Neoplasia 4 Flashcards
What aspect of our immune system is responsible for recognizing cancer?
Cell-mediated Immunity - Specifically CD8+ cells because because the antigens are presented on MHC class I
What is the difference between a tumor specific antigen and a tumor associated antigen?
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
What overly or aberrantly expressed protein is often recognized by the T cells of patients with melanoma?
Tyrosinase
What are some mutated oncogenes that are often recognized by CTLs after they are presented on MHC class I?
Oncogene Products:
- *HER-2
- Mutated RAS
- BCR/ABL fusion Proteins
Tumor Suppressors:
- mutated p53
What are CA-125 and CA-19-9 associated with?
- what are they?
These are Altered Cell Surface Glycoproteins found in certain cancers
CA-125 - ovarian
CA-19-9 - colon and pancreatic
- *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?
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.
How does the EBV virus find its target cell to infect?
- what is this target cell?
EBV targets B cells via CD21
Other than altering their surface determinants how do cancers ensure that they aren’t attacked by CTLs?
Secretion of TGF-ß prevents many T-cells from being produced
What features should you look for in a B-cell to know if they have Burkitt’s Lymphoma?
Large Vaculoes is a very good indicator of Burkitt’s
T or F: people in immunocompromised states are more susceptible to cancer
True, they have less immune surveillance so they are more likely to have uncontrolled cell growth
T or F: pregnancy is an immunocompromised state and thus pregnant women are more likely to get cancer
True, pregnant women are more prone to breast and cervical cancers
What causes Superior Vena Cava Syndrome?
- what are the symptoms?
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
T or F: impingement on adjacent stuctures is one of the main problems caused by tumors.
True
What is a paraneoplastic syndrome?
- what are the most common?
Hypercalcemia
Cushing Syndrome
Nonbacterial Thrombotic Endocarditis
What cancer is commonly known to cause Hypercalcemia?
- how does it do this?
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
What causes Cushing Syndrome?
- what are some symptoms of Cushing Syndrome?
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
What causes Nonbacterial Thrombotic Endocarditis?
- what are some symptoms?
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
What are some major risks associated with tumors ulcerating through adjacent surfaces?
- 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???
What is Kassabach-Merrit Syndrome?
- what is it caused by?
Kassalbach-Merrit:
- Sponateous or Traumatic Rupture with Hemoperitoneum
- Leads to Intratumoral bleeding and Consumptive Coagulopathy
Cause:
- Vascular Tumor usually cause this
What is Consumptive Coagulopathy?
All clotting factors and platelets are bound up in the tumor leaving the rest of the body at a bleeding risk
What is the risk with Low grade Appendiceal Mucinous Neoplasms?
*They can spread to the peritoneum as Pseudomyxoma Peritonei but are not invasive in the appendix
What is/are believed to be the driving factor(s) of cachexia?
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)
Between the tumor and the patient what does grading refer to?
Tumor
What rating system is used to give a prognosis to a patient?
Staging
What does Grading look at?
Looks at how well that tumor is differentiated
What tumors are placed in a grading category based on the diagnosis?
Brain Cancers are Classified this way via the WHO grading System
What system is used to grade the severity of Lung cancers?
- what is this looking at?
TLM method
T - Tumor Size (T1, T2, T3, T4)
L - Lymph Node Size (N0, N1, N2, N3)
M - Metastsis (M0, M1)
What two cancers are commonly staged on how much they have invaded more so than just size?
Colon Cancers
Bladder Cancer
What are the different forms of biopsy for a skin lesion?
Punch Biopsy (for something a little deeper) Shave Biopsy (shave it off) Exision Biopsy (cut around it)
What are the steps in the process of preparing a slide to look for pathology?
- Fixation and Select good Tissue sample
- Paraffin Processing
- Embed Tissue in Paraffin Blocks
- Section Tissues
- Stain
**Note: if you decide you need a different stain on the tissue then you’ve got to start over
What technique might you use to diagnose thyroid cancer without excising any part of the thyroid?
Fine-needle aspiration and Cytologic Smears allow us to look at cells to see if cancer is present
Why is frozen sectioning used?
- are there any drawbacks?
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
Which of the following are used at either Diagnosis of Heriditary predisposition for cancer, prognosis or diagnosis?
- BCR-ABL
- BRCA1
- HER-2
- EGFR
Heriditary Marker:
- BRCA 1
Prognostic Marker:
- HER-2 (bad px)
- EGFR
Dx:
- BCR-ABL
What drug works on both BCR-ABL and KIT gene mutations?
- what diseases are cause by these mutations?
Imatinib
Diseases:
BCR-ABL = Chronic Myeloid Leukemia
c-KIT = Gastro Intestinal Stromal Tumor
What different types of cancers could arise from a BRAF(V600E) mutation?
- Melanoma
- Papillary Thyroid Carcinoma
- Hairy Cell Leukemia
- Langerhans Cell Histocytes
- Colon Adenocarcinomas
