Midterm 3 Pathology Flashcards
(395 cards)
1
Q
What are the common symptoms for breast disease?
*Not specific for cancer, fibrotic growths, cysts
A
- Pain
- Palpable masses
- Nipple discharge
- older the patient the more likely that it is malignant
2
Q
At what age do you start mammography? why?
A
~40 yrs b/c younger women have denser breast tissue making it difficult to identify a mass
3
Q
How do Mammography work? show?
A
- it detects density
- can show architectural distortions
- identifies calcification
- changes over time and these changes can indicate pathologies such as cancers
- can use imaging to help guide biopsy needle in order to sample a growth
4
Q
What percent of breast cancers are NOT detected by mammography?
A
~10%, but can be detected by palpitation
5
Q
How predictive are mammography?
A
85-90%
6
Q
What are 4 points of Acute mastitis?
A
- can cause breast abscesses and necrosis
- typically associated with women who are breastfeeding
- can be caused by plugged ducts
- can be infectious or non-infectious
7
Q
What is fat necrosis of breast usually associated with?
A
Trauma –> from a seat belt during an accident
8
Q
What are 6 points of Breast cysts?
A
- Fibrolytic changes
- higher risk of breast cancer
- occurs 20-40 years old
- doesn’t typically occur after menopause
- can calcify
- can look like cancer on mammogram
9
Q
What is the most common benign neoplasm in breast tissue?
A
Fibroadenomas
10
Q
What are 3 characteristics of benign neoplasm in breast tissue?
A
- mostly connective tissue
- well circumscribed
- don’t typically remove unless uncomfortable
11
Q
At what age does breast carcinoma rarely occur?
A
Under 25 years old
12
Q
What is the incidence of breast carcinoma?
A
~30% by 70 yrs old
13
Q
Is there racial influence in breast carcinoma?
A
No, but there is environmental influences
14
Q
Is Breast carcinoma inherited?
A
5-10% yes
BRCA 1 and 2 most common inherited genes
15
Q
How many new breast cancers are there in the U.S. in a year?
A
~250,000
16
Q
What are the symptoms of Breast carcinoma?
A
- pain
2. masses
17
Q
How are masses assessed for breast cancer?
A
- palpitation
- mammography
- ultrasound
- MRI
- Tissue Biopsy
18
Q
What is the prognosis of breast carcinoma?
A
- 5 year survival rate of stage 0 (early stage) = 92%
2. stage IV (late) = 13%
19
Q
What is the prognosis of breast carcinoma based on?
A
- size
- axillary node status
- distant metastasis
20
Q
What indicated if breast carcinoma will respond to hormonal treatment?
A
If the tumor expresses estrogen/progesterone receptors
21
Q
What are the types of breast cancer?
A
- Invasive carcinoma: 75-85%
- most are DUCTAL and increases with age
- invasive and noninvasive types
22
Q
What can be done to remove smaller breast masses?
A
lumpectomies to remove smaller masses
23
Q
What are benign epithelial lesions in breast tissue
A
typically fibrocytic changes
~60% of women have microscopic cysts associated with epithelial tissue
24
Q
What causes cervical cancers?
A
HPV (human papillomavirus) –> associates squamous cell neoplasm represents MOST cervical cancers
25
How do you detect cervical cancer early?
pap smear
26
What are the risk factors for cervical cancer?
1. Multiple sex partners
2. immunosuppression
3. early age of first sexual contact
4. oral contraception for >5 years
5. nicotine use
27
What causes Endometrial polyps?
1. Hypertension
2. Obesity
3. Late menopause
28
What is the type of endometrial cancer?
Adenocarcinoma
29
What are the risks for endometrial cancer?
1. obesity
2. diabetes
3. hypertension
30
What is the treatments for endometrial cancer?
1. Hysterectomy- TX OF CHOICE!
| 2. Radiation/chemotherapy adjunctive
31
What is the common cause of endometritis (infections)?
IUDs (intrauterine devices)
32
What can endometrial hyperplasia progress to?
can progress to cancer
33
What causes endometrial hyperplasia?
Exaggerated responses due to excessive estrogen
| eg. excessive ovarian activity
34
What is the treatment for endometrial hyperplasia?
1. Progesterone
| 2. hysterectomy
35
What are the types of ovarian masses?
1. non neoplastic cysts (e.g. follicular)
| 2. Neoplastic (e.g. endometroioid)
36
What are the characteristics of ovarian neoplastic masses?
1. most are SPORADIC
| 2. CONTRACEPTIVES can decrease risk
37
What is the treatment for neoplastic ovarian masses?
Total hysterectomy + removal of surrounding tissue + chemotherapy
38
What are the symptoms for ovarian masses?
1. Pelvic pain
2. Pelvic mass
3. Abdominal bleeding
39
Can you screen for ovarian cancer?
Unlike cervical cancer, there is NO EFFECTIVE SCREENING
40
How much of calcium is stored in bones?
99%
41
In adults, what are bones the primary site for?
Hematopoeises
42
T/F bones are constantly remodeling?
True
43
Medullary bone resists ________?
Compression forces
44
Cortical bone is _____ and resists ______
thick, bending forces
45
What is the preiosteum?
1. Tough fibrous membrane
2. covers bone surfaces except at joins
3. well innervated
46
What is a disease of abnormal bone matrix?
Osteogenesis imperfecta
47
what is the body deficient of in osteogenesis imperfecta?
Deficient or defective of TYPE 1 collagen --> too little bone
48
What are the symptoms of osteogenesis imperfecta?
Generalize osteopenia that leads to
1. multiple fractures and bone deformities
2. malformed teeth (dentin deficiency)
49
What is scurvy?
1. acquired bone disease from vitamin C deficiency
50
What is rickets?
1. acquire disease of bone from vitamin D deficiency
2. Type of Osteomalacia
3. can be from lack of calcium or phosphate
4. inadequate bone mineralization
5. wide, deformed long bone epiphyses
51
What endocrine factors can cause acquired bone diseases?
