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167 Cards in this Set
- Front
- Back
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MC sites for primary adenocarcinoma-
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esophagus
endometrium lung kidney |
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TP53 functions
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inhibits cyclin D kinase and activates BAX apoptosis gene
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what does BAX do
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inhibits BCL2 acitivity as an antiapoptosis gene
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RB gene prevents what
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cell from entering the S phase
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primary cancer more common that mets in what two sites
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colon adenocarcinoma
cervix-squamous cell CA |
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mets to the brain from-
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primary lung cancer
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mets to bone from
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primary breast cancer
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mets to lung from
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primary breast cancer
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mets to liver from
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primary lung cancer, also from colon in a non smoker
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second most common cancer and cancer killer in adults
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colorectal cancer
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MC cancer killer in adults
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lung cancer
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Cushing's and hyponatremia
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small cell of lung
ACTH, ADH |
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Cushing's and hypocalcemai
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medullary carcinoma of thyroid
ACTH, calcitonin |
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hypercalcemia and secondary polycythemia
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renal cell CA
PTH like peptide, EPO |
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hypoglycemia and secondary polycethemia
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hepatocellular CA
insulin like GF, EPO |
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increase in AFP and beta-HCG
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testicular cancer
yolk sac-AFP choriocarcinoma-BHcg |
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what cancer can be prevented by a vaccine
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liver cancer also cervical cancer
Hep B and HPV vaccines |
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4 common primary sites of squamous cell cancer
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mainstem bronchus
mid-esophagus vulva penis |
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upper and lower lip cancers
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upper-basal cell
lower-squamous cell |
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liver cancer type
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adenocarcinoma
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4 sites associated with smoking-cancer
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lung
bladder kidney larynx |
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MC incidence of cancer in men-descending order
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prostate
lung colon |
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MC mortality in men-descending order
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lung
prostate colon |
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MC incidence in women-descending order-
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breast
lung colorectal |
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MC mortality in women-descending order-
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lung
breast colorectal |
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most common GYN cancers-descending order-
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endometrium
ovarian cervical |
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mortality in GYN cancers-descending order-
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ovarian
endometrium cervical |
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25 year old male, unilateral gynomastia, cough, xray with multiple nodular masses in both lungs, what is the primary cancer
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testicle, choriocarcinoma produces Hcg with is a LH analouge producing gynomastia
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TP53 and RAS-what is the primary mechanism for activation
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point mutation
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ERBB2-mechanism for activation
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amplification, breast cancer
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ABL-mechanism for activation-cancer?
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translocation, 9, 22 CML
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MYC-activation and cancer
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translocation 8,14 and Burkitts lymphoma
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RB suppressor gene-activation and cancer
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point mutation
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N-MYC-activation and cancer
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amplification, neuroblastoma
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DNA splicing defect with skin cancer
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xeroderma pigmentosum
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Fanconi’s syndrome:
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AR, DNA repair defect, acute leukemia
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Ataxia telangiectasia:
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AR, chromosome instability, malignant lymphoma
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Bloom’s syndrome:
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AR, chromosome instability, acute leukemia
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colon cancer-chromosome and gene
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5, APC supressor gene
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BRCA1-chromsome
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17
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retinoblastoma-c'some
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13
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Wilm's tumor-c'some
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11
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osteogenic sarcome-c'some
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13
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proper sequence for chemical oncogenesis-
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initation
promotion progression |
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what is progression in chemical oncogenesis
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progression is where different subsets of cancer cells are programmed for different functions: e.g., metastasize, locally invade, resist chemotherapy agents
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hep B and C-cancer?
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hepatocellular CA
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EBV-cancer?
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nasopharyngeal CA
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HPV 16, 18-cancer
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cervical and anal
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HSV8-cancer?
