Exam 1 (Tumors PDF pages 1-20) Flashcards
What is anaplasia?
test q
-loss of cellular differentiation and function
-characteristic of most malignancies
-backwards formation/goes back to embryonic quality (no function)
define atrophy
-wasting
-a decrease in size of an organ or tissue, may result from death and resorption of cells, diminished cellular proliferation, pressure, ischemia, malnutrition, decreased activity, or hormonal changes
define benign
test q
-no recurrent or progressive
-non-malignant
-usually favorable for recovery
What is cachexia?
a state of ill health, malnutrition, and wasting
define cancer
test q
malignant neoplasm marked by uncontrolled growth and the spread by abnormal cells
Cancers that arise in epithelial tissues are called….
test q
carcinomas
Cancers that arise from mesenchymal tissues are called…
test q
sarcomas
What is a carcinoma?
test q
-a new growth or malignant tumor that occurs in epithelial tissue
-tends to infiltrate and produce metastases
What is carcinoma in situ (CIS)?
test q
-malignant cell changes in the epithelial tissue that do not extend beyond the basement membrane
-in place/ “stage 0”
-surface level cancer
What is a carcinogen?
test q
any substance of agent that produces cancer or increases the risk of developing cancer
define carcinogenesis
the production or origin of cancer
What is a co-carcinogen?
a chemical or environmental factor that enhances the action of a carcinogen
What is chemotherapy?
the application of chemical reagents that have a specific and toxic effect on a disease causing pathogen
What is contact inhibition?
-the natural process of arresting cell growth when 2+ cells come in contact with each other
-this inherent control falls in malignant neoplasia growth
define embolus
clot that is moving in circulation
define etiology
the study of the cause of disease
What is hemangioma?
a benign tumor composed of newly formed blood vessels
What is a hematoma?
a swelling of mass of blood, usually clotted, confined to an organ, tissue, or space and caused by a break in the blood vessel
define infiltration
the process of a substance passing into and being deposited within the substance of a cell, tissue, or organ
What is leukemia?
a malignancy of the blood forming cells in the bone marrow
define lymphadenopathy
disease of the lymph nodes
define malaise
a generalized, non-specific feeling of discomfort
define malignant
test q
-growing worse
-resisting treatment
-cancerous growth
-tending or threatening to produce death
define metastasis
test q
-change of place
-movement of cancer cells from one part of the body to another
-may spread through the lymphatic circulation or bloodstream
define neoplasm
a new formation of tissue, as a tumor or growth
define oncogenesis
tumor formation and development
What is an oncogene?
-a potentially cancer inducing gene
-under normal conditions, such genes play a role in the growth and proliferation of cells but when altered in some way by a cancer causing agent like radiation, carcinogens, or a virus, this may cause the cell to be transformed to a malignant state
define prodromal
-pertaining to the initial stage of a disease
-the interval between the earliest symptoms and the appearance of a rash or fever
What is a sarcoma?
test q
a cancer arising from connective mesenchymal tissues such as bone, cartilage, fibrous tissue, muscle, blood, and lymph vessels
What is a sign?
-abnormality noted by an observer or doctor
-objective finding
define stroma
supporting tissue or matrix of an organ or tumor
What is a symptom?
-abnormality noted by a patient
-subjective finding
What is a syndrome?
A group of symptoms and signs of disordered function related to one another by means of some anatomical, physiological, or biochemical peculiarity
What is a tumor?
-a swelling or enlargement
-one of the 4 classic signs of inflammation, the others are calor/heat, dolor/pain, and rubor/redness
What is a tumor angiogenesis factor?
-a protein present in animal and human cancer tissue
-appears to be essential to cancer growth
What is a tumor marker?
test q
a substance whose presence in blood serum serves as a biochemical indicator for the possible presence of a malignancy
What are the general clinical characteristics of benign tumors?
-grow by expansion, compressing the tissues around them and forming a fibrous capsule
-round, smooth, and regular to palp
-tend to grow slowly and not recur after removal
-rarely cause severe problems BUT may cause pressure effects and damage depending on their anatomical location; tumors of endocrine glands may secrete/over secrete hormones, rarely undergo malignant transformation
-histologically, benign tumors are well differentiated, closely resembling the tissue of origin
How do you distinguish a benign tumor from a malignant tumor?
biopsy only
What are the general clinical characteristics of malignant tumors?
