NSG 533 Advanced Pathophysiology Exam 2 Questions With Complete Solutions Grade A+

1. Many tumors have begun to metastasize at the time of detection. What percentage? - ANSWER It is estimated that 60% of patients with solid tumors have microscopic or macroscopic metastasis at diagnosis 2. How does Heterogeneity of tumor affect metastasis? - ANSWER Each cell within tumor mass is not equal in metabolic needs, resistance to treatment, etc. 3. What signaling protein allows for endothelial cells to migrate to growing tumors?? - ANSWER Tumor necrosis factor-alpha stimulates migration of endothelial cells 4. Which pro-angiogenic growth factor is over expressed in a wide range of solid tumors? - ANSWER Vascular endothelial growth factor (VEGF) 5. Overexpression of what protein in cancer cells breaks down EC matrix and basement membranes and is associated with decreased survival - ANSWER Matrix metalloproteinases (MMP) are proteolytic enzymes that degrade EC matrix and basement membrane 6. Recent data supports hypothesis that cancer cells interact with____________ to stimulate and release ______. - ANSWER local stromal cells MMP 7. How is immune function related to decreased cancer survival? - ANSWER Deficient immune function can promote escape from immune destruction of tumor cells 8. What are 2 ways metastatic cancer cells use platelets to their benefit? - ANSWER - Malignant cells secrete substances that signal platelet aggregation which maximizes their ability to arrest in blood vessel. - Tumor-platelet aggregate may be protected from immune cell penetration 9. Why is normal platelet function is required for optimal metastasis? - ANSWER Unless tumor cell can enter capillary bed, it will most likely not survive the hostile environment of the circulation 10. What are 4 common sites of metastasis? - ANSWER Bone Lung Liver CNS 11. What are the 5 steps in metastatic process - ANSWER Detachment from primary tumor Invasion of surrounding tissue, entry into lymphatic vessel or blood vessel Survival in transport Arrest in distant organ capillary bed Establishment of secondary tumor 12. Intrinsic inflammation pathway - ANSWER Driven by genetic alterations resulting in inflammation & neoplasia. 13. Extrinsic inflammation pathway - ANSWER Driven by inflammatory conditions that increase cancer risk. 14. Hypertrophy - ANSWER Increase in size of cells; this process does not involve proliferation, but there is often co existence hyperplasia 15. How does cell differentiation relate to cancer/metastasis? - ANSWER Fully differentiated cells are often incapable of dividing and are committed to perform functions of the particular tissue they compose 16. Cell differentiation grades 1 (____) to Grade 4 (_____) - ANSWER well differentiated, low grade poorly differentiated, high grade, anaplastic--hallmark of malignancy 17. Hyperplasia - ANSWER Increase in number of cells; the 2 main causes are chronic irritation & hormonal influences 18. Metaplasia - ANSWER When affected tissue is replaced with mature cell of another tissue not normally found in affected tissue; eg, columnar epithelium in the respiratory tract of smokers is replaced with squamous cells 19. Dysplasia - ANSWER Abnormal cytologic features and tissue organization; size, shape, and organization of cell is varied; possibly reversible; strongly associated with subsequent neoplasm 20. Anaplasia - ANSWER Profound cytologic disorganization; hallmark of malignant tumors that are poorly differentiated 21. Which abnormal growth patterns are reversible? - ANSWER Growth patterns up to and including metaplasia are reversible 22. In TNM classification, T categorizes what? - ANSWER T categories are based on the size of the breast cancer and whether it has spread to nearby tissue 23. Hereditary diffuse gastric cancer (HDGC) susceptibility syndrome involves germ line mutations in which gene? What does it encode? - ANSWER CDH1 gene that encodes the protein E-cadherin 24. Hereditary breast & ovarian cancer is more common in which ethnic group? - ANSWER More common in people of Ashkenazi Jewish decent 25. Women with hereditary breast & ovarian cancer (HBOC) syndrome have a germ line mutation in which gene? - ANSWER Either BRCA1 or BRCA2 26. Approximately what percent of gastic cancers involves germ line mutations in CDH1 gene? - ANSWER Approximately 3 % of all gastric cancers 27. Life time risk of developing breast & ovarian cancer is up to _____% (breast) and _____% (ovarian). - ANSWER 85% 40% 28. HNPCC (Hereditary non-polyposis colorectal cancer), also known as Lynch Syndrome, comes from a mutation in several genes involved in what function? - ANSWER DNA repair 29. EMBRA - ANSWER - Early age on onset: 40 - 50 years for adult onset cancers - Multiple primary cancers in a single individual: (breast & ovarian) - Bilateral cancers in paired organs (breast, kidney) - Rare presentations of cancer (male with breast cancer) - Abnormalities known to be linked with ↑ cancer risk—atypical nevi & risk of melanoma 30. What is one of the most common types of hereditary cancer? - ANSWER Breast and ovarian cancer 31. Familial cancers suggest a clustering of cancers that likely occurred by chance. How is this explained? - ANSWER There may be a combination of genetic and non genetic (i.e., environmental) factors that contributed to the development of cancers within a family. i.e. smoking, obesity 32. True or False. In familial cancer, an alteration in a single major gene is typically identified. - ANSWER False. In familial cancer, an alteration in a single major gene is unlikely or not identified 33. What are four examples of environmental factors that may influence cancer risk? - ANSWER Diet, lifestyle, sun exposure, hormonal responses 34. In TNM classification, N categorizes what? - ANSWER The N category is based on which of the lymph nodes near the breast, if any, are affected by the cancer. There are 2 classifications used to describe N. One is clinical—before surgery—the other is pathological. 35. In TNM classification, M categorizes what? - ANSWER The M category depends on whether the cancer has spread to any distant tissues and organs. M0: No distant cancer spread. M1: Cancer has spread to distant organs. 36. Inherited forms of cancer are __________ mutations are thought to account for approximately _______% of all adult cancers - ANSWER germ line 5-10% 37. What are the three defining characteristics of cancer cells? - ANSWER Dysregulated growth - this factor alone does not cause malignancy; ability to invade and metastasize are of equal pathophysiologic importance Capacity for local invasion Metastasis 38. Up to ____% of cancers are linked to environmental factors. - ANSWER 90% 39 Bening tumor or malignant tumor? Slow growth - ANSWER Benign tumor 39. Which population is particularly at risk in developing cancer related to immunologic factors? - ANSWER Kidney transplants - greater risk of developing cancer after having a transplant and having been on long-term immunosuppression. 40. Bening tumor or malignant tumor? Defined capsule - ANSWER Benign tumor 41. Bening tumor or malignant tumor? Not invasive - ANSWER Benign tumor 42. Well differentiated - resembles tissue from which they arose - ANSWER Benign tumor