Chapter 1

incidence rate = ______________

# new cases/population

In what part of the body are transitional epithelium located?

Bladder

What would a tumor arising from cells lining the oral cavity be called?

Squamous cell carcinoma

(True or False) Malignant tumors are capable of invading blood vessels & benign tumors are not.

True

Veins of the _______________arrive to the liver

abdomen

What is the tissue of origin for Chondrosarcoma?

cartilage

Neoplasia means

new growth

Neoplasm means

new growth

True or false: often it is not possible to determine the actual cause of death with cancer.

true

prevalence rate = _______________

(# new cases + # of people living with the disease)/ population

mesenchymal cells are from the _____________ layer and can be called the "________________".

- Mesoderm - "middle cells"

what are 2 descriptive adjectives relating to form or function of a tumor?

- papillary -psammomatous

malignant tumor

-An abnormal tissue mass that can spread into neighboring tissue and to other parts of the body; a cancerous tumor. -composed of cells that do not appear similar to the normal cells from wich it developed from -structure is atypical (Poor differentiation)

What are the 2 tissues that are also considered mesenchymal tissues, but have their own classification system?

-Blood (Leukemia) -Lymphatic tissue (Lymphoma)

What are the roles surgery plays in the overall management and treatment of cancer?

-Diagnosis -Primary treatment -multidisciplinary treatment -palliation -(local treatment only)

Describe what is happening in the picture and mention angiogenesis.

-From the original tumor site, parts have made it past the basement membrane and are infiltrating into surrounding tissue -intravasation into blood vessels and travel/disseminate -they then arrest in the capillary bed -extravasation through blood vessel wall and into another tissue -to colonize and proliferate

What is the difference between incidence and prevalence?

-Incidence: # of new cases at a particular time -prevalence: # of individuals living with the disease at a certain point in time

When a tissue sample is taken during biopsy, what medical professional is it sent to, to be looked at?

-Pathology

Correlate between differentiation and proliferation.

-Poor/less differentiation = more proliferation -Good/Strong/more differentiation = less proliferation

what are two subsections that go off of myosarcoma, originating in the muscle tissue?

-Rhabdomyosarcoma -leiomyosarcoma

What are the two characterization types of aneuploidy?

-Tetraploid -Hypoloid

What is meant by differentiation?

-The more differentiation a cell has, the less likely it is to be able to divide -Poor differentiation = malignant -Good/strong differentiation = benign

How would a theory of cancer as an initially diffuse disease affect the treatment and outcome?

-When cancer is thought to be diffuse at the time of diagnosis: surgery and radiation therapy are not treatment options. Chemotherapy is not effective when the tumor burden is high. When the theory is that the cancer is already

benign tumor

-a mass of abnormal cells that remains at the site of origin -composed of cells that appear similar to the normal cells from which it developed from (Good differentiation)

Where in the body are glandular epithelium found?

-areas specialized to produce and secrete substance

How are cancer cells identified?

-biopsy -surgery

Where in the body are transitional epithelium found?

-bladder (general location -areas to be distended or stretched

What are the main sites of metastasis for breast?

-bone, brain, liver, lung

What are the main sites of metastasis for prostate?

-bone, liver, lung, adrenal gland

When metastasizing, lung cancers usually spread to the _______________ and prostate cancer typically metastasizes to the ________________.

-brain -bone

What are the main sites of metastasis for lung?

-brain, bone, liver, opposite lung, adrenal gland

Where is carcinoma in situ commonly found?

-breast cancer -melanoma

Define Malignant Pleural Effusion.

-build up of fluid and cancer cells that collects between the chest wall and lung

What is all included in the lymphatic system?

-capillaries -vessels -valves -ducts -nodes -organs

What are risk factors identified with the cause of disease?

-carcinogens

define metastasize

-cells gone beyond original site, spread to other places

What is the result of spread through infiltration, intravasation, & extravasation?

-colonization and proliferation of metastatic tumor = poor prognosis

Data collection became standardized so information could be _____________________

-combined from mult. registries. -National Cancer Data base (NCDB) & Commission on Cancer (CoC)

How does cancer cause death?

-commonly due to involvement of vital organs

Mesenchymal cells make up what in the body? (4 things)

-connective tissue -muscle -bone -cartilage

What does a psammomatous look like?

