Exam 4 - Cancer Flashcards
1
Q
What does neoplasm mean?
A
Cancerous tumor
2
Q
What is a benign tumor?
A
Abnormal growth of tissue
3
Q
What do the edges of a cancerous tumor look like?
A
Uneven edges with finger like projections
4
Q
What do the edges of a benign tumor look like?
A
Well defined edges
5
Q
Speed of growth
Benign vs malignant
A
Benign tumors grow slowly, malignant tumors grow rapidly
6
Q
Differentiation
Benign vs malignant tumors
A
Benign tumors are well differentiated with a low mitotic index. Look like the tissue from which it arose
Malignant tumors are anaplastic and have a high mitotic index. Poorly differentiated and do not look like the tissue from which it arose
7
Q
Capsule
Benign vs malignant tumors
A
Benign have a well defined capsule
Malignant tumors are not encapsulated
8
Q
Invasiveness
Benign vs malignant tumors
A
Benign are not invasive
Malignant invade local structures and tissues
9
Q
Metastasize?
Benign vs malignant
A
Benign do not metastasize
Malignant spread distantly through blood stream and lymphatics
10
Q
What is a lipoma?
A
Benign fatty tissue tumor under skin
11
Q
What is a glioma?
A
Benign tumor in brain
12
Q
What is a leiomyoma?
A
Benign tumor in uterus
13
Q
What is a chondroma?
A
Benign tumor of soft tissue or bone
14
Q
How are benign tumors named?
A
From the tissues they arise
With the suffix “-oma”
15
Q
How are malignant tumors named?
A
According to tissues from which they arise
16
Q
What are malignant epithelial tumors referred to as?
A
Carcinomas
17
Q
Type of glandular epithelial tumor
A
Adenocarcinoma
18
Q
Malignant connective tissue tumors are called?
A
Sarcomas
19
Q
What is a rhabodmyosarcoma?
A
Malignant tumor of skeletal muscles
20
Q
What are lymphomas?
A
Cancers of lymphatic tissue
21
Q
What are leukemias?
A
Cancer of blood forming cells
22
Q
What type of tumor is carcinoma in situ?
A
Squamous cell tumor that does not penetrate other structures. Stays small if caught in time
23
Q
Stage one of cancer spread
A
Cancer confined to the organ of origin
24
Q
Stage 2 of cancer
A
Cancer is locally invasive (spread to tissue right around it)
25
Stage 3 of cancer
Cancer that has spread to regional structures such as lymph nodes
26
Stage 4 of cancer
Cancer that has spread to distant sites
27
Where does stage 4 liver cancer spread to?
Lungs
28
Where does stage 4 prostate cancer spread to?
Bone
29
Why is it important to know what stage of spread cancer is in?
Track the speed
Know how to treat
For cancer accreditation
30
What does the TNM system measure?
```
T = Tumor
N = Lymph node
M = Metastases
```
31
What does the number with the T in TNM equal?
The number equals the size of the tumor and its local extent
32
Explain the different measurements of the T in TNM
```
T0 = Breast free of tumor
T1 = Lesion <2 cm in size
T2 = Lesion 2-5 cm
T3 = Skin and/or chest wall involved by invasion
```
33
What does the number with the N in TNM equal?
Lymph node involvement. A higher number means more nodes are involved
34
Explain the different measurements of the N in TNM
```
N0 = No axillary nodes involved
N1 = Mobile nodes involved
N2 = Fixed nodes involved
```
35
What does the M equal in TNM?
Extent of distant metastases
36
Explain the different measurements of the M in TNM
```
M0 = No metastases
M1 = Metastases that can be seen
M2 = Suspected metastases
```
37
What do cells look like when they are in dysplasia phase?
Do not follow logical pattern. Different sizes and shapes
38
What does dysplasia mean?
Abnormal size and shape of cells
39
Another name for Cancer in situ?
CIS
40
When cells are in situ neoplasm, what do they look like?
Very large irregular cells that have started to have finger like projections, but have not turned to cancer yet (may have a couple of cancer cells, but have not passed any barriers yet)
41
What do cells in an invasive neoplasm look like?
