothelioma

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31
Q

What carcinomas are associated with cigarette smoke?

A

carcinoma of oropharynx, esophagus, lung, kidney, and bladder

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32
Q

What is the most most common carcinogen in the world?

A

polycyclic hydrocarbons in cigarette smoke

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33
Q

What is the key carcinogen for urothelium tissue?

A

cigarette smoke

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34
Q

What carcinoma is associated with nitrosamines?

A

intestinal type of stomach carcinoma

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35
Q

What carcinoma is naphthylamine associated with?

A

urothelial carcinoma of the baldder

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36
Q

What carcinoma is vinyl chloride associated with?

A

angiosarcoma of the liver

*used to make PVC for use in pipes

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37
Q

What carcinoma is associated with nickel, chromium, beryllium, or silica?

A

lung carcinoma

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38
Q

What carcinomas are associated wtih EBV?

A

nasopharyngeal carcinoma (neck mass), Burkitt lymphoma, and CNS lymphoma in AIDS

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39
Q

Which two pts are most susceptible to EBV nasopharyngeal carcinoma?

A

Chinese male and pt from Africa

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40
Q

What carcinoma is associated with HHV-8?

A

Kaposi sarcoma - tumor of endothelial cells

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41
Q

What 3 populations are susceptible to KS?

A

1) older Eastern European males –> respond to excision
2) AIDS pts –> Tx w/ ARV agents
3) transplant pts –> reduce immunosuppression

42
Q

What carcinoma is associated with HBV and HCV?

A

hepatocellular carcinoma

43
Q

What carcinomas are associated with HTLV-1?

A

adult T-cell leukemia/lymphoma

44
Q

What carcinomas are associated with high-risk HPV

A

squamous cell carcinoma of the vulva, vagina, anus, and cervix; adenocarcinoma of the cervix

45
Q

What carcinomas are associated with ionizing radiation?

A

AML, CML, and papillary carcinoma of the thyroid via hydroxyl free radicals

46
Q

What carcinomas are associated with nonionizing radiation (i.e. UVB)?

A

basal cell carcinoma, squamous cell carcinoma, and melanoma of the skin

47
Q

How does nonionizing radiation damage DNA?

A

results in nicks in pyrimidine dimers

-xeroderma pigmentosum mutation - more predisposed to skin cancers

48
Q

What are the 3 key systems that can be disrupted by carcinogens?

A

1) proto-oncogenes
2) tumor suppressor genes
3) regulators of apoptosis

49
Q

What are the categories of oncogenes?

A

growth factors, growth factors receptors, signal transduction, cell cycle regulation

50
Q

Overexpression of what growth factor leads to astrocytoma?

A

PDGF - autocrine loop

51
Q

What cancer does ERBB2 (HER2/neu) receptor amplification lead to?

A

subset of breast carcinomas

52
Q

What cancers do point mutation of neural growth factor receptor RET lead to?

A

MEN 2A, MEN 2B, and sporadic medullary carcinoma of the thyroid

53
Q

What is the MOA of Trastuzumab for breast cancer?

A

HER2/neu receptor antagonist

54
Q

What cancer does point mutation of the stem cell growth factor receptor KIT lead to?

A

GI stromal tumor

55
Q

What cancers do point mutation in GTP-binding protein RAS lead to?

A

carcinomas, melanomas, and lymphomas

56
Q

What cancer does t(9:22) with tyrosine kinase ABP lead to?

A

CML and some types of ALL(very poor prognosis)

57
Q

Why is RET diagnosis testing important?

A

prophylactic removal of thyroid

58
Q

What helps RAS cleave a phosphate from GTP?

A

GAP (GTPase-associated protein)

59
Q

What cancer does t(8/14) involving IgH with TF c-MYC lead to?
C14: IgH
C8: C-MYC

A

Burkitt lymphoma

60
Q

What cancer does amplification with TF N-MYC lead to?

A

Neuroblastoma

61
Q

What cancer does amplification with TF L-MYC lead to?

