Exam 1: Ch 7 Flashcards Preview

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Flashcards in Exam 1: Ch 7 Deck (90):
1

2nd leading cause of death in US

all cancers lumped together

2

leading cause of death for children 3-15 YOA

cancer

3

what is the 5-year survival rate of cancer

64%

4

prevalence vs incidence

prevalence: how many have the disease

incidence: how many new cases (stable overall now)

5

is cancer a single disease?

no

some organs are much more likely to produce cancer

some cancers are much more deadly

6

cancers that are readily cured

Hodgkin's disease
`
testicular

acute lymphoblastic leukemia

7

cancers with low 5-year survival rates

small cell lung cancer

pancreatic

8

high incidence, low death rates

prostate, breast

9

lower incidence, high death rates

lung and bronchus

pancreatic

10

neoplasm

new growth, synonymous with tumor

benign or malignant

benign have well differentiated cells, malignant less so

11

tumor name identifies....

tissue of origin

12

benign tumor add ___ to the end

oma

13

fibroma, adenoma, hemagioma, papilloma

fibroma: benign fibrous tumor

adenoma: benign glandular

hemagioma: benign blood vessel tumor

papilloma: benign projections from any surface

14

carcinoma, sarcoma, adenocarcinoma, hemangiosarcoma,

carcinoma: malignant epithelial tumor

sarcoma: malignant mesenchymal

adenocarcinoma: malignant glandular

hemangiosarcoma: malignant blood vessel tumor

15

polyp

growth projecting from mucosa

16

cancer in situ

localized malignant tumor that hasn't broken through the basement membrane

17

benign tumor characteristics

well differentiated cells

slow growth, no mets

well defined edges

unlikely to be lethal

may compress vital structures --brain

18

malignant tumor characteristsics

grow fast

anaplasia -- undifferentiated

attract blood vessels

spread widely

lethal

19

2 major types of malignant tumor

solid: start in 1 organ, spread through blood/lymph

hematological: cancers of blood-forming cells, begin disseminated

20

lack of differentiation makes cancer cells look _____

abnormal

cells and nuclei of various shape

nuclei contain extra DNA and stain very dark

21

cancer cells are graded on the basis of...

degree of anaplasia

the more abnormal, the more dangerous

grade 1: fairly well differentiated

grade 4: high degree of anaplasia

22

genetic instability

large scale chromosome abnormalities

important to know genetic makeup of individual and the cancer

23

cancer cells divide ____, live ____, and ____ together

rapidly, long, crowd

24

how to cancer cells escape apoptosis

they have their own telomerase so they're immortal

proliferate without proper signals

25

3 things cancer cells have a loss of

density inhibition: cells can pile up

cohesion: cells no longer stick together

anchorage dependence: can live detached

26

tumor specific antigens (TSAs)

cancer cells express abnormal surface antigens

can target mets to particular tissues

may be useful as markers in treatment

27

some cancers express...

hormones and clotting factors

paraneoplastic syndrome

28

determinants of tissue growth rate

# of cells going through cell cycle

duration of cell cycle

# of cells dying

29

why do cancer cells grow fast

avoid apoptosis

almost all tumor cells are cycling (no G0)

30

malignant tumors have a high.. and a short...

high growth fraction (fraction of total cells in cell cycle)

short doubling time (time for a tumor to double in size)

31

if a tumor has no blood supply..

they don't get very big

epithelial tissue is avascular

32

invasion of nearby tissue

bordering tissues or seeding of a body cavity

requires secretion of proteases to break through basement membrane

seeding can occur during surgery

33

metastasis

development of secondary tumors at distant sites

through lymph or blood

34

lymphatic metastasis

sentinel node mapping checks nodes that drain area of the tumor

35

mets through blood

metalloprotease enzymes break down collagen

brain receives high blood flow and lots of mets

lungs receive entire CO, common site of mets

36

tumors from the abd cavity spread to ___ via blood

liver

37

some tumors bind to sites in specific ___

tissues

prostate cancer --> bone

38

how do cancer cells evade the immune system

stop secreting TSAs

aggregate as emboli

kill immune cells

39

angiogenesis

tumor cells attract blood vessels

allows tumors to grow

40

proto oncogene

normal

stimulate cell division normally

turn into oncogene (cause cancer)

41

examples of tumor suppressor gene inactivation

RB -- retinoblastoma

BRCA 1

p53

42

examples of oncogenes

RAS

RAF

HER-2 (breast)

43

oncogene formation

point mutations, insertions, deletions

translocations can create fusion proteins that are always active

amplification can lead to over expression of genes

44

loss of tumor suppressor activity

requires either an inherited mutation plus 1 hit OR

2 hits

45

p53 gene product

monitors cells for genetic mutations

arrests cell cycle with mutation present so repair or apoptosis can occur

abnormal in 50% of all cancers

46

epigenetic mechanisms

methylation of promotor region can silence tumor suppressor genes

47

3 steps of tumor cell transformation

initiation: cell exposed to carcinogen --> irreversible changes (multiple small doses cause damage)

promotion: growth becomes unregulated

progression: tumor cells become fully malignant

48

cancer cells can be familial

BRCA 1 & 2 are TS genes... mutation increases breast cancer risk

40% of retinoblastoma is autosomal dom. Rb gene mutation

familial adenomatous polyposis autosomal dom

49

hormones may drive cancers of the ...

