Instructions:

• Answer 50 questions in 15 minutes.
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• Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. Neoplastic progression: normal state - before anything goes wrong

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2. Tumor nomenclature: Blood vessels What do you call a benign tumor of this tissue? .. a malignant one?
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants
Ovarian - malignant epithelial tumors
Small cell lung carcinoma and intracranial neoplasms
Benign: hemangioma Malignant: Angiosarcoma


3. Tumor suppressor gene: WT1 chromosome? Associated tumor?

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4. Adult T- cell leukemia What is the assocciated oncogenic virus?
Follicular and undifferentiated lymphomas (inhibits apoptosis)
Paget's dz of bone
HTLV-1
Metastasis = Spread to distant organ Must survive immune attack. 'Seed and soil' theory of metastasis: Seed = tumor embolus Soil = target organ -- liver - lungs - bone - brain... Angiogenesis allows for tumor survival Decr cadherin - Increase laminin


5. tumor: Burkitt's lymphoma What is the associated oncogene?
Down syndrome
C - myc
HTLV-1
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma


6. Cervical carcinoma (types 16 - 18) Penile/anal carcinoma What is the assocciated oncogenic virus?
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
HPV
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
Hypocellular Protein - poor Specific gravity > 1.012 Due to: Increase hydrostatic pressure Decr oncotic pressure Na+ retention


7. Hypovolemic/cardiogenic shock
Low - output failure. Findings: cold - clammy pt; low cardiac output; Increase TPR.
Rubor (redness) Dolor (pain) Calor (heat) Tumor (swelling) Functio laesa (loss of fxn)
Abnormal cells lacking differentiation; like primitive cells of the same tissue - often equated w/ undifferentiated malignant neoplasms. Little or no resemblance to tissue of origin. Irreversible.
[aka Kaposi's sarcoma - associated herpesvirus] Kaposi's sarcoma Body cavity fluid B- cell lymphoma


8. Tumor nomenclature: Fat What do you call a benign tumor of this tissue? .. a malignant one?
HHV-8
Benign: lipoma Malignant: liposarcoma
Colon carcinoma
Liver (angiosarcoma)


9. Oncogene: N - myc Associated tumor?
N euroblastoma
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
P 16
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)


10. Things that initiate Free radical injury
Radiation exposure Metabolism of drugs (phase I) Redox rxtn Nitric oxide Transition metals Leukocyte oxidative burst *Reperfusion after anoxia induces free radical production (e.g. - superoxide) and is a major cause of injury after thrombolytic thera
Neoplastic cells hae not invaded basement membrane. High nuclear/cytoplasmic ratio and clumped chromatin Neoplastic cells encompass entire thickness Tumor cells are monoclonal <img src='220c.JPG' />
EBV
Aggressive malignant lymphomas (non - Hodgkin's) and Kaposi's sarcoma


11. Neoplasm: Colonic adenocarcinoma With what dz is this associated?
Ulcerative colitis
Larynx (squamous cell carcinoma) Lung (squamous cell and small cell carcinomas) Kidney (renal cell carcinoma) Bladder (transitional cell carcinoma)
Lung cancer deaths have plateaued in males - but continue to Increase in females. Cancer is the 2nd leading cause of death in the USA (heart dz is 1st).
Secondary osteosarcoma and fibrosarcoma


12. Tumor suppressor gene: NF1 chromosome? Associated tumor?
Esophagus - stomach
T = size of T umor N = N ode involvement M = M etastases
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Assoc: Neurofibromatosis type 1


13. Tumor markers: PSA
Autoimmune dz's (e.g. - Hashimoto's thyroiditis - myasthenia gravis)
Squamous cell lung carcinoma - renal cell carcinoma - and breast carcinoma
Degree of cellular differentiation based on histologic appearance of tumor. Usually graded I- IV based on degree of differentiation and number of mitoses per high - power field; character of tumor itself.
Prostate - Specific Ag. Used to screen for prostate carcinoma. Can also be elevated in BPH and prostatitis.


14. tumor: Breast - ovarian - and gastric carcinomas What is the associated oncogene?
Degree of cellular differentiation based on histologic appearance of tumor. Usually graded I- IV based on degree of differentiation and number of mitoses per high - power field; character of tumor itself.
Erb - B2
Occurs during embryogenesis - hormone induction (menstruation) - immune cell - mediated death - injurious stimuli (e.g. - radiation - hypoxia) - atrophy (e.g. - endometrial lining during menopause)
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)


15. Carcinoma vs. sarcoma
Immunodeficiency states
Lung cancer deaths have plateaued in males - but continue to Increase in females. Cancer is the 2nd leading cause of death in the USA (heart dz is 1st).
Carcinoma = epithelial origin Sarcoma = mesenchymal origin (blood vessels - muscle - bone - fat - etc.) Both imply malignancy
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.


16. Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness) What neoplasm would create this paraneoplastic effect?
Breast - ovarian - and gastric carcinomas
Tartrate - resistant acid phosphatase. Hairy cell leukemia -- a B- cell neoplasm. 'TRAP the hairy animal.'
Thymoma - small cell lung carcinoma
Burkitt's lymphoma nasopharyngeal carcinoma


17. Tumor nomenclature: Blood cells What do you call a benign tumor of this tissue? .. a malignant one?
Benign: -- Malignant: Leukemia - lymphoma
APC
Assoc.: Retinoblastoma - osteosarcoma
Emigration (rolling - tight binding - diapedesis); chemotaxis (bacterial products - complement - cytokines); phagocytosis and killing.


18. Tumor markers: CA-19-9
Typically multiple well - circumscribed tumors at grety- white border. Overall - approximately 50% of brain tumors are from metastases.
Radiation exposure
Membrane lipid peroxidation Protein modification DNA Breakage
Pancreatic adenocarcinoma


19. Tumor markers: Alkaline phosphatase

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20. Oncogene: c - myc Associated tumor?

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21. Neurofibromatosis type 1 What is the tumor suppressor gene?
Mediated by E- selectin and P- selectin on vascular endothelium binding to sialyl Lewis^x on the leukocyte. <img src='218a.JPG' />
Xeroderma pigmentosum - albinism
Increase in # of cells. Reversible.
NF1


22. Neoplasm: Gastric adenocarcinoma With what dz is this associated?
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
C - myc
Chronic atrophic gastritis - pernicious anemia - postsurgical gastric remnants


23. Dz: Cirrhosis (alcoholic - hepatitis B or C) What is the associated neoplasm?
Hepatocellular carcinoma
Assoc: breast cancer
Amylin protein Derived from AE (AE = E ndocrine)
Beta -2 microglobulin Derived from MHC class I proteins.


24. Primary tumors that metastasize to liver

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25. Colon cancer
TB (caseating) Syphilis Listeria monocytogenes Wegener's granulomatosis Leprosy Bartonella Some fungal pneumonias Sarcoidosis Crohn's dz *Granuloma formation is IL-2 - interferon - gamma mediated.
Ras
Benign: Leiomyoma Malignant: Leiomyosarcoma
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC


26. Neoplastic progression: step 3 Invasive carcinoma

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27. Migration (step 4 in leukocyte extravasation)

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28. Oncogene: abl Associated tumor?
Fibrous tissue formation in response to a neoplasm. Irreversible.
CML
Cells have increased in # (hyperplasia ) Abnormal proliferation of cells w/ loss of size - shape - and orientation (dysplasia ) <img src='220b.JPG' />
Benign: lipoma Malignant: liposarcoma


29. Acute inflammation
Prostate carcinoma.
A clonal proliferation of cells that is uncontrolled and excessive. Irreversible.
Loss of fxn --< cancer; both allels must be lost for expression of dz.
Neutrophil - eosinophil - and Ab - mediated. Rapid onset (seconds - minutes) - lasts minutes - days.


30. Neoplastic progression: step 1 Hyperplasia/dysplasia

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31. Tumor nomenclature: Epithelium What do you call a benign tumor of this tissue? .. a malignant one?
Benign: Adenoma - papilloma Malignant: Adenocarcinoma - papillary carcinoma
Malignant melanoma
High - output failure; high mixed venous pressure. Findings: hot pt - dilated arterioles - decr TPR.
1 adult cell type is replaced by another. Often 2' to irritation and/or environmental exposure (e.g. - squamous metaplasia in trachea and bronchi of smokers) Reversible.


32. Chronic inflammation
Cellular swelling Nuclear chromatin clumping Decr ATP synthesis Ribosomal detachment Glycogen depletion Fatty change
N euroblastoma
Increase vascular permeability - vasodilation - endothelial injury.
Mononuclear cell mediated: Characterized by persistent destruction and repair. Associated w/ blood vessel proliferation - fibrosis. Granuloma -- nodular collections of epithelioid macrophages and giant cells.


33. Paraneoplastic effects of tumors: Small cell lung carcinoma and intracranial neoplasms Causes...? Effect?
Hepatocellular carcinoma
Causes: ADH Effect: SIADH
Coagulative (heart - liver - kidney) Liquefactive (brain) Caseous (tuberculosis) Fat (pancreas) Fibrinoid (blood vessels) Gangrenous (limbs - GI tract)
WT1


34. Dz: Xeroderma pigmentosum - albinism What is the associated neoplasm?
Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin
Neutrophils exit from blood vessels at sites of injury and inflammation in 4 steps: 1.) Rolling 2.) Tight binding 3.) Diapedesis 4.) Migration <img src='218a.JPG' />
Mediated by ICAM -1 on vascular endothelium binding to LFA-1 (integrin) on the leukocyte ('Hold on tight to your CAM era') <img src='218a.JPG' />
Ovarian - malignant epithelial tumors


35. Oncogene: erb - B2 Associated tumor?
P 16
Liver (angiosarcoma)
Breast - ovarian - and gastric carcinomas
N euroblastoma


36. Paraneoplastic effects of tumors: Leukemias and lymphomas Causes...? Effect?
Bcl -2
Causes: Hyperuricemia due to excess nucleic acid (e.g. - cytotoxic therapy) Effect: Gout - urate nephropathy
Liver (angiosarcoma)
Benign: -- Malignant: Leukemia - lymphoma


37. Type of amyloid protein: Dialysis - associated Protein? Derived from...?
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
A- CAL protein Derived from calcitonin (A- CAL = CAL citonin)
Beta -2 microglobulin Derived from MHC class I proteins.


38. Neoplasm: Melanoma - basal cell carcinoma - and esp. squamous cell carcinomas of the skin With what dz is this associated?
Xeroderma pigmentosum - albinism
Leukemias and lymphomas
Down syndrome
Mediated by ICAM -1 on vascular endothelium binding to LFA-1 (integrin) on the leukocyte ('Hold on tight to your CAM era') <img src='218a.JPG' />


39. Dz: Paget's dz of bone What is the associated neoplasm?
Beta - amyloid Derived from amyloid precursor protein (APP)
Fibroblast emigration and proliferation; deposition of ECM.
Bcl -2
Secondary osteosarcoma and fibrosarcoma


40. Chemical carcinogens: CCl4 What is the affected organ?
Liver (centrilobular necrosis - fatty change)
Visceral malignancy (stomach - lung - breast - uterus)
APC
Benign: lipoma Malignant: liposarcoma


41. Necrosis is characterized by...?
Plasma membrane damage Lysosomal rupture Ca2+ influx --< oxidative phosphorylation Nuclear pyknosis - karyolysis - karyorrhexis Mitochondrial permeability
Breast - ovarian - and gastric carcinomas
Enzymatic digestion and protein denaturation - with release of intracellular components. Inflammatory.
Actinic keratosis


42. Which usually has more prognostic value - tumor stage or grade?
Pancreatic adenocarcinoma
Gastric adenocarcinoma
Causes: ADH Effect: SIADH
Usually stage < grade


43. Neoplasm: Visceral malignancy (stomach - lung - breast - uterus) With what dz is this associated?
Neuorblastoma - lung - and gastric cancer.
Acanthosis nigricans (hyperpigmentation and epidermal thickening)
IL-8 C5a Leukotriene B4 Kallikrein
CML


44. Hyperplasia
Increase in # of cells. Reversible.
Causes: Ab's against presynaptic Ca2+ channels at NMJ Effect: Lambert - Eaton syndrome (muscle weakness)
Programmed cell death; ATP required. Mediated by caspases.
Rb


45. Free radical degradation
Astrocytoma - angiomyolipoma - and cardiac rhabdomyoma
Ovarian - malignant epithelial tumors
Tumor markers should not be used as the primary tool for cancer Dx. They may be used to confirm Dx - to monitor for tumor recurrence - and to monitor response to therapy.
Produced thru enzymes (catalase - superoxide dismutase - glutathioe peroxidase) - spontaneous decay - antioxidants (Vitamins A - C - E).


46. Chemical carcinogens: Alkylating agents What is the affected organ?
Beta - amyloid Derived from amyloid precursor protein (APP)
Leukocyte travels thru the interstitium to the site of injury or infxn guided by chemotactic signals (e.g. - cytokines) <img src='218a.JPG' />
HBV - HCV
Blood (leukemia)


47. Tumor nomenclature: < 1 cell type What do you call a benign tumor of this tissue? .. a malignant one?
Benign: mature teratoma (women) Malignant: immature teratoma and mature teratoma (men)
Neoplastic cells hae not invaded basement membrane. High nuclear/cytoplasmic ratio and clumped chromatin Neoplastic cells encompass entire thickness Tumor cells are monoclonal <img src='220c.JPG' />
Leukemias and lymphomas
P 53


48. Tumor suppressor gene: DCC chromosome? Associated tumor?
May be poorlly differentiated - erratic growth - locally invasive/diffuse - may metastasize.
Metastases to bone - obstructive biliary dz - Paget's dz of bone.
Assoc: Colon cancer [DCC = D eleted in C olon C ancer]
Beta - amyloid Derived from amyloid precursor protein (APP)


49. Chemical carcinogens: Nitrosamines (e.g. - in smoked foods) What is the affected organ?
Renal cell carcinoma - hemangioblastoma
Esophagus - stomach
[DCC = D eleted in C olon C ancer] What is the tumor suppressor gene? DCC
Usually stage < grade


50. Neoplasm: Squamous cell carcinoma of esophagus With what dz is this associated?
Cirrhosis (alcoholic - hepatitis B or C)
Plummer - Vinson syndrome (atrophic gastritis - esophageal webs - anemia; all due to iron deficiency)
L - myc
Neoplastic cells hae not invaded basement membrane. High nuclear/cytoplasmic ratio and clumped chromatin Neoplastic cells encompass entire thickness Tumor cells are monoclonal <img src='220c.JPG' />