Neoplasia Flashcards
(115 cards)
1
Q
Two components make up a tumor; its ………… and its ………. which is made of …………..?
A
parenchyma (tumor cells)
stroma
connective tissues, blood vessels and cells of the immune system
2
Q
Tumor behaviour is dependent on its …………. while its growth and spread is dependent on its …………
A
parenchymal component
stromal component
3
Q
Benign tumors of gland are termed ………….., if the glands are cystic, the term ………….. is used.
A
adenoma
cyst adenoma
4
Q
Benign epithelial tumors with finger-like projections are called …………
A
papillomas
5
Q
A tumor that projects above the epithelial surface is called a ……….. If it is glandular, it is called an ………..
A
polyp
adenomatous polyp
6
Q
Tumors of epithelial origin are designated ………… while those of mesenchymal origin are termed …………
A
carcinomas
sarcomas
7
Q
What are mixed tumors?
A
These cells originate from a single neoplastic clone that has the capacity to produce both epithelial and messenchymal cells.
Sometimes, tumors are made of cells from different lines of differentiation and may have both epithelial and mesenchymal components/cells
8
Q
A classical example of mixed tumor is?
A
pleomorphic adenoma
9
Q
What are teratomas?
A
These tumors contain components from more than one germ layer (ectoderm, mesoderm and endoderm)
10
Q
Teratomas originate from ………. cells found in ………, ………… and ……….
A
totipotent
ovaries, testis and sometimes in the midline where there may be abnormal embryonal rests
11
Q
Teratomas may be mature, immature and ……….:
solid or cystic
A
monodermal
12
Q
What is a harmatoma?
A
A harmatoma is a disorganised mass of tissue composed of cells indigenous to the involved tissue
13
Q
A disorganised mass of tissue composed of cells indigenous to the involved tissue is called a ?
A
Harmatoma
14
Q
What is a choriostoma?
A
A choriostoma is an ectopic rest of tissues or cells
15
Q
An ectopic rest of tissues or cell is called a?
A
Choriostoma
16
Q
Define differentiation?
A
Differentiation is defined as the extent to which a neoplastic cell resemble its normal counterpart both histologically and physiologically
17
Q
………………. is defined as the extent to which a neoplastic cell resemble its normal counterpart both histologically and physiologically
A
Differentiation
18
Q
Cells are said to be anaplastic when there is ………?
A
no differentiation
19
Q
Cells are said to be ……… when there is no differentiation
A
anaplastic
20
Q
Benign tumors are generally well differentiated, while malignant tumors may range from well differentiated to completely anaplastic (well, moderately, poorly
differentiated, anaplastic)
True or false?
A
True
21
Q
Several other morphologic features are characteristics of malignancy, list them?
A
- Pleomorphism
- Abnormal nuclear morphology
- Mitosis
- Loss of polarity
- Necrosis
- Local invasion
- Metastasis
22
Q
Benign tumors are discreet, palpable, mobile and readily removed by surgery. Exceptions however exist e.g …………
A
hemangioma
23
Q
Define metastasis
A
This is defined as spread of a tumor to sites that do not have physical continuity with the primary site
of the tumor
24
Q
Metastasis is a feature exclusive to malignant tumors, true or false?
A
True
25
……… are malignant but do not metastasize?
Gliomas
26
There are three pathways through
which cancers spread to distant sites, list them?
1. Direct seedlings of body cavities or surfaces
2. Lymphatics (most common with carcinomas)
3. Hematogenous (most common with sarcomas)
27
Hematogenous pathway of spread is most common with?
Sarcoma
28
Lymphatic pathway of spread is most common with?
Carcinomas
29
CANCER IS A MULTIFACTORIAL DISEASE CAUSED BY AN INTERPLAY OF BOTH GENETIC AND ENVIRONMENTAL FACTOR, true or false?
True
30
………….. lies at the heart of carcinogenesis?
Nonlethal genetic damage
31
A tumor is formed by the …………. of a single cell that has incurred …………?
clonal expansion
genetic damage
32
Four classes of genes are the principal targets of cancer causing mutations, list them?
1. growth promoting proto-oncogenes
2. growth inhibiting tumor suppressor genes
3. genes that regulate apoptosis
4. DNA repair genes
33
Carcinogenesis results from the accumulation of ………….. in a stepwise fashion over time?
complementary mutations
34
The malignant phenotype are changes that are known as the ……..?
Hallmarks of cancer
35
There are 8 important hallmarks of cancer, list them?
