Neoplasia 4

Question 1

What aspect of our immune system is responsible for recognizing cancer?

Answer 1

Cell-mediated Immunity 
- Specifically CD8+ cells because because the antigens are presented on MHC class I

Question 2

What is the difference between a tumor specific antigen and a tumor associated antigen?

Answer 2

Tumor Specific antigens are ONLY found on Tumors

Tumor Associated antigens are often found on tumor, but may also be present on some cells in the body

Question 3

What overly or aberrantly expressed protein is often recognized by the T cells of patients with melanoma?

Answer 3

Tyrosinase

Question 4

What are some mutated oncogenes that are often recognized by CTLs after they are presented on MHC class I?

Answer 4

Oncogene Products:

• *HER-2
• Mutated RAS
• BCR/ABL fusion Proteins

Tumor Suppressors:
- mutated p53

Question 5

What are CA-125 and CA-19-9 associated with?

- what are they?

Answer 5

These are Altered Cell Surface Glycoproteins found in certain cancers
CA-125 - ovarian
CA-19-9 - colon and pancreatic

Question 6

• *Suppose on the first bout of B cell lymphoma you treat a patient with Rituximab, and you suspect their B cell lymphoma has come back.
• what tests can you use to see if the cancer came back?
• why?

Answer 6

Rituximab is a mAb drug specific for CD-20 so it will kill CD20 positive cancer cells

• When the cancer returns CD20 is a terrible marker to use because you more than likely knocked out all of these cells with the first round of chemo.
• Surviving cancer cells will have different markers meaning that a CD20 test would be useless.

Question 7

How does the EBV virus find its target cell to infect?

- what is this target cell?

Answer 7

EBV targets B cells via CD21

Question 8

Other than altering their surface determinants how do cancers ensure that they aren’t attacked by CTLs?

Answer 8

Secretion of TGF-ß prevents many T-cells from being produced

Question 9

What features should you look for in a B-cell to know if they have Burkitt’s Lymphoma?

Answer 9

Large Vaculoes is a very good indicator of Burkitt’s

Question 10

T or F: people in immunocompromised states are more susceptible to cancer

Answer 10

True, they have less immune surveillance so they are more likely to have uncontrolled cell growth

Question 11

T or F: pregnancy is an immunocompromised state and thus pregnant women are more likely to get cancer

Answer 11

True, pregnant women are more prone to breast and cervical cancers

Question 12

What causes Superior Vena Cava Syndrome?

- what are the symptoms?

Answer 12

Pancoast Lung Tumors are known to call this, blood doesn’t drain back to the heart efficiently so you get EDEMA IN THE FACE

**Removal of the tumor will relieve the edema

Question 13

T or F: impingement on adjacent stuctures is one of the main problems caused by tumors.

Answer 13

True

Question 14

What is a paraneoplastic syndrome?

- what are the most common?

Answer 14

Hypercalcemia
Cushing Syndrome
Nonbacterial Thrombotic Endocarditis

Question 15

What cancer is commonly known to cause Hypercalcemia?

- how does it do this?

Answer 15

Paraneoplastic Syndrome

Squamous Cell Carcinomas are often associated with Hypercalcemia

**Releases Parathyroid Hormone (PTH) or a substance with similar activity that acted on the kidney’s and gut to increase Absorption of Calcium

**Problem arises because the tumor has no shut off mechanism (no feedback regulation) so it just gets progressively worse

Question 16

What causes Cushing Syndrome?

- what are some symptoms of Cushing Syndrome?

Answer 16

Paraneoplastic Syndrome

Too Much ACTH via adrenal dysfunction or by cancer that secretes ACTH

Symptoms: 
Moon Face
Small Arms and Legs
Truncal Obestity (man boobs) 
Buffalo Hump neck

Question 17

What causes Nonbacterial Thrombotic Endocarditis?

- what are some symptoms?

Answer 17

Paraneoplastic Syndrome

Lesions are composed of Fibrin and Platelets

Unknown cause, possible Endothelial Injury mediated by TNF and IL-1 in a hypercoagulable state

***CAN LEAD TO SYSTEMIC EMBOLIZATION

Question 18

What are some major risks associated with tumors ulcerating through adjacent surfaces?

