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Flashcards in Cancer Deck (35):
1

what is cancer?

Rapidly abnormally growing tissue which metastasises

2

what is a neoplasm?

New growth - abnormal mass of tissue, the growth of which is virtually autonomous and exceeds that of normal tissues. The growth is uncoordinated and persists after the cessation of the stimuli that initiated the change.

3

What is a carcinogen?

Has potential to cause cancer

4

How are tumours named?

Benign tumours end in -oma

Malignant tumours end in:
carcinoma - parenchyma
sarcoma - stromal

5

What is parenchyma and what is stroma?

parenchyma - functional tissue of an organ

stroma - tissue with connective or structural role e.g. vessels, connective tissue, blood cells

6

What are the four differences between benign and malignant tumours?

- Differences in differentiation
Malignant tumours show anaplasia (no differentiation)
Benign tumour cells are relatively well differentiated

- Rate of Growth
Benign tumour are slower growing than malignant tumours

- Local Invasion
Benign tumours don't tend to infiltrate the basal lamina

- Metastasis
Benign tumours don't metastasise

7

What are the mechanisms of invasion/metastasis?

- lymphatics
- haematogenous
- body cavities
- contiguous - shares a common border so touching

8

Which route to carcinomas commonly follow?

lymphatics

9

Which route do sarcomas usually follow?

haematogenous

10

Why do tumours use veins rather than arteries to spread?

The walls are thinner

11

What are the most common cancers in men and women?

women: breast, lung, colon/rectum

men: prostate, lung and colon/rectum

12

How does geography affect the epidemiology of cancer?

- Stomach cancer higher in Japan compared to the USA
- Colon cancer much less in Japan
- Melanoma much more common in NZ and Australia
- Hepatocellular Carcinoma more common in Uganda due to aflatoxin
- High incidence of oesophageal cancer in China and Iran due to nitrates in soil and abrasives in diet

13

What are some examples of how genetics can lead to cancers?

Autosomal dominant inherited cancer syndrome:
retinoblastoma, FAP

Recessive:
Xeroderma Pigmentosum - increases susceptibility to skin cancers

Familial Cancer Syndromes:
Multiple Endocrine Neoplasia (MEN)

14

What percentage of cancers have hereditary origin?

10%

15

What is carcinogenesis?

- Involves multiple mutations over a period of time
- Malignancy is acquired in a step-wise fashion - tumour progression
- The non-lethal changes in the cell are the driving force of carcinogenesis

16

What are the 4 types of regulatory genes?

- oncogenes
- TSG
- pro-apoptotic/anti-apoptotic genes
- DNA repair genes

17

What are the main classes of carcinogens?

- chemicals
- viruses
- radiation
- hormones
- bacteria, fungi and parasites
- miscellaneous

18

What are chemical carcinogens?

- No common structural features
- Some need metabolic conversion from inactive procarcinogen to an active ultimate carcinogen while others don't
- If appropriate enzyme is present within the skin, tumour occurs at the site

19

What are the major classes of chemical carcinogens?

Hydrocarbons
Amines
Nitrosamines
Azo dyes
Alkylating agents

20

Who are affected by oncogenic viruses and give examples?

- Generally affect the young and immunosuppressed
- HPV: cervical cancer
- HBV: hepatocellular carcinoma
- EBV: Burkitt's lymphoma

21

What are some DNA/RNA oncongenic viruses, and bacterial carcinogens?

DNA - HPV, EBV, HBV
RNA - HTLV1: causes leukaemia
Bacterial - H.pylori (gastric carcinoma)

22

Which cancers does radiation cause?

Ultraviolet - BC(basal cell carcinoma), SCC (squamous cell carcinoma) and MM

Ionising Electromagnetic Radiation - causes increase in leukaemia and solid tumours

23

What are the clinical effects of tumours?

- anxiety
- pressure, ulceration, infection and bleeding
- metabolic cancer cachexia (reduced fat and muscle)
- paraneoplastic syndrome (consequences of cancer e.g. by immune system or cell secretion) for example neuropathies

24

What are some tumours associated with oncogenes?

- Brukitt's lymphoma
- Neuroblastoma

25

What are some examles of TSG involved in tumours?

- Rb gene (retinoblastoma)
- p53 is mutated in most cancers
- BRCA1/2

26

What are anti-apoptotic genes?

- If you get an anti-apoptotic gene, then defected cells won't kill themselves
- Anti-apoptotic Bcl-2 genes prevent apoptosis causing unregulated proliferation
- It is upregulated in lymphomas

27

What are DNA repair genes?

- Genomic instability syndromes - inherited mutations in DNA repair genes
- Not directly oncogenic
- Act by permitting mutations to occur during normal cell cycles

28

What are some types of DNA repair genes?

Mismatch Repair
Nucleotide Excision Repair
Recombination Repair

29

How is metastasis of the cancer determined?

To see if the cancer has metastasised imaging will be used:
CT
MRI
PET

30

How can a cancer diagnosis be made?

- Cytology (fine needle aspiration)
- Histology (core biopsy, incisional or excisional biopsy)

Then:
Tumour Typing
Immunocyto/histochemistry
Flow cytometry
Molecular Methods (PCR, FISH, DNA microarrays, spectral karyotyping)
Tumour Markers

31

What is grading and what is staging?

Grading and staging are different

Histological - low or high grade (less useful than staging). Based on the degree of differentiation

Staging is the single most important parameter, combining clinical, radiological and pathological findings.

32

What is the main staging system?

TNM

1) Size of the primary tumour
2) Has it spread to lymph nodes?
3) Has is metastisised?

33

What is the purpose of screening and give examples of screening programmes?

- Detect cancer either at pre-invasive stage/early

In the UK there is screening for:
Cervical Cancer
Breast Cancer
Colorectal Cancer

34

What things are needed for a screening programme to be successful?

- Reliable prediction of tumour behaviour
- Treatment available
- Target population has enough people to justify expense
- Cost-effective and reliable screening tool

35

Which vaccinations are given to reduce the risk of cancer?

HPV - cervical cancer

HBV - liver cancer