Oncology 1 Flashcards
(135 cards)
1
Q
cancer
A
refers to a large group of diseases characterized by uncontrolled cell proliferation and spread of abnormal cells
2
Q
what is the CDC’s leading cause of death?
A
cancer
3
Q
how do normal cells become cancer cells?
A
normal cell –> hyperplasia –> dysplasia –> cancer
4
Q
differentiation - normal cells
A
form different tissues to specialize in different functions
5
Q
differentiation - malignant cells
A
- differentiation is altered and may be lost completely
- completely lost identity w/ the parent tissue is considered as undifferentiated (anaplastic)
6
Q
less differentiated a tumor becomes, the __________ metastasis occurs, and the ________ the prognosis is
A
faster; worse
7
Q
dysplasia
A
a disorganization of cells in which an adult cell varies from its normal size, shape, or organization
8
Q
what is the first level of dysplasia (early dysplasia)?
A
metaplasia
9
Q
metaplasia
A
a reversible and benign but abnormal change in which one adult cell changes from one type to another
10
Q
anaplasia
A
- loss of cellular differentiation
- the most advanced form of metaplasia
11
Q
what is considered the hallmark feature of malignant disease?
A
anaplasia
12
Q
hyperplasia
A
increased # of cells in tissue –> increased tissue mass
13
Q
neoplastic hyperplasia
A
the increase in cell mass d/t tumor formation and is an abnormal process
14
Q
tumors (neoplasms)
A
- abnormal new growth of tissue
- benign or malignant
- primary or secondary
- carcinoma in situ
15
Q
T/F: tumors serve no useful purpose
A
TRUE
16
Q
what may harm the host organism by competing for vital blood supply and nutrients?
A
tumors (neoplasms)
17
Q
carcinoma in situ
A
- a localized, pre-invasive, and possibly premalignant tumor of epithelial tissue
- contained w/in host organ and haven’t broken through basement membrane
18
Q
steps in cancer development
A
cell w/ mutation –> hyperplasia –> dysplasia –> in situ cancer –> invasive cancer
19
Q
how is a neoplasm classified?
A
on the basis of cell type, tissue of origin, degree of differentiation, anatomic site, or whether it is benign or malignant
20
Q
how are tumors (benign or malignant) named when they’re classified by cell type?
A
according to the tissue from which they arise
21
Q
surface epithelium (skin) and mucous membrane benign neoplasm
A
papilloma
22
Q
surface epithelium (skin) and mucous membrane malignant neoplasm
A
squamous cell, basal cell, and transitional cell carcinoma
23
Q
epithelial lining of glands or ducts benign neoplasm
A
adenoma
24
Q
epithelial lining of glands or ducts malignant neoplasm
A
adenocarcinoma
25
pigmented cells (melanocytes of basal layer) benign neoplasm
nevus (mole)
26
pigmented cells (melanocytes of basal layer) malignant neoplasm
malignant melanoma
27
fibrous tissue benign neoplasm
fibroma
28
fibrous tissue malignant neoplasm
fibrosarcoma
29
adipose benign neoplasm
lipoma
30
adipose malignant neoplasm
liposarcoma
31
cartilage benign neoplasm
chondroma
32
cartilage malignant neoplasm
chondrosarcoma
33
bone benign neoplasm
osteoma
34
bone malignant neoplasm
osteosarcoma
35
blood vessels benign neoplasm
hemangioma
36
blood vessels malignant neoplasm
hemangiosarcoma
37
smooth muscle benign neoplasm
leiomyoma
38
smooth muscle malignant neoplasm
leiomyosarcoma
39
striated muscle benign neoplasm
rhabdomyoma
40
striated muscle malignant neoplasm
rhabdomyosarcoma
41
nerve cells benign neoplasm
neuroma
42
glia malignant neoplasm
glioma or neuroglioma
43
ganglion cells benign neoplasm
ganglioneuroma
44
ganglion cells malignant neoplasm
neuroblastoma
45
nerve sheaths benign neoplasm
neurilemoma
46
nerve sheaths malignant neoplasm
neurilemic sarcoma
47
meninges benign neoplasm
meningioma
