Chapter 3 - Principles of Neoplasia (No Tables)

Question 1

What are the three characteristics of neoplastic growth that differentiate it from hyperplasia and repair?

Answer 1

1. Unregulated
2. Irreversible
3. Monoclonal

Question 2

How can clonality be determined?

Answer 2

Glucose-6-Phosphate Dehydrogenase (G6PD) enzyme isoforms

Question 3

What is the normal ratio of G6PD isoforms in any tissue?

Answer 3

1:1

Question 4

How can clonality of B lymphocytes be determined?

Answer 4

Immunoglobulin Light Chain phenotype (kappa or lambda)

Question 5

What is the normal kappa:lambda ratio

Answer 5

3:1

Question 6

What are the 3 leading causes of death in adults?

Answer 6

1. Cardiovascular Disease
2. Cancer
3. Cerebrovascular Disease

Question 7

What are the 3 leading causes of death in children?

Answer 7

1. Accidents
2. Cancer
3. Congenital Defects

Question 8

What are the 3 most common cancers in adults by incidence?

Answer 8

1. Breast/Prostate
2. Lung
3. Colorectal

Question 9

What are the 3 most common causes of cancer mortality in adults?

Answer 9

1. Lung
2. Breast/Prostate
3. Colorectal

Question 10

How many divisions occur before the earliest clinical symptoms arise?

Answer 10

30

Question 11

Why are cancers that are detected late more likely to have a poor prognosis?

Answer 11

Each division increases the number of mutations

Question 12

What are the 2 goals of screening?

Answer 12

1. Catch dysplasia before it becomes carcinoma
2. Catch carcinoma before clinical symptoms arise

Question 13

What type of screen detects cervical dysplasia?

Answer 13

Pap Smear

Question 14

What type of screening detects breast cancer?

Answer 14

Mammography

Question 15

What 2 tests detect prostate carcinoma?

Answer 15

Prostate Specific Antigen

Digital Rectal Exam

Question 16

What 2 tests detect colonic adenoma?

Answer 16

Hemoccult test

Colonoscopy

Question 17

What are the 3 different kinds of regulatory systems that can be disrupted to cause tumors?

Answer 17

1. Proto-oncogenes
2. tumor supressor genes
3. regulators of apoptosis

Question 18

What are the 4 types of proto-oncogenes?

Answer 18

1. Growth Factors
2. Growth Factor receptors
3. Signal Transducers
4. Cell Cycle Regulators

Question 19

What is the mechanism of Ras as an Oncogene?

Answer 19

It stays bound to GTP which prolongs it’s active state resulting in increased growth signals

Question 20

On what chromosome is IgH (immunoglobulin heavy chain) located?

Answer 20

14

Question 21

Which two proto-oncogenes are known to translocate with IgH to become oncogenes?

Answer 21

c-MYC (chromosome 8)

cyclin D1 (Chromosome 11)

Question 22

What oncogene is the cause of 70-80% of tumors?

Answer 22

RAS gene family

Question 23

What does cyclin D1 control?

Answer 23

The transition from G₁ to S phase

Question 24

What type of tumor is know for its “starry sky appearance?”

Answer 24

Burkitt Lymphoma

Question 25

What is the general function of tumor suppressor genes?

Answer 25

**regulate cell growth** (which would reduce the risk of tumor formation)

Question 26

What are the two discussed tumor suppressor genes?

Answer 26

p53 and Rb

Question 27

What is the normal function of p53?

Answer 27

regulates progression from G₁ to S slows cycle when DNA is damaged induces apoptosis when DNA is too damaged for repair

Question 28

How does p53 induce apoptosis?

Answer 28

upregulates BAX which disrupts Bcl2 Cytochrome C leaks out of mitchondira Cytochrome C activates Caspase

Question 29

What ist he Knudson two-hit hypothesis?

Answer 29

both copies of a gene must be knocked out for tumor formation.

Question 30

To which genes does the Knudson two-hit hypothesis apply?

Answer 30

p53 and Rb

Question 32

What is the normal function of Rb?

