Patho unit 2 ch 9

The flashcards below were created by user jnikrap on FreezingBlue Flashcards.

  1. Neoplasm (Tumor)
    New and abnormal development of cells that are unresponsive to normal growth control mechanisms
  2. What are the two types of neoplasms?
    • Benign tumor: Cells do not invade the surrounding tissue
    • Malignant tumor: They invade the surrounding tissues and they have the ability to travel to, and proliferate at distant sites (metastasis)
  3. Benign Neoplasms
    • Slow growth
    • Encapsulated
    • Non-invasive
    • Well differentiated
    • Low mitotic rate
    • Do not metastasize
  4. Malignant Neoplasms
    • Rapid Growth
    • Non-encapsulated 
    • Invade local structures and tissues
    • Poorly differentiated
    • High mitotic rate
    • Metastasize
  5. Examples of Malignant neoplasms
    • Carcinomas: Epithelial tissue-Adenocarcinoma, squamous cell carcinoma
    • Sarcomas: Connective tissue-Chondrosarcoma, osteosarcoma
    • Lymphosarcomas: Lymphatic tissue
    • Retinoblastoma and neuroblastoma
  6. Carcinoma in situ (CIS):
    Stage 0
    • Pre-invasive epithelial malignant tumors
    • The neoplasm is localized in the epithelium and has not broken through the basement membrane and invaded surrounding tissue
  7. Transformation
    • Process by which a normal cell becomes a cancer cell (malignant growth)
    • Not a single event
  8. Anaplasia
    • Loss of differentiation (de-differentiation) immature cells 
    • Loss of organization
  9. Histological  Features of Cancer Cells
    • Bizarre Nuclei: Cells don't go through normal cell division, or are rapidly dividing
    • Bizarre cell shape and size
    • Invasion of the basement membrane
    • De-differentiation: i.e. more like embryonic cells
    • Cellular or extracellular accumulations: e.g. "mucus lakes" in lung cancer
    • Necrotic debris
  10. Abnormal Gene Expression in Cancer Cells
    • Turn in genes which :
    • guide the cell through the cell cycle/cell division (violate checkpoints)
    • Bring blood vessels to the cell (angiogenesis)
    • Helps the cancer cell move to places it doesn't belong 
    •   -dissolve connective tissue barriers
    •   -move into and out of blood vessels
    • Collectively, these are called oncogenes ("cancer genes")
  11. Tumor cell Markers (TCM)
    • Biological markers produced by cancer cells:
    •   -Any kind of cellular product could be a tumor marker- Hormones, antibodies, enzymes
    •   An antigen found on a cancer cell membrane-Tumor specific antigen
    • An alteration of the genes or chromosomes in the nucleus
  12. Tumor marker examples:
    • "Ectopic" hormone production is the production of hormones by tumors of non-endocrine origin
    • ACTH, HCG, HGH, thyroid-stimulating hormone, epinephrine and norepinephrine from the adrenal medulla
  13. Tumor Marker Examples:
    • Cancers do not produce new or unique enzymes; instead we find the abnormal levels of normal enzymes
    • Usually only detected in the blood when the tumor is very large or metastasis has occurred
  14. Tumor Marker Examples:
    produced by some cancers (e.g. multiple myoloma)
  15. Tumor Marker Examples:
    Tumor-specific antigens (TSA's)
    • cancer cells express "non-self" antigens
    • These TSA's "fly" like a flag
    •   -Markers from the surface of their cell membranes
  16. Tumor Marker Examples:
    Viral Tumor-specific antigens
    produced and expressed by virally-transformed cells
  17. Tumor Marker Examples:
    Oncofetal Tumor-Specific antigens
    Expressed by cells during embryonic development but are absent or low in normal adult cells
  18. Tumor Marker Examples:
    Protein Tumor-specific Antigens
    • Function in proliferation, enzymatic processes, as receptors, and cellular structures 
    •   -Prostate-specific antigen (PSA)
    •   -PSA is a glycoprotein produced by the prostate whose values are related to prostate mass
    •   -it is therefore a tumor cell marker ( TCM) used as a screening test for prostate cancer.
  19. Paraneoplastic Syndromes
    • Signs and symptoms unrelated to the local effects/presence of the neoplasm
    • Caused by substances released from the tumor or an immune response to the tumor
    • Examples:
    •   -Hypercalcemia in breast and renal carcinomas from PTH-related protein
    •   -
  20. Anchorage-independence
    • Ability to mitotically divide without being bound to other cells 
    • continued growth even when unattached from orriginal tissue
  21. Autonomy
    • The cancer cells independence from normal cellular controls 
    • Cell cycle control, repair, cell growth, differentiation factors, and growth factor receptors
  22. Proto-oncogenes
    Unaltered, normal healthy alleles of genes that control/regulate cellular growth and differentiation
  23. Oncogene
    is a proto-oncogene that has been altered (mutated) by carcinogenic agent
  24. Tumor-suppressor genes (anti-oncogenes)
    • Encode for proteins that inhibit cell division
    • Cancer can occur due to the activation of oncogenes or the inactivation of tumor-suppressor genes.
  25. P53 (Tumor-Suppressor) Gene Mutations
    • Normally, if cells are exposed to hypoxic environment, p53 is activated to produce the p53 protein
    • The p53 protein will activate apoptosis 
    • In many cancers, the p53 gene is mutated, allowing the abnormal proliferation of cells
  26. Contributors to cancer Growth:
    Autocrine stimulation
    Cancers acquire the ability to secrete and respond to their own growth factors
  27. Contributors to cancer Growth:
    Increased expression of the growth-factor receptors
