Precancerous Conditions and Neoplasia III
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Questions and Answers

What is the result of tumor cells failing to express co-stimulatory molecules for T-cells?

  • T-cells undergo apoptosis (correct)
  • T-cells differentiate into a new cell type
  • T-cells are sensitized against cancer cells
  • T-cells are activated to fight infection

    • What is the effect of tumor growth factor- β (TGF-β) on the immune system?

  • It is a potent immunosuppressant (correct)
  • It has no effect on the immune system
  • It enhances the immune response
  • It stimulates T-cell proliferation

    • What is the result of antigen masking by tumor cells?

  • The immune system is differentiated into a new cell type
  • The immune system is enhanced to fight infection
  • The immune system is unable to recognize the tumor (correct)
  • The immune system is activated to fight the tumor

    • What is a common effect of local tumor progression?

    <p>The surrounding tissue is compressed and damaged</p> Signup and view all the answers

    What is a potential effect of a benign pancreatic β-cell adenoma?

    <p>It produces excessive insulin causing hypoglycemia</p> Signup and view all the answers

    What is a common complication of tumor growth?

    <p>Bleeding and secondary infections</p> Signup and view all the answers

    What is an acute presentation of a tumor?

    <p>All of the above</p> Signup and view all the answers

    What is a potential effect of a pituitary adenoma?

    <p>It causes hypopituitarism</p> Signup and view all the answers

    Which of the following conditions is NOT an example of a non-neoplastic precancerous condition?

    <p>Villous adenoma of the colon</p> Signup and view all the answers

    What is the term for the immune system's ability to detect and eliminate emerging malignant cells?

    <p>Immune surveillance</p> Signup and view all the answers

    What is the estimated percentage of individuals with congenital immunodeficiencies who develop cancers?

    <p>5%</p> Signup and view all the answers

    Which of the following is a mechanism by which tumor cells can escape the immune system?

    <p>Loss or reduced expression of MHC molecules</p> Signup and view all the answers

    What is the term for the increased frequency of cancers in immuno-deficient hosts?

    <p>Immuno-deficiency associated cancer</p> Signup and view all the answers

    What is an example of an acquired immunodeficiency?

    <p>AIDS</p> Signup and view all the answers

    What is the purpose of HLA class I molecules in immune response to tumors?

    <p>To activate cytotoxic T cells</p> Signup and view all the answers

    Which of the following is NOT a reason why most cancers occur in individuals without immune deficiency?

    <p>The immune system is always able to detect and eliminate tumor cells</p> Signup and view all the answers

    What is the primary purpose of grading and staging of cancers?

    <p>To assess the prognosis of a disease</p> Signup and view all the answers

    What is the main difference in weight loss between cancer cachexia and starvation?

    <p>Equal loss of fat and muscle in cancer cachexia, whereas muscle mass is preserved in starvation</p> Signup and view all the answers

    What is the significance of the number of mitoses in cancer grading?

    <p>It is a microscopic feature that influences the expected behavior of cancers</p> Signup and view all the answers

    What is the classification of a well-differentiated cancer?

    <p>G1</p> Signup and view all the answers

    What is the reason for increased basal metabolic rate in cancer cachexia despite reduced food intake?

    <p>Unknown, as it is a paradoxical phenomenon</p> Signup and view all the answers

    What is the basis of the TNM staging system?

    <p>The size of the primary cancer, its extent of local extension, and its spread to regional lymph nodes</p> Signup and view all the answers

    What percentage of patients with cancer exhibit paraneoplastic syndromes?

    <p>10%</p> Signup and view all the answers

    What does the 'T' in the TNM staging system refer to?

    <p>The size of the primary cancer</p> Signup and view all the answers

    What is the term for the production of hormones not indigenous to the tissue of origin of the tumor?

    <p>Ectopic hormone production</p> Signup and view all the answers

    What is the significance of 'N0' in the TNM staging system?

    <p>It indicates the absence of nodal involvement</p> Signup and view all the answers

    What is the term for the clinical syndromes that occur in patients with cancer that cannot be explained by local or distant spread of the tumor?

    <p>Paraneoplastic syndromes</p> Signup and view all the answers

    What is the frequency of hypertrophic osteoarthropathy and clubbing of the fingers in patients with bronchial carcinomas?

    <p>10%</p> Signup and view all the answers

    What is the classification of an undifferentiated cancer?

    <p>G4</p> Signup and view all the answers

    What is the significance of 'M1' in the TNM staging system?

    <p>It indicates the presence of blood-borne metastases</p> Signup and view all the answers

    What is the term for the production of soluble factors by the tumor and the host in response to the tumor?

    <p>Tumor necrosis factor (TNF) production</p> Signup and view all the answers

    What is the term for the weakness, anorexia, and anemia that occur frequently in patients with cancer?

    <p>Cancer cachexia</p> Signup and view all the answers

    What is the primary advantage of using monoclonal antibodies in identifying cell products or cell surface markers?

    <p>To identify specific cell surface markers and products</p> Signup and view all the answers

    Which of the following tumors is NOT associated with an elevated carcinoembryonic antigen (CEA) level?

    <p>Squamous cell carcinoma of the lung</p> Signup and view all the answers

    What is the primary use of flow cytometry in the diagnosis of cancer?

