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CLIN MED PA 581: HEME/ONC. EXAM 5 > Intro to Oncology > Flashcards

Intro to Oncology Flashcards

Objectives

1
Q

What is Cancer?

A
  • A disease of uncontrolled growth of abnormal cells in the body
  • A disease of aging
    • 70% of cancer cases occur >50
    • 65% of cancer deaths occur after 65
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2
Q

Cancer Incidence in 2018

A
  • 1.7 million new cases diagnosed
  • Lung, colorectal, breast, and prostate
    • 50 to 55% of all new cancers
    • 50% of cancer deaths
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3
Q

most common cancer in men

A

Prostate cancer

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4
Q

most common cancer in women

A

Breast cancer

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5
Q

2nd and 3rd most common cancer in both sexes

A
  • 2nd= lung cancer
  • 3rd= colorectal cancer
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6
Q

What is normal cellular growth

A
  • All growing cells go through a cycle, during which there are checkpoints – opportunities for growth/the cell cycle to be stopped if necessary
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7
Q

Two types of genes involved in the cellular growth process

A
  1. Genes that are needed for the normal functioning of the cell
  2. Genes that determine the differentiating characteristics of the particular cell type
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8
Q

Cell Cycle

A
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9
Q

What is a cellular adaptation?

A
  • Normal cellular adaptation occurs in response to a stimulus, or stress, and *usually* ceases once the need for adaptation has ceased.
    • Cells are able to adapt to increased work demands or threats to survival by changing their size, number, or sometimes function.
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10
Q

Types of cellular adaptations chart

A
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11
Q

Hypertrophy

A
  • Increase in cell size with an increase in the amount of function in tissue mass.
  • Is the result of an increased workload
  • Commonly in cardiac and skeletal muscles
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12
Q

Hyperplasia

A
  • Increase in the number of cells in an organ or tissue
  • Tissues that are capable of mitotic division
    • The epidermis, intestinal epithelium, and glandular tissue
  • Hormonal and compensatory
    • Breast and uterine enlargement due to pregnancy
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13
Q

Dysplasia

A
  • Faulty/abnormal cell formation in size, shape, or arrangement of cells.
  • REVERSIBLE change in mature cells to an atypical or disorderly appearance
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14
Q

Metaplasia

A
  • Change of cells from a normal type for a certain tissue to that of an abnormal type
  • Could develop into cancer
  • Metaplasia is a REVERSIBLE change of one mature cell type to another cell type
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15
Q

Neoplasia

A
  • Abnormal tissue that forms tumors (neoplasms)
    • Loss of differentiation and reversion to a more primitive form and is IRREVERSIBLE
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16
Q

How does neoplasia differ from normal cellular growth

A
  • Neoplasias lack the normal regulatory control over cell growth and division
    • Neoplasms are classified into benign and malignant
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17
Q

benign neoplasms

A
  • composed of well-differentiated cells that retain original structure and function but have lost the ability to control cell proliferation
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18
Q

Malignant neoplasms

A
  • less differentiated and have the lost the ability to control both cell differentiation and proliferation
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19
Q

Cell Proliferation

A
  • Cell division
  • Adaptive response for when cells old cells need replacement or when more cell are needed
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20
Q

In all neoplasms, the genetic changes that allow excessive and uncontrolled proliferation is..?

A
  • unregulated by the normal growth stimuli
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21
Q

Cell Differentiation

A
  • The process of specialization whereby new cells acquire the specific structural and functional characteristics of the cells they replace
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22
Q

Cell differentiation in benign neoplasms

A
  • composed of well differentiated cells
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23
Q

Cell differentiation in malignant neoplasms

A
  • less differentiated or undifferentiated
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24
Q

Benign neoplasm characteristics

A
  • Usually grow slowly but progressively
  • Well differentiated
  • Usually well-demarcated masses that do not invade
  • Do not metastasize
  • Usually non-life threatening
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25
Q