1. Self sufficiency in growth signals
2. Insensitivity to growth inhibitory signals
3. Altered cellular metabolism
4. Evasion of apoptosis
5. Limitless replicative potential
6. Sustained angiogenesis
7. Ability to invade and metastasise
8. Ability to evade the host immune response
36
Gain of function mutation in growth promoting genes (proto-oncogenes) convert them to their mutated
counterparts (oncogenes) which in turn lead to formation of ………?
oncoproteins
37
Mutated counterparts, may acquire amplified functions, may develop resistance to inhibitory signals, and may induce changes in cells that alter cellular metabolism in favor of proliferation, true or false?
True
38
About oncoproteins, examples of growth factors include?
PDGF, TGF alfa, VEGF
39
Oncoproteins fall into the following categories
1. Growth factors
2. Growth factor receptors
3. Signal transducers
4. Non receptor tyrosin kinase related protein
5. Transcription factors
6. Cyclins and cyclin dependents kinases
40
About oncoproteins, examples of growth factors receptors include?
ERBB1 (encoding EGFR)
ERBB2 (encoding HER2)
ALK
MET
41
About oncoproteins, examples of signal transducers include?
receptor tyrosin kinase related
like RAS (HRAS, KRAS, NRAS), PI3K, AKT, BRAF (serine/threonine protein kinases)
42
About oncoproteins, examples of Non receptor tyrosin kinase related protein mutations include?
usually take the form of translocations e.g
BCR-ABL (9:22), point mutations e.g JAK2
43
About oncoproteins, examples of Cyclins and cyclin dependent kinases include?
cycin D, CDK4
44
About oncoproteins, examples of transcription factors include?
MYC, MYB, FOS,JUN
45
There are so many tumor suppressor genes and their products perform their suppressing function in a variety of pathways
Arrest of cell cycle is done by?
RB, p53
46
There are so many tumor suppressor genes and their products perform their suppressing function in a variety of pathways
Cyclin/CDK inhibitors include?
CDKN2A
47
There are so many tumor suppressor genes and their products perform their suppressing function in a variety of pathways
Inhibitors of signal transduction include?
PTEN, NF1, NF2, APC, PTCH
48
There are so many tumor suppressor genes and their products perform their suppressing function in a variety of pathways
Transcription factors include?
WT1, MEN1
49
There are so many tumor suppressor genes and their products perform their suppressing function in a variety of pathways
DNA repair genes include?
BRCA1, BRCA2, MLH1, MSH 2, MSH 6
50
There are so many tumor suppressor genes and their products perform their suppressing function in a variety of pathways
Inhibitors of metastastis, angiogenesis and progrowth metabolism include?
VLH, STK11, SDHB, SDHD
51
The guardian of the genome is the?
Tp53 gene
52
…….. is a protein product is p53 protein?
TP53 gene
53
The most frequently mutated gene in cancers is ……. and is located on
chromosome …….
Tp53 gene
17p13.1
54
Inheritance of a defective Tp53 gene leads to ……..
Li fraumeni syndrome
55
Those with ……….., syndrome have a …… fold increase in risk of developing malignant tumors by age ….?
Li fraumeni
25
50
56
P53 release is stimulated by cellular stressors like ……..?
DNA damage, excessive growth signals, hypoxia, and shortened telomeres.
57
In a normal undisturbed cell, p53 is held bound to a ……… which targets its for ……….,
protein MDM2
ubiquitination
58
when a cell is stressed by DNA damage or hypoxia, ………… phosphorylate the ……….. and disrupts their binding and p53 degradation thus allowing
p53 to accumulate
ATM and ATR
p53/MDM2 complex
59
If the stress is an oncogenic stress, this leads to an increased expression of ………. which is a product of ……….
p14/ARF
CDNK2A gene
60
…….. binds to MDM2 and displaces p53, allowing it again to accumulate
P14/ARF
61
P14/ARF binds to ……… and displaces p53, allowing it again to accumulate
MDM2
62
Once p53 has accumulated it can lead to?
1. Cell cycle arrest by inducing expression of p21 (a cyclin dependent kinase inhibitor
2. P53 induced senescence
3. Apoptosis by inducing expression of BAX and PUMA
63
rapid uptake of oxygen by cancer cells, a distinct form of cellular metabolism in which glucose is converted to lactic acid is called?
warburg effect” a.k.a aerobic glycolysis
64
The advantage of Warburg effect is?
that the cancer cells do not utilize all the carbon moieties delivered by glucose for ATP production
65
Instead of producing 36 molecules of ATP, aerobic glycolysis produces about …… molecules of ATP; an
amount just enough to meet the cell’s energy requirement “The metabolic sweet spot”
4
66
About altered cellular metabolism, The promoters of this alteration include …….?
