Cancer Predispostitions Flashcards
Hereditary Retinoblastoma Clinical
Sensitive to radiation, trilateral RB
Hereditary Retinoblastoma Screening
Birth -8wks non-sedated eye exam q2-4 wks
8wks-12mo monthly sedated eye exam
12-24 mo sedated eye exam q 2mo
24-36 mo q3 mo
36 mo-48 mo q4mo
48 mo-60 mo q6 mo the stop
NF1 Clinical
High variable expressivity
LGG and optic pathway glioma
MPNST
Leukemia (JMML)
GIST and duodenal carcinoid tumors
Breast Cancer
Plexiform neurofibromas
Pheochromocytomas
Embryonal rhabdomyosarcomas
Iris Hamartomas (Lisch nodules)
Sphenoid wing dysplasia macrocephaly
NF2 clinical
bilateral vestibular schwannomas
meningioma
ependymoma
astrocytoma
intradermal schwannoma
retinal hamartomas
cortical wedge cataract
NF2 Screening
Annual brain MRI starting at age 10y
annual audiology exam
Nevoid Basal Cell Carcinoma (Gorlin Syndrome) Gene
PTCH1 & SUFU
Nevoid Basal Cell Carcinoma (Gorlin Syndrome) Clinical
Desmoplastic nodular medulloblastoma (SUFU - SHH type)
Basal cell carcinoma
Keratogenic cysts of the Jaw (PTCH1)
Cardiac fibromas
Ovarian fibromas
Macrocephaly
Milia
bifid ribs, wedge shaped vertebrae
Nevoid Basal Cell Carcinoma (Gorlin Syndrome) Screening
Annual derm exam starting at 10 yrs
SUFU brain MRI q3-4 mo until age 3y then q6 mo until age 5y
PTCH1 panorex annual
Von Hippel-Lindau Clinical
hemangioblastoma
retinal angioma
renal cell carcinoma later in life
pheochromocytoma
endodermal sinus tumor (ear)
Von Hippel-Lindau Screening
Annual eye exam starting at birth
brain and spine MRI every other year starting at 8yrs
annual abdomen MRI starting at 10 yrs
Audiogram every other year starting at 5 yrs
Rhabdoid Tumor Predisposition Type 1 Gene
SMARCB1
Rhabdoid Tumor Predisposition Type 1 Clinical
ATRT 30% of ATRT have germline RTP mutation
schwannomas
meningiomas
Rhabdoid tumor of the kidney
Rhabdoid Tumor Predisposition Type I screening
MRI brain q3mo until 5yrs
annual abdominal US
Constitutional Mismatch Repair Deficiency (CMMRD) - Lynch Syndrome Gene
MSH2, MLH1, MSH6, PMS2
Autosomal recessive
High penetrance
variable expressivity
Constitutional Mismatch Repair Deficiency (CMMRD) - Lynch Syndrome Clinical
Hypermutated g=high grade glioma
colon cancer
leukemia
cafe-au-lait spots
Constitutional Mismatch Repair Deficiency (CMMRD) - Lynch Syndrome Screening
annual whole body MRI
annual CBC
q4mo abdominal US
Li-Fraumeni Gene
TP53 on chromosome 17
Li-Fraumeni Clinical
Osteosarcoma <5yrs
adrenocortical carcinoma
anaplastic rhabdomyosarcoma
Choroid plexus carcinoma
Triple positive breast cancer
hypodiploid B-ALL
infiltrative astrocytoma, high grade gliomas
Li-Fraumeni Screening
Annual whole body MRI
Annual brain MRI
Abdominal US q3-4 mo
Annual skin exam
Rothmund Thomson Syndrome Type II Gene
RECQL4
Autosomal Recessive
Rothmund Thomson Syndrome Type II Clinical
Osteosarcoma - multicentric
poikiloderma
short
sparse hair
juvenile cataracts
skeletal abnormalities
radial ray defects
premature aging
PTEN Harmartoma Syndrome (Cowden) Gene
PTEN
PTEN Hamartoma Syndrome (Cowden) Clinical
Papillary thyroid cancer
Lipomas
GI hamartomas
Breast cancer
endometrial cancer young (40 y)
Macrocephaly
IQ
Trichilemmoma (subq lumps)
PTEN Hamartoma (Cowden) Syndrome Screening
Every other year thyroid US starting 7 yrs
MEN1 Clinical
Pancreatic neuroendocrine tumors (secrete insulin)
Pituitary adenomas (secrete prolactin)
Parathyroid tumors (primary hyperparathyroidism)
MEN2A Gene
RET activating
MEN2A Clinical
95% of MEN2
100% medullary thyroid cancer
primary hyperparathyroidsim
MEN2A screening
thyroidectomy by age 5 y
Neck US CEA level calcitonin Q6 mo x2 then annual
plasma metanephrines annual
MEN2B Gene
RET activating
MEN2B Clinical
5% MEN2
100% very aggressive medullary thyroid cancer (<1 yr)
50% pheochromocytoma
No primary hyperparathyroidsim
Mucosal neuromas
intestinal gnaglioneuromas
marfanoid
MEN2B Screening
Thyroidectomy before age 1y
Neck US CEA calcitonin Q6 mo x2 then annual
Plasma metanephrines starting age 11y
MEN4 Gene
CDKN1B
MEN4 Clinical
Pituitary adenoma
parathyroid tumors (hyperparathyroidism)
genitourinary tumors
Carney Complex Gene
PRKAR1A
Carney Complex Clinical
lentigines
Pituitary adenoma (GH)
Cardiac myomas
Psammomatous melanotic schwannoma
Large cell calcifying sertoli cell tumors
Carney COmplex screening
Annual ECHO
Annual GH prolactin IGF1 starting in adolescence
