Neoplasia (Cancer) Flashcards
Neoplasia
- Greek for “new growth”
- Abnormal growth
- No useful function
- Expense of the host
Neoplastic spectrum?
-from benign to malignant
Benign Neoplasms?
- Not very aggressive
- Easily removed
- mild
Benign neoplasms nomenclature?
- End in “-oma” (Lymphoma-exception)
- Prefix usually dictates location of benign tumor
Benign neoplasms treatment?
1) Excisional
- Snare polypectomy
- Endoscopic Mucosal Resection
- Surgery
- Colectomy
Where cancer usually found?
- usually in polyps
1) pedunculated polyp (sticking out)
2) sessile polyp (under tissue)
How treat pedunculated polyp vs sessile polyp
pedunculated- just cut/excise
sessile- inject water, then excise
-can also do partial/full colectomy (remove collon, sections of colon)
Harder benign lesions to remove?
- based on location
- face, uterine fibroids and bone lesions are hard to remove
- due to infertility, complications in surgery (nerve damage)
Malignant Neoplasms
- a bad kind
- Aggressive; grow very fast
- Metastasis = displacement (Mets
- Primary neoplasm leads to a secondary neoplasm
Primary vs secondary neoplasm
1) Primary: where cancer starts
2) Secondary: is when cancer get into blood/lymph/CSF, infect different areas/organs
Routes of mets? (metastasis)
1) Hematogenous
- colon cancer
2) Lymphomatous
- breast cancer
3) CSF (cerebrospinal fluid)
Bone Mets
1) Osteoblastic Lesions
2) Osteolytic Lesions
Osteoblastic Lesions
bone forming
Osteolytic Lesions?
Results?
-Bone breakdown
-Hypercalcemia due bone breakdown & release of extra Ca
Pathological Fractures
PB KTL Mnemonic
Lead Kettle Mnemonic
Prostate = blastic
Breast = both
Kidney, Thyroid & Lung = Lytic
Sarcoma
- Malignant Neoplasms
- Originate from connective tissue, muscle, or bone
Carcinoma
- Malignant Neoplasms
- Originate from epithelial tissue
Staging mean in malignant neoplasms?
- the spread of the cancer
- larger the number (1-4) means more advanced cancer, means worse prognosis
What does staging determine? How determine the stage of the cancer?
1) Determines prognosis and treatment plan
2) Done by physical exam or may require surgery
Grading in malignant neoplasms?
- degree of anaplasia (lack of differentiation)
- or degree of differentiation
- nuclear features that tell us how invasive the CA is
- more undifferentiated (more anaplasia= bad)
What are the grades and what do they mean?
GX Grade cannot be assessed G1 Well differentiated (Low grade) G2 Moderately differentiated (Intermediate grade) G3 Poorly differentiated (High grade) G4 Undifferentiated (High grade)
What does anaplasia mean?
- more differentiated cells are, slower they grow
- anaplasia means are embryonic cells, have no differentiation and huge growth rates
How does cancer usually move in regards to differentiated vs undifferentiated cells?
-Cancer usually begins in differentiated tissue; works backward toward more undifferentiated state
How Cancer Starts?
- is a multistep process, requires many mutations over many levels to accumulate over time
1) mutations in inherited genetics, germ cells, or somatic cells
2) Mutations in key regulatory genes- protooncogenes, tumor suppressing genes, apoptosis, DNA repair
What causes cancer?
1) external factors (diet, smoking, carcinogens, sun/UV exposure
2) internal factors (genetics)
3) unknown env exposure
4) viruses (like HPV)
How do we diagnose cancer?
1) Physical exam, labs, imaging
2) gold standard= Microscopic examination by pathologist (cytology)
3) Fine needle aspiration
4) PAP smear
5) CT-guided biopsy
Why is cancer bad?
1) destruction of tissue structure
2) cancer cachexia (catabolic state, breaking down muscle and tissue so look anorexic/wasted)
3) hormonal effects
Why is tissue destruction a bad thing?
- as the cancer grows in an organ it can invade it and take over so that organ’s own cells are destroyed
- In time the organ or structure can no longer do its job
- can squish the brain, cause edema and swelling from inflammatory response
Cancer Cachexia?
- the state of ill health, malnutrition, and wasting
- is catabolic rxt
- tumors release certain proteins (cytokines) that decrease appetite and alter fat metabolism
- can even release hormones saying aren’t hungry even though are starving to death
Cancer and Hormonal Effects?
- cancers produce hormones, if produce too much can have effect on the whole body
- can cause overproduction of inulin if in the pancreas therefore leading to hyperglycemia
Cushing’s Syndrome causes and presentation?
- to much ACTH due to cancer in pituitary or adrenal
- cancer in thyroid/ lungs can cause it
- plrual neuroplastic syndrome
- emotional surges
- hump in back
- stria/stretch marks
- acne
Polycythemia Vera
- Myleoproliferative blood disorder; too much RBCs
- can be due smoking, decrease oxygenation, increase RBC
- cancer in RBC proliferation
Anemia; types & causes?
- Anemia of chronic disease
- Iron Deficiency (colon CA) - Myelophthisic anemia (cause immature stem cell–> lead to mature RBC/unusable RBC)
How tell myelophthisic anemia?
Nucleated RBCs
Tear drop RBCs
Paraneoplastic Syndromes?
-Distant effects of a tumor not related to metastasis; mimic metastasis but usually due to ectopic hormone secretions
Paraneoplastic Syndrome examples?
1) Acanthosis Nigricans (stomach Ca)
2) Eaton-Lambert myasthenic Syndrome (small cell carcinoma of lungs)
3) Seborrheic keratosis
(Stomach CA)
4) Superficial migratory thrombophlebitis
(Pancreatic CA)
5) Nephrotic Syndrome
(Lung, breast, stomach CA)
How is cancer treated
1) Surgery
2) Radiation (XRT)
cancer cells more sensitive to it
3) Radiosurgery-Gamma Knife
4) Chemotherapy
Chemotherapy and types?
- antineoplastic drugs, kill rapidly dividing cells
1) Alkylating
2) Anti-metabolites
3) Topoisomerase inhibitors
4) Cytotoxic antibioties
Why chemo a double-edged sword:
have:
1) Bone marrow myelosupression–> have no WBC/neutrophils
2) Digestive tract degradation of mucositis
3) Hair follicles die–> alopecia (hair loss)
How do we prevent cancer?
1) Lifestyle modifications
2) Immunizations
3) Screening
4) Treat predisposing conditions
(GERD, Barrots esophogous
Dysplasia is characterized by what 4 major pathological microscopic changes?
1) Anisocytosis (cells of unequal size)
2) Poikilocytosis (abnormally shaped cells)
3) Hyperchromatism (excessive pigmentation)
4) Presence of mitotic figures (an unusual number of cells which are currently dividing).
Anisocytosis
-cells of unequal size
Poikilocytosis
-abnormally shaped cells
Hyperchromatism
-excessive pigmentation
Presence of mitotic figures
-illustrates an unusual number of cells which are currently dividing
Carcinoma in situ,
- low grade dysplasia
- means “cancer in place”,
- represents transformation of neoplastic lesion to one in which cells undergo no maturation; cells divide rapidly but have no differentiation
- are thus considered cancer-like
- they remain in place
high vs low grade dysplasia…how to test for it/treat?
-Dysplasia is earliest form of pre-cancerous lesions
-high grade= more likely to become malignant, low grade= less likely, usually treated and are ok
high grade dysplasia?
- Invasivecarcinoma
- cancer has invaded beyond basement membrane & has potential tometastasize
