Neo Part 2

Question 1

Familial cancers

Answer 1

Breast
Ovarian
Colon

Question 2

Inhereted autosomal dominant cancer

Answer 2

Familial retinoblastoma (40% familial)

Question 3

Autosomal recessive

Answer 3

Xerodermal pigmentosim

Question 4

Features that characterize familial cancers include:

Answer 4

early age at onset
tumors arising in two or more close relatives
sometimes multiple or bilateral tumors

Question 5

cancers that are not associated with specific marker phenotypes, e.g. The transmission pattern is not clear.

Answer 5

Familial

Question 6

cancers can be linked to the inheritance of mutant genes. Examples include linkage of BRCA1 and BRCA2 genes to familial breast and ovarian cancers.

Answer 6

Familial

Question 7

Acquired Preneoplastic Disorders

Answer 7

Regenerative
Hyperplastic

Atrophic

Ulcerative

Dysplastic

Question 8

Acquired Preneoplastic Disorders in:

hepatocellular carcinoma in

endometrial carcinoma in

Lung cancer in

gastric carcinoma in

colorectal carcinoma in

Answer 8

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)

Question 9

Clinical Features of Neoplasia

Answer 9

Local effect
   Pressure effect
   Functional activity (e.g. hormone synthesis)
   Bleeding
   Infection
Cachexia (wasting) 
Paraneoplastic syndromes

Question 10

loss of body fat and body mass associated with weakness, anorexia, and anemia
Often correlates with tumor size and extent of metastases

Answer 10

Cachexia

Question 11

Origin of cancer cachexia is multifactorial:

Answer 11

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

Question 12

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

Answer 12

Paraneoplastic Syndromes

Most common ones: hypercalcemia, Cushing syndrome, and nonbacterial thrombotic endocarditis

Question 13

Paraneoplastic Syndromes Often associated with the following neoplasms:

Answer 13

bronchogenic and breast cancers and hematologic malignancies

Question 14

Paraneoplastic Syndromes

Answer 14

Endocrinopathies
Neuromyopathies
Osteochondral Disorders
Vascular Phenomena
Fever
Nephrotic Syndrome

Question 15

Cushing’s Syndrome

Mechanism and example

Answer 15

ACTH Like substance

Lung oat cell carcinoma

Question 16

Hyponatremia Mechanism and example

Answer 16

Inappropriate ADH secretion

Lung oat cell carcinoma

Question 17

Trousseau’s Syndrome

Mechanism and example

Answer 17

Hyper coagulable state

Various carcinomas

Question 18

Endocrinopathies

Answer 18

Hypercalcemia

Hypoglycemia

Carcinoid syndrome

Polycythemia

WDHA syndrome watery diarrhea, hypokalemia, and achlorhydria

Question 19

Causes of hypercalcemia in cancer:

Answer 19

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)

Question 20

Hypoglycemia - caused by

Answer 20

tumor over-production of insulin or insulin like activities

Fibrosarcoma, Cerebellar hemangioma, Hepatocarcinoma

Question 21

Carcinoid syndrome - Caused by

Answer 21

serotonin and bradykinin produced by the tumor

Bronchial carcinoids, Pancreatic carcinoma, Carcinoid tumors of the bowel

Question 22

Neuromyopathies

Answer 22

Myasthenia - A block in neuromuscular transmission possibly caused by host antibodies against the tumor cells
(e.g. Bronchogenic carcinoma)

Question 23

Osteochondral Disorders

Answer 23

Hypertrophic osteoarthropathy and clubbing of the fingers

e.g. Bronchogenic carcinoma

Question 24

Vascular & hematoligical changes

Answer 24

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)

Question 25

Fever

Answer 25

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.

Question 26

Nephrotic Syndrome

Answer 26

probably caused by damage to renal glomeruli by tumor antigen-antibody complexes.

Question 27

What Are The Final Complications Of Malignancy (Causes Of Death)

Answer 27

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

Question 28

Tumor Diagnosis

Answer 28

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

Question 29

Tumor markers: sometimes diagnostic or prognostic

Some serological markers associated with malignant tumors

Answer 29

hCG
AFP
Calcitonin 
Prolactin
CA 125
PSA

Question 30

hCG associated with

Answer 30

Choriocarcinoma

Question 31

AFP

Answer 31

hepatocellular carcinoma

Question 32

Calcitonin

Answer 32

Thyroid medullary carcinoma

Question 33

Prolactin

Answer 33

Pituitary adenomas

Question 34

CA 125

Answer 34

Ovarian cancer

Question 35

PSA

Answer 35

prostate carcinoma