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Neoplasia Flashcards

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1
Q

“Triple Approach” to diagnosis

A
  • involves clinical, radiological, and pathological examinations
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2
Q

Type

A
  • benign vs. malignant

- primary vs. secondary

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3
Q

Grade

A
  • how clearly a tumor resembles its tissue of origin

- can be simply ‘low grade’ or ‘high grade’ OR can be broken down into a more specific system

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4
Q

Stage

A
  • the extent of the disease process

- T.N.M classification (tumor size, nodal involvement, metastatic activity)

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5
Q

Carcinoma

A
  • any malignant cancer of the epithelium
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6
Q

Squamous cell (ie, in the skin)

A
  • benign: squamous cell papilloma

- malignant: squamous cell carcinoma

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7
Q

Glandular cell (ie, in the GIT)

A
  • benign: adenoma

- malignant: adenocarcinoma

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8
Q

Transitional cell (ie, in the urothelium)

A
  • bengin: transitional cell papilloma

- malignant: transitional cell carcinoma

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9
Q

Sarcoma

A
  • any malignant cancer of connective tissue (of the mesenchyme)
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10
Q

Fat cell

A
  • benign: lipoma

- malignant: liposarcoma

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11
Q

Smooth muscle cell

A
  • benign: leiomyoma

- malignant: leiomyosarcoma

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12
Q

Striated muscle cell

A
  • benign: rhabdomyoma

- malignant: rhabdomyosarcoma

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13
Q

Fibrous tissue

A
  • benign: fibroma

- malignant: fibrosarcoma

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14
Q

Cartilage

A
  • benign: chondroma

- malignant: chondrosarcoma

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15
Q

Bone

A
  • benign: osteoma

- malignant: osteosarcoma

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16
Q

Plasma cell

A
  • myeloma
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17
Q

CNS cell

A
  • glioma
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18
Q

Placenta

A
  • choriocarcinoma
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19
Q

Risk Factors (5 major ones)

A
  • age: breast, colon, lung cancers
  • genetic factors/predisposition: Retinoblastoma, Familial Adenomatous Polyposis Coli (FAP/APC)
  • environmental factors: smoking (lung) , asbestos (lung, mesothelioma), scrotal cancer in chimney sweeps
  • geography: malignant melanoma in Australia & California; hepatocellular carcinoma in Sub-Saharan Africa; gastric carcinoma in Japan, China, USSR, & S. America
  • carcinogenic agents: radiation, chemicals, viruses
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20
Q

Major Routes of Spread

A
  • direct extension (ex: lung cancer)
  • lymphatic spread (ex: breast cancer)
  • blood vessels (ex: rhabdosarcoma)
  • transcolomic (ex: ovarian and gastric cancers)
  • CSF (won’t usually exit the nervous system, however)
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21
Q

Neoplasia

A
  • new tissue growth that is unregulated, irreversible, and monoclonal
  • it is therefore distinct from hyperplasia and repair
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22
Q

G6PD

A
  • glucose-6-phosphate dehydrogenase (?)
  • X-linked gene, so females have two alleles and each cell randomly expresses only one via X-inactivation
  • the ratio of the two alleles can be used to determine the clonality of a growth (if it’s polyclonal = hyperplasia, monoclonal = neoplasia)
  • hyperplasia/polyclonal growth maintains the 1:1 ratio of the alleles
  • neoplasia/monoclonal growth will change it
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23
Q

Androgen Receptor Isoforms

A
  • can be used in the same was as G6PD to determine clonality of a growth
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24
Q

