Path: Clinical Aspects of Neoplasia

Question 1

What are the 3 most common symptoms of of lung cancer, starting from most common?

Answer 1

cough, hemoptysis (blood in cough), dyspnea

Question 2

Do most pts with prostate cancer present with symptoms upon diagnosis?

Answer 2

No

Question 3

How is prostate cancer Dx’d if no symptoms usually present?

Answer 3

screening for PSA (normal <4) or rectal exam

Question 4

T/F: 55% of women with breast cancer have no symptoms at the time of Dx. How do we Dx it if no symptoms?

Answer 4

True; mammography (that’s why mammography is important)

Question 5

T/F: risk for breast cancer increases with age

Answer 5

True

Question 6

T/F: risk for breast cancer increases with later onset of menarche

Answer 6

False, increases with early menarche (more exposure to estrogen?)

Question 7

T/F: risk for breast cancer increases with later menopause.

Answer 7

True (more exposure to estrogen?)

Question 8

At what age begins a risk factor for colon cancer?

Answer 8

60

Question 9

What are the 3 most common symptoms of colon cancer?

Answer 9

Abdominal pain (44%)
Changes in bowel habits: diarrhea, constipation (43%) hematochezia, melena (40%)

Question 10

T/F: many colon cancer pts are asymptomatic at the time of Dx by screening colonoscopy.

Answer 10

True

Question 11

What does the prognosis of colon cancer depend on?

Answer 11

Stage (goes from 74% 5-yr survival Stage I to 6% 5-yr survival for stage IV)

Question 12

T/F: a substantial body of evidence supports a protective effect of aspirin and other NSAIDs on the development of colonic adenomas and cancer.

Answer 12

True

Question 13

List 4 risk factors for colon cancer.

Answer 13

hereditary forms of colon cancer, age, family/personal history, inflammatory bowel disease

Question 14

What foods should one stay away from and what foods are good when attempting a diet protective of colon cancer.

Answer 14

avoid: processed and charred red meat, EtOH, high calorie diet
good: veggies, wheat bran (unprocessed), folate

Question 15

What is a paraneoplastic syndrome?

Answer 15

symptoms not attributable to direct effects of tumor (or hormones native to the primary tumor organ)
Occur in about 10% of cancer pts
-cachexia does not count

Question 16

What is the type of cancer most likely to cause a para-neoplastic syndrome and why?

Answer 16

small cell carcinoma because it is a neuroendocrine tumor

Question 17

What are the 3 most common paraneoplastic syndromes?

Answer 17

Hypercalcemia, Cushing syndrome (moon-face–ACTH), Carcinoid syndrome (flushing & diarrhea–Serotonin)

Question 18

What are the symptoms of hypercalcemia of malignancy and why are they happening?
Also, how do you treat it?

Answer 18

nausea, vomiting, constipation, polyuria, disorientation, lethargy, seizures
Mech: parathyroid hormone-related protein (PTRHP), etc.
Tx: hydration, bisphosphonates (prevent osteopenia)

Question 19

What is the most common lung cancer type to cause hypercalcemia?

Answer 19

squamous cell carcinoma

Question 20

What are the signs & symptoms of Cushing syndrome?

Answer 20

weight gain, central obesity, moon face, weakness, hirsutism, hypertension, glucose intolerance, depression, etc…but also buffalo hump fat deposition, bc don’t you dare forget that shit, it’s hilarious.

Question 21

What is the most common source of ACTH causing Cushing syndrome?

Answer 21

pituitary adenoma

Question 22

What are the symptoms of carcinoid syndrome?

Answer 22

attacks of cutaneous flushing, diarrhea, cramps, nausea, vomiting, cough, etc…

Question 23

List the 5 main direct effects of tumors.

Answer 23

1- impingement on adjacent structures
2- obstruction (e.g. of intestine)
3- functional activity (e.g. hormones)
4- surface ulceration (+/- bleeding, infection)
5- infarction +/- rupture

Question 24

What are the two steps in Dx of cancer?

Answer 24

1- discovery (S&S, screening)
2- specific Dx (biopsy [most common, usually best], fine needle aspiration cytology, exfoliative cytology)
+/- immunohistochemistry, flow cytometry, molecular testing

Question 25

What is a Dx method that can reveal the presence of individual tumor cells in a biopsy (under microscope) when they may be hard to identify otherwise?

Answer 25

immunostaining

Question 26

Remind me, what is anaplasia?

Answer 26

condition whereby cells lose the morphological characteristics of mature cells and their orientation with respect to each other and to endothelial cells.
Features: larger than differentiated cells, higher nuclear/cytoplasmic ratio [bigger nuclei, less cytoplasm] pleomorphic (varying in shape and size)
Nuclear abnormalities: angulated shape, hyperchromatism, clumped chromatin, mitoses, nucleoli

Question 27

How do you determine tumor stage, again?

Answer 27

Anatomic extent of tumor, including tumor primary size, extent of lymph node and distant metastases.

Question 28

What is the tumor grade?

Answer 28

A qualitative assessment of the differentiation of a tumor (extent to which it resembles normal tissue at primary site)