-grow by local invasion and infiltration with destruction of surrounding tissue
-usually poorly circumscribed and unencapsulated
-tumor is often fixed to surrounding tissues
-rough and irregular to palp, and if close to surface it may cause ulceration
-grow rapidly and difficult to remove surgically in their entirety
-chief definitive feature of malignant tumors is their tendency to spread locally, and by various routes to distant sites- metastasis
-histologically, malignant tumors are often poorly differentiated, invade and infiltrate surrounding tissues in a tentacular fashion with destruction. Invasion of vessels may be seen, aggressive tumors show frequent mitosis
-exhibit pleomorphism (variation in size and shape)
-increased nuclear cytoplasm ratio of 1:1
-hyperchromic (increased DNA)
-malignant cells lack contact inhibition- normally cells should bounce off each other but malignant cells infiltrate tissues
What is pleomorphism?
variation in size/shape
What is hyperchromic?
increased DNA
What are intermediate tumors?
tumors that are between benign (slow-growing and unlikely to spread) and malignant (fast-growing, aggressive, and likely to spread)
ex: ganglioneuroblastoma or giant cell tumor
-oma= ?
tumor (usually benign)
chondr/o=?
cartilage
What is a chondroma?
benign cartilage tumor
If the parent tissue is connective tissue like cartilage, bone, adipose, or muscle, then in order to name the malignancy, you must add -______________ to the root
sarcoma
What is a chondrosarcoma?
malignant cartilage tumor
oste/o=
bone
What is an osteoma?
benign bone tumor
What is an osteosarcoma?
malignant bone tumor
lip/o=
adipose tissue
What is a lipoma?
benign adipose tumor
What is a liposarcoma?
malignant adipose tumor
leiomy/o=
smooth muscle
What is a leimyoma?
smooth muscle benign tumor
What is a leiomyosarcoma?
smooth muscle malignant tumor
rhabdomy/o=
skeletal muscle
What is a rhabdomyoma?
skeletal muscle benign tumor
What is a rhabdomyosarcoma?
skeletal muscle malignant tumor
hemangi/o=
blood vessel
What is a hemiangiosarcoma?
malignant blood vessel tumor
lymphangi/o=
lymph vessel
What is a lymphangioma?
benign lymph vessel tumor
What is a lymphangiosarcoma?
malignant lymph vessel tumor
neurofibr/o=
nerve sheath
What is a neurofibroma?
benign nerve sheath tumor
What is a neurofibrosarcoma?
malignant nerve sheath tumor
-blastoma=?
malignancy arising in embryonic tissues in the precursor cells
In chorionic epithelium, the benign tumor is called a __________________ and the malignancy is a _________________
hydatidiform mole, choriocarcinoma
As a tumor grows, nutrients are provided by direct ___________ from the circulation
diffusion
What are the 2 major categories of mutated genes that cause cancer?
oncogenes and tumor suppressor genes
Which gene plays a role in cell division and DNA repair and are critical for detecting inappropriate cell growth signals?
tumor suppressor genes
What are the 3 main categories of carcinogens?
1) viruses
2) radiation
3) chemicals
Which cancer is associated with cytomegalovirus?
kaposi’s sarcoma
Which cancers are associated with epstein barr virus?
-burkitt’s lymphoma
-immunoblastic lymphoma
-nasopharyngeal carcinoma
Which cancer is associated with hep B virus?
hepatocellular carcinoma
Which cancer is associated with herpes virus 8?
kaposi’s sarcoma
Which cancers are associated with HIV?
kaposi’s sarcoma and lymphoma
Which cancer is associated with human papilloma viruses?
cervical carcinoma
Which cancers are associated with human T cell lymphotrophic virus?
T cell lymphomas and hairy cell leukemia
Which cancer is associated with merkel cell polyomavirus (MCV)?
merkel cell carcinoma
What radiations are carcinogenic?
1) UV radiation may induce skin cancer by damaging DNA
2) ionizing radiation is able to remove electrons from atoms to change the molecular structure of cells
alpha fetoprotein (AFP, normally found in human embryo) may be elevated in what cancers?
liver and testicular cancer
Carcinoembryonic antigen (CEA) rises in what cancer?
colon cancer
beta human chorionic gonadotropin (B-HCG) is elevated in what cancers?
choriocarcinoma and testicular cancers
Serum Abs are elevated in which cancer?
multiple myeloma
CA125 is elevated in which cancer?
test q
ovarian
CA27-29 is elevated in which cancer?
breast
prostate specific antigen (PSA) and prostatic acid phosphatase is elevated in which cancer?
prostate cancer
What is the difference between clinical and pathologic staging?
clinical= uses info from case hx, exam, and non-invasive studies
pathologic= requires biopsy/tissue specimens
What is a sentinel node biopsy?
a sentinel lymph node is defined as the 1st lymph node to which cancer cells are most likely to spread from a primary tumor (may be more than one sentinel lymph node)
One of the grading systems for tumors is called TNM classification. What does TNM stand for?
test q
T= tumor size (has it invaded nearby tissue?)
