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41 Cards in this Set

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Discuss acquired cancer-causing genetic mutations
Genetic injury acquired in somatic cells by environmental agents. DNA is the primary and most important target of:
1. Chemical carcinogens (involves initiation/promotion). These are mutagens that induce changes in protooncogenes, cancer-suppresor genes, and genes that regulate apoptosis
2. Radiation carcinogen, including UV (cause pyrimidine dimers in DNA) and ionizing rays
3. Viral and microbial carcinogens, including HPV, EBV, HBV. The only RNA oncogenic virus is HTLV-1
Discuss Germline cancer-causing genetic mutations
oGenetic injury in somatic cells inherited in the germ line
oDivided into three categories
1.Inherited cancer syndromes (Single mutant allele of the cancer suppressor genes, including Rb, p53, BRCA-1/2, APC, NF-1, WT-1. Has marker phenotype
2.Familial cancers
•Transmission pattern not clear
oNO marker phenotype
•Autosomal recessive syndromes of defective DNA repair
Describe the indications, advantages, and disadvantages of Needle Biopsy
Used when excision of small lesion is not possible. Margins may not be representative and center may be necrotic. Requires appropriate preservation of the specimen. There is a usual fixative (Formalin), or a special fixative (glutaraldedyde) for electron microscopy. Prompt refrigeration for hormone, receptor or other molecular analysis
Describe the indications, advantages, and disadvantages of Frozen section
opermits histologic evaluation within minutes
odesirable in determining the nature of a mass lesion or in evaluating the margins of an excised cancer to ascertain that the entire neoplasm has been removed
obetter histologic detail is provided by the more time-consuming routine methods. Needed-for example, when extremely radical surgery, such as the amputation of an extremity, may be indicated
Describe the indications, advantages, and disadvantages of Immunohistochemistry
oInvolves detection of cell products or surface markers by monoclonal antibodies
Binding of antibodies can be revealed by fluorescent labels or chemical reactions
oUseful in:
Diagnosis of undifferentiated tumors (using tissue specific intermediate filaments)
Categorizations of leukemias and lymphomas (using antibodies)
Determination of the site of origin of metastases (reagents for specific cell types)
Detection of molecules that have prognostic or therapeutic significance)
Describe the indications, advantages, and disadvantages of exfoliate cytology (Papanicolaeu smears)
oExamines cancer cells that are readily shed
Diagnosis of dysplasia, cancers and carcinoma in situ
Used for invasive cancer of the cervix, tumors of the stomach, bronchus, urinary bladder
oInterpretation based on changes in the appearance of individual cells
Discuss the indications, advantages, and disadvantages of Fine needle aspiration
oInvolves aspirating cells and attendant fluid with a small-bore needle, followed by cytologic examination of the stained smear
oUsed most commonly for the assessment of readily palpaple lesions (breast, thyroid, lymph)
oModern imaging techniques enable the method to be extended to lesions in deep-seated structures, such as pelvic lymph nodes and pancreas
oless invasive and more rapidly performed than are needle biopsies
What are the indications, advantages, and disadvantages of tumor markers
oTumor-derived or tumor-associated molecules detected in blood and other body fluids
oNOT primary methods of diagnosis – are adjuncts to diagnosis or determining response to therapy
CEA – produced by fetal gut, liver, and pancreas
•Increases in cancers of the colon, pancreas, stomach, breast
Alpha-fetoprotein – produced by fetal yolk sac and liver
•Increases in cancers of the liver and testicular germ cells
What are the indications, advantages, and disadvantages of Flow cytometry
orapidly and quantitatively measures several individual cell characteristics
membrane antigens, DNA content of tumor cells
oused in classification of leukemias and lymphomas
ofrom a variety of sources
fresh-frozen surgical biopsy specimens (from which nuclei can be extracted)
pleural or peritoneal effusions associated with cancer, bone marrow aspirations
cells obtained by irrigation of the urinary bladder
ouseful due to relationship between abnormal DNA content and prognosis
What are the indications, advantages, and disadvantages of Genetic analysis
oinvolves PCR or FISH analysis
oused for
Diagnosis of malignant neoplasms
•Such tumors are associated with clonal rearrangements of T and B cell antigen receptor genes
Prognosis of malignant neoplasms
Detection of minimal residual disease
•unique nucleic acid sequences generated by the translocation
Diagnosis of hereditary predisposition to cancer
•BRCA1, BRCA2, and the RET
DNA microarray analysis and proteomics
List the organs in which cytology plays an important role in cancer case findings
•Fine needle aspiration for breast, thyroid, and lymph nodes (easily palpable)
•Exfoliate cytology (Pap Smear) for cervical cancer (often at the in situ stage)
oAlso used for endometrial/ bronchogenicgastric carcinoma, and bladder/prostatic tumors
Discuss the epidemiology of malignant neoplasms
•In the US, cancer is responsible for 23% of all deaths annually
•Cancers of the lung, female breast, prostate, and colon/rectum constitute more than 50% of cancer diagnoses and cancer deaths in the U.S. population
•Over the past 50 years, the overall age-adjusted cancer death rate has significantly increased in men, whereas it has fallen slightly in women
