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Flashcards in Neoplasia Deck (30):
1

Neoplasia
Uncontrolled, clonal proliferation of cells. Can be ____ or ____.

Anaplasia
Complete lack of differentiation of cells in a ____

benign
malignant
malignant neoplasm

2

Tumor grade vs stage

Grade:
Degree of ____ and mitotic activity on histology. Range from low grade (well differentiated) to high grade (poorly differentiated, undifferentiated or anaplastic).

Stage generally has more ____ value than grade (eg, a high-stage yet low-grade tumor is usually ____ than a low-stage yet high-grade tumor).

cellular differentiation
prognostic
worse

3

Tumor grade vs stage

Stage:
Degree of ____ based on site and size of 1° lesion, spread to regional lymph nodes, presence of metastases. Based on ____ (c) or pathology (p) findings. Example: cT3N1M0

TNM staging system (Stage = Spread):
T = Tumor size/invasiveness
N = Node involvement
M = Metastases
Each TNM factor has independent prognostic value; ____ factors are often most important

localization/spread
clinical
N and M

4

Tumor nomenclature

Carcinoma implies ____ origin, whereas sarcoma denotes ____ origin. Both terms imply ____.

Benign tumors are usually well differentiated, well demarcated, low mitotic activity, no metastasis, no necrosis.

Malignant tumors may show poor differentiation, erratic growth, local invasion, metastasis, and decreased apoptosis.

Upregulation of ____ prevents chromosome shortening and cell death.

Terms for non-neoplastic malformations include ____ (disorganized overgrowth of tissues in their native location, eg, ____) and ____ (normal tissue in a foreign location, eg, gastric tissue located in distal ileum in ____).

epithelial
mesenchymal
malignancy

telomerase

hamartoma
peutz-jeghers polyps
choristoma
meckel diverticulum

5

Epithelium
Benign: ____
Malignant: ____

Mesenchyme
Blood cells:
Benign: ____
Malignant: ____

Smooth muscle:
Benign: ____
Malignant: ____

Striated muscle:
Benign: ____
Malignant: ____

Conn. tissue:
Benign: ____
Malignant: ____

Bone:
Benign: ____
Malignant: ____

Fat:
Benign: ____
Malignant: ____

Melanocyte:
Benign: ____
Malignant: ____

adenoma, papilloma
adenocarcinoma, papillary carcinoma

none
leukemia, lymphoma

hemangioma
angiosarcoma
leiomyoma
leiomyosarcoma

rhabdomyoma
rhabdomyosarcoma

fibroma
fibrosarcoma

osteoma
osteosarcoma

lipoma
liposarcoma

nevus/mole
melanoma

6

Cancer epidemiology
Skin cancer (____ > ____ >> melanoma) is the most common cancer

basal
squamous

7

Cancer incidence
Men
1. ____
2. Lung
3. ____

Cancer mortality
Men
1. ____
2. Prostate
3. ____

prostate
colon/rectum

lung
colon/rectum

8

Cancer incidence
Women
1. ____
2. Lung
3. ____

Cancer mortality
Women
1. ____
2. Breast
3. ____

breast
colon/rectum

lung
colon/rectum

9

Cancer incidence
Children (6-14)
1. ____
2. Brain and CNS
3. ____

Cancer mortality
Children (6-14)
1. ____
2. Brain and CNS
3. ____

leukemia
neuroblastoma

leukemia
neuroblastoma

10

Cancer incidence
Lung cancer incidence has dropped in ____, but has not changed signi cantly in ____.

