Neoplasia 3-6 Flashcards
1
Q
Characteristics of Malignant neoplasms`
The major characteristics that are:
____________
____________
___________
________
A
Lack or loss of differentiation (anaplasia) High rate of growth
Invasiveness
Metastasis
2
Q
Characteristics of Malignant neoplasms: Differentiation/Anaplasia
Undifferentiated tumours exhibit features of ______ i.e lack of differentiation
A
anaplasia
3
Q
Differentiation is defined as the extent to which ______________________
A
parenchyma cells of tumours resemble comparable normal cells
4
Q
_______ is the hall mark of malignant transformation histologically
A
Anaplasia
5
Q
Level of differentiation is used to grade tumours histologically into __________
A
well, moderate or poorly differentiated
6
Q
Tumours that resemble cell of origin are _____ differentiated and vice versa
A
well
7
Q
Functional differentiation
The ability of tumours to _______________
A
retain the function of the cell of origin refers to functional differentiation
8
Q
___ differentiated tumours retain their functions while _____ tumours do not often retain any function
A
Well
anaplastic
9
Q
Well differentiated Squamous Cell Carcinoma produces _____
Well diff. adenocarcinoma produces _______
Well-differentiated Hepatocellular Carcinoma produces _____
A
keratin; glands/mucin
bile
10
Q
Functional Differentiation
Sometimes, unanticipated functions emerge
E.g some produce fetal proteins,
Others produce ectopic hormones leading to _________.
e.g bronchogenic CA producing ACTH,PTH etc
A
paraneoplastic syndrome
11
Q
Histologic Characteristics of malignant cells
Pleomorphism-cells of ___________
____chromatism
___eased nucleocytoplasmic ratio
________ chromatin
A
different sizes & shapes
Hyper
Incr
Coarsely clumped
12
Q
Histologic Characteristics of malignant cells
( small or Large?) , multiple, prominent nucleoli
__________ mitoses
Presence of tumours ____ cells
Disorderliness or markedly disturbed orientation
A
Large
Numerous, bizarre
giant
13
Q
Characteristics of Malignant tumours: High rate of growth
Certain factors are known to determine the growth rate:
_________
_______
___________
A
Blood supply
Hormone dependence
Level of differentiation
14
Q
Malignant tumours grow more (slowly or rapidly?) while benign tumours grow more (slowly or rapidly ?)
A
Rapidly; slowly
15
Q
Malignant tumours grow to progressively ______ surrounding tissue
A
invade
16
Q
Characteristics of tumours: Local invasion
Invasion starts from _____ of the ______ to involve the _____
A
penetration
basement membrane
stroma
17
Q
Most benign tumours are encapsulated
T/F
A
T
Exception; haemangioma
18
Q
Mention a benign tumor that isn’t encapsulated
A
Hemangioma
19
Q
Some malignant tumours may have pseudocapsule
T/F
A
T
20
Q
Examples of malignant tumours that may have pseudocapsule
A
Wilm’s tumours
21
Q
Characteristics of Malignant tumours: Metastasis
Metastasis refers to _____ of tumor cells _________________
A
spread
from the primary site to form tumour implants at distant site.
22
Q
Metastasis is an important hallmark of malignancy
T/F
A
T
23
Q
Some malignant tumours do not metastasis
T/F
A
T
24
Q
Examples of malignant tumors that don’t metastasize
A
Examples are:
basal cell Carcinoma of skin,
malignant glial tumours of the brain
25
Characteristics of Malignant tumours: Metastasis
The major routes of metastasis are:
_______
________
__________
Blood vessel
Lymphatics
Body cavities-
26
Which organ is metastasis rare in?
Spleen
27
Metastatic cascade refers to the __________ that tumour cells takes to ________
sequential steps
spread from the primary site to form new growth at distant site
28
all cells within the tumour bulk spread to distant sites
T/F
F
Not all cells within the tumour bulk can spread to distant sites
29
Metastatic cascade is broadly divided into three major stages:
_________
___________
_________
Invasion Intravasation Extravasation
30
Mechanism of metastasis
Stages of emigration from primary tumour to other sites include:
Loss of ability to ______
Increase ability to adhere to the __________
_________ of ECM
________through the ECM
The cells form aggregates (homo-or heterotypic) within vessels & migrate through BM
Form tumour emboli at secondary sites
adhere to each otherget detached
Basement membrane & Extracellular
matrix(ECM)
Degradation
Migration
31
Grading of Malignant tumours
Grading: Refers to level of ________ of tumour cells to normal similar cell of origin
microscopic resemblance
32
_____ differentiated tumour closely resembles cell of origin while _____ differentiated tumour do not have any resemblance
Well
poorly
33
Same grading system is used for different tumours
T/F
F
Different
34
Level of differentiation correlates with _____ but does not always correlate with ________
aggressiveness
biologic behaviour
35
Grading is based on ______ assessment of the tumour.
histological
36
Examples of grading
prostatic cancer is graded using _______ system,
squamous cell carcinoma of cervix using _______________
Gleason’s
extent of keratin formation
37
Grades 1-IV is used with increasing _____ or decreasing ________
anaplasia
level of differentiation
38
Grading of tumours
Grade1- ?
