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Pathoma > Chapter 3 - Principles of Neoplasia (No Tables) > Flashcards

Chapter 3 - Principles of Neoplasia (No Tables) Flashcards

1
Q

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

A
  1. Unregulated
  2. Irreversible
  3. Monoclonal
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2
Q

How can clonality be determined?

A

Glucose-6-Phosphate Dehydrogenase (G6PD) enzyme isoforms

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3
Q

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

A

1:1

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4
Q

How can clonality of B lymphocytes be determined?

A

Immunoglobulin Light Chain phenotype (kappa or lambda)

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5
Q

What is the normal kappa:lambda ratio

A

3:1

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6
Q

What are the 3 leading causes of death in adults?

A
  1. Cardiovascular Disease
  2. Cancer
  3. Cerebrovascular Disease
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7
Q

What are the 3 leading causes of death in children?

A
  1. Accidents
  2. Cancer
  3. Congenital Defects
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8
Q

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

A
  1. Breast/Prostate
  2. Lung
  3. Colorectal
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9
Q

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

A
  1. Lung
  2. Breast/Prostate
  3. Colorectal
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10
Q

How many divisions occur before the earliest clinical symptoms arise?

A

30

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11
Q

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

A

Each division increases the number of mutations

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12
Q

What are the 2 goals of screening?

A
  1. Catch dysplasia before it becomes carcinoma
  2. Catch carcinoma before clinical symptoms arise
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13
Q

What type of screen detects cervical dysplasia?

A

Pap Smear

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14
Q

What type of screening detects breast cancer?

A

Mammography

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15
Q

What 2 tests detect prostate carcinoma?

A

Prostate Specific Antigen

Digital Rectal Exam

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16
Q

What 2 tests detect colonic adenoma?

A

Hemoccult test

Colonoscopy

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17
Q

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

A
  1. Proto-oncogenes
  2. tumor supressor genes
  3. regulators of apoptosis
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18
Q

What are the 4 types of proto-oncogenes?

A
  1. Growth Factors
  2. Growth Factor receptors
  3. Signal Transducers
  4. Cell Cycle Regulators
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19
Q

What is the mechanism of Ras as an Oncogene?

A

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

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20
Q

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

A

14

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21
Q

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

A

c-MYC (chromosome 8)

cyclin D1 (Chromosome 11)

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22
Q

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

A

RAS gene family

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23
Q

What does cyclin D1 control?

A

The transition from G1 to S phase

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24
Q

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

A

Burkitt Lymphoma

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25
Q

What is the general function of tumor suppressor genes?

A

regulate cell growth

(which would reduce the risk of tumor formation)

26
Q

What are the two discussed tumor suppressor genes?

A

p53 and Rb

27
Q

What is the normal function of p53?

A

regulates progression from G1 to S

slows cycle when DNA is damaged

induces apoptosis when DNA is too damaged for repair

28
Q

How does p53 induce apoptosis?

A

upregulates BAX

which disrupts Bcl2

Cytochrome C leaks out of mitchondira

Cytochrome C activates Caspase

29
Q

What ist he Knudson two-hit hypothesis?

A

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

30
Q

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

A

p53 and Rb

31
Q
A
32
Q

What is the normal function of Rb?

A

“holds” the E2F transcription factor to stop progession into the S phase

(“lets go” when phosphoylated by CDK4 complex)

33
Q

What is Li-Fraumeni syndrome?

A

One p53 is knocked out due to genetics.

34
Q

How does dysfunction of Rb cause a tumor?

A

Mutated Rb doesn’t “hold” E2F which allows for uncontrolled growth.

35
Q

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

A

Sporadic = Unilateral Retinoblastoma

Germline = Bilateral Retinoblastoma

(familial retinoblastoma)

36
Q

Why is overexpression of Bcl2 a problem?

A

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

37
Q

What causes overexpression of Bcl2?

A

translocation of Bclw and IgH

t(14:18)

38
Q

Do cancer cells have increased of decreased

  1. Telomerase
  2. FGF
  3. VEGF
A

All increased

39
Q

How do tumor cells avoid immune system surveillance?

A

downregulating expression of MHC class I

40
Q

What are the 5 steps of tumor Spread?

A
  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
41
Q

By which route do carcinomas normally spread?

A

Lymphatic

42
Q

By which route do sarcomas normally spread?

A

Hematogenous

43
Q

What types of carcinomas metastasize via hematogenous routes?

A
  1. Renal Cell Carcinoma (renal vein)
  2. Hepatocellular Carcinoma (Hepatic vein)
  3. Follicular Carcinoma of the Thyroid
  4. Choriocarcinoma
44
Q

What type of cancer characteristically seeds body cavities?

A

Ovarian Carcinoma

45
Q

What does this picture depict?

Based on the above answer, what type of cancer is it?

A

Seeding of the Omenturm

Ovarian Carcinoma

46
Q

What are the 4 clinical features of benign tumors?

A
  1. slow growing
  2. well circumscribed
  3. distinct
  4. mobile
47
Q

What are the 4 clinical features of malignant tumors?

A
  1. Rapid growing
  2. Poorly circumscribed
  3. Infiltrative
  4. Fixed to surrounding tissues and local structures
48
Q

What is the hallmark of malignancy?

A

Metastatic Potential

49
Q

What type of tissue does a stain for keratin detect?

A

Epithelium

50
Q

What type of tissue does a stain for Vimentin detect?

A

Mesenchyme

51
Q

What type of tissue does a stain for desmin detect?

A

Muscle

52
Q

What type of tissue does a stain for GEAP detect?

A

Neuroglia

53
Q

What type of tissue does a stain for PSA detect?

A

Prostatic epithelium

54
Q

What type of tissue does a stain for ER detect?

A

Breast Epithelium

55
Q

What type of tissue does a stain for thyroglobulin detect?

A

Thyroid follicular cells

56
Q

What type of tissue does a stain for Chromogranin detect?

A

Neuroendocrine cells

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

57
Q

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

A

Melanoma

58
Q

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

A

Well-differentiated

59
Q

What is the key prognostic factor of cancer?

A

Staging

60
Q

What is TNM staging?

A

T- tumor size

N - Sprea do regional lymph nodes

M - Matastasis

61
Q

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

A

Left = benign (well-differentiated)

Right = malignant (poorly differentiated)

Pathoma (4 decks)

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