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USLME Step 1 > Neoplasms - First Aid 2014 > Flashcards

Neoplasms - First Aid 2014 Flashcards

1
Q

What is P-glycoprotein?

A

Also known as Multidrug resistance protein 1 (MDR1). Expressed by some other cancer cells (e.g. colon, liver) to pump out toxins, including chemotherapeutic agents (one mechanism of decreased responsiveness or resistance to chemotherapy over time).

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2
Q

What is desmoplasia?

A

Fibrous tissue formation in response to neoplasm (e.g. linitis plastica in diffuse stomach cancer).

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3
Q

How do carcinomas and sarcomas spread? and what are notable exceptions?

A

Carcinomas generally spread by lymphatics.
Sarcomas generally spread by blood.

Exceptions with carcinomas include: renal cell carcinoma (invades renal vein), hepatocellular carcinoma (hepatic vein), follicular carcinoma of the thyroid, and choriocarcinoma. All of these are by blood.

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4
Q

What’s the difference between a hemangioma and an angiosarcoma?

A

Both neoplasms of blood vessels.

Hemangioma is benign while angiosarcoma is malignant.

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5
Q

What causes decreased apoptosis in malignant cells?

A

upregulation of telomerase prevents chromosome shortening and cell death so less apoptosis.

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6
Q

What is cachexia mediated by?

A

TNF-alpha (cachectin), IFN-gamma, IL-6.

remember: this is weight loss, muscle atrophy, and fatigue in chronic disease (AIDS, cancer, heart failure, TB etc). `

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7
Q

What disease is associated with visceral malignancy (esp. stomach)?

A

Aconthosis nigricans (hyperpigmentation and epidermal thickening)

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8
Q

What disease is associated with Squamous cell carcinoma of the skin?

A

Actinic keratosis

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9
Q

What disease is associated with aggressive malignant lymphomas (non-Hodgkin) and Kaposi sarcoma?

A

AIDS

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10
Q

What disease is associated with Lymphoma?

A

Autoimmune diseases (e.g. Hashimoto thyroiditis, SLE).

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11
Q

What disease is associated with espohageal adenocarcinoma?

A

Barrett esophagus (chronic GI reflux)

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12
Q

What disease is associated with gastric adenocarcinoma?

A

Chronic atrophic gastritis, pernicious anemia, postsurgical gastric remnants.

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13
Q

What disease is associated with hepatocellular carcinoma?

A

cirrhosis

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14
Q

What disease is associated with small cell lung cancer?

A

Cushing syndrome, SIADH, Lambert Eaton myasthenic syndrome

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15
Q

What disease is associated with lung cancer?

A

dermatomyositis

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16
Q

What disease is associated with ALL, AML?

A

Down syndrome (ALL: age > 5 years, AML age < 5 years).

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17
Q

What disease is associated with malignant melanoma?

A

dysplastic nevus

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18
Q

What disease is associated with squamous cell lung cancer?

A

hypercalcemia (from PTHrp)

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19
Q

What disease is associated with malignant lymphomas?

A

immunodeficiency states

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20
Q

What disease is associated with thymoma?

A

myasthenia gravis, pure RBC aplasia

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21
Q

What disease is associated with secondary osteosarcoma, fibrosarcoma?

A

Paget disease of the bone

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22
Q

What disease is associated with squamous cell carcinoma of esophagus?

A

Plummer-venson syndrome (decreased iron)

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23
Q

What disease is associated with renal cell carcinoma, hepatocellular carcinoma?

A

polycthemia. Both malignancies can produce EPO.

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24
Q

What disease is associated with leukemia, sarcoma, papillary thyroid cancer, and breast cancer?

A

Radiation exposure.

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25
Q

What disease is associated with giant cell astrocytomas, renal angiomyolipoma, and cardiac rhabdomyoma?

A

tuberous sclerosis (facial angiofibroma, seizures, intellectual disability).

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26
Q

What disease is associated with colonic adenocarcinoma?

A

ulcerative colitis

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27
Q

What disease is associated with melanoma, basal cell carcinoma, and especially squamos cell carcinoma of the skin?

