Chapter 9 - Neoplasia Flashcards
0
Q
What is the origin of squamous and transitional epithelium?
A
Ectoderm: squamous or transitional epithelium
1
Q
Benign tumors: epithelial or connective tissue origin
A
Benign tumors: epithelial or connective tissue origin
2
Q
What is the origin of glandular epithelium?
A
Endoderm: glandular epithelium
3
Q
What is the origin of epithelium?
A
Epithelial origin: derive from ectoderm or endoderm
4
Q
Connective tissue is derived from which embryonic tissue?
A
Connective tissue: mesoderm
5
Q
What is a mixed tumor?
A
Mixed tumor: two patterns; same germ cell layer; e.g., parotid gland tumors
6
Q
Teratomas can be derived from which germ cell layers?
A
Teratoma: ectoderm, endoderm, mesoderm
7
Q
Where are teratomas located?
A
Teratomas: at or close to midline; ovary MC site
8
Q
What are the sites for squamous cell carcinoma?
A
SCC sites: mouth, larynx, cervix
9
Q
What are the sites for an adenocarcinoma?
A
Adenocarcinoma sites: distal esophagus → rectum; pancreas, breast, kidneys
10
Q
What are the sites for a transitional cell carcinoma?
A
TCC sites: bladder, ureter, renal pelvis
11
Q
What is the origin of sarcomas?
A
Sarcomas: connective tissue origin
12
Q
What is a hamartoma?
A
Hamartoma: nonneoplastic overgrowth tissue; bronchial hamartoma
13
Q
What is a choristoma? Give an example.
A
Choristoma: normal tissue foreign location; pancreatic tissue stomach wall
14
Q
Define parenchyma.
A
Parenchyma: neoplastic component
15
Q
Define stroma.
A
Stroma: nonneoplastic supporting tissue
16
Q
What question describes the grade of a cancer?
A
Grade of cancer: does cancer resemble its parent tissue?
17
Q
Give two examples of features of a low grade cancer.
A
Low grade: keratin pearls, glands with lumens
18
Q
Describe a high grade cancer.
A
High grade/anaplastic: no differentiating features
19
Q
How do cell organelles differ between a normal cell and a malignant cell?
A
Fewer mitochondria; less prominent RER; loss of cadherins
20
Q
How do nuclear features differ between a normal cell and a malignant cell?
A
Both nucleus and nucleoli are larger with irregular borders
Malignant tumors: normal/abnormal mitotic spindles; hyperchromatic nuclei
21
Q
Describe the metabolism of a malignant cell.
A
Malignant cells use anaerobic glycolysis for energy; ↑lactic acid in neoplastic cells
22
Q
What is the role of PET scanning in cancer patients?
A
PET scan: diagnosis, staging, monitoring of therapy
23
Q
What do malignant cells store in the cytosol?
A
Malignant cells store glycogen in the cytosol
24
Describe the growth rate of benign tumors.
Benign tumors have a slow growth rate
25
Describe the growth rate of malignant tumors.
Malignant tumors have a variable growth rate
26
What is the relationship between growth rate and the degree of differentiation?
Growth rate correlates with degree of differentiation
27
How many population doublings must occur in order for a tumor mass to become clinically detectable?
Clinically detectable: 30 population doublings to produce 10^9 cells (1 g tissue)
28
How are tumors with an increased growth rate treated?
Tumors with ↑growth rate treated with cell cycle–specific chemotherapy
29
What phases of the cell cycle are inhibited by methotrexate and vincristine?
Methotrexate inhibits S phase; vincristine inhibits M phase
30
Describe the origin of most benign and malignant tumors.
Most benign/malignant tumors arise from single precursor cell (monoclonal)
31
What are telomere complexes?
Telomere complexes: repetitive sequences nontranscribed DNA at ends of chromosomes
32
What is the function of telomere complexes?
Prevent end-to-end chromosome fusion during mitosis; important for cell longevity
33
What happens to telomeres with each cell division?
Telomeres shorten with each cell division; few nucleotide bases remain → signal for apoptosis
34
Describe the telomerase activity in malignant cells.
Malignant cells: telomerase activity upregulated; prevents apoptosis
35
What does upregulation of DAF prevent?
Upregulation DAF prevents MAC formation; cancer cells cannot be killed
36
Describe the properties of benign tumors with respect to invasion.
Benign tumors do not invade; enclosed by fibrous tissue capsule
37
What is the second most important criterion for malignancy?
Invasion: second most important criterion for malignancy
38
What tissues are resistant to invasion?
Tissues resistant to invasion: cartilage, elastic artery tissue
39
What is angiogenesis?