N= are lymph nodes involved?
M= did it metastasize?
What is the grading system called for prostate cancer- ranks it on a scale of 2-10?
gleason system
Besides the TNM system, what is the other grading scale called for breast cancer?
bloom richardson system
What is the grading system called for kidney cancer?
fuhrman system
What is the most common pathway of metastasis for carcinomas?
lymphatic dissemination (thru lymphatic channels that circulate thru/out the body)
Metastatic spread of cancer via the thoracic duct may lead to an enlargement of the left supraclavicular node known as the ______________, leading to an appreciable mass that can be recognized clinically as a _____________ sign (often, but not always, from a cancer in the abdominal cavity)
Virchow node (VN), Troisier
Does hematogenous dissemination occur mainly through arteries or veins? Why?
veins bc veins are thin-walled and offer little resistance to tumor
Which cancer disseminates into the vertebral vein system and metastasizes to the pelvis, lumbar spine, and remainder of the axial skeleton?
prostate cancer
Carcinoma of the uterus causes direct extension/local invasion to what?
iliac bones
What are the 2 uncommon ways for tumors to spread?
1) implantation of inoculation (mechanical transport of tumor cells by surgical instruments or gloves
2) seeding of tumor along one of the natural pathways of the body, like lower urinary tract tumor from a higher lesion
What are the most common sites for metastasis?
bone, lungs, and liver
Clinically, cure is defined as…
the permanent absence of signs or symptoms of a disease, complete remission or complete response as disappearance of clinical evidence of disease
What are the methods of therapy for cancer?
major:
-surgery
-radiation
-chemo
other:
-hormonal therapy (for breast, prostate, and endometrial cancers)
-immunotherapy
What is the most common type of radiation therapy?
external beam with linear accelerator
What is brachytherapy?
-type of radiation therapy
-involves the placement of radioactive seeds through guided imagery (delivers higher doses of radiation over a longer period)
What are some adverse effects of radiation therapy?
-lethargy
-fatigue
-mucusitis
-cutaneous manifestations like burns
-GI and GU symtoms
-hepatitis
-cytopenia (low blood cells)
How long does 1 course of radiation therapy last?
large daily doses over a 3 week period for palliative tx or smaller doses daily for 6-8 weeks for curative tx
How is chemo administered? What are the adverse effects of chemo?
usually through IV or orally
can be one drug or multiple, but multiple is more common
adverse effects occur more commonly in those tissues with the highest intrinsic turnover rate (bone marrow, hair follicles, and GI epithelium)
What are the 2 types of benign epithelial neoplasms?
dermal and vascular lesions
What are the 5 benign dermal lesions?
1) wart
2) epidermal cysts
3) keloids
4) moles/nevi
5) seborrheic keratoses
Which dermal lesion is this?
-common benign epithelial lesion
-almost universal in the population, affecting all ages
-caused by HPV infection
-has various types
warts
What are common warts (verrucae vulgaris)?
-generally asymptomatic warts
-sharply demarcated
-often at sights of trauma of on head/neck
Which warts are found at sights of trauma, usually the head and neck?
common warts
Which warts occur on the palms and soles and are flattened by pressure?
palmar and plantar warts
Which warts are flat to broad based smooth to velvety papules on the perineal, perirectal, labial, and penile areas?
genital warts (also called condylomata acuminata or venereal warts)
Which dermal lesion is this?
-slow growing benign cysts containing keratinous (keratinous or sebaceous cyst), follicular (pilar cyst) or sebaceous (steatocystoma) material
-frequently found on the scalp, ears, face, back, or scrotum
epidermal cysts
Which dermal lesion is this?
-smooth overgrowths of fibroblastic tissue that may arise in areas of injury (surgical scars, acne scars) or may occur spontaneously
-more frequent in African Americans and tend to appear on the upper trunk
keloids
Which dermal lesion is this?