Hyperparathyroidism
52
What is Osteoperosis?
1. acquired disease of bone where there is reduced bone mass
2. very common in elderly, esp women
53
What is Osteomalacia?
1. . acquire bone disease involving lack of normal mineralization
2. uncommon
3. caused by renal failure (renal osteodystrophy) and vitamin D deficiency in an adult
54
What is Hyperparathyroidism?
unabated bone breakdown to increase serum Ca levels that leads to significant skeletal changes
55
What are the GENETIC causes of Osteoporosis?
1. Age
2. Low estrogen
3. fair hair and skin
4. tall and thin
56
What are the BEHAVIORAL causes of Osteoporosis?
1. Inactivity
2. smoking/alcohol
3. malnutrition
4. medication (chronic corticosteroids)
57
How many ppl in the U.S. have osteoporosis?
10 million
| Mostly women
58
How many women have at least 1 osteoporitic fracture?
1/3 of women > 50 yrs old
59
Why is kyphosis?
1. Disorder of bone instability
| 2. abnormal forward curvature of the spine
60
What is Scoliosis?
1. disorder of bone instability
| 2. abnormal lateral curvature of spine
61
What are the different types of fractures?
1. Complete
2. Closed (overlying tissue intact)
3. Commuted - bone splintered
4. Displaced - fractured bone is not aligned
5. compound - bone goes into overlying skin
62
What is Oseomyelitis?
Inflammation of bone/marrow
63
What are the routes of infection for Osteomyelitis?
1. Blood borne
| 2. Direct contiguous
64
What type of trauma can contribute to osteomyelitis?
1. Trauma from compound fractures
| 2. trauma from surgery
65
What bacteria can cause pyogenic infections in osteomyelitis? where?
1. Staph aureus
2. Salmonella
3. bone centered
66
What granulomatous infection can cause osteomyelitis? where?
1. TB or fungal
2. POTT DISEASE when associated with TB
3. affect joints including spine
67
How can diabetes lead to Osteomyelitis?
- poor circulation in the extremities
| - if chronic can form a drainage site and can even become osteosarcoma
68
What is Osteoarthritis?
Loss of articular cartilage with secondary changes in bone
69
How present in ppl is Osteoarthritis?
present to some degree in most ppl >65 yrs
70
When do symptoms worsen in Osteoarthritis?
With excessive use
71
What is osteoarthritis caused by?
Due to wear and tear
72
Are there inflammatory changes with Osteoarthritis?
No
73
What is Rheumatoid arthritis?
Autoimmune disease that causes
1. joint swelling
2. pain and tenderness
3. often extreme distortions of joint and surrounding bone
4. deforming and debilitating
74
What is the prevalence of RA in the US?
1% and 75% are female
75
In what ethnicity is RA the most common and uncommon?
Caucasions most
| uncommon in Asians
76
At what age does RA onset?
25-50 years
*Can have juvenile arthritis
77
What areas are affected by RA?
1. small joints of hand (NOT DIP joint)
2. some large joints
3. Ulcers
4. Pulmonary nodules and fibrosis
5. Carditis and pericarditis
6. Vasculitis
78
Other inflammatory arthritides? (6)
1. Psoriatic (psorias) arthritis
2. Autoimmune (lupus erythematosus, scleroderma)
3. Postinfections (rheumatic fever)
4. Infections (staph, strep, tb)
5. Gout (crystallized uric acid)
6. Lyme Disease UNTREATED --> arthritis and neurological consequences
79
What is the primary cause of GOUT?
reduced renal excretion of purine
80
What is the primary treatment for GOUT?
Allopurinol -- decreases the synthesis of purines
81
What are the symptoms of Gout?
1. hot, swollen, pain in joints
2. progressive joint destruction
3. gouty tophi (crystalized aggregates of uric acid)
82
What is pseudo gout?
crystal deposits of calcium pyrophosphate
83
What are Ganglion cyst?
A cyst resulting from connective tissue around joints -- often painful!
84
How does skin provide protection against infection?
1. UV
2. Mechanical
3. Chemical
4. Thermal
5. Dehydration
85
What sensation does skins cause?
1. Touch
2. Pressure
3. Pain
4. Temperature
86
How does skin thermoregulate?
1. Hair
2. Subcutaneous adipose tissue
3. Sweat
87
What metabolic function does skin provide?
1. Energy Storage
| 2. Vitamin D synthesis
88
What are 3 types of cells in Skin?
1. Squamous cells
2. basal cells
3. melanocytes
89
What are squamous cells?
1. Keratinocytes in the epidermis
2. physical barrier to microorganism
3. secretion of cytokines
90
What types of cells are found in the basal cell layer?
1. Stem cells
2. melanocytes
3. langerhans cells
91
What are melanocytes?
Pigment producing cells
92
What are langerhans Cells?
Antigen presenting
93
What are skin appendages?
1. Hair
2. Sebaceous Glands
3. Sweat glands
94
What are 2 types of sweat glands?
Apocrine
| Eccrine
95
What are apocrine glands?
Sweaty milky with odors located near hair follicles
96
What are eccrine glands?
Found widely distributed and sweat is watery for thermal control
97
What are sebaceous glands?
Near hair follicles, secrete sebum for lubrication and to prevent water loss
98
What is a macule?
1. flat
2. circumscribes
3. less than 5 mm
99
what is a papule?
1. elevated dome
or
2. flat topped
3. more than 5 mm
100
What is a nodule?
1. elevated dome
| 2. > 5 mm
101
What is a plaque?
1. elevated flat topped lesion
| 2. > 5 mm
102
What is lichenfication?
thickened skin due to repeated rubbing
103
What is a pustule?
1. discrete
| 2. pus filled raised lesion
104
What is a scale?
1. dry
2. plate like excrescence
3. imperfect cornification
105
What is a vesicle?
