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ALU 201 > Chapter 3 > Flashcards

Chapter 3 Flashcards

1
Q

which cancer is. leading cause of cancer death

A

lung cancer

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2
Q

which cancer is. 2nd leading cause of cancer death in men and women

A

breast- women

prostate - men

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3
Q

which cancer has 3rd highest incidence and death rate

A

colon and rectal tumors

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4
Q

what is the median age at dx for malignant melanoma

A

59-63 in blacks and caucasians

52-56 yrs in other ethnic groups

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5
Q

what % of all skin malignancies are MM

A

4-5%

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6
Q

which 2 countries have highest rates of MM

A

Australia and New Zealand

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7
Q

what % of MM are localized at time of dx

A

84%. localized
9% extend to regional nodes or in-transit
4% have distant mets

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8
Q

what race has highest risk of developing MM, then which gender

A

caucasians (20-1), males

except women under 49

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9
Q

MM lesions are more common on head/neck for men or women?

A

men

and for women, on extremities and tors

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10
Q

what is most common risk factor for MM

A

sun exposure

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11
Q

what are risk factors for MM

A

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

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12
Q

prob of developing MM from benign nevi is increased by what?

A

number and size of lesions.

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13
Q

what are the characteristics of atypical nevi

A

variable pigmentation
irregular outline
indistinct borders

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14
Q

what % of MM lesions arise from the transformation of a pre-existing lesion?

A

20-30%

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15
Q

describe the ABCDE criteria for identifying clinically suspicious skin lesions

A 
A =  asymmetry
B = border irregularity
C = color variation
D = diameter >=  6mm
E = evolving with changes over time (growth, color variation, itching, bleeding)
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16
Q

what are the 4 major histologic types of melanoma

A
  1. superficial spreading melanoma
  2. nodular melanoma
  3. lentigo maligna
  4. aural lentiginous melanoma
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17
Q

which subtype of melanoma in most common, and what percent are this type

A

superficial spreading (60-70%)

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18
Q

which subtype of melanoma is the 2nd most common and what percent are this type

A

nodular (15-30%)

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19
Q

which has more rapid onset and progression (depth), nodular or superficial spreading

A

nodular

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20
Q

what % of melanoma are lentigo malignant and what group of people are most affected. faster or slower progression?

A

5%
older individuals
slower progression

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21
Q

what is the least common subtype of melanoma. why are they difficult to dx

A

acral lentiginous

diff to dx due to location (palm, sole, under nail) and in people with dark complexions. poorer prognosis

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22
Q

what are the prognostic factors for mortality in melanoma

A 
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
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23
Q

define ulceration (of melanoma)

A

no skin surface cells overlying the tumor, so malignant cells extend through the surface layer.
invasion through epidermis is marker for metastatic potential

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24
Q

what are the 5 clark levels

A

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

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25
Q

melanoma staging system evaluates tumors based on:

A
  1. local extent
  2. presence of lymph node mets, designated the N category
  3. existence of mets indicated by the M category
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26
Q

describe depth stages (malignant melanoma)

A

T1 <= 1.0 mm
T2 1.01-2.0 mm
T3 2.01-4.0 mm
T4 >4mm

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27
Q

what is added to the T category when ulceration is present (MM)

A

“b”

so stage T1b would be stage 1 with ulceration

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28
Q

why is ulceration often used to determine if SNL bx required or not

A

LN mets are uncommon in MM without ulceration but occur in 10% of ulcerated lesions

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29
Q

what is the most commonly diagnosed malignancy in males in the US

A

prostate cancer

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30
Q

what is the second leading cause of death in males after lung cancer in the US

A

prostate cancer

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31
Q

prostate cancer represents roughly ___% of all new cancer diagnoses in males, excluding non-MM skin cancers

A

20%

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32
Q

death rates in black males from prostate cancer are ____ than that of white males

A

more than double

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33
Q

what is the most important risk factor for developing prostate cancer

A

age

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34
Q

most males, if they live long enough, will develop some evidence of what type of cancer?

A

prostate

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35
Q

75% of clinically significant prostate tumors are diagnosed in over age ___

A

65

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36
Q

other than age, what are the important risk factors for developing prostate cancer?

