Path: Epidemiology of Cancer Flashcards Preview

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Flashcards in Path: Epidemiology of Cancer Deck (38)
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1
Q

The incidence of cancer varies with all of the following except:
age, sex, race, comorbidities, geography, genetic background,

A

comorbidities

2
Q

Why is geographic variation in cancer incidence a risk factor?

A

thought to stem from different environmental exposures

3
Q

Cancers are most common in adults over age ___.

A

60

4
Q

Important environmental factors implicated in carcinogenesis include …?

A

infectious agents, smoking, alcohol, diet, obesity, reproductive history, and carcinogens

5
Q

There are 2 conditions related to tissue injury and the immune system that increase the risk of cancer. What are they?

A

chronic inflammation; immunodeficiency

6
Q

____ cancer is much more fatal than prostate or breast cancer.

A

Lung

7
Q

Why are most brain tumors in children benign yet fatal?

A

Most of the brain tumors in children are technically “benign”, but they tend to be fatal because they cannot be surgically removed, often do not respond to non-surgical therapies, and their autonomous growth in the unexpandable space of the skull compresses vital brain structures.

8
Q

About 60% of childhood cancer deaths are due to ____ ____ and ____ ____.

A

acute leukemias; brain tumors

9
Q

Acquired conditions that predispose to cancer can be divided into 3 categories. Please name them.

A
  1. chronic inflammations
  2. precursor lesions
  3. immunodeficiency states
10
Q

Chronic inflammatory disorders and precursor lesions include many conditions that are all associated with ____ ____ ____. What is the significance of this?

A

increased cellular replication; this state creates a “fertile” soil for development of malignant tumors because of the repeated rounds of cell replication

11
Q

Immunodeficiency states predispose to what kind of cancers?

A

virus-induced

12
Q

Precursor lesions can be defined as …?

A

localized morphologic changes that are associated with a high risk of cancer

13
Q

The majority of tumor arising in the context of chronic inflammation are what kind of tumor?

A

carcinoma

14
Q

Virtually all precursor lesions arise in what tissue and are associated with increased risk of what type of cancer?

A

epithelial tissue; carcinoma

15
Q

How/why are pap smears useful?

A

they can detect dysplasia (precursor lesion) of the cervical endometrium before it becomes cancer

16
Q

What is dysplasia?

A

disordered growth; cellular atypia and messed up architecture; not [yet] cancer

17
Q

Normal uterine epithelium will have what histological features?

A

single basal cell layer; the higher cells and their nuclei are flatter than the basal cells; abundant glycogen in cytoplasm (appearing as clear cytoplasm)

18
Q

When basaloid cells are located here in the cervix, the worse the dysplasia. Where is “here”?

A

“here” is higher in the epithelium

19
Q

True or false: severe dysplasia looks pretty much the same as earl neoplasia, therefore can also be classified as carcinoma in situ.

A

False - severe dysplasia looks

pretty much the same as early neoplasia (carcinoma in situ), but is NOT cancer (yet)

20
Q

What is CIN?

A

cervical intraepithelial neoplasia; the term for all dysplasia and carcinoma in situ seen in cerival epithelium

21
Q

What is SIL?

A

squamous intraepithelial lesion, refers to cerival epithelium

22
Q

Which leads to cancer: chronic inflammatory diseases infectious or non-infectious etiologies?

A

trick question - either etiology can lead to cancer

23
Q

How does chronic inflammation lead to cancer? (3 areas of increased risk)

A
  • increased cell proliferation to repair the tissue damage
  • increase in the number of tissue stem cells - susceptible to mutation/transformation
  • activated immune cells produce ROS that are directly genotoxic
24
Q

What are 4 important examples of chronic inflammatory conditions that lead to cancer?

A
  1. inflammatory bowel disease, esp. ulcerative colitis –> carcinoma of colon
  2. chronic hepatitis, especially chronic hepatitis C –> hepatocellular carcinoma
  3. chronic pancreatitis –> pancreatic carcinoma
  4. chronic cholecystitis –> gallbladder carcinoma
25
Q

Chronic epithelial injury often leads to metaplasia, which is what?

A

the replacement of one cell type with a second that is better able to survive the ongoing insult

26
Q

What is helicobacter pylori gastritis and how does it lead to cancer?

A

infectious Gram-negative bacterium that injects its CagA, activates cell proliferation pathways, causes degradation of p53; epithelial cells are irritated by this and undergo metaplasia, a precursor to gastric adenocarcinoma

27
Q

True or false: precursor lesions inevitably progress to cancer.

A

False - but they are associated with increased cancer risk

28
Q

What are 3 examples of precursor lesions in the setting of chronic inflammation,a nd can be recognized by the presence of metaplasia?

A
  1. Barrett esophagus - due to GERD
  2. Squamous metaplasia of bronchial mucosa - due to smoking
  3. Intestinal metaplasia of the stomach - due to chronic gastritis
29
Q

What is non-inflammatory hyperplasia?

A

hyperplasia caused by something other than chronic inflammation; ex: endometrial hyperplasia is caused by sustained strogenic stimulation of the endometrium

30
Q

Non-inflammatory hyperplasia can potentially progress to what type of cancer?

A

endometrial carcinoma

31
Q

Another group of precursor lesions is ____ ____ that are at risk for malignant transformation.

A

benign neoplasms - but be aware that MOST benign neoplasms won’t undergo malignant transformation

32
Q

Benign tumors are at high risk for malignant transformation because they possess ____ ____.

A

genomic instability

33
Q

What is leukoplakia?

A

a patch of white thickening of squamous epithelium that may occur in the oral cavity, penis, or vulva and gives rise to squamous carcinoma

34
Q

____ is a lesion related to leukoplakia, but often already carcinoma in situ so it is beyond precursor.

A

Erythroplakia

35
Q

Patients with immunodeficiency have a higher incidence of malignancies of certain types; what are they? (3)

A
  1. B-cell lymphoma of B cells infected with EBV
  2. Kaposi sarcoma, a proliferation of endothelial cells due to HHV8
  3. Squamous cell carcinomas of cells infected with oncogenic HPV
36
Q

What is the difference between lymphomas and leukemias?

A

lymphomas are solid hematologic malignancies and leukemias are liquid hematologic malignancies.

37
Q

NF is an autosomal dominant disorder caused by mutations in the TSG ____, which has what function? What is the cellular phenotype of the NF mutation?

A

neurofibromin - a negative regulator of Ras; mutation in NF leads to Ras hyperactivity (hence tumor development)

38
Q

Patients with NF1 have what clinical signs/symptoms?

A

learning disabilities, seizures, skeletal abnormalities, vascular abnormalities, pigmented nodules of the iris (Lisch nodules), and pigmented skin lesions (axillary freckling and café au lait spots) in various degrees.