Chapter 3 Flashcards
which cancer is. leading cause of cancer death
lung cancer
which cancer is. 2nd leading cause of cancer death in men and women
breast- women
prostate - men
which cancer has 3rd highest incidence and death rate
colon and rectal tumors
what is the median age at dx for malignant melanoma
59-63 in blacks and caucasians
52-56 yrs in other ethnic groups
what % of all skin malignancies are MM
4-5%
which 2 countries have highest rates of MM
Australia and New Zealand
what % of MM are localized at time of dx
84%. localized
9% extend to regional nodes or in-transit
4% have distant mets
what race has highest risk of developing MM, then which gender
caucasians (20-1), males
except women under 49
MM lesions are more common on head/neck for men or women?
men
and for women, on extremities and tors
what is most common risk factor for MM
sun exposure
what are risk factors for MM
sun exposure (intermittent intense more than total time in sun)
skin tone (fair skin with freckles)
use of tanning beds
hx of organ transplantation, Dx of prior melanoma or other skin cancers
presence of benign nevi or dysplastic nevi
family hx
prob of developing MM from benign nevi is increased by what?
number and size of lesions.
what are the characteristics of atypical nevi
variable pigmentation
irregular outline
indistinct borders
what % of MM lesions arise from the transformation of a pre-existing lesion?
20-30%
describe the ABCDE criteria for identifying clinically suspicious skin lesions
A = asymmetry B = border irregularity C = color variation D = diameter >= 6mm E = evolving with changes over time (growth, color variation, itching, bleeding)
what are the 4 major histologic types of melanoma
- superficial spreading melanoma
- nodular melanoma
- lentigo maligna
- aural lentiginous melanoma
which subtype of melanoma in most common, and what percent are this type
superficial spreading (60-70%)
which subtype of melanoma is the 2nd most common and what percent are this type
nodular (15-30%)
which has more rapid onset and progression (depth), nodular or superficial spreading
nodular
what % of melanoma are lentigo malignant and what group of people are most affected. faster or slower progression?
5%
older individuals
slower progression
what is the least common subtype of melanoma. why are they difficult to dx
acral lentiginous
diff to dx due to location (palm, sole, under nail) and in people with dark complexions. poorer prognosis
what are the prognostic factors for mortality in melanoma
depth of invasion presence or absence of ulceration mitotic rate if mets to LNs or other sites ulceration mitosis (dividing cells on microscopic exam) mets age of onset anatomic site (trunk, head, neck) vascular invasion clark level
define ulceration (of melanoma)
no skin surface cells overlying the tumor, so malignant cells extend through the surface layer.
invasion through epidermis is marker for metastatic potential
what are the 5 clark levels
clark level I - epidermis only
clark level 2 - upper portion of the papillary dermis
clark level III - fills the papillary dermis
clark level IV - reticular dermis
clark level V- subcutaneous fat
melanoma staging system evaluates tumors based on:
- local extent
- presence of lymph node mets, designated the N category
- existence of mets indicated by the M category
describe depth stages (malignant melanoma)
T1 <= 1.0 mm
T2 1.01-2.0 mm
T3 2.01-4.0 mm
T4 >4mm
what is added to the T category when ulceration is present (MM)
“b”
so stage T1b would be stage 1 with ulceration
why is ulceration often used to determine if SNL bx required or not
LN mets are uncommon in MM without ulceration but occur in 10% of ulcerated lesions
what is the most commonly diagnosed malignancy in males in the US
prostate cancer
what is the second leading cause of death in males after lung cancer in the US
prostate cancer
prostate cancer represents roughly ___% of all new cancer diagnoses in males, excluding non-MM skin cancers
20%
death rates in black males from prostate cancer are ____ than that of white males
more than double
what is the most important risk factor for developing prostate cancer
age
most males, if they live long enough, will develop some evidence of what type of cancer?
prostate
75% of clinically significant prostate tumors are diagnosed in over age ___
65
other than age, what are the important risk factors for developing prostate cancer?
family history, genetic, possibly hormones diet and obesity may play role
what is a transition sequence to prostate cancer?
normal prostatic epithelium > proliferative inflammatory atrophy (PIA) > PIN > invasive cancer
what does DRE screen for
glandular induration (hard or firm texture), discrete nodules, asymmetry of the gland
what % of prostate tumors does DRE miss
23-45%
what other factors can increase the PSA level?
