Week 4 Flashcards
Which of the following is not associated with squamous cell carcinoma of esophagus?
A. Tobacco
B. Alcohol
C. Achalasia
D. HPV infection
E. Barrett’s esophagus
Answer: E. Barrett’s esophagus is intestinal metaplasia where there is change in normal squamous histology to more columnar appearing cells which is seen in the intestine. Barrett’s is associated with increased incidence of esophageal adenocarcinoma, but not esophageal squamous cell carcinoma.
A, B, C, and D are all associated with squamous esophageal cancer. Tobacco and Alcohol increases risk of Squamous cell Cancer by up to 20x
SM 274b GI Cancer (Kalyan)
Learning Objective: 3. identify risk factors of esophageal, pancreatic, Liver Cancer
Which of the following diseases is best matched with a treatment? Consider what the correct treatment would be for the mismatched pairs.
- Chronic myeloid leukemia – hydroxyurea
- Polycythemia vera – imatinib
- Essential thrombocytosis – phlebotomy
- Multiple myeloma – rituximab
- Chronic lymphocytic leukemia – daratumumab
- Non Hodgkin’s B cell lymphoma – aspirin
- Myelofibrosis – CAR T cell
- Melanoma - nivolumab
Correct answer: 8. Melanoma – nivolumab/anti-PD1
Potential treatment disease pairings (other pairings are also possible)
- Chronic myeloid leukemia – imatinib, Bcr-Abl tyrosine kinase inhibitor
- Polycythemia vera – aspirin, phlebotomy, hydroxyurea, ruxolitinib
- Essential thrombocytosis – aspirin, if thrombosis risk is high; hydroxyurea
- Multiple myeloma – daratumumab, anti-CD38 Ab specific for plasma cells
- Chronic lymphocytic leukemia – ibrutinib, fludarabine
- Non Hodgkin’s B cell lymphoma – rituximab, anti-CD20; CAR T cell therapy
- Myelofibrosis – hydroxyurea, ruxolitinib
- Melanoma - nivolumab/anti-PD1
SM 275b Tumor Immunology (Chandra)
Learning Objective 3. Describe the approaches used in cancer immunotherapy (blockade of CTLA-4 and PD-1,etc)
A 15-month-old girl presents with a large abdominal mass, weight loss, and fever. At surgery, a large infiltrative tumor with areas of hemorrhage and necrosis is removed. A photomicrograph of a section from this tumor is shown in figure below. Which of the following is the most likely diagnosis?
(A) embryonal rhabdomyosarcoma
(B) malignant lymphoma
(C) neuroblastoma
(D) teratoma
(E) Wilms’ tumor
Answer:
(C) This is a neuroblastoma and is one of a group of childhood tumors described as “small, round, blue-cell tumors,” consisting as they do of monotonous small cells with dense, blue nuclei. The characteristic microscopic feature of a neuroblastoma is the pseudorosette, a ring of primitive neuroblasts surrounding a central space filled with fibrillar extensions from the cells. Many of these can be seen in the figure. These are called pseudorosettes because they do not have a central lumen as is found, for example, in the rosettes in retinoblastoma.
Embryonal rhabdomyosarcoma (choice A) is a type of rhabdomyosarcoma typically found in children under the age of 10. It can arise in a number of locations and sarcoma botryoides is one form. It does not form rosettes. Malignant lymphomas (choice B) and leukemias are together the most common malignancies of childhood in the United States, but rosette formation is not a distinctive microscopic feature. Teratomas (choice D) in infants and young children are usually benign tumors found in the midline (e.g., sacrococcygeal, mediastinal). They are composed of tissues with a normal histologic appearance derived from all three germ layers. Wilms’ tumor (choice E) or nephroblastoma is derived from primitive blastema cells and sometimes displays aborted attempts to form glomeruli or renal tubules, but not rosettes.
SM 276b Pediatric Cancer (Elizabeth Sokol)
Learning Objective 2. Understand how pediatric cancers differ from adult malignancies in both prognosis and distribution by histology and tumor site
Lange USMLE Q&A
A 66-year-old woman presents to her neurologist with a 4-week history of increasing right leg weakness. An MRI with contrast medium reveals an irregular left cerebral mass with
cystic areas and surrounding tissue edema. A stereotactic biopsy is performed and sections
demonstrate a neoplasm with increased cellularity, nuclear pleomorphism, vascular proliferation, and areas of necrosis surrounded by dense rims of pleomorphic cells. Based on this clinical and morphological information, which of the following is the most likely diagnosis?
(A) ependymoma
(B) glioblastoma multiforme
(C) metastatic sarcoma
(D) oligodendroglioma
(E) pilocytic astrocytoma
(F) primary lymphoma
(B) Astrocytomas are the most common primary intracranial neoplasms and the majority of these tumors arising in adults are high grade, supratentorial and, as suggested by the MRI,
lack a clear margin of separation from the normal surrounding tissue. The microscopic
features of vascular proliferation and necrosis classify this particular patient’s tumor as a
grade 4 astrocytoma or glioblastoma multiforme. A rapid clinical onset is typical for these tumors.