-pigmented flat or raised lesions composed of clusters of melanocytes or nevus cells
moles (nevi)
What is seborrheic keratoses?
-dermal lesion
-pigmented superficial epithelial lesions
-common in middle or old age
-may be round or oval
-flesh colored, brown, or black
-appear “stuck” to the skin
What are the 4 benign vascular lesions?
1) infantile hemangioma
2) nevus flammeus
3) port-wine stain
4) spider angioma
Which benign vascular lesion is this?
-most common tumor of infancy
-affects 10-12% of infants by 1 year
-classified by appearance as superficial, deep, cavernous, or by descriptive terms (ones with bright red appearance are sometimes called a “strawberry hemangioma”)
-depending on location may interfere with function
-most spontaneously involute, starting at about 12-18 months of age
infantile hemangioma
Which benign vascular lesion is this?
-flat pinkish marks
-commonly located on the nape, glabella, and eyelids
-tends to fade overtime
nevus flammeus
Which benign vascular lesion is this?
-flat, reddish to purple lesions appearing anywhere on the body
-tend to become darker and more palpable
-if seen in the trigeminal area, may be a component of Sturge-Weber syndrome (also known as Weber syndrome, which has similar lesions on the meninges and cerebral cortex with epilepsy)
port-wine stain
Which benign vascular lesion is this?
-bright red, faintly pulsatile lesion consisting of a central arteriole with projections resembling the legs of a spider
-seen in patients with hepatic cirrhosis, pregnant women, or women taking OC, also seen in patients with vit B12 def
spider angioma (also known as spider nevus, vascular spider, or nevus araneus)
What are the 4 malignant epithelial lesions?
1) basal cell carcinoma (aka rodent ulcer)
2) squamous cell carcinoma
3) melanoma (malignant melanoma)
4) oral squamous cell carcinoma
What is the most common type of skin cancer?
test q
basal cell carcinoma (aka rodent ulcer)
Which cancer is this?
-most common in fair skinned, sun-exposed individuals, rare in African Americans
-clinical presentation is highly variable, but most commonly begins as a shiny papule, enlarging slowly and progresses to show a shiny, pearly border with prominent dilated vessels (telangiectasia) on the surface with a central ulcer
-rarely metastasizes but can invade healthy tissue
-treatment may involve curettage, electrodessication, surgical excision, cryosurgery, or radiation therapy
basal cell carcinoma (aka rodent ulcer)
What is the 2nd most common type of skin cancer?
squamous cell carcinoma
Which cancer is this?
-common in sun-exposed areas, pre-existing keratoses, and burn scars
-may begin as a red papule or plaque with a scaly or crusted surface and may become nodular, eventually ulcerates and invades underlying tissue
-treatment is the same as for basal cell carcinoma, but there is a higher risk for metastasis, so follow up is necessary
squamous cell carcinoma
What is the other name for superficial squamous cell carcinoma in situ?
Bowen’s disease
What is the most deadly skin cancer?
melanoma
Which cancer is this?
-arises from melanocytes in pigmented areas like the skin, mucous membranes, eyes, and CNS
-risk factors include sun exposure, family hx, increased number of melanocytic nevi, large congenital nevus, and dysplastic nevus
-vary in size, shape, and color (though usually pigmented) and in their propensity to metastasize
-there are 4 main types of this cancer
melanoma
What does ABCDE stand for?
A= asymmetry of mole
B= border
C= color
D= diamater
E= evolving
What is lentigo maligna melanoma?
-accounts for up to 15% of melanomas
-arises from a Hutchinson’s freckle or malignant melanoma in situ
-tends to arise in older patients
What is the most common type of melanoma?
superficial spreading melanoma (2/3 of all melanomas)
What is superficial spreading melanoma?
-occurs most commonly on women’s legs and men’s torsos
-lesion is usually a plaque with indurated areas and shows red, white, black, and blue spots
What is nodular melanoma?
-10-15% of all melanomas
-appears anywhere as a dark, protuberant papule or plaque, usually enlarging rapidly
-aggressive tumor
What is acral lentiginous melanoma?
-uncommon skin cancer, however is the most common melanoma for African Americans
-arises on the palmar, plantar, and subungual skin (under finger nail)
What is the most common oral or pharyngeal carcinoma?
oral squamous cell carcinoma
What is oral squamous cell carcinoma?
