Neoplasms... Dun Dun Dunnnnn Flashcards
a growth that usually does not cause cancer or have the capability to cause
Benign
a growth that has the capability of causing cancer and
malignant
A malignant neoplasm
Cancer
any abnormal growth of new cells aka tumor
• Not all form tumor masses (leukemia)
• Can be benign or malignant
Neoplasm
a growth that can be benign or malignant
• Named after the cells from which they arise
Tumor
the study of neoplasms
Oncology
Number one cancer for females
Breast Cancer
Number one cancer for males
Prostate Cancer
Number one cancer that kills
Lung Cancer
7 Hallmarks of Cancer
- Self-sufficiency of growth (“go”) signals
- Evasion of growth suppression
- Cells divide indefinably (unlimited reproduction
- Avoid apoptosis (programmed cell death)
- Recruit nutrients via growth of new blood supply (angiogenesis)
- Invade nearby tissue and spread to distant tissue (malignant neoplasms only)
- Evade immune surveillance
Cause of cancer
• Damage to DNA- root cause of all neoplasms
T/F- • Most of the time the link between disease and behavior or environment is not obvious
True
Environmental factors that stimulate cancer development
- Chemicals
- Dyes
- UV light
- Viruses
- Chronic Inflammation
- Smoked Food
- Genetically predisposed cancer
4 Categories of Mutant Genes
- Proto-oncogenes
- Tumor Suppressor Genes
- Genes that regulate apoptosis
- DNA repair genes
o The “go” genes
o RAS genes-control the transcription of genes that control cell growth and proliferation
o Overexpression and amplification of cell growth
Proto-oncogenes
Characteristics of Proto-Oncogenes
RAS Attaches to a GTP to turn the cell growth on
Off- destruction of GTP molecule
90% of this cancer are caused by RAS genes
Pancreatic Cancer
o The “stop” switches that restrain cell growth by producing proteins that inhibit cell dividing – stop to repair or destroy so the bad cell growth doesn’t continue
o If damage occurs here- the cells divide uncontrollably
Tumor Suppressor Genes
This is a mutant tumor suppressor gene that causes 50% or more of cancers
P53 gene
This gene encourages breast cancer
BRCA gene
Characteristics of the BRCA gene
-Can genetic test to see if you have this mutation
-• Not allow for repair of damage DNA
If you have a mutation in the BRCA gene it doesn’t allow for the P53 gene
T/F- * Carcinogenesis is a multistep process- no single mutation is capable of causing a neoplasm- cancers arise from the accumulation of multiple mutations
True
Inheritable germ cell defects- increase risk of cancer to a certain degree but they do not guarantee it
• Inheritable cancer syndromes:
chaotic cell growth (reversible and so is metaplasia)
o When it becomes serious it is called carcinoma in situ
Dysplasia
o Confined to the epithelium- can’t reach blood vessels so it is not invasive
carcinoma in situ
What is the slowest process of malignancy?
The initial mutation to occur and develop
T/F- • Neoplasms grow by forming a clone
True
a tumor composed of multiple sets of cells that differ a little from all of the rest
Tumor Cell Heterogeneity
Describe survival of the fittest in neoplasm
o Highly malignant cells tend to survive and the less malignant cells die
o Tumors that find/have a blood supply are the most likely to survive
o Tumor cells have exponential growth
the fraction of dividing cells- determines the cell growth rate
Growth Fraction
What types of tumor are effected by chemotherapy
o Tumors with a high growth fraction are usually effected by chemotherapy (more sensitive to drugs that inhibit cell division)
-higher amounts of cells are dividing
How many generations does it take until the tumor is the size of a grape?
30
The degree to which the neoplasm resembles normal tissue in structure and function- degree of specialization
Degree of Differentiation
tissue is normal
o Benign cells
Perfectly differentiated
tissue shows some resemblance of normal tissue (appearance and function)
o Grow slowly and are slow to invade and late to metastases
Well differentiated
tissue show little to no resemblance of normalcy (appearance and function)
o Grow rapidly, invade aggressively, and metastasize early
o Lose function of that organ- and that can manifest to other symptoms
o Malignant cells are usually poor differentiated
Poorly differenced
Loss of differentiation
anaplasia
Lack of differentiation
Pleomorphism
Dark nuclei due to extra genetic information
Hyperchromatism
How are neoplasms nourished?
