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Patho II > Neoplasia > Flashcards

Neoplasia Flashcards

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1
Q

What are the two types of tumors?

A

Benign and Malignant

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2
Q

What are the characteristics of Benign tumors?

A 
Innocent behavior
Localized lesions
Don't spread
Patient typically survives
Surgically removable
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3
Q

What do benign tumors have that malignant tumors don’t have?

A

a pressed fibrous connective tissue capsule made of stromal cells

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4
Q

What are the characteristics of Malignant tumors?

A

“cancer”
aggressive behavior
Metastasis

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5
Q

Fibroma is…

A

Benign tumor of adult fibrous tissue

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6
Q

Myxoma is…

A

benign tumor of embryonic fibrous tissue

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7
Q

Lipoma is…

A

Benign tumor of fat

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8
Q

Chondroma is…

A

Benign tumor of cartilage

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9
Q

Osteoma is…

A

Benign tumor of bone

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10
Q

Fibrosarcoma is…

A

Malignant tumor of adult fibrous tissue

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11
Q

Myxosarcoma is…

A

Malignant tumor of embryonic fibrous tissue

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12
Q

Liposarcoma is…

A

Malignant tumor of fat

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13
Q

Chondrosarcoma is…

A

Malignant tumor of Cartilage

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14
Q

Osteosarcoma is…

A

Malignant tumor of bone

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15
Q

Hemangioma is…

A

Benign tumor of blood vessels

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16
Q

Lymphangioma is…

A

Benign tumor of lymph vessels

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17
Q

Hemangiosarcoma/angiosarcoma is…

A

Malignant tumor of blood vessels

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18
Q

Lymphangiosarcoma is…

A

Malignant tumor of lymph vessels

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19
Q

Leiomyoma is…

A

Benign tumor of smooth muscle

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20
Q

Rhabdomyoma is…

A

Benign tumor of striated muscle

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21
Q

Leiomyosarcoma is..

