Chapter 3 - Principles of Neoplasia Flashcards
What are the three key features of Neoplastic tissue growth?
- Unregulated
- Irreversible
- Monoclonal
Which two substances can be used to determine clonality, and with which values?
- G6PD (1:1)
- Kappa:Lambda immunoglobulin light chain (3:1)
What is the characteristic differences between a benign and a malignant tumor?
Benign: localized, no metastasis
Malignant: invade, metastasis
What is the tissue of origin of carcinomas?
Epithelium
Which type of tissue is the origin of sarcomas?
Mesenchymal
What is the most common tumor in children?
Hemangioma
What is the most common cancer in children?
Acute leukemia
What are the five categories of oncogens?
- Growth factors
- Growth factor receptor
- Signal transducers
- Nuclear regulators
- Cell cycle regulators
Which tumor is associated with platelet-derived growth factor (PDGFB)?
Astrocytoma
Which tumor is associated with Epidermal growth factor receptor (ERBB2)?
Subset of breast cancer
Which tumor is associated with Neural growth factor receptor (RET)?
MEN 2A, MEN 2B and sporadic medullary carcinoma of thyroid
Which tumor is associated with Stem cell growth factor receptor (KIT)?
GI stromal tumor
Which tumor is associated with GTP-binding protein (RAS)?
Carcinomas, melanoma, and lymphoma.
Which tumor is associated with tyrosine kinase (ABL)?
CML and some types of AML
Which tumor is associated with transcription factor (c-MYC)
Burkitt lymphoma (stary skies)
Which tumor is associated with transcription factor (n-MYC)?
Neuroblastoma
Which tumor is associated with transcription factor (l-MYC)?
Small cell lung carcinoma
Which tumor is associated with cyclin (CCND1)?
Mantel cell lymphoma
Which tumor is associated with Cyclin-dependent kinase (CKD4)?
Melanoma
Case: During your rotation in Africa you come across many patients with a specific type of cancer. You learn that the high incidence comes from a fungal infestation that is quite common in the area. This fungi causes the carcinogen. Which type of cancer is it, and what is the toxin?
Hepatocellular carcinoma, most common cancer in Afrika. Derived from aspergillus. CA: Aflatoxin
Case: As a child your patient chemotherapy for cancer. Today, 25 years later the patient has developed a different form of cancer. WHich type of cancer is the most likely?
Leukemia/Lymphoma
Case: Your patient is a severe alcoholic, who you have been trying to convince to quite drinking for a very long time. In a last ditch effort you decide to tell him about the increased cancer risk related to alcohol. Which three cancers could you mention?
Squamos cell carcinoma of oropharynx and upper esophagus, pancreatic carcinoma and hepatocellular carcinoma
Case: 50 year old builder comes into your office due to chest pain, shortness of breath and weight loss. You take an x-ray expecting to find the most common diagnosis with this presentation, but instead you find the other, less likely cause. What diagnosis should you give the patient, and what did you think it was?
Mesothelioma (least likely)
Lung carcinoma (most likely)
Case: A 30 year old actress doing period films has discovered a blemish on her cheek and decides to go see her doctor. She is a sticler for authenticity and wears costumes and make up originally from the era. She has never had a reaction to it before, but she is now afraid that she may have become allergic to something in the make-up. You inform her that it is actually more serious than she thinks, and she has developed cancer. Which other forms of cancer can the substance in question cause?
Arsenic
SCC, lung cancer, angiosarcoma of the liver.
What is the most common carcinogen world wide, and what can it cause?
Cigarette smoke
Carcinoma of the oropharynx, esophagus, lung, kidney and bladder.
What is the cause of the high rate of stomach cancer in Japan, and what two types of stomach cancer can it cause?
Nitrosamines from smoked foods, intestinal and diffuse type.
Napthylamine is a carcinogen responsible for one specific type of cancer. Which one, and what is the source of exposure?
Urothelial carcinoma, cigarette smoke
Which carcinogen derived from occupational exposure may cause angiosarcoma of the liver.
Vinyl chloride
Which carcinogen derived from occupational exposure may cause lung carcinoma?
Nickel, chromium, beryllium, or silica.
Case: An Asian male presents to your office with a newely developed Neck mass which turns out to be neoplastic. Which oncogenic virus is most likely the cause of the neoplasm?
EBV, may cause nasopharyngeal carcinoma, Burkitt lymphoma, and CNS lymphoma in AIDS
Case: Patient is an older german male who has developed Karposi sarcoma after an infection with a oncogenic virus. Which virus?
HHV-8
Which “common” blood born infection is likely to cause hepatocellular carcinoma?
HBV and HCV
What is the role of BAX in tumor supression, and which mediator works on it?
Bax disrupts Bcl2 which causes release of cytochrome c and induction of apoptosis. Bax is upregulated by p53, if p53 faile to induce DNA repair.
What is the syndrom associated with a two hit mutation of the p53 gene, which is associated with multiple types of carcinomas and sarcomas?
Li-Frameni syndrome
Case: Patient presents with both carcinoma and sarcoma simultainiously. Tests show that it is due to a germline mutation. Which germline mutation, and what is the syndrome in question?
p53 gene, Li-Fraumeni Syndrome
Case: Patient has been diagnosed with bilateral retinoblastoma. His mother had the same symptoms and his uncle developed osteosarcoma. Where is the germline mutation?
Familial retinalblastoma
Rb gene is mutated causing constitutively free E2F, which allows progression through the cell cycle.
Which protein is over expressed in follicular lymphoma causing acumulation of B-cells?
Bcl2, due to a t(14;18)
Through which mechanisms does carcinomas spread?
- Downregulation of E-cadherin leads to dissociation.
- Destruction of basment membrane through collagenase (type IV)
- Attacment to fibronectin in the extracellular matrix leads to local spread.
- Entrance into vascular or lymphatic system causes distance metastasis.
Which types of cancers spreads hematogeously?
Sarcomas, plus renal cell carcinoma, hepatocellular carcinoma, follicular carcinoma of the thyroid, and choriocarcinoma (placenta)