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Kaposi's sarcoma
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EBV in patient with HIV, what cancer
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CNS lymphoma
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screening test that has contributed to decline in incidence of specific cancer in US
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Pap smear
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what cancer has had increased incidence in US in past few years
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malignant melanoma
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most cancers first mets where-
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lymph node subscapular sinus
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CAE marker
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colorectal, breast, pancreas
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CA19-9 marker
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pancreatic cancer
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CA15-3 marker
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breast cancer
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CA125 marker
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ovarian
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PSA marker
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prostate adenocarcinoma
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calcitonin marker
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medullary thyroid
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beta-HCG marker
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choriocarcinoma
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a-feto proteins marker
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liver cancer
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hypertensive 1 year old, multiple nodular masses in skin, small basophilic staining cells that are S100 antigen postive, what is primary lesion
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adrenal medulla-neuroblastoma-(malignant tumor of adrenal medulla, an APUD tumor derived from neural crest and containing neurosecretory granules);
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MC benign tumor in a women
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lyeiomyoma-smooth muscle tumor
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what factor responsible for primary cancer in US
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polycyclic hyrdocarbons from smokes
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what organism causes adenocarcinoma of stomach and GI lymphoma and why
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H. pylori, cytokine injury to mucosa
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what cancer invades but does not mets
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basal cell
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papillary CA of thyroid mets
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cervical nodes
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testicular cancer common mets
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lung
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AML, mets where
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everywhere
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can squamous cell mets
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yep
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65 year old female, abdominal distention, induration of pouch of Douglas-
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ovarian with seeding, anterior to rectum and posterior to uterus, most dependant portion of the pelvic cavity
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75 year old man, point tenderness in spine, increased ALP, what is first test or procedure
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DRE
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describe properties of malignant cells-
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-longer cell cycle than parent
-require 30 doubling time before detectable -atypical and typical mitotic spindles -more DNA content than parent cells -upregulate telomerase activity to remain immortal -enhance angiogensis-secretion of GF's |
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What enhances ablility of malignant cells to invade
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receptors for laminin, fibronectin
type IV collagenases inactivation of E-cadherin genes |
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what tissues are resistant to malignant cell invasion
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elastic arteries
cartilage |
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mets to spine in woman most likely what primary cancer and why
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breast, batson venous plexus
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left supraclavicular node, where is cancer
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stomach, then pancreas
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esophagus nodes mets
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nodes sub adjacent to tumor
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mouth cancer nodes involved
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submental
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lung cancer nodes involved-
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right supraclavicular and hilar nodes
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met cancer in liver of non-smoking women is most likely from where
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colon
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kidney cancer likes to mets where
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lung, from smoking
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lytic lesions in 65 year old woman with anemia, increased ESR, abnormal electrophoeris-cancer where
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plasma cells-multuple myeloma, secrete osteoclast activating factor-IL-1
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solitary, non-neplastic process commonly confused with cancer, where and what
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lung, bronchial hartoma or granuloma
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58 year old man, microcytic anemia, what is first test
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stool guaic, colon CA MCC in that age
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what growth alteration has highest change of cancer
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actinic keratosis-squamous cell
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pancreatic tissue in the wall of the stomach is called-
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choriostoma (heterotropic rest)
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is a bronchial hartoma neoplastic
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nope
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does prostatic hyperplasia progress to prostate cancer
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nope
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number one thing for M and M in US
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smoking, followed by poor diet, lack of excercise and alcohol
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tumors in young women that are from all 3 germ layers are commonly found where-
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ovaries-cytsic heratoma-MC
also in anterior mediastimum, pineal gland |
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Ewings sarcoma-where
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bone
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Wilm's tumor-where
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kidney
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common primary CNS tumors in kids
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medulloblastoma, cystic astrocytoma of cerebellum
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embryonal rhabdosarcoma-where in kids
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soft tissue
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induration of rectal pouch in elderly female with bilateral ovarian masses is from what process
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seeding from ovarian cancer
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which two cancers are more common in whites than blacks
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malingnant melanoma
testicular cancer |
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what cancers are more common in blacks than whites
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breast
lung mutiple myleoma |
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Courvoisier's sign-
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palpable gallbladder due to blockage of CBD, CA of head of pancrease
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two common signs of pancreatic cancer, not stomach cancer
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Trosseua's sign, Courvisier's sign
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What is the MC paraneoplastic syndrome?
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Hypercalcemia: not due to metastasis but to secretion of a PTH like peptide (primary squamous of lung or renal cell carcinoma; no lytic lesions in bone).
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Pulmonary osteoarthropathy (clubbing):
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lung cancer
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dermatomysositus
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underlying malignancy
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Marantic vegetations on the mitral valve
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: association with mucous secreting tumors (e.g., colon, pancreas)
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Eaton-Lambert syndrome:
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muscle weakness resembling myasthenia gravis; associated with small cell carcinoma of lung; antibody is directed against calcium channel in muscle.