1) BPH 2) prostatitis 3) prosthetic massage 4) surgery 5) instrumentation (bx or resection) of the gland… recent ejaculation can raise the value slightly
what medications can lower PSA levels by about one half
finasteride (prosper) and dutasteride (Avodart)
what is upper limit for normal PSA values in most labs?
4.0 ng/ml
what are the PSA upper limits of normal for Caucasian males by age
1) 2.5 at ages 40-49
2) 3.5 at ages 50-59
3) 4.5 at ages 60-69
4) 6.5 at ages 70-79
what is PSA velocity
rate of rise of the PSA level
what is difference in value of PSA testing between insurance and clinical setting
PSA assay is very good test for finding advanced, incurable disease with early mortality, which makes it highly valuable in the insurance area, even when it is of limited value clinically
what is free PSA useful for
prostate cancer produces more bound PSA, thus reduces the % of total unbound material. so measuring free PSA and its % of total PSA level can improve diagnostic accuracy of PSA level (lower free PSA more likely cancer)
what is PSA density
requires measurement of prostate volume. cancer produces more PSA per gram of tissues than BPH.
TRUS is useful for what?
not useful screening tool. used to evaluate the gland when suspicion of malignancy is increased.
what is use for multi parametric MRI for prostate imaging
useful for staging and to better assess need for a bx. results in reduction in number of unnecessary biopsies, a higher yield of significant cancers, and a need for fewer bx cores.
how many cores are sampled on a standard prostate bx?
10-12 or more, unless MRI targeted.
most prostate cancer is which type?
adenocarcinoma (>95%).
what are the key features of importance on a prostate bx?
1) presence of invasive cancer 2) grade, or degree of malignancy of the cells 3) stage, or extent of the tumor
Most prostate cancers are which type
adenocarcinoma (>95%)
what are they key features of importance on a prostate bx
1) presence of invasive cancer. 2) grade, or degree of malignancy of the cells 3) stage, or the extent of the tumor
what is the range of Gleason scores, which scores more favorable
1-10, composite range 6-10, range 6 and below more favorable
explain TNM system for staging prostate cancer
T = extent of tumor. N = any LN mets. M = distant mets. small letters c or p are placed in front of the staging categories to designate whether they were clinically or pathologically derived
what are the most important prognostic factors in prostate cancer
1) stage of tumor. 2) Gleason grade group 3) pre-treatment PSA level
what is the Gleason grading system
used to assess degree of malignancy based on cellular patterns on tissue samples
what are the two major forms of curative treatment for presumed organ-confined prostate cancer
surgery and radiation
what is the double time for prostate cancer
2-4 yrs
should there be PSA recurrence after prostate cancer, what is avg time to the development of clinically evident mets
8-10 yrs, then another 5 yrs until death
what factors, if present, predict more rapid progression from PSA recurrence to mortality?
1) shorter time from treatment to PSA recurrence 2) higher Gleason score 3) short PSA doubling time
what is the most commonly diagnosed cancer and leading cause of death from malignancy among females in the USA
breast cancer
the majority (80%) of breast cancer are _____ lesions
invasive
20% of Breast cancer lesions are ____
in situ
what is the most important risk factor for the development of breast cancer
age
incidence rates of breast cancer peak age at what age
75-79
other than age, what are other risk factors to development of breast cancer?
family history, estrogen exposure, benign breast disease, environmental factors (radiation ETOH, smoking, obesity), prior hx of breast cancer
which DCIS tumors are at greatest risk for recurrence?
high nuclear grade, comedonecrosis on bx, younger age at onset, larger size, presence of palpable nodule, multiple in situ lesions
is LCIS truly breast cancer
no, lobular neoplasia/hyperplasia, precursor lesion
most invasive breast cancers are of which type
adenocarcinoma, most are invasive ductal carcinoma, followed by invasive lobular carcinoma
describe TNM system for staging breast cancer
T= size and/or local extent of tumors. N= nodal status. M= any distant mets.
