Neoplasia - Midterm 1

Question 1

Steps of Carcinogenesis (oncogenesis)? What does it ultimately lead to?

Answer 1

1. Genome alterations that initiate and maintain development of cancer
   ● Sustained proliferative signaling
   ● Evading growth suppressors
   ● Genomic instability
   ● Enabling replicative immortality
2. Secondary to genomic change
   ● Inducing angiogenesis
   ● Reprogramming energy metabolism
3. Tumour resistance to destruction
   ● Resistance to apoptotic cell death
   ● Tumour-promoting inflammation
   ● Evading immune destruction

● Ultimately: activation of invasion and metastasis

Question 2

How does chemo therapy work? What are they at greater risk for?

Answer 2

Chemotherapy – attack rapidly dividing cells – toxic to bone marrow

All of GI tract is rapid growing cells – chemo leaves individuals prone to ulcerations/infections
Therapy-induced nausea countered with anti-emetic therapy

Hair and follicles – hair loss may be temporary

-At risk for infection and hemorrhage

Question 3

“chemo brain” symptoms?

Answer 3

Weakness, lack of energy, and depression

Question 4

Excisional Biopsy Vs Incinsional Biopsy?

Answer 4

Excisional biopsy – complete removal of area – margins of healthy tissue – mastectomy, partial colectomy

Incisional biopsy – removal of portion of lesion – lymph node biopsy – muscle mass biopsy

Question 5

What is Hypertrohy? What is it a response to?

Answer 5

-increase of cell size

-response to mechanical load or stress – increased use increase the size of tissue or organ

“over nourished”

kidneys – increase stimuli will increase the size of the organ through atrophy from transplant

Uterus – pregnancy – physiological – fibroids – pathological NOT in cases of endometriosis

Question 6

What are the 3 ways in which radiation therapy causes DNA damage?
What does effective cell killing require?

Answer 6

■ Lethal: cell is killed

■ Potentially lethal: cell is severely affected so that the modifications in its environment will cause death

■ Sublethal: cell can subsequently repair itself

Effective cell killing requires good local oxygen delivery

Question 7

What is syndrome of Cachexia?

Answer 7

Muscle weakness and wasting of the body – type of energy disorder (increased resting energy expenditure)

a wasting syndrome that leads to loss of skeletal muscle and fat,

Patients that have cachexia will no longer respond to cancer treatments

This is the end stage of cancer - this is a systemic organ shut down that we will not recover from

Question 8

Side effects to radiation therapy?

Answer 8

Side effects of treatment – fatigue & skin changes – hair loss and mouth problems depending on where the cancer is

Usually lasts 2 weeks to 2 months – can last for months or years as healthy cells take time to recover

Question 9

What is Neoplasia?

Answer 9

○ “New growth”
○ May be referred to as tumour

-Uncontrolled abnormal growth (cells that aren’t related to anything)

○ Either benign or malignant

Question 10

What is most commonly done if tumour is benign?

Answer 10

Surgical removal

Question 11

What does Radiation do to cancer? What does it do to normal tissue?

Answer 11

Radiation causes slow changes in cancer and irreversible damage in normal tissue ■ (normal tissue has a maximum lifetime dose that it can tolerate)

○ Well suited to treat localized disease that is hard to reach by surgery (e.g brain)

Question 12

Ionizing radiation damages?

Answer 12

cancer cell’s DNA

Question 13

Potential causes of Atrophy?

Answer 13

Can be physiological (occurs naturally) or pathological:
-pressure
-Change in use of organ not related to the aging process – consider a stroke victim – the shrinkage of their muscles is due to their inability to use their limb – similar to aging, but still considered to be pathological
blood supply - Could be cut off to that area
nutrition - decrease in nutrition
hormonal stimulation
nervous system stimulation

Question 14

What is Hyperplasia? What are some physiological types?

Answer 14

Increase in cell number - increased rate of cellular division

Compensatory - adaptive mechanism think regeneration on liver cells after liver transplant

Hormonal – estrogen dependent organ – uterus – endometrium thickens in anticipation of pregnancy – hyperplasia/hypertrophy if pregnant, endometrial sloughing if not- Mentstal cycle

Question 15

What is dysplasia? It is most common in?

