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Flashcards in Disorders of Cell Growth Deck (31)
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What is a tumour

- Swelling or mass
- Two general types of tumours
- Benign (non-cancerous)
- Malignant (cancerous)


What is a neoplasm

- An abnormal mass of tissue
- Growth of which exceeds and is uncoordinated with that of normal tissues
- Persists in same excessive manner after cessation of stimuli which evoked change


What is neoplasia and dysplasia

- Cancer, new growths of cells in the body
- Mutated proto-oncogenes / tumour suppressor genes
- Irreversible
- Replacement of one mature cell type with a less mature cell type
- Mutations in genome, epigenetic changes, principally in epithelia


What are the features of a benign tumour

- Nomenclature (-oma)
- Localised
- Non-invasive, slow growth
- Resemble tissue of origin
- Encapsulated / circumscribed edge, intact surface
- Exophytic growth
- Homogenous cut surface
- No metastases


What are the features of a malignant tumour

- Nomenclature (-carcinoma or -sarcoma)
- Non-localised
- Invasive, rapid growth
- Poor resemble of tissue of origin
- Poorly defined and irregular border, ulcerated, vascular permeation
- Endophytic growth
- Heterogenous cut surface / necrosis
- Metastases common


What are the common causes of cancer

- Sporadic (non-familial) cancers caused by DNA damage and genomic instability
- Oncogenic viruses carry genes that can lead to cancer (HPV / EBV)
- Inheritance of one defective copy of a tumour suppressor gene / cancer susceptibility gene
- Li-Fraumeni Syndrome - Mutant TP53
- Hereditary Breast / Ovarian Cancer (HBOC) - Mutant BCRA1 / BRCA2
- Lynch Syndrome - Abnormal DNA mismatch repair


What are some genetic mutations found in cancer

- Gene Deletion / Inactivation: Loss-of-function, tumour suppressor genes (TP53)
- Gene Amplification: Copy number changes, hyper-activity of proto-oncogenes, oncogenes (MYC, EGFR)
- Protein Activating Mutation: Gain-of-function, BRAF V600E, IDH1 R132
- Translocations: BCR-ABL
- Epigenetic Alterations: Histone H3


What are proto-oncogenes

- Encode proteins that normally control cell growth / proliferation
- When mutated become oncogenes that cause self-sufficiency
- Extracellular signalling, hormones, GFs, signal transduction and nuclear proteins


What are oncogenes

- Jammed accelerator
- Genes / proteins that activate normal cell proliferation
- These genes are mutated in cancer resulting in uncontrolled proliferation
- Gain-of-function mutation (dominant)


What are tumour suppressor genes

- Defective brakes
- Genes / proteins that normally prevent cell proliferation are mutated in cancer resulting in uncontrolled proliferation
- Loss of function mutation (recessive) or loss of heterozygosity
- TP53, RB, CDKN2A (Ink4a / Arf), CDKN2B (Ink4b)


What is the p53 tumour suppressor gene (loss of function mutation)

- Tetramer DNA complex containing TFs (can bind DNA), - When mutated multiple cellular processes are disrupted
Activated By:
- Lack of nucleotides
- UV / ionising radiation
- Oncogene signalling
- Hypoxia
- Blockage of transcription
- Cell cycle arrest and senescence or return to proliferation
- DNA repair
- Block of angiogenesis
- Apoptosis


What are gain of function mutations

- Results in constitutive kinase activity, increased stimulation
- Cause of melanoma (BRAF V600E), lung cancer, colorectal cancer, thyroid carcinoma, paediatric low grade glioma and craniopharyngioma


List the 6 hallmarks of cancer

- Sustained proliferative signalling
- Resistance to anti-growth signals
- Immortality
- Resistance to apoptosis
- Sustained angiogenesis
- Invasion / metastasis


What is sustained proliferative signalling (1)

- Constitutively activated growth signalling
- Often driven by oncogenes


What is resistance to anti-growth signals (2)

- Unregulated cell cycle progression (mutated CDKs, kinases and cyclins)
- Inactivated cell cycle checkpoints (inactivation of tumour suppressors)
- Leads to cells with aneuploidy, DNA damage and incomplete DNA replication


What is immortality (3)

