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41 Cards in this Set

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Is hormone production more typical of benign or malignant tumors?
Benign. Malignant tumors may be sufficiently undifferentiated to produce hormones.
Melena and hematuria are characteristic of neoplasms of?
The gut and urinary tract
What does the term cachexia encompass ?
Progressive loss of body fat and lean muscle with weakness, anorexia and anemia.
Why does cachexia occur in cancer?
The BMR is increased in cancer, despite reduced food intake. However, it is probably the result of soluble factors such as cytokines produced by the tumor and the host. In contrast, the adaptational response in starvation is a low BMR.
What are some soluble factors that may contribute to cachexia ?
TNF - mobilizes fats from stores and suppresses appetite

IL-1, IF-y, LIF - synergize with TNF

Proteolysis-inducing factor and lipid-mobilizing factor - Increase the catabolism of muscle and adipose tissue and reduce protein synthesis by decreasing mRNA translation + ^ protein catabolism.
What are paraneoplastic syndromes?
Symptom complexes in cancer patients that cannot be readily explained, either by the local or distant spread of the tumor or by the elaboration of hormones produced by the tumor.
Cushing syndrome may be caused by which forms of underlying cancers?
1) Small-cell carcinoma of the lung
2) Pancreatic carcinoma
3) Neural tumors
SIADH may be caused by which tumors?
1) Small-cell of lung
2) Intracranial neoplasms
Hypercalcemia results frequently from these tumors
1) Squamous cell carcinoma of lung
2) Breast
3) Renal
4) Adult T-cell leukemia/lymphoma
What is the causal mechanism for hypercalcemia in cancer?
1) Osteolysis induced by cancer

2) Calcemic humoral substances produced by extraosseous neoplasms : PTHRP, TGF-a, TNF, IL-1
Is hormone production more typical of benign or malignant tumors?
Benign. Malignant tumors may be sufficiently undifferentiated to produce hormones.
Melena and hematuria are characteristic of neoplasms of?
The gut and urinary tract
What does the term cachexia encompass ?
Progressive loss of body fat and lean muscle with weakness, anorexia and anemia.
Why does cachexia occur in cancer?
The BMR is increased in cancer, despite reduced food intake. However, it is probably the result of soluble factors such as cytokines produced by the tumor and the host. In contrast, the adaptational response in starvation is a low BMR.
What are some soluble factors that may contribute to cachexia ?
TNF - mobilizes fats from stores and suppresses appetite

IL-1, IF-y, LIF - synergize with TNF

Proteolysis-inducing factor and lipid-mobilizing factor - Increase the catabolism of muscle and adipose tissue and reduce protein synthesis by decreasing mRNA translation + ^ protein catabolism.
What are paraneoplastic syndromes?
Symptom complexes in cancer patients that cannot be readily explained, either by the local or distant spread of the tumor or by the elaboration of hormones produced by the tumor.
Cushing syndrome may be caused by which forms of underlying cancers?
1) Small-cell carcinoma of the lung
2) Pancreatic carcinoma
3) Neural tumors
SIADH may be caused by which tumors?
1) Small-cell of lung
2) Intracranial neoplasms
Hypercalcemia results frequently from these tumors
1) Squamous cell carcinoma of lung
2) Breast
3) Renal
4) Adult T-cell leukemia/lymphoma
What is the causal mechanism for hypercalcemia in cancer?
1) Osteolysis induced by cancer

2) Calcemic humoral substances produced by extraosseous neoplasms : PTHRP, TGF-a, TNF, IL-1
Hypoglycemia may be caused by these major underlying cancers
1. Ovarian
2. Fibrosarcoma
3. Other mesenchymal sarcomas
What is carcinoid syndrome ? Causal mechanism? Major tumors associated with it?
An array of symptoms that occur secondary to carcinoid tumors. The syndrome includes flushing and diarrhea, and, less frequently, heart failure and bronchoconstriction.

Caused mainly by serotonin, bradykinin, kallikrein secretion.