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MC ionizing radiation induce cancer-
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acute leukemia, radiologists
papillary thyroid cancer close second |
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3 cancers caused by non-ionizing radiation
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squamous cell, basal cell, melanoma
UVB |
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presence of gastric mucosa in bleeding Meckels is
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choristoma (heterotopic rest)
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normal tissue in a place it should be is called a
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hartoma
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seeding implies-
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exfoliation of malignant cells in a cavity
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cachexia primarily from what and why
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tumor necrosis factor-a: recall that it is a signal for apoptosis and individual cell death. It also suppresses the appetite center and inhibits capillary lipoprotein lipase, hence FAs are not available for b-oxidation in the mitochondrial matrix
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An ulcerated lesion that develops in a keloid secondary to a third degree burn or an ulcer located at the orifice of a chronically draining sinus that does not respond to medical management is most likely due to
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development of a squamous cell carcinoma: due to constant irritation of squamous epithelium
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Hematuria in a 58-yr-old smoker would most likely be associated with which of the following groups of cancers?
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Renal cell carcinoma/transitional cell carcinoma of the bladder: both are most commonly due to smoking and both would be expected to produce hematuria owing to their access to urine
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The most common site for a primary cancer in the gastrointestinal tract is the
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sigmoid colon: also the most common site for diverticula and polyps in the entire GI tract
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The presence of nucleated RBCs and immature neutrophils (e.g., myeloblasts, progranulocytes) in the peripheral blood of a non-smoking 52-yr-old woman with bone pain would most likely be due to…
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. metastatic breast cancer to bone: called a leukoerythroblastic smear, metastasis pushes hematopoietic cells out into the peripheral blood; called myelophthisic anemia
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Which of the following is most responsible for the increased incidence of basal cell carcinoma in the United States?
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Sun exposure beginning at an early age: also true for malignant melanoma
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In Bangladesh, a great number of people are developing squamous cell cancers of the skin. Epidemiologists have attributed this to contamination of the water supply with which one of the following chemicals?
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Arsenic: also associated with lung cancer and angiosarcoma of the liver
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Nitrites:what cancer and why
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: stomach cancer: nitrosylation combines nitrites with amines to produce nitrosamines, which are carcinogenic. Vitamin C prevents nitrosylation
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uranium-cancer?
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lung
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aniline dyes, cancer?
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bladder
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lead, what cancer?
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no cancer at all
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arsenic, what cancer?
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lung, squamous of skin, angiosarcoma of liver
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Cancer related to inactivation of the RB suppressor gene in a non-smoking 19-yr-old woman would most likely be located in the…
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distal femur: osteogenic sarcoma; other RB relationships include retinoblastoma (young child) and breast cancer (> 50-yrs-old)
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Which of the following most enhances the development of a primary cancer in the oropharynx, esophagus, and larynx in a smoker?
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Alcohol: second MCC in these sites, synergistic with smoking
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A 65-yr-old smoker, who has been a roofer for the past 30 yrs, would most likely develop a primary cancer in which of the following sites?
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Lung: asbestos was present in roofing material in that time-frame, mesotheliomas of pleura are not related to smoking, primary lung cancer is the MC cancer related to asbestos exposure with or without smoking. Asbestos is not a risk factor for cancers of the mouth, larynx, or esophagus
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A tumor marker that is converted into amyloid would most likely be located in which of the following sites?
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Thyroid: calcitonin in a medullary carcinoma. Calcitonin is made by C cells in the thyroid gland. It inhibits osteoclasts, hence hypocalcemia is a potential complication
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Aflatoxins play a prominent role in the development of which of the following cancers?
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Hepatocellular carcinoma: due to HBV, aflatoxins are products of the Aspergillus mold and are carcinogenic
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A history of radiation of the head and neck area would most likely predispose to a cancer in which of the following sites?
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Thyroid (papillary adenocarcinoma)
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A mixed tumor would most likely be located in the…
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. parotid gland
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3 cancers that have propensity to invade vessel
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Follicular carcinoma of thyroid: rarely invade lymph nodes unlike papillary thyroid cancers
Hepatocellular carcinoma: loves to invade hepatic and portal vein tributaries Renal cell carcinoma: has been known to invade the renal vein and extend all the way up the vena cava to the right heart. |
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An autopsy on a 56-year-old man, who was a smoker for 30 years, demonstrates a yellow mass extending up the vena cava. Prior to death, he was being evaluated for hematuria. Which of the following is the most likely diagnosis?