- No limit to cell divisions
- Telomere length extension by telomerase, infinite replicative ability
- Inactivated cell death pathways
- Hayflick Limit: Number of times cell can divide before telomeres shorten and inhibit duplication


What is resistance to apoptosis (4)

- Resistance to programmed cell death
- Activation of survival signalling pathways (AKT)
- BCL2 over-expression in cancer prevents induction of apoptosis


What is sustained angiogenesis (5)

- Formation of blood vessels
- Activated vascular endothelial GF signalling
- Tumour: Transformed or neoplastic cells, proliferating
- Stroma: Normal cells (normal DNA), connective tissue, BV and host immune/inflammatory cells, provides support to enable tumour growth


What is invasion / metastasis (6)

- Loss of cell-to-cell interactions
- Loss of contact inhibition
- Loss of anchorage dependence
- Cells in culture and in vivo exhibit contact-inhibition
- Cancer cells lack contact inhibition feedback mechanisms, clumps or foci develop


Describe how molecular understanding of cancer can be used in research

- Elucidation of oncogenic mechanisms
- Identification of therapeutic targets
- Identification of cancer biomarkers
- Validation of candidate therapeutic targets and biomarker signatures
Clinical Utility:
- Classification of patients based on disease prognosis
- Stratification of patients based on predicted therapeutic response


What is multistep carcinogenesis

- Carcinogenesis is a multistep process resulting from accumulation of multiple genetic alterations
- Collectively give rise to transformed phenotype and associated hallmarks
- Most cancers have at least 6-9 different mutations


What are common translocations / genetic changes in cancer

- Burkitt’s Lymphoma: Affects antibody rearrangement (T cells)
- Acute Promyelocytic Leukaemia (APL): Stalls myeloid differentiation
- Acute Lymphoblastic Leukaemia (ALL): Constitutive ABL kinase activity
- Ewing’s Sarcoma: Inhibits differentiation, solid tumour
- Deletions: Loss of tumour suppressor genes
- microRNAs (miRNA): Increase expression of oncogenes, decrease expression of tumour suppressor genes
- Epigenetic Changes: Post-translational modification of histones, abnormal DNA methylation


What is grading and staging of cancers

- Staging: Progression or spread through the body
- Grading: Cell differentiation and rate of cell growth


What are common characteristics of cancer

- Genetic origin – DNA damage / change and epigenetic changes (histone modifications)
- Accumulation of specific mutations promoting cancer
- Cell division without growth control
- Parasitic in nature
- Require endocrine support of host
- Dependent on host blood supply and nutrition
- Heritable changes which get passed on to daughter cells
- Usually clonal, derived from one single cell


What are the 4 fundamental features to distinguish and characterise benign vs malignant neoplasms

- Differentiation and anaplasia
- Rate of growth
- Local invasion
- Metastasis


Describe differentiation and anaplasia in benign vs malignant

- Benign: In parenchyma fairly normal, well differentiated cells, still fulfil tissue function, mitosis rare but normal
- Malignant: In parenchyma differentiated to completely undifferentiated cells with loss of tissue function, nuclei hyper chromatic and large, several nuclei possible, anaplasia


Describe rate of growth in benign vs malignant

- Benign: Slow growth (months to years) and mitosis is rare but normal
- Malignant: Fast growth, atypical, numerous mitosis, growth rate usually inversely proportional to level of differentiation


Describe local invasion in benign vs malignant

- Benign: Remains localised at site of origin, most are encapsulated but not all
- Malignant: Progressive growth, infiltration, invasion, destruction and penetration of surrounding tissue, no development of well defined capsules


What is metastasis

- Metastasis: Spreading of malignant neoplasms
- Metastases: Secondary implants, originating from a primary lesion, of a different cellular origin (different morphology, colour, cell to cell signalling)


Describe metastasis in benign vs malignant

- Benign: Never
- Malignant: Pathways of dissemination, seeding within body cavities, lymphatic / hematogenious to liver, lungs, veins and arteries (less)


Describe the process of metastasis

- Detachment at tumour site invasion of surrounding connective tissues
- Intravasation into blood / lymph / body cavities, evasion of host defence (immune escape)
- Extravasation from blood vessel into secondary sites
- Proliferation and angioneogenesis (VEGF)