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Neoplasia > Neoplasia > Flashcards

Neoplasia Flashcards

1
Q

“Triple Approach” to diagnosis

A
  • involves clinical, radiological, and pathological examinations
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2
Q

Type

A
  • benign vs. malignant

- primary vs. secondary

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3
Q

Grade

A
  • how clearly a tumor resembles its tissue of origin

- can be simply ‘low grade’ or ‘high grade’ OR can be broken down into a more specific system

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4
Q

Stage

A
  • the extent of the disease process

- T.N.M classification (tumor size, nodal involvement, metastatic activity)

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5
Q

Carcinoma

A
  • any malignant cancer of the epithelium
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6
Q

Squamous cell (ie, in the skin)

A
  • benign: squamous cell papilloma

- malignant: squamous cell carcinoma

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7
Q

Glandular cell (ie, in the GIT)

A
  • benign: adenoma

- malignant: adenocarcinoma

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8
Q

Transitional cell (ie, in the urothelium)

A
  • bengin: transitional cell papilloma

- malignant: transitional cell carcinoma

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9
Q

Sarcoma

A
  • any malignant cancer of connective tissue (of the mesenchyme)
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10
Q

Fat cell

A
  • benign: lipoma

- malignant: liposarcoma

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11
Q

Smooth muscle cell

A
  • benign: leiomyoma

- malignant: leiomyosarcoma

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12
Q

Striated muscle cell

A
  • benign: rhabdomyoma

- malignant: rhabdomyosarcoma

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13
Q

Fibrous tissue

A
  • benign: fibroma

- malignant: fibrosarcoma

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14
Q

Cartilage

A
  • benign: chondroma

- malignant: chondrosarcoma

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15
Q

Bone

A
  • benign: osteoma

- malignant: osteosarcoma

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16
Q

Plasma cell

A
  • myeloma
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17
Q

CNS cell

A
  • glioma
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18
Q

Placenta

A
  • choriocarcinoma
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19
Q

Risk Factors (5 major ones)

A
  • age: breast, colon, lung cancers
  • genetic factors/predisposition: Retinoblastoma, Familial Adenomatous Polyposis Coli (FAP/APC)
  • environmental factors: smoking (lung) , asbestos (lung, mesothelioma), scrotal cancer in chimney sweeps
  • geography: malignant melanoma in Australia & California; hepatocellular carcinoma in Sub-Saharan Africa; gastric carcinoma in Japan, China, USSR, & S. America
  • carcinogenic agents: radiation, chemicals, viruses
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20
Q

Major Routes of Spread

A
  • direct extension (ex: lung cancer)
  • lymphatic spread (ex: breast cancer)
  • blood vessels (ex: rhabdosarcoma)
  • transcolomic (ex: ovarian and gastric cancers)
  • CSF (won’t usually exit the nervous system, however)
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21
Q

Neoplasia

A
  • new tissue growth that is unregulated, irreversible, and monoclonal
  • it is therefore distinct from hyperplasia and repair
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22
Q

G6PD

A
  • glucose-6-phosphate dehydrogenase (?)
  • X-linked gene, so females have two alleles and each cell randomly expresses only one via X-inactivation
  • the ratio of the two alleles can be used to determine the clonality of a growth (if it’s polyclonal = hyperplasia, monoclonal = neoplasia)
  • hyperplasia/polyclonal growth maintains the 1:1 ratio of the alleles
  • neoplasia/monoclonal growth will change it
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23
Q

Androgen Receptor Isoforms

A
  • can be used in the same was as G6PD to determine clonality of a growth
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24
Q

Clonality of B Cells

A
  • determined by ratio of Ig light chain phenotype (kappa or lambda), with the normal ratio being 3:1
  • change in this ratio indicates lymphoma
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25
Q

Top 3 Causes of Death in Adults

A

1) cardiovascular disease
2) cancer
3) cerebrovascular disease

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26
Q

Top 3 Causes of Death in Children

A

1) accidents
2) cancer
3) congenital defects

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27
Q

Most Common Cancers in Adults by Incidence and Death (not including skin malignancies because they are very common, easy to treat, and rarely life-threatening)

A

by incidence:

1) breast/prostate
2) lung
3) colorectal

by death:

1) lung
2) breast/prostate
3) colorectal

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28
Q

Why is Prostate Cancer Clinically Silent for a Long Time?