A

small cell lung carcinoma

62
Q

What carcinoma does t(11; 14) involving IgH with CCND1 (cyclin D1) lead to?

A

mantle cell lymphpoma

63
Q

What cancer does amplication of CDK4 lead to via cyclin D1?

A

melanoma

64
Q

What is the most highly regulated phase of the cell cycle?

A

G1 –> s

65
Q

What is the region next to the follicle of the lymph node?

A

mantle

66
Q

What chromsome does cyclin D1 come from?

A

chromosome 11

67
Q

What phase of the cell cycle does p53 regulate?

A

G1 –> S

68
Q

How does p53 induce apoptosis when there is severe mutation in the cell?

A

it will upregulate BAX which disrupts BCL2 and causes cytochrome c to leak from the mitochondria to activate caspases in apoptosis

69
Q

What the germline mutation of p53?

A

Li-Fraumeni syndrome

70
Q

How does Rb regulate G1–>S

A

Rb holds E2F. When it is phosphorylated by cyclinD/CDK4, it causes E2F to be released and activate progression G1–>S

71
Q

What happens with Rb mutation?

A

EF2 will be constitutively free to activate G1–>s

72
Q

What does sporadic mutation of Rb lead to?

A

sporadic retinoblastoma

73
Q

What does germline mutation of Rb lead to?

A

bilateral retinoblastoma and osteosarcoma

74
Q

How does BCL2 regulate apoptosis?

A

It stabilizes the mitochondrial membrane so that cytochrome c can’t leak out

75
Q

What is Bcl2 overexpressed in?

A

follicular lymphoma: t(14;18) moves Bcl2 (c18) to Ig heavy chain locus (c14); results in increased Bcl2

76
Q

What is necessary for cell immortality?

A

telomerase

77
Q

How do cancer cells avoid senescence?

A

they upregulate telomerase, which preserves telomeres

78
Q

What are the growth factors are commonly produced by tumor cells?

A

FGF and VEGF

79
Q

How do tumor cells evade immune surveillance?

A

downregulation of MHC I

80
Q

What type of tumors tend to be mobile?

A

benign tumors

81
Q

What type of tumors tend to be fixed to surrounding tissues?

A

malignant tumors

82
Q

What is the way to make an absolute Dx of tissue?

A

biopsy or excision

83
Q

How do the nuclei appear in benign tumors?

A

uniform; low nuclear to cytoplasmic ratio

84
Q

How do the nuclei appear in malignant tumors?

A

nuclear pleomorphism and hyperchromasia; high nuclear to cytoplasmic ratio

85
Q

What is the absolute distinguishing feature between benign and malignant tumors?

A

benign tumors do not metastasize; malignant tumors do

86
Q

What tissue type is found in the intermediate filament keratin?

A

epithelium - i.e. carcinoma

87
Q

What tissue type is found in the intermediate filament vimentin?

A

mesenchyme - i.e. sarcoma

88
Q

What tissue type is found in the intermediate filament desmin?

A

muscle

89
Q

What tissue type is found in the intermediate filament GFAP

A

neuroglia

90
Q

What tissue type is found in the intermediate filament neurofilament?

A

neurons

91
Q

What is PSA+?

A

prostatic epithelium

92
Q

What is ER+?

A

breast epithelium

93
Q

What is thryoglobulin+?

A

thyroid follicular cells

94
Q

What is chromogranin+?

A

neuroendocrine cells (i.e. small cell carcinoma of lung and carcinoid tumors)

95
Q

What is S-100+?

A

melanoma, langerhans histiocytosis, and schwannomas

96
Q

What are the uses of serum tumor markers?

A

screening, monitoring response to treatment, and monitoring recurrence

97
Q

What is staging of cancer dependent on?

A

size and spread - #1 prognostic factor

98
Q

What is T for in TNM staging?

A

tumor size or depth of invasion

99
Q

What is N for in TNM staging?

A

spread to regional lymph nodes; second most important prognostic factor

100
Q

What is M for in TNM staging?

A

metastasis; single most important prognostic factor

High Yield Pathoma (4 decks)

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