A

xeroderma pigmentosum, albinism

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28
Q

What oncogene is dysregulated in CML, ALL?

A

BCR-ABL, tyrosine kinase

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29
Q

What oncogene is dysregulated in follicular and undifferentiated lymphomas?

A

Bcl-2, anti-apoptotic molecule (inhibits apoptosis)

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30
Q

What onocgene is dysregulated in melanoma?

A

BRAF, serine/threonine kinase.

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31
Q

What onocgene is dysregulated in gastrointestinal stromal tumor (GIST)?

A

c-kit, cytokine receptor (for stem cell factor)

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32
Q

What oncogene is dysregulated in burkitt lymphoma?

A

c-myc, transcription factor

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33
Q

What oncogene is dysregulated in breast, ovarian, and gastric carcinomas?

A

HER2/neu (c-erbB2), tyrosine kinase

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34
Q

What oncogene is dysregulated in lung tumors?

A

L-myc, transcription factor. L for lung

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35
Q

What oncogene is dysregulated in neuroblastoma?

A

N-myc, transcription factor. N for neuro

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36
Q

What oncogene is dysregulated in colon cancer, lung cancer, pancreatic cancer?

A

Ras, GTPase.

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37
Q

What oncogene is dysregulated in MEN2A,2B?

A

ret, tyrosine kinase

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38
Q

What tumor suppressor is dysregulated in colorectal cancer (associated with FAP)?

A

APC

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39
Q

What tumor suppressors are dysregulated in breast and ovarian cancer?

A

BRCA1, BRCA2

DNA repair proteins

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40
Q

What tumor suppressor is dysregulated in pancreatic cancer?

A

CPD4/SMAD4.

DPC - deleted in pancreatic cancer.

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41
Q

What tumor suppressor is dysregulated in colon cancer?

A

DCC - deleted in colon cancer

42
Q

What tumor suppressor is dysregulated in MEN type 1?

A

MEN1

43
Q

What tumor suppressor is dysregulated in neurofibromatosis type 1?

A

NF1 - RAS GTPase activating protein (neurofibromin)

44
Q

What tumor suppressor is dysregulated in neurofibromatosis type 2?

A

NF2 - merlin (schwannomin) protein

45
Q

What tumor suppressor is dysregulated in melanoma?

A

p16, cyclin-dependent kinase inhibitor 2A.

46
Q

What tumor suppressor is dysregulated in most human cancer/Li-Fraumeni syndrome?

A

p53, transcription factor for p21, blocks G1->S phase.

47
Q

What tumor suppressor is dysregulated in breast cancer, prostate cancer, endometrial cancer?

A

PTEN

48
Q

What tumor suppressor is dysregulated in retinoblastoma, osteosarcoma?

A

Rb, inhibits E2F; blocks G1 -> S phase

49
Q

What tumor suppressor is dysregulated in Tuberous sclerosis?

A

TSC1 (hamartin protein), TSC2 (tuberin protein).

50
Q

What tumor suppressor is dysregulated in von Hippel-Lindau disease?

A

VHL - inhibits hypoxia inducible factor 1a

51
Q

What tumor suppressor is dysregulated in Wilms Tumor (nephroblastoma)?

A

WT1, WT2.

52
Q

What is the tumor marker for mets to bone, liver, Paget disease of the bone, seminoma?

A 
alkaline phosphatase (ALP)
for seminoma, we're talkign about placental ALP
53
Q

What is the tumor marker for hepatocellular carcinoma, hepatoblastoma, yolk sac (endodermal sinus) tumor, testicular cancer, mixed germ cell tumor?

A

alpha-fetoprotein.
Normally made by fetus.
In the case of mixed germ cell tumor, it is co-secreted with B-hCG.

54
Q

What is the tumor marker for hyaditiform moles and choriocarcinomas (gestational trophoblastic disease), testicular cancer?

A

B-hCG.

Commonly associated with pregnancy.

55
Q

What is the tumor marker for breast cancer?