Rapid growth of disorganized cells that will spread
| Has crossed barrier
42
Sequence of cellular and tissue changes progressing from normal cells to an invasive neoplasm:
Normal cells
Dysplasia
In situ neoplasm (CIS)
Invasive neoplasm
43
During transformation of cancer cells, what does autonomy mean?
A cell that is independent from the normal cells around them
44
During transformation of cancer cells, what does anaplasia mean?
Over time, the cells lose their differentiation and don’t have clear lines from other cells
45
During transformation of cancer cells, what is pleomorphic?
A type of anaplasia
| The cells’ size and shape has variation and they don’t look like each other
46
What is a major hallmark of a cancer cell?
Tumor markers
47
What are tumor markers?
Substances produced by cancer cells
48
Where are tumor markers found?
On plasma cell membranes, in the blood, CSF, or urine
49
Types of tumor markers
```
Hormones
Enzymes
Genes
Antigens
Antibodies
```
50
What are tumor markers used for?
- Where the cancer originated and how to go about treating it
- Screen and identify individuals at high risk
- Follow the clinical course of cancer
51
What causes tumor markers?
Movement and uncontrollable growth of cells
52
What is it important to remember when a tumor marker is found?
Nonmalignant tumors also produce tumor markers
| So must go to area and do diagnostic testing to determine if tumor is cancerous
53
What is cancer predominantly a disease of?
Aging
| The older your cells are, the higher probably that they will proliferate
54
*What is the first thing that happens when cancer develops
Cell proliferation or expansion (dysplasia)
55
As a result of a mutation, what are cancer cells able to do?
They become autonomous and can act however they want to (this gives them an advantage over other cells)
56
What do cancer cells act like that gives them an advantage over other cells?
Increased growth rate
| Decreased apoptosis
57
What occurs to take care of the new cancer cells that grow?
Angiogenesis
58
What is angiogenesis?
Growth of new vessels around cancer cells to supply them
59
What do advanced cancers secrete?
Angiogenic factors
60
What do tumors release?
Chemotactic factors
Enzymes (tumor markers)
Tumor angiogenic factors
61
What are the six hallmarks of cancer?
```
Autonomous
Not sensitive to signals of normal cells
Do not die like normal cells
Grow as fast and as big as they want
Ability to feed themselves (b/c of vessel growth)
Metastasis
```
62
What are predator viruses?
Viruses that come when you have a weakened immune system (because of cancer)
63
Predator virus associated with HIV
Kaposi’s Sarcoma Herpesvirus (KSHV)
64
What is KSHV?
Cancer associated with pts who have long term, untreated HIV (predominantly in the lungs)
65
Bacteria associated with bacterial cause of cancer
Helicobacter pylori
66
Chronic infections helicobacter pylori is associated with
Peptic ulcer disease
Stomach carcinoma
Lymphomas
67
How are these infections caused by helicobacter pylori caused?
Overgrowth of the helicobacter pylori, caused by the cancer
68
What does local spread of tumor mean?
Direct invasion of contiguous organs (organs surrounding the tumor)
69
How do tumors metastasize in distant organs?
Through lymphatics and blood
70
How do tumors metastasize by way of implantation?
During surgery to remove tumor
| Either borders were not clear upon removal, or cancer cells were dropped into different area during surgery
71
What are the phases of tumor spread?
Transformation
Growth
Local invasion
Distant metastasis
72
What is the transformation phase of tumor spread?
Cell growth that is so rapid, they grow to adjacent tissue, but not through the border
73
What is the growth phase of tumor spread?
Rapid spread
74
What is the local invasion phase of tumor spread?
Invades nearby organs and tissue
75
What is the distant metastasis phase of tumor spread?
Cells jump into other organs that are not near by where the cancer originated
76
Which phase of tumor spread is when most cancers are caught? And why?
Distant metastasis
| Because it finally shows up in predominant organ
77
*What is tumor spread dependent on?
Rate of growth
Degree of differentiation
Presence or absence of an atomic barriers
Various biologic factors
78
What is the prerequisite for metastasis?
Local spread (invasion) - must come first
79
First stage of the metastatic process?
Local spread (invasion)
80
What are the mechanisms of local spread?
Cellular multiplication
Mitotic rate vs cellular death rate
Mechanical pressure
Release of lyric enzymes (when they do die)
Decreased cell-to-cell adhesion
Increased motility of individual tumor cells
81
How are patterns of tumor spread staged?
