Neo Part 2 Flashcards
Familial cancers
Breast
Ovarian
Colon
Inhereted autosomal dominant cancer
Familial retinoblastoma (40% familial)
Autosomal recessive
Xerodermal pigmentosim
Features that characterize familial cancers include:
early age at onset
tumors arising in two or more close relatives
sometimes multiple or bilateral tumors
cancers that are not associated with specific marker phenotypes, e.g. The transmission pattern is not clear.
Familial
cancers can be linked to the inheritance of mutant genes. Examples include linkage of BRCA1 and BRCA2 genes to familial breast and ovarian cancers.
Familial
Acquired Preneoplastic Disorders
Regenerative
Hyperplastic
Atrophic
Ulcerative
Dysplastic
Acquired Preneoplastic Disorders in:
hepatocellular carcinoma in
endometrial carcinoma in
Lung cancer in
gastric carcinoma in
colorectal carcinoma in
Regenerative (e.g. hepatocellular carcinoma in cirrhosis)
Hyperplastic (e.g. endometrial carcinoma in endometrial hyperplasia)
Dysplastic (e.g. Lung cancer in bronchial dysplasia)
Atrophic (e.g. gastric carcinoma in atrophic gastritis)
Ulcerative (e.g. colorectal carcinoma in ulcerative colitis)
Clinical Features of Neoplasia
Local effect Pressure effect Functional activity (e.g. hormone synthesis) Bleeding Infection Cachexia (wasting) Paraneoplastic syndromes
loss of body fat and body mass associated with weakness, anorexia, and anemia
Often correlates with tumor size and extent of metastases
Cachexia
Origin of cancer cachexia is multifactorial:
reduced calorie intake due to loss of appetite
increase in basal metabolic rate
central effects of tumor on hypothalamus, probably related to macrophage production of TNF & IL-1
Symptoms other than cachexia that cannot be explained by local or distant spread of the tumor They appear in 10-15% of patients with cancer
Paraneoplastic Syndromes
Most common ones: hypercalcemia, Cushing syndrome, and nonbacterial thrombotic endocarditis
Paraneoplastic Syndromes Often associated with the following neoplasms:
bronchogenic and breast cancers and hematologic malignancies
Paraneoplastic Syndromes
Endocrinopathies Neuromyopathies Osteochondral Disorders Vascular Phenomena Fever Nephrotic Syndrome
Cushing’s Syndrome
Mechanism and example
ACTH Like substance
Lung oat cell carcinoma
Hyponatremia Mechanism and example
Inappropriate ADH secretion
Lung oat cell carcinoma
Trousseau’s Syndrome
Mechanism and example
Hyper coagulable state
Various carcinomas
Endocrinopathies
Hypercalcemia
Hypoglycemia
Carcinoid syndrome
Polycythemia
WDHA syndrome watery diarrhea, hypokalemia, and achlorhydria
Causes of hypercalcemia in cancer:
Hormonal (e.g. PTHrP synthesis in squamous cell lung carcinomas)
Osteolytic metastatic disease of bone (e.g. metastatic breast carcinoma)
Tumor-derived factors (e.g. TGF-α, that activates osteoclasts and the active form of vitamin D)
Hypoglycemia - caused by
tumor over-production of insulin or insulin like activities
Fibrosarcoma, Cerebellar hemangioma, Hepatocarcinoma
Carcinoid syndrome - Caused by
serotonin and bradykinin produced by the tumor
Bronchial carcinoids, Pancreatic carcinoma, Carcinoid tumors of the bowel
Neuromyopathies
Myasthenia - A block in neuromuscular transmission possibly caused by host antibodies against the tumor cells
(e.g. Bronchogenic carcinoma)
Osteochondral Disorders
Hypertrophic osteoarthropathy and clubbing of the fingers
e.g. Bronchogenic carcinoma
Vascular & hematoligical changes
Hyper-coagulability leading to:
venous thrombosis (Trousseau’s phenomenon) e.g.Pancreatic and bronchogenic carcinomas
nonbacterial thrombotic endocarditis
e.g. sterile vegetations on valves that occur with advanced carcinomas.
Anemia (e.g. Thymic neoplasms)
Fever
Associated with bacterial infections
Common where blockage of drainage occurs
Not associated with infection
Likely caused by response to necrotic tumor cells and/or immune response to necrotic tumor proteins.
Nephrotic Syndrome
probably caused by damage to renal glomeruli by tumor antigen-antibody complexes.
What Are The Final Complications Of Malignancy (Causes Of Death)
metastases cachexia severe anemia, throbocytopeina hypercoagulability rupture into major vessels e.g. bleeding compression of vital organs organ failure e.g. renal failure infection e.g. pneumonia
Tumor Diagnosis
History and Clinical examination Imaging - X-Ray, US, CT, MRI Tumor markers- laboratory analysis Cytology –Pap smear, FNAB Biopsy - Histopathology. Molecular Tech – Gene detection.
Immunohistochemistry
Flow cytometry
Electron microscopy
In Situ Hybridization
Tumor markers: sometimes diagnostic or prognostic
Some serological markers associated with malignant tumors
hCG AFP Calcitonin Prolactin CA 125 PSA
hCG associated with
Choriocarcinoma
AFP
hepatocellular carcinoma
Calcitonin
Thyroid medullary carcinoma
Prolactin
Pituitary adenomas
CA 125
Ovarian cancer
PSA
prostate carcinoma