- Must have nourishment from the bloodstream
* Must develop their own network of blood vessels through angiogenesis
Characteristics of tumors with blood supplies
o Tumors with rich nourishment are more prone to metastasize because blood vessels are accessible for invasion
o Tumors need O2
o Cancers have a higher metabolic rate (why one of the biggest symptoms is weight loss)
o Any cell divisions increases the metabolic demand
the direct extension of a tumor into adjacent tissue
o Need lymphatic tissue and blood supply
Invasion
the discontinuous spread of tumor from one site to another and it is the most reliable sign of malignancy
Metastasis
What are the 3 types of metastases?
- seeding
- lymphatic spread
- hematogenous spread
- Tumor cells float from point to point in body fluid
* Tumor implants to adjacent tissues
Seeding
This type of metastasis is seen in ovarian cancer and gastric carcinoma
Seeding
- Tumor cells invade lymphatic vessels and go into the lymphatic chain by the flow of lymph fluid
- Enlarged lymph nodes could present
- Increased filtration can result in splenomegaly- because it is trying to filter more
Lymphatic spread
- Occur as tumor cells invade blood vessels
- Veins are typically invaded easiest because the walls are thin
- Tumor cells follow natural venous flow
Hematogenous Spread
What 2 organs do metastases tend to travel to?
- Liver
- Lungs (both highly vascularized)
What are clinical signs of cancer
- Unintentional weight loss
- Fatigue
- Night sweats
- Chills
- Aches
- Anorexia (loss of appetite`)
When is it almost guaranteed that your patient has colon cancer?
if there is blood in the stool in a patient over 50 and they lost weight
causes headaches, loses peripheral vision, highly vascularized, brain tumors whether they are benign or malignant cause headaches
Pituitary adenoma
What are distant effects of cancer?
- Hyponatremia
- Hypercalcemia
- Hypo/Hyperglycemia
- High metabolic rate
What are procoagulant proteins?
o Cancers that can amplify procoagulent proteins- can increase your chances of clotting and could be cause of cancer and increases procoagulent proteins
What cancers have high procoagulant proteins?
Kidney and stomach cancer have a high rate of these
The immune system’s ability to recognize and attack non-self-invaders
Immune Surveillance
Clinical Manifestations of Cancer
- Pressure- due to the tumor expanding onto nearby tissue
- Infection of Bleeding- from ulceration or surfaces
- Infarction or Rupture
- Generalized wasting (cachexia)
- Production of hormones- effect different organs
What is neoplastic syndrome?
a set of systemic symptoms not due to local or metastatic spread of a tumor
What are examples of effects caused by neoplastic syndromes?
o Caused by hormones o Mental aberration o Hypercalcemia o Hypoglycemia o Thrombophlebitis
a progressive loss of weight accompanied by weakness, lethargy, fatigue, and anemia’
Cachexia
Characteristics of cachexia
o Causes fat and muscle loss
o Poor appetite and increased basal metabolic rate
o Wasting
o Can be given appetizing pills that make them want to eat
the study of individual cells for any abnormalities
o Ex. Pap Smear
Cytology
a thin needle is inserted and clusters of cells and fluid are aspirated and put onto a slide for reading
o Seen in thyroid nodules after
o A nodule bigger than an 1 cm
Fine Needle Aspiration
physically separating and sorting individual cells according to characteristics
o Leukemias and blood cancers
o Spin them down and separate them
Flow Cytometry
a collection of intact pieces of tissue to be examined
o Breast, prostate, lung, pancreatic
o Multiple samples of tissues themselves – looks at staging too
Biopsy
Bathing a biopsy specimen with antibody against specific tumor proteins to see if they attach to tumor cells- this indicates that tumor proteins are present
Immunohistochemistry
substances produced by normal or neoplastic tissue that may appear in the blood at increased levels in the presence of a neoplasm
o Can be very useful in early detection of cancers
o Useful in confirming the diagnosis
Tumor Markers
Carcinoembryonic Antigen (CEA)
Type of tumor marker
• Do not use for early detection but use for reoccurrence
• Specific to the colon- do other testing as well
• Rise in CEA levels could be a sign of reoccurrence
Alpha-fetoprotein
Type of tumor marker that is used for Liver cancer- it is elevated
CA 19
Type of tumor marker that is used for pancreatic cancer
Prostate Specific Antigen
- Used for prostate cancer screening- monitor the trend of the levels, not the actual levels
- Larger prostate = increased levels of PSA
- Look for spikes in trend- do some further testing
Pap Smears
• Taking a sample of cervix and look for cell differentiation
a mass that protrudes from an epithelial surface
Polyp
grows in a fern like pattern with prominent folds
Papilloma
hollow center
Cystic
Describe grading
the assessment of the degree of differentiation, nuclear atypical, mitotic figures, and gross structures
o Done under a microscope and looking for differentiation
o “How bad does the tumor look?”
