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123 Cards in this Set

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T/F
Cancer is the 2nd leading cause of death in the USA after cardiovascular disease
True
Define Neoplasia
Neoplasia literally means "new growth"
Define Neoplasm
Neoplasm is the new growth
Define Tumor
Tumor is now equated with Neoplasm
(it was originally applied to the swelling caused by inflammation)
Define Parenchyma
The Parenchyma is the proliferating neoplastic cells of a tumor
Define Stroma
Supportive Stroma of atumor is made up of connective tissue and blood vessels
Define Choristoma
Choristoma is a congenital anomaly composed of a heterotopic rest of cells; example: pancreatic tissue found in the submucosa of the stomach.
(Choristoma is confusing nomenclature)
T/F
A Hamartoma is a neoplasm that presents as a mass of disorganized tissue indigenous to a particular site; example: nodule in lung containing cartilage, bronchi, blood vessels
FALSE
A Hamartoma is a malformation not a neoplasm (the rest of the statement is correct though)
What type of tumor is made up of a variety of parenchymal cell types representative of MORE than one germ and usually all three germ layers?
Teratoma
Define oncology
Oncology is the study of tumors or neoplasms (Greek oncos means tumor)
How are benign epithelial tumors classified?
1. Cells of origin
2. Microscopic architecture
3. Macroscopic patterns
Benign tumors of mesenchymal cells generally have the suffix -OMA appended
What type of tumors have:
1.The parenchmal cells usually resemble each other
2. Stem cell may undergo divergent differentiation, creating mixed tumors
3. However, these mixed tumors are composed of cells representative of a single germ layer
Malignant Tumors
Define Cancer
Cancer (Latin for Crab) is the common term for ALL MALIGNANT TUMORS
Define Carcinoma
Carcinomas are malignant neoplasms of epithelial origin arising from any of the three germ layers
Define Sarcoma
Malignant tumor arising in mesenchymal tissue is called sarcoma
(Greek Sar means fleshy)
Define Mixed tumor
Stem cells undergo divergent differentiation, creating mixed tumors. These are composed of cells from a SINGLE germ layer
i.e. mixed tumor of salivary gland origin
When do most cancers occur?
Most carcinomas occur in the later years of life (55 years and older)
How frequently are children victims to cancer?
>10% of deaths in children are due to cancer
Where are skin cancer deaths caused by melanomas most frequent, New Zealand or Iceland?
New Zealand 6x > Iceland
Where is stomach carcinoma more common?
Japan
T/F
Children and elderly people are more likely to develop cancer than adults
True
T/F
Most cancers are familial
False
most cancers are sporadic, but some are familial
T/F
Predisposition to hereditary cancers may be autosomal dominant or autosomal recessive
True
What type of hereditary type are linked to inheritance of a germ-line mutation of cancer suppressor genes?
Autosomal Dominant
What type of hereditary type are typically associated with inherited defects in DNA repair?
Autosomal Recessive
What are some Familial cancers?
Familial clustering of cases, but role of inherited predisposition not clear for each individual
1. Breast cancer (not linked to BRCA1 or BRCA2)
2. Ovarian cancer
3. Pancreatic cancer
What are some Inherited Autosomal Recessive Syndromes of Defective DNA Repair?
1. Xeroderma Pigmentation
2. Atazia-telangiectasia
3. Bloom syndrome
4. Fanconi Anemia
What genes are affected by Inherited (Autosomal Dominant) Cancer Syndromes?
RB
p53
p16INK4A
APC
NF1, NF2
BRCA1, BRCA2
MEN1, RET
MSH2, MLK1, MSH6
PATCH
What inherited (Autosomal Dominant) predisposition arises from mutated RB gene?
Retinoblastoma
What inherited (Autosomal Dominant) predisposition arises from mutated p16INK4A gene?
Melanoma
What inherited (Autosomal Dominant) predisposition arises from mutated APC gene?
Familial adenomatous polyposis/colon cancer
What inherited (Autosomal Dominant) predisposition arises from mutated NF1, NF2 genes?
Neurofibromatosis 1 &2
What inherited (Autosomal Dominant) predisposition arises from mutated BRCA1, BRCA2 genes?
Breast & Ovarian Tumors
What inherited (Autosomal Dominant) predisposition arises from mutated MEN1, RET genes?