Angiogenesis: new capillary sprouts form from parent capillaries
40
Describe the role of TNF in angiogenesis.
TNF important in stimulating synthesis of angiogenesis factors
41
What does angiogenesis require?
Angiogenesis: requires growth factors, chemotactic factors, and enzymes
42
What from the bone marrow is also used in angiogenesis?
Angiogenesis also uses EPCs in producing new capillary sprouts
43
What does bevacizumab do?
Bevacizumab inhibits binding of VEGF to endothelial cells in new capillary sprouts
44
Within the primary tumor, what develops the capacity to invade and metastasize?
Clonal proliferation of cells can invade/metastasize
45
Describe the first step of invasion of malignant cells.
1st step invasion: lose cell-to-cell adhesion molecules (cadherins)
46
Describe the second step of invasion of malignant cells.
2nd step invasion: attach to basement membrane and degrade it
47
Describe the third step of invasion of malignant cells.
3rd step invasion: attach to ECM and degrade it
48
Describe the fourth step of invasion of malignant cells.
4th step invasion: stimulate cell motility
49
What is intravasation?
Invade capillaries to enter the circulation (intravasation)
50
What do malignant cells do while in the circulation?
Evade or be destroyed by host defense cells
51
What do malignant cells that successfully evade host defense cells do?
Form tumor emboli coated by fibrin and platelets
52
Where do tumor emboli attach? What subsequently occurs?
Tumor emboli attach to capillaries at target organ and repeat the 4-step process of invasion
53
Describe the homing of tumor cells.
Homing of tumor cells: chance deposition; Batson paravertebral plexus; produce chemokines that go to specific sites with chemokine receptors similar to primary tumor; chemoattractants released from target sites
54
What is the most important criterion of malignancy?
Metastasis most important criterion of malignancy
55
What criterion of malignancy is characteristic of basal cell carcinoma?
BCC invade but do not metastasize
56
Describe the first step for dissemination of carcinomas.
Carcinomas: lymphatic spread → regional nodes; first line of defense
57
Describe the hematogenous phase of cancer dissemination in carcinomas.
Tumor cells in nodes invade efferent lymphatics → systemic circulation
58
Describe the dissemination of sarcomas.
Sarcomas initially have hematogenous spread; avoid nodes
59
Where do malignant cells in the portal vein metastasize to?
Malignant cells in portal vein → metastasize to liver
60
Where do malignant cells in the vena cava metastasize to?
Malignant cells in vena cava → metastasize to lungs
61
What types of cancer have hematogenous spread?
Both carcinomas/sarcomas have hematogenous spread
62
Define seeding of malignant cells.
Seeding: exfoliation from serosal surface and invade tissue in body cavity
63
Give three examples of seeding of malignant cells.
Seeding: malignant surface-derived ovarian cancers; omental implants
Peripherally located lung adenocarcinomas seed pleural cavity
GBM uses spinal fluid to seed distant sites (brainstem, spinal cord)
64
What is the most common site of bone metastasis?
Bone metastasis: vertebrae MC site
65
What is the most common cancer metastatic to bone?
Breast cancer MC cancer metastatic to bone
66
Describe the connections of the paravertebral venous plexus.
Paravertebral venous plexus: connections with vena cava and vertebral bodies
67
What are the first and second most common cancers producing osteoblastic metastases?
Prostate cancer MCC osteoblastic metastases, followed by breast cancer
68
What are the lab and radiographic findings of bone metastases?
Osteoblastic metastasis: ↑serum ALP; radiodensities in radiographs
69
What are the radiographic findings of osteolytic metastases?
Osteolytic metastases: radiolucencies in bone
70
How does a tumor locally activate osteoclasts?
PGE2, IL-1 produced by tumor locally activate osteoclasts
71
What are the osteolytic cancers?
Osteolytic cancers: lung, kidney, breast
72
What are the clinical findings in osteolytic metastasis?
Osteolytic metastasis: hypercalcemia, pathologic fractures
73
How is bone pain in cancer treated?
Bone pain: localized radiation
74
What is the most common site for metastasis?
Lymph nodes: MC site for metastasis; site of choice for carcinoma
75
What is the second most common cause of death in the U.S.?
Cancer: 2nd MCC death in U.S.
76
What is the most common external cause of cancer?
Tobacco MC external cause of cancer
77
Name an important risk factor for cancer.
Age is an important risk factor for cancer
78
What is the relationship between cancer incidence and age?
Cancer incidence increases with age
79
African-Americans have a higher incidence of what two cancers?
African-Americans: ↑incidence prostate cancer, multiple myeloma
80
The Japanese have a lower incidence of what two cancers?
Japanese: ↓incidence prostate and breast cancer
81
What is the most common cause of disease-related (noninjury) mortality 1-14 years of age?
