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Neoplasia 5,23
| Question | Answer |
|---|---|
| New growth | NEOPLASIA |
| mass of cells that composes Neoplasia is known as what? | NEOPLASM |
| Characteristics of Neoplasm | competes with normal cells & tissue for metabolic needs, steady increase in size, growth is irreversible, Origin of all neoplasm is Loss of Responsiveness to growth controls. |
| Neoplastic masses that cause swelling is called what? | TUMORS |
| study of tumors? | ONCOLOGY |
| what are the two types of tumors? | Benign (localized and cannot spread and typically enclosed by fibrous capsule) or Malignant (can invade and destroy adjacent structures and spread) |
| Frequently cause of death, all malignancies are known as what? | Cancers |
| What are Malignancies of Mesenchymal tissue called? | Sarcomas (typically with suffix "oma", ex: osteoma) |
| What are Malignancies of epithelial in origin called? | Carcinomas (Fibrous tissue=> fibrosarcoma; stratified squamous epithelium => squamous cell carcinoma) |
| Neoplasm that exhibit more than one cell type and contain cells from more than one germ later are called what? | Teratomas |
| What are two non-neoplastic growth with inappropriate terminology? | Hamartoma & Choristoma |
| A congenital anomaly presenting a localized overgrowth of cells normally found in that location? | Hamartoma |
| Congenital anomaly presenting as a localized overgrowth of cells that is not in its proper location, also described as Heterotropic rest of cells? | Choristoma |
| What are the ways to differentiate that is a tumor is benign or malignant? | Differentiation, dysplasia/anaplasia, rate of growth, local invasion and metastasis. |
| Tumors refers to the extent to which tumor cells resemble their cells of origin, both morphologically and functionally? | Differentiation |
| "backward formation" and implies dedifferentiation(reversion of specialized cell or tissue) with a loss of structural and functional differentiation. | Anaplasia |
| Features of Anaplasia | Pleomorphism, Nuclear hyperchromatism, Increased nuclear/cytoplasmic ratio, Giant cells, Increased mitotic index, Abnormal mitotic figures, Prominent or multiple nucleoli, failure of recognizable patterns, loss of specialized structures/architecture. |
| (may be termed atypia or dyskeratosis) refers to histopathologic findings within non-neoplastic epithelium that are similar but less severe than anaplasia. | Dysplasia |
| characteristics of Dysplasia | typically arises under influence of carcinogenic agents but not always, carcinomas are typically preceded by areas of premalignant dysplasia. |
| tumors usually correlates inversely with the level of tumor differentiation, also correlates directly with aggressiveness. | Growth Rate |
| the ability of a tumor to grow by progressive infiltration, invasion, destruction and penetration of the surrounding tissue. | Local Invasion. |
| refers to the development of secondary implants discontinuous with the primary tumor, possibly in remote sites. | Metastasis |
| Characteristic of Metastasis | Only malignancies have the ability to metastasize, in general the more anaplastic and large the primary neoplasm, the more likely of its metastatic spread. Local INVASIVENESS and METASTATIC are the Most Important criteria in identifying Malignancy. |
| What are the 3 ways Malignancies disseminate? | 1. Seeding within body cavities 2. Hematogenous (vascular) spread 3. Lymphatic spread |
| Name the important characteristics of Benign Tumors | 1. well-differentiated 2. slow growing 3. most are encapsulated, especially epithelial 4. remains localized |
| Name the important characteristics of Malignant Tumors | 1. less differentiated than their benign counterparts 2. varying degrees of anaplasia 3. most are UNencapsulated 4. most grow rapidly 5. often spread and metastasize |
| What are the 4 predisposing factors for Neoplasia | 1. Geographic and Environmental factors 2. Age 3. Heredity 4. Acquired Preneoplastic Disorders |
| Characteristic of Geographic and Environmental Factors | Cancers vary between countries and differences are usually Due to Environment rather than genetic. Study show 65% environmental & 26-42% heredity. Worst environmental carcinogen are from Tobacco and Alcohol. |
| Characteristic of Age Factors | frequency of cancer increases with age, due to accumulation of somatic mutations, decline of immune system, most cancer occur between 55-75, 10% death under 15 yrs of age. |
| Characteristic of Heredity Factors | cancer occurs in 1 of 4-5 individuals, Hereditary forms are divided in 3 categories: Autosomal Dominant, Autosomal Recessive and Familial cancer of Uncertain origin. |
| What cancer syndrome are well-defined cancers in which inheritance of single mutant gene? | Autosomal Dominant Cancer Syndrome |
| What cancer syndrome that are associated with Chromosomal instability and increased prevalence of related cancer? | Autosomal Recessive Syndromes of Defective DNA repair |
| What is the cancer that characterized by the clustering of malignancies within groups of related individuals typically without specific marker phenotypes and no clear transmission pattern? | Familial Cancers |
| What are the 3 types of Autosomal Dominant Cancer Syndromes that are typically found within the Dentist scope of practice? | Multiple Endocrine Neoplasia Type 2B, Gardner Syndrome, and Nevoid Basal Cell Carcinoma Syndrome (Gorlin Syndrome). |
| Multiple mucosal Neuromas, Phenochromocytomas and Medullary carcinoma of the thyroid are what type of Autosomal Dominant Cancer? | Multiple Endocrine Neoplasia Type 2B |
| Multiple Osteomas, Epidermoid Cysts and Polyposis (developed into colon carcinoma) are what type of Autosomal Dominant Cancer? | Gardner Syndrome |
| Multiple Odontogenic Keratocysts, Nevoid basal cell carcinoma, Bifid ribs, and Calcified falx are what type of Autosomal Dominant Cancer? | Nevoid Basal Cell Carcinoma Syndrome (GORLIN SYNDROME) |
| Characteristics of Acquired Preneoplastic Disorders | 1. Persistent regenerative cell replications 2. Hyperplastic & Dysplastic Proliferation 3. Chronic Gastritis/ulcerative Colitis 4. Leukplakia of oral cavity, vulva, or penis 5. Villous Adenomas of the colon. |
| Name the 4 regulatory genes. | 1. Proto-oncogenes 2. Growth-inhibiting cancer suppressor (Antioncogenes) 3. Genes that regulate programmed cell death (Apoptosis) 4. Genes involved in DNA repair. |
| This gene promote cell growth and held in check by suppressor genes. | Proto-oncogenes |
| A proto-oncogene that hits critical mutation and transforms into an active what? (this promotes uncontrolled cell growth) | Oncogene |
| What are the two types of suppressor genes? | Governors & Guardians |
| This suppressor gene has the ability to stop abnormal cell proliferation. | Governors |
| This suppressor gene is responsible for detection and destruction of cells with chromosomal damage. | Guardians |
| A classic example of Chronic Myelogenous Leukemia (CML) in which 90% have specific karyotypic alteration (reciprocal & translocation of chromosome 9&22). | Philadelphia Chromosome |
| What is the term for the stepwise fashion of acquired cancerous attributes? | Tumor Progression |
| Name the 8 fundamental Hallmark of Cancer | Self-sufficiency in growth signals, Insensitivity to growth-inhibitory signals, Evasion of apoptosis, Limitless replicative potential, Development of sustained angiogenesis, Ability to invade/metastasize, Reprogram energy metabolism, Evasion of Immune sys |
| Characteristics of Self-sufficiency in Growth signals | Ability to promote cell growth in the absence of normal growth-promoting signals, acquired ability to synthesize their own growth factors, and may be able to send signals to stromal cells to promote tumor growth. |
| Characteristics of Insensitivity to growth-inhibitory signals | Loss of growth-inhibitory signals due to 2 mutation in both alleles on the affected gene are altered (two-hit hypothesis). The 2 common genes are RB Genes (governor) & p53 Gene (guardian). |
| The gene mutation that is largely responsible for the formation of Retinoblastoma is what? | RB Gene |
| One of the most important tumor suppressor gene that blocks neoplastic transformation through 3 interconnected mechanism is what? | p53 Gene |
| What are the 3 interconnected mechanism that p53 Gene is responsible for? | Quiescence, Senescence & Apoptosis |
| Damaged DNA that are detected and removed from the replicative pool and causes a PAUSE in cell cycling in order to provide time for DNA repair is termed what? | Quiescence |
| The permanent removal of DNA that cannot repaired from active cell cycling is termed what? | Senescence |
| With the assistance of p53 this process induces programmed cell death? | Apoptosis |
| Characteristics of Evasion of Apoptosis | Evasion of apoptosis can occur through mutation of p53 or by acquired attribute that prevent apoptosis, this tumor is NOT due to explosive cell proliferation but secondary to protection from apoptosis (growth over time). |
| Characteristics of Limitless Replicative Potential | As cells replicate their chromosome shortens, if allowed to continue this leads to chromosomal abnormality. Some tumors activate an enzyme (Telomerase) that maintain chromosome length and continued growth. |
| Characteristics of Development of Sustained Angiogenesis | Angiogenic switch initiates the vascularization to the area of dormant tumors. This is important in the metastasis of the cancerous tissue. |
| Characteristics of Ability to Invade and Metastasize | Ability of neoplastic cells to detach from each other, attach to matrix component, degrade extracellular matrix and migrate through the stroma. Metastasis occurs by entering lymphatic or vascular sys, survive immune sys, exit at distant site, & grow. |
| Characteristic of Reprogramming Energy Metabolism | Cancerous cells that shift metabolism to glycolysis (Warburg Effect), this is an aerobic glycolysis & produce less energy but allow cells to divide more rapidly and out compete normal cells. |
| Characteristic of Evasion of Immune System | Most tumors arise form immunocompetent patients, this allows for prevention of recognition or destruction of tumor cells. |
| Tumor-Promoting Inflammation can cause Malignancy | Inflammation is a response to tumors as a protective attempt to contain the neoplasm, but this inflammation can trigger growth factors and favor additional DNA damage and malignancy. |
| Name the 3 primary carcinogenic agents | Chemical, Radiation Energy and Oncogenic Organisms |
| What is the mechanism by which Chemical become carcinogenic agents? | Direct or Indirect Mechanism. |
| What is the term for indirect acting carcinogens and what is their active form called? | Procarcinogens and active form is Ultimate Carcinogens |
| Agents that augment the activity of carcinogens are called what? | Promoters (induce cell turnover and enhance DNA damage) |
| What is required for Promoters to augment the activity of carcinogens? | Initiators |
| Characteristics of Carcinogens | It is dose dependent (larger the dose = greater tumor prevalence), involves multiple stages, multiple genes, multiple mechanism and time lag of 5-30 yrs. |
| Characteristic of Radiation carcinogens | Radiation produces chromosomal breakage, translocation and point mutation, damaged cells accumulate additional mutation and typically appear after a long latent period. |
| Name 5 examples of latent induced diseases due to Radiation carcinogens. | Leukemia (atom bomb survivors), Sunlight exposure and skin cancer, Thyroid cancer (head & neck radiation), Neoplasm from Chenobyl accident, and Lung cancer (radioactive elements). |
| Name the two types of Oncogenic Oraganism | RNA Oncogenic Viruses & DNA Oncogenic Viruses |
| What is the primary mechanism by which RNA Oncogenic Viruses work and its name? (RNA viruses capable of producing virus specific-DNA) | The mechanism is Reverse Transcriptase: aka. Retroviruses. |
| What is the only known human retroviruses associated with RNA Oncogenic Virus? | Human T-cell Leukemia Virus-1 (HTLV-1) |
| Name the four DNA Oncogenic Viruses | Human Papillomavirus (HPV), Epstein-Bar Virus (EBV), Human Herpesvirus-8 (HHV-8), and Hepatitis B Virus (HBV) |
| What virus is the known cause of mononucleosis and has been implicated in a variety of human cancers, most notably Burkitt Lymphoma, Hodgkin disease, Nasopharyngeal carcinoma and B cell lymphoma? | Epstein-Barr Virus (EBV) |
| This virus is strongly linked epidemiologically to hepatocellular carcinoma? What is the virus also linked to hepatocellular carcinoma derived from RNA virus? | Hepatitis B Virus. Hepatitis C Virus. |
| What is the Oncogenic Bacteria strongly associated with Gastric Carcinoma and Gastric Lymphoma? | Helicobacter Pylori |
| What is the term for the bodies ability to recognize nonself and destroyed by the immune system? | Immune Surveillance |
| What is the name of the antigen that are present primarily on tumor cells and typically not on normal cells? | Tumor-Specific Antigens |
| What is the name of the antigen present on tumor cells, but also on some normal untransformed cells? | Tumor-Associated Antigens (aka Differentiation-Specific Antigens) |
| Although these antigens may not be detectable by the immune system, diagnostic screenings can be performed to reveal what TWO MARKERS that may be present at low levels in normal cells, but elevated levels as possible cancer indication? | CD10 & Prostatic Specific Antigen (PSA) |
| What are the 6 Effects of Tumors on Hosts? | 1. Location and Impingement on structures 2. Hormone production 3. Complications (hemorrhage, infection, necrosis) 4. Malignant transformation 5. Cachexia 6. Paraneoplastic Syndromes |
| What is the name of the progressive loss of body fat and lean body mass, accompanied by profound weakness, anorexia and anemia in cancer patient? | Cachexia |
| What is the term for a disease or symptom that is the consequence of cancer in the body but, unlike mass effect, is not due to the local presence of cancer cells? | Paraneoplastic Syndrome |
| Name 5 common examples of Paraneoplastic Syndrome | 1. Trousseau Sign 2. Hypercalcemia 3. Clubbing of fingertips 4. Cushing Syndrome 5. Acanthosis Nigricans |
| What is the term for multiple venous thrombi occur with carcinoma of the pancreas or lung? | Trousseau Sign |
| What is the term for Epithelial Hyperplasia seen in association with abdominal carcinomas? | Acanthosis Nigricans |
| What is the term for attempting to estimate a tumors aggressiveness or degree of malignancy based on histophathologic degree of anaplasia and differentiation? | Grading |
| What are the 4 Carcinoma Grades and characteristics of each? | Grade I - well-differentiated, mildly anaplastic. Grade II - Moderately differentiated, moderately anaplastic. Grade III - Poorly differentiated, severely anaplastic. Grade IV - Undifferentiated. |
| What are the 3 Precancerous Dysplasia and characteristics of each? | Mild Dysplasia - Dysplasia present in the basilar 1/3. Moderate Dysplasia - Dysplasia present in the basilar 1/2. Severe Dysplasia - Dysplasia present in all layers except the keratin layer. |
| Term for Dysplasia present throughout the epithelium without invasion into the underlying tissue? | Carcinoma in-situ |
| Term for an attempt to document the extent and spread of a tumor in a classification system, based on size of primary lesion, extent of spread to regional lymph nodes & presence or absence of metastasis? | Staging |
| What does TMN stand for in the Staging of Oral Cancer? | T - Primary Tumor, M - Distant Metastasis, N - Regional Lymph Nodes |
| What is the marker that is elevated in individuals with carcinoma of the prostate but also seen in non-neoplastic enlargement of the gland? | Prostatic Specific Antigen |
| This is released by 60-90% of colorectal carcinomas, 50-80% of pancreatic cancers and 25-50% of gastric and breast cancer. | Carcinoembryonic Antigen (CEA) |
| What is the name of the assay that is associated with cancer of the liver, stomach, pancreas and gonadal sites, as well as cirrhosis, hepatitis and pregnancy? | alpha-Fetoprotein |
| Name the 6 most common Skin Tumors | 1. Seborrheic Keratosis 2. Actinic Keratosis 3. Squamous cell Carcinoma 4. Basal Cell Carcinoma 5. Melanocytic (nevocellular) nevus 6. Malignant Melanoma |
| This type of tumor typically occurs after 40 and lesion increases with age, classic presentation is a tan to dark brown plaque or nodule that has a "stuck-on" appearance. | Seborrheic Keratosis |
| What is the name of the sudden eruptive appearance of hundred of seborrheic keratosis, that represents a paraneoplastic syndrome? | Sign of Leser-Trelat |
| This tumor refers to the epithelial dysplasia of the skin, due to chronic sunlight exposure associated with excess build-up of keratin, presents as tan-brown, red or normal colored patches with a sandpaper-like consistency. | Actinic Keratosis |
| This tumor is a common malignancy that arise from any Epithelial surfaced lined by stratified squamous epithelium, common in the oral cavity. | Squamous Cell Carcinoma |
| This type of tumor is a common cancer of the skin that frequently occurs on the face and scalp, does not occur in the oral cavity but represents 70% of all skin cancers. Neoplasm arises from basal layer of epidermis or hair follicle. | Basal Cell Carcinoma |
| This type of skin tumor refers to any congenital or acquired proliferation of benign melanocytes, generally appear in children, enlarge with growth and stabilize at puberty, consist of localized melanocytic cells. | Melanocytic (nevocellular) Nevus |
| Name the three most common types of Melanocytic Nevus and their characteristics. | 1. Junctional Melanocytic Nevi - melanocytes in epidermis next to the Junction with dermis. 2. Intradermal Melanocytic Nevi - melanocytes in the dermis. 3. Compound Melanocytic Nevi - melanocytes in epidermis & dermis. |
| Basic characteristic of Melanocytic Nevi | Symmetrical, tan-to-brown, uniformly pigmented with defined and rounded borders. Begins as flat lesions and becomes more elevated nodules. In adulthood it reduces in size and decrease in pigmentation. |
| The name of this Nevi that occur sporadically or be inherited as an autosomal dominant trait, larger than most acquired nevi (>5mm), Variability in pigmentation, irregular borders, and occur on non-sun exposed and sun exposed surface. | Dysplastic Nevi |
| What is the name of skin tumor that is highly malignant neoplasm of the skin seen in the oral cavity, esophagus, meninges, anus and retina with high prevalence in high sun-exposed geographic locations. | Malignant Melanoma |
| What are the ABCs of Clinical Signs of Early Diagnosis for Malignant Melanoma? | Asymmetrical lesion, Border irregularity, Color variegation with lesion, Diameter enlarging, & Evolution |
| Name the two phases of malignancy growth and their characteristics. | Radial Growth Phase - characterized by superficial spread without deep invasion. Vertical Growth Phase - characterized by cells infiltrating deep into connective tissue and frequent metastasis. |
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