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29 Cards in this Set
- Front
- Back
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apoptosis
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programmed cell death
a defect in a cells knowing when to die causes imbalance in favor of proliferation adn presumably cancer |
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defect in apoptosis
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follicular low grade non-Hodgkin's lymphoma
translocation between chromosomes 14:18 results in juxtaposition of bc1-2 gene to Ig heavy chain gene over expression of be 1-2 causes failure of apoptosis and immortality of cells. future therapies will be directed at "reminding" the cell to die |
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p-53
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the molecular policeman
implicated for more than 50% of human cancers p53 protein is thought to regulate cell proliferation located on chromosome 17 Dna damage results in increased expression of p53 |
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increased p53
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causes a pause in the cell cycle between G1/S that is required for repair of DNA damage before DNA replication and cell division. Under normal circumstances, overwhelming DNA damage or unrepairable DNA damage leads to apoptosis, probably mediated by p53
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Le- Fraumeni syndrome
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germ line mutation or loss of p53
50% of pts develop invasive cancer by age 30 rhabdomyosarcoma, breast, brain, soft tissue, osteosarcoma, leukemia, adrenocoortical carcinoma |
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Lung cancer
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75-80 % are non small cell lung cancer and 20-25 % are small cell
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histology and associations of lung cancer
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squamous cell cancer cavitates and tends to be central
SCC is associated with humeral hypercalcemia secondary to release of PTH like products |
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adenocarcinoma
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tends to be peripheral "coin lesions" and may be associated with clubbing, hypertrophic pulmonary osteoarthropathy
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small cell cancer
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tends to be central and and is often associated with a variety of paraneoplastic symptoms especially hyponatremia, cushings,
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variety of paraneoplastic symptoms
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caused by impaired release of acetylcholine from nerve terminals and clincally manifested by weakness and fatigability of proximal msucles
diagonostic EMG shows increasing amplitude of action potential with high frequency stimulation- hypercalcemia is rare |
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tx of lung cancer
non small cell |
surgically
PET scans superior for medistinal spread and distant metiastinal |
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what is not best done on a PET scan?
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brain
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when is a CT scan used diagnostically with non-small cell cancer
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localized abnormal hot spots
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+ PET scan
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requires confirmation with medistinal exploration
false + occu from inflammation |
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- PET scan in the mediastinum
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proceed to surgery
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unresectable and metastic disease (lung cancer)
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chemotherapy
carboplatin and taxol is most common others are = effective (8mo survival) but may be more toxic |
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tx small cell lung cancer
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limited disease to one hemithorax that can be encompassed within one radiation field (includes patients with mediastinal and hilar nodes)
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extensive disease
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outside one radiation field
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gold standard of small cell cancer tx
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combination of irinotecan (CPT11 and cisplatin + etopsode
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colorectal cancer
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90 % occus in pts ocer 50
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90 % of colon cancer
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spradic colon cancer
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risk factors for colon cancer
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+ family history
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colon cancer screening
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need to detect polyps
fecal occult blood test (anually) flexible sigmoidoscopy q 5yrs colonscopy q 10 yrs barium enema q 5 yrs |
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progression of colon cancer
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adenomatous polyp
evolves into a carcinoma (10-12years) |
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+ guaiac test
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most common neoplastic lesion that is found is the adenomatous polyp
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tumor suppressor gene
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5q
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extraclonic manifestations of colon cancer
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mandibular osteomas
polyps in distal stomach small bowel and congenital hypertrophy of the retinal pigment epithelium gardner's syndrome |
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other hereditary colon cancers not assoc. with extensive polyposis
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hereditary non-polyposis colon cancer = lynch syndrme
characterized by adenomatous polyps in proximal colon with high incidences of malignant degeneration at least 5 different DNA repair genes have been incriminated for HNPCC |
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HNPCC
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occurs in the proximal colon
pt @ higher risk for enometrium, stomach, small intestine, brain, hepatoilary system, urinary tract, and ovary |