Grade 2
Grade 3
Grade 4
Well differentiated
Moderately differentiated
Poorly differentiated
Nearly anaplastic
39
Gleasons’s pattern scale
Should I?
Maybe?
If I see it in PQ
40
Staging of Malignant tumours
Staging is defined as the extent of ________.
tumour spread
41
Staging of Malignant tumours
It is based on 3 parameters:
____ of primary tumour,
+/- _______,
+/- _________
size
lymph node
distant blood borne metastasis
42
Staging of Malignant tumours
2 systems are used _____ and ______.
TNM and AJC
43
TNM staging system
u T- _____
u N- ____,
u M- ______.
tumour size
node
metastasis
44
AJC grading system
American Joint Committee on Cancer staging system is of clinical importance.
T/F
T
45
AJC grading system
______________
American Joint Committee
46
I-IV grading system incorporates all 3 parameters
T/F
T
47
Staging-Tumour size
Tis- Carcinoma ___, tumour is _______
1- (Small or large?) , _________ (within or beyond?) primary organ site
2- (Smaller or Larger?) , (more or less?) invasive (within or beyond?) the primary organ site
3- (Smaller or Larger?) and/or invasive (within or beyond?) margins of primary organ site
4- Very ____ and/or very ____, spread to _________
in-situ; limited to the epithelium
Small; minimally invasive ; within
Larger; more; within
Larger ; beyond
large; invasive; adjacent organs
48
Staging-Nodal spread
No- ___ lymph node involvement
N1- _____ lymph node involvement
N2- ____ regional lymph node involvement
N3- ______ lymph node
involvement
No
Regional
Extensive
More distant
49
Staging-distant metastasis
Mo- ____ distant metastasis
M1 - ______ Distant metastasis
No
Presence of
50
The stages of breast cancer
0- abnormal cells are (present or absent ?) but ____________________
1- early stage: cancer has _____________ in (small or large?) area
2-localized: tumor is between __-__mm and ____ lymph nodes are involved or a tumor __________ mm with ___ lymph nodes involved
3- regional spread: Timor is __________mm with more lymph nodes involved across a (narrower or wider?) region. In some cases, cancer may have spread to skin or chest wall
4- distant spread: cancer has ____________
Present; have not spread to nearby tissue
spread to other tissue ; small
20-50; some; larger fhan 50; no
larger than 50; wider
spread beyond the breast to other parts of the body
51
Carcinogenesis
Refers to the process of _________ of normal cells by _______ agents
malignant transformation
carcinogenic
52
Carcinogenic agents are classified into:
u ______
u ______
u ______
physical
chemical
microbiologic
53
Physical carcinogenic agents
Examples of physical carcinogens are
______,_______,______,______,______
ionising radiation, X-ray, radiotherapy, Ultraviolet light, atomic energy
54
Physical carcinogenic agents
Effect: _______ changes in cell-mutation
chromosomal
55
Physical carcinogenic agents
Examples of tumours in this category
_________ Ca
_______carcinoma
_______ cell carcinoma, all of the skin
________
________ Cancer
_______ Cancer
Basal cell
melano
squamous
Leukeamia
Thyroid
Breast
56
Chemical carcinogens/promoters
Direct acting- have _____ region which easily forms ____ bond with DNA
e.g _____ agents (anticancer drugs such as _________,_________ ,_______)
electrophylic; covalent
alkylating; cyclophosphamide, chlorambucil, nitrosourea
57
Chemical carcinogens/promoters
Indirect acting- have to be converted to _________ in the ______
e.g___________ in cigarette, _________ in anyline dye
active metabolite in the liver
polycyclic hydocarbon
beta naphthylamine
58
Chemical promoters
Promoters- they ________________________________
e.g ____
Act in conjunction with carcinogenic agents to promote cellular transformation
aflatoxin B1
59
Chemical carcinogenesis goes through 3 steps:
Initiation- exposure- _________ followed by a ________ to __________ initiated cell
Promotion- initiated cell is encouraged to _________________
Effect- ______,_____, or _____
DNA alteration ; round of mitosis; fix the change
proliferate at the expense of the normal cell
transformation (progression), dormancy or regression.
