Oncopathology 3 Flashcards
 Inherited DNA mutations are known as “…………………” These are present in ………………of the body
1- germline mutations
2-all cells
We can detect “germline mutations” By ………………….
by analysis of cells from the blood such as white blood cells.
Acquired DNA mutations are known as “…………….”. These are present only in the………….. cells
1-somatic mutations
2- tumor
We can detect the somatic mutations by …………..
analysis of tumor cells.
Cancers that are linked directly to specific cancer genes are “……………” and are due to [germline mutations/ somatic mutations] in cancer genes.
1-Hereditary cancers
2- germline mutations
In Hereditary cancer syndromes many ppl have 100% penetrance (meaning all individuals who have inherited the mutation will develop cancer
❌
The correct answers :
1-do not have 100% penetrance
2- not all
Most of Hereditary Cancer Syndromes put the individual at risk of development of [single type of tumor /multiple types of tumors].
multiple types of tumors
Hereditary Cancer Syndromes can present with manifestations other than neoplasms such
as …………..
endocrine dysregulation.
………………is the possibility to express phenotypes based on the genotype.
Penetrance
Types of Hereditary Cancer Syndromes are :
1………………..
2………………..
1-autosomal dominant
2- Autosomal Recessive
The majority of hereditary cancer syndromes are [autosomal dominant/Autosomal Recessive]
autosomal dominant
The majority of the autosomal dominant in the hereditary cancer syndromes are due to
[germline mutations / somatic mutations] in ……………..Genes.
1-germline mutations
2- Tumorsuppressor
The majority of hereditary cancer syndromes are autosomal dominant and majority of those are due to germline mutations in ………………….
Tumor suppressor Genes
Autosomal Recessive hereditary cancer syndromes are mostly due to mutations in genes that affect ………….
DNA repair.
RB is [autosomal dominant/ autosomal recessive] inheritance
autosomal dominant
TP53 is [autosomal dominant/ autosomal recessive] inheritance
TP53 leads to ………… syndrome
1- autosomal dominant
2- Li-Fraumeni syndrome
CDKN2A “Cyclin-Dependent Kinase Inhibitor 2A.” is [autosomal dominant/ autosomal recessive] inheritance
CDKN2A leads to ………….. syndrome
1-autosomal dominant
2- melanoma
APC is [autosomal dominant/ autosomal recessive] inheritance
APC leads to ………… syndrome
1-autosomal dominant
2- Familial adenomatous polyposis (FAP) or colon cancer
NF 1+2 are [autosomal dominant/ autosomal recessive] inheritance
NF 1+2 leads to ………… syndrome
1-autosomal dominant
2-Neurofbromatosis 1+2
BRCA 1+2 are [autosomal dominant/ autosomal recessive] inheritance
BRCA 1+2 lead to …………… syndrome
1- autosomal dominant
2- Breast and Ovarian tumors
MENI+ RET are [autosomal dominant/ autosomal recessive] inheritance
MENI+ RET lead to …………………. syndrome
1-autosomal dominant
2-multiple endocrine neoplasia 1+2
MSH2+6 & MLH are [autosomal dominant/ autosomal recessive] inheritance
MSH2+6 & MLHare lead to ………………. Syndrome
1-autosomal dominant
2- Hereditary nonpolyposis colon cancers
PTCH1 is [autosomal dominant/ autosomal recessive] inheritance
PTCH1 leads to …………… syndrome
1- autosomal dominant
2-Nevoid basal cell carcinoma syndrome
1- genes Which involved in nucleotide excision repair are [autosomal dominant/ autosomal recessive] inheritance
2-These genes lead to ……………….Syndrome
1- autosomal recessive
2- Xeroderma pigmentosum
ATM is [autosomal dominant/ autosomal recessive] inheritance
ATM leads to …………….. syndrome
1-autosomal recessive
2- Ataxia-telangiectasia
BLM is [autosomal dominant/ autosomal recessive] inheritance
BLM leads to …………… syndrome
1-autosomal recessive
2- Bloom syndrome
1- GENES WHICH INVOLVED IN REPAIR OF DNA CROSS-LINK
1- ARE [autosomal dominant/ autosomal recessive] inheritance
2- GENES WHICH INVOLVED IN REPAIR OF DNA CROSS-LINK
LEAD TO …………….. SYNDROME
1-autosomal recessive
2-fanconi anemia
the majority of cancer cases in children are………….,………….., and
…………..
leukemias
CNS tumors
sarcomas
Why the frequency of cancer increases with age ?
1- because of the accumulation of somatic mutations that drive cancer with age.
