Ch. 4 - Cancer Pt. 1

Question 1

What type of tumors lacks the ability to invade neighboring tissue or to metastasize?

Answer 1

Benign tumors. Generally, they have a slower growth rate than malignant tumors, and their cells usually have normal features. While most benign tumors have no mortality risk, some have the potential to adversely affect morbidity and mortality

Question 2

Benign tumors with higher risk potential include:

Answer 2

Tumors susceptible to malignant transformation (such as hepatocellular adenoma)
Tumors associated with high future cancer risk
Highly vascular tumors that have the potential to hemorrhage (particularly with trauma or attempted surgical resection)
Tumors that have aggressive variants capable of locally invasive behavior and even of metastasizing
Tumors that, due to their location, can cause a mass effect, resulting in either damage to surrounding tissue due to pressure from the mass or obstruction, such as benign tumors of the brain, spinal cord, and heart
Endocrine tumors

Question 3

Malignant tumors have several characteristics that both define them and enhance their ability to proliferate. These include:

Answer 3

The ability to evade apoptosis
Unlimited growth potential due to overexpression of oncogenes which promote cell growth, and/or inhibition of tumor suppressor genes which inhibit cell division
Increased rate of cell division (i.e., mitotic rate)
The altered ability of cells to differentiate
The ability to generate/promote blood vessel growth (i.e., angiogenesis or neovascularization)
Deregulation of cohesive molecules allowing cancer cells to cross through thin-walled capillaries and lymphatic channels

Question 4

What are some microscopic findings of malignant tumors?

Answer 4

Large number of rapidly dividing cells
Variation in nuclear size and shape
Variation in cell size and shape
Loss of specialized cell features specific to the organ
Loss of normal tissue organization
Poorly defined tumor boundary

Question 5

What are common terms associated with DNA mutations of malignant tumors?

Answer 5

Hyperplasia, atypical hyperplasia, carcinoma in situ, and invasive cancer

Question 6

How does cancer kill?

Answer 6

Invasion or destruction of a vital organ (e.g., brain, lungs, liver)
Consumption of the body’s nutrients and blood supply causing wasting
Blood clots associated with hypercoagulable state, especially in those with solid tumors of the abdomen, resulting in pulmonary embolism and stroke
Effects of treatment that impact immune suppression causing opportunistic infections as well as complications of chemotherapy, radiation, and surgery

Question 7

What is the most important prognostic factor associated with a malignancy?

Answer 7

The stage of cancer at the time of diagnosis. In general, the earlier the malignancy can be diagnosed and treated, the more favorable the prognosis. Followed closely is grade.

Question 8

What are warning signs that can be suspicious for an underlying malignancy?

Answer 8

Change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, non-painful thickening or lump, indigestion or difficulty swallowing, change in color, size, or shape of a skin lesion, freckle, skin growth or mole, and nagging cough or hoarseness

Question 9

From an underwriting perspective, other signs or symptoms that can be a cause for concern include:

Answer 9

Unexplained weight loss, poor appetite, anemia, fever/chills/night sweats, thrombosis, and increased fatigue

Question 10

What is an invasive procedure that involves the removal of tissue or sampling of cells for microscopic evaluation by a pathologist to determine whether a lesion is benign or malignant?

Answer 10

A biopsy

Question 11

What are the most common types of cancer?

Answer 11

1. Carcinoma

Question 12

What is the most essential document in tumor underwriting?

Answer 12

The pathology report. Many times, there will be more than one pathology report for a tumor. The first one is usually the initial biopsy and the second one will be from an additional surgical procedure completed

Question 13

Identify the tumor grade: Well-differentiated - phenotypically most like the normal cell

Answer 13

Grade 1

Question 14

Identify the tumor grade: Moderate differentiated

Answer 14

Grade 2

Question 15

Identify the tumor grade: Poorly differentiated

Answer 15

Grade 3

Question 16

Identify the tumor grade: Undifferentiated, anaplastic - phenotypically least like the normal cell

Answer 16

Grade 4

Question 17

What grade of tumors can be referred to as “low grade”?

Answer 17

Grade 1 and 2

Question 18

What grade of tumors are called “high grade”?

Answer 18

Grade 3 and 4

Question 19

Staging of a cancer is a tool that considers several factors including?

Answer 19

1. Size of tumor
2. Depth of penetration into and/or through an organ
3. Whether it has invaded adjacent organs
4. If and how many lymph nodes are involved
5. Presence of distant metastasis

Question 20

What is pathologic staging based on?

Answer 20

It is based on microscopic findings

Question 21

What is clinical staging based on?

Answer 21

All available information obtained before surgery is performed to remove a tumor or if non-surgical treatment is planned

Question 22

The staging process requires an extensive workup. What are some components of the workup?

