Exam 2 Flashcards
metastases
spreading of tissue invasion
cancer
transformation or change in cells
ACS lifetime risk: men versus women
1 in 2 men
1 in 3 women
estimated new cases of cancer: percentages of men
prostate 27%
lung and bronchus 14%
colon and rectum 8%
estimated new cases of cancer: percentages of women
breast 29%
lung and bronchus 14%
colon and rectum 8%
estimated deaths: % of men
lung and bronchus 28%
prostate 10%
colon and rectum 8%
estimated deaths: % of women
lung and bronchus 26%
breast 15%
colon and rectum 9%
oncogenesis
process of formation of tumors or cancer
study of formation of tumors has led to the understanding that:
oncogenes transform normal cells into malignant cells
can be independent or, current theory, is that this is done with a virus
oncogenes
CA causing genes
tumor-suppressor genes
suppress oncogenes from causing transformation
carcinogenesis
process of normal cell becoming malignant
tumor (neoplasm)
abnormal mass of tissue
characteristics of a tumor (neoplasm)
- no useful purpose
- may harm host
- growth usually exceeds normal tissue growth and continues after stimulus that triggered change has ceased
- benign or malignant
- primary or secondary
where do carcinomas arise from?
epithelial cells
where do sarcomas arise from?
mesenchymal tissues
where do lymphomas arise from?
lymph tissue
where do adenocarcinomas arise from?
glandular tissues
how do benign differ from malignant?
differentiation and anaplasia
rate of growth
local invasion
metastasis
what is differentiation
process of cells changing as they develop into different tissues
-extent to which cells resemble normal cells
- benign closely mimic
- malignant cells differ widely in extent of differentiation
what is anaplasia
lack of differentiation
- poor differentiation is hallmark of malignancy
- poorly differentiated (anapestic) tumors show complete disarray of tissue architecture
what is dysplasia
disorderly but non-neoplastic growth (may reverse or progress to malignancy)
highly marked lesion -> pre-invasive neoplasm
what is metaplasia
mild or early dysplasia
what is hyperplasia
increase in number of cells
normal or abnormal - e.g., breast tissue in pregnancy. bone healing
what is tumor grading?
degree of differentiation and number of mitoses in amor
how abnormal the tumor looks microscopically
what is tumor staging?
anatomic extent of the tumor and its spread
- size of primary
- extent of local and distant spread
specific to type of cancer
what is the TNM system?
Tumor, Node, Metastasis
detailed system that classifies tumors developed by AJCC (american joint committee on cancer)
-then often simplified to roman numerals I to IV
what are the key elements of staging?
location of the primary tumor tumor size and number of tumors lymph node involvement cell type and tumor grade presence or absence of metastasis
TNM Staging: T (primary tumor)
TX = primary tumor cannot be evaluated
T0 = no evidence of primary tumor
Tis = carcinoma in situ
T1-T4 = size and/or extent of the primary tumor
TNM Staging: N (regional lymph nodes
NX = regional lymph nodes cannot be evaluated
N0 = no regional lymph node involvement (no cancer found in the lymph nodes)
N1-N3 = involvement of regional lymph nodes (number and/or extent of spread)
TNM Staging: M (distant metastasis)
MX = distant metastasis cannot be determined
M0 = no distant metastasis
M1 = distant metastasis
Stages based on TNM combinations
0 = carcinoma in situ
I, II, III = higher numbers: more extensive disease with greater tumor size, and/or spread of the cancer to nearby lymph nodes and/or organs adjacent to the primary tumor
IV = cancer has spread to another organ
according to ACS, does a cancer stage ever change?
no - keep cancer stage as that at diagnosis, rather than change as condition progressive
if there is an “R” on the end of TNM (TNMR) then the person has been restaged
what is TNM NOT used for?
leukemia
lymphomas
brain tumors
female gynecologic system cancers
what type of staging system do lymphomas use?
