Chapter 10: Cancers: Cells out of control Flashcards
What is an abnormal mass of cells caused by uncontrolled growth?
Neoplasm
What is a malignant neoplasm with the ability to spread?
Cancer
When cells of malignant neoplasm spread to another location that is called
metastasis
When cell shrinks in size it is called
atrophy
When cell enlargens in size it is called
hypertrophy
When cells multiply it is called
hyperplasia
Normal cell growth in wrong location
metaplasia
Loss of cell to cell contact inhibition; cells crawling on top of each other
dysplasia
Difference between benign and malignant
benign is usually well circumscribed, does not outgrow its capsule, does not outgrow its blood supply; does not metastasize; obeys physiology
Malignant is the opposite of the above.
What do malignant cells secrete to increase blood supply to “feed the tumor”
angiostatin
MC tumor of any organ (be careful, it doesn’t say “primary”)
metastasis
Usually -oma on end means benign tumor. What are some exceptions?
seminoma, lymphoma, mesothelioma, retinoblastoma
What ending do you give tumor if it has epithelial tissue origin?
carcinoma
What ending do you give tumor if it has connective tissue origin?
sarcoma
malignant gland tumor of epithelial origin
adenocarcinoma
a tumor that has tissue from ectoderm, mesoderm and endoderm (hair, teeth, bone)
teratoma
MC primary cancer overall in US?
basal cell carcinoma #2 squamous cell carcinoma of skin (but because of slow growth and early detection, usually not listed in MC cancers that cause death)
MC primary cancer of liver
hepatocellular adenocarcinoma
MC primary breast cancer
invasive ductal carcinoma
MC primary lung cancer
adenocarcinoma
MC intracranial tumor (brain)
meningioma
MC primary brain tumor
astrocytoma
MC astrocytoma in child
pilocytic astrocytoma (posterior fossa, “Rosenthal fibers”(worm-like, corkscrew fibers)
4 neoplasms with Psammoma bodies
PSAMM
Papillary thyroid carcinoma
Serous-
Adenocarcinoma of ovary
Meningioma
Mesothelioma
brain tumor associated with NF1
optic glioma and neural crest derived tumors
brain tumor of oligodendrocytes that cause personality changes and movement disorders
oligodendroglioma
brain tumor of ependymal cells that line ventricles
ependymomas
What happens if an ependymoma obstructs CSF flow?
non-communicating hydroencephalus
What are signs and symptoms of non-communicating hydroencephalus?
papillary edema, blurring of disc, headache, seizures
Peripheral neuromas, axillary freckling, Lisch nodules, pheochromocytoma, and optic gliomas associate with
NF1
Which chromosome is affected in NF1?
Ch 17
Which chromosome is affected in NF2?
Ch22
Which tumor suppressor gene is inactivated in NF2?
MERLIN
What brain tumors are seen in NF2?
meningiomas, bilateral schwannomas (Ch22, 2 ears)
What skin anamoly is seen in NF2?
cafe au lait spots
What other disease can you see cafe au lait spots with precocious puberty?
McCune–Albright Syndrome
Which syndrome has noted port wine stain on forehead with angiomas of brain and retina accompanied by learning disabilities.
Sturge-Weber Syndrome
Which disease can you see ash leaf spots (hypopigmentation) and sebaceous adenomas?
tuberous sclerosis
What three organs are affected in Tuberous Sclerosis?
brain (tubors); heart (rhabdomyoma/rhabdomyosarcoma); kidney (renal cell carcinoma)
Which two tumor suppressor genes are responsible for TS and which chromosome are they found on?
