Clinical Aspects of Common Cancers Flashcards
What are the pathologic features of a benign neoplasm?
- NEVER invade or metastasize
- Necrosis is uncommon
- circumscribed/encapsulated
- Can cause injury by compression/interference with the function of adjacent structures-tumor grade: none
What are the pathologic features of a malignant neoplasm?
- Invade and metastasize
- cause injury by local and distant tissue destruction
- necrosis is common
- Tumor grade: from low-high
What is the difference between a low grade and a high grade tumor?
Low: well-differentiated
High: poorly differentiated, possibly anaplastic (no morphology)
Malignant tumors of epithelium arise from a ____
malignant stem cell
What are the key mutations of a malignant stem cell to become a malignant tumor?
oncogenes, lose tumor suppressor genes, develop genome instability, lose ability to undergo apoptosis
What are the histological features that define invasion?
carcinoma has brooken through the basement membrane at the base of the epithelium (some tumor cells can metastasize by directly shedding into and seeding body cavities w/o breaking through the bm).
What is the difference between stage and grade?
stage: how much has the tumor spread
grade: how much have the tumor cells differentiated
What is the strongest predictor of prognosis (stage or grade)?
Stage
What is T in the TNM classification for staging?
T=size of tumor (Tis- “tumor in situ” (still confined to epithelium) or T1-4 for increasing size and involvement
What is N in the TNM classification for staging?
Lymph Node involvement. No= no involvement, N1-4 for increasing size and involvement
What is M in the TNM classification for staging?
presence of metastasis . Mo= no evidence of distant mets, M1 evidence of mets
What is advanced stage cancer?
large primary, + nodes, and + distant mets.
How do you check grade?
check patients histo slides
What does low vs high grade mean?
low- well differentiated, normal cell features: goodhigh- poorly differentiated, anaplastic: bad
What are the four major types of cancer?
- Squamos cell carcinoma (25-40%)
- Adenocarcinoma (25-40%)
- Large Cell carcinoma (10-15%)
- Small Cell carcinoma (20-25%)
Normally the respiratory tree is lined by ______ cells
pseudostratified ciliated columnar epithelial
Which kinds of lung cancer are linked to smoking?
small cell, adenocarcinoma, squamos cell. (Just not Large cell)
Features of squamos cell carcinoma.
- metaplasia: pseudostratified ciliated columnar epithelia change to large squamos epithelia
- typically arise centrally, in major bronchi
- stain + for keratin
features of adenocarcinoma.
- can occur centrally in major bronchi or in periphery
- Form gland-like structures
- stain + for mucin
What is bronchioalveolar carcinoma?
a variant of adenocarcinoma, not linked with smoking, tumor cells grow in alveolar septae and most spots in lung. very little stroma produced by tumor. Good prognosis
What are general features of large cell carcinoma?
- high grade cancer
- can arise anywhere in lungs
- cancer cells do not produce keratin, or mucin and don’t form glands.
- pleomorphic, bizarre looking cells
What are general features of small cell carcinoma?
- can arise anywhere in lungs
- cancer cells don’t produce mucin, keratin, or form glands-terrible prognosis-brain mets are common
- small, dark staining cells that form clusters
- stain + for neuroendocrine markers
- can produce paraneoplastic syndrome
What are the classic symptoms of pancreatic carcinoma?
- back pain
- unexplained, painless jaundice
- migratory thrombophlebitis
what are risk factors of pancreatic carcinoma?
diabetes mellitus, ki-ras mutation (often loss of p16, SMAD4, and p53), chronic pancreatitis,
What is the prognosis of pancreatic carcinoma?
terrible, 5 year survival=
What is a whipple procedure? what type of cancer is it used in?
pancreatic carcinoma. removes large part of pancreas, common bile duct, gall bladder, and duodenum
Why would a patient with pancreatic carcinoma need a common bile duct stent?
relieves obstruction, the cancer in the pancreas often compresses the common bile duct causing jaundice
What are typical pathologic features of colorectal cancer?
- moderately well differentiated
- mainly sporadic (non- genetic)
- arise in innermost mucosal layer of bowel wall in pre-existing polyps
how does colon cancer develop?
pre-existing polyps
If colon cancer arises on L side of the colon what clinical features can be expected?
constipation, change in stool caliber, sometimes colon is obstructed
If colon cancer arises on R side of the colon what clinical features can be expected?
less symptoms. fecal stream is mostly liquid at this point so tumors can grow large before any obstruction occurs
What are inherited conditions that increase the risk of colorectal cancer?
- Familial Adenomatous polyposis or adenomatous polyposis coli-HNPCC (lynch syndrome)
- loss of mutY base excision repair enzyme’-ki-ras, p53, DCC, MCC problems= genomic instability
what do values of 8-10 indicate on the Gleason scale?
aggressive behavior. can kill a patient
How does the gleason score work?
Your predominant pattern (scored 1-5 based on microscopic appearance; 5 is worst) is added to your subordinate pattern so max is 10
high grade lesions in prostate cancer behave _____ and predict ______
aggressively fatal disease
How do the cells appear in grade 5 on gleason score?
no gland formation, tumor cells infiltrate as sheets and cords.
PSA is a screening tool for what cancer?
prostate. stands for serum prostate specific antigen.
What is the gold standard for prostate cancer diagnosis?
blind “random” biopsiesthese are only about 50% sensitive
Whats this bad boy? (lung cancer?
squamos cell carcinoma
Who dat bad mamma jamma? (lung cancer)
adenomatous carcinoma
Who dat bumma gumma? (lung cancer)
bronchioalveolar carcinoma (growing in the septum of the lung)
What U call this guy? (lung cancer)
large cell carcinoma
WHO DAT? (lung cancer)
small cell carcinoma