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renal cell carcinoma with invasion of the vessel: renal cell carcinomas are bright yellow and commonly invade the renal vein and extend into the vena cava
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A 62-year-old man from China develops jaundice associated with a palpable gallbladder and light colored stools. He has lost over 20 pounds in the last month. He is not a smoker. Liver function studies demonstrate a conjugated bilirubin fraction > 50% and markedly increased concentrations of alkaline phosphatase and -glutamyltransferase. The -fetoprotein concentration is normal. A urinalysis shows increased bilirubin and absent urobilinogen. A CBC demonstrates marked eosinophilia. A CT of the pancreas is normal. Which of the following is the most likely diagnosis?
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Cholangiocarcinoma: the patient most likely has developed this cancer from infestation of the bile duct by Clonorchis sinensis (Chinese liver fluke). The marked eosinophilia and history of non-smoking makes pancreatic carcinoma less likely. A palpable gallbladder is commonly associated with both pancreatic cancer and cholangiocarcinoma. Note the obstructive jaundice laboratory findings in the patient.
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HPV 16 and 18 have what role in cancer
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inactivate TP 53 via E6 and RB via E7, squamous cells continuously move from G1 to S phase
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HTLV-1-how it causes cancer
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it activates the tax gene, which leads to polyclonal T cell proliferation and inhibition of the TP53 suppressor gene resulting in a monoclonal proliferation of malignant helper T cells
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, it is associated with Burkitt's lymphoma, nasopharyngeal carcinoma, mixed cellularity Hodgkin's disease, and primary CNS lymphoma
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EBV
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Autosomal dominant variant is associated with a "two hit" point mutation leading to a white eye reflex in a newborn
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RB suppressor gene: located on chromosome 13, this gene produces RB protein, which prevents the cell from entering the S phase. The AD variant has one of the genes already inactivated on one of the chromosomes, hence only one more hit (mutation) leads to inactivation of the gene and cancer, in this case a retinoblastoma, which produces a white eye reflex. There is also an increased incidence of osteogenic sarcoma at a later date.
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Normally increases degradation of b-catenin, hence inhibiting activation of nuclear transcription. Inactivation of the gene results in colon cancer by 35-40 years of age.
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APC suppressor gene. Located on chromosome 5, inactivation of this gene eventuates in familial polyposis with transformation into cancer before 40 years of age.
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Inactivation of this gene leads to an increased incidence of bilateral renal cell carcinoma and pheochromocytoma
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VHL suppressor gene. Von Hippel-Lindau suppressor gene is associated with cerebellar hemangioblastomas and the above cancers.
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Inactivation of this gene by a point mutation leads to unrestricted Cdk4 activity and an increased incidence of lung, colon, and breast cancer.
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TP53 suppressor gene. Inactivation of this gene is responsible for 70% of the above cancers
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Inactivation of this gene, which is located on the same chromosome as the TP53 suppressor gene and has the same function as the TP53 suppressor gene, results in an increased incidence of breast and ovarian cancer in women and prostate cancer in men
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BRCA-1 suppressor gene. Located on chromosome 17, it also helps the TP53 suppressor gene in DNA repair
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The protein product of this gene normally inhibits phosphorylation of the RB protein, hence preventing movement of the cell from the G1 to the S phase. Inactivation of the gene leads to pancreatic cancer in 100% of cases.
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transforming growth factor b. The question describes its primary function and what happens when the gene is inactivated.
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The increased incidence of primary CNS malignant lymphoma directly parallels the increase in which of the following diseases?
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. AIDS: the majority of patients with HIV have EBV, which is a potent polyclonal stimulator of B cells (causes increased mitotic activity) hence increasing the potential for t(8;14) translocations (Burkitt's) and other types of lymphoma that can develop within and out of the confines of the brain
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this is the MC primary brain cancer in adults and it arises from astrocytes
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Glioblastoma multiforme
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this is the MC primary brain tumor in children and it arises from astrocytes
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Cerebellar astrocytoma
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A 45-year-old man, who works with polyvinyl chloride, develops a mass in the liver. A chest x-ray demonstrates multiple densities in the both lungs. Which of the following is the most likely diagnosis?
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Angiosarcoma: vinyl chloride is a polymer in polyvinyl chloride, which is found in plastics. Angiosarcoma is the MC cancer association. Note how sarcomas metastasize to lungs.
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Which of the following is the most effective host defense against cancer?
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Cytotoxic T cells: they recognize the altered class I antigens on malignant cells and destroy them (type IV cellular immunity)
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work directly or indirectly via type II mechanisms or activation by interleukin 2; also a very potent mechanism for killing cancer cells.