Ann Arbor staging system
how does grading classify cells?
using abnormal appearance under a microscope
what are the key elements of grading?
differentiation/histologic grading
nuclear grade
what is the nuclear grade
size and shape of nucleus and the % of tumor cells that are dividing
differences between grades 1 and grades 2-4
1: resemble normal cells, tend to grow and multiple slowly, least aggressive
2-4: increasing lack of differentiation, tend to grow and multiply faster as grade number increases
AJC on Cancer grading guidelines:
GX = grade cannot be assessed (undetermined grade)
G1 = well-differentiated (low grade)
G2 = moderately differentiated (intermediate grade)
G3 = poorly differentiated (high grade)
G4 = undifferentiated (high grade)
why is grading an “imperfect system”?
different tumors and parts of tumors may be at different grades
grading may change as tumor grows
importance of grading in treatment and prognosis varies with specific cancers
what are the risk factors for CA?
age inactivity overweight/obese heredity viruses race/ethnicity geography presence of precancerous lesions occupation behaviors (diet, nutrition, drugs, activity, sexual behaviors, etc.) gender (hormones, etc.) SES stress
what is the most important risk factor and why?
AGE
increase up to about age 84
- longer exposure?
- shifts in immune system?
- genetic mutations with age?
what CAs are age risk increases greatest for?
leukemia’s, digestive system, cervical, breast, prostate and skin (especially basal and squamous cell carcinomas)
how is heredity a risk factor for CA?
(interacts with environment)
- familial cancers
- inherited cancer syndromes - single mutant genes in an autosomal dominant pattern
- autosoma recessive syndromes of defective DNA repair
what are three common treatments of CA?
surgery
radiation
chemotherapy
what types of surgeries are used to treat cancers
biopsies (bx)
-open, needle, stereotactic
resections
-partial or debulking, complete
treatment access (e.g., brachytherapy)
reconstruction
mohs surgery or chemosurgery for skin lesions
-inspection of each sequential microscopic layer of the tumor fills all layers removed
lymph node dissection
-traditional, sentinel node
what are the reasonings for radiation treatment?
curative or palliative
decreasing size of the tumor
decreasing metastasis risk
what are the types of radiation treatment?
traditional telotherapy
brachiotherapy
gamma knife
when is chemotherapy used as a CA treatment
for cancers that have spread or are unable to be treated by surgery
may be used with other treatments
is chemotherapy a specific or systemic treatment?
systemic
tends to target more rapidly dividing cells
–this is why hair falls out and why people get nauseous (hair cells are rapidly dividing, and the cells on the lining of the GI tract are rapidly dividing)
alkylating (medication class)
directly damage DNA to stop cancer cells from reproducing
antimetabolites (medication class)
interfere with DNA and RNA growth
anti-tumor antibiotics (medication class)
interfere with enzymes involved in cell replications
topoisomerase inhibitors (medication class)
affect DNA copying
mitotic inhibitors (medication class)
interfere with mitosis or enzymes needed for necessary replication proteins
corticosteroids (medication class)
for edema, nausea, and sensitivity reactions
hormone therapy (medication class)
alters specific hormonal actions (e.g., blocks hormones involved in hormone dependent tumors)
immunotherapy (medication class)
stimulate immune system to identify and attack cells
- also known as biological response modifiers - BRMs
- relatively new and many still experimental stage
- categories include interferon, interleukins, antibodies, hematopoietic agents, and stem cell replacement techniques
what is the main function of the immune system?
to protect self from foreign substances and organisms
-the strategy it uses to differentiate self from non-self and remove non-self
uses complex network of specialized organs and cells to fight off invaders
what is immunology
branch of medicine that studies the physiological mechanisms allowing the body to recognize foreign materials and neutralize them
external protection (immune system)
skin, hair, mucus, ear wax, etc.
internal protection (immune system)
primary and secondary organs of the immune system
what are the primary organs of the immune system
leukocytes (white blood cells)
- formed in bone marrow
- all leukocytes start as stem cells
thymus
-T-lymphocytes mature here
what are the secondary organs of the immune system?
where leukocytes are stored
- lymph nodes
- tonsils and adenoids
- spleen
- Peyer’s patch (small intestines)
what are the 3 types of leukocytes?