1. fluid filled raised area
| 2. less than 5 mm
106
What is Acantholysis?
loss of intercellular adhesion keratinocytes --> epidermis falls apart and sloughs off
107
What is acanthosis?
diffuse epidermis hyperplasia
108
What is excoriation?
Traumatic breakage of skin (e.g. result of intense scratching)
109
What is a bulla?
Fluid filled raised area > 5mm
110
What is dyskeratosis?
abnormal keratization deeper in epidermis
111
What is hyperkeratosis?
hyperplasia of stratum corneum
112
What is spongiosis?
intercellular edema of epidermis
113
What is Urticaria (hives) ?
| acute
1. type 1 Hypersensitivity mediated by antigens (pollen, food, drugs, insect venom)
2. mediated by IgE
3. w/o IgE = direct mast cell degranulation
114
What is eczematous dermatitis?
| acute
1. delayed hypersensitivity reaction
2. can be pruritic
3. edematous or oozing plaque/vesicles
4. most common is contact dermatitis
115
What is Allergic contact dermatitis?
| acute
Cellular memory of the reaction sot hat future contacts cause an increases dermatitis reaction
116
What is Erythema multiforma?
| acute
1. Hypersensitivity to infections and drugs b/c of cytotoxic CD8+ t cells attack basal cells of skin and mucosae
2. Dermal edema --> can have blisters and necrosis
3. wide range of expressions and severity
4. can be severe life-threatening rx known as Stevens Johnson Syndrome
117
What is Stevens Johnson Syndrome?
| (acute)
1. Generalized reaction to medicines all over the body (sulfonamides, salicyclates)
2. reaction to infections such as herpes virus or fungal infections
118
What is psoriasis?
| Chronic
1. Inciting antigen (self or environmental)
2. auto-rejection OR envrionmentally induced
3. can be accompanied by increased heart attacks and arthritis
119
What is the prevalence of psoriasis in US?
1-2 %
120
What is the treatment for psoriasis?
1. NSAIDS
| 2. Immunosuppressant drugs
121
What types of lesions does psoriasis have?
well marked by pink and salmon colored plaques?
122
What occurs microscopically in psoriasis?
regular acanthosis in epidermis
123
What is Lichen Planus?
| chronic
- CD8+ cytotoxic T cell response to antigens in basal cell layer of epidermis
- unknown inciting mechanisms
124
What age and where on body does lichen planus affect?
1. middle age
| 2. extremities and oral cavity
125
What types of lesions does licen planus have?
Lace-like white markings
126
How long does it take for lichen planus to resolve?
after 1-2 years, but often persists in oral cavity
127
What occurs in tissue in lichen planus?
Hyperkerotosis and epidermal hyperplasia
128
What is Impetigo?
| infectious dermatosis
Superficial bacterial infection of the skin primarily in kids
129
What are the causitive agents of impetigo?
1. staph and strep infections superficially
130
Where does impetigo occur?
On face and extremities
131
How is Impetigo spread?
Contagious through contact
132
What types of lesions on in impetigo?
honey color crusted pustules
133
What are 2 superficial fungal infections?
1. Tinea (ring worm)
| 2. Candida
134
What population do superficial fungal infections usually affect?
Immunocompromised patients
135
What are viral infections?
| infectious dermatosis
Verrucae "wart"
| caused by HPV
136
What are verrucae transmitted?
1. By direct contact with infected individual
| 2. auto-innoculation and spread
137
What are histological features of Verruace?
1. epidermal hyperplasia
| 2. papillomatosis
138
What are 2 conditions in which bulbous blistering is the prominent feature?
1. Pemphigus
| 2. Dermatitis Herpetiformis
139
What is pemphigus?
1. automimmune hypersensitivity reaction (IgE disrupts desmosome)
2. painful flaccid blister like deep erosions that crust after rupture
140
What is the tx for pemphigus?
Immunosuppressant drugs
141
What is dermatitis Herpetiformis?
1. Associated with Celiac disease
2. autoimmune mediated by IgA antibodies to gluten
3. pruritis urticaria and grouped vesicles
142
What type of tx is there for dermatitis herpetiformis?
Responds to gluten free diet
Immunosuppresant?
143
What strain causes Oral expression of herpes simplex?
HSV1 (cold sores)
144
What causes gential herpes?
HSV2
145
How is herpes expressed?
1. grouped vesicles
2. epidermal acantholysis
3. vesicles
4. sloughing
146
What type of distribution does Zoster have?
1. dermatomal
| 2. when involves trigeminal nerve can be VERY dangerous spreading to surrounding tissues such as eye or brain
147
What causes and who gets shingles?
1. Varicella Zoster Virus causes later in life
| 2. to ppl who had chicken pox when younger
148
How is shingles expressed?
1. unilateral dermatomal distribution
| 2. expresses as a band of rash that often itches, burns, or throbs.
149
How long does shingles last?
weeks to months
150
How do you treat shingles?
anti-inflammatories or opioid analgesics
151
What can happen in extreme cases of shingles?
intense neuralgia and does not respond to traditional analgesics
152
Is shingles contagious?
No, typically doesn't repeat, but can in some cases
153
what are 3 expressions of Acne?
1. open comodones (blackheads)
2. closed comodones (white heads)
3. cysts, pustules, abscesses
154
What causes Acne Vulgaris?
hormone changes (sex hormones), increases testosterone influence
155
What does Acne vulgaris block?
1. hair follicles
| 2. sebaceous glands
156
What happens to hair follicles in acne vulagaris?
1. Hair follicles have proliferation of lining cells and cellular sloughing
2. forms a cellular plug
3. traps bacteria, cellular debris and sebum
157
What happens to glands in acne vulgaris?
1. Gland ruptures
2. contents form cysts, abscesses, and scarring
3. area is inflamed and swollen
158
What are 4 tx for acne vulgaris?
1. antibiotics
2. keratolytics
3. drying agents
4. vitamin A (topical and systemic- Accutane)
159
What is perioral dermatitis?