Multiple endocrine neoplasia 1 & 2
What inherited (Autosomal Dominant) predisposition arises from mutated MSH2, MLH1, MSH6 genes?
Hereditary nonpolyposis colon cancer
What inherited (Autosomal Dominant) predisposition arises from mutated PATCH gene?
Nevoid basal cell carcinoma syndrome
What is an abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the change
Neoplasm
What part of the tumor largely determines its biologic behavior and is the component from which the neoplasm derives its name?
the parenchyma of the tumor
What is the term for when parenchymal cells of a tumor stimulate the formation of abundant collagenous stroma?
Desmoplasia
What kind of tumors have the suffix -OMA?
Benign mesenchymal cells
What is a fibroma?
A benign tumor from fibroblastic cells
What is a osteoma?
A benign tumor of osteoblasts
What is a chondroma?
Benign cartilaginous tumor
What is the term for benign epithelial neoplasm that forms a glandular pattern or to a tumor arising from glands but not reproducing glandular patterns?
Adenoma
What are benign epithelial neoplasms producing microscopically or macroscopically visible finger-like or warty projections from epithelial surfaces?
Papillomas
What are benign tumors forming large cystic masses in organs such as the ovary called?
Cystadenomas
What is the term for a benign or malignant neoplasm that produces a macroscopically visible projection above a MUCOSAL surface and projects into a lumen, as in the GI tract?
POLYP
T/F
It is preferred that the term polyp be used only with benign tumors as malignant polyps are better called polypoid cancers
True
What is a malignant tumor arising from fibroblastic cells?
Fibrosarcoma
What is a malignant tumor arising from osteoblastic cells?
Osteosarcoma
What is a carcinoma with a glandular growth pattern microscopically?
Adenocarcinoma
What is a malignant tumor producing recognizable squamous cells arising in any epithelium of the body called?
Squamous Cell Carcinoma
What is a cancer that is composed of undifferentiated cells called?
a poorly differentiated or undifferentiated malignant tumor
T/F
A Melanoma is a benign tumor
False
Melanoma is a malignant tumor of melanocytes and should be called a melanocarcinoma
What is the biggest difference between a Hamartoma and a Choristoma?
Hamartoma has a mass of tissue indigenous to that site ( nodule in lung containing cartilage, bronchi, blood vessels)
Choristoma has cells that are not normally found in that region (pancreatic tissue in stomach)
What are the 4 main differences between Benign and Malignant tumors?
1. Differentiation and Anaplasia
2. Rate of Growth
3. Local Invasion
4. Metastasis
What term refers to the extent to which parenchymal cells resemble comparable normal cells, both morphologically and functionally?
Differentiation
What are Well-Differentiated tumors composed of?
Well-differentiated tumors are composed of cells resembling the mature normal cells of the tissue of origin of the neoplasm
How do Poorly or Undifferentiated tumors present?
Poorly or Undifferentiated tumors have primitive appearing unspecialized cells
What is the differentiation of Benign tumors?
In general, Benign tumors are Well Differentiated
What is the differentiation of Malignant tumors?
Malignant tumors range from Well Differentiated to Undifferentiated
What term is used to describe malignant neoplasms composed of undifferentiated cells?
Anaplastic
Lack of differentiation or anaplasia is considered a hallmark of malignant transformation
{anaplasia literally means to form backward, but lack of differentiation is not the consequence of dedifferentiation}
What are the morphologic and functional changes which define anaplasia?
1. Pleomorphism
2. Hyperchromatism
3. Large Numbers of Mitoses
4. Atypical, Bizarre Mitotic Figures
5. Tumor Giant Cells
6. Orientation is disturbed
What marker of anaplasia is the variation of size and shape of the cells and their nuclei?
Pleomorphism
What marker of anaplasia is when nuclei contain an abundance of DNA and are extremely dark staining?
Hyperchromatism
What marker of anaplasia refers to the quatity of replication?
Anaplastic tumors usually possess large Numbers of Mitoses
T/F
The presence of mitoses does not necessarily indicate that a tumor is malignant or that the tissue is neoplastic
True
What marker of anaplasia involves shapes of mitotic figures?