TS1 (Ch 9– hamartin); TS2 (Ch16–tuberin)
MC primary brain cancer
grade IV astrocytoma a.k.a. Gliobastoma Multiforme
What does GM look like histologically?
pseudopallisading pleiomorphic cells around central hemorrhage/necrosis; “garland-like”
most common brain cancer (“didn’t say primary!!)
metastasis (usually at grey-white junction) and usually from lung, breast & skin
MC pituitary tumor?
pituitary adenoma
pituitary adenoma (acidophilic)
produce prolactin and growth hormone
pituitary adenoma of (basophilic)
produce ACTH, TSH, FSH, LH
most common functional tumor of pituitary
prolactinoma
Which medicine can shrink prolactinoma?
bromocriptine/cabergoline (dopa agonist)
What tumor could cause precocious puberty?
pinealloma
Englargement of pineal gland could cause..
noncommunicating hydroencephalus and Parinaud’s syndrome (eyes fixed down ward, cannot look up)
Which eye problem is seen in Marfan’s syndrome?
can’t look down
Which eye problem is seen in homocystinuria?
can’t look up
Which brain tumor develops from Rathke’s pouch, may damage pituitary, is quite cystic and liquid inside has “motor-oil” appearance?
craniopharyngioma
MC childhood malignant primary brain tumor
medulloblastoma (cerebellar, papilledema, headaches, ataxia)
What “neuro” origin tumor grows medially in abdomen and is known to exhibit “dancing eyes, dancing feet”?
neuroblastoma
Rule of 10 for pheochromocytomas
10%in children; 10%bilateral; 10%metastatic; 10% familial; 10%malignant (don’t forget to turn it around 90% in adults; 90% unilateral; 90% not metastatic; 90% idiopathic; 90% benign
Neural crest locations MOTEL PASS
melanoma
odentoblasts
tracheal cartilage
enterochromaffin (make serotonin)
laryngeal cartilage
pseudo unipolar cells (cover neurons)
adrenal medulla
schwann cells
spiral membrane (aorto-pulmonary membrane)
Which tests can detect neural crest cancers?
urinary or serum VMA, metanephrines, or HVA (dopamine)
Medicine for neural crest tumors (to control)
phenoxybenzamine
Definite treatment for neural crest tumors
surgical removal
The four T tumors of anterior mediastinum
thymus, thyroid, T-cell leukemia(hairy cell)/lymphoma, teratomas
What is the main T cell leukemia?
hairy cell leukemia
What test is positive in hairy cell leukemia?
TRAP (tartrate resistant acid phosphatase)
Two kinds of T cell lymphomas:
mycosis fungoides (cutaneous), and sezary syndrome (systemic)
What autoimmune disease is thymoma associated with?
Myasthenia gravis
Which organs are immunoprivileged (have barriers)
thymus, brain, eyes, testes, (remember if one eye loses immunoprivilege, the other loses it too)
What is the first thing to do if a thyroid mass is discovered?
ultrasound (to determine if cystic or solid)
If a thyroid mass is cystic, what is the next step in management?
FNA (fine needle aspiration)–diagnostic and therapeutic
If thyroid mass is solid, what is the next step in management?
If less than 1 cm, do thyroid scan: hot nodule, treat for hyperthyroidism; cold nodule and previous irradiation of the neck, lobectomy; no previous irradiation, fine needle biopsy.
If greater than 1 cm, fine needle biopsy.
PTH up, Ca up, PO4 down What is the meaning?
primary hyperpituitarism (moans, groans, stones and psychiatric overtones)
Tx for primary hyperparathyroidism
bisphosphanates (remember to sit up at least 30 minutes after taking them!); parathyroidectomy if severe
Most common cancer of parafollicular gland?
medullary carcinoma of thyroid (produces calcitonin)
3 Ps of MEN1 (Werner’s syndrome)
pituitary, pancreatic, parathyroid tumors
MENII (Sipple Syndrome)
medullary carcinoma of thyroid (parafollicular secretes Calcitonin), pheochromocytoma, +/- parathyroid adenomas
mutation in RET
MEN IIb
Marfanoid habitus,pheochromocytoma, mucosal neuroma (like bumps on tongue) mutation in RET
MC tumor of heart?
myxoma (more common in females: pass out and recover a few seconds later–estrogen connection)
What are the two central primary lung cancers?
squamous cell carcinoma and small celll carcinoma
What hormone does squamous cell carcinoma often produce?