48
meninges malignant neoplasm
meningeal sarcoma
49
retina malignant neoplasm
retinoblastoma
50
lymph nodes malignant neoplasm
lymphoma
51
bone marrow malignant neoplasm
leukemias, myelodysplasia, and myeloproliferative syndromes
52
plasma cells malignant neoplasm
multiple myeloma
53
staging
the stage of disease reflects the rate of growth, the extent of the neoplasm, and the prognosis
54
stage 0
carcinoma in situ (premalignant, pre invasive)
55
stage I
early stage, local cancer
56
stage II
increased risk of spread bc of tumor size
57
stage III
local cancer has spread but may not be disseminated to distant regions
58
stage IV
cancer has spread and disseminated to distant sites
59
TNM Staging System - T
Primary Tumor
60
TNM Staging System - Tx
primary tumor can't be assessed
61
TNM Staging System - T0
no evidence of primary tumor
62
TNM Staging System - TIS
carcinoma in situ (confined to site of origin)
63
TNM Staging System - T1, T2, T3, T4
progressive increase in tumor size and involvement locally
64
TNM Staging System - N
regional lymph nodes
65
TNM Staging System - Nx
nodes can't be assessed
66
TNM Staging System - N0
no metastasis to regional lymph nodes
67
TNM Staging System - N1, N2, N3
increasing degrees of involvement of regional lymph nodes
68
TNM Staging System - M
distant metastasis
69
TNM Staging System - Mx
presence of distant metastasis cannot be assessed
70
TNM Staging System - M0
no distant metastasis
71
TNM Staging System - M1
distant metastasis
72
who is grading done by?
pathologist using different grading (numerical score or scale) for different types of tumors
73
grading
- the lower the value --> lower tumor grade --> better differentiation of tissue w/in tumor
- highly scored/scaled tumor is considered a high-grade tumor w/ poor cellular differentiation and a tendency to metastasize early
74
what are the most commonly diagnosed cancers?
lung, breast, and colorectal
75
what is the most prevalent cancer in the world?
lung cancer
76
what accounts for the largest # of cancer deaths worldwide?
lung cancer
77
in men, what are the most common cancers predicted to be?
cancers of the prostate, lung and bronchus, and colon/rectum
78
in women, what are the 3 most commonly dx cancers expected to be?
cancers of the breast, lung and bronchus, and colon/rectum
79
what are the two categories of causative agents of cancers?
1. endogenous (genetic) origin
2. exogenous (environment or external) origin
80
most cancers develop as a result of multiple _________, _______, and ________ factors working together
environmental, viral, genetic
- to disrupt the immune system, along w/ failure of an aging immune system to recognize and scavenge the less differentiated cells
81
what are the most common cancers showing a familial pattern?
prostate, breast, ovarian, and colon cancers
82
___% of all cancers are caused by 1(+) of nearly 500 different cancer-causing agents
50%
(e.g. tobacco use, viruses, chemical agents, physical agents, drugs, alcohol, hormones)
83
carcinogens
etiologic agents capable of initiating the malignant transformation of a cell (i.e., carcinogenesis)
84
cancer risk factors
- heredity
- aging
- lifestyle
- geographic location & environmental variables
- ethnicity
- precancerous lesions
- stress
85
somatic mutation theory
- early in the study of cancer
- concept that neoplasia originates in a single cell by acquired genetic change
- remains the view of cancer pathogenesis most supported by experimental evidence
86
what laid the foundation of modern cancer cytogenetics (study of chromosomes in cancer)?
the discovery that chromosomal aberration is one of the basic mechanisms of tumor cell proliferation
87
what can chromosomal changes include?
