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pathoma > Principles of Neoplasia > Flashcards

Principles of Neoplasia Flashcards

1
Q

Tumors derived from what lineage?

A

Monoclonal

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2
Q

Neoplasia growth characteristics

A

Unregulated, irreversible, monoclonal

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3
Q

Clonality determined by:

A

G6PD or androgen receptor isoforms

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4
Q

Clonailty of B lymphocytes determined from

A

Ig light chain
Kappa:Lambda = 3:1 ratio
Hyperplasia maintains ratio
Lymphoma: monoclonal

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5
Q

Which is monoclonal? Benign or malignant tumors?

A

BOTH

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6
Q

Epithelium tumor prefix

A

adeno or papill

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7
Q

Mesenchyme are what tissues and prefix

A

Lipo (fat)
Osteo (bone)
Chondro (cartilage)
Agio (blood vessel)

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8
Q

Are there benign lymphcyte tumors?

A

NO- all are malignant and called lymphoma/leukemia

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9
Q

Melanocyte

A

Nevus: benign
Melanoma: malignant

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10
Q

Cancer begins as what?

How many divisions until earliest clinical symptoms arise?

A

A single mutated cell

30 divisions

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11
Q

Each double results in increased what?

A

Mutations

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12
Q

Pap smear screens for?

A

Cervical dysplasia

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13
Q

Mammography screens for?

A

In situ breast cancer (DCIS often calcifies)

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14
Q

PSA/DRE screens for?

A

Prostate carcinoma

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15
Q

Hemoccult test and colonoscopy screen for?

A

Colonic adenoma (before it becomes carcinoma)

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16
Q

Cancer formation initiated by?

A

DNA mutations

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17
Q

Chemical agent: Alfatoxin

A

HCC

From aspergillus

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18
Q

Chemical agent: alkylating agent

A

Leukemia/lymphoma

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19
Q

Chemical agent: alcohol

A

SCC of oropharyrnx & upper esophagus
Pancreatic carcinoma
HCC

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20
Q

Chemical agent: Arsenic

A

SCC of skin, lung

Angiosarcoma of liver

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21
Q

Chemical agent: asbestos

A

Lung carcinoma

Mesothelioma

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22
Q

What 3 chemicals will you find in cigarette smoke?

A

Arsenic
Naphthyalmine
*Polycyclic hydrocarbons

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23
Q

Chemical agent: nitrosamines

A

Stomach cancer - smoked foods (Japan)

Intestinal vs diffuse type
Nitrosamine related to intestinal type

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24
Q

Chemical agent: napthylamine

A

Urothelial carcinoma of bladder

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25
Q

Chemical agent: cigarette smoke

A

Carcinoma of oropharynx, esophagus, lung, kidney, bladder

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26
Q

Chemical agent: vinyl chloride

A

Angiosarcoma of liver

PVC in pipes

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27
Q

Chemical agent: nickel, chromium, beryllium, silica

A

Lung carcinoma

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28
Q

Oncogenic viruses: EBV

A

Nasopharyngeal carcinoma
1. Chinese male
2. African individual (region of Africa)
Neck mass

Burkitt lymphoma

CNS lymphoma in AIDS

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29
Q

Oncogenic viruses: HHV-8

A

Kaposi Sarcoma
Endothelial cells

  1. Eastern European Males (older) - excise lesions
  2. AIDS pts
  3. Transplants - immunosuppressed
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30
Q

Oncogenic viruses: HBV/HC

A

HCC

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31
Q

Oncogenic viruses: HTLV-1

A

Adult T-cell leukemia/lymphoma

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32
Q

Oncogenic viruses: High risk HPV

A

SCC of vulva, vagina, anus, cevix

Adenocarcinoma of cervix

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33
Q

Radiation: Ionizing (nuclear reactor accidents & radiotherapy)

A

AML, CML, papillary carcinoma of thyroid

Hydroxyl free radicals generated and hit DNA causing damage

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34
Q

Oncogenic viruses: Nonionizing (UVB most common)

A

BCC, SCC, melanoma

Form pyrimidine dimers in DNA

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35
Q

Disrupted systems include

A

Proto-oncogenes
Tumor suppressor genes
Regulators of apoptosis

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36
Q

Proto-oncogenes essential for

A

cell growth and differentiation

37
Q

Oncogene leads to

A

unregulated cell growth

38
Q

4 categories of oncogenes

A
  1. GF
  2. GF receptors
  3. Signal transducers
  4. Cell cycle regulators
39
Q

GF oncogene: PDGFB

A

Astrocytoma

Overexpression of PDGFB Growth factor - overgrowth of the cell/division

40
Q

GF Receptor: ERBB2 (HER2/neu)

A

Breast carcinoma
Amplification

Epidermal GF receptor

41
Q

GF Receptor: RET

A

MEN2A, 2B
Sporadic medullary carcinoma of thyroid

Point mutation

Neural GF Receptor

42
Q

GF Receptor: KIT

A

GI stromal tumor

Point mutation
Stem cell GF receptor

43
Q

Signal transducers: RAS gene family

A

Carcinoma, melanoma, lymphoma

Point mutation
GTP biding protein (instead of inactive form of RAS-GDP)

44
Q

Signal transducers: ABL

A

CML and some ALL

t(9,22) with BCR
Tyrosine Kinase

45
Q

What defines CML?

