Tumor

___ is a tumor supressor gene

p53

chromosome abnormalities cause a high ___ risk

recurrence

asthenia

weakness

When p21 is complexed with cdk2 the cell cannot pass through to the next stage of cell division; mutant p53 can no longer bind DNA in an effective way, and as a consequence the p21 protein is not made available to act as the ___ for cell division; Thus, the cells ___, and form tumors

'stop signal'; divide uncontrollably

tumor-suppressor genes

A gene whose protein product inhibits cell division, thereby preventing the uncontrolled cell growth that contributes to cancer.

fibronectin

An extracellular glycoprotein secreted by animal cells that helps them attach to the extracellular matrix.

tumors in cancer patients are injected with ___, which activates ___ and moves them to the tumor site; then, the tumor is killed

BCG; macrophages

one of the most common immunotherapies

Bacillus Calmette-Guerin (BCG)

Stiff Person Syndrome

Rare, progressive neurological disorder characterized by painful muscle spasms and muscle stiffness of the spine and lower extremities; associated with antibodies against Glutamic acid decarboxylase

dysplasia

abnormality in differentiation and proliferation of cells

detection of childhood cancers is often ___; ___% have metastasized at the time of diagnosis; they are ___ responsive to treatment; there are ___ with treatment; ___% are cured

accidental; 80; more; long-term consequences; greater than 70

hormone therapy can include ___ or ___ of receptors; often interferes with cellular ___ and ___

activation; blockage; growth; signaling

surgeries for cancer include ___ and ___ sampling; ___ surgery; and ___ surgery

biopsy; lymph node; debulking; palliative

metastasis officers in the first ___ encountered by circulating cells

capillary bed

epithelial cancer

carcinoma

chemotherapy compartment 2

cells capable of entering the cell cycle in the G1 phase

cells of a benign neoplasm are ___; and have well defined borders; cells move ___, but ___; growth is ___ and ___

cohesive; outward; do not spread; slow; stable

combination chemo

combo of drugs is more effective if each drug is effective alone; suppresses resistance, increases kill; reduces injury to healthy cells; *don't use drugs with same toxicities

angioblasts proliferate into ___ cells; this form particularly relates to the embryonal development of the vascular system.

de novo endothelial cells

hypertrophy

enlargement of cells (or organ)

degradation or dissolution of the matrix using ___ and ___

enzyme and actin rich pseudopods

Matrix metalloproteinases (MMP)

enzymes that degrade the collagenous ECM and break through the basement membrane surrounding the tumor, allowing tumor cells to migrate toward the blood or lymph vessels

goal of ionizing radiation is to ___ without ___ and to avoid ___

eradicate cancer; excessive toxicity; damage to normal structures

oncogenes

genes that cause cancer by blocking the normal controls on cell reproduction

adeno

glandular tissue

neural cancer

glioblastoma

organ tropism is associated with the effects of ___ factors; ___; ___; ___ receptors; and ___ factors

growth factors; chemokine; hormones; tissue-selecting homing; chemotactic

hyperplasia

increase in the # of cells within tissue

encephalitis

inflammation of the brain

other cancer treatments include ___, ___, ___ therapy, and ___ therapy

ionizing radiation; surgery; hormone; immuno

stage 2

locally invasive

immunotherapy used because theoretically, anti-tumor responses can selectively eliminate cancer cells while sparing normal cells; immune memory is ___; numerous immunological mechanisms are capable of ___ different types of cancer; biological ___ are used

long lived; rejecting; biological response modifiers

more aggressive and destructive neoplasm

malignant neoplasm

promotion

mutated cell grow and reproduces; dependent on continued exposure to carcinogen

___ and ___ are 2 genetic factors associated with cancers

oncogenes; tumor-supressor genes

Poorly differentiated or undifferentiated

only slight resemblance to ancestor; unspecialized proliferating elements

hypoplasia

organ in dwarfed

neoplasms need ___ and ___; they make their own ___ supply line from adjacent tissue to meet their needs

oxygen and nutrients; vascular

In the cell, p53 protein binds DNA, which in turn stimulates another gene to produce a protein called ___ that interacts with a cell division-stimulating protein (___)

p21; cdk2;

differentiation

progeny of dividing stem cells become specialized to perform a particular task

neoplastic cells: persistent ___; ___; formation of ___; ___; and etiology of cancer