A
  • because it commonly begins in the posterior region and therefore will not affect the urethra (which is located at the center) until it becomes large enough
  • DRE as a screening, because the posterior region of the prostate is palpable from the rectum
  • vs. BPH which occurs centrally in the prostate and DOES affect the urethra (urinary symptoms)
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29
Q

Aflatoxins

A
  • correlated with hepatocellular carcinoma

- derived from Aspergillus, which can contaminate stored grains

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30
Q

Alkylating Agents

A
  • correlated with leukemia and lymphoma

- a side effect of chemotherapy (this is why leukemia is a potential long-term side effect of chemo)

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31
Q

Alcohol

A
  • correlated with squamous cell carcinoma of oropharynx & upper esophagus, pancreatic carcinoma, and hepatocellular carcinoma
  • pancreatic carcinoma is a result of chronic pancreatitis
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32
Q

Arsenic

A
  • correlated with squamous cell carcinoma of skin, lung cancer, and angiosarcoma of liver
  • present in cigarette smoke
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33
Q

Asbestos

A
  • correlated with lung cancer and mesothelioma (former more so than the latter)
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34
Q

Cigarette Smoke

A
  • correlated with squamous cell carcinoma of oropharynx & esophagus, lung cancer, kidney cancer, and bladder cancer
  • contains polycyclic hydrocarbons, which are extremely carcinogenic
  • the most common carcinogen in the world
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35
Q

Nitrosamines

A
  • correlated with stomach carcinoma (the intestinal type)

- found in smoked foods, which explains the high incidence of stomach carcinoma in Japan)

36
Q

Naphthylamine

A
  • correlated with urothelial carcinoma of bladder

- found in cigarette smoke

37
Q

Vinyl Chloride

A
  • correlated with angiosarcoma of liver

- occupational, present in PVC pipes

38
Q

EBV

A
  • Epstein-Barr Virus; an oncogenic virus
  • correlated with nasopharyngeal carcinoma, Burkitt’s lymphoma, CNS lymphoma in AIDS patients
  • classic patient of nasopharyngeal carcinoma due to EBV is Chinese male or African person
39
Q

HHV-8

A
  • Human Herpes Virus - 8; an oncogenic virus

- correlated with Kaposi sarcoma in old Eastern European males, AIDS patients, immunosuppressed patients

40
Q

HBV

A
  • Hepatitis B Virus; an oncogenic virus
  • correlated with hepatocellular carcinoma
  • a DNA virus
41
Q

HCV

A
  • Hepatitis C Virus; an oncogenic virus
  • correlated with hepatocellular carcinoma
  • an RNA virus
42
Q

HTLV-1

A
  • an oncogenic virus

- correlated with adult T-cell leukemia/lymphoma

43
Q

High Risk HPV

A
  • strains 16, 18, 31, 33 are oncogenic viruses

- correlated with squamous cell carcinoma of vulva, vagina, anus, and cervix

44
Q

Ionizing Radiation

A
  • correlated with papillary carcinoma of thyroid, AML, and CML
  • nuclear reactor accidents, radiotherapy
45
Q

Non-Ionizing Radiation

A
  • correlated with basal cell carcinoma, squamous cell carcinoma, and melanoma of skin
  • UV-B sunlight
46
Q

PDGF

A
  • platelet derived growth factor

- its overexpression causes astrocytoma

47
Q

ERBB2 (HER2)

A
  • a epidermal growth factor receptor

- its amplification causes breast carcinoma

48
Q

RET

A
  • a neural growth factor receptor

- translocation or point mutation causes medullary carcinoma of thryoid w/ MEN2 growth pattern

49
Q

KIT

A
  • a stem cell growth factor receptor

- point mutation causes GI stromal tumor

50
Q

RAS

A
  • a signal transducer
  • a GTP-binding protein with GTPase activity (via GAP)
  • point mutation causes carcinomas, melanomas, and lymphomas
51
Q

ABL

A
  • Abelson Leukemia oncogene; a signal transducer
  • a tyrosine kinase found on chromosome 9
  • t( 9;22) w/ BCR causes CML and some ALL
52
Q

Philadelphia Chromosome

A
  • t (9;22)
  • puts ABL under BCR’s transcription
  • causes CML and some ALL
53
Q

C-myc

A
  • a transcription factor, found in chromosome 8

- t (8;14) with IgH causes Burkitt’s lymphoma

54
Q

N-myc

A
  • a transcription factor

- its amplification causes neuroblastoma

55
Q

L-myc

A
  • a transcription factor

- its amplification causes lung carcinoma

56
Q

cyclin D1

A
  • a cell cycle regulator, needed to progress from G1 to S
  • found in chromosome 11
  • t (11;14) with IgH causes Manthe Cell lymphoma
57
Q