oincrease in men can be largely attributed to lung cancer
oimprovement in women is mainly attributable to a significant decline in death rates from cancers of the uterus, stomach, liver, and most notably, carcinoma of the cervix
•Environmental factors significantly influence occurrence of specific forms of cancer around the world
o Japanese death rate from stomach cancer 7X the US’
o Japanese death rate from colon cancer much less than US
• Japanese immigrant catch up to US after moving here
•Smoking – carcinomas of the oropharynx, larynx, lung
•Age – most common in those older than 55
o Hemaotpoietic tumors, neuroblastomas, Wilms tumors, retinoblastomas, sarcomas of bone and skeletal muscle common in those younger than 15
•Hereditary – inherited cancer syndromes, familial cancers, and autosomal recessive syndromes of defective DNA repair all play a role in cancer even in the presence of clearly defined environmental factors
•Carcinogens – radiation and many chemical are known to be carcinogens; viruses are highly suspected
•Preneoplastic disorders – certain clinical conditions are associated with increased risk of cancer
o Cirrhosis of the liver
o Atrophic gastritis of pernicious anemia
o Chronic ulcerative colitis
o Leukoplakia of the oral and genital mucosa
What are the most common cancers in men
Prostate, lung, colon/rectum, melanoma of skin, Non-hodgkin lymphoma
What are the most common cancers that cause death in men
Lung and bronchus, prostate, colon/rectum, pancreas, non-hodgkin lymphoma
What are the most common cancers in women
Breats, lung, colon/recum, uterus, ovary
What are the most common cancers that cause death in women
Lung and bronchus, breast, colon/rectum, pancreas, ovary
List the relative incidence of, and mortality due to, cancer for each sex and decade
o Females
 Colon/ rectum/ uterine/ stomach cancer decreased since 1930s
 Breast cancer increased 8X since 1930s
oMales
 Stomach cancer decreased 8X since 1930s
 Lung cancer increased 18X since 1930s
Discuss the mechanism by which neoplasms produce Anemia
Thymic neoplasms with the mechanism unknown
Discuss the mechanism by which neoplasms produce Hypercalcemia
PTH from squamous cell carcinoma of lung, breast/renal carcinoma
Discuss the mechanism by which neoplasms produce venous thrombosis
Pancreatic/bronchogenic carcinoma from tumor products
Discuss the mechanism by which neoplasms produce Dermatomyositis
immunologic response to bronchogenic/breast carcinoma
Discuss the mechanism by which neoplasms produce Polycythemia
erythropoietin production from renal/hepatocellular carcinoma
What does a pap smear help prevent
Cervical carcinoma
What does avoidance of ionizing radiation help prevent
myeloid leukemias, followed by thyroid cancer in children
What does self-examination help prevent
Testicular cancer and breast cancer
What does avoidance of excessive sunlight help prevent
Squamous cell carcinoma and melanoma
What do routine laboratory studies by fine needle aspiration help prevent
Cancer in the breast, thyroid, and lymph
examples of variations in types of neoplasms and incidence of neoplasms related to Geographic location
Stomach cancer in Japan, colon cancer in the US
examples of variations in types of neoplasms and incidence of neoplasms related to Age
Under 15, hematopoietic system tumors, neuroblastomas, retinoblastomas, sarcomas of bone/muscle
examples of variations in types of neoplasms and incidence of neoplasms related to Sex
Women, breast cancer
examples of variations in types of neoplasms and incidence of neoplasms related to Race
Hispanics in the US have lower frequency of most common tumors but more stomach, liver, uterine, cervix, and gallbladder tumors
examples of variations in types of neoplasms and incidence of neoplasms related to Occupation
Cadmium in yellow pigments, solders, batteries, metal plating leads to prostate cancer
examples of variations in types of neoplasms and incidence of neoplasms related to Socioeconomic status
Poorer people have higher incidence of colon/rectal cancer (from bad diets)
Cite at least three neoplasms that produce the same hormones as the organ from which the tumor arises
Benign Beta-cell adenoma (Less than 1 cm in diameter may produce enough insulin for fatal hypoglycemia)
Pituitary adenoma
Pancreatic carcinoma
Cite at least three examples of paraneoplastic syndromes
1. Cushing's Syndrome--ACTH. Small cell carcinoma of the lung, pancreatic carcinoma, neural tumors
2. Syndrome of inappropriate ADH (or ANP). Small cell carcinoma of the lung, intracranial neoplasms
3. Hypercalcemia (PTH). Squamous cell carcinoma of lung, breast carcinoma, renal carcinoma, adult T-cell leukemia/lymphoma, Ovarian carcinoma
What neoplasms is HCG associated with
Trophoblastic tumors, nonseminomatous testicular tumors
What neoplasms is Calcitonin associate with
Medullary carcinoma of thyroid
What neoplasms are catecholamines associated with
Phenochromocytoma and related tumors
What neoplasms is alpha-fetoprotein associated with
Liver-cell cancer, nonseminomatous germ cell tumors of testis
Contrast the effects of benign and malignant tumors on the host
• All tumors, even benign may cause morbidity and mortality
• Both malignant and benign disorders are often palpable masses
• Both types of neoplasia may cause problems due to:
o Location and impingement
o Functional activity (eg, hormonal)
o Bleeding and secondary infections
o Initiation of acute symptoms caused by rupture or infarct
List the common signs and symptoms of malignancy
•Unusual bleeding or discharge
•A lump or thickening
•Sore that does not heal
•Change in bowel or bladder habits
•Persistent indigestion or difficulty swallowing