Exam 5: Common Cancers Flashcards
Breast Cancer
Etiology: Prolonged reproductive life , Over the age of 50 years, Obesity (Increased levels of estrogen in adipose tissue), Family history of breast cancer, Nulliparous or Late childbirth (after age 30 yrs), Genetic predisposition (BRCA1 and BRCA2 - defective tumor suppressor genes)
1 out of 8 women will have breast cancer
Disease Process: either “over-expression” of estrogen and progesterone receptors (ER-Positive) or human epidermal growth factor receptor-2 (HER2-Positive)
Non-tender to palpation, Firm, Irregular borders, Adherence to the skin or chest wall, Upper, outer quadrant of breast, Nipple discharge/retraction, Swelling in one breast, Peau d’orange
Luminal A:
Slow-growing breast cancers, 90% cure rate, often found on screening mammograms.
Luminal B:
Aggressive cancers that invade blood vessels and lymph nodes. Often difficult to surgically remove the tumor from surrounding tissue with clear margins.
Basal:
Very aggressive, rapidly growing cancer that lacks estrogen, progesterone and HER2 receptors.
HER2 Positive:
Overproduction of HER2 -> Signals breast cancer to grow and spread.
Most common sites of breast cancer mets:
bones, lung, liver, brain
Colorectal cancer
Etiology: Age, Genetics, Obesity, Physical inactivity, Tobacco use, Insulin resistance, IBS, Diet (Low fiber, high amount of animal fat, low in vitamin A, C and E)
Most commonly begins as a “polyp” - > “Adenomatous Polyps” - Polyps with cancerous potential
Change in BM, rectal bleeding, rectal/abdominal mass
Colonoscopy with a biopsy, FOBT (Fecal Occult Blood Test), Sigmoidoscopy
Overall survival is increasing due to increased detection early, but still not great
Most common sites of colorectal cancer mets:
liver
Non-Small Cell Lung Cancer (NSCLC) -
NSCLC is more common (80%) lung CA, slow growing and spreading
Adenocarcinoma -
In the alveoli. Most common (more in women).Periphery -> bronchoalveolar. Usually large at time of diagnosis -> mets early. May not be associated with smoking or exposure*
Squamous cell carcinoma -
Found in the center of the lung next to an air tube (bronchus), detected in sputum. Grows slowly -> spreads to major bronchi. Paraneoplastic syndrome: hypercalcemia
Large cell carcinoma -
Can occur in any part of the lung. Highly anaplastic (poorly differentiated). Difficult to categorize as squamous or adenocarcinoma. Tends to grow and spread faster. Poor prognosis spread to distant sites early.
Small Cell Lung Cancer (SCLC) -
Almost always associated with cigarette smoke, treated with chemotherapy. Small oval cells that grow in clusters, rapid growth and most malignant -> mets early. Poorest prognosis (only 10% over 2yrs). Arises out of bronchus. Paraneoplastic complications common. Small cell carcinoma & Combined small cell carcinoma
Most frequent sites of lung cancer metastasis:
liver, adrenal glands, bone, brain
Ovarian cancer
Etiology: Older age (median age is 63yrs), Early Menarche <12yrs, Late menopause >52 yrs, Genetics -> BRCA, 1st degree relative with CA, Lynch syndrome, Nulligravity (not pregnant), Endometriosis, Asbestos
CM: Subacute - Adnexal mass, Pelvic or abdominal pain, Bloating, GI symptoms, N/V, constipation, Urinary frequency/urgency. Acute - Pleural effusion (SOB), Bowel obstruction (N/V), Venous thrombosis. Rarely have paraneoplastic syndromes.
Diagnosis: CT pelvic scan, Surgical evaluation: to determine malignancy removal of ovary or biopsy, Cancer Antigen-125 (CA-125), Assess for metastasis.
Prognosis/general statistics: 90% survival rate with early diagnosis
Most common sites of ovarian cancer mets:
adjacent organs and lungs
Pancreatic cancer
Etiology: age, alcohol, obesity, diabetes mellitus, male gender, and genetics, smoking
Disease Process: Most (85%) are adenocarcinomas of the pancreatic ducts in head, body or tail -> Can spread quickly anywhere
Clinical Manifestations/Signs & Symptoms:
Most pancreatic cancer discovered due to symptoms at a metastasis site rather than disruption of pancreatic function. Pain, jaundice, and weight loss. DVT less common.
Diagnosis: Ultrasonography / CT
Prognosis/general statistics: Lowest 5 year survival rate (10%) of all major cancers. Very poor.
Most frequent sites of pancreatic cancer metastasis:
liver, peritoneum, and lungs.
Prostate cancer
Etiology: Age, Genetics/family history, Diet high in fat, red meat, fried food and dairy, Smoking, Alcohol intake *mixed results, High intake ETOH increased risk
Epidemiology: African ancestry higher risk
CM: Asymptomatic in early stages, Enlarged prostate found on digital rectal exam (DRE), Decreased force of urinary stream, Incomplete emptying of the bladder, Palpates as hard and unmovable, large inguinal lymph nodes, pain in back - vertebrae mets
Diagnosis: PSA*, Digital rectal exam, Confirmed through biopsy
Prognosis/general statistics: 5-year survival is about 98%
Common sites of prostate mets
vertebrae
Bladder cancer
Etiology: Cause is not fully understood but thought to be carcinogens that are excreted in the urine and stored in the bladder. Products/chemicals used in the manufacture of rubber, textiles, paint, chemicals, and petroleum. Smoking & age.
Disease Process: Urothelial carcinoma of cells that line bladder
Can be low-grade noninvasive tumors or high-grade tumors that invade bladder wall and metastasize
CM: Increased frequency, Urgency, Dysuria, Hematuria**
Diagnosis:Ultrasonography, CT, MRI
Prognosis/general statistics: 5 year survival rate near 80%; Good if low grade type or caught before metastasis