Day 1 part 2- Cancer Flashcards
What are 2 other names for a fecal occult blood test?
~stool guaiac test
~Hemoccult test
What is the fecal occult blood test?
~Test fecal sample for blood
~Can be bleeding anywhere along gastrointestinal tract
Why look at urine cytology?
Reveal cancer cells from kidney, ureters, bladder or urethra
What type of cells are you looking for in urine cytology?
Looking for dysplastic & metaplastic cells
What are the 3 most common imaging used for cancer screening?
~Standard radiographs (chest radiograph)
~Mammography
~Endoscopy (colonoscopy & sigmoidoscopy)
What are you looking for on a standard chest radiograph?
~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
What is a mammography?
Low power radiographic imaging of the breast
What position is the image taken?
Done horizontally, vertically and on the bias
What can you use a mammography for?
Can use to image both cancerous & benign growths
Why is a mammography so important?
~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
What are the current Screening Guidelines for ACS for getting a mammography?
~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.
What is a sigmoidoscopy?
~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
What is a colonoscopy?
~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
Why are blood tests used are screening for cancer?
~Screening blood tests and diagnostic blood tests
~Serum immunoglobulins that are often elevated in multiple myeloma
~Tumor markers associated with specific forms of cancer
Tumor markers associated with specific forms of cancer (for ovarian cancer)
Cancer antigen 125 (CA 125) for ovarian cancer
Tumor markers associated with specific forms of cancer (for medullary thyroid cancer)
Calcitonin
Tumor markers associated with specific forms of cancer (for liver cancer)
Alpha-fetoprotein (AFP)
Tumor markers associated with specific forms of cancer (for germ cell tumors, such as testicular cancer and ovarian cancer)
Human chorionic gonadotropin (HCG)
Tumor markers associated with specific forms of cancer (for uterine cancer)
Serum p53 antibody
~may hold value (recent study: Sensitivity-64%, Specificity –96%, PPV-78% & NPV-92%)
Tumor markers associated with specific forms of cancer (for colon cancer)
~CA19-9 and CA 242 biomarkers
~Tissue inhibitor of metalloproteinases 1 (TIMP1)
Different types of biopsy and cytological examinations:
~Fine Needle Aspiration and Cytology (FNAC) ~Excisional biopsy ~Core biopsy ~Bronchoscopy & Biopsy ~CT guided lung biopsy ~ Visual inspection with colposcopy ~Cervical biopsy ~Prostate biopsy
Fine Needle Aspiration and Cytology is used when:
~Breast abnormalities
~Just serous fluid – likely benign
~If cells send them for analysis
Excisional biopsy is used when:
~Entire lump is removed and cyctology done
~Considered the definitive diagnostic & treatment method
Core biopsy is:
~Only a section of the breast lump is removed
could disrupt the cancer cells
Bronchoscopy & Biopsy is:
~Can be used a an imaging technique for certain lung cancers
~Most commonly combined with biopsy and cytological assessment for diagnosis
CT guided lung biopsy-
Cytological examination of the suspicious tissue under the microscope by a pathologist
What are two biospies/ cytological examinations used for cervical cancer?
~Visual inspection with colposcopy
~Cervical biopsy – determine magnitude of dysplasia and type of cancer cells
Details on prostate cancer- biopsy and cytological examination
~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
What is the staging of cancer based on?
~Tumor size
~Spread to Lymph Nodes
~Metastasis
How do you categorize cancer staging?
0-4
4 being the worse
Cancer: Stage 0
~Tumor in situ (non-invasive)
~No spread to lymph nodes & no metastasis
Cancer: Stage I (IB)
~Tumor invasive but small in size
~No spread to lymph nodes & no metastasis
Cancer: Stage II (IIB)
~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
Cancer: Stage III (IIIA)
~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
Cancer: Stage III (IIIB)
~Tumor of any size
~Spread to most distal lymph nodes sampled
~No metastasis
Cancer: Stage IV
any metastasis
Staging for Colorectal Cancer (all of them)
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
What does breast cancer use to classify?
~Receptor status
~DNA assays
~types of newer molecular biology based tumor classification system
Receptor status details on Breast Cancer
~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
What are the three important receptors that breast cancer may or may not have?
~Estrogen receptor (ER)
~Progesterone receptor (PR)
~HER2/neu
DNA assays details on Breast Cancer
~Used to classify the cancer by the specific genetic mutation involved
~BRCA 1 or BRCA 2
~P53 tumor suppression gene
What are the types of newer molecular biology based tumor classification system in Breast Cancer?
~Luminal A
~Luminal B
~HER2-positive
~Basal-like breast cancers
Details on Luminal A
~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
Details on Luminal B
~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
Details on HER2-positive
~Have several gene mutations associated with epidermal growth factor
~20% of early onset breast cancers
~Considered high risk
Details on Basal-like breast cancers
~“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
What is the Gleason scale?
Is it better to be high or low?
Do you want good or poor differentiation?
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).