PTHrp
What hormones are small cell carcinomas able to produce?
ACTH, ADH, PTH, TSH
Which primary lung cancer is not related to smoking?
bronchoalveolar adenocarcinoma
Which syndrome of SCLC is when antibodies to presynaptic Ca channels produce muscle weakness that gets better with repetitive movement?
Lambert–Eaton
Which complication of SCLC present with low serum osmolarity and high urine osmolarity?
SIADH
If after high dose dexamethasone, the cortisol level is suppressed, where was the problem?
pituitary
If after high dose dexamethasone, the cortisol level is NOT suppressed, which two possible origins did problem originate? How can we distinguish one from the other?
could be a problem from adrenal gland or Lung cancer (SCLC) if ACTH is down from adrenal; if ACTH is up from lung cancer (or we can CT chest to find lesion)
What kind of pneumocosis comes from coal dust?
anthracosis
What kind of pneumocosis comes from shipyard work, construction, or plumbing?
asbestosis
What kind of pneumocosis comes from sandblasting?
silicosis
What kind of pneumocosis can you see eggshell calcifications in the hilum?
silicosis
What kind of pneumocosis could come from working in electronics or space industry?
berryliosis
All pneumocosis show restrictive lung pattern: what would lab values pAO2, RR, pCO2, pH look like?
pAO2 down, RR up, pCO2 down, pH up respiratory alkalosis
What three differentials for hilar calcifications?
silicosis, sarcoidosis, lymphoma
What is cancer of pleura?
mesothelioma
What is the histological finding of mesotheliomas?
psammoma bodies
most common primary cancer of nasopharynx
nasopharyngeal carcinoma MCC seen in Chinese men
Most common primary cancer of oral cavity
squamous cell carcinoma from smoking, chewing tobacco
Most common primary cancer of esophagus
squamous cell carcinoma
risk factors for esophageal SCC
Barrett’s esophagus
How does Barrett’s esophagus often present
odonyphagia (first cannot eat solids, then cannot drink liquids)
If a person has Barrett’s, how often should they have an endoscopy?
If they have low dysplasia, give endoscopy once every 6-12 mo.
cancer associated with Virchow’s nodes
stomach adenocarcinoma
What kind of cells can be seen in stomach adenocarcinoma biopsy?
signet ring (M cells making mucin)
What if stomach adenocarcinoma spreads to ovaries? What is it called?
Kruckenberg tumor
1 risk factor for stomach MALToma (kind of B cell lymphoma)
H. pylori
Tx for H. Pylori
triple therapy: clarythromycin, amoxicillin, PPI; if resistant to amoxicillin: metronidazole; if no response chemotherapy
top risk factors for UGI cancers
1 smoking, alcohol, nitrates, Japanese race
most common cancer of ileum
lymphoma
most common cancer of the appendix
carcinoid: usually originates from 1)pancreas 2) ileum; puts out large amount of serotonin; check urinary serotonin levels;
What other condition could develop with carcinoid syndrome?
Pellagra: dermatitis, diarrhea, dementia (death) because using up niacin to make serotonin
Tx for carcinoid syndrome
octreatide
top colon cancer risk factors
low fiber diet, high fat diet, polyps, UC
In familial polyposis, which gene is inactivated? Which gene is activated?
APC inactivated, KRAS activated
When should children in families with FAP get colonoscopy and how often?
yearly colonoscopy by age 12
Which disease presents with osteomas and sebaceous adenomas (bone tumors)
Gardner’s
Which present with osteomas, sebaceous adenomas (polyps) and brain tumors?
Turcot’s
Lynch syndrome (HNPCC) is associated with which gene mutations?