proliferation; invasive growth; metastases; immortality

childhood cancers have a ___ latency periods; adult cancers have a ___ latency period

short; long

adjuvant chemotherapy is often used after the ___

surgical removal of a tumor

therapeutic index

the ratio between the toxic and therapeutic concentrations of a drug

biopsy

the removal of living tissue from the body for diagnostic examination

persistent proliferation

unrestrained growth and division (most distinguising property)

organ tropism

Preferential growth of cancerous cells in certain organs

initiation

initial contact with carcinogen that triggers mutation

blood cancer

leukemia

once in blood or lymph, the cancer cells are then transported to other tissues; initially there is ___ between the cell and the vessel wall that allows the cancer cell to ___ until ___ are formed; this process of metastasis is similar to how WBC are recruited to sites of inflammation

weak adhesion; roll along; stronger bonds

a benign neoplasm is usually ___ differentiates; while a malignant one is usually ___ differentiated

well; poorly

M is the extent of metastases; graded from M__-M__ M0 = M1 = M2 =

0-2; no metastasis; demonstrable metastasis; suspected metastases

Tumor size graded form T__-T__; number equals the ___ fat he tumor and its local extent; can vary according to site

0-3; size

p53 gene has been mapped to chromosome ___

17

there are over ___ forms of cancer

200

___% of children with cancer are now cured; children are more responsive and are better able to tolerate treatments; they are more likely to be enrolled in ___; however, there are long-term effects of treatment and ___ ramifications

78; clinical trials; psychological

cachexia is present in ___% of cancers at their death

80

few prevention strategies for childhood cancers; whereas adult cancers are ___% preventable

80

breast cancer

Adenocarcinoma

possible carcinogenic drugs/viruses include ___ steroids, ___ agents, ___ agents, ___ virus, and HIV

Anabolic androgenic; cytotoxic; immunosuppressive; Epstein-Barr

monoclonal antibodies

Antibodies produced by a single clone of B lymphocytes and that are therefore identical in structure and antigen specificity

ionizing radiation damages the ___ of the cancer cells

DNA

Paraneoplastic syndromes include ___ syndrome, ___ syndrome, ___, ___, ___ degeneration, limbic or brainstem ___, ___, ___, and sensory ___

Lambert-Eaton myasthenic; stiff-person; encephalomyelitis; myasthenia gravis; cerebellar; encephalitis; neuromyotonia; opsoclonus; neuropathy

tumor cells secrete a protein called ___

MMP

angiogenesis leads to ___ of the tumor

Neo-vascularization

opsoclonus

Neuroblastoma

Rb gene

Retinoblastoma

TNM system of staging

T- tumor size N- nodal involvement M- metastasis

most common form of kidney cancer found in childhood; 75% of diagnosis occur under the age of __

Wilm's tumor (nephroblastoma); 5

neoadjuvant therapy

a cancer treatment that precedes other treatment, such as administering chemotherapy or radiation therapy to a patient before surgery

neuromyotonia

a rare neuromuscular disorder that involves continuous peripheral nerve stimulation of the muscles

atrophy

adult sized organ shrinks

___ is a dietary factor that's been shown to increase risk of breast and colon cancers

alcohol

etiology of cancer

alteration of DNA caused by chemical carcinogens, viruses, or radiation

cancer patients often suffer from ___, ___, and ___ (blood disorders)

anemia; leukopenia; thrombocytopenia

development of new blood vessels; formation of thin-walled endothelium lined structures with/without muscular smooth muscle wall and pericytes (or fibrocytes); this form plays an important role during the adult life span, also as "repair mechanism" of damaged tissues.

angiogenesis

cachexia is associated with ___, early ___, weight ___, ___, ___, ___ alteration; and altered ___, ___, and ___

anorexia; satiety; loss; anemia; asthenia; taste; protein; lipid; carb metabolism

angiogenesis often used to summarize all different types and medication of ___

arterial vessel growth

formation of medium-sized blood vessels possessing the tunica media and the adventitia

arteriogeneisis

Myethenia Gravis

autoimmune disease; antibodies against acetylcholine receptor cause abnormal muscular fatiguability

