Patho-Module 2 Chapter 9 – Flashcards
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Tumor
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Also called a neoplasm; it is defined as uncontrolled cellular replication.
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Properties of tumor
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It can be either benign (non cancerous) or malignant (cancerous).
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Characteristics of a malignant tumor
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o Grows rapidly o Non encapsulated o Invades local structure and tissues o Poorly differentiated o High mitotic index (divides rapidly) o Can spread distantly through the blood
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Benign Tumor
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* Grows slowly * Well defined capsule * Not invasive * Well differentiated * Slow mitotic index (grows slowly) * Does not metastasize
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Malignant Tumor
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* Grows rapidly * Non encapsulated * Invades local structure and tissues * Poorly differentiated * High mitotic index (divides rapidly * Can spread distantly through the blood
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Benign naming
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Named according to the tissue from which they arise.
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Benign Tumor Examples
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Lipoma: tumor of fat cells
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Malignant Tumor Examples
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Adenocarcinoma: tumor of glandular tissue
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Malignant Naming
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Named according to the cell type of origin.
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* What is cancer in situ?
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o Early pre-invasive stage tumors; three outcomes: * May remain noninvasive * May become invasive * Regress and disappear * Common sites: cervix, breast, oral, skin etc.
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Characteristics of anaplastic cells
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Loss of cellular differentiation
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What are tumor markers? How are they used?
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o Substances produced by benign and cancer cells. These include: hormones, enzymes, genes, antigens, antibodies. o They are not considered definitive diagnostic tests but may suggest a type of tumor. Used for screenings and identifying those at risk.
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Behavioral changes common to cancer cells
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o They can transform from normal to malignant o They don't need growth factors to multiply o Lack contact inhibition (crowd on top of each other) o Immortality (keeps reproducing and living)
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Cells that undergo significant genetic mutations
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Results in cancer
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Proto-oncogenes
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GOOD, normal non malignant cells; accelerates cell proliferation
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Oncogenes
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BAD, mutated genes that do not behave normally, activated in cancer cells, cancers depend on these to survive
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Type of mutations produce oncogenes
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Point mutation Chromosomal Translocation Gene Amplification Tumor suppressors Gene Silencing
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Point Mutation
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Alteration of 1 or a few nucleotides
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Chromosome Translocation
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Large Changes in chromosome
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Gene Amplification
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Duplication of a region of a chromosome over and over
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Tumor Suppressors
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Inactivate genes -Loss of heterozygosity
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Gene Silencing
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Not a mutation; gene just doesn't work
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Tumor Suppressor Genes
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Encodes proteins to negatively regulate proliferation
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Inactivation of Tumor Suppresor Genes
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Chromosomal loss > genetic change > loss of tumor suppressor function
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Effects of Tumor Suppressor Genes
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Results in loss of heterozygosity- can unmask inactivating mutations in recessive tumor suppressor genes
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Gene silencing
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Occurs during cell division and does not mutate the DNA, whole regions of chromosomes are "shut off."
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Effects of gene silencing
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Changes in gene silencing contributes to cancer, can shut off tumor suppressor genes, and can contribute to the expression of oncogenes
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Role of Caretaker Genes
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Maintain the DNA ; encode proteins that are involved in repairing damaged DNA
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The result of chromosomal instability in relationship to cancer cells
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Loss of heterozygosity- can unmask inactivating mutations in recessive tumor suppressor genes
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Germline Cancer Cells
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Inherited DNA mutations, located in testes and ovaries
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Somatic Cancer Cells
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Body cells mutations to DNA happen during one's lifetime
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The alterations in growth signals associated with cancer
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o Autocrine stimulation- Cancer secretes its own growth factor disables apoptosis o Increased growth factor receptors o Growth signal mutations- inactivation of tumor suppressor RB o Angiogenesis
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* How do cancer cells use angiogenic growth factors?
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Once a tumor gets to a certain size it needs its own blood supply; they secrete multiple factors (VEGF and PDGF) that stimulate new blood vessel growth
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What is the effect of angiogenesis on cancer cells?
