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heme/onc > laboratory diagnosis > Flashcards

laboratory diagnosis Flashcards

1
Q

example of a mass screening

A

Pap smears for cervical cancer

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2
Q

example of a screening for asymptomatic patietns

A

PSA in men for prostate cancer

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3
Q

example of a screening for symptomatic patients

A

CA-125 for ovarian cancer

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4
Q

gold standars for tumor tissue biopsy

A

histology

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5
Q

biomarkers are used for

A

prognostic and predictive use

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6
Q

three identifiers preferred

A

yep

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7
Q

normal overlying mucosa makes primary adenocarcinoma very unlikely

A

yep

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8
Q

Tumor type?

Cytokeratins (CK), Epithelial Membrane Antigen (EMA)

A

carcinoma

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9
Q

tumor type?

ER, PR, GCDFP-15, GATA-3

A

breast

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10
Q

tumor type?

PSA, PSAP

A

prostate

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11
Q

tumor type?

TTF-1, Napsin A, CK7

A

lung adenocarcinoma

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12
Q

tumor type?

CDX2, CK20, CEA

A

colon

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13
Q

tumor type?

CD10, vimentin, RCC, PAX2, PAX8

A

kidney (renal cell carcinoma)

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14
Q

tumor type?

Leukocyte common antigen (CD45)

A

lymphoma

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15
Q

tumor type?

S-100, Melan-A, HMB-45, SOX-10

A

melanoma

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16
Q

tumor type?

CK, chromogranin, synaptophysin, CD56

A

neuroendocrine tumor

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17
Q

tumor type?

CK, ß-HCG, AFP, PLAP

A

Germ cell tumor

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18
Q

tumor type?

Variable and tumor-type specific
vimentin, desmin, smooth muscle actin, CD31, CD34

A

soft-tissue/sarcoma

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19
Q

Clinicopathologic correlation is essential in addition to immunohistochemistry

A

yep

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20
Q

small cell lung carcinoma:

  1. type of tumor
  2. tumor analysis needed?
  3. surgery?
  4. chemo?
A
  1. neuroendocrine carcinoma
  2. no further tumor analysis needed
  3. surgery a no go
  4. platinum-based chemo
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21
Q

tumor treatment depends on (4)

A
  1. tumor subtype
  2. tumor stage
  3. molecular testing for NSCLC
  4. multidisciplinary tumor conference
22
Q

CK5 - , p56 - , TTF +, CK7 +, napsin A+

A

adenocarcinoma

23
Q

CK5 + , p56 + , TTF -, CK7 -, napsin A-

A

squamous cell carcinoma

24
Q

predictive molecular studies (4)

A
  1. DNA sequence analysis
  2. FiSH
  3. RNA-based gene expression studies
  4. immune checkpoint inhibition therapy
25
Q

Examples in lung cancer

  1. DNA sequence analysis
  2. FiSH
  3. RNA-based gene expression studies
  4. immune checkpoint inhibition therapy
A
  1. DNA sequence analysis- EGFR mutation to predict response to tyrosine kinase inhibitors
  2. FiSH- EML4-ALK fusion for ALK inhibitor therapy
  3. RNA-based gene expression studies- potential drug targets
  4. immune checkpoint inhibition therapy- nivolumab: PD-L1 expression by IHC
26
Q

______ is essential for further testing

A

tissue conservation

27
Q

Tumors with specific therapies; represent _____ of CUP

A

10 -15%

28
Q

initial IHC goal is to

A

broadly categorize tumor

29
Q

Ck 7 -/CK 20+

A

colorectal and merkel cell carcinoma

30
Q

Ck 7 +/CK 20+

A

urothelial, ovarian, and pancreatic cancer and cholangiocarcinoma

31
Q

Ck 7 -/CK 20-

A

hepatocellular, renal cell, prostate, squamous cell

32
Q

Ck 7 +/CK 20-

A

lung, breatm thryoid, endometrial, cervical and pancreatic carcinoma and cholangiocarcinoma

33
Q

A characteristic that is objectively measured as an indicator of normal biological processes, pathogenic processes, or a pharmacological response to a therapeutic intervention.

A

biomarker

34
Q

A biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease.

A

biomarker

35
Q

cancer biomarker prognostic

A

assess survival probabilities- tumor size

36
Q

cancer biomarker :

predictive

A

effective drug therapy– ER, HER2 and KRAS

37
Q

cancer biomarker :

therapeutic monitor

A

detect tumor recurrence– CEA

38
Q

cancer biomarker:

risk stratification

A

chance of getting cancer- BRCA1

39
Q

pT3

A

tumor extends into subserosal fat

40
Q

Lymph nodes positive for metastatic tumor (histology)

A

Higher tumor stage is prognostic of poorer survival

41
Q

Presence of K-ras mutation in tumor (DNA analysis)

A

Predicts lack of therapeutic response to a specific drug

42
Q

Monitor postoperative serum CEA levels (tumor marker)

A

Increasing values signal tumor recurrence

43
Q

Immunohistochemistry:

  1. Loss of expression in tumor
  2. May prompt DNA analysis

Microsatellite DNA Analysis

  1. Additional peaks in tumor
  2. Confirms microsatellite instability

Conclusion?

A
  1. Consider genetics consultation

2. Possible Lynch syndrome (HNPCC)

44
Q

if the tumor has this mutation it will not respond to cetuximab

A

Kras

45
Q

A substance produced by a tumor or by a host in response to the tumor’s presence.

A

tumor markers

46
Q

clinical uses of serum tumor markers: (4)

A
  1. Screening select populations (sensitivity and specificity are variable)
  2. An aid in diagnosis in correlation with clinical/imaging/pathology
  3. Primary use: Monitor response to therapy or recurrence
  4. Not used for primary diagnosis
47
Q
  • Absence ctDNA after surgery associated with better prognosis, less chance of relapse
  • Prognosis aids in selecting treatment and need for adjuvant therapy
  • Patients at high risk may need targeted treatment

–Low risk patients can be spared unnecessary chemotherapy

A

prognosis determination

48
Q
  • ctDNA analyzed by blood test (liquid biopsy)
  • Can be repeated for consistent monitoring of response to treatment
  • Elevated ctDNA or increased number of mutations indicate treatment failure/relapse earlier than clinical relapse
A

monitoring treatment efficacy/relapse

49
Q
  • Sequencing ctDNA informs choice of therapy to target specific mutations
  • Monitors intratumoral heterogeneity to refine targeted treatment
A

selection of treatment

50
Q
  • Increased ctDNA correlates with advanced tumor stage/tumor burden
  • Can be repeated more often than imaging or traditional biopsies
A

tumor size/disease burden

51
Q
  • Poor sensitivity for early stage tumors
  • Insufficient ctDNA to allow for an accurate test result
  • ctDNA for early diagnosis and early intervention and higher cure rates
A

defection in asymptomatic individuals (screening)

heme/onc (30 decks)

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