Neoplasia Flashcards
1
Q
Paraneoplastic syndromes in lung adenocarcinoma
A
- Hypertrophic pulmonary osteoarthropathy.
- Trousseau’s syndrome.
2
Q
In general, what makes a tumour malignant?
A
- Invasion.
- Metastases.
3
Q
What is the pathological process in colonic tubulovillous adenoma?
A
Dysplasia.
4
Q
What is Dysplasia, what does it signify, and what is it seen in
A
- Morphological term.
- Describes disorderly proliferation.
- Signifies the early steps of progression in carcinogeneisis.
- Seen in pre-malignant tumours.
5
Q
What does Carcinoma define
A
Describes malignant cancers arising from epithelial type tissues.
6
Q
What does Sarcoma define
A
Decribes malignant cancers arising from bone and soft tissue (muscle, blood vessels, fat, CT).
7
Q
What is the most likely malignant diagnosis in a 29-year-old woman living in Australia?
A
Malignant melanoma
8
Q
What are the most common cancers excluding skin.
Also most common to metastasise.
A
4 B’s:
- Breast.
- Bronchus (Lung).
- Bowel.
- Brostate.
9
Q
What are the most common tumours in Childhood
A
- Osteosarcoma.
- Ewings.
- Primitive neuroectodermal tumours (PNET).
- Medulloblastoma.
10
Q
Patient with rectal cancer, previous sebaceous adenoma and loss of MLH1 and / or MSH2 proteins.
What is the diagnosis?
A
Muir-Torre Syndrome.
11
Q
What are the top 3 cancers in Lynch syndrome MSH2 mutation carriers (or EPCAM)
A
- Colon (50-80%).
- Endometrial (25 - 60%).
- Urinary tract (12% women, 28% men).
12
Q
Chance of developing breast cancer if have mutated BRCA1
A
6 in 10 (60%).
13
Q
Chance of developing breast cancer if have mutated BRCA2
A
4 in 10 (40%).
14
Q
Which tumour marker is likely to be elevated in hepatocellular carcinoma?
A
AFP
15
Q
What cancers can have an elevated Ca 125 and CEA.
A
- Breast (can also have elevated Ca 15-3, CA27.29).
- Pancreatic (can also have elevated Ca 19-9).
- Ovarian.
- Lung.
16
Q
What virus is associated with Cervical Cancer and other female genital cancers
A
HPV subtypes 16 and 18
17
Q
Which infectious organism is associated with Kaposi sarcoma?
A
HHV8.
18
Q
What are the histological features of Burkitt’s lymphoma
A
- “Starry sky” appearance
- Basophilic lymphoma cells (monotonous background of dark cells which looks like the night “sky”).
- Pale / clear macrophages (“Stars”).
19
Q
What is the histological feature of cervical cells from HPV
A
Koilocytosis.
Koilocytes =
- Squamous epithelial cells.
- Large, irregular perinuclear cavitation (cleared out area around nucleus).
- Nuclear enlargement.
- Dense nuclear chromatin (dark nucleus).
- Rim of condensed cytoplasm around perinuclear cavitation (gives “halo” appearance to cell)
20
Q
In a textile factory which uses aniline dyes, which cancer is the workers at higher risk of developing?
Aniline dye = aromatic azo dye
A
Bladder cancer
21
Q
Chemical-industry workers who use benzene are at risk of which cancer?
A
- Leukaemia.
- Hodgkin lymphoma.
22
Q
What is Aflatoxin B-1 and what is it suspected to cause?
A
What it is:
- Toxin produced by Aspergillus flavus.
- Grows on mouldy grains and peanuts.
Cause:
- Liver cancer in underdeveloped countries.
23
Q
Individuals with Li-Fraumeni syndrome inherit a mutated copy of which tumour-suppressor gene?
A
Tp53
24
Q
What is Tumour Grading?
A
- Microscopic description of tumour.
- Based on how closely a tumour resembles the tissue of origin.
25
What contributes to the T stage in TNM staging of a melanoma?
Thickness of melanoma (Breslow thickness).
## Footnote
Tell you how far melanoma has spread locally
26
What is T N M staging?