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Allows the cancer to receive blood and continue to grow
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The function of telomerase and telomere caps
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Keeps cell from dividing infinitely
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Function of telomerase and telomere caps in cancer cells
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Protects telomere found in germ cells; cancer cells keep telomerase alive in somatic cells which allow for unlimited division
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Cancer metabolism
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Needs large amounts of glucose, they often grow in hypoxic and acidic environments
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How does chronic inflammation increase the risk for cancer?
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Inflammatory cells migrate to the site of injury and release cytokines and growth/survival factors that stimulate cell proliferation, in addition inflammatory cells release compounds such as reactive oxygen species which can promote mutations and block the cellular response to DNA damage
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Chronic Inflammation (cancer risk)
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Examples: Ulcerative colitis, Hep B and C
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Viruses associated with cancer
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Hep B and C HPV Epstein Barr Kaposi HIV Human T Cell Leukemia
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Hep B and C
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Chronic inflammation
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HPV
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Viral DNA becomes accidentally integrated into the genomic basal cell of the cervix
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Epstein Barr
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Stimulates B cell lymphoma
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Kaposi
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Sarcoma herpes virus
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HIV
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severe rare lymphomas
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Human T Cell Leukemia
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Lymphoma virus
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Bacterial causes of cancer
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Helicobacter pylori
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H. Pylori
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Most common cause of gastric infections; causes most peptic ulcers, gastric lymphomas, and gastric carcinomas
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Metastasis
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Spread of cancer cells to distant tissues and organs; one of the defining characteristics of malignant cancer
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Local Invasion
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Invades surrounding tissue
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Distant metastasis
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invades bloodstream and lymph tissue
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Spread of Cancer
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Invades local tissue à invades the lymph à enters the blood stream à invades other body parts
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Factors that increase the cancer cell's ability to metastasize
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o Gene mutations o Deletions o Translocations o Gene silencing o RNA changes
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Stage 1
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Confine to organ of origin
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Stage 2
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Locally invasive
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Stage 3
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Regional Structures Involved; lymph nodes
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Stage 4
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Spread to distant sites
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TNM Staging
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Tumor Spread Node Involvement Metastasis
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What are paraneoplastic syndromes? What are examples of this disorder?
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o Triggered by cancer but not explained by local tumor effects; caused by biological substances (cytokines), immune response o Tumor secreting serotonin o Antibody response attacks nervous system
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Pain associated with cancer
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Results from direct pressure, obstruction, invasion of a sensitive structure, stretching of visceral surfaces, tissue destruction, infection, and inflammation
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Goal of Pain Control
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To control pain rapidly and completely
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Most frequently reported symptom of cancer and cancer treatment
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fatigue
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Suggested causes of fatigue associated with cancer
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Sleep disturbances, level of activity, nutritional status, other environmental and physical factors
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Cachexia
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Overproduction of cytokines
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Symptoms associated with cachexia
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Wasting emaciation, anemia, altered taste, weakness, early satiety
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Causes the anemia associated with cancer
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In cancer erythropoietin is suppressed
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The role of erythropoietin
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Erythropoietin is produced in the kidneys, it stimulate the bone marrow which produces RBC's,
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Causes the leukopenia and thrombocytopenia associated with cancer
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Direct tumor invasion of the bone marrow causes both leukopenia and thrombocytopenia
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What is the most significant complication and cause of death associated with cancer?
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INFECTION
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What are the causes of infection associated with cancer?
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Low WBC count, immunosuppression, surgery, poor tissue perfusion
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What effect does cancer have on the GI system?
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o Ineffective mucosal barrier o Stomatitis, vomiting, diarrhea
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What effect does chemotherapy have on hair and skin?
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o Hair- alopecia o Skin- decreased renewal rates of cells; erythema due to radiation
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Chemotherapy
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Chemicals used to take advantage of cancer cell vulnerabilities
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Radiation therapy
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Eradicate cancer without producing toxicity, avoids damage to normal structures, used to treat localized cancers
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Surgical therapy
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Removal of tumors, symptom relief
