Usmle: Pathology - Neoplasms

Front 1

Hallmarks of cancer

Back 1

-Evasion of apoptosis
-Growth signal self-sufficiency
-Anti-growth signal insensitivity
-Sustained angiogenesis (VEGF)
-Limitless replication (telomerase)
-Tissue invasion and metastisis (malignant)

Front 2

Carcinoma in situ/preinvasive

Back 2

-Neoplastic cells have not invaded basement membrane
-High nuclear/cytoplasm ratio
-Neoplastic cells encompass entire thickness

Front 3

Cancer invasion

Back 3

-Downregulate e-cadherin
-Invade basement membrane using collagenases and hydrolases (metalloprotinases)

Front 4

Cancer metastasis

Back 4

-Spread to distant organs
-Carcinomas (epithelial cancer) spread via lymphatics (breast cancer and lymphadenopathy)
-Sarcomas (connective tissue cancer) spread via blood vessel

Front 5

Hyperplasia

Back 5

-Increase in number of cells (reversible)

Front 6

Metaplasia

Back 6

-Change in cell type due to stress
-Columnar -> squamous (most common)
-Barett's Esophagus (squamous -> columnar)

Front 7

Dysplasia

Back 7

-Abnormal growth with loss of cellular shape, orientation and size
-Commonly pre-neoplastic
-Reversible

Front 8

Anaplasia

Back 8

-Loss of structural differentiation and function
-Irreversible

Front 9

Neoplasia

Back 9

-Monoclonal proliferation that is uncontrolled and excessive
-Maybe be benign (-oma) or malignant (carcinoma/sarcoma)
-Irreversible

Front 10

Tumor grading

Back 10

-Determined by degree of differentiation and mitotic activity (histologically)

Front 11

Cancer staging

Back 11

-More prognostic value
-Tumor size
-Node involvement (second most important factor)
-Metastasis (most important factor)

Front 12

Types of cancer table (from First Aid)

Back 12

Front 13

Benign tumor characteristics

Back 13

-Well differentiated
-Low mitotic activity
-Well demarcated
-Not metastasis or necrosis

Front 14

Malignant tumor characteristics

Back 14

-May be poorly differentiated
-Erratic growth
-Locally invasive/diffuse
-Ability to metastasize
-Decreased apoptosis

Front 15

Cachexia

Back 15

-Side effect of chronic disease; weight loss, muscle atrophy and fatigue

Front 16

Diseases associated with neoplasms

Back 16

-Aids and Kaposi sarcoma
-Barrett esophagus and Esophageal adenocarcinoma
-Cirrhosis and Hepatocellular carcinoma
-Radiation exposure and Leukemia, thyroid cancer and angiosarcoma
-Xeroderma pigmentosum and Skin cancers

Front 17

Oncogenes and cancer table (from First Aid)

Back 17

-HER2/neu; Breast, ovarian and gastric carcinomas
-RAS; Colon cancer
-bcl-2; Follicular B-cell lymphomas

Front 18

Tumor supressor table (from First Aid)

Back 18

-APC; Colorectal cancer (associated with FAP)
-BRCA1/BRCA2; Breast and ovarian cancer
-DCC; colon cancer
-NF1/NF2; neurofibromatosis 1 and 2
-p53; Most cancers
-RB; retinoblastoma

Front 19

Tumor markers

Back 19

-Example PSA (prostate cancer)
-Shouldn't be used as primary tool for diagnosis, but can be used to monitor response to therapy/recurrence

Front 20

Oncogenic microbes

Back 20

-EBV; Burkitt lymphoma, Hodgkin lymphoma and nasopharyngeal carcinoma
-HBV/HCV; Hepatocellular carcinoma
-HHV-8; Kaposi sarcoma
-HPV; Cervical and penile/anal carcinoma (16,18), head and neck or throat cancer
-H. pylori; Gastric adenocarcinoma (rare/lethal) or MALT (Mucosa-Associated Lymphoid Tissue) lymphoma (common/benign)
-HTLV-1 (Human T-cell Lymphotropic virus); Adult T-cell leukemia/lymphoma
-Schistosoma haematobium; Bladder cancer (squamous cell)

Front 21

Carcinogens table (from First Aid)

Back 21

-Aflatoxins (Aspergillus); Hepatocellular carcinoma
-Arsenic; Skin and lung (in cigarettes) cancer
-Asbestos; Mesothelioma
-Cigarette smoke; Lung,throat, bladder and kidney (toxins are concentrated in urine)
-Ethanol; Hepatocellular carcinoma, oral/throat cancers
-Vinyl chloride; Angiosarcoma

Front 22

Paraneoplastic syndromes

Back 22

-Hypercalcemia with breast cancer
-Cushings (cortisol) with small cell lung carcinoma

Front 23

Cancer epidemiology

Back 23

-Incidence (in order from highest to lowest)
-Male; Prostate, Lung, Colon/rectum
-Femal; Breast, Lung, Colon/rectum
-Mortality (again in high-low order)
-Men; Lung, Prostate
-Women; Lung, Breast

Front 24

Common sites of metastasis

Back 24

-Brain; primary tumor- Lung > breast > genitourinary > bone > melanoma > GI
-Liver; primary tumor- Colon >> stomach > pancreas
-Bone; primary tumor- Prostate, breast > lung > thyroid

Front 25

FAP (Familial Adenomatous Polyposis)

Back 25

-Autosomal dominant mutation of APC gene.
-2-hit hypothesis
-100% progress to colorectal cancer unless colon is resected
-Thousands of polyps arise at young age; pancolonic; always involves rectum.

Front 26

Hereditary Nonpolyposis Colorectal Cancer (HNPCC/Lynch syndrome)

Back 26

-Autosomal dominant mutation of DNA mismatch repair genes
-80% progress to colorectal cancer; proximal colon is always involved

Front 27

Molecular pathways to colorectal cancer

Back 27

-Microsatellite instability (~15%): DNA mismatch repair gene mutation -> sporadic and HNPCC syndrome
-APC/β-catenin (chromsomal instability) (~85%) -> sporadic cancer

Front 28

APC/β-catenin/WNT and cancer

Back 28

-Picture of the pathway