Cancer mortality
Cancer is the 2nd leading cause of death in the United States (____ is 1st).

men
women
heart disease

11

PARANEOPLASTIC SYNDROMES

Cutaneous

Acanthosis nigricans
Descript/mechanism:
____ velvety plaques in ____ and neck

Most commonly assoc. cancers:
____ and other visceral malignancies (but more commonly associated with ____ and insulin resistance)

Sign of Leser-Trelat
Descript/mechanism:
Sudden onset of multiple ____

Most commonly assoc. cancers:
____ and other visceral malignancies

hyperpigmented
axilla

gastric adenocarcinoma
obesity

seborrheic keratoses
GI adenocarcinoma

12

PARANEOPLASTIC SYNDROMES

Endocrine

Hypercalcemia
Descript./mech:
____
increased 1,25-(OH)2 vitamin D3 (calcitriol)

Most commonly associated cancers:
____ of lung, head, and neck; renal, bladder, breast, and ovarian carcinomas
____

Cushing syndrome
Descript./mech:
increased ____

Most commonly associated cancers:
____

Hyponatremia (SIADH)
Descript./mech:
increased ____

Most commonly associated cancers:
____

PTHrP
squamous cell carcinomas

ACTH
SCLC

ADH
SCLC

13

PARANEOPLASTIC SYNDROMES

Hematologic
Polycthemia
Descript./mech.:
increased ____

Most commonly associated cancers:
____, hepatocellular carcinoma, ____, pheochromocytoma, ____

Pure red cell aplasia
Descript./mech.:
Anemia with low ____

Most commonly associated cancers:
____

Good syndrome:
Descript./mech.:
____

Most commonly associated cancers:
____

Trousseau syndrome
Descript./mech.:
Migratory superficial ____

Most commonly associated cancers:
____, especially pancreatic

Nonbacterial thrombotic (marantic) endocarditis
Descript./mech.:
Deposition of sterile ____ thrombi on heart valves

Most commonly associated cancers:
____, especially pancreatic

erythropoietin
renal cell carcinoma
hemangioblastoma
leiomyoma

reticulocytes
thymoma

hypogammaglobulinemia
thymoma

thrombophlebitis
adenocarcinomas

platelet
adenocarcinomas

14

PARANEOPLASTIC SYNDROMES

Neuromuscular

Anti-NMDA receptor encephalitis
Decript./mech.:
____ disturbance, memory deficits, seizures, ____, autonomic instability, ____ dysfunction

Most commonly associated cancers:
Ovarian ____

Opsoclonus-myoclonus ataxia syndrome
Decript./mech.:
“____, dancing feet”

Most commonly associated cancers:
____ (children), ____ (adults)

Paraneoplastic cerebellar degeneration
Decript./mech.:
Antibodies against antigens in ____ cells

Most commonly associated cancers:
____ (anti-Hu), gynecologic and ____ (anti-Yo), and ____ (anti-Tr)

Paraneoplastic encephalomyelitis
Decript./mech.:
Antibodies against ____ antigens in neurons

Most commonly associated cancers:
____

Lambert-Eaton myasthenic syndrome
Decript./mech.:
Antibodies against ____ channels at NMJ

Most commonly associated cancers:
____

Myasthenia gravis
Decript./mech.:
Antibodies against postsynaptic ____ receptors at NMJ

Most commonly associated cancers:
____

psychiatric
dyskinesias
language

teratoma

dancing eyes
neuroblastoma
SCLC

purkinje
SCLC
breast cancers
hodgkin lymphoma

Hu
SCLC

presynaptic (P/Q-type) Ca2+ SCLC

ACh
thymoma

15

Oncogenes

Fill in later

16

Tumor suppressor genes

Fill in later

17

Oncogenic microbes

EBV
associated cancer:
____, Hodgkin lymphoma, ____, 1° CNS lymphoma (in immunocompromised patients)

HBV, HCV
associated cancer:
____

HHV-8
associated cancer:
____

HPV
associated cancer:
____ and penile/anal carcinoma (types 16, 18), ____ cancer

burkitt lymphoma
nasopharyngeal carcinoma

hepatocellular carcinoma

kaposi sarcoma

cervical
head and neck

18

Oncogenic microbes

H pylori
associated cancer:
Gastric adenocarcinoma and MALT lymphoma

HTLV-1
associated cancer:
____

Liver fluke (clonorchis sinesis)
____

Schistosoma hamatobium
associated cancer:
____ (squamous cell)

adult T-cell leukemia/lymphoma
cholangiocarcinoma
bladder cancer

19

Carcinogens list

Update this

20

Carcinogens list x2

Update this if you need to

21

Psammoma bodies
Laminated, concentric spherules with ____ calcification,

PSaMMoma bodies are seen in:
____ of thyroid
____ of ovary
____
____

dystrophic
papillary carcinoma
serous papillary cystadenocarcinoma
meningioma
malignant mesothelioma

22

Serum tumor markers
Tumor markers should not be used as the ____ tool for cancer diagnosis or screening.

