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House AMP > Neoplasia 3-6 > Flashcards

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

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2
Q

Characteristics of Malignant neoplasms: Differentiation/Anaplasia

Undifferentiated tumours exhibit features of ______ i.e lack of differentiation

A

anaplasia

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3
Q

Differentiation is defined as the extent to which ______________________

A

parenchyma cells of tumours resemble comparable normal cells

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4
Q

_______ is the hall mark of malignant transformation histologically

A

Anaplasia

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5
Q

Level of differentiation is used to grade tumours histologically into __________

A

well, moderate or poorly differentiated

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6
Q

Tumours that resemble cell of origin are _____ differentiated and vice versa

A

well

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7
Q

Functional differentiation

The ability of tumours to _______________

A

retain the function of the cell of origin refers to functional differentiation

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8
Q

___ differentiated tumours retain their functions while _____ tumours do not often retain any function

A

Well

anaplastic

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9
Q

Well differentiated Squamous Cell Carcinoma produces _____

Well diff. adenocarcinoma produces _______

Well-differentiated Hepatocellular Carcinoma produces _____

A

keratin; glands/mucin

bile

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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

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11
Q

Histologic Characteristics of malignant cells

Pleomorphism-cells of ___________

____chromatism

___eased nucleocytoplasmic ratio

________ chromatin

A

different sizes & shapes

Hyper

Incr

Coarsely clumped

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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

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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

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14
Q

Malignant tumours grow more (slowly or rapidly?) while benign tumours grow more (slowly or rapidly ?)

A

Rapidly; slowly

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15
Q

Malignant tumours grow to progressively ______ surrounding tissue

A

invade

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16
Q

Characteristics of tumours: Local invasion

Invasion starts from _____ of the ______ to involve the _____

A

penetration

basement membrane

stroma

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17
Q

Most benign tumours are encapsulated

T/F

A

T

Exception; haemangioma

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18
Q

Mention a benign tumor that isn’t encapsulated

A

Hemangioma

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19
Q

Some malignant tumours may have pseudocapsule

T/F

A

T

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20
Q

Examples of malignant tumours that may have pseudocapsule

A

Wilm’s tumours

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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.

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22
Q

Metastasis is an important hallmark of malignancy

T/F

A

T

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23
Q

Some malignant tumours do not metastasis

T/F

A

T

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24
Q

Examples of malignant tumors that don’t metastasize

A

Examples are:
basal cell Carcinoma of skin,
malignant glial tumours of the brain

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25
Q

Characteristics of Malignant tumours: Metastasis

The major routes of metastasis are:
_______
________
__________

A

Blood vessel
Lymphatics
Body cavities-

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26
Q

Which organ is metastasis rare in?

A

Spleen

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27
Q

Metastatic cascade refers to the __________ that tumour cells takes to ________

A

sequential steps

spread from the primary site to form new growth at distant site

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28
Q

all cells within the tumour bulk spread to distant sites

T/F

A

F

Not all cells within the tumour bulk can spread to distant sites

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29
Q

Metastatic cascade is broadly divided into three major stages:

_________
___________
_________

A

Invasion Intravasation Extravasation

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30
Q

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

A

adhere to each otherget detached

Basement membrane & Extracellular
matrix(ECM)

Degradation

Migration

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31
Q

Grading of Malignant tumours

Grading: Refers to level of ________ of tumour cells to normal similar cell of origin

A

microscopic resemblance

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32
Q

_____ differentiated tumour closely resembles cell of origin while _____ differentiated tumour do not have any resemblance

A

Well

poorly

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33
Q

Same grading system is used for different tumours

T/F

A

F

Different

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34
Q

Level of differentiation correlates with _____ but does not always correlate with ________

A

aggressiveness

biologic behaviour

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35
Q

Grading is based on ______ assessment of the tumour.

A

histological

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36
Q

Examples of grading

prostatic cancer is graded using _______ system,

squamous cell carcinoma of cervix using _______________

A

Gleason’s

extent of keratin formation

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37
Q

Grades 1-IV is used with increasing _____ or decreasing ________

A

anaplasia

level of differentiation

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38
Q

Grading of tumours

Grade1- ?
Grade 2
Grade 3
Grade 4

A

Well differentiated

Moderately differentiated

Poorly differentiated

Nearly anaplastic

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39
Q

Gleasons’s pattern scale

Should I?

