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
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
3
Q
most common cancer in men
A
Prostate cancer
4
Q
most common cancer in women
A
Breast cancer
5
Q
2nd and 3rd most common cancer in both sexes
A
- 2nd= lung cancer
- 3rd= colorectal cancer
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
7
Q
Two types of genes involved in the cellular growth process
A
- Genes that are needed for the normal functioning of the cell
- Genes that determine the differentiating characteristics of the particular cell type
8
Q
Cell Cycle
A
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.
10
Q
Types of cellular adaptations chart
A
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
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
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
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
15
Q
Neoplasia
A
- Abnormal tissue that forms tumors (neoplasms)
- Loss of differentiation and reversion to a more primitive form and is IRREVERSIBLE
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
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
18
Q
Malignant neoplasms
A
- less differentiated and have the lost the ability to control both cell differentiation and proliferation
19
Q
Cell Proliferation
A
- Cell division
- Adaptive response for when cells old cells need replacement or when more cell are needed
20
Q
In all neoplasms, the genetic changes that allow excessive and uncontrolled proliferation is..?
A
- unregulated by the normal growth stimuli
21
Q
Cell Differentiation
A
- The process of specialization whereby new cells acquire the specific structural and functional characteristics of the cells they replace
22
Q
Cell differentiation in benign neoplasms
A
- composed of well differentiated cells
23
Q
Cell differentiation in malignant neoplasms
A
- less differentiated or undifferentiated
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
25
Q
Benign tumor example
A
- Spherical
- Compresses/pushes normal structures
- Well-organized capsule
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
27
Q
Progression of Malignancy
A
- invasion
- metastasis
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
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
- Fecal occult blood test
71
Q
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