Answer 15

-Changes in the size, shape, organization, and appearance of cells (abnormal size, shape, and organization of cells – also called atypical hyperplasia – not always related to cancer)

common in cervix and respiratory tract – if the cause is removed the changes are reversible

sporadic growth (“pre cancer” cells)

Often a precursor for malignancy - This means that there are cells there that have the potential to cause cancer but means you DO NOT HAVE CANCER
can remain stable
can regress & disappear
can progress to an invasive metastatic cancer

This is setting you up for cancer

Question 16

What is syndrome of Cachexia?

Answer 16

Muscle weakness and wasting of the body – type of energy disorder (increased resting energy expenditure)

Patients that have cachexia will no longer respond to cancer treatments

This is the end stage of cancer - this is a systemic organ shut down that we will not recover from

Question 17

Side effect to hormone and immunotherapy cancer treatment?

Answer 17

immunotherapy – muscle aches, SOB, edema, HA, weight gain, diarrhea

Hormone therapy – bloating, breast swelling, headaches, mood changes, nausea

Question 18

Pain is one of the most (blank) manifestations of cancer, little to no pain is felt during the (blank) stages of (blank)

What influences cancer pain?

Answer 18

1.) Feared

2.) early stages

3.) of malignant disease

Influenced by fear, anxiety, sleep loss, fatigue, and overall physical deterioration

Question 19

What is Metaplasia? What is it caused by?

Answer 19

Reversible replacement of one mature cell by another, sometimes less differentiated, cell type This is where cancer starts growing

Caused by chronic injury or irritation – reprogramming of stem cells in response to signals generated from cell’s environment – best example is the effect smoking has on the airway.

Question 20

How are vaccines used in cancer treatment/therapy?

Answer 20

Vaccines to prevent diseases that are known to cause cancer

Question 21

What are the goals of radiation cancer therapy? Rapidly growing cells are more?

Answer 21

Eradicate cancer without excessive toxicity
Avoid damage to normal structures

Pre or post operative
○ May be with surgery and/or chemo
○ Kills cancer cells while minimizing damage to normal structures

Rapidly growing cells are more radio sensitive

Question 22

Classification and staging of cancer

Answer 22

Stage 1 – confined to the organ of origin

Stage 2 – locally invasive

Stage 3 – spread to regional structures, such as lymph nodes

Stage 4 – spread to distant sites, liver to lung, prostate to bone

Question 23

What is wasting syndrome? What is it an increase in?

Answer 23

increased resting energy expenditure

-It is an increase in apoptosis and decrease in regeneration

Loss of myofibrillar proteins in muscle cells = muscle weakness/fatigue
○ Abnormal protein/amino acid metabolism = causes cachetic muscle

Question 24

What is cachexia? What are the main clinical manifestations?

Answer 24

-Multiorgan syndrome ( a wasting syndrome that leads to loss of skeletal muscle and fat)

-○ Profound weakness, anorexia, anemia

● Common with most solid tumours
● More common in children and elderly

Question 25

What is Anemia? What can cause it in cancer therapy? Signs/symptoms?

Answer 25

-Decrease in hemoglobin in the blood Caused by lack of transfer of iron from storage to blood cell precursors (Lack enough healthy red blood cells to carry adequate oxygen to your body’s tissues)

-Cytotoxic chemotherapy can cause it

○ Malignancy in blood-forming organs (Tumour invasion into bone marrow)

-Pale
-light headed
-Not enough 02
-Lack of energy

-Treatment: administration of erythropoietin
○ Disadvantage: increases risk of blood clots and decreases cancer survival

Question 26

Potential causes of Atrophy?

Answer 26

Can be physiological (occurs naturally) or pathological:
-pressure
-hange in use of organ not related to the aging process – consider a stroke victim – the shrinkage of their muscles is due to their inability to use their limb – similar to aging, but still considered to be pathological
blood supply - Could be cut off to that area
nutrition - decrease in nutrition
hormonal stimulation
nervous system stimulation

Question 27

Causes of cancer-associated pain?

Answer 27

-Can be both direct and indirect

○ Direct pressure
○ Obstruction
○ Invasion of sensitive structures
○ Stretching of visceral surfaces
○ Tissue destruction
○ Infection
○ Inflammation

*Specific sites are more prone to cancer pain

*Pain treatment: NSAIDs, narcotics, palliative surgery, radiation therapy

Question 28

Why is scheduling of chemotherapy medication important?

Answer 28

to avoid medication resistance

Question 29

“-oma” Vs “-sarcoma, carcinoma” suffix?

