clinical medicine

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Author:
mdeguzman7
ID:
142867
Filename:
clinical medicine
Updated:
2012-03-21 18:19:43
Tags:
neoplasm oncology cancer
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Description:
clin med alterations in cell differentiation - Neoplasm oncology cancer
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  1. What is Neoplasia?
    • aka TUMOR or swelling or ONCOS
    • persistent abnormal growth of tissue
    • exceeds and uncoordinated with growth of surrounding normal tissues
    • cells have ability to replicate in absence of growth factor controls
    • offspring of new mass of cells have no useful fx
  2. What makes tumors simlar to organs?
    • they have parenchyma (fx) and stroma (support)
    • they look similar to cells from originating parent organ
    • they perform some of fxs that parent organ perform
  3. What makes tumors different from organs?
    • Do not contribute to homeostsis
    • grow rapidly than surrounding tissue
    • some beingn tumors and all malignant tumors never cease to grow
    • most tumors show some derangement of histologic architecture
  4. What are the characteristics of a benign tumor?
    • BENIGN - --- OMA , adenoma, chondroma "good tumor"
    • 1. cell resembes normal cells and tumor architecture resembles that of parent organ
    • 2. are usually spherical and compbress surrounding tissue
    • 3. grow slowly
    • d. never metastasize outside the parent tissue
  5. Are all benign tumors good?
    Not necessarily. some can still be very dangerous --> "MALIGNANT BY LOCATION"

    • 1. pituitary adenomas - crush normal putuitary gland an optic nerves
    • 2. carniopharyngiomas - destroy the hypothalamus
    • 3. meningiomas - compress the brain
  6. What are the characteristics of malignant tumors?
    • MALIGNANT --carcinomal (epithelial origin) or --sarcoma (mesynchymal)
    • Grow rapidly vs benign
    • differ morphologically and functionally
    • tumor architecture less organized than parent
    • tumors are locally invasive/destructive (grow into surrounding tissue)
    • tumor will metastasize to site remote from origin (EXCEPT basal cell carcinoma and gliomas)
    • resemblance to parent cells determine tumor's aggresiveness
  7. I-V Tumor gradings (by pathologist)
    • grade I = well (similar) differentiated -> normal
    • grade II = not so well differntiated
    • grade III = worse than grade II --> anaplastic
    • grade IV = poor - differentiated --> anaplastic (no recognizability0
    • grade V = not differentiated --> anaplastic (no resemblance)
  8. Tumor stages: (by oncologist) based on tumor SPREAD
    • Stage I: Tumor is < 1 cm diamter WITHOUT metastases
    • Stage II: Tumor is > 1 cm diameter but WITH metastases to REGIONAL lymph nodes
    • Stage III: Tumor has infiltrated a deep tissue structure WITH DISTANT metastases
  9. CLINICAL STAGING by TNM system
    T- Tumor
    N- Lymph Nodes
    M- Metastases
    • T (1-3)
    • T1 - tumor < 1cm
    • T2 - tumor > 1cm
    • T3 - tumor invades non-resectable structure
    • ======
    • N (0-2)
    • N0 - no tumor in regional lymph nodes
    • N1 - tumor is in a nearby lymph node
    • N2 - tumor is in a distant/far lymph node
    • ======
    • M (0-1)
    • M0 - no distant metastases
    • M1 - distant metastases
  10. What is the microscopic appearance and histologic diagnosis of malignancy?
    • Big Nucleus (more dna) : less cytoplasm ratio
    • wrinkled edges
    • Numerous, bizarre mitosis lasting longer than normal tissue
    • various sizes of cells w/ loss of orientation to one another
    • Possibly a mitotic figure? seen in center of malignant neoplasm
  11. What are the means of Malignant Tumor invasion?
    • 1. Local infiltration: intra epithelial spread - early cancers replaced by layer of malignant tumor that DOES NOT PENETRATE Basement Membrane
    • eg Carcinoma in situ

    • 2. Metastatic spread: transfer of malignant cells from one place to a non connected site.
    • -->1st penetrates BM then also through surrounding Extracellular environment
    • --> then via Lymphatics (if epithelial origin aka Carcinoma)
    • --> then via Blood Vessels (if mesenchymal origin aka Sarcoma)
  12. What are the 3 classes of carcinogenic agents?
    • chemicals
    • physical agents (e.g. radiation, asbestos...)
    • oncogenic viruses
  13. Chemical carcinogen characteristics:
    • 1. diverse in structure: synthetic or natural
    • 2. derect-relating (no chemical conversion) or Indirect reacting (nee metabolic conversion)
    • 3. they are highly reactive electrophils that react with electron rich atoms in DNA - mutagens
    • 4. they might need promoters to help express carcinogenicity
  14. What is chemical carcinogenesis the probable result of?
    • 1. initiation - irreversible, usually not detectable
    • 2. promotion - action of the 2nd agents that without, they have little cancerous acitivity
  15. What are some of the most potent chemical carcinogens that are INDIRECT?
    • 1.polycyclic H-carbons - coal, tar origins - eg smoke
    • 2. aromatic amines and AZO dyes - aniline dye and rubber industry exposure --> bladder and liver tumors
    • 3. nitrosamines - nitrates, food preservatives convert to nitrosamines, blamed for certain liver cancer
    • 4. metals - like nickel, chromium, cobalt from occupational setting
    • 5. saccharines and cyclamates - artifiicial sweeteners if used in extremely large doses
  16. What are the physical carcinogens?
    • 1. Radiation - (uv, xray, radionuclides)
    • has mutagenic effects --> chromosome breakage, translocation and point mutations.
    • eg SUN

    2. Asbestos - can be cheimical and physical (inhalation) is associated with malignant mesothelioma
  17. What are the viral etiologies of cancer?
    • 1. RNA Retrovirus --> T cell leukemia and lymphoma
    • 2. DNA HPV --> carcinoma of the cervix
    • 3. DNA Hep B --> Hepatocellular carcinoma
    • 4. DNA Epstein-Barr Vbirus --> lymphoma and naso pharyngeal carcinoma
  18. What are some of the symptoms caused by malignant tumors?
    • cachexia
    • fever (common in Hodgkins)
    • hematologic syndromes (
    • endocrine syndromes
    • neurologic syndromes (SC, and peripheral nerves)
    • ---> subacute motor nueropathy lower motor weakness presents without sensory (ALS, etc)
    • ---> sensor motor peripheral neuroapthy - distal weakness and sensory loss (dg changes in dorsal root ganglia)

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