A

family history, genetic, possibly hormones diet and obesity may play role

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37
Q

what is a transition sequence to prostate cancer?

A

normal prostatic epithelium > proliferative inflammatory atrophy (PIA) > PIN > invasive cancer

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38
Q

what does DRE screen for

A

glandular induration (hard or firm texture), discrete nodules, asymmetry of the gland

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39
Q

what % of prostate tumors does DRE miss

A

23-45%

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40
Q

what other factors can increase the PSA level?

A

1) BPH 2) prostatitis 3) prosthetic massage 4) surgery 5) instrumentation (bx or resection) of the gland… recent ejaculation can raise the value slightly

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41
Q

what medications can lower PSA levels by about one half

A

finasteride (prosper) and dutasteride (Avodart)

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42
Q

what is upper limit for normal PSA values in most labs?

A

4.0 ng/ml

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43
Q

what are the PSA upper limits of normal for Caucasian males by age

A

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

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44
Q

what is PSA velocity

A

rate of rise of the PSA level

45
Q

what is difference in value of PSA testing between insurance and clinical setting

A

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

46
Q

what is free PSA useful for

A

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)

47
Q

what is PSA density

A

requires measurement of prostate volume. cancer produces more PSA per gram of tissues than BPH.

48
Q

TRUS is useful for what?

A

not useful screening tool. used to evaluate the gland when suspicion of malignancy is increased.

49
Q

what is use for multi parametric MRI for prostate imaging

A

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.

50
Q

how many cores are sampled on a standard prostate bx?

A

10-12 or more, unless MRI targeted.

51
Q

most prostate cancer is which type?

A

adenocarcinoma (>95%).

52
Q

what are the key features of importance on a prostate bx?

A

1) presence of invasive cancer 2) grade, or degree of malignancy of the cells 3) stage, or extent of the tumor

53
Q

Most prostate cancers are which type

A

adenocarcinoma (>95%)

54
Q

what are they key features of importance on a prostate bx

A

1) presence of invasive cancer. 2) grade, or degree of malignancy of the cells 3) stage, or the extent of the tumor

55
Q

what is the range of Gleason scores, which scores more favorable

A

1-10, composite range 6-10, range 6 and below more favorable

56
Q

explain TNM system for staging prostate cancer

A

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

57
Q

what are the most important prognostic factors in prostate cancer

A

1) stage of tumor. 2) Gleason grade group 3) pre-treatment PSA level

58
Q

what is the Gleason grading system

A

used to assess degree of malignancy based on cellular patterns on tissue samples

59
Q

what are the two major forms of curative treatment for presumed organ-confined prostate cancer

A

surgery and radiation

60
Q

what is the double time for prostate cancer

A

2-4 yrs

61
Q

should there be PSA recurrence after prostate cancer, what is avg time to the development of clinically evident mets

A

8-10 yrs, then another 5 yrs until death

62
Q

what factors, if present, predict more rapid progression from PSA recurrence to mortality?

A

1) shorter time from treatment to PSA recurrence 2) higher Gleason score 3) short PSA doubling time

63
Q

what is the most commonly diagnosed cancer and leading cause of death from malignancy among females in the USA

A

breast cancer

64
Q

the majority (80%) of breast cancer are _____ lesions

A

invasive

65
Q

20% of Breast cancer lesions are ____

A

in situ

66
Q

what is the most important risk factor for the development of breast cancer

A

age

67
Q

incidence rates of breast cancer peak age at what age

A

75-79

68
Q

other than age, what are other risk factors to development of breast cancer?

A

family history, estrogen exposure, benign breast disease, environmental factors (radiation ETOH, smoking, obesity), prior hx of breast cancer

69
Q

which DCIS tumors are at greatest risk for recurrence?

A

high nuclear grade, comedonecrosis on bx, younger age at onset, larger size, presence of palpable nodule, multiple in situ lesions

70
Q

is LCIS truly breast cancer

A

no, lobular neoplasia/hyperplasia, precursor lesion

71
Q

most invasive breast cancers are of which type

A

adenocarcinoma, most are invasive ductal carcinoma, followed by invasive lobular carcinoma

72
Q

describe TNM system for staging breast cancer

A

T= size and/or local extent of tumors. N= nodal status. M= any distant mets.