A

Maybe?
If I see it in PQ

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40
Q

Staging of Malignant tumours

Staging is defined as the extent of ________.

A

tumour spread

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41
Q

Staging of Malignant tumours

It is based on 3 parameters:

____ of primary tumour,
+/- _______,
+/- _________

A

size

lymph node

distant blood borne metastasis

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42
Q

Staging of Malignant tumours

2 systems are used _____ and ______.

A

TNM and AJC

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43
Q

TNM staging system

u T- _____
u N- ____,
u M- ______.

A

tumour size

node

metastasis

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44
Q

AJC grading system

American Joint Committee on Cancer staging system is of clinical importance.

T/F

A

T

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45
Q

AJC grading system

______________

A

American Joint Committee

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46
Q

I-IV grading system incorporates all 3 parameters

T/F

A

T

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47
Q

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 _________

A

in-situ; limited to the epithelium

Small; minimally invasive ; within

Larger; more; within

Larger ; beyond

large; invasive; adjacent organs

48
Q

Staging-Nodal spread

No- ___ lymph node involvement

N1- _____ lymph node involvement

N2- ____ regional lymph node involvement

N3- ______ lymph node
involvement

A

No

Regional

Extensive

More distant

49
Q

Staging-distant metastasis

Mo- ____ distant metastasis

M1 - ______ Distant metastasis

A

No

Presence of

50
Q

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 ____________

A

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
Q

Carcinogenesis
Refers to the process of _________ of normal cells by _______ agents

A

malignant transformation

carcinogenic

52
Q

Carcinogenic agents are classified into:

u ______
u ______
u ______

A

physical

chemical

microbiologic

53
Q

Physical carcinogenic agents

Examples of physical carcinogens are

______,_______,______,______,______

A

ionising radiation, X-ray, radiotherapy, Ultraviolet light, atomic energy

54
Q

Physical carcinogenic agents

Effect: _______ changes in cell-mutation

A

chromosomal

55
Q

Physical carcinogenic agents

Examples of tumours in this category

_________ Ca

_______carcinoma

_______ cell carcinoma, all of the skin

________

________ Cancer

_______ Cancer

A

Basal cell

melano

squamous

Leukeamia

Thyroid

Breast

56
Q

Chemical carcinogens/promoters

Direct acting- have _____ region which easily forms ____ bond with DNA

e.g _____ agents (anticancer drugs such as _________,_________ ,_______)

A

electrophylic; covalent

alkylating; cyclophosphamide, chlorambucil, nitrosourea

57
Q

Chemical carcinogens/promoters

Indirect acting- have to be converted to _________ in the ______

e.g___________ in cigarette, _________ in anyline dye

A

active metabolite in the liver

polycyclic hydocarbon

beta naphthylamine

58
Q

Chemical promoters

Promoters- they ________________________________

e.g ____

A

Act in conjunction with carcinogenic agents to promote cellular transformation

aflatoxin B1

59
Q

Chemical carcinogenesis goes through 3 steps:

Initiation- exposure- _________ followed by a ________ to __________  initiated cell

Promotion- initiated cell is encouraged to _________________

Effect- ______,_____, or _____

A

DNA alteration ; round of mitosis; fix the change

proliferate at the expense of the normal cell

transformation (progression), dormancy or regression.

60
Q

Microbiologic agents of cancer

DNA viruses-form ______ with ________ leading to _______ and then ______

e.g;
Human papilloma virus - ______

hepatitis B virus - ______,

Epstein Barr virus - _______ and ____

A

stable association; host genome

integration

mutation

Ca cervix; liver Ca; nasopharyngeal Ca and Burkitt lymphoma

61
Q

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- _________

A

tax

replication of T-cell- mutation

T cell leukaemia

bladder Ca

cholangiocarcinoma

Kaposi sarcoma

62
Q

Molecular basis of carcinogenesis

u Tumours are “___clonal”

