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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
What is the goal of pap smears?
detect cervical dysplasia (CIN) before it becomes carcinoma
26
What carcinoma is associated with aflatoxins?
hepatocellular carcinoma
27
What do alkylating agents increase the risk of?
leukemia/lymhpoma
28
What carcinomas are associated with alcohol use?
squamous cell carcinoma of oropharynx and upper esophagus, pancreatic carcinoma, and hepatocellular carcinoma
29
What carcinomas are associated with arsenic?
squamous cell carcinoma of skin, lung cancer (arsenic is in cigarette smoke), and angiosarcoma of the liver
30
What carcinomas are associated with asbestos?
lung carcinomas >>>>>>> mesothelioma
31
What carcinomas are associated with cigarette smoke?
carcinoma of oropharynx, esophagus, lung, kidney, and bladder
32
What is the most most common carcinogen in the world?
polycyclic hydrocarbons in cigarette smoke
33
What is the key carcinogen for urothelium tissue?
cigarette smoke
34
What carcinoma is associated with nitrosamines?
intestinal type of stomach carcinoma
35
What carcinoma is naphthylamine associated with?
urothelial carcinoma of the baldder
36
What carcinoma is vinyl chloride associated with?
angiosarcoma of the liver | *used to make PVC for use in pipes
37
What carcinoma is associated with nickel, chromium, beryllium, or silica?
lung carcinoma
38
What carcinomas are associated wtih EBV?
nasopharyngeal carcinoma (neck mass), Burkitt lymphoma, and CNS lymphoma in AIDS
39
Which two pts are most susceptible to EBV nasopharyngeal carcinoma?
Chinese male and pt from Africa
40
What carcinoma is associated with HHV-8?
Kaposi sarcoma - tumor of endothelial cells
41
What 3 populations are susceptible to KS?
1) older Eastern European males --> respond to excision 2) AIDS pts --> Tx w/ ARV agents 3) transplant pts --> reduce immunosuppression
42
What carcinoma is associated with HBV and HCV?
hepatocellular carcinoma
43
What carcinomas are associated with HTLV-1?
adult T-cell leukemia/lymphoma
44
What carcinomas are associated with high-risk HPV
squamous cell carcinoma of the vulva, vagina, anus, and cervix; adenocarcinoma of the cervix
45
What carcinomas are associated with ionizing radiation?
AML, CML, and papillary carcinoma of the thyroid via hydroxyl free radicals
46
What carcinomas are associated with nonionizing radiation (i.e. UVB)?
basal cell carcinoma, squamous cell carcinoma, and melanoma of the skin
47
How does nonionizing radiation damage DNA?
results in nicks in pyrimidine dimers | -xeroderma pigmentosum mutation - more predisposed to skin cancers
48
What are the 3 key systems that can be disrupted by carcinogens?
1) proto-oncogenes 2) tumor suppressor genes 3) regulators of apoptosis
49
What are the categories of oncogenes?
growth factors, growth factors receptors, signal transduction, cell cycle regulation
50
Overexpression of what growth factor leads to astrocytoma?
PDGF - autocrine loop
51
What cancer does ERBB2 (HER2/neu) receptor amplification lead to?
subset of breast carcinomas
52
What cancers do point mutation of neural growth factor receptor RET lead to?
MEN 2A, MEN 2B, and sporadic medullary carcinoma of the thyroid
53
What is the MOA of Trastuzumab for breast cancer?
HER2/neu receptor antagonist
54
What cancer does point mutation of the stem cell growth factor receptor KIT lead to?
GI stromal tumor
55
What cancers do point mutation in GTP-binding protein RAS lead to?
carcinomas, melanomas, and lymphomas
56
What cancer does t(9:22) with tyrosine kinase ABP lead to?
CML and some types of ALL(very poor prognosis)
57
Why is RET diagnosis testing important?
prophylactic removal of thyroid
58
What helps RAS cleave a phosphate from GTP?
