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Internal Med > Oncology > Flashcards

Oncology Flashcards

1
Q

Oncology/Cancer

A

refers to a large group of diseases characterized by uncontrolled cell proliferation and spread of abnormal cells

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2
Q

Malignant cells

A

differentiation is altered and may be lost completely

completely lost identity with the parent tissue is considered as undifferentiated (anaplastic)

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3
Q

The less differentiated a tumor becomes….

A

the faster metastasis occurs and the worse the prognosis is

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4
Q

Dysplasia

A

a disorganization of cells in which an adult cell varies from its normal size, shape or organization

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5
Q

Metaplasia

A

first level of dysplasia

  • reversible and benign but abnormal change in which one adult cell changes from one type to another
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6
Q

Anaplasia

A

loss of cellular differentiation

the most advanced form of metaplasia and is considered the hallmark feature of malignant disease

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7
Q

Meta-

A

indicating change, alteration

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8
Q

Hyperplasia

A

increased number of cells in tissue or tissue mass

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9
Q

Neoplastic hyperplasia

A

the increase in cell mass due to tumor formation and is an abnormal process

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10
Q

-plast

A

living substance, organelle

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11
Q

Tumors (neoplasms)

A

abnormal new growth of tissue, serves no useful purpose, may harm host by competing for vital blood supply and nutrients

benign vs malignant

primary - tumor in pancreas
secondary - tumor/cancer cells in pancreas expands to liver

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12
Q

Carcinoma in situ

A

localized, pre-invasive, and possibly premalignant tumor of epithleal tissue

contained within the host organ and have not broken through basement membrane

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13
Q

Classification of neoplasm

A

cell type, tissue of origin, degree of differentiation ,anatomic site, benign vs malignant

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14
Q

Classification by cell type

A

epithelial tissue, connective tissue and muscle, nerve tissue, lymphoid tissue and hematopoietic tissue

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15
Q

Benign tissue suffix

A

-OMA

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16
Q

Malignant tissue suffix

A
  • SACROMA
  • CACINOMA

and lymphoma

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17
Q

Staging

A

stage of disease reflects the rate of growth, extent of the neoplasm and the prognosis

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18
Q

Stage 0

A

carcinoma in situ (premalignant, preinvasive)

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19
Q

Stage 1

A

early stage, local cancer

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20
Q

Stage 2

A

increased risk of spread because tumor size

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21
Q

Stage 3

A

local cancer has spread but may not be disseminated to distant regions

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22
Q

Stage 4

A

cancer has spread and disseminated to distant sites

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23
Q

TNM Staging system (Tx, T0, Tis, T1, T2, …)

A

T: Primary tumor
N: Regional lymph nodes
M: Distant metastasis

x = can not be assessed
0 = no evidence of tumor
IS = carcinoma in situ (confined to site of origin)
1, 2, 3, 4; progressive increase in tumor size and involvement locally

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24
Q

Grading

A

numerical score or scale done by pathologists for different types of tumors

lower the value the lower the tumor grade and the better differentiation of tissue within the tumor

a highly scored/scaled tumor is considered a high-grade tumor with poor cellular differentiation and a tendency to metastasize early

high score is bad (i think)

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25
Q

Incidence commonly diagnosed cancers

A

most commonly diagnosed cancers are lung, breast and colorectal

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26
Q

most prevalent cancer in the world is

A

lung cancer

lung cancer accounts for the largest number of cancer deaths worldwide

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27
Q

Gender-based incidence

A

men; prostate, lung and bronchus and colon/rectum most common

women; breast, lung and bronchos and colon/rectum

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28
Q

Etiology (two main causes)

A
  1. endogenous (genetic) origin
  2. Exogenous (environmental or external) origin
29
Q

How does most cancer develop

A

as a result of multiple environmental, viral, and genetic factors working together
to disrupt the immune system, along with the failure of an aging immune system, to recognize an scavenge the less differentiated cells

30
Q

What are the most common cancers showing a familial pattern?

A

prostate, breast ovarian and colon cancers

31
Q

What % of cancers are caused by nearly 500 different cancer-causing agents

A

50%

32
Q

Carcinogens

A

etiologic agents capable of initiating the malignant transformation of a cell

33
Q

Risk factors for cancer

A

heredity, aging, lifestyle, geographic location and environmental variables, ethnicity, precancerous lesions, stress

34
Q

Pathogenesis of cancer; somatic mutation theory

A

the concept that neoplasia originates in a single cell by the acquired genetic change was proposed and remains today the view of cancer pathogenesis most supported by experimental evidence

35
Q

What discovery laid the foundation of modern cancer cytogenetics (study of chromosomes in cancer)?

A

chromosomal aberration (change in structure/number of chromosomes) is one of the basic mechanisms of tumor cell proliferation

36
Q

How does chromosomal changes contribute to malignant process?