Describes *spread* of tumour:
* **T**umour = size of tumour and any spread into nearby tissue. Given score from 1 - 4.
* **N**odes = spread to LNs. Given score from 0 - 3.
* **M**etastasis = spread to other sites of body. Given score from 0 - 1.
27
28
A 35-year-old male has noticed slight enlargement of right testis and breast enlargement over the past 6 months.
Which kind of testicular tumour is he likely to have?
Seminoma.
## Footnote
Germ-cell tumour
29
What is SIADH, what are the symptoms, and what cancer is it associated with?
What it is:
* Syndrome of inappropriate antidiuretic hormone secretion.
* Too much ADH --> retention of H20 --> hyponatraemia.
Symptoms:
* Confusion / disorientation / delirium.
* Generalised muscle weakness.
* Myoclonus.
* Tremor.
* Asterixis.
* Hyporeflexia.
* Ataxia.
* Dysarthria.
* Generalised seizures.
* Coma.
Cancer:
* Small cell lung cancer.
30
hypertrophic pulmonary osteoarthropathy
associated with adenocarcinoma of lung
31
75-year-old male with back pain. Radiological evidence of multiple sclerotic lesions are identified in the vertebrae.
What is the most likely primary malignancy?
## Footnote
**NB.** Osteosclerotic lesions (AKA osteoblastic) = new bone formation.
Prostate.
## Footnote
Prostate cancers typically produce **osteoblastic** (sclerotic) lesions.
32
What are the features of carcinoid syndrome, what percent of carcinoid tumours have carcinoid syndrome, and what is the cause?
Features:
* Cardiac - pulmonary / tricuscid thickening / stenosis, endocardial fibrosis.
* Liver - hepatomegaly.
* GI - diarrhoea, cramps, N+V, retroperitoneal / pelvic fibrosis.
* Skin - cutaneous flushes, cyanosis.
* Respiratory - cough, wheeze, dyspnoea.
Percent:
* 5%.
Cause:
* Endogenous secretion of vasoactive substances, mainly serotonin and kallikrein.
33
Which cancers can metastasise to the kidneys, and what is the typical feature in the kidney to indicate this is metastasis and not primary?
Cancers:
* Lungs.
* Breast.
* Colon.
Feature:
* Multiple renal tumours / masses on gross macroscopy.
34
CT showing liver with multiple nodules.
Is this likely to be primary cancer or metastases?
Metastases.
35
What is the normal PRIMARY role of BRCA1 and BRCA2 genes?
Transcriptional regulation and DNA repair.
36
Multiple endocrine neoplasia type 1 (MEN 1):
*-Main syndrome features*
* Pituitary adenoma.
* Parathyroid hyperplasia.
* Pancreatic tumours.
37
Multiple endocrine neoplasia type 2 (MEN 2):
*-Main syndrome features*
* Parathyroid hyperplasia.
* Medullary thyroid carcinoma.
* Pheochromocytoma.
38
Multiple endocrine neoplasia type 2B (MEN 2B):
*-Main syndrome features*
* Mucosal neuromas.
* Marfanoid body habitus.
* Medullary thyroid carcinoma.
* Pheochromocytoma.
39
Paraneoplastic syndromes in lung squamous cell carcinoma
* Humoral hypercalcaemia of malignancy (PTHrP).
* Pancoast syndrome.
40
Paraneoplastic syndromes in small (oat) cell lung carcinoma
## Footnote
Microscopy: cells with very little cytoplasm and lots of nuclear moulding i.e. appear small.
* SIADH.
* Lambert-Eaton myasthenic syndrome.
* Cerebellar degeneration.
* Cushings^ (from ACTH)
## Footnote
^Sx: HTN, easy bruising
41
What is the term for benign epithelial tumours vs malignant epithelial tumours
Benign = adenoma.
Malignant = carcinoma.
42
What is the term for benign smooth muscle tumours vs malignant smooth muscle tumours
Benign = Leiomyoma (AKA fibroid in uterus).
Malignant = Leiomyosarcoma.
43
What is the term for benign blood vessel tumours vs malignant BV tumours
Benign = Haemangioma.
Malignant = Angiosarcoma.
