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MOD Midterm > Neoplasia > Flashcards

Neoplasia Flashcards

1
Q

What is neoplasia?

A

A clonal process initiated by a genetic mutation conferring growth advantage on the cells involved
Can be benign or malignant

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2
Q

How can benign tumors cause harm?

A

SC compression, airway compression, hemorrhage, hormone secretion

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3
Q

What are hematopoietic malignancies?

A

Leukemias and lymphomas are malignant

Do not stay localized

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4
Q

Describe the stroma of breast carcinoma cells

A

Fibrous and contributes to the hard scirrhous nature of the tumor mass (helps with identification of the mass during palpation)

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5
Q

The cellular clone that encompasses the tumor cellularity is the primary population responsible for what?

A

Invasion, spread and metastasis

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6
Q

Induction of changes in surrounded stroma by the tumor can result in what?

A

Formation of a friendly microenvironment that cancer growth may depend on
Characteristic texture of the cancer

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7
Q

What is a carcinoma?

A

Malignant tumor derived from epithelium

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8
Q

What is a sarcoma?

A

Malignant tumor derived from mesenchyme(ex. Bone, muscle, fibrous tissue, cartilage, fat, BVs)

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9
Q

What is a teratoma?

A

From totipotent stem cells
Has epithelial elements stemming from ectoderm as well as mesenchymal elements
Defined on the basis of more than one germ cell layer

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10
Q

What are hamartomas?

A

An overgrowth of mature tissues that normally occur in an area of the body but with disorganization and often with one element predominating

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11
Q

What are choristomas?

A

A mass of tissue histological ply normal for a part of the body other than the one in which it is located (heterotopic/ectopic)

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12
Q

What is metaplasia?

A

One cell type is replaced with another typically as a stress responses
This new cell type is prone to acquisition of genetic damage leading to dysplasia

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13
Q

What is dysplasia?

A

Disordered growth

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14
Q

What is carcinoma in situ?

A

Full thickness, severe dysplasia
Can be proliferative, pleomorphic and expansive
Has to have a basement membrane otherwise it is just an invasive carcinoma
Can be larger than the invasive component

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15
Q

What are the morphologic changes that lead to cancer?

A

Metaplasia —> dysplasia —> carcinoma in situ

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16
Q

What is differentiation?

A

How much does the neoplasm resemble the cells of origin?
A lot = well differentiated
Not at all = poorly differentiated

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17
Q

What is a malignant tumor of gastric epithelium?

A

Adenocarcinoma

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18
Q

What morphologic feature (microscopically viewable) can reflect the tumors rate of growth?

A

Mitotic features

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19
Q

What are the telltale morphologies of poorly differentiated malignancy?

A 
Anaplasia (lack of differentiation) 
Pleomorphism (variability of cell size/shape) 
Abnormal nuclear morphology 
Increased or abnormal mitosis 
Loss of polarity
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20
Q

Stains showing a feature in malignant cells like mucin-production reflect a degree of what?

A

Glandular differentiation —> adenocarcinoma

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21
Q

Immunostains showing the tumor cells express Ags or other cellular components of the cell of origin may also reflect what?

A

Higher levels of differentiation

Ex. Thyroid carcinoma showing positive staining of thyroglobulin

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22
Q

Endocrine tumors are often associated with what?

A

Hormone secretion

Often very well differentiated

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23
Q

In acute leukemias the cancerous cells have halted maturation at what stage?

A

Blast stage

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24
Q

In chronic leukemias the cancer cells consist of what type of cells?

A

Mature blood cells

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25
Q

What are smooth muscle tumors?

A

Leimyomata (well circumscribed uterine tumor)

Leiomyosarcoma (poorly circumscribed, necrotic, hemorrhagic uterine tumor)

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26
Q

What are the types of metastasis?

A

Lymphatic spread, hematogenous spread, direct seeding

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27
Q

What is metastasis via lymphatic spread?

A

Gain entry to lymphatic vessels
MC route of spread for carcinomas
Depends on regional drainage

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28
Q

What is metastasis via hematogenous spread?