A
  • remains unclear
  • chromosomal rearrangements may lead to oncogene activation

another proposed mechanism suggests that chromosomal changes inactivate a tumor suppressor gene through chromosomal deletion

37
Q

Current theory of oncogenesis

A

oncogenes; cancer-causing genes or proto-oncogenes

they have the ability to transform normal cells into malignant cells independently or incorporated with a virus

both oncogenes and tumor supressor genes are present in their normal nonmutated form in cells and contribute to the regulation of cell division and death

38
Q

Tumor suppressor genes

A

have the opposite effect of oncogenes (anti-oncogenes)

39
Q

Cancer stem cell hypothesis

A
40
Q

Carcinogenesis

A

process by which a normal cell undergoes malignant transformation

**Just know its MULTSTEP

involving progressive changes after genetic damage to or alteration of cellular DNA through the development of hyperplasia, metaplasia dysplasia, carcinoma in situ, invasive carcinoma, metastatic carcinoma in that order

41
Q

Immunosurveillance

A

how do we know the immune system plays a role in cancer? ;

  • a higher incidence of cancer after immunosuppression or in immunodeficiency
  • infiltration of tumors by lymphocytes and macrophages
  • lymphocytes proliferation in response to tumors
  • regression of metastases after ablation of the primary tumor
  • immune-mediated spontaneous regression of human tumors
42
Q

Tumor-Specific antigens (TSAs)

A

TSAs are uniquely expressed by tumor cells and are not expressed by normal cells

T cells recognize different types of tumor antigens

43
Q

Tumor-associated antigens (TAAs)

A

Expressed by tumors AND normal cells

higher level on tumors relative to normal cells or are expressed at different stages of development or differentiation

44
Q

Major immune responses against tumors

A
  • involves both innate and adaptive immunity

big players:

  • NK cells
  • macrophages
  • Cytotoxic CD8 + T cells (cytotoxic T lymphocytes)
45
Q

Macrophages (what is required for them to be activated?)

A

tumor antigen-specific CD4 + T cells and B cells are required for antibody production and cytokine activation of macrophages

46
Q

Why is immunity often insufficient to clear tumors? Why does cancer develop in an immunocompetent individual

A
  • malignancies proliferate at such a rapid rate that immune defenses are simply overtaken
  • many tumors are weak immunogens, perhaps because they vary only slightly from self-antigens
  • tumors have also evolved to evade innate and adaptive immune responses known as immune escape
47
Q

Know tumor evasion strategies

A
48
Q

How do malignant tumors differ from benign tumors in regards to invasion and metastases?

A
  • malignant tumors differ from the benign in their ability to metastasize or spread from th eprimary site to othe rlocations in the body
49
Q

When does metastasis occur

A

when cells break away from the primary tumor, travel through the body via the blood or lymphatic system and become trapped in capillaries of organs

50
Q

5 most common sites of metastasis

A

lymph nodes, liver, lung, bone, brain

51
Q

table 9.3

A
52
Q

Seed vs Soil theory of metastasis

A

some cancers favor certain sites of metastasis over others so that metastases only occur if the cancer cell (seed) finds favorable microenvironment at the site of the host (the soil)

aka certain tumor cells seem to have specific affinity for certain organ

traditional cancer treatment targets seed whereas todays research also focuses on the soil (target site)

53
Q

How many % of clients with newly diagnosed cancers have clinically detectable metastases?

A

30 %

54
Q

At least __ % of the remaining clients who are clinically free of metastases harbor occult (hidden) metastasis

A

30-40%

55
Q

Why is complete surgical removal of disease impossible?

A

most people have multiple sites of metastatic diseases

56
Q

Where is metastasis is more likely to occur?

A

veins (opposed to arteries) because the cancer cannot break through the arterial wall

57
Q

Key factors to cancer cure

A

eradicating metastases

58
Q

What is required for a tumor to grow?

A

depends on its ability to gain access to an adequate supply of blood and sometimes hormonal factors

59
Q

Mechanisms of metastasis

A

angiogenesis - blood vessels from preexisting vessels grow into the solid tumor

tumors excrete acid-like enzymes that dissolve the basement membrane and break through to the lymphatics

cancer cells can enter the bloodstream where lymph nodes drain into veins

60
Q

Metastic spread usually occurs within ___ years after initial diagnosis and treatment of malignancy

A

3-5

61
Q

Where is metastasis most common to occur?

A

areas of the body that provide environment rich in nutrition

  1. pulmonary system (lungs)
  2. hepatic system (liver)
  3. skeletal system (bone)
  4. CNS
62
Q

Pulmonary system

A

most common of all metastatic tumors

venous drainage of msot areas of the body is through the superior and inferior venae cavae into the heart, making the lungs the first organ to filter malignant cells

symptoms;
- dry cough
- pleural pain
- shortness of breathe or dyspnea
- hemoptysis

63
Q

Hepatic system

A

bc the liver filters blood coming in from the gastrointestinal tract, its primary metastatic site for tumors of the stomach, colorectum and pancreas

symptoms;
- abdominal or right upper Q pain
- general malaise and fatigue
- anorexia
- early satiety and weight loss
- low grade fevers

64
Q

Skeletal muscle (bone)

A

osteolytic type - decreased bone density

65
Q

CNS - brain

A
66
Q

CNS - spinal cord

A
67
Q

Diagnosis of metastasis

A
68
Q

cancer recurannce

A

Internal Med (25 decks)

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