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Tumor

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A growth of tissue caused the uncontrolled replication of cells.

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Neoplasm

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New tumor growth that can be benign or malignant.

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Benign tumors

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They are not called cancers. They are well-emcapsulated, well differentiated, retain normal tissue structure, and do not invade the capsule, nor do they spread to regional lymph nodes or distant location.

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Malignant tumors

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Grow more rapidly then benign tumors. have specific microscopic alterations which include loss of differentiation, absense of normal tissue organization, lack of a capsule, invasion into blood vessels, lymphatics, and surrounding structures, and distant spread (metastasis).

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Adenocarcinoma

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A cancer that arises from ductal or glandular epithelium. Ex. a malignant tumor arising from breast glandular tissue is called mammary adenocarcinoma.

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Anaplasia

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Without form. It is recognized by a marked increase in nuclear size, with evidence of ongoing proliferation such as mitotic figures. The increased amount of anaplasiac cells we see, is related to increased malignancy.

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Angiogenesis

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New blood vessel growth. Occurs in the embryo and fetal development, and tumor growth.

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Angiogenic Factors

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Advanced cancers are able to secrete factors that will stimulate new blood vessel growth. Ex. Vascular endothelial growth factor.

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Apoptosis

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Programmed cell death.

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Autocrine stimulation

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Cancers acquire the ability to secrete and respond to their own growth factors.

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Autonomy

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This refers to the cancer cell's independence from normal cellular controls.

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Cancer

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Any malignant growth or tumor caused by abnormal and uncontrolled cell division.

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Carcinoma

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Cancers arising in epithelial tissue.

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Carcinoma in Situ (CIS)

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Preinvasive epithelial tumors of glandular or squamous cell origin. Can be found in cervix, skin, oral cavity, esophagus, and bronchus. A pap smear can pick up CIS in the cervix.

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Caretaker gene

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Genes that are responsible for maintenance of genomic activity. They encode proteins that are involved in repairing damaged DNA. Mutations can be caused by UV rays.

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Chromosome amplification

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A genetic abnormality that turns on oncogenes. They are the result of duplication of a small piece of a chromosome over and over again. Results in increased expression of oncogenes and in some cases, drug resistant genes.

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Chromosome instability

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This increases in malignant cells. Results in a high rate of chromosome loss.

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Human T cell leukemia-lymphoma virus (HTLV)

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An oncogenic retrovirus linked to the development of adult T cell leukemia and lymphoma (ATLL). Inherited vertically (by children from infected parents) and horizontally (breast-feeding, sexual intercourse, etc.

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Leukemia

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Cancers of blood-forming cells.

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Local spread

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A prerequiste for metastasis and the first step in the metastic process. In its earliest stages it is a function of direct tumor extension.

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Loss of heterozygosity (LOH)

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Loss of a region on one chromosome that corresponds to a mutated region on the other chromosome; loss of the same loci on both chromosome inactivates the affected gene.

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Lymphoma

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Cancers of the lymphatic tissue.

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Metastasis

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The spread of cancer cells from the site of the original tumor to distant organs and tissues throughout the body.

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Oncogene

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Mutant genes that in their normal nonmutant state direct synthesis of proteins that positively regulate (accelerate) proliferation. They have a dominant effect because only one of the cell's two copies has mutated. This leads to unregulated growth.

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Sarcoma

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Cancers arising from connective tissues. Ex. Malignant cancers of skeletal muscle are termed rhabdomyosarcomas.

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Telomerase

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An enzyme that catalyzes the lengthening of telomeres. The enzyme includes a molecule of RNA that serves as a template for new telomere segments.

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Telomere

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Protective cap made of DNA that is found on the ends of a chromosome. They shorten after each cell division cycle and need to be restored by telomerase. When non-germ cells begin to proliferate abnormally, their telomere caps become shorter with each cell division.

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Tumor marker

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Biologic markers. Substances found on tumor plasma membranes or in blood, spinal fluid, or urine. Can be use to 1.) screen and identify individuals at high risk for cancer, 2.) help diagnose the specific type of tumor for individuals with clinical manifestations relalting to cancer, as in adrenal tumors, and 3.) follow the clinical course of cancer.