-contains granular material

How does cancer indirectly cause death?

-decreased ability to fight infections

Incidence of cancer occurrence can be linked to what?

-demographics

etiology and epidemiology together help to...

-determine screening test for early detection -develop patient education programs -identify target populations

What is the neoplastic process?

-disordered growth -new growth beyond the limits of normal cell growth pattern

Define Pleomorphic

-distorted cell shape -used to describe variability in the size, shape and staining of cells and/or their nuclei

Define dysplasia

-distorted growth -abnormal development of cells within tissues or organs

What cells are able to proliferate?

-embryonic cells

abdominal cavity contains...

-encloses most digestive organs and kidneys

what is the name of a benign epithelial tumor?

-epithelioma

How does cancer directly cause death?

-erosion -hemorrhage

Retrospective study

-evaluates data and events that already occurred to correlate info to the cause of disease

Peritoneal Effusion

-excess collection of fluid in the abdomen

Explain the direct spread of cancer.

-expansion into intercellular spaces and infiltration into adjacent spaces -to any structure nearby (overylying skin, underlying bone)

Define metastasize

-exporting cancer cells to other parts of the body -beyond original site Ex.) Starts in the lungs and spreads to the brain

the lymphatic system is a _____________ system, a complex network of tissues and organs

-filtration

Where are epithelial cells located throughout the body?

-form the covering of all body surfaces, line body cavities and hollow organs

Prospective study

-forward looking cohort studies with a known starting point

Why is Etiologic information important?

-future prevention and education -identify people of higher risk

what 10 things of demographics can attribute to incidence?

-gender -age -geographic location -race/ethnicity -chemicals -obesity -diet -hormones -immunosuppression -infectious agents

What cancer's tissue of origin is adenoma?

-glandular epithelium

Where in the body are simple cuboidal epithelium found?

-glandular tissue & kidney tubules

Define infiltration

-growing beyond original layer of tissue into surrounding tissue

Why is it important for us to understand the lymphatic system, including location of lymph nodes an direction of flow?

-in order for us to know where to look and what lymph nodes to look in, to find tumors faster

Define hyperplasia

-increase in number of cells -increase in the number of cells in an organ or tissue that appear normal under a microscope

What is a cancer registry?

-information system intending for the collection, storage, and analysis of data on people with cancer

What is it called when certain stains are used to prepare the slide and the nucleus appears darker than normal cells

-it has hyperchromatic nuclei

Define hypoloid

-less than the normal number

Where in the body are pseudostratified columnar epithelium found?

-lines respiratory tract and some tubes in male reproductive tract

Where in the body are simple columnar epithelium found?

-lines stomach and intestines

What are the main sites of metastasis for colorectal?

-liver, lung, peritoneum

What are the main sites of metastasis for ovarian?

-liver, lung, peritoneum

Define anaplasia

-loss of cell differentiation -describes cells that have lost their unique characteristics that define them as a certain tissue type

Cancer registry is used to/as:

-maintain cancer incidence reporting system -resource to study cause of cancer -provide information used in establishing cancer prevention programs -help administrators decide where to allocate funds for equipment

What does a papillary look like?

-nipple-shaped elevation

Explain what is Lymphatic spread.

-one way flow throughout vessels -pressure system (fluid flows from larger to smaller vessels (arteries and veins)

pre-metastatic niche

-organs of future metastasis are chosen and modified by tumor secreted factors -time when tumor cells seed -proliferation and colonization occur

What is the impact on treatment intent of blood borne spread?

-palliative treatment intent (make patient feel comfortable and give pain relief)

Defined population

-population with specified characteristics such as: size, time period, location, age, sex, race, occupation, etc.

what is another way or name to say carcinoma in situ?

-pre-cancer -stage 0 cancer

Where in the body are simple squamous epithelium found?

-present where absorption and transport of materials is necessary -kidney, alveoli of lungs, walls of capillaries

What type of data is recording in cancer data collection?

-primary site of cancer -cell type -extent of the disease -treatment info

What is the role of radiation therapy in the treatment of cancer?

-primary treatment -multidisiplinary treatment -palliation -(local treatment only)

Define transplantation

-process of moving cells, tissues, and organs from one site to another for the purpose of replacing or repairing damaged or diseased organs and tissues -cancer that is spread mechanically (not naturally)

Define Apoptosis

-programmed cell death -controls cells from getting out of control

What is the impact on treatment intent of direct spread and lymphatic spread?