Size of the tumor
Degree of local invasion
Extent of metastasis
Tumor staging by TNM system
82
How do doctors determine the size of the tumor?
* CT scan
Ultrasound
Biopsy
Sometimes MRIs
83
When tumor spread is documented, what 4 things should be documented?
Size of tumor
Is it in local region?
How much has it spread throughout body?
Tumor staging by TNM system
84
Stages of metastasis of cancer from primary site to distant site
```
Direct or continuous extension
Penetration into lymphatics, blood vessels, or body cavities
Transport into lymph or blood
Transport to secondary sites
Entry and growth in secondary sites
```
85
Where does metastasis often occur first?
In the capillary bed encountered by circulating cells
86
Major organs that distant metastases occur
Lungs
Brain
Liver
Bone
87
Why doesn’t distant metastases occur in kidneys?
Because this is the last place waste is transported to, and it has already clung onto a different organ before it gets to that point
88
If a patient has breast cancer and has cancer in their axillary lymph nodes, is that local or distant metastases?
Local but is called metastases to distant organs because it traveled through lymphatics or blood
89
Steps of metastasis
```
Primary tumor
Proliferation / angiogenesis
Detachment / invasion
Embolism / circulation
Transport
Arrest in organs (this is where it has spread to)
Adherence to vessel wall
Extravasating
Establishment of micro environment
Proliferation / angiogenesis in new site
Metastasis in new site
```
90
Most common environmental risk factor of cancer
Tobacco
91
What is another important environmental risk factor of cancer?
Obesity
92
Cancer risk factors that are related to diet (biologic - endocrine)?
Hyperinsulinemia
Excessive weight
Increased triglyceride levels
Low physical activity
93
Organs cancer associated with diet (biologic - endocrine) are correlated to
Colon
Breast
Pancreatic
Endometrial
94
Where does cancer occur that is related to endogenous hormones?
Adipose tissue - releasing fatty acids
95
Environmental risk factors of cancer
```
Tobacco
Obesity
Alcohol consumption
Sexual behavior
Physical activity
Occupational hazards
Air pollution
```
96
Clinical manifestations of cancer
```
Pain
Fatigue
Anemia
Leukopenia and thrombocytopenia
Infection
Cachexia
```
97
Most frequently reported symptom of cancer
Fatigue
98
What is pain with cancer influenced by?
```
Fear
Anxiety
Sleep loss
Fatigue
Physical deterioration
```
99
Why is anemia commonly associated with malignancy?
The tumors need to be fed with extra blood
100
Causes of anemia
Chronic bleeding (iron deficiency)
Severe malnutrition
Medical therapies
Malignancy of blood-forming organs
101
What is leukopenia and thrombocytopenia?
Direct tumor invasion of bone marrow
| This symptom only occurs when bone marrow is involved
102
What are the causes of leukopenia and thrombocytopenia?
Direct tumor invasion of bone marrow
Chemotherapeutic agents
Radiation therapy
103
Most significant cause of complications and death with cancer and why?
Infection
| Because immunity is so damaged
104
What clinical manifestation comes along before first sign of cancer?
Paraneoplastic syndromes
105
Most severe form of malnutrition (spelling)
Cachexia
106
What is Cachexia?
Most severe form of malnutrition seen in later stages of cancer
107
Clinical manifestations of Cachexia
```
Anorexia
Early satiety (full after 1-2 bites)
Weight loss
Anemia
Athenia (numbness and tingling)
Poor performance
Taste alterations
Altered metabolic levels (protein, lipid, and extreme carb metabolism)
```
108
What are the side effects of cancer treatment related to?
Depends what kind of treatment they’re having and where the cancer is
109
Side effects of cancer treatment in GI tract
Results in decreased cell turnover
| Oral ulcers, malabsorption, fowl smelling diarrhea - from radiation
110
Side effects of cancer treatment in bone marrow
Suppression, pancytopenia
111
Side effects of hair and skin during cancer treatment
Alopecia
Skin breakdown and dryness
(From radiation and chemotherapy)
112
Side effects of cancer treatment in reproductive tract
Sterility
Decreased fertility
Premature menopause
113
Side effect of cancer treatment in any area of the body
Very weak immunity
