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COT - Exam 2 > 15.3 - Cancer Biology > Flashcards

15.3 - Cancer Biology Flashcards

1
Q

Clinically-usefl classes of breast cancer

A
  • ER+
  • PR+
  • HER2/neu+
  • triple negative
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2
Q

What are two genes some familial cancers are linked to

A
  • BRCA1

- BRCA2

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3
Q

Skin Cancers

A
  • include
    1) Keratomas
    2) Melanomas
  • these cancers typically have two phases
    A) radial growth phase
    B) Vertical growth phase
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4
Q

Staging of skin and breast cancer

A
  • by considering their size and mitotic frequency
  • extent of tissue layers invaded
  • whether cancerous cells have entered sentinel lymph nodes
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5
Q

Metastases

A
  • in the most dangerous cancers
  • those that have managed to proceed through the entire lymph drainage and entered the blood
  • have potential to produce new growths at distant, unrelated sites in body
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6
Q

Breast Cancer

A
  • affects 1:8 women
  • incidence increases dramatically with age
  • most originate in ductal cells
  • minority originate in secretory cells
  • anti-estrogen durgs (tamoxifen) have been used for several decades with varying degrees of success
  • 2-5% have of breast + ovarian cancers have mutated in genes BRCA1 and BRCA2 (risk increased to 50-80% in germline mutation)
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7
Q

BRCA1 and BRCA2

A
  • mutated in 2-5% of breast and ovarian cancers
  • mutation in the germ line increases the risk to 50-80%
  • both function ubiquitously in DNA repair and regulation of transcription
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8
Q

Current state of breast cancer treatments involves first assessing the state of receptor expression on the cancerous cells, what are the 4 patterns of expression that have been identified and their respective targeted treatments

A

1) Express the estrogen receptor
- classical anti-estrogen drugs
2) Expresse the progesterone receptor
- also have pharmacologic treatments
3) Express the epidermal growth factor receptor (HER2/neu)
- treatments based on monoclonal antibodies
4) triple negative (minority group)
- express none of the previous 3 receptors
- treated with non-specific chemotherapy agents
- soon be candidates for emerging personalized medicine

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9
Q

What is personalized medicine

A

= emerging field
- triple negative cancers may be candidates for this treatment soon
= treatment involves knowledge of the particularities of a individual patient’s genome

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10
Q

3 cancers commonly arising from cells in the integument and their associated cells

A

1) squamous cell carcinoma = keratinocytes
2) basal cell carcinoma = stratum basale keratinocytes
3) Melanomas = melanocytes

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11
Q

Melanoma

A
  • typically linked with more fatality - presumably having something to do with the fact that the melanocyte is intrinsically capable of more migration
  • progresses within the epidermis in two phases
    1) Radial Growth Phase
    2) Vertical Growth Phase
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12
Q

Radial Growth phase in melanomas

A
  • the most noticeable cellular migration occurs parallel to the skin surface
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13
Q

Vertical growth phase in melanomas

A
  • cells stack perpendicular to the surface
  • 1st increasing the thickness of the epithelium
  • 2nd breaching the BM to invade underlying tissues
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14
Q

Describe the staging of melanoma based on the tissue layers breached

A
  • Level 1 = malignant cell clusters are confined to the epidermis
  • Level 2 = Clusters invade the dermal papillae
  • Level 3 = clusters reach to the reticular dermis
  • Level 4 = clusters invade the reticular dermis
  • Level 5 = clusters invade the hypodermis
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15
Q

What does level 1 staging of melanoma signify?

A
  • malignant cell clusters are confined to the epidermis
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16
Q

What does level 2 staging of melanoma signify?

A
  • clusters invade the dermal papillae
17
Q

What does level 3 staging of melanoma signify?

A
  • clusters reach to the reticular dermis
18
Q

What does level 4 staging of melanoma signify?

A
  • clusters invade the reticular dermis
19
Q

What does level 5 staging of melanoma signify?

A
  • clusters invade the hypodermis
20
Q

What occurs once malignant cells invade the CT (i.e. post stage level 5 melanoma)?

A
  • Immune response is generated
  • tumor-infiltrating lymphocytes are seen in great numbers
  • this used with other observable factors is used to predict melanoma prognosis
    A) tumor thickness
    B) ulceration
    C) mitotic rate
  • in more advanced cases tumor cells travel via the lymphatic system
21
Q

What are sentinel lymph nodes and their relevance to cancer/tumors/metastasis

A

= the first lymph nodes along the path of drainage from the affected region

  • if tumor cells are present –> investigate successive nodes up the lymphatic chain towards L or R thoracic ducts
  • -> important because most of the body bronchopulmonary nodes are part of this chain
  • which is why metastases to the lung tissue are common in melanoma
22
Q

Tumor cells present in the last nodes before lymph is drained via the thoracic duct into the systemic circulation indicates what?

A
  • distant metastases, far from site of origin are possible

= much poorer prognosis

23
Q

Describe the staging of cancer based on progression through the lymphatics

A
  • considered in N and M categories for melanoma and often for other types of cancers (Colon, prostate, also breast cancer due to well studied lymphatic drainage)
  • NX = regional nodes cannot be assessed
  • N0 = no spread to adjacent nodes
  • N1 = spread to one node
    • N1a = diagnosed on pathology
    • N1b = detectable clinically
  • N2 = spread to 2-3 nearby nodes
    • N2a = diagnosed on pathology
    • N2b = detectable clinically
  • N3 = spread to 4 or more nodes
  • M0 = no evidence of distant metastases
  • M1a = metastases to skin, sub-q or distant lymph nodes
  • M1b = metastases to lung
  • M1c = all other metastases
24
Q

What does NX cancer staging of progression through the lymphatic signify?

A

= regional nodes cannot be assessed

25
Q

What does N0 cancer staging of progression through the lymphatic signify?

A

= no spread to adjacent nodes

26
Q

What does N1a cancer staging of progression through the lymphatic signify?

A

= spread to 1 node

- diagnosed on pathology

27
Q

What does N1b cancer staging of progression through the lymphatic signify?

A

= spread to 1 node

- detectable clinically

28
Q

What does N2a cancer staging of progression through the lymphatic signify?

A

= spread to 2-3 nearby nodes

- diagnosed on pathology

29
Q

What does N2b cancer staging of progression through the lymphatic signify?

A

= spread to 2-3 nearby nodes

- detectable clinically

30
Q

What does N3 cancer staging of progression through the lymphatic signify?

A

= spread to 4 or more nodes

31
Q

What does M0 cancer staging of progression through the lymphatic signify?

A

= no evidence of distant metastases

32
Q

What does M1a cancer staging of progression through the lymphatic signify?

A

= metastases to skin, sub-1 or distant lymph nodes

33
Q

What does M1b cancer staging of progression through the lymphatic signify?

A

= metastases to lung

34
Q

What does M1c cancer staging of progression through the lymphatic signify?

A

= all other metastases

35
Q

Describe the pattern of lymphatic drainage from the breast

A

= 75% of the breast volume drains laterally to axillary nodes
= 25% drains medially to various lymph nodes of the internal mammary chain

36
Q

Describe the other cancers that staging by layers is useful for, and how

A

1) Cancers of the GI tract
- most lymph drainage occurs from the submucosal layer
- -> penetration of the muscularis mucosae layer is an important landmark for GI-system cancers
2) Bladder cancers
- muscularis mucosae in the bladder is a particularly challenging but important landmark in bladder cancer staging

COT - Exam 2 (28 decks)

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