___ cancers are more prevalent on sun or radiation exposed areas of skin; typically associated with lesions that have raised, rolled, ___ borders with and ___ centers

basal cell carcinoma; pearly; ulcerated

when MMP reaches a blood or lymph vessel, they break down the ___ surrounding the vessel through enzymatic action, opening access to the ___ cells lining the vessel; the tumor cells then enter the blood or lymph by passing through the ___ of these cells

basement membrane; epithelial; tight junctions

non-cancerous, localized, noninvasive; usually cause little harm but can be lethal; occludes organs and interferes with function

benign neoplasm

growth of cancerous colonies depend on an adequate ___

blood supply

in metastasis, tumor cells detach from the original tumor site, invade and spread through the ___ and ___ and then begin the process of ___ to establish a new colony in a distant site

blood; lymphatics; seeding

leukopenia and thrombocytopenia are caused by direct tumor invasion of ___; also problematic because ___ are toxic to the ___

bone marrow; chemo drugs; bone marrow

most sever of malnutrition

cachexia

immortality

cancer cells undergo endless division due to enzyme and don't die like normal cells

stage 1

cancer confined to organ of origin

Local invasion

cancer spreads to contiguous organs

distant metastasis

cancer spreads to distant organs

growth

cancerous cells grow

chemotherapy compartment 3

cells not dividing or that have irreversibly left the cell cycle; these cells die a natural death

chemotherapy compartment 1

cells undergoing mitosis and cytokinesis

genetic changes include abnormal ___; local ___ formation; ___ of surrounding; ability to ___

cellular proliferation; tumor; invasion; metastasize

well differentiated structure

close resemblance to ancestors

metaplasia

differentiation stem cells under adverse conditions (pattern of differentiation changes)

principle of dose intensity

direct correlation between dose of a chemotherapeutic agent and killing of tumor cells

local spread of tumors

direct invasion of contiguous organs

6 steps of metastasis: ___ or ___ ___ into ___, ___, or ___ transport into the ___ or ___ transport to ____ ___ and ___ in ___

direct or continuous extensions; penetration into lymphatics, blood vessels, or body cavities; transport into lymph or blood; transport to secondary sites; entry and growth in secondary sites

little or no pain is associated with the ___; influenced by fear, anxiety, sleep loss, fatigue, and overall physical deterioration

early stages of malignancy;

effector cell lymphokines

effector cells are activated by lymphokines and are capable of killing cancer cells

goal of chemo is to ____

eliminate enough tumor cells that the immune system can eradicate the rest

mesenchyme

embryonic connective tissue

3rd most common childhood cancer

embryonic tumors

debulking surgery

excision of a major part of a tumor that cannot be completely removed

cancer cells exit capillaries and enter organs

extravasation

side effects of cancer treatment: main symptom is ___ also disrupts ___, ___, ___, and ___; causes loss of ___

fatigue; GI tract; bone marrow; skin; reproductive tract; hair

___ is a subjective clinical manifestation of cancer; -Tiredness, weakness, lack of energy, exhaustion, lethargy, inability to concentrate, ___, sleepiness, boredom, and lack of motivation

fatigue; depression

malignant cells are unresponsive to ___

feedback mechanisms

tumor cell attaches using ___ and ___

fibronectin; laminin

connective tissue cancer is sarcoma, but can be further divided into ___ or ___

fibrosarcoma; osteosarcoma

sentinel nodes

first set of lymph nodes to receive metastatic cancer cells from an involved organ

T0 = T1 = T2 = T3 =

free of cancer; lesion < 2cm; lesion 2-5 cm; skin/chest wall involved in invasion

neoplasm interfere with the needs of the host and have uncoordinated ___; function independently of homeostatic control and interfere with ___

growth rate; host homeostasis

single agent chemotherapy

had significant initial response rates, but the duration of the response was short-lived; less common; used when combo therapy is less effective

stage 3

has invaded regional structures (lymph nodes)

stage 4

has spread to distant sites and other organs

paraneoplastic syndromes are a group of rare disorders that are triggered by an abnormal ___ to a neoplasm; paraneoplastic syndrome are thought to happen when ___ or ___ mistakenly attack normal cells in the ___ instead of the tumor

immune response; cancer-fighting antibodies; T cells; nervous system

malignant neoplasms trigger an ___ reaction from the body

immunologic

encephalomyelitis

inflammation of the brain and spinal cord

malignant transformation occurs in 3 stages (___, ___, and ___)