44
What is the term for benign nerve tumours vs malignant nerve tumours
Benign = Neuroma.
Malignant = Malignant peripheral nerve sheath tumour.
45
What is the term for benign fat tumours vs malignant fat tumours
Benign = Lipoma.
Malignant = Liposarcoma.
46
What is the term for benign melanocyte tumours vs malignant melocyte tumours
Benign = Naevus.
Malignant = Melanoma.
47
Describe the microscopy of uterine leiomyoma (AKA fibroid)
Parallel bundles (fascicles) of spindled (elongated) smooth muscle cells.
48
What gene is associated with familial retinoblastoma
RB1
49
Li-Fraumeni:
*What is Li-Fraumeni syndrome, what gene mutation is it associated with, what is the inheritance, and what cancers can it lead to?*
What it is:
* Very rare cancer predisposition syndrome.
Gene mutation:
* Germline mutations of TP53 tumour suppressor gene (produced p53 protein).
Inheritance:
* Autosomal dominant.
Cancers:
* **Osteosarcoma.**
* **Soft-tissue sarcomas.**
* **Breast cancer.**
* Brain tumours.
* Adrenocortical carcinoma.
* Leukaemia.
* Lung ca.
* Pancreatic ca.
50
What gene is associated with Familial adenomatous polyposis
APC
51
What genes are associated with Hereditary nonpolyposis colorectal cancer
* MLH1
* MSH2
* MSH6
* PMS1
* PMS2
52
What gene is associated with Wilms' tumour
WT1
53
What gene is related to von Hippel-Lindau
VHL
54
What gene is related to Cowden
PTEN
55
What cancers can have an elevated CEA and Ca 19-9
GI:
* Stomach.
* Colon.
* Pancreas.
56
What tumour markers are elevated in prostate cancer
PSA
57
What tumour markers are elevated in Testicular cancer
* AFP.
* HCG.
58
What cancers have been associated with EBV and how has it been linked
Cancers:
* Burkitt lymphoma ("starry sky" histology).
* Nasopharyngeal carcinoma.
* Hodgkin's disease ("owl-eye" cells [Reed sternberg]).
* B-cell lymphoma in the immunocompromised.
How:
1. Latent infection with EBV.
2. EBV binds CD21 on B cells.
3. Polyclonal B cell expansion with expression of EBV antigen.
4. Some B-cells killed by EBV-specific cytotoxic T cells.
5. Some B-cells undergo mutation (MYC tranlocation between Ch 8 and 14).
6. Proliferation of neoplastic clone cells.
59
What cancers have been associated with Hep B and C chronic liver disease
Hepatocellular carcinoma
60
What cancer has been associated with Herpes virus 8 (HHV8)
Kaposi sarcoma
61
What cancer has been associated with H.pylori
Gastric lymphoma
62
What cancer has been associated with RNA retroviruses (HTLV-1)
T-cell leukaemia / lymphoma
63
What chemical carcinogen are mine workers exposed to and what cancer can this cause.
Chemical:
* Nickel.
Cancer:
* Nasal cavity cancer.
* Lung cancer.
64
What chemical carcinogen are vineyard workers exposed to, where can this chemical be found, and what can this chemical cause
Chemical:
* Arsenic.
Found in:
* Fungicides.
* Alloys.
* Electrical devices.
* Medication.
Cause:
* Skin cancer.
* Lung cancer.
* Haemangiosarcoma.
65
What is asbestos, what are some properties, what is its structure, where can it be found, and what can this chemical cause
What it is:
* General term for number of fibrous **magnesium silicates.**
Properties:
* Fire-resistant.
* Good acoustic insulator.
* Good thermal insulator.
Structure:
* Long, thin fibres.
Found in:
* Existing consruction.
* Fire-resistant textiles.
* Friction materials.
* Roofing papers.
* Floor tiles.
Cause:
* Lung mesothelioma.
* Asbestosis.
* Pleural fibrous plaques.
* GI cancers.
66
Where can Radon be found, and what cancers can this chemical cause
Found in:
* Quarries.
* Mines.
Cancer:
* Lung.
67
Where can vinyl chloride be found, and what cancers can this chemical cause
Found in:
* Refrigerant.