A

t(9,22) (Philadelphia chromosome)

46
Q

Ph+ ALL

A

t(9,22) ALL

47
Q

Nuclear regulators: c-MYC

A

Burkitt Lymphoma (B cell)

t(8,14) involving IgH
IgHeavy chain on 14
Translocation with Myc gene on 8
Myc sits on Heavy chain so it will get turned on 
"starry sky" appearance

Transcription factor

48
Q

Nuclear regulators: n-MYC

A

Neuroblastoma

Amplification

49
Q

Nuclear regulators: l-MYC

A

Lung cell carcinoma (small cell)

50
Q

Cell cycle regulators: CCND1 (cyclin D1)

A

Mantle cell lymphoma

t(11, 14) involving IgH
Cyclin

G1-S phase
cyclin D1 on chromosome 11

51
Q

Cell cycle regulators:CDK4

A

Melanoma

Amplification
Cyclin-dependent kinase

52
Q

p53 regulates what?

A

cell cycle: G1 to S phase

p53 sees mutation: call in DNA repair enzymes
OR
too damaged and will call in BAX to destroy BCL2 - which stabilizes CYT C, so induces apoptosis

53
Q

LI Fraumeni syndrome

A

one mutation in p53 inherited

increased risk for multiple types of carcinoma and sarcomas

54
Q

Rb regulates

A

Progression from G1 to S

Needs E2F to do this (normally bound by RF) and needs to be phosphorylated
and then will release E2F

Phosphoylated by Cyclin D/CDK4 complex

Allows cell to go from G1 to S

If mutation in Rb - forms tumor from released E2F

55
Q

Sporadic mutation of Rb

A

unilateral retinoblastoma

56
Q

Germline mutation of Rb

A

bilateral retinoblastoma and osteosarcoma

57
Q

Bcl2 normally stablizes mito membrane preventing release of

A

Cytochrome C

58
Q

What happens when cytochrome C is released from mito?

A

Activates apoptosis - releases caspases

59
Q

Bcl 2 overexpressed in what?

A

Follicular lymphoma

t(14,18)
Bcl 2 (18) to Ig heavy chain (14) results in increased Bcl2
60
Q

What is necessary for cell immortality?

A

Telomerase: upregulated in cancers

61
Q

GF in angiogenesis for tumor growth and survival

A

FGF and VEGF

Fibroblast GF
Vascular endothelial GF

62
Q

How do tumors cells avoid immune surveillance?

A

CD8” cells detect and destroy mutated cells by detecting the abnormal cells presented on MHC I

Tumor cells downregulate MHC I

63
Q

How does cancer spread occur?

A

Down regulation of E-Cadherin leading to dissociation of attached cells

Cells attach to laminin and destroy BM (type 4 collagen) - via collagenase

Cells attach to fibronectin in ECM and spread locally

Either gain access to BV or lymphatics

64
Q

What type of spread is characteristic of carcinomas?

A

Lymphatic spread

Initial spread is to regional draining lymph nodes

65
Q

What type of spread is characteristic of sarcomas (and some carcinomas)?

A

Hematogenous spread

66
Q

What are the exceptions of carcinomas that spread hematogenously instead of thru the lymphatics

A

RCC
HCC
Follicular carcinoma of the thyroid
Choriocarcinoma (placental tissue - trophoblasts)

67
Q

RCC spreads into what vein?

A

Renal

68
Q

HCC spreads into what vein?

A

Hepatic

69
Q

How does ovarian carcinoma spread?

A

Seeding

“omental caking”

70
Q

Characteristics of benign tumors

A

Slow growing
Well circumscribed
Distinct
Mobile

71
Q

Characteristics of malignant tumors

A

Rapid growing
Poorly circumscribed
Infilitrative
Fixed to surrounding tissue

72
Q

Histologic features of benign tumors

A 
Organized growth
Uniform nuclei
Low nuclear to cytoplasmic ratio
Minimal mitotic activity
Lack of invasion
No metastatic potential
73
Q

Histologic features of malignant tumors

A 
Disorganized growth
Nuclear pleomorphism w/ hyperchromasia
High nuclear to cytoplasmic ratio
High mitotic activity
Invasion
74
Q

Absolute distinguishing feature between malignant and benign?

A

BENIGN NEVER METASTASIZE!

75
Q

Intermediate filaments: keratin

A

epithelium

76
Q

Intermediate filaments: vimentin

A

Mesenchyme

77
Q

Intermediate filaments: Desmin

A

Muscle

78
Q

Intermediate filaments: GFAP

A

neuroglia

79
Q

Intermediate filaments: Neurofilament

A

Neurons

80
Q

PSA

A

prostate epithelium

81
Q

ER

A

breast epithelium

82
Q

Thyroglobulin

A

Thyroid follicular cells

83
Q

Chromogranin

A

Neuroendocrine cells

Carcinoid is best, small cell carcinoma worst

84
Q

S-100

A

Melanoma

85
Q

What’s useful for screening, monitoring response to tx, monitoring recurrence?

A

Serum tumor markers - proteins released by tumor

86
Q

Elevated levels of tumor serum marker requires what for dx of carcinoma?

A

Biopsy

87
Q

1 prognosis factor for cancer for staging?

A

Size and spread

88
Q

Single most prognostic factor

A

Metastasis

pathoma (12 decks)

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