GAP (GTPase-associated protein)
59
What cancer does t(8/14) involving IgH with TF c-MYC lead to? C14: IgH C8: C-MYC
Burkitt lymphoma
60
What cancer does amplification with TF N-MYC lead to?
Neuroblastoma
61
What cancer does amplification with TF L-MYC lead to?
small cell lung carcinoma
62
What carcinoma does t(11; 14) involving IgH with CCND1 (cyclin D1) lead to?
mantle cell lymphpoma
63
What cancer does amplication of CDK4 lead to via cyclin D1?
melanoma
64
What is the most highly regulated phase of the cell cycle?
G1 --> s
65
What is the region next to the follicle of the lymph node?
mantle
66
What chromsome does cyclin D1 come from?
chromosome 11
67
What phase of the cell cycle does p53 regulate?
G1 --> S
68
How does p53 induce apoptosis when there is severe mutation in the cell?
it will upregulate BAX which disrupts BCL2 and causes cytochrome c to leak from the mitochondria to activate caspases in apoptosis
69
What the germline mutation of p53?
Li-Fraumeni syndrome
70
How does Rb regulate G1-->S
Rb holds E2F. When it is phosphorylated by cyclinD/CDK4, it causes E2F to be released and activate progression G1-->S
71
What happens with Rb mutation?
EF2 will be constitutively free to activate G1-->s
72
What does sporadic mutation of Rb lead to?
sporadic retinoblastoma
73
What does germline mutation of Rb lead to?
bilateral retinoblastoma and osteosarcoma
74
How does BCL2 regulate apoptosis?
It stabilizes the mitochondrial membrane so that cytochrome c can't leak out
75
What is Bcl2 overexpressed in?
follicular lymphoma: t(14;18) moves Bcl2 (c18) to Ig heavy chain locus (c14); results in increased Bcl2
76
What is necessary for cell immortality?
telomerase
77
How do cancer cells avoid senescence?
they upregulate telomerase, which preserves telomeres
78
What are the growth factors are commonly produced by tumor cells?
FGF and VEGF
79
How do tumor cells evade immune surveillance?
downregulation of MHC I
80
What type of tumors tend to be mobile?
benign tumors
81
What type of tumors tend to be fixed to surrounding tissues?
malignant tumors
82
What is the way to make an absolute Dx of tissue?
biopsy or excision
83
How do the nuclei appear in benign tumors?
uniform; low nuclear to cytoplasmic ratio
84
How do the nuclei appear in malignant tumors?
nuclear pleomorphism and hyperchromasia; high nuclear to cytoplasmic ratio
85
What is the absolute distinguishing feature between benign and malignant tumors?
benign tumors do not metastasize; malignant tumors do
86
What tissue type is found in the intermediate filament keratin?
epithelium - i.e. carcinoma
87
What tissue type is found in the intermediate filament vimentin?
mesenchyme - i.e. sarcoma
88
What tissue type is found in the intermediate filament desmin?
muscle
89
What tissue type is found in the intermediate filament GFAP
neuroglia
90
What tissue type is found in the intermediate filament neurofilament?
neurons
91
What is PSA+?
prostatic epithelium
92
What is ER+?
breast epithelium
93
What is thryoglobulin+?
thyroid follicular cells
94
What is chromogranin+?
neuroendocrine cells (i.e. small cell carcinoma of lung and carcinoid tumors)
95
What is S-100+?
melanoma, langerhans histiocytosis, and schwannomas
96
What are the uses of serum tumor markers?
screening, monitoring response to treatment, and monitoring recurrence
97
What is staging of cancer dependent on?
size and spread - #1 prognostic factor
98
What is T for in TNM staging?
tumor size or depth of invasion
99
What is N for in TNM staging?
spread to regional lymph nodes; second most important prognostic factor
100
What is M for in TNM staging?
metastasis; single most important prognostic factor

High Yield Pathoma (4 decks)

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