More important as a morphologic feature of malignant neoplasia is the presence of Atypical, Bizarre mitotic figures
T/F
Generally the more rapidly growing and the more anaplastic a tumor, the less likely it is that therre will be specialized functional activity. The cells in benign tumors are almost always well differentiated and resemble their normal cells of originl; the cells in cancer are more or less differentiated but some loss of differentiation is always present
True
What are the properties of Differentiated cells?
1. Mimic the structure of their parent origin
2. Resemble their cells of origin
3. Show a remarkable uniformity in size shape and nuclear configuration
4. Show evidence of normal function even if useless
5. Have relatively infrequent mitotic figures
What are the properties of Undifferentiated cells?
1. Generally show a haphazard arrangement
2. Bear little resemblance to the cells of origin
3. Tend to vary widely in size, shape and nuclear configuration
4. Provide little evidence of normal function
5. Show frequent mitoses often of abnormal type
Compare the rate of tumor growth between benign and malignant tumors
Generally most Benign tumors grow Slowly over a period of years, whereas most Cancers grow Rapidly, sometimes at an erratic pace. (in general, the growth rate of tumors correlates with their level of differentiation and thus most malignant tumors grow more rapidly than do benign ones
Compare the local invasion properties for benign tumors
Nearly all benign tumors grow as cohesive expansile masses that remain localized.
Because benign tumors typically grow slowly, they usually develop a rim of compressed connective tissue which may be called a fibrous capsule.
Describe the local invasive properties of malignant tumors
The growth of malignant tumors is accompanied by progressive infiltration, invasion, and destruction of surrounding tissue leaving them poorly demarcated. (next to development of metastases, invasiveness is the most reliable feature that differentiates malignant from benign tumors)
What are the two most reliable indicators to separate malignant from benign tumors?
Metastases & Invasiveness
What are tumor implants that are Discontinuous with the primary tumor?
Metastases
What % of newly diagnosed cancer patients with solid tumors present with metastases?
30%
What are the different pathways of spread that metastasis may follow?
1. Direct seeding of body caivities or surfaces
2. Lymphatic seeding
3. Hemtogenous spread
What parts of the body most do direct seeding of Body Cavities and Surfaces occur?
Seeding of Body Cavities and Surfaces may occur whenever a malignant tumor penetrates into a natural open field.
Peritoneal cavity is most often involved, but pleural, pericardial, subarachnoid and joint spaces may be affected
What is the most common pathway for the initial dissemination of carcinomas?
Lymphatic spread (sarcomas may also use this route)
What is the pattern of lymph node involvement for metastases?
Follows the natural routes of drainage
T/F
Nodal enlargement in proximity to a cancer does not necessarily mean dissemination of the primary tumor.
True
What pathway of metastasis is typical of Sarcomas, but carcinomas may also follow this route?
Hematogenous Spread
Which areas are most frequently involved secondarily in hematogenous dissemination?
Liver and Lungs
What blood vessels are more easily invade by tumors and certain cancers, such as renal cell carcinomas, under the hematogenous spread?
Veins are more easily invaded
T/F
Benign tumors do not cause morbidity and mortality
FALSE
ALL tumors, even benign ones, can cause morbidity and mortality
What types of problems affect the host that are common between benign and malignant tumors?
1. Location and impingement on adjacent structures
2. Functional activity such as hormone synthesis
3. Bleeding and secondary infections when they ulcerate
4. Initiation of acute symptoms caused by either rupture or infarction
T/F
Neoplasms arising in endocrine glands may produce manifestations by elaboration of hormones
True
What is the term for Cancer patients commonly suffereing progressive loss of body fat and lean body mass accompanied by profound weakness, anorexia and anemia?
CACHEXIA
*************
Is cachexia caused by the nutritional demands of the tumor?
NO
Is reduced food intake alone sufficient to explain the cachexia of malignancy?
No
What is Cachexia the result of?
Cachexia results from the action of soluble factors such as cytokines TNF-ALPHA & IL-1 either produced by the tumor or the host
What are symptom complexes in cancer patients that cannot readily be explained, either by the local or distant spread of the tumor or by the elaboration of hormones indigenous to the tissue from which the tumor arose?
PARANEOPLASTIC SYNDROMES
************************************
Why are Paraneoplastic syndromes important?
1. They may represent the earliest manifestation of an occult tumor
2. They may represent significant clinical problems and may even be lethal
3. They may mimic metastatic disease and therefore confound treatment
What is the difference between the Grade and Staging of tumors?
