PATHOLOGY_WEEK_3 – Flashcards
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What is the 2nd leading cause of death? 23%
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Cancer
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What are the 3 leading causes of male cancer incidence?
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1. prostate 2. lung and bronchus 3. colon and rectum
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What are the 3 leading causes of female cancer incidence?
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1. breast 2. lung and bronchus 3. colon and rectum
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Define: Neoplasia
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"New Growth"
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Define: Tumor
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Swelling or Mass
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What is 'cancer' in latin?
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"Crab" -grabs on and won't let go
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"-oma" is the suffix denoting what?
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a benign tumor
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Define: carcinoma
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A malignant tumor arising from an epithelial cell
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Define: sarcoma
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A malignant tumor arising from a stromal or mesenchymal tissue (soft tissue) -MESODERMALLY DERIVED
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Define: lymphoma
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A malignant tumor arising from lymphoid tissue
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Define: Leukemia
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A malignant WBC tumor arising in the bone marrow
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What is desmoplasia?
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A fibrous tissue response to a tumor
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What is an adenoma?
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A benign epithelial neoplasm composed of glandular tissue
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What is a papilloma?
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A benign epithelial neoplasm that has 'finger like projections'
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What is a polyp?
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A mucosal elevation which may have a stalk i.e. wart = skin polyp
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What is a teratoma?
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Neoplasm made up of tissues from more than one germ cell layer -Ovary ; Testes
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What is a choristoma?
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An ectopic rest of normal tissue in an abnormal place -thyroid tissue in ovary or testes
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What is a hamartoma?
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A malformation of tissue in an organ which is indigenous to that organ i.e. lung
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What is an abnormal mass that grows in an uncontrolled and uncoordinated manor?
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neoplasia
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What is a benign tumor?
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characterized by slow local expansie growth
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What is a malignant tumor?
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More aggressive than a benign tumor. -autonomous proliferation of cell that acts like a parasite -outcompete the host for nutrients -capable of spreading
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What are monoclonic tumors?
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1 single cell that turns into a tumor
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What are polyclonic tumors?
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Many cells mutating into a tumor
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What is ALWAYS seen in cancer?
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DNA mutation
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What is a 'normal' cell cycle
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Balance between cell growth and cell loss
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5 phases of cell replication
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G1: interphase -cell is committed to divide G0: Prolonged interphase when cell is NOT committed to divide S: DNA replication G2: period between DNA replication and mitosis M: mitotic phase
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What are the 5 steps of evolution of a cancer?
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1. normal cell 2. malignant transformation -"mutation" 3. local growth of tumor cells 4. local incasion 5. distant metasteses
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Malignant transformation of a tumor
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May be congenital or acquired -For a malignant transformation to occur usually 2 or more mutations are required
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What does the DNA mutation alter in a normal cell?
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uncoordinated cell proliferation
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Protooncogenes
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Increase in # of cells -normal genes that regulate cell growth and differentiation - skin, GI, etc. -constantly producted *Can mutate into an oncogene
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Oncogene
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Factors associated with gene expression -Genes that cause a malignant transformation of a cell -cause inappropriate cellular proliferation -growth promotion
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Anti-Oncogenes
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Decrease in cell production Tumor suppressor genes! -Inhibit cell growth -Associated w/ programmed cell death -If a mutation occurs in an anti-oncogene: regulation can be inactivated -->increase in production of cells
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Apoptosis
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Programmed cell death
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After how many 'doublings' of a cell, can the tumor become detected
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30 1 gm
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After ___#_____ doublings, the tumor is 1000gm
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40
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Tumor Heterogenaety
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Many different kinds of mutation Many capabilities of a tumor -allows tumor to evolve and survive in host!! BAD
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The original cell or 'clone' after 30 doublings has the opportunity to undergo additional mutations resulting in multiple __________
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Subclones
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TRUE/FALSE Each subclone has the same biologic behavior
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FALSE
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TRUE/FALSE Subclones can develop abilities to secrete growth factors, invasive potential and resistance to chemo
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TRUE
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Why does early detection have an impact on cancer progression?
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The earlier the detection: the fewer the subclones, the greater the likelihood of successful treatment
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What are the 3 requirements for a growing tumor?
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1. Vascular supply -within 1-2mm of a blood vessel 2. Tumors can produce angiogenesis factors that stimulate capillary proliferation 3. Hormonal stimulation and growth factors
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TRUE/FALSE Tumors can produce their own growth factors
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TRUE Autocrine or paracrine
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What are some mechanisms of invasion and metastasis?
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transformation clonal expansion and diversification adhesion and invasion of basement membrane migration through Extracellular matrix (collagen) Vascular invasion tumor embolus adhesion to endothelium through basement membrane growth at new site
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Why have grading and staging systems been developed?
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Establish 'standards or benchmarks' for cancers
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What can provide prognostic indicators as to the behavior of cancers and assist in determining best course of treatment?
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Grading and staging system
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"the level of differentiation" of cancer
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GRADING -scoring how aggressive
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"Extent of spread of tumor"
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STAGING -local invasion, size, lymph nodes, metastasis
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What grading system do you use for the prostate?
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Gleason grading
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What grading system do you use for melanomas?