2- the decline of immune competence with age
Examples of acquired Predisposing condions to cancer :
1-
2-
- Chronic inflammatory conditions,such as
chronic Helicobacter Pylori gastritis. - Immunodeficiency states, which predispose to virus-induced cancers,such as certain types of Lymphoma.
…………………….are external environmental agentsthat can inflict genetic damage, leading to carcinogenesis.
Carcinogenic Agents
There are 3 major classes of carcinogenic agents:
1-
2-
3-
- Chemicals
- Radiant Energy
- Microbial products
Types of Chemical Carcinogens:
1-
2-
1-Direct-acKng agents
2-Indirect-acKng agents
…………………. Is Directly carcinogenic and require no metabolic conversion in the body.
Direct-acting gents
……………… is Require metabolic conversion in the body to become carcinogenic
Indirect- acting agents
What is the difference between Direct-acKng agents and Indirect-acKng agents ?
*Direct-acKng agents: Directly carcinogenic and require no metabolic conversion in the body.
*Indirect-acKng agents: Require metabolic conversion in the body to become carcinogenic
The most common types of cancer that develops after chemotherapy are………….
leukemias
Direct-Acting Agents include many of the……………. drugs (such as…………).
1-cancer chemotherapy
2- alkylating agents
An example of Indirect-Acting Agent is…………..which forms during
combustion of………….. and implicated in …………… cancer
1- the carcinogen “Benzo(a)pyrene”
2- tobacco
3- lung
In the body, benzo(a)pyrene cause…………. damage.
DNA
B-naphthylamine (industrial chemical) implicated in……… cancer
Bladder
• Aflatoxin-B, a naturally occurring agent produced by…………….contaminates poorly stored grains, is implicated in…………. cancer.
1- Aspergillus fungus
2- Liver
What is the function of electrophile group?
1- electrophile group gets access to the DNA (so they are mostly lipophilic to enter through the cell membrane)
2- The electrophile group binds to the DNA and causes DNA damage.
3- The DNA repair genes will recognize this damage and try to repair it:
A- the DNA repair succussed and cell turns back to normal.
B- the DNA repair cannot remove the electrophile group and cell die.
C- DNA repair fails, cell survives, mutation happens… if these mutation affects the
cancer genes -> tumor initiation.
What is the function of electrophile group?
1- electrophile group gets access to the DNA (so they are mostly lipophilic to enter through the cell membrane)
2- The electrophile group binds to the DNA and causes DNA damage.
3- The DNA repair genes will recognize this damage and try to repair it:
A- the DNA repair succussed and cell turns back to normal.
B- the DNA repair cannot remove the electrophile group and cell die.
C- DNA repair fails, cell survives, mutation happens… if these mutation affects the
cancer genes -> tumor initiation.
What is the function of electrophile group?
1- electrophile group gets access to the DNA (so they are mostly lipophilic to enter through the cell membrane)
2- The electrophile group binds to the DNA and causes DNA damage.
3- The DNA repair genes will recognize this damage and try to repair it:
A- the DNA repair succussed and cell turns back to normal.
B- the DNA repair cannot remove the electrophile group and cell die.
C- DNA repair fails, cell survives, mutation happens… if these mutation affects the
cancer genes -> tumor initiation.
1- ……………..are substancesthat augment carcinogenicity of chemicals. It can be certain………… or ……………
2- What is its function ?
Promoters
hormones or drugs
Stimulate the cancer cell to proliferate.(support carcinogenic processes.)
Radiation energy includesseveral forms:
1-
2-
3-
4-
- Radiographs and Radiation Therapy used in medicine.
- Radionuclides (Radioactive material).
- Radiation generated from nuclear fission.
- Ultraviolet (UV) rays of sunlight,
The survivors of Atomic Bombs on Hiroshima and Nagasaki had a markedly increased incidence of……….
leukemia
Survivors of Chernobyl nuclear plant incident had and still have high levels of cancer incidents (including………., breast,………., and………. cancer).
thyroid,breast, colon, and lung cancer
……………..cancer is highly associated with radiation.
Thyroid
ionizing radiation can cause …………and…………., and less frequently………….. mutations
1- chromosome breakage
2- chromosomal rearrangements
3-point mutations
Example of Therapeutic Ionizing Radiation (Radiotherapy) :
Therapeutic irradiation of head and neck can give rise to papillary thyroid cancer
In the UV light-induced skin damage the greatest risk are……….. people who live in locales such as
Australia and New Zealand that receive a great deal of sunlight.
fair-skinned
UV light can cause by forming pyrimidine dimers.
1- DNA damage
2- pyrimidine dimers
type of DNA damage is repaired by the ………repair pathway.
nucleotide excision
DNA damage is divided to 2 types:
1-………………..