1. young women
2. long term steroid use or cosmetic use
3. follicular papules, vesicles and pustules
160
What is Seorrhea Keratosis?
1. neoplastic benign
2. elderly, middle aged
3. coin like plaques; stuck on appearance
4. tan to dark brown granular surface
161
What are the most common cancer?
malignant Skin Cancer
162
What are most skin cancers caused by?
Most are from UV in fair skinned persons
163
What is the most common malignancy worldwide?
Basal cell
164
How aggressive is basal cell carcinoma?
1. least aggressive
2. does not metastasize
3. slow growing
165
How is basal cell carcinoma treated?
Local incision
166
What is the second most common skin cancer?
Squamous cell carcinoma
167
How aggressive is squamous cell?
1. intermediate aggression
2. no metastasis
3. red scaling plaques locally aggressive
168
What is the least likely skin cancer?
Melanoma
169
How aggressive is Melanoma?
Aggressive and metastasizes
170
What are warning signs of melanoma?
1. rapid enlargment of nevus
2. new pigmented lesion- not from pre existing nevi
3. irregular borders
4. irregular surface and colors
171
What causes Melanoma?
UV exposure and genetics
172
What is the prognosis for Melanoma?
Poor it metastasized
173
What are the common sites for melanoma metastasis ?
1. lungs
2. liver
3. brain
174
Why can Melanoma metastasize?
1. high mitotic rate
| 2. lack of immune response to slow down (esp. when hits lymph nodes)
175
What is a stye?
Skin infection like a pimple on eyelid- mostly external
176
What are the three types of cancer in the eye?
1. Basal and squamous cell carcinoma of eyelid- usually slow growing
2. melanoma- varying colors and potentially aggressive -- usually in older people
177
What is glaucoma?
1. high intraocular pressure in the anterior chamber
2. increase pressure within the eye due to increased production or decreased outflow of aqueous humor (replaced every 2 hours; supplies nutrients and removes waste)
3. can damage optic nerve and cause blindness
178
```
What is closed angle glaucoma?
prevalence?
cause?
symptoms?
tx?
```
1. iris fused to cornea
2. less than 10%
3. rapid closure of drainage canals
4. symptoms typically noticeable
5. surgery usually necessary.
179
```
What is open angle glaucoma?
cause?
symptoms?
prevalence?
population?
risk factors?
```
1. Wide space between iris and cornea
2. slow clogging of drainage canals
3. symptoms subtle and often undetected
4. most common 90%; 3 million cases in the U.S.
5. African Americans esp. vulnerable
6. increased risk with diabetes and HP
180
What is Gonioscopy?
Measures anterior chamber angle in eye
181
What is tonometry?
Measures intraocular pressure
182
What are cataracts?
opacification of lens
183
What causes cataracts?
1. diabetes
2. UV exposure
3. aging
184
What is the treatment for cataracts?
typically surgical removal
185
What occurs in diabetic retinopathy?
associated with hemorrhaging and ischemic spots (expressed COTTONWOOL spots)
186
What causes similar retinopathoies as diabetes?
Hypertension
187
What is the prevalence of age-related macular degeneration?
>10% patients > 80 years old
almost never occurs in individuals
188
What is the most common cause of severe loss of sight in 60+ patients?
age related macular degeneration
189
What are risk factors for age related macular degeneration?
1. smoking
2. gene polymorphism
3. cardiovascular disease
190
What is the consequence of age related macular degeneration?
loss of central vision
191
Does macular degeneration progress faster in wet or dry?
Wet - hemorrhage and fluid present
*but dry is large majority
192
What are the pharm tx options for wet age macular degeneration?
1. options minimal
2. maybe antioxidants help reduce development; minimal benefit
- vitamin C
- zinc oxide
193
What are the pharm tx for dry age macular degeneration?
None
194
What is generally the tx for age related macular degeneration?
name?
1. monoclonal Ab (anti-angiogenic Ab)
| 2. Bevacizumab (Avestatin)
195
How do you use Bevacizumab?
Inject into vitreous humor; 1-2x/month for WET age macular degeneration
196
What occurs in retinal detachment?
retinal tear resulting from trauma
197
What is the most common tumor in children?
Retinoblastoma
198
Why is the Ear often involved in REFERRED pain associated with mouth and dental structures?
because both are innervated by the trigeminal complex
199
What is Meniere disease?
Inner ear disease
200
What are the symptoms of Meniere disease?
1. Vertigo
2. hearing loss
3. nausea
4. sometimes migraine headaches
5. hearing loss
6. swimming feeling
7. tinnitus
8. balance problems
201
What is the pathology of Meniere disease?
endolymphatic hydrops --> swelling/excess fluid in labyrinth
202
What are the risks for Meniere disease?
1. improper inner ear fluid drainage
2. allergies
3. viral infections
4. head trauma
5. migraines
203
What diagnostic tests are done for Meniere disease?
1. Hearing
| 2. balance assessments
204
Is surgery a common treatment for Meniere disease?
No, some surgical interventions, but extreme
205
What is otitis media?
Typically associated with blockage of the Eustachian tube
206
What infections can cause otitis medita?
1. strep penumonia
| 2. haemophilus influenza
207
What are the symptoms of otitis media?
1. pain
2. ear discharge
3. headache
4. hearing loss
5. tinnitis
6. vertigo
7. immobile eardrum (swollen and inflamed)
8. fever
208
What is the second leading cause of death in the U.S.?
Cancer
209
What causes cancer?
accumulation of DNA mutations in cells acquired spontaneously or induced- usually multiple mutations
210
What are the 5 properties of cancer?
1. Non-responsive to normal physiologic cues
2. Lack of response to growth inhibitory signals
3. avoid normal cell cycle mediated death
4. develops own angiogenesis
5. evades immune detection
211
What is a neoplasm?
uncontrolled growth of cells, progeny of a single cell
212
What do neoplasm names usually end in?