MYC, PI3K/AKT and mutations in IDH enzyme
67
About altered cellular metabolism, Inhibitors of this alterations include ……….
STK11, P53
68
About limitless replicative potential, The immortal property is acquired when the cell succeeds in achieving?
1. Evasion of senescence
2. Evasion of mitotic crisis
3. Self renewal
69
Cancer cells evade apoptosis by?
1. Loss of P53 function
2. Over expression of anti apoptotic members of the BCL2 family (BCL2, MCL, BCLx
70
Normal cells have the capacity to divide ….. to …… times after which the cell leaves the cell cycle and never divides again
60
70
71
About evasion of senescence, Increased expression of ……. and …… are believed to be key players
p53
p16
72
About evasion of senescence, p53 and p16 maintain …. in a hypo phosphorylated state and disruption of the RB dependent ……. phase check point allows cells to bypass senescence
RB
G1/ S
73
In cancer cells, ………… is reactivated so that they can escape the mitotic crisis
telomerase activity
74
In cancer cells, telomerase activity is reactivated so that they can escape the ……..
mitotic crisis
75
Three mechanisms enable cancer cells to acquire stem cell
like properties, list them?
1. Conversion of somatic cells to cells that acquire stemness. MYC plays a key role in this conversion
2. The presence of stem cells within the tumor that are called cancer stem cells
3. These cells express MDR1, a factor that makes them resistant to chemotherapeutic agents
76
About self renewal, These cells express ……….., a factor that makes them resistant to chemotherapeutic agents
MDR1
77
Tumors need blood to survive and without new blood vessels, will not grow beyond ………
1 to 2mm in diameter
78
Angiogenesis is controlled by a balance between ……….
promoters and inhibitors of angiogenesis
79
In tumor cells, angiogenesis is favoured because, Hypoxia induces the expression of ….. and …… via
……. which stimulate proliferation of endothelial cells
VEGF and bFGF
HIF1 alfa
80
In tumor cells, angiogenesis is favoured because Driver Mutations in genes that affect angiogenesis e.g
…….?
p53, RAS, MYC
81
In tumor cells, angiogenesis is favoured because of Proteases elaborated from ……….?
tumor cells or their stromal cells
82
Unlike normal blood vessels, blood vessels that form in tumors are ……. and thus also play important roles in metastasis
haphazard, leaky an dilated
83
metastatic cascade involve two phases, list them?
1. Invasion of the ECM
2. Vascular dissemination, tissue homing and colonization
84
Invasion of extracellular matrix: For malignant cells to metastasize, they must …..?
breech the underlying basement membrane,
traverse the interstitial connective tissue and
ultimately gain access into blood vessels.
85
About Invasion of extracellular matrix: This they do by the following steps?
1. Loosening up of tumor cell-tumor cell interactions
2. Degradation of ECM
3. Attachment to remodelled ECM components
4. Migration invasion of tumor cell
86
Concerning Vascular dissemination, homing and colonization: when
successfully within the vasculature, some tumor cells die by ………, or are destroyed by the immune system.
anoikis
87
What determines metastatic sites include …….?
location and vascular drainage of the tumor,
tropism,
escape from tumor dormancy
88
Normally the immune system through the agency of cytotoxic T cells and NK cells attack and destroy tumor cells. Tumor cells however may evade this mechanism through
the following processes?
1. Selective outgrowth of antigen negative variants
2. Loss or reduced expression of MHC molecules
3. Engagement of pathways that inhibit T cell activation (CTLA4, PD-L1, PDL-2)
4. Secretion of immunosuppressive factors
5. Induction of regulatory T cell
89
Other hallmarks of cancer include?
1. Genomic instability (mutator phenotype)
2. Mutations in DNA repair genes (microsatallite instability): MSH2, MSH6, MLH1
3. DNA polymerase
4. P53
5. Regulated instability in lymphoid cells
6. Epigenetic changes
90
carcinogenic agents are generally grouped into three categories, list them?
1. Chemicals
2. Biological agents
3. Radiation
91
Alkylating agents are an example of
Direct acting chemical carcinogens do not require any metabolic conversion to become carcinogenic
92
Indirect acting chemical carcinogens are those that require metabolic conversion to become active carcinogens. They are mostly converted by the ……….,
cytochrome p450 enzyme system.