A

Gain entry to arterial/venous vessels
Classic for sarcoma but may be seen in carcinomas
Lung, liver, and bone are primary targets

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29
Q

What is metastasis is via direct seeding?

A

Gain entry to a free compartment/body cavity (like the peritoneal space)
Also known as trans-coelomic spread

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30
Q

Describe a sentinel LN biopsy

A

At the time of surgery tracer dye is injected into the tumor
The first LN to take up this dye is known as the sentinel LN
These LNs are preferentially removed
This isolates the most likely site of metastasis for emulation and prevents more extensive lymphadenectomy

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31
Q

What is Virchow node?

A

Supraclavicular lymphadenopathy (classically left sided)
Often associated with carcinoma especially in older adults
Any thoracic or abd carcinoma may be responsible

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32
Q

What is TNM staging?

A

T: tumor size, extent of invasion
N: degree and manner of nodal Mets
M: presence/absence of distant Mets

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33
Q

What are the features of malignancy?

A

Tumor differentiation (morphology, staining qualities, hormone secretion, serum markers)
Rate of growth (mitotic figures)
Local invasion (TNM staging)
Metastasis

34
Q

What types of cancers does asbestos cause?

A

Lung, esophageal, gastric, and colon carcinoma

Mesothelioma

35
Q

What is the typical use of asbestos?

A

Formerly used for many applications bc of fire, heat and friction resistance
Still found in existing construction as well as fire resistant textiles, friction materials (i.e. brake linings), underlayment and roofing papers, and floor tiles

36
Q

What type of cancer can benzene cause?

A

Acute myeloid leukemia

37
Q

What is the typical use for benzene?

A

Component of light oil
Many applications exist in printing and lithography, pain, rubber, dry cleaning, adhesives and coatings and detergents
Formerly widely used as solvent and fumigant

38
Q

What type of cancer is caused by radon and its decay products?

A

Lung carcinoma

39
Q

What is the typical use for radon?

A

From decay of minerals containing Uranium

Potentially serious hazard in quarries and underground mines

40
Q

What type of cancer is caused by vinyl Cl?

A

Hepatic angiosarcoma

boards

41
Q

What is the typical use for vinyl chloride?

A

Refrigerant
Monomer for vinyl polymers
Adhesive for plastics
Formerly inert aerosol propellant in pressurized containers

42
Q

Cancer risk increases with what?

A

Age

  • Increasing changes for sporadic mutations
  • Waning immunity
43
Q

What sets many childhood cancers apart from adult cancers?

A

Germline mutations

44
Q

What are acquired predisposing conditions for cancer?

A

Chronic inflammation
Precursor lesions
Immunodeficiency

45
Q

Why does screening work?

A

IDs cancer early and before they are cancers

46
Q

What is the colon adenoma to carcinoma sequence?

A

Occurs with colon polyps

47
Q

Benign neoplasms are not typically the precursor to what?

A

Their malignant counterparts

48
Q

What are paraneoplastic syndromes?

A

Some cancer bearing individuals develop signs and sx that cannot readily be explained by the anatomic distribution of the tumor or by the elaboration of hormones indigenous to the tissue from which the tumor arose

49
Q

Wha are two lung cancers with typical paraneoplastic syndromes?

A

Squamous carcinoma

Small cell neuroendocrine carcinoma

50
Q

Describe the paraneoplastic syndrome that occurs with squamous cell carcinoma?

A

Humoral hypercalcemia of malignancy
Elaboration of PTHrP
Works on PTH receptors to give pts hypercalcemia

51
Q

Describe the paraneoplastic syndrome that occurs with small cell neuroendocrine carcinoma?

A

Cushing syndrome

Hypercortisolism due to excessive ACTH secretion by tumor cells

52
Q

What is Trousseau syndrome?

A

Paraneoplastic thrombophilia classically associated with pancreatic carcinoma
(Look for this type of cancer when pt as thrombus that cannot be explained)

53
Q

Describe acute promyelocytic leukemia

A

The leukemic cells express tissue factor which activates Factor X
High levels of annexin II receptors on plasma cells convert plasminogen into plasmin
Both TF and Ann II are highly expressed by APL cells

54
Q

Describe disseminated intravascular coagulopathy (DIC)

A

An acquired coagulopathy
Endothelial injury and anticoagulation dysfunction cause widespread thrombin release
Pro inflammatory cytokines activate platelets
Lodged thrombin cause ischemic damage
As coagulation factors are consumed and endothelial injury continues hemorrhage can develop

55
Q

In which type of cancer is ERBB2 amplification seen?