60
Microbiologic agents of cancer
DNA viruses-form ______ with ________ leading to _______ and then ______
e.g;
Human papilloma virus - ______
hepatitis B virus - ______,
Epstein Barr virus - _______ and ____
stable association; host genome
integration
mutation
Ca cervix; liver Ca; nasopharyngeal Ca and Burkitt lymphoma
61
Microbiologic agents of cancer
RNAviruses- e.g HTLV-1. Has ___ gene which leads to _____________ and then transformation causing _________
Others;
schistosoma haematobium - ________
liver fluke - ____________.
Herpes simplex- _________
tax
replication of T-cell- mutation
T cell leukaemia
bladder Ca
cholangiocarcinoma
Kaposi sarcoma
62
Molecular basis of carcinogenesis
u Tumours are “___clonal”
mono
63
Tumors are monoclonal
This implies that a tumour mass results from _______ of a _________ that has incurred genetic change referred to as mutation
clonal expansion
single progenitor cell
64
Multiple mutations leads to ____ tumours
malignant
65
4 major classes of genes are involved
These are the targets of mutation and include:
_______
_______
_______
_________
Tumour promoter,
Tumour suppressor
Apoptotic genes and
DNA repair genes
66
Molecular basis of carcinogenesis
Proto-oncogens are abnormal constituents of the cell that promote abnormal cell growth and differentiation
T/F
F
Normal
Normal
67
Oncogens are ______ that can ___________
They are derived from ______
gene sequences
transform normal cell to cancer cell.
proto-oncogens
68
Oncogens produce ______ –e.g. growth factors, membrane products and enzymes which resemble normal proteins that control growth and
differentiation
oncoproteins
69
Tumour promoter/activating gene
Behavior (Dominant or recessive?) )
What does that mean?
Dominant
only one mutant allele of the gene need be present to cause transformation.
70
The genetic mechanisms that convert proto-oncogens to oncogens are:
_____ mutation- e.g. ___ oncogen
________-e.g c- ____ , c- ____
Gene ______- N-_____, c-___
Point; ras
Translocation; myc; abl
amplification; myc; erb
71
Gene translocation
c- myc in _______ [from chromosome ___ to ___]
c-abl in _____________ (from chromosome __ to ___]
Burkitt lymphoma; 814
Chronic myeloid leukaemia ; 922
72
Gene amplification
N-myc amplification in _________, and c-erb in ____
neuroblastoma
breast cancer
73
Tumour supressor genes Also referred to as ______
antioncogens
74
Tumor suppressor genes
Behaviour (Dominant or Recessive?)-
And what does that mean?
Recessive
The 2 alleles of the gene must be damaged to transform cells
75
Tumor suppressor genes
Examples are
___gene- in Retinoblastoma
___ gene –in colon cancer and several other cancers
____ gene-in colon cancer
___,_____ gene- neurofibrosarcoma
___,____ gene- in breast cancer
_____ genes -nephroblastoma
Rb
P53
APC
NF-1, NF-2
BRCA-1, BRCA-2
WT-1
76
Abnormality in suppressor gene is either ______ or ———-
deletion or inhibition
77
Apoptotic genes
(Dominant or recessive?)
may be dominant or recessive.
78
Examples of apoptotic genes
______ gene in B cell lymphoma
_____
c- _____
bcl –2
p53
myc
79
deletion of apoptotic gene will _________ of the mutant cell, ______ its survival and thus allowed to _______ leading to tumours
prevent programmed death
Extends
proliferate
80
DNA repair genes
These are genes that affect the ______________________ including the ______,_________, and ________.
ability of the body to repair non-lethal damage to other genes
proto-oncogens, tumour suppressor genes and apoptotic genes
81
Inability to repair genes lead to ______ in the genome that leads to _____ transformation.
mutations
neoplastic
82
Behaviour of DNA repair genes is Dominant or Recessive?
What does that mean?
Recessive
both alleles must be lost to induce genomic instability,
83
DNA repair genes may be considered as tumour suppressor genes
T/F
T
84
DNA repair genes are called ‘______ genes’.
caretaker
85
Inactivation of dna repair genes results in tumour directly
F
does not result in tumor directly but increased mutation of all other genes including those that control cell division
86
DNA repair genes
_____,_____ mutation in HNPCC syndrome(hereditary non- polyposis colon cancer)
____,_____ genes in breast cancer
MLH1, MSH2
BRCA-1, BRCA-2
87
HNPCC syndrome( ____________________)
hereditary non- polyposis colon cancer
88
Effects of malignant tumour on the host
___________ effects e.g pituitary adenoma
Functional activity e.g insulinoma
________
Secondary ______
_______/_____
Cancer cachexia-due to effect of _____ (Wt. Loss+anaemia+ anorexia+ weakness)
_________ syndrome
Local pressure
Harmorrhage
Infarction; rupture
cytokines
Paraneoplastic
89
Paraneoplastic syndrome
Refers to symptom complex that occurs in cancer patient that can be explained by local or distant spread of the tumour.