- addition or deletion of entire chromosomes (numerical changes)
- translocations, deletions, inversions, and insertions of parts of chromosomes (structural changes)
88
chromosomal rearrangements may lead to ___________
oncogene activation
89
chromosomal changes inactivate a tumor suppressor gene through ______________
chromosomal deletion
90
oncogenes
- aka cancer-causing genes or protocols-oncogenes
- have the ability to transform normal cells into malignant cells, independently or incorporated w/ a virus
91
tumor suppressor genes
have the opposite effect of oncogenes (anti-oncogenes)
92
are oncogenes and tumor suppressor genes present in all cells?
yes --> in their normal, non mutated form, they contribute to the regulation of cell division and death
93
current cancer research focuses
- regulation of cellular proliferation and expression of oncogenes and tumor suppressor genes
- telomere length and telomerase
- free-radical induced DNA damage and regulation of apoptosis
- immune fxn and response (e.g., senescence, surveillance, enhancement)
- cellular and humoral factors associated w/ the chronic inflammatory process
94
cancer stem cell hypothesis
there are different fxnl and morphologic cancer cells w/in a single tumor and hierarchical order in which the abnormal stem cells form and feed a cancer
95
why are tumor-initiating stem cells resistant to chemo and radiation therapy?
bc their DNA repair mechanisms are more highly developed
96
new direction in cancer stem cell research
targeting and eliminating these cells may be a more efficient and direct way to eradicate cancer w/o killing fast-growing normal cells
97
carcinogenesis
- the process by which a normal cell undergoes malignant transformation
- usually a multistep process
98
multistep process of carcinogenesis
- 7 or 8 genetic events; that means genetic instability
- involving progressive changes after genetic damage to or alteration of cellular DNA through the development of hyperplasia, metaplasia, dysplasia, carcinoma in situ, invasive carcinoma, and metastatic carcinoma in that order
99
cancer and the immune system
- immunosurveillance
- tumor-specific antigens
- tumor-associated antigens
- major immune response against tumors
- tumor evasion strategies
- cancer immunotherapy
100
immunosurveillance
1. a higher incidence of cancer after immunosuppression or in immunodeficiency
2. infiltration of tumors by lymphocytes and macrophages
3. lymphocyte proliferation in response to tumors
4. regression of metastases after ablation of the primary tumor
5. immune-mediated spontaneous regression of human tumors
101
tumor-specific antigens (TSAs)
- uniquely expressed by tumor cells and are not expressed by normal cells
- T cells recognize different types of tumor antigens
102
what are tumor-associated antigens (TAAs) expressed by?
tumors AND normal cells --> higher levels on tumors relative to normal cells or are expressed at different stages of development/differentiation
103
major immune responses against tumors
- involve both innate and adaptive immunity
- NK cells
- macrophages --> tumor antigen-specific CD4+ T cells and B cells are required for antibody production and cytokine (i.e. IFN-a; TNf-a) activation of macrophages
- Cytotoxic CD8+ T cells (cytotoxic T lymphocytes)
104
why is immunity often insufficient to clear tumors? why does cancer develop in an immunocompetent individual?
1. malignancies proliferate at such a rapid rate that immune defenses are simply overtaken
2. many tumor antigens are weak immunogens, perhaps bc they vary only slightly from self-antigens
3. tumors have also evolved to evade innate and adaptive immune responses, known as immune escape
105
how do malignant tumors differ from benign tumors?
in their ability to metastasize or spread from the primary site to other locations in the body
106
when does metastasis occur?
when cells break away from the primary tumor, travel through the body via the blood or lymphatic system and become trapped in the capillaries of organs
107
what are the 5 most common sites of metastasis?
lymph nodes, liver, lung, bone, brain
108
seed vs soil theory of metastasis
- some cancers favor certain sites of metastasis over others so that metastases only occur if the cancer cell (the seed) finds a favorable microenvironment at the site of the host (the soil)
- certain tumor cells seem to have specific affinity for certain organs
- traditional cancer tx targets the seed, whereas today's research also focuses on approaches that target the soil
109
approximately ____% of clients w/ newly dx cancers have clinically detectable metastases
30%
110
at least ____-____% of those who are clinically free of metastases harbor cult (hidden) metastases
30-40%
111
metastasis is more likely to occur via the _______ as opposed to the ______ bc the cancer can't break through the ______ wall
veins; arteries; arterial
112
what is the key factor to cancer cure?
