Mnemonics: Neoplasia

Hallmarks of Cancer (Hanahan & Weinberg)

What needs to be memorized: The 10 fundamental characteristics that define cancer: Sustaining proliferative signaling, Evading growth suppressors, Resisting cell death, Enabling replicative immortality, Inducing angiogenesis, Activating invasion & metastasis, Reprogramming energy metabolism, Evading immune destruction, Genome instability, Tumor-promoting inflammation

Mnemonic: "Super Excited Ravi Eats Ice-cream After Running, Even Gets Trophies"

🔗 The Breakdown:

• Super → Sustaining proliferative signaling
• Excited → Evading growth suppressors
• Ravi → Resisting cell death (apoptosis)
• Eats → Enabling replicative immortality
• Ice-cream → Inducing angiogenesis
• After → Activating invasion and metastasis
• Running → Reprogramming energy metabolism
• Even → Evading immune destruction
• Gets → Genome instability & mutation
• Trophies → Tumor-promoting inflammation

SCLC Paraneoplastic Syndromes

What needs to be memorized: The three major paraneoplastic syndromes associated with Small Cell Lung Cancer: SIADH, Cushing syndrome, Lambert-Eaton myasthenic syndrome

Mnemonic: "SCLC causes SCL problems"

🔗 The Breakdown:

• S → SIADH (ADH secretion)
• C → Cushing syndrome (ACTH secretion)
• L → Lambert-Eaton myasthenic syndrome (LEMS)

Steps of Metastatic Cascade

What needs to be memorized: The 7 sequential steps: Invasion of basement membrane, Intravasation, Circulation in bloodstream, Arrest in capillary bed, Extravasation, Formation of micrometastasis, Growth to macrometastasis

Mnemonic: "I Invited Cricketers, All Enjoyed Food & Games"

🔗 The Breakdown:

• I → Invasion of basement membrane
• Invited → Intravasation (entering vessels)
• Cricketers → Circulation in bloodstream
• All → Arrest in capillary bed
• Enjoyed → Extravasation (exiting vessels)
• Food → Formation of micrometastasis
• Games → Growth into macrometastasis

Key Features Distinguishing Malignant Tumors

What needs to be memorized: The critical features that make tumors malignant: Metastasis ability, Anaplastic/poorly differentiated cells, Don't stay local (invade), Infiltrative growth pattern

Mnemonic: "Malignant tumors are MAD-I (mad/angry)"

🔗 The Breakdown:

• M → Metastasis (present in malignant, absent in benign)
• A → Anaplastic/poorly differentiated
• D → Don't stay local = Local invasion
• I → Infiltrative growth pattern

💡 Tip: Think of cancer cells as "angry" - they don't follow rules, invade everywhere, and spread throughout the body!

Anaplasia Features

What needs to be memorized: Seven microscopic features of poorly differentiated cells: Pleomorphism, Abnormal nuclear morphology, High nuclear-cytoplasmic ratio, Increased mitotic activity, Atypical mitoses, Loss of polarity, Giant cells

Mnemonic: "Papa Has Improved After Leaving Gym"

🔗 The Breakdown:

• Papa → Pleomorphism (variation in size & shape)
• Has → High nuclear-cytoplasmic ratio
• Improved → Increased mitotic activity
• After → Atypical mitoses
• Leaving → Loss of polarity
• Gym → Giant cells + Abnormal nuclear morphology

💡 Remember: "Gym" also reminds you of Abnormal nuclear morphology - the nucleus looks "pumped up" and abnormal!

Grading vs Staging

What needs to be memorized: Grading assesses histologic differentiation; Staging assesses anatomical spread (TNM system)

Mnemonic: "Grade the Quality, Stage the Quantity"

🔗 The Breakdown:

• Grade → Quality of cells (How well differentiated? Histologic appearance)
• Stage → Quantity of spread (How far has it spread? TNM classification)

💡 Remember: Grading = Goodness of cells, Staging = Spread of disease

Important Proto-oncogenes

What needs to be memorized: Major proto-oncogenes that when mutated lead to cancer: RAS, MYC, HER2/NEU, RET, ABL (BCR-ABL)

Mnemonic: "RAM's HERo BAtsman"

🔗 The Breakdown:

• RAM → RAS oncogene
• M → MYC oncogene
• HERo → HER2/NEU oncogene
• BAtsman → BCR-ABL fusion oncogene (CML)

💡 Cricket reference: Think of oncogenes as aggressive batsmen who keep scoring (proliferating) without control!

Important Tumor Suppressor Genes

What needs to be memorized: Major tumor suppressors: RB (Retinoblastoma), P53, APC, BRCA1/2, NF1/2, WT1, VHL

Mnemonic: "RuBy Papa ka BRCA APC VW car, NF WT model"

🔗 The Breakdown:

• RuBy → RB (Retinoblastoma gene)
• Papa → P53 (Guardian of the genome)
• BRCA → BRCA1/2 (Breast & ovarian cancer)
• APC → APC (Colorectal cancer, FAP)
• VW → VHL (Von Hippel-Lindau - RCC)
• NF → NF1, NF2 (Neurofibromatosis)
• WT → WT1 (Wilms tumor)

💡 Remember P53 as "Papa" - the protective father figure that guards the genome!