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Clarks system: breslow system
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Grading system for endometrial cancers?
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FIGO system
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What grading system would you use for bladder cancers?
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Grade I-III
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AJCC staging categories
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TNM T1-T4 : size of primary tumor N1-N3 : degree of node involvement M0-M1 : presence of distant metastasis
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How does cancer actually kill you?
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Take over of cellular function -->organ failure
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How do clinical symptoms of neoplasia usually present?
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Compromise of primary organ or involvement or compression of surrounding tissue
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Bone marrow neoplasia complications
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Involvement by leukemia or metastasis reduces hematopoeisis and leads to anemia, infectious and abnormal bleeding -not producing RBC/WBC in that bone i.e. prostrate and breast cancer
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Lung Cancer neoplasia complications
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Either primary or metastasis -compromise oxygen exchange and obstruction airways and blood flow leading to coughing infections and hypoxia -Increase fluid, decreased exchange of gas
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Bone Lesion complications
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Primary or metastatic can cause pathologic fractures
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Liver neoplasia complications
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Function is compromised when hepatic parenchyma is destroyed by a growing tumor
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Colon neoplasia complications
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Colon cancer can cause and obstruction, perforation or blood loss
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Cachexia
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Metaboloic disorder -wasting of the body due to lack of nutrition and shifted metabolic demands
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Neurologic symptoms of neoplasia
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Pain when involving or compressing surrounding nerves -loss of function -headache (intracranial tumor)
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Epithelial neoplasia nomenclature
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squamous papilloma v. squamous cell carcinoma Adenoma v. adenocarcinoma Transitional cell papilloma v. papillary transitional cell carcinoma
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Mesenchymal/soft tissue neoplasia Nomenclature
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Lipoma v liposarcoma leiomyoma v leiomyosarcoma lymphangioma v lymphangiosarcoma
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Teratoma/mixed tumor nomenclature
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Mature teratoma (dermoid cyst) v. Immature teratoma (malignant) Pleomorphic adenoma v. malignant mixed tumor
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What are the 2 types of malignant WBC neoplasms
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Leukemia and lymphoma
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What are the 4 types of leukemia?
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1. AML -acute myelogenous leukemia 2. ALL -acute lymphocytic leukemia 3. CLL -Crhonic lymphocytic leukemia 4. CML -chronic myelogenous leukemia
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What are the 2 categories of lymphomas?
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Hodgkins lymphomas Non-Hodgkins lymphomas
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4 Types of hodgkins lymphomas
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1 nodular sclerosing 2. lymphocyte predominantly 3. lymphocyte depleted 4. mixed cellularity
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Describe benign neoplasia
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Local growth/slow Well circumscribed ; encapsulated Good plane of dissection (easily dissected) Follows a benign course -problems: compression of surrounding tissue Can become malignant
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Describe malignant neoplasia
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Grows by invading ; destroying surrounding normal tissue Growth is rapid Poorly defined borders -harder to take out Sometimes encapsulated Capable of spreading beyond primary site ; growth @ secondary site Follows an aggresive and deadly course
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Malignant lesion
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Tumor has NOT invaded basement layer Carcinoma in situe (CIS) Primary (where it starts) Secondary (where it ends)
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How does cancer spread?
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Direct spread of local structures/organs Lymphatic spread Hematogenous spread
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How does a malignant lesion spread 'directly'?
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1.Tumors arising in peritonea cavity -seeing of peritoneeal surfaces by malignant cell 'dropping off' the source 2. pleural cavity common place for direct seeding fo tumors -i.e. ovary and surrounding tissue
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How does a malignant lesion spread through lymphatic system?
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Lymph nodes commonly involved in carcinoma -Primary drainage site of organ
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Why are lymph nodes the 1st thing to be involved in cancer spread?
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Primary drainage site of organ
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Breast cancer's spreading through lymphatic system
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Arise in upper/lateral quadrant: axillary nodes Medial quadrants: infra/supra clavicular nodes
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Prostate involved lymph nodes
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Pelvic or inguinal lymph nodes
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Lung lymph node involvement
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Perihilar and mediastinal lymph nodes
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Head and neck cancer lymph node involvement
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Radial neck nodes
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Malignant lesions hematogenous spread
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Venous system **anything accepting venous blood can be metastized -liver and lungs are common Arterial system **distal to the heart, has to go by heart and lungs -important to ID vascular or lymphatic structures around lesion
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Clinical test for neoplasia?
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Tumor markers palpable lesions obstruction in colon neurologic symptoms imaging studies cytogenic abnormalities biopsy abnormal PAP
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PSA tests for what kind of cancer?
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Prostate
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How are metastatic tumors named?
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After the original site
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What % of carcinomas are epithelial based?
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80-90%
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How does cancer spread?
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Direct contact, through blood (hematogenous) or lymph...
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TRUE/FALSE Subclones can develop abilities to secrete growth factors, invasive potential and resistance to chemo
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TRUE
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After how many 'doublings' of a cell, can the tumor become detected
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30 1 gm
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What is ALWAYS seen in cancer?
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DNA mutation
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What is an adenoma?
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Neoplasm of glandular tissue. cancer of small and large bowels
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What is the 2nd leading cause of death? 23%
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Cancer