Describe staging
- An evaluation of tumor behavior o 1, 2, 3, 4 o 4- Metastasized o 2 and 3- Lymph node involvement o “What is the tumor doing” TNM system- • T= size of the primary tumor • N= extend of lymph node involvement • M= metastasis beyond lymph nodes
Describe surgery
removal of the tumor
Most common
Are cancers that are too advanced that surgery is not an option
Describe radiofrequency ablation
destroy the tumor without removing it
• Inserting a probe that emits high frequency radio waves that heats the tissue to the point of necrosis
Describe cryotherapy
freezing a tumor until necrosis
Describe laser therapy
used to treat superficial cancers by burning the tumor away
Describe radiation therapy
damage DNA so that cell division stops
Shrink cells or kill the floating ones
What is the most important thing ever in care of neoplasms
Early Detection: Make sure everything is is up to date with care
What is the early detection test for cervical cancer?
Pap smear
When should you get your first pap?
21 years old or 3 years after you first start having sex
How often do you get paps between the years of 21 and 30?
every year
How often do you need to get a pap when you are over 30?
Every 2 to 3 years- If you have a history of normal paps
If the patient has a hysterectomy (not because of cancer) do they need a pap?
Nopers
What is the early detection test for breast cancer?
Mammogram
When do you get your first mammogram?
Baseline at 35
If your baseline mammogram is normal how often do you go after that?
Annually starting at 40
If you have a family history of breast cancer when do you get your first mammogram?
Earlier than 35
T/F- Mammograms are compared year to year?
TRUE DUHH
What is the preventative test for colorectal cancer?
Colonoscopy
What is the point/goal of a colonoscopy
get in there and look for polyps (pre malignant neoplasms)- remove the polyp the pre malignant polyp
Is colorectal cancer preventative if it is caught in a colonoscopy?
Yeahhhh mannn
When is a colonoscopy first needed?
Age 50
If your colonoscopy is normal at age 50, what happens then?
Repeat in 10 years- after 3 years you are done
What if you have a family history of colorectal cancer?
They will screen 10 years earlier
Is a sigmoidostomy sufficient enough?
NOPEEEERRRSSS
What is the preventative screening test for prostate cancer?
PSA levels (prostate specific antigen)
When do you start monitoring your PSA levels?
At 50
What do you watch with PSA levels?
The trend of the levels
If there is blood in a patients stool, what is that indicative of?
Colorectal Cancer
Who is at the highest risk for lung cancer
Smokers
Is a chest x ray sufficient for lung cancer screening?
No- it can mill a lot and you probably wont be able to see something small
What is a better testing alternative for lung cancer?
Low residue CAT scan
When should a low residue CAT be ordered?
If the patient is over 50 and they have a 30 pack/year smoking history
Describe pack/year measurements
number of years you have smoked*how many packs a day you smoke
How does a CAT scan work
It takes small pictures of your lungs to see if there are any nodules
T/F- CAT scan screening shows up with enlarged perihylar lymph nodes with a lung lesion- it will be malignant process not to be ignored
True
