Intro Path Flashcards
Acanthosis nigricans
Rare neoplastic indicator of visceral malignancy (more commonly associated with insulin resistance)
Barrett esophagus
Precursor to esophageal adenocarcinoma
Chronic atrophic gastritis, postsurgical gastric remnants
Predispose to gastric adenocarcinoma
Cirrhosis
Predisposes to hepatocellular carcinoma
Ulcerative colitis
Predisposes to colon adenocarcinoma
Actinic keratosis
Precursor to SCC of the skin
Dermato- and polymyositis
Predispose to visceral malignancies, particularly GU
Dysplastic nevus
Precursor to malignant melanoma
Multiple seborrheic keratoses
GI, breast, lung, and lymphoid malignancies
Paget disease of the bone
Predisposes to secondary osteosarcoma and fibrosarcoma
Plummer-Vinson Syndrome
Predisposes to SCC of the esophagus
Tuberous sclerosis
Often manifests with multiple hamartomatous (benign) tumors including giant cell astrocytomas, renal angiomyolipomas, cardiac rhabdomyomas; tumors may become malignant
Xeroderma pigmentosum, albinism
Predispose to SCC, basal cell carcinoma, melanoma
AIDS
Predisposes to aggressive lymphoma (non-Hodgkin) and Kaposi Sarcoma
Autoimmune diseases (like Hashimoto thyroiditis, SLE)
Predispose to lymphoma
Down Syndrome
Predisposes to acute lymphocytic leukemia
Immunodeficiency
Predisposes to lymphoma, melanoma, renal cell carcinoma
Li-Fraumeni syndrome
p53 mutation predisposes to various cancer types at a young age (sarcoma, breast, leukemia, adrenal gland)
Radiation exposure
High risk of developing leukemia, sarcoma, papillary thyroid cancer, breast cancer
Oncogenes
Gain of function leading to increased cancer risk. Need damage to only 1 allele.
Tumor suppressor gene
Loss of function leading to increased cancer risk. Both alleles must be lost for expression of disease
BCR-ABL
Oncogene
Gene product = tyrosine kinase
Tumor = CML, ALL
BCL-2
Oncogene
Gene product = Antiapoptotic molecule (inhibits apoptosis)
Tumor = Follicular and undifferentiated lymphomas
BRAF
Oncogene
Gene product = Serine/Threonine kinase
Tumor = Melanoma, non-Hodgkin lymphoma
c-kit
oncogene
Gene product = Cytokine receptor
Tumor = Gastrointestinal stromal tumor (GIST)
c-myc
Oncogene
Gene product = Transcription factor
Tumor = Burkitt lymphoma
HER2/neu (c-erbB2)
Oncogene
Gene product = Tyrosine kinase
Tumor = Breast, ovarian, and gastric carcinomas
L-myc
Oncogene
Gene product = Transcription factor
Tumor = Lung tumor
L = Lung
N-myc
Oncogene
Gene product = Transcription factor
Tumor = Neuroblastoma
N = Neuroblastoma
RAS
Oncogene
Gene product = GTPase
Tumor = Colon cancer, lung cancer, pancreatic cancer
RET
Oncogene
Gene product = Tyrosine kinase
Tumor = MEN2A and 2B, medullary thyroid cancer
APC
Tumor Supressor Gene
Gene product = -
Tumor = Colorectal cancer (associated with FAP)
BRCA1/BRCA2
Tumor Supressor Gene
Gene product = DNA repair protein
Tumor = Breast and ovarian cancer
DCC
Tumor Supressor Gene
Gene product = DCC (Deleted in Colon Cancer)
Tumor = Colon cancer
DPC4/SMAD4
Tumor Supressor Gene
Gene product = DPC (Deleted in Pancreatic Cancer)
Tumor = Pancreatic cancer
MEN1
Tumor Supressor Gene
Gene product = Menin
Tumor = MEN1
NF1
Tumor Supressor Gene
Gene product = Ras GTPase activating protein (neurofibromin)
Tumor = Neurofibromatosis type 1
NF2
Tumor Supressor Gene
Gene product = Merlin (Schwannomin) protein
Tumor = Neurofibromatosis type 2
p16
Tumor Supressor Gene
Gene product = Cyclin-dependent kinase inhibitor 2A
Tumor = Melanoma
p53
Tumor Supressor Gene
Gene product = Transcription factor for p21, blocks G1 to S phase transition.
Tumor = Most human cancers, Li-Fraumeni syndrome
PTEN
Tumor Supressor Gene
Tumor = Breast cancer, prostate cancer, endometrial cancer
Rb
Tumor Supressor Gene
Gene product = Inhibits E2F; blocks G1 to S phase transition
Tumor = RetinoBlastoma, osteosarcoma
TSC1
Tumor Supressor Gene
Gene product = Hamartin protein
Tumor = Tuberous sclerosis
TSC2
Tumor Supressor Gene
Gene product = Tuberin protein
Tumor = Tuberous sclerosis
VHL
Tumor Supressor Gene
Gene product = Inhibits hypoxia inducible factor 1a
Tumor = von Hippel-Lindau disease, renal cell carcinoma
WT1/WT2
Tumor Supressor Gene
Tumor = Wilms Tumor (nephroblastoma)
Tumor markers
should not be used as primary screening tool for cancer diagnosis or screening.