Answer 29

-Oma:
-Bengin
-Cells are well differentiated
-Grow slowly
-Local effects (only grow locally)
-Non-invasive
-Do not metastasize

sarcoma, carcinoma:
-Cancer
-Grow rapidly
-non-encapsulated
-Generlized effects
-Invasive (sends out crap like ectentions)
-Metastasis (can spread distantly)

Question 30

Needle aspiration Vs Exfoliative cytology?

Answer 30

Needle aspiration – small gauge needle removes dissociated cells – thyroid, breast

Exfoliative cytology – brushing of tissue from surfaces – skin, throat, colon

Question 31

How does chronic inflammation increase your risk for cancer?

Answer 31

Proliferation of cells alone does not cause cancer, but it has a greater chance in an inflammatory environment

Cytokine is released from inflammatory response – these cytokines can promote the growth of tumor cells,

Free radicals produced in the inflammatory response, or the production of Reactive chemical species can damage DNA and promote mutations these damaged healthy cells

DNA damage (initiation) - Inflammatory microenvironment (promotion) - Proliferation (progression) - Aniogensis (Invasion & metastasis)

Question 32

Ex of Atrophy? what is it caused by?

Answer 32

Cerebral atrophy – destroys connections – caused by stroke, traumatic brain injury, Alzheimer’s,

Question 33

How do single agent and multiple factor agents in chemotherapy work?

Answer 33

1.) Single agents will only shrink cancer and are rarely curative

2.) Multiple agents (chemo cocktails) are given at specific time intervals to attack cancer cells from different angles – more successful (target vulnerabilities in cancer cells)

Question 34

What does chemotherapy attack? How is it a balancing act?

Answer 34

Chemotherapy attacks fast growing cells – typical of cancer cells – travels throughout the body and can damage other healthy cells
- bone marrow
- hair follicles
- cells in the mouth, digestive tract, and reproductive system

Balancing act to determine strength to fight cancer while not damaging too many healthy cells and avoid side effects

Question 35

cachexia involves alterations in? What does it depend on?

Answer 35

○ Heart function
○ Liver protein synthesis
○ Hypothalamus mediators
○ Brown adipose tissue/GI function

● It is an energy balance disorder: ↓ in energy intake and ↑energy expenditure. Depends on tumor type and its growth phase

Question 36

How does hormone and immunotherapy cancer treatment work?

Answer 36

Immunotherapy: initiate an immune response, boost an inadequate response, convert a tumour-protective response to a tumour destructive response

• Unique antigens on cancer cells can be targeted by T cells
• Vaccines against oncogenic viruses provide protection and prevent onset of viral-induced tumors

Hormonal Therapy:
-Deprive cancer cells of hormone signals to divide

It targets cancers that use hormones to grow – can slow or stop the growth of cancer
- Can add, block, or remove hormones

Question 37

What is Cancer IN STIU?

Answer 37

Cancer in situ are in epithelial cells – precancerous state

Early stage they have not become invasive – not considered malignant. Seen in cervix, mouth, stomach, breast and large bowel

1 – can remain stable for extensive period of time
2 – can progress to invasive metastatic cancer
3 – regress and disappear
(it develops its own blood supply and this is how its feeding its growth and spreading its cells throughout the body)

Question 38

What are the side effects of chemotherapy?

Answer 38

atigue, hair loss, easy bruising, infection, N & V, anemia, appetite changes

Question 39

Malignant tumors may secrete various symptoms that cause?

Answer 39

● Increased ADH secretion
● Excess ACTH production
● Hypercalcemia
● Pro-coagulation factors

Question 40

What is the physiological understanding of cancer pain related to a decrease in muscle contractibility?

Answer 40

■ Loss of muscle function due to cancer treatment metabolic products and circulating
cytokines (TNF, IL-1)

Question 41

What is alopecia and skin erythema?

Answer 41

Alopecia: hair loss resulting from chemotherapy effects on hair follicles. Temporary

Skin erythema: redness caused by radiation

Question 42

What are Paraneoplastic syndromes?

Answer 42

● Symptom complexes that are triggered by a cancer but are not caused by direct local effects of tumour mass

● Rare, but they may be the earliest known symptoms of an unknown cancer and can be life-threatening/irreversible

(a group of rare disorders that occur when the immune system has a reaction to a cancerous tumor known as a “neoplasm)

Question 43

Potential causes for cancer?