initiation; promotion; progression

other forms of immunotherapy include ___ administration; injection of ___; ___; and ___

interferon; antigens; effector cell lymphokines; monoclonal antibodies

biological response modifier

interferon; one of a group of proteins that may help slow or stop the growth of cancer cells

cancer cells invade lymphatics and blood vessels

intravasation

locomotion into the ECM is with ____ (or ___); these are ___-rich protrusions of the plasma membrane that are associated with ___ (step 3) in cancer invasiveness and also involved in ___ (migration)

invadopodia; pseudopodia; actin; degradation of the ECM; metastasis

laminin

key protein found in the basement membrane to which integrins from cells attach

once securely attached to the endothelial lining, cancer cells ___ and ___; they also leave an open pathway that allows ___

leave the vessel; enter the tissue; less invasive tumor cells to invade the tissue and grow

childhood cancers make of ___%; adult cancers make up ___%

less than 1; 99

most common childhood cancer

leukemias

lymphoid cancer is called ___; there is also ___

lymphoma; Hodgkin's disease

invasive growth

malignant cells are free of constraints that inhibit invasive growth so they penetrate adjacent tissues

sarcoma

malignant tumor of connective tissue

malignant neoplasms can cause severe ___ r/t the effect of cytokines and response to tumor

malnutrition

local spread increases ___; release of ___; decreased ___; increased ___

mechanical pressure; lytic enzymes; cell-to-cell adhesion; motility

most childhood cancers originate from the ___ layer; this layer gives rise to the connective tissue (bone, cartilage, muscle, blood) blood vessels, gonads, kidneys, and the lymphatic system

mesodermal germ

Even if surgery was successful in removing all visible cancer, there may be a chance that the cancer could return. This may be due to ___ bits of cancer that may remain and are undetectable with current methods.

microscopic

paraneoplastic syndromes typically affect ___ to ___ people and are most common in individuals with ___, ___, ___, or ___ cancers

middle-age; older; lung, ovarian, lymphatic, or breast

local spread/invasion- ___ rate higher than ___ rate (___)

mitotic; cellular death; cellular multiplication

nodal involvement (lymph nodes); higher number means that ___; graded from N__-N__

more lymph nodes are involved; 0-2

there is no cure of paraneoplastic syndrome; nothing to stop the progressive ___

neurological damage

Lambert-Eaton myasthenic syndrome

neuromuscular disorder presenting with proximal muscle weakness; associated with small cell lung cancer

increased risk of infection in cancer pts because of the fall in ___ and ___ counts; ultimately causes death

neutrophil and lymphocyte

neoplasm

new growth of an abnormal mass of proliferating cells

progression

no longer dependent on carcinogen exposure; proliferation continues

N0 = N1 = N2 =

no nodes involved; mobile nodes involved; fixed nodes involved

connective tissue cancers in childhood are ___ and ___; in adulthood, they are ___

non-epithelial; mesenchymal; carcinomas

the ___ like the Rb gene is a tumor suppressor gene; its activity stops the formation of tumors

p53 gene

If a person inherits only one functional copy of the ___ from their parents, they are predisposed to cancer and usually develop several independent tumors in a variety of tissues in early adulthood, this is a rare condition called ___ syndrome; most tumors just have ___ associated with them

p53 gene; Li-Fraumeni; p53 mutations

cancer s/s = ___

pain

symptom complexes that cannot be explained by the local or distant spread of the tumor or by the effects of hormones released by the tissue from which the tumor arose

paraneoplastic syndromes

environmental cancer factors include ___ or ___ exposure to ___ or ___ or ___; increased ___

prenatal; childhood; ionizing radiation; drugs; viruses (childhood); parental age

mechanisms for cancer pain is ___; ___; and ___ of sensitive structures; ___ of visceral surfaces; tissue ___; and ___

pressure; obstruction; invasion; stretching; destruction; inflammation

there are ___ factors and also ___

proangiogenic; angiogenesis inhibitors

direct extension

process of tumor cells moving into adjacent tissues and organs

for malignant neoplasms, growth is ___ and ___; cells are not ___; there is un-encapsulated irregular expansion (borders not defined); ___ and destroys tissues; proliferating cell (___ and ___ to create secondary tumors)