-usually occurs after age 50
-risk factors includes smoking, especially 2+ packs a day, alcohol abuse, smokeless tobacco, and HPV infection
-can begin on the floor of the mouth or on lateral or ventral surface of the tongue, lower lip, palate, and tonsillar area
-begins asymptomatic initially and may appear in areas of erythoplakia (red plaque) or leukoplakia (white plaque) with induration and rolled edges
-tonsillar involvement may present with asymmetric swelling and sore throat with pain after often radiating to ipsilateral ear
-tx= surgery and radiation therapy
What are the 4 benign breast neoplasias?
1) fibrocystic changes
2) fibroadenomas
3) phyllodes tumor
4) intraductal papillomas
What is the most frequent benign disorder of the breast?
fibrocystic changes
Which benign breast neoplasia is this?
-includes a range of changes within the breast involving both glandular (lobules and ducts) and stromal tissues
-most common in women of childbearing age (20-50)
-happens with hormonal changes
-symptoms include breast pain and tender lumps or areas of thickening in the breast
-symptoms may vary depending on which phase of cycle
-for most women, no tx is needed
-some report that avoidance of caffeine or other stimulants may have an impact on symptoms
fibrocystic changes
Which benign breast neoplasia is this?
-benign tumors made up of both glandular and stromal breast tissues
-most common in women in 20s/30s
-use of oral contraceptives before the age of 20
-tend to be round and well encapsulated and often feel like a marble within the breast, are usually firm and non-tender and felt like they can be moved under the skin
fibroadenomas
Which benign breast neoplasia is this?
-described as an overgrowth of connective tissue
-rare
-usually benign
-usually felt as a painless lump and grows quickly causing the skin to stretch
phyllodes tumor
Which benign breast neoplasia is this?
-described as wart like growths of gland tissue and fibrovascular tissue which grow within the breast ducts
-can be found in breast ducts close to the nipple (often the cause of clear of bloody discharge when found here) or in ducts further from the nipple
-in cases of multiple papillomas, there is a link to an increased risk of breast cancer
-usually occur in slightly older women (40+ y/o)
intraductal papillomas
What is the 2nd leading cause of cancer death in women?
breast cancer
What is the #1 cause of cancer death in both men and women?
lung cancer
What is the 2nd leading cause of cancer death in men?
prostate cancer
About 5% of women with breast cancer carry an inherited mutation of what genes?
BRCA1 or BRCA2 (BRCA1 is also linked to ovarian cancer)
define nulliparity
never having children
What are the 4 main malignant breast neoplasias?
1) ductal carcinoma in situ (DCIS)
2) lobular carcinoma in situ (LCIS)
3) invasive or infiltrating ductal carcinoma (IDC)
4) invasive or infiltrating lobular carcinoma (ILC)
Which cancer is this?
-cancer cells are inside the ducts but have not spread through the walls of the ducts into surrounding breast tissue
-about 1/5 new breast cancer cases diagnosed with this
-best diagnostic tool is mammogram
ductal carcinoma in situ (DCIS), also known as intraductal carcinoma
Which cancer is this?
-begins in the milk producing glands (lobules) but does not go through the walls of the lobules
-breast feeding may prevent this one
lobular carcinoma in situ (LCIS), also known as lobular neoplasia
What is the most common type of breast cancer?
invasive or infiltrating ductal carcinoma (IDC)
Which cancer is this?
-starts in a milk passage (duct) of the breast
-has broken through the wall of the duct and invaded the fatty tissue of the breast
invasive or infiltrating ductal carcinoma (IDC)
Which cancer is this?
-starts in the milk producing glands (lobules)
-can metastasize as an IDC
-may be harder to detect by mammogram, so thermography is better
invasive or infiltrating lobular carcinoma (ILC)
What is paget disease of the nipple?
-starts in the breast ducts and spreads to the skin of the nipple and then to the areola, the dark circle around the nipple
-rare cancer, only 1% of cases
-the skin of the nipple and the areola often appears crusted, scaly, and red, with areas of bleeding or oozing
-may have burning or itchy feeling
-almost always associated with either DCIS or IDC
What is inflammatory breast cancer?
-uncommon, invasive cancer, 1-3% of cases
-usually no single lump or tumor
-instead it makes the skin of the breast look red and feel warm and gives the skin a thick pitted appearance that looks like an orange peel
-blocks lymph vessels in the skin
-may become tender and itchy
-often mistaken for mastitis in the early stages
-may not appear on mammogram bc theres no lump
-does not have a good prognosis bc its hard to catch
