Neoplasia Flashcards
The oral contraceptive pill (OCP) is protective against which of the following?
A Ovarian carcinoma
B Cervical carcinoma
C Venous thrombosis
D Hepatic adenoma
A
Explanation
No link has been shown between the OCP and breast cancer. If a woman has Human Papilomavirus (HPV) and is on the OCP, she may be at a higher risk of developing cervical carcinoma. Hepatic adenoma is connected to the use of the OCP. Women on the OCP are at increased risk of venous thrombosis especially if they smoke.
Studies have shown the OCP to be protective against endometrial and ovarian carcinomas
The most common type of thyroid carcinoma is?
A Follicular
B Anaplastic
C Medullary
D Papillary
D
Explanation
In the western world, thyroid carcinoma accounts for 1.5% of all cancers. Cancers arise from follicular epithelium except medullary cancer which arise from the parafollicular or C cells. Medullary cancer occurs in 5% of cases, anaplastic cancer in <5%, follicular cancer 10-20% and papillary cancer 75-85%
Acanthosis nigricans is associated with all of the following malignancies, with the exception of?
A Uterine
B Lung
C Gastric
D Brain
D
Explanation
Acanthosis nigricans is associated with Gastric carcinoma, lung carcinoma, and uterine carcinoma and its cause is thought to be immunological; secondary to secretion of epidermal growth factor. Acanthosis nigricans can be an important marker of benign and malignant conditions: Benign: 80% develops gradually and usually occurs in childhood or during puberty (1) Autosomal dominant trait w/ variable penetrance (2) In association w/ obesity or endocrine abnormalities (esp. pituitary or pineal tumours and DM) (3) as part of several rare congenital syndromes Malignant: lesions arising in middle[aged and older individuals in association w/ underlying cancers, most commonly gastrointestinal adenocarcinomas.
Extra: This disorder is commonly associated with an internal malignancy, usually adenocarcinoma, and most commonly of the gastrointestinal tract or uterus, and less commonly of the lung, prostate, breast, or ovary. The stomach is the most common site. Acanthosis nigricans of the oral mucosa or tongue is highly suggestive of a neoplasm, especially of the gastrointestinal tract.
Asbestos is associated with all the following conditions, except?
A Pleural plaques
B Siderosis
C Bronchial carcinoma
D Mesothelioma
B
Explanation
Asbestosis exposure is linked with six disease processes:
1. Parenchymal interstitial fibrosis (asbestosis)
2. Localised fibrous plaque, or rarely diffuse pleural fibrosis
3. Pleural effusions
4. Lung cancer
5. Malignant pleural and peritoneal mesothelioma
6. Laryngeal carcinoma
Siderosis is inflammatory but does not actually cause scarring of the lungs, as it is a non-fibrotic condition: Siderosis occurs in electric-arc and oxyacetylene welders who inhale small particles of iron oxide during the course of their work. In contrast to the lack of clinical signs and symptoms, the radiographic findings can be impressive with high attenuation micronodules and reticular opacities. The micronodules do not reflect fibrosis but rather radiopaque accumulation of metal particles within alveolar macrophages. On CT scanning, these nodules are frequently found in a centrilobular location; patchy ground-glass opacities may also be present. Of note, some of these radiographic findings are reversible and may resolve almost completely after exposure ceases.
Source: Uptodate
Which of the following is a skin manifestation of an underlying malignancy?
A Melanoma
B Naevus
C Epidermoid cyst
D Acanthosis nigricans
D
Explanation
Acanthosis nigricans (AN) is a brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds such as the posterior and lateral folds of the neck, axilla, groin, umbilicus, forehead and other areas. It can be an important cutaneous marker of benign and malignant conditions
AN can be benign or malignant, while former is much more common and insulin resistance is implicated as one of the causes, Malignant AN can be a cutaneous manifestation of an underlying aggressive malignancy - (90% are Gut tumours, especially gastric cancer).
Note: see below about epidermoidcysts. I have left the question as is, but please be aware
Epidermoid cyst can be a feature of Gardner syndrome
Gardner syndrome is a variant of ‘familial adenomatous polyposis’ (FAP), an inherited disease that is characterised by gastrointestinal polyps, multiple osteomas (benign bone tumours), and skin and soft tissue tumours. Polyps tend to form at puberty with the average age of diagnosis around 25 years of age. In almost all patients, polyps will progress to malignancy, resulting in colorectal cancer so that timely detection is essential. What are the clinical features of Gardner syndrome?