granulocytes
lymphocytes
monocytes
what are the 4 granulocytes
neutrophils
eosinophils
basophils
mast cells
what are the 4 types of lymphocytes
b-lymphocytes
T4 - helper lymphocytes
T8 - killer lymphocytes
natural killer (NK)
what are the 2 types of monocytes
macrophages
dendritic cells
what is the turnover rate of granulocytes
2-3 days
what is the turnover rate of monocytes
months to years
what are some characteristics of neutrophils
come from the bone marrow
increase in the presence of infection (if someone has low immunity, they will have low neutrophils)
without a lot of neutrophils, immune system will be low
neutrophils are produced FAST, so they will be killed off by chemo (thats why chemo pt’s are given drugs to help with immunity)
what does an elevated amount of eosinophils mean?
allergic response to something
characteristics of basophils
circulate in peripheral blood
antihistamines target mast cells
mast cells gone awry - cause anaphylaxis response
what are monocytes critical for?
first response
will hang around for a while (while the response continues)
what are the jobs of the immune system?
- to differentiate self from non-self
2. to remove the non-self
what is an antigen
any substance or organism that is capable of setting off an immune response
process specific cell markers that identifies it as self or non-self
(major histocompatibility complex molecules MHC-Class 1)
what are epitopes
identifying molecule of antigen (antigen determinant) that marks organism, tissue, or protein as either self or non-self
major histocompatibility complex proteins
genes on chromosome 6
-unique fingerprint - cell markers identify self
produces tolerance of self
human leukocyte antigen (HLA)
class I type A, B, C
class II type D (DP, DQ, DR)
discovered on leukocytes
inherited
what are the two types of immunity?
- innate (natural) immunity
2. acquired (adaptive) immunity
what is innate (natural) immunity
first line of defense
attack any non-self substance
what is acquired (adaptive) immunity
learn to identify specific foreign antigens as non-self
then be able to make rapid response to destroy them when encountered later
characteristics of innate immunity
- non-specific
- lacks memory
- remain unchanged no matter how often the antigen is presented
- fast response
- both external and internal components
purpose of innate immunity
external component - prevents access to environment by providing a physical or chemical barrier
internal component - uses a non-specific response to destroy any invaders that manage to enter internal environment
components of external defense (innate immunity)
PASSIVE
- skin, hair, nails
- GI tract acid secretions
- dendritic cells located in tissue with external environment contact, Langerhan’s cells
“border patrol”
components of internal defense (innate immunity)
ACTIVE
-phagocytes
(neutrophils, monocytes, eosinophils, basophils, mast cells, dendritic cells)
-natural killer cells
-complement
“state police”
what are phagocytes
cell eaters
most important cells in INNATE immune system
engulf and digest microorganisms
antigen presenting cell
what are the 3 antigen presenting cells?
phagocytes
natural killers (NK)
complement
what are natural killers?
recognizes any non-self
important role in destroying virally infected cells and tumor cells
what is complement?
plays role in destruction of foreign cells
20-25 proteins circulating in blood system
what are the 3 actions that complement uses to destroy invaders
attract phagocytes (chemotaxis)
mark or tag cells for destruction
antigen-antibody complex sets off complement cascade which destroys cell
what are the 2 purposes of acquired (adaptive) immunity?
- to eliminate any foreign antigens that have managed to slip by the external and internal Innate Barriers
(Primary Immune Response) - prepare the organism to be able to respond more quickly to future attacks from that particular bacteria or virus
(Secondary Immune Response)
characteristics of adaptive immunity
specific response to a particular antigen
slow to respond (initially) - primary immune
develops future immunity - secondary immune response
what are the two types of acquired immunity?
humoral (immunoglobulin immunity) B-cell immunity. antigen/antibody complex
cell mediated (t-cell immunity)
what is humoral acquired immunity?
- mediated by antibodies present in body fluids or secretions
- B-lymphocyte is main player
- circulate in blood, lymphatic system, and other body secretions (body humors, hence the name humoral)
what are b-lymphocytes?
produced in bone marrow
have immunoglobulins attached to its surface
main player in humoral immunity
what are immunoglobulins?
antibodes
antigen recognition molecules
what are the functions of immunoglobulins
- directly attach antigens, destroy or neutralize them, neutralize the toxins and lyse the organisms cell
- activate the compliment system
- activate anaphylaxis via histamine release in tissue and blood
- stimulate antibody-mediated hypersensitivity
five classes of immunoglobulins
IgG, IgM, IgA, IgD, IgE
IgG
anti-bacterial and anti-viral (75%), complement, neutralize toxins
IgM
initial response, antigen recognition, complement (10%)
IgA
mucus membrane
IgD
communication, antigen recognition
IgE
parasites and allergic reactions
what do plasma cells do in the humoral response
produce specific antibodies for immediate response to antigen
(primary immune response)
IgG, IgE, IgA
what do memory cells do in the humoral response?