2-………………..
1- Single strand damage
2- Double strands damage, is more severe and more likely to produce genetic alteration
Each DNA damage has different repair mechanisms:
1- For Single strand damage: ………………..
2- For Double strands damage:………………….
1-Mismatch repair -Base excision repair -Nucleotide excision repair
2- Homologues recombination -Non-homologues DNA end joining -Microhomology-mediated end joining
Xeroderma Pigmentosum due to the mutations in ………. mainly those related to…………..
in DNA repair genes
nucleotide excision repair pathway.
The type of HBV & HCV [ DNA virus/ RNA Virus / BACTERIA
And it is Implicated in……….
1-DNA virus
2- Hepatocellular carcinoma
The type of EBV …………..
And itv Implicated in………..
1-DNA virus
2- Burkitt Lymphoma, Some cases of Hodgkin Lymphoma, Nasopharyngeal Carcinoma, Lymphomas in immunocompromised patients, other neoplasms
The type of HPV …………..
And itv Implicated in………..
1- DNA virus
2- Cervical Cancer, Oropharyngeal cancer
The type of HPV …………..
And itv Implicated in………..
1- DNA virus
2- Cervical Cancer, Oropharyngeal cancer
The type of HPV …………..
And itv Implicated in………..
1- DNA virus
2- Cervical Cancer, Oropharyngeal cancer
The type of HHV-8 (KSHV) …………..
And itv Implicated in………..
1- DNA virus
2- Kaposi Sarcoma, other neoplasms
The type of Helicobacter Pylori…………..
And itv Implicated in………..
Bacteria
Gastric Cancer, Gastric Lymphoma
The type of Helicobacter Pylori…………..
And itv Implicated in………..
Bacteria
Gastric Cancer, Gastric Lymphoma
Human Papillomavirus(HPV) has several serotypes, each related to a different condition.
• Types 1,2,4, and 7 are related to……………….
• Types 6 and 11 are related to…………….. which have low malignant potential.
• Types 16 and 18 are known as …………HPV serotypes and are related to ……………
1- cutaneous warts.
2-genital warts
3-high-risk
4- cervical cancer, particularly squamous cell carcinoma.
- In addition, some cases of oropharyngeal cancer (particularly around the tonsils) are related to high-risk HPV.
When HPV infects susceptible cells and gets integrated into the host cell genome, it can produce two viral gene products which are:
………. and ……..
E6 and E7.
The oncogenic effects of E6 include:
• it can bind to and cause degradation of p53/RB (an important tumor suppressor gene).
• It can stimulate the expression of…………
1- P53
2- TERT (catalytic part of telomerase)
it can bind to and cause degradation of p53 ( in the HPV) :
The oncogenic effects of E6
It can stimulate the expression of TERT in the (HPV):
The oncogenic effects of E6
It can bind to E2F and release it from RB, allowing progression through the cell cycle (in the HPV)
E7
…………….It inactivates CDK inhibitors p21 and p27
and possibly stimulates cyclins/CDKs. ( in HOV)
The oncogenic effects of E7
Tumors can be asymptomatic and can be clinically silent for many years [✅ \ ❌]
✅
When the tumour will be painful?
Tumorsthat commonly invade nerves are commonly painful,such as certain head & neck tumors
How tumors cause clinical problems?
- Impingement on adjacent structures(Mass effect) by eithercompression or direct invasion.
- Functional activity by production of substances that cause problems (such as Paraneoplastic Syndromes)
- Bleeding and infectionsif the tumor ulcerates into luminal surfaces.
- Symptomsresulting from rupture or infarction
- Cachexia
Impingement on adjacent depends on the……….
location
Examples of Impingement on adjacent are :
1- Pituitary adenoma compressing the normal pituitary gland and causing hypopituitarism.
2- A small tumor in the bile duct causing obstruction of bile flow and resulting in obstructive jaundice.
3- ovarian tumors within the abdominopelvic cavity
Tumors that do not cause symptoms due to impingement tend to be larger/ smaller at the time of diagnosis as they remain asymptomatic for a long time. An example is Tumors that do not cause symptoms due to impingement tend to be larger
1- larger
2- An example is ovarian tumors within the abdominopelvic cavity.
Tumors that do not cause symptoms due to impingement tend to be larger/ smaller at the time of diagnosis.
An example is………….
1- larger
2- An example is ovarian tumors within the abdominopelvic cavity.
Tumors that do not cause symptoms due to impingement tend to be larger/ smaller at the time of diagnosis as they remain asymptomatic for a long time. An example is Tumorsthat do not cause symptoms due to impingement tend to be larger
at the time of diagnosis as they remain asymptomatic for a long time. An
example is ovarian tumors within the abdominopelvic cavity……….
