Day 1 part 2- Cancer

Question 1

What are 2 other names for a fecal occult blood test?

Answer 1

~stool guaiac test

~Hemoccult test

Question 2

What is the fecal occult blood test?

Answer 2

~Test fecal sample for blood

~Can be bleeding anywhere along gastrointestinal tract

Question 3

Why look at urine cytology?

Answer 3

Reveal cancer cells from kidney, ureters, bladder or urethra

Question 4

What type of cells are you looking for in urine cytology?

Answer 4

Looking for dysplastic & metaplastic cells

Question 5

What are the 3 most common imaging used for cancer screening?

Answer 5

~Standard radiographs (chest radiograph)
~Mammography
~Endoscopy (colonoscopy & sigmoidoscopy)

Question 6

What are you looking for on a standard chest radiograph?

Answer 6

~May reveal an obvious mass
~Widening of the mediastinum - suggestive of spread to lymph nodes there
~Atelectasis (collapse of alveoli) secondary to blockage of airways
~Consolidation secondary to fluid infiltrates into the airways and alveoli or pneumonia
~Pleural effusion triggered by cancer cell irritation of pleural membranes

Question 7

What is a mammography?

Answer 7

Low power radiographic imaging of the breast

Question 8

What position is the image taken?

Answer 8

Done horizontally, vertically and on the bias

Question 9

What can you use a mammography for?

Answer 9

Can use to image both cancerous & benign growths

Question 10

Why is a mammography so important?

Answer 10

~Early detection and thus early treatment and better prognosis!!!
~1/10th radiation of an average chest x-ray
~1-2/1000 lead to diagnosis of cancer

Question 11

What are the current Screening Guidelines for ACS for getting a mammography?

Answer 11

~Women ages 40 to 44should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so.

~Women age 45 to 54should get mammograms every year.

~Women 55 and oldershould switch to mammograms every 2 years, or can continue yearly screening.

~Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.

~All womenshould be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening. They also should know how their breasts normally look and feel and report any breast changes to a health care provider right away.

Question 12

What is a sigmoidoscopy?

Answer 12

~Patient in side lying position lightly anesthetized

~Lighted probe (sigmoidoscope) is inserted into the rectum and lower colon to check for polyps and other abnormalities

Question 13

What is a colonoscopy?

Answer 13

~Same as sigmoidoscopy but view entire colon
~If polyps are found during the procedure they can be removed immediately
~Tissue can also be taken for biopsy

Question 14

Why are blood tests used are screening for cancer?

Answer 14

~Screening blood tests and diagnostic blood tests
~Serum immunoglobulins that are often elevated in multiple myeloma
~Tumor markers associated with specific forms of cancer

Question 15

Tumor markers associated with specific forms of cancer (for ovarian cancer)

Answer 15

Cancer antigen 125 (CA 125) for ovarian cancer

Question 16

Tumor markers associated with specific forms of cancer (for medullary thyroid cancer)

Answer 16

Calcitonin

Question 17

Tumor markers associated with specific forms of cancer (for liver cancer)

Answer 17

Alpha-fetoprotein (AFP)

Question 18

Tumor markers associated with specific forms of cancer (for germ cell tumors, such as testicular cancer and ovarian cancer)

Answer 18

Human chorionic gonadotropin (HCG)

Question 19

Tumor markers associated with specific forms of cancer (for uterine cancer)

Answer 19

Serum p53 antibody

~may hold value (recent study: Sensitivity-64%, Specificity –96%, PPV-78% & NPV-92%)

Question 20

Tumor markers associated with specific forms of cancer (for colon cancer)

Answer 20

~CA19-9 and CA 242 biomarkers

~Tissue inhibitor of metalloproteinases 1 (TIMP1)

Question 21

Different types of biopsy and cytological examinations:

Answer 21

~Fine Needle Aspiration and Cytology (FNAC) 
~Excisional biopsy 
~Core biopsy
~Bronchoscopy & Biopsy
~CT guided lung biopsy
~ Visual inspection with colposcopy
~Cervical biopsy 
~Prostate biopsy

Question 22

Fine Needle Aspiration and Cytology is used when:

Answer 22

~Breast abnormalities
~Just serous fluid – likely benign
~If cells send them for analysis

Question 23

Excisional biopsy is used when:

Answer 23

~Entire lump is removed and cyctology done

~Considered the definitive diagnostic & treatment method

Question 24

Core biopsy is:

Answer 24

~Only a section of the breast lump is removed

could disrupt the cancer cells

Question 25

Bronchoscopy & Biopsy is:

Answer 25

~Can be used a an imaging technique for certain lung cancers

~Most commonly combined with biopsy and cytological assessment for diagnosis

Question 26

CT guided lung biopsy-

Answer 26

Cytological examination of the suspicious tissue under the microscope by a pathologist

Question 27

What are two biospies/ cytological examinations used for cervical cancer?