A

Malignant tumor of smooth muscle

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22
Q

Rhabdomyosarcoma is…

A

Malignant tumor of striated muscle

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23
Q

Papilloma, Seborrheic Keratosis, and some skin adnexal tumors are…

A

benign tumors of stratified squamous epithelial tissue

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24
Q

Adenoma is…

A

Benign tumor of Glandular Epithelium

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25
Hepatic Adenoma, Renal Tubular adenoma, and Bile duct adenoma are...
Benign tumor of Liver, kidney and Bile duct
26
Squamous cell carcinoma, epidermoid carcinoma and some skin adnexal tumors are...
Malignant tumors of stratified squamous epithelial tissue
27
Adenocarcinoma is..
Malignant tumor of Glandular Epithelium
28
Hepatoma, hepatocellular carcinoma, renal cell carcinoma, hypernephroma cholangiocarcinoma are...
Malignant tumors of Liver, Kidney, and bile duct
29
Transitional cell papilloma is...
Benign tumor of transitional epithelium
30
Transitional cell carcinoma is...
Malignant tumor of transitional epithelium
31
Seminoma, embryonal cell carcinoma are..
Malignant tumors of testis
32
Glioma grades 1-3 anaplastic, glioblastoma grade 4 are...
Malignant tumors of glial cells
33
Ganglionneuroma is...
Benign tumor of nerve cells
34
Neuroblastoma and Medulloblastoma are...
malignant tumors of nerve cells
35
Meningioma is...
Benign tumor of meninges
36
What are the two basic components of all tumors?
Neoplastic cells | Supporting Stroma
37
What are neoplastic cells?
constitute the tumor parenchyma
38
What do neoplastic cells determine?
classification of tumors and their biologic behavior
39
What is the supporting stroma?
non-neoplastic connective tissue, blood vessels, and adaptive/innate immunity cells Supports growth and proliferation of tumor cells Tumor Microenvironment
40
What does the supporting stroma determine?
how the tumor will grow and proliferate
41
What does the tumor microenvironment consist of?
Hematopoietic Cells Cells with Mesenchymal Origin Non cellular components
42
What are hematopoietic cells?
cells arising in bone marrow T and B cells Natural Killer Cells macrophages neutrophils
43
What are cells with mesenchymal origin?
``` Fibroblasts Myofibroblasts Mesenchymal stem cells Adipocytes Endothelial Cells ```
44
What are the noncellular components of the tumor microenvironment?
ECM: proteins glycoproteins proteoglycans
45
What is the significance of the tumor microenvironment?
protects cancer cells | Has important influence on the malignancy outcome and treatment responses
46
What is differentiation?
How closely tumor cells histologically and functionally resemble their normal cell counterpart
47
What is anaplasia?
lack of differentiation of tumor cells; MALIGNANCY's HALLMARK
48
What is metaplasia?
replacement of one cell type with another cell type; normal physiologic response to chronic inflammation
49
What is dysplasia?
CHAOS; loss of cellular uniformity and architectural organization
50
What is carcinoma in situ?
Marked dysplastic changes involving the ENTIRE thickness of the epithelium
51
What is invasive carcinoma?
the basement membrane isn't intact anymore so the cells can escape and metastasize
52
What doesn't have local invasion?
Benign tumors
53
What is metastasis?
invasion of lymphatics, blood vessels, or body cavities by tumor, followed by transport and growth of secondary tumor cell masses dislodged from the primary tumor
54
What are pathways of tumor spread?
Seeding of body cavities and surfaces Lymphatic spread Hematogenous Spread Iatrogenic spread
55
What is seeding of body cavities and surfaces?
disperson into peritoneal, pleural, pericardial, subarachnoid, and joint spaces Will spread into places that there isn't a barrier
56
What is lymphatic spread?
Transport of tumor cells to regional nodes and throughout the body Mostly associated with carcinomas
57
What is hematogenous spread?
typical of sarcoma and some carcinomas; metastasis follows the venous flow pattern
58
What are the most common sites of hematogenous spread?
Lung and liver
59
What is iatrogenic spread?
when they do a biopsy and the surgical instrument is a tool for seeding the cancer
60
What is tumor metastatic tropism?
a tumor's tendency to metastasize to specific organs indicates the cancer cells ability to adopt to and colonize in the microenvironment of secondary tissues
61
Which cancers metastasize to the brain?
Lung tumors breast tumors Melanoma
62
What cancers metastasize to the liver?
pancreatic cancer
63
What cancers metastasize to the bone marrow?
prostate cancer
64
What are the mechanisms of tropism?
Some tumor cells have adhesion molecules with expression of ligands in a specific organ Some tumor cells have chemokine receptors in particular organ Microenvironment of an organ might not be suitable
65
What are two places that are rarely sites of metastasize?
Skeletal muscle and spleen
66
What may also determine where tumors metastasize to?
circulation layouts like primary colon cancer following the portal vein drainage from the colon to the liver and causing liver cancer
67
What are environmental risk factors of cancer?
``` infectious agents smoking alcohol consumption diet obesity Reproductive history carcinogens ```
68
Why is age an important risk factor for cancer?
because as we age we accumulate somatic mutations and have a decline in immune response
69
What are three acquired predisposing factors in cancer?
chronic inflammation precursor lesions Immunodeficiency states
70
Why does chronic inflammation increase the risk of cancer?
because there is an increased flow of immune response cells to the site which can increase the chance of mutation in that area; ROS are also produced and they damage DNA
71
Where do precursor lesions occur and why do they increase the risk of getting cancer?
