case study 3 Flashcards
Describe the differences in the histology of the tumour, if it had been assessed as an adenoma (rather than an adenocarcinoma) b. list and define 2 names that would apply to cells from a malignant tumour (4)
a) adenoma - cells would be well differentiated and well organized (benign tissue)
b) cells from a malignant tumour: anaplasia (loss of differentiation) & pleomorphic (different sizes and shapes)
List 3 other characteristics of an adenocarcinoma that would differentiate it from a benign tumour (3)
more rapid growth, no capsule meaning can invade local tumours, can be metastasized
Explain Ms. Peters’ feelings of weakness and fatigue, supporting your explanation with the lab values obtained. (2)
she is anemic, the values of her hemoglobin, hematocrit, & RBC count tests are low suggesting anemia
Why was she asked about a heavy menstrual flow (1)
to make sure the loss of blood wasn’t due to menstruation
What does “fecal occult blood” mean? Why did the positive fecal occult blood result in Ms. Peters undergoing a colonoscopy? How does the result of the colonoscopy explain her initial clinical manifestations (including constipation?) (5)
microscopic blood found in the stool (hidden) the positive reading led to colonoscopy because it suggests there’s bleeding somewhere, possibly due to tumour
What is the significance of the serum CEA level? What would a subsequent rise in this value (after a period of a few years) possibly indicate? (2)
used as a tumour marker where a rise in level is associated with colon-rectal cancer, if the tumour is removed CEA levels decrease. after a few years if the levels rise, this will indicate that the cancer is back
If Ms. Peters’ condition was specifically identified as a type of cancer for which higher risk runs in families, identify what type of gene might likely be involved, and explain the mechanism that lies behind the inheritance effect (4)
gene involved - tumour suppressor genes
mechanism - slow cell growth due to the recessive effect with a greater chance of losing both cells since you only have one
What is the diagnosis for Mr. Chow’s condition? (3)
squamous cell carcinoma because his sputum contains bad cells, the spreading to lymph nodes, and biopsy shows cells are present in the mass
Based on your diagnosis, account for the signs/symptoms that caused him to see his doctor (5)
chronic coughing = irritation in airways
wheezing and shortness of breath = obstruction
hoarse voice = involvement of laryngeal nerve
coughing up blood = tumour is eroding blood cells
Is Mr. Chow’s tumour a carcinoma in situ? Why/why not? (1)
no, not a carcinoma in situ because there’s spread to local lymph nodes
Identify the TNM classification of his condition. List the facts from his case that support your choice of values for the TNM system (3)
t - tumour size
N - spreading to lymph nodes
M - length of spread (metastasis)
What factors in his case indicates a greater risk of this type of cancer, and how would this increase his risk of cancer (3)
age - more cell mutations as you get older
gender - this cancer is more common in men
smoking - increases exposure to carcinogens
If it is decided that Mr. Chow’s treatment will be chemotherapy followed by surgery, what term would apply to the chemotherapy? Why would it be given prior to the surgery?
neoadjuvant reduces size of the tumour
If chemotherapy was used after the surgery, what term would apply to the chemotherapy? Why would it be given after the surgery?
adjuvant, kills and remaining cells after surgery
Identify and explain several iatrogenic manifestations that Mr. Chow may experience
anemia, leukopenia, thrombocytopenia, ulcers, loss of hair, nausea, infection