Clonality of B Cells

A
  • determined by ratio of Ig light chain phenotype (kappa or lambda), with the normal ratio being 3:1
  • change in this ratio indicates lymphoma
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25
Top 3 Causes of Death in Adults
1) cardiovascular disease 2) cancer 3) cerebrovascular disease
26
Top 3 Causes of Death in Children
1) accidents 2) cancer 3) congenital defects
27
Most Common Cancers in Adults by Incidence and Death (not including skin malignancies because they are very common, easy to treat, and rarely life-threatening)
by incidence: 1) breast/prostate 2) lung 3) colorectal by death: 1) lung 2) breast/prostate 3) colorectal
28
Why is Prostate Cancer Clinically Silent for a Long Time?
- because it commonly begins in the posterior region and therefore will not affect the urethra (which is located at the center) until it becomes large enough - DRE as a screening, because the posterior region of the prostate is palpable from the rectum - vs. BPH which occurs centrally in the prostate and DOES affect the urethra (urinary symptoms)
29
Aflatoxins
- correlated with hepatocellular carcinoma | - derived from Aspergillus, which can contaminate stored grains
30
Alkylating Agents
- correlated with leukemia and lymphoma | - a side effect of chemotherapy (this is why leukemia is a potential long-term side effect of chemo)
31
Alcohol
- correlated with squamous cell carcinoma of oropharynx & upper esophagus, pancreatic carcinoma, and hepatocellular carcinoma - pancreatic carcinoma is a result of chronic pancreatitis
32
Arsenic
- correlated with squamous cell carcinoma of skin, lung cancer, and angiosarcoma of liver - present in cigarette smoke
33
Asbestos
- correlated with lung cancer and mesothelioma (former more so than the latter)
34
Cigarette Smoke
- correlated with squamous cell carcinoma of oropharynx & esophagus, lung cancer, kidney cancer, and bladder cancer - contains polycyclic hydrocarbons, which are extremely carcinogenic - the most common carcinogen in the world
35
Nitrosamines
- correlated with stomach carcinoma (the intestinal type) | - found in smoked foods, which explains the high incidence of stomach carcinoma in Japan)
36
Naphthylamine
- correlated with urothelial carcinoma of bladder | - found in cigarette smoke
37
Vinyl Chloride
- correlated with angiosarcoma of liver | - occupational, present in PVC pipes
38
EBV
- Epstein-Barr Virus; an oncogenic virus - correlated with nasopharyngeal carcinoma, Burkitt's lymphoma, CNS lymphoma in AIDS patients - classic patient of nasopharyngeal carcinoma due to EBV is Chinese male or African person
39
HHV-8
- Human Herpes Virus - 8; an oncogenic virus | - correlated with Kaposi sarcoma in old Eastern European males, AIDS patients, immunosuppressed patients
40
HBV
- Hepatitis B Virus; an oncogenic virus - correlated with hepatocellular carcinoma - a DNA virus
41
HCV
- Hepatitis C Virus; an oncogenic virus - correlated with hepatocellular carcinoma - an RNA virus
42
HTLV-1
- an oncogenic virus | - correlated with adult T-cell leukemia/lymphoma
43
High Risk HPV
- strains 16, 18, 31, 33 are oncogenic viruses | - correlated with squamous cell carcinoma of vulva, vagina, anus, and cervix
44
Ionizing Radiation
- correlated with papillary carcinoma of thyroid, AML, and CML - nuclear reactor accidents, radiotherapy
45
Non-Ionizing Radiation
- correlated with basal cell carcinoma, squamous cell carcinoma, and melanoma of skin - UV-B sunlight
46
PDGF
- platelet derived growth factor | - its overexpression causes astrocytoma
47
ERBB2 (HER2)
- a epidermal growth factor receptor | - its amplification causes breast carcinoma
48
RET
- a neural growth factor receptor | - translocation or point mutation causes medullary carcinoma of thryoid w/ MEN2 growth pattern
49
KIT
- a stem cell growth factor receptor | - point mutation causes GI stromal tumor
50
RAS
- a signal transducer - a GTP-binding protein with GTPase activity (via GAP) - point mutation causes carcinomas, melanomas, and lymphomas
51
ABL
- Abelson Leukemia oncogene; a signal transducer - a tyrosine kinase found on chromosome 9 - t( 9;22) w/ BCR causes CML and some ALL
52
Philadelphia Chromosome
- t (9;22) - puts ABL under BCR's transcription - causes CML and some ALL
53
C-myc
- a transcription factor, found in chromosome 8 | - t (8;14) with IgH causes Burkitt's lymphoma
54
N-myc
