patho xam 5 - cancer

Question 1

Which cancers are usually caught in late stages because they are hard to screen for?

Answer 1

Ovarian - early s/s are easy to dismiss
Pancreatic

Question 2

What is the difference between a carcinoma and a sarcoma?

Answer 2

carcinoma - epithelial
bladder, pancreatic - adenocarcinoma, lung

Sarcoma - connective tissue

just oma - benign; sarcoma or carcinoma - malignant

Question 3

pre-invasive lesion, does not cross the basement membrane

Answer 3

carcinoma in situ, cancer in situ

Question 4

Which types of cancers are disseminated from the beginning?

Answer 4

hematological

vs “solid tumors”

Question 5

poorly differentiated, do not resemble cells of nearby tissue or origin

Answer 5

malignant

Question 6

grows by expansion

Answer 6

benign

VS. malignant - secretes VEGF to support angiogenesis

Question 7

eg. Cushing’s syndrome in lung cancer

Answer 7

paraneoplastic syndrome

Question 8

7 warning signals of cancer

Answer 8

1. change in bowel or urinary habits
2. sore that doesn’t heal
3. unusual bleeding or discharge
4. thickening/lump
5. indigestion or dysphagia
6. obvious change in wart or mole
7. nagging cough or hoarseness

Question 9

What markers are used for lung, breast and ovarian, and which is specific to breast?

Answer 9

CA125, CEA

breast -HER2

Question 10

breast cancer which is characterized by overexpression of estrogen and progesterone receptors?

Answer 10

ER+ (estrogen receptor positive)

Question 11

Staging or grading? differentiation

Answer 11

Grading - I (well-differentiated), II, III (poorly differentiated)

Question 12

Staging or Grading? TNM system

Answer 12

Staging
T- size
N- lymph node involvement
M - metastasis

Question 13

BRCA1 and BRCA2 genes

Answer 13

autosomal dominant - defective tumor suppressor genes

related to ovarian and breast

Question 14

Clinical manifestations of breast cancer?

Answer 14

non-tender, firm, irregular borders, adhered to chest wall or skin
upper, outer quadrant, nipple discharge, unilateral swelling, skin/nipple retraction, peau d’orange

Question 15

why is the breast self-exam less relevant, but still necessary?

Answer 15

50% of palpable tumors have already metastasized. 90% of palpable breast masses are non-cancerous

Question 16

for which cancer is pleural effusion (SOB) and venous thrombosis an acute symptom?

Answer 16

Ovarian - type and severity of sx does not reliably correspond to disease state
risk factors: endometrosis, asbestos exposure early menarche, late meno, BRCA/1st degree relative, nulligravity

rare to have paraneoplastic syndromes

Question 17

for which cancers is diet a bigger concern?

Answer 17

prostate and colorectal

Question 18

word for loss of body fat/anorexia and weight loss associated with cancer

Answer 18

cachexia

Question 19

Rank by order associated with smoking

Answer 19

small cell carcinoma > adenocarcinoma

Question 20

Differentiate between non small cell carcinomas

Answer 20

squamous cell - detect in sputum, slow growing, hypercalcemia
large cell - any part of lung, poorly differentiated, faster spreading/early malignancy
adenocarcinoma - most common nsclc, least associated with smoking, more common in women, usually large at dx

Question 21

prognosis for SCLC

Answer 21

10% live 2 years post dx
metastasizes early through blood, arises out of bronchus, small oval cells

Question 22

SIADH, hypercalcemia, anemia

Answer 22

paraneoplastic complications common with lung cancer

Question 23

elevated bilirubin/liver, pain, jaundice

Answer 23

pancreatic cancer

Question 24

differential risk for african american pop’n

Answer 24

bladder cancer - half the risk vs white
prostate - highest risk of developing/dying from

Question 25

5 year survival for prostate cancer

Answer 25

98%
PSA - good diagnostic combo with digital rectal exam
asymptomatic in early stages, similar symptoms as BPH, large inguinal lymph nodes

Question 26

T0 or Tx or Tis

Answer 26

T0 - no evidence of primary tumor, tx - tumor cannot be assessed
Tis- carcinoma in situ

Question 27

M1

Answer 27

distant metastasis present

Question 28

For which cancer is diabetes a risk factor, and obstructive bowel issues a clinical manifestation?

Answer 28

colorectal

diabetes also risk factor for pancreatic cancer, as is male gender

Question 29

which cancers (exclusive of genital cancers) are more common in men than women?

which cancers (exclusive of genital cancers) are more common in women than men?

Answer 29

men - bladder/urinary, pancreatic

women - adenocarcinoma

other:
lung - leading cause of cancer-related death
pancreatic - 4th leading cause of death, despite10th/8th(women) prevalence

Question 30

Which is more prevalent, small cell or non-small cell carcinoma?

Answer 30

non-small cell carcinoma - 80% of lung cancers

cigarette smoke r/t 90% of lung cancers