breast, ovary, endometrium, and prostate

50

obesity contribution to cancer

adipose produces androgens and estrogens, which increases breast cancer risk

higher insulin and IGF1 stimulates cell division

51

NK cell

general cancer killer

52

macrophages

take up TSA's and activate T helper cells, which activate B cells to release antibodies that attack cancer cells

53

cytotoxic t cells

kill cancer cells directly

54

immune system kills most ___ cells

cancer

failure results in cancer to succeed

immune suppression leads to cancer, aids and Kaposi's sarcoma

55

chemical carcinogens may cause up to ___% of cancers

30

many associated w/ lifestyle choices

56

direct vs indirect chemical carcinogen

direct: cause cancer without chemical change in the body

indirect: require chemical alteration in the body

57

polycyclic hydrocarbons

produced with tobacco burns and meat is charbroiled

58

EtOH causes what kinds of cancer

oral and esophageal

59

radiation causing cancer

impact depends on dose, age, sex

long latency period for leukemia, thyroid and skin cancer

intense sun exposure in childhood most dangerous

therapeutic radiation also a risk

60

oncogene viruses

HPV permanently changes genes of cervix

Epstein-Barr virus --> lymphomas and nasopharyn cancer

Hep B --> liver cancer

61

cancer disrupts tissues

local/regional or direct effects (extreme pain)

erodes or compresses blood vessels, nerves, lymph vessels

destroys bone and marrow

obstructs lumens

causes effusions

62

cancer cachexia and anorexia

many cancers cause anorexia (loss of appetite) and cachexia (wasting away)

weight loss could be an early symptom

makes prognoses more negative by increasing toxicity and side effects of chemo

63

cytokines may play a role in

TNF, IL-1 & 6

impact satiety center to decrease appetite

cause fever to increase calorie use

64

anemia

result from treatment as well as disease

poor quality of life and poor outcome

from blood loss, hemolysis, or impaired hematogenesis

decreases tolerance of treatment

65

paraneoplastic syndrome

cancer cells can produce hormones

ADH (hyponatremia)

ACTH (Cushing's syndrome)

PTH (hypercalcemia)

GH (acromegaly)

66

coagulation factors

cancer cells can produce

67

cancer cells can produce ___ that trigger an _____ response

antigens, autoimmune

causes muscle weakness

68

eaton-lambert syndrome

small cell lung cancer

autoimmune production of antibodies to motor end plate structures

type of paraneoplastic syndrome

69

cancer screening

observation

palpation (breast, thyroid, prostate, lymph nodes)

xrays: mammography

70

observation of epithelial cells

pap smear: examination of epithelial cells of cervix on a microscope slide

71

tumor markers

antigens may be produced/overproduced by tumors, but not in early stages

PSA: prostate cancer

CA125: ovarian cancer

alpha-fetal protein (AFP): liver cancer

carinoembryonic antigen (CEA): colorectal/GI cancer

72

biopsy and types

tissue removal for testing

needle: palpable tumors and those IDed by xray

endoscopy: lumen

excisional: remove entire tumor

73

immunohistochemistry

antibodies used to find cancer cells

74

microarray technologies

screen genome for cancer risk alleles

allows for tumor testing

75

gleason score

level of anaplasia in prostate biopsy

76

staging

assess spread of tumor

TNM system

77

TNM system

T: elements of stage & grade

N: are lymph nodes positive?

M: presence of metastasis

78

radiation therapy

primary treatment for some cancers

palliative, decreases size of cancers

pre or post op

some cancers more sensitive to radiation than others

79

radiation mechanism and modes of delivery

DNA damage causes apoptosis

external beam: linear accelerator

brachytherapy: inserted sealed source

injected: I-131 for thyroid cancer

80

adverse effects of radiation therapy

injures or kills normal cells

GI effects: diarrhea N/V

bone marrow suppression

skin burns and hair loss

81

chemotherapy

can potentially reach all tumors and mets

cancer cells killed exponentially (fixed fraction die with each dose)

more effective against high growth factor tumors

can be a primary form of treatment

82

chemo drugs can be classified by ____

stage

S-phase specific: methotrexate blocks DNA synthesis

83

phase non-specific chemo

alkylating agents damage resting DNA

84

adverse rxns to chemo

bone marrow suppression

vomiting and diarrhea

fatigue and hair loss

drugs themselves are carcinogenic and teratogenic

85

nadir

time point of max toxicity

86

hormonal therapy

useful when tumors express hormone receptors

removal of gonads in sex hormone responsive cancers

aromatase inhibitors block androgen (estrogen in peripheral tissue -- breast cancer)

hormone receptor blocker tamoxifin

87

immune therapy

active: give antigen

passive: give monoclonal antibody or other immune activators

adoptive: give activated immune cells

88

targeted therapy

monoclonal antibodies against cancer antigens

angiogenesis inhibitors

specific drugs to block action of chimeric cancer proteins (Gleevec for CML)

89

Downs may inc risk for which cancer

acute lymphoblastic leukemia

90

childhood cancers

many have good prognosis

survivors may have chronic health problems from radiation/chemo

increased risk for 2nd malignancy