MSH1,2; MCH1
Which liver tumor is associated with estrogen use or injected steroids and could rupture and lead to life-threatening hemorrhage if ruptured?
hepatic adenoma
Which disease is associated with arteriovenous malformations in brain, GI and pulmonary?
Osler-Weber-Rendu
Which gene mutation is associated with Osler-Weber-Rendu?
ALK1, ALK2 on Ch12
Which disease leads to AVM or cysts in brain and abdomen?
VHL, from VHL gene on Ch3 (increase susceptibility to renal cell carcinoma)
Name 2 cancers where smoking is protective:
UC and endometriosis, all other cancers #1 risk factor
name risk factors for hepatocellular carcinoma
smoking, alcohol, Hep B, Hep C, schistosomiases, aniline dyes, aflatoxin, vinyl chloride (angiosarcoma); benzene
Most common primary cancer of biliary tract
cholangiosarcoma
Which autoimmune biliary disease is associated with anti-mitochondrial antibodies?
Primary Biliary cholangitis (PBC)
Which biliary disease is seen in men with UC and is associated with pANCA.
primary sclerosing cholangitis (PSC)
Adenocarcinoma of which organ is associated with Trousseau syndrome (migratory thrombophlebitis) and why?
pancreatic adenocarcinoma because mucin interacts with PLTs and makes them “sticky”, so pts. develop clots in various veins
What is Libman Sachs endocarditis
a noninfectious endocarditis due to antigen-antibody (IgG-C3-IgM) immune complex deposition in heart valves
Which pancreatic adenoma can cause elevated glucose, lipids and ketones
glucagnoma (maybe treated as diabetes, but does not respond to insulin)
Which pancreatic adenoma can cause very low blood glucose?
insulinoma
Which pancreatic adenoma could cause severe constipation?
somatostatinoma
Which pancreatic adenoma could cause watery diarrhea?
VIPoma
Most common primary ovarian tumor?
serous adenocarcinoma (highly malignant and most mucinous cancer in women)
ovarian cancer with elevated estrogen
granulosa cell tumor
ovarian cancer with high AFP
yolk sac tumor
ovarian cancer with high hCG
choriocarcinoma
ovarian cancer with masculinization
Sertoli-Leydig (elevated testosterone)
ovarian cancer that could cause pseudomyxoma peritonei
mucinous cystadenocarcinoma
fibroma associated with pleural effusion or ascites
Meig’s syndrome
germ cell tumor with elevated LDH
dysgerminoma/seminoma or embryonal cell carcinoma
most common tumor in uterus
leiomyoma
most common cancer
endometrial adenocarcinoma
irregularly enlarged uterus (nonsymmetrical)
fibroids
Tx for fibroids:
OCPs, leuprolide (GnRH analogue); surgery (uterine artery embolization)
bleeding between periods or after menoupause:
endometrial adenocarcinoma
risk factors for endometrial adenocarcinoma
early menarche, late menopause, PCOS, obesity
most common cancer of cervix
squamous cell carcinoma
most common cause of cervical cancer (preventable)
HPV
most common mass of vagina
warts, Bartholin cysts
tx of Bartholin cysts
1st time: antibiotics; reoccurrence: marsupialization (open gland); after age 50 BIOPSY
most common cancer of vagina (upper half)
squamous cell from cervix
most common cancer lower vagina
children–rhabdomyoma; adults rhabdomyosarcoma (sarcoma botryoides “bunch of grapes”
treatment for warts
trichloroacetic acid, podophyllum drops, cryosurgery
Most common primary kidney cancer
children–Wilm’s tumor (WAGR Wilm’s, Aniridia, GU abnormalities, retarded mentation)
Adults- renal cell carcinoma
What hormones could renal cell carcinoma produce and their effects?