annual brain spine chest abdomen and pelvis MRI
thyroid US if nodules present
Hereditary Pheochromocytoma Paraganglioma Syndrome Gene
SDHA, SDHB, SDHC, SDHD
SDHB = bad
Hereditary Pheochromocytoma Paraganglioma Syndrome Clinical
30% of all pheochromocytomas
Renal cell carcinoma
Papillary thyroid carcinoma
pituitary adenoma
GIST
Hereditary Pheochromocytoma Paraganglioma Syndrome screening
Whole body MRI every other year starting at 6-8 yrs
Annual metanephrines
Annual methoxytyramine
annual BP
DICER1 Clinical
Pleuropulmonary blastoma
cystic nephroma
sertoli lydif cell tumor of the ovary
papillary or follicular thyroid cancer
embryonal rhabdomyosarcoma of the cervix, uterus or thorax)
gynandroblastoma
pineoblastoma
DICER1 screening
chest CT 3-6 mo then at 2.5-3yrs if normal
CXR q6mo until age 8 y then annual until age 12 y
THyroid US q3yrs starting at 8yo
abdominal US q6mo until 8y then annual until 12 y
Pelvic US q6-12 mo until 40 y
Familial Adenomatous Polyposis (Gardiner/Turcot Sx) Gene
APC (if negative MUTYH)
FAP/Gardiner/Turcot Clinical
Hepatoblastoma (<2%) but we check all hepatoblastoma for APC
Abdominal Desmoid tumors
CNS embryonal tumors
Colon Cancer
FAP screening
Quarterly AFP and Abdominal US until age 4y
Colonoscopy starting at 12y
Hereditary neuroblastoma Genes
PHOX2B - congenital hypoventilation/hirschprungs
ALK activation
RASopathies
Hereditary neuroblastoma screening
Abdominal US urine VMA/HVA CXR q3mo until age 6y then q6 mo until age 10y
Wilms Tumor Predispositions genes
WT1 and 11p15.5
WAGR
WT1 + PAX6
Wilms tumor
aniridia
GU abnormalities
intellectual disability
Denys-Drash
WT1
diffuse mesangial sclerosis of the kidney
Fraiser Syndrome
WT1 intron 9
focal segmental glomerulosclerosis
Perlman Syndrome
DIS3L2
polydactaly
fetal ascites
mesoneproblastoma
Bhoring-Opitz Syndrome
ASXL1
syndromic with intellectual disability
Wilms Tumor Predispositions screening
Renal US q3mo until 7y
Bloom Syndrome gene
BLM
autosomal recessive
Bloom syndrome clinical
Wilms tumor
colon cancer
breast cancer
leukemia
increased toxicity to radiation and chemo
poor growth
narrow head
butterfly rash
telangiectasias
cafe-au-lait spots
photosentitivity
Bloom syndrome screening
abdominal US q3mo until 8y
colonoscopy starting at 12y
breast MRI starting at 18y
whole body MRI every 1-2 yrs
Beckwith-Wiedemann SYndrome Gene
imprinting defect on 11p15.5 needs DNA methylation
Beckwith-Wiedemann Syndrome Clinical
Hepatoblastoma
Wilms tumor
large tongue
hemihypertrophy
macrocephaly
omphalocele
organomegaly
other similar syndromes Simpson-Golabi-Behmel & trisomy 18
Beckwith-Wiedeman Syndrome Clinical
Renal US q3mo until 7y
Abdominal US & AFP q3mo until 4y
FH tumor predisposition SYndrome gene (Hereditary leiomyomatosis and renal cell carcinoma)
Fumarate hydratase
FH tumor screening
Annual abdominal US starting at 8y
annual derm exam
Rhabdoid tumor predisposition type II gene
SMARC4
Rhabdoid tumor predisposition type II clinical
small cell carcinoma of the ovary hypercalcemic type
rarely ATRT
Rhabdoid predisposition type II screening
pelvic US q3-6 mo
bilateral oophrectomy
Noonan Syndrome gene
PTPN11 SOS1 RAF1 KRAS
Noonan Syndrome Clinical
JMML
ALL
Short
strabismus
pulmonary valve stenosis
sheild chest
short neck
low ears
Ataxia telangiectasia gene
ATM
Autosomal recessive
Ataxia telangiectasia clinical
Leukemia lymphoma T-cell, diffuse large B cell
radiosensitivity
immunodeficiency
carcinomas
gliomas
progressive neurodegeneration
cerebellar ataxia age 3-4 yrs
occular cutaneous telangiectasias
DM
premature ovarian insufficiency
progressive lung disease
Nijmegen breakage syndrome gene
NBN
Autosomal recessive
Nijmegen Breakage Clinical
T-cell ALL/lymphoma DLBCL
HIgh radiosensitivity
immunodeficiency
rhadomyosarcomas
gliomas
meningiomas
thyroid carcinoma
microcephaly
sloped forehead with receding mendible
IQ
Familial Platelet Disorder with AML Gene
RUNX1
Familial Platelet Disorder with AML Clinical
Monosomy 7 AML
30-40% risk of MDS/AML w anticipation
aspirin like platelet defect w mild thrombocytopenia
Thrombocytopenia 5 gene
ETV6
Thrombocytopenia 5 clinical
Hyperdiploid B-ALL, MDS AML
Mild thrombocytopenia
ANKRD26 thrombocytopenia
Thrombocytopenia 2
AML (8%)
moderate thrombocytopenia
CEBPA familial AML
2 variants of CEBPA in leukemia
germline 1 variant
highly penetrant, increased mutations in leukemia