Chapter 12
A carcinoma is a cancer arising from epithelial tissue.
Adenocarcinomas arise from ductal or glandular structures.
Intravasation is the movement of cancer cells thru the lumen of the vasculature is
mediated actively and passively depending on tumor type. Circulating tumor cells
(CTCs) need help to survive in vasculature. Chemokines help. CTCs survive in the
bloodstream during metastasis. Metastatic tumor cells travel from the primary site to
a distant site directly through the bloodstream. They break away from the primary
site and invade nearby blood vessels.
Adjuvant chemotherapy is given after surgical excision of a cancer with the goal of
eliminating micrometastases.
Tumor-specific antigens (TSAs) are only found on cancer cells and include antigens
from oncogenic viruses and altered glycoproteins and glycolipids. When present,
TSAs are processed by tumor cells and presented on cell surface by MHC class I
molecules and are targets of CD8+ T-cytotoxic cells (NK cells).
Characteristics of intestinal polyps: During clonal proliferation progressively altered
populations of colon cells arise over time. Clones that outgrow the fastest
out-compete other clones, producing more malignant and abnormal appearing
growths. One early mutation in colon CA is loss of tumor-suppressor gene APC.
Accumulation of mutations has been studied from normal colon to benign polyp to
cancerous polyp.
Chronic inflammation is an important factor in the development of cancer.
Inflammation may result from many causes. Chronic h pylori infection increases risk
for gastric ca. Tumors commonly produce cytokines and chemokines that are
chemotactic factors for monocytes and macrophages. Tumor associated
macrophages (TAMs) have a diminished cytotoxic response and release a variety of
cytokines that block T-cytotoxic cell and NK cell functions and promote a tumor’s
growth and spread. Successful tumors are capable of interrupting the inflammatory
response.
Cancers arising from connective tissue usually have the suffix -sarcoma.
Only CA arising from epithelial cells are called carcinomas
Carcinoma in situ refers to preinvasive epithelial malignant tumors of glandular or
squamous cell origin. They are localized to epithelium and haven't broken through
the local basement membrane or invaded surrounding tissue.
Anaplasia is the loss of cellular differentiation, irregularities of size and shape of
nucleus, and loss of normal tissue structure. Highly disorganized. Reduced ability to
produce new cells.
Tumor cell markers are substances produced by both benign and malignant cells that
are found either in or on the tumor cells in blood, spinal fluid or urine. Tumor
markers may be hormones, enzymes, genes, antigens and/or antibodies.
Screening and Identifying individuals at high risk for CA are ways for tumor markers
to be used.
Multiple (accumulation) genetic mutations are required for the evolution of
full-blown CA.
Cancer cells have mutations that enable them to proliferate in the absence of
external growth signals. Some CAs acquire the ability to secrete growth factors that
stimulate their own growth, autocrine stimulation.
Apoptosis is a self destruct mechanism cells have when growth is excessive.
The ras is an intracellular-signaling protein that regulates cell growth.
Oncogenes are mutant genes that positively regulate/accelerate rate of tissue
proliferation.
The t(8;14) translocation occurs in Burkitt’s lymphoma. Chromosome translocation.
Gene amplifications are the result of the duplication of a small piece of a
chromosome over and over again. The n-nyc oncogene is amplified in 25% of children
with neuroblastoma.
The retinoblastoma (Rb) gene normally strongly inhibits the cell division cycle. When
inactivated, the cell division cycle can proceed unchecked.
Two hits are required to inactivate the two alleles of a tumor-suppressor gene
because each person has 2 alleles, one from each parent.
A point mutation (alteration of nucleotide pairs) in the ras gene converts it from a
regulated proto-oncogene to an unregulated oncogene, an accelerator of cellular
proliferation.
CA cells somehow activate (turn on) telomerase to restore and maintain their
telomeres and make it possible for cells to divide over and over (indefinitely).
Benign tumors are generally named according to tissues that they come from and
include suffix -oma.
CA are named according to the cell type they originate from. Lip (adipose or fat
tissues).
Infection with HPV causes virtually all cervical CAs. Cervical Ca is detected via Pap
test.
Decreased renewal rates of epidermal layers in the skin may lead to skin breakdown
and dryness, altering normal barrier protection against infection.
Chronic inflammation causes cancer by releasing compounds such as reactive
oxygen species that promote mutations.
Inherited mutations that predispose to CA are invariably in tumor suppressor genes.
Most common mutations conferring resistance to apoptosis occur in the TP53 gene.
Chemotherapy and radiation therapy may cause a decreased cell turnover, thereby
leading to oral ulcers (stomatitis), malabsorption, and diarrhea.
By recruiting new vascular endothelial cells and initiating the proliferation of
existing blood vessel cells, VEGF and bFGF, allow small cancers to become large
cancers.
CA that's locally invasive is Stage 2. Stage 1 is confined to the origin organ.
Spreading to lymph nodes is stage 3. Stage 4 is when it spreads to distant sites.
Pain is generally associated with late-stages of cancer.
Brachytherapy is useful in txmt of cervical, prostate and head and neck cancers.
Survival rate of Hodgkin diseases is 99% for stage 1 and 70% for stage 4.
Iron is malabsorbed in individuals with gastric, pancreatic, or upper intestinal
cancers.
Cancer cells must have mutations that enable them to proliferate in absence of
external growth signals. Autocrine stimulation.
Caretaker genes maintain genomic integrity.
In normal nonmutant state, an oncogene is referred to as a proto-oncogene.
Pleomorphic cells are a result of anaplasia.
Fatigue is the most frequently reported symptom of CA and CA treatment.
The bone is the most common site of metastasis for prostate CA.
A benign tumor is well differentiated with its tissue appearing similar to the tissue it
came from.
Germ and Stem cells are considered immortal.
The blood and lymph are most common routes for distant metastasis.
Anaplasia affects the size, ability to differentiate, tissue structure and shape of cells.
Indwelling medical devices, visitor-introduced microorganisms, and inadequate
wound care are most common causes of hospital acquired (nosocomial) infections.
Many common malignancies occur in older age as a result of decline in immunologic
functions, predisposition to nutritional inadequacies and effects of immobility on the
immune system.
Chemotherapy: Take advantage of specific vulnerabilities in specific CA cells.
Radiation: Used to kill CA cells while minimizing damage to normal structures.
Staging: Provides a framework to determine treatment.
Angiogenesis: The process of cancer cell growth.
Target Agent: Guided by the molecular analysis in specific diseases.
HPV causes cervical Ca.
Human herpesvirus (HHV) 8 causes Kaposi Sarcoma.
Hepatitis B Virus (HBV) causes liver Ca.
H. Pylori causes stomach Ca.