They may be used to monitor tumor____ and ____ to therapy, but definitive diagnosis is made via ____.

primary
recurrence
response
biopsy

23

Serum tumor markers

Alkaline phosphatase
associated cancer:
Metastases to ____ or liver, ____ disease of bone, seminoma (placental ALP).

notes:
Must exclude hepatic origin by checking ____ and GGT levels.

alpha-fetoprotein
associated cancer:
____ carcinoma, hepatoblastoma, ____ (endodermal sinus) tumor, mixed germ cell tumor.

notes:
Normally made by fetus. Transiently elevated in ____. High levels associated with ____ and abdominal wall defects, low levels associated with ____.

beta-hCG
associated cancer:
____ and Choriocarcinomas (Gestational trophoblastic disease), ____ cancer, mixed germ cell tumor.

notes:
Produced by ____ of the placenta.

CA15-3/CA 27-29
associated cancer:
____ cancer.

bone
paget

LFTs

hepatocellular
yolk sac

pregnancy
neural tube
down syndrome

hydatidiform moles
testicular
syncytiotrophoblasts

breast

24

Serum tumor markers

CA 19-9
associated cancer:
____.

CA 125
associated cancer:
____

Calcitonin
associated cancer:
____ (alone and in MEN2A, MEN2B).

CEA
associated cancer:
Major associations: ____ and pancreatic cancers.
Minor associations: ____, breast, and ____ thyroid carcinomas.

notes:
____ antigen. Very nonspecific.

Chromogranin
associated cancer:
____ tumors.

PSA
associated cancer:
____ cancer.

notes:
____ antigen.
Can also be elevated in BPH and ____.
Questionable risk/benefit for screening. Surveillance marker for recurrent disease after ____.

pancreatic adenocarcinoma
ovarian cancer
medullary thyroid carcinoma

colorectal
gastric
medullary
carcinoembryonic

neuroendocrine

prostate

prostate-specific
prostatitis
psotatectomy

25

P-glycoprotein

Also known as ____.

Classically seen in ____ carcinoma but also expressed by other cancer cells (eg, colon, liver).

Used to pump out toxins, including chemotherapeutic agents (one mechanism of responsiveness or resistance to chemotherapy over time).

multidrug resistance protein 1 (MDR1)
adrenocortical

26

Cachexia

Weight loss, muscle atrophy, and fatigue that occur in ____ disease (eg, cancer, AIDS, heart failure, COPD). Mediated by ____, IFN-γ, ____, and IL-6.

chronic
TNF
IL-1

27

Common metastases

Most sarcomas spread ____; most carcinomas spread via ____.

However, Four Carcinomas Route Hematogenously: ____ carcinoma, Choriocarcinoma, ____ carcinoma, and Hepatocellular carcinoma.

hematogenously
lymphatics

follicular thyroid
renal cell
hepatocellular

28

Site of metastasis

Brain
Primary tumor:
____ > breast > ____, colon, kidney.

Notes:
50% of brain tumors are from metastases. Commonly seen as multiple well-circumscribed
tumors at ____ matter junction.

lung
melanoma
gray/white

29

Site of metastasis

Liver
Primary tumor:
____ >> stomach > ____.

Notes:
____ are the most common sites of metastasis after the regional lymph nodes.

colon
pancreas
liver

30

Site of metastasis

Bone
Primary tumor:
____, breast > lung, ____, kidney.

Notes:
Bone metastasis >> ____ tumors (eg, multiple myeloma, lytic). Common mets to bone: breast (____), lung (lytic), thyroid (____), kidney (lytic), prostate (blastic). Predilection for ____

prostate
thyroid

primary bone
mixed
lytic
axial skeleton