-radical treatment intent

How are blood borne things spread?

-start with direct invasion through basement membrane into blood vessel

What is epidemiology?

-study of disease incidence and patterns of disease in populations

What is Etioogy?

-study of the cause of cancer

Define carcinogen

-substance or agent that can cause cancer by damaging DNA

When does transplantation of cancer happen?

-surgery or biopsy -surgical hands -along needle tract during biopsy

What is the role of chemotherapy in the treatment of cancer?

-systematic treatment -primary treatment -multidisciplinary treatment

Define Necrosis

-tissue death -unexpected due to infection

Under a microscope, metastatic tumors look similar to what area?

-to the original tumor, not the tissue it resides in

Define metaplasia

-transformation of one cell type to another -conversion of one cell type to another and can include conversions between tissue specific stem cells

Define tetraploid

-twice the normal diploid number

Define cancer

-uncontrolled cell growth -neoplasm characterized by uncontrolled growth of anaplastic cells that tend to invade surrounding tissue and metastasize to distant body sites

Name the location of which the visceral layer, prarietal layer and serous fluid are in the lungs.

-visceral layer: inner layer, covers internal organs -parietal layer: outer layer, lines the body cavity -serous fluid: between the two layers

Worse differentiation=

-worse prognosis -more metastases

Name 2 types of Carcinomas

1. Adenocarcinoma 2. Squamous Cell Carcinoma

If malignant cells invade other pulmonary vessels, they can be swept off into the arterial side of the pulmonary circulation and lead to what 3 parts of the body?

1. Brain 2. Heart 3. Skin

In order, what are the top 3 types of cancer for women?

1. Breast 2. Lung & Bronchus 3. Colorectal

What are 5 modes of spread for cancer?

1. Direct 2. Lymphatics 3. Blood 4. Trans-coelomic 5. Transplantation

In order, what are the top 3 most common childhood cancers? Name the percentage as well.

1. Leukemia (29%) 2. Brain/CNS (26%) 3. Neuroblastoma (6%

3 most common childhood cancers

1. Leukemia (29%) 2. Brain/CNS (26%) 3. Neuroblastoma(6%)

In order, what are the top 3 types of cancer that women die from?

1. Lung & Bronchus 2. Breast 3. Colorectal

In order, what are the top 3 types of cancer that men die from?

1. Lung & Bronchus 2. Prostate 3. Colorectal

What 6 locations in the body are the most common destinations of blood borne metastases?

1. MOST COMMON: lungs 2. liver 3. brain 4. skin 5. bone 6. RARELY: skeletal muscle, heart, and spleen

What are the 3 main functions of lymphatic system?

1. Maintain fluid balance 2. Absorb and transport fats to bloodstream 3. produce lymphocytes and macrophages to protect against infectious agents and foreign bodies

Name the malignant cancer that comes from each of the tissue of origins shown: 1. Bone 2. Fibrous tissue 3. Fatty tissue 4. Cartilage 5. Muscle

1. Osteosarcoma 2. Fibrosarcoma 3. Liposarcoma 4. Chondrosarcoma 5. Myosarcoma

In order, what are the top 3 types of cancer for men?

1. Prostate 2. Lung & bronchus 3. Colorectal

What are the 2 types of epidemiological studies?

1. Retrospective study 2. Prospective study

Epithelial cells can have a single layer or multiple layers. What are those each called?

1. Simple 2. Stratified

what are the 3 shapes of epithelial cells?

1. Squamous (flat) 2. Cuboidal (cubed) 3. Columnar (column like)

Name 3 examples of carcinoma, type - Adenocarcinoma. Also name their tissue of origin.

1. Squamous cell carcinoma - origin: squamous cells 2. Adenocarcinoma - origin: glandular 3. Bile Duct Carcinoma - origin: bile duct

Name 3 examples of carcinoma, type - Squamous Cell Carcinoma. Also name their tissue of origin.

1. Squamous cell papilloma - origin: squamous cell 2. Bile Duct Adenoma- origin: bile duct 3. Adenoma - origin: glandular

What are the 4 tumor classifications?