A

mono

63
Q

Tumors are monoclonal

This implies that a tumour mass results from _______ of a _________ that has incurred genetic change referred to as mutation

A

clonal expansion

single progenitor cell

64
Q

Multiple mutations leads to ____ tumours

A

malignant

65
Q

4 major classes of genes are involved

These are the targets of mutation and include:
_______
_______
_______
_________

A

Tumour promoter,
Tumour suppressor
Apoptotic genes and
DNA repair genes

66
Q

Molecular basis of carcinogenesis

Proto-oncogens are abnormal constituents of the cell that promote abnormal cell growth and differentiation

T/F

A

F

Normal

Normal

67
Q

Oncogens are ______ that can ___________

They are derived from ______

A

gene sequences

transform normal cell to cancer cell.

proto-oncogens

68
Q

Oncogens produce ______ –e.g. growth factors, membrane products and enzymes which resemble normal proteins that control growth and
differentiation

A

oncoproteins

69
Q

Tumour promoter/activating gene

Behavior (Dominant or recessive?) )

What does that mean?

A

Dominant

only one mutant allele of the gene need be present to cause transformation.

70
Q

The genetic mechanisms that convert proto-oncogens to oncogens are:

_____ mutation- e.g. ___ oncogen

________-e.g c- ____ , c- ____

Gene ______- N-_____, c-___

A

Point; ras

Translocation; myc; abl

amplification; myc; erb

71
Q

Gene translocation

c- myc in _______ [from chromosome ___ to ___]

c-abl in _____________ (from chromosome __ to ___]

A

Burkitt lymphoma; 814

Chronic myeloid leukaemia ; 922

72
Q

Gene amplification

N-myc amplification in _________, and c-erb in ____

A

neuroblastoma

breast cancer

73
Q

Tumour supressor genes Also referred to as ______

A

antioncogens

74
Q

Tumor suppressor genes

Behaviour (Dominant or Recessive?)-

And what does that mean?

A

Recessive

The 2 alleles of the gene must be damaged to transform cells

75
Q

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

A

Rb

P53

APC

NF-1, NF-2

BRCA-1, BRCA-2

WT-1

76
Q

Abnormality in suppressor gene is either ______ or ———-

A

deletion or inhibition

77
Q

Apoptotic genes

(Dominant or recessive?)

A

may be dominant or recessive.

78
Q

Examples of apoptotic genes

______ gene in B cell lymphoma

_____
c- _____

A

bcl –2

p53

myc

79
Q

deletion of apoptotic gene will _________ of the mutant cell, ______ its survival and thus allowed to _______ leading to tumours

A

prevent programmed death

Extends

proliferate

80
Q

DNA repair genes

These are genes that affect the ______________________ including the ______,_________, and ________.

A

ability of the body to repair non-lethal damage to other genes

proto-oncogens, tumour suppressor genes and apoptotic genes

81
Q

Inability to repair genes lead to ______ in the genome that leads to _____ transformation.

A

mutations

neoplastic

82
Q

Behaviour of DNA repair genes is Dominant or Recessive?

What does that mean?

A

Recessive

both alleles must be lost to induce genomic instability,

83
Q

DNA repair genes may be considered as tumour suppressor genes

T/F

A

T

84
Q

DNA repair genes are called ‘______ genes’.

A

caretaker

85
Q

Inactivation of dna repair genes results in tumour directly

A

F

does not result in tumor directly but increased mutation of all other genes including those that control cell division

86
Q

DNA repair genes

_____,_____ mutation in HNPCC syndrome(hereditary non- polyposis colon cancer)
____,_____ genes in breast cancer

A

MLH1, MSH2

BRCA-1, BRCA-2

87
Q

HNPCC syndrome( ____________________)

A

hereditary non- polyposis colon cancer

88
Q

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

A

Local pressure

Harmorrhage

Infarction; rupture

cytokines

Paraneoplastic

89
Q

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

A

F

It can’t

90
Q

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

A

earliest manifestation; an occult

lethal

metastatic

91
Q

Classification of paraneoplastic syndromes

_______
_______
_________
_________
__________

A

Endocrinopathies
Dermatological
Nerve and muscle
Bone and joint
Vascular/heamatological