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Natural killer cells
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Which of the following most distinguishes a malignant from a benign tumor?
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Capacity to metastasize: this is the best answer
Capacity to invade tissue: second best answer Angiogenesis: third best answer |
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Male and female members of a family have an increased incidence of leukemia, breast cancer, brain tumors, and sarcomas. Which of the following mechanisms is most likely responsible for the cancers in this family?
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Point mutation of a suppressor gene: the family is afflicted with the AD Li-Fraumeni multicancer syndrome, which is associated with inactivation of the TP53 suppressor gene, which is usually accomplished with a point mutation.
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A 65-year-old farmer has a crateriform lesion on the bridge of his nose. Which of the following is the mechanism for development of this lesion?
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Point mutation of a suppressor gene: the patient has a basal cell cancer. UVB light excites adjacent pyrimidine bases in DNA strands causing them to form pyrimidine dimers, which distort the DNA helix. This poses problems for DNA repair by the TP53 suppressor gene product leading to inactivation of the TP53 suppressor gene and cancer. Order of removal of dimer: endonuclease, exonuclease, 5’-3’ synthesis of new strand with base pairing, ligase.
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A 52-year-old man develops weight loss, generalized lymphadenopathy, and hepatosplenomegaly. He has daily exposure to benzene at his work place. Which of the following is the most likely diagnosis in this patient?
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Acute leukemia: benzene is associated with acute leukemia and aplastic anemia. Note the generalized nature of the metastasis with leukemias. This would not be expected with carcinomas and sarcomas.
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Which of the following characterize sarcomas rather than carcinomas?
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Derive from mesenchymal tissue: carcinomas derive from epithelial tissue
Predilection for hematogenous dissemination: carcinomas usually metastasize to lymph nodes first and from there, they can gain access to the efferent lymphatics with eventual spread hematogenously |
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Which of the following best explains the increased incidence of choriocarcinoma in Southeast Asia?
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Hemoglobin Bart's disease: due to 4 a-globin chain deletions. Increased incidence of spontaneous abortions predisposes to choriocarcinoma
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Which of the following conditions is associated with inactivation of DNA mismatch genes leading to an increase in colon cancer?
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Hereditary non-polyposis syndrome (Lynch syndrome--AD-- mismatch genes normally correct incorrect matching of nucleotide bases. If inactivated, the mismatches may result in mutations leading to colon cancer arising de novo as opposed to a polyp in familial polyposis
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AD disorder with VHL suppressor gene. Cerebellar hemangioblastoma, pheochromocytoma, bilateral renal cell carcinoma
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Von-Hippel Lindau disease
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AD disorder with APC suppressor gene. Inactivation of gene allows b-catenin to increase nuclear transcription leading first to polyp formation and then cancer before age 40
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Familial polyposis
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AR disorder with deficiency of DNA repair enzymes. UVB light related cancers of the skin are increased.
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Xeroderma pigmentosum:
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: AD syndrome with hamartomatous polyps in the GI tract that do not transform into colon cancer; however, there is a marked increase in de novo colorectal cancer. Also have mucosal pigmentation on the lips and oral mucosa. Increased incidence of an ovarian tumor.
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Peutz-Jeghers syndrome
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A 45-year-old man with a renal transplant is on immunosuppressive agents to prevent rejection. Which of the following cancers is he most susceptible to developing in the future?
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Squamous cell carcinoma of the skin
Malignant lymphoma: close second best answer |
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Rapidly growing cancers are most likely to develop which of the following anemias?
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Macrocytic anemia due to folate deficiency: liver only has 3-4 months supply of folate. Rapidly growing cancers use up the folate in making DNA.
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Microangiopathic hemolytic anemia-cancer?
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: only if the cancer produced DIC
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Autoimmune hemolytic anemia: which cancer
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chronic lymphocytic leukemia
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Iron deficiency anemia-which cancer
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colon
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how much B12 stores
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6-9 years in the liver
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Treatment of which of the following will decrease the risk for developing cancer?
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GED and PUD
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Gastroesophageal reflux, cancer-
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treatment of glandular metaplasia (Barrett’s esophagus) with proton blockers decreases the risk for developing distal esophageal adenocarcinoma
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PUD, what cancer risk-
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H. pylori is the MCC of peptic ulcer disease; therefore, eradication of H. pylori will decrease the risk for developing gastric lymphoma and stomach adenocarcinoma
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