-OMA
213
What is a benign epithelial tumor if glandular called?
Adenoma
214
What is a benign epithelial tumor if papillary called?
Papilloma
215
What makes a tumor malignant?
Metastasizes
216
What is an epithelial malignant tumor called?
Carcinoma
ex. squamous cell carcinoma
217
What is a mesenchymal malignant tumor called?
Sarcoma
218
What is a lymphoid malignant tumor called?
Lymphoma
219
What is a malignant melanocytic tumor called?
Melanoma
220
What is a malignant hematopoietic tumor called?
Leukemia
221
What is a lipoma?
Benign fat tumor
222
What is malignant fat tumor?
liposarcoma
223
What is malignant bone cancer?
Osteosarcoma
224
What is malignant skeletal muscle tumor? in kids..
Rhabdomyosarcoma
225
What is benign skeletal muscle tumor?
Rhabdomyoma
226
What is malignant tumor of smooth muscle?
Leiomyosarcoma
227
What is a benign tumor of smooth muscle?
Leiomyoma
228
What are inflammatory masses- no neoplasm?
Granulomas
229
What is a hemartoma?
mal-developed tissue native to site (nodular tongue)
| not neoplasma
230
What is a choristoma?
mal-developed tissue in other organ
| not neoplasm
231
What is the leading cause of cancer deaths in U.S.? Second for men? Second for women?
1. Lung cancer
2. prostate
3. Breast
232
What is the most common cause of sporadic cancers?
Environmental
| *subset are hereditary
233
What are solid tumor mutation panels?
Next generation sequencing used for solid tumor tissue and assessed for multiple potential targets for therapeutics responses -- sometimes can predict prognosis
234
T/F success response to cancer kills 100% cells?
False, common for success response not to kill "all" of the cells (99.9% kill)-- may lead to recurrence months to years later
235
Chromosomal changes associated with cancers include?
1. Deletions
2. Translocations
3. duplications
4. amplifications
5. abnormal number of chromosomes
236
What process looks for chromosomal changes associated with cancer?
Cytogenics
237
What is Philadelphia Chromosome?
- 9:22 translocation on chromosome 22
- leads to chronic myelocytic leukemia
- detect with molecular strategies like PCR and microarrays
238
What 7 things must a malignant tumor do to grown?
1. Develop a signal to proliferate
2. avoid apoptosis
3. invade stroma (if carcinoma)
4. metastasize
5. induce angiogenesis
6. alter DNA in order to allow continued mitosis (normally cells stop dividing after 15x doubling)
7. develop telomerase to prevent cellular senescence
239
What are the 7 genetic targets for tumors?
1. Oncogenes
2. Tumor suppressor genes
3. apoptosis regulating genes (P53)
4. DNA repair genes
5. Mismatched repair gene mutations
6. angiogenesis
7. develop properties for invasiveness
240
What are oncogenes?
Promote proliferation
| eg. growth factors or corresponding receptors
241
What tumor suppressor genes are inhibited by tumors?
1. BRCA-1 and BRCA-2, breast and ovaries
2. P53 gene
3. WT-1 gene, regulates apoptosis in Wilm's Tumor (children kidney cancer)
4. APC- adenomatous poyposis coli tumors in bowel and pancreas
242
What is the most common suppressor gene mutation?
P53 gene- lost in 50% malignancies
243
What is a gene involved with errors in mismatch repair genes?
HNPCC gene
| Hereditary nonpolyposis colon cancer
244
What is angioneogenesis?
Tumors release vascular endothelial growth factor-- allows them to grow past 2 mm
245
What do most chemotherapies target? result?
1. target proliferating cells
2. good for killing fast growing tumors, not so good for slow or non growing tumor cells
3. injure rapidly proliferating normal cells such as:
- bone marrow
- intestinal mucosa
- hair
246
T/F metastatic pattern is all the same between tumors?
False, the patterns VARY
- subtle differences in endothelium
- varying growth factors, other factors in different sites
247
What mutations can cause cancer?
1. Chemical carcinogens
- alkylating agents
- nitrosamines in food
2. UV light (skin cancer)
3. Radiation
248
What is the Ames test?
measures if a chemical alters genetic changes in bacteria and would be a carcinogen
249
What 4 tumor viruses cause cancer?
1. HPV- human papilloma virus, carcinoma of cervic and oropharyngeal
2. Epstein Barr: mononucleosis
3. Hep B and C viruses: hepatocellular carcinoma
4. HHV 8 herpes Virus- Kaposi Sarcoma (AIDS)
250
What bacteria and inflammation can cause cancer?
1. H. pylori - gastric adenocarcinoma
| 2. Asbestosis
251
What are 6 chemical carcinogens to cause cancer?
1. Reactive chemical (free radicals) alter DNA
2. Alkylating agents- some used to treat cancer
3. Polycarbon aromatics: benzopyrene in smoke and cooked meat
4. Aflatoxin - fungus on peanuts and other foods (not so much in US.
5. Nitrosamine/nitrates in foods
6. Metal Ions: nickel, aresnic
252
What types of hormones can cause cancer?
Sex hormones
253
How does a lack of immune response cause cancer?
1. Immunocompromised-- altered host response to tumor can interfere with natural defense mechanisms
2. immunosuppressed children have 200x increased risk for cancer
254
T/F having a genetic predisposition can cause cancer?
True
255
T/F Variation in hepatic susceptability of CYP1A1 and glutathione activity can cause cancer?
True
256
What type of cancer can be caused by radiation?
Skin cancer caused by UV radiation
257
What type of cancer can be cause by xray and gamma radiation?
1. Leukemias
2. Papillary thyroid
3. breast cancer
258
How do cancers kill?
1. growth and metastasis
2. involve vital organs
3. get a flood of cytokines that shut down organ function
4. cachexia
259
What is carcinoid syndrome?