Answer 32

"holds" the E2F transcription factor to stop progession into the S phase ("lets go" when phosphoylated by CDK4 complex)

Question 33

What is Li-Fraumeni syndrome?

Answer 33

One p53 is knocked out due to genetics.

Question 34

How does dysfunction of Rb cause a tumor?

Answer 34

Mutated Rb doesn't "hold" E2F which allows for uncontrolled growth.

Question 35

What is the differecne between the outcomes of sporadic mutation and germline mutation of Rb?

Answer 35

Sporadic = Unilateral Retinoblastoma Germline = Bilateral Retinoblastoma (familial retinoblastoma)

Question 36

Why is overexpression of Bcl2 a problem?

Answer 36

Too much Bcl2 overstabilizes the mitchodrial membrane and Cytochrome C is too tightly contained in the mitochondria which prevents apoptosis.

Question 37

What causes overexpression of Bcl2?

Answer 37

translocation of Bclw and IgH t(14:18)

Question 38

Do cancer cells have increased of decreased 1. Telomerase 2. FGF 3. VEGF

Answer 38

All increased

Question 39

How do tumor cells avoid immune system surveillance?

Answer 39

downregulating expression of MHC class I

Question 40

What are the 5 steps of tumor Spread?

Answer 40

1. **Downregulation of E-cadherin** (dissociates from attached cells) 2. **Attaches to laminin** 3. **Destroys Basement Membrane** 4. **Attaches to fibronectin** in the ECM and spreads locally 5. **Enters vascular or lymphatic spaces**

Question 41

By which route do _carcinomas_ normally spread?

Answer 41

Lymphatic

Question 42

By which route do _sarcomas_ normally spread?

Answer 42

Hematogenous

Question 43

What types of _carcinomas_ metastasize via _hematogenous_ routes?

Answer 43

1. Renal Cell Carcinoma (renal vein) 2. Hepatocellular Carcinoma (Hepatic vein) 3. Follicular Carcinoma of the Thyroid 4. Choriocarcinoma

Question 44

What type of cancer characteristically seeds body cavities?

Answer 44

Ovarian Carcinoma

Question 45

What does this picture depict? Based on the above answer, what type of cancer is it?

Answer 45

Seeding of the Omenturm Ovarian Carcinoma

Question 46

What are the 4 clinical features of benign tumors?

Answer 46

1. slow growing 2. well circumscribed 3. distinct 4. mobile

Question 47

What are the 4 clinical features of malignant tumors?

Answer 47

1. Rapid growing 2. Poorly circumscribed 3. Infiltrative 4. Fixed to surrounding tissues and local structures

Question 48

What is the hallmark of malignancy?

Answer 48

Metastatic Potential

Question 49

What type of tissue does a stain for keratin detect?

Answer 49

Epithelium

Question 50

What type of tissue does a stain for Vimentin detect?

Answer 50

Mesenchyme

Question 51

What type of tissue does a stain for _desmin_ detect?

Answer 51

Muscle

Question 52

What type of tissue does a stain for _GEAP_ detect?

Answer 52

Neuroglia

Question 53

What type of tissue does a stain for _PSA_ detect?

Answer 53

Prostatic epithelium

Question 54

What type of tissue does a stain for _ER_ detect?

Answer 54

Breast Epithelium

Question 55

What type of tissue does a stain for _thyroglobulin_ detect?

Answer 55

Thyroid follicular cells

Question 56

What type of tissue does a stain for _Chromogranin_ detect?

Answer 56

Neuroendocrine cells (i.e. small/oat cell carcinoma of the lung)

Question 57

What type of tissue does a stain for _S-100_ detect?

Answer 57

Melanoma

Question 58

What has a better progniosis, a poorly-differentiated or a well-differentiated tumor?

Answer 58

Well-differentiated

Question 59

What is the key prognostic factor of cancer?

Answer 59

Staging

Question 60

What is TNM staging?

Answer 60

T- tumor size N - Sprea do regional lymph nodes M - Matastasis

Question 61

Which side of the image is benign and which is malignant?

Answer 61

Left = benign (well-differentiated) Right = malignant (poorly differentiated)