A

Breast carcinoma

This can be used in Tx

56
Q

Which genetic aberration is seen in chronic myeloid leukemia?

A

BCr-ABL PCR

57
Q

Which genetic aberration is also seen in breast cancer?

A

BRCA1/2

Germline testing for this aberration can be used for risk assessment and management

58
Q

What type of testing is done for lung carcinoma?

A

EGFR and ALK testing

Can be used for tx

59
Q

What are the different uses of the Philadelphia chromosome?

A

Diagnose And Treat (imatinib [gleevec/glivec] tyrosine kinase inhibitor, extremely effective at controlling this cancer clone)
Monitor (BCR-ABl PCR)

60
Q

Wha are direct carcinogens?

A

Carcinogenic right out of the gate

No need for conversion

61
Q

What are indirect carcinogens?

A

A metabolic process must take place for the substance to become an active carcinogen

62
Q

What is cytochrome p450 responsible for?

A

Converting most indirect carcinogens into their active forms
Highly polymorphic - the potency of the active carcinogen will vary from person to person

63
Q

What are pyrimidine dimers?

A

Ex. Thymine dimers
Form in the presence of UVB rays
These dimers distort the DNA which blocks the progress of DNA and RNA polymerase

64
Q

How is removal of pyrimidine dimers primarily accomplished under normal circumstances?

A

Utilizing NER

65
Q

What is Xeroderma pigmentosum?

A

Absence of NER
Marked freckle hyperpigmentation, atrophy and numerous warty and nodular growths occur
Tumors (skin cancers) can develop in most pts before 10 yrs of age

66
Q

What happens if you overwhelm NER especially by excess exposure to UV light?

A

Sporadic melanomas and other skin cancers

67
Q

Ionizing radiation exposure can cause what?

A

Downstream carcinogenesis even years after initial exposure

68
Q

What is the human T cell leukemia virus (HTLV1) associated with?

A

Endemic T cell leukemias/lymphomas

69
Q

What are hepatitis B and C viruses associated with?

A

Hepatocellular carcinomas

70
Q

What is H pylori associated with?

A

B cell lymphomas of the stomach

71
Q

Describe human papilloma virus (HPV)

A

Associated with squamous carcinoma of the cervix, anogenital region and pharynx/larynx
High risk serotypes associated with cancer are able to integrate viral sequences into the host chromosomes
E6 and E7 are the viral proteins associated with oncogenesis

72
Q

As progressive integration of E6/7 proteins occurs there is inactivation of what?

A

Tumor suppressor genes and upregulation of oncogenic pathways

73
Q

Describe Epstein Barr Virus (EBV)

A

Implicated in oncogenesis in B cell lymphomas as well as certain carcinomas
First virus associated with cancer when described in associated with endemic Burkitt lymphoma

74
Q

EBV infection results in what?

A

Immortalization and increased replication of B lymphocytes
EBNA 2 upregulates oncogenes
LMP induces cell proliferation

75
Q

What mutation occurs in Burkitt lymphoma?

A

IgH/MYC

76
Q

What is Burkitt lymphoma?

A

A form of non-Hodgkin’s lymphoma in which cancer starts in B cells
Recognized as a fast growing human tumor and is associated with impaired immunity and rapidly fatal if untreated

77
Q

Which tumor marks would be present in the breast?

A

CA 15-3

78
Q

Which tumor markers would be present in the liver/bile duct?

A

CEA, AFP, CA-19

79
Q

Which tumor marker is present in the ovaries?

A

CA-125

80
Q

Which tumor markers are present in the stomach, pancreas and colorectal system?

A

CEA, CA 19-9

81
Q

Which tumor markers would be present in the prostate?

A

PSA

82
Q

Which tumor markers would be present in the testicle?

A

AFP, BHCG

MOD Midterm (8 decks)

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