1. metastasis of intestinal carcinoid
2. flushing and diarrhea
3. right heart fibrosis
260
What is the most common type of malignancy?
Carcinoma- epithelium/endothelium
261
Where does carcinoma most often metastasize?
1. to regional lymph nodes
| 2. can spread through blood dependent on type
262
Squamous cell Carcinoma
1. similar appearance regardless of primary site
2. usually slow growing in skin
3. associated with lips or lung more dangerous
4. can form keratin pearls
263
Adenocarcinoma?
1. Forms glands/fused glands with lumen
| 2. tumors of cuboidal or columnar cells
264
What are the 4 types of adenocarcinomas?
1. Colon
2. Prostate- fairly innocuous looking, lose basal cell layer. PSA immunostain
3. Breast- many positive for estrogen receptors; scirrhous ductal and tubular
4. lung:
- -small cell carcinomas are aggressive with poor prognosis
- - large cell carcinomas are slower with better prognosis
265
What are neuroendocrine tumors?
Carcinoids of GI tract and Lung
- small cell lung carcinoma highly malignant
- small bowel carcinoid: low grade tumor. nests of bland tumor cells growing in bowel wall under mucosa
- can check by immunostaining or electronmicroscopy
266
What is Kaposi's sarcoma linked with?
AIDS
267
What is angiosarcoma?
Malignant tumor of endothelial tissue (vessels); can result from radiation therapy
268
What is chondrosarcoma?
Malignant tumor of cartilage (chondrocytes)
269
What is Osteosarcoma?
Malignant tumor of bone
270
t/f mesenchymal tumors or sarcomas are more of a pushing rather than invasive cancer?
True
271
What is criteria for mesenchymal tumors?
Different for malignancy, depending on
1. site
2. tumor type
3. clinical situation-- malignancy determined by clinical follow up- what is malignant is what can metastasize and kill the patient
4. clinical information is vital
272
```
What is Hodgkin's Lymphoma?
population?
example?
prognosis?
cells?
Virus?
Tx?
```
1. Lymphoma that is more common in younger patients; B cell neoplasm
2. eg. lymphoblastic leukemia
3. usually good prognosis
4. Sometimes characterized by Reed Sternberg cells (large, multinucleated B lymphocytes)
5. EBV virus found in ~80%
6. Anthracycline, doxorubicin, bleomycine, vinblastine
273
Non Hodgkins lymphoma
prognosis?
example?
1. various levels of aggressiveness/sometimes poor prognosis
2. Burkitt's Lymphoma- a type of non-hodgkin's lymphoma linked to Epstein Barr infection and can affect maxilla and mandible; very aggressive from B lymphocytes. Poor prognosis
274
What does acute leukemia principally affect?
Bone marrow
275
What is lymphoma classified on?
Hodgkins vs non hodgkins
B or T cell neoplams
size of tumor cells
follicular or not
276
What is incidence?
Newly diagnoses cases/time
277
What is mortality?
death/time period
278
What is prevalence?
new and pre-existing cases at one moment
279
How does TNM grading work?
T: size and extent of primary tumor
N: presence and number of lymph node metastases
M: presence of distant metastases
280
How do Serological tests grade tumors?
| 4 antigens?
most useful for assessing cancer RECURRENCE after treatment
PSA: prostate specific antigen
CBA: carcinoembryonic antigen- colon carcinoma
CA-125: serous ovarian carcinoma
HCG: choriocarcinoma
281
What is epidemiology of cancer?
1. 1.5 million new cancers diagnosed in 2011; with 600,00 cancer deaths in that year
2. lung cancer is leading cause of cancer deaths in U.S. followed by prostate for men and breast cancer for women
282
T/F japanese risk of gastric cancer is 7x that in the U.S.
True
283
T/F breast cancer is more common in the US and Europe than in other countries
True
284
What is the most common cancer in Africa and why?
Liver cell Carcinoma due to link with viral hepatitis
285
Is environment or genetics more important in causing cancer?
Environment
286
What is an example of genetic risk for cancer?
1. Familiar adenomatous poyposis/colon cancer linked to APC gene
2. some breast and ovarian cancers linked to BRCA 1 and 2 genes
287
What are the 3 types of treatment for Cancer?
1. Surgical removal
2. radiation therapy- maximize exposure of tumor and minimize exposure to normal tissue
3. Chemotherapy
288
How does Chemotherapy work?
1. most damage to rapidly proliferating cells
2. treats whole body
3. tumor can develop resistance
4. often multiple drugs required
5. can cause cancer later
289
What is the most common cancer in children?
Acute lymphoblastic Leukemia (ALL)
290
What is the most common acute form of leukemia in adults?
Acute myelogenous leukemia (AML)
291
What is the single most active agent in acute myelogenous leukemia?
Cytarbine
292
What is multiple myeloma?
Plasma cell malignancy, primarily in bone marrow
293
What are the symptoms of multiple myeloma?
1. Bone pain
2. Fractures
3. Anemia
294
What is the treatment for multiple myeloma?
1. Alkylating agent
| 2. prednisone
295
What is stage 1 of breast cancer?
1. small primary tumor
| 2. surgery alone is an 80% cure
296
What is stage 2 of breast cancer?
1. positive node
2. post operative use of chemo
3. 6 cycles of cyclophosphamide, methotrexate and fluorouracil = CMF protocol
297
What is stage 3-4 breast cancer?
Very major challenge
298
What is best resolution of breast cancer?
much more effective resolution due to early treatments (diagnose and tx)
299
Prostate cancer etiology?
1 in 8 men
300
What is prostate cancer effect on PSA and acid phosphatase?
Elevates PSA and acid phosphatase
301
How do you treat prostatic cancer?
treat by:
1. eliminating testosterone production through surgical castration
2. luteinizing hormone releasing hormone (LHRH) agonists block release of LHRH
302
What is the most common GI malignancy?
Colorectal cancer
303
What is the tx for Colorectal cancer?