    <p>To identify cell surface antigens</p> Signup and view all the answers

    Which of the following tumor markers is NOT associated with germ cell tumors of the testis or ovary?

    <p>Carcinoembryonic antigen (CEA)</p> Signup and view all the answers

    What is the primary difference between biochemical assays and monoclonal antibodies in the diagnosis of cancer?

    <p>Method of detection</p> Signup and view all the answers

    Which of the following molecular techniques is used to analyze the expression of multiple genes in a single reaction?

    <p>DNA microarray analysis</p> Signup and view all the answers

    What is the primary advantage of using prostate-specific antigen (PSA) in the diagnosis of prostate cancer?

    <p>It is sensitive to prostate cancer</p> Signup and view all the answers

    Which of the following is a limitation of using biochemical assays in the diagnosis of cancer?

    <p>They are not specific to cancer</p> Signup and view all the answers

    Study Notes

    Precancerous Conditions

    • Certain conditions are known to have an increased risk of association with cancer, divided into two groups:
      • Non-neoplastic conditions (e.g., chronic ulcerative colitis, chronic atrophic gastritis, chronic viral B & C hepatitis, cutaneous actinic keratosis, leukoplakia of oral cavity, vulva, and penis)
      • Benign neoplasms (e.g., villous adenoma of the colon, familial adenomatous polyposis of the colon)

    Host Defenses against Cancer—Tumor Immunity

    • A normal function of the immune system is to inspect the body for emerging malignant cells and destroy them (immune surveillance)
    • The strongest evidence for the existence of immune surveillance is the increased frequency of cancers in immuno-deficient hosts (congenital or acquired)
    • Mechanisms developed by tumor cells to escape the immune system:
      • Selective outgrowth of antigen-negative tumor cells
      • Loss or reduced expression of MHC molecules
      • Lack of co-stimulation
      • Immunosuppression (e.g., tumor growth factor-β, secreted by many tumors)
      • Antigen masking: cell-surface antigens of tumors may be hidden or masked from the immune system
      • Killing of cytotoxic T cells

    Effects of Tumors on the Host

    • Local progression:
      • Critical locations (e.g., pituitary adenoma)
      • Obstructions (e.g., neoplasms in the GIT)
    • Functional hormonal activity:
      • Neoplasms arising in endocrine glands may produce manifestations by synthesizing hormones
      • More common with benign tumors than with cancers
    • Bleeding and secondary infections:
      • Destructive growth of cancers or expansile pressure of a benign tumor
      • Ulcerations, leading to bleeding and infections
    • Acute presentation:
      • Perforation of the stomach, small or large intestine
      • Spontaneous rupture or infarction of the tumor itself
    • Cancer cachexia:
      • Syndrome of progressive loss of weight, accompanied by weakness, anorexia, and anemia
      • Due to anorexia, tumor parasitism, and the action of soluble factors (e.g., tumor necrosis factor)
      • Paradoxically increased basal metabolic rate despite reduced food intake
      • Equal loss of fat and muscle, unlike in starvation
    • Paraneoplastic syndromes:
      • Symptom complexes that occur in patients with cancer, can't be explained by local or distant spread of the tumor or by the elaboration of hormones not indigenous to the tissue of origin
      • Frequent (10% of patients with cancer)
      • May be the earliest manifestations of an undiscovered malignancy
      • May be serious and sometimes fatal
      • May simulate clinically metastatic disease and confuse management
      • Examples: endocrinopathies, neuromyopathies, dermatopathies, hypertrophic osteoarthropathy, vascular and hematologic changes, fever, nephrotic syndrome, and amyloidosis

    Grading and Staging of Cancers

    • Grading:
      • Microscopic features that influence the expected behavior of cancers
      • Classified into four grades (1 to 4) with increasing anaplasia (G1: well-differentiated, G2: moderately differentiated, G3: poorly-differentiated, G4: undifferentiated)
      • Less clinical value than staging
    • Staging:
      • Based on the size of the primary cancer, extent of local extension, and presence or absence of blood-borne metastases
      • Two major staging systems: International Union Against Cancer (UICC) and American Joint Committee (AJC)
      • TNM system: T (primary tumor size), N (node involvement), M (metastases)
      • Staging varies for each specific form of cancer, but general principles apply

    Tools for Diagnosing and Monitoring Cancers

    • Availability of specific monoclonal antibodies has greatly facilitated the identification of cell products or cell surface markers
    • Biochemical assays (serum tumor markers):
      • Tumor markers: substances released by cancer cells or created by the body in response to cancer cells
      • Examples: carcinoembryonic antigen (CEA), prostate-specific antigen (PSA), α-fetoprotein (AFP)
    • Flow cytometry:
      • Technique used to measure individual cell characteristics (e.g., membrane antigens, DNA content)
      • Used for classification of leukemias and lymphomas
    • Molecular techniques:
      • PCR (polymerase chain reaction)
      • Real-time PCR
      • DNA microarray analysis
      • Tissue microarrays analysis

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    Description

    This quiz covers precancerous conditions, including non-neoplastic and benign neoplasms, that increase the risk of cancer development. Examples of such conditions are discussed.

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