93
The active counterparts of Indirect acting chemical carcinogens are called?
ultimate carcinogens
94
Potent examples of Indirect acting chemical carcinogens include?
polycyclic hydrocarbons produced from animal fat during broiling or grilling of meat,
benzo (a) pyrone formed during high temperature combustion of tobacco in cigerette
95
Most chemical carcinogens are highly reactive …….. that can react with …………… in cells and thus their targets are DNA, RNA and proteins
electrophiles
nucleophilic atoms
96
One theme in microbial carcinogenesis is that Infection triggers cellular proliferation which at first is ……. and then eventually becomes …….. by the acquisition of ……….?
polyclonal
monoclonal
driver mutations
97
Human T cell Lymphocytic virus 1 (HTLV1) is an …… virus that causes ……… by mechanisms which are suspected to involve ……..?
RNA
Adult T cell leukemia/lymphoma (ATLL)
viral genes that interfere with host gene expression
98
Human papilloma virus (HPV): the high risk HPV’s, types ……. and ……. cause …………. in part by their ………. proteins which mediate the degradation of ………. and inhibit
…….. activity?
16, 18
squamous cell carcinoma of the cervix and anorectal region
E6 and E7
p53, reactivate telomerase (E6)
retinoblastoma
99
Ebstien bar virus causes ………. and many other malignancies through various mechanism
B cell Lymphomas, Nasopharyngeal carcinomas
100
Helicobacter pylori is a gram negative bacteria found in the G.I.T. it has been implicated in ……. and …….. by inducing chronic inflammation and also expressing
an oncogenic material; ……….. which induces unregulated growth in ……….?
gastric adenocarcinomas and gastric B cell lymphomas
cytosin associated A gene (CagA)
gastric epthelial cell
101
Two forms of radiant energy are mutagenic and carcinogeneic?
1. Ultraviolet (UV) radiation
2. Ionizing radiation: electromagnetic (X rays and gamma rays) and particulate (a rays) radiation are all carcinogenic.
102
There are three types of UV radiations; ……., ……. and …….. UVB is carcinogenic because it can cause ……….?
UVA(320-400nm), UVB(280-320) and UVC (200-280)
pyrimidine dimers to form in DNA
103
The most succeptible tissues to Ionizing radiation are ….?
myeloid cells, thyroid gland, breat lung and salivary glands
104
What is Cancer cachexia?
Cancer cachexia is a hypercatabolic state defined by loss of muscle mass (with or without fat loss) that cannot be explained by diminished food intake
105
Cancer cachexia occurs commonly in patients with …..?
advanced gastrointestinal, pancreatic and lung cancers
106
Cancer cachexia is believed to be mediated by …..?
TNF, IL-1 and IL-6
107
What is Paraneoplastic syndrome?
Paraneoplastic syndromes are signs and symptoms that a cancer provokes and that cannot readily be explained by the anatomic distribution of the tumor or by elaboration of hormones indigenous to the tissue from which the tumor arose
108
Cancer cachexia is believed to be mediated by …..?
TNF, IL-1 and IL-6
109
The most common endocrinopathic paraneoplastic syndrome is ……. and it usually caused by excessive production of …….,
Cushing’s syndrome
corticotropin by carcinoma of the lungs
110
Other paraneoplastic syndromes include?
1. Neuromyopathic paraneoplastic syndromes
2. Acanthosis nigricans
3. Hypertrophic osteoathropathies
4. Migratory thrombophlebitis
5. Disseminated intravascular coagulopathies
111
What is grading?
Grading is the stratification of cancers based on their degree of differentiation and in some cancers, the number of mitosis or other architectural features
112
Grading is the stratification of cancers based on their degree of …….. and in some cancers ………
differentiation
the number of mitosis or other architectural features
113
What is staging?
The staging of a tumor accesses how much a tumor has spread
114
The commonest method of staging tumors is the ……….. which is that proposed by the American
Joint committee on cancer Staging (AJCC); T stands for ………, N stands for ………. and M stands for ………..
TNM staging
tumor size
nodal metastasis
distant metastasis
115
Common examples of tumor markers include?
1. Prostate specific antigen (PSA) in prostate cancers
2. Carcinoembryonic antigen (CEA) in tumors of the GIT and pancreas
3. alphafetoprotein (AFP) in hepatic cancers and germ cell tumors
4. Cancer antigen 125 (CA-125) in ovarian tumors
5. HCG for testicular cancers and choriocarcinomas e.t.c