they occur in settings of chronic inflammation and change the cells
72
What determines whether precursor lesions will be become malignant or not?
there genetic expression pattern
73
What type of T cell deficiency also increased the risk of cancers?
CD8+
74
What are the 10 Hallmarks/Characteristics of Cancer?
``` Sustaining Proliferative Signaling Avoiding Immune Destruction Enabling replicative immortality tumor promoting inflammation Activating invasion and metastasis Genomic instability Inducing angiogenesis Resisting cell death Deregulating cellular energetics ```
75
What are the normal steps of cell proliferation?
1) Growth factor binding to cell surface receptor 2) Activation of signal transduction proteins 3) Initiating DNA transcription
76
What are oncogenes?
genes that promote autonomous cell growth; cancer cells have these
77
What are protooncogenes?
Genes that inhibit autonomous cell growth
78
What does tyrosine kinase-mediated signal transduction do in normal cells?
causes cellular growth, apoptosis, and cell migration
79
In cancer cells, what happens to tyrosine kinase pathway?
The pathway is hyperreactive due to mutations
80
What causes activation of oncogenes to malignant transformation?
Mutations or Overexpression of MYC oncogenes
81
How is MYC oncogenes hyperactivated in human tumors?
by translocation between Chromosome 8 and 14
82
What cancers do MYC oncogenes overexpression cause?
Burkitts lymphoma B cell lymphoma Lung cancers
83
What is Burkitt Lymphoma?
an aggressive type of B cell lymphoma most often in children and young adults
84
What do tumor suppressor genes do normally?
slow down cell divisions, repair DNA mistakes, and activate apoptosis
85
What happens to tumor suppresor genes in cancer?
they are inactivated
86
What is Loss of heterozygosity?
mutation of both alleles of tumor suppressor genes are needed for carcinogenesis
87
What are examples of LOH?
RB and P53
88
What does RB gene mutation cause?
persistent cell cycling which contributes to the pathogenesis of childhood tumor Retinoblastoma
89
What does the TP53 protein normally do?
prevents the growth of genetically defective cells
90
How does the TP53 protein prevent the growth of genetically defective cells?
Senses DNA damage Arrests the cell cycle If DNA can be repaired, the cell undergoes S phase If DNA cannot be repaired, TP 53 induces apoptosis
91
What percentage of cancers have a mutated p53 gene?
50%
92
What is antitumor immunity?
t cell recognition of tumor antigen leading to t cell activation
93
How does the tumor evade immune response?
Failure to produce tumor antigen causing lack of T cell recognition of tumor Mutations in MHC genes or genes needed for antigen processing causing lack of T cell Recognition of tumor Production of immunosuppressive proteins or expressin of inhibotry cell surface proteins causing inhibition of T cell activation
94
What type of immunity does tumor cells evade?
cell mediated Immunity: CD8+ T cells Natural Killer Cells Macrophages
95
How do tumor cells enable replicative immortality?
By keeping telomerase active so that the tumor cells telomeres never get so short that they would undergo apoptosis
96
What is the metastatic cascade?
Invasion of ECM Vascular disemmination and homing of tumor cells
97
What are the steps in invasion of ECM?
1) detachment and loosening of intracellular junctions 2) ECM degredation 3) Migration
98
How is the ECM degraded in the invasion of ECM?
by proteases creating a passage
99
What are the 4 theories on how metastasis occurs?
1) Clonal evolution model 2) metastasis signature 3) metastatic variants 4) microenvironment
100
What is the clonal evolution model?
rare variant clones in the primary tumor cause it to metastasize
101
What does the microenvironment do to cause metastasis?
influences angiogenesis, local invasiveness, and resistance to immune defense of the host
102
What is genomic instability?
a process of gene alterations which cause DNA repairs to not be fixed and unstable DNA; can increase the risk of cancer
103
What genes are mutated in breast cancer?
BRCA1 and 2
104
What gene is mutated in ovarian, prostate, and stomach cancers?
BRCA 2
105
What is angiogenesis?
new blood vessel growth
106
What is angiogenesis' dual effect on tumor growth?
1) stimulates tumor growth through endothelial cell production of growth factors 2) influences metastatic potential
107
How does angiogenesis increase for tumor cells?
the tumor cells sense hypoxia and this causes upregulation of VEGF which causes angiogenesis
108
What cells are primed for apoptosis?
Normal cells that have a predominance of PROAPOPTOTIC proteins
109
What cells are unprimed for apoptosis?
Cancer cells that have a predominance of ANTIAPOPTOTIC proteins
110
What pathway do cancer cells use to get their energy?
anaerobic respiration because they don't have a lot of oxygen and they can move faster because this pathway only creates two molecules of ATP
111
What are the two steps involved in chemical carcinogenesis?
1) Initiation | 2) Promotion
112
What is initiation of chemical carcinogenesis?
induction of IRREVERSIBLE mutations in the genome Can be direct acting agents or indirect acting agents
113
What is promotion of chemical carcinogenesis?
can induce tumors in previously initiated cell by stimulating cellular proliferation short lived, REVERSIBLE, and non-tumorigenic by themselves
114
What are direct acting agents of initiation?
They don't need metabolic activation; need to be cautious
115
What are indirect acting agents of initiation?
They do need metabolic activation; ex. polycyclic hydrocarbons
116
What are two types of radiation carcinogenesis?
UV rays of sunlight | Ionizing Radiation
117
What are some forms of ionizing radiation?
Xrays, gamma rays
118
What are the most toxic, mutagenic, and carcinogenic UV light induced DNA photoproducts?