Grade is the level of differentiation
Stage is the spread of a cancer within the patient
What is grading of a tumor based upon?
Grading is based on the degree of differentiation of the tumor cells and the number of mitoses within the tumor as presumed correlates of the neoplasm's aggressiveness
(Cancers are classified as grades I-IV with increasing anaplasia)
What is the Staging of a cancer based upon?
Stagin is based on the
1. size of the primary lesion
2. extent of spread to regional lymph nodes
3. presence or absence of blood-borne metastases
What are the 2 major staging systems?
1) UICC Union International Contre Cancer
2) AJC American Joint Committee on Cancer Staging
What does the T stand for in the UICC TMN system?
T
Primary tumor: T0 (in situ), T1-T4 with increasing size
What does the Mstand for in the UICC TMN system?
M
Metastases: MO (none), M1 & M2 indicates the amount of metastases
What does the N stand for in the UICC TMN system?
N
Regional lymph node involvement: NO (none), N1-N3 denotes involvement of an increasing number and range of nodes
What does the AJC system use?
divides all cancers into stages 0-IV
Incorporating within each of these stages the size of the primary lesion as well as the presence of nodal spread and distant metastases
What are sampling approaches for histologic and cytologic methods of lab diagnosis of cancer?
1. Excision or biopsy
2. Fine-needle aspiration
3. Cytologic smears
What is the utility of immunohistochemistry?
1. Categorization of undifferentiated malignant tumors; ie keratin in tumors of epithelial origin
2. Categorization of Leukemias and Lymphomas; ie classification of T and B cell tumors
3. Determination of site of origin of metastatic tumorsl ie prostate-specific antigen in a tumor
4. Detection of molecules that have prognostic or therapeutic significance; ie detection of hormone (estrogen and/or progesterone) receptors in breast cancer cells
What are molecular diagnosis methods used for?
1. Diagnosis of malignant tumors
2. Prognosis of malignant neoplasms
3. Detection of minimal residual disease
4. Diagnosis of hereditary predisposition to cancer
When using molecular diagnosis, what is an example of diagnosis of malignant tumors?
Molecular techniques used in differentiating benign (polyclonal) proliferations of T or B cells from malignant (monoclonal) proliferations
When using molecular diagnosis, what is an example of Prognosis of malignant neoplasms?
N-myc gene and deletions of 1p bode poorly for patients with neuroblastoma
When using molecular diagnosis, what is an example of Detection of minimal residual disease?
PCR-based amplification gives a measure of residual leukemia cells intreated patients with chronic myeloid leukemia
When using molecular diagnosis, what is an example of Diagnosis of hereditary predisposition to cancer?
Germ line mutation in cancer suppressor genes is associated with an extremely high risk of developing specific cancers
What is flow cytometry used for?
Flow cytometry can rapidly and quantitatively measure several individual cell characteristics, such as membrane antigens and DNA content of tumor cells.
Cell surface antigens can be used for classification; ie Leukemias.lymphomas
Relationship between DNA content and prognosis; ie aneuploidy-poorer prognosis
What are tumor markers?
Tumor markers are biochemical indicators of the presence of a tumor
What can be used as a tumor marker?
Cell surface antigen
Cytoplasmic proteins
Enzymes and hormones
ie CEA carcinoembryonic antigen is found in carcinomas of colon, pancreas, lung, stomach and breast
What tumor markers lack both specificity and the sensitivity required for the detection of early cancers?
CEA assays
What tumor marker is associated with liver cell cancer and nonseminomatous germ cell tumors of the testis?
Alpha-fetoprotein AFP
T/F
AFP only shows up in nonseminomatous germ cell tumors of the testis
FALSE
AFP can be seen in non-neoplastic conditions such as cirrhosis and hepatitis
Which of these terms appli more to a benign neoplasm than to a malignant one?
1. metastasis
2. well-differentiated
3. expansile
4. invasive
5. slow growth
6. overall rapid growth
7. undifferentiated
8. mitotic figures which are abundant and abnormal
9. mitotic figures which are normal
?
.
Well-differentiated
Expansile
Slow growth
Mitotic figures which are normal
.
Lymphoma
Pleomorphic Adenoma
.
Lung Cancer
.
Cachexia
.
A & C
.
Think that
Rhabdomyoma is correct & Adenocarcinoma is correct
.
All of the above