5 Fluorouracil (40-50% response rate)
304
What is late complication of alkylating agents?
Secondary malignancy
305
What is the most common secondary malignancy from alkylating agents?
Acute myelogenous leukemia- observed as early as 2-4 years after
306
What are the 3 secondary malignancies?
1. non-hodgkin's lymphoma
2. bladder cancers (associated with cyclophosphamide therapy)
3. acute myelogenous leukemia
307
What is chemical esophagitis?
Irritants to squamous mucosa that can cause acute inflammation and possible ulceration
308
What can cause chemical esophagitis?
1. corrosives
2. smoking
3. alcohol
4. chemotherapy
309
In what population does infectious esophagitis usually occur in?
immunosuppressed
310
What often causes infectious esophagitis?
1. Herpes
2. Candida
3. Cytomeaglovirus
311
What often occurs in infectious esophagitis?
ulcers
312
What happens in CMV?
1. affects entire G1 tract
2. neonates acquire thru birth canal or infected breast milk
3. adults acquire through sexual transmission or needles
4. multiple discrete, well circumscribed superficial ulcers
313
What causes reflux esophagitis?
relaxation of gastroesophageal sphincter
314
What are the symptoms of reflux esophagitis?
1. burning
2. excessive salivation
3. choking
315
What are aggravating factors in reflux esophagitis?
1. obesity
2. pregnancy
3. drug use
316
How and what drugs aggravate reflux esophagitis?
1. Alcohol/tobacco
2. narcotics
3. nicotine patch
- -> all of these decrease esophageal pressure
317
What is the medical tx for reflux esophagitis?
1. Antacids
2. H2 blockers
3. PPI (proton pump inhibitors)
318
What lifestyle tx is there for reflux esophagitis?
1. lose weight
2. stop smoking
3. drinking
319
What complications exist for reflux esophagitis?
1. ulceration
2. stricture
3. Barrett esophagus
320
What happens histologically in Barrett esophagus?
long tongues of extended columns of epithelium cells into esophagus
321
What is reactive gastropathy?
erosive gastritis
322
What is erosive gastritis induced by?
1. alcohol
2. NSAIDs
3. iron
4. Stress
5. post gastrectomy-bile reflux
323
What is acute gastritis?
- Acute stomach injury
| - asymptomatic with possible significant blood loss
324
Acute Peptic ulceration symptoms
1. Nausea
2. Vomiting
3. NSAIDs
4. Stress
325
what are 2 type of chronic gastritis ?
1. H. pylori gastritis
| 2. autoimmune gastritis
326
What occurs in H. pylori gastritis?
Duodenal and pyloric ulcers --> can lead to cancer
327
What happens in autoimmune gastritis?
fadj
328
What can cause peptic ulcer disease?
1. H.pylori
| 2. NSAIDs
329
What happens in peptic ulcer disease?
1. increased acid
| 2. punched out ulcers- potential for perforation and hemorrhage
330
What is peptic ulcer disease likely also involved in?
adenocarcinoma development
331
What is autoimmune atrophic gastritis?
1. Genetic factors
2. no ulcers
3. decreased gastric acid
4. intestinal metaplasia
5. long term effects relate to malabsorption of B12 (pernicious anemia)
332
What are 2 types of stomach polyps?
1. Hyperplasetic polyps-- in response to gastric injury, around ulcers
2. sporadic :
- fundic gland polyps
- B-catenin mutations
- 50% FAP, secondary to use of PPI
333
What does gastric carcinoma look like?
1. intestinal tissue type (gland forming) and diffuse type (signet ring cell)
2. some have hereditary connection (CDH1)
334
What percentage of the time is intestinal obstruction mechanic?
neoplasm and infarction?
1. 80%
| 2. 20%
335
What is Hirschsprung disease?
1. congenital defect in colonic innervation
| 2. failure to pass meconium
336
What is Celiac sprue/disease?
1. immune mediated- triggered by ingestion of gluten
| 2. Malnutrition from Fe, B12 malabsorption = atrophic glossitis
337
What dental effects does celiac disease have?
1. enamel defects
2. delayed eruption
3. recurrent apthous ulcers
4. cheilosis
338
What is Lymphocytic colitis?
increased intraepithelial lymphocytes
339
What are the symptoms of Irritable bowel syndrom
1. relapsing pain
2. bloating
3. relapsing and alternating constipation/diarrhea
340
What are factors of Irritable bowel syndrom?
1. diet
2. abnormal gastrointestinal motility
3. stress
341
Are there any microscopic abnormalities in irritable bowel syndrome?
no
342
What causes infectious self limiting colitis?
1. salmonella
2. E. coli
3. shigella
4. clostridium
343
What happens in pseudomembranous colitis?
cause?
follows?
therapy?
1. cells slough off
2. clostridium difficile (toxin A and B)
3. person to person
4. follows broad spectrum antibiotic therapy that alter gut flora
344
What is the most common nosocomial infection in older adults?
Pseudomembranous colitis
345
What are 2 types of inflammatory bowel disease?
1. Crohn's disease
2. ulcerative colitis
*multifactorial with host mucosal immune response, intestinal microbiota and epithelial dysfunction
346
what is crohn's disease?
1. similar to ulcerative colitis
2. skips lesions and has intermediate constrictures
3. epithelioid granulomas
4. fistulas and perianal disease
5. affects upper GI tract
6. transmural inflammation
347
What are the oral manifestations of Crohn's disease?
1. .5 % have oral lesions
2. usually males
3. liner and deep ulcerations
348
What happens in ulcerative colitis?
1. more continuous especially in colon
2. no transmural inflammation
3. no fistulas and not perianal
349
What are the oral manifestations of ulcerative colitis?