    • Gene amplification allows cancer cells to create numerous copies of genes and expression of gene products 
    •   -HER2/neu in breast cancers
    •   -bcr/abl receptor tyrosine kinase in CML
  28. Contributors to cancer Growth:
    • Normally, the only cells in the body that are immortal are stem cells
    • other cells can only divide a given number of times 
    • Telomeres are protective end-caps of chromosomes, maintained by telomerase
    • As the telomeres are lost, a cell loses its ability to divide
    • cancer cells can activate telomerase
  29. Contributors to cancer Growth:
    • Physiological process contributing to the growth of new blood vessels 
    • through secretion of angiogenic factors, cancers can continue to enlarge
  30. Metastasis
    • The spread of cancer from the initial site of neoplasm development to distance tissues of the body
    • localized neoplasms are much easier to treat 
    • Metastasis, similar to the initial cancer development, is a sequence of events
  31. Metastasis:
    cells break loose from their original location
  32. Metastasis:
    • Cellular proliferation
    • Barrier destruction by lytic enzymes
    •   -Secretion of protease activators
    • Down-regulation of cell adhesion molecules 
    •   -Desmosomes, hemidesmosomes, and tight junctions 
    • Increased motility
    •   -secretion of autocrine motility factors
  33. Metastasis:
    • passage into vessels (blood or lymph)
    • Lymphatic spread
    • blood dessemination 
    •   -
  34. Metastasis:
    Adherence in favorable sites
    • Metastatic cancer cells can spread diffusely throughout the body, but certain types of cancerous cells have a preference for specific organs
    • This is often referred to as " organ tropism"
    •   -Factors encouraging colonization
    •     -Growth factors from target organ
    •     -Hormones
    •     -Presence of tumor receptors on the tissue
    •     -Route
  35. Metastasis:
    Leaves blood vessels and invades secondary tissue
  36. Metastasis:
    establishment in new tissue
  37. Metastasis:
    • Local transformation and extension 
    • Motility
    • Angiogenesis
    • Invasion
    • Intravasation (blood/lymph penetration)
    • Adherence at a favorable site
    • Extravasation
    • Colonization
  38. Cancer Staging
    • Stage 1: Neoplastic cells in original site- Well-differentiated cells
    • Stage 2: Metastatic cell in original site and local lymphatics- Moderately-differentiated cells
    • Stage 3: Cells in original site and distant lymphatics- Poorly differentiated cells
    • Stage 4: Metastatic cells are found in many body areas- very poorly-differentiated cells
  39. Systemic Effects of Neoplasms
    • Vessel invasion- bleeding
    • Lymphatic invasion- lymphedema
    • Nerve invasion- pain, numbness, tingling
    • Bone marrow invasion- pancytopenia, infection, and bleeding
    • Liver invasion- hepatic insufficiency
  40. Clinical Manifestations:
    • Little or no pain is associated with early malignancy
    • Pain is influenced greatly by fear, anxiety, sleep loss, and psychological responses
    • Pressure on sensitive structures, obstruction, severe stretching of tissues- all cause pain
    • Patients that have terminal cancer will usually manifest severe pain
    •   -Bone metastases (periosteal irritation, medullary pressure and/or fractures)
  41. Clinical Manifestations:
    • Due to:
    •   -Sleep disturbance
    •   -Biochemical changes to treatment
    •   -Diminished activity level
    •   -Nutritional status
    • Muscle tone loss can be due to lack of activity and/or circulating necrosis factors
  42. Clinical Manifestations:
    • Reduction in red blood cell numbers
    • Causes
    •   -chronic bleeding
    •   -Malnutrition
    •   -therapies
    •   -Malignancy in blood-forming organs
    • Malignancy of the bone marrow can also cause leukopenia and thromboycytopenia
  43. Clinical Manifestations:
    • This is the most common event leading to the demise of patient with malignancy
    • Reduction in immunologic functions due to treatment regimens
    • Poor wound care
    • Comprised patient care
  44. Clinical Manifestations:
    Cachexial Syndrome
    • State of ill health, wasting, emaciation and decreased quality of life
    • Symptoms
    •   -Reduced sweet, sour, and salty sensation
    •   -depression of appetite (early filling response)
    •   -Weight loss and asthenia (marked weakness)
    •   -Altered metabolism (increased BMR)
    •   -Cachexia and anorexia are present in 80% of cancer deaths
  45. Cancer Treatments
    • intended to destroy cells that are in a stage of vulnerability 
    •   -Mitotically active cells are very vulnerable
    • The chemotherapy must eliminate enough cells to allow the immune system to destroy the others
    • Usually a cocktail of drugs
    • Molecular-era anti cancer drugs
    • "Targeted therapy"
    •   -Enzyme inhibitors
    •   -monoclonal antibodies
    •     -Directed at a specific tumor antigen
  46. Cancer Treatments:
    • Damages the DNA of the rapidly dividing neoplastic cells
    • General and targeted radiation therapy
  47. Cancer Treatments:
    Excisional, Debulking, Palliative
    • useful when the tumor is accessible and has not passed beyond stage 3 (regional lymph nodes) 
    • The tumor and any affected lymph nodes must both be removed
    • Surgery decreases the total number of cancer cells, giving normal immune mechanisms a fighting chance
    • Palliative surgery can relieve symptoms of malignancy
Card Set:
Patho unit 2 ch 9
2013-09-18 21:23:33
Patho unit

Patho unit 2ch 9
Show Answers: