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PATHO: Neoplasia
Neoplasia and Lung Cancer
88
Nursing
Undergraduate 3
02/07/2011

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Cards

Term
malignant transformation
Definition
  • first step in tumor formation
  • initiation of tumor growth
Term
tumor establishment
Definition
  • second step in tumor formation
  • proliferation/promotion
  • abnormal cells get comfy and start to influence the surrounding area
  • HAVE to get here successfully to have cancer
Term
metastatic spread
Definition
  • third and final step of tumor formation
  • tumor has escaped from its original boundaries
  • not all tumors get to this step
Term
neoplasia
Definition
  • new growth
  • an umbrella term
Term
aplasia
Definition
absence of growth
Term
tumor
Definition
growth of cells; a neoplastic event
Term
metaplasia
Definition
a normal cell type that changes to an abnormal cell type and has the ability to reverse back to the normal cell type
Term
dysplasia
Definition
  • difficulty in growth
  • problems with normal maturation
  • normal growth is difficult for the cell
Term
autonomy
Definition
  • the characteristic event that takes place during malignant transformation
  • start getting a new cell population that is now independent of normal cell controls
Term
what are the two main components of malignant transformation?
Definition
  1. mutation of proto-oncogenes to oncogenes
  2. removal/inhibition of tumor suppressor genes

(BOTH of these must be present to allow for malignant transformation)

Term
oncogenes
Definition
abnormal cells that stimulate abnormal growth
Term
when do non-genetic factors become important?
Definition
in tumor establishment → ex: nutritional status (because it feeds the tumor/abnormal cells)
Term
anaplasia
Definition

tissues of specific grouping lose cellular differentiation characteristics; become like blastic, undifferentiated cells → no longer specialized for a certain tissue

 

this is significant because when these cells move out of their original boundaries, nothing kicks them out for being different → they are set up to be successful in colonizing

Term
what are the steps of metastatic spread?
Definition
  1. cells must separate from each other and the primary tumor
  2. cells must pass through the basement membrane
  3. cells must jump onto a conduit (transportation) to get where they want to go
  4. once they reach their destination, they must succesfully colonize (angiogenesis must occur)
Term
what must happen for tumor establishment to be successful?
Definition
the transformed cell must escape cancer immunosurveillance
Term
what are the characteristics of a malignant tumor?
Definition
  • loss of topoinhibition
  • anaplasia
  • invasiveness (local)
  • metastasis (distant)
Term
topoinhibition
Definition
CIG (contact inhibition of growth); cells grow to a boundary
Term
loss of topoinhibition
Definition
during malignant transformation, boundaries mean nothing to abnormal/tumor cells
Term
invasiveness (local)
Definition
going into the basement membrane
Term
metastasis (distant)
Definition
breaking free of the original boundaries and going somewhere else to colonize
Term
cadherins
Definition
  • proteins that help our cells anchor to each other
  • start breaking down/not working during metastasis which allows freedom of movement to cancer cells
Term
what is the relationship between anaplasia and metastasis?
Definition
the ↑ anaplastic = the ↓ specific = the ↑ higher the degree of metastasis
Term
cancer is a disease of the _____.
Definition

cancer is a disease of the cell.

(not of the tissue)

Term
cancer is proven to be a disease of the cell and not of the tissue because of what 3 things?
Definition
  1. changes in the nucleus
  2. changes in the cytoplasm
  3. changes in the cell membrane
Term
what are the different types of cell nuclei that can be seen in the presence of cancer?
Definition
  1. pyknotic (condensed info)
  2. diffuse
  3. lobed (mostly in neutrophils)
  4. multinuclear (each have independent nuclear events)
Term
what are the different changes that can occur with the cell cytoplasm in the presence of cancer?
Definition
  1. microtubular disorganization
  2. rounded mitochondria
Term
what are the different changes in cell membrane that can be seen in the presence of cancer?
Definition
  1. ↓ number of cell junctions
  2. ↑ sialomucoproteins
  3. ↑ fibrinolysin/plasmin
  4. ↑ receptors
  5. change in antigenicity
Term
receptors
Definition
allow for multiplication of abnormal cells; ↑ growth potential
Term
desmosomes
Definition
cell junctions that control cell-to-cell adhesion
Term
nexus junctions
Definition
cell junctions that control cell-to-cell communication
Term

sialomucoproteins

 

Definition
acidic proteins that enhance cell motility → metastasis
Term
fibrinolsyin/plasmin
Definition
strong proteolytic action capable of destroying intracellular proteins → local invasiveness
Term
what are the new antigens created by malignant cells because of changes in the cell membrane?
Definition
  1. TSA
  2. TAA
Term
carcinogens
Definition
factors that affect the DNA/genome causing a change in the genetic code of the cell
Term
asynchronous
Definition
cells in a tumor no longer care what the other one is doing
Term
what are the two components of the fact that carcinogenesis is mutagenesis?
Definition
  1. carcinogenic insult must affect the genome
  2. the progeny of a malignant cell is also malignant
Term
what kind of cells die the easiest?
Definition
rapidly cycling cells
Term
rapidly cycling cells
Definition
those that are undergoing constant continued mitosis (normal cell division)
Term
why do rapidly cycling cells die easily?
Definition

because they are vulnerable when they are doing all their internal working → vulnerability occurs when machinery is at work

 

that is why cells in G0 are more resistant (they are in the resting phase)

Term
what are the different components of evidence proving that both rapidly changing malignant and non-malignant cells are vulnerable?
Definition
  1. alopecia (hair loss)
  2. myelosuppression (suppressing immune system)
  3. GI disturbances
  4. sterility in males
Term
what are the different phases of tumor development?
Definition
  1. tumor in situ
  2. invasive tumor
  3. metastatic spread
Term
tumor in situ
Definition
  • a tumor that stays in category 1
  • sitting on top of basement membrane
  • no metastasis yet → best time to remove it
  • best type of tumor to have
Term
invasive tumor
Definition
tumor that has started to attack the basement membrane
Term
metastatic spread
Definition
  • tumor has jumped into the vascular highway (blood, lymph)
  • worst type of tumor to have
Term
what are the different types of malignant tumors?
Definition
  1. epithelial tissue (carcinomas)
  2. non-hematopoietic mesenchymal connective tissue (sarcomas)
  3. hematopoietic & lymphoid tissue (leukemias, lymphomas)
  4. neural tissues (gliomas, chorid plexus, peripheral nerve, retinal, etc)
  5. miscellaneous (melanoma, neuroblastoma, etc)
Term
carcinoma
Definition
  • malignant tumor of the epithelial tissue
  • lung, colon, breast, prostate
  • ectoderm/mesoderm
Term
sarcoma
Definition
  • malignant tumor of the non-hematopoietic mesenchymal connective tissue
  • mesoderm
Term
leukemia and lymphoma
Definition
  • malignant tumors of the hematopoietic and lymphoid tissue
Term
which types of malignant tumors are from the embryonic source of cell tissue?
Definition
  • carcinomas (endo/ectoderm)
  • sarcomas (mesoderm)
Term
what is the pre-requisite for metastasis?
Definition
the primary tumor must be in the invasive phase → must involve the basement membrane
Term
what are the influencing factors of metastasis?
Definition
  1. ↓ cell-to-cell adhesiveness (↓ desmosomes)
  2. ↑ cell motility (↑ sialomucoproteins)
  3. mechanical forces
Term
what are the different primary dissemination routes involved in metastasis?
Definition
  1. lymphatic spread
  2. hematogenous spread
  3. cerebrospinal pathway
Term
what are the mechanisms of formation in metastasis?
Definition
  1. cells detach from primary and each other
  2. cells gain access to a distributive system
  3. cells able to survive in distributive system
  4. cells adhere to vascular endothelium and secure vascular supply (angiogenesis) and stroma
  5. unopposed tumor growth