1. less common than in crohn's disease
2. usually males
3. edematous oral submucosa
350
Do colonic hyperplastic polyps have malignant potential?
no, decreased cell turnover resulting in a pile up of cells within the surface
351
What is adenoma in colon?
a type of colonic polyp that is a precursor to adenocarcinoma
-size correlates with risk of malignancy
352
what perecent of cancer deaths is Invasive Colonic Adenocarcinoma responsible for?
responsible for 15% of all cancer related deaths in the US
353
what are the dietary features of invasive colonic adeocarcinoma?
1. increased risk with low fiber (veggies)
| 2. high intake carbohydrates and fat
354
What is cholecystitis?
1. acute often cause by gallstones and obstruction and can become chronic
2. cholestasis (stoppage and reduction of bile flow) causes jaundice
*bile is common mechanism for excretion of toxins and drugs
355
What are 5 types of liver disease?
1. Fatty liver
2. Hepatitis
3. Biliary disease
4. metabolic disease
5. Vascular
356
What can liver disease go on to cause?
Cirrhosis
357
What causes fatty liver disease?
ETOH- ethyl alcohol
Obesity
Diabetes Melitus
*not an inflammatory disease!!
358
What causes hepatitis?
1. virus
2. drug
3. autoimmune
359
What types of cells are in the liver?
1. hepatocytes
2. duct cells
3. blood vessels
360
What is the organization of the liver?
1. Portal tracts contain the portal triad
2. blood from different sources mix/goes to the sinusoids and enriches hepatocytes
3. blood then drains into the 'central veins' and exits to the hepatic vein that goes to the heart to be recycled
361
What is the portal triad?
1. bile ducts
2. portal veins-- bring blood from gut with nutrients and recently consumed drugs
3. hepatic artery from the heart
362
What is the role of hepatocytes?
1. all the metabolic work of liver
| 2. absorb nutrients and drugs
363
Where do most hepatotoxic event occur in the liver?
Central vein
364
What is the #1 cause of liver toxicity?
Drugs
365
Why are liver biopsies potentially dangerous?
can cause major hemorrhaging
366
What is steatosis?
Fatty liver, where there are fat globules in hepatocytes
367
What is metabolic syndrome? and what does it cause?
1. Alcohol
2. obesity
3. diabetes
* causes fatty liver
368
What is the worst case of fatty liver?
1. worst destruction is fibrosis b/c can lead to collagen scar and permanent injury
2. end stage fibrosis
369
What happens when hepatocytes dies in large sheets?
1. areas fill up with blood
2. blood can build up due to heart failure
3. cause backflow around the central vein
370
What happens if cannuliculi in liver fill with bile?
1. due to cholestasis
2. person becomes jaundiced
3. often caused by drugs
371
Acute hepatic disease is more ________?
Lobular
372
Chronic hepatic disease is more ____________?
Portal with fibrosis and collagen bridges
373
What is hepatitis?
| cause?
1. Inflammation of the liver
| 2. viruses, toxins and drugs
374
If caused by virus hepatitis can be what? who needs to be careful?
1. contagious
| 2. dentists need to be careful with these patients
375
Acute and Chronic hepatitis resolve?
1. acute often resolves itself
| 2. chronic less likely to recover (fibrosis often a part of this)
376
What is acute hepatitis caused by?
Hep A and E viruses
| 1-3 months
377
Hep B and C viruses start with ___________ and progress to ___________ with fibrosis progressing to ___________ and ________ carcinoma: tend to be the more severe
1 acute hepatitis
2. chronic hepatitis
3. hepatocellular
378
Hepatitis A
Source?
Route of transmission?
chronic?
prevention?
1. Feces
2. Fecal- oral
3. no
4. pre/post exposure immunization
379
Hepatitis B
Source?
Route of transmission?
chronic?
prevention?
1. blood/blood- derived, body fluids
2. percutaneous, permucosal
3. yes
4. pre/post exposure immunization
380
Hepatitis C
source?
route of transmission?
Chronic?
Prevention?
1. blood/blood derived, body fluids
2. percutaneous, permucosal
3. yes
4. blood screening; risk behavior modification
381
Hepatitis D
Source?
Route of transmission?
Chronic?
Prevention?
1. blood/ blood derived, body fluids
2. percutaneous, permucosal
3. yes
4. pre/post screening immunization; risk behavior modification
382
Hepatitis E
Source
Route of transmission
Chronic
Prevention?
1. feces
2. fecal-oral
3. no
4. ensure safe drinking water
383
Hep C is found in how many ppl worldwide?
>170 million carriers
384
Hep C virus?
1. acute phase usually asymptomatic and not diagnosed
2. chronic phase, Ab present 5-20 weeks
3. 60% related to parenteral exposure
4. caused by RNA virus
5. can lead to hepatocarcinoma
6. no vaccines
385
Hep B stats?
1. 2 billion chronically exposed in the world
2. 350 million infected
3. 15-25% of infected will go into chronic phase and most will die from complications
4. can lead to cancer of liver (hepatocarcinoma)
386
What is really important for Hep B?
GET VACCINATED
387
What causes Heb B?
DNA virus
388
What happens in the chronic phase of Hep B?
Cirrhosis = portal hypertension; causes ascites 85% of time in chronic phase with cirrhosis
389
Cirrhosis Definition?
1. Nodules- regenerative hepatocyte nodules
| 2. fibrosis- surrounding nodules
390
Autoimmune hepatitis?
1. unusual
2. found in obese females predominantly
3. rapid response to steroids
4. 80% have extensive fibrosis
391
What are metabolic disease usually associated with?
Iron overloads
392
What is Wilson's Disease?
Metabolic disease from copper metabolic defect that leads to hepatitis and then cirrhosis
393
How is hepatitis severity evaluated?
1. Grade - degree of inflammation
| 2. Stage- degree of fibrosis
394
What is most important in determining prognosis for hepatitis?
Stage- extreme if it progresses to cirrhosis that include collagen surround hepatic nodules (hepatocytes)
395
Hepatocellular Carcinoma?
1. most deadly cancer
| 2. if has been increasing due to increases in the incidence of Hep B and C