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Tumor suppressor genes

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Genes which code for proteins that suppress tumor formation by applying brakes on cell proliferation. (mutation that creates a deficiency would contribute to carcinogenesis). Both of the cell's two genes must be defective to lead to abnormal cell division. Inactivation occurs by loss of function, mutation, and LOH.

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Charactersitics of Benign tumors

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They grow slowly. They are microscopically well-differentiated with a low mitotic index (Low mobility). They are well-differentiated; looks like the tissue from which it arose. They have a well-defined capsule. They are not invasive. They do not metastasize. THESE WILL BE ON THE TEST!!

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Characteristics of Malignant tumors

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They grow rapidly. They are anaplastic (without form) and have a high mitotic index (High mobility). They are poorly differentiated; does not look like the tissue from which it arose. They are not encapsulated. They invade local structures and tissues. They spread distantly through the bloodstream and the lymphatics. THESE WILL BE ON THE TEST!!!

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Examples of benign tumors

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Lipoma- fatty tumor Gliosis- intercranial Leiomyoma- uterine (smooth muscle) Chondroma- cartilage

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Examples of malignant tumors

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Liposarcoma- fat Glioma- intercranial Leiomyosarcoma- Uterine (smooth muscle) Chondrosarcoma- cartilage

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Pleomorphic

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Variable size and shape. Example; anaplastic cells are of variable size and shape.

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Know Cancer Staging.

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Stage 1- Cancer is confined to the organ of origin. (Local spread) Stage 2- Cancer is locally invasive. Stage 3- Cancer has spread to regional structures such as lymph nodes. Stage 4- Cancer has spread to distant sites, such as liver cancer spreading to the lungs, or prostate cancer spreading to the bones.

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A woman is admitted to the ER. Blood and urine tests indicate raised levels of catecholamines (epinephrine and related compounds). What cancer could this be an indication of and why?

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The cancer could be Pheochromocytoma (cancer of the adrenal medulla). The presence of increased amounts of epinephrine is a tumor marker for this condition.

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A 55 year old man goes in for a routine exam. A routine blood test indicates high levels of PSA (prostate specific antigen) in the blood. What could this indicate?

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Prostate cancer. PSA is a tumor marker for this condtion.

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The presence of the tumor marker CEA (Carcinoembryonic antigen) indicates what cancers?

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Colon, liver, pancreas, lung, breast, ovarian.

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Liver and germ cells secrete what protein?

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alpha Fetoprotein. This is a tumor marker for hepatic and germ cell cancers.

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What would falling PSA levels after treatment for prostate cancer indicate?

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Falling PSA levels would indicate that the treatment is working.

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Clonal Proliferation or Clonal Expansion

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A result of mutations. A cell will acquire chracteristics that will allow it to have an advantage over neighboring cells. The more proliferation there is, the higher risk of cancer.

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Describe the p53 gene.

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A tumor suppressor gene that 1)attempts to repair DNA damages or 2) stops the cell cycle, or 3)initiates apoptosis. Defects in this gene may be inherited or are caused by exposure to carcinogens. Loss of this gene may facilitate angiogenesis and resistence to apoptosis.

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Describe the Rb gene

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This is a tumor suppressor gene (retinoblastoma gene). It is responsible for pRB protein. If a mutation causes lack of this protein, the cell will be constantly in the "on" position. Mutations in this gene have been ID'd in a number of cancers including bone, bladder, some lung, and some breast cancers.

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Proto-oncogene

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These are the regulators of normal cell process; growth promoting; mutations activate them to function as oncogenes (tumor producing genes). They are normal.

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Point mutation

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The most common cause of genetic lesions in cancer. Usually seen in pancreatic and colorectal cancers. They are changes in one or a few nucleotide base pairs. A point mutation is ras converts it from a regulated proto-oncogene to an unregulated oncogene, accelerating cellular proliferation.

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What are some of the viruses that are implicated in cancers?