Cyclobutane Pyrimidine Dimers (CPDs) | 6-4) pyrimidine-pyrimidone photoproducts (6-4PPs
119
What causes the most prominent damage to our macromolecules?
UVB rays
120
How does UVB rays damage our macromolecules?
damages DNA by creating pyrimidine dimers that create a kink in the DNA structure
121
What does UVA rays create?
ROS
122
Which type of UV rays is there no protection for?
UVA rays
123
How does ionizing radiation cause cancer?
1) damages the nucleotides or DNA sugar molecules 2) causes strand breaks in DNA 3) indirect DNA damage by increasing ROS in cell
124
Both benign and malignant tumors cause problems by?
Location and impingement on adjacent structures Functional activity such as hormone production Bleeding and Infection Symptoms from tumor rupture or infection Cachexia
125
What are effects of locally located tumors?
Intracranial tumors can expand and destroy things around them like the pituitary GI tract tumors may cause obstruction of the bowel or ulcerate
126
What effect does hormone production of tumors have?
causes pareneoplastic syndrome such as hypoglycemia or hypercalcemia
127
What is cancer cachexia?
weight loss greater than 5%, or weight loss greater than 2% in individuals already showing depletion according to current body weight and height profound loss of muscle mass and fat
128
What are the stages of cancer Cachexia?
Precachexia Cachexia Refractory Cachexia
129
What causes Cancer Cachexia?
multifactorial causes but NOT caloric intake
130
What is the pathophysiology of cancer cachexia?
underlying chronic inflammation causing a hypermetabolic state
131
What is a widely accepted cytokine associated with cancer cachexia?
TNF alpha
132
What is associated with cancer cachexia?
lipolysis and lipid mobilizing factor
133
What is paraneoplastic Syndrome?
tumor associated syndromes where the symptoms are not directly related to the spread of the tumor The earliest clinical manifestations of a neoplasm and can mimic distant spread
134
What are the 4 tumor associated syndromes that the patients can develop?
Endocrinopathies Paraneoplastic Neurologic Syndromes Thrombotic Diatheses Hypercalcemia
135
What are paraneoplastic endocrinopathies?
non-endocrine cancers that produce hormones or hormone like factors
136
Small cell lung cancer causes what disease by releasing ACTH?
Cushings
137
What percentage of patients with Cushing syndrome have lung carcinomas?
50%
138
What is the most common paraneoplastic syndrome?
Hypercalcemia
139
What tumors are associated with paraneoplastic hypercalcemia?
Breast Lung Kidney Ovary
140
What are paraneoplastic neurologic syndromes?
heterogenous group of disorders caused by mechanisms other than metastases, metabolic, and nutritional deficits, infections, coagulopathy, or side effects of cancer treatment
141
What is the pathogenesis of paraneoplastic neurologic syndromes?
there are antibodies in the serum or CSF of the cancer patients
142
What two types of antibodies are found in paraneoplastic neurologic syndromes?
Antibodies directed against intracellular neuronal proteins Antibodies directed against neuronal cell surface or synaptic proteins
143
What are antibodies directed against intracellular neuronal proteins?
well characterized and have association with cancer in the body Hu/ANNA-1 Ri/ANNA-2
144
What are antibodies directed against neuronal cell surface or synaptic proteins?
aren't always associated with cancer NMDA receptor
145
What is paraneoplastic thrombotic diatheses?
a vicious cycle between activation of the platelet and tumor growth that feed off of eachother
146
What is the pathogenesis of paraneoplastic thrombotic diatheses?
1) Tumor stimulates TPO 2) platelet production is increased 3) activated platelets form a shield around the tumor cells 4) platelets also increase metastasis by stimulating angiogenesis
147
What is tumor grading?
degree of differentiation Higher grade are more aggressive than lower grade
148
What is tumor staging?
Size and spread of primary tumor
149
What are low grade tumors?
Well differentiated
150
What are high grade tumors?
undifferentiated
151
What system is used for staging?
TNM system
152
What does the T stand for in staging?
primary tumor (T1-4)
153
What does the N stand for in staging?
regional lymph node involvement (N1-4)
154
What does the M stand for in staging?
metastases (M0, M1)
155
What methods do we have for laboratory diagnosis of cancer?
``` Histologic and Cytological methods Fine needle aspiration Flow cytometry Immunohistochemistry Circulating tumor cells ```
156
What ways can laboratory evaluation of a lesion be done?
Excision or biopsy Fine Needle Aspiration Cytologic Smears
157
What is the most important method of diagnosis?
Histologic examination
158
What must be confirmed by a biopsy?
Cytologic diagnosis
159
What is fine needle aspiration (FNA)?
involves apsiration of cells and fluids from tumor or masses taht are palpable
160
Where can FNA be performed?
breast thyroid lymph nodes
161
What is cytologic smears?
involve examination of exfoliated cells like in PAP smears
162
What is flow cytometry?
measures the presence of membrane antigens or DNA content of tumor cells
163
What cancers use flow cytometry?
Leukemia | Lymphoma
164
What is immunohistochemistry?
detects cell products or surface markers using specific antibodies
165
What is imunohistochemistry used for?
Diagnosis of undifferentiated tumors Determination of site of origin of metastases Detection of molecules with prognostic or therapeutic significance
166
What are circulating tumor cells?
are a subpopulation of tumors cells originated from the primary cancer They assist in monitoring and predicting cancer progression and evaluating treatment
167
What do circulating tumor cells have the ability to do?
disseminate and proliferate as a metastatic lesion

Patho II (16 decks)

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