Answer 27

~Visual inspection with colposcopy

~Cervical biopsy – determine magnitude of dysplasia and type of cancer cells

Question 28

Details on prostate cancer- biopsy and cytological examination

Answer 28

~Prostate biopsy only truly diagnostic procedure
~Histological changes scored using 1-5 Gleason score based upon lack of differentiation in cells
~Higher number poorer is the prognosis

Question 29

What is the staging of cancer based on?

Answer 29

~Tumor size
~Spread to Lymph Nodes
~Metastasis

Question 30

How do you categorize cancer staging?

Answer 30

0-4

4 being the worse

Question 31

Cancer: Stage 0

Answer 31

~Tumor in situ (non-invasive)

~No spread to lymph nodes & no metastasis

Question 32

Cancer: Stage I (IB)

Answer 32

~Tumor invasive but small in size

~No spread to lymph nodes & no metastasis

Question 33

Cancer: Stage II (IIB)

Answer 33

~Tumor of moderate size, spread to most proximal lymph nodes & no metastasis

		OR

~Tumor is large or any size that has invaded nearby adjacent tissues, no spread to lymph nodes & no metastasis

Question 34

Cancer: Stage III (IIIA)

Answer 34

~Smaller tumors but spread to intermediate distance lymph nodes & no metastasis

		OR

~Tumor of any size that has invaded other organs adjacent organs, no spread to lymph nodes or only most proximal lymph nodes & no metastasis

Question 35

Cancer: Stage III (IIIB)

Answer 35

~Tumor of any size
~Spread to most distal lymph nodes sampled
~No metastasis

Question 36

Cancer: Stage IV

Answer 36

any metastasis

Question 37

Staging for Colorectal Cancer (all of them)

Answer 37

Stage 1 – Tumor spread into muscular layer of wall, no nodal involvement & no metastasis

Stage 2 - Tumor invasion of visceral peritoneum & adherence to other tissues, no nodal involvement & no metastasis

Stage 3 – Any tumor size with increasing nodal involvement

Stage 4 - Metastasis

Question 38

What does breast cancer use to classify?

Answer 38

~Receptor status
~DNA assays
~types of newer molecular biology based tumor classification system

Question 39

Receptor status details on Breast Cancer

Answer 39

~Breast cancer cells have receptors on their surface and in their cytoplasm and nucleus
~Chemical messengers such as hormones bind to receptors, and this causes changes in the cell
~Breast cancer cells may or may not have three important receptors

Question 40

What are the three important receptors that breast cancer may or may not have?

Answer 40

~Estrogen receptor (ER)
~Progesterone receptor (PR)
~HER2/neu

Question 41

DNA assays details on Breast Cancer

Answer 41

~Used to classify the cancer by the specific genetic mutation involved
~BRCA 1 or BRCA 2
~P53 tumor suppression gene

Question 42

What are the types of newer molecular biology based tumor classification system in Breast Cancer?

Answer 42

~Luminal A
~Luminal B
~HER2-positive
~Basal-like breast cancers

Question 43

Details on Luminal A

Answer 43

~Estrogen and progesterone receptor-positive and HER2-negative tumors
~Genetically resemble normal breast tissue more closely than other tumors,
~Associated with a low risk of recurrence
~More early onset breast cancers than any other type

Question 44

Details on Luminal B

Answer 44

~Have estrogen or progesterone receptors (or both) but in smaller numbers than luminal A tumors.
~Their genetic profiles are more abnormal than luminal A.
~Account for 8-15% of early onset breast cancers
~Considered intermediate to high risk

Question 45

Details on HER2-positive

Answer 45

~Have several gene mutations associated with epidermal growth factor
~20% of early onset breast cancers
~Considered high risk

Question 46

Details on Basal-like breast cancers

Answer 46

~“triple-negative” tumors & are estrogen-, progesterone-, and HER2-negative
~15% of early onset tumors.
~Because they grow and metastasize rapidly so classified as high risk
~Women with a BRCA1 mutation are more likely to develop these tumors than another type
~Often detected before they’ve spread to the lymph nodes so traditionally not classified as high risk

Question 47

What is the Gleason scale?
Is it better to be high or low?
Do you want good or poor differentiation?

Answer 47

Gleason scale is for classifying histology all changes after a Prostate Cancer biopsy.
It is based upon lack of differentiation of cells.
Higher number means poorer differentiation, which is bad (not what you want).