Pathology - Chapter 07 - Neoplasms - Clinical Aspects

Front 1

Is hormone production more typical of benign or malignant tumors?

Back 1

Benign. Malignant tumors may be sufficiently undifferentiated to produce hormones.

Front 2

Melena and hematuria are characteristic of neoplasms of?

Back 2

The gut and urinary tract

Front 3

What does the term cachexia encompass ?

Back 3

Progressive loss of body fat and lean muscle with weakness, anorexia and anemia.

Front 4

Why does cachexia occur in cancer?

Back 4

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.

Front 5

What are some soluble factors that may contribute to cachexia ?

Back 5

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.

Front 6

What are paraneoplastic syndromes?

Back 6

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.

Front 7

Cushing syndrome may be caused by which forms of underlying cancers?

Back 7

1) Small-cell carcinoma of the lung
2) Pancreatic carcinoma
3) Neural tumors

Front 8

SIADH may be caused by which tumors?

Back 8

1) Small-cell of lung
2) Intracranial neoplasms

Front 9

Hypercalcemia results frequently from these tumors

Back 9

1) Squamous cell carcinoma of lung
2) Breast
3) Renal
4) Adult T-cell leukemia/lymphoma

Front 10

What is the causal mechanism for hypercalcemia in cancer?

Back 10

1) Osteolysis induced by cancer

2) Calcemic humoral substances produced by extraosseous neoplasms : PTHRP, TGF-a, TNF, IL-1

Front 11

Is hormone production more typical of benign or malignant tumors?

Back 11

Benign. Malignant tumors may be sufficiently undifferentiated to produce hormones.

Front 12

Melena and hematuria are characteristic of neoplasms of?

Back 12

The gut and urinary tract

Front 13

What does the term cachexia encompass ?

Back 13

Progressive loss of body fat and lean muscle with weakness, anorexia and anemia.

Front 14

Why does cachexia occur in cancer?

Back 14

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.

Front 15

What are some soluble factors that may contribute to cachexia ?

Back 15

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.

Front 16

What are paraneoplastic syndromes?

Back 16

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.

Front 17

Cushing syndrome may be caused by which forms of underlying cancers?

Back 17

1) Small-cell carcinoma of the lung
2) Pancreatic carcinoma
3) Neural tumors

Front 18

SIADH may be caused by which tumors?

Back 18

1) Small-cell of lung
2) Intracranial neoplasms

Front 19

Hypercalcemia results frequently from these tumors

Back 19

1) Squamous cell carcinoma of lung
2) Breast
3) Renal
4) Adult T-cell leukemia/lymphoma

Front 20

What is the causal mechanism for hypercalcemia in cancer?

Back 20

1) Osteolysis induced by cancer

2) Calcemic humoral substances produced by extraosseous neoplasms : PTHRP, TGF-a, TNF, IL-1

Front 21

Hypoglycemia may be caused by these major underlying cancers

Back 21

1. Ovarian
2. Fibrosarcoma
3. Other mesenchymal sarcomas

Front 22

What is carcinoid syndrome ? Causal mechanism? Major tumors associated with it?

Back 22

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

Front 23

Major underlying cancers for polycythemia? Causal mechanism?

Back 23

Gastric carcinoma
Renal carcinoma
Cerebellar hemangioma
Hepatocellular carcinoma

EPO is responsible

Front 24

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?

Back 24

Pro-opiomelanocortin

Front 25

What is the most common paraneoplastic syndrome?

Back 25

Hypercalcemia

Front 26

What type of hypercalcemia is not a paraneoplastic syndrome?

Back 26

Hypercalcemia secondary to skeletal metastases

Front 27

What is Acanthosis nigricans? What to suspect?

Back 27

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.

Front 28

Trousseau phenomena (venous thrombosis) can be seen most commonly in which underlying cancers? Cause?

Back 28

Pancreatic carcinoma
Bronchogenic carcinoma
Other cancers

Tumor products are the cause (especially mucins that activate clotting)

Front 29

Hypertrophic osteoarthropathy and clubbing of the fingers is seen commonly in

Back 29

Bronchogenic carcinoma

Front 30

Acute DIC is most commonly associated with?

Back 30

Acute promyelocytic leukemia and prostate adenocarcinoma

Front 31

In grading and staging of tumors, the term grade refers to what? stage?

Back 31

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.

Front 32

What is staging based on? Current system for staging?

Back 32

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)

Front 33

Immunohistochemical categorization of undifferentiated malignant tumors has proved useful with?

Back 33

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.

Front 34

Apart from categorizing undifferentiated tumors, what else is immunohistochemistry useful in?

Back 34

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

Front 35

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?

Back 35

1) "Good"
2) Bad

It is confirmed by FISH (confirms amplification of genomic region containing the ERBB2 gene)

Front 36

What has flow cytometry proved useful in?

Back 36

Identification and classification of tumors arising from T and B lymphocytes and from mononuclear-phagocytic cells.

Front 37

Is the PSA test sensitive and specific?

Back 37

No. It suffers from low sensitivity and low specificity

Front 38

For the following tumor markers list their tumors

hCG
Calcitonin
Catecholamine + metabolites

Back 38

hCG = Trophoblastic tumors, nonseminomatous testicular tumors

Calcitonin = Medullary carcinoma of thyroid

Catecholamines = Pheochromocytoma and related tumors

Front 39

For the following oncofetal antigens, list their tumors

AFP
CEA

Back 39

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

CEA = Carcinomas of colon, pancreas, lung, stomach and heart

Front 40

List the tumors for the following:

Neuron-specific enolase (isoenzyme)
Ig
CA-125 (mucin)
CA-19-9 (mucin)
CA-15-3 (mucin)

Back 40

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

Front 41

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) ???????

Back 41

1) Colon cancer
2) Pancreatic cancer
3) Lung cancer
4) Bladder cancer