Clinical features of Gardner syndrome can be divided into two types, cutaneous and non-cutaneous. The most noticeable cutaneous feature of Gardner syndrome is the appearance of epidermoid cysts. These cysts can be differentiated from ordinary epidermoid cysts by the following factors:
Epidermoid inclusion cysts of Gardner syndrome (50–65%) occur at an earlier age (around puberty) than ordinary cysts
Epidermoid cysts occur in less common locations such as the face, scalp and extremities compared to ordinary cysts
Cysts tend to be multiple in over half of the patients with Gardner syndrome
As with ordinary epidermoid cysts, cysts in Gardner syndrome are usually asymptomatic (without symptoms), however in some cases they may be pruritic (itchy) and/or inflamed, and they may rupture.
Sometimes the cysts have hybrid features with pilomatricoma like histopathology
Other cutaneous features include desmoid cysts, fibromas, lipoma, leiomyomas, neurofibromas and pigmented skin lesions.
Non-cutaneous features include:
Gastrointestinal polyps that nearly always transform into colonic adenocarcinomas (colon cancer).
Osteomas – these benign bone tumours are essential in making the diagnosis of Gardner syndrome. They occur most commonly in the mandible (jawbone) but may also grow in the skull and long bones.
Dental abnormalities – as well as osteomas in the jaw there may be other dental abnormalities such as unerupted extra teeth and caries
Multifocal pigmented lesions of the fundus in the eye – seen in 80% of patients. These lesions may be present shortly after birth and can be the first marker of the disease.
Source: https://www.dermnetnz.org/topics/gardner-syndrome/
Which of the following is NOT an example of a paraneoplastic syndrome?
A Gynaecomastia
B Hypercalcaemia
C Hypocalcaemia
D Hyperuricaemia
D
Explanation
Paraneoplastic syndrome (PN) are symptom complexes in cancer bearing individuals that cannot be explained ,either by the local or distant spread of the tumour or by the elaboration of hormones indigenous to the tissue from which the tumour arose.
These occur in about 10% of persons with malignant disease
Lung carcinomas can be associated with several PN syndromes: the hormones or hormone like factors elaborated are
Parathyroid hormone producing hypercalcaemia. Calcitonin producing hypocalcaemia. Gonadotropins producing gynaecomastia.
Hyperuricaemia occurs form increased nucleic turnover (leukaemias and other aggressive malignancies. It does not appear to be a result of a paraneoplastic syndrome
Which of the following chronic inflammatory states DOES NOT have the capacity for malignancy?
A Psoriases
B Inflammatory bowel disease
C Cystitis
D Sialadenitis
A
Explanation
The precise mechanism linking chronic inflammation to cancer has not been well established. It has been shown that in the presence of chroninc inflammation the immune response may become maladaptive, promoting tumourgenesis. As with any cause of tissue injury , there is a compensatory proliferation of cells to repair the damage. In some cases, chronic inflammation may increase the production of stem cells whcih may become the subject to the effect of mutagens.
Psoriases does not lead to cancer. The other options do. Other examples include: reflux oesophagitis, lichen planus, hepatitis, AIDS, PID, osteomyelitis. mononucleosis, Hashimoto’s thyroiditis and chronic pancreatitis.
Which of the following is a characteristic of myelofibrosis?
A Blood film shows a leukoerythroblastic anaemia
B Mean survival is 5-8yrs
C Thrombocytopaenia occurs early in the disease
D There is an increased proliferative cell production in the bone marrow
A
Explanation
Myelofibrosis, the hallmark of which is the development of obliterative fibrosis leading to suppression of the bone marrow cell production causing cytopaenias and neoplastic extramedullary haematopoiesis. Clinical features include fullness in the splenic region because of anaemia and splenomegaly. Leukoerythroblastosic anaemia is present on blood film. Platelets are normal early in the disease but thrombocytopaenia intervenes as the disease progresses. Median survival is 3-5yrs. Transformation to AML occurs in 5-20% of cases. Treatment is difficult but bone marrow transplant is being tried in younger patient and kinase inhibitors offer some future hope
Which is not a feature of intravascular haemolytic anaemia?
A Conjugated hyperbilirubinaemia
B Haemoglobinaemia
C Haemosiderinuria
D Anaemia
A
Explanation
In all types of uncomplicated HA, the bilirubin is unconjugated. The level of hyperbilirubinaemia is dependent on the functional capacity of the liver and the rate of haemolysis. When liver function is normal, the jaundice is not severe
UpToDate:
Intravascular hemolysis refers to hemolysis that occurs primarily within the vasculature. This occurs when there is a considerable amount of structural damage to the RBC membrane (eg, mechanical shearing, complement MAC) or when the reticuloendothelial system becomes overwhelmed. When severe, intravascular hemolysis is characterized by pink or brown serum and dark urine with free serum and urine hemoglobin. The pink color is due to oxyhemoglobin and the brownish color is due to the oxidized form, methemoglobin.