T/F
F
It can’t
90
Importance of paraneoplastic syndrome are:
1) They may represent the ______ of ________ malignancy
2)May represent a significant clinical problems that may be _____
3)May mimic ____ disease and therefore complicate clinical management
earliest manifestation; an occult
lethal
metastatic
91
Classification of paraneoplastic syndromes
_______
_______
_________
_________
__________
Endocrinopathies
Dermatological
Nerve and muscle
Bone and joint
Vascular/heamatological
92
Paraneoolastic syndrome
_________- small cell Ca of the lung, pancreatic ca, neural tumours (___-like subst)
_______-small cell Ca, intracranial tumours (Inapp.___ secretion)
_______–fibrosarcoma, Hepatocellular cancer(_____-like subst)
Cushing syndrome; ACTH
Hyponatrimia; ADH
Hypoglyceamia; insulin
93
Tumour Markers
Are biochemical indicators of tumour presence, either __________ in excess or _____________
Produced by the tumour cells
overexpressed or produced in response to the tumour
94
Tumor markers
Levels increase with _______ and highest with ______
tumour progression
metastasis
95
Classification of tumour markers
Tumour markers found _________
Tumour markers found ______
in blood or other body fluids
on tumour cells
96
Tumour markers-in blood & body fluids
u Oncofetal antigens u Hormones
u Specific proteins
u Isoenzymes
u Glycoproteins
Just see the list
97
Classification of Tumour markers
Oncofetal antigens
These antigens are _____ in tumours and are normally expressed _________
re-expressed
during fetal development,
98
Oncofetal antigens
Examples are:
u ____________-Hepatocellular carcinoma, Non seminomatous germ cell tumour of testes
u ____________-Ca pancreas, colon, stomach, lung, breast
Alpha feto-protein(AFP)
Carcinoembryonic antigen(CEA)
99
Tumour markers- Specific proteins
u ___________ in multiple myeloma, other gammopathies
u _____________ in Ca prostate
Beta 2 microglobulin
PSA (prostate specific antigen)
100
Isoenzymes
________-prostate cancer
________- lung cancer and neuroblastoma
Prostatic acid PO4
Neuron specific enolase
101
Glycoprotein/mucin
CA-125- in ______ cancer
CA-15-3 – in ____ cancer
CA-19-9- in _______ cancers
ovarian
breast
colon and pancreatic
102
Tumour markers found on tumour cells
uBRAF, KRAS, EGFR - in _____ cancer
uER/PR, HER-2NEU- _____ cancer
colon
Breast
103
Treatment of cancer
________
————-
____therapy
______therapy
Surgery
Radiation
Chemo
Immuno
104
Treatment of tumor
Radiation: effectiveness depends on _________ and ___________
how radiosensitive the tumour is
the body’s ability to tolerate the dose without serious effect.
105
Treatment of tumor
Chemotherapy: effectiveness depends upon the __________________
ability of the drug to selectively kill the tumour cells and not normal cells.
106
Prevention of cancer
This can be divided into 3 steps:
Primary-____________
Secondary -_______,______
Tertiary - _______,______
prevent exposure to risk factors
early detection, diagnosis
palliative -prompt treatment
107
Secondary prevention of breast cancer
1) _______ for every woman including young girls
2)_______ every _____ from age __-__
3)________ screening
4)______ scan
Breast self examination
clinical breast examination; 1-3years; 20-39
mammography
ultrasound
108
Cervical cancer Screening-
By _____
By _____ testing
By ____
Pap smear
HPV-DNA
VIA
109
VIA = _________
visual Inspection with acetic acid)
110
HPV-DNA testing
This is used for women above ______
Negative HPV-DNA testing can be repeated after ____yrs
30yrs
5-10
111
Positive HPV-DNA testing is final
T/F
F
It can be further investigated
112
HPV vaccine options
List 3 drugs
Cervarix
Gardasil
Gardasil-9
113
Who is it for , how many doses, what infections does it prevent
Cervarix
Gardasil
Gardasil-9
Girls 9-26;3; 16 and 18
Girls and boys 9-26;3 ; 6,11,16,18
Girls 9-26, boys 9-15;3; 6,11,16,18,33, 31,45,52, 58
114
Screening for Prostate cancer
__________
_____________ test
Digital rectal exam (DRE)
Prostate specific antigen (PSA)
115
Screening for Prostate cancer
Digital rectal exam (DRE):
Examination of the _____ through the ____ to estimate the ____ and feel for _____ or other abnormalities.
prostate; anus
size; lumps
116
Screening for prostate cancer
Prostate specific antigen (PSA) test:
Measures the _______ in the blood.
levels of PSA in the blood can be higher in men who have _____
level of PSA
prostate cancer
117
PSA levels can not be higher in men with other conditions that affect the prostate besides prostate cancer
T/F
F
the level may also be elevated in other conditions that affect the prostate.