Benign tumor example

A
  • Spherical
  • Compresses/pushes normal structures
  • Well-organized capsule
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26
Q

Malignant tumor characteristics

A
  • Erratic rate of growth but tend to grow rapidly
  • Poorly differentiated or undifferentiated
  • Locally invasive/infiltrate surrounding tissues
  • Metastasizes
  • Great vascularity
  • High mitotic rate – cell production greater than cell loss
  • Atypical tissue structure / irregular in shape
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27
Q

Progression of Malignancy

A
  • invasion
  • metastasis
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28
Q

For invasion of tumor to occur

A
  • Cell adhesion to the basement membrane
  • Local proteolysis of the membrane
  • Movement of cell through the membrane
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29
Q

Metastasis occurs when

A
  • Cells gain access to circulation and repeat above at remote sites
  • Tumor cells then generate blood vessels to support local growth (angiogenesis)
30
Q

Metastatic cancer

A
  • development of a secondary tumor in a site distant from the primary location
  • Spreads by direct invasion, lymphatics, or bloodstream
  • Metastatic cancer has the same name and same type of cancer cells as the primary (original) cancer
    • ex: Colon cancer with metastatic liver disease
31
Q

Cancer as a Genetic Disease occurs via…

A
  • Alterations in specific genes causes unrestrained cellular growth
  • Damage to DNA can arise as result of:
    • Exposure to carcinogen
    • Exposure to certain viruses
    • Inherited damage (inherited allele)
    • Spontaneous errors
32
Q

Genes Associated with Cancer

A
  • Mutated proto-oncogenes, i.e. oncogenes
  • Mutated Tumor-suppressor genes
33
Q

Proto-oncogenes

A
  • Code for normal proteins involved in a cell’s normal growth control pathway
34
Q

Oncogenes

A
  • Arise from the mutation of proto-oncogenes
  • Oncogenes code for a mutated version and/or excessive quantities of various growth proteins
35
Q

causes of oncogenes

A
  • increased cell division
  • decreased cell differentiation
  • inhibition of cell death
  • cell’s growth pathway to become hyperactive
36
Q

Examples of Oncogenes Found in Cancer

A
37
Q

Tumor Suppressor Genes (TSG)

A
  • Normal cells have regulatory mechanisms that protect them against activated oncogenes
  • TSGs produce proteins that restrain cell growth and division
  • When TSGs are mutated/inactivated, the signal that usually inhibits cell proliferation is removed resulting in unregulated cell growth
  • Mutations in TSGs are generally recessive
38
Q

Hereditary Breast Cancer

A
  • Mutation in Breast Cancer Susceptibility Gene 1 or 2, which are TSGs
  • These mutations result in inc breast Cancer in females and males
    • BRCA-1
    • BRCA-2
39
Q

BRCA-1

A
  • maps to chromosome 17q21
    • inc in Ashkenazi Jewish women
    • inc risk of ovarian cancer in females and prostate cancer in males
40
Q

BRCA-2

A
  • on chromosome 13
41
Q

More hereditary cancer chart

A
42
Q

Non-genetic cancer risk factors

A
  • Tobacco products
  • Chemicals
    • Benzene, nickel, asbestos, petroleum products
  • Aging
  • Ultraviolet exposure
  • Ionizing radiation
  • Viral infections
  • Excessive Alcohol
  • Sedentary lifestyle, poor diet, obesity
43
Q

Tobacco as risk factor for cancer

A
  • The most common, preventable cause of cancer
  • ~ 30% of all cancer deaths in US are directly linked to tobacco
    • 171,000 deaths in US
    • 1.42 million deaths world wide
    • 85-90% of lung cancer cases occur in smokers
  • Tobacco smoke contains over 4000 chemicals
    • 70 of which are known carcinogens
44
Q

