Neuroplasia part II

Question 1

Both benign and malignant tumors can cause problems due to?

Answer 1

o Location* and effect on adjacent structures
o Functional activity such as hormone production*
o Bleeding and infection
o Symptoms from tumor rupture or infection
o Cachexia*

Question 2

Intracranial tumors, such as pituitary adenoma can?

Answer 2

expand and destroy the remaining pituitary gland

Question 3

GI tract tumors may cause ?

Answer 3

obstruction of the bowl or ulcerate

Question 4

Hormone production may cause what type of paraneoplastic syndromes ?

Answer 4

o May cause paraneoplastic syndromes such as hypoglycemia (increased insulin production) or hypercalcemia (PTH-producing tumors—- fake PTH proteins)

Question 5

What is cancer cachexia ?

Answer 5

o A multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass (with or without the loss of fat mass) that cannot be fully reversed by conventional nutritional support and causes a progressive functional weakening

Question 6

Pathophysiology of Cancer Cachexia and Targets for Therapy?

Answer 6

• Basometabolic Rate: The minimum amount of energy that you need to function while you are resting

o Cytokines, inflammation and hypermetabolic state
 ↑BMR → Energy deficit→ muscle wasting (you need more energy to break down things)

o Lipolysis and lipid mobilizing factor
 Tumor cells releasing those lipid mobilizing factors that synthesizes adipose tissue to be lysed

o Genetics
 Genes that contribute to weight loss

o Cancer treatment contribution
 Withdrawing androgen therapy in patients with prostate cancer so the tumor isn’t being fed – these patients go through muscle wasting

o Reduced dietary intake/absorption
 When you are depressed in pain you will eat less

Question 7

Paraneoplastic syndromes are defined as ?

Answer 7

o They are tumor associated syndromes where the symptoms are not directly related to the spread of tumor
o They may be the earliest clinical manifestations of a neoplasm and can mimic distant spread

Question 8

Paraneoplastic syndrome: Hypercalcemia

• Mechanism ?
• Example ?

Answer 8

• Mechanism (PTH-like substance)

- Example Lung (squamous cell) carcinoma

Question 9

Paraneoplastic syndrome: Hypocalcemia

• Mechanism ?
• Example ?

Answer 9

-Mechanism: Insulin-like substance

• Example: Various carcinomas and sarcomas
  o IGF-2 -its doing its affect in a global way its insulin-independent

Question 10

Mechanisms of Paraneoplastic Hypercalcemia?

Answer 10

• 80% of the time- Tumor secretion of parathyroid hormone-related protein (PTHrP)
• 20% of the time- Osteolytic metastases with local release of cytokines (including osteoclast activating factors)
• Tumor production of calcitriol (independent of the PTH because tumor is producing it)

Question 11

Paraneoplastic Neurologic Syndromes is defined as ?

Answer 11

o A heterogeneous group of disorders caused by mechanisms other than metastases, metabolic and nutritional deficits, infections, coagulopathy, or side effects of cancer treatment

Question 12

Pathogenesis of Paraneoplastic neurologic syndromes?

Answer 12

o Antibodies directed against intracellular neuronal:
 Examples: Hu(aka type 1 anti neuronal nuclear antibody [ANNA-1]. Ri (aka type 2 anti-neuronal nuclear antibody [ANNA-2]

o Antibodies directed against neuronal cell surface or synaptic proteins
 Ex: antibodies against the (NMDA)

Question 13

Grading of tumors is based on?

Generally higher-grade tumors are?

Answer 13

o Based on the degree of differentiation

o Generally, higher-grade tumors are more aggressive than lower-grade tumors

Question 14

Staging is based on ?

It uses what type of system to do the staging?

Answer 14

o Based on the size of the primary tumor and the extent of local and distant spread
o Uses a TNM system

Question 15

Cytologic (Pap) smears:

Involve?

Test for?

Answer 15

• Cytologic (Pap) smears:
o Involve examination of exfoliated cells
o Cancer of uterine cervix
o Cancer of endometrium

Question 16

Histologic Examination

Answer 16

o Most important method of diagnosis (tissue biopsy)
 GOLD STANDARD
o When possible, cytologic diagnosis must be confirmed by biopsy

Question 17

Flow cytometry:

Measures?

Tests for?

Answer 17

o Measures the presence of membrane antigens or DNA content of tumor cells
 Leukemia
 Lymphoma

Question 18

Fine-Needle Aspiration (FNA):

involves ?

Answer 18

o Involves aspiration of cells and fluids from tumor or masses
 Breast
 Thyroid
 Lymph nodes

Question 19

Immunohistochemistry

Detects?

Used for?

Answer 19

Immunohistochemistry detects cell products or surface markers using specific antibodies, its used for:
o Diagnosis of undifferentiated tumors
o Determination of site of origin of metastases
o Detection of molecules with prognostic or therapeutic significance

Question 20

Circulation Tumor Cells (CTC’s) are defined as ?

Answer 20

• Definition:
o A subpopulation of tumor cells originated from the primary cancer
o Have the potential to disseminate and proliferate as metastatic lesion
o Cancer cells that shed into blood stream are a predictive biomarker, associated with metastasis

Question 21

Clinical Applications of CTC’s ?

Answer 21

• To study tumor evolution and tumor genetic heterogeneity(the quality or state of being diverse in character or content.)
o Individual tumor cells can be isolated with a variety of techniques
o Furthermore, CTC’s can be isolated from peripheral blood
o After isolation, single cells are lysed, and their DNA or RNA is amplified