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Pathology > Neoplasia 2 h/o > Flashcards

Neoplasia 2 h/o Flashcards

1
Q

BRCA-1 and 2 are caretaker genes, what does this mean?

A

Caretaker genes

-affect genetic instability and DNA repair

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2
Q

How do follicular B cell lymphomas avoid apoptosis?

A

Fusion of the Bcl-2 gene from chromosome 18 to the active IgH locus on chromosome 14 leads to overproduction of Bcl-2 (anti-apoptotic protein)

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3
Q

How does follicular lymphoma generally present in patients?

A
  • Very slowly developing enlargement of lymph nodes
  • Not painful
  • Avg patient age is 60
  • No treatment
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4
Q

What two factors normally inhibit angiogenesis?

A
  • Thrombospondin-1 (induced by p53)

- VHL (Von Hippel Lindau): destroys HIF-1, preventing the formation of VEGF

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5
Q

What factors play a role in the angiogenic switch?

A
  • HIF-1 alpha
  • basic FGF
  • loss of p53
  • decreased thrombomodulin-1
  • overcoming anti-angiogenic factors (angiostatin,endostatin, vasculostatin)
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6
Q

What is the function of the drug Bevacizumab?

A

Anti-VEGF agent used in tumor suppression

-only mildly helpful in most cases

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7
Q

T/F sustained angiogenesis is essential for tumors to grow larger than 2 mm, but inhibiting this has limited efficacy in controlling cancer

A

True

-a million tiny foci of cancer (<2mm) can have lethal effect without sustained angiogenesis

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8
Q

What are the steps of invasion by malignancy?

A

1) Detachment of tumor cells from each other (due to downregulation of E-Cadherin or mutated Catenin)
2) Degradation of basement membrane and E.C. matrix (MMPs)
3) Attachment of tumor cells to exposed basement membrane components (mediated by laminin & fibronectin receptors)
4) Migration of escaped malignant tumors through interstitium (autocrine motility factor)

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9
Q

What is the metastatic trend for colon cancer (where does it travel)?

A

Colon –> Lymph nodes –> liver

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10
Q

Where do prostate and breast cancers normally metastasize to?

A

breast/prostate–> lymph nodes –> bone

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11
Q

Why do cancers have normal metastatic pathways?

A

Combination of drainage pathway and organ differences (some organs have different endothelial cell ligands expressed for adhesion molecules, etc)

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12
Q

Where can tumor cells travel when they invade veins and what life-threatening condition can they cause?

A
  • Pass through right heart and go to lungs
  • Tumor embolus gets stuck and clot formation obstructs small pulmonary blood vessels
  • leads to pulmonary hypertension and right heart failure
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13
Q

What does a carcinogenic initiator do?

A

Causes a pre-cancer mutation

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14
Q

What does a carcinogenic promoter do?

A

Causes proliferation of initiated cells

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15
Q

What’s an example of a direct chemical carcinogen?

A

Few examples, mainly reactive electrophiles

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16
Q

How do indirect chemical carcinogens function?

A

require metabolic activation of pro-carcinogen

-this is commonly done by CYP40 Monoxygenases

17
Q

What are some examples of indirect chemical carcinogens?

A

Estrogen, alcohol, anti-cancer chemotherapy agents

18
Q

How does obesity increase a patient’s risk for breast cancer?

A

Fat cells make estrogen, a pro-carcinogen

19
Q

What can radiation therapy cause?

A

Sarcoma development

20
Q

What type of cancer does nuclear power plant leaks commonly cause?

A

Thyroid cancer

21
Q

What kinds of cancer does HPV cause?

A

Uterine cancer, cancers of the mouth and upper respiratory tract

22
Q

What kind of cancer do Hep C and Hep B cause

A

Liver cancer

23
Q

What cancer does Epstein Barr virus cause?

A

Lymphoma (in immunocompromised patients)

24
Q

What cancers can Helicobactor pylori cause?

A

Lymphoma, gastric carcinoma

25
Q

T/F Development of a vaccine against HPV has made it possible to prevent many cancers of the uterine cervix

A

True

26
Q

What is the principle effector mechanism by which the immune system scans for tumors?

A

CD8 cytotoxic lymphocytes recognize tumor antigens

-NK cells, macrophages and antibodies also play a role

27
Q

What are a few way in which tumor cells can resist immune surveillance?

A

Decreased expression of MHC molecules, lack of co-stimulation, antigen masking

  • Tumors can also induce TGF beta, which is a potent immunosuppressant.
  • tumor cells can activate Tregs to suppress immune response
  • Some tumors express FasL which can engage Fas on immune cells and induce apoptosis in the immune cell
28
Q

What is a paraneoplastic syndrome?

A

symptoms not attributable to direct effects of tumor are called paraneoplastic
-most common is hypercalcemia (due to release of parathyroid hormone-related protein from tumor)

29
Q

What is Cachexia?

A

Catabolic state of severe wasting mediated by tumor necrosis factor
-cancer is the most common cause

30
Q

What type of lung cancer most commonly causes hypercalcemia?

A

Squamous cell carcinoma

31
Q

Is hypercalcemia a complication of malignancy?

A

Yes,

common symptoms are nausea, vomiting, altered mental status

32
Q

What is a common cause of Cushing syndrome?

A

Pituitary adenomas
-overproduction of ACTH causes adrenals to constantly make cortisol. This causes weight gain, central obesity, moon face, weakness, hypertension…et al

33
Q

T/F cancer causes a hypocoagulable state

A

False, cancer causes a hypERcoagulable state

34
Q

What is tumor stage?

A

Anatomical extent of a tumor

  • primary tumor size, extent of lymph node and distant metastases
  • Radiologist thing
35
Q

What’s tumor grade?

A

Qualitative assessment of tumor differentiation

  • How bad does it look in comparison to normal tissue
  • Pathologist thing
36
Q

Does tumor stage or grade carry more weight in a prognosis?

A

Tumor stage carries far more prognosis than grade

Pathology (4 decks)

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