Ingredients in Cigarettes

A
45
Q

Tobacco causing cancer pathophys

A
  • Tobacco delivers carcinogens directly to the tissues >>Tissue exposure to carcinogens >>formation of covalent bonds between the carcinogens and DNA (DNA adduct formation) >>resulting accumulation of permanent mutations in critical genes
46
Q

cancers associated w/ tobacco

A
47
Q

radiation as risk factor for cancer

A
  • Ionizing radiation
    • Gamma rays, X-rays, CT scans
  • Nonionizing radiation
    • Microwaves, cell phones, UV light
48
Q

viral infection as a risk factor for cancer

A
  • Growing evidence that some cancers are associated with viral infection
    • Some viruses carry an oncogene and incorporate it into human DNA when the virus infects the cell
    • Some can turn on a human oncogene when the virus infects the cell
    • All oncogenic viruses have the ability to stimulate unlimited cell growth
49
Q

Oncogenic Viruses Examples

A
  • EBV
    • Burkitt’s lymphoma
  • HPV, types 16 and 18
    • cervical cancer
  • Hepatitis B and C
    • hepatic carcinoma
50
Q

For nonsmokers, the biggest modifiable risk factors are …?

A
  • are nutrition and physical activity
    • Decreased physical activity is associated with an increased risk of cancer
    • Obesity linked to breast, uterine, colon cancers
    • High intake of processed meat is associated with an increased risk of colon cancer
51
Q

Excess alcohol as risk factor for cancer

A
  • Linked to inc risk of
    • Head & neck cancers
    • Esophageal cancers
    • Liver cancers
52
Q

Physical activity associated with a decreased risk of

A
  • Breast cancer
  • Colon cancer
  • Prostate cancer
  • Endometrial cancer
53
Q

Diets high in fruits and veggies may decrease risk of

A
  • Esophageal cancer
  • Colon cancer
  • Stomach cancer
54
Q

Cancer Prevention Strategies

A
  • Detecting precancerous lesions
    • Ex: Routine Pap smears, mammograms
  • Modifying risk factors
    • Ex: Smoking cessation, moderation of alcohol intake, increase physical activity
  • Immunization
    • Ex: HPV vaccine (cervical cancer)
  • Chemoprophylaxis
    • Tamoxifen has been shown to reduce the incidence of breast CA by 50% in high-risk women
55
Q

Clinical manifestations of cancer result from

A
  • Pressure from local tumor growth
  • Infiltration or metastatic invasion of tumor cells in other organs
56
Q

Warning signs of cancer

A
  • Unusual bleeding or discharge
  • Thickening, swelling, or lump in the breast or elsewhere in the body
  • Persistent indigestion /difficulty swallowing
  • Obvious change in a skin lesion
  • Persistent new cough or hoarseness
  • Unexplained weight loss
  • New, persistent pain
  • Blood in the urine
  • Recurrent nausea & vomiting
  • Recurrent fevers
  • Enlarged lymph nodes
57
Q

Paraneoplastic Syndrome

A
  • another clinical manifestation of cancer caused by the presence of tumor cells in the body
    • Hormones or cytokines excreted by tumor cells exert unusual hormonal or metabolic effects
  • More common with cancers of the lung, breast, ovaries or lymphatic system
58
Q

Paraneoplastic effects of tumor are…

A
  • remote effects that are not related to the direct invasion, obstruction, or metastasis
    • Effects can be metabolic, hematologic, neurologic, etc
  • Divided into which system they effect
    • Effects/findings can appear similar to those of primary endocrine, hematologic, neurologic, or neuromuscular disorders
59
Q

Paraneoplastic Syndromes are clinically important b/c..