Cancer MCC disease-related (noninjury) mortality 1–14 years of age
82
What are the top three cancers in decreasing order in children?
Cancers in children, decreasing order: leukemia, CNS, neuroblastoma
83
How do the locations of cancer in children compare to that in adults?
Cancers in children occur in different sites than in adults
84
What are the top three cancers in decreasing order in men?
Cancers in men, decreasing order: prostate, lung, colon/rectum
85
What are the top three cancers in decreasing order in women?
Cancers in women, decreasing order: breast, lung, colon/rectum
86
What are the top three sites of gynecologic cancers in decreasing order?
Sites of gynecologic cancers, decreasing order: endometrium, ovary, cervix
87
What are the top three sites for cancer-related deaths in men in decreasing order?
Sites of cancer-related deaths in men, decreasing order: lung, prostate, colon/rectum
88
What are the top three sites for cancer-related deaths in women in decreasing order?
Sites of cancer-related deaths in women, decreasing order: lung, breast, colon/rectum
89
What are the top three gynecologic sites for cancer-related deaths in women in decreasing order?
Sites of gynecologic cancer–related death, decreasing order: ovary, endometrium, cervix
90
Which cancer is increasing most rapidly worldwide?
Malignant melanoma: increasing most rapidly worldwide
91
Describe the epidemiology of cancer in China.
China: NP carcinoma (EBV), esophageal SCC (smoking/alcohol)
92
Describe the epidemiology of cancer in Japan.
Japan: stomach adenocarcinoma (smoked foods)
93
Describe the epidemiology of cancer in Southeast Asia.
Southeast Asia: HCC (HBV postnecrotic cirrhosis, aflatoxins)
94
Describe the epidemiology of cancer in Sub-Saharan Africa.
Sub-Saharan Africa: Burkitt lymphoma linked to EBV; KS linked to HHV-8
95
What is the most important prevention modality in cancer?
Stop smoking: most important prevention modality
96
How can the risk for colorectal cancer be decreased?
↑Dietary fiber, ↓dietary animal saturated fat: ↓risk colorectal cancer
97
How can the risk for oropharyngeal cancer, upper to midesophageal cancer, and HCC be decreased?
↓Alcohol intake: ↓risk for alcohol-related cancers
98
How can the risk for estrogen-related endometrial/breast cancer be decreased?
Reduce weight: ↓risk estrogen-related endometrial/breast cancer
99
How can the risk for skin cancer be decreased?
Sunscreen: ↓risk for BCC, SCC, melanoma
100
What does HBV immunization decrease the risk of?
HBV immunization: ↓HCC risk
101
What does HPV immunization decrease the risk of?
HPV immunization: ↓risk for cervical/penile SCC
102
What does a cervical Pap detect?
Cervical Pap: detects squamous dysplasia → precursor for SCC
103
What is the purpose of a colonoscopy?
Colonoscopy detects/removes precancerous polyps
104
What does mammography detect?
Mammography detects nonpalpable breast masses
105
Compare the sensitivity and specificity of serum PSA for the diagnosis of prostate cancer.
Serum PSA: more sensitive than specific for Dx prostate cancer
106
What does treatment of H. pylori infection decrease the risk of?
Rx H. pylori infection: ↓risk gastric lymphoma
107
What does treatment of GERD decrease the risk of?
Rx GERD: ↓risk distal adenocarcinoma in esophagus
108
What are the types of gene mutations producing cancer?
Point mutations, balanced translocations, insertion viral genome, deletion, amplification, overexpression
109
What are proto-oncogenes involved in?
Proto-oncogenes: involved in normal growth/repair
110
What do mutations in proto-oncogenes result in?
Mutations in proto-oncogenes: sustained activity of the gene
111
What is the function of tumor suppressor genes? What are the main sites of control in the cell cycle?
Suppressor genes: prevent unregulated cell growth; G1 to S phase, nuclear transcription
112
What do mutations in tumor suppressor genes result in?
Mutations in suppressor genes → unregulated cell growth
113
What is the function of the BCL2 gene family?
BCL2 gene family: antiapoptosis genes; prevent cytochrome c from leaving mt
114
What does the t(14;18) translocation in B cells cause?
t(14;18) translocation in B cells: overexpression mutation → B cell follicular lymphoma
115
What is the function of DNA repair genes?
Repair genes: correct errors nucleotide pairing; excise pyrimidine dimers
116
What are the enzymes in DNA repair?
Enzymes in DNA repair: endonuclease, exonuclease, polymerase, ligase
117
What is the effect of mutations involving DNA repair genes?
