Exam 7 L. 6

Question 1

Cancer

Answer 1

1) cancer is a genetic disease
2) self-sufficiency in growth signals
3) in-sensitivity to anti-growth signals
4) ability to evade apoptosis
5) limitless replication potential
6) sustained angiogenesis
7) capacity to invade tissues and metastasize

Question 2

What is it?

Answer 2

1) obtain confirmed histologic/cytologic diagnosis

2) confirm cytology with histopathology

Question 3

Sarcoma

Answer 3

Originates from connective tissue/stroma (i.e. bone, cartilage, muscle)

Question 4

Carcinoma

Answer 4

Originates from epithelial tissue (parenchyma, glandular structures, surfaces and linings)

Question 5

Criteria of malignancy

Answer 5

1) pleomorphism
2) anisocytosis
3) macrocytosis
4) variation in N:C
5) increased N:C
6) variation in stages of maturation

Question 6

Nuclear features of malignancy

Answer 6

1) Anisokaryosis
2) macronuclei
3) multiple nuclei
4) abnormal mitoses
5) fine chromatin
6) nuclear molding

Question 7

Gold standard for diagnosis of cancer**

Answer 7

HISTOLOGY

Question 8

Benign versus malignant tumors: biologic criteria

Answer 8

Criteria = ability to spread, invasiveness growth rate
Benign: non-metastatic, noninvasive, slow to moderate growth rate
malignant: metastatic, invasive/destructive, variable (often rapid)

Question 9

Clinical staging

Answer 9

Estimate the extent of the cancer

• T = tumor size, measured precisely, recorded
• N = lymph node status
• M = distant metastasis, know probable sites (usually requires imaging)

Question 10

N-regional lymph node

Answer 10

1) size, consistency are not sufficient
2) histologic exam: entire lymph node-gold standard
- alternatives: fine needle aspiration and cytology

Question 11

M-metastasis

Answer 11

1) detection of pulmonary metastasis
- 3 view thoracic radiographs: detection 5-8 mm
- CT detection lung metastasis: detection at 1-3 mm

Question 12

Metastatic routes

Answer 12

1) vascular invasion with hematogenous spread
2) most sarcomas
- tumor cells travel vasculature lodge in small capillaries
- metastasis arise in tissues with high density capillary beds: lungs, liver, spleen
3) most carcinomas
- tumor cells gain access to lymphatics that drain the tumor bed
- metastatic lesions arise in LN, lymphatic vessels, and sites of high lymphatic activity (spleen, bone marrow)

Question 13

As part of clinical staging…

Answer 13

Determine if there is any concurrent disease

Question 14

Definitive cancer treatment

Answer 14

1) Cure: removing all tumor cells (usually through surgery or radiation, drug therapy usually isn’t a cure)
2) complete remission: no gross evidence of disease

Question 15

Palliation

Answer 15

1) improve quality of life with some tumor control possible is a prolonged remission
2) preserve quality-of-life with no tumor control

Question 16

Cancer therapy

Answer 16

Multimodality therapy often gives the best results!

Question 17

How often is response to therapy assessed?

Answer 17

1) the goal of follow-up is to detect tumor recurrence or metastasis at the earliest possible time to maximize further therapy
2) for postoperative or post radiation therapy patients, evaluate at regular intervals (i.e. 1, 2, 3, 5, 7, 9, and 12 months)
3) hematologic malignancies weekly to biweekly