A
  • They may provide early clues to the presence of some cancers
  • The metabolic or toxic effects of the syndrome may create a more urgent situation than cancer itself
    • Hypercalcemia, hyponatremia
  • Once the tumor has been treated and resolved, the paraneoplastic syndrome resolves as well
    • Return of sxs may signify recurrence of the cancer
60
Q

Paraneoplastic Endocrine Syndromes

A
  • The tumor tissue itself secretes the hormone that produces the syndrome (ectopic hormone production)
    • Ectopic hormones are usually pro-hormones of higher molecular weight than those secreted by the normal, differentiated endocrine cell
    • Believed to result from activation of oncogenes in the tumor
61
Q

Types of Paraneoplastic Endocrine Syndromes

A
62
Q

Paraneoplastic Neurologic Syndromes

A
  • Paraneoplastic neurologic disorders occur in 2-3% of patients with small cell lung cancer
  • In 60% of patients the neurologic symptoms precede the cancer diagnosis
  • Most are induced by the patient’s immune system in response to the tumor
    • Immunologic response (antibodies, WBCs) directed against neuronal proteins/antigens that are expressed by the tumor, but antigens are also predominantly expressed by the nervous system
  • Antibodies may be detected in the CSF and serum
63
Q

Surgical Biopsy Cancer Dx

A
  • Requires surgery where an external incision is made and mass(es) or piece of mass is removed / organ or piece of organ could be removed
  • Fluid can also be aspirated for diagnostic purposes
  • Small amount of tissue may be left behind to monitor response to chemo, ex: lymphomas
64
Q

Needle Biopsy cancer Dx

A
  • Needle is injected into the area of concern for diagnosis
  • Several passes of needle is made into mass
  • Pathology is often on hand to give preliminary diagnosis
    • Ex: FNA (fine needle aspiration); core biopsy as in stereotactic breast biopsy, ultrasound/CT guided needle biopsy
65
Q

Endoscopic Biopsy with or without Ultrasound Dx of cancer

A
  • Endoscopy allows the direct visualization and biopsy of small masses/areas of concern, especially hard-to-reach/visualize organs like the pancreas
  • Fiberoptic scope and lens is used to directly view an organ
  • If a mass is visualized with the camera, ultrasound is used to guide fine needle aspiration/biopsy
  • Often done under sedation
  • No external incisions are made
66
Q

Types of Endoscopic Biopsy

A
  • colonoscopy
  • esophagogastroduodenoscopy
  • endoscopic retrograde cholangiopancreatography
  • endoscopic ultrasound
  • cystoscopy
  • colposcopy
  • bronchoscopy
67
Q

Frozen Section Biopsy cancer Dx

A
  • During surgery, a specimen/piece of tissue is removed, quick-frozen in a cryostat machine, cut by microtome, and stained immediately for examination by a pathologist
  • Takes less than 30 minutes
  • Allows for rapid diagnosis of possible malignant lesions during surgery
    • If the tissue is determined to be cancerous and is amenable to surgery, the mass can be removed at that time
    • If the tissue is determined to be benign, then the mass may not always need to be removed and the surgery can end
68
Q

Exfoliative Cytology Cancer Dx

A
  • Microscopic examination of cells desquamated from a body surface or lesion as a means of detecting malignancy and microbiologic changes, to measure hormonal levels, etc.
  • Such cells are obtained by aspiration, washing, scraping, brushing, etc
    • Ex: Pap Smear for cervical cancer/changes
69
Q

Bone Marrow Biopsy cancer Dx

A
  • Bone marrow biopsy provides a definitive diagnosis for hematologic malignancies
70
Q

Clinical Laboratory Tests for cancer Dx

A
  • The following may detect the possibility that a cancer is present:
    • Fecal occult blood test
      • Ex: Colorectal cancer
    • CBC (complete blood count) with Differential
      • Ex: Leukemia
    • Urinalysis
      • Ex: renal tubular epithelial casts, high amounts of protein
    • Serum protein electrophoresis
      • Ex: Bence Jones protein
    • Papanicolaou (Pap) test
      • Ex: Cervical cancer
71
Q
A

CLIN MED PA 581: HEME/ONC. EXAM 5 (1 decks)

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