1- larger
2- An example is ovarian tumors within the abdominopelvic cavity.
A small tumor in the bile duct causing obstruction of bile flow and resulting in …………..
obstructive jaundice
obstructive jaundice and cachexia it almost always refer to………..
pancreatic cancer
Examples of hormone Production by tumors (Functional Activity) :
1………………….
2………………..
1- Pancreatic endocrine tumors producing pancreatic hormones(i.e Insulinoma) and causing severe hypoglycemia.
2- Adrenal gland adenomas that produce aldosterone,resulting in hyperaldosteronism and causing hypertension and hypokalemia.
Hormones Production by tumors lead to :
1- Pancreatic endocrine tumors»_space;> ……………..
2- Adrenal gland adenomas »_space;» …………
1- Insulinoma and causing severe hypoglycemia
2-hyperaldosteronism and causing hypertension and hypokalemia.
Majority of hormone-producing tumors are [well-differentiated/poorly differentiated] cell and benign [more/ less] than malignant.
1-well-differentiated
2-more
Example of malignant tumor that produce hormone is : (exception)
medullary thyroid carcinoma.
Which is secret calcitonin
** it is malignant even though it is functionally acting ( hormone production)
…………….It is occur due to production of substance not normally produced by the tissue of origin
Paraneoplastic Syndromes
…………….It is occur due to production of substance not normally produced by the tissue of origin
Paraneoplastic Syndromes
…………….It is occur due to production of substance not normally produced by the tissue of origin
Paraneoplastic Syndromes
Hypercalcemia Usually due to production of………. by the tumor
PTHrP “parathyroid hormone related peptide”
production of ACTH by the tumor leads to ……….
Cushing Syndrome
Bleeding & Infections This commonly occurs in carcinoma of the……………… tract.
Some of the symptoms of the GIT tumors include bleeding per rectum or melena.
gastrointestinal
Rupture and infraction commonly happens in the ……….. tumors
GIT
If perforation occurs ( in the in GIT tumors), gut contents spill into the abdominal cavity causing ……….
peritonitis
a GIT tumor may cause intestinal obstruction leading to ……………
infarction
…………… is progressive loss of body fat and lean body mass accompanied by weakness, anorexia, and anemia.
Cachexia
Cancer Cachexia occurs in many cancer patients and is related to the ……… and………..
size and the extent of cancer spread
Cancer Cachexia is results from substances and………. produced by the tumor and the host, resulting in high calorie expenditure and high basal metabolic rate of the body.
•…………. is one of these substances and is implicated in cachexia development.
1- cytokines
2- TNF
………..is one of these substances and is implicated in cachexia development.
TNF
………..is the level of differentiation of a neoplasm.
Cancer Grade
………. is the extent of spread of a neoplasm within a patient.
Cancer Stage
[ grading or staging ] is much greater clinical value of cancer
Staging
the correlation between grade and biologic behavior is perfect [✅ \ ❌]
❌
is less than perfect
Grading is based on the……………. appearance of the tumor, ( primarily ) on the degree of……….. of tumor cells, and (in some) tumors to other parameters such as number of…….. and presence of certain morphologic features.
1-histologic
2-differentiation
3-mitoses
The major staging system used by oncologists worldwide is known as the…….
It uses a classification called the……….. system (T = Tumor, N = Lymphnodes, M = Metastasis).
1-AJCC system (American Joint Committee on Cancer
2-TNM
• ACJJ and TNM are complementary systems and are used together.
Breast cancer and colon cancer have……….. grade
three
the higher the grade, the……… the behavior.
worse
the higher the grade, the……… the behavior.
worse
[Staging /Grading ]How much the neoplasm spread to the patient.
Staging
The AJCC system uses the………… staging system
TNM
• TNM is based on assessing
• T =
• N =
• M =
Each of these is assigned a number corresponding to the extent of spread. e.g (T2 N1 M0).
1- the primary tumor (usually in terms of size but can include other parameters)
2-regional lymph node involvement
3-presence or absence of metastasis
T0 in the TNM staging refers to
An in situ lesion.
For M category n the TNM, M0 means………..
no distant metastasis
For N category in the TNM , N0 means…………, whereas N1
to N3 refersto involvement of an increasing number of lymph nodes.
no lymph node involvement
TNM staging can be divided into:
• Clinical stage (cTNM)
is based on the information obtained by physical examination, radiologic examination, and endoscopy.
• Pathologic stage (pTNM)
depends on pathologic examination of the tumor grossly and microscopically after removal of the tumor.