1. Well differentiated 2. Moderated differentiation 3. Poor differentiation 4. Undifferentiated

Explain the path of micromet from start to finish.

1. cell transformation (tumor development) 2. Angiogenesis (from blood supply or create own) 3. Invasion 4. Intravasation 5. Adhere to wall to get into tissues (requiring angiogenesis again) 6. Extravasation 7. metastasis or secondary tumor (caused by something else)

Malignant cells in the lungs can form what 3 things?

1. colonies (growing much like original tumor) 2. deposits (on visceral pleura) 3. Invade other pulmonary vessels

Explain the lymphatic spread shown in the photo.

1. fluid leaves interstitial spaces, becomes lymph 2. lymph enters lymphatic capillary 3. enters lymph node (afferent vessel) 4. exit node (efferent vessel) 5. travel to trunk 6. passes to collecting ducts 7. empty to subclavian veins 8. empty to superior vena cava 9. drains to the heart and back to bloodstream

What are some characteristics of benign neoplasms? (7)

1. good differentiation 2. may keep growing or reach a limit 3. slow growth rate (few cells in mitosis) 4. typically encapsulated by fibrous tissue 5. doesn't destroy surrounding tissue 6. doesn't spread distantly 7. Descriptive name ending in "oma" (except carcinoma)

What are some appearances of cancer cells?

1. hypertrophic 2. pleomorphic 3. increased nuclear/cytoplasmic ratio 4. aneuploidy 5. hyperchromatic nuclei 6. abnormal mitosis present

Name 5 characteristics of cancer.

1. increased cell size 2. distorted cell shape 3. abnormal mitosis present 4.deviation in the normal amount of chromosomes 5. nucleus enlarged

What are some characteristics of malignant neoplasms? (7)

1. poor differentiation 2. uncontrolled growth (no apoptosis mechanism) 3. Rapid growth rate (many cells in mitosis) 4. abnormal spread locally and distantly 5. no encapsulation, allowing infiltration 6. invasive, destroys surrounding tissue 7. descriptive name commonly ending in "carcinoma" or "sarcoma"

What is the order of the metastatic process from start to finish. (7 steps)

1.Cell Transformation 3.Angiogenesis 4.Invasion 5.Intravasation 6.Adherence 7.Extravasation 8.Metastatic Tumor Growth

Concept of disease registries date back to what year?

1500's

Modern Cancer Registries began in the early _____________'s.

1900's

What year what SEER established?

1973

What are the first and second leading cause of deaths for children?

1st: accidents 2nd: cancer

What is the first and second leading cause of death in the U.S.?

1st: heart disease 2nd: cancer (1 in every 4 deaths)

What is the order of plasias (ana, hyper, dys, etc.)

???????????

Define aneuploidy

Abnormal number of chromosomes.

Difference between afferent and efferent vessels.

Afferent: bring lymph into node & is larger and more numerous Efferent: bring lymph away from the node & is smaller and less numerous

What are the characteristics of benign and malignant cells?

Benign tumors: -not malignant -they are usually well differentiated -do not invade neighboring tissue -often encapsulated -do not harm the host unless their location is such that the tumor expansion will affect the host. Malignant cells: -have a range of differentiation -some are slow growing -others are fast growing -have the ability to leave the primary tumor and spread to distant sites -infiltrate and destroy neighboring cells.

What is the difference in destruction of tissue for both benign and malignant tumors?

Benign: does NOT destroy Malignant: yes destructive

What is the difference in encapsulation for both benign and malignant tumors?

Benign: encapsulation with fibrous tissue Malignant: normal to increased encapsulation rate

What is the difference in the local mode of growth for both benign and malignant tumors?

Benign: expanding and pushing Malignant: no encapsulation!

What is the difference in differentiation for both benign and malignant tumors?

Benign: good/strong differentiation Malignant: poor differentiation

What is the difference of life threat for both benign and malignant tumors?

Benign: little to rare Malignant: can be to yes

Difference between benign or malignant.

Benign: mild character, doesn't threaten ones life and is non-cancerous Malignant: cancerous and can take someone's life

What is the difference in blood vessel invasion for both benign and malignant tumors?

Benign: no invasion of blood Malignant: invasilon of blood to metastasize, ect

What is the difference in metastases for both benign and malignant tumors?