Answer 18

• Bleeding Risks (coughing cause embolization of vessels exposed in tumor)
• Seems like it could ulcerated from one body cavity to another (colon) and cause sepsis???

Question 19

What is Kassabach-Merrit Syndrome?

- what is it caused by?

Answer 19

Kassalbach-Merrit:
- Sponateous or Traumatic Rupture with Hemoperitoneum

• Leads to Intratumoral bleeding and Consumptive Coagulopathy

Cause:
- Vascular Tumor usually cause this

Question 20

What is Consumptive Coagulopathy?

Answer 20

All clotting factors and platelets are bound up in the tumor leaving the rest of the body at a bleeding risk

Question 21

What is the risk with Low grade Appendiceal Mucinous Neoplasms?

Answer 21

*They can spread to the peritoneum as Pseudomyxoma Peritonei but are not invasive in the appendix

Question 22

What is/are believed to be the driving factor(s) of cachexia?

Answer 22

TNF-alpha, IL-6, and IL-1 may cause:

• Metabolically active Brown Adipose Tissue to increase (thermogenesis, Lipolysis)
• Fat stores are Depleted
• Liver increases Acute Phase Protein Release
• Anorexia (from neurological effects)

Question 23

Between the tumor and the patient what does grading refer to?

Answer 23

Tumor

Question 24

What rating system is used to give a prognosis to a patient?

Answer 24

Staging

Question 25

What does Grading look at?

Answer 25

Looks at how well that tumor is differentiated

Question 26

What tumors are placed in a grading category based on the diagnosis?

Answer 26

Brain Cancers are Classified this way via the WHO grading System

Question 27

What system is used to grade the severity of Lung cancers?

- what is this looking at?

Answer 27

TLM method

T - Tumor Size (T1, T2, T3, T4)
L - Lymph Node Size (N0, N1, N2, N3)
M - Metastsis (M0, M1)

Question 28

What two cancers are commonly staged on how much they have invaded more so than just size?

Answer 28

Colon Cancers

Bladder Cancer

Question 29

What are the different forms of biopsy for a skin lesion?

Answer 29

Punch Biopsy (for something a little deeper)
Shave Biopsy (shave it off) 
Exision Biopsy (cut around it)

Question 30

What are the steps in the process of preparing a slide to look for pathology?

Answer 30

1. Fixation and Select good Tissue sample
2. Paraffin Processing
3. Embed Tissue in Paraffin Blocks
4. Section Tissues
5. Stain

**Note: if you decide you need a different stain on the tissue then you’ve got to start over

Question 31

What technique might you use to diagnose thyroid cancer without excising any part of the thyroid?

Answer 31

Fine-needle aspiration and Cytologic Smears allow us to look at cells to see if cancer is present

Question 32

Why is frozen sectioning used?

- are there any drawbacks?

Answer 32

Its faster than time consuming routine methods

Drawbacks:

• Challenging to analyze and to visualize margins
• Poor Histologic detail

**sometimes its better to just wait a few days and use traditional methods

Question 33

Which of the following are used at either Diagnosis of Heriditary predisposition for cancer, prognosis or diagnosis?

• BCR-ABL
• BRCA1
• HER-2
• EGFR

Answer 33

Heriditary Marker:
- BRCA 1

Prognostic Marker:

• HER-2 (bad px)
• EGFR

Dx:
- BCR-ABL

Question 34

What drug works on both BCR-ABL and KIT gene mutations?

- what diseases are cause by these mutations?

Answer 34

Imatinib

Diseases:
BCR-ABL = Chronic Myeloid Leukemia
c-KIT = Gastro Intestinal Stromal Tumor

Question 35

What different types of cancers could arise from a BRAF(V600E) mutation?

Answer 35

• Melanoma
• Papillary Thyroid Carcinoma
• Hairy Cell Leukemia
• Langerhans Cell Histocytes
• Colon Adenocarcinomas