They may be used to monitor tumor recurrence and response to therapy, but definitive diagnosis is usually made via biopsy
Alkaline phosphatase (ALP)
tumor marker
Metastases to bone or liver, Paget disease of bone, seminoma (placental ALP)
Alpha fetoprotein (AFP)
tumor marker
Hepatocellular carcinoma, hepatoblastoma, yolk sac (endodermal sinus) tumor, mixed germ cell tumor
Normally made by fetus. Transiently elevated in pregnancy; high levels associated with neural tube and abdominal wall defects, lower levels associated with Down Syndrome
B-hCG
Tumor marker
Hydatidiform moles and Choriocarcinomas (Gestational trophoblastic disease), testicular cancer, mixed germ cell tumor.
Produced by syncytiotrophoblasts of the placenta
CA 15-3/CA 27-29
Tumor marker
Breast cancer
CA 19-9
Tumor marker
Pancreatic adenocarcinoma
CA 125
Tumor marker
Ovarian cancer
Calcitonin
Tumor marker
Medullary thyroid carcinoma
CEA
Tumor marker
CarcinoEmbryonic Antigen. Very nonspecific but produced by about 70% of colorectal and pancreatic cancers; also produced by gastric, breast, and medullary thyroid carcinomas
Chromogranin
Tumor marker
Neuroendocrine tumors/carcinoid
PSA
Tumor marker
Prostate-specific antigen. Prostate cancer.
Can also be elevated in BPH and prostatitis. Questionable risk/benefit for screening.
EBV
Associated with:
Burkitt lymphoma
Hodgkin lymphoma
Nasopharyngeal carcinoma
Primary CNS lymphoma (in immunocompromised)
HBV, HCV
Associated with:
Hepatocellular carcinoma
HHV-8
Associated with:
Kaposi Sarcoma
HPV
Associated with:
Cervical and penile/anal carcinoma (types 16, 18)
Head and neck cancer
H. pylori
Associated with:
Gastric adenocarcinoma
MALT lymphoma
HTLV-1
Associated with:
Adult T cell leukemia/lymphoma
Liver fluke
Associated with:
Cholangeiocarcinoma
Schistosoma haematobium
Associated with:
Bladder cancer (squamous cell)
Aflatoxins (Aspergillus)
Carcinogen
Liver
Impact = Hepatocellular carcinoma
Alkylating agents
Carcinogens
Blood
Impact = Leukemia/lymphoma
Aromatic amines (benzidine, 2-naphthylamine)
Carcinogens
Bladder
Impact = Transitional cell carcinoma
Arsenic
Carcinogen
Liver - Angiosarcoma
Lung - Lung cancer
Skin - SCC
Asbestos
Carcinogen
Lung
Impact = Bronchogenic carcinoma > mesothelioma
Carbon tetrachloride
Carcinogen
Liver
Impact = Centrilobular necrosis, fatty change
Cigarette smoke
Carcinogen
Bladder - transitional cell carcinoma Cervix - Cervical carcinoma Esophagus - SCC/adenocarcinoma Kidney - RCC Larynx - SCC Lung - Squamous cell and small cell carcinoma Pancreas - Pancreatic adenocarcinoma
Ethanol
Carcinogen
Esophagus - SCC
Liver - HCC
Ionizing radiation
Carcinogen
Thyroid - Papillary thyroid carcinoma
Nitrosamines (smoked foods)
Carcinogen
Stomach - gastric cancer
Radon
Carcinogen
Lung - Lung cancer (2nd leading cause after cigarette smoke)
Vinyl chloride
Carcinogen
Liver - Angiosarcoma
Psammoma bodies
Laminated, concentric spherules with dystrophic calcifications. PSaMMoma bodies are seen in:
Papillary carcinoma of thryoid
Serous papillary cystadenocarcinoma of ovary
Meningioma
Malignant mesothelioma
1,25-(OH)2D3 (Calcitriol)
Linked to paraneoplastic syndrome
Effect = hypercalcemia
Neoplasm = Hodgkin lymphoma, NH-Lymphoma
ACTH
Linked to paraneoplastic syndrome
Effect = Cushing syndrome
Neoplasm = Small cell lung carcinoma, renal cell carcinoma
ADH
Linked to paraneoplastic syndrome
Effect = SIADH
Neoplasm = Small cell lung carcinoma, intracranial neoplasms
Antibodies against presynaptic Ca channels at NMJ
Linked to paraneoplastic syndrome
Effect = Lamber-Eaton myasthenic syndrome (muscle weakness)
Neoplasm = Small cell lung carcinoma
Erythropoietin
Linked to paraneoplastic syndrome
Effect = Polycythemia
Neoplasm = Renal cell carcinoma, hemangioblastoma, hepatocellular carcinoma, leiomyoma, pheochromocytoma
PTHrP
Linked to paraneoplastic syndrome
Effect = Hypercalcemia
Neoplasm = Squamous cell lung carcinoma, renal cell carcinoma, breast cancer
Cancer incidence - Men
1) Prostate
2) Lung
3) Colon/rectum
Lung cancer incidence has dropped in men, but has not changed in women.
Cancer incidence - Women
1) Breast
2) Lung
3) Colon/rectum
Cancer mortality - Men
1) Lung
2) Prostate
3) Colon/rectum
Cancer is the second leading cause of death in the US (heart disease number 1)
Cancer mortality - Women
1) Lung
2) Breast
3) Colon/rectum
brain metastasis
Lung > breast > prostate > melanoma > GI
50% of brain tumors are from metastases. Commonly seen as multiple well-circumscribed tumors at gray/white matter junction
Liver metastasis
Colon»_space; stomach > pancreas
Liver and lung are the most common sites of metastasis after the regional lymph nodes
Bone metastasis
Prostate, breast > lung, thyroid, kidney
Bone mets»_space; primary bone tumors (multiple myeloma, lytic). Common mets to bone: breast (mixed), lung (mixed), thyroid (lytic), kidney (lytic), prostate (blastic).
Predilection for axial skeleton