Benign: no metastases Malignant: yes metastases

What is the difference in mitotic rate for both benign and malignant tumors?

Benign: normal Malignant: normal to increased rate

What is the difference in growth rate for both benign and malignant tumors?

Benign: normal growth Malignant: normal to accelerated growth rate

What is the tissue of origin for Osteoma?

Bone

What is the difference between carcinoma in situ and stage 1 carcinoma?

Carcinoma in situ: malignant changes are at the cellular level (considered non-invasive) Stage 1 carcinoma: invasive and spreads beyond the basement membrane

What do DCIS and LCIS stand for?

DCIS: Ductal Carcinoma in Situ LCIS: Lobular Carcinoma in Situ

During embryonic development, the 3 layers are formed in what order?

Ectoderm --> Mesoderm --> Exoderm

What is the difference between etiology and epidemiology?

Etiology looks for the cause of disease. Epidemiology looks for the incidence of disease in specific groups.

(True or False) Benign tumors have a higher mitotic rate than malignant tumors.

False

(True or False) Malignant tumors are encapsulated.

False

(True or False) The term neoplasm is only used when describing a malignant tumor.

False

(True or False) Hypertrophy and hyperplasia have the same meaning.

False - Hypertrophy means the increase in cell size and Hyperplasia means increase in the number of cells

(True or False) Malignant tumors destroy nearby tissues by pushing and expanding

False, benign tumors push and expand while malignant tumors are invasive and infiltrate other tissues

True or false: Chance of transplantation during surgery or biopsy is extremely high.

False: it is extremely low. -surgeons follow standard procedures to safely prevent cancer cells from spreading during procedures

________________________ are required to report new cancer diagnosis to a central cancer registry.

Healthcare facilities

____________________ is a malignant tumor of smooth muscle.

Leiomyosarcoma

_________________________ are used to provide statistical information about patterns of cancer occurrences and death rates.

National databases

_______________ is a characteristic of cancer.

Neoplasm

A new and abnormal growth of cells is a ______________

Neoplasm (tumor)

What is the tissue of origin for Malignant Melanoma?

Neuroectoderm

Does dissemination mean metastasis?

No, the tumor could spread and nothing happens. In order to metastasize, it must establish a blood supply

What would a primary tumor of the bone be called?

Osteosarcoma

what is the name for multiple layered column shaped epithelial cells?

Pseudostratified columnar

_____________________ is a malignant tumor of striated muscle.

Rhabdomyosarcoma

SEER stands for...

Surveillance, Epiedemiology, and End Results Program

What roles does the radiation therapist play in patient care and treatment?

The radiation therapist is the one individual in the cancer center who sees the patient on a daily basis. -Radiation therapists provide: comfort, education, referrals as needed, and accurate treatment. -To ensure the patient receives accurate treatment, the radiation therapist is involved in continuous quality improvement and quality assurance.

(True or False) Tumors arising in the aero-digestive tract will most likely be squamous cell carcinoma.

True

True or false: more than 100 types of cancer have been identified and categorized.

True

True or false: most solid tumors originate from epithelial tissues, therefore considered carcinomas.

True: because epithelial cells are widely distributed and metablolically active

multicentric tumors

Tumors that have more than one focus of the disease (many primary tumors in surrounding area) ex.) breast or lung

Correlate between differentiation and prognosis.

Usually: -Poor differentiation = more aggressive cancer = more likely to metastasize = worse prognosis -Good/Strong differentiation = better prognosis

Retrospective cohort study

a group of people have been exposed to a specific potential disease causing agent are followed to see if people develop the disease

Retrospective case-control study

a group of people who have the disease are compared to similar people who do not have it

ascites

abnormal accumulation of fluid in the abdomen

Benign or Malignant: -Adenoma

benign

Benign or Malignant: -Osteoma

benign

Benign or Malignant: -Papilloma

benign

pelvic cavity encloses...

bladder and reproductive organs

Trans-coelomic spread is seeding across a __________________.

body cavity

In normal cellular proliferation, cell birth = ___________________

cell birth = cell death

Define anaplastic

cells dont look like they should or act as they should

Define necrosis

death of tissue

Which is not a potential result of micro-metastasis? a.) disintegration b.) dormancy c.) tumor cell death d.) metastatic colonization

disintegration- process of losing strength or cohesion

Define Pleomorphic

distorted cell shape

dorsal body cavity contains

encloses brain and spinal cord

What original tissue type is the malignant tumor, Carcinoma, from?