CDK4

A
  • a cell cycle regulator

- its amplification causes melanoma

58
Q

p53

A
  • a tumor supressor gene; involved in 50% of cancers
  • regulates the G1 to S phase checkpoint; makes sure the cell’s DNA is undamaged before replication begins
  • if DNA is damaged, it triggers cell cycle arrest for repair
  • if damage is unrepairable, apoptosis is triggered
59
Q

Bcl2

A
  • a regulator of apoptosis
  • stabilizes the mitochondrial membrane, preventing cytochrome c release
  • located on chromosome 18
60
Q

Bax

A
  • inhibits Bcl2, allowing cytochrome c release, and triggering apoptosis
  • it is recruited by p53 when DNA damage is unrepairable
61
Q

Follicular Lymphoma

A
  • a result of t (14,18), placing Bcl2 under IgH’s transcription
  • results in an increase in Bcl2 production and a resulting inability to undergo apoptosis
62
Q

What is the Hypothesis for TSG Inactivation Called?

A
  • Knudson’s 2-hit Hypothesis
63
Q

Li-Fraumeni Syndrome

A
  • germline mutation in chromosome 17p leads to a knockout of one p53 allele
  • results in a large predisposition to many cancers
64
Q

Rb

A
  • a tumor supressor gene
  • regulates the G1 to S phase checkpoint; it sequesters E2F, which is needed for progression into S phase
  • upon phosphorylation by cylcin D/CDK4 complex, it releases E2F and allows for entry into S phase
65
Q

Sporadic Mutations of Rb will yield _______________

A
  • unilateral retinoblastoma
  • it is very rare for one cell to lose both of its Rb alleles, and it is even rarer for two cells (one in each eye) to do so
66
Q

Germline Mutation + Sporadic Mutation of Rb will yield ______________

A
  • bilateral retinoblastoma
67
Q

3 Checkpoints of the Cell Cycle

A
  • G1 to S transition
  • G2 to M transition
  • M-phase check (occurs during metaphase)
68
Q

Aneuploidy

A
  • having more than 23 pairs of chromosomes

- normal cells that have this will undergo apoptosis (cancer cells ignore the apoptotic signals)

69
Q

MDM2

A
  • degrades p53

- is normally sequestered by p14^ARF

70
Q

First Step in Invasion

A
  • E-cadherin is a surface protein that links adjacent cells together
  • for cancer cells to spread, they must down regulate E-cadherin; this is the first step in invasion
71
Q

Second Step in Invasion

A
  • invading tumor cells attach to laminin

- basement membrane made up of laminin and collagen IV

72
Q

Third Step in Invasion

A
  • collagenase degrades collagen (degrades the basement membrane)
  • tumor cell secretes collagenase, allowing entry into the ECM
73
Q

Fourth Step in Invasion

A
  • tumor cell attaches to fibronectin in the ECM

- tumor cell can now spread locally

74
Q

Fifth Step in Invasion

A
  • eventually, the tumor cells will reach a blood vessel or lymphatic and spread to other parts of the body (metastasize)
75
Q

Carcinomas tend to spread via ____________

A
  • the lymphatics

- exceptions are: renal cell carcinoma, hepatocellular carcinoma, follicular carcinoma of thyroid, and choriocarcinoma

76
Q

Sarcomas tend to spread via ____________

A
  • the blood (they spread hematogenously)
77
Q

Xeroderma Pigmentosa

A
  • a genetic defect (autosomal recessive), leading to an inability to repair DNA damaged by UV light
  • predisposes patient to malignancy
78
Q

Cyclin B pairs up with CDK__

A
  • CDK1

- cyclin B/CDK1 complex is necessary to enter M phase

79
Q

Cyclin A pairs up with CDK__

A
  • CDK 1 and CDK 2
80
Q

Cyclin D pairs up with CDK__

A
  • CDK 4 and CDK 6
81
Q

Cyclin E pairs up CDK__

A
  • CDK 2
82
Q

Mult-Step Model of Colorectal Carcinoma

A
  • mutation in chromosome 5 (APC LOF) allows for increased cell growth –> de-methylation of DNA results in adenoma –> mutation in Ras leads to intermediate adenoma –> mutation in chromosome 18 (DCC LOF) leads to late-stage adenoma –> mutation in chromosome 17 (p53 LOF) leads to carcinoma –> other mutations result in metastasis
83
Q

What are the four tumors that can cause SVC obstruction

A
  • the four “T”s

- (terrible) lymphoma, thyroid, thymus, teratoma

84
Q

Hamartoma

A
  • a tumor consisting of cartilage and normal tissue cells that are normally seen in the area, but are disorganized
85
Q

Heterotopia

A
  • a tumor consisting of properly organized tissue, but of a different type than is normally seen in the area

Neoplasia (3 decks)

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