* Plastic adhesives.
Cancer:
* Hepatic angiosarcoma.
68
Where can beryllium be found, and what cancers can this chemical cause
Found in:
* Aerospace applications.
* Nuclear reactors.
Cancer:
* Lung.
69
Where can Cadmium be found, and what cancers can this chemical cause
Found in:
* Batteries.
* Alloy.
* Metal plating and coating.
Cancer:
* Prostate.
70
Where can chromium be found, and what cancers can this chemical cause
Found in:
* Metal alloys.
* Paints.
* Pigments.
Cancer:
* Lung.
71
Where can ethylene oxide be found, and what cancers can this chemical cause
Found in:
* Fruit / nut ripening agents.
* Rocket propellant.
* Fumigants.
* Sterilants.
Cancer:
* Leukaemia.
72
What is the protein produced by gene TP53 and what is it's role.
Protein:
* p53.
Role:
* Monitors cell stress.
* Prevents cancer by inducing transient cell cycle arrest to allow repair of damaged DNA.
* If damaged DNA unable to be repaired induces cell senescence OR apoptosis.
73
What is familial adenomatous polyposis coli and what can it transform into?
What it is:
* Condition of large intestine.
* Multiple adenomatous polyps.
Transform into:
* Colonic adenocarcinomas.
74
What cancer is neurofibromatosis type 1 associated with
Neurofibrosarcoma
75
What are the features of von Hippel-Lindau syndrome and what is it a risk factor for?
Features:
* Retinal angiomas.
* Cerebellum haemangioblastomas.
* Cysts in kidney, liver, pancreas, epididymis.
* Renal haemangioblastoma.
At risk of:
* Renal carcinoma.
76
What is Tumour Staging?
* How much cancer there is in the body and how far it has spread.
* **TNM** staging.
77
What cancer is most commonly associated with hypercalcaemia?
Squamous cell carcinoma.
78
What are paraneoplastic syndromes and what are some examples.
* Disease manifestations that occur **with** but **NOT due to** cancer in the tissues / organs concerned.
* Can be due to secretion of soluble, specific factors by the tumour.
* Symptoms of disease manifestations can occur **before** underlying cancer detected.
* Removal of primary cancer MAY cause syndrome to subside.
Examples:
* General - anorexia, weight loss, low-grade fever (due to TNF and IL-6), weakness / fatigue.
* Endocrine-related e.g. Cushings (usually seen with small cell carcinomas).
* SIADH.
* Lambert-Eaton Myasthenic syndrome.
* Hypertrophic pulmonary osteoarthropathy.
79
What is Lambert-Eaton Myasthenic Syndrome (LEMS), what are the symptoms, and what cancer is it associated with?
What it is:
* Rare, autoimmune disorder in < 10 yo or > 40 yo.
* Autoimmunity against voltage-gated calcium channels on presynaptic motor nerve terminals --> loss of functional channels on motor nerve terminal.
* Can be a paraneoplastic syndrome (50%).
Symptoms:
* Muscles - weakness, fatigue, pain.
* Difficulty walking.
* Hyporeflexia.
* Speech impairment.
* Swallowing problems.
Cancer:
* Small cell lung cancer.
80
What cancer is hypertrophic pulmonary osteoarthropathy and digital clubbing commonly associted with?
Non-small cell lung cancers (usually adenocarcinoma).
81
What is Cushing's syndrome, what are the features, what cancer is it associated with and why?
What it is:
* Excess adrenal glucocorticoids.
Features:
* Central obesity.
* Diabetes.
* Fatigue.
* HTN.
* Osteoporosis.
* Acne.
* Stretch marks.
* Muscle weakness.
* Anxiety / depression.
* Moon face.
* Peripheral muslce wasting
Cancer:
* Small cell lung cancer.
Why:
* Excess ACTH secretion from small cells of lung
82
What cancers are osteolytic bone lesions commonly associated with
* Multiple myeloma.
* Breast cancer.
83
What cancer is commonly associated with cryptorchidism (undescended testis) and if untreated what other conditions can it cause?
Cancer:
* Seminoma (germ cell tumour).
Other conditions:
* Torsion.
* Infertility.
