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