eradicating metastases, often already present at the time of dx
113
mechanisms of metastasis
1. invasive growth
2. induction of vascular growth
3. vascular invasion
4. adherence to endothelial cells/thrombosis of peripheral sinusoids
5. continuation of invasive growth w/ extravasation
6. formation of primary and secondary metastatic foci
114
what does the ability of a tumor to grow beyond a very small mass (1-2 mm) depends on?
its ability to gain access to an adequate supply of blood and in some cases (e.g., breast and prostate) the presence of hormonal factors
115
angiogenesis in metastasis
blood vessels from pre-existing vessels grow into the solid tumor
116
tumors excrete acid-like enzymes that dissolve the _________ and break through to the _______
basement membrane; lymphatics
117
where can cancer cells enter the bloodstream?
where lymph nodes drain into veins
118
metastatic spread usually occurs w/in __ to __ years after initial dx and tx of malignancy, although some low-grade lesions can reappear __ to __ years later
3 to 5 yrs; 15-20 yrs
119
where do clinical manifestations of metastasis most commonly occur?
areas of the body that provide an environment rich in nutrition to the colonized tumor cells:
1. pulmonary system (lungs)
2. hepatic system (liver)
3. skeletal system (bone)
4. CNS
120
what is the most common of all metastatic tumors?
pulmonary system (lungs)
121
metastasis in the pulmonary system (lungs)
venous drainage of most areas of the body is through the superior and inferior vena cava into the heart, making the lungs the first organ to filter malignant cells
122
Sx of metastasis in the pulmonary system (lungs)
- dry persistent cough
- pleural pain (pleural invasion)
- SOB or dyspnea (pleural effusion)
- hemoptysis (bronchial tissue invasion)
123
metastasis of the hepatic system (liver)
the liver filters blood coming in from the GI tract --> primary metastatic site for tumors of the stomach, colorectal, and pancreas
124
Sx of metastasis of the hepatic system (liver)
- abdominal and/or RUQ pain
- general malaise and fatigue
- anorexia
- early satiety and weight loss
- low-grade fevers
125
osteolytic type of metastasis in the skeletal system (bone)
- marked by areas of decreased bone density
- increased bone resorption --> hypercalcemia
126
osteoblastic type of metastasis in the skeletal system (bone)
appearing as areas of dense scarring and increased bone density
127
in metastasis of the skeletal system, the axial skeleton is most commonly involved with the spread to what?
spine, pelvis, ribs, proximal femurs, proximal humerus, and skull
128
what is the primary sx in metastasis in the skeletal sx (bone)?
pain
- usually deep and worsened by activity, especially weight bearing
- spinal metastases manifest w/ pain, neurologic sx, and instability
129
what is the most common primary tumor to metastasize to the brain?
lung cancer
130
tumor cells traveling from the lung via the ___________ and __________ can result in metastases to the CNS
pulmonary veins; carotid artery
131
clinical manifestations of the brain metastases depend on the _________
location
- increase intracranial pressure, obstruct the normal flow of CSF, change mentation and contribute to cognitive impairment, and reduce sensory and motor fxn
- life threatening and emotionally debilitating
132
what results from metastatic involvement of the vertebrae?
epidural spinal (usually anterior) cord compression
- progressive central or radicular back pain often aggravated by recumbency, weight bearing, sneezing, coughing or Valsalva maneuver
133
what do spinal cord and nerve root compression in metastasis of CNS cause?
either insidious or rapid loss of neurologic fxn
- gradual onset of distal weakness and sensory changes, including numbness, paresthesias, and coldness
134
dx of metastasis
metastases usually reproduce the cellular structure of the primary growth well enough to enable a pathologist to determine the site of the primary tumor
135
what describes the time btwn dx and cancer recurrence or relapse?
- may be local
- regional
- disseminated
- or a combo