A

CA-15-3/CA-27-29

56
Q

What is the tumor marker for pancreatic adenocarcinoma?

A

CA-19-9

57
Q

What is the tumor marker for ovarian cancer?

A

CA-125

58
Q

What is the tumor marker for medullary thyroid carcinoma?

A

calcitonin

59
Q

What is the tumor marker for colorectal cancer and pancreatic cancers?

A

CEA, carcinoembryonic antigen.
Very nonspecific but produced by 70% of colorectal and pancreatic cancers; also produced by gastric, breast, and medullary thyroid carcinomas.

60
Q

What is the tumor marker for prostate adenocarcinoma?

A

PSA, prostate specific antigen.
Used to follow prostate cancer.
Can also be elevated in BPH and prostatitis. Questionable risk/benefit for screening.

61
Q

What is the tumor marker for melanomas, neural tumors, schwannomas, Langerhans cell histiocytosis?

A

S-100. Neural crest origins.

62
Q

What is the tumor marker for hairy cell leukemia?

A

TRAP, tartrate-resistant acid phosphatase

TRAP the hairy animal. Largely replaced by flow cyt.

63
Q

What is the microbe associated with burkitt lymphoma, hodgkin lymphoma, nasopharyngeal carcinoma, CNS lymphoma (in immunocompromised?

A

EBV

64
Q

What is the microbe associated with hepatocellular carcinoma?

A

HBV, HCV

65
Q

What is the microbe associated with Kaposi Sarcoma, body cavity fluid B-cell lymphoma?

A

HHV-8

66
Q

What is the microbe associated with cervical and penile/anal carcinoma, head/neck or throat cancer?

A

HPV.

16/18 with the penile/anal carcinoma form

67
Q

What is the microbe associated with Gastric adenocarcinoma and MALT lymphoma?

A

H. pylori

68
Q

What is the microbe associated with Adult T-cell leukemia/lymphoma?

A

HTLV-1

69
Q

What is the microbe associated with cholangiocarcinoma?

A

liver fluke (Clonorchis sinensis)

70
Q

What is the microbe associated with bladder cancer squamos?

A

schistosoma haematobium

71
Q

What is the cancer associated with aflatoxins (aspergillus)?

A

Liver and hepatocellular carcinoma.

72
Q

What is the cancer associated with alkylating agents?

A

Blood and leukemia/lymphoma

73
Q

What is the cancer associated with aromatic amines (e.g. benzidine, 2-naphthylamine)?

A

Bladder and transitional cell carcinoma.

74
Q

What is the cancer associated with arsenic?

A

Liver - Angiosarcoma
lung - lung cancer
skin - squamous cell carcinoma.

75
Q

What is the cancer associated with asbestos?

A

Lung and bronchogenic carcinoma > mesothelioma

76
Q

What is the cancer associated with carbon tetrachloride?

A

Liver and centrilobular necrosis, fatty change

77
Q

What is the cancer associated with cigarette smoke?

A

Bladder - transitional cell carcinoma
Esophagus - squamous cell carcinoma/adenocarcinoma
Kidney - renal cell carcinoma
Larynx - squamous cell carcinoma
Lung - Squamous cell and small cell carcioma
Pancreas - pancreatic adenocarcinoma.

78
Q

What is the cancer associated with ethanol?

A

liver and hepatocellular carcinoma

79
Q

What is the cancer associated with ionizing radiation?

A

thyroid and papillary thyroid carcinoma

80
Q

What is the cancer associated with nitrosamines (smoked food)?

A

stomach and gastric cancer

81
Q

What is the cancer associated with radon?

A

lung and lung cancer (2nd leading cause after cigarette smoke)

82
Q

What is the cancer associated with vinyl chloride?

A

liver and angiosarcoma.

83
Q

What is the paraneoplastic syndrome associated with hodgkin lymphoma, some non-Hodgkin lymphomas?

A

1,25-(OH)2D3 (calcitriol)

Hypercalcemia

84
Q

What is the paraneoplastic syndrome associatd with small cell lung carcinoma?