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Hepatitis B & C (liver cancer). Epstein Barr Virus-EBV (Bcell lymphoma). Kaposi Sarcoma Herpesvirus- KSHV (side effect of HIV/AIDS). Human papillomavirus-HPV (Cervical cancers). Human T cell leukemia-lymphoma virus-HTLV (Tcell leukemia and lymphoma) These all can be passed on either vertically or horizontally.

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What is a bacteria that infects more than half of the world's population?

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H. Pylori. It is a common cause of gastric infection and is implicated in peptic ulcer disease, gastric lymphomas, and gastric carcinomas.

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MALTomas

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Tumors that arise mucous associated lymphoid tissues. H. Pylori is the main culprit.

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Mechanisms of local spread

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1. Cellular proliferation or multiplication. (mitotic rate vs. cellular death rate. 2. Angiogenesis and perhaps lyphogenesis. (Increased pressure) 3. Digestion of capsules and other structural barriers. (release of lytic enzymes) 4. Changes in cell-to-cell adhesion (loss of fibronectin making cancer cells slippery). 5. Increased motility of individual tumor cells.

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Phases of tumor spread

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1. Transformation 2. Growth 3. Local Invasion 4. Distant Metastesis

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Dissemination

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Movement of cancerous cells in the blood or through the lymphs.

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What is the most common mode of spread in metastasis?

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The lymphatic system. Example: Colorectal cancer will spread to the liver through the mesentaric lymphatics.

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What is the significance of capillary beds and metastasis?

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Metastasis often occurs in the first capillary bed that the circulating cells encounter.

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Organ Tropism

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Preferential growth of cancerous cells in certain organs. The right cancer "seed" and the right "soil" or tissue.

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Carcinogen

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Cancer causing agents

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What is the biggest risk factor for cancer?

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Smoking. Smoking has a multipotent carcinogenic mixture. It has been linked to cancers of the lung, lower urinary tract, aerodigestive tract (rectal and anal), liver, cervical, kidney, pancreas, as well as myeloid leukemia.

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Bystander effects

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Chromosomal abberations and mutations that exist in not only the clonal progeny of the irraiated cells, but also in other cells (nonclonal) that were not directly radiated.

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Ultra violet radiation causes what type of cancer?

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Basal cell carcinoma. At risk are light-skinned, fair haired, blue-eyed people. The majority of damage happens in our teen years.

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Xenobiotics

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Foreign compounds that are not part of our core metabolism. These include toxic, mutagenic, and carcinogenci compounds. Can be counteracted by detoxification enzymes and antioxidant systems.

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Phase 1 activation enzymes

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Enzymes that activate xenobiotics.

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How does obesity correlate with cancer?

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Adipose tissue releases free fatty acids. Free fatty acids give rise to insulin resistance and cause chronic hyperinsulemia. Correlates with colon, breast, endometrial, and pancreatic cancers.

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Alcohol increases risks for what types of cancers?

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Oral cavity, pharynx, hypopharynx, larynx, liver, and esophageal cancers. Alcohol alters the mucosal integrity of the GI tract.

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The risk factor that contributes to mesothelioma

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Asbestos

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Radon

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A natural radioactive gas derived from the radioactive decay of uranium that is ubiquitous in rock and soil. Can cause lung cancers. Small cell carcinoma occurs in miners.

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Cachexia

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A condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with diseases such as advanced cancer. Includes anorexia, early satiety, weight loss, altered lipid carb metabolism, asthenia (tingling), taste alterations, etc.

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What is the goal of chemotherapy?

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The goal is to eliminate enough cancer cells so that the body's defense can eradicate any remaining cancer cells. CURATIVE!!!

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Adjuvant therapy

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Used after the primary treatments (surgery) have been completed to decrease the chance that a cancer will recur. Ex. A melanoma is removed and then chemo or radiation follows.

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Are benign tumors removed?

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Yes. An example is colon polyps. These may be benign, but they could turn cancerous later.

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Biologic Response Modifiers (BRM's)

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Substances produced by normal cells that block tumor growth or stimulate the immune system to fight cancer.

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Stomatitis

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Inflammation of the mucous membrane of the mouth. Can be caused by chemo and radiation.

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Alopecia

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Loss of hair.

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