A+P: Hereditary CA Flashcards
Biggest RFs for CA
- age
- environmental exposures
Categories of Cancer
- Sporadic
- Familial
- Hereditary
Describe Sporadic CA
- occur by chance or related to environmental factors
- general population risk
Describe Familial CA
- multiple genes & environmental factors may be involved
- some incr CA risk
Describe Hereditary CA
- gene mutation is inherited in family
- significantly incr CA risk
Sporadic Cancer Facts
- Common at older ages
- “Common CAs”
- only 1-2 affected in a family
- CAs w/ a clear cause
What two Hereditary CA germline mutations cause CA predisposition?
oncogenes & tumor suppressor genes
Describe oncogenes.
- promote cell growth & survival
accelerator
Describe tumor suppressor genes
- regulate cell growth, DNA repair, cell cycle
brakes
What oncogenes are linked to hereditary CA syndromes?
- CDK4
- KIT
- MET
- RET
CDK4 gene incr risk of what CA?
cell cycle regulator malignant melanoma syndrome
KIT gene incr risk of what CA?
tyrosine kinase-familial GI stromal tumor
MET gene incr risk of what CA?
tyrosine kinase - familial papillary renal cell carcinoma
RET gene incr risk of what CA?
tyrosine kinase - multiple endocrine neoplasia
Which happens more somatic or germline?
somatic
– mechanisms activating oncogenes
Various functions of tumor suppressor genes?
- regulation of cell cycle
- growth inhibition through cell contact
- repair of DNA damage/chromosome breakage
Tumor suppressor genes have a loss of function from one or both copies of gene?
BOTH
What is the majority cause of hereditary CA conditions?
tumor suppressor genes
Hereditary CA Factors
- Young CAs
- Rare CAs
- Multiple CAs/tumors
- Multiple related CAs
Describe Hereditary CA: Young Cancers
- breast 50 or under
- colorectal or endometrial under 50
Describe Hereditary CA: Rare Cancers
- male breast
- pancreatic
- ovarian
Describe Hereditary CA: Multiple CAs/tumors
- bilateral CAs
- multiple primaries
Describe Hereditary CA: Multiple related CAs
- breast, ovarian, pancreatic, prostate
- colorectal, endometrial
Most hereditary CAs have what pattern of inheritance?
autosomal dominant & reduce penetrance
List the 6 genes related to hereditary breast CA
- HBOC - BRCA 1 & 2
- Li - Famumeni Syndrome (TP53)
- Cowden Synd (PTEN)
- PALB2
- Hereditary Diffuse Gastric CA (CDH1)
- Peutz-Jeghers Synd (STK11)
High risk genes (40-60%)
- BRCA 1 & 2
- CDH1
- PALB2
- PTEN
- STK11
- TP53
Moderate risk genes (17-40%)
- ATM
- BARD1
- CHEK2
- NF1
- RAD51C/D
Elevated Risk Genes (<15%)
- Lynch Synd
- BRIP1
HBOC - BRAC 1/2 gene increases breast CA risk by???
> 60%
Management of breast cancer with BRCA genes?
- Annual breast MRI starting at age 25-29
- mammo at age 30
RRM
Which BRCA gene carries a highest risk for breast, prostate, & pancreatic CAs?
BRCA 2
Management of male breast CA w/ BRCA genes
Annual mammo starting at age 50
Management of Ovarian CA in BRCA 1 gene
RRSO b/t 35 - 40yo
Management of Ovarian CA in BRCA 2 gene
RRSO b/t 40 - 45yo
Management of pancreatic CA for both BRCA genes
Screen those w/ FHx of pancreatic CA
Management of prostate CA for both BRCA genes
Screening starting at age 40
Which BRCA gene has an incr risk of melanoma?
BRCA 2
Management of melanoma in BRCA 2 gene
Annual full-body skin exam & minimizing UV exposure
PALB2 incr risk of breast CA by what %?
41 - 60%
Management of breast CA w/ PALB2 gene?
Annual breast MRI & mammo at age 30
RRM
Li - Faumeni Syndrome (TP53) incr the risk of breast cancer by what %?
> 60%
Managment of breast CA for Li-Fraumeni Synd
Annual breast MRI starting at age 20-29 & mammo at age 30
Li – Fraumeni Syndrome – TP53 increases the risk of what different CAs compared to other genes
- Soft tissue sarcoma
- osteosarcoma
- CNS tumor
- Adrenocortical carcinoma
Many other CAs have been assoc. w/ LFS, especially__.
melanoma, colorectal, gastric & prostate
Hereditary Diffuse Gastric Cancer – CDH1 incr risk for what CAs
- Lobular Breast CA
- Diffuse Gastric CA
Hereditary Diffuse Gastric Cancer – CDH1 incr breast CA by what %?
36 - 55%
Management of Hereditary Diffuse Gastric Cancer – CDH1 breast CA
Annual breast MRI & mammo at age 30
Do males or females have a higher risk of gastric CA from Hereditary Diffuse Gastric CA – CDH1
Males
Incr risk for brain tumors cerebellar dysplastic gangliocytoma (Lhermitte-Duclos disease), may be pathognomonic, What gene is this?
Cowden Syndrome - PTEN
Cowden Synd (PTEN) incr risk of what CAs
- breast
- thyroid
- colorectal
- endometrial
- renal
- melanoma
Cowden Syndrome - PTEN incr risk of breast CA by what %
40 -60%
Management of breast CA w/ Cowden Synd (PTEN)
Annual breast MRI & mammo starting at age 30
Management of Cowden Syndrome - PTEN thyroid CA
Annual thyroid US at age 7
Management of Cowden Syndrome - PTEN colorectal CA
Colonoscopy every 5yrs starting at age 35
Management of Cowden Syndrome - PTEN endometrial CA
- Start screening by age 35
- Hysterectomy
Management of Cowden Syndrome - PTEN renal CA
- Renal US at 40, repeated
- every 1-2 yrs
Management of Cowden Syndrome - PTEN melanoma
annual derm exam
Non Cancerous Features of PTEN (5)
- Autism Spectrum d/o or developmental delay
- Macrocephaly
- Penile freckling (Bannayan-Riley-Ruvalcaba synd)
- Derm features
- Vascular features
Describe derm features seen w/ PTEN?
- Trichilemmomas
- Papillomatous lesions
- Acral keratoses
- Mucosal lesions
- Lipomas
Describe vascular features seen w/ PTEN?
- Arteriovenous malformations
- hemangiomas
2 Diagnostic criteria for Peutz-Jeghers synd (STK11)
- 2 or more Peutz-Jeghers-type hamartomatous polyps of the GI tract
- Mucocutaneous hyperpigmentation of mouth, lips, nose, eyes, genitalia, or fingers
Peutz-Jeghers syndrome - (STK11) NOTE
Mucocutaneous pigmentation (CAN FADE) & hyperpigmented macules
ATM incr risk of what CAs
- breast
- contralateral breast
- ovarian
- pancreatic
- prostate
BRIP1 incr the risk of what CAs
- breast
- ovarian