Tumors : hepatocellular carcinoma, bronchial adenoma (carcinoid), pancreatic carcinoma
Major underlying cancers for polycythemia? Causal mechanism?
Gastric carcinoma
Renal carcinoma
Cerebellar hemangioma
Hepatocellular carcinoma

EPO is responsible
What is found elevated in serum levels in lung cancer patients with Cushing's that is not found in patient with excess corticotropin produced by the pituitary?
Pro-opiomelanocortin
What is the most common paraneoplastic syndrome?
Hypercalcemia
What type of hypercalcemia is not a paraneoplastic syndrome?
Hypercalcemia secondary to skeletal metastases
What is Acanthosis nigricans? What to suspect?
It is a poorly defined hyperpigmentation of the skin. In the context of malignancies, it is a paraneoplastic syndrome. When seen in individuals over 40, it may point to malignancy. Most commonly the responsible cancers are gastric carcinoma*, lung carcinoma and uterine carcinoma.
Trousseau phenomena (venous thrombosis) can be seen most commonly in which underlying cancers? Cause?
Pancreatic carcinoma
Bronchogenic carcinoma
Other cancers

Tumor products are the cause (especially mucins that activate clotting)
Hypertrophic osteoarthropathy and clubbing of the fingers is seen commonly in
Bronchogenic carcinoma
Acute DIC is most commonly associated with?
Acute promyelocytic leukemia and prostate adenocarcinoma
In grading and staging of tumors, the term grade refers to what? stage?
Grade refers to the level of differentiation of tumor cells and, in some cancers, the number of mitoses or architectural features. Stage refers to the extent of the spread of cancer.

In general, with a few exceptions, grading has proved less clinically useful than has staging.
What is staging based on? Current system for staging?
The size of the primary lesion, its extent of spread to regional lymph nodes, and the presence or absence of blood-borne metastases

TNM system. T for primary tumor. T1-T4 and T0 for in situ. N for lymph node involvement (ex. N0 = no involvement) and M for metastases (M0 = no distant metastases)
Immunohistochemical categorization of undifferentiated malignant tumors has proved useful with?
Antibodies specific to intermediate filaments. Solid tumors often contain intermediate filaments characteristic to their cell of origin. Presence of cytokeratins, points to an epithelial origin (carcinoma) whereas desmin is specific for neoplasms of muscle cell origin.
Apart from categorizing undifferentiated tumors, what else is immunohistochemistry useful in?
1) Determining the site of origin of metastatic tumors (ex. PSA and thyroglobulin)

2) Detecting molecules that have prognostic or therapeutic significance. (ex. estrogen/progesterone receptor detecting in breast cancer
For the following scenerios, indicate whether the prognosis is good or bad.

Receptor-positive breast cancer
ERBB2 overexpression in breast c.

How is overexpression of ERBB2 confirmed?
1) "Good"
2) Bad

It is confirmed by FISH (confirms amplification of genomic region containing the ERBB2 gene)
What has flow cytometry proved useful in?
Identification and classification of tumors arising from T and B lymphocytes and from mononuclear-phagocytic cells.
Is the PSA test sensitive and specific?
No. It suffers from low sensitivity and low specificity
For the following tumor markers list their tumors

hCG
Calcitonin
Catecholamine + metabolites
hCG = Trophoblastic tumors, nonseminomatous testicular tumors

Calcitonin = Medullary carcinoma of thyroid

Catecholamines = Pheochromocytoma and related tumors
For the following oncofetal antigens, list their tumors

AFP
CEA
AFP = Liver cell cancer, nonseminomatous germ cell tumors of testis

CEA = Carcinomas of colon, pancreas, lung, stomach and heart
List the tumors for the following:

Neuron-specific enolase (isoenzyme)
Ig
CA-125 (mucin)
CA-19-9 (mucin)
CA-15-3 (mucin)
N-enolase - Small cell lung and neuroblastoma

Ig - multiple myeloma and others
CA-125 - ovarian cancer
CA-19-9 - colon cancer + pancreatic
CA-15-3 - breast cancer
The following findings are associated with?

1) p53, APC, RAS mutants in stool+serum
2) p53 and RAS mutants in stool and serum
3) p53 and RAS mutants in sputum and serum
4) ???????
1) Colon cancer
2) Pancreatic cancer
3) Lung cancer
4) Bladder cancer