Quiz 3 Flashcards
What are the four general steps of tumor progression?
What is the common initial site of spread for a carcinoma?
regional lymphatics, to the regional lymph nodes
Hematogenous spread is more characteristic of what type of cancer?
sarcomas (some carcinomas also)
Which 4 carcinomas prefer hematogenous spread?
What type of metastisis is characteristic of ovarian carcinoma?
seeding of the body cavities “omental caking”
What is required for a dx of cancer?
biopsy or excision
Do benign or malignant tumors have a low nuclear to cytoplasmic ratio?
benign tumors
Do benign tumors ever metastasize?
Benign tumors never metastasize
What test is preferred to characterize malignant tumors that are difficult to classify on histology?
Immunohistochemistry
What are serum tumor markers?
Proteins released by tumors
What are three uses of measuring serum tumor markers?
-Screening (still requires tissue biopsy/excision for dx
-Monitoring reponse to treatment
-Monitoring recurrence
What is staging of cancer based on?
Size and spread
What is the key prognostic factor of cancer?
staging (NOT grade)
What does the TNM staging acronym stand for?
T- tumor size or DOI
N- spread to regional lympoh nodes (2nd most important)
M- metastasis (most important)
Define neoplasia:
uncontrolled autonomous growth of cells
Define anaplasia:
loss of differentiation
Define pleomorphism:
cells that look different from each other
What is the most common primary bone tumor?
Osteosarcoma
What is the most common soft tissue sarcoma in children?
Rhabdomyosarcoma
What are the two major groups of lung cancer?
Small cell (SCLC)
Non-small cell (NSCLC)
What is the difference between a neoplasm and a tumor?
a neoplasm is a new growth, and a tumor is a mass
What are the two histological components of a tumor?
parenchyma (malignant cells) and stroma (CT between cells)
How is a carcinoma defined?
A cancer arising from epithelial tissue
How is a sarcoma defined?
A cancer arising from solid tissue
How is a leukemia/lymphoma defined?
A cancer arising from the blood
What is the difference between liposarcoma and lipoma?
Liposarcoma- maligant tumor of fat
Lipoma- benign tumor of fat
What is melanoma?
A malignant tumor of melanocytes
What is a seminoma?
A tumor of germ cells (in testis)
What are the three most important carcinogens?
Chemicals, oncogenic viruses, and radiation
What is HTLV-1? With what kind of cancer is it associated?
It is a retrovirus endemic to Japan, the Caribbean, Africa, and South America
It causes adult T-cell leukemia/lymphoma
What pathologies are caused by HPV? What is its basic MoA?
Benign warts, cervical cancer, and oropharyngeal cancer
Viral oncoproteins E6 and E7 bind to p53 and Rb and neutralize their function
What what general areas is EBV implicated in respect to cancer?
EBV is a ubiquitous herpes virus implicated in develop of Burkitt lymphomas, B-cell lymphomas in patients with T-cell immunosuppression, and several other cancers
What two viruses are responsible for 70 to 85% of hepatocellular carcinomas worldwide?
HBV and HCV
What is being shown in this tumor sample?
a Homer-Wright rosette
What translocation is associated with 90% of Ewing sarcomas?
t(11;22) FLI1-EWSR1
What type of neuroblastic tumor is visible here? What histological features are notable?
a neuroblastoma
neuropil
small primitive cells
What type of neuroblastic tumor is visible here? What histological features are notable?
a ganglioneuroblastoma
neuropil
small primitive cells
schwannian stroma
maturing ganglion cells
What type of neuroblastic tumor is visible here? What histological features are notable?
a ganglioneuroma
ganglion cells
schwannian stroma
What are the key risk factors of lung cancer?
cigarette smoke, radon, and asbestos
What are the two most common benign lesions that can explain a solitary nodule in the lungs?
granuloma
bronchial hamartoma (lung tissue + cartilage)
What percent of lung carcinomas are non-small cell?
85%
Why is the percentage of small-cell vs. non-small cell lung carcinomas significant?
small-cell: poor response to surgery, good response to chemotherapy
non-small cell: good response to surgery; poor response to chemotherapy
What are the two most common types of non-small cell lung carcinoma?
Adenocarcinoma (40%)
Squamous cell carcinoma (30%)
What two factors define squamous cell carcinoma of the lungs?
keratin pearls
intercellular bridges
What type of neoplasm is especially associated with occupational exposure to asbestos?
mesothelioma
What is the only modaility recommended in high risk colon cancer patients (family history of CRC)?
Sigmoidoscopy/colonoscopy
For what groups would an autologous HCT be indicated?
several solid cancers
HL/NHL
For what groups would an allogeneic HCT be indicated?
several leukemias, as well as myeloproliferative neoplasms
What is an example of a go-to drug to treat CRS (cytokine release syndrome) as an effect of CAR T therapy?
Tocilizumab
A cancer involving high PD-L1 expression with no driver mutation would merit what first line treatment? (not chemotherapy)
Immunotherapy
EGFR mutations are more commonly seen in what three demographics?
women
Asian ancestry
non-smokers
What is the first line treatment for a stage IV NSCLC with an activating EGFR mutation?