rapid; progressive; cohesive; invades; breaks off; spreads

in metaplasia, the dividing cells differentiate into cells that are not usually found in that area (may be ___ or ___); this is ___

regular; adaptable; reversible

tumor cells can develop ___ to certain chemotherapies; so when tumor is killed, these ___ cells stay and then they can proliferate to form new tumors

resistance; resistant

started muscle cancer

rhabdomyosarcoma

2nd most common childhood cancer

sarcomas

___ is linked with possible ___ detection of adult cancers; the cancers are usually ___ or ___ at the time of diagnosis; ___ responsive to treatment; fewer ___ with treatment; ___% cured

screening; early; local; regional; less; long-term consequences; less than 60%

formation of metastases

secondary tumors occur at distant sites

4 stages of cancer- involves the ___ of the tumor and the degree to which it has ___ and the extent to which it has ___

size; invaded; spread

dysplasia causes a variations in cell ___; cell ___; ___ and ___

size; shape; appearance; arrangement

causes of fatigue include ___ disturbance; biochemical changes from circulating ___; could be related to disease and treatment; ___ factors; low level of activity; poor ___ status; and ___ factors

sleep; cytokines; psychosocial; nutritional; environmental

smokers often develop ___ cancer

small carcinoma of the lung

the most avoidable risk factor for cancer is ___

smoking/exposure to tobacco

metastasis

spread of cancer from primary site of origin to a distant site

they built a ___ (or supporting framework) of liver, spleen, lymph nodes; red bone marrow; reticular lamina of basement membrane; around blood vessels and muscles; this is not part of the neoplastic cell

stroma

the body may modulate the growth of the ___ as an ___ defense

stroma; anti-neoplastic

palliative surgery

surgery performed to relieve pain or other symptoms but not to cure the cancer or prolong a patient's life

transformation

the process that converts a normal cell to a cancer cell

adjuvant chemotherapy

the use of chemotherapy after primary treatments like surgery or radiation

childhood cancers involve ___; adult cancers involve ___

tissues; organs

4 phases of tumor spread

transformation, growth, local invasion, distant metastasis

oma

tumor

3 step theory of invasion

tumor cell attachment to the ECM; proteolytic degradation/dissolution of the ECM; locomotion into the ECM

the ECM is an active participant in neoplastic and physiologic invasion, and acts as an information highway, an immune sanctuary, and a storage depot supporting ___ and drug resistance.

tumor growth

adenoma

tumor of a gland

metastases

tumor spreads to distant organs through the lymphatic system or blood circulation

asscoiated angiogenic growth factors: ___ factor; ___ factor; ___ factors and loss of ___

tumor-associated angiogenic; basic fibroblast growth; vascular endothelial growth; p53

treatment of paraneoplastic syndrome: treat the ___/___ first, then put the pt on ___

tumor/cancer; immunosuppressants

chemotherapy

use of nonselective cytotoxic drugs that target vital cellular machinery or metabolic pathways critical to malignant and normal cell growth and replication

embryonic tumors originate during ___; embryonic tissues are unable to ___ or differentiate into ___; commonly names with the term "___" (ex: ___)

uterine life; mature; fully developed cells; blast; nephroblastoma; retinoblastoma

as tumor grow, they reach a size that requires additional ___ to sustain growth; to achieve this they release proteins to stimulate ___ growth into and around the tumor

vasculature; blood vessel

___ is the formation of vascular structure from circulating or tissue-resident endothelial stem cells (called ___)

vasculogenesis; angioblasts

Neurologic symptoms generally develop over a period of days to weeks and usually occur prior to the tumor being discovered; include difficulty in ___ and ___, loss of ___, loss of ___, ___, ___ loss, ___ problems, ___ disturbances, dementia, seizures, sensory loss in the limbs, and vertigo/dizziness

walking; swallowing; muscle tone; fine motor coordination; slurred speech; memory; vision; sleep;

cachexia is a ___ syndrome characterized by dramatic loss of ___ and ___ and often accompanied by substantial weight ___; most commonly seen in ___ and ___ cancer, but also lung, esophageal, colorectal, and head and neck cancers

wasting; skeletal muscle; adipose tissue; loss; gastric; pancreatic