In adults, ependymomas (choice A) are more usually located in the spinal cord. Their microscopic appearance is somewhat variable but they often form pseudorosettes. Metastatic sarcoma (choice C) in the brain is unusual and its microscopic appearance would most likely be a spindle cell tumor. Oligodendrogliomas (choice D) usually have a prolonged clinical onset and microscopically are composed of sheets of cells with a “fried egg” appearance. Calcification and a capillary network commonly accompany these tumors. Pilocytic strocytomas (choice E) are usually seen in children and young adults. Their usual location is cerebellar but they may be found in the cerebrum on occasion. Microscopically they demonstrate many hair-like glial processes. Primary lymphomas (choice F) are seen more typically in immunosuppressed individuals and are usually of B-cell origin; the general histology that characterizes lymphomas is not consistent with the description given in this case.
SM 277b CNS cancers (Kumthekar)
Learning Objective Describe the types and grading of primary CNS malignancies, with prognosis
Lange USMLE Q&A
You develop a screening test for glioblastoma which detects the cancer before symptoms begin. You decide to run a clinical trial to see how this screening test will affect GBM mortality. How would lead time and length time bias affect your trial given the nature of most glioblastoma cases?
Lead time bias refers to the overestimation of survival due to earlier detection, but otherwise unchanged disease course. Given that there are no great treatments for GBM, screening for GBM may not necessarily change the length of survival, unless those treatments are significantly more effective in earlier stages of the disease.
Length time bias refers to the overestimation of survival due to detection of more slowly progressing cases. Most malignant GBM cases tend to progress quickly, therefore cases that are found through screening may not be as malignant.
Lead-time bias is due to early detection. Remember the “d” in lead is for early detection. Length-time bias is due to slow cases being detected more often simply because they are slowly progressing. Remember the “g” in length is for slowly progressing.
SM 278b Cancer Screening (N. Dolan)
Learning objective 4. Define biases specific to studies of effectiveness of screening programs.
Select all of the ways in which radiation induces cell death:
A. Induction of double stranded breaks in the DNA
B. Induction of single stranded breaks in the DNA
C. Direct damage of DNA by the photon
D. Generation of free radicals by the photon to lead to DNA damage
E. DNA damage during M phase
F. DNA damage during G2 phase
G. DNA damage during S phase
Answer:
A, C, D, E, F are all ways which radiation induces cell death
A. Induction of double stranded breaks in the DNA – Double stranded breaks are difficult to repair accurately
B. Induction of single stranded breaks in the DNA – Single stranded breaks can be repaired accurately and therefore do usually not lead to cell death
C. Direct damage of DNA by the photon – 1/3 of radiation damage occurs through direct damage
D. Generation of free radicals by the photon to lead to DNA damage – 2/3 of radiation damage occurs through indirect damage
E. DNA damage during M phase – cells are more sensitive to radiation damage
F. DNA damage during G2 phase – cells are more sensitive to radiation damage
G. DNA damage during S phase – cells are least sensitive to radiation damage
SM 279b Radiation Oncology (Sachdev)
Learning Objective Describe the basics of radiation biology – the mechanism of radiation induced cell kill. (MKS 1b)
Which of the following agents used in combination therapy for HL has pulmonary fibrosis as its most serious toxicity? What are the toxicities of the other drugs?
(A) bleomycin
(B) cisplatin
(C) doxorubicin
(D) mechlorethamine
(E) vincristine
Answer: A
A. Bleomycin is an antibiotic chemotherapeutic agent that produces single- and doublestrand breaks. It is useful in combination therapy for Hodgkin disease because it produces little myelosuppression, but it does produce serious toxicity involving the lung, including life-threatening pulmonary fibrosis. PFTs from patients who have been treated with Bleomycin will show a restrictive pattern if pulmonary fibrosis is present
B. Cisplatin (choice B) is used alone and in combination to treat a wide variety of carcinomas. Toxicity from this includes: renal toxicity and ototoxicity
C. Doxorubicin (choice C) is another natural product used in Hodgkin disease that acts by DNA intercalation. The primary toxicity of doxorubicin is cumulative cardiac damage, so that lifetime dosage of the drug must be limited. All patients receiving treatment with this drug should have an echocardiogram performed prior to starting.
D. Mechlorethamine (choice D) is a nitrogen mustard compound used in Hodgkin disease that alkylates DNA, especially at the N7 position of guanine. Its primary toxicity is myelosuppression.
E. Vincristine (choice E) is a natural product derived from the vinca plant and acts by interfering with microtubule assembly. It is useful in HL. Its primary toxicity is peripheral neuropathy, manifested as numbness, tingling, and pain. A very similar vinca alkaloid, vinblastine, has the same mechanism of action, but causes myelosuppression rather than neuropathies
SM 280b Cancer Survivorship (Kircher)
Learning Objective: List 5 potential organ systems that can be impacted by a late effect of cancer treatment (MKS1a)
Lange USMLE Q&A