what are the T designations for breast cancer (staging)
Tis= carcinoma in situ. T1 <2.0 cm. T1mi <1mm T1a >1mm but %5mm, T1b >5mm but <10mm. T1c >10mm but <20mm. T2 >2 but <5cm. T3 >5cm. T4 any size with extensions Chest wall. or skin or both or with inflammatory changes
describe N designations for Breast cancer staging
pN0 no nodal involvement. pN1 (1- 4 pos nodes), pN2 (4-9 nodes pos), pN3 10 or more nodes positive
in breast cancers mortality primarily results from what
distant mets
how does tumor size impact assessing risk of breast cancer mortality
the larger the lesion, the greater the risk for mets and mortality
how does histologic grade of breast cancer impact prognosis
the less differentiated the lesion, the greater the risk for progression and mortality
do post or premenopausal women fare worse with breast cancer
premenopausal women fare worse, especially those age under 35
______ invasion on pathologic specimen is associated with higher risk of local and distant spread of breast cancer
lymphatic or vascular invasion
what is triple negative breast cancer
ER neg, PR neg, HER-2 neg. more common age <40, hispanic and black females, and in majority of BRCA1 tumors. more aggressive poorer prognosis
mortality from breast cancer varies with the three major prognostic factors (name them)
1) lymph node status. 2) tumor size. 3) histologic grade
which cancer is the 3rd most common cancer in the US for both males and females and 3rd leading cause of death from malignancy
colon cancer
what are risk factors for colon cancer
age, hereditary syndromes, family hx, diet, obesity, inflammatory bowel disease (UC and Chron’s), smoking, ETOH
do hyperplastic polyps carry a significant risk for development of colon cancer?
No, unless large in number
which adenomatous polyps carry most risk for colon cancer
1) tubular adenomas have lowest risk of malignant transformation and are most common type. 2) tubulovillous adenomas carry 4x the risk. 3) villous adenomas risk 5 times higher
in general how long does it take for a colon polyp to develop to carcinoma
10 to 15 years
what hereditary syndromes can cause colon cancer
familial adenomatous polyposis syndrome (FAP), juvenile polyposis, Gardner’s syndrome, Turcot’s syndrome, Cowden syndrome, Peutx-Jegher’s syndrome. most important is hereditary nonpolyposis colon cancer (HNPCC or Lynch syndrome)
what are the items of greatest importance on a path report (colorectal cancer)
1) extent of invasion of the bowel wall 2) degree of differentiation 3) presence of lymph node involvement
describe T system details re colon cancer
Tis - carcinoma in situ, intramucosal carcinoma with no extension through muscular mucosal. T1 - invasion of submucosa. T2 - invasion of the muscular propria. T3 - invasion through the bowel wall into the pericolorectal tissues. T4 - direct invasion of other organs or structures
describe N system in colon cancer staging
N0 - no node invasion. N1 - 1-2 nodes pos. N2 4 or more nodes pos.
describe M system for colon cancer staging
M0 no mets. M1 mets present
name other prognostic factors in colon cancer
differentiation tumors with abnml DNA content, gross tumor perforation of bowel wall, direct invasion of adjacent organs lymphovascular and perineurial invasion, high CEA level, low total number of LNs in the surgical specimen, infiltrating pattern of growth at the tumor border, gene mutations.
is tumor size an important prognostic factor in colon cancer
no
what is the only curative therapy for colorectal cancer
surgery, hemocolectomy
what is use of chemo and radiation for colon cancer
adjuvant therapy to eradicate micromets and increase cure rates for those treated with surgery. for metastatic disease, chemo alone not curative but may extend survival from mean of 6 months to 30 months
is stage 1 colon cancer usually treated with chemo
no, surgery alone
is stage II colon cancer treated with chemo?
primarily surgery, and adjuvant chemo for higher risk stage II lesions can be of value
adjuvant chemo is generally advised for what stage of colon cancer
stage III
chemo is standard treatment for what stage of colon cancer
stage 4
how is CEA testing useful re colon cancer
CEA is a protein typically found in the detal or developmental period, but also in blood of individuals with colorectal cancer. elevations prior to sx are a poor prognostic indicator, marker for higher risk of recurence
are late recurrences of colon cancer common?
no, most recurrences are found within first 2-3 years after initial treatment
is treatment available for recurrent colon cancer/.
no, so rigorous f-u regimen is recommended. colonoscopy at on year post op then even 3-5 yrs
what are the major risk factors for mortality with colon cancer
extent of disease locally, grade of tumor, present of LN mets
PSA velocity greater than 0.75 ng/ml per year is highly suggestive of (malignancy, prostatitis, BPH or proliferative inflammatory atrophy)?
malignancy
does chemo significantly increase survival rates for malignant melanoma?
no
breast cancer is often less advanced at time of dx for males than females, true or false
false
true or false- breast cancer survival patterns by stage are similar in males and females
true
the most important prognostic factor for invasive breast cancer mortality is? (distant mets, degree of local control, age at dx or tumor size)
distant mets
unfavorable prognostic factors for colorectal cancer include which of the following? (A - elev CEA, B- gross tumor perforation of bowel wall, C - well differentiated tumor)
A and B (elev CEA and gross tumor perf of bowel wall)