Answer 22

1. Thorough physical examination
2. Laboratory tests
3. Biopsies of sites such as the lymph nodes and bone marrow
4. Tests such as x-rays, CT, MRI, and sometimes PET scans

Question 23

Identify the stage: in situ tumor

Answer 23

Stage 0

Question 24

Identify the stage: organ-confined tumor

Answer 24

Stage 1

Question 25

Identify the stage: Invasion of adjacent areas or nearby lymph nodes

Answer 25

Stage II

Question 26

Identify the stage: Regional metastases or invasion of more distant lymph nodes

Answer 26

Stage III

Question 27

Identify the stage: Distant metastases

Answer 27

Stage IV

Question 28

What does the Tis designation represent?

Answer 28

Carcinoma in situ

Question 29

What determines the numerical value assigned to the letter T in the TNM system?

Answer 29

The size and degree of invasion

Question 30

What does the Tx designation represent?

Answer 30

Tx means that the tumor cannot be evaluated

Question 31

What does the M0 designation represent?

Answer 31

M0 indicates no distant metastasis

Question 32

What does the M1 designation represent?

Answer 32

M1 indicates metastasis to distant organs

Question 33

What does the M designation represent?

Answer 33

M represents the presence of distant metastasis

Question 34

What is Mitotic rate?

Answer 34

Mitotic rate is a marker for how rapidly the cells are dividing, which indicates how fast the tumor is growing. Higher mitotic index correlates with higher grade cancers. Mitotic rate is a major prognostic consideration in melanoma

Question 35

What do positive estrogen receptor/progesterone receptors represent in relation to breast cancer?

Answer 35

Associated with low grade cancer with better survival. It is most amenable to hormone treatment such as Tamoxifen in improving recurrence-free survival

Question 36

What is ERBB2 (formerly HER2 or neu) associated with?

Answer 36

Epidermal growth factor with more aggressive or high-grade cancers, including breast, ovarian, stomach, bladder, and lung

Question 37

Treatment decisions are usually based on the type, location, stage, and grade of the malignancy. What are the main methods of cancer treatment?

Answer 37

1. Surgery 2. Radiation therapy 3. Chemotherapy 4.Targeted therapy or molecularly-targeted therapies 5. Hormone therapy 6. Stem cell transplantation 7. Organ transplantation

Question 38

What are the three types of radiation therapy for cancer?

Answer 38

1. External beam - the most frequent form of radiation treatment. Targets a particular part of the body. The radiation interacts with tissues and is absorbed, damaging the DNA of the exposed cells. 2. Brachytherapy - a radioactive source is placed inside or next to the area requiring treatment. It is commonly used to treat localized prostate cancer and cancers of the head and neck, as well as other malignancies. 3. Unsealed source radiotherapy - involves the use of soluble forms of radioactive substances that are administered to the body by injection or ingestion. The most common one is radioactive iodine to treat thyroid cancer

Question 39

When can an active surveillance strategy be embraced?

Answer 39

Common with low grade, low stage prostate cancer as well as with small kidney tumors. Can also be used for certain thyroid cancers such as papillary carcinoma.

Question 40

What cancers are NOT followed for an extended interval after completion of treatment?

Answer 40

Low -risk skin cancers

Question 41

What are signs of potential tumor recurrences?

Answer 41

1. Unexplained weight loss 2. Persistent or worsening fatigue 3. Elevation of liver-related and other blood tests 4. Anemia 5. Bleeding episodes 6. Enlarged lymph nodes 7. Localized bone pain 8. Neurological abnormalities 9. Deep venous thrombosis (DVT) 10. Recent onset of undiagnosed or worsening symptoms

Question 42

What are the ten essential questions to be resolved in every cancer case?

Answer 42

1. What is the specific type of tumor? 2. When was it diagnosed? 3. What was the stage at diagnosis? 4. Are there any pathology reports or other factors that have a significant bearing on prognosis? 5. How was the cancer treated and when did treatment end? 6. Has the proposed insured been compliant with the recommended follow-up? 7. Are there any significant interim symptoms or findings where cancer recurrence has not yet been ruled out? 8. Has there been a recurrence of the cancer and, if so, when was it and what treatment was given? 9. Is there any evidence of delayed adverse effects from treatment? 10. What is the prognosis?

Question 43

The treatment that is more effective with high growth rate/metastatic cancers is: 1. active surveillance 2. surgery 3. radiation 4. chemotherapy

Answer 43

4. chemotherapy

Question 44

All of the following are common characteristics of malignant tumors EXCEPT: 1. slow growth rate 2. anaplastic cells 3. infiltrating growth pattern 4. extensive mitotic activity

Answer 44

1. slow growth rate

Question 45

Which of the statements regarding carcinoma in situ is/are correct? A. It can be a noninvasive cancer B. It is reported as Tx in the TNM staging system C. It can have a high probability of progression to invasive cancer

Answer 45

A & C only are correct

Question 46

An increase in the number of normal cells due to an excessive rate of cell division is: 1. hypertrophy 2. metaplasia 3. atypia 4. hyperplasia

Answer 46

4. hyperplasia

Question 47

All the following are tumor markers EXCEPT: 1. alpha-fetoprotein (AFP) 2. carcinoembyonic antigen (CEA) 3. C-reactive protein (CRP) 4. prostate-specific antigen (PSA)

Answer 47

3. C-reactive protein (CRP)