Free hemoglobin binds to haptoglobin, and the hemoglobin-haptoglobin complex is rapidly removed by the liver, leading to a reduction in plasma haptoglobin, often to undetectable levels. Dimers of alpha-beta globin that are not bound by haptoglobin are small enough (molecular weight 34,000 daltons) to be filtered by the glomerulus and appear in the urine as hemoglobinuria.
Urine hemosiderin may be seen several days after an episode of intravascular hemolysis, as renal tubular cells take up the heme, degrade it, store it as hemosiderin, and eventually are shed into the urine. Urine hemosiderin is detected using Prussian blue staining (iron stain) of the urine sediment
Which cancer marker and corresponding tumour is correct?
A Alpha feto-protein (AFP) and lung cancer
B HCG and ovarian cancer
C Neuron specific enolase and neuroblastoma
D CA 125 and colon cancer
C
Explanation
Ca 125= ovarian cancer
Ca 19-9= colon cancer and pancreatic cancer
Ca 15-3= breast cancer.
AFP= liver cancer (HCC), nonseminomatous germ cell tumour of testis.
HCG= trophoblastic tumours and nonseminomatous testicular tumours.
Note: This table appears in older editions of the TB. The latest edition does not appear to have this table in the chapter of neoplasia.
In the latest edition examples
CEA: colon, pancreas, stomach and breast
AFP: hepatocellular cancer, yolk sac remnants in the gonads and teratocarcinomas and embryonal cell carcinomas
PSA: prostatic adenocarcinoma
Which cancers kills more people (both female and male combined)?
A. Lung
B. Pancreas
C. Lymphoma
D. Colon
A
Explanation
Cancers of the lung, female breast, prostate and colon constitute more than 50% of cancer diagnosis and cancer deaths.
Lung - male 31%, female 26%
Colon - male 8%, female 9%
NH Lymphoma - male 3%, female 3%
Pancreas - male 6%, female 6%
With regards to cancer spread, which of the following is correct?
A Spleen is the most common site of metastatic deposit
B Haematogenous spread is the most common pathway for the initial dissemination of carcinomas
C 30% of solid tumours present with metastatic disease
D Bowel cancer is typified by seeding to the peritoneum
C
Explanation
Dissemination of cancers may occur through:
(1) direct seeding of body cavities or surfaces
(2) lymphatic spread, and
(3) haematogenous spread
Although direct transplantation of tumour cells, e.g. on surgical instruments, may occur, but is rare.
30% of newly diagnosed solid tumours (excluding skin cancers other than melanomas) present with metastases.
Metastatic spread strongly reduces the chance of a cure
(1) Seeding of body cavities and surfaces occurs whenever a malignant neoplasm penetrates into a natural “open field”. Most often involved is the peritoneal cavity, but any other cavity may be affected. Ovarian carcinoma in particular, displays such seeding.
(2) Lymphatic spread is the most common pathway for the initial dissemination of carcinomas and sarcomas. The pattern of lymph node involvement follows the natural routes of lymphatic drainage.
(3) Haematogenous metastases commonly involve the liver and lung because all the portal blood drains to the liver and all the caval blood drains through the lungs.
What is the most common brain tumour in childhood?
A Meningioma
B Astrocytoma
C Medulloblastoma
D Lymphoma
B
Explanation
The current TB does not clearly state a most common brain tumour of childhood. The most common poorly differentiated neoplasm is medulloblastoma – which accounts for 20% of brain tumours in children. Meningiomas are predominantly benign tumours of adults. Gliomas are the most common group of primary brain tumours (which includes astrocytomas, oligodendrogliomas, ependymomas).
“Neoplasms that exhibit sharp peaks in incidence in children younger than age 10 years include (1) leukaemia, (2) neuroblastoma, (3) Wilms tumour, (4) hepatoblastoma, (5) retinoblastoma, (6) rhabdomyosarcoma, (7) teratoma, (8) Ewing sarcoma, (9) juvenile astrocytoma, (10) medulloblastoma, (11) ependymoma
An interent search “Pilocytic astrocytoma (Grade 1): This slow-growing tumor is the most common brain tumor found in children”
Uptodate: Paediatric primary brain and CNS tumours: distribution by tumour type:
Pilocytic astrocytoma -15.5%
Gliomas -11.7%
Embryonal -11.4% (medulloblastoma 63.7% in the group)
Meningioma -2.6%
Lymphoma -0.3%
Source: Uptodate: Epidemiology of central nervous system tumours.