73
Q

what are the T designations for breast cancer (staging)

A

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

74
Q

describe N designations for Breast cancer staging

A

pN0 no nodal involvement. pN1 (1- 4 pos nodes), pN2 (4-9 nodes pos), pN3 10 or more nodes positive

75
Q

in breast cancers mortality primarily results from what

A

distant mets

76
Q

how does tumor size impact assessing risk of breast cancer mortality

A

the larger the lesion, the greater the risk for mets and mortality

77
Q

how does histologic grade of breast cancer impact prognosis

A

the less differentiated the lesion, the greater the risk for progression and mortality

78
Q

do post or premenopausal women fare worse with breast cancer

A

premenopausal women fare worse, especially those age under 35

79
Q

______ invasion on pathologic specimen is associated with higher risk of local and distant spread of breast cancer

A

lymphatic or vascular invasion

80
Q

what is triple negative breast cancer

A

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

81
Q

mortality from breast cancer varies with the three major prognostic factors (name them)

A

1) lymph node status. 2) tumor size. 3) histologic grade

82
Q

which cancer is the 3rd most common cancer in the US for both males and females and 3rd leading cause of death from malignancy

A

colon cancer

83
Q

what are risk factors for colon cancer

A

age, hereditary syndromes, family hx, diet, obesity, inflammatory bowel disease (UC and Chron’s), smoking, ETOH

84
Q

do hyperplastic polyps carry a significant risk for development of colon cancer?

A

No, unless large in number

85
Q

which adenomatous polyps carry most risk for colon cancer

A

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

86
Q

in general how long does it take for a colon polyp to develop to carcinoma

A

10 to 15 years

87
Q

what hereditary syndromes can cause colon cancer

A

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)

88
Q

what are the items of greatest importance on a path report (colorectal cancer)

A

1) extent of invasion of the bowel wall 2) degree of differentiation 3) presence of lymph node involvement

89
Q

describe T system details re colon cancer

A

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

90
Q

describe N system in colon cancer staging

A

N0 - no node invasion. N1 - 1-2 nodes pos. N2 4 or more nodes pos.

91
Q

describe M system for colon cancer staging

A

M0 no mets. M1 mets present

92
Q

name other prognostic factors in colon cancer

A

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.

93
Q

is tumor size an important prognostic factor in colon cancer

A

no

94
Q

what is the only curative therapy for colorectal cancer

A

surgery, hemocolectomy

95
Q

what is use of chemo and radiation for colon cancer

A

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

96
Q

is stage 1 colon cancer usually treated with chemo

A

no, surgery alone

97
Q

is stage II colon cancer treated with chemo?

A

primarily surgery, and adjuvant chemo for higher risk stage II lesions can be of value

98
Q

adjuvant chemo is generally advised for what stage of colon cancer

A

stage III

99
Q

chemo is standard treatment for what stage of colon cancer

A

stage 4

100
Q

how is CEA testing useful re colon cancer

A

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

101
Q

are late recurrences of colon cancer common?

A

no, most recurrences are found within first 2-3 years after initial treatment

102
Q

is treatment available for recurrent colon cancer/.

A

no, so rigorous f-u regimen is recommended. colonoscopy at on year post op then even 3-5 yrs

103
Q

what are the major risk factors for mortality with colon cancer

A

extent of disease locally, grade of tumor, present of LN mets

104
Q

PSA velocity greater than 0.75 ng/ml per year is highly suggestive of (malignancy, prostatitis, BPH or proliferative inflammatory atrophy)?

A

malignancy

105
Q

does chemo significantly increase survival rates for malignant melanoma?

A

no

106
Q

breast cancer is often less advanced at time of dx for males than females, true or false

A

false

107
Q

true or false- breast cancer survival patterns by stage are similar in males and females

A

true

108
Q

the most important prognostic factor for invasive breast cancer mortality is? (distant mets, degree of local control, age at dx or tumor size)

A

distant mets

109
Q

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

A and B (elev CEA and gross tumor perf of bowel wall)

ALU 201 (20 decks)

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