- a transcription factor | - its amplification causes neuroblastoma
55
L-myc
- a transcription factor | - its amplification causes lung carcinoma
56
cyclin D1
- a cell cycle regulator, needed to progress from G1 to S - found in chromosome 11 - t (11;14) with IgH causes Manthe Cell lymphoma
57
CDK4
- a cell cycle regulator | - its amplification causes melanoma
58
p53
- a tumor supressor gene; involved in 50% of cancers - regulates the G1 to S phase checkpoint; makes sure the cell's DNA is undamaged before replication begins - if DNA is damaged, it triggers cell cycle arrest for repair - if damage is unrepairable, apoptosis is triggered
59
Bcl2
- a regulator of apoptosis - stabilizes the mitochondrial membrane, preventing cytochrome c release - located on chromosome 18
60
Bax
- inhibits Bcl2, allowing cytochrome c release, and triggering apoptosis - it is recruited by p53 when DNA damage is unrepairable
61
Follicular Lymphoma
- a result of t (14,18), placing Bcl2 under IgH's transcription - results in an increase in Bcl2 production and a resulting inability to undergo apoptosis
62
What is the Hypothesis for TSG Inactivation Called?
- Knudson's 2-hit Hypothesis
63
Li-Fraumeni Syndrome
- germline mutation in chromosome 17p leads to a knockout of one p53 allele - results in a large predisposition to many cancers
64
Rb
- a tumor supressor gene - regulates the G1 to S phase checkpoint; it sequesters E2F, which is needed for progression into S phase - upon phosphorylation by cylcin D/CDK4 complex, it releases E2F and allows for entry into S phase
65
Sporadic Mutations of Rb will yield _______________
- unilateral retinoblastoma - it is very rare for one cell to lose both of its Rb alleles, and it is even rarer for two cells (one in each eye) to do so
66
Germline Mutation + Sporadic Mutation of Rb will yield ______________
- bilateral retinoblastoma
67
3 Checkpoints of the Cell Cycle
- G1 to S transition - G2 to M transition - M-phase check (occurs during metaphase)
68
Aneuploidy
- having more than 23 pairs of chromosomes | - normal cells that have this will undergo apoptosis (cancer cells ignore the apoptotic signals)
69
MDM2
- degrades p53 | - is normally sequestered by p14^ARF
70
First Step in Invasion
- E-cadherin is a surface protein that links adjacent cells together - for cancer cells to spread, they must down regulate E-cadherin; this is the first step in invasion
71
Second Step in Invasion
- invading tumor cells attach to laminin | - basement membrane made up of laminin and collagen IV
72
Third Step in Invasion
- collagenase degrades collagen (degrades the basement membrane) - tumor cell secretes collagenase, allowing entry into the ECM
73
Fourth Step in Invasion
- tumor cell attaches to fibronectin in the ECM | - tumor cell can now spread locally
74
Fifth Step in Invasion
- eventually, the tumor cells will reach a blood vessel or lymphatic and spread to other parts of the body (metastasize)
75
Carcinomas tend to spread via ____________
- the lymphatics | - exceptions are: renal cell carcinoma, hepatocellular carcinoma, follicular carcinoma of thyroid, and choriocarcinoma
76
Sarcomas tend to spread via ____________
- the blood (they spread hematogenously)
77
Xeroderma Pigmentosa
- a genetic defect (autosomal recessive), leading to an inability to repair DNA damaged by UV light - predisposes patient to malignancy
78
Cyclin B pairs up with CDK__
- CDK1 | - cyclin B/CDK1 complex is necessary to enter M phase
79
Cyclin A pairs up with CDK__
- CDK 1 and CDK 2
80
Cyclin D pairs up with CDK__
- CDK 4 and CDK 6
81
Cyclin E pairs up CDK__
- CDK 2
82
Mult-Step Model of Colorectal Carcinoma
- mutation in chromosome 5 (APC LOF) allows for increased cell growth --> de-methylation of DNA results in adenoma --> mutation in Ras leads to intermediate adenoma --> mutation in chromosome 18 (DCC LOF) leads to late-stage adenoma --> mutation in chromosome 17 (p53 LOF) leads to carcinoma --> other mutations result in metastasis
83
What are the four tumors that can cause SVC obstruction
- the four "T"s | - (terrible) lymphoma, thyroid, thymus, teratoma
84
Hamartoma
- a tumor consisting of cartilage and normal tissue cells that are normally seen in the area, but are disorganized
85
Heterotopia
- a tumor consisting of properly organized tissue, but of a different type than is normally seen in the area

Neoplasia (3 decks)

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