Neoplasm Flashcards
A ____ refers to a mass. This mass can be ___ meaning it is localized to an area or _____ meaning it have the potential to metastasize and spread.
Tumor
Benign
Malignant
____ means new tissue growth that is unregulated, irreversible, and derived from a single (monoclonal) cell
Neoplasia
____ is also monoclonal but may not have achieved unregulated cell growth potential and is often reversible (pre-malignant)
Dysplasia
Tumor nomenclature:
The exceptions of nomenclature:
If the tumor ends in -oma it doesn’t always mean that it is benign. If it end in -blastoma it almost always means malignant
Cancer is the ____ leading cause of death in adults and children
Second
Cancer screening is effective because cancer usually begins as a ___ ___ cell. The goal of screening is to catch ____ before it becomes metastatic cancer.
Single mutated
Dysplasia
Carcinogenesis:
Cancer formation is initiated by DNA damage of ___ ___ which evade’s DNA repair mechanisms and is not lethal to the cell. _____ are agents that damage DNA and include chemicals, viruses and radiation
Stem cell
Carcinogens
Some DNA mutations will disrupt ___ ___, allowing for tumor growth and progression. Disrupted systems include ____, ___ ___ genes, and regulators of ___.
Regulatory systems
Proto oncogenes
Tumor suppressor
Apoptosis
Schematic of carcinogenesis:
The first step of carcinogenesis is called the ___ step. Initiators are agents that can cause DNA damage, but are not by themselves sufficient to cause a tumor. The second step: _____ are agents that can induce tumor formation from initiated cells, but do not damage DNA directly such as ____, ___, and ____.
Initiation
Promoters
Hormones, drugs, and phenols
Picture of initiation and promotion:
____ is an example of a virus that causes cervical cancer
HPV
Hallmarks of cancer cells:
Four classes of normal regulatory genes are primary targets of genetic damage in neoplastic transformation:
Proto-oncogenes are genes that if ____ form oncogenes that lead to unregulated cellular growth. These are genes that encode ___ ___, ___ __ receptors, signal transducers, ___ ___ regulators
Upregulated
Growth factors
Growth factor
Cell cycle
Table of proto-oncogenes:
Tumor suppressor genes regulate cell growth and decrease the risk of tumor formation. ____ and ____ are classic examples
p53
Rb (retinoblastoma)
p53 will stop the cell cycle in response to DNA damage. If repair is not possible, p53 upregulates ____, disrupting ___, and inducing apoptosis
Bax
Bcl2
Both ____ of the p53 gene must be knocked out for tumor formation (Knudson two hit hypothesis).
Copies
Rb regulates progression from __ to __ phase, same as p53. It holds the ___ transcription factor. When Rb is ____ it releases ____. When both copies of Rb are knocked out, ____ is uninhibited allowing for progression through the cell cycle.
G to S
E2F
Phosphorylated
E2F
E2F
Table of tumor suppressor genes:
____ is a regulator of apoptosis. It prevents apoptosis is normal cells and promotes apoptosis in mutated cells. ____ is over expressed in follicular lymphoma and ignores the usual signals for apoptosis and continues to ___.
Bcl2
Bcl2
Proliferate
Other things necessary for tumor development:
____ is necessary for cell immortality. ____ (create their own blood supply) is necessary for tumor survival and growth.
Telomerase
Angiogenesis
Cancer also must avoid ___ ___. Mutations often result in production of abnormal proteins, which are typically expressed on MHC class one and destroyed. But tumor cells evade immune surveillance by ____ ____ ___.
Immune surveillance
Downregulating MHC class I
Tumor progression, and cancer growth is important but the __/___ is more closely related to severe cancer
Morbidity/mortality
Accumulation of mutations eventually results in tumor ability to ____ into surrounding tissues and spread
Invade
Epithelial tumor cells often down regulate _____, which normally attaches epithelial cells to each other. Down regulation leads to ____ of cells
E-cadherin
Dissociation
____ destroys collagen type IV in the basement membrane. Cancer cells attached to ____ in the extra cellular matrix and spread locally. Entrance into ___ or ___ spaces allows for metastasis.
Collagenase
Fibronectin
Vascular
Lymphatic
____ is distant spread of tumor cells. Lymphatic spread is characteristic of ____. Hematogenous spread is characteristic of ___ and some ___, typically spreads to lungs.
Metastasis
Carcinomas
Sarcomas, carcinomas
Seeding of body cavities is characteristic of ___ ___, which often involves the peritoneum
Ovarian carcinoma
___ tumors tend to be slow growing, well circumscribed, distant, and mobile. ___ tumors are usually rapid growing, poorly circumscribed, infiltrative, and affixed to surrounding tissues and local structures
Benign
Malignant
___ is generally required before a tumor can be classified as benign or malignant with certainty.
Biopsy
Histology basics:
____ and ____ testing is used to characterized tumors that are difficult to classify on histology
Immunohistochemistry
Molecular
Picture of benign tumor- follicular adenoma of the thyroid:
Notice the organized growth and uniform nuclei
Picture of malignant tumor- squamous cell carcinoma of the lung:
Notice poorly defined edges , disorganized growth, high nuclear to cytoplasmic ratio
Specific markers for specific tissues, that help define the origin tissue of the tumor
Elevated levels of tumor markers still require a ___ for diagnosis of carcinoma
Biopsy
____ ____: production of substances, by a tumor that are not expected based on the cell or tissue of origin. Example: lung cancer is producing ___ or ___ and presenting with Cushing’s syndrome or hypercalcemia
Paraneoplastic syndromes
ACTH
PTH
Cancer gradings of malignant types:
Microscopic assessment of differentiation. Well differentiated is ___ ___ and resembles normal parent tissue. Poorly differentiated is ___ ___ and does not resemble the original tissue type. Moderately differentiated is somewhere in between.
Low-grade
Hi grade
Grading of tumors is important for determining the ___.
Prognosis
Cancer ____ is assessing how far the tumor has spread. This is the key prognostic factors typically more important than grading. It requires full removal of the tumor. Uses ___ staging system.
T:
N:
M:
Staging
TNM
Tumor size
Spread to regional lymph nodes
Metastasis
Review
Review
Cancer drugs