prepare body to respond quickly to specific antigen if it is introduced at a later time
(don’t need APC)
knows what to look for
(secondary immune response)
antigen-antibody complex
destruction of antigen (5 things)
- neutralize toxins from bacterial infections (IgG)
- mark antigen for easy recognition by phagocytes and others
- agglutination (certain antibodies promote clumping)
- complement fixation (IgG, IgM) sets off a chain reaction
- initiate inflammation (all)
these all draw phagocytes and NK to the area to destroy the antigen
what is the main player in cell-mediated immune response?
t-lymphocytes
where are t-lymphocytes produced?
in the bone marrow, BUT they MATURE in the THYMUS
two primary types of T-cells?
helper T-cells (T4, CD4, Th)
killer T cells (T8, CD8, Tc)
where are T-cells found
in blood and lymph throughout the body
what is an antigen presenting cell
APC is phagocyte that processes the antigen and exposes the epitope
what does helper t-cell receptor do?
recognizes and attaches to the exposed epitope and becomes activated
will then multiply into specific active and memory cells
helper t-cell roles
- though the release of cytokines stimulate the proliferation of B-cells and their release of antibodies
- plays a role in the activation of killer -cells
- simulates the activity of macrophages
THEY JUST HELP! - do not destroy or attack
they are the brains of the organization
when are killer t cells activated
when exposed to antigen/epitope
what is primary immunodeficiency (PID)
congenital
inherited deficiencies in the ability of the individual to produce one or more cells of the immune response
-relatively rare that can lead to increased risk of disease
what is common variable immunodeficiency (CVI)
inability to produce sufficient antibodies
what is secondary immunodeficiency
result of immune system compromised by disease or drug therapies
iatrogenic secondary immunodeficiency
compromised immune system usually secondary to chemotherapy or immunosuppressive drug therapy
acquired secondary immunodeficiency
can also be associated with a disease that affects th immune system such as leukemia, hodgkin’s disease, or HIV/AIDS
what are problems of immunodeficiency
individual is more susceptible to opportunistic infections
decrease ability to protect self from the proliferation of cancer cells
what are hypersensitivity disorders
exaggerated or inappropriate immune response
EX) allergic response
damage is from the RESPONSE, not the allergen
what are the 4 classification of hypersensitivity classification
I - anaphylactic (allergies)
II - cytolytic/cytotoxic
III - immune complex
IV - cell-mediated/delayed
what is anaphylactic hypersensitivity
hypersensitivity to a foreign substance causing body to overproduce antibody IgE
what is cytolytic/cytotoxic hypersensitivity
IgG and IgM antibodies bind to self cells
what is immune complex hypersensitivity
antigen-antibody accumulation
IgG and IgM
what is cell-mediated/delayed hypersensitivity
t-cell response
what type of allergy?
eczema, asthma, anaphylactic shock
type I
what type of allergy?
blood incompatibility, autoimmune hemolytic anemia, myasthenia gravis, graves disease
type II
what type of allergy?
systemic lupus erythematosus (SLE), hepatitis B, bacterial endocarditis, rheumatoid arthritis
type III
what type of allergy?
graft vs host disease, contact dermatitis, poison ivy, diabetes, guillain-barre, MS, ulcerative colitis, crohn’s disease
type IV
what is autoimmunity?
loss of tolerance for one’s own cells - attack cells
antibodies and t-cells can sometimes cross-react and attack cells that have markers that may resemble the epitope of the foreign antigen
can involve one specific organ or tissues of many parts of the body
correspond to type II, III, or IV hypersensitivity
examples of autoimmune diseases
addison disease, adrenal gland crowns disease, intestines DM, pancreas polymyositis, muscle cells thyroiditis, thyroid ulcerative colitis, colon ankylosing spondylitis, spine MS, myelin Myasthenia gravis, nerve/muscle synapse reiter's syndrome, ligaments and tendons RA, connective tissue sjogren's syndrome, glands SLE, skin, joints, organs, CNS