Mutations DNA repair genes: allow cells with nonlethal damage to proliferate
118
What is the most common carcinogen in the U.S.?
Polycyclic hydrocarbons in tobacco smoke MC carcinogen
119
What do direct-acting carcinogens react with? Give an example.
Direct-acting carcinogens react with DNA (e.g., alkylating agents)
120
What do indirect-acting carcinogens require? Give an example.
Indirect-acting carcinogens require metabolic conversion (e.g., polycyclic hydrocarbons)
121
Describe the sequence of chemical carcinogenesis?
Chemical carcinogenesis: initiation → promotion → progression
122
Describe the initiation of chemical carcinogenesis. Give an example.
Initiation: irreversible mutation; e.g., ionizing radiation
123
Describe the promotion of chemical carcinogenesis. Give an example.
Promotion: proliferation mutated cell; promoters (e.g., estrogen) cannot induce cancer
124
Describe the progression of chemical carcinogenesis.
Progression: development of tumor heterogeneity
125
What is the only bacteria that produces cancer?
H. pylori only bacteria that produces cancer
126
Which parasite causes SCC in the bladder?
S. haematobium: SCC in bladder
127
Which parasites cause cholangiocarcinoma of the bile ducts?
Clonorchis sinensis, Opisthorchis viverrini: cholangiocarcinoma bile ducts
128
What are the oncogenic microbial agents in cancer in decreasing order?
Oncogenic microbial agents and cancer: viruses > bacteria > parasites
129
What is the most common cancer due to ionizing radiation?
Leukemia: MC cancer due to ionizing radiation; AML/CML
130
What are the ionizing radiation-induced cancers in addition to leukemia?
Ionizing radiation: papillary cancer thyroid; lung, breast, bone cancers; liver angiosarcoma
131
How does UVB light affect DNA?
UVB light produces pyrimidine dimers that distort DNA
132
What is the most common cancer due to excessive UV light exposure? What other cancers may result?
BCC: MC cancer due to excessive UV light exposure; others—SCC, melanoma
133
What cancers are associated with physical injury?
SCC: 3rd-degree burn scars; orifice of draining sinus
134
What is the most effective host defense against cancer?
Cytotoxíc CD8 T cells: most effective host defense
135
How do NK cells kill malignant cells?
NK cells kill cell directly (type IV HSR)/indirectly via type II HSR
136
What is more important than grade of cancer?
Stage more important than grade of cancer
137
A malignant tumor ≥2 cm has the inherent ability to do what?
Malignant tumor ≥2 cm: inherent ability to metastasize
138
Describe staging in order of decreasing prognostic significance.
Staging in order of decreasing prognostic significance: M > N > T
139
Name a complication of disseminated cancer.
Cachexia is complication of disseminated cancer
140
What is cachexia?
Catabolic process including anorexia, muscle wasting, body fat loss
141
What does PIF do?
PIF causes degradation of skeletal muscle
142
What are the functions of LIF?
LIF ↓body fat; ↑TNF suppresses appetite/initiates apoptosis
143
What is the most common anemia in malignancy?
ACD MC anemia
144
Iron deficiency is most often due to what?
Iron deficiency: usually colorectal cancer
| GI blood loss (e.g., colorectal cancer)
145
Describe the cause of macrocytic anemia in malignancy.
Macrocytic anemia: folic acid deficiency; tumor uses folic acid for DNA synthesis
146
What is the cause of cold AIHA in malignancy? Which malignancy is associated with cold AIHA?
Cold AIHA: IgM cold agglutinins (CLL)
147
What is myelophthisic anemia?
Myelophthisic anemia: marrow replacement by cancer and/or fibrous tissue
148
What are the lab findings in myelophthisic anemia?
Immature normal cells in peripheral blood; teardrop cells
149
What adjective describes hemostasis in malignancy?
Hemostasis in malignancy: thrombogenic
150
Why is there increased risk for vessel thrombosis in malignancy?
Thrombocytosis, ↑coagulation factors, procoagulants from cancer cells
151
What is the cause of DIC in malignancy?
DIC: intravascular coagulation due to cancer releasing tissue thromboplastin
152
What is a common cause of death in cancer?
Gram-negative sepsis: common cause of death in cancer
153
What is a paraneoplastic syndrome?
Paraneoplastic syndrome: distant effects unrelated to metastasis
154
What does a cytokeratin positive stain indicate?
Cytokeratin +: epithelial tissue origin
155
What does a vimentin positive stain indicate?
Vimentin +: connective tissue origin
156
What does a CD45 positive stain indicate?
CD45 +: malignant lymphoma
157
What are tumor markers used for?
Markers: Dx cancer, estimate tumor burden, detect recurrences, follow tumor response to therapy