Answer 43

Multifactorial:
■ Alterations in genes

■ Various risk factors (Age, tobacco, genetics (e.g. down
syndrome, ALK disease), gender, alcohol, chronic inflammation, infection (H. pylori, Herpes, HPV, Hepatitis), occupation, ionizing radiation, early menarche/late menopause/few pregnancies, # of sexual partners, UV, obesity, diet)

Question 44

Risk factors for Cancer?

Answer 44

Hereditary – if a cancer appears more frequently in a family, but is not hereditary they are labeled as familial cancer

-Genetics – born with a gene mutation that may make you more likely to develop certain cancers – 5-10% of cancers are hereditary
Example - Down syndrome – more likely to develop acute lymphocytic leukemia

Hormones – post menopausal women taking hormone replacement therapy are at an increased risk of developing breast cancer

Question 45

ABCDE for mole growth?

Answer 45

A: Asymmetry
B: Border
C: Color
D: Diameter
E: Evolving

Question 46

What is the most reported symptom of cancer/treatment? What is it described as? What is it caused by?

Answer 46

-Fatigue

-Described as: tiredness, weakness, lack of energy, exhaustion, lethargy, inability to concentrate, depression, sleepiness, boredom, and lack of motivation

● Caused by dysregulation of physiologic, biochemical, and psychological systems

Question 47

Causes of Paraneoplastic syndromes?

Answer 47

-Immune response triggered by tumour (antibody response that attacks NS and causes neurological disorders)

-Biological substance from tumour (e.g. hormones, cytokines)
■ Ex: some release of serotonin, which causes flushing, diarrhea, wheezing, rapid heart rate

Question 48

How do single agent and multiple factor agents in chemotherapy work?

Answer 48

1.) Single agents will only shrink cancer and are rarely curative

2.) Multiple agents (chemo cocktails) are given at specific time intervals to attack cancer cells from different angles – more successful

Question 49

Ex of Paraneoplastic syndromes?

Answer 49

Examples of syndromes: cushing’s syndrome, SIADH, hypoglycemia, myasthenia, venous thrombosis, anemia, nephrotic syndrome etc

Question 50

Leukopenia Vs thrombocytopenia?

Answer 50

● Leukopenia: decreased total white blood cell count - Direct invasion of bone marrow

● Thrombocytopenia: decreased number of platelets

Question 51

Factors that predispose cancer patients to infection?

Answer 51

○ Age
■ Old age: decline in immune system, immobility, nutritional inadequacies

○ Tumour
■ Nutritional derangements, certain sites favour growth of microorganisms, immobility, immune defects, metastasis to bone marrow

○ Leukemias
■ Inadequate granulocyte production, thrombocytopenia, Pneumosystis carinii can develop

○ Lymphomas and other mononuclear phagocyte malignancies
■ Immune defects, splenectomy in children

○ Surgical treatment
■ Interrupts first line of defense, hemorrhage, dead spaces, decreased perfusion, nutritional
derangements, immobility

Question 52

What is Atrophy? Where is it most commonly seen?

Answer 52

decreasing of cell size – not numbers – leads to a decrease in the size of the organ - lack of nutrition

most commonly seen in skeletal muscle, heart, secondary reproductive organs, & brain
(Number of cells didn’t change, the cell sizes became smaller)

Question 53

Causes of thrombocytopenia? What is it a major cause of?

Answer 53

Caused by direct tumour invasion of bone marrow

● Chemotherapeutic drugs are toxic to dividing cells in bone marrow, causing
granulocytopenia/thrombocytopenia

-Is a major cause of hemorrhage and It also accompanies disorder of disseminated intravascular coagulation that occurs in acute
promyelocytic leukemia

Question 54

Anaplasia Vs Pleomorphism

Answer 54

Anaplasia: Poorly differentiated cancer cell

Pleomorphism: Varied shapes of cancer cells (variability of size and shape) - referred to as “pleomorphic”

Question 55

What is Granulocyopenia?

Answer 55

lack of granulocytes – innate immune system

Question 56

Debulking surgery Vs Palliative surgery Vs Prophylactic surgery?

Answer 56

Debulking surgery – reduces the size of the tumour to relieve symptoms – not curative

Prophylactic surgery – individuals who have certain markers and likely to develop cancer will have potential organs removed

Palliative surgery - surgery to interrupt pain signals, stent placements to relieve obstruction

Question 57

Clinical manifestations of cancer?

Answer 57

● Depend on localization and type of tumor

● Symptom variety/intensity will increase as malignancy progresses (as the cancer gets worse the symptoms get worse)