epithelial cells

Define body cavity

fluid filled space in the body that holds and protects organs

Cancer is rapid cellular proliferation followed by _______________________ but _________________ proliferation.

followed by continuous but slowed proliferation

Epithelial cells are a major tissue in ____________

glands

What is the tissue of origin for Adenocarcinoma?

glandular epithelium

What original tissue type is the malignant tumor, Adenocarcinoma, from?

glandular epithelium

Define infiltration

growing beyond original layer of tissue into surrounding tissue

thoracic cavity contains...

heart and lungs

Define hypertrophy

increase in cell size

Define proliferation

increase in number of cells

Endophytic tumors grow __________________.

inward -invade underlying tissue =worse prognosis

Biologic behavior means:

is it benign or malignant

What cancer's tissue of origin is smooth muscle?

leiomyosarcoma

The more differentiation a cell has the ____________ likely it is to be able to divide.

less likely

Where are epithelial cells found?

lining of all body cavities and body surfaces

Define hemorrhage

loss of a large amount of blood in a short period of time.

In what part of the body are squamous epithelium located?

lungs

Carcinomas from epithelial tissues most often spread through the ___________________.

lymphatic system

Benign or Malignant: -Adenocarcinoma

malignant

Benign or Malignant: -Chondrosarcoma

malignant

Benign or Malignant: -Leiomyosarcoma

malignant

Benign or Malignant: -Malignant Melanoma

malignant

Benign or Malignant: -Rhabdomyosarcoma

malignant

Benign or Malignant: -Transitional Cell Carcinoma

malignant

what is carcinoma in situ?

malignant changes at the cellular level

What original tissue type is the malignant tumor, Sarcoma, from?

mesenchymal cells

define extravasation

movement of a cell through a wall of a blood vessel of lymph vessel, into another tissue

define intravasation

movement of a cell through a wall of a blood vessel or lymph vessel

Cancer data collection starts with identification of _____________________________.

new cancer diagnosis

Will all tumor cells that enter the bloodstream become a metastasis?

no

Does tumor mean cancer?

no - can be benign

Does cancer mean a tumor?

no - ex. Leukemia

Does it take long for things to transport through the layers of simple squamous epithelium?

no, single layer

proliferation refers to the increase in ___________________________

number of cells

anatomic site refers to...

origin or region

Exophytic tumors grow _________________.

outward -can invade usually in later stages

What cancer's tissue of origin is squamous, or transitional cells epithelium?

papilloma

What cancer's tissue of origin is striated muscle?

rhabdomyosarcoma

Is a tumor of the heart considered a carcinoma or a sarcoma?

sarcoma

_________________ originate from the mesenchymal cells

sarcomas

What lines the body cavities and covers organs?

serous membranes

growth refers to increase in ____________

size

Is it easier for infiltration to happen more rapidly in soft tissue or bone?

soft tissue

90% of all head nad neck cancers are ______________________________ carcinomas.

squamous cell carcinomas

Define demographics

statistical data relating to the population and particular groups within it.

___________________ veins arrive to the lungs

systemic veins

Define erosion

the process of eroding or being eroded by wind, water, or other natural agents.

Define histogenesis.

tissue of origin and cell type

define disseminate

to distribute or scatter over a range

Encapsulate

to take in; to surround; to encase or protect

What cancer's tissue of origin is transitional cells?

transitional cell carcinoma

True or false: a cancer cell's nucleus could be as large as the entire cell.

true

True or false: data collection typically ends after the patients death.

true

True or false: the lungs are the most common site of asis for sarcomas

true

True or false: tumors that remain localized are easier to treat.

true

What is an eponym?

tumors named after the person who first characterized the cancer

What is a carcinoma?

tumors originating from epithelial cells

define sarcoma

tumors originating from mesenchymal cells

Define adenocarcinoma

tumors that originate from glandular epithelium

Define squamous cell carcinoma

tumors that originate from squamous cell types of epithelium

In blood borne spread, which are most common, arteries or veins?

veins: they are thinner

on the Gompertzian growth curve, what are the x and y axises labled?

x-axis: time y-axis: cell number