If JG cell hyperplasia: up renin, up ALDO=HTN
If peritubular interstitial hyperplasia, up EPO, polycythemia vera
What is Conn’s syndrome
hyperplasia of glomerula of adrenals, ALDO up=HTN
What is Cushing syndrome
adrenal adenoma of fasciculata makes more cortisol
What will an adenoma in adrenal medulla lead to?
pheochromocytoma; up in metanephrines
Most common primary cancer of bladder
transitional cell adenocarcinoma
risk factors for transitional cell adenocarcinoma of bladder
aniline dyes, benzene, aflatoxin, cyclophosphamide
What is the rescue drug for doxirubicin causing cardiomyopathy?
dextrazoxane
What is the rescue drug for methotrexate causing Bone marrow depletion?
leukovorin (folinic acid)
What is the rescue drug for cyclophosphamide causing bladder cancer?
Mesna (a scavenger drug)
What is the rescue drug for cysplatin causing nephrotoxicity?
Amifostine
Which parasite can cause squamous cell carcinoma of bladder?
schistosoma haematobium
What is the difference between prostatitis, prostatic hyperplasia, and prostate adenocarcinoma on digital rectal exam?
prostatitis the prostate will feel soft and boggy; prostatic hyperplasia prostate is big with no nodules, prostate adenocarcinoma prostate is hard and nodular
Rx for benign prostate hyperplasia:
terazosin/doxazocin (alpha 1 antagonists relax sphincter); finasteride/dutasteride 5 alpha reductase inhibitor (shrink prostate); TURP transurethral resection of prostate
Most common cancer of testes in first year of life
yolk sac cancer
most common cancer of testes in teens to adults
seminoma
most common skin cancer
basal cell
most common malignant skin cancer
squamous cell carcinoma
most malignant skin cancer
melanoma
What determines the prognosis of melanoma?
depth of invasion
most common bone cancer of epiphysis
chondrosarcoma
most common bone cancer of metaphysis
osteosarcoma: starburst effect on cortex; “Codman’s triangle”
most common bone cancer of diaphysis (middle) for children
Ewing’s osteosarcoma t(11,22); onion skinning
most common tumor of breast under 25 y/o
fibroadenoma (estrogen dependent)
most common tumor of breast above 25 y/o
fibrocystic disease (progesterone dependent)
most common cancer of breast
intraductal adenocarcinoma
presenting sign of intraductal adenocarcinoma
dimpling of breast
breast cancer with nipple bleeding
intraductal papilloma
breast cancer with cells lined up in single file
lobular adenocarcinoma
breast cancer with focal areas of necrosis
comedocarcinoma
breast cancer with peau d’orange
inflammatory adenocarcinoma (most malignant)
a sarcoma that explodes out of breast then stops growing; wide excision is curative
cystosarcoma phyllodes
ulcerative rash around nipple associated with intraductal adenocarcinoma
Paget’s Disease
tx for cystic breast mass
FNA
tx for firm breast mass
lumpectomy and biopsy
benign firm breast mass
removal only
malignant firm breast mass
after lumpectomy, perform modified radical mastectomy, nodal dissection, check for estrogen/ progesterone +, Raloxifene for estrogen +, chemo for premenopausal and radiation for postmenopausal; HER2NEU Tran2zumab (SE cardiomyopathy rescue drug Dextrazoxane–same for doxirubicin)
PSA marker for
prostate cancer
CEA marker for
colon, pancreas, biliary cancers
S-100 marker for
melanoma (neural crest)
AFP
yolk sac tumor, choriocarcinoma
hCG
choriocarcinoma,
C-myc
Burkitt’s lymphoma
L-myc
small cell lung cancer
N-myc and bombesin
neuroblastoma
desmin
rhabdosarcoma
vimentin
sarcoma
Ca-125
serous adenocarcinoma of ovaries
Ca-19
pancreatic cancer
BCL2
follicular lymphoma
RET
MEN II
RB
retinoblastoma, osteosarcoma
p53
everything!