GI Cancer Tumor Markers

What needs to be memorized: Three main GI markers: CEA (Colorectal), CA 19-9 (Pancreatic), AFP (Hepatocellular carcinoma)

Mnemonic: "GI mein teen markers: CEA Colon ka, 19 Pancreas ka, AFP liver ka"

🔗 The Breakdown:

• CEA → Colorectal cancer (also colon sounds like CEA)
• 19 (CA 19-9) → Pancreatic cancer
• AFP → Hepatocellular carcinoma (Alpha-FetoProtein - also in germ cell tumors)

💡 Association tip: AFP is also elevated in pregnancy (fetal protein), just like in liver "regeneration" gone wrong!

Female Reproductive Tumor Markers

What needs to be memorized: CA 125 (Ovarian cancer), CA 15-3 (Breast cancer), hCG (Choriocarcinoma, Germ cell tumors)

Mnemonic: "Female markers: 125 Ovary, 15-3 Breast, hCG baby-related cancers"

🔗 The Breakdown:

• CA 125 → Ovarian cancer (12+5 = never 0, like ovaries produce eggs)
• CA 15-3 → Breast cancer (15-3 = 12, breast examination at 12 o'clock position)
• hCG → Choriocarcinoma & germ cell tumors (pregnancy hormone = pregnancy-related cancers)

Oncogenic Viruses and Associated Cancers

What needs to be memorized: HPV (Cervical), EBV (Burkitt, Nasopharyngeal, Hodgkin), HBV/HCV (Hepatocellular), HTLV-1 (Adult T-cell leukemia), HHV-8 (Kaposi sarcoma)

Mnemonic: "Hari's Exam Hall Hierarchy: HPV, EBV, Hepatitis, HTLV, HHV"

🔗 The Breakdown:

• HPV (16, 18) → Cervical cancer (also oropharyngeal)
• EBV → Burkitt lymphoma, Nasopharyngeal CA, Hodgkin lymphoma (BNH)
• Hepatitis (HBV/HCV) → Hepatocellular carcinoma (obvious association!)
• HTLV-1 → Adult T-cell leukemia (T in the name!)
• HHV-8 → Kaposi sarcoma (HIV/AIDS association)

💡 For EBV, remember "BNH" - sounds like "Benign" but it's actually causing malignant lymphomas!

Routes of Tumor Metastasis

What needs to be memorized: Lymphatic route (most carcinomas), Hematogenous route (sarcomas, RCC, HCC, follicular thyroid), Seeding/Transcoelomic (ovarian, gastric)

Mnemonic: "LHS - three routes of cancer spread"

🔗 The Breakdown:

• Lymphatic → Preferred by Carcinomas (epithelial tumors)
• Hematogenous (blood) → Preferred by Sarcomas, also RCC, HCC, follicular thyroid CA
• Seeding (transcoelomic) → Ovarian cancer, Gastric cancer (peritoneal spread)

💡 Remember: "Carcinomas Like Lymphatics, Sarcomas prefer HEMAtogenous (blood sounds like hema)"

Paraneoplastic Antibodies

What needs to be memorized: Anti-Hu (SCLC causing encephalomyelitis), Anti-Yo (Ovarian/Breast causing cerebellar degeneration), Anti-VGCC (SCLC causing Lambert-Eaton)

Mnemonic: "HuYo! Very Good Cancer Student"

🔗 The Breakdown:

• Hu (Anti-Hu) → SCLC → Encephalomyelitis (brain & spinal cord)
• Yo (Anti-Yo) → Ovarian/Breast cancer → Cerebellar degeneration (balance problems)
• Very Good (Anti-VGCC) → SCLC → Lambert-Eaton syndrome (muscle weakness)

💡 Both Anti-Hu and Anti-VGCC are associated with SCLC (lung), so remember "HuVGCC = lung problems"

Types of Carcinogens

What needs to be memorized: Five major categories: Chemical, Radiation, Viral, Bacterial, Parasitic

Mnemonic: "Cancer Risk: Chemical, Radiation, Viral, Bacterial, Parasite se"

🔗 The Breakdown:

• C → Chemical carcinogens (tobacco, aflatoxin, asbestos, benzene)
• R → Radiation (UV, ionizing radiation)
• V → Viral (HPV, EBV, HBV, HCV, HTLV-1, HHV-8)
• B → Bacterial (H. pylori → gastric cancer)
• P → Parasitic (Schistosoma → bladder cancer, Clonorchis → cholangiocarcinoma)

Two-Hit Hypothesis (Knudson)

What needs to be memorized: Concept that both alleles of tumor suppressor genes must be inactivated for cancer; applies to hereditary cancers like Retinoblastoma

Mnemonic: "Tumor Suppressor ko do Hit chahiye, Dhoni style - both hands on bat"

🔗 The Breakdown:

• First Hit → Germline mutation (inherited) - one hand off the bat
• Second Hit → Somatic mutation (acquired) - second hand off, total loss of control
• Example → RB gene in Retinoblastoma (RB = both hands like in cricket)

💡 Remember: You need BOTH hits to knock out the suppressor, just like you need both hands off the bat to lose complete control!

Carcinoma vs Sarcoma - Origin

What needs to be memorized: Carcinoma arises from epithelial tissue; Sarcoma arises from mesenchymal tissue

Mnemonic: "Carcinoma = Common (epithelium is everywhere), Sarcoma = Strong tissues (bone, muscle, connective)"

🔗 The Breakdown:

• CARcinoma → Epithelial origin (skin, glands, organs) - 90% of cancers
• SARcoma → Mesenchymal origin (bone, muscle, fat, vessels, cartilage) - rare

💡 Think: "CAR" drives on epithelial roads (surface tissues), "SAR" is strong like muscles and bones!