when all of these things occur = METASTATIC SUCCESS

Term
stroma
Definition
  • the matrix of the tissue
  • where the abnormal cell must anchor during tumor establishment
Term
what are the general characteristics of metastasis?
Definition
  1. cells are less differentiated than primary
  2. mets may appear several years after primary
  3. a well vascularized area/organ increases the chance of success
Term
cytotoxic therapy approaches
Definition
induce apoptosis; cellular basis
Term
what are the two types of physiology-based treatment for metastatic tumors?
Definition
  1. local modalities
  2. systemic modalities
Term
give examples of local modality physiology-based treatment
Definition
  1. surgery
  2. radiotherapy (XRT)
Term
what type of physiology-based treatment is used for in situ or invasive tumors?
Definition
surgery (local modality)
Term
radiotherapy
Definition
  • local modality
  • damage cell membranes and DNA in nucleus
  • works on normal and metastatic cells
  • more focal → less fallout
Term
give examples of systemic modality physiology-based treatment
Definition
  • chemotherapy (CRT)
  • immunotherapy
Term
immunotherapy
Definition
manipulates relationship → marks tumor cells for destruction
Term
what is the leading cause of cancer death in the world?
Definition
lung cancer
Term
what are the predisposing factors of lung cancer?
Definition
  1. tobacco smoking (+85%)
  2. occupational and environmental risks
  3. synergistic effects
Term
what are the different histological classes of lung cancer?
Definition
  1. non-small cell carcinoma
  2. small (oat) cell carcinoma
Term
non-small cell carcinoma
Definition
  • completely variable in presentation
  • less lethal
Term
small (oat) cell carcinoma
Definition
  • very aggressive
  • almost always seen in smokers
  • central (hilar), main stem bronchi areas
  • round, irregular borders, 2cm
  • very rapid hematogenous spread
Term
what are the types of non-small cell carcinoma?
Definition
  1. squamous cell (epidermoid carcinoma)
  2. adenocarcinoma
  3. large cell carcinoma
Term
squamous cell (epidermoid carcinoma)
Definition
  • central (hilar/perihilar)
  • small, nodular, irregular borders
  • spreads mostly to lymphatic, local sites
  • best type to get
Term
adenocarcinoma
Definition
  • peripheral areas (alveoli areas)
  • small, focal, scar-like
  • hematogenous spread to distant sites
Term
large cell carcinoma
Definition
  • peripheral areas
  • large masses ( >4cm)
  • hematogenous spread to distant sites (closer to vascular supplies)
Term
what is the difference between squamous cell (epidermoid carcinoma) and small (oat) cell carcinoma?
Definition
small (oat) cell carcinoma = hematogenous spread
Term
paraneoplastic syndromes
Definition

common results of immune system being triggered because of the original pathology → syndrome that comes out of something going wrong with the immune system's response to the tumor

 

ex: fever

Term
what are the initial, non-specific signs and symptoms of lung cancer?
Definition
  1. chronic dry/productive cough
  2. dyspnea (trouble breathing) and wheezing
  3. fever
Term
what are the advanced stages of lung cancer?
Definition
  1. hemoptysis (blood in saliva)
  2. hoarsness (laryngeal nerve impeded)
  3. dysphagia
  4. pleuritic pain
  5. pericardial effusion
Term
symptomatic tumors
Definition
tumors that are inoperable because they are too invasive
Term
most common lung cancer-associated causes of death
Definition
  1. pulmonary infection (40%)
  2. metastatic disease (40%)
  3. cardiac involvement (15%)
Term
what are the determinants of poor prognosis of lung cancer
Definition
  1. late detection
  2. poor response to treatment
  3. rapid growth and metastasis
Term
squamous cell (epidermoid carcinoma) growth and metastasis information
Definition
  • ↑ growth rate
  • moderate metastatic potential
Term
adenocarcinoma growth and metastasis information
Definition
  • ↓ growth rate
  • ↑ metastatic potential
Term
small (oat) cell growth and metastasis information
Definition
  • ↑ growth rate
  • ↑ metastatic potential
Term
what are the different types of tumor spread?
Definition
  1. direct (local)
  2. lymphatic (regional)
  3. hematogenous (distant)
Term
direct (local) tumor spread
Definition
tumor spread to the bronchi, pleura, and cardiac sac/vessels
Term
lymphatic (regional) tumor spread
Definition
tumor spread to the hilar nodes, supraclavicular and paraaortic nodes, right adrenal
Term
hematogenous (distant) tumor spread
Definition
tumor spread to the liver, bones, adrenal, brain, kidneys
Term
what are the types of treatment for lung cancer
Definition
  • curative
  • paliative
Term
curative treatment
Definition

treatment used only in early stages; surgery, chemo

 

(surgery not used for oat cell)

Term
paliative treatment
Definition

treatment used in later stages

 

ex: XRT, CRT, chemo

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