92
Q

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)

A

Cushing syndrome; ACTH

Hyponatrimia; ADH

Hypoglyceamia; insulin

93
Q

Tumour Markers

Are biochemical indicators of tumour presence, either __________ in excess or _____________

A

Produced by the tumour cells

overexpressed or produced in response to the tumour

94
Q

Tumor markers

Levels increase with _______ and highest with ______

A

tumour progression

metastasis

95
Q

Classification of tumour markers

Tumour markers found _________
Tumour markers found ______

A

in blood or other body fluids

on tumour cells

96
Q

Tumour markers-in blood & body fluids
u Oncofetal antigens u Hormones
u Specific proteins
u Isoenzymes
u Glycoproteins

A

Just see the list

97
Q

Classification of Tumour markers

Oncofetal antigens
These antigens are _____ in tumours and are normally expressed _________

A

re-expressed

during fetal development,

98
Q

Oncofetal antigens

Examples are:
u ____________-Hepatocellular carcinoma, Non seminomatous germ cell tumour of testes

u ____________-Ca pancreas, colon, stomach, lung, breast

A

Alpha feto-protein(AFP)

Carcinoembryonic antigen(CEA)

99
Q

Tumour markers- Specific proteins

u ___________ in multiple myeloma, other gammopathies
u _____________ in Ca prostate

A

Beta 2 microglobulin

PSA (prostate specific antigen)

100
Q

Isoenzymes

________-prostate cancer

________- lung cancer and neuroblastoma

A

Prostatic acid PO4

Neuron specific enolase

101
Q

Glycoprotein/mucin

CA-125- in ______ cancer
CA-15-3 – in ____ cancer
CA-19-9- in _______ cancers

A

ovarian

breast

colon and pancreatic

102
Q

Tumour markers found on tumour cells

uBRAF, KRAS, EGFR - in _____ cancer
uER/PR, HER-2NEU- _____ cancer

A

colon

Breast

103
Q

Treatment of cancer

________

————-

____therapy

______therapy

A

Surgery
Radiation

Chemo

Immuno

104
Q

Treatment of tumor

Radiation: effectiveness depends on _________ and ___________

A

how radiosensitive the tumour is

the body’s ability to tolerate the dose without serious effect.

105
Q

Treatment of tumor

Chemotherapy: effectiveness depends upon the __________________

A

ability of the drug to selectively kill the tumour cells and not normal cells.

106
Q

Prevention of cancer

This can be divided into 3 steps:

Primary-____________

Secondary -_______,______

Tertiary - _______,______

A

prevent exposure to risk factors

early detection, diagnosis

palliative -prompt treatment

107
Q

Secondary prevention of breast cancer

1) _______ for every woman including young girls

2)_______ every _____ from age __-__

3)________ screening

4)______ scan

A

Breast self examination

clinical breast examination; 1-3years; 20-39

mammography

ultrasound

108
Q

Cervical cancer Screening-

By _____
By _____ testing
By ____

A

Pap smear

HPV-DNA

VIA

109
Q

VIA = _________

A

visual Inspection with acetic acid)

110
Q

HPV-DNA testing
This is used for women above ______

Negative HPV-DNA testing can be repeated after ____yrs

A

30yrs

5-10

111
Q

Positive HPV-DNA testing is final

T/F

A

F
It can be further investigated

112
Q

HPV vaccine options

List 3 drugs

A

Cervarix
Gardasil
Gardasil-9

113
Q

Who is it for , how many doses, what infections does it prevent

Cervarix
Gardasil
Gardasil-9

A

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
Q

Screening for Prostate cancer

__________
_____________ test

A

Digital rectal exam (DRE)

Prostate specific antigen (PSA)

115
Q

Screening for Prostate cancer

Digital rectal exam (DRE):
Examination of the _____ through the ____ to estimate the ____ and feel for _____ or other abnormalities.

A

prostate; anus

size; lumps

116
Q

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 _____

A

level of PSA

prostate cancer

117
Q

PSA levels can not be higher in men with other conditions that affect the prostate besides prostate cancer

T/F

A

F

the level may also be elevated in other conditions that affect the prostate.

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