EGFR inhibitors
What are the 5 stages of metastases?
- Invasion- MMPs play important role
2.Intravasation - Circulation
- Extravasation
- Colonization- rate-limiting step
What type of paraneoplastic syndrome is most commonly caused by a carcinoid?
carincoid syndrome (caused by secretion of serotonin, histamine, kallikrein, prostaglandins)
What type of paraneoplastic syndrome is most commonly caused by small cell carcinoma?
cushing syndrome (caused by secretion of ACTH)
What type of paraneoplastic syndrome is most commonly caused by squamous cell carcinoma?
Hypercalcemia (caused by secretion of PTHRP)
What testing would be done in a suspected case of HNPCC or Lynch syndrome?
IHC and microsatellite instability (MSI on PCR)
Where do hyperplastic polyps most commonly present?
the left colon
Where do juvenile polyps most commonly present?
the rectum
What type of cancer is the second most common in both men and women?
lung cancer
What is the most common type of cancer in men?
prostate cancer
What is the most common type of cancer in women?
breast cancer
What type of cancer is the leading cause of cancer deaths in men and women?
lung cancer
What is the 5 year survival for a lung cancer diagnosed with distant metastases?
4.7%
What are the two possible stages of Small cell lung cancer?
Limited- tumor is confined to ipsilateral hemithorax and regional nodes.
Extensive- tumor beyond the boundaries of limited disease
What complications from lung cancer are indicatd by the acronym SPHERE?
S- SVC syndrome
P- Pancoast Tumor
H- Horner’s syndrome (PAM)
E- Endocrine abnormalities
R- Recurrent laryngeal nerve dysfunciton
E- effusions
What type of polyp matches this etiology? What is most significant?
Hyperplastic polyp;
serrated crypts (part-way)
commonly in left colon
No malignant potential
What type of polyp matches this etiology? What is most significant?
Juvenile polyp;
generally harmless
bleeding from protrusion through anal sphinctre
with dysplasia poses cancer risk
What type of polyp best matches this etiology?
Hamartamous polyp
What is the cancer risk in a carcinoma of 2cm or greater?
5-15%
What is the cancer risk of a pedunculated polyp? a sessile polyp?
P: 1-15%
S: 5-50%
What is the cancer risk of a tubular polyp? A villous polyp?
T: 1-15%
V: 5-50%
What is the cancer risk of a polyp with high-grade dysplasia?
5-50%
What type of APC mutations are most common?
Nonsense (truncating mutations)
What are microsatellites?
repeating sequences of noncoding DNA
Why is microsatellite instability important to recognize?
instability in microsatellites indicates ineffective DNA copy mechanisms, i.e. defective MMR enzyme
What disease matches this etiology?
Familial adenomatous polyposis
What treatment is typical for a dx of FAP?
What disease matches this etiology?
Hereditary nonpolyposis colorectal carcinoma (Lynch syndrome)
What disease matches this etiology?
HNPCC/Lynch syndrome
What disase matches these descriptors?
Colorectal cancer
What disase matches this etiology?
Colorectal cancer
What are the preferred methods of screening for colorectal cancer?
What are the treatments for colorectal cancer at stages I-IV?
In what demographics is prostate cancer most common? What is the largest risk factor?
Is a high PSA always indicated of prostate cancer? What level is worrisome?
What two approaches are most common for tx of low risk prostate cancer?
What is an ideal treatment for localized prostate cancer of medium/high risk?
What options are available for tx of advanced prostate cancer?
Using the colon crypt as an example, what key molecules are needed for stem cell maintenance?
Wnt and B-catenin
Using the colon crypt as an example, what key molecules are needed for the proliferation of amplifying cells?
Ephrin
Using the colon crypt as an example, what key molecules are needed for the differentiation of crypt cells?
TGF-B, Hh, BMP, and others
What type of tumors tend to favor lymphatic spread?
carcinomas
What type of tumors favor hematogenous spread?
sarcomas
What treatments are favored for CRS (cytokine release syndrome) induced by CAR T cell therapy?
Tocilizumab
dexamethasone/methylprednisone
What type of lung cancer may be indicated by the following histology slide?
Small-cell lung cancer
What type of lung cancer may be indicated by the following histology slide?
carcinoid
What type of lung cancer may be indicated by the following histology slide?
Adenocarcinoma of the lung
What type of lung cancer may be indicated by the following histology slide?
Squamous cell carcinoma of the lung
What is the standard of treatment for local (stage 1 or II) NSCLC?
surgery, possibly with adjuvant chemotherapy or IT
What is the standard of treatment for a regional NSCLC (stage III)?
chemotherapy and radiation therapy
What is the standard of treatment for distant NSCLC (stage IV)
Multiple lines of chemo and radiation therapy depending on tumor type
What drug family is the standard chemotherapy for lung cancers?
platinum-based drugs
What testing could be done in suspected cases of Lynch syndrome or HNPCC?
IHC and microsatellite instability (PCR)
MSH2 and MLH1 mutations are involved in mutations in what process?
mismatch repair (MMR)
What clinical triad might suggest an inflammatory polyp?
rectal bleeding, mucus discharge, and an inflammatory lesion of anterior rectal wall