A

ACTH, ADH
Cushing syndrome, SIADH

Also Lambert Eat myasthenic syndrome (muscle weakness) from antibodies against presynaptic Ca+2 channels at NMJ.

85
Q

What is the paraneoplastic syndrome associated with small cell lung carcinoma and intracranial neoplasms?

A

ADH

SIADH

86
Q

What is the paraneoplastic syndrome associated with renal cell carcinomas, thymoma, hemangioblastoma, hepatocellular carcinoma, leiomyoma, pheochromocytoma?

A

EPO, polycythemia.

87
Q

What is the paraneoplastic syndrome associated with squamous cell lung carcinoma, renal cell carcinoma, breast cancer?

A

PTHrP, hypercalcemia.

88
Q

What is associated with psammoma bodies?

A

laminated, concentric, calcific spherules.
PSaMMoma bodies seen in:
Papillary carcinoma of thyroid
Serous papillary cystadenocarcinoma of ovary
Meningioma
Malignant mesothelioma

89
Q

What’s the cancer incidence for males and females?

A

Male: prostate (32%), lung (16%), colon/rectum (12%)
Female: Breast (32%), lung (13%), colon/rectum (13%)
Lung cancer incidence dropping in men but not women

90
Q

What’s the cancer mortality for men and females?

A

Male: Lung (33%), prostate (13%)
Female: Lung (23%), Breast (18%).
Cancer is second leading cause of death, heart disease is 1st.

91
Q

What commonly metastasizes to brain and where?

A

Lung > breast > genitourinary > osteosarcoma > melanoma > GI.

50% of brain tumors are from mets. Commonly seen at multiple well circumscribed tumors at grey/white junction.

92
Q

What commonly metastasizes to liver?

A

Colon&raquo_space;> stomach > pancreas

Liver and lung are the most common sites of metastasis after the regional lymph nodes.

93
Q

What commonly metastasizes to bone?

A

Prostate, breast > lung > thyroid

Bone mets» primary bone tumors (e.g. multiple myeloma, lytic). WHole body bone scan shows tumor predilection for axial skeleton.
Prostate = blastic.
Breast = lytic and blastic.

94
Q

What is a strawberry hemangioma?

A

Benign capillary hemangioma of infancy.
Appears in first few weeks of life (1/200 births); grows rapidly and regresses spontaneously at 5-8 years old.

Strawberries are sweet and cherries are sour

95
Q

What is a cherry hemangioma?

A

Benign capillary hemangioma of the elderly. Does not regress. Frequency increases with age.

Strawberries are sweet and cherries are sour

96
Q

What is a pyogenic granuloma?

A

Polypoid capillary hemangioma that can ulcerate and bleed. Associated with trauma and pregnancy.

97
Q

What is a cystic hygroma?

A

cavernous lymphangioma of the neck. Associated with Turner syndrome?

98
Q

What is a glomus tumor?

A

Benign, painful, red-blue tumor under fingernails. Arises from modified smooth muscle cells of glomus body (in dermis layer of skin involved in temperature regulation…AV shunt)

99
Q

What is bacillary angiomatosis?

A

Benign capillary skin papules found in AIDS patients. Caused by Bartonella henselae infections. Frequently mistaken for Kaposi’s sarcoma.

100
Q

What is angiosarcoma?

A

Rare blood vessel malignancy typically occurring in the head, neck, and breast areas. Usually in elderly, on sun-exposed areas. Associated with radiation therapy and arsenic exposure. Very aggressive and difficult to resect due to delay in diagnosis.

101
Q

What is lymphangiosarcoma?

A

Lymphatic malignancy associated with persistent lymphedema (e.g. post radical mastectomy).

102
Q

What is Kaposi sarcoma?

A

Endothelial malignancy most commonly of the skin, but also mouth, GI tract, and respiratory tract. Associated with HHV-8 and HIV. Frequently mistaken for bacillary angiomatosis.

notes: purple patches